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1,"2018-04-19 02:59:41","Abdominal Pain in Children","Abdominal Pain in Children Page Content Article BodyConstipation often is blamed for abdominal pain, and while it’s rarely a problem in younger infants, it’s a common cause of pain in older children, especially in the lower part of the abdomen. When a child’s diet lacks plenty of fluids, fresh fruits and vegetables, and fiber rich in whole grains, bowel problems are more likely to occur. For more information, talk to your pediatrician. Urinary tract infections (UTI) are much more common in one- to five-year-old girls than in younger children. UTIs produce discomfort in the abdomen and the bladder area, as well as some pain and burning when urinating. These children also may urinate more frequently and possibly wet the bed. However, the infection usually does not produce a fever. If your child complains of these symptoms, take her to the pediatrician, who will examine her and check her urine. If an infection is present, an antibiotic will be prescribed, which will eliminate both the infection and the abdominal pain. Strep throat is a throat infection caused by bacteria called streptococci. It occurs frequently in children over three years of age. The symptoms and signs include a sore throat, fever, and abdominal pain. There may be some vomiting and headache as well. Your pediatrician will want to examine your child and swab her throat to check for strep bacteria. If the results are positive for strep, your child will need to be treated with an antibiotic. Appendicitis is very rare in children under age three and uncommon under the age of five. When it does occur, the first sign is often a complaint of constant stomachache in the center of the abdomen, and later the pain moves down and over to the right side. Lead poisoning most often occurs in toddlers living in an older house where lead-based paint has been used. Children in this age group may eat small chips of paint off the walls and woodwork. The lead is then stored in their bodies and can create many serious health problems. Parents also should be aware of toys or other products with unacceptable lead content. Symptoms of lead poisoning include not only abdominal pain, but also constipation, irritability (the child is fussy, crying, difficult to satisfy), lethargy (she is sleepy, doesn’t want to play, has a poor appetite), and convulsions. If your child is exposed to lead paint, has eaten paint chips or been exposed to toys with cracking, peeling, or chipping paint and has any of the above symptoms, call your pediatrician. She can order a blood test for lead and advise you as to what else needs to be done. Milk allergy is a reaction to the protein in milk, and can produce cramping abdominal pain, often accompanied by vomiting, diarrhea, and skin rash. Emotional upset in school-age children sometimes causes recurrent abdominal pain that has no other obvious cause. Although this pain rarely occurs before age five, it can happen to a younger child who is under unusual stress. The first clue is pain that tends to come and go over a period of more than a week, often associated with activity that is stressful or unpleasant. In addition, there are no other associated findings or complaints (fever, vomiting, diarrhea, coughing, lethargy or weakness, urinary tract symptoms, sore throat, or flulike symptoms). There also may be a family history of this type of illness. Finally, your child probably will act either quieter or noisier than usual and have trouble expressing her thoughts or feelings. If this type of behavior occurs with your child, find out if there’s something troubling her at home or school or with siblings, relatives, or friends. Has she recently lost a close friend or a pet? Has there been a death of a family member, or the divorce or separation of her parents? Your pediatrician can suggest ways to help your child talk about her troubles. For example, he may advise you to use toys or games to help the child act out her problems. If you need additional assistance, the pediatrician may refer you to a child therapist, psychologist, or psychiatrist. Last Updated 11/21/2015 Source Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)","{
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2,"2018-04-19 02:59:52","Abdominal Pains in Infants","Abdominal Pains in Infants Page Content Article BodyColic usually occurs in infants between the ages of ten days and three months of age. While no one knows exactly what causes it, colic seems to produce rapid and severe contractions of the intestine that probably are responsible for the baby’s pain. The discomfort often is more severe in the late afternoon and early evening, and may be accompanied by inconsolable crying, pulling up of the legs, frequent passage of gas, and general irritability. You can try a variety of approaches to colic, which might include rocking your baby, walking with her in a baby carrier, swaddling her in a blanket, or giving her a pacifier. Intussusception is a rare condition that may cause abdominal pain in young infants (usually between eight months and fourteen months of age). This problem occurs when one part of the intestine slides inside another portion of the intestine, creating a blockage that causes severe pain. The child will intermittently and abruptly cry and pull her legs toward her stomach. This will be followed by periods without stomach pain and often without any distress. These children also may vomit and have dark, mucousy, bloody stools that often look like blackberry jelly. It is important to recognize this cause of abdominal pain and to talk to your pediatrician immediately. She will want to see your child and perhaps order an X-ray called an air or barium enema. Sometimes doing this test not only enables the diagnosis but also unblocks the intestine. If the enema does not unblock the intestine, an emergency operation may be necessary to correct the problem. Viral or bacterial infections of the intestine (gastroenteritis) are usually associated with diarrhea and/or vomiting. On and off abdominal pain is often also present. Most cases are viral, require no treatment, and will resolve on their own over a week or so; the pain itself generally lasts one or two days and then disappears. One exception is an infection caused by the Giardia lamblia parasite. This infestation may produce periodic recurrent pain not localized to any one part of the abdomen. The pain may persist for a week or more and can lead to a marked loss of appetite and weight. Treatment with appropriate medication can cure this infestation and the abdominal pain that accompanies it. Last Updated 11/21/2015 Source Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)","{
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3,"2018-04-19 02:59:56","Appendicitis in Teens","Appendicitis in Teens Page Content Article BodyEarly adolescence is prime time for appendicitis, a potentially serious inflammation of the appendix. The small appendage, located on the right side of the lower abdomen, sticks out from the colon like a protruding tongue. Should it become inflamed and need to be surgically removed—the sole treatment for appendicitis—the appendix is hardly missed, for it has no known function. Symptoms that Suggest Appendicitis may Include: Persistent abdominal pain that migrates from the midsection to the right lower abdomen Nausea and vomiting Constipation Gas pain Diarrhea Low fever, beginning after other symptoms Tenderness in the right lower abdomen Abdominal swelling Elevated white blood cell count Appetite loss “Anybody who’s had appendicitis will tell you that pain is unlike any other kind of pain,” says Dr. Alan Lake, M.D. “In adolescents, it begins as a vague stomachache near the navel. Then patients feel it in the lower part of the right side of the abdomen.” He describes the sensation as a peculiar combination of pressure and fullness. The distinctive symptom should be heeded very seriously; should the appendix rupture, it may infect the double-layer peritoneal membrane that lines the abdominal cavity. The medical term for this is peritonitis. Notify your pediatrician at once or contact a local hospital emergency department. While you wait to see the doctor, instruct your teen to lie down and be still. Any kind of movement, including coughing or taking a deep breath, can exacerbate the pain. Don’t offer water, food, laxatives, aspirin or a heating pad. How Appendicitis Is Diagnosed Physical examination and thorough medical history, plus one or more of the following procedures: White blood cell count Urinalysis, to rule out a urinary-tract infection Ultrasound Lower GI series (barium enema) CT scan Exploratory laparoscopic surgery How Appendicitis Is Treated Surgery: Appendicitis can be difficult to diagnose definitely. Therefore, your physician may not schedule the appendectomy until the symptoms have progressed somewhat. Conventional “open” surgery usually requires a two day hospital stay, barring complications, and leaves youngsters with a small scar, but completely cured. Helping Teens To Help Themselves Youngsters should be encouraged to follow these basic guidelines for a healthy digestive tract: Eat at regular hours. Drink lots of water (at least eight cups of water or other liquid every day). Keep physically active. Chew food slowly and thoroughly before swallowing. Use aspirin and nonsteroidal anti-inflammatory medications sparingly; these drugs can irritate the fragile gastrointestinal lining. Don’t smoke; cigarettes, too, contribute to ulcers. Listen to your body! Don’t suppress the urge to move your bowels. Try not to strain during bowel movements. And most important, even with a busy schedule regular meals should be taken daily. Attempts should be made to have at least some of these meals sitting around a table preferably allowing time to talk, chew and digest. This will not only help your teens’ gut, but help the whole family stay connected. Last Updated 11/21/2015 Source Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)","{
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4,"2018-04-19 03:00:03","Bowel Function in Eating Disorders","Bowel Function in Eating Disorders Page Content Article BodyAdolescents with bulimia—the binge-purge syndrome—frequently abuse laxatives to provoke diarrhea and purge unwanted calories. Constipation, by contrast, is a recognized complication of anorexia. Apart from a diet that is woefully deficient in nutrients and bulk, an anorexic teenager has weakening of the intestinal muscles and an overall slowing of body metabolism, both of which are directly due to starvation. In addition, adolescents with this serious eating disorder typically drink very little for fear of becoming bloated. The weight of stool retained in the intestines can make it difficult to judge whether treatment is progressing. Finally, constipation may be worsened by medications used to treat anorexia. Specialists treating adolescents with anorexia manage constipation through a diet that includes adequate fiber and fluids. They also encourage moderate exercise and may recommend stool softeners and other medications if necessary. Last Updated 11/21/2015 Source Nutrition: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2011)","{
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5,"2018-04-19 03:00:10","Campylobacter Infections","Campylobacter Infections Page Content Article BodyCampylobacter are a type of bacteria that produce infections in the GI tract. They are a major bacterial cause of diarrheal sickness among children in the United States. You may hear your pediatrician use the names Campylobacter jejuni or Campylobacter coli, which are the most common Campylobacter species associated with diarrhea. Common ways that a child can get the infection are from contaminated food, especially undercooked chicken; unpasteurized milk; and household pets, most often puppies, cats, hamsters and birds. Infection can also spread by person-to-person contact. The incubation period is usually 2 to 7 days. Signs and Symptoms Illness caused by Campylobacter infections includes diarrhea, stomach pain, and fever. Blood may be present in the stools. In young infants, bloody diarrhea may be the only sign that an infection is present. Severe diarrhea can cause dehydration, with symptoms such as excessive thirst and a decline in the frequency of urination. Campylobacter can also enter the blood stream and infect other organs, though this is not common. In rare cases, complications caused by the body’s immune system may develop. The antibodies made against Campylobacter can react against the child’s body, causing an uncommon form of arthritis called reactive arthritis, a skin sore called erythema nodosum, and a serious condition of the nerves called Guillain-Barré syndrome. With Guillain-Barré syndrome, the child develops weakness that usually starts in the legs and moves up the body. What You Can Do If your child has blood in his diarrhea or stools, you should call your pediatrician. Children with Campylobacter infections tend to get better on their own without any particular treatment. Until your child’s diarrhea goes away, make sure he drinks lots of fluids. Rehydration fluids are sold in stores, but can also be made at home. Talk to your pediatrician about how to include the proper amount of salt and sugar. How Is the Diagnosis Made? The blood and feces can be tested in the laboratory for the presence of Campylobacter bacteria. This will help your pediatrician give you an exact diagnosis of the cause of your child’s diarrhea. Treatment Sometimes, particularly when a Campylobacter infection is severe, antibiotics may be given. If taken early in the course of the illness, antibiotics such as erythromycin and azithromycin can eliminate the bacteria from the stool in 2 to 3 days and shorten the length of the illness. When your pediatrician gives these medicines, make sure your child takes them as instructed. Over the counter antidiarrheal medicines may make your child sicker and should not be taken if there is blood in the stools. What Is the Prognosis? If your child has a mild Campylobacter infection, the illness may last only for a day or two. In other cases, youngsters may recover within a week, although about 20% have a relapse or a prolonged or severe illness. Prevention Many cases of Campylobacter infections are connected with touching or eating undercooked poultry. Therefore, proper food handling and preparation are important. To prevent these infections in your family: Wash your hands thoroughly after handling raw poultry. Also, wash cutting boards and utensils with soap and water after they’ve been in contact with raw poultry. It is important to cook poultry thoroughly before eating. Drink only milk that has been pasteurized. Because pets can be carriers of Campylobacter bacteria, members of your family should wash their hands thoroughly after having contact with the feces of dogs, cats, hamsters, and birds. Wash your hands carefully after touching the underclothes or diapers of young children and infants with diarrhea. Children should always wash their hands before eating. If a child that attends child care has diarrhea, you should tell the caregivers right away. Preventing Gastroenteritis Wash your hands. Don’t share utensils. Wash and/or peel raw fruits and vegetables. Cook meats thoroughly. Avoid contaminating foods eaten raw (eg, fruit, salad) with foods that get cooked (eg, chicken, turkey, beef, pork). Last Updated 11/21/2015 Source Adapted from Immunizations and Infectious Diseases: An Informed Parents Guide (Copyright © 2006 American Academy of Pediatrics) and updated 2011","{
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6,"2018-04-19 03:00:17","Celiac Disease in Children & Teens","Celiac Disease in Children & Teens Page Content​By: Anthony Porto, MD, MPH, FAAPPeople are thinking about celiac disease and the possibility of a gluten intolerance more often now than they have in the past. About 30% of people living in the United States are following some form of a gluten-free diet—either by choice or due to a medical condition. In this article, the American Academy of Pediatrics (AAP) answers common questions about celiac disease, gluten-related disorders, and following how children can follow a gluten-free diet.What is celiac disease?Celiac disease is a life-long condition affecting the small intestine. When a person with celiac disease eats, or is exposed to gluten (a protein found in food that contains rye, barley and wheat), his or her body destroys the intestinal villi—small, finger-like projections in the small intestine that absorb nutrients from food. Damage to the villi means that nutrients from food cannot be properly absorbed by the body and can lead to gastrointestinal symptoms, poor absorption of nutrients, and potentially to poor weight gain. No matter how much a person eats, he or she remains malnourished. When this happen to children, it can affect their growth and development. Once a child stops eating gluten, the villi heal and can absorb nutrients normally.Who is at risk for celiac disease?Approximately 35-40% of people carry one or both celiac genes—called HLA-DQ2 and DQ8. Those who carry one or both genes are considered to be ""at risk"" of developing celiac disease, although only a small percentage will actually develop the condition. In addition, children with certain conditions and/or syndromes may be more at risk for celiac disease. Children with one or more of the following are at an increased risk of developing celiac disease and should be considered for testing:First-degree relatives (children, siblings) of a person with celiac diseaseDown syndromeType 1 diabetesSelective IgA deficiencyTurner syndromeWilliams syndromeAutoimmune thyroiditisWhat are the symptoms of celiac disease?The symptoms of celiac disease vary widely and are influenced by age. Very young children may have poor growth, which begins at the time that they start eating any gluten-containing solid foods—about 6 months of age. Other classic symptoms in children this age are diarrhea and gas.  Older children and teens may have other symptoms such as abdominal pain, vomiting, and constipation. Non-gastrointestinal symptoms include delayed growth during puberty (short stature), skin rashes, iron deficiency anemia that does not respond to iron supplementation, elevated liver function tests, and bone problems (osteoporosis). Note that some children, particularly those in high-risk groups, will not show any symptoms and are typically found to have celiac disease through a blood test. What is the difference between celiac disease and gluten sensitivity?In addition to celiac disease, there are two other classes of gluten-related disorders: wheat allergy and non-celiac gluten sensitivity. Wheat allergy is an immediate, allergic response to wheat protein (IgE-mediated). It can lead to gastrointestinal symptoms and other symptoms seen with celiac disease. Non-celiac gluten sensitivity is not well defined, and some doctors believe it may only be caused by an intolerance to wheat and not to all gluten-containing grains. The type of intolerance seen in non-celiac gluten sensitivity does not lead to intestinal inflammation, as is seen in celiac disease.How do I know if my child has celiac disease or another gluten-related disorder?For celiac disease: Several tests are done to officially diagnose celiac disease. The first step is a blood test to look for certain antibodies—including tissue transglutaminase IgA. The level of these antibodies is usually high in people with celiac disease, but it is almost never increased in people without it. If the test is positive, a biopsy of the small intestine is recommended to confirm the diagnosis of celiac disease. The biopsy is usually collected during a test called an upper endoscopy—where a tube with a small camera on the tip is passed into the mouth and down the gastrointestinal tract and removes small pieces of the surface of the small intestine. The biopsy is not painful and is performed by a pediatric gastroenterologist while a child is sedated.  ​Other testing may include additional blood work for other antibodies such as deamidated gliadin IgG and endomysial IgA. Genetic testing may also be performed by taking a swab of the cheek; this is done in certain circumstances if the diagnosis of celiac disease is not certain. For a wheat allergy: Blood tests or skin- prick tests can be done to see if there is an elevated wheat IgE blood level or a skin reaction to the presence of wheat antigen on the skin. For non-celiac gluten sensitivity: There are no accurate tests available for evaluating. A child should continue to eat foods containing gluten until all testing is complete. Starting a gluten-free diet or avoiding gluten before testing may make it difficult to confirm the diagnosis. What is the treatment for celiac disease?The only available treatment for celiac disease is a strict life-long, gluten-free diet. It is important to limit cross-contamination—even crumbs containing gluten can lead to symptoms and intestinal inflammation. Additionally, gluten may be found in certain medications and in some non-food items such as shampoo and make-up—but these are not harmful unless they are eaten. Talking to a knowledgeable dietitian can help parents and children make the needed adjustments to a gluten-free lifestyle. Without treatment, children with celiac disease can go on to develop anemia, osteoporosis, and other complications.Is the gluten-free diet healthy?Just because a food is labeled ""gluten-free"" does not mean it is better for you. Therefore, reading labels may not always be the most efficient way to remain healthy and symptom-free. See Gluten-Free Food Labeling. ​Processed gluten-free foods are not vitamin fortified. For example, they may lack B vitamins and iron and be high in fat and sugar and low in protein. Eat naturally gluten-free and healthy foods. These include fruits, vegetables, meats and fish, as well as a variety of grains including amaranth, millet and quinoa. Some children with celiac disease may also need a daily multivitamin.What accommodations can be made for a child with celiac disease?Parents of children who are newly diagnosed with celiac disease will need to speak to their child's teacher or child care provider about the condition, what foods are safe, and what to do in case of inadvertent exposure to gluten.School lunches: Schools are required by law to provide substitutions to the school meals for children with celiac disease—if their needs are supported by a statement signed by a licensed doctor. The doctor's order may require certain products to be purchased for the child. Schools may not charge children with certified special dietary needs more than they charge other children for program meals or snacks. In other words, children who receive free lunches cannot incur any charges for their meals and children who pay full-price cannot be charged extra for the special foods the school must purchase.Classroom management: Children with a 504 plan or those who can document their condition are entitled not only to lunch, but to a plan for classroom management of their celiac disease. That might mean young children with celiac will not have access to glue or other gluten-containing art class items they might taste or put in their mouths. It might mean older children will not have field trips where they might encounter gluten, such as a tour of a bread factory. Additional Information & Resources: Common Food Allergies Diagnosing Food Allergies in ChildrenAsk the Pediatrician: My wife and I are on a gluten-free diet. Is it ok for our baby to also eat gluten-free?Ask the Pediatrician: When should I introduce wheat into my baby's diet?Celiac Disease FoundationGluten Intolerance Group of North America About Dr. Porto: Anthony Porto, MD, MPH, FAAP is a board-certified pediatrician and board-certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Clinical Chief of Pediatric Gastroenterology at Yale University and Director, Pediatric Gastroenterology at Greenwich Hospital in Greenwich, CT. He is also the medical director of the Yale Pediatric Celiac Program. Within the American Academy of Pediatrics, Dr. Porto sits on the PREP Gastroenterology Advisory Board and is a member of the Section on Gastroenterology, Hepatology and Nutrition. He is also a member of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition's Public Education Committee, a pediatric expert on nutrition for The Bump's Real Answers, and is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers. Follow him on Instagram @Pediatriciansguide. ​ Article Body Last Updated 7/24/2017 Source American Academy of Pediatrics (Copyright © 2017)","{
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7,"2018-04-19 03:00:22",Cholera,"Cholera Page Content Article BodyCholera is an infection of the intestines caused by bacteria called Vibrio cholerae. It causes a watery diarrhea that can range from mild to extremely severe. Cholera is rare in the United States but if you travel with your child to parts of the developing world, your child may contract cholera by drinking water or, less commonly, eating food such as raw or undercooked shellfish contaminated with V cholerae. Cholera has occurred in children who have visited Latin America or Asia or consumed food imported from that part of the world. Contaminated crabs, oysters, and other shellfish from the Gulf of Mexico have also caused cholera. It is probably not spread through person-to-person contact. There are some species of Vibrio that do not cause cholera, although they can produce diarrhea and may be responsible for blood and wound infections. They are associated with preparing or eating raw or undercooked seafood, particularly oysters, shrimp, and crabs. Signs and Symptoms In some cases of Vibrio infection, no symptoms are present. In most cases, however, there is mild to moderate diarrhea. In a relatively small number of cases, the watery diarrhea becomes severe and dehydration occurs. Vomiting, sometimes severe, is common. Early signs of dehydration include thirst, dry mouth, sunken eyes, and decreased urination. In the most severe cases, especially when lost fluids are not replaced, very serious complications can develop, including seizures, shock, and coma. In noncholera Vibrio infections, the most common symptom is diarrhea, with watery stools accompanied by abdominal cramps. Other symptoms may include headaches, chills, a low-grade fever, and vomiting. Diarrhea caused by these Vibrio infections can be bloody with mucus. Skin infections typically are very painful with redness and swelling. Fever is often present. Large blisters may form in more serious infections. When the bacteria gets into the bloodstream, the child will become very ill. There may be bleeding into the skin, low blood pressure, and sometimes shock. How Is the Diagnosis Made? Laboratory tests can detect the presence of Vibrio bacteria in the child’s feces, wounds, or blood. Treatment Children with dehydration due to cholera need to be rehydrated right away. This can usually be done with oral solutions made specifically for this purpose and available over the counter. For youngsters who are moderately to severely ill, intravenous fluids may be necessary. They also may be given antibiotics such as trimethoprim sulfamethoxazole, doxycycline, or tetracycline to get rid of the bacteria and shorten the duration of the diarrhea. Antidiarrheal medicines can make the illness worse, particularly in young children, and should not be used. Noncholera Vibrio infections causing diarrhea usually get better without treatment in 2 to 3 days, but it is important to make sure your child remains well hydrated. Antibiotics may be prescribed for severe infections. For skin infections, your child will need antibiotics. If the infection is mild, an oral antibiotic will be given. More serious skin infections and bacteria in the blood are treated in the hospital with intravenous antibiotics. In some cases, your child may require surgery to drain pus and damaged tissues. Prevention V cholerae can be killed by boiling, filtering, or treating water with chemicals such as chlorine or iodine. Adequately cooking food that may contain the organism will also destroy bacteria. Leftover cooked seafood should be refrigerated as soon as possible. When traveling abroad: Take precautions such as making sure your food is thoroughly cooked and the water is boiled. Avoid salads, raw vegetables, fruits that have already been peeled, and food from street vendors. Consume safe beverages such as carbonated drinks with no ice and tea and coffee prepared with boiled water. When taking measures like these, the risk of contracting cholera is low. Although 2 cholera vaccines have been made, they are of only limited effectiveness and not available in the United States. Last Updated 11/21/2015 Source Adapted from Immunizations and Infectious Diseases: An Informed Parents Guide (Copyright © 2006 American Academy of Pediatrics) and updated 2011","{
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8,"2018-04-19 03:00:28","Clostridium difficile","Clostridium difficile Page Content Article BodyClostridium difficile is a cause of diarrhea in children. It is also responsible for producing a serious form of colitis (inflammation of the colon) called pseudomembranous colitis. These infections are often contracted in the hospital while a child is receiving antibiotic treatment, although illness may develop days or weeks after leaving the hospital. These anaerobic bacteria are often found normally in the gut of newborns and young children. The disease is caused when the bacteria produce a toxin (poison) that damages the lining of the gut. This happens most often when your child is taking antibiotics that kill other bacteria in the gut, permitting C difficile to multiply to very high numbers. The incubation period for this illness is not known. The bacteria can live in the gut for long periods without causing illness. Signs and Symptoms C difficile causes diarrhea with stomach cramps or tenderness, fever, and blood and mucus in the stools. How Is the Diagnosis Made? To make a proper diagnosis, your child’s stool can be tested for the presence of toxins produced by C difficile. Treatment Because antibiotic use and overuse is associated with C difficile infections, children on antibiotics should be taken off these medicines as soon as possible. In mild cases, children may get better once they stop taking the antibiotics. Some children, however, may need to be given particular medicines such as metronidazole or vancomycin that fight the bacteria. Most children make a full recovery. If a relapse of the illness occurs, which happens in up to 10% to 20% of patients, the same treatment is often repeated. Prevention It may be possible to prevent or reduce the risk of C difficile disease through proper hand washing, as well as the proper handling of dirty diapers and other waste matter. Also, the use of antibiotics should be limited to only those circumstances in which it is absolutely necessary. Last Updated 11/21/2015 Source Immunizations ＆ Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)","{
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9,"2018-04-19 03:00:31","Communicating Hydrocele","Communicating Hydrocele Page Content Article BodyIf the opening between the abdominal cavity and the scrotum has not closed properly and completely, abdominal fluid will pass into the sac around the testis, causing a mass called a communicating hydrocele. As many as half of all newborn boys have this problem; however, it usually disappears within one year without any treatment. Although most common in newborns, hydroceles also can develop later in childhood, most often with a hernia. If your son has a hydrocele, he probably will not complain, but you or he will notice that one side of his scrotum is swollen. In an infant or young boy, this swelling decreases at night or when he is resting or lying down. When he gets more active or is crying, it increases, then subsides when he quiets again. Your pediatrician may make the final diagnosis by shining a bright light through the scrotum, to show the fluid surrounding the testicle. Your doctor also may request an ultrasound examination of the scrotum if it is very swollen or hard. If your baby is born with a hydrocele, your pediatrician will examine it at each regular checkup until around one year of age. During this time your child should not feel any discomfort in the scrotum or the surrounding area. But if it seems to be tender in this area or he has unexplained discomfort, nausea, or vomiting, call the doctor at once. These are signs that a piece of intestine may have entered the scrotal area along with abdominal fluid. If this occurs and the intestine gets trapped in the scrotum, your child may require immediate surgery to release the trapped intestine and close the opening between the abdominal wall and the scrotum. If the hydrocele persists beyond one year without causing pain, a similar surgical procedure may be recommended. In this operation, the excess fluid is removed and the opening into the abdominal cavity closed. Last Updated 11/21/2015 Source Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)","{
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10,"2018-04-19 03:00:39","Constipation in Children","Constipation in Children Page Content​​Bowel patterns vary from child to child just as they do in adults. What's normal for your child may be different from what's normal for another child. Most children have bowel movements 1 or 2 times a day. Other children may go 2 to 3 days or longer before passing a normal stool. For instance, if your child is healthy and has normal stools without discomfort or pain, ­having a bowel movement every 3 days may be her normal bowel pattern. Children with constipation may have stools that are hard, dry, and difficult or painful to pass. These stools may occur daily or be less frequent. Although constipation can cause discomfort and pain, it's ­usually temporary and can be treated.  Constipation is a common problem in children. It's one of the main reasons children are referred to a specialist, called a pediatric gastroenterologist. Here is information from the American Academy of Pediatrics (AAP) about constipation and its causes, symptoms, and treatments, as well as ways to prevent it.  What causes constipation?Constipation frequently occurs for a variety of ­reasons.  Diet. Changes in diet, or not enough fiber or fluid in your child's diet, can cause constipation. Illness. If your child is sick and loses his ­appetite, a change in his diet can throw off his system and cause him to be constipated. Constipation may be a side effect of some ­medicines. Constipation may result from certain medical conditions, such as hypothyroidism (underactive thyroid gland).Withholding. Your child may withhold his stool for different reasons. He may withhold to avoid pain from passing a hard stool, which can be even more painful if your child has a bad diaper rash. Or he may be dealing with issues about independence and control—this is common between the ages of 2 and 5 years. Your child may also withhold because he simply doesn't want to take a break from play. Your older child may withhold when he's away from home, at camp, or at school, because he's embarrassed or uncomfortable using a public toilet.Other changes. In general, any changes in your child's routine, such as traveling, hot weather, or stressful situations, may affect his overall health and how his bowels function.If constipation isn't treated, it may get worse. The longer the stool stays inside the lower intestinal tract, the larger, firmer, and drier it becomes. Then it becomes more difficult and painful to pass the stool. Your child may hold back his stool because of the pain. This creates a vicious cycle.  What are the symptoms of ­constipation?Symptoms of constipation may include:  Many days without normal bowel movementsHard stools that are difficult or painful to passAbdominal pain, such as stomachaches, ­cramping, or nauseaRectal bleeding from tears, called fissuresSoiling Poor appetiteCranky behaviorYou may also notice your child crossing her legs, making faces, stretching, clenching her buttocks, or twisting her body on the floor. It may look as if your child is trying to push the stool out, but instead she's trying to hold it in.  How is constipation treated?Constipation is treated in different ways. Your child's doctor will recommend what is best for your child's situation. In some cases, your child may need to have a medical test before your child's doctor can recommend treatment. For example, your child's doctor may need to look inside your child's body and x-rays may be used to create these images. In most cases, no tests are needed.  What is encopresis?If your child withholds her stools, she may ­produce such large stools that her rectum stretches. She may no longer feel the urge to pass a stool until it is too big to be passed without the help of an enema, laxative, or other treatment. Sometimes, only liquid can pass around the stool and leaks out onto your child's underwear. The liquid stool may look like diarrhea, confusing both parent and pediatrician, but it's not. This problem is called encopresis.Dietary changesBabies. Constipation is rarely a problem in younger infants. It may become a problem when your baby starts solid foods. Your child's doctor may suggest adding more water or juice to your child's diet.Older children. When a child or teen is con­stipated, it may be because his diet doesn't include enough high-fiber foods and water. Your child's doctor may suggest adding higher-fiber foods to your child's diet and may encourage him to drink more water. These changes in your child's diet will help get rid of abdominal pain from constipation.​MedicineIn some cases, your child's doctor may prescribe medicine to soften or remove the stool. Never give your child laxatives or enemas unless your child's doctor says it's OK; laxatives can be dangerous to children, if not used properly. After the stool is removed, your child's doctor may suggest ways you can help your child develop good bowel habits to prevent stools from backing up again.  How can constipation be prevented?Because each child's bowel patterns are different, become familiar with your child's normal bowel patterns. Make note of the usual size and consistency of her stools. This will help you and your child's doctor determine when constipation occurs and how best to treat it. If your child doesn't have normal bowel movements every few days or is uncomfortable when stools are passed, she may need help in developing proper bowel habits.  You can…  Encourage your child to drink plenty of water and eat higher-fiber foods.Help your child set up a regular toileting routine.Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life.Getting enough fiber in your dietThe AAP recommends that people between the ages of 2 and 19 years eat a daily amount of fiber that equals their age plus 5 grams of fiber. For example, 7 grams of fiber are recommended if your child is 2 years of age (2 plus 5 grams).  Remember…If you are concerned about your child's bowel movements, talk with your child's doctor. A simple change in diet and exercise may be the answer. If not, your child's doctor can suggest a plan that works best for your child. Additional Information from HealthyChildren.org: Infant ConstipationAbdominal Pain in Children Stomachaches in Children & TeensKids Need Fiber: Here's Why and How​ Article Body Last Updated 2/28/2017 Source Constipation and Your Child (Copyright © 2005 American Academy of Pediatrics, Updated 10/2016)","{
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11,"2018-04-19 03:00:43",Diarrhea,"Diarrhea Page Content Article BodyWhat is the best way to treat diarrhea? Most children with mild diarrhea can continue to eat a normal diet including formula or milk. Breastfeeding can continue. If your baby seems bloated or gassy after drinking cow's milk or formula, call your pediatrician to discuss a temporary change in diet. Special fluids for mild illness are not usually necessary. Special fluids for moderate illness Children with moderate diarrhea may need special fluids. These fluids, called electrolyte solutions, have been designed to replace water and salts lost during diarrhea. They are extremely helpful for the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. Use only commercially available fluids—brand-name and generic brands are equally effective. Your pediatrician or pharmacist can tell you what products are available. If your child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again. Reminder–Do's and Don'ts Do Watch for signs of dehydration which occur when a child loses too much fluid and becomes dried out. Symptoms of dehydration include a decrease in urination, no tears when baby cries, high fever, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes. Keep your pediatrician informed if there is any significant change in how your child is behaving. Report if your child has blood in his stool. Report if your child develops a high fever (more than 102°F or 39°C). Continue to feed your child if she is not vomiting. You may have to give your child smaller amounts of food than normal or give your child foods that do not further upset his or her stomach. Use diarrhea replacement fluids that are specifically made for diarrhea if your child is thirsty. Don't Try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments. Prevent the child from eating if she is hungry. Use boiled milk or other salty broth and soups. Use ""anti-diarrhea"" medicines unless prescribed by your pediatrician. Last Updated 11/21/2015 Source Diarrhea and Dehydration (Copyright © 1996 American Academy of Pediatrics, Updated 7/2004)","{
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12,"2018-04-19 03:00:50","Drinks to Prevent Dehydration in a Vomiting Child","Drinks to Prevent Dehydration in a Vomiting Child Page Content Article BodyFor vomiting children, the main risk is water loss, or dehydration, especially if fever causes them to sweat more or they are also losing fluid through diarrhea. When vomiting is severe or prolonged, a child may lose sodium, potassium, and chloride. These minerals have a crucial role in the transmission of nerve impulses and the contraction of muscles, and in regulating the body’s fluid balance. While missing a meal or two will cause no harm to an otherwise healthy child, it’s important that a sick child continue to drink water to take care of normal daily needs, plus extra to make up for fluid loss and prevent dehydration. Young children are especially susceptible to dehydration because they are less efficient at conserving water than older children and adults. In addition, small body size means that it takes less fluid loss to lead to dehydration. Offer frequent sips of water or, if your child doesn’t feel like drinking, ice chips to suck on. Build up to 1 oz an hour, then 2 oz an hour until the child is able to drink normally. Your pediatrician may recommend a commercial rehydration solution to help replace lost sodium and potassium in a young child. These come in liquid and Popsicle-like forms to make them more appealing to children. It also makes certain that the liquid is taken slowly. Older children may ask for commercial sports drinks, but these should be used with care. They replace salts, but they also contain large amounts of sugar, which can make diarrhea worse. A child who wants a change from plain water may enjoy sips of fruit juice diluted half-and-half with water or flat soda. If your child is too sick to drink or listless, or shows signs of progressive dehydration such as dry mouth, fewer tears, or urinates less frequently, seek urgent medical attention. Contact your pediatrician immediately. Last Updated 11/21/2015 Source Nutrition: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2011)","{
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13,"2018-04-19 03:00:57","Food Poisoning","Food Poisoning Page Content Article BodyEach year more than 30 million Americans suffer from food poisoning, which can be especially hazardous for babies and young children. If two or more members of your family experience cramps, nausea, vomiting, or diarrhea after eating the same food, food poisoning is the likely cause. To reduce the chance of food poisoning, wash hands with hot water and soap both before and while preparing meals, wash dish towels and sponges, and refrigerate all food immediately after a meal. Click here to listen Last Updated 1/23/2016 Source A Minute for Kids","{
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14,"2018-04-19 03:01:02","Food Poisoning and Food Contamination","Food Poisoning and Food Contamination Page Content Article BodyFood poisoning occurs after eating food contaminated by bacteria. The symptoms of food poisoning are basically the same as those of stomach flu: abdominal cramps, nausea, vomiting, diarrhea, and fever. But if your child and other people who have eaten the same food all have the same symptoms, the problem is more likely to be food poisoning than stomach flu. The bacteria that cause food poisoning cannot be seen, smelled, or tasted, so your child won’t know when she is eating them. These organisms include: Staphylococcus Aureus (Staph) Staph contamination is the leading cause of food poisoning. These bacteria ordinarily cause skin infections, such as pimples or boils, and are transferred when foods are handled by an infected person. When food is left at a specific temperature (100 degrees Fahrenheit [37.8 Celsius])—generally one that is lower than the temperature needed to keep food hot—the staph bacteria multiply and produce a poison (toxin) that ordinary cooking will not destroy. The symptoms begin one to six hours after eating the contaminated food, and the discomfort usually lasts about one day. Salmonella Salmonella bacteria (there are many types) are another major cause of food poisoning in the United States. The most commonly contaminated foods are raw meat (including chicken), raw or undercooked eggs, and unpasteurized milk. Fortunately, salmonella are killed when the food is cooked thoroughly. Symptoms caused by salmonella poisoning start sixteen to forty-eight hours after eating, and may last two to seven days. E. Coli Escherichia coli (or E. coli) is a group of bacteria that normally live in the intestines of children and adults. A few strains of these bacteria can cause food-related illnesses. Undercooked ground beef is a common source of E. coli, although raw produce and contaminated water have caused some outbreaks. Symptoms of an infection typically include diarrhea (which can range from mild to severe) to abdominal pain, and in some cases nausea and vomiting. Some E. coli outbreaks have been quite severe and have even caused deaths in rare instances. The optimal treatment for an E. coli–related illness is rest and fluids (to counteract dehydration). But if symptoms are more severe, you should have a discussion with your pediatrician. Clostridium Perfringens Clostridium perfringens (C. perfringens) is a bacterium frequently found in soil, sewage, and the intestines of humans and animals. It usually is transferred by the food handler to the food itself, where it multiplies and produces its toxin. C. perfringens often is found in school cafeterias because it thrives in food that is served in quantity and left out for long periods at room temperature or on a steam table. The foods most often involved are cooked beef, poultry, gravy, fish, casseroles, stews, and bean burritos. The symptoms of this type of poisoning start eight to twenty-four hours after eating, and can last from one to several days. Shigellosis Shigella infections, or shigellosis, are intestinal infections caused by one of many types of shigella bacteria. These bacteria can be transmitted through contaminated food and drinking water, as well as via poor hygiene (in child care centers, for example). The organisms invade the lining of the intestine, and can lead to symptoms such as diarrhea, fever, and cramps. Shigellosis and its symptoms usually subside after about five to seven days. In the meantime, your child should consume extra fluids and (if your pediatrician recommends it) a rehydrating solution. In severe cases, your doctor may prescribe antibiotics, which can shorten the duration and intensity of the infection. Campylobacter One form of infectious food poisoning is caused by the bacteria Campylobacter, which a child may ingest when he eats raw or undercooked chicken, or drinks unpasteurized milk or contaminated water. This infection typically leads to symptoms such as watery (and sometimes bloody) diarrhea, cramps, and fever, about two to five days after the germs are consumed in food. To diagnose a Campylobacter infection, your doctor will have a culture of a stool specimen analyzed in the laboratory. Fortunately, most cases of this infection run their course without any formal treatment, other than making sure that your child drinks plenty of fluids in order to replace the fluids lost from diarrhea. When symptoms are severe, however, your pediatrician may prescribe antibiotics. In most cases, your child will be back to normal in about two to five days. Botulism This is the deadly food poisoning caused by Clostridium botulinum. Although these bacteria normally can be found in soil and water, illness from them is extremely rare because they need very special conditions in order to multiply and produce poison. Clostridium botulinum grows best without oxygen and in certain chemical conditions, which explains why improperly canned food is most often contaminated and the low-acid vegetables, such as green beans, corn, beets, and peas, are most often involved. Honey also can be contaminated and frequently causes severe illness, particularly in children under one year of age. This is the reason why honey should never be given to an infant under the age of one year. Botulism attacks the nervous system and causes double vision, droopy eyelids, decreased muscle tone, and difficulty in swallowing and breathing. It also can cause vomiting, diarrhea, and abdominal pain. The symptoms develop in eighteen to thirty-six hours and can last weeks to months. Without treatment, botulism can cause death. Even with treatment, it can cause nerve damage. Cryptosporidiosis In very uncommon situations, watery diarrhea, low-grade fever, and abdominal pain may be caused by an infection known as cryptosporidium. This infection is of special concern in children who do not have a normal immune system. Other sources of food poisoning include poisonous mushrooms, contaminated fish products, and foods with special seasonings. Young children do not care for most of these foods and so will eat very little of them. However, it still is very important to be aware of the risk. If your child has unusual gastrointestinal symptoms, and there is any chance she might have eaten contaminated or poisonous foods, call your pediatrician. Treatment In most cases of food-borne illnesses, all that’s necessary is to limit your child’s eating and drinking for a while. The problem will then usually resolve itself. Infants can tolerate three to four hours without food or liquids; older children, six to eight. If your child is still vomiting or her diarrhea has not decreased significantly during this time, call your pediatrician. Also notify the doctor if your child: Shows signs of dehydration Has bloody diarrhea Has continuous diarrhea with a large volume of water in the stool, or diarrhea alternating with constipation May have been poisoned by mushrooms Suddenly becomes weak, numb, confused, or restless, and feels tingling, acts drunkenly, or has hallucinations or difficulty breathing Tell the doctor the symptoms your child is having, what foods she has eaten recently, and where they were obtained. The treatment your pediatrician gives will depend on your child’s condition and the type of food poisoning. If she is dehydrated, fluid replacement will be prescribed. Sometimes antibiotics are helpful, but only if the bacteria are known. Antihistamines help if the illness is due to an allergic reaction to a food, toxin, or seasoning. If your child has botulism, she will require hospitalization and intensive care. Prevention Most food-borne illness is preventable if you observe the following guidelines. Cleanliness Be especially careful when preparing raw meats and poultry. After you have rinsed the meat thoroughly, wash your hands and all surfaces that have come in contact with the raw meat and poultry, with hot, sudsy water before continuing your preparation. Always wash your hands before preparing meals and after going to the bathroom or changing your child’s diaper. If you have open cuts or sores on your hands, wear gloves while preparing food. Do not prepare food when you are sick, particularly if you have nausea, vomiting, abdominal cramps, or diarrhea. Food Selection Carefully examine any canned food (especially home-canned goods) for signs of bacterial contamination. Look for milky liquid surrounding vegetables (it should be clear), cracked jars, loose lids, and swollen cans or lids. Don’t use canned or jarred goods showing any of these signs. Do not even taste them. Throw them away so that nobody else will eat them. (Wrap them first in plastic and then in a heavy paper bag.) Buy all meats and seafood from reputable suppliers. Do not use raw (unpasteurized) milk or cheese made from raw milk. Do not eat raw meat. Do not give honey to a baby under one year of age. Food Preparation and Serving Do not let prepared foods (particularly starchy ones), cooked and cured meats, cheese, or anything with mayonnaise stay at room temperature for more than two hours. Do not interrupt the cooking of meat or poultry to finish the cooking later. Do not prepare food one day for the next unless it will be frozen or refrigerated right away. (Always put hot food right into the refrigerator. Do not wait for it to cool first.) Make sure all foods are cooked thoroughly. Use a meat thermometer for large items like roasts or turkeys, and cut into other pieces of meat to check if they are done. When reheating meals, cover them and reheat them thoroughly.   Last Updated 11/21/2015 Source Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)","{
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15,"2018-04-19 03:01:06","Gastroesophageal Reflux & Gastroesophageal Reflux Disease: Parent FAQs","Gastroesophageal Reflux & Gastroesophageal Reflux Disease: Parent FAQs Page Content​​​​By: Anthony Porto, MD, MPH, FAAPAll babies spit up— and it often seems like everything they just ate comes right back up! So, how do you know if your spitty baby's symptoms are normal or part of a larger problem?To help you sort it all out, the American Academy of Pediatrics (AAP) answers common questions about typical digestive functioning and explains the differences between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD).What are the differences between GER and GERD? Without getting too technical, spit-up (also called reflux, gastroesophageal reflux, or GER) is the movement of stomach contents into the esophagus, and sometimes through the mouth and nose. When reflux is associated with other symptoms, or if it persists beyond infancy, it is considered a disease and is known as gastroesophageal reflux disease or GERD. GER in infants is not considered a disease and does not include a ""D."" In fact, GER is considered normal. These infants are known as ""happy spitters,"" because they are not cranky and do not appear to be in a great deal of pain when spitting up. In fact, your baby may feel better after a good spit-up. Other symptoms of GER include mild feeding problems, such as occasional prolonged feeds or interrupted feeds.When is spit-up or GER normal?GER usually begins at approximately 2 to 3 weeks of life and peaks between 4 to 5 months. Most babies who are born at full term will have complete resolution of symptoms by the time they are 9 to 12 months old. In most babies, GER disappears as the upper digestive tract functionally matures. In addition, normal development, including improved head control and being able to sit up, as well as the introduction of solid food, will help improve GER symptoms.What are the causes of GER?If your baby's stomach is full or his or her position is changed abruptly, especially after a feeding, the stomach contents—food mixed with stomach acid—press against the valve at the top of the stomach. This is called the lower esophageal sphincter. This ring of muscle normally relaxes to let food pass from the esophagus into the stomach and then tightens again to keep the food there. When it is not fully developed or it opens at the wrong time, the stomach contents move back or reflux into the esophagus. See Why Babies Spit Up for more information on this. In older children, diet can play more of a role. Large meals and highly acidic or spicy meals, as well as carbonated or caffeinated beverages, can lead to increased GER symptoms. In addition, GER is more common in children who are overweight or obese. How do I know if my child has GERD? Unlike GER, GERD is associated with complications from acid reflux. Call your pediatrician if your child exhibits any of the following signs or symptoms: Refusal to feedCrying and/or arching the back during feeds (i.e., seems to be in pain) Blood or greenish color in the spit-up Increase in frequency or intensity of the spit-up (i.e., forceful)Belly is swollen or distended or feels hard Respiratory symptoms—including wheezing and coughingIn addition, let your pediatrician know if you notice that your baby doesn't seem to be gaining weight or is having fewer wet and dirty diapers, as these may be signs that not enough of what he or she eats is staying down.How will my pediatrician evaluate my baby for GER?The AAP believes it is important for all pediatric health care providers to be able to properly identify and treat children with reflux symptoms, and to distinguish GER from more worrisome disorders to avoid unnecessary costs and treatments.Your child's pediatrician will review your child's symptoms and feeding patterns and assess your child's growth by plotting his or her weight and height on a growth chart. This information will help them determine whether your child is a ""happy spitter"" or has symptoms of GERD. How is GER or GERD treated?While we wish we had a ""quick fix"" for babies who spit up, the truth is that for a good many spitty babies, it is mostly a matter of time. Lifestyle changes—including feeding and/or position changes—are recommended as first-line therapy for both GER and GERD. If GERD is severe, treatment may include medication or surgery. The surgery to correct reflux is called fundoplication.Treatment options during infancy: Burp at natural pauses in feeding and keeping your child upright for up to thirty minutes after feeding. If your bottle-fed baby spits up unusually often, your pediatrician may recommend thickening his or her formula with a very small amount of baby cereal. Never add solids to the bottle unless your pediatrician advises it. See Oatmeal: The Safer Alternative for Infants & Children Who Need Thicker Food for more information on this line of treatment. Consider smaller and more frequent feedings, but be sure your baby is taking in enough to keep up typical growth and development. Consider keeping your baby in an upright position—in a stroller or carrier—for the first half hour or so after feeding. Always closely supervise your baby during this time.Regardless of whether or not your baby warrants watchful waiting or medical intervention, the AAP does have additional and simple feeding suggestions that can help you deal with the situation at hand. See Remedies for Spitty Babies for more treatment tips. Treatment options for an older child: Avoid fried and fatty foods; they slow down the rate of the stomach emptying and promote reflux. Peppermint, caffeine, and certain asthma medications can make the lower esophageal sphincter relax and allow stomach contents to reflux back into the esophagus. Some experts believe that tomato-based products have a similar effect. If any food seems to produce reflux or heartburn, keep it out of the diet for a week or two and then reintroduce it. If symptoms reoccur, avoid that food until your pediatrician recommends to reintroduce it into the diet.Sometimes your pediatrician may recommend medications that neutralize or decrease the acid in your child's stomach to treat symptoms associated with GERD. When might my pediatrician refer my child to a pediatric gastroenterologist? Your pediatrician may refer your child to see a pediatric gastroenterologist, a pediatrician who has specialized training in problems of the gastrointestinal tract—including GERD—for a variety of reasons including:Poor weight gainFeeding problemsNo response to medical therapyA pediatric gastroenterologist will review your child's history, examine your child and review his or her diet history and growth charts. Sometimes, it can be helpful for a pediatric gastroenterologist to observe your child being fed or self-feeding. Based on the visit, he or she will decide whether your child may benefit from additional testing or from the addition of or a change in medications. Additional Information & Resources: Infant VomitingCommon Feeding ProblemsGastroesophageal Reflux: Management Guidance for the Pediatrician (AAP Clinical Report)  About Dr. Porto:Anthony Porto, MD, MPH, FAAP is a board certified pediatrician and board certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Clinical Chief of Pediatric Gastroenterology at Yale University and Director, Pediatric Gastroenterology at Greenwich Hospital in Greenwich, CT. He is also the medical director of the Yale Pediatric Celiac Program. Within the American Academy of Pediatrics, Dr. Porto sits on the PREP Gastroenterology Advisory Board and is a member of the Section on Gastroenterology, Hepatology and Nutrition. He is also a member of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition's Public Education Committee, a pediatric expert on nutrition for The Bump's Real Answers, and is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers. Follow him on Instagram @Pediatriciansguide. ​ Article Body Last Updated 3/27/2017 Source American Academy of Pediatrics (Copyright © 2017)","{
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16,"2018-04-19 03:01:10","Giardia Intestinalis Infections","Giardia Intestinalis Infections Page Content Article BodyGiardiasis is the name doctors give to infections caused by a microscopic parasite called Giardia Intestinalis. This organism may be found in the stools of an infected person. It can be transmitted by person-to-person contact in places like child care centers and among family members who have not properly washed their hands after using the bathroom or changing diapers. Giardia may also be present in contaminated food and water and is a risk for campers drinking untreated water from mountain streams, which can be contaminated by stool from infected animals and campers.Signs and Symptoms Most children with a Giardia infection have no symptoms at all. A few have abdominal pain and watery, foul-smelling diarrhea that can lead to dehydration. They may also have excessive gas and bloating and could have a poor appetite, leading to weight loss. Fever is uncommon. Most often, symptoms begin 7 to 14 days after exposure to the Giardia parasite and can last, without treatment, for about 4 to 6 weeks. How Is the Diagnosis Made?A stool sample from your child will be examined for the presence of Giardia Intestinalis.Treatment To keep your child well hydrated, she should drink plenty of liquids recommended by your pediatrician, such as over-the-counter or homemade oral rehydrating solutions. Your doctor may also prescribe prescription medicines (most commonly, metronidazole, furazolidone, or nitazoxanide) that cure most cases after 5 to 7 days of treatment. ​If your child has Giardia organisms in the stool but does not have symptoms, no treatment is needed.Prevention When a child attends a child care center, parents should make sure the staff members practice good hygiene and encourage children to wash their hands frequently with soap and water.  Toys that a child puts in her mouth should be washed and disinfected before another youngster plays with them. It is a good idea to wash and peel raw fruits and vegetables before they are eaten. Children should avoid drinking untreated water from streams, lakes, rivers, and ponds.  Take bottled water on camping trips or boil, filter, and treat your drinking water with chemical tablets before drinking it.​ Last Updated 4/18/2016 Source Adapted from Immunizations and Infectious Diseases: An Informed Parents Guide (Copyright © 2006 American Academy of Pediatrics) and updated 2011","{
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17,"2018-04-19 03:01:14","Healthy Children Radio: Tummy Troubles","Healthy Children Radio: Tummy Troubles Page Content Article Body​​​When your child is complains of a stomachache​, how do you know whether it's something you can address at home, or an illness requiring urgent medical care ​Pediatric emergency medicine physicianElizabeth Murray, DO, FAAP, joins the Healthy Children show on RadioMD to offer guidance on assessing your child's symptoms, treating at home and making the decision to call the doctor or head to the emergency department. Segment 1: Fever, Vomiting, Stomach Ache: When Is This an Emergency? Additional Information: Stomachaches in Children & Teens Surviving the Stomach Bug: Truths & Tips for Parents When to Call the Pediatrician: Fever When Your Child Needs Emergency Medical Services Last Updated 1/23/2016 Source American Academy of Pediatrics (Copyright © 2014)","{
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18,"2018-04-19 03:01:25","Helicobacter Pylori Infections","Helicobacter Pylori Infections Page Content Article BodyMost people, including doctors, used to believe that ulcers (sores) in the stomach or duodenum (the first section of the small intestine) were caused by stress, alcohol, or spicy foods. Now we know that this isn’t the case. In fact, these ulcers, called peptic ulcers, are most often (although not always) caused by bacteria—specifically, an organism called Helicobacter pylori. H pylori infections occur at a low rate in children in the United States, but may infect more than 75% of children in developing countries. Although infections increase in frequency as people get older, most children and adults with H pylori will never develop an infection. No one is certain how H pylori is contracted, but person-to-person contact could play a role, as could transmission through contaminated food and water. The incubation period is also unknown. Signs and Symptoms When H pylori causes an ulcer, the intensity of the symptoms can vary. In some cases, there will be no symptoms at all. Ulcers can cause a burning or gnawing pain in the stomach that may come and go, often happening a few hours after eating, as well as during the night, and then actually subsiding while eating food and drinking water. Other symptoms may include: Bloating Burping Nausea and vomiting Loss of appetite Weight loss Bloody vomit and dark stools from bleeding in the stomach or duodenum What You Can Do In the past, doctors treated peptic ulcers by recommending a bland diet as well as bed rest. But today, these lifestyle strategies appear to be inappropriate approaches to managing ulcers. When to Call Your Pediatrician Contact your pediatrician if your child Has burning stomach pain that is worse between meals and in the early morning hours and feels better when he eats Has persistent abdominal pain, vomiting, loss of appetite, or weight loss Has bloody stools or bloody vomit How Is the Diagnosis Made? Your pediatrician will take a medical history of your child and may perform some simple tests. Your pediatrician may sometimes refer your child to a specialist to conduct the more complicated and invasive tests needed to make the diagnosis of an H pylori infection. These tests include analyzing a small piece of tissue (a biopsy) obtained through a device called an endoscope, which is threaded down the throat to the stomach. The tissue is then examined under the microscope and tested for evidence of H pylori infection. Your pediatrician can also look at the esophagus, stomach, and duodenum with x-ray film (an upper GI series). There are noninvasive tests that can determine whether bacteria are present by analyzing a child’s blood, stool, or breath. The breath test can detect carbon dioxide released by a product made by H pylori. Treatment Doctors only prescribe treatment for H pylori infections if they have progressed to an actual ulcer. Combinations of antibiotics such as amoxicillin, clarithromycin, and metronidazole can be taken by your child to kill the bacteria. Make sure he takes the full course of these antibiotics as directed by your pediatrician. They are usually prescribed in combination with drugs called proton pump inhibitors or histamine receptor blockers that interfere with the production of acid in the stomach. What Is the Prognosis? An H pylori infection increases the risk of developing stomach cancer later in life. Prevention There is no known way to prevent H pylori infections. However, a vaccine that could someday prevent the infection is currently being researched. Last Updated 11/21/2015 Source Immunizations ＆ Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)","{
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19,"2018-04-19 03:01:31",Hepatitis,"Hepatitis Page Content Article BodyHepatitis means “inflammation of the liver.” This inflammation can be caused by a wide variety of toxins, drugs, and metabolic diseases, as well as infection. There are at least 5 hepatitis viruses. Hepatitis A is contracted when a child eats food or drinks water that is contaminated with the virus or has close contact with a person who is infected with the virus. Hepatitis A is present in the stool as early as 1 to 2 weeks before a person develops the illness. The infection can be spread in child care settings when caregivers do not wash their hands after changing the diaper of an infected baby or from infant to infant because most very young infants do not wash their hands or have their hands washed for them. This virus also can be spread during male homosexual activity. The incubation period is 2 to 6 weeks. Hepatitis B is spread through the blood and body fluids of an infected person, including through saliva or semen. (Because of the routine screening of donated blood, it is very unlikely that your child will get hepatitis B via a blood transfusion.) The virus can be spread through intimate sexual contact with an infected person or by using nonsterilized needles or syringes for drug use, tattoos, or body piercing. An infected pregnant woman can give the virus to her newborn during the delivery. Person-to-person transmission is uncommon and generally limited to long-term close contact with people with chronic hepatitis B infection. The incubation period is 2 to 5 months. Hepatitis C infections are most often acquired from transfusions of contaminated blood, although your child’s risk of contracting the virus by this route is very low because of routine testing of donated blood. Sexual transmission and transmission among family members through close contact is uncommon. When hepatitis C infections occur in children and teenagers, doctors frequently can’t determine how the virus was acquired. The incubation period is 2 weeks to 6 months. Hepatitis D can be contracted in ways similar to hepatitis B, including through blood, sexual contact, and the use of non-sterilized needles or syringes. Unlike the hepatitis B virus, transmission of hepatitis D from mother to newborn is uncommon. The hepatitis D virus causes hepatitis only in people who already have a hepatitis B infection. Hepatitis E is rare in the United States. When it has occurred abroad, it has been associated with drinking contaminated water. Hepatitis Viruses Type Transmission Prognosis A Fecal-oral (stool to mouth), contaminated food and water Expect full recovery. B Blood, needles, sexual 10% of older children develop chronic infection.90% of newborns develop chronic infection. C Blood, needles; often unclear Expect chronic infection. D Blood, needles, sexual Makes hepatitis B infection more severe. E Traveler: fecal-oral, contaminated food and water Expect recovery, although pregnant women are at risk for severe disease. Others A variety of viruses can affect the liver Signs and Symptoms Hepatitis symptoms tend to be similar from one virus type to another. Many of these symptoms are flu like, such as fever, nausea, vomiting, loss of appetite, and tiredness, sometimes with pain or tenderness of the liver in the right upper abdomen. A hepatitis infection is also associated with jaundice, a yellow discoloration of the skin and a yellowish color to the whites of the eyes. This is caused by inflammation and swelling of the liver with blockage and backup of bile (bilirubin) into the blood. This backup also usually causes the urine to turn dark orange and stools light yellow or clay colored. However, many children infected with the hepatitis virus have few if any symptoms, meaning you might not even know that your child is sick. In fact, the younger the child, the more likely she is to be symptom free. For example, among children infected with hepatitis A, only about 30% younger than 6 years have symptoms, and most of them are mild. Symptoms are more common in older children with hepatitis A, and they tend to last for several weeks. Children infected with the hepatitis B and C viruses are often free of symptoms or have only a very mild illness. When to Call Your Pediatrician If your youngster has developed any of the symptoms associated with hepatitis, including jaundice, or if she has had contact with someone who has hepatitis (eg, in a child care center), call your pediatrician. How Is the Diagnosis Made? If your pediatrician suspects that your child has hepatitis, your pediatrician will conduct a physical examination and take a thorough medical history to determine whether your child may be at risk of getting the infection. Your doctor may also order a simple blood test that can determine whether your child is infected with the hepatitis virus and if so, which type. Treatment In most cases, no specific therapy is given for acute hepatitis. The child’s own immune system will fight and overcome the infecting virus. Your pediatrician will recommend supportive care for your child, which can include rest, a well-balanced diet, and lots of fluids. Do not give your child acetaminophen without talking to your pediatrician first—there is a risk of toxicity because her liver may not be fully functioning. Your pediatrician may also want to reevaluate the dosages of any other medicines your child is taking. They may have to be adjusted because of changes in the liver’s ability to manage the current dosages. If a child develops chronic hepatitis B or C, your pediatrician will probably send her to a specialist in gastroenterology or, in some instances, a liver specialist (hepatologist). Medicines such as interferon and ribavirin are used in adults with chronic hepatitis, but there are limited studies of these drugs in children. Your doctor may recommend enrolling your child in a study using these medicines or others. What Is the Prognosis? Most children with hepatitis fully recover. The mild symptoms of hepatitis A, for example, tend to resolve on their own within a month or less, and your child will be back to normal. Chronic infections are extremely rare. Some children with acute hepatitis B, particularly those who have contracted it before 5 years of age, develop a chronic infection. These children can become lifetime carriers of the virus. In certain cases, the chronic liver infection causes progressive damage, leading to scarring (cirrhosis) and liver cancer. Hepatitis C infections become long lasting in at least half of the children who develop this infection. In adults, chronic hepatitis leads to cirrhosis in 60% to 70% of patients, while in children this is unusual (less than 5%). Prevention Vaccines are available to protect children from hepatitis A and B. The hepatitis A vaccine is approved only for youngsters 2 years and older. The hepatitis A vaccines, however, are not recommended for everyone, but should be given to children living in US communities with consistently high hepatitis A rates. Other groups considered high risk, including certain travelers, should also be vaccinated for hepatitis A. When immediate protection is needed following close contact with a person with hepatitis A, your doctor may recommend an injection of immune (gamma) globulin. The hepatitis B vaccine is part of the recommended series of immunizations given to children beginning at birth. Your child should receive a total of 3 doses of the hepatitis B vaccine. Although there is no vaccine specifically for hepatitis D, the hepatitis B vaccine should protect against hepatitis D. Hepatitis D cannot develop unless a hepatitis B infection is already present. To further lower your youngster’s risk of hepatitis, she should practice good hygiene and avoid contaminated food and water. Encourage your child to wash her hands before eating and after going to the bathroom. If she spends time in a child care setting, make sure the staff practices good hand washing behaviors, especially after changing diapers and when preparing and serving food to children. Before traveling with your child to foreign countries, ask your pediatrician about the risk of exposure to hepatitis and any precautions that your family needs to take. In some cases, your pediatrician may recommend that your child receive the hepatitis A vaccine or an injection of gamma globulin, or both, before traveling abroad. General food precautions for travelers should be observed. Last Updated 11/21/2015 Source Immunizations ＆ Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)","{
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20,"2018-04-19 03:01:36","Hepatitis C","Hepatitis C Page Content Article BodyWhat is Hepatitis C and why should I be concerned about it? Hepatitis C virus is a virus that can cause liver disease. Although most people recover from the initial phase of HCV infection, up to 80% of them may develop evidence of chronic liver infection that may lead to much more serious liver problems and possibly death. Hepatitis C virus is the cause of approximately 10,000 deaths each year in the United States. Symptoms of HCV Infection with HCV usually begins as nothing more than a mild flulike illness (although many babies and children show no symptoms). Some people may experience one or more of the following: Flulike symptoms (body aches, fever, diarrhea, or nausea) Extreme tiredness Lack of appetite or weight loss Dark yellow urine Light, clay-colored bowel movements Stomach pain, especially in the upper right side of the abdomen Jaundice (a yellowing of the eyes and skin) Infants with HCV infection also may have an enlarged liver or spleen, grow more slowly, or fail to gain weight. If your child has some of the symptoms of HCV infection, contact your pediatrician. Be sure to tell your pediatrician if your child has been exposed to anyone with HCV. To diagnose HCV infection, your pediatrician will examine your child and test your child's blood for the virus. How HCV is Spread Hepatitis C virus cannot be spread by touching, hugging, or kissing. Therefore, children with HCV infection can participate in all normal childhood activities and should not be excluded from child care centers or schools. However, because it can be spread through contact with blood, parents of children with HCV infection should make sure household items such as toothbrushes, razors, nail clippers, or other items that may contain small amounts of blood, are not shared. Hepatitis C virus also can be spread through sexual contact. Infected teens and young adults should be strongly advised to avoid having sex. If they are going to have sex, they need to use latex condoms to prevent the spread of HCV. Drinking alcohol also should be avoided by anyone with HCV infection because alcohol can speed up liver damage. Long-Term Effects of HCV Infection In some children, HCV infection can lead to persistent liver disease in the form of cirrhosis or scarring of the liver. Cirrhosis occurs when the liver cells die and are replaced by scar tissue and fat. The liver eventually stops working and can no longer remove wastes from the body. Infants who develop cirrhosis of the liver because of chronic HCV infection may require a liver transplant to survive. Children infected with HCV also are at risk for developing other serious liver diseases, including liver cancer. Hopes for a Cure While at the present time there is no vaccine to prevent hepatitis C, hope for treatment is on the horizon. Recent medical advances may result in the testing of several new drugs for HCV infection within the next few years. Last Updated 11/21/2015 Source Hepatitis C (Copyright © 2003 American Academy of Pediatrics)","{
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