Major Depression in Teens

Major depression is a type of mood disorder. It’s also known as clinical depression or unipolar depression. There are 3 main types of depression: 

  • Major depression (clinical depression)
  • Bipolar disorder (manic depression)
  • Persistent depressive disorder (dysthymia)

Major depression goes beyond the day’s normal ups and downs. It involves a teen’s body, mood, and thoughts. It can affect and disrupt eating, sleeping, or thinking patterns.

Depression is not the same as being unhappy or in a blue mood. It’s also not a sign of personal weakness. It can’t be willed or wished away. Teens with depression can’t merely pull themselves together and get better. Treatment is often needed.

Depression has no single cause. Many factors, such as genetics and the environment, play a role.

A teen may be more likely to have major depression if he or she has:

  • Family history of depression,
    especially if a parent had depression when young
  • Lots of stress
  • Abuse or neglect
  • Physical or emotional trauma including
    peer problems, bullying, and academic trouble
  • Other mental health problems
  • Loss of a parent, caregiver, or other
    loved one
  • Cigarette smoking
  • Loss of a relationship, such as moving
    away or losing a boyfriend or girlfriend
  • Other chronic illnesses, such as
    diabetes
  • Other developmental, learning, or
    conduct disorders
  • Gender issues, especially if the person is bullied
  • Suffered a traumatic brain injury

Each teen with major depression may have different symptoms. A teen often needs to have several of these symptoms during the same 2-week period to be diagnosed with major depression.

  • Lasting feelings of sadness
  • Feelings of despair, helplessness, or guilt
  • Low self-esteem
  • Feelings of not being good enough
  • Feelings of wanting to die or wishing
    to already be dead.
  • Loss of interest in usual activities or activities once enjoyed
  • Trouble with relationships
  • Sleep problems, such as insomnia
  • Changes in appetite or weight
  • A drop in energy
  • Problems concentrating or making decisions
  • Suicidal thoughts or attempts
  • Frequent physical complaints, such as headache, stomach ache, or fatigue
  • Running away or threats of running away from home
  • Sensitivity to failure or rejection
  • Irritability, hostility, aggression

Symptoms of major depression may look like other mental health problems. Make sure your teen sees his or her healthcare provider for a diagnosis.

A teen with major depression may have other mental health problems, such as substance abuse or an anxiety disorder. So early diagnosis and treatment is important to your teen getting better.

A mental health professional often diagnoses major depression after a mental health evaluation. He or she may also evaluate the family and talk with teachers and care providers.

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

Major depression can often be treated. Treatment may include one or more of the following:

  • Antidepressant medicines. These can be very helpful, especially when used with psychotherapy.
  • Talk therapy (psychotherapy). This treatment helps teens with depression change their distorted views of themselves and the environment around them. It also finds stressors in the teen’s environment and teaches him or her how to stay away from them. A teen will also learn how to work through hard relationships.
  • Family therapy
  • School input

Without treatment, major depression can last for weeks, months, or years. It can cause relationship and social problems. Depression is also linked to a higher risk for suicide. This risk rises when the depressed teen has other mental health problems. These include conduct disorder and substance abuse. This is especially true for teen boys.

Researchers don’t know how to prevent major depression in a teen. But knowing the risk factors, spotting it early, and getting expert help for your teen can help ease symptoms and improve your teen’s quality of life.

As a parent, you play a key role in your teen’s treatment. Here are things you can do to help:

  • Keep all appointments with your teen’s
    healthcare provider.
  • Talk with your teen’s healthcare
    provider about other providers who will be involved in your teen’s care. Your teen
    may get care from a team that may include counselors, therapists, social workers,
    psychologists, and psychiatrists. Your teen’s care team will depend on his or her
    needs and how serious the depression is.
  • Tell others about your teen’s
    depression. Work with your teen’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 teen with depression
    may be helpful.
  • Take all symptoms of depression and
    suicide very seriously. Seek treatment right away. Suicide is a health emergency.
    Talk with your teen’s healthcare provider for more information on suicide including
    whom to call and what to do (for example never leaving the teen alone). Have a
    written emergency plan.

For several reasons, many parents never seek the right treatment for their teen with depression. This is true even though many people with major depression who seek treatment get better. They often improve within weeks. Continued treatment may help keep symptoms from coming back.

Call your healthcare provider right away if your teen:

  • Feels extreme depression, fear, anxiety, or anger toward him or herself or others
  • Feels out of control
  • Hears voices that others don’t hear
  • Sees things that others don’t see
  • Can’t sleep or eat for 3 days in a row
  • Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your teen has suicidal thoughts, a suicide plan, and the means to carry out the plan.

  • Major depression is a type of mood
    disorder. It is not the same as being unhappy or in a blue mood. It can be treated
    with a combination of medicine and psychotherapy.
  • Depression is caused by a combination
    of factors, such as genetics and the environment.
  • A teen may have a higher risk for
    depression if he or she has a family history of it. Trauma, stress, and abuse can
    also make a teen prone to it.
  • Symptoms include feelings of sadness,
    despair, and guilt. A teen may lose interest in activities and have problems sleeping
    and eating.
  • A mental health professional can
    diagnose major depression after a mental health evaluation.
  • Talk therapy and certain medicines can
    help treat depression.
  • Major depression is linked to a higher
    risk for suicide.

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.

Vaginitis in Teens

Vaginitis is any inflammation or
infection of the vagina. It’s a common problem in girls and women of all ages. It
develops when the walls of the vagina become inflamed because of an infection or
irritant. 

Bacteria, yeast, viruses, and
chemicals can cause vaginitis. The most common types are:

  • Yeast infection. This is caused by
    one of the many species of fungus known as candida. These normally live in the vagina
    in small numbers. Candida may also be in the mouth and digestive tract in both boys
    and girls. Infection happens when something upsets the normal balance. For example,
    antibiotics can kill bacteria that normally balances the amount of yeast in the
    vagina. Too much yeast grows, causing an infection. Another cause can be pregnancy,
    which changes hormone levels. Diabetes can also be a cause because of too much sugar
    in the urine.
  • Bacterial vaginosis. This infection
    is caused when certain types of normal vaginal bacteria grow out of control and cause
    inflammation. 
  • Trichomoniasis (trich). This is a
    sexually transmitted infection (STI) caused by a parasite. This parasite passes
    between partners during sexual contact. Most boys don’t have symptoms with
    trichomoniasis. So the infection is often not diagnosed until a girl has vaginitis
    symptoms.
  • Viral vaginitis. Viruses are a common
    cause of vaginitis. Most are spread through sexual contact. The herpes simplex virus
    (HSV) can cause viral vaginitis. The human papillomavirus (HPV) can also cause viral
    vaginitis. Both of these are spread through sexual contact.
  • Noninfectious vaginitis. This is
    vaginal irritation without an infection. It’s most often caused by an allergic
    reaction or irritation. Chemicals in vaginal sprays, douches, or spermicides can
    cause it. It may also be caused by perfumed soaps, detergents, or fabric softeners.
    Even chemicals in clothing can cause symptoms.

A girl is more at risk for
vaginitis if she:

  • Has recently taken antibiotics
  • Is pregnant
  • Has diabetes that is not
    well-controlled
  • Has HIV
  • Is using an immunosuppressant
    medicine
  • Is using high-estrogen
    contraceptives
  • Is having corticosteroid therapy,
    which weakens the immune system

Symptoms can occur a bit
differently in each girl.

The symptoms of a yeast infection
can include:

  • A thick, white, odorless vaginal
    discharge that is like cottage cheese
  • Itching and redness of the vulva and
    vagina
  • Pain with urination or sex

The symptoms of bacterial vaginosis
can include:

  • A thin, white fluid from the
    vagina
  • A thick, gray or green fluid from the
    vagina
  • Fishy smell to the fluid

The symptoms of trichomoniasis can
include:

  • Frothy, greenish-yellow fluid from the
    vagina that smells musty
  • Itching or burning in and around the
    vagina and vulva
  • Swelling or redness at the opening of
    the vagina
  • Light bleeding, especially after
    sex
  • Burning during urination
  • Pain in the lower belly (abdomen)
  • Pain during sex
  • No symptoms, in some cases

The symptoms of viral vaginitis can
include:

  • Pain in the genital area from sores,
    if the cause is HSV
  • Painless warts on the vagina, rectum,
    vulva, or groin, if the cause is HPV. But a girl may have the virus without visible
    warts.

The symptoms of noninfectious
vaginitis can include:

  • Vaginal itching or burning
  • Fluid from the vagina
  • Pelvic pain, especially during sex

The symptoms of vaginitis can be
like other health conditions. Make sure you see your healthcare provider for a
diagnosis.

The healthcare provider will ask
about your pre-teen or teen’s symptoms and health history. He or she will give you child
a physical exam. The physical exam may include a pelvic exam. Your child’s provider may
also check vaginal fluid under a microscope.

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

Yeast infection

Treatment may include:

  • Antifungal vaginal creams and
    suppositories
  • Vaginal tablets
  • Antifungal medicines that are taken
    by mouth (oral)

Bacterial vaginosis

Treatment is with
antibiotics.

Trichomoniasis

Treatment is done with oral
antibiotics. All sexual partners need to be treated. This is to prevent the infection
occurring again.

Viral vaginitis

Treatment depends on the
cause:

  • This virus can be treated with
    antiviral medicine. These include acyclovir, valacyclovir, and famciclovir. These
    medicines don’t kill the virus. But they can decrease the pain and shorten the
    length of the outbreak.
  • Most HPV infections go away within
    6 to 12 months. Some infections last and can lead to cancer of the vulva, vagina,
    or anus.

Noninfectious vaginitis

Treatment is done by finding out
what caused the reaction or irritation, and removing it from use.

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

HPV is the main cause of cervical
cancer in women. 

An HPV vaccine can prevent
infection by the types of HPV that cause most cervical cancers. The vaccine also helps
prevent genital warts as well as some cancers of the vulva, vagina, and anus. The
vaccine is given to children and young adults ages 9 to 26, ideally before they become
sexually active. Ask your healthcare provider for more information.

Call the healthcare provider if
your teen has:

  • Symptoms that don’t get better, or get
    worse
  • New symptoms
  • Vaginitis is any inflammation or
    infection of the vagina. It’s a common problem in girls and women of all ages. It
    develops when the walls of the vagina become inflamed because of an infection or
    irritant. 
  • Bacteria, yeast, viruses, and
    chemicals can cause vaginitis.
  • The symptoms of vaginitis can include
    pain, itching, burning, sores, fluid from the vagina, and other problems.
  • Treatment may include medicines. The
    type of medicine depends on the cause.
  • An HPV vaccine can prevent infection
    by the types of HPV that cause most cervical cancers.

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 you r 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.

Menstrual Cramps (Dysmenorrhea) in Teens

Menstrual cramps are severe,
painful cramps that occur during a period. There are 2 types:

  • Primary. This starts soon after a
    girl gets her first period. It’s usually lifelong. But it may get better over
    time.
  • Secondary. This type is caused by
    another health problem, such as a growth or infection. It usually starts later.

Most cramps are caused by abnormal
tightening of the muscles of the uterus (contractions). This is from changing hormone
levels. The hormone prostaglandin controls the contractions of the uterus.

Secondary menstrual cramps are
often caused by endometriosis. This is when tissue that forms the inside lining of the
uterus also grows outside the uterus. It can grow on other organs inside the pelvis or
belly (abdomen). This can also cause internal bleeding, infection, and pelvic pain.

Other causes of secondary menstrual
cramps can include:

  • Infection of the reproductive organs (pelvic inflammatory disease)
  • Fibroids (noncancer (benign) growths
    in the uterus)
  • Fertilized egg that implants outside the uterus (ectopic pregnancy)
  • Pregnancy loss (miscarriage)
  • Other infection in the pelvis
  • Growths in the pelvis such as tumors or polyps

A girl is more at risk for menstrual cramps if she has:

  • Her first period at an early age
  • Long or heavy periods
  • A family history of menstrual cramps

Smoking also increases the risk.

Symptoms can occur a bit differently in each teen. The most common symptoms include:

  • Cramping and pain in the lower abdomen
  • Low back pain
  • Pain spreading down the legs

Other symptoms can include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Tiredness
  • Weakness
  • Fainting
  • Headaches

Symptoms occur just before
menstrual bleeding starts each month. The pain can last for 1 to 2 days or more. It then
lessens at the end of the period.

Symptoms of secondary menstrual
cramps can start several days before menstrual bleeding starts. The pain may get worse
and last for days, weeks, or longer.                            

Menstrual symptoms can be like
other health conditions. Make sure you r child sees 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 your
family’s health history. The provider will give you r teen a physical exam. The physical
exam may include a pelvic exam. Your daughter may also have tests, such as:

  • Ultrasound. This painless test uses sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function. They also assess blood flow through various vessels.
  • Laparoscopy. This procedure uses a thin tube with a lens and a light (laparoscope). The scope is inserted into a small cut (incision) in the abdominal wall. The healthcare provider can see abnormal growths in the pelvis and abdomen.
  • Hysteroscopy. This is an exam of the
    cervix and inside of the uterus. It’s done with a viewing tool (hysteroscope)
    inserted through the vagina.

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

  • Pain medicines that block prostaglandins, such as aspirin or ibuprofen
  • Acetaminophen
  • Birth control pills (oral contraceptives)
  • IUD with progesterone
  • Good diet
  • Enough sleep
  • Regular exercise
  • Heating pad across the lower abdomen
  • Hot bath or shower
  • Transcutaneous electrical nerve stimulation (TENS)
  • Surgery
  • Acupuncture
  • Abdominal massage
  • Relaxation methods

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

Possible complications include
missed school or work because of severe pain. Menstrual cramps can be caused by a
condition such as endometriosis. If left untreated, this may have an impact on your
teen’s future ability to get pregnant.

Painful periods can be difficult to
cope with every month. You can help by making sure you r teen has the tools to treat
pain symptoms quickly. Your child may also need emotional support during painful
days.

Call the healthcare provider if
your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms
  • Menstrual cramps are severe, painful
    cramping that occurs with a period.
  • Menstrual cramps often start soon
    after a girl gets her first menstrual period.  It’s usually lifelong. But it may get
    better over time. It is caused by abnormal tightening of the muscles of the uterus
    (contractions). This is due to changing hormone levels.
  • Secondary menstrual cramps are caused
    by another health problem, such as a growth or infection. It is often caused by
    endometriosis.
  • There are many treatment options. They
    include pain medicines, hormone treatment, heating pad, surgery, and other
    methods.
  • Painful periods can be hard to cope
    with every month. You can help by making sure your teen has the tools to treat pain
    symptoms quickly. Your child may also need emotional support during painful
    days.

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 you r 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

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

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

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.