Orthopedic Diseases & Conditions

What are abdominal wall defects?

Abdominal wall defects are congenital defects involving the stomach, intestines or other organs. During the development of the fetus, the stomach and intestines begin to form outside the abdomen, and later stay uncovered (gastroschisis) or stay enclosed in the amniotic membranes (omphalocele). Occasionally, problems occur and wither they remain outside or squeeze through the abdominal wall.

How is it treated?

This condition can be treated with a surgical recreation of the abdominal wall with advanced tissue advancement techniques. It is generally apparent when a baby is born with this condition. Either the base of the umbilical cord will bulge or actually contain the baby’s internal organs.

Is my child a candidate?

Most children born with this problem require immediate and urgent care.

What does abdominal wall defects surgery involve?

The newborn’s exposed intestines are covered with a sterile dressing, while fluids and antibiotics are being administered intravenously. Surgery is then required to replace the intestines in the abdomen and close the opening. Prior, the skin of the abdominal wall often must be stretched to ensure there is enough tissue to cover the opening. If the skin can’t be enlarged enough to compensate, skin flaps are created. If the intestine sticking out is large, it is wrapped in a silo and moved back into the abdomen in a staged process over several days or weeks. When all the intestines are back in the abdomen, the opening is surgically closed.

What is abnormal skull shape?

The skull is made up of several bones that come together and join at specific points. As the brain grows, the skull makes room and expands with the brain. In some instances, the skull may grown and develop abnormally due to several potential issues resulting in an abnormal skull shape. The Palm Beach Surgical Specialists are experienced in the diagnosis and treatment of various skull conditions.

What are some of the conditions included in abnormal skull shape?

There are multiple conditions that encompass abnormal skull shape. These conditions include:

• Plagiocephaly – this is a condition where a portion of a baby’s skull becomes flat due to continued pressure in a specific location usually from too much time in one position. This normally occurs within the first few months after birth but it can occur within the womb during pregnancy.
• Craniosynostosis – this involves premature closing of one or more of the skull plates, or the premature adjoining of the skull bones. This can result in the brain growing in a different direction causing an abnormal skull shape.

What are the treatment options for abnormal skull shape?

Treatment options for abnormal head shape vary depending on the condition and severity of the condition. In some cases, conservative treatment options may be recommended while in other cases, surgery may be required.

With plagiocephaly treatment options can include repositioning exercises and in some cases, therapy. In some instances, with more severe cases, helmet therapy may be recommended to reshape the skull.

Craniosynostosis, unlike plagiocephaly, is a birth defect and may affect pressure on the brain. Treatment options to correct craniosynostosis often involves surgical options. Depending on the specific case, a procedure may be performed either endoscopically or through open surgery to reshape the skull.

The Achilles tendon – the largest tendon in the body – connects the calf muscles to the heel bone and is used for walking, running and jumping. Achilles tendinitis is inflammation of the Achilles tendon.

Achilles tendinitis is typically not related to a specific injury, but instead results from repetitive stress to the tendon. Other factors may affect the tendon like a sudden increase in the amount or intensity of exercise activity, tight calf muscles, or a bone spur.

Common symptoms of Achilles tendinitis include pain and stiffness along the Achilles tendon, especially in the morning; pain along the tendon or back of the heel that worsens with activity; severe pain the day after exercising; thickening of the tendon; bone spur; and swelling that gets worse throughout the day with activity.

A doctor will examine the area and order imaging tests like x-ray or magnetic resonance imaging (MRI) for diagnosis. Nonsurgical treatments include rest, ice, and physical therapy. Anti-inflammatory medication and cortisone shots may also help. Braces or boots can ease pain. Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure that may stimulate healing.

Surgical options are usually considered after at least six months of pain and other symptoms. There are several different types of surgery that can lengthen the calf, repair the tendon, or transfer a tendon from another part of the body.

Sports, hobbies or work that require frequent pivoting and turning often cause anterior cruciate ligament (ACL) sprains or tears. ACL injuries are the most common knee injuries, many of which require surgery. About half of all injuries to the ACL also occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Injured ligaments are considered “sprains” and are graded on a severity scale of one to three. Most ACL injuries are complete or near complete tears, or grade three sprains. Symptoms may include hearing or feeling a “pop,” intense knee weakness, pain with swelling, loss of range of motion, tenderness along the joint, and discomfort when walking.

Diagnosing an ACL injury usually involves a doctor’s examination and X-rays or an MRI or CT scan.

If the overall stability of the knee is intact, your doctor may recommend nonsurgical options. Rest, ice, bracing, and physical therapy may help those who have slight injuries or do not have an active lifestyle. Surgery is needed for active patients and those with serious tears. Rebuilding the ligament with a tendon from the patient or a cadaver, followed by physical therapy and rehabilitation, will help get the patient back to normal.

Most sports injuries can be treated at home with the RICE approach. RICE stands for rest, ice, compression, and elevation.

• Rest – Stop or greatly reduce activity that might affect the injured area. Weight-bearing activity on joints in the leg may need to be assisted with crutches.
• Ice – Put a cold pack of a bag of ice wrapped in a towel or a bag of frozen vegetables on the injury for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
• Compression – An elastic compression from a pharmacy will help reduce swelling and provide mild support.
• Elevation – Recline as you rest and elevate the injury above your heart.

Non-steroidal anti-inflammatory medicines like aspirin and ibuprofen will help reduce inflammation and ease pain. Symptoms like pain and swelling that persist should be examined by a doctor. Untreated injuries could lead to permanent damage or disability. Doctors may prescribe a more specific brace or cast for minor injuries and may order advanced testing if they suspect a more serious problem.

A sprained ankle is a very common injury that affects people of all ages and abilities. When the ligaments of the ankle are forced to stretch beyond the normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers. This usually happens when the foot rolls, twists or moves in an abnormal angle in relation to the foot. Symptoms include pain and swelling or even hearing or feeling a “pop” in the ankle area.

To diagnose a sprained ankle, doctors will complete a physical exam and order x-rays or MRI or CT studies. The sprain is graded on a scale of one to three. Most ankle sprains can be treated with ice, rest, bracing, elevation, anti-inflammatory medications, and physical therapy. Grade two sprains may need more time to heal than grade one sprains. If the sprain is a grade three, involving a full tear, surgery may be needed, although this is quite rare.

The knee is the largest joint in the body, and one of the most easily injured. Because many sports like football, skiing, soccer, running, and basketball require intense use and manipulation of the knee area, it is a common area for athletes of all abilities to injure.

The knee is made up of four main parts: bones, cartilage, ligaments, and tendons. Common knee injuries include fractures, dislocations, sprains, and ligament tears. In many cases, the injury will affect more than one structure in the knee. Pain and swelling are the most common signs of knee injury. The knee may also “catch” or lock up. Instability in the knee makes it feel like it is weak or giving way.

To diagnose knee injuries, a doctor will complete a physical exam and order x-rays or other imaging studies. Arthroscopy, a minimally invasive surgical procedure, can also be used to view the joint and make more specific diagnoses.

Many knee injuries can be successfully treated with simple measures, such as rest, icing, compression or bracing, and elevation. When pain and swelling subside, physical therapy and rehabilitation can help strengthen the area. Other injuries may require surgery. Arthroscopy allows a doctor to make some repairs while viewing the area. If there is a complicated injury affecting a number of knee structures, open surgery may be needed.

What is Biliary Atresia?

Atresia is a rare disease that affects infants two to eight weeks after birth. The baby’s bile flow from the liver to the gallbladder is blocked, causing the bile to be trapped in the liver. This results in scarring and damage to the liver, which can cause it to fail.

What causes atresias?

The answer to this question isn’t fully clear. For some children. it seems to occur with improper formation to the womb. Others seem to be impacted by the body’s immune system or a viral infection that occurs after birth.

Is my child a candidate?

The younger the infant is at the time of surgery, the more likely the surgery will be successful. By the time the baby is 4 months old, the surgery can prove to be ineffective. Other determinants include the extent of liver damage, number and size of ducts, etc.

What does biliary surgery involve?

Babies with this condition undergo a Kasai procedure or hepatoportoenterostomy, which re-establishes bile flow from the liver into the intestine. The surgery focuses on removing the damaged ducts outside of the liver, while identifying smaller ducts that are still open and draining bile. The intestine is then attached to this portion of the liver, so that bile can flow directly from the remaining healthy bile ducts into the intestine.

What is recovery like?

Following surgery, infants usually remain in the hospital for a couple of weeks to manage the work up and the surgery. Patients need to undergo long-term antibiotic therapy to reduce the risk of infection. Other medications may also be prescribed to encourage a successful follow-up with bile drainage and decreased jaundice. There is no cure for this condition however, this procedure encourages better health for several if not many years and optimizes the baby’s flow of bile. If this procedure doesn’t work, liver transplantation is necessary.

Atresia of the Intestines

Atresia of the intestines is a condition where there is not continuity in a segment of the intestine. This can be either because the intestinal lumen is separated by an extra wall or web or because the two ends are not connected at all and each ends in a blind pouch. This condition exists prior to the birth of the infant. For this reason, many of these atresias can be diagnosed prenatally. Babies with this condition undergo surgery where intestinal continuity is restored either by removing the web or connecting the two separated ends.

What are brain and spinal cord cysts?

Cysts are fluid-filled sacs that develop within the body, in this case on the spine, known as syringomyelia (spinal cord cyst) or in the brain (brain cyst). Depending on the size and location, the cysts may cause damage or can elicit symptoms.

What are the different forms of brain and spinal cord cysts?

There are two main types of spinal cord tumors:

• Congenital syringomyelia – This form of a spinal cord cyst occurs from a congenital condition. Usually, a spinal cord cyst is caused by Chiari malformation which can allow for the cyst to develop in the neck area.
• Acquired syringomyelia – This form of a spinal cord cyst develops after birth. This can be caused by spinal cord injury, meningitis, arachnoiditis, tethered cord syndrome, spinal cord tumor and bleeding into the cord.

The types of brain cysts include:

• Arachnoid cyst – This occurs between the brain and the arachnoid membrane which is one of the protective coverings of the brain.
• Colloid cyst – This is gel-filled cyst that usually forms in one of the four ventricles of the brain that hold cerebral spinal fluid.
• Dermoid cyst – This is a rare cyst that forms when skin cells become trapped when the brain and spinal cord are forming during pregnancy. These cysts can contain sweat glands and hair follicle cells.
• Epidermoid cyst – This also occurs when tissue is trapped when the brain and spinal cord form however, they do not contain sweat glands or hair follicles.
• Pineal cyst – This occurs in the middle of the brain on the pineal gland. They rarely cause issues but can occasionally affect vision.
• Brain abscess – This can happen anywhere in the brain and is usually caused by a bacterial infection but can also be caused by parasite or fungus.
• Neoplastic cyst – This occurs as a result of a benign or malignant tumor.

What are the symptoms?

Symptoms of brain and spinal cord cysts can vary depending on the size and location of the cysts.

Symptoms of spinal cord tumors can include:

• Muscle weakness
• Loss of reflexes
• Headache
• Reduced sensitivity to pain and temperature
• Back, shoulder, arm and leg stiffness
• Neck, arm and back pain
• Scoliosis

What are the treatment options?

Treatment options for brain and spinal cord cysts can vary depending on the size, location, severity and progression of the cysts. In some cases, if there is a lack of symptoms, monitoring may be recommended. For those who are symptomatic, surgery is usually recommended. At Palm Beach Children’s Surgical Specialists, we are committed to providing advanced treatment options for your child.

What is a brain and spinal cord tumor?

A brain or spinal tumor occurs when abnormal cells form in the tissues of the brain or spinal cord. These tumors can be either malignant (cancerous) or benign (noncancerous). Benign brain tumors normally grown and press on a specific area off the brain and rarely spread to other tissues while a malignant brain tumor is likely to grow and spread into other tissues.

Depending on where the tumor is located, it can affect certain brain or motor functions.

What are the symptoms of a brain or spinal cord?

The symptoms of a brain or spinal tumor can vary from child to child depending on multiple factors including its size, location, how quickly the tumor is growing and the age of the child.

Some of the symptoms of a brain tumor can include:

• Headaches in the morning or headaches that dissipate after vomiting
• Nausea/vomiting
• Vision, hearing or speech problems
• Difficulty walking or balance issues
• Unusual fatigue
• Personality changes
• Seizures
• Increased head size

Symptoms of a spinal tumor can include:

• Back pain
• Changes in bowel habits/difficulty urinating
• Leg weakness
• Difficulty walking

Additional symptoms for some children can also include difficulty reaching some growth development milestones including sitting up, waling and speaking in sentences.

What are the treatment options?

If a brain tumor is suspected, a biopsy may be conducted to test the cells. In most cases, surgery may be performed to remove the tumor. At Palm Beach Children’s Surgical Specialists, we are committed to providing quality advanced care your little ones.

What are Bronchogenic Cysts?

This congenital condition involves abdominal growths found mostly in the portion of the chest cavity separating the lungs. The cysts generally have thin walls and are filled with fluid.

What are the symptoms?

The symptoms of bronchogenic cysts are often non-existent until they become infected later in life. Many times they are diagnosed incidentally when testing for something completely different. If they become large, they can cause some respiratory problems, trouble swallowing and infections. other symptoms can include: wheezing, noisy breathing and chest pain.

How are they diagnosed?

When concerned about bronchogenic cysts, thoracic surgeons can identify them using various diagnostic tools, including: X-ray, esophogram, CT scan and MRI, as well as a bronchoscopy.

What does surgery for bronchogenic cysts involve?

When diagnosed, the patient has to be carefully evaluated for the most appropriate individual treatment. Symptomatic cysts should be removed surgically.

What is recovery like?

Usually, a chest tube is required after surgery to drain air and fluid from the chest cavity. Children should avoid strenuous activity for several weeks post-surgery. Wound care instructions should be followed carefully and pain medicine administered.

What is cerebral palsy?

Cerebral palsy is a group of disorders that affect movement, balance, muscle tone and posture. Cerebral palsy results from damage to or abnormalities within the brain as it develops, usually before birth. The word cerebral refers to the brain and palsy refers to an impairment or loss of motor function.

What are the symptoms of cerebral palsy?

The symptoms of cerebral palsy normally appear during infancy or preschool years and are associated with impaired movement.

The signs and symptoms can vary amongst children, however, some of the symptoms can include:

• Variations in muscle tone (too stiff or too floppy)
• Stiff or tight muscles and exaggerated reflexes
• Lack of balance
• Tremors
• Delays in reaching motor skills milestones
• Favoring one side of the body
• Difficulty walking (walking on roes, crouched gait or “scissored” gait)
• Difficulty swallowing/excessive drooling
• Difficulty sucking or eating
• Delays in speech development
• Fine motor skills difficulties

How is cerebral palsy treated?

Currently, there is no cure for cerebral palsy however, there are treatment options to help improve quality of life. Medications ca be used to lessen muscle tightness to improve functional abilities and treat pain. Therapies can also be recommended to assist in muscle training or increase flexibility and balance as well as improve speech capabilities depending on the type of therapy. In some, cases, surgery may be required to lessen muscle tightness and reduce pain.

What are chest wall deformities?

Chest wall deformities are conditions of the chest wall, also known as funnel chest, that cause the sternum and rib cartilage to protrude. The condition is more prevalent in boys and often becomes more pronounced during the adolescent growth spurt.

What are the symptoms?

For most patients, the only symptom of a chest wall deformity is a slight indentation in their chest. For some, this indentation worsens in early adolescence. If the case is severe enough to compress the lungs and heart, additional symptoms can include: coughing/wheezing, heart palpitations, chest pain, fatigue, heart murmur and decreased exercise tolerance.

How is it diagnosed?

Chest wall deformities can usually be diagnosed upon examination. If the doctor is concerned that your child might have other problems that are caused by this condition, tests such as a chest x-ray, CT, electrocardiogram, echocardiogram, lung function test or an exercise test may be ordered. We assess the severity of the deformity by imaging and examination to determine surgical options and timing.

What does treatment involve?

Treatment for chest wall deformities varies. For people with a mild issue, physical therapy to develop core musculature can suffice. By performing the correct exercises, patients can improve posture and increase chest expansion. For people with moderate to severe issues, the problem can be surgically repaired by shaping the chest wall. Pectus Carinatum or rib flaring are amenable to individualized bracing designed by doing 3D scanning of the child’s thorax.

What is Chiari malformation?

Chiari malformation is a defect that occurs when a portion of the skull is smaller than normal. This causes a portion of the brain to extend into the spinal canal. This could cause pressure on the brain and spinal cord. Some noted conditions associated with Chiari malformation include:

• Headache
• Sleep apnea
• Hydrocephalus – buildup of fluid in the brain
• Neuromuscular issues

What are the types of Chiari malformation?

There are four types of Chiari malformations:

• Type I – this is the most common form of Chiari malformation and can often go undiagnosed until symptoms appear during childhood or even adulthood.
• Type II – this form of Chiari malformation typically exudes more severe symptoms that normally appear in childhood. Type II normally affects children born with spina bifida, specifically myelomeningocele, a form of spina bifida where the spinal canal and backbone do not fully close before birth.
• Type III – this form of Chiari malformation is extremely rare and serious. This occurs when a portion of the brain herniates, or stick out, through an opening in the back of the skull.
• Type IV – this form of Chiari malformation is very rare. This occurs when a portion of the brain is underdeveloped or missing.

What are the treatment options?

Treatment options for Chiari malformation can vary depending on the type and severity of the condition. In some cases, with very mild symptoms, treatment may not be necessary and the condition will be monitored as the child grows. Minor symptoms including pain or headache may be treated with medications.

For some cases, surgery may be required to ease symptoms or stop the progression of damage to the central nervous system. The neurosurgical treatment options can include:

• Shunt repair – Sometimes symptoms of Chiari malformation can be treated by repairing a malfunctioning shunt used to treat hydrocephalus or buildup of spinal fluid.
• Decompression surgery – When symptoms are severe, decompression surgery may be required. This will allow more space around the upper spine and lower brain by removing some bone to relieve pressure on the spinal cord. This will also restore normal spinal fluid flow.
• Syringomyelia surgery – In some cases, a fluid-filled cyst may develop on the spine. When this occurs, a shunt may be inserted to drain the cyst and relieve the pressure.

When an abnormal condition appears at birth, it’s called a congenital condition. There are a number of congenital problems that affect the bones, muscles and tendons. Many can be addressed in early childhood to give the patient an opportunity for more traditional growth and development.

Some congenital orthopaedic conditions include: metatarsus adductus, also known as metatarsus varus, a common foot deformity that causes the front half of the foot to turn in; clubfoot, also known as talipes equinovarus, a foot deformity; developmental dysplasia of the hip joint; congenital limb defects; osteogenesis imperfecta (OI), also known as brittle-bone disease; and muscular dystrophy (MD), a disorder of the muscles.

Through examination and imaging, doctors can analyze the extent of the congenital problem and how it affects surrounding bones and tissues. Your Palm Beach Health Network Physician Groups team is experienced with every treatment from splints and bracing to complex surgeries like limb lengthening. Treating orthopaedic congenital deformities often includes physical therapy and rehabilitation as part of a comprehensive treatment plan.

What are congenital lobar emphysema and lung lesions?

Congenital lobar emphysema is a rare respiratory disorder generally diagnosed in newborns or young infants, though occasionally found in adulthood. Patients breathe air in, but the air can’t escape, resulting in overinflation of the lobes of the lungs. If severe enough, the disorder can result in related heart problems.

What are the signs and symptoms of congenital lobar emphysema and lung lesions?

The major symptoms of this disorder are difficulty breathing or rapid respiration, an enlarged chest, compressed lung tissue in the section nearest to the diseased lobe. Sometime in severe cases bluish skin tones can result from a lack of oxygen in the blood.

How is this diagnosed?

Two types of tests are used to diagnose congenital lobar emphysema and lung lesions. First, radiological tests are employed to determine which part of the lung and which lobe is affected and how much. Doctors can order X-rays and CAT scans to diagnose this disease. The other type of test that is typically used is a lung function test. This also helps determine how impaired the child’s breathing is from the lesion and if surgery is required.

What does treatment involve?

Treatment of congenital lobar emphysema depends on the condition of the lungs. If lung damage is minimal, there may not be any adverse effects. If the condition affects the ability to breathe, the affected lobe of the lung – or even the whole lung – may need to be surgically removed.

A dwarf is a person of short stature with an adult height under 4′ 10”. Dwarfism itself is not a disease. However, there is a greater risk of some health problems for people with dwarfism. With proper medical care, most people with dwarfism have active lives and traditional life spans.

More than 200 different conditions can cause dwarfism, but one type called achondroplasia, causes about 70 percent of dwarfism cases. Achondroplasia is a genetic condition that causes arms and legs to develop shorter in comparison to the head and trunk. This is a type of disproportionate dwarfism, where some parts of the body are small, and others are of average size or above-average size. Disorders causing disproportionate dwarfism inhibit the development of bones. Proportionate dwarfism describes a body that is proportionately small.

A number of disorders causing dwarfism can cause a variety of developmental problems and medical complications, so a number of specialists may be involved in diagnosing and treating health problems. Some team members could include a hormone disorder specialist; ear, nose and throat (ENT) specialist, orthopedics specialist; heart specialist; mental health provider; nervous system abnormalities specialist; and dental specialist.

The Tenet Florida Physician Specialists orthopaedics team may correct some dwarfism skeletal problems through procedures like altering growth plates, straightening bones, supporting the spine and limb lengthening.

What is dystonia?

Dystonia is a movement disorder that causes involuntary muscle contractions resulting in repetitive movement and twisting. This condition can affect one part of the body, adjacent parts or the whole body. It has no cure.

What are the symptoms of dystonia?

Dystonia can start in one place in the body, such as in the leg, neck or arm and then recur during a very specific action, such as when you write. It tends to get worse and more noticeable over time. Stress, anxiety and fatigue worsen the symptoms, as well.

What areas of the body can be affected?

Dystonia can affect the neck, eyelids, jaw or tongue, voice box, vocal cords, hands and forearms.

What causes dystonia?

The cause is unknown, and it may be an inherited condition. It can also be a symptom of many other conditions, such as: Parkinson’s disease, Huntington’s disease, Wilson’s disease, traumatic brain injury, birth injury, stroke, brain tumor, oxygen deprivation, infections, reaction to medication or heavy metal poisoning.

How is it diagnosed?

In the course of the medical exam, the doctor may recommend blood or urine tests to look for toxins, MRI/CT scan to identify brain abnormalities and EMG to see the electrical activity in your child’s muscles.

What are the treatments?

Treatments for dystonia can include a variety of medications that can help manage the symptoms. Physical, occupational and speech therapy are often recommended. There are also surgical treatments for patients with severe symptoms. Deep brain stimulation can be used to help control muscle contractions.

Bones, cartilages, ligaments, muscles, tendons and fluid work together to make the elbow joint. With such a complex system, there are a number of ways to injure the area.

One common cause of elbow pain is tendonitis, which is an inflammation or injury to the tendons that attach muscle to bone. Tendinitis of the elbow is often a result of a sports injury or overuse in playing tennis or golf. Other causes of elbow pain include sprains, strains, fractures, dislocations, bursitis and arthritis.

Treatment depends on the cause. A physical exam, patient history, and imaging tests will all aid in diagnosis. Sometimes arthroscopy, a procedure that inserts a camera into the joint, is used to better visualize the area.

Mild injuries may be treated with rest, ice, compression or bracing, elevation, and pain management. More complicated injuries may use arthroscopy to make some repairs. Additional minimally invasive or open surgery might also be required. In most cases, physical therapy and rehabilitation will aid in healing, strengthening and regaining motion.

What is Tracheoesophageal Fistula?

Tracheoesophageal fistula (TF) is a birth defect that occurs as the fetus is developing in the mother’s uterus. The condition results in an abnormal connection between the esophagus and the trachea, in one or more places. These tubes, which are generally not connected, have separate functions – the esophagus carries food to the stomach and the trachea carries oxygen to the lungs. When a baby with a TF drinks, the fluid can get into the baby’s lungs.

What is Esophageal Atresia?

TF often occurs in combination with esophageal atresia, another birth defect. In this case, the esophagus forms in two parts, rather than one. One part connects to the stomach, and the other to the throat. Since they aren’t connected, food can’t get into the stomach to be used by the body.

Are some babies prone to these birth defects?

While these conditions aren’t known to be genetically based, they are more often seen in babies with other digestive tract, heart, kidney and urinary tract, muscular or skeletal problems, VACTERL syndrome, or Trisomy 13, 18, or 21.

What are the symptoms?

• Round, full abdomen
• Vomiting
• Frothy, white bubbles in the mouth
• Coughing or choking when feeding
• Difficulty breathing

How is it diagnosed?

After a small tube is inserted in the mouth or nose of the baby and guided into the esophagus, a chest X-ray is performed which demonstrates the tube is unable to be passed down through the esophagus to the stomach.

What is the treatment?

These problems need to be corrected surgically. Either open or minimally invasive surgery may be applicable, according to the opinion of the physician. Even with the surgery, about half of the children will still need to be treated for acid reflux long term.