Pediatric Surgery Conditions

Abdominal tumors are abnormal growths in the abdomen. They can occur in the stomach, intestines or other organs. There are many different types of abdominal tumors in children. Although many are not cancerous (benign), some are cancerous. Types of tumors can include:

• Neuroblastoma , a type of cancerous tumor
• Adrenal tumors, which may be cancerous or benign
• Wilms tumor, a type of cancerous tumor found on the kidney
• Hepatoblastoma, a rare type of liver cancer
• Sarcoma, a type of cancer that can grow in soft tissue or bone

What are the signs and symptoms of abdominal tumors?

Symptoms can vary depending on the type of tumor. General symptoms can include:

• A lump or swelling in the stomach area
• Pain in the belly
• Nausea or vomiting
• Weight loss or unusual weight gain

Please note there are many conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes abdominal tumors?

Experts do not know the cause of many types of abdominal tumors.

How are abdominal tumors treated?

Treatment for abdominal tumors depends on the type of tumor, its size and whether it is cancerous or benign. Options may include both surgical and non-surgical treatments. Your child’s doctor will discuss your child’s individual treatment plan with you.

SURGICAL

Surgery to remove and biopsy the mass may be needed. The experienced surgeons at Connecticut Children’s use minimally invasive techniques whenever possible.

NON-SURGICAL

If the tumor is cancerous, your child may have radiation and chemotherapy to help kill cancer cells or shrink the tumors. In some cases, these options may be combined with surgery.

Abdominal wall masses include any type of growth that develops in the abdomen wall.

Possible masses in children can include:

• Desmoid tumor, which is not cancerous. These tumors grow from the connective tissue in the body.
• Sarcoma, which is a type of cancer. These masses can grow in soft tissue or bone.
• Neuroblastoma, which is a type of cancer.

What are the signs and symptoms of abdominal wall masses?

Symptoms can vary depending on the type of mass. General symptoms can include:

• A lump or swelling in the abdominal area
• Pain
• Nausea and cramping

Please note there are many conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes abdominal wall masses?

Experts do not know the cause of many types of abdominal wall masses.

How are abdominal wall masses treated?

Treatment for abdominal masses depends on the type of mass, its size and whether it has spread to other parts of the body. It may include both surgical and non-surgical options. Doctors at

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an abdominal tumor.

Surgical

• Surgery to remove and biopsy the mass may be needed.

Non-surgical

• Your child may have radiation and chemotherapy to help kill cancer cells or shrink the tumors. In some cases, these options may be combined with surgery.

An abscess is a pocket of pus under the skin. Most abscesses are caused by an infection that develops in a cut or wound. It is made up of pus and white blood cells that the body sends to fight the infection.

Abscesses can develop anywhere on the skin, deeper inside the skin or in a tooth. Children are more likely to get an abscess when they don’t properly clean or care for their cuts.

What are the signs and symptoms of an abscess?

Common symptoms of an abscess include:

• An area on the skin that looks like a pimple and may leak fluid
• Skin that is red or swollen
• A bump on the skin that may be painful or tender
• Fever and chills (from the infection)

What causes an abscess?

Most abscesses are caused when an infection develops in a cut or wound. In some cases, they can be caused when a foreign body, like dirt or a hair, gets caught in a cut.

How are abscesses treated?

Treatment for abscesses can vary based on how severe the infection is, and may include surgical or non-surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an abscess.

Surgical

• Sometimes surgery is needed to drain the pus from a large abscess.

Non-Surgical

• Antibiotic medicines can treat the infection.
• The doctor may drain the pus from the abscess by making a small cut in it.

Addison’s disease occurs when the adrenal glands don’t make enough of two hormones, cortisol and aldosterone. These hormones affect many bodily functions, including the body’s response to stress, blood pressure, and salt and water balance. When there are low levels of these hormones, it can cause problems with the way the body works. In some cases, Addison’s disease can cause severe symptoms that can be life threatening.

What are the signs and symptoms of Addison’s disease?

Symptoms of Addison’s disease may include:

• Muscle weakness
• Feeling very tired
• Stomach pain
• Loss of appetite
• Weight loss

Please note there are many conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

In some cases, the symptoms can appear suddenly or can get worse very quickly. This is called Addisonian crisis or acute adrenal failure. It can be a life-threatening condition and needs medical treatment right away. Symptoms of Addisonian crisis include:

• Intense pain in the stomach, lower back or legs
• Low blood pressure
• Nausea, vomiting or diarrhea
• Dizziness or fainting

If your child has any of these symptoms, call their doctor or get medical help right away.

What causes Addison’s disease?

Addison’s disease occurs when the adrenal glands are damaged in some way. It is most often caused by an autoimmune disorder. It can also be caused by:

• An infection in the adrenal glands
• Cancer
• A problem with the pituitary gland
• Suddenly stopping steroid medicines, such as prednisone

How is Addison’s disease treated?

Treatment involves taking prescription hormones to replace the hormones your child’s body is not making. Your child will need to take these hormones every day for the rest of their life. It’s also a good idea to have them wear a medical alert bracelet in case of emergency.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for Addison’s disease.

Adrenal tumors and masses are growths on the adrenal glands. These are the two glands that sit on top of the kidneys. Adrenal glands make hormones that help the body deal with stress.

Some adrenal tumors produce extra hormones that can cause symptoms. These are called functioning tumors. Tumors that do not produce hormones are called non-functioning tumors. Most adrenal tumors are not cancerous (benign), but some types are.

Adrenal tumors include:

• Adrenal adenomas. These are the most common type of adrenal tumor. They are usually not functioning and are not cancerous.
• Adrenocortical carcinomas. These are a rare type of cancerous tumor. Most of these tumors in children are functioning tumors that make extra hormones.
• Pheochromocytomas. These tumors are usually not cancerous but do produce extra hormones that can cause symptoms.

What are the signs and symptoms of adrenal tumors?

Symptoms of adrenal tumors can vary depending on the type of tumor. They can include:

• Pain or fullness in the stomach
• High blood pressure
• Changes in weight
• Having signs of early puberty, such as growing body hair, a deeper voice or growing faster than average

Please note there are many conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes adrenal tumors?

Experts are not sure what causes adrenal tumors. Adrenocortical carcinomas may be related to genetic syndromes, such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome and hemihyperplasia.

How are adrenal tumors treated?

Treatment for adrenal tumors depends on the type of tumor and whether it is cancerous. The team at Connecticut Children’s will discuss all your child’s treatment options with your family.

SURGICAL

• Surgery to remove the tumor is usually the main treatment for adrenocortical carcinomas. Our experienced surgeons use minimally invasive techniques whenever possible.

NON-SURGICAL

• Your child’s doctor may prescribe medicines to manage the symptoms of noncancerous tumors.
• Chemotherapy or targeted therapy may be used to kill cancer cells.

Alimentary tract duplications are a rare type of mass or cyst that grows in the gastrointestinal (GI) tract. They can vary in size and shape and are usually attached to a specific organ. Although alimentary tract duplications can form anywhere along the GI tract, the most common location is in the small intestine.

These masses develop during early pregnancy and are a condition a baby is born with.

What are the signs and symptoms of alimentary tract duplications?

The symptoms of alimentary tract duplications can vary depending on where they are located. Symptoms may include:

• Stomach pain
• Vomiting
• Internal bleeding
• Trouble breathing

What causes alimentary tract duplications?

Alimentary tract duplications occur early in pregnancy when a baby is still developing. Experts aren’t sure exactly what causes them.

How are alimentary tract duplications treated?

Alimentary tract duplications need to be removed by surgery. The goal is to remove as much of the mass as possible, so it does not grow back.

At Connecticut Children’s, our surgeons use minimally invasive techniques to remove alimentary tract duplications and other GI masses whenever possible.

An anal fissure is a tear in the anal canal. Anal fissures are common in children. They are most often caused by passing large stools or constipation.

What are the signs and symptoms of an anal fissure?

Symptoms of an anal fissure may include:

• Blood in the stool or on toilet paper
• Itchiness
• Pain

What causes anal fissures?

Anal fissures are caused when the tissue around the anus stretches too much, causing a tear. This most commonly occurs from constipation or passing large or hard stool.

How are anal fissures treated?

In most cases, anal fissures can be treated at home. But if your child has chronic symptoms, your child’s doctor may discuss surgical treatment options. Treatment depends on how severe your child’s symptoms are. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an anal fissure.

SURGICAL

• If your child’s anal fissure is severe or chronic, surgery may be needed to repair the anus.

NON-SURGICAL

• Your child’s doctor may prescribe ointments or creams for the area.
• Fiber supplements or stool softeners can help with constipation.
• Drinking lots of fluids and eating foods high in fiber (beans, vegetables, fruits) can also help with constipation.
• Sitting in a few inches of plain, warm water a few times a day can help ease soreness.

An anorectal malformation occurs when the anus or rectum don’t develop properly before birth. Anorectal malformations can cause a problem with passing stool from the body. The anus may be missing, blocked by a layer of skin or be narrower than normal. If the anus is completely blocked, it is called imperforate anus. Less often, the rectum may be blocked or narrow.

The child may also have an abnormal passage (called a fistula) from the rectum to another part of the body, such as the urinary tract or the vagina.

Children with anorectal malformations may also be born with birth defects in other parts of the body.

What are the signs and symptoms of anorectal malformations?

Anorectal malformations are often found shortly after birth. Common signs include:

• No visible anus or a membrane over the anus
• An anus in a location that is not normal
• Not passing any stool in the first 24 hours after birth
• Passing stool through the fistula and out of the vagina, urethra or perineum (the area between the anus and genitals)

What causes anorectal malformations?

Anorectal malformations occur while a baby is developing during pregnancy. In most cases, experts don’t know what causes anorectal malformations. In rare cases, the condition may run in families. Children with certain genetic syndromes may also be more likely to have an anorectal malformation.

How are anorectal malformations treated?

Anorectal malformations are treated with surgery. The specific type of surgery your child needs depends on the type of the malformation. Sometimes children need more than one surgery to repair the problem. Connecticut Children’s team of surgeons will create an individual treatment plan for your child based on their condition. Whenever possible, we use laparoscopic surgical techniques using small incisions.

Appendicitis is the inflammation of the appendix, a small organ attached to the large intestine. The appendix is located in the lower right area of the stomach. Appendicitis is most common in children and young adults ages 10 to 30, but it can occur in people of all ages. Appendicitis is an emergency condition that needs immediate care. If appendicitis is not treated, the appendix can burst. This can cause severe health complications.

What are the signs and symptoms of appendicitis?

The most common symptom of appendicitis is pain in the stomach. This pain may:

• Start suddenly
• Begin in the area around the belly button and move to the lower right side of the stomach
• Be severe enough to wake your child if they are sleeping
• Feel worse when your child moves, coughs or takes a deep breath

Other symptoms of appendicitis can include:

• Fever
• Nausea or vomiting
• Loss of appetite
• Swelling in the stomach

Please note there are many conditions that can cause stomach pain. If your child has these symptoms, it’s important to see your doctor for proper diagnosis and treatment.

What causes appendicitis?

Appendicitis can have several causes.

• Inflamed tissue in the wall of appendix caused by an infection
• A blockage in the appendix
• Inflammatory bowel disease

In some cases, the cause of appendicitis is not known.

How is appendicitis treated?

Appendicitis is treated by removing the appendix as soon as possible. This surgery is called an appendectomy. At Connecticut Children’s we perform laparoscopic surgery whenever possible to remove the appendix. This type of surgery uses small incisions and a thin tube with a video camera at the end, called a laparoscope, to see inside the stomach. The surgeon then uses small tools to remove the appendix.

Barrett’s esophagus is a condition in which the tissue lining the esophagus is damaged and replaced by tissue that resembles the lining of the intestines. It is often caused by chronic gastrointestinal reflux (GERD).

Although Barrett’s esophagus is rare in children, those who have GERD may be more likely to have the condition. Over time, the cell changes in Barrett’s esophagus can lead to a higher risk for esophageal cancer. This makes it important for children with Barrett’s esophagus to have regular screenings.

What are the signs and symptoms of Barrett’s esophagus?

Barrett’s esophagus has no symptoms. Children with GERD may have symptoms such as heartburn, trouble swallowing, or burning or pain in the chest.

What causes Barrett’s esophagus?

Experts think Barrett’s esophagus is caused by chronic inflammation of the esophagus, called esophagitis. This inflammation is often caused by GERD. Children with certain conditions, such as esophageal atresia and eosinophilic esophagitis are more likely to have GERD.

How is Barrett’s esophagus treated?

The treatment for Barrett’s esophagus will depend on the amount of tissue damage caused by the condition. In many cases, severe tissue damage does not occur until adulthood. However, your child’s doctor will monitor their esophagus regularly for changes in tissue. Treatment options can be surgical or non-surgical depending on the severity of the disease.

NON-SURGICAL

• Medicine to reduce stomach acid and control GERD symptoms is usually the first step in treatment.
• Removing the damaged cells in the esophagus using an endoscope.

SURGICAL

If non-surgical treatments don’t work, your child may need surgery to remove the damaged part of the esophagus.

Biliary atresia is the blockage of bile ducts that prevents proper drainage of bile out of the liver. Bile is used in the body to help digest fats and carry waste from the liver to the intestines. Bile normally travels from the liver to the gallbladder through tubes called bile ducts. When these ducts are blocked, bile builds up in the liver causing liver damage and scarring.

What are the signs and symptoms of biliary atresia?

Babies with biliary atresia typically appear healthy at birth but develop symptoms around 2 to 8 weeks old. Most of the time, the first sign of biliary atresia is jaundice – yellowing of the skin and eyes.

Other symptoms of biliary atresia include:

• Dark-colored urine
• Light-colored stools
• Abdominal swelling
• Weight loss

Please note there are other conditions with symptoms similar to biliary atresia. Several tests may be needed to properly diagnose biliary atresia. This can include blood tests, imaging tests, a liver biopsy or diagnostic surgery. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes biliary atresia?

Experts don’t know exactly what causes biliary atresia. It is thought that biliary atresia can develop during pregnancy or shortly after birth. Research is currently being conducted to further understand the possible causes.

How is biliary atresia treated?

A surgery called the Kasai procedure is used to treat biliary atresia. In this procedure, the surgeon connects a portion of the intestine to the liver, allowing bile to properly drain. Although the Kasai procedure can allow the child to live a healthy life for several years, most children will eventually need a liver transplant.

The multidisciplinary team at Connecticut Children’s has extensive experience treating biliary atresia and will discuss the best treatment approach with your family.

A branchial cleft is an abnormal formation of tissue in the neck that is filled with fluid. This condition develops during the first stages of pregnancy, when the neck and throat tissue is forming. Branchial clefts can become infected, especially when your child has another infection like a cold.

What are the signs and symptoms of a branchial cleft?

The main symptom of a branchial cleft is a small bulge on either side of the neck. The bulge will likely be painless unless infected. If infected, it may leak or cause pain or redness.

What causes a branchial cleft?

Branchial clefts occur while a baby is developing. They are caused by an abnormal growth in the neck and throat tissue that leads to a fluid-filled pocket.

How are branchial clefts treated?

Treatment will depend on your child’s symptoms and how severe they are. It will also depend on whether the cleft is infected or not. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a branchial cleft.

NON-SURGICAL

• Antibiotics may be needed if your child develops an infection
• If the cleft is infected, your child’s doctor may need to puncture the pocket to drain the fluid

SURGICAL

• The cleft may need to be removed by surgery if your child has severe symptoms, such as repeated infections or trouble swallowing or breathing. The experienced surgeons at Connecticut Children’s use minimally invasive techniques whenever possible.

A bronchogenic cyst is a formation of tissue in the area between the lungs. These cysts normally contain mucus or fluid. Most bronchogenic cysts are small and non-cancerous.

In rare cases, the cyst grows too big and can push against the trachea or the esophagus. This pressure can cause trouble breathing or swallowing.

What are the signs and symptoms of a bronchogenic cyst?

Most babies do not have any symptoms. When they do occur, symptoms may include:

• Trouble breathing
• Frequent infection of the lungs

What causes a bronchogenic cyst?

Bronchogenic cysts occur when a baby is developing during pregnancy. Experts aren’t sure exactly what causes them.

How are bronchogenic cysts treated?

Bronchogenic cysts need to be removed by surgery, typically shortly after birth. But, if the baby does not have symptoms, surgery may be delayed until the lungs are more developed.

At Connecticut Children’s, our surgeons are skilled in using minimally invasive (thoracoscopic) techniques to perform surgery on children with bronchogenic cysts. Our experienced team will work with your family to discuss treatment options.

Burns are an injury caused by heat. The heat can come from a variety of sources, such as thermal, chemical, electrical or radiation.

Studies show most burns in children happen by accident at home.

Burns are classified by how severe they are.

• First-degree burns are the most minor type of burn. They only affect the top layer of skin.
• Second-degree burns are more serious burns. They affect both the top layer of skin and some of the layer below it.
• Third-degree burns are the most severe type of burns. They affect all layers of the skin.

What are the signs and symptoms of burns?

The symptoms of burns can vary depending on the type of burn and how severe they are.

Symptoms of first-degree burns include:

• Redness
• Minor pain and swelling

Symptoms of second-degree burns include:

• Blisters
• Peeling skin
• More severe pain

Symptoms of third-degree burns include:

• Whitish or yellowish look to skin
• Dry look to skin

What causes burns?

Some common causes of burns in children include sunburn, scalding liquids, flames from fireplaces or lighters, or spilled or swallowed chemicals.

How are burns treated?

Treatment for burns will depend on the type of burn and how severe it is. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a burn.

Surgical

• Some second-degree and most third-degree burns may need skin grafts to repair the skin.

Non-Surgical

• Most first- and second-degree burns can be treated at home with various types of first aid.

Neuroendocrine tumors (NETs) are tumors that develop from neuroendocrine cells, which are found throughout the body. Although NETs can form anywhere in the body, they are most common in the gastrointestinal tract, lungs, pancreas, rectum and appendix. They are a rare type of tumor.

Some NETs produce excess hormones, while some do not produce hormones at all. This can affect the type of symptoms they cause.

Many NETs are slow growing, but others can grow quickly and spread to the other areas of the body.

What are the signs and symptoms of neuroendocrine tumors?

Symptoms depend on the tumor’s size, where it is located and if it produces hormones. Common signs may include:

• Abdominal pain
• High blood pressure, dizziness or heart palpitations
• Nausea or vomiting
• Excessive sweating
• Weight loss
• A lump under the skin
• Pain in the area where the tumor is growing

What causes NETs?

Experts don’t know exactly what causes NETs. Children who have certain hereditary conditions, such as multiple endocrine neoplasia and tuberous sclerosis, may be more likely to develop NETs.

How are NETs treated?

Treatment for NETs can depend on where the tumor is located, its size and whether it has spread to other parts of the body. It often includes both surgical and non-surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a neuroendocrine tumor.

SURGICAL

• Surgery to remove and biopsy the tumor may be needed.

NON-SURGICAL

• Your child may have radiation and chemotherapy to help kill cancer cells or shrink the tumors. In some cases, these options may be combined with surgery.
• If the tumor is producing hormones, your child’s doctor may prescribe medicines to control excess hormones.

Chronic abdominal pain is any type of pain in the stomach area that lasts for more than two weeks. It is a common condition in children, especially between the ages of 5 to 10. The pain may be constant or it may come and go over time.

In a small number of cases, the child has a medical condition that is causing the pain, such as heartburn or Crohn’s disease. In most cases, doctors are not able to link the pain to any medical condition. This is called functional abdominal pain. But this doesn’t mean the pain is not real. The pain may keep children from school or out of other activities.

What are the signs and symptoms of chronic abdominal pain?

The symptoms of chronic abdominal pain can vary. Symptoms may include:

• Feeling of pain or burning in stomach area
• Bloating or fullness
• Loss of appetite
• Nausea or vomiting
• Diarrhea or constipation

In many cases, your child may not be able to describe the pain or tell you where it is located.

Please note there are many conditions that can cause similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes chronic abdominal pain?

In some cases, an underlying medical condition is the cause of the pain. But more often, the pain is triggered by something else. Possible causes include:

• Stress or anxiety
• A need for attention
• Irritable bowel syndrome
• A nervous system that is more sensitive to pain

How is chronic abdominal pain treated?

In many cases, the pain gets better on its own after time. If treatment is needed, your child’s doctor may recommend one or more of the following.

Surgical

• If your child has a medical condition that is causing the pain, such as Crohn’s disease, they may need surgery. At Connecticut Children’s, our surgeons are skilled in using minimally invasive (laparoscopic) techniques to perform surgery on children and teens with all types of abdominal conditions.

Non-Surgical

• Behavioral therapy
• Relaxation exercises
• Medicines to relax the muscles or to ease anxiety

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for chronic abdominal pain.

The diaphragm is a thin piece of muscle that normally separates the chest from the abdomen. A congenital diaphragmatic hernia is a hole in the diaphragm that allows a baby’s intestines to move into the chest area, where it can crowd the heart and lungs. It occurs when the diaphragm doesn’t close properly during development.

Babies with a congenital diaphragmatic hernia may develop serious lung problems, such as pulmonary hypoplasia , because the lungs can’t grow properly.

There are two main types of congenital diaphragmatic hernias:

• A Bochdalek hernia is a hole in the side or back of the diaphragm. This is by far the most common type.
• A Morgagni hernia is a hole in the front of the diaphragm. This hernia may cause less severe symptoms, but it is much less common.

What are the signs and symptoms of a congenital diaphragmatic hernia?

A congenital diaphragmatic hernia is usually found before a baby is born, during a routine ultrasound. If it is not found before birth, most babies have symptoms right after birth, including:

• Difficulty breathing
• A blue color to the skin

Some babies with a Morgagni hernia may not have symptoms right away.

What causes a congenital diaphragmatic hernia?

Congenital diaphragmatic hernias develop early in pregnancy. Experts do not know what causes some babies to have them.

How is a congenital diaphragmatic hernia treated?

Most congenital diaphragmatic hernias need to be treated with surgery right after the baby is born. During surgery, the surgeon will gently move the baby’s organs out of the chest cavity and close the hole in the diaphragm. After surgery, your baby may need more treatment for lung problems. The team at Connecticut Children’s can help you coordinate care for your baby’s individual needs.

Constipation is when a child has hard stool that is hard to pass or has fewer bowel movements than normal. It is a common problem in children. The condition is usually temporary, but it can get worse if it is not treated.

What are the signs and symptoms of constipation?

Symptoms of constipation may include:

• Having stools that are hard or painful to pass
• Not passing any stool for more than a few days in a row
• Stomachaches or cramping
• Wet brown spots on your child’s underwear
• Bleeding from the anus

What causes constipation?

There are a few different causes of constipation. They can include:

• Delaying having a bowel movement. Children may hold stool because they do not want to stop playing or are embarrassed to use a public bathroom.
• Taking certain medicines that can cause constipation.
• Dietary issues, such as not eating enough fiber or drinking enough fluids.

How is constipation treated?

Treatment options for constipation may depend on your child’s age and how severe the constipation is. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for constipation.

NON-SURGICAL

• Dietary and behavior changes are usually the first steps to treat constipation. This may include eating more fiber, drinking more fluids, and creating a toilet routine.
• Your child’s doctor may suggest laxatives, enemas or stool softeners to help relieve your child’s symptoms.

SURGICAL

• In very rare cases, some children may need surgery to clear the bowels of feces. Our experienced surgical team will work with your family to discuss your child’s treatment options.

Cushing syndrome occurs when there is too much of the hormone cortisol in the blood. Sometimes called the “stress hormone,” cortisol helps many different tissues and organs in the body respond to change. Cushing syndrome is rare in children.

What are the signs and symptoms of Cushing syndrome?

Cushing syndrome can cause a wide range of symptoms. Some of the most common symptoms in children may include:

• Weight gain in the face, neck and upper body
• Fatty pad between the shoulders
• Thin arms and legs
• Slow growth in height
• Reddish purple stretch marks on the arms, chest, belly or thighs
• Round, red face
• Acne
• Thin skin that easily bruises

What causes Cushing syndrome?

Cushing syndrome can be caused by the overuse of corticosteroids, or steroid medications that contain glucocorticoid. Cushing syndrome can also be caused by a tumor. Most tumors that cause Cushing’s syndrome are located in the pituitary or adrenal glands and are not cancerous.

How is Cushing syndrome treated?

Treatment for Cushing syndrome can be surgical or non-surgical and depends on the cause of excess cortisol in the blood. Your child’s endocrinologist will discuss the treatment options with you.

SURGICAL

If a tumor is found to be the cause, treatment often involves surgery and radiation therapy to remove the tumor. In some cases, the adrenal glands need to be removed as well. Our experienced surgical team at Connecticut Children’s will work with your family to discuss your child’s treatment options.

NON-SURGICAL

If the cause of your child’s Cushing syndrome is the overuse of corticosteroids, our endocrinology team can work with you to adjust your child’s dosage.

Cystic lung disease is a general name for four conditions that cause cysts or growths on the lungs. These cysts can interfere with a baby’s breathing. The conditions are:

• Brochogenic cysts
• Cystic adenomatous malformation
• Lobar emphysema
• Pulmonary sequestration

What are the signs and symptoms of cystic lung disease?

Symptoms of cystic lung disease can include:

• Trouble breathing
• Wheezing
• Getting pneumonia often

What causes cystic lung disease?

Cystic lung disease is a condition that most often develops before a baby is born. Experts do not know the cause.

How is cystic lung disease treated?

Treatment will depend on the type of condition your baby has and if they are having symptoms. In most cases, the cysts need to be removed by surgery. At Connecticut Children’s, our experienced surgeons use minimally invasive techniques whenever possible.

Duodenal atresia or stenosis occurs when the top part of the small intestine, the duodenum, does not develop correctly. In duodenal atresia, the duodenum is completely blocked, so milk and fluids cannot pass into the digestive tract. In duodenal stenosis, the duodenum is abnormally narrow, making passage of fluids difficult.

Duodenal atresia and duodenal stenosis are both rare conditions that a baby is born with. Babies who have duodenal atresia sometimes have other types of birth defects, such as Down syndrome. Sometimes duodenal atresia is diagnosed by ultrasound before birth.

What are the signs and symptoms of duodenal atresia or stenosis?

Symptoms of duodenal atresia or stenosis start shortly after birth and can include:

• Vomiting
• Not being able to feed
• Swelling in the upper stomach area

Some babies with duodenal stenosis have less severe symptoms that may not start until they are a bit older.

What causes duodenal atresia or stenosis?

Duodenal atresia or stenosis are conditions that develop during pregnancy, before a baby is born. Experts do not know the exact cause.

How are duodenal atresia or stenosis treated?

Duodenal atresia or stenosis needs to be treated by surgery to repair the duodenum. The surgery is usually done a few days after your baby’s birth. At Connecticut Children’s, our surgeons use minimally invasive techniques whenever possible to repair all types of congenital anomalies in children.

An epigastric hernia is a small hole in the wall of the stomach muscle between the chest and the belly button. Part of the intestine pushes through this hole. Most epigastric hernias are small.

Epigastric hernias are often a condition a baby is born with. They are more common in boys than in girls.

What are the signs and symptoms of an epigastric hernia?

Some epigastric hernias do not cause any symptoms. If your child does have symptoms, they may include:

• A small bulge above the belly button
• Discomfort or pain in the area that may get worse when the child coughs, sneezes or stands

What causes an epigastric hernia?

Epigastric hernias occur during pregnancy when the muscles in the stomach don’t grow together correctly during a baby’s development. They can also occur after birth if the muscles are weak or strained.

How is an epigastric hernia treated?

Epigastric hernias do not close on their own, so most will need surgery. At Connecticut Children’s, this surgery is often done as an outpatient procedure so your child can go home the same day.

During hernia repair surgery, your child is put under general anesthesia. The surgeon will make a small incision at the area, push the intestine back inside the muscle wall and close the hole with stiches.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an epigastric hernia.

An embedded foreign body is any type of object stuck in the skin, such as a wood splinter, thorn, fishhook or piece of glass.

What are the signs and symptoms of an embedded foreign body?

Symptoms of an embedded foreign body may include:

• Pain, especially if pressure is applied to the area
• A feeling that something is stuck in the skin

What causes an embedded foreign body?

An embedded foreign body occurs by accident. It can happen if your child steps on a sharp object, gets a splinter or gets something else stuck in their skin.

How are embedded foreign bodies treated?

Treatment for embedded foreign bodies depends on the type of object embedded and how deep it is embedded. You may be able to treat minor embedded objects at home. If the object is larger or more deeply embedded, call your child’s doctor. They can discuss the best treatment options for your child.

SURGICAL

In rare cases, your child may need surgery to remove the object.

NON-SURGICAL

• In many cases, the object can be removed at home with a sterilized needle and tweezers. Wash the area before and after removing the object.
• Antibiotic cream applied to the area can help prevent infection.
• If you have any trouble removing the object, or if the area looks infected, call your child’s doctor.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an embedded foreign body.

The esophagus is a tube that connects the mouth to the stomach. Esophageal atresia occurs when a baby’s esophagus does not develop properly. Babies with esophageal atresia have an esophagus with two sections that do not connect. This means that food cannot get from the mouth to the stomach. In some cases, it can also cause problems with breathing.

Some babies with esophageal atresia are also born with a condition called tracheoesophageal fistula. This is when part of the esophagus is connected to the trachea. In many cases, babies with esophageal atresia are born with other types of health problems as well.

There are four types of esophageal atresia:

• Type A. The upper and lower sections of the esophagus have closed ends that do not connect. Neither end is connected to the trachea.
• Type B. This is a very rare type. The upper part of the esophagus is connected to the trachea, and the lower part has a closed end.
• Type C. This is the most common type. The upper part of the esophagus has a closed end, and the lower part is connected to the trachea.
• Type D. This type is the rarest and most severe. Neither end of the esophagus is connected to each other, but both are connected to the trachea.

What are the signs and symptoms of esophageal atresia?

Many babies are identified before birth to have esophageal atresia. This is a treatable condition and prenatal consultation with surgeons prior to birth is recommended. Our esophageal atresia team is available virtually and in person to talk with your family about esophageal atresia.

In most cases, babies with esophageal atresia may have symptoms shortly after birth that include:

• Having trouble breathing
• Choking or coughing while feeding
• A blue color to the skin, especially while feeding
• Spitting up or drooling
• Frothy white bubbles in the mouth

What causes esophageal atresia?

Esophageal atresia is a condition that develops early in pregnancy. Experts do not know what causes it, but in some cases the condition is linked to other syndromes.

How is esophageal atresia treated?

Esophageal atresia is a serious condition that needs to be treated with surgery shortly after the baby’s birth.

• If the two ends of the esophagus are close together, the surgeon may be able to connect them with surgery.
• If the ends are farther apart, your baby may need a surgery called the Foker procedure to make the esophagus longer.
• Sometimes babies with esophageal atresia get a gastrostomy tube (G-tube) until surgeons can repair the esophagus. A G-tube goes in through the belly to deliver breast milk or formula right to the stomach.

The specialists in our Esophageal Atresia Program at Connecticut Children’s are experienced at treating all types of esophageal atresia. The team will discuss specific options with your family based on the type of esophageal atresia your child has and how severe the condition is. Some children need more than one surgery to correct the problem.

Esophageal dysmotility is when the muscles in esophagus do not work properly. Children with esophageal dysmotility often have dysphagia or difficulty swallowing foods and liquids. All children with esophageal atresia are born with some type of esophageal dysmotility and symptoms can worsen as they get older due to multiple reasons.

What are the signs and symptoms of esophageal dysmotility?

The symptoms of esophageal dysmotility can include:

• Heartburn (a burning feeling in the throat or chest)
• Regurgitating of food
• Chest pain
• Trouble swallowing
•  The feeling that something is stuck in the throat and/or chest
• Inability to keep down saliva or secretions – this may be a sign that food is stuck or impacted in the esophagus and may require a surgical removal
• Weight loss

What causes esophageal dysmotility?

There are several reasons a child may have esophageal dysmotility. These can include:

• Swelling, disease or infection in the esophagus
• A problem with the nerves of the brain and/or in the wall of the esophagus that affects how the muscles work
• A problem with the muscles in the esophagus, mouth or throat

How is esophageal dysmotility treated?

The treatment for esophageal motility depends on what is causing the condition. Treatment options can be surgical or non-surgical depending on the severity of the disease. Some potential non-surgical options include but are not limited to changes in your child’s diet, injections of botulinum toxin (botox) in the area of concern, and dilation or stretching of the tissue of the esophagus with a balloon using the a long tube called an endoscope. Surgical options will depend on the cause of the underlying reason for each patient’s esophageal dysmotility. Treatment with surgery will be considered after the appropriate evaluation has been made and surgery is recommended by the team members of the esophageal atresia program

An esophageal stricture is a swelling or narrowing of the esophagus, the tube that connects the mouth to the stomach. Esophageal strictures can make it hard to swallow. Some babies are born with esophageal stricture, but they can also occur after an injury or surgery of the esophagus.

What are the signs and symptoms of esophageal strictures?

Common symptoms can include:

• Trouble swallowing
• Coughing
• Choking on foods or refusal to feed
• Weight loss

Please note there are other conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes esophageal strictures?

Esophageal strictures can have a few causes:

• Born with a narrow esophagus
• Swallowing a caustic substance, such as household cleaners or batteries
• Surgery on the esophagus
• Gastroesophageal reflux disease (GERD)

How are esophageal strictures treated?

Treatment for esophageal strictures can vary depending on how severe they are. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an esophageal stricture.”

NON-SURGICAL

Esophageal dilation may help open the esophagus. During the procedure, a doctor uses an endoscope (a long tube) to enter the esophagus and inflates a small balloon to stretch the tissue. The doctor may also place a stent in the esophagus to help keep it open while the tissue heals.

SURGICAL

If esophageal dilation does not help, your child’s doctor may recommend surgery.

The diaphragm is a thin piece of muscle that normally separates the chest from the abdomen. Eventration of the diaphragm occurs when this muscle does not develop properly. It is a rare condition that a baby is born with.

What are the signs and symptoms of eventration of the diaphragm?

Some children do not have any symptoms. For those who do have symptoms, they can include:

• Difficulty breathing
• Frequent lung infections
• Not gaining weight

Please note there are many conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes eventration of the diaphragm?

Eventration of the diaphragm occurs when the diaphragm does not develop properly in pregnancy. Experts do not know what causes some babies to be born with this condition.

How is eventration of the diaphragm treated?

Most children with this condition will need a surgery called diaphragmatic plication to repair the diaphragm. Whenever possible, our surgeons at Connecticut Children’s perform this surgery using minimally invasive techniques.

A femoral hernia occurs when part of the intestine pushes though a weak spot in the groin area in the upper thigh. Femoral hernias are an uncommon type of hernia, and they are very rare in children.

In severe cases, the hernia can block blood supply to the part of the intestine or bowel trapped inside the hernia. This is called a strangulated hernia and can be a life-threatening condition.

What are the signs and symptoms of a femoral hernia?

Symptoms or a femoral hernia may include:

• A small lump on the inner thigh
• Discomfort or pain in the groin area

What causes a femoral hernia?

Femoral hernias can occur when the muscles in the groin are weakened. In children, this is usually due to another medical condition.

How are femoral hernias treated?

Femoral hernias do not close on their own, so the only treatment is surgery to close the hernia. At Connecticut Children’s, our surgeons use minimally invasive techniques whenever possible.

Fibroadenomas are a type of noncancerous (benign) breast lump. They are one of the most common types of benign breast lumps found in girls and teens. Fibroadenomas can vary in size and usually do not cause pain. There can be just one or many, and they may be found in one or both breasts.

What are the signs and symptoms of fibroadenomas?

Fibroadenomas are firm, solid lumps that have a well-defined shape. They are easily moved around and may feel like a small marble under the skin. They can shrink or become larger over time.

What causes fibroadenomas?

Doctors don’t know what causes fibroadenomas. They may be related to female hormones.

How are fibroadenomas treated?

Treatment for fibroadenomas depends on their size. Small fibroadenomas may not need any treatment. Your child’s doctor may watch the tumor over time for any changes. For larger lumps, treatments include both surgical and non-surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a fibroadenoma.

SURGICAL

A lumpectomy or excisional biopsy is a surgery to remove the fibroadenoma. The surgeon may also send it for a biopsy to check for cancer.

NON-SURGICAL

Cryoablation is a procedure to destroy the fibroadenoma without using surgery. In this procedure, the doctor inserts a tool called a cryoprobe into the skin. The cryoprobe emits a gas that freezes and destroys the tumor.

The gallbladder is an organ that makes and stores bile, the fluid that helps digest food and drink. Gallbladder disease occurs when bile backs up in the gallbladder. The most common cause is gallstones, which can develop when the bile hardens and creates stones.

While gallbladder disease and gallstones are more common in adults, they are becoming more common in children and teens. Children or teens may be more likely to have gallstones if they:

• Are obese
• Eat a diet high in fat
• Have certain conditions, such as cerebral palsy or Crohn’s disease
• Have a blood disease such as sickle cell anemia or beta thalassemia
• Take certain medicines, such as birth control pills
• Have needed intravenous (IV) nutrition

What are the signs and symptoms of gallbladder disease?

In some cases, gallbladder disease may not cause any symptoms. But if children do have symptoms, they may include:

• Pain in the middle or upper right of the stomach area that may spread to the back or shoulder
• Stomach pain may be worse after eating fatty foods
• Nausea or vomiting
• Fever or chills
• Jaundice, which is a yellowing of the skin or whites of the eyes

Please note there are many conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes gallbladder disease?

The most common cause of gallbladder disease in children is gallstones.

How is gallbladder disease treated?

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for gallbladder disease. In some cases, the pain of gallstones may be managed by avoiding foods that cause pain, such as fatty or greasy foods. But the only consistent treatment for gallbladder disease involves surgery to remove the gallbladder, called a cholecystectomy. Whenever possible, our surgeons at Connecticut Children’s perform this surgery laparoscopically, using a few small incisions and a video camera.

A gastrocutaneous fistula is an opening between the stomach and the skin. It can occur after a child has a gastronomy tube (G-tube) removed. A G-tube is a device used to help supply nutrition to a child who cannot eat enough food. In most cases, when the G-tube is removed, the opening closes quickly. But when the opening doesn’t close after a few weeks, it can become a gastrocutaneous fistula.

What are the signs and symptoms of a gastrocutaneous fistula?

The gastrocutaneous fistula will look like an open area where the G-tube has been removed. Your child’s doctor will know if the area is not closely properly.

What causes a gastrocutaneous fistula?

The main cause of a gastrocutaneous fistula in children is removal of a G-tube. Children who have a G-tube for more than 11 months may have a higher risk of developing a gastrocutaneous fistula when it is removed.

How are gastrocutaneous fistulas treated?

Gastrocutaneous fistulas need to be closed with surgery. Whenever possible, our surgeons at Connecticut Children’s perform this surgery laparoscopically, using minimally invasive techniques.

Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back up into the esophagus, the tube that connects the mouth and the stomach. It is a more serious and chronic type of gastroesophageal reflux (GER), which is common in babies and sometimes occurs in older children. But not all children with GER have GERD. Babies and children with GERD have symptoms that occur often or don’t go away.

Over time, GERD can lead to another condition, called Barrett’s esophagus. This is when the lining of the esophagus becomes damaged from constant exposure to stomach acid.

What are the signs and symptoms of GERD?

The symptoms of GERD in babies and children include:

• Heartburn (in older children)
• Symptoms of asthma (in children under 12)
• Trouble swallowing (in children under 12)
• Frequent coughing, gagging or choking
• Stomach pain
• Burping
• Not eating
• Wheezing
• Bad breath
• A sour taste in the mouth

Please note there are many conditions with symptoms similar to GERD. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes GERD?

GERD is often caused by a problem with the lower esophageal sphincter (LES). This is a muscle at the end of the esophagus. The LES opens to let food into the stomach and closes to keep food inside the stomach. When the LES does not close properly, stomach acid can flow back up into the esophagus. This causes heartburn and the other symptoms of GERD. Babies often have a weak LES.

Some foods can make the LES remain open longer than it should. These include:

• Peppermint
• Chocolate
• Fatty foods

Some other things that can cause GERD include:

• Taking certain medicines
• Secondhand smoke
• Being obese

How is GERD treated?

The options to treat GERD may depend on your child’s symptoms and how severe the condition is. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for GERD.

Surgical

• A surgery, called a Nissen fundoplication, can reduce symptoms of GERD. During the surgery, the surgeon wraps the top part of the stomach around the esophagus to tighten the LES. At Connecticut Children’s, it is often done as laparoscopic surgery. This type of surgery uses small incisions and a thin tube with a video camera at the end, called a laparoscope, to see inside the esophagus.

Non-Surgical

• In some cases, making lifestyle or diet changes can reduce the symptoms of GERD. These may include limiting foods that can cause GERD, eating smaller portions and not lying down after eating.
• Medicines can help reduce the amount of stomach acid or help the stomach empty faster, which can reduce symptoms.

Young children often put things in their mouths and can swallow them by mistake. When this occurs, the swallowed item is called a gastrointestinal foreign body. Children between the ages of 6 months and 3 years are the most likely to swallow a foreign body. The most common items that children swallow are coins, button batteries, magnets, screws and nails.

A bezoar is a clump of fabric, hair or other indigestible material that a child swallows or chews on. It can get stuck in the stomach and not pass through the intestines. Bezoars are most common in children ages 10 to 19.

In many cases, these items pass through the digestive system without complications. But sometimes they may need to be removed.

What are the signs and symptoms of gastrointestinal foreign bodies and bezoars?

Common symptoms can include:

• Stomach pain
• Nausea
• Vomiting
• Diarrhea

What causes gastrointestinal foreign bodies and bezoars?

Gastrointestinal foreign bodies and bezoars occur when a child swallows an item by mistake.

How are gastrointestinal foreign bodies and bezoars treated?

Treatment for gastrointestinal foreign bodies and bezoars depends on the object that is swallowed and if your child is having symptoms. Treatment may include surgical or non-surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a a gastrointestinal foreign body or bezoar.

SURGICAL

In some cases, the object will need to be removed surgically. This may be the case for batteries, magnets and sharp items. Large bezoars may also need to be removed with surgery. Our experienced surgical team at Connecticut Children’s uses minimally invasive techniques whenever possible.

NON-SURGICAL

In many cases, the object will pass through the digestive system without any problems. Your child’s doctor may decide to monitor the object through a series of x-rays.

Gastroschisis occurs when a baby’s intestines grow outside of the baby’s body, through an opening in the stomach wall. It is a condition that occurs while a baby is developing.

The opening most often develops on the right side of the baby’s belly button. It can vary in size. If it is large, other organs may also grow outside of the body. Because the intestines are not covered with skin, they are exposed to amniotic fluid. This can make them irritated or swollen.

What are the signs and symptoms of gastroschisis?

Gastroschisis may be found on an ultrasound before the baby is born. After the baby’s birth, the opening in the stomach wall is easily visible.

What causes gastroschisis?

Gastroschisis develops early in pregnancy. Experts do not know exactly what causes the condition, but it is more common in mothers under age 20. In some cases, it may be linked to environmental factors, medicines the mother takes during pregnancy, or what she eats or drinks.

How is gastroschisis treated?

Gastroschisis needs to be treated with surgery shortly after birth. If the opening is small, your baby may need only one surgery. If the opening is larger, and there are many organs outside of the body, the surgery may need to be done in stages.

Whatever your baby’s surgical needs, you can rest assured that our surgical team at Connecticut Children’s have years of experience in caring for children with gastroschisis, as well as other types of congenital anomalies.

Hemorrhoids are swollen veins in the anal area. They can be inside the anus (internal) or around the outside of the anus (external).

What are the signs and symptoms of hemorrhoids?

Common symptoms of hemorrhoids include:

• Pain or irritation around the anus
• Itching around the anus
• Swelling or a lump around the anus
• Bright red spots of blood in stool or in the toilet or on toilet paper after a bowel movement

What causes hemorrhoids?

Hemorrhoids are most often caused by straining during bowel movements. They can also be caused by chronic constipation or diarrhea.

How are hemorrhoids treated?

Hemorrhoid treatment is based on how severe the hemorrhoids are. Your child’s treatment may include surgical or non-surgical options.

Surgical

• Surgery to remove the hemorrhoids may be needed if other treatments don’t work. At Connecticut Children’s, our experienced surgeons use minimally invasive techniques whenever possible.

Non-surgical

• Using creams or suppositories to reduce the swelling of hemorrhoids
• Sitting in a warm water bath
• Using ice packs to reduce swelling

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for hemorrhoids.

Hirschsprung disease is a rare disease that a baby is born with. It occurs when some or all the nerves in the large intestine (colon) are missing. These nerves help move stool through the colon and out of the body. When they are missing, stool can get backed up inside the colon. This can cause the colon to become blocked and can lead to infection, swelling and pain.

What are the signs and symptoms of Hirschsprung disease?

The symptoms of Hirschsprung disease can vary depending on how severe the condition is. Babies with severe disease usually have symptoms shortly after birth. These may include:

• No bowel movement in the first 48 hours after birth
• Green or brown vomit
• A swollen belly

Babies with less severe disease may have symptoms that develop over time:

•  Constipation
• A swollen belly
• Delayed growth
• Loss of appetite

What causes Hirschsprung disease?

Hirschsprung disease develops during pregnancy. Experts don’t know exactly what causes it.

How is Hirschsprung disease treated?

Hirschsprung disease is usually treated with a surgery called a pull-through procedure. In this surgery, the surgeon removes the part of the colon that is missing nerve cells. If possible, they connect the healthy part to the anal opening. At Connecticut Children’s, our surgeons most often perform this surgery in one step using minimally invasive (laparoscopic) techniques.

Some children need to have the surgery in two stages. If this is this case, the child first has ostomy surgery. During this surgery, the surgeon removes the diseased part of the colon. Then they attach the healthy end of the colon to an opening made in the belly called a stoma. The stool passes through the stoma and into a bag the child wears outside the body. The bag needs to be emptied several times a day.

Once the colon has healed, the surgeon connects it to the anus during a second surgery and sews the stoma closed.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for Hirschsprung disease.

Inflammatory bowel disease is a chronic inflammation of the digestive tract. It can be diagnosed at any age. There are two main types of IBD:

• Crohn’s disease can occur in any part of the digestive tract, from the mouth to the anus. However, it often appears only in certain areas, skipping over some parts of the digestive tract. Crohn’s disease causes inflammation in the entire thickness of the intestinal wall.
• Ulcerative colitis occurs only in the large intestine (colon) and rectum. It affects only the first layer of the intestinal wall, rather than the entire thickness.

It can be hard to tell the difference between the two types of IBD.

What are the signs and symptoms of irritable bowel disease?

The symptoms of IBD in children include:

• Stomach pain
• Diarrhea
• Blood in the stool
• Frequent bowel movements
• Weight loss
• Fever
• Fatigue
• Joint pain

The symptoms of IBD may come and go. Sometimes children can go for a long time — months or even years — without having any symptoms.

Please note there are many conditions with symptoms similar to IBD. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes IBD?

Experts don’t know exactly what causes IBD, but it seems to be a combination of genetics, the immune system and environmental factors. IBD can run in families.

How is irritable bowel disease treated?

The options to treat IBD may depend on your child’s symptoms and how severe the condition is. Your child’s doctor may recommend surgery if the condition cannot be treated by medicine alone.

Surgical

• Surgery for Crohn’s disease may help relieve symptoms. But it is not a cure. Crohn’s disease can come back after surgery and affect another part of the digestive tract.
• Surgery for ulcerative colitis involves removing the colon (colectomy). The surgeon then creates a pouch from the small intestine (J-pouch) in place of the rectum.
• At Connecticut Children’s, our surgeons are skilled in using minimally invasive (laparoscopic) techniques to perform surgery on children and teens with IBD.

Non-surgical

• Medicines can help reduce inflammation and the risk for infection.
• Dietary therapy can help ensure that children get the nutrition they need to grow.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for IBD.

An ingrown toenail is when the corner of a toenail grows into the skin next to it. It usually occurs when the nail is cut too short, and the skin grows over the nail. It happens most often in the big toe. Ingrown toenails can become painful, swollen and infected.

What are the signs and symptoms of ingrown toenails?

Common symptoms of ingrown toenails include:

• Pain in the toe
• Redness or swelling around the edge of the nail

If your child has any of the following symptoms, the nail may be infected:

• Pus or discharge from the area
• A bad smell
• A feeling of warmth in the area

What causes ingrown toenails?

Ingrown toenails are most often caused by cutting the nail too short. Other causes can include:

• Ripping the nail instead of cutting it, or cutting it in a rounded shape
• Wearing shoes that are too tight
• Using the toe for a repeated activity, such as kicking a ball

How are ingrown toenails treated?

In many cases, the ingrown toenail can be treated at home by soaking the foot in a warm saltwater bath a few times a day. But if the toenail becomes infected, you may need to visit your child’s doctor for treatment.

Surgical

• Sometimes surgery is needed to remove a section of the nail or the whole nail.

Non-surgical

• Antibiotic medicines may help if the toe is infected.
• The doctor may remove the corner of the nail and drain the pus from the area.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an ingrown toenail.

Inguinal hernias are one of the most common conditions we care for.

An inguinal hernia is a bulge in the groin that can extend down towards the scrotum. It occurs when there is an opening between the abdomen and groin area that doesn’t close properly during development. As the baby grows, parts of the intestine, fluid, or fatty tissue can push through the opening.

If the hernia can be pushed back into the abdomen, it is called a reducible hernia. This will still need surgical repair. If it can’t be pushed in, it is called an incarcerated hernia. Incarcerated hernias need treatment right away because the intestine may be trapped inside the hernia.

Inguinal hernias are often a condition a baby is born with, but also may develop over time. The bulge may not become apparent until several years later. They are more common in boys than in girls.

What are the signs and symptoms of an inguinal hernia?

Symptoms of an inguinal hernia may include a swelling or bulge in the groin or scrotum that may seem bigger when the baby is crying, straining, or coughing.

If the hernia is incarcerated, your baby may also have:

• Pain
• Vomiting
• Redness in the area
• Fever

What causes an inguinal hernia?

Inguinal hernias occur when the canal between the abdomen and groin area does not close during a baby’s development. This opening allows fluid, fat, or part of the intestine to move into the canal, creating the hernia. In girls, an ovary may also become stuck in the opening.

Groin hernias are quite common. Babies who are born prematurely or who have a family history of hernias have a higher risk of having an inguinal hernias. Also children with chronic constipation, chronic cough, or difficulty urinating are at higher risk.

How is an inguinal hernia treated?

Inguinal hernias need to be treated with surgery. In most cases, the surgery is done soon after the hernia is found so the intestine inside does not become stuck or lose blood flow. If the hernia is stuck, your child may need surgery right away. At Connecticut Children’s, our experienced surgeons have multiple techniques for hernia repair, and will discuss the risks and benefits of the different approaches with families, to allow you to make the most informed decision for your child.

Intestinal atresia is the name for several conditions in which a baby’s intestines do not develop correctly. It can affect either the small or large intestine and can range from a blockage of the intestine to missing entire sections of the intestine. Intestinal atresia causes problems with the way a baby digests and absorbs nutrients. It is a condition that develops before a baby is born.

The types of intestinal atresia include:

• Pyloric atresia, which affects the pylorus, the opening between the stomach and small intestine (this type is very rare)
• Duodenal atresia , which affects the duodenum (the top part of the small intestine)
• Ileal atresia, which affects the ileum (the lower part of the small intestine)
• Jejunal atresia, which affects the jejunum (the middle part of the small intestine)
• Colonic atresia, which affects the colon (the large intestine)

What are the signs and symptoms of intestinal atresia?

Symptoms start shortly after birth and can include:

• Vomiting
• Not being able to feed
• Swelling or bloating in the stomach

In some cases, intestinal atresia is found on an ultrasound before the baby’s birth.

What causes intestinal atresia?

Intestinal atresia develops before a baby’s birth. Experts think that it occurs due to a lack of blood supply to the baby’s intestines. They are not sure why this happens, but it may run in families.

How is intestinal atresia treated?

Intestinal atresia is treated by surgery. The surgery is usually done a few days after your baby’s birth. The type of surgery your baby has will depend on the type of atresia and how severe it is. At Connecticut Children’s, our surgeons use minimally invasive techniques whenever possible to repair all types of congenital anomalies in children

Kidney (renal) tumors are abnormal growths on the kidneys. They can either be cancerous or not cancerous (benign). Although rare, there are many different types of kidney tumors that can occur in children. A few types of these tumors include:

• Wilms tumor (the most common type of kidney tumor in children)
• Renal cell cancer (very rare in children under age 15)
• Congenital mesoblastic nephroma (the most common kidney tumor in infants)
• Ewing sarcoma of the kidney (rare but may occur in young adults)
• Multilocular cystic nephroma (benign tumors that can occur in infants and children)
• Rhabdoid tumor (a cancerous tumor that can occur in infants and young children)

What are the signs and symptoms of kidney tumors?

Symptoms of kidney tumors can vary depending on the type of tumor. They can include:

• Pain or swelling in the stomach area
• Blood in the urine
• High blood pressure
• Weight loss

Please note there are many conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes kidney tumors?

The cause of kidney tumors depends on the type of tumor. In many cases, experts do not know what causes kidney tumors.

How are kidney tumors treated?

Treatment for kidney tumors depends on the type of tumor and whether it is cancerous. The team at Connecticut Children’s will discuss all your child’s treatment options with your family.

SURGICAL

Surgery is often the main treatment for kidney tumors. Our experienced surgeons use minimally invasive techniques whenever possible.

• Nephrectomy is a surgery to remove the entire kidney. In some cases, nearby lymph nodes may be removed as well to check to see if the cancer has spread.
• A partial nephrectomy may be done if the cancer is in both kidneys. This surgery removes the tumor and an area of tissue around the tumor.
• In some cases, children may need a kidney transplant if the cancer is found in both kidneys.

NON-SURGICAL

Chemotherapy, radiation therapy or targeted therapy may be used to help shrink the tumor or kill cancer cells.

Labial adhesions are when the inner lips of the vulva become stuck together. This can completely or partially cover the vaginal opening. Labial adhesions are most common in girls ages 3 months to 6 years, before puberty begins.

What are the signs and symptoms of labial adhesions?

Most children with labial adhesions have no symptoms. When symptoms do occur, they may include:

• Pain, irritation or itching around the vagina
• Frequent urinary tract infections
• Leaking or dribbling urine after urinating

What causes labial adhesions?

Experts think the low levels of estrogen in the body before puberty may play a role in causing labial adhesions. Other causes may include:

• Fecal soiling
• Irritation from diaper rash or soaps

How are labial adhesions treated?

If there are no symptoms, labial adhesions may not need any treatment. In many cases, the adhesions become unstuck during puberty, when the body starts making estrogen. If treatment is needed, your child’s doctor will discuss treatment options with you.

Surgical

• In rare cases, surgery may be needed if the adhesion is very thick and will not separate using topical cream. Our expert team of surgeons at Connecticut Children’s have specialized training in the gynecological needs of girls and young women of all ages.

Non-surgical

• Your child’s doctor may prescribe estrogen cream or other types of cream to help separate the adhesion.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for labial adhesions.

A lumbar hernia occurs when parts of the intestine or other organs push through a weak spot in the muscles of the lower back. Lumbar hernias are a rare type of hernia, and are very uncommon in children.

What are the signs and symptoms of a lumbar hernia?

Some children may have no symptoms. When symptoms do occur, they may include:

• A lump on the lower back
• Lower back pain
• Fussiness

What causes a lumbar hernia?

Lumbar hernias in children are sometimes a condition a baby is born with, but can also develop over time. They can occur because of a problem with the development of the muscles or other problems in development. They can also develop after an injury or operation in the area.

How are lumbar hernias treated?

Lumbar hernias are treated with surgery to close the hernia. At Connecticut Children’s, our surgeons use minimally invasive techniques to approach this condition whenever possible.

A lung abscess is a cavity filled with pus inside the lung. It is usually caused by an infection, like pneumonia, in the lungs. Lung abscesses are very rare in children.

What are the signs and symptoms of a lung abscess?

Common symptoms can include:

• Fever
• Cough
• Chest pain
• Trouble breathing or fast breathing

What causes a lung abscess?

In most cases, a lung abscess in children is caused by an infection in the lung, such as pneumonia.

How is a lung abscess treated?

Treatment for lung abscesses may include both surgical and non-surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a lung abscess.

NON-SURGICAL

• Antibiotics are usually the main treatment for a lung abscess.
• If antibiotics do not work, the abscess may need to be drained using a long tube guided by a CT scan.

SURGICAL

• In rare cases, part of the infected lung tissue may need to be removed by surgery.

Lung lesions or nodules are abnormal growths in a baby’s lungs. There are many different types of lung lesions and nodules in children. Some are solid, while others are filled with fluid. Most are not cancerous (benign). Though rare, lung lesions and nodules in children can include:

• Congenital cystic adenomatoid malformations (CCAM), also known as congenital pulmonary airway malformations (CPAM)
• Congenital lung cysts (CLC)
• Pulmonary sequestrations

What are the signs and symptoms of a lung lesion or nodule?

• An abnormal growth in the lungs, often detected on a routine ultrasound during pregnancy.
• It is unusual for a baby born with a lung lesion or nodule to have any symptoms at birth. On rare occasions, a newborn with a lung lesion or nodule has difficulty breathing.

What causes lung lesions or nodules?

Experts do not know the cause of lung lesions and nodules that develop before birth.

How are lung lesions and nodules treated?

Treatment for lung lesions and nodules depends on the type, size and exact location of the mass. Your obstetrician may recommend watching the lung lesion or nodule closely through pregnancy to see if it needs treatment.

SURGICAL

Most lung lesions or nodules need to be removed with surgery within the first few months after a child’s birth. At Connecticut Children’s, our surgeons use minimally invasive options as often as possible to reduce bleeding and recovery time.

NON-SURGICAL

In some cases, the lung lesion or nodule will stop growing or shrink during pregnancy and will not require surgery.

Lymphadenopathy is the medical term for swollen lymph nodes. Lymph nodes are the bean-sized structures found in many areas of the body, including the neck, underarm, groin, chest and stomach. They act as a filter for the immune system and can swell if your child has an infection or illness.

Lymphadenopathy can occur in just one area, such as the underarm, or in many areas. In some cases, children may have swelling of the lymph nodes that does not go away.

What are the signs and symptoms of lymphadenopathy?

The symptoms of lymphadenopathy may include:

• Swollen lumps where lymph nodes are located
• Redness or warm skin in the swollen area
• Fever

Please note there are other conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes lymphadenopathy?

Swollen lymph nodes are most often caused by a virus or infection. It is common for children to have lymphadenopathy when they are sick. In some cases, the cause can be cancer of the lymph system (lymphoma).

How is lymphadenopathy treated?

There are a few treatment options for your child’s lymphadenopathy, including non-surgical and surgical treatments. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for lymphadenopathy.

NON-SURGICAL

• Antibiotics to treat an underlying infection.
• Other medicines to treat illnesses that may be causing the lymphadenopathy.

SURGICAL

• If the swelling does not go down after medical treatment, your child’s doctor may suggest a biopsy to find the reason for the enlarged lymph nodes.
• In some cases, your child may need surgery to remove the lymph node that is enlarged. Our experienced surgical team at Connecticut Children’s will work with your family to discuss your child’s treatment options. Our surgeons use minimally invasive options as often as possible to reduce bleeding and recovery time.

A lymphatic malformation is a non-cancerous growth or cyst in a lymphatic vessel, which is a part of the immune system. Children with lymphatic malformations are born with a lymphatic vessel that isn’t developed correctly. This causes fluid to become trapped and form a spongy growth, often found on a child’s head or neck.

What are the signs and symptoms of a lymphatic malformation?

Lymphatic malformations are usually visible at birth or by the age of 2. Symptoms may vary, depending on the size and location of the cyst, but can include:

• Spongy lump on the neck, head or face. A lymphatic malformation can occasionally form on the arms, legs, chest, belly or pelvis.
• Bleeding or pain at the site of the lump.
• Redness, warmth, discharge or swelling at the site of the lump, if infected.
• Breathing, speaking or swallowing problems, if on the chest.
• Vision problems, if on the eye.
• Problems using the bathroom, if on the pelvis.

What causes a lymphatic malformation?

Lymphatic malformations develop when a baby is forming during pregnancy. Experts do not know what causes a lymphatic vessel to develop incorrectly. Lymphatic malformations are more common in children with Down syndrome, Turner syndrome and other genetic conditions.

How are lymphatic malformations treated?

Treatment for a lymphatic malformation depends on the size and location of the growth. In some cases, your child’s doctor may recommend watching the growth over time to see if it needs treatment.

The multidisciplinary vascular anomalies team at Connecticut Children’s has extensive experience treating lymphatic malformations in young children and will discuss the best treatment approach with your family.

SURGICAL

If a child’s lymphatic malformation affects their breathing or a nearby organ, it may need to be removed with surgery. At Connecticut Children’s, our surgeons use minimally invasive options as often as possible to reduce bleeding and recovery time.

NON-SURGICAL

Some lymphatic malformations can be treated with medicines that shrink the cyst.

Neonatal cholestasis occurs when bile does not flow properly from the liver to the intestine in a newborn. It can range from a mild condition that gets better without treatment to a more serious condition that can cause further health problems and liver disease.

What are the signs and symptoms of neonatal cholestasis?

The symptoms of neonatal cholestasis may start to appear a few weeks after your baby’s birth. They can include:

• A yellowing of the skin and whites of eyes (jaundice)
• Dark colored urine
• Not gaining weight
• Itchy skin

What causes neonatal cholestasis?

Neonatal cholestasis can have a few different causes. These include:

• Viruses
• Liver diseases
• Genetic disorders

How is neonatal cholestasis treated?

There is no specific treatment for neonatal cholestasis. Treatment is usually focused on managing specific symptoms. Some babies may need to take supplements or special formulas to help them absorb nutrients.

In rare cases, babies who develop end-stage liver disease may need liver transplantation surgery. Our experienced team at Connecticut Children’s will work with your family to discuss your child’s treatment options.

Neuroblastoma is a cancerous solid tumor found in children. It often starts in the tissue of the adrenal glands or abdomen. Though it is a condition a child is born with, neuroblastoma is typically not found until the tumor grows big enough to affect the surrounding organs.

What are the signs and symptoms of neuroblastoma?

Symptoms of neuroblastoma may include:

• Lump in the abdomen
• Swollen, painful belly
• Decreased appetite and weight loss
• Loss of strength or movement in the legs

Occasionally, a child with neuroblastoma will develop a lump in the neck, causing shortness of breath or difficulty swallowing. If the cancer has spread, there can be other symptoms throughout the body.

What causes neuroblastoma?

Neuroblastoma is a condition that develops during a baby’s development. There is very rarely a family history. Like most childhood cancers, experts do not know what causes neuroblastoma.

How is neuroblastoma treated?

Surgery and chemotherapy are the most common treatments for neuroblastoma. Depending on the stage of the cancer and if it has spread, additional treatments may be necessary. The multidisciplinary solid tumor team at Connecticut Children’s has extensive experience treating neuroblastoma and will discuss the best treatment approach with your family.

Obesity is weighing more than is healthy for your weight. Obesity in children is measured by their body mass index (BMI). When a child’s BMI is at or above the 95th percentile for children of their age and height, they are obese.

Obesity is becoming a more common health concern in children. It can lead to health problems such as type 2 diabetes, high blood pressure and sleep apnea . Children who are obese may also be at risk for low self-esteem, bullying and depression.

What are the signs and symptoms of obesity?

You may not be able to tell if your child is obese by looking at them. Children grow at different rates and have different sized frames. The best way to know if your child is obese, or at risk of becoming obese, is to talk with their doctor.

What causes obesity?

In most cases, obesity is caused by taking in many more calories than are used in physical activities. Children and teens who consume a lot of fast foods, baked goods, sugary drinks and unhealthy snacks may be at a higher risk for obesity. Being inactive also puts them at higher risk.

Other things that can increase a child’s risk for obesity include:

• A family history of being overweight or obese
• Taking certain medications
• Hormonal issues

How is obesity treated?

Treatment for obesity is based on your child’s age, weight and whether they are having medical problems because of their weight. Treatment may include surgical or non-surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for obesity.

SURGICAL

Our experienced surgeons at Connecticut Children’s offer three types of weight loss surgery, called bariatric surgery, for obese teens. Our team will work with your family to help you choose the best surgical option for your child. All weight loss surgeries are performed using a few small incisions on the stomach. This is called laparoscopic surgery.

• Laparoscopic sleeve gastrectomy is a surgery that removes about 80% of the stomach using small incisions. The new stomach holds less food and liquid, reducing the appetite.
• Laparoscopic gastric bypass is a surgery that also decreases the size of the stomach. But in this surgery, the way that food is digested is changed. The smaller stomach pouch is attached to the middle of the small intestine, so food bypasses the larger part of the stomach and upper part of the small intestine as it gets digested.
• Laparoscopic adjustable gastric banding is a surgery that places a band made of silicone around the top part of the stomach. The size of the band can then be adjusted with injections of fluid through a port placed under the skin. The band can also be removed later if needed. This surgery is also done using small incisions.

NON-SURGICAL

In most cases, the first step in treating obesity is making changes in diet and exercise habits. These may include:

• Making changes to your child’s diet, such as limiting sweetened drinks and fast food and cutting back on portion sizes
• Limiting time sitting in front of the TV or computer
• Starting an exercise program or getting more activity
• Taking medicines as part of a weight-loss program

Omphalocele is a birth defect that causes a baby’s abdominal organs to stick outside of the belly in a clear sac. It occurs when the abdominal wall does not form properly in the womb. During normal development, the intestines push up into the umbilical cord but return inside the belly by 11 weeks. In babies with omphalocele, the intestines do not return to the belly.

The omphalocele may be small or large. It may contain only a portion of the intestines, or most of the abdominal organs such as the intestines, liver and spleen. Babies with a small omphalocele can sometimes be delivered vaginally, but most of the time they are born by cesarean section (C-section).

What are the signs and symptoms of omphalocele?

Omphalocele is usually seen during a routine ultrasound before the baby is born. If the omphalocele is not found during pregnancy, it is diagnosed immediately at birth. Once omphalocele is diagnosed, doctors check for other conditions such as heart defects and genetic abnormalities. Sometimes babies born with omphalocele have lungs that are smaller than normal, which can cause trouble breathing.

What causes omphalocele?

Experts don’t know the exact cause of omphalocele, but it is a possibility that genetic mutations or environmental factors play a role. Babies with omphalocele often have other birth defects.

How is omphalocele treated?

Treatment depends on the size of the omphalocele and whether the baby has any other conditions. All babies with this condition need surgery. Our experienced surgical team at Connecticut Children’s will work with your family to discuss your child’s treatment options.

• If the omphalocele is small, surgery is performed soon after birth to place the exposed intestine into the abdominal cavity and close the abdominal wall.
• If the omphalocele is large, it is treated using a staged approach. A mesh material is sewn over the omphalocele and is continuously tightened. The organs are gradually moved back into the abdominal cavity. When this process is complete, the mesh material is removed, and surgery is performed to close the abdominal wall.
• If the abdominal cavity is too small to hold the exposed organs or if your baby has breathing problems, the “paint and wait” method may be used. The omphalocele sac is covered with antibiotic cream and eventually skin grows over the membrane. A ventilator may be used during this time to help the baby breathe. When your baby is stable, the organs are gradually pushed inside the belly. This process could take several months. Once all the organs are contained in the belly, surgery is performed to close the opening.

Ovarian and uterine masses include any type of growth that develops in the ovaries or uterus. The ovaries and uterus are parts of the reproductive system in girls and women. Ovarian and uterine masses are rare in children, but possible masses can include:

• Ovarian tumors, which may be non-cancerous or cancerous
• Ovarian cysts
• Uterine fibroids

What are the signs and symptoms of ovarian and uterine masses?

These symptoms may vary, depending on the type of mass, but can include:

• Pain in the stomach or pelvic area
• Heavy menstrual bleeding
• Frequent urination
• A feeling of fullness in the stomach
• Nausea and vomiting
• Low back pain

What causes ovarian and uterine masses?

Experts do not know the cause of many types of ovarian and uterine masses.

How are ovarian and uterine masses treated?

Treatment for ovarian or uterine masses depends on the type of mass. In some cases, your child’s doctor may recommend watching the mass over time to see if it needs treatment. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an ovarian or uterine mass.

Surgical

• Some masses, such as cancerous tumors and fibroids, may need to be removed with surgery. At Connecticut Children’s, our surgeons use minimally invasive options as often as possible to reduce bleeding and recovery time.

Non-Surgical

• Some masses, such as uterine fibroids or ovarian cysts, may be treated with medicines.

Ovarian cysts are small sacs filled with fluid or blood that grow on or in an ovary. The ovaries are part of the female reproductive system. Ovarian cysts can grow on one or both ovaries. They are common in girls and women of all ages.

What are the signs and symptoms of ovarian cysts?

In many cases, these cysts do not have any symptoms and they go away on their own with no problems.

If larger cysts develop, they may cause:

• Pelvic pain
• Bloating or a feeling of fullness in the lower stomach area
• Irregular periods

If a cyst bursts, it is an emergency and can cause the following symptoms:

• Nausea and vomiting
• Severe pelvic pain
• Passing out

In rare cases, cysts can also cause ovarian torsion, twisting the ovary. This is also an emergency and causes the same type of symptoms as a burst cyst.

What causes ovarian cysts?

Most ovarian cysts develop due to changing levels of hormones in the menstrual cycle.

How are ovarian cysts treated?

Many ovarian cysts go away on their own and do not need any treatment. Or the doctor may choose to monitor the cyst over time. If your child’s cysts do need treatment, your doctor may discuss surgical or non-surgical options.

Surgical

• If a cyst is especially large or does not go away, it may need to be removed by surgery.
• Emergency surgery may be needed if the cyst has burst or has caused ovarian torsion.

Non-surgical

• Hormonal medicine, such as birth control pills, can help prevent more cysts from growing
• The cyst may be drained if it is very large to prevent ovarian torsion.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for ovarian cysts.

The hiatus is an opening in the diaphragm. It allows the esophagus to pass from the chest area into the stomach. A paraesophageal hernia occurs when the lower part of the esophagus or the stomach bulge up through the hiatus into the chest. It is a type of hiatal hernia.

In most cases, when a child has a paraesophageal hernia, it is something they are born with.

What are the signs and symptoms of a paraesophageal hernia?

Some paraesophageal hernias do not cause any symptoms. If your child does have symptoms, they may include:

• Reflux or heartburn
• Shortness of breath
• Chest pain
• Coughing
• Swallowing problems
• Burping

What causes a paraesophageal hernia?

Experts don’t know what causes paraesophageal hernias in children. In most cases, it is a condition the child is born with.

How are paraesophageal hernias treated?

Most paraesophageal hernias that cause symptoms will need to be treated with surgery. Connecticut Children’s experienced surgeons perform this surgery using small incisions and laparoscopic techniques. During surgery, the intestines are moved back into the abdomen and the surgeon puts stiches or a special mesh around the hiatus to make the opening smaller. This prevents another hernia from forming.

Pectus excavatum is a deformity in the chest wall that gives the chest a sunken look. It happens because of a problem with the way the cartilage in the breastbone (sternum) and ribs develop.

The condition is usually diagnosed by the time a child is age 1 and is more common in boys than in girls. Pectus excavatum can range from mild to severe.

What are the signs and symptoms of pectus excavatum?

In most cases, the chest will have a slight to moderate sunken appearance. This may become more noticeable as the child grows. In many cases, your child may not have any other symptoms, especially if the condition is mild. Symptoms in children with a more severe condition may include:

• Shortness of breath, especially with exercise
• Chest pain

What causes pectus excavatum?

Experts do not know what causes pectus excavatum. In some cases, it may run in families.

How is pectus excavatum treated?

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for pectus excavatum. Some children with very mild cases may not need treatment. For children who do need treatment, surgery to correct the condition is the only option.

There are a few surgical options to treat pectus excavatum. At Connecticut Children’s, our surgeons most often use the Nuss procedure, a minimally invasive approach. During the procedure, the surgeon uses small incisions to insert a metal bar under the breastbone. This bar lifts and corrects the shape of the breastbone over time. Usually, the bar stays in the chest for about two years.

A pilonidal cyst is a pocket of skin debris, hair and other tissue. They are usually located on the lower back, near the crease of the buttocks. If the cyst becomes infected, it is called a pilonidal abscess.

Pilonidal cysts are more common in teenagers and young adults. Boys are more likely to have them than girls.

What are the signs and symptoms of pilonidal cysts?

Common symptoms include:

• Pain or tenderness around the cyst
• Swelling and redness
• A skin opening that drains pus or blood
• Hair coming out of the cyst

What causes pilonidal cysts?

A pilonidal cyst is usually caused by ingrown hairs that become infected. The immune system responds by forming a cyst around the “foreign object.”

Factors that increase the risk of developing pilonidal cysts include:

• A family history of pilonidal cysts
• Spending a lot of time sitting
• Having a lot of body hair
• Wearing tight clothing against the tailbone area
• Being overweight

How are pilonidal cysts treated?

If the cyst is not infected, it may not need treatment. If the cyst becomes infected or keeps coming back, treatment may include both non-surgical or surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a pilonidal cyst.

SURGICAL

• If the cyst comes back after other treatment, your child may need surgery to remove the cyst.

NON-SURGICAL

• Your child’s doctor may drain the abscess through a small incision.
• Antibiotic medicines may be used if the cyst is infected.

Pulmonary sequestration is a mass of abnormal tissue that forms in or around the lungs. This tissue does not work like normal lung tissue and has no function. Pulmonary sequestration is a condition that develops while a baby is forming during pregnancy.

There are two main types of pulmonary sequestration:

• Intralobar masses are those that grow inside the lung. This is the more common type.
• Extralobar masses develop outside of the lung, but somewhere near it.

The size of the mass can vary. In many cases, the mass does not grow during pregnancy. But sometimes, the mass may become large and push against other organs, such as the heart. In these cases, your doctor may want to monitor the mass during pregnancy.

What are the signs and symptoms of pulmonary sequestration?

Pulmonary sequestration is often found on an ultrasound before a baby is born. Once a baby is born, symptoms may include:

• Trouble breathing
• Cough
• Feeding problems
• Frequent lung infections

Please note there are other conditions with similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes pulmonary sequestration?

Pulmonary sequestration is a condition a baby is born with. Experts think it occurs when an extra lung bud grows during a baby’s development. It does not usually run in families.

How is pulmonary sequestration treated?

If your baby’s mass is very large or is pushing against other organs, your baby may need treatment before birth (fetal intervention), or your doctor may plan for a special delivery to care for your baby right after birth.

No matter what size the mass is, pulmonary sequestrations need to be removed with surgery. Our experienced surgical team at Connecticut Children’s will work with your family to discuss your child’s treatment options.

• Surgery for intralobar masses usually involves removing part of the lung (segmentectomy) or the entire lobe of the lung (lobectomy).
• For extralobar masses, the pulmonary sequestration is removed using minimally invasive thorascopic surgery.

Pyloric stenosis is a narrowing of the pylorus — the opening between the stomach and the small intestine. It occurs when the muscle surrounding this opening is abnormally thick. This prevents the normal movement of stomach contents into the small intestine, causing severe vomiting. Symptoms usually occur in infants 2 to 8 weeks old, but it can be diagnosed at any time from birth to around 6 months of age.

What are the signs and symptoms of pyloric stenosis?

The most common symptom of pyloric stenosis is persistent vomiting that becomes worse over time. Vomiting can be projectile and usually occurs after feeding.

Other symptoms of pyloric stenosis include:

• Dehydration
• Weight loss
• Constant hunger
• Tiredness
• Fewer bowel movements

What causes pyloric stenosis?

It is not clear what causes pyloric stenosis, but both environmental and genetic factors seem to be involved. Pyloric stenosis can run in families and is more common in boys than girls.

How is pyloric stenosis treated?

Pyloric stenosis is treated with surgery. In this operation (pyloromyotomy), the surgeon cuts through the thickened muscle fibers to widen the pylorus. At Connecticut Children’s our surgeons are skilled in using minimally invasive (laparoscopic) techniques to perform surgery on infants with pyloric stenosis.

Sickle cell anemia is a group of hereditary blood disorders that causes red blood cells to have a crescent or “sickle” shape. Normal red blood cells are smooth and shaped like discs, allowing them to easily travel through blood vessels and deliver oxygen throughout the body. In children with sickle cell anemia, the red blood cells are inflexible and sticky, causing them to get stuck in blood vessels and block blood flow. This can cause a variety of symptoms including stroke and severe pain. The sickle cells are also destroyed more quickly than normal red blood cells, which can lead to a low level of red blood cells in the body (anemia).

What are the signs and symptoms of sickle cell anemia?

The symptoms of sickle cell anemia can vary and range from mild to severe. Usually, symptoms appear in children around 5 months of age.

Some early signs of sickle cell anemia include:

• Jaundice – yellowing of the skin and eyes
• Hand-foot syndrome – painful swelling of the hands and feet

One of the most common symptoms of sickle cell anemia is pain. This sudden and sharp pain happens when the sickle cells become stuck in the blood vessels and block blood flow. This can occur in many parts of the body and can range from mild to severe. Most children also have mild to moderate anemia (low level of red blood cells).

Some other complications of sickle cell anemia include:

• Infection
• Acute chest syndrome
• Eye damage
• Kidney damage
• Stroke
• Gallstones
• Splenic sequestration (blood trapped in spleen)
• Severe anemia
• Leg ulcers

What causes sickle cell anemia?

Sickle cell anemia is a caused by a genetic mutation that affects hemoglobin – protein in red blood cells that carries oxygen from the lungs to the rest of the body. This causes the red blood cells to be crescent-shaped and sticky instead of round and smooth. Sickle cell anemia is hereditary.

How is sickle cell anemia treated?

Treatment of sickle cell anemia is mostly used to manage symptoms and prevent complications. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for sickle cell anemia.

• Because sickle cell anemia increases risk of infection, most children will have to take penicillin until at least age 5. It is also important that children stay up to date on routine vaccinations and take additional vaccines recommended for sickle cell anemia patients.
• Most pain related to sickle cell anemia is treated using over-the-counter pain medicine. In severe cases, pain medicines may be prescribed, or pain may be treated in the hospital.
• Blood transfusions may be used to treat severe anemia and other complications of sickle cell anemia.
• In some cases, a drug that increases fetal hemoglobin (hydroxyurea) is used to prevent complications.

A bone marrow transplant (also called stem cell transplant) is the only known cure for sickle cell anemia. In this procedure, abnormal stem cells are replaced by healthy stem cells from a donor, usually a brother or sister. The compatibility of the donor is very important in determining the outcome of the procedure. Bone marrow transplants can have serious complications and are only performed for severe cases of sickle cell anemia.

Slipping rib syndrome occurs when cartilage of the lower ribs “slips” or moves. This movement causes mild to intense pain in the upper abdominal area and may cause a slipping or popping feeling in the lower ribs.

What are the signs and symptoms of slipping rib syndrome?

Common symptoms of slipping rib syndrome include:

• Pain in the upper abdominal or chest area
• A slipping or popping feeling in the lower ribs
• Pain when force is put on the ribs

What causes slipping rib syndrome?

Slipping rib syndrome can have a few causes.

• A problem with the development of the lower ribs during pregnancy.
• A chest injury caused by sports or a fall.

How is slipping rib syndrome treated?

Treatment may depend on your child’s symptoms and how severe they are. It may include both non-surgical and surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for slipping rib syndrome.

NON-SURGICAL

• Over-the-counter pain medications, such as Ibuprofen, to help with pain.
• Avoiding certain activities that can aggravate the area.
• Using ice or hot packs to relieve pain.
• Wearing a chest brace or seeing a physical therapist.
• Corticosteroid injections for more severe pain.

SURGICAL

• In rare cases, surgery may be needed to remove the cartilage and lower ribs. Our experienced surgical team at Connecticut Children’s will work with your family to discuss your child’s treatment options.

Spherocytosis is blood disorder that causes red blood cells to have a weakened cell membrane and spherical in shape. These abnormal red blood cells are destroyed faster and have a shorter lifetime than normal red blood cells. This leads to a low level of red blood cells in the body (anemia).

What are the signs and symptoms of spherocytosis?

Symptoms of spherocytosis vary and can range from mild to severe. Spherocytosis can be diagnosed at any point from early childhood to adulthood. The most common sign of spherocytosis is anemia.

Symptoms of spherocytosis include:

• Paleness
• Tiredness
• Jaundice
• Shortness of breath
• Fast heartbeat
• Stomach pain

What causes spherocytosis?

Spherocytosis is caused by genetic mutations that lead to defects in the cell membrane of red blood cells. Most cases of spherocytosis are hereditary, but a small number of cases may be caused by random genetic mutations.

How is spherocytosis treated?

There is no known cure for spherocytosis. Treatment is used to manage symptoms and may include surgical or non-surgical options. Some mild cases of spherocytosis may not require any treatment.

Our experienced team at Connecticut Children’s will work with your family to discuss your child’s treatment options.

NON-SURGICAL

• Folic acid supplementation
• Blood transfusions to help with severe anemia

SURGICAL

• In severe cases, your child’s doctor may recommend a splenectomy (removal of the spleen) or a partial splenectomy (removal of part of the spleen). Since the abnormal red blood cells are damaged and destroyed in the spleen, a splenectomy or partial splenectomy can increase the lifetime of red blood cells. This can increase the level of red blood cells in the body. Whenever possible, our surgical team at Connecticut Children’s performs this surgery using minimally invasive (laparoscopic) techniques.

Spontaneous pneumothorax is a collection of air around the lung that causes it to collapse. It is caused by a small weak spot inside the lung that ruptures, allowing air to leak into the area surrounding the lung. This air pushes against the lung, so it cannot expand as much as normal during breathing.

In most cases the pneumothorax only affects one side of the lung, but it can affect both sides.

What are the signs and symptoms of pneumothorax?

The symptoms can vary depending on the size of the pneumothorax. They may include:

• Pain or tightness in the chest
• Back or shoulder pain
• Shortness of breath
• Fast heart rate
• Tiring easily

What causes pneumothorax?

There is often no known cause for pneumothorax. Tall teenage boys have an increased risk for the condition, possibly due to rapid growth in the chest area.

How is pneumothorax treated?

Treatments for pneumothorax can depend on the size of the pneumothorax and how severe your child’s symptoms are. A small pneumothorax may not need any treatment. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for pneumothorax.

NON-SURGICAL

• Needle aspiration is a procedure to pull the air out of the chest using a small needle.
• A chest tube may be inserted to drain the air from the space around the lungs.
• Supplemental oxygen may help improve symptoms.

SURGICAL

• If symptoms are severe or do not respond to other treatment, your child may need surgery. The goal of the surgery is to remove the weak areas from the lung. In many cases, the surgeons at Connecticut Children’s perform this operation using minimally invasive techniques, using two to four small incisions.

A tracheobronchial foreign body is a small object or piece of food that gets stuck in a child’s airway or lungs. This can happen when children put small objects in their mouths, or don’t swallow food properly and it gets into the airway. It is more likely to happen when a child is eating, playing or crying. This condition is most common in children under age 5.

What are the signs and symptoms of tracheobronchial foreign bodies?

Symptoms can depend on the size and shape of the foreign body. Common symptoms can include:

• Sudden coughing or choking
• Trouble breathing
• Wheezing
• Fever
• Pneumonia
• A blue tint to skin (cyanosis)

If you think your child may have inhaled any type of foreign body, you should call your doctor or seek medical care right away.

What causes tracheobronchial foreign bodies?

Tracheobronchial foreign bodies occur when a child inhales an item by mistake.

How are tracheobronchial foreign bodies treated?

Tracheobronchial foreign bodies need to be removed. In most cases, the items can be removed by using a long lighted tube called a bronchoscope and small forceps. During the procedure, your child will be put under general anesthesia. In rare cases, the surgeon may have to cut into the child’s trachea to remove an object. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a tracheobronchial foreign body.

Tracheomalacia is when the cartilage in a child’s windpipe (trachea) is not strong enough to keep it open during breathing. This can cause the windpipe to collapse when breathing out, making it hard to breathe.

This condition can range from mild to severe, and in some cases can be life-threatening. Babies born with tracheomalacia are often born with other medical conditions or syndromes, such as heart defects, abnormalities of the esophagus, gastroesophageal reflux or connective tissue disorders.

What are the signs and symptoms of tracheomalacia?

The signs and symptoms of tracheomalacia can range from mild to severe. They may include:

• Noisy breathing (stridor)
• Noisy cough
• High-pitched breathing
• Trouble breathing
• Shortness of breath
• A bluish tint to the skin (cyanosis)
• Having many respiratory infections
• Choking during feeding

What causes tracheomalacia?

Tracheomalacia is caused by either weak or soft cartilage that isn’t strong enough to keep the trachea open, or by pressure on the cartilages from nearby structures that weakens them. Pressure can occur if there are abnormalities of the heart or large blood vessels in the chest because they can squeeze the trachea from the front or sides. Esophageal Atresia and Tracheoesophageal Fistula are often associated with tracheomalacia for both of the above reasons, because the esophagus can become dilated and press on the trachea from behind, and also the tracheal cartilages in this disease process are often softer and weaker.

How is tracheomalacia treated?

Treatment options can be surgical or non-surgical depending on the severity of the disease.

NON-SURGICAL

• Most cases of tracheomalacia do not need any treatment. Instead, your child’s doctor will monitor the condition. In many cases, the child will outgrow the problem as the trachea gets stronger.

SURGICAL

In rare cases, tracheomalacia causes difficulty breathing that is severe enough to require a breathing machine, called a ventilator. In these cases, surgery may be required.

• A tracheostomy is a surgery that allows a breathing tube to be placed through the neck, and this tube can be strong enough to keep the airway open and often allow removal of the breathing machine. There are cases of severe tracheomalacia that require a ventilator for more than the newborn period, and a tracheostomy allows these babies to be much more comfortable on a ventilator for long term periods. A tracheostomy allows these babies to smile, to eat by mouth, sometimes to go home from the hospital, and go through normal infant developmental stages, even while we assist their breathing with the ventilator.
• For heart or blood vessel abnormalities, the abnormal blood vessels may be surgically re-routed to remove the pressure.
• Aortopexy is a surgery that opens the trachea by moving up the aorta (the body’s main blood vessel) and attaching it to the back of the breastbone (sternum).
• Posterior tracheopexy is a surgery where the soft part of the trachea is secured posteriorly to the lining tissue of the spine muscles. This helps keep the trachea open. This surgery can be done, if needed, during esophageal atresia repair.There are several surgeries that are designed to repair tracheomalacia and avoid or eliminate a tracheostomy.

Our specialists at Connecticut Children’s are experienced at treating all types of tracheomalacia and we work together to care for children with this disease. The team will discuss specific options with your family based on your child’s individual needs.

An umbilical hernia is a bulge you can feel or see on your child’s belly button. It develops when part of the intestine pushes through the muscle in the stomach wall. In most cases, the hernia does not cause any pain.

In rare cases, the intestines can get caught inside the hernia. This is called an incarcerated hernia and it can cause severe pain. This condition needs to be treated right away.

Umbilical hernias are common in children. They are more common in children born prematurely.

What are the signs and symptoms of an umbilical hernia?

• A swelling or bulge in the belly button area
• The bulge may get larger if the child is crying
• Redness or pain at the bulge (incarcerated hernia)

What causes an umbilical hernia?

As a baby develops during pregnancy, the umbilical cord passes through a small opening in the muscles of the baby’s stomach wall to connect with the mother. Usually, this opening closes on its own after birth. When it doesn’t close properly, it can cause an umbilical hernia to form.

How is an umbilical hernia treated?

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an umbilical hernia. In many cases, the umbilical hernia will close on its own by the time a child is 3 or 4 years old. If the hernia does not close, your child may need surgery to repair the hernia. At Connecticut Children’s, this surgery is often done as an outpatient procedure so your child can go home the same day.

During hernia repair surgery, your child is put under general anesthesia. The surgeon will make a small incision at the bottom of the belly button. The surgeon then pushes any intestine back inside the muscle wall and repairs the opening with stiches to prevent another hernia.

A urachal cyst is a sac of tissue that develops between the bladder and belly button. The urachus is the remainder of a channel that is formed during the first trimester of pregnancy. It usually disappears before a baby is born, but parts of it may remain in some people. When this happens, a urachal cyst can develop. They are most common in older children and adults.

What are the signs and symptoms of a urachal cyst?

Urachal cysts usually have no symptoms unless they become infected. An infected cyst can cause:

• Fever
• Pain in the lower belly
• Pain when urinating
• A lump in the belly
• Urinary tract infection

Please note there are many conditions with symptoms similar to urachal cysts. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes urachal cysts?

A urachal cyst can occur when a sac or fluid or air develops in the urachus. While the urachus usually disappears after birth, a part of the urachus can remain in some people.

How are urachal cysts treated?

Not all urachal cysts need treatment. In some cases, your child’s doctor may suggest watching the cyst instead of treating it. If treatment is needed, it involves removing the cyst with surgery. Whenever possible, our surgeons at Connecticut Children’s perform this surgery laparoscopically, using minimally invasive techniques.

VACTERL association is a group of conditions a baby is born with that affect many parts of the body. VACTERL is an acronym for some of the most common conditions found as part of this syndrome:

• V — vertebral abnormalities, such as missing vertebrae, missing ribs or curving of the spine (scoliosis)
• A —anorectal malformation, a condition in which the anal opening is absent or in an unusual position
• C — cardiac (heart) defects, such as ventricular septal defects, atrial septal defects and tetralogy of Fallot
• TE — tracheal-esophageal problems, such as esophageal atresia and tracheoesophageal fistula
• R — renal (kidney) problems, such as abnormal development of the kidneys
• L — limb abnormalities, including underdevelopment of the forearm, missing or underdeveloped thumbs or extra fingers

Children with VACTERL association usually do not have all the conditions listed but can have three or more.

What are the signs and symptoms of VACTERL association?

Symptoms of VACTERL association can vary widely depending on which conditions your child has. Some of the symptoms may be noticeable shortly after birth, while others may not be apparent right away.

Some symptoms in infants may include:

• An anus that is missing or is covered with a thin layer of skin
• Missing thumbs or extra fingers
• A short or underdeveloped forearm
• Trouble feeding or swallowing
• Fast breathing or difficulty breathing

What causes VACTERL association?

Experts do not know what causes VACTERL association.

How is VACTERL association treated?

The treatment for VACTERL association can vary depending on which conditions your child has. In most cases, the conditions associated with VACTERL are not life threatening and can be treated with surgery.

The specialists at Connecticut Children’s are experienced at treating VACTERL association and will discuss specific options with your family based on your child’s specific symptoms.

Wilms tumor is a cancerous tumor that is found in the kidneys. It is the most common type of kidney cancer in children. Usually only one kidney is affected (unilateral), but, in a small number of cases it can affect both kidneys (bilateral). It is most often diagnosed in children ages 2 to 3.

What are the signs and symptoms of Wilms tumor?

The most common symptom of Wilms tumor is a hard lump in the abdomen.

Children can also have a wide range of other symptoms including:

• Fever
• Abdominal pain or swelling
• High blood pressure
• Blood in the urine
• Constipation
• Loss of appetite
• Fatigue

Please note there are many conditions with symptoms similar to Wilms tumor. It’s important to see your child’s doctor for proper diagnosis and treatment.

What causes Wilms tumor?

Most cases of Wilms tumor are the result of random genetic mutations with no known cause. However, children with certain syndromes, such as WAGR syndrome, Denys-Drash syndrome or Beckwith-Wiedemann syndrome are more likely to develop Wilms tumor. According to experts, it is unlikely that Wilms tumor is hereditary.

How is Wilms tumor treated?

Treatment of Wilms tumor usually involves a combination of surgery and chemotherapy. In some advanced cases, radiation therapy is also used. A radical nephrectomy (removal of the kidney) is usually performed when only one kidney is affected. In cases where both kidneys are affected, the surgeon may recommend a partial nephrectomy (removal of the tumor). Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for Wilms tumor.