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UMBILICAL HERNIA
If you notice that your baby has a little lump which protrudes from his umbilicus when he cries or coughs, it is likely that he has an umbilical hernia. This is very common and is caused by the ring which normally surrounds the umbilical cord failing to close completely after birth. An umbilical hernia generally does not cause problems, and usually does not persist beyond 5 years of age. In rare cases, a small loop of bowel can be trapped in the opening and may require surgical removal. Umbilical hernias which do not disappear or are larger than 2-3 cm can be repaired surgically — this is usually for cosmetic rather than medical reasons. Do not tape the hernia — it does not help and may damage the baby’s tender skin.
WIND (FLATULENCE, EXCESSIVE GAS)
Passing bowel gas is a normal and necessary function in humans. Bowel gas is released by gas-producing foods and by the swallowing of air. Children swallow large amounts of air when sucking on empty bottles, and when crying. Carbonated drinks cause excess wind, as do foods which are difficult to digest, such as beans. Occasionally excess wind is a sign of milk intolerance, and gas is increased during bouts of diarrhoea or with marked constipation. No treatment is necessary for excess wind, except perhaps teaching your child, when he is old enough, to pass wind in a socially acceptable manner!
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When children are sick they tend to vomit more readily than adults. It is often a single event and the child is back to normal again soon afterwards.
Cause
There are numerous causes of vomiting, but the most common is that associated with any infection, either viral or bacterial, even the common cold. Motion sickness is another cause of vomiting. Vomiting can sometimes occur in association with more serious illnesses such as appendicitis or meningitis.
Projectile vomiting, which is a forceful throwing up of the contents of the stomach, is characteristic of pyloric stenosis.
Young babies tend to vomit up small amounts of milk after feeds. This is called posseting, and is normal. It can usually be reduced if you burp your baby a little more during feeds.
Clinical features
Vomiting is often accompanied by abdominal pain and diarrhoea. Dehydration is one of the serious risks of vomiting, especially in young babies .
Treatment
Medications against vomiting should not be used in children due to the risk of serious side effects. The most important part of the treatment of vomiting is adequate fluid replacement to prevent dehydration.
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NAUSEA
Nausea is the feeling that you want to vomit. It is also known as being bilious or nauseated. Young children will not be able to tell you that they feel nauseated, but they may look pale and sweaty, and complain of a stomach ache. Older children will be able to describe additional symptoms such as dizziness.
Cause
There are many causes of nausea in children, but by far the most common are gastroenteritis, ear infections and motion sickness.
Treatment
Medications against nausea should not be given to children, due to the risk of serious side effects. If your child has nausea it is advisable to see your doctor.
SWALLOWED FOREIGN OBJECT
Babies and toddlers tend to explore things by placing them in their mouths and so they may swallow something which is not food. Many objects will be passed in the stools. If your child does not vomit, cough or complain of abdominal pain, simply sift the stools through a fine wire mesh for the next few days until the object appears. The commonest objects swallowed are coins and beads. Sometimes an X-ray may be taken to locate the object inside the gastrointestinal system.
If your child swallows a sharp, or poisonous object such as a battery or nails or pins, you should seek immediate medical attention. These objects can be life threatening. See also Essential first aid in Chapter 1 for Choking and poisoning.
When to see your doctor
Take your child to hospital immediately if he is choking, coughing, vomiting or having difficulty breathing, or if you are not sure what he has swallowed.
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Pyloric stenosis is a condition which can affect young babies during their first few weeks of life. It occurs more commonly in boys than in girls. The outlet of the stomach into the intestine (the pylorus) is normally surrounded by a sphincter of muscle which prevents food from moving backwards. In babies with pyloric stenosis there is a thickening of this muscle and this causes a blockage.
Cause
The exact cause of pyloric stenosis is not known but it is thought to be influenced by genetic factors.
Clinical features
The classic sign of pyloric stenosis is projectile vomiting, which is a very forceful throwing up of the contents of the stomach, and results from a build up of stomach contents which cannot pass on to the intestine. The baby may also fail to gain weight and may be constipated. The baby is usually restless and cries a lot. He may wish to feed immediately after vomiting because he is hungry. If not diagnosed early, the baby is at risk of becoming dehydrated. Occasionally a lump can be felt in the upper abdomen during feeding.
Investigations
A barium meal is usually administered to confirm the diagnosis, although this may be unnecessary if the doctor can feel the lump.
Treatment
If there is a strong suspicion that your baby has pyloric stenosis, he will be admitted to hospital immediately for surgery. An operation will be performed to release the blockage by splitting the overgrown muscle fibres of the pylorus. This operation usually has no complications and the baby can be taken home after a few days.
When to see your doctor
See your doctor immediately if your baby has the symptoms described.
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