Balancing Academics and Serious Illness

When your child has a serious or chronic illness, it's hard to think beyond the next treatment. While health is the first priority, education also is important. You'll want to help your child stay on top of schoolwork as much as possible and plan for when he or she can return to school.

Not only does staying connected to school bring academic, cognitive, psychological, and social benefits — it's also your child's legal right. Under federal law, kids with disabilities are entitled to educational support, and your child might qualify for free services under the Individuals with Disabilities Education Act (IDEA).

With a little planning and a lot of communication, you can help your child balance treatment and academics.

Plan Ahead

First, talk to your doctor about how long your child is likely to be away from school and whether the treatment might interfere with concentrating, doing homework, and meeting deadlines. Are there side effects that might have an academic impact? What does your doctor recommend when it comes to attendance, tutoring, or studying?

Then talk to the teachers and school staff, and encourage your child, if well enough, to do the same. It may be necessary to set a reduced schedule or shift due dates for papers and tests. With your help, your son or daughter can work with teachers to help plan the workload. The more notice teachers have, the easier it will be to come up with a flexible solution.

Some kids who spend a lot of time away from school or in the hospital have Individual Education Plans (IEPs). These are customized goals and learning strategies created by the teachers, school psychologists (or other specialists), and counselors. IEPs take a child's individual needs into account. Under the IDEA, kids who qualify for an IEP will receive one at no cost, in addition to receiving free support services (such as a tutor) to help them reach educational milestones. IEPs can be requested by you or anyone on your child's education team.

Seek Out Hospital-Based Support

If your child will be spending long stretches in the hospital, ask a doctor, nurse, or child-life specialist about onsite schooling. Many hospitals provide this service free of charge to their patients. The two most common types of educational support include bedside schooling and classroom schooling. Typically, bedside schooling is for children who are too ill to leave their hospital rooms or have weakened immune systems due to chemotherapy. Other kids who are well enough might be educated individually or in small groups in an onsite hospital classroom.

Licensed teachers who are K-12-certified in a variety of subjects and special education work intensively with students to make sure that they don't fall behind in their studies. To stay on track, hospital-based teachers work closely with teachers from a child's school to maintain curriculum continuity and ease reentry into the classroom when the child is well again. School is scheduled around medical tests and therapies, and always takes a child's medical condition and strength into consideration. Whether your child is being educated at school, in the hospital, or at home, remember that getting better is the main priority. So be realistic about what he or she can handle. Kids may feel an unspoken pressure from parents, teachers, and themselves to continue with schoolwork, and this anxiety could hurt their recovery.

Stay Connected

Maintaining ties with classmates and teachers can help your child maintain a sense of normalcy during this difficult time. Your child might even be able to listen to a lesson or join a class over the computer. Programs nationwide offer free or low-cost laptops for use in the hospital; check with your doctor or medical staff to see if this service is available to you.

In addition to academic isolation, your child may feel cut off socially from friends and classmates. Online social networking sites, email, instant messaging (IM), text messaging, and talking on the phone can help kids stay connected. Also consider encouraging a letter-writing, email, or care package campaign from classmates — you might even set up a collection box at school where they can deposit notes and pictures. Arrange for visits from your child's friends and, if your son or daughter is up to it, take the group out to school plays, sports events, classroom parties, and other social gatherings. Staying connected will make for a smoother transition socially and academically when your child returns to school after treatment. 

Reviewed by: Alycia Taggi

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Salmonella Infection

A salmonella infection is a foodborne illness caused by the salmonella bacteria carried by some animals, which can be transmitted from kitchen surfaces and can be in water, soil, animal feces, raw meats, and eggs. Salmonella infections typically affect the intestines, causing vomiting, fever, and other symptoms that usually resolve without medical treatment.

You can help prevent salmonella infections by not serving any raw meat or eggs, and by not keeping reptiles as pets, particularly if you have very young children.

Hand washing is a powerful way to guard against salmonella infections, so it's essential to teach kids to wash their hands, particularly after trips to the bathroom and before handling food in any way.

Salmonella Basics

Not everyone who ingests salmonella bacteria will become ill. Children, especially infants, are the most likely candidates to get sick from it. About 50,000 cases of salmonella infection are reported in the United States each year and about one third of those are in kids 4 years old or younger.

The type of salmonella most commonly associated with infections in humans is called nontyphoidal salmonella. It is carried by chickens, cows, and reptiles such as turtles, lizards, and iguanas.

Another, rarer form of salmonella, typhoidal salmonella (typhoid fever), is carried only by humans and is usually transmitted through direct contact with the fecal matter of an infected person. This kind of salmonella infection can lead to high fever, abdominal pain, headache, malaise, lethargy, skin rash, constipation, and delirium. It occurs primarily in developing countries without appropriate systems for handling human waste.

Signs and Symptoms

A salmonella infection generally causes nausea, vomiting, abdominal cramps, diarrhea (sometimes bloody), fever, and headache. Because many different kinds of illnesses can cause these symptoms, most doctors will take a stool sample to make an accurate diagnosis.

Symptoms of most salmonella infections usually appear within 3 days of contamination and typically go away without medical treatment.

In cases of typhoid fever caused by salmonella bacteria, early symptoms are the same. But in the second week, the liver and spleen can become enlarged, and a distinctive "rose spotted" skin rash may appear. From there, the infection can cause other health problems, like meningitis and pneumonia.

People at risk for more serious complications from a salmonella infection include those who:

• have compromised immune systems (such as people with HIV)
• take cancer-fighting drugs
• have sickle cell disease or an absent or nonfunctioning spleen
• take chronic stomach acid suppression medication

In these higher-risk groups, most doctors will treat an infection with antibiotics to prevent it from spreading to other parts of the body and causing additional health problems.

Prevention

You have many ways to help prevent salmonella bacteria from making your family sick. Most salmonella bacteria appear in animal products and can be killed by the heat from cooking. So it's important to make sure that you don't serve raw or undercooked eggs, poultry, or meat. Microwaving is not a reliable way to kill the salmonella bacteria.

Because salmonella bacteria can contaminate even intact and disinfected grade A eggs, avoid serving poached eggs or eggs that are served sunny-side up.

Salmonella also can be spread through cross-contamination, so when you're preparing meals, keep uncooked meats away from cooked and ready-to-eat foods. In addition, thoroughly wash your hands, cutting boards, counters, and knives after handling uncooked foods.

Some foods may contain unrecognized raw-food products and should be avoided. Caesar salad dressing, the Italian dessert tiramisu, homemade ice cream, chocolate mousse, eggnog, cookie dough, and frostings can contain raw eggs. Unpasteurized milk and juices also can be contaminated with salmonella.

Fecal matter is often the source of salmonella contamination, so hand washing is extremely important, particularly after using the toilet and before preparing food.

Take care to avoid contact with the feces of family pets — especially reptiles. Wash your hands thoroughly after handling an animal and ensure that no reptiles are permitted to come into contact with an infant. Even healthy reptiles (especially turtles and iguanas) are not appropriate pets for small children and should not be in the same house as an infant.

Treatment

If your child has a salmonella infection and a healthy immune system, your doctor may let the infection pass without treatment. But any time your child develops a fever, headache, or bloody diarrhea, call the doctor to rule out any other problems.

If your child is infected and has a fever, you may want to give acetaminophen to reduce his or her temperature and relieve cramping. As with any infection that causes diarrhea, it's important to give your child plenty of liquids to avoid dehydration.

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Male Problems

Things That Can Go Wrong With the Male Reproductive System

Boys may sometimes experience reproductive system problems, including:

Disorders of the Scrotum, Testicles, or Epididymis
Conditions affecting the scrotal contents may involve the testicles, epididymis, or the scrotum itself.

• Testicular trauma. Even a mild injury to the testicles can cause severe pain, bruising, or swelling. Most testicular injuries occur when the testicles are struck, hit, kicked, or crushed, usually during sports or due to other trauma. Testicular torsion, when one of the testicles twists around, cutting off its blood supply, is also a problem that some teen males experience, although it's not common. Surgery is needed to untwist the cord and save the testicle.
• Varicocele. This is a varicose vein (an abnormally swollen vein) in the network of veins that run from the testicles. Varicoceles commonly develop while a boy is going through puberty. A varicocele is usually not harmful, although it can damage the testicle or decrease sperm production. Take your son to see his doctor if he is concerned about changes in his testicles.
• Testicular cancer. This is one of the most common cancers in men younger than 40. It occurs when cells in the testicle divide abnormally and form a tumor. Testicular cancer can spread to other parts of the body, but if it's detected early, the cure rate is excellent. Teen boys should be encouraged to learn to perform testicular self-examinations.
• Epididymitis is inflammation of the epididymis, the coiled tubes that connect the testes with the vas deferens. It is usually caused by an infection, such as the sexually transmitted disease chlamydia, and results in pain and swelling next to one of the testicles.
• Hydrocele. A hydrocele occurs when fluid collects in the membranes surrounding the testes. Hydroceles may cause swelling in the scrotum around the testicle but are generally painless. In some cases, surgery may be needed to correct the condition.
• Inguinal hernia. When a portion of the intestines pushes through an abnormal opening or weakening of the abdominal wall and into the groin or scrotum, it is known as an inguinal hernia. The hernia may look like a bulge or swelling in the groin area. It can be corrected with surgery.

Disorders of the Penis

Disorders affecting the penis include:

• Inflammation of the penis. Symptoms of penile inflammation include redness, itching, swelling, and pain. Balanitis occurs when the glans (the head of the penis) becomes inflamed. Posthitis is foreskin inflammation, which is usually due to a yeast or bacterial infection.
• Hypospadias. This is a disorder in which the urethra opens on the underside of the penis, not at the tip.
• Phimosis. This is a tightness of the foreskin of the penis and is common in newborns and young children. It usually resolves itself without treatment. If it interferes with urination, circumcision (removal of the foreskin) may be recommended.
• Paraphimosis. This may develop when a boy's uncircumcised penis is retracted but doesn't return to the unretracted position. As a result, blood flow to the head of the penis may be impaired, and your son may experience pain and swelling. A doctor may use lubricant to make a small incision so the foreskin can be pulled forward. If that doesn't work, circumcision may be recommended.
• Ambiguous genitalia. This occurs when a child is born with genitals that aren't clearly male or female. In most boys born with this disorder, the penis may be very small or nonexistent, but testicular tissue is present. In a small number of cases, the child may have both testicular and ovarian tissue.
• Micropenis. This is a disorder in which the penis, although normally formed, is well below the average size, as determined by standard measurements.

If your son has symptoms of a problem with his reproductive system or he has questions about growth and sexual development, talk with your doctor — many problems with the male reproductive system can be treated.

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Female Problems

Problems of the Female Reproductive System

Your daughter may sometimes experience reproductive system problems. Below are some examples of disorders that affect the female reproductive system.

Problems of the Vulva and Vagina

• Vulvovaginitis is an inflammation of the vulva and vagina. It may be caused by irritating substances (such as laundry soaps or bubble baths). Poor personal hygiene (such as wiping from back to front after a bowel movement) may also cause this problem. Symptoms include redness and itching in the vaginal and vulvar areas and sometimes vaginal discharge. Vulvovaginitis can also be caused by an overgrowth of Candida, a fungus normally present in the vagina.
• Nonmenstrual vaginal bleeding is most commonly due to the presence of a vaginal foreign body, often wadded-up toilet paper. It may also be due to urethral prolapse, a condition in which the mucous membranes of the urethra protrude into the vagina and form a tiny, doughnut-shaped mass of tissue that bleeds easily. It can also be due to a straddle injury (such as when falling onto a beam or bicycle frame) or vaginal trauma from sexual abuse.
• Labial adhesions, the sticking together or adherence of the labia in the midline, usually appear in infants and young girls. Although there are usually no symptoms associated with this condition, labial adhesions can lead to an increased risk of urinary tract infection. Sometimes topical estrogen cream is used to help separate the labia.

Problems of the Ovaries and Fallopian Tubes

• Ectopic pregnancy occurs when a fertilized egg, or zygote, doesn't travel into the uterus, but instead grows rapidly in the fallopian tube. A woman with this condition can develop severe abdominal pain and should see a doctor because surgery may be necessary.
• Endometriosis occurs when tissue normally found only in the uterus starts to grow outside the uterus — in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, painful periods, and general pelvic pain.
• Ovarian tumors, although they're rare, can occur. Girls with ovarian tumors may have abdominal pain and masses that can be felt in the abdomen. Surgery may be needed to remove the tumor.
• Ovarian cysts are noncancerous sacs filled with fluid or semisolid material. Although they are common and generally harmless, they can become a problem if they grow very large. Large cysts may push on surrounding organs, causing abdominal pain. In most cases, cysts will disappear on their own and treatment is unnecessary. If the cysts are painful, a doctor may prescribe birth control pills to alter their growth, or they may be removed by a surgeon.
• Polycystic ovary syndrome is a hormone disorder in which too many male hormones (androgens) are produced by the ovaries. This condition causes the ovaries to become enlarged and develop many fluid-filled sacs, or cysts. It often first appears during the teen years. Depending on the type and severity of the condition, it may be treated with drugs to regulate hormone balance and menstruation.
• Ovarian torsion, or the twisting of the ovary, can occur when an ovary becomes twisted because of a disease or a developmental abnormality. The torsion blocks blood from flowing through the blood vessels that supply and nourish the ovaries. The most common symptom is lower abdominal pain. Surgery is usually necessary to correct it.

Menstrual Problems

A variety of menstrual problems can affect girls, including:

• Dysmenorrhea is when a girl has painful periods.
• Menorrhagia is when a girl has a very heavy periods with excess bleeding.
• Oligomenorrhea is when a girl misses or has infrequent periods, even though she's been menstruating for a while and isn't pregnant.
• Amenorrhea is when a girl has not started her period by the time she is 16 years old or 3 years after starting puberty, has not developed signs of puberty by age 14, or has had normal periods but has stopped menstruating for some reason other than pregnancy.

Infections of the Female Reproductive System

• Sexually transmitted diseases (STDs). These include infections and diseases such as pelvic inflammatory disease (PID), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), human papillomavirus (HPV, or genital warts), syphilis, chlamydia, gonorrhea, and genital herpes. Most are spread from one person to another by sexual contact.
• Toxic shock syndrome. This uncommon illness is caused by toxins released into the body during a type of bacterial infection that is more likely to develop if a tampon is left in too long. It can produce high fever, diarrhea, vomiting, and shock.

If you think your daughter may have symptoms of a problem with her reproductive system or if you have questions about her growth and development, talk to your doctor — many problems with the female reproductive system can be treated.

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Lymphatic System Problems

Problems of the Lymphatic System

Certain diseases can affect the lymph nodes, the spleen, or the collections of lymphoid tissue in certain areas of the body.

• Lymphadenopathy. This is a condition where the lymph nodes become swollen or enlarged, usually because of a nearby infection. Swollen lymph glands in the neck, for example, can be caused by a throat infection. Once the infection is treated, the swelling usually goes away. If several lymph node groups throughout the body are swollen, that can indicate a more serious disease that needs further investigation by a doctor.
• Lymphadenitis. Also called adenitis, this inflammation of the lymph node is caused by an infection of the tissue in the node. The infection can cause the skin overlying the lymph node to swell, redden, and feel warm and tender to the touch. This infection usually affects the lymph nodes in the neck, and it's usually caused by a bacterial infection that can be easily treated with an antibiotic.
• Lymphomas. These cancers start in the lymph nodes when lymphocytes undergo changes and start to multiply out of control. The lymph nodes swell, and the cancer cells crowd out healthy cells and may cause tumors (solid growths) in other parts of the body.
• Splenomegaly (enlarged spleen). In someone who is healthy, the spleen is usually small enough that it can't be felt when you press on the abdomen. But certain diseases can cause the spleen to swell to several times its normal size. Most commonly, this is due to a viral infection, such as mononucleosis. But in some cases, more serious diseases such as cancer can cause the spleen to expand. Doctors usually tell someone with an enlarged spleen to avoid contact sports like football for a while, because a swollen spleen is vulnerable to rupturing (bursting). And if it ruptures, it can cause a huge amount of blood loss.
• Tonsillitis. Tonsillitis is caused by an infection of the tonsils, the lymphoid tissues in the back of the mouth at the top of the throat that normally help to filter out bacteria. When the tonsils are infected, they become swollen and inflamed, and can cause a sore throat, fever, and difficulty swallowing. The infection can also spread to the throat and surrounding areas, causing pain and inflammation. A child with repeated tonsil infections may need to have them removed in a procedure called a tonsillectomy.

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Skin, Hair, and Nails Problems

Things That Can Go Wrong With the Skin, Hair, and Nails

Some of the things that can affect the skin, nails, and hair are described below.

Dermatitis

The term dermatitis refers to any inflammation (swelling, itching, and redness) possibly associated with the skin. There are many types of dermatitis, including:

• Atopic dermatitis (eczema). It's a common, hereditary dermatitis that causes an itchy rash primarily on the face, trunk, arms, and legs. It commonly develops in infancy, but can also appear in early childhood. It may be associated with allergic diseases such as asthma and seasonal, environmental, and food allergies.
• Contact dermatitis. This occurs when the skin comes into contact with an irritating substance or one that the person is allergic or sensitive to. The best-known cause of contact dermatitis is poison ivy, but there are many others, including chemicals found in laundry detergent, cosmetics, and perfumes, and metals like nickel plating on jewelry, belt buckles, and the back of a snap.
• Seborrheic dermatitis. This oily rash, which appears on the scalp, face, chest, and back, is related to an overproduction of sebum from the sebaceous glands. This condition is common in infants and adolescents.

Bacterial Skin Infections

• Impetigo. Impetigo is a bacterial infection that results in a honey-colored, crusty rash, often on the face near the mouth and nose.
• Cellulitis. Cellulitis is an infection of the skin and subcutaneous tissue that typically occurs when bacteria are introduced through a puncture, bite, or other break in the skin. The area with cellulitis is usually warm, tender, and has some redness.
• Streptococcal and staphylococcal infections. These two kinds of bacteria are the main causes of cellulitis and impetigo. Certain types of these bacteria are also responsible for distinctive rashes on the skin, including the rashes associated with scarlet fever and toxic shock syndrome.

Fungal Infections of the Skin and Nails

• Candidal dermatitis. A warm, moist environment, such as that found in the folds of the skin in the diaper area of infants, is perfect for growth of the yeast Candida. Yeast infections of the skin in older children, teens, and adults are less common.
• Tinea infection (ringworm). Ringworm, which isn't a worm at all, is a fungus infection that can affect the skin, nails, or scalp. Tinea fungi can infect the skin and related tissues of the body. The medical name for ringworm of the scalp is tinea capitis; ringworm of the body is called tinea corporis; and ringworm of the nails is called tinea unguium. With tinea corporis, the fungi can cause scaly, ring-like lesions anywhere on the body.
• Tinea pedis (athlete's foot). This infection of the feet is caused by the same types of fungi that cause ringworm. Athlete's foot is commonly found in adolescents and is more likely to occur during warm weather.

Other Skin Problems

• Parasitic infestations. Parasites (usually tiny insects or worms) can feed on or burrow into the skin, often resulting in an itchy rash. Scabies and lice are examples of parasitic infestations. Both are contagious and can be easily caught from other people.
• Viral infections. Many viruses cause characteristic rashes on the skin, including varicella, the virus that causes chickenpox and shingles; herpes simplex, which causes cold sores; human papillomavirus, the virus that causes warts; and a host of others.
• Acne (acne vulgaris). Acne is most common in teens. Some degree of acne is seen in 85% of adolescents, and nearly all teens have the occasional pimple, blackhead, or whitehead.
• Skin cancer. Skin cancer is rare in children and teens, but good sun protection habits established during these years can help prevent skin cancers such as melanoma (a serious form of skin cancer that can spread to other parts of the body) later in life, especially among fair-skinned people who sunburn easily.

In addition to these diseases and conditions, the skin can be injured in a number of ways. Minor scrapes, cuts, and bruises heal quickly on their own, but other injuries — severe cuts and burns, for example — require medical treatment.

Disorders of the Scalp and Hair

• Tinea capitis, a type of ringworm, is a fungal infection that forms a scaly, ring-like lesion in the scalp. It's contagious and common among school-age children.
• Alopecia is an area of hair loss. Ringworm is a common cause of temporary alopecia in children. Alopecia can also be caused by tight braiding that pulls on the hair roots (called tension alopecia). Alopecia areata (when hair falls out in round or oval patches on the scalp) is a less common condition that can affect children and teens.

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Mouth and Teeth Problems

Problems of the Mouth and Teeth

Proper dental care — including a good diet, frequent cleaning of the teeth after eating, and regular dental checkups — is essential to maintaining healthy teeth and avoiding tooth decay and gum disease.

Common mouth and dental diseases and conditions — some of which can be prevented, some of which cannot — are :

Disorders of the Mouth

• Aphthous stomatitis (canker sores). A common form of mouth ulcer, canker sores occur in women more often than in men. Although their cause isn't completely understood, mouth injuries, stress, dietary deficiencies, hormonal changes (such as the menstrual cycle), or food allergies can trigger them. They usually appear on the inner surface of the cheeks, lips, tongue, soft palate, or the base of the gums, and begin with a tingling or burning sensation followed by a painful sore called an ulcer. Pain subsides in 7 to 10 days, with complete healing in 1 to 3 weeks.
• Cleft lip and cleft palate are birth defects in which the tissues of the mouth and/or lip don't form properly during fetal development. Children born with these disorders may have trouble feeding immediately after birth. Reconstructive surgery in infancy and sometimes later can repair the anatomical defects, and can prevent or lessen the severity of speech problems later on.
• Enteroviral stomatitis is a common childhood infection caused by a family of viruses called the enteroviruses. An important member of this family is coxsackievirus, which causes hand, foot, and mouth disease. Enteroviral stomatitis is marked by small, painful ulcers in the mouth that may decrease a child's desire to eat and drink and put him or her at risk for dehydration.
• Herpetic stomatitis (oral herpes). Children can get a mouth infection with the herpes simplex virus from an adult or another child who has it. The resulting painful, clustered vesicles, or blisters, can make it difficult to drink or eat, which can lead to dehydration, especially in a young child.
• Periodontal disease. The gums and bones supporting the teeth are subject to disease. A common periodontal disease is gingivitis — inflammation of the gums characterized by redness, swelling, and sometimes bleeding. The accumulation of tartar (a hardened film of food particles and bacteria that builds up on teeth) usually causes this condition, and it's almost always the result of inadequate brushing and flossing. When gingivitis isn't treated, it can lead to periodontitis, in which the gums loosen around the teeth and pockets of bacteria and pus form, sometimes damaging the supporting bone and causing tooth loss.

Disorders of the Teeth

• Cavities and tooth decay. When bacteria and food particles stick to saliva on the teeth, plaque forms. The bacteria digest the carbohydrates in the food and produce acid, which dissolves the tooth's enamel and causes a cavity. If the cavity isn't treated, the decay process progresses to involve the dentin. The most common ways to treat cavities and more serious tooth decay problems are: filling the cavity; performing root canal therapy, involving the removal of the pulp of a tooth; crowning a tooth with a cap that looks like a tooth made of metal, porcelain, or plastic; or removing or replacing the tooth. A common cause of tooth decay in toddlers is "milk bottle mouth," which occurs when a child goes to sleep with a milk or juice bottle in the mouth and the teeth are bathed in sugary liquid for an extended period of time. To avoid tooth decay and cavities, teach your kids good dental habits — including proper tooth-brushing techniques — at an early age.
• Impacted wisdom teeth. In many people, the wisdom teeth are unable to erupt normally so they either remain below the jawline or don't grow in properly. Dentists call these teeth impacted. Wisdom teeth usually become impacted because the jaw isn't large enough to accommodate all the teeth that are growing in and the mouth becomes overcrowded. Impacted teeth can damage other teeth or become painful and infected. Dentists can check if a person has impacted wisdom teeth by taking X-rays of the teeth. If the X-rays show there's a chance that impacted teeth may cause problems, the dentist will usually recommend that the tooth or teeth be extracted.
• Malocclusion is the failure of the teeth in the upper and lower jaws to meet properly. Types of malocclusion include overbite, underbite, and crowding. Most conditions can be corrected with braces, which are metal or clear ceramic brackets bonded to the front of each tooth. The wires connecting braces are tightened periodically to force the teeth to move into the correct position.

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Metabolism Problems

Metabolism Problems

In a broad sense, a metabolic disorder is any disease that is caused by an abnormal chemical reaction in the body's cells. Most disorders of metabolism involve either abnormal levels of enzymes or hormones or problems with the functioning of those enzymes or hormones. When the metabolism of body chemicals is blocked or defective, it can cause a buildup of toxic substances in the body or a deficiency of substances needed for normal body function, either of which can lead to serious symptoms.

Some metabolic diseases are inherited. These conditions are called inborn errors of metabolism. When babies are born, they're tested for many of these metabolic diseases in a newborn screening test. Many of these inborn errors of metabolism can lead to serious complications or even death if they're not controlled with diet or medication from an early age.

Examples of metabolic disorders and conditions include:

G6PD deficiency. Glucose-6-phosphate dehydrogenase, or G6PD, is just one of the many enzymes that play a role in cell metabolism. G6PD is produced by red blood cells and helps the body metabolize carbohydrates. Without enough normal G6PD to help red blood cells handle certain harmful substances, red blood cells can be damaged or destroyed, leading to a condition known as hemolytic anemia. In a process called hemolysis, red blood cells are destroyed prematurely, and the bone marrow (the soft, spongy part of the bone that produces new blood cells) may not be able to keep up with the body's need to produce more new red blood cells. Kids with G6PD deficiency may be pale and tired and have a rapid heartbeat and breathing. They may also have an enlarged spleen or jaundice — a yellowing of the skin and eyes. G6PD deficiency is usually treated by discontinuing medications or treating the illness or infection causing the stress on the red blood cells.

Galactosemia. Babies born with this inborn error of metabolism do not have enough of the enzyme that breaks down the sugar in milk called galactose. This enzyme is produced in the liver. If the liver doesn't produce enough of this enzyme, galactose builds up in the blood and can cause serious health problems. Symptoms usually occur within the first days of life and include vomiting, swollen liver, and jaundice. If galactosemia is not diagnosed and treated quickly, it can cause liver, eye, kidney, and brain damage.

Hyperthyroidism. Hyperthyroidism is caused by an overactive thyroid gland. The thyroid releases too much of the hormone thyroxine, which increases the person's basal metabolic rate (BMR). It causes symptoms such as weight loss, increased heart rate and blood pressure, protruding eyes, and a swelling in the neck from an enlarged thyroid (goiter). The disease may be controlled with medications or through surgery or radiation treatments.

Hypothyroidism. Hypothyroidism is caused by an absent or underactive thyroid gland and it results from a developmental problem or a destructive disease of the thyroid. The thyroid releases too little of the hormone thyroxine, so a person's basal metabolic rate (BMR) is low. In infants and young children who don't get treatment, this condition can result in stunted growth and mental retardation. Hypothyroidism slows body processes and causes fatigue, slow heart rate, excessive weight gain, and constipation. Kids and teens with this condition can be treated with oral thyroid hormone to achieve normal levels in the body.

Phenylketonuria. Also known as PKU, this condition occurs in infants due to a defect in the enzyme that breaks down the amino acid phenylalanine. This amino acid is necessary for normal growth in infants and children and for normal protein production. However, if too much of it builds up in the body, brain tissue is affected and mental retardation occurs. Early diagnosis and dietary restriction of the amino acid can prevent or lessen the severity of these complications.

Type 1 diabetes mellitus. Type 1 diabetes occurs when the pancreas doesn't produce and secrete enough insulin. Symptoms of this disease include excessive thirst and urination, hunger, and weight loss. Over the long term, the disease can cause kidney problems, pain due to nerve damage, blindness, and heart and blood vessel disease. Kids and teens with type 1 diabetes need to receive regular injections of insulin and control blood sugar levels to reduce the risk of developing problems from diabetes.

Type 2 diabetes. Type 2 diabetes happens when the body can't respond normally to insulin. The symptoms of this disorder are similar to those of type 1 diabetes. Many kids who develop type 2 diabetes are overweight, and this is thought to play a role in their decreased responsiveness to insulin. Some can be treated successfully with dietary changes, exercise, and oral medication, but insulin injections are necessary in other cases. Controlling blood sugar levels reduces the risk of developing the same kinds of long-term health problems that occur with type 1 diabetes.

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Lungs Problems

Problems of the Lungs and Respiratory System

The respiratory system is susceptible to a number of diseases, and the lungs are prone to a wide range of disorders caused by pollutants in the air.

The most common problems of the respiratory system are:

Asthma. More than 20 million people in the United States have asthma, and it's the #1 reason that kids chronically miss school. Asthma is a chronic inflammatory lung disease that causes airways to tighten and narrow. Often triggered by irritants in the air such as cigarette smoke, asthma flares involve contraction and swelling of the muscles lining the tiny airways. The resulting narrowing of the airways prevents air from flowing properly, causing wheezing and difficulty breathing, sometimes to the point of being life-threatening. Management of asthma starts with an asthma management plan, which usually involves avoiding asthma triggers and sometimes taking medications.

Bronchiolitis. Not to be confused with bronchitis, bronchiolitis is an inflammation of the bronchioles, the smallest branches of the bronchial tree. Bronchiolitis affects mostly infants and young children, and can cause wheezing and serious difficulty breathing. It's usually caused by specific viruses in the wintertime, including respiratory syncytial virus (RSV).

Chronic obstructive pulmonary disease (COPD). COPD is a term that describes two lung diseases — emphysema and chronic bronchitis:

• Long-term smoking often causes emphysema, and although it seldom affects children and teens, it's a condition that can have its roots in the teen and childhood years. Learning to talk to your kids about smoking is a key part of preventing smoking-related diseases. In emphysema, the lungs produce an excessive amount of mucus and the alveoli become damaged. It becomes difficult to breathe and get enough oxygen into the blood.
• In bronchitis, a common disease of adults and adolescents, the membranes lining the larger bronchial tubes become inflamed and an excessive amount of mucus is produced. The person develops a bad cough to get rid of the mucus. Cigarette smoking is a major cause of chronic bronchitis in teens.

Common cold. Caused by over 200 different viruses that cause inflammation in the upper respiratory tract, the common cold is the most common respiratory infection. Symptoms may include a mild fever, cough, headache, runny nose, sneezing, and sore throat.

Cough. A cough is a symptom of an illness, not an illness itself. There are many different types of cough and many different causes, ranging from not-so-serious to life-threatening. Some of the more common causes affecting kids are the common cold, asthma, sinusitis, seasonal allergies, croup, and pneumonia. Among the most serious causes of cough iare tuberculosis (TB) and whooping cough (pertussis).

Cystic fibrosis (CF). Affecting more than 30,000 children and young adults in the United States, cystic fibrosis is the most common inherited disease affecting the lungs. Affecting primarily the respiratory and digestive systems, CF causes mucus in the body to be abnormally thick and sticky. The mucus can clog the airways in the lungs and make a person more vulnerable to bacterial infections.

Lung cancer. Caused by an abnormal growth of cells in the lungs, lung cancer is a leading cause of death in the United States and is usually caused by smoking cigarettes. It starts in the lining of the bronchi and takes a long time to develop. Symptoms include a persistent cough that may bring up blood, chest pain, hoarseness, and shortness of breath. Radon gas exposure (radon is a gas that occurs in soil and rocks) may also be a cause of lung cancer. Radon is more likely to occur in certain parts of the United States. You can check your home's radon level by purchasing a radon kit at your local home supply or hardware store.

Pneumonia. This inflammation of the lungs usually occurs because of bacterial or viral infection. Pneumonia causes fever and inflammation of lung tissue, and makes breathing difficult because the lungs have to work harder to transfer oxygen into the bloodstream and remove carbon dioxide from the blood. Common causes of pneumonia are influenza and infection with the bacterium Streptococcus pneumoniae.

Pulmonary hypertension. This condition occurs when the blood pressure in the arteries of the lungs is abnormally high, which means the heart has to work harder to pump blood against the high pressure. Pulmonary hypertension may occur in children because of a heart defect present at birth or because of a health condition such as HIV infection.

Respiratory diseases of newborns. Several respiratory conditions can affect a newborn baby just starting to breathe for the first time.

Premature babies are at increased risk for conditions such as:

• Respiratory distress syndrome of the newborn. Babies born prematurely may not have enough surfactant in the lungs. Surfactant helps to keep the baby's alveoli open; without surfactant, the lungs collapse and the baby is unable to breathe.
• Apnea of prematurity (AOP). Apnea is a medical term that means someone has stopped breathing. Apnea of prematurity (AOP) is a condition in which premature infants stop breathing for 15 to 20 seconds during sleep. Apnea of prematurity generally occurs after 2 days of life and up to a week of life. The lower the infant's weight and level of prematurity at birth, the more likely the baby is to have AOP spells.
• Bronchopulmonary dysplasia (BPD). BDP involves abnormal development of lung tissue. Sometimes called chronic lung disease or CLD, it's a disease in infants characterized by inflammation and scarring in the lungs. It develops most often in premature babies who are born with underdeveloped lungs.

Other respiratory conditions in newborns include:

• Meconium aspiration. Meconium aspiration occurs when a newborn inhales (aspirates) a mixture of meconium (baby's first feces, ordinarily passed after birth) and amniotic fluid during labor and delivery. The inhaled meconium can cause a partial or complete blockage of the baby's airways.
• Persistent pulmonary hypertension of the newborn (PPHN). In the uterus, a baby's circulation bypasses the lungs. Normally, when a baby is born and begins to breathe air, his or her body quickly adapts and begins the process of respiration. PPHN occurs when a baby's body doesn't make the normal transition from fetal circulation to newborn circulation. This condition can cause symptoms such as rapid breathing, rapid heart rate, respiratory distress, and cyanosis (blue-tinged skin).
• Transient tachypnea of the newborn (TTN). Rapid breathing in a full-term newborn (more than 60 breaths a minute) is called transient tachypnea.

Although some respiratory diseases can't be prevented, many chronic lung and respiratory illnesses can be prevented by avoiding smoking, staying away from pollutants and irritants, washing hands often to avoid infection, and getting regular medical checkups.

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Urinary Tract Problems

Problems of the Kidneys and Urinary Tract

Like other systems in the body, the entire urinary tract is subject to diseases and disorders.

In kids, the more common problems include:

Congenital problems of the urinary tract. As a fetus develops in the womb, any part of the urinary tract can grow to an abnormal size or in an abnormal shape or position. One common congenital abnormality (an abnormality that exists at birth) is duplication of the ureters, in which a kidney has two ureters coming from it instead of one. This defect occurs in about 1 out of every 125 births and can cause the kidney to develop problems with repeated infections and scarring over time.

Another congenital problem is horseshoe kidney, where the two kidneys are fused (connected) into one arched kidney that usually functions normally, but is more prone to develop problems later in life. This condition is found in 1 out of every 500 births.

Glomerulonephritis is an inflammation of the glomeruli, the parts of the filtering units (nephrons) of the kidney that contain a network of capillaries (tiny blood vessels). The most common form is post-streptococcal glomerulonephritis, which usually occurs in young children following a case of strep throat. Most kids with this type of nephritis recover fully, but a few can have permanent kidney damage that eventually requires dialysis or a kidney transplant.

High blood pressure (hypertension) can result when the kidneys are impaired by disease. The kidneys control blood pressure by regulating the amount of salt in the body and by producing the enzyme renin that, along with other substances, controls the constriction of muscle cells in the walls of the blood vessels.

Kidney (renal) failure can be acute (sudden) or chronic (occurring over time and usually long lasting or permanent). In either form of kidney failure, the kidneys slow down or stop filtering blood effectively, causing waste products and toxic substances to build up in the blood.

Acute kidney failure may be due to many things, including a bacterial infection, injury, shock, heart failure, poisoning, or drug overdose. Treatment includes correcting the problem that led to the failure and sometimes requires surgery or dialysis. Dialysis involves using a machine or other artificial device to remove the excess salts and water and other wastes from the body when the kidneys are unable to perform this function.

Chronic kidney failure involves a deterioration of kidney function over time. In children, it can result from acute kidney failure that fails to improve, birth defects of the kidney, chronic kidney diseases, repeated kidney infections, or chronic severe high blood pressure. If diagnosed early, chronic kidney failure in children can be treated but usually not reversed. The child will usually require a kidney transplant at some point in the future.

Kidney stones (or nephrolithiasis) result from the buildup of crystallized salts and minerals such as calcium in the urinary tract. Stones (also called calculi) can also form after an infection. If kidney stones are large enough to block the kidney or ureter, they can cause severe abdominal pain. But the stones usually pass through the urinary tract on their own. In some cases, they may need to be removed surgically.

Nephritis is any inflammation of the kidney. It can be caused by infection, medications, an autoimmune disease (such as lupus), or it may be idiopathic (which means the exact cause may not be known or understood). Nephritis is generally detected by protein and blood in the urine.

Nephrotic syndrome is a type of kidney disease that leads to loss of protein in the urine and swelling of the face (often the eyes) or body (often around the genitals). It is most common in children younger than 6 years old and is more prevalent in boys. Nephrotic syndrome is often treated with steroids.

Urinary tract infections (UTIs) are usually caused by intestinal bacteria, such as E. coli, normally found in feces. These bacteria can cause infections anywhere in the urinary tract, including the kidneys. Most UTIs occur in the lower urinary tract, in the bladder and urethra. UTIs occur in both boys and girls. However, uncircumcised males are about 3 to 12 times more likely than circumcised males to develop a UTI before age 1. In school-age children, girls are more likely to develop UTIs than boys; this may be because girls have shorter urethras than boys.

Vesicoureteral reflux (VUR) is a condition in which urine abnormally flows backward (or refluxes) from the bladder into the ureters. It may even reach the kidneys, where infection and scarring can occur over time. VUR occurs in 1% of children and tends to run in families. It's often detected after a young child has a first urinary tract infection. Most kids outgrow mild forms of VUR, but some can develop permanent kidney damage and kidney failure later in life.

Wilms' tumor is the most common kidney cancer occurring in children. It is diagnosed most commonly between 2 and 5 years of age and affects males and females equally.

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Immune System Problems

Things That Can Go Wrong With the Immune System

Disorders of the immune system can be broken down into four main categories:

1. immunodeficiency disorders (primary or acquired)
2. autoimmune disorders (in which the body's own immune system attacks its own tissue as foreign matter)
3. allergic disorders (in which the immune system overreacts in response to an antigen)
4. cancers of the immune system

Immunodeficiency Disorders

Immunodeficiencies occur when a part of the immune system is not present or is not working properly. Sometimes a person is born with an immunodeficiency — these are called primary immunodeficiencies. (Although primary immunodeficiencies are conditions that a person is born with, symptoms of the disorder sometimes may not show up until later in life.) Immunodeficiencies can also be acquired through infection or produced by drugs. These are sometimes called secondary immunodeficiencies.

Immunodeficiencies can affect B lymphocytes, T lymphocytes, or phagocytes. Some examples of primary immunodeficiencies that can affect kids and teens are:

• IgA deficiency is the most common immunodeficiency disorder. IgA is an immunoglobulin that is found primarily in the saliva and other body fluids that help guard the entrances to the body. IgA deficiency is a disorder in which the body doesn't produce enough of the antibody IgA. People with IgA deficiency tend to have allergies or get more colds and other respiratory infections, but the condition is usually not severe.
• Severe combined immunodeficiency (SCID) is also known as the "bubble boy disease" after a Texas boy with SCID who lived in a germ-free plastic bubble. SCID is a serious immune system disorder that occurs because of a lack of both B and T lymphocytes, which makes it almost impossible to fight infections.
• DiGeorge syndrome (thymic dysplasia), a birth defect in which children are born without a thymus gland, is an example of a primary T-lymphocyte disease. The thymus gland is where T lymphocytes normally mature.
• Chediak-Higashi syndrome and chronic granulomatous disease both involve the inability of the neutrophils to function normally as phagocytes.

Acquired immunodeficiencies usually develop after a person has a disease, although they can also be the result of malnutrition, burns, or other medical problems. Certain medicines also can cause problems with the functioning of the immune system. Secondary immunodeficiencies include:

• HIV (human immunodeficiency virus) infection/AIDS (acquired immunodeficiency syndrome) is a disease that slowly and steadily destroys the immune system. It is caused by HIV, a virus which wipes out certain types of lymphocytes called T-helper cells. Without T-helper cells, the immune system is unable to defend the body against normally harmless organisms, which can cause life-threatening infections in people who have AIDS. Newborns can get HIV infection from their mothers while in the uterus, during the birth process, or during breastfeeding. People can get HIV infection by having unprotected sexual intercourse with an infected person or from sharing contaminated needles for drugs, steroids, or tattoos.
• Immunodeficiencies caused by medications. Some medicines suppress the immune system. One of the drawbacks of chemotherapy treatment for cancer, for example, is that it not only attacks cancer cells, but other fast-growing, healthy cells, including those found in the bone marrow and other parts of the immune system. In addition, people with autoimmune disorders or who have had organ transplants may need to take immunosuppressant medications. These medicines can also reduce the immune system's ability to fight infections and can cause secondary immunodeficiency.

Autoimmune Disorders

In autoimmune disorders, the immune system mistakenly attacks the body's healthy organs and tissues as though they were foreign invaders. Autoimmune diseases include:

• Lupus is a chronic disease marked by muscle and joint pain and inflammation. The abnormal immune response may also involve attacks on the kidneys and other organs.
• Juvenile rheumatoid arthritis is a disease in which the body's immune system acts as though certain body parts such as the joints of the knee, hand, and foot are foreign tissue and attacks them.
• Scleroderma is a chronic autoimmune disease that can lead to inflammation and damage of the skin, joints, and internal organs.
• Ankylosing spondylitis is a disease that involves inflammation of the spine and joints, causing stiffness and pain.
• Juvenile dermatomyositis is a disorder marked by inflammation and damage of the skin and muscles.

Allergic Disorders

Allergic disorders occur when the immune system overreacts to exposure to antigens in the environment. The substances that provoke such attacks are called allergens. The immune response can cause symptoms such as swelling, watery eyes, and sneezing, and even a life-threatening reaction called anaphylaxis. Taking medications called antihistamines can relieve most symptoms. Allergic disorders include:

• Asthma, a respiratory disorder that can cause breathing problems, frequently involves an allergic response by the lungs. If the lungs are oversensitive to certain allergens (like pollen, molds, animal dander, or dust mites), it can trigger breathing tubes in the lungs to become narrowed, leading to reduced airflow and making it hard for a person to breathe.
• Eczema is an itchy rash also known as atopic dermatitis. Although atopic dermatitis is not necessarily caused by an allergic reaction, it more often occurs in kids and teens who have allergies, hay fever, or asthma or who have a family history of these conditions.
• Allergies of several types can occur in kids and teens. Environmental allergies (to dust mites, for example), seasonal allergies (such as hay fever), drug allergies (reactions to specific medications or drugs), food allergies (such as to nuts), and allergies to toxins (bee stings, for example) are the common conditions people usually refer to as allergies.

Cancers of the Immune System

Cancer occurs when cells grow out of control. This can also happen with the cells of the immune system. Lymphoma involves the lymphoid tissues and is one of the more common childhood cancers. Leukemia, which involves abnormal overgrowth of leukocytes, is the most common childhood cancer. With current medications most cases of both types of cancer in kids and teens are curable.

Although immune system disorders usually can't be prevented, you can help your child's immune system stay stronger and fight illnesses by staying informed about your child's condition and working closely with your doctor.

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Heart and Circulatory System Problems

Problems of the Heart and Circulatory System

Problems with the cardiovascular system are common — more than 64 million Americans have some type of cardiac problem. But cardiovascular problems don't just affect older people — many heart and circulatory system problems affect children and teens, too.

Heart and circulatory problems are grouped into two categories: congenital, which means the problems were present at birth, and acquired, which means that the problems developed some time during infancy, childhood, adolescence, or adulthood.

Congenital heart defects. Congenital heart defects are abnormalities in the heart's structure that are present at birth. Approximately 8 out of every 1,000 newborns have congenital heart defects ranging from mild to severe. These defects occur while the fetus is developing in the mother's uterus and it's not usually known why they occur. Some congenital heart defects are caused by genetic disorders, but most are not. What all congenital heart defects have in common, however, is that they involve abnormal or incomplete development of the heart.

A common sign of a congenital heart defect is a heart murmur — an abnormal sound (like a blowing or whooshing sound) that's heard when listening to the heart. Usually a heart murmur is detected by a doctor who's listening to the heart with a stethoscope during a routine exam. Murmurs are very common in children and can be caused by congenital heart defects or other heart conditions.

Arrhythmia. Cardiac arrhythmias, also called dysrhythmias or rhythm disorders, are abnormalities in the heart's rhythm. They may be caused by a congenital heart defect or they may be acquired later. An arrhythmia may cause the heart's rhythm to be irregular, abnormally fast, or abnormally slow. Arrhythmias can occur at any age and may be discovered during a routine physical examination. Depending on the type of rhythm disorder, an arrhythmia may be treated with medication, surgery, or pacemakers.

Cardiomyopathy. Cardiomyopathy is a chronic disease that causes the heart muscle (the myocardium) to become weakened. Usually, the disease first affects the lower chambers of the heart, the ventricles, and then progresses and damages the muscle cells and even the tissues surrounding the heart. In its most severe forms, this condition may lead to heart failure and even death. Cardiomyopathy is the #1 reason for heart transplants in children.

Coronary artery disease. The most common heart disorder in adults, coronary artery disease is caused by atherosclerosis. Deposits of fat, calcium, and dead cells, called atherosclerotic plaques, form on the inner walls of the coronary arteries (the blood vessels that supply the heart) and interfere with the smooth flow of blood. Blood flow to the heart muscle may even stop if a thrombus, or clot, forms in a coronary vessel, which may cause a heart attack. In a heart attack (or myocardial infarction), the heart muscle becomes damaged by lack of oxygen, and unless blood flow returns within minutes, muscle damage increases and the heart's ability to pump blood is compromised. If the clot can be dissolved within a few hours, damage to the heart can be reduced. Heart attacks are rare in children and teens.

Hyperlipidemia/hypercholesterolemia (high cholesterol). Cholesterol is a waxy substance that's found in the body's cells, in the blood, and in some of the foods we eat. Having too much cholesterol in the blood, also known as hypercholesterolemia or hyperlipidemia, is a major risk factor for heart disease and can lead to a heart attack.

Cholesterol is carried in the bloodstream by lipoproteins. Two kinds — low-density lipoproteins (LDL) and high-density lipoproteins (HDL) — are the most important. High levels of LDL cholesterol (the bad cholesterol) increase a person's risk for heart disease and stroke, whereas high levels of HDL cholesterol (the good cholesterol) can protect against these.

A blood test can indicate if someone's cholesterol is too high. A child's cholesterol level is borderline if it's 170 to 199 mg/dL, and it's considered high if it's above 200 mg/dL.

About 10% of teens between 12 and 19 have high cholesterol levels that put them at increased risk of cardiovascular disease.

High blood pressure (hypertension). Over time, high blood pressure can cause damage to the heart and arteries and other body organs. The symptoms of hypertension can include headache, nosebleeds, dizziness, and lightheadedness. Infants, kids, and teens can have high blood pressure, which may be caused by genetic factors, excess body weight, diet, lack of exercise, and diseases such as heart disease or kidney disease.

Kawasaki disease. Kawasaki disease (also known as mucocutaneous lymph node syndrome) affects the mucous membranes (the lining of the mouth and breathing passages), the skin, and the lymph nodes (part of the immune system). It can also lead to vasculitis, an inflammation of the blood vessels. This can affect all major arteries in the body — including the coronary arteries. It can also cause inflammation of the heart muscle, called myocarditis. When coronary arteries become inflamed, a child can develop aneurysms, which are weakened and bulging spots on the walls of arteries. This increases the risk of a blood clot forming in this weakened area, which can block the artery, possibly leading to a heart attack. In addition to the coronary arteries, the heart muscle, lining, valves, or the outer membrane that surrounds the heart can become inflamed. Arrhythmias or abnormal functioning of some heart valves can occur. Kawasaki disease has surpassed rheumatic fever as the leading cause of acquired heart disease in children in the United States.

Rheumatic heart disease. Usually the complication of an untreated strep throat infection, rheumatic fever can lead to permanent heart damage and even death. Most common in children between 5 and 15 years of age, it begins when antibodies the body produces to fight the strep infection begin to attack other parts of the body. They react to tissues in the heart valves as though they were the strep bacteria and cause the heart valves to thicken and scar. Inflammation and weakening of the heart muscle may also occur. Usually, when strep throat infections are promptly treated with antibiotics, this condition can be avoided.

Stroke. Strokes occur when the blood supply to the brain is cut off or when a blood vessel in the brain bursts and spills blood into an area of the brain, causing damage to brain cells. Children or infants who have experienced stroke may be suddenly numb or weak, especially on one side of the body, and they may experience a sudden severe headache, nausea or vomiting, and difficulty seeing, speaking, walking, or moving. During childhood, strokes are rare.

Getting plenty of exercise, eating a nutritious diet, maintaining a healthy weight, and getting regular medical checkups are the best ways to help keep the heart healthy and avoid long-term problems like high blood pressure, high cholesterol, and heart disease.

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Vision Problems

Some of the most common eye problems are refractive errors. These are the problems that eye doctors check for routinely in a vision test. Refraction means bending of light rays to focus the light coming from an image. Refractive errors are problems with the focusing of the eye, because of the way the eye is shaped, which causes the image you see to be blurred.

Refractive errors include:

• Astigmatism. In astigmatism, there's a problem with the curve of the cornea. This causes part of the eye's image to be blurry. Corrective lenses such as contact lenses or glasses can usually correct vision in people with astigmatism.
• Nearsightedness. Also called myopia or shortsightedness, nearsightedness occurs when the eye focuses the image of an object in front of the retina instead of directly on it. In most cases, people can't see well far away, but can see objects clearly close up. The condition tends to get somewhat worse through childhood and adolescence, but stabilizes in adulthood. People with this condition may need to wear glasses or contacts to correct their vision. Laser eye surgery is now commonly used in adults to correct nearsightedness permanently by changing the shape of the cornea. Laser surgery is not used in kids and teens because the eye may still be growing and the refractive error changing.
• Farsightedness. Also called hyperopia or longsightedness, farsightedness occurs when the incoming image is not focused on the retina, but behind it. This makes it difficult to see close objects clearly, even though far-off objects can be seen clearly. Glasses or contact lenses can correct this problem in kids and teens. Most adults develop a form of farsightedness called presbyopia as they get older.

Some of the other eye problems that can affect children and teens include:

Blindness. This is the loss of useful sight. Blindness can be temporary or permanent and it has many causes. Birth defects or damage to any portion of the eye, the optic nerve, or the area of the brain responsible for vision can lead to blindness. The visual impairment cannot be corrected with surgery or corrective lenses, and the condition can make it difficult to perform everyday activities. Diabetes, problems with the macula, and eye changes because of aging account for most blindness in the United States.

Cataracts. Some children are born with cataracts, a cloudiness of the eye's lenses that prevent images from being seen clearly or at all. But cataracts are much more prevalent in the elderly among whom surgery to remove cataracts and correct vision is common. In infants and young children, cataracts must be treated to prevent permanent problems with development of vision.

Color blindness. Color blindness is caused by problems in the pigments of the cones in the retina. Most people who are color-blind can see some colors. In most cases, someone who is color-blind confuses some colors with others, usually red and green. People can be born color-blind or they may develop the condition over time. The most common form of color blindness is an inherited condition that affects boys much more often than girls. Color blindness cannot be corrected.

Conjunctivitis. Conjunctivitis refers to inflammation (redness, pain, and swelling) of the conjunctiva. One type of conjunctivitis is called pinkeye, a common contagious infection in which the eyes become pinkish red and watery, and pus may form. Pinkeye is usually treated with eyedrops. Conjunctivitis may also occur due to allergies or from a scratch on the surface of the eye.

Dacryostenosis. Dacryostenosis is a blockage of the tear drainage system of the eye occurring in the lower eyelid. This is a fairly common problem in infants, but often improves with time.

Eye injuries. Injuries to the eye are one of the most common preventable causes of blindness. Eye injuries may be caused by irritants such as sand, dirt, or other foreign bodies on the eye's surface. Chemicals or foreign bodies that become embedded in the eye can also cause pain and loss of vision. Forceful blows to the eye can cause bleeding inside the eye and damage to the cornea, retina, and other important eye structures.

Glaucoma. One of the leading causes of blindness in the United States, glaucoma is a disorder that causes fluid pressure to build up inside the eye, potentially causing damage to the optic nerve. Although it can occur in infants and children, it is much more common among older adults. Unless detected early by routine screening tests, it usually goes undiagnosed until some vision is lost.

Macular degeneration is an eye disease that mainly affects older people. But sometimes infants and children can develop it, too. When someone has macular degeneration, the middle area of the retina becomes scarred. This causes eyesight to deteriorate over many years. The cause of macular degeneration is unknown in most cases, but it tends to run in families, which indicates that genes and heredity are involved.

Retinoblastoma. This is a cancerous tumor in the eye that usually appears in the first 5 years of life. There may be permanent vision loss, and the affected eye(s) may have to be removed.

Retinopathy of prematurity. Premature babies sometimes have damage to the blood vessels in the eye's retina, a condition known as retinopathy of prematurity, which can lead to severe vision loss in some cases.

Strabismus. A condition in which the eyes appear crossed, strabismus is usually caused by a defect in the balance of the pull exerted by the muscles that help the eyes stay straight and move together properly. Surgery on the eye muscles can help realign the eyes. Permanent vision loss in the less-used eye (amblyopia) can occur if the condition is not treated in early childhood.

Sty. A sty is an infection of one of the follicles from which the eyelashes grow. Sties are treated by applying warm compresses and using antibiotics.

Proper care of your child's eyes includes having periodic eye exams at routine office checkups and by an eye specialist according to the schedule recommended by your doctor. Signs that a very young child may be having vision trouble include constant eye rubbing, tearing or redness, and trouble following an object. Older kids may squint or sit too close to the TV. Kids who are having trouble seeing might also complain of headaches at the end of the day.

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Endocrine System Problems

Problems With the Endocrine System

Too much or too little of any hormone can be harmful to the body. For example, if the pituitary gland produces too much growth hormone, a child may grow excessively tall. If it produces too little, a child may be abnormally short.

Controlling the production of or replacing specific hormones can treat many endocrine disorders in children and adolescents, some of which include:

Adrenal insufficiency. This condition is characterized by decreased function of the adrenal cortex and the consequent underproduction of adrenal corticosteroid hormones. The symptoms of adrenal insufficiency may include weakness, fatigue, abdominal pain, nausea, dehydration, and skin changes. Doctors treat adrenal insufficiency by giving replacement corticosteroid hormones.

Cushing syndrome. Excessive amounts of glucocorticoid hormones in the body can lead to Cushing syndrome. In children, it most often results when a child takes large doses of synthetic corticosteroid drugs (such as prednisone) to treat autoimmune diseases such as lupus. If the condition is due to a tumor in the pituitary gland that produces excessive amounts of corticotropin and stimulates the adrenals to overproduce corticosteroids, it's known as Cushing disease. Symptoms may take years to develop and include obesity, growth failure, muscle weakness, easy bruising of the skin, acne, high blood pressure, and psychological changes. Depending on the specific cause, doctors may treat this condition with surgery, radiation therapy, chemotherapy, or drugs that block the production of hormones.

Type 1 diabetes. When the pancreas fails to produce enough insulin, type 1 diabetes (previously known as juvenile diabetes) occurs. Symptoms include excessive thirst, hunger, urination, and weight loss. In children and teens, the condition is usually an autoimmune disorder in which specific immune system cells and antibodies produced by the immune system attack and destroy the cells of the pancreas that produce insulin. The disease can cause long-term complications including kidney problems, nerve damage, blindness, and early coronary heart disease and stroke. To control their blood sugar levels and reduce the risk of developing diabetes complications, kids with this condition need regular injections of insulin.

Type 2 diabetes. Unlike type 1 diabetes, in which the body can't produce normal amounts of insulin, in type 2 diabetes the body is unable to respond to insulin normally. Children and teens with the condition tend to be overweight, and it is believed that excess body fat plays a role in the insulin resistance that characterizes the disease. In fact, the rising prevalence of this type of diabetes in kids has paralleled the dramatically increasing rates of obesity among kids in recent years. The symptoms and possible complications of type 2 diabetes are basically the same as those of type 1. Some kids and teens can control their blood sugar level with dietary changes, exercise, and oral medications, but many will need to take insulin injections like patients with type 1 diabetes.

Growth hormone problems. Too much growth hormone in children who are still growing will make their bones and other body parts grow excessively, resulting in gigantism. This rare condition is usually caused by a pituitary tumor and can be treated by removing the tumor. In contrast, when the pituitary gland fails to produce adequate amounts of growth hormone, a child's growth in height is impaired. Hypoglycemia (low blood sugar) may also occur in kids with growth hormone deficiency, particularly in infants and young children with the condition.

Hyperthyroidism. Hyperthyroidism is a condition in which the levels of thyroid hormones in the blood are excessively high. Symptoms may include weight loss, nervousness, tremors, excessive sweating, increased heart rate and blood pressure, protruding eyes, and a swelling in the neck from an enlarged thyroid gland (goiter). In kids the condition is usually caused by Graves' disease, an autoimmune disorder in which specific antibodies produced by the immune system stimulate the thyroid gland to become overactive. The disease may be controlled with medications or by removal or destruction of the thyroid gland through surgery or radiation treatments.

Hypothyroidism. Hypothyroidism is a condition in which the levels of thyroid hormones in the blood are abnormally low. Thyroid hormone deficiency slows body processes and may lead to fatigue, a slow heart rate, dry skin, weight gain, constipation, and, in kids, slowing of growth and delayed puberty. Hashimoto's thyroiditis, which results from an autoimmune process that damages the thyroid and blocks thyroid hormone production, is the most common cause of hypothyroidism in kids. Infants can also be born with an absent or underdeveloped thyroid gland, resulting in hypothyroidism. It can be treated with oral thyroid hormone replacement.

Precocious puberty. Body changes associated with puberty may occur at an abnormally young age in some kids if the pituitary hormones that stimulate the gonads to produce sex hormones rise prematurely. An injectable medication is available that can suppress the secretion of these pituitary hormones (known as gonadotropins) and arrest the progression of sexual development in most of these children.

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Digestion Problems

Digestive System Problems

Nearly everyone has a digestive problem at one time or another. Some conditions, such as indigestion or mild diarrhea, are common; they result in mild discomfort and get better on their own or are easy to treat. Others, such as inflammatory bowel disease, can be long lasting or troublesome. A doctor who specializes in the digestive system is called a GI specialist or gastroenterologist.

Problems With the Esophagus

Problems affecting the esophagus may be congenital (present at birth) or noncongenital (developed after birth). Examples include:

• Congenital conditions. Tracheoesophageal fistula is a connection between the esophagus and the trachea (windpipe) where there shouldn't be one. In babies with esophageal atresia, the esophagus comes to a dead end instead of connecting to the stomach. Both conditions are usually detected soon after a baby is born — sometimes even before — and require surgery to repair.
• Noncongenital conditions. Esophagitis (inflammation of the esophagus) can be caused by infection, certain medications, or gastroesophageal reflux disease (GERD). With GERD, the esophageal sphincter (the valve that connects the esophagus with the stomach) doesn't work well and allows the acidic contents of the stomach to move backward up into the esophagus. GERD often can be corrected through lifestyle changes, such as dietary adjustments. Sometimes, though, it requires treatment with medication.

Problems With the Stomach and Intestines

Almost everyone has experienced diarrhea or constipation. With diarrhea, muscle contractions move the contents of the intestines along too quickly and there isn't enough time for water to be absorbed before the feces are pushed out of the body. Constipation is the opposite: The contents of the large intestines do not move along fast enough and waste materials stay in the large intestine so long that too much water is removed and the feces become hard.

Other common stomach and intestinal disorders include:

• Gastrointestinal infections can be caused by viruses, by bacteria (such as Salmonella, Shigella, Campylobacter, or E. coli), or by intestinal parasites (such as amebiasis and giardiasis). Abdominal pain or cramps, diarrhea, and sometimes vomiting are the common symptoms of gastrointestinal infections. These usually go away on their own without medicines or other treatment.
• Appendicitis, an inflammation of the appendix, most often affects kids and teens between 11 and 20 years old, and requires surgery to correct. The classic symptoms of appendicitis are abdominal pain, fever, loss of appetite, and vomiting.
• Gastritis and peptic ulcers arise when a bacterium, Helicobacter pylori, or the chronic use of drugs or certain medications weakens the protective mucous coating of the stomach and duodenum, allowing acid to get through to the sensitive lining beneath. This can irritate and inflame the lining of the stomach (gastritis) or cause peptic ulcers, which are sores or holes in the lining of the stomach or the duodenum that cause pain or bleeding. Medications usually successfully treat these conditions.
• Inflammatory bowel disease (IBD) is chronic inflammation of the intestines that affects older kids, teens, and adults. There are two major types: ulcerative colitis, which usually affects just the rectum and the large intestine; and Crohn's disease, which can affect the whole gastrointestinal tract from the mouth to the anus as well as other parts of the body. They are treated with medications and, if necessary, intravenous (IV) feedings to provide nutrition. In some cases, surgery may be necessary to remove inflamed or damaged areas of the intestine.
• Celiac disease is a disorder in which the digestive system is damaged by the response of the immune system to a protein called gluten, which is found in wheat, rye, and barley and a wide range of foods, from breakfast cereal to pizza crust. People with celiac disease have difficulty digesting the nutrients from their food and may experience diarrhea, abdominal pain, bloating, exhaustion, and depression when they eat foods with gluten. Symptoms can be managed by following a gluten-free diet. Celiac disease runs in families and can become active after some sort of stress, such as surgery or a viral infection. A doctor can diagnose celiac disease with a blood test and by taking a biopsy of the small intestine.
• Irritable bowel syndrome (IBS), a common intestinal disorder, affects the colon and may cause recurrent abdominal cramps, bloating, constipation, and diarrhea. There is no cure, but IBS symptoms may be treated by changing eating habits, reducing stress, and making lifestyle changes. A doctor may also prescribe medications to relieve diarrhea or constipation. No one test is used to diagnose IBS, but a doctor may identify it based on symptoms, medical history, and a physical exam.

Problems With the Pancreas, Liver, and Gallbladder

Conditions affecting the pancreas, liver, and gallbladder often affect the ability of these organs to produce enzymes and other substances that aid in digestion. Examples include:

• Cystic fibrosis is a chronic, inherited illness where the production of abnormally thick mucus blocks the ducts or passageways in the pancreas and prevents its digestive juices from entering the intestines, making it difficult to properly digest proteins and fats. This causes important nutrients to pass out of the body unused. To help manage their digestive problems, people with cystic fibrosis can take digestive enzymes and nutritional supplements.
• Hepatitis, a condition with many different causes, is when the liver becomes inflamed and may lose its ability to function. Viral hepatitis, such as hepatitis A, B, or C, is highly contagious. Mild cases of hepatitis A can be treated at home; however, serious cases involving liver damage may require hospitalization.
• The gallbladder can develop gallstones and become inflamed — a condition called cholecystitis. Although gallbladder conditions are uncommon in kids and teens, they can occur in those who have sickle cell anemia or are being treated with certain long-term medications.

Keeping Digestion on Track

The kinds and amounts of food a person eats and how the digestive system processes that food play key roles in maintaining good health. Eating a healthy diet is the best way to prevent common digestive problems.

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