Hearing loss, deafness, or hearing impairment is the complete or partial loss of the ability to hear sounds in one or both ears. Hearing loss in babies before developing speech and language skills is called prelingual hearing loss, which may negatively impact the development of auditory centers of the brain.

Read this post to learn more about the causes, types, symptoms, diagnosis, treatment, prevention, and outcomes of hearing loss in babies.

Causes Of Hearing Loss In Babies

Some babies may have hearing loss from birth (congenital deafness), while a few may lose hearing during infancy.

Problems of the outer and middle ear cause hearing loss since they prevent the conduction of sound to the inner ear. External and middle ear problems that cause hearing loss may include (1):

• Birth defects of ear structures
• Accumulation of fluid behind the eardrum
• Ear wax buildup
• Scars on the eardrum
• Foreign objects in the ear canal
• Eardrum injuries or rupture

Some babies could have hearing loss due to inner ear problems. Damage to the nerve endings in the inner ear can be the cause of hearing loss. This can be due to:

• Genetic disorders
• Congenital infections such as toxoplasmosis, herpes, or measles
• Exposure to certain medications or toxic substances in intrauterine life or early infancy
• Brain infections, such as meningitis, encephalitis, or measles infection, damaging the hearing function of the brain
• Abnormal inner ear structure
• Tumors

A family history of auditory impairment and low birth weight could increase the risk of hearing loss in many babies.

Types Of Hearing Loss

Hearing loss can be of the following types (2).

• Conductive hearing loss where something in the outer ear or middle ear prevents the sound from passing to the inner ear. Some causes of conductive hearing loss can be cured with surgeries and medications.
• Sensorineural hearing loss occurs due to issues in the inner ear or auditory (hearing) nerve.
• Mixed hearing loss is a combination of conductive hearing loss and sensorineural hearing loss.

Auditory neuropathy spectrum disorders may cause hearing loss due to damage to the hearing nerve or inner ear, leading to failed conduction of sound-related impulses to the brain. In such cases, even though the sound is conducted normally in the ear, the brain fails to understand it.

Hearing loss is classified in the following ways based on the degree of hearing loss (3).

• Mild hearing loss when someone can hear some sounds but has difficulty hearing soft or low sounds.
• Moderate hearing loss is when a person cannot hear another person’s normal voice, but they do hear loud voices.
• Severe hearing loss is when someone only hears some loud sounds and unable to hear normal sounds levels.
• Profound hearing loss in which the person does not hear any speech sounds and may hear only very loud sounds.

The degree of hearing loss depends on the sound levels (decibels) a person can hear. 10 to 15 decibel sound levels are heard in normal hearing. The sound levels that can be heard on each degree of hearing loss are listed in the table below (4).

Depending on the onset and clinical features, the hearing loss can be described in the following ways (5).

• Unilateral or bilateral hearing loss: Hearing loss affects one ear (unilateral) or both ears (bilateral)
• Progressive or sudden hearing loss: Sudden hearing loss is a rapid onset of hearing loss, whereas progressive hearing loss may occur over time.
• Pre-lingual or post-lingual hearing loss: Hearing loss before the baby learns to speak is called prelingual hearing loss, and after learning to talk is known as post-lingual hearing loss.
• Fluctuating or stable hearing loss: Hearing loss stays the same over time in stable hearing loss, and it may get better or worse in fluctuating hearing loss.
• Congenital, acquired, or delayed onset of hearing loss: Hearing loss present at birth is called congenital hearing loss, and if it occurs later, it is called acquired or delayed onset of hearing loss.
• Symmetrical or asymmetrical hearing loss: Similar loss of hearing on both ears is called symmetrical hearing loss. If there is a different degree of hearing loss level in both ears, it is called asymmetrical hearing loss.

Doctors may combine the types, degree, onset, and clinical presentation of the hearing loss to name the hearing loss in your baby. These terms may help to understand the type and cause of hearing loss in the baby.

Signs And Symptoms Of Hearing Loss In Babies

The following signs and symptoms may indicate a hearing loss in babies (6).

1. Newborn lacking Moro reflex (not startled by loud noises)
2. No reaction (no smile) if you speak to older babies
3. May not achieve speech milestones such as saying single words by 15 months and two-word sentences by age two
4. Not turning their head or responding to sounds
5. Not making cooing or babbling sounds
6. Unable to follow basic commands

Many children are diagnosed with hearing loss during school-age even if they had congenital hearing loss. So noticing the signs of hearing loss at an early age could be beneficial since babies can develop their speech and language skills at a natural pace after the repair in many cases.

Diagnosis Of Hearing Loss In Babies

Doctors may look at a baby’s ear using an otoscope to identify any abnormalities, wax, or foreign objects that cause hearing loss. The following tests are performed to determine the presence of a hearing loss in babies (7).

• Auditory brainstem response (ABR) test is done using electrodes to see the response of the auditory nerve to sounds.
• Otoacoustic emissions (OAE) test by placing microphones in babies ears to evaluate the presence of sound Hearing loss can be diagnosed if there is no echo of sound in the ear canal.
• Visual response audiometry or play audiometry can help evaluate the hearing loss in older babies by noticing their response to sounds through play. 

Treatment Of Hearing Loss In Babies

Treatment may begin as early as by six months of age since this could help the baby develop speech and language skills at a normal pace. Depending on the cause of hearing loss and general health status, any of the following treatment options are given (8).

• Cochlear implant for profound sensorineural hearing loss
• Medications to treat infections
• Ear tube placement in babies with recurrent ear infections
• Removal of tumors
• Surgical correction of structural anomalies

Speech and language therapies could improve the baby’s communication skills affected by hearing loss. Even though hearing cannot be restored in some babies, early speech therapy and sign language training could improve their life quality.

Prognosis Of Hearing Loss In Babies

Middle ear or outer ear problems causing hearing loss can be cured with surgery or medications in many cases. There is no treatment for some inner ear problems and nerve damages.

The outcome depends on the severity and type of hearing loss. Babies with profound hearing loss have positive outcomes after cochlear implants. Advanced hearing aids and speech therapy may help babies develop normal speech and language skills as their peers without hearing problems. 

Prevention Of Hearing Loss In Babies

All cases of hearing loss in babies cannot be prevented. Maternal vaccination and avoiding exposure to toxins and medications that may damage the baby’s hearing could reduce the risk of congenital hearing loss.

Immunization of your baby, as per recommendation, could prevent some of the infections that may lead to hearing issues. You may also ensure that your baby is not exposed to loud noises since this may result in noise-induced hearing loss.

Treating brain infections and ear infections on time may reduce the risk of hearing loss in some babies. Seeking genetic counseling may also help the couple plan a pregnancy if they have a family history of hearing loss.

Hearing loss in babies could be congenital or develop later. Some conditions causing hearing loss can be cured with medications and surgery. Delaying these interventions could affect your baby’s hearing functions since the auditory centers of the brain may not develop if the hearing is not proper. Timely treatment and appropriate speech therapy can help the baby develop normal auditory and speech skills in the long run.

References:

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A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that middle schoolers from a predominantly Latinx community, with elevated levels of mental health problems, showed a reduction in symptoms during the early stages of the pandemic.

While the negative impact of the COVID pandemic on mental health is widespread, our study found that COVID-19 stay-at-home measures may have offered some protective effects for youth mental health early in the pandemic. These may be related to increased time with family, fewer social and academic pressures, more flexible routines, factors related to Latinx culture and the socio-emotional learning program that students were engaged in throughout the study period.”

Francesca Penner, MA, Study Coordinator, University of Mississippi Medical Center, Mississippi, MA, USA

The findings are based on the Identity Development in Typical Adolescents Study, a US-based ongoing longitudinal project tracking identity development in adolescence, that began in January 2020, prior to the onset of the pandemic.

A sample of 322 young adolescents (Mage = 11.99, 55% female), with a racial/ethnic composition of 72.7% Hispanic/Latinx; 9.3% Black or African American; 5.9% Multiple Races; 5.0% Asian; 1.6% White; and 1.2% American Indian, completed a mental health screening measure prior to the COVID-19 pandemic and at three bi-weekly time points starting one month into stay-at-home orders (mid-April, early May, late May, 2020). A subsample also completed a survey about their experience at home during COVID-19.

For youth who had elevated levels of mental health problems pre-pandemic, symptoms were significantly reduced across domains during the pandemic. Reductions in internalizing, externalizing and overall problems were clinically significant. For youth without notable pre-pandemic mental health problems, there were statistically significant reductions in internalizing and overall problems, and no change in attention or externalizing problems. Further analyses revealed that better family functioning was consistently related to lower mental health symptoms in youth during the bi-weekly follow-ups.

“These results have important clinical implications,” said senior author Carla Sharp, PhD, who led the study, and is a professor in the Department of Psychology, University of Houston, Texas. “First, promoting family functioning during COVID-19 may have helped protect or improve youth mental health during the pandemic. Further, it is important to consider cultural factors, such as familism and collectivism in Latinx communities that may buffer the early effects of disasters on mental health to COVID-19 stress.

“It also points to the need to determine specific features of stay-at-home measures that may be protective for youth mental health: for example ongoing socio-emotional learning programs in schools that can pivot to support mental health during crises, increased family time, changes in school structure, addressing middle school peer stress, more sleep, and more flexible routines.”

It is of course possible that the negative impact of stay-at-home orders began to take effect after the study period ended in May 2020. Assessments were completed while the academic year was still in session and the COVID-19 outbreak worsened in the school’s region after that time. Mental health may have declined later as the spread increased in the area or as stay-at-home measures continued.

The window when this study was conducted may present a unique “natural experiment” with the combination of increased time at home while stress related to COVID-19 in this region was not yet at its peak. Related, families who were financially impacted by COVID-19 may have had worsening stress that had not yet manifested during follow-up points. Further analysis indicated that in families where job loss occurred due to the pandemic, children did not experience the same level of reduction in total mental health problems at the first follow-up, compared to children in families where no job loss occurred.

“Our findings underline the importance of the family environment and Latinx collectivist values of community connection for promoting child resilience and brings into stark focus the possibility that school environments may exacerbate mental health difficulties,” said co-author, Jessica Hernandez Ortiz, a graduate student working with Dr. Sharp, who is currently leading the follow-up of the sample to assess more long-term effects of COVID-19 on adolescent mental health outcomes. “Removal from that context into a less pressured environment immediately and positively impacts mental health.”

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If you’re pregnant, you might be a little bit too familiar with advice from passersby concerning your pregnancy and the health of your baby. These ideas may be confusing, and ultimately it’s up to you to determine what the right advice is. If you’re struggling to find good advice about staying healthy while pregnant, here are a few tips to keep in mind and ask your doctor about.

Exercise safely

Unless instructed by a doctor not to exercise while pregnant, it is recommended to engage in physical activities for two hours and thirty minutes each week. Maintaining a healthy weight through exercise and good dietary practices can help you control your cholesterol, blood sugar, and blood pressure. Engage in less strenuous activities such as walking, dancing, swimming, or riding a bicycle. Activities such as soccer, skiing, gymnastics should be discouraged to avoid hitting your belly or falling. Also, avoid working out in a place with extreme heat, and do all exercises in moderation. Staying healthy while pregnant also involves practicing Kegel exercises to assist you during and after delivery.

Make regular visits to the doctor

Start prenatal clinics early for the doctor to monitor your health and that of the unborn baby. Start medications if your doctor recommends any to you. If you experience any symptoms like dizziness, bleeding, fever, vomiting, extreme headaches, or swelling, you should go to the hospital immediately. Avoid self-medication because you may not be aware of the impact that certain medications could have on your baby. As per the Centers for Disease Control and Prevention (CDC) recommendations, pregnant mothers should get flu and whooping cough vaccines. Ask your doctor about this and make sure to get vaccinated at the right time during your pregnancy.

Eat in-season fruits and vegetables

Staying healthy while pregnant has a lot to do with how you nourish yourself. During pregnancy, you shouldn’t cut calories or attempt a fad diet. Your focus needs to be on providing proper nutrition for both yourself and your unborn child. Some major biotech crops, like corn and soybeans, may have additives that aren’t good for you during pregnancy, so try to shop local and organic when possible. Ensure your diet has fruits and vegetables, such as dark leafy green vegetables, which are rich in iron. Those nutrients are essential for making red blood cells and helping your body function properly.

Stay away from harmful substances and practices

If you’re concerned about staying healthy while pregnant, you need to avoid drugs, alcohol, and smoking. Not sure what these substances can do to your baby during pregnancy? Let’s take a look:

• Alcohol: Alcohol is passed to the baby while in the womb and may cause mental and physical abnormalities. It can also cause FASDs (Fetal Alcohol Spectrum Disorders).
• Drugs: The use of cocaine, heroin, and other drugs may expose the baby to congenital disabilities, premature birth, and even addiction to the substance you’re using.
• Tobacco: This substance contains nicotine which may cause sudden infant death syndrome (SIDS), low weight at birth, premature births, and problems related to the respiratory system.

Make sure that you’re thinking about your baby and avoiding these substances until you are done breastfeeding to keep your baby safe and healthy.

Drive safe

When pregnant, you’ll still need to travel at times, which is okay. However, staying healthy while pregnant means taking every precaution necessary when travel is part of the picture. Consult your doctor if going for a longer distance and out of the country. If driving, take serious safety measures to avoid accidents. In 2020, motor vehicle accident fatalities fell by 2%, which means people took proper care on the road. Always wear a safety belt and place it between your breasts and avoid placing it across or above your belly. Sit a considerable distance away from the steering wheel and dashboard. If you feel dizzy or tired, do not drive. With spring showers, there are certain season-specific risks, like hydroplaning, so make sure that you’re driving in safe conditions when you go out.

When you’re concerned about staying healthy while pregnant, make sure you keep these tips in mind. In addition, don’t hesitate to reach out to your doctor with questions.

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Nosebleed or epistaxis happens when the blood vessels or capillaries inside the nose rupture. In children, nosebleeds generally occur in the front area of the nose, which consists of many tiny blood vessels. Recurrent nosebleeds are common in children, however, parents might be worried as they can be dramatic and seem like the child is losing a lot of blood.

Nosebleeds are rarely serious in children. However, if your child experiences nosebleeds repeatedly or the nose bleeding worsens, you may have to seek your doctor’s advice.

Read this post to learn the causes of nosebleeds in children and the first aid and treatment options you could consider.

Types Of Nosebleeds

There are two types of nosebleeds: anterior nosebleeds and posterior nosebleeds.

• Anterior nosebleeds: These are common in children and occur from the front of the nose.
• Posterior nosebleeds: These occur from deep inside the nose, and the blood usually flows down to the back of the throat. Posterior nosebleeds are rarely seen in children and might occur due to an underlying condition or an injury.

Causes For Nosebleeds In Children

In the majority of cases, the reasons for nosebleeds in children are benign and self-limiting. Anterior nosebleeds are common in children and could be caused by any of the following reasons.

• Nose-picking. This is a common habit in children and is often done to remove an uncomfortable sensation in the nose. However, sometimes, it becomes a habit, and children might pick their noses unconsciously. Picking the nose can scratch the inner surface of the nose, causing it to bleed (1).
• Dry climate. You might notice frequent nosebleeds in children during the winters. The dry weather causes the insides of the nose to dry, crack, and crust, resulting in bleeding (2).
• Nosebleeds could also be a side effect of using nasal sprays or cold and allergy medicines (3).
• Physical trauma. Nosebleeds can also happen in children when they suffer from an injury or a broken nose.
• Infections and allergies. Infections such as the common cold and allergies due to dust mite or hay fever can also cause nosebleeds in children.

Posterior nosebleed

Nosebleeds from the posterior part of the nose can be a symptom of bleeding disorders, tumors, or sinuses (4).

If your child experiences repeated nosebleeds and the reasons mentioned above are ruled out, the problem could be deeper and might require prompt medical attention.

Are Recurring Nosebleeds In Kids A Problem?

A cross-sectional study of 1,218 children aged 11–14 years suggests that about 9% of children experience recurrent nosebleeds, with most of them outgrowing the condition as they age (5). If your child experiences repeated nosebleeds, it can irritate the lining of the nose and rupture the blood vessels, resulting in further nosebleeds even from a slight action or trauma.

Symptoms Of Nosebleeds In Children

The primary symptom of a nose bleed is blood dripping from the nostrils. When the blood drips from the anterior part of the nose, it usually starts from one nostril. However, in posterior nosebleeds, the blood is likely to drip from both nostrils. In both cases, the bleeding is usually painless. However, if the bleeding is due to an injury, your child is likely to experience pain (6).

Diagnosis Of Nosebleeds

Your doctor will do a physical examination of your child’s nose to determine if there is an injury. The doctor may also ask you the child’s medical history and any other symptoms your child might have.

How To Stop Nosebleeds In A Child?

It could be alarming to see blood dripping from your child’s nose. However, you can make it stop with some simple steps.

• Ask your child to stay calm and reassure them it is going to be ok.
• Make your child sit on a chair with their head tilted slightly forward. Do not let them tilt their head back or lie flat, as the blood might flow into the throat and cause gagging.
• Gently pinch the soft part of the nose with a tissue and hold it for ten minutes. You can also place ice on the bridge of the nose.
• Once the bleeding subsides, ask your child to relax and not blow, pick, or rub their nose.

Treatment For Nosebleeds In Children

First aid may stop the nosebleed for the time being, but the nosebleed may occur again if the underlying cause is not treated. The treatment for nosebleeds depends on the cause. These tips can also help prevent nosebleeds in children.

• If your child’s nosebleed is due to nose-picking, keep your child’s fingernails short to prevent them from injuring the insides of their nose. If your child is younger, place mittens on their hands to discourage them from nose-picking.
• Use saline drops or lubricating nasal gels to prevent your child’s nose from getting dry.
• Talk to your pediatrician about the usage of nasal sprays and limit their use as much as possible.
• Make sure your child uses protective gear while playing sports to protect the nose from getting injured.

Risks And Complications Of Nosebleeds in Children

While nosebleeds may seem like a serious issue, they rarely cause complications. However, posterior nosebleeds could be due to an underlying medical condition, such as a tumor or a sinus, and may cause additional complications (4).

Children who have allergies, a deviated septum, or those who live in dry and warm climates are at a higher risk of developing nosebleeds (7).

When To Call The Doctor?

Call your healthcare provider if:

• You are unable to stop the nosebleed using the tips mentioned above.
• There is an injury on the face or head.
• There is heavy bleeding.
• A foreign object is stuck in your child’s nose.
• Your child feels weak, faints, or has trouble breathing.
• The nosebleeds happen frequently (more than once a week).

Nosebleeds can be scary, but often, they are normal and can be contained by following a few simple steps. However, it is important to understand the reason behind the nosebleed in your child so that you can prevent it from happening again. Also, if your child shows other symptoms, it is best to talk to your pediatrician.

References:

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Ventricular septal defect (VSD) is an abnormal opening in the ventricular septum, the tissue or wall that separates the heart’s lower chambers (ventricles). It is one of the most common types of congenital heart defects, accounting for about half of congenital heart disease cases in babies.

The ventricular septum prevents the mixing of oxygenated and deoxygenated blood contained within the left and right ventricle, respectively. Opening in the ventricular septum could allow blood from the left ventricle to reach the right ventricle and lungs. Advanced cases could also display the reverse flow of the blood from the right ventricle to the left ventricle.

The treatment often involves surgical closure of the opening, and it could improve the baby’s condition. Read this post to know about the types, causes, symptoms, diagnosis, treatment, and prevention of ventricular septal defect in babies.

Types Of VSD In Babies

Ventricular septal defects are classified into four basic types based on their location in the heart (1).

• Muscular VSD is the most common type, located in the septum’s muscular portion. This may close naturally in most babies without any surgical interventions.
• Membranous VSD is an opening in the upper part of the ventricular septum, known as a membranous septum, near the valves. This type may not close naturally and often requires surgery to close it.
• Atrioventricular canal type VSD is associated with atrioventricular canal defect. In this type, the defect is located below tricuspid and mitral valves, which are valves between the upper chambers (atria) and lower chambers (ventricles) of the heart.
• Conalseptal VSD is rare and occurs below the pulmonary valve, the valve between the right ventricle and pulmonary artery leading to the lungs.

Causes And Risk Factors For VSD

VSD is a congenital heart defect, which means it is present at birth. The fetal heart development begins as a hollow tube and is later divided into four chambers. VSD could occur due to fetal heart development problems during the first eight weeks of pregnancy.

Genetic factors, such as chromosomal abnormalities, or environmental factors, such as exposure to teratogens, may interfere with the heart’s normal partition, leaving an opening in the ventricular septum (2).

Babies with a positive family history of VSD and Down’s syndrome may have an increased risk of developing VSD. In some cases, there may be no discernible cause or risk factor associated with VSD.

Signs And Symptoms Of VSD

Signs and symptoms may vary based on the size of the defect and the baby’s age. The ventricular septal defect allows blood from the left ventricle to reach the right ventricle. This may increase the work of the right ventricle and the lungs. If the hole is larger, more blood enters the heart’s right side, causing severe symptoms.

The following signs and symptoms are seen in infants with VSD (3).

• Additional blood reaching the lungs may cause congestion and rapid or heavy breathing
• Fatigue
• Sweating
• Refusal to feed
• Pale skin
• Rapid heart rate
• Poor weight gain

These symptoms and signs may also be seen in more severe congenital heart diseases. You may consult the pediatrician for early diagnosis and treatment.

Complications Of VSD

Small-size VSD may not cause any complications. Mild to life-threatening complications are often seen in babies with large and medium-size defects. These complications may include (4):

• Pulmonary hypertension (high blood pressure in the lungs’ blood vessels) can be seen in VSD due to excess blood flow to the lungs.
• Heart failure may occur in some babies since the lungs have too much blood and the heart has to work harder to pump blood.
• Endocarditis is the inflammation of the heart’s inner lining (endocardium).
• Valve failures and rhythm abnormalities may occur due to abnormal blood flow in the heart.
• Eisenmenger’s syndrome occurs in babies with severe VSD with pulmonary hypertension. This is a condition in which the direction of shunting reverses, which means the blood from the right ventricle (deoxygenated blood) begins to reach the left ventricle due to pulmonary hypertension. This may cause cyanosis in babies.

Cyanosis in a baby with previous VSD symptoms may indicate Eisenmenger’s syndrome (reversal of blood flow). You may seek immediate medical care since this may increase the risk of complications, such as cerebrovascular accidents, hemoptysis (coughing up blood), and syncope (loss of consciousness).

Prevention Of VSD In Babies

Prevention may not be possible in most cases. However, the following pregnancy care may reduce the risk for VSD in some babies (5).

• Preconception and early prenatal care may help the mother begin a healthy lifestyle and diet before fetal heart
• Seek prescriptions before taking medications in pregnancy to prevent fetal damage due to certain medicines.
• A balanced diet with recommended vitamins (including folic acid) and iron supplements helps the fetus’ optimal growth.
• Regular exercise during pregnancy may also be beneficial for the fetus.
• Vaccination may reduce the risk of congenital defects due to infections.
• Maternal diabetic control during pregnancy may reduce the risk of heart problems in babies.
• Avoid illegal drugs, alcohol, and tobacco products during pregnancy.

If you or your partner has a family history of VSD or other genetic defects, seek genetic counseling, especially before conception.

Diagnosis Of VSD

Signs and symptoms are often suggestive of VSD in some babies. Doctors may hear heart murmurs using a stethoscope during the physical examination of babies with VSD.

The following tests are often done to diagnose the presence, size, location, and complications of the VSD in babies (6).

• An echocardiogram helps determine the size, severity, and location of the VSD and other heart A fetal echocardiogram may allow diagnosis before birth.
• Chest X-ray may help look for the heart’s size (cardiac enlargement) and excess fluid in the lungs.
• Electrocardiogram or ECG may help identify rhythm abnormalities by recording the heart’s electrical activity.
• Pulse oximetry could determine the blood’s oxygen levels. Shunting of blood may reduce the blood’s oxygen levels.
• Cardiac catheterization by inserting a catheter (thin, flexible tube) through the arm’s or groin’s blood vessels could help assess the heart’s structure and function.

Babies with genetic abnormalities may require genetic testing to identify the abnormality. Doctors may plan the interventions based on the diagnostic results. 

Treatment Of VSD In Babies

Small-size defects may not need surgical repair in most cases. Doctors may observe for symptoms and wait for the opening to close independently. However, small openings near the heart valves require surgical closure to prevent complications.

Medium and large VSD may require surgical repair within the first year of life. Treatment for VSD may include the following interventions (7).

• Open heart surgery is done to close the opening with stitches or patches. General anesthesia is needed for this procedure, and babies are supported with a heart-lung machine.
• The catheter procedure uses a special mesh device to close the opening without a chest incision.
• Extra nutrition is prescribed for babies who are tired during feeding or unable to feed themselves due to VSD to meet optimal growth.
• Medications, such as diuretics (furosemide/Lasix), are often prescribed to reduce the blood circulation in the lungs.

The type of procedure is chosen based on the size of the opening and babies health status. You may talk with the pediatric cardiac surgeon or cardiologist to know the best treatment option for your baby. Your baby may require several follow-up visits after the surgery to ensure improvement. Long-term prognosis may depend on the type of VSD and its severity, and adequate lifestyle management may help improve the outcome in the long run.

References:

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Governments and health leaders across the globe are today calling for urgent action on adolescent wellbeing.

In an open letter published by The BMJ, they warn that the current generation of adolescents – 1.2 billion people aged 10-19 worldwide – “are at risk of inheriting a world blighted by climate change and scarred by covid-19.”

The 30 signatories include the Partnership for Maternal, Newborn & Child Health, the World Health Organization, United Nations and its related agencies, youth led organizations, civil society, foundations, academia, and government representatives in Africa, the Americas, Asia and Europe.

Although adolescents have been spared the most severe direct effects of the pandemic, the indirect effects on their wellbeing are devastating, they argue.

They explain that, even before covid-19, adolescents and young adults faced many challenges to their wellbeing, including social injustice and inequalities, inadequate mental health, and a crisis of connection to family, community and society, with increasing numbers living on the streets or dropping out of school.

Yet between 2003 and 2015, development assistance for adolescent health accounted for only 1.6% of total development assistance for health, despite a third of the total global burden of disease estimated to have roots in adolescence.

When adolescents move into young adulthood, many face unemployment or unstable employment, they add. In 2017, 34% of young women and 10% of young men aged 15-24 years were not in employment, education or training, with more pronounced disparities in northern Africa and southern Asia.

And even among employed adolescents and young adults, an increasing proportion have poor job security, variable weekly earnings, and minimal or no health or social security coverage.

“These examples show that, as a global community, we have paid insufficient attention to the multidimensional and intersectional nature of adolescent wellbeing and the importance of the transition to young adulthood,” they write.

As a result, they have committed to a call to action for adolescent wellbeing to ensure that today’s adolescents are empowered to solve the problems they are inheriting.

Underpinning this is a new agreed definition and conceptual framework for adolescent wellbeing to inform policies and programming.

This framework includes good health and optimum nutrition; connectedness, positive values, and contribution to society; safety and a supportive environment; learning, competence, education, skills, and employability; and agency and resilience.

“We invite everyone – decision makers, policy makers, civil society, service providers, educators, donors, innovators, and, most importantly, adolescents themselves – to support this call to action,” they write.

“Together, we can ensure that it results in concrete policies, integrated programs, and sustained investments for adolescent wellbeing.”

They stress that adolescents, youth and youth led organizations “are at the heart of this initiative and will continue to be so.” But they say “we all have a part to play in achieving these goals if we are to deliver a more equitable and inclusive world for this and future generations.”

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Breastfeeding twins means feeding two babies optimally. However, feeding twins optimally without compromising breast milkquality and quantity is a valid concern for a mother. But this should not stop a mother from breastfeeding her twins.

Experts believe that most mothers can breastfeed twins successfully with proper guidance and prompt support. If you are a new mother to twin babies or expecting twins soon, knowing about breastfeeding twins in detail can help you stay prepared.

This post tells you about how you can breastfeed twins, its benefits, and alternatives to look for when breastfeeding twins isn’t possible.

Why Should You Breastfeed Your Twins?

Twins attain the same benefits by breastfeeding as a singleton. However, these benefits are increasingly prudent for babies born prematurely, which may often be the case in twin birth.

• Breast milk is an easy-to-digest, tailored food offering nutrients to grow and develop. It is crucial for premature babies who are mostly underdeveloped and likely to have an immature digestive system (1).
• Breast milk provides antibodies that boost immunity and help fight infectious diseases. Premature babies are more prone to infections than babies born full-term (2).
• Breastfeeding allows the mother to interact with the babies and have skin-to-skin contact, which boosts the baby’s overall growth and development. It is preeminent for premature babies who need kangaroo care to hasten development and reduce hospital stays (3).

Other than these, breastfeeding boosts the mother-baby bond essential to develop trust.

How To Breastfeed Twins?

According to the American Academy of Pediatrics (AAP), the best way to breastfeed twins is to feed them simultaneously (tandem breastfeeding), establishing a twin nursing schedule (4). It means that if one baby is awake and ready to feed, you should wake up the other baby and feed them as well.

The first few weeks after birth, infants feed eight to 12 times per day, for about 20 to 30 minutes per session. In such a schedule, feeding two babies at different times can become taxing, leaving no time for the mother to rest.

In case you aren’t comfortable yet feeding two babies simultaneously, feed the weak feeder first and the other one later. Once you get the hang of tandem feeding, practice the right position so that you and the babies are comfortable during nursing. As the babies grow, they will develop their sleep-wake cycles owing to which you may have to feed them separately.

Appropriate Positions To Breastfeed Twins Simultaneously

During nursing, positioning yourself and the babies comfortably is necessary to avert unnecessary physical strain. Below are some breastfeeding positions to try (5) (6).

https://www.shutterstock.com/image-vector/mother-breastfeeding-her-twins-front-cross-318536036

1. Double football hold or double-clutch: Place the babies on pillows almost under your arm such that their legs point backward. Support their heads and backs with your hands and arms, respectively. This position lets you avoid any pressure on your belly, especially after a C-section.
2. Double cradle hold or front cross: Place both the babies in the cradle position wherein their legs overlap and make an X in your lap. Use your arms to support their backs and your hands to support their heads. You may stay seated or lie while feeding in this position, especially while feeding the babies at night.
3. Cradle and football hold: Place one baby in the cradle position and the other in a football position. The baby who latches easily should be placed in the cradle position and the other in the football hold.
4. Upright latch hold: In this breastfeeding position, each baby latches to a breast while seated in an upright position. The babies could sit on your legs, or you may place a pillow. You will still have to support their back and heads with your arms and hands.

You may initially need help to position the babies during breastfeeding. However, with practice, both you and your babies will learn to adjust to the chosen breastfeeding position.

Tips To Breastfeed Twins

Below are some simple tips to ensure the safe and optimum breastfeeding of twins.

1. Get a feeding or nursing pillow: You can use bed pillows or cushions as props to support babies, your back, and your arms while feeding. However, arranging regular pillows or cushions for every feed and keeping them in place while nursing could be a hassle. Therefore, it is good to consider using a specialized twin-feeding or nursing pillow.
2. Seek support and position the babies properly: When you begin feeding, putting two babies on your breast could require help. It is essential to seek support as proper positioning of the babies is vital for correct latchingand comfortable feeding. If you are alone, pick a position that offers maximum support and works the best for you and your babies.
3. Ascertain they are latching right: Once your babies are appropriately positioned, check if they have latched correctly. You can tell a baby has latched correctly when their lips flange out and cover the entire areola. You will also see the baby move their mouth and neck while swallowing. Improper latching could affect the amount of milk consumed by the baby and also cause other nursing issues, such as sore nipplesfor the mother.
4. Shift breasts: You may feel that one of your babies or both are more comfortable feeding on one breast, compelling you to let them feed on that breast. But experts advise switching breasts for each baby at each feeding session. It is done so that both breasts get equal stimulation, otherwise breastfeeding problems, such as breast engorgement and clogged milk ducts, may occur.
5. Take advice and follow what suits you: If you can’t breastfeed twins simultaneously, consult your healthcare provider or lactation consultant and explore feeding one baby at a time or feeding expressed milk to one baby. If breast milk production and supply aren’t enough to meet the needs of two, don’t hesitate to enquire about formula use.
6. Focus on your health and well-being: Breastfeeding two is a demanding task requiring you to stay healthy and active. It is crucial for good milk flow and to pass the breastfeeding journey Therefore, you must eat a well-balanced diet containing various foods and exercise regularly. You may consult a certified nutritionist to get a customized diet plan suitable for your needs.

You can also join community groups where you can interact with mothers who currently are or were breastfeeding twins. It will give you motivational and emotional support vital for breastfeeding twins.

What To Do If Breastfeeding Twins Is Not Possible?

While several mothers breastfeed their twins successfully, it may not be possible in some cases. In such instances, experts advise supplementing breastfeeding with infant formula. Additionally, you may feed expressed or pumped breast milk to one or both the babies using a bottle.

Many mothers may be able to breastfeed one baby at a time if not simultaneously, and you may explore this option as well. Monitor the babies’ growth and development and talk to your healthcare provider in case of any concerns.

Frequently Asked Questions

1. Will I make enough milk to breastfeed two?

Yes, most mothers make enough milk to breastfeed their twins (7). Breast milk production is based on demand and supply; thus, the more you breastfeed, the more milk you make. Nevertheless, if you suspect your milk supply isn’t sufficient, you can consult a lactation expert for solutions.

2. How many calories does a mother burn when breastfeeding twins?

A healthy breastfeeding mother burns around 500 to 700Kcal per day to produce milk while nursing a singleton (8). If you are breastfeeding twins, you may burn more calories since your breasts need to produce almost double the milk.

Breastfeeding twins is a demanding task that could require adequate practice initially. While most mothers can pass this journey smoothly, a few may discover challenges, which can be passed through patience, persistence, and appropriate guidance. Remember to focus on your health, too, since it will greatly influence the production and supply of breast milk for your twins.

References:

The post How To Breastfeed Twins: Positions And Tips To Follow appeared first on Parenting Boss.

Parachute reflex is a primitive, postural reflex where a baby standing in an upright position, when lowered face down towards a flat surface, extends the arms outwards and spreads the fingers wide (just like a parachute) to prevent a fall.

For most full-term, healthy babies, this gross motor skill appears around five months of age, much before they begin to walk or crawl (1). However, it fully develops by the age of eight to nine months. A well-developed parachute reflex in babies is a crucial developmental milestone. If you have a young baby or expecting one soon, knowing about parachute reflex and some other essential reflexes can help track their development.

This post tells you why parachute reflex is vital for babies, how it is tested, and what if babies have multiple reflexes missing.

Why Do Infants Develop Parachute Reflex?

Parachute reflex is an involuntary reaction indicating healthy neuromotor development of an infant (2). Experts suggest that parachute reflex is vital to determine the baby’s ability to react to a stimulus (i.e., a falling position) and prevent injury due to falling.

During routine check-ups, especially around nine months, healthcare providers and doctors check for parachute reflex in babies to rule out hemiparesis (3). Hemiparesis is a neurological condition where muscle-weakening or paralysis occurs in one side of the body (4).

How To Test The Presence Of Parachute Reflex In An Infant?

Most pediatricians and healthcare providers check parachute reflex in healthy, full-term babies using the following steps (5).

1. Hold the baby in an upright position by firmly gripping them from their chest. Ensure they are calm and alert.

2. Raise the baby upwards and quickly but gently rotate them facing downwards as if they are falling.

3. As the baby rotates, note their response. The baby should extend their arms forward and spread fingers to prevent a fall.

In most full-term babies, healthy babies, the reflex develops entirely by 12 months of age and then stays indefinitely.

Other Primitive Reflexes

There are some more essential reflexes that mark the healthy overall development of a baby (6).

1. Rooting reflex: If you stroke a baby’s cheek or touch the corner of their mouth, they will turn their head towards that direction. This reflex allows the baby to locate the mother’s breast or a bottle and begin feeding. The reflex disappears by four months of age.

2. Suck reflex: It is a survival reflex that manifests around the 32nd week of the pregnancy and fully develops by the 36th week. It prepares the baby to suck as soon as the mouth’s roof or palate is touched. Babies gradually fine-tune this reflex with the rooting reflex, letting them use this combination reflex to suck on the pacifier, hand, or fingers to self-soothe.

3. Moro reflex: It appears in babies when they are just a few weeks old and then disappears by two months. In this reflex, the baby arches their back, throws out their arms and legs, rapidly brings their arms together, and cries in response to a sudden movement or loud noise. It is a startle response which is why the reflex is also known as the startle reflex.

4. Tonic neck reflex: In this reflex, when a baby’s head turns to one side, the arm to that side straightens, and the opposite arm bends at the elbow as if the baby is fencing. It is the reason this reflex is also known as fencing posture, which abates once the baby is between five and seven months of age.

5. Grasp reflex: It is an essential reflex wherein a stroke or a touch on the baby’s palm causes them to close their fingers, forming a fist. This reflex allows the baby to grasp things or objects. The reflex wanes once the baby is around five to six months old.

6. Stepping reflex: Also known as dance or walking reflex, this reflex makes a baby step as if they are walking when held in an upright position and their sole touches a flat surface. The reflex disappears by two months of age and returns around 12 months as a voluntary action, called walking.

These reflexes together prepare your baby to survive in the world outside the mother’s womb and learn different skills to act voluntarily.

What If One Or More Reflexes Are Absent In A Baby?

Reflexes mark developmental milestones. As babies grow and develop at different rates, some delay may happen and is usually normal. However, a partial or complete absence of one or more reflexes could indicate an underlying neurological or motor growth and developmental issue.

For instance, a partial or complete absence of the sucking reflex may indicate brain damage and/or a syndrome that could affect the overall growth and development (7). Similarly, the presence of a reflex long after the time it should disappear indicates a brain or nervous system problem (8).

Parachute reflex is a protective, involuntary action essential for babies to develop. While the presence of parachute reflex lets a baby prevent fall, its absence indicates a neuromotor concern. If you suspect your baby has a partial or complete lack of one or more reflexes, consult a pediatrician promptly. A doctor will evaluate your baby, determine the precise cause, and suggest appropriate therapies and treatments.

References:

The post Baby Parachute Reflex: Definition, Age, Reflex Test And More appeared first on Parenting Boss.

In some cancers, including leukemia in children and adolescents, obesity can negatively affect survival outcomes. Obese young people with leukemia are 50% more likely to relapse after treatment than their lean counterparts.

Now, a study led by researchers at UCLA and Children’s Hospital Los Angeles has shown that a combination of modest dietary changes and exercise can dramatically improve survival outcomes for those with acute lymphoblastic leukemia, the most common childhood cancer.

The researchers found that patients who reduced their calorie intake by 10% or more and adopted a moderate exercise program immediately after their diagnosis had, on average, 70% less chance of having lingering leukemia cells after a month of chemotherapy than those not on the diet-and-exercise regimen.

Lingering cancer cells in the bone marrow, which are more likely to be found in overweight individuals, are associated with worse survival and a higher risk of relapse, often leading to more intense treatments like bone marrow transplants and immunotherapy.

We tested a very mild diet because this was our first time trying it, and the first month of treatment is already so difficult for patients and families. But even with these mild changes in diet and exercise, the intervention was extremely effective in reducing the chance of having detectable leukemia in the bone marrow.”

Dr. Steven Mittelman, Senior Author, Chief of Pediatric Endocrinology, UCLA Mattel Children’s Hospital and Member of the UCLA Jonsson Comprehensive Cancer Center

As part of the clinical trial, which took place at Children’s Hospital Los Angeles, researchers worked with registered dieticians and physical therapists to create personalized 28-day interventions for 40 young people between the ages of 10 and 21 who were newly diagnosed with acute lymphoblastic leukemia.

The intervention was designed to cut participants’ calorie intake by a minimum of 10% in order to reduce both fat gain and lean muscle loss. The physical activity component included a target level of 200 minutes per week of moderate exercise.

The results, published in the American Society of Hematology’s journal Blood Advances, showed a decrease in fat gain among those who were overweight and obese, as well as an improved insulin sensitivity and an increase in the beneficial hormone adiponectin, which is involved in regulating glucose and breaking down fatty acids. Most importantly, the researchers found a 70% decrease in the chance of having lingering leukemia cells in the bone marrow -; known medically as minimal residual disease -; when compared with a historical control group.

“We hoped the intervention would improve outcomes, but we had no idea it would be so effective,” Mittelman said. “We can’t really add more toxic chemotherapies to the intense initial treatment phase, but this is an intervention that likely has no negative side effects. In fact, we hope it may even reduce toxicities caused by chemotherapy.”

“This is the first trial to test a diet-and-exercise intervention to improve treatment outcomes from a childhood cancer,” said principal investigator and lead author Dr. Etan Orgel, Director of the Medical Supportive Care Service in the Cancer and Blood Disease Institute at Children’s Hospital Los Angeles. “This is an exciting proof-of-concept, which may have great implications for other cancers as well.”

Next steps include further testing of the approach in a multicenter randomized trial, which will be launched later this year, the researchers said.

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If your breast milk smells and tastes off or soapy, it could be due to high lipase activity. Lipase is an enzyme naturally found in breast milk. This enzyme has several benefits, such as hydrolyzing milk fat into easily digestible and absorbable fatty acids. Parents share that babies refuse to breastfeed or bottle-feed expressed milk due to these changes.

Besides, they feel apprehensive about these changes and worry if the milk is fit for babies. If you are a new mother or soon to be one, knowing about the changes in breast milk’s taste and smell due to lipase can help avoid undue speculations.

This post tells you about lipase activity in human breast milk, its causes, and effective ways to manage it.

Causes Of High Lipase In Breast Milk

There’s no evident cause as to why breast milk could develop high lipase content. It’s simply the case that some mothers have excess lipase in their breast milk while others don’t. Lipase is an enzyme in breast milk that facilitates digestion and absorption of nutrients, especially fats.

Stored expressed breast milk is believed to have high lipase levels that hasten the milk break down, altering milk’s taste and smell (1). Even then, some mothers report no change in their milk’s smell or taste. In either case, properly stored breast milk is safe, and its off smell and flavor don’t indicate it is unfit for the baby. 

Does High Lipase Milk Affect The Baby’s Health?

No clinical evidence demonstrates the short- or long-term effects of high lipase breast milk on an infant’s health. There are no known adverse effects, as well. The changes in the flavor and taste of stored milk happen due to lipolysis, which has antimicrobial effects that prevent microbial growth in thawed refrigerated breast milk (2).

It could mean that these changes are favorable for your baby. In fact, a study showed that lipase in breast milk could compensate for pancreatic lipase functions during infancy, helping in healthy growth, particularly in preterm infants (3). If you still don’t find your breast milk smell or taste appropriate, check your breast pump parts, storage containers, and consult a pediatrician. You may also consider avoiding strong-smelling foods, such as garlic and fish. 

Can You Test Lipase In Breast Milk, At Home?

Although lipase activity in breast milk is a normal activity, if you wish to determine it, you can do it right at home with the following steps.

• Express some breast milk, store it in a suitable container, and freeze or refrigerate. You may taste a small quantity of milk to determine its flavor and odor before storing it.
• Let the container stay in the freezer or refrigerator for one to two days.
• After the stipulated time, check the odor and taste. If the milk smells and tastes off or soapy, it is highly likely that your breast milk has a high lipase content.

If your milk has high lipase content and your baby refuses to feed, you may try some interventions. 

Tips To Mask Off Breast Milk Smell And Flavor

Here are some steps to resolve your milk’s smell and taste due to high lipase activity.

1. Don’t store breast milk for too long. Ideally, the baby should consume the expressed milk within a few minutes. Nevertheless, it may not always be possible. Therefore, label the milk containers with the date of pumping before storing them.
2. Note the time as to when the milk turns sour and smells off. Following this timeline will help determine the approximate time when your stored milk changes flavors due to lipase activity. In most cases, the shift in the milk’s taste occurs after 24 hours of storage. So, pump and store milk accordingly to avoid milk wastage.
3. Try scalding. According to lactation experts, scalding fresh expressed milk before storing can deactivate lipase. Scalding milk involves heating it until it just begins bubbling around the edges and not boiling (4). Boiling milk isn’t advisable as it can destroy the essential nutrients. Experts suggest heating breast milk in a pan below 180°F (82.2°C).
4. Mix stored milk with freshly expressed milk or solids. You can mix stored milk with freshly expressed milk to mask its flavor before serving it to the baby. For older babies who consume breast milk along with solids, you can add solids to breast milk. Oatmeal and infant cereals are some safe foods that you can add to breast milk.

Other than these measures, altering breast pumps speed and pressure might also help prevent changes in breast milk’s taste and smell. You may also ensure that the breast pump and its parts are sterile to prevent bacterial contamination, which could also alter breast milk’s taste and flavor.

Breast milk is vital for babies. Its taste and smell are some of the factors that affect the baby’s appetite. A baby might stop feeding stored breast milk due to these changes. But, rest assured, the soapy taste and smell of properly stored milk are mostly safe, provided the cause is high lipase activity and not something else. If you are concerned about the possible cause of the milk’s soapy flavor, do not hesitate to speak to a lactation consultant. 

References:

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