Category: Health

What is Dylexia?

[start highlight] Dyslexia is a condition characterized by reading difficulty, with difficulty in phonological decoding and spelling. While in primary grade, your child may have difficulty in spelling and reading aloud. Read aloud with your child whenever you can: this is extremely helpful. [end highlight]

Success in school depends largely on reading skills and, more important, remembering what one has read. Children presenting impairment in these crucial points are in disadvantage and thus tend to feel frustrated and disinterested, which, later in life, can lead to a spiral of unemployment and underachievement.

What is Dyslexia?

According to the International Dyslexia Association, “Dyslexia is a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities.
These difficulties typically result from a deficit in the phonologic component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction.
Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede the growth of vocabulary and background knowledge.

How common is dyslexia?

Prevalence and incidence rates vary widely, possibly due to different methods or tests used to assess them. The table below shows statistical data taken from studies.

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Prevalence of Dyslexia
– 3.6 to 8.5% (Italy)
– 4.5 to 12% (US)
Cumulative Incidence of Dyslexia
– 9.9% of children at 10 years, metropolitan area
– 3.9% of children at 10 years, small town
– 6.5% high-school children

Prevalence – The total number of cases of a disease in a given population at a specific time.
Incidence – number of new cases within a specified time period in a population.
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How can I tell if my child is dyslexic?

If you have doubts or think your child may need to be evaluated, take her/him to the doctor. In fact, early diagnosis and adequate intervention are critical regarding dyslexia. Although symptoms of dyslexia may be present in kindergarten, reading disability is seldom diagnosed before first grade or when children start to learn how to read; some cases are diagnosed even later than 4^th, generally in children with a IQ above average.
There are some features of possible dyslexia that can be present in children attending kindergarten: difficulty in learning nursery rhyme and in pronouncing words (children may confuse words which sound similar) or difficulty to learn and remember the names of letters. It is interesting to notice that the ability to name letters by the end of kindergarten is a strong predictor of reading ability in primary school.
While in first grade, your child may have difficulty in spelling and reading aloud. However, most other skills like reading comprehension, oral vocabulary and understanding new concepts are well developed.

Do dyslexic children perform differently from average readers?

A group of investigators conducted a research, which included 62 dyslexic children and 51 average readers. Considering all tasks, a majority of individual children with dyslexia performed within norms, but some slight differences were found as shown in the table below as performance scores for different tasks.

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Performance Scores: Average readers vs Dyslexic readers

n = 113 (51 average readers and 62 dyslexic readers)

	Average Readers	Dyslexic readers
1.      Reading
–        Pseudo-words	119.3	85.95
–        Words	108.78	84.81
–        Sum	116.73	81.15
2.      Phonological processing
–        Phonological awareness: rythm	18.88	16.15
–        Short term memory	36.39	31.92

 
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Are there other conditions that can cause reading difficulty?

Yes, while dyslexia is a primary cause for reading difficulty, this can also be secondary to a number of conditions that should be excluded: hearing, vision or cognitive impairment; genetic syndromes; toxins; emotional distress or family dysfunction.

Is there a treatment for dyslexia?

Yes, special education is the best available option. During special education classes, children are stimulated to learn the names and sounds of letters, how to construct words like in a puzzle, as well as how words and parts of them are written and how they sound. It can also be a good strategy to give these children extra-time to perform tasks or evaluation tests in school.

What can I do to help my child with dyslexia?

Yes. First of all, remember your child is not lazy so do not recriminate her/him for the difficulty dyslexia adds; in fact, she/he has difficulty in reading because of some differences in the way her/his brain works regarding this skill. With the adequate treatment and follow-up, she/he can succeed. Read aloud with your child whenever you can: this is extremely helpful.

Summary and Recommendations

• Dyslexia is a condition characterized by reading difficulty, with difficulty in phonological decoding and spelling.
• A child with dyslexia may talk later and may show difficulty to learn letters in kindergarten.
• Dyslexia is usually more apparent by the first grade, when children may have show difficulty to read words and to spell them.
• Dyslexia is a primary reading difficulty, but reading problems can also be secondary to variety of conditions.
• Read aloud with your child a lot, because this is extremely helpful. A child with dyslexia may need to enter a special education program.

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References

1. Reading disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR®), American Psychiatric Association, Washington, DC 2000. p.429.
2. International Dyslexia Association. Definition of dyslexia. org/FactSheets.htm (Accessed on 1/11/2013).
3. Shaywitz S. Overcoming dyslexia: A new and complete science-based program for

reading problems at any level, Alfred A. Knopf, New York 2003.

4. Miller AC, Keenan JM. Ann Dyslexia. 2009 Dec;59(2):99-113. How word decoding skill impacts text memory: The centrality deficit and how domain knowledge can compensate.
5. Messaoud-Galusi S, Hazan V, Rosen S. Investigating speech perception in children with dyslexia: is there evidence of a consistent deficit in individuals? J Speech Lang Hear Res. 2011 Dec;54(6):1682-701.
6. Temple E, Deutsch GK, Poldrack RA, Miller SL, Tallal P, Merzenich MM, Gabrieli JD. Neural deficits in children with dyslexia ameliorated by behavioral remediation: evidence from functional MRI. Proc Natl Acad Sci U S A. 2003 Mar 4;100(5):2860-5.

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What is Attention Deficit Hyperactivity Disorder (ADHD)?

[mme_highlight] Attention Deficit Hyperactivity Disorder is the most common neurobehavioral disorder of childhood and one of the most common of all diseases in childhood. The main symptoms are lack of attention, hyperactivity and impulsivity. Most children with ADHD improve with a combination of medication and behavioral treatment. [/mme_highlight]

Attention Deficit Hyperactivity Disorder is the most common neurobehavioral disorder of childhood and one of the most common of all diseases in childhood, affecting 8 to 10% of children aged 4 to 17 years. The main symptoms are lack of attention, hyperactivity, and impulsivity. ADHD can have a tremendous impact in the academic achievement, general well-being and social development of children.

How common is ADHD?

Statistical data shows that ADHD is, in fact, a very common disorder. A systematic review and meta-analysis characterizing the worldwide prevalence of ADHD reported that its prevalence was 5.3%. However, our data refers only to diagnosed cases of ADHD and many children with this condition remain undiagnosed, thus not counting to data.
However, at first sight, it seems that the incidence and prevalence of ADHD has been increasing, which can be misleading. The truth is that it is the frequency of diagnosis – and not necessarily the disease – that is increasing, maybe in relation with progressive clinician awareness to ADHD. Note also that in 1998 the incidence among boys was 10 times higher than in girls, and five times higher in 2010.

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Incidence of ADHD between 1998 and 2010 (UK) 1)      Overall incidence in population (all ages) –        1998: 6.9 cases per 100 000 inhabitants –        2007: 12.2 cases per 100 000 inhabitants –        2010: 8.8 cases per 100 000 inhabitants   2)      Incidence among children and adolescents 6 to 17 years old –        1998: 39.3 cases per 100 000 inhabitants 6-17 years old –        2007: 79 cases per 100 000 inhabitants 6-17 years old –        2010: 59.7 cases per 100 000 inhabitants 6-17 years old

Incidence – number of new cases within a specified time period in a population.
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Prevalence of ADHD between 1998 and 2010 (UK) 1)      Overall prevalence in population (all ages) –        1998: 30.5 cases per 100 000 inhabitants –        2007: 88.9 cases per 100 000 inhabitants –        2010: 81.5 cases per 100 000 inhabitants   2)      Prevalence among children and adolescents 9 to 17 years old –        1998: 192.4 cases per 100 000 inhabitants 9-17 years old –        2007: 549.8 cases per 100 000 inhabitants 9-17 years old –        2010: 506.4 cases per 100 000 inhabitants 9-17 years old

Prevalence – The total number of cases of a disease in a given population at a specific time.
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What are the symptoms of ADHD?

• Hyperactivity: this includes restlessness, excessive talking, difficulty to remain seated when required to do so and difficulty to play quietly. Hyperactivity generally is acknowledged by 4 years old, usually peaks around 7 to 8 years of age, becoming less noticeable in adolescents.
• Impulsivity: this can become apparent as a difficulty waiting turns, answering too quickly, disruptive classroom behavior or interrupting peers’ activities. The time course is the same as hyperactivity, but usually impulsivity remains a problem throughout life.
• Inattention: this can present as difficulty to memorize, easy distraction, losing things, disorganization, underachievement in school and poor concentration.

These three symptoms are used to divide AHDA in three subtypes: the predominantly inattentive type (formerly known as attention deficit), the predominantly  hyperactive-impulsive type and the combined one.

What are the causes for ADHD?

The causes for this condition remain unclear, but some theories have been discussed. Studies have shown that the disease is caused by an imbalance of the chemicals acting in the brain, which can be inherited. Exposure to tobacco smoke before birth may also be implied.

What diseases can be associated with ADHD?

Over 65% of those with ADHD also have other associated diseases, like dyslexia, developmental coordination disorder, Tourette’s syndrome, autistic spectrum disorders and substance abuse. ADHD is also associated with disrupted parent–child relationships and increased parent stress levels. Many studies investigated the relationship between self-esteem and ADHD, however, the results remain controversial.
The study below suggests that lower self-esteem is more likely in children with ADHD, which puts the focus on the importance of an early detection of psychological well-being in children with ADHD to prevent long-term impact.

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Scores in the subscales of a self-esteem scale: ADHD vs. non ADHD children and adolescents (study design: A total of 85 children and adolescents with ADHD and 26 without the condition were included in the study. To assess the self-esteem all the clinical and control children and adolescents completed the Self-Esteem Multidimensional Test (TMA), which has 6 subscales –personal, skills, emotional, school, family, body. ADHD children Non-ADHD children (controls) Personal 92.96 105.65 Skills 89.16 101.34 Emotional 94.44 106.31 School 89.47 105.04 Family 91.57 106.31 Body 98.43 114.42 Total score 90.96 107.31

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When to seek for medical help?

If you suspect your child may have ADHD you should start by talking to your child’s teacher, this way you will know if your child has difficulties in different settings (home and school), which is important to make a diagnosis of ADHD. Then, you should find medical advice.

What are the available treatments for ADHD?

Most children with ADHD improve significantly with a combination of medication and behavioral treatment. Behavioral treatment alone is general recommended for pre-school aged children, while stimulant medicines are the first-line attention deficit hyperactivity disorder (ADHD) treatment for school-aged children. Methylphenidate and amphetamines are the most commonly prescribed stimulants; they aim to improve the communication between the different areas of your child’s brain. These drugs must be taken as prescribed and under medical supervision.

Summary and Recommendations

• Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common developmental disorders.
• The presenting symptoms of the disease are hyperactivity, impulsivity and inattention.
• ADHD can negatively interfere with the general well-being of children, their social life, academic performance and development of social skills.
• A combination of medication and behavioral treatment has proven to be effective in most children with ADHD.

[mme_references]
References

1. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, Wolraich M, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128:1007.
2. Holden SE, Jenkins-Jones S, Poole CD et al. The prevalence and incidence, resource use and financial costs of treating people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). Child Adolesc Psychiatry Ment Health. 2013 Oct 11;7(1):34.
3. Zwi M, Jones H, Thorgaard C, York A et al. Parent training interventions for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003018.
4. Mazzone L, Postorino V, Reale L et al. Self-esteem evaluation in children and adolescents suffering from ADHD. Clin Pract Epidemiol Ment Health. 2013 Jul 11; 9:96-102.
5. http://www.parentsmedguide.org/ParentGuide_English.pdf (accessed 21/10/2013)

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What if my child has got fever?

[mme_highlight] Fever is one of the commonest symptoms of childhood diseases. About 70% of preschool children have a fever each year. Colds, bronchiolitis, ear infections and urinary tract infections are among the most frequent causes of fever. You should carefully monitor your child with fever and look for the alarm signs. [/mme_highlight]

Fever is a symptom, not a disease. In fact, it is one of the most common symptoms of childhood diseases, being the cause of nearly 65–70% of all pediatric visits. About 70% of preschool children have a fever each year. Clinically, fever is defined as an increase in body temperature of 1°C or more above the standard mean.
It has been shown that fever is an adaptive response to challenge with micro-organisms or other known pyrogens.  Although the associated conditions are often self limiting, the fever itself can cause distress and discomfort to the child and anxiety to parents.

What are the cut-off values for fever?

To define fever, it is important to understand that temperature elevation that is considered “abnormal” depends on the age of the child and the site of measurement. A study conducted in Harvard with a multiethnic and socially diverse sample of parents showed that only 42% of parents knew the correct temperature for fever, far less than one should expect.
Note that in children who suffer from diseases that compromise the immune system (sickle cell disease, neutropenia, HIV), cut-off values are different. The table below shows the cut-off values considered as fever; if your child has a temperature measure correspondent to “fever of concern” as stated below, take her/him to the doctor.

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	Cutt-off values for fever by age and site of measurement Age Cutt-off for fever (ºC) Cutt-off for fever (ºF) Fever of concern (ºC / ºF) Newborn (0-28 days) ≥38.0 ≥ 100.4 ≥38 / ≥100.4 1 – 3 months ≥ 38.0-38.2 ≥ 100.4 – 100.7 ≥38 / ≥100.4 3 – 36 months ≥ 38.0-39.0 ≥ 100.4 – 102.2 ≥39/ ≥102.2 > 3 years ≥ 37.8-39.4 ≥ 100 – 103.4 ≥39.5/ ≥103.1

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What are the most common causes of fever?

A fever poses the diagnostic of infection on top of the list of possible underlying causes; colds, bronchiolitis, ear infections and urinary tract infections are among the most likely illnesses to cause fever.

Can fever be a sign of pneumonia?

Yes, in fact among children presenting with fever to an emergency department, bacterial pneumonia is the most common serious bacterial infection, in developed countries. However, to identify children at risk, many signs and symptoms other than fever should be taken into account. According to the latest research, respiratory rate is the clinical feature with the most consistent and the strongest evidence for predicting lower respiratory tract infection.
Respiratory rate is simple to measure: count the number of times your child breathes in one minute. The table below shows the normal range values for respiratory rate, according to APLS (Advanced Pediatric Life Support).  A respiratory rate above the normal range values is named tachypnoea and reflects an acute response of body to respiratory distress.
The other table is taken from a study and shows how respiratory rate increases with temperature. The study concluded that respiratory rate, adjusted for age, increased by around 2.2 breaths / minute per 1°C rise in body temperature.

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	Respiratory Rate Normal range values by age –breaths/minute (APLS) Age Respiratory Rate Age Respiratory Rate Newborn 40-60 2 years 20-28 1 month 30-50 4 years 20-26 3 months 30-45 6 years 18-24 6 months 25-35 8 years 18-22 1 year 25-30 10 years+ 16-20

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Respiratory Rate values expected for different temperatures in children (1 month to 16 years) Respiratory Rate Centiles (breaths/minute) Temperature (ºC) by age group 1 to < 12 months 36.0-36.9ºC 37 45 55 65 37.0-37.9ºC 38 48 57 69 38.0-38.9ºC 40 50 60 72 39-39.9ºC 42 52 63 75 12 to < 24 months 36.0-36.9ºC 28 35 41 49 37.0-37.9ºC 32 39 47 55 38.0-38.9ºC 35 42 50 60 39-39.9ºC 36 44 53 62 24 to < 5 years 36.0-36.9ºC 23 27 31 36 37.0-37.9ºC 25 30 35 40 38.0-38.9ºC 27 32 38 44 39-39.9ºC 29 35 41 48 5 to < 16 years 36.0-36.9ºC 19 23 27 32 37.0-37.9ºC 21 26 30 36 38.0-38.9ºC 23 28 34 41 39-39.9ºC 24 30 36 44

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What are the available treatments?

Fever may play a role in fighting infections, however it makes children uncomfortable and it is dangerous for children in shock – this is the rationale to treat fever. Also, keep in mind that a high temperature value is not necessarily correlated to more serious disease. That is why it is so important that you monitor your child’s appearance and behavior.
Your doctor may prescribe acetaminophen, ibuprofen or a combination of these two.  Some cost-effectiveness results from studies have shown that over the course of the whole illness, treating children with both acetaminophen and ibuprofen may lead to less use of other healthcare resources than does either of the drugs alone. This would result in lower costs to the health system, as well as to parents because of time off work.

Summary and Recommendations

• Fever is one of the commonest symptoms of childhood diseases.
• Fever is generally a response the body generates to combat infection.
• The cut-off values that define fever depend on age, place of measurement and state of the immune system.
• Colds, bronchiolitis, ear infections and urinary tract infections are among the most frequent causes of fever.
• Acetaminophen, ibuprofen or the combination of these two are the most common therapeutic regimens.
• You should carefully monitor your child with fever and look for the following alarm signs:
• Temperature values above the “fever of concern” values stated in the table above.
• Febrile seizures.
• Fever in a children with a chronic disease.
• Fever accompanied by skin rash.

[mme_references]
References

• Erkek, N., Senel, S., Sahin, M., Ozgur, O. and Karacan, C. (2010), Parents’ perspectives to childhood fever: Comparison of culturally diverse populations. Journal of Paediatrics and Child Health, 46: 583–587.
• Taveras EM, Durousseau S, Flores G. Parent’s beliefs and practices reagarding childhood fever: a multiethic and socioeconomically diverse sample of parents. Pediatr Emerg Care. 2004 Sep; 20(9): 579-87.
• Hay AD, Heron J, Ness A; ALSPAC study team. The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study. Fam Pract. 2005 Aug;22(4):367-74.
• Hollinghurst S, Redmond N, Costelloe C. et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): economic evaluation of a randomised controlled trial. BMJ. 2008 Sep 9;337:a1490.
• Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I, et al.
• Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age:a systematic review of observational studies. Lancet 2011;377:1011-8.
• Nijman RG, Thompson M, van Veen M Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever: prospective observational study. BMJ. 2012 Jul 3;345:e4224.

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What if my child has constipation?

[mme_highlight] Constipation is a common health problem in childhood accounting for 3% of general pediatric visits. It is classified as functional in 90% of cases (not linked to a disease).  Signs frequently seen in constipated children are a reduction of bowel movements and crying when having one. Dietary and hygienic measures resolve the majority of constipation episodes.  [/mme_highlight]

Constipation is a common health problem in childhood accounting for 3% of general pediatric visits. Constipation is a common symptom and frequently believed to be something that children “grow out of.” However, studies have found that complaints of constipation of about 30% chronically constipated children persisted into young adulthood. Approximately 50% of the children also experienced at least one relapse within the first 5 years after initial successful treatment.

What is the norm regarding bowel habits?

There is a huge variation for that concept. However, in a UK based study of 350 pre-school children (1-4 years of age), 96% of the children passed bowel motions between 3 times a day to alternate daily. Stool frequency is also age-dependent. A study with 800 babies described a peak frequency of 4.4 bowel movements per day at 5 days of age, which may be as high as 13 per day in breast fed infants.

What are the causes of constipation?

90% of cases of constipation in children are defined as functional – this means no organic cause is subjacent. Functional constipation can be explained by factors such as withholding stool, problems during toilet training and lack of fiber in diet. When constipation is secondary to a disease it is named organic.
There are three periods during which a child may be more prone to develop constipation complaints: the first, when solid food and cereals are introduced; the second occurs with toilet training; the third period may occur when children enter school, not only because this is a milestone for child’s development, but also because of some reluctance in using the bathroom as it is unfamiliar to the child.

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Causes of Constipation in Children

• Functional: 91%
• Organic: 9%
• Cerebral Palsy: 6%
• Hypothyroidism: 1%
• Down Syndrome + Hypothyroidism: 1%
• Meningomyelocele: 0.5%
• Hypokalemia (low potassium levels): 0.5%

Study design: 355 children were assessed for constipation.
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What are the signs of constipation?

Some signs may indicate your child has constipation:

• Less number of bowel movements, compared to your child’s normal;
• Pain, crying or arch back (in babies) with bowel-movement;
• Leak small amounts in pants (in children already toilet trained).

What can I do to help my child?

• Give her/him aliments with fiber, such as fruit, vegetables, and cereals.
• Offer him juice of prune, apple or pear.
• Avoid milk and milk-derived aliments, like yogurt, cheese and ice cream.
• Put your child to sit on the toilet for 5 to 10 minutes after meals.
• To help constipation ameliorate, stop potty training for a while.

What serious diseases can be associated with constipation?

Examples of diseases presenting with constipation and requiring additional investigation and specific treatment are: cow’s milk intolerance, Hirschsprung disease, cystic fibrosis and anorectal anomalies.

What if constipation persists?

If constipation seems to be recurrent, it may happen because of insufficient time using the bathroom, fear of using an unfamiliar one or fear of feeling pain either because of hard stools or an anal fissure.

In the case of recurrent constipation, a “clean out” treatment can be attempted in order to empty bowels, always in addition to the dietary measures stated above. It can be done with PEG (polyethylene glycol) and/or Milk of Magnesia®.

Summary and Recommendations

• Constipation is very common in children and it is classified as functional in 90% of cases (not linked to a disease).
• Signs frequently seen in constipated children are a reduction of bowel movements and crying when having one. Dietary and hygienic measures resolve the majority of constipation episodes.
• There are some alarm signs you should keep in mind:
• Frequent constipation or constipation in children younger than 4 months old.
• If your child does not have a bowel movement even after trying the measures explained above for one day.
• Blood in stools or in diaper/underwear (look for an anal fissure).
• If your child seems to be in serious pain.
• If you noticed your child has lost weight or is not thriving adequately.
• If your child presents fever, vomiting or diarrhea.

[mme_references]
References

1. Borowitz SM, Cox DJ, Tam A, et al. Precipitants of constipation during early childhood. J Am Board Fam Pract 2003; 16:213.
2. Ozlem Bekem Soylu. Clinical Findings of Functional and Secondary Constipation in Children. Iran J Pediatr. 2013 June; 23(3): 353–356.
3. Weaver LT, Steiner H. The bowel habit of young children. Arch Dis Child. 1984;59:649–652. doi: 10.1136/adc.59.7.649
4. Nyhan WL. Stool frequency of normal infants in the first week of life. Pediatrics. 1952;10:414–425.

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What if my child has blood in urine?

[mme_highlight] 3 to 4% of all children with ages 6 to 15 experience hematuria at least once, but commonly it is not associated with a severe condition. The main causes of hematuria are: infections, kidney stones, trauma and inherited diseases. [/mme_highlight]

The finding of even microscopic amounts of blood in a child’s urine alarms family. Although common, hematuria, which means “urine with blood”, is a sign or symptom but generally it is not related with a severe condition.  3 to 4% of all children with ages 6 to 15 experience hematuria at least once.
To understand hematuria, it is important to distinguish the origin of hematuria – from kidney or from urinary tract – and the types of hematuria – microscopic or macroscopic. Hematuria is macroscopic if blood is visible to the naked eye; otherwise, it is called microscopic.  It is also very useful to have a general knowledge of urinary system’s anatomy: we have two kidneys (that filter urine), two ureters (that move urine from the kidneys to the bladder), a bladder (a “bag” that holds urine), and the urethra (that carries urine out of the bladder).

What are the causes of hematuria?

• Urinary Tract Infection;
• Kidney stones;
• Trauma;
• Vigorous exercise;
• Inherited diseases;
• Drugs;
• Urinary Tract Cancer (extremely rare in children).

It is also important to know if there is a history of hematuria in the family or test family to investigate it, as Familial hematuria is the most common cause of persistent hematuria in children.

What are the symptoms of hematuria?

Hematuria can occur without any associated symptom. Symptoms depend on the subjacent cause for the hematuria. In a urinary tract infection, children can feel ill, with chills and flank pain; fever, irritability and loss of appetite are frequent in young children, while burning while urinating, urinating many times and lower belly pain can be present in older children.
Flank pain can appear with kidney stones. Other kidney diseases can present with symptoms such as fatigue, abdominal pain, pale skin and high blood pressure.

What tests are used to study hematuria?

The dipstick test is an easy way to test hematuria; it uses a reagent strip embedded in hydrogen peroxide, which catalyses a chemical reaction in which hemoglobin is involved. It is not the most trustable test, but it is used due to its easiness, availability and low cost. It can detect hematuria when there are 5 to 10 red blood cells per microlitre of blood.

Urynalisis is the gold standard to test for microscopic hematuria, considered for values above 2 to 5 red blood cells per high power field (ampliation of 40 times in the microscopy).

A CT (computerized tomography) scan may be needed in selected cases.

What situations can mistake hematuria tests?

There are a number of situations that can cause a “false positive” hematuria result. It is the case of aliments like beet, mushrooms and berries and some medicines, as ibuprofen, rifampin, nitrofurantoin. Let your doctor know about these.

Why Urinary Tract Infections can be a cause of Hematuria?

Normally, there are no bacteria in the urinary tract. However, if bacteria enter the bladder they can cause an infection, which then leads to hematuria. These infections are called urinary tract infections (UTI). If bacteria go up in the urinary tract, they can reach the kidneys, causing one of the most serious type of UTI which, if not treated quickly, can lead to a permanent damage to the kidneys.

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Probability of Urinary Tract Infection (UTI) among girls presenting with fever Risk Factors in Girls: –        Caucasian –        Age < 12 months –        Temperature ≥ 39ºC –        Fever ≥ 2 days –        Absence of another source of infection   If no risk factor or 1 risk factor is present: ≤ 1% probability of UTI If no more than 2 risk factors are present : ≤ 2% probability of UTI

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Probability of Urinary Tract Infection (UTI) among boys presenting with fever Risk Factors in Boys: –        Non African –        Temperature ≥ 39ºC –        Fever ≥ 24 hours –        Absence of another source of infection   If no more than 2 risk factors are present (circumcised): ≤ 1% probability of UTI If no more than 3 risk factors are present (circumcised): ≤ 2% probability of UTI If uncircumcised probability of UTI is > 1% even if no risk factor is present.

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What is the treatment for hematuria?

There is no specific treatment, as the treatment is not aimed at hematuria, but rather at its underlying cause. In addition, a symptomatic treatment may be necessary to relieve pain or to lower fever. In the case of a urinary tract infection, antibiotics are prescribed. If the cause of your child’s hematuria is a bruise to the kidney, she/he might not need any treatment.

Gross Hematuria

Gross hematuria in children is not a common situation, accounting for approximately 1 in 1000 visits to a pediatrician. There are multiple causes, as seen in the table below, but the implications of gross hematuria tend to be less serious in children when compared to adults, especially because urologic malignancies are much less common in children.

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	Gross Hematuria in Children Study Design: 342 children, 1994-2003 –        Benign Urethrorrhagia: 19% of male patients –        Urinary Tract Infection: 14% of male patients –        Trauma: 14% of male patients –        Congenital urologic abnormalities: 13% o all patients –        Kidney stones: 5% of all children.

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Summary and Recommendations

• Hematuria can occur in children, but commonly it is not associated with a severe condition.
• Hematuria can be classified as microscopic or macroscopic (gross hematuria).
• The main causes of hematuria are: infections, kidney stones, trauma and inherited diseases.
• Urinary tract infections can present with hematuria, fever, chills and flank pain.
• A dipstick test or urinalysis are generally sufficient to investigate hematuria.
• Treatment is aimed at the underlying cause.
• If you see blood in your child’s urine or if the urine has a different appearance (like tea stained or pink) take her/him to a doctor.

[mme_references]
References

1. Subcommittee onUrinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610.
2. Greenfield SP, Williot P, Kaplan D. Grosshematuria in children: a ten-year review. Urology. 2007 Jan;69(1):166-9.
3. Meyers Evaluation of hematuria in children. Urol Clin North Am. 2004 Aug;31(3):559-73, x.
4. Vehaskari VM, Rapola J, Koskimies O, et al. Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr 1979; 95:676.

[/mme_references]

What if my child has seizures?

[mme_highlight] Febrile seizures represent the most common form of seizures in childhood, with a prevalence of 2 to 5 % of all children; generally these seizures are self-limited.  A seizure refers to a single event; if it becomes recurrent it is called epilepsy.  Any insult to the cerebral cortex can cause a seizure. [/mme_highlight]

Seizures account for 1 to 5% of all emergency department visits. Seizures can be classified as febrile and afebrile, being the former the most frequent. When a seizure becomes recurrent it is called epilepsy. Transient epileptic discharges may appear in an electroencephalogram in 3 to 5% of healthy children, particularly in those with a positive history of seizure activity in the family.

How common are seizures in childhood?

[mme_databox]

Statistics of Seizures ·        Age adjusted prevalence in general population (developed countries): 4-8/1000 people ·        3.6% risk of experiencing at least one seizure during a life of 80 years. ·        Febrile seizures: 2 to 5% of all children (U.S. and Europe)/ 8% (Japan) ·        Afebrile seizures: 1% of all children will have at least one till the age of 14.

Prevalence – The total number of cases of a disease in a given population at a specific time.
[/mme_databox]

What are febrile seizures?

Febrile seizures represent the most common form of seizures in childhood, with a prevalence of 2 to 5 % of all children living in United States and Europe, a number that turns to 8% in Japan.

Febrile Seizures can be defined as a seizure accompanied by fever in a child from 6 months to 6 years of age, without evidence of central nervous system lesion or infection. Febrile seizures can cause your child to pass out and have jerking movements of limbs and face. They generally do not last more than 1 to 2 minutes. After the seizure, your child may feel confused or sleepy; this is normal.

There is an association between seizure and bacterial meningitis has been established by studies. There is a confounding element in this case – fever – and that is why it is imperative to rule out bacterial meningitis before making a diagnosis of febrile seizure.

Why do febrile seizures occur?

The exact process that leads to febrile seizures to occur remains unknown.  However, several factors such as vitamin B6 deficiency, electrolyte disturbances (sodium, potassium, and chloride), reduction in serum and cerebrospinal fluid (CSF) zinc levels, as well as low gamma-aminobutyric acid (GABA) levels are thought to play a role.
The study shown below found that zinc levels in children with febrile seizures were significantly lower than those in children with afebrile seizures.
[mme_databox]

Zinc Levels and febrile seizures: evidence (Study design: 288 pre-school children, mean age, diagnosed with febrile seizures (n=248) and afebrile seizures (n=40)) Mean serum zinc levels: Febrile seizures group: 60.5±12.7 μg/dL Afebrile seizures group:  68.9 ±14.5 μg/dL

[/mme_databox]

How can I help my child if she/he is having a febrile seizure?

Keep calm, do not try to stop the movements and put your child on side. If the seizure lasts more than 5 minutes, call the emergency. Even if it recovers spontaneously and your child is with fever, take her/him to the doctor as soon as possible, to make sure it was a febrile seizure. Generally, these seizures are self-limited; doctor can prescribe medicines to lower fever or to treat a possible infection.
Keep also in mind that children with a first episode of febrile seizure have higher odds to have another one. It is important to emphasize that febrile seizures do not cause brain damage.

What is epilepsy?

A seizure refers to a single event; if it becomes recurrent it is called epilepsy. Epilepsy is not itself a disease, but rather a manifestation of a pathology involving the cerebral cortex, like in the case of a brain tumor. The epileptic crisis are classified as partial or generalized. The complex crisis occurs when a limited group of neurons from one of the hemispheres in the brain is activated. Partial crisis are subdivided in simple and complex, without or with loss of consciousness, respectively.
The generalized crisis involves the two hemispheres of brain and loss of consciousness may be the first manifestation.  Seizures tend to be stereotyped (similar to previous seizures), random (in anytime of the day) and without being related to any precipitator like environment or psychological events.
Bear in mind that any insult to the cerebral cortex can cause a seizure, even if it is transient: trauma, infection, bleeding (subarachnoid hemorrhage) and low levels of calcium or sodium.

What is the medical approach to childhood epilepsy?

Your doctor will order some tests to investigate the cause of epilepsy in your child, like a blood sample, an electroencephalogram (EEG), computerized tomography (CT) or a magnetic resonance (MRI). Treatment usually involves medicines to prevent seizures. These can have interaction with other medicines and vice versa, thus it is important you tell your doctor about any medicine your child is taking. A special diet or a brain surgery may be necessary in a few cases.

Summary

• Seizures are common in children. Any insult to the cerebral cortex can cause a seizure.
• Seizures can be classified as febrile and afebrile, depending on the presence of fever. Febrile seizures are the most common, occurring in 2 to 5 % of all children.
• Epilepsy is diagnosed when seizures are recurrent. Your doctor will ask exam tests to try to find the cause of the epilepsy and possibly will prescribe a medicine to prevent seizures in your child.
• If your doctor has prescribed a therapeutic regimen to prevent seizures, follow it strictly.
• Call the emergency if a seizure lasts more than 5 minutes or if you notice repeated seizures overtime.
• Take your child to a doctor after a seizure. Alarm signs are an increase in the number or in the duration of seizures.

[mme_references]
References

1. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures (1996) Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics 97: 769–772; discussion 773–765.
2. Najaf-Zadeh A, Dubos F, Hue V, Pruvost I, Bennour A, Martinot A. Risk of bacterial meningitis in young children with a first seizure in the context of fever: a systematic review and meta-analysis. PLoS One. 2013;8(1):e55270.
3. Lee JH, Kim JH. Comparison of serum zinc levels measured by inductively coupled plasma mass spectrometry in preschool children with febrile and afebrile seizures. Ann Lab Med. 2012 May;32(3):190-3.
4. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1981; 22:489.
5. Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940-1980. Epilepsia 1991; 32:429.
6. Oka E, Ohtsuka Y, Yoshinaga H, et al. Prevalence of childhood epilepsy and distribution of epileptic syndromes: a population-based survey in Okayama, Japan. Epilepsia 2006; 47:626.
7. Murphy CC, Trevathan E, Yeargin-Allsopp M. Prevalence of epilepsy and epileptic seizures in 10-year-old children: results from the Metropolitan Atlanta Developmental Disabilities Study. Epilepsia 1995; 36:866.

[/mme_references]

What if my baby has infantile spasms?

[mme_highlight] Infantile spasms are a rare form of epilepsy of the early infancy, occurring predominantly in the first year of life. The triad of West syndrome comprises infantile spasms, hypsarrhythmia (EEG pattern) and mental retardation. The prognosis is better if the neurologic history and examination were normal prior to the onset of febrile seizures. [/mme_highlight]

Infantile spasms are a severe form of epilepsy of early infancy. This epileptic disorder was first described by Dr. William James West in his own son in 1841. Named after Dr. West, the triad of West syndrome comprises infantile spasms, hypsarrhythmia (EEG (electroencephalogram) pattern) and mental retardation. An early diagnosis and a good response to treatment increase the chances for a normal development.

How common are infantile spasms?

Infantile spasms are a rare form of epilepsy of the early infancy, occurring predominantly in the first year of life. The table below shows incidence and proportion of infantile spasms by time of onset. Spasms usually cease by 5 years of age, but then other forms of seizures appear in as many as 60% of children with infantile spasms.

[mme_databox]

	Epidemiologic (statistical) data for Infantile Spasms ·        Incidence: 2 to 3.5 cases per 10.000 live births ·        Time of  Onset: –        Range: 1 day to 4.5 years of life –        90% during the first year –        50 to 77% between 3 and 7 months of life (peak incidence) –        Very rarely in children older than 18 months of life. ·        Ratio boys:girls – 60:40.

Incidence – number of new cases within a specified time period in a population.
[/mme_databox]

How does an infantile spasm look like?

Infantile spasms are muscular contractions lasting 1 to 2 seconds.  3 main types of spasms have been identified:

• Flexor spasms: sudden flexion of the neck, trunk and limbs associated with contraction of the abdominal muscles.
• Extensor spasms: sudden extension of the neck and trunk, with inward or outward movement of limbs.
• Combination of flexor and extensor spasms: generally, with flexion of the neck, trunk, and arms with extension of legs.

[mme_databox]

Types of Infantile Spasms (Study: 5042 spasms were obseved in 24 infants) –        Flexor spasms: 33.9% of spasms –        Extensor spasms: 22.5% of spasms –        Combination flexor+extensor spasms: 42%. Note: Most of infants had more than one type of spasm

[/mme_databox]

What are the causes for infantile spasms?

The classification of infantile spasms by cause includes the categories of cryptogenic and symptomatic.

[mme_databox]

Classification of Infantile Spasms ·        Cryptogenic –        10 to 40% of cases; –        No underlying cause identified; –        Normal development prior to onset of infantile spasms. ·        Symptomatic: –        remaining cases; –        when a cause can be demonstrated.

[/mme_databox]

Although much remains unclear, the following conditions may cause infantile spasms:

• Metabolic disorders (eg., phenilketonuria, vitamine B12 deficit);
• Malformations (eg., microcephaly, tetralogy of Fallot);
• Tuberous sclerosis complex;
• Infections (cytomegalovirus has been implicated);
• Immune pathogenesis;
• Neoplasms (eg., basal ganglia glioma);
• Genetic syndromes (eg., Down’s syndrome, cri du chat syndrome);

How are infantile spasms diagnosed?

In the majority of cases, the first alert for further clinical evaluation is set by parents. Parents usually bring their child to a doctor because of episodes that can be mistaken with a colic or gastro esophageal reflux. Parental videos of the infant spasms may help the clinical evaluation. Generally, an EEG is done and further testing may be needed according to the clinical set.

Is there any association between infantile spasms and vaccination?

Studies have ruled out this association. This was a debated issue for more than 50 years, but a recent consensus stated that the risk of vaccine induced encephalopathy or epilepsy, if it exists at all, is extremely rare, very different from the higher risk of not vaccinating.

What is the treatment for infantile spasms?

Your doctor will guide you and certainly answer all your questions. Give the medicines to your baby exactly as prescribed as this increases the likelihood for recovery. Generally, antiepileptic drugs and ACTH (adrenocorticotropic hormone) are the therapeutic regimens offered.

What is the prognosis for infantile spasms?

It is consensual that the prognosis is better if the neurologic history and examination were normal prior to the onset of infantile spasms. Rapid cessation of infantile spasms and normalization of EEG also add for a good prognosis. Factors accounting for poor prognosis are mental retardation and abnormal mental status prior to the onset of infantile spasms.

Summary and Recommendations

• Infantile Spasms are a severe and rare form of epilepsy of early infancy, generally appearing in the first year of life.
• Infantile spasms can be flexor, extensor or a combination of both.
• Parents and caregivers are generally the first to notice the spasms. If this is the case, take your child to a doctor. A video recording of the spasms may be helpful. An EEG is generally part of the investigation.
• The prognosis is better if there was no prior history of neurologic impairment. Rapid cessation of spasms and normalization of EEG are also good signs.

[mme_references]
References

1. Fois A. Infantile spasms: review of the literature and personal experience. Ital J Pediatr. 2010 Feb 8;36:15.
2. James W Wheless, Patricia A Gibson, Kari Luther Rosbeck et al. Infantile spasms(West syndrome): update and resources for pediatricians and providers to share with parents. BMC Pediatr. 2012; 12: 108.
3. Kellaway P, Hrachovy RA, Frost JD Jr, Zion T. Precise characterization and quantification of infantile spasms. Ann Neurol 1979; 6:214.
4. Shields WD: West’s syndrome. J Child Neurol 2002, 17(suppl 1):S76–

[/mme_references]

Why do babies spit up?

[mme_highlight] Spitting up is very common: approximately half of infants between birth and three months have at least one episode of spiting up each day. This can become a disease – Gastroesophageal Reflux Disease (GERD) – when the acid that comes from the stomach causes irritation or injury in the esophagus. This happens in a minority of infants. [mme_highlight]

The term “spit up”, although of common use, can be misleading as it does not differentiate between two terms: reflux or regurgitation, which happens when gastric content returns to mouth, without any muscle pulling it up; vomit, which refers to expelling gastric content pulled by abdominal and thoracic muscles.  
It can be hard for parents to tell if their child is vomiting or spitting up, because some babies reflux in large amounts or in an apparently forceful way. However, generally, the term spitting up is used to describe gastroesophageal reflux, which is a medical term.

What is Gastroesophageal reflux?

Reflux can be described as an effortless regurgitation of the gastric content and it happens in healthy babies, children and adults. It can be useful to remember the pathway of food: it goes from the mouth and down the esophagus to reach the stomach, passing through a muscle called lower esophageal sphincter; the function of this sphincter is to loose in order to let food pass to the stomach and then to contract to prevent that food going backwards to the esophagus.
Spitting up is, indeed, very common: approximately half of infants between birth and three months have at least one episode of spiting up each day. This can become a disease – Gastroesophageal Reflux Disease (GERD) – when the acid that comes from the stomach causes irritation or injury in the esophagus. This happens in a minority of infants. There are some signs and symptoms that can be cues to this disease; if this is the case, take your child to see a doctor:

• Refusal to eat and frequent crying or leaning the neck and back, as if in pain.
• Frequent coughing.
• Persistent forceful vomit.
• Inadequate weight progression.

If reflux is not pathologic (like in GERD) it is not likely to cause pain and thus it is not probably a cause of irritability or difficulty to sleep in a child, as it is frequently believed.

When will my baby stop spitting up?

As mentioned above, reflux can happen sparsely in any healthy children or adult. However you will notice the frequency of spitting up will decrease as your child grows, as shown below.

[mme_databox]
Rate of cessation of reflux (when spitting up stops)

• spitting up almost disappears in more than 50% of infants as they reach 10 months;
• in 80% of infants by 18 months;
• in 98% among 2-year-olds.

[/mme_databox]

When should I be worried?

Seek for medical advice if your child has acid reflux accompanied by the following symptoms:

• Recurrent pneumonia or coughing (this can mean your infant inhalates the regurgitated aliments).
• Fail to gain weight.
• Recurrent vomiting, diarrhea or blood in the stools.
• Long period crying or persistent refusal to drink or eat.

It is important to understand that infections, like gastroenteritis, can be a cause of vomits. Go to a doctor if your child has vomits accompanied by other signs and symptoms like fever. Note also that forceful vomits in infants can be an alarm sign for a serious condition, like in pyloric stenosis, which is a constriction in the stomach, and in intestinal obstruction, when an intestine region gets blocked.

How to treat reflux?

There is no recommendation to treat infants with uncomplicated reflux – as stated above, it will disappear with growth. There are some simple measures that can improve reflux, like thickening the food offered and avoidance of tobacco smoke. In fact, one study revealed that such conservative measures alone can improve reflux in more than 80% of infants.

Summary and Recommendations

• Spitting up is very common in infants. Almost 50% of infants present at least one reflux episode per day till 3 months of age.
• In most children reflux episodes have stopped by the age of 2.
• If the reflux episodes cause injury to the esophagus it is called Gastroesophgeal Reflux Disease (GERD).
• Refusal to eat, frequent cough or inadequate weight gain should be alarm signs.
• Take your child to a doctor if she/he presents with vomit and other symptoms like fever.

[mme_references]
References

• Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49:498.
• Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics 1998; 102:E67.
• Orenstein SR, Magill HL, Brooks P. Thickening of infant feedings for therapy of gastroesophageal reflux. J Pediatr 1987; 110:181.

[/mme_references]

Why do babies cry?

[mme_highlight] All babies cry even without having any medical condition and they tend to cry during the first three months after birth more than at any other time. Crying related to colic is louder and more intense, being almost impossible to soothe a baby with colic. [mme_highlight]

When a baby cries persistently it can become an issue for parents, who can start doubting the quality of their care or if their child may have a more serious condition. All babies cry even without having any medical condition and they tend to cry during the first three months after birth more than at any other time.

A study based on records written by parents, keeping a record of their child’s crying periods, showed that, although there is an obvious individual variation, the average duration of crying, per day is:

• 0 to 6 weeks of life: 110-118 minutes per day;
• 10 to 12 weeks of life: 72 minutes per day.

Colic, the excessive crying

The term colic is often used to describe excessive crying. The duration of crying per day in a baby with colic can be up to two hours per day. Certainly babies cry, even if they do not have colic, but generally less time per day. Approximately 40% of all infants have colic, which usually starts three to six weeks after birth and in 90% of infants it ends by four months of age.
There can also be some features and patterns linked to colic that patents should notice. Both the onset and end of a colic episode are frequently easy to recognize, with a sudden period of crying regardless of the previous mood of the baby and mostly at evening. The crying will end when the gas passes or the bowel moves. Over time, parents will understand that colic is indeed different from other normal crying patterns: crying related to colic is louder and more intense, being almost impossible to soothe a baby with colic.

Other causes of crying

• Fatigue and/or overstimulation: It is possible that the accumulation of excessive stimuli during day may increase crying at evening. Babies often cry when they become tired from playing or being handled. Soothing the baby is the key.
• Hunger: There are some periods in which your baby will want to feed with more frequency than parents are used to; if this is the case, simply feed your child to see if this soothes the crying.
• Pain: search for anything than can be a cause of pain, like a hair wrapped around a finger or a diaper which may be too tight.
• Gastroesophageal reflux: this can be suggested when crying starts after feeding.
• Food sensitivities: what the mother eats passes to the milk and this can cause a reaction or digestive pain in the baby.

How much crying is too much crying?

During the first three months of life, the duration of crying per day can vary between 42 minutes to 2 hours. However, assessing the duration of crying is not the most important feature to notice in crying.  The context and quality of crying can be key points to try to understand why your child is crying. To sum up, there is no quantitative definition for “excessive crying” and it is normal for an infant to cry for up to two hours per day. If you have concerns about you infant’s pattern and cause of crying, do not hesitate to discuss the subject with a health care provider.

Summary and Recommendations

• Crying is a normal behavior in babies. Crying for up to two hours per day is within the normal range.
• Crying time has a peak during the first three months of life.
• Colic is many times defined by excessive crying. Babies with colic often present a different crying pattern, which can be louder (high-pitched) and more intense; it can be very difficult to soothe a baby with colic.
• Other situations that make your baby more prone to cry can be: fatigue, hunger, pain and gastroesophageal reflux.

[mme_references]
References

• St James-Roberts I, Halil T. Infant crying patterns in the first year: normal community and clinical findings. J Child Psychol Psychiatry 1991; 32:951.
• Lehtonen LA, Rautava PT. Infantile colic: natural history and treatment. Curr Probl Pediatr 1996; 26:79.
• Geertsma MA, Hyams JS. Colic–a pain syndrome of infancy? Pediatr Clin North Am 1989; 36:905.

[/mme_references]

What is the right diet for breastfeeding moms?

[mme_highlight] Maternal diet directly affects the content of vitamin A, B1 (thiamin), B2 (riboflavin), B5 (pantothenic acid), B6 (pyridoxine), B12 (cobalamin), D, E, selenium and iodine in human milk. There is no specific need for restrictive diet but the diet should be such to replenish the body’s reserve supplies of fats, calcium etc. [mme_highlight]

Research studies have demonstrated that the calories required for the adequate production of breast milk are supplied by the body’s fat reserves laid during pregnancy. The energy required to produce an average of 750 mL quantity of milk is 630 kcal per day. About 400 to 500 calories are needed above your intake during pregnancy in order to provide enough energy to supply the needs of your growing baby. Therefore, it is very important for a breastfeeding mother to eat a well-balanced diet.

How can diet affect the composition of mother’s milk?

Mother’s diet can affect the concentration of vitamins and minerals in breast milk. It has been found in research studies that vegan mothers may require supplementation with vitamin B₁₂to their diet. Maternal diet directly affects the content of vitamin A, B1 (thiamin), B2 (riboflavin), B5 (pantothenic acid), B6 (pyridoxine), B12 (cobalamin), D, E, selenium and iodine in human milk.
The proportion of the different fatty acids present in breast milk also varies with the fat content in the mother’s diet.

What is the relationship between breastfeeding, diet and weight loss?

Research has proved that mothers who breastfeed their baby, reach their pre pregnancy weight faster when compared to mothers who do not breastfeed. It has also been found in studies that aggressive weight loss programs or dieting should not be considered during breastfeeding as it may be harmful for the baby.
When weight loss happens fast, the fat of the body is burned and stored toxins are released, which may reach mother’s bloodstream ending up in the breast milk thus posing a potential damage to the baby.

You should lose weight gradually, using a healthy combination of a low fat, well balanced diet and moderate exercise. Breastfeeding burns up the fat deposited during pregnancy to produce milk and hence aids in the weight loss. It has been shown in research studies that most breastfeeding mothers can lose about 0.5 Kg a month due to the energy demands required for producing milk.
Limiting the food that a breastfeeding mother eats in the early weeks of lactation may hamper the production of milk and reduce the milk supply.

How can mother’s diet affect the baby?

Research has provided ample evidence that the presence of even traces of a particular substance in breast milk may upset some babies. It is advisable that before cutting down a particular substance from diet, a breastfeeding mother should consult her doctor to ensure that she continues to receive a healthy and balanced diet.
The American Academy of Pediatrics has also stated that babies who are breastfed have a lower risk for SIDS (Sudden Death Infant Syndrome).

The table below enlists the most common culprits that may upset your baby.

Food type	Sample	Effect on baby	What to do?
Vegetables	Cabbage, onion, garlic, broccoli, Brussels sprouts, turnip	Wind, crying	Leave these vegetables out of diet for two weeks
Cow’s milk and products	Milk, cheese, yogurt, butter	Allergic reaction, intolerance	Exclude dairy products from your diet. Consult your doctor
Cold foods	Ice-cream, yogurt, frozen dessert	A type of food poisoning listeriosis (but very unlikely)	Ensure that the frozen desserts are pasteurized. Use well-cooked desserts as boiling will kill the bacteria.
Ready to eat foods	Preservatives, dyes and additives	Upset baby, discomfort	Remove ready to eat meals from your diet
Ready to eat foods	Eggs, citrus foods, wheat, corn, spicy food, peanuts, soy, chocolate, oily fish especially tuna fish	Allergen, may cause restlessness, discomfort, crying, posseting and colic	Keep them out of diet for two weeks. Minimize the intake of oily fish as it contains mercury and pollutants.

What is the effect of mother’s diet on baby’s weight?

Breastfed infants have been shown to gain the right amount of weight and are usually not overweight. It is known that if there is a reduced caloric intake, it leads to reduced milk supply and ultimately leading to weight gain problems in the baby. Studies have also shown that most of the babies gain an average of 4 to 7 ounces per week for the first month of life, 1-2 pounds per month for 2 to 6 months and about 1 pound per month in the next 6 months.
It has also been seen that breastfed babies grow at the same rate as their formula fed counter parts for the first four months of their life but at a slower pace after that. In fact it is a proven fact that frequent feeding sessions and thorough emptying of the breast at each feed causes the baby to gain more weight.

Diet recommendations for a breastfeeding mother

The Indian Council of Medical Research has recommended the following dietary allowance for lactating mothers;

• 0-6 months: 550 Kcal per day (over and above the pre pregnancy intake)
• 7-12 months: 400 Kcal per day (over and above the pre pregnancy intake)

Mothers should maintain a balanced diet and take their pre natal vitamins. There is no specific need for restrictive diet but the diet should be such to replenish the body’s reserve supplies of fats, calcium etc The American Academy of Pediatrics recommends nutritive foods such as carbohydrates, vegetables, fruits and whole grains for nursing mothers.
Certain nutrients required by the baby may be lacking in the breast milk if the mother’s diet is inadequately supplied with them such as iodine and Vitamin B₁₂.

The most important factors to be considered while constituting the diet for a nursing mother to produce milk and stay healthy herself are:

Proteins: One serving of protein is equivalent to 2&1/2 to 3 glasses of skim or low fat milk; 1&1/4 cups evaporated skim milk; 1&3/4 cups low fat yogurt; ¾ cup low fat cottage cheese; 2 large eggs plus two whites; 5 egg whites; 3 to 3 & ½ ounces fish, meat or poultry; 5 to 6 ounces tofu; 5 to 6 tablespoons peanut butter.

Vitamin C: ½ cup strawberries, ¼ small cantaloupe, ½ grape fruit, 1 small orange, ½ to ¾ cup citrus juice, ½ large kiwi, mango or guava, 2/3 cup broccoli or cauliflower, 1 cup cabbage or kale, ½ medium green bell pepper or 1/3 medium red bell pepper, 2 small tomatoes or 1 cup tomato juice is equivalent to 1 serving of Vitamin C.

Calcium: The foods which provide calcium are Parmesan cheese, skim or low fat milk, non- fat dry milk, low fat cottage cheese, broccoli, collards or kale, molasses, salmon and sardines.

Green leafy and yellow vegetables and yellow fruits: Fruits like apricot, cantaloupe, mango, peach, and vegetables like broccoli, carrot, winter squash, sweet potato, canned pumpkin, tomato, red chili or pepper should form a part of daily diet of the nursing mother.

Carbohydrates: Carbohydrates such as cooked brown rice, wild rice, millet, kasha, barley, whole cornmeal, wheat germ, unprocessed bran, whole grain crackers, lentils, beans, split peas, lima beans should be given.

Iron rich foods: Foods like beef, blackstrap molasses, chick peas, dried legumes, dried fruit, oysters, sardines, soybeans, and soy products, spinach and liver are foods are rich in iron.

Fluids: Water is a major constituent of the breast milk. At least 10- 12 glasses of water must be taken every day. Fluids will help the body to produce the milk needed for your baby. 8 cups of fluids in the form of water, fruit and vegetable juices, milk, soups and seltzer can also be taken to make up for the fluid requirement of the nursing mother.

Vitamin supplements: Supplement in the form of a pregnancy or lactation formula is helpful as an adjunct for the daily diet. 4 micrograms of vitamin B12, 0.5 milligrams of folic acid 400 milligrams of vitamin D are necessary requirements for a nursing mother. A supplement designed for nursing mothers also provides the extra iron needed by the mother which was depleted during pregnancy.

The Australian Government, National Health and Medical Research Council, Department of Health and Ageing, has released dietary guidelines in 2013, stating the minimum servings of different food types for breastfeeding women.
[mme_databox]

Food	Serves per day
Grain (cereal) foods, whole grains, high fiber, cereal variety	5-7
Vegetable and legumes/beans	7
Fruit	5
Milk, yoghurt, cheese	2
Lean, meats and poultry, Fish, eggs, tofu, nuts and seeds, legumes/beans	2
Extra foods (eg cakes, pies, soft drinks, lollies etc)	0-2 & ½

[/mme_databox]

Summary and Recommendations

• The mother’s diet directly affects the composition of breast milk, including the amount of vitamins, selenium, iodine and fat.
• Losing weight after delivery should be a gradual process, using a combination of diet and exercise. Losing weight too fast can even be harmful either for breast milk production or and its composition.
• Certain foods may trigger reactions in babies, like allergies or making babies cry. If you think this is the case, remove the aliment from the diet for a couple of weeks. Check first with your doctor to ensure you do not remove essential nutrients from your diet.
• If you are breastfeeding, make sure your diet is balanced, containing protein, vitamins, carbohydrates and iron. It is advisable that you take supplements of vitamin B12, folic acid and vitamin D.

[mme_references]
References

• Anderson, J. (2013, April). Sample Daily Food Patterns from Eat for Health: Australian Dietary Guidelines. Retrieved from Diet and Weight Loss while Breastfeeding , Australian Breastfeeding Association.
• Board, B. C. (2007). Diet for a Healthy Breastfeeding Mum. Retrieved from Babycenter: http://www.babycenter.com/0_diet-for-a-healthy-breastfeeding-mom_3565.bc
• Bouchez, C. (2003). Your Nutritional Needs While Breastfeeding. Retrieved from WebMD: http://www.webmd.com/food-recipes/features/your-nutritional-needs-while-breastfeeding
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