What is tracheoesophageal fistula?

Tracheoesophageal fistula is an abnormal connection in one or more places between the esophagus (the tube that leads from the throat to the stomach) and the trachea (the tube that leads from the throat to the windpipe and lungs). Normally, the esophagus and the trachea are two separate tubes that are not connected.

Tracheoesophageal fistula is also known as TE fistula or simply TEF.

TE fistula is a birth defect, which is an abnormality that occurs as a fetus is forming in its mother's uterus.

When a baby with a TE fistula swallows, the liquid can pass through the abnormal connection between the esophagus and the trachea. When this happens, liquid gets into the baby's lungs. This can cause pneumonia and other problems.

What is esophageal atresia?
TE fistula often occurs with another birth defect known as esophageal atresia. The esophagus is a tube that leads from the throat to the stomach. With esophageal atresia, the esophagus does not form properly while the fetus is developing before birth, resulting in two segments; one part that connects to the throat, and the other part that connects to the stomach. However, the two segments do not connect to each other.

Since the esophagus is in two segments, liquid that a baby swallows cannot pass normally through the esophagus and reach the stomach. Milk and other fluids cannot be digested if the esophagus does not connect to the stomach.

If a TE fistula is also present, liquid that a baby swallows can pass through the connection between the esophagus and the trachea and go into the lungs. This can cause pneumonia and other problems.

What causes tracheoesophageal fistula and esophageal atresia?
As a fetus is growing and developing in its mother's uterus before birth, different organ systems are developing and maturing. The trachea and the esophagus begin developing as one single tube. At about four to eight weeks after conception, a wall forms between the fetus' esophagus and trachea to separate them into two distinct tubes. If this wall does not form properly, TE fistula and/or esophageal atresia can occur.

Which babies develop tracheoesophageal fistula or esophageal atresia?
These two problems are not thought to be inherited. However, they are often seen when a baby has other birth defects, such as:

Trisomy 13, 18, or 21

Other digestive tract problems (such as diaphragmatic hernia, duodenal atresia, or imperforate anus)

Heart problems (such as ventricular septal defect, tetralogy of Fallot, or patent ductus arteriosus)

Kidney and urinary tract problems (such as horseshoe or polycystic kidney, absent kidney, or hypospadias)

Muscular or skeletal problems

VACTERL syndrome (which involves Vertebral, Anal, Cardiac, TE fistula, Renal, and Limb abnormalities)

Up to one-half of all babies with TE fistula or esophageal atresia have another birth defect.

What are the symptoms of TE fistula or esophageal atresia?
The symptoms of TE fistula or esophageal atresia are usually noted very soon after birth. The following are the most common symptoms of TE fistula or esophageal atresia. However, each child may experience symptoms differently. Symptoms may include the following:

Frothy, white bubbles in the mouth

Coughing or choking when feeding

Vomiting

The blue color of the skin, especially when the baby is feeding

Difficulty breathing

Very round, full abdomen

Other congenital malformations might be present, such as the ones mentioned in the previous section.

Symptoms of TE fistula or esophageal atresia may resemble other conditions or medical problems. Please consult your child's doctor for a diagnosis.

What tests are usually done to diagnose the problem?
Along with a physical examination and medical history, imaging studies are usually done to evaluate whether a baby has TE fistula and/or esophageal atresia. X-rays are taken to look at the chest and abdomen.

A small tube may also be placed into the mouth or nose and then guided into the esophagus. With esophageal atresia, the tube usually cannot be inserted very far into the esophagus. The tube's position in the esophagus can also be seen with the X-ray.

What is the treatment for TE fistula or esophageal atresia?
If your baby has TE fistula or esophageal atresia, he or she will need surgery to fix the problem. The type of surgery depends on the following:

Type of abnormality

The overall health of the baby and medical history

The opinion of the surgeon and other health care providers involved in the baby's care

Expectations for the course of the condition

Your opinion and preference

When TE fistula is repaired, the connection between the esophagus and the trachea is closed in surgery. Repair of esophageal atresia depends on how close the two sections of esophagus are to each other. Sometimes esophageal atresia requires more than one surgery. Your baby's surgeon and other health care providers will decide when it is best to do the operations based on your baby's condition and the type of problem.

Could my child have problems in the future?
Some children born with esophageal atresia have long-term problems.

Swallowing food or liquids may be difficult due to:

Problems with the normal movement of foods and liquids down the esophagus (peristalsis).

Scarring that can occur in the esophagus after surgery as the wounds heal, which can partially block the passage of foods.

Sometimes, a narrowed esophagus can be widened or dilated with a special procedure done while the child is under general anesthesia. In other cases, another operation may be necessary to open up the esophagus so food can pass to the stomach properly.

About one-half of children who had esophageal atresia repaired will have problems with GERD or gastrointestinal reflux disease. GERD causes acid to move up into the esophagus from the stomach. When acid moves from the stomach into the esophagus, it causes a burning or painful feeling known as heartburn. GERD can usually be treated with medications prescribed by a doctor.

Tongue Ulcers
Mouth ulcers — also known as canker sores or tongue ulcers— are normally small, painful lesions that develop in your mouth or at the base of your gums. They can make eating, drinking, and talking uncomfortable.

Women, adolescents, and people with a family history of mouth ulcers are at higher risk for developing mouth ulcers.

Mouth ulcers aren’t contagious and usually go away within one to two weeks. However, if you get a canker sore that is large or extremely painful, or if it lasts for a long time without healing, you should seek the advice of a doctor.

What triggers mouth ulcers?
There is no definite cause behind mouth ulcers. However, certain factors and triggers have been identified. These include:

minor mouth injury from dental work, hard brushing, sports injury, or accidental bite
toothpaste and mouth rinses that contain sodium lauryl sulfate
food sensitivities to acidic foods like strawberries, citrus, and pineapples, and other trigger foods like chocolate and coffee
lack of essential vitamins, especially B-12, zinc, folate, and iron
allergic response to mouth bacteria
dental braces
hormonal changes during menstruation
emotional stress or lack of sleep
bacterial, viral, or fungal infections
Mouth ulcers also can be a sign of conditions that are more serious and require medical treatment, such as:

Celiac disease (a condition in which the body is unable to tolerate gluten)
inflammatory bowel disease
diabetes mellitus
Behcet’s disease (a condition that causes inflammation throughout the body)
a malfunctioning immune system that causes your body to attack the healthy mouth cells instead of viruses and bacteria
HIV/AIDs

What symptoms are associated with mouth ulcers?
There are three types of canker sores: minor, major, and herpetiform.

Minor
Minor canker sores are small oval or round ulcers that heal within one to two weeks with no scarring.

Major
Major canker sores are larger and deeper than minor ones. They have irregular edges and can take up to six weeks to heal. Major mouth ulcers can result in long-term scarring.

Herpetiform
Herpetiform canker sores are pinpoint size, occur in clusters of 10 to 100, and often affect adults. This type of mouth ulcer has irregular edges and will often heal without scarring within one to two weeks.

You should see a doctor if you develop any of the following:

unusually large mouth ulcers
new mouth ulcers before the old ones heal
sores that persist more than three weeks
sores that are painless
mouth ulcers that extend to the lips
pain that can’t be controlled with over-the-counter or natural medication
severe problems eating and drinking
high fever or diarrhea whenever the canker sores appear

Tooth decay is the primary cause of toothaches for most children and adults. Bacteria that live in your mouth thrive on the sugars and starches in the food you eat. These bacteria form a sticky plaque that clings to the surface of your teeth.

Acids produced by the bacteria in plaque can eat through the hard, white coating on the outside of your teeth (enamel), creating a cavity. The first sign of decay may be a sensation of pain when you eat something sweet, very cold or very hot. Sometimes decay will show as a brown or white spot on the tooth.

Other causes of a toothache can include:

An accumulation of food and debris between your teeth, especially if your teeth have spaces between them
Inflammation or infection at the root of the tooth or in the gums
Trauma to the tooth, including injury or grinding your teeth
Sudden fracture of the tooth or tooth root
A split in the tooth that occurs over time
Teeth that start to appear (erupt) through the gums, such as with teething or wisdom teeth that don't have enough room to emerge or develop normally (impacted wisdom teeth)
A sinus infection that can be felt as pain in the teeth
A toothache often requires some sort of treatment by your dentist.

Self-care tips
Until you can see your dentist, try these self-care tips for a toothache:

Rinse your mouth with warm water.
Use dental floss to remove any food particles or plaque wedged between your teeth.
Consider taking an over-the-counter (OTC) pain reliever to dull the ache, but don't place aspirin or another painkiller directly against your gums because it may burn your gum tissue.
If the toothache is caused by trauma to the tooth, apply a cold compress to the outside of your cheek.
Use caution with products containing benzocaine
Previous advice included sparingly applying an OTC antiseptic containing benzocaine directly to the irritated tooth and gum for temporary relief. But benzocaine has been linked to a rare and serious, sometimes deadly, condition called methemoglobinemia, which decreases the amount of oxygen that the blood can carry. So follow these guidelines:

Talk to your dentist or doctor before using an OTC antiseptic containing benzocaine.
Don't use any products that contain benzocaine — such as teething gels with benzocaine (Anbesol, Orabase, Orajel, others) — in children younger than 2 years old.
Never use more than the recommended dose of benzocaine.
Store products containing benzocaine out of the reach of children.

Overview
Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck.

Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may cause tonsillitis.

Because appropriate treatment for tonsillitis depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when bacterial tonsillitis occurs frequently, doesn't respond to other treatments or causes serious complications.

Symptoms
Tonsillitis most commonly affects children between preschool ages and the mid-teenage years. Common signs and symptoms of tonsillitis include:

Red, swollen tonsils
White or yellow coating or patches on the tonsils
Sore throat
Difficult or painful swallowing
Fever
Enlarged, tender glands (lymph nodes) in the neck
A scratchy, muffled or throaty voice
Bad breath
Stomachache, particularly in younger children
Stiff neck
Headache
In young children who are unable to describe how they feel, signs of tonsillitis may include:

Drooling due to difficult or painful swallowing
Refusal to eat
Unusual fussiness
When to see a doctor
It's important to get an accurate diagnosis if your child has symptoms that may indicate tonsillitis.

Call your doctor if your child is experiencing:

A sore throat that doesn't go away within 24 to 48 hours
Painful or difficult swallowing
Extreme weakness, fatigue or fussiness
Get immediate care if your child has any of these symptoms:

Difficulty breathing
Extreme difficulty swallowing
Drooling
Causes
Tonsillitis is most often caused by common viruses, but bacterial infections can also be the cause.

The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat. Other strains of strep and other bacteria also may cause tonsillitis.

Why do tonsils get infected?
The tonsils are the immune system's first line of defense against bacteria and viruses that enter your mouth. This function may make the tonsils particularly vulnerable to infection and inflammation. However, the tonsil's immune system function declines after puberty — a factor that may account for the rare cases of tonsillitis in adults.

Risk factors
Risk factors for tonsillitis include:

Young age. Tonsillitis most often occurs in children, but rarely in those younger than age 2. Tonsillitis caused by bacteria is most common in children ages 5 to 15, while viral tonsillitis is more common in younger children.
Frequent exposure to germs. School-age children are in close contact with their peers and frequently exposed to viruses or bacteria that can cause tonsillitis.
Complications
Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause complications such as:

Difficulty breathing
Disrupted breathing during sleep (obstructive sleep apnea)
Infection that spreads deep into surrounding tissue (tonsillar cellulitis)
Infection that results in a collection of pus behind a tonsil (peritonsillar abscess)
Strep infection
If tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn't treated, or if antibiotic treatment is incomplete, your child has an increased risk of rare disorders such as:

Rheumatic fever, an inflammatory disorder that affects the heart, joints and other tissues
Poststreptococcal glomerulonephritis, an inflammatory disorder of the kidneys that results in inadequate removal of waste and excess fluids from blood
Prevention
The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best prevention is to practice good hygiene. Teach your child to:

Wash his or her hands thoroughly and frequently, especially after using the toilet and before eating
Avoid sharing food, drinking glasses, water bottles or utensils
Replace his or her toothbrush after being diagnosed with tonsillitis
To help your child prevent the spread of a bacterial or viral infection to others:

Keep your child at home when he or she is ill
Ask your doctor when it's all right for your child to return to school
Teach your child to cough or sneeze into a tissue or, when necessary, into his or her elbow
Teach your child to wash his or her hands after sneezing or coughing

Canker sores
Mouth ulcers — also known as canker sores — are normally small, painful lesions that develop in your mouth or at the base of your gums. They can make eating, drinking, and talking uncomfortable.

Women, adolescents, and people with a family history of mouth ulcers are at higher risk for developing mouth ulcers.

Mouth ulcers aren’t contagious and usually go away within one to two weeks. However, if you get a canker sore that is large or extremely painful, or if it lasts for a long time without healing, you should seek the advice of a doctor.

What triggers mouth ulcers?
There is no definite cause behind mouth ulcers. However, certain factors and triggers have been identified. These include:

minor mouth injury from dental work, hard brushing, sports injury, or accidental bite
toothpastes and mouth rinses that contain sodium lauryl sulfate
food sensitivities to acidic foods like strawberries, citrus, and pineapples, and other trigger foods like chocolate and coffee
lack of essential vitamins, especially B-12, zinc, folate, and iron
allergic response to mouth bacteria
dental braces
hormonal changes during menstruation
emotional stress or lack of sleep
bacterial, viral, or fungal infections
Mouth ulcers also can be a sign of conditions that are more serious and require medical treatment, such as:

celiac disease (a condition in which the body is unable to tolerate gluten)
inflammatory bowel disease
diabetes mellitus
Behcet’s disease (a condition that causes inflammation throughout the body)
a malfunctioning immune system that causes your body to attack the healthy mouth cells instead of viruses and bacteria
HIV/AIDs

What symptoms are associated with mouth ulcers?
There are three types of canker sores: minor, major, and herpetiform.

Minor
Minor canker sores are small oval or round ulcers that heal within one to two weeks with no scarring.

Major
Major canker sores are larger and deeper than minor ones. They have irregular edges and can take up to six weeks to heal. Major mouth ulcers can result in long-term scarring.

Herpetiform
Herpetiform canker sores are pinpoint size, occur in clusters of 10 to 100, and often affect adults. This type of mouth ulcer has irregular edges and will often heal without scarring within one to two weeks.

You should see a doctor if you develop any of the following:

unusually large mouth ulcers
new mouth ulcers before the old ones heal
sores that persist more than three weeks
sores that are painless
mouth ulcers that extend to the lips
pain that can’t be controlled with over-the-counter or natural medication
severe problems eating and drinking
high fever or diarrhea whenever the canker sores appear