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'children' Parentelligence posts

Hernias: why are some watched while others are repaired?

The most common thing that I see as a pediatric surgeon is a child with a lump that is thought to be a hernia. A hernia is a bulging of tissue through an opening in the muscle layers that isn’t normally present. In children, these openings are usually the result of a developmental process that just didn’t quite reach completion. Some hernias need surgery emergently, while others are observed for years with the expectation that they will close on their own.

Here are some pointers to help understand this wide range of approaches to hernias:

Location is very important in considering how aggressive to be with hernias. Belly button (umbilical) hernias are...

Fixing Chest Wall Deformities: A Minimally Invasive Option

Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

(Image source)

Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves ...

No One is Too Young for a Hearing Test!

How young is too young for a hearing test?

Your child is never too young for a hearing test! Different ages require special considerations, but children of all ages can have their hearing tested. Most children born in Washington State receive a hearing test before being discharged from the hospital.

Hearing tests are painless and encouraged for all newborns. According to statistics, approximately 3 in 1000 births will result in permanent hearing loss. Additionally, chronic ear infections, speech and language concerns and some illnesses and infections may lead your child to need a test.

You may remember having your hearing screened as a child at school. Hearing tests have come a long way from the traditional method of wearing headphones and raising a hand in response to a tone! Hearing is assessed using different tools and techniques based on the age of a child...

How to avoid and care for cuts

It happens so quickly. You’re innocently chopping up vegetables for dinner when you find yourself on the receiving end of a cut — ouch! “Cuts are very common,” says Steven Rittenberg, M.D., who specializes in Internal Medicine at the Swedish Issaquah Primary Care Clinic. “However, there are some practical ways to prevent them, and some specific steps for treating them that can save you a trip to the doctor.”

Avoiding The “Ouch!”

Preventing cuts in the home is largely common sense, but life gets busy and we get careless, so here are a few reminders:

  • Keep knives sharp. Although this may sound counter-intuitive, a sharp knife slides more easily through an item avoiding a slip that may cut something you didn’t intend to cut, like your finger.
  • Pay attention. Resist the temptation to become distracted while using a knife.
  • Cut away from, not toward, yourself.
  • Don’t hold food that you are cutting; use a cutting board.
  • Don’t leave knives in dangerous places — loose in a drawer, in the sink, on the counter or facing up in the dishwasher — especially if you have children.
  • When handing someone a knife or sharp scissors, hold the flat part of the knife blade or closed blades of the scissors so they can grasp the handle.
  • Don’t pick up broken glass; sweep or vacuum it up thoroughly.

Treating It Right

When a cut does occur, the proper treatment will help to avoid infection or other complications:

The Practice Argument

 Practice, practice, practice...all kids are involved in something they have to practice. They all practice spelling and math equations. They might practice their soccer drills, or their cello. The old saying “practice makes perfect” is true.

So, did you know that arguing with your kids is also practice? Practice for what? What possible good could come from arguing? Just like any other skill, when you argue with your kids you’re developing their ability to stand up for themselves. This is crucial in standing up to peer pressure and bullies.

No one person is right 100% of the time, including parents, but parents often don’t want to admit when they’re wrong. When our kids make mistakes, and we tell them 'it’s okay, everyone makes mistakes' and yet, some parents refuse to admit when they make mistakes. Is it a matter of pride, or do we believe that if we admit we made a mistake that it will appear as though we’re weak?

Preventing Pertussis

We currently have a pertussis (whooping cough) epidemic occurring in Washington State. Infants under 6 months of age are particularly vulnerable but anyone, even if you are fully vaccinated, could potentially contract the disease and spread it.

(Is it really an epidemic? Yes: an epidemic (of a disease) affects many persons at the same time, and spreading from person to person in a locality where the disease is not permanently prevalent.)

Pertussis (whooping cough) is a very contagious disease caused by a type of bacteria called Bordetella pertussis. Among vaccine-preventable diseases, pertussis is one of the most commonly occurring ones in the United States (CDC).

What are the symptoms of whooping cough?

The early signs for pertussis are ...

Look Before You Lock

 Why is it so dangerous to leave a child alone in a car?  Because of biology, anatomy, thermodynamics.

Let’s talk a little about Infant and Child Anatomy:

  • Infants and children do not temperature regulate well. They have too much surface area for their body mass, meaning they lose heat too quickly because they don’t have enough mass to contain the heat.
  • Because they lose heat quickly, they generate it faster, 3 to 5 times faster than adults. For example, when you’re holding a baby for a while and then hand them off to someone else, you feel chilled. This is because the baby was generating so much heat that our temperature drops. (We are the best thermo-regulators that a baby can have.)

Next, let’s set the stage and look at what happens in a car:

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