Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

Childhood allergies rarely present as isolated issues. While one child may experience itchy skin and rashes, another may complain of a perennial runny nose and some wheeze a lot with infections, and yet others present with food-related symptoms. Although these are distinctly different manifestations, they could have a single root cause.

What Causes Allergies In Children?

Childhood allergies are basically an inappropriate immune response towards a substance that usually presents no harm, be it a food item or an allergen in the environment. However, it is not always easy to pick out what is causing the allergic response. The child's medical history as well as the nature and accompanying circumstances of the reaction, play a pertinent role in picking out what is precipitating the problem.

Two children may present with similar complaints but have different underlying allergic conditions. Understanding the pattern of the disease helps decide what investigations are needed and how best the condition can be managed.

Also read: In-Toeing In Children: When It Needs Assessment

How Allergies Can Affect Multiple Body Systems

Allergic diseases can affect multiple body systems. The most common are the skin, upper respiratory tract and the lower respiratory tract. Skin allergy manifests as atopic dermatitis or urticaria, upper respiratory tract can cause allergic rhinitis and conjunctivitis and lower respiratory tract can manifest as asthma.

There are also food allergies which could present with gastrointestinal symptoms or even more serious reactions. A child may also face multisystem involvement and this can sometimes be life-threatening like in a case of anaphylaxis.

Understanding The Role Of Type 2 Inflammation

Allergic disorders may present with multisystem involvement due to the fact that type 2 inflammation is a key driver in the pathology. Cytokines such as IL-31, IL-13 and IL-5 are integral to the formation of IgE antibodies and the activation of eosinophils. Genetic predisposition, skin barrier dysfunction, environmental exposure and the gut microbiota also contribute towards the development of allergies.

There is usually an evolution of allergic diseases as a child grows older. This is commonly referred to as the atopic march. It is common for a child to present with atopic dermatitis and then develop food allergies, allergic rhinitis or asthma later on in life. However, this is not always the case, and an allergic disorder cannot be extrapolated to the presence of any other based on this association alone.

Awareness to these associations can help parents and doctors to watch out for developing conditions and ensure early and appropriate intervention. For example, in a child presenting with persistent eczema, investigation for associated allergic disorders is vital if the history supports it. Early diagnosis and management can also help the parents identify red flags and seek help sooner.

Also read: Toddler’s Swollen Knee Turned Out To Be Juvenile Arthritis Diagnosis: Signs Parents Should Not Ignore

How Are Childhood Allergies Diagnosed?

A thorough clinical history is an extremely valuable tool when it comes to diagnosing allergies. It is important for the doctor to know what the likely allergen was, how soon after exposure the symptoms cropped up, whether similar symptoms have occurred before, and what body systems are involved.

The timing of the reaction and whether it is a one-off or recurrent episode is important. A reaction occurring minutes after ingesting a certain food is very different from a food that causes symptoms after days of consumption.

Treatment And Management Of Allergies In Children

Skin prick tests and specific IgE blood tests are commonly used to screen for sensitisation to common allergens, but these are just pointers. A positive test does not necessarily signify a clinically relevant allergy. The symptoms and exposure history must always be taken into consideration.

Testing for specific IgE to a panel of foods without a clear indication is not only misleading but can also be harmful. Parents may unnecessarily eliminate food groups from the child's diet based on a positive test, thereby affecting nutrition. Similarly, total IgE levels are not helpful in diagnosing a specific allergy.

The treatment varies from managing acute symptoms (with antihistamines or steroids) to controlling chronic conditions (with regular inhaled steroids for asthma). Avoiding the allergen where possible, and treating flare-ups appropriately are the cornerstones of management. Immunotherapy with allergen extracts may be indicated in selected patients with respiratory allergies. Biologics may be considered in certain conditions under specialist supervision.

Why Childhood Allergies Need A Holistic Approach

Children at risk of anaphylaxis should have a personalised action plan and an epinephrine auto-injector available at all times.

Childhood allergies should not be managed in isolation. The focus should be on the child as a whole rather than a single presenting complaint. Awareness and management of any associated conditions can help prevent potentially serious complications.

By Dr Gargi Mathur, Senior Paediatrician, Shalby International Hospitals, Gurugram

Parents may notice that a child’s feet point inward while walking or running. This is called in-toeing. It is common in young children and, in most cases, reflects normal development of the foot or leg bones. Many children improve naturally as they grow, without treatment.

However, it is not always helpful to dismiss a persistent or troublesome walking pattern as “just a growing phase.” The child’s age, the cause, whether the pattern is worsening, and its effect on movement all matter.

What can cause in-toeing?

In-toeing usually comes from one or more of three areas:

1)Foot: The front of the foot curves inward, a condition called metatarsus adductus. Flexible cases often improve naturally.

2)Shin: The shin bone turns inward, called internal tibial torsion. This is common in toddlers and usually improves with growth.

3)Thigh: The thigh bone turns inward, called femoral anteversion. It may become more noticeable when a child begins running or walking with the feet turned in.

The appearance of the feet alone does not always reveal the cause. A clinician can assess the child’s walking pattern and examine the hips, knees, shins and feet.

Also read: Hailey Bieber Opens Up About PMDD After Childbirth: What Is It And How Is It Different From PMS?

When should parents seek advice?

An occasional inward-pointing step, without pain or difficulty, usually needs observation rather than treatment. Arrange an assessment if the child:

• Trips or falls often, or has difficulty running, jumping or keeping up with peers.
• Avoids play or sports because of the way they walk.
• Has pain, swelling, a limp or difficulty bearing weight.
• Has a marked difference between the two legs.
• Develops a new or rapidly worsening walking pattern.
• Has a foot that is rigid or cannot be gently moved toward a straight position.
• Pain, limping, sudden onset, or marked asymmetry are reasons to look beyond a routine developmental variation.

What does assessment involve?

The clinician will ask when the in-toeing began, whether it is changing, and whether it affects daily activities. They will observe the child standing and walking, and assess foot flexibility, hip and leg rotation, balance and function.

X-rays are not routinely needed when the history and examination fit a typical developmental pattern. They may be considered if there is pain, trauma, unusual examination findings or concern for another condition.

Also read: Excessive Screen Time & Mental Health: Expert Urges Parents To Limit Children's Screen Time At Times Health Summit 2026

Does every child need physiotherapy, special shoes or braces?

No. For typical, painless developmental in-toeing, reassurance and observation are usually appropriate. Special shoes, braces and orthotics do not correct the usual rotational causes. Physiotherapy may help when there is a separate issue—such as weakness, balance difficulty or impaired coordination—but it does not generally change the underlying bone rotation.

If in-toeing is severe, persistent and causing substantial functional difficulty, a paediatric orthopaedic specialist can advise whether further evaluation or treatment is appropriate. Surgery is rarely needed and is generally considered only for older children with severe deformity and significant functional problems.

A practical message for parents: Most children with in-toeing walk and play normally, and their alignment improves as they grow. The aim is not to make every child’s walking look identical; it is to ensure the child moves comfortably and safely. Seek an assessment for pain, limping, sudden change, pronounced asymmetry or meaningful difficulty with everyday activities.

Model and entrepreneur Hailey Bieber recently opened up about her postpartum journey, shifting focus on one of the least-discussed aspects of women’s health: premenstrual dysphoric disorder (PMDD).

Hailey said that she experienced PMDD after the birth of her son, Jack Blues Bieber. It is a menstrual health condition that can cause intense emotional and physical symptoms.

In an interview with Women's Wear Daily, Bieber spoke about how motherhood drew her towards women's health, especially considering the challenges she faced after childbirth.

"After I had my son, I struggled with [PMDD] a bit, and there's just not a lot of conversation or research around it," she said.

Bieber, who welcomed her son with husband Justin Bieber in August 2024, had previously discussed her diagnosis during an appearance on the SHE MD podcast in March 2026. She said she was diagnosed approximately six months after giving birth.

Although she had experienced premenstrual syndrome (PMS) before pregnancy, she noticed that the emotional symptoms leading up to her period had become much more intense.

"I was like, 'This just feels way more intense than before,' like, the lead-up to getting your period," she said.

She said she experienced overwhelming emotions, adding, “Why does it feel like my whole entire life is gonna end? Like, I don't understand.”

Bieber said her symptoms gradually improved over time. She also highlighted how speaking about her experience helped her feel less isolated. "Conversation, for me personally, makes me feel less alone," she said.

What Is Premenstrual Dysphoric Disorder (PMDD)?

Also read: 8 Signs Of 'Pregnancy' That Are Likely PMS

Premenstrual dysphoric disorder is a severe form of premenstrual syndrome (PMS) that causes intense emotional, mental and physical symptoms during the days leading up to menstruation.

By Dr Sushma K, Obstetrics, Gynecology and Reproductive Medicine, Apollo Hospitals, Seshadripuram, Bangalore told HealthandMe, "It is a chronic medical condition related to the menstrual cycle. It affects approximately around 3 to 8 percent of the women who are menstruating. So it not only causes physical symptoms, like premenstrual syndrome, it also causes emotional and psychological symptoms. It typically occurs one or two weeks before menstruation starts."

Unlike premenstrual syndrome, PMDD can significantly interfere with a person's ability to work, relationships, social life and other daily activities. When it comes to symptoms, patients can have sudden onset of sadness, increased sensitivity, or tearfulness, sudden spells of crying, severe irritability, anger, depressed mood and anxiety.

Dr Sushma said, "These emotional symptoms can also have physical manifestations. For example, decreased interest in going to school, office, and difficulty concentrating. Some may resort to overeating. Some may have excessive sleepiness or some may face insomnia. Some also experience restlessness, discomfort, joint swelling, muscle pain, and abdominal bloating.”

PMDD Vs PMS

Also read: The Menstrual Cycle and Nutrition: Does Your Body Really Need Different Foods at Different Times?

PMS and PMDD are both caused due to hormonal changes in the menstrual cycle. However, the intensity of symptoms and their effects on daily life distinguish the two conditions.

Dr Sushma said, "PMS is a mild to moderate condition and it can be easily managed. It comes with physical symptoms like bloating, breast pain, tiredness, and mood changes. It also does not interfere with people’s daily routine and relationships. It occurs in almost around 75% of the people who are menstruating."

PMDD symptoms can be more severe, especially depression, anxiety, irritability and emotional distress. These symptoms can disrupt work, relationships and everyday functioning.

She added, "But PMDD is more severe. It will impair daily life. It also causes more intense psychological and emotional symptoms than physical symptoms."

So PMDD is not just an extreme version of a bad premenstrual week. It is a recognised health condition that may require medical treatment.

Why Does PMDD Happen?

Experts say that the exact cause of PMDD is not fully understood yet. But they believe it may be due to an increased sensitivity to normal hormonal changes during the menstrual cycle.

After ovulation, levels of hormones like oestrogen and progesterone fluctuate. In some individuals, the brain may respond differently to these hormonal changes, affecting mood regulation and other bodily functions. Serotonin, a neurotransmitter involved in regulating mood, sleep and appetite, may also play a role.

Dr Sushma explained, "PMDD is a very severe depressive disorder. Patients may have panic attacks, depression, and thoughts of self-harming. So these are the key main important differences. PMDD may happen because of disrupted dysfunctions in the central nervous system during the menstrual cycle. That is because of how the central nervous system reacts to the normal estrogen and progesterone levels during the menstrual cycle.”

PMDD In New Mothers

Hailey Bieber's experience has sparked conversation about PMDD risk after childbirth. Pregnancy, childbirth and the postpartum period involve significant hormonal and physical changes.

However, PMDD is linked to the menstrual cycle and its recurring hormonal fluctuations. The return of menstrual cycles after childbirth may make premenstrual symptoms intense. However, there is limited evidence establishing that childbirth directly causes PMDD.

Dr Sushma said, "New mothers may not face premenstrual dysphoric disorder because there is no ovulation. The lady is not menstruating because she is lactating. But once the ovulation starts, the symptoms of PMDD will return. These symptoms can worsen because the mother is sleep deprived or she faces a lot of hormonal changes. There is also a newborn. So the baby’s care-giving also adds to the stress. So PMDD may get aggravated in new mothers."

PMDD should also not be confused with postpartum depression. Postpartum depression can occur after childbirth and is not restricted to the days before menstruation.

The doctor explained, "Postpartum depression is not cyclical. Whereas PMDD will come in a cyclical manner, mostly 10-12 days before periods, which is usually in the luteal phase. Also, it may resolve after the bleeding starts.

Whereas postpartum depression is not related to the menstrual cycle."