HEALTH PROBLEMS: NEWBORN

Nascosto

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

The most common symptoms

Reflux is unlikely to reveal clear signs of its presence during the first days of life because, even if the preconditions are present, it takes some time for oesophagitis to develop.

Regurgitation

At birth, therefore, the first sign is simply a tendency to regurgitate frequently, but almost always without any discomfort or suffering. What is the difference between “regurgitating frequently” and the sporadic spitting up typical of almost all normal newborns? It means regurgitating more often, after each feed.

If babies are breast-fed, for the reasons explained above, those with a predisposition to reflux may be apparently well even for the first three or four months. By contrast, babies fed on formula milk begin to show significant signs of the disorder almost immediately.

Painful attacks

In any case, sooner or later, all of them become unsettled and then experience painful attacks, causing them to cry intermittently for hours. These attacks are usually mistaken for “colic”.

As time passes, the baby will regurgitate more and more often and even some hours following a feed, perhaps when you are just getting ready to give the next feed.

Vomiting

Sometimes the baby will suffer from projectile vomiting. In more acute cases, this can simulate a different disorder that is much rarer than reflux, known as hypertrophic pyloric stenosis (I will explain the different later).

Hiccupping

From the outset, the baby suffers from persistent hiccupping after nearly every feed. This is one of the most characteristic signs of oesophagitis. Inflammation of the oesophagus simulates the phrenic nerve endings, causing the diaphragm to contract rhythmically. Most children who suffer from reflux actually give advance warning of their disorder by hiccupping before birth when they are still in their mother’s belly.

Wind, burping and difficulty in feeding

The baby burps frequently, often hours after a meal, due to the large quantity of air swallowed in the intervals between feeds as he or she continually gulps back the milk that comes up. Perhaps due to the sensation of being bloated by all this air or due to swallowing difficulties caused by the oesophagitis, the baby is very unsettled while feeding, and feeds turn into battles with the breast (or bottle). The baby latches on for a few minutes, then suddenly stiffens, kicks, breaks away and cries in evident frustration. Despite wanting to feed quickly, he or she is unable to and ultimately gives up the struggle after a few minutes of this performance. Then the baby begins to protest hungrily after half an hour to an hour and latches back on to finish feeding. This can go on and on in a continuous loop, reducing the mother to the brink of exhaustion because she has no time at all to rest.

None of this is life-threatening, of course, but let’s try to put ourselves in the shoes of the poor baby and mother. All this unpleasantness does not give them much to be cheerful about. Since I personally experienced this problem with my daughters, I have noticed that the eyes of these babies express what you would expect in their situation: pain, irritation and resignation.

The baby grows normally

Despite this unenviable situation, apart from the odd rare case, children with reflux manage to get enough nutrition and grow normally. This means that their suffering (and that of their family) is often unfairly overlooked and paediatricians will dismiss concerns with comments such as: “Don’t go looking for problems. Your baby is growing nicely, there’s nothing wrong!” Along the same lines, most of my gastroenterologist colleagues only classify reflux as “reflux disease” (and so therefore worthy of attention and treatment) if it is accompanied by complications such as stunted growth, aspiration pneumonia, severe oesophagitis etc. Only a very small percentage of children with the disorder would be deserving of attention according to this definition.

The baby wants to be held all the time

When I see a child with reflux for the first time, the scene that unfolds before me is always the same, with a few minor variations. One of the parents talks to me while the other holds the baby upright with its head resting on his or her shoulder and paces around the room. If the parent sits down and tries to place the baby in a more horizontal position, the baby immediately begins to squirm and cry angrily. I no longer question this behaviour. I know it goes on throughout the day at home and I believe that it is one of the toughest consequences of gastroesophageal reflux. Parents naturally do not want to leave the baby crying inconsolably. This is totally understandable but leads inevitably to habits that will be very difficult to break even once the reflux is finally cured or has cleared up spontaneously.

HIP DISPLASIA

Work in progress.

PENIS NOT OPENING

“You must never try to open the foreskin with manual maneuvers …”

The skin that covers the tip of the penis, the foreskin, is provided with a very narrow opening at birth and is strongly glued to the tip of tit, that is to the glans. The latter is therefore almost completely invisible at birth and generally remains so for a few months up to at least the first year of life.

Slowly the opening of the foreskin widens and the adhesions with the glans detach, so that the latter gradually emerges from its “captivity”. It takes a few months to a few years for this process to complete, sometimes up to ten years. It should also be known that a dense and whitish secretion normally forms between the foreskin and the glans, the so-called smegma. This, initially not having an outlet to the outside, accumulates here and there forming whitish sketches, the “smegamic cysts”, which protrude on the sides of the pea tip, under the skin. It is precisely the accumulation of smegma between the skin and glans which, acting like a wedge, favors the spontaneous detachment I mentioned above.

Sometimes the secretion can become infected and lead to the formation of pus between the glans penis and the foreskin. This infection, called balanoposthitis, manifests itself as a foreskin with swelling and redness of the tip of the pea. Balanoposthitis causes intense pain that is accentuated by pressure or when the child pees. The infection almost always heals spontaneously with the release of a little pus and blood from the tip of the pea.

Even trivial inflammations of the area covered by the diaper, due to the action of pee or feces, can cause a slight swelling of the foreskin right around its opening, so that this is temporarily narrower. When the inflammation subsides, everything returns to the way it was before and the skin continues to gradually widen.

In short, if parents limit themselves to observing normal hygiene, that is, washing the child’s genitals daily, without forcing them to open, in almost all children the glans will uncover spontaneously. It is quite rare that surgery is required because this process did not complete within the first ten years.

It is therefore completely unjustified to make more or less forced manual opening maneuvers of the foreskin, which are often also counterproductive. In fact, in these maneuvers, tiny wounds can be found on the edge of the foreskin which, by healing, stiffen the opening and then make the operation inevitable.

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

All the viral infections of the respiratory tract described so far, with their bacterial complications, reach their maximum frequency from the moment the child begins to go to the nursery or kindergarten. This is because the opportunities for contact with other children increase exponentially and thus the possibility of contracting viruses increases.

It is calculated that a child who goes to kindergarten the first year can get a new respiratory viral infection every week and this explains why his nose never stops running and the cough never stops: while he is about to recover from an infection, another begins, which overlaps the previous one.

This situation, which US pediatricians have rightly called the “asylum syndrome”, is practically inevitable and generally does not create any serious health risks for the child.

Therefore my recommendation to parents who consult me ​​exasperated by the long succession of ailments is not to pay too much attention to the runny nose, cough and periodic fever: these are symptoms that will disappear gradually, leaving an immunity that will then allow the little one. to attend real school without making too many sick leave. In short, it is a “tax to be paid to become a member of the community”.

It is easy to understand how a second child, born when the first has already started attending kindergarten, is exposed to all the diseases that his brother brings home and therefore always has one too. With the aggravating circumstance that he is smaller and more vulnerable to possible complications, especially bronchiolitis, bronchitis and otitis. Personally, I have defined this situation as the “second-born syndrome”, a problem which, in addition to that of the first-born, can cause big headaches for the whole family.

The only weapons that can be used to counter these problems are those of prevention and treatment of complications, waiting patiently for the “storm” to pass. And the best prevention consists in carrying out all the recommended immunizations, particularly those against pneumococcus (responsible for a large part of the ear infections, bronchitis and pneumonia of this period) and the anti-flu one.

For those children who, despite all precautions, fall ill too often with otitis media and / or bronchitis and risk significant damage, there is a remedy to which I have already mentioned and which consists in prophylaxis with small daily doses of sulfonamides or antibiotics for some months.

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