Blog

Bronchiolitis – This year seems to be a bad one with RSV!

We have already started to see atlleast 2-3 cases of severe Bronchiolitis every day. It is a very common respiratory illness in babies less than 1 year of age, in winter. It can be caused by several viruses, but this year, it seems to be the well associated, Respiratory Syncitial Virus coming back with a vengence. There is no treatment except supportive management with oxygen/breathing support, if needed and keeping them well hydrated with fluids.

https://www.nhs.uk/conditions/bronchiolitis/

Why do babies cry excessively?

All children cry. But when your child is crying excessively, and you don’t know the reason why, it can be very stressful and upsetting. Children cry for a reason, but they can’t tell you the reason they are upset, especially when they are newborn. Crying is the only way they are able to communicate a problem or a need.

There can be multiple causes for your child to be crying so much. It is usually common in children younger than 1-year-old, especially as they have no other way of telling you that something is wrong. Here are some of the reasons your baby may be crying excessively:

  1. The baby is hungry – The most common cause of an excessively crying baby is hunger. You should always make sure that you are feeding your baby a healthy amount.  Sometimes babies may not be getting enough milk, and fail to gain weight correctly. If you’re concerned about your babies weight gain, always consult your GP or paediatrician.
     
  2. The baby is too hot or cold – Babies will often cry if they are not at a comfortable temperature, or if they are wearing comfortable clothes. This can be easily solved by ensuring the room is at a comfortable temperature, or that the baby is wearing enough comfortable clothes.
     
  3. Wet or dirty nappy – it may be obvious, but a wet or dirty nappy can cause babies a lot of discomfort, causing them to cry a lot of the time. Make sure your baby always has a clean nappy, and don’t leave a dirty nappy on the baby for a long period of time.
     
  4. An indication of an illness – some of the most common causes of persistent crying in a baby is an illness. Common illnesses that affect babies include:
  • Colic – the condition that causes excessive crying in babies that are only a few weeks old, and usually stops after the baby is 4 months old. This problem usually passes, and is nothing to worry about.
  • Blocked nose
  • Ear infection
  • Urine infection
  • Gastroeosophageal Reflux Disease (GORD). This is a common condition in children in which food and stomach acid travels back up the food pipe towards the throat, causing pain in babies like heartburn. This can be avoided by regularly burping your child after feeds, and allowing the baby to sleep with its head raised to around 30 degrees. This can be done by placing 2 pillows beneath the mattress at the head end. Feed thickeners or anti-reflux medicine can also be used.
  • Some more serious but rare conditions can cause excessive crying, such as meningitis.

If you are worried about excessive crying in your child, you should see a specialist paediatrician who will be able to advise on the most appropriate course of action. If your baby is crying excessively and has fever you should see your GP as soon as possible as this may be a sign of a more serious illness.

Haemangioma (strawberry nevus)

A haemangioma is a collection of small blood vessels that form a lump under the skin. They are sometimes called ‘strawberry marks’ because the surface of a haemangioma may look a bit like the surface of a strawberry.

Superficial haemangiomas are usually a raised, bright red area of skin, which feels quite warm because the abnormal blood vessels are close to the surface. A superficial haemangioma may appear initially as a small area of pale skin on which a red spot develops.

Deep haemangiomas may appear bluish in colour because the abnormal blood vessels are deeper in the skin. Sometimes they are not noticeable for the first few weeks, only appearing as a lump as the haemangioma grows. This is particularly true if the surface of the skin is not affected.

Haemangiomas are not usually present at birth but develop a few days or weeks later. They often grow rapidly in the first three months. It is unusual for haemangiomas to grow after six to 10 months of age, when most haemangiomas tend to have a ‘rest period’ and then begin to shrink.

As the blood vessels in a haemangioma are so near the surface of the skin, they can bleed if they are scratched. It is important to keep nails cut short and buffed smooth, so that they don’t catch the surface of the haemangioma.

If the haemangioma starts to bleed, apply pressure over it with a clean handkerchief, cloth or tissue for at least five minutes. If blood soaks through the handkerchief, cloth or tissue, put another one on top and keep up the pressure. Do not take it off to have a look as this could start the bleeding again.

If the bleeding continues, even after pressing down on the haemangioma for five minutes, we recommend people go to their nearest NHS Walk-In Centre or Accident and Emergency department

A beta blocker called Propranolol may be needed when the haemangioma is near the eye, lips, or nappy area. Treatment may need to continue for 18 months or longer but results are promising.

Tests for Cow’s milk (protein) allergy

I get asked this very often when I diagnose CMPA in a baby. The most common type of CMPA is Non IgE mediated. It presents at the age of 4-6 weeks onwards. The symptoms are dry skin, reflux (unsettled, vomity baby), runny stools or worsening constipation. Some babies are also snuffly and have blocked nose, all the time.

The severe form, which is IgE mediated CMPA, presents earlier, within days as vomit as soon as milk is given (usually formula), sneezes, rash over face and sometimes breathing difficulty. This can be diagnosed with a blood test (specific IgE for milk) or a skin prick test to milk. Fortunately, this is much less common than Non IgE mediated cases.

There is no test for the Non IgE mediated CMPA as IgE (Immunoglobulin E) is not involved in the allergy. It is still a true allergy. The good thing is that children with this condition grow out of it between the age of 1 to 2 years. (IgE mediated CMPA may persist for 7-8 years or even longer).

The best test is going dairy free (if you are breast feeding) or giving a special (Extensively Hydrolysed) formula, which is on prescription (Aptamil Pepti, Nutramigen or Similac Alimentum). They all taste bad but the babies get used to it pretty quickly as their taste buds are not very well developed. It may take 2-4 weeks before you see marked improvement in symptoms.

Then at 4 weeks, you reintroduce the dairy in babies or mother’s diet.

If symptoms return – It confirms CMPA and you should go back to ‘dairy free diet’

If they don’t – It possibly was not CMPA and you can relax !

https://www.allergyuk.org/assets/000/002/176/iMAP_2_Management_of_Mild_to_Moderate_Non-IgE_Cow’s_Milk_Allergy_original.pdf?1539852537