Bedwetting or nocturnal enuresis is involuntary passage of urine while the child is asleep at an age beyond which the sphincter control is normally developed. An occasional lapse by child should not cause concern. Bedwetting is of two types - Persistent (or primary) type and the Regressive type. In persistent type child has never been dry at night and in regressive type, the sphincter control is developed at normal age and child remains dry for several months after which child again starts wetting bed at night.
Prevalence of nocturnal enuresis at 5 yrs of age is 7% for males and 3% for females. At 10 yrs of age it is 3% for males and 2% for females and at 18 yr of age it is 1% for males and rarely present in females. There is a marked familial pattern.
Persistent Type:
Persistent type of bed wetting is due to delay in maturation of neurological control of sphincters. Persistent type of nocturnal enuresis may also be due to inadequate or inappropriate toilet training. Parents who demand rapid toilet training may generate an angry response, the child unconsciously defy them by wetting the bed. But on the other hand parents who do not understand the timely need of toilet training may undermine childs effort to control the bladder.
One hypothesis also suggests that these children sleep deeply hence signal from distended bladder indicating the need to empty the bladder does not reach the conscious level of their brain during sleep. Treatment for Persistent type of Nocturnal Enuresis
1.Children should not be given liquids after dinner
2.Child should void before going to sleep
3.No punishment or humilation of child
4.Reward therapy - Reward the child for being dry at night
5. Conditional devices (alarm that rings when child wets the sheet) is reserved for persistent and refractory cases and is successful in more than 90% cases.
6.Bladder stretching exercises
7.Drug treatment is effective only briefly and there is exacerbation of symptoms once drug is discontinued.
Regressive type:
This type of bedwetting is precipitated by stressful environmental events such as birth of a sibling, death in family, marital conflict and moving to a new home.
Treatment for Regressive type of Nocturnal Enuresis:
This type of bedwetting is transitory. Prognosis is better and management is easier than persistent type. In both types of bedwetting organic pathology is found only in small number of cases. Organic causes such, as anomalies of urinary tract, juvenile diabetes; nephropathies and neurologic illnesses should be excluded by physical examination and investigations.
Common Cold:
The common cold is a contagious viral infection of the upper respiratory tract. A large variety of viruses are associated with common cold and that is why the body does not seem to be develop immunity against them. It commonly infects school-going children and the incidence of cold lessens with age. It is normal for a child to have cold eight or more times a year. This is because there are hundreds of different viruses and young children are meeting each one of them for the first time. Gradually they build up immunity and get fewer colds. Colds are caused by viruses and not bacteria, so antibiotics do not help.
Signs and Symptoms:
As the common cold mainly affects the upper respiratory tract, i.e. the nose, throat and the wind pipe, the symptoms mainly relate to them only. A cold often starts with a "tickle" in the throat, a runny or stuffy nose and sneezing. Children with colds may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite.
Duration:
Cold usually takes seven to 14 days in recovery . In case of an added infection by the bacteria or complications like sinusitis, ear infection, laryngitis or bronchitis occur, the illness will be prolonged.
Prevention:
As described earlier because of the huge number of viruses that can cause common cold, it has not been possible to develop an effective vaccine for this. Therefore prevention remains the best cure for common cold.To prevent spreading a cold, a child should avoid contact with other people for the first two to four days of the cold. Unfortunately, someone just coming down with a cold is contagious even before he/she knowsit is an infection. Children with colds should wash their hands thoroughly and frequently, especially after blowing their nose. When coughing or sneezing they should cover their nose and mouth.
Treatment:
Most of the colds are due to viruses and are self limiting, so treatment in the form of antibiotics is not generally required. Though medicine cannot cure common cold it can be used to relieve a few of the symptoms like muscle ache and headache. Some of the treatments worth trying are: taking salted water through the nostrils to relieve nasal congestion and petroleum jelly on the skin under the nose to soothe rawness. An older child can suck on hard candy or cough drops to relieve sore throat.Over the counter drugs like decongestants/ antihistamines should not be given to infants as they have been reported to cause hallucination, irritability, and irregular heartbeats in infants.
Plenty of extra fluids - juice, water, - should be consumed. Chicken soup, an age old remedy for the common cold is also worth trying for by the non-vegetarians.Some times babies who snuffle can’t breath easily when feeding or asleep. Raising the head of the mattress slightly by putting a blanket underneath may help. Your doctor may prescribe nose drops, which can help. Nose drops should not be used for more than a few days otherwise they may make the situation worse. You could try gently tickling your baby's nostrils-a sneeze might help clear your baby's nose.
A menthol rub or capsules containing a decongestant liquid, can put on to a piece of cloth which may help your child breathe more freely, specially at night. You can buy them from the pharmacist. Don’t use menthol products for babies under three months without asking your doctor, and be careful not to let your baby swallow a menthol capsule.Under normal circumstances common cold goes without any medication as such.
Diaper Rash:
Diaper rash is very common in babies and is not a sign of parental neglect. Most babies get nappy rash at some time in the first 18 months. Diaper rash is a type of irritant dermatitis (inflammation of the skin) that is localized to the diaper area in infants and often spares the skin of the folds beneath the diaper. Diaper rash may become infected by bacteria or yeast normally present on the skin. Effective treatment can eliminate diaper rash.
What causes diaper rash?
1.Common diaper rash is caused by at least two factors:
2.Contact irritation; and/or
3.Local skin infection due to overgrowth of various bacteria or fungal organisms.
Other causes include:
1.A sensitive skin
2. Rubbing or chaffing
3. Strong soap, detergent or bubble bath
4. Baby wipes containing alcohol
5. Diarrhoea or illnesses
6. Changes in diet such as weaning or changing from breast milk to formula.
In its early stages the rash may appear as red patches on your baby's bottom or there may be general redness. The skin may look sore and be hot to touch and there may be spots, pimples or blisters.
What treatments are recommended for diaper rash?
1.Avoidance of the precipitating agents: The best treatment for diaper rash is avoidance of the precipitating agents, which led to the contact irritation and to regions becoming secondarily infected by skin bacteria or yeast.
2.Open-air exposure of the irritated skin: is also extremely effective in helping clear up diaper rash.
3.Application of petroleum jelly: should a rash develop, simple cleansing with water and soft cloths tends to be less irritating to the injured skin than disposable wipes. Frequent application of one of the many diaper area ointments containing petroleum jelly (e.g. Vaseline) provides an effective barrier against skin irritants.
4.Several topical antibiotic ointments: in case there is a bacterial or yeast infection associated with the rash then a pediatrician should be consulted. Topical antibiotic ointments are available for therapy in these situations.
Protecting your baby from nappy rash
1.Change the nappy as soon as you can when it becomes wet or soiled. You may find your young baby needs changing 10 to 12 times a day, and older children at least 6 to 8 times.
2.Clean the whole nappy area thoroughly, wiping from front to back. Use a mild baby soap with plain water, or specially formulated baby lotion or gentle baby wipes. If using soap and water, rinse off the soap and pat dry thoroughly and gently.
3.Lie your baby on a towel and leave the nappy off for as long and as often as you can to let fresh air get to the skin.
4.How about not using disposable diapers?
Parents often wonder if switching from disposable to cloth diapers will lessen the likelihood of contact type diaper rash. In fact, the opposite seems to be true. The absorbent gel material found in most of today's disposable diapers draws moisture away from the skin area, thus helping to promote a healthy diaper area.
How should an allergic rash be treated?
For an allergic reaction to the fragrances or other components found in disposable diapers or wipes, eliminating the offending agents by using either simple water cleansing of the skin and a switch to another brand of disposable diapers or using cloth diapers instead is usually therapeutic.
Should steroid ointments be used?
The rash in many cases appears very red and serious, but attention to above-mentioned tips (like keeping the baby dry, exposing skin to air) can bring about a rapid relief. However, in some cases a minimally concentrated hydrocortisone cream may be recommended. However, the excessive usage of steroid ointments/creams can cause lot of other sideffects. They should only be used under the guidance of a pediatrician or another physician who is fully familiar with their application to infants.
Fever
Fever is a relatively common problem in children. As the body is trying to recognize and fight an enormous variety of viruses, bacteria and other microrganisms, fever is often, if not always, the result of this process. Fever can quickly make a child uncomfortable and sometimes dehydrated. Since fever may point to underlying illness, finding the cause of fever is the priority.
What is fever?
When the body's temperature rises above its normal level then it is called as fever. The average normal temperature of a human being is 98.6 degrees F ( 37 degrees C). A person's body temperature varies at different times of the day - slightly lower in the morning and slightly higher in the evening.
Your child may have a fever if the body temperature is:
higher than 100.4 degrees F (38 degrees C) measured rectally
higher than 100 degrees F (37.8 degrees C) measured orally or in the ear
higher than 99 degrees F (37.2 degrees C) measured under the arm
Guidelines for treating a feverish child:
1.Most children appear comfortable until their temperature reaches 38.50C and therefore no antipyretic medications is required.
2.Infants 3 months and younger require medical evaluation.
3.Refurbish the body fluids to prevent dehydration. High fever causes rapid fluid loss and can quickly lead to dehydration, especially in younger children. Water, soup, ice pops and juices are good to be given. Drinks containing caffeine, including colas and tea, should be avoided.
4.Do not force your child to eat if the child does not feel like eating. Let your child eat what she wants (in reasonable amounts). If the child has diarrhea, limit the intake of fruits and juice.
5.Sponging the child’s body with a wet compress, especially keeping it on the forehead, temples and the feet is a very effective method of bringing down the temperature. Use lukewarm water; cool water may cause shivering, which actually raises body temperature. Don't use rubbing alcohol, since it can be toxic. Sponging can be repeated as often as required.
6.Overheating due to overdressing can aggravate the fever so dress the child lightly, and make sure bedclothes too are light.
7.Children whose temperatures are lower than 102 degrees F (38.9 degrees C) usually do not require medication to treat their fever, unless they are uncomfortable. If your child's temperature is higher than 102 degrees F (38.9 degrees C), give her acetaminophen or ibuprofen based on the package recommendations for age or weight. If you don't know the recommended dose for your child's age and weight, call your doctor. Aspirin is not recommended for children under age 12.
Call your doctor if:
1.An infant 3 months or younger has a rectal temperature of 100.4 degrees F (38 degrees C) or higher.
2.An infant age 3 to 6 months has a temperature of 101 degrees F (38.3 degrees C) or higher.
3.Your child older than 6 months has a temperature of 104 degrees F (40 degrees C) or higher.
Your child shows any of the following symptoms along with fever :
1.inconsolable crying
2.continued irritability after fever has dropped
3.difficulty awakening
4.confusion or delirium
5.body rashes with fever
6.stiff neck
7.difficulty in breathing
8.the child refuses fluids or seems too ill to drink adequately
9.baby has any signs of dehydration
10.the child has a seizure or if
11.he/ she is still feverish after 72 hours
The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether the child has other symptoms with the fever. Nevertheless it is better to consult a doctor if you are confused regarding the exact condition of your child
Common Ear Nose Throat ProblemsPain In the Ear
Otalgia Earache is a common complaint especially among the children. It can often be quite severe and incapacitating. It could be due to causes locally in the ear or referred from other areas. Common local causes
1.Boil in the ear- Severe Pain in the ear Increased Pain on moving pinna & jaw.Analgesics & antibiotics will be required.
2.Impacted wax - In some people excessive wax may be secreted and deposited as a plug in the ear canal leading to decreased hearing & pain. It has to be removed by syringing or instrumental manipulation. Hard wax may repair softening with wax solvents before removal.
3.Infection of ear canal ( Otitis externa ) - Excessive scratching of ear canal with match sticks or hair pins leads to trauma to the ear canal and subsequent infection. Systemic antibiotics and local application of antibiotic drops may be required
4.Otomycosis ( Fungal infection of the ear) - You may have intense itching in the ear, discomfort and watery discharge .Seen commonly in swimmers and in tropical climates. Antifungal drops may be required.
5.Foreign body in the ear - A variety of foreign bodies are seen in the ear. Children are notorious in putting all sorts of things in their ears, the common ones being pieces of paper, thermocol pieces, grain seeds, chalk pieces, beads etc. Importantly, any manipulation to take out the foreign body at home should be avoided and an ENT specialist should be consulted.
6.Acute Suppurative Otitis Media (ASOM) - It is an acute inflammation of middle ear by bacteria. This condition is commonly seen in infants and children. Factors interfering with normal functioning of eustachian tube(the duct connecting the middle ear to the mouth cavity) predispose to ASOM.An E.N. T specialist should be consulted in the early stage when there is a mild earache. Antibacterial therapy decongestants and antipyretics are indicated. Minor surgery- incising the drum and releasing the pus may be indicated in a few cases.
7.Trama to the ear - A slap on the ear or a very loud noise can cause traumatic rupture of tympanic membrane and pain in the ear with decreased hearing. The ear should be examined and appropriate treatment instituted.
Other causes – of referred pain in the ear are - A carious tooth - Impacted molar tooth- Acute tonsillitis
As is evident from above, pain in the ear could really be due to a wide variety of reasons and it may indeed be difficult for the patient or the attendants at home to find out the reason. A tendency to put any kind of drops or oil should strictly be avoided. The best thing to do is to consult an E.N.T. specialist and get a thorough check up.
Worms
Worm infestations constitute an important health problem, especially in the children. Worm infestations are generally not noticed but can sometimes lead to significant problems, which affect many organ systems. Most of these are a result of unsanitary living conditions and poor food preparation. In countries like India, these constitute an important public health problem because infestation by hookworms is the cause of anemia in a significant number of children.
A wide variety of worms infest humans, these range from half-inch pinworms to tape worms as long as 30 feet. The more important among them are the pinworms, the roundworms, and the hookworms.
Most (not all) of the worms live in the intestines and generally don't cause prominent symptoms unless they penetrate the intestinal wall and move to another part of the body. Any worm infestation can lead to respiratory or cardiovascular complications.
Pinworms: These are very small worms, the size of about 2-4 mm, white in color and generally seen in clumps. It is characterized by the intense itching it produces in the anal area. Pinworms live in people's lower intestinal tracts. The female worm leaves the anus to deposit eggs in the anal area at night and induces severe itching. The consequent scratching transfers the eggs to the host's fingers. If inadvertently eaten, the eggs reach the intestines - hatch in the intestines and thus the cycle continues.
Roundworms causing Ascariasis: Roundworms constitute a major public health problem. It is estimated that upto 1/4th of the world's population is infected with roundworms. It lives in the small intestine, lays enormous quantities of eggs that are excreted in the feces. The eggs remain viable for a long time in the soil and can enter the body in unwashed or raw food. Foods that are eaten raw like salads and vegetables readily transmit the infection. Children playing in soil can also pick up infection.
Hookworms: It has been estimated that more than 200 million people are infected in India alone. Hookworms enter the body through skin, commonly through bare feet. It may also be acquired by food also. The larvae migrate to the small intestine, where they may live for several years taking nutrients from the intestinal walls. Hookworm infection causes chronic blood loss and depletion of body's Iron stores leading to Iron deficiency anemia. This can lead to retarded growth; Low Birth Weight babies (if the mother is infected). Their eggs are excreted in feces; if the infested feces contaminate soil, the cycle is repeated.
Symptoms
Apart from the characteristic itching in the anal area produced by pinworm infection most of the symptoms of worm infection are non characteristic. These include:
1.Anemia
2.Diarrhea
3.Nausea, vomiting
4.Changes in appetite and fatigue
5.Wheezing, coughing or other breathing difficulties.
Diagnosis
Most of the worms can be diagnosed from stool samples, which demonstrate their eggs/cysts. Pinworms can be diagnosed by using a piece of sticky tape to pick up any eggs that may be around the anal area; the tape is then checked under a microscope. The worm itself is sometimes visible in stool samples or around the anus.
Treatment
Most worms, thankfully, can be treated with a wide variety of available medicines effectively. Medicines commonly used include Mebendazole, Albendazole, Piperazine and Pyrantel.The treatment is usually repeated after two weeks to ensure removal of the worms and their eggs.
Prevention
1.Make sure children always wash their hands after going to the bathroom and before eating.
2.Keep fingernails short to reduce the chances of picking up worm eggs underneath them.
3.Wash all the vegetables, fruits thoroughly before eating raw.
4.Meat, especially pork should be thoroughly cooked before eating.
5.Ensure that children don't play barefoot in soil.
Prevalence of nocturnal enuresis at 5 yrs of age is 7% for males and 3% for females. At 10 yrs of age it is 3% for males and 2% for females and at 18 yr of age it is 1% for males and rarely present in females. There is a marked familial pattern.
Persistent Type:
Persistent type of bed wetting is due to delay in maturation of neurological control of sphincters. Persistent type of nocturnal enuresis may also be due to inadequate or inappropriate toilet training. Parents who demand rapid toilet training may generate an angry response, the child unconsciously defy them by wetting the bed. But on the other hand parents who do not understand the timely need of toilet training may undermine childs effort to control the bladder.
One hypothesis also suggests that these children sleep deeply hence signal from distended bladder indicating the need to empty the bladder does not reach the conscious level of their brain during sleep. Treatment for Persistent type of Nocturnal Enuresis
1.Children should not be given liquids after dinner
2.Child should void before going to sleep
3.No punishment or humilation of child
4.Reward therapy - Reward the child for being dry at night
5. Conditional devices (alarm that rings when child wets the sheet) is reserved for persistent and refractory cases and is successful in more than 90% cases.
6.Bladder stretching exercises
7.Drug treatment is effective only briefly and there is exacerbation of symptoms once drug is discontinued.
Regressive type:
This type of bedwetting is precipitated by stressful environmental events such as birth of a sibling, death in family, marital conflict and moving to a new home.
Treatment for Regressive type of Nocturnal Enuresis:
This type of bedwetting is transitory. Prognosis is better and management is easier than persistent type. In both types of bedwetting organic pathology is found only in small number of cases. Organic causes such, as anomalies of urinary tract, juvenile diabetes; nephropathies and neurologic illnesses should be excluded by physical examination and investigations.
Common Cold:
The common cold is a contagious viral infection of the upper respiratory tract. A large variety of viruses are associated with common cold and that is why the body does not seem to be develop immunity against them. It commonly infects school-going children and the incidence of cold lessens with age. It is normal for a child to have cold eight or more times a year. This is because there are hundreds of different viruses and young children are meeting each one of them for the first time. Gradually they build up immunity and get fewer colds. Colds are caused by viruses and not bacteria, so antibiotics do not help.
Signs and Symptoms:
As the common cold mainly affects the upper respiratory tract, i.e. the nose, throat and the wind pipe, the symptoms mainly relate to them only. A cold often starts with a "tickle" in the throat, a runny or stuffy nose and sneezing. Children with colds may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite.
Duration:
Cold usually takes seven to 14 days in recovery . In case of an added infection by the bacteria or complications like sinusitis, ear infection, laryngitis or bronchitis occur, the illness will be prolonged.
Prevention:
As described earlier because of the huge number of viruses that can cause common cold, it has not been possible to develop an effective vaccine for this. Therefore prevention remains the best cure for common cold.To prevent spreading a cold, a child should avoid contact with other people for the first two to four days of the cold. Unfortunately, someone just coming down with a cold is contagious even before he/she knowsit is an infection. Children with colds should wash their hands thoroughly and frequently, especially after blowing their nose. When coughing or sneezing they should cover their nose and mouth.
Treatment:
Most of the colds are due to viruses and are self limiting, so treatment in the form of antibiotics is not generally required. Though medicine cannot cure common cold it can be used to relieve a few of the symptoms like muscle ache and headache. Some of the treatments worth trying are: taking salted water through the nostrils to relieve nasal congestion and petroleum jelly on the skin under the nose to soothe rawness. An older child can suck on hard candy or cough drops to relieve sore throat.Over the counter drugs like decongestants/ antihistamines should not be given to infants as they have been reported to cause hallucination, irritability, and irregular heartbeats in infants.
Plenty of extra fluids - juice, water, - should be consumed. Chicken soup, an age old remedy for the common cold is also worth trying for by the non-vegetarians.Some times babies who snuffle can’t breath easily when feeding or asleep. Raising the head of the mattress slightly by putting a blanket underneath may help. Your doctor may prescribe nose drops, which can help. Nose drops should not be used for more than a few days otherwise they may make the situation worse. You could try gently tickling your baby's nostrils-a sneeze might help clear your baby's nose.
A menthol rub or capsules containing a decongestant liquid, can put on to a piece of cloth which may help your child breathe more freely, specially at night. You can buy them from the pharmacist. Don’t use menthol products for babies under three months without asking your doctor, and be careful not to let your baby swallow a menthol capsule.Under normal circumstances common cold goes without any medication as such.
Diaper Rash:
Diaper rash is very common in babies and is not a sign of parental neglect. Most babies get nappy rash at some time in the first 18 months. Diaper rash is a type of irritant dermatitis (inflammation of the skin) that is localized to the diaper area in infants and often spares the skin of the folds beneath the diaper. Diaper rash may become infected by bacteria or yeast normally present on the skin. Effective treatment can eliminate diaper rash.
What causes diaper rash?
1.Common diaper rash is caused by at least two factors:
2.Contact irritation; and/or
3.Local skin infection due to overgrowth of various bacteria or fungal organisms.
Other causes include:
1.A sensitive skin
2. Rubbing or chaffing
3. Strong soap, detergent or bubble bath
4. Baby wipes containing alcohol
5. Diarrhoea or illnesses
6. Changes in diet such as weaning or changing from breast milk to formula.
In its early stages the rash may appear as red patches on your baby's bottom or there may be general redness. The skin may look sore and be hot to touch and there may be spots, pimples or blisters.
What treatments are recommended for diaper rash?
1.Avoidance of the precipitating agents: The best treatment for diaper rash is avoidance of the precipitating agents, which led to the contact irritation and to regions becoming secondarily infected by skin bacteria or yeast.
2.Open-air exposure of the irritated skin: is also extremely effective in helping clear up diaper rash.
3.Application of petroleum jelly: should a rash develop, simple cleansing with water and soft cloths tends to be less irritating to the injured skin than disposable wipes. Frequent application of one of the many diaper area ointments containing petroleum jelly (e.g. Vaseline) provides an effective barrier against skin irritants.
4.Several topical antibiotic ointments: in case there is a bacterial or yeast infection associated with the rash then a pediatrician should be consulted. Topical antibiotic ointments are available for therapy in these situations.
Protecting your baby from nappy rash
1.Change the nappy as soon as you can when it becomes wet or soiled. You may find your young baby needs changing 10 to 12 times a day, and older children at least 6 to 8 times.
2.Clean the whole nappy area thoroughly, wiping from front to back. Use a mild baby soap with plain water, or specially formulated baby lotion or gentle baby wipes. If using soap and water, rinse off the soap and pat dry thoroughly and gently.
3.Lie your baby on a towel and leave the nappy off for as long and as often as you can to let fresh air get to the skin.
4.How about not using disposable diapers?
Parents often wonder if switching from disposable to cloth diapers will lessen the likelihood of contact type diaper rash. In fact, the opposite seems to be true. The absorbent gel material found in most of today's disposable diapers draws moisture away from the skin area, thus helping to promote a healthy diaper area.
How should an allergic rash be treated?
For an allergic reaction to the fragrances or other components found in disposable diapers or wipes, eliminating the offending agents by using either simple water cleansing of the skin and a switch to another brand of disposable diapers or using cloth diapers instead is usually therapeutic.
Should steroid ointments be used?
The rash in many cases appears very red and serious, but attention to above-mentioned tips (like keeping the baby dry, exposing skin to air) can bring about a rapid relief. However, in some cases a minimally concentrated hydrocortisone cream may be recommended. However, the excessive usage of steroid ointments/creams can cause lot of other sideffects. They should only be used under the guidance of a pediatrician or another physician who is fully familiar with their application to infants.
Fever
Fever is a relatively common problem in children. As the body is trying to recognize and fight an enormous variety of viruses, bacteria and other microrganisms, fever is often, if not always, the result of this process. Fever can quickly make a child uncomfortable and sometimes dehydrated. Since fever may point to underlying illness, finding the cause of fever is the priority.
What is fever?
When the body's temperature rises above its normal level then it is called as fever. The average normal temperature of a human being is 98.6 degrees F ( 37 degrees C). A person's body temperature varies at different times of the day - slightly lower in the morning and slightly higher in the evening.
Your child may have a fever if the body temperature is:
higher than 100.4 degrees F (38 degrees C) measured rectally
higher than 100 degrees F (37.8 degrees C) measured orally or in the ear
higher than 99 degrees F (37.2 degrees C) measured under the arm
Guidelines for treating a feverish child:
1.Most children appear comfortable until their temperature reaches 38.50C and therefore no antipyretic medications is required.
2.Infants 3 months and younger require medical evaluation.
3.Refurbish the body fluids to prevent dehydration. High fever causes rapid fluid loss and can quickly lead to dehydration, especially in younger children. Water, soup, ice pops and juices are good to be given. Drinks containing caffeine, including colas and tea, should be avoided.
4.Do not force your child to eat if the child does not feel like eating. Let your child eat what she wants (in reasonable amounts). If the child has diarrhea, limit the intake of fruits and juice.
5.Sponging the child’s body with a wet compress, especially keeping it on the forehead, temples and the feet is a very effective method of bringing down the temperature. Use lukewarm water; cool water may cause shivering, which actually raises body temperature. Don't use rubbing alcohol, since it can be toxic. Sponging can be repeated as often as required.
6.Overheating due to overdressing can aggravate the fever so dress the child lightly, and make sure bedclothes too are light.
7.Children whose temperatures are lower than 102 degrees F (38.9 degrees C) usually do not require medication to treat their fever, unless they are uncomfortable. If your child's temperature is higher than 102 degrees F (38.9 degrees C), give her acetaminophen or ibuprofen based on the package recommendations for age or weight. If you don't know the recommended dose for your child's age and weight, call your doctor. Aspirin is not recommended for children under age 12.
Call your doctor if:
1.An infant 3 months or younger has a rectal temperature of 100.4 degrees F (38 degrees C) or higher.
2.An infant age 3 to 6 months has a temperature of 101 degrees F (38.3 degrees C) or higher.
3.Your child older than 6 months has a temperature of 104 degrees F (40 degrees C) or higher.
Your child shows any of the following symptoms along with fever :
1.inconsolable crying
2.continued irritability after fever has dropped
3.difficulty awakening
4.confusion or delirium
5.body rashes with fever
6.stiff neck
7.difficulty in breathing
8.the child refuses fluids or seems too ill to drink adequately
9.baby has any signs of dehydration
10.the child has a seizure or if
11.he/ she is still feverish after 72 hours
The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether the child has other symptoms with the fever. Nevertheless it is better to consult a doctor if you are confused regarding the exact condition of your child
Common Ear Nose Throat ProblemsPain In the Ear
Otalgia Earache is a common complaint especially among the children. It can often be quite severe and incapacitating. It could be due to causes locally in the ear or referred from other areas. Common local causes
1.Boil in the ear- Severe Pain in the ear Increased Pain on moving pinna & jaw.Analgesics & antibiotics will be required.
2.Impacted wax - In some people excessive wax may be secreted and deposited as a plug in the ear canal leading to decreased hearing & pain. It has to be removed by syringing or instrumental manipulation. Hard wax may repair softening with wax solvents before removal.
3.Infection of ear canal ( Otitis externa ) - Excessive scratching of ear canal with match sticks or hair pins leads to trauma to the ear canal and subsequent infection. Systemic antibiotics and local application of antibiotic drops may be required
4.Otomycosis ( Fungal infection of the ear) - You may have intense itching in the ear, discomfort and watery discharge .Seen commonly in swimmers and in tropical climates. Antifungal drops may be required.
5.Foreign body in the ear - A variety of foreign bodies are seen in the ear. Children are notorious in putting all sorts of things in their ears, the common ones being pieces of paper, thermocol pieces, grain seeds, chalk pieces, beads etc. Importantly, any manipulation to take out the foreign body at home should be avoided and an ENT specialist should be consulted.
6.Acute Suppurative Otitis Media (ASOM) - It is an acute inflammation of middle ear by bacteria. This condition is commonly seen in infants and children. Factors interfering with normal functioning of eustachian tube(the duct connecting the middle ear to the mouth cavity) predispose to ASOM.An E.N. T specialist should be consulted in the early stage when there is a mild earache. Antibacterial therapy decongestants and antipyretics are indicated. Minor surgery- incising the drum and releasing the pus may be indicated in a few cases.
7.Trama to the ear - A slap on the ear or a very loud noise can cause traumatic rupture of tympanic membrane and pain in the ear with decreased hearing. The ear should be examined and appropriate treatment instituted.
Other causes – of referred pain in the ear are - A carious tooth - Impacted molar tooth- Acute tonsillitis
As is evident from above, pain in the ear could really be due to a wide variety of reasons and it may indeed be difficult for the patient or the attendants at home to find out the reason. A tendency to put any kind of drops or oil should strictly be avoided. The best thing to do is to consult an E.N.T. specialist and get a thorough check up.
Worms
Worm infestations constitute an important health problem, especially in the children. Worm infestations are generally not noticed but can sometimes lead to significant problems, which affect many organ systems. Most of these are a result of unsanitary living conditions and poor food preparation. In countries like India, these constitute an important public health problem because infestation by hookworms is the cause of anemia in a significant number of children.
A wide variety of worms infest humans, these range from half-inch pinworms to tape worms as long as 30 feet. The more important among them are the pinworms, the roundworms, and the hookworms.
Most (not all) of the worms live in the intestines and generally don't cause prominent symptoms unless they penetrate the intestinal wall and move to another part of the body. Any worm infestation can lead to respiratory or cardiovascular complications.
Pinworms: These are very small worms, the size of about 2-4 mm, white in color and generally seen in clumps. It is characterized by the intense itching it produces in the anal area. Pinworms live in people's lower intestinal tracts. The female worm leaves the anus to deposit eggs in the anal area at night and induces severe itching. The consequent scratching transfers the eggs to the host's fingers. If inadvertently eaten, the eggs reach the intestines - hatch in the intestines and thus the cycle continues.
Roundworms causing Ascariasis: Roundworms constitute a major public health problem. It is estimated that upto 1/4th of the world's population is infected with roundworms. It lives in the small intestine, lays enormous quantities of eggs that are excreted in the feces. The eggs remain viable for a long time in the soil and can enter the body in unwashed or raw food. Foods that are eaten raw like salads and vegetables readily transmit the infection. Children playing in soil can also pick up infection.
Hookworms: It has been estimated that more than 200 million people are infected in India alone. Hookworms enter the body through skin, commonly through bare feet. It may also be acquired by food also. The larvae migrate to the small intestine, where they may live for several years taking nutrients from the intestinal walls. Hookworm infection causes chronic blood loss and depletion of body's Iron stores leading to Iron deficiency anemia. This can lead to retarded growth; Low Birth Weight babies (if the mother is infected). Their eggs are excreted in feces; if the infested feces contaminate soil, the cycle is repeated.
Symptoms
Apart from the characteristic itching in the anal area produced by pinworm infection most of the symptoms of worm infection are non characteristic. These include:
1.Anemia
2.Diarrhea
3.Nausea, vomiting
4.Changes in appetite and fatigue
5.Wheezing, coughing or other breathing difficulties.
Diagnosis
Most of the worms can be diagnosed from stool samples, which demonstrate their eggs/cysts. Pinworms can be diagnosed by using a piece of sticky tape to pick up any eggs that may be around the anal area; the tape is then checked under a microscope. The worm itself is sometimes visible in stool samples or around the anus.
Treatment
Most worms, thankfully, can be treated with a wide variety of available medicines effectively. Medicines commonly used include Mebendazole, Albendazole, Piperazine and Pyrantel.The treatment is usually repeated after two weeks to ensure removal of the worms and their eggs.
Prevention
1.Make sure children always wash their hands after going to the bathroom and before eating.
2.Keep fingernails short to reduce the chances of picking up worm eggs underneath them.
3.Wash all the vegetables, fruits thoroughly before eating raw.
4.Meat, especially pork should be thoroughly cooked before eating.
5.Ensure that children don't play barefoot in soil.
