Monthly Archives: August 2014

nose bleed (mayaclinic.in)

How to manage child with nose bleed (Epistaxis) ?

 

Epistaxis (Nosebleed): What to do?

nose bleed (mayaclinic.in)

 

One of the most frightening sites for a parent is to see their child bleed from nose. But you can rest assure that in most cases it is not serious. Most of them can be treated at home.

 nosebleed

It occurs due to bleeding from small vessels of nose. It happens as a result of break in the tissue lining of nose (mostly in front part or “anterior” of nose).

 Epistaxis Management        images

Cause:

  • Irritation and lack of moisture in the nasal membrane
  • Dry air or warm air can lead to crusting of membrane inside nose and it may cause itching which can lead to scratching or nose picking. It in turn leads to bleeding.
  • Allergic conditions and cold
  • Repeated nose blowing
  • Excessive use of antihistamines and Decongestant medicines can also lead to it.
  • Serious causes: Head Injury
  • Bleeding disorders

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In some cases bleeding can occur from posterior part of nose which can be dangerous. It leads to flow of blood down the back of throat.

Frequent or long time bleeding if occurs; you should consult doctor.

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What can be done at home?

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  • Do not Panic and remain Calm
  • Make your child sit in your lap and tilt his or her head slightly forward.
  • Gently pinch nose with clean cloth.
  • Keep applying pressure on nose for about 10 minutes. If we stop too soon bleeding may start again
  • If child is leaning back, it may cause blood to flow down the throat which may in turn cause gagging, coughing or vomiting.
  • Discourage child to blow nose, picking, rubbing.
  • Ice pack on forehead might help.

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When to call doctor?

  • Frequent nose bleed
  • Long time duration of bleeding or difficult to control bleeding
  • Foreign body in nose
  • Bleeding from any other site as well
  • Associated symptoms like fever, rashes etc
  • Easy bruising tendency
  • Medication: recently added or long term

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Urgent Attention needed if:

  • Bleeding is heavy
  • Associated with weakness or dizziness
  • Head injury or history of fall
  • Bleeding continues after two attempts of applying pressure for 10 minutes each

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Prevention:

  • Avoid nose picking (Keep finger nails trimmed most of the time)
  • Use saline nasal spray frequently during illness
  • Vaporizer or steam helps
  • Protective gears while playing or driving to prevent injury

 

Even after taking all the precautions, sometimes child starts bleeding without any obvious reason. So do not panic as most of them are harmless and can be stopped easily.

Discuss with your doctor (Child specialist/ ENT specialist) or contact us at Maya Clinic.

 

Regards

Dr Rahul Varma

” Healthy Kids, Happy Family”

 

How to manage Motion Sickness ?

Motion sickness

 

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Motion sickness as we all know happens while traveling. It is more common in young children.

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Motion sickness is very common while traveling especially to hilly areas. It can happen in any mode of transportation.

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Symptoms can start suddenly or gradually. Most common symptoms are Nausea, Vomiting, dizziness, sweating etc.  It usually stops as soon as we journey is completed. More frequent travelers have less of these symptoms.

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How to prevent it

  • Try to occupy the seat where minimum motion will be felt
  • Road Trip: better to sit in front seat or drive yourself
  • Train travel: Window seat and face forward
  • Plane travel: Seat over front edge of wing is better. Direct the air vent flow towards your face
  • By water (Ship): try to get front or middle cabin which is near the water level.

 motion-sickness-prevention-and-treatment-pyramid

Treatment options:

  • Focus on distant stationary object. Do not stress yourself and avoid reading.
  • Try to keep your head still
  • Avoid smoking
  • Avoid spicy food or heavy meals
  • Avoid Alcohol
  • Drink carbonated beverage to help settle stomach or Eat dry crackers

 

motionsickness

  • Drugs:
    • Antihistaminics: 30 to 60 minutes prior to journey
    • Transdermal Patch
    • Hyosine (Buscopan)
    • Phenergan (Promthazine)

These drugs should be given only under medical supervision after advice from your doctor.

Scopoderm_Patches_1.5mg-1       patch MS

For detail reading log on to below mentioned link

http://motionsickness.org/

 

Dr Rahul varma

 

Typhoid Fever (mayaclinic.in)

Typhoid Fever: things we should know

 

 

Typhoid Fever (mayaclinic.in)

 

Typhoid Fever is so commonly heard off in our country. (I think most common as well as most over diagnosed disease in India).

typhoid

Cause: It is caused by bacteria called Salmonella Typhi (S.Typhi) typically living in humans and are shed through a person’s feces (poop) or urine (pee). Bacteria get into blood and spreads quickly inside leading to high grade fever within a week or two.

Without treatment, typhoid fever may last a month or more and become very serious, even life-threatening. Even after treatment during recovery phase a person can transmit this disease to others.

  food infected

Cause of Spread: 

  • Due to unclean water intake, unhygienic food and poor sanitation facilities.
  • Drinking water (and other drinks) and eating food handled by someone who has typhoid or is still a carrier.
  • Infected people can pass it on to others by touching them with unwashed hands.
  • Contaminated water by sewage, more so in area with poor sanitation and inadequate water treatment

Typhoid fever is named after a lady called typhoid mary who was suffering from this disease and used to serve food in USA leading to epidemic of this disease in that area.

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Symptoms: Severity depends upon vaccination status, age, general health etc

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  • Mild to High grade Fever
  • Stomach pain
  • Body pain, weakness
  • Diarrhea or constipation
  • Poor appetite
  • Reddish spotted rash

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Complications

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Complications: Intestinal perforation (rare)

 

Diagnosis:

Salmonella_typhimurium- gram negative bacilli under high magnification of 15000 X

  • History and examination
  • Blood tests :
    • Typhi Dot IgM: during first few days of fever
    • Widal test: after 5 days of fever (It gives false report before that). Unfortunately this test is most misused test in India. And many false positives reports are given by various labs even on first day of illness.
    • Blood Culture is gold standard: But in most cases antibiotics have been started early so yield of this test is low. And beside it is costly, so many quacks start treatment rather than testing. This treatment is often incomplete and in inadequate doses leading to drug resistance and disease recurrence.

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Treatment:

  • Antibiotics: important to give for proper duration and in adequate doses. Please do not stop medicine on your own once child starts feeling better after 2- 3 days.
  • Some Cases might not respond to oral medication and need for Intravenous medication along with fluids might arise.

Plant for treating Typhoid Fever

Stopping the Spread

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Prevent the spread to others: Wash hands regularly. People with typhoid fever should avoid preparing food. Children should stay away from school until doctor certifies them to join back school.

How to prevent Infection

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Vaccination: It is Available and routinely given around 2 years of age and every 3 years after that. Even if your child is vaccinated (Vaccine is not 100% effective and loses its effectiveness over time)

  • Sanitize water.
  • Cook all food.
  • Avoid raw food.
  • Wash hands frequently

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Feel free to contact your child doctor for any queries or contact us at MAYA CLINIC.

Regards

Dr Rahul Varma

” Healthy Kids, Happy Family”

 

dengue-fever heading

Want to stay safe from Dengue Fever? Read on

 Dengue Fever

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Dengue Fever as we all know spread from bite of an infected Mosquito. It has 4 serotypes. It can cause very severe life threatening illness; however most cases are milder in nature.

Huge number of cases has been reported worldwide (50-100 million cases every year worldwide).

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Dengue virus is transmitted by Aedea Mosquito. It bites during day time only. Outbreaks can occur at anytime, however rainy season with high humidity increases changes of transmission.

Symptoms:

Occurs after 4-10 days of mosquito bite and symptoms can last from 2 to 7 days usually.

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High grade Fever associated with atleast 2 of the below mentioned features should raise suspicion of Dengue Fever:

  • Headaches
  • Body ache.  esp pain behind eyes
  • Joint Pain, bone pain, Muscular pains
  • Nausea, vomiting
  • Rashes (usually extensive red colored all over body)
  • Itching

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Most crucial Phase of Dengue illness occurs once fever subsides; i.e. at deffervescence of Fever as most of the complications arises at this time. At this time platelet counts start decreasing along with rise in Hematocrit values. 3rd space losing occurs, so it is very important to prevent dehydration and let your child have PLENTY OF FLUIDS.

 dengue-diagram

Severe Cases (also called dengue hemorrhagic fever):

Special attention needs to be given to these warning signs as it could lead to severe dengue:

  • Severe abdominal pain
  • Persistent vomiting
  • Bleeding from any site eg gums, blood in vomiting etc
  • Rapid breathing
  • Fatigue/ restlessness
  • Altered sensorium

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Treatment:

  • At present no vaccine is available.
  • No specific medication for dengue fever.
  • Mainstay of treatment is supportive
  • Patients should seek medical advice, rest and drink plenty of fluids.
  •  Paracetamol (Crocin) is the drug of choice for Fever. Other medications like aspirin or ibuprofen should be avoided as it increases the risk of bleeding.
  • Vital Monitoring along with blood test to have a look at Hematocrit along with platelet count.
  • Platelet transfusion in some cases

Infection with one strain will provide life-time protection only against that particular strain. However, it is still possible to become infected by other strains and develop into severe dengue. Usually re-infection cases are severe.

With proper medical care and early recognition, case-fatality rates are below 1%.

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What should be done by Patients and Relatives?

  • If you suspect you have dengue you first need to avoid panic and consult a doctor soon.
  • Drink plenty of fluids, watch for urine output & watch for bleeding from any site.
  • For diagnosis, your doctor will
    • Evaluate your signs and symptoms
    • Test your blood for evidence of a dengue virus using NS1 Antigen or serology test (IgG& IgM).

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How Dengue is spread:

  • Bite from infected mosquito (Aedes aegypti)
  • Day time biting by this mosquito (esp early morning & evening)
  • Does not spread by contact

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Mosquitoes  breading Ground:

  • Clear water in nearby areas esp water filled containers etc.
  • Rest Indoors in dark areas like closet, under beds, behind curtain etc.

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Preventive measures:

  • Source reduction: eliminate mosquitoe’s egg laying sites.  Examples of the following habitats are listed:
  • Indoor, Ant traps, Flower vases and saucers
  • Water storage tank (domestic drinking water, bathroom, etc…)
  • Plastic containers, Bottles, Outdoor, Discarded bottles and tins
  • Discarded tyres, Artificial containers, Tree holes, potholes, construction sites, Drums for collecting rainwater
  • Shells, husks, pods from trees, Leaf axils of various plants
  • Community participation is the key to dengue prevention. As every household aims to reduce vector density, the transmission rate will decrease or maybe even stop.
  • Protecting yourself from mosquito bites: It can be done by using
    • Long-sleeved clothing and mosquito repellents are the most viable options.
    • Window and door screens, air conditioning reduces the risk of mosquitoes coming into contact with the household members.
    • Mosquito nets (and/or insecticide-treated nets) will also provide additional protection to people sleeping during the day, or protect against other mosquitoes which can bite at night (such as malaria).
    • Household insecticides aerosols, mosquito coils or other insecticide vaporizers maybe also reduce biting activity.

 outbreak

 

 

Feel free to contact your doctor for detail or contact us at MAYA CLINIC.

Regards

Dr Rahul Varma

 

 

Is your child Anemic?

Is your child Anemic?

 P_iron1

 

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 of life when top milk is started, it leads 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).

 anemia image

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

  • Birth till 6months: 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 as in adolescence more blood loss 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 less likelyhood 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 (pooty).
  • Worm Infestation
  • Iron requirement is more than normal in certain conditions like preterm babies, menstruating adolescent girls, children involved in extreme physical activities.

Signs-and-Symptoms-of-Anemia

 

What are Effects of iron Deficiency?

  • Irritability
  • Poor apetite
  • 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.

 food

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

 

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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

 

Infantile Hemangiomas: FAQ

 Infantile Hemangiomas

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What is it?

Infantile hemangioma or Strawberry Mark is common type of birth mark. It is usually not visible at birth. They increase in size for few months, remain stable for next few months and subside by few years.

They are not cancer like growth. They are full of small blood vessels and are bright red in color.

When it appears?

During 1st few weeks of life in most cases but may take up to 6 months to be visible.

Why my child? Did I do anything wrong?

No. You could not have done anything to prevent it. Cause of this disorder is not known yet. They are seen more commonly in preterm babies and girls and with multiple pregnancy eg twins, or triplets.

Capillary_haemangioma 

Site:

Most commonly over face, scalp and neck but sometimes over buttocks as well.

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Types:

  • Superficial hemangiomas
  • Deep hemangiomas
  • Mixed hemangiomas

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They occur in different shapes and sizes. Most children have single lesion (around 80%) but they can be multiple.

full101_161743superficial hemangioma rendering 

Are they painful?  No they are not painful

Will they grow in size? Yes, they have 3 phases

  • Growing phase: rapidly grows for first few months
  • Resting phase: by 8 to 14 months of age
  • Involution phase: starts shrinking after 1 year of age upto 5 years

Will they reoccur in next pregnancy? No increase in risk.

Will it come back? No. once it fades away, it does not grow again.

Complications

  • Interference with organ function: like vision, mouth or diaper area.
  • Ulceration
  • Bleeding 
  • TPS-growth-1 

Will the hemangioma leave a scar?

It might leave a scar depending upon size, location and whether it has got infected or ulcerated. Diagnosis is clinical in most cases. Sometimes Doppler might be done to check the blood flow.

Treatment:

No treatment in most cases. But some may need treatment. Options are

hemangioma 1

 

  • Observation: Most hemangiomas will disappear with time and without active intervention.
  • Oral systemic corticosteroids
  • Surgical removal: Only in some cases and mostly due to cosmetic reasons or in certain cases if it is interfering with organ function like vision.
  • Laser therapy:  your doctor will tell you the best option regarding your baby.
  • lazer treatment  tt
  • Medications like Vincristine, Propranolol, Regranex (becaplermin) gel etc. However currently, the FDA has not approved the use of any medication for the treatment of infantile hemangiomas.

For Detail reading regarding this disorder, you can read on the below link.

http://hemangiomaeducation.org/index.html

 

Or feel free to contact MAYA CLINIC / your child specialist

Regards

Dr Rahul Varma

 

Size and Volume of Newborn’s stomach

” Stomach sizes of Newborn baby in 1st few days of life”

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Emphasis should be on; “How well the baby is sucking” on breast rather than on how much is the milk output. On first day of life baby’s milk requirement is very less, so milk output is also less (and if you try to express milk will hardly get a drop or two). But if the baby is sucking well on breast he/she will take out milk as per requirement. Over next few days as the stomach size increases and babies requirement increases, mother’s milk output will also increases.

 

God has planned everything very beautifully, so as a nursing mother do not worry too much. Just make sure baby is sucking well on breast. and have positive thoughts in your mind. Rest everything will be fine.

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 Milk output can be increased by only 2 mechanisms; first when baby sucks on breast and second when mother has positive feeling and there is no stress. These 2 things leads to increase in level of 2 hormones in body; namely Oxcytoxin & Prolactin.

So any amount of tension in mother’s mind (related to baby, Personal or professional) can lead to suppresion of hormones and decrease in milk output.

So Just relax and enjoy Motherhood. God has blessed mothers with a feeling and art called Breastfeeding which no father can ever do. So Feel blessed and continue breast feeding.

 

Regards

Dr Rahul Varma

www.mayaclinic.in