Together, three types of bacteria account for over 90 percent of bacterial meningitis: H. influenza type b, meningococcus, and pneumococcus.
These bacteria are transmitted by person-to-person contact through respiratory secretions. Many people carry these bacteria with no serious consequence. (Pneumococcus, for instance, is the most common cause of ear infections.) A few people get very sick. Pneumococcus causes meningitis in about 3 per 100,000 people. (Textbook of Pediatric Infectious Disease, Saunders 1998)
Sudden onset meningitis features shock, internal bleeding, purple spots, and reduced consciousness at the very outset, with a rapidly progressive course often resulting in death within 24 hours.
More commonly, meningitis begins with several days of upper respiratory symptoms or gastrointestinal symptoms. Most children have high fevers, severe headaches, and poor feeding. They may also have muscle aches, nasal congestion, vomiting, neck stiffness, and seizures.
Children with meningitis become increasingly irritable and/or lethargic. The presence of petechiae (purple spots that indicate internal bleeding) is a sign that the infection may be raging out of control.
Pneumococcal meningitis is a devastating disease. Of all causes of meningitis, it is the most likely to have a negative outcome (Pediatric Infectious Disease Journal, May 1993). The overuse of antibiotics is resulting in increasingly resistant strains of pneumococcus every month.
In 1991, a vaccine against the H. influenzae Type b (HIB) bacteria was incorporated into the routine immunization schedule beginning at 2 months of age. The amount of meningitis plummeted. Arkansas Children's Hospital had about 27 cases of HIB meningitis per year in the 1980's before the vaccine was used. By 1993, the number had dropped to only 1.7 per year (Southern Medical Journal, Jan 1994). During the same period the number of cases dropped by 95 percent in the United States as a whole (Textbook of Pediatric Infectious Diseases, Saunders 1998).
The new pneumococcal vaccine for infants is now FDA approved and recommended by the American Academy of Pediatrics for all children less than 2 years of age. Vaccination of children between 2 and 5 years of age may also be considered on an individual basis. In large clinical studies, the vaccine has been shown to decrease the risk of invasive pneumococcal infection (i.e. meningitis and blood infections) by more than 93%. It has also been shown to decrease the risk of pneumonia and otitis media (ear infections). More information about the vaccine can be found at www.cdc.gov/.
I think my 3-year-old son has a mild case of convergent strabismus. How can this be treated?
Strabismus is quite common in children, affecting about 1 in 25 kids. Convergent strabismus or esotropia is a condition where the eyes turn slightly in. Often convergent strabismus is caused by farsightedness. When it is, glasses to correct the farsightedness are usually the best treatment for the short run. These kids usually love their glasses, both because they can see better, but even more because eye muscles can relax. They will usually not need the glasses once they have outgrown their farsightedness.
If farsightedness is not the cause, then patching is usually the best treatment. If patching is not successful, then surgery on the eye muscles is sometimes done.
Amblyopia, or lazy eye, is often the result of strabismus--one eye stops seeing as well as the other. For amblyopia, eye drops can take the place of patching. There was a great study published in March 2002, where half the kids wore patches for six hours a day for six months and half had one eye drop per day. The two groups improved about the same.
There is another situation called pseudostrabismus where it looks like the eyes turn in but they are really straight. It's just that the bridge of the nose is wide and this situation gets better on its own as kids grow into their faces. When there is a question, kids should get tested by a pediatric ophthalmologist. If there is real strabismus, even if mild, the results are much better if treated early.
When a toddler or preschooler is still using a bottle to go to sleep, this choice has become a deeply ingrained habit. Weaning her from the bottle will require either finding an effective substitute, or using tremendous force to break the patterns. Click here for Dr. Greene’s tips for weaning a child from a bedtime bottle.
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