Category Archives: acutely ill child

critical care, sick child

Acute Encephalitis Syndrome in Children

acute encephalitis syndrome-mayaclinic


  • 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”

AES- mayaclinic

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.


Dr Rahul varma

How to be safe in this season of viral infection ?

We all have gone through these viral infections whenever season is changing. But when it comes to your child, u want to be double sure that nothing serious is missed. As these infections mostly are viral , so antibiotics  medications have no role ( and we do not have any anti viral medication). Things gradually improve with time with supportive and symptomatic management.
Antibiotic as name suggests is against bacteria ( anti – biotic ).
So giving unnecessary antibiotics,  will not make any difference in total duration of illness rather it can cause more harm in form of antibiotic resistance and side effects.

Proper hand washing and maintaining hygiene is best way to protect your child.

Danger signs which we should be careful of are

1. Fast breathing 
            ?   > 60 /minutes in children less than 2 months of age
?   > 50 in 2 to 12 months
?   > 40 in children > 2years

2. Chest indrawing (means to get adequate oxygen into the lungs , child has to put extra efforts andnuse accessory muscles for breathing).

3. Poor oral feeding by child ( apetite in general is decreased in any illness but if not taking even sips of water warrants immediate attention)

4. Poor activity/ lethargy (a child who is irritable and cranky is still better than child who is totally exhausted and not interactive and is dull )

So if above danger signs are present, they are suggestive of severe chest infection. Do not wait and show to your pediatrician immediately.
Another  point which I wanted to highlight is that intensity of fever is not always in co relation with severity of illness i.e. severe pneumonia can have low grade fever and simple viral fever can have high grade fever.

But whenever in doubt , it is always better to visit your pediatrician early rather then regret later.

Stay healthy

Dr. Rahul varma

“Healthy kids, Happy family”

Croup or LTB: respiratory illness of infant and young children

  • Croup or LTB (Laryngo tracheo bronchitis) is respiratory illness of infants and young children which starts just like any other viral illness but can be life threatening if danger signs are ignored.
  • Croup is a respiratory illness usually caused by a virus. As the illness progresses, windpipe becomes swollen, which narrows the space available for air to enter the lungs.
  • The viruses that cause croup can be spread easily through coughing, sneezing, and respiratory secretions (mucus, droplets from coughing or sneezing).
  • Croup is usually mild, although it is possible for symptoms to become severe and life-threatening. Symptoms usually start gradually, beginning with nasal irritation, congestion, and a runny nose, which may worsen after 12 to 48 hours to include difficulty breathing, a “barking cough”, and hoarseness. Symptoms of croup usually resolve within one week.
  • If, at any time, a child develops features of worsening or severe croup, the parent should seek immediate medical attention. Danger signs include:
  1. Difficulty breathing
  2. Pale or blue-tinged skin, especially in the lips, fingers, toes, or earlobes
  3. Severe coughing spells
  4. Drooling or difficulty swallowing
  5. Inability to speak or cry due to difficulty taking a breath
  6. A whistling sound with breathing or noisy-high pitched breathing while sitting or resting(stridor)
  7. Sucking in of skin around the ribs with breathing (retractions)
  • Mild croup can usually be treated at home. Home treatment includes using mist from a humidifier or by sitting with the child in a bathroom filled with steam generated by running hot water from the shower. Hot steam humidifiers should be avoided because of the risk of burns.
  • Severe croup is a life-threatening illness and treatment should not be delayed for any reason and opinion of child specialist doctor should be taken immediately (as oxygen and need to secure the airway is needed).
  • Clinical Diagnosis: No investigation is needed.
    • Child may be given mist treatment (humidified air) in addition to a single dose of a glucocorticoid medication. The most frequently used glucocorticoid is dexamethasone.
    • Coughing can be treated with warm, clear fluids to loosen mucus on the vocal chords. Warm water, apple juice, or lemonade is safe for children older than six months.
    • Smoking in the home should be avoided; smoke can worsen a child’s cough.
    • Keep the child’s head elevated. A child may be propped up in bed with an extra pillow. Pillows should not be used with infants younger than 12 months of age.
    • Other therapies, such as antibiotics, cough medicines, decongestants, and sedatives, are not recommended for children with croup. Antibiotics do not treat viruses, which cause most cases of croup.
    • Parents should not leave child unattended for long time especially during night so that they will be immediately available if the child begins to have difficulty breathing.

Unfortunately, there is no way to prevent croup. There are no vaccines against most of the viruses that can cause croup.

Simple hygiene measures can help to prevent infection with the viruses that can lead to croup. These measures include:

  • Frequent hand washing with soap and water.
  • Use of alcohol-based hand rubs.
  • Avoid close contact with other adults and children with upper respiratory infection when possible. This may be difficult, especially when in public, but parents can try to limit direct contact. In addition, infants or children who are sick should not be sent to day care or school as this can potentially cause others to become ill.
  • Yearly vaccination for the influenza virus is recommended for individuals older than six months, who are having repeated respiratory illnesses.

Whenever in doubt its always better to consult your child specialist/ Pediatrician.

stay healthy


Dr Rahul Varma

When to consult a doctor?

General Medical (Health and Safety) Issues in Children

Remember you and your child doctor have same goal: to help your child to grow up healthy and happy.

Asking Question:  Most new parents hesitate in asking questions that they think might be too simple or silly. But if there`s any kind of question on your mind, you are entitled to an answer. Most of the child specialists are happy to answer all your queries. It is best to pen down on piece of paper all your questions (or easier to note on your mobile phone) before you go for doctor visit.

Sometimes there might be difference of opinion or misunderstanding between you and doctor. If you are not satisfied with diagnosis, you can take second opinion. (Some of the doctors can see the tension in your face and they themselves offer second opinion or super specialist opinion). You can simply search on internet regarding the diagnosis and see for yourself.

Regular check up: If you are getting vaccination on time, than for first 2 years, you will be having regular visits to your Pediatrician (Child specialist). After that once a year you should visit, your doctor for routine examination and growth monitoring. These regular visits will ensure that your baby is growing well, gaining weight adequately, no nutritional deficiency, development is good.  Growth charts should be made for every child with regular plotting of weight, height and head circumference (for 1st 3 years).

Telephonic conversations: For some illnesses consulting on phone can help (depending on policy of your child specialist) before you fix an appointment, so that treatment can be started on time.

Specific symptoms:

  • Fever:  For small children less than 3 months, any documented fever above 100 F, should be shown to child specialist. As the child grows old; general activity of child will decide, the urgency to show to doctor. Any fever above 100F, Crocin (Paracetamol) should be given immediately (10 to 15 mg per kg body weight). At height of fever, any child might become dull, but if child is active, alert and playfull once the fever subsides, than it is more reassuring for us. But if fever persists for more than 3 to 5 days, you should consult doctor for opinion.
  • Rapid breathing: With high fever, child can have fast breathing but if even after fever has subsided and still child is having rapid breathing: it’s a dangerous sign, u need to consult doctor immediately. Normal range of respiration (count the number of breaths in 60 seconds, with each in-out being one breath) is
  • Less than 60 per minute till 2 months of age.
  • Less than 50 per minute for 2months to 12 months of age.
  • Less than 40 per minute for children more than 2 years
    • Retractions: You can see the skin suck in (retract) over the collarbones and between and under the ribs. Chest indrawing of any form is severe, needs urgent attention of doctor.
    • Nosiy breathing:
      • It can be simply because of mucus in nose(nose block) or
      •  due to windpipe (stridor), which will be loudest when child is breathing in or
      • Whistling (Wheezing) sound coming from deep inside lungs.

It is best to put the saline nasal drops and clear the nose. And if child is still having noisy breathing it is better to show to your Pediatrician.

  • Pain: It is difficult to tell in small babies, as only thing that will be seen by you is crying (inconsolable cry). Whenever in doubt give pain killer (Syp Ibuprofen) and if pain or excessive cry persists then show to child specialist.
  • Vomiting:  Vomiting of any unusual type warrants immediate attention. That means if child is looking sick or different in any ways.

Usually all small kids might vomit feeds once in a while, or vomiting can be associated with loose motion which can be easily managed at home with medicines.  But if vomiting persists even after oral medication, it is in best interest to show to pediatrician to prevent dehydration.

  • Diarrhea: most of young children have loose motion, which are viral infection needing adequate fluid intake (and do not need antibiotics unless until blood is seen in stools). Most of the complications occur due to dehydration, so it is important to give frequent oral fluids eg. ORS, coconut water, homemade ORS, dal ka paani etc.
  • Head Injury: Fall from bed is very common.  Danger signs which need urgent medical attention are
  •           > If your baby is unconscious, drowsy or keep going back to sleep after fall
    •           > Has bleeding from ear, nose or throat
    •           > Having persistent vomiting
    • Poison: If child has taken anything which you suspect could be poisonous than take your child to nearby hospital which has child specialist available.
    • Rashes: Any viral fever can have rashes, small size, multiple, reddish in color. Or with changing season allergic rashes can be there. Show to your child doctor by routine visit. But any rash that could be from bleeding into the skin: either large purplish blotches or small red spots that don`t go away when you stretch the skin over them, should be looked at right away.


Not everything can be covered here, but golden rule is “Whenever in doubt show to your child doctor”. It is better to show rather than regret later regarding delay in diagnosis and treatment.

Again remember you and your child doctor have same goal: to help your child to grow up healthy and happy.

Stay healthy and keep smiling


Dr Rahul

“ Healthy kids, happy family”

Burn injury in children

burn 33

  • Hot water burns like fire
  • A scald is the most common form of burn seen in children, caused by hot water or liquid. The hotter the liquid and the longer the time the skin is exposed to it, the more severe the injury.
  1. Keep all hot liquids out of reach of young children.
  2. Keep young children out of the kitchen when cooking.
  3. Check bath temperature before placing your child in it.
  4. Never leave your child unattended by an adult in the bathroom.
  • First aid for all burn injuries
  1. Remove any clothing.
  2. Apply 20 minutes of cool running water.
  3. Cover with a clean cloth or clean plastic cling wrap.
  4. Seek medical advice if the skin is broken or the burn area is larger than a 20 cent piece.


Dr Rahul varma

Are you worried about use of Nebulizer for your child? Read on

Nebulizers: Myths and Facts

In my Clinical practice I have seen so many parents and relatives of young children saying “NO to Nebulization”. Many parents do not want to nebulizer their kids as they think it causes addiction and is meant only for severe asthmatic patient.

Any person who is new to nebulization may have some misconceptions (especially lots of myth in public). The aim of this blog is to clear them.


What is Nebulizer?

It is a device which delivers liquid medicine in form of a mist inhaled in to the lungs. It is battery/electricity operated. Patients breathe through mouthpiece or face mask. They come in different shapes and sizes and create sound (as driven by a motor).

 nebulizer (


Myth #1: It will cause addiction and will have to be used every time.

Fact: Nebulization is a mode of delivering a medicine. It does not cause addiction. Addiction is a attribute of drug (or medicine); it does not depend on mode of delivery. If any medicine has addiction potential, it will be for every mode of delivery i.e. oral, intravenous, intramuscular etc.


Myth#2: It is very strong i.e very high dose of medicines given through it.

Facts: Doses of medicine is very less as compared to oral medicine.  As drug goes directly where it is intended lower dose is needed. (Up to 100 to 1000 times less dose is needed in nebulizer as compared to oral or intravenous medicine).


Myth#3: It has more side effects

Facts:  Side effects are far less with nebulizers. As the drug is delivered directly into the lungs where it has to act; hence side effects are less. Whereas oral medications in form of syrups and dispersal tablets first goes into stomach where they are absorbed and then distributed in body so side effects are more.


Myth#4: It takes longer time for drug to start acting.

Facts: Wrong.  As the medicine is going in form of mist directly into the lungs, so it will act faster and give relief much more quickly than oral medication.


Myth#5: It is very expensive.

Facts: No, the cost of each vial of medicine is very low as compared to oral medicines. And in case condition of child worsens than cost of one day of hospitalization will be much more than entire course of nebulization.

Myth#6: It is used ONLY for ASTHMA patients.

Facts: Nebulization is used in many conditions in children eg. Bronchiolitis, Wheeze associated lower respiratory tract infection (WLARI), RSV infection, emphysema. Most commonly it helps via dilating respiratory passage (bronchodilation) or decreasing edema (in case epinephrine is used). For children it is difficult to spit out sputum, so use of nebulization might help.


Myth#7: It is very complicated.

Facts: It is very simple and easiest way. You just have to connect the tubing with mask and fill the medicine and turn on the device. Child can breathe normally; no need to take deep breathing. Even your child can do it on its own and may feel like it’s a playful activity rather than and forceful thing (giving oral medicines). Inhalers are more complicated for children.


Myth#8: Proper dose is not delivered via nebulizer as most of it will go in air.

Fact: Nebulizers are considered as the best way to deliver the medicines in children (in case of hyper reacting airway illness). With inhalers you need to coordinate breathing with medicine dispersal. Oral medications can have erratic absorption as it depends on condition of gut (stomach upset can lead to poor absorption of medicines).

 nebulizer kids(

Myth#9: You have to carry your nebulizer with you.

Fact: Now, so many portable ones are there, so it is very easy to carry them.

 nebulizers 3 clinic

Myth#10:  My baby is very small, it may harm the baby.

Facts: No. Smaller the baby more difficult it s for them to take out their flem. Nebulization will help them to take out all the secretions as it  will dilate the  respiratory passage. Nebulization will not harm your baby.

And lastly have faith in your doctor; they will not advise anything that is not good for baby. Remember both parents and doctors want your baby to get well soon.


 nebulizaion (


Feel free to contact your child specialist or contact us at MAYA CLINIC.


Dr Rahul Varma

” Healthy Kids, Happy Family”

My Child had a fall; what should I do?

Protect Your loved ones: Child injuries can be prevented



Young children are always on the go, running around, jumping, climbing, and exploring things. That is why they are bound to fall a few times. But situation can be a bit panicking sometime for parents. Most of these falls will cause minor injuries only like bruising cut etc, but some can be serious and we should know what to do for first aid and when to contact child doctor and emergency services.

What need to be done?

If any of the below things happen, need to call ambulance and plan to shift child to nearby hospital

  • Child unconscious
  • Having difficulty in breathing
  • Having Seizure
  • Suspected serious injury to head, neck, back
  • If not breathing at all start CPR

injury in child

If by your assessment you feel child is fine i.e. actively moving, breathing, conscious and no major bleed; then

  • Make your child comfortable (either taking child in lap or putting child to bed with you close by)
  • Cold sponging can be done on any obvious bump or minor bruises
  • Can give Ibuprofen or paracetamol (in age appropriate dose as told by your pediatrician in past)
  • Do not leave child unattended for next few hours
  • Let the baby rest, as after initial period child might sleep for next few hours.
  • Watch closely for any danger sign (explained in next section)

Danger signs to look for

  • Repeated vomiting
  • Bleeding from Ear, Nose or Throat
  • Child is sleepy most of the time or loses consciousness at any time
  • Very irritable all the time and difficult to comfort the baby even after giving painkiller
  • Child is complaining of severe pain in any part of body especially head, neck
  • Not able to see properly or difficulty in focusing on objects
  • Not able to walk properly
  • Any other thing or symptom which you feel is not right (it is always better to consult child doctor in case of doubt)


Prevention is better

  • Never leave children unattended while they are playing (whether indoor or outdoor)
  • Childproof all the gates, doors, side railing on stairs, so as to avoid child accidentally opening them and putting themselves in danger
  • Child-Proofing
  • Always put straps/ seat belts for kids while they are using high chair, car seats, strollers etc
  • Wear all the protective gears in outdoor activities like skating, biking etc
  • Do not keep sharp objects in open and try to avoid furniture and decorative stuffs with sharp edges.
  • Supervision is must whenever your child is in balcony, roof or any place that is high up
  • Fall from bed is very common at night. So try to have cot with railing which is properly fixed
  • If you are sharing your bed with kids (common practice in India), make sure baby in sleeping in between both the parents. Best is try to have some sort of protection on all the four sides of child, as your baby can turn 360degree during sleep and fall from any side. (You can have low floor beds).


Discuss with your child specialist during routine visit what all you can do to prevent injuries in children.



Dr Rahul Varma

“Safe kids, Healthy kids”

How to protect yourself and your loved ones from Swine Flu?

Swine Flu

Swine flu home

Cases of Swine Flu (Influenza viral infection) are on a rise in Delhi- NCR. Many cases have been reported and few deaths too.

swine flu 1

But there is no reason to panic. We all need to follow few simple steps and universal precautions, so that we all can be safe. Most of cases of flu infections which have been reported are with H1N1 (i.e. Swine flu) only and Vaccination against same is available. But it takes around 2 week for protection to develop after vaccination.

 Swineflu 2

Tips to prevent against Swine Flu (Flu like illnesses)

  • Proper Hand wash to reduce spread of germs.
  • Staying away from sick people.
  • If you have flu like symptoms; then try to stay at home and avoid crowded places.
  • Eat Nutritious food especially food rich in Vitamins and Minerals.
  • Get Vaccinated with Flu vaccine. This year vaccine covers for H1N1 strain. Vaccination is more important in high risk age group i.e. children, Old age, people suffering from chronic medical condition, pregnant ladies.
  • IF you or your loved ones develop flu like symptoms it is better to consult your doctor. Who if needed will get testing done and assess for need for anti viral medications.

flu 2

Common Symptoms associated with Swine Flu are:

  • Fever (chills or even subjective feeling of feeling feverish)
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Body aches, Headache
  • Fatigue (tiredness)
  • Children can have vomiting and diarrhea too


If you want read in detail regarding Swine Flu, click on the below link of CDC, USA. Remember it’s a US based site, so few things will be different from India due to geographical difference.



Dr Rahul Varma

FAQ regarding Plaster cast care in Kids.

 fiberglass cast kids

Plaster Cast Care

Children sometimes need cast for proper healing of injured bone. Parents as well as kids will have lots of queries regarding cast. In this blog we will try to answer few common ones.

  1. What is a plaster cast? A cast is something which prevents bone from moving and helps in early healing. It is basically a big bandage with multiple layers (soft cotton inside and hard outer layer) to prevent bone from moving.
  2. Types of Casts available? Mainly 2 types:
    • Plaster of Paris (POP): white powder bandage that forms a thick paste and hardens quickly when mixed with water. Once hard and dried they need to be prevented from getting wet
    • Fiberglass or Synthetic: they are plastic material which is mold able, comes in various bright colors, water resistant and are lighter in weight but heavier on your pocket (expensive).
      plaster cast Vs Fiberglass
  3. How cast is applied? Initially layer of soft cotton is wrapped around injured area after cleaning. Next, either fiberglass or POP cast is applied over soft inner layer.
    plaster Cast kids
  4. Can POP cast get wet? NO, a big No. Wet cast will not hold in place and may even irritate the underlying skin. Cover in plastic bag if you need to go near water. Give sponge bath instead of shower.
  5. Can Fiberglass or synthetic cast get wet? They are water proof from outside but inside soft padding can get wet.
  6. Can my friends sign or draw on my POP cast? Yes, surely it can make the whole experience little less painful for the kids. You can even put stickers and draw some pictures and messages. It will be difficult to write on fiberglass cast.
    writing on cast
  7. What to do if my child has itching? Try to blow some cool air using hair dryer (never use warm or hot air). Do not put oil or baby powder or scratch; as it can irritate skin, can even lead to infection.
  8. What to do if skin or finger’s get blue or pale or tingling sensation? It could be very tight plaster so consult your doctor immediately. There could be redness at the edges of fiberglass cast if child picks on the padding underneath.
    blueness of finger
  9. If the cast cracks, what can be done? Consult your doctor for that. It can occur due to cast being hit or crushed or injured area beneath has swelled.
  10. Will cast be painful? For 1st few days it can be painful (but not very severe), doctor might prescribe pain killer medications like ibuprofen. After a while it is fine.
  11. Is it necessary to put all broken bones under cast? some fractures like ribs, collarbone do not need casts , they heal on its own. Some may need special strap like “figure of eight strap for collar bone”. Splint or buddy tape for fractured finger.
  12. How will the cast be removed? Using electric saw. It might look scary and child might feel vibratory movement. It is very quick and painless procedure.
    Digital Camera Exif JPEG

13. Once cast is removed, what next? It might look very pale, dry and small. You may feel very weak while moving the body part. But do not worry everything will be fine soon. You will need good physiotherapy for early recovery. Exercise under warm water will also help.


When to call doctor urgently:

  • High grade fever
  • Severe Pain
  • Tingling or numbness
  • Swelling or redness increases near plaster cast
  • Cold peripheries
  • Foul smelling discharge from cast
    redness and pain

Key Points or Summary:

  • Keep cast clean and dry
  • Can put extra padding near rough edges of cast to protect against scratches.
  • In case of Itching over skin, hair dryer can be used in cool setting. But never blow hot air into cast.
  • Do not insert anything to scratch inside the cast.
  • Encourage child to move his or her fingers or toes to promote circulation
  • Do not bear weight on the cast


Feel free to call your doctor or MAYA CLINIC for any queries.


Dr Rahul Varma

“ Healthy Kids, Happy Family”