Common Issues in Childhood

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  • FEVER:
    They are often viral fevers until proved otherwise, especially when there is no focus for infection. It is difficult to distinguish between bacterial and viral infections. Bacterial infections are usually local and focal, while viral ones are more generalized. There are as many as 300 varieties of viruses that attack humans during a lifetime, 100 of them attacking in the first 10 years, and 40-50 of them in the first few years of life itself! Fevers may be associated with vomitings, diarrhoea, cough, cold, rashes and bodyache. Symptoms have a waxing phase peaking around day 3, followed by a waning phase until day 7. Most of them are self-limiting, and can be managed with anti-pyretics like Paracetamol itself. So parents must not make fevers, obstacles in the path of a Superhero, because they are unavoidable encounters each and all have to face throughout life especially during early childhood. None is exempted!

    A record of fever must be maintained. Kids must not be haunted with food all the time if he doesn’t wish to eat during fever. There are sufficient stores of food in our body for emergency situations. They are replenished as soon as the disease process is over.

    WHEN SHOULD YOU SEE A DOCTOR?

    If child:

    • Is under 2 months old
    • Is extremely irritable, crying a lot or excessively sleepy
    • Has difficulty in breathing
    • Temperature is high even after 2days of Paracetamol
    • Complains of neck pain or rigidity
    • Has a convulsion
    • Pulls at the ear or complains of ear pain
    • Has not wet a diaper or urinated for 12 hours
    • Lips, tongue and lining of mouth are dry and dull
    • Complains of a sore throat

  • DIARRHOEA:
    Loose motions occur due to an insult to the part of the intestines responsible for absorption, and there is no medicine possible to repair it the same day. Whether they are bacterial or viral, they are usually self-limiting. Antibiotics must only be considered if there is high grade fever >101 deg F, or if stools are mixed with pus and blood. It is necessary to understand that the treatment should be to prevent dehydration than to stop diarrhea.

  • COUGH AND COLD:
    Kids fall a prey to these viral infections just like adults, but the course of their coughs and colds is usually prolonged. The reason is highly mechanical. It is because children are not only smaller in their external appearance but their airways from nose to the lungs are also smaller and narrower. So they easily get clogged by mucus and secretions, and it is very difficult for them to clear their airways themselves. Vomitings may aid this clearance in little children, therefore it is wise to use minimal cough medications to avoid drying of secretions within the airways.
    Steam of saline water with Tulsi leaves should be used instead. Cough medications tend to worsen symptoms in babies and children. Parents must remind themselves of the natural course of the disease than pressurize the doctor for injections or a change of treatment. All kids normally have 6-8 episodes of cough and cold in the first year of life, therefore your child is not the ‘only one’! Maintenance of good personal hygiene and a flu vaccine are the best means of prevention.

  • DENGUE FEVER:
    Dengue is an innocuous biphasic viral illness caused by bite of an Aedes mosquito, characterized by abrupt onset fever, rashes, flushing of face and severe pain behind the eyes. Doctor must be consulted immediately and child investigated. There is no need of a platelet transfusion until the patient has active bleeding. If fever lasts for 10 days or more, it should not be mistaken for dengue fever. It is serious if patients have a low platelet count with a raised white cell count. Prevention from mosquito bites, is its best cure, the most potent breeding place for mosquitoes being your very own bathroom, so it should be mopped dry after use!

  • TUBERCULOSIS:
    Though an endemic disease of our country, the diagnosis of tuberculosis in children is entirely clinical. There is no single confirmatory test for it. There is indeed a scoring system to diagnose tuberculosis in kids in cases of suspicion, for instance, when there is an adult with active tuberculosis in the family or when history of an immediate contact is positive.
    Diagnosis should be well correlated with the growth chart before leaping to any conclusion. Pediatric problems like minor lymph nodes in the neck or recurrent attacks of cough should not be unnecessarily subjected to an anti-tubercular treatment. Issue of appetite may just be socio-emotional, and not a manifestation of a dreadful disease like tuberculosis!

  • CHILDHOOD ASTHMA:
    Recurrent coughs and colds are an inevitable part of early childhood. But in kids in whom they cause difficulty in breathing, high breathing rates, distress is more at midnight and early hours of the morning, relatively take longer to be cured and respond well to bronchodilators like Salbutamol or nebulization, it is a hyperactive airways disease or Childhood Asthma. It is often confused with Allergic Bronchitis, Eosinophilia or Recurrent Pneumonia. At other times, for the fear of Asthma being taken as a social stigma, doctors hesitate to diagnose it and parents refuse to accept it as Childhood Asthma.
    Incidence of Childhood Asthma is 15-20% and falls to 3% as children progress to adulthood. Most of the kids outgrow it – some at 2-3 years of age, and others by 8-12 years. It is because smaller kids have narrower airways which broaden as they grow. The risk is 40% in children with one of the parents affected, and rises to 70% in case of both.
    Childhood Asthma is not a single disease entity. It’s a group of disorders ranging from mild to severe, and parents need to understand that it is quite different from asthma as seen and feared of, in adults. Kids well treated with anti-inflammatory along with inhaler therapy at the earliest, outgrow it faster and completely. It is because their bodies do not make permanent antibodies for it, which is so in adults. There are many fallacies regarding inhalers in the society including doctors, which should be got over with. It is necessary to understand the nature and the course of the disease. Inhalers treat the target organ i.e. the airways with 200-2000 times lesser dosage than what has to be administered orally or through injections. Would you prefer eye drops for your eye infection or a tablet for it? So the cure lies in beating in the bush than about it!
    Children spend majority of their time at home besides school, so the indoor pollutants are major culprits or triggers to their Asthma. Mopping their room 3-4 times a day keeps it off dust.

  • GROWTH CHARTS:
    Growth charts are specifically customized and individualized to the child’s growth. Genetic predisposition is its major determinant. It is assessed relative to the mid-parental height, rather than comparing him with other kids. Growth charts are devised to evaluate a child’s growth at a point of time, and more importantly, serial measurements of growth in a given period of time, exhibit the actual growth pattern. Do not be over-concerned. There are times when even children of the same class are not of the same age.
    For instance, in case of a child having loose motions since 6 months, if it is because of taking lot of sugar and biscuits, it is not going to alter the growth pattern of a child, but if it is due to some infection, it hampers the growth percentile, the weight and then the height. Even wheat allergy (Celiac Disease) and hormonal disorders which hamper growth can be suspected the same way. This is the most useful tool to assess the growth of a child, and also to monitor the effectiveness of treatment being administered.