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Croup

Alternative Names: Viral croup; Laryngotracheobronchitis – acute; Spasmodic croup

Definition:
Croup  is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a “barking” cough, stridor, and hoarseness. It may produce mild, moderate, or severe symptoms, which often worsen at night.

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The barking cough of croup is the result of inflammation around the vocal cords (larynx) and windpipe (trachea). When the cough reflex forces air through this narrowed passage, the vocal cords vibrate with a barking noise. Because children have small airways to begin with, those younger than age 5 are most susceptible to having more-marked symptoms with croup.

Croup typically occurs between the ages of six months and six years, but the peak age is two and it’s less common after three. Children with asthma may get repeated episodes.

Croup usually isn’t serious. Most cases of croup can be treated at home. Sometimes, your child will need prescription medication.

Once due primarily to diphtheria, this cause is now primarily of historical significance in the Western world due to the success of vaccination.

Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years. It accounts for about 5% of hospital admissions in this population. In rare cases, it may occur in children as young as 3 months and as old as 15 years. Males are affected 50% more frequently than are females, and there is an increased prevalence in autumn (fall).

History:
The word croup comes from the Early Modern English verb croup, meaning “to cry hoarsely”; the name was first applied to the disease in Scotland and popularized in the 18th century. Diphtheritic croup has been known since the time of Homer’s Ancient Greece and it was not until 1826 that viral croup was differentiated from croup due to diphtheria by Bretonneau. Viral croup was thus called “faux-croup” by the French, as “croup” then referred to a disease caused by the diphtheria bacteria. Croup due to diphtheria has become nearly unknown due to the advent of effective immunization

Symptoms:
Croup is characterized by a “barking” cough, stridor, hoarseness, and difficult breathing which usually worsens at night. The “barking” cough is often described as resembling the call of a seal or sea lion.

As the cough gets more frequent, the child may have labored breathing or stridor (a harsh, crowing noise made during inspiration).The stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably.

Other symptoms include fever, coryza (symptoms typical of the common cold), and chest wall indrawing. Drooling or a very sick appearance indicate other medical conditions

Rarely, croup can last for weeks. Croup that lasts longer than a week or recurs frequently should be discussed with your doctor to determine the cause.

Causes:
Viral croup is the most common. Other possible causes include bacteria, allergies, and inhaled irritants. Acid reflux from the stomach can trigger croup.

Croup is usually (75% of the time) caused by parainfluenza viruses, but RSV, measles, adenovirus, and influenza can all cause croup.

Before the era of immunizations and antibiotics, croup was a dreaded and deadly disease, usually caused by the diphtheria bacteria. Today, most cases of croup are mild. Nevertheless, it can still be dangerous.

Croup tends to appear in children between 3 months and 5 years old, but it can happen at any age. Some children are prone to croup and may get it several times.

In the northern hemisphere, it is most common between October and March, but can occur at any time of the year.

In severe cases of croup, there may also be a bacterial superinfection of the upper airway. This condition is called bacterial tracheitis and requires hospitalization and intravenous antibiotics. If the epiglottis becomes infected, the entire windpipe can swell shut, a potentially fatal condition called epiglottitis.

Diagnosis:
Croup is a clinical diagnosis. The first step is to exclude other obstructive conditions of the upper airway, especially epiglottitis, an airway foreign body, subglottic stenosis, angioedema, retropharyngeal abscess, and bacterial tracheitis.

A frontal X-ray of the neck is not routinely performed, but if it is done, it may show a characteristic narrowing of the trachea, called the steeple sign. The steeple sign is suggestive of the diagnosis, but is absent in half of cases.

Other investigations (such as blood tests and viral culture) are discouraged as they may cause unnecessary agitation and thus worsen the stress on the compromised airway. While viral cultures, obtained via nasopharyngeal aspiration, can be used to confirm the exact cause, these are usually restricted to research settings. Bacterial infection should be considered if a person does not improve with standard treatment, at which point further investigations may be indicated

Severity:
The most commonly used system for classifying the severity of croup is the Westley score. It is primarily used for research purposes rather than in clinical practice. It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions.The points given for each factor is listed in the table to the right, and the final score ranges from 0 to 17.

*A total score of ? 2 indicates mild croup. The characteristic barking cough and hoarseness may be present, but there is no stridor at rest.
*A total score of 3–5 is classified as moderate croup. It presents with easily heard stridor, but with few other signs.
*A total score of 6–11 is severe croup. It also presents with obvious stridor, but also features marked chest wall indrawing.
*A total score of ? 12 indicates impending respiratory failure. The barking cough and stridor may no longer be prominent at this stage.
85% of children presenting to the emergency department have mild disease; severe croup is rare (<1%).

Treatment :-
Most cases of croup can be safely managed at home, but call your health care provider for guidance, even in the middle of the night.

Cool or moist air might bring relief. You might first try bringing the child into a steamy bathroom or outside into the cool night air. If you have a cool air vaporizer, set it up in the child’s bedroom and use it for the next few nights.

Acetaminophen can make the child more comfortable and lower a fever, lessening his or her breathing needs. Avoid cough medicines unless you discuss them with your doctor first.

You may want your child to be seen. Steroid medicines can be very effective at promptly relieving the symptoms of croup. Medicated aerosol treatments, if necessary, are also powerful.

Serious illness requires hospitalization. Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for medical attention or hospitalization.

Medications are used to help reduce upper airway swelling. This may include aerosolized racemic epinephrine, corticosteroids taken by mouth, such as dexamethasone and prednisone, and inhaled or injected forms of other corticosteroids. Oxygen and humidity may be provided in an oxygen tent placed over a crib. A bacterial infection requires antibiotic therapy.

Increasing obstruction of the airway requires intubation (placing a tube through the nose or mouth through the larynx into the main air passage to the lungs). Intravenous fluids are given for dehydration. In some cases, corticosteroids are prescribed.

Alternative Treatments :-
Since most croup cases are mild in severity, over the counter treatments are often used. These treatments include ointments such as Vick’s or other menthol creams. These often are used to open up the airways. Other over the counter treatments include humidifiers to keep the humidity up in a room and lessen the chances of the airways becoming further inflamed or irritated.

Other methods of breaking croup attacks include hot shower exposure and cold air exposure. In the hot shower method, the shower is used as a sauna, in that the shower is running but people sit outside of it, taking in the warm, humid air. This method can be very effective when used in ten minute increments. Cuddling or reading to the child can limit the stress that is on the child during such a treatment. Cold or cool air exposure is another very effective alternative treatment. This method of treatment relies on the idea that the inflamed tissues will cool and shrink when exposed to cool air. Since most croup cases occur during the fall or winter seasons, this is often achieved simply by going outside or driving with the windows rolled down.

Lifestyle and home remedies:
Croup often runs its course within three to seven days. In the meantime, keep your child comfortable with a few simple measures.

*Stay calm. Comfort or distract your child — cuddle, read a book or play a quiet game. Crying makes breathing more difficult.

*Moisten the air. Use a cool-air humidifier in your child’s bedroom or have your child breathe the warm, moist air in a steamy bathroom. Although researchers have questioned the benefits of humidity as part of emergency treatment for croup, moist air seems to help children breathe easier — especially when croup is mild.

*Get cool. Sometimes breathing fresh, cool air helps. If it’s cool outdoors, wrap your child in a blanket and walk outside for a few minutes.

*Hold your child in an upright position. Sitting upright can make breathing easier. Hold your child on your lap, or place your child in a favorite chair or infant seat.

*Offer fluids. For babies, water, breast milk or formula is fine. For older children, soup or frozen fruit pops may be soothing.

*Encourage resting. Sleep can help your child fight the infection.

*Try an over-the-counter pain reliever. If your child has a fever, acetaminophen (Tylenol, others) may help. Cough syrup, which doesn’t affect the larynx or trachea, isn’t likely to relieve your child’s cough. Over-the-counter cold preparations are not recommended for children younger than age 5.

Your child’s cough may improve during the day, but don’t be surprised if it returns at night. You may want to sleep near your child or even in the same room so that you can take quick action if your child’s symptoms become severe.

Prognosis:
Viral croup is usually a self-limited disease, but can very rarely result in death from respiratory failure and/or cardiac arrest. Symptoms usually improve within two days, but may last for up to seven days. Other uncommon complications include bacterial tracheitis, pneumonia, and pulmonary edema

Prevention:
To prevent croup, take the same steps you use to prevent colds and flu. Frequent hand washing is most important. Also keep your child away from anyone who’s sick, and encourage your child to cough or sneeze into his or her elbow.

To stave off more-serious infections, keep your child’s immunizations current. The diphtheria, Haemophilus influenzae type b (Hib) and measles vaccines offer protection from some of the rarest — but most dangerous — forms of upper airway infection.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/croup2.shtml
http://www.mayoclinic.com/health/croup/DS00312
http://en.wikipedia.org/wiki/Croup
http://www.nlm.nih.gov/medlineplus/ency/article/003215.htm

http://modernmedicalguide.com/croup-acute-spasmodic-laryngitis/

http://savingmommymoney.com/croup-symptoms-and-cure

http://www.methodsofhealing.com/Healing_Conditions/croup/

http://www.sciencephoto.com/images/download_lo_res.html?id=770500647

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Which Infant Formulas Contain Hidden Toxic Chemicals?

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Although artificial human milk is regulated by the FDA, researchers from the Centers for Disease Control and Prevention found that a thyroid-affecting chemical used in rocket fuel contaminated 15 brands of powdered infant formula — including two that accounted for 87 percent of market share in 2000. The top offenders included Similac and Enfamil.

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The International Formula Council blamed the perchlorate on the water used to make the formula rather than the powder. However, pre-mixed liquid formulas come with their own potential toxins, such as the chemical BPA.

And in China, 76 tons of melamine-tainted milk products were recently seized, just two years after melamine-adulterated formula killed six infants and hospitalized thousands more.

Mother Jones reports:
“For all these reasons the American Academy of Pediatrics remains less than sanguine about infant formula, recommending exclusive breastfeeding for six months and continued nursing ‘until at least the baby’s first birthday.’ Indeed, they credit mother’s milk with everything from breast cancer risk reduction to obesity prevention.”

Source: Mother Jones July 12, 2010

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Ankyloglossia or Tongue -tie

Definition:
By definition, complete ankyloglossia is the total adherence of the tongue to the floor of the mouth. Partial ankyloglossia is incomplete separation of the tongue from the bottom of the mouth due to a short frenulum, which is a fibrous membrane extending from the bottom of the tongue to an area below the bottom front teeth. Tongue-tie can be evident when the baby is crying or by careful inspection.

CLICK TO SEE THE PICTURES…..>….(01)....(1).…..….(2)..……...(3)..……..…………..

List of images in Gray's Anatomy: XII. Surface...
List of images in Gray’s Anatomy: XII. Surface anatomy and Surface Markings (Photo credit: Wikipedia)

Symptoms:
There are certain facial features that have been found to be associated with a short frenulum.

*High-arched palate: characterized by a higher than normal arch of the roof of the mouth.
*Retrognathia: very small chin.
*Micrognathia: a recessed or undefined chin.
*Prognathism: a protruding lower jaw.
*Can’t stick the tongue forward
*Difficulty feeding
*Excessive attachment of tongue to bottom of the mouth
*V-shaped notch in tip of tongue

Causes:
Tongue-tie causes a significant portion of of the problems encountered with breastfeeding. It also is thought to pose other short term and long term complications, such as speech impediments, problems with swallowing, and the formation of teeth arrangement. There is some controversy over the defining characteristics of tongue-tie as well as the treatments.

When we hear the term “tongue-tied”, most of us have a mental image of someone who is struggling to speak in public, but is stammering nervously and is at a loss for words. In reality, tongue-tie is a medical condition that affects many people, and has special implications for the breastfed baby.
The medical term for the condition known as tongue-tie is “ankyloglossia”. It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and tight, causing the movement of the tongue to be restricted.
Tongue-tie is congenital (present at birth) and hereditary (often more that one family member has the condition). It occurs relatively often: between 0.2% and 2% of babies are born with tight frenulums.

To tell if your baby is tongue-tied, look at him and stick out your tongue. Even tiny babies will imitate you. If he is unable to extend his tongue fully, or if it has a heart shaped appearance on the tip, then you should have him evaluated by his doctor. You can also try putting your finger in his mouth (pad side up) until he starts sucking. See if his tongue extends over his gum line to cup the bottom of your finger. If not, you may want to have him checked.
In most cases, the frenulum recedes on its own during the first year, and causes no problems with feeding or speech development. A lot depends on the degree of the tongue-tie: if the points of attachment are on the very tip of the tongue and the top ridge of the bottom gum, feeding and speech are more likely to be affected than if the frenulum is attached further back.

Severe tongue-tie can cause problems with speech. Certain sounds are difficult to make if the tongue can’t move freely (especially ‘th’, ‘s’, ‘d’, ‘l’, and ‘t’). In addition to forming specific sounds, tongue-tie may also make it hard for a child to lick an ice cream cone, stick out his tongue, play a wind instrument, or French kiss. While these may not seem like important skills to you as a new mother, someday they may be very important to your child! Dental development may also be affected, with severe tongue- tie sometimes causing a gap between the two lower front teeth.
Of more immediate importance is the negative impact that a tight frenulum can have on a baby’s ability to breastfeed effectively. In order to extract milk from the breast, the baby needs to move his tongue forward to cup the nipple and areola, drawing it back in his mouth and pressing the tissue against the roof of his mouth. This compresses the lactiferous sinuses (the pockets behind the areola where the milk is stored) and allows the milk to move into the baby’s mouth. The tongue plays an important role in breastfeeding, and if the baby’s frenulum is so short that his tongue can’t extend over the lower gum, he may end up compressing the breast tissue between his gums while he nurses, which can cause severe damage to the nipples.
Tongue-tie can cause feeding difficulties such as low weight gain and constant fussiness in the baby. Nursing mothers may experience nipple trauma (the pain doesn’t go away no matter what position is used), plugged ducts, and mastitis.

Some tongue-tied babies are able to nurse effectively, depending on the way the frenulum is attached, as well as the individual variations in the mother’s breast. If the mother has small or medium nipples, the baby may be able to manage to extract the milk quite well in spite of being tongue-tied. On the other hand, if the nipples are large and/or flat, then even a slight degree of tongue-tie may cause problems for a nursing baby.
In addition to problems with nipple soreness and weight gain, some other signs that the baby may be having problems nursing effectively include breaking suction often during feedings, and making a clicking sound while nursing. Since these symptoms can also be caused by other problems, it’s a good idea to be evaluated by a knowledgeable health care provider (a lactation consultant if possible) to rule out causes other than tongue-tie. Tongue-tie should definitely be considered a possibility if breastfeeding doesn’t improve even after other measures such as adjustments in positioning have been tried.
If it is determined that tongue-tie is causing breastfeeding difficulties, there is a simple procedure called a “frenetomy” that can quickly correct the problem. In a relatively painless in-office procedure, the doctor simply clips the frenulum to loosen it and allow the tongue full range of motion. It takes less than a second, and because the frenulum contains almost no blood, there is usually only a drop or two of blood. The baby is put on the breast immediately following the procedure, and the bleeding stops almost instantly. Anesthesia and stitches are not necessary. The baby cries more because he is being restrained for a few seconds that he does because of pain. Comparing the procedure to ear piercing is a good analogy. Both involve a second or two of discomfort and a very small risk of infection, but are overall very safe and simple procedures.

Diagnosis
According to Horton et al., diagnosis of ankyloglossia may be difficult; it is not always apparent by looking at the underside of the tongue but is often dependent on the range of movement permitted by the genioglossus muscles. For infants, passively elevating the tongue tip with a tongue depressor may reveal the problem. For older children, making the tongue move to its maximum range will demonstrate the tongue tip restriction. In addition, palpation of genioglossus on the underside of the tongue will aid in confirming the diagnosis.

In most cases, the mother notices an immediate improvement in both her comfort level and the baby’s ability to nurse more efficiently. If the tongue-tie isn’t identified and the frenulum isn’t clipped until the baby is several weeks or months old, then it may take longer for him to learn to suck normally. Sometimes suck training is necessary in order for him to adapt to the new range of motion of his tongue. If tongue-tie is causing severe breastfeeding difficulties, then the sooner the frenulum is clipped, the better. Sometimes children end up having the procedure done when they are much older, because the problem isn’t identified until after they begin developing significant speech problems.

Even though clipping the frenulum is a simple, safe, and uncomplicated procedure, it may be difficult to find a doctor who is willing to perform it. The history of treating tongue-tie is somewhat controversial. Up until the nineteenth century, baby’s frenulums were clipped almost routinely. Because of the potential for feeding and speech problems, midwives were reported to keep one fingernail sharpened so that they could sweep under the tongue and snip the frenulum of just about all newborn babies. Any procedure that involves cutting tissue in the mouth can potentially involve infection or damage to the tongue, especially back in the days before sterile conditions and antibiotics. Because the procedure was overdone and in most cases, wasn’t really necessary, doctors became very reluctant to clip frenulums at all and the procedure was rarely performed.

Part of the reason frenotomies fell out of favor for many years was the fact that doctors discovered that in all but the most severe cases, speech was not affected by tongue-tie. They preferred to take a “wait and see” approach and let nature take it’s course. Most of the time, the frenulum would stretch out on its own with no intervention.

During the same time period that frenotomies were becoming less common, the rate of breastfeeding also declined dramatically. Bottle-feeding doesn’t present the same feeding difficulties for tongue-tied babies that breastfeeding does, because the mechanics are very different and extension of the tongue doesn’t play as big a role in feeding from the bottle. Since the majority of babies were bottle fed, it was easy for doctors to say that they weren’t going to perform an unnecessary procedure that didn’t interfere with feeding, and rarely caused speech problems.
Even today, with most infants in this country starting out breastfeeding, it may be difficult to find a doctor who recognizes the problem that tongue-tie can present for a nursing baby and is willing to perform a frenotomy. The procedure is seldom mentioned in the pediatric literature, and is no longer routinely taught in medical school.

If you feel that your baby’s breastfeeding difficulties may be due to tongue-tie, you may need to work at finding a health care provider who can diagnose the problem and clip the frenulum. Although any pediatrician or general family practitioner can theoretically perform a frenotomy, many prefer to make a referral to an oral surgeon, dentist, or ENT specialist.

Diagnosis of Clinically Significant Tongue-Tie
Based on a combination of anatomical appearance and functional disturbance:

Anatomical Type I: Frenulum attaches to tip of tongue in front of alveolar ridge in low lip sulcus….

Type II: Attaches 2-4mm behind tongue tip and attaches on alveolar ridge…..click for picture.

Type III: Attaches to mid-tongue and middle of floor of the mouth, usually tighter and less elastic. The tip of the tongue may appear “heart-shaped”

Type IV: Attaches against base of tongue, is shiny, and is very inelastic

CLICK & SEE THE PICTURES

Effects:-
Ankyloglossia can affect feeding, speech, and oral hygiene   as well as have mechanical/social effects.   Ankyloglossia can also prevent the tongue from contacting the anterior palate. This can then promote an infantile swallow and hamper the progression to an adult-like swallow which can result in an open bite deformity.   It can also result in mandibular prognathism; this happens when the tongue contacts the anterior portion of the mandible with exaggerated anterior thrusts.    The authors sent a survey to a total of 1598 otolaryngologists, pediatricians, speech-language pathologists and lactation consultants with questions to ascertain their beliefs on ankyloglossia; 797 of the surveys were fully completed and used in the study. It was found that 69 percent of lactation consultants but only a minority of pediatricians answered that ankyloglossia is frequently associated with feeding difficulties; 60 percent of otolaryngologists and 50 percent of speech pathologists answered that ankyloglossia is sometimes associated with speech difficulties compared to only 23 percent of pediatricians; 67 percent of otolaryngologists compared to 21 percent of pediatricians answered that ankyloglossia is sometimes associated with social and mechanical difficulties. Limitations of this study include a reduced sample size due to unreturned or incomplete surveys.

Feeding
Messner et al. studied ankyloglossia and infant feeding. Thirty-six infants with ankyloglossia were compared to a control group without ankyloglossia. The two groups were followed for six months to assess possible breastfeeding difficulties, defined as nipple pain lasting more than six weeks, or infant difficulty latching onto or staying onto the mother’s breast. Twenty-five percent of mothers of infants with ankyloglossia reported breast feeding difficulty compared with only 3 percent of the mothers in the control group. The study concluded that ankyloglossia can adversely affect breastfeeding in certain infants. Infants with ankyologlossia do not, however, have such big difficulties when feeding from a bottle.  Limitations of this study include the small sample size and the fact that the quality of the mother’s breast feeding was not assessed.

Wallace and Clark also studied breastfeeding difficulties in infants with ankyloglossia.[8] They followed 10 infants with ankyloglossia who underwent surgical tongue tie division. Eight of the ten mothers experienced poor infant latching onto the breast, 6/10 experienced sore nipples and 5/10 experienced continual feeding cycles; 3/10 mothers were exclusively breastfeeding. Following a tongue tie division, 4/10 mothers noted immediate improvements in breastfeedings, 3/10 mothers did not notice any improvements and 6/10 mothers continued breastfeeding for at least four months after the surgery. The study concluded that tongue tie division may be a possible benefit for infants experiencing breastfeeding difficulties due to ankyloglossia and further investigation is warranted. The limitations of this study include that the sample size was small and that there was not a control group. In addition, the conclusions were based on subjective parent report as opposed to objective measures.

Speech
Messner and Lalakea studied speech in children with ankyloglossia. They noted that the phones likely to be affected due to ankyloglossia include sibilants and lingual sounds such as [t d z s ? ð n l]. In addition, the authors also state that it is uncertain as to which patients will have a speech disorder that can be linked to ankyloglossia and that there is no way to predict at a young age which patients will need treatment. The authors studied 30 children from one to 12 years of age with ankyloglossia, all of whom underwent frenuloplasty. Fifteen children underwent speech evaluation before and after surgery. Eleven patients were found to have abnormal articulation before surgery and nine of these patients were found to have improved articulation after surgery. Based on the findings, the authors concluded that it is possible for children with ankyloglossia to have normal speech in spite of decreased tongue mobility. However, according to their study, a large percent of children with ankyloglossia will have articulation deficits that can be linked to tongue tie and these deficits may be improved with surgery. The authors also note that ankyloglossia does not cause a delay in speech or language but, at the most, problems with enunciation. Limitations of the study include a small sample size as well as a lack of blinding of the speech-language pathologists who evaluated the subjects’ speech.

Messner and Lalakea also examined speech and ankyloglossia in another study. They studied 15 patients and speech was grossly normal in all of the subjects. However, half of the subjects reported that they thought that their speech was more effortful than other peoples’ speech.

Horton et al. discussed the relationship between ankyloglossia and speech. The authors believe that tongue tie contributes to difficulty in range and rate of articulation and that compensation is needed. Compensation at its worst, the article states, may involve a Cupid’s bow of the tongue.

While the tongue tie exists, and even years after removal, common speech abnormalities include mispronunciation of words. The most common is pronouncing Ls as Ws; for example the word “lemonade” would come out as “wemonade.”

Mechanical/Social
Ankyloglossia can result in mechanical and social effects. Lalakea and Messner studied 15 people, aged 14 to 68 years. The subjects were given questionnaires in order to assess functional complaints associated with ankyloglossia. Eight subjects noted one or more mechanical limitations which included cuts or discomfort underneath the tongue and difficulties with kissing, licking one’s lips, eating an ice cream cone, keeping one’s tongue clean and performing tongue tricks. In addition, seven subjects noted social effects such as embarrassment and teasing. The authors concluded that this study confirmed anecdotal evidence of mechanical problems associated with ankyloglossia and that it suggests that the kinds of mechanical and social problems noted may be more prevalent than previously thought. Furthermore, the authors note that some patients may be unaware of the extent of the limitations they have due to ankyloglossia since they have never experienced normal tongue range. A limitation of this study is the small sample size that also represented a large age range.

Lalakea and Messner note that mechanical and social effects may occur even without other problems related to ankyloglossia such as speech and feeding difficulties. Also, mechanical and social effects may not arise until later in childhood as younger children may be unable to recognize or report the effects. In addition, some problems may not come about until later in life, such as kissing.

Complications
The complications are rare, but recurrence of tongue tie, tongue swelling, bleeding, infection, and damage to the ducts of the salivary glands may occur.

Treatment:
Surgery is seldom necessary but if it is needed, it involves cutting the abnormally placed tissue. If the child has a mild case of tongue tie, the surgery may be done in the doctor’s office. More severe cases are done in a hospital operating room. A surgical reconstruction procedure called a z-plasty closure may be required to prevent scar tissue formation.

Prognosis:
Surgery, if performed, is usually successful.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://tonguetie.ballardscore.com/
http://www.breastfeeding-basics.com/html/tonguetie.shtml
http://en.wikipedia.org/wiki/Ankyloglossia
http://www.righthealth.com/topic/Tongue_Tie_Treatment/overview/adam20?fdid=Adamv2_001640&section=Full_Article

http://www.blueskydentaloffice.com/Children_s_Dentistry.html

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Toolkit Helps Parents Recognize a Child’s Risk of Obesity

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Some simple interventions used by pediatricians were enough to change a parent’s perspective about a child’s being overweight or obese, and change the parent’s behaviors at home to reduce those risks.
..
Researchers confirmed previous reports that parents of overweight or obese children do not recognize their child’s weight problem. But this time, by arming pediatricians with a “toolkit,” an easily used chart and a series of questions and suggestions, the researchers addressed several problems.

“Doctors often don’t have time to discuss overweight; they don’t have the tools to do it; and many aren’t confident that they’re going to make a difference in their patients’ lives,” said Eliana Perrin, lead author of the study.

“Also, parents don’t recognize weight problems or don’t know how to make things better, and even if they do, there are often barriers to healthier eating or more activity for these families,” says Perrin.

As First Lady Michelle Obama‘s “Let’s Move!” campaign aims to reduce childhood obesity – almost one-third of young people are overweight – two leading questions are how to affect that change and if it can be successful.

Perrin’s study is likely the first evidence that a parent’s assessment of their child’s weight can be changed. Her study also showed improved dietary behaviors in children and reduced time playing video games or watching television, called “screen time.”

“We found something we can do to help stem the obesity epidemic,” says Perrin, whose previous research in childhood obesity has shown that using a body mass index, or BMI, chart color-coded like a traffic light helps parents understand the often confounding measurement.

Perrin’s research group trained pediatric resident physicians on how to use the color-coded BMI chart and a revision of a questionnaire called “Starting the Conversation,” originally designed by Alice Ammerman, a co-author on the study. The STC gives health care providers a snapshot of potential red flags to help counsel patients as well as tips to implement change.

Parents were asked about their children’s weight status and discussions about weight in the doctor’s office. The Starting the Conversation form used in this study was revised by Perrin and asked parents about non-healthy eating habits – frequency of sugary snacks, sugar-sweetened beverages and eating out at restaurants, as well as activity and screen time. It also asked about the parent’s readiness to change. The pediatrics residents were instructed to show parents their children’s weight status in a color-coded BMI chart and were taught to use the parents’ responses to the questionnaire to engage the parents in discussions about healthier eating behaviors and activities.

Researchers enrolled 115 children ages 4 to 12 who were covered by Medicaid or the State Health Insurance Program and repeated the Starting the Conversation questionnaire as well as questions about weight status at one-month and three-month follow-up appointments.

The study showed the most significant improvement in dietary changes among children who were overweight. At follow up, they were more likely than healthy-weight children to drink lower-fat milk and showed the largest reduction in the frequency of eating out. But overall, children improved fruit and vegetable consumption, decreased sweetened beverages and unhealthy snacks, drank lower-fat milk more and reduced screen time.

In the initial visit, all of the parents of healthy-weight children accurately perceived their child’s weight. However, only 57 percent of overweight children’s parents did so at baseline. That improved significantly to 74 percent at three month follow up.

BMI was measured and tracked and a few children became more overweight, while more reached healthier weights but no significant improvements in weight status were noted in this short study, Perrin says. “The research has to be replicated and expanded, and it must determine if improvements in parental perception of children’s weight motivates families to improve behavior and, ultimately, leads to healthier weight over time,” she says.

“Everyone’s talking about BMI and we have a lot of studies to show that parents do not see their overweight children as overweight. That often does not sink in with parents,” Perrin says. “This is the first time we’ve seen a changed perspective from parents. We hope that parents who know their children are overweight will be empowered to help them achieve healthier lifestyles that can last a lifetime.”

Source: Elements4Health

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Soda Consumption at an Early Age Indicator of Unhealthy Childhood Diet

Young girls who drink soda have less healthy diets through adolescence than their peers who do not drink soda, according to a Penn State study.
The ten-year study showed that girls who drank soda at age five had diets that were less likely to meet nutritional standards for the duration of the study, which ended at age 15.Girls who did not drink soda at age five did not meet certain nutritional requirements, but their diets were healthier.

The difference between the two groups in nutrient intake is “not just because of what they are consuming, but because of what they are not consuming,” said Laura Fiorito, postdoctoral fellow in Penn State’s Center for Child Obesity Research.

Milk intake differed greatly between the two groups — soda drinkers drank far less milk than non-soda drinkers — and milk has all of the nutrients that differed between the groups except fiber. At age five, non-soda drinkers consumed 10 to 11 ounces of milk daily, while soda drinkers had less than seven ounces.

“Adequate nutrient intake is important for optimal health and growth,” the researchers reported in a recent issue of the Journal of the American Dietetic Association.

For example, low calcium intake is associated with increased risk of bone fractures and higher added sugar is associated with dental problems and the development of several chronic diseases, such as type 2 diabetes.

The Institute of Medicine, part of the National Academy of Sciences, recommends that girls between age 14 and 18 receive at least 65 milligrams of vitamin C daily. In this study, soda drinkers fell short at just 55 milligrams daily, while non-soda drinkers exceeded the recommendation at 70.5 milligrams daily.

Although soda drinkers had less healthy diets, both groups failed to meet recommendations for certain nutrients. The Institute recommends that girls age 14 to 18 receive at least 1,300 milligrams of calcium daily. At age 15, soda drinkers in the study averaged 767 milligrams a day, while non-soda drinkers had slightly higher intakes at 851 milligrams a day, but were still deficient.

The researchers also found that both groups increased their soda consumption by age 15. However, soda drinkers were consuming nearly twice as much soda at age 15 than their counterparts — 6.6 ounces a day versus 3.4 ounces a day.

Although the study has considerable implications on how beverages impact diet, Fiorito believes children may already have developed drinking preferences and patterns by age five.

“We think that the patterns develop when they are younger. Some studies show that children already drinking soda or carbonated beverages at age two,” said Fiorito.

The study followed 170 girls for 10 years, documenting meals three times every two years. Girls classified as “soda drinkers” — those who drank roughly four ounces of soda daily at age five — showed much lower intakes of fiber, protein, vitamin C, vitamin D, calcium, magnesium, phosphorous, and potassium throughout the study than “non-soda drinkers” — those who had no soda intake at age five. Also, the soda drinkers had much higher intake of added sugars. The study did not distinguish between diet and regular soda because the “soda drinkers” drank both types, but diet soda intake was very low at age five.

Parents of soda drinkers in the study had higher body mass indexes than non-soda drinkers’ parents. Fiorito believes this suggests that “parents model consumption patterns for their children,” and that the parents’ unhealthy eating habits not only contributed to an increased BMI, but influenced children.

There have been other studies on the effects of soda on dieting, but this is the first study to track the consumption of multiple beverages over a ten-year period. Included in the study were coffee/tea, soda, milk, 100 percent fruit juice, and fruit drinks – any fruit-flavored drinks with less than 100 percent fruit juice.

Other beverages have come under scrutiny in recent years for their possible negative health consequences. For example, the American Academy of Pediatrics issued a formal statement in 2001 that recommended limits on children’s fruit juice intake. The Academy has not issued any formal statement on soda, but this study provides a clear link showing that soda can prevent people from maintaining a healthy diet.

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Source:Elements4Health :June8.2010

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