Thrush (Oral Candida Infection) in Children

Thrush is a mouth infection that is
common in babies and children. Symptoms include white or yellow velvety patches in the
mouth. Thrush is caused by a type of fungus called Candida. Candida is found naturally
on the skin and in the mouth. But if Candida grows out of control, it can cause thrush.

Thrush is not a serious problem for a healthy child. It can be treated with antifungal medicine.

Candida yeast is common in the everyday environment. It only causes a problem when it grows out of control. This can happen if a child:

  • Has taken antibiotics
  • Uses inhaled corticosteroids, such as for asthma
  • Uses a pacifier often
  • Has a weak immune system

A child is more at risk for thrush if he or she:

  • Had a very low birth weight
  • Passed through the birth canal of a mother with a yeast infection
  • Has taken antibiotics
  • Uses inhaled corticosteroids, such as for asthma
  • Uses a pacifier often
  • Has a weak immune system

Thrush causes milky white or yellow patches to form on the tongue or inner cheeks. These patches can be painful and may bleed. Some babies have no pain from thrush. Others may have pain and be fussy and refuse to feed. It may hurt when your child swallows. Thrush can also cause cracked skin in the corners of the mouth. Symptoms can occur a bit differently in each child.

The symptoms of thrush can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. This will include looking in your child’s mouth.

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

A healthy baby with mild thrush may not need any treatment. More severe cases are likely to be treated with a liquid antifungal medicine. This is given through a dropper into your child’s mouth. Or the medicine may be given as pills in an older child. Follow the healthcare provider’s instructions for giving this medicine to your child.

Breastfeeding mothers may develop thrush on their nipples. If you breastfeed, both you and your child will be treated. This is to prevent passing the infection back and forth. You may be given an ointment to apply to your skin, or an oral antifungal medicine.

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

It’s also important to boil
(sterilize) disinfect any pacifiers, bottle nipples, or
toys that your child may put in his or her mouth after each use. This will prevent your
child from being infected again.                                                        

To care for your child at home:

  • Wash your hands well with warm water and soap before and after caring for your child. Have your child wash his or her hands often.
  • If your child uses a nipple or a pacifier, boil it for 5 to 10 minutes after each use.
  • Wash drinking cups using warm water and soap after each use.

If your child takes inhaled corticosteroids, have your child rinse their mouth after taking the medicine. Also ask the healthcare provider about using a spacer on the inhaler. This can help lessen the risk for thrush.

Call the healthcare provider if your child:

  • Has symptoms that don’t get better, or get worse
  • Has new symptoms
  • Stops eating or drinking

Get medical care right away if your child is 3 months old or younger and has a fever of 100.4°F (38°C) or higher. Fever in a young baby can be a sign of a dangerous infection.

  • Thrush is a common mouth infection in babies and children. It’s not a serious problem for a healthy child. It can be treated with antifungal medicine.
  • Thrush is caused by a type of fungus called Candida. Candida is found naturally on the skin and in the mouth. But if Candida grows out of control, it can cause thrush.
  • Thrush causes milky white or yellow patches to form on the tongue or inner cheeks. These patches can be painful and may bleed. Some babies have no pain from thrush. Others may have pain and be fussy and refuse to feed. It may hurt when your child swallows.
  • A healthy baby with mild thrush may not need any treatment. More severe cases are likely to be treated with a liquid antifungal medicine.
  • Breastfeeding mothers may develop thrush on their nipples. If you breastfeed, both you and your child will be treated.
  • It’s also important to boil
    (sterilize) any pacifiers, bottle nipples, or toys that your child may put in his or
    her mouth after each use.

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.

Respiratory Syncytial Virus (RSV) in Children

RSVis
a viral illness that causes symptoms such as trouble breathing. It’s
the most common cause of inflammation of the small airways in the lungs (bronchiolitis)
and pneumonia in babies.

RSV is spread when a child comes into contact with fluid from an
infected person’s nose or mouth. This can happen if a child touches a contaminated
surface and touches his or her eyes, mouth, or nose. It may also happen when inhaling
droplets from an infected person’s sneeze or cough.

A child is more at risk for RSV if
he or she is around other people with the virus. RSV often occurs in yearly outbreaks
in
communities, classrooms, and childcare centers. RSV is more common in winter and early
spring months.

RSV can affect a person of any
age but causes the
most problems for the very young and very old. Most babies have been
infected at least once by the time they are 2 years old. Babies can also be reinfected
with the virus. Infection can happen again anytime throughout life. RSV infection
in
older children and adults may seem like an episode of severe asthma. Babies born
prematurely or with heart, lung, or immune system diseases are at increased risk for
more severe illness.

Symptoms start about 2 to 5 days
after contact with the virus.

The early phase of RSV in babies
and young children is often mild, like a cold. In children younger than age 3, the
illness may move into the lungs and cause coughing and wheezing. In some children,
the
infection turns to a severe respiratory disease. Your child may need to be treated
in
the hospital to help with breathing.

The most common symptoms of RSV
include:

  • Runny nose
  • Fever  
  • Cough
  • Short periods without breathing
    (apnea)
  • Trouble eating, drinking, or
    swallowing
  • Wheezing
  • Flaring of the nostrils or straining
    of the chest or stomach while breathing
  • Breathing faster than usual, or
    trouble breathing
  • Turning blue around the lips and
    fingertips 

The symptoms of RSV can
seem
like other health conditions. Make sure your child sees his or her healthcare provider
for a diagnosis.

The healthcare provider will ask about your child’s symptoms and
health history. He or she may also ask about any recent illness in your family or
other
children in childcare or school. He or she will give your child a physical exam. Your
child may also have tests, such as a nasal swab or wash. This is a painless test to
look
for the virus in fluid from the nose.

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

Antibiotics are not used to treat
RSV. Treatment for RSV is done to help ease symptoms. Treatment may include:

  • More fluids. It’s very important to
    make sure your child drinks plenty of fluids. If needed, your child will get an
    intravenous (IV) line to give fluids and electrolytes.
  • Oxygen. This
    is extra oxygen given through a mask, nasal prongs, or an oxygen tent.
  • Suctioning of mucus.  A thin tube is
    put into the lungs to remove extra mucus.
  • Bronchodilator medicines. These may
    be used to open your child’s airways. They are often given in an aerosol mist by a
    mask or through an inhaler.
  • Tube feeding. This may be done if a
    baby has trouble sucking. A thin tube is put through the baby’s nose and down into
    the stomach. Liquid nutrition is sent through the tube.
  • Mechanical ventilation. A child who
    is very ill may need to be put on a breathing machine (ventilator) to help with
    breathing.
  • Antivirals. Some children with severe infections
    may
    need
    treatment with an antiviral
    medicines.

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

In high-risk babies, RSV can lead to severe breathing illness and
pneumonia. This may become life-threatening. RSV as a baby may be linked to asthma
later
in childhood.

The American Academy of Pediatrics
(AAP) recommends that babies at high risk for RSV get a medicine called palivizumab.
Ask
your child’s healthcare provider if your child is at high risk for RSV. If so, ask
about
monthly injections during RSV season to help prevent infection.

To reduce the risk for RSV, the AAP
recommends all babies, especially preterm infants:

  • Be breastfed
  • Be protected from contact with
    smoke
  • Not go to childcare with lots of
    children during their first winter season
  • Not have contact with sick people

Also make sure that household
members wash their hands or use an alcohol-based hand cleaner before and after touching
a baby with RSV.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms

  • RSV is a viral illness that causes
    trouble breathing. It is more common in winter and early spring months.
  • Most babies have been infected at
    least once by the time they are 2 years old. Babies can also be re-infected with the
    virus. Infection can happen again anytime throughout life.
  • Treatment for RSV may include extra
    oxygen. This is extra oxygen given through a mask, nasal prongs, or an oxygen tent.
    A
    child who is very ill may need to be put on a breathing machine (ventilator) to help
    with breathing
  • In high-risk babies, RSV can lead to
    severe respiratory illness and pneumonia. This may become life-threatening. RSV as
    a
    baby may be linked to asthma later in childhood.
  • Babies at high risk for RSV receive a
    medicine called palivizumab. Ask your child’s healthcare provider if your child is
    at
    high risk for RSV.

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.

Pneumothorax in Children

A pneumothorax is an air leak in the lungs. It’s when air from the
lungs leaks into the chest area. The leak may start suddenly or may develop slowly. It
often occurs in the first 24 to 36 hours after birth. How serious the illness is depends
on where the leak is, how quickly the leak occurs, and how much air is leaking.

The most common cause of
pneumothorax is from air delivered by a breathing machine (mechanical ventilator). A
baby born with a lung disease may need to be on a breathing machine.

Pneumothorax can also occur suddenly in children. But this is
uncommon.

Another cause is meconium
aspiration. This is when a baby is still in the mother’s uterus and breathes in its
first stool (meconium). Air may then become trapped, causing the lungs to expand too
much. This can lead to air leaks.

Children at risk for a pneumothorax
are:

  • Babies with other lung diseases such
    as respiratory distress syndrome
  • Babies on a mechanical ventilator
  • Premature babies whose lung tissue is
    more fragile
  • Babies with meconium aspiration

Symptoms may be a bit different for
each child. Some otherwise healthy babies can develop an air leak that does not cause
symptoms or distress. Others may have these symptoms:

  • Irritability and restlessness
  • Rapid breathing
  • Grunting
  • Nostril flaring
  • Skin on the chest sinks in around the
    ribs when the child breathes (chest wall retractions)
  • Pale or bluish skin color

These symptoms may look like other
health problems. Make sure your child sees his or her healthcare provider right away for
a diagnosis.

Your child’s healthcare provider
can diagnose a pneumothorax with a health history and physical exam. Your child may also
need:

  • Chest X-rays. This test makes images
    of internal tissues, bones, and organs. It may show air in places that is not normal,
    a collapsed lung, or structures in the chest that aren’t in a normal position.
  • Transillumination. During this test,
    the healthcare provider puts a fiber-optic light probe on the baby’s chest wall. The
    side of the chest with the air leak shows a brighter light. This test is often used
    in an emergency.

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

Treatment for a pneumothorax
depends on how big it is and what symptoms it is causing. Some air leaks that do not
cause symptoms or distress may get better on their own without treatment. As the leak
seals over, air is absorbed into your child’s body.

For air leaks that cause symptoms,
treatment may include:

  • Giving extra oxygen. Giving oxygen to
    your child may help heal the air leak more quickly.
  • Removing the collected air. The
    healthcare provider puts a syringe or a thin tube (catheter) through the chest wall
    into the air space. The air may be removed with the syringe. Or the tube may be
    connected to a drainage system to help remove the air until the leak can seal.

A pneumothorax in a child can lead
to:

  • Cardiac arrest
  • Death

Even when the air pressure and settings on mechanical ventilators are
carefully watched, air leaks can still happen. Your baby’s healthcare team will watch
your baby carefully for signs of an air leak. If that occurs, treatment can be started
as quickly as possible.

Call your child’s healthcare provider if your child has any symptoms
of a pneumothorax.

Call 911 if
your child is having trouble breathing.

  • A pneumothorax is an air leak in the
    lungs. It’s when air from the lungs leaks into the chest area.
  • A pneumothorax may start suddenly or
    may develop slowly. It often occurs in the first 24 to 36 hours after birth.
  • A baby who needs to be on a breathing
    machine is most at risk for a pneumothorax.
  • A baby with an air leak has a hard
    time breathing. He or she may breathe rapidly or grunt.
  • Treatment may include giving extra
    oxygen or removing the air with a syringe or tube.
  • Some air leaks may get better without
    treatment.

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.

Phenylketonuria (PKU) in Children

Phenylketonuria (PKU) is a rare metabolic disorder. Children with PKU can’t process an amino acid called phenylalanine. Phenylalanine is in many common foods. It helps the body make protein. It’s also important for brain growth. It’s normally changed to tyrosine, which helps create all of the body’s proteins. But with PKU, the amino acid can build up in the bloodstream and cause harm. PKU is found with a simple blood test. All newborn babies in the U.S. are screened for PKU.   

PKU is caused by a defect in a gene known as the PAH gene. This defect changes the way that phenylalanine is broken down by the body during digestion. PKU is passed on to children when each parent has 1 mutated gene. This means that neither parent has any symptoms of PKU, but both are carriers of the faulty gene. PKU is an autosomal recessive disease. This means that a child needs to inherit 1 faulty gene from each parent to show signs of the disorder.

A child is at risk for PKU if his
or her parents each have 1 faulty PAH gene. PKU affects 1 out of every 10,000 to 15,000
newborns born in the U.S.

If a baby is not tested and has undiagnosed PKU, he or she may show signs or symptoms at several months old. Some babies with PKU may seem more drowsy and listless than normal. They may have feeding problems. As they continue to take in protein and phenylalanine through their diets, they may have growth, mood, behavior, and thinking problems, as well as other problems. Symptoms can range from mild to severe based on how much phenylalanine is in the blood.

The symptoms of PKU can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

All newborn babies in the U.S. are screened for PKU with a blood test. If you adopt a child from another country, he or she may need to be screened for PKU and other genetic diseases.

PKU is treated with a special diet.
Newborn babies who test positive for PKU are placed on phenylalanine-free formula right
away.

As babies start to eat solid food, their diet will need to be restricted. This is because phenylalanine is found in many foods with protein. A child with PKU should not eat milk, fish, cheese, nuts, beans, or meat. A child with PKU can eat many foods low in protein, such as vegetables, fruits, and some cereals. Your child may also need to take mineral and vitamin supplements to make up for nutrients missing from the diet.

Children with PKU can’t tolerate the sugar substitute called aspartame. Aspartame contains phenylalanine. You will need to read all food labels to make sure your child avoids foods and drinks that contain this sweetener.

A baby born to a woman who has PKU
that is not controlled with a special diet is at high risk for serious problems. The
developing baby in the uterus can be exposed to very high levels of phenylalanine. This
can cause low birth weight, slow growth, small head, behavior problems, and heart
disorders. These mothers are also at risk for pregnancy loss.

If PKU in a child is not diagnosed and treated, phenylalanine will build up in the bloodstream until it reaches levels that can cause brain damage. It can also cause permanent damage to organs and tissues around the body. PKU can lead to:

  • Developmental delays
  • Heart defects, especially in infants born to mothers with PKU and uncontrolled phenylalanine in pregnancy
  • Autism
  • Intellectual disability
  • Very small head size (microcephaly)
  • Behavioral problems
  • Seizures
  • Eczema (a skin condition marked by an
    itchy red rash or blisters)
  • Pale hair and skin compared with other family members
  • Delayed physical growth
  • Musty body odor

Women with PKU who are of childbearing age should be careful to follow a strict low-protein diet. Your healthcare provider may advise genetic counseling. You can discuss with a counselor the risk for PKU in a future pregnancy.

Children born with PKU will need to follow a lifelong low-protein diet and stay away from aspartame. If they don’t, they may have mood disorders, poor memory and problem-solving skills, depression, and uncontrollable shaking (tremors).

If your baby is born with PKU, you can do certain things to take care of him or her:

  • Keep all appointments with your baby’s healthcare provider.
  • To help with dietary restrictions and planning, your healthcare provider may refer you to a registered dietitian:
    • Natural sources of protein have too much phenylalanine for children with PKU. So your child can’t have meat, milk, or other common foods that contain protein. Instead, he or she must eat a variety of processed foods that are phenylalanine-free.
    • Your child can eat fruits, vegetables, and limited amounts of certain grain cereals.
    • Your child can have special nutritional products, including infant formula without phenylalanine.
  • Consider genetic testing and counseling to understand your risk of passing on the gene that causes PKU.
  • Tell others about your baby’s condition. Work with your child’s healthcare provider to develop a treatment plan.
  • Reach out for support from local community services. Being in touch with other parents who have a child with PKU can also be helpful.

Call the healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms that concern you
  • Phenylketonuria (PKU) is a rare metabolic disorder. Children with PKU can’t process an amino acid called phenylalanine.
  • Phenylalanine is in many common foods. But it can build up in the bloodstream of children with PKU. This can cause growth, mood, behavior, and thinking problems, as well as other problems ranging from mild to severe.
  • If PKU is untreated, phenylalanine will build up in the bloodstream until it reaches levels that can cause brain damage and other serious problems.
  • With treatment and dietary restrictions, a child with PKU can grow and develop normally.
  • All newborn babies in the U.S. are screened for PKU with a blood test. If you adopt a child from another country, he or she may need to be screened for PKU and other genetic diseases.
  • PKU is treated with a special diet. Newborn babies who test positive for PKU are placed on phenylalanine-free formula right away.
  • If you are a woman with PKU, your healthcare provider may advise genetic counseling. You can discuss with a counselor the risk of PKU in a future pregnancy.

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.

Circumcision for Children

Circumcision is a surgery to remove
the skin covering the end of the penis. This skin is called the foreskin.  This surgery
is most often done 1 or 2 days after a baby boy’s birth. Circumcision can also be done
on older boys. This can be more complex. An older boy may need medicine (general
anesthesia) to put him to sleep during the procedure.

In some cultures, circumcision is a
religious practice or a tradition. It’s most common in Jewish and Islamic faiths. In the
U.S., newborn circumcision is not required. It’s an elective procedure. This means you
can choose to have your child circumcised or not. Circumcision is often done 1 to 2 days
after birth. It’s helpful to decide before your baby is born.

It’s important to learn about the
benefits and risks of circumcision. According to the American Academy of Pediatrics
(AAP):

  • Problems with the penis (such as irritation) can happen with or without circumcision.
  • There is no difference in health and cleanliness (hygiene) with or without circumcision, as long as a boy can handle cleaning and care.
  • There is a higher risk of urinary tract infection (UTI) in uncircumcised boys. This is more so in babies younger than 1 year old. But the risk for UTI in all boys is less than 1%.
  • Newborn circumcision does give some protection from cancer of the penis later in life. But the overall risk of penile cancer is very low in developed countries, such as the U.S.
  • Circumcised boys and men have a lower
    risk for some sexually transmitted infections. This includes HIV.

The AAP has found that the health benefits of circumcision are greater than the risks. But the AAP also found that these benefits are not great enough to advise that all newborn baby boys be circumcised. Parents must decide what is best for their baby.

Circumcision has some risks. But the rate of problems is low. The most common risks are bleeding and infection.

The skin of the penis is also very sensitive after a circumcision. The area can get irritated from contact with the baby’s diaper or with the ammonia in urine. This can be treated by putting petroleum jelly on the penis for a few days.                                      

There may be other risks. This depends on your baby’s health. Talk about any concerns you have with the healthcare provider before the surgery.

Make sure the healthcare provider fully explains the procedure. Ask if anesthetic is used for a circumcision. The AAP advises anesthetic. This helps reduce a baby’s pain during the procedure.

If your baby is born early or has other health problems, he may not be circumcised until he is ready to leave the hospital. If your baby has a physical problem with his penis, he may not be circumcised. This is because the foreskin is used in a future surgery on the penis.

The procedure is usually done by an
obstetrician or pediatrician in the hospital. When it’s done for religious reasons,
other people may do the surgery after the baby comes home from the hospital.

Circumcision is done only on healthy babies. The procedure is painful. So the AAP recommends using a local anesthetic. This numbs the area of the penis where the incision will be made. There are different types of anesthetic. A healthcare provider may put a numbing cream on your child’s penis. Or he or she may inject small amounts of anesthetic around the penis. There are risks with any anesthetic, but these are considered safe. In addition to the anesthetic, your healthcare provider may give your baby a pacifier dipped in sugar water. This can help soothe him while the procedure is happening.

A circumcision can be done in several ways. The procedure usually takes about 15 minutes or less. The procedure goes like this:

  • The healthcare provider will give your baby a local anesthetic.
  • The healthcare provider then cleans the penis with an antiseptic.
  • The healthcare provider will gently loosen the foreskin from around the head of the penis, making a small slit in the foreskin.
  • The healthcare provider may use one of the common methods to remove the foreskin. These methods use devices that help protect the penis while removing the foreskin.
  • The healthcare provider may attach a clamp over the head of the penis. Or the provider may place a plastic ring over the head of the penis. This makes it easier to cut the foreskin.
  • The healthcare provider will use surgical tools to remove the foreskin. This exposes the end of the penis.
  • The healthcare provider may place some petroleum jelly or ointment on the head of the penis and cover it with a loose gauze dressing.

After the circumcision, you will
need to care for your baby’s penis until it heals. This includes cleaning the area with
plain water at least once a day. You will also need to clean it if the area is dirty
after a bowel movement. Then let the area dry, and put petroleum jelly on it. This keeps
the gauze dressing from sticking.

You may be asked to remove the
dressing the next day. Or you may be asked to use a new dressing, and some petroleum
jelly, each time you change diapers. When the gauze dressing is no longer needed, you
may be told to keep putting petroleum jelly on the end of the penis for a few more days.
This helps prevent the penis from sticking to the diaper.

Some swelling on the penis is
normal. It’s also normal for the penis to develop a crust. This will go away after a few
days. A small amount of bleeding is not unusual. But if you see a blood stain on your
baby’s diaper that is bigger than a quarter, call the healthcare provider right away. If
the penis keeps bleeding, apply firm pressure with a washcloth for several minutes. Then
look to see if the bleeding has stopped. If the bleeding continues, bring your child to
the emergency room.

If a plastic ring was used, it
should fall off within 10 to 12 days. Tell your healthcare provider if this doesn’t
happen.

A baby’s penis usually fully heals
from a circumcision in 7 to 10 days.

Call your child’s healthcare
provider if your baby has any of the following:

  • Fever
  • Wound that doesn’t stop bleeding
  • No urine 6 to 8 hours after the
    procedure
  • Redness or swelling that doesn’t get
    better after 3 days, or gets worse
  • Yellow discharge or yellow coating on
    the penis after 7 days

Before you agree to the test or the procedure for your child make sure you know:

  • The name of the test or procedure
  • The reason your child is having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • When and where your child is to have the test or procedure
  • Who will do the procedure and what that person’s qualifications are
  • What would happen if your child did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or your child has problems
  • How much will you have to pay for the test or procedure

Birth Defects in Children

A birth defect (congenital anomaly)
is a health problem or abnormal physical change that is present when a baby is born.

Birth defects can be very mild,
where the baby looks and acts like any other baby. Or birth defects can be more severe.
Some birth defects cause a single problem. Others cause problems in more than one body
system or organ. Birth defects may cause lifelong disability and illness. Some severe
birth defects can be life-threatening. A baby may live for only a few weeks or months.
Or a child may die at a young age, such as when he or she is a teen.

Some birth defects can’t be cured.
These include defects that cause learning or thinking problems. But many physical birth
defects can be treated with surgery. Repair is possible for many birth defects,
including cleft lip or cleft palate, and certain heart defects.

When a baby is born with a birth
defect, the first question often asked by the parents is “How did this happen?”
Sometimes this question can’t be answered. This can be very upsetting for parents.. It’s
normal to want to know why your baby has a health problem.

Birth defects can happen for many
reasons. They can happen because of the mother’s exposure to certain things while she is
pregnant. Or they can happen because of certain genes or changes in genes (mutations).
It could also be a combination of these things. But often the cause isn’t known.

The different causes of birth
defects include:

  • Inheritance and gene
    defects. 
    Inheritance means a trait passed on to you from one of your parents.
    Examples of normal inherited traits are eye color and blood type. Genes are what give
    you your traits. Sometimes a child can inherit not only those genes for normal traits
    such as eye color, but also disease-causing genes that cause a birth defect.
  • Chromosome problems. Chromosomes are
    stick-like structures in the center (nucleus) of each cell. Chromosomes contain your
    genes. Changes in chromosomes can cause health problems.
  • Multifactorial inheritance. This
    means that many things are involved in causing a birth defect. These things are often
    both genetic and environmental.
  • Teratogens. A teratogen is a
    substance that can cause a birth defect. It is often something in the environment
    that the mother may be exposed to during her pregnancy. It could be a prescribed
    medicine, an illegal drug, alcohol use, a toxic chemical, or a disease that the
    mother has. Any of these could increase the chance for the baby to be born with a
    birth defect.

Birth defects are found in babies
all over the world, in families of from all countries and backgrounds. Any time a woman
becomes pregnant, there is a chance the baby will have a birth defect. Most babies are
born healthy. In fact, almost 1 in every 33 babies born in the U.S. has a major birth
defect. The risk for birth defects varies by type of defect, family health history, age
of parents, and other factors. Your healthcare provider can tell you more about your
child’s risk for birth defects.

Symptoms vary widely. They depend
on the type of birth defect. Symptoms can be a bit different for each child. They can
include things such as:

  • Abnormal shape of head, eyes, ears,
    mouth, or face
  • Abnormal shape of hands, feet, or
    limbs
  • Trouble feeding
  • Slow growth
  • Frequent infections
  • Joint problems
  • Spinal cord not fully enclosed (spina
    bifida)
  • Kidney problems
  • Heart problems
  • Intestinal problems

The symptoms of birth defects can
seem like other health conditions. Have your child see his or her healthcare provider
for a diagnosis.

Many birth defects can be diagnosed
before birth with tests. Chromosome problems such as Down syndrome can be diagnosed
before birth by looking at cells in the amniotic fluid or from the placenta. Or they can
be found by looking at the baby’s DNA in the mother’s blood (noninvasive prenatal
screening). These tests are very accurate.

Fetal ultrasound during pregnancy
can also show the possibility of certain birth defects. But ultrasound is not 100%
accurate. Some babies with birth defects may look the same on ultrasound as those
without problems.

Tests that can be done while a baby
is in the uterus include the following.

Alpha-fetoprotein (AFP)

This blood test measures the
levels of a protein called AFP (alpha-fetoprotein). This protein is released by the
baby’s liver and is found in the mother’s blood. AFP is sometimes called maternal
serum AFP (MSAFP). AFP screening may be one part of a 2-, 3-, or 4-part screening.
It’s often called a multiple marker screen. The other parts are:

  • Human chorionic gonadotropin
    (hCG).
    This is a hormone released by some cells in the placenta. High hCG
    levels may mean that the baby has Down syndrome. This condition is a chromosome
    problem. It causes learning problems and some physical changes.
  • Estriol. This is a hormone made by
    the placenta, and by the baby’s liver and adrenal glands. Low levels may mean the
    baby has Down syndrome.
  • Inhibin. This is a hormone made by
    the placenta. Abnormal levels may mean an increased risk for Down syndrome.

Nuchal translucency screening

This is an ultrasound test often
done late in the first trimester. Thickening of the area at the back of the baby’s
neck may mean an increased risk for Down syndrome or other chromosome problems.

Amniocentesis

This test takes a small sample
of the amniotic fluid that surrounds the baby. The sample is used to diagnose
chromosome problems and open neural tube defects such as spina bifida. Testing can be
done for other genetic defects and disorders. This depends on family history and lab
testing available at the time of the test. The American College of Obstetricians and
Gynecologists advises amniocentesis around 15 to 20 weeks of pregnancy for women who
are at higher risk for chromosome problems. These include women who are older than 35
at delivery. It also includes women who have had an abnormal blood test that means
they are at higher risk for a chromosome problem or neural tube defect such as spina
bifida. In some cases, amniocentesis may be done as early as 14 weeks.

Chorionic villus sampling (CVS)

This test takes a sample of some
tissue from the placenta. This tissue has the same genetic material as the baby. It
can be tested for chromosome problems and some other genetic problems. This depends
on family history and lab testing available at the time of the test. Unlike
amniocentesis, CVS does not give information on neural tube defects such as spina
bifida. Women who have the CVS test also need a follow-up blood test between 16 and
18 weeks of pregnancy. This blood test is to screen for neural tube defects.

Ultrasound

This is a test that uses sound
waves to create an image of the internal organs. Some physical birth defects can be
found with ultrasound.

Noninvasive prenatal screening

This is a test that looks at the
mother’s blood. The lab looks for genetic material called DNA that comes from the
placenta. This DNA is the same as the baby’s DNA. The lab looks for chromosome
problems such as trisomy 13, trisomy 18, and trisomy 21.

Sometimes birth defects are not
diagnosed until after birth. A baby may be diagnosed with a physical exam by a
healthcare provider. The healthcare provider may also take a blood sample. This is
looked at in a lab to find chromosome problems. This is important so the parents know
the risk for that birth defect in future pregnancies.

There is no cure for birth defects.
But children can often be treated to help reduce problems. Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on how severe the
condition is. Children may benefit from surgery, medicines, physical or occupational
therapy, education intervention, and other types of help. Talk with your child’s
healthcare providers about the risks, benefits, and possible side effects of all
treatments.

Possible complications vary widely
by type of birth defect. They may include 1 or more of the following:         

  • Heart problems
  • Intestinal problems
  • Vision problems
  • Hearing problems
  • Thyroid problems
  • Learning problems
  • Middle ear infections
  • Diabetes
  • High blood pressure
  • Severe infections
  • Chronic lung disease
  • Autism
  • Attention-deficit/hyperactivity
    disorder (ADHD)
  • Obsessive compulsive disorder
    (OCD)
  • Anxiety

Researchers are trying to find ways
to prevent many birth defects. Not all birth defects can be prevented. There are only a
few ways currently known to help prevent certain defects. Taking steps to be healthy
before and during pregnancy is important. Getting vaccinated against certain infections
such as rubella can prevent birth defects caused by that infection. Not drinking during
pregnancy can prevent birth defects caused by alcohol. Taking a prenatal vitamin that
includes folic acid can help prevent neural tube defects such as spina bifida.

If your baby is born with a birth
defect, you can do certain things 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 included in your child’s care. Your child may
    receive care from a multidisciplinary team. This team may include counselors, social
    workers, clergy, genetic counselors, dietitians, physical therapists, and speech
    therapists. Your child’s care team will depend on your baby’s condition.
  • Call your provider if you are
    concerned about your baby’s symptoms.
  • Think about having genetic testing and
    counseling to understand your risk.
  • Tell others of your baby’s condition.
    Work with your child’s healthcare provider to create a treatment plan.
  • Ask for support from local community
    services. This may include your faith community and organizations that specialize in
    birth defects, such as the March of Dimes.
  • A birth defect is a health problem or
    abnormal physical change that is present when a baby is born. Birth defects range
    from very mild to life-threatening and limiting.
  • Birth defects can happen for many
    reasons. But often the cause isn’t known.
  • Many birth defects can be diagnosed
    before birth with tests. Your healthcare provider will talk with you about
    testing.
  • The risk for birth defects varies by
    type of defect, family health history, age of parents, and other factors. Your
    provider can tell you more about your risk of having a child with a birth
    defect.
  • There is no cure for birth defects.
    But children can often be treated to help reduce problems.
  • Researchers are trying to find ways to
    prevent many birth defects. Not all birth defects can be prevented. Taking steps to
    be healthy before and during pregnancy is important.

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.