June 20, 2016

GINGIVOSTMATITIS - (MOUTH INFECTION IN CHILDREN)

What is gingivostomatitis?

Gingivostomatitis is the long name for a condition that results in a very sore mouth. It's caused by a viral infection and is common in children. The symptoms can be mild or severe. While it can be disconcerting to see sores in your baby's mouth — and to know that she hurts — usually there's no cause for worry.

Most people carry around the viruses that can cause the condition. In fact, your baby's bout of gingivostomatitis may be her initial infection with the herpes simplex virus type 1 (HSV-1), which most people pick up in early childhood and carry for the rest of their lives. The initial infection usually goes unnoticed, but if it does make itself known, it does so in the form of gingivostomatitis. (HSV-1 can cause cold sores, too.)

Gingivostomatitis can also be caused by a coxsackie virus, the culprit in hand, foot and mouth disease and herpangina.

What are the symptoms?

The sores are small (about 1 to 5 millimeters in diameter), grayish or yellowish in the middle, and red around the edges. Their severity and location depend on which virus is causing the gingivostomatitis.

Your baby may have sores on her gums (also called the gingiva), on the inside of her cheeks, in the back of her mouth, or on her tonsils, tongue, or soft palate. Her gums may be inflamed and may bleed easily.

Because the sores can be very painful, your baby will probably be irritable, may drool more than usual, and won't feel like eating or drinking much. She may also have bad breath and a high fever (up to 104 degrees), and the lymph nodes on the sides of her neck may be swollen and tender. If you notice these symptoms in your baby, give your doctor a call.

Note: In rare cases, gingivostomatitis that's caused by herpes can spread to the eye and infect the cornea. Herpes simplex keratitis, as such an infection is called, can cause permanent eye damage. Take your baby to the doctor right away if she has gingivostomatitis and you notice that her eyes look watery and red or that she's sensitive to light — both early symptoms of herpes simplex keratitis.

How is gingivostomatitis treated?

Because this is a viral infection, antibiotics won't help. The sores in your baby's mouth should be gone in a week or two. Here are a few things you can do to make her more comfortable and keep her otherwise healthy while she has it:

    -Infants' acetaminophen or ibuprofen can help relieve pain and lower fever. (If your baby is younger than 3 months old, ask her doctor before giving her any painkillers. And never give aspirin to anyone under the age of 20. It can trigger a rare but dangerous illness called Reye's syndrome.) If the pain is so severe that your baby won't eat even with the help of these over-the-counter pain medications, your doctor may prescribe a stronger pain medicine.
    -Though she may not want to drink because swallowing is painful, it's extremely important that your baby get enough fluids. Make sure she gets plenty of breast milk or formula. If your baby is at least 4 months old, you can also try offering her cool, nonacidic, noncarbonated drinks such as water or diluted apple juice. Dehydration can sneak up rapidly in babies and young children — this is the main complication you need to be aware of if your baby has gingivostomatitis. Call your doctor if your child goes for more than six hours without urinating or taking in liquid, or if she shows any signs of dehydration.
    If your baby's eating solids, the usual ones are good: strained baby food, mashed potatoes, yogurt, applesauce, and other soft, bland foods that don't require chewing. But don't force your baby to eat solids if her mouth hurts.

Can gingivostomatitis be prevented?

Because so many adults and children carry the herpes virus, and because they can pass it (and the coxsackie virus) on even if they have no symptoms, there's no practical way to prevent gingivostomatitis. You can, however, try to keep people who have an active herpes infection or any other mouth sores from kissing, sharing food, or playing in close contact with your baby. (That includes you, if you happen to have an outbreak.)

If your baby's sores are caused by the herpes virus, the virus will stay in her body for life. The good news is that the first episode of gingivostomatitis is usually the worst, and it won't necessarily be a frequent plague

June 16, 2016

THRUSH IN YOUR BABY'S MOUTH!

My baby has white patches on the insides of her cheeks. What could this be?

It could be a common and harmless yeast infection known as thrush. Thrush looks like cottage cheese or milk curds on the sides, roof, and sometimes the tongue of a baby's mouth. It's most common in babies 2 months and younger, but it can appear in older babies, too.

What causes thrush?

Yeast is a normal part of everyone's digestive system, but when there's an imbalance, an infection sets in. Most infants first come in contact with yeast as they travel down the birth canal. Thrush can develop when hormonal changes right after birth trigger an overgrowth of yeast in your baby's mouth.

After your baby is born, antibiotics taken by you (if you're breastfeeding) or your baby can trigger a case of thrush. That's because antibiotics kill off "good" bacteria that keep yeast in check.

Some moms and babies pass the infection back and forth: Your baby can pass thrush on to you if you're breastfeeding, resulting in a painful yeast infection on your nipples that will need a doctor's treatment. And you can trigger a case of thrush in your baby if you're breastfeeding and you develop a yeast infection on your nipples from taking antibiotics. On the other hand, some moms remain uninfected even while breastfeeding babies who have thrush — and some breastfed babies are not affected by their mother's yeast infection.

Some people think thrush can also be caused by prolonged sucking on a bottle or pacifier. Others think poor hygiene of bottle nipples is to blame. But infants who breastfeed exclusively and don't use pacifiers can also get it, so it's hard to pinpoint any one cause. Some babies (and some moms) are simply more susceptible than others to yeast.

How can I know for sure that it's thrush?

If you think your baby has thrush, look for the characteristic white patches. Then gently touch a patch with a gauze-covered finger. If it is thrush, it probably won't come off very easily, but if it does, you'll find a raw, red area underneath that may bleed.

If you notice a white coating on your baby's tongue but nowhere else, it's probably just milk residue (especially if you can wipe it off). Thrush patches can appear on your baby's tongue, but are most often found on the sides of the mouth. These spots can be painful — you may first suspect thrush if your baby starts crying when nursing or sucking on a pacifier or bottle.

How can I treat thrush?

In many cases, no treatment is necessary. Thrush typically clears up on its own in a couple of weeks. Some babies find thrush painful and bothersome, while others don't seem to notice. If your baby seems uncomfortable, by all means call your pediatrician, who may be able to give you a prescription over the phone for an oral fungal medication called Nystatin. You'll "paint" the medicine on the white patches with the enclosed applicator (or your finger) several times a day for ten days. It may take a week to clear up the infection. If the infection doesn't seem to be clearing up, call your doctor. Some babies with thrush also develop a yeast diaper infection. If that happens, your doctor can prescribe a fungal medication to use in the diaper area.

If you're breastfeeding a baby with thrush, many doctors also recommend that you apply Nystatin or Lotramin to your nipples so that you and your baby won't pass the infection back and forth.

Can I do anything to prevent my baby from getting thrush?

Nothing can be done to keep babies from picking up yeast as they pass through the birth canal. To ward off future infections, avoid giving your baby antibiotics unnecessarily (antibiotics can bring on a case of thrush by killing off bacteria that keep yeast under control). Cleaning and sterilizing pacifiers may also help. And some pediatricians advise breastfeeding mothers to let their nipples air dry between feedings to prevent thrush.

Is thrush dangerous?

No. But if your baby is very fussy and uncomfortable, thrush could interfere with breast- or bottle-feeding. Your doctor may recommend that you give your baby acetaminophen for the pain.

A hungry baby who finds it painful to eat is a very sad sight, and a bout of thrush can be very trying — but it's usually short-lived. Give your baby all the comfort he needs and follow your pediatrician's instructions for pain relief and medication, and this infection, too, shall pass!

June 10, 2016

TAKING CARE OF YOUR CHILD'S FEET

As your toddler gets more mobile, it's important to keep an eye on her feet. Looking after them now will help to protect her from foot problems in later life.

How are my toddler's feet developing?

When your baby's born, the bones in her feet are made of soft, flexible cartilage. This gradually hardens over time. They won't be fully developed until her late teens.

To begin with, your baby's feet are quite flat. But by the time she's about two years old, you should be able to see what kind of foot shape she has.

Your toddler will inherit one of three main foot shapes from either you or your partner:

Tapered: her big toe is the biggest of all her toes.
Rounded: her second or third toe is longer than her big toe.
Square: all her toes are about the same length.

How can I take care of my toddler's feet?

Allow your toddler's feet to develop as naturally as possible. Let her spend time without shoes every day so she can exercise the muscles in her feet. You can encourage her to flex and stretch them by tickling her. 

Socks or tights made from cotton, or a cotton and wool mix, will keep your toddler's feet warm while giving them room to develop. Regularly check that she's wearing the right size, especially if you tumble dry them. Socks can shrink, and if they're too tight, this can restrict how your toddler's feet grow. Even if your toddler isn't walking yet, make sure that any soft booties she wears also have lots of room for her toes to move.

You should also check that your toddler's bedding and sleepsuits have plenty of space for her toes to move around easily. If you tuck her in too tightly, she may not be able to move her feet around at night, which is bad for their development. 

Wash your toddler's feet thoroughly and dry them well between the toes. You could also use a sprinkling of talcum powder to help keep her feet dry and healthy. Just be sure to shake off any excess powder so it doesn't clump between her toes.

Cut her toenails straight across to prevent them from becoming ingrown.

When can my toddler have her first shoes?

Don't be in a rush to buy your toddler's first pair of shoes. She only needs them when she's ready to walk outside, which is usually once she's already confident about taking a few steps indoors.

As your toddler learns to walk, let her stay barefoot indoors. This allows her feet to develop and strengthen without restriction. Just make sure that the floor is clean and safe.

What are the best shoes for my toddler?

Choose comfortable shoes made from soft leather, with lightweight flexible soles, padded ankles and non-slip bottoms. There should be a secure, adjustable fastening such as Velcro, a buckle or laces. This will hold her feet in place so they don't slip forward. 

Buying the right size is really important. Find a shop with a professional shoe-fitter, who can make sure you get exactly the right size for your toddler. The shoes should come in whole sizes and half sizes, with a choice of widths, so that you can get a pair that's a perfect fit.

There should be plenty of room in the toe area, so your little one can grow. Even adults need at least 1cm (0.4in) of space between the end of their longest toe and the end of their shoe. Check her shoes by gently pressing the top of the tip while she has them on. 

Once your toddler's wearing shoes, get her feet measured every six weeks to eight weeks. Children's feet grow, on average, two full sizes a year until they're four, and one size a year after that. 

Shoes take on the shape of the feet that wear them. While it may be tempting to save money by using second-hand shoes, they may be harmful to your toddler's feet.

What foot problems should I watch out for?

Check your child's feet regularly, as it's unlikely that she'll tell you if they feel sore. Here are some common foot problems:

Blisters

Blisters are often caused by new or ill-fitting shoes. If your toddler gets a blister, check her shoe-size in case her foot width or size has changed.

In the meantime, remove her shoes and socks for a while to allow the blister to dry up. Don't burst it, as this can cause infection. If the skin's already broken, apply an antiseptic plaster or other dry, sterile dressing, to protect it as it heals. 

Ingrowing toenails

Ingrown toenails happen when nails grow into the surrounding flesh. If your toddler has one, it may cause the skin at side of her toenail to appear red or swollen, and her toe may feel quite sore.

Being careful about how you cut your toddler's nails may prevent them from becoming ingrown in the first place. 
Cut your child's toenails, and her fingernails, straight across, rather than in a curve. Use nail clippers and file any sharp edges if necessary. Never cut down the side of your child's toenails or cut them too short. The corners should be just clear of the fleshy part of the toe. 

If your toddler's toenails are sore, ask your GP or health visitor to take a look.

Athlete's foot

Athlete's foot is a fungal infection that causes a red, itchy, moist rash, usually between the toes. It's rare in toddlers, but it may be more likely to happen if you take your child swimming a lot. This is because the fungus thrives in warm, damp areas like showers and changing rooms. 

You can help to prevent athlete's foot by dressing your toddler in cotton socks, and drying between her toes properly after baths and swimming. Speak to your pharmacist before buying any over-the-counter treatments, as some aren't suitable for young children.

Verrucas

Verrucas are small warts, often with a black speck in the centre, that are found on the soles of the feet. They're most often picked up at swimming pools. If your toddler gets a verruca, it's fine to leave it to clear up by itself. They usually disappear within two years. 

If the verruca is painful for your toddler though, you can treat it with salicylic acid. You can buy this over the counter or get it on prescription from the practice nurse at your GP surgery. 

Hand, foot and mouth disease

Hand, foot and mouth disease is a mild viral infection that's not unusual in children under 10. It can cause small spots to appear on your toddler's mouth, hands and feet, and these may develop into blisters. The rash may also extend up her arms and legs, and occasionally causes small blisters or spots around the nappy area. 

The disease is also sometimes accompanied by a slight fever, tummy ache or sore throat. Fortunately, it usually resolves itself within a week or so.

What about foot development problems?

Developmental problems are much less common than the minor ailments above, and in many cases resolve themselves. However, they may also need treatment. So if you suspect a developmental problem with your toddler's feet, talk to your health visitor or GP. If necessary, they can refer your child to a foot specialist (podiatrist or chiropodist).

Here are some of the more common developmental foot conditions:

Flat feet is normal in toddlers. This is partly due to posture, and partly because they have more fat than adult feet. By the time your child's five, her arches should naturally be more developed.

In-toeing and out-toeing are when toddlers walk with their feet turning inwards ("pigeon-toed") or outwards. Chances are it will correct itself as your toddler becomes more confident on her feet. In most cases, in-toeing and out-toeing get better on their own by the age of eight or nine.

Toe walking is when a child walks on her toes, without putting much weight on her heels. It's normal in young toddlers, but shouldn't usually persist after she's three years old. If it does, see your health visitor or GP who can refer you to a physiotherapist.

Talipes (club foot) is a congenital condition where one or both feet bend inwards and downwards. Experts are unsure of the cause, but it's thought that genetic factors can play a part, as it sometimes runs in families. Treatment for club foot begins soon after birth and usually involves physiotherapy to manipulate the foot gently back into shape.

June 8, 2016

HEAT RASHES!

What is heat rash?

If your baby suddenly develops a bright-red pimply rash on his neck, under his arms, or near the edges of his nappy or underwear, it's probably heat rash. Heat rash, also known as prickly heat or miliaria, can appear when your baby overheats in hot and humid weather. 

The rash often appears in folds of your baby's skin and on parts of his body where clothing fits snugly. If your baby wears hats, the rash may even spread across his scalp or forehead.

Is heat rash serious?

No, but it is a sign that your baby is too warm. If you don't take steps to cool him off, he could become ill with heat exhaustion or heat stroke.

If this happens, your baby will be unable to control his body temperature, his body temperature may become much higher than normal and he could become dehydrated.

What causes heat rash?

When it's hot and humid outside, your baby sweats to cool down. If he sweats so much that his skin pores clog and sweat can't get out, heat rash develops. Babies and young children are particularly prone to heat rash because their sweat glands are not fully developed. 

Tight or heavy clothing can trap the sweat as well, making the rash worse. A baby can get heat rash from anything that causes him to sweat heavily, such as a high temperature.

Is heat rash painful for my baby?

No, it isn't usually painful, but it can be annoyingly itchy. The intense prickling or stinging sensation may be distressing for your baby. Some of the pimples may also be tender to the touch.

How should I treat heat rash?

Most heat rashes will clear up within a few days. In the meantime, here's what you can do to relieve your baby's itching and discomfort:

Try to reduce heat and humidity.
Move into an airy room or a shady spot. Try using a mini fan if you are out and about in a hot country or in the summer heat. If the weather stays hot at night, place a fan in your baby's room to circulate the air.

Take off his clothes or dress him in cotton. Synthetic fabrics, such as polyester and nylon, trap heat. Opt for natural fibres instead. Where possible, loosen or remove his clothing and give him as much nappy-free time as you can.

Keep his skin cool.
Cool the affected areas directly using cold, wet flannels, or give your baby a tepid bath or shower. Let the air dry his skin as much as possible rather than using towels. This can help to heal the rash.

Use calamine lotion.
Smooth on plenty of the lotion (but not near his eyes). This is particularly helpful if your baby seems irritable and cries when you touch his skin.

Use hydrocortisone cream.
Use this cream on the advice of your doctor or pharmacist if the rash is severe.
Don't use any other ointments and lotions, as they can make the rash worse by trapping moisture in the skin. 

Keep an eye on your baby during this time. As his temperature drops, he could get chilly and need to be warmed up again.

How can I prevent heat rash?

Keep your baby comfortably cool by dressing him in loose, light, cotton clothing, particularly in warm weather. 

If you aren't sure whether he's overheated, touch his skin. Damp hot skin is a sign that he is too warm. On a hot day, keep your baby inside or look for cool, shady or breezy places to sit and play outside. Make sure your baby drinks plenty of fluids so he doesn't get dehydrated.

Should I take my baby to the doctor for heat rash?

See your doctor if:
-your baby has a fever
-the rash doesn't go away after three days or four days
-the rash appears to be getting worse.

June 6, 2016

SOME FACTS ABOUT NEWBORN SLEEP!

Sleep can be one of the most baffling issues of new parenthood. As many of us learn through gritty nights and zombie-like days, babies simply don't snooze like the rest of us. Here's why.   

Some newborns party all night and sleep all day

Many babies arrive in the world with their days and nights completely reversed. These little night owls sleep for longer stretches during the daytime, saving their more alert periods for the moonlit hours.

A baby who wakes every hour at night to kick his legs, eat, and demand an adult's loving care makes for increasingly exhausted parents. "This can be very challenging for adults, because our bodies are not physiologically oriented to being up all night," "That's why shift work is so difficult."

Try to nap during your baby's longer stretches of sleep, and remember that the day/night switcheroo is temporary. As your baby's brain and central nervous system mature, his sleep cycles will get longer and more sleep will occur at night. Most babies adjust to the family timetable in a month or so.

You can assist this process by creating a calm, dark environment at night, while letting the sun shine in during the day. "During daytime feedings, I talk a lot to my baby, while the night feedings are very quiet with as little light as possible," says one mom. "This is helping her figure it out." 

Newborn sleep is erratic and unpredictable

In those early weeks, your baby may rack up sleep hours like a college student home on winter break. But here's the catch: Most babies don't stay asleep for more than two to four hours at a time, day or night, during the first few weeks of life.

Newborns typically sleep 14 to 18 hours a day in the first week and 12 to 16 hours by the time they're a month old. (Because every baby is an individual, some sleep quite a bit less or quite a bit more than average.)

Unfortunately, even if your baby is a sleep glutton, you may find yourself staggering around like a wet dishrag. In a recent survey, 71 percent of moms revealed that lack of sleep is the hardest part of having a newborn.

You can blame your lack of energy on the erratic nature of your baby's sleep. "My 9-week-old's sleep is so sporadic!" says one mom. "Sometimes we'll get a good four-hour stretch, while other times, she'll be up within an hour."

In contrast, some parents are startled and even alarmed by how much their new baby sleeps. "My 9-day-old baby sleeps all day, with only five minutes here and there of awake time," one mom says. "Should I be worried?"

Not at all, says a pediatrician. He says it's normal for some newborns to sleep up to 20 hours per day. If this describes your baby, get your 40 winks now because the phase won't last long.

Newborns don't need peace and quiet to sleep

Don't feel like you have to whisper or tiptoe quietly around your sleeping newborn. "Most young babies can sleep in the noisiest, brightest places" "They don't need the same kind of sleep environment we do." 

This isn't surprising when you consider that your baby just spent nine months in utero – which is not the serene place you might think. The sounds of the mother's heartbeat, digestive system, and other bodily functions are actually quite loud.

Many newborns sleep better surrounded by some kind of repetitive sound, like a fan or white-noise machine. "I put my daughter's bassinet next to our noisy dishwasher while it ran, and she napped like a dream," says one mom.

New babies are also too young to be distracted by the sparkly necklace worn by the woman across the room or by an impulse to engage the nearest stranger in a smiling game. They simply sleep whenever they need to. So, at least at first, you probably won't need to shush visitors. And you'll be able take your baby out and about without worrying about sabotaging his rest.

The uncanny ability to doze through a thunderstorm is so strong in some babies that parents wonder whether their baby hears properly. If you're concerned, certainly check in with your baby's doctor. But because newborns are screened for hearing problems shortly after birth, the most likely explanation is that your child is simply "sleeping like a baby."

Enjoy it while it lasts. As your baby leaves the newborn phase behind, gets on a schedule, and becomes more aware of his environment, he'll begin to outgrow this "sleep anytime" stage. Then noise and other distractions do start to matter, and you may find yourself tiptoeing through the house.

Babies have their own sleep personalities

Babies are anything but blank slates, and they come to us with their own sleep temperaments. "There are definitely individual differences in how babies sleep, just as there are light sleepers and heavy sleepers among adults," says a pediatrician.

Parents of more than one child often see these differences from very early on. As one mom of two says, "My first baby was a sound sleeper, but my second tossed and turned a lot and woke up after short periods."

Personality comes into play too, Some babies are more determined and will fight sleep as long as they can. Others are more easygoing.

Whether or not you won the baby sleep lottery, you can begin to teach your baby good sleep habits by establishing a bedtime routine and reading up on baby sleep basics.

Babies need a spartan sleeping space

A generation ago, a well-appointed crib included a nice soft bumper, a few cozy blankets, and a pillow or two. But things have changed. It turns out that it's much safer for babies to sleep in a more streamlined environment. The safest sleeping position and space for babies is on their back on a firm, flat mattress with a tight-fitting sheet and nothing else.

A bed with no blankets or pillows? Sounds chilly and uncomfortable to an adult, but with the right clothing, it's just perfect for a baby.

Remove any item from the sleeping area that could potentially suffocate a baby, cause overheating, or otherwise impair breathing, including blankets, bumpers, pillows, stuffed animals, or quilts. This reduces your baby's risk of SIDS.

If you're one of the percent of moms who share a bed with their baby, you can reduce your baby's risk of SIDS by following a few basic guidelines.

And even though your baby can't yet safely sleep under that gorgeous quilt you received as a baby gift, you can still get plenty of use out of it. Hang it on the nursery wall, drape it over the back of your rocking chair, or let your baby spend tummy time on it during the day.

June 1, 2016

POSTPARTUM PSYCHIATRIC DISORDERS!

The Postpartum Period
During the postpartum period, about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety. Postpartum psychiatric illness is typically divided into three categories:
(1) postpartum blues
(2) postpartum depression and
(3) postpartum psychosis.