Monthly Archives: October 2013

Asthma in children

child-asthma     ASTHMA_kid

In this disease airways are hyperreactive, which means that there is narrowing of airways which leads to difficulty in breathing.

By definition, Asthma is a chronic inflammatory disorder of the airways, characterized by recurrent, reversible, airway obstruction. Airway inflammation leads to airway hyperreactivity, which causes the airways to narrow in response to various stimuli, including allergens, exercise, and cold air.

Most common symptoms of Asthma is Wheezing but all asthmatic children do not wheeze. Most common symptoms of recurrent airflow obstructions are

  • Recurrent wheeze (wheeze is heard by stethoscope but sometimes audible whistling sounds )
  • Recurrent isolated cough
  • Recurrent breathlessness
  • Nocturnal cough
  • Tightness of chest

Signs are (examination by doctor):

  • Generalized rhonchi (wheezing sounds heard with a stethoscope)
  • Prolonged expiration
  • Chest hyperinflation (on X ray of Chest)

 

The Ten Commandments of Asthma

 

  • Asthma is a chronic condition with episodic symptoms. There is a need for continuous preventer drugs for certain grades of asthma. The drugs used for asthma ‘control’ asthma but do not ‘cure’ asthma.
  • A majority of children outgrow their symptoms as they grow older.
  • There are lots of myths and misconceptions regarding inhaled therapy which need to be cleared. Medications given using inhaled route have their own merits and advantages.
  • Discuss the selected regime and address concerns regarding usage of medications with your doctor.
  • Discuss the usage and maintenance of the inhaler device selected.Carry the inhaler device at each follow up visit.
  • It may take some time taken to note improvement and need for compliance with the prescribed preventer drugs cannot be over-emphasized.
  • Dealing with triggers / precipitants like dust, pollen, fur, smoke, exercise etc can go a long way in controlling the symptoms, and preventing asthmatic attacks. Diet has a small role in causation of symptoms.
  • Maintain a diary of events and carry it at each follow up visit. Record days that there are events such as daytime cough, nocturnal cough, wheeze, reliever medication use, doctor/hospital visits, school absenteeism due to symptoms etc.
  • Learn how to manage acute exacerbations/ sudden asthmatic attacks at home prior to doctor contact.
  • Go for the follow up visit 2-4 weeks after institution of preventer regime. Subsequent visits may be planned 2-8 weekly according to the severity or earlier in case of recurrences, or as your specialist plans.

The eleventh commandment (During follow up)

  • Identify any lacunae in understanding and clarify all doubts in subsequent meetings.

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Advantages of the inhaled route (MDI pump and nebulizers) are

  • ‘Smaller dose’: Contrast the milligram (mg) concentration of syrups and tablets with the microgram (mcg) concentration of the same drug in the inhaled form.
  • ‘Target delivery’ – ‘Quicker action’: Drug is delivered directly to the site of action. Reliever drugs, therefore, act faster.
  • ‘Safer’: Smaller dose and thus, much better safety profile than with oral therapy. This is particularly relevant for steroids.

Misconceptions which need to be cleared

  • Is inhaled therapy addictive?  I want to emphasize that addiction liability is a property of the drug rather than device / route. Example that alcohol, though oral, is still addictive. None of the asthma medications are known to cause dependence.
  • Is inhaled therapy strong? No, as discussed earlier, smaller dose is needed (microgram concentration) of drugs used.
  • Is inhaled therapy expensive? The inhaler device is a one-time purchase. Only drugs need to be purchased subsequently. A few inhaled drugs may be slightly more expensive than oral drugs on a per dose basis but these in the context of the child’s well being, safety and reduced doctor / hospital visits are better option.
  • Are inhalers easy enough for children to use? MDI pumps used with spacer can be given to small children also with ease and technique is very easy.

Typical features of this disease

  • Afebrile episodes (most cases)
  • Personal atopy or skin allergy
  • Atopy / Asthma in a parent or sibling
  • Exercise / Activity: In a smaller child, laughing or crying may provoke symptoms.
  • Triggers: These are usually inhaled irritants or aeroallergens (page 10).
  • Seasonality: Sudden temperature changes, flowering season and harvesting time are risk situations. This feature can be judged only after observation over a sufficient time period.
  • Later onset of symptoms (usually around 3 years of age)
  • Relief with bronchodilator (asthalin )± short-course oral steroid

In children, asthma is a clinical diagnosis, made by evaluation over time, either retrospectively or prospectively.

Investigations help in confirming or ruling out alternative diagnoses, rather than in diagnosing asthma.

Asthma Poster

Classification of asthma, Treatment protocol and whether asthma is well controlled or poorly controlled can be read in detail by reading the below mentioned link.

As per management of asthma, there are plenty of medicines which can be given by different routes . So discuss in detail with your Child Specialist / Pediatrician regarding what is best for your child.

Most of the children outgrow this disease with proper treatment and live symptom free life. There are plenty of sports persons who had asthma and they still compete at international level.

Our positive mind set along with caring attitude and emotional support for children can give them symptom free childhood.

If you are interested in reading in detail regarding this disease (that to especially in Indian scenario), than read the guidelines of Indian Academy of Pediatrics. Below is the link for that.

 

For any queries feel free to contact at Maya Clinic or discuss with your child specialist.

“Healthy kids, Happy family”

Regards

Dr Rahul Varma

 

Hand, Foot, and Mouth Disease (HFMD)

 

HFMD

Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth (herpangina), and a skin rash.

Cause: Viral (Enterovirus group), most common Coxsackievirus A16, Enterovirus 71 etc.

Signs & Symptoms:

  • usually starts with a fever, poor appetite, a vague feeling of being unwell (malaise), and sore throat.
  •  1 or 2 days after fever starts, painful sores develop in the mouth (herpangina). They begin as small red spots that blister and that often become ulcers. The sores are often in the back of the mouth.
  • A skin rash develops over 1 to 2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.
  • Young children, may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.
  • Persons infected with the viruses that cause hand, foot, and mouth disease may not get all the symptoms of the disease. They may only get mouth sores or skin rash.

Diagnosis:

Clinical diagnosis, no investigation needed. Depending on how severe the symptoms are, samples from the throat or stool may be collected and sent to a laboratory to test for the virus.

Transmission:

The viruses that cause hand, foot, and mouth disease (HFMD) can be found in an infected person’s:

  • nose and throat secretions (such as saliva, sputum, or nasal mucus),
  • blister fluid, and
  • feces (stool).

An infected person may spread the viruses that cause hand, foot, and mouth disease through:

  • close personal contact,
  • the air (through coughing or sneezing),
  • contact with feces,
  • contaminated objects and surfaces.

This is why people should always try to maintain good hygiene (e.g. handwashing) so they can minimize their chance of spreading or getting infections.

You should stay home while you are sick with hand, foot, and mouth disease. Talk with your child specialist if you are not sure when you should return to school. The same applies to children returning to daycare.

Hand, foot, and mouth disease is not transmitted to or from pets or other animals.

Prevention

There is no vaccine to protect against the viruses that cause hand, foot, and mouth disease.

A person can lower their risk of being infected by

  • Washing hands often with soap and water, especially after changing diapers and using the toilet.
  • Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
  • Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.

If a person has mouth sores, it might be painful to swallow. However, drinking liquids is important to stay hydrated. If a person cannot swallow enough liquids, these may need to be given through an IV in their vein.

Treatment

There is no specific treatment for hand, foot and mouth disease. However, some things can be done to relieve symptoms, such as

  • To relieve pain and fever: Crocin
  • Using mouthwashes or sprays that numb mouth pain

Parents who are concerned about their children symptoms should contact their child specialist/ Pediatrician.

 

Health complications from hand, foot, and mouth disease are not common.

For further reading you can go to the below mentioned link.

http://www.cdc.gov/hand-foot-mouth/

Stay healthy and prevent infections

 

Regards

 

Dr. Rahul Varma

 

 

BRONCHIOLITIS (common lower respiratory illness of young children)

Small children are very prone to viral infections involving the respiratory tract; most of them are Viral URI (upper respiratory tract infections). These URI usually have running nose along with fever and cough.

Whereas in Bronchiolitis, cough and fast breathing is major concern.Timely visit to child specialist/ Pediatrician is best for early detection and prevention of serious illness.

Bronchiolitis_anatomy_PI

Bronchiolitis: most common lower respiratory (airway) illness in Infants

Cause: viral illness (RSV virus most common, parainfluenza virus, influenza virus, adenovirus).

Symptoms usually get worse during the first three days and then gradually improve. During this time, your child may experience:

  • Cough and fast breathing (with audible wheezing or whistling sound sometimes).
  •  Fever.
  • Noisy breathing
  • Irritability
  • Poor  feeding

Total duration of illness is around 1 week (with waxing and waning course).

Following are the danger signs

  • increased difficulty breathing or wheezing as they breathe
  • poor feeding
  • no wet nappy for 12 hours or more
  • a rapid breathing rate of > 50 breaths per minute in 2months to 12 months child
  • being very tired or lethargic

Bronchiolitits

Diagnosis: Clinical diagnosis, no investigations needed if diagnosis is clear from history and physical examinations done by a child specialist / Pediatrician.

Treatment:

Supportive:

  • Keep your child upright (symptoms worsen on lying down)
  • Drink plenty of fluids
  • steam inhalation or saline nebulization
  • Smoke free environment
  • paracetamol drops for fever
  • Saline nasal drops

Specific:

  • Nebulization with Adrenaline
  • Trial with salbutamol can be given, if response there then continue or else give adrenaline nebulization only.

Following drugs have no role in treatment of this disease:

  • Antibiotics
  • Steroids
  • Antiviral drugs like rabavirin etc

As this infection is viral illness, so it cannot be prevented but keeping good personal hygiene will decrease the chances of catching this illness in children.

Stay healthy

Regards

Dr Rahul