Downs

syndrome, (trisomy 21), is a chromosomal condi0on caused by the presence of all or part of an extra 21st chromosome.
This chromosomal abnormality can be caused by:

1) Chromosomal non-dysjunc0on during maternal meiosis: With nondisjunc0on, a gamete (i.e., a sperm or egg cell) is produced with
an extra copy of chromosome 21; the gamete thus has 24 chromosomes. When combined with a normal gamete from the other
parent, the embryo now has 47 chromosomes, with three copies of chromosome 21.

2) Robertsonian Transloca0on: the long arm of chromosome 21 is aHached to another chromosome and the chromosome count is 46.

3) Mosaicism: when some cells display trisomy 21 but others have a normal karyotype.

Clinical Features:

Small stature Bowel abnormali0es: duodenal or oesophageal

Developmental delays atresia, Hirchsprungs
Small midface: hypoplas0c frontal sinuses, myopia, Delayed closure of fontanelles
small/short ears Bradycephaly
Short, broad hands, feet and digits, single palmar Lax joints
crease, clinodactyly Exaggerated space between rst and 2nd toe
Congen0al heart disease: VSD, endocardial cushion
defect

TURNERS SYNDROME

Turner syndrome is a genetic disorder that affects a girl's development. The cause is a missing or incomplete X
chromosome, with the most common karotype being 45X (functional monosomy of chromosome 45).

Clinical Manifesta0ons

Short stature Increased weight, obesity

Swelling of the hands and feet (lymphedema), Webbed neck (from cystic hygroma)
Shortened metacarpal IV, Small fingernails Coarctation of the aorta , Bicuspid aortic valve
Broad chest (shield-like) and widely spaced Horseshoe kidney
nipples
Visual impairments sclera, cornea, glaucoma,
Low hairline etc.
Reproductive Sterility Ear infections and hearing loss
Rudimentary ovaries gonadal streak High waist-to-hip ratio (hips are not much bigger
(underdeveloped gonadal structures that later than the waist)
become fibrosed)
Learning disabilities
Amenorrhoea

The Denver Developmental Screening Test (DDST), commonly known as
the Denver Scale, is a test for screening cognitive and behavioural problems in
preschool children.

The scale reflects what percentage of a certain age group is able to perform a certain
task. In a test to be administered by a pediatrician or other health or social service
professional, a subject's performance against the regular age distribution is noted.
Tasks are grouped into four categories (social contact, fine motor skill, language, and
gross motor skill) and include items such as smiles spontaneously (performed by 90%
of three-month-olds), knocks two building blocks against each other (90% of 13-month-
olds), speaks three words other than "mom" and "dad" (90% of 21-month-olds),
or hops on one leg (90% of 5-year-olds).

While this study acknowledges the test's utility for detecting severe developmental
problems, the test has been criticized to be unreliable in predicting less severe or
specific problems.
Hand-foot-and-mouth disease is an illness that causes sores in or on the mouth and on the hands, feet, and sometimes
the buttocks and legs. Hand-foot-and-mouth disease is caused by a virus called an enterovirus, most likely the
cocksackieviruses.
The virus spreads easily through coughing and sneezing. It can also spread through infected stool, such as when you
change a diaper or when a young child gets stool on his or her hands and then touches objects that other children put in
their mouths. Often the disease breaks out within a community.
Incubation: 3-6 days.
S/S:
Fever ,headache, fatigue, malaise , sore throat.
Referred ear pain.
Body rash, followed by sores with blisters on palms of hand, soles of feet, and sometimes on the lips.
The rash is rarely itchy for children, but can be extremely itchy for adults
Sores or blisters may be present on the buttocks of small children and infants.
Irritability in infants and toddlers
Loss of appetite.
Diarrhoea

Complications:

viral or aseptic meningitis

encephalitis
paralytic polio
may be linked to nail loss

SCABIES
 Caused by the mite Sarcoptes scabiei, a tiny and not directly
visible parasite, and it is highly contagious because infected
humans do not manifest signs or symptoms approx. 10 days thus
facilitating transmission.
Most children exhibit eczematous eruption composed of red,
excoriated papules and nodules.
Severe and paroxysmal (night) pruritis is hallmark.
Distribution is the most diagnostic finding.

S/S:
Itching: made worse by warmth and during the night, puritis
Rash: burrow formation that occurs in interdigital web spaces, hands, feet, wrists, elbows, axilla, back, buttocks, groin and
genetalia. (warm environments favoured by mite)
Acropustulosis, or blisters and pustules on the palms and soles of the feet, are characteristic symptoms of scabies in infants.

Management:
Treatment must often involve the entire household or community to prevent re-infection.
Options to improve itchiness include antihistamines.
Permethrin 5% lotion is applied over the entire body and should be left on for 8-12 h and then rinsed (before bedtime,
showered off in the morning)
Lindane was previous DOC for scabies. Now only used as a second-line treatment if other agents fail or are not tolerated.
Transcutaneous absorption can lead to neurotoxicity.
Sulfur Topical Ointment: Oldest known treatment. Treatment of choice in infants < 2 mo and in pregnant or lactating women.
Less acceptable to patients as a result of its odor and messy application.
Ivermectin: Not recommended for children under 6 years of age. Effective after a single dose and is used with a topical agent.

ECZEMA or ATOPIC DERMATITIS

Eczema, or atopic dermatitis, often occurs in infants and children with a family history of allergic
conditions, such as eczema or asthma. The rash can initially develop as red, itchy, dry areas on the
cheeks and scalp that spread to the arms and body. They later appear on the elbows, wrists and
knees.

Keeping the skin moisturized, avoiding skin irritants and applying mild cortisone creams may help
control the condition.

IMPETIGO CONTAGIOSA
This common form of impetigo, also called nonbullous impetigo, most often begins as a red sore near
the nose or mouth which soon breaks, leaking pus or fluid, and forms a honey-colored scab, followed
by a red mark which heals without leaving a scar.

It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes.

Impetigo usually clears on its own in two to three weeks, but treatment with antibiotics or ointments
can prevent complications, such as scarring and more severe infections.
Roseola Infantum is a viral illness in young kids, most commonly affecting those between 6 months and 2 years old. It is
usually marked by several days of high fever (3-7 days), followed by a distinctive rash just as the fever breaks.

Two common and closely related viruses can cause roseola:

1. human herpesvirus type 6 (HHV-6)
2. human herpesvirus type 7 (HHV-7).
These viruses belong to the same family as herpes simplex viruses (HSV), but HHV-6 and HHV-7 do not cause the cold
sores and genital herpes infections that HSV can cause.

S/S:
mild upper respiratory illness
high fever (often over 39.5C) for up to a week. Fast rising fever can also trigger febrile seizures in 10-15%
young children.
Swollen neck nodes
Irritability, decreased appetite

The high fever often ends abruptly, and at the same time a pinkish-red, flat or raised rash appears on the trunk and
spreads over the body. The rash's spots blanch on touch, and individual spots may have a lighter "halo" around them. The
rash usually spreads to the neck, face, arms, and legs.

Treat the fever with acetaminophen or ibuprofen. Do not use Aspirin risk of Reye syndrome.
The rash disappears on its own.

Chickenpox is caused by the varicella-zoster virus (VZV) and involves an itchy rash of spots that look like blisters can appear
all over the body and be accompanied by flu-like symptoms.

The first symptoms of chickenpox include:

 A fever of 38.3 to 39.4. Little or no appetite.
Feeling sick, tired, and sluggish. Headache and sore throat
.
The first symptoms are usually mild in children, but can be severe in teens/adults. Symptoms may continue through the illness.

About 1 or 2 days after the first symptoms of chickenpox appear, an itchy rash develops. During a typical course of chickenpox:
Red swollen spots/bumps appear and turn into blisters filled with clear or cloudy fluid and that look like pimples.
The blisters break open, often leaking fluid.
A dry crust forms over the broken blisters as they heal.

Chickenpox is most contagious from 2 to 3 days before the rash appears until all the blisters have crusted over. They remain
contagious until all lesions have crusted over (this takes approximately six days).

To relieve the symptoms of chickenpox, people commonly use anti-itching creams and lotions. These lotions are not to be used
on the face or close to the eyes. Neem leaves can be made into paste form and can be applied on the rashes. Warm water bath
with neem leaves may be helpful.
If oral acyclovir is started within 24 hours of rash onset it decreases symptoms by one day but has no effect on complication
rates.
MILIARIA/HEAT RASH

The initial event that causes the inflammatory response is occlusion of the sweat duct during periods of physical activity or heat
exposure

Symptoms of miliaria include small red rashes, called papules, which may itch or more often cause an intense 'pins-and-needles'
prickling sensation. These may simultaneously occur at a number of areas on a sufferer's body, the most common including the face,
neck, under the breasts and under the scrotum. Other areas include skin folds, areas of the body that may rub against clothing, such as
the back, chest, and stomach, etc

There are three types of miliaria, classification depends on where the ducts are blocked.

In miliaria crystallina, the ducts in the top layers of the skin are affected, causing the rash to look like tiny, clear blisters that break
easily. Miliaria rubra occurs deeper in the skin, usually red bumps appearing in babies between the first and third week of life, states the
Mayo Clinic. Miliaria profunda, a less common childhood rash, affects the deepest layers of skin and appears as if goose bumps. Most
heat rash goes away when sweating is reduced or eliminated.

Diaper rashes are common in babies between 4 and 15 months old. They may be noticed more when babies begin
to eat solid foods.
Diaper rashes caused by infection with a yeast or fungus called Candida are very common in children. Candida
grows best in warm, moist places, such as under a diaper. A yeast-related diaper rash is more likely to occur in
babies who:
Are not kept clean and dry
Are taking antibiotics, or whose mothers are taking antibiotics while breast feeding
Have more frequent stools

Other causes of diaper rashes include:

Acids in the stool (seen more often when the child has diarrhea)
Ammonia (produced when bacteria break down urine)
Diapers that are too tight or rub the skin
Reactions to soaps and other products used to clean cloth diapers

TR:
Keep the area clean and dry. Use petroleum jelly to reduce moisture. Avoid scented wipes, corn starch and
talcum powder.
The use of antacids (eg. Dica, Maalox) may be useful to neutralize the alkality caused by urine breakdown.
Antifungals like miconazole, clotrimazole, and ketaconazole for Candida infection.

DDx: Other rashes that occur in the diaper area include seborrhoeic dermatitis and atopic dermatitis.

BILATERAL CEPHALOHEMATOMA

A cephalhematoma is a hemorrhage (a collection of blood) found between the skull and periosteum of a
newborn baby as a result of birth trauma. They are bounded by the outer layer of the periosteum and the
sutures, so they do not cross the midline.

During vaginal delivery, the mothers cervix grips the scalp of the child causing tearing of tiny vessels that
nourish the periosteum from the bone side leading to hemorrhaging under the periosteum.

Delivery forceps have commonly been associated with cranial birth trauma and injury, but in more recent years
vacuum extraction (aided by a device such as a ventouse) has become the preferred instrument to aid vaginal
delivery. Use of the ventouse can also lead to caput succedaneum, a subgaleal hematoma, or
cephalhematoma.

Usual management is mainly observation. May resolve spontaneously.

DDx: In the neonate, swelling of the scalp may also be seen with caput succedaneum and subgaleal
hemorrhage (subaponeurotic hemorrhage).
OPTHALMIA NEONATORUM

Neonatal conjunctivitis presents during the first month of life. It may be infectious or non infectious organism is
transmitted from the genital tract of an infected mother during birth or by infected hands. If left untreated it can
cause blindness.

Causes:
Gonococci (Neisseria gonorrhoeae)

Chlamydia (Chlamydia trachomatis)

Herpes simplex virus (HSV-2),

Staphylococcus aureus

Streptococcus haemolyticus
Streptococcus pneumonia

Treatment:

Prophylaxis - antenatal, natal, and post-natal

Systemic therapy with antibiotics/antiviral depending on cause.

Mumps (epidemic parotitis) is a viral disease of the human species, caused by the mumps virus. It is
characterized by painful swelling of the salivary glands classically the parotid gland. Painful testicular
swelling (orchitis) and rash may also occur. The symptoms are generally not severe in children. The disease is
generally self-limiting, running its course before receding, with no specific treatment apart from controlling the
symptoms with pain medication.

Fever and headache are prodromal symptoms of mumps, together with malaise and anorexia. Other
symptoms of mumps can include dry mouth, sore face and/or ears and occasionally in more serious cases,
loss of voice. 20% of patients are asymptomatic.

Mumps is a contagious disease that is spread from person to person through contact with respiratory
secretions and can also survive on surfaces and transferred via contact.

There is no specific treatment for mumps. Symptoms may be relieved by applying ice or heat to the affected
neck/testicular area and pain meds such as paracetamol or ibuprofen.

Prevention is based upon vaccination, two shots at 1 year and then again at 3-5 years.


The BARLOW MANEUVER is a physical examination performed on infants to screen for developmental dysplasia
of the hip.
The maneuver is easily performed by adducting the hip (bringing the thigh towards the midline) while applying
light pressure on the knee, directing the force posteriorly. If the hip is dislocatable - that is, if the hip can be
popped out of socket with this maneuver - the test is considered positive.

The ORTOLANI TEST is a physical examination for developmental dysplasia of the hip. It is performed by an
examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner's index
fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant's legs
using the examiner's thumbs.

A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into
the acetabulum. Specifically, this tests for posterior dislocation of the hip.

1
2
1. Neurofibromatosis 1 is an autosomal dominant condition that causes symptoms including tumors (called
neurofibromas) formed from nerve tissue. While the tumors are usually benign (non-cancerous), they may
be a concern if their location means that theyre pinching a nerve or otherwise interfering with other parts of
the body.
The disorder affects all neural crest cells (Schwann cells, melanocytes and endoneural fibroblasts).
It Causes tumors - may cause bumps under the skin, coloured spots, skeletal problems, pressure
on spinal nerve roots on spinal nerve roots.
melanocytes dysfunction - disordered skin pigmentation and caf au lait spots

Because there is no cure for the condition itself, the only therapy is to manage symptoms or complications.
Surgery may be needed when the tumors compress organs or other structures For families with NF,
genetic screening and counselling is available

2. These are light tan or light brown spots that are usually oval in shape. They usually appear at birth but may
develop in the first few years of a child's life. Cafe-au-lait spots may be a normal type of birthmark, but the
presence of several cafe-au-lait spots larger than a quarter may occur in neurofibromatosis (a genetic
disorder that causes abnormal cell growth of nerve tissues).

Diphteria is an upper respiratory tract illness caused by the toxin produced by Corynebacterium diphtheria. It is
prevented by immunisation.
Characterized by:
sore throat
low fever
pseudomembrane on the tonsils, pharynx, and/or nasal cavity.

A milder form of diphtheria can be restricted to the skin. Less common consequences include myocarditis
and peripheral neuropathy.
Treatment:
Diphtheria antitoxin neutralizes circulating toxin and reduces the progression of the disease. The effect is
greatest if it is administere. Asymptomatic carriers do not require antitoxin.
Antibiotics should also be administered as soon as possible to patients with suspected diphtheria. Antibiotics
help eradicate the bacteria, stopping toxin production, and also help prevent transmission.
Penicillin and erythromycin are the recommended antibiotics. Asymptomatic carriers do require antibiotics.
Supportive measures intubation, tracheostomy in case of obstruction.

Complications: myocarditis, arrhythmias, CHF, muscle paralysis, muscle weakness, and vision problems,
ccccccccccccc kidney failure, death.
TETANUS NEONATORUM
This is a form of generalized tetanus that occurs in newborns. Infants who have not acquired passive
immunity because the mother has never been immunized are at risk. It usually occurs through infection of the
unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. The usual incubation
period after birth is 3-10 days, which is why it is sometimes referred to as the disease of the seventh day. The
newborn usually exhibits irritability, poor feeding, rigidity, facial grimacing, and severe spasms with touch. The
mortality rate exceeds 70%.

GENERALIZED TETANUS
This is the most common type of tetanus, representing about 80% of cases. The generalized form usually presents
with a descending pattern. The first sign is trismus, or lockjaw, and the facial spasms called risus sardonicus,
followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms
include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur
frequently and last for several minutes with the body shaped into a characteristic form called opisthotonos.

The primary symptoms are caused by tetanospasmin, a neurotoxin produced by Clostridium tetani bacteria.

Treatment: Debriding wounds if necessary.

Supportive: If ventilation compromised Sedate, intubate NG tube. Tracheostomy if required.
Tetanus antitoxin.
Benzodiazepines for sedation, decrease rigidity, and control spasms.
Measles, aka rubeola, is one of the most contagious infectious diseases. Tt can affect people of all
ages, although primarily a childhood illness. Measles is marked by prodromal fever, cough, coryza,
conjunctivitis, and pathognomonic Koplik spots, followed by an erythematous maculopapular rash on
the third to seventh day. Infection confers life-long immunity.

Patients who have acute measles are generally immunosuppressed after, and can predispose them
to otitis media, pneumonia, bronchitis, and encephalitis. Acute measles encephalitis has a mortality
rate of 15% (and has no treatment).

Infection is transmitted via respiratory droplets, which can remain active and contagious. Children
who are immunodeficient, (eg. HIV/AIDS, leukemia, chemotherapy), and also infants who lose
passive immunity before getting vaccinated are at risk.

It is caused by the measles virus, an RNA virus of the genus Morbillivirus within the
familyParamyxoviridae.

Treatment: Supportive care:

IV resuscitation depending on dehydration.
Antipyretics, Antibiotics, Post-exposure prophylaxis.
Vitamin A supplementation
Tonsillitis is inflammation of the tonsils most commonly caused by viral or bacterial infection. When caused by
a bacterium belonging to the group A streptococcus it is typically referred to as strep throat.

Common S/S: pain in the ears or neckain in the ears or

sore throat neck

red, swollen tonsils

Common causes: (Viral)
pain when swallowing Common causes: (Viral)
1. adenovirus
fever 2. rhinovirus
coughing 3. influenza
4. coronavirus
headache 5. respiratory syncytial virus (RSV)
tiredness
Less Common causes: (Bacterial)
chills Staphylococcus aureus
a general sense of feeling unwell (malaise) Streptococcus pneumonia
Mycoplasma pneumoniae
white pus-filled spots on the tonsils Chlamydia pneumoniae
(exudates) pertussis
diphtheria
swollen neck nodes
TR: For discomfort: pain relief, anti-inflammatory, antipyretics, warm salt water gargle, lozenges
If group A streptococus penicillin or amoxicillin DOC. Cephalosporins and macrolides alternatives.
Rubellais a contagious viral infection best known by its distinctive red rash. Rubella is not the same
as measles (rubeola), though the two illnesses do share some characteristics, including the red rash.

The causative organism is a single-stranded RNA togavirus, transmitted by means of respiratory

droplets. The virus replicates in the nasopharynx and regional lymph nodes, resulting in viremia. The
virus then may spread to the skin, CNS, synovial fluid, and transplacentally to a developing fetus

S/S:

mild fever, conjunctivitis,

headache, swollen neck nodes,
rhinorrhea, aching joings,

a fine, pink rash that begins on the face and quickly spreads to the trunk and then the arms and
legs, before disappearing in the same sequence. The rash causes itching and often lasts for about
three days.

Treatment is supportive. Prevention via vaccination at 1 year and then again at 3-5 years.
NEONATAL HYPERBILIRUBINEMIA

Jaundice is a common, temporary and usually harmless condition in newborn infants. Bilirubin is an orange/red pigment in
the blood, and produced when RBCs break down. As it builds up, it deposits on the subcutaneous tissue and whites of the
baby's eyes to appear yellow.

Physiological jaundice: Most common cause (50%). Babys liver is immature, and bilirubin is processed slower.
The jaundice first appears at 2-3 days of age and usually disappears by 1-2 weeks, and its levels are harmless.

Breast-feeding jaundice: Baby does not drink enough breast milk. It occurs in 5% to 10% of newborns.

Breast-milk jaundice: Occurs in 1% to 2% of breast-fed babies caused by a special substance produced in the
breastmilk, that causes too large an amount of bilirubin reabsorbed from the intestines before the baby gets rid
of it in the stool. Starts at 4 to 7 days of age and may last 3 to 10 weeks. It is not harmful.

Rhesus or ABO incompatibility: If a baby and mother have different blood types, sometimes the mother
produces antibodies that destroy the newborn's RBCs causing a sudden buildup of bilirubin in the baby's blood.
This serious type of jaundice usually begins during the first 24 hours of life.

Treatment:
Breastfeed every 2-3 hours or supplement as advised for breastfeeding jaundice.
Phototherapy (light treatment) is the process of using light to eliminate bilirubin in the blood. Your baby's skin and
blood absorb these light waves. These light waves are absorbed by your baby's skin and blood and change bilirubin
into products, which can pass through their system. If bilirubin levels continue to rise despite phototherapy treatment,
he may need to be admitted to ICU for an exchange transfusion.
Tetralogy of Fallot (TOF) is a congenital heart defect which is classically understood to involve four anatomical
abnormalities of the heart (although only three of them are always present). It is the most common cyanotic heart defect,
and the most common cause of blue baby syndrome.

S/S:

cyanosis Clubbing Irritability

SoB Poor weight gain A heart murmur
Syncope Tiring easily during play
Tet spells - rapid drop in the amount of oxygen in the blood.- deep blue skin, nails and lips after crying, feeding, having
a bowel movement, or kicking his or her legs upon awakening.

Abnormalities:
A. Pulmonic stenosis: reduces blood flow to the lungs.

B. VSD: allows deoxygenated blood in the RV to flow into the LV and mix with oxygenated blood fresh from the lungs. It
dilutes the supply of oxygenated blood to the body and eventually can weaken the heart.

C. Overriding aorta.: The aorta is shifted slightly to the right and lies directly above the VSD receiving blood from both the
RV & LV, mixing the oxygen-poor blood from the RV with the oxygen-rich blood from the LV.

D. RV Hypertrophy: Due to the VSD and OA, the pumping action is overworked, it the muscular wall of the RV enlarges
and thickens. Over time this may cause the heart to stiffen, become weak and eventually fail.

Risk Factors: Maternal rubella, maternal alcoholism, baby born with downs, mother age >40, parent with TOF.

Treatment: Corrective surgery.

ERBS PALSY

Erbs palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically
the severing of the upper trunk C5C6 nerves. These form part of the brachial plexus, comprising the ventral
rami of spinal nerves C5C8 and thoracic nerveT1.

The most common cause of Erb's palsy is dystocia, an abnormal or difficult childbirth or labor. Neonates can
also be affected by a clavicle fracture unrelated to dystocia.

The paralysis can be partial or complete; the damage to each nerve can range from bruising to tearing. The
most commonly involved nerves are the suprascapular nerve, musculocutaneous nerve, and the axillary nerve.

The signs of Erb's Palsy include loss of sensation in the arm and paralysis and atrophy of the deltoid, biceps,
and brachialis muscles.[8] "The position of the limb, under such conditions, is characteristic: the arm hangs by
the side and is rotated medially; the forearm is extended and pronated. The arm cannot be raised from the
side; all power of flexion of the elbow is lost, as is also supination of the forearm

O/E: absent moro on that side, decreased grip.

Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months,
necessitate rehabilitative therapy, or require surgery.
A club foot, also called congenital talipes equinovarus (CTEV), is a congenital deformity involving one foot or both. The
affected foot looks like it has been rotated internally at the ankle. Occurs 1 in every live births, and 2:1 males female ratio.

Club foot is mainly idiopathic - the cause is unknown. Experts say the condition is not caused by the fetus' position in the
uterus. Sometimes club foot may be linked to skeletal abnormalities, such as spina bifida cystica.

A newborn's bones and joints are extremely flexible, and treatment usually begins in the first week or two after birth.
Options include:
Stretching and casting (Ponseti method)
The foot is moved in the correct position and held by a cast, and repositioned once a week for several months. Surgery to
lengthen the Achilles tendon toward the end of this process is also done. Having realigned the shape of the foot, parents must
maintain it by doing stretching exercises, using special shoes and braces and making sure they are used as long as needed.
Stretching and taping (French method)
Working with a physical therapist, parents move the foot daily and hold it in position with adhesive tape. A machine is used
continuously move the baby's foot while he or she sleeps. After two months, cut treatment back to three times a week until the
baby is 6 months old. Once the shape is corrected, continue to perform daily exercises and use night splints until the baby is of
walking age. Greater time commitment than Ponsetti. Can also be combined with Ponsetti method.
Surgery
In some cases, when clubfoot is severe or doesn't respond to nonsurgical treatments, babies may need more invasive surgery.
An orthopedic surgeon can lengthen tendons to help ease the foot into a better position. After surgery, your child will be in a
cast for up to two months, and then need to wear a brace for a year or so to prevent the clubfoot from coming back.

Even with treatment, clubfoot may not be totally correctable. But in most cases babies who are treated early grow up to wear ordinary
shoes and lead normal, active lives
.
TINEA VERSICOLOR

Tinea versicolor is a fungal infection of the skin. It's also called pityriasis versicolor and is caused by a type of
yeast that naturally lives on your skin( malessezia furfur also implicated in causing dandruff and seborrhoeic
dermatitis). When the yeast grows out of control, the skin disease, which appears as a rash, is the result.
Acidic bleach from the growing yeast causes areas of skin to be a different color than the skin around them.
These can be individual spots or patches.

Treatment:
Topical anti-fungals OTC: selenium sulfide, miconazole, clotrimazole, and terbinafine.
Presciptions anti-fungals may be needed.
Anti-fungal pills: These may be used to treat more serious or recurrent cases of tinea versicolor. Or in
some cases for a simpler and quicker resolution of the infection.

Treatment usually eliminates the fungal infection. However, the discoloration of the skin may take up to several
months to resolve.
TINEA CAPITIS is a superficial fungal infection (dermatophytosis) of the scalp. The disease is primarily caused
by dermatophytes in the Trichophyton and Microsporum genera that invade the hair shaft.
It may appear as thickened, scaly, and sometimes boggy swellings, or as expanding raised red rings
(ringworm).
The treatment of choice by dermatologists is a safe and inexpensive oral medication, griseofulvin x 1/12.

TINEA CORPORIS is a superficial dermatophyte (Microsporum, Epidermophyton and Trichophyton.) infection

characterized by either inflammatory or noninflammatory lesions on the glabrous skin (ie, skin regions except
the scalp, groin, palms, and soles).
The lesion begins as an erythematous, scaly plaque that may rapidly worsen, enlarge, may become annular in
shape. As a result of the inflammation, scale, crust, papules, vesicles, and even bullae can develop, especially
in the advancing border.
Topical antifungal creams or in difficult to treat cases systemic treatment with oral medication may be required.

The most commonly used antifungal creams are clotrimazole, ketoconazole, miconazole, terbinafine,tolnaftate,
and butenafine.

The antifungal medications most commonly used are itraconazole and terbinafine.