Monthly Archives: September 2013

Rabies vaccination after dog bite/monkey bite

rabies    

rabies

Rabies vaccination after dog bite/monkey bite

Dog bite/ Monkey bite is very scary situation for young kids and their parents. We need to consult doctor immediately as treatment has to be started within 24 hours.  Dog bites can lead to rabies disease.

Rabies disease can be prevented with vaccination, but if it occurs it is 100% fatal worldwide.

Rabies can occur with dog bite, monkey bite or any other domestic or wild animals.

Specially if dog bite is unprovoked, chances of dog being rabied is high. Beside as we know the illness is 100% fatal, so whenever in doubt its better to vaccinate the child.

 

Category of bite:

 

Table 1: Type of contact, exposure and recommended post-exposure prophylaxis

 

Category Type of contact Type of exposure Recommended post-exposure prophylaxis
I  Touching or feeding of animals Licks on intact skin  None 
  • None, if reliable case history is available

 

II  Nibbling of uncovered skinMinor scratches or abrasions without bleeding Minor
  • Wound management
  • Anti-rabies vaccine

 

III Single or multiple transdermal bites or scratches, licks on broken skinContamination of mucous membrane with saliva (i.e. licks) Severe • Wound management• Rabies immunoglobulin

•Anti-rabies vaccine

 

 

Management:

  • Keep a watch on dog for 10 days if possible.
  • Wound cleaning
  • If needed Rabies Immunoglobulin
  • Anti rabies vaccines (as per protocol)

Not previously vaccinated:

  • Wound cleansing:  All post exposure prophylaxis (PEP) should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (e.g., povidine-iodine solution) should be used to irrigate the wounds.
  • Human rabies immune globulin (HRIG): Administer 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around and into the wound(s), and any remaining volume should be administered at an anatomical site (intramuscular [IM]) distant from vaccine administration. Also, HRIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered. The dose of equine rabies immunoglobulin  is 40 IU per kg body weight of patient and is given after testing for sensitivity
  • Vaccine:  Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV)
    • IM (deltoid area): 1ml dose, on days 0, 3, 7, 14, 28.
    • ID (intradermal): 0.1ml in both arms, on 0, 3, 7, 28.

Previously vaccinated:

  • Wound cleansing:  All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds.
  • HRIG: HRIG should not be administered.
  • Vaccine: HDCV or PCECV 1.0 mL, IM (deltoid area†), 1 each on days 0 and 3

For further reading, click on the below link. It will tell you regarding Rabies treatment in details as per govt of India.

http://www.ncdc.gov.in/Rabies_Guidelines.pdf

Or you can get in touch with Maya Clinic or your Child specialist / Pediatrician for queries.

Stay healthy and stay away from stray dogs.

Regards

Dr Rahul varma

 

Bed wetting: how to deal with this very common illness

Bed wetting: how to deal with this very common illness

bedwetting

“Bedwetting is a topic people often shy away from. Parents may be embarrassed to broach the subject with their child specialist/pediatrician, and doctors typically assume that if a child is wetting the bed, the parents will inquire about it. Parents need to be proactive and talk with their child’s pediatrician.”

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Bedwetting (sometimes called nocturnal enuresis) is a common condition that affects many children and young people. Although most children grow out of it, this may take many years and some may need help to become dry at night. It can be very distressing and have a considerable impact on the child or young person. It can also be very stressful for their family.

bed-wetting Bedwetting-Boy-D1

Although bedwetting is rarely caused by a serious medical disorder and often resolves itself, it’s a condition that can create anxiety, embarrassment, and shame. These feelings are heightened when the child is invited to a sleepover —by relatives, friends and during family marriage.

The combination of several factors is the usual culprit that leads to bedwetting: an increased production of urine during the night, a small bladder capacity, poor arousal from sleep, and constipation.

kidneybrainboy

Parents should keep two issues in mind.

  • First, bedwetting is common, and children should not be punished for it.
  • Second, parents should always remember that bedwetting is a medical problem — it happens because a child’s brain and bladder are not communicating with each other at night.

 

What Parents Need to Know

Most frequently asked questions about bedwetting.

  1. Does bedwetting run in families?
    Most children who wet the bed have at least one parent or close relative who had the same problem as a child. Approximately 45 percent of children wet the bed if one parent wet the bed as a child, and 75 percent wet the bed if both parents were bedwetters.
  2. Is bedwetting more common in boys or girls?
    Prior to age 13, boys wet the bed twice as often as girls. By the time adolescence rolls around, these numbers equal out. Interestingly, girls are more likely than boys to have other bladder symptoms, such as urgency, frequency, or daytime wetting.
  3. Does bedwetting go away on its own?
    Every year, 15 percent of children older than 5 who wet the bed become dry with no intervention. Although children usually follow the same pattern as their family members, this is not always the case. Because there is no way to predict when a child will overcome his wetting, I recommend that children start a bedwetting program if they’re motivated to become dry.
  4. How can I tell if my child is motivated to work on becoming dry at night?
    There are four signs you can look for to see if your child is ready to work on becoming dry:

    1. He starts to notice that he’s wet in the morning and doesn’t like it.
    2. He tells you he doesn’t want to wear Pull-Ups/ diapers anymore.
    3. He tells you he wants to be dry at night.
    4. He doesn’t want to go on sleepovers because he’s wet at night.
  5. Do you recommend restricting fluids in the evening to keep children dry?
    Some people think restricting fluids after dinner helps children stay dry. Although this helps some children, it doesn’t work for most — if a child limits fluids, he may wet the bed with four ounces of urine instead of six, but he’s usually still wet. My approach to restricting fluids is practical. If a child tells me that limiting fluids helps him stay dry, I give it my “OK.” Otherwise, I generally don’t recommend this approach. Stopping tea, coffee, milk at night do help.
  6. What is the best way to treat bedwetting?
    Behavioral Therapy is best approach with help of bedwetting alarm; it yields the best results. Bedwetting alarms are now available in India. This device teaches the child’s brain to pay attention to his bladder while sleeping. Bedwetting alarms have two basic parts. (1) a wetness sensor that detects urine and (2) an alarm unit that produces a loud sound when a child wets the bed.
  7. How does the bedwetting alarm work?

alarm   images

The alarm’s sensor has the ability to detect small amounts of moisture. When a child wets the bed, the urine in his underpants turns on the alarm. When the alarm goes off it awakens the child so he can go to the bathroom and finish urinating in the toilet. After weeks of hearing the alarm, the child’s brain learns to pay attention to the full bladder signals and he wakes up before wetting the bed.

9. Are drugs an effective way to treat bedwetting?

The medication that is prescribed most frequently is called desmopressin (brand name: DDAVP). Desmopressin is a manufactured form of the hormone the brain produces to decrease urine production at night. The effects of desmopressin only last for a short period of time, and children usually relapse when medication is stopped. For this reason, doctors generally recommend this for sleepovers, vacations, or special occasions.

Words of Encouragement for Children

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Following are the strategies to help ease your child’s anxiety.

  • Do not punish or shame children for being wet at night.
  • Remind children that bedwetting is no one’s fault.
  • Let children know that lots of kids have the same problem.
  • Let children know if anyone in the family wet the bed growing up.
  • Maintain a low-key attitude after wetting episodes.
  • Praise children for success in any of the following areas: waking up at night to urinate, having smaller wet spots or having a dry night.
  • Encourage children to go on sleepovers.

Treatment:

  • Behavior therapy is main stay of treatment. Positive attitude and patience on part of parents is the biggest virtue on basis of which successful treatment depends.
  • Have a proper schedule; give dinner 2 hours prior to sleep and wake child once after going to sleep for toilet. Eg. If child sleeps around 11 pm, then dinner should be taken by 9 pm. Child should be asked to go to toilet before going to sleep and put an alarm around 1 am – 2 am. Waking child only once during night gives best result as repeatedly waking child during night have a bad impact on child’s behavior and may make child stubborn.
  • More than 70 to 80% children recover with this lifestyle only; but parents and every member of family need to support the child and encourage him. He should not be taunted or scolded. Otherwise all the hard work put by parents will go waste if you beat your child or scold your child in between sometimes.
  •  Do not discuss about bedwetting with others (relatives and friends) in front of child. Child feel embarrassed and it has devastating effect on child’s psychology.
  • Remember he/she is your child and not doing it deliberately. If you guys do not control your anger and frustration, your child will never come out of it. And your  personal or professional anger or frustration should not disturb your relationship with your child.
  • Drinks containing caffeine (such as cola, tea and coffee) should be avoided.
  • Milk should be given during day only and not during evening or night.
  • The child or young person should be given advice on the importance of using the toilet regularly during the day and you should encourage use of the toilet at regular intervals (around four to seven times a day, including just before bed). This should continue alongside any other treatment for bedwetting.
  • Reward System: Rewards should be given for agreed behavior  rather than dry nights, for example, they may be given for drinking the correct amount during the day, using the toilet before sleep, helping to change wet sheets, and, if appropriate, taking tablets or using an alarm correctly. These should be agreed with the child or young person beforehand. Systems that punish or take away rewards should not be used.
  • Punishment is absolutely NO. All your gains will vanish if you keep punishing child even once in a while. If punishment continues, your child will become more stubborn and as they grow old more behavior issues creep up like aggressive behavior, anti social behavior, drugs etc.
  • Desmopressin treatment:  A drug called desmopressin should be offered  to treat bedwetting under supervison of child specialist,
    • If fast or short-term improvement is the priority.
    • Other drugs like anticholenergic along with desmopressin and Imipramine can also be given but only after consulting someone who is expert in this field as these drugs need to be used with caution.

 

Feel free to contact Maya clinic for further queries regarding this topic.

At Maya Clinic, we have Child Development and Behavior Specialist; Dr. Smitha Sairam. She can be consulted with prior appointment only.

Stay Healthy

Regards

Dr. Rahul Varma