Nasal Surgery: Preparing for Surgery

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Nasal Surgery: Preparing for Surgery

Nasal surgery may be done at your
healthcare provider’s office, a surgery center, or a hospital. You will be told how
to
prepare for surgery. Follow these directions carefully. And be sure you have your
questions
answered before the procedure.

Before surgery

Follow all the instructions you are
given. Plus:

  • Tell your healthcare provider
    about any medicines you take. This includes over-the-counter medicines, herbs, and
    supplements. You may need to stop taking some or all of them before surgery.

  • Tell your healthcare provider
    if you have a pacemaker.

  • Do not take medicines
    containing aspirin or ibuprofen during the
    14 days before surgery, unless your healthcare
    provider tells you to do so.

  • Don’t drink or eat for
    8 hours before surgery.

  • Don’t wear makeup, jewelry, or contact lenses to surgery.

  • Have an adult family member
    or friend drive you home after surgery.

You may spend the night in the
hospital. This is uncommon. Your healthcare provider can talk about this possibility
with you. 

Anesthesia

You will be given medicine to keep
you from feeling pain during surgery. This is called anesthesia. Your healthcare
provider will talk with you about the type you will have. You may have 1 of 3 types.

  • Local anesthesia. This numbs the nose and area around it. You may also be given medicine
    to relax you. But you will remain awake. Expect to hear noises and see movement during
    the surgery.

  • Monitored anesthesia care. This makes you drowsy or lightly asleep during surgery.
    You can still expect to hear some sounds.

  • General anesthesia. This puts you into a state like deep sleep during surgery. You
    will hear and remember nothing.

Adjustment Disorders in Children

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An adjustment disorder is an
unhealthy emotional or behavioral reaction to a stressful event or change in a person’s
life. The response happens within 3 months of the stressful event. Some events that may
lead to this problem in a child or teen are:

  • A family move
  • Death of a parent, sibling, grandparent, or other significant
    person
  • Parents’ divorce or separation
  • Death of a pet
  • A new brother or sister
  • A sudden sickness in the child or a
    family member
  • A long-lasting (chronic) illness in
    the child or a family member

Adjustment disorders are a reaction to stress. There is not one direct cause. Children and teens differ in their personalities, past experiences, vulnerability, and coping skills. Where they are in their development and ability to deal with a stressor may also play a part in how they react. Stressors also vary in how long they last, how strong they are, and what effect they have.

Adjustment disorders happen at all ages and are quite common in children and teens. They happen equally in boys and girls. They happen in all cultures. But the stressors and signs may vary based on cultural influences.

Children and teens have different
symptoms of an adjustment disorder than adults do. Children tend to have more behavioral
symptoms, such as acting out. Adults have more depressive symptoms. Age differences also
affect how long symptoms last, how strong they are, and what effect they have.

In all adjustment disorders, the reaction to the stressor seems to be more than what is thought to be normal. Or the reaction greatly interferes with how the child functions day to day.

There are 6 subtypes of adjustment disorder. They are based on the type of major symptoms a child may feel. Each child’s symptoms may vary. These are the most common symptoms of each subtype:

  • Adjustment disorder with depressed mood. A child may feel depressed, tearful, and hopeless.
  • Adjustment disorder with anxiety. Symptoms may include nervousness, worry, and jitteriness. A child may also fear losing important people in his or her life.
  • Adjustment disorder with anxiety and depressed mood. A child has a mix of symptoms from both of the above subtypes (depressed mood and anxiety).
  • Adjustment disorder with disturbance of conduct. A child may violate other people’s rights or violate social norms and rules. Examples include not going to school, destroying property, driving recklessly, or fighting.
  • Adjustment disorder with mixed disturbance of emotions and conduct. A child has a mix of symptoms from all of the above subtypes.
  • Adjustment disorder unspecified. A child has reactions to stressful events that don’t fit in one of the above subtypes. These may include behaviors such as withdrawing from friends and school.

Symptoms of an adjustment disorder
can look like other health problems or mental illnesses. Have your child see his or her
healthcare provider for a diagnosis.

A mental health expert such as a
psychiatrist often makes the diagnosis after an evaluation. He or she talks with you,
your partner, and your child. He or she will ask for a full history of your child’s
development, life events, emotions, behaviors, school performance, and the stressful
event.

Treatment will depend on your
child’s symptoms, age, and health. It will also depend on how severe the disorder is.

Treatment may include:

  • Psychotherapy using cognitive behavioral
    methods.     A child learns how to better solve problems, communicate, and handle
    stress. He or she will also learn how to control impulses and anger.
  • Family therapy. This therapy is often
    focused on making needed changes in the family. It may include improving
    communication skills and family interactions. It may also boost support among family
    members.
  • Peer group therapy. This therapy
    develops social and interpersonal skills.
  • Medicines. These are not often used.
    But a child may need them for a short time if a certain symptom is severe.

It’s not known how to prevent an adjustment disorder in a child. But spotting it early and getting expert help for your child can ease severe symptoms. Taking these steps can enhance a child’s normal growth and development. It can improve your child’s quality of life.

You can do these things to help your child:

  • Keep all appointments with your
    child’s healthcare provider.
  • Talk with your child’s healthcare
    provider about other providers who will be included in your child’s care. Your child
    may get care from a team that may include counselors, therapists, social workers,
    psychologists, and psychiatrists. Your child’s care team will depend on your child’s
    needs and how serious the adjustment disorder is.
  • Work closely with school staff. Your
    child’s adjustment disorder may significantly interfere with his or her ability to
    learn. If this is the case, the Americans with Disabilities Act (ADA) or Section 504
    of the Civil Rights Act may allow the school to offer reasonable accommodations in
    the school setting.
  • Tell others about your child’s
    adjustment disorder. Work with your child’s healthcare provider and school to create
    a treatment plan.
  • Reach out for support from local
    community services. Being in touch with other parents who have a child with an
    adjustment disorder may be helpful.

Call your child’s healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms
  • An adjustment disorder is an unhealthy emotional or behavioral reaction to a stressful event or change in a child’s life.
  • Symptoms happen within 3 months of the stressful event.
  • There are 6 subtypes. They are based on the major symptoms a child may feel, such as depression or anxiety.
  • A psychiatric evaluation can help diagnose it.
  • Personal, family, and group therapy can help.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Bulimia Nervosa in Children

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Bulimia nervosa is an eating disorder. It’s also called bulimia. A child with bulimia overeats or binges uncontrollably. This overeating may be followed by self-induced throwing up (purging).

A child who binges eats much larger amounts of food than would normally be eaten within a short period of time (often less than 2 hours). The binges happen at least twice a week for 3 months. They may happen as often as several times a day.

Bulimia has two types:

  • Purging type. A child with this type regularly binges and then causes himself or herself to throw up. Or the child may misuse laxatives, diuretics, enemas, or other medicines that clear the bowels.
  • Nonpurging type. Instead of purging after binging, a child with this type uses other inappropriate behaviors to control weight. He or she may fast or exercise too much.

Researchers don’t know what causes bulimia. Some things that may lead to it are:

  • Cultural ideals and social attitudes about body appearance
  • Self-evaluation based on body weight and shape
  • Family problems

Most children with bulimia are girls in their teens. They tend to be from a high socioeconomic group. They may have other mental health problems, such as an anxiety or mood disorders.

Children with bulimia are more likely to come from families with a history of:

  • Eating disorders
  • Physical illness
  • Other mental health problems, such as mood disorders or substance abuse

Each child may have different symptoms. But the most common symptoms of bulimia are:

  • Usually a normal or low body weight but sees him or herself as weighing too much
  • Repeated episodes of binge eating, often in secret
  • Fear of not being able to stop eating while bingeing
  • Self-induced throwing up, often in secret
  • Excessive exercise or fasting
  • Strange eating habits or rituals
  • Improper use of laxatives, diuretics, or other medicines to clear the bowels
  • In girls, irregular periods, or no period at all
  • Anxiety
  • Discouragement because he or she is not satisfied with his or her appearance
  • Depression
  • Obsession with food, weight, and body shape
  • Scarring on the back of the fingers from self-induced throwing up
  • Overachieving behaviors

The symptoms of bulimia nervosa may look like other health problems. Make your child sees his or her healthcare provider for a diagnosis.

Parents, teachers, and coaches may be able to spot a child with bulimia. But many children with it first keep their illness hidden. If you notice symptoms of bulimia in your child, you can help by seeking a diagnosis and treatment early. Early treatment can often prevent future problems.

A child psychiatrist or a mental health expert can diagnose bulimia. He or she will talk with you, your partner, and teachers about your child’s behavior. Your child may need psychological testing.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment often involves a mix of the following:

  • Individual therapy
  • Family therapy
  • Behavior changes
  • Nutritional rehabilitation
  • Medicine for depression or anxiety, if needed

Bulimia can lead to malnutrition. It can harm nearly every organ system in the body. That’s why early diagnosis and treatment is important. Some health problems it may cause are:

  • Damage to the throat, stomach, and bowels
  • Dehydration
  • Tooth decay

Health complications may happen during treatment. Because of this, both your child’s healthcare provider and a registered dietitian nutritionist (RDN) must be part of the care team. You as a parent play a vital role in treatment.

Experts don’t know how to prevent bulimia. But early detection and treatment can lessen symptoms. They can also help your child’s normal development. It can also improve his or her quality of life. Encouraging your child to have healthy eating habits and realistic attitudes toward weight and diet may also help.

Here are things you can do to help your child:

  • Keep all appointments with your child’s healthcare provider.
  • Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, psychiatrists, and registered dietitian nutritionists. Your child’s care team will depend on your child’s needs and how serious the bulimia is.
  • Tell others about your child’s bulimia. Work with your child’s healthcare provider and schools to develop a treatment plan.
  • Reach out for support from local community services. Being in touch with other parents who have a child with bulimia may be helpful.

Call your child’s healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms
  • Bulimia nervosa is an eating disorder.
  • A child with this eating problem overeats or binges uncontrollably. He or she may also engage in other activities to control weight. He or she may cause himself or herself to throw up or exercise too much.
  • Social attitudes toward body appearance and family problems may lead to bulimia.
  • A mental health expert can diagnose this eating problem.
  • A child may need therapy and nutritional rehab.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Open Neural Tube Defects (ONTDs) in Children

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Open neural tube defects (ONTDs) are problems with the way the brain, spinal cord, or spine forms while a baby is growing in the mother’s uterus. These problems occur in about 1 in every 1,500 newborn babies each year.   

The types of neural tube defects include:

  • Spina bifida. This is when the spine doesn’t grow normally over the spinal cord. Babies born with spina bifida may have minor or short-term problems. Or they may have lasting (permanent), serious physical problems. These may include paralysis, lack of bowel and bladder control, club feet, a buildup of spinal fluid in the head (hydrocephaly), and intellectual disability. In most cases, a child may need 1 or more surgeries after birth. This is the most common kind of ONTD.
  • Anencephaly. This defect is when part of the brain and skull don’t form. It occurs when the neural tube doesn’t close at the base of the skull. Babies with anencephaly often die in the uterus after 20 weeks of pregnancy (stillborn). Or they only live for a very short time after birth.
  • Encephalocele. This is a very rare condition. With this defect, the brain or its coverings poke through the skull. This can occur anywhere from the forehead to the lower back of the skull. But it may also occur in the front of the skull, near the nose and sinuses. In most cases, a child may need multiple surgeries after birth.

During pregnancy, the brain and spine begin as a flat plate of cells. This plate rolls into a tube, called the neural tube. The tube is completely formed 28 to 32 days after conception. If all or part of the neural tube fails to close, this leaves an opening. The opening is called an open neural tube defect. The opening in the tube may be left exposed or covered with bone or skin.

Neural tube defects are caused by genes passed on from both parents and from environmental factors. Some of these factors include obesity, uncontrolled diabetes in the mother, and some prescription medicines. In most cases, a child with a neural tube defect has no family history of this problem. ONTDs happen 5 times more often in girls than boys.

Once a child with a neural tube
defect has been born in the family, the chance that this problem will happen in another
child rises to 1 in 25. The type of neural tube defect can differ the second time. For
example, a family’s first baby could be born with anencephaly. A second baby could have
spina bifida instead.

Other risk factors for neural tube defects include:

  • Mother’s
    age.     Spina bifida is more common in teen mothers.
  • History of
    miscarriage.    A woman who has had miscarriages in the past has a higher risk of having a baby
    with neural tube defects.
  • Birth
    order.     First-born babies are at higher risk.
  • Socioeconomic status. Children born into lower socioeconomic families
    are at higher risk for spina bifida. Researchers think that poor diet may be a
    factor.

Symptoms depend on the type of ONTD. And they can occur a bit differently in each child.

Symptoms of spina bifida can include:

  • Area on the back that looks abnormal, such as a small hairy patch, dimple, or birthmark, or a pouch-like bulge (sac)
  • No feeling below the place on the spine where the sac is
  • No ability to move the legs (paralysis)
  • Constipation or incontinence

The baby may also have other problems such as:

  • Increased fluid and pressure in the head area (hydrocephalus)
  • Heart problems
  • Bone problems
  • Intellectual disability                                     

Symptoms of anencephaly can include:

  • No bones on the back of the head
  • Missing bones on the front and sides of the head
  • Large areas of brain missing
  • Folding of the ears
  • Split in the roof of the mouth (cleft palate)
  • Congenital heart defects

Symptoms of encephalocele can include:

  • Bulging sac at back of skull
  • Face defects
  • Fluid on the brain (hydrocephaly)
  • Small head
  • Weakness of arms or legs
  • Trouble moving, walking, reaching
  • Intellectual disability
  • Vision problems
  • Delayed growth and development
  • Seizures

The signs and symptoms of open neural tube defects can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

ONTDs can be diagnosed before birth with tests that include:

  • Blood
    test.    A test called a quad screen measures 4 substances in the mother’s blood. This
    can see if there is an increased risk for neural tube defects and other problems.
    This test is done between 16 and 18 weeks of pregnancy. It measures levels of
    alpha-fetoprotein (AFP) and other things in the blood. AFP is a protein made by the
    baby growing in the uterus. If a baby has an open neural tube defect, the AFP level
    in the mother’s blood will be higher than normal. The test isn’t conclusive. This
    means it can’t prove that your baby has an open neural tube defect. But it can show
    if your baby is at risk for an ONTD. The test can show if you need more testing. The
    American College of Obstetrics and Gynecology (ACOG) advises that this blood test be
    offered to all pregnant women.
  • Prenatal
    ultrasound.    This imaging test uses high-frequency sound waves and a computer to make images
    of blood vessels, tissues, and organs. Ultrasounds let healthcare providers see the
    internal organs as they function. They also show blood flow through blood vessels.
    Prenatal ultrasound may be able to find an open neural tube defect. Your provider may
    also use ultrasound to look at some of the baby’s other organs and body systems.
  • Amniocentesis. This test looks at a small sample of the fluid that
    surrounds the baby in the uterus. The healthcare provider uses a long, thin needle to
    reach the amniotic sac. He or she takes the sample of fluid and checks it for AFP.
    The test may not be able to find small or closed defects.

After birth, a healthcare provider makes a diagnosis with a physical exam.

If your baby has an ONTD, you may need to have a cesarean section to deliver your baby. This is often done to lower the risk for damage to the spinal cord that may occur during a vaginal delivery.

If your child has spina bifida or encephalocele, he or she may need surgery to:

  • Fix and close the defect
  • Treat hydrocephalus
  • Treat bone (orthopedic) problems
  • Repair bowel and bladder problems

A baby may also need:

  • Rehabilitation
  • Positioning aids that help the child sit, lie, or stand
  • Braces and splints that help prevent deformity and give support or protection to areas of the body
  • Medicines

Talk with your child’s healthcare
providers about the risks, benefits, and possible side effects of all treatments.

There is no cure or standard treatment for anencephaly. Treatment is supportive. This means efforts are made to keep the baby as comfortable as possible. Anencephaly most often leads to death in days or weeks. Grief counseling services are available to help parents cope with the loss of their child.

Babies with spina bifida are at high risk of developing a latex allergy. This is because they are exposed to latex during the many medical and surgical procedures they need. Your baby’s healthcare team will do their best to limit how much latex your baby is exposed to. Your baby’s healthcare providers can help you find out which products contain latex and also find products that are latex-free.

Up to 3 in 4 babies with anencephaly are stillborn. Anencephaly most often leads to death in days or weeks.

The neural tube closes 28 to 32 days after a baby is conceived. This is before many women know that they are pregnant. Normal development of the brain and spinal cord may be affected during these first 3 to 8 weeks of pregnancy by:

  • Not getting enough vitamins such as folic acid and other nutrients
  • Infection
  • Using prescription medicine or alcohol
  • Being around hazardous chemicals and other substances
  • Genetic problems

Folic acid is in prenatal vitamins. Getting this vitamin early in pregnancy is important to prevent an ONTD. Researchers have found that a woman who gets enough folic acid (vitamin B-9) can help lower the risk for neural tube defects. Folic acid is found in some leafy green vegetables, nuts, beans, citrus fruits, and fortified breakfast cereals. Experts recommend that all women of childbearing age take a daily multivitamin containing 400 to 800 micrograms of folic acid.

If you have had a child with a neural tube defect, your healthcare provider may recommend taking a larger amount of folic acid before your next pregnancy. Your provider may tell you to take this extra amount for 1 to 2 months before conception and then through the first trimester.

Your healthcare provider may also
advise genetic counseling. You can talk with a counselor about the risk of a neural tube
defect in a future pregnancy. Also talk with your provider about getting a prescription
for folic acid to lower the risk for another open neural tube defect.

 Your child’s healthcare providers will work to prevent deformities or keep them to a minimum. They will also work to help your child make the most of his or her capabilities. Physical and occupational rehabilitation, plus extra support in school, can help a child function as well as possible.

If your baby is born with an ONTD, there are things you can do to take care of yourself and your baby:

  • Keep all appointments with your baby’s healthcare provider.
  • Talk with your baby’s healthcare
    provider about other providers who will be part of your child’s care. Your child may
    get care from a multidisciplinary team that may include counselors, social workers,
    clergy, genetic counselors, and physical or occupational therapists. Your child’s
    care team will depend on your baby’s condition.
  • Call your baby’s healthcare provider if you are concerned about your baby’s symptoms.
  • Consider genetic testing and counseling to understand your risk.
  • Tell others about your baby’s condition. Work with your child’s healthcare provider to develop a treatment plan.
  • Ask for support from local community services, such as your faith community, and organizations that specialize in birth defects, such as the March of Dimes.

A diagnosis of anencephaly can be overwhelming and upsetting. You will face difficult decisions about how to care for your baby. Because many babies born with anencephaly may not live beyond the first few days or weeks of life, you may have to cope with your baby never coming home from the hospital.

Call the healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms
  • Open neural tube defects (ONTDs) are problems with the way the brain, spinal cord, or spine forms while a baby is growing in the womb.
  • The types of neural tube defects include spina bifida, anencephaly, and encephalocele. Treatment for an ONTD depends on the type of defect your child has.
  • Neural tube defects are caused by genes passed on from both parents and from environmental factors.
  • Symptoms can include a bulging sac on the back of the neck or head, or a very small head.
  • Experts recommend that all women of childbearing age take a daily multivitamin containing 400 to 800 micrograms of folic acid. Getting this vitamin early in pregnancy is important to prevent an ONTD.
  • ONTDs can be diagnosed before birth with tests that include a blood test, prenatal ultrasound, or amniocentesis.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Developmental Dysplasia of the Hip in Children

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Developmental dysplasia of the hip (DDH) is a health problem of the hip joint. It’s when the joint hasn’t formed normally, so it doesn’t work as it should. DDH is present at birth. It is more common in girls than boys. 

In a normal hip joint, the top (head) of the thighbone (femur) fits snugly into the hip socket. In a child with DDH, the hip socket is shallow. As a result, the head of the femur may slip in and out. It may dislocate. This means it moves partly or completely out of the hip socket.

A combination of things may lead to DDH. It may be partly genetic. DDH tends to run in families. It may also be partly environmental, such as:

  • The baby’s response to the mother’s hormones during pregnancy
  • A tight uterus that makes it hard for the fetus to move around
  • A breech delivery, when the baby is born bottom-first instead of headfirst

First-born babies are at higher risk because the uterus is small and there is limited room for the baby to move. That may affect how the hip develops. Other risk factors are:

  • Family history of DDH, or very
    flexible ligaments
  • Position of the baby in the uterus,
    especially the breech position
  • Other orthopedic problems, such as
    clubfoot
  • Female sex. DDH is more common in girls than boys.

The following are the most common symptoms of DDH. Symptoms can occur a bit differently in each baby. They can include:

  • The leg may appear shorter on the side of the dislocated hip
  • The leg on the side of the dislocated hip may turn outward
  • The folds in the skin of the thigh or buttocks may appear uneven
  • The space between the legs may look wider than normal

The symptoms of DDH may seem like other health problems of the hip. Make sure your baby sees his or her healthcare provider for a diagnosis.

DDH is sometimes noted at birth. A healthcare provider screens newborn babies in the hospital for this hip problem before they go home. But DDH may not be discovered until later checkups.

Your baby’s healthcare provider makes the diagnosis of DDH with a physical exam. During the exam, he or she asks about your baby’s birth history and whether other family members have DDH.

Your baby may also need these
tests:

  • X-rays. This test makes images of internal tissues, bones,
    and organs.
  • Ultrasound (sonography). This test uses high-frequency
    sound waves and a computer to make images of blood vessels, tissues, and organs. It
    is used to view internal organs as they function and to assess blood flow through
    various vessels.

Treatment will depend on your
baby’s symptoms, age, and general health. It will also depend on how severe the
condition is.

The goal of treatment is to put the
head of the femur back into the socket of the hip so that the hip can develop normally.
Treatment choices vary for babies. They may include:

  • A special brace or harness. The
    Pavlik harness is most often used. It is used on babies up to 6 months of age to hold
    the hip in place, while allowing the legs to move a little. Your baby’s healthcare
    provider puts the harness on and periodically checks its fit. The harness may fix the
    DDH. But sometimes the hip may still be partly or completely dislocated.
  • Casting. If your child still has DDH,
    a cast may help. This is called a spica cast.
  • Surgery. If the other methods don’t work, or if DDH is
    diagnosed at age 6 months to 2 years, your child may need surgery to realign the hip.
    Your child may then have to wear a spica cast for up to 6 months after surgery. This
    special cast holds the hip in place as it heals. After the cast is removed, your
    child may need a special brace or physical therapy exercises to strengthen the
    muscles around the hip and in the legs.

If DDH is found early, many babies
do well with the Pavlik harness, and if needed, casting. Some babies may need one or
more surgeries as they grow because the hip can dislocate again. If DDH is left
untreated, a child may develop differences in leg length and a duck-like gait. Later in
life, he or she may have pain or arthritis in the hip.

  • DDH is a health problem of the hip joint. The hip socket is shallow. This allows the head of the femur to dislocate, slipping in and out of the socket.
  • DDH is present at birth. It may be
    caused by genetic problems and environmental factors.
  • A baby with DDH may have one leg that looks shorter than the other.
  • Newborns are screened for DDH before they leave the hospital.
  • Treatment may include a Pavlik
    harness, casting, or surgery.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Turner Syndrome (Monosomy X) in Children

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Turner syndrome (TS or monosomy X)
is a genetic disorder that occurs in girls. It causes many traits and problems. Girls
with TS are shorter than most girls. They don’t go through normal puberty as they grow
into adulthood. They may also have other health problems such as heart or kidney
problems. The seriousness of these problems varies from girl to girl. Many of the health
problems affecting girls with Turner syndrome can be managed or fixed with treatment.
Turner syndrome is rare. It occurs in about 1 in 2,000 to 2,500 girl babies.

When a baby is conceived, a normal egg cell and normal sperm cell start with 46 chromosomes. The egg and sperm cells then divide in half. The egg and sperm cells then have 23 chromosomes each. When a sperm with 23 chromosomes fertilizes an egg with 23 chromosomes, the baby will then have a complete set of 46 chromosomes, or 23 pairs. Half are from the father and half are from the mother. The 23rd pair is called the sex chromosomes. In females, the 23rd pair is two X chromosomes. In males, the 23rd pair is one X and one Y chromosome.

There are 2 types of Turner
syndrome: monosomy X TS and mosaic TS. About half of all girls with Turner syndrome have
a monosomy disorder. Monosomy means that a person is missing one chromosome in the pair.
Instead of 46 chromosomes, the person has only 45 chromosomes. This means a girl with TS
has only one X chromosome in her 23rd pair.
Sometimes an error occurs when an egg or sperm cell is forming. This causes it to have a
missing sex chromosome. But it is often an error that happened by chance when the
father’s sperm cell was forming. The missing sex chromosome error can occur in either
the mother’s egg cell or the father’s sperm cell.

Girls with mosaic TS have
chromosome changes in only some cells, but not all cells. A small number of cases have
the normal number of 46 chromosomes, but with part of the X chromosome missing. When
only part of an X chromosome is missing (deletion), a girl with the syndrome will often
have milder signs of TS. The features of TS depend on which part of the X chromosome is
missing.

During a pregnancy, the healthcare provider may have seen a structure called a cystic hygroma during a fetal ultrasound. A cystic hygroma is a fluid-filled sac at the base of the neck. It often goes away before birth. But sometimes the sac is there when the baby is born.

Girls with TS often have:

  • Puffy hands and feet at birth
  • Wide neck with folds of skin down the sides of neck (webbed
    neck)
  • Short height
  • A low hairline at the back of the
    neck
  • Feeding problems as a baby
  • Small differences in the shape and
    position of the ears
  • Broad chest with widely spaced
    nipples
  • More small brown moles (nevi) on the
    skin than normal
  • Deep-set nails 
  • Small jaw
  • Narrow top of the inside of the
    mouth
  • Skeletal problems
  • Eye problems requiring glasses

Chromosome problems such as TS can
often be diagnosed before birth. This is done by looking at cells in the amniotic fluid
or from the placenta. This can also be done by looking at the amount of the baby’s DNA
in the mother’s blood. This is called noninvasive prenatal screening. These tests are
very accurate.

Fetal ultrasound during pregnancy can also show the possibility of Turner syndrome. But ultrasound is not 100% accurate. Problems due to the disorder may not be seen with ultrasound.

If a healthcare provider thinks
that your newborn baby girl may have TS, he or she will often take a small sample of
your baby’s blood. The lab will look at the sample to see if one X sex chromosome is
missing.

The healthcare provider may refer you to a genetic counselor. This expert can explain the results of chromosome tests, as well as tests available to diagnose chromosome problems before a baby is born.

Sometimes a girl with TS doesn’t have any problems as a baby or child. It’s only when she doesn’t go through puberty or is shorter than her peers that her healthcare provider may suspect TS.

There is no cure for TS. But many of the more serious problems can be treated. For example, growth hormone and androgen therapy can increase the final adult height of a girl. She can also take hormone therapy to develop secondary sex traits such as breasts, pubic hair, and underarm hair. Surgery can fix coarctation of the aorta, if needed. And medicines are available to treat high blood pressure, diabetes, and thyroid problems. A woman with TS can have children by using donor eggs. 

Being shorter than normal is the
most common feature of TS as a girl grows. The average adult height of a woman with TS
is 4 feet, 8 inches. A girl may also have cubitus valgus. This means that when she
stands with her arms at her side, her elbows will be slightly bent. She can’t keep her
arms perfectly straight at her side. Most girls with TS will need treatment with growth
hormone over time.

Most women with TS are born with
poorly formed or missing ovaries. Ovaries make estrogen. Without it, a girl with TS will
not develop sexually. The normal signs of puberty don’t happen unless the girl is given
hormone therapy. This includes breast development, menstrual periods, and growth of
pubic hair and hair elsewhere on the body. Most girls with the syndrome won’t be able to
have children (are infertile) as adults. Most girls will need to be treated with
estrogen at some point for a normal progression of puberty and sexual
development.                                              

Other common problems with TS affect the heart, kidney, and thyroid. About 1 in 10 girls with TS is born with coarctation of the aorta. This means the main artery that leaves the heart is narrowed. This problem sometimes needs to be fixed with surgery.

Girls with TS generally have normal
intelligence. They tend to score higher on their verbal IQ than their nonverbal IQ. But
they may have problems with spatial perception. They may also have certain learning
disabilities.

Other possible problems include:

  • Middle ear infections
  • Diabetes
  • Dry skin
  • High blood pressure
  • Low bone density and increased risk of fractures
  • Curving of the spine (scoliosis and kyphosis)
  • Hearing loss
  • Hypothyroidism
  • Celiac disease
  • Inflammatory bowel disease
  • Vitamin D deficiency
  • Metabolic syndrome
  • Coronary heart disease as an adult

Researchers don’t know how to
prevent the chromosome error that causes this disorder. In general, a woman who has a
child with Turner syndrome is not at increased risk of having another baby with the
condition. TS is often not inherited in families. It happens randomly.

If your baby girl is born with TS, there are things you can do to take care of yourself and your baby.

  • Keep all appointments with your baby’s
    healthcare provider.
  • Talk with your healthcare provider
    about other providers who will be part of your child’s care. Your child may receive
    care from a multidisciplinary team that may include experts such as counselors,
    social workers, genetic counselors, physical therapists, and speech therapists.
  • Call your healthcare provider if you
    are concerned about your baby’s symptoms.
  • Think about having genetic testing and
    counseling to understand your risk.
  • Tell others about your baby’s
    condition. Work with your child’s healthcare provider to create a treatment
    plan.
  • Reach out for support from local
    community services. Being in touch with other parents who have a daughter with TS can
    also be helpful.
  • If your child has any of the complications listed above, she
    will need screening and monitoring at periodic intervals. Make sure you understand
    the monitoring schedule that applies to your child.

Call the healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms
  • Turner syndrome (TS) is a genetic disorder that occurs in girls.
  • Girls with TS generally have normal intelligence. But they are shorter than most girls. They don’t go through normal puberty as they grow into adulthood. And they may also have heart, thyroid, or kidney problems.
  • There is no cure for TS. But many of the more serious problems can be treated with hormone therapy, surgery, and medicines.
  • A woman with TS can have children by using donor eggs. 
  • Chromosome problems such as TS can
    often be diagnosed before birth. This is done by looking at cells in the amniotic
    fluid or from the placenta. These tests are very accurate.
  • Experts don’t know how to prevent the
    chromosome error that causes TS. It often happens by chance during conception. It
    does not often run in families.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.