Vomiting in infants/children

What causes vomiting in babies/kids?

Gastroesophageal reflux disease:
Seen in minority of kids. Most kids are “happy spitters”; they effortless regurgitate mild amounts of milk. In actually GERD, infants tend to have recurrent fussiness or irritability and feeding aversion.

Milk protein induced enteritis:
Intolerance of dietary proteins (most commonly milk protein) typically presents with bloody stools. However, in some infants, they may have vomiting.

Pyloric stenosis:
Occurs in approximately 3 in 1,000 live births, more commonly in males. The classic presentation of is a three-to six-week-old baby who develops immediate non-bilious, often projectile vomiting after eating and demands to be re-fed soon afterwards (a “hungry vomiter”).

Intestinal obstruction:
Frequently causes bile staining in the vomit.
Causes of infant intestinal obstruction:
 Malrotation – anomaly of fetal intestinal development
 Hirschsprung disease – bilious vomit, abdominal distension, and failure to pass stool
 Intussusception
 Pyloric stenosis

Usually is viral.

Condition of impaired emptying of gastric contents. May cause vomiting after meals; usually occurs many hours after ingestion of food.

Most common cause of intestinal obstruction in infants between 6 and 36 months of age. Patients typically develop the sudden onset of intermittent, severe, crampy, progressive abdominal pain, accompanied by inconsolable crying and drawing up of the legs toward the abdomen. Vomiting may follow.

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Yet Another Benefit of Aspirin….


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Are baby teething aids safe?

This question was originally raised in 2006.  Since then, more studies into over-the-counter products like Anbesol and Orajel have been conducted.  Here’s a link to the article:  http://thechart.blogs.cnn.com/2012/06/01/fda-warns-about-benzocaine-in-baby-pain-gels/?hpt=he_c2

As with most over the counter products, they should be used according to instructions, and not more than recommended.  Doing this will limit the potential for side effects.  Using Anbesol/Orajel sparingly and for short periods will likely not cause the methemoglobinemia discussed in the article.  However, the potential is there — so if there is any question, contact your doctor.

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Not all red eyes are “pink eyes”

Red eye typically is from conjunctivitis, which literally means “inflammation of the conjunctiva.”   The conjunctiva lines the inside surface of the eyelids and covers the surface of the eye.   It is usually transparent.  When it is inflamed it looks pink or red.
Conjunctivitis can be from bacteria, viruses, or allergy.

Bacterial conjunctivitis — spread by direct contact with the patient.  It is highly contagious.   Patients complain of redness and discharge in one eye, although it can also be in both.  The affected eye often is “stuck shut” in the morning.

Viral conjunctivitis —may be part of a viral illness with fever, sore throat, and upper respiratory tract infection.  It is highly contagious and is spread by direct contact with the patient.    Patients may have  watery discharge and a burning, sandy feeling in one eye.   The second eye usually becomes involved within 24 to 48 hours.  The symptoms get worse for the first three to five days,  and gradually get better over two weeks.

Allergic conjunctivitis — caused by airborne allergens contacting the eye.  It presents as redness, watery discharge, and itching in both eyes.

Noninfectious, nonallergic conjunctivitis — The usual cause is mechanical or chemical insult.  Chemical splashes can cause reddness and discharge.  Foreign bodies in eyes can cause reddness and  discharge for 12 to 24 hours.  If you wear contacts and have red eye, stop using the contacts immediately and wait at least 24h before seeking evaluation;  sometimes contacst can cause red eye.

To treat bacterial causes, ointment is preferred over drops for children.  Ointment stays on the lids.  There is no treatement for viral conjunctivitis.   Warm or cool compresses may provide  symptomatic relief.  There are many medications for allergic conjunctivitis.

Because there are so many different causes of red eye, you or your child should seek evaluation and treatment if you experience this.

After treatment, the next questions is always, “When can I send my child back to daycare/school?”  Bacterial and viral conjunctivitis are both highly contagious and spread by direct contact.   Do not share tissues, towels, or cosmetics.   Most daycare centers and schools and require that students receive 24 hours of medication before returning to school.

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“My doctor said my itching isn’t from dry skin, but scabies”

Scabies is a skin condition that causes very itchy skin.  It is caused by a skin mite that burrow under your skin and lay eggs.   This is spread by person to person contact, or by picking up a mite from someone elses clothes.

People with scabies usually get little red bumps or blisters on their skin. Sometimes the bumps are hard to see. Some people even notice tiny tunnels in their skin where the mites have buried themselves.

These are the body parts that are most often affected by scabies:

  • The fingers and webbing between the fingers
  • The skin folds around the wrists, elbows, and knees
  • The armpits
  • The waist
  • The sides and bottoms of the feet

Scabies is treatable, but can be hard to get rid of.   Permethrin cream is most commonly used.  This kills the mites.   Itching can last for a week, even after the scabies mite is gone.

When you start treatment, wash all the clothes you and others in your home wore in the last 4 to 5 days in hot water. Then dry them in a dryer on high heat. You should also wash any sheets and blankets or towels people in your home have touched.   Scabies mites usually die without contact with human skin after a few days.

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How to help your “pooping and puking” child

I have a lot of patients who come to the office complaining of their children having vomiting or diarrhea, or both.  These stomach issues are enough to make anyone miserable, but getting to the point of dehydration is even worse.  Here are some things you can do at home to help prevent dehydration. 

 If your child has had several episodes of vomiting or diarrhea, you will need to replace lost fluids and electrolytes.

Children older than 1 year may have clear soups, clear sodas or juice mixed with water.  Avoid plain water – it doesn’t contain enough salt and nutrients to help with dehydration.  Also, avoid dark sodas – they are typically very high in sugar and can irritate your stomach.

Oral rehydration solutions (Pedialyte) are great for children under 1, as well as older children.  Try small amounts of Pedialyte at first.  When your child is able to keep the drink down, slowly increase how much you give.
If your child keeps vomiting, wait 30 to 60 minutes after the last time he or she vomited, and then try a few sips of Pedialyte, and increase as tolerated.

When your child stops vomiting, increase Pedialyte and add clear broths or clear sodas.

Restart solids when they can tolerate fluids.  Avoid foods with a lot of sugar and fat.  It’s best to avoid dairy products for a short while.  Try bland foods for the first 24 hours; these include bananas, rice, applesauce, toast, saltine crackers and unsweetened cereals. If your child does well with these foods, you can add other foods.   

Do not give you child any medication to stop the diarrhea.  If it’s caused by an infection, diarrhea is a way for the body to get rid of that infection. Giving medicines that stop diarrhea may actually interfere with the body’s efforts to heal.

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How does caffiene really effect you?

ImageCaffeinated coffee and tea are the most consumed, socially-acceptable stimulants in the world. Caffeine consumption has multiple  effects

  • Alertness — Caffeine consumption leads to increased alertness, energy, and ability to concentrate, particularly when you are fatigued or working at night.
  • Headache — Caffeine can alleviate or generate headache symptoms. Caffeine has been used in the treatment of headache.  Stopping chronic caffeine consumption can also lead to headaches, which is the most common symptom of caffeine withdrawal.
  • Psychiatric — Acute caffeine intake is associated with anxiety, nervousness, insomnia, irritability, and even panic attacks. Patients with pre-existing anxiety disorders may be more susceptible
  • Cardiovascular — Although caffeine can increase heart rate and blood pressure, low coffee consumption (up to three cups per day) may protect against myocardial infarction. Heavier coffee intake may trigger coronary and arrhythmic events in susceptible individuals.  
  • Type 2 diabetes mellitus — There is a dose-dependent inverse association between consumption of coffee (both caffeinated and decaffeinated) or tea and risk of type 2 diabetes’ the more coffee/tea consumed, your risk of diabetes is less.
  • Osteoporosis — high coffee intake may be associated with lower bone mineral density and increased fracture risk in women.  Tea consumption, on the other hand, was associated with higher bone density, although this did not decrease fracture risk.
  • Urinary frequency and incontinence — Caffeine intake is associated with increased urinary frequency and.

Caffeine withdrawal — You may exhibit Sx of

  • Headache
  • Tiredness/fatigue
  • Decreased energy/activeness
  • Decreased alertness/attentiveness
  • Drowsiness/sleepiness
  • Decreased contentedness/well-being
  • Depressed mood
  • Difficulty concentrating
  • Irritability
  • Fuzzy/foggy/not clearheaded

Caffeine withdrawal can occur with abstinence from daily doses as low as 100 mg/day. Withdrawal symptoms typically occur within 12 to 24 hours after discontinuing caffeine, peak at one to two days, and may persist for up to nine days.

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