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A - Z of Childhood Illnesses

A

On this page: AIDS What is AIDS? When to suspect AIDS in children? Myths about AIDS Prevention of AIDS Allergies Asthama Eczema Urticaria Anaphylaxis (severe allergic shock) Hay fever Diarrhoea due to allergy to foods Anaemia Anorexia (Poor Appetite) Attention Deficit Hyperactivity Disorder (ADHD) Autism

AIDS

This subject is discussed here with a twofold aim. To give you information about AIDS which you may also pass to you child at an appropriate age. To remove certain myths about the subject. What is AIDS? AIDS stands for Acquired Immune Deficiency Syndrome. This disease is caused by Human Immunodeficiency Virus (HIV). Due to this infection the person acquires a deficiency in his immune system which normally was helping him to fight infections. With this deficiency he may even fail to fight ordinary infections and often dies from serious infections. This disease may also cause a certain type of cancer. India is not spared of this disease. More and more cases of AIDS are being reported specially from metropolises like Mumbai and Chennai. According to the latest records, 72,207 persons are found to have tested HIV-positive in the state of Maharashtra. The disease is spread by having sexual contact with a male or female having the AIDS virus. Sex with more than one partner and homosexuality increase the risk. Blood transfusions from an infected donor and needles infected with the blood of an infected person are other sources of infection. Thus drug users sharing the same needle are at a high risk. A pregnant mother having AIDS can pass the infection to her baby. When to suspect AIDS in children? The disease is suspected in children who fail to grow normally, frequently get diarrhoea and skin infections, persistent white patches in the mouth due to a fungus infection called thrush, have generalized enlargement of lymph glands, rapid spread of tuberculosis, repeated pneumonias and develop certain types of cancers. But it is important to remember that most children who suffer from the above symptoms in our country are likely to be having more common childhood illnesses, malnutrition and tuberculosis, without having AIDS. Young people must know that after the AIDS virus enters the system of the person, it may take months or years before the symptoms of AIDS appear. Yet this person can spread the disease by donating blood or having sex or sharing needles with another person. So a person can get AIDS from an individual who may otherwise look completely fit and healthy. Hence, it is important to be careful before developing an intimate relationship with another person. It seems that for several reasons the traditional Indian concept of not having sex before marriage needs to be revived. One such reason is the prevention of sexually transmitted diseases like AIDS for which there is no cure and which invariably kills its victim. Myths about AIDS It is also equally important to know that AIDS IS NOT SPREAD by casual contact such as playing, studying, eating, touching, or even living together with a patient of AIDS. It also does not pass to another person through food, water, mosquitoes or sharing the same toilet. Hence we should not shun a patient of AIDS but use rubber gloves if you have ever handle his blood or soiled clothes. Advice of experts can also be sought. It is being spread that you can have safe sex with anyone if you use a condom. This is a half-truth. Please remember that use of condom for sex with an infected person significantly reduces but does not completely eliminate the risk of getting AIDS. Prevention of AIDS The real prevention of AIDS lies in having sex only with a faithful married partner, avoiding use of unsterilized needles and blood transfusion with blood which has not been tested for HIV. If this test is not possible in an emergency, blood donation from a known close friend or relative should be undertaken. At the community level we must spread awareness of this disease among young people, work for moral and spiritual regeneration, create such socio-economic conditions that husbands and wives do not have to separate to find work and individuals do not have to sell their bodies for sex.

Allergies

Allergy can be understood as an abnormal/hypersensitive reaction to certain substances termed allergens. These substances are well-tolerated by most people but those who are allergic, react adversely to these agents. Some common allergens are: foods like eggs, fish, wheat, corn, artificial milk in liquid and powder form, milk products, soya preparations, nuts, peanut butter, chocolates, tomatoes, pork, citrus fruits, and coconut; house dust; certain drugs like penicillin and sulpha; pollen of some flowers; animal hair and feathers. Children with a family history of allergy are more prone to get allergic disorders. COMMON ALLERGIES Allergies can manifest as attacks of asthma, chronic cough, eczema, hay fever (allergic cold), urticaria (hives), anaphylaxis (severe allergic shock), diarrhoea and pain and distension of the abdomen. Children with allergies need help but should not be overprotected.

Asthama

A typical case A four-year-old child goes to sleep normally, gets up in the middle of night wheezing. He has difficulty in taking air in as well as pushing it out. His breathing is faster than usual. When he breathes in, he has to sometimes take the help of his neck muscles to take the air in. The normal gap between the two clavicles (collarbones) tends to dip during inspiration (breathing in). While breathing out, the child makes a musical hissing sound termed 'wheezing'. The expiration (breathing out) is more prolonged than usual. The child finds it easier to breathe sitting or wants a pillow or two on his lap to put his head on it for comfort. This is a typical story of a child having an attack of asthma. If the child has had eczema before or has similar attacks before this episode or has a strong family history of allergy or was artificially-fed (not breastfed), the diagnosis is more or less confirmed. It does not mean that a breastfed child cannot get asthma. The point worth nothing is that artificially-fed children are at a much higher risk. Diagnosis of asthma If this is the first attack your child had, it is important to show him to a doctor so that he can decide whether it is asthma or not. To further confirm the diagnosis he may give medicine for the wheeze. A dramatic improvement in the condition with the anti-asthmatic drug almost clinches the diagnosis. Prevention Besides a familial tendency, allergy to certain foods, allergens listed earlier, sudden exertion in the form of unaccustomed exercise or sports, anxiety or unresolved conflict at home school, abrupt variation in environmental temperature and respiratory infections may precipitate an attack. However, sports should be encouraged. Children who get exercise- induced asthma are given medication for their asthma immediately before the activity. House dust mixed with mites in the room in which the child sleeps should be specially taken care of. The room should be kept scrupulously clean and have minimum furniture in it. Old books, clothes, blankets and musty bedding may trigger the attacks. Put these out frequently in the sun. Make sure too dust remains on fans, in corners, behind or underneath the furniture or on curtains. Thin curtains which can be washed frequently are better than thick or heavy curtains. Mop the room with a wet cloth rather than dust it. Avoid using wool blankets and carpets in the bedroom. Also avoid keeping stuffed toys and plants. Pets with long hair should not be allowed to come into contact with the child. If the child is very attached to the pet and you are not sure if it is adding to the child's allergy problem, you may keep the pet out of the bedroom but not send it out of the home. If you have a vacuum cleaner, use it only while the child is away from home. Let the child avoid using all types of talcum powder, strong perfumes, soaps which smell, all types of cold drinks advertised, a sudden variation of temperature (for instance entering a very cold air-conditioned room from outside where the temperature is very high), sudden exertion and food allergies if known. The common foods mentioned above may be eliminated completely to begin with. Let an item be introduced into the child's diet when he is perfectly all right. Watch for a week. If the child remains well (without any drugs), he shall probably tolerate that item of food well. Any doubtful item should be avoided for six months and then tried again. Any food to which the child reacts severely should be avoided for at least one year before any attempt is made again to see if the child can tolerate it. Bananas are often blamed for bringing on attacks of cold and asthma. This is probably not true. However, I shall respect your opinion if you feel strongly about it or about any other fruit. But if the child who is given a banana gets an attack on to it. A banana, specially when given on an empty stomach (at least half an hour to one hour before meals) is a healthy fruit and should not be easily discarded. Outcome The good news about asthma is that if the attacks start in early childhood, they are more likely to disappear with age. Also in children without a history of hereditary and other factors mentioned above, and in whom the attacks always start with a viral cold rather than coming up suddenly, the diagnosis of asthma should never be made in a hurry. Such children may temporarily react to a cold with a wheeze but may not have asthma. Half the children with definite attacks of asthma are likely to stop getting the attacks by the time they reach their teens (13-19 years). Nevertheless, those who have severe getting attacks in adulthood. At times children with asthma may have a persistent cough which is worse at night. These children may not have any attacks of wheezing but they do benefit from drugs prescribed for asthma. Treatment If your child gets an attack of asthma, do not overreact. You may unknowingly pass your anxiety to the child making his attack worse. Follow the advice given earlier by your doctor. Give the prescribed medication by mouth or by inhalation, keep the child comfortably warm without covering him excessively, let there be free flow of air into the room (if you have an air-conditioner, you can use it) and give him enough liquids including water. If he has fever, avoid Aspirin and ibuprofen, as they can worsen the attack of asthma. Paracetamol would be better. Avoid giving cough syrups (specially those containing codeine). As long as your child is not in acute distress and is accepting some food and enough liquids, you can manage him at home. Wheezing by itself should not worry you. But if his breathing becomes faster, if he has difficulty taking in air and if he is becoming exhausted, ask your doctor who may advice hospitalization. This should be done before the child starts fighting for breathe or becomes blue. If you are parents who in general are against the unnecessary use of drugs like corticosteroids and antibiotics, I am with you. But in a situation like the above, if your doctor decides to give such medication, you should not hesitate to use it. If your child is getting too frequent attacks, you consider buying a nebuliser, to be kept at home. This is very handy for use during an acute attack. You may also like to consult a child psychologist or a family counsellor to see if he needs extra emotional support. An older child may be introduced to yoga. But do not force him to practice it if he is not interested or is not yet ready for it. What about skin tests for allergy and desensitization? In these, repeated injections with increasing concentration of extracts of the substance to which the child shows an allergic reaction are given. They may be considered if you have tried other measures under expert supervision, and you find that your child cannot carry out his normal activities including schooling and your doctor assures you that there is a competent person who will do these tests and who will undertake the follow-up treatment. Pollution and asthma As one concerned with increasing pollution in our cities. I would like to conclude this section by drawing your attention to the role of pollution on the incidence of asthma among our child population. After having extensively worked in rural as well as urban areas, I have been seeing many more cases of this disease in city children compared to those living in our villages. The incidence in the major cities is of the order of about 5 per cent. My colleagues in Mumbai and Delhi feel that the incidence of the disease has been consistently rising in these two cities over the last 10 years. They all feel that atmospheric pollution- through automobile exhaust fumes and industry- is mainly responsible for this increase. I agree with them. So far, the government seems to have failed in curbing this menace. A time has come when public-spirited citizens should seriously consider joining hands with non- governmental organizations and prepare short and long-term actions plan to protect our children from the health hazards of atmospheric pollution.

Eczema

When to suspect it? If your two or three-month old baby develops red patches of itchy, dry skin on his face, forehead and back of ears, he is probably heading for an allergic skin condition called eczema. Itching makes the rash worse and the skin ooze. As the secretions dry up, scaly patches may be noticed. If the broken-down skin becomes infected, pus-like discharge is observed and the child develop fever. In older children eczema presents as itchy, dry skin. The front of the elbows and the back of the knees are more commonly affected. Eczema is more common in babies given artificial milk. Babies exclusively breastfed for the first four to six months of life are less prone. Particularly, in families with a strong family history of allergy, this period of exclusive breastfeeding is advisable for six months. An older child may get this allergy with an egg or wheat preparation. Another similar condition termed as contact dermatitis may develop because of contact with an irritating substance. Examples are woollen clothing, certain soaps or oils, besan (gram flour paste), a bubble bath, disposable diapers or certain plants. Treatment The treatment of eczema remains more or less symptomatic. The principles are to keep the skin moist, minimize itching and to try to find the possible allergen. Frequent washing of the skin (specially with soap) is likely to dry it more. Avoid it. Use soap less often. Linseed oil may be applied over the itchy patches. You may get an ointment (ung. emulsificans aquosum, B.P.) from you chemist. This may be used in place of soap. Pat the skin dry with a soft towel and do not rub. Avoid applications of besan (gram flour) paste on the skin. Some children may also get a rash by using certain expensive soaps (including baby soap) and oils. Milk cream applications may also cause rash. Keep the child's nails short. Some parents use mittens (as hand gloves) to prevent itching. In general, I am against this practice. However, if the itching is severe, they may be used at night. But make sure that you check inside the mittens. They should be smooth and not have any loose threads which may get entangled in the child's fingers. Sometimes your doctor may prescribe an oral antihistamine drug like chlorpheneramine. Cold compresses on the rash may be found soothing. Ointments containing corticosteroid may give immediate relief but you should avoid using them without the advice of your doctor. They can get absorbed from the skin and give rise to side-effects, specially if used over large areas. If applied, they should be used in very small amounts. If the skin gets infected, your doctor may prescribe an antibiotic. A mother who is breastfeeding may try omitting possible allergens from her diet like milk and milk products, egg, wheat etc. (See opening paragraph on section of allergies). Some people may scare you that you may not produce enough breastmilk for your baby if you do not take enough milk. Give them the example of cows which do not drink milk at all! However, if you are on a prolonged milk-free diet, you may consider taking some calcium preparation. A diet which includes fruits, vegetables, and sprouts also supplies the necessary calcium and vitamins. Some babies having allergy to cow's milk may tolerate soya milk better. Sometimes, allergy to soya milk too is seen in children.

Urticaria

This condition manifests as itchy, pink or reddish raised patches of skin which tend to come and go, to reappear on other parts of the body. The size of the patches may vary from 1 millimetre to a few centimeters (giant urticaria). Itching may be severe or mild. Urticaria may follow intake of certain foods like fish, eggs and nuts, or some drugs, or certain infectious agents. Contact with some plants may also be responsible. At times no obvious cause can be determined. Most cases respond to antihistamines. As the patches tend to recur, treatment may be continued for as long as the doctor advises. At times an injection of adrenaline is given for immediate relief, specially if the patches are also associated with oedema or swelling. If the cause is known, the same should be taken care of.

Anaphylaxis (severe allergic shock)

This is a serious, though rare reaction following injection of certain drugs like penicillin and antitoxins that are made from horse serum for treatment of tetanus or for poisoning following snake or scorpion bites. Occasionally, the sting of an insect may also cause it. The patient with anaphylaxis complains of a constricting sensation in the throat and chest and develops urticaria and has difficulty in swallowing. He may become unconscious and stop breathing. This is a serious condition needing immediate medical attention. An injection of adrenaline and mouth-to-mouth breathing with cardiac (heart) massage is needed. Such a reaction can sometimes also be seen with oral medication.

Hay fever

This is a seasonal condition related to allergens present in the child's environment like pollens from trees or grass. It presents as itching in the nose and palate and frequent sneezing and watery discharge from the nose, with or without redness of eyes. The attacks only appear in a certain season of the year and respond dramatically, though temporarily to antihistamines. The child becomes completely free of symptoms once removed from the offending environment. Similar symptoms are seen all through the year in some children. In such cases, the underlying cause is an allergen at home like house dust or animal hair. This has been discussed under the management of asthma.

Diarrhoea due to allergy to foods

Diarrhoea with or without abdominal distension, and pain in the abdomen can occur in some children following ingestion of artificial milk, certain food additives or preservatives and other foods mentioned under the heading of asthma. The symptoms may be related to allergy or to some other mechanism. Some children with allergy to artificial milk (liquid as powder) may also develop skin rashes, vomiting, have bleeding from the intestines besides their lungs being affected.

Anaemia

Anaemia is common Anaemia is quite common in infants as well as older children. Keep this possibility in mind if you notice a sudden change in the behaviour of your child or if he starts falling ill to frequently. Iron deficiency is the commonest cause of anaemia. There are also other type of anaemia. When to suspect iron-deficiency anaemia Mild iron-deficiency anaemia may not produce any obvious symptoms. But anaemia, if not taken care of makes a child irritable, causes loss of appetite, tiredness, starts making him inattentive at school, and prone to recurrent infections. The child's school performance may suffer. Treatment with iron may dramatically improve his behaviour and general condition. Importance of Iron Iron is essential for the formation of haemoglobin, a red pigment present in our red blood cells which carry oxygen to different parts of our body. Why is iron deficiency common? Iron in breastmilk is very well-absorbed. Hence, breastfed babies rarely get iron-deficiency anaemia. But even such children can become anaemic if iron-containing foods are not added to their diet after the age of about 6 months. Iron in animal milk is very poorly absorbed. Hence babies on such milk are more likely to become anaemic. Moreover, babies given animal milk before the age of 6 months are also liable to a daily loss of a small amount of blood due to irritation of the intestine which animal milk causes. Doctors now recommend exclusive breastfeeding roughly for the first 6 months of life. Other Children given large amounts of milk and starchy foods are sure to get iron- deficiency anaemia. Diagnosis of anaemia Iron-deficiency anaemia is common between the age of 9 to 24 months, and is evident in most children around their first birthday. Children given animal milk are likely candidates even at an earlier age. Anaemia should be suspected in older children, including adolescents, if you notice the symptoms mentioned earlier. It must, however, be stressed that these symptoms may also be due to other causes. For instance your child who is 'not eating well' may want to feed himself or he is rebelling just because he is being forced to eat. A child behaving oddly may have unfavourable circumstances at home or at school. After anaemia is suspected, look at the colour of the skin, the conjunctiva of the eye, the tongue and the nails for pallor. Unfortunately, the pallor in the skin and mucous membrane may become evident only when the haemoglobin falls well below the normal- the normal being around 11 gms or more. Again, remember that a pale-looking skin is a common feature of children who are fair and are kept mostly indoors. Children who are suffering from an iron-deficiency anaemia of long standing may also have thin, brittle, spoon- shaped curved nails. The growth of these children may also get affected. Severe anaemia may also lead to shortness of breath, swelling of limbs and an increased heart rate. As iron deficiency is the commonest cause of anaemia, doctors often ask for CBC (Complete Blood Count) only to diagnose it. The haemoglobin of such patients is lower than normal and the red cells are found to be hypochromic (pale looking) and microcytic (smaller than the normal size). The mean haemoglobin between 6 months and six years is 12g/dl (with a normal range of 10.5-14) and between 7 and 12 years it is 13g/dl, with a normal range of 11.0-16. The patient is given oral iron in adequate dosage and the blood test is repeated after completion of the course. The blood picture should return to normal. If not, we conclude that either the child was not given the medicine regularly or the diagnosis needs to be reconsidered. The diagnosis of iron deficiency can be confirmed by doing some further tests. Prevention of iron deficiency Apart from exclusively breastfeeding the child for about 6 months, and continuing breastfeeding into the second year, fruits, vegetables and home-made soft foods should be added to the child's diet after 5 to 6 months. Food items that should be specially kept in mind are green and yellow vegetables, fruits, ragi(nacbni), tomatoes, raisins, red beans and unpeeled potatoes. Non-vegetarians can include meat, liver, egg and fish in the diet. Babies born prematurely are given iron in medical form from the age of 6 weeks. Treatment of iron-deficiency anaemia Let your doctor prescribe a preparation containing iron. Do not buy the so-called tonics sold over the counter. Most of them contain too little iron. Make sure that the chemist gives the same medicine that your doctor prescribes. For instances, one commonly prescribed iron medicine contains only 32 mg of elemental iron per 5 ml (one teaspoon) while another contains 250 mg of elemental iron per 5 ml. A child weighing 10 kgs will only need about 10 ml of the first preparation. If by mistake, the child is given the latter medicine in the same dosage, he may suffer from a serious type of poisoning. In any case, all iron-containing medicines should be kept away from the reach of children. The total amount of iron is to be divided in three doses per day and given in between meals. Milk hinders the absorption of iron with meals. Cereals can also interfere with the absorption of iron. However, vitamin C helps in the absorption and so we may give a citrus fruit or fruit juice after the medication. Iron can temporarily stain the teeth a greyish-black. Give the child a little water after giving the dose. If possible brush his teeth after each dose. You should know that as some iron is excreted with the stools, they may also be dark in colour. Anaemia due to goat's milk Goat's milk is deficient in folic acid. This deficiency can also result in anaemia. These children need folic acid. It may be noted that quite a few iron-containing medicines also have folic acid added. Pica Pica (eating mud, wall scrappings, paper etc.) can also interfere with absorption of iron. Such children need treatment with iron and should also be dewormed. Hookworm anaemia Hookworms acquired while walking barefeet on a field with the ova and larvae of hookworm, can also cause anaemia. The larvae hatch and penetrate the skin of feet. Adult hookworms hook themselves to the upper intestines and suck blood. The eggs of the worms are excreted in stools. People with hookworms should be instructed not to walk barefeet and should be treated for eradicating hookworms from the system. Very often these people have iron deficiency and need treatment for the same. Conditions that can be confused with iron-deficiency anaemia An iron-deficiency type of picture can also sometimes be seen in children with 'lead poisoning' secondary to application of surma to the eyes and in children with pica mentioned earlier. Surma may contain high levels of lead. In market samples studied in Mumbai, it was found that most had high levels of lead varying from 20-80 per cent. While discussing iron-deficiency anaemia, we should familiarize ourselves with a condition called 'Thalassemia trait'. Children with this condition also have microcytic, hypochromic type of anaemia. In absence of iron deficiency, these children do need medication. This is a hereditary condition acquired from one of the parents. It does not harm the child. But if such a child marries a person having the similar trait, their offspring’s can suffer from a serious disease called Thalassemia Major. The diagnosis of thalassemia is made by doing a special test for measuring different types of haemoglobins present in the blood. Treatment Iron injections Children with iron deficiency are sometimes given injections of iron. These are needed only in patients who do not tolerate oral iron at all or those whom the doctor cannot follow to make sure that the drug is given regularly. This category would include children going out of town. Side-effects of oral iron Some amount of constipation or two or three somewhat loose motions in a child treated with iron can be ignored. A small percentage of children may get severe constipation with iron. One may try reducing the dose a little (say 7.5 ml per day in place of 10 ml) or try another iron preparation. It must be added that any preparation can cause a bowel upset in an individual patient. However, while a particular patient may not tolerate a certain preparation, he may accept another without any side-effects. G-6-PD deficiency A passing reference may be made about a type of anaemia that may occur due to excessive breakdown, red blood cells deficient in an enzyme called G-6-PD. Its deficiency is seen in about 5 per cent of the Indian population. It is more common (around 15 per cent) in communities like the Parsis, the Sindhis, Punjabis, Bhanushalis and Lohanas. If severe, the condition can present soon after birth or may appear later due to toxic effects of drugs on these G-6-PD deficient red cells. A simple test is carried out to detect this deficiency and children with diagnosis should avoid drugs like paracetamol, sulpha, certain anti-malarials like primaquine, nitrofurantoin and furazolidone (prescribed for urinary infection and gastro-intestinal infections respectively), water soluble form of vitamin K and chloramphenicol. I have seen a young girl with G-6-PD deficiency who almost died after having been given dapsone an anti-leprosy drug. Other causes of anaemia Though rare, certain other causes of anaemia should also be kept in mind viz. anaemia in a new-born due to blood group incompatibility (see 'Jaundice'); excessive bleeding at any age; infections; certain drugs and serious diseases like leukaemia (see 'Cancer').

Anorexia (Poor Appetite)

Most children who are brought to my consulting rooms for not eating enough are normal pre-school children who are otherwise active and full of life. But if your child looks unwell and goes off food, then your doctor might like to have a close look at the child and try to find the cause of his anorexia. My experience of working with rural children shows that mothers rarely see a doctor for such a complaint. On the other hand, almost fifty per cent of the mothers in our cities bring their children to the doctor for not eating enough. I would certainly be worried if a new-born baby suddenly stops suckling. If he has thrush (curd like white patches which do not come off easily) inside the mouth, a simple treatment would set matters right. Otherwise, a severe infection may be cooking which needs urgent attention. Also, an older child or an adolescent who is losing weight (weighed on the same scale at intervals) or one who gets tired easily and appears unwell and listless may also needs a thorough check-up and investigations. He may, for instance be anaemic or may have diseases like jaundice (due to infection of his liver), tuberculosis or urinary infection. In adolescents, often girls, a rare disease like anorexia nervosa is seen. The patient gets a compulsive desire to lose weight and becomes emaciated due to vigorous dieting. Such a condition is related to a severe emotional disturbance and must be taken care of with the help of a psychiatrist or a family counsellor. The bulk of the cases of anorexia belong to the age group of 1-3 years. Parents of these children appear extremely anxious. Quite often, the child brought in with this complaint is the first in the family. The mother has usually tried 'all possible methods' to make the child eat, and he rebels. Nearer his first birthday he shows interest to feed himself. If permitted, he enjoys doing so though he makes a mess and manages to put hardly anything in his mouth. A clever mother allows him to learn to manage by himself. In between, she does assist the child but makes him feel that he is doing it himself. She does not mind the mess. She knows that the child could be persuaded to eat more without his messing around, but she avoids the temptation and allows him to manage with his own fingers or with the help of a spoon. The child allows her to help in between but the moment he shows reluctance to eat any more, she avoids any attempt to make him finish the remaining food. Such a child is likely to create less problems while eating compared to a mother who forces him to eat. In case you are worried about your child who weighs less than those around him, keep in mind that the child who is small at birth (though he was born at the expected time) is likely to remain small. So have a look at his birthweight. Also the size of the child may follow that of the parents. You may also get worried if your child's weight gain and appetite seems to be less in the second 6 months than in the first 6 months. But then remember that an average breastfed infant may gain about 20 gms of weight per day in the first 3 months, about 15 gms between 3-6 months and even less in the next 6 months. Some children are given too much milk or other dairy products and hence they do not eat enough of other foods. This is not desirable. At times, we may have to completely stop the milk for a couple of months until the child develops healthy food habits. Some children do not eat enough food at a time. Such children should be offered food or feeds more often, say every 2-3 hours. If a child does not eat enough of one item, but you feel he is still hungry, you can offer him something else - say a fruit or your feed. Drugs like cyproheptadine to stimulate the appetite are given by some doctors. They are not recommended.

Attention Deficit Hyperactivity Disorder (ADHD)

Children with ADHD are intelligent. Yet they do poorly in school because they are often misunderstood by parents as well as teachers. Their impulsive behaviour and lack of attention gets on the nerves of others. They are ridiculed for the same and thus they lose their confidence. Once the diagnosis is made, these children can be helped with proper management and do reasonably well in school and later in life. Unfortunately, the diagnosis is often made wrongly or is delayed. In case of the former, parents and teachers forget that many normal toddlers may appear hyperactive and not bother to concentrate. Hence, the diagnosis of ADHD should not be made till the child has spent a year or two in normal school. Secondly, some drugs can also cause the hyperactivity features of ADHD. ADHD can also be noticed in certain other conditions like rejection by the family, psychiatric disorders connected with depression and anxiety, deafness and visual handicaps. Diagnosis The child must have at least two of the three important features: inattention, hyperactivity and impulsiveness. The diagnosis must be made by an expert before any treatment is started. Treatment Efforts should be first made to manage the child without any medication. Experts plan structured daily programmes for these children. Daily routines are fixed and followed in a consistent manner. Care is taken to see that the child goes to sleep and gets up at fixed hours and has regular timings for his meals and studies. The child gets rewards for his good behaviour. Individual attention is given by the teacher. Parents as well as teachers set up small attainable goals for him to build his confidence and self-esteem. Cases with a definite diagnosis and which do not improve with the above approach may need certain specific drugs for this condition. When clearly indicated, these drugs are helpful. But they should given only under expert supervision so that the does can be properly adjusted, keeping the possible side-effects and efficacy in mind.

Autism

A disease of uncertain causation, autism, though rare, is worth being aware of, because early treatment with an expert is extremely important. The condition is suspected in an infant who appears rather withdrawn as if lost in his own world. If you pick him up (not that he showed any desire to be picked up), he may either resent having been disturbed in his routine or he may get interested, for example, in the pen in your pocket, completely ignoring you. These children seem to show no affection and prefer toys or other inanimate objects to persons. If you try to catch their attention, they are not likely to be bothered. Eye contact is almost absent with these children. They may spend hours playing with the same toy or some article, doing the same thing all the time unlike normal children who are eager to gain new experiences with the help of people around them. This is a serious disorder. With expert help, some cases can be helped while others fail to show any significant improvement.