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Childhood problems

Diarrhoea

What should be the home management of a child with diarrhoea?

A child has diarrhoea when there is a change from normal bowel habits to more frequent and looser or watery stools. The stools are often foul smelling. During the diarrhoeal episodes the baby becomes sick, irritable and/or lethargic. Most diarrhoea is self-limiting and last for 2-3 days. The key point in home management of a child with diarrhoea is replacing the fluid losses with oral liquids. This should be started as soon as the child develops diarrhea. He should be given increased amount of fluids normally given at home like lemon water, coconut water, soup, daal water, butter milk etc. Breast-fed infants should be offered breast milk more frequently. He can also be given Oral Rehydration Solution. Oral Rehydration Solution or ORS is a lifesaving medicine to cure and prevent dehydration. It is readily available at all health facilities. One packet of WHO ORS is dissolved in recommended amount of water (1 litre of clean potable water). Discard and prepare fresh ORS after 24hrs. ORS can be given as small frequent sips. A child who is losing fluids due to diarrhoea will accept ORS readily.Most children with diarrhoea do not require any other medication. Consult a doctor if a child develops any of the danger signs listed below

What are the danger signs of diarrhoea?

The major concern in diarrhoea is rapid fluid loss resulting in dehydration. To prevent this serious side effect it is important to replace lost water and electrolytes at the earliest. Any significant dehydration constitutes an emergency, so be aware of the following signs:

  • Excessive thirst/ irritability
  • Sunken eyes
  • Dry lips, tongue and skin
  • Decreased amount of urine
  • Very frequent passage of watery stools
  • Lethargy or poor oral acceptance of fluids
  • A child with any of the above signs should be shown to a doctor without delay
  • Consult the doctor also if the child has blood in his stools. This is dysentery and child requires to be given medicines for this.

 

How can diarrhoea be prevented?

Diarrhoea is an important cause of sickness in children. It can be prevented by simple measures like:

  • Drinking clean drinking water
  • Exclusive breast feeding for first 6 months
  • Avoid use of bottle for feeding the infant
  • Frequently washing the child‘s hands, washing hands before preparing food and specially on cleaning the child after he has passed stools
  • Keeping food articles covered.
  • Giving only freshly prepared food to the child. Any food that is left over from a previous meal should not be given to the child again at the next meal
  • Avoiding consuming food prepared and served in unhygienic conditions

 

Respiratory infection

When the children with cough and cold should be shown to a doctor?

Cough and Cold are among the most common problems of childhood. Often, these are accompanied by fever. Most common cause of cough and cold in children is viral infection. These are mild, self-limiting illnesses that improve over a few days. The child remains alert, active and continues to accept food, though sometimes the appetite may be reduced. These mild episodes respond well to paracetamol (if there is fever), and home remedies like ginger with honey. If the child remains sick beyond 2-3 days, ?looks sick? and is not feeding well, a he should be shown to a doctor. If a child younger than 2 months of age has cough, he should be shown to a doctor without delay since their condition may worsen rapidly. Sometimes, the child develops more severe form of illness called pneumonia. In pneumonia a child breathes faster than normal and parents may notice that the child is having difficulty in breathing. Sometimes an audible sound may be heard when the child breathes. A child with severe pneumonia may also become lethargic and develop difficulty in feeding. A child with any of the above signs must be promptly shown to a doctor.

Accidents

How can accidents to children be avoided ?

Accidents are very likely to occur in young children as they attain mobility, learn to reach out for objects and climb, due to a natural desire to learn and explore and an inability to know from experience the consequences of what they are doing. The common household accidents involving young children include falls, cuts, burns/scalds, electric shocks, near drowning and poisoning due to ingestion of chemicals/drugs. It is vital to safe-guard the child against these accidents. Some of the important precautions include:

  • Keep the doors leading outside the home and the stairway firmly latched.
  • Ensure that the open areas like the balcony and the lawn have a railing through which child cannot get out, at the same time there is no danger of his hand/ limbs getting stuck
  • The windows should be safe so that a child cannot jump out of them.
  • The infant‘s cot should have bars all around, and when the child is old enough to climb over them, he should be using a bed.
  • Keep all sharp instruments like knives, scissors, needles etc out of children‘s reach
  • Match-boxes, gas stoves, heaters, electric iron etc should be kept out of children‘s reach to avoid fire accidents
  • All unused electricity/power points should be covered. Children have a strong tendency to poke in a finger in the sockets!
  • To avoid accidental poisonings, keep bottles of all medicines, insecticides, domestic toilet cleaning solutions, kerosene oil, mosquito repellants etc firmly closed and out of children‘s reach.
  • Children‘s toys or clothes should not have loose small parts that can come off easily. The children tend to put these in their mouth and swallow. Likewise, keep small objects like coins, beads etc out of their reach. Children are known to suffocate even while playing with polythene bags.
  • Never leave a child alone in the bathroom or leave a bucket of water lying on the floor when the baby is around
  • A young child should never be left unattended when outside the home. Due to their natural curiosity and inexperience they are at a high risk of accidents in water-pools, staircases, falling from terraces, shocks from electric appliances etc.

Serious illness

What are the signs of serious illness in an infant/young child?

A very sick child may have one or more of the following features

  • Not able to feed
  • Abnormally sleepy or difficult to awake (lethargic)
  • Fast breathing
  • Convulsions
  • Vomiting everything taken
  • Very high fever

A child with any of these symptoms should be shown to a doctor without delay.

Tuberculosis

What is tuberculosis?

Tuberculosis or TB is caused by bacteria. It is a highly contagious disease that affects the lungs but can also affect the intestines, bones and joints, lymph glands, brain, and other tissues of the body. TB can cause serious illness and death.

How to recognize the disease?

An ill child living with a suspected or confirmed case of tuberculosis can suffer from TB. If a child has weight loss, cough and difficulty in respiration which does not respond to antibiotic therapy for acute respiratory infection, h/se may have TB. You should immediately consult doctor for further treatment of child

How is it spread?

TB is spread when individuals come in contact with cough or sneeze droplets of infected lung tuberculosis individuals. A variety of tuberculosis called bovine tuberculosis occurs due to consumption of raw cattle milk without boiling.

How is the disease prevented?

Vaccination with Bacillus Calmette-Guerin (BCG) as per the schedule will prevent serious forms of childhood tuberculo

If not given at birth, when should BCG be given?

If not given at birth or along with DPT-l, it can be given any time before 1 year of age

If no scar appears after administering BCG, should one re-vaccinate the child ?

There is no need to revaccinate the child if there is no scar

Polio

What is polio?

Polio is a viral infection that affects the nervous system and can cause severe illness, paralysis, and even death. Due to intensive immunization campaigns, there has been a very significant decline of polio cases in the country since 1999.

How to recognize the disease?

The disease manifests as sudden onset of weakness and paralysis of the leg(s), and/or arm(s)and/or trunk and this paralysis was not present at birth or associated with serious injury or mental retardation.

How is it spread?

Polio is transmitted by contact with, fecal matter, usually as a result of poor hygiene, or indirectly through contaminated water, milk, or food. More than 50 percent of all cases involvechildrenless than three years of age.

How is the disease prevented?

Immunization with the Oral Polio Vaccine (OPV) is the only way to effectively prevent infection. Oral Polio Vaccine should be routinely administered as per the immunization schedule and during pulse polio campaigns till 5 years of age.

If not given at birth, when should OPV-O be given?

OPV-0 dose can be given up to 15 days afterbirth

Till what age can a child be given OPV?

Under the Pulse Polio Immunization Programme, OPV is given to children up to 5 years of age.

Diphtheria

What is diphtheria?

Diphtheria is caused by bacteria. Diphtheria is an infectious disease that commonly infects the tonsils and throat pharynx, forming a membrane that can lead to obstructed breathing and death.

How to recognize the disease?

Diphtheria will cause sore throat with gray patch or patches in the throat, which is recognized by doctor

How is it spread?

The bacteria causing diphtheria inhabit the mouth, nose and throat of an infected person. It spreads from person to person by coughing and sneezing.

How is the disease prevented?

Immunizing children with DT/DPT as per the immunization scheduleis an effective method of preventing diphtheria.

Pertussis (Whooping Cough)

What is whooping cough?

Pertussis, commonly known as whooping cough, is caused by bacteria. Pertussis is a highly contagious disease, involving the respiratory tract. It is characterized by repeated cough that may lead to aspiration and possible death, in a few cases.

How to recognize the disease?

A history of repeated and violent coughing, with anyone of the following: cough persisting for two or more weeks, fits of coughing, cough followed by vomiting, typical whoop in older infants

How is it spread?

Pertussis bacteria live in the mouth and nose of the patient and are spread easily through the air, usually from coughing or sneezing.

How is the disease prevented?

DPT vaccine given according to the immunization schedule will prevent Pertussis. Half of all deaths due to pertussis are in children less than 12 months

Tetanus

What is tetanus?

Tetanus is caused by bacteria. People of all ages can become infected with tetanus

How to recognize the disease?

Neonatal Tetanus presents with a history of normal suck and cry during the first two days of life, onset of illness between 3 and 28 days of life, inability to suck followed by stiffness of neck and body and/or jerking of muscles.

How is it spread?

Tetanus is present in dirt, intestines and faeces of animals. It enters the body through cuts, punctures or other wounds/infections (like ear infection) and occurs when bacteria come in contact with broken skin or injuries, and also unclean cutting and dressing of the umbilical cord. Neonatal Tetanus (NNT) affects newborn babies that lead to death, if not treated. It generally occurs during the first few days of life, when a woman delivers in unsanitary conditions.

How is the disease prevented?

The most effective method of prevention is immunization with DPT vaccine in early childhood

If a child could not receive DPT 1, 2, 3 and OPV1, 2, 3 as per the schedule, till what age can the vaccine be given?

The DPT and OPV vaccine can be given till 5 years of age

HWhy give DPT in the outer mid-thigh and not the buttocks?

DPT is given in the outer mid-thigh and not in the buttock to prevent damage to a nerve. Moreover, the vaccine deposited in the fat of buttock region is not available to develop immunity

What should one do if the child is found allergic to DPT or develops infection of the brain after DPT?

If a child is allergic or develops brain infection after DPT, it should be given DT vaccine during the second dose as it is usually the P (Pertussis) component of the vaccine which causes the allergy / brain infection.

Measles

What is measles?

Measles is a highly infectious illness caused by a virus that can be found in the nose, mouth or throat of an infected person. Infection is characterized by fever, cough and spreading rash that may lead to death due to secondary infections like diarrhea and pneumonia

How to recognize the disease?

A history of fever with rash with cough or running nose or red eyes.

How is it spread?

The virus is transmitted through the air by respiratory droplets expelled by infected individuals during coughing and sneezing.

How is the disease prevented?

The measles vaccine is effective in preventing measles and should be given according to the immunization schedule.

When can measles be given if the child has not received measles vaccine in 9-12 months of age as per schedule?

A single dose of measles vaccine can be given till 5 years of age if the child has not received the vaccine during 9-12 months of age as per the schedule.

Hepatitis B

What is hepatitis B?

Hepatitis B is a highly infectious viral disease (40-100 times more infectious than HIV) and is the leading cause of jaundice, and liver cancer

How to recognize the disease?

Clinical signs and symptoms include fever, headache, nausea, vomiting, jaundice (yellowish eyes) and light or gray stools. Final confirmation is done by laboratory tests.

How is it spread?

The disease spreads through contact with infected blood or body fluids. It can be acquired during childbirth, through unprotected sex, use of unsterilized needles and sharing of toothbrushes or razors.

How is the disease prevented?

By immunizing children, we can prevent infection and its complications. Hepatitis B vaccine is given as 'zero' dose at birth for hospital deliveries and at 6,10, and 14 weeks of age to all the infants. At present the vaccine is provided through routine immunization programme in selected states only.

Japanese Encephalitis

What is Japanese encephalitis?

Japanese encephalitis (JE) is caused by a virus. It is one of the most deadly forms of viral brain infection in India. It is prevalent in certain geographical areas in some of the states.

How is it spread?

JE is spread by mosquitoes. The virus normally infects birds and domestic animals, especially pigs. Children get the disease when bitten by mosquito that has bitten an infected ani

How is the disease prevented?

Immunization is the single most important measure to control Japanese Encephalitis. It is provided at the government centres in districts where the JE is endemic

Vitamin A

WWhat should be the minimum gap between two doses of Vitamin A?

The minimum gap between any two doses of vitamin A should be 6 months.

Is giving Vitamin A essential for my baby?

Vitamin A helps in the vision and keeping skin healthy. It should be administered to the baby along with the immunization shots. The first dose of vitamin A suspension is given at the age of 9 months along with the measles vaccine at the health centers. Second dose is given when the child is of one and half months of age, followed by every six months till three years of age. It is given free of cost at government health centers and hospital

Learning disability

What is learning disability?

A child with a learning disability cannot try harder, pay closer attention, or improve motivation on their own; they need help to learn how to do those things. A learning disability, or learning disorder, is not a problem with intelligence. Learning disorders are caused by a difference in the brain that affects how information is received, processed, or communicated. It is a very common condition. As many as 1 out of every 5 children has a learning disability.

How do I know whether my child has learning disability?

When a child has a learning disability, he or she:

  • may have trouble learning the alphabet, rhyming words, or connecting letters to their sounds
  • may make many mistakes when reading aloud, and repeat and pause often;
  • may not understand what he or she reads
  • may have trouble with spelling;
  • may have very messy handwriting or hold a pencil awkwardly;
  • may struggle to express ideas in writing;
  • may learn language late and have a limited vocabulary
  • may have trouble remembering the sounds that letters make or hearing slight differences between words
  • may have trouble understanding jokes, comic strips, and sarcasm;
  • may have trouble following directions
  • may mispronounce words or use a wrong word that sounds similar;
  • may have trouble organizing what he or she wants to say or not be able to think of the word he or she needs for writing or conversation;
  • may not follow the social rules of conversation, such as taking turns, and may stand too close to the listener;
  • may confuse math symbols and misread numbers;
  • may not be able to retell a story in order (what happened first, second, third);
  • may not know where to begin a task or how to go on from there.
If a child has unexpected problems learning to read, write, listen, speak, or do math, then teachers and parents may want to investigate more. The same is true if the child is struggling to do any one of these skills. The child may need to be evaluated to see if he or she has a learning disability

My child has learning disability. What should I do?

Do not worry. Learning disability is very common. One in every five child suffers from it. Learn about learning disabilities. The more you know, the more you can help yourself and your child. These are important points

  • Praise your child when he or she does well. Children with learning disabilities are often very good at a variety of things. Find out what your child really enjoys doing, such as dancing, playing soccer, or working with computers. Give your child plenty of opportunities to pursue his or her strengths and talents.
  • Find out the ways your child learns best;
  • Let your child help with household chores. These can build self-confidence and concrete skills
  • Make homework a priority
  • Pay attention to your child's mental health. Be open to counselling, which can help your child deal with frustration, feel better about himself or herself, and learn more about social skills
  • Meet with school personnel and help develop an educational plan to address your child's needs
  • Establish a positive working relationship with your child's teacher. Through regular communication, exchange information about your child's progress at home and at schoolke or hearing slight differences between words
If a child has unexpected problems learning to read, write, listen, speak, or do math, then teachers and parents may want to investigate more. The same is true if the child is struggling to do any one of these skills. The child may need to be evaluated to see if he or she has a learning disability

Malnutrition

What is malnutrition?

Malnutrition is a condition that develops when the body does not get the proper amount of protein, energy (calories), vitamins, and other nutrients it needs to maintain healthy tissues and organ function.

How does it happen?

Poor eating habits or lack of available food may lead to malnutrition. Malnutrition occurs in children who are either undernourished or over nourished. Children who are over nourished may become overweight or obese, which may lead to long-term health problems and social stress

What will be effects upon the health of my baby?

Malnutrition in young children puts them at a higher risk of experiencing health problems such as stunted growth, mental retardation, and increasedsusceptibility to infectious diseases.

How will I know whether my child is developing malnutrition?

Symptoms of malnutrition are, poor weight gain, slowing of linear growth, and behavioural changes - Irritability, apathy, decreased social responsiveness, anxiety, and attention deficits.

How a child suffering from malnutrition be managed at home?

Children with long term malnutrition may require caloric intakes in excess of 120-150 kcal/kg/d to achieve appropriate weight gain. The diet must include adequate amounts of protein and other macronutrients. Any micronutrient deficiencies must be diagnosed and corrected to achieve adequate physical growth and mental development. Most children with mild malnutrition respond to increased oral caloric intake and supplementation with vitamin, iron, and folate supplements. The requirement for increased protein is met typically by increasing the food intake, which, in turn, increases both protein and caloric intake. Adequacy of intake is determined by monitoring weight gain.

Intestinal worms

What are intestinal worms?

Infection by intestinal parasitic worms is widespread throughout the world, affecting millions of people. Children are particularly susceptible and typically have the largest number of worms, which cause a number of health problems; making them unwell, affecting their physical and mental development, and affecting their attendance and performance at school. Three of the most common kinds of worms that infect children are roundworm (Ascarislumbricoides), whipworm (Trichuristrichiura) and hookworm (Ancylostoma duodenale and Necatoramericanus). These worms live in the intestines and their numbers build up through repeated infection. Children may often be infected with more than one kind of worm.

What are the symptoms of worm intestinal worm infection?

The different kinds of worms can cause different symptoms, and children with only a few worms probably won‘t notice any symptoms. However, with heavier infections, common symptoms in children with one or more kind or worm may include: Loss of appetite, Distended abdomen, Painful abdomen, Coughing, Fever, Vomiting, Diarrhoea, Listlessness and generally feeling unwell

What is the treatment for intestinal worms?

Treatment for intestinal worms is simple, cheap and effective, with a single dose of Albendazole (400mg pills), which kills the adult worms. As re-infection is likely to occur, treatment should take place once a year, or every six months

How do you prevent becoming infected with intestinal worms, and passing on infection to others?

Few tips for prevention of worms are

  • Wash all fruits and vegetables in clean water before eating.
  • Wear shoes or slippers (to prevent hookworm infection). Water from septic tanks or other potentially contaminated
  • Water from septic tanks or other potentially contaminated sources should not be used for watering vegetables
  • Defecate in a latrine, rather than in the bush or around the home or school
  • Children should be taught to wash their hands after using the latrine, after playing in dirty soil, after farming or gardening and before preparing or eating food.

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