Childhood ilnesses







ANAL FISSURES

ANAL FISSURES

It is a tear in the lining of the anus, which is seen in very constipated children. This crack is revealed by pain at the time of defecation, sometimes associated with bleeding.

The treatment consists in making this tear heal either by a diet and local care; or, in the event of failure, by a surgical intervention.

Copyright photo : Par Bernardo Gui — personale work, public domain

Bibliography : Anal Fissure: Symptoms, Diagnosis and Treatment by Pierpaolo Sileri and Achille Lucio Gaspari

ANAL FISTULES

They are often seen in infants.

A gland in the wall of the rectum becomes infected, producing a small abscess, which goes towards the edge of the anus and outside it.

Treatment is surgical.

Bibliography : Fistules anales: utilisation des colles de fibrineby Laurent Abramowitz 

ANAL IMPERFORATION

These are newborn babies whose anus is not in place:

- in girls, it is often touched at the level of the vulva (vulvar anus);

- In boys, the rectum ends in a cul-de-sac and no orifice is visible.

These children must be operated on from birth.

Copyright photo : Par Marc A Levitt, Alberto Peña — Marc A Levitt, Alberto Peña. Anorectal malformations. Orphanet Journal of Rare Diseases. 2, 33. 2007. PMID 17651510., CC BY 2.0,

Bibliography : Anorectal Malformations in Children: Embryology, Diagnosis, Surgical Treatment, Follow-up de Alexander Matthias Holschneider et John M. Hutson

APPENDICITIS

Appendicitis is an inflammation, then infection of the ileo-caecal appendage, leading to the formation of an abscess inside the appendix. This abscess can rupture in the abdomen, resulting in peritonitis.

The signs are very varied, it is one of the most difficult diagnoses of pediatric surgery, and it is better to operate without diagnostic certainty than to let develop the appendicular infection.

Can be associated to varying degrees:

- predominant abdominal pain in the right iliac fossa;

- fever may be high, generally 37.8 ° C to 38 ° C, a fever at 40 ° C points to peritonitis;

- vomitings.

Before any of these signs and a fortiori if they are concomitant and persistent, you must consult a doctor because the diagnosis is based on the clinical examination carried out. An elevation of the white blood cells can be observed but is not constant. Similarly, an x-ray of the abdomen can show indirect signs of appendicitis.

The clinical pictures are very varied, and we observe everything from the child who has been suffering for several days, even weeks, to the child who develops peritonitis in a few hours.

The treatment consists, by an incision of the right iliac fossa and to remove the appendix. Hospitalization lasts five to eight days.

Copyright photo : Par Drahreg01 — Travail personnel, CC BY-SA 4.0

Bibliography : Controversies in Pediatric Appendicitis By Catherine J. Hunter 

HOME ALLERGIES

If it is accepted that the occurrence of an allergy requires a specific genetic background, hereditary predisposition, the meeting with the allergen constitutes the second essential factor for its manifestation. To prevent or, at least, to mitigate the effects of the allergen, precautions must be taken from the first months of the newborn: they will be all the more important as the allergic ascendants are numerous. Breastfeeding thus increases the immunological capacities of the allergic child and avoids the possible risks of sensitization to non-breast milk.

In the child's bedroom, avoid:

- anything that attracts or retains dust (carpets, double curtains, down cushions);

- bedding in animal matter (feathers, carded wool, hair) or vegetable (kapok, hair);

- the presence of green plants, animals;

- tobacco smoke and various vapors;

- humidity on the walls, especially those exposed to the west (rain)

However, we will take care:

- ventilate the room frequently; sunshine cleanses the atmosphere, while confined air promotes humidity and the multiplication of mites;

- choose bedding made of latex foam or other synthetic material, and periodically expose it to the sun or treat it with acaricide bombs;

- wash the sheets and pillowcases frequently and rinse them well to remove traces of detergents;

- maintain a mild temperature, around 20 ° C;

- prefer washable plush toys to be cleaned often.

Worsening allergies, infections should be avoided. The usual vaccinations will be carried out very early in allergic children. They are generally well tolerated, with the exception sometimes of the pertussis vaccine which may require special precautions which your doctor will tell you. Only smallpox vaccine should never be given to a child when he has eczema.

Virus infections should be prevented as much as possible. So, avoid:

- placing the allergic child in the crèche, if the parents have the possibility;

- contact with other infected children. His father or mother will wash their hands, put on a mask and change clothes before taking the child if they have a cold or flu.

The same precautions apply to adolescents and adults "at allergy risk".

Quick recourse to the doctor is essential during infections.

Copyright photo : public domain

Bibliography : Home Allergies: Don't Let Your Home Make You Sick  by William E. Walsh 

INFANT ANOREXIA

Anorexia in infants is a "refusal to eat" most often occurring between five and eight months, after a change in eating habits: switching from bottle to spoon, introduction of new foods, modification of meal times ... It can also follow a dietary restriction, itself due to a constraint or trauma.

The anorexic infant is lively, toned, awake; he shows curiosity for those around him. Weight growth is satisfactory: there is no fever, vomiting, or any other kind of deterioration of the general state, which the doctor checks.

Quickly a vicious circle sets in: the mother becomes anxious, tries to make the child eat by seduction, cunning, or force; then a real fight begins, from which the child always comes out victorious. Guilt and anxiety worsen, the mother's behavior is increasingly inappropriate, and the child settles in an attitude of refusal.

The treatment, often simple and effective, must be early: cessation of forcing food, after the doctor has reassured the mother that there is no risk for the child, who often compensates for the little he eats by snacking and by absorption of milk or sugary drinks. If necessary, a third person, father or nanny, can give the meal to the child who accepts it without problem.

It may happen, but this is rare, that anorexia in infants takes more severe forms: the child is pale, tired and emaciated. Hospitalization eliminates a rare organic pathology (heart disease, digestive malabsorption, infection, encephalopathy or tumor), but also separates the mother from the child.

Very different is early essential anorexia, which appears from birth in a child showing no interest in bottles, then actively refusing them: these are sometimes the first signs of infantile psychosis.

Bibliography : Handbook of Nutrition and Pregnancy de Carol J. Lammi-Keefe, Sarah C. Couch

KETOACIDOSIS OR HYPERCETONEMIA

Acetonemic vomiting will be evoked in front of the association of vomiting which is often incoercible, an acetonemic odor of the breath and behavioral disorders (aggressiveness or torpor). The apparent gravity contrasts with a normal clinical examination. The triggering causes are usually fever, food intolerance, shock, but very often no cause is found. The treatment of the crisis consists of administering sugary drinks, in small quantities at regular intervals. Apart from the crises: the practice of a sport, a particular diet made of five small sweet divided meals, will avoid the occurrence of crises. The subsequent progression to migraine is classically recognized.

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