Noisy breathing is mostly caused by a partial blockage or narrowing at some point in the airways (respiratory tract). This can occur in the mouth or nose, in the throat, in the larynx also called as a voice box, in the trachea (breathing tube), or further down into the lungs. It is created by turbulent, or irregular, airflow caused by the narrowed airway. This can create the collapse of surrounding tissues or can be a single fixed point of narrowing. One type of noisy breathing is Stertor. This implies a noise created in the nose or the back of the throat. It is typically low-pitched and most closely sounds like nasal congestion you might experience with a cold, or like the sound made with snoring. Stridor is a higher-pitched noise that occurs with obstruction in or just below the voice box. Determination of whether stridor occurs during inspiration, expiration, or both helps to define the level of obstruction. Wheezing is a high-pitched noise that occurs during expiration. Wheezing typically is due to narrowing, spasm, or obstruction of the smaller airways in the lungs. What Are Some Causes of Noisy Breathing?<ul><li>Infection- Viral or bacterial infections can cause swelling of the tissues in the airway (such as cold-causing nasal congestion) anywhere from the nose to the lungs. Depending on the type of infection, this could be treated with supportive care, medications, or more invasive intervention. Croup is an example of a viral infection that causes swelling and related narrowing of both the larynx and trachea.</li><li>Fixed narrowing of the airway at birth- certain conditions can cause a child to be born with a narrowed airway. This can occur at multiple points in the respiratory tract. An example of this includes congenital subglottic stenosis.</li><li>Abnormal swelling or growth within the respiratory tract can cause obstruction. Swelling or scarring can cause acquired subglottic stenosis. This could also include a cyst or vascular birthmark (hemangioma) in the airway. A foreign object or food item can be aspirated (sucked into) the airway and can cause obstruction and noisy breathing.</li><li>Floppy tissues in the respiratory tract can cause noisy breathing. This is because of the collapse of these tissues into the airway. This can partially obstruct airflow and cause a collapse of surrounding tissues. Examples of this include pharyngomalacia, laryngomalacia, tracheomalacia, and bronchomalacia.</li><li>Compression of the airway from an external structure. This can be due to a crossing blood vessel, the heart, or other structures outside of the airway that put pressure on the airway and cause collapse.</li><li>Spasm of the airways related to underlying medical conditions, like asthma, or due to irritants in the environment.</li><li>Problems with the vocal cords moving normally. This can occur with Vocal Cord Paralysis, or with Paradoxical Vocal Cord Dysfunction (PVCD)</li><li>Recurrent Respiratory Papillomatosis can cause a problem with the voice and can also cause noisy breathing.</li></ul> How Is Noisy Breathing Evaluated?Evaluation of noisy breathing starts with obtaining a history and performing a physical examination. This information is critical in narrowing down the cause of noisy breathing and in determining how severe the symptoms are. Important aspects of the history include whether it was present at birth, or has developed later on, and the time course over which it has developed. Certain characteristics of the noisy breathing help us to determine the location of narrowing. These include whether noisy breathing occurs on inspiration, expiration, or both. The pitch and loudness of noisy breathing is also an important factor. Depending on the history and examination findings, your Pediatric Otolaryngologist may recommend an In-Office Laryngoscopy/Nasopharyngoscopy or an Operative Laryngoscopy and Bronchoscopy. At times, certain X-Rays or other tests, like Sleep Studies and Swallowing Studies may be recommended. What Is the Treatment for Noisy Breathing?Many treatment options are available for noisy breathing and depend on the cause of the symptoms. At times, monitoring and supportive care are recommended. Certain medications may be helpful in treating symptoms or managing related conditions. For more severe issues, surgery may be recommended. Your Pediatric Otolaryngologist will discuss all possible treatment options with you and make recommendations for the most appropriate treatment. What Are Concerning Symptoms That I Should Look for in My Child with Noisy Breathing?It can be difficult for a parent or family member to discern the severity of a problem when there is noisy breathing. If you are concerned, we urge you to seek medical evaluation immediately. In particular, signs that indicate more severe conditions include: irritability, poor feeding, pulling in of the skin at the collar bone, between the ribs, or under the ribs, flaring of the nose, increasing effort to breathe, and poor weight gain or weight loss, especially in infants. Symptoms that should trigger emergent evaluation include pauses in the breathing, color change of the skin (particularly if the lips, face, or hands are turning blue), drooling, appearing lethargic or tired, or any other sudden change from a child’s normal breathing pattern. If any of these or other concerning signs develop, please seek immediate medical attention.

Noisy breathing is very common in children and can be a sign of many different conditions, some of which are very benign and some of which require urgent treatment.

What is Noisy Breathing or Stertor or Stridor or Wheezing

Ravina Sewani

In mastitis, your breasts might become tender, warm to touch, breast may get swollen, get a breast lump, skin redness, experience burning sensation continuously or while breast-feeding. Mastitis is an inflammation of the breast due to ineffective draining of milk. Mastitis is known to happen in only one breast but sometimes it can happen in both your breasts. Mastitis requires medical advice right away. When you are breastfeeding, milk production is a continuous process and if you do not empty your breasts, the pressure around the breasts increases and the milk builds up in the surrounding breasts tissues. This build up of milk causes redness and swelling. If the milk enters into the blood stream, your immune system might respond with fever or with chills and heat alternatively. Mastitis sometimes is also caused by bacteria entering your body through your cracked nipples or milk ducts. The risk of mastitis increases there is poor draining of milk, sore or cracked nipples, inefficient nursing, or if you wear a tight-fitting dress restricting your milk flow, if you smoke or have a poor nutrition compromising your immunity. If left untreated, mastitis could lead to abscess. Mastitis can be prevented by ensuring drainage of the milk from your breasts while breast-feeding. This can be done by allowing your baby to fully feed from one breast before offering the other.The usual treatment for mastitis includes prescription of antibiotics. Mastitis can recur if you do not treat the cause. You need to drain your breast totally during every feed. Continue to breastfeed through your bout of mastitis as this may help you. If you do not do this, you run the risk of another infection.

Mastitis is an inflammation of the breast due to ineffective draining of milk.

Mastitis in mothers

Palak Vyas

Tearing is a normal function of the eye. But when tear ducts get blocked due to infection and inflammation, tears well up in the eye and fall excessively; this is called "eye watering". In newborns, the condition usually resolves itself within a few weeks. Common causes of watery eyes:<ul><li>Allergies</li><li>Blocked tear duct</li><li>Common cold</li><li>Dry eyes</li><li>Ingrown hair lashes</li><li>Pink eye (Conjunctivitis)</li><li>Stye (a red, painful lump near the edge of the child’s eyelid)</li><li>Tear duct infection</li><li>Eye injury</li><li>Chemical splash in the eye</li></ul> Symptoms associated with watery eyes:<ul><li>Eye pain</li><li>Eye infection</li><li>Runny nose</li><li>Vision impairment</li><li>Sneezing</li><li>Swelling in the eyes</li><li>Redness in the eyes</li></ul> Treating eye watering:<ul><li>Sometimes a sticky liquid may form around the baby's eye or eyes. You can use a piece of cotton wool that has been soaked in sterile water to clean the eyes. Make sure to boil the water to make it sterile and then cool enough before dabbing it on the child’s eyes with cotton wool.</li><li>Sometimes tears can be relieved by gently massaging the tear ducts. Apply light pressure with the finger and thumb to the outside of the nose.</li><li>If the situation persists for more than a day, consult a doctor.</li></ul>

The problem of constant tears usually resolves within a few weeks in a newborn. If eye watering is accompanied with other problems, you might want to consult a eye specialist for your child.

Treating eye watering

Conjunctivitis in children is very common. Conjunctivitis causes red, irritated and sticky eyes. It is caused either by an infection (viral or bacterial) or due to allergies (irritants). Symptoms of conjunctivitis can last from 3 days to 3 weeks. If the child is younger than 6 weeks, consult a doctor immediately. Causes:<ul><li>Bacteria</li><li>Viruses</li><li>Allergy</li><li>Pollution</li></ul> Signs and symptoms of conjunctivitis:<ul><li>Redness of the white part of the eye</li><li>Irritation or itching in the eye</li><li>Bacterial conjunctivitis shows stringy discharge</li><li>More tears than usual</li><li>Swelling of the eyelids</li><li>Crusting of the eyelids or eyelashes</li></ul> Treatment of conjunctivitis:<ul><li>Viral conjunctivitis may last for one to two weeks and does not need medical treatment. It resolves on its own.</li><li>For bacterial and allergic conjunctivitis, see a doctor. Symptoms usually improve within 24 to 48 hours once treatment is started. Bacterial conjunctivitis is usually treated for five to seven days.</li></ul>You can use follow any of the following remedies to treat conjunctivitis in children:<ol><li>Salt water solution: Add 1/2 tablespoon of salt to pot of boiling water. Let it cool down. Then dip a cotton ball in this water, squeeze it a bit and keep it on both the eyelids of the baby.</li><li>Potato Slice: Peel the skin of raw potato. Wash it properly, Cut very thin slices and place them on both the eyelids of your child.</li><li>Chamomile oil: Add a few drops of chamomile oil in lukewarm distilled water. Dip cotton balls in this and place it on both eyelids of the baby for 5-7 minutes. Please note that this is not recommended for children below 1 year.</li><li>Consult an eye specialist if the problem persists for more than a few days.</li></ol> Prevention of conjunctivitis:<ul><li>Ask your children to wash their&nbsp;hands often throughout the day with soap and warm water or use an alcohol-based hand sanitizer. Wash your hands before and after using the eye drops. Also wash your hands if you come into contact with an infected person’s eyes, clothes, or other personal items.</li><li>Ask your child not to&nbsp;touch or rub his/her eyes.</li><li>Do not allow sharing of personal items such as towels, blankets, pillowcases, etc.</li><li>Wash bedding, washcloths, and towels in hot water after you use them.</li><li>Do not send your child to school or play if he has severe conjunctivitis with pus and sticky discharge.</li></ul>

Here are Conjunctivitis Causes, Symptoms, Treatment, and Prevention.

All about Conjunctivitis

When moms start feeding the newborns, the nipple often turns red and pointy instead of round and smooth. This could be due to the problem in latching technique, insert your finger into the corner of your baby's mouth to stop feeding for a while when you feel pain -- and then try latching on again. Ideally, your baby should take at least one inch of your areola (entire circle surrounding the nipple) into the mouth. Measures to treat sore nipples:<ul><li class="ql-align-justify">When you take bath, clean the area with water and do not apply any soap. Your areola secretes oil that keeps your nipples moist. If you use soaps, these protective oils might be removed.&nbsp;Air-dry your nipples and do not rub them harsh. There is no need to clean your breasts before breastfeeding, offer your breasts as such. The microbes on your breast surface will help in the development of your baby's gut bacteria. You need to only clean your breasts before feeding if you have an infection.</li><li class="ql-align-justify">Apply few breast milk drops. Massage a few drops of breastmilk before and after the feed to heal your nipples.</li><li class="ql-align-justify">Your doctor might sometimes prescribe you creams to apply on your nipples.</li><li class="ql-align-justify">If you need instant relief after nursing, use hydrogel pads.</li><li class="ql-align-justify">Sometimes the pain is also due to blocked milk duct, massage your breasts with warm water. This will help to unplug ducts and clear the lumps, milk gets released and there is a relief in pain. Note that breastfeeding is the best way to unclog ducts, do not stop breastfeeding due to the pain.</li></ul> These are only temporary relief solutions. You will have to work on the cause of your soreness like poor latch or baby's tongue tie etc. A lactation consultant will be able to help you better. Some women face nipple structural challenges as well. Some of them have flat nipples or very large nipples. In any case, there is no need to worry as generally newborns can nurse on all types of nipple structures. Just ensure that there is a proper latch during the breastfeeding and that the baby is gaining adequate weight. However, here are a few things which might help you if you are facing a lot of trouble:<ul><li class="ql-align-justify">If you inverted nipples, they will naturally protrude out as the pregnancy progresses. Even if this does not happen, your baby will be able to latch on and feed properly. If the baby is facing some troubles, a nipple shield will be very helpful in this case. Consult your doctor or a breastfeeding specialist to help you accustom to the use of nipples.</li><li class="ql-align-justify">If you have flat nipples, they will raise with stimulation. If they don't, do not worry as long as your baby holds on to the areola apart from nipples. If along with flat nipples, you have engorged breasts, your baby might struggle with the latch. In this case, use your fingers to pull the nipple towards your baby's mouth. Your doctor might suggest you to use breast pumps in this case.</li><li class="ql-align-justify">If you have large nipples, it will take your baby a few days to have a proper latch. But if you have adequate milk supply, your baby will get enough milk and gain wait adequately. You can try football hold if you have large nipples.</li></ul>

Breastfeeding can sometimes get overwhelming, not just emotionally, but physically too. Nipple care is very important for the first few months of feeding.

Nipple care

Lip tie is a condition where the underside of the upper lip tethers to the top of the gum with a skin tag. The piece of tissue behind your upper lip is called the frenulum. When these membranes are too thick or too stiff, they can keep the upper lip from moving freely. This condition is called a lip tie. Lip tie isn’t dangerous for babies, as long as they’re gaining weight according to their paediatrician’s guidelines. But lip tie, once diagnosed, is easy to correct. A baby with a tongue tie may not necessarily have a lip tie. Babies with lip tie may face challenges to breastfeed or bottle-feed, as it restricts the baby from stretching the lips to open the mouth wide. Causes: The causes of lip tie are still unknown. Lip tie symptoms:<ul><li>Difficulty in breastfeeding is one of the most common indications that your child may have a lip tie or tongue tie.</li><li>Struggling to latch on to the breast</li><li>Difficulty breathing during feeding</li><li>Making a clicking sound while nursing</li><li>Falling asleep often during nursing</li><li>Acting extremely fatigued by nursing</li><li>Slow weight gain or lack of weight gain</li><li>Colic</li></ul> If a child has a lip tie and you’re a breastfeeding mother, you may experience:<ul><li>Pain during or after breastfeeding</li><li>Breasts that feel engorged even right after nursing</li><li>Blocked milk ducts or mastitis</li><li>Fatigue from breastfeeding constantly even though your child never seems to be full</li></ul> Babies who have a severe lip or tongue-tie may go on to have difficulty eating from a spoon or eating finger foods, according to the American Speech-Language-Hearing Association. Lip ties don’t have as many complications later in life. Some paediatricians believe that an untreated lip tie can lead to a higher likelihood of tooth decay for toddlers. Diagnosis: A lip tie is diagnosed through a physical exam. Most paediatricians can diagnose a lip tie based on its appearance. Treatment:A lip tie can be treated on the basis of the class of lip tie. Whether it is a class 1, class 2, class 3 or class 4. It can also be fibrous, fleshy, thick or thin depending upon the texture of the skin fold. Manual treatment: For class 1 and class 2 lip ties, the baby doesn’t need any formal treatment. Parents have to gently slide the finger underneath the upper lip to stretch frenulum tissue. This type of manual practice can gradually release the tightness of the tissue and the child will have normal mobility of the upper lip. Frenectomy: This is a small surgical procedure where the frenulum is cut through an operation. A frenulum is a small fold of tissue that prevents an organ in the body from moving too far. Doctors usually use laser technology to cut the frenulum and so it is called laser frenectomy. General anaesthesia is not used; instead, a local topical numbing agent is applied to the frenulum. In this procedure, a child may or may not require stitches. The procedure hardly takes a few minutes to complete. Babies can experience mild pain post the procedure. Stay vigilant for any signs of swelling or bleeding from the lips and contact the doctor immediately. Prevention: Lip tie cannot be prevented.

Here are Lip Tie Symptoms, Causes, Diagnosis, Treatment, and Prevention.

All about Lip tie

Samiksha Choithani

The first yellow milk (fluid) produced in the breasts is called colostrum. It is the first stage of breast milk production. Colostrum is thicker than your usual breast milk. Colostrum/yellow milk lasts until the transitional phase or mature milk is produced i.e. till the second or fifth day after the birth. Colostrum is like a child’s first immunisation, it is full of antibodies, white blood cells and other immune properties. Benefits of Colostrum for the baby are:Builds a strong immune system.Creates a tough layer on baby’s stomach and intestines to fight with germs that cause illness.It serves as a laxative that helps your baby pass the first dark stool/poop.Prevents jaundice.It is a perfect blend of nutrients to make the child’s brain, eyes and heart strong.Prevents low blood sugar in newborns. A baby should take 1-4 tablespoons of colostrum per day. Note: Do not give honey or any other food substance during birth, the first yellow milk is a great source of nutrition.

Colostrum has multiple benefits for a baby's health and should be the first food give to a baby after birth.

Colostrum and its benefits for Babies

Choking occurs when your baby takes more milk into its mouth than (s)he can swallow at a time. Excess milk spills into the airway and blocks the flow of air, which leads to choking. It can be a frightening sight for any mother to see her baby coughing and sputtering milk while struggling to breathe. Reasons behind choking during breastfeeding:<ol><li>Milk oversupply- When a mother produces excessive milk, the milk releases from the milk ducts in a forceful and almost explosive manner. This is called Milk Ejection Reflex. The baby is not able to swallow that much amount easily and starts choking up.</li><li>Improper latch</li></ol> You might be producing excessive milk if you notice:<ul><li>The baby is choking, gagging.</li><li>The baby is trying to clamp the nipple to slow down the flow.</li><li>The baby is trying to pull away from the breast.</li><li>The baby is refusing to nurse and is spitting up frequently.</li></ul> What to do:<ul><li>When you find your baby choking on milk, there are methods that can dislodge the milk from blocking the airway. Since babies have delicate bodies, it must be done with caution.</li><li>Turn your baby upside down and give them intermittent back blows and chest thrusts combined with gentle taps to the back, to open up the airways. The chest thrusts should be given with two or three fingers on the lower half of the breastbone, while supporting the head with the other hand. This should be continued until the block is removed.</li><li>It’s important to note that if the baby doesn’t recover and becomes unconscious, (s)he should be rushed to the nearest hospital, while still continuing the dislodging procedure.</li></ul> Prevention:<ul><li>Try and slow down your supply: Say if you are nursing with the right breast, then press your left nipple of the left breast with your right hand’s palm toward ribs and count till five. This signals your body to slow down the flow.</li><li>Stick to a single breast for a few feeds: This way one of the breasts gets fully emptied and this also slows down the flow in the other breast.</li><li>Baby’s latch: Ensure that the baby is latched properly. If the baby is latched properly, the milk should directly get into the baby’s throat and not his mouth. So when the latch is not proper, there is more risk of the baby’s mouth getting filled up with milk more than it can take and that is when your baby might end up choking.</li><li>You can recline on a surface and then feed the baby in your arms. This is a good nursing position.</li><li>While breastfeeding, if the other breast feels uncomfortable, you can express some milk from it and apply a cool compress to relieve the discomfort. As you continue this procedure, express lesser milk, until there is no need to do so.</li></ul>

A breastfeeding child chokes when (s)he takes more milk in mouth than (s)he can gulp down.

Choking during breastfeeding

Wheat allergy is an allergic reaction to foods containing wheat. Allergic reactions can be caused by eating wheat and also, in some cases, by inhaling wheat flour. Wheat is found in many foods, including some you might not suspect, such as soy sauce, ice cream and hot dogs. Wheat allergy sometimes is confused with celiac disease, but these conditions differ. Wheat allergy occurs when your body produces antibodies to proteins found in wheat. In celiac disease, a specific protein in wheat — gluten — causes a different kind of abnormal immune system reaction. Symptoms of wheat allergy:<ul><li>Swelling, itching or irritation of the mouth or throat</li><li>Hives, itchy rash or swelling of the skin</li><li>Nasal congestion</li><li>Headache</li><li>Difficulty breathing</li><li>Cramps, nausea or vomiting</li><li>Diarrhoea</li><li>Anaphylaxis</li></ul> Causes:Exposure to a wheat protein triggers the body's immune system for an allergic reaction. Your child can develop an allergy to any of the four classes of wheat proteins — albumin, globulin, gliadin and gluten. Sources of wheat proteins:<ul><li>Breads and bread crumbs</li><li>Cakes, muffins and cookies</li><li>Breakfast cereals</li><li>Pasta</li><li>Semolina</li><li>Soy sauce</li><li>Meat products, such as hot dogs</li><li>Dairy products, such as ice cream</li><li>Natural flavourings</li><li>Modified food starch</li><li>Vegetable gum</li><li>Cosmetics</li></ul> Risk factors:<ul><li>Family history: The chances of your child being allergic to wheat are higher if there is someone in the family who is allergic to wheat.</li><li>Age: Wheat allergy is most common in babies and toddlers, who have immature immune and digestive systems.</li></ul> Difference between Wheat Allergy and Celiac Disease:Wheat allergy involves an allergic response to any of the four proteins in wheat. Whereas, celiac disease is caused by gluten (a type of wheat protein). Celiac disease does not cause an immune response but rather causes a problem with the absorption of food in the intestines. Diagnosis:Symptoms of wheat allergy and celiac disease are overlapping hence an allergist can determine whether an allergy is present or not. You will be required to give your child's medical history, family's medical history combined with a skin-prick or a blood test. Prevention:<ul><li>Develop a habit of reading the food labels for ingredients and allergy information.</li><li>Teach your child to mention about the allergy whenever (s)he goes to visit someone.</li><li>Inform your child’s school about your child’s allergy. You can also give the medicines prescribed by your child’s doctor to the school which they can use in case of sudden allergic reactions.</li><li>Be careful about the possibility of cross-contact; especially when visiting a restaurant.</li><li>Always keep the allergy medication handy for your child.</li></ul> Treatment:<ul><li>The best way to prevent allergies of any sort in children is to avoid the source of the allergen.</li><li>In allergies, paediatricians usually prescribe antihistamine medicines for mild allergic reactions. Whereas for severe allergic reactions like anaphylaxis, your child’s paediatrician will prescribe an adrenaline auto-injector (AAI).</li></ul>

Some children can develop allergic reactions towards wheat and need to be fed on a different cereal.

insect sting allergy health concern

Following article(s) will help solve your concern.