It seemed she had some constipation, and it was noted that her mom was scheduled for major surgery. Were the stomachaches, then, a tension-stress response? That’s often the case. Still, her folks were quite worried and pressed for an answer.
Finally, an upper GI series showed that her intestines were in backwards - a condition known as malrotation. Malrotation is a time-bomb for children! Often with little warning, children with this condition can go from happy and healthy to shock as the intestines twist - a condition called volvulus. This twisting cuts off blood supply to the intestines. Acute volvulus can thus lead to the loss of most of the intestinal tract if it is not properly diagnosed and corrected within minutes to hours.
In our patient’s case, the twisting was partial and chronic. One minute she was smiling and hungry, the next she could be writhing on the floor.
When her parents got the call (at about 9 PM) from Dr. Treskova explaining the life-threatening nature of the diagnosis, they rushed her to Maria Fareri Children’s Hospital at Westchester Medical Center. There, she was evaluated by a team led by pediatric surgeon Dr. Samir Pandya. After a day of observation, she underwent a semi-urgent laparoscopic repair.
It took almost ten long days for her intestines to start functioning again. During this time, she had to remain in the PICU with a naso-gastric tube in place and IV fluids running. At last, there were signs of recovery. Since then, she’s been back home and has returned to being a typical two year-old.
Leaving Adolescents Unattended: A Touchy Subject
A couple years ago, an attorney mentioned in passing that he was defending the father of a ten year-old boy. Dad had put his son to bed and left to go buy him some food for breakfast. The son woke and called his mom (the parents were estranged). Mom called CPS. Dad was charged with neglect.
At about the same time, a local school sent home a flier for an American Red Cross Babysitting Course. The course is offered to children 11 to 15 years of age. Does it make sense that a parent of a 10 year-old that leaves his son unattended for a half-hour can get into serious trouble, but the parents of a six month-old infant can leave the baby in the care of their 11 year-old daughter with impunity? This raises even more questions:
There are a substantial number of factors a thoughtful parent must take into consideration when deciding whether or not to leave their older child unattended. Among them are:
It’s said that raising a child is like letting go of a spring. It’s best done gradually. So before leaving your adolescent home for the evening while you go out to dinner, consider how they’ve handled shorter times unattended. If Tommy tore the house apart while you were out shoveling the driveway for 20 minutes, leaving him home alone even for an hour is asking for trouble.
Besides leaving an adolescent home alone, a parent may also be confronted with decisions about walking to the bus stop. In New York, a child as young as age five, may walk up to a mile to or from school. Walking, especially in the dark or in a dangerous neighborhood certainly seems riskier than being in a locked apartment of house – and yet the authorities do not apparently see it that way. Even more contentious, perhaps, is the decision about leaving (an) older child(ren) in the car while a parent runs in to pick up a pizza, a prescription, and such. A few years ago, a mom was arrested for leaving her toddler in the car while she threw coins in a Salvation Army kettle.
So, where can parents go for advice? Unfortunately, every situation is different, and there are no clear guidelines; there isn’t an app for this! Well-intentioned parents can bring up their concern with their child’s teacher or pediatrician, but should do so discreetly. As mandated-reporters, if a teacher or healthcare worker disagrees with what you are already doing, they may feel compelled to file a report to social services. Along the same lines, parents may want to encourage their children to use discretion when answering the phone or the door if they are at home alone in early adolescence.
The waters are even muddier when it comes to special needs situations. Growing numbers of children these days have learning disabilities, attention deficit disorder, Asperger’s, or mood and anxiety disorders. In such situations, it may be questionable to leave even high school-age children un-chaperoned.
Times have certainly changed. The rules that governed our parents’ decisions in this area a generation ago may not apply as well as we’d like. And with fifty percent of children now being raised in single-parent households, the issue of supervision is more important than ever. If you are the parent of a 5th or 6th grade child, we hope that this brief discussion has heightened your awareness of the complexity and seriousness of this matter.
It has been common practice for pediatricians, starting when children enter early adolescence, to dismiss parents from the exam room. Although this routine may have given children an opportunity to discuss matters that they did not want their parents to hear about, it obviously put some children at risk. Our office has never encouraged this practice. If a parent is not available and a patient needs a private area of the body examined, a nurse serves as chaperone.
Besides sump pumps, dehumidifiers, and perhaps the judicious application of Clorox (other options exist), what can parents do to prevent or relieve mold allergy symptoms in their little ones? A study from New Orleans published last year suggests that vitamin D may be helpful. While the researchers focused on patients with cystic fibrosis and one particular mold (aspergillus) and studied the effects of vitamin D on lymphocyte function, it seems likely that clinical trials will eventually prove vitamin D helpful to all children exposed to common molds.Fecal Transplants
The article also called attention to the analogous situation of childbirth, at which time children that are born vaginally receive an inoculation or transplant of their mother’s internal microbes. One of these, bifidobacterium longum, may keep bad players like clostridia and klebsiella out of the baby. Infants born by c-section are not colonized with bifido bacteria.