HEALTH PROBLEMS: NEWBORN

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VACCINATIONS

Why it’s important to vaccinate your children

The main goal we parents have is to make our children feel good, help them survive.  We feed them, we dress them, we protect them.

If children today were exposed to all the diseases they were exposed to 50 years ago, without the protection of vaccines, they would end up in the same situation as the children of that time.

For example, diphtheria outbreaks caused many deaths, as did whooping cough. Today people in the developed world don’t know what diphtheria is, there are few people with whooping cough. We no longer see this phenomenon because two generations have already been vaccinated and therefore these organisms are no longer circulating in the environment.

A short time ago, meningitis caused by meningococcal, pneumococcal, Hemophilus, measles or mumps caused many deaths.

Rubella killed, and also resulted in many children with severe deformations if the mother contracted rubella during pregnancy. Today this no longer happens because mothers were vaccinated against rubella when they were young girls, 20-30 years ago.

The bacterium of tetanus is present on the ground, or on rusty nails. If it gets inside a wound of a person not vaccinated against tetanus, the individual will have terrible neurological symptoms and die a very excruciating death. When I was a child, you could hear of so many children dying of tetanus.

Polio used to deform many children, and in Italy alone one thousand children died of measles each year.

 

Vaccines are the reason for the survival of millions of children around the world who would have died of these terrible diseases. 

 

Vaccine table

The table below (you can download it) is the recommended vaccination schedule.

Vaccines are done  as soon as possible to reduce the risks.

Until a child has been vaccinated, he or she risks contracting the actual disease.

The only reason to delay vaccination is  if  the child  is very ill with very high fever fever, if he has an important ongoing disease (not a cold or other trivial disease).

 

Download Vaccination Shedule

REFLUX

Work in progress.

HIP DISPLASIA

Work in progress.

PENIS NOT OPENING

Work in progress.

SMALL LABIA GLUED TOGETHER (SINECHE)

Labial Adhesions (SYNECHIAE)

A few mothers, with a very keen spirit of observation, occasionally point out to me that their little girl’s labia minora are “fused” together. They leave only a small hole open from which urine can escape.

This type of adherence of the labia minora to each other is a very frequent phenomenon, even if it is not always so evident.

It too, like vulvitis, is due to the lack of estrogen in early childhood and, like the adherence of the foreskin to the glans in boys, does not require any special care or attention, aside from normal daily hygiene.

The labial adhesions disappear spontaneously within the first year of life.

URINARY TRACT INFECTIONS (TRUE AND FALSE)

Urinary tract infections in the first year of life usually have much more significance than in adulthood. Since the child cannot report symptoms that allow for orientation on the diagnosis, parents are often baffled when the pediatrician suspects it, perhaps only on the basis of an apparently unjustified fever.

The fact is that an infant suffering from a urinary tract infection has only generic symptoms:

  • most often has a high fever;
  • loses appetite;
  • He is less energetic than usual;
  • if the infection is not diagnosed and treated, or recurs often in the long run, the child will not grow adequately;
  • especially the little ones may have vomiting and diarrhea that confuse diagnosis and suggest a gastrointestinal infection.

When a urinary tract  infection in infants is suspected, simple urinalysis is not enough to confirm or exclude it. There is always a need for so-called urine culture, to identify exactly the responsible germ. The laboratory’s response often states that “colonies of Escherichia Coli have developed …”. Well, this germ is the most common responsible for urinary infections in children. Be careful, however, because there is contamination to confuse ideas. In fact, during the collection of urine, especially from an infant, germs present on the skin around the urine exit often end up in the container. These, growing in the culture medium, give a false positivity.

This happens much more easily when urine is collected with plastic bags applied with an adhesive around the genitals.

Yet, as we have seen, it is essential to know for sure if there is an infection or if the germs found are the result of contamination. Therefore, when the sachet method gives positive results, to avoid unnecessarily treating the child, it is necessary to repeat the urine culture.

Sometimes, when you cannot be sure of the results obtained with the sachet method, it is preferable to take the sample with a catheter, or with the so-called suprapubic puncture. The latter consists in aspirating the urine directly from the bladder with a needle introduced into the lower part of the tummy, after having thoroughly disinfected the skin, thus obtaining a sample that is certainly not contaminated by external germs. When you know the type of germ that causes the infection, through the antibiogram you can choose the antibiotics that fight it more effectively.

Urinary malformations

The most serious malformation is an obstruction of the urinary tract , which can occur at any level. The most affected points are the junction between the pelvis and the ureter and the vesicoureteral valves. Another common site of obstruction is the urethra, at the exit from the vescia (hydronephrosis ureteral bladder valve obstruction), an anomaly that almost exclusively affects males. In the first two cases the flow of urine is interrupted only on the affected side, while in the third case it is blocked from the bladder upwards. The obstruction causes dilation of the urinary tract “upstream”, up to hydronephrosis, which literally means “kidney full of water”, sometimes so massive as to give the kidney a double or triple volume respect to normal. 

The ultrasound scans performed during pregnancy and especially the “morphological” one reveal most of these malformations and make it possible to promptly intervene, even immediately after birth, on any pathology that could cause serious damage to the kidneys.

In the first months of life, the ultrasound allows you to follow the evolution of minor anomalies, such as slight dilations of the pelvis or renal calyces, discovered during pregnancy. Obstructions of the urinary tract predispose to recurrent infections and always cause a strong increase in pressure against the kidney and therefore must be corrected surgically as soon as possible.

Vesicoureteral reflux (i.e. the return of urine from the bladder upwards towards the kidneys) is due to an abnormality of the vesicoureteral valves, which remain too open by one or both sides. Ultrasound cannot highlight this problem. Thus, when the specialist suspects its presence, he resorts to cystography, an examination which consists in introducing a contrast fluid into the bladder, which is then followed with X-rays, to find out if it goes up the ureters towards the kidney.

 The presence of severe reflux is considered by many specialists to be a predisposing factor to recurrent kidney infections (pyelonephritis) and must therefore be corrected with surgery. Other specialists do not believe there is a direct relationship between reflux and infections. Therefore, they advise you to wait until, as usually happens, the reflux disappears spontaneously, paying attention only to discover and promptly treat any infections. Pyelonephritis

The most serious infection of the urinary tract is pyelonephritis, which is localized in the pelvis and calyces and therefore involves the kidney itself.These infections are always accompanied by very high fever and are therefore unlikely to escape diagnosis. If they are not treated promptly, they can damage the kidney tissue, and if they are repeated numerous times without treatment, the kidney can be largely replaced by scar tissue and lose its function irretrievably. There is a technique, renal scintigraphy, which is most sensitive to specifying the damage to the kidney caused by these infections. It is practiced by injecting a radioactive chemical (the radiation dose is less than that of a single X-ray) which is concentrated only in the kidney. A device captures the radiation and outlines the image of the organ, highlighting any parts that may not work. This type of information is essential to decide the greater or lesser aggressiveness of the investigations and treatments to prevent further damage. 

If a child in the first year of life has a persistent high fever not accompanied by other symptoms, it is possible that he has pyelonephritis and it is always advisable to perform a urinalysis and urine culture to ascertain it.

If the pediatrician strongly suspects this infection, to avoid damage, he usually starts antibiotic therapy even before knowing the result of these tests. If the results confirm the suspicion, the antibiotic treatment is completed and, after an interval of a few days, the urine culture is repeated to ascertain that the cure has taken place. In addition, even if the child no longer has a fever, the tests are usually repeated periodically, in order to promptly detect and treat any recurrence of the infection. If these occur repeatedly, specialists usually recommend a prophylaxis (preventive care) with an antibiotic or a sulfonamide to be administered in small quantities for several months. In the presence of vesicoureteral reflux, considered by many to be a predisposing factor for these events, surgery to correct the anomaly is often recommended.

SECOND-BORN SYNDROME: FREQUENT COLDS, BRONCHITIS

Work in progress.

FISTULES

Work in progress.

CONSTIPATION AND DIARRHEA

Normal Evacuation

Even a pure and liquid food such as milk, after digestion, leaves parts (waste) unabsorbed. These, together with intestinal mucus (which serves to protect the intestine) make up the faeces of a newborn.

If a baby is breastfed, the faeces are semi-liquid and eliminated quickly even after each feeding (therefore up to 7 times a day). This can cause slight irritation around the anus, which is resolved quickly with local treatments.

On the other hand, artificial milk tends to result in more pasty faeces which are evacuated more slowly, 2/3/4 times a day.

 

Episodes of Constipation

It can happen from time to time that a child, due to nervousness and increased tension, may not evacuate for 4/5 days.

In the breast-fed infant, however, the faeces will remain semi-liquid and the baby will have no trouble evacuating after this period. It is therefore not necessary to intervene.

On the other hand, in the bottle-fed infant, the stools tends to become hard if not passed over a period of a few days. In this case, any evacuation can cause pain and the anus is subject to small cracks, especially if already irritated. The baby will remember this painful experience, and this can lead the baby to hold back the stools to avoid repeating it.

Some babies can hold their stools for up to 10 days or more if nothing is done. In these cases, constipation can become a medical problem, with faecal impaction (in older children) which can cause grave illness if not trated.

It is important to intervene early if you notice that the newborn begins to retain stools for 6/7 days. This causes suffering, so help is needed. Laxatives solve the problem but are addictive and can themselves cause local irritation. Today, stool softeners are used (such as macrogol or lactulose) which can solve the problem without side effects, but which take time, even 7/10 days to work. It is absolutely necessary to have patience. The moment the colon is first emptied of these faecal masses, the baby does not automatically resume normal habits. It is therefore necessary to continue with the softener for the time necessary (even for months) to definitively return to normal.

 

Causes of constipation

The urge to evacuate is nothing more than the reflex of the rectum that fills up to the point of being stimulated to contract and evacuate. The problem is that the stimulus occurs naturally while human beings tends to hold it back to do it at the ‘right time’. This way the child often learns to hold them even when they shouldn’t, and the stool hardens. Nutrition is never what makes stool harder. At most, there are foods with more fibre that increase the volume of stools (but still do not make them harder). Changing nutrition is neither the solution nor the cause of neonatal constipation.

 

The reflux

One of the causes of constipation is reflux. In this case, the child has abdominal and intestinal pain and discomfort and tends to retain faeces for this reason.

 

Congenital megacolon disease

Rare condition where the colon is malformed towards the end, where there is a small part that does not allow normal peristalsis (movement of the stool towards the anus), a sort of almost impassable ring. This “ring” causes the faeces to accumulate. Initially these children are considered normally constipated but the fact that they never have the “stimulus” must ring alarm bells. Biopsies are needed to check if there is a lack of ganglion cells in the colon, which are those with neuromuscular capacity for contraction and evacuation.

This pathology is called megacolon because if neglected the colon becomes huge, with serious consequences.

 

Baby during weaning

The only difference is how the stool changes. In those during and after weaning the waste become more recognizable. You will see bits of food. This means that the baby has not digested everything he has eaten, which is completely normal.

Solid feeding produces firmer stools than breast milk, but not infant formula.

 

Dysentery / diarrhoea

It is normal for newborns to have liquid stools from time to time, up to six or seven times a day. If they do not become more frequent and are not accompanied by fever / vomiting and general malaise, there is nothing to fear or to do.

On the other hand, when the newborn has very watery discharges (over 5/6) per day accompanied by malaise, and other symptoms such as fever and / or vomiting, he could have gastroenteritis, that is a viral inflammation of the intestine that usually lasts 2/3 days and heals spontaneously. What you can do for the baby is to give him fluids (usually special saline solutions for rehydration) in small quantities, very often.

In some cases, however, the infection is bacterial and therefore antibiotics are required, regularly prescribed by the doctor.

FOOD ALLERGIES AND INTOLERANCES, GASTROENTERITIS, RISK OF DEHYDRATION

Food allergies are much rarer than some pediatricians claim. It is estimated that only 2 or 3 percent of children are affected by this problem and, in most cases, the allergy is limited to just one food.

Unfortunately, however, in Italy, as in many other countries,  it has become customary for pediatricians to diagnose this problem with criteria that lead to the needless sacrifice of many children. A doctor will sometimes say that a child “does not grow well”, even when from an objective point of view this is not true.

I constantly see children who have been described as “underweight” and who are perfectly healthy and well fed. If you really want to understand something, you have to start from the idea that the growth of a child should not be evaluated only with scales.

Diets for no reason

Personally, all I do is free (yes, free!) little ones who have been put on a diet for months without any valid scientific reason.

And this is little. A few months ago an extremely distressed family came to me due to the fact that their nearly two-year-old child had been fasting for a few days because, according to doctors in a provincial hospital, he was suffering from severe food intolerances.

This diagnosis was made because the baby, after a viral gastroenteritis contracted at six months, had continued to experience a few liquid discharges a day.

Although a very strict diet had not improved this symptoms, the poor little man was still considered “intolerant” and his diet had been restricted progressively more and more, until the decision to subject him, without ever having a well-founded diagnosis, to a “parenteral diet” ”, ie through a cannula introduced into a large vein.

This type of feeding, however, never manages to give enough food for normal growth, so the child, who had been treated in this way for a couple of months now, looked similar to that of a severely small third world  malnourished child.

The difficulty of convincing parents

I had a hard time convincing the parents that their little one did not have an intolerance and that it would be right to return him to normal feeding. They were so frightened and traumatized that I had to work very gently to encourage them to feed the little one back to a normal diet for his age.

The result is that, after a few weeks, it was possible to remove the parenteral feeding cannula and that now the child eats everything, and grows normally.

Think of how much suffering was unnecessarily inflicted on this child and his family to follow a concept of allergy or intolerance that has no equal in the world.

If your child has undergone the diagnosis of “multiple” allergy or intolerance, that is to several foods at the same time, do not give up: most likely he does not have any food-related ailments, but symptoms that can be explained otherwise.

 

COMMON SKIN PROBLEMS: NEONATAL ACNE

From the third, fourth week up to about two months, many infants have a rash on the cheeks which, due to its similarity to adolescent acne, is called neonatal acne.

It is often attributed to an intolerance to milk, even to mother’s milk. In reality this phenomenon has nothing to do with diet and is instead caused by the disappearance of maternal hormones (passed from the placenta) from the infant’s body, causing a situation similar to the hormonal variations of adolescence.

PROBLEMATIC SKIN PROBLEMS: ATOPIC DERMATITIS (ECZEMA)

Dry, rough skin that peels a little more than normal is a delicate skin that has a lower production of fat and sebum, so it tends to dry out easily, and when drying, it tends to become a little itchy, so much so that the children who have this type of skin tend to scratch themselves, which can also cause skin lesions or infections.

So the so-called atopic dermatitis is usually the skin problem of the skin that lacks those factors that keep it well hydrated, that is the skin fat, which allows the skin not to dry out and not to have excessive evaporation.

 

It is true that a child who has this problem also has a greater chance of having respiratory allergies but it is not automatic, and atopic dermatitis is not in itself an allergic problem, as it is not caused by a food or a substance in particular, but it is precisely a characteristic of the skin that becomes irritated because it becomes too dry, peels, and prompts the child to scratch.

 

What I recommend is to use creams or vaseline oil to compensate for insufficient sebum, waiting for this issue to disappear spontaneously as the child matures.

REAL URINARY TRACT PROBLEMS