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A - Z of Childhood Illnesses

B

On this page: Backache Bed-Wetting Birth Deformities And Congenital Abnormalities Bites & Stings Scorpion stings Snake bites Bleeding Bones, Joints & Muscle Injuries Injuries to bone Pulled elbow Sprains affecting a joint Injury to the tip of the finger Injury to the muscles Bow Legs & Knock Knees Breathlessness Bronchiolitis Burns

Backache

Do not ignore a persistent backache Backache in children is not common. But if your young one complains of persistent backache lasting more than 2-3 days, do not ignore it. First think of any unaccustomed, undue or sudden exertion. Has he recently joined a gym or yoga or karate classes? Has he developed a new interest in athletics? If he otherwise looks well, probably we can wait for a few days more and things should settle down. What about his mood? An older child having emotional problems at home or in school may also present with backache. Is the backache a part of a flu-like illness presenting with fever and generalized bodyache and relieved by paracetamol? If the pain persists for a week or more, do see your doctor. Our spine is made of a number of small bones called vertebrae. Each vertebrae is separated by a disc from its neighbour. The pain could be due to a disease of the vertebrae or the disc. The cause could be an acute infection or even a chronic infection like tuberculosis. Scoliosis (curvature of the spine), rheumatic diseases or even malignant diseases like tumours and leukaemia can also rarely cause backache. Sometimes the pain may not be related to the spine. For instance, a child with urinary infection may also complain of pain on one or both sides of the lower back.

Bed-Wetting

This needs to be given importance only if your child is constantly wetting his bed in sleep after his fourth birthday. This must be differentiated from the situation where the child's nappy or pant is wet all the time during the day as well as at night. If so, you must immediately see your doctor for ruling out urinary infection, any congenital abnormality of the urinary tract, diabetes or diseases connected with the nervous system. When to suspect a psychological cause? If your child, who remained dry all through the night for a sufficiently long period reverts to bed-wetting, it is to be taken note of. You should specially look for any psychological factor that might be causing such 'accidents'. Examples of these could be sibling rivalry due to the arrival of a new baby, moving to a new house, joining a new school or emotional disturbance because of a problem at home or in school. A typical case If your child has never been dry while asleep and is now nearing his fourth or fifth birthday, we are dealing with a typical case of bed-wetting. This is possibly due to a delay in the maturation of the nervous system that controls the bladder mechanism. Ordinarily, as soon as the bladder of a child aged three or more becomes full, he gets signals from his bladder to empty it. In some families, this system takes more time to develop. It is possible that your older child or even your husband had a similar history. At times your husband may not admit it openly. I remember a father who came back into my consulting room after his wife and child had left and quietly mentioned, 'Doctor, I did not feel like admitting in the presence of my wife and son, but for your information, I was also wetting my bed till I was nine years old'. Incidentally, girls tend to achieve control over their bladder earlier than boys. Management of a child with bed-wetting It is important to realize that a child who is wetting the bed is not doing it 'to teach you a lesson'. The fact is that he cannot control his bladder. Hence, he deserves to be understood rather than punished. He should not put to shame for this act in the presence of others, especially his friends. Some parents try not to give too much fluid or other drinks to the child towards the late evening. We are not sure if it helps but I think it may be worthwhile to try and see if it helps Another method is the 'alarm device'. It is an electric appliance connected to a pad on which the child sleeps. As soon as the child passes the first few drops of urine, the alarm rings. A child who has already been explained about this mechanism, wakes up on his own. Otherwise, the partner(s) wake him up, he stops the alarm and passes urine. Gradually, the child gets conditioned and stops passing urine as soon as he hears the alarm. In due course of time, he gets so conditioned that he succeeds in controlling his urge to pass urine. The alarm is used for another month or two after the control has been achieved. Drugs are also prescribed in resistant cases. Imipramine commonly prescribed. If used and found helpful it must be continued for a period of three months. As this drug can have side-effects, it should not be used without the advice of your doctor. Fortunately, most cases can be handled without drugs by understanding parents with the help of a competent and sympathetic physician. Laughter and passage of urine Mention may also be made of children who involuntarily pass urine if they suddenly burst out with laughter. They otherwise have full control on their bladder. This condition improves spontaneously as the child grows up.

Birth Deformities And Congenital Abnormalities

These two conditions are often used interchangeably. Causes of birth deformities A few examples are hare lip, cleft palate, congenital heart disease. Down's syndrome and certain bone deformities. If your baby is born with a birth defect, it is often due to a factor beyond your control and so you need not feel guilty. It is true that use of alcohol and tobacco during pregnancy can lead to birth defect. These are two avoidable causes. Similarly, certain drugs taken during pregnancy, specially during first 3 months of pregnancy can cause problems. No drug should be taken by a pregnant mother without the advice of her doctor. Unfortunately, in most cases of birth defects, often no cause can be traced. But it is advisable for parents of a child with a birth defect to seek the advice of a genetic counsellor before they decide to have another child. This is important because the same defect can occur in more than one child. Your family doctor or paediatrician can guide you in this matter. Prevention of birth defects To prevent these defects, you can also take a few more precautions. For example, if you are married to a close relative (consanguineous marriage), if you have diabetes, thalassemia trait, (for further information about thalmassemia see under 'anaemia') or any infection like German measles during pregnancy, you must discuss the possible risks with your doctor. Birth defects due to abnormalities of chromosomes Fortunately, birth defects are rare. And even if they do occur, they may be minor and cause no harm to the baby. If the defect is due to a chromosomal abnormality, and this happens to be your first child, you could not have done much to prevent it. The only thing you can do now is to discuss with your doctor the possible risk in your next child. A word about chromosomes. They are present in the nucleus of all cells of the body. (An exception is the red cell). We have 46 chromosomes twenty-three are passed to the child from the father and 23 from the mother. These chromosomes carry several genes on which depend our looks like the colour of our eyes and the size of our nose, and also the way different cells in our body function. Abnormalities of chromosomes can result in certain diseases like Down's syndrome.

Bites & Stings

Commonest are the bites from mosquitoes. You can recognize them by a slightly raised red area with a bite mark at the centre. When your child starts itching soon after a bus or a train ride, consider the possibility of bed bugs. Look for a bed bug under his pant. If he is bitten by something in a garden and complains of severe pain and swelling at the site, probably he has been bitten by a bee or a wasp. Treatment Most insect bites disappear within a day a two without any treatment. Calamine lotion does help in reducing the itching. For wasp or bee stings, cold ice-packs with a small hand towel or a piece of cloth should be applied locally. The child may object to these at first but then finds it quite comforting. Vinegar application to a wasp sting and lime to a bee sting also relieves pain. Bees also have a venom sac attached to the stinger. If the stinger is present, scrape it with a knife. Do not try to remove it with your finger, other wise you may squeeze the venom sac and push more venom into the child's system. The stinger of honey bee is difficult to remove. So leave it alone. Anaphylactic shock Rarely, the insect stings may result in an anaphylactic shock (see section on allergies). This is an emergency. Help must be sought. Prevention To prevent insect bites, avoid areas where the insects are more likely to be around (garden, pools of water etc.). Though many insects are colour blind, some are attracted by bright colours and flowery prints. A strong smell attracts all. So dress the child accordingly. Keep his hands covered in pants and full-sleeved shirts. If you decide to use a mosquito repellent cream, read the label of the product to check out its safety for babies. Even if the safety is assured, use only for the exposed parts and then also sparingly. The medicine in these repellents can get absorbed through the thin skin of the baby and can be harmful. If mosquitoes are a problem at night, keep the windows closed in the evening (when mosquitoes are more likely to enter into the room). Open the windows at night and use a mosquito net that covers the whole bed. I am against the use of an umbrella-type net for small babies. It can close automatically and injure the baby. It may also be noted that the repellents help prevent bites by mosquitoes and not of bees and wasps. Use of mosquito repellents, coils and mats Coils should be avoided. They can cause chronic cough in some children. Dr N.G Wagle, an expert in this field advises the use of 5 to 10 ml of critonella oil mixed with 100 ml of coconut oil. Dip a cotton swab in the oil and keep the swab near the head-end of the bed to repel the mosquito which are attracted by the carbon dioxide exhaled by a person. The oil can also be used for the skin in place of mosquito repellents creams. If the mat is to be used, switch on the appliance in the absence of the child. Open the windows after an hour or two. Switch off the appliance and then bring the child in. By then you have taken care of the mosquitoes which were inside. The new lot of mosquitoes is less likely to come in, once it is dark. Scorpion stings These can be dangerous. It is a good habit to turn the shoes upside down before wearing them. If children pick up this habit, they are likely to follow it when they go to a scorpion- infested area. The sting is very painful and more dangerous if the child is stung for second time. Local treatment with an ice-pack in a hand towel or a piece of cloth helps. Apply pressure on the wound with a thick bandage or pieces of cloth. It reduces the risk of spread of the venom. Scorpion antitoxin which is available with most hospitals should be injected preferably within two hours after the scorpion bite. Spider bites can also cause problems similar to bee and wasp stings. A bite of the monitor lizard (Goh) having a forked tongue like that of a snake is not poisonous. Snake bites Most snakes in our country are non-poisonous. They are in fact helpful to us. They kill mice and other harmful pests. These non-poisonous snakes should therefore not be killed. It is, however important to seek medical advice for all suspected cases of snake bite. It is helpful to know that even when bitten by a poisonous snake, a person may not suffer any ill-effects if no venom has been injected in his system. There are four common types poisonous snakes in India. They are the Indian cobra (Nag) the Indian krait (Bangarus) the Russel's viper (Daboia) and the saw scaled viper (phoorsa). All of us are familiar with the cobra. The krait has white transverse lines right from the neck down to the tail. The viper has a triangular head and narrow neck. It is important to know about the symptoms of poisoning due to snake venom because you sometimes we may not notice any obvious bite. If the child complains that he has be bitten by a snake, take it seriously and look for the site of the bite because the bite marks of poisonous snake differ from those of a non-poisonous snake. The poisonous snakes have long fangs. The bites of these snakes leave behind marks of two fangs. The bites of non poisonous snake leaves behind two rows of teeth marks, but no marks of fangs are seen. The symptoms of snake poisoning area related to the species of the snake that has bitten the person. The venom of the cobra and the krait affect the nervous system. Besides local pain at the site of bite, the patient may therefore manifest weakness of the eye muscle resulting in drooping of the eyelids, double vision and squint. There are may be difficulties in swallowing a cough and a paralysis of muscle required for breathing. The patient may also complain of pain in the abdomen, loose motions and vomiting. The blood pressure may drop and the patient may collapse. The respiratory paralysis can lead to death if the patient does not receive adequate treatment in time. These poisonous snakes leave behind fangs marks. Rarely, there may be insignificant teeth marks. Swelling at the site of the cobra and krait bite is not common. Compared to the cobra and krait, the bite of the viper is usually very severe and the local swelling is quite marked. Blister may form around the site of bite. The bite of the viper affects the blood system. The venom prevents the blood from clotting. Patients develop vomiting, the blood pressure falls and bleeding may occur from different parts of the body. The bleeding may continue if treatment is not given and the patient may go into a state of shock. The treatment of snake bite must be prompt. If the live or dead snake is available, take it to the hospital for the doctor to decide if it is poisonous or not. Do not panic. Keep the child on an empty stomach. Do not suck the bite site and do not make cuts into it. Keep the bite site lower than the level of the heart. Apply a tourniquet or a rubber tube or any constricting band between the bite site and the heart. To maintain the bloody supply, the tourniquet should be slackened for a few seconds at regular intervals of about 10 minutes. The bitten part should be kept steady. Usually the bite is on the lower limb. The more it is moved, the faster the venom spreads. The child should not be allowed to walk. The venom from the site usually spreads through the lymph vessels lying under the skin. The best way to reduce the risk is to put a pressure bandage on the limbs and to immobilize it with a splint. For that instance take any clean cloth (a crepe bandage, if available is better) and apply it over the bite site and above it. Then apply a splint (a thin long piece of wood or any other material) which should include joints on either site of bites. This prevents the use of muscle around the bite site and hence reduces the lymph flow and spread of the venom. Carry the child flat with the bite site at a level lower than the heart. For pain paracetomal can be given. Local application of ice reduces the pain. But direct prolonged contact of ice with the skin can result in damage of the underlying tissue. So crush some ice and pack it around the bandage. For poisonous bites, an injection of a polyvalent antivenom (which protect the venom of all common poisonous snakes) must be given as soon as possible. Do not delay in taking the child to the nearest hospital. Patients may also need antibiotics and protection against tetanus. Those who with severe complication may also have to be administered blood and blood products and put on artificial respiration.

Bleeding

When to seek immediate attention for a child with bleeding ? You must get in touch with your doctor or a hospital in the following situations : If your child is bleeding persistently or profusely. In the meanwhile give the child first aid as discussed under the heading of 'Cuts'. If the child is bleeding and has unexplained fever, looks severely anaemic, have jaundice, complains of persistent headache or has disturbed consciousness. Such a child could have serious diseases like leukaemia, severe liver disease, meningitis or bleeding inside the skull (intracranial bleed) If there is a history of bleeding in him or other members of the family, or bleeding following minor injuries, or spontaneous bleeding from any site without any provocation factors. Such child may have a hereditary condition called haemophilia. This needs to be fully investigated and managed properly under expert advice. A few common cause of bleeding Cuts (see under the heading of cuts). Nose (see under the heading of nose-related problems). Vomiting of blood (Also called haematemises). This could be due to severe bouts of vomiting without any bleeding disorder. It can also be due to drugs like Aspirin and certain other pain relieving drugs, specially if these are taken on an empty stomach. Blood in stools. This can be due to a fissure caused by hard motions in a child with constipation. In such case the hard stools are streaked with fresh blood. A rectal polyp is another cause for passage of fresh blood in the stools. The typical history is that of a child who passes drops of bloods after having passed a motion. Spitting of blood or haemoptysis. This could be due to certain disease in the lungs the lungs. Blood trickling from the back of the nose and brought out from the mouth can also be mistaken for haemoptysis.

Bones, Joints & Muscle Injuries

Injuries to bone Fractures in the children are not uncommon. Often they are not serious. For instances, when children learn to walk, they fall frequently and can get the so called 'toddler fractures'. The child avoids bearing weight on that leg and tends to limp. These children recover without any treatment. But if the symptoms persist for more than a day or two, you must see the doctor. Fortunately, most get better by restricting the movement of the part and surgery is rarely needed. After an injury, the bone may not fracture right through. It may just bend and a crack may be noticed only on one side of the bone. If the bone breaks through the skin and comes out of the surface, it is termed as open fracture and needs much more careful handling. Fractures affecting the growth plate at the end of the bones also needed specialised treatment. Otherwise, the normal growth of that particular bone is affected. If you suspect a fracture (pain local swelling and lack of movement of the affected limb), make a splint from a piece of wood or folded newspaper. Put it under the injured site to prevent the movement. Use cold compresses on the site till your doctor sees the child. If there is a possibility of a fracture affecting the spine or neck, do not remove the child yourself. Let the doctor handle the case. If there is bleeding, apply firm pressure on the wound. (See under section on cuts). The doctor may ask for an X-ray and decide to set the bone by manipulation (closed reduction) or by an operation (open reduction). The latter procedure is often not needed in children. It is advisable not to give any food or drink to the child in such cases because the doctor may decide to give the child anaesthesia for which a state of fasting is essential. Pulled elbow Your child is walking by your side with your hand holding his. He suddenly decides to move away from you. You pull him forcefully towards you. He complains of pain near his elbow which is slightly bent. Straightening the elbow causes more pain. This is the description of a pulled elbow. These children have a rather loose elbow joint. When you pulled him, the upper end of the bone nearer the arm was pulled towards you creating a space between this bone and the other bones. The tissue nearby slid into this newly created space. When the pull is released, the bone goes back to its earlier position the tissue gets trapped inside the joint and the child gets pain. A doctor in the casualty of the hospital can easily set it right to bring immediate relief from pain. Sprains affecting a joint The common example is twisted ankle joint. The ligament holding the joints together are either stretched excessively or get torn. Your child gets pain, refuses to walk and you notice swelling around the particular joint. There could be an underlying fracture. So medical opinion is desirable. While waiting for your doctor, keep the joint motionless. If you have an elastic bandage, wrap it around the joint. Do not make it to tight. Remove it for a while every two hours to make sure that the blood flow is not obstructed. For pain you can give the child paracetamol or ibuprofen, keep the joint raised and give cold compresses with crushed ice in a small hand towel or a piece of cloth. If you have not been able to consult a doctor, apply cold compresses for about twenty minutes, once an hour, for a day or two. After a day or two the swelling becomes less or does not increase any further. Then hot compresses every two or three hours should be given. In case the child cannot move his toe or the foot appears limp, deep-seated serious injuries might have occurred and hence urgent medical advice is needed. Injury to the tip of the finger This can be very painful and may even lead to permanent deformity of a growing nail. The tip of the finger can get caught in the closing door of the car or at home. Sometimes the injury is not severe and the child does not complain of much pain. There is not much swelling as well. Such cases can get better without any treatment. The problem arises if you notice swelling or blood under the nail. Such a situation needs urgent medical attention. While waiting for your doctor, give cold compresses with crushed ice in a small hand towel or a piece of cloth. If ice is not available, take cold water and let the finger be dipped into it. If the skin is cut, wash it with water and put a sterile gauze (available in packets with your chemists) on it. If the finger is bleeding, a cold compresses will help. Too much pressure to stop the bleeding should be avoided as there may also be an underlying fracture. Keep the finger a little raised. The doctor will decide if there is a need to remove blood from the under the nail by making a small hole in it. If he suspects a fracture, he will ask for an X-ray. Help of an orthopaedic surgeon is essential if a fracture is confirmed or if there is damage to the nail-bed where growth of the nail takes place. Injury to the muscles The annual athletic meet in school is to take place after one week. The heats are being hold. Your child takes part in the hundred meter race. After that he complains of severe pain in one or more muscles. Sometimes he cannot move the affected part possibly because of bleeding within the muscle which makes it stiff. Raise that limb and gently massage it after applying hot compresses. In future let him start an exercise to which he is accustomed to gradually and do warms ups before any active sport.

Bow Legs & Knock Knees

Most infants normally have bow legs. Similarly, most pre-school children have knock knees. Both these conditions need no treatment except in the following cases before the child starts school. Rickets can cause bowing of legs. But in case the child would also have other features of rickets. You should also consult your doctor if only one leg is affected or if the bow legs seem to get worse after 2 years of age. In case of knock knees, if the gap between the ankles, with the child lying down (legs touching the bed), is more than 10 cms or if the knock knees persist after 7 years of age, further investigations and treatment may be required.

Breathlessness

Any child who is breathing over 50 times a minute is at risk. Take it seriously. Smaller children normally have faster rate of breathing than older children. But you should immediately show the child to a doctor if the rate of breathing is as follows. Upto 2 months of age    60 or more per minute 2 months to 1 year       50 or more per minute 1 to 5 years                40 or more per minute Older children              30 or more per minute To count the rate, place your watch (with a seconds’ hand) over the chest of the child and count the number of breaths per minute. Along with fast breathing, if the spaces between the lower ribs of a child's chest go as in as the child breathes, rush to the doctor. If such a child is unable to drink anything, it is a medical emergency and the child should be taken to a hospital immediately. A few common causes of breathlessness discussed under individual headings are : Pneumonia, asthma, bronchiolitis, stridor associated with a foreign body or serious infection of the throat and heart failure due to congenital or acquired heart disease.

Bronchiolitis

An infant between 2 and 6 months of age, having a mild cold like symptoms with low fever may become rapidly ill and restless, develop severe cough, fast breathing (50 or more per minute) and wheezing, and may become blue. This picture suggest the possibility of the child having bronchiolitis. This disease is seen mostly during the winter months. It is due to a viral infection and hence antibiotics are not helpful. Children with the bronchiolitis often need hospitalization. An X-ray will be taken. Oxygen and intravenous fluids may have to be given. If the chest X-ray shows evidence of a bacterial pneumonia, antibiotics will be prescribed. If the infant gets more than one attack of `bronchiolitis'; it is possible he may be having bronchial asthma. Try and prevent this serious disease by keeping your child away from children or adults who have a viral cold.

Burns

Preventions Preventions of burns should be of paramount importance to all parents. (See chapter on prevention of accidents). Minor burns may cause discomfort but severe burns can endanger life or lead to crippling deformities. Treatment Whatever the extent of the burn first put cold water over the burn. Do not use ice. If cold water is not available, keep pouring tap water or stored water over the area for some time. Remove all clothing from the burnt area. Cover the area with a clean piece of cloth. Do not apply any ointment, ghee or honey without any advice of your doctor. Do not puncture the blisters. Generally, doctors also leave the small blister alone. The large blisters are punctured to avoid accidental rupture and infection. Let your doctor decide if the child needs hospitalization. This may have to be considered in case of burns of face, hands, genitals and feet; in all third degree burns (see below); first and second degree burns involving more than 25 per cent of body and burns due to chemicals or electric shock. In first degree burns, the patient only has redness with or without slight swelling of the skin. The second degree causes blisters and much swelling. The third degree burns damage even deeper layers of the skin. The skin may appear white or charred. The extent of the burns is calculated by the `Rule of Nine'. RULE OF NINE Part Of The Body Percentage Total (%) Face 9(18 in infants) 9 Front and back 18 each 36 Upper limbs 9 each 18 Lower limbs 18 each (13.5 in infants) 36 Perineum 1 1 Grand Total   100 In case of extensive burns, do not give anything by mouth to the child until you have seen the doctor. Otherwise, plenty of liquids should be given. If the child has received his usual immunizations (including DTP or triple antigen) as per schedule, there is no need for tetanus oxiod except for severe burns when your doctor may decide to give it. If it a booster dose of DPT (Diphtheria, Pertusis and tetanus) is due, it can be given. This includes tetanus toxoid.