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Umbilical hernia. Banding your baby’s belly?

October 18, 2013
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This practice is quite common, most do to prevent the navel “pops” (outie) or what is the same to develop umbilical hernia, which is completely wrong, the baby’s umbilical hernia develops with and without band or sash. The band only may cause discomfort and harm your baby and will not bring any benefit at all, only will keep him upset, not allowing him to eat properly, can damage skin and even promote infection of the umbilical stump (navel). Some mothers besides placing a bandage or tight girdle put a coin or marble on the navel which is equally useless.

Most umbilical hernias in infants disappear by year of age; only in case of large hernias will need surgery to close.


An umbilical hernia is a defect or hole in the abdominal wall through which protrude a portion of the intestines of your baby, you will see that this increases with straining as it does during crying, and must be reducible or return your baby’s intestines by that same hole when relaxing and doing a little pressure with your fingers, you can feel under the skin that covers your baby’s belly button like air bubbles contained in the gut.

The risk of an umbilical hernia and what should be very aware, is strangulated or incarcerated hernia, i.e. the portion of intestine that go out through the hole in the abdominal wall is no longer possible to go back through the same hole and is tightened, that portion of bowel is in risk of running out of blood, you would see your baby having an intense crying because this is very painful, and a change in color of the skin of the navel with a tone that is become purple, something like that if you put a tight band around your finger for a few minutes .

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The Importance of Vitamin A

October 18, 2013
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Vitamin A has many functions in the body , maintains the function and cell growth, maintaining the integrity of the skin, mucous membranes and epithelia , aids in the function of the eye, is involved in red blood cell production, immunity, reproduction and breastfeeding.

The different forms of vitamin A include Beta carotene that are fruits and vegetables, and preformed vitamin A (retinol, retinoic acid) in products of animal origin. Vitamin A is an essential nutrient which cannot be synthesized, therefore must be consumed through the diet.

The amounts of vitamin A contained in foods like fruits and vegetables are small, making it difficult for a child to reach the daily requirement of vitamin A by eating only fruits and vegetables. So children in homes where it is difficult to get animal products like eggs and dairy products will most often are deficient in vitamin A.

fruits and food source of vitamin AVitamin A deficiency predisposes to diseases such as diarrhea and respiratory diseases, if we add that these patients with vitamin A deficiency are also often malnourished, this leads to a large number of deaths in childhood, mainly in developing countries.

In a publication of the British Medical Journal in August 2011 included 17 studies with 194,483 pediatric patients less than 5 years, which found that vitamin A supplementation reduced mortality for all causes by 24%, 28% in cases of diarrhea. Reduce the incidence of diarrhea and measles, reduces the prevalence of vision problems.

Vitamin A comes from animal sources such as eggs, meat, milk, cheese, cream, liver, kidney and cod liver oil (most of them also rich in saturated fats and cholesterol)

The sources of beta-carotene: orange and yellow fruits bright as melon, grapefruit and peaches. Vegetables such as carrots, pumpkin, sweet potato, broccoli, spinach and most green leafy vegetables.

Adequate intake of vitamin A can reduce the presence of diseases such as diarrhea and respiratory infections and associated mortality, if a child is not consuming enough vitamin A in the diet, it should receive a supplement of Vitamin A, and this is recommended on children especially in developing countries where mortality from diarrheal and respiratory diseases is high.

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Until when is chickenpox contagious?

October 18, 2013
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Chickenpox is a viral disease that is easily transmitted to susceptible individuals (those not vaccinated and those who have never had chickenpox), it becomes contagious 1-2 days before the rash or skin lesions appears and ends their contagious period until all lesions are dry and crusted, even if the crusts are not fallen, this period can vary between 5 and 7 days. It is recommended the person with chickenpox stay home during the entire period of contagious

How is chickenpox spread?

Chickenpox is spread through contact with skin lesions and also through the air when an infected person coughs or sneezes. Chickenpox and shingles (herpes zoster) are caused by the same virus, a person with zoster or ” shingles” can also transmit the virus of chickenpox

How soon do symptoms appear after exposure to chickenpox?

Chickenpox symptoms appear 14-21 days after being in contact with the sick person who transmitted the disease (incubation period).

Anyone older than 1 year who has not had chickenpox is recommended to receive the vaccine

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Can I take antibiotics while breastfeeding?

October 17, 2013
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The answer is YES, it is common that some doctors suggest the suspension of breastfeeding because intake of antibiotics, the reality is that in general there are few drugs that contraindicates breastfeeding, most antibiotics don’t contraindicate.

Virtually there are no antibiotics that contraindicate breastfeeding, even those contraindicated in children under eight years old as tetracycline, although excreted in breast milk, are not detected in the blood of the baby.


The most commonly used antibiotics for throat infections, urine tract, sinusitis, otitis, etc.,  don’t contraindicate breastfeeding , most drugs that are contraindicated for example antiviral used to treat HIV infection as Abacavir, Enfuvirtide, emitricitabine, Stavudine, etc. . and some worming antiprotozooarios as Amodiaquine, Dihidroemetine, Nitazoxanide , etc.

Do antibiotics excreted in breast milk?

Yes, they are excreted in small amounts and some of them can have adverse effects, but the benefits of breastfeeding far outweighs any risk that may take the baby when receiving  breast milk with a minimal content of antibiotics

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October 17, 2013
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Hepatosplenomegaly is defined as the abnormal growth of the spleen and liver size greater than expected for age. 1.2 The normal liver can be felt up to 3 cm below the right costal margin in the neonate, 2 cm in infants and 1 cm up to age 7 years. 3 Overall estimated values greater than 3.5 cm in neonates and 2 cm in children, obtained by palpation on below the right costal margin at the midclavicular line are indicative of hepatomegaly. 4 total liver size is determined by measuring the distance from the upper edge, determined by percussion, and the lower edge, as determined by palpation, the line level midclavicular, or imaging studies considering the length of the vertical axis. 5 The total size of the liver a week of age is 4.5 to 5 cm, at 12 years of 7-8 cm in boys and 6 to 6.5 cm in girls. 3

The normal spleen is palpable to 2 cm below the left costal margin in neonates and infants under 6 months. 3 in 30% of infants, 10% of children and 5% of healthy adolescents, spleen palpable 1-2 cm below the left costal margin. Splenomegaly is said to exist when the spleen is palpable 2 cm below the costal margin. 5

It is important to remember that the presence of liver or spleen palpable not always indicatehepatosplenomegaly, as this can occur by displacement of the diaphragm in case of pneumothorax or by orthopedic abnormalities such as narrow chest or pectus excavatum. Additional sources of confusion are retroperitoneal mass, choledochal cyst, distended gallbladder or perihepatic abscess. A normal variant right hepatic lobe (Riedel lobe) may extend below the right costal margin and be confused with hepatomegaly, in which case there will be no clinical or laboratory hepatic impairment. 1, 3, 5

The existence of these visceromegalies either in isolation or in combination, it is often the local manifestation of a systemic disease. The predominant growth of one of them usually depends on the cause of the process, all this occurs primarily by the amount ofreticuloendothelial  tissue contaied in  both organs  and the venous drainage system. 2

The frequency of this condition is not well known. It is estimated that the demand for pediatric hospital care of patients with hepatosplenomegaly without specific etiology is approximately 6-8 patients per year. 2, 6, 7

It has been observed that the hepatosplenomegaly  without specific etiology affect mainly infants and toddlers, and more than half of the cases are due to infection. In the final diagnoses of hepatosplenomegaly predominate infectious processes, followed by neoplastic, metabolic, hematologic and congested. The most useful tool to reach the final diagnosis is liver biopsy, followed by bone marrow biopsy and metabolic screening. 2, 6, 7

An estimated time is required approximately 23 days to establish the final diagnosis and an average of 22 examinations performed. 4 patients remain undiagnosed range from 7.0% to 9.5%. 2, 7

In the year 1991 published Sotelo experience Sonora Children’s Hospital in 63 children with hepatosplenomegaly of unknown origin in a period of ten years, this work gave rise to the diagnostic approach in three phases: Phase I, which corresponds to basic studies laboratory, Phase II, which includes  blood cultures, and immunological studies and phase III corresponding to viral serology studies, biopsies and specialized studies. This paper also proposes the classification of patients with hepatosplenomegaly according to its cause in 5 groups: infectious, neoplastic, hematological, and metabolic failure. 7

Trejo et al., Attempted to build a clinical guideline for establishing the etiologic diagnosis of hepatosplenomegaly in children. In this study are taken to fever and anemia to establish four main groups: a) Hepatosplenomegaly and fever, b) Hepatosplenomegaly and anemia, c) Hepatosplenomegaly with fever and anemia, and c) Hepatosplenomegaly without fever and anemia. With the use of this classification was achieved until the diagnosis in 83% of cases and reduced the time for diagnosis by 50%. 3

Bricks in 1998 reported a series of 89 children with hepatosplenomegaly in a hospital in Sao Paulo Brazil, in a period of three years. In this study children with hepatosplenomegaly were grouped into two groups: 1) Children with slight increase in the size of liver and / or spleen, no signs and symptoms of serious disease in which the problem will be resolved in less than 2 months and 2) Children with significant increase or change in the consistency of liver and / or spleen, with other signs and symptoms suggestive of chronic diseases. In the first group the most common problems found were anemia and infectious diseases and general pediatrician may find diagnosis with few tests, but in the second group must refer them to sub specialists to broaden the scope of the approach. 6


1. – Walker WA, Mathis RK. Hepatomegaly. Approach to the differential diagnosis. Pediatr Clin North Am 1975, 22: 935-48.

2. – AA Loredo, Mata QL, RL Carvajal. Hepatosplenomegaly of unknown etiology: clinical approach for diagnosis in 57 cases. Bol Med Hosp Infant Mex 1989; 46: 41-6.

3. – Trejo JA, Soria SN, EJ Garduño. Construction and validation of a clinical guideline for the etiologic diagnosis of hepatosplenomegaly in children. Bol Med Hosp Infant Mex 1995; 52: 160-67.

4. – JC Gutierrez, Pavón BP. Hepatosplenomegaly. Diagnostic and therapeutic protocols in pediatrics. Spanish Association of Pediatrics.

5. – Wolf AD, Levine JE. Hepatomegaly in neonates and Children. Pediatr Rev 2000, 21: 303-10.

6. – Bricks LF, Cocozza AM. Experience in the Evaluation of Children with hepatosplenomegaly at a teaching ambulatory, Sao Paulo, Brazil. Rev Inst Med Trop S. Paulo 1998, 40: 269-75.

7. – CN Sotelo. Hepatosplenomegaly of unknown origin. Study of 63 cases. Gac Med Mex 1991; 127: 321-26.

8. – BS Wilkins. The spleen. Br J Haematol 2002, 117: 265-74.

9. – Grover SA., Barkun AN, Sackett DL. Does this patient have splenomegaly?. JAMA 1993, 270: 2218-21

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Use and abuse of antibiotics

October 17, 2013
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Antibiotics are substances capable to destroy, prevent or delay the multiplication of bacteria.

With the discovery of penicillin (Alexander Fleming 1928) and market introduction (1942)humankind believed  had  won the war against bacteria and infections, but did not have to spend much time for humanity to realize that they were very wrong, because within two years of the introduction of penicillin began to appear the first bacteria resistant to follow increasing day by day.

Bacteria are able to evolve and adapt to newer antibiotics, this adaptability is known as bacterial resistance.

The main cause of bacterial resistance is the indiscriminate use of antibiotics.

The World Health Organization estimates that about 50% of the worldwide antibiotics are administered unnecessarily. In children under 5 occur most unnecessary exposure to antibiotics, it is associated with the vast majority of infections are viral in this age group for which antibiotics are useless.


The inappropriate use of antibiotics includes:

a) prescription of antibiotics by the doctor

b) Medical errors by selecting the antibiotic, dose and duration of treatment.

c) The self-prescription and non-adherence by patients

Factors contributing to the abuse of antibiotics:

a) Lack of knowledge by the physician

b) Influence pharmaceutical industry trade

c) Perception of doctor that  patient expect to receive antibiotics: “Make an antibiotic prescription takes a minute, explain and convince the mother that her child does not need an antibiotic can take much longer.”

We all have bacteria normally living in our bodies, most live in the skin and in our gut where fermentation and help digest food, good bacteria are our “flora” which prevents bad or pathogenic bacteria causing infections

So what happens when you take an antibiotic improperly?

1. – The bacterial flora is removed leaving the way clear for pathogenic bacteria to cause infection.

2. – Bacteria become resistant to antibiotics after exposure.

3. – All antibiotics may have side effects.

4. – When buying an antibiotic is not necessary economic resources are diverted.

5. – Infections caused by resistant bacteria are generally more serious and have higher mortality, just as more expensive treatment.

Misuse of antibiotics eventually affects all of society, so a person can get an infection with resistant bacteria but never in his life has taken antibiotics, this being infected by another person with inappropriate use of antibiotics and resistant bacteria.

So the fight against bacteria becomes a vicious circle, where the discovery and introduction of new antibiotics can not keep up against the emergence of resistant bacteria, which ironically became resistant due to overuse of antibiotics. So the misuse and abuse of antibiotics affects the appearance of resistant bacterial infections.

The only way to combat resistant bacteria and infections is making appropriate use of antibiotics, you can help avoiding self-medication and going with your doctor if you or your family sick.

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Misuse of antibiotics in children

October 17, 2013
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Most respiratory symptoms especially in children under 5 years with colds, cough, sore throat, runny nose and sometimes fever are caused by viruses, for viruses antibiotics are useless, flu will cure without antibiotics only at exactly the same time, few respiratory infections are caused by bacteria, and rarely will require an antibiotic to heal, unfortunately are children under five years who receive the most part of unreasonably antibiotics, approximately 70 % of all antibiotics in children under 5 years are improperly used.

children antibiotics

The use of antibiotics improperly brings several consequences, from economic to do an unnecessary expense, health consequences of child who may have adverse reactions to antibiotics (allergies, diarrhea, liver damage, kidney disease, etc.), Occurrence of bacterial resistance, damage of normal flora bacteria which can lead to other infections, and ultimately impact the entire society transmitting these resistant bacteria making antibiotics less useful to treat infections, having to use increasingly powerful antibiotics and more expensive.

When antibiotics were invented or rather when they were introduced commercially as penicillin (only 70 years ago), naively believed that mankind had won the war against bacteria, it was not long before he realized that it was not well and just two years after the introduction of penicillin had development of resistant bacteria, and clearly the ongoing battle is being won by the bacteria, who with each new antibiotic learn to develop resistance to them, so there are now resistant bacteria to all known antibiotics and gradually these bacteria are spread throughout the world, the person with an infection by one of these multi-resistant bacteria is virtually condemned to death as they did before the advent of antibiotics, where infections were the leading cause of death and life expectancy was just over 40 years old

So you have to be more aware in use of antibiotics, especially in our children where they are used unjustifiably, remembering that they get sick more often than adults, but most of these infectious conditions (respiratory, gastrointestinal, etc.) are viral in origin, so it will heal with and without antibiotics, and often antibiotics rather than only benefit would harm them.

Unfortunately most of these antibiotics unjustified are indicated by a doctor for various reasons, one is ignorance, it is proven that the more knowledge you have of disease (in this case children) and antibiotics (mechanism of action, spectrum, resistance, sensitivity, tissue penetration, etc.) the lower the inappropriate use of them, and there are studies that show that a general practitioner or family physician will make greater use of antibiotics in children under 5 years than a pediatrician, even so a pediatrician continues to use a large proportion of antibiotics is not justified.

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Fever Phobia

October 17, 2013
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Misconception that fever is an enemy to fight and eradicate at any cost with antipyretic drugs, undressing the child, rubbing alcohol or cold water. Fever is not an enemy, is an ally that helps fight infections.

The main cause of fever in children is viral infections. Virtually all viral infections are self-limiting, ie cure alone, with and without medication.

child fever


- The fever if not controlled can continue raising the temperature indefinitely.

- All children with fever may convulse

- The fever can kill neurons and cause mental retardation

- Fever can cause irreversible neurological disorders such as deafness, blindness and coma

- Any fever is a sign of serious infection

- You should measure and control the temperature every hour even if the child is asleep.



- Your child is under 3 months old.

-The boy looks bad, sick and weak

- He is irritable, crying too much, inconsolable and not calm

- Decay intense, sleepy, hard to keep him awake, looks disoriented or offline without interacting or not responding to stimuli

- Refuse to eat or take food

- Difficulty breathing, breath is very rapid and deep

- Have abnormal movements or convulsions

- Present signs of bleeding at any level, urine, nose, gums.

- Sprout spots on the skin

- Fever over three days worse instead of better

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Ten points about infections in children

October 17, 2013
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1) Most of all childhood infections are viral in origin, especially in children under 5 years.

2) All children get sick more than one occasion, on average about 6 respiratory infections a year, as they grow up the number of infections decreases.

3 ) There are factors that can make a child get sick more often than others as don’t receive breast milk, live with smokers , attend daycare or childcare, nutritional status and incomplete vaccination schedule.

4) For viral infections antibiotics are useless, most of the time children do not require an antibiotic to heal.

5 ) Virtually all viral infections are self-limiting , ie self-healing with and without medication at the same time

6) All medicines may cause side effects or undesirable, if a viral infection cure with and without medication is sometimes better not to give them especially in babies.

7) Most of all symptoms of most concern to parents (fever , cough , diarrhea , vomiting ) are defense mechanisms of our body to try to eliminate the infection , therefore only under special indications try to control them.

8) It is always better to be safe than sorry, make sure you have the vaccination updated with your children, proper sanitation and good nutrition.

9) Antibiotics are not always the solution to an infection with fever, never pressure to your doctor or demand antibiotics that could end up prescribing it even knowing that it is not necessary.

10) Always consult your doctor if your child has a fever that lasts more than three days, children under 2 months, refuse food and liquids, looks very ill or depressed,  red spots on the skin, signs of bleeding , abnormal movements or seizures , any other situation that you think is not normal.

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A World Without Antibiotics. Again?

October 17, 2013
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have ever imagined what would have happened if  Duchesne and Fleming had not discovered antibiotics? Probably probably still die from diseases  like leprosy, tuberculosis or syphilis. So common diseases such as pneumonia, would cause hundreds of deaths and sequelae worldwide. Definitely, the antibiotics is one of the most important developments in the history of medicine.

What if our dear antibiotics were no longer useful? Probably would be a public health crisis, people dying of diseases that were treatable. And this can happen sooner than you think.

Bacteria are living agents as such are subject to change and adapt to the environment. As larger animals, natural selection allowed to develop only the strongest. In the case of bacteria which multiply at much higher rates, this occurs much faster, allowing some strains become resistant to their attackers, in this case, antibiotic.

Why Resistance occurs ? Basically, because the use of antibiotics incorrectly, increase the exposure of the bacteria to these molecules, thus increasing its ability to be resistent. Treating viral infections with antibiotics, failure to complete treatment, using broad spectrum antibiotics when not required, etc..

How do we avoid this?

It’s a snowball that is already running, and it is in our hands to try to stop it.

  • As doctors: Rational use of antibiotics: antibiotics use only if bacterial infection, preventing its use in any respiratory symptoms “just in case”; avoid using broad spectrum antibiotics indiscriminately and without justification; maintain treatment by right time, avoiding antibiotics changes that appear not to be working.
  • As patients: Complete the time for which they were given the antibiotics, even before you feel good and do not use antibiotics without medical indication, avoiding self-medication.

If we work together, we can finally avoid falling into a world where antibiotics are useless, returning to die from common infections.

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