Abdominal wall hernias occur when an organ or the fascia of an organ protrudes through the wall of the cavity that normally contains it. Risk factors for developing these hernias include obesity, ascites, increasing age, and surgical wounds. Symptoms of abdominal wall hernias include a palpable lump, cough impulse, pain, obstruction (more common in femoral hernias), and strangulation (which can compromise the bowel blood supply and lead to infarction). There are several types of abdominal wall hernias, including inguinal hernias (which account for 75% of cases and are more common in men), femoral hernias (more common in women and have a high risk of obstruction and strangulation), umbilical hernias (symmetrical bulge under the umbilicus), paraumbilical hernias (asymmetrical bulge), epigastric hernias (lump in the midline between umbilicus and xiphisternum), incisional hernias (which may occur after abdominal surgery), Spigelian hernias (rare and seen in older patients), obturator hernias (more common in females and can cause bowel obstruction), and Richter hernias (a rare type of hernia that can present with strangulation without symptoms of obstruction). In children, congenital inguinal hernias and infantile umbilical hernias are the most common types, with surgical repair recommended for the former and most resolving on their own for the latter.

Differential diagnosis of vomiting and poor weight gain in infants

Vomiting and poor weight gain are common symptoms in infants, but they can be caused by different conditions that require specific management. One possible cause is pyloric stenosis, which results from an enlarged muscle at the outlet of the stomach, leading to projectile vomiting, dehydration, and failure to thrive. Another possible cause is gastro-oesophageal reflux disease (GORD), which may also involve vomiting, but not projectile, and may respond to conservative measures such as frequent feeds and upright positioning, or medication such as Gaviscon® or proton pump inhibitors. Cow’s milk protein allergy is another potential cause, which may present with a range of symptoms, including vomiting, but not projectile, and may require an exclusion diet for the mother if breastfeeding. Gastroenteritis is a common cause of vomiting and diarrhoea in infants, but it usually resolves within a few days and does not cause an abdominal mass. Finally, volvulus is a rare but serious condition that involves a twisted bowel, leading to acute obstruction and ischaemia, which requires urgent surgical intervention. Therefore, a careful history, examination, and investigations, such as ultrasound or blood tests, may help to differentiate these conditions and guide appropriate treatment.

Meningitis poses a higher risk to neonates, particularly those with low birth weight, prematurity, traumatic delivery, fetal hypoxia, and maternal peripartum infection. The initial symptoms are usually vague and may include elevated body temperature, respiratory distress, apnea, episodes of bradycardia, low blood pressure, difficulty feeding, irritability, and decreased activity.

Organisms causing meningitis in children

Meningitis is a serious condition that can affect children of all ages. The organisms that cause meningitis vary depending on the age of the child. In neonates up to 3 months old, Group B Streptococcus is the most common cause, which is usually acquired from the mother during birth. E. coli and other Gram-negative organisms, as well as Listeria monocytogenes, can also cause meningitis in this age group.

From 1 month to 6 years old, Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), and Haemophilus influenzae are the most common organisms that cause meningitis. In children over 6 years old, Neisseria meningitidis and Streptococcus pneumoniae are the most common causes.

It is important for parents to be aware of the signs and symptoms of meningitis, such as fever, headache, stiff neck, and sensitivity to light. If a child is showing these symptoms, they should be taken to a doctor immediately for evaluation and treatment. Early diagnosis and treatment can help prevent serious complications and improve outcomes.

The Barlow manoeuvre is a technique used to try and dislocate a newborn’s femoral head. If successful, the Ortolani manoeuvre can then be used to relocate the dislocated femoral head. The Thomas test is not appropriate for neonates and is used to identify hip flexion contractures in older patients. The Denis Brown bar is an orthotic device used in conjunction with the Ponseti method to correct a fixed talipes.

Developmental dysplasia of the hip (DDH) is a condition that affects 1-3% of newborns and is more common in females, firstborn children, and those with a positive family history or breech presentation. It used to be called congenital dislocation of the hip (CDH). DDH is more often found in the left hip and can be bilateral in 20% of cases. Screening for DDH is recommended for infants with certain risk factors, and all infants are screened using the Barlow and Ortolani tests at the newborn and six-week baby check. Clinical examination includes testing for leg length symmetry, restricted hip abduction, and knee level when hips and knees are flexed. Ultrasound is used to confirm the diagnosis if clinically suspected, but x-ray is the first line investigation for infants over 4.5 months. Management includes the use of a Pavlik harness for children under 4-5 months and surgery for older children with unstable hips.

Measles: A Highly Infectious Viral Disease

Measles is a viral disease caused by an RNA paramyxovirus. It is one of the most infectious known viruses and is spread through aerosol transmission. The disease has an incubation period of 10-14 days and is infective from the prodromal phase until four days after the rash starts. Measles is now rare in developed countries due to immunization programs, but outbreaks can occur when vaccination rates drop, such as during the MMR controversy of the early 2000s.

The disease is characterized by a prodromal phase, which includes irritability, conjunctivitis, fever, and Koplik spots. The latter typically develop before the rash and are white spots on the buccal mucosa. The rash starts behind the ears and then spreads to the whole body, becoming a discrete maculopapular rash that may become blotchy and confluent. Desquamation may occur after a week, typically sparing the palms and soles. Diarrhea occurs in around 10% of patients.

Measles is mainly managed through supportive care, and admission may be considered in immunosuppressed or pregnant patients. The disease is notifiable, and public health should be informed. Complications of measles include otitis media, pneumonia (the most common cause of death), encephalitis (typically occurring 1-2 weeks following the onset of the illness), subacute sclerosing panencephalitis (very rare, may present 5-10 years following the illness), febrile convulsions, keratoconjunctivitis, corneal ulceration, diarrhea, increased incidence of appendicitis, and myocarditis.

If an unimmunized child comes into contact with measles, MMR should be offered within 72 hours. Vaccine-induced measles antibody develops more rapidly than that following natural infection.

Possible Diagnoses for a Child with Right Iliac Fossa Pain and High Temperature

When a child presents with right iliac fossa pain and high temperature, several possible diagnoses should be considered. One of them is mesenteric adenitis, which is characterized by abdominal pain resulting from mesenteric lymphadenopathy and often accompanied by enlarged neck nodes and a recent history of viral upper respiratory tract infection. Appendicitis is another possibility, but it tends to present with a low-grade fever and peritoneal irritation that causes involuntary muscle spasm in the abdominal wall. Meckel’s diverticulitis, which is clinically indistinguishable from appendicitis, is an intra-operative or radiological diagnosis and can cause gastrointestinal bleeding, obstruction, inflammation, or umbilical discharge. Retroperitoneal appendix abscess is an uncommon type of infection that presents with fever, back pain, and abdominal pain, but it can also cause other symptoms such as gastrointestinal bleeding, poor wound healing, chest pain, general discomfort, urinary frequency, and haematuria. Finally, urinary tract infection (UTI) is unlikely if there are no nitrites or leukocytes on urine dipstick, but it can cause non-specific symptoms such as vomiting/diarrhoea, mild abdominal pain, dysuria, frequency, and enuresis, especially in infants.

Breastfed infants may be susceptible to vitamin K deficiency, as breast milk lacks sufficient amounts of this nutrient. The baby in question is likely experiencing idiopathic vitamin K deficiency, with breastfeeding being the only known risk factor. It is possible that the baby did not receive a vitamin K injection at birth, as they were born in Ukraine. Gender, age, vaginal delivery, and birth order are not associated with an increased risk of vitamin K deficiency.

Haemorrhagic Disease of the Newborn: Causes and Prevention

Newborn babies have a relatively low level of vitamin K, which can lead to the development of haemorrhagic disease of the newborn (HDN). This condition occurs when the production of clotting factors is impaired, resulting in bleeding that can range from minor bruising to intracranial haemorrhages. Breast-fed babies are particularly at risk, as breast milk is a poor source of vitamin K. Additionally, the use of antiepileptic medication by the mother can increase the risk of HDN in the newborn.

To prevent HDN, all newborns in the UK are offered vitamin K supplementation. This can be administered either intramuscularly or orally. By providing newborns with adequate levels of vitamin K, the risk of HDN can be significantly reduced. It is important for parents and healthcare providers to be aware of the risk factors for HDN and to take steps to prevent this potentially serious condition.

If a newborn lacks red reflex, it is important to consider the possibility of retinoblastoma. Other causes should also be evaluated, but urgent referral to an ophthalmologist for a comprehensive, dilated eye examination is necessary.

Retinoblastoma is a prevalent type of eye cancer that is commonly found in children, with an average age of diagnosis at 18 months. It is caused by a loss of function of the retinoblastoma tumor suppressor gene on chromosome 13, which is inherited in an autosomal dominant pattern. About 10% of cases are hereditary. The most common presenting symptom is the absence of red-reflex, which is replaced by a white pupil (leukocoria). Other possible features include strabismus and visual problems.

When it comes to managing retinoblastoma, enucleation is not the only option. Depending on how advanced the tumor is, other treatment options include external beam radiation therapy, chemotherapy, and photocoagulation. The prognosis for retinoblastoma is excellent, with over 90% of patients surviving into adulthood.

Perthes’ disease is commonly seen in children aged between 4 and 8 years, as is the case with this untreated patient. The other age ranges mentioned are not typical for this condition.

Understanding Perthes’ Disease

Perthes’ disease is a degenerative condition that affects the hip joints of children, typically between the ages of 4-8 years. It is caused by a lack of blood supply to the femoral head, which leads to bone infarction and avascular necrosis. This condition is more common in boys, with around 10% of cases being bilateral. The symptoms of Perthes’ disease include hip pain, stiffness, reduced range of hip movement, and a limp. Early changes can be seen on an x-ray, such as widening of the joint space, while later changes include decreased femoral head size and flattening.

To diagnose Perthes’ disease, a plain x-ray is usually sufficient. However, if symptoms persist and the x-ray is normal, a technetium bone scan or magnetic resonance imaging may be necessary. If left untreated, Perthes’ disease can lead to complications such as osteoarthritis and premature fusion of the growth plates.

The severity of Perthes’ disease is classified using the Catterall staging system, which ranges from stage 1 (clinical and histological features only) to stage 4 (loss of acetabular integrity). Treatment options include keeping the femoral head within the acetabulum using a cast or braces, observation for children under 6 years old, and surgical management for older children with severe deformities. The prognosis for Perthes’ disease is generally good, with most cases resolving with conservative management. Early diagnosis is key to improving outcomes.

The usual age for performing hypospadias surgery is approximately 12 months.

Understanding Hypospadias: A Congenital Abnormality of the Penis

Hypospadias is a condition that affects approximately 3 out of 1,000 male infants. It is a congenital abnormality of the penis that is usually identified during the newborn baby check. However, if missed, parents may notice an abnormal urine stream. This condition is characterized by a ventral urethral meatus, a hooded prepuce, and chordee in more severe forms. The urethral meatus may open more proximally in the more severe variants, but 75% of the openings are distally located. There appears to be a significant genetic element, with further male children having a risk of around 5-15%.

Hypospadias most commonly occurs as an isolated disorder, but it can also be associated with other conditions such as cryptorchidism (present in 10%) and inguinal hernia. Once hypospadias has been identified, infants should be referred to specialist services. Corrective surgery is typically performed when the child is around 12 months of age. It is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure. In boys with very distal disease, no treatment may be needed. Understanding hypospadias is important for parents and healthcare providers to ensure proper management and treatment of this condition.