I often have questions from concerned parents whose children are growing perfectly normally, but their “belly sticks out”.  This is often a comment made about little girls (gender specific concerns already!) and I tell the parents that there are not many toddlers that don’t have protuberant little tummies.

If you go to the pool in the next several months, check out the baby pool,  as this is not a good age to wear a bikini or “speedo” with that big tummy pushing down the bottoms,   save that look for later on.

Now, what do you typically look for in  child who you suspect might have celiac disease?  Celiac disease typically causes failure to thrive in young children. I know this well,  as I got this question wrong on my oral boards many years ago, and have spent the last 20 years making sure never to miss a case. (maybe I should leave that little tidbit out?)

At any rate, you see symptoms like persistent diarrhea, weight loss or failure to gain weight, a large protuberant abdomen, and a lack of appetite (no, being a picky eater does not count).   Because celiac disease is an auto-immune disease where the body responds abnormally to a protein (gluten) found in foods like wheat,  rye, barley and many other prepared foods, it differs from a food allergy.  A food allergy typically causes symptoms like hives, wheezing or vomiting.

The first step in testing for possible celiac disease will be a blood test on your child.  This will show if there are elevated levels of antibodies, called tissue-trans-glutaminase (tTG), in the blood. If a child has high levels of these antibodies (tTG), then a biopsy of the small intestine may be taken to confirm the diagnosis.

A small bowel biopsy is done while a child is sedated, through an endoscope, and actually takes a small piece of the lining of the intestine to see if the villi are flattened and damaged.  The gluten in the diet of a child with celiac disease causes these changes to the intestine, and once gluten is removed from the diet the villi will return to normal and normal absorption of food will take place.

If a child is confirmed to have celiac disease (which is as lifelong problem) they have to remain on a gluten free diet, which means restricting many foods and drinks.  A gluten free diet, while seemingly difficult to adhere to at first, will allow the child to grow and develop normally and your child will typically have more energy and feel better in general.  After being on a gluten free diet another blood test may be done to confirm that the tTG level has come down.

With the advent of more gluten free products it has become easier for parents and children to follow a gluten free diet. There are many websites that help teach a family to read labels (similar to those with a food allergy) and to also provide resources for recipes or products that are gluten free.

Although I continue to look for a patient with celiac disease, I have yet to diagnose one, and remember to consider the diagnosis in any child who is having “failure to thrive”.

That’s your daily dose for today.  We’ll chat again tomorrow!

Send Dr. Sue your question now!

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In 2008 there were 1.2 million new cases of chlamydia, a sometimes symptom-less infection that can lead to infertility in women. It was the most ever reported, up from the old record of 1.1 million cases in 2007. 

Better screening is the most likely reason, said Dr. John M. Douglas Jr. of the U.S. Centers for Disease Control and Prevention.

Syphilis, which was on the verge of being eliminated in the United States about 10 years ago, also has been on the rise. Statistics show that about 13,500 cases of the most contagious form of the disease were reported in 2008, up from about 11,500 the year before.

Syphilis can kill if untreated, but chlamydia is not life-threatening. Neither is gonorrhea, which appears to have plat eaued in recent years. Gonorrhea cases dropped to about 337,000 cases in 2008, down from about 356,000 cases.

Girls, ages 15 through 19, had the largest reported number of chlamydia and gonorrhea cases, accounting for more than one in four of those cases. But they’re often screened more than other people, since 1993 federal recommendations that emphasize testing for sexually active women age 25 and under.

Syphilis, chlamydia and gonorrhea can all be treated with antibiotics but untreated can cause pelvic inflammatory disease, infertility, ectopic pregnancy and can infect newborns.

Overall, CDC estimates that 19 million new sexually transmitted infections occur each year, almost half among 15- to 24-year-olds.

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PCV7 was first approved in the U.S. in 2000 for the prevention of pneumococcal meningitis, pneumonia, and bacterial blood infections. The Prevnar 7 vaccine covered 7 different serotypes (strains) of S. pneumonia, a bacteria that also often causes otitis media (ear infections) in children. Since the introduction of PCV7 there has been a dramatic decrease in the number of invasive pneumococcal diseases seen in children,  as well as a reduction in the incidence of ear infections caused by the S. pneumonia bacteria that are due to serotypes in the vaccine.

The new PCV13 now covers an additional 6 serotypes of the bacteria which should provide even more coverage and protection against pneumococcal disease, and therefore even better protection for young children.  For many parents this will be a “non” event as the doses of PCV7 that had been used until March  are now being returned to the drug company and are being routinely replaced with PCV13 . PCV13 will ultimately replace PCV7 in the routine immunization schedule throughout the country.  The side effect profile is no different for the vaccines.

The new recommendations for PCV13 are important for those that have children who are between 12 – 15 months of age, and who have finished the 4 dose PCV7 series.  For those children, it is now recommended that those over 15 months and up to 6 years of age, receive a 5th dose of Prevnar, but with the newer PCV13. This will provide some immunity to the 6 additional serotypes in the newer vaccine and give these young children broader protection against invasive pneumococcal disease.

So the next time you see your pediatrician and you have a child over the age of 1 but under the age of 6, ask your doctor about getting a 5th dose of Prevnar, with PCV13.   I f you have an infant, I would ask your pediatrician’s office if they have started using PCV13 for routine vaccination.  The continued science involved in developing better and more protective vaccines is one more step toward preventing serious childhood illnesses.

That’s your daily dose.  We’ll chat again tomorrow.

Send your question to Dr. Sue right now!

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