Archive for January, 2011


Posted by on Monday, 24 January, 2011

Nebulizers are commonly used for treatment of cystic fibrosis, asthma, COPD and other respiratory diseases. The common technical principle for all nebulizers is to either use oxygen, compressed air or ultrasonic power, as means to break up medical solutions/suspensions into small aerosol droplets, for direct inhalation from the mouthpiece of the device. When using a nebulizer for inhalation therapy with medicine to be administered directly to the lungs, it is important to note that inhaled aerosol droplets can only penetrate into the narrow branches of the lower airways, if they have a small diameter of 1-5 micrometers. Otherwise they are only absorbed by the mouth cavity, where the effect is low. They also accept their medicine in the form of a liquid solution, which is often loaded into the device’s difuser chamber upon use.

Cleaning procedures for medical nebulizer equipment

After each use, disassemble the nebulizer as directed and rinse arts thoroughly in hot running water.

The mouthpiece should be washed in a detergent solution once a day.

The following disinfecting procedure should be followed twice a week:

Disassemble the nebulizer and immerse all parts in a warm detergent solution (Ivory, Joy, etc,) and scrub with a soft bottle-brush. If the tube, which connects the compressor to the nebulizer, is clear and dry, it does not have to be washed. If it has moisture inside or is dirty, wash it along with the other parts. Do not immerse compressor in water!

Rinse all articles in hot water and shake off excess.

Completely immerse all articles in a white vinegar solution and allow soaking for 30 minutes. Vinegar solution is 1 part vinegar to 2-3 parts water.

Rinse well in hot water and shake off excess and drain small parts on a clean towel.

When everything is completely dry, it may be reassembled for the next use.

It is also a good idea to dip a cloth in the vinegar solution and wipe down the outside of the compressor machine.

Asperger Syndrome

Posted by on Wednesday, 19 January, 2011

What is Asperger Syndrome?

Asperger Syndrome or (AS) disorder is a neurological disorder characterized by poor social interactions, obsessions, odd speech and mannerisms. The syndrome is considered part of the spectrum of pervasive developmental delay and is sometimes referred to as “high-functioning autism.”

Like children with autism and other pervasive development delay disorders, children with Asperger syndrome have difficulty with social interactions. They have the most difficulty with interpreting nonverbal cues from other people such as facial expressions and body language. Direct eye contact may be difficult. As a result, they have a hard time forming friendships with their peers. In addition, they do not seek to share interests or experiences with other people. For example, if they like toy trains, they do not bring the toy over to someone to show it off.

Unlike most children with other forms of pervasive developmental delay, children with Asperger syndrome do not have obvious delay in language development. They often have very large vocabularies that seem advanced compared to other children their age; this sometimes earns them the moniker of the “little professor.” Despite their large vocabularies, these children are quite literal in their understanding of what others are saying. Also, with the exception of social skills, children with Asperger syndrome usually acquire self-help skills like toileting and dressing at the same ages as their peers.

In addition to their problems with social interactions, children with Asperger syndrome often have an obsessive interest in a particular subject and very little interest in much else. They may obsessively seek information about maps or clocks or some other topic. They may also be very inflexible in their habits and rigidly adhere to certain routines or rituals. Children with Asperger syndrome may show odd mannerisms such as hand-flapping or peculiar postures that make them appear clumsy.

At this time, there is no ‘cure’ for Asperger syndrome. Children with Asperger syndrome often grow up to be consider an “odd” or “eccentric” adult. However, they can be helped tremendously by treatment with social skills training, parental education and training, behavior modification and other psychosocial interventions. Because children with Asperger disorder can also have debilitating compulsions and anxiety related to social interactions, sometimes medications can be prescribed that will help with those aspects of the condition.

Like so many behavioral disorders, there is a spectrum and it can be a difficult diagnosis to make. Because people with Asperger syndrome often have obsessive or compulsive behavior, they are frequently diagnosed with Obsessive-Compulsive Disorder (OCD); however, most people with OCD do not have difficulty in their social interactions or understanding body language. Another common misdiagnosis is anxiety disorder because of the distress noted with changes in routine or with social interactions. But again, people with anxiety disorders do not have difficulty with nonverbal language or obsessive interests or rituals.
Aspergers syndrome is a type of Pervasive Developmental Disorder, and others include Autism and Retts syndrome.

Chicken Pox

Posted by on Tuesday, 18 January, 2011


Chicken pox is a viral infection caused by the Herpes varicella zoster virus. It’s spread in droplets inhaled into the respiratory tract. Complications are rare but serious, and can occur in previously healthy children.

chicken pox

Chicken pox tends to affect children under ten. Most children have had the infection by this age. In older children and adults, chickenpox can be more severe.
It’s more common in late winter and spring. Children who are immunosuppressed (for example, on steroids) are particularly vulnerable to complications, as are newborn babies who may catch the infection from their mother in late pregnancy.

The incubation period (from exposure to onset of symptoms) is 14 to 24 days. The initial symptoms are mild fever and headaches. Younger children may seem generally grouchy. These are followed within hours by the appearance of a typical rash. Crops of red spots appear, which quickly develop central fluid-filled blisters that are intensely itchy. After a couple of days these scab over and dry up.
The rash mostly affects the trunk, but may appear anywhere on the body, including the scalp and the mouth. In about one in ten cases symptoms are so minimal the infection goes unnoticed. Complications of the infection are uncommon but include viral pneumonia, secondary bacterial infection and encephalitis.

The doctor should be notified if the child seems particularly unwell, has a cough, headache, if the skin is particularly inflamed or infected, or there are other worrying symptoms. For young babies or children with immunity problems, always seek medical advice. Give pain-relieving syrup and plenty of fluids. Calamine lotion and antihistamine medicines may relieve the itching. Keep the child’s hands clean and their fingernails short. Try to discourage them from scratching the spots, as they can scar.

The spots may be infectious until they’ve fully scabbed over, but no child should need to be kept from school for more than five days. In severe cases, antiviral treatment may be recommended.

Most children recover without long-term problems. But children at high risk who are exposed to chicken pox must be treated with immunoglobulin injections to prevent the infection, or antiviral drugs to treat it. There is also a vaccine that can be given to prevent chickenpox. After infection the virus lies dormant in the body but can emerge later to cause shingles.


Posted by on Monday, 17 January, 2011

What is Croup?

Croup is a common childhood viral illness that is easily recognized because of the distinctive characteristics that children have when they become infected. Like most viral illnesses, there is no cure for croup, but there are many symptomatic treatments that can help the child to feel better faster.


Croup, also called laryngotracheobronchitis, most commonly affects children between the ages of six months and three years, usually during the late fall, winter and early spring. Symptoms, which often include a runny nose and a brassy cough, develop about 2-6 days after being exposed to someone with croup.

One of the distinctive characteristics of croup is the abrupt or sudden onset of symptoms. Children will usually be well when they went to bed, and will then wake up in the middle of the night with a croupy cough and trouble breathing. The cough that children with croup have is also distinctive. Unlike other viral respiratory illnesses, which can cause a dry, wet, or deep cough, croup causes a cough that sounds like a barking seal.

Another common sign or symptom of croup is inspiratory stridor, which is a loud, high-pitched, harsh noise that children with croup often have when they are breathing in. Stridor is often confused with wheezing, but unlike wheezing, which is usually caused by inflammation in the lungs, stridor is caused by inflammation in the larger airways.

The pattern of croup symptoms is also characteristic. In addition to beginning in the middle of the night, symptoms, which are often better during the day, worsen at night, although they are usually less intense each night. Symptoms also become worse if the child becomes anxious or agitated.

The symptoms of croup are caused by inflammation, swelling and the buildup of mucus in the larynx, trachea (windpipe) and bronchial tubes. Since younger infants and children have smaller airways, it makes sense that they are the ones most affected by croup. In contrast, older children will often just develop cold symptoms when they are infected by the same virus.

Children with croup will usually also have a hoarse voice, decreased appetite and a fever, which is usually low grade, but may rise up to 104 degrees F.

Croup Assessment

Because of the characteristic signs and symptoms of croup, this diagnosis is usually fairly easy to make. You can often tell a child has croup while they are still in the waiting room or before you enter the exam room, therefore, testing is usually not necessary.

Specifically, an xray is usually not required, and is usually only done to rule out other disorders, such as ingestion of a foreign body. When an xray is done, it will usually show a characteristic ‘steeple sign,’ which shows a narrowing of the trachea.

When assessing a child with croup, it is important to determine if he is having trouble breathing. Fortunately, most children have mild croup and have no trouble breathing, or they may only have stridor when they are crying or agitated. Children with moderate or severe croup will have rapid breathing and retractions, which is a sign of increased work of breathing. They may also have stridor when they are resting.

The croup score is an easy and standardized way to figure out if a child has mild, moderate or severe croup, which can help to dictate what treatments are necessary. The croup score is based on a child’s color, level of alertness, degree of stridor, air movement, and degree of retractions, with 0 points given if these findings are normal or not present, and up to 3 points given for more severe symptoms.

  • Inspiratory Stridor
  • None (0 points)
  • When agitated (1 points)
  • On/off at rest (2 points)
  • Continuous at rest (3 points)
  • Retractions
  • None (0 points)
  • Mild (1 points)
  • Moderate (2 points)
  • Severe (3 points)
  • Air Movement/Entry
  • Normal (0 points)
  • Decreased (1 points)
  • Moderately decreased (2 points)
  • Severely decreased (3 points)
  • Cyanosis (Color)
  • None (0 points)
  • Dusky (1 point)
  • Cyanotic on room air (2 points)
  • Cyanotic with supplemental oxygen (3 points)
  • Level of Alertness (Mentation)
  • Alert (0 points)
  • Restless or anxious (1 points)
  • Lethargic/Obtunded (2 points)

In general, children with a croup score of less than 4 have mild croup, 5-6 have mild/moderate croup, 7-8 have moderate croup, and greater than 9 have severe croup.


Although, like most viral infections, there is no cure for croup, there are many treatments that can help improve the symptoms and make the child feel better. Mild croup symptoms can usually be safely treated at home. Common treatments include using humidified air, which can be delivered by a cool mist humidifier. Using a hot steam vaporizer is usually discouraged because of the risk of the child getting burned if he touches it. Instead, warm steam can be delivered by turning on all of the hot water in the bathroom, including from the shower and sink, close the bathroom door and holding the child as he breathes in the steamy, humidified air.

On cool nights, exposure to the cool nighttime air may also help symptoms, and this phenomenon is responsible for another characteristic finding of croup, the fact that children often get better on the way to the emergency room. To take advantage of this, it may help to bundle the child up and walk around outside for several minutes. It is probably not a good idea to keep his window open though, as you don’t want him to get too cold.

Other treatments can include using a fever reducer (acetaminophen or ibuprofen containing products) and/or a non-narcotic cough suppressant (although they probably won’t suppress the cough of croup).

Since symptoms worsen if the child is crying and agitated, trying to keep the child calm may also improve his symptoms.

Children with moderate or severe croup, or who aren’t quickly responding to home treatments, will need medical attention for further treatments, which usually includes administering a steroid to help decrease swelling and inflammation and improve breathing. An injection of dexamethasone has been the standard way of administering this steroid, but new studies have shown that an oral steroid (Prelone, Orapred, etc) or steroid delivered by a nebulizer (Pulmicort) may also be effective.

For children with severe respiratory distress, treatment, in a hospital setting may include a breathing treatment with racemic epinephrine. Because there is a risk of a ‘rebound’ and worsening breathing, children are usually observed for 2-4 hours after receiving racemic epinephrine. Chlildren who continue to have difficulty breathing, or who require more than one treatment, are usually hospitalized.

A mist or oxygen tent has long been used to treat children who are hospitalized, but there use has been decreased because it makes it harder for the hospital staff to observe the child and notice if he is getting worse. Instead, blow by oxygen or cool mist may be used.

A newer treatment that is being researched is the use of a helium-oxygen mixture for children with severe croup.

The main symptoms of croup typically last only 2-5 days, but more rarely, they can last several weeks. Once the barking cough and difficulty breathing improve, the child may continue to have cold symptoms for 7-10 days.

Celiac Disease

Posted by on Sunday, 16 January, 2011


Celiac disease is an autoimmune disorder, with symptoms that range from gas and diarrhea to irritability and depression. It is caused by an intolerance to the protein gluten, which is found in foods that contain wheat, rye, and barley.


Children can develop symptoms of celiac disease once gluten has been introduced into their diet, and is usually sometime between 6 months and 2 years of age, although the symptoms may not be formally diagnosed as being caused by celiac disease until they are much older.

Symptoms of celiac disease can include:

  • delayed growth and failure to thrive
  • chronic diarrhea
  • behavioral changes, including irritability

    recurrent gas, abdominal bloating, and pain

    pale, foul-smelling, or fatty stools


  • fatigue
  • unexplained iron deficiency anemia (a low red blood cell count)
  • delayed puberty

These symptoms do vary though, and some people with celiac disease have no symptoms at all, infants with classic celiac disease are often described as ‘clingy, irritable, unhappy children who are difficult to comfort.’

Diagnosis of Celiac Disease

Although some people simply try and see if their child will improve on a gluten-free diet to see if their child has celiac disease, since this is a lifelong condition, formal diagnosis and testing is usually a good idea.

Testing for celiac disease can include screening blood tests, such as:

  • Immunoglobulin A (IgA)
  • anti-tissue transglutaminase (tTGA)
  • IgA anti-endomysium antibodies (AEA)

If these screening tests are suspicious for celiac disease, a small bowel biopsy will usually be done by a pediatric gastroenterologist to confirm the diagnosis.

Treatments for Celiac Disease

There is no cure or medication to treat celiac disease. Instead, parents must put their children on a gluten-free diet that doesn’t contain any foods that are made with wheat, rye, or barley.

To help avoid gluten, including many grains, pasta, cereals, and other processed foods with gluten, it can help to learn to read food labels and look for and avoid products with the following ingredients on the label:

  • wheat, including durum, graham, kamut, semolina, spelt, triticale

    barley, including malt, malt vinegar, or malt flavoring which can be made from barley


Gluten can also be found in some candy, cold cuts, soy sauce, vitamins, herbal supplements, over the counter medications, and prescription medications. And although often overlooked, gluten is also found in communion wafers, lip balms, and Play Doh.

Fortunately, there are many gluten-free breads and pastas and even gluten-free medications for children on a gluten-free diet. Still, it can be hard to follow a gluten-free diet, so you may seek help from a registered dietician to make sure that your child still eats well balanced meals, while keeping gluten out of his diet.

What You Need To Know About Celiac Disease

Infants are often first introduced to gluten when they ‘graduate’ from rice cereal and start a single grain cereal with barley or Cheerios, etc. Many experts also recommend that a child on a gluten-free diet also avoid oats, although this is controversial and is still being researched. The Celiac Sprue Association, a nonprofit support group, states that ‘pure oats may be included as part of a gluten-free diet,’ but then goes on to suggest that people on a gluten-free diet avoid oats anyway because ‘uncontaminated oat sources are not readily available.’

Celiac disease is genetic and so can run in certain families, especially if they are descendants of people from northern Europe.

Many experts think that celiac disease is underdiagnosed in the United States.

Celiac disease is also known as celiac sprue, gluten-sensitive enteropathy, and non-tropical sprue. Children don’t outgrow celiac disease and so must continue the gluten-free diet their whole life.