Between 6 and 12 mo of age, after they become accustomed to solid foods and liquids by bottle and/or cup, most infants decrease the volume and frequency of breast-feeding . As the infant demands less milk, the mother’s supply gradually diminishes without causing discomfort from engorgement.

Weaning can be initiated when mutually desired by the mother and infant by substituting formula by bottle or cup for part and, subsequently, all of a breast-feeding. Breast-feeding is eventually replaced with formula-feeding, at which time the infant is weaned completely. Occasionally, an infant takes a cup as readily as a bottle. If so, the intermediate transfer from breast to bottle before transferring from bottle to cup can be avoided. These changes should be made gradually and should be a pleasant experience, not a conflict, for both the mother and the infant.

When cessation of nursing is necessary at an early age, use of a tight breast binder and application of ice bags may help decrease milk production. Restriction of the mother’s fluid intake and small doses of estrogen for 1–2 days also may help decrease milk production.

Important Principles for Weaning:

Begin at appx. 6 months  of age

Avoid foods with high allergenic potential (cow’s milk, eggs, fish, nuts, soybeans). Continue reading »

VN:F [1.9.2_1090]
Rating: 10.0/10 (1 vote cast)
VN:F [1.9.2_1090]
Rating: +2 (from 2 votes)
  • Share/Bookmark

Retinoblastoma occurs at a rate of 3.7 cases per million in the USA, with no racial or gender predilection. Overall, about 60% of cases are unilateral and nonhereditary, 15% are unilateral and hereditary, and 25% are bilateral and hereditary. Bilateral involvement at presentation is found in 42% of cases <1 yr of age, 21% of cases in children who are 1 yr of age, and less commonly in children presenting at older ages.

Clinical Manifestations:

Only about 10% of retinoblastomas are detected by routine ophthalmologic screening in the context of a positive family history. Retinoblastoma classically presents with leukocoria, a white pupillary reflex , which often is first noticed when a red reflex is not present at routine newborn or well-child examination or in a flash photograph of the child. Strabismus often is the initial presenting complaint. Orbital inflammation, hyphema, or pupil irregularity occurs with advancing disease.

Pain usually is a feature if secondary glaucoma is present.

Diagnosis:

The diagnosis is established by the characteristic ophthalmologic findings. Biopsy is contraindicated. Evaluation usually requires an examination under general anesthesia by an Continue reading »

VN:F [1.9.2_1090]
Rating: 0.0/10 (0 votes cast)
VN:F [1.9.2_1090]
Rating: 0 (from 0 votes)
  • Share/Bookmark

Treatment of an infant with wheezing depends on the underlying etiology. Response to bronchodilators is unpredictable, regardless of cause, but suggests a component of bronchial hyperreactivity. It is appropriate to administer albuterol aerosol and objectively observe the response. For infants <3 yr of age, it is acceptable to continue to administer inhaled medications through an MDI with mask and spacer if a therapeutic benefit is demonstrated. Therapy should be continued in all patients with asthma exacerbations from a viral illness.

The use of ipratropium bromide in this population is controversial, but it appears to be somewhat effective as an adjunct therapy. It is also useful in infants with significant tracheal and bronchial malacia who may be made worse by ?-2 agonists such as albuterol because of the subsequent decrease in smooth muscle tone.

A trial of inhaled steroids may be warranted in a patient who has responded to multiple courses of oral steroids, has moderate to severe wheezing, or a significant history of atopy including food allergy or eczema. Inhaled steroids are appropriate for maintenance therapy in patients with known reactive airways but are controversial when used for episodic or acute illnesses.

Oral steroids are generally reserved for atopic wheezing infants thought to have asthma that is refractory to other medications. Their use in first-time wheezing infants or those infants that do not warrant hospitalization is controversial.

Infants with acute bronchiolitis who are experiencing respiratory distress should be Continue reading »

VN:F [1.9.2_1090]
Rating: 0.0/10 (0 votes cast)
VN:F [1.9.2_1090]
Rating: 0 (from 0 votes)
  • Share/Bookmark
© 2012 Easy Pediatrics Suffusion WordPress theme by Sayontan Sinha