Tag Archives: pediatrician in Vaishali

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).


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.

tm                       typhoid-mary-article  

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


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




Complications: Intestinal perforation (rare)



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.



  • 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


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


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


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


Dr Rahul Varma

” Healthy Kids, Happy Family”


Cough in Children: What to do ?



Cough is the most common symptom and in all probabilities every child has had it once.  Important fact which I would like to share is that COUGH is a Protective reflex. It protects the spread of infection to airways in lung. But on certain occasions it needs a doctor’s visit; especially if the child is having breathing difficulty and not able to sleep at all at night.

Different types of Cough:


Cough with barking sound:

Swelling in upper airway leads to barking cough i.e. swelling of Voice box (Larynx) or Windpipe (trachea) or whole of upper part in LTB (Croup). Croup is due to viral infection in most cases. It is sudden in onset and severe in younger kids with narrow airway. It has harsh, noisy character which occurs when child inhales.


Cough with whistling (or musical sound):

When lower airway is involved it leads to musical or whistling sound. It can be sometimes audible from a distance too. Common causes are viral infections like Bronchiolitis in young children, WALRI & Asthma. Foreign body is also important cause in kids.


Cough with Fever:

Cough associated with mild fever & running nose is mostly due to common cold. But if cough is associated with high grade fever and no running nose and breathing difficulty than Pneumonia needs to be ruled out. You should visit your child specialist soon.


Cough with vomiting:

Post tussive vomiting is very common in young children and should not be a cause a worry. As babies are not able to throw up mucus and secretions from lungs naturally by taking deep breath voluntarily, so vomiting with cough might relieve the child for some times . It occurs as cough can sometimes trigger gag reflex.

Persistent Cough:

Viral infections can last for 2 weeks. Children with asthma, allergies or chronic infections or repeated viral infections can cause persistent cough but if cough persists for more than 3 weeks than doctor visit is needed.

Prevent triggers: Cold Air, perfumes, Smoke, ice creams etc can start or prolong the cough in children.


When is the right time to visit Child Specialist?

If your child is having any of the below features, you should contact your pediatrician

  • Fast breathing
  • Deep and effortful breathing
  • Bluish color on lips, face
  • High grade fever and no running nose
  • Young child less than 3 months old especially with fever
  • Special sound with cough. Eg Whopping cough, Stridor (noisy), musical sounds/ wheezing etc
  • Blood with cough
  • Child is very weak, irritable and cranky
  • Poor oral intake, decrease urine output and looks dehydrated.


Expected treatment from Doctor?

Listening to the sound of cough can help doctor, besides History and clinical examinations.

Doctor should try to find the cause of cough and treat that. If it is viral infection, it will have its own course and will settle down with time only (usually around 2 weeks in children). No need of any cough syrup (medicine), unless the cough is disturbing sleep or child is coughing continuously for few minutes at a stretch and his life is disturbed significantly.

If cough medications are to be used than it is better to avoid combination drugs.


Home remedies:

  • Honey at bed time can have soothing effect and prevent cough.
  • Warm milk with Haldi
  • Warm saline gargles
  • Steam inhalation can be given in certain cases. But in small kids , need to be very careful that they do not get burn injury with hot water. Best way is to generate steam via hot water in closed room or bathroom. And sit with your child in that room and let the child breath normally.
  • Cool-mist humidifier in your child’s bedroom might help with sleep.
  • Keep child well hydrate
  • Avoid over the counter medications and give them only on prescription of a child specialist.


Feel free to contact MAYA CLINiC for any queries.


Dr Rahul Varma

“Healthy Kids, Happy Family”


Could my child have Diabetes ?

Diabetes in Children


Diabetes Mellitus (DM); name itself is  fearful and more so if in context to children. It is a metabolic disorder with high blood sugar level. Major Symptoms are increased urination, increased thirst and hunger. Insulin is the only way by which body can use sugar. If insulin decreases sugar rises.


4 types: three most common types are type 1, type 2, and gestational diabetes. 4th is due rare genetic disorders

Most common in children is DM type 1 (Insulin dependent, IDDM or Juvenile diabetes).


Type 1DM:


It is an autoimmune disorder in which body starts to destroy its own cell (beta cells of pancreas that makes insulin). Pancreas loses its ability to produce Insulin.

Type 1 is less common than type 2 DM.

2 main factors: genetics and the environment (certain viruses, toxins which can trigger autoimmune response).


Type 2 DM:


More common in adults but nowadays seen in children too.

Pancreas still makes insulin but is not effective (Insulin resistance)


It is hard to diagnose in adolescent; as some cases are asymptomatic.

Lifestyle changes (which are leading to unhealthy gain in weight) like

  • Decrease physical activities
  • More screen time
  • Fast food

It can be managed with Exercise and change in diet but in some cases medicine or Insulin injections are needed.

Gestational DM is diabetes that develops during pregnancy.





Chart is depicting few signs and symptoms of adults too.


  • frequent peeing (urination) in large amounts (polyuria)
  • increase in thirst (polydipsia)
  • dry mouth or throat
  • weight loss
  • increase in appetite (polyphagia)
  • feeling tired or weak
  • diaper rash that doesn’t improve with medicated cream



  • weight loss
  • stomach aches
  • nausea and vomiting
  • heavy, rapid breathing (Kussmaul breathing)
  • drowsiness



Random Blood sugar level > 200mg/dl

Urine test for ketones

It will need further evaluation under guidance of child specialist or Pediatric endocrinologist.




Life changes full circle at the time when diagnosis is confirmed. 

Coping with the diagnosis is also difficult to start with as parents are in denial /shock. It usually is followed by sadness/fear/anxiety. Some will have feeling of guilt and some will have anger.


Parents (and children as well):

  • Need to learn the skills needed to take care of child (injection insulin, measure blood sugar at home etc)
  • Face Emotional Disturbance
  • Life style changes (dietary changes, need to count calories.)





  • Maintain the blood sugar level as close to normal as possible at all times to avoid complications.
  • Coping well with disease and trying to have a healthy and productive life.


Basic treatment of type 1 diabetes:

  • Insulin ( via injections or pump)
  • Balanced meal with help of dietician
  • Monitoring of blood sugar levels
  • Regular check up

Nursing Intervention Nursing Care Plan for Children with Diabetes Mellitus


Basic Treatment Type 2 diabetes:


  • Healthy Lifestyle
  • Increased physical activity
  • Balanced food
  • Weight loss
  • In some cases medications


Dietician: Proper Meal plan is needed to have a calorie count.


Growth and Development should not be affected and child should be able to live a healthy life.

prevention at school

School life should also be not affected.

For any queries refer to your child specialist or Pediatrics endocrinologist. Feel free to contact Maya Clinic .


Dr Rahul varma

“Healthy Kids, Happy Family”


Thalassemia in children





It is genetic disorder of blood in which abnormal Hemoglobin is made leading to decrease in oxygen carring capacity of red blood cell.  RBC (red blood cells) are destroyed at faster rate leading to anemia and need for repeated blood transfusion.

  images (1)

This inherited disorder is carried in genes and passed on from one generation to next generation. People who are Carrier may have no disease but when both parents are carrier, it can pass on to children.


2 types of Thalassemias are there: Alpha and Beta.

We will discuss beta thalassemia in detail.


There are 3 types of beta thalassemia.

  1. Beta thalassemia minor, or beta thalassemia trait, happens when one of the beta globin genes is mutated. Milder form, usually needing no treatment
  2. Beta thalassemia major (Cooley’s anemia) happens when both of the beta globin genes are mutated. Most Serious and can be life threatening if repeated blood transfusion not given
  3. Beta thalassemia intermedia may also occur when both of the beta globin genes are mutated, but less severe. Usually moderate symptoms and sometimes need blood transfusion.


13Beta Thalassemia Signs Symptoms Treatment

Common symptoms of beta thalassemia include:

  • fatigue, weakness, or shortness of breath
  • a pale appearance or a yellow color to the skin (jaundice)
  • Anemia
  • Poor growth
  • irritability
  • deformities of the facial bones
  •  abdominal swelling (liver and spleen enlarged)
  • Delayed puberty
  • Repeated infections



CBC, Hb Electrophoresis


11 16 

Both parents should be tested for Thalassemia before or during early pregnancy. If both parents are carriers of the beta thalassemia disorder, doctors will need to conduct more tests on a fetus before birth(CVS / Amniocentesis).


People who carry beta thalassemia genes should seek Gentic counseling, if they’re considering having children.



Children with Thalassemia major require life-long , ongoing medical care which include blood transfusions.


Standard Treatment:

  • Repeated Blood Transfusions
  • Iron Chelation Therapy
  • Floic acid supplements


Cure:    Stem cell Transplant with HLA matched donor

Future:  Gene Therapy

Research is going on. It may be possible to insert normal hemoglobin gene into stem cells in bone marrow. This will allow children with thalassemias to make their own healthy red blood cells and hemoglobin.



Dr. Rahul Varma



Heat Stroke in children: what are signs and how to manage

Heat Stroke


Human body generates a lot of heat. In normal circumstances, our body is cooled via sweating and heat radiating through skin.

In very hot and humid environment, this natural cooling mechanism of our body fails leading to build up of heat in body to dangerous levels. It can lead to various illnesses related to heat such as Heat cramps, heat exhaustion and Heat stroke.



  • Prolong exposure to heat and sun
  • Dehydration
  • Prolong and excessive exercising
  • Excessive clothing

Kids are more at risk as they do not drink enough fluids.



Heat cramps is the earliest sign of heat illness. If recognized early and treated well, then severe form of heat illnesses can be avoided.

Management of Heat cramps include: Shift child to a cool place, adequate rest and plenty of fluids. If possible, give fluids that contain salt and sugar. Do stretching of involved muscles.


Heat exhaustion is a more severe heat illness that occurs when exposure to heat is there in absence of adequate fluids. Following are the symptoms:

  • Increased thirst
  • weakness
  • fainting
  • muscle cramps
  • Nausea or vomiting
  • irritability
  • headache
  • increase sweating
  • cool, clammy skin
  • elevation of body temperature, but less than 104°F (40°C)


Management of Heat exhaustion

  • Shift the child to cooler area, remove excessive clothing and give plenty of fluids to drink (salt containing fluids preferable eg. ORS, coconut water etc).
  • Wrap a wet cloth or spray cool water on your child’s skin.
  • Call for medical help if as soon as possible. If child is not able to drink, then may need IV fluids via drip set.

If left untreated, heat exhaustion can develop into heatstroke, which can be fatal.



The most severe form of heat illness and it can be life threatening.

In this condition body is not able to regulate temperature leading to very high body temperature i.e. 106F or 41.1C or more and can have bad effects on brain and in some cases can even cause death.

Risk Factors are extreme physical activity and too much of cloths in hot and humid environment with poor oral intake of fluids.


Never leave a child in car alone, it is very dangerous. In USA lots of cases of Death has occurred due to accidentally leaving child in car. Inside car temperature can reach as high as 125 F ( 51.7C) in just 20 minutes.

Management of Heat Stroke:

Call for emergency medical help if your child has been in hot environment and shows one or more of these symptoms of heatstroke:

  • severe headache
  • weakness, dizziness
  • confusion
  • nausea
  • rapid breathing and heartbeat
  • loss of consciousness
  • Seizure
  • no sweating
  • flushed, hot, dry skin
  • temperature of 104°F (40°C) or higher

While waiting for help:

  • Get your child indoors or into the shade. Undress your child and sponge him or her with cool water.
  • Do not give fluids unless your child is awake, alert, and acting normally.
  • Shift to medical facility as soon as possible




To help protect kids from heat illness:

  • Kids should be advised to drink plenty of fluids whenever in hot and humid weather even if they are not feeling thirsty.
  • Cloths should be light colored and loose.
  •  Do not play for long duration in daytime, play mostly in evening and if possible in shade.
  •  Teach kids to come indoors, rest, and hydrate immediately whenever they feel overheated.


Dr Rahul Varma

” Healthy kids, Happy Family”


How long will this diarrhea (or loose motions) last in my child?


Diarrhea from a viral infection usually lasts several days to 2 weeks, regardless of the type of treatment.



Acute watery Diarrhea (Acute Gastroenteritis)
Diarrhea is the sudden increase in the frequency and looseness of stools. Mild diarrhea is the passage of a few loose or mushy stools. Severe diarrhea is the passage of many watery stools. The best indicator of the severity of the diarrhea is its frequency.

The main complication of diarrhea is dehydration from the loss of too much body fluid. Symptoms of dehydration are a dry mouth, the absence of tears, infrequent urination (for example, none in 12 hours), and a darker, concentrated urine. The main goal of diarrhea treatment is to prevent dehydration.


Diarrhea from a viral infection usually lasts several days to 2 weeks, regardless of the type of treatment. The main goal of treatment is to prevent dehydration. Your child needs to drink enough fluids to replace the fluids lost in the diarrhea. Don’t expect a quick return to solid stools.

What all can be given during Diarrhea?

Increased fluids and dietary changes are the main treatment for diarrhea.

Frequent, watery diarrhea

  • Fluids

Encourage your child to drink lots of fluids to prevent dehydration. Any fluid with both salt and sugar given in adequate amount is fine but we need to avoid only sugary drinks like juices etc. Salt helps in better absorption into the gut. Milk and water are both fine. However, if your child refuses solids, give your child just milk, rather than water. Offer short and frequent meals.

ORS (roughly 10 ml/kg per stool ) or simply as much as possible. Encourage child and offer ORS after every motion.

Avoid fruit juices, because they all make diarrhea worse.

  • Table foods

Keep giving your child table foods while he has diarrhea. The choice of food is important. Banana, curd, dalia, khichri, dal and rice , nimbu pani , sikangi etc. Starchy foods are digested best. Examples of such foods are dried cereals, grains, bread, crackers, rice, pasta, and mashed potatoes. Soft-boiled eggs and yogurt are easily digested and provide some protein.


How long will it last?

Mild diarrhea (loose stools)

Follow a regular diet with a few simple changes:

  • Eat more foods containing starch. Starchy foods are easily digested during diarrhea. Examples are cereal, breads, crackers, rice, mashed potatoes, and pasta.
  • Drink extra water. Avoid all fruit juices and carbonated drinks.
  • Milk and milk products are fine.
  • Avoid beans or any other foods that cause loose stools

What is the treatment and precautions?

There is no effective, safe drug for diarrhea. Extra fluids and diet therapy work best.

WHO recommends only 2 things: ORS and Zinc.

  • ORS
  • Zinc: 20mg/kg once a day for 14 days for children more than 6 months.
  • If you are breastfeeding, then keep breastfeeding on demand,
  • Probiotics

Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy ones.

Yogurt is the easiest source of probiotics. Give your child 2 to 6 ounces (60 to 180 ml) of yogurt twice daily.

Probiotic supplements in granules, tablets, or capsules are also available in health food stores.

  • Common mistakes

Fruit juices, cold aerated drinks, glucose water, Kool-Aid and soda pop, should be avoided because they contain no salt and too much sugar. Use only the fluids suggested here.

Fruit juices (especially apple and grape) should be avoided because they are too concentrated and make the diarrhea worse.

Clear fluids alone should be used for only 4 to 6 hours because the body needs more calories than clear fluids can provide. Milk is a good well balanced fluid for diarrhea.

The most dangerous myth is that the intestine should be “put to rest.” Restricting fluids can cause dehydration.


  • Prevention

Diarrhea can be very contagious. Always wash your hands after changing diapers or using the toilet. This is crucial for keeping everyone in the family from getting diarrhea.

  • Diaper rash from diarrhea

The skin near your child’s anus can become irritated by the diarrhea. Wash the area near the anus after each motion. Cleaning should be done softly and by patting only (do not rub with pressure). Then protect it with a thick layer of petroleum jelly or other ointment (Zinc based). This protection is especially needed during the night and during naps. Changing the diaper quickly after stools also helps.

  • Overflow diarrhea in a child not toilet-trained

For children in diapers, diarrhea can be a mess. Place a cotton washcloth inside the diaper to trap some of the more watery stool. Use diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under running water in the bathtub.

  • Vomiting with diarrhea

If your child has vomited more than twice, follow your doctor’s recommended treatment for vomiting instead of this treatment for diarrhea until your child has gone 8 hours without vomiting.


When should I call my child’s doctor (Pediatrician)?


  • There are signs of dehydration (no urine in more than 10-12 hours, very dry mouth, no tears).
  • Any blood appears in the diarrhea.
  • The diarrhea is severe (more than 8 stools in the last 8 hours).
  • The diarrhea is watery AND your child also vomits repeatedly.
  • Your child starts acting very sick.
  • Oral intake almost zero i.e. child not even taking plain water

What should parents avoid giving their children if they have diarrhea or are vomiting?
Do not give your child sugary drinks, such as fruit juice or sweetened fruit drinks, carbonated drinks, sweetened tea, broth or rice water. These have the wrong amounts of water, salts and sugar. They can also make your child’s diarrhea worse.
Talk to your doctor before giving over-the-counter medications to stop diarrhea. If your child’s diarrhea is very serious, do not offer plain water. Drinking only water may lead to low blood sugar or low sodium levels in your child’s blood.

For any other query , feel free to contact us at MAYA CLINIC or talk to your child specialist.


Dr Rahul varma


Picky eater or fussy eater

fussy 2 fussy

Feeding your little angels can be a big headache and a daily struggle for most of the parents. But with proper approach and patience, it can be done.

Ten salient things which can help you get over it are

  1. Do not force child to eat. You should respect your child’s appetite. If baby is not hungry do not push for it. Do not bribe your child. Give small portion of feeds and gradually increase the serving size.
  2. Make a routine and try to stick to it. It helps as child knows that its meal time now and baby is mentally prepared and less anxious.
  3. It takes time for child to accept new food. Gradually introduce new food, one by one. Books say baby might take 20 times before he or she starts liking that particular food. Introduce one food at a time.
  4. Make meal time more fun. Cut fruits and vegetable in different shapes and sizes. Even shape of roti can be made like his/her favorite animal. Or can put sauce in various shapes.
  5. Take your child for grocery shopping with you and ask him to pick and choose what fruit or vegetable he wants to eat in his meals. It will help as child will be very happy to be part of decision making. (obviously holds true only for slightly elder kids)
  6. Lead by example. Eat variety of healthy foods yourself, child will follow you soon.
  7. Minimize distractions. (There should be no room for TV or other electronic gadgets in dinning space).
  8. Do not offer outside food as a reward (A visit to local McDonald outlet should not be a reward or party for something good your child has achieved). By doing this child start thinking that junk food is very good as it is offered as reward.
  9. Always watch your child when he/she is eating. It is safe that way (to prevent choking in small kids) and children feel happy to share time with parents.
  10.  In case you think that growth and development of your child is not appropriate for his/her age or you have any doubt (or any queries regarding food allergies), its best to consult your child doctor.


“Healthy Kids, Happy family”


Dr Rahul Varma


Bruxism (Teeth grinding) in children

bruxism bruxism1

Teeth grinding or Bruxism ( medical term for the grinding of teeth or the clenching of jaws) is very commonly seen in young children by parents.

Parent commonly attribute it to worms, which is wrong.

Two to three out of every 10 kids will grind or clench, experts say, but most outgrow it.

Causes of Bruxism

  • Not clear completely
  • as a response to pain, such as an earache or teething
  • Stress (usually nervous tension or anger)  is another cause. For eg. If arguing with siblings or parents can lead to this. Or some tension in school setting due to  bullying or school test etc.
  • Hyperactive child, other medical illness ( eg, Cerebral palsy etc)

Treating Bruxism


  • Comforting and supporting your child is needed as most of the kids outgrow this condition with passage of time.
  • If needed visit to dentist can help just to rule out dental anomalies. In very severe case dentist might prescribe a night guard molded to child’s teeth.
  • Relaxing before going to sleep help eg. Listening to music, reading a book , parents sleeping with kids in same room.
  • Discuss with child what is upsetting him/her. Tell them everything is going to be alright. If the issue is more complicated, such as moving to a new town, discuss your child’s concerns and try to ease any fears. If you’re concerned, talk to your doctor.
  • In severe cases it is always better to visit your child doctor for opinion.
  •  Childhood bruxism is usually outgrown by adolescence.


Dr Rahul varma



Overweight and childhood Obesity

food         Obesity-Cycle  

Childhood Obesity is a major health problem these days. Initially it was supposed to be disease of western countries and affluent class, but data clearly shows that it is very rampant in middle class families. Main reason as we all know are changing lifestyle with lots of junk food and minimal physical activity. It is important to be in touch with your pediatrician.

Definition: Simplistically, Obesity results from an imbalance of caloric intake and energy expenditure.

BMI (Body Mass index): BMI charts are available which can be used in children > 2years old,

BMI= Weight (in kg)/ Height (in meter)2

Obesity:  BMI more than or equal to 95th percentile

Overweight:  BMI between 85th and 95th percentile

Factors leading to obesity:


  • Enviornmental factors:
    • calorie dense food
    • consumption of processed foods
    • limited physical activity
    • sedentary interests: computers, TV, video games


  • Genetics factors also play important role in some cases

Co-Morbidities associated with childhood obesity:

  • Cardiovascular: Dyslipidemia, Hypertension
  • Endocrine: Type 2 Diabetes Mellitus, Metabolic syndrome, polycystic ovary Syndrome
  • Gastrointestinal: Gall bladder disease, Non Alcoholic fatty liver disease
  • Psychosocial effects and stigma
  • Orthopedic complications:  joint pain etc.
  • Respiratory: Sleep Apnea
  • Neurologic:  Pseudotumor cerebri



Successful intervention for obesity is challenging and is best accomplished using multimodal approaches to accomplish lifestyle change. In children we do not want rapid weight loss as child is in growing phase and adequate nutritious diet is needed. So it is best to try to retain the same weight or very slow weight loss.

  • Catch them young – school age children must be targeted
  • Do not skip meals especially Breakfast
  • Increase awareness: media; school teachers; governmental and NGO effort
  • Minimise advertising pressure for  “junk foods”
  • School play grounds; “Games periods”
  • Health food in school canteens

Traffic light Diet Plan:

Features Green light food Yellow light food Red light food
Quality Low -calorie, high –fiber, low-fat, nutrient-dense Nutrient-dense, but higher in calories and fat High in calories, sugar and fat
Types of food Fruits, vegetables Lean meats, dairy, starches, grains Latty meats, sugar, fried foods
Quantity Unlimited Limited Infrequent or avoided



  • India is in the midst of an escalating epidemic of life style disorders associated with childhood


• The important causes of the epidemic in India appear to be:  unhealthy eating pattern, reduced

physical activity, increased sedentary pursuits .

• Prevention must begin early in the form of a public health campaign directed towards lifestyle

changes of the family / society as a whole. The campaign requires strong social and political will.

• Health professionals must think `prevention of obesity’ at all visits, monitor BMI and ensure that

‘nutrition messages’ are not conflicting and confusing.

• Special strategies for different ages and channels of interventions for prevention of obesity have

been outlined.

• Clinic based individual assessment of the obese child and principles of therapy are provided.


For any queries consult your child doctor or feel free to contact Maya Clinic. we will be more than happy to answer all of them.


Dr Rahul Varma

“Healthy Kids, Happy Family”


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.


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”


Dr Rahul Varma