You Can Easily Prevent ‘Ear Infection’( In Bengali ‘Kan Paka’)

Ear infections are one of the most common illnesses among the babies and young children. Most common form of infection is the ‘Otitis Media’ (middle ear infection). It is very common in children between 6 months to 3 years of age. It is not a contagious disease. Its consequences can be very severe if not treated. It usually occurs with cold. The causative agents may be virus or bacteria. There is a tube that connects the ear cavity with the throat. In children this tube is wider, shorter and almost horizontal, so germs are carried easily from throat to ear cavity. Sign symptoms develop very rapidly after infection, ranging from unexplained fever, trouble in sleeping, tugging or pulling of affected ear, having trouble in hearing quiet sounds, older can tell bout ear pain specially at night. Younger babies remain extremely irritable, continuously crying and refuse breast feeding. Sometimes they show discharging of thin yellowish or whitish fluid from affected ear. This fluid may contain germs, so one should be careful while checking baby’s ear. One must wash hands after handling the affected ear. We(doctors) make diagnosis by examining the ear with a specialized instrument called ‘Auroscope’. We prescribe oral antibiotic after diagnosis and advice regular clearance of ear discharge with cotton. For fever and pain paracetamol is enough. Occasionally some nasal drops are prescribed depending on situation. You can take your child to a child specialist or ENT specialist. To prevent ear infection 1) ) breast feed your baby 2) avoid bottle feeding 3) immunize according to our national schedules(EPI) 4)use a cotton ball soaked with oil to cover the ear opening while bathing your child 5) Do not breast feed/bottle feed your baby in lying position or during sleep.

Asthma (In Bengali ‘Hapani’)- Not Only a Disease of Adults

Asthma can occur in children. Many factors are related to asthma- genetic(asthma in parents, grandparents, siblings etc), environmental(allergens which triggers asthma), viral infections, atopy(allergy in patient and family) etc. In asthma the inner wall of the airway become sore, swollen and narrow. Asthma in young children can be difficult to diagnose. Sometimes it can be difficult to tell whether a child has asthma or another childhood conditions like bronchiolitis(airway viral infection) or pneumonia(viral or bacterial infection). Most children who have asthma develop their first symptoms before 5 years of age. Wheeze(a typical noisy sound during breathing) is the most classic sign of asthma but all wheeze do not go on to develop asthma. Childhood asthma may begins with bronchiolitis(a viral infection) in 25-30% cases and symptoms remit by adolescent period. Only 5% develop persistent asthma. Depending on the wheeze we can classify children into 2 categories: early onset wheeze, appearing during the 1st 3 years of life, which is transient, resolves with time. Late onset wheeze appears mostly around 6 years and remains persistent. In this case there must be a positive family history of asthma or atopy. A young child having frequent wheezing episodes should be considered to have asthma  rather than airway infection if: 1) a  parent has asthma 2) history of atopy in family or the child itself like atopic dermatitis(allergic itchy skin condition), rhinitis (sneezing, nasal discharge, itchiness on exposure to dust, pollens, cold, fumes, pets etc), conjunctivitis(red eye with itchiness) 3) repeated attacks of wheeze(in younger)/night cough(in young)/trouble breathing or chest tightness(in older children) without any infection or other illness 4) presence of triggering or precipitating factors. You should know about the precipitating factors: infections (flu, common cold), irritants (cigeratte smoke, air pollutants), pets, foods( prawns, brinjal, hilsha fish etc), dust, pollens, shifting of temperature or humidity (mostly cold or moist air), drugs (aspirin) , stress, exercise etc. Asthma can be diagnosed from history of patient and his family. Lung function tests are often used to make a definite diagnosis in older children that are not applicable in case of younger. We may use a 4/6 weeks trial of asthma medicines to see if they make a difference in your child’s symptoms or not. After confirming the diagnosis we classify asthma, score the patient and advise step care management. We use two types of medicine- one for quick relief and another for long term control. But most important part of treatment is the asthma education. Due to lack of asthma education many asthmatic children suffer in spite of taking all effective medicines appropriately. Remember two things for asthma- it is a totally controllable disease & prevention is better than cure.

“Autism”- Your Special Child

As a parent, you never want to believe that your precious child has a problem. When it is about autism parents only see a dark future. After starting journey with their autistic child they find new hope in every steps of life. No matter your child’s age, don’t lose hope. Treatment can reduce the effect and help your child to learn, grow and thrive well. Autism appears in infancy and early childhood affecting many basic areas of  development such as talking, playing, learning & interacting with other signs and symptoms varies from child to child. Some have mild impairment while others have severe problems. Basic three areas of development- language and communication, behaviour, social interaction are more or less affected in autism. You can find that your child isn’t doing many things that his or her brother did at same age. An autistic child initially may have only speech delay. They usually do not look at your eyes (little or no eye to eye contact). Whenever anything is needed they do not point that object what other normal children do, they hold your hand and take you towards that object. They usually play with part of a toy/object like wheel of a car, TV remote etc. They show some unusual behavior (not age appropriate) or body movement in a repetitive manner. An autistic child do not feel interest to play with other babies of his/her age, rather they remain busy with themselves. Most of the time they remain quiet, but sometime become violent. They cannot pretend imaginary play like cooking, riding horse, driving car etc. Whenever you notice this sort of behavior in your child, don’t forget to take him/her to a child development specialist. Autism diagnosis is possible as early as three years of age. Diagnosis includes some checklist evaluation containing information about your child. No blood test, CT scan or MRI is needed. If a diagnosis of autism is made, don’t panic. Remember it is a difficult aspect of life, not a life threatening illness. Your autistic child is not mad at all, he/she is your special child who needs special care.

‘Thalassaemia’- The Silent Killer

Thalassaemia is usually an inherited (acquired from parents) blood disorder caused by defect in the core structure of the cell called ‘gene’. Thalassaemia is caused by alterations (mutations) in the ‘gene’ that makes haemoglobin. The condition produces ineffective haemoglobin within red blood cells, which in turn causes anaemia. Red blood cells are important for carrying oxygen to all organs in the body, this process is hampered. Thalassaemia is sometimes mistaken for iron deficiency anaemia until blood tests are carried out. Thalassaemia is a lifelong condition. Beta thalassaemia is more prevalent than alpha. Beta thalassaemia has different forms: beta thalassaemia major, requiring lifelong regular blood transfusion along with other therapies. Beta thalassaemia intermedia, a milder form of the condition and the severity will differ between individuals, from mild anaemia to the need for frequent blood transfusions. Beta thalassaemia minor can lead normal life without any treatment. Most babies born with beta thalassaemia won’t show symptoms until they are about six months old. Symptoms include: anaemia , jaundice , enlarged abdomen (tummy) caused by an enlarged liver or spleen, growth failure, skeletal deformities (unusual bone growth) and many other consequences. Too much iron deposited in the body due to disease process can cause silent internal organ damage if not treated. Two blood tests are sufficient to diagnose this disease- CBC with PBF & Hb electrophoresis. To prevent the disease the following measures can be undertaken- increase awareness among people, avoid cousin marriage, check carrier state before marriage by blood tests, haemoglobin electrophoresis after birth(at one year of age), test(chorionic villus sampling) during pregnancy etc. All tests are available in our country.

Awareness, not fear, is necessary for Dengue Fever

Dengue fever is a viral fever, the carrier of which is Aedes mosquito. Let’s discuss about how Aedes mosquitoes can be destroyed, and the fever prevented.

Steps to prevent dengue:

1) Throw any unusable containers that are lying around inside the house, outside the house, on the roof, on any corners, into the dustbin, and keep any bushes and drains nearby your house clean.

2) Always be alert that any usable container isn’t left water clogged for more than 5 days.

3) Make sure that unused car tires, discarded tin containers, plastic bottles, earthen pots( used for containing curd), cans, cavities in tree trunks, coconut shells, flower pots, refrigerator/ air cooler trays, etc, aren’t left water clogged for more than 5 days.

4) If anyone from your house or from nearby has dengue, then a doctor has to be consulted, and the nearest city corporation must be informed.

 Symptoms of dengue fever:

1) Sudden rise of body temperature to 104/1050

2) Headache, muscle pain, pain behind the eyes, stomach ache, backbone pain

3) Loss of appetite, vomiting tendency, vomiting

4) Bleeding underneath skin, conjunctival bleeding

5) Black tar-like stool

6) Bleeding from gum, nose, mouth and anus

7) Internal bleeding in case of hemorrhagic dengue fever, and accumulation of water in the abdomen ( ascitis) and the lungs ( pulmonary oedema)

8) Appearance of measles-like rash

9) Decreased blood pressure, rapid pulse, restlessness, hypothermia, breathing difficulty, unconsciousness

Initial treatment (at home):

Reduction of high body temperature is vital. For this, pour water on the head, and perform whole-body-sponging with luke warm water. Paracetamol can be used. Give the patient huge quantities of liquid diet- plain water, saline water, green coconut water, fresh juice, milk, etc.

Never do this:

1) Giving any medicine other than paracetamol (aspirin, ibuprofen, naproxen, diclofenac, etc).

2) Wasting time instead of consulting a physician, if any form of bleeding manifests.

Newborn and Jaundice

The yellow discoloration (jaundice) of a baby after birth is a common thing. If there is jaundice, the baby has to be kept in the mild sunlight in the morning, and this is known by all mothers and grandmothers of our country. Maximum (over 2/3) newborn babies develop jaundice after birth and in almost all cases, this is physiological jaundice. Physiological jaundice appears usually at or after 48 hours, the Bilirubin level remains at 12-15 mg/dl, the baby remains healthy otherwise and jaundice clears within 10 days. Physiological jaundice cures spontaneously without treatment. If jaundice appears within first 48 hours after birth, then it is termed as pathological jaundice. There are many causes behind this, but the two most contributing factors are- 1) a mother having blood group ‘O’ while the babies blood group is ‘A’ or ‘B’ 2) If the mother has negative blood group and her first baby has a positive blood group, and if the mother doesn’t take anti-D injection within the proper time after her first baby is born, then her future babies who have a positive blood group have much higher chances of having jaundice. Therefore at least be aware of this fact that if jaundice appears within first 48 hours, then a physician must be consulted; if it appears within 24 hours, do nothing but rush to a physician immediately. If jaundice persists for more than 10 days in term-baby and for more than 14 days in pre-term baby, then it is called prolonged jaundice. A physician has to be consulted in this case as well. The laboratory test that we do to detect the level of jaundice is serum bilirubin (total/direct/indirect). Every child has a normal bilirubin level in respect to his/her weight and age. When the bilirubin level exceeds this normal value, then treatment is necessary. Treatment for jaundice includes breastfeeding, phototherapy, exchange transfusion and the treatment for the cause of jaundice. Jaundice first appears on the face and then gradually heads downwards. Jaundice should always be looked for in broad daylight because it cannot be distinguished in the nighttime. If the child has jaundice, then consult a pediatrician instead of going to an ayurvedic physician (Kabiraj). Don’t compromise on frequent breastfeeding when the baby has jaundice.

Do not shake your baby forcefully

When a baby keeps crying vigorously, he/she is often shaken in order to stop the crying. Again, if adults get very angry over the kids, they tend to shake the kids to express their anger. This shaking has a bad side to it, which is known as ‘shaken baby syndrome’. When babies are shaken forcibly, their brain strikes against  the skull (bones which cover the brain), getting  injured. Therefore blood vessels along the outside of brain, nerves, and brain tissue might get torn apart; the result of which might be bleeding in the brain, swelling of brain, increased pressure in the brain, and other accidents. Not only that, retinal hemorrhage might be followed by blindness; permanent physical or mental disabilities, and even death may occur.Babies have a softer brain, underdeveloped neck muscles, and the size and weight of their head is greater in proportion to their body. Therefore when shaken forcibly, the balance between the head, neck, etc is not maintained, and the injuries are faced. Usually this occurs more in babies under two years of age, but this can occur in babies aged over 2 years as well; the chances are greater in cases of newborns. Even if shaken forcefully for a short time only (5secs), accidents may occur. There is no need to be terribly frightened because what women generally do is- they place their baby on their knees and shakes them gently to put the baby to sleep. Many others toss the baby in the air. This doesn’t cause any injury. Therefore the message is that, a baby must NEVER be shaken with force in any circumstance whatsoever.

My baby cries every night

A mother notices that, all of a sudden her completely healthy child cries out loud almost every day, after evening, and that the baby cannot be consoled by any means. At all other times the baby is completely all right. The reason for this crying is ‘infantile/baby colic’. This can affect one in every 5-6 newborn. Usually it starts 3-4 weeks after birth, takes a severe form in between the 4-6 weeks, and gets cured within 3-4 months of age. This occurs in a certain time of day, particularly in the evening or after. The signs for this are – the baby cries out loud all of a sudden, babies’ hands clench, legs curl up, the face reddens, and the belly appears swollen, etc. Symptoms may become more severe soon after feeding, especially in babies who are not assisted to belch. It may persist from a few minutes to a few hours. Often it is seen that this colicky cry stops after the baby passes gas or stool. Even if the exact reasons are unknown, stomach or intestinal gas, overfeeding, certain proteins in breast milk/formula, excitement, etc are considered to be the most important causes of this colicky cry. However, the good news is that it doesn’t cause any harm to the child, this has no complications, and it resolves spontaneously without treatment over time. The modalities of treatment available are-1) proper counseling of parents as well as family members about this condition because it makes their life hell 2) advising the mother to refrain from certain foods, such as, cow’s milk and dairy products, chocolate, coffee, soy, nuts, wheat, onion, etc 3) switching the formula ( some baby may be sensitive to proteins in formula) 4) avoiding overfeeding/ two quick feeding 5)using medication like Simethicon ( Flacol drop) 6) adoption of various safe remedies to stop babies’ cries. However, if poor weight gain, vomiting (if altered color or if forceful),stool change (diarrhoea/constipation/blood mixed), abnormal temperature (fever/hypothermia), lethargy, irritability (crying all day), etc, are associated with this colicky cry, then taking your baby to a doctor is a must.

Toilet/Potty training

Toilet training refers to teaching a child how to use the toilet/potty for urination or defecation. This is more or less a difficult task and therefore parents have to spend a considerable amount o f time behind it. To achieve this, children should not be forced or scolded, rather they should be encouraged. Usually children master bowel control (defecation) earlier than bladder control (urination). A female child masters bowel control and bladder control earlier than a male child. Toilet training depends on the child’s physical and emotional readiness, social norms, cultural factor, mutual understanding between child and parent, etc. However, if we consider the age factor, then a child can be habituated with toilet training within 18-24 months. If started earlier, the training will take a long time to complete. Whether the baby is ready for toilet training or not, can be inferred in various ways; for example, the degree to which a child is interested in potty/toilet, whether the child is capable of understanding the general instructions for toilet training, whether the child creates a sound, facial expression or a particular posture before urination or defecation, whether the child can sit on the potty chair or get up after using it, etc. If most of the answers are ‘no’, then you need to wait some time more before starting toilet training. Therefore buy the age appropriate equipments at the right time, prefix a routine for as many times you will provide toilet training and start the training. Make an attempt on toilet training at least once before putting your child to sleep at night. This will reduce chances of bed wetting. Bangladeshi mothers use a unique whistling sound in order to make their children urinate. From this alone, it can be understood that success of toilet training depends on two factors- your ability to understand your child’s vocal or body language, and whether your child understands what you want him/her to understand. Depict the whole process in such a way so that your child assumes toilet training to be a game

Natural history of ‘TEETH’

Every new event related to a child brings about tremendous joy for the parents. One such event is the eruption of teeth. Often parents get worried when their child’s tooth doesn’t erupt timely. The first set of teeth that erupts is called primary teeth, deciduous teeth, or milk teeth. All of these shed off later to be replaced by secondary or permanent teeth. The total number of milk teeth is 20 and that of permanent teeth is 32. Usually milk teeth begin to erupt when the baby is 6-7 months old and eruption gets completed by the age of 24-30 months. Teeth of the lower jaw erupt slightly earlier than those of the upper  jaw. The milk teeth start shedding off when the baby is around 6-7 years old, and this process continues up till the child has an age of 12-13 years. The eruption of permanent teeth starts simultaneously with the beginning of the shedding process, and this happens when the child is aged 6-7 years. While the permanent teeth eruption is getting completed, the child reaches adulthood. The last set of teeth erupts at an age of 17-25 years. This set is called third molar or wisdom teeth. Up till now, this article has been about normal teething process but there can be exceptions. Many children may be born with teeth, which is called ‘natal teeth’. This can be pre-deciduous teeth, in which case the teeth might be loose, having no root, and poorly formed. In this case, extraction of the teeth is necessary because chance of aspiration/choking is very likely. If root is present, then it is deciduous teeth which have erupted early. In this case extraction isn’t necessary. Teeth are a human beings precious body part. Therefore teach your children to take care of their teeth from a very early age. Teeth should be brushed 2 times daily- once after breakfast, and once after dinner.