Traveling and Asthma

Your child's asthma shouldn't stop you from planning a family vacation, sending your child to stay with friends for a week, or signing your child up for sleepover camp. With some careful preparation and communication, you and your child should be able to enjoy all the benefits of life away from home.

Before you travel, make sure that your child's asthma is well controlled. If it's been flaring up, you should check in with the doctor. Your child might need a change in medications or might need to see the doctor before you leave.

Before You Go

When packing, be sure to include your child's rescue and controller medications. Keep them handy, not buried in the car trunk. And if you're flying, be sure to take them in your carry-on luggage. That way, you'll have them if your child needs the medications during the flight and later, if your checked bags go astray.

You'll also want to pack your child's peak flow meter, if he or she uses one, and your child's health insurance card. Your child's asthma action plan is a great item to bring along as well. By having a copy, you'll have the names of medicines, dosage information, and your child's doctor's phone number, just in case.

If you're traveling abroad, it's a good idea to have a letter from your child's doctor that describes your child's diagnosis, medications, and equipment. This can help you with airport security or customs. It's also smart to have the generic names of your child's medicines, in case they're called something else in another country.

If your child uses a nebulizer, you might want to invest in a portable version. Many of these can be plugged into the cigarette lighter in a car. If you'll be traveling abroad, make sure you have the adapter you need to use it.

Rolling Along

Buses, trains, and cars may contain many of the same potential allergens as your home, including dust mites and mold that are trapped in the upholstery or the ventilation system. You can't do much about the bus or train, but if you're traveling by car, try this: Run the air conditioner or heater, with the windows open, for at least 10 minutes. This will help reduce mold and dust mites in the car.

If pollen counts or pollution levels affect your child's asthma and are high during your trip, travel with the windows closed and the air conditioner on.

Taking to the Sky

The air quality on planes may affect your child's asthma. Although all flights within the United States are smoke free, some international flights are not. On these flights, make sure when you reserve your seats that you're as far from the smoking section as possible.

The air on planes is also very dry, so you should make sure your child drinks plenty of water while you're in the air. Many airlines permit the use of battery-operated nebulizers (except during takeoff and landing), but check on this in advance. Nebulizers aren't routinely included in aircraft emergency kits due to their bulky size. But inhalers with spacers have been shown to be as effective as nebulizers in treating asthma and might be easier to keep on hand when traveling.

Your Home Away From Home

Your child's triggers will determine what steps you need to take to prevent asthma flare-ups where you're staying. If pollen or air pollution triggers your child's asthma - and you're traveling to a region with high readings - you may want to schedule a trip during times of the year when pollen counts and smog levels are lower.

If dust mites or mold are a problem and you'll be staying in a hotel, check to see if there are any rooms that have been allergy proofed. Requesting a sunny, dry room away from the hotel's pool might also help. If animal allergens trigger your child's asthma, request a room that has never had pets in it. And you should always stay in a nonsmoking room.

If you'll be staying in a rented cottage or cabin that's near the beach or in a forest, ask that it be thoroughly aired out before you arrive. Make sure any friends or family you'll be staying with know about your child's asthma triggers before you arrive. Although they won't be able to clear away all dust mites or mold, they can dust and vacuum carefully, especially in the room in which your child will sleep.

If scented candles, potpourri, aerosol products, or wood fires bother your child, ask your hosts to avoid using them. You should also ask that no one smokes inside while your child is there.

Because it can take months for animal dander to be effectively removed from a room, even if a pet isn't allowed in there, you probably won't want to stay with friends or family who have a pet if animal dander is a trigger for your child.

Wherever you'll be staying, you may want to bring your child's pillow and possibly even a blanket from his or her bed to make sure your child has some hypoallergenic bedding.

Time zone changes can be tricky. When traveling, try to have your child take his or her medicine at the usual home time. Upon arrival in another time zone, remember to adjust the dosage times to the local clock.

Activity Savvy

If your child's asthma is well controlled, you should be able to plan any sightseeing, hiking, or other leisure activities. Just keep your child's asthma triggers in mind when planning what you'll do. For example, avoid lots of walking or hiking when the air pollution or pollen counts are likely to be high or if the weather is going to be extremely cold and dry. If you'll be camping, keep your child away from the fire.

A ski vacation or hiking trip aren't out of the question. But make sure you plan for plenty of rest (indoors if possible), carry your child's rescue medication at all times, and be prepared to change your plans if your child is struggling with his or her asthma.

As at home, if anyone else will be supervising your child, you should make sure that person knows about your child's asthma and is familiar with his or her asthma action plan.

Solo Adventures

If your child will be traveling alone (for example, going to sleepover camp or to stay with friends or family), make sure that you prepare him or her, as well as any adults who will be taking care of your child. It's extremely important that his or her counselor or chaperone is familiar with and has copies of your child's asthma action plan, list of medications, and emergency phone numbers. You'll also want to provide written (and notarized) permission for the counselor or chaperone to care for your child in an emergency.

Make sure you sit down with your child before the trip to go over the asthma action plan and what he or she should do in an emergency. Your child should be familiar with any asthma triggers, should know how to administer his or her medication, and should be able to recognize the signs of a flare-up.

Telling your child that you've let the adults who will care for him or her know what to do during a flare-up should also help relieve any nervousness your child feels. And of course, you should reassure your child that he or she isn't different from other kids because of the asthma and that he or she should be able to join in on all the fun while traveling.

If your child hasn't been taking his or her controller medications and has been relying on rescue medication to control his or her asthma, it might not be a good idea to let your child go away alone, especially for an extended period of time. You'll want to discuss this with your child's doctor.

Most of all, be sure that your child still takes his or her medicine and tries to avoid triggers. If your child tries to ignore asthma during a trip, he or she could end up in the emergency department - and that's no place to spend a vacation.

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Fetal Alcohol Syndrome

Alcohol (wine, beer, or liquor) is the leading known preventable cause of mental and physical birth defects in the United States.

When a woman drinks alcohol during pregnancy, she risks giving birth to a child who will pay the price — in mental and physical deficiencies — for his or her entire life.

Yet many pregnant women do drink alcohol. It's estimated that each year in the United States, 1 in every 750 infants is born with a pattern of physical, developmental, and functional problems referred to as fetal alcohol syndrome (FAS), while another 40,000 are born with fetal alcohol effects (FAE).

Signs and Symptoms

If you adopted a child or consumed alcohol during pregnancy and are concerned that your child may have FAS, watch for characteristics of the syndrome, which include:

• low birth weight
• small head circumference
• failure to thrive
• developmental delay
• organ dysfunction
• facial abnormalities, including smaller eye openings, flattened cheekbones, and indistinct philtrum (an underdeveloped groove between the nose and the upper lip)
• epilepsy
• poor coordination/fine motor skills
• poor socialization skills, such as difficulty building and maintaining friendships and relating to groups
• lack of imagination or curiosity
• learning difficulties, including poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem-solving skills
• behavioral problems, including hyperactivity, inability to concentrate, social withdrawal, stubbornness, impulsiveness, and anxiety

Children with FAE display the same symptoms, but to a lesser degree.

Diagnosis and Long-Term Effects

Problems associated with FAS tend to intensify as children move into adulthood. These can include mental health problems, troubles with the law, and the inability to live independently.

Kids with FAE are frequently undiagnosed. This also applies to those with alcohol-related neurodevelopmental disorder (ARND), a recently recognized category of prenatal damage that refers to children who exhibit only the behavioral and emotional problems of FAS/FAE without any signs of developmental delay or physical growth deficiencies.

Often, in kids with FAE or ARND, the behavior can appear as mere belligerence or stubbornness. They may score well on intelligence tests, but their behavioral deficits often interfere with their ability to succeed. Extensive education and training for the parents, health care professionals, and teachers who care for these kids are essential.

How Much Alcohol Is Too Much?

It's clear that abusing alcohol during pregnancy is dangerous, but what about the occasional drink? How much alcohol constitutes too much during pregnancy?

No evidence exists that can determine exactly how much alcohol ingestion will produce birth defects. Individual women process alcohol differently. Other factors vary the results, too, such as the age of the mother, the timing and regularity of the alcohol ingestion, and whether the mother has eaten any food while drinking.

Although full-blown FAS is the result of chronic alcohol use during pregnancy, FAE and ARND may occur with only occasional or binge drinking.

Because alcohol easily passes the placental barrier and the fetus is less equipped to eliminate alcohol than its mother, the fetus tends to receive a high concentration of alcohol, which lingers longer than it would in the mother's system.

Mothers who drink during the first trimester of pregnancy have kids with the most severe problems because that is when the brain is developing. The connections in the baby's brain don't get made properly when alcohol is present. Of course, in the early months, many women don't even know they're pregnant.

It's important for women who are thinking about becoming pregnant to adopt healthy behaviors before they get pregnant.

Women who abstain from alcohol in early pregnancy may feel comfortable drinking in the final months. But some of the most complex developmental stages in the brain occur in the second and third trimesters, a time when the nervous system can be greatly affected by alcohol. Even moderate alcohol intake, and especially periodic binge drinking, can seriously damage a developing nervous system.

Prevention Is the Key

FAS can be completely prevented by not drinking any alcohol during pregnancy.

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Kawasaki Disease

Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but can affect all ethnic groups.

Signs and Symptoms

Kawasaki disease can't be prevented, but usually has telltale symptoms and signs that appear in phases.

The first phase, which can last for up to 2 weeks, usually involves a persistent fever higher than 104° Fahrenheit (39° Celsius) and lasts for at least 5 days.

Other symptoms that typically develop include:

• severe redness in the eyes
• a rash on the stomach, chest, and genitals
• red, dry, cracked lips
• swollen tongue with a white coating and big red bumps
• sore, irritated throat
• swollen palms of the hands and soles of the feet with a purple-red color
• swollen lymph nodes

During the second phase, which usually begins within 2 weeks of when the fever started, the skin on the hands and feet may begin to peel in large pieces. The child also may experience joint pain, diarrhea, vomiting, or abdominal pain. If your child shows any of these symptoms, call your doctor.

Complications

Doctors can manage the symptoms of Kawasaki disease if they catch it early. Symptoms often disappear within just 2 days of the start of treatment. If Kawasaki disease is treated within 10 days of the onset of symptoms, heart problems usually do not develop.

Cases that go untreated can lead to more serious complications, such as vasculitis, an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart.

In addition to the coronary arteries, the heart muscle, lining, valves, and the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves also can occur.

Diagnosis

No one test can detect Kawasaki disease, so doctors usually diagnose it by evaluating the symptoms and ruling out other conditions.

Most kids diagnosed with Kawasaki disease will have a fever lasting 5 or more days and at least four of these symptoms:

• redness in both eyes
• changes around the lips, tongue, or mouth
• changes in the fingers and toes, such as swelling, discoloration, or peeling
• a rash in the trunk or genital area
• a large swollen lymph node in the neck
• red, swollen palms of hands and soles of feet

If Kawasaki disease is suspected, the doctor may order tests to monitor heart function (such as an echocardiogram) and might take blood and urine samples to rule out other conditions, such as scarlet fever, measles, Rocky Mountain spotted fever, juvenile rheumatoid arthritis, or an allergic drug reaction.

Treatment

Treatment should begin as soon as possible, ideally within 10 days of when the fever begins. Usually, a child is treated with intravenous doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection. The child also might be given a high dose of aspirin to reduce the risk of heart problems.

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Ewing's Sarcoma

Ewing's sarcoma is a cancerous tumor that grows in bones or soft tissue near bones and usually affects adolescents.

Named after Dr. James Ewing, the American pathologist who identified the cancer in the 1920s, it can develop anywhere in the body, but most commonly affects the arms, legs, ribs, spinal column, and pelvis.

Treatment for Ewing's sarcoma involves a combination of chemotherapy, surgery, and/or radiation. With early diagnosis and proper treatment, many kids who develop it have a good chance of recovery.

Signs and Symptoms

Ewing's sarcoma often goes unnoticed or misdiagnosed as growing pains (due to its subtle, gradual onset) or a sports injury because symptoms often mimic those of injuries kids can get out on the field.

Soreness at the tumor site, accompanied by swelling or warmth, is common. Pain may be worse during exercise or at night, and a tender lump may develop in the affected area a few weeks after pain begins. If the tumor grows in a leg bone, the child may have an unexplained limp. A low-grade fever also can develop.

If cancer has spread, or metastasized, to other areas of the body like the lungs or bone marrow, symptoms may appear there as well. In some cases, the first sign of the disease is a broken arm or leg that occurs for no reason at all (or after a minor accident) because the cancer has weakened the bone, making it vulnerable to a break.

A child who experiences any of these symptoms should see a doctor as soon as possible. Waiting to seek treatment or assuming that symptoms will resolve on their own without treatment may lead to a more advanced form of the disease at diagnosis.

Diagnosis

To diagnose Ewing's sarcoma, a doctor will ask for your child's medical history, perform a physical examination, and order X-rays, an MRI (magnetic resolution imaging), or bone scans to detect abnormalities in bone structure. A tissue sample of the tumor (biopsy), which is later analyzed in a lab, must be performed in order for a diagnosis to be made.

Sometimes the doctor orders a needle biopsy, using a long hollow needle to take a sample of the tumor. Alternatively, the doctor may order an open biopsy, in which a portion of the tumor is removed. These are performed in the operating room by a surgeon while a child is under general anesthesia.

If a diagnosis of Ewing's sarcoma is made, the doctor will order additional imaging tests to determine if the cancer has spread to any other part of the body. Other exams will make sure that vital organs, such as the heart and kidneys, are functioning normally and able to tolerate treatment.

Once treatment begins, doctors monitor the patient and order additional imaging tests to determine how well it is working and whether the cancer continues to spread.

Chemotherapy/Radiation

The course of treatment for Ewing's sarcoma depends on many factors, including the size and location of the tumor and whether the disease has metastasized.

Regardless of a tumor's characteristics, every patient with Ewing's sarcoma undergoes chemotherapy initially to shrink the tumor (before surgical removal or radiation) and prevent the spread of cancer cells to other parts of the body. Chemotherapy is also given after a tumor is removed to help ensure that cancer cells do not come back.

A typical course of chemotherapy lasts 6 to 9 months. Children are required to stay in the hospital for a few days during treatment, which occurs every 2 to 3 weeks. Some kids may need to be hospitalized between treatments for complications or side effects, like fever or infection. Chemotherapy drugs are delivered intravenously (through a vein).

If surgery is needed, radiation may be given to shrink the tumor before surgical removal. Radiation also may be recommended in place of surgery if the tumor's location would make surgery too dangerous or difficult. During radiation, high-energy X-rays are directed at the tumor site to kill cancer cells and keep them from growing and multiplying.

Most kids who undergo radiation don't need to stay at the hospital overnight; they usually visit the hospital 5 days a week for several weeks.

Surgical Removal

After a course of chemotherapy, and possibly radiation, most tumors are removed surgically. Tissue that is removed during the procedure may need to be replaced with a live tissue graft (from the patient's own body), donor tissue (usually from a bone bank), or artificial tissue (made from metal or other synthetic material).

If a tumor has attached itself to nerves and blood vessels, amputation (removing part of a limb along with the tumor) might be the only choice. The amputated limb will be replaced with an artificial limb, usually made from metal.

Side Effects

Amputation carries its own short- and long-term side effects. It usually takes at least several months until a young person learns to use a prosthetic leg or arm. Learning to cope with the psychological and social aspects takes longer, but many children find they can resume favored activities in the long run.

With a tissue graft (donor or otherwise), one usually starts moving the affected body part almost immediately. Physical therapy and rehabilitation for 6 to 12 months after surgery usually helps a child recovering from Ewing's sarcoma of the leg to walk, initially with a walker or crutches, and then without assistive devices.

Early complications after surgery include infection and slow healing of the surgical wound, and the metal prosthetic device or the bank bone might need to be replaced in the long term. Other late problems might include fracture of the bank bone or failure of the bank bone to heal to the child's bone, which might require more surgery. Some kids will be limited in the types of sports they can play due to the risk of breakage.

Many chemotherapy medications also carry the risk of both short- and long-term problems. Short-term effects include anemia, abnormal bleeding, and increased risk of infection due to destruction of the bone marrow, as well as kidney, liver, or heart damage. Some drugs carry a risk of bladder inflammation and bleeding into the urine. Years after chemotherapy for Ewing's sarcoma, patients have an increased risk of developing other cancers and may have difficulties with fertility.

Prognosis

A child with Ewing's sarcoma who is diagnosed early on and does not have metastatic disease has up to a 70% chance of being cured of the cancer.

When the disease has spread, successful treatment is much more difficult. However, with the potent combination of treatments currently available — and powerful new therapies on the horizon — the outlook for kids with advanced disease is improving.

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Neurocutaneous Syndromes

Neurocutaneous syndromes are genetic disorders that lead to abnormal growth of tumors in various parts of the body. These disorders usually first appear as skin lesions like birthmarks, but can eventually lead to tumors that affect the central nervous system and other parts of the body. While some conditions can be diagnosed at birth, others don't produce symptoms until later in life.

These diseases are caused by the abnormal development of cells in the earliest stages of an embryo's development. Although there is no cure for any of the neurocutaneous syndromes, treatments are available to help a child manage the symptoms and any health problems that they can cause.

What Are the Types of Neurocutaneous Syndromes?

There are several neurocutaneous syndromes, but the most common ones that involve children include:

• neurofibromatosis, types 1 and 2 (NF1 and NF2)
• Sturge-Weber syndrome
• tuberous sclerosis (TS)
• ataxia-telangiectasia (A-T)
• von Hippel-Lindau disease (VHL)

Symptoms vary widely from condition to condition, and they affect different kids in different ways. Often, the full effects of these diseases - even if they are detected at birth - do not emerge until the child grows up. The educational, social, and physical problems that the conditions cause must be managed throughout a child's life.

Neurofibromatosis

Neurofibromatosis is one of the most common neurocutaneous syndromes. It can cause tumors to grow on a child's nerve cells, producing skin changes, bone deformities, eye problems, and other complications, particularly in the brain.

Neurofibromatosis is usually inherited, but up to half of new cases occur because of changes (mutations) within a person's genes. Once a mutation has taken place, the changed (mutant) gene can then be passed on to succeeding generations. The child of a parent with neurofibromatosis has a 50% chance of having the disease.

There are two different kinds of this disorder, neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2). NF1 accounts for approximately 90% of all cases.

Neurofibromatosis Type 1

NF1 occurs in about 1 in 4,000 babies born in the United States. When diagnosing NF1, doctors typically take a thorough medical history because children with NF1 often have a parent with the disease. NF1 is also known as von Recklinghausen disease.

The classic sign of NF1 is a skin pigment problem known as "café-au-lait" spots. These light brown, coffee-colored patches may be present at birth and may look like freckles at first. The spots increase in size and number during the first few years of life. A child diagnosed with NF1 will usually have at least six café-au-lait spots that are larger than freckles.

Another common sign of NF1 is the presence of Lisch nodules, tiny, benign (noncancerous) tumors found on the iris of the eye. In rare cases, tumors can develop along the optic nerves and affect a child's vision. During puberty, benign tumors called neurofibromas develop on or under the skin or along the nerves of the body. Bone deformities also may develop.

Treatment of a child with NF1 focuses on managing the symptoms. If a child has complications involving the eye, nervous system, spine, or bones, he or she will be referred to an appropriate specialist for treatment. In cases where these neurofibromas are causing chronic pain, growing into vital body organs, or causing infections, the growths can be removed through surgery.

Children with NF1 also have a high incidence of seizures, learning disabilities, attention deficit disorder, and speech problems. Therapy and specialists are available to manage those symptoms.

Neurofibromatosis Type 2

Neurofibromatosis type 2 is less common. It occurs in about 1 in 40,000 births. Kids who have this disease typically develop tumors on the auditory nerves (the nerves leading to the ear).

The symptoms of NF2, which typically appear in the teen years or early twenties, can include hearing loss, ringing of the ears, and problems with balance. Different treatment options are available to help a child manage these problems.

Tuberous Sclerosis

Tuberous sclerosis, or TS, is a disorder that causes benign growths called tubers to form on several different body organs, including the brain, eyes, kidneys, heart, skin, and lungs. It occurs in approximately 1 in 6,000 births. There is a 50% chance that the child of a parent with TS will have the disease.

The condition is often first recognized when a child has seizures or shows developmental delays. The severity of TS symptoms vary greatly between kids, ranging from mild skin abnormalities to mental retardation or kidney failure.

Treatment of TS usually includes medication to prevent seizures, treatments to address skin problems, surgery to remove tumors, and the management of high blood pressure caused by kidney disease.

Sturge-Weber Syndrome

Sturge-Weber syndrome is a rare condition that affects the skin and the brain. It is caused by a spontaneous genetic mutation. It is not passed down by parents who carry the disease. Because it frequently goes undiagnosed, it is difficult to estimate how many people currently have the disease.

Each case of Sturge-Weber is unique and symptoms vary widely from child to child. The most visible marker of the disease is a facial birthmark or "port wine stain" that appears when the child is born. It usually covers at least one upper eyelid and the forehead area.

Sturge-Weber syndrome can lead to neurological problems, including unusual blood vessel growths on the brain called angiomas. These growths often cause seizures that begin before a child's first birthday and can worsen with age. A child also may experience convulsions on the side of the body that's opposite from the port-wine stain.

About 30% of patients with Sturge-Weber also develop glaucoma (increased pressure inside the eye that impairs vision), typically in the eye that is affected by the port-wine stain. That eye might also be enlarged (a condition called buphthalmos). Some kids who suffer from this disease also experience strokes.

Treatments, medications, and surgery can help a child cope with the health problems associated with the disease.

Children as young as 1 month old who have Sturge-Weber can undergo laser treatment to reduce or remove port-wine stains. Anticonvulsant medication may be used to control seizures associated with the disorder, and surgery is available to control glaucoma and vision problems.

Ataxia Telangiectasia

Ataxia telangiectasia is a progressive degenerative disease that involves a large number of major body systems. It is a recessive genetic disease, meaning that both parents carry the gene that could combine to cause A-T in their children but do not have the disease themselves. Two parents with the mutated gene have a 25% chance of having a child affected by A-T.

A-T is usually noticed in the second year of life as a child develops problems with balance and slurred speech caused by ataxia (lack of muscle control). The ataxia occurs because the cerebellum, the part of the brain that controls muscle movement, is degenerating. Eventually, the lack of muscle control becomes severe enough for the child to require a wheelchair.

Another symptom of A-T is the appearance of tiny, red, spiderlike veins in the corners of the eyes or on the ears and cheeks when exposed to sunlight. The veins are known as telangiectases, and they are harmless.

About 70% of children with A-T also have immune system problems that make them more susceptible to chronic upper respiratory infections, lung infections, and pneumonia. Children with A-T are also very susceptible to developing certain cancers, such as leukemia and lymphoma.

Currently, no treatment is available for A-T and there is no way to stop its progression. But treatment is available to help kids manage their symptoms. Physical therapy and occupational therapy may help maintain flexibility, and speech therapy can help address slurring and other speech problems. Special medications may be given to help enhance weakened immune systems.

Von Hippel-Lindau Disease

Von Hippel-Lindau disease, or VHL, is a genetic disorder involving the abnormal growth of blood vessels. It usually occurs in certain areas of the body, such as the brain and other parts of the central nervous system, the retina of the eye, the adrenal glands, the kidneys, or the pancreas. The prevalence of the disease is unknown, but the child of a parent who carries the gene that causes VHL has a 50% chance of having the disorder.

Blood vessels usually grow like branches on a tree, but in kids with VHL, the vessels form small tumors called angiomas. Doctors carefully monitor angiomas because, depending on where they are located, they can cause other medical problems. For example, angiomas on the retina of the eye may lead to vision loss.

Symptoms of VHL typically appear when a person is between 10 and 30 years old. VHL is diagnosed using a special imaging technique called magnetic resonance imaging (MRI) or a computerized tomography (CT) scan. A thorough physical examination and blood tests are also performed.

The symptoms of VHL, which depend on the size and location of the angiomas, can include headaches, balance problems, dizziness, weakness, vision problems, and high blood pressure. Fluid-filled cysts or tumors (benign or cancerous) may develop around the angiomas, worsening these symptoms. People with this disorder have a higher risk of developing cancer, especially kidney cancer.

VHL treatment will depend on the size and location of the angiomas. The goal of treatment is to treat the tumors while they are small and before they put pressure on any of the major organs, such as the brain, or on the spine. Surgery may be required to remove the tumors before they create severe problems.

The prognosis for VHL patients depends on the location of the tumors and the complications they cause. Fortunately, early detection and treatment can improve a child's treatment outcome.

Caring for Your Child

The illnesses associated with neurocutaneous syndromes can place enormous stress and emotional burdens on you and your child, and it is easy to feel overwhelmed. Early intervention is important to helping your child achieve the best quality of life possible.

The focus of treatment is to prevent or minimize complications and maximize the child's strengths. Keep in mind the following tips:

• Positive reinforcement can strengthen your child's self-esteem and foster a sense of independence. Let your child find out what he or she is capable of, especially when performing daily living skills.
• Support groups for you and your child can be extremely beneficial, so seek out local chapters that address your child's particular illness (for a partial listing, click on the Additional Resources tab). Not only do these groups provide a supportive social environment, they also are a great way to share knowledge and resources.
• Psychotherapy or other supportive treatments can boost your child's self-esteem and coping skills, so ask your child's treatment team for appropriate referrals. Therapy also can help you and other family members deal with the stress involved in caring for a child with a chronic illness or disability.
• Physical, occupational, or speech therapy can help your child improve some of the developmental delays caused by his or her specific illness.
• Check with your local hospital or university for seminars or informational classes about neurocutaneous syndromes. By educating yourself and your family members, you can become a valuable resource in your child's long-term treatment.

A number of medical professionals may care for your child during diagnosis and treatment. These professionals can include a family practitioner, pediatrician, neurologist, neurosurgeon, orthopedic surgeon, oncologist, and ophthalmologist. A genetic counselor also may help by providing you with information about genetic testing and the risk of passing the disease on to another child.

Remember that although each of these conditions is challenging, supportive therapies and treatments are available to help both you and your child.

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Asperger Syndrome

Asperger syndrome (AS) is a neurobiological disorder that is part of a group of conditions called autism spectrum disorders. The term "autism spectrum" refers to a range of developmental disabilities that includes autism as well as other disorders with similar characteristics.

They are known as spectrum disorders because the symptoms of each can appear in different combinations and in varying degrees of severity: two children with the same diagnosis, though they may share certain patterns of behavior, can exhibit a wide range of skills and abilities.

As a result, general terms such as "low-functioning," "high-functioning," "autistic tendencies," "pervasive developmental disorder," and others are often used to describe children whose behaviors fall within the spectrum. Kids with AS share many of the same symptoms as those with "high-functioning autism."

It's estimated that more than 400,000 families are affected by AS. Because milder cases are being identified more frequently, the incidence appears to be increasing. However, like other autism spectrum disorders, AS is often difficult to diagnose and treat.

What Is Asperger Syndrome?

The disorder is named after Hans Asperger, a Viennese pediatrician who, in 1940, first described a set of behavior patterns apparent in some of his patients, mostly males. Asperger noticed that although these boys had normal intelligence and language development, they had severely impaired social skills, were unable to communicate effectively with others, and had poor coordination.

According to the Asperger Syndrome Coalition of the United States, the onset of AS is later than what is typical in autism — or at least it is recognized later. Many kids are diagnosed after age 3, with most diagnosed between the ages of 5 and 9.

AS is characterized by poor social interactions, obsessions, odd speech patterns, and other peculiar mannerisms. Kids with AS often have few facial expressions and have difficulty reading the body language of others; they might engage in obsessive routines and display an unusual sensitivity to sensory stimuli (for example, they may be bothered by a light that no one else notices; they may cover their ears to block out sounds in the environment; or they might prefer to wear clothing made only of a certain material).

Overall, people with AS are capable of functioning in everyday life, but tend to be somewhat socially immature and may be seen by others as odd or eccentric.

Other characteristics of AS include motor delays, clumsiness, limited interests, and peculiar preoccupations. Adults with AS have trouble demonstrating empathy for others, and social interactions continue to be difficult. Experts say that AS follows a continuous course and usually lasts a lifetime. However, symptoms can wax and wane over time, and early intervention services can be helpful.

Signs and Symptoms

Because the symptoms of AS are often hard to differentiate from other behavioral problems, it's best to let a doctor or other health professional evaluate your child's symptoms. It's not uncommon for a child to be diagnosed with attention deficit hyperactivity disorder (ADHD) before a diagnosis of AS is made later.

These signs and symptoms might be present in a child with AS:

• inappropriate or minimal social interactions
• conversations almost always revolving around self rather than others
• "scripted," "robotic," or repetitive speech
• lack of "common sense"
• problems with reading, math, or writing skills
• obsession with complex topics such as patterns or music
• average to below-average nonverbal cognitive abilities, though verbal cognitive abilities are usually average to above-average
• awkward movements
• odd behaviors or mannerisms

It's important to note that, unlike kids with autism, those with AS might show no delays in language development; they usually have good grammatical skills and an advanced vocabulary at an early age. However, they typically do exhibit a language disorder — they might be very literal and have trouble using language in a social context.

Often there are no obvious delays in cognitive development or in age-appropriate self-help skills such as feeding and dressing themselves. Although kids with AS can have problems with attention span and organization, and have skills that seem well developed in some areas and lacking in others, they usually have average and sometimes above-average intelligence.

What Causes Asperger Syndrome?

Researchers and mental health experts are still investigating the causes of autism and AS. Many believe that the pattern of behavior that characterizes AS may have many causes. There seems to be a hereditary component to AS, and research indicates that in some cases AS may be associated with other mental health disorders such as depression and bipolar disorder. Researchers are also looking into whether environmental factors that affect brain development might play a role.

Contrary to the incorrect assumptions some may make about people with the disorder, AS is not caused by emotional deprivation or the way a person has been brought up. Because some of the behaviors exhibited by someone with AS may be seen by others as intentionally rude, many people wrongly assume that AS is the result of bad parenting — it isn't. It's a neurobiological disorder whose causes are not yet fully understood.

Currently, there is no cure for the disorder — kids with AS become adults with AS. But many lead full and happy lives, and the likelihood of achieving this is enhanced with appropriate education, support, and resources.

Diagnosing Asperger Syndrome

Asperger syndrome can be very difficult to diagnose. Children with AS function well in most aspects of life, and so it can be easy to attribute their strange behaviors to just being "different."

According to mental health experts, if your child has AS, early intervention is very important. Intervention involving educational and social training, performed while a child's brain is still developing, is highly recommended.

If your child exhibits some of the symptoms and behaviors that are typical of AS, it's critical to seek help from your doctor. He or she can refer you to a mental health professional or other specialist for further evaluation.

When a specialist assesses your child, a thorough "psychosocial" evaluation will be performed. This includes a careful history of when symptoms were first recognized, the child's development of motor skills and language patterns, and other aspects of personality and behavior (including favorite activities, unusual habits, preoccupations, etc.).

Particular emphasis is placed on social development, including past and present problems in social interaction and development of friendships. A psychological evaluation and assessment of communication skills are usually conducted to determine your child's strengths and skills that may be deficient.

Treating Asperger Syndrome

Because AS can present patterns of behaviors and problems that differ widely from child to child, there isn't a "typical" or prescribed treatment regimen. However, your child may benefit from the following forms of treatment:

• parent education and training
• specialized educational interventions for the child
• social skills training
• language therapy
• sensory integration training for younger kids, usually performed by an occupational therapist, in which they are desensitized to stimuli to which they're overly sensitive
• psychotherapy or behavioral/cognitive therapy for older children
• medications

It will help if you involve all of your child's caregivers in the treatment. The health professionals who are caring for your child should know what the others are doing, and you will often find yourself acting as the "case manager" in this scenario. Teachers, babysitters, other family members, close friends, and anyone else who cares for your child also should be involved.

It's important to know that many people can provide assistance. Finding the right program for your child is key and getting help early is important. Kids with AS can and do experience great gains with the appropriate treatment and education.

Helping Your Child

Although AS presents challenges for affected kids and their parents, you can help your child adjust and offer support in many ways:

• Look into educational or training programs for parents. You're your child's first teacher and you'll continue to be the cornerstone in supporting his or her development.
• Teach your child self-help skills. Learning these skills helps kids achieve maximum independence.
• Because it's not always obvious that a child has AS, alert others to the fact that your child has special needs. As a parent, you may have to take on the role of educator when dealing with teachers, medical personnel, and other caregivers.
• Find a program that addresses your child's specific needs or areas of "deficiency." The Autism Society of America (ASA) encourages family members to talk to the program director to determine if the curriculum or program addresses their child's particular issues.
• Choose special programs or treatments that focus on long-term outcomes and that take the developmental level of your child into consideration.
• Remember that your child is part of a family unit and that his or her needs should be balanced with the those of other family members.
• Get support for yourself and other family members. You can't help your child if you are not meeting your own emotional and physical needs. Your community may offer support groups at a local hospital or mental health center. There is considerable state-to-state variation in the types of government-sponsored services and other programs available to children with autism spectrum disorders and their families.

Your Child's Future

Currently, few facilities are specifically dedicated to providing for the needs of kids with AS. Some children are in mainstream schools where their progress depends on the support and encouragement of parents, caregivers, teachers, and classmates. However, some go to special schools for kids with autism or learning disabilities.

Many people with AS can function well in most aspects of life, so the condition does not have to prevent your child from succeeding academically and socially.

You may feel overwhelmed and discouraged if your child is diagnosed with AS. Remember that your child's treatment team can provide enormous support and encouragement for your child — and your family.

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Night Terrors

Most parents have comforted their child after the occasional nightmare. But if your child has ever experienced what's known as a night terror (or sleep terror), his or her fear was likely inconsolable — no matter what you tried.

A night terror is a sleep disruption that seems similar to a nightmare, but with a far more dramatic presentation. Though night terrors can be alarming for parents who witness them, they're not typically cause for concern or a sign of a deeper medical issue.

What Are Night Terrors?

During a typical night, sleep occurs in several stages. Each is associated with particular brain activity, and the rapid eye movement (REM) stage is the stage when most dreaming occurs.

Night terrors happen during deep non-REM sleep. Unlike nightmares (which occur during REM sleep), a night terror is not technically a dream, but more like a sudden reaction of fear that happens during the transition from one sleep phase to another.

Night terrors typically occur about 2 or 3 hours after a child falls asleep, when sleep transitions from the deepest stage of non-REM sleep to lighter REM sleep, a stage where dreams occur. Usually this transition is a smooth one. But rarely, a child becomes agitated and frightened — and that fear reaction is a night terror.

During a night terror, a child might suddenly sit upright in bed and shout out or scream in distress. The child's breathing and heartbeat might be faster, he or she might sweat, thrash around, and act upset and scared. After a few minutes, or sometimes longer, a child simply calms down and returns to sleep.

Unlike nightmares, which kids often remember, kids won't have any memory of a night terror the next day because they were in deep sleep when it happened — and there are no mental images to recall.

What Causes Night Terrors?

Night terrors are caused by over-arousal of the central nervous system (CNS) during sleep. This may happen because the CNS (which regulates sleep and waking brain activity) is still maturing. Some kids may inherit a tendency for this over-arousal — about 80% who have night terrors have a family member who also experienced them or sleepwalking (a similar type of sleep disturbance).

Night terrors have been noted in kids who are:

• overtired or ill, stressed or fatigued
• taking a new medication
• sleeping in a new environment or away from home

Night terrors are relatively rare — they happen in only 3–6% of kids, while almost every child will have a nightmare occasionally. Night terrors usually occur between the ages of 4 and 12, but have been reported in kids as young as 18 months. They seem to be a little more common among boys.

A child might have a single night terror or several before they cease altogether. Most of the time, night terrors simply disappear on their own as the nervous system matures.

Coping With Night Terrors

Night terrors can be very upsetting for parents, who might feel helpless at not being able to comfort or soothe their child. The best way to handle a night terror is to wait it out patiently and make sure the child doesn't get hurt by thrashing around. Kids usually will settle down and return to sleep on their own in a few minutes.

It's best not to try to wake kids during a night terror. Attempts usually don't work, and kids who do wake are likely to be disoriented and confused, and may take longer to settle down and go back to sleep.

There's no treatment for night terrors, but you can help prevent them. Try to:

• reduce your child's stress
• establish and stick to a bedtime routine that's simple and relaxing
• make sure your child gets enough rest
• prevent your child from becoming overtired by staying up too late

Understanding night terrors can reduce your worry — and help you get a good night's sleep yourself. But if night terrors happen repeatedly, talk to your doctor about whether a referral to a sleep specialist is needed.

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Febrile Seizures

Febrile seizures are full-body convulsions caused by high fevers (febrile means "feverish"). They affect kids 6 months to 5 years old, and are most common in toddlers 12 to 18 months old. The seizures typically last for a few minutes and are accompanied by a fever above 102° Fahrenheit (38.9° Celsius).

Although they can be frightening, febrile seizures usually stop on their own and don't cause any other health problems. Having one doesn't mean that a child will have epilepsy or brain damage.

About Febrile Seizures

During a febrile seizure, a child's whole body may convulse, shake, and twitch, and he or she may moan or become unconscious. This type of seizure is usually over in a few minutes, but in rare cases can last up to 15 minutes.

Febrile seizures stop on their own, while the fever continues until it is treated. In some cases, kids feel sleepy afterwards; in others, there are no lingering effects.

No one knows why febrile seizures occur, although some evidence suggests that they're linked to certain viruses. Febrile seizures are not considered epilepsy, but a child who has had a febrile seizure has a slightly increased risk of developing epilepsy, especially if there is a family history.

Treating Febrile Seizures

If your child has a febrile seizure, stay calm and:

• Make sure your child is in a safe place and cannot fall down or hit something hard.
• Lay your child on his or her side to prevent choking.
• Watch for signs of breathing difficulty, including any color change in your child's face.
• If the seizure lasts more than 10 minutes, or your child turns blue, it is probably a more serious type of seizure — call 911 right away.

It's also important to know what you should not do during a febrile seizure:

• Do not try to hold or restrain your child.
• Do not put anything in your child's mouth.
• Do not try to give your child fever-reducing medicine.
• Do not try to put your child into cool or lukewarm water to cool off.

Again, unless the seizure lasts for more than 10 minutes or your child has trouble breathing, there's no need to rush to the ER.

When the seizure is over, call your doctor for an evaluation. Some kids who have a febrile seizure will have another in the future.

The doctor will examine your child and ask you to describe the seizure. In most cases, no additional treatment is necessary. The doctor may recommend the standard treatment for fevers, which is acetaminophen or ibuprofen. But if your child is under 1 year old, looks very ill, or has other symptoms such as diarrhea or vomiting, the doctor may recommend some testing.

Febrile seizures can be scary to witness but remember that they're fairly common, not usually a symptom of serious illness, and in most cases don't lead to other health problems. If you have any questions or concerns, talk with your doctor.

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Dwarfism

There's been a lot of discussion over the years about the proper way to refer to a child with dwarfism. Many people who have the condition prefer the term "little person" or "person of short stature." For some, "dwarf" is acceptable. For most, "midget" definitely is not. But here's an idea everyone can agree on: Why not simply call a person with dwarfism by his or her name?

Being of short stature is only one of the characteristics that make a little person who he or she is. If you're the parent or loved one of a little person, you know this to be true. But here are some facts that other people may not realize about dwarfism and those who have it.

Dwarfism:

• is a condition characterized by short stature. Technically, that means an adult height of 4 feet 10 inches or under, according to the advocacy group Little People of America (LPA).
• can be caused by any one of more than 200 conditions, most of which are genetic. The most common type, accounting for 70% of all cases of short stature, is called achondroplasia.
• can and most often does occur in families where both parents are of average height. In fact, 85% of children with achondroplasia are born to average-size parents.

Dwarfism isn't:

• an intellectual disability. A person who has dwarfism is typically of normal intelligence.
• a disease that requires a "cure." Most people with the condition can live long, fulfilling lives.
• a reason to assume someone is incapable. Little people go to school, go to work, marry, and raise children, just like their average-size peers.

What Causes Short Stature?

More than 200 conditions are known to cause short stature in a child. Most are caused by a spontaneous genetic mutation in the egg or sperm cells prior to conception. Other conditions are caused by genes inherited from one or both parents. In either of these cases, two average-size parents can have a child with short stature (though this is far more likely to occur with a spontaneous mutation). Similarly, depending on the type of condition causing the short stature, it is possible for little people to have an average-size child.

What prompts a gene to mutate is not yet clearly understood. The change is seemingly random and unpreventable, and can occur in any pregnancy. Generally, when average-size parents have a child with short stature due to a spontaneous mutation, it is rare to have a second child who is also of short stature. However, if parents have some form of dwarfism themselves, the odds are much greater that their children will have it as well. A genetic counselor can help determine the likelihood of passing on the condition in these cases.

Dwarfism has other causes, including metabolic or hormonal disorders in infancy or childhood. Chromosomal abnormalities, pituitary gland disorders (which influence growth and metabolism), absorptive problems (when the body can't absorb nutrients adequately), and kidney disease can all lead to short stature if a child fails to grow at a normal rate.

Types of Short Stature

Most types of dwarfism are known as skeletal dysplasias, which are conditions of abnormal bone growth. They're divided into two types: short-trunk and short-limb dysplasias. People with short-trunk dysplasia have a shortened trunk with longer limbs, whereas those with short-limb dysplasia have an average-sized trunk but small arms and legs.

By far, the most common skeletal dysplasia is achondroplasia, a short-limb dysplasia that occurs in about 1 of every 26,000 to 40,000 babies of all races and ethnicities. It can be caused by a spontaneous mutation in one gene or a child can inherit the gene from a parent who has achondroplasia. People with achondroplasia have a relatively long trunk and shortened upper parts of their arms and legs. They may share other features as well, such as a large head with a prominent forehead, a flattened bridge of the nose, shortened hands and fingers, and reduced muscle tone. The average adult height for someone with achondroplasia is about 4 feet.

Diastrophic dysplasia is another, less common form of short-limb dwarfism. It occurs in about 1 in 100,000 births, and is also sometimes characterized by cleft palate, clubfeet, and ears with a cauliflower appearance. People who have it tend to have shortened forearms and calves (this is known as mesomelic shortening).

Spondyloepiphyseal dysplasias (SED) refers to a group of short-trunk skeletal conditions that affect about 1 in 95,000 babies. Along with achondroplasia and diastrophic dysplasia, it is one of the most common forms of dwarfism. In some forms, a lack of growth in the trunk area may not become apparent until the child is between 5 and 10 years old; other forms are apparent at birth. Often, kids with this disorder also have clubfeet, cleft palate, and a barrel-chested appearance.

In general, dwarfism caused by skeletal dysplasias results in what is known as disproportionate short stature — meaning the limbs are short in comparison with the rest of the body. Metabolic or hormonal disorders typically cause proportionate dwarfism, meaning a person's arms, legs, and trunk are all shortened but remain in proportion to overall body size.

Diagnosis

Some types of dwarfism can be identified through prenatal testing if a doctor suspects a particular condition and tests for it. But most cases are not identified until after the child is born. In those instances, the doctor makes a diagnosis based on the child's appearance, failure to grow, and X-rays of the bones. Depending on the type of dwarfism the child has, diagnosis often can be made almost immediately after birth.

Once a diagnosis is made, there is no "treatment" for most of the conditions that lead to short stature. Hormonal or metabolic problems may be treated with hormone injections or special diets to spark a child's growth, but skeletal dysplasias cannot be "cured." People with these types of dwarfism can, however, get medical care for some of the health complications that are associated with short stature. Problems associated with the different forms of dwarfism involve other body systems — such as vision or hearing — and require careful monitoring.

Possible Complications and Treatments

Short stature is the one quality all people with dwarfism have in common. After that, each of the many conditions that cause dwarfism has its own set of characteristics and possible complications. Fortunately, many of these complications are treatable, so that people of short stature can lead healthy, active lives.

For example, some babies with achondroplasia may experience hydrocephalus (excess fluid around the brain). They may also have a greater risk of developing apnea — a temporary stop in breathing during sleep — because of abnormally small or misshapen airways or, more likely, because of airway obstruction by the adenoids or the tonsils. Occasionally, a part of the brain or spinal cord is compressed. With close monitoring by doctors, however, these potentially serious problems can be detected early and surgically corrected.

As a child with dwarfism grows, other issues may also become apparent, including:

• delayed development of some motor skills, such as sitting up and walking
• a greater susceptibility to ear infections and hearing loss
• breathing problems caused by small chests
• weight problems
• curvature of the spine (scoliosis)
• bowed legs
• trouble with joint flexibility and early arthritis
• lower back pain or leg numbness
• crowding of teeth in the jaw

Proper medical care can alleviate many of these problems. For example, surgery can often bring relief from the pain of joints that wear out under the stress of bearing weight differently with limited flexibility. Surgery also can be used to improve some of the leg, hip, and spine problems people with short stature sometimes face.

Nonsurgical options may help, too — for instance, excessive weight can worsen many orthopedic problems, so a nutritionist might help develop a healthy plan for shedding extra pounds. And doctors or physical therapists can recommend ways to increase physical activity without putting extra stress on the bones and joints.

Helping Your Child

Although types of dwarfism, and their severity and complications, vary from person to person, in general a child's life span is not affected by the dwarfism. Though the Americans with Disabilities Act protects the rights of people with dwarfism, many members of the short-statured community don't feel that they have a disability.

You can help your child with dwarfism lead the best life possible by building his or her sense of independence and self-esteem right from the start. Here are some tips to keep in mind:

• Treat your child according to his or her age, not size. If you expect a 6-year-old to clean up his or her room, don't make an exception simply because your child is small.
• Adapt to your child's limitations. Something as simple as a light switch extender can give a short-statured child a sense of independence around the house.
• Present your child's condition — both to your child and to others — as a difference rather than a hindrance. Your attitude and expectations can have a significant influence on your child's self-esteem.
• Learn to deal with people's reactions, whether it's simple curiosity or outright ignorance, without anger. Address questions or comments as directly as possible, then take a moment to point out something special about your child. If your child is with you, this approach shows that you notice all the other qualities that make him or her unique. It will also help prepare your child for dealing with these situations when you're not there.
• If your child is teased at school, don't overlook it. Talk to teachers and administrators to make sure your child is getting the support he or she needs.
• Encourage your child to find a hobby or activity to enjoy. If sports aren't going to be your child's forte, then maybe music, art, computers, writing, or photography will be.
• Finally, get involved with support associations like the Little People of America. Getting to know other people with dwarfism — both as peers and mentors — can show your child just how much he or she can achieve.

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Milk Allergy

Almost all infants are fussy at times. But sometimes infants are excessively fussy because they have an allergy to the protein in cow's milk, which is the basis for most commercial baby formulas.

A person of any age can have a milk allergy, but it is more common among infants. Approximately 2% to 3% of infants have a milk allergy, and they typically outgrow it.

If you think that your child has a milk allergy, talk with your child's doctor. There are tests that can diagnose the condition and alternatives to milk-based formulas and dairy products that your doctor can recommend.

What Is a Milk Allergy?
A milk allergy occurs when the child's immune system mistakenly sees the milk protein as dangerous and tries to fight it off. This starts an allergic reaction, which can cause an infant to be fussy and irritable, and cause an upset stomach and other symptoms. Most children who are allergic to cow's milk also react to goat's milk and sheep's milk, and some of them are also allergic to the protein in soy milk.

Infants who are breastfed have a lower risk of developing a milk allergy than infants who are formula fed, but researchers don't fully understand why some children develop a milk allergy and others don't. It's believed that in many cases, the allergy is genetic.

Typically, a milk allergy goes away on its own by the time a child is 3 to 5 years old, but some children never outgrow it.

A milk allergy is not the same thing as lactose intolerance, the inability to digest the sugar lactose, which is rare in infants and more common among older kids and adults.

Symptoms of a Milk Allergy
Symptoms of cow's milk protein allergy will generally appear within the first few months of life. An infant can experience symptoms either very quickly after feeding (rapid onset) or not until 7 to 10 days after consuming the cow's milk protein (slower onset).

The slower-onset reaction is more common. Symptoms may include loose stools (possibly containing blood), vomiting, gagging, refusing food, irritability or colic, and skin rashes. This type of reaction is more difficult to diagnose because the same symptoms may occur with other health conditions. Most children will outgrow this form of allergy by 2 years of age.

Rapid-onset reactions come on suddenly with symptoms that can include irritability, vomiting, wheezing, swelling, hives, other itchy bumps on the skin, and bloody diarrhea. In rare cases, a potentially severe allergic reaction called anaphylaxis can occur and affect the baby's skin, stomach, breathing, and blood pressure. Anaphylaxis is more common in other food allergies than in a milk allergy.

Diagnosing a Milk Allergy
If you suspect that your infant is allergic to milk, call your baby's doctor. The doctor will likely ask about any family history of allergies or food intolerance and then do a physical exam. There's no single lab test to accurately diagnose a milk allergy, so your doctor might order several tests to make the diagnosis and rule out any other health problems.

In addition to a stool test and a blood test, the doctor may order an allergy skin test, in which a small amount of the milk protein in inserted just under the surface of the child's skin with a needle. If a red, raised spot called a wheal emerges, the child may have a milk allergy.

The doctor may also request an oral challenge test. After you stop feeding your baby milk for about a week, the doctor will have the infant consume milk, then wait for a few hours to watch for any allergic reaction. Sometimes doctors repeat this test to reconfirm the diagnosis.

Treating a Milk Allergy
If your infant has a milk allergy and you are breastfeeding, it's important to restrict the amount of dairy products that you ingest because the milk protein that's causing the allergic reaction can cross into your breast milk. You may want to talk to a dietician about finding alternative sources of calcium and other vital nutrients to replace what you were getting from dairy products.

Since January 2006, all food makers must clearly state on package labels whether the foods contain milk or milk-based products, indicating this in or next to the ingredient list on the packaging. Keep in mind, though, that this law applies only to foods packaged after the start of 2006, so some foods packaged before then may not have any information about food allergens.

If you are formula-feeding your infant, your doctor may advise you to switch to a soy protein-based formula. If your infant can't tolerate soy, the doctor may have you switch to a hypoallergenic formula, one in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.

Two major types of hypoallergenic formulas are available:

• Extensively hydrolyzed formulas have cow's milk proteins that are broken down into small particles so that they are less allergenic than the whole proteins in regular formulas. Most infants who have a milk allergy can tolerate these formulas, but in some cases, they still provoke allergic reactions.
  
  
• Amino acid-based infant formulas, which contain protein in its simplest form (amino acids are the building blocks of proteins). This may be recommended if your baby's condition doesn't improve even after a switch to a hydrolyzed formula.

There are also "partially hydrolyzed" formulas on the market, but they are not considered truly hypoallergenic and they can still provoke a significant allergic reaction.

The formulas available in the market today are approved by the U.S. Food and Drug Administration (FDA) and created through a very specialized process that cannot be duplicated at home. Goat's milk, rice milk, or almond milks are not safe and are not recommended for infants.

Once you switch your baby to another formula, the symptoms of the allergy should go away in 2 to 4 weeks. Your child's doctor will probably recommend that you continue with a hypoallergenic formula up until the baby's first birthday, then gradually introducing cow's milk into his or her diet.

If you have any questions or concerns, talk with your child's doctor.

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