Congenital Heart Disease

Congenital heart disease (CHD) is a heart-related problem that is present at birth. There are many different types of congenital heart defects that vary in severity. The defects may affect various structures in the heart, including the valves, the veins leading to the heart, the arteries leaving the heart, the connections and interrelationships among these various parts, and even the location of the heart within the chest.

A physician may suspect that one of these heart defects is present if a child is not growing normally, is having breathing problems at birth, has a heart murmur or has one or more signs (e.g., a bluish tint to the skin called cyanosis). Various diagnostic tests are available to help physicians find the exact cause of the heart problem and to determine the proper treatment.

Each year, roughly 36,000 babies are born with CHD in the United States, which amounts to almost one child in every one hundred being born with some form of CHD. Although there was a time when children born with congenital heart disease often had little hope for a full life, modern medicine now provides multiple treatment options.

CHD may be treated with certain medications, minimally invasive procedures, and surgeries that offer the promise of a much brighter and healthier future. There are approximately one million Americans living today with a congenital heart defect. The advancements have been so successful over the last forty years that there are more adults alive today with treated CHD than children with CHD.

Tetanus

Tetanus is a medical condition that is characterized by a prolonged contraction of skeletal muscle fibres. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Infection generally occurs through wound contamination, and often involves a cut or deep puncture wound. As the infection progresses, muscle spasms in the jaw develop, hence the common name, lockjaw. This is followed by difficulty in swallowing and general muscle stiffness and spasms in other parts of the body. Infection can be prevented by proper immunization and by post-exposure prophylaxis.

Signs and symptoms

Tetanus affects skeletal muscle, a type of striated muscle. The other type of striated muscle, cardiac or heart muscle cannot be tetanized, because of its intrinsic electrical properties. In recent years, approximately 11% of reported tetanus cases have been fatal. The highest mortality rates are in unvaccinated persons and persons over 60 years of age. C. tetani, the bacterium that causes tetanus, is recovered from the initial wound in only about 30% of cases, and can be found in patients who do not have tetanus.

The incubation period of tetanus ranges from 3 to 21 days, with an average onset of clinical presentation of symptoms in 8 days. In general, the further the injury site is from the central nervous system, the longer the incubation period. The shorter the incubation period, the higher the chance of death. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. On the basis of clinical findings, four different forms of tetanus have been described.

Local tetanus is an uncommon form of the disease, in which patients have persistent contraction of muscles in the same anatomic area as the injury. The contractions may persist for many weeks before gradually subsiding. Local tetanus is generally milder; only about 1% of cases are fatal, but it may precede the onset of generalized tetanus.

Cephalic tetanus is a rare form of the disease, occasionally occurring with otitis media (ear infections) in which C. tetani is present in the flora of the middle ear, or following injuries to the head. There is involvement of the cranial nerves, especially in the facial area.

Generalized tetanus is the most common type of tetanus, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is trismus, or lockjaw, and the facial spasms called risus sardonicus, followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes with the body shaped into a characteristic form called opisthotonos. Spasms continue for 3–4 weeks, and complete recovery may take months.

Neonatal tetanus is a form of generalized tetanus that occurs in newborn infants. It occurs in infants who have not acquired passive immunity because the mother has never been immunized. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus is common in many developing countries and is responsible for about 14% (215,000) of all neonatal deaths, but is very rare in developed countries

Prevention

Tetanus can be prevented by vaccination.^[5] The CDC recommends that adults receive a booster vaccine every ten years, and standard care practice in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than 3 lifetime doses of the vaccine. The booster cannot prevent a potentially fatal case of tetanus from the current wound, however, as it can take up to two weeks for tetanus antibodies to form.^{[citation needed]} In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, DPT/DTaP vaccine, which also includes vaccines against diphtheria and pertussis. For adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used.

Treatment

The wound must be cleaned. Dead and infected tissue should be removed by surgical debridement. Metronidazole treatment decreases the number of bacteria but has no effect on the bacterial toxin. Penicillin was once used to treat tetanus, but is no longer the treatment of choice, owing to a theoretical risk of increased spasms. However, its use is recommended if metronidazole is not available. Passive immunization with human anti-tetanospasmin immunoglobulin or tetanus immune globulin is crucial. If specific anti-tetanospasmin immunoglobulin is not available, then normal human immunoglobulin may be given instead. All tetanus victims should be vaccinated against the disease or offered a booster shot.

Mild tetanus

Mild cases of tetanus can be treated with:

• Tetanus immune globulin IV or IM
• metronidazole IV for 10 days
• diazepam
• tetanus vaccination

Severe tetanus

Severe cases will require admission to intensive care. In addition to the measures listed above for mild tetanus:

Lock-jaw in a patient suffering from tetanus.

• human tetanus immunoglobulin injected intrathecally (increases clinical improvement from 4% to 35%)
• tracheostomy and mechanical ventilation for 3 to 4 weeks,
• magnesium, as an intravenous (IV) infusion, to prevent muscle spasm,
• diazepam (known under the common name Valium) as a continuous IV infusion,
• the autonomic effects of tetanus can be difficult to manage (alternating hyper- and hypotension, hyperpyrexia/hypothermia) and may require IV labetalol, magnesium, clonidine, or nifedipine.

Drugs such as diazepam or other muscle relaxants^{[citation needed]} can be given to control the muscle spasms. In extreme cases it may be necessary to paralyze the patient with curare-like drugs and use a mechanical ventilator.

In order to survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3500-4000 Calories, and at least 150g of protein per day, is often given in liquid form through a tube directly into the stomach, or through a drip into a vein. This high-caloric diet maintenance is required because of the increased metabolic strain brought on by the increased muscle activity.

Hydrocephalus

Hydrocephalus is the abnormal enlargement of the brain cavities (ventricles) caused by a build-up of cerebrospinal fluid (CSF). Usually, the body maintains a constant circulation and absorption of CSF. Untreated, hydrocephalus can result in brain damage or death. There is no cure, but hydrocephalus can be managed with surgery.

Cerebrospinal fluid (CSF) is a clear fluid that is made and absorbed by the brain. CSF circulates through the cerebroventricular (brain cavity) system and then through the subarachnoid space that surrounds the brain and spinal cord. It serves to protect and nourish the brain and spinal cord.

Symptoms

Hydrocephalus sometimes has no symptoms (it is asymptomatic). When symptoms occur, they can include:

• Difficulty in walking

• Incontinence

• Memory problems

• Headache

• Nausea and vomiting

• Loss of consciousness

• Vision problems

• Hearing sensitivities

• Seizures

• Enlarged skull (infants).

The movement of cerebrospinal fluid

The brain contains cavities called ventricles. Cerebrospinal fluid is made in the ventricles, then flows down channels through the brain and exits near the base of the skull. The fluid then moves to the surface of the brain and spinal cord and is absorbed just below the top of the skull.

If the movement of CSF is hampered along any point of this journey, the fluid will build up behind the blockage. The ventricles enlarge with fluid and pressure rises inside the skull (intracranial pressure).

A range of causes

Hydrocephalus can be caused by problems with CSF secretion, CSF flow or CSF absorption. The

different categories of hydrocephalus include:

• Congenital hydrocephalus – is present from birth and is associated with other birth

defects such as spina bifida and Dandy-Walker syndrome.

• Acquired hydrocephalus – can be triggered by tumours, infection or bleeding within the brain that blocks the movement or absorption of CSF.

• Normal pressure hydrocephalus – older people are more commonly affected. Generally,

CSF outflow over the surface of the brain is reduced, for unknown reasons.

Diagnosis methods

The various tests used to diagnose hydrocephalus include:

• Physical examination

• Eye examination

• CT scan

• MRI scan.

Treatment options

Treatment depends on the underlying cause, but can include:

• Drugs – for example, antibiotics are given in the case of infection. Surgery is needed if clearing the infection doesn’t resolve the hydrocephalus.

• Surgery – the cause of the blockage is surgically removed. In cases of temporary

hydrocephalus, a small catheter may be inserted to allow the fluid to drain while the underlying cause (such as bleeding) has time to resolve. In other cases (such as congenital hydrocephalus), a permanent tube (shunt) is inserted to allow the excess CSF to drain out.

• Wait and see approach – if hydrocephalus is found incidentally (for example, during a CT or MRI examination for other reasons) and is not causing any symptoms, no specific treatment other than careful review and monitoring by a doctor may be needed.

(www.betterhealth.vic.gov.au)

Kernicterus

What is kernicterus?

Kernicterus is a type of brain damage that causes athetoid cerebral palsy and hearing loss. It also causes problems with vision and teeth and sometimes can cause mental retardation. In some newborn babies, the liver makes too much yellow pigment called bilirubin. When too much bilirubin builds up in a new baby's body, the skin and whites of the eyes turn yellow. This yellow coloring is called jaundice. Jaundice is very common in newborn babies and usually goes away by itself. A little jaundice is not a problem, but a few babies have too much jaundice. If not treated, high levels of bilirubin can damage the brain.�

Who can develop kernicterus?

Any baby with untreated jaundice is at risk for kernicterus. This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice get better by themselves. If their skin is very yellow, they might need phototherapy treatment. If phototherapy does not lower the baby's bilirubin levels, the baby may need an exchange transfusion.

What are some warning signs of kernicterus?

• Very yellow or orange skin tones (beginning at the head and spreading to the toes)
• Increased sleepiness, so much that it is hard to wake the baby
• The baby is not as alert and awake
• High-pitched cry
• Poor sucking or nursing
• Weakness, limpness, or floppiness
• The baby's body is arched like a bow (the head and heels are bent backward and the body forward) (www.cdc.gov)
  

New advances in prevention of asthma and allergy in children

Respiratory infections
There may be a link, not yet firmly established, between bacterial infection in early childhood and the prevention of allergy and asthma later in childhood. This is suggested by the finding that children growing up with limited access to antibiotics have less allergic disease. Extensive exposure to animals in infancy also appears to be beneficial, suggesting that certain bacterial infections or bacterial products such as endotoxin can prevent the tendency of the immune system to produce allergic responses. This research does NOT mean that serious bacterial infection in children should go untreated!

Fish oil
There is some evidence that asthma occurs more often in children who rarely eat fish, possibly because of inadequate omega 3 fatty acids in the diet.

Early allergy injection treatment
Two studies in young children who became allergic to a single allergen such as house dust mites showed that allergy shots against that allergen prevented the development of allergy to other allergens. This suggests that allergy testing and injection treatment in children may be important to consider before the time when this is usually first done - i.e., under age 5 years. The cost-effectiveness of doing this is unknown at present.

Asthma

My baby's wheezing. Could she have asthma?

You may be alarmed if you hear your baby wheezing, but the chances are that it's not asthma. Many young children wheeze when they have an upper respiratory tract infection or a cold.

Asthma, on the other hand, is an inflammation of the lungs' small breathing tubes (bronchioles). If the wheezing frequently recurs in the absence of a cold, ask for your GP's opinion. In a child less than a year old, the airways are so small that they can make a wheezing sound which is not true asthma. Wheezing can be quite common in early childhood, and unless the attacks persist past the age of three, most doctors say there's no cause for alarm.

What causes asthma?

Asthma in most children and adults is a reaction to a trigger -- usually tobacco smoke, pet fur, mould spores, dust mites, or pollen (although respiratory infections and exercise in cold air can also trigger an attack). As in other types of allergies, the trigger stimulates IgE antibodies to produce histamine and other chemical mediators. It's the location of the chemical reactions -- in the lungs -- which distinguishes asthma. Chemicals released by the antibodies swell the lung's lining and tighten the muscles of the airway, and they also start producing mucus.

What are the risk factors for asthma?

A toddler who lives with a parent who smokes is nearly three times as likely to wheeze as a child in a smoke-free home. Genetics play a role, too. Children with an asthmatic parent develop asthma at three to six times the rate of children who don't have asthma in the family. Living in large towns and poor housing conditions seem to make children more vulnerable to the illness, too.

I've heard asthma's on the rise. Why?

Asthma is increasing. Ironically, industrialisation, energy-efficient houses, and eradication of many childhood illnesses, such as measles and mumps, may be partly to blame. For reasons unknown, asthma isn't much of a problem in pre-industrial societies. But when development moves in, asthma follows.

According to some experts, we are spending more and more time sealed in energy-efficient houses. Indoor air is ripe with allergens, such as dust mites or pet hair. If children spend much of their time in front of the TV or computer, they spend less time outside in the fresh air. All this seems to have translated to an increase in asthma.

The ever-ready immune system, too, which used to marshal its defences against chicken pox and rubella, now has little more to do than combat an onslaught of dust mites, the microscopic pests whose presence is related to asthma. According to researchers, it may be that this over-enthusiastic immune system responds to an allergen a little too zealously (akin to putting out a match with a hosepipe), which might contribute to asthma as well.

Can asthma be cured?

Asthma is a chronic condition, and there is no known cure. However, asthma can be successfully managed with medicines, and by reducing the exposure to the trigger for the asthma when possible. Many children outgrow asthma, or the severity lessens as they get older. Work with your doctor to find out the best treatment and method to manage your child's asthma.

Football and children

When we play sports—we have opponents and we practice good behaviour on the playing field and there we find a way to win—but we also have fun. Sports are very important, they help sensitize feelings and through that you can bring about peace. Football is played in fields, in refugee camps, and even amidst situations of war and armed-conflict. Wherever you find children, you will also most likely find football.

Of course football equipment is required by sponsored leagues and schools. Making sure that the equipment fits your child appropriately is of utmost importance. If you want to buy used equipment, be sure to have your child fitted for the right size and then go bargain-hunting.

Here is a list of necessary equipment and equipment that may help prevent injuries.

* Helmet with a face mask
* Protective pads for thighs and hips (can come as a girdle)
* Shoulder pads
* Padded shirt
* Cleats
* Gloves
* Mouth guard
* Leg and ankle braces
* Other equipment that may be suggested by your child’s coach

Kids should listen to their coach at all times. Football rules can be complex and it is important to know the rules in order to help the team and play safe. Make sure your child understands the rules of the game, what is expected of his position, and ask questions if there is any misunderstanding or confusion.

Most of all, encourage your child to have fun!

It’s hardly controversial to argue that a results-oriented approach at the early ages propagates over-coaching that stifles individual creativity.

But if score lines aren’t what we should use to judge progress at the younger ages, what do we look for? There should be recognition of a kid trying to control a ball, or trying to pass the ball, or trying to make some move, even if it doesn’t work. Instead of valuing the final score, watching individual progress is how to judge development. When a 6- or 7-year-old, for example, begins to look up from the ball, it’s a sign that he’s advancing as a player.

For teams at the older age groups, judging performance beyond trophies is a matter of seeing progress in the different facets of the game.

Clearly, the age of your child is important. Most parents can remain calm watching a high-school age athlete play, sports, because they know that the athlete is old enough to handle difficult situations themselves. On the other hand, watching a young child play sports brings out all our natural urges to protect and nurture our offspring. Too often, the problem in youth sports is not crazy, out-of-control parents, but the fact that we put children in very competitive situations at too young an age.

Competitive sports programs are a big part of the growing-up experience for many children. But as parents, we should not accept current sports programs as being “best” for our children without examining the effect they have on our lives. There is lots of room for improvement.

If children are not learning and improving their skills, it can’t be fun. If it isn’t fun, children won’t want to come back to play soccer. So be prepared, know the game and the proper skill progressions, and provide the child with numerous opportunities to explore and discover through active participation.

Books and Babies

Books and Babies

Babies love to listen to the human voice. What better way
than through reading!
What you'll need
Some baby books (books made of cardboard or cloth with flaps to
lift and holes to peek through)

What to do

1. Start out by singing lullabies and folk songs to your
baby. At around 6 months, look for books with brightly
colored, simple pictures and lots of rhythm. (Mother Goose
is perfect.) At around 9 months, include books that
feature pictures and names of familiar objects.

2. As you read, point out objects in the pictures and make
sure your baby sees all the things that are fun to do with
books. (Pat the Bunny by Dorothy Kunhardt is a classic
touch-and-feel book for babies.)

3. Vary the tone of your voice, sing nursery rhymes, bounce
your knee, make funny faces, do whatever special effects
you can to stimulate your baby's interest.

4. Allow your child to touch and hold cloth and sturdy
cardboard books.

5. When reading to a baby, be brief but read often.