Foreign bodies of the larynx and trachea in children

A child's body is a developing system that, due to its immaturity, is especially susceptible to infections and viruses. Some diseases especially easily affect children's bodies. Such pathologies include reactive pancreatitis - spasm of the excretory ducts of the pancreas. Today, the concept of “reactive pancreatitis” is not used among gastroenterologists, but it can still be found in pediatric practice1.

Reactive pancreatitis cannot be called a separate disease. Rather, it is a reaction to viral influence, a malfunction of the gastrointestinal tract, or improperly organized nutrition1.

This form of inflammation of the pancreas in children most often develops as a chronic problem, but in cases of systematic malnutrition, an exacerbation of the disease is possible.

"Chop" how much? History of blowing or cheating

In Dagestan, a method from the arsenal of traditional medicine – chop removal – has long been popular.
The essence of the procedure is that the chop removal specialist, usually a woman, blows through the patient’s nasopharynx with his mouth through the nostrils and, using air pressure, pushes out the stuck foreign objects, which “fly out” through the patient’s mouth. Most often, the clients of “chopchi”, as they are called, are children. The child has a poor appetite, fever or other slightest manifestation of malaise - and some mothers immediately rush to healers who remove chops, which they learn about from relatives, friends or from advertisements posted around the city.

Molodezhka, with the help of certified doctors, tried to figure out whether this method really has a healing effect.

The word "chopchi", as described in Wikipedia, means "gatherer of brushwood" or "the art of blowing lumps."

This is a healing practice in traditional Azerbaijani medicine, which consists of “blowing” out of the throat and nose of children and adults pieces of food stuck there or carelessly swallowed small objects (seeds, bones), which, according to belief, can cause illness in children, cause vomiting, feeling unwell, high fever, diarrhea.

To blow or not to blow?

A Molodezhka correspondent found people who have experienced “chop removal” themselves.

Malaikat Mansurova encountered such a problem as a security guard at the age of 24. She didn’t believe it, she says, but it turned out to be true. There were no symptoms, only a feeling of heaviness in the throat and bad breath.

– I saw an otolaryngologist. The doctor said there was redness and prescribed rinses and antibiotics. After treatment, the discomfort in the throat did not go away. I don’t know, maybe I got an incompetent doctor. I don't dare to judge. I often heard the common diagnosis in our republic - chop, but did not believe that this could happen in adults.

Out of desperation, I decided to go, especially since a woman lived not far from us who cleans them. To be honest, I didn’t know how the process itself went. She sat me down on a chair, massaged my throat hard, until sparks came from my eyes, and blew into my nose! At that very second, a swollen sunflower seed and a small chicken bone flew out of my mouth. To say that I was shocked is to say nothing.

Since then I began to believe. How can you not believe it if you’ve experienced it yourself?

***

The grandmother of schoolboy Abdulla Khanumaga Mirzegasanova says that once they had to “kidnap” the boy from an infectious diseases hospital in the middle of the night and take him to a healer whom a neighbor praised.

“He was two years old then.” The child was burning all over, the temperature did not subside, he was vomiting and swearing. Abdullah's mother gave it to us through the transfer window at the hospital. And so we, my grandparents, took him to clean up the chop. Somehow they begged us to be accepted. The healer was already asleep, but she came to her senses.

I blew out a piece of meat and cucumber. This woman told us to eat the yolk of a hard-boiled egg to speed up the healing. And we took the boy back to the hospital. The next day, the child ate the entire can of pilaf that his mother brought for him and him. The temperature subsided and he recovered.

Illustration: rhinos.rf.

***

The mother of three-year-old Amir Tamila Abdullaeva tells her story.

– I heard that there are charlatans who build businesses on children’s chops. They have a fixed rate - 400 rubles. Usually blowers take as much as you give them.

And they give you 100-200 rubles, but you go to them often. It’s the charlatans who get hooked on the “chronic” crisis, because the more often you apply, the more they profit.

If you go to them every week, I think you need to look for the cause of the disease no longer in the chop itself...

But one day my son Amir began to feel unwell: he stopped eating, was losing weight before our eyes, and was acting up. When the temperature rose and the child became completely weak, she called an ambulance. The medications prescribed by doctors did not help, and I decided, as it seemed to me then, to take extreme measures. Based on the advice of people like me, my mother found a healer right away.

I apologize for the naturalism, but after she blew out clots of sputum with rot and a piece of apple from the child, he, having cried and calmed down, began to recover. He immediately asked me to eat. A week later I regained my previous weight. She took as much money from us as I gave myself, that is, she did not have a fee. I don’t know if we were lucky or what, but we came across a good blower.

Fortunately, such troubles did not happen again.

***

Imara Atlukhanova said that just the other day she took her child to clean up the chop.

“We visit her more often than our relatives—almost every week.” Two children - one gets stuck on something, then the other. They say this happens until the age of five. I don't know if this is actually true. The day before yesterday we blew out six pieces of cucumber. After this my appetite returned instantly!

Initial examination

– I do not welcome the method of removing a chop by blowing and do not recommend turning to such “healers”, although there is a category of people who are sure that you should always use so-called folk methods. This is their opinion, their right,” says therapist Khanum Aliyeva.

– It will not be difficult for an ENT doctor to reliably establish whether there is something in the nasopharynx. As a therapist, for any manifestation of any symptoms, I recommend turning not to amateur healers, but to specialists, because treatment does not end with the so-called blowing.

There should be an initial examination of the nasopharynx by a pediatrician and pediatric otolaryngologist, who will make a diagnosis and prescribe treatment.

Lorklinika1.ru.

The respiratory tract is at risk

Pediatrician Madina Ismailova also does not support, as she says, “these dubious methods.”

- Is it dangerous. Blowers can blow stuck particles into the respiratory tract, and the child may simply suffocate or end up on the operating table. I had a case where such “miracle doctors” blew nuts and wild onions into the lungs, and the child needed a bronchoscopy. Pulmonary atelectasis may occur. All this entails longer treatment and severe consequences.

To be honest, at the reception, some mothers admit that they have already been to the “healers”, but after they cleared, only complications began.

And in general, haven’t you thought about the fact that this person who is blowing the air could be infected? From any point of view, this is unethical, unaesthetic, unhygienic and unsafe.

Not a single doctor will recommend the method of blowing or purging, but, unfortunately, our people have such a mentality: they no longer listen to doctors, but to word of mouth - neighbors, girlfriends, acquaintances... A medical alternative to these “swindlers” is an examination by a competent therapist and otolaryngologist in under sterile conditions.

pilmohealth.com.

ENT to help

Otolaryngologist Semed Javadov believes that it is impossible to blow out small bones from fish or chicken, because they stick into the mucous membrane.

– Remember the expression: when I eat, I am deaf and dumb? Why can't you eat and talk at the same time? Because food is thrown back into the nasopharynx, when inhaling, for example. As an ENT specialist, at the first suspicion that something is stuck in the nasopharynx, I advise you to come to an appointment.

Do not look for solutions from any charlatans, they will not help you. First we need to find out the reasons why this happened. If this is a mechanical action (childish curiosity, careless inhalation, talking while eating), then the specialist will simply pull out all the excess from the nasopharynx.

If the cause is a disease, it will be necessary to undergo a course of treatment.

Help or quackery?

Doctor of Medical Sciences, chief otolaryngologist of the Ministry of Health of Dagestan Yunuskadi Dzhamaludinov says that chopchi has been known for a long time, but their services have become especially popular recently.

– Many people appeared who called themselves healers. But to me, they are charlatans. Imagine the complex anatomical structure of the nose, nasopharynx and oropharynx.

In addition, you need to know physiology.

When these charlatans undertake to help poor people, they psychologically influence them (and they are well versed in the methods of psychological influence), suggesting that this is actually an easy path to recovery.

I used to work at the Republican Clinical Hospital. There was a general section for children and adults. We came across difficult cases. “Chop players,” instead of blowing out/removing the foreign body, only made everything worse. The foreign body passed further into the respiratory tract.

So we had to extract it with special tools. Bronchoscopy is usually performed here.

At that time, this intervention was quite crude: we had to use a metal bronchoscope to climb even into the lower sections of the respiratory tract and pull out some watermelon seeds and everything that they blew out and that got stuck in the small bronchi. Sometimes we even had to open the trachea...

Now there are new endoscopes, and it is much easier to do this. The endoscopic system allows you to take an image of any part of the nasal cavity. Even the narrowest places can be reached with an endoscope and everything can be illuminated and seen on the screen in an enlarged form.

I can invite any of these charlatans: let them bring the patient, first we will examine his nasal cavity and nasopharynx with an endoscope. And I will show them that there is nothing there and cannot be. They invent this themselves.

Just in case, they always have any foreign body in their pocket. They talk to the patient in advance, distract them, and at the right moment they pull out what they need. And then they pass it off as the “results” of their work.

Most often it is an apple peel, a piece of banana, pear, watermelon seed, piece of paper, cotton wool... You name it.

In general, there is no explanation for this other than sleight of hand.

Regina Kurbanova

Source: //md-gazeta.ru/obshhestvo/74720

Survey

In order for a doctor to diagnose food poisoning, as a rule, it is enough to carefully interview the parents and examine the child. Sometimes the doctor may additionally prescribe:

a blood test to see if symptoms are caused by a bacterial or viral infection;
stool analysis to rule out infection caused by abnormal bacteria;
If an examination by a surgeon is required, he may also prescribe an additional examination.

Online consultation with pediatrician Olga Nikolaevna Tekutyeva

Registration online

During the consultation, you will be able to voice your problem, the doctor will clarify the situation, interpret the tests, answer your questions and give the necessary recommendations.

About security in children's institutions. A little look from the inside

Although I work in a different area of security, one day the security guard who guards the school in our private security company fell ill, and I was asked to come in for one shift and replace him. What I saw:

The school has 1500 children in 2 shifts. And I'm alone. It's impossible to keep track of everyone.

There are metal detector frames, but they are for show and generally it is not clear why.

When the food is delivered, I have to stand by the car and look to see what... But I don’t know what I’m supposed to look there. According to the instructions, he must be present during unloading and accompany the car to the gate. And the fact that at the same time the post (checkpoint, the main entrance, that is) without security does not bother anyone.

Every hour I have to go around the school and check whether the vile ISIS members (banned on the territory of the Russian Federation) have planted a bomb. The post is again unattended. And leaving to go to the toilet is a crime, because I left my post.

I understand parents who are not allowed to go to school - this is their child, they want to know what is happening at school.

Plus, they were in full swing preparing for the talent competition, about 500 parents came in and out during the day, and I repeat, alone. I stopped writing them down in the journal in the first half of the day, just for show.

I just need to go to the toilet - that would be a violation. I’m kind of leaving, no, not like that, I’m leaving my post. At one's own risk.

In the morning, when I came for my shift, together with a security guard, a group of 5 accountants stood as a wall at the entrance, turning away parents. From the outside it looked as if you had come to the CIA headquarters.

But the next morning, at the end of my shift, one mother harshly trolled this stupid, ostentatious system: she took out an unfolded passport, much like American police officers take out their badges in action movies, said that she had the right to accompany the child, her husband turned on the camera and she calmly passed .

I didn’t even write it down in the visit log, I just found it funny because of the evil-looking teachers. In general, these moments amused me. I just stood and watched this circus, as parents squabbled with teachers. It was funny.

There are some children who have diabetes. How can I not let my parent in? Of course, I ignored these rules and skipped them, writing them down in the visitor log. Because the administrator on duty was not there (she should accompany visitors around the school, but if she accompanied everyone, this would require a whole staff of duty administrators).

There are also children who cannot undress themselves. But that's not the question. And the question is why parents cannot help a child if he is not able to. Grandparents came to pick up their grandchildren 15 minutes before the end of classes (again, I don’t want to judge why, they wanted to come earlier).

The hall is full of benches and various armchairs, but no, I don’t have the right to let them in and they are standing in the vestibule in 30 degrees below zero.

I don’t understand all this strictness and access control regimes - it’s all for show. Someone has already correctly written that this is all in order to relieve oneself of at least part of the responsibility.

If something serious happens and the school administration turns on the parrot Kesha, “What are we, we’re nothing, it’s the security guard who should monitor the access control, we pay them money, and they’re lazy, idle, punish them.”

By the way, my teachers told me: “It’s your responsibility, why should you and I stand here and unwrap our parents and freeze our precious little feet. They pay you a lot of money, and we are teachers.”

And to my question, how am I supposed to single-handedly let 1,500 children a day in and out (even though it’s impossible to remember them all) to about 500 parents who love to quarrel (just imagine quarreling with everyone, that’s what nerves you must have) plus various visitors (inspectors, food delivery, technicians, electricians), plus watching the gate when the products are delivered, they told me “your problems, you are paid, so solve them.” And the fact that I’m not a wizard and the fact that they pay us for protection, I won’t be able to provide them with security at the level of a secret military base, they don’t care. The contract amount is 1.5 million rubles (I found out from a folder with official documentation). This includes a fire alarm, panic button and maintenance of all security systems, including cameras. All inclusive type. Many will think - a lot. But if you count: the security guard’s salary, taxes, deductions, the maintenance of the State Security Bureau, gasoline (after all, according to the instructions, the security guard is obliged to press the button at the slightest provocation), the salary of other employees (accountants, personnel officers, security engineers) does not come out that much, I would say it remains meager net profit. Yes, yes, my naive friend, 1.5 million wooden ones is not a lot in our time, if you want security at the level of Fort Knox. The only reason why Chops like to work with schools and kindergartens is that they pay on time and without delays. We signed the certificate of completion of the work and the next day the money was in our pocket (in our current account).

Who wrote: “So what should we leave now without any security at all?” Here, as the singer Maksim sang, my answer is yes. Seriously. For the first time in 5 years of working as a security guard, I felt like I was useless, present in this place, simply because I was supposed to. At night, when it became quiet, I rattled off in my head a dozen ways to enter the school unnoticed or without arousing the suspicion of the guard.

And this does not include cases of open penetration and neutralization of a security guard. It's better to spend this money on something important. Security in such institutions is nothing more than a screen put up by the state to reassure the people, like “look, professional security, your children are protected, the state takes care of its young citizens, it spends MILLIONS on contracts with private security companies.”

When I read headlines like this, it makes me laugh. This is dust in the eyes. Creating visibility, call it what you want. That is, I then understood that if I were removed from this school, nothing would change. This will not make the school any less or safer. Moreover, many security guards do harm, because theft of school property is common among my colleagues.

Our security guard has had countless cases where a security guard stole something from a school. It’s just that many people don’t want to admit that in our world you can die at the hands of a psychopath in broad daylight in a crowded place. You always need to look for the culprits. For some reason, it doesn’t happen that this is just a fatal coincidence.

That no one is to blame (except the killer, of course, although given his mental disorder, I don’t know how applicable this is).

There must be someone to blame: a security guard, a teacher, the FSB, the police, you see, criminals are walking around the city. Or a psychiatrist at worst. He should have isolated him from society in the dark.

And the fact that neither the police, nor the FSB, nor a psychiatrist has the gift of Charles Xavier and not a single psychiatrist can say when a mentally healthy person decides to stage a postal 2 or manhunt in real life does not bother anyone.

For some reason, I always remember Charles Whitman in such cases: there was a healthy guy who served in the Marine Corps and there was no objective reason to believe that he would experience a phase shift. And one “beautiful” day he killed his mother, barricaded himself in a high-rise building and sent a bunch of people to the next world with a rifle.

Or, for example, one of your loved ones was killed by lightning. You won’t blame the state or anyone else for the fact that they are to blame for not installing a lightning rod on every corner. And you can’t put a security guard or a policeman on every corner.

Reminds me of the situation with doctors: if the patient died, then the doctor is bad and killed the patient. And the fact that with all the fantastic achievements of medicine you can die from a splinter in your finger, or the patient would have died in any case, does not bother anyone. There must be a culprit. So it goes.

And don’t forget: the salaries of school security guards are low. They either take women there or pensioners who may have a disability (I’m serious). It is generally difficult to expect heroism from them. The most they can do is press the panic button in time.

So, for me, it’s easier to install emergency buttons on the walls in plastic boxes (like firefighters who only call the National Guard) and pay the National Guard for remote security. And it will be ten times cheaper and more effective, because their prices for remote security are very affordable. The school security guards you see now are useless people.

And the point is not that they take just anyone there and they are all drunkards/idlers/thieves (underline as appropriate), but that one in the field is not a warrior.

I wouldn’t be surprised if they now station a company of armed riot police in that ill-fated kindergarten and check everyone more seriously than at the checkpoint at “Area 51” in Nevada. Naturally, bureaucrats need to report on the work done.

What's the point of all this: the security guard will, of course, be found guilty, perhaps even imprisoned - it's a high-profile case. But to me he is nothing more than a scapegoat. There are no guilty parties here.

There is no protection from mental disorders of the people around us. When the next killer like this will happen, and who they will be, it will be almost impossible to figure out.

And as I already said, you can’t put a special forces company in every kindergarten; the budget will simply go broke to support such an army.

And by the way, after that shift I decided never to substitute in schools and kindergartens again.

Source: //pikabu.ru/story/pro_okhranu_v_detskikh_uchrezhdeniyakh_nebolshoy_vzglyad_iznutri_7025253

Differences between diarrhea and loose stools

Any mother should clearly know what distinguishes diarrhea in a 1-2 year old child without body temperature from loose stool. Loose stools may appear periodically. All children, without exception, face this. Loose stools can be caused by drinking a large amount of juice, as well as a consequence of a viral infection or some other disease.

Diarrhea is very loose stool. With diarrhea, the child goes to the toilet up to five times a day. This malaise poses a danger to the child - it provokes a lack of water in the body.

Chop symptoms in children

Glanders is an acute infectious disease characterized by the formation of pustules (ulcers), ulcers, and multiple abscesses (purulent inflammation of tissue) in internal organs on the skin and mucous membranes.

The causative agent of glanders is a bacterium (Pseudomonas mallei). The disease is most often transmitted to humans from sick animals (for example, horses, mules, donkeys) through tactile contact (touching).

The pathogen enters the body through minor damage to the skin (for example, a scratch, burn).

Symptoms of glanders in a child

Acute onset (chills, elevated body temperature, muscle and joint pain).
A bright red spot (nodule) forms at the site of pathogen penetration.
During the day, the spot on the skin turns into a blister with bloody contents.
After 1-3 days, the blister bursts and an ulcer forms in its place.
The glandular ulcer is crater-shaped; on the skin around it, the same opening nodules with dead, decaying contents appear.
Swelling of the affected area.
Damage to facial skin.
The contents of spots and ulcers are carried into the body by the bloodstream and affect internal organs (for example, liver, spleen, lungs, heart).
With the development of damage to internal organs, the condition worsens sharply: body temperature rises again;
blood (arterial) pressure drops, pulse quickens;
cough occurs as a manifestation of damage (inflammation) of the lungs;
mucous and bloody discharge often comes out with a cough, wheezing can be heard in the lungs;
skin lesions become more extensive;
body temperature rises and falls during the day (a difference of 3-4 degrees);
joint damage (pain, swelling, impaired mobility).

Forms of glanders in a child

Acute glanders.

Acute onset of the disease.
Skin lesions in the form of characteristic ulcerations (ulcer formation) only at the site of bacterial penetration.
Rapid spread of the infectious process to internal organs (for example, liver, lungs).
High body temperature, rapid development of skin symptoms in the form of blisters, which then ulcerate.
Chills, weakness, muscle-joint pain.
A bright red spot (nodule) forms at the site of pathogen penetration.
During the day, the spot on the skin turns into a blister with bloody contents.
After 1-3 days, the blister bursts and an ulcer forms in its place.
A glanders ulcer looks like a volcano crater; new nodules appear on the skin around it; they open on their own, forming together an even more extensive ulcer.
Swelling of the affected area.
Damage to facial skin.
The contents of spots and ulcers are carried into the body by the bloodstream and affect internal organs (for example, liver, spleen, lungs, heart).
With the development of damage to internal organs, the condition worsens sharply: body temperature rises again;
blood pressure drops, pulse quickens;
cough occurs as a manifestation of damage (inflammation) of the lungs;
mucous and bloody discharge often comes out with a cough, wheezing can be heard in the lungs;
skin lesions become more extensive;
body temperature rises and falls during the day (a difference of 3-4 degrees);
joint damage (pain, swelling, impaired mobility).

Chronic glanders:

gradual development of the disease;
increased body temperature, weakness;
body temperature can change unpredictably, sometimes falling, sometimes rising;
muscle-joint pain manifests itself with less force;
these symptoms of acute glanders are extended in time and less intense;
multiple pustules (vesicles with purulent contents) appear on the skin, most of them burst, and ulcers form in their place;
purulent foci (inflammation with pus in the center) arise in the muscles, some of them open to the surface of the skin;
Inflammation of the lungs caused by the glanders bacterium often occurs; it is distinguished from ordinary inflammation by the formation of inflammatory foci with purulent contents in their center; such ulcers (abscesses) form in large numbers and are difficult to treat;
loss of muscle mass increases up to pronounced thinness;
Serious changes in metabolism occur, outwardly they are manifested by pallor of the skin up to a porcelain white color, the tongue becomes large, dense, loses mobility, yellow nodules (dense, discolored areas on the skin) and plaques (similar to nodules, but rising above) appear on the skin. the skin is not in the form of a tubercle, but with well-defined edges).

Causes of glanders in a child

The disease is rare among people.
A person becomes infected through tactile contact (touching) with sick animals (for example, horses, mules, donkeys).
The glanders bacterium is transmitted through damaged skin, feed, water, food, and purulent secretions of a sick animal.

LookMedBook reminds you that this material is posted for informational purposes only and does not replace medical advice!

Diagnosis of glanders in a child

Analysis of complaints and medical history (when body temperature appeared, pain in muscles and joints, etc.).
Analysis of the epidemiological history (whether the sick person had contact with animals, which ones, when, etc.).
For diagnosis, the isolation of glanders bacteria from ulcers and ulcers is used (they take the contents of ulcers and grow bacteria from it on special nutrient media).
Determination of the level of antibodies (specific proteins of the immune system, the main function of which is to recognize the pathogen (virus or bacteria) and its further elimination) in the blood using special laboratory tests: agglutination reaction (RA) and complement fixation reaction (CFR).
A consultation with an infectious disease specialist is also possible.

Treatment of glanders in a child

Treatment for glanders takes place in a hospital. Patients are isolated in the department for especially dangerous infections.
Antibiotic therapy for at least 25 days.
The abscesses are carefully opened and treated using surgical instruments and antibacterial agents.
Detoxification therapy (aimed at eliminating intoxication - poisoning by bacterial waste products).
General restorative treatment: vitamins, inhalation of gas mixtures with a high oxygen content.
Treatment of associated disorders (low blood pressure, pneumonia (pneumonia), affected joints, etc.) is also carried out.

Complications and consequences of glanders in a child

Damage to vital organs: lungs, heart, liver.
Even after recovery, disturbances in the affected organs may persist (for example, if the process has affected bones and ligaments, motor function may not be fully restored; similarly, disturbances may persist in the internal organs).
If glanders is not treated, the prognosis is always unfavorable.

Prevention of glanders in children

The overwhelming majority of cases of the disease are of an occupational nature (those whose work is related to the care and breeding of horses, mules, donkeys - drovers, cattle breeders, jockeys) are affected.
Since infection occurs through tactile contact (touch) with a sick animal, special attention must be paid to the condition of the animals (regular veterinary control).
Avoid contact with those animals from which you can become infected (horses, mules, camels, donkeys) and with all their secretions and feed.
Sick people are isolated in specialized departments for especially dangerous infections.
If infection is suspected, patients are observed for 21 days, with a ban on leaving the city and visiting public places.

Non-traditional treatment for reflux

System of endoscopic signs of GER in children (according to G. Tytgat as modified by V.F. Privorotsky et al., 2002)

Morphological changes

0 degree. There are no signs of damage to the esophageal mucosa.

I degree. Moderate focal erythema and (or) friability of the mucous membrane of the abdominal esophagus.

II degree. The same + total hyperemia of the abdominal esophagus with focal fibrinous plaque and the possible appearance of single superficial erosions, often linear in shape, located at the tops of the folds of the mucosa.

III degree. The same + spread of inflammation to the thoracic esophagus. Multiple (sometimes merging) erosions located in a circular pattern. Increased contact vulnerability of the mucous membrane is possible.

IV degree. Esophageal ulcer, Barrett's syndrome, esophageal stenosis.

Motor disorders

A. Moderately expressed motor disturbances in the area of the LES (raising of the Z-line up to 1 cm), short-term provoked subtotal (along one of the walls) prolapse to a height of 1–2 cm, decreased tone of the LES.

B. Clear endoscopic signs of NKJ, total or subtotal provoked prolapse to a height of more than 3 cm with possible partial fixation in the esophagus.

B. The same + pronounced spontaneous or provoked prolapse above the crura of the diaphragm with possible partial fixation.

Histological examination of biopsy specimens of the esophagus and (or) stomach, as well as x-ray examinations of the upper gastrointestinal tract are carried out according to standard methods and are described in the relevant manuals.

The “gold standard” for determining pathological GER is daily pH monitoring, which allows not only to record the fact of reflux, but also to determine its nature (physiological or pathological). The study is carried out using Gastroscan-24 (Russia) or Sinectics-medical AB (Sweden) devices. To date, there are no uniform standards that allow us to definitely establish the connection between GER and bronchial obstruction. To document this fact, equipment is needed that allows one to simultaneously assess respiratory function and register GER. Therefore, various indices are currently being developed to judge the presence of such a relationship [9].

The principle of the acid perfusion test (Bernstein test) is to assess the child’s subjective sensations during artificial acidification of the lower third of the esophagus with a 0.1% solution of hydrochloric acid (or pure lemon juice, the pH of which is known). The test is assessed as positive in cases where the child experiences chest pain or heartburn in the first 3 minutes of the test.

The basic method for studying the functional state of the lungs is spirometry (study of external respiration function). The study is carried out using a computer spirograph, in which air flow is measured using flow meters, and the volume is calculated by integrated flow.

Bronchoprovocation tests allow us to determine the reactivity of the tracheobronchial tree. Tests with methacholine and histamine are carried out only during remission. These irritants directly affect the bronchi, which have smooth muscle fibers. This leads to a reduction in the latter, stimulation of cholinergic activity and an increase in vascular permeability. In low concentrations, these drugs do not have side effects and do not cause long-term broncho-obstructive reactions.

Pulse oscillometry allows you to determine the components of total respiratory resistance (friction and reactance in a certain frequency range).

In the above diagnostic algorithm there is no mention of scintigraphy of the esophagus (to confirm the fact of reflux) and lungs (to ascertain aspiration of gastric contents into the lungs) using food labeled with a technetium isotope. The limited data available in the literature indicate the low sensitivity of this method [3,6,8,9].

One of the key questions of the “relationship” of GER and BA is the following: does GER play the role of the only triggering point of the bronchial obstruction mechanism or does it act as an integral part of some combined mechanism?

In the latter case, there may be a triple component of the triggering of bronchial obstruction: atopy, infectious dependence and GER. What place does each factor occupy on this kind of “pedestal of honor”? This is a question, the answer to which would significantly facilitate the development of adequate treatment programs and allow us to avoid the formation of forms of AD that are torpid to the basic treatment.

Unfortunately, there is no exact answer to this question yet, and we have to come to terms with the fact that in real life we have only two situations that allow us to associate GER with bronchial obstruction syndrome or BA: 1) “pure” GER-dependent variant; 2) a variant in which GER plays a certain negative role in the genesis of AD along with other factors.

CF, unlike AD, is not a model of a “classical” GER-dependent disease, and the relationship between GER and CF is less clear. However, the disorders that occur with CF, such as increased intra-abdominal pressure during coughing, slower gastric emptying, impaired motor function, increased production of hydrochloric acid, are “fertile ground” for the occurrence of GER and the development of GERD.

How is diarrhea not accompanied by fever treated?

Diarrhea should be treated by drinking plenty of fluids, as well as introducing a large amount of vegetables and fruits into the child’s diet. But it is recommended to remove complex carbohydrates and carbonated water from the diet.

After the specialist determines the cause of diarrhea, some additions will be made to the baby’s diet. For example, a child may be prohibited from consuming whole milk, fiber and fats. With all the diet, the baby will have to be given medications prescribed by the doctor.

To prevent diarrhea in a two-year-old baby , parents should carefully monitor the child’s diet, as well as the cleanliness of his hands before and after eating, as well as after visiting the toilet. Children need to be taught hygiene skills from an early age.

Prevention

Inflammation of the paranasal sinuses is a disease that is very often diagnosed in children of any age. Usually occurs against the background of reduced immunity. Taking this into account, maximum attention should be paid to measures that will restore and strengthen the body's defenses. Doctors advise starting to take care of this from childhood. It is very important to provide a balanced diet rich in vitamins and minerals.

Children's multivitamin complexes "Vitrum" and "Azbuka" have proven themselves very well. If the child is not allergic to the components of the drugs, use immunomodulators - pharmaceutical and natural (ginseng, echinacea, lemongrass, etc.).

Always try to properly treat seasonal infectious diseases - colds, flu and other diseases - until complete recovery. One possible cause of rhinosinusitis is dental disease. Particular attention should be paid to the treatment of the teeth of the upper jaw. Living a full life, daily physical activity and proper nutrition will help your child stay fit and get sick less often. Sinusitis is dangerous due to severe complications. Constant headaches and prolonged runny nose - such symptoms should cause vigilance in parents. You should not self-medicate. The best option is to consult a doctor immediately. Only he will be able to determine the cause of the illness and select therapy taking into account the individual and age characteristics of the child.