Childhood illness
Childhood Illness
Abdominal Pain
If your child has abdominal pain, but otherwise looks well, you can be almost sure that the problem is not serious. However , if the look of the child causes anxiety , seek professional help.
Causes:
- Psychological Factors
- Medical Causes
- Others
1 . Psychological Factors
School going children often complain of recurrent pain , usually located around the navel. In most cases the pain is not severe and the child does not complain about it. If he is involve in doing something interesting. It rarely wakes him up from sleep. He is perfectly alright in between the attacks, which may last for a moments or longer but rarely more than half an hour. Be alert to see if there is any reason for the child to become emotionally upset . Is he being bullied in school ? Is he afraid of his new teacher ? Are the pending examinations causing him too much anxiety ? Is the the child upset because of a quarrel between the parents ?
It is not always easy to probe the mind of a child. If the symptoms persist, take the advise of a doctor , who may even refer him to a family counselor, psychologist or psychiatrist. Don't upset the child by remarks like 'You are just acting' or 'Do not try to fool us'. It is believed that such children do get pain. But the symptom is probably due to some , not yet fully understood mechanism or is related more to the mind rather than the body- possibly a subconscious way of attracting a parent's attention for more body contact. Hence the treatment lies in understanding the child, helping him with the underlying emotional problem, if any rather, than being harsh towards him.
If one has more of sweets , one may suffer from worm problems.
Medical causes
Worms
Ascariasis/ Roundworm
Roundworms are parasites that live in your intestine. A parasite is a creature that lives in or on another creature in order to survive. They have long round bodies The round worm measure from 15 to 35 cms in length and are 3-4 mms in diameter. They are either passes out as worms or their eggs are excreted. If a person defecates in the open, the soil also gets contaminated with eggs. child may touch the infected soil and the infection may travel from the hand to the mouth. .Alternatively, food can become infected by the excreta or by flies. Most children with ascariasis do not have any complaints. Sometimes, it may cause pain in the abdomen, and even intestinal obstruction, resulting in absence of stools. and persistent vomiting. grinding the teeth while sleeping (Bruxism) is not due to worms. Washing one's hand thoroughly with soap and water before a meal should be a ritual, even if the child uses a spoon, knife, fork for eating. Also teach your child to wash his hands thoroughly after going to the toilet. Albendazole or mebendazole is used for the treatment of ascariasis.
Threadworm / Pinworm
Threadworms, also known as pinworms, are tiny parasitic worms that infect the large intestine of humans. Threadworms are a common type of worm infect particularly in children under the age of 10. The worms are white and look like small pieces of thread.Threadworm are quite common and usually more of a nuisance than a serious problem. Only rarely when they block the appendix do they cause abdominal pain. Generally children may not sleep well due to itching around the anus. This happens because the thread like, female worms measuring about 1 cm, come out of the intestine at night and lay eggs on the skin around the anus. The eggs are carried by the child or an adult under the fingernails or they may spread in homes through clothing or bedding. The patient may ingest these eggs from his own fingernails or may infect others by contamination of food while serving/cooking. These eggs when swallowed, grows to adulthood. It is important to treat all the members of the family, including the house help, with a single dose of mebendazole (syrup or tablet) for children and adults with a repeat dose after 2 weeks. In certain cases, the treatment may have to be repeated every three months.
Hookworm
Hookworms are intestinal, blood-feeding, parasitic roundworms that cause types of infection known as helminthiases. Hookworm infection is common in countries with poor access to adequate water, sanitation, and hygiene. Hookworm attach themselves to upper, small intestine and suck blood resulting in Anemia. Larva of hookworm emerge from eggs lying in warm damp soil and penetrate the skin of people walking barefoot in farms or gardens. They grow to adulthood inside the body. Anemia is treated with iron and the patient is given mebendazole as for ascariasis.
Whipworm
A whipworm infection, also known as trichuriasis, is an infection of the large intestine caused by a parasite called Trichuris trichiura. The infection is caused by ingestion of eggs passed in the stool, and spreads with unclean hands and through flies, which in turn, contaminate water and food. Whipworm rarely cause a pain in the abdomen, but they are important, through not common cause of prolapse of rectum in children. Treatment of whipworm is same as ascariasis that is mebendazole tab.
Tapeworm
Tapeworms are flat, segmented worms that live in the intestines of some animals. Animals can become infected with these parasites when grazing in pastures or drinking contaminated water. Eating under cooked meat from infected animals is the main cause of tapeworm infection in people. Tapeworm are several meters long and inhabits the intestines. They have several segments which are passed into the stools as small, flat , white pieces like seeds of gourd(kadu/pumpkin) about 1 cm long.
The infection stems from eating infected pork or beef which is not cooked properly. Food or water contaminated with the eggs of tapeworm may also cause infection. The disease may therefore develop also in children who do not eat meat.Tapeworm may not cause much problem except for mild pain in abdomen. But in rare cases they may form cysts in the child's brain. This condition is called neurocystcercosis and can lead to headaches, fits or even death.
Neurocysticercosis affecting brain.
Meat eaters must make sure that it is well cooked. Personal hygiene for all members of the family remains equally important. Any drug for this illness must be taken as per advice of your doctor.
The most common treatment for tapeworm infection involves oral medications that are toxic to the adult tapeworm, including: Praziquantel (Biltricide) Albendazole (Albenza) Nitazoxanide (Alinia)
Bacillary Dysentery
Frequent motions (not necessarily loose) with passage of blood or mucus and accompanied by gripping pain that increases at the time of passing a motion is usually due to bacillary dysentery. At times, the child doesn't pass any fecal matter, but only blood and or mucus. The child can get infected from close contact with an infected person or by consuming infected water or food.
If facilities exist, a routine stool examination can be undertaken. It will show the presence of mucus, red blood cells and leukocytes. Macrophages may also be present. Treatment consist of adequate hydration, food and drugs.
Drugs are required to control the bacterial infections. Some doctors advise anti-motality drugs to reduce the frequency of motions. Such drugs contain Lopermide and Diphenoxylate that are banned for use in children. Besides prolonging the illness such drugs can also have serious side effects and must not be given.
Giardiasis and Amoebiasis
Giardiasis and Amoebiasis may be suspected in children with persistent or recurrent pain in abdomen. A stool examination of a fresh sample is undertaken to confirm the diagnosis.
Pruritis Ani
Itching in the anal region is also common among children and the commonest. cause are the intestinal worms and also due to hemorrhoid. The treatment off course id determining (if due to worms). The management of hemorrhoids has already been discussed.
Application of rose oil with or without vinegar is helpful in relieving the symptoms. Application of Aloe vera juice is also beneficial in this condition.Rectal prolapse is also common and it is managed with laxatives and rose oil locally. In all the above condition, nutritious diet containing proteins, essential vitamins etc ia essential.
Food Poisoning
Food poisoning should be suspected if those who have eaten the same food start getting abdominal pain, diarrhea and vomiting with or without fever.
Children should be discouraged from eating milk products outside the home.
Food should be eaten the same day it is cooked. If this is not possible, the left over item should be rapidly cooled in storage or kept in deep freeze compartment of refrigerator, and thoroughly heated before consumption. Make sure that the center of the food gets heated, leaving no cool spots. The treatment is same for diarrhea.
Acute Glomerulonephritis
Also called Acute nephritis .This is a disease of kidney following bacterial infection of the throat or skin. Atypical case usually affects a school going children; it is extremely rare in the pre-school period.
Symptoms : About 3 weeks a sore throat or skin infection, the parents notice that the child is passing less urine and it is reddish in color. On getting up in the morning, the face is found to be puffy. The swelling is more marked below the eyes and spreads also to the lower limbs. In some cases, the blood pressure goes up and the child may also gets fits. The doctor will first ask for a urine test and than may order for blood test.
Fortunately 95% of children recover completely without any damage to kidneys. The child looks normal within 2-3 weeks when the urine output and color becomes normal and the swelling disappears. The urine may show the presence of red cells and albumin for a longer period. Most likely, the doctor will reassure the family and will not prescribe any further medicine.
Treatment
The child is advised bed rest and certain restrictions in diet, salt and water intake.The doctor will also prescribe medicine for the residual throat infection or skin infection. and for the raised blood pressure twice daily. If the blood pressure is high or the child has convulsions or marked reduction of urine output, she may wish to hospitalize the child.
Sore Throat and Vomiting
Sore throat with enlargement of glands in the abdomen may cause abdominal pain in children above 2 years of age. The pain disappears as the sore throat gets treated. Severe bouts of cough or vomiting leading to soreness of the abdominal muscles may also present as abdominal pain. The remedy lies in treating the cause of sore throat, cough or vomiting.
Tuberculosis of abdomen
Tuberculosis of the abdomen should be considered if the child who complains of pain in abdomen has associated features connected with a possible diagnosis of tuberculosis. These features include : A history of close contact with an adult having tuberculosis; loss of appetite and weight, distention of abdomen with or without evidence of intestinal obstruction; and evidence of tuberculosis else where in the body. Anti-Tubercular treatment is given.
Constipation
This is a common cause of abdominal pain in children. the child does not look ill, nor he fever but gets intermittent colicky pain in the stomach. There is no vomiting and the appetite is usually not affected. The child may have moved his bowels, but it may have been an incomplete evacuation.
Surgical Causes
Appendicitis
Appendicitis refers to inflammation of Appendix, a tail like structure connected the caecum portion of large intestine located in the right lower abdomen. If not detected early, an inflamed appendix may burst open, leading to a serious condition called peritonitis. A child with a possible diagnosis of appendicitis needs immediate attention of a pediatric surgeon.
Intestinal Obstruction
Intestinal obstruction is a serious surgical condition. Some of the cases are congenital obstruction (from birth), a mass of round worm obstructing the intestine, intussusception and an obstructed inguinal hernia.The child has pain in abdomen, constipation, distention of the abdomen and projectile vomiting (vomit shooting out of the mouth). It may be green in color (due to presence of bile) or may even contain feces.The urgent case of a surgeon is vital.
Intussusception
Intussusception is a condition in which one portion of the intestine slips inside the portion next to it. The condition occurs commonly between the ages of 3 months and 3 years.
There is a sudden onset of pain which last for 2-3 minutes and then occurs in repeated bouts every quarter hour or so. While a child becomes red in the face when he cries, in intussusception, the child looks pale, acutely ill, refuses to eat or drink and appears to be collapsing with continuing bouts. At this stage, the child may pass blood in the stool.
A surgical opinion is urgently needed in such a situation. .
Inguinal hernia
Torsion of Testis
Other Possible causes of abdominal pain Children
- Colic in small infants
- Referred pain from the chest in a child with Pneumonia or plural infection
- Urinary infection
- Stone in urinary tract
- Injury to abdomen
- Allergy or intolerance to animal milk
- Dietary indiscretion
- Hepatitis (infection of liver)
- Malaria
- Hunger with low blood sugar
- Abdominal epilepsy
Cerebral Palsy (C.P)
Unusual stiffness of the body or limpness should alert us to the possibility of C.P.
Besides stiffness or limpness,these children can also have other problems like excessive drooling, speech disturbances, dental, eye, and hearing problems, convulsions and different grades of mental retardation. However, 50% of children with C.P are mentally normal.
Management
If there is a specialized center nearby for care of children with C.P, your doctor will refer you there for treatment. Otherwise write to the spastic society of India K.C. Marg, Bandra Reclamation, Mumbai with the background of the child.. They may suggest the center nearest to your home.
Chickenpox
Chickenpox is an infection caused by the varicella-zoster virus. It causes an itchy rash with small, fluid-filled blisters. Chickenpox is highly contagious to people who haven't had the disease or been vaccinated against it. Today, a vaccine is available that protects children against chickenpox.Chickenpox in children is usually a very mild disease. It occurs less frequently in older children and adults, but if they get the disease, it is more extensive and causes a lot of discomfort to the patient.
Chickenpox is a viral infection and highly infectious, if one child gets the infection at home or in the school, those in contact with him are likely to get the disease after a period of 2 to 3 weeks. As the disease confers lifelong immunity, you are safe if you have had it before.
Onset and course
Often, the first thing you notice one or two tiny blisters on the back or chest. The child is otherwise normal. New blisters appears rapidly. The blister forms crust or scabs. Some children, specially older ones, may get high fever and look quite ill, while younger one will have low fever or no fever at all. The rash of chickenpox usually begins within a day of the onset of fever in the form of red spots that itch. Within a few hours, they turn first into small pimples and than into blisters on a red surface (almost like due drop on a red leaf). The spots are very itchy. The blisters with clear fluid become cloudy within a day and than become crusted.. While this is happening, new red spots or blisters may be noted in the nearby area. Typically in a small portion of the body , you may notice the rash in different stages- the red spot, the clear blister, the cloudy blister and the crusted ones- at the same time.
The rash is mostly confined to the chest back, face and head. The legs and the hands are generally not involved. Spots may also appear in the mouth and vagina. Small gland often develop at the back of a neck and the armpits. The total period of illness is about a week to 10 days. While the disease may initially be confused with insect bite or pimples, the rash of chickenpox keep changing its characteristics very fast, while insect bites or pimples do not follow this pattern.
Once all the spots become crusted and no new crops appear the patient is no longer infectious. He can infect others from a day before the spots are first noticed to the day all the spots are crusted. Once that happens, the child should be ready to go to school and play with other children. Unfortunately , in some schools, , the child is not allowed to join for 3 weeks till all the scabs have fallen off. Please note that only in case of small pox , which is now eradicated the scab could infect others. Interested parents may consider meeting the school authorities in this connection so that children are not unnecessarily kept away from school.
Treatment
The spots of chickenpox are itchy . A daily bath helps, because sweating increases the itching. Keeps the child's nail short. Explain to an older child that he should avoid scratching because it may leave behind scars. For smaller children mittens may be used at night. If itching is severe apply cool packs of cloth soaked in water from boiled and strained neem leaves. Plain calamine lotion applied to the spot also reduces itching. It is not advisable to use calamine mixed with other ingredients. Neem leaves may also be spread on the bed sheet.If the itching is very severe, your doctor may prescribe an antihistamine preparation to be given by mouth. If the fever does not bother the child, avoid using any drug. If required, a paracetamol preparation may be used to lower the temperature. Never give aspirin to a child suffering from chickenpox or influenza, because it may lead to a serious disease called Reye's Syndrome. No diet restriction are required. The child should be allowed to eat his usual healthy nutritious food. If he does not feel hungry, make sure he has enough of liquids including fruit juices, coconut water and plain water.
Choking
Symptoms
Your 2 year old is eating peanuts and running around. Suddenly, he starts coughing violently. There is a strong possibility that he has inhaled the peanut into the windpipe, resulting in obstruction to the free flow of air.
Do not panic. Coughing might help in expelling the peanut. Sometimes, if the obstruction is more severe, due to foreign object or food, he may not be able to talk normally and may turn blue. Treat this as an emergency and act quickly as possible. Sometimes, a little water or milk or soup or any other liquid tend to go into the wind pipe and the child coughs to stop that or to expel the little liquid that might have gone into the wind pipe.This need not be a cause of worry.
Management
Step 1
If your small infant has difficulty in breathing and is becoming blue, shout for help. Lay him in a head down position on your forearm. Let your arm rest on your tilted thigh with his head just below your knee.Then give 4 rapid blows on the back with the heel of your other hand between the 2 shoulder blades. It may be inconvenient to rest an older infant on the arm. Lay him face down on your lap with the head towards the ground and supported with one hand.
Step 2
If you find no improvement put him on the floor on the back. Using 2 or 3 fingers, give 4 rapid chest thrust over the breastbone lying in the center of the chest.
Step 3
If you can now see the foreign object or food in the child's mouth and feel confident that you can easily remove it, pluck it out with your finger.
Step 4
If the child is not breathing follow step 3 with mouth to mouth breathing etc.
Step 5
Keep repeating step 1 and 4 till the child improves or you get some medical help.
The Heimlich Man oeuvre to help an older child with choking.
Stand behind the child and wrap your arms around the waist. Make a fist with one hand and grasp it with other hand . Put your fisted hand on the other upper abdomen just below the breast bone of his chest. Then give abdomen thrust by pressing into the abdomen with a sudden spring upward jerk. You may have to do this repeatedly (up to dozen times) for him to bring a foreign object. If the child is unconscious, give the abdominal thrust with the child lying down.
Cardiac pulmonary resuscitation and mouth to mouth breathing may be required if the child is not breathing.
Common Cold
Cold are very common.
- No antibiotics helps in common cold, because it is viral infection.
- Drugs containing phenylpropanolamine (What is phenylpropanolamine? Phenylpropanolamine is a decongestant. It works by constricting (shrinking) blood vessels (veins and arteries) in your body. Phenylpropanolamine is an ingredient used in many over-the-counter (OTC) and prescription cough and cold medications as a decongestant) and anti-histamines (anti-allergy medicines) are harmful in common cold.
- Opening of the nasal passage is all that is needed if the nose gets blocked.
Accept cold as an Unavoidable nuisance
Many different viruses (over 200) can give rise to colds. In infants below two months, the cold may more rarely, be due to a bacterial infection. The baby may also have high fever. Such infants may need antibiotics.
Typically, the cough due to cold is noticed during sleep, if the child is lying on the back, the watery discharge from the back of the nose drips down the throat. Nature does not want this stuff to go into the windpipe and the protective mechanism makes a child cough with the post nasal drip. Such a child will sleep better on the stomach. (however making a small infant sleep on the stomach is not considered safe).
Taking care of a blocked nose
If the nose appeared blocked, use nose drops suggested by your doctor. To use these drops effectively, let your child lie down. Put two drops into the right nostril. Let the head be turned to the same side and keep there for a minute, Then repeat the same procedure for the other side. Petroleum jelly or Vaseline may be applied to the outer edge of nostrils chapped by repeated blowing and wiping.
Make sure that the child has enough liquids. Fluids especially warm once, helps to thin nasal secretions and loosen phlegm.
Children who eat chicken can be given hot chicken soup to sip. It has also been found helpful in clearing nasal mucus, as compared to sipping hot water.
Use of Antihistamines
Some doctors use antihistamine to dry up secretions. This is not advisable. The watery secretions are helping the virus to get out (as in the case of diarrhea). So we should not act against the nature's helpful mechanism.
When do you need antibiotics for the cold?
If your child or infant has persistent thick, yellow or green discharge from the nose, he may need an antibiotic. But remember that before your child recovers from a cold, the thin nasal discharge often normally becomes thick green or yellow.This does not require antibiotics. It is the persistent discharge that needs attention. Let your doctor decide about the use of antibiotics.
If your child has a persistent discharge from one side of the nose, then also you should see your doctor, especially if the discharge is foul smelling or mixed with blood. It may be due to the foreign body or due to a rare condition like Diphtheria.
Constipation
Abnormally infrequent and difficult passage of motions is not common in children, but can be quite troublesome, when it does happen. A child may pass hard motions because of which he may get fissures or cuts near the anus. These can be very painful. The child starts thinking that the passage of motions causes pain. He than purposely starts withholding his stools. In consequence, the stools become drier and firmer, making it more difficult for the child to evacuate. Soon a vicious cycle starts, some times child soils his under clothes when liquid waste leaks around the solid waste.
Normal infrequent motions
Some exclusively breastfed babies pass normal motions once every 2 to 3 days and sometimes even less frequently.The motions are not hard. This is normal and requires no treatment.
Treatment
Eating sufficient fruits, vegetables, sprouts whole grains and fluids helps in the prevention as well as the treatment of constipation. Regular bowel habits and a relaxed pace for morning routines also helps to avoid constipation.
Drinking water on empty stomach is helpful. warm water with a teaspoon of honey is preferable. Many children may pass a motion after that . Others may get used to passing a motion after drinking milk or after breakfast.The child should be relaxed while sitting in the toilet. A young child is encouraged to sit for about 15 minutes. You may engage him with something interesting like a toy or a book or a puzzle. If he does not evacuate, the child should not be forced to do so.
The diet should have more fibers in the form of fruits like figs (fresh as well as dry) raisins, plums, apricot, vegetables specially raw and leafy vegetables, peas and beans and sprouts. Whole wheat flour chapatis and bread, unpolished rice and enough liquids.
Foods that should be omitted or reduced include white bread, bakery goods, milk, butter, cream, cheese, nuts, popcorn, sausages, sweet potatoes, spaghetti, macaroni, and noodles. Avoid giving the child milk products since they can depress the activity of the colon. Cow and buffalo milk can also cause milk allergy and anal fissures, which may cause chronic constipation. via stool avoidance. Soya based milk can be tried in such cases.
Although oral medicines can be helpful, do not medicate without consulting a doctor. Bisacodyl suppository (available as dulcolax) 5 mg for under two,s and 10 mg for children over two, may be used. It should be inserted at the same time each day, preferably after a meal. Use it daily for a month, 2 times a week in the next month and then once week for 3 months.
In severe cases, hospitalization may be needed to manage the child and also to investigate for some other rare causes like congenital megacolon (Hertzsprung disease)and hypothyroidism that can give rise to constipation.
Cough
Six important facts to be kept in mind if a child has a cough
1 . Call the doctor immediately if a child with a cough is breathing over 50 times a minutes.
2 . A child with a cough and cold should be encouraged to eat and drink plenty of liquids. You can reduce the risk of respiratory infections by making sure that a baby is exclusively breastfed for about 6 months and continues breastfeeding after that.
3 . A child with a cough and cold should be kept warm (not hot) in an environment free from smoke.
4 . A good doctor helps you to find a cause and treats the same and does not prescribe cough syrups and expectorants.
5 . Cough per SE is a helpful phenomenon. Do not try to unduly suppress it. If the child is breathing normally, coughs and cold can be treated at home without drugs.
6 . Most medicines sold for cough and cold are useless and possibly harmful.
Less serious causes
- Cold
- Smoking
- Adenoids
- Habit of clearing the throat
- Sinus infection
- Attention seeking device
- Tropical Eosinophilia
- Measles
- Hay Fever (Respiratory Allergy)
Serious Causes
- Pneumonia
- Bronchiolitis
- Asthma
- Tuberculosis
- Whooping Cough
- Congenital Heart Disease
- Foreign body in the bronchi
- Tracheoesophageal Fistula
- Croup
Symptomatic Relief of Cough
Cough is a helpful mechanism. Do not try to unduly suppress it without the advice of your doctor. Let your child drink plenty of liquids, including water. For symptomatic relief of cough, extract the juice from a dozen or more leaves of tulsi plant. Give a teaspoon of this juice mixed with honey or jaggery, 4 times a day. If the cough is very troublesome , make a mixture of equal quantities honey, lime juice and brandy and give 1/2 teaspoon to 1 teaspoon of this mixture 4 times a day. Avoid giving honey to infants, and alcohol if the child has rapid breathing.
Diphtheria
Diphtheria is not commonly seen in these days in children coming from higher socio- economic groups and among those who have received the injections of D.P.T (Triple antigen) vaccine at regular interval.
Symptoms
Diphtheria mostly affects the throat, larynx (voice box) and the nasal passage.
After a day or two of low grade fever, the child complains of a sore throat. Examination of a throat reveals a dirty white or grayish membrane extending from the tonsils and throat to the palate. Glands below the jaw may swell up Swelling of the neck may also appear. The child has difficulty in swallowing, if the larynx is also involved, hoarseness and noisy breathing is noticed.
Treatment
Once the diagnosis is suspected, the doctor will get a throat swab examined by pathologist and accordingly begin treatment.
Crying
When infant is crying incessantly and looks unwell, get him examined by a doctor. He may have an infection like earache,a cold with a blocked nose, flu like illness, with headache and body ache, a chest infection like bronchiolitis, or infection of meninges and raised intra-cranial pressure due to a tumor. The crying may also be due to abdominal pain.
Crying in a child who appears otherwise normal
Hunger remains one of the commonest cause of crying. Even a toddler may cry for this reason. But all crying is not due to hunger. If in doubt, feed the child, otherwise look for other possible causes.
A child may cry because he is feeling hot or cold, or has a wet nappy, or want to be picked up and cuddled or shown things at home or has been over stimulated by adults around him or just feel tired. Some small babies quieten as soon as they are wrapped up in a sheet or blanket.
Other causes of crying are pain at the site of injection or a child having been hit by an older sibling. Do not leave the later alone with the baby again but also do not punish him.
Infantile Colic
Babies may also have sudden bouts of crying for no apparent reason. The onset of these bouts is usually between the age of 2 and 4 weeks.They can occur at any time of the day and night but are more common after about 6.00 in the evening. The baby suddenly starts crying. Nothing seems to work. The child seems at the top of his voice, draw the thighs and legs towards the abdomen, may pass some gas or have a distended abdomen. Colicky cries are slightly shorter than those caused by hunger. These attack usually stops by the time the child is three months old they are termed evening colic.
Management
Don't allow the child to cry unnecessarily. If a child keeps crying, he swallows more air, which probably make him cry more because of anger and distension of abdomen. Do not hesitate to pick up the child for fear of spoiling him. A small child's need has to be met be it for food or more human contact. Make the child feel secure, loved and wanted.You will have enough time to discipline him later.
Although it has not been proven that certain foods eaten by a breastfeeding mother can upset her baby, it may be worth give up milk, egg, fish, peanuts and peanut butter, soya preparations, wheat caffeine, garlic onion, and cabbage from your diet for a few days. if you find a marked improvement in the child, you can again try and introduce these food items in turn and see if you can find a correlation between any particular food and colic in your baby.
Earache, Ear Infection and Deafness
Middle Ear Infection
Symptoms
In a typical case, the child wakes up with high fever at night, crying and rubbing his ears. He remains restless throughout the night. The next morning, pus is discharged from the ear, after which he stops crying.
In some case of ear infection, hearing is only temporarily reduced and usually returns to normal after the infection is brought under control. Sometimes, a fluid may remain behind the ear drum even after a cold. This is clear fluid. In 30% of the cases, this also gets absorbed spontaneously within about 2 months.
Treatment
The mainstay of treatment of the middle ear infection is antibiotics, given by mouth in proper doses for 10 days. However, two out of three children may recover without antibiotics if we wait for three days. No ear drops should be put in the ear, the ear should be kept dry to help heal the perforation of the ear drum through which pus had come out. To dry the ear, clean the pus nearer the ear lobe with clean linen. To dry the inside of the ear canal insert a small wick made from new news paper into the ear and let it soak up the pus. Keep changing the wick every two minutes till the ear looks clean and dry. Do this three times a day.. The child should not be allowed to to go swimming till he recovers from the infection.
If symptoms suggestive of enlarged adenoids are present, removal of the adenoid may be considered.
Similarly, if the fluid behind the ear drum persist for a prolonged period, you may be offered tiny tubes (tympanostomy tubes) to put in the ear drum to keep draining middle ear . Doctors are divided on whether these tubes (also called gromet) give definite benefit or not. In older children, a wait and watch strategy may be adopted, because we can easily assess if the hearing is improving or not. In infants and toddlers, the decision sometimes tilts in favour of using these tubes because prolonged hearing loss can affect development of speech around this age. To prevent middle ear infections, parents should prefer breast feeding, avoid bottle feeding a child in lying position, avoid use of pacifier, and tobacco smoke.
Tics
Except for a rare condition called Tourette's Syndrome, most tics are transitory and disappears within a couple of months.
Tics are irregular, uncontrollable, unwanted, and repetitive movements of muscles that can occur in any part of the body. Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics
A compulsive, repetitive sound or movement that’s often difficult to control.
COMMON Causes
Tics can have causes that aren't due to underlying disease. Examples include transient tic disorders in childhood or family history of tic.
Tics refers to certain repeated involuntary movements that appears suddenly in some school going children The otherwise normal child start blinking, shrugging the shoulders, twisting the neck, coughing clearing the throat or snuffing. The frequency of these movement vary from child to child.. They do not occur when the child is asleep.Through more common in school children, tics can also be seen in pre-school children.
In some cases there is a history if the child has passed through a stressful situation before the appearance of tics. In others the illness may have proceeded the appearance of these movements.
Parents must remember that children do not undertake these movements on purpose. They have no control over them. The movement take place spontaneously. Hence the child should not be ridiculed or punished for them. If the parents are patient, the movement disappear within a couple of months.
Tourette's Syndrome
In the tic referred above the child has the same type of movement all along. In Tourette's Syndrome the movement keep changing. Besides the abnormal movements the symptoms given above the child with Tourette's Syndrome may exhibits a chewing movement and thrusting of tongue. Some of these children may have other specific learning disorders and attention deficit hyperactivity disorder (ADHD)
Torticollis
Torticollis in new born
A typical story is that the mother notices a sudden new swelling, the size of a big marble, on one side of a neck when the baby is about two weeks old. This is called "Congenital muscular torticollis" or 'Sterno-mastoid swelling'. The baby is not much bothered by it, but tend to keep the head tilted on one side. The swelling disappears spontaneously after 2-4 months. If it persists, that side of the face start looking different from the other side.
The causes of this condition is uncertain, though it is often associated with breech or forceps delivery. In some cases a congenital dislocation of the hip also occurs. Ultrasonography may help in confirming the diagnosis of congenital muscular torticolis. In absence of that, the possibility of some problem related to the eye or the nervous system has to be considered.
Treatment
The treatment consist of stretching the affected neck muscle by slowly moving the child's head away from the side of the swelling. This is to be done quite frequently, throughout the day. Or do when ever you are changing the baby's diaper.
Torticollis in older children
This is usually due to an unusual posture, an injury, as secondary to a sore throat, due to a problem with the spine or due to a drug given to check vomiting.
Vaginal Discharge
Normal Discharge
New born babies and older girls (when they are likely to start getting their periods) often have a clear, white odourless discharge, without any itching or burning.This is normal and needs no treatment except frequent changing of undergarments.
Discharge that Smells or give rise to irritation and burning
In adolescent,this sort of discharge needs to be correctly diagnosed and the child showed to a gynecologist.
In younger children, it is often due to lack of cleanness, a bubble bath, nylon undergarments or thread worms. Rarely it could be associated with foreign body in the vagina, fungal infection diabetes, masturbation or sexual abuse.
A urine examination should be undertaken if the child also complains of burning while passing urine.
Vomiting
Vomiting in normal children
Quite a few small infants as well as older children vomit once or more during the course of the day but remains otherwise well. It seems that they have a rather more sensitive vomiting center in the brain. They vomit even if they seem to have no other problem.They vomit if they are excited, unhappy, fearful or because of any illness. The vomiting becomes less frequent as these children grow. vomit once or twice during the course of the day but remain otherwise well. It seems they have a rather more sensitive vomiting center in the brain. The vomit even if they seem to have no their problems. They vomit if they are excited, unhappy, fearful or because of any illness. The vomiting becomes less frequent as these children grows and then stops without any special treatment.
Parents must not show undue anxiety when the child vomits. This may make matters worse. A typical scene is witness when a child is getting late for his school bus and his mother wants him to finish his glass of milk. He tries it in a gulp of hurry and brings most of it up. Giving solid before the child is ready for them or force feeding children are other common causes. The child should never be forced to eat or drink in such situation. Older children should be put to bed early at night so that they get up in advance, before the school bus arrives. If the child hates to drink milk in the morning do not insist that he has it.
Even if there is enough time, an occasionally child does not want to eat any thing in the morning. . In general i would like children not to go to school on an empty stomach. I would suggest offering the child fruit or fruit juice.. If he refuses that, give him some healthy snacks (fresh fruits , dry fruits, nuts or sandwich made with whole wheat bread) to take to school for his short recces.
Some infant swallow a lot of air while feeding and bring out milk quite often after a feed, some are helped by burping. Others vomit as soon as they are lifted up to the burp. Check the position of these babies at the breast so that they have enough of areola (the dark portion of the breast behind the nipple) in their mouth.
If bottle fed change over to cup feeding (which is better than spoon feeding). If you must bottle feed, check that the whole in the nipple is not too small.
Some babies bring up curds after each feed or after some of the feeds. They are otherwise well thriving active and passing urine normally. This is called possetting and is normal.. Nothing should be attempted to set it right. May be you can buy some more bibs.
However consult your doctor if your child is dehydrated following vomiting. He may like to treat the cause and give intravenous fluids if required.
A dehydrated child looks sick and passes too little, dark urine. You should be equally concern if he shows lack of alertness or behaves as if he was not fully conscious. This could be due to meningitis.
Three causes that need attention are :
- Obstruction of intestinal tract due to surgical condition.
- Infection.
- Head injury.
Consider a possibility of intestinal obstruction by a small baby brings up green vomit. Do not give this child anything to eat or drink and take him to your doctor. Such children may also have distention of abdomen and dehydration.
In a condition called pyloric stenosis the child may present with projectile vomiting and failour to gain weight.
An intussusception and appendicitis are also to be kept in mind.
Nature Cure
Following a bout of over eating, child felt like vomiting. This is natures mechanism of throwing toxic substances out of the body. With a little assurance child should be coaxed into Drinking water which would allow for easy vomiting. Two or three vomits would have rid the body of all toxic matter and the child would have slept peacefully. And will be completely well in the morning.
Infections
An infection of the stomach and intestine (gastro-enteritis) is the commonest infection resulting in diarrhea and vomiting.
Suspect hepatitis, if your toddler or older child has developed marked loss of appetite and passes high colored urine.
A small baby who stops taking feeds, vomit and looks unwell may have septicemia, a serious type of infection. It may or may not be accompanied by fever..
An infant showing above symptoms with a bulging of soft spot (anterior frontenelle) on the head, with or without stiffness of neck, may have meningitis, needing urgent treatment.
Children with whooping cough also tend to vomit after a severe bout of coughing, ear and urinary infection may also be associated with vomiting.
Seasonal vomiting, probably due to viral infection, may affect a large number of children in city. These children do not have any of the features mentioned above and settle down with sympathetic treatment of the vomiting in 2-3 days.
Some other causes
Some other causes of vomiting is poisoning, travel sickness, gastro-oesophageal reflux and migraine. Some children with allergy to artificial milk can get a severe attack of vomiting with even a small intake of milk. Many drugs like antibiotic and drugs for diarrhea and other illness, may cause vomiting.
Gastro-oesophageal reflux refers to upward movement of contents of the stomach into the esophagus. Infants presents with vomiting and older children with pain abdomen and chest pain. In infant, seated position, worsen the reflux. Putting the child on stomach or upright carried position is better. Avoid putting the child on stomach during sleep. Elevating the head of bed for older children is advisable. Drugs are often prescribed. Surgery may be needed in intractable cases.
Head Injury
Some children bring out a streak of blood with a forceful vomit. This need not cause undue anxiety. But if becomes a common feature, your doctor would consider a possibility of condition like hiatus hernia..Off course, if bleeding is also noticed from other sites a bleeding disorder has to be kept in mind.
Treatment
Treatment depends on the cause. No drug for vomiting to be given without the advice of your doctors. If your doctor decides to give a medicine to check vomiting, do not give anything by mouth, for an hour. By then, the drug will have started acting and you can give small amount of a drink or the child's favorite fruit or food. Do not give too much at a time. Give a small amounts but offer them at frequent intervals.
A child may occasionally get a peculiar side effect due to the commonly used drugs for vomiting. He may roll his eyes upwards and his whole body may go into spasm. Fortunately almost all cases recover after the drug is stopped. Some patients are given another medicine to counteract the effect of the earlier drug.
Wheezing
A wheeze is a high pitched whistling sound associated with breathing due to narrowing of air passage. This is to be differentiated from noisy breathing due to partial blockage of the nose or due to the collection of phlegm in the wind pipe and its branches.
Most cases of recurrent wheezing are due to asthma. A viral infection called bronchiolitis affecting smaller infants can also presents as a wheeze. In older children, tropical eosinophilia is also common cause. A foreign body in the airway or a gland (due to tuberculosis or any other cause). Pressing on the airway can give rise to wheeze.
If you suspect that your child is wheezing for the first time in his life, let a doctor confirm it. Do not give any medicine on your own.
If the child is not crying the doctor will be able to here the wheeze well with his stethoscope. Hold your child up in your arms with his head on your shoulder. Do not undress him. Let the doctor listen to his back first. and then notice his breathing.
If your doctor confirm that it was wheeze, he may give the child an injection, or a medicine with a nebulizer, or by mouth and wait for the response. If he finds dramatic improvement, he may suspect that the child has asthma, If you know that that child gets recurrent wheezing you may follow the advise given by your doctor. You may also like to read the section on asthma. If he considers that tropical eosinophilia should be ruled out, he may ask for the blood test.
Whooping Cough (Pertusis)
In a typical case the child with a whooping cough severe bouts of cough. He coughs and coughs, his face becomes red he grasp something for support and then makes funny kind of sound (a whoop) as if he was taking a deep breath in, through the partially closed upper end of his wind pipe. The whole episode is followed by a vomit. Children who had having whooping cough vaccine as a part of DPT ,
either do not get the disease or get it in a milder form without the typical whoop and the vomit. Otherwise the illness last for about 6 weeks. A history of contact with whooping cough aids in making the diagnosis.
I would not delay the use of antibiotics in whooping cough. The drug of choice is erythromycin, which is started as soon as the diagnosis is made. The drug is more effective if stared early in the course of disease.It should be given in full dose for a period of two weeks. I have also found a drug, salbutamol commonly used for the treatment of asthma to be of help in reducing the severity of the bouts of cough. A calm smokeless environment is of great help to a small baby The mother's lap is the greatest comfort for the child. A feed or a food given soon after a vomit is often retained.
If people in contact with the baby are given erythromycin for a period of 14 days, They are likely to be protected to a significant extent.
Emergencies in Children
- Abdominal pain
- Allergies
- Artificial Respiration
- Asthma
- Bites & Stings
- Bleeding
- Bones, joints & muscles injuries
- Breathlessness
- Bulging Fontanel
- Burns
- Choking
- Common cold in an infant
- Convulsions
- Croup
- Crying
- Cuts
- Dog bite
- Diarrhea with dysentery
- Drawning
- Electric shock
- Eye problems, including injury to the eye
- Fractures
- Head injuries
- Hernia
- High Fever
- Mouth to mouth resuscitation
- Nose related problems
- Poisoning
- Rabies
- Scorpion bite
- Snake bite Splinters
- Stridor
- Unconscious child
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