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

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

Diagnosis:

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.

Treatment:

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...)

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 www.similac.com/recall/lookup to check if the product that you have included in the recall. You may also call 1-800-986-8850

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.

Source:

cdc.gov

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.

Symptomatology
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
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.

Treatment
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.

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**