Archive for December, 2011

Dust Mites

Posted by on Monday, 19 December, 2011

What is a dust mite allergen?

Dust mites are microscopic organisms that can live and thrive throughout homes and schools. The mites and their waste products thrive in the following:

  • Bedding
  • Upholstered furniture
  • Carpets

dust mite

Dust mites thrive in warm, humid conditions and feed on the shed scales of human skin. The waste products of the dust mite are what produce allergic reactions and asthma. The best way to prevent dust mites is to limit your child’s exposure. Be sure to pay special attention to the bedroom, especially the mattress and pillows.
iconWays to decrease dust mite exposure include the following:

Beds
 – Every bed in your house should have wooden or metal frames. Do not allow your child to sleep on a couch, sofa, or hide-a-bed. If your child has asthma and sleeps in a bunk bed, he/she should sleep in the top bunk.

Mattress/Box Spring
 – Place all mattresses and box springs in a zippered, and tape over the zippers with electrical or duct tape.

Pillows -
 Encase pillows in zippered, dust-proof covers. Pillows should be made of Dacron or other synthetic fiber. Do not use foam, feather, or “Down” pillows.

Bedding
 – Avoid wool or down blankets. Wash all bedding (sheets, pillowcases, blankets)
in hot water. Cold water will not kill the dust mites. Dry all clothes and bedding in the dryer to avoid pollen sticking to them when on a clothesline.

Floor coverings
 – If possible, remove wall-to-wall carpeting. If not, vacuum the carpet frequently (at least twice a week). If your child has asthma, only vacuum when your child is away and will not return to the room for several hours after you have finished. Substitute multi-layered vacuum bags for regular single layer bags. Small, washable cotton rugs may be used if washed often. Wood, tile, or vinyl flooring without a rug is best, and they should be mopped at least weekly.

Furnace (heating) – 
Electric or gas heat is recommended. Do not use wood stoves or kerosene heaters. Change the air filters on the furnace every month. Cover all furnace outlets in the room with or cover the outlets with 10 thicknesses of cheesecloth or muslin. This will catch dust in the furnace air. Change the cheesecloth when it gets dusty underneath (about every two weeks).

Stuffed animals
 – Limit the number of stuffed animals to 2 or 3. Keep all stuffed animals off of the bed and wash them about once a month to remove dust mite allergens. Stuffed animals can also be put in a hot dryer for 20 minutes to remove dust mites.


Hand-Foot-Mouth Disease

Posted by on Saturday, 17 December, 2011

What is hand-foot-mouth disease (HFMD)?

Hand-foot-mouth disease is an illness caused by a virus that results in a distinctive rash – small, blister-like bumps in the mouth, and on the hands and feet. The blisters may also appear in the diaper area and on the legs and arms. The lesions in the mouth usually appear on the tongue, the sides of the cheeks, or near the throat.

hand-foot -mouth disease

What causes hand-foot-mouth disease?

Hand-foot-mouth disease is caused by a virus. The most common viruses that cause hand-foot-mouth-disease include the following:

  • Coxsackie virus
  • Other enteroviruses

This disease is very common in children, particularly children under the age of 10. It is seen most often in the summer and fall. The virus is usually spread through fecal-oral contact, although other modes of transmission have been reported. Good hand washing is necessary to help prevent the spread of the disease.

What are the symptoms of hand-foot-mouth disease?

The following are the most common symptoms of hand-foot-mouth disease. However, each child may experience symptoms differently. Symptoms may include:

  • Blister-like bumps in the mouth (on the tongue, the cheeks, and near the throat and tonsils)
  • Blister-like bumps on the palms of the hands and the soles of the feet; bumps may also be seen on the arms, legs, and diaper area.
  • Mild fever

How is hand-foot-mouth disease diagnosed?

Hand-foot-mouth disease is usually diagnosed based on a complete history and physical examination of your child. The rash of hand-foot-mouth disease is unique, and usually allows for a diagnosis simply on physical examination.

Treatment for hand-foot-mouth disease:

    Specific treatment for hand-foot-mouth disease will be determined by your child’s physician based on:

  1. Your child’s age, overall health, and medical history.
  2. Extent of the disease.
  3. Your child’s tolerance for specific medications, procedures, or therapies.
  4. Expectations for the course of the disease.
  5. Your opinion or preference.

The goal of treatment for hand-foot-mouth disease is to help decrease the severity of the symptoms. Since it is a viral infection, antibiotics are ineffective.

Treatment may include:

  • Increased fluid intake to prevent dehydration – provide cool, iced fluids in small amounts frequently acetaminophen for any fever.
  • Proper hand washing is essential in helping to prevent the disease from being spread to other children.

Hemifacial Microsomia

Posted by on Saturday, 17 December, 2011

What is hemifacial microsomia (HFM)?

Hemifacial microsomia (HFM) is a condition in which the tissue on one side of the face is underdeveloped, affecting primarily the aural (ear), oral (mouth), and mandibular (jaw) areas. Sometimes, both sides of the face can be affected and may involve the skull, as well as the face.

Hemifacial microsomia is also known as Goldenhar syndrome, brachial arch syndrome, facio-auriculo-vertebral syndrome (FAV), oculo-auriculo-vertebral spectrum (OAV), or lateral facial dysplasia.

What are the different types of HFM?

The deformity in hemifacial microsomia varies greatly in the degree of severity and in the area of the face involved. The disorder varies from mild to severe. In the more severe cases, the following structures are underdeveloped:

  • The external and middle ear
  • The side of the skull
  • The thickness of the cheek tissue
  • The upper and lower jaws
  • The teeth
  • Some of the nerves that allow facial movement
  • In the milder forms, only some of the structures are affected and to a lesser degree.

What causes hemifacial microsomia?

Hemifacial microsomia usually occurs sporadically (occurs by chance), but is thought to be inherited in some families. This is because of the many familial (cases occurring more than once in a family) cases reported.

The following patterns of inheritance have been observed:

Autosomal- (Dominant 
Autosomal) dominant means that one gene is necessary to express the condition, and the gene is passed from parent to child with a 50 percent risk for each pregnancy. Males and females are equally affected and there is great variability in expression of the gene. In other words, a parent may unknowingly have a very mild sign of hemifacial microsomia, such as preauricular tags (skin tags by the ear), but the child is more severely affected. The family may not come to the attention of a geneticist until the birth of the child with a more severe condition. Other relatives with mild expression of the gene are often discovered at that time, confirming autosomal dominant inheritance.

Autosomal (Recessive 
Autosomal) recessive means that two copies of the gene are necessary to express the condition, one inherited from each parent, who are carriers. Carrier parents have a one in four, or 25 percent, chance with each pregnancy to have a child with hemifacial microsomia. Males and females are equally affected.

Multifactorial inheritance means that “many factors” are involved in causing a birth defect. The factors are usually both genetic and environmental. Often one gender (either male or female) is affected more frequently than the other in multifactorial traits. There appears to be a different “threshold of expression,” which means that one gender is more likely to show the problem, over the other gender. In hemifacial microsomia, males are slightly more likely to be affected than females.

Observations made from families who have one child with hemifacial microsomia show that the overall chance for another child to be born with hemifacial microsomia is about 2 to 3 percent. Parents and other family members should have a thorough evaluation to help give more definite recurrence information. In addition, hemifacial microsomia is sometimes found in children with various types of chromosome abnormalities. Chromosomes are the structures in our cells that carry our genes. Genes determine traits such as blood type and eye color. Chromosome abnormalities are usually sporadic (occur by chance).

Which parts of the facial bone are involved?

One of the most obvious problems in hemifacial microsomia is the underdevelopment of the upper and lower jaws on the affected side. It may appear that your child’s mouth slants upward toward the involved side. Often the forehead and cheek are flattened on the affected side with one orbit (eye socket) smaller than normal.

What other areas of the face are affected?

Other areas of your child’s face that may be affected by hemifacial microsomia include the following:
Your child may have unequal cheek fullness (asymmetry) because of the underdeveloped fat and muscle. Some parts of the face may not move normally, which may cause a “crooked” smile.

There is a wide range of ear abnormalities associated with HFM. Your child may have a mildly misshapen ear or almost complete absence of the external ear (atresia). Small tags of skin may also be present in front of the ear(s).

Occasionally, the central nervous system is affected, causing parts of the face to not move symmetrically (equally).

How is HFM diagnosed?

HFM is typically diagnosed after a comprehensive medical history and physical examination by a geneticist. There is not a blood test to diagnose HFM. Because the spectrum of severity is so wide, the diagnosis should come from an experienced geneticist skilled in diagnosing craniofacial anomalies. CT scans and x-rays of the face may also be ordered for accurate diagnosis.

Diagnostic tests that may be performed to confirm the diagnosis of hemifacial microsomia include:
x-rays of the head – a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues and bones of the head onto film.

Computed tomography scan (Also called a CT or CAT scan.) of the head – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the head. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for HFM:

Specific treatment for HFM is extremely variable because there are so many differences in the types of HFM. Any child with suspected HFM should be evaluated by a craniofacial anomalies team. Each of the specialists will have a proposed treatment plan depending on the severity of your child’s specific physical findings.

After a diagnostic evaluation and meeting with a craniofacial team, the following treatment options may be discussed:

  • For severe underdevelopment of the lower jaw, reconstruction using a bone graft taken from the ribs may be suggested.
  • Another possibility to lengthen the underdeveloped mandible (jaw) would be to place a device on the jaw for bone distraction. This technique avoids the need for bone grafts.
  • The external ear is usually reconstructed between the ages of 6 to 8 years. This is a multiple stage process with several months between each surgery.
  • Further surgery in the soft tissue of the cheek to increase symmetry, or possibly jaw surgery, may be needed when your child reaches adolescence.

Because hemifacial microsomia involves so many areas of the body, many specialists are required, including the following:

  • The craniofacial surgeon performs the jaw surgery and ear reconstruction.
  • The geneticist counsels the patient and family regarding the recurrence risks of hemifacial microsomia.
  • The nurse coordinator acts as a liaison between the family and many specialists and assists in patient education.
  • The ophthalmologist evaluates vision and eye movements.
  • The orthodontist follows the jaw growth and alignment of teeth to assist the surgeon in an optimal result of jaw surgery.
  • The otolaryngologist assesses hearing abnormalities and coordinates middle ear surgery or hearing aides, if needed.
  • The speech therapist evaluates the speech development and coordinates speech therapy, if necessary.