BYE BYE BABY BLUES
There's nothing quite as disconcerting as having to deal with a child's illnesses, especially among newborns and infants up to the age of one year, since they are not able to communicate their symptoms clearly.
"With better vaccine converage and heightened oral rehydration programmes (for diarrhoea) nationwide, the pattern of infant illnesses has changed," says Dr.R Khubchandani, paediatric consultant at Mumbai's Jaslok and Breach Candy hospitals."Cases of vaccine-preventable diseases like whooping cough and measles along with diarrhoea have reduced," he adds.
Let's take a look at some of the most common ailments and infections that plague the zero to 12-month age group today...
UPPER RESPIRATORY TRACT INFECTIONS
"Viral fevers, middle ear infections, sometimes even bronchitis and pneumonia, are fairly ommon in the infant age group," says Dr.Jagdish Chinnappa, consulting paediatric specialist with Bangalore's Manipal Hospital.
BRONCHITISInflammation of the bronchi(the main airways to the lungs)is called bronchitis. This condition is usually a complication of a viral infection such as a common cold or influenza, but can be caused by a bacterial infection.
SYMPTOMSSimilar to a common cold, but it includes high fever (102 deg F), a harsh cough that gets worse at night and greenish/yellow sputum as well as wheezing or whistling.
CAUSES Usually a viral infection, it can also be caused by bacteria.
TREATMENTAntibiotics and symptomatic relief for cough. Administer warm drinks to relieve the cough.
PREVENTIVE MEASURES: Keep the environment smoke free. Air in the child's room should be moist(use a humidifier or take the child to the bathroom and turn on the hot water taps to humidify the air rapidly).
EAR INFECTION: (OTITIS MEDIA) Inflammation of the middle ear is a common cause of ear-ache in young children. It is often a painfu complication of an upper respiratory tract infection such as a common cold or a throat infection.
SYMPTOMS : Fever, ear ache that gets worse at night (babies may tug at the ears or have difficulty sucking on breast or bottle as pain radiates to the jaw), irritability.
CAUSES: Children are susceptible to ea infections as their Eustachian tubes are short and horizontal. So germs can easily travel through them into the middle ear. And because the tubes are horizontal (not vertical like adults) drainage is poor, especially in infants who spend plenty of time on their backs.
TREATMENT : Antibiotics, eardrops.
PREVENTIVE MEASURES : A smoke-free environment, an upright bottle feeding position to prevent milk from entering the ear, breast feeding if possible, an elevated sleeping position, if the child has a cold.
SKIN DISORDERS
"Young skin is sensitive and skin reactions are common amongst infants," says Dr Leena Hiremath, consulting paediatrician at Pune's Jehangir Hospital.
ATOPIC ECZEMA A common rash that usually appears in children below 18 months of age.
SYMPTOMS: Itchy, inflamed skin, Scalp, cheeks, forearms fronts of legs are most often affected, although the rash can appear anywhere.
CAUSES:The cause of atopic eczema is unknown.
TREATMENT: A corticosteroid cream or ointment may be prescribed. An antihistamine is often prescribed to help the child sleep at night if itchiness keeps him awate.
PREVENTIVE MEASURES: Use a mild soap and avoid fragrant bubble baths. Keep the skin moisturised and soft using a specially formulated cream for sensitive baby skin.Dress the child in cotton clothing to prevent irritation and chafing from synthetic fabrics.
NAPPY RASH : This affects most babies at some stage. It can also be precipitated by diarrhoea and illness.
SYMPTOMS : Sore nappy area, with red, raw spots.
CAUSES: The main cause is wetness.New borns urinate often and have frequent, loose bowel movements. A baby left in a dirty nappy for too long is more likely to develop nappy rash; however, it can still strike the bottoms of babies with particularly sensitive skin, even if their parents are frequent nappy changers. Older babies who are sick and taking antibiotics may suffer from diarrhoea( a side offect), which can cause nappy rash.
TREATMENT: Exposing the bare bottom to warm, dry air as much as possible. The doctor may prescribe a corticosteroid cream.
PREVENTIVE MEASURES:Change the nappy as soon as possible after washing and drying the area, protect the skin by applying water-repellent zinc cream.
Full vaccine course key to developing immunity TIME FOR FOLLOW-UP BOOSTER
A number of disease are covered under the national immunization progamme, but doctors say that follow-up rate of booster doses, especially given at 10 & 16 years of age, is very poor in India.
IMMUNIZATION ROUTINE
Primary vaccination
Bacillus Calmetic-Guirin
Vaccine against tuberculosis Administered at Birth
Oral polio
Vaccine against polio Administrated at Birth, 6,10, 14 weeks
DPT
Vaccine against diphtheria, pertussis & tetanus Administered at 6,10,14 weeks
Hepatitis B
Against blood-borne disease Administered at birth,6,10,14 weeks
Measles vaccine
Administered at 9-12 months
Optional vaccines
H influenza (type B)
Against flu Administered at 6,10,14 weeks
Booster does at 18 mths
Hepatitis A
Against water-borne diseases Administered at 12 yr
Booster does at 18yr
Chicken pox
Administered at 1 yr Booster does at 10yr
Pneumococcal vaccine
Against pneumonia Administered at 6,14,20 weeks
Typhoid (VI)
Administered at 12 yrs Booster dose at Every 3 yrs*
Meningococcal
Against meningitis Administered at 2 yrs Booster does at Every 3 yrs*
BOOSTER DOSES |
DPT & oral polio
16-24 months |
DT 5 years(doctors
recommend
DTP booster
does at 10 years of age) |
Tetanus Toxoid(TT)
At 10 years & again at 16 years |
Vitamin A
9,18,24,30 & 36 months after birth of the infant |
Every year, a large number of children get
vaccinated for diseases like
pertussis, tuberculosis,
hepatitis-B, and measles under the national immunization programme .But very few go on to complete the full course losing track of booster doses that are administrated at 10 and 16 years. The lack of awareness among parents for to give
vaccination doses to the child in proper time are to blame for the low turnout rate.
Doctors say most children don’t get mandatory booster does for
tetanus at the age of 10 and 16. “If they are given the booster doses, the kids can develop immunity for life. It would also bring down indiscriminate use of tetanus. But we don’t see many turning up for booster doses at 10 and 16 years of age,” said Dr Bir singh, professor of community medicine, AIIMS.
Similarly, the incidence of the contagious
pertussis (whooping cough) is rising among kids in the 10-plus age group. The national immunization programme recommends booster does for
diphtheria and
tetanus at the age of 5.”These days, we see a lot of pertussis cases in children above 10 years. With time, the effect of the vaccine decreases. That is why booster doses of DTP(diphtheria, pertussis and tetanus) are required at the age of 10,” said DR Pankhaj Garg, consultant, neo –natology, Sir Ganga Ram Hospital.
Doctors the national immunization programme is religiously followed for children up to two years.”Till 24 months
vaccines are given at an interval of 2 to 3 months. But when we ask parents to come after two or four years, their turnout is dismal, “said Dr. Sisir Paul, paediatrician Max Healthcare.
Docs give 2-year-old with rare liver disease reason to smile
Paras smiles constantly as though to compensate for not doing go during the whole of last year. His huge abdomen had made it impossible for him o eat, Sleep or smile. At two years and three months, this child from Belgagum had undergone, this child from Belgaum had undergone a lifetime of medical misery-periodic draining o the abdomen liquid, trips to various doctors, and many
homegrown medications.
Suffering from a rare liver disease called the Budd-Chiari Syndrome,Paras’s parents Dattaram and Shipa Madali not only waited for months before getting the right diagnosis, they were told that it was impossible to cure. They were advised that it was too risky to unclog his blocked liver (hepatic) veins, a manifestation of the syndrome.”There was a period in which we made peace with the inevitable, but during New Years Eve I couldn’t bear to see his plight, said Dattaram. That is when, though their family doctor’s friends in Mumbai, they consulted Dr. Abha Nagral of Jslok Hospital.
But paras were a revelation for the medical team of Dr. Nagral, paediatrician Dr. Fazal Nabi and interventional radiologist Dr. Shaji Marar-who last month published a paper in the Journal of Pediatric Gastroenterology and Nutrition on treating Buddchiari children. When the entire fluid from Paras’s abdomen was drained, the 11-kg child shrunk to 6kg.” He is perhaps the lightest child to have undergone a surgical procedure for BudChiari,” they say. None of the 16 children they have treated so far were as weak. It made his medical management in the ICU and OT that much more difficult.
Passing a catheter through a vein in Paras’s neck, Dr. Marar created a direct connection of sorts between the portal vein and the inferior vena cava(the largest vein in the body) to allow blood to flow through Paras’s liver once again.
While getting discharged on Wednesday, the Madalis were happy with their smiling baby, but Dr. Nagral is worried about the poor diagnosis of the syndrome among children.”The syndrome manifests in some children after a bout of fever and dehydration. For some reason, the blood becomes less viscous and clots in the hepatic veins, which have the slowest flow. Many of these children are wrongly diagnosed as liver failure patients and d prescribed a transplant, ”she says.
The poor awareness is apparent from the case of Jui, the six-year-old daughter of Dadar residents Madhura and Vidyhadhar mhatre “Jui’s abdomen started bloating when she was little over one,” recalls madhura. The family went to several doctors and hospitals before going to KEM Hospital in Pune where they got the right diagnosis a year later.”She went through an angioplasty of one of the liver veins in a city hospital, but the liquid started filling up in her abdomen the very next day,” says her mother. They returned to the Pune doctor who directed them to the Jaslok team. “Jui has a stent in one of her liver veins and has not had any problems in the last three years,” says Madhura.
Liver surgeons Dr, hemant Vadeyar from Kokilaben Dhirubhai Ambani Hospital says that Budd-Chiari among children is rare.” Not only is the incidence one in a lakh, there are few doctors qualified to carry out the needed intervention. While newer minimally invasive,” he says. Incidentally, Paras’s underwent a transjugular intrahepatic portosystemic shunt(TIPS). Dr. Hemant Deshmukh ,head of a the interventional radiology department at KEM Hospital in Parel says that “doing TIPS in a child is a morbid procedure. The outcome is guarded.”
Understanding Budd-Chiari Syndrome
WHAT Budd- chiari Syndrome is a rare problem that results from blood clotting in the veins flowing out of the liver(hepatic veins). The high pressure of blood in these veins lead to an enlarged liver, and to an accumulation of fluid in the abdomen, called ascites
SYMTOMS Majaor systems include pain in the upper right-hand portion of the abdomen and a build-up of fluid in the abdomen.
CAUSES Blood disorders are the most common causes but in order people there could be various reasons from sickle cell anemia, liver cancer failure, infection, injury, etc.
TREAMENT Patients undergo hepatic vein catheterisation in which a narrow tube is passed through the neck (via the right internal jugular vein) until it reaches the hepatic veins. An instrument at the tip of the catheter measures the pressure within each segment of the hepatic vein in the same procedure, the surgeon can re-route blood flow around the clotted hepatic vein into a large vein called the vena cava At times, and doctors use a stent to remove the blockage. In worst cases, liver transplantation is performed In a few patients, a ‘balloon Catheter’ can open the blocked blood vessels without major surgery
PROGNOSIS if Surgery is done before permanent liver damage sets in long. term survival is possible. In these cases. damaged liver cells can actually recover
INCIDNECE: it is extremely rare. Congenital forms of Budd-Chiari syndrome are the most common cause of the syndrome worldwide. Particularly in Asia. A study in Sweden reports an incidence of about 1 case per million population per year. It is rare in the general population and even more so in children. Peak incidence seems to be in persons aged 40-50 years.
Steadily falling infant deaths show a sudden rise in '09
According To A Unicef Report, 65% Of The Fatalities Occur Within 28 Days of Birth.
Mumbai: It may come as a shock that the city which had been seeing a steady, decline in the number of infant deaths since the past few years, recorded a sudden increase in their numbers in 2009. The year saw more infants dying than in 2008-5,866 infants in 2009 compared with 5,754 in 2008. This was revealed in a recent data retrieved through the Right to Information.
Of the infants who died in 2009, 2,738 were female while 3,128 were male. The maximum number of deaths was recorded in May at 742. Comparatively, fewer deaths were registered in February and March.
Since 2006, the number of infant deaths recorded by the BMC kept dropping every successive year.
While 6,218 infants died in 2006, 5,892 died in 2007. Details received under the RTI, which was failed by Chetan Kothari, show up that the maximum number of deaths took place in the M-East Ward at 920, followed by 493 deaths in the L Ward.
In fact, the recent Human Development Report (2009), Prepared by the National Resource Centre for Urban Property and the All-India Institute of Local Self-Government, Mumbai, with support from the UN Development Prgramme, the Union ministry of housing and urban poverty alleviation and the BMC, pointed to the fact that the M-East Ward, which includes Deonar, Anushakti Nagar, Tromby and Mankhud, was ranked the worst.
In fact, of the six wards in the eastern suburbs, five were below the city's humban development measure(HDM) average, including the L Ward, which includes Kurla.
Meanwhile, the RTI figures also show that the number of births fell last year compared with those in the earlier year.
While 1,75,298 births were recorded in 2009, 1,82,759 were registered in 2008.
Experts said the deaths are directly proportional to the population.
Explaining that the population at the M-East Ward and the L Ward has been significantly increasing, Dr.Gourish Ambe, the civic executive health officer, said, "The Socio-economic condition in the tow wards is not very high either. The slum population in these areas is about 80-90%.
Ambe, though, emphasied that the rise in infant deaths by a mere 100-odd number is not significant. "The population of the city increases every year. If the death figures are touching 5,000 or 6,000, a difference of a few 100 is not significant ," he said.
However, social experts still see this as a significant increase."Although the population increases, and there is a new entry of migrants, an increase by 100 deaths is still high. One thing is true, that there is no sign of deline of mortality," said professor R N Sharma of the Centre for Development Studies at the Tata Institute of Social Sciences(TISS). "It's not surprising that most deaths are in the M-East Ward because it has become the dumping grounds of the poor."
About the decrease in the number of births, Sharma said that the authenticity of the figures should first be established. "It is difficult to comment on this because one is not sure if they are real or projected figures," he said.
A Unicef report titled The State of the World's Children 2009 showed that while Maharashtra fared better than several other Indian states, the statistics were alarming-149 of every 1,00,000 women who go into labour die during childbirth, and 65% of the total deaths of infants under five years of age occur within 28 days of their birth.
Dr Indu Khosla, paeditrician who practised in Andheri, said that 30% of infant deaths occur, as early neo-natal deaths.
"Mostly, they die immediately after birth, or within a month after birth. The common causes are asphyxia, prematurity and retardation in growth," said Khosla. "Then, the common causes of death within the year since birth are respiratory infections such as bronchiolosis and pnuemonia, followed by diarrhoea and dehydration,"Khosla added.
BABY STEPS
BIRTH
Male 91,355
Female 83,943
Total 1,75,298
INFANT DEATHS
Male 3,128
Female 2,738
Total 5,866
Trichological solution for children’s hair problems
More and more young children in today’s modern world are coming up with stress related symptoms of hair such as Alopecia Areata and Trichotillomania.
Alopecia Areata: children with this condition have a complete loss of hair in one to three areas of the scalp, sometimes up to two inches in diameter, without scalp redness or scaling. Another finding can be pitting of the nails in children with this condition. Why the hair falls out from the roots is still a mystery. What is known is that the condition is not contagious, nor caused by foods, this is an auto immune problem it is advisable to consult a trichologist who is best qualified to tackle hair related issues and will treat the problem with specific amino acids. Oddly, the new hair may temporarily be white, but eventually the hair returns to its natural colour.
Alopecia Totalis: This is the next stage of Aopecia Areata. In this a person starts losing hair on the entire scalp.
Alopecia Universalis: This is the next stage of Alopecia Totalis. In this a person starts losing hair on the entire scalp and total body hair including eyebrows, eyelashes and moustaches.
Pseudopelade: this is a stage which comes when the above three stages are crossed. In Pseudopelade, non scarring Alopecia becomes scarring alopecia in which the hair roots are dead and there is no chance of re-growth. In this the skin of the scalp becomes like a horse shoe.
Trichoatillomania: This is a condition in which a child actually pulls the hair out, leaving an irregular patch of hair loss with broken off hair of different sizes , mainly on the scalp, but may involve the eyebrows and eyelashes as well. The habit of pulling out one’s hair is usually practiced in bed before falling asleep or when the child is studying or watching television. The best treatment is to ignore the hair pulling and concentrate on why the child is anxious, nervous or frustrated. Since it is a psychological problem connected with the hair, treatment will involve counseling by our Trichologist.
Problems of hair related to hygiene.
Lice: Lice are a very common problem, especially for kids ages 3 years to 12 years girls more often than boys). Lice aren’t dangerous and they don’t spread disease, but they are contagious and can just be downright annoying. Your child might find it hard to concentrate on their studies and to sleep, because they are so busy scratching their heads. These bites may cause your child’s scalp to become itchy and inflamed and persistent scratching may lead to skin irritation and even infection. For some kids, the irritation is mild: for others, a more bothersome rash with crushing and oozing may develop.
Dandruff: Dandruff is the result of the normal growing process of the skin cells of the scalp. Shedding of dead skin cells from the scalp at an excessive rate is the result of the normal growing process of the skin cells of the scalp. Dandruff is usually seasonal. It is most severe the winter and mildest during the summer. Dandruff scales usually occur as small, round, white- to-gray patches on top of the head. Scaling can occur anywhere on the scalp, in the hair, on the eyebrows, the beard and can spread to the neck and shoulders. Dandruff is often known as ‘dry scalp but people with oily scalps tend to suffer the most. An oily scalp tend to supports the growth of P. ovale. Since dandruff is a natural process, it cannot be eliminated. It can only be managed and controlled.
Tinea capitis: Also called the ‘ringworm’ is a common cause of hair loss in children. The condition is caused by a fungus (not a worm!) that invades the hair loss, with broken-off hair (black dot ringworm), scales enlarge lymph glands, or the formation of a kerion, a large, red, boggy nodule on the scalp. There may also be mild scalp itching and scaling. Ringworm of the scalp is not dangerous. Without treatment, however, the hair loss can be considerable and some children will develop a boggy tender welling of the scalp known as a kerion. Children three to ten years of age are more susceptible to Ringworm Infection and boys are affected more than the girls.
Problems of Hair among teenage children due to fashion:
Traction alopecia: or physical damage to the hair is especially common among girls. The human hair is quite fragile and really does not respond well to the many physical and chemical assaults it has to endure in the name of beauty. Constant teasing. Fluffing, combing, washing, curling, blow drying, hot combing, straightening and bleaching can do a number on the fragile hair, causing them to fall out, especially those by the hair line and along the front and sides. Styles that apply tension to the hair, such as tight ponytails, braiding, barrettes, and permanent waving can also damage the hair.
Problems is new born children:
Toe Tourniquet Syndrome:
Increased hair loss a few months after delivering an infant is a common postpartum condition known as telogen effluvium. A much less common condition involving young infants is the hair-thread tourniquet syndrome, or toe tourniquet syndrome, which involves hair or tread becoming so tightly wrapped around a toe or finger that pain, injury, and sometimes loss of the tow or finger. Accidental cases involving human hair almost always involve the toes, and usually occur at the age when mothers are experiencing excessive hair loss. This association is significant in that anticipatory guidance of new parents experiencing rapid hair loss may prevent cases of the toe tourniquet syndrome and it associated problems. Visit a Trichologist to tackle hair problems of growing children.
TENDER HEARTS IN NEED OF HEALING TOUCH
One in every hundred babies suffers fron Congenital Heart Defect. And According to a study, more than 200 paediatric cardiac centres are needed across the country, but only 14 exist. There is a felt need to address this problem. Deepa Suryanarayan takes a look at what hospitals have to offer to the city's children with major heart problems.
Congenital Heart Defect
CHD is the most common birth defect.
The incidence of CHD is roughly one every 100 live babies.
About 2 to 2.5 lakh new borns with CHD are born in India every year.
Of these around 75,000 require surgery just after they are born.
However, according to paediatric cardiologists, only around 8,000 surgeries are actually conducted.
According to a study of CHD in India, the country needs 200 paediatric cardiac centres, of which only 14 exist, thereby increasing the motality in children with CHD.
A majority of children born in developing countries an dafflicted with CHD do not get the necessary care, leading to high morbidity and mortality.
Hi-tech hospitals can deal with it
Types of heart disease
Atherosclerosis, Coronary, Rhematic, Congenital, Myocarditis, Angina, Arrhythmia
Causes
Congenital defects, infection, narrowing of the coronary arteries, high blood pressure or disturbances
Symptoms
When symptoms occur, they vary from person to person and may include chest pain, shortness of breath, weakness and fatigue, palpitations, lightheadedness, and fainting.
Statistics
*Cardiovascular disease (CVD) is the most common cause of deaths in India.
*Approximately 16 lakh deaths occur in India every year due to CVD.
*50 per cent of heart patients in India are under 45 years of age
