Childhood Stress

Sources of Stress in Children

Stress in your children commonly arise from outside sources (such as your family, friends, or school), but they can also come from within. The pressure we place on ourselves can be most significant because there is often a discrepancy between what we think we ought to be doing and what we are actually doing in our lives.

Stress can affect anyone , even kids , who feels overwhelmed. Toddlers, for example, may be anxious if the person they most need to feel safe — a parent — isn't around enough. In preschoolers, separation from parents is the greatest cause of anxiety.

As kids get older, academic and social pressures (especially the quest to fit in) create stress. In addition, well-meaning parents sometimes unwittingly add to their kids' stress. High-achieving parents might have great expectations for their kids, who may lack their parents' motivation or capabilities. Parents who push their kids to excel in sports or who enroll them in too many activities can cause stress and frustration if their kids don't share their goals.

Many kids are too busy to have time to play creatively or relax after school. Kids who complain about the number of activities they're involved in or refuse to go to them may be signaling that they're overscheduled.

Talk with your kids about how they feel about extracurricular activities. If they complain, discuss the pros and cons of quitting one activity. If quitting isn't an option, explore ways to help manage your child's time and responsibilities so that they don't create so much anxiety.

Kids' stress may be intensified by more than just what's happening in their own lives. Do your kids hear you talking about troubles at work, worrying about a relative's illness, or fighting with your spouse about financial matters? Parents should watch how they discuss such issues when their kids are near because children will pick up on their parents' anxieties and start to worry themselves.

World news can cause stress. Kids who see disturbing images on TV or hear talk of natural disasters, war, and terrorism may worry about their own safety and that of the people they love. Talk to your kids about what they see and hear, and monitor what they watch on TV so that you can help them understand what's going on.

Also, be aware of complicating factors, such as an illness, death of a loved one, or a divorce. When these are added to the everyday pressures kids face, the stress is magnified. Even the most amicable divorce can be a difficult experience for kids because their basic security system — their family — is undergoing a tough change. Separated or divorced parents should never put kids in a position of having to choose sides or expose them to negative comments about the other spouse.

Symptoms of Stress

While it's not always easy to recognize when kids are stressed out, short-term behavioral changes — such as mood swings, acting out, changes in sleep patterns, or bedwetting — can be indications. Some kids experience physical effects, including stomachaches and headaches. Others have trouble concentrating or completing schoolwork. Still others become withdrawn or spend a lot of time alone.

Younger children may show signs of reacting to stress by picking up new habits like thumb sucking, hair twirling, or nose picking; older kids may begin to lie, bully, or defy authority. A child who is stressed may also have nightmares, difficulty leaving you, overreactions to minor problems, and drastic changes in academic performance.

Reducing Stress

How can you help kids cope with stress? Proper rest and good nutrition can boost coping skills, as can good parenting. Make time for your kids each day. Whether they need to talk or just be in the same room with you, make yourself available.

Even as kids get older, quality time is important. It's really hard for some people to come home after work, get down on the floor, and play with their kids or just talk to them about their day — especially if they've had a stressful day themselves. But expressing interest in your kids' days shows that they're important to you.

Help your child cope with stress by talking about what may be causing it. Together, you can come up with a few solutions like cutting back on after-school activities, spending more time talking with parents or teachers, developing an exercise regimen, or keeping a journal.

You can also help by anticipating potentially stressful situations and preparing kids for them. For example, let a child know ahead of time that a doctor's appointment is coming up and talk about what will happen there.

Remember that some level of stress is normal; let kids know that it's OK to feel angry, scared, lonely, or anxious and that other people share those feelings.

Helping Your Child

When kids can't or won't discuss these issues, try talking about your own concerns. This shows that you're willing to tackle tough topics and are available to talk with when they're ready. If a child shows symptoms that concern you and is unwilling to talk, consult a counselor or other mental health specialist.

Books can help young kids identify with characters in stressful situations and learn how they cope. Check out Alexander and the Terrible, Horrible, No Good, Very Bad Day by Judith Viorst; Tear Soup by Pat Schweibert, Chuck DeKlyen, and Taylor Bills; and Dinosaurs Divorce by Marc Brown and Laurene Krasny Brown.

Most parents have the skills to deal with their child's stress. The time to seek professional attention is when any change in behavior persists, when stress is causing serious anxiety, or when the behavior is causing significant problems in functioning at school or at home.

If you need help finding resources for your child, consult your doctor or the counselors and teachers at school.

All about Congenital Heart Disease

It will be a real desperate situation  to know that your child has a congenital heart lesion (congenital means one that's present at birth). But congenital heart disease is a relatively common condition that affects almost 1 in every 100 newborns around the world. Newer technology, Medical experts, and experience can make accurate diagnosis and treatments that allow nearly every form of congenital heart disease to be treated.

Most defects today are treated with surgery, catheter procedures, and sometimes medication. Thanks to advances in techniques, surgical and heart catheterization procedures can treat congenital heart defects that once could not be treated effectively.

Cardiac surgery and cardiac catheterizations are now being performed on younger children — in fact, it's common for them to be done during infancy or even the newborn period. This has resulted in many long-term advantages for these children.

Although nothing can be guaranteed with 100% certainty, most kids with heart problems can enjoy happy and healthy futures.

Why Do Some Babies Have Congenital Heart Defects?

The human heart begins to form as a single tubular structure at about the fourth week of pregnancy. By the eighth week, this tube will gradually increase in length, eventually twisting upon itself. A wall, or septum, grows to divide the upper (atrial) and lower (ventricular) chambers into left and right sides. Four valves made of tissue develop, which will keep blood moving forward through the cardiac chambers, lungs, and body as the heart pumps.

Because the placenta (and not the fetus' lungs) does the work of exchanging oxygen and carbon dioxide, it's possible for even severe developmental abnormalities of the heart to exist without causing difficulties for the fetus. Such abnormalities may become important only after the fetus' circulation transitions to the newborn state after birth (when the umbilical cord is clamped at the time of delivery, the placenta is no longer involved in the baby's circulation).

The newborn becomes dependent upon the lungs and circulatory system for the oxygen and blood flow needed to survive outside of the womb. The right side of the heart receives oxygen-poor blood flowing back from the body and pumps it to the lungs, where the circulating blood picks up more oxygen. The left side of the heart receives oxygen-rich blood from the lungs and pumps it out to the body.

Multiple genetic and environmental factors interact to alter the development of the heart during the early stages of a fetus' development (the first 8 to 9 weeks during pregnancy). Sometimes, the cause of a congenital heart defect is known. Certain environmental exposures during the first trimester of pregnancy may cause structural abnormalities (including anticonvulsant medications such as phenytoin, the dermatologic medication isotretinoin, or lithium salts for manic-depressive illness). Uncontrolled diabetes, alcohol or drug abuse, or exposure to industrial chemicals during pregnancy can also increase the risk of congenital heart malformations. But most of the time, the specific cause of congenital heart disease is not known.

Over the past 25 years, advances in ultrasound imaging techniques have led to the availability of sophisticated tools such as fetal echocardiography, making it possible for many congenital heart malformations to be diagnosed as early as the 12th to 20th week of pregnancy. The use of such imaging has reassured many parents-to-be that their baby's heart is normal. For others, it has offered an opportunity to know long before the birth that there's a malformation. This gives the family and doctors the ability to make well-informed decisions about the best treatment options.

Signs and Symptoms of Congenital Heart Disease

After birth, the first sign of congenital heart disease is often the presence of a heart murmur. A murmur in itself is not a disease, but simply a sound. As the heart pumps blood, it sometimes creates vibrations that are heard through the doctor's stethoscope as a noise, or murmur.

Not all heart murmurs are signs of abnormalities — in fact, heart murmurs usually don't indicate the presence of any heart problem. Sometimes, a doctor can determine with the stethoscope alone whether a particular murmur is a sign of heart disease. In other cases, additional tests — such as chest X-rays, electrocardiograms (EKGs), or echocardiograms — are performed to help determine the exact nature of a murmur.

Although many children with minor forms of congenital heart disease may not require any treatment, some can have serious symptoms early on that will require medical or surgical treatment within the first year of life. One such symptom can be breathing difficulties from lung congestion. This is usually the result of excessive blood flow from the left side to the right side of the heart through abnormal connections between the two sides of the circulation, such as holes in the heart (as in ventricular septal defect, atrial septal defect, atrioventricular canal, and patent ductus arteriosus).

Or the congestion could be the result of obstructions to blood flow on the left side of the heart, resulting in a backup of blood in the blood vessels returning blood from the lungs (such as in aortic stenosis, coarctation of the aorta, and hypoplastic left heart syndrome). The shortness of breath in these babies may interfere with their ability to feed and may result in an inability to gain weight adequately. Such babies may require medical treatment or a procedure such as surgery or cardiac catheterization within the first weeks of life.

Other symptoms of congenital heart disease relate to an inadequate amount of oxygen carried within the blood. These infants usually appear to have blue skin, a condition called cyanosis. This can be due to an obstruction of blood flow to the lungs (such as in tricuspid atresia or pulmonary atresia) or due to a hole within the heart that allows oxygen-poor blood to flow from the right to the left side of the heart and out to the body (such as in total anomalous pulmonary venous return or Ebstein's anomaly). It can also be related to an abnormal positioning (transposition) of the arteries leaving the heart. In any of these cases, less red oxygenated blood comes from the lungs and more blue unoxygenated blood is carried to the body, causing the blue skin color.

Treatment for Congenital Heart Defects

Many heart abnormalities (including patent ductus arteriosus, ventricular septal defect, truncus arteriosus, atrioventricular septal defect, tetralogy of Fallot, and transposition of the great arteries) can be corrected with a single operation in early infancy. More complex abnormalities (including hypoplastic left heart syndrome and tricuspid atresia) may require a series of two or three operations beginning in the newborn period and completed at approximately 3 years of age. With most complex abnormalities, the children spend the majority of their time in the care of their parents at home, with occasional visits to the pediatric cardiologist (a heart specialist) as well as to the child's primary care doctor.

Less invasive procedures done in the cardiac catheterization laboratory, rather than the operating room, may be used to treat some conditions. Such treatments may include balloon angioplasty or valvuloplasty to relieve an obstruction of a blood vessel (such as in coarctation of the aorta) or a valve obstruction (such as in pulmonary or aortic stenosis). In these procedures, a pediatric cardiologist inserts a catheter, a thin plastic tube with a special balloon attached, into a blood vessel. The balloon is then inflated to stretch open the narrow area of the blood vessel or heart valve. Another procedure called transcatheter device occlusion may be used to close abnormal openings or holes within the heart or blood vessels (such as in patent ductus arteriosus, atrial septal defects, and ventricular septal defects) without requiring surgery.

Some abnormalities, such as small- or moderate-sized ventricular septal defects, may close or decrease in relative size as your child grows. While waiting for the hole to close, the doctor may prescribe medicines for your child, which some kids also need to take after surgery.

Whether treated surgically or medically, your child will need to regularly visit a pediatric cardiologist. At first, these appointments may be fairly frequent (perhaps every month or two), but after treatment, they may be cut back, sometimes to just once a year. Your child's cardiologist may use tools like X-rays, electrocardiograms, or echocardiograms to monitor the defect and the effects of treatment.
Preventing Infection

Kids with congenital heart disease are at risk for the development of bacterial endocarditis, an infection of the tissue that lines the heart and blood vessels. This serious illness requires prolonged treatment with intravenous antibiotics in a hospital setting.

Any time a child has a surgical procedure, the surgical incision can introduce bacteria into the bloodstream. Although the white blood cells of the body usually destroy these germs before an infection can occur, the rough surfaces that may be present within a congenitally malformed heart may allow some germs to survive and reproduce, resulting in an infection of the heart lining.

Fortunately, the risks of bacterial endocarditis can be greatly reduced by taking a dose of specific antibiotics before any scheduled medical procedures that have a risk for introducing germs into the bloodstream. This includes dental work and certain types of surgery.

However, some parents misinterpret this to mean that dental visits and cleanings are potentially dangerous and that they can avoid risk by avoiding the dentist. This is incorrect! In fact, the riskiest thing to do is to ignore dental health, which may allow teeth to develop cavities and gums to become infected. Along with taking antibiotics correctly, it's important for children with heart defects to take good care of their teeth by brushing and flossing properly. Your child should begin visiting a dentist as early as possible, and those visits should be as frequent as the dentist recommends.

Taking measures to prevent bacterial endocarditis is recommended for kids with almost all congenital cardiac malformations (except in the case of isolated ostium secundum and atrial septal defect). Discuss these preventive measures with your child's doctor, pediatric cardiologist, and dentist. Local chapters of the American Heart Association (AHA) or your pediatric cardiologist can give you free wallet cards detailing the recommended antibiotics and their appropriate doses.
If You Suspect a Problem

Although sudden serious downturns during or after cardiac treatment aren't common, you should watch for certain signs that could signal a need for medical attention. If your child appears to be working harder than normal to breathe, call your child's doctor right away.

Other signs that warrant immediate medical attention include:

* a bluish tinge or color (cyanosis) to the skin around the mouth or on the lips and tongue
* an increased rate of breathing or difficulty breathing
* poor appetite or difficulty feeding (which may be associated with color change)
* sweating while feeding
* failure to thrive (failure to gain weight or weight loss)
* decreased energy or activity level
* prolonged or unexplained fever

Call the doctor immediately if your child has any of these symptoms.


Caring for Your Child

Parenting kids with heart defects includes learning about basics like feeding, giving medicines, and watching for signs of trouble, but it also involves encouraging kids to become involved in their own care.

Because most congenital heart defects are now treated during infancy, it's often necessary to explain to an older child what happened in the past. When your child is old enough to understand, explain why he or she has a surgical scar, needs to take medication, or needs to visit the pediatric cardiologist. Describe the treatment in a way your child can understand and don't try to hide the details.

If kids believe they have a role in their care, they're likely to be more confident and positive. Your doctor may be able to suggest ways to discuss these issues.

Participation in some physical activities may be limited, but kids can still play and explore with friends. Always check with your child's cardiologist about which activities your child should or should not be doing. Certain competitive sports may be restricted, for example.

Although it's tempting for parents to be overly protective, sheltering kids can make them feel isolated and stigmatized — which may do more harm than a heart defect in the long run. So do everything you can to make sure your child leads as normal a life as possible.

All about Breast feeding

1) when to start Brast feeding in a newborn baby?

Breast feeding should be started as early as possible in all newborn babies regardles of the mode of delivery whethere it is cesarean section or normal delivary. Sometimes the mother may be sedated after the ceasaren surgeory but the baby should be put to breast as early as possible.

2) What is the best feeding technique for the newborn baby?
When suckling, the baby should hold the areola (dark area around the nipple) in its mouth and not just the nipple. Hold your baby in the crook of your arm, with the baby's upturned face towards you.Make sure that the baby's mouth and chin are near the nipple.The baby should hold the areola and the nipple inside its mouth, with its lips curled out.The baby's chin should rest on your chest.To facilitate this, in the beginning, the mother should slightly raise the nipple and insert it in the baby's mouth, with the upper areola just covered by the lips.The baby will feel the urge to suckle and will start sucking strongly and will swallow properly.It will look calm and contented.Importantly, this method reduces pain in the nipple, which some mothers feel.After feeding or in between, do not abruptly remove the baby from the breast.Slowly insert your little finger in the baby's mouth, open it, and then gently remove the breast.This prevents injury to the nipples.While breastfeeding, always feed the baby from breast and only when it empties out, then switch the baby to the other.A simple way to remember this is to wear a bangle in the arm from which side you are feeding and then, at the next feed, switch over.It is a fallacy that the right breast has food and the left breast has water.The sooner this is dispelled the better or else engorgement and hardening of breasts will take place.Not only are these painful but also can have long-lasting side effects.Always burp the baby on your shoulder after every feed.

3) Are fruit juices, soups etc. recommended in the initial few months after birth?No, after birth for 4 months nothing else except mother's milk is required. Other things can be harmful

4) Should gripe water, ghutti etc. be given? No, their use is unscientific and can be harmful.

Are Headphones Safe for Your Kids Ears?

These days, headphones join us on the bus, on the train, on the sidewalk, mid-conversation with a friend, and in the check-out line. These contexts might make it difficult to hear, which might lead us to turn the volume all the way up.

But how loud is too loud? A study published in the Archives of Internal Medicine suggests that increasing the volume on your headphones to drown out background noise can increase your risk of hearing loss.

Brian Fligor, director of diagnostic audiology at Children's Hospital Boston, addressed this issue in a recent Time.com article. He explained when to be concerned about the use of headphones and what we can do to reduce our risk of hearing loss, such as lowering the volume or reducing listening time. As a recent New York Times article points out, other options include using earbuds that build volume safety into their hardware.

HIV AIDS

What is AIDS?
AIDS denotes Acquired Immune Deficiency Syndrome. It is caused by the HIV virus (Human Immunodeficiency Virus). AIDS is the final disease stage of HIV whereby the patient’s immune system is completely destroyed and the patient suffers from variety of problems.

Is AIDS the same as HIV infection?
HIV infection means that a patient is infected with HIV virus. A patient with HIV infection may look completely healthy (asymptomatic carrier state), may have opportunistic infections such as TB, pneumonia or may finally go into full-blown AIDS. AIDS is the condition where the patient’s immune system is completely destroyed and the patient succumbs to various infections, has wasting and develops symptoms such as cancers, fever and diarrhea.

REMEMBER, NOT EVERY HIV INFECTED PERSON HAS AIDS.

How does one get HIV infection?
o Unprotected sexual intercourse with an infected person
o Sharing infected syringes and needles (as seen in drug abusers)
o Transfusion with contaminated blood & blood products.
Over 80% of HIV infection worldwide is sexually acquired.

In children, in addition to the above-mentioned routes of transmission, mother to child transmission during pregnancy, at birth or through breast feeding is the predominant mode of transmission and accounts for almost 80-85% of HIV infection in children.

What happens when a person acquires HIV infection?
Soon after contracting HIV, some persons may develop flu like illness with swollen lymph nodes, fever, malaise and rash lasting for 2 to 3 weeks. This is called as Acute (Primary) HIV infection. This stage is usually not seen in children as the primary infection is acquired at the time of pregnancy or at birth due to mother to child transmission.
Following the primary infection, a patient may remain and feel completely healthy. This is known as the asymptomatic stage. This stage usually lasts for 8-10 years in adults. However, in children this stage is shortened. During this stage, the virus is actively replicating in the body but the body’s immune system is also working hard to control the infection. Hence the patient remains asymptomatic. In children, the immune system is not fully mature. As a result, the virus soon overcomes the immune system and the patient starts manifesting signs and symptoms of the disease.
Once, the immune system breaks down, patient develops various infections such as TB, Pneumonia, Diarrhea, Herpes zoster etc. The virus may also affect various organs of the body such as lungs, eyes, gastrointestinal tract, brain, heart, liver and skin and cause various organ dysfunctions. During advanced stage of the disease, patient develops unexplained weight loss, fever; infections by unusual organisms and in adults’ rare cancers (Lymphoma & Kaposi’s sarcoma) can also develop. With development of AIDS, patient usually succumbs to the disease until and unless intervention with drugs is given.
I know an HIV infected person. Can I get HIV through such a contact?
No, HIV is not transmitted through casual contact at home or elsewhere. Sharing toilets, utensils, swimming pools, working in the same office, going to same school, insect bites do not transmit the virus.
There is also no risk of contracting HIV while donating blood, as all equipments used are sterile, used only once and discarded.

How does one test for the HIV virus?
Once a person gets HIV infection, the antibody against HIV appears in the blood only after 3-6 months after the virus has entered the body. The routine test (ELISA) detects the antibody to HIV virus. A positive test means that the person is infected with HIV. A negative test result means that no antibodies were detected at the time of the test. This would mean that either the person is uninfected or is in the window period (The period where the HIV virus is present in the body but antibodies have not developed). If there is a strong suspicion of exposure to the virus, a repeat test may be required after few weeks to overcome the window period. Confirmation of HIV infection can be done by other tests such as Western-Blot test. To detect the virus itself, tests such as PCR tests and viral culture are available. These tests are especially useful to diagnose HIV infection in infants as they may have maternal antibodies to HIV virus in their blood, which may give a false positive ELISA test. These tests can also be used to diagnose HIV infection during window period.

REMEMBER, A POSITIVE TEST DOES NOT MEAN THE PERSON HAS AIDS. IT INDICATES THAT THE PERSON IS HIV INFECTED.

Is there any treatment for HIV infection and AIDS?
At present there is no cure for this disease. Certain drugs called as antiretroviral drugs (ART) slow down the progression of the disease and can help the patient lead a normal, healthy life.
Certain vaccines are being developed against the HIV virus, however they are still in the trial phase.
Thus, the best treatment is prevention against the infection.

What are the precautions that an HIV infected person undertake?
First and foremost, the person suspected to have HIV infection should consult an HIV counselor and an HIV physician to understand the disease, various treatment options available and to ensure a normal healthy life as long as possible. Such a person should not have casual sex, should not donate blood or organs and in case of a female should avoid getting pregnant.

Adults should follow the following precautions:
· Advocate monogamous relationship with one uninfected partner.
· Avoid casual sex and practice safer sex (e.g., use of condoms)
· Do not inject drugs or share needles & syringes
· Receive only safe blood products
· Ensure that ear piercing; tattooing and acupuncture instruments are sterilized.

To avoid mother to child transmission of HIV following steps have found to be beneficial:
· ART to pregnant lady and to the baby after birth.
· Elective caesarian section (this prevents contact of baby to vaginal secretions at time of birth).
· Avoiding breast feeding (Breast milk is known to transmit HIV virus).

A pregnant lady should undergo voluntary testing for HIV infection and it found positive should consult an HIV specialist for prevention of mother to child transmission of HIV.

All about Head Lice

What are head lice? Head lice (Pediculus Capitis) are insects that are found on human head on the scalp and hair. These insects are parasitic in nature and feed on human blood that they suck through the scalp. They are almost a quarter on size as compared to rice grain and somewhat brownish in color. Though they are difficult to spot especially when they are in hair, but they can be seen by naked eyes when you put strain on your eyes. How does one suspect that one has head lice? A head louse can be very irritating as it very hard to find in the human hair due to its color and causes itching. But whenever there is itching in head, doesn’t mean that there are head lice. The only sure indication is when you see a head louse (lice is plural for head louse) in head. Is head live seen in people with poor hygiene? Often it is confused that that people with bad hygiene are infested with head lice. Head lice has nothing to do with personal hygiene, and they spread when people come in contact with a person already affected by head lice. How do head lice spread? Head lice are wingless creatures and cannot fly or swim. They spread whenever a person comes in direct contact with an infected person, or maybe using a comb that an infected person is using, or may be through bedrolls and pillows which a louse may use to migrate to other person scalp. How did head lice come into existence? It would be interesting to know when did head lice started, but as in case of all living beings, nobody knows this fact. But it is assured that they have been accompanying humans since quite long. What is the life span of head louse? The life cycle of head lice is very small, approximately 40 days in total. There entire life cycle is divided in three phases, i.e. nits, nymphs and adults. Nits are somewhat off-white in color and these are eggs which are laid by female head louse. Nits are very difficult to be identified as they are very small and can be often confused as dandruff. Once nits are layed, it takes around a week’s time for these nits to hatch. After hatching, they lice are undeveloped and immature and are called nymphs. The life cycle of nymphs is approximately a week, but they are mature enough to suck blood during this period. After a week, these nymphs are developed in a fully grown adult head lice. They have six legs with claws which they use to hold the hair firmly to avoid falling from the head. An adult head lose lives nearly 30 days on a human head if it is lucky. If it falls from a human head, it will hardly survive for 48 hours if it fails to find another human host as it survives only on human blood. How fast can head lice multiply? A female head louse can start laying eggs within 10 days of adult lifecycle. A female louse can lay upto 100 eggs during her entire life cycle on the human head. Not all of them hatch, hence at a time not many head lice are present in the head. How can head lice be prevented? Avoid use of others comb, caps, and mufflers. Make sure that the bed lines have been properly cleaned before you lie on it. Avoiding head to head contact if you know the person is infested with head lice. Though these are golden rules for head lice, it is very hard to make them follow to children’s. Hence it is found that most of the infected people are children. Can head lice be removed without medications? If you want to avoid applying medicated lotions, you might prefer wet combing or combing on oiled hair with special fine comb as the best option. These combs are designed specifically for head lice, as the space between two teeth of comb is very small, which avoids the louse getting slipped through it. Also as the hair is wet or oiled, the grip of lice on hair is comparatively weaker as compared to dry hair. The only problem comes when you have to comb again and again, which sometimes can leave a burning sensation on the scalp

What is Nasolacrimal Duct Obstruction ?

Nasolacrimal Duct Obstruction

My baby has excess watering of the eyes. What is the cause? Nasolacrimal duct obstruction is the commonest cause of watering of eyes in infants. Nasolacrimal duct is the duct that drains the tears from the eyes to the nose. In most of the children, the nasolacrimal duct opens before the first birthday.  What are the signs and symptoms of nasolacrimal duct obstruction? The most common symptoms of nasolacrimal duct obstruction are excess tearing and mucus discharge. This may lead to recurrent red eyes and infections. The excessive tearing can produce secondary skin changes on the lower eyelids as well.  What is the treatment for nasolacrimal duct obstruction?  Massage of the nasolacrimal sac leads to relief of obstruction. Antibiotics may be required for recurrent infections. In children in which the nasolacrimal duct obstruction does not resolve, probing is the surgical treatment.

Thinking of Some Nice Gift Ideas For Children ??

Kids always like gifts. When child does something that needs rewarding, an inexpensive gift could make a powerful statement and influence them. Kids are often picky. Finding the right gift can be hard. Children love to learn, despite how they act at school. Educational toys are great for kids.

Hooked on Phonics is a leading toys that helps children learn and have fun. You might also consider toys that let your child exercise and learning at the same time.

Trampolines sometime have a sing-a-long tool and learning games that help your child learn while exercising. The songs include music that teaches the child to count. They also have sound-recognition devices and memory enhancers. The child can also enjoy the sounds of animals while matching memories to learn.

Melissa and Doug learning tools are great for helping children grow while they learn. If the child is starting to learn the alphabet, you might consider the gift of sound puzzles that let the child have fun while learning the sounds of alphabets. The puzzles have colorful shapes with various letters.

This amazing toy can clasp on the walls. The child has over 20 choices of goals to select each week. Parents and children can track these goals daily, by using the flowers, stars, bears, balls, faces, etc. Magnets are included in the package, which leaves good statements to the child’s progress. For example, if the child had a good week reward he/she with the sparkling magnets that says you is a star, etc. You can also personalize your own magnets, since blanks are included.

Smaller children like learning tools that include sound. The Sorting Clocks are excellent learning tools. The child places a multicolored number in the proper slot and learns to tell time.

Children love to be trained at tasks, however, in spite of their recalcitrance. For that reason, some of the better gifts for children are educational games, toys, electronic-learning devices and so forth. Software games make great gifts for children and they are cheap too. Often, you can find computer games for less than $10. Some stores offer freebies, and you pay only for shipping and handling. If you are looking for a gift, compare, contrast and buy the best deal

Fearing of Attention Deficit Hyperactivity Disorder in your child?

ADHD In Children

There are several parents who live in the fear of whether their child has Attention Deficit Hyperactivity Disorder. Unlike many other disorders and other problems, ADHD can be one which bears both psychological and social impacts on virtually everyone who has anything to do with the child. ADHD, acronym for Attention Deficit Hyperactivity Disorder, is a neurological syndrome, mostly found in young children aged below 7 years. ADHD can be characterized by forgetfulness, hyperactivity, mood swings, distractibility, and poor impulse control. ADHD can effect on both children and adults and as many as 5 to 8% of all children are victims of this psychological disorder. It is estimated that many children with ADHD go undiagnosed each year.

It is reported that most ADHD cases in children develop before the age of 7, but the diagnosis comes only when there are problems in their development. For instance, parents or other relatives notice symptoms of ADHD in a child only when he/she exhibits a behavior which is inappropriate in attention or the child shows disability to keep track of his/her belongings. When your child shows any of these disabilities, it is necessary for you to seek out the help of a pediatrician.

There are mainly three types of Attention Deficit Hyperactivity Disorder - predominantly inattentive, predominantly hyperactive-impulsive, and a combined type. Some of the most common symptoms of ADHD include impulsive behavior (such as excessive talking, interrupting others, and blurting out answers before the question should be answered); destructiveness; restlessness; difficulties in reengaging a previous task; and inattentiveness which can be both a difficulty with sustaining attention. While for some children who are predominantly inattentive type of ADHD, the symptoms of ADHD can be sluggish behavior, daydreaming, confused behavior, hypo active, and staring occasionally. Further, some of these symptoms may not appear all in a sudden, or they’ll remain hidden until the child find himself/herself in a situation when he/she starts behaving a bit out of place.

In most of the cases, your physician will refer a psychiatric doctor for diagnosis of the condition. A psychiatric doctor will perform a series of tasks like talking to the child, observing him/her while playing and socializing as well as some other tests. If the physician certifies that your child has ADHD then there are several courses of action which you and your physician can talk about to determine how to find the solution for ADHD.

The treatment for ADHD includes a broad range of medications such as amphetamines, methylphenidate, and others. While some of these medications can result in increasing the levels of hyperactivity disorder in children without ADHD, in children who have ADHD disorders, these medications can help to focus and keep them in control. There are also several other types of alternative medications such as specific diets, Vitamin B6, and the use of pycnogenol. However, it is recommended to consult your physician before starting the treatment process

Is it necessary for me to store my baby's cord blood?

Umbilical cord blood

Up to 180mL of blood from a newborn baby that is returned to the neonatal circulation if the umbilical cord is not prematurely clamped. In some obstetric and midwifery practices, physiological extended-delayed cord clamping protocol, as well as water birth, allows for the cord blood to pulse into the neonate for 5-20 minutes after delivery. If the umbilical cord is not clamped, a physiological clamping occurs upon interaction with cold air, when the internal gelatinous substance, called Wharton's jelly, swells around the umbilical artery and veins.

Cord blood harvesting

A cord blood bank may be a private commercial enterprise, or a public medical resource.

Cord blood banking is controversial in the medical and parenting community. Blood collected this way takes up to 180mL from the neonate (sometimes up to half of the total blood volume) which is a highly controversial subject in perinatal medicine. Cord blood is rich in hematopoietic stem cells, however, The American Academy of Pediatrics 2007 Policy Statement on Cord Blood Banking states that:

"Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood;"

Cord blood is stored by both public and private cord blood banks. Public cord blood banks store cord blood for the benefit of the general public, and most U.S. banks coordinate matching cord blood to patients through the National Marrow Donor Program (NMDP). Private cord blood banks are for-profit organizations which store cord blood for the exclusive use of the donor or donor's relatives.

Public cord blood banking is supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases. Private banking is unlawful in France and Italy, and opposed by the European Group on Ethics in Science and New Technologies.

New parents have the option of storing their newborn's cord blood at a private cord blood bank or donating it to a public cord blood bank. The cost of private cord blood banking is approximately $2000 for collection and approximately $125 per year for storage, as of 2007. Donation to a public cord blood bank is not possible everywhere, but availability is increasing. Several local cord blood banks across the United States are now accepting donations from within their own states. The cord blood bank will not charge the donor for the donation; the OB/GYN may still charge a collection fee, although many OB/GYNs choose to donate their time.

After the first sibling-donor cord blood transplant was performed in 1988, the National Institute of Health (NIH) awarded a grant to Dr. Pablo Rubinstein to develop the world's first cord blood program at the New York Blood Center(NYBC), in order to establish the inventory of non embryonal stem cell units necessary to provide unrelated, matched grafts for patients.

In 2005, University of Toronto researcher Peter Zandstra developed a method to increase the yield of cord blood stem cells to enable their use in treating adults as well as children.

Controversy

While there is general support in the medical community for public banking of cord blood, the question of private banking has raised objections from many governments and nonprofit organizations. The controversy centers on varying assessments of the current and future likelihood of successful uses of the stored blood. In March 2008, a paper was published by Nietfeld et al. in the journal Biology of Blood and Marrow Transplantation which computed the lifetime probability (up to age 70) that an individual in the US would undergo a stem cell transplant. The likelihood of an autologous transplant using your own stem cells is 1 in 435, the likelihood of an allogeneic transplant from a matched donor (such as a sibling) is 1 in 400, and the net likelihood of any type of stem cell transplant is 1 in 217.

The National Marrow Donor Program estimates that by the year 2015, there will be 10,000 cord blood transplants world-wide per year using publicly banked cord blood. It is therefore vitally important to build public repositories of cord blood donations throughout the world. In the United States, the Health Resources and Services Administration (HRSA) of the US Dept. of Health and Human Services is responsible for funding national programs to register marrow donors and bank cord blood donations:

The European Union Group on Ethics (EGE) has issued Opinion No.19 titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded that "[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms." However, in the final section 1.27 of their Opinion, the EGE admits that: "if in the future regenerative medicine developed in such a way that using autologous stem cells became possible, then the fact to have one's own cord blood being stored at birth could increase the chance of having access to new therapies."

In May 2006, The World Marrow Donor Association (WMDA) Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage stated that:

1. The use of autologous cord blood cells for the treatment of childhood leukemia is contra-indicated because pre-leukemic cells are present at birth. Autologous cord blood carries the same genetic defects as the donor and should not be used to treat genetic diseases.
2. There is at present no known protocol where autologous cord blood stem cells are used in therapy.
3. If autologous stem cell therapies should become reality in the future, these protocols will probably rely on easily accessible stem cells.

As of spring 2008, there are several known instances where autologous use of cord blood is indicated:

1. Whereas the WMDA cautioned against autologous transplant for diseases with a genetic signature, there are pediatric cancers (ex: neuroblastoma) and acquired conditions (ex: aplastic anemia) which can be treated by autologous transplant. There has even been one autologous transplant for leukemia
2. Type 1 Diabetes, also known as Juvenile Diabetes, has been shown to improve if treated shortly after onset with an infusion of autologous cord blood. The American Diabetes Association reports that 1 in 7000 children is diagnosed each year with Type 1 diabetes, and 1 in 600 children are living with it.
3. Cerebral Palsy and other forms of pediatric brain injury have responded well to infusions of autologous cord blood in a clinical trial conducted at Duke University. The Brain Injury Association of America estimates that the prevalence of Cerebral Palsy is about 1 in 300 among children up to age 10.

All about Kawasaki disease

Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but can affect all ethnic groups.
Signs and Symptoms

Kawasaki disease can't be prevented, but usually has telltale symptoms and signs that appear in phases.

The first phase, which can last for up to 2 weeks, usually involves a persistent fever higher than 104° Fahrenheit (39° Celsius) and lasts for at least 5 days.


Other symptoms that typically develop include:

* severe redness in the eyes
* a rash on the stomach, chest, and genitals
* red, dry, cracked lips
* swollen tongue with a white coating and big red bumps
* sore, irritated throat
* swollen palms of the hands and soles of the feet with a purple-red color
* swollen lymph nodes

During the second phase, which usually begins within 2 weeks of when the fever started, the skin on the hands and feet may begin to peel in large pieces. The child also may experience joint pain, diarrhea, vomiting, or abdominal pain. If your child shows any of these symptoms, call your doctor.
Complications

Doctors can manage the symptoms of Kawasaki disease if they catch it early. Symptoms often disappear within just 2 days of the start of treatment. If Kawasaki disease is treated within 10 days of the onset of symptoms, heart problems usually do not develop.

Cases that go untreated can lead to more serious complications, such as vasculitis, an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart.

In addition to the coronary arteries, the heart muscle, lining, valves, and the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves also can occur.
Diagnosis

No one test can detect Kawasaki disease, so doctors usually diagnose it by evaluating the symptoms and ruling out other conditions.

Most kids diagnosed with Kawasaki disease will have a fever lasting 5 or more days and at least four of these symptoms:

* redness in both eyes
* changes around the lips, tongue, or mouth
* changes in the fingers and toes, such as swelling, discoloration, or peeling
* a rash in the trunk or genital area
* a large swollen lymph node in the neck
* red, swollen palms of hands and soles of feet

If Kawasaki disease is suspected, the doctor may order tests to monitor heart function (such as an echocardiogram) and might take blood and urine samples to rule out other conditions, such as scarlet fever, measles, Rocky Mountain spotted fever, juvenile rheumatoid arthritis, or an allergic drug reaction.
Treatment

Treatment should begin as soon as possible, ideally within 10 days of when the fever begins. Usually, a child is treated with intravenous doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection. The child also might be given a high dose of aspirin to reduce the risk of heart problems.

Do Allergies Cause Asthma?

Although allergies and asthma are separate conditions, they are related. People who have allergies — particularly those that affect the nose and eyes — are more likely to have asthma. If you have allergies or asthma, your child is more likely to have it, too, because the tendency to develop these conditions is often inherited.
But not everyone who has allergies has asthma, and not all cases of asthma are related to allergies. About 75% of kids who have asthma also have an allergy to something. And many people who have asthma find their symptoms get worse when they're exposed to specific allergens (things that can cause allergic reactions in some people).

With any kind of allergy, the immune system overreacts to normally harmless substances such as pollen or dust mites. As part of this overreaction, the body produces an antibody of the immunoglobulin E (IgE) type, which specifically recognizes and attaches to the allergen when the body is exposed to it.

When that happens, it sets a process in motion that results in the release of certain substances in the body. One of them is histamine, which causes allergic symptoms that can affect the eyes, nose, throat, skin, gastrointestinal tract, or lungs. When the airways in the lungs are affected, symptoms of asthma can occur.

Future exposure to the same allergens can cause the reaction to happen again. So if your child has asthma, it's wise to explore whether allergies may be triggering some of the symptoms. Talk with your doctor about how to identify possible triggers, which can be things other than allergens, such as cold air, pets, or tobacco smoke. Your doctor might also recommend visiting an allergist for allergy tests. If your child is allergic to something, that substance may be causing or contributing to asthma symptoms (coughing, wheezing, and trouble breathing).

If it does look like allergens are an important trigger for the asthma symptoms, do what you can to help your child avoid exposure to the allergens involved. If this doesn't control the asthma symptoms adequately, the doctor may also prescribe medications or allergy shots.

Croup

What is croup?

Croup is a condition that develops quickly in children and is usually caused by a viral infection in the upper airways that is localised in the throat and surrounding tissues. It is characterised by a barking cough.
It usually occurs in young children under five years of age, and in most cases clears up spontaneously in 24 to 48 hours.
Very rarely, croup is a sign of something much more serious, such as diphtheria.
How do you get croup?

The virus can either be transferred through airborne droplets produced by coughing and sneezing, or passed from one person to another by touch. From the hands, the virus may enter the mucous membrane of the eyes and nose.
Croup is usually caused by the parainfluenza virus, although there are many other possible viral causes. These include the RS virus, influenza virus type A, rhinovirus, adenovirus, and Coxsackie virus.
If a child has had croup before, it tends to recur when they have a cold. After the age of four to five years, these symptoms decrease in severity.
There may be an allergic element connected to the parainfluenza virus.
What are the signs of croup?

• A characteristic rough, barking cough.
  
• Hoarseness and noisy breathing.
  
• The symptoms often occur at night when the child has been lying down for a couple of hours.
  
• Fever.
  

What should one be especially aware of?

• The child becoming more tired.
  
• Difficulty breathing.
  
• Blueness around the mouth, nose, and nails.
  

Seek urgent medical help if any of these problems occur.
What can you do yourself?

• Calm the child as much as possible.
  
• Keep calm yourself. Obvious signs of uneasiness and anxiety will upset the child.
  
• Sit the child up, which will allow them to breathe more easily.
  
• Inhaling steam may lessen the symptoms - to create steam, try sitting the child in the bathroom with the hot tap running.
  
• Avoid heavy meals, since coughing may provoke vomiting.
  
• Encourage the child to drink plenty of fluids.
  
• If the child has a fever they should wear as few clothes as possible and not be put under warm bedclothes.
  

How does the doctor make a diagnosis?

• The diagnosis is made on the basis of the symptoms of the disease.
  
• If the doctor wants to know which micro-organism has caused the disease, a swab from the throat can be taken for examination.
  
• An X-ray may be needed, but only if the child is ill enough to need hospital admission.
  

Future prospects
Croup usually clears up without a problem in three to four days. However, the coughing may last some time longer. The disease usually gets worse at night when the child is lying down.
Additional problems that may be caused by croup include:

• severe breathing problems and lack of oxygen.
  
• blocking of the airways (obstruction). This is rarely seen, but is life-threatening.
  

How is croup treated?
Since the disease is a viral infection it cannot be treated with antibiotics.
Serious cases of croup result in admission to hospital where the patient will be given oxygen, corticosteroids and adrenaline by inhalation-treatment

Chickenpox (varicella)

What is chickenpox?

Chickenpox is a highly contagious illness that is common in children. It causes an itching skin rash with blisters. The disease is caused by the varicella-zoster virus and usually runs its course without problems.
How do you catch chickenpox?
The viral infection is transferred from one person to another through direct contact with the broken chickenpox blisters and through airborne droplets.
The infectious period lasts from about three days before the rash appears until all the blisters have formed scabs.
The incubation period between being infected with chickenpox until the disease breaks out and symptoms appear is 10 to 20 days.
What are the symptoms of chickenpox?

• A rash that usually begins on the body and face and later often spreads to the scalp and limbs.
  
• It may also spread to the mucous membranes especially in the mouth and on the genitals.
  
• The rash is often itchy.
  
• It begins as small red spots which develop into blisters in a couple of hours.
  
• After one or two days, the blisters turn into scabs.
  
• New blisters may appear after three to six days.
  
• The number of blisters differs greatly from one person to another.
  
• The infected person may run a temperature.
  
• These symptoms are mild in young children.
  
• Chickenpox lasts 7 to 10 days in children and longer in adults.
  
• Adults can feel very ill and take longer to recover. They are also more likely than children to suffer complications.
  

Who is at risk of complications?

• Pregnant women who have not had chickenpox.
  
• People with a weak immune system, such as those with acute or chronic leukaemia or HIV.
  
• Patients taking medicine to suppress their immune system, such as long-term oral corticosteroids.
  

Those in the at-risk group who are exposed to the varicella-zoster virus can be given an injection of varicella-zoster-immunoglobin to boost their immunity. In some countries, vaccination against chickenpox is available.
How does the doctor make a diagnosis?
The diagnosis is made by observing the symptoms and the typical appearance of the rash.
How is chickenpox treated?

• The treatment mostly consists of easing the symptoms.
  
• Remember that an infected person will be contagious until new blisters have stopped appearing and until all the blisters have scabs. They should stay at home while they are infectious.
  
• Avoid scratching the blisters because of the risk of infection.
  
• Cut the nails short or make the patient wear gloves.
  
• Pay attention to personal hygiene.
  
• Calamine lotion will help to relieve the itching.
  
• Keep the patient in cold surroundings, as heat and sweat may make the itching worse.
  
• In attacks of chickenpox where the itching is so serious that the child's sleep is totally disturbed, antihistamine medicines with a heavily sedative effect can be used. Antihistamines are medicines for allergic reactions, motion sickness or insomnia .
  
• In serious cases of chickenpox in people with a weak immune system, aciclovir (eg Zovirax tablets/suspension), which works specifically against chickenpox, can be used.
  

Which complications might arise?

• Bacteria may infect the blisters.
  
• Occasionally scars may remain at the site of the blisters.
  
• Conjunctivitis.
  
• Pneumonia.
  
• In very rare cases, chickenpox can result in complications such as meningitis, encephalitis, inflammation of the heart (myocarditis) or Reye's syndrome.
  

Future prospects
Once a person has had chickenpox, they will have immunity to the disease for the rest of their life. However, the virus may return later in life as shingles.
A person who has active shingles can infect others with chickenpox, but cannot give shingles to someone else.

Rheumatic Fever and Your Child

1. What is Rheumatic fever?

Rheumatic fever is usually seen in children between 5 and 15 years where, after an episode of fever and sore throat, child again develops fever, joint pain and joint swellings along with heart disease. There is a strong relationship with the throat infection caused by the bacteria Streptococcus.

2. What kind of children develops rheumatic fever?

Both male and female children are equally affected. In India this disease is rarely seen in children below 5 years. This disease is common in children of poor socioeconomic condition leading to unhygienic and over crowded living conditions. In the above mentioned scenario, the streptococcal bacteria producing sore throat which lead on to rheumatic fever develop commonly and spreads from one child to the other. Along with this, poor nutrition decreases the child’s resistance power to infection. In India when the rate of rheumatic fever in children between 5 and 15 years is around 6 per 1000, in Kerala it is 2 per 1000. Rheumatic heart disease contributes to 40 – 50 % of cardiac patients in a hospital. In S.A.T. hospital, every year, around 100 children get admitted due to rheumatic fever.

3. How does sore throat predispose to rheumatic fever?
Not every child with streptococcal infection of the throat develops rheumatic fever. Some children are genetically susceptible. The antibodies (molecules produced by the body to counter the infection) produced against streptococcal bacteria unfortunately react with the heart muscle, joints and sometimes the nervous system resulting in the manifestations of rheumatic fever.

4. What is the clinical picture of rheumatic fever?
At the onset, please remember that all the manifestations of rheumatic fever may not be seen in a single patient. Diagnosis is often made with the help of certain clinical features and other laboratory investigations.
The main clinical features consist of heart disease, arthritis (inflammation of the joints), chorea (purposeless jerky movements), subcutaneous nodules (swelling seen beneath the skin) usually seen on bony prominences like elbows, shin, back of the head and spine which are non tender and a peculiar rash (erythema marginatum). The rash is faintly reddish, non-itching, which appear as a red spot or as serpigenious. But it is difficult to recognize the rash in Indian children due to the dark complexion of the skin.
Patients who have subcutaneous nodules almost always have heart disease. In India, these swellings are seen only about 5% of patients.

5. How does rheumatic fever affect the heart?
Rheumatic fever affects all the three layers of the heart (pericardium, myocardium and endocardium). It is seen in 50-75 % patients of acute rheumatic fever. Almost 80% of the patients who develop heart disease do so within the first two weeks of the onset of rheumatic fever. In pericarditis there is swelling of the pericardium covering the heart and fluid collection beneath the pericardium. Myocarditis leads to heart failure. In endocarditis, the heart valves are damaged and results in rheumatic valvular disease. Rheumatic valvular disease can be long lasting and it can even cause death of the patient.

6. What are the special features of joint pain due to rheumatic fever?
Knee joint, ankle joint and elbow joint are the commonly affected joints. Rarely smaller joints like joints in the fingers and toes are also involved. Because of the pain and swelling in the joint it is difficult to bend and straighten the joints. 50-70% of rheumatic fever patient’s joint problems are seen within the first few days itself.

7. What is this abnormal movement called Chorea?
Chorea is a late feature usually occurring 3 months after the onset of rheumatic fever. The affected child is emotionally disturbed and drops things he or she is carrying and also there is a deterioration of handwriting. This shivering spontaneously disappears in 6 weeks.

8. Is it necessary to do blood test, E.C.G., Echo test?
Yes. ASO, ESR and WBC Count are elevated. ECG and Echo test are necessary to find out the status of the heart.

9. What is the treatment of rheumatic fever?
Complete bed rest is advised for some period. If there is heart disease, restrict salt intake. Drugs like Penicillin, Aspirin and Steroid are used for the treatment

10. How can we prevent Rheumatic fever?
Do not ignore your child’s sore throat. Consult your doctor. Proper treatment of sore throat can go a long way in preventing the first attack of rheumatic fever. Once the child develop rheumatic fever penicillin treatment is a must because it prevents the development of heart disease due to rheumatic fever.

11. How long does the penicillin treatment to be continued?
(a) Rheumatic fever, no heart disease
Penicillin treatment for 5 years from last attack or 21 years which ever is later.
(b) Rheumatic fever, had heart disease but now there is no sequelae.
Penicillin treatment for 10 years or till 25 years for the child which ever is later.
(c) Rheumatic fever, rheumatic heart disease existing.
Penicillin preferably life long or at least till 40 years of age.

11. Does penicillin treatment has any side effect?
Penicillin injection some times produces pain and fever. So it is better to take injections on holidays. Rarely penicillin injections produce severe allergy and sudden death. But parents should understand that such allergy is very rare and if penicillin is not used, heart valves of the child will get severely damaged. So before every penicillin injection test dose is taken. But test dose may be negative and allergy can come on injection. So any allergy is noted and parent should be immediately reported to the doctor and it requires emergency treatment.
Tablets can substitute injections. Penicillin tablets 250 mg two times a day to be taken and to be continued irrespective of the age of the patient.

12. Is there a chance of infection to heart valves due to rheumatic fever?
Definitely yes. There is increased chance of infection to heart valves in those with rheumatic fever than those without it. Due to rheumatic fever, infection can occur to normal heart valves and those with heart disease at birth.

(1) What are the symptoms of infections to heart valves?
Prolonged fever, reduction in weight, body pain, joint pain, head ache etc. The efficiency of the heart decreases. Spleen enlargement, red spots appearing in the skin, bleeding inside the brain, pus inside the brain, paralysis of the body parts can occur.

(2) How does a heart valve get infected?
Usually after dental extraction or after dental surgical treatment, heart valves can get infected.

(3) Does this infection has treatment, if so, how long?
Yes. At least 6 weeks treatment is necessary.

13. How can we prevent this disease to heart valve?
Those with rheumatic heart disease should have their teeth very clean. Very good personal hygiene. Inform the dentist about your heart disease. And while treating dental problems, a good cover of antibiotic treatment is necessary to prevent infection to heart valves.

14. (1) How does this heart valvular damage occurs?
Mainly the mitral valve connecting the two left sided chambers of the heart and the aortic valve connecting the aorta with the left side of the heart are involved. These diseases are called mitral stenosis (constriction of valves), mitral regurgitation (enlargement of the valve ring producing leak of blood while the heart pumps), aortic stenosis, and aortic regurgitation respectively.

(2) What are the symptoms for the child if the heart valves are damaged?
In the beginning there need not be any symptoms. But once the disease progresses, child will develop tiredness, breathlessness, palpitation, difficulty in playing etc.

(3) What treatment to be done once heart valves are damaged?
Once rheumatic fever comes (even if there is no heart disease) penicillin treatment should be continued to prevent the recurrence of rheumatic fever. Recurrence of rheumatic fever causes severs heart valvular damage. Dental treatments should be done under antibiotic cover to prevent infections (infective endocarditis). If the heart function is poor, drugs like Digoxin is necessary and anemia (pallor) should be prevented.

(4) Is surgery is necessary for heart valvular damage?
Surgery may be necessary when there are symptoms like sever tiredness or breathlessness or when heart function decreases irrespective of treatment. Surgery is mainly Valvotomy or valve replacement. Balloon treatment for valve construction is now available and is cheaper nowadays.

(5) Can a child with heart valvular damage go to school and play?
A child with good heart function can go to school, play like any other child. But penicillin treatment to be continued.

(6) A Girl child had rheumatic fever— can she get married, get pregnant and deliver?
If there is no heart valvular damage, there is no problem for marriage or delivery, but penicillin to be continued. If heart valves are damage, special care should be taken during pregnancy and if there is no severe damage to valves, pregnancy can be continued. But delivery for such a lady should be in a hospital with all the facilities. Mitral stenosis can be corrected before pregnancy through surgery. So a lady can undergo surgery and then get pregnant. But somebody who has severe damage to heart valves, better not to get pregnant as during pregnancy or delivery heart disease can get worse or even death can occur.

15. Be Careful
If your child is having any symptoms of rheumatic fever, consult a doctor, take treatment. If you are careful, no need to get worried.

Diabetes in children

Type 1 diabetes is the most common form of diabetes in children: 90-95 per cent of under 16s with diabetes have this type.

It is caused by the inability of the pancreas to produce insulin.

Type 1 diabetes is classified as an autoimmune disease, meaning a condition in which the body's immune system 'attacks' one of the body's own tissues or organs.

In Type 1 diabetes it's the insulin-producing cells in the pancreas that are destroyed.

How common is it?


Childhood diabetes isn't common, but there are marked variations around the world:

• in England and Wales 17 children per 100,000 develop diabetes each year
  
  
• in Scotland the figure is 25 per 100,000
  
  
• in Finland it's 43 per 100,000
  
  
• in Japan it's 3 per 100,000.
  
  

The last 30 years has seen a threefold increase in the number of cases of childhood diabetes.

In Europe and America, Type 2 diabetes has been seen for the first time in young people. This is probably in part caused by the increasing trend towards obesity in our society.

But obesity doesn't explain the increase in the numbers of Type 1 diabetes in children - who make up the majority of new cases.

What causes childhood diabetes?


As with adults, the cause of childhood diabetes is not understood. It probably involves a combination of genes and environmental triggers.

The majority of children who develop Type 1 don't have a family history of diabetes.

What are the symptoms?


The main symptoms are the same as in adults. They tend to come on over a few weeks:

• thirst
  
  
• weight loss
  
  
• tiredness
  
  
• frequent urination.
  
  

Symptoms that are more typical for children include:

• tummy pains
  
  
• headaches
  
  
• behaviour problems.
  
  

Sometimes diabetic acidosis occurs before diabetes is diagnosed, although this happens less often in the UK due to better awareness of the symptoms to look out for.

Doctors should consider the possibility of diabetes in any child who has an otherwise unexplained history of illness or tummy pains for a few weeks.

If diabetes is diagnosed, your child should be referred to the regional specialist in childhood diabetes.

How is diabetes treated in children?


The specialised nature of managing childhood diabetes means that most children are cared for by the hospital rather than by their GP.

Most children with diabetes need insulin treatment. If this is the case, your child will need an individual insulin routine, which will be planned with the diabetes team.

• Most now use frequent daily dosage regimes of fast-acting insulin during the day and slow-acting insulin at night.
  
  
• Very small children normally don't need an injection at night, but will need one as they grow older.
  
  
• Increasing numbers of older children use continuous insulin pumps.
  
  

Often in the first year after diagnosis, your child may need only a small dose of insulin. This is referred to as 'the honeymoon period'.

As well as insulin treatment, good glucose control and avoidance of ‘hypos’ (low blood glucose attacks) is important. This is because many of the complications of diabetes increase with the length of time diabetes has been present.

What can parents do?
Living with diabetes can put families under considerable strain, so access to backup support is crucial. This may be from your GP, the hospital team or social services.

Understanding all the different aspects of diabetes and its treatment requires patience, but will benefit your child and family life.

The diabetes team at the hospital can help you with the list below.

• Learn how to administer insulin injections. Insulin is usually injected into the skin over the abdomen or the thighs.
  
  
• Know the symptoms of low blood glucose and diabetic acidosis and what to do about them.
  
  
• Make sure glucose is always available.
  
  
• Measure blood glucose levels and teach your child how to do this as soon as they are old enough.
  
  
• Teach your child how to self-administer insulin injections as soon as they are old enough - around the age of nine is typical.
  
  
• See the doctor on a regular basis, and particularly if your child becomes ill for any reason - treatment is likely to need adjusting.
  
  
• Inform the school and friends about the symptoms of low blood glucose and what to do about them.
  
  
• Contact your local diabetes association for help and support.
  
  

Diet

A trained dietician is usually one of the members of the hospital diabetes team.

It's important to give your child a healthy balanced diet that is high in fibre and carbohydrates.

A healthy diet is the same for everyone, whether or not they have diabetes.

How much your child should eat depends on age and weight. The dietician and parents should determine this together.

Sweets are no longer off limits because the 'diabetic diet' is now a relic of the past.

Once your child gets to know how her body responds to eating and taking insulin, sweets in moderation are possible - accompanied by the appropriate dose of insulin.

Physical activity

Physical activity is important for children with diabetes, who should try to exercise every day.

Physical activity lowers the blood sugar level, so if your child takes insulin, she may need to reduce the dose.

This is because a combination of too much insulin and exercise can lower the blood sugar level and lead to hypos. To counter this, your child should always carry sugar.

Physical activity also affects how much your child can eat. Before your child exercises or plays sport, give extra bread, juice or other carbohydrates.

In the long term

A child who develops diabetes will live with the condition longer than someone who develops diabetes in adulthood.

The longer diabetes is present, the higher the risk of long-term complications such as those affecting the eyes and kidneys.

These can start after puberty, but are usually a concern only in later life.

Regular checkups for late-stage complications begin around the age of nine. From then on, this checkup is done every year.