Tracheo-Oesophageal Fistula (TOF) and Oesophageal Atresia (OA) are rare congenital conditions of the oesophagus (food pipe) and/or trachea (airway) that affect one in every 3,500 babies. But is becoming more common these days according to recent research.  Babies born with TOF or TEF need to have intensive neo-natal care prior to corrective surgery, normally within days of birth.
Some children have to undergo additional surgical interventions later on in their lives. Whilst many children born with TOF or TEF will experience only a few problems, others may have difficulties with swallowing and digesting food, Gastro-Oesophageal Reflux (where the acidic stomach contents pass back into the lower oesophagus) and respiratory problems. The effects of surgery and associated health problems can add a great deal to the usual challenges of parenthood. All this above is explained in detail on this website.

Currently, nobody knows what causes TOF-OA or EA-TEF. For the new parent of a TOF or TEF child, this is very important to understand –

it was not your fault, you couldn’t have done anything to prevent it, as your read with-in this website.

With the benefits of modern medical intervention and the active support of groups, the outlook for children with TOF-OA & EA-TEF is very positive.

OA or EA

In Oesophageal Atresia (OA) (UK) way of wording, EA is the way of other countries, the baby is born with a pouch at the top of its oesophagus (food pipe) which prevents food from reaching the stomach. Prior to surgery, this pouch can fill up with food and saliva, which can eventually overflow into the baby’s trachea (windpipe), entering the lungs and causing choking.

TOF or TEF

In Tracheo-Oesophageal Fistula (TOF), the bottom end of the baby’s oesophagus is joined to its trachea (windpipe). Without surgical intervention, this causes air to pass from the windpipe to the food pipe and stomach. It can also allow stomach acid to pass into the lungs. Again on this website, you can view x-ray photos and even 3D video to help you understand better.

      

 Photos can be found on the web

Barium Swallow Finds Oesophageal Atresia

zenkers

Barium Meal (Yuck Yuck Yuck) swallowed finds narrowing

doublearchlat

 Barium Meal Flowing into the lungs

figure_TJP_524_0

Tracheo-esophageal Fistula in a Newborn, seen by swallowing a Barium Meal

www.youtube.com/watch?v=0npXA5IAdmg?rel=0

Before the BirthPolyhydramnios (too much amniotic fluid) Website to try and help MUM’s to BE

 www.nhs.uk/conditions/polyhydramnios/Pages/polyhydramnios.aspxwww.uhs.nhs.uk/OurServices/Childhealth/Neonatalsurgery/Conditionswetreat/OesophagealAtresiaandTracheo-oesophagealFistula%28TOF%29.aspx

mum with   high water

What is polyhydramnios?

Polyhydramnios means you have too much amniotic fluid in your womb (uterus). It happens in fewer than one in 500 pregnancies in the UK, so it isn’t common. Most cases of polyhydramnios are mild or moderate.
The amniotic fluid surrounding your baby protects him from being hurt if you have a  blow your tummy or if your tummy is squashed. The fluid also protects your baby against infection, as well as helping his lungs to develop. The amount of fluid around your baby gradually increases until there is about one litre (1.8 pints) surrounding him at 37 weeks. This amount usually decreases to around half a litre (0.9 pints) by 40 weeks Your baby will regularly swallow amniotic fluid, which then passes out of his body as urine. This is how he controls the volume of amniotic fluid around him.When this delicate balance is disturbed, the volume of amniotic fluid can increase rapidly. Polyhydramnios is usually diagnosed when the amniotic fluid volume reaches two litres (3.5 pints) or more. In severe cases of polyhydramnios, there may be as much as three litres (5.3 pints) of fluid, or three times the normal amount, around your baby.

How can I tell if I have polyhydramnios?

It can sometimes be hard for you to tell since your body is continually changing throughout pregnancy. However, you may notice that your tummy is getting unusually large and feeling more taut than usual and that your skin is stretched and shiny. You may feel uncomfortable and breathless and find it hard to climb a flight of stairs.
Polyhydramnios tends to build up gradually, so is often picked up from about 30 weeks of pregnancy when the levels of fluid have got noticeably higher. However, in rare cases, it can come on very rapidly over the course of just a few days so may be picked up earlier in pregnancy or during the mid-pregnancy scan  Rapid, acute polyhydramnios is more common if you’re having twins or more

www.babycentre.co.uk/a551936/polyhydramnios#ixzz3gzBmNoiO

 Imaging of Congenital Anomalies of the Gastrointestinal Tract

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.  (To give you just an idea as to how things work)The radiological imaging plays a vital role in the evaluation of patients with congenital anomalies of the gastrointestinal tract. The evaluation of these patients, most of which present early after birth, frequently requires the use of various imaging modalities for making the correct diagnosis and planning surgical correction. This article reviews the common congenital anomalies of the gastrointestinal tract including obstructive lesions, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. The plain radiograph is often diagnostic in neonates with complete gastric of upper intestinal obstruction and further radiologic evaluation may be unnecessary. An upper gastrointestinal series should be performed in all patients with incomplete intestinal obstruction. Sonography is useful in the evaluation of many congenital anomalies affecting paediatric gastrointestinal tract especially hypertrophic pyloric stenosis, enteric duplication cysts, midgut malrotation, meconium ileus and meconium peritonitis. Moreover, CT and MRI has assumed a greater importance as these provide excellent anatomic details which may be necessary for correct diagnosis as well as treatment planning. This is particularly true for evaluation of congenital anomalies such as oesophagal/enteric duplications, vascular rings and anorectal anomalies. It is important to be familiar with the role nad usefulness of the various imaging modalities so that these can be used judiciously to avoid unnecessary radiation exposure while minimising the patient discomfort.A wide spectrum of congenital anomalies may affect the gastrointestinal tract, some of which manifest early after birth while others may not present till late childhood or adulthood. Imaging plays a very useful role in these developmental lesions, most of which present with obstruction. In most cases, plain radiography, gastrointestinal contrast study or Ultrasound (US) suffice. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) are increasingly proving more useful to provide an accurate diagnosis, especially in difficult cases. Developmental lesions of the neonatal gastrointestinal tract can be grouped as follows:1 Structural Attributed to embryologic maldevelopment Oesophagal atresia with or without fistula.

medind.nic.in/icb/t05/i5/icbt05i5p403.pdf

water poli-01 Polyhydramnios-Ultrasound-Picture

AFTER BIRTH How do I know if I have a swallowing problem?

Normally, individuals rarely choke during a meal. Occasionally, food will stick in the oesophagus for a few seconds (especially solid foods) but will pass spontaneously or can be washed down easily with liquids. However, there are a number of symptoms that require evaluation for a possible swallowing problem, including:

  • Frequent choking on food.
  • Hesitancy in food passage for more than a few seconds.
  • Pain when swallowing.
  • Recurring pneumonia (an indication that food may be going into the lungs rather than the oesophagus).

Urgent evaluation by a doctor is required when food becomes lodged in the oesophagus for more than 15 minutes and will not pass spontaneously or with liquids.Some people are unaware that they have swallowing problems because they compensate unconsciously by choosing foods that are easier to eat, or they eat more slowly. They are at risk of choking or having large pieces of solid food lodge in the oesophagus if they let down their guard.

How are swallowing problems diagnosed?

If you feel you have a swallowing problem, your doctor will decide which phase of swallowing needs to be tested. She will order the appropriate tests after asking questions to determine the details of your swallowing symptoms and previous medical problems, as well as performing an appropriate physical examination. Three tests are most commonly used to evaluate a swallowing problem:

  • Barium swallow and follow through. The patient swallows a barium preparation (liquid or other forms that show up under X-ray) and an X-ray machine with video recording capability is used to view its movement through the oesophagus. This is often performed under the guidance of a speech and language therapist, an expert in swallowing as well as speech.
  • Upper endoscopy A flexible, narrow tube (endoscope) is passed into the oesophagus and projects images of the inside of the pharynx and oesophagus on a screen for evaluation.
  • Manometry This test measures the timing and strength of oesophageal contractions and muscular valve relaxation.

Among other tests that may be necessary, according to the specific needs of the individual, are an impedance test and a pH probe test (for acid reflux) this is talked about on a different page of this site

How are swallowing problems treated?

The form of treatment for your swallowing problem will depend on the type of problem a person has. Sometimes, the problem will resolve itself without treatment. On other occasions, the condition can be managed easily, such as by using a special tool called an oesophagal dilator to stretch an oesophagus narrowed from acid reflux. However, the problem may be complex, requiring a specialist or the coordination of several specialists.If you have a chewing or swallowing problem there are several things you can do to make eating and drinking easier and safer, including:

Positioning

  • Sit upright at a 90-degree angle.
  • Tilt your head slightly forward.
  • Remain sitting upright or standing for 15 to 20 minutes after eating a meal.

Dining environment

  • Minimise distractions in the area where you eat.
  • Stay focused on the tasks of eating and drinking.
  • Do not talk with food in your mouth

Amount and rate

  • Eat slowly.
  • Cut your food into small pieces and chew it thoroughly.
  • Do not try to eat more than 1/2 teaspoon of your food at a time.

Swallowing

  • You may need to swallow two or three times per bite or sip.
  • If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before taking a breath. Repeat if necessary.
  • Concentrate on swallowing frequently.

Saliva management

  • Drink plenty of fluids.
  • Periodically suck on lollies, ice cubes or lemon ice, or drink lemon-flavoured water to increase saliva production, which will increase swallowing frequency.

Food consistency

  • Minimise or eliminate foods that require chewing and eat more soft foods.
  • Purée your food in a blender.
  • If thin liquids cause you to cough, thicken them with a liquid thickener (your speech and language therapist can recommend one for you). You can also substitute thicker liquids for thin ones, such as syrup for juice and cream soup for plain broth.

Taking medications

  • Ask your pharmacist for his or her recommendations on which tablets can and should not be crushed and which medications can be prescribed in a liquid form.

 

Balloon Endoscopy with the CRE™ Balloon Dilator

This animation and short video clip shows how balloon endoscopy with the CRE™ Balloon is used to dilate strictures of the GI tract.

www.youtube.com/watch?t=16&v=ZK24oR1qhsI?rel=0

 

HOW A LONG GAP IS REPAIRED

 Long-Segment Colonic Interposition for Esophageal Atresia: 3D Animation (How long gap is mended on a Baby but in a 3D film) Very interesting.  

www.youtube.com/watch?v=8_0mT4BW3Wc?rel=0

Esophageal Dilation due to a narrowing of the esophagus 

What is Oesophagal Dilation?
Oesophagal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your oesophagus [swallowing tube]. Doctors can use various techniques for this procedure. Your doctor might perform the procedure as part of a sedated endoscopy

www.youtube.com/watch?v=UPlMtKpld78?rel=0

Dilation of an Esophageal-Jejunal Anastomotic Stricture (To give you an insight as to what happens)

 Published on Feb 13, 2014

Dilation of an Esophageal-Jejunal Anastomotic Stricture with the CRE™ Wireguided 12/15 mm Balloon, featuring Dr Vanbiervliet

www.youtube.com/watch?v=w9yO4hJhOjY?rel=0

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Specialist Milks

click on the next button to move the page over

The common feeding issues that babies encounter include colic, reflux and regurgitation. The Department of Health recommends exclusive breastfeeding for the first six months.

If breastfeeding is not possible, a range of specialist kinds of milk is available to help alleviate the distress caused to babies who experience these feeding issues. Pharmacists have an important role to play in explaining what may cause different feeding issues and how they can be resolved.

Colic is one of the most common gastrointestinal complaints in babies and can affect up to one in five infants1. It can start within weeks of birth and may continue up to four-six months of age.

Virtually all infants will experience some symptoms of gastroesophageal reflux (GOR) but it is normally nothing to worry about. GOR is the effortless passage of gastric contents into the oesophagus with or without regurgitation or vomiting. Symptoms peak at 3 months of age 9 and usually resolve between 12 and 14 months of age.

Allergies and intolerances

Lactose intolerance

http://www.pharmacymagazine.co.uk/specialist-milks

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TEF = TOF more info

3D medical animation

This 3D medical animation shows a tracheoesophageal fistula in which the oesophagus has an abnormal connection to the trachea. The animation explains the normal development of the oesophagus and trachea, as well as how a tracheoesophageal fistula and esophageal atresia form. The effects of the fistula on the lungs are shown. Key steps of the operation to repair a tracheoesophageal fistula are depicted.

https://www.youtube.com/watch?v=gn0p-rnWeIg?rel=0

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TEF = TOF

Tracheoesophageal Fistula and Esophageal Atresia What is tracheoesophageal fistula?

Tracheoesophageal fistula is an abnormal connection in one or more places between the esophagus (the tube that leads from the throat to the stomach) and the trachea (the tube that leads from the throat to the windpipe and lungs). Normally, the esophagus and the trachea are two separate tubes that are not connected.Tracheoesophageal fistula is also known as TE fistula or simply TEF.TE fistula is a birth defect, which is an abnormality that occurs as a fetus is forming in its mother’s uterus.When a baby with a TE fistula swallows, the liquid can pass through the abnormal connection between the esophagus and the trachea. When this happens, liquid gets into the baby’s lungs. This can cause pneumonia and other problems.

What is esophageal atresia? 

TEF = TOF

fistula often occurs with another birth defect known as esophageal atresia. The esophagus is a tube that leads from the throat to the stomach. With esophageal atresia, the esophagus does not form properly while the fetus is developing before birth, resulting in two segments; one part that connects to the throat, and the other part that connects to the stomach. However, the two segments do not connect to each other.Since the esophagus is in two segments, liquid that a baby swallows cannot pass normally through the esophagus and reach the stomach. Milk and other fluids cannot be digested if the esophagus does not connect to the stomach.If a TE fistula is also present, liquid that a baby swallows can pass through the connection between the esophagus and the trachea and go into the lungs. This can cause pneumonia and other problems.

What causes tracheoesophageal fistula and esophageal atresia?  

TEF = TOF

As a fetus is growing and developing in its mother’s uterus before birth, different organ systems are developing and maturing. The trachea and the esophagus begin developing as one single tube. At about four to eight weeks after conception, a wall forms between the fetus’ esophagus and trachea to separate them into two distinct tubes. If this wall does not form properly, TE fistula and/or esophageal atresia can occur.

Which babies develop tracheoesophageal fistula or esophageal atresia?

TEF = TOF

These two problems are not thought to be inherited. However, they are often seen when a baby has other birth defects, such as:

  • Other digestive tract problems (such as diaphragmatic hernia, duodenal atresia, or imperforate anus)
  • Heart problems (such as ventricular septal defect, tetralogy of Fallot, or patent ductus arteriosus)
  • Kidney and urinary tract problems (such as horseshoe or polycystic kidney, absent kidney, or hypospadias)
  • Muscular or skeletal problems
  • VACTERL syndrome (which involves Vertebral, Anal, Cardiac, TE fistula, Renal, and Limb abnormalities)

Up to one-half of all babies with TE fistula or esophageal atresia have another birth defect.

What are the symptoms of TE fistula or esophageal atresia?  

TEF = TOF

The symptoms of TE fistula or esophageal atresia are usually noted very soon after birth. The following are the most common symptoms of TE fistula or esophageal atresia. However, each child may experience symptoms differently. Symptoms may include the following:

  • Frothy, white bubbles in the mouth
  • Coughing or choking when feeding
  • Vomiting
  • Blue color of the skin, especially when the baby is feeding
  • Difficulty breathing
  • Very round, full abdomen

Other congenital malformations might be present, such as the ones mentioned in the previous section.

Symptoms of TE fistula or esophageal atresia may resemble other conditions or medical problems. Please consult your child’s doctor for a diagnosis.

What tests are usually done to diagnose the problem?

Along with a physical examination and medical history, imaging studies are usually done to evaluate whether a baby has TE fistula and/or esophageal atresia. X-rays are taken to look at the chest and abdomen.

A small tube may also be placed into the mouth or nose and then guided into the esophagus. With esophageal atresia, the tube usually cannot be inserted very far into the esophagus. The tube’s position in the esophagus can also be seen with the X-ray.

impacked food

Stricture with food bolus. Frontal view from a barium swallow examination in a patient with a repaired EA shows a stricture at the anastomotic site, with a bolus of food proximal to the stricture.

What is the treatment for TE fistula or esophageal atresia?

If your baby has TE fistula or esophageal atresia, he or she will need surgery to fix the problem. The type of surgery depends on the following:

  • Type of abnormality
  • Overall health of the baby and medical history
  • Opinion of the surgeon and other health care providers involved in the baby’s care
  • Expectations for the course of the condition
  • Your opinion and preference

When TE fistula is repaired, the connection between the esophagus and the trachea is closed in surgery. Repair of esophageal atresia depends on how close the two sections of esophagus are to each other. Sometimes esophageal atresia requires more than one surgery. Your baby’s surgeon and other health care providers will decide when it is best to do the operations based on your baby’s condition and the type of problem.

Could my child have problems in the future?

Some children born with esophageal atresia have long-term problems.

Swallowing food or liquids may be difficult due to:

  • Problems with the normal movement of foods and liquids down the esophagus (peristalsis).
  • Scarring that can occur in the esophagus after surgery as the wounds heal, which can partially block the passage of foods.

Sometimes, a narrowed esophagus can be widened or dilated with a special procedure done while the child is under general anesthesia. In other cases, another operation may be necessary to open up the esophagus so food can pass to the stomach properly.

About one-half of children who had esophageal atresia repaired will have problems with GERD, or gastrointestinal reflux disease. GERD causes acid to move up into the esophagus from the stomach. When acid moves from the stomach into the esophagus, it causes a burning or painful feeling known as heartburn. GERD can usually be treated with medications prescribed by a doctor.

www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02018

Newborn

Nasogastric tube (NG tube) and Gastronomy Tubes

www.birth-defect.org/reflux/

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Tracheoesophageal Fistula and Esophageal Atresia in the Newborn EA = OA

 The esophagus (food pipe) and trachea (windpipe) are 2 separate tubes. The esophagus runs behind the trachea inside the chest. Both of these tubes start at the throat. The food you eat travels down the esophagus into the stomach. The air you breathe travels down the trachea into the lungs. In some babies, these tubes don’t form correctly during pregnancy.This can lead to the problems described below. Your baby might these problems.

 TOF/OA = EA=TEF

Photo 1

Tracheoesophageal Fistula and Esophageal Atresia in the Newborn

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Photo 2

In normal anatomy, the trachea connects to the lungs. The esophagus connects to the stomach.

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Photo 3

With esophageal atresia, the esophagus doesn’t attach to the stomach. Food can’t reach the stomach.

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Photo 4

With tracheoesophageal fistula, the trachea and esophagus are connected. Air can go into the stomach, and food can go into the lungs.

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Photo 5

With this combination of fistula and atresia, air goes into the stomach and the lungs. Food can’t reach the stomach.

85108

 

What Is Tracheoesophageal Fistula?

A tracheoesophageal fistula (TEF) = TOF is an abnormal opening between the trachea and the esophagus. During pregnancy, the baby’s trachea and esophagus start out as one tube. During the first trimester, they are supposed to separate into 2 tubes. If the wall of tissue between the trachea and esophagus doesn’t form fully, an opening between the 2 tubes remains. This is a fistula. When the baby eats, food can pass from the esophagus through the fistula into the trachea. This can cause breathing problems. Symptoms of TEF = TOF  include coughing and difficulty breathing that worsens when feeding.

 

Esophageal atresia is an abnormality, or birth defect, of the esophagus that occurs early in pregnancy, as the baby is developing. The esophagus forms in the first few months of fetal life as a long, hollow, continuous tube joining the mouth to the stomach. In newborns with this birth defect, formation of this continuous esophageal tube is interrupted.

www.pedsurg.ucsf.edu/conditions–procedures/esophageal-atresia.aspx

 

What Is Esophageal Atresia?

Esophageal atresia (EA) = OA occurs when the esophagus doesn’t attach to the stomach; therefore, food can’t get from the esophagus into the stomach. The main symptoms of EA include vomiting and drooling.

How Are the Problems Diagnosed?

If your baby has problems eating or breathing, chokes during feeding, or coughs up a lot of fluid or mucus, he or she may have TEF or EA. = TOF or OA Your health care provider will take an X-ray to learn more. This will show if the baby has one or both problems. The X-ray is often done with a feeding tube put into the baby’s esophagus to see if the tube reaches the stomach.

How Are the Problems Treated?

Both of these problems require surgery. Your baby will receive nourishment through an IV (intravenous) line until surgery can be done. A breathing machine may also be needed:

  • To treat TEF = TOF the opening between the trachea and esophagus is closed during surgery.
  • To treat EA = OA  the esophagus is connected to the stomach. In some cases, a tube with a weighted tip is put into the esophagus. This helps stretch the tissues to reach the stomach. It make take a few weeks before the esophagus is long enough to reach the stomach. The baby will stay in the neonatal intensive care unit during this time. When the esophagus is long enough, surgery is done to attach it to the stomach.

What Are the Long-Term Effects?

  • EA = OA Treatment of TEF = TOF often has a good outcome. Once the fistula is closed, many babies don’t have problems. But in some cases, ongoing breathing problems can occur.can cause more serious problems. If the oesophagus must be stretched, your baby may have permanent swallowing problems. Many babies develop GERD (gastroesophageal reflux disease). Also, your baby will have been fed through an IV until after treatment. As a result, your baby may have trouble moving on to breast or bottle feeding’s. For instance, your baby may have trouble learning how to suckle and breathe at the same time. The doctor can tell you more about how your baby is likely to progress.

AFTER READING THE ABOVE PLEASE WATCH THIS SMALL VIDEO THEN YOUR UNDERSTAND NEVER GIVE UP HOPE

www.youtube.com/watch?v=D_RJqD9Ewxc#t=97

Bronchitis and Pneumonia EXPLAINED HERE along with a lot more other bits

www.birth-defect.org/adult-info/

Carbonated soft drinks

Researchers have found published data for a strong biological basis to explain the increased duration of oesophageal exposure to acid as the consumption of carbonated soft drinks increases. These carbonated soft drinks are related to gastric distension, which can trigger reflux.

Studies show the consumption of one can of soda a day corresponds to 53.5 minutes of elevated acid levels in the stomach. When this is figured on an annual basis, that’s about 53 gallons of soda per year, with 32,100 more minutes of elevated acid reflux per year, and the oesophagus’ exposure to it.

Drinking a carbonated soda seems harmless enough, so why the worry about the risk of oesophageal cancer?There is a biological link between soft drink consumption and increased gastric pressure, which can result in increased reflux. And recurring acid reflux is the most important risk factor for oesophageal adenocarcinoma.”If you drink a quarter of a litre of water, your stomach distends by a quarter of a litre, but if it’s a carbonated drink, your stomach may distend to maybe half a litre. This causes reflux – the acid of the stomach is thrown back into the food pipe.

“DONT PANIC’  just something I came across while looking for something different.

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Oesophageal Balloon Dilatation

PDF File

PDF means a down loadable fact sheet

https://www.wwl.nhs.uk/Library/All_New_PI_Docs/Audio_Leaflets/Gastroenterology/Oesophageal_Balloon/end008_oesoph_balloon_dilation316v3.pdf

This next bit is to give you a rough idea what a dilatation means, I have added photos to help you understand better

What is esophageal dilatation?

The esophagus is the tube that carries food and liquid from the mouth to the stomach. If it becomes too narrow, swallowing food or liquid may be difficult. Esophageal dilatation (also called dilation) is a technique used to stretch or open portions of the esophagus that are too narrow.

There are different causes of esophageal strictures (narrowing), including allergies and injury. Your primary physician is responsible for finding out what is causing the problem. Your physician will refer you to the interventional radiologist, who will perform the dilatation.

How is esophageal dilatation performed?

Using live X-ray (fluoroscopy) for guidance, a doctor places a flexible wire into the mouth and down the esophagus, past the narrowed area. Then a deflated balloon is threaded over the wire and inflated into a sausage shape to stretch and enlarge the narrowed area. Sometimes more than one balloon will be used. Your child will be protected by an X-ray shield during this procedure.

A  /  Narrowing

B / The Balloon used to stretch the area, some Doctors use air, some water.

C / The area has been stretched 

On a Personal note having had this done many times as a child, I would eat tubes of ice cream as I found for me it helped.

 Will my child be awake for the procedure?

No. All children are given general anesthesia for the procedure. (As far as I know)

What are the risks of esophageal dilatation?

The procedure is considered low-risk. However, potential complications include:

Esophageal tear

Bleeding at the treatment site (coughing or throwing up blood)

Mediastinitis (severe inflammation of tissue in the chest area)

Will my child have pain after the procedure?

Some children experience chest pain or pain with swallowing in the first 24 hours after the procedure. You may give over-the-counter pain medication.

What are the diet restrictions after the procedure?

No food or drink for four hours after the procedure.

After four hours, try clear liquids such as water, broth or ginger ale. If your child can drink the liquids without pain, you may offer him or her soft foods such as mashed potatoes and pudding, as tolerated.

Stay on a soft diet for at least 24 hours.

No hot food for at least 24 hours; food may be lukewarm.

No “sharp” foods such as cookies, chips or crackers for at least 24 hours.

Transition your child to a regular diet after 24 hours, as long as swallowing the foods isn’t painful.

http://www.chop.edu/treatments/esophageal-dilatation#.V2LdkfkrKUk

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Understanding Esophageal Dilation

What is Esophageal Dilation?

Esophageal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus [swallowing tube]. Doctors can use various techniques for this procedure. Your doctor might perform the procedure as part of a sedated endoscopy. Alternatively, your doctor might apply a local anesthetic spray to the back of your throat and then pass a weighted dilator through your mouth and into your esophagus.

Why is Esophageal Dilation Done?

The most common cause of narrowing of the esophagus, or stricture, is scarring of the esophagus from reflux of stomach acid occurring in patients with heartburn. Patients with a narrowed portion of the esophagus often have trouble swallowing; food feels like it is “stuck” in the chest region, causing discomfort or pain. Less common causes of esophageal narrowing are webs or rings (which are thin layers of excess tissue), cancer of the esophagus, scarring after radiation treatment or a disorder of the way the esophagus moves [motility disorder].

How Should I Prepare for the Procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to drink, including water, for at least six hours before the examination. Your doctor will tell you when to start fasting.

Tell your doctor in advance about any medications you take, particularly aspirin products or anticoagulants (blood thinners such as warfarin or heparin), or clopidogrel. Most medications can be continued as usual, but you might need to adjust your usual dose before the examination. Your doctor will give you specific guidance. Tell your doctor if you have any allergies to medications as well as medical conditions such as heart or lung disease. Also, tell your doctor if you require antibiotics prior to dental procedures, because you might need antibiotics prior to esophageal dilation as well.

 What Can I Expect during Esophageal Dilation?

Your doctor might perform esophageal dilation with sedation along with an upper endoscopy. Your doctor may spray your throat with a local anesthetic spray, and then give you sedatives to help you relax. Your doctor then will pass the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope does not interfere with your breathing. At this point your doctor will determine whether to use a dilating balloon or plastic dilators over a guiding wire to stretch your esophagus. You might experience mild pressure in the back of your throat or in your chest during the procedure. Alternatively, your doctor might start by spraying your throat with a local anesthetic. Your doctor will then pass a tapered dilating instrument through your mouth and guide it into the esophagus. Your doctor may also use x-rays during the esophageal dilation procedure.

 

What Can I Expect after Esophageal Dilation?

After the dilation is done, you will probably be observed for a short period of time and then allowed to return to your normal activities. You may resume drinking when the anesthetic no longer causes numbness to your throat, unless your doctor instructs you otherwise. Most patients experience no symptoms after this procedure and can resume eating the next day, but you might experience a mild sore throat for the remainder of the day.

If you received sedatives, you probably will be monitored in a recovery area until you are ready to leave. You will not be allowed to drive after the procedure even though you might not feel tired. You should arrange for someone to accompany you home, because the sedatives might affect your judgment and reflexes for the rest of the day.

What are the Potential Complications of Esophageal Dilation?

Although complications can occur even when the procedure is performed correctly, they are rare when performed by doctors who are specially trained. A perforation, or hole, of the esophagus lining occurs in a small percentage of cases and may require surgery. A tear of the esophagus lining may occur and bleeding may result. There are also possible risks of side effects from sedatives.

It is important to recognize early signs of possible complications. If you have chest pain, fever, trouble breathing, difficulty swallowing, bleeding or black bowel movements after the test, tell your doctor immediately.

Will Repeat Dilations be Necessary?

Depending on the degree and cause of narrowing of your esophagus, it is common to require repeat dilations. This allows the dilation to be performed gradually and decreases the risk of complications. Once the stricture, or narrowed esophagus, is completely dilated, repeat dilations may not be required. If the stricture was due to acid reflux, acid-suppressing medicines can decrease the risk of stricture recurrence. Your doctor will advise you on this.

http://www.asge.org/patients/patients.aspx?id=392

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Image guided esophageal dilation procedure

Esophageal dilation

An image guided esophageal dilation procedure is a procedure performed to help increase the size of the opening in your child’s esophagus.  The esophagus is the tube that carries food or liquids from the mouth to the stomach.  The narrowing can prevent food or drink from passing into the stomach and back up into the mouth.  It can also cause your child to have excessive drooling of saliva as this also can have difficulty passing through the narrowed esophagus.  As a result, your child may not be able to receive adequate nutrition or become at risk for aspiration (contents going down the airway) and lung infections.

Conditions treated by this procedure

The most frequent cause of esophageal stricture (narrowing) in children are a result of complications related to prior surgeries involving the esophagus such as children who have a history of esophageal atresia or trachea-esophageal fistula (conditions in which children are born with an abnormal closure or communication of the esophagus to the airway).  Other conditions in children that may lead to esophageal stricture include ingestion of toxic material or prior radiation or injury to the esophagus area.

Treatment and recovery

The procedure typically requires 30 – 60 minutes to complete. During this time, your child will typically be sedated with anesthesia. A catheter is placed through the mouth into the stomach across the area where the esophagus is narrowed.  An balloon is positioned at the site of narrowing using X-ray guidance.  The balloon is inflated to stretch the narrowing and increase the size of the narrowing.  The balloon is deflated and x-ray dye is injected into the esophagus to ensure that the opening is sufficient.  The balloon and catheter are then removed.

Following the procedure, your child can generally sit in bed, a chair or walk following recovery from anesthesia sedation. Your child may be limited to liquids initially following the procedure then advanced as tolerated to other forms of nutrition. Your child may have some soreness following the procedure.  Typically this can be well controlled with ibuprofen or Tylenol.  Your child may also have some discomfort with swallowing following the procedure for the first 24 hours. Your child can resume normal activities as tolerated following the procedure.

Initially following the procedure and recovering from anesthesia your child will be limited to clear liquids to determine if your child can tolerate oral intake.  Your child may be limited to soft puree foods for the first 24 hours then transitioned to diet as tolerated there-after

Esophageal dilation risks

There is the potential risk that the dilation can cause a tear in the esophagus.  This is generally self limiting and will heal.  However, rarely this can lead to leakage of contents into the chest and potentially an infection.

http://www.chw.org/medical-care/imaging/interventional-radiology/image-guided-esophageal-dilation-procedure/

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Baby poop: A complete guide

www.babycenter.com/0_baby-poop-a-complete-guide_10319333.bc#articlesection1

If you’d like to see pictures of many of the poop types described below, check out our photo guide to baby poop.

Yes, the photos are real!  www.babycenter.com/baby-poop-photos

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Coffee Ground Vomiting

Haematemesis

Is the vomiting of blood. This condition occurs when there is bleeding in the oesophagus, stomach or duodenum, i.e. bleeding proximal to the duodenal-jejunal junction. It is very rare for bleeding entering the gut distal to this point to return to the stomach.

The colour and volume of the vomit is an indicator to how long the blood has been in the stomach. Dark blood or ‘coffee grounds’ suggests a smaller bleed which has been altered by contact with gastric acid. A large volume of bright red blood is suggestive of a rapid and sizeable haemorrhage.

Coffee grounds coloured vomit, Please note this can be a Small amount or larger 

2013-10-30_060509_photo1

Hematemesis in infants induced by cow milk allergy.

Abstract

This study was conducted in order to analyse the clinical manifestations, the endoscopic findings, the histology of the gastrointestinal mucosa, the treatments and the clinical course in infants who had hematemesis induced by cow milk allergy. The medical records were reviewed retrospectively. The criteria for the diagnosis of CMA included elimination of cow milk formula resulting in improvement of symptoms, specific endoscopic and histologic findings as well as the exclusion of other causes. Twenty-three infants with a diagnosis of hematemesis were analyzed, which included 20 infants with CMA and 3 infants with gastroesophageal reflux disease (GERD). In the CMA group were 12 girls and 8 boys whose ages were 4.3 +/- 1.4 months. The onset of vomiting after starting cow milk formulas was 70.6 +/- 48.9 days. Gastroduodenoscopy was performed on 15 patients showing erythema, erosion and friability of the gastric mucosa in all patients and lymphoid hyperplasia in the duodenal bulb in 7 patients. Eight patients had mild to moderate eosinophilic infiltration and 5 patients had eosinophilia. Cow milk formulas were changed to other formulas: two children were initially given extensively hydrolyzed casein formulas and later followed by a soy formula, 14 were given a soy formula and 4 were given partially whey hydrolyzed formulas. All patients showed clinical signs of improvement a few days later. Patients that were able to tolerate cow milk were 1.5 +/- 0.9 years old. During the follow-up period (2.6 +/- 1.8 years after treatment) 4 patients were diagnosed with asthma, 4 patients with chronic respiratory symptoms, 4 patients with constipation and 2 others with food allergies. CMA induced gastritis in infancy may not be classified as eosinophilic gastritis because of the low level of eosinophilic infiltration. The elimination of cow milk and subsequent substitution with a soy formula is the proper management.

www.ncbi.nlm.nih.gov/pubmed/15198338

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Constipation

Let the puppets teach you about constipation and what you can do to treat it. Sammy gets constipated and goes to the doctor to learn what he can do to feel better.

WATCH:-  http://www.muschealth.com/video/default.aspx?videoid=10759

What is Hirschsprung disease (HD)?

Hirschsprung* disease (HD) is a disease of the large intestine that causes severe constipation or intestinal obstruction. Constipation means stool moves through the intestines slower than usual. Bowel movements occur less often than normal and stools are difficult to pass. Some children with HD can’t pass stool at all, which can result in the complete blockage of the intestines, a condition called intestinal obstruction. People with HD are born with it and are usually diagnosed when they are infants. Less severe cases are sometimes diagnosed when a child is older. An HD diagnosis in an adult is rare.

Digestive_Boy

HD is a disease of the large intestine that causes severe constipation or intestinal obstruction.

For more info visit the website yourself and read the mass of info on this subject   www.niddk.nih.gov/health-information/health-topics/digestive-diseases/hirschsprung-disease/Pages/ez.aspx

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Endoscopy

Sent to us from a USA Parent

Watch the Puppets get ready for an endoscopy.

  The Puppets can teach you about the procedure and what to expect before, during and after.

WATCH:- www.muschealth.com/video/default.aspx?videoid=10760

CHILD has a Fluoroscopy scan at The Royal Children’s Hospital, Melbourne. FROM HER EYES

www.youtube.com/watch?v=ga_xcOug_sE&feature=youtu.be

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What is Colic?

Colic is defined as repeated episodes of excessive and inconsolable crying in a newborn baby who otherwise appears to be perfectly healthy. The condition can affect up to 1 in 3 babies, so you’re not alone.

It is thought that colic can be caused by milk sensitivity. This is because, in the first months of life, some babies are unable to break down lactose, a complex sugar in breast and formula milk. This is called temporary lactase deficiency. It can produce wind, bloating and cause discomfort, and one of the main symptoms is inconsolable crying.

As any parent with a distressed, crying baby knows, colic affects a whole household and can be very frustrating and be upsetting for all involved.

If you suspect your baby has colic it can help to keep a cry diary, and speak to your health visitor. You could also try a 1 week trial of Colief Infant Drops to help diagnose whether sensitivity to milk-sugar lactose could be the problem.

Could it be something else?

Other conditions can cause excessive crying, such as constipation and gastro-oesophageal reflux (GORD). If your baby has other symptoms, such as blood in the stools and vomiting.

FIND video’s and more info here http://colief.com/what-is-colic

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What is Aspiration?

Aspiration in children is a serious and common problem. It usually presents with an initial episode of choking with subsequent respiratory symptoms. Aspiration occurs whenever secretions, solid food or liquids “go down the wrong pipe” and enter the airway and lungs.  Aspirating material into the lungs can lead to respiratory problems, such as pneumonia.  While there may be observable signs that accompany aspiration events, such as coughing, choking, eye reddening during eating or a gurgly vocal quality after swallowing, infants and children can also aspirate “silently,” or with no observable symptoms.

If your child is found to be aspirating, follow-up therapy is recommended to work with you and your child to develop a feeding/swallowing program based on your child’s unique needs.

Signs and risks for aspiration

http://www.childrensomaha.org/Main/What-is-Aspiration.aspx

When a Child Aspirates

The ability to swallow safely is the primary prerequisite for becoming an oral feeder. When a child aspirates, oral feedings are often discontinued; and the child is given a feeding tube for eating. Many professionals recommend stopping the use of food at home and in therapy programs until the child swallows without aspirating on a modified barium swallow study. This leaves parents and therapists with many questions and implies a wait-and-see approach.

http://new-vis.com/fym/papers/p-feed9.htm

Aspiration in Babies and Children

What is aspiration in babies and children?

Aspiration is when something enters the airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. Aspiration can happen when a person has trouble swallowing normally. This is known as dysphagia. It can also happen if a child has gastroesophageal reflux disease (GERD). This is when the contents of the stomach come back up into the throat.

When your child swallows food, it passes from the mouth down into the throat. This is called the pharynx. From there, the food moves down through a long tube (oesophagus) and into the stomach. This journey is made possible by a series of actions from the muscles in these areas. If your child has dysphagia, the muscles don’t work normally. They cause problems with the swallowing process.

The pharynx is also part of the system that brings air into the lungs. When a person breathes, air enters the mouth and moves into the pharynx. The air then goes down into the main airway (trachea) and into the lungs. A flap of tissue called the epiglottis sits over the top of the trachea. This flap blocks food and drinks from going down into the trachea when your child swallows. But in some cases, food or drink can enter the trachea. It may go down as your child swallows. Or it may come back up from the stomach. A child with dysphagia is much more likely to aspirate. A child with a developmental or health problem is more likely to have dysphagia.

Aspiration can happen during a feeding or meal. And it can happen after a feeding or meal. This is common for babies and children with certain health conditions. Aspiration can also happen when at any time when your child swallows saliva.

If your child aspirates a small amount of material, it may not cause much harm. This can happen in children who don’t have a health problem. It can happen when eating, sleeping, or talking. But aspiration that happens often or in a large amount can be serious.

http://www.saintlukeshealthsystem.org/health-library/aspiration-babies-and-children

Chest-X-Ray of Foreign Body in Lungs

 http://www.waent.org/archives/2012/Vol5-1/20121005-aspiration-fb/Figure-1b.jpg

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Childhood Gastro-oesophageal Reflux

Gastro-oesophageal reflux is very common in babies and young children. Regurgitation of a small quantity of milk after a feed without any other symptoms (possetting) is harmless in young infants and doesn’t need any investigations or treatment.

Reflux may be more severe and associated with other symptoms. This condition is usually diagnosed without needing any tests but some babies with more troublesome symptoms may be referred for further investigations. There are various treatments available including feed thickeners, anti-regurgitant milk, Gaviscon® and various medications. However, for the majority of cases, gastro-oesophageal reflux is a self-limiting condition and, with time, improves without any complications.

Gastro-oesophageal reflux is extremely common. Regurgitation of a small quantity of milk after a feed without any other symptoms (possetting) is harmless in young infants. Around one in two babies in the UK have regurgitation. This occurs when some of their feed effortlessly returns into their mouth from their stomachs. This is most commonly caused by reflux.

It occurs because the muscle at the lower end of the food pipe (oesophagus) is too relaxed. So, some of the contents of the stomach pass up into the oesophagus, leading to regurgitation or being sick (vomiting). As the contents of the stomach are acidic this can irritate the lining of the oesophagus. When gastro-oesophageal reflux is associated with troublesome symptoms (such as poor weight gain, unexplained crying or distressed behaviour) it is known as gastro-oesophageal reflux disease (GORD).

Gastro-oesophageal reflux is more common in babies who are born prematurely and also in those who have a very low birth weight. It is also more common in babies or children who have some impairment of their muscles and nerves (for example, those with cerebral palsy) or those with cow’s milk allergy.

Reflux occurs both in breastfed and in bottle-fed babies.

Many babies and children have some gastro-oesophageal reflux which leads to being sick (vomiting) or regurgitation of some of their feeds. This is not always associated with other symptoms.

Other symptoms of gastro-oesophageal reflux can include symptoms that are similar to baby colic. These may be uncontrolled crying, drawing the legs up towards the tummy and pain in the tummy after feeding. Some older babies may refuse feeds, as they associate feeds with pain on swallowing. More uncommonly some babies or children have some blood in their stools (faeces) or their vomit.

Older children with reflux may complain of heartburn and a foul-tasting, watery fluid intermittently coming into their mouth.

Some babies with GORD have poor weight gain and can be more unsettled than normal. Occasionally, babies may wheeze as a result of more severe reflux.

For most babies and children, further tests are not needed as your doctor will be able to make the diagnosis by talking to you and examining your baby or child. You may be asked to keep a diary of the amount of fluid and food your baby or child is taking and also how often they are bringing up food.

Click on the underlined RED Wording

Your doctor may refer your baby or child for further tests if they are having more severe symptoms. These may include:

 pH monitoring of the food pipe (oesophagus). This involves inserting a very small probe down into the oesophagus to measure the amount of acid in the oesophagus.

 Endoscopy. This involves a small tube with a camera at the end being inserted into the oesophagus to look for any inflammation of the lining of the oesophagus and/or the stomach. 

Barium swallow. This involves having a drink of barium followed by an X-ray. This test is not often performed nowadays.

For more info click here

http://patient.info/health/childhood-gastro-oesophageal-reflux-leaflet

 

Professional reference: PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the Parents leaflet above.

Gastro-oesophageal reflux (GOR) is the non-forceful regurgitation of milk and other gastric contents into the oesophagus.  Asymptomatic effortless regurgitation of a small quantity of milk after a feed (possetting) is quite normal in young infants and doesn’t need any investigations or treatment.

GOR should be distinguished from vomiting which is an active process, requiring the forceful contraction of the diaphragm and abdominal muscles. It occurs where there is incompetence of sphincter of the gastro-oesophageal junction or where raised intragastric or intra-abdominal pressures to exist sufficient to overcome this mechanism.

Physiological, asymptomatic reflux occurs in all adults and children but is infrequent (<5% of any 24-hour period, mostly occurring postprandially). Gastro-oesophageal reflux disease (GORD) occurs when reflux is persistent, more frequent and gives rise to troublesome symptoms or complications.

For more info click here

http://patient.info/doctor/childhood-gastro-oesophageal-reflux-pro

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