Category Archives: Common Disorders In Infants And children

Sudden Infant Death Syndrome (SIDS Facts)

Sudden infant death syndrome may occur unexpectedly in an otherwise healthy baby while it is sleeping. The cause of SIDS cannot be usually identified, even with detailed postmortem examination.Here are some SIDS Facts:

  • The exact cause of sudden infant death syndrome is still unknown.
  • Measures such as placing the babies on their backs to sleep, making them sleep on firm beds, removing all materials which may block their breathing, avoiding overheating, and preventing exposure to cigarette smoke, may help reduce the incidence of sudden death syndrome.
  • Losing a child unexpectedly to SIDS is extremely traumatic and causes guilty feeling in parents. They require counseling and the help of support groups to deal with it.

SIDS, which is sometimes referred to as crib death, occurs at the rate of 1 in 2,000 babies under the age of one year.  One among the most common causes of infant mortality, SIDS mostly occurs in infants younger than 1 year of age, with the highest incidence found in those between 2 months to 4 months of age. Its incidence is higher in infants born prematurely or too small for gestational age, as well as in those who have infections of the upper respiratory tract or had breathing problems at birth.

Infants of Native Americans and blacks are found to be more prone to SIDS, even though the reason for this is not clear. It is more prevalent among economically weaker sections of the society. Infants born to single mothers, women younger than 20 years of age, and those who used banned drugs and tobacco during their pregnancy are at higher risk. Babies whose siblings had died earlier due to SIDS also carry an increased risk.

The exact cause of sudden infant death syndrome is not known. Certain breathing abnormalities may be the reason behind it. Apnea, or prolonged periods without breathing, had been observed in some babies who later succumbed to SIDS. Low oxygen level in the blood is also detected in them. Placing babies to sleep on their stomach is found to be a risk factor for SIDS. Blankets, pillows and soft bedding which may interfere with their breathing also may increase the risk. Sleeping along with the baby on soft beds, cushions or on sofas may cause SIDS.

The common factors which may cause SIDS are known, but there are no sure ways for preventing it. Making infants sleep on their backs at night, and during the day, can definitely help reduce the chances, as it has been observed that the incidence of SIDS have reduced significantly since more parents have been educated in this regard. A firm surface to sleep is also important. The cots and the mattress should be safety- approved and anything which may block the baby’s breathing, such as soft toys, bumper guards, thick blankets and pillows should be removed from the cot. Fitted sheets should be used. Overheating should be avoided as it is suspected to be a cause of SIDS, though not proven. Babies should be protected from exposure to cigarette smoke as it is injurious to their health in addition to being a risk factor for SIDS.

Losing a baby to SIDS is extremely distressing to the parents, as they are totally unprepared for such a sudden tragic event. In addition to grief, they may feel terrible guilt too. The investigations by the police and the social service, which follow the death of the child, add to the trauma. Doctors and other qualified medical personnel should explain the situation to the parents and provide the required counseling to help them cope with the sudden loss. Interacting with other parents who have had a similar experience, joining support groups, and learning more about SIDS by reading and visiting web sites, may be helpful as well.

Precautions to be taken to reduce the risk of Sudden Infant Death Syndrome:

  • Infants should be placed on their backs to sleep during the day and the night.
  • They should sleep on a firm bed with a fitted sheet.
  • Objects which may suffocate the infant, such as soft toys, pillows, blankets and loose bedding, should be removed from the sleeping area.
  • Smoking during pregnancy should be strictly avoided and infants should be protected from exposure to tobacco smoke.
  • Infants should have a specific sleeping area, separated from where the adults and other children sleep yet close enough for frequent monitoring.
  • Avoid the infant getting overheated during sleep.
  • Babies should be awake, and closely supervised, when they lie on their stomachs.
  • A pacifier can be given to the infant when it is laid down for sleeping.

Monitors and other products which claim to prevent SIDS are not always dependable.

Watch This Video about Sudden Infant Death Syndrome

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

What Is Reye Syndrome

What Is Reye Syndrome ?

Reye syndrome causes inflammation of the brain and impairment of liver function. This rare, but potentially fatal, disorder is associated with certain viral infections in children and the use of the drug aspirin.

  • The typical symptoms include a viral infection followed by nausea and severe vomiting, lethargy, confusion and in some cases, coma.
  • The exact cause is not known, but certain viral infections and the use of the drug aspirin may be the trigger.
  • Reye syndrome is diagnosed from the typical symptoms, blood tests and a liver biopsy.
  • The severity and the extent of damage suffered by the brain determine the prognosis, with the rate of mortality ranging from 2% to 80% depending on the stage of the illness.
  • This condition is treated mainly by lowering the excess pressure in the brain and treating the other symptoms present.

Even though the exact reason for Reye syndrome is not known, it is often found to occur following certain viral infections such as a flu caused by the influenza virus or chicken pox which is caused by the virus varicella. It is found to occur mostly in children who are given the drug aspirin to bring down the fever caused by these viral infections. Aspirin is no longer given to children in view of the increased chance of it being a trigger for Reye syndrome, except to treat certain specific disorders such as Kawasaki disease and juvenile idiopathic arthritis. Those children who require aspirin therapy are vaccinated against viral infections such as chicken pox and influenza to avoid the risk of developing Reye syndrome.

With the decline in the use of aspirin in children, the incidence of Reye syndrome has become much less frequent, with only about 2 cases occurring in a year. It usually affects children below 18 years of age, and is more prevalent in winter season and the latter part of fall.

Symptoms

Reye syndrome can be mild or severe. It usually starts with the typical symptoms of an upper respiratory tract infection of viral origin, influenza, or occasionally of chickenpox. After 5 days to a week, the child suddenly has nausea and severe vomiting. The child’s condition deteriorates rapidly, with lethargy, disorientation and confusion setting in, often within the same day. Seizures may occur, and the child may fall into a coma which progresses steadily. Liver function may become impaired, leading to problems with blood clotting which may cause bleeding. Ammonia levels in the blood may increase excessively due to loss of liver function.

Diagnosis

Reye syndrome is suspected when children suddenly have vomiting, and start displaying symptoms of encephalopathy or brain dysfunction. Blood tests and a biopsy of the liver tissue are done to rule out other possible causes and to confirm Reye syndrome. The condition is categorized into 5 stages according to its severity, with the mildest form as stage I, and the severest as stage V.

Prognosis

The prognosis greatly depends on several factors such as the extent of damage inflicted on the brain by the inflammation, the duration of the brain dysfunction, the blood ammonia level, the pressure in the brain, and how fast the coma progresses. The mortality rate varies according to the stage of the disease severity and progression; the stage I carrying a 2 % risk and children in coma in the stages IV and V having 80%. If the children survive the critical phase, they may recover completely, but those who have suffered severe symptoms may sustain brain damage which can result in muscular weakness, intellectual disabilities or seizures.

Treatment

Reye syndrome has no particular treatment; mainly the symptoms are treated after admitting the affected child in the intensive care unit. If liver is affected, the child may have problems with clotting of blood. In such cases, fresh frozen plasma or vitamin K is given to help blood clotting. Endotracheal intubation is done to lower the pressure in the brain and reduce swelling. In this procedure, a tube is placed in the windpipe, and a high breathing rate is induced. Raising the head of the bed, restricting fluid intake, and giving mannitol or other drugs which help the body remove excess water, are other measures taken to reduce the swelling. The pressure in the brain may be monitored with a device placed in the head. Dextrose is administered to maintain normal blood sugar levels.

Watch This Video about Reye Syndrome

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Kawasaki Syndrome (Disease)

Kawasaki Syndrome, which mostly occurs in children below 5 years of age, results in vasculitis, or inflammation of the walls of the blood vessels, throughout the body.

  • The common symptoms include fever, a bright red coloration of the tongue, usually called strawberry tongue, swollen and cracked lips, and rashes in different parts of the body.
  • In some cases, the disease causes serious heart complications which can become fatal, if not treated.
  • Kawasaki Syndrome is thought to be associated with some infection, but the exact cause is not known.
  • Kawasaki Syndrome is diagnosed based entirely on symptoms, as no specific diagnostic test is available.
  • Almost all the children who are affected by Kawasaki Syndrome recover completely with timely medical intervention.
  • Treatment involves administration of aspirin and immunoglobulin in high doses.

Kawasaki Syndrome, which is also known as Kawasaki disease, causes the walls of the blood vessels to become inflamed. The inflammation is usually wide spread, affecting almost all the blood vessels in the body. Most of the serious consequences of the disease result from the inflammation of the blood vessels of the heart. Kidneys and pancreas also can be affected. The exact cause of Kawasaki Syndrome is not yet known, but it is thought to be an auto immune disease triggered by a virus or some other organism or an abnormal response of the immune system to certain infections. A genetic predisposition to the disease is observed in children of Japanese descent.

Children less than 5 years of age are the most affected, while most cases of Kawasaki Syndrome occur in children between 1 to 8 years of age. However, younger infants as well as adolescents are also affected. The incidence in boys is double that of girls. Though the disease is more prevalent in children of Japanese origin, thousands of cases are reported every year in the United States alone.

Symptoms

High fever marks the beginning of the disease. High temperature, often above 102° F or 38.9° C, may prevail for about 1 week to 3 weeks. Conjunctivitis or redness of eyes may appear in a day or two, but no discharge from the eye is seen. Rashes in different parts of the body may appear in about 5 days. The trunk, diaper area, and the mucous membranes are the most affected. The lining of the mouth, and vagina in girls, become red in color; the throat, tongue and the lips also become bright red. The swollen, red lips become dry and develop vertical cracks. The palm of the hand and the soles of the feet appear purplish red. The hands and feet may become swollen and even painful. Peeling of skin from the fingers and toes may start about ten days after the onset of the disease.  Swollen lymph nodes found in the neck area is a typical symptom, and they may be tender to touch.  The disease may persist from a few weeks to a few months.

In about half the cases, the disease may affect the heart and cause irregular heart rhythms and rapid heartbeats. These complications usually start within the first one to four weeks, and affect one out of every five children with the disease. If it is not treated immediately, half of these affected children may develop a severe heart problem known as coronary artery aneurysm. It is bulge in the arterial wall of the coronary artery, which can promote blood clotting that may result in heart attacks. Those who have aneurisms are at greater risk of sudden death due to a blockage of the coronary artery, or rupture of the aneurism. Meningitis, or the inflammation of the membranes lining the brain, and that of tissues lining the eyes, ears, urethra, and joints, may result in painful conditions. Liver and gallbladder also may be affected. However, these symptoms do not cause any permanent damage, and get resolved eventually.

Diagnosis

Diagnosis of Kawasaki Syndrome is based on certain predefined symptoms. If a child has four out of these five bench mark symptoms, Kawasaki Syndrome is diagnosed. Other diseases such as juvenile idiopathic arthritis, scarlet fever, and measles, which have similar symptoms, are ruled out by blood tests and blood culture. Throat swabs are also taken for cultural study. Pediatric cardiologists experienced in treating children with heart disorders are consulted, to deal with the heart complications which may develop due to Kawasaki Syndrome.

On diagnosing Kawasaki Syndrome, further investigations are initiated to detect possible heart complications such as leaking heart valves and coronary artery aneurysms. Pericarditis, or inflammation of the pericardium enveloping the heart, and heart muscle inflammation, known as myocarditis, is also investigated. Electrocardiography as well as echocardiography is done to determine the type and extent of the damage. Heart complications may not always develop at the beginning of the disease, but they can appear at any time during the following months, even up to a year from the onset of the disease. Hence, the ECG and echocardiography are repeated at specific intervals, first at two to three weeks, then again at six to eight weeks, and may be after six months to one year.

If the results of Electrocardiography tests or echocardiography are found to be abnormal, a stress test may be conducted. Heart catheterization may be required, if aneurisms are detected.

Prognosis

Complete recovery is possible in most cases of Kawasaki Syndrome, especially if the coronary arteries of the children are not affected by the disease in the first two months. If coronary artery is affected, the prognosis usually depends on the extent of damage caused; but with timely treatment, fatality due to Kawasaki Syndrome is almost nil in the United States. If the condition is not treated, about 1% of affected children may die of the disease or its complications, mostly within 6 months from the time of appearance of the symptoms. But in some cases, death may occur even 10 years after having the disease. Aneurysms may get resolved within 1 year in most of the cases. If aneurisms are large, the chances of them resolving are less. Even if the aneurysms eventually resolve, children who have had them are at a higher risk of developing heart problems later in life.

Treatment

Treatment initiated within 10 days of the onset of fever can considerably reduce the damage caused to the coronary artery. Other distressing symptoms such as rashes, high temperature, and general discomfort, are also reduced within days of starting drug therapy. Immunoglobulin is administered intravenously in high doses for one to four days, while aspirin in high doses is given orally. The dosage of aspirin is reduced when the fever subsides, usually within four or five days. However, lower doses of aspirin should be continued for at least two months from the first appearance of symptoms. It is discontinued only if all symptoms of inflammation have disappeared, and if coronary artery aneurysms are absent. To minimize the risk of blood clotting, aspirin has to be used log-term, if coronary artery aneurism is present.

The use of aspirin in children who have a viral infection such as chicken pox or influenza considerably increases the risk of a potentially fatal condition called Reye syndrome. Children who require long-term use of aspirin, such as those who have developed Kawasaki Syndrome, are vaccinated against these infectious viral diseases as a precaution. Influenza vaccine needs to be repeated every year; and it is given as an injection, instead of as a nasal spray. If a child on aspirin therapy contracts chickenpox or influenza, aspirin is temporarily discontinued, and dipyridamole is given instead, to minimize the risk of developing Reye syndrome. If a child has a large coronary aneurysm, anticoagulants such as dipyridamole or warfarin may be used to prevent blood clots from forming.

Watch This Video About Kawasaki Disease:

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Failure to Thrive In Infants

Failure to thrive in infants is characterized by abnormally low rate of weight gain and delayed physical growth of the child, leading to development delays. It adversely affects the physical and mental maturation of the child.

  • Malnutrition or certain medical disorders occurring in children is the usual cause of failure to thrive in most cases.
  • Failure to thrive is determined by comparing the growth chart of the child, a thorough physical examination, and the feedback from parents regarding the health and growing environment of the child.
  • Malnutrition and undernourishment in the first year of the child’s life may result in developmental delays in the child.
  • Failure to thrive is treated by treating the underlying cause of the condition.

Children who are underweight consistently, and fail to gain weight normally for no apparent reason, are regarded as having the condition referred to as failure to thrive.  The underlying reason for this condition may vary between individual cases. The growing environment of the child and other social factors may be keeping the child from receiving necessary nutritional inputs, affecting the child’s normal growth and development. In some cases, certain medical disorders occurring in the child may retard the normal developmental pace.

Many less-than-ideal family situations and social conditions may be responsible for malnourishment in the child. In unstable families, the absence of proper mealtimes and nutritious meals may affect the appetite of the child and considerably reduce its food intake. Mental disorders and abusive habits in the parents may result in neglect and abuse of the child, preventing its normal growth. Poor financial status of the family may be causing inadequate food supply and affecting the nutritional quality of the food available. Lack of environmental stimulation may adversely affect the physical and mental development of the child.

In some cases, the failure to thrive in infants may be due to a disease or a medical disorder present in the child. A physical defect such as cleft palate, or cleft lip, may be interfering with feeding, due to which the child fails to receive enough nourishment. Other disorders which may result in malnutrition include gastroesophageal reflux, physical abnormalities such as a malabsorptive syndrome, or narrowing of the esophagus. Certain tumors and infections in the child, hormonal insufficiencies, heart disease, metabolic disorders like diabetes, cystic fibrosis, and kidney disease, are a few of the other medical reasons for growth retardation. HIV infection and some genetic disorders also may be responsible for the failure to thrive.

Diagnosis

When the child’s rate of growth has been steady even if it is lower than the standard growth rate of children of the same age, the child is assessed to be small for its age, but growing normally.  However, when the child’s growth chart shows reduced weight gain and retarded growth when it is compared to the previous records, the doctor may suspect failure to thrive, especially if no specific medical cause for the growth retardation can be identified.

The reason for the failure to thrive in infants is investigated by asking the parents about the child’s feeding habits, bowel movements and illnesses. The financial status of the parents and other social conditions and family atmosphere which may interfere with the child’s nutritional intake are discussed, and assessed, to determine the underlying cause of malnourishment. The doctor may try to detect any specific disease in the child, or any disorder which runs in the family, by questioning the parents and examining the child thoroughly. Blood tests, urine tests and x-rays may be conducted if the doctor feels that further investigations are necessary to identify the possible medical cause for the failure to thrive.

Prognosis

If a child is malnourished in the first year of its life, it may result in permanent damage to the physical and mental well being of the child. Optimal nutrition is essential for brain development, and nutritional deficiencies, especially in the first year, may precipitate irreversible damage. With timely medical intervention, the child may recover physically in most cases, and may continue to grow normally, with better nutritional inputs. However, their mental development may lag behind; their verbal skills may remain lower than normal; they may have emotional and social problems as well.

Treatment

Failure to thrive in infants is treated mainly by treating or removing the root cause of the condition. If the child is diagnosed with any medical disorder which may be affecting normal growth and development, it is treated appropriately. By comparing the weight gain of the child with that of children of the same age, it is possible to determine how abnormally low the child’s weight is. If the failure to thrive is found to be mild or moderate, a high calorie nutritious diet and a regular feeding schedule may help the child recover. The financial and social conditions of the parents may be analyzed to see whether they could be affecting the child’s nutritional intake. Parents are counseled about providing an environment conducive to the normal growth and development of the child. If the failure to thrive is found to be severe, the child may need hospitalization and intensive treatment. A panel of specialists, including psychiatrists, nutritionists, behavioral therapists and social workers, may have to collaborate to find the possible reasons for the condition and to determine ways and means to tackle it.

Watch This Video about Failure to Thrive

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Fever in Infants and Young Children

Fever is the abnormally high body temperature resulting from the body’s response to infections, inflammatory conditions or injuries.  

  • When children have fever, they become irritable and show disinclination to eat and drink properly. Their sleep also may be disturbed.
  • Viral infections such as gastroenteritis and cold are the most common cause of fever in infants and children.
  • Fever is diagnosed from the symptoms and from reading the body temperature with a clinical thermometer. The cause of the fever may be determined by a physical examination or further testing.
  • Drugs such as acetaminophen and ibuprofen may be used to bring down the temperature and reduce the discomfort of the child.

Normal body temperature may vary slightly between individuals. Hence, temperature readings below 100.3° F or 38° C are not considered to be a cause concern, unless the child seems distressed. However, if the body temperature is above 100.4° F or 38° C, it is an abnormal condition requiring medical attention, especially in infants below three months.

Causes and Symptoms

The usual causes of fever in infants are viral infections which cause common cold and gastroenteritis in infants and children. Fever due to viral infections subside on its own as the infection gets resolved, and does not require any treatment other than drugs to reduce the temperature and the discomfort of the child. However, fever resulting from bacterial infections, which occur less frequently, requires antibiotic therapy to overcome the infection and lower the body temperature. Ear infections and respiratory tract infections are usually caused by bacteria. Infections of the kidneys and the bladder also may be bacterial in origin.

Certain bacterial infections in the blood may lead to potentially fatal conditions such as meningitis and a widespread infection called sepsis. The only external symptom of these serious conditions may be fever, but more often than not, the affected children look severely ill, which may indicate the severity of their condition and lead to timely diagnosis. Infections are not the only causes of fever, but other conditions causing fever are not very common. Fever due to such other conditions usually persists for several days, often until the causes are detected and treated appropriately.

When infants and children are vaccinated against certain diseases, fever may appear as a reaction to the vaccine. However, it is normal, and should not be a reason to avoid vaccinations. Giving acetaminophen just before and after the vaccination may help avoid fever and associated discomforts resulting from vaccination. Ibuprofen also may be given to lower high temperature.

When infants have fever, they are generally irritable and do not feed well. Their sleep also may be extremely disturbed, which may add to the irritation. Children who are older may become listless and lose interest in activities and play. Very high temperature may make some children unresponsive and extremely lethargic. However, some children may look and act perfectly normal even when they have high fever. In some cases, the rapidly increasing fever may result in seizures which are referred to as febrile seizures.

Diagnosis and Treatment

Fever in infants can be easily diagnosed, but it may be a challenge to determine the exact cause of the fever. Temperature below 100.3° F or 38° C is considered as low grade fever. If no other symptoms or signs of distress are present, low grade fever is often ignored. If it appears for only a short period of time, no treatment is required. Infants having a temperature above 100.4° F or 38° C need to be examined by a doctor to determine the cause. A description of the infant’s symptoms and a thorough physical examination may help the doctor diagnose the cause and prescribe appropriate treatment. In older children, high fevers, recurring fevers, and fevers accompanied by pain, require medical attention.

Very young infants who develop a fever, especially those below 2 months old, require immediate medical attention. It is more difficult to determine the reason for the fever in them, as other accompanying symptoms are not easy to identify. Due to the immaturity of their immune system, they are also more prone to serious infections, and to developing life threatening conditions such as sepsis and meningitis. Blood tests and urine tests are conducted to detect infections which may be causing the fever. A lumbar puncture or spinal tap may be done to test for meningitis. If the doctor notices any abnormality in breathing, a chest x-ray may be done detect respiratory tract infections.

In older infants and young children with fever, detailed testing is not usually done if the doctor diagnoses it to be viral in origin. However, blood tests and urine tests may be prescribed if the infant appears very ill and the cause cannot be determined by a physical examination. In some cases, a spinal tap also may be performed. When children above 3 years have fever, the doctor may be able to assess other symptoms by observing the behavior of the child. After a thorough physical examination, the doctor may decide if any further testing is required. If the child has very high fever, and the cause cannot be determined by physical examination, the doctor may prescribe blood tests and urine tests.

In most cases, the only treatment required may be lowering the temperature and reducing the physical discomforts. Plenty of water should be given to avoid dehydration.  Acetaminophen is commonly used to bring down the temperature. Ibuprofen also can be used reduce fever as well as discomforts associated with it. Once the child feels better, and becomes willing to eat and drink sufficient amount of fluids, no further treatment may be necessary. A sponge bath with warm water may reduce the body temperature and make the child feel even better.

Aspirin should not be given to children to treat fever as it can cause a serious reaction known as Reye’s syndrome in some children who have fever due to viral infections. A child with fever should not be given a cold bath or sponge bath with cold water. Warm water should be used instead. The practice of rubbing a child with alcohol or the extract of witch hazel is not advisable. They carry the risk of being ingested accidentally. They may release harmful fumes which can irritate the eyes too.

If the fever does not subside in a few days, and the reason for the fever is not known, detailed testing may be required to determine the cause. In rare cases, even after detailed testing, the reason cannot be determined. This condition is referred to as fever of unknown origin. When bacterial infections are detected, appropriate antibiotics are prescribed. When the cause of the fever is something other than infections, appropriate medical and surgical treatment may be required.

Measuring a Child’s Temperature

Temperature in the mouth, armpit, rectum or ear can be measured to determine the extent of fever in infants. Both digital and glass thermometers are widely used to measure the temperature, but thermometers which contain mercury are not advised due to the risk of mercury poisoning in case of breakage.

Temperature in the rectum: This gives the closest reading to internal body temperature and can be considered an accurate measure of fever. A digital or glass thermometer, with the bulb smeared with a lubricant such as petroleum jelly, should be inserted gently into the rectum with the child lying down on its front. At least half inch of the thermometer should be inside the rectum and it should be held in position for about two to three minutes.

Temperature in the mouth: Oral temperature is also accurate measure of fever, but the procedure is difficult in infants and young children. The bulb of the thermometer is placed under the tongue and gently held in place by keeping the mouth closed for about three minutes. Digital or glass thermometers can be used.

Temperature in the ear: A special digital device is required to measure the temperature in the ear. This device measures the infrared radiation emanating from the eardrum. The ear canal is sealed with the tip of the device before it is switched on. A digital reading is displayed on the device. The measurement is accurate, but it is not suitable for measuring fever in infants below three months old.

Temperature in the armpit: The thermometer is placed in the armpit and held in place by keeping the arm close to the body for 4 to 5 minutes. The temperature reading is not as accurate as oral or rectal readings, but the procedure is easier and least invasive. Digital or glass thermometers can be used.

Watch This Video about Fever in Infants and Toddlers

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Undescended Testes and Retractile Testes

Undescended testes is condition in which the testes have not descended into the infant’s scrotum as they normally do prior to birth, and continue to remain inside the newborn’s abdomen instead. 

Undescended testes, referred to as cryptorchidism, occur at birth in about 3% of boys.  In most cases, the testes usually descend by themselves within 6 months. Premature infants are more prone to having this abnormal condition. Children born in families with a history of cryptorchidism also have a greater chance of having undescended testes. In about 50% of cases, only the right testis may be Undescended. About 25% of affected boys may have this condition on both sides.

Undescended testes do not cause any symptoms in the affected boys. But later in life, they can get twisted inside their abdomen, resulting in a condition called testicular torsion. This can have consequences such as impaired sperm production and hernia in men. Those who have testicular torsion are at higher risk of developing testicular cancer too. The testes which are not descended can be brought down surgically into the scrotum. This surgery is usually performed if the testes do not descend on their own even after the child is one year old.

Retractile testes may occur in some boys whose testes which are descended tend to move back into the abdomen at times. Testes with this back and forth movement are termed hypermobile. This condition does not carry any additional risk of complications such as cancer, hernia or infertility. Surgical correction is also not required. In most cases, once the boys reach puberty, the testes do not usually retract back into the abdomen anymore.

Watch This Video about Undescended Testes and Retractile Testes:

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Skin Rashes in Infants

Skin rashes of different types may occur in infants and children due to various reasons, but usually they are not very serious.

  • Rashes in infants  may be caused by viral, fungal and bacterial infections, or due to irritation of the skin and allergies.
  • Different types of rashes include itchy red rashes; fluid filled cysts; yellow scaly rashes; milky pimples or bumps on the skin.
  • Many rashes disappear without any treatment. Some may become better with the application of moisturizers and gentle cleansing lotions.
  • Application of anti fungal and anti bacterial ointments and antibiotic therapy may be necessary in some cases. Anti-itch medication can relieve severe itching.

Diaper rash:

It is one of the most common rashes in infants. This bright red rash appearing in the diaper area is due to the irritation caused to the tender skin by the almost constant contact with excretory materials such as urine and stools. The areas of the skin which are in touch with the diaper are especially affected. It is also referred to as diaper dermatitis.

Bacterial and fungal infections can also cause diaper rash. A typical fungal infection caused by Candida gives rashes, bright red in color, along the skin creases. Tiny red spots also may be present. Diaper rash due to bacterial infections are rarer. Babies who are exclusively fed on breast milk are found to have lower incidence of diaper rash as their stools may not have as many irritating substances and enzymes as the stools of infants who take formula milk. Using highly absorbent diapers, with moisture-locking gel filling, may reduce rashes by keeping the infant dry. Frequent diaper changes, and avoiding plastic pants which keep moisture in and restrict air circulation, also may help. Most children who have diaper rash are not usually bothered by the condition.

The usual treatment for diaper dermatitis is frequent change of diapers, and allowing for air circulation in the diaper area. Mild soaps should be used to clean the affected area. Most cases of diaper rash clear up without any further treatment. Petroleum jelly, ointments containing zinc, vitamin A & D ointment, or moisturizers, can act as a barrier to moisture and may prevent rashes. If Candida infection is present, the doctor may prescribe an antifungal cream to clear up the rash. Antibiotic creams may be required to treat rashes caused due to bacterial infections.

Eczema:

It is a dry rash causing the skin in the affected area to appear red and scaly. It usually appears as patches at the joints of the hands and legs. Cold weather and dry climate worsens the condition. The rashes due to eczema, otherwise referred to as atopic dermatitis, may come and go without any apparent reason. Its cause is also not known. Allergy is thought to be the trigger for eczema and it is considered to be similar in origin to asthma. It usually runs in families too, much like asthma does.

Many children who have eczema in infancy and childhood may outgrow the condition eventually. However, in some cases, the episodes continue lifelong. There is no cure for eczema, but the condition can be treated with moisturizers, corticosteroid creams and the use of gentle cleansing agents. Anti-itch medication, and humidified air, may give some relief to the itching and scaling skin. Identifying triggers such as dust mites and other allergens, and avoiding them, may reduce the frequency and severity of attacks.

Cradle cap:

It is a crusty and scaling yellow and red rash often occurring on the infant’s scalp. Occasionally it may appear in some skin folds too. The cause of this condition, also referred to as seborrheic dermatitis, is not known. Infants with cradle cap do not seem to be bothered by the condition, and it usually disappears by the time the infant is six months old. Applying mineral oil to the scalp, and using shampoos regularly to wash the head, may help reduce the crusty scales. Those crusts tangled in the hair can be gently removed with a comb. A severe cradle cap which persists, and does not respond to the above measures, may require treatment with corticosteroid creams or the application of shampoos containing selenium.

Tinea:

It is a fungal infection affecting the skin in different parts of the body. While tinea capitis affects the skin of the scalp, tinea corporis, commonly called ringworm, appears on the body. When tinea is diagnosed in infants and children, it is treated in the same way this fungal infection is treated in adults. In some children, the condition may be worsened by an inflammatory response to the infection causing the formation of a scalp mass known as kerion. This complication requires further specialized treatment.

Molluscum contagiosum:

It is a rash caused by a virus. It appears as a cluster of pearly pimples or flesh-colored bumps, and disappears after a while without any specific treatment.

Milia:

They appear as small pearly white cysts on the infant’s face in the early days of life. It is caused by the first oil secretions from the newborn’s skin glands. They disappear within days, without any treatment.

Common Viral Infections:

They are common causes of rashes appearing suddenly in infants, as well as, children. Roseola, rubella, and the infection erythema infectiosum, which is known as the fifth disease, are viral infections causing characteristic rashes. They are not serious, and do not cause much discomfort to the children. Other common rash-forming viral diseases such as chicken pox and measles are increasingly becoming rare as vaccinations against them are being widely used.

Watch This Video About Viral Skin Rashes in Babies :

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Separation Anxiety in Babies

Separation anxiety usually occurs in older infants when they feel afraid that their parents are leaving them.

  • Extreme panic and crying when the mother or father leaves the room is the usual sign of separation anxiety in babies.
  • It may appear in infants older than 8 months and is usually strongest in the period between 10 months to one and a half years of age.
  • Separation anxiety may eventually resolve by itself as the child grows older and realizes that parents always come back after they leave.
  • Most two year olds may have overcome separation anxiety.

Infants may display separation anxiety when one of their parents disappears for the briefest of periods. They show their fear of being left alone, by crying. It is common in infants older than 8 months, and is considered normal in children up to two years of age. The intensity of separation anxiety may differ from child to child, and the duration also differs. It is found to be dependent on the relationship between the parents and the child. Children with strong, stable, emotional attachment to parents often overcome separation anxiety much earlier than those who have a less stable relationship.

Infants usually begin to recognize the special status of their parents by the time they are 8 months old. Younger infants may readily accept substitute care givers, but once they realize their special relationship to their parents, they may become more attached to them, and may show a certain amount of reluctance towards others. Separation anxiety in babies originates from this new realization, and the disappearance of one of the parents may trigger severe stress and anxiety in them. Their memory being still very short and immature, they may not be able to associate their parents’ disappearance with past experiences of their coming back. The children may gradually overcome their anxiety as their memory becomes mature, and their sense of time improves. They can now visualize their parents in their absence, and remember the instances in the past when they invariably come back.

When a child displays separation anxiety, the parents need not limit the occasions which require separation in response to the child’s reaction. Doing so may actually interfere with the child’s normal development. When the parents leave the room, the child may protest and cry, but they can call out to the child from another room of the house, instead of rushing back in to pacify the child. This will help the child realize that the parents are around even when they are not present in the room. If the parents gradually increase the amount of time they spend away from the child’s presence may help the child accept the separation better. It may help prepare the child for day-long separation, if the parents are planning to work away from home.

If the child has to be left in a day care, parents should leave without making a fuss after they drop the child off, even if the child is crying. Prolonging the process of separation can only make it more difficult for the child as well as the parents. The care givers should be encouraged to distract the child with a game or a toy as soon as the child is brought into the center, instead of making an event of hugs and goodbyes. The parents should never stay longer than necessary as a response to the child’s crying. When the child is tired or hungry, separation anxiety tend to be worse. Ensuring that the child is rested and well-fed before the parents leave may help reduce separation anxiety.

Children who display separation anxiety between 8 months and 2 years of age do not suffer any long-term harm, as it is part of their normal development. However, if it persists beyond 2 years, it may be a cause concern, especially if it interferes significantly with the normal development of the child. Sudden changes in life may trigger anxiety even in children who have overcome separation anxiety. Starting school can be an extremely stressful change of routine to children, but most of them rapidly adjust to the changes. Excessive separation anxiety in a few children may prevent them from interacting normally with other children in the school and taking part in activities. Such a situation is considered abnormal, and the child may need medical intervention to overcome the separation anxiety.

Watch This Video about Separation Anxiety in Infants

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Bowel Problems (Diarrhea And Constipation) in Infants

Bowel problems may occur in infants and young children due to insufficient fiber content in the diet, gastroenteritis, digestive tract infections as well as infections elsewhere in the body, use of antibiotics, and certain disorders.

  • Constipation and diarrhea are the usual symptoms of bowel problems in infants and young children.
  • Treatment of bowel problems depends on the symptoms and the cause.
  • Constipation is treated by making changes in the diet, and by drug therapy, if necessary. Along with rehydration measures, antibiotics may be used to treat diarrhea.

The frequency and nature of bowel movements and the texture of stools may vary between infants. It usually depends on the diet, as well as the age, of the child. Infants taking formula milk may have darker and more solid feces, while breastfed babies normally have mustard-yellow, semisolid stools. Babies usually have more than one or two bowel movements a day, but very frequent, watery stools are never normal. If it lasts for more than 12 hours, the infant should be treated for diarrhea. It is not necessary that every infant should have daily bowel movements. More than the irregularity of bowel movements, it is the texture of the stool, and the difficulty in passing it, determines whether the child is having constipation.

Diarrhea in Infants: 

Diarrhea is characterized by very frequent bowel movements of loose, watery stool.

Diarrhea in infants and young children can be either acute or chronic. Suddenly appearing diarrhea, which lasts no more than a few days, is termed acute diarrhea. It is more often caused by viral gastroenteritis, and is usually accompanied vomiting and stomach cramps. In fact, an episode may begin with vomiting, which often stops in a day or two, while the diarrhea persists for a few more days. Gastrointestinal parasites, bacterial infection of the stomach or elsewhere in the body, and the use of certain antibiotics, are some of the other causes of acute diarrhea. Rapid dehydration due to loss of body fluids through frequent vomiting and watery stools can make acute diarrhea dangerous in infants and young children. The main focus of the treatment is replacement of the electrolytes and fluids lost. If the diarrhea does not resolve by itself within two to three days, antibiotic therapy may be started to clear up bacterial infections which may be causing the diarrhea. On the other hand, if the diarrhea is due to the use of antibiotics, doctor may stop the medication or substitute it with other suitable drugs.

Diarrhea lasting for prolonged periods, often several weeks to a few months, is termed chronic diarrhea. Allergies towards certain food items in the diet, and lactose intolerance, are the most common causes of chronic diarrhea in infants. Gastrointestinal parasites, as well as malnutrition, can be the cause of chronic childhood diarrhea in underdeveloped countries. Children who have certain disorders such as cystic fibrosis or celiac disease may suffer from chronic diarrhea.

Constipation in Infants: 

Constipation is characterized by hard stools passed infrequently and with difficulty.

Irregular bowel movements alone are not considered as constipation as it is normal for some infants and children to pass stools only once in three or four days. When the stool is not passed for more than 5 days, it may become very hard and bowel movements may become painful and strained. Passage of hard stools may bruise and cut the anal canal, resulting in blood-stained stools.

Dehydration and lack of fiber in the food are the usual causes of constipation in infants. Changes in the diet or feeding pattern also may cause constipation. Certain congenital abnormalities and deficiencies in the infant may be responsible for constipation in some cases. Hirschsprung’s disease, characterized by lack of movement in the large intestines due to a nerve defect, often causes constipation. Hypothyroidism, abnormalities in the potassium and calcium levels, and the use of certain drugs such as opioids, anticholinergic medication, and antihistamines, also may result in constipation.

Constipation is treated differently according to the infant’s age. Very young infants, especially those under two months old and are feeding well, may be given light corn syrup to relieve constipation. One teaspoon of the syrup can be mixed with morning and evening feeds. Those older than two months can be given apple juice or prune juice to drink. Infants older than 4 months can have mashed and strained prunes, apricots, and plums, which would add extra fiber to their diet and relieve constipation. High-fiber cereal preparations also may help. Children one year old and above, will benefit from fiber-rich foods in their regular diet. Cooked spinach, beans, and peas are good sources of fiber. So are fresh fruits and whole grain crackers and cereals.

Infants and young children should not be given enema, suppository or over-the-counter laxatives, unless prescribed by a doctor. If the constipation is severe, the doctor may treat the child with drugs. Specific disorders which may cause constipation are treated accordingly. Those who have thyroid deficiency may be treated with thyroid hormones. Children with low calcium levels can take supplemental calcium to make up. A child with Hirschsprung’s disease may need surgery.

Watch this Advice About Infant Diarrhea & Vomiting :

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Feeding Problems in Infants and Young Children

Feeding problems are common in infants and young children. Most of the problems may not have any serious consequences, and may get resolved without any medical intervention.

  • Overfeeding, underfeeding, gastroenteritis, excessive loss of fluids, spitting up and vomiting food, and gastroesophageal reflux, are the most common feeding problems in infants.
  • Most of the feeding problems in infants and young children may resolve by themselves. However, medical intervention may be necessary in some cases.
  • Proper feeding techniques may help avoid feeding problems in infants.

Spitting Up Milk:

This usually occurs soon after feeding. Some of the swallowed milk is brought up effortlessly through either the nose or the mouth or both. Spitting up is partially due to the air swallowed with the milk, which is brought up as a burp along with the milk. This is most common in very young infants who are not able to stay in an upright position while feeding and afterwards.  Almost all babies spit up milk, but feeding too fast, or swallowing too much air due to a faulty feeding mechanism, can make spitting up worse. Most infants do not have any discomfort while burping up milk. Spitting up semi-solid food is also common in older infants. The valve between the esophagus and the stomach, which normally prevents the stomach contents from returning into the esophagus, is not fully functional and efficient in them. This may result in bringing up partially digested food along with the gas. Spitting up becomes less frequent as the infant grows older, and it may eventually stop by the time the infant is one year old.

Certain feeding techniques and feeding positions may help reduce spitting up milk. Feeding the infant before it becomes very hungry may help avoid fast feeding which increases the chance of spitting up. If the infant is bottle fed, the flow of milk can be controlled by using a nipple with a smaller opening which lets out no more than a few drops of milk when the bottle is held upside down. Holding the infant upright while feeding, and afterwards, and stopping every five minutes for burping, also may reduce spitting up.

If the infant seems to experience any discomfort while spitting up, and if the frequency does not decrease by the end of the first year, it may be a condition called gastroesophageal reflux, which requires medical attention. If the food being spit up is greenish in color, or has blood mixed in it, or if choking or coughing is associated with spitting up, medical attention is necessary.

Vomiting

Forceful throwing up of ingested food is referred to as vomiting, which is almost always associated with discomfort. Unlike spitting up food, which is common in infants, vomiting is never considered a normal occurrence even in infants. A stomach infection such as viral gastroenteritis, urinary tract infections, ear infections or some other infection in the body may be the cause of vomiting in babies and children. Certain serious disorders such as hypertrophic pyloric stenosis may be responsible for projectile vomiting which may occur occasionally in some infants who are two weeks to four month-old. It results from a blockage at the junction of the stomach and the intestine. Potentially fatal inflammatory conditions such as appendicitis and meningitis or intestinal blockages also may cause vomiting. More often than not, vomiting due to these conditions is accompanied by severe pain, fever and lethargy. Vomiting may be continuous and persistent too.

Vomiting due to gastroenteritis usually tapers off without any specific treatment. Preventing dehydration, by giving the infant fluids, or specially prepared electrolyte solutions (ORS), is important. Small amounts of the prepared solution should be given more frequently, instead of giving a larger quantity, especially if frequent vomiting is present. Popsicles or jellies may be given to older children. With adequate rehydration measures, most infants and children may recover within a day. However, certain symptoms, if present, may indicate severe dehydration or some other serious disorder which require medical intervention. They include the following symptoms:

  • Severe pain in the abdomen
  • High fever
  • Inability to hold down even small amounts of fluid
  • Inability to pass urine
  • Frequent vomiting which continues over 12 hours
  • Bile or blood in the vomit
  • Extreme lethargy and weakness

Underfeeding:

Underfeeding occurs when the infant is provided with less nutritional input than is required for normal healthy growth. This may arise due to problems with the infant or its mother or caregiver. If the infant has difficulty sucking milk, or swallowing food, it may result in underfeeding. Extreme fussiness, and certain disorders or illness, may cause lack of appetite in the infant, and it may refuse feedings. Faulty feeding techniques and improper preparation of formula can result in the infant receiving less nourishment than it requires. Mental instability and abusive nature, as well as poverty, and ignorance in parents are also some of the reasons for underfeeding.

Community healthcare agencies and volunteers can help educate parents on the correct usage of formula milk. The concentration of the formula should be adjusted according to the age of the infants. Illiterate parents who cannot follow the instructions on the container should be educated on the preparation of age-appropriate formula. Since breast milk has all the nutrition required by the infant in the first 6 months of life, promoting breast feeding, and educating new mothers on the correct way of feeding the baby, can help avoid underfeeding, especially in economically and socially weak communities. Frequent monitoring of the growth of the infant will help assess whether it is receiving adequate nutrition. If underfeeding is the result of parental neglect or abuse, Child Protective Services must intervene.

Overfeeding:

Providing more than the required amount of nutrition to the infant is considered overfeeding. Some parents tend to offer bottle whenever the infant cries, irrespective of the reason for the crying. Offering the bottle to distract the child from stressful situations, such as separation from parents, pain from bumps and falls, removing undesirable items from reach etc., as a reward, or to keep the child occupied, are common causes of overfeeding. It is not only a bad practice; it can cause long-lasting harm to the child’s emotional and physical well-being. Short term consequences may be frequent spitting up of food and diarrhea. Obesity and associated disorders are the long-term negative outcome of overfeeding.

Dehydration: 

Loss of fluid from the body, either due to vomiting, or through diarrhea, is the most common reason for dehydration. When fluid intake is insufficient, as in the case of inadequate breast feeding or when the infant is not able to draw in enough quantity of milk, it may lead to dehydration. Marked decrease in the frequency of urination, crying without shedding tears, dry mouth, decreased activity, and listlessness, are the usual symptoms of moderate dehydration. Severe dehydration may make the infant lethargic and sleepy. Dehydration may lead to salt imbalances in the body, which in turn worsens the symptoms such as lethargy. It may cause seizures which can result in brain damage and death. Dehydration should be promptly treated with electrolyte solutions given orally. If severe vomiting is present, fluids may have to be administered intravenously.

Treating Dehydration:

Infants and young children are highly vulnerable to rapid dehydration when they have certain illnesses with symptoms such as vomiting or diarrhea. The fluid loss has to be compensated by giving the child fluids containing the electrolytes which are lost through vomit and frequent watery stools. Since breast milk contains all the electrolytes and fluid required by the infant, dehydration in a breast-fed infant can be prevented by frequent feeds. Formula-fed infants require specially formulated oral rehydration solutions which have the required electrolytes in the right proportion. ORS is available in drug stores as well as in grocery stores. The powder should be diluted with water according to the instructions on the pack. Pre-mixed preparations also may be available. The quantity to be given depends on the age of the child and its tolerance. As a general rule, 1to 3 ounces per pound of body weight, in 24- hours, is the ideal amount.

Older children may have clear soups and diluted fruit juices. Plain water is not enough, as it doesn’t contain the required electrolytes. Colas and sweetened fruit juices are not recommended, as they have too much sugar and no salt. They may contain chemicals which irritate the stomach too.

When fluids are given orally, care should be taken to introduce small quantities at a time. A teaspoonful or two, once every 10 minutes, is sufficient to start with. If it is tolerated, the amount can be gradually increased. If vomiting and diarrhea have reduced, formula milk can be reintroduced after a day. If liquids such as soups are well-tolerated by older children, bland foods such as toasts, jellies and rice can be given after 12 hours.

If the dehydrated infants or children cannot tolerate oral feeding due to severe vomiting, intravenous administration of fluids may be necessary. Feeding through nasogastric tube also can be considered. In this procedure, fluids are fed through a plastic tube passed into either the stomach, or the small intestine, via the nose and the throat. Extreme dehydration can be life threatening and may require intensive care.

Watch This Interview About Feeding Problems in Infants and Young Children:

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS
You might also likeclose