Giardiasis

Giardiasis, an illness that affects the digestive tract, is caused by a microscopic parasite called Giardia lamblia. The parasite attaches itself to the lining of the small intestines in humans, where it sabotages the body's absorption of fats and carbohydrates from digested foods.

Giardia is one of the chief causes of diarrhea in the United States, and is transmitted through contaminated water. It can survive the normal amounts of chlorine used to purify community water supplies, and can live for more than 2 months in cold water. As few as 10 of the microscopic parasites in a glass of water can cause a severe case of giardiasis in a human being who drinks it.

Young kids are three times more likely to have giardiasis than adults, which leads some experts to believe that our bodies gradually develop some form of immunity to the parasite as we grow older. But it isn't unusual for an entire family to have giardiasis, with some family members having diarrhea, some just crampy abdominal pains, and others with few or no symptoms.

Signs and Symptoms

It's estimated that between 1% and 20% of the U.S. population has giardiasis, and this figure may be 20% or higher in developing countries, where giardiasis is a major cause of epidemic childhood diarrhea. But more than two thirds of people who are infected may have no signs or symptoms of illness, even though the parasite is living in their intestines.

When the parasite does cause symptoms, the illness usually begins with severe watery diarrhea, without blood or mucus. Giardiasis affects the body's ability to absorb fats from the diet, so the diarrhea contains unabsorbed fats. That means that the diarrhea floats, is shiny, and smells very bad.

Other symptoms include:

• abdominal cramps
• large amounts of intestinal gas
• an enlarged belly from the gas
• loss of appetite
• nausea and vomiting
• sometimes a low-grade fever

These symptoms may last for 5 to 7 days or longer. If they last longer, a child may lose weight or show other signs of poor nutrition.

Sometimes, after acute (or short-term) symptoms of giardiasis pass, the disease begins a chronic (or more prolonged) phase.

Symptoms of chronic giardiasis include:

• periods of intestinal gas
• abdominal pain in the area above the navel
• poorly formed, "mushy" bowel movements (poop)

Prevention

Here are some ways to protect your family from giardiasis:

• Drink only from water supplies that have been approved by local health authorities.
• Bring your own water when you go camping or hiking, instead of drinking from sources like mountain streams.
• Wash raw fruits and vegetables well before you eat them.
• Wash your hands well before you cook food for yourself or for your family.
• Encourage your kids to wash their hands after every trip to the bathroom and especially before eating. If someone in your family has giardiasis, wash your hands often as you care for him or her.
• Have your kids wash their hands well after handling anything in "touch tanks" in aquariums, a potential source of giardiasis.
• Have your water checked on a regular basis if it comes from a well.

Also, it's questionable whether infants and toddlers still in diapers should be sharing public pools. But certainly they should not if they're having diarrhea or loose stools (poop).

Contagiousness

People and animals (mainly dogs and beavers) who have giardiasis can pass the parasite in their stool. The stool can then contaminate public water supplies, community swimming pools, and "natural" water sources like mountain streams. Uncooked foods that have been rinsed in contaminated water may also spread the infection.

In child-care centers or any facility caring for a group of people, giardiasis can easily pass from person to person. At home, an infected family dog with diarrhea may pass the parasite to human family members who take care of the sick animal.

Diagnosis

Doctors confirm the diagnosis of giardiasis by taking stool samples and sending them to the lab to be examined for Giardia parasites. Several samples may be needed before the parasites are found.

For that reason the doctor may order a much more sensitive test called the Enzyme-Linked ImmunoSorbent Assay or ELISA test.

Less often, doctors make the diagnosis by looking at the lining of the small intestine with an instrument called an endoscope and taking samples from inside the intestine to be sent to a laboratory. This is done in more extreme cases, when a definite cause for the diarrhea hasn't been found.

Treatment

Giardiasis is treated with prescription medicines that kill the parasites. Treatment typically takes 5 to 7 days, and the medicine is usually given as a liquid that your child can drink. Some of these medicines may have side effects, so your doctor will tell you what to watch for.

If your child has giardiasis and your doctor has prescribed medication, be sure to give all doses on schedule for as long as your doctor directs. This will help your child recover faster and will kill parasites that might infect others in your family. Again, encourage all family members to wash their hands frequently, especially after using the bathroom and before eating.

A child who has diarrhea from giardiasis may lose too much fluid in the stool and become dehydrated. Make sure the child drinks plenty of fluids but no caffeinated beverages, because they make the body lose water faster.

Ask the doctor before you give your child any nonprescription drugs for cramps or diarrhea because these medicines may mask symptoms and interfere with treatment.

Duration

The incubation period for giardiasis is 1 to 3 weeks after exposure to the parasite. In most cases, treatment with 5 to 7 days of antiparasitic medication will help kids recover within a week's time. Medication also shortens the time that they're contagious. If giardiasis isn't treated, symptoms can last up to 6 weeks or longer.

When to Call the Doctor

Call the doctor whenever your child has:

• large amounts of diarrhea, especially if he or she also has a fever and/or abdominal pain
• occasional, small episodes of diarrhea that continue for several days, especially if appetite is poor, and your child is either gradually losing weight or isn't gaining as much as expected

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Cough

Chugging cough medicine for an instant high certainly isn't a new practice for teens, who have raided the medicine cabinet for a quick, cheap, and legal high for decades. But unfortunately, this dangerous, potentially deadly practice is on the rise.

So it's important for parents to understand the risks and know how to prevent their kids from intentionally overdosing on cough and cold medicine.

Why Do Kids Abuse Cough and Cold Remedies?

Before the U.S. Food and Drug Administration (FDA) replaced the narcotic codeine with dextromethorphan as an over-the-counter (OTC) cough suppressant in the 1970s, teens were simply guzzling down cough syrup for a quick buzz.

Over the years, teens discovered that they still could get high by taking large doses of any OTC medicine containing dextromethorphan (also called DXM).

Dextromethorphan-containing products — tablets, capsules, gel caps, lozenges, and syrups — are labeled DM, cough suppressant, or Tuss (or contain "tuss" in the title).

Medicines containing dextromethorphan are easy to find, affordable for cash-strapped teens, and perfectly legal. Getting access to the dangerous drug is often as easy as walking into the local drugstore with a few dollars or raiding the family medicine cabinet. And because it's found in over-the-counter medicines, many teens naively assume that DXM can't be dangerous.

Then and Now

DXM abuse is on the rise, according to recent studies, and easy access to OTC medications in stores and over the Internet could be contributing to the increase.

The major difference between current abuse of cough and cold medicines and that in years past is that teens now use the Internet to not only buy DXM in pure powder form, but to learn how to abuse it. Because drinking large volumes of cough syrup causes vomiting, the drug is being extracted from cough syrups and sold on the Internet in a tablet that can be swallowed or a powder that can be snorted. Online dosing calculators even teach abusers how much they'll need to take for their weight to get high.

One way teens get their DXM fixes is by taking "Triple-C" — Coricidin HBP Cough and Cold — which contains 30 mg of DXM in little red tablets. Users taking large volumes of Triple-C run additional health risks because it contains an antihistamine as well.

The list of other ingredients — decongestants, expectorants, and pain relievers — contained in other Coricidin products and OTC cough and cold preparations compound the risks associated with DXM and could lead to a serious drug overdose.

Besides Triple-C, other street names for DXM include: Candy, C-C-C, Dex, DM, Drex, Red Devils, Robo, Rojo, Skittles, Tussin, Velvet, and Vitamin D. Users are sometimes called "syrup heads" and the act of abusing DXM is often called "dexing," "robotripping," or "robodosing" (because users chug Robitussin or another cough syrup to achieve their desired high).

What Happens When Teens Abuse DXM?

Although DXM can be safely taken in 15- to 30-milligram doses to suppress a cough, abusers tend to consume as much as 360 milligrams or more. Taking mass quantities of products containing DXM can cause hallucinations, loss of motor control, and "out-of-body" (disassociative) sensations.

Other possible side effects of DXM abuse include: confusion, impaired judgment, blurred vision, dizziness, paranoia, excessive sweating, slurred speech, nausea, vomiting, abdominal pain, irregular heartbeat, high blood pressure, headache, lethargy, numbness of fingers and toes, facial redness, dry and itchy skin, loss of consciousness, seizures, brain damage, and even death.

When consumed in large quantities, DXM can also cause hyperthermia, or high fever. This is a real concern for teens who take DXM while in a hot environment or while exerting themselves at a rave or dance club, where DXM is often sold and passed off as similar-looking drugs like PCP. And the situation becomes even more dangerous if these substances are used with alcohol or another drug.

Being on the Lookout

You can help prevent your teen from abusing over-the-counter medicines. Here's how:

• Lock your medicine cabinet or keep those OTC medicines that could potentially be abused in a less accessible place.
• Avoid stockpiling OTC medicines. Having too many at your teen's disposal could make abusing them more tempting.
• Keep track of how much is in each bottle or container in your medicine cabinet.
• Keep an eye out not only for traditional-looking cough and cold remedies in your teen's room, but also strange-looking tablets (DXM is often sold on the Internet and on the street in its pure form in various shapes and colors).
• Watch out for the possible warning signs of DXM abuse listed above.
• Monitor your child's Internet usage. Be on the lookout for suspicious websites and emails that seem to be promoting the abuse of DXM or other drugs, both legal and illegal.

Above all, talk to your kids about drug abuse and explain that even though taking lots of a cough or cold medicine seems harmless, it's not. Even when it comes from inside the family medicine cabinet or the corner drugstore, when taken in large amounts DXM is a drug that can be just as deadly as any sold on a seedy street corner. And even if you don't think your teens are doing it, chances are they know kids who are.

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Scarlet Fever

Scarlet fever is caused by an infection with group A streptococcus bacteria. The bacteria make a toxin (poison) that can cause the scarlet-colored rash from which this illness gets its name.

Not all streptococci bacteria make this toxin and not all kids are sensitive to it. Two kids in the same family may both have strep infections, but one child (who is sensitive to the toxin) may develop the rash of scarlet fever while the other may not. Usually, if a child has this scarlet rash and other symptoms of strep throat, it can be treated with antibiotics. So if your child has these symptoms, it's important to call your doctor.

Symptoms of Scarlet Fever

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks. Areas of rash usually turn white when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.

Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever above 101° Fahrenheit (38.3° Celsius), and swollen glands in the neck. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. A child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. With antibiotic treatment, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the child may not get a sore throat.

Preventing Scarlet Fever

The bacterial infection that causes scarlet fever is contagious. A child who has scarlet fever can spread the bacteria to others through nasal and throat fluids by sneezing and coughing. If a child has a skin infection caused by strep bacteria, like impetigo, it can be passed through contact with the skin.

In everyday life, there is no perfect way to avoid the infections that cause scarlet fever. When a child is sick at home, it's always safest to keep that child's drinking glasses and eating utensils separate from those of other family members, and to wash these items thoroughly in hot soapy water. Wash your own hands frequently as you care for a child with a strep infection.

Treating Scarlet Fever

If your child has a rash and the doctor suspects scarlet fever, he or she will usually take a throat culture (a painless swab of throat secretions) to see if the bacteria grow in the laboratory. Once a strep infection is confirmed, the doctor will likely prescribe an antibiotic for your child to be taken for about 10 days.

Caring for a Child With Scarlet Fever

A child with severe strep throat may find that eating is painful, so providing soft foods or a liquid diet may be necessary. Include soothing teas and warm nutritious soups, or cool soft drinks, milkshakes, and ice cream. Make sure that the child drinks plenty of fluids.

Use a cool-mist humidifier to add moisture to the air, since this will help soothe the sore throat. A moist warm towel may help to soothe swollen glands around your child's neck.

If the rash itches, make sure that your child's fingernails are trimmed short so skin isn't damaged through scratching.

When to Call the Doctor

Call the doctor whenever your child suddenly develops a rash, especially if it is accompanied by a fever, sore throat, or swollen glands. This is especially important if your child has any of the symptoms of strep throat, or if someone in your family or in your child's school has recently had a strep infection.

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Polio

Polio (also called poliomyelitis) is a contagious, historically devastating disease that was virtually eliminated from the Western hemisphere in the second half of the 20th century. Although polio has plagued humans since ancient times, its most extensive outbreak occurred in the first half of the 1900s before the vaccination, created by Jonas Salk, became widely available in 1955.

At the height of the polio epidemic in 1952, nearly 60,000 cases with more than 3,000 deaths were reported in the United States alone. However, with widespread vaccination, wild-type polio, or polio occurring through natural infection, was eliminated from the United States by 1979 and the Western hemisphere by 1991.

Signs and Symptoms

Polio is a viral illness that, in about 95% of cases, actually produces no symptoms at all (called asymptomatic polio). In the 4% to 8% of cases in which there are symptoms (called symptomatic polio), the illness appears in three forms:

• a mild form called abortive polio (most people with this form of polio may not even suspect they have it because their sickness is limited to mild flu-like symptoms such as mild upper respiratory infection, diarrhea, fever, sore throat, and a general feeling of being ill)
• a more serious form associated with aseptic meningitis called nonparalytic polio (1% to 5% show neurological symptoms such as sensitivity to light and neck stiffness)
• a severe, debilitating form called paralytic polio (this occurs in 0.1% to 2% of cases)

People who have abortive polio or nonparalytic polio usually make a full recovery. However, paralytic polio, as its name implies, causes muscle paralysis - and can even result in death. In paralytic polio, the virus leaves the intestinal tract and enters the bloodstream, attacking the nerves (in abortive or asymptomatic polio, the virus usually doesn't get past the intestinal tract). The virus may affect the nerves governing the muscles in the limbs and the muscles necessary for breathing, causing respiratory difficulty and paralysis of the arms and legs.

Contagiousness

Polio is transmitted primarily through the ingestion of material contaminated with the virus found in stool (poop). Not washing hands after using the bathroom and drinking contaminated water were common culprits in the transmission of the disease.

Prevention

In the United States, it's currently recommended that children have four doses of inactivated polio vaccination (IPV) between the ages of 2 months and 6 years.

By 1964, the oral polio vaccine (OPV), developed by Albert Sabin, had become the recommended vaccine. OPV allowed large populations to be immunized because it was easy to administer, and it provided "contact" immunization, which means that an unimmunized person who came in contact with a recently immunized child might become immune, too. The problem with OPV was that, in very rare cases, paralytic polio could develop either in immunized children or in those who came in contact with them.

Since 1979 (when wild polio was eliminated in the United States), the approximately 10 cases per year of polio seen in this country were traced to OPV.

IPV is a vaccine that stimulates the immune system of the body (through production of antibodies) to fight the virus if it comes in contact with it. IPV cannot cause polio.

In an effort to eradicate all polio, including those cases associated with the vaccine, the Centers for Disease Control and Prevention (CDC) decided to make IPV the only vaccine given in the United States. Currently, the CDC and American Academy of Pediatrics (AAP) recommend three spaced doses of IPV given before the age of 18 months, and an IPV booster given between the ages of 4 to 6, when children are entering school.

If you're planning to travel outside the United States, particularly to Africa and Asia (where polio still exists), be sure that you and your child have received a complete set of polio vaccinations.

Duration

Although the acute illness usually lasts less than 2 weeks, damage to the nerves could last a lifetime. In the past, some patients with polio never regained full use of their limbs, which would appear withered. Those who did fully recover might go on to develop post-polio syndrome (PPS) as many as 30 to 40 years after contracting polio. In PPS, the damage done to the nerves during the disease causes an acceleration of the normal, gradual weakness due to aging.

Treatment

In the height of the polio epidemic, the standard treatment involved placing a patient with paralysis of the breathing muscles in an "iron lung" - a large machine that actually pushed and pulled the chest muscles to make them work. The damaged limbs were often kept immobilized because of the confinement of the iron lung. In countries where polio is still a concern, ventilators and some iron lungs are still used.

Historically, home treatment for paralytic polio and abortive polio with neurological symptoms wasn't sufficient. However, asymptomatic and mild cases of abortive polio with no neurological symptoms were usually treated like the flu, with plenty of fluids and bed rest.

The Future of Polio

The World Health Organization (WHO) is working toward eradicating polio throughout the world. Significant strides have already been made. In 1988, 355,000 cases of polio in 125 countries were reported. By the end of 2004, there were just 1,255 cases.

Six countries (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) still have polio circulating, and the virus could be introduced to other countries. If the polio virus is imported into a country where not enough people have been immunized, there's the risk that it could spread from person to person. That's what has happened in some countries in Africa and Asia. So until it has been eliminated worldwide, it's important to continue vaccinating kids against polio.

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Tuberculosis

Tuberculosis (popularly known as "TB") is a disease caused by the bacteria Mycobacterium tuberculosis. It mainly infects the lungs, although it can affect other organs as well.

When someone with untreated TB coughs or sneezes, the air is filled with droplets containing the bacteria. Inhaling these infected droplets is the usual way a person gets TB.

One of the most dreaded diseases of the 19th century, TB was the eighth leading cause of death in children 1 to 4 years of age during the 1920s. As the general standard of living and medical care improved in the United States, the incidence of TB decreased. By the 1960s, it wasn't even in the top 10 causes of death among children of any age group.

But TB is making a comeback in the United States today — particularly among the homeless, those in prison, and those rendered susceptible because of HIV infection.

Signs and Symptoms

In older infants and children, primary pulmonary tuberculosis (the first infection with the tuberculosis bacteria) usually produces no signs or symptoms, and a chest X-ray shows no signs of infection. Rarely, there may be enlargement of the lymph nodes and possibly some coughing.

In most cases, only a tuberculin skin test (used to figure out if someone has been infected by the tuberculosis bacteria) is positive, indicating that the child has been infected. Children with a positive tuberculin test, even if they show no disease, will usually need to receive medication.

This primary infection usually resolves on its own as a child develops immunity over a 6- to 10-week period. But in some cases, it can progress and spread all over the lungs (called progressive tuberculosis) or to other organs. This causes signs and symptoms such as fever, weight loss, fatigue, loss of appetite, and cough.

Another type of infection is called reactivation tuberculosis. Here, the primary infection has resolved, but the bacteria are dormant, or hibernating. When conditions become favorable (for instance, a lowered immunity), the bacteria become active. Tuberculosis in older kids and adults may be of this type. The most prominent symptom is a persistent fever, with sweating during the night. Fatigue and weight loss may follow. If the disease progresses and cavities form in the lungs, the person may experience coughing and the production of saliva, mucus, or phlegm that may contain blood.

Prevention

The prevention of TB depends on:

• avoiding contact with those who have the active disease
• using medications as a preventive measure in high-risk cases
• maintaining good living standards

New cases and potentially contagious patients are identified through proper use and interpretation of the tuberculin skin test.

A vaccine called BCG (Bacille Calmette-Guérin) is considered controversial because it isn't very effective in countries with a low incidence of TB. For this reason, BCG isn't usually given in the United States. However, it may be considered for kids emigrating to countries where TB is prevalent.

Contagiousness

Tuberculosis is contagious when it's airborne and can be inhaled by others.

In general, children are not considered contagious, and usually get the infection from infected adults. The incubation period (the time it takes for a person to become infected after being exposed) varies from weeks to years, depending on the individual and whether the infection is primary, progressive, or reactivation TB.

Treatment

A doctor may recommend hospitalization for the initial evaluation and treatment of TB, especially if:

• the child is a young infant
• there are severe drug reactions
• there are other diseases along with TB

However, most kids with tuberculosis can be treated as outpatients and cared for at home. The treatment is usually in the form of oral medications. In some cases, three or four drugs may be prescribed.

Even though treatment may require months to complete, it's vitally important that the full course of medications be taken in order for tuberculosis to be cured.

Duration

Tuberculosis is a chronic disease that can persist for years if it isn't treated.

When to You Call the Doctor

Call the doctor if your child:

• has been in contact with a person who has (or is suspected to have) tuberculosis
• has persistent fever
• complains of sweating at night
• develops a persistent cough that doesn't respond to standard cough medications

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Ascariasis

Ascariasis is an intestinal infection caused by a parasitic roundworm. While it is the most common human infection caused by worms in the world, ascariasis is not common in the United States. It occurs in varying prevalence worldwide, with far greater frequency in areas with poor sanitation or crowded living conditions.

Signs and Symptoms

Although no symptoms may occur, the greater the number of worms involved in the infestation, the more severe a child's symptoms are likely to be. Kids are more likely than adults to develop gastrointestinal symptoms because they have smaller intestines and are at greater risk of developing intestinal obstruction.

Symptoms seen with mild infestation include:

• worms in stool
• coughing up worms
• loss of appetite
• fever
• wheezing

More severe infestations can result in more serious signs and symptoms, including:

• vomiting
• shortness of breath
• abdominal distention (swelling of the abdomen)
• severe stomach or abdominal pain
• intestinal blockage
• biliary tract blockage (includes the liver and gallbladder)

Description

Ascariasis occurs when worm eggs of the parasite Ascaris lumbricoides commonly found in soil and human feces are ingested. The eggs can be transmitted from contaminated food, drink, or soil. The roundworms range in size from 5.9 to 9.8 inches for adult males and 9.8 to 13.8 inches for adult females. The worms can grow to be as thick as a pencil and can live for 1 to 2 years.

Ascariasis is frequently found in developing countries where sanitary conditions are poor or in areas where human feces are used as fertilizer. When the eggs are swallowed and passed into the intestine, they hatch into larvae. The larvae then begin to move through the body.

Once they get through the intestinal wall, the larvae travel from the liver to the lungs through the bloodstream. During this stage, pulmonary symptoms such as coughing (even coughing up worms) may occur. In the lungs, the larvae climb up through the bronchial tubes to the throat, where they are swallowed. The larvae then return to the small intestine where they grow, mature, mate, and lay eggs. The worms reach maturity about 2 months after an egg is ingested from the soil.

Adult worms live and remain in the small intestine. A female worm can produce up to 240,000 eggs in a day, which are then discharged into the feces and incubate in the soil for weeks. Children are particularly susceptible to ascariasis because they tend to put things in their mouths, including dirt, and they often have poorer hygiene habits than adults.

Ascariasis is common in warmer or tropical climates, particularly in developing nations, where it can affect large segments of the population. Ascariasis is rare in the United States, due to strict sanitation rules and regulations.

Contagiousness

Ascariasis is not spread directly from one person to another. To become infected, an individual has to consume the worm's eggs.

Prevention

The most important measure of protection against ascariasis is the safe and sanitary disposal of human waste, which can transmit eggs. Areas of the world that use human feces as fertilizer must thoroughly cook all foods or clean them with a proper iodine solution (particularly fruits and vegetables).

Children who are adopted from developing nations are frequently screened for worms as a precautionary measure. Kids who live in underdeveloped areas of the world may be prescribed a preventive deworming medication.

These practices are recommended for all children:

• Try as much as possible to keep kids from putting things in their mouths.
• Teach kids to wash hands thoroughly and frequently, especially after using the bathroom and before eating.

Professional Treatment

The doctor will usually prescribe antiparasitic medication to be taken orally to kill the intestinal roundworms. Sometimes the stool will be re-examined about 3 weeks after treatment to check for eggs and worms. Symptoms usually disappear within 1 week of starting treatment.

Very rarely, surgical removal of the worms may be necessary (particularly in cases of intestinal or liver-related obstruction, or abdominal infection). A child who has ascariasis should be evaluated for other intestinal parasites, such as pinworm.

Home Treatment

If your child has ascariasis, the medication prescribed should be administered accordingly. To prevent reinfection:

• Ensure that your child washes his or her hands properly, particularly after using the bathroom and before eating.
• Have your pets checked for worms regularly.
• Keep your child's fingernails short and clean.
• Sterilize any contaminated clothing, pajamas, and bedding.
• Evaluate the source of the infection. Additional sanitation measures in or around your home may be necessary.

When to Call the Doctor

If your child has any of the symptoms of ascariasis, contact your doctor right away. Stool samples will be sent to a laboratory to check for eggs and worms and confirm the diagnosis.

Call the doctor if symptoms do not improve with treatment or if new symptoms occur.

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Hepatitis

The word hepatitis simply means an inflammation of the liver without pinpointing a specific cause. Someone with hepatitis may:

• have one of several disorders, including viral or bacterial infection of the liver
• have a liver injury caused by a toxin (poison)
• have liver damage caused by interruption of the organ's normal blood supply
• be experiencing an attack by his or her own immune system through an autoimmune disorder
• have experienced trauma to the abdomen in the area of the liver

Hepatitis is most commonly caused by one of three viruses:

• the hepatitis A virus
• the hepatitis B virus
• the hepatitis C virus

In some rare cases, the Epstein Barr Virus (which causes mononucleosis) can also result in hepatitis because it can cause inflammation of the liver. Other viruses and bacteria that also can cause hepatitis include hepatitis D and E, varicella (chickenpox), and cytomegalovirus (CMV).

Hepatitis A
In children, the most common form of hepatitis is hepatitis A (also called infectious hepatitis). This form is caused by the hepatitis A virus (HAV), which lives in the stools (feces or poop) of infected individuals. Infected stool can be present in small amounts in food and on objects (from doorknobs to diapers).

The hepatitis A virus is spread:

• when someone ingests anything that's contaminated with HAV-infected stool (this makes it easy for the virus to spread in overcrowded, unsanitary living conditions)
• in water, milk, and foods, especially in shellfish

Because hepatitis A can be a mild infection, particularly in children, it's possible for some people to be unaware that they have had the illness. In fact, although medical tests show that about 40% of urban Americans have had hepatitis A, only about 5% recall being sick. Although the hepatitis A virus can cause prolonged illness up to 6 months, it typically only causes short-lived illnesses and it does not cause chronic liver disease.

Hepatitis B
Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide spectrum of symptoms ranging from general malaise to chronic liver disease that can lead to liver cancer.

The hepatitis B virus spreads through:

• infected body fluids, such as blood, saliva, semen, vaginal fluids, tears, and urine
• a contaminated blood transfusion (uncommon in the United States)
• shared contaminated needles or syringes for injecting drugs
• sexual activity with an HBV-infected person
• transmission from HBV-infected mothers to their newborn babies

Hepatitis C
The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. The symptoms of the hepatitis C virus can be very similar to those of the hepatitis A and B viruses. However, infection with the hepatitis C virus can lead to chronic liver disease and is the leading reason for liver transplant in the United States.

The hepatitis C virus can be spread by:

• sharing drug needles
• getting a tattoo or body piercing with unsterilized tools
• blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been routinely screened for the disease)
• transmission from mother to newborn
• sexual contact (although this is less common)

Hepatitis C is also a common threat in kidney dialysis centers. Rarely, people living with an infected person can contract the disease by sharing items that might contain that person's blood, such as razors or toothbrushes.

Diagnosis

All of these viral hepatitis conditions can be diagnosed and followed through the use of readily available blood tests.

Signs and Symptoms

Hepatitis, in its early stages, may cause flu-like symptoms, including:

• malaise (a general ill feeling)
• fever
• muscle aches
• loss of appetite
• nausea
• vomiting
• diarrhea
• jaundice (a yellowing of the skin and whites of the eyes)

But some people with hepatitis may have no symptoms at all and may not even know they're infected. Children with hepatitis A, for example, usually have mild symptoms or have no symptoms.

If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes:

• jaundice
• foul breath
• a bitter taste in the mouth
• dark or "tea-colored" urine
• white, light, or "clay-colored" stools

There can also be abdominal pain, which may be centered below the right ribs (over a tender, swollen liver) or below the left ribs (over a tender spleen).

Contagiousness

Hepatitis A, hepatitis B, and hepatitis C are all contagious.

The hepatitis A virus can be spread in contaminated food or water, as well as in unsanitary conditions in child-care facilities or schools. Toilets and sinks used by an infected person should be cleaned with antiseptic cleansers. People who live with or care for someone with hepatitis should wash their hands after contact with the infected person. In addition, when traveling to countries where hepatitis A is prevalent, your child should be vaccinated with at least two doses of the hepatitis A vaccine.

The hepatitis B virus can be found in virtually all body fluids, though its main routes of infection are through sexual contact, contaminated blood transfusions, and shared needles for drug injections. Household contact with adults with hepatitis B can put people at risk for contracting hepatitis. But frequent hand washing and good hygiene practices can reduce this risk.

All kids in the United States are routinely vaccinated against hepatitis B at birth and use of the hepatitis B vaccine can greatly decrease the incidence of this infection. Ask your doctor about this vaccine. Even adults can be vaccinated if they feel they're at risk.

The hepatitis C virus can be spread through shared drug needles, contaminated blood products, and, less commonly, through sexual contact. Although hepatitis C can be spread from a mother to her fetus during pregnancy, the risk of passing hepatitis C to the fetus isn't very high (about 5%). If you're pregnant, contact your doctor if you think you may have been exposed to hepatitis C.

Over the past several years, improved medical technology has almost eliminated the risk of catching hepatitis from contaminated blood products and blood transfusions. But as tattoos and acupuncture have become more popular, the risk of developing hepatitis from improperly sterilized equipment used in these procedures has increased. Shared needles in drug use and shared straws in cocaine use are two very common ways for hepatitis C to spread.

Prevention

In general, to prevent viral hepatitis you should:

• Follow good hygiene and avoid crowded, unhealthy living conditions.
• Take extra care, particularly when drinking and swimming, if you travel to areas of the world where sanitation is poor and water quality is uncertain.
• Never eat shellfish from waters contaminated by sewage.
• Remind everyone in your family to wash their hands thoroughly after using the toilet and before eating.
  
• Use antiseptic cleansers to clean any toilet, sink, potty-chair, or bedpan used by someone in the family who develops hepatitis.

Because contaminated needles and syringes are a major source of hepatitis infection, it's a good idea to encourage drug awareness programs in your community and schools. At home, speak to your child frankly and frequently about the dangers of drug use. It's also important to encourage abstinence and safe sex for teens, in order to eliminate their risk of hepatitis infection through sexual contact.

A hepatitis A vaccine is available, and is especially recommended for those who:

• travel abroad
• have other forms of liver disease
• have many sexual partners
• are in high-risk occupations, such as health-care and child-care personnel

If you're planning to travel abroad, consult your doctor in advance so you and your family have enough time to complete the required immunizations. The vaccine is especially useful for staff of child-care facilities or schools where they may be at risk of exposure.

There's also a hepatitis B vaccine, which should be given to both children and adults as part of routine immunization.

Unfortunately, there's no vaccine for hepatitis C — animal studies indicate that it may not be possible because the virus doesn't cause the kind of response that would be needed for a vaccine to be successful.

Duration

For viral hepatitis, the incubation period (the time it takes for a person to become infected after being exposed) varies depending on which hepatitis virus causes the disease:

• For hepatitis A, the incubation period is 2 to 6 weeks.
• For hepatitis B, the incubation period is between 4 and 20 weeks.
• For hepatitis C, it's estimated that the incubation period is 2 to 26 weeks.

Hepatitis A is usually active for a short period of time and once a person recovers, he or she can no longer pass the virus to other people. It's practically unheard for people to become chronic carriers of hepatitis A. Almost all previously healthy persons who develop hepatitis A will completely recover from their illness in a few weeks or months without long-term complications.

With hepatitis B, 85% to 90% of patients recover from their illness completely within 6 months, without long-term complications.

However, 75% to 85% of those who are infected with hepatitis C do not recover completely and are more likely to continue to have a long-term infection. People with hepatitis B (the percentage who don't recover completely) or hepatitis C who continue to be infected can go on to develop chronic hepatitis and cirrhosis of the liver (the chronic degeneration and disruption of the structure of the liver). Some people with hepatitis B or C may also become lifelong carriers of these viruses and can spread them to other people.

Treatment

When symptoms are severe or laboratory tests show liver damage, it's sometimes necessary for hepatitis to be treated in the hospital. Here's a quick look at the treatments available for the various hepatitis viruses:

• There are no medications used to treat hepatitis A because it's a short-term infection that goes away on its own.
• Hepatitis B can sometimes be treated using medications. Four drugs are approved for use in adults with hepatitis B, but there hasn't been enough research yet on their use in children. However, you can talk to your child's doctor about a drug that may be available in some centers on a research basis for children.
• The treatment of hepatitis C has improved significantly with the use of two medications, only one of which is approved for use in children. Another more effective drug isn't approved for children yet but is available for kids in some centers on a research basis. In those adults who've just been infected with hepatitis C (by accidental needle injury, for example), combination therapy with the two drugs is the treatment of choice and can eliminate the virus in about 50% of the people infected.

Children with mild hepatitis may be treated at home. Except for using the bathroom, they should rest in bed until the fever and jaundice are gone and their appetite is normal. Kids with a lack of appetite should try smaller, more frequent meals and fluids that are high in calories (like milkshakes). They should also eat healthy foods rich in protein and carbohydrates and drink plenty of water.

When to Call the Doctor

Call the doctor if your child:

• has symptoms of hepatitis
• attends a school or child-care facility where someone has hepatitis
• has been exposed to a friend or relative with the illness

If you have an older child who volunteers at a first-aid station, hospital, or nursing home, be sure that he or she is aware of proper safety procedures for preventing contact with blood or body fluids. You may also want to have your child immunized against the hepatitis B virus. Call your doctor if you believe your child may have been exposed to a patient with hepatitis.

If you already know your child has hepatitis, call your doctor if you notice any of the following symptoms, which may be signs of their liver condition worsening:

• confusion or extreme drowsiness
• skin rash
• itching

Also, monitor your child's appetite and digestive functions, and call the doctor if your child's appetite decreases, or if nausea, vomiting, diarrhea, or jaundice increase.

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Mad Cow Disease

Mad cow disease has been in the headlines in recent years. While a serious illness, it primarily affects cattle and, possibly, other animals, like goats and sheep — the risk to human beings is extremely low.

What Is Mad Cow Disease and How Do People Get It?

The medical name for mad cow disease is bovine spongiform encephalopathy, or BSE for short. BSE is an incurable fatal brain disease. It is called mad cow disease because it affects a cow's nervous system, causing the animal to act strangely and lose control of its ability to do normal things, such as walk.

Only certain animals can get BSE — people don't actually get mad cow disease. However, experts have found a link between BSE and a rare brain condition that affects people called variant Creutzfeldt-Jakob disease (CJD). Researchers believe that people who eat products from cows that have BSE are at risk of developing a form of CJD.

CJD is caused by an abnormal type of protein in the brain called a prion. When people have CJD, cells in the brain die until the brain eventually has a "sponge-like" appearance. During this time, people with the disease gradually lose control of their mental and physical capabilities.

To date, very few people have been diagnosed with the form of CJD that's been linked to mad cow disease. By November 2006, only 200 cases of this rare condition had been reported worldwide. Of these, most were identified in Britain. Several of the people diagnosed with the disease outside Britain — including two cases in the United States — had a history of exposure in Britain or in a country where government officials reported BSE.

Because the form of CJD that's been linked to mad cow disease is relatively new and extremely rare, experts are still learning about it. However, researchers believe that the disease is not contagious among people — in other words, you can't get CJD from someone else who has it. There have been a few cases of CJD that are believed to have been transmitted through blood transfusions. At present, it appears that the main way people get the disease is from eating contaminated meat.

Experts don't yet know exactly how long the incubation period is for CJD (in other words, how long it takes from the time a person contracts it to the time that symptoms appear). However, they do believe that it takes years, if not decades, from the time someone gets the disease until the first signs appear. Once they do, the brain can deteriorate within a year.

What's Being Done About It?

BSE doesn't spread naturally from cow to cow; it's suspected to be transmitted by feeding cows animal meal. However, the U.S. Food and Drug Administration (FDA) introduced an "animal feed" rule in 1997 prohibiting the feeding of most proteins made out of mammals to ruminant animals (such as cows, sheep, and goats), which was what was thought to have begun the BSE epidemic in the United Kingdom. According to the FDA, 99% of the facilities raising cattle for human consumption are currently in compliance with the feed rule.

The type of protein that causes mad cow disease can't be removed or destroyed when beef is processed or cooked. For this reason, the U.S. government has established several procedures to protect the public. One of these involves removing the parts of the cow that are at highest risk of containing BSE-causing proteins — the brain and spinal cord — to reduce the chances of contaminating the meat people eat.

In October 2005, the FDA proposed additional safeguards to help protect consumers from BSE. These prohibit the use of any high-risk cattle materials in the feed of any animal. In this way, the FDA continues to decrease the already tiny possibility of infection with BSE.

In addition, there is a system in which samples of animals are tested. This is one way to help prevent contaminated meat from reaching the shelves. The testing system helped officials identify some contaminated meat in Washington state in December 2003 — one of only three cases of mad cow disease found in the United States so far. The government also has a recall policy in place for meat that's suspected of being contaminated.

If you're wondering if it's safe to continue drinking cow's milk, rest assured that it is — the U.S. Department of Agriculture (USDA) says there is no evidence that the disease can be transmitted through cow's milk and milk products. It's also extremely unlikely that a person will contract CJD from eating beef.

CJD itself is pretty rare — each year, only one in 1 million people in the United States die of the disease. And because only three cows in the United States have been found to be infected with mad cow disease, which can't be spread from cow to cow, the chance that you will or anyone in your family will eat meat infected with the disease is extremely low.

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Broken Bones

The harder kids play, the harder they fall. The fact is, broken bones, or fractures, are common in childhood and often happen when kids are playing or participating in sports. Most fractures occur in the upper extremities: the wrist, the forearm, and above the elbow. Why? When children fall, it's a natural instinct for them to throw their hands out in an attempt to stop it.

Although many kids will have one at some point, a broken bone can be scary for them and parents alike. To help make things a little easier if a spill results in a fracture, here's the lowdown on what to expect.

How Do I Know if It's Broken?

Falls are a common part of childhood, but not every fall will result in a broken bone. The classic signs of a fracture are pain, swelling, and deformity. However, if the break isn't displaced (see Different Types of Fractures, below), it may be harder to tell.

Some telltale signs that a bone is broken are:

• You or your child heard a snap or a grinding noise during the injury.
• There's swelling, bruising, or tenderness around the injured part.
• It's painful for your child to bear weight on the injury, touch it, press on it, or move it.
• The injured part looks deformed. In severe breaks, the broken bone may be poking through the skin.

What Do I Do?

If you suspect that your child has a fracture, you should seek medical care immediately.

Do not move the child — and call for emergency care — if:

• the child may have seriously injured the head, neck, or back
• the broken bone comes through the skin. Apply constant pressure with a clean gauze pad or thick cloth, and keep the child lying down until help arrives. Don't wash the wound or push in any part of the bone that's sticking out.

For less serious injuries, try to stabilize the injury as soon as it happens by following these quick steps:

1. Remove clothing from the injured part. Don't force a limb out of the clothing, though. You may need to cut clothing off with scissors to prevent causing your child any unnecessary additional pain.
2. Apply a cold compress or ice pack wrapped in cloth.
3. Place a makeshift splint on the injured part by:
   • keeping the injured limb in the position you find it
   • placing soft padding around the injured part
   • placing something firm (like a board or rolled-up newspapers) next to the injured part, making sure it's long enough to go past the joints above and below the injury
   • keeping the splint in place with first-aid tape
4. Seek medical care and don't allow the child to eat, in case surgery is needed.

Different Types of Fractures

A doctor may be able to tell whether a bone is broken simply by looking at the injured area. But the doctor will order an X-ray to confirm the fracture and determine what type it is.

Reassure your child that, with a little patience and cooperation, getting an X-ray to look at the broken bone won't take long. Then, he or she will be well on the way to getting a cool — maybe even colorful — cast that every friend can sign.

For little ones who may be scared about getting an X-ray, it might help to explain the process like this: "X-rays don't hurt. Doctors use a special machine to take a picture to look at the inside of your body. When the picture comes out, it won't look like the ones in your photo album, but doctors know how to look at these pictures to see things like broken bones."

However, a fracture through the growing part of a child's bone (called the growth plate) may not show up on X-ray. If this type of fracture is suspected, the doctor will treat it even if the X-ray doesn't show a break.

Children's bones are more likely to bend than break completely because they're softer. Fracture types that are more common in kids include:

• buckle or torus fracture: one side of the bone bends, raising a little buckle, without breaking the other side
• greenstick fracture: a partial fracture in which one side of the bone is broken and the other side bends (this fracture resembles what would happen if you tried to break a green stick)

Mature bones are more likely to break completely. A stronger force will also result in a complete fracture of younger bones. A complete fracture may be a:

• closed fracture: a fracture that doesn't break the skin
• open (or compound) fracture: a fracture in which the ends of the broken bone break through the skin (these have an increased risk of infection)
• non-displaced fracture: a fracture in which the pieces on either side of the break line up
• displaced fracture: a fracture in which the pieces on either side of the break are out of line (which might require surgery to make sure the bones are properly aligned before casting)

Other common fracture terms include:

• hairline fracture: a thin break in the bone
• single fracture: the bone is broken in one place
• segmental: the bone is broken in two or more places in the same bone
• comminuted fracture: the bone is broken into more than two pieces or crushed

Getting a Splint or Cast

The doctor might decide that a splint is all that's needed to keep the bone from moving so it can heal. Whereas a cast encircles the entire broken area and will be removed by the doctor when the bone is healed, a splint usually supports the broken bone on one side.

When the doctor puts on a splint, a layer of cotton goes on first. Next, the splint is placed over the cotton. A splint may be made of stiff pieces of plastic or metal or can be molded out of plaster or fiberglass to fit the injured area comfortably. Then cloth or straps (which usually have Velcro) are used to keep the splint in place. The doctor might need to readjust the splint later, or you and your child might get instructions on how to do it at home. Your child might be allowed to remove it carefully to take a bath.

However, most broken bones will need a cast. A cast, which keeps a bone from moving so it can heal, is essentially a big bandage that has two layers — a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving.

Casts are typically made of either:

• plaster of paris: a heavy white powder that forms a thick paste that hardens quickly when mixed with water. Plaster of paris casts are heavier than fiberglass casts and don't hold up as well in water.
• synthetic (fiberglass) material: made out of fiberglass, a kind of moldable plastic, these casts come in many bright colors and are lighter and cooler. The covering (fiberglass) on synthetic casts is water-resistant, but the padding underneath is not. You can, however, get a waterproof liner. The doctor putting on the cast will decide whether your child should get a fiberglass cast with a waterproof lining.

Although some kids might find casts cool when they're finally on their broken parts, the process of getting them put there can be scary, especially for a child in pain. Knowing what happens in the cast room might help alleviate some worry — both yours and your child's.

For displaced fractures (in which the pieces on either side of the break are out of line), the bone will need to be set before putting on a cast. To set the bone, the doctor will put the pieces of the broken bone in the right position so they can grow back together into one bone (this is called a closed reduction). During a closed reduction, the doctor will realign the broken bone so that it heals in a straighter position. The child is given medicine, usually through an IV, when this is done to help keep the bone from hurting. A cast is then put on to keep the bone in position.

So how is a cast actually put on? First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.

Once the cast is on, the doctor will probably recommend that your child prop the splinted or casted area on a pillow or stool for a few days to reduce swelling. A child who has a cast on a foot or leg (called a walking cast) shouldn't walk on it until it's dry (this takes about 1 hour for a fiberglass cast and 2 or 3 days for a plaster cast).

If the cast or splint is on an arm, the doctor might give your child a sling to help support it. A sling is made of cloth and a strap that loops around the back of the neck and acts like a special sleeve to keep the arm comfortable and in place. A child with a broken leg will probably get crutches to make it a little easier to get around.

Some pain is expected for the first few days after getting a cast, but it usually isn't severe. The doctor may recommend acetaminophen or ibuprofen. However, if your child seems to be in a lot of pain, call the doctor.

If the cast is causing your child's fingers or toes to turn white, purple, or blue, the cast may be too tight and you should call the doctor right away. Also be sure to call if the skin around the edges of the cast gets red or raw — that's typically a sign that the cast is wet inside from sweat or water. Also, kids shouldn't pick at or remove the padding from the edges of fiberglass casts because the fiberglass edges can rub on the skin and cause irritation.

More Serious Breaks

Although most broken bones simply need a cast to heal, other more serious fractures (such as compound fractures) might require surgery to be properly aligned and to ensure the bones stay together during the healing process. Open fractures need to be cleaned thoroughly in the sterile environment of the operating room before they're set because the bone's exposure to the air poses a risk of infection.

With breaks in larger bones or when the bone breaks into more than two pieces, the doctor may put a metal pin in the bone to help set it before placing a cast. Don't worry, though — as with any surgery, your child will be given medicine so that he or she won't feel a thing. And when the bone has healed, the doctor will remove the pin.

When Will a Broken Bone Heal?

Fractures heal at different rates, depending upon the age of the child and the type of fracture. For example, young children may heal in as little as 3 weeks, while it may take 6 weeks for the same kind of fracture to heal in teens.

It's important for your child to wait to play games or sports that might use the injured part until your doctor says it's OK.

Preventing Broken Bones

Although fractures are a common part of childhood, some kids are more likely to have one than others. For example, those with an inherited condition known as osteogenesis imperfecta have bones that are brittle and more susceptible to breaking.

Be sure your child is getting enough calcium to decrease the risk of developing osteoporosis (a condition that also causes the bones to be more fragile and likely to break) later in life. Also, don't forget to motivate kids to get involved in regular physical activities and exercise, which are very important to bone health. Weight-bearing exercises such as jumping rope, jogging, and walking can also help develop and maintain strong bones.

Although it's impossible to keep kids out of harm's way all the time, you can help to prevent injuries by taking simple safety precautions, such as childproofing your home, making sure kids always wear helmets and safety gear when participating in sports, and using car seats and seat belts for kids at every age and stage.

If your child does get a broken bone, remember that even though it can be frightening, a fracture is a common, treatable injury that many kids experience at one time or another. With a little patience, your child will be back to playing and running around before you know it.

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Tonsillectomy

When the tonsils are removed with a microdebrider, it is called a powered intracapsular tonsillectomy. A microdebrider (pronounced "MI-cro-duh-BREE-der") is a powered instrument that has a very small rotating tip.

Typically, traditional tonsillectomy techniques remove the tonsil tissue completely, which exposes the underlying throat muscles to bacteria, thermal injury and inflammation. This is believed to cause the severe pain, slower recovery and higher rate of complications associated with traditional tonsillectomies.

But recent research has found that, in many cases, a near-complete (90-95%) removal of tonsil tissue provides a safe and effective treatment with considerably less pain and a faster recovery. The powered intracapsular tonsillectomy is based upon this evidence.

In this technique, the surgeon uses the microdebrider to precisely remove 90-95% of the tonsils. A thin layer of tonsil tissue is deliberately left intact as a protective shield for the delicate throat muscles, which helps reduce postoperative pain and recovery time.

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Advantages

The advantages of a powered intracapsular tonsillectomy include:

• Reduced postoperative pain
• Faster recovery and return to normal activity
• Fewer hospital readmissions for complications

Reduced postoperative pain
Traditional tonsillectomies often involve intense postoperative pain, primarily because 100% of the tonsil tissue is removed. When the tonsils are completely removed, it exposes the delicate, underlying throat muscles. The exposed muscles are vulnerable to bacteria that release endotoxins, which can increase swelling and pain.

In addition, the surgeon has to apply cauterization (heat) directly to the exposed muscles to stop any bleeding. All of this contributes to the severe pain associated with a traditional tonsillectomy, which sometimes causes dehydration.

But the powered intracapsular tonsillectomy protects the delicate throat muscles from exposure because a thin layer of tonsil tissue is left intact. This significantly reduces the amount of pain most patients experience after surgery.

Faster recovery and return to normal activity
Because the throat muscles are protected and the pain is greatly reduced, the recovery is typically twice as fast. Children who undergo the powered intracapsular technique can expect to return to normal activity in 2.5 half days.

This means parents can go back to work sooner after their child's operation. In contrast, children who have traditional tonsillectomies usually need seven to ten days to recuperate with a parent or guardian taking care of them. The most minimal radiofrequency techniques generally take 5 days before the patient returns to normal activity. Pain medications usually will be consumed for 4 days with the intracapsular technique and 6.5 days with the low power technique.

Fewer hospital readmissions for complications
Dehydration and bleeding are the two main complications associated with traditional tonsil surgery. Dehydration can occur when the pain upon swallowing is so severe that it inhibits normal drinking and eating.

Readmissions for standard technique tonsillectomies have been reported at up to 4% for bleeding and nearly 4% for dehydration. According to Koltai et al, tonsillectomies using the powered intracapsular technique have a complication rate of about 1% for bleeding and 1% for dehydration. Other studies have reported similar results.

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Disadvantages

Because the tonsils are not 100% removed, the potential exists that the tonsils may regrow and need to be removed or that they may become infected. However, the risk of regrowth does not appear to be significant.

According to a presentation at a May 2003 national meeting of ENT (ear, nose, and throat) specialists, the incidence of regrowth was 0.56% in 892 patients who underwent a powered intracapsular tonsillectomy.

From http://www.itonsil.com/

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Adenoidectomy

This technique uses a microdebrider (pronounced "MI-cro-duh-BREE-der"), a powered instrument that has a very small rotating tip. It is designed to remove both hard tissue (bone) and soft tissue.

Some ENT (ear, nose and throat) specialists began using this device for adenoid removal about eight years ago, and it has several advantages:

• More effective treatment for chronic ear infections
• More precise tissue removal and reduced risk
• Faster procedure with less blood loss
• Improved visualization and access to anatomy
• More effective treatment for chronic ear infections

The power-assisted adenoidectomy is more effective in treating chronic ear infections because the microdebrider removes adenoid tissue more completely than other techniques, even while leaving a very thin ridge of tissue between the nose and mouth to prevent serious complications.

At a May 2003 national meeting of ENT specialists, researchers presented a study that highlighted the differences between powered, curette, and suction cautery adenoidectomies. The study looked at 1270 children that had received an adenoidectomy and a second set of vent tubes because of recurring ear infections.

Researchers followed these children for one year and recorded how many of them had to have a third set of vent tubes because the ear infection had returned, even after an adenoidectomy was performed.

The children in the study who underwent a power-assisted adenoidectomy were much less likely to require an additional vent tube operation due to subsequent ear infections.

The results of the study were:

• Out of the 75 children who received a curette adenoidectomy, 9.3% (seven children) needed an additional vent tube operation.
• Out of the 743 children who received a suction cautery adenoidectomy, 23.3% (175 children) needed an additional vent tube operation.
• Out of 452 powered adenoidectomy patients, only 3.5% (16 children) needed an additional vent tube operation.
• 16 cases of transient and 3 cases of permanent velopharyngeal insufficiency (VPI) were noted, mostly in suction cautery patients.

More precise tissue removal and reduced risk
With other adenoidectomy methods, it can be difficult to control the amount of tissue being removed. If too much is removed, other tissues nearby may be damaged and complications can ensue. If too little adenoid tissue is removed, the adenoids may regrow and the disease may return.

As a powered instrument, the microdebrider offers the surgeon greater precision and control. This helps reduce the risk of unintentional damage to nearby tissues while removing the maximum amount of disease-causing tissue.

Clinical studies have demonstrated that the microdebrider allows for more complete adenoid removal, which is particularly important in cases where the adenoids need to be removed due to recurring infections.

In addition, the power-assisted adenoidectomy may reduce the risk of velopharyngeal insufficiency (VPI), a complication that can occur when the muscular opening between the back of the nose and throat is inadvertently damaged.

This muscular opening is called the nasopharnygeal sphincter or Passavant's Ridge. Temporary or permanent VPI can result when this muscle is injured, a condition in which there is an excessive nasal sound to the voice. VPI can also affect normal drinking and eating by allowing liquids to flow into the nose from the back of the mouth.

Faster procedure, less blood loss
All adenoid surgery involves some degree of bleeding. Using the microdebrider, there is slightly less blood loss during surgery as compared to a curette adenoidectomy. In addition, the surgeon can remove the adenoids more quickly with the microdebrider than with other techniques. This is particularly significant in cases where the adenoids are quite large, such as in obstructive sleep apnea.

Improved visualization and access to anatomy
With improved visualization and access, the surgeon can remove tissue more precisely and safely. Unlike curette adenoidectomies, the surgeon can directly see the adenoid tissue while using the microdebrider to remove it. The shape of the microdebrider also provides improved access to the difficult region where the adenoids are located.

Disadvantage
Although it shortens the length of the surgery, the cost for a power-assisted adenoidectomy is about $100.00 more per surgery than using a curette. However it is less expensive than some of the more recently popularized radiofrequency techniques.

Thanks to someone who gives this information. For further and other method about tonsil and adenoid, you can see the site at http://www.itonsil.com/

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Tonsilitis

Tonsillitis is an inflammation of the tonsils, the fleshy clusters of tissue on both sides of the back of the throat that fight off germs that enter the body through the mouth. The tonsils become enlarged and red, and can be coated with a yellow, gray, or white substance.

All forms of tonsillitis are contagious. It usually spreads from person to person by contact with the throat or nasal fluids of someone who is infected. A person with tonsillitis will have a sore throat, fever, swollen glands in the neck, and trouble swallowing.

Treating Tonsillitis

How doctors treat tonsillitis depends on whether it was caused by a virus or by group A streptococci bacteria. Doctors often can tell the difference just by looking at the tonsils, and can detect strep bacteria with a rapid strep test or a throat culture.

If tonsillitis is caused by a virus, the body will fight off the infection on its own. If it's caused by strep bacteria, the doctor probably will prescribe an antibiotic. If so, make sure that your child completes the full course of treatment to prevent the development of any complications.

If your child gets frequent bouts of tonsillitis (more than 5 to 7 times during a 12-month period) or repeat infections over several years, the doctor may consider a tonsillectomy to remove the tonsils.

Caring for Your Child

Kids with tonsillitis need plenty of nourishment and rest. If your child finds swallowing so painful that eating is difficult, try serving liquids and soft foods, like nutritious soups, milkshakes, smoothies, ice pops, or ice cream.

Make sure that your child drinks lots of fluids and gets plenty of rest, and take his or her temperature regularly. Use a nonprescription pain reliever, such as acetaminophen or ibuprofen, for throat pain.

Be sure to keep your sick child's drinking glasses and eating utensils separate, and wash them in hot, soapy water. All family members should wash their hands frequently. After a bout of tonsillitis that's caused by the strep bacteria, throw out your child's toothbrush and replace it with a new one.

Preventing Tonsillitis

To prevent tonsillitis, avoid letting your child near anyone who already has tonsillitis or a sore throat. Make sure to practice good hand-washing habits, and teach kids to do the same.

If you think your child has symptoms of tonsillitis or has been exposed to someone who is infected, call your doctor.

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