Children and teens with CFS have many of the same issues as other children with chronic illnesses, confounded by the fact that they have an illness which is poorly understood, often misunderstood, and too often misdiagnosed. And what do we tend to do when we don’t understand an illness? We tend to deny it, ignore it, and accuse the sufferer of malingering. My son Brian once said that “I wish I had an illness like cancer or diabetes instead that people could easily understand and that I wouldn’t have to constantly explain”.

We also have to remember that kids have a full-time job: school. This is not just where they are working on their education, but where most of their opportunities for social interaction and even extra-curricular activities occur. School-age kids need to socialize; school is usually the foundation for those social interactions. Children and teens with CFS can easily become isolated, especially if they have prolonged periods of school absence and if their friendships are based around group activities such as sports. It was important to us to let all of Brian’s friends (and their parents) know that Brian’s illness was not contagious, that he welcomed visitors, and we had an open-door policy for parents who needed a place for their kids to come hang out. To facilitate this, I made sure to serve the best snacks in town (even when Brian had no appetite).

While students with CFS may qualify for special services under the Individuals with Disabilities Education Act (IDEA) and/or Section 504 of the Rehabilitation Act, it is often difficult to obtain these services, especially if the exacerbations of the illness are inconsistent. In most cases, parents must go through the process of obtaining an Individual Educational Plan (IEP) for affected children and the school must provide reasonable accommodations including home tutoring if necessary. This process takes time and persistence. And even once a plan is in place, it may be difficult to schedule home tutoring for a child with unpredictable sleep needs and energy cycles as well as numerous doctors’ and physical therapy appointments.

The issues of how difficult this process is for the parents goes way beyond the scope of space I have for this entry! Suffice it to say that caring for a child with a chronic illness affects the entire family: emotionally, financially, and in every other possible way. If both parents are employed outside the home, flexible child-care arrangements must be made, in addition to home-schooling arrangements. This, alone, can be a tremendous hurdle.

Long before we completed the IEP process, we did a few things that were very helpful for my son throughout the course of his illness. First, when he couldn’t even read, we instituted what I called “The Tivo Curriculum”. While parenting groups and even the American Academy of Pediatrics have strongly criticized the fact that most children watch too much television, we embraced it as an extremely valuable educational tool. Using Tivo, I could enter keywords related to Brian’s academic subjects (e.g. “Ancient Greece” or “evolution”) and get lists of appropriate television programs on those topics. We also tivo’ed general education science shows such as “Myth Busters” and “Beyond Tomorrow”. Using the theory that “laughter is the best medicine”, we used the tivo curriculum to combat Brian’s eventual depression as well, taping all sorts of comedy shows (e.g. “Whose Line is It Anyway?”), funny movies, and stand-up comedians.

While we had professional home tutoring when needed, we relied most heavily on a high school student tutor. Having an older boy come to the house to work with him was easier than a “real” teacher and gave Brian some sense of social interaction as well. This was also much more cost effective (and he was a brilliant student)!

In addition to keeping as up-to-date as possible with homework and other assignments, we asked all of Brian’s teachers to send home any videos that they thought would be helpful in supplementing their curricula. Obviously, this was much more helpful in some subjects than others, but we did discover a video teaching series from The Teaching Company (www.teach12.com) which even helped with algebra and physics. We found that the best way to homeschool algebra (which I have long forgotten!) was to enroll Brian in an online distance learning course run by the Johns Hopkins Center for Talented Youth (http://cty.jhu.edu/cde/index.html); it was fortunate that Brian had already qualified for this program prior to his illness.

These were some of the strategies that worked for us. Managing Brian’s illness—and teaching Brian to adjust to a new “normal” in his life—continues to be an ongoing learning experience for our entire family. We had many advisers along the way, but no specific written plan or instructions. I hope that my writing this will help other families as they struggle to help their children and teens manage CFS or other chronic illnesses. . .and I’m always open to hearing other success strategies!

For more information about CFS, go to www.cfids.org or www.njcfsa.org.

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

Dr. Greene’s Answer:

The West Nile virus (WNV) can be scary, but even in places where it has been appearing for a few years, the number of people who get it is very, very tiny.

Thankfully, the majority of cases of West Nile VirusWNV are asymptomatic, meaning the patient doesn’t even feel sick. About 20% of infected people develop a febrile illness called West Nile Fever. Less than 1% ever develop the most frightening form of WNV, West Nile Neuroinvasive disease.

The symptoms of West Nile Fever are often like the flu: fever, headache, muscle pain, weakness, abdominal symptoms, and sometimes a rash.

The symptoms of West Nile Neuroinvasive disease are like meningitis or encephalitis: bad headache, light sensitivity, stiff neck, and fever. There may be abnormal movements, muscle weakness, and paralysis.

As of yet, there is not a specific treatment, just support until people get over it. Of the 19 people in the United States who got the West Nile virus in the year 2000, the average hospital stay was 7 days. Five were sick enough to be in an ICU and two were sick enough to be on a ventilator. Two died. But this is out of many millions of people in the area, and one-third of those who got sick were older than age 75. The two who died were both over age 80.

The average age of people in the New York “epidemic” was 63. Kids can get it, but it’s much less common. West Nile is rough on birds, though. Avoiding mosquitoes and birds is the best way to prevent it.

Dr. Greene’s Answer:

GERD stands for Gastroesophageal Reflux Disease. Normally, when we eat, food passes from our mouths to our stomachs through a tube called the esophagus. When food or acid in the stomach travels back up the esophagus, the process is called gastroesphageal reflux.

Many people have some degree of reflux. You may have experienced the feeling of heartburn after a large meal. When reflux occurs on occasion, it typically does not cause any problems. However, when it occurs frequently, it can cause damage and inflammation to the esophagus. Gastroesphageal reflux disease describes reflux that is abnormally frequent or damaging.

All newborns have a small amount of reflux. Spit up, is by definition, a reflux event. However, if the spit up is frequent or causes pain, poor feeding, poor growth, breathing problems, or damage to the esophagus, treatment is usually prescribed.

For babies with a mild degree of reflux, pediatricians may recommend nonmedical treatments such as thickened feeds or sitting the baby up at a 45-degree angle during and after feeds. Giving smaller, more frequent feedings makes good sense and is reported by many doctors and parents to have made a difference. An AR formula is an easy thing to try. Enfamil AR adds some rice without changing the number of calories kids get. It goes down thin then thickens in the stomach. Carnation Good Start, with its partially hydrolyzed proteins, has been able to show that the formula goes through the stomach quicker, but studies proving its effects n reflux are lacking.

Many children outgrow mild GERD as their stomach muscles mature. In more severe cases, babies often need medications to help control symptoms. Very rarely, surgery may be needed.

Pyloric stenosis, is far less common than GERD. It occurs when, the valve at the bottom of the stomach grows so tight, that liquid in the stomach comes shooting back up. The classic thing with pyloric stenosis is projectile vomiting, where the vomit shoots out forcefully away from the body. However, not all kids with pyloric stenosis have this (or vice versa). But the one thing most of these kids have in common is that the vomiting is progressive. It occurs more and more often over time, usually immediately after a feeding, but not necessarily after all feedings. It usually starts after 3 weeks of age, but can begin anywhere up to 5 months. It is most common in firstborns, especially firstborn boys. While nonmedical treatments have been explored in other countries, in the United States, the primary mode of treatment is surgery. When done by an experienced pediatric surgeon, the surgery is rather simple and the recovery time can be quick. Many babies are eating and feeling well enough to go home within 24 to 48 hours after surgery.

Introduction to pneumonia:

The word “pneumonia” sounds alarm bells in many parents. It is understandably disturbing because some pneumonias are quite serious, particularly in those whose immune systems are vulnerable (newborns, the elderly, and people with HIV). The good news is that the great majority of pneumonias in children and adolescents are mild or easily treatable at home.

What is pneumonia?

Bronchiolitis, bronchitis, and pneumonia are all words that denote the location in the body of a problem. Bronchiolitis refers to inflammation in the bronchioles, the smaller airways that branch off from the main bronchi or breathing tubes. Bronchitis is inflammation in these larger, main breathing tubes. Pneumonia refers to inflammation of the lungs themselves.
A variety of viruses, bacteria, and other organisms can cause pneumonia. Not all pneumonias, however, are infections. GE reflux, foreign bodies, smoke inhalation, or harsh fumes can all cause pneumonias as well.

Who gets pneumonia?

Children who are exposed to inhaled irritants, such as tobacco smoke or toxic fumes, are at a higher risk of developing pneumonia.
Most kids who get pneumonia have a cold or other viral upper respiratory infection first. For this reason, most pneumonia occurs during cold and flu season. The respiratory viruses interfere with the lungs’ normal defense mechanisms. The same viruses (adenovirus, RSV, influenza, parainfluenza [croup]) can spread into the chest. Alternatively, pneumonia-causing bacteria can invade the lungs (pneumococcus, streptococcus, staphylococcus, Haemophilus influenzae).
Other childhood viral infections such as chickenpox, measles, rubella, herpes, and mono can cause pneumonia directly.
Viral pneumonias are fairly common. They peak during the toddler years, and become a bit less common each year.
Bacterial pneumonias are less common. Most occur in children with cystic fibrosis or an underlying immune problem.
All children who get two or more pneumonias within one year should have their immune system and lung anatomy evaluated by their doctor, to ensure they have no underlying illness putting them at greater risk for pneumonias.

What are the symptoms of pneumonia?

Viral pneumonias usually begin with several days of cold symptoms, especially a runny nose and a cough. The cough deepens, the breathing speeds up, and the child acts sicker. There may be signs of respiratory distress, including flaring of the nostrils or retractions (pulling in on the muscles between the ribs) with breathing. There is often wheezing and a fever.
Bacterial pneumonias often start suddenly with shaking chills, a high fever, a cough, and signs of respiratory distress. Sometimes they begin more gradually or mildly.

Is pneumonia contagious?

Most pneumonias are contagious.

How long does pneumonia last?

The length of the pneumonia depends on the specific organism causing it. Some pneumonias last as little as several days, although two to three weeks is more common. The cough can last even longer.

How is pneumonia diagnosed?

The diagnosis is usually based on history, physical examination, and chest x-ray. If a bacterial pneumonia is suspected, appropriate cultures of the sputum and blood are also important.

How is pneumonia treated?

Children with bacterial pneumonias need a full course of the appropriate antibiotics. Most children with viral pneumonias do not need antibiotics or specific anti-viral medicines.
All those with breathing difficulties should have the level of oxygen in their blood measured and should receive breathing support, which might include oxygen or nebulized bronchodilator medications (such as albuterol).
Generally, cough suppressants are not wise during pneumonia. The body needs the cough to protect the lungs. We all know how difficult it is to have a child blow his nose to clear mucus from his body. A child’s cough is a powerful tool for moving mucus and clearing an infection from the lungs.

How can pneumonia be prevented?

Breastfeeding and avoiding exposure to unhealthy smokes and fumes help prevent pneumonias.
Vaccines are available against some common pneumonias, including pneumococcal, Haemophilus influenza (HIB), measles, and the flu.
Beyond this, the same measures proven to help prevent colds and other upper respiratory infections can also prevent many pneumonias.

Related A-to-Z Information:

Adenovirus, Airborne Transmission, Allergies (Allergic Rhinitis), Anthrax, Asthma, Chickenpox (Varicella), Common Cold, Contact Transmission, Cough, Croup, Cystic Fibrosis, Droplet Transmission, Febrile seizures, Gastroesophageal Reflux, Haemophilus Influenzae (H flu, Hib), Human Herpesvirus, Measles, Meconium Aspiration, Mononucleosis (Mono), Respiratory Distress, RSV (Respiratory syncytial virus), Rubella (German measles), Sinusitis, Staph (Staphylococcus aureus), Streptococcus (Strep), Tuberculosis, Wheezing

Introduction to diarrhea:

Normal baby stool can look a lot like an adult’s diarrhea stool. Healthy baby poop is often soft and runny, and (especially in the first month) quite frequent. One 2-week-old with 10 runny stools a day may be perfectly healthy, while another 4-month-old with 3 stools a day, all firmer than the other baby’s, may have diarrhea. So how can a parent tell?

What is diarrhea?

When children lose more fluid and electrolytes in the stool than is healthy, they have diarrhea. Diarrhea can be caused by a change in diet (including a change in mother’s diet if the baby is breastfed), by infection, by antibiotic use, or by a number of rare diseases. Each year there are about one billion cases of diarrhea in children worldwide. In most cases (more than 990 million of them), the diarrhea will resolve by itself within a week or so. Still, more than 3 million young children die each year from diarrhea (about 400-500 in the United States).

Who gets diarrhea?

Most children will have diarrhea several times throughout childhood. Most children with diarrhea have a viral infection in the gastrointestinal tract. Rotavirus, adenovirus, and the Norwalk virus are common causes. Bacteria, such as campylobacter or salmonella, and parasites, such as Giardia, can also cause diarrhea.
Diarrhea hits hardest in children 3 to 24 months old, although it can happen at any age.
Viral diarrhea is most common between November and May in the temperate climates of the Northern hemisphere.

What are the symptoms of diarrhea?

Look for a sudden increase in the frequency of the stools. Each child has her own stool frequency pattern that changes slowly over time. If it changes noticeably within only a few days, she may have diarrhea.
Any baby who has more than one stool per feeding should also be suspected of having diarrhea, even if this isn’t a sudden change.
Also, look for a sudden increase in the water content of the stool. Other signs of illness in your baby, such as poor feeding, a newly congested nose, or a new fever, make the diagnosis of diarrhea more likely.

Is diarrhea contagious?

Most infections that cause diarrhea are quite contagious, spread by the fecal-oral route and by fomites.

How long does diarrhea last?

The duration of diarrhea will depend on the underlying cause. Diarrhea caused by antibiotic use may last as long as the child is taking the antibiotics.
An average diarrhea virus lasts for 5 to 7 days.

How is diarrhea diagnosed?

Diarrhea is diagnosed by history, physical exam, and by examining the stool. If there is blood or pus in the diarrhea, or if the diarrhea is not improving as expected, stool studies may be performed to determine the specific cause. These might include stool cultures, viral studies, and tests for parasites.

How is diarrhea treated?

The central concern with diarrhea is the possibility of dehydration from loss of body fluids. Treatment is aimed at preventing dehydration, the real culprit. Most children with diarrhea can be treated safely at home.
If your baby is breastfed, don’t stop. Breastfeeding helps prevent diarrhea (making diarrhea only half as likely) and it also speeds recovery. If your baby still seems thirsty after or between nursing sessions, you can supplement with an oral rehydration solution such as Pedialyte.
If your baby is formula-fed, you might want to switch to a soy-based formula while the diarrhea lasts. A soy formula containing fiber (Isomil DF) can be even more effective at slowing down the stool. Do not dilute the formula. As with breastfed babies, supplementation with an oral rehydration solution can help replenish the fluids and electrolytes that have been lost in the diarrhea stools.
If your baby is already big enough to be taking solid foods, carrots, rice cereal, bananas, potatoes, and applesauce can help slow down the stools. Avoid fruit juices, peas, pears, peaches, plums, prunes, and apricots until the stools are back to normal, which should be within a week or so.
Yogurt and other sources of beneficial bacteria can help to actively treat diarrhea from any cause.
If the diarrhea lasts longer than a week, or is accompanied by more than 72 hours of fever, get in touch with your pediatrician. Contact your pediatrician right away, however, if your baby won’t drink or appears to be getting dehydrated (dry mouth, crying without tears, sunken soft spot, lethargic, or going 8 hours without producing urine) or if your baby is under two months old and has diarrhea with a fever. Vomiting for 24 hours, 8 stools in 8 hours, or the presence of blood, mucus, or pus in the stool should also prompt a call to your pediatrician.

How can diarrhea be prevented?

Most diarrheas are infections spread primarily via the fecal-oral route. Invisible organisms from the stool hide on hands, toys, and surfaces. From there, they make it into someone’s mouth.
Children whose stool overflows diapers or toilets should be kept out of day cares and schools. General fecal-oral and fomite precautions also decrease the spread of diarrhea germs. Every child eventually gets some, but cleaning and hand washing can delay infections and make them milder and briefer.
Eating active culture yogurt or other sources of beneficial bacteria can also minimize diarrhea, especially diarrhea caused by antibiotics or infections.

Related A-to-Z Information:

Adenovirus, Campylobacter, Celiac Disease, Clostridium Perfringens, Dehydration, E. Coli, Fecal-Oral Transmission, Fomites, Food Allergies, Food Poisoning, Gastroenteritis, Giardia Lamblia, Norwalk Virus, Rotavirus, Salmonella, Staph (Staphylococcus aureus), Vomiting

Related concepts:

Developmental dysplasia of the hip, DDH

Introduction to congenital hip dislocation:

Waddling, limping, toe-walking, and unequal leg lengths in a toddler or older child may be the sign of a hip problem that went undiagnosed in infancy.
One goal of the frequent well-baby exams during the first year is to be sure that the hips are developing properly.

What is congenital hip dislocation?

The hip is a ball and socket joint that normally allows for a wide range of motion, while holding the leg securely in the joint.
In some children, the joint is too lax, leading to instability of the hips. Although this is commonly called congenital hip dislocation, the hips are rarely dislocated at birth. The hips haven’t developed completely, but the dislocation happens later on. The condition is more accurately called “dislocatable hips” or “developmental dislocation of the hips” (DDH).

Who gets congenital hip dislocation?

Anyone can be born with DDH, but it tends to run in families. It is especially common in firstborn children. Hip instability is far more common in girls than in boys. It is also more common among those who are born in the breech position.
Hip dislocation is often associated with congenital torticollis. If a baby has torticollis or turned-in feet, careful attention should be paid to the hips.

What are the symptoms of congenital hip dislocation?

In babies, parents may notice an unequal number of thigh skin folds, uneven knee position, or legs that appear to be different lengths.
Often, however, the instability is only noticed when a doctor feels “clunks” when maneuvering the hips in a particular way during well-baby exams.
Hip “clicks” may be concerning to parents, but these usually do not represent a problem by themselves. Nevertheless, if there is any concern about the stability of the hips, it would be wise to have a physician examine your child.

Is congenital hip dislocation contagious?

No.

How long does congenital hip dislocation last?

Unless the problem is corrected before the baby begins to bear weight, long-term hip damage can occur.

How is congenital hip dislocation diagnosed?

The diagnosis is suspected on physical exam and confirmed with imaging studies.

How is congenital hip dislocation treated?

Treatment depends on the developmental status of the hips. Treatment often involves holding the hips in the correct position so that they can continue their development. This might be accomplished with harnesses, splints, or other devices. Sometimes surgery is needed to correct the problem. In most cases, earlier identification of the problem allows for more conservative treatment options.

How can congenital hip dislocation be prevented?

Often hip instability cannot be prevented. Avoiding excess exposure to estrogens or medicines that relax the hips and avoiding breech delivery may prevent some cases.

Related A-to-Z Information:

Anorectal Malformations (Imperforate anus), Arthritis (Juvenile rheumatoid arthritis, JRA), Cerebral Palsy, Cleft Lip and Palate, Clubfoot, Constipation, Elbow Subluxation, Fractures, Hernia (Inguinal hernia), Hydrocele, Hydrocephalus, Inconspicuous Penis, Muscular Dystrophy, Scoliosis, Spina Bifida, Sprains, Tibial Torsion (Turned-in feet), Torticollis

Introduction to bronchiolitis:

Worried parents stand over the crib, listening to their baby cough and struggle to breathe. He may have bronchiolitis. Most parents have heard of pneumonia or bronchitis, but what does bronchiolitis mean?

What is bronchiolitis?

Bronchitis is inflammation of the large airways in the chest and pneumonia is inflammation of the lung tissue. Bronchiolitis is inflammation of the smaller airways connecting the two.
Bronchiolitis is usually a viral infection. RSV is responsible for the illness in many children. Adenovirus, parainfluenza (croup), and other viruses can also cause bronchiolitis.
In adults and older children, RSV usually appears as a bad cold. However, in babies and toddlers whose bronchioles are smaller and easier to plug, these viruses often cause bronchiolitis when inhaled.

Who gets bronchiolitis?

Bronchiolitis is primarily a disease of young children before their second birthdays. The most common age for bronchiolitis is about 6 months.
Winter and early spring are bronchiolitis season. Children in day care are usually much more likely to get bronchiolitis. Kids who are exposed to cigarette smoke are at even higher risk. Babies who attend day care are less likely to get bronchiolitis than those who stay home with a parent who smokes.
Boys are more often affected, as are formula-fed infants. Those at high risk for asthma also appear to be prone to bronchiolitis.
Most kids who get bronchiolitis have been exposed to an adult or another child with a cold in the previous week.

What are the symptoms of bronchiolitis?

Bronchiolitis usually begins with cold symptoms such as a runny nose, sneezing, and perhaps a mild cough. The appetite is often decreased. The child may have a fever or might be a bit cooler than normal.
After a day or two, breathing becomes faster and the cough becomes more severe. It may be a deep or wheezy cough. The child may develop wheezing and respiratory distress.
Breathing difficulties can make it hard for babies to feed.

Is bronchiolitis contagious?

Bronchiolitis is very contagious. It spreads most commonly by contact transmission, droplet transmission, and fomites.

How long does bronchiolitis last?

Mild bronchiolitis may last only for a day or so. Often the disease lasts 5 to 12 days. The first 3 days are the most critical.

How is bronchiolitis diagnosed?

Diagnosis is often based on the history and physical exam. A chest x-ray can give additional information, as can a pulse oximeter to measure oxygen levels. A nasal swab for RSV and other viruses might be done to identify the specific cause of bronchiolitis.

How is bronchiolitis treated?

There are no specific medicines for treating bronchiolitis at home. It is important to give plenty of fluids to prevent dehydration. Also, a humidifier or saline nose drops might be recommended to thin the mucus.
Some children need supplemental oxygen or even mechanical help to breathe.  A powerful aerosol treatment specifically against RSV is sometimes used for hospitalized children.
Steroids and antibiotics are not usually helpful. It is unclear whether inhaled medications such as albuterol are helpful.

How can bronchiolitis be prevented?

If possible, protect your baby from exposure to sick individuals during the peak bronchiolitis season. In addition, good hand washing, particularly just before anyone handles susceptible infants, can decrease spread. Don’t forget to use a tissue when you cough or sneeze.
Two products are now available to prevent RSV infection in children at high risk for serious disease. RSV-IGIV (RespiGam) and palivizumab (Synagis) have been approved for high-risk children (such as premature babies and infants with severe heart or lung diseases).

Related A-to-Z Information:

Adenovirus, Asthma,Common Cold, Contact Transmission, Cough, Croup, Cystic Fibrosis, Dehydration, Droplet Transmission, Fomites, Pneumonia, Respiratory Distress, RSV (Respiratory syncytial virus, Sudden Infant Death Syndrome (SIDS), Wheezing

Related concepts:
Fever Blisters, Herpes Labialis, Secondary Herpes

Introduction to cold sores:

Kids often feel the tingling before you can see the sore. If your child has a cold sore, he is likely to have them again and again before he grows up. You will want to learn what to expect and what to do.
A cold sore does not mean that your child has recently been exposed to herpes. People don’t get cold sores with the first herpes infection.

What is cold sores?

Cold sores or fever blisters are caused when a prior herpes infection flares up again. They are usually caused by herpes simplex type 1 (HSV-1).

Who gets cold sores?

Cold sores can affect anyone who has had a prior herpes infection (up to a third of children have by the time they grow up). They are most likely to occur during times of change or stress, including sunburns, fatigue, illnesses, allergies, fevers, temperature changes, or along with the menstrual cycle.

What are the symptoms of cold sores?

Children usually have one or several blisters on or around the mouth – most often at the border of the lip and the skin of the face. They occasionally occur elsewhere (such as the palate).
The blisters or ulcers are often accompanied or preceded by tingling or itching.

Is cold sores contagious?

Cold sores are quite contagious, either by direct contact or by contact with mouth secretions.

How long does cold sores last?

Once infected, people have the herpes virus for life. Individual cold sores tend to last for about 3 to 7 days. They are most contagious during the first three or four days.

How is cold sores diagnosed?

Cold sores are often diagnosed based on the symptoms and physical exam. The diagnosis can be confirmed with a variety of viral tests.

How is cold sores treated?

Prescription antiviral medications are available, but the benefit they confer may not outweigh the costs for many kids. If used, they are best started at the very beginning of a cold sore — within the first 24 hours. If cold sores are frequent and problematic, you might want to have the medicine on hand.
Sleep and lots of non-acidic liquids to drink can help. Options for pain relief include acetaminophen, ibuprofen, or a variety of ointments or mouth rinses your pediatrician can recommend.
Do not use steroid creams or gels on a suspected herpes infection – this could make the infection worse.

How can cold sores be prevented?

Avoiding close contact with people shedding the virus is the best way to avoid primary herpes (see article on herpes simplex). Teach your child not to share drinks or utensils, and not to exchange kisses with someone with mouth sores.
Once infected, cold sores are best reduced by maintaining good sleep, good nutrition, and good health in general. Sometimes cold sores are unavoidable.

Related A-to-Z Information:

Allergies (Allergic Rhinitis), Baby Acne, Body-Fluid Transmission, Chickenpox (Varicella), CMV (Cytomegalovirus), Conjunctivitis (Pink eye), Contact Transmission, Coxsackievirus, Diaper Rash, Eczema, Encephalitis, Erythema Toxicum (Baby rash), Hand-Foot-Mouth Disease, Herpangina, Human Herpesvirus, Impetigo, Milia, Miliaria, Sexual Abuse, Sunburn, Warts

Related concepts:

Talipes equinovarus

Introduction to clubfoot:

What do Olympic gold medalist figure skater Kristi Yamaguchi, Super Bowl Champion All-Pro quarterback Troy Aikman, actor-writer-musician-composer Dudley Moore, Hall of Fame sports announcer Pat Sumerall, romantic poet Lord Byron, comedian-actor-writer-director Damon Wayans, British King Richard III, Heisman trophy winner Charles Woodson, and Olympic gold medalist pioneering women’s soccer star Mia Hamm all have in common?
You’ve already guessed. They were all born with clubfeet!

What is clubfoot?

Clubfoot is a deformity of the foot and lower calf. The bones, joints, muscles, and blood vessels of the limb are abnormal.

Who gets clubfoot?

Anyone can be born with clubfoot. It can run in families and is slightly more common in boys. Most children born with clubfoot have no other congenital problems, but sometimes clubfoot occurs in association with other abnormalities or syndromes.

What are the symptoms of clubfoot?

Although the name “clubfoot” sounds like a brutish Dickensian deformity, the actual appearance is that of a normal foot turned down and inwards. Without treatment, the child would walk on the outer edge of the foot. It is stiff and cannot be brought into normal position.

Is clubfoot contagious?

No

How long does clubfoot last?

Clubfoot does not improve with time. It lasts until treated.

How is clubfoot diagnosed?

The diagnosis is made by physical examination. X-rays are used to further evaluate clubfoot.

How is clubfoot treated?

Clubfoot is treated by an orthopedic surgeon. Taping, splints, and casts are often used. The foot is gently stretched closer to the correct position and then placed in a cast to hold it there. This procedure is repeated multiple times to bring the foot into the best position possible.
Surgical correction may be needed.
Treatment may take months or years.

How can clubfoot be prevented?

Prevention of clubfoot is usually not possible.

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Anorectal Malformations (Imperforate anus), Arthritis (Juvenile rheumatoid arthritis, JRA) , Cerebral Palsy, Cleft Lip and Palate, Congenital Hip Dislocation, Constipation, Early Puberty, Enuresis (Bed-wetting), Hernia (Inguinal hernia), Hydrocele, Hydrocephalus, Inconspicuous Penis, Meningitis, Muscular Dystrophy, Polio, Spina Bifida, Tibial Torsion (Turned-in feet), Torticollis, Undescended Testicle (Cryptorchidism)