A to Z of children’s health problems

Dr. Mandar V. Bichu gives the concluding part of the series.

Things to know

Not eating well. No appetite, or anorexia, is one of the common complaints parents have regarding their child’s food intake.

Unless it is accompanied by growth failure or other significant symptoms, anorexia is usually not a problem.

Commonly, the no-appetite complaint is often related to physiological factors such as painful teething, individual likes and dislikes and a natural slowing down of growth in post-one year of children.

Parental tactics such as force-feeding, food fads, over-reliance on milk-feeds, late introduction of semi-solid foods and refusal to allow the child to self feed are often the root causes.

Things to do

Discuss and understand whether no appetite in your child is related to a medical problem or a natural physiological cause.

Things to know

Being overweight means having a weight higher than normal for a particular age or height. Obesity is to have excess body fat in addition to being overweight.

There has been a 100 per cent rise in obesity in the Middle East countries over the last 20 years.

Childhood obesity has doubled in children and tripled in adolescents in last 30 years.

Faulty genes, metabolic or hormonal diseases and medicines can sometimes cause obesity.

Most common cause of obesity is faulty lifestyle (lack of physical exercise and faulty diet pattern).

Things to do

Set a good parental role model for lifestyle.

Establish good food habits from infancy.

Encourage regular physical activity.

Pica, or dirt-eating, is an annoying and potentially dangerous habit where a child regularly eats unusual non- food items from his/her vicinity.

Almost 10-30 per cent of children between 1- 6 years suffer from this condition at some point of their life.

The substances eaten are commonly mud, clay or wall-paint. Even things like plaster, pebbles, ash, wallpaper, strings, rags, stationery items (paper, pencils, crayons), shoe-soles, hair and stools are sometimes habitually eaten by pica patients.

Parental neglect, psychological/behavioural problems and mental retardation can cause pica but many times there is no underlying cause.

It can lead to lead poisoning, worm infestation, iron deficiency or surgical intervention.

Things to do

Get a medical opinion to rule out associated problems.

Establish a good nutritional pattern.

Clear the environment of ‘offending’ items.

Many quick-fix medicines are sold for chronic problems (asthma, obesity, diabetes, joint-disease etc.), promising sure-shot quick cures without any need to make any changes in the lifestyle. These advertisements are unethical and these products are almost always bogus.

It is wise to know that every medical problem cannot be fully solved only through OTC medicine syrups, pills and injections.

Correction of faulty lifestyle habits is an important part of managing many medical problems.

Not all proclaimed herbal or alternative remedies are safe.

Things to do

Do not over-rely on medicines for cure. Ask your doctor for advice and not just the prescription.

Do not indulge in self-medication by falling prey to advertisements. Take proper medical guidance.

Eye-strain, eye rubbing, lid inflammation, headache, holding objects/reading material close, not able to see clearly either the near or the far objects are the warning signals that there might be a refractory error of the eyes.

Sometimes, a squint (cross-eye) is the first sign of an underlying refractive error.

Near-sightedness (myopia), far-sightedness (hypermetropia) and astigmatism are the main refractory errors of the eyes.

Things to do

Regular eye-check-ups by an eye-specialist are advisable before discharge from newborn nursery, at 6 months, at 3 years, at 5-6 years and at the first sign/suspicion of any eye problem.

Unbreakable plastic-made spectacles/glasses with prescribed appropriate lenses are most commonly used to treat refractive errors in children.

Things to know

Because of typical childhood traits such as curiosity, ignorance, fearlessness and physical/emotional immaturity, children are always more prone for accidents both, at and away from home.

Falls, cuts, burns, electrical shocks, choking, poisoning, drowning and road-accidents are always possible when children are around.

Things to do

Be aware that children are at higher risk for accidents.

Be alert for that danger in their presence.

Prevent domestic accidents by using child-proofing methods.

Tonsils and adenoids are lymphoid tissues, which produce antibodies and play an important role in immunity.

Tonsils are situated at the back of the throat and adenoids behind the nose and above the throat, covered by soft palate.

Abnormal enlargement (hypertrophy) of tonsils and adenoids occurs when their lymphoid tissue starts working overtime as a result of a chronic infection or an allergy.

Once enlarged, they lose their protective role and instead become easy targets for infections. They also start blocking the respiratory passage. Enlarged tonsils also block the food passage.

Frequent infections (of throat, nose, ear and sinuses); mouth breathing, snoring and sleep apnea are some common symptoms of tonsil and adenoid problems.

Things to do

Humidification of air (cold mist humidifier), nasal drops, decongestants, anti-allergic medicines and antibiotics under medical guidance give good results.

Umbilical hernia is a common problem in newborns and infants.

A balloon-like belly button which increases in size on crying is the way it looks.

It happens because coils of the intestines protrude from an opening in a weak abdominal wall.

It is usually a harmless condition and corrects itself by year 1.

Things to do

Usually there is no treatment needed.

Vomiting is the forceful ejection of stomach contents and can be caused by many conditions. The age of the patient, associated symptoms and clinical/investigative findings are important factors in ascertaining the diagnosis.

In newborns and infants, vomiting can be caused by simple feeding errors (overfeeding, not burping well or wrong feeding position); reflux, infections or surgical conditions.

In older children, vomiting can be due to infection, motion sickness, food intolerance, medicine side-effects, poisoning or surgical problems.

The infection causing vomiting need not be only limited to gastrointestinal tract. Upper respiratory infections, pneumonia, meningitis and generalized septicaemia also can cause vomiting.

Surgical conditions causing vomiting can be congenital (e.g. birth defects of stomach and intestines) or acquired (e.g. appendicitis).

Things to do

Do not just try to suppress vomiting with anti-emetic medicines. It may mask the serious internal cause.

Always take a medical opinion.

In many cases, bottle-feeding is often started under the wrong presumption of mother’s milk being inadequate.

Breast-feeding, which is inarguably the best feeding method for the baby, is often stopped when bottle-feeding begins.

If the sterilisation method and feeding position are not proper, then bottle-feeding makes the baby prone for many infections (particularly gastrointestinal, ear and upper respiratory infections). Overfeeding and obesity are common in bottle-fed babies.

Prolonged bottle-feeding beyond the age of 1 year can cause additional problems such as tooth decay, reluctance for solid foods and constipation.

Ready-made baby-foods do not offer any great advantage over home-cooked foods.

Things to do

Always consult your doctor to know the proper technique of breastfeeding, bottle-feeding and weaning.

Be aware of the pitfalls in bottle-feeding and baby-foods.

Stop the bottle-feeding by 1 year and start cup feeding.

Investigations such as X-rays, scans and blood/urine/stool tests do provide additional information and they are priceless when necessary.

Such tests are usually necessary in case of uncertain diagnosis, unresponsiveness to treatment or suspected complications.

Unfortunately, it is a harsh reality that many patients are subjected to many needless tests in simple straightforward illnesses.

Things to do

Jaundice, characterised by yellow skin and eyes, is not a disease by itself but a sign of excessive blood levels of bilirubin, a waste-product chemical produced during the normal breakdown of red cells in the body.

In newborn babies, jaundice is most commonly ‘physiologic’, meaning it is as a result of immature metabolic system. It is usually transient and harmless.

In older children and adults, the jaundice is commonly ‘Infectious’, caused by hepatitis viral infection affecting liver. There are many types (hepatitis A,B, C, D and E) of such viruses.

Things to do

Exposure to mild sunlight and frequent feeds are often enough to treat Physiologic jaundice in newborns. Some babies may need phototherapy or exposure to special tube-lights.

Infectious jaundice is usually managed symptomatically and doesn’t have a specific treatment.

Sleep periods vary from 15-18 hours/day in infancy to about 10-11 hours/day in childhood.

At younger ages, the lack of sleep may manifest as hyperactivity, irritability or fretfulness.

Later on in life, it can cause decreased attentiveness, decreased short-term memory, delayed response and inconsistent performance at school, college or work.

Apart from an inability to fall asleep or frequently getting up during the sleep, there are certain specific sleep-related problems like nightmares, night terrors and night walking (Somnambulism).

Things to do

Be prepared for some sleepless nights in early infancy as the babies sleep more in the day and also have a lighter sleep. But rest assured that naturally, their night sleep patterns will improve after 6 months.

Establish a good sleep schedule from an early age.

Keep a winding-down preparatory time before the actual sleep time.

Do not use a feeding bottle or a sweetened pacifier as a sleeping device for your baby/child as it would lead to serious tooth decay.