Tag Archives: child health

Pontine Glioma

Childhood cancer is ordinarily treatable. Although it can be scary when one’s child develops cancer, children’s resilience means cancers in children respond very well to treatment. The only exception is brain tumors, which, because it requires such precision to treat anything in the brain, are the riskiest for children. That includes a cancer of the brainstem called a pontine glioma, one of the most dangerous tumors to treat.

The brainstem is the part of the brain that controls essential function. It’s difficult to label any part of the brain the most important—the entire thing is important—but it is the brainstem in which dysfunction has the most inevitably noticeable and broadest, and widest ranging effects. The pons, where pontine glioma develops, is responsible for breathing.

Children who develop pontine glioma will have trouble walking, standing, and speaking, because the tumor affects parts of the brain that communicate with the arms and legs, as well as the speech areas. It also affects the facial muscles, making eye movement and swallowing difficult and causing one side of the face to droop. Children with this type of tumor may also have trouble closing their eyes all the way, and may have double vision. Pontine gliomas often grow rapidly, causing damage as they do.

It is not known what causes these tumors to develop. There is a type of fungal infection of the scalp that is ordinarily treated with radiation, and children who have had this radiation treatment are more prone to developing glioma of the brainstem, but not all cases can be traced to that source. In a recent study, researchers found that the genetic code of the tumor contains gene mutations that had not previously been linked to any form of cancer, and they say this may prove to be a useful diagnostic tool in the future.

Sadly, children diagnosed with pontine glioma are not expected to survive more than nine months. Fortunately, however, new treatments are being developed that could well save lives. Now that mutations linked with pontine glioma have been discovered, scientists are tracing the effects of those mutations, determining how they relate to tumor development, and finding ways to prevent tumors from developing and destroy them when they do.

Enterovirus Outbreak

Enterovirus 68 as been known for more than 50 years, but a recent outbreak that has hospitalized children across the United States has parents looking for answers. Enteroviruses are a common source of childhood illnesses, primarily causing respiratory or inflammatory disease. Most ordinary infectious diseases children get growing up result from enteroviruses. These diseases are generally fairly mild and quickly run their course, causing nothing worse than temporary discomfort. However, enterovirus 68 is on of the more severe types. Only six outbreaks were reported from 2005 to 2011, but since this past August, there have been nearly 700 cases throughout the country, resulting in five deaths.

The cold is a type of enterovirus and indeed most enteroviruses are spread like colds, through close contact. That means any sort of direct touching, or sharing eating utensils or drinking glasses, or toys. People can also pick up the virus by touching their faces after touching a surface that has the virus on it, such as a chair or table at which a sick person has recently been sitting. The spread can be prevented by washing hands and surfaces, and avoiding shaking hands with, kissing, or hugging people who might be infected. Most people with enterovirus 68 can treat it with the care given a cold—rest for a week, plenty of fluids. It is slightly more of a danger for children with asthma. It is unusual, though not unheard of, for enterovirus 68 to be deadly.

What is unusual about the August outbreak is its size. After fewer than 100 reported cases in the Unites States in half a century, the recent outbreak has seen 30 cases per day at just one hospital, with close to 700 overall over about two months. Some experts say it’s a statistical artifact, with previous cases going unrecognized, while better diagnostic techniques and greater attention by health agencies are making the virus more readily identified without actually being more common. This frequently happens with rare or recently discovered diseases. Some enterovirus 68 patients have had paralysis, but it’s not clear i or how this relates to the virus.

Congenital Heart Defects

Congenital heart defects are the most common kind of birth defect among children born in the United States, affecting nearly one percent of all newborns in the country. There are multiple kinds of heart defect, classified according to the location of the problem within the heart as well as what, specifically, is wrong. The types of heart defect include:

Complete atrioventricular canal defect, a failure of the walls separating the chambers to meet and fully close. This means blood entering the lungs mixes with blood that s to circulate to the rest of the body, causing improper oxygen distribution.

Truncus arteriosus, in which the blood vessels leading in from the lungs and out to the body are fused together, when they are supposed to be separate. This condition also interferes with proper circulation of the blood through the body.

Ebstein’s anomaly, in which the heart valve on the left side cannot fully close.

Tetralogy of Fallot, the co-occurrence of four different malformations. These are a hole between the heart’s lower chambers, the aorta right above this hole and connected to both chambers rather than only the left, a blockage in the link between the heart and the lungs, and a thickening of the wall of the right chamber.

Pulmonary valve stenosis, in which the heart valve doesn’t open all the way and blood sometimes flows back out.

Atrial septal defect, a hole in the wall separating the heart’s upper chambers.

Coarctation of the aorta, a narrowing of the artery that carries blood out of the heart. This can can lead to high blood pressure, which is dangerous in infants.

It is often important that heart defects in newborns and infants be treated, usually with surgery. Because these defects are typically diagnosed so young—symptoms are frequently apparent early on, such as the tetralogy of Fallot, which can result in blue skin—and because infants born with heart defects may have other illnesses as well, there might be limits on the types of surgery that can be performed. In some cases, however, it is possible to leave the defect as is, at least temporarily, and it is sometimes possible for children born with heart defects to grow up quite healthy regardless.

Measles Returns

Decades ago, measles was a common childhood disease, and complications were also common. Around one-third of people who contract measles—and it was nearly ubiquitous at one time—get some other medical condition a a direct result. The most common of these is otitis media, or a middle ear infection, which may result in hearing loss. Other complications include pneumonia, bronchitis, and encephalitis; in many cases measles can even be fatal. Measles can also cause corneal ulceration and scarring, which could lead to diminished eyesight.

These complications are largely in the past, however, thanks to measles vaccination, which became available in 1963 in the United States and was almost universal after 1977. The measles vaccine provides immunity to 95 percent of children older than one year who receive a single dose, and most of the remaining five percent develop immunity after a second dose.

During the heyday of the disease, "measles parties" to allow infected children in a community to spread the disease to their uninfected neighbors—especially the girls, because women who get the disease as adults, particularly during pregnancy, are prone to miscarriage or to having children with birth defects—were common. Measles vaccination is the same basic principle, stimulating an immune response so the disease doesn’t affect adults, but in a more certain and concentrated way with less suffering involved.

Unfortunately, measles has recently had a resurgence. In the late 1990s, false controversy began to be sown over the safety and efficacy of vaccines, and the 610 cases reported last year were the first large harvest. As parents are delaying vaccinating their children against measles—such as by rejecting the measles-mumps-rubella combined vaccine in favor of getting the three immunizations separately and spaced out—or refusing entirely, communities across the United States are seeing a growing number of measles cases, despite the disease having been declared eradicated in the Americas in 2002. In 2014, there were more than 200 cases of measles reported in the country for the first time in 17 years.

Not all parents who don’t vaccinate fear the bogeyman of alleged safety issues; some interpret religious requirements as forbidding it, and some have genuine medical reasons they can’t. However, when almost all children are vaccinated, herd immunity protects those who are not. Herd immunity means if someone is infect, even a highly contagious disease such as measles has no place to go.

Cerebral Palsy And Heredity

Damage to areas within the largest part of the brain—the cerebrum—typically before or during birth is called "cerebral palsy." This term refers not to one specific condition but is a name for a broad category of motor deficiencies that result in physical disability. The damage may result from inflammation, infection, or low birth weight or birth defects. Over half of all children with cerebral palsy have been found to have birth defects or low birth weight. Babies born with cerebral palsy may be floppy or stiff. Children with these conditions often exhibit language problems, not necessarily due to cognitive deficits—though such deficits are not uncommon—but as a result of respiratory problems or difficulties with facial muscle control.

The causes of cerebral palsy are not clear. Contrary to what was once believed, babies born with the umbilical cord wrapped around the neck, which actually happens in as many as a third of all pregnancies, are not at significantly higher risk for cerebral palsy. Rather, women who have infectious diseases such as rubella, chickenpox, or toxoplasmosis during pregnancy are more likely to have children with birth defects such as cerebral palsy. Multiple birth are associated with low birth weight, and particularly if there has been a miscarriage, one or more of the infants are at heightened risk for a form of cerebral palsy.

Researchers have also found a family connection in cerebral palsy. Siblings, children, and first cousins of children who are born with cerebral palsy are themselves at higher than normal risk of thee conditions. One study found that, while children who are twins are already three times as likely as single births to have some form of cerebral palsy, when one twin develops one, the other is 15 times more likely to do so as well. The same study showed younger siblings of children with cerebral palsy showed a sixfold increase in risk, roughly the same as children of parents with cerebral palsy.

The good news is that by adolescence, with proper treatment, children with cerebral palsy have quality of life roughly comparable to that of children who are not affected. In a survey, teenagers with cerebral palsy self-assessed as doing as well as—or better than in some areas—their peers.

Flu Vaccine

Flu season means flu vaccine time. Th widely available influenza vaccine is one of the most effective ways to stop the spread of the contagious viral illness. The flu virus changes slightly from year to year, which is why a new vaccine is needed each season, but the vaccine provides long-term protection against each season’s specific strain of the disease.

The flu vaccine works in two primary ways. First, it prompts the immune system to produce antibodies that fight off a specific strain of influenza virus, making it easier for the body to rid itself of an infection before it can cause illness. Second, it reduces the level of flu virus in the population, so people fewer are exposed to the virus in the first place. This means the vaccine is effective even for the small number of people who do not produce sufficient antibodies in response to the vaccine, or for whom vaccination is unsafe.

In some cases people are reluctant to get vaccinated because of erroneous beliefs about the vaccine. While the vaccine does contain flu virus, it is in an inactive form, enough to trigger an immune response, but not enough to actually sicken most people. The vaccine can cause side effects in some patients, but many fears—of neurological problems, of heart disease, of Alzheimer’s—are exaggerated, or often the opposite of the case, in that flu vaccine reduces these risks. Conversely, people often liken "flu" to a bad cold, even though flu killed thousands of people per year.

There are people for whom flu vaccine is not recommended. People who have had severe allergic reactions in the past are poor candidates for vaccination. None of the types of vaccines are approved for children under six months. People who are not feeling well should get better before being vaccinated. Other people need to take precautions before vaccination. It may not be possible for people with egg allergies to receive the vaccine, and they should discuss the best course of action with their healthcare professionals. Similarly, people with Guillain-Barré syndrome are prone to complications and should talk to a doctor. Vaccination is recommended for everyone else, particularly people under four or over 50 and their caregivers, children or teenagers on aspirin therapy, people with suppressed immune systems, people with certain chronic conditions such as diabetes, health care workers, and anyone else at high risk of flu complications.

Stuttering And Stigma

It is estimated that 70 million people worldwide stutter when they speak—not a momentary pause or repetition as they organize their thoughts, but a chronic, ongoing difficulty with the flow of their speech. That means repeating sounds, prolonging sounds, or unnatural, unneeded, and unintended pauses between syllables and words. Almost all children speak this way when they’re first learning, but about one percent of the time, it does not resolve itself. Stuttering can interfere with clear communication, and what’s more, the embarrassment it can cause may lead people to avoid talking, which in turn means avoiding social and professional situations that require speaking in front of others, which can seriously hold people who stutter back in their lives and careers.

The good news is that recent research shows preschoolers who stutter actually do better in school, and academically and socially. Although speech therapy is recommended for older children who stutter, it is not considered necessary for very young children, according to the study, and may even be harmful. Instead, the researchers recommend waiting a full year before starting the child in speech therapy in most cases. The exceptions are if the child exhibits distress at stuttering or shows unusual shyness or reluctance to talk as a result. It is also important for parents not to shame or stigmatize the child for stuttering, which itself may cause distress.

That can be difficult for parents who themselves remember stutter and feeling stigmatized for it. Indeed, stuttering has been found to have a genetic component, in that a predisposition to develop a stutter is passed down in the genes. Sometimes, particularly in people genetically prone to stuttering, stress can trigger it. In the past, left-handed children were frequently forced to use their right hands, and this often led to a stutter developing.

Regardless of the cause, stuttering is treatable, even if not wholly curable. Speech therapy can lead to noticeable improvement in fluency at any age. Often, it is a vicious cycle—stutterers experience stress when speaking, which exacerbates the stutter—and the most effective therapy has as its goal breaking that cycle. Support groups are particularly good for this. As fear of stuttering recedes, the stutter itself lessens.

The Facts Behind Leukemia

Each year, 3,500 American children are diagnosed with leukemia, a form of cancer that affects the bone marrow, which is responsible for white blood cells. Because white blood cells are so important to the immune system, leukemia can open the door to opportunistic infections. Symptoms include painless swollen lymph nodes, bleeding or bruising easily, joint pain, unexplained rapid weight loss, weakness, fatigue, and night sweats. It is one of the commonest types of childhood cancer—one in every four pediatric cancer patients is diagnosed with leukemia. However, while leukemia is generally presented as a childhood cancer 90 percent of leukemia cases are diagnosed in adults, and adults typically have a different form of the disease.

In fact, the risk of leukemia actually rises with age. The reason it is associated with children is not because it is particularly common among children, but because it is one of the few cancers to affect children in significant number at all. The causes of leukemia re not known, except for a handful of causative factors that account for a very small percentage of cases. However there are known risk factors in addition to age. Certain chemicals, such as benzine, can lead to leukemia, as can some chemotherapy drugs used to treat cancer elsewhere in the body. Radiation exposure is also a risk factor. Certain genetic disorders can lead to leukemia, and it can run in families.

One commonly blamed culprit is power lines, but scientists have found the grid innocent in causing leukemia. In the latest of a number of studies seeking to get to the bottom of the purported link, children in Great Britain born between 1962 and 2008 were no found to be more likely to be diagnosed with leukemia if they grew up near overhead power lines than their peers who were raised father away.

Recent research into how the body fights off leukemia has presented researchers with a possible new avenue of treatment for the disease. The immune system looks for a chemical signature that identifies lymphoma, and then destroys it. However, when leukemia is treated by chemotherapy, this isn’t necessarily enough to eradicate the surviving few tumor cells. By mimicking this signature, doctors can keep the immune cells responsible for protecting against leukemia to remain on guard.

Understanding SIDS

Babies sometimes die, unpredictably, and doctors aren’t really sure why. Sudden infant death syndrome, or crib death, strikes about 2,500 children a year, between one and 12 months old, but because the cause is so hard to pin down, it is almost impossible for pediatricians to prevent or predict. Researchers have traced it to difficulties regulating the carbon dioxide content of blood, but it is not clear why that happens. The strongest hypothesis involves abnormalities in the brain that interfere with proper breathing, or premature babies whose brains are not fully developed at birth, and so less expert in controlling respiration.

Recent research suggests that crib death babies show similar signs as babies who were accidentally asphyxiated, suggesting that oxygen deprivation is at the root of the deaths. The study compared deaths from SIDS to infant deaths from head trauma, infection, drowning, and asphyxiation. Death by asphyxiation leaves behind a chemical calling card in the brain that is seldom present in other types of infant fatalities. The researchers found this same chemical signature present inn the brains of infants who had does of SIDS.

This improved understanding may be able to help medical professionals get a better grasp on what advice to give to parents that can help prevent crib death. There are some recommendations that are already known to reduce the incidence of SIDS. Babies should be put to sleep on their backs. Particularly if crib death is a form of asphyxiation, it is better for a child too young to roll over not to be facing the mattress. According to some studies, a baby sleeping face-down has as much as 12 times the risk of SIDS. Similarly, a crib is actually a safer place for the baby to sleep than a big soft bed. Newborns who sleep in the same room as at least one parent are less prone to crib death.

The same room, however, does not mean the same bed. Despite the benefits of proximity, more than two thirds of infants who dies were in bed with their parents at the time of death, according to a study. Different research found that babies who co-sleep have five times the SIDS risk of those in their own cribs.

Vaccination And Pertussis

Pertussis, or whooping cough, is a disease of the bad old days, now largely eradicated through vaccination—except that it’s making a comeback. It starts out resembling an ordinary cold, but "cough" is an understatement. A pertussis patient will cough constantly, sometimes to the point of nausea. It interferes with sleeping, eating, drinking, talking. Sometimes, the coughing leaves patients gasping for air, or they cough hard enough to break ribs. Whooping cough can last for months.

Thanks to vaccination, pertussis almost disappeared entirely. However, thanks to an increasing tendency for parents not to vaccinate their children, more and more children are getting the disease. The disease can be annoying in adults but fatal to babies, but in 1940, a vaccine was introduced, and within a few generations became a standard part of childhood.

In recent years, however, vaccination has begun to be perceived, wrongly, as dangerous, and the diseases such as pertussis that it prevents perceived, also wrongly, as harmless, and the numbers have accordingly gone up—30 percent over last year, according to the Centers for Disease Control and Prevention. In 21 states, whooping cough cases have more than tripled. That’s nearly as many states as require only a doctor’s note, or less, for an exemption from vaccination requirements. Marin County, California, which has among the highest vaccine exemption rates in the country, also has the second highest rate of whooping cough.

Refusal to vaccinate doesn’t affect only the unvaccinated children. When enough people in a community are immune to a disease, it is impossible for the disease to establish a foothold, protecting even babies too young to be vaccinated or the tiny minority in whom the vaccine itself was ineffective. This herd immunity, however, requires that 93 percent of the population receive the vaccine.

That’s why medical professionals are working on ways to ensure that more people are vaccinated. One approach is to give pregnant women the TDaP vaccine, which combines the vaccine for pertussis with those for tetanus and diphtheria, during the third trimester. This has been found to have no adverse effects on the mother or the fetus, and, once born, the baby starts out with temporary immunity during what would otherwise be the most vulnerable period of life.