An Article Published in Healthy Life Magazine in Issue May 2013

HEALTH ask our experts-

Kids ` Health

      Q.1 Hello doctor! I have been through your previous  articles and find them quite interesting and helpful, now since I am a mother of a 7 days old baby boy who has tooth in his lower jaw since birth, and my doctor says that  there is nothing to worry but I still want to know if I have to do anything for that?

Answer:

Well thanks for reading my articles regularly, Yes I write with an aim to help out all my readers with some general important topics, now coming to your cute little boy, even I suggest that there is nothing to worry about it, as some baby do have tooth at birth, the only thing is that if that tooth is loose from the gums then there is a chance, that tooth may fall off the gums and baby may swallow that, so in that case we suggest to remove those loosen tooth but otherwise there should not be a problem until and unless it hurts your nipple while breast feeding your baby.

     Q.2 Doctor, I run an orphan age home where I have kids of all ages, and as you know they commonly suffer from diarrhea and some land up with severe dehydration at times by the time we could consult the doctor, so please suggest me some danger signs of this disease and some immediate home management till we can get them a proper medical treatment.

     

      Answer:     

    First of all, I would like to praise you for the good human service that you are providing home and shelter to those kids. Well I can understand but the main cause of diarrhea in these children is lack of proper hygiene and sanitation, it would be great if you could educate your helpers out there especially who looks after fooding/ drinking and sanitation part. Now coming to the queries part, the first and most important is giving ORS/homemade salt sugar water solution to any child suffering from diarrhea or provide them with homemade liquids like moong dal-pani, rice kanji, salted lassi, coconut water, soup. Give ORS every time child passes loose stool. These will prevent dehydration and will decrease the morbidity. Apart from these there are some important danger signs you should know in diarrheal diseases or when should you seek the medical help immediately: like decrease in urine output, Inability to drink/feed/suck, Increase irritability, lethargy, sunken eyes, depressed anterior fontanelles , absent tears, dry tongue and mouth.

         Q3. Hello doctor! I have been through your article on immunization in healthy life magazine  so thought to ask you my doubt. My child is 5 years old and goes to school, he is been vaccinated with all the regular government vaccines  and some optional vaccines along with MMR vaccine,  but then I receive a letter  from his school asking for  a permission for vaccination with  MR vaccine which is being provided by the government in free  these days and since my regular doctor is out of town for long could you please suggest on it?

     

     Answer:

Thanks for  the question. I am happy to know that you have updated yourself with latest information on vaccination and have been immunizing your child regularly.

Now coming to your queries,  it is  not at all  necessary to immunize your child with this MR vaccine if you have completed two doses of MMR vaccine with your regular doctor. Because  this  government MR vaccine  is only against Measles and Rubella but the one you have given  as MMR also contains vaccine against Mumps which is as important as the other vaccines and 2 doses are given 1 month apart to get its optimal effect.  And  you can pass on the message that this vaccine should not be given to a child who is suffering from fever  or some other acute illness  at the time of vaccination  or it is contraindicated in child who is allergic to egg protein .

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An Article published in Healthy Life Magazine in Issue April 2013

A word so simple, but yet diseased with morbidity but may turn into the word of mortality if not taken care in time. It is common but potentially serious illness in early childhood. A child suffer on an average 10-20 episodes of diarrhea in the first five year of life and it accounts for 20% of all pediatric admission in hospital.

Since this is one of the most common cause of morbidity and mortality in developing countries like ours, especially in children below 5yrs of age, it is very important to know the basic facts about this illness and recognize its severity in time and get the timely medical management to prevent its further complication and death. So here are some of the most frequently asked questions by the parents/Patients.

Q1. What is diarrhea?

Answer:

It’s merely an infection of the Gastrointestinal tract with change in consistency of the stool.

It is defined as a passage of liquid or watery stool more than three times a day

Q2. What are the causes of diarrhea?

Answer:

Diarrhea can be caused by various organisms like: bacteria, viruses, parasites and  protozoans e.g: rotavirus, cholera, E.coli, salmonella, shigella, campylobacter, giardia, amoeba, cryptosporidium, ascariasis. It can also be a symptom of some underlying systemic, metabolic  or chronic diseases like: chronic malnutrition, lactose intolerance, measles, pneumonia, typhoid, urinary tract infection, ear infection, hyperthyroidism, heavy metal poisoning, cancers etc.

Q3. What are the risk factors which may precipitate diarrheal diseases?

Answer:

The most common being poor eating habits like eating and drinking of unhygienic food and water, poor sanitation, lack of proper hygiene while cooking or preparing food , immunodeficiency state, chronic systemic illness, vitamin deficiency, prolong antibiotic uses etc

Q4. What other symptoms can my child face during this diarrheal disease?

Answer:

Child will develop frequent loose stools with or without blood and mucus with some commonly seen symptoms like: crampy abdominal pain, vomiting, fever, weakness, lethargy, and rashes in the perianal area. While some will  present with symptoms of underlying diseases.

Q5.What is the difference between Diarrhoea  and Dysentery ?

Answer:

Diarrhoea with visible blood in the stool is called dysentery. It is more severe form and presents with fever, crampy abdominal pain, tenesmus and is responsible for 15% of death in diarrhoeal  diseases.

Q6. When should I see my doctor for this illness?

Answer:

You can see the doctor any time for this illness but better if you visit your doctor before your child develops complication of this disease like dehydration, dyselectrolytemia, seizures which increases the risk of mortality. But visit your doctor or seek nearby health facility if your child have frequent loose watery stool, blood in the stool, fever, repeated vomiting and  if child is unable to drink or eat.

Q7. What are the danger signs in diarrhea illness?

Answer:

The most important danger signs in diarrhoeal disease is:

Inability to drink/feed/suck

Decrease in urine output

Increase irritability, lethargy

Sunken eyes

Depressed anterior fontanelle

Weight loss of more then 10% of body weight

Absent tears, dry tongue and mouth.

The above  mainly indicates the signs of severe dehydration hence in these case  parents should immediately consult their doctor or a nearby health facility.

Q8. What is the basic home management that one should take before visiting the doctor?

Answer:

First and foremost is ORS, or home made salt sugar water solution each time the baby pass stool. The other food that can be given is clear fluids, rice kanji, salted lassi, coconut water, soup, yoghurt drink, dal pani and if the baby is on mother’s milk continue breast feeding. But there is a miss concept that water should not be given to the child with diarrhea disease in village, so it’s very important to educate such people the importance of early feeding and ORS in diarrhea.

Q9. How can I prepare ORS at home?

Answer:

It’s a mixture of water sugar and salt. Take 1 litre of water, mix 4 tea-spoon full of sugar, and half spoon of salt. Give it to a child every time a child passes loose stool or after vomiting.

Use the solution within 24 hours of preparation.

Q10.Which type of food should I feed my child  during diarrhea illness?

Answer:

ORS and soft diet basically rice based diet, banana, curd, khichari (jaulo) and liquids as mentioned before.

11. What type of food should we avoid during diarrhea?

Answer:

Hot spicy oily food, junk foods, Plain sugar or Glucose water, soft drinks, canned juices, citrus fruits, meat, fish etc

12. What if my baby develops nappy rashes?

Answer:

In case the baby develops nappy rashes then avoid putting nappy’s to the baby, keep the area clean open and dry, wipe the area softly after the baby passes stool, avoid harsh rubbing and one can apply diaper rash free cream or coconut oil that is easily available and meet your doctor to prevent its further worsening.

                                                                                                                        

 13. What is the treatment for diarrhea?

Answer:

It includes: giving adequate fluids, feeding properly, rational use of drugs, and applying of preventive measures in day to day life.

The most important is ORS, homemade fluids, IV fluids, soft diet, dietary supplement, extra calorie diet, breast feeding, vitamin and mineral supplements mainly zinc, vitamin A, vit B-complex, appropiate antibiotics and vaccination as per the doctor advice.

Q14. What are the complications of dairrhoea?

Answer:

It mainly causes dehydration leading to shock, dyselectrolytemia, renal failure, acid base imbalance, malnutrition and complication related to underlying systemic diseases causing diarrhea.

  

Q15. How can I prevent diarrhea?

Answer:

It’s the illness of low socio-economic  people because of the poor eating and drinking habits with unhygienic living condition and poor sanitation.  So the most important step to prevent diarrhea is to maintain proper hygiene and good sanitation.

Wash hands before feeding infants, cooking meals and after going to toilets. Exclusive breast feeding, avoid bottle feeding or the feeding bottles should be sterilized every day.

The cooking utensils should be washed properly before cooking. The vegetables, fruits and salads should be washed properly before cooking and eating. Use of clean drinking water. Eat freshly prepared and well cooked food

One should avoid eating outside on the road side because the food is uncovered and there is increased chance of infection through flies, dust and mosquitoes.

Vitamin supplements is necessary in case of chronic illness, avoid inappropriate and random use of antibiotics, treatment of systemic illness on time.

The most important is by vaccination like we have vaccine against diarrhea e.g. rotavirus vaccine, cholera vaccine, typhoid vaccine, measles vaccine and consult your pediatrician for these vaccination.

 Hence disease so simple but yet fighting with increased mortality number in developing countries like our’s. It demands early recognition and treatment, with increase necessity to educate people and increase awareness especially among rural and village peoples.

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PARENTS QUERY CORNER

HEALTH ask our experts,

        Parents Queries published in HealthyLife Magazine in Feb 2013 issue.

                                           
                            Baby`s Health

                                                                                                       
Q 1. My child is 18 months old and he is been vaccinated with all the government vaccine but I haven’t given him any additional vaccination. As we listen from our friends and relatives that there are lot more vaccine to be given and I have completely no idea about it, so could you please suggest on it, and please advice how important are those vaccines?

Answer:

Good that you have given all the government vaccines but there are many more vaccines available which is as important as the vaccines you have already given , the only problem is lack of public awareness regarding these newer important vaccines. And the other thing is the cost factor as these vaccines are little costly and is not included in the national immunization programme of Nepal. Hence we give these vaccines after one to one discussion with the parents. These newer vaccines are very useful to prevent your child from harmful diseases like: Mumps, Rubella, Flu, Pneumonia, Chickenpox, Typhoid, Meningitis, Hepatitis A and B infection ,Yellow fever, Rabies, Diarrhea some of which are communicable disease and are more common in school going children . This is to inform all the parents that these vaccines are available as: MMR, Influenza (Vaxigrip), Inject able polio (IPV), DPT booster, Pneumococcal, Meningococcal, Chickenpox (Okavax), Typhoid, Hepatitis A and B, Yellow fever, Rabies, Rota virus, Japanese encephalitis, Td booster, Human papilloma virus (HPV) vaccine. Thus by giving these newer vaccines, children are been protected against harmful infections before they come into contact with the infection in the community by using the body’s natural defense mechanism and by triggering an immune response to the disease without actually suffering from the disease. And stress should be given on booster doses as with period of time the effect of the vaccines goes on decreasing hence booster doses are required to boost up the immune response to a good level. And for other details on vaccination please check out my BLOG at 

http://www.drkabitakeyal.blogspot.com

Q2. I have a 1 year old baby girl and she usually suffers from pneumonia, whenever I land up with doctors they always comments that I was late for her check up and so the pneumonia is worsen and she requires admission. So could you please highlight on some important symptoms or signs by which I can early recognize her problem and take her to the doctor on time?

Answer:

Pneumonia is a broad term that is been used for most of the lower respiratory tract infection. It is more common in children less than five years of age. This being the commonest cause for seeking health facility in developing countries like ours it is important to know about some common signs and symptoms for its early recognition and treatment in time. Child with pneumonia will usually present with fever, cough, noisy breathing, fast breathing, poor feeding and vomiting at times. This is the time you should meet your pediatrician and get her treated before the disease become severe. But in case if child presents with fast breathing, restlessness, chest in drawing, (kokha hanne), wheeze, grunting, bluish discoloration of lips and skin, inability to drink/feed, Inability to rest properly then it indicates severe pneumonia and this is life threatening and requires urgent hospital admission without delay. My advice as a doctor is, since your child is just 1 year old, vaccinate your kid with pneumococcal and influenza vaccine for its prevention.

Q 3. My son is 7 years old and he usually suffers from constipation, he have difficulty in passing stools because of which he has pain and cries at times while passing stool. He also complains of passing blood at times when he have hard stool, which worries me? So doctor is there anything to be worried about and how do I help him?

Answer:

I know this is the common problem that we come across in our day to day OPD.

Most of the time constipation is just a habitual and because of improper dietary habits, but sometime it could be because of some disease like Hypothyroidism, some local anal problem like fissures or piles. So the most important thing for your son would be: give him a diet rich in fibers, green leafy vegetables, fruits, milk, increase liquid diet.

Help him to pass his stool comfortably by applying some Vaseline or lubricants around the anal area and examine locally for some wound,crack or some mass coming out per anus, which may be the cause of painful defecation. Finally get a surgical consultation to rule out some local anal problems and incase if your child is on chubbier side, with poor school performance, increase laziness then get his thyroid hormone tested after consulting with an endocrinologist.

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