Flat feet and falls in a toddler

My daughter, who is 2,has very flat feet. She walked at 13 months and is very active but falls over a lot. What should I do?

Toddlers often have flat feet. They are due to lax ligaments (structures that hold our joints together) and the fact that the area where the arch of the foot is located contains a lot of fat, so that little or no arch can be seen in toddlers. Walking at 13 months is normal and of no concern.

It is normal for toddlers to fall a lot- they usually have bruises on the fronts of their legs and their foreheads are often bruised. falls on flat surfaces are not a worry. However, you should protest them from falling downstairs (by a gate at the top) because serious damage can be done. Likewise, the play area outside should not have steep areas or cliffs where a toddler can fall and do themselves harm.

Fever and rash in an 8-month-old

Our 8-month-old son has been very hot for the last 4 days. I have seen his doctor who has not been able to find a cause and just prescribed Tylenol when he is irritable. He has developed a red spotty rash today but seems less feverish. Is this measles?

No, this is not measles. From your description he has had Roseola. It is also known as “erythema subitum”. Erythema means redness and subitum refers to the subsidence of the fever. Thus, as the fever stops the rash appears.

This is a viral infection that is very difficult to diagnose until the rash appears. The rash will disappear in a couple of days and your child will be happy and well.

Febrile Convulsions

My 25-month-old daughter has been in hospital for the second time with a febrile convulsion. I have been told that it is not epilepsy but they look like an epileptic convulsion that I saw on a video once. What is the difference?

The convulsion of febrile convulsion and that of the commonest form of epilepsy (generalised tonic-clonic or Grand Mal) are identical in appearance. The difference is that febrile convulsions only occur in young children (usually under 3 but sometimes up to 6 years). Commonly there is a family history of febrile convulsions. If a father, mother, sister or brother had febrile convulsions there is a 16 times greater chance that a young child will have one compared to a child with no family history. Because you and her father would not recall having had them at such a young age, it is worth checking with your parents or an older relative about the chance that you did.

Because an epileptic convulsion may be triggered by a febrile illness in a child, who has epilepsy and they look identical to febrile convulsions it is usual to wait until a second one occurs. In 60% of children with febrile convulsions there is only 1 episode but in 40% they are repeated. If a second episode of convulsing happens an electroencephalogram (E.E.G.) may be performed. This is a painless procedure in which the brain’s electrical activity is recorded while not fitting. If this is normal it is very unlikely (although not impossible) that the child has epilepsy.

A reassuring fact is that febrile convulsions are much commoner than epilepsy at your child’s age.

Eczema in a 10-week-old

My doctor has diagnosed my 10-week-old son as having eczema. We have been given some cream but could you explain eczema to me?

Eczema means a scaly rash. Most doctors mean “atopic eczema” when they just say “eczema”. There are other scaly rashes that are called eczema. Another eczema that is common in babies is seborrheic dermatitis. As both it and atopic eczema improve on corticosteroid creams telling the difference may not seem important. However, the course of the condition will be very different.

Atopic eczema is part of atopy in which some combination of the following may occur: asthma, hayfever (allergic rhinitis) or a tendency to allergies. Seborrheic dermatitis tends to disappear by 2 years, only to reappear as dandruff in adolescence. Many cases of atopic eczema also disappear by 2 and most have resolved by 6. Some remain life-long.

It is important to emphasize that your child may grow out of his eczema and never develop any of these conditions in later life, no matter which of these 2 common scaling rashes he has.

Eczema does not produce permanent scarring by itself. If it is scratched (and eczemas are very itchy) it may become secondarily infected and antibiotics needed. If this secondary infection is severe, it may cause scarring.

Babies with eczema in the diaper region (usually seborrheic dermatitis) may have repeated and very difficult to control diaper rash. This will require antiseptic baths as well as corticosteroid cream – this require medical attention and advice

Anaemia in a 2-year-old girl

What is anaemia and how do I find out if my daughter has it? My mother tells me that I looked very pale as a child and was diagnosed as having anaemia. My 2-year-old daughter looks pale but she is otherwise well.

Anaemia is a reduced number of red cells in the bloodstream. These red cells contain haemoglobin and use this to carry oxygen from the air in our lungs to all parts of the body. If we become anaemic slowly, the body compensates, for example the heart beats more strongly and more rapidly. So we may not notice that we have a problem but if the anaemia is bad enough the anaemic person looks pale.

Some people, both adults and children, are naturally pale without having anaemia. To find out if your daughter is anaemic she needs to have a blood test. This can be organised by your local doctor.

If anaemia is present it is necessary to find out why. Most of the many causes of it are readily fixed. In a 2-year-old the most likely cause would be an inadequate amount of iron in the child’s diet. The best source of iron is red meat. If a significant iron-deficiency is found, this can be fixed by giving iron medicine by mouth in a single dose per day

Glue ear in a 2 and half year old

Last week you answered a question about infection in the middle ear. My 2 and a half-year-old son has a condition called glue ear and his paediatrician has referred him to an ENT surgeon for possible operation. What is this condition, what causes it and does he really have to have the operation?

“Glue Ear” (or serous otitis media to give it its medical name) is a condition in which there is a collection of fluid in the middle ear on a persistent basis. This is due to poor drainage of the middle ear by the tube, which drains into the nose (even though the common cold is not present).

This may lead to repeated ear infections because the fluid provides a suitable place for bacteria to grow. It can also cause a hearing loss. The ENT surgeon can cut the eardrum under general anaesthesia. He/she can suck out the fluid and place a tiny drainage tube in the eardrum that will drain fluid and prevent the fluid from rea cumulating.

If there is temporary deafness speech development is inhibited but this will pick up once the deafness resolves. Glue ear usually resolves by itself and studies done comparing children who have their glue ear treated by surgery with those in whom no surgery was done have found no difference between the 2 groups after 5 years. Even the speech had picked up so that the 2 groups had similar speech and intelligence at the end of the 5 years. There is no doubt that surgery restores hearing immediately.

I hope this helps you make up your mind as to whether to have the surgery done on your son.