Early diagnosis, treatment better for children

Question:

Dear Dr. Donya,

Hi, my name is Indu. My daughter was born on Dec. 21, 1997. When she was six months old, we found that she didn't have a vagina. We are confused and don't know which doctor should be contacted. Although she's almost three years old she has never bee seriously ill, and she has no problem urinating.

When she was born, her condition was normal, so why is this happening to her? How can she menstruate without a vagina and how can she marry?

Dr.Donya, please tell us what we should do. My husband told me that we have to wait until she grows up. Please help us.

-- Indu & husband

Answer:

Dear Indu,

Thank you for letting me help. You told me that she looked normal when she was born and then six months later you discovered that you were unable to locate her vaginal canal. Indu, as alarming as this situation may be, your daughter's condition is not uncommon.

Based on your information, she needs to be evaluated with a complete physical examination by a pediatrician (child specialist doctor) or pediatric endocrinologist (doctor who specializes in hormone and reproductive development in children). She may have a "defect in the development of reproductive system" which ranges from mild to severe developmental defect such as; 1. "Labial adhesions", the labia minora has a central line of adherence from an area immediately inferior to the clitoris to the anal line. This is commonly seen in children younger than six years of age and the condition is often asymptomatic (no symptom). The lesions are usually associated with local inflammation from hypoestrogenic (low estrogen) a common state of preadolescent. Once the vaginal becomes more acidic, as occurs with puberty, the labial adhesions almost always disappear. The treatment is implicating estrogen cream and may require 2-8 weeks therapy. 2. Congenital (born with) absence of the vagina (vaginal agenesis) and presence of normal vulva (opening of vaginal canal). This disorder may have other organ abnormalities too, such as uterus, renal or bone structure. Vaginoplasty can be done by plastic surgery when the patient is matured. 3. Incomplete fusion of vagina. The doctor will do external genitalia examination to determine the development of her reproductive organs also her internal organs including cervix, uterus and ovaries, which can be done by a simple and painless pelvic ultrasound or computerized tomography (CT Scan). Further investigation will depend on what her doctor has found so my advice is take her to see a doctor, get a proper diagnosis and begin treatment as early diagnosis and treatment is always better than later.

-- Dr. Donya

Question:

Dear Donya,

I am really grateful to the Post for your feature every Wednesday and I have started collecting your articles as they have helped me a lot.

Doctor, I am a first time mother and have a four month old daughter. I shall be obliged if you could answer the following questions: 1. Doctor, what percentage of birth weight would you say is "safe" before the mother or the baby's doctor decide to supplement formula with breast milk? 2. My daughter has started having semi-solid foods and she prefers them to milk! What is the least amount of milk she must have every day so that her calcium intake is safely maintained? 3. When she cries of hunger and I offer her a bottle of milk (she has been on formula from birth), she fusses a lot and after a lot of comforting goes to sleep. As soon as she is asleep, she avidly consumes her bottle of milk. What can be the reason of this fussing? 4. As she stays in an air-conditioned room all day and night, do you advise using face cream and body lotion on her so that her skin stays soft and beautiful ?

Thank you very much for reading my questions. I am eagerly awaiting the answers.

Best regards,

-- Preeti

Answer:

Dear Preeti,

Thank you for your comment. It cheers me up.

1. Weight loss of 5 to 10 percent in newborns is normal during the first few days of life from water loss. However the birth weight is generally regained by the 10th day. In the first six months, weight increases by 0.5 to 1 kilogram per month until doubling of birth weight at six months.

2. At four months old, your daughter needs 115 kilocalories per kilogram weight per day. Milk, 1 ounce (30 ml) has 20 kilocalories and the recommend daily mineral intake for infant on formula is 60 milligrams per kilogram weight per day. So if your daughter weighs six kilograms, she needs 690 kilocalories per day (six times 115) of which 360 milligrams calcium per day (six times 60).

3. In young infants, the brain develops in response to external environment such as adjusting with day and night, cold and hot, communication to care-giver. Sometimes we don't understand what they want. The more growing, the more both of you learn how to cope with each other. I think in your case she may need your soothing comfort or something other than a bottle of milk, you may know by now what to give to bring her to sleep.

4. As for face cream and body lotion I am not keen on them because sometimes babies get allergies to them. But if her skin seems dry by the air-conditioning I am not against you using cream to moisten her skin. I think the Balinese have a better idea in massaging their babies with coconut oil.

-- Dr.Donya