Common Illnesses of Babies Part2

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Common Illnesses of Infants and Children Part 2

• P.Naina Mohamed
• Pharmacologist

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Introduction

• Illnesses discussed in this presentation
• Nausea and Vomiting
• Spitting up in babies
• Diarrhea
• Stomach Flu
• Diaper rash
• Oral thrush
• Asthma/Reactive Airway Disease (RAD)

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Nausea and Vomiting

• Nausea
• Unpleasant sensation of wanting to vomit.
• Associated with cold sweat, pallor, salivation,
  loss of gastric tone, duodenal contraction, and
  the reflux of intestinal contents into the
  stomach.
• Precedes vomiting, but can occur by itself.
• Vomiting
• Forceful expulsion of the contents of the
  gastrointestinal system out through the mouth.
• Evolved as a defense mechanism of the body
• Vomiting serves as a protective function to get
  rid of the noxious substances that have been
  ingested from the body, rather than allowing them
  to be retained and absorbed by the intestine.

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Reasons for vomiting in babies and children

• Food poisoning.
• Gastro-intestinal infection
• Colds and flu.
• Chest infections, such as pneumonia or
  bronchitis.
• Sore throat due to tonsillitis or Strep throat.
• Gastro-esophageal reflux disease (GERD).
• Urinary tract infection (UTI).
• Appendicitis.
• Hepatitis.
• Blockage in the bowel, such as pyloric stenosis
  or duodenal atrasia.
• Food or milk allergy or intolerance.
• Ingestion (eating or drinking) or inhalation
  (breathing in) of toxins.
• Medications - such as antibiotics
• Head injury.
• Infections of brain tissues, such as meningitis.
• Dizziness - motion sickness.
• Overeating.
• Excitement.
• Extreme anxiety or emotional stress.

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Mechanism of Vomiting

• Distention or Acute infectious gastroenteritis
• Irritation of the GI mucosa
• Activation of 5-HT3 receptors of CTZ of fourth
  ventricle of the brain
• Closure of Glottis
• Contraction and fixing of Diaphragm
• Closure of Pylorus
• Relaxation of Gastric wall and esophageal orifice
  
• Forceful contraction of Abdominal muscles
• Vomiting

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Causes of Vomiting

• Neonates
• Forceful vomiting in newborns can indicate a
  serious conditions like Pyloric stenosis
  (blockage or narrowing of the stomach) or
  Intestinal obstruction (blockage of the
  intestines) and always requires further
  evaluation.
• Infants can also vomit because of infections of
  the intestine or other parts of the body. Any
  young infant (newborn to 3 months) who develops a
  temperature of 100.4º F (38º C) or higher, with
  or without vomiting, should see a doctor or
  nurse.
• Children
• The most common cause of vomiting in older
  infants and children is infectious
  gastroenteritis (an infection of the stomach or
  intestines), usually caused by a virus. Vomiting
  caused by gastroenteritis usually begins suddenly
  and resolves quickly, often within 24 hours.
  Other signs of gastroenteritis can include
  nausea, diarrhea, fever, or abdominal pain.
• Gastroenteritis can develop after eating
  contaminated food or putting a contaminated
  object (or hand) into the mouth. The viruses that
  commonly cause gastroenteritis are spread easily.
  Careful hygiene (especially hand washing) can
  prevent these infections from spreading.
• Less commonly, vomiting occurs after consuming
  improperly stored or prepared foods that contain
  bacteria or toxins this is called food
  poisoning.
• Other illnesses like gastroesophageal reflux,
  peptic ulcer disease and others can also cause
  vomiting in older infants and children.

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Home Care

• The following are some simple recommendations to
  help the children with nausea and vomiting at
  home
• If a breastfeeding infant vomits, he or she
  should continue to breastfeed unless your doctor
  or nurse tells you otherwise.
• Oral rehydration solutions are not usually needed
  for infants who exclusively breastfeed because
  breastmilk is more easily digested.
• If your infant vomits immediately after nursing,
  you can try to breastfeed more frequently and for
  a shorter time. For example, breastfeed every 30
  minutes for five to 10 minutes. If vomiting
  improves after two to three hours, resume the
  usual feeding schedule.
• If vomiting worsens or does not improve within 24
  hours, call your child's doctor or nurse.
• If your infant drinks formula, initially offer
  one to two ounces of an oral rehydration solution
  every 30 minutes for two to three hours. If
  vomiting improves, resume feeding with full
  strength infant formula.
• If vomiting worsens or does not improve within 24
  hours, call your child's doctor or nurse.

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Home Care

• Children who are vomiting but are not dehydrated
  can continue to eat a regular diet as tolerated.
  Dehydrated children require rehydration
  (replacement of lost fluid).  
• Monitor for signs of dehydration, and do not
  force the child to eat, especially during the
  first 24 hours. Encourage the child to drink
  fluids. The best fluids are the commercially
  prepared oral rehydration solutions.
• Oral rehydration therapy (ORT) was developed as a
  safer, less-expensive, and easier alternative to
  intravenous (IV) fluids. Oral rehydration
  solution (ORS) is a liquid solution that contains
  glucose (a sugar) and electrolytes (sodium,
  potassium, chloride), which are lost with
  vomiting and diarrhea.
• Children who refuse to drink or who vomit
  immediately after drinking ORS should be
  monitored closely for worsening dehydration.
  Children who are not dehydrated can continue to
  drink ORS between episodes of vomiting to prevent
  dehydration.
• you should not give antiemetic drugs to an infant
  or child unless the child's doctor or nurse has
  recommended them.
• Other fluids, including water, diluted juice, or
  soda can be given in small quantities.

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Home Care

• Apple, pear, and cherry juice, and other
  beverages with high sugar content, should be
  avoided. Sports drinks should also be avoided
  since they have too much sugar and have
  inappropriate electrolyte levels.
• Recommended foods include a combination of
  complex carbohydrates (rice, wheat, potatoes,
  bread), lean meats, yogurt, fruits, and
  vegetables. High fat foods are more difficult to
  digest, and should be avoided.
• It is not necessary to restrict a child's diet to
  clear liquids or the BRAT diet (bananas, rice,
  applesauce, toast). Although these and similar
  foods might be recommended to decrease diarrhea,
  these foods do not contain enough nutrients for a
  child.

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When to seek medical help

• You should call your doctor or nurse immediately
  if your child has any of the following
• Bile (green) or blood-tinged (red or brown) vomit
  
• Any episode of vomiting in a newborn, or vomiting
  that continues for more than 24 hours in an
  infant or child
• If an infant refuses to eat or drink anything for
  more than a few hours
• Moderate to severe dehydration dry mouth, no
  tears when crying, not urinating or having a wet
  diaper in four to six hours (for babies and young
  children) or not urinating in six to eight hours
  (for older children).
• Abdominal pain that is severe, even if it comes
  and goes
• Fever higher than 102ºF (39ºC) once or fever
  higher than 101ºF (38.4ºC) for more than three
  days but in case of newborn (From birth to 3
  months) the temperature should be less than
  38.0ºC.
• Behavior changes, including lethargy or decreased
  responsiveness

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Spitting up

• Spitting up is another common occurrence during
  infancy. Infants normally spit up small amounts
  (usually lt 5 to 10 mL) during or soon after
  feedings, often when being burped.
• Causes
• Rapid feeding,
• Air swallowing, and
• Overfeeding
• Vomiting is differed from spitting up in
  forcefulness and associated illnesses. Vomiting
  generally occurs soon after a meal and produces a
  much greater volume than spitting up.
• Some babies spit up more than others, but most
  are out of this phase by the time they are
  sitting. A few heavy spitters will continue
  until they start to walk or are weaned to a cup.
  Some may continue throughout their first year.

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Possible Mechanism

• Infants (Less than 6 to 12 months)
• Have incompletely developed Sphincter or valve
• (elastic-like muscle at the entry to the stomach
  which closes like a valve to prevent liquids from
  being pushed back up)
• The valve is easily pushed back by the contents
  of the stomach
• Regurgitation or Spitting up

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Difference between regurgitation and vomiting?

• Unlike spitting up, vomiting is characterized by
  the forceful expulsion of the contents of the
  stomach.
• It's important to know the difference between
  vomiting and spitting up because repeated
  vomiting can be a signal of a more serious
  illness, and because it can easily lead to
  dehydration.
• Dehydration is a dangerous condition in which
  excessive loss of body fluids results in a
  potentially life-threatening imbalance of water
  and essential body salts.
• If vomiting is persistent, accompanied by very
  high temperatures and/or increasing lethargy, or
  if vomit contains blood, medical attention should
  be sought immediately.
• Occasional vomiting, if unaccompanied by other
  symptoms, may not be a cause for concern but
  should be discussed with a doctor.

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Home Care

• Make each feeding calm, quiet, and leisurely.
• Avoid interruptions, sudden noises, bright
  lights, and other distractions during feedings.
• Burp your bottle-fed baby at least every three to
  five minutes during feedings.
• Avoid feeding while your infant is lying down.
• Hold the baby in an upright position for 20 to 30
  minutes after each feeding.
• Do not jostle or play vigorously with the baby
  immediately after feeding.
• Try to feed her before she gets frantically
  hungry.
• If bottle-feeding, make sure the hole in the
  nipple is neither too big (which lets the formula
  flow too fast) nor too small (which frustrates
  your baby and causes her to gulp air). If the
  hole is the proper size, a few drops should come
  out when you invert the bottle, and then stop.
• Elevate the head of the entire crib with blocks
  (dont use a pillow) and put her to sleep on her
  back. This keeps her head higher than her stomach
  and prevents her from choking in case she spits
  up while sleeping.
• Any upright position, such as holding your baby
  to your shoulder (as you would to burp him or
  her), will help reduce regurgitation.However,
  placing the baby in an infant seat can make
  matters worse and should be avoided, especially
  immediately after a feeding. The baby's slouching
  position in this kind of seat puts pressure on
  the stomach that can result in regurgitation. Be
  sure to consult your doctor before making any
  changes in your baby's position or diet.

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Diarrhea

• Diarrhea is frequent loose or watery bowel
  movements that deviate from a child's normal
  pattern.
• Diarrhea is a very common pediatric concern and
  causes 2 to 3 million deaths/yr worldwide. It
  accounts for about 9 of hospitalizations in the
  US among children aged lt 5 yr.
• Breastfed infants who are not yet receiving solid
  food often have frequent loose bowel movements
  that are considered normal.
• Diarrhea may be accompanied by anorexia,
  vomiting, acute weight loss, fever, or passage of
  blood.
• Gastroenteritis is the most common cause.
• Testing is rarely necessary in acute diarrhea.
• Dehydration is likely if diarrhea is severe or
  prolonged.
• Oral rehydration is effective in most cases.
• Antidiarrheal drugs (eg, loperamide IMODIUM) are
  not recommended for infants and young children.

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Types

• Acute diarrhea usually is caused by
• Gastroenteritis
• Antibiotic use
• Food allergies
• Food poisoning
• Most gastroenteritis is caused by a virus
  however, any enteric pathogen can cause acute
  diarrhea.
• Chronic diarrhea usually is caused by
• Dietary factors
• Infection
• Celiac disease
• Chronic diarrhea can also be caused by anatomic
  disorders and disorders that interfere with
  absorption or digestion.

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Possible Mechanism

• Gastroenteritis
• Inflammation or ulceration of the intestinal
  mucosa
• Outpouring of plasma, serum proteins, blood, and
  mucous
• Increases fecal bulk and fluid content
• Diarrhea

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Treatment

• Vomiting and diarrhea is treated by replacing the
  fluid lost with a balanced fluid and electrolyte
  solution called Oral rehydration solution (ORS).
• Oral rehydration solution (ORS) should contain
  complex carbohydrate or 75 mEq/L glucose and 75
  mEq/L Na (total 245 mOsm/L solution). ORS is
  recommended by the WHO.
• Antidiarrheal drugs eg, loperamide are not
  recommended for infants and young children.
• Sports drinks, sodas, juices, and similar drinks
  have too little Na and too much carbohydrate to
  take advantage of Na/glucose cotransport, and the
  osmotic effect of the excess carbohydrate may
  result in additional fluid loss.
• Specific causes are treated (eg, gluten-free diet
  for children with celiac disease).
• Children should eat an age-appropriate diet as
  soon as they have been rehydrated and are not
  vomiting. Infants may resume breast milk or
  formula.

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Stomach Flu

• Stomach Flu is Contagious.
• "Stomach flu" isn't actually the flu (influenza)
  but gastroenteritis, an upset stomach usually
  caused by a virus.
• Symptoms
• There is often fever at the onset along with
  variable degrees of respiratory symptoms.
• vomiting tends to occur primarily in the first
  day or two of the illness it may be as little as
  once or twice a day or as severe as literally
  vomiting each and every time fluid are offered. 
• When diarrhea is present, it may be very
  infrequent and may be as often as a stool an
  hour! 
• How it spreads
• Close contact with someone who has it
• By eating food that's been prepared or touched by
  someone who has it.
• Prevention
• Try to keep your child away from people who have
  the stomach flu.
• Teach him to wash his hands frequently,
  particularly before eating and after using the
  bathroom.
• Teach your child to avoid sharing foods and
  utensils with other kids.
• Teach him not to put his fingers in his mouth.

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Stomach Flu

• Treatment
• There is no specific treatment for stomach flu.
• Give your child popsicles and extra fluids to
  make sure he stays well hydrated.
• He should also rest.
• Avoid spicy foods and fried foods.
• Give small amounts of bland foods like gelatin,
  toast, crackers, rice, or bananas at first.
• Feed him small amounts frequently.
• If you think your child is not drinking enough or
  voiding enough (a child 1 year or older needs to
  void at least once every four hours) call your
  doctor.
• If your little one is less than 1 year and has
  vomiting or diarrhea, consult your doctor.

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Diaper rash

• Diaper rash is a generalized term indicating any
  skin irritation that develops in the
  diaper-covered region.
• Diaper rash is very common in babies.
• Diaper rash is most commonly a kind of contact
  dermatitis.
• Diaper rash may become secondarily infected by
  bacteria or yeast normally present on the skin.
  In this case, topical antibiotic ointments
  provide a rapid and effective therapy.
• Synonyms
• Diaper dermatitis (dermatitis inflammation of
  the skin), napkin (or "nappy") dermatitis and
  ammonia dermatitis.
• Causes
• Overhydration of the skin
• Maceration
• Prolonged contact with urine and feces
• Retained diaper soaps
• Topical preparations
• More than 3 diarrheal stools per day
• Side effects of oral antibiotics

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Possible Mechanism

• Increased wetness in the diaper area
• Increased penetration of irritant substances
• Superhydration urease enzyme found in the stratum
  corneum liberates ammonia from cutaneous bacteria
• Lipases and proteases in feces mix with urine on
  nonintact skin
• Increased (Alkaline) surface pH
• Increased irritation
• Diaper Rash

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Diaper rash

• Advantage of Breast Feeding
• Breastfed infants
• Lower pH of feces
• Less susceptible to diaper dermatitis

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Diaper rash

• Prevention
• Avoidance of skin irritants by frequent diaper
  changing provides the number-one preventative
  measure.
• Treatment
• Frequent diaper changes
• simple cleansing with water and soft cloths tends
  to be less irritating to the injured skin than
  disposable wipes.
• Application of topical barriers (Petroleum jelly
  (Vaseline) or Zinc oxide cream), and rarely
  topical antibiotic/antifungal ointments, or
  low-potency hydrocortisone cream.
• open-air exposure of the irritated skin is also
  extremely effective in helping clear up diaper
  rash.
• Let the baby go without a diaper for short
  periods of time, such as during naps.
• Avoid using plastic or tightfitting diaper
  covers.
• Use larger than usual sized diapers until the
  rash goes away.
• The absorbent gel material found in most of
  today's disposable diapers draws moisture away
  from the skin area, thus helping to promote a
  healthy diaper area.
• Avoid High-potency steroid creams, powders, and
  concentrated baking-soda/boric-acid baths and
  neomycin-containing ointments.

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Oral Thrush

• Oral thrush is a yeast infection of the mouth
  that is caused by a fungal microorganism called
  Candida albicans.
• Oral thrush is most common in infants and is
  generally not a serious condition, but it can be
  uncomfortable and lead to difficulties with
  eating or infant feeding if it does not resolve
  or is not treated.
• 50 of the population has candida in their
  mouths.
• Causes
• Oral thrush may occur in babies because their
  immune systems take time to mature, making them
  less able to resist infection leading to sores
  and lesions in the mouth and on the tongue.
• Under normal circumstances candida albicans is
  kept under control by bacteria. Taking strong
  antibiotics, especially for a long period of
  time, may kill bacteria, which can alter the
  balance of microorganisms in the mouth and result
  in a proliferation of yeast.
• Candida albicans can also cause a yeast or thrush
  infection in the vagina, resulting in the
  exposure of an infant to the infection during the
  vaginal birthing process.
• It can also cause an infection in a woman's
  nipples, which can then be transmitted to an
  infant's mouth during breastfeeding.

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Oral Thrush

• Infants
• Immature immune system
• Less protection against Candida
• sores and lesions in the mouth and on the tongue
• Oral Thrush

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Oral Thrush

• Candida
• Infection in the vagina
  Infection in woman's nipples
• Vaginal birth exposes the infant
  Breastfeeding transmits the
• to the infection
  infection to the infant
• Oral Thrush

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Oral Thrush

• Symptoms
• Thrush appears as whitish, velvety lesions in the
  mouth and on the tongue. Underneath the whitish
  material, there is red tissue that may bleed
  easily. The lesions can slowly increase in number
  and size.
• Lesions will begin to appear within the mouth,
  and one may have pain associated with lesion
  development. The corners of the mouth may crack
  when one opens the mouth.
• If an older child or adult gets thrush in the
  mouth, or ulcers that look like they may be
  thrush, it may be a sign of another disease, so
  have a doctor check.
• Other symptoms can include a loss of taste, or
  feeling as if swallowed a cotton ball. The thrush
  can become severe enough that one may have
  difficulty swallowing food.

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Oral Thrush

• Prevention
• Pregnant women should consult with their licensed
  health care provider if they have symptoms of a
  vaginal yeast infection, such as vaginal itching
  and a cheesy white discharge.
• Nursing women who have nipple discharge or pain
  should also notify their provider so they can be
  examined for a thrush infection in the nipples,
  which could be transmitted to the mouth of a
  nursing infant.
• Thoroughly clean the nipples and pacifiers in hot
  water or dishwasher after each use.
• Storing milk and prepared bottles in the
  refrigerator prevents yeast from growing.
• If Breastfeeding nipples are red and sore,
  there's a chance the mother may have a yeast
  infection on her nipples, and that herself and
  the baby are passing it back and forth.
• Treat the mother with antifungal ointment on her
  nipples while the baby is being treated with the
  antifungal solution.
• Changing diapers frequently also prevents the
  fungal diaper rashes.

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Oral Thrush

• Treatment
• The treatment may be drops or a gel which needs
  to be spread around the inside of the mouth, not
  just put on the tongue.
• If the baby is breastfeeding, the mother's
  nipples may need to be treated at the same time
  as the baby to prevent the infection passing back
  and forth.
• In many cases oral thrush in infants can
  disappear on its own and may need no treatment
  other than watching the progress of the mouth
  lesions. Because oral thrush may affect feedings,
  the pediatrician should still be notified if
  symptoms appear in an infant.
• Treatment of older children and adults with oral
  thrush includes diagnosing any underlying
  diseases that may increase the risk for the
  infection. These include HIV/AIDS and diabetes.
  Treating the high blood sugar levels of diabetes
  may resolve a current infection and is key to
  minimizing the risk of developing recurrent
  infections of oral thrush.
• A treatment plan may also include medications,
  including prescription topical or oral antifungal
  medications, such as fluconazole.
• Therapy may also include eating yogurt or taking
  acidophilus supplements, which can help to
  correct the abnormal balance of microorganisms in
  the mouth, which leads to oral thrush.
• Using antiseptic mouth washes may also be
  recommended.

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Asthma/Reactive Airway Disease (RAD)

• Reactive airways disease (RAD) is a term used to
  describe breathing problems in children up to 5
  years old.
• Asthma develops atleast in 5 years old child.
• The terms "reactive airway disease" and "asthma"
  are used interchangeably and the term "reactive
  airway disease" is used when asthma is suspected,
  but not yet confirmed.
• Reactive airway disease (RAD) is transient.
• RAD can resolve over time or it can progress to
  frank asthma.
• Asthma is a chronic condition of wheezing brought
  on by various triggers like cigarette smoke,
  viruses, allergens, cold air and exercise.

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Factors increasing the risk of RAD

• Asthmatic mother or Someone in the family has
  allergies.
• Absence of breast feeding or breastfed fewer than
  3 months.
• Lung infection caused by a virus, such as
  respiratory syncytial virus (RSV).
• Treated in the hospital for bronchiolitis
• Secondhand smoke.
• Tobacco smoke during pregnancy or the first year
• Triggers of allergy like pollen and pets.

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Pathophysiology of RAD

• Environmental stimuli
• Induction of an allergen-antibody interaction
• Release of mediators like histamine, tryptase,
  heparin, leukotrienes, platelet-activating
  factor, cytokines, interleukins, and tumor
  necrosis factor from mast cells
• Airway inflammation
• Smooth muscle hyper responsiveness, edema, and
  increased mucous production
• Increased work of breathing

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Signs and symptoms of RAD

• Wheezing Wheezing is a high-pitched whistling
  sound
• Trouble breathing Chest tightness, flare
  nostrils and also take shorter, faster breaths
  than usual.
• Cough Cough that does not go away and make
  crackle sound during breathing and coughing.
• Fast heartbeat Heart may beat faster than usual
  due to breathing trouble.
• Runny nose Runny nose may be present along with
  other signs and symptoms of RAD  

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Preventive Measures

• Do not let anyone smoke around the child
  Cigarette smoke can harm the child's lungs and
  cause breathing problems. Do not let anyone smoke
  inside home and quit smoking.
• Keep all follow-up visits Make sure the child
  gets all of the vaccines recommended.
• Avoid triggers Avoid areas where there is
  pollution, perfume, or dust. Remove pets from
  home.
• Breastfeed your infant Breast milk helps protect
  the child from allergies that can trigger
  wheezing and other problems.
• Help the child get enough exercise and eat
  healthy foods The child may need to take
  medicine through an inhaler 10 to 15 minutes
  before exercise. Give the child healthy foods.
• Avoid spreading illness Keep the child away from
  others illnesses. Do not send the child to
  school or daycare when he is sick.
• Make changes to your home Keep your home free
  from the triggers like dust mites, cockroaches,
  or mold. Keep the humidity (moisture level in the
  air) low. Fix leaks, and remove carpets where
  possible. Use mattress covers, and wash bedding
  every 1 to 2 weeks in hot water. Wash tables and
  other surfaces with weak bleach (1 tablespoon of
  bleach in a gallon of water).

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Treatment of RAD

• Short-acting bronchodilators (Salbutamol) They
  are used to relieve sudden, severe symptoms, such
  as trouble breathing. These medicines may be
  called relievers or rescue inhalers.
• Long-acting bronchodilators (LABA) Long-acting
  bronchodilators (Salmeterol, Formeterol) may be
  called controllers. These medicines help open the
  airways over time, and is used to decrease and
  prevent breathing problems. Long-acting
  bronchodilators should not be used to treat the
  child for sudden, severe symptoms, such as
  trouble breathing.
• Corticosteroids These medicines help decrease
  swelling and open the child's air passages so he
  can breathe easier.
• Breathing treatments Use a nebulizer or an
  inhaler to help breathe in the medicine.
• Oxygen Oxygen helps to breathe easier.

37
References

• CURRENT Diagnosis Treatment Pediatrics, 21e
  William W. Hay, Jr., Myron J. Levin, Robin R.
  Deterding, Mark J. Abzug, Judith M. Sondheimer
• Pediatric Clinical Advisor Instant Diagnosis
  and Treatment , Second Edition
• Lynn C. Garfunkel, Jeffrey M.
  Kaczorowski, and Cynthia Christy

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References

• http//www.cdc.gov/parents/infants/diseases_condit
  ions.html
• http//www.nlm.nih.gov/medlineplus/commoninfantand
  newbornproblems.html
• http//www.nichd.nih.gov/health/topics/infantcare/
  conditioninfo/Pages/basics.aspx
• http//children.webmd.com/treating-common-illness-
  10/slideshow-infant-symptoms
• http//www.clinicalpediatrics.com/Management-of-Co
  mmon-Illnesses-of-Infants-and-Ch.html