Tag Archives: pediatrician in vasundhara

Congenital Hypothyriodism

Can my child have thyroid related problem at birth? YES, read on.

Congenital Hypothyroidism (CH)

Congenital Hypothyriodism    

Hypothyroidism is condition in which thyroid gland does not produce thyroid hormone in sufficient quantity. And if this condition is present right from birth, it is called Congenital Hypothyroidism (CH).

Congenital Hypothyroidism (CH) is most common preventable cause of Mental retardation in children.

It is also known as Cretinism, Endemic Cretinism (Iodine Deficiency), Congenital Myxedema.

Hypothyroidism is usually an age related change seen in older people, especially ladies. However its incidence is on a rise in younger population too.

physiology of CH

Newborn babies are also vulnerable; more so because there are no specific symptoms which can lead to early diagnosis. Because of this reason most of the private hospitals are now doing cord blood testing (Newborn Screening) to rule out thyroid related illnesses.

Good news for parents is that it can be diagnosed easily by testing (Newborn screening) and can be treated comfortable; so that child can live a normal life just like any other baby.

Hypothyroid in children

Signs and symptoms

Most of the children are asymptomatic (due to trans-placental transfer of maternal thyroid hormones)

If symptomatic; then following are the features

  • Prolong Jaundice during first few weeks of life (earliest sign)
  • During first month of life there is feeding difficulties (Sluggishness , sometimes even choking spells during nursing)
  • Lack of interest, Somnolence (sleepy all the time), large head size (due to myxedema).
  • Breathing difficulties due to large protruded tongue, also noisy breathing, nasal obstruction
  • During 1st year of life babies are sleepy all the time, have poor appetite, cries very little and sluggish most of the time.
  • Large protruded abdomen mostly has umbilical hernia.
  • A puffy appearance to the face. Dull looking
  • Cold to touch and mottled skin, edema of genital region and extremities
  • Constipation not responding to treatment
  • Poor muscle tone
  • Anemia can be there
  • Developmental delay
  • Slow heart rate

CH-mayaclinic

In children and teenage it can lead to

  • Poor growth leading to in short stature
  • Delayed eruption of teeth
  • Delayed puberty
  • Poor mental development

anatomy of thyroid gland

Thyroid gland is a butterfly- shaped organ at base of the neck.

 Hypothyroid

Causes:

  • Absent (agenesis) or (abnormal location) ectopic in location or underdeveloped
  • Genetic causes:  about 15% of cases are thought to be inherited
  • Iodine deficiency in mothers
  • Use of anti thyroid medicines in mothers

 Diagnosis: It is done by newborn screening in most cases

newborn screening

 Management:

  • Hormone replacement is the treatment (Safe and easy in children too)
  • L-thyroxine tablets are small and can be crushed into food or dissolved into a small amount of formula, juice or other liquid. No liquid formulation is available.    thyroid_treatment
  • Child specialist along with Pediatric Endocrinologist will treat children with thyroid or any other hormonal problems
  • Treatment to be started as soon as diagnosis made; since damage to brain once done can never be reversed
  • Overdosing of L-thyroxine in children can lead to
    • Faster heart rate
    • Loose motions
    • Poor sleep
    • Shakiness or tremors
    •  Soy-based formulas and Iron supplements can reduce the absorption of thyroid hormone.
    • Regular monitoring of child every few months
    • Developmental assessment

Congenital Hypothyroidism, before and after treatment (mayaclinic.in)

FAQ

Q. My child is too small? What if I do not treat my child?

Ans. It can lead to Mental retardation and developmental delay in children. Damage once done can never be reversed.

Q. Is it genetic disease?

Ans. About 15% cases are inherited and genetic counseling need to be done. Genetic testing can be done using blood sample.

Q. What are the tests need to be done to confirm it?

Ans.  If newborn screening is positive:

  • then blood tests are repeated after 72 hours of life which includes TSH, T4,T3.
  • Thyroid Ultrasound and Scan need to be done in certain cases

diagnosis of CH

Q. Can it be diagnosed during pregnancy?

Ans. NO

Q. Can elder siblings also have it?

Ans. If elder siblings are growing well, healthy and developmentally normal. Most likely the answer is NO.

For Any queries related thyroid disease or you want to discuss any other health related issues feel free to contact MAYA CLINIC. Or discuss with your child specialist.

Regards

Dr Rahul Varma

 

Breath-holding spells

Breath-holding spells

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Your child cries, and stops breathing, and almost turns blue. It is one of the scariest situations for parents. The episode seems life threatening but in reality, it is relatively benign (not serious). And it does not pose any risk to the health of the child.

It’s a very challenging situation for the caregiver, and needs to be handled with patience rather than panic. One thing which parents need to understand is that breath-holding spells are an involuntary reflex. The episodes usually last less than a minute (though it may seem like ages to the anxious parent), and after that the child regains consciousness and starts breathing normally.

Usual age of occurrence is from 6 months to 6 years but they can occur at earlier age too. Few cases have been reported in newborns also, but in such small babies, other factors need to be ruled out. Family history may be positive in some cases.

Episodes typically start after excessive crying.  Children usually outgrow this disease by the time they start going to school.

Breath holding spells are of two types

  • Cyanotic:  Child turns blue in face
  • Pallid:       Child turns pale, almost white

In both the cases the child stops breathing and loses consciousness for few seconds. In very rare cases seizures might occur, but these are benign and do not cause any long term harm.

Breath-Holding-Spell-1024x614 

What to do if your child stopped breathing during a spell

  • Stay calm
  • While your child is in the brief unconscious phase, just check she is safe and has fallen flat on the ground
  • Remove any sharp object in vicinity which can cause damage to child.
  • Once she is awake, try to appear normal and unaffected by the whole thing.

When to See your Child Doctor

  • After first episode
  • These episodes are not harmful but proper check up and investigations might be needed to rule out underlying medical condition.
  • Consult your child specialist to determine triggers of spell and to know how to prevent future spells and how to deal with it if it happens again.

1

How to prevent Future Spells

  • Try to prevent the trigger
  • You should try not to give in to tantrums of children
  • No special attention after spells, otherwise in a way we might reinforce the behavior.
  • Iron supplementation might help in decreasing the incidence, more so if child is anemic.
  • Reassure yourself and find a way to discipline your child in a way that does not provoke another spell
  • As the child grows old he develops better coping skills
  • With experience, courage and guidance from your child specialist you should be able to provide a safe and structured environment to your child.
  • In some cases when episodes are very frequent, some medications (like Piracetam) might be needed. But in most cases it can be avoided.

 holdingbreath_big

Condition that should be ruled out

  • Heart conditions with rhythm disturbances like Arrhythmia etc via ECG or ECHO.
  • Anemia (Get Hemoglobin done)
  • Seizure like episodes and Seizure Disorder.

 

Feel free to contact Maya Clinic for any queries or discuss with your pediatrician.

Regards

Dr Rahul Varma