South Africa is also committed to other arrangements in the region. In general, the intensity of surveillance is a product of social i. Int J Clin Pract. Is the pharmaceutical industry, whose profits are based on large segments of the population suffering from major illnesses, interested in eliminating their customer base? There are national committees in 38 [industrialized] countries, each established as an independent local non-governmental organization.
The Girl Star  project is a series of films which documents stories of girls from the most disadvantaged communities across five northern states in India who, through via education, have managed to break socio-economic constraints to make a success of their lives and become self-sufficient. These young women have grown to become role models in their communities, inspiring younger girls to go to school and continue their education. Kids United is a French musical group of four children six children when the group was formed born between and The first album Un monde meilleur A better world was launched on Universal Children's Day in , it received gold certification in France.
UNICEF Ambassadors are leaders in the entertainment industry, representing the fields of film, television, music, sports and beyond. They help raise awareness of the needs of children, and use their talent and fame to fund-raise, advocate, and educate on behalf of UNICEF. Until the facilities was a 25,m 2 warehouse at Marmormolen in Copenhagen. With construction of a 45,m 2 UN City that is to house all UN activities in Copenhagen under one roof,  the warehouse service has been relocated to outer parts of the Freeport of Copenhagen.
The centre, formally known as the International Child Development Centres, has as its prime objectives to improve international understanding of issues relating to children's rights, to promote economic policies that advance the cause of children, and to help facilitate the full implementation of the United Nations Convention on the Rights of the Child in industrialized and developing countries.
It reaffirms the centre's academic freedom and the focus of IRC's research on knowledge gaps, emerging questions and sensitive issues which are relevant to the realization of children's rights, in developing and industrialized countries. It capitalizes on IRC's role as an interface between UNICEF field experience, international experts, research networks and policy makers and is designed to strengthen the centre's institutional collaboration with regional academic and policy institutions, pursuing the following goals:.
UNICEF has a policy preferring orphanages only be used as temporary accommodation for children when there is no alternative. UNICEF has historically opposed the creation of large-scale, permanent orphanages for children, preferring instead to find children places in their extended families and communities, wherever possible.
This has led UNICEF to be skeptical of international adoption efforts as a solution to child care problems in developing countries; UNICEF has preferred to see children cared for in their birth countries rather than be adopted by foreign parents. Major news outlets such as US News have asserted UNICEF's intervention that on giving large cash payments to developing countries can lead to a cessation of international adoptions until all of its recommendations are in place, and have even labeled UNICEF a "villain" for the extent of its negative impact on orphans.
One concern is that the child mortality rate has not decreased in some areas as rapidly as had been planned, especially in Sub-Saharan Africa, where in "the region still has the highest child mortality rate: From Wikipedia, the free encyclopedia.
Cartoons for Children's Rights. This section needs to be updated. Please update this article to reflect recent events or newly available information. United Nations portal Hunger relief portal. Retrieved 4 April Children, Women and Human Rights p. Retrieved 9 July The Irish Times , July 25, Retrieved 24 February Retrieved 16 December Diaphragms can rarely be double. Anastomotic malfunction requiring prolonged intravenous nutrition and hospitalization has prompted development of a diamond shape larger stoma.
Tapering or plication of the dilated duodenum is another effective method of improving disturbed transit. Other complications after surgery are megaduodenum with blind loop syndrome, biliary reflux, cholestatic jaundice, delayed transit and bowel obstruction.
Early mortality is associated to prematurity and associated malformations. Long-term follow-up is warranted to identify late problems. The diagnostic characteristics are: The rotation and normal fixation of the intestinal tract takes place within the first three months of fetal life.
In the earliest stages when the intestinal tract is recognizable as a continuous tube, the stomach, small intestine, and colon constitute a single tube with its blood supply arising posteriorly.
The midgut portion of this tube, from the second portion of the duodenum to the mid-transverse colon, lengthens and migrates out into an extension of the abdomen, which lies at the base of the umbilical cord. Here this loop of bowel undergoes a degree counterclockwise twist at its neck.
In the center of the twisted loop lie the blood vessels that will become the superior mesenteric artery and vein. After rotation, the small intestine quite rapidly withdraws into the abdominal cavity, with the duodenum and the proximal jejunum going first. During this process the duodenojejunal junction goes beneath and to the left of the base of the superior mesenteric vessels.
This leaves the upper intestine, including the stomach and the duodenum, encircling the superior mesenteric vessels like a horseshoe with its opening on the left side of the embryo. The small intestine then follows into the abdomen, and withdrawal of the right half of the colon takes place so that it lies to the left. At the next step, the cecum and the right colon begin to travel across the top of the superior mesenteric vessels and then down to the right lower quadrant.
The colon now lies draped across the top of the superior mesenteric vessels, again like a horseshoe, with its opening placed inferiorly. The duodenojejunal loop is said to attach to the posterior abdominal wall soon after its turn, whereas the mesenteric attachments of the entire colon and of the remaining small bowel gradually adhere after they arrive in their normal positions. In malrotation the right colon can create peritoneal attachments that include and obstruct the third portion of the duodenum Ladd's bands.
The diagnostic hallmarks are: A UGIS is more reliable than barium enema, most patients present in first month of life neonatal , but may present at any time. The treatment is immediate operation; volvulus often means strangulation. Needs fluid and electrolyte replacement. Ladd's procedure consist of: In cases of questionable non-viable bowel a second look procedure is required.
Meconium ileus is a neonatal intraluminal intestinal obstruction caused by inspissated meconium blocking the distal ileum. The meconium has a reduced water, abnormal high protein and mucoproteint content, the result of decreased pancreatic enzyme activity and prolonged small bowel intestinal transit time. Meconium Ileus is classified into two types: The distal small bowel cm of distal ileum is relatively small, measuring less than 2 cm in diameter and contains concretions of gray, inspissated meconium with the consistency of thick glue or putty.
It is often beaklike in appearance, conforming to the shape of the contained pellets. Proximally, the mid-ileum is large, measuring up to 7 cm in diameter.
It is greatly distended by a mass of extremely thick, tenacious, dark green or tarry meconium. The unused small colon microcolon contains a small amount of inspissated mucus or grayish meconium.
A cystic mass or atresia of the bowel may occur. The degree of obstruction varies, may be cured in mild cases by rectal irrigations. Failure to pass meconium, abdominal distension and vomiting are seen in more severe cases.
The diagnosis is suspected with findings of: Some cases may show calcifications in the peritoneum Meconium peritonitis. This test is not useful in infant during first weeks of life. It consist of a careful gastrograffin enema after the baby is well-hydrated. Gastrograffin is a hyperosmolar aqueous solution of meglumine diatrizoate containing 0. Long-term prognosis depends on the degree of severity and progression of cystic fibrosis pulmonary disease.
Total colonic aganglionosis TCA is found in approx. There are three critical phases for patients with TCA The first period comprises the time from birth until correct diagnosis. Patients with TCA present with a large variety of symptoms.
Several authors have outlined the diagnostic problems in patients with TCA 2,4, Atypical symptoms may lead to excessively delayed diagnosis. Patients present with either ileus or symptoms as in typical Hirschsprung's disease but additionally with recurrent vomiting. In patients presenting with ileus, diagnosis may be delayed for several weeks because causative factors like volvulus or meconium ileus do not primarily warrant investigations for aganglionosis.
Furthermore, TCA may be associated with other anomalies of the gastrointestinal tract. Only a few reports of TCA associated with small bowel atresia and volvulus can be found 3, 7.
In cases of midgut volvulus without malrotation, aganglionosis has to be ruled out. Neonatal appendicitis, a very rare disease, may be the leading symptom of TCA. Therefore, rectal biopsies are mandatory in those cases. Additional to the diagnostic problems due to atypical and heterogenic symptoms, histochemical examination of rectal biopsies may prove negative or equivocal because increased acetylcholinesterase activity may not be present in TCA 5,10, Furthermore, there is no typical radiographic pattern 13, Plain abdominal radiographs usually suggests low bowel obstruction whereas barium enema usually does not show pathognomonic features.
If no mechanical obstruction is found at laparotomy in neonates presenting with ileus, it is suggested to resect the appendix to rule out TCA. If rectal mucosal biopsies are negative or equivocal, biopsies should be repeated or a formal sphincterectomy for thorough analysis is done. The second period lasts from the raising of stoma to its closure, including the definite surgical procedure. Failure to thrive and excessive fluid losses have been reported in patients with ileostomies 2.
Post-ileostomy complications, however, have been eliminated after the importance of oral sodium supplementation to maintain the enteral co-transport system has been realized Interestingly, right transversostomies may show a good function even in cases of TCA.
Therefore, frozen section biopsies are mandatory when raising a stoma. The definitive surgical procedure has been debated 2,5,8,9, Colonic patch graft procedures were the first proposals for surgical management of TCA The rational behind were to use the distinctive resorptive function of part of the aganglionic colon 6.
Use of the right colon has the theoretical advantage of improved water resorption. However the colon patch procedures have significant complications, e. Actually, a modified Duhamel's pull-through procedure seems favorable in the treatment of TCA 2, The third critical phase begins with closure of the stoma. Complications in this period are predominantly recurrent episodes of sub-ileus and diarrhea or nocturnal incontinence. The cause for sub-ileus is a raised tone in the residual sphincter.
Repeated manual anal dilatations may be mandatory. Side effects of large doses of Loperamide are mental irritability and dyskinesia.
Significantly better survival of the patients with TCA nowadays is mainly attributed to more accurate diagnosis and improved management of infants with ileostomies. A new approach to total aganglionosis of the colon. Surg Gynecol Obstet Cass DT, Myers N: Pediatr Surg Int 2: Total colonic aganglionosis with or without ileal involvement: A review of 27 cases.
J Pediatr Surg Festen C, Severijner R, v. The absorptive function of colonic aganglionoic intestine: Are the Duhamel and Martin procedures rational? Ikeada K, Goto S: Total colonic aganglionosis with or without small bowel involvement: An analysis of patients. A new surgical approach to extensive aganglionosis.
Further experience with the colonic patch graft procedure and long-term results. Suction biopsy in Hirschsprung's disease. Arch Dis Child A possible cause of anastomotic failure following repair of intestinal atresia. Can J Surg Surgical management of Hirschsprung's disease involving the small intestine. Improvements in the management of total colonic aganglionosis.
Pediatr Surg Int 5: The importance of oral sodium replacement in ileostomy patients. Progr Pediatr Surg Diagnosis of congenital megacolon: J Pediatr Surg 7: Imperforate anus IA is a congenital anomaly in which the natural anal opening is absent. Diagnosis of IA is usually made shortly after birth on routine physical examination. The incidence of IA is approximately 1 in live births and it is more common in males.
Its etiology is unknown and it runs equally through all racial, cultural and socio-economic groups. IA is classified as either "high" or "low" depending on the termination of the distal rectum. When the rectum ends above the levator muscles the malformations are classified as high, and when the rectum ends below the levator muscles the malformations are classified as low. High lesions are more frequent in males, low ones in females. Determination of the level of the lesion by abdominal x-ray or perineal ultrasound is critical for appropriate management.
Children who have IA may also have other congenital anomalies. Vertebral defects, Anal atresia, Cardiac anomalies, Tracheoesophageal fistula, Esophageal atresia, Renal anomalies, and Limb anomalies.
Repair of low IA is relatively simple and is usually treated with perineal anoplasty; however, repair of high IA is more complex.
Patients are initially given a temporary colostomy and time is given to allow the child to grow. A pull-through operation is completed at a later date. Independent of the level of the lesion, the goal of the surgery is the creation of adequate nerve and muscle structures around the rectum and anus to provide the child with the capacity for bowel control. Male patients will benefit from perineal inspection to check for the presence of a fistula wait hours of life before deciding.
During this time start antibiotherapy, decompress the GI tract, do a urinalysis to check for meconium cells, and an ultrasound of abdomen to identify urological associated anomalies.
Perineal signs in low malformations that will NOT need a colostomy are: These infants can be managed with a perineal anoplasty during the neonatal period with an excellent prognosis. Meconium in urine shows the pt has a fistula between the rectum and the urinary tract. Flat "bottom" or perineum lack of intergluteal fold , and absence of anal dimple indicates poor muscles and a rather high malformation needing a colostomy.
Patients with no clinical signs at 24 hours of birth will need a invertogram or cross-table lateral film in prone position to decide rectal pouch position. Those cases with high defect are initially managed with a totally diverting colostomy. Diverting the fecal stream reduces the chances of genito-urinary tract contamination and future damage. These infants require a colostomy before final corrective surgery.
The colostomy can be done electively before discharge from the nursery while the GI tract is decompressed by dilatation of the fistulous tract.
A single orifice is diagnostic of a persistent cloacal defect usually accompany with a small-looking genitalia. Cloacas are associated to distended vaginas hydrocolpos and urologic malformations. This makes a sonogram of abdomen very important in the initial management of these babies for screening of obstructive uropathy hydronephrosis and hydroureter. Hydrocolpos can cause compressive obstruction of the bladder trigone and interfere with ureteral drainage.
Failure to gain weight and frequents episodes of urinary tract infections shows a poorly drained urologic system. A colostomy in cloacas is indicated. Radiological evaluation will be of help along with a diverting colostomy in this cases. Perineal fistulas can be managed with cutback without colostomy during the neonatal period.
The most important prognostic characteristic is the severity of the IA. Patients with low IA have a good probability of having normal stool patterns. Patients with high IA report more problems such as fecal incontinence and constipation. For patients who cannot maintain normal bowel function, the use of a special diet, underpants liners, enemas and drugs have ameliorated their lives.
Long-term follow up with both qualitative and quantitative quality of life considerations of these patients is very important. References 1- Chen CJ: The treatment of imperforate anus: J Pediatr Surg 34 Inheritance of familial congenital isolated anorectal malformations: Am J Med Genetics Do children with repaired low anorectal malformations have normal bowel function?
J Pediatr Surg 32 6: Semin Pediatr Surg 4 1: Management of anorectal malformations during the newborn period. World J Surg 17 3: Posterior sagittal approach for the correction of anorectal malformations. Surgical treatment of high imperforate anus. World J Surg 9 2: J Pediatr Surg 17 5: Although intussusception can occur at any age, the greatest incidence occurs in infants between months of age.
Over half of the cases are in the first year of life. Frequently occurs after a recent upper respiratory infection, by Adenovirus type 3 that causes a reactive lymphoid hyperplasia that act as lead point of Peyer's patch. Meckel's diverticulum, polyps, Henoch's Schonlein purpura, hematoma, lymphoma, foreign bodies, and duplications.
Most children have no lead point and it is felt that enlarged mesenteric nodes or swollen Peyer's patches may be the cause. The baby has intermittent periods of severe discomfort with screaming, stiffening and drawing up of the legs, followed by periods of rest. Vomiting may occur and bloody, mucoid currant jelly stool may be passed. The baby may become dehydrated and appear acutely ill. Frequently, lethargy may be an early sign. To be successful, the barium must reflux into the terminal ileum.
The surgeon should be notified before an attempt at barium reduction, and should be present at the time of study. Recently the use of gas enema reduction has been successful in patients with: Ultrasonography can be used as a rapid sensitive screening procedure in the initial diagnosis of intussusception.
Previous adverse clinical features that precluded barium reduction can be replaced during gas reduction. Predictors of failure of reduction are: Air reduction pneumocolon is a very effective alternative method since it brings less radiation shorter flouroscopy time , less costs and less morbidity in cases of perforations.
Failure of hydrostatic reduction requires urgent operation through a right lower quadrant horizontal incision. The intussusception is reduced by pushing on the distal bowel like a tube of toothpaste rather than pulling the proximal bowel. Most cases are ileo-colic intussusception, and a few are jejuno-jejunal or ileo-ileal intussusception. The traditional method of diagnosing and managing ileo-colic intussusception is barium enema contrast reduction.
In China where this is the most common surgical emergency in childhood, pneumatic reduction has been used for more than 25 years. A recent tendency toward this approach is seen in recent years in Occident. Small bowel aeration is a sign of complete reduction.
Gas enema reduction is very successful in patients with: The condition can occur in an isolated form either localized to colon or disseminated throughout the bowel , or associated to other diseases such as Hirschsprung's HD , neurofibromatosis, MEN type IIB, and anorectal malformations.
Clinically two different types of isolated IND have been described: Type A shows symptoms of abdominal distension, enterocolitis, bloody stools, intestinal spasticity in imaging studies Ba Enema since birth, is less common and associated with hypoplasia of sympathetic nerves. Type B is more frequent, symptoms are indistinguishable from that of HD, with chronic constipation, megacolon, and repeated episodes of bowel obstruction.
Management depends on clinical situation; conservative for minor symptoms until neuronal maturation occurs around the 4th year of life, colostomy and resectional therapy for life threatening situations. The most common congenital diaphragmatic hernia CDH is that which occurs through the postero-lateral defect of Bochdalek. It is caused by failure of the pleuroperitoneal membrane to develop adequately and close before the intestines returning to the abdomen at the tenth week of gestation.
The intestines then enter the pleural cavity and cause poor lung development leading to pulmonary hypoplasia a reduced number of alveoli per area of lung tissue. This defect is postero-lateral in the diaphragm and may vary in size. Stomach, liver or spleen may be partly in chest as well.
The clinical presentation is that the newborn becomes rapidly cyanotic, acidotic, and has poor ventilation. Major findings relate to the degree of pulmonary maldevelopment. Chest films will show intestines in the chest. Placement of a radiopaque nasogastric tube may show the tube coiled in the lower left chest. Higher risk factors are: Treatment consist of rapid intubation and ventilation with use of muscle relaxants, placement of a nasogastric tube to prevent gaseous distension of the intestines and preoperative stabilization of arterial blood gases and acid-base status.
Surgery can be undertaken when one of the following objectives are met: Operative management consist of abdominal approach, closure of hernia by primary repair or use of mesh, and correction of malrotation. Postoperative management is very difficult.
Due to hypoplastic lungs, there is frequently pulmonary hypertension leading to right-to-left shunting and progressive hypoxemia, hypercarbia, and acidosis that worsens the pulmonary hypertension. The use of chest tubes may cause overstretching of the already hypoplastic alveoli causing: Postoperatively, the infant should be kept paralyzed and ventilated and only very slowly weaned from the ventilator.
The severity of pulmonary hypoplasia, both ipsilaterally and contralaterally, is the main determinant of outcome. ECMO extracorporeal membrane oxygenator has come to reduce somewhat the mortality of this condition. The mortality of CDH is directly related to the degree of lung hypoplasia associated. Death is caused by persistent pulmonary hypertension and right ventricular failure.
Prospective studies of prenatally diagnosed fetus prior to 25 wk. This unsolved problem has prompted investigators to develop new treatment options such as preoperative stabilization, jet-frequency ventilation, and ECMO. Another area of development is intrauterine fetal surgical repair. To achieve success fetal surgery should: Intrauterine repair has meet with limited success due to herniation of the fetal liver into the chest through the defect.
Disturbance of the umbilical circulation during or after liver reduction causes fetal death. Positive-pressure ventilation after birth reduces the liver before the baby comes for surgical repair. Harrison USFC Fetal Treatment Center has devised separate fetal thoraco-abdominal incisions to deal with this problem "two-step dance" , reducing or amputating the left lateral segment of the liver. Another less invasive approach is enlarging the hypoplastic lungs by reducing the normal egress of fetal lung fluid with controlled tracheal obstruction called PLUGS Plug Lung Until it Grows.
Infants and children will present with either respiratory or gastrointestinal symptoms such as: Occasionally the child is asymptomatic. A rise intrabdominal pressure by coughing or vomiting transmitted to any defect of the diaphragm makes visceral herniation more likely.
Diagnosis is confirmed by chest or gastrointestinal contrast imaging. Management consists of immediate surgery after preop stabilization. Most defects can be closed primarily through an abdominal approach. Chest-tube placement in the non-hypoplastic lung is of help. Surgical results are generally excellent. A few deaths have resulted from cardiovascular and respiratory compromise due to visceral herniation causing mediastinal and pulmonary compression.
First described in , Morgagni Hernias MH are rare congenital diaphragmatic defects close to the anterior midline between the costal and sternal origin of the diaphragm. Almost always asymptomatic, typically present in older children or adults with minimal gastrointestinal symptoms or as incidental finding during routine chest radiography mass or air-fluid levels. Infants may develop respiratory symptoms tachypnea, dyspnea and cyanosis with distress.
Cardiac tamponade due to protrusion into the pericardial cavity has been reported. US and CT-Scan can demonstrate the defect. Trans-abdominal subcostal approach is preferred with reduction of the defect and suturing of the diaphragm to undersurface of sternum and posterior rectus sheath. Large defects with phrenic nerve displacement may need a thoracic approach. Results after surgery rely on associated conditions. Two types of esophageal hernia recognized are the hiatal and paraesophageal hernia.
Diagnosis is made radiologically always and in a number of patients endoscopically. The hiatal hernia HH refers to herniation of the stomach to the chest through the esophageal hiatus. The lower esophageal sphincter also moves. It can consist of a small transitory epiphrenic loculation minor up to an upside-down intrathoracic stomach major. HH generally develops due to a congenital, traumatic or iatrogenic factor. Most disappear by the age of two years, but all forms of HH can lead to peptic esophagitis from Gastroesophageal reflux.
Repair of HH is determined by the pathology of its associated reflux causing failure to thrive, esophagitis, stricture, respiratory symptoms or the presence of the stomach in the thoracic cavity. In the paraesophageal hernia PH variety the stomach migrates to the chest and the lower esophageal sphincter stays in its normal anatomic position. PH is a frequent problem after antireflux operations in patients without posterior crural repair.
Small PH can be observed. With an increase in size or appearance of symptoms reflux, gastric obstruction, bleeding, infarction or perforation the PH should be repaired. The incidence of PH has increased with the advent of the laparoscopic fundoplication. A hernia is defined as a protrusion of a portion of an organ or tissue through an abnormal opening. For groin inguinal or femoral hernias, this protrusion is into a hernial sac.
Whether or not the mere presence of a hernial sac or processus vaginalis constitutes a hernia is debated. Inguinal hernias in children are almost exclusively indirect type. Those rare instances of direct inguinal hernia are caused by previous surgery and floor disruption. An indirect inguinal hernia protrudes through the internal inguinal ring, within the cremaster fascia, extending down the spermatic cord for varying distances.
The direct hernia protrudes through the posterior wall of the inguinal canal, i. The embryology of indirect inguinal hernia is as follows: During the third month of gestation, the processus vaginalis extends down toward the scrotum and follows the chorda gubernaculum that extends from the testicle or the retroperitoneum to the scrotum.
During the seventh month, the testicle descend into the scrotum, where the processus vaginalis forms a covering for the testicle and the serous sac in which it resides. At about the time of birth, the portion of the processus vaginalis between the testicle and the abdominal cavity obliterates, leaving a peritoneal cavity separate from the tunica vaginalis that surrounds the testicle. The typical patient with an inguinal hernia has an intermittent lump or bulge in the groin, scrotum, or labia noted at times of increased intra-abdominal pressure.
A communicating hydrocele is always associated with a hernia. This hydrocele fluctuates in size and is usually larger in ambulatory patients at the end of the day. If a loop of bowel becomes entrapped incarcerated in a hernia, the patient develops pain followed by signs of intestinal obstruction. If not reduced, compromised blood supply strangulation leads to perforation and peritonitis.
Most incarcerated hernias in children can be reduced. Patients with ASD who avoid several types of food, such as protein, usually will accept foods in the carbohydrate group. Which of the following is one of the best approaches to addressing problem-eating behaviors? Introduce one new food every three weeks until the child gets accustomed to eating it.
Evaluate the foods the child agrees to eat for potential deficiencies. Which of the following supplements have been shown to reduce anxiety and aggression, decrease hyperactivity and impulsivity, and increase attention span in ASD patients? Omega-3 fatty acids c. Which of the following treatments may aid in removing toxic compounds from the gut of ASD patients?
Poor cognitive functioning c. Poor social functioning d. All of the above. Significant delays in language skills b. Abnormal responses in balance c. Delayed reactions to pain d. A near genius IQ. A viral infection such as the flu in the third trimester has been shown to triple the odds of a child developing ASD.
Which of the following is not an early sign of ASD in infants? Not wanting to cuddle b. Lack of eye contact c. Abnormal responses to touch and affection d.
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Sensory neuropathy from pyridoxine abuse: