बच्चों की सामान्य बीमारियां (COMMON AILMENTS OF CHILDREN)

तीन या उससे ज्यादा बार पतली टट्टी जाने को दस्त कहते हैं। छोटे बच्चों को दस्त और उल्टी (diarrhoea / diarrhea & vomiting) की शिकायत एक सामान्य बीमारी है। साधारणतः, छः माह से तीन वर्ष के बीच के बच्चों को यह परेशानी/बीमारी ज्यादा होती है। इसी उम्र में बच्चों के दाँत भी निकलते हैं इसीलिए जनमानस में यह भ्रांति होती है की यह परेशानी दाँत निकालने से होती है। हालांकि, इसका दाँत निकालने से कोई संबंध नहीं होता है। बच्चों में दाँत निकालना एक सतत प्रक्रिया है, जैसे बच्चे का बड़ा होना। दस्त और उल्टी की बीमारी कारण अधिकतर बार बच्चे के मुंह से गंदगी (feco-oral route) का जाना है। बच्चों का खाना बनाते या खिलाते समय सफाई की कमी, गंदा पानी, शादी-ब्याह या होटल वगैरह का खाना, छोटे बच्चों द्वारा अशुद्ध वस्तुओं को मुंह से चाटना, बच्चों को बॉटल से दूध पिलाना, एंटिबायोटिक दवाओं सेवन, आदि इसके प्रमुख कारण हैं। स्वच्छता एवं स्वच्छता प्रक्रियाएं अपनाने से बच्चों में होने वाले दस्त कम हो जाते हैं।

उल्टी-दस्त के साथ कई बार बुखार भी आता है। अधिकतर बार बुखार एवं उल्टी एक-से-दो दिन में ठीक हो जाता है पर दस्त को ठीक होने में ज्यादा समय लगता है।

छः माह से छोटे शिशु कभी-कभी बार-बार थोड़ी-थोड़ी पोट्टी करते हैं, इसमें ज्यादा पानी नहीं होता है और मात्रा भी अधिकतर कम ही होती है, इसका रंग भी सुनहरा पीला होता है, इसको दस्त नहीं कहते है। बड़ा बच्चा भी यदि थोड़ी-थोड़ी बार-बार पोट्टी जा रहा पर वह पनीली नहीं है तो उसे दस्त नहीं कहेंगे।

जब दस्त में पानी की मात्रा तो कम होती है पर हर बार दस्त पेट में मरोड़ के साथ ही आते हैं तथा इसमें बलगम और थोड़ी खून की मात्रा भी होती है, इनको पेचिश (Dysentery) कहते हैं। पेचिश कुछ विशेष तरह के बेक्टेरिया या अमीबा के करण होती है। पेचिश के इलाज के लिए एंटिबायोटिक दवा का उपयोग करने की जरूरत हो सकती है।

यदि बच्चा बहुत ज्यादा पानी वाले दस्त कर रहा है या दस्त काफी ज्यादा बार हो रहे हैं या बच्चा ओआरएस (ORS) का घोल वाला पानी नहीं पी रहा है तो दस्त चिंताजनक हो सकते हैं क्योंकि इससे बच्चे को पानी की kakami

उल्टी-दस्त की बीमारी में इलाज बहुत ही साधारण होता है। अधिकतर बार उल्टी तो अपने से ही ठीक हो जाती है, पर कभी-कभी उल्टी की सामान्य दावा जैसे ओरल (Oral) Perinorm या Domperidon जैसी दवाई डॉक्टर से परामर्श करके ली जा सकती है। बुखार के लिए बुखार की सामान्य दावा ओरल (Oral) Paracetamol ही काफी होती है। दस्त के लिए बच्चे को मौखिक पुनर्जलीकरण समाधान (ओआरएस या Oral Rehydration Solution) का लगातार सेवन करना बहुत ही जरूरी है। ओआरएस न सिर्फ बच्चे को निर्जलीकरण से बचाता है, यह दस्त को जल्दी ठीक करने में भी बहुत उपयोगी है। ओआरएस के पाउडर को पानी की सही मात्रा में मिलाकर बनाना बहुत ही महत्वपूर्ण है। सामान्य नियम के अनुसार जितना पानी बच्चे की दस्त में निकलता है उससे थोड़ा ज्यादा ओआरएस बच्चे को पिलाना अच्छा होता है। उल्टी-दस्त के दौरान बच्चे का सामान्य खाना / माँ का दूध आदि यथावत जारी रखने चाहिए। ओआरएस के अलावा ओरल ज़िंक (Oral Zink) भी दस्त की महत्वपूर्ण दवाई है, जो की सभी दस्त की शिकायत वाले बच्चों को जरूर देनी चाहिए। ओरल प्रोबायोटिक्कस (Oral Probiotics) भी दस्त को जल्दी ठीक करने में मदद करती है। समान्यतः यदि दस्त में कोई ब्लड या मवाद नहीं आ रहा हो तो एंटिबायोटिक दवाएँ बच्चे के दस्त को ठीक करने में कोई मदद नहीं करती हैं, एंटिबायोटिक दवायें सेवन दस्त का एक कारण है तथा इनका अनावश्यक सेवन हानिकारक होता है और इससे बचना चाहिए।

ध्यान रखने योग्य बातें: ORS/ ओआरएस के दो तरह के पैकेट आते हैं: एक 200 एमएल पानी में घोलने लिए छोटा पैकेट होता है तथा दूसरा 1000 एमएल पानी में बनाना होता है। यह जानकारी पैकेट के ऊपर लिखी होती है। घोल बनाते समय पानी की मात्रा का ध्यान रखना जरूरी है।

कभी-कभी बच्चे ओआरएस या दवा नहीं पीते हैं एवं जबरदस्ती पिलाने पर उल्टियाँ करते हैं। ऐसे में दवा तो थोड़े से दूध या किसी और घोल में मिला के दी जा सकती है। पर यदि बच्चा ओआरएस नहीं पीता है तो थोड़ी मुश्किल है। बच्चे को जबरदस्ती पिलाने से कम नहीं चलता है। ज़्यादातर बच्चों पर यह विधि काम नहीं करती है। इसके लिए दो ही उपाय हैं। पहला, आजकल ओआरएस कई सारे स्वाद में आता है, तो अलग-अलग स्वाद पिला के देखें एवं जो बच्चा अच्छे से पिए उसे पिलाते रहें। दूसरा, बच्चे को खेल-खेल में दवा एवं ओआरएस पिलाने की कोशिश करें – जैसे अलग-अलग स्वाद का ओआरएस छोटे-छोटे गिलास में भर कर उसके सामने स्वाद से पिये एवं उसे पीने के लिए उत्साहित करें एवं धैर्य रखें।

छोटे बच्चों को खांसी/जुकाम (Cough/Cold) की शिकायत एक सामान्य बीमारी है। साधारणतः, छः माह से पाँच वर्ष के बीच के बच्चों को यह परेशानी/बीमारी ज्यादा होती है। खांसी/जुकाम अधिकतर सामान्यतः ऊपरी श्वास पथ के संक्रमण (Upper Respiratory Tract Infection) के कारण होता है। यह अधिकतर वाइरस (Virus) से होने वाली बीमारी है। ऊपरी श्वास पथ के संक्रमण droplet infection होते हैं एवं एक संक्रमित व्यक्ति से दूसरे व्यक्ति को खाँसने/छींकने के साथ फैलते हैं (सभी सांस की नली और ऊपरी श्वास पथ के वाइरस से होने वाले संक्रमण कोरोना वाइरस के संक्रमण जैसे ही फैलते हैं)। बार बार साबुन-पानी से हाथ धोने एवं खाँसते/छींकते समय मुह्न एवं नाक को मास्क या रुमाल या हाथ से कवर करके रखने से इसका फैलना कम किया जा सकता है।

नौ माह से तीन वर्ष के छोटे बच्चे ज़्यादातर कोई भी वस्तु उठा कर सीधा मुह्न में ले कर जाते हैं। हालांकि यह इनके विकाश क्रम का हिस्सा होता है, पर यह बच्चों में बार-बार होने वाले दस्त और ऊपरी श्वास पथ के वायरल संक्रमण (Diarrhoea & Upper Respiratory Tract Infection) का भी कारक है।

छोटे बच्चों को खांसी/जुकाम (Cough/Cold) सामान्यतः अपने से ही ठीक होने वाली बीमारी होती है। कई बार बुखार और दस्त भी इसके साथ ही होते हैं।

खांसी/जुकाम के संक्रमण के समय अधिकता बार इलाज सामान्य रोगसूचक (symptomatic) ही होता है। अधिकतर बार ज्यादा-से-ज्यादा पानी पीना (यदि संभव हो तो थोड़ा गुनगुना करके), खाना बराबर खाना (छोटे बच्चों को माँ का जारी रखें), ताजे फल और सब्जी का ज्यादा सेवन करना, नमक डालकर गुनगुने साफ पीने के पानी से गरारे करना (ज्यादा छोटे बच्चे गरारे नहीं कर पाएंगे), एवं जरूरत पड़ने पर डॉक्टर की सलाह से साधारण एलर्जी विरोधी (simple anti-allergic) दवा काफी होती है।

जुकाम में नाक में ज्यादा चिपचिपे तरल पदार्थ बनते हैं जिन्हें बार-बार निकालना पड़ता है। बड़े बच्चे और वयस्क तो ऐसा आसानी से कर पाते हैं, पर छोटे बच्चे इसमें असमर्थ होते हैं। वैसे भी छोटे बच्चे ज़्यादातर नाक से ही सांस लेते है और जरूरत पड़ने पर भी अच्छे से मुह्न से सांस नहीं ले पाते हैं। इसी से उनको नाक बंद होने से परेशानी/चिड़चिड़ापन/माँ का दूध अच्छे से ना पी पाना आदि ज्यादा होता है। ऐसे में नाक में डालने वाला नमक के पानी का घोल (Saline Nasal Drops) का इस्तेमाल छोटे बच्चों की नाक के स्राव को निकालने में काफी मदद करता है। इसके एक से दो बूंद बच्चे के दोनों नथुनों में एक से दो मिनिट के अंतर से तीन-से-चार बार डालें। इससे नाक के अंदर जमें स्राव ढीले हो कर बच्चे के छीकने/खाँसने/या रोने के साथ निकल जाते हैं।

बुखार आने पर डॉक्टर की सलाह से साधारण पेरासीटामोल (simple Paracetamol) की दवा काफी होती है। पर बुखार को लगातार माप कर उसका चार्ट बनाना उपयोगी होता है।

यदि दस्त साथ में हों तो दस्त का साधारण इलाज (ओआरएस का घोल, ज़िंक, एवं ओरल प्रोबायोटिक्कस) ही काफी होता है।

साधारण खांसी/जुकाम में अधिकतर बार बच्चे का बुखार101 F / 38.5 C से ज्यादा नहीं होता है और वह एक-दो दिन में ही ठीक भी हो जाता है। जुकाम अधिकतर बार ठीक होने में पाँच-से-सात दिन लगा देता है। बच्चों में खांसी आमतौर पर पूरी तरह से ठीक होने के लिए एक से तीन हफ्ते का समय ले सकती है।

दस में से नौ बार साधारण खांसी/जुकाम से कोई उलझन (Complication) नहीं होता है। यह साधारण symptomatic इलाज के साथ ही ठीक हो जाता है और इसमें किसी प्रकार की एंटिबायोटिक दवाओं की आवश्यकता नहीं होती है। अनावश्यक एंटिबायोटिक और स्टेरोयाड दवाओं का सेवन हानिकारक होता है और इससे बचना चाहिए।

घर पर ध्यान रखने योग्य बातें:

यदि बच्चे का बुखार 102F/39C से ज्यादा होता है या तीन दिन से ज्यादा रहता है, या बच्चे को सांस लेने में परेशानी हो रही है, या बच्चा तेज सांस ले रहा है या उसकी छाती पर सांस लेते समय गड्डे पड़ रहे हैं या बच्चा अच्छे से दूध नहीं पी पा रहा है या ज्यादा शांत या ज्यादा चिड़चिड़ा है तो तुरंत बच्चे को तुरंत डॉक्टर को दिखाना चाहिए, यह निमोनिया भी हो सकता है।

कभी भी बुखार आने पर बुखार नाप कर उसका चार्ट बनाना हमेशा अच्छा होता है। यह याद रखना उचित होगा की बुखार सिर्फ लक्षण है और इसके कई कारण हो सकते है। अलग-अलग बीमारियों में बुखार का प्रतिरूप (pattern) अलग-अलग होता है। और तापमान का चार्ट बनाने से ना सिर्फ बीमारी प्राथमिक रोग (primary disease) के बारे में जानकारी मिलती है, यह रोगी को दी गई दवाओं के असर/प्रतिक्रिया के बारे में जानकारी भी देता है। कई बार यह अनावश्यक रक्त परीक्षणों (unnecessary blood tests) से भी बचाता है।

बच्चों को बुखार आना एक सामान्य बात है। यह शरीर के रोग-प्रतिरोधक तंत्र की रक्षात्मक प्रतिक्रिया है। शरीर में होने वाले संक्रमण, कुछ दवाओं से होने वाली प्रतिक्रिया, टीकाकरण से शरीर में होने वाली प्रतिक्रिया, आदि के करण बुखार आ सकता है। सामान्य वाइरल संक्रमण जैसे फ्लू बच्चों में बुखार का सबसे प्रमुख कारणों में से एक है। खांसी/जुकाम, दस्त/उल्टी, निगलने में दर्द जैसी परेशानियां सामान्यतः बुखार के साथ हो सकती हैं। बुखार अपने आप में चिन्ता की बात नहीं होती है क्योंकि यह तो किसी भी प्रकार के संक्रमण के प्रति शरीर की प्रतिक्रिया को दर्शाता है। हाँ, पर बुखार के कुछ कारण चिंताजनक हो सकते हैं।

कभी भी बुखार आने पर सारा ध्यान इस बात पर होना चाहिए की बुखार का कारण क्या है, क्योंकि बुखार तो सिर्फ एक लक्षण है। बुखार कम करने की दवाओं जैसे पेरासीटामॉल का काम सिर्फ बच्चे को बुखार या शरीर के ज्यादा तापमान से होने वाली असहजता कम करना होता है। ज्यादा तेज बुखार आने पर पेरासीटामॉल दवा देने के साथ ही बच्चे के शरीर को सामान्य साफ पानी से भी पोंछा जा सकता है, यह बच्चे के तापमान को जल्दी कम करने में सहायक होता है। पर ध्यान रखें पानी बहुत ठंडा ना हो और इससे पहले बुखार की दवा की खुराक जरूर दे दें।

हमारे शरीर का सामान्य तापमान 37C /98.6F के आसपास (0.6C कम या ज्यादा) होता है। सामान्यतः, शरीर के अंदर के तापमान (मलाशय, मुख या काँख से नापा गया) के 100.4F/38C से ज्यादा होने को बुखार कहा जाता है।

कभी भी बच्चे का शरीर छूने पर गर्म लगने पर तापमान को थर्मामीटर से नाप कर उसे लिख कर नोट करते जाएँ। को बुखार नापने की लिए साधारण डिजिटल थर्मामीटर को बच्चे की काँख में लगा कर एक से दो मिनट के लिए रखें। तापमान नाप लेने पर थर्मामीटर में बीप की आवाज आती है। थर्मामीटर की टिप हमेशा काँख में ही रहनी चाहिए। यदि बच्चे गरम लगता है पर थर्मामीटर में तापमान सामान्य आता है तो उसे अच्छे से लगा कर फिर से जाँचना ज्यादा उचित होता है।

कंपकंपी के साथ बुखार का आना की शरीर की तेजी से अपना तापमान बड़ाने की कोशिश को दर्शाता है । कुछ बीमारियों जैसे की पेशाब की थैली का संक्रामण, मलेरिया, टॉन्सिलायटिस, आदि में कंपकंपी के साथ बुखार आ सकता है।

कई बार कुछ लक्षण जैसे पेशाब में जलन या बार-बार पेशाब जाना, खाना या थूक निगलने में परेशानी, खांसी/जुकाम, घर के अन्य सदस्यों को साथ में होने वाली परेशानियाँ जैसे उल्टी/दस्त या खांसी/जुकाम का होना, बच्चे के शरीर पर किसी भी प्रकार के चिकत्ते या लाल दाने होना, बच्चे का ज्यादा गर्मी में रहना या गर्म मौसम में कम पानी पीना आदि डॉक्टर को बीमारी की जड़ पता लगाने में मदद करते हैं। बुखार के साथ किसी भी प्रकार की परेशानी होने पर उसे परामर्शदाता डॉक्टर को अवश्य बताना चाहिए।

ज़्यादातर बुखार के एपिसोड आत्म-सीमित (Self-Limiting) होते हैं (शरीर का रोग-प्रतिरोधक तंत्र जैसे ही शरीर में होने वाले संक्रमण को काबू में करता है बुखार ठीक हो जाता है) और बुखार की सामान्य दवा जैसे पेरासीटामॉल (Paracetamol) से ही ठीक हो जाते हैं (पेरासीटामॉल दवा सिर्फ बुखार के लक्षण को ठीक करती है)। बुखार आने पर ज्यादा-से-ज्यादा पानी पीना (यदि संभव हो तो थोड़ा गुनगुना करके), खाना बराबर खाना (छोटे बच्चों को माँ का दूध जारी रखें), ताजे फल और सब्जी का ज्यादा सेवन करना, आदि शरीर की तंदुरुस्ती बनाए रखने में और बुखार एवं संक्रमण को जल्दी ठीक करने में मददगार सिद्ध होता है।

एंटीबायोटिक दवाओं की जरूरत सिर्फ बेक्टेरिया से होने वाले संक्रमणों में ही होती है। ज़्यादातर बुखार के एपिसोड सामान्य वाइरल संक्रमण के करण होते हैं एवं आत्म-सीमित (Self-Limiting) होते हैं। एंटीबायोटिक दवाओं का अनावश्यक उपयोग नुकसानदायक होता है।

कभी भी बुखार आने पर बुखार नाप कर उसका चार्ट बनाना हमेशा अच्छा होता है। यह याद रखना उचित होगा की बुखार सिर्फ लक्षण है और इसके कई कारण हो सकते है। अलग-अलग बीमारियों में बुखार का प्रतिरूप (pattern) अलग-अलग होता है। और तापमान का चार्ट बनाने से ना सिर्फ बीमारी प्राथमिक रोग (primary disease) के बारे में जानकारी मिलती है, यह रोगी को दी गई दवाओं के असर/प्रतिक्रिया के बारे में जानकारी भी देता है। कई बार यह अनावश्यक रक्त परीक्षणों (unnecessary blood tests) से भी बचाता है।

खतरे के लक्षण: यदि बच्चे का बुखार 102F/39C से ज्यादा होता है या तीन-चार दिन से ज्यादा रहता है, या बच्चे को सांस लेने में परेशानी हो रही है, या बच्चा तेज सांस ले रहा है या उसकी छाती पर सांस लेते समय गड्डे पड़ रहे हैं या बच्चा अच्छे से दूध नहीं पी पा रहा है या ज्यादा शांत/सुस्त या ज्यादा चिड़चिड़ा है, या 6--8 बार पेशाब नहीं गया है, या सामान्य खांसी/जुकाम के अलावा कोई भी लक्षण दिखते हैं जैसे पेशाब में जलन या बार-बार पेशाब जाना, शरीर पर किसी भी प्रकार के चिकत्ते या लाल दाने होना, खाना या थूक निगलने में परेशानी, चक्कर आना, गर्दन का कडा होना, बहुत ज्यादा दस्त या उल्टी होना, शरीर की असामान्य हलचल होना, आदि परेशानियों होने पर बच्चे को तुरंत डॉक्टर को दिखाना चाहिए।

घर पर क्या करें: अगर बुखार 101 F से कम है तो ज्यादा चिंता की बात नहीं है। बुखार को नाप कर नोट करें। यदि तापमान सामान्य से ज्यादा है और बच्चा असामान्य महसूस कर रहा है तो डॉक्टर की बताई गई डोज़ में पेरासीटामॉल (Paracetamol) की दवा दें। 102F या उससे ज्यादा बुखार में बच्चे को झटके आने का खतरा भी होता है। ऐसे में बुखार कम करने के लिए दवा देने के अलावा नल के पानी से बच्चे के शरीर को पोंछ सकते है।

जब तक की बुखार बहुत ज्यादा न हो या पेरासीटामॉल दवा से न उतरता हो Combination दवाएं जैसे (Paracetamol+Ibuprofen) आदि का अनुचित उपयोग ना करें, यह दवाएं बुखार पर तो ज्यादा असर करती हैं, पर न सिर्फ इनके दुष्प्रभाव भी ज्यादा होते हैं। पेरासीटामॉल बुखार उतारने की सबसे सुरक्षित दवा है और सही डोज़ में (15 mg/kg/डोज़) में यह काफी सुरक्षित और प्रभावी होती है। बुखार बना रहने पर इसे 4--6 घंटे में फिर से दिया जा सकता है। शरीर के तापमान को सामान्य करने का कोई विशेष महत्व नहीं होता है, इसीलिए यदि बच्चा असामान्य महसूस नहीं कर रहा तो दवा को अनावश्यक ज्यादा प्रयोग ना करें।

कभी-कभी बुखार में बच्चे खाना-पीना भी कम कर देते हैं, ऐसे में उन्हे थोड़ा-थोड़ा करके पानी, फलों का रस, ओआरएस आदि पिलाते रहना चाहिया। घर का बना हल्का खाना जैसे खिचड़ी, दलिया, या और कुछ जो भी बच्चा पसंद करे उसे खिलाते रहना चाहिए। यदि बच्चा कुछ भी नहीं खा-पी रहा है तो तुरंत अपने डॉक्टर से संपर्क करें।

यदि बच्चे को बुखार के साथ झटके आते हैं (Febrile Seizures): सामान्यतः 1—5 वर्ष के बीच के कुछ बच्चों को तेज़ बुखार के साथ झटके आ सकते हैं। तेज़ बुखार के साथ आने वाले झटके ज़्यादातर कुछ मिनट में ही ठीक हो जाते हैं। झटकों के आते समय बच्चे को करवट से लिटा दें, यदि वह तेज़ी से दाँत पीस रहा है तो ध्यान दें की वह अपनी जीभ न काट ले। मुंह से निकालने वाले झाग को कपड़े से साफ कर दें। ध्यान रखें की हाथ-पैर चलाने से उसे कोई चोट न लगे। झटके ठीक होने पर उसे डॉक्टर के पास ले कर जाए।

जिस बच्चे को एक बार बुखार के साथ झटके आए हैं उसे अगली बार फिर तेज़ बुखार के साथ झटके आ सकते हैं। ज़्यादातर बुखार के पहले दिन ही यह झटके आते हैं। ऐसे बच्चों के इलाज के लिए अपने शिशुरोग विशेषज्ञ की सलाह अवश्य लें।

What is allergic rhinitis

Allergic rhinitis is a reaction that occurs when your child breathes in something they are allergic to, like dust, dander or pollen. Sometimes, allergic rhinitis is called hay fever.

• Almost always genetic

• Affects up to 20 percent of children and 30 percent of adolescents

• It's estimated that 75 percent of children with asthma also have allergic rhinitis

There are two types of allergic rhinitis.

Seasonal

• Occurs mostly during pollen seasons.

• Doesn't usually develop until after 6 years of age.

Perennial

• Occurs throughout the year

• Commonly seen in younger children

How we care for allergic rhinitis

allergy disorders are tackled by a team approach, coordinating care with immunotherapy, behavior modification and investigational therapies.

What is acne?

Acne is a chronic disorder of the hair follicles and sebaceous glands located in the middle layer of the skin. In acne, the sebaceous glands are clogged, which leads to pimples and cysts. While a mild case of acne may resolve itself on its own, more serious cases may need intervention to stop the outbreak and prevent long-term scarring.

Acne is a common condition that affects millions of people in the U.S. It most often begins in puberty, when the male sex hormones — known as androgens — increase in both boys and girls, causing the sebaceous glands in the middle layer of skin to become more active and produce more sebum.

Acne can occur anywhere on the body but most often appears on the face, chest, upper back, shoulders and neck in the form of blackheads, whiteheads, pus-filed cysts and solid, raised bumps. Depending on the severity of the acne, it can be treated with either topical medications or oral antibiotics, or a combination of the two.

The most severe cases are treated with the oral drug isotretinoin or Accutane, which can have serious unwanted side effects, including psychiatric issues and serious consequences for women who are pregnant or planning to become pregnant.

How does acne develop?

The sebaceous glands, located in the middle layer of skin, produce oil, or sebum, which normally travels to the skin's surface via hair follicles. But when skin cells plug the follicles, blocking the oil coming from the sebaceous glands, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation.

Acne progresses in the following manner:

• Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).

• Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).

• Infection and irritation cause whiteheads to form.

Eventually, the plugged follicle bursts, spilling oil, skin cells and the bacteria onto the skin surface. In turn, the skin becomes irritated, and pimples or lesions begin to develop. The basic acne lesion is called a comedo.

Acne can be superficial, producing pimples without abscesses, or deep, producing inflamed pimples that push down into the skin and cause pus-filled cysts that rupture and result in larger abscesses.

What is anaphylaxis?

Also called anaphylactic shock, anaphylaxis is a dangerous reaction to an allergen, or an item that your child is allergic to. In most cases, anaphylaxis is a medical emergency. Anaphylaxis can occur anywhere from seconds to an hour after your child’s exposure to an allergen.

If your child is in anaphylactic shock, call emergency right away and rush to the nearest hospital.

What are the symptoms of anaphylactic shock?

It’s important to remember that each child may experience symptoms differently. However, the most common symptoms of anaphylaxis are:

• tightness or swelling of the throat

• severe itching of the skin

• nausea and vomiting

• stomach pain

• heart failure

• irregular heart beats

• lowered blood pressure

How is anaphylaxis treated?

At the hospital, your child's doctor will probably be treated with an injection of epinephrine, which will help stop the severe effects caused by the allergen. As a follow up, the physician may instruct you on the use of an emergency allergy kit that contains epinephrine to have near your child in case of future episodes.

What is abdominal pain?

Abdominal pain is discomfort or pain located anywhere between the chest and the pelvis. Every child will have an upset stomach at some point and most times, it’s nothing serious. Children with stomach pain typically return to overall good health and grow well.

Abdominal pain that continues and does not resolve with usual therapeutic treatments is functional abdominal pain.

For mild abdominal pain, you can typically wait for your child to get better with home care remedies. You should call your doctor if your child has:

• stomach pain that lasts more than a week, even if it comes and goes

• stomach pain that gets more severe and frequent, or makes the child nauseous or vomit with pain

• stomach pain that does not improve in 24 hours

• a burning feeling during urination

• diarrhea for more than two days

• vomiting for more than 12 hours

• fever over 100.4 degrees Fahrenheit

• poor appetite for more than two days

• unexplained weight loss

In some cases, abdominal pain is the sign of something more serious. You should seek medical help immediately if your child:

• is a baby younger than 3 months and has diarrhea or vomiting

• is unable to pass stool, especially if the child is also vomiting

• is vomiting blood or has blood in the stool (especially if the blood is maroon or dark, tarry black)

• has sudden, sharp abdominal pain

• has a rigid, hard belly

• has had a recent injury to the abdomen

• is having trouble breathing

• is currently being treated for cancer

What are the symptoms of abdominal pain?

Abdominal pain can be accompanied by symptoms like:

• nausea

• excessive gas or bowel movements

• diarrhea

• constipation

• vomiting

What causes abdominal pain in children?

The gastrointestinal tract is a complicated system of nerves and muscles that pushes food through the digestive process. Some children's nerves are very sensitive and feel pain in response to even normal intestinal activities.

The most likely cause of stomach pain is not eating enough, not going to the bathroom, or a combination of the two. In some cases, a specific problem such as constipation, heartburn, or a food allergy causes abdominal pain. In other cases, the cause may not be so clear.

An infection, stress, or lack of sleep may make the intestinal nerves more sensitive to pain. In some cases, the problem may be genetic, which means it "runs in the family" and other family members have a similar history of the problem.

How we care for abdominal pain in children

Our doctors works with parents and children to relieve many kinds abdominal pain.

What is appendicitis?

Appendicitis is a painful swelling and infection of the appendix (a narrow, finger-like pouch that branches off the large intestine). Doctors are not really sure what the appendix does, but removing it is not harmful. Appendicitis is the most common cause of emergency surgery in childhood.

Appendicitis affects 1 in 1,000 people. Most cases of appendicitis occur between the ages of 10 and 30 years.

Since an infected appendix can rupture and be a life-threatening problem, call your health care provider or go to the emergency room immediately if your child has these symptoms:

• sudden, pronounced pain around the belly button area

• in a short period of time, the pain moves to the lower right-hand part of the abdomen and your child may have a difficult time breathing

What are the symptoms of appendicitis in children?

The following are the most common symptoms of appendicitis in kids. However, each child may experience symptoms differently. Symptoms may include:

• pain in the abdomen, which may start in the area around the belly button and move over to the lower right-hand side of the abdomen, but may also start in the lower right-hand side of the abdomen

• usually increases in severity as time passes

• may be worse with moving, taking deep breaths, being touched, coughing, or sneezing

• may spread throughout the abdomen if the appendix ruptures

• nausea and vomiting

• loss of appetite

• fever and chills

• changes in behavior

• diarrhea or constipation

What causes appendicitis in children?

Appendicitis occurs when the interior of the appendix becomes filled with something that causes it to swell, such as mucus, stool, or parasites. The appendix then becomes irritated and inflamed. The blood supply to the appendix is cut off as the swelling and irritation increase. Adequate blood flow is necessary for a body part to remain healthy. When the blood flow is reduced, the appendix starts to die. Rupture (or perforation) occurs as holes develop in the walls of the appendix, allowing stool, mucus, and other substances to leak through and get inside the abdomen. An infection inside the abdomen known as peritonitis occurs when the appendix perforates.

Why is appendicitis in children a concern?

An irritated appendix can rapidly turn into an infected and ruptured appendix, sometimes within hours. A ruptured appendix can be life-threatening. When the appendix ruptures, bacteria infect the organs inside the abdominal cavity, causing peritonitis. The bacterial infection can spread very quickly and be difficult to treat if diagnosis is delayed.

How we care for appendicitis?

Appendicitis can be an emergency situation. The Department of Pediatric Surgery at Neo Children Hospital has surgeons ready to diagnose appendicitis and then remove your child's appendix, either before or after it has ruptured.

Appendicitis is the most common childhood surgical emergency, but the diagnosis can be challenging, especially in children, often leading to either unnecessary surgery in children without appendicitis, or a ruptured appendix and serious complications when the condition is missed.

What is autism spectrum disorder (ASD)? What does it mean if a child is “on the spectrum”? Can autism be treated? Will my child always have it? What supports can help our family?

While there’s currently no “cure” for ASD, our understanding is evolving rapidly. Early diagnosis and therapy can be very helpful in helping children with ASD gain new skills.

What is autism spectrum disorder?

ASD is a complex disorder of very early brain development that is approximately four times more common in boys than girls. Different children can be affected in very different ways, ranging from mild to severe, but they share two main categories of symptoms:

• Difficulty with social communication and social interactions

• Repetitive behaviors and restricted or unusual interests, including sensory symptoms such as heightened sensitivity to noise, touch or smell.

ASD was previously recognized as several separate disorders, including autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger’s disorder. Based on their shared symptoms, these were merged under a single ASD diagnosis with the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Does my child have autism?

ASD is currently diagnosed through close observation of the child’s symptoms and development. Autism Spectrum Disorders symptoms typically appear early in your child’s development, and many parents may notice subtle signs even during infancy. Some children also have language impairment, intellectual disability or genetic conditions that include other kinds of symptoms.

If you suspect you have a child with ASD, or have any concern about your child’s behavior or development—at any age—don’t wait for a check-up. Bring it up with your primary care provider. Trust your instincts.

What is celiac disease?

Celiac disease, which comes from the Greek word for “abdominal,” is a lifelong intolerance to gluten — a protein found in wheat, barley, rye, and also in oats that have been contaminated with gluten from other products. In people with celiac disease, gluten damages the lining of the intestines. This can prevent them from absorbing nutrients and cause a variety of other symptoms.

When food enters the stomach, it’s broken down into tiny digestible particles, which then travel through the small intestine. The small intestine is lined with villi — tiny finger-like projections that absorb nutrients from the food passing through. In celiac disease, gluten damages the intestine and causes the villi to break down, leaving a smooth lining that can no longer absorb nutrients.

Celiac disease is far from uncommon. An estimated 1 in 150 people are affected by the condition — typically more girls than boys — and many are undiagnosed.

As you build up your knowledge, living with celiac disease usually gets a lot easier with time. There is no “cure,” but lifelong avoidance of gluten is an effective treatment.

What are the signs symptoms of celiac disease in children?

The symptoms of celiac disease can be very different from child to child. In some cases, a child may have celiac disease and not exhibit any symptoms. Celiac disease is common, and most people don’t know that they have it.

The symptoms of celiac disease can be very different from child to child and also dependent on age. The classic symptoms that are prevalent in children under the age of 3 include:

• abdominal pain and/or cramps

• abdominal distension (bloating)

• diarrhea (loose stools)

• constipation (hard stools)

• nausea

• vomiting

• decreased appetite

• increased fatigue

• weight loss or poor weight gain

• short stature or poor growth

• frequent mouth ulcers

Now that there are blood tests that can help establish a celiac disease diagnosis, and doctors are becoming increasingly familiar with atypical signs and symptoms, celiac disease is also increasingly being diagnosed in older children — in fact, the average age of diagnosis is currently around 9 years old. These signs and symptoms of celiac disease in children include:

• delayed puberty

• behavioral problems

• iron deficiency

• osteopenia/osteoporosis

• hepatitis

• arthritis

• infertility

• migraines

• seizures

• neuropathy

Other signs and symptoms of CD may include: delayed puberty, behavioral problems, iron deficiency, osteopenia/osteoporosis, hepatitis, arthritis, infertility, migraines, seizures and neuropathy. Kids with concerning symptoms or those in high-risk groups (such as having a family member with celiac disease, having diabetes mellitus, autoimmune thyroid disease or Down syndrome) should be evaluated for celiac disease.

What causes celiac disease in children?

Doctors haven’t yet figured out exactly how someone develops celiac disease. We do know that children with celiac disease always inherit one particular gene from a parent that makes them susceptible to the disease. But since many people have that gene but never develop celiac disease, it’s likely that other genes play a part, too.

Some researchers believe that celiac disease may be triggered by the combination of:

• having the gene(s) that make you susceptible

• exposure to gluten

• exposure to a toxin or an infection (such as a rotavirus)

Gluten sensitivity is often an indication of celiac disease, but there are other reasons why a child may feel better on a gluten-free diet. Your child may have one of the following:

• a food allergy or an allergic gastrointestinal disease such as eosinophilic esophagitis (condition also known as “EE” or “EoE.”) Eosinophilic esophagitis is an allergic reaction that causes inflammation and damage to the esophagus — the muscular tube that connects mouth to stomach.

• irritable bowel syndrome (IBS)

• non-celiac gluten sensitivity

Celiac disease is a genetic disease and diagnosed via a blood test and endoscopy. During an endoscopy, a physician will biopsy the small intestines. This is an important test because it allows the doctor to examine the villi.

If you suspect your child is gluten sensitive, it is important to have her evaluated by her pediatrician — ideally in partnership with a pediatric gastroenterologist.

“The gluten-free diet is a highly effective treatment for celiac disease,” Weir says. “Removing gluten stops the inflammatory process allowing for normalization of elevated celiac markers in the blood and intestinal healing. However, if this happens before the evaluation for celiac disease is complete, the diagnosis can be missed.”

A gluten-free diet is the only treatment for celiac disease.

“Managing a strict, gluten-free diet is doable but can be tricky because even very small amounts of gluten can cause ongoing intestinal damage,” Weir says.

If your child has been diagnosed with celiac disease, Weir recommends consulting with a dietician who specializes in the disease to discuss dietary options, recipes, shopping and cooking tips.

What is cerebral palsy (CP)?

Cerebral palsy (CP) is the most common motor disability of childhood. CP is a group of disorders that affect muscle tone, posture, and movement as a result of damage to an infant's developing brain. Though the damage doesn't progress, the symptoms change over time with growth and development.

Children with CP often have one or more associated conditions, including learning disabilities, developmental delays, epilepsy, problems with vision or hearing, and challenges with speech and communication. They can also have other medical concerns, such as feeding and nutritional difficulties and respiratory issues.

What are the different types of cerebral palsy?

There are several types of cerebral palsy. They are classified by the kind of motor function issues the child has:

• spastic diplegia: spastic movements of the legs

• spastic quadriplegia: spastic movements in all four limbs (both arms and legs)

• spastic hemiplegia: spasticity that affects one half, or one side, of the body (such as the right arm and right leg)

• athetoid: involuntary, uncontrolled, and purposeless movements

• dystonia: sustained or repetitive muscle contractions that do not relax, causing twisted or fixed postures

It is sometimes helpful to think of dystonia as an "overflow" of movements due to abnormal signals from the brain's movement system. This differs from spasticity, which describes increased muscle tone, due to exaggerated stretch reflexes. Reflexes are normally suppressed by signals from the brain and spinal cord that allow us to move properly, and an inability to properly suppress reflexes results in spasticity.

It is not uncommon to have both spasticity and dystonia with CP, and it is often difficult to tell them apart because they both result in too much muscle tone.

What are the symptoms of cerebral palsy?

Cerebral palsy symptoms can vary from child to child. Symptoms range from muscle weakness and poor motor control to muscle tightness (spasticity), to movement disorders (dyskinesias).

Children with CP may also have other symptoms including:

• seizures

• vision loss or trouble seeing

• hearing loss or trouble hearing

• speech problems

• learning disabilities

• behavioral problems

• developmental delays

• difficulty swallowing (dysphagia)

• challenges with nutrition

• respiratory problems

• gastroesophageal reflux (GERD)

• constipation

• fragile bones

Infants with CP are often slow to reach developmental milestones, such as learning to roll over, sit, crawl, or walk. They may also have certain reflexes past the time these reflexes normally disappear (primitive reflexes). While CP doesn't progress or worsen over time, your child's symptoms may change with age.

What are the causes of cerebral palsy?

There are many causes of CP, but all occur either during pregnancy, birth, or shortly after birth. Common causes include brain malformations, infection, or stroke. In a small number of cases, oxygen deprivation is the cause. In many cases, the cause is unknown.

Sometimes, CP occurs as a complication of another condition, like premature birth, low birth weight, or neurological trauma.

How we care for cerebral palsy

Because cerebral palsy can refer to several different types of brain injury, it's important to seek treatment from experts from many different disciplines who understand:

• a child's symptoms of cerebral palsy might not match any given "textbook" example

• cerebral palsy may affect many parts of a child's body

• how and why other medical conditions can occur alongside cerebral palsy

• the vital role of orthopedic support

What is cholestasis?

Cholestasis is a problem with the flow of bile that happens when the bile ducts are blocked or the liver has a problem producing bile. Children with cholestasis have trouble absorbing nutrients and gaining weight.

In a healthy system, bile flows through a tube called the common bile duct to the small intestine, where it helps to absorb fat. Bile also helps eliminate bilirubin, a waste product of the body’s continuous break down old red blood cells and creation of new ones.

What is bile?

Bile is liquid produced in the liver and excreted into the intestine. Bile consists of water, electrolytes, bile salts, bilirubin, cholesterol and other substances that our body wants to get rid of.

• Bile salts play an important role in helping the body absorb fat.

• Bilirubin, another component of bile, is formed by the breakdown of hemoglobin. It gives bile a yellowish-greenish color.

A child develops cholestasis when bile backs up in the blood stream. When bile and bilirubin stay in the body, a child will develop jaundice

Who is at risk for cholestasis?

Cholestasis is a rare condition that affects approximately 1 in every 2,500 newborn infants. Boys and girls have the condition in roughly equal numbers. In newborns, cholestasis can be an inherited condition. The condition can affect children of any age.

Some women develop cholestasis in pregnancy. This typically occurs in the third trimester and clears up after they give birth. Cholestasis in pregnancy does not increase a baby’s risk of being born with the condition, however, it does increase the risk of premature birth.

What are the symptoms of cholestasis liver disease?

Cholestasis symptoms include:

• jaundice, yellowish eyes and skin

• dark yellow or brown urine

• grey or white stools

• swollen or extended abdomen

• itchy skin

• nausea or vomiting

• slow weight gain

What causes cholestasis?

There are two types of cholestasis that affect infants and children:

• obstructive cholestasis, blockage of bile flow

• hepatocellular cholestasis, a problem with the production of bile at the liver( hepatic) cell level

The following conditions increase a child’s risk of obstructive cholestasis:

• biliary atresia, caused by blocked or damaged bile ducts

• choledochal cysts, an inherited malformation of the bile ducts

• Alagille syndrome, an inherited condition in which a child has underdeveloped/ too few bile ducts

• cystic fibrosis that causes thick bile and secretions that block the bile ducts

Conditions and treatments that destroy the liver cell or change its function increase a child’s risk of hepatocellular cholestasis:

• hepatitis A, hepatitis B or hepatitis C infection

• certain medications and total parenteral nutrition

Are some children at greater risk for cholestasis?

Certain things can increase a child’s risk for developing cholestasis, including:

• premature birth, being born before 37 weeks of pregnancy

• short bowel syndrome, loss of a functioning small intestine

• receiving parenteral nutrition, food delivered through a vein, for more than 2 to 4 weeks

What is constipation?

Constipation is a condition in which a child has infrequent bowel movement — fewer than three in a week — or bowel movements that are difficult or painful to pass.

Constipation is a common concern among parents of small children. In fact, almost 5 percent of pediatrician visits are related to constipation and at least 25 percent of visits to pediatric gastroenterology specialists are due to problems with constipation.

Constipation that is prolonged and does not resolve with the usual therapeutic measures is called “intractable constipation.” It’s usually been present for many years and requires more comprehensive testing and therapy.

What are the symptoms of constipation?

While children may experience symptoms differently, constipation symptoms may include:

• not having a bowel movement for several days or passing hard, dry stools

• abdominal bloating, cramps, or pain

• decreased appetite

• clenching teeth, crossing legs, squeezing buttocks together, or turning red in the face as your child tries to hold in a bowel movement to avoid discomfort

• fecal incontinence, including small liquid or soft stool smears that soil your child's underwear

What causes constipation?

In general, there is no specific abnormality associated with constipation. It can be triggered by changes occurring in your child’s life and may not be related to an underlying medical condition. There are probably some genetic factors since this problem often seems to run in families. Contributing causes may include:

• poor diet, full of high-fat, low-fiber foods and/or not enough liquids

• changes in diet, such as a switch from breast milk to formula or beginning to eat solid foods

• lack of exercise

• emotional issues related to using public bathrooms, toilet training, or stress

• changes in bowel routines

• avoidance; hard, dry stools can be painful to push out, and the child might avoid using the bathroom to avoid the discomfort. Eventually, the intestine will not be able to sense the presence of stool.

Medical conditions and problems that can cause constipation in children include the following:

• Hirschsprung's disease: a condition that occurs when some of your baby’s intestinal nerve cells don’t develop properly, causing them to interfere with the movement of food and stools in the intestines

• congenital abnormalities of the intestinal tract, rectum, or anus, like imperforate anus

• problems of the nervous system, such as cerebral palsy

• endocrine problems, such as hypothyroidism

• certain medications, such as iron preparations, some antidepressants, ADHD medications, and narcotics

• underlying problems with the way the colon moves

• neurologic problems associated with low muscle tone, or spinal cord injury or defect.

What is a congenital diaphragmatic hernia?

The diaphragm is a thin layer of muscle and tissue that separates the chest and abdominal cavity. It is the major muscle that the body uses to breathe. When your child has a congenital diaphragmatic hernia (CDH), it means that there’s a hole in that layer — or, rarely, that the diaphragm is missing altogether. CDH affects about one in every 2,500 babies.

In CDH, the contents of your child's abdomen, which may include the stomach, intestines, liver, and/or spleen, may go through the hole and into the chest. This prevents the normal development of the lung on that side, and also affects the growth of the other lung. When your child’s lungs don’t fully develop, they will have trouble breathing after birth.

When the organs from the abdomen prevent the lungs from growing, the poor lung growth is called pulmonary hypoplasia. Healthy lungs have millions of small air sacs (alveoli), each of which resembles a balloon filled with air. With pulmonary hypoplasia:

• There are fewer air sacs than normal.

• The air sacs that are present are only able to partially fill with air.

• The air sacs deflate easily because of problems with a lubricating fluid called surfactant.

When this happens, your baby is unable to take in enough oxygen to stay healthy.

What are the different types of CDH?

There are two kinds of CDH:

• A Bochdalek hernia is a hole in the back of the diaphragm. Ninety percent of children have this type of CDH.

• A Morgagni hernia involves a hole in the front of the diaphragm which has very little effect on the lung development.

CDH is a serious, life-threatening condition. However, the outlook for babies born with a CDH has greatly improved with advances in treatment.

What causes a congenital diaphragmatic hernia (CDH)?

While we don’t know exactly what causes CDH, scientists believe that multiple genes from both parents — as well as a number of environmental factors that we do not yet fully understand — may contribute.

What are the symptoms of CDH?

Every child may experience symptoms differently, but possible symptoms of a Bochdalek diaphragmatic hernia may include:

• difficulty breathing

• fast breathing

• fast heart rate

• cyanosis (blue color of the skin)

• abnormal chest development, with one side being larger than the other

• abdomen that appears caved in

A baby born with a Morgagni hernia may or may not show any symptoms. Babies with a Bochdalek type of CDH are more likely to have another birth defect. Complications of a CDH may include:

• Chronic lung disease: This serious condition can require your child to have oxygen or medications after being discharged from the hospital.

• Pulmonary hypertension: This is a condition in which the blood vessels in the lung itself are poorly developed and do not pick up the oxygen as well from the air delivered to the lungs. This may be temporary or can be so severe that it is life threatening.

• Gastroesophageal reflux: This is a condition in which acids and fluids from the stomach move up to the esophagus and can cause heartburn, vomiting, feeding, or lung problems.

• Failure to thrive: Children with the most serious lung problems are most likely to have growth problems. Some require special feeding tubes to give enough calories to grow adequately.

• Developmental delays: These include delays in the ability to roll over, sit, crawl, stand, or walk. Your baby will almost always reach these milestones, just usually at an older age than most children.

• Hearing loss: A hearing test will be performed prior to your baby leaving the hospital.

How we care for CDH at Neo Children Hospital

Pediatric Surgeons at Neo Children Hospital routinely does complex surgeries like CDH. Most of our previous babies have been discharged with good health and are doing well.

What is a congenital heart defect (CHD)?

A congenital heart defect (CHD) is a structural problem of the heart that develops during pregnancy. About one out of 100 babies is born with a congenital heart defect. There are many types of congenital heart defects, ranging from simple to complex. Most are diagnosed and treated early in infancy.

What are the symptoms of a congenital heart defect?

Symptoms of congenital heart defects in infants and children include:

• cyanosis (a bluish tint to the skin, fingernails, and lips)

• respiratory distress

• poor feeding

• poor weight gain

• recurrent lung infections

• less ability to exercise or play actively compared to other children

What causes congenital heart disease?

Many congenital heart diseases in babies have a genetic cause. Some known associations include:

• chromosome abnormalities, such as Down syndrome, trisomy 18 and trisomy 13, and Turner syndrome

• microdeletion or microduplication syndromes, such as DiGeorge syndrome

• single gene defects

• environmental factors

If you have a congenital heart defect, we recommend you speak with a genetic counselor or genetic specialist before becoming pregnant.

How are congenital heart defects diagnosed?

In some cases, congenital heart defects are discovered before a baby is born during a fetal ultrasound. Some types of complex congenital heart defects are apparent shortly after birth. Less severe defects may not be found until the child is older. Some congenital heart defects are discovered after the doctor hears a heart murmur.

What are the tests for congenital heart disease?

Depending on the child’s CHD symptoms or heart murmur, the doctor may order one or more of the following tests to diagnose a congenital heart defect:

• electrocardiogram

• echocardiogram (cardiac ultrasound)

• chest x-ray

• blood test for genetic analysis

If your child has been diagnosed with a chromosomal or other genetic abnormality, genetic counseling is helpful to determine the risk of heart defects for other children you may have in the future.

What are the treatment options for congenital heart defects?

Treatment is based on the specific type of congenital heart defect your child has and the severity of the defect. Some mild heart defects don't need any treatment. Others can be treated with medications, interventional procedures, or surgery.

What is Down syndrome?

Down syndrome is a genetic condition that happens when a child is born with an extra chromosome. The extra chromosome affects the way the child’s brain and body develop, leading to developmental delays, intellectual disability and an increased risk for certain medical issues.

Down syndrome is the most common genetic cause of intellectual disability, affecting approximately 1 in every 700 children. It is named for John Langdon Down, the British physician who first recognized the traits of Down syndrome in 1866.

The chance that a baby will be born with Down syndrome increases with a mother’s age:

• 1 baby out of every 1,000 born to women under age 30

• 1 baby out of every 400 born to women older than 35

• 1 baby out of every 60 born to women older than 42

Some expectant parents choose to undergo prenatal testing to find out in advance if their child will have Down syndrome. These optional tests, performed during pregnancy, can identify a fetus’s sex, age, size and placement in the uterus. They can also detect conditions such as Down syndrome, congenital heart defects, genetic conditions and other birth defects.

Down syndrome and intellectual disability

Most children with Down syndrome have some level of intellectual disability ⎯ usually in the mild to moderate range. People with mild intellectual disability are usually able to learn how to do everyday things like read, hold a job, and take public transportation on their own. People with moderate intellectual disability usually need more support.

Many children with Down syndrome can participate in regular classrooms, though they may need extra help or modifications. Thanks to widespread special education and community programs, more and more people with Down syndrome graduate from high school, attend college and work in their communities.

Down syndrome and medical problems

Children with Down syndrome can have a variety of health issues. About half are born with a congenital heart defect, a structural problem with the heart that develops during pregnancy.

The most common congenital heart defects in children with Down syndrome include:

• atrioventricular septal defect, the most common heart defect in children with Down syndrome

• patent ductus arteriosus

• tetralogy of Fallot

Many children with heart defects also develop pulmonary hypertension, a condition that can cause lasting lung damage if left untreated.

Other health issues that commonly affect children with Down syndrome include:

• hearing loss

• vision problems

• ear infections

• obstructive sleep apnea

Flu (Influenza) is a viral infection that affects the upper respiratory system, which includes the nose and throat, the airways (also called bronchial tubes), and the lungs. While everyone is at risk for getting the flu, children can be more likely to get sick from this virus.

In young children, women who are pregnant, the elderly, and those with other health conditions, the flu can require them to be hospitalized. In some cases, the flu can be very serious or even deadly.

The experts at Boston Children’s care for children with flu and help them avoid complications like pneumonia that can lead them to become seriously ill.

What are flu symptoms?

Common flu symptoms include:

• fever

• chills

• body aches

• headache

• sore throat

• cough

• runny or stuffy nose

• tiredness

• vomiting and/or diarrhea

How long does flu last?

Your child may have some flu symptoms, or all of them. Most symptoms last about a week. But the tiredness may linger longer. If you notice the symptoms are not getting better, or are getting worse, always call your pediatrician.

Flu complications and warning signs

If your child has the flu, it’s important to be on the lookout for any complications. Always seek emergency medical care if you notice the following signs in your child:

• fast breathing or trouble breathing

• bluish or gray skin color (cyanosis)

• not drinking enough fluids

• severe or persistent vomiting

• not waking up or not interacting

• extreme irritability/not wanting to be held

• flu-like symptoms improve but then return with fever and worse cough

What causes flu complications in children?

Childhood obesity (when a child is significantly overweight) is one factor that can increase a child’s risk for health complications with the flu.

Other risk factors include:

• asthma

• diabetes

• heart disease

• kidney disease

How is flu spread?

Flu (influenza) is highly contagious, which means that it can be passed from person to person easily. A person with the flu can spread the virus 24 hours before any symptoms appear.

The influenza virus is typically spread through droplets that are released in the air when someone affected coughs, sneezes, or talks. These droplets, which can travel as far as six feet, may land on the nose or mouth of someone else and make them ill.

The virus can also survive briefly on common surfaces such as doorknobs, phones, tabletops, and faucets. While this is a less common way that flu is spread, when someone touches these surfaces and then touches their nose or mouth, they may become infected.

What are the different types of flu?

Influenza type A and influenza type B

The most common type of flu is seasonal flu, which makes many people sick every year. Seasonal flu is caused by influenza A or influenza B viruses.

H1N1 and other types of flu

There is also a type C virus that causes either mild respiratory symptoms or in some people, no symptoms.

One subtype of Influenza A is called H1N1. In 2009, a new H1N1 virus emerged and caused a pandemic, but that strain has now become one of the circulating seasonal flu viruses.

What is the difference between flu and cold?

The common cold usually takes a few days to progress and usually causes milder symptoms, while the flu can come on more suddenly and the symptoms may be more severe.

It can be difficult to tell whether a person has the flu or other type of viral infection. This makes it important to call your pediatrician if your child becomes sick. Also, be sure to keep them home to prevent spreading the illness.