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Hemiatrophy and its treatment in children - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Growth and Development in Children
Answered by

General & Family Physician
Practicing since : 2004
Answered : 36 Questions
Doctor :   hi
Doctor :   Dr. XXXXXXXX here.
Doctor :   please proceed with your health query
User :   good day dr
Doctor :   good day to you too
User :   i would like to ask about one of my 4 month old twin baby girl
User :   just rescently, i noticed hemiatrphy on her upper and lower extremity
User :   with leg length discrepancy if i were to say on the said lower extremity
Doctor :   ok. what is the said leg length discrepancy?
User :   i consulted their pedia and i right then prompted for a babygram
User :   left leg is somewhat a bit longer than the right affected leg
Doctor :   ok
User :   then after the babygram, i was told to consult an ortho specialist...
Doctor :   ok
User :   referred to ortho specialist for further evaluation and manangement
Doctor :   4 month is a very young age. the actual length discrepancy should be noted once the child starts walking.
Doctor :   you can get the babygram done now to see if any other problem is there with the joint and joint space
Doctor :   but as the child grows, minor discrepancies get corrected
User :   upon consult to an ortho specialist, i was told that the baby gram has no significant findings,
Doctor :   ok
Doctor :   do you have the baby gram image with you?
Doctor :   is yes, could you send it to me on YYYY@YYYY
User :   then i was taught to correctly measure the leg length manually...
Doctor :   ok.
Doctor :   what did the manual measurement show?
User :   as done, no discrepancy noted
Doctor :   ok. that is good, babies are known to keep legs in position of ease which gives false feeling of discrepancy, that is why is suggested to wait til the child starts walking
User :   as to the hemiatrophy, i was simply told, it could possibly be because of the weight burden over my baby during her nine months time in my tummy like the weight of my intestines on her
Doctor :   ok. it could be correct, the atrophy should go away with a good diet and exercise later
Doctor :   continue to breast feed the baby
Doctor :   make sure that you eat well
User :   then i was advised to manually massage my baby's leg everyday, then measure it weekly, and have a follow up check up after 3 months...
Doctor :   ok
Doctor :   along with massage do passive exercises of flexion and extension at all joints
Doctor :   hip, knee and ankle
User :   however, it was two weeks now that im doing the massage, yet, i dont see any improvement on my baby's leg, though, i dont really know, if its too early to say
User :   or am i doing the right massage technique
Doctor :   for the ankle joint do mild internal and external rotation movements
Doctor :   be very gentle with the exercises
Doctor :   two weeks is too early to notice changes
Doctor :   you will have to wait for about 2-3 months time to see considerable changes
Doctor :   be in touch with a child physiotherapist
Doctor :   to guide you with the massage and exercises
User :   if i'l be sending you the babygram of my baby, how can i get the response from you sir
Doctor :   if you can send it immediately i will reply now in sometime after looking at it
Doctor :   if it needs further opinion I would suggest you to take help from our panel orthopedicians
Doctor :   but since there is no actual measured leg length discrepancy
Doctor :   you should not worry about it
User :   i dont have with me the official reading yet, but il have the copy of it later from the ortho doc,
Doctor :   rather focus on the diet, massage and physiotherapy to correct the atrophy
Doctor :   ok
User :   and probably keep in touch with you again later, will it be fine doc XXXXX?
Doctor :   yes, you can be in touch with me once you get the official copies of the reports
Doctor :   but as of now, there is no need to worry about the leg length discrepancy since there is no actual measured leg length discrepancy
User :   my baby is bottlefed with s-26 gold since birth, im on antibiotic after the surgery when my babies were born, when im done with my meds, they refused breastfeeding
Doctor :   they will refuse breast feeding since they are used to bottle feeds
Doctor :   breast feeding will be cumbersome for them
Doctor :   but you can get them back to it
Doctor :   they will need to learn to suck on the breast
User :   im planning for a supplemental feeding since they're 4 months old now, is cerelac good for them since it contain
Doctor :   i will tell you the technique.
Doctor :   you can drip milk from the bottle while they are on the breast such that they know milk is avialable
Doctor :   and slowly they will start sucking
Doctor :   and yes you can slowly start them on simple foods, i would advise to start them on home foods first
Doctor :   like over cooked mashed rice with a bit of salt added
User :   traces of soya and my babies were diagnosed glucose-6-phosphate dehydrogenace deficient by newborn screening?
Doctor :   and boiled apples, mashed
Doctor :   ok. then in that case you shoul dbe careful in selecting what to give them and what to avoid
User :   will i have my milk back since its 4 months now since theie birth?
Doctor :   yes you will have milk back once they start sucking
Doctor :   you can take help from your healthcare provider to prescribe you supplements to help milk production
User :   is avocado and banana fine for supplemntal feeding?
Doctor :   refined sugar, white flour, high fructose corn syrup should be limitedly used for your babies
Doctor :   visit this link for more information on G6PD
User :   so you mean, no cerelac or gerber for them? how about multivitamins, whats best for their age?
Doctor :   WWW.WWWW.WW Doctor :   the normal multivitamin syrups that come are fine. the pediatric ones should be given as drops
Doctor :   about 5 drops per day daily until they are one year old
Doctor :   and then depending on need the dose can be readjusted.
User :   is promivit fine for them with the profan tlc plus?
User :   my baby seem like to snore while sleeping, is it fine?
Doctor :   these are the drugs/medicines that should not be given to them. you can find the complete list in this link
Doctor :   and make a note of them n keep with you always
Doctor :   promivit is fine, continue them
Doctor :   WWW.WWWW.WW Doctor :   you can go through these links in your free time
User :   ok, il try to visit the said link, tnxtnx...
Doctor :   babies snoring while sleeping is suggestive of some soft tissue obstruction
User :   we dont have child physiotherapist in our place, any other option on the correct massage technique doc XXXX ?
Doctor :   it could be due to the bottle feeds too which can make the orophagyngeal tissues laxed since they are not worming hard on breast feeding.
Doctor :   any physiotherpaist can help, but a child physiotherapist is better.
Doctor :   you can consult the physiotherapist available in your area of location.
User :   is this alarming, my baby snoring?
User :   any help po?
Doctor :   no, not needed, they usually come out of it after they grow up
Doctor :   do not worry on that
Doctor :   try to get them back to breast feeding
Doctor :   and start with supplemental diet slowly with simple carbohydrates, then adding protien and fat to it
User :   ok doc AAAAAAA il try the technique you just told me, how long then will they be back to breastfeeding?
Doctor :   best would be to consult a nutritionist for their weaning diet and diet habits further in life
Doctor :   it depend on how hard you try and how much effort they put in, it could vary from 1-2 month stime
Doctor :   best would be to consult a nutritionist for their weaning diet and diet habits further in life such that any diet related complications (due to G6PD status) can be avoided
Doctor :   have you followed what I have said?
User :   yes doc ... il try the get back step to breastfeeding, then d supplemntal feedings for them, and the multivitamins...
Doctor :   is there anything else I can help you with?
User :   about the physiotherapist, il just work on that?
User :   how often should they be fed with the supplemental feeding po?
Doctor :   yes you could work on the physiotherapist part to get the best efforts done for your babies
Doctor :   if they are breast feeding well then all major meal timings they shoul dbe fed with that
Doctor :   also you can give them small feeds upto 5-6 times a day in small amounts as tolerated by them
User :   i was told about the idea of getting a neuro help to rule out compression issues in regard to my baby, is it logical to do?
Doctor :   be careful in choosing food stuff for them
Doctor :   meet a nutritionist for the complete list of foods to be given and what to be avoided for them.
Doctor :   if the movements and sensation in the legs are affected, then a neuro opinion would be needed
Doctor :   along with nerve conduction studies to look for any compression issues
User :   affected in what sense po?
Doctor :   as long as the movements and sensations are fine, you do not need to worry
Doctor :   affected in the sense reduced as compared to other leg both the range of movements and the sensations
Doctor :   did you follow what I said?
User :   how can i test correctly the sensation, how to compare if its symmetrical?
Doctor :   it should be done by the pediatrician
Doctor :   it can be done by you too, taking a cotton wisp
Doctor :   and touching at symmetrical points
Doctor :   to see how baby reacts
Doctor :   when touched on both legs
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