Many parents are very much concern about their blood group combination. A common query is ‘which combination of blood group between husband and wife is better?’ If the husband’s and wife’s blood group is same (for example husband is ‘A’ and wife is ‘A’) there is no problem. But if the wife is having negative blood group (for example ‘A negative’) and the husband is positive (A positive), a ‘Lethal Gene’ is formed which further prevent the successful development of the embryo. In that case baby may born dead or may be blind since birth. Besides these, when a negative mother carries a positive baby, the first baby remains unaffected. But during delivery positive blood from baby enters the mother through placenta (গর্ভফুল).This produce an antibody in mother’s blood which is called ‘Rh antibody’. During second pregnancy if the baby is again positive the mother’s preformed antibody enters the baby through placenta and destroy baby’s red blood cell. This is known as ‘Rh Incompatibility’. If husband is positive baby should have its blood group checked immediate after birth. If baby is positive mother should be given ‘anti D’ injection within 72 hrs of delivery. If baby is negative nothing to do.
Parents have common queries about the age of babies when meat can be introduced in diet. Many parents want to start meat at 3rd or 4th months of age. Some parents consider that only chicken is safe for children as a source of meat. As we all know that the first six months is the time of exclusive breast feeding, nothing additional can be given during this time. When weaning has been fully established, meat can gradually be introduced in diet. From practical point of view, it is better starting with chicken. Step by step, beef or mutton can be given. For any kind of food which is new for your baby, follow the rule “start low go slow”. Any meat can be given depending upon the tolerance and digestion capacity of your baby. Each 100 gm of beef contain 118 kcal energy and 25 gm protein. Animal protein contains all essential amino acids many of which are lacking in vegetable protein like pulse. Moreover red meat contains huge amount of iron. If we consider the food value of meat (chicken/beef /mutton) it is one of the most important sources of nutrition to build body of your growing children. Only when a baby exhibits repeated attacks of allergy or any repeated physical problem to a particular type of meet that should be avoided. Otherwise there is no recommendation that beef cannot be given to kids.
Stammering or stuttering (তোতলানো), is a problem in speech fluency. This is one of the most common speech disorders in children. The problem is in the flow of sounds they produce, feeling like a sudden loss of control of words. Actually what happen is repetition of a syllable or word like mu…mu…mu…mummy or using of undue pause or prolongation of a sound while talking. So naturally they avoid the problem words. Its exact cause is unknown but genetic or other factors may play role. If a father had stammering his sons are likely to experience it. Stress, tension, anger or fear can trigger it. Diagnosis is confirmed by a speech language specialist .Treatment is based on proper counseling and mental support to the parents. Parents should not pressurize the child, scold him or blame for it. Affected child should be encouraged to talk more and more. If it persists then speech therapy can be applied. Early diagnosis and treatment is highly effective if it is started during preschool ages. But follow up sessions are important to prevent relapses. Parents, school teacher and therapist may play the key role to overcome this problem.
Now a days, the environmental temperature and the humidity in air is very high in Bangladesh. As a result excessive sweating occurs. Body looses huge amount of water and salt and gets dehydrated. Anybody exposed to high temperature for long time can be a victim to ‘Heat Stroke’ or ‘Sun Stroke’. Heat stroke occurs due to high body temperature and dehydration. Children and older persons are more vulnerable. The symptoms are vomiting tendency or frank vomiting, excessive weakness, headache, muscle pain, elevated body temperature, lack of sweating, abnormal behavior, palpitation, breathing difficulty or unconsciousness. When anybody gets heat stroke he/she should immediately be taken in a cool place (under air cooler or fan), cloths should be removed, cool water in the body or ice pack in armpit, neck, back or groin should be applied immediately. If able to drink cold liquid should be given. It is wise to prevent heat stroke than to treat it. Two simple measures can prevent this unwanted life threatening situation- avoid prolong exposure or exercise in a very hot and humid weather and drink more and more pure liquids.
Rotavirus is the most common cause of diarrhea in children. Worldwide, rotavirus is estimated to cause >111 million cases of diarrhea annually in children younger than 5 yr. Rotaviruses are classified into seven groups (A, B, C, D, E, F, and G) among which group A (mostly), group B and occasionally group C cause human infection. Rotavirus infection is most common during winter months in temperate climates (as in Bangladesh). Disease tends to be most severe in babies 4-36 months of age. Infants younger than 3 months are relatively protected by inherited immunity from mother and breast-feeding. Rotavirus spread efficiently via contaminated water and food, and outbreaks are common in children’s hospitals and child-care centers. Rotavirus infection begins with mild to moderate fever as well as vomiting, followed by frequent, watery stools which often continue for 5-7 days. Stool contains no blood and dehydration may develop rapidly. Avoiding and treating dehydration and providing adequate nutrition are the main goals in treatment of rotavirus diarrhoea. There is no routine role for antiviral or antibiotics drug treatment. Probiotic may have some benefits only in mild cases and not in dehydrating disease. ORS is enough for mild to moderate dehydration but severe dehydration requires immediate intravenous therapy after hospitalization. Oral rehydration solution available in our country (ORS by SMC) is appropriate for treating mild to moderate dehydration. Breast-feeding should be continued during diarrhea and rehydration. Normal age appropriate diet is also encouraged. Our parents are particularly concerned about rotavirus vaccine. The pentavalent vaccine (Rota Teq) is given at 2, 4, and 6 months of age. The 1st dose should be administered between 6 and 12 week of age, with all 3 doses completed by 32 week of age. The monovalent vaccine (Rotarix) is administered as 2 oral doses at 6 and 10 week. There should be at least 4 weeks interval between two doses and the doses should be completed by 24 weeks of age. Rotavirus vaccine can be given safely along with other EPI vaccine. In Bangladesh, monovalent vaccine is commonly used. You can choose any one vaccine for your kids or can rely on your doctor’s choice.
Adenoid also known as pharyngeal tonsil or nasopharyngeal tonsil, are situated high in the throat behind the nose and are not visible through the mouth or nose without special instruments. Adenoids are part of the immune system, which helps fight infection and protects the body from bacteria and viruses. At times, they become infected, enlarged and may even cause airway obstruction. Adenoids are only present in children. They start to grow from birth and are biggest when your child is approximately three to five years old. By age seven to eight they start to shrink and by the late teens, are barely visible. The adenoids will have disappeared completely in adulthood. It may be necessary to remove the adenoids if they become swollen or enlarged due to infection or allergies. If your child’s adenoids are enlarged, it may be hard to breathe through the nose. The common features of adenoid enlargement are mouth breathing, nose sounds(snoring during sleep), nasal blocked, runny nose, repeated ear infections, restlessness during sleep, pauses in breathing for a few seconds at night(may indicate sleep apnea). Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness, and may even cause behavioral or school performance problems in some children. X-rays is sufficient in determining the size and shape of the adenoids. Removal of the adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. An adenoidectomy is a quick operation to remove the adenoids. It takes about 30 minutes to perform and is carried out in hospital by an (ENT) surgeon. So, if your child is between 3-5 years, having mouth breathing and snoring during sleep, have a check up for enlarged adenoid.
Hand, foot, and mouth disease is a common and contagious viral illness that usually affects children younger than 5 years old. However, it can sometimes occur in adults. It looks like chicken pox, so anybody can be confused. It usually starts with a fever, loss of appetite, sore throat and a feeling of being unwell (malaise). One or two days after the fever, painful sores can develop in the back of the mouth, as small red spots that blister and can become ulcers(herpangina). A skin rash with red spots, and sometimes with blisters, may also develop over one or two days on the palm and sole; it may also appear on the knees, elbows, buttocks or genital area giving an impression of chicken pox. Some people, especially young children, may get dehydrated if they are not able to swallow enough liquid because of painful mouth ulcers. The virus that causes hand, foot, and mouth disease can be spread by the infected person’s saliva, cough, or nasal secretion, blister fluid, and stool. Generally, a person with hand, foot, and mouth disease is most contagious during the first week of illness. You child should stay home while he/she is sick with hand, foot, and mouth disease. Treatment is only symptomatic- paracetamol to relieve pain and fever (Aspirin should not be given to children), mouthwashes or sprays that numb mouth pain, enough liquid to prevent dehydration. There is no vaccine to protect against the virus. Some measures can prevent the spread of infection like hand washing with soap and water, especially after changing diapers and using the toilet, avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease. Like other viral diseases it usually cures without any significant complications.
Scabies, also known as the “seven year itch”, is a highly infectious skin disease. It is one of the three most common skin disorders in children. Most common symptoms are severe itchiness specially at night. Pimple like rash, small pus filled bumps are seen commonly around the wrist, in between fingers, waist line, armpit, groin, palm and sole and scalp in case of young children. Although they can occur at any place but mites (which causes the disease) prefer to reside in certain parts of the body mentioned above. Excessive scratching of the itchy rash may cause skin breakdown and bacterial infection. In severe cases, crust form from this lesion known as crusted scabies. Crowded living condition like day care centers, overcrowded family, lack of personal hygin and close contact with affected person increases the risk of spread. Other family members may be affected simultaneously (mother- child involvement is most frequent). Diagnosis is made clinically (no tests are required). A number of medicines specific for scabies are available like permethrine (mostly used), crotamiton, lindane, ivermectin etc depending on the age and severity. Along with specific therapy, anti-histamine and antibiotic may be used depending on the severity of itching and bacterial infection. All family members who are affected must be treated simultaneously. All clothing, bedding, towels used by the affected persons should be washed in boil water, dried properly and must be calendared. Otherwise the germ will remain alive and cure will be very difficult. Both prevention and treatment of scabies is very important because infected scabies may led to kidney disease.
Is your baby a very calm, quiet and good baby? Does he/she remain sleepy all the time? Not interested in feeding, but surprisingly gaining weight? Not passing stool daily? If the answers are ‘Yes’, you must think of Congenital Hypothyroidism. Now the question arises what is Congenital hypothyroidism (CH)? It can be defined as the lack of thyroid hormones since birth results from complete or partial loss of thyroid (a butterfly shaped gland situated at the lower neck) function. If it is not detected and treated early, it can cause irreversible brain damage and poor mental development. What is the cause? May be defect (structural or functional) in the major hormone producing glands like pituitary and/or thyroid, use of some anti thyroid medications (carbimazole) by mother or due to iodine deficiency. At birth baby may be normal, but gradually develops feeding problem, excessive sleepiness, less activity, low frequency of crying, constipation, prolonged jaundice( yellow skin, eyes, urine) persisting more than 14 days after birth and so on. By 3 months features of hypothyroidism come out completely. There may be protrusion of tongue, hoarseness of voice while crying, low body temperature, rough skin, swollen mass over the neck (goiter), excessively gaining weight etc. As delay in identifying this problem can cause irreversible brain damage and low IQ level, every baby should be screened after birth for congenital hypothyroidism. This test is usually carried out on the 5th day after birth via a simple pinprick collection of blood and analysis of TSH, T4 hormones. It is a part of newborn screening program throughout the world but not well established in Bangladesh. The aim of this screening is early detection and hormone replacement to halt all these disabilities. It can be serious if not diagnosed early but it is a completely treatable disease. If your doctor suggests the screening of hypothyroidism for your newborn baby don’t say ‘Not Now’.
The urinary system consists of kidney up to the genitalia. Many problems of this system can start before birth and some develop thereafter. Kidney diseases are much more common in children. Infection anywhere in the pathway of urination (UTI) mainly but not exclusively affects female babies. It manifests as fever, refusal of breast feeding, screaming or crying during urination, frequent urination (many times more than the usual), burning sensation during urination, irritability, cloudiness of urine etc. We diagnose urine infection by urine routine and culture test to see the growth of bacteria. If bacteria is positive antibiotic therapy is needed. UTI in any child under two years of age must be evaluated by a child kidney specialist (Paediatric Nephrologist). ‘Hydronephrosis’(enlarged swollen kidney) is one of the most common problem which usually starts when a child is in its mother’s womb. It can be easily diagnosed during pregnancy by ultrasonogram(USG). Another common birth defect in male babies is ‘Posterior Uretheral Valve’. The newborn present with poor urinary stream, palpable urinary bladder, repeated urinary infection and hydronephrosis. Diagnosis can be made by USG and MCU (micturating cystourethrogram) with RGU(retrograde urethrogram). Treatment is surgery. Pinhole orifice of the foreskin of penis (Phimosis) may cause difficulties in urination and repeated UTI. If so, circumcision is the solution. If a child of 4-6 years rapidly develops swelling of whole body including genitalia, scanty urine and a curd like concentration of urine while boiling in a test tube, ‘Nephrotic Syndrome’ is the highest possibility. ‘Acute glomerulonephritis’( passage of red urine with hypertension and swollen face) is the disease of 5-15 years. In case of ‘Chronic Kidney Disease’ you may find your child is getting pale (anemia) day by day, not gaining weight, having hypertension and changes in bones. If you suspect any sign that arises question in your mind, do consult your Paediatric Nephrologist. Your timely decision can save the child’s kidney.