Immunization is the means of producing immunity (resistance by the body) to a specific disease. There are two types of immunization – active and passive. Active immunization is accomplish by injecting weakened or killed viruses or bacterial into the body. This stimulates the body’s natural defense system. Certain specialized white blood cell produce substances known as antibodies, which are carried in the bloodstream and are tailor – made to fight invading organism.
These antibodies remain in the body for years – sometimes a lifetime – to protect it against that particular disease. Passive immunization involves injecting read-made antibodies into the body. These antibodies are usually extracted from the blood of humans who are immune to a certain disease or of animals that have been immunized solely for the purpose of producing antibodies to be used in passive immunization. Passive immunization is borrowed immunity and is only temporary, but it serves to protect a person who may already be infected until the body has time to create sufficient quantities of its own antibodies. Immunization can protect against diphtheria, measles, mumps, pertussis (whooping cough), polio, rubella (German measles), and tetanus.
The Apgar score is a general evaluation of a baby’s condition, made soon after birth, to determine immediately whether the newborn needs emergency care. The Apgar scoring system was devised by the late Virginia Apgar, M.D., and the letters of her last name are an acronym for the factors being scored. At one minute and five minutes after an infant’s birth , a delivery room nurse, anesthesiologist, or pediatrician rates five factors, using a scale of 0 to 2: A (Appearance) – A score of 2 is given if the skin is completely pink; 1 if it is pink except for the hands and feet, which are bluish; and 0 if the entire body is blue (indicating lack of oxygen). P (Pulse) – A score of 2 is given for a pulse above 100; 1 for a rate less than 100; 0 for no pulse. G (Grimace, or reflex irritability) – A score of 2 is given if the baby cries vigorously when slapped lightly on the soles of the feet; 1, if the baby makes only a grimace or slight cry; 0, if there is no response.
A (Activity) – an active infant is given a score of 2; an infant who makes some movement of arms and legs, 1; a limp and motionless infant, 0. R (Respiration) – Strong efforts to breathe, together with vigorous crying, score a 2; slow, irregular breating; 1; no breathing at all, 0. Most babies score between 7 and 10 when tested one minute after birth. They are breathing well, crying, pinkish in color, active, and need to emergency measures. Those babies who score from 4 to 6 usually need help immediately.
The throat is suctioned to remove thick mucus, small blood clots, or bits of swallowed membrane ( from the amniotic sac that enclosed the baby before birth). Oxygen is sometimes given to assist breathing and restore color. The baby with an Apgar score of less than 4 is limp, pale or bluish, and perhaps without a heartbeat, and is in grave danger. The throat is suctioned, and the baby is placed on a mechanical respiratory until the baby can breathe on his or her own. A second Apgar score is determined five minutes after birth and recorded on the baby’s chart beside the first score.
The second score is a good measure of the baby’s adaption to the world outside the womb. A food allergy is an unusual sensitivity to a specific food. A food allergy is not a food intolerance, which exists when the body lacks the enzymes that are needed to digest a certain food. A food allergy exists when the body’s immune system manufactures antibodies as a reaction to the food. This food then becomes an ingestant allergen (an allergy-causing substance that is swallowed or eaten).
Any food can become an allergen, but the foods most commonly found to cause allergic reactions are milk, eggs, shellfish, fish, peanuts, chocolate, tomatoes, strawberries, and citrus fruits. The symptoms of a food allergy most commonly arise in the digestive tract and include cramps, nausea, vomiting, and diarrhea. Other signs that may also be present include hives, rash, headache, nasal congestion, and anaphylactic shock (a very serious reaction that can be fatal, characterized by breathing problems due to swelling of the larynx and collapse of blood vessels). Food allergies occur more often in children than in adults. Food allergy is diagnosed by having the patient maintain a detailed record of all foods eaten, as well as of the times when symptoms appear.
Elimination trials may also help identify the allergen; the patient eliminates one food at a time from the diet to see if the symptoms disappear. In addition, several tests are used to detect various types of allergens: scratch tests, in which a small amount of the suspected allergen is applied to a scratch on the skin; intracutaneous tests, in which a small amount of the allergen is injected in or under the skin; and radioallergosorbent testing, in which antibodies developed in response to specific allergens are measured in a blood sample. There is no way to treat a food allergy other than to avoid eating the food and to treat the symptoms of a reaction should one develop. Fortunately, children usually outgrow these allergies. Some doctors feel that infants who are breast-fed for up to a year are less likely to develop food allergies than babies who are formula-fed or who are breast-fed for only a couple of months.
This continues to be a controversial issue. Sudden Infant death syndrome (also called crib death) is the unexplained and sudden death of a baby- often, the baby is perfectly well when put to bed but dies silently during sleep. In the United states, SIDS is second only to accidents as a cause of death in infants from two weeks to one year of age, causing 8,000 to 10,000 deaths from SIDS occur in the third or fourth month of life, with higher death rates for boys, children of teenage mothers, infants from poor families, and babies who were premature. Cigarette smoking by the mother during pregnancy appears to be one of the biggest risk factors for SIDS, as is use of drugs such as cocaine or heroin during pregnancy. There are more SIDS deaths in the winter than in the summer.
It once was thought that SIDS is caused by smothering in the bedding, but this is untrue. It is also not attributable to clogging of the airways by vomited food, to bottle feeding, or to any other cause that parents could prevent. Some investigators believe that a combination of conditions is necessary to trigger SIDS, including a narrowed and inflamed airway, temporary airway obstruction, chronic oxygen deficiency, and irregular breathing, leading to a spasm of the trachea (wind-pipe) and death. Research continues. Parents who lose a child to SIDS are totally unprepared for the death and usually have overwhelming guilt feelings – that something they did or did not do caused the death of their child.
An autopsy will usually prove that the death was not the parents’ fault. Doctors and nurses who take the time to discuss the death fully with the parents can be very helpful. So can another parents who has lost a child to SIDS. There are now many local chapters of National Sudden Infant Death Syndrome Foundation and the International Council for Infant Survival, both of which can be valuable sources of counseling and information. Treatment of a patient with a cleft lip or a cleft palate ( or both ) requires the services of a specialized team that includes a pediatrician, an orthodontist ( a dentist who specializes in the prevention or correction of misalignment of teeth), a speech therapist, a plastic surgeon, a psychologist, an audiologist ( a specialist in communication disorders), and an otolaryngologist ( a physician who specializes in the treatment of disorders of the ears, nose, and throat).
Treatment may take place at a specialized clinic hospital center or may be coordinated by pediatrician who consult experts as needed. Before any treatment can begin, however, steps must be taken to permit the child to eat. a cleft lip prevents normal sucking, and cleft palate allows milk to run out of the nose, ofter causing a choking and vomiting. Special feeding devices are used, such as a nipple with an enlarged flange to cover the cleft or a regular nipple with enlarged holes. A small syringe with a short rubber tube, like one used to baste a turkey, may be used to feed a child with a cleft lip, although sometimes such a child cab be breast-fed.
A few days after birth, an orthodontist skilled in cleft palate repair may be able to fashion an appliance that provides a temporary roof for the mouth, enabling regular feeding. At the same time, the appliance prevents the mouth from being distorted before the plate can be closed. Some surgeons correct a cleft lip in the first few days of the child’s life because it will make the baby more acceptable to his or her parents and make it easier to feed the baby by bottle. However other surgeons delay the operation fro two to eight months, so that surgeon will not interfere with the growing bonds of affection between mother and baby (for one thing, the baby cannot breast-feed for six weeks after the operation ) and to rule out other birth defects that might interfere with recovery. Plastic surgery to correct cleft plate usually takes place in the second year of life.
Some surgeons repair the soft palate first, when the child it between 6 and 18 months of age, and the hard palate much later – sometimes not until the age of five years. Although early surgery helps the child’s emotional and speech development, some surgeon wait because they are concerned that early surgery may cause distortion of growth in the middle third of the face. While waiting, the child wears an appliance that acts as a roof over the mouth. The problems created by cleft palate and cleft lip cannot be solved only by surgery. The services of an orthodontist are needed for youngster with cleft palate, not only to make appliances but to straighten teeth that are poorly positioned.
A speech therapist aids the child in developing speech, which is altered because of the missing or inadequate soft palate or artificial palate. A psychologist helps to treat emotional and social problems sometimes caused by being different in speech or appearance. An otolaryngologist should examine the child monthly for middle ear infections, which are common in young children with cleft palate. An audiologist helps those children who develop hearing loss because of middle ear infections. With proper care and encouragement and with modern plastic surgery, the average child with a cleft can make a good recovery.
Cleft lip and cleft palate, a defect in one of every 700 to 800 newborns, is characterized by a split running through all or part of the upper structure of the mouth. A cleft lip ( or harelip) may be only a small notch near the center of the upper lip, or it may extend into the nostril. A cleft in the palate can be minor as a split in the uvula (the little projection of tissue that hangs down in the back of the throat), or it may divide the entire soft palate (the muscular tissue that covers the roof of the mouth). In its most severe form, a cleft splits not only the soft palate ( the bony roof of the mouth) and upper jaw, joining with a cleft lip. Thee cleft may even divide the palate into three parts, resulting in a split on either side of the nose and leaving the middle section of the upper jaw and gum dangling.
The formation of a cleft lip occurs in the early stage of pregnancy, soon after the fourth week, when the baby’s face starts in form. Bulges of tissue on either side of the face grow toward the midline to form the nostrils and lips. at about the seventh week they normally meet and join; if they do not, a cleft lip is the result. A failure of development in eight week of pregnancy causes cleft palate. The palate is formed from two plates of tissue, which originally are on either side of the developing tongue.
As the head and neck grow, the tongue moves downward and the tissue plates move into position and fuse into – one unless there is an error or weakness, which results in cleft palate. The underlying causes of cleft lip and cleft palate are not fully understood. There is an inherited tendency toward the defects. More than one-fourth of children with cleft lip also have a relative with a cleft. If parents without cleft defects have one child with a cleft, they have a five percent risk of having a second child with a cleft; if they have two children with clefts, there is a 12 percent risk of a cleft in future children.
Perhaps some difference in the uterus, such as poor blood supply to the fetus, combines with an inherited weakness to produce the error of development. Certain chemicals or medications, too may vitamins or not enough, and viruses have been suggested as possible causes of cleft defects. Cleft lip and cleft palate are often associated with other birth defects. Of every six children who have a cleft lip, with or without cleft palate, one will have one or more other birth defects. almost 50 percent of children with cleft palate also have another defect, such as joined fringes or toes, malformed ears, spina bifida, heart disease, or clubfoot.
Circumcision the surgical removal of the foreskin, the retractable sleeve of skin covering the glans ( the head of the penis). In some regions, the operation is performed as a religious ritual on the eighth day following birth. In hospitals, it is usually done on the day before a baby boy goes home. In any event, if it is to be done for non medical reasons, it should be done in infancy and not later, when it is a more serious operation and might harm the child psychologically. During the five-minute operation, which is usually done without anesthesia, the foreskin is carefully cut away.
Gauze coated with petroleum jelly is applied to the incision. In most cases, the incision heals rapidly, forming a dry scab that drops off after a few days. Although the incision should kept clean (but not submerged in bathwater), no other special care is necessary. Other than a few drops of blood that might be produces if the diaper rubs against the cut, there is normally bleeding. Routine circumcision for new borns is controversial.
The decision should be made by the parents after consideration of both sides of the question. The operation has become standard in America hospitals in recent decades as cleanliness measure. In a young boy, the foreskin completely covers the head of the penis and cannot be pulled back very far. If the penis is not kept clean, urine and other substances can cause irritation of the glans and perhaps lead to infection between the foreskin and the glans. However, normal care can prevent this problem.
There is some recent evidence that uncircumcised males have a higher rate of bladder and kidney infections, but further information is needed be fore any strong conclusions can be drawn. Even though the foreskin at first cannot be pulled back very far because of bands of tissue that bind it to the glans, it is necessary to wash only the part of the glans that can be uncovered comfortably at any one stage (the foreskin should never be forced back). The bands of tissue gradually dissolve, and by later childhood, the foreskin can be pulled back completely. Some researchers believe that circumcision reduces the risk of cancer of the penis in the circumcised man and cancer of the cervix ( the neck of the uterus) in his sexual partner and may help prevent venereal disease. However, there is insufficient evidence to support these views.
Very seldom is there a medical reason to perform a circumcision. It should never be done on the first day of life, or if the baby is ill or premature. Furthermore, it should be delayed indefinitely if there is any abnormality of the glans or penis, so that the foreskin can be used later as graft tissue to repair the defect. It should not be done if the mother was taking any medication that promotes bleeding, such as an anticoagulant or aspirin, during pregnancy or is taking such a medication while breast-feeding, nor should it be done if there is any family history of hemophilia or other bleeding disorders. Risks of circumcision include local infection, which may lead to significant hemorrhage and mutilation.
Many medical authorities feel that there is no absolute medical reason for routine circumcision of the newborn. Adequate hygiene offers the same advantages as routine circumcision without the risk of the operation. Parents, therefore, should consider all factors – cultural, religious, and medical – before making decision about circumcision. Colic means different things to different people, but the universal characteristic is crying - not just shot periods of fussiness that can be stopped by changing or feeding or cuddling - but long periods of crying with no apparent cause that defy all attempts to stop them. It has long been assumed that colic arises from some gastroin -testinal disorder.
However, studies have shown no correlation between colic and poor weight gain or excessive vomiting, constipation, or diarrhea. Colicky babies are generally quite healthy, with no sign of nutritional problems. Nor does the problem appear to be hunger; the crying spell often begin after a feeding, not before one. It has been suggested that bottle – feeding is at fault, but breast-fed infants ar just as like to have colic. Lactose intolerance, food sensitivity, and allergies have also been suggested as causes.
Some babies with colic seem to have no such digestive symptoms – their crying seems to be related to general irritability, possibly because of immaturity of the nervous system or exceptional sensitivity to the environment. Other babies have a combination of the two types. Colic most often begins when an infant is two to four weeks old. The baby will cry inconsolably for hours a day. These bouts of crying often occur as if on schedule (most often in the late afternoon or early evening).
The colicky baby pulls hie or her legs up, clenches his or her fists, screams, and turns red. The baby may nurse briefly but then stop to continue crying. The abdomen may be distended as if with gas, and the baby may even pass gas frequently. Generally, these are no other gastrointestinal symptoms; the bowel movements are normal, and the baby doesn’t spit up any more than most babies. The baby’s sleep pattern is often disrupted – he or she may wake frequently (every two hours or so), cry fretfully, take one to two ounces of formula or a few minutes at the mother’s breast, fall into fitful sleep, and then awaken to repeat the sequences.
Before assuming that your baby has a colic, check for other possible causes of crying , such as pain from open diaper pin or discomfort from being overheated, constipated, hungry, or wet. See whether your baby responds promptly to talking and cuddling - a baby in pain can be destructed, but only temporarily. Also check for signs of illness: colic is not associated with fever, diarrhea, vomiting, cough, a runny nose, or reddened eyes. Your pediatrician will not to rule out more serious causes of crying before assuming that your baby colic. Signs of illness, such as sores in the mouth or gastrointestinal or urinary tract problems, will be sought.
Although conclusive scientific evidence for a dietary basis for colic is lacking, your doctor may want to investigate the possibilities that something in the baby’s diet (or in the mother’s diet if the baby is breast-fed) may be causing the condition. If the colic seems to be due, at least in part, to an accumulation of gas in the abdomen, do not overfeed the baby and be sure to burp him or her thoroughly after feedings. If you are bottle-feeding, the check the nipple hole, if it is too larger or too small, the baby may be swallowing too much air. A warm hot-water bottle on the abdomen may relieve some discomfort. The baby may be most comfortable lying on his her stomach.
If the colic seems to be due to irritability, it might be helpful to restrict visitors and keep the home environment as peaceful as possible. Some researchers believe that overly sensitive babies may be upset by an atmosphere changed with too much noise, too much activity, and too much emotional stress. Your physician will probably not recommended any medical treatment of colic. Colic usually ends two or three months after it begins, with no physical or emotional consequences. Outside intervention and prevention for child abuse When physicians, teachers, or other professional suspect child abuse, they are required by law in the most state to report it to a government social service agency or welfare department.
However, punishment of the parents is not the goal of the law. Jailing a parent might injure the child as much as the original abuse if the parent is capable of being good father or mother in the future. Removing the child from the family may be necessary to protect the youngster from future injury, but most cases this is not done or the removal is only temporary. The child may stay in the hospital for few days while the case is studies and parents are interviewed. In many communities, a team made up of a social worker, a pediatrician, a psychiatrist, and other specialist talk to the child and the parents and develop a long term treatment plan.
This often involves periodic visits by social workers to the home and psychological help for one or both parents. Practical help, such as day care for small children and household help by a trained homemaker, can ease the burdens on an overworked mother. If there is a local chapter pf Parents Anonymous, an organization of parents who formerly abuse their children, this may be another source of support. Parents who are afraid that they might abuse their children should talk frankly to their family doctor or social worker. Joining a parent support group may be a helpful way to share child – care ideas and experiences.
If a baby is born ill or prematurely and must stay in the hospital after the mother come home, the parents should visit the baby every day and stay as close as possible so that the baby will not be a stranger when he or she comes home.