Thursday, October 28, 2010

Osteochondroma(Exostosis or Benign Bone tumor)

Osteochondroma is a developmental abnormality where a part of the growth plate forms an outgrowth on the surface of the bone.

2 types of osteochondroma

Solitary-this is the most common tumor which accounts to 35% of all the benign tumors. This grows with a child or adolescent and usually stops at maturity. This is usually diagnosed in patients age 10 to 30 years old, it occurs equally in males and females. We do not know the cause of this and there is no way to prevent this from occurring in some patients.

Multiple Osteochondromatosis-this are multiple osteochondroma(more than 2) which is familial (it usually runs in families). It is 70% inherited and only 30% that occurs randomly. It usually occurs within the first three decades of life. Males are more often affected than females.

This can be affected depending where the lesions are located. A patient may have deformities of the forearms and a short stature. This is caused by abnormal growth from the growth plates.

Symptoms and signs of a tumor becoming cancerous
  • Growth of osteochondroma after puberty
  • Pain at the sight of an osteochondroma
  • A cartilage cap larger than two centimeters


x-ray of the affected long bone

if cancer is suspected MRI and CT Scan is indicated.


Nonsurgical treatment-tumors with no signs of cancer and are asymptomatic are just watched carefully

Surgical Treatment-if the tumor causes pain and deformity the portion of the bone need to be removed

This is usually monitored by the Orthopedic surgeon.

American Academy of Osteopathic Surgeons

Tuesday, October 26, 2010

What is Cholera?

We have not seen this type of gastroenteritis for a long time but when we flip through the news it has been spreading in Haiti. It has caused several deaths because of severe dehydration.
Cholera is characterized by voluminous diarrhea without abdominal cramps or fever. Dehydration and shock can occur within 4-12 hours if fluids losses .are not replaced. Stools are colorless with small flecks of mucus "rice-water". Most infected people have no symptoms and some only have mild to moderate diarrhea lasting 3 to 7 days,fewer than 5% have severe watery stools with dehydration.

Humans are the only documented natural host in ingestion of contaminated water or undercooked/raw shellfish, raw or partially dried fish,moist grains,moist vegetables. Direct person to person contact has not been documented.

Oral or parenteral rehydration to correct dehydration and electrolyte abnormalities,
Oral rehydration solution is preferred unless the patient is obtunded or is in shock. The World Health Organization's oral rehydration solution has been the standard.
Antimicrobial therapy can eradicate the bacteria more quickly. The drug of choice is oral doxycycline as a single dose or a 3 day dose of tetracycline. This medications are not usually given to children younger than 8 years of age but if the patient has cholera the benefits might outweigh the risks in administering the medication. If strains are resistant to the tetracyclines you can give the ciprofloxacins, ofloxacins and the trimethoprim-sulfamethoxazoles.

Control Measures:

Hygiene - disinfection or boiling of water prevents transmission, appropriate hand washing after defecating is appropriate. Keep food promptly refrigerated.
Treatment of Contacts - administration of antibiotics within 24 hours of identification of cholera may prevent infection among household contacts
Vaccine -there is no vaccine currently available for cholera in the United states but there are 2 vaccines available but this are not proven to be effective at all, no country requires the cholera vaccine for entry

What is the Newborn Screening?

This a program from the State of Arizona that screens all newborns for disorders that if diagnosed early enough can be treated. There are also different programs for the different states with regards to the newborn screeen.This comprise of a blood spot screening which detects 28 disorders and a hearing test. The blood spot specimens are analyzed by the State Laboratory. Most babies are born healthy and the screening can identify ones with problems. Approximately 300 newborns each year in Arizona has been identified to have some type of disorder. They can develop organ damage, developmental deal, mental retardation and even death. The disorders can not be cured but it can be treated to avoid or limit the complications.

The test must be timely. The first bloodspot test should be done between 24 and 36 hours of age or prior to discharge from the hospital. For some disorders, false negative results can occur with later testing. The second screen should be done at the first outpatient visit between 5 and 10 days of age.

The hearing test is done in the hospital and any re-screening should be done within 2 weeks and diagnostic testing should be done as soon as possible following the failed outpatient scree. Completing diagnostic testing before three months of age ensures that testing can be done without anesthesia or sedation.

The Arizona screening panel includes:
  • 6 amino acid disorders
  • fatty acid oxidation disorders
  • 9 organic acid disorders
  • Biotinidase deficiency
  • Classic galactosemia
  • Congenital Hypothyroidism
  • Congenital Adrenal Hyperplasia
  • 3 hemoglobin diseases
  • Cystic Fibrosis
  • Hearing loss

The incidence in the population is rare, but the potential devastating results and the high costs of treating undiagnosed infants is thought to justify the mass screening. Hearing loss is the most common approximately 2-4 per 1000 births,

Arizona Newborn Screening Program Guidelines-August 2010

Friday, October 22, 2010

Gastroesophageal Reflux in Infants

This is defined as the passage of gastric contents to the esophagus. Once the food reaches the stomach this will be mixed with acidic enzymes that help break down the food in smaller pieces. If the contents of the stomach goes to the esophagus this may cause problems in some babies, because the lining of the esophagus is not designed to hold acidic substances. Most babies have some kind of gastroesophageal reflux but are not bothered by it, they are what you call "happy spitters". Once the babies show symptoms this is called gastroesophageal reflux disease.
Reflux results from the transient relaxation of the lower esophageal sphincter.

Signs and symptoms of GERD (Gastroesophagel Reflux Disease):
  • recurrent vomiting
  • poor weight gain
  • weight loss
  • difficulty swallowing
  • abdominal pain
  • chest pain
  • coughing
  • regurgitation
  • apnea
  • wheezing
  • hoarseness
  • stridor
  • abnormal neck posturing (Sandifer syndrome)
  • refusal to eat

Diagnostic Approaches

1. Most of the diagnosis of GERD/GER can be obtained by a careful history and physical examination

2. Upper Gastrointestinal Series (UGIS) this is a series of abdominal x-rays which can rule out any anatomical reason for the symptoms

3. Esophageal pH monitoring-this is a useful, valid and reliable test to see the correlation of reflux with the symptoms. We usually hospitalize the baby and insert a probe close to the lower esophageal sphincter and monitor the heart rate, respiratory rate and oxygenation. This is also used to assess the response to treatment.

4. Endoscopy and Biopsy - this is done by a gastroenterologist, they put a tube down the esophagus and get a tissue sample to check if there is any type of inflammation that has been occurring in the area.

5. Empiric Medical Therapy - A trial of medication can be useful if the GER is causing and specific symptoms

Treatment options:

  • there is evidence to support a trial of a hypoallergenic formula for 1-2 weeks may work
  • may add 1 tsp of rice cereal to an ounce of formula this will of course will increase the caloric density of the formula
  • positioning the infant, elevate the head at a 45 degree angle when sleeping and do nor move the baby too much after feeding
  • Acid-Suppressant therapy-this blocks the production of acid which in turn relieves the symptoms
  • Prokinetic therapy - this reduces the incidence of regurgitation and vomiting but with the multiple side effects of the medications this has not been readily available in the market
  • surgical therapy - this is the last resort which generally results in a favorable outcome

Tuesday, September 28, 2010

What are enlarged adenoids?

Adenoids are a collection of lymphoid tissue that runs through the nasal passages and to the back of the throat. This filters bacteria, viruses to prevent it from entering the body, while doing this it can grow big (hypertrophy). This can grow big enough resulting in blockage of the nose, obstruction of the eustachian tube and can block the clearance of mucous. The adenoids usually involute by 5 years of age but some persists beyond this age and cause problems.

Signs and Symptoms
  • mouth breathing
  • persistent cold symptoms that does not seem to get better
  • voice can be altered with a nasal, muffled quality to it
  • coughing worse a night from purulent drainage
  • chronic ear infections
  • loud snoring with periods of cessation of breaths (apnea)
  • chronic sinusitis
  • bad breath
  • impairment of taste and smell
  • can not sleep through the night, tosses and turns
  • seem to wake-up very tired
  • chronic sinus infections


The adenoids can only visualized indirectly by using mirrors. When a patient opens their mouth you see the tonsils but not the adenoids. Some doctors order an x-ray of the neck to see the size of the adenoids whether this encroaches the airway.


This can only be cured by surgical removal of the adenoids with or without the tonsils. This is done by a qualified Ear, Nose and Throat specialist. The patient undergoes general anesthesia and wakes up in the recovery room. They do not need to make any skin incision because they can go through the mouth. Healing takes a few weeks to occur but recovery is great. Patients are advised to eat soft, mush diet and cold foods are also recommended (ice pops, ice cream...)

Friday, September 24, 2010

Similac Recall

Abbott the company that produces Similac is recalling some products following an internal review, which detected the presence of a small common beetle in the formula in one of their manufacturing factories. There is a possibility that infants who accidentally ingest this can have some stomach cramps and may refuse to eat.

The recall includes the following:
  • certain Similac powder product lines offered in plastic containers
  • certain Similac powder lines offered in 8-ounce, 12.4 ounce and 12.9-ounce cans

Please visit to check if the product that you have included in the recall. You may also call 1-800-986-8850

Friday, August 27, 2010

Sleep Tight and Do not let the Bed Bugs Bite

Bed bugs are small insects that feed on the blood of mammals and birds. They are sometimes referred as "red coats", "chinches" or "mahogany flats". They are usually active at night but when they are hungry they feed during the daytime. They usually populate human dwellings, birds nests or bat caves since this offers warmth a place to hide and a host to feed on. They usually populate human dwelling especially if it is crowded. They live in cracks, crevices in walls, furniture, behind wood paneling, behind wallpaper or under carpeting. They can be transferred from one place to another via clothing, luggage, bedding and furniture. They do not have the means to cling to hair, fur or feathers and are rarely found in hosts.

Bed Bugs do not carry any danger to man,it is basically a nuisance. They usually work at night when you are sleeping and the bite is painless. Most people do not react to them but there are a few individuals who will be allergic to their saliva resulting in welts, itching and swelling. The typical lifespan is 10 months and can survive for weeks without feeding.

How to get rid of "BED BUGS?"
  • wrapping in big plactic containers infected mattress or small items to suffocate the bed bugs
  • expose the mattress to intense cold or heat or you can wrap it in special plastic bags to get rid of the bedbugs
  • wash all bedsheets, clothes and curtains in hot water on a regular basis
  • vacuum and steam-clean carpets
  • use insecticides for household use only with "pyrethins" as an active ingredient
  • do not bring in old mattresses and box spring sets and old furniture which can harbor the bed bugs (if you must try to inspect the seams of the mattress inside the box)
  • seal all cracks and crevices in the house which are hiding places for the bug
  • using a hot blow dry aim this at the crevices to force the bugs out

They are one of the most difficult things to treat because they can hide very well. If all fails call the pest control guy.


Wednesday, August 18, 2010

Salmonella from Eggs

According to the Center's for Disease there is a countrywide recall of shelled eggs because they found out that it had caused several outbreaks of Salmonella in California, Colorado and Minnesota. On August 13, 2010, Wright County Egg of Galt, Iowa conducted a nationwide voluntary recall.
Tips to reduce the risk of getting Salmonella from eggs
  • keep eggs refrigerated at <45f(<7c)>
  • discard cracked or dirty eggs
  • wash hands, cooking utensils and food preparation surfaces with soap and water after contact with raw eggs
  • eggs should be cooked until both the white and the yolk are firm and need to be eaten promptly after cooking
  • do not keep eggs warm or at room temperature for more than 2 hours
  • refrigerate unused or leftover egg-containing food promptly
  • avoid restaurant dishes made with raw or undercooked, unpasteurized eggs
  • consumption of raw or undercooked eggs should be avoided especially by young children, elderly persons, persons with weakened immune systems or debilitating illness

Symptoms of Salmonella

  • diarrhea after 12-72 hours of ingestion of contaminated food or beverage
  • abdominal cramps with fever

illness may last for 4-7 days and most persons recover without antibiotic treatment.

Information for the Center's of Disease

Imperforate Anus

This is a congenital anomaly where the rectum ends in a blind pouch and you might have an opening into the vulvovaginal area in females and urethra in males. This is considered a disorder which have occurred during embryogenesis in the hindgut. This occurs in 1 in 5000 livebirths with slight male preponderance. This are classified into two kinds a low lying and a high lying rectal pouch. The experts use the pubococcegeal line as a guide to determine if the lesion is high or low. High lesions usually come with an underlying fistula wither rectourinary or rectovginal fistula.

This is present at birth and the first things that happens is that you would not notice stools in the first 24 hours and this could be associated with abdominal distention. In some cases where there is a fistula you can see the stools and the urine seem to come in the same opening. If you notice this the first thing to do is transfer the baby at a pediatric surgical center,do not feed the baby temporarily then administer IV fluids and IV antibiotics specially when there is a fistula through the urinary tract. We worry about t a urinary tract infection.
Diagnosis can be done with a combination of physical examination and and x-rays.
this is associated with the VACTERL syndrome (vertebral anomalies, anal atresia, cardiac problems, Tracheoesophageal fistula, renal problems and limb abnormalithes.

Need to watch for constipation as the child grows bigger and to take care of this problem medically. The surgeon is consulted for anoplasty and serial dilations will be done. colostomy is done for high lesions.

Tuesday, June 22, 2010

Puberty is the product of Change

This is a stage in ones life that changes occur rapidly. Between early childhood and 8-9 years
of age the part of the brain that secretes the sex hormones are dormant. After this stage the hormones start to secrete and produce its effect. The onset of puberty is more related to skeletal maturity than to chronological age.

In girls, the breast bud is usually the first sign of puberty (10-11 year)
followed by the appearance of the pubic hair 6-12 months of age later and menarche will
follow between 2-2.5 years but may take as long as 6 years, In the United States the
peak age of menarche is 12.75 years old. There are however a wide variation in the stages
of development.

In boys, the first sign of puberty is testicular enlargement. Pubic hair then appears.
Growth acceleration in boys occur 2 years after the girls but can still continue till they are 18 years old. The pattern of sexual development follows parent's genetic pattern. If both parents develop early the chances that the children will also develop early is a highly likely.

What is considered pubertal delay?

  • no signs of pubertal development by age 14 years old, in girls
  • greater than 5 year interval between thelarche (breast development) and adrenarche (pubic and axillary hair development) in girls
  • no signs of testicular enlargement by age 14 years old
  • greater than 5 years for genital development
  • primary amenorrhea no menarche by 16 years old with presence of secondary sexual characteristics
  • primary amenorrhea no menarche by 14 years old without secondary sexual characteristics

What is defined as precocious puberty?

  • traditionally defined as any sign of secondary sexual maturation before 8 years old in girls and 9 year old in boys

**recent data suggest early puberty may not even warrant extensive work-up if it occurs after 6 years old in African American girls and after 7 years old in white girls**

Wednesday, June 9, 2010

Protect your child from the Sun's rays

The temperature has been heating up again here in Arizona. The scorching heat went up to 110 degrees F last weekend and we can not but re-emphasize to everyone the importance of sun protection. It has been tempting to go dip in the pool during the middle of the day but that sun's rays are at its peak at this time

According to the American Academy of Pediatrics the sun's invisible ultraviolet rays are what cause damage to your child's skin even on foggy or hazy days . Hats and umbrellas do not completely protect children because UV lights reflect off the sand, water and other surfaces.

To protect against sun damage the AAP offers the following suggestions:

  • Keep children away from the sun between 10am to 4pm
  • use sunscreen with a sun protection factor(SPF) of at least 15. Apply 30 minutes before going outside and reapply every 1.5 to 2 hours especially while in water
  • dress your child in a light cotton outfit with long sleeves and long pants and a wide brimmed hat
  • use a beach umbrella to keep the child in the shade
  • keep babies under 6 months of age away from the sun. Sunscreen maybe used in small areas of the body such as the face and the back of the hands
  • the skin is not the only thing that needs protection but sunglasses are very important to protect your eyes


The Importance of Immunizing your Child

Please take a look at the link from the American Academy of Pediatrics on the Importance of immunizing your child and following th recommended schedule.

Monday, June 7, 2010

Periorbital cellulitis and Orbital cellulitis

Postorbital cellulitis

Periorbital cellulitis

Periorbital or preseptal cellulitis is the inflammation of the eyelids and the other soft tissues outside the orbit. This can be caused by trauma, or by an infected wound or an abscess in the lid. This can also be caused by a stye, conjunctivitis, infected blocked tear duct and insect bite. The most important thing to consider is to differentiate this with orbital cellulits which involves the inflammation of the tissues of the orbit with proptosis and limitations of eye movement. Sometimes it is hard to differentiate the two especially when the eyes are really swollen and it is hard to examine the movement of the eye. We then order a CT scan of the head and the orbits to determine if there is extension in the orbits. Orbital cellulitis follows a direct infection from a wound, deposition of organisms from the eyelids, conjunctiva, metastatic involvement from a tumor. The most common cause in children is paranasal sinusitis. Orbital cellulitis have complications which result in meningitis and cerebral abscess . Prompt hospitalization with intravenous antibiotic therapy and surgical drainage of the infected sinuses are part of the treatment.

Monday, May 10, 2010

Ventricular Septal Defect (VSD)

VSD is the most common congenital anomaly of the heart and it accounts for 15-25% of congenital heart disease. This is described as a "hole in the heart". The heart is made of 4 chambers the right and left atrium on top of the right and left ventricles. Unoxygenated blood comes from all the body and is channeled into the right atrium this then goes to the right ventricle and this gets oxygenated through the lungs then passes the left atrium to the left ventricle and this becomes oxygenated blood that gets distributed through the aorta to the rest of the body. The VSD is basically a hole in between the chambers of the ventricles that result in mixing of the oxygenated and unoxygenated blood.

Usually for the first few weeks of life a heart murmur can be heard by your doctor and most of the babies will be asymptomatic especially when the VSD is small. In some cases when the VSD is moderate or large the babies will not be gaining enough weight. They will be breathing faster than usual and sometimes their color looks dusky from time to time.

Small VSD usually close over time. This will be followed-up by the baby's cardiologist Moderate to large VSDs might need surgical intervention but they do not do the surgery till the baby is about 6 months of age. They want the baby to be gaining enough weight by giving them a high caloric diet at 24 to 26 kcal per ounce and putting some feeding tube to help them gain weight.They also start them on some diuretics or heart medicine to help maintain them and try to control their symptoms.

The great thing about this ventricular septal defects is that most of them resolve on its own and it is easily correctable by surgery.

Tuesday, May 4, 2010

What is Bell's Palsy?

The chief complaint that you would hear most of the time would be "one side of my child's face does not seem to be moving, this is more noticeable when he cries, laughs or screams". The child will be unable to close the eye on the affected side and the corner of the mouth will droop. This is considered a common disorder in infancy to adolescence. Taste on the front of the tongue might be lost but there should be no numbness to the area. The most important thing you want to prevent is dryness of the affected are which will result in keratitis. Your doctor will prescribe some eye drops to prevent this from happening. The facial nerve on the affected side is considered to be swollen thus this symptoms appear.

The most common reason for this palsy is that the child had some type of viral infection approximately 2 weeks prior to the event. Most common cause is the Epstein-Barr virus, Lyme disease (you usually see this in the Northeast area), herpesvirus and mumps virus. This has excellent prognosis because 85% will resolve completely without residuals, 10% with very mild residual weakness and only 5% are left with severe facial weakness.

Steroids do not induce remission and is not recommended but since the pathophysiology is swelling of the facial nerve some people think that this might help a little bit. If palsy seems to be chronic or persistent you need to consider other facial nerve tumors that can impinge on the nerve to present with the symptoms. Physical therapy might help a little bit in the recovery process.

Monday, April 5, 2010


Koplik's Spot
Measles Rash

Measles remains the most common disease in other parts of the world and this is the leading cause of vaccine preventable deaths among young children. There has been pockets of epidemics in Europe and South Africa in the last year according to the Centers for Disease Control and Prevention. Immigration can not be avoided and exposure to the measles virus is inevitable in the United States. The problem is with the scare that "MMR is linked to autism" there are a number of families who refuse to vaccinate their children and it will only be time before we see this spread all over the country. Since most physicians have not seen measles for a long time they may not be familiar with how it presents.

Signs and Symptoms
  • fever
  • runny nose

  • cough

  • watery eyes/conjunctivitis

  • erythematous maculopapular rash
  • Koplik's spot (rash noticed in the inner cheek area)


  • croup
  • ear infections
  • pneumonia
  • diarrhea
  • encephalitis (Infection of the brain)
  • subacute sclerosing panencephalitis (SSPE) a rare degenerative central nervous disease characterized by behavioral and intellectual deterioration and seizures

The only natural hosts of the measles are humans and is transmitted by direct contact with infectious oral droplets. Incubation period is from 8 to 12 days from exposure to onset of symptoms. There is a specific antibody test for measles IgM antibody to test for the infection.


There is no specific treatment for measles, it is mostly symptomatic . The vaccine is most most effective in preventing this from occurring.

Resource: and the redbook

Monday, March 22, 2010

What to do with my Biting Toddler?

Biting behavior in toddlers is a developmental response to frustration and anger. Remember that the communication skills at this age is very limited and they do not know how to respond to their environment. Toddlers who bite do not do this purposefully or maliciously. You can not assume that the child is willfully misbehaving. If you know that this is a developmental response we can intervene and teach him the right way to react to what he feels.

  • Do not bite him back because this is sending him a wrong message that biting is okay and he will be repeating it again.
  • Watch and re-direct - if he is at home and you are in the vicinity you can pretty much predict when he starts getting upset and will start to bite, try to re-direct his attention by showing him a different activity or a different toy, try to distract him. You can instruct the people at the daycare to do the same thing.
  • Teach - when a biting episode happens look into his eye sternly and talk in short sentences "biting is not good", "do not bite". Long winding explanations do not work with toddlers the meaning will be lost after a few seconds. Try to go and console the victim and make sure to let him go close to the victim to show him what he has done to cause harm.
  • Avoid playful biting - this can send mixed signals to the toddler that it is alright to bite
  • Time outs - If biting becomes worse we need to result to timeouts. One minute for each year of age. You look into their eyes and tell them in short sentences what they did wrong and go to the time out chair. This may take awhile before they understand it. Do not do this longer than the recommended time because if they stay there longer they might forget what was the reason they were put in timeout in the first place.
  • Change Day cares - you can try to look for a daycare with smaller class sizes, sometimes toddlers get frustrated when they do not get the attention so they will try to do things to get it whether it is good or bad.

First Aid for Bites:

  • after a bite wash the area very well with soap and water
  • call your pediatrician if there is a break in the skin because this might warrant prophylactic antibiotics, the mouth has a lot of bacteria which might result in infection

New Car Seat Recommendations

The newest recommendation by the American Academy of Pediatrics is that the infant needs to be rear-facing in a car seat till they turn 2 years of age. Multiple studies have shown that infants survive the accident better with less injuries facing backwards than forwards.

  • birth to 2 years of age up to 35 lbs rear-facing

(get a rear-facing convertible seat for children up to 35 pounds)

  • over 2 year of age forward facing car-seat with a harness
  • under 4 feet 9 inches tall booster seat
  • over 4 feet 9 inches tall-safety belt in the back seat
  • All children under the age of 13 years old should ride in the back seat

What is the Arizona law?

The Arizona Child Passenger Restraint Law says that children under 5 years of age need to be in a child passenger restraint device when in a moving vehicle.

As you can see what is lawful in Arizona may not be safe for the children. Children older than 5 years of age and under 4 feet 9 inches still needs to be in a booster seat.

Wednesday, February 10, 2010

Hepatitis C

This is a virus that is indistinguishable from the signs and symptoms of Hepatitis A and B. The only way to differentiate this is to obtain a blood work for the hepatitis panel.

Signs and Symptoms:
  • fever
  • malaise
  • anorexia
  • nausea
  • vomiting
  • jaundice
  • hepatitis
  • asymptomatic

They noticed that jaundice secondary to Hepatitis C occurs less than 20% of the time and abnormalities in liver function is less pronounced as compared to Hepatitis B. Persistent infection in children occur 50-60% of the time but most children are asymptomatic. Studies on therapy has been limited and the available mode of treatment is only effective half of the time. With advancing age people who have chronic hepatitis C infection are a a risk of developing chronic hepatitis and possible cirrhosis or hepatocellular carcinoma. Children with chronic infection should be screened periodically.

There is a 5% chance an infant of an infected mother would acquire the infection. The anti-HCV test should not be performed until after 18 months of age because it might result in a false positive because of passive maternal antibody which is present in their bloodstream.

Resource: The Redbook by the American Academy of Pediatrics

Monday, February 1, 2010

What is Intussusception?

This is the most common cause of intestinal obstruction from 3 months of age to 6 years old. This usually involves the lower gastrointestinal tract resulting in a telescoping of the more proximal part into the distal portion of the gut. There is a male to female predominance as 4:1. As a pediatrician this is one of the differential diagnosis we think of once babies are inconsolable .

Signs and Symptoms:
  • sudden onset of severe paroxysmal colicky pain
  • infant looks normal in between episodes
  • this can be accompanied by straining and loud cries
  • if this is not reduced the infant will become progressively weak and lethargic
  • vomiting may occur early in the course
  • blood may start passing within the first 12 hours which is called the currant jelly stool because mucous and blood are intermixed together, but this might not occur in 1-2 days in some cases


The history and physical is usually sufficient to diagnose this entity. Plain abdominal x-ray maybe warranted to show signs of obstruction. Barium enema will show a filling defect resulting from the obstruction.

Differential Diagnosis:

It is particularly difficult to sometimes differentiate this from gastroenteritis. Meckel's diverticulm is usually painless with bloody stools. The bloody stools from Henoch-Schonlein Purpura usually have joint pains.


This is considered an emergency procedure once diagnosis is certain and if there are no signs of shock or dehydration reduction by using an air enema is thetreatment of choice if not exploratory laparotomy with manual reduction by the surgeon is indicated.

Wednesday, January 20, 2010

My baby has ACNE!

Neonatal Acne
This usually appears after a few days after birth. You will notice small papules usually on the nose, cheeks of full term infants. This is a normal response to mother's hormones which stimulate the glands on the face. You do not have to do anything because this resolves spontaneously by 4 to 6 months of age. Just clean face with plain water. Do not put any lotions, soaps on the area. This might just irritate your baby's face.

Tuesday, January 19, 2010

My Newborn Has a Rash

Erythema Toxicum
This rash usually appears after 24-48 hours after birth and can appear up to the 10th day of life. This is a benign and self-limiting condition with the cause unknown. This was called as "flea bites of the newborn"because it is very similar to how flea bites look like. The rash are usually 2 to 3cm in diameter and you can have vary from a few lesions to a hundred and when you look closely you will see a central pustule or papule. This can be found on the face, arms, back, chest and abdominal area. The palms and soles of the feet are spared. This usually resolves in 5-7 days of age and no treatment is necessary.

Friday, January 8, 2010

Doctor My Baby has an "outie"!!

We often hear parents tell us that their baby has an outie and grandmother would recommend putting a coin on the umbilicus to strap it down to help make this better. An outie is a bulge on the umbilicus which is more prominent when the baby cries, coughs or strains. We call this an"umbilical hernia". This is due to the imperfect closure or weakness of the muscles in the umbilical ring. The size of the defect ranges from 1cm to 5cm but larger ones are rare. Most umbilical hernia that appear before 6 months of age will resolve by 1 year of age. Even large ones at 5-6cm spontaneously resolve by 5-6 years of age. The chances of the intestinal contents be trapped through the defect is rare. Surgery is only indicated if the defect progressively becomes large after the age of 2 or if this is greater than 2cm big. This is less likely to resolve spontaneously and if it persists by the age of 3-4 years old. The other indication for surgery is that if the hernia is strangulated. So now we now know that putting a coin on the umbilicus would not help in the treatment of an umbilical hernia.

Tuesday, January 5, 2010

Childproofing Checklist

  • first things first get all the poisonous substances(detergent, bathroom cleaners...) and put on higher ground (so children can not reach)
  • make sure the sharp edges of the tables and corners are protected by edge bumpers
  • door stops and door holders are essential
  • do not put the cribs close to the blinds with the strings hanging, babies can get strangulated on these cords
  • smoke detectors (make sure you have one at each level of the house)
  • all swimming pools at home should be gated accordingly adhering to the federal standards
  • safety latches and locks (especially for the kitchen and the bathroom cabinets and drawers)
  • safety gates (preferably the ones that screws on the walls)
  • window guards(bars in guard should not be more than 4 inches apart)-make sure you have a window that can be used as a fire escape
  • outlet covers (make sure you get the ones that the child can not remove)
  • carbon monoxide detectors
  • when you visit someone or when you have visitors, make sure all the purses are out of reach (they can have a different kinds of medications in their purse that you do not want your child to get into)

Once everything is in place the last thing you need to do is get down on your knees and crawl all over the house to see what else your child might be interested in to get to it and do something to make your house safe. Try to do the childproofing of your house as early as 4-6 months of age and re-evaluate every few months to see if it is still effective protection according to your child's developmental stage. Remember children can outgrow the way you childproof your house. Re-evaluate from time to time.

Head Injury

Once your child turns 6 month to 5 years of age you need to be very careful about minor head injuries. Babies' heads are a little bit big compared to their bodies so basically they are top heavy. Their coordination is not very good but they are very brave and go were no adult would boldly go because they do not know better. Most minor head injury in infants and young children are preventable and close adult supervision can not replace any state-of-the-art childproofing equipment that you might use.

What are the signs and symptoms of a mild head injury?
  • child crying but consolable
  • minor scalp swelling
  • minor cut or laceration of the scalp
  • mild headaches
  • vomiting 2 to 3 times

What are signs and symptoms of a potential serious injury?

  • crying non-stop and inconsolable
  • on feeling the scalp area you might feel a cracking sound there might be a fracture
  • blood or clear fluid coming from the nose or ears
  • obvious serious wound i.e. a big laceration or swelling
  • seizures
  • loss of consciousness
  • vomiting more than 2-3 times after the injury
  • changes in behavior such as increased sleepiness, agitation, confusion or sluggishness
  • headaches are getting worse

Call you doctor or 911 if you see any of the signs and symptoms of a potential serious injury.

Prevention is the Key:

  • avoid letting your baby sleep on the bed (they tend to roll over and fall), I can not but emphasize this so many times but still a lot of the parents are letting toddlers/infants sleep with them.
  • do not use walkers (they become a little more mobile than what their development can handle so they tend to pull on things resulting in furniture falling on them), they tend to fall on steps (it is actually a good thing here in Arizona that we mostly have 1 story houses with no basements)
  • childproof the house
  • can not emphasize more the need for close adult supervision ( the most important tool is prevention) but sometimes those babies are pretty quick just a few seconds that you do not look at them, accidents happen.