Cradle cap

• Coxsackievirus A24 and enterovirus 70 with acute hemorrhagic conjunctivitis (pinkeye)

• Coxsackieviruses B1-B5 with myocarditis (inflammatory heart disease)

Treatment

Treatment is usually aimed at easing symptoms.

Prevention

Because these viruses spread chiefly by contact with fecal excretions, scrupulous hand washing is always the best defense against spread of these infections. Otherwise, there is no known way to prevent infection with these viruses other than isolating the affected patient.

cradle cap A harmless, common skin condition in infants in which thick yellow greasy scales form in patches over the scalp. It is a form of seborrheic dermatitis, which may also occur on the face, neck, behind the ears, and in the diaper area. Without treatment, it may persist for months, but when properly cared for, the condition usually fades away within a few weeks. A doctor should be consulted if the skin looks inflamed, or if the condition worsens.

Treatment

The baby's hair should be washed with baby shampoo or a mild anti-dandruff shampoo once a day; after lathering, the scaly scalp should be massaged with a soft toothbrush for a few minutes. For very crusty conditions, olive or mineral oil should be rubbed into the baby's scalp an hour before a shampoo. The oil loosens and softens the scales, which can then be washed off. All the oil must be washed out, because if this is left in the hair it could aggravate the problem.

This treatment may need to be repeated for several days until the scales are all washed away. Baby's hair should be brushed daily with a soft bristle brush to help loosen scales that can then be removed with a fine-tooth comb.

A mild corticosteroid solution or cream may be prescribed in severe cases until the condition clears.

craniofacial conditions A group of conditions which children may either be born with or develop later, in which the bones of the head and face grow inappropriately.

Craniosynostosis This condition, which means "fused bones of the skull," occurs when the skull fuses too early. A child's skull is made up of a group of different bones that fit together like a jigsaw puzzle; the areas where the bones meet are called sutures. As a baby grows, the brain rapidly increases in size and causes the skull bones to expand. In cran-iosynostosis, the fused part of the skull cannot enlarge, which may lead to overgrowth and abnormalities in the shaped skull.

In "multi-suture craniosynostosis," more than one suture of the skull is prematurely closed. Multi-suture craniosynostosis includes the Apert, Crouzon, Pfeiffer, and Saethre-Chotzen syndromes.

The main treatment for craniosynostosis during infancy is surgery, which will relieve intracranial pressure, assure that the skull has the capacity to accommodate the brain's growth, and cosmetically improve the appearance of the child's head.

Apert syndrome In this condition, the skull and the face grow abnormally, producing bulging eyes that are usually wide-set and tilted down at the sides. Children with this condition usually have problems with teeth alignment due to the underdevelopment of the upper jaw, and some have cleft palate, or webbed fingers and toes.

After the child is evaluated by a multispeciality craniofacial surgery team at a children's medical center, the condition can be surgically treated to correct the skull, mid-face, and palate. Hearing problems can be treated by a hearing specialist.

Crouzon syndrome In this condition, the sutures in the head are prematurely fused so that the skull and face grow abnormally, producing bulging eyes, receding upper jaw, and protruding lower jaw. There also may be problems with teeth due to abnormal jaw growth.

There is no cure for Crouzon syndrome, but many of the symptoms can be treated with complex surgery best provided by comprehensive cran-iofacial teams at major centers. Surgeries used to treat the symptoms of Crouzon syndrome include the removal and replacement of portions of the cranial bone (craniectomy) as early as possible after birth. This can help prevent pressure and damage to the brain and can maintain a skull shape that is as normal as possible. surgery to treat protruding eyeballs is done directly on the eye sockets or on the bones surrounding the eye sockets. Removing a portion of the jawbone can help treat a protruding lower jaw, which is often very successful in normalizing the appearance of the jaw. Finally, surgeons also can repair a cleft palate, and braces and other orthodontic treatments are usually necessary to help correct misalignment of teeth. An ophthalmologist and otolaryngologist (ear, nose, and throat specialist) should monitor infants and children with Crouzon syndrome. These specialists can check for problems and provide corrective treatment as necessary.

Pfeiffer syndrome in this condition, sutures that fuse too soon produce a high forehead and pointed top of the head. The middle face appears flattened, the nose is small and has a flattened appearance, eyes are widely spaced, and the upper jaw is underdeveloped, which causes the lower jaw to appear prominent. The thumbs and big toes are very broad, and teeth are often crowded.

Multiple staged surgery is usually recommended for patients with pfeiffer syndrome. in the first year of life, doctors can release the sutures of the skull to allow for brain growth and expansion. skull remodeling may need to be repeated as the child grows. If necessary, mid-facial advancement and jaw surgery can be done to provide adequate room for the eyes and to correct the occlusion. Although there is a significant malformation of the fingers and toes, usually these function adequately and do not require the surgical attention of a plastic surgeon and specialist.

Saethre-Chotzen syndrome In this condition, irregular head growth is caused when more than one suture is fused prematurely. Eyelids are droopy and eyes are widespread, bulging, and possibly crossed. The upper jaw may be underdeveloped, the nose may look "beaked," and the area between the nostrils is off center. Fingers are short and certain fingers may be fused. The hairline may be low.

Multiple staged surgery is also the general treatment plan for patients with Saethre-Chotzen syndrome, and is similar to the procedures for pfeiffer syndrome. in the first year of life the surgeon will release the synostotic sutures of the skull to allow adequate brain growth and expansion. This procedure may need to be repeated in the life of the child. Depending on the severity of the skull deformity, this procedure may be done in one stage or two stages.

If necessary, mid-facial advancement and jaw surgery can be done to provide adequate room for the eyes and to correct the occlusion to an appropriate functional position. Eye muscle surgery often needs to be performed by a pediatric ophthalmologist to correct the imbalance in the muscular structures of the eye as well as the drooping of the eyelids.

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