Your child - what you need to know?

Ear Wax …..is it good or bad for your child?

2010-03-19T07:15:00.000-07:00

Many parents ask ‘which is the best way to remove the wax from the ear?’

Actual question should be 'Do you really need to remove the wax in the ear??'

First of all wax has some protective function in our ears. Wax lubricates the ear canal and prevents drying of the skin. It also helps in cleaning along with the jaw movements. Some literature suggests that the wax protects from some of the infections. So, it is not all that bad!

However excess wax or impacted wax may result in impaired hearing.

You do not need to clear the wax from your child’s ear routinely. One should attempt to remove the wax only if it is giving you problems. If in doubt get your child’s ear checked. For most cases softening the wax with olive oil or almond oil is enough to move the wax. Well impacted wax may have to be removed by a procedure called ‘syringing’ by your doctor. Other commercial preparations may be available in some countries to soften the ear wax. Using cotton buds is not advisable. These buds may push the wax further in.

A little wax in your child’s ear? Let it be ….relax.

Does your child suffer from ear infection?

2010-03-19T06:58:00.000-07:00

Most of you may have come across children screaming with ear ache. The most common cause of ear ache in children is ear infection. The short tube (eustacian tube) in their ear which gets blocked easily makes them susceptible to ear infection. Infection of the middle ear, known as ‘otitis media’ in medical language is very common in children. About 1 in 4 children suffer from ear infection at some time during their first 10 years. There are different types of ear infection. The two most common types are discussed here.

1. The commonest presentation is a child presenting with fever, earache and irritability. This may be preceded by respiratory tract infection such as cold or cough. Younger children may pull their ears. These symptoms are suggestive of ‘acute ear infection (otitis media)’. In severe cases ear drum (tympanic membrane) may perforate and there will be discharge of pus into the ear canal which parents may notice.
Diagnosis is based on these symptoms and when your doctor looks into the child’s ear with an instrument called ‘otoscope’, ear drum may look red and bulging.

Treatment: Most of the time ear infection resolves on its own. Pain can be treated with simple medicines such as paracetamol. Some cases may need antibiotics. If you are prescribed antibiotics please complete full 5 day course. Incomplete course of antibiotics may lead to further complications.

2. Glue ear: This condition is not associated with ear ache. Glue ear is very common in children. Normally children present with reduced hearing capacity. Sometimes the child’s written performance is much better than the oral performance and this comes to the attention of teachers in school indicating the possibility of hearing problem.

Most of the time glue ear resolves on its own. Children who are > 3 years or who have a speech/ language/ developmental problem should be seen by ENT specialists. These children may need adenoidectomy or ‘grommet’ insertion.

School age children with suspicion of hearing problem should have their hearing accurately assessed by what is known as ‘audiometry’.

IMPORTANT: When the child has ear ache DO NOT put oil into the ear.

If you are concerned about your child’s hearing do seek medical opinion. He may be suffering from a treatable condition.

Type I Diabetes- Treatment

2010-03-19T06:26:00.000-07:00

Type I diabetes can not be cured, but can be kept under control. INSULIN is the only treatment for this type of diabetes. Together with insulin, diet and exercise play an important part in the management of diabetes.

Insulin: As mentioned in the previous posts insulin is a hormone secreted by pancreas and it is lacking in patients with diabetes. These patients can be given insulin in the form of injections to control their blood sugar. If swallowed, our stomach will simply digest insulin. Therefore it has to be given in the form of injection. In the past, insulin was derived from animals such as cows and pigs. Currently, human insulin is available in the market. It is much safer to use this type of insulin. Various types of insulin are available. Depending on the timing of the onset, peak and duration of their action, they are classified as short acting, intermediate acting and long acting insulin. In addition there are rapidly acting and slow acting insulin analogues. Availability of various forms of insulin gives more flexibility to how we treat diabetes. Insulin injections can be given using various devices.

Simplest and cost effective way is to inject using a needle and a syringe.

A little more expensive device but easy to use is ‘insulin pens’.

Insulin can also be given using a pump. Pumps are very expensive, but give flexibility to the patients.

Using each of these devices requires a lot of guidance and education and details will be explained in future posts.

Diet: Diet plays a very important role in controlling your diabetes. Never skip your meals, especially if you have taken your insulin. Always follow your meal plan according to the advice given by your dietician.

Physical Activity: Physical activity improves the action of insulin and helps to keep the blood sugars low.

Thus, treatment of diabetes involves a combination of insulin treatment and patient education.

Remember, insulin should be used as advised. Improper use of insulin could be dangerous.

When to suspect diabetes in children?

2009-11-30T10:33:00.000-08:00

The symptoms of type 1 diabetes are as follows:

Passing more urine and more frequently
Drinking water too much and more often
Weight loss
Weakness and lethargy
Excessively hungry (sometimes loss of appetite)
Infections such as ‘thrush’ (candidiasis)
Bedwetting at night in a previously ‘dry at night’ child

Some of the symptoms mentioned above (excessive drinking, passing more urine, wet at night) may be difficult to notice in a very young child.
These symptoms may be present for one week to six months prior to the presentation at the hospital.

Some patients (about 25%) with type 1 diabetes may present with ‘Diabetic ketoacidosis (DKA)’ a more serious form of symptoms. In this case child will be unwell and comes with vomiting, tummy pains and dehydration (dry mouth, lips, sunken eyes etc). Some kids may be in ‘coma’ when they present with diabetes to their doctor.

Diagnosis
Diabetes is diagnosed based on the symptoms mentioned above and is confirmed with a blood test. Any time (random) blood sugar concentration of > 11.1mmol/L (200mg/dL) or a blood sugar after an over night fasting (fasting blood sugar) > 7.0mmol/L (126mg/dL) confirms diabetes. Doctors may also do a urine test (to check for glucose and ketones) and few other blood tests at the time of diagnosis.
Next post will be on 'treatment for type 1 diabetes'.

What causes Type I Diabetes (Juvenile diabetes)?

2009-11-25T16:48:00.000-08:00

As mentioned in the previous post, diabetes is characterised by increased levels of glucose in blood. Children almost always develop Type I diabetes (except obese children). As you know, glucose is the source of energy for us. Insulin is necessary for taking up glucose from the blood into the muscles, liver and other parts of the body. Whenever glucose level in blood increases (after eating), insulin is secreted into blood for the absorption of glucose into the liver, muscles etc. This is illustrated in the picture below. Type I diabetes results when our body makes too little/ no insulin.

Insulin is a ‘hormone’ (a special chemical) formed in the ‘pancreas’. Pancreas is a small gland present in our body that lies just behind the stomach. Occasionally, body’s immune system starts attacking it’s own tissues. This is known as ‘autoimmune mechanism’. Even though the exact cause for diabetes in children is not clear, an autoimmune mechanism (where parts of pancreas (islets) which make insulin are destroyed by body’s own immune system) is proposed. Some environmental factors or simple viral illness may trigger this. And also, if there is some one in the family (father, mother or sibling) with childhood diabetes, chances of getting it increases.

When there is no insulin……..

Glucose can not be used for energy. Instead fat is used for energy which in turn will lead to formation of a poisonous (to explain in simple terms) substance called ‘ketones’. Body will try to get rid of excess glucose in the blood by passing it in urine. This makes the child pass urine frequently and as a consequence makes him thirsty. Excess glucose in the blood leads to various complications which will be explained in subsequent posts. Thus, diabetes evolves.

This picture is the summary of what happens in diabetes.

Diabetes Mellitus …….a brief introduction.

2009-11-11T07:36:00.000-08:00

An elderly relative of mine asked me: “‘V’ has diabetes it seems. He is only 9 years. Can anyone get diabetes at such a young age? Anything can happen in this ‘Kaliyuga’.” She was surprised by the fact that even children could get diabetes. It was difficult to convince her that childhood diabetes is not a new disease but, people are more aware of it these days. Prior to the discovery of insulin in 1920s children with diabetes did not live for longer than 6 months from the onset of symptoms. Thanks to Banting and his team at the University of Toronto for this amazing discovery which has changed the lives of millions of diabetic patients. Diabetic patients these days can lead a reasonably normal life provided they stick to their diet and insulin regimen.

The word ‘diabetes mellitus’ stands for ‘sweet urine’. Commonly people just say ‘diabetes’. Diabetes is a condition that causes high sugars in our blood. This happens due to lack of or resistance to insulin, a hormone required for transport of glucose from blood into different parts of our body. There are 4 types of diabetes described in the literature:

Type I – Juvenile Diabetes or Insulin Dependent Diabetes. In this blog we are going to talk mainly about this diabetes which is seen in children. This is due to lack of insulin and insulin injection is the treatment for this.

Type II- Non Insulin Dependent Diabetes. This is the adult diabetes which everyone would know about. It is usually seen in relation to obesity in children (rare). During the initial stages this type of diabetes can be managed with lifestyle modification (diet and exercise). Some times these patients need tablets or insulin to control their diabetes.

Type III- It is the diabetes associated with certain conditions such as ‘cystic fibrosis’. We are not going into details of this type in this blog.

Type IV- ‘Gestational Diabetes’. It is the diabetes which some women get during pregnancy. It is different from all other types.

Details about type I diabetes will continue in the next post.

Doctor- Patient/ Parent Communication………how can we make it better?

2009-11-05T07:25:00.001-08:00

I thought of writing this post today after reading a review article somewhere on the net. The article was written by a grieving father of an unlucky 7 month old baby who died in a super-specialty hospital due to an illness (not sure what the diagnosis was). I felt really sorry for his loss which can never be compensated by anyone. He was understandably very unhappy and angry with the doctor who treated his daughter. I do not know what exactly was wrong with the baby or whether she was treated appropriately (I hope she was) or not. But, after reading what this dad had written, one thing was clear: obvious communication gap between the doctors and the parents.

Doctor- patient/ parent relationship plays a vital role in medicine and more so in paediatric practice. Excellence in clinical care can only be achieved with mutual respect and effective communication between the parents and the doctor. Sometimes, because of the time constraints and other reasons communication between doctors and patients is compromised to a great extent. If the patient has a minor illness from which he is going to recover, this lack of clear communication may not affect him much. However, when the patient has a serious illness/ an illness which can not be cured easily, lack of information may significantly compromise the quality of care he is receiving as in the above mentioned case. There are few things which both doctors and patients can keep in mind to improve their consultation.

I am just referring to paediatricians here as that is what I am! We need to understand how anxious the parents are when their child is unwell (no matter whether it is simple cold and fever or a major illness…parents are always anxious when it comes to their little ones). Having a child of my own definitely helps me in this regard! In my opinion, every parent should be explained (irrespective of availability of consulting time) what exactly is wrong with their child (the diagnosis in simple terms), what treatment is given and what are the signs should they watch for after going home. I do understand that the busy practitioners have very limited time to spend with each patient. In some circumstances (eg. if there is a sick child to attend), parents should be given an opportunity to contact the doctor later at some point.

The responsibility to build a good rapport lies with the parents too. Parents should understand the limitations of the doctors. Even though most public are of the opinion that every doctor should be able to diagnose each and every patient, in reality it is not possible. Despite great advances in diagnosis and treatment medicine still has a lot of limitations. Many a times even the experts end up treating patients just by guesses. In such situations an honest explanation by your doctor should satisfy you. Parents should not hesitate to ask their doubts or questions with the doctor. If you don’t ask you may not get it! But, when you are aware of your doctor’s time limits, ask related questions only! If you are not satisfied with the treatment you are getting, explain to your doc why so and listen to his explanation. ‘The patients and the practice experience are often the best teachers of physicians.’

Fever fits (febrile convulsion/ febrile seizure)

2009-10-28T05:38:00.000-07:00

(The terms seizure, fits, convulsion are used interchangeably here. But in medicine, there is difference between these words)
Some children have a tendency to throw seizure (commonly people refer to it as fits) when they have fever. This is fairly common in children between 6 months to 6 years of age. It may be frightening for the parents to watch their child fitting. Some knowledge about this condition not only helps to keep calm, but also to manage the child appropriately.

Can my child develop fever fits?
The parents who know about fever fits (through friends or relatives) tend to ask this question. Any child may develop fever fits. The chances of developing fever fits increase if there is a family history of the same (if one or both parents or siblings had febrile convulsion in childhood). We can also say that recurrent infections with fever also increase the chances of having a fever fits. A child with a tendency to fit may take a seizure even when he has a low grade fever.

How does a child look while having a fever fit?
A child may not feel quite right and may be uncomfortable. He may not be able to express how he is feeling. You may just notice him to collapse/ loose consciousness. The whole body may go very stiff and then arms, legs and body may start twitching. Most of the time whole episode lasts for a very short time (around 5 min). Drooling and soiling is common with fits. Child may look very pale or even blue (especially around the mouth and lips) for a brief period. Young child may sometimes just go limp and unresponsive without obvious twitching. Once the jerking stops usually the child is sleepy for a short while (time varies usually 15-20min).

What can you do when a child is fitting?
Try to calm down and do not panic.
Call the ambulance if you are too frightened.
Make sure he is in a safe place (eg on the floor).
Remove the furniture, sharp things from surrounding.
You can turn his head to one side.
Do not put anything in the mouth.
When jerking stops put the child on his side. This is called recovery position(as seen in the picture). This helps to prevent aspiration.
If the fit does not stop by 5 min you need to call an ambulance.
If it is the first episode of febrile fits/ if you do not know the cause of fever/ you are worried about anything else you need to see the doctor even if the convulsion stops within 5 min.

Measures to control temperature
Whenever your child develops fever administer an appropriate dose of fever medicines (eg. Paracetamol, Ibuprofen). Paracetamol is a safe medicine. Parents should not hesitate to give this medicine to their children for high temperature. Giving smaller doses (less than the required amount) may not bring the temperature down effectively. So, make sure you keep this medicine always handy and give appropriate dose to your child whenever he develops fever.
Remove excessive clothing.
You can use cold cloth to keep on the face of the child to reduce temperature.
Give plenty of fluids.

Not so good signs
Fever fits lasting for more than 15 min.
Fever fits involving only a part of the body (eg, one leg/ arm/ one side) and not the whole body.
Fever fits recurring within 24 hours/ during the same episode of fever.
In these circumstances you must consult a paediatrician.

Good things about fever fits
Simple fever fits (fits due to fever of common causes such as viral infection, sore throat etc lasting for less than 15 min), do not cause brain damage or developmental delay.
Most of the children who develop fever fits do not develop epilepsy later on in life.

Children usually grow out of it by 5-6 years of age. Some children suffer only one episode of febrile fits in life whereas others develop fits whenever they have a fever. It is not possible to predict who does what.

It is important to establish the cause for fever when a child develops fever fits.

Calorie content of common foods

2009-10-21T05:57:00.000-07:00

After reading the last post you may want to work out how much exactly your child is eating each day. For this we need to know how much calorie we get from the foods we commonly eat (‘cal’ generally means kilocalories here).

You might know this:
1 gram of carbohydrates and proteins give you 4 cal of energy
1 gram of fat yields 9 cal of energy
Older children should get 50 percent to 65 percent of their calories from carbohydrates, 20 percent to 30 percent from fat, and 15 to 35 percent from protein. Infants and children less than 2 years may need a slightly higher proportion of fat (25 to 40 percent).

Here is a list which may be useful:

Rice: Rice is the staple food for most of us.
100grams rice = 370 cal and 7-8 gram proteins
Rice also contains B group vitamins (brown rice) and starch.

Bread: 1slice = 70 cal (white), 60 cal (brown)
Also contains proteins, iron and B complex vitamins

Milk: As everyone agrees very nutritious for children, contains high quality proteins, vitamins and calcium. Most children need 2-3 glasses of milk everyday.
100ml full fat milk= 66 cal, 3.9 g fat (1 serving = 8 oz gives 150 cal)
100ml semi skimmed milk= 47 cal, 1.6g fat, 3.2 g proteins

Cheese: Cheese is modified form of milk.
100gram cheese = 400cal
Also rich in Vitamins A, D, calcium, fat and contains salt.

Fish: Rich in vitamins A, B, and D; zinc, iron, and calcium;
Omega 3unsaturated fatty acid essential for the body
150gm white fish meat = 138cal, 30g protein

Coconut: Contains saturated fat, fibre, potassium and iron
50g coconut flesh = 170 cal, 2g of protein, 18g of fat, 7g of fibre.
250ml cup of coconut milk = 575cal, 8g of protein, 63g of fat.
Since coconut contains a lot of saturated fat it is not so health friendly.

Eggs: Very nutritious and easily available.
Egg white contains proteins and egg yolk minerals and fat.
1 egg (boiled) = 75 cal,
1 raw egg = 108 cal
Egg also contains on average 6g of protein and 6g of fat.
Also very rich in iron and zinc; Vitamins A, B group, D, and E.

Potato (100 gram/ 1 medium, boiled) = 53 cal
Apple (1 medium) = 53cal
Banana (1medium) =143cal

Some of you might be familiar with the ‘Food pyramid’. This gives the ranges of various food portions which should be included in your child’s diet.

How much should our children eat?

2009-10-16T14:05:00.000-07:00

Every child needs an appropriate amount of carbohydrates, fat, proteins, minerals and vitamins to grow normally. Food is consumed mainly in three forms: carbohydrates, fat, proteins. Carbohydrates and fat are the main source of energy and protein helps to grow.

Carbohydrates: Food containing carbohydrates include rice, bread, pasta, potatoes, lentils, cereals, beans, sugar, sweets, sugary drinks, jam and so on. Carbohydrates provide energy.

Fat: Foods rich in fat include butter, vegetable oil, cheese, cream, fried foods, meat etc. Fat also provides energy. Everyone understands that eating too much of fat is not good for health. There are 2 types of fat: unsaturated (eg.vegetable oil and fish) and saturated (other animal fat). Unsaturated fat is better for our body.

Proteins: Essential for growth. Milk, beans, cheese, eggs, fish, meat, soya are rich in proteins.

For a child who is growing normally, there is no need to count how many calories (energy) he is consuming each day. But, it may be of interest to some parents to know how much your child should be getting (approximately). Energy and protein requirement varies from child to child and depends on the age, sex, weight and activities of the child. Food consumption also varies every day. Here is a rough guide to show many calories children need at different ages (protein requirement in brackets):

0-6months: 100 kcal/kg body wt/day (2.2gram/ kg body wt/day)

6-12 months: 90cal/kg body wt/day (1.6 gram/kg body wt/day)

Toddlers : 1,300cal (1.1grams/kg body wt/day)

4- 10yrs: 1,800- 2,000 cal (1.0 gram/kg body wt/day)

Adolescents: 2,500-3,000cal (0.9gram/kg body wt/day)

Adults: 2,500cal (0.8grams/kg body wt/day)

In general boys require more calories than girls. Children who are very active will need more calories than the ones with sedentary lifestyle.

All you need to know about ‘ASTHMA’……(Part 2)

2009-10-13T09:03:00.000-07:00

Asthma management:
These days there are a number of medications available in various forms to treat asthma. Most commonly these medications are delivered through ‘inhalers’ (seen in the pic.). Inhalers deliver the medicine directly into your lungs/ chest and have fewer side effects. In India, I have seen many people still using syrups for asthma. These medicines taken in the form of syrups go through the blood. They not only take longer time to work on the lungs but also cause more side effects. Our understanding about asthma keeps changing through advanced research (especially in western world) and it is important for the doctors to keep up to date with newer advances in order to deliver the safest and best treatments to the patients.

Inhalers are easy to use once you understand how to use it (how to use inhalers will be explained in another post). In younger children, together with the inhaler another device called 'spacer'+/- mask should be used. If not used properly your child may not get the required dose. There are mainly 2 types of medications delivered through these inhaler devices.

Relievers- to be taken whenever the symptoms appear. Reliever opens up narrowed airway.

Preventers- to be taken every day to prevent asthma attacks. This medicine(a steroid) tries to keep the redness and swelling of the airways under control.

In case of mild asthma you only need a reliever (to be taken whenever you are wheezy or breathless). In moderate to severe cases (eg. If you need to use your reliever medication more than 2-3 times a week) you also need a preventer to be taken every day even when you are well.

During some episodes where your symptoms are really bad you may need a short course of steroid tablets and oxygen. Antibiotics if there is bacterial infection. If your child is not well enough to take inhaler another machine called ‘nebuliser’ can be used to dispense asthma medicines to relieve your child’s symptoms. There are other medicines used in severe cases. Most of the kids manage just with relievers and preventers. Doses may differ depending on severity and age of the child. If your child has severe asthma you may need to consult a respiratory specialist/ chest doctor.

How can you help your child’s asthma?
First thing is to understand what it is and what problems can it cause.
Let your child stay away from allergens/ triggers as much as possible.
Administer the medication appropriately.

A note on alternative medicine (Ayurveda, homeopathy etc) for asthma:
I have heard many people saying ‘Ayurveda works best for asthma and other chronic conditions etc.’ I am not an expert in this field and hence can not comment on it. But, I can firmly say that it is only allopathic or English medicine which can save your child if he has a life threatening asthma attack. Allopathic medicines are based on a lot of research and evidence and their benefits to a great extent outweigh the minor side effects when used appropriately. I really feel sorry for some people who just keep trying all sorts of things on earth and fail to understand their child’s actual problem and let their child suffer (even though unintentional). If one can understand ‘what exactly is asthma’ it would not be difficult to keep it under control.

All you need to know about ‘ASTHMA’……(Part 1)

2009-10-08T08:42:00.000-07:00

Asthma or wheezing is very common in children. Many of the parents are unaware of the basic mechanism underlying this condition and hence panic on hearing this word. Understanding your child’s underlying condition not only helps to relieve your anxiety but also guides you to the right treatment. Since I personally know some families with asthma, I thought of writing some basic facts about this condition in my next few posts.

What is asthma?
Some people have very sensitive airways when compared to others. When they come in contact with certain agents such as dust, pollen, viruses etc their airways go narrower (by muscle contraction), swollen and red. This leaves very small space for the air to go through making it difficult for them to breath. When air passes through narrow airways it causes a whistling kind of noise (as in a flute) which is called as ‘wheeze’. Good thing is, most of the times, airway narrowing is reversible (comes back to original size) with medication. If one can understand this concept it is not difficult to keep the asthma under control.

Does my child suffer from asthma?
If you have noticed any/ all of these symptoms with your child talk to your doc.
Wheezing (musical/ whistling noise while breathing)
Recurrent cough
Shortness of breath or rapid breathing
Tightening in the chest (bigger kids)
These symptoms may come and go. Some common triggers which make these symptoms worse include: house dust mite, molds, cold, flu, exercise, pollen, dogs etc.
If there is a known trigger try to avoid it (eg. keeping the house free of dust, avoiding pets etc).

How is it diagnosed?
Normally, based on the symptoms, family history and signs (listening to your child with a stethoscope). In older kids special tests to measure lung function may be performed. Occasionally, blood tests to look for infection and X- ray to look at the lungs may be needed.

Management......see next post.

Is asthma curable?
Most of the times asthma can be managed very well and symptoms can be kept under control. But, it is not curable. However, some kids grow out of it as they get older.

Will my child grow out of it?
Some kids grow out of it. They do so especially if they tend to wheeze just with viral infections and do not have any allergies or eczema. If there are other members in the family with asthma, eczema or allergy or if your child in addition suffers from allergies and eczema, the chances of him growing out of asthma is less.

Can asthma appear at any age?

Yes, asthma can present at any age.

Growth Charts

2009-10-02T16:32:00.000-07:00

What are growth charts?
Growth charts are specially designed charts that are used to monitor height and weight (head circumference in younger ones) in children. There are various types of growth charts available to use. Growth chart used in the UK or US may not be very appropriate to be used in India. IAP (Indian Academy of Pediatrics) recommends using the growth chart given here in the picture (Agarwal, et al., 1994). Your paediatrician should have these charts for you. Different growth charts are used for boys and girls as there is a difference in growth pattern between the two.

How does your paediatrician interpret growth charts?
Growth charts are based on the weight (and height and head circumference) measurements of thousands of children. The growth chart mentioned above is based on the measurements of affluent urban Indian children. The lines on IAP growth chart represent various percentiles (97th, 75th, 50th, 25th and 3rd). If your child is on the 25th centile line that means 75% of children of his age are heavier (and the rest lighter) than him but he might be completely normal. As long as your child is between the 3rd and 97th centile lines there is no need to worry. However, they are supposed to follow the line they are on. For example, if a child was on 75th centile at 2 years and drops down to 3rd centile at 2.5 yrs of age that is a worrying sign.

This information may be confusing for those of you who are not familiar/ not seen a growth chart. If you are not clear ask your paediatrician to explain to you. Growth monitoring is an important tool to identify problems such as under-nutrition, chronic ill health, hormone deficiency etc in children.

What is the ideal weight for my child?

2009-10-02T16:26:00.000-07:00

This is a very common question asked by the parents in paediatric clinics. A single number in kilograms is not an answer to this question. Weight of a child is determined by various factors (genetics, nutrition, underlying diseases, hormones and development). Sometimes parents unnecessarily worry about their child for being thin compared to his peers. Some ask for medicines (a tonic!) to increase the weight of their child. A child who is thin may be perfectly healthy. Each child is different and comparing to other children even though useful to some extent, can lead to undue anxiety. The best way to find out whether your child’s weight is appropriate for his age/ height is by plotting their weight on the 'growth charts'. A single measurement of weight may not be very informative. Serial weight measurements taken at various intervals would give a lot of information about the health and nutritional status of the child. During the first year, convenient way to get your child’s weight entered on the growth chart is during your ‘vaccination visits’.
Next post on 'growth charts'.

How can you help your baby while he/she is teething?

2009-10-01T07:01:00.000-07:00

Some babies can be miserable when they are teething. This will obviously lead to anxiety among parents. Symptoms of teething could be relieved by some simple measures in most of the babies. The main principles used to relieve pain while teething are ‘counter pressure’ and ‘cold’. You can try the following:

Teething rings (see pic): They work based on both the principles mentioned above. A teething ring can be placed in a refrigerator (not freezer) and given to the baby to chew. You need to clean them after each use.
You can rub the gums with cold clean wash cloth or with your clean fingers.
You can also give cold pureed food and cold vegetable cubes (of right size) to sooth your little one's gums.
If your baby is still distressed you can give an appropriate dose of paracetamol.
Do not use teething gel which contains anaesthetics. They numb the gums as well as the tongue and may interfere with swallowing. Chronic use of these gels may lead to other serious side effects.

If your child is still very miserable check with your doctor to make sure that the symptoms are not because of some other illness.

Does my child need antibiotics?

2009-09-30T09:19:00.000-07:00

I have come across a lot of parents who are very anxious about giving (or not giving) antibiotics to their children. Therefore, I thought I should definitely write about antibiotics in this blog. There are a lot of myths associated with antibiotics.

What are antibiotics?
Antibiotics are the medicines that are used to treat infections caused by bacteria (but not viruses). Antibiotics work by killing or inhibiting the spread of bacteria. Since the discovery of antibiotics in 1930s, many people have survived dreadful infections which they would not have otherwise.

Are antibiotics harmful to our body?
No. Immune system in our body protects us from infections. But, some times it needs a little extra help in which case antibiotics are helpful. They are not harmful to body but, help us fight the bacteria which cause infection.

Does my child need antibiotics whenever he is unwell?
No. Common reasons for kids to be unwell include colds and coughs, loose stools, fever, earache etc. Most of the times these are caused by viruses and do not obviate the need for antibiotics. Only when the symptoms are caused by bacteria they need antibiotics.

How do I know whether my child has bacterial or viral infection?
Most of the times doctors can decide whether it is bacterial or viral infection based on the severity and specific symptoms. But, sometimes it is not possible to differentiate between the two. Bacterial infections usually tend to be more severe. Viral infections are much more common. Your doctor should be able to decide which category your child falls into.

Mis-use of antibiotics:
Overuse and inappropriate use of antibiotics may lead to antibiotic resistance (will be explained in subsequent posts) and the emergence of ‘Super bugs’. In that case antibiotics may not work next time you take it.

Take home message:

When your child is prescribed an antibiotic, please complete the full course.
Do not use some one else’s antibiotics.
Do not buy antibiotics for children with out consulting your doctor.
Do not hesitate to give antibiotics to your child when prescribed (your child may be suffering from a potentially serious illness).
If your child is not prescribed antibiotics do not panic. He/she may just have a viral illness which is self limiting.
You do not need antibiotics for common cold.

Signs and symptoms of teething in babies

2009-09-14T03:17:00.000-07:00

While teething may be painless for some babies, others experience a lot of distress. Following are some of the signs and symptoms commonly attributed to teething process.

Drooling and rash
Wanting to chew on things
Irritability and crying
Disrupted eating or sleeping patterns
Diarrhoea and high grade fever are primarily not caused by teething and make sure you consult your doctor in presence of these symptoms

Most of these symptoms are not based on the evidences and one should be careful NOT to ignore the possibility of other illnesses.

Eczema

2009-09-12T15:11:00.000-07:00

Eczema is a common problem in children. It can be very distressing for the child as well as for the parents. Good thing about ‘childhood eczema’ is that most children grow out of it.
How does eczema present?
It is characterised by dry skin, itching and excoriation (scratches). In poorly controlled cases it can lead to thickening and scarring of the skin. Any part of the skin may be involved but common sites are face and skin creases including back of the knee (as seen in the picture). Eczema (atopic eczema) may present at any age but in about 75% of the children some signs pointing to the diagnosis of eczema are present by 6 months of age.
What causes eczema in children?
What causes eczema is not clear but it tends to run in families. Other substances such as dust, pets, wool and rarely certain diet can also trigger eczema.
Treatment
Children with eczema have a dry, irritable skin. Constant care is required to prevent flare ups. Here is a list of things which you can do to keep your child’s eczema under control:

Avoid wool and acrylic materials.

Avoid perfumed products and strong cleansers.

Use mainly cotton clothes. Cotton materials rarely irritate skin.

Use very mild soap and avoid bubble bath.

Use plenty of emollients (such as E45) – they should be applied at least twice daily even when the skin is free of eczema.

Use of topical steroids (applied over the skin)
These are essential part of management but should be used with caution. Parents should understand that the overuse of topical steroids is unlikely if it is used appropriately where and when there is a flare up. Ointment based, low potency topical steroids should be used as prescribed by your doctor for a flare up. Oral steroids are usually not given for eczema.
Severe cases
Hospital admission for wet dressing may be needed in severe cases. Antibiotics (given by mouth) may be necessary for weeping eczema (suggestive of bacterial infection). Your doctor may prescribe a sedative for the child to take at night to help with itching as itching is common at night. Dietary exclusion should only be undertaken in severe cases and only if parents report worsening of eczema after eating certain food products. If anyone is interested in knowing the details about dietary exclusion, it will be published later on this blog.
It is important to keep your child’s eczema under control to avoid severe flare ups. Therefore, use emollients liberally and do not wait for the eczema to get worse. During flare ups do not hesitate to use topical steroids as advised by your doctor. In most cases good control of the condition is achievable with above mentioned measures. You can only wait and see if your child grows out of it.

Diarrhoea

2009-09-12T15:03:00.000-07:00

Diarrhoea (loose stools) is very common in young children. It can be acute (sudden onset and lasts for less than 2 weeks) or chronic (lasts longer). This post is about ‘acute diarrhoea’ in children. The main aim of treatment in diarrhoea is to give plenty of fluids to prevent dehydration.
What causes diarrhoea?
Most common cause of diarrhoea in children is a virus (most commonly rota virus). Virus spreads through contaminated water or food and also from person to person through contact. Food poisoning can also cause diarrhoea. Bacteria such as salmonella and campylobacter cause food poisoning. Non-infectious diarrhoea is uncommon in children and will be explained in subsequent blogs.
Signs and Symptoms
Children with viral diarrhoea present with frequent, loose, watery stools. In case of rota virus stools may be blackish green in colour and may be foul smelling. Child might experience vomiting and stomach cramps. Fever is also common. If your child does not take plenty of fluids, signs of dehydration (sunken eyes, dry lips and tongue, reduced urine out-put, lethargy) may become evident.
Warning signs
A child who does not drink or has had severe diarrhoea and vomiting is more likely to have severe dehydration. Signs of severe dehydration include drowsiness, cold feet and hands, irritability and passing very little urine. In presence of these signs you should contact your doctor immediately.
Treatment
What can you do at home?

Give your child plenty of fluids to drink. ORS (oral rehydration solution) is the best rehydration solution which can be used during this illness. ORS contains salts and glucose needed for the body. It comes under various trade names (Dioralyte, Rehydrat, Electral etc) in sachets to be mixed with water to give your child as a drink.
Each time after passing stools give 50-100 mls of fluids to replace the loss. If he/ she is vomiting give smaller amount (5mls/5min).
If your child is not taking solids do not worry (as long as he/she is taking fluids).
If you are breast feeding continue to do so.
Wash their hands thoroughly with soap and water after toilet and before food.
Avoid sending them to school/ nursery/ swimming pools.

When does the child need hospital treatment?
If you notice any of the above mentioned ‘warning signs’, you need to see the doctor. If your child is severely dehydrated he may need fluids given through his veins (i.e. through the blood circulation via IV cannula). Calories and salts can be given in this way to the child in the hospital. If you notice blood in stools you need to contact the doctor as this could be due to bacteria and may be more dangerous.Medication is not usually needed in children to stop diarrhoea.Main stay of treatment is maintaining hydration.
‘Toddlers diarrhoea’ will be explained in the subsequent blogs.

Time of appearance of primary teeth (milk teeth, baby teeth)

2009-09-12T14:45:00.000-07:00

Milk teeth usually start appearing from the age of 6 months. But, this may differ from child to child, with some children developing their first teeth after their first birthday. Occasionally babies are born with one or more teeth. These may need to be removed if they are loose or interfering with feeding.(Picture from http://commons.wikimedia.org/wiki/File:Baby-first_teeth.jpg)

Here is a list explaining the timing of the teething process in babies and toddlers:
6-12 months : Bottom front teeth (central incisors) followed by top central incisors
9-13 months : Lateral incisors.
12-14 months : Back teeth (1st molars)
16-18 months: Canines
18-30 months: 2nd molars

There are 20 milk teeth in total. Normally, primary dentition is complete by 2.5 to 3.0 years.
Coming up: signs and symptoms of teething, how can you help your child while he is teething?

Development of your child during infancy (0-1yr)

2009-09-12T11:23:00.000-07:00

The birth of your bundle of joy is a great moment for you. From day 1, every mother would eagerly watch and enjoy the developmental milestones of her baby. Although most babies reach their milestones at similar ages, each one of them is unique. Some parents worry unnecessarily after comparing their baby to other babies in their family circle or neighbourhood. To avoid this undue concern and anxiety, it is important to know ‘when’ to expect ‘what’ from your baby.
‘Infancy’ is the term given to the developmental stage from birth to first 12 months. During infancy babies grow very rapidly. Therefore, there is a lot for you to anticipate from your little one during this time! The following paragraphs explain about what you should be expecting from your baby during the first 12 months of their life.
Your newborn
Ø Normal newborn babies adopt a flexed position. Their hip and knees remain fully flexed, fists clenched and elbows bent. They keep their arms and legs close to the front of their body.
Ø Healthy newborns hold your fingers tight when you stroke their hands (grasp reflex).
Ø They turn their heads when their cheeks are touched and start sucking when you place your finger or a pacifier in their mouth (rooting and sucking reflex).
Ø Most of these primitive reflexes start to disappear by 3-4 months of age.
Ø For newborns crying is the main way of communication.
The first 6-8 weeks
Ø Do not expect too much of activities from your newborn during the first two months.
Ø What they need at this time is about 16 hours of sleep in a day and milk whenever they are hungry.
Ø Their neck muscles are still weak during the first two months.
Ø You may get the first smile from your baby during this period.
Ø Babies can hear your voice and turn their head towards sound.
Ø They can also see the light as well as objects within a range of about 30-35cms. They can not actually focus properly on the objects which are far away.
3- 4 months
Ø By this time, neck muscles are more developed and many infants can hold their head up when sitting.
Ø Some babies may roll over from back to the sides.
Ø By this age your baby may start grasping dangling toys which you offer.
Ø They also babble and are more interested in their surroundings.
5-6 months
Ø Most babies can roll over from back to stomach and some babies can sit upright with out support for a brief period of time.
Ø They may be able to hold their own bottle for a short period.
Ø They reach out for toys.
Ø They like your interaction- keep talking and singing to them whenever you can.
6-9 months
Ø From 6-8 months, babies can sit with out or with little support.
Ø Some babies start crawling and some can pull themselves up to stand.
Ø Babies of this age are very curious. They like touching, banging and throwing objects. Be careful- they may put anything into their mouth!
Ø By 9 months, they look for the toys you hide from them.
Ø When excited they squeal and laugh and no doubt, mommies get excited too!
9-12 months
Ø Most babies start cruising around the furniture and some start walking before their first birthday. If your baby does not walk before his/her first birthday, do not worry- some take longer time (up to 18 months) to start walking.
Ø Babies start picking up small things (pincer grasp) at around 9 months of age. Therefore, keep your house clean.
Ø Older infants attempt to mimic the sounds we say and can understand simple commands such as ‘come here’. They may be able to say 2-4 words (e.g. Mama, dada) by their first birthday.

This is just the summary of what you should be looking for. Some may do more and some a little behind. If your child is very much behind or you are worried, consult your doctor.