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Common Illnesses of Babies Part2


Common illnesses of babies like nausea and vomiting, diarrhea, diaper rash, oral thrush and reactive airway disease (RAD) are discussed in this presentation. – PowerPoint PPT presentation

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Title: Common Illnesses of Babies Part2

Common Illnesses of Infants and Children Part 2
  • P.Naina Mohamed
  • Pharmacologist

  • Illnesses discussed in this presentation
  • Nausea and Vomiting
  • Spitting up in babies
  • Diarrhea
  • Stomach Flu
  • Diaper rash
  • Oral thrush
  • Asthma/Reactive Airway Disease (RAD)

Nausea and Vomiting
  • Nausea
  • Unpleasant sensation of wanting to vomit.
  • Associated with cold sweat, pallor, salivation,
    loss of gastric tone, duodenal contraction, and
    the reflux of intestinal contents into the
  • Precedes vomiting, but can occur by itself.
  • Vomiting
  • Forceful expulsion of the contents of the
    gastrointestinal system out through the mouth.
  • Evolved as a defense mechanism of the body
  • Vomiting serves as a protective function to get
    rid of the noxious substances that have been
    ingested from the body, rather than allowing them
    to be retained and absorbed by the intestine.

Reasons for vomiting in babies and children
  • Food poisoning.
  • Gastro-intestinal infection
  • Colds and flu.
  • Chest infections, such as pneumonia or
  • Sore throat due to tonsillitis or Strep throat.
  • Gastro-esophageal reflux disease (GERD).
  • Urinary tract infection (UTI).
  • Appendicitis.
  • Hepatitis.
  • Blockage in the bowel, such as pyloric stenosis
    or duodenal atrasia.
  • Food or milk allergy or intolerance.
  • Ingestion (eating or drinking) or inhalation
    (breathing in) of toxins.
  • Medications - such as antibiotics
  • Head injury.
  • Infections of brain tissues, such as meningitis.
  • Dizziness - motion sickness.
  • Overeating.
  • Excitement.
  • Extreme anxiety or emotional stress.

Mechanism of Vomiting
  • Distention or Acute infectious gastroenteritis
  • Irritation of the GI mucosa
  • Activation of 5-HT3 receptors of CTZ of fourth
    ventricle of the brain
  • Closure of Glottis
  • Contraction and fixing of Diaphragm
  • Closure of Pylorus
  • Relaxation of Gastric wall and esophageal orifice
  • Forceful contraction of Abdominal muscles
  • Vomiting

Causes of Vomiting
  • Neonates
  • Forceful vomiting in newborns can indicate a
    serious conditions like Pyloric stenosis
    (blockage or narrowing of the stomach) or
    Intestinal obstruction (blockage of the
    intestines) and always requires further
  • Infants can also vomit because of infections of
    the intestine or other parts of the body. Any
    young infant (newborn to 3 months) who develops a
    temperature of 100.4º F (38º C) or higher, with
    or without vomiting, should see a doctor or
  • Children
  • The most common cause of vomiting in older
    infants and children is infectious
    gastroenteritis (an infection of the stomach or
    intestines), usually caused by a virus. Vomiting
    caused by gastroenteritis usually begins suddenly
    and resolves quickly, often within 24 hours.
    Other signs of gastroenteritis can include
    nausea, diarrhea, fever, or abdominal pain.
  • Gastroenteritis can develop after eating
    contaminated food or putting a contaminated
    object (or hand) into the mouth. The viruses that
    commonly cause gastroenteritis are spread easily.
    Careful hygiene (especially hand washing) can
    prevent these infections from spreading.
  • Less commonly, vomiting occurs after consuming
    improperly stored or prepared foods that contain
    bacteria or toxins this is called food
  • Other illnesses like gastroesophageal reflux,
    peptic ulcer disease and others can also cause
    vomiting in older infants and children.

Home Care
  • The following are some simple recommendations to
    help the children with nausea and vomiting at
  • If a breastfeeding infant vomits, he or she
    should continue to breastfeed unless your doctor
    or nurse tells you otherwise.
  • Oral rehydration solutions are not usually needed
    for infants who exclusively breastfeed because
    breastmilk is more easily digested.
  • If your infant vomits immediately after nursing,
    you can try to breastfeed more frequently and for
    a shorter time. For example, breastfeed every 30
    minutes for five to 10 minutes. If vomiting
    improves after two to three hours, resume the
    usual feeding schedule.
  • If vomiting worsens or does not improve within 24
    hours, call your child's doctor or nurse.
  • If your infant drinks formula, initially offer
    one to two ounces of an oral rehydration solution
    every 30 minutes for two to three hours. If
    vomiting improves, resume feeding with full
    strength infant formula.
  • If vomiting worsens or does not improve within 24
    hours, call your child's doctor or nurse.

Home Care
  • Children who are vomiting but are not dehydrated
    can continue to eat a regular diet as tolerated.
    Dehydrated children require rehydration
    (replacement of lost fluid).  
  • Monitor for signs of dehydration, and do not
    force the child to eat, especially during the
    first 24 hours. Encourage the child to drink
    fluids. The best fluids are the commercially
    prepared oral rehydration solutions.
  • Oral rehydration therapy (ORT) was developed as a
    safer, less-expensive, and easier alternative to
    intravenous (IV) fluids. Oral rehydration
    solution (ORS) is a liquid solution that contains
    glucose (a sugar) and electrolytes (sodium,
    potassium, chloride), which are lost with
    vomiting and diarrhea.
  • Children who refuse to drink or who vomit
    immediately after drinking ORS should be
    monitored closely for worsening dehydration.
    Children who are not dehydrated can continue to
    drink ORS between episodes of vomiting to prevent
  • you should not give antiemetic drugs to an infant
    or child unless the child's doctor or nurse has
    recommended them.
  • Other fluids, including water, diluted juice, or
    soda can be given in small quantities.

Home Care
  • Apple, pear, and cherry juice, and other
    beverages with high sugar content, should be
    avoided. Sports drinks should also be avoided
    since they have too much sugar and have
    inappropriate electrolyte levels.
  • Recommended foods include a combination of
    complex carbohydrates (rice, wheat, potatoes,
    bread), lean meats, yogurt, fruits, and
    vegetables. High fat foods are more difficult to
    digest, and should be avoided.
  • It is not necessary to restrict a child's diet to
    clear liquids or the BRAT diet (bananas, rice,
    applesauce, toast). Although these and similar
    foods might be recommended to decrease diarrhea,
    these foods do not contain enough nutrients for a

When to seek medical help
  • You should call your doctor or nurse immediately
    if your child has any of the following
  • Bile (green) or blood-tinged (red or brown) vomit
  • Any episode of vomiting in a newborn, or vomiting
    that continues for more than 24 hours in an
    infant or child
  • If an infant refuses to eat or drink anything for
    more than a few hours
  • Moderate to severe dehydration dry mouth, no
    tears when crying, not urinating or having a wet
    diaper in four to six hours (for babies and young
    children) or not urinating in six to eight hours
    (for older children).
  • Abdominal pain that is severe, even if it comes
    and goes
  • Fever higher than 102ºF (39ºC) once or fever
    higher than 101ºF (38.4ºC) for more than three
    days but in case of newborn (From birth to 3
    months) the temperature should be less than
  • Behavior changes, including lethargy or decreased

Spitting up
  • Spitting up is another common occurrence during
    infancy. Infants normally spit up small amounts
    (usually lt 5 to 10 mL) during or soon after
    feedings, often when being burped.
  • Causes
  • Rapid feeding,
  • Air swallowing, and
  • Overfeeding
  • Vomiting is differed from spitting up in
    forcefulness and associated illnesses. Vomiting
    generally occurs soon after a meal and produces a
    much greater volume than spitting up.
  • Some babies spit up more than others, but most
    are out of this phase by the time they are
    sitting. A few heavy spitters will continue
    until they start to walk or are weaned to a cup.
    Some may continue throughout their first year.

Possible Mechanism
  • Infants (Less than 6 to 12 months)
  • Have incompletely developed Sphincter or valve
  • (elastic-like muscle at the entry to the stomach
    which closes like a valve to prevent liquids from
    being pushed back up)
  • The valve is easily pushed back by the contents
    of the stomach
  • Regurgitation or Spitting up

Difference between regurgitation and vomiting?
  • Unlike spitting up, vomiting is characterized by
    the forceful expulsion of the contents of the
  • It's important to know the difference between
    vomiting and spitting up because repeated
    vomiting can be a signal of a more serious
    illness, and because it can easily lead to
  • Dehydration is a dangerous condition in which
    excessive loss of body fluids results in a
    potentially life-threatening imbalance of water
    and essential body salts.
  • If vomiting is persistent, accompanied by very
    high temperatures and/or increasing lethargy, or
    if vomit contains blood, medical attention should
    be sought immediately.
  • Occasional vomiting, if unaccompanied by other
    symptoms, may not be a cause for concern but
    should be discussed with a doctor.

Home Care
  • Make each feeding calm, quiet, and leisurely.
  • Avoid interruptions, sudden noises, bright
    lights, and other distractions during feedings.
  • Burp your bottle-fed baby at least every three to
    five minutes during feedings.
  • Avoid feeding while your infant is lying down.
  • Hold the baby in an upright position for 20 to 30
    minutes after each feeding.
  • Do not jostle or play vigorously with the baby
    immediately after feeding.
  • Try to feed her before she gets frantically
  • If bottle-feeding, make sure the hole in the
    nipple is neither too big (which lets the formula
    flow too fast) nor too small (which frustrates
    your baby and causes her to gulp air). If the
    hole is the proper size, a few drops should come
    out when you invert the bottle, and then stop.
  • Elevate the head of the entire crib with blocks
    (dont use a pillow) and put her to sleep on her
    back. This keeps her head higher than her stomach
    and prevents her from choking in case she spits
    up while sleeping.
  • Any upright position, such as holding your baby
    to your shoulder (as you would to burp him or
    her), will help reduce regurgitation.However,
    placing the baby in an infant seat can make
    matters worse and should be avoided, especially
    immediately after a feeding. The baby's slouching
    position in this kind of seat puts pressure on
    the stomach that can result in regurgitation. Be
    sure to consult your doctor before making any
    changes in your baby's position or diet.

  • Diarrhea is frequent loose or watery bowel
    movements that deviate from a child's normal
  • Diarrhea is a very common pediatric concern and
    causes 2 to 3 million deaths/yr worldwide. It
    accounts for about 9 of hospitalizations in the
    US among children aged lt 5 yr.
  • Breastfed infants who are not yet receiving solid
    food often have frequent loose bowel movements
    that are considered normal.
  • Diarrhea may be accompanied by anorexia,
    vomiting, acute weight loss, fever, or passage of
  • Gastroenteritis is the most common cause.
  • Testing is rarely necessary in acute diarrhea.
  • Dehydration is likely if diarrhea is severe or
  • Oral rehydration is effective in most cases.
  • Antidiarrheal drugs (eg, loperamide IMODIUM) are
    not recommended for infants and young children.

  • Acute diarrhea usually is caused by
  • Gastroenteritis
  • Antibiotic use
  • Food allergies
  • Food poisoning
  • Most gastroenteritis is caused by a virus
    however, any enteric pathogen can cause acute
  • Chronic diarrhea usually is caused by
  • Dietary factors
  • Infection
  • Celiac disease
  • Chronic diarrhea can also be caused by anatomic
    disorders and disorders that interfere with
    absorption or digestion.

Possible Mechanism
  • Gastroenteritis
  • Inflammation or ulceration of the intestinal
  • Outpouring of plasma, serum proteins, blood, and
  • Increases fecal bulk and fluid content
  • Diarrhea

  • Vomiting and diarrhea is treated by replacing the
    fluid lost with a balanced fluid and electrolyte
    solution called Oral rehydration solution (ORS).
  • Oral rehydration solution (ORS) should contain
    complex carbohydrate or 75 mEq/L glucose and 75
    mEq/L Na (total 245 mOsm/L solution). ORS is
    recommended by the WHO.
  • Antidiarrheal drugs eg, loperamide are not
    recommended for infants and young children.
  • Sports drinks, sodas, juices, and similar drinks
    have too little Na and too much carbohydrate to
    take advantage of Na/glucose cotransport, and the
    osmotic effect of the excess carbohydrate may
    result in additional fluid loss.
  • Specific causes are treated (eg, gluten-free diet
    for children with celiac disease).
  • Children should eat an age-appropriate diet as
    soon as they have been rehydrated and are not
    vomiting. Infants may resume breast milk or

Stomach Flu
  • Stomach Flu is Contagious.
  • "Stomach flu" isn't actually the flu (influenza)
    but gastroenteritis, an upset stomach usually
    caused by a virus.
  • Symptoms
  • There is often fever at the onset along with
    variable degrees of respiratory symptoms.
  • vomiting tends to occur primarily in the first
    day or two of the illness it may be as little as
    once or twice a day or as severe as literally
    vomiting each and every time fluid are offered. 
  • When diarrhea is present, it may be very
    infrequent and may be as often as a stool an
  • How it spreads
  • Close contact with someone who has it
  • By eating food that's been prepared or touched by
    someone who has it.
  • Prevention
  • Try to keep your child away from people who have
    the stomach flu.
  • Teach him to wash his hands frequently,
    particularly before eating and after using the
  • Teach your child to avoid sharing foods and
    utensils with other kids.
  • Teach him not to put his fingers in his mouth.

Stomach Flu
  • Treatment
  • There is no specific treatment for stomach flu.
  • Give your child popsicles and extra fluids to
    make sure he stays well hydrated.
  • He should also rest.
  • Avoid spicy foods and fried foods.
  • Give small amounts of bland foods like gelatin,
    toast, crackers, rice, or bananas at first.
  • Feed him small amounts frequently.
  • If you think your child is not drinking enough or
    voiding enough (a child 1 year or older needs to
    void at least once every four hours) call your
  • If your little one is less than 1 year and has
    vomiting or diarrhea, consult your doctor.

Diaper rash
  • Diaper rash is a generalized term indicating any
    skin irritation that develops in the
    diaper-covered region.
  • Diaper rash is very common in babies.
  • Diaper rash is most commonly a kind of contact
  • Diaper rash may become secondarily infected by
    bacteria or yeast normally present on the skin.
    In this case, topical antibiotic ointments
    provide a rapid and effective therapy.
  • Synonyms
  • Diaper dermatitis (dermatitis inflammation of
    the skin), napkin (or "nappy") dermatitis and
    ammonia dermatitis.
  • Causes
  • Overhydration of the skin
  • Maceration
  • Prolonged contact with urine and feces
  • Retained diaper soaps
  • Topical preparations
  • More than 3 diarrheal stools per day
  • Side effects of oral antibiotics

Possible Mechanism
  • Increased wetness in the diaper area
  • Increased penetration of irritant substances
  • Superhydration urease enzyme found in the stratum
    corneum liberates ammonia from cutaneous bacteria
  • Lipases and proteases in feces mix with urine on
    nonintact skin
  • Increased (Alkaline) surface pH
  • Increased irritation
  • Diaper Rash

Diaper rash
  • Advantage of Breast Feeding
  • Breastfed infants
  • Lower pH of feces
  • Less susceptible to diaper dermatitis

Diaper rash
  • Prevention
  • Avoidance of skin irritants by frequent diaper
    changing provides the number-one preventative
  • Treatment
  • Frequent diaper changes
  • simple cleansing with water and soft cloths tends
    to be less irritating to the injured skin than
    disposable wipes.
  • Application of topical barriers (Petroleum jelly
    (Vaseline) or Zinc oxide cream), and rarely
    topical antibiotic/antifungal ointments, or
    low-potency hydrocortisone cream.
  • open-air exposure of the irritated skin is also
    extremely effective in helping clear up diaper
  • Let the baby go without a diaper for short
    periods of time, such as during naps.
  • Avoid using plastic or tightfitting diaper
  • Use larger than usual sized diapers until the
    rash goes away.
  • The absorbent gel material found in most of
    today's disposable diapers draws moisture away
    from the skin area, thus helping to promote a
    healthy diaper area.
  • Avoid High-potency steroid creams, powders, and
    concentrated baking-soda/boric-acid baths and
    neomycin-containing ointments.

Oral Thrush
  • Oral thrush is a yeast infection of the mouth
    that is caused by a fungal microorganism called
    Candida albicans.
  • Oral thrush is most common in infants and is
    generally not a serious condition, but it can be
    uncomfortable and lead to difficulties with
    eating or infant feeding if it does not resolve
    or is not treated.
  • 50 of the population has candida in their
  • Causes
  • Oral thrush may occur in babies because their
    immune systems take time to mature, making them
    less able to resist infection leading to sores
    and lesions in the mouth and on the tongue.
  • Under normal circumstances candida albicans is
    kept under control by bacteria. Taking strong
    antibiotics, especially for a long period of
    time, may kill bacteria, which can alter the
    balance of microorganisms in the mouth and result
    in a proliferation of yeast.
  • Candida albicans can also cause a yeast or thrush
    infection in the vagina, resulting in the
    exposure of an infant to the infection during the
    vaginal birthing process.
  • It can also cause an infection in a woman's
    nipples, which can then be transmitted to an
    infant's mouth during breastfeeding.

Oral Thrush
  • Infants
  • Immature immune system
  • Less protection against Candida
  • sores and lesions in the mouth and on the tongue
  • Oral Thrush

Oral Thrush
  • Candida
  • Infection in the vagina
    Infection in woman's nipples
  • Vaginal birth exposes the infant
    Breastfeeding transmits the
  • to the infection
    infection to the infant
  • Oral Thrush

Oral Thrush
  • Symptoms
  • Thrush appears as whitish, velvety lesions in the
    mouth and on the tongue. Underneath the whitish
    material, there is red tissue that may bleed
    easily. The lesions can slowly increase in number
    and size.
  • Lesions will begin to appear within the mouth,
    and one may have pain associated with lesion
    development. The corners of the mouth may crack
    when one opens the mouth.
  • If an older child or adult gets thrush in the
    mouth, or ulcers that look like they may be
    thrush, it may be a sign of another disease, so
    have a doctor check.
  • Other symptoms can include a loss of taste, or
    feeling as if swallowed a cotton ball. The thrush
    can become severe enough that one may have
    difficulty swallowing food.

Oral Thrush
  • Prevention
  • Pregnant women should consult with their licensed
    health care provider if they have symptoms of a
    vaginal yeast infection, such as vaginal itching
    and a cheesy white discharge.
  • Nursing women who have nipple discharge or pain
    should also notify their provider so they can be
    examined for a thrush infection in the nipples,
    which could be transmitted to the mouth of a
    nursing infant.
  • Thoroughly clean the nipples and pacifiers in hot
    water or dishwasher after each use.
  • Storing milk and prepared bottles in the
    refrigerator prevents yeast from growing.
  • If Breastfeeding nipples are red and sore,
    there's a chance the mother may have a yeast
    infection on her nipples, and that herself and
    the baby are passing it back and forth.
  • Treat the mother with antifungal ointment on her
    nipples while the baby is being treated with the
    antifungal solution.
  • Changing diapers frequently also prevents the
    fungal diaper rashes.

Oral Thrush
  • Treatment
  • The treatment may be drops or a gel which needs
    to be spread around the inside of the mouth, not
    just put on the tongue.
  • If the baby is breastfeeding, the mother's
    nipples may need to be treated at the same time
    as the baby to prevent the infection passing back
    and forth.
  • In many cases oral thrush in infants can
    disappear on its own and may need no treatment
    other than watching the progress of the mouth
    lesions. Because oral thrush may affect feedings,
    the pediatrician should still be notified if
    symptoms appear in an infant.
  • Treatment of older children and adults with oral
    thrush includes diagnosing any underlying
    diseases that may increase the risk for the
    infection. These include HIV/AIDS and diabetes.
    Treating the high blood sugar levels of diabetes
    may resolve a current infection and is key to
    minimizing the risk of developing recurrent
    infections of oral thrush.
  • A treatment plan may also include medications,
    including prescription topical or oral antifungal
    medications, such as fluconazole.
  • Therapy may also include eating yogurt or taking
    acidophilus supplements, which can help to
    correct the abnormal balance of microorganisms in
    the mouth, which leads to oral thrush.
  • Using antiseptic mouth washes may also be

Asthma/Reactive Airway Disease (RAD)
  • Reactive airways disease (RAD) is a term used to
    describe breathing problems in children up to 5
    years old.
  • Asthma develops atleast in 5 years old child.
  • The terms "reactive airway disease" and "asthma"
    are used interchangeably and the term "reactive
    airway disease" is used when asthma is suspected,
    but not yet confirmed.
  • Reactive airway disease (RAD) is transient.
  • RAD can resolve over time or it can progress to
    frank asthma.
  • Asthma is a chronic condition of wheezing brought
    on by various triggers like cigarette smoke,
    viruses, allergens, cold air and exercise.

Factors increasing the risk of RAD

  • Asthmatic mother or Someone in the family has
  • Absence of breast feeding or breastfed fewer than
    3 months.
  • Lung infection caused by a virus, such as
    respiratory syncytial virus (RSV).
  • Treated in the hospital for bronchiolitis
  • Secondhand smoke.
  • Tobacco smoke during pregnancy or the first year
  • Triggers of allergy like pollen and pets.

Pathophysiology of RAD
  • Environmental stimuli
  • Induction of an allergen-antibody interaction
  • Release of mediators like histamine, tryptase,
    heparin, leukotrienes, platelet-activating
    factor, cytokines, interleukins, and tumor
    necrosis factor from mast cells
  • Airway inflammation
  • Smooth muscle hyper responsiveness, edema, and
    increased mucous production
  • Increased work of breathing

Signs and symptoms of RAD
  • Wheezing Wheezing is a high-pitched whistling
  • Trouble breathing Chest tightness, flare
    nostrils and also take shorter, faster breaths
    than usual.
  • Cough Cough that does not go away and make
    crackle sound during breathing and coughing.
  • Fast heartbeat Heart may beat faster than usual
    due to breathing trouble.
  • Runny nose Runny nose may be present along with
    other signs and symptoms of RAD  

Preventive Measures
  • Do not let anyone smoke around the child
    Cigarette smoke can harm the child's lungs and
    cause breathing problems. Do not let anyone smoke
    inside home and quit smoking.
  • Keep all follow-up visits Make sure the child
    gets all of the vaccines recommended.
  • Avoid triggers Avoid areas where there is
    pollution, perfume, or dust. Remove pets from
  • Breastfeed your infant Breast milk helps protect
    the child from allergies that can trigger
    wheezing and other problems.
  • Help the child get enough exercise and eat
    healthy foods The child may need to take
    medicine through an inhaler 10 to 15 minutes
    before exercise. Give the child healthy foods.
  • Avoid spreading illness Keep the child away from
    others illnesses. Do not send the child to
    school or daycare when he is sick.
  • Make changes to your home Keep your home free
    from the triggers like dust mites, cockroaches,
    or mold. Keep the humidity (moisture level in the
    air) low. Fix leaks, and remove carpets where
    possible. Use mattress covers, and wash bedding
    every 1 to 2 weeks in hot water. Wash tables and
    other surfaces with weak bleach (1 tablespoon of
    bleach in a gallon of water).

Treatment of RAD
  • Short-acting bronchodilators (Salbutamol) They
    are used to relieve sudden, severe symptoms, such
    as trouble breathing. These medicines may be
    called relievers or rescue inhalers.
  • Long-acting bronchodilators (LABA) Long-acting
    bronchodilators (Salmeterol, Formeterol) may be
    called controllers. These medicines help open the
    airways over time, and is used to decrease and
    prevent breathing problems. Long-acting
    bronchodilators should not be used to treat the
    child for sudden, severe symptoms, such as
    trouble breathing.
  • Corticosteroids These medicines help decrease
    swelling and open the child's air passages so he
    can breathe easier.
  • Breathing treatments Use a nebulizer or an
    inhaler to help breathe in the medicine.
  • Oxygen Oxygen helps to breathe easier.

  • CURRENT Diagnosis Treatment Pediatrics, 21e
    William W. Hay, Jr., Myron J. Levin, Robin R.
    Deterding, Mark J. Abzug, Judith M. Sondheimer
  • Pediatric Clinical Advisor Instant Diagnosis
    and Treatment , Second Edition
  • Lynn C. Garfunkel, Jeffrey M.
    Kaczorowski, and Cynthia Christy

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