Health Problems: Toddlers

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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

REFLUX FROM SIX MONTHS TO ONE YEAR

Children regurgitate less but projectile vomit occasionally. They still hiccup.

After the beginning of weaning, between five and six months of age, reflux babies usually regurgitate less and find it so much easier to feed that they might seem “cured”. At least this is what many parents conclude and therefore take a unilateral decision to stop treatment. Another reason is that they are concerned about giving their child so many medicines, despite my reassurances that they are harmless.

Regurgitation, vomiting and hiccups.

They usually have to think again, though, if the child continues to suffer despite being apparently cured Some lingering regurgitation and the occasional episode of sporadic vomiting, together with annoying hiccupping indicate the condition is still present.

Burping

Children also give an impression of always having food sitting heavily on their stomachs and struggling to digest it. They will often burp several hours after a meal.

Food cut into small pieces causes bouts of vomiting

As the months go by, reflux babies usually will not accept food cut up into small pieces as other babies do. If the food contains bits, however small, they will tend to cause bouts of vomiting and be spat out.  The explanation is that even though the oesophagitis may be mild, it makes the oesophagus more sensitive and causes it to go into spasm when swallowing solid food fragments.  In other words, a mild form of dysphagia occurs.

Noisy swallowing

For the same reason, when swallowing, the child sometimes produces a gurgling noise, as though the food is going down with difficulty, between spasms and attacks of wind.

Coughing fits

A tendency to frequent coughing fits when lying down, with a few spells of nightly vomiting, also continues in this age group.

The constipation continues and sometimes even gets worse. How come?

Because children are scared of the painful bowel movements and do everything to hold it in. At certain times, when they eventually manage to move their bowels, they cry with pain and sometimes expel a few drops of blood because passing the hard stools opens up a small lesion known as an anal fissure.

The child drinks continuously

In this second part of their first year, very many children with reflux begin to demand a drink continuously.

For example, from when she began to crawl at eight months old, my daughter began the habit of always grasping a bottle full of apple juice in her hand. This was the drink of choice to give to babies in the USA at that time. Every now and then she stopped, sat down and drank a little, always producing a very creditable burp immediately afterwards.  She demanded a full bottle every evening when she was put down to sleep, so that she could quench her thirst whenever she woke. At that time, we were unaware that the fact she wanted to drink all the time was a sign that she was tormented by reflux. It was an instinctive way of giving herself relief, i.e. drinking to force back down the acid she was bringing up. I had not realized that the fluid she was taking was facilitating the reflux, inexorably bringing her gastric contents back up and forcing her to drink again after a short time and perpetuating a vicious cycle.

The baby wants to breast feed all the time

When babies are still being breast-fed at this stage, their mothers usually give in and allow them to feed very often, even at night, for the same reason and with the same consequences as the habit of continually drinking a bottle of water.

The baby also regurgitates solid food

It may seem counter-intuitive, but solid foods that should by all rights help the baby not to regurgitate come back up even several hours after a meal. This happens more often with fruit (particularly with blended baby foods) and all other sweet foods, which accentuate the gastric acid and exacerbate the reflux symptoms.

The baby wakes up all the time

The thing that really worries and exasperates parents most at this stage, however, is the increasing problem of sleep. I can illustrate this by describing what happened to Marta. Even though she went down happily, after an hour or two she began to wake up, fidgeting and crying, forcing us to pick her up and comfort her. When we put her back down, she seemed to struggle desperately against a mysterious adversary. She tossed and turned, moaned, lost her dummy, got onto her knees with her bottom in the air (her favourite sleeping position) sat up suddenly and then threw herself down as if she was having a nightmare. Her ceaseless movement almost always meant that she ended up at the other end of her cot, with her head pressed against the bars or cot bumper. This meant that she had no peace, at least until the early hours of the morning. Then she began to sleep more calmly until she eventually woke up to start the day. From time to time, my wife and I were sorely tempted to take her into our bed, and to hell with our good intentions of not spoiling her! II often had to work a night shift at the hospital and the next day was usually real torture. There was no rest.

FOOD ALLERGIES

Very often I see children for the first time who have been on a diet for months or even years for inconsistent reasons.

Maybe because they have had some patches of red, rough skin or because they have a few sporadic episodes of vomiting or because they have two or three loose stools a day or because they don’t seem to grow adequately.

The goal of these diets would be not only the elimination of symptoms but also the “prevention” of future allergies. In fact, parents are explained that, if one of them is an “allergic subject” (that is, has any symptoms of allergy of any kind), their child could be himself and therefore every effort must be made to prevent severe allergies from developing in the future. Thus, by virtue of this type of motivation, diets are almost always decided and maintained despite the lack of convincing evidence of the alleged intolerances and despite the fact that it is evident that food restrictions do not bring about any change in symptoms. In short, the sacrifice would be worthwhile, because it can still save the child from a risky future….

Learn to defend yourself from carelessness

Following these criteria, in practice a disproportionate percentage (20, 30% according to my estimates) of Italian children are declared allergic and sooner or later put on a diet for long periods of time.

Experience tells me that not only is all this unjustified and expensive, but that it is profoundly harmful from a psychological point of view. In fact, when I see the parents of these children, the concern and uncertainty that dominates them immediately jumps to my eyes. Among other things, what keeps them most in doubt and despair is precisely the fact that diets do not change the symptoms for which they had consulted the pediatrician at all, which leads them to fear that their little one may be affected. from a serious and incurable problem.

It is easy to understand how these feelings lead parents to behaviors that weigh heavily and negatively on the psychological well-being of the child. Above all, they make them excessively protective of him, thus causing him a sense of fragility and precariousness that could deeply affect his personality and forever.

It is first and foremost for this reason that I think it is important that people learn to defend themselves from the carelessness with which food allergy is diagnosed in our country and forcing perfectly healthy children to go on expensive and useless diets.

The real symptoms of food allergy

Let’s see what are the symptoms that can seriously justify the suspicion of food allergy, according to the criteria considered valid by the Allergy Committee of the American Academy of Pediatrics. Symptoms can be of two types:

  1. acute, that is, they can occur in the hours immediately after taking responsible food. In this case, it is generally very easy to notice the cause-effect link between food intake and consequent symptoms.
  2. chronic, that is, they can develop slowly, over the course of weeks or months. In this case it is easy to fall into misinterpretation and overdiagnosis.

Acute symptoms

Gastrointestinal symptoms: The first symptoms that typically occur when a child is allergic to a food are, after a few minutes or at most within a couple of hours, violent, jet vomiting and, soon after, profuse, explosive, often diarrhea. containing blood. These symptoms generally subside within a few hours or a day at most from food intake.

Skin symptoms: Also within a few minutes or a few hours, an urticaria that causes a lot of itching appears on the skin in various parts of the body and on a rapidly growing surface (not only on the face or other limited areas of skin).

Respiratory symptoms: Sometimes the child, in addition to the symptoms described above, may also experience an attack of allergic rhinitis, with numerous sneezing and profuse nasal discharge or even severe difficulty in breathing due to a bronchospasm caused by the allergic reaction, a symptom that makes the reaction resemble to an attack of bronchial asthma.

Anaphylaxis: If the symptoms described above are ignored or misinterpreted and the child eats the offending food again and again, a true anaphylactic shock can occur which can cause severe loss of blood pressure, leading to cardiac arrest. and to death.

Foods most frequently implicated in causing acute symptoms of food allergy: Cow’s milk, eggs, fish, soy, peanuts, hazelnuts.

Chronic symptoms

Gastrointestinal Symptoms: Instead of acute vomiting and diarrhea, affecting the gastrointestinal system can occur:

  1. “Allergic enteropathy”

Characterized by all of the following symptoms together:

  • Persistent vomiting
  • Diarrhea with more than six discharges per day
  • Atopic dermatitis (we’ll see what that means shortly)
  • Clear signs of malnutrition due to the intestinal damage caused from allergy, damage to be demonstrated with an intestinal biopsy.
  • A very intense pallor, due to severe anemia caused by discharge
  •   microscopic blood from the damaged intestinal mucosa
  • Edema in various parts of the body due to a loss of proteinsfrom the damaged intestine and which often makes one think wrongly of  a kidney disease.

It is important to reiterate that, for the doctor to be justified in suspecting allergic enteropathy, it is necessary that all these symptoms are present together and therefore it is necessary to avoid confusing it with other non-allergic disorders, such as gastroesophageal reflux (characterized only by regurgitation and vomiting), or with nonspecific diarrhea (a harmless syndrome characterized by five to six soft stools a day in children who are otherwise well). It is then necessary that the malnutrition mentioned above is not decreed following the impression of a mother worried because the baby does not gain weight at the rate she would like, but that it is a true arrest of weight and stature and that the child appears frankly anemic.

  1. “Allergic colitis”

Allergic colitis is a real colitis with frequent discharges (more than six seven a day) and always containing blood. Rather rare, allergic colitis is almost always due to cow’s milk and almost always occurs in children under the age of two.

Skin symptoms:

The chronic skin manifestations of allergies are those that generate the greatest number of errors and excesses of diagnosis. In fact, as I have already mentioned, some rough and red spots isolated here and there on the body are often attributed to food allergy, spots most often due to irritative factors completely unrelated to the allergy. But what can instead be considered as a true skin sign of allergy? We see.

There is a skin disorder called “atopic dermatitis” which can be considered a sign of food allergy, but only in a limited percentage of cases. Meanwhile, how does atopic dermatitis, often misdiagnosed, manifest itself? To be able to say that a child has this skin disease there must be five conditions:

  1. the redness must extend over a large part of the surface of the body and be particularly intense in the crease of the elbow and behind the knees (therefore not only on the face, hands and legs)
  2. It must cause intense and constant itching, which causes the child to scratch obsessively
  3. The skin therefore becomes scaly and rough all over the place, a symptom defined as “lichenification”.
  4. These symptoms must all be chronic, ie have been present continuously for weeks or months
  5. There must almost always exist in the family people who are affected by the same symptoms or who suffer from very serious allergic phenomena, such as chronic bronchial asthma.

Following these criteria, only 5 to 12 percent of children can be called “atopic” and not, as happens in our country, about half of the children.

Furthermore, as I mentioned above, even the presence of true atopic dermatitis is not necessarily the symptom of a food allergy. Indeed, the most recent statistics show that only about 30% of children with this disorder have a demonstrable food allergy.

But, since chronic symptoms and especially skin symptoms are easily equivocal, what is the evidence to declare that a certain child is indeed allergic to a certain food and eliminate it from his diet?

When the acute symptoms described above occur, the diagnosis is generally obvious, because the symptoms immediately follow food intake and are unequivocally linked to it.

Double-blind test with the “placebo” control The dilemma arises instead when the symptoms are chronic, especially if they are limited to the skin, and it is therefore more difficult to link them to food intake. In this case it is only the so-called double-blind placebo-controlled trial that can be considered a definite and definitive confirmation of the diagnosis. Here’s how this test is done.

When a pediatrician, based on the symptoms I have just described, has valid reason to suspect that the child is allergic to a certain food, he or she may decide to try to eliminate that food from the child’s diet and only that, not ten foods, such as it is often done without any discrimination.

After about two weeks on the diet, a second doctor comes into play who, not knowing the type of diet the child is subjected to (because he is kept “blind” to this information), evaluates the presence or absence of symptoms of allergy.

Immediately after, an unrecognizable powder is introduced into his diet, which can be either the offending food or a “placebo”, ie an inert substance. Both the child’s parents and the second doctor are kept “blind”, that is, unaware of what the child is being given (this is where the expression “double blind” comes from). This doctor after two weeks evaluates any changes in the baby’s symptoms.

Subsequently, always in the same way, the other “powder” is introduced and, after two weeks, the same “blind” doctor evaluates the results. All this complicated system of tests is necessary to avoid errors in the diagnosis due to the preconception that the doctor and the mother may have if they know the diet assigned to the child.

Well, the results of these double-blind tests always show that a large percentage of food allergy diagnoses are false. Only a small fraction of children (from 2% to 8%) are ultimately actually allergic to one food and only about 10% of these (i.e. less than one percent of the total) are allergic to two foods together. Multiple food allergy (ie to many foods at the same time), which is unfortunately diagnosed with great frequency and carelessness in this country, is an extreme rarity.

Alternative evidence of food intolerance:

As if the approximation and lightness with which many traditional doctors diagnose food allergies and subject many children to unnecessary dietary sacrifices were not enough, for some years there has also been evidence of intolerance of “alternative” medicines, first of all those of homeopathic medicine.

Well, try to critically read the description of an “authoritative representative” of this type of medicine. I hope you can grasp his almost childish irrationality. The evidence he lists does not have the slightest scientific basis, that is, no research has ever proved its validity. Even if some statements of homeopaths (such as “allergy is a natural defense of the organism” or “immunological support therapy”, or “the diet is based on the principle of ‘cleansing’ the organism”) are very seductive for not experts and can confuse and fascinate, I advise you to keep a skeptical and rational spirit …

Alternative medicine deals with allergy by considering it as a natural defense of the organism. The efforts of homeopaths and naturists are therefore aimed at strengthening the immune defenses of the child rather than at treating the allergic manifestation. This does not mean, however, that in the case of severe symptoms no drugs are used, but that any drug therapy for alternative medicine is associated with immunological support therapy. An immunological support therapy based on two procedures:

– the dilution of the allergen which involves taking in drops by mouth of minimal quantities of the substance to which the child has the allergy in order to increase the body’s tolerance;

– the administration of minerals, again by mouth, such as manganese, zinc and copper which are currently lacking in children’s nutrition and capable of reducing the allergic reaction.

Identifying the food or substance responsible for the allergic manifestation also in this case is the basis of every treatment. To do this, alternative medicine relies on two procedures: diet and diagnostic tests.

The diet is based on the principle of cleansing the organism in which to introduce foods gradually (elimination diet) or in rotation (rotation diet) (Note by R. A .: elimination and rotation diets have been abandoned by the official allergology because they are useless) . The rest time and therefore the period in which the child does not eat the food that causes him allergy, allows you to decrease the intensity of the reaction and achieve greater tolerance to the food.

Among the numerous unconventional tests, the most common are:

  • the Dria test which highlights a variation in muscular effort following the administration of a food.

The child is made to sit in a special high chair, then his ankle is tied with a strap connected to a computer and asked to contract the thigh muscle. During the contraction, a solution of the suspect food is placed in his mouth, under the tongue. Food intolerance is signaled by the computer which records a change in the contraction of the thigh muscle. Since the child’s cooperation is required for this test, it is recommended around the age of five. The advantages that lead to choosing these tests are three: it is not bloody as it does not require cuts on the skin or injections, it has no side effects and, above all, it is fast (one hour is enough to test over 30 foods).

  • the kinesiological muscle test is another tool that correlates muscular effort to the allergic reaction.

In this case, the food, as well as being placed in the mouth, can be held in the hand or the child can be asked to think about the food. The examiner makes a specific muscle effort and checks if the muscle has a loss of power. If so, it is established that the food tested is responsible for allergy. This test has the same advantages as the Dria test and therefore is fast, practical and does not foresee cuts on the skin.

  • the cytotoxic test unlike the others is based on a blood test. The blood is brought into contact with a number of food substances which in the event of an allergy will cause swelling in the granulocytes (a type of white blood cell) visible under a microscope. The advantage is that it can also be used for very young children.

The times are a little longer due to the laboratory analysis (blood test).

  • Nogier’s pulse reflex test signals the existence of particular reflexes of the organism that can be related to its energy variations. This means that putting the food suspected of causing allergy in contact with the baby’s skin, you will feel an acceleration of the pulse in the wrist.

The advantages of this test are the speed of execution and the immediacy of the results.

  • Electrodermal tests such as the Vega test indicate the skin’s ability to conduct energy. In this case an electric circuit in which a vial with the food is inserted, is put in contact with the baby’s skin through electrodes. Electrical variations indicate the presence of a food allergy or intolerance. A quick test that, however, raises some doubts even in doctors specializing in alternative medicine.

After about two weeks on the diet, a second doctor comes into play who, not knowing the type of diet the child is subjected to (because he is kept “blind” to this information), evaluates the presence or absence of symptoms of allergy.

Immediately after, an unrecognizable powder is introduced into his diet, which can be either the offending food or a “placebo”, ie an inert substance. Both the child’s parents and the second doctor are kept “blind”, that is, unaware of what the child is being given (this is where the expression “double blind” comes from). This doctor after two weeks evaluates any changes in the baby’s symptoms.

Subsequently, always in the same way, the other “powder” is introduced and, after two weeks, the same “blind” doctor evaluates the results. All this complicated system of tests is necessary to avoid errors in the diagnosis due to the preconception that the doctor and the mother may have if they know the diet assigned to the child.

Well, the results of these double-blind tests always show that a large percentage of food allergy diagnoses are false. Only a small fraction of children (from 2% to 8%) are ultimately actually allergic to one food and only about 10% of these (i.e. less than one percent of the total) are allergic to two foods together. Multiple food allergy (ie to many foods at the same time), which is unfortunately diagnosed with great frequency and carelessness in this country, is an extreme rarity.