Gastroenteritis is a viral infection of the gut. The rotavirus is one of the most common viruses responsible, particularly in children, and it often appears in epidemics, and usually in spring or early summer. It passes from one person to another through contamination of the hands and food. Another virus that may be responsible is the Astrovirus amongst many others.
Patients develop an uncomfortable feeling in the stomach, gurgling, cramping pains and then vomiting. A few hours later the vomiting starts to ease, and diarrhoea develops. The infection lasts from one to three days and young children may become rapidly dehydrated and require urgent hospitalisation.
Usually no investigations are necessary, but faeces tests may be performed if another cause is suspected and blood tests are sometimes necessary for dehydration.
The treatment involves a specific diet to replace the fluid and vital salts that are rinsed out of the body by the vomiting and diarrhoea, and then careful reintroduction of foods. In adults, medications can be used to slow diarrhoea, and paracetamol can be used for belly pain at all ages. Some children develop intolerance to milk sugar (lactose) after the infection, and this may prevent them from returning to a normal diet for weeks or months.
Take small amounts of food and fluids very frequently (every hour), rather than large amounts three times a day. DAY 1 CLEAR FLUIDS ONLY.
Repalyte, Hydralyte and Gastrolyte (available from chemists and taste better if cold) are best, but white grape juice, clear soups, Bonox, very dilute flat lemonade, very dilute cordial, and frozen cordial may be used for a short time in milder cases. Average 50 mLs. an hour for a child, 100 mLs. an hour for an adult.
Do NOT drink plain water.
Isomil, Prosobee, Infasoy etc. can be used as a milk substitute in infants.
Lactose free milk (“Lactaid”) may be used.
Breast milk is perfect for infants even with gastroenteritis.
DAY 2 LIGHT DIET.
Continue clear fluids and add bread, toast, boiled rice, dry biscuits (eg: quarter slice of bread, half a dry biscuit every half hour) .
DAY 3 ADD NUTRITION.
Boiled vegetables, fruits, white meats (chicken breast, fish), cereals.
DAY 4 GRADUALLY INCREASE FOOD INTAKE
Until return to normal.
AVOID
All dairy products (eg: milk, cream, cheese, butter, ice cream, custard, yoghurt), eggs, red meat,
fatty and fried foods until completely better.
See also DIARRHOEA; NAUSEA AND VOMITING; ROTAVIRUS
German measles (rubella or third disease) is a contagious viral infection caused by a Togavirus, which is widespread in the community, and causes epidemics every few years. It spreads from one person to another with coughs and sneezes, but can be caught only once in a lifetime, although an infection in a child may be so mild that it is completely overlooked. The incubation period is two to three weeks.
Infection occurs most commonly in children, and produces a fine rash over the body that lasts only two or three days, is not itchy, and is not accompanied by the sore eyes and cold symptoms associated with common measles. There are often some enlarged lymph nodes at the back of the neck, and in severe cases there may be a fever, runny nose and joint pains.
If a pregnant woman catches the disease between the sixth and twelfth weeks of pregnancy, infection may cause blindness, deafness, heart damage and other serious defects to her child. As a result, an antibody blood test is sometimes done to confirm the disease or determine the immune status of a pregnant woman.
Paracetamol for fever and discomfort is all the treatment that is necessary.
Children must be excluded from school for four days after the rash first appears.
An effective vaccine is available, and all children are now given mumps, measles and rubella as a combined vaccine at one and four years of age. Once infected with, or vaccinated against rubella, antibody levels rise permanently and reinfection is not possible.
See also FIFTH DISEASE; MEASLES; ROSEOLA INFANTUM; VIRUS
A glue ear develops when phlegm and mucus from the nose pass up the thin Eustachian tube into the middle ear. It is difficult for these thick, sticky secretions to escape through the Eustachian tube to the back of the nose, particularly if the adenoids, which surround the opening of the tube into the nose, are swollen.
There is a feeling of blockage in the affected ear similar to that felt when descending (more common) or ascending a mountain and being unable to pop the ears clear. The glue may also be responsible for a middle ear infections (otitis media) and deafness.
Examination of the ear by an otoscope (magnifier and light) shows an opaque and bulging eardrum, and special instruments can measure the pressure in the middle ear. The surgical insertion of a small tube (grommet) through the eardrum to relieve the pressure is often necessary. Recurrent cases may require the surgical removal of the adenoids, which are lymph nodes that surround the nasal opening into the Eustachian tubes. There are very good results after appropriate treatment, but the problem may recur after the grommets fall out.
See also EARACHE; OTITIS MEDIA
Before a parent becomes concerned about the failure of a child to grow in height or weight, they should look at themselves. If both parents are small, it is unlikely that the child is going to reach average height. Genetics play a vital part in development and growth, and many of the causes of abnormally reduced growth are caused by a defect in the individual’s genes.
A child that is deprived of adequate nutrition will obviously not reach his or her expected height or weight, and anyone who suffers from a long-term illness will have his or her growth affected. Conditions as varied as severe asthma, underactive thyroid gland, heart disease (eg. hole in the heart), kidney infections or failure, coeliac disease (inability to digest gluten in wheat), other conditions in which food is poorly absorbed, deficiencies of vitamins or minerals (particularly zinc), Crohn disease (thickening and ulceration of a segment of gut) and cystic fibrosis (thick mucus in lungs and gut) are examples.
Steroid drugs may be used to control some long-term diseases, but can affect growth as a side-effect.
Psychiatric conditions such as anorexia nervosa may severely affect the nutrition of teenagers (particularly girls) and prevent them from ever reaching their expected height or weight.
The pituitary gland in the centre of the brain controls every other gland (eg. thyroid, ovary, testes) in the body. If this becomes diseased or damaged by a tumour it will have generalised adverse effects including altered growth rates.
Precocious puberty is the term for a very early development of adult sexual characteristics. Growth may cease early when this occurs, resulting in the individual being shorter than expected.
Foetal alcohol syndrome is caused by the mother drinking excessive amounts of alcohol during pregnancy, and results in a small baby that grows very slowly in the first few years of life. Small amounts of social drinking, and even the occasional episode of drunkenness during pregnancy do NOT cause this problem (although they are not advisable).
A large number of rare syndromes that affect the individual’s genetic make-up, bodily functions and general health can affect growth and result in dwarfism. A few of these include:- Bassen-Kornzweig syndrome (poor food absorption, poor coordination)
- Cockayne syndrome (blind and deaf)
- de Lange syndrome (intellectual disability, small head, hairy skin)
- Down syndrome (broad face, intellectual disability, slanted eyes)
- Hurler syndrome (abnormal facial development, inflamed joints)
- Laron dwarfism (due to lack of somatomedin C).
- Noonan syndrome (wide neck, prominent chest)
- Turner syndrome (female who fails to develop sexually due to a genetic defect)
- von Gierke syndrome (low blood sugar, persistent diarrhoea)
- Russell-Silver syndrome (uneven size of body sides).
See also CHILD SMALL; FAILURE TO THRIVE