Our 10-year-old son was born with a congenital heart defect which was corrected with an operation when he was a week old. He had a procedure when he was 5 to pump up a narrowed aorta, but otherwise his annual heart scans have been fine. His paediatric cardiologist says that my son can play sports, but he does not have much stamina. A recent aerobic activity left him with pains in his legs for three days. He is very academic and would rather read or play on his computer than exercise. He will soon start secondary school where cross-country running is compulsory, but I am worried about forcing him to exercise when he feels so weary afterwards. What is your view? Gabrielle Brown, Altrincham, Chesire
It would be advisable for your son to have some exercise built in to his daily routine, but cross-country running is not a good idea. Even though it is some years since his operation, a hard physical activity could place too much strain on his heart. Tired legs and aching muscles after exercise is more likely on account of him not being used to much activity and a lack of physical fitness.
Your son’s most recent heart scan was fine. The exercise test allowed the paediatric cardiologist to monitor your son’s heart while he was running on a treadmill. The specialist was able to assess exactly how his heart was responding to and coping with exercise. It sounds as if this was also fine. Nonetheless, despite the results, you should discuss exercise options with his new school. He may need the option of being able to sit out some sport if he feels tired.
IMPETIGO FEAR
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My nephew had the skin disorder impetigo around his temple a few years ago. It took a week to clear, but he then had pain in his hip. It was found that the infection had travelled to his hip joint and he was in hospital for a week. Also, his leg turned inwards, but this is now better thanks to exercises and healthy growth. I had no idea that impetigo could travel to other parts of the body. Is this common and should parents be warned about it? Christine Pugh, Edinburgh
The complications that your nephew experienced were fairly unusual. Impetigo is an infectious skin condition that results in small blisters, most often around the nose, lips and ears, that break and then crust over to form scabs. It generally clears up without any problems.
I suspect that what happened in your nephew’s case was that one or other of the bugs associated with impetigo, such as staphylococcus aureus or Group A beta-haemolytic streptococcus, may have escaped into the bloodstream, leading to bacteraemia (presence of bacteria in the blood). This eventually spread to the hip joint, causing bacterial arthritis.
The family were right to seek early medical attention. He should also perhaps have had routine immunology tests to make sure that his immune system was working properly. If he hasn’t had problems with infections since, it is unlikely that he has an underlying immune deficiency, though.
In general, if your child has recently has an infectious illness and you are concerned about their recovery, see your GP.
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Jane Collins is the chief executive and honorary consultant paediatrician at Great Ormond Hospital
OVER TO YOU
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E-mail Dr Jane Collins at drjane@thetimes.co.uk or write to her at Body&Soul, The Times, 1 Pennington Street, E98 ITT. Please include your name, address and telephone number. Dr Collins cannot enter into individual correspondence.