Related concepts:

AS, ASD, Aortic Valve Stenosis, Atrial Septal Defects, CHD, Coarctation of the Aorta, Hypoplastic Left Ventricle, Patent Ductus Arteriosus, PDA, PS, Pulmonary Valve Stenosis, Tetralogy of Fallot, TGA, TOF, Total Anomalous Pulmonary Venous Return, Transposition of the Great Arteries, Tricuspid Atresia, Truncus

Introduction to congenital heart disease:

A baby’s heart begins to beat as early as 22 days into the pregnancy. But it doesn’t always progress properly.

What is congenital heart disease?

Complex folding and development of the heart before a baby is born results in distinct chambers separated by walls and valves. Important large blood vessels enter and leave the heart. The arrangements change again around the time of birth, when oxygen begins to arrive through the lungs instead of the umbilical cord. Problems in early development, or in adjusting from fetal circulation to life in the outside world, can result in congenital heart disease (CHD).
There are many types of congenital heart disease. They can be very mild, or they can be quite serious. Some require surgical treatment.
The eight most common types are listed below:
Ventricular septal defect (VSD): This is the most common type of congenital heart disease. In the case of VSD, the wall between the two largest chambers of the heart (the ventricles) does not finish forming.
Atrial septal defect (ASD): The wall between the two entry chambers of the heart (the atria) does not finish forming.
Patent ductus arterious (PDA): A normal fetal blood vessel that connects the pulmonary artery to the aorta fails to close at the time of birth.
Coarctation of the aorta (COA): The aorta leaves the left ventricle as the largest artery in the body. A coarctation is an abnormal narrowing of a segment of the artery.
Tetralogy of Fallot (TOF): Classically, this condition is a combination of four defects: 1) a large VSD, 2) narrowing of the exit to the right ventricle (pulmonary stenosis), 3) overdevelopment of the muscular wall of the right ventricle (right ventricular hypertrophy), and 4) the aorta is positioned above the wall separating the two sides of the heart (an overriding aorta).
Pulmonary valve stenosis (PS): This is a narrowing of the valve at the exit of the right ventricle that directs blood through the pulmonary artery to receive oxygen from the lungs.
Aortic valve stenosis (AS): This is a narrowing of the valve at the exit of the left ventricle that directs blood into the aorta, where oxygenated blood flows to supply the body.
Transposition of the Great Arteries (TGA): The aorta exits from the right ventricle, and carries oxygen depleted blood to the body; the pulmonary artery exits from the left ventricle and carries oxygen-rich blood to the lungs to receive oxygen. Without some type of additional defect that mixes the two circulations, the child cannot survive. This might be an ASD, VSD, or PDA.

Who gets congenital heart disease?

About one in 200 children are born with congenital heart disease of some form. It is more common in babies born early, but it can happen to anyone. Many factors can lead to congenital heart disease, but it sometimes runs in families. A variety of pediatric conditions are sometimes associated with specific types of heart defects, for example ASD, VSD, or other heart defects in children with Down syndrome.
Conditions in pregnant women (such as diabetes or rubella) can also lead to congenital heart disease. Some medications, such as those used to treat seizures, can lead to CHD in children. Drinking alcohol during pregnancy is another cause of CHD.

What are the symptoms of congenital heart disease?

Some forms of congenital heart disease may have no symptoms. They might be suspected by hearing a murmur on a routine physical examination. Sometimes symptoms such as poor feeding, shortness of breath, poor growth, frequent pneumonias, sweating, or dusky coloring lead to the diagnosis.
Some forms of congenital heart defects show up as medical emergencies, perhaps with respiratory distress, cardiac distress, or blue coloring.

Is congenital heart disease contagious?

No, although infectious diseases such as rubella can lead to CHD.

How long does congenital heart disease last?

This varies with the type and extent of the defect. Some will last until they are corrected surgically–sometimes requiring a series of operations. Some forms of CHD, however, do heal spontaneously. Many VSDs, for instance, close during infancy or toddlerhood with no treatment.

How is congenital heart disease diagnosed?

The diagnosis is suspected based on the history and physical exam. Further workup may include studies such as EKGs, chest x-rays, and echocardiograms.

How is congenital heart disease treated?

The treatment depends on the type and the extent of the defect. It might involve medications, operations, or sometimes no treatment at all other than just watching and waiting for it to heal on its own.

How can congenital heart disease be prevented?

Congenital heart disease is often impossible to prevent. Avoiding toxic exposures, such as drinking alcohol during pregnancy, prevents some CHD. Similarly, avoiding certain infections during pregnancy, such as rubella (preventable by immunization), can prevent some CHD.

Related A-to-Z Information:

Anemia (Low hemoglobin), Cleft Lip and Palate, Clubfoot, CMV (Cytomegalovirus), Down Syndrome, Epilepsy, Fetal Alcohol Syndrome, Fifth Disease, Lyme Disease, Pneumonia, Respiratory Distress, Rheumatic Fever, Rubella (German measles), Type I Diabetes, Vomiting

Related concepts:

The Gower Sign, Landouzy-Dejerine Disease, Steinert Disease

Introduction to muscular dystrophy:

Fundraising telethons and vague images of disabled children loom in most parents’ minds when they hear the words “muscular dystrophy.” The truth is that rapid advances in molecular genetic engineering hold promise for children with muscular dystrophy. Support of these efforts makes good sense.

What is muscular dystrophy?

The muscular dystrophies are a group of illnesses that share several things in common. They are all, first and foremost, muscle diseases as opposed to brain or nerve diseases. They all involve the death of individual muscle fibers. They are all hereditary conditions. And they all progress over time (as opposed to cerebral palsy, which doesn’t get worse or better).

Who gets muscular dystrophy?

Duchenne muscular dystrophy is the most common of the muscular dystrophies. It is an X-linked recessive condition, so it occurs in boys whose mothers are carriers. It appears around the world in all ethnic groups. Becker muscular dystrophy is a milder form of the same condition.
Emery-Dreifuss muscular dystrophy is a very rare form of muscular dystrophy that is also an X-linked recessive condition, with affected boys born to mothers who are carriers.
Myotonic muscular dystrophy (Steinert disease) is the second most common type. It is found most often in North America, Europe, and Australia. It is an autosomal dominant condition, which means that when one of the parents has the condition, about half of the children will (both boys and girls). There are no carriers without the illness.
Facioscapulohumeral muscular dystrophy (Landouzy-Dejerine disease) is a very rare form of muscular dystrophy that is also an autosomal dominant condition. When a parent has the condition, about half of the children will. There are no carriers without the illness.
Congenital muscular dystrophy and limb-girdle muscular dystrophy are autosomal recessive conditions. If both of the parents are carriers, about half of the children will be carriers, and about one-fourth of the children will have the disease. If only one parent is a carrier, the disease is not passed on, but about one-fourth of the children will be carriers.
The Fukuyama type of congenital muscular dystrophy is especially common in Japan, but is also found in Europe and the Middle East.

What are the symptoms of muscular dystrophy?

The hallmark symptom of muscular dystrophy is progressive muscle weakness. In classic Duchenne muscular dystrophy, the boys appear normal at birth. Looking back, perhaps they had poor head control compared to their peers. Nevertheless, they roll over, sit, stand, and walk at a typical age. By age 3, the weakness is clear. They will often need to walk their hands up their legs in order to stand up (the Gower sign). They tend to have large calves, and waddle when they walk. With aggressive treatment, most can walk until about age 12, but death usually occurs before adulthood. These boys often also have heart disease. Learning disability or mental retardation are some of the many other symptoms common in this condition.
Becker muscular dystrophy is a milder form of the same condition. The progressive course may take more than twice as long, but the progress is still relentless.
Children with limb-girdle muscular dystrophy appear normal until the school years or even into young adulthood. Weakness develops first in the muscles close to the trunk–around the shoulders and hips. Most can walk until about age 30. Enlargement of the calf muscles is also common in this condition. Intellectual growth is normal.
Children with Enery-Dreifuss muscular dystrophy usually appear healthy until school age. Weakness around the elbows and the ankles is often the first sign. Enlargement of the calf muscles does not occur. Intellectual growth is normal.
Children with congenital muscular dystrophies are noticeably weak at the time of birth. Nevertheless, these tend to be milder forms of muscular dystrophy with a slowly progressive course.
Facioscapulohumeral muscular dystrophy also appears in young babies. The earliest signs are weakness of the face and shoulder muscles. The eyes are often open during sleep.
Myotonic muscular dystrophy may also have symptoms in the first few years, including an upper lip shaped like an upside-down V. Muscles of the face and fingers usually show weakness first.
Depending on the type of muscular dystrophy, complications may also include cataracts, diabetes, heart disease, hypothyroidism, immunodeficiency, mental retardation, scoliosis, seizures, or testicular atrophy.

Is muscular dystrophy contagious?

No.

How long does muscular dystrophy last?

The muscular dystrophies are all lifelong, progressive conditions. Some, such as Duchenne muscular dystrophy, usually lead to death in late childhood, while others, such as Becker muscular dystrophy, commonly allow people to live to age 40.

How is muscular dystrophy diagnosed?

The diagnosis is made by muscle biopsy. It is suspected by the history and physical exam, and by lab tests, such as one for a muscle enzyme called CK. An electromyogram (EMG) is a test of the electrical activity in muscles that may be used to evaluate nerve and muscle conditions.

How is muscular dystrophy treated?

So far, there is no cure for the muscular dystrophies. Aggressive treatment is important to prevent and manage complications. This may include physical therapy and nutritional support. Meanwhile, scientists are searching for a cure or at least for ways to slow progression. Molecular genetic engineering seems to hold the most promise (Expert Opinion on Biological Therapy. 8(8):1051-61, 2008 Aug.).

How can muscular dystrophy be prevented?

Once a child has been conceived with the genes for muscular dystrophy, the disease cannot be prevented.

Related A-to-Z Information:

Arthritis (Juvenile rheumatoid arthritis, JRA), Bowlegs, Cataracts, Cerebral Palsy, Clubfoot, Congenital Heart Disease, Depression, Epilepsy, Fractures, Fragile X Syndrome, HIV, , Polio, Rabies, Rickets, Scoliosis, Sprains, Torticollis, Toxic Synovitis, Type I Diabetes, Undescended Testicle (Cryptorchidism)

Related concepts:

varicella-zoster virus, chickenpox, shingles

Introduction to chickenpox:

Chickenpox is one of the classic childhood diseases. A young child covered in pox and out of school for a week is a typical scene. The first half of the week feels miserable from itching; the second half miserable from boredom. Since the introduction of the chickenpox vaccine, classic chickenpox is becoming less and less common.

What is chickenpox?

Chickenpox is caused by the varicella-zoster virus, a member of the herpesvirus family.
Chickenpox is one of the most contagious childhood illnesses. The disease is usually mild, although serious complications sometimes occur.
Some of the complications include impetigo (especially when the pox are scratched), hepatitis, pneumonia, encephalitis, meningitis, Reye syndrome, and severe invasive streptococcal infections.

Who gets chickenpox?

Before the vaccine, chickenpox was a standard feature of childhood. Still, most cases occur in children younger than ten. The illness is most common in the late winter and early spring.
Adults and older adolescents usually get sicker with chickenpox than younger children do. Years after having chickenpox, some adults and older adolescents may then get shingles, a painful second outbreak of a varicella-zoster virus rash.
Children under one year of age whose mothers have had chickenpox are not very likely to catch it. If they do, they often have mild cases because they retain partial immunity from their mothers’ blood. Children under one year of age whose mothers have not had chickenpox, or whose inborn immunity has already waned, can get severe chickenpox.
Complications are more common in those who are immunocompromised either from an illness (e.g. AIDS) or from a type of medicine (e.g. chemotherapy). Some of the worst cases of chickenpox have been seen in children who have taken steroids during the incubation period, before they have any symptoms. These children are usually being treated for asthma.

What are the symptoms of chickenpox?

Most children with chickenpox act sick with vague symptoms, such as a fever, headache, tummy ache, or loss of appetite, for a day or two before (and 2-4 days after) breaking out in the classic pox rash.
The average child develops 250-500 small, fluid-filled blisters over red spots on the skin (“dew drops on a rose petal”). The blisters often appear first on the face, trunk, or scalp and spread from there. After a day or two, the blisters become cloudy and then scab. Meanwhile, new crops of blisters are springing up in groups. The pox often appear in the mouth, in the vagina, and on the eyelid.
The pox itch intensely.
The pox are worse in children who have other skin problems, such as eczema or a recent sunburn. Some children get more than 1500 pox.
Some children who have had the vaccine will still develop a mild case of chickenpox. They usually recover much quicker and only have a few pox. These often do not follow the classic descriptions of the disease.

Is chickenpox contagious?

People who have chickenpox become contagious 24 hours (and sometimes as long as 48 hours) before breaking out. They remain contagious while uncrusted blisters are present, usually one week or less after breaking out.
Chickenpox is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission.
Even those with mild illness after the vaccine may be contagious.

How long does chickenpox last?

Most children feel better, have scabs on all of the pox, and are safe to return to school or other activities within one week of the beginning of the rash. The pox may remain visible for days or weeks after that, but most of them will not scar unless bacteria are introduced during scratching.
Once someone catches chickenpox, the viral infection usually lasts for a lifetime, with the virus kept in check by the immune system. About 1 in 10 adults will experience shingles, a very painful rash, when the virus re-emerges during a period of stress for the body.

How is chickenpox diagnosed?

Chickenpox is usually diagnosed from the history and the classic rash. Blood tests and tests of the pox themselves can make the diagnosis if there is a question.

How is chickenpox treated?

Historically, treatment has been aimed at keeping children comfortable while their own bodies fight the illness. Aveeno Bath (or other oatmeal baths) in lukewarm water provides a crusty, comforting coating on the skin. An oral antihistamine will help to ease the itching, as will topical lotions such as Calamine or Sarna. Remember to trim the fingernails short to reduce secondary infections and scarring.
Safe antiviral medicines have been developed. To be effective, they usually must be started within the first 24 hours of the rash. For most otherwise healthy children, the benefits of these medicines may not outweigh the costs.
However, for those with skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma) or those who have recently taken steroids, the antiviral medicines may be very important. The same is true for adolescents and for children who must take aspirin on an ongoing basis.
Some doctors also give antiviral medicines to people in the same household who subsequently come down with chickenpox. Because of their increased exposure, they would normally experience a more severe case of chickenpox.

How can chickenpox be prevented?

Because chickenpox is airborne and is so contagious before the rash appears, it is difficult to avoid. It is even possible to catch chickenpox from someone on a different aisle in the supermarket, who doesn’t even know they have chickenpox!
A chickenpox vaccine has been available since 1995. It is about 100 percent effective against moderate or severe illness, and 85 or 90 percent effective against mild chickenpox. The Advisory Committee on Immunization Practices (ACIP) has recently recommended a two-dose vaccination series for varicella. They recommend a first dose administered at age 12-15 months and a second dose at age 4-6 years. Therefore, many children, adolescents, and adults who received only one dose based on previous recommendations are now receiving a “catch up” vaccine.
Why the change? A randomized clinical trial of 1 dose versus 2 doses of varicella vaccination showed that the estimated vaccine efficacy of 2 doses for a 10-year observation period was 98.3%, significantly higher than the efficacy of 1-dose vaccination.

Related A-to-Z Information:

Asthma,

Conjunctivitis (Pink eye), Contact Transmission, Droplet Transmission, Eczema, Encephalitis, Exanthems (Childhood rash), Febrile seizures, Headache, HIV, Human Herpesvirus, Impetigo, Pinworms, Pneumonia, Poison Ivy, Oak, and Sumac, Reye Syndrome, Smallpox, Streptococcus (Strep), Sunburn

Introduction to wheezing:

Our airways are designed to be responsive to harmful substances in the air. If we walk through clouds of smoke, our airways will shrink, protecting our delicate lung tissues from the noxious ingredients in the smoke. They should return to normal when we begin to breathe fresh air.
Some people – those with asthma – have an exaggerated tightening response.

What is wheezing?

Wheezing is the noise made by air moving through tight airways in the chest. Classically, wheezing is heard when children are breathing out, and these tiny airways collapse.
Wheezing does not necessarily mean asthma – and vice versa.
Wheezing can progress to respiratory distress.

Who gets wheezing?

Wheezing is the classic symptom of asthma, but it is also an important feature of other problems such as inhaled foreign bodies, RSV infections, other types of bronchiolitis, or cystic fibrosis. Wheezing might be a symptom of gastroesophageal reflux or of a food allergy. It can also be present during many common viral infections, especially during the first two years of life.
Not all children with asthma wheeze. Some cough instead, as a way to move air through the narrowed airways.

What are the symptoms of wheezing?

Tight, noisy breathing during expiration.

Is wheezing contagious?

No – although the causes of wheezing may be contagious.

How long does wheezing last?

Wheezing lasts as long as the airways are too tight. The duration depends on the underlying cause.

How is wheezing diagnosed?

The cause of wheezing should be carefully considered. Inhaled foreign objects should always be suspected – especially with the first episode of wheezing. They are most common at the age when the child is unlikely to be able to describe what happened.
Reflux should also be considered as a possible cause, as should other sources of airway obstruction.
Wheezing and asthma are so linked in many people’s minds that other causes are often missed.

How is wheezing treated?

Wheezing is treated by reversing the tightness of the small airways of the chest. This might be done with bronchodilator medicines to relax the smooth muscles around the airways. It might be done with anti-inflammatory medicines to reduce swelling within the airways. Or it might be done by removing an inhaled object.

How can wheezing be prevented?

Wheezing can often be prevented by taking steps to prevent the individual underlying causes. See separate articles

Related A-to-Z Information:

Adenovirus, Asthma, Bronchiolitis,Common Cold, Cough, Cystic Fibrosis, Food Allergies, Gastroesophageal Reflux, Peanut Allergy, Pneumonia, RSV (Respiratory syncytial virus)

Related concepts:

HPV, Verrucae, Common warts, Genital warts, Condylomata accuminata

Introduction to warts:

Contrary to well-established belief, the underside of a wart is smooth and round, and the entire wart is confined to the epidermis — the outermost layer of the skin. There are no ‘roots’!
Even without roots, warts can be difficult to destroy.
Warts will not leaves scars, though some of the more aggressive wart therapies might.

What are warts?

Warts are infections caused by viruses that are present everywhere, making them among the most common of all childhood skin conditions. The culprit will be one of more than 70 types of human papillomaviruses (HPV). They are spread when the virus touches a part of the skin where the outer protective layer is broken, either by minor trauma or by moisture. This happens most commonly on the fingers, elbows, knees, and the bottoms of the feet. Warts on the bottom of the feet are called plantar warts – named for the plantar surface (sole) of the foot.
Genital warts (condylomata accuminata) should be addressed carefully in children in order to be sure there has been no sexual abuse.

Who gets warts?

Anyone can get warts.
Some people get warts more easily than others. Warts are more common in children than in adults, partly because of their less mature immune systems and partly because they spend more time in wet-floored locker rooms and in active, close play.
Common warts occur in about 1 in 10 children. Genital warts occur in about 1 in 3 sexually active teens.

What are the symptoms of warts?

Warts are firm or fleshy bumps that might become yellowish tan, grayish black, brown, or remain flesh-colored.
Under a magnifying glass, the roughened surface of a wart often looks like a tiny cauliflower. The little black dots sometimes seen are the ends of blood vessels that the wart has recruited to bring it food.
Plantar warts often make running, jumping, and even walking, uncomfortable. The tenderness can change posture and cause strain elsewhere in the body. A little wart can be a big problem. Sometimes filing with an emery board and/or wearing a doughnut bandage can alleviate the discomfort. The warts are usually most tender when they are growing most rapidly. Often, the pain will disappear within a few days even if nothing is done.

Are warts contagious?

Yes. They are spread when the virus touches a part of the skin where the outer protective layer is broken. Warts can spread by direct contact (from yourself or someone else) and by means of fomites.
Genital warts can spread through the birth experience, through innocent contact, or through sexual contact.

How long does it last?

Warts generally appear 1 to 6 months after the person has become infected. Most warts will eventually go away on their own, expelled by the body’s immune system. About 25 percent are gone within 3 to 6 months and 65 percent disappear within 2 years.

How are warts diagnosed?

Warts are usually diagnosed by careful examination. Sometimes lab confirmation is needed. Genital warts should be evaluated carefully in children in order to be sure there has been no sexual abuse.

How are warts treated?

Warts should be treated if they are spreading, unsightly, or continue to be painful.
Treatments abound, varying from as gentle and simple as taping a patch of banana peel on before bed, to as high-tech and powerful as superpulsed carbon-dioxide-laser vaporization.
The active ingredient in most over-the-counter wart remedies is salicylic acid, a natural substance found in many plants (willow bark) and most fruits. It can be applied either as a liquid or a patch (I prefer the patch). With regular application, many warts will disappear within 12 weeks. These topical treatments often work best if the surface of the wart is disrupted with warm soaks and/or an emery board before application.
Physicians use many options to treat warts (surgery, lasers, chemical cautery, electrodesiccation, lasers, and even chemotherapy), but freezing is the most common. Gentle freezing repeated every week or two — usually at least 4 times — is more effective than a single aggressive attempt to freeze. This approach is less painful and much less likely to scar. Physicians often use different chemical methods on genital warts.
Even though these techniques destroy the bulk of the wart viruses, direct destruction is only a part of the story. This can be seen by how poorly they work in people who have immune deficiencies. In the final analysis, it’s our own immune systems that are activated and engaged to eliminate the warts. Squaric acid applications are aimed specifically at triggering this immune response.
Sometimes oral medicines such as cimetidine are used.
Hypnosis has also been tried as a means of activating the immune system. When studied scientifically, hypnotic suggestion has proven to be as powerful as many conventional medical treatments at getting rid of warts. ‘Charming warts’ is particularly effective with children, and is discussed in leading medical textbooks. I’ve had success with dabbing warts with paint and letting children watch them glow under a black light! For added impact, I’ve sometimes pressed a painted wart onto a piece of filter paper to make a spot, and then burned the paper. I tell the child it will fall off in two weeks – and it does!

Mark Twain’s quaint solution, then, is consistent with the latest medical science:
Why, you take your cat and go and get in the graveyard ‘long about midnight when somebody that was wicked has been buried; and when it’s midnight a devil will come, or maybe two or three, but you can’t see ‘em, you can only hear something like the wind, or maybe hear ‘em talk; and when they’re taking that feller away, you heave your cat after ‘em and say, ‘Devil follow corpse, cat follow devil, warts follow cat, I’m done with ye!’ That’ll fetch ANY wart.

How can warts be prevented?

Avoiding contact with warts is the best way to prevent them – particularly when there is a break in the skin.
Avoiding sucking or chewing on fingertips can prevent some warts on the hands. Wearing something on the feet in locker rooms and at the pool can prevent many plantar warts.

Related A-to-Z Information:

Chickenpox (Varicella), Cold Sores (Herpes simplex), Contact Transmission, Coxsackievirus, Eczema, Fomites, Hand-Foot-Mouth Disease, Hemangioma, Impetigo, Milia, Miliaria, Mongolian Spots, Moles (Nevi), Poison Ivy, Oak, and Sumac, Pustular Melanosis, Ringworm (Tinea corporis), Salmon Patches (Stork bites), Sexual Abuse, Stye, Thumb-sucking

Introduction to vomiting:

It tugs at our hearts to hear our children retch, to watch them vomit, and to feel helpless to make it go away. Vomiting is intense. It grabs our attention, and it’s intended to! Vomiting is a signal that something going on in the body needs to be addressed.

What is vomiting?

Your child’s body has a relatively small number of symptoms with which to respond to an ever-changing, wide variety of invaders and irritants. Sneezing ejects the intruders from the nose, coughing from the lungs and throat, diarrhea from the intestines, and vomiting from the stomach.
Vomiting is a forceful action accomplished by a fierce downward contraction of the diaphragm along with a sudden tightening of the abdominal muscles against a relaxed upper stomach with an open sphincter, propelling the contents up and out.
Vomiting is a complex, coordinated, automatic reflex. An increase in saliva production may occur just before vomiting. Retching signals the beginning of the vomiting event.
Vomiting is orchestrated by the vomiting center of the brain. It responds to signals coming from the gastrointestinal tract (the mouth, stomach, and intestines), the bloodstream (and medicines or infections it contains), from the balancing systems in the ear (think motion sickness), and from the brain itself (including unsettling sights, smells, or even thoughts).
An amazing variety of stimuli can trigger vomiting, from migraines to kidney stones.

Who gets vomiting?

Vomiting is extremely common. Almost all children will vomit several times during their childhood. The most common situation is a child with a viral gastrointestinal infection, such as rotavirus.
Infections elsewhere in the body can also cause vomiting. Other classic situations are kids with pneumonia, ear infections, urinary tract infections, hepatitis, meningitis, or appendicitis.
Children with inborn errors of metabolism, such as PKU or galactosemia, will start vomiting at an early age.
Children with obstructions in the gastrointestinal tract often vomit. An obstruction could occur almost anywhere along the tract, but a common one in babies is pyloric stenosis.
Children with food poisoning, perhaps from E coli, staphylococcus, or Norwalk virus, are another important group who vomit.
Children with brain tumors, hydrocephalus, or other causes of increased pressure in the skull will vomit. Any child with headaches that awaken him from sleep and early morning vomiting should be evaluated.

What are the symptoms of vomiting?

Vomiting itself is the symptom. Children with persistent vomiting need to be evaluated.
Signs that a vomiting child needs to be seen right away include vomiting that lasts longer than 24 hours, changes in level of alertness, signs of dehydration, blood or bile in the vomit, or severe abdominal pain.
“Spitting up,” the gentle sloshing of stomach contents up and out of the mouth, sometimes with a burp, is an entirely different process. Some spitting up is normal for babies, and usually gets gradually better over time. Worsening spit up might be GE reflux disease, and should be discussed with your doctor.

Is vomiting contagious?

Hearing, seeing, or smelling someone else vomit will often stimulate your own vomiting center.
Some of the important causes of vomiting are contagious, but many are not.

How long does vomiting last?

Vomiting with most minor illnesses will end within 24 hours. When children vomit for longer than that it is important for them to be seen, both to assess their hydration and to diagnose the cause of the vomiting.

How is vomiting diagnosed?

The evaluation begins with a history and physical examination. Often no other tests are necessary. The work-up might involve a wide variety of tests, including blood tests, urine tests, or x-rays, depending on what problems are suspected.

How is vomiting treated?

Keeping kids hydrated is one of the initial concerns. Offer steady, small amounts of clear liquids, such as electrolyte solutions. Giving solid foods, or more than a few ounces of liquid at a time, will likely stimulate further vomiting. A child who isn’t able to keep liquid down, or appears to be getting dehydrated, needs to be seen.
The other initial concern with vomiting is to get a general idea of the cause. Most vomiting comes from mild viral illnesses. Nevertheless, if the vomiting might come from a toxic ingestion or Reye syndrome (a liver disease usually arising from children taking aspirin), or some other medical emergency, the child needs to be seen immediately.

How can vomiting be prevented?

A number of medicines are effective at preventing vomiting. Your doctor is unlikely to prescribe these because in most situations the vomiting is an important part of getting well. In some situations, however, preventing the vomiting makes life much better.

Related A-to-Z Information:

Appendicitis, Celiac Disease, Dehydration, Diarrhea, E. Coli, Ear Infection, Encephalitis, Food Poisoning, Galactosemia, Gastroesophageal Reflux, Headache, Hepatitis A, Hepatitis B, Hernia (Inguinal hernia), Hydrocephalus, Intussusception, Meningitis, Motion sickness, Norwalk Virus, Pertussis (Whooping cough), Phenylketonuria (PKU), Pneumonia, Pyelonephritis, Pyloric Stenosis, Reye Syndrome, Rotavirus, Staph (Staphylococcus aureus), Urinary Tract Infection (Cystitis)

Related concepts:

Kidney reflux

Introduction to vesicoureteral reflux:

Antibiotics are overused. In recent years, we have become increasingly cautious about their misuse. When parents hear that long-term, daily antibiotics might be recommended for their children with reflux just to prevent urinary tract infections, they are often concerned. But protecting the kidneys can be an excellent reason to take antibiotics.

What is vesicoureteral reflux?

Urine is normally created by the kidneys, flows down through tubes called ureters, and enters the bladder. The bladder is a holding tank. When the bladder muscle contacts and the sphincter relaxes, urine flows down and out of the body through the urethra.
Why doesn’t the urine flow back into the ureters when the bladder contracts? The ureters enter the thick-walled bladder at an angle. The long path through the muscle acts as a valve. The ureters close as the bladder contracts — an elegant system.
Reflux happens when the muscle-valve doesn’t work. The path of the ureters through the muscle may be too straight or too short, or the muscle in that area may be too thin or too weak. Sometimes the person has an extra ureter with poor valve function. When the bladder contracts, some of the urine is propelled down and out, but some is ejected back up into the ureters.
This puts pressure on the kidneys, and provides an opening for bacteria to travel further up into the body.

Who gets vesicoureteral reflux?

Reflux affects about 1 child in 100. It tends to run in families. Children with reflux are usually born with it. If one child has it, about 1/3 of the siblings will have it. If a woman has reflux, about half of her children will.
Reflux is more common in people with other urinary tract problems and in some other conditions, such as spina bifida.

What are the symptoms of vesicoureteral reflux?

Reflux usually comes to medical attention because someone looked for it after a urinary tract infection.
Apart from infections, the damage done by reflux is often silent and unobserved. Reflux can lead to scarring of the kidneys, high blood pressure, poor growth, and kidney failure.

Is vesicoureteral reflux contagious?

Reflux is not contagious.

How long does vesicoureteral reflux last?

How long it is expected to last depends on the severity of the reflux. Reflux is classified on a scale of Grade I to Grade V. In Grade I reflux, the urine flows up a short way through a normal-appearing, undilated ureter. In Grade II, the urine makes it all the way to the kidney, but the structures still look normal. By Grade V reflux, though, the ureters are dilated like elongated water balloons all the way up the kidney, where the normal structures are compressed and pushed out of place.
Grade I and Grade II reflux will likely go away on their own. Grade III reflux is more likely to resolve the younger the child is when it is diagnosed. Grade IV reflux may also go away, especially if it is only on one side. Grade V reflux rarely disappears without surgery.
If reflux does heal on its own, the average age is 6 or 7.

How is vesicoureteral reflux diagnosed?

Imaging studies are needed to diagnose reflux. These are often wise to obtain in young children who have had urinary tract infections. Most will need a renal ultrasound and some will also need a cystogram called a VCUG (a study where a catheter is put into the bladder, some marker is put into the urine, and pictures are taken when the bladder contracts).
The ultrasound is easy, and shows if there is damage to the kidney. When there is a normal ultrasound, parents often wonder why a VCUG or other cystogram is needed. The ultrasound detects kidney scarring (which the VCUG cannot), but it does not detect most reflux.

How is vesicoureteral reflux treated?

The most significant lasting damage from reflux comes when infections scar the kidneys. The goal of treatment is to prevent infections and prevent scarring.
Sometimes surgery is done to correct the reflux. Sometimes children are treated with long-term antibiotics to prevent infections while waiting for them to outgrow the reflux.

How can vesicoureteral reflux be prevented?

Children are born with reflux. Preventing the complications of reflux involves either long-term antibiotics to prevent urinary tract infections or surgery to correct the reflux.

Related A-to-Z Information:

E. Coli, Enuresis (Bedwetting), Gastroesophageal Reflux, Hernia (Inguinal hernia), Hydrocele, Hypospadius, Meatal Stenosis, Pyelonephritis, Undescended Testicle (Cryptorchidism)

Related concepts:

UTI, Cystitis, Bladder Infection

Introduction to urinary tract infections:

When adults get bladder infections, they typically report burning with urination. Young children, however, may not offer such easy clues.

What is urinary tract infections?

Infections of the urinary tract are common in young children. Bacteria may enter the urinary tract from the opening and travel upward. Less commonly, they may enter the urinary tract through the bloodstream.
If the infection is in the bladder, it is called cystitis. If it is in the kidney, it is called pyelonephritis.
E. coli, a type of stool bacteria, is the most common cause of urinary tract infections. Many other types of bacteria can cause infections. Even viruses, such as adenovirus, can infect the bladder.

Who gets urinary tract infections?

Urinary tract infections are more common in girls, because the short, straight trip up to the bladder is easier for bacteria to traverse. About 1 in 20 girls develop urinary tract infections, most commonly around the age of toilet learning.
The most common age for boys to get urinary tract infections is before the first birthday. Uncircumcised boys get more urinary tract infections than their peers.

What are the symptoms of urinary tract infections?

Bladder infections can cause lower abdominal pain, increased urination, uncomfortable urination, tenderness over the bladder, blood in the urine (hematuria), or a fever. In young children, the only symptoms noticed might be fussiness and perhaps a fever. Perhaps the urine will look or smell different than usual.
A high fever (or a febrile seizure) suggests pyelonephritis.
Sometimes bacteria in the urine are discovered only on a screening urine test. In retrospect, they may have been causing symptoms, such as bedwetting, that weren’t recognized.

Is urinary tract infections contagious?

Urinary tract infections are not usually spread from person to person, but are caused when stool bacteria makes it into the opening where urine emerges.

How long does urinary tract infections last?

Most urinary tract infections clear up quickly – within days – when the appropriate antibiotics are started.

How is urinary tract infections diagnosed?

Urinary tract infections are diagnosed with urine cultures. They may be suggested by the history and physical exam or by a urinalysis test.

How is urinary tract infections treated?

Most urinary tract infections are best treated promptly with antibiotics to prevent possible damage to the kidneys.
The cultured urine will be tested against several antibiotics to see which work best against that specific strain of bacteria. Treatment should not be delayed to wait for this result. It should be started immediately and switched if necessary when the antibiotic sensitivity results are available.

How can urinary tract infections be prevented?

Some urinary tract infections can be prevented by reducing exposure to stool. This means changing diapers promptly, and in older girls, teaching them to wipe from front to back.
Most young children who have had a urinary tract infection should have imaging studies performed to look for urine reflux (urine that flows upward at times toward the kidney) and to look for any abnormality in the urinary tract. The studies could also identify any scarring that may have occurred.
Depending on the results of these studies, specific medicines or surgery may be needed to prevent further urinary tract infections.

Related A-to-Z Information:

Adenovirus, Dehydration, Diaper Rash, Diarrhea, E. Coli, Enuresis (Bedwetting), Febrile seizures, Hematuria,

Hypospadius, Inconspicuous Penis, Labial Adhesions, Pyelonephritis, Sexual Abuse, Spina Bifida, Vesicoureteral Reflux

Related concepts:

Cryptorchidism, Retractile testicle, Acquired undescended testicle

Introduction to undescended testicle:

A boy’s testes normally begin life up in the abdomen, as do ovaries. Before birth, they normally descend through a flexible tube, called the inguinal canal, and end up in the scrotum.

What is undescended testicle?

The testes usually make their journey from within the abdomen down into the scrotum at around 32 to 36 weeks’ gestation. Sometimes, one or both testes do not make this journey by the time a boy is born.
Most of the time, an undescended testicle remains in the inguinal canal, and can be felt under the skin up above the scrotum. Sometimes the testicle remains in the abdomen and sometimes it is absent altogether.
If both “testes” remain in the abdomen, they may actually be ovaries. Sometimes what appears to be a boy is actually a girl with congenital adrenal hyperplasia. There are several other disorders of sex hormone production that result in ambiguous genitalia, and may include undescended or absent testes
Acquired undescended testicle is the name given when testes are found in the scrotum at birth, but as the boy grows, one or both appears to move back upwards. This is usually found in preschool or school-age boys, and is thought to result from the spermatic cord (the cord that the testicles hang from) not growing as rapidly as the rest of the body.
Undescended testicles can lead to future infertility and/or testicular cancer. They are also associated with inguinal hernias in which part of the intestines travel down the still-open inguinal canal. There is some evidence that boys with an undescended testis/testes are at higher lifetime risk of developing male breast cancer.
Retractile testes are those that are in the scrotum some of the time, but then spring up out of the scrotum from time to time. A normal reflex in healthy boys pulls the testes up close to the body when protection or warmth is needed. In some boys, this reflex is particularly strong. Retractile testes are not thought to be at any higher risk for infertility or cancer.

Who gets undescended testicle?

Undescended testicles can occur in any boy, but they are far more common among those who are born early. Sometimes they occur as a complication of hernia repair surgery.
Undescended testicles appear to be getting more common.

What are the symptoms of undescended testicle?

Undescended testicle is suspected when the testis is not easily identified in the scrotum. The testes are easiest to find when the boy is relaxed and warm with the knees flopped apart–as in a warm bath.
Sometimes the scrotum is smaller and less developed on the side of the undescended testicle, with fewer folds and wrinkles.

Is undescended testicle contagious?

No

How long does undescended testicle last?

Most undescended testicles descend on their own in the first three months. Many more will descend during the next three months. Those that are still undescended in six months generally require treatment.
The testicles themselves usually remain normal during the first six months, whatever their location, but after about six months the cells in the testicles gradually begin to change.

How is undescended testicle diagnosed?

The initial diagnosis of undescended testicle is made on physical exam. If the testis is not located, an imaging study, such as an ultrasound, or surgery is needed to locate the testicle.

How is undescended testicle treated?

The usual treatment of undescended testicle is surgery, often performed by a pediatric urologist, to bring the testicle into the scrotum and attach it there. This is usually outpatient surgery, with a very high success rate. It is performed at the earliest appropriate age.
Occasionally hormone treatment is used in an attempt to trigger the testicle’s journey to continue into the scrotum.

How can undescended testicle be prevented?

Prevention is often not possible. Preventing preterm delivery is the best way to prevent undescended testicles. This would include obtaining good prenatal care and avoiding exposures (such as tobacco smoke, infections, or drugs) that might trigger early labor.

Related A-to-Z Information:

Cleft Lip and Palate, Clubfoot, Early Puberty, Hernia (Inguinal hernia), Inconspicuous Penis, Labial Adhesions, Meatal Stenosis, Spina Bifida, Strabismus (Crossed eye, Wandering eye, Wall eye), Torticollis, Umbilical Hernia

Related concepts:

Bellybutton Bulge

Introduction to umbilical hernia:

When parents come to me about an umbilical hernia, their concern is both about the word “hernia” and about the appearance of the soft lump on their baby’s belly. They want the belly button to look “normal”.
Parents almost never ask me about taping a coin to the belly button to “hold it in.” But when I bring up the idea, most parents report that they have heard from someone that the coin worked. Many report that they are coin-taping at home.
Does it work? If not, what does?

What is an umbilical hernia?

The umbilical cord is a strong, flexible pipeline. It carries a mother’s lifeblood to her child, and anything that might harm the child is removed by her mother. This conduit enters the baby between the two rectus abdominus muscles of the abdominal wall. These two muscles (which we later try to keep firm with sit-ups) are connected by a white line of tough fibrous tissue called the linea alba. The umbilical ring is a small hole (about 1/2 inch in diameter) through which the umbilical cord passes into the belly. Usually, after the umbilical cord is cut and the stump begins to wither and fall off, the umbilical ring closes and the linea alba becomes a smooth, unbroken band.
If the umbilical ring is still open, the child has an umbilical hernia. The belly button “pooches” out, and gets bigger if the baby is crying or straining. Sometimes it looks almost like a balloon. When the baby is relaxed, this balloon can be gently pushed back into the belly — only to reemerge a few minutes later.

Who gets an umbilical hernia?

Umbilical hernias are quite common. They are found in about 10 percent of all babies, and as many as 90 percent in some ethnic groups.
They are also much more common in girls and in premature babies.

What are the symptoms of umbilical hernia?

Often, the hernia isn’t noticed when the child is very young, since the hernia may not pop out until the baby begins tightening the abdominal muscles and building up pressure in the belly. When sticking out, the hernia might be as small as a cherry or as large as a lime.
This type of hernia does not cause pain or other symptoms.

Is an umbilical hernia contagious?

No

How long does an umbilical hernia last?

Most umbilical hernias disappear within the first year. Some last until school age or beyond.

How is an umbilical hernia diagnosed?

Umbilical hernias are diagnosed during a physical exam. Further studies are usually not necessary.

How is an umbilical hernia treated?

The word hernia conjures up thoughts of surgery, and appropriately so since many types of hernia are best treated with surgery. Umbilical hernias are an exception to this and are not a cause for alarm.
In the not too distant past, the most popular medical treatment for umbilical hernias was to push in the pouch and tape a coin over the belly button to prevent it from pooching out again. Most of the time this worked and the umbilical hernia disappeared by the time the baby was a year old. Umbilical bands or straps were a variation on this theme.
We now know that not using a coin, band, or strap works just as well — and avoids skin irritation. Over 85 percent of umbilical hernias will disappear by age one even if you do nothing at all.
Predictably, the smaller the hernia (not the smaller the balloon, but the smaller the opening in the belly wall) the more likely the hernia is to close by itself. Still, even large hernias (6 cm opening) have been known to close spontaneously by kindergarten. Those that first appear after 6 months of age are less likely to correct themselves.
There are a wide variety of opinions about when, if ever, surgery is useful. I would consider surgery if the ring is still bigger than 2 cm across at one year, if the defect grows after one year, or if it is still present at kindergarten (when further spontaneous closure becomes very unlikely). There is certainly no rush.
The surgery itself is simple and safe. The incision is tiny, and a couple of stitches usually suffice to close the remaining hole in the linea alba. Voila! An innie!
There is one caveat to this! Children with umbilical hernias are at a slight risk of having some abdominal contents get stuck inside the herniated sac, called an incarcerated Umbilical Hernia. This is a medical emergency, since the abdominal contents, potentially including the intestines, must be released from inside the hernia before they lose their blood supply. Generally the symptoms include a hard, firm hernia that may be painful or have a color-change.

How can umbilical hernia be prevented?

No preventive measures are known, except good prenatal care to reduce the risk of pre-term delivery.

Related A-to-Z Information:

Anorectal Malformations (Imperforate anus), Colic, Gastroesophageal Reflux, Hernia (Inguinal hernia), Hydrocele, Hypospadius, Inconspicuous Penis, Labial Adhesions, Meatal Stenosis, Nearsightedness, Pseudostrabismus, Undescended Testicle (Cryptorchidism)