Acute Encephalitis Syndrome in Children

acute encephalitis syndrome-mayaclinic

TIPS TO BE SAFE

  • It occurs mainly in small children, make sure to give them healthy meals minimum 3 times a day.
  • Key to preventing such condition is to have plenty of fluids with added sugar to prevent hypoglycemia.
  • Avoid long hours of fasting ( especially have good dinner)

  • Maintain proper nutrition and health on regular basis

  • In case of any danger sign report to nearby health facilities ( but continue giving glucose water to child on the way to hospital

  • Do not panic

  • Vaccination can help in preventing against a specific virus called JE ( Japanese encephalitis) but it does not guarantee 100% protection against all other causes.

  • Recommendations for vaccinations are quite clear for children living or visiting high endemic areas of eastern UP and bihar esp.

Acute encephalitis syndrome (AES) affects central nervous system, mostly in children and young adults. It starts with high fever, then hampers neurological functions causing mental disorientation, seizure, confusion, delirium, coma

It usually occurs in small children.

Relation between hypoglycaemia, children and AES

“The possible association with some toxin in litchi or in environment need to be documented. Methylene cyclopropyl glycine (MCPG) which has been known to be a content of litchi fruit has been shown to cause hypoglycaemia in experimental animals,” the study stated. Several children in Muzaffarpur who suffer from AES before 2014 have a history of visit to litchi orchards, the study found. The impact is worse on undernourished children who remain hungry for several hours.

Malnourishment a key

“A Centre for Disease Control, Atlanta team, and CMC Vellore’s virologist Dr Jacob John’s findings in past have narrowed down to malnutrition, heat, humidity and poor hygiene as reasons of AES”. AES onset is reported mostly in mornings, especially when a child goes without food the previous night and the sugar level in blood dips further.

“A malnourished child has no buffer stock of sugar in liver”

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Key to preventing such condition is to have plenty of fluids with added sugar to prevent hypoglycemia.

Avoid long hours of fasting ( espcially have good dinner)

Follow advice of your doctor and other support staff of health dept.

Regards

Dr Rahul varma

Vacation and Holiday safety tips for children

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With summer vacation round the corner, this is the time where most of the families plan a holiday with family and friends. It could be your favorite tourist destination or home town visit to grandparents. Lot of travelling, odd time sleep, special traditions and awesome food and hectic schedule; it all can take a toll on the health of your little ones.

Here are few tips which might come handy in making holidays memorable and preventing emergency visits to hospital.

  • Choking and swallowing: avoid keeping foods which can cause choking near young kids. In less than 3-4 years old kids, peanuts, ground nuts, any small round items like tree decoration, small toys can be very dangerous, if accidently swallowed. Danger of these items going into lungs and causing breathing difficulty. We get lots of Emergency room visits for the same, it might even need bronchscopy to remove these items.
  • Poisoning: Lots of accidental ingestion of poisonous decorative items, which might look very attractive to small babies (eg Christmas decorative items, toilet cleaner, floor cleaner). Sometime kids might accidently drink alcohol based drinks (left over of party), dispose of all those stuff safely, before going to sleep.
  • Fire: Accident burn injuries are common near bonfire. Whenever partying make sure kids are under constant supervision.
  • Road safety tips to avoid accidents: Use Car seats for small kids and proper size seat belts for older kids (it can be life saving in case of accidents on long road trips).
  • Accidents: Keep fancy decoration items which are easily breakable out of reach of children. Keep children under constant supervisions. Outdoor activities of kids need to be monitored too.
  • Kit of emergency drugs to be kept safely with you before travelling. Common medicines for vomiting, gas , fever can be kept to be used in case of emergency before you are able to consult any doctor.
  • Maintain general Hygiene measures at all time and follow universal precautions. It is always advisable to have a general check up done with your doctor before you head for long holidays.

Happy Holidaying

Regards

Dr Rahul Varma

Holi safety tips

Few tips for safer holi with your loved ones

 

 

  • Common issues happens with Skin, eye
  • Organic and natural colors, skin friendly colors ( avoid strong chemicals, not good for your skin )
  • Can use oil or  creams for skin and hair before starting holi to avoid long term damage and easy removal of colors later on.
  • Protect your eyes: wash eyes frequently, can even use sunglasses to protect but if significant burning or redness better to consult eye doctor.
  • Try to save face and specially eyes from unwanted attack by water balloons or unwanted people coming from behind to color you.
  • Preferably stay indoor to avoid unwanted Hooligans.
  • Car safety: keep windows closed. avoid crowded places ( avoid Mob like situation). Keep your cool , no point in getting into fight with anyone.
  • Stay in groups, do not roam alone , better to be safe.
  • If you have skin allergy, better to consult your skin specialist rather than self medication
  • Wet floors can lead to injury, so avoid running around water.
  • Avoid alcohol or bhang.. even over indulgence in food can be bad, which you might regret later.
  • Drinking and driving is absolute  NO NO.
  • Think about your loved one before doing anything silly.

This is a festival to spread happiess, do not be the reason for someone’s saddness. do not push people to play holi , if they do not want.

regards

Dr Rahul Varma

Urinary infection in children: what need to be done?

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  Definition of urinary tract infection (UTI) is  growth of significant number of organisms of single species  in urine sample along with Symptoms. ( First aid for urinary pain in children. )

Types of UTI and common symptoms

Simple UTI: mild fever, irritable, Pain during urination, increased frequency and urgency

Complicated UTI: High grade fever, vomiting, stomache, dehydration and toxic looking child

Symptoms present less often are: heamturia, voiding issues, bed wetting , failure to thrive may also be present

 

Risk factors:    Girl child , poor hygiene, Vesicoureteral reflux (VUR), Voiding dysfunction, obstruction in urinary tract

Urine collection: mid stream clean catch sample gives most accurate report in home settings

Urine routine , microscopy s/o UTI: pus cells in urine sample, along with positive nitrate and leucocyte esterase .

Gold standard test is urine culture.. as its report takes aroung 48 hours to come, we can start antibiotics after sending urine sample for culture in consultation with doctor and wait for culture report for further plan of action.

Treatment:

Plenty of fluids, oral antibiotics and other supportive care as advised by your doctor

Plan of action as per age ( preferably in consultation with pediatric nephrologist)

  • Less than 1 years: Ultrasound, MCU and DMSA scan
  • 1-5 years of age: ultrasound and DMSA, ( if DMSA is abnormal than MCU to be done)
  • More than 5 years: Ultrasound only ( if abnormal  further work up)

In high risk cases ,we might need prophylaxis to prevent repeated episode of urinary infection.

Whenever in doubt consult pediatric nephrologists

Regards

Dr Rahul Varma

Erb’s palsy ( common injury to baby during birth)

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Erbs palsy  ( brachial plexus injury)

One of the common type of birth injury which happens in newborn baby while delivery. (happens mostly in assisted deliveries like vaccum or forceps). In this injury there is damage to nerves supplying shoulder and arm; which in turn leads to decrease in movement of that shoulder. Nerves are 5th and 6th cranial nerve (part of brachial plexus nerves) , which are damaged while passing through a point called Erb’s point.

One way that the brachial plexus nerves are affected is when the baby is passing through the birth canal at an awkward angle, with the head being turned to one direction while the arm is being pulled in the opposite direction.

1-2 babies per 1000 newborn delivery worldwide are affected.

Various risk factors involved in this condition are

  1. Large size baby/ good weight of baby.
  2. Assisted delivery .eg use of forceps or vacuum
  3. Excessive pulling/ traction on shoulders during delivery
  4. Gestational diabetes mellitus
  5. Prolong labour

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Symptoms:

  • Not able to move upper limb well. Especially shoulder joint. Affected arm is hanging by side of body and may be bent at elbow.
  • If not able to move even fingers; (not able to grip , your fingers properly) then it suggests severe injury and involvement of lower plexus of nerves too.
  • Can have collar bone fracture along with it, which might be worsening the movement of that side.
  • It often looks like that baby has paralysis of the affected side

 

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Types of Nerve Injuries

There are four types of nerve injuries.

  1. Neurapraxia: nerve is stretched, not complete tear. (so recovers early within 3 months).
  2. Neuroma: more serious damage to nerves
  3. Rupture: nerve is torn; will need intervention(as it will not heal on its own)
  4. Avulsion: is complete tear and most serious of all. ( luckily it is very rare)

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Treatment:

  • Multidisciplinary approach will decide the plan of care for baby: will include pediatrician, need help from neurologist, orthopedic and neuro physiotherapist.
  • Intermittent immobilization and positioning to prevent contractures
  • Gentle massage (as advised by physio)
  • Surgery if severe damage to nerve or complete tear of nerve.
  • Electric stimulation may help

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Prognosis:

  • It depends on degree of damage: likely most of the cases are mild.
  • If the hand grasp/ grip is good and finger movement is present: it suggests good prognosis.
  • It may take few months to few years to recover.

Be in regular follow and adhere to advice of your doctor.

Regards

Dr Rahul varma

Anemia: more common in children than we think.

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Anemia is very commonly seen in young children who are mainly on milk based diet (As milk is poor source of iron). Breast milk has small quantity of iron but it is readily absorbed in body; so for first 6 months of life iron deficiency is not prominent. But after 6 months, when top milk is started, it can lead to anemia if proper iron supplementation or appropriate weaning food is not given.

That is the very reason you will see all the infant formula feeds and cereals fortified with iron these days. As iron is needed to make Hemoglobin; which is oxygen carrying component of red blood cells (RBCs).

 What is the right Quantity of Iron needed by my Kid?

  • From birth till 6 months: Adequate iron is there in mother’s breast milk. No need for supplementation unless baby is preterm or suffering from any illness.
  • 7 -12 months: 11mg per day. It can be given by using infant formula feeds or cereals fortified with Iron or using iron supplement drops.
  • Toddlers: 7 mg/day; Kids aged 4-8 years need around 10 mg per day. Older kids between 9- 13 years need around 8 mg/day.
  • Adolescent boys need 11 mg /day and girls 15 mg/day of iron. Girls need more during their adolescence as more blood is lost during menstruation.
  • Special need in athletes and children involving extreme physical activities need even more iron.

How deficiency develops?

  • Infants and young children mainly on cow’s milk develop iron deficiency as cow’s milk is low in iron and it also makes child less hungry and there is a less likelihood of child eating iron rich foods.
  • Cow’s milk also decreases absorption of iron and can irritate lining of intestine causing minor intestinal bleeding and gradual loss of Iron in stool.
  • Worm infestation
  • Iron requirement is more than normal in certain conditions like preterm babies, menstruating adolescent girls, children involved in extreme physical activities.

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What are Effects of iron Deficiency?

  • Irritability
  • Poor appetite
  • Poor growth and development
  • Behavioral problems
  • Fatigue and weakness
  • Pale skin and mucous membranes
  • Rapid heartbeat or a new heart murmur (detected in an exam by a doctor)

If any of the above symptoms is there in your child, consult your child specialist / Pediatrician and discuss regarding iron deficiency and need for supplementation. Excess of iron is also bad, so it should be taken in appropriate doses only after consulting your child doctor.

Common source of Iron in Diet

Both animal and plant source foods are available which are rich in Iron

  • Red meat
  • Dark poultry
  • Tuna
  • Salmon
  • Eggs
  • Tofu
  • Enriched grains
  • Dried beans and peas
  • Dried fruits
  • Leafy green vegetables
  • Blackstrap molasses
  • Iron-fortified breakfast cereals

How to avoid Iron Deficiency in your child

  • Limit the intake of milk: 500 to 700 ml a day after 1 year of life and focus on staple diet.
  • Continue serving iron-fortified cereal until kids are 18-24 months old.
  • Avoid giving iron supplements with milk as leads to poor absorption.
  • Serve iron-rich foods alongside foods containing vitamin C — such as tomatoes, broccoli, oranges, and strawberries — which improves the body’s absorption of iron.
  • Avoid serving coffee or tea at mealtime — both contain tannins that reduce iron absorption.

Once Iron is started in Iron deficient child; within 2 -3 days you will see significant improvement in diet.

Regards

Dr Rahul Varma

Why Doing Away With the Gadgets Is Important for Your Kid

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Steve Jobs did not allow his kids to own and use an iPad at home. He feared that the iPad would turn his kids into addicts of the device. He should know. After all, he was the founder of Apple Inc. and the father of the digital revolution. Most, if not all, Silicon Valley techs and engineers limit and shield their kids from technology and prefer to send their kids to schools where the focus is on hands on learning and computers are not easily accessible.

Why do the people at the pinnacle of digital change shield their kids from this technological marvel? The reasons are too many and varied, but everyone agrees on some common pitfalls of early exposure to technology.

Children learn better from real life experiences rather than screen time. It is more so if activities involve moving and doing. Various surveys and studies show that on an average 12-month-old baby is exposed to up to 2 hours of screen time a day.

Young age (< 2 years) is very critical for learning of new concepts. Most of the learning involve 3 dimensional Sensory- motor experiences which cannot be replicated on a 2 dimensional screen. Active play involves better hand – eye coordination , fine motor skill development.

Example:  Compare a ball in real life and a ball on Screen.

Infants are still developing concept of 3 dimensional vision. For a small baby  watching on screen a BALL is just a flat, shaded circle. In real life if we roll a ball across floor it proceeds in a single motions and gradually slows and stops finally. But on Screen same action cannot be done; it will be broken up. Small babies may stare at bright colors and motions on screen but their brain is not capable of making sense or meaning out of these amazing pictures. By  the age 2 years brain has developed enough and baby can understand things better. Due to all this confusion it is better to avoid screen time in small babies.

Distorted sense of reality:

Early exposure to technological marvels such as tablets, smart phones and computers are detrimental to the physical and mental growth of children. They give children a distorted view of reality and interfere with the natural development of the child’s brain

Co-ordination and dexterity:

Children as young as 3 and 4 when exposed to the iPad may become experts at swiping the screen, but lag behind in developing dexterity in their fingers that comes by playing sports or musical instruments.

Concept of space:

Young children have still not developed a sense of space and each new walking, bending and climbing experience helps to develop a sense of space. Early exposure to the iPad interferes with this development and gives children a distorted sense of depth and space.

Social Skills:

Various studies have shown that children growing on iPads or other similar screen devices tend to lag behind in development of real time social skills. Regular activities such as developing social skills and making friends become a task for such children. Such children do not spend time with their own thoughts and imagination and require constant stimulation.

Emotional skills:

Development of internal mechanism of self-regulation is an important milestone in a child’s emotional development. Constant and continuous use of such devices to distract and control the behavior of children impedes their ability of self-regulation.

Maths and Science:

Playing with blocks in real time develops visual-motor skills and sensorimotor skills in children that are the base of all learning. Application of maths, science and logic in the classroom and outside comes naturally for kids whose basic skills are well – development. Playing with real blocks and puzzles is frustrating for young minds who are used to manipulating objects by swiping the screen.

The list of the evils of early exposure to screen only gets longer with time. There has been very little systematic research and the technology is still quite new to fully understand its complete effects. For now, the safest thing to do is keep that tablet away from your kids or at least stop using it as a baby sitter.

Snoring in Children

 

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As uncommon and abnormal as it may seem, snoring in babies is not always a red flag for your baby’s health. Many babies produce noises like whiffing, snuffing and snoring while sleeping. If your baby snores rarely or occasionally, then it’s not a cause of concern. But if it has become a chronic habit of your little angel to snore, then consulting your Pediatrician is always advisable.

But before you start panicking, let’s understand the causes of snoring in babies.

Causes of Snoring in Babies

  • Cold and flu infections: This is the most common cause of snoring in babies. As your baby’s airways are very small and narrow when they are few months old, mucous secretions during a cold or flu infection easily block her nose and throat. As a result, your baby may snore while she is suffering from cold or throat infections.
  • Allergies: Your baby may be allergic to down filling in the mattress or pillows or allergic to pet hairs if you have a dog or cat. This may obstruct the airways of your baby while she sleeps and become the cause of snoring.
  • Enlarged tonsils or adenoids: Adenoids are lymph nodes at the junction of nose and throat which may enlarge due to various infections. Similarly, tonsils are lumpy lymph tissues located at the back of throat, which can also enlarge due to repetitive infections. Although the rate in newborn babies, with time these can contribute to obstruction in breathing which can in turn cause snoring.
  • Deviated Nasal Septum: Nasal septum is the bone that separates both the nostrils and in case of a deviated septum, this bone may be structurally misaligned obstructing one of the nostrils. This could be a cause of chronic snoring in your baby.
  • Laryngomalacia: In very young babies, the cartilage that keeps the nasal airways open may remain underdeveloped for some time after birth. As a result, your newborn may snore frequently until this cartilage develops properly.
  • Throat abnormalities: Cystic formations in the throat or abnormal palate movement can also cause snoring in babies.
  • Sleep Apnea: This is a condition wherein your baby experiences obstruction in breathing for several seconds, causing lack of oxygen and acute breathlessness. This may happen multiple times during sleep and can cause loud snoring in your baby.

How to correct snoring in your baby?

Once you have identified the cause of snoring in your baby, in consultation with her pediatrician, you can start with the corrective measures to alleviate your baby’s snoring.

You can take the following steps to correct snoring:

If your baby is suffering from cold, flu or allergies; use a humidifier in your baby’s room and put saline nasal drops in your baby’s nose to help her breathe better while sleeping.

Also remove any allergens or allergy-causing agents from your baby’s room to avoid any breathing obstructions.

Change your baby’s position or put a pillow under her head when she’s asleep to help keep her airways open.

If your baby is suffering from sleep apnea, enlarged adenoids and tonsils may be responsible. You can either reduce this enlargement with medicines or can even get them surgically removed once your baby is a little older.

Throat abnormalities and deviated nasal septum can only be corrected surgically and you should consult your Pediatrician/ ENT specialist for complete corrective action.

Thus, if your little one snores, the next time she dozes off, rest assured that it’s nothing to worry about. With proper care and as she grows, this problem can be easily resolved.

 

Regards

Dr Rahul Varma

Ways to Get Your Toddler’s Attention and Keep It

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You might have experienced this- you are reading aloud a book to your 15-month- old kid and halfway through she wanders away across the room towards the bookshelf. Well! This is a perfectly normal behaviour for her. Psychologists explain that toddlers are innately distractible. They cannot stick on with one thing as long as an older child or adults can. After a couple of minutes, they venture in search of other things. Besides, another reason for your toddler to not comply with your instructions is that she is taking the first step towards becoming her own person. She is walking her way to independence and may tend to do exactly the opposite of what you might have suggested to her.

Read on to find simple ways to get attention of your toddler and have them be seated for a couple minutes to play with a toy or draw etc.

  • First and foremost, is your time. If you want results, it require good quality time. Take time out from your social networking and other stuff and focus on your child’s future. Father’s too have equal responsibility to take out time.
  • Get down to their level to talk to them. Squat down or pick them up, make an eye contact to get their attention to what you have to say.
  • Put in confident good humor in your language. Use silly voices, make up tunes to sentences or sing your instructions to them. For example, if you want to tell them, ‘It’s time to take a bath’, just sing it to them. This will intrigue them to listen to you. Always remember, yelling instructions may get the work done, but no one enjoys the process of doing it.
  • Never impose your choice of play or activity on them. Let them choose what they want for themselves. This makes them pay more attention to things they do while enjoying the task.
  • Television or videos are a complete ‘No No’ in the first two years of a child’s life. In fact, TV, rattles and other noise-making toys overwhelm a child’s attention rather than encouraging the child to actively flex his/her muscles to focus. On the contrary, give them toys that are more open-ended so that they can curiously engage in them with more than one special sense.

Children enjoy games. Engage with them in fun-filled games so that they learn to pay attention. Here are few games you can play with your children:

  • Make hand puppets or finger puppets and use them to give simple instructions (like clap your hands, spin around, etc) to your child. It paves the path for the budding independence of the child as it is a friendly puppet that is instructing them.
  • Go on a treasure hunt with them. This way they learn to follow two- to three-step instructions as well.
  • Mimic voices. Draw the child’s attention to the distantly heard voices and then both of you can mimic it one by one.
  • Use flashlight to focus on different objects in a dark room and let them name them.
  • Last but not the least, model good behavior. Listen to them respectfully and they will learn to be good listeners.

A long attention span is vital for creative, athletic and academic achievement. Attentive listeners make the best friends, spouses and parents. The basic skills of focusing and concentrating learnt in the first few years of life go a long way to help them deal with difficult problems of life and pursue their dreams.