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A - Z of Childhood Illnesses

C

On this page: Cancer Cerebral Palsy (CP) Chicken Pox Choking Heimlich manoeuvre Circumcision Cleft Lip & Palate Common Cold Use of antihistamines

Cancer

Cancer does not respect age. It can affect even a children. Fortunately, early detection and treatment can now save over half the children who get afflicted by this disease. Cancer can affect lymph nodes or glands. This results in Hodgkin's disease. Leukaemia refers to cancer of the blood. In both these diseases the child feels weak, complains of poor appetite can loose weight may have unexplained fever and enlargements of his liver and spleen. In both cases the child can have enlargement of the lymph nodes but the nodes are likely to be much more enlarged in Hodgkin's disease. They can found in different parts of the body including the abdomen the chest, armpits and groins but are more likely to be discovered first in the neck. The chest nodes are usually detected in an X-ray of the chest. In leukaemia, severe anaemia, a tendency for bleeding and tenderness in the bones are the more salient features. Bone tumours cause pain and swelling at the site of the tumour. The bones of the limbs are commonly affected. Brain tumours lead to persistence headaches, vomiting, tiredness, visual disturbances unsteady gait and convulsions. Children can also have cancer of the kidney (Wilms tumour), the suprarenal gland lying above the kidney the liver, the skin and the eye. The Silver Lining Let me conclude this subject on a happy note. A few years ago, I saw a very healthy and happy child. His mother had leukaemia as a child. When the diagnosis was confirmed, her parents cried and cried. They lived in a joint family. The whole family rallied to give the best to the child. The physician treating her was happy that the child was brought to him without having been messed-up by half hearted treatment. A full course of anti-leukaemia treatment cured the young girl and she latter became the proud mother of that lovely child who had come to me. Though initially, it was an expensive and painful affair, ultimately this illness brought the whole family nearer to each other and `nearer' in the mother’s words `to God'.

Cerebral Palsy (CP)

A child with celebral palsy is also sometimes called a spastic child because in quite a few children with cerebral palsy the muscle have increased tone. But this is a misnomer because some children with cerebral palsy can also be hypotonic or limp. Additional facts about cerebral palsy Early the diagnosis helps in management. However, if the diagnosis in case of your child was delayed do not lose heart. Even now the child can benefit from a holistic approach to management. Fifty per cent of children with CP are mentally normal. Many children with CP can become useful citizens. With training, most of them can look after themselves. A small number will need supervision for several years. The child improves much faster if both parents share the responsibilities of looking after the child. A caring joint family can be an asset. As the child with CP often needs extra care, there is always a possibility that the other children in the family or your spouse may feel neglected. This can lead to other problems. Such risks can be minimized. When to suspect cerebral palsy. Though the cause is not known in most cases, the children whose brain has maldevelopment or has been damaged during pregnancy at the time of delivery or soon after birth, run the potential risk of cerebral palsy. Children who had severe jaundice within 30 hours after birth of those who had prematurely can also get this disease. Unusual stiffness of the body or limpses should alert us to the possibility of CP. If you notice that your child is slow in learning new skills as compared to his older sibling or children his age, you should consult your doctor to rule out this possibility. Besides stiffness or limpness, these children can also have another problems like excessive drooling, speech disturbances, dental, eye and hearing problems, convulsions and different grades of mental retardation. Management Do not give your child any medicine without expert advice. If there is a specialised centre nearby for care of children with CP your doctor will refer you there for treatment. If there is no place near where you live, write to the Spastics Society of India (The Spastics Society of India, K.C.marg Bandra reclamation, Mumbai. Phone: 6430703/04). Give the background of the child. They may suggest a centre nearest to your home. The child is educated at the centre, the individual problem is discussed together by the paediatrician, neurologist, orhtopaedic surgeon, psychologist physiotherapist, occupational therapist, speech therapist, social worker and others. They chalked out a plan of action for your child. You will be called to the centre for a few visits to help you learn the art of managing such children. Later on, you will be able to give the same training at home. As far as possible you will be encouraged to let your child study in a school for normal children. But in some cases, admission to schools for children in need of special care is required. No specific drug is available for CP. But sometimes a drug to reduce the stiffness may be advised. Occasionally, an expert may administer an injection into specific muscles. Some children may benefit from surgery. None of such treatment should be undertaken without expert advice.

Chicken Pox

Chickenpox in children is usually a very mild disease. It occurs less frequently in older children and adults but if they get the disease, it is more extensive and cause a lot of discomfort to the patient. A highly infectious disease Chickenpox is virus infection. It is highly infectious. If one child gets the infection at home or in the school, those in contact with him are likely to contract the disease after a period of 2 to 3 weeks. As the disease usually confers a lifelong immunity, if you have had the disease before, you are safe. Onset and course of chickenpox Often the first thing the parents notice are one or two tiny blisters on the back or the chest. The child is otherwise normal. New blisters appear rapidly. Parents learn from crusts or scrabs. Some children, specially the older ones may get high fever and look quite ill. But the younger ones have low fever or no fever at all. The rash of chickenpox usually begins within a day of the onset of fever. It begins in the form of red spots which itches. Within a few hours, they turn first into small pimples and then into blisters on a red surface (almost like a dew drop on a red leaf). The spots are very itchy. The blister with clear fluid become cloudy within a day and then become crusted. While this happening, new red spots or blister may be noted in the nearby area. Typically, in a small portion of the body, you must notice the rash in different stages-the red spot, the clear blister, the cloudy blister and the crusted one. The rash is mostly confined to the chest, back, face and the head. The legs and hands are generally not involved. Spots may also appear in the mouth and vagina. Small glands often develop at the back of the neck and the armpits. The total period of the illness is about a week or ten days. How to differentiate chickenpox from insect bites or pimples ? The disease may be confused with the insect bites or with pimples. The rash of chickenpox keeps changing its characteristics very fast. The insect bites or pimples do not follow this pattern. While pimples are confirmed to the face the bites are to be found mostly on the exposed parts of the body like the legs and the arms. A child is not infectious to others once all the spots are crusted. Once all the spots become crusted and no new crops appear, the patient is no longer infectious. He can infect the others from a day before the spots are first noticed to the day all the spots are crusted. Once that happens, the child should be ready to go to the school and play with the other children. Unfortunately, in some schools, the child is not allowed to join till all the scabs or crusts have fallen off. It is to be noted that whereas the scabs of smallpox which is now eradicated, could infect others, those of chickenpox cannot. Interested parents may consider meeting the school authorities in this connection so that the children are not unnecessarily kept away from school. Treatment The spots of chickenpox are very itchy. A daily bath helps because sweating increases the itching. Keep the nails short. An older child may be explained that he should avoid scratching because it may leave behind scars. For smaller children, mittens may be used at night. If itching is severe, apply cool packs of cloth soaked in water from boiled and strained neem leaves. Plain calamine lotion applied to the spot also reduces itching. It is not advisable to use calamine mixed with other ingredients. Neem leaves, may also be spread on the bedsheet. If the itching is very severe, your doctor may prescribe an antihistamine preparation to be given by mouth. If the fever does not bother the child avoid using any drug. If required, a paracetamol preparation may be used to lower the temperature. Never give aspirin to a child suffering from chickenpox or influenza because it may lead to serious disease called Reye`s Syndrome. No diet restrictions are required. The child should be allowed to eat his usual healthy nutritious food. If he does not feel hungry, make sure he has enough of liquids including fruit juices, coconut water and plain water. Complications in children and during pregnancy Chickenpox is not a serious disease. But complications like pneumonia and encephalitis can rarely occur. If a pregnant women gets the disease in the first three months of pregnancy, there are two or three percent chances of her baby suffering a birth defect. A new born baby is protected from getting the disease if his mother has had chickenpox in the past. But risk of a new born getting the disease are quite high (about fifty percent) if the mother develops chickenpox within five days before or two days after the delivery. A baby whose mother develops chickenpox after delivery may be given the chicken pox immunogobulin, if available. These babies should be kept away from other children for three weeks. If the mother has had chickenpox her newborn is protected for above six month of age. Such a newborn can be brought home if the older children are having chickenpox. If the mother is not sure is she has already had chickenpox, the newborn may be kept away from the older children for about two weeks. A drug company seems to be pushing the use of their drug for the treatment of all cases of chickenpox. This drug also has side effects and should not be used in routine cases of chickenpox. It is reserved for the special situations to be decided upon by your doctor. In any case it is really effective only if the treatment is started within 24 hours of the onset of the disease. Antibiotics are also of no use in this viral infection except in rare cases where secondary bacterial infection might have supervened.

Choking

When to suspect choking Your two year old is eating peanuts. He starts running. Suddenly he starts coughing violently. There is a strong possibility that he has inhaled the peanut into his windpipe, resulting in the obstruction to the free flow of air. Do not panic. Coughing might help him in expelling the peanut. Sometimes, if the obstruction is more severe due to foreign object food, he may not be able to talk normally and may turn blue. Treat this case as an emergency and act as quickly as detailed below. Sometimes a little water or milk or soup or any other liquid tends to go into the windpipe and the child coughs to stop that or to expel the little liquid that might have gone into the windpipe. This need not to be cause of worry. Emergency steps to be followed Step 1 If you are infant is difficulty in breathing and is becoming blue, shout for help, lay him in a head down position on your forearm. Let your arm rest on your tilted thigh with his head just below your knee. Then give four rapid blows on his back with the heel of your other hand between the two shoulder blades. It may be convenient to rest an older infant on the arm. Lay him face down on your lap, with his head towards the ground and supported with one hand. Step 2 If you find no improvement, put him on the floor on his back. Using two or three fingers give four rapid chest thrust over the breastbone lying in the centre of the chest. Step 3 If you can now see the foreign object or food in the child’s mouth and feel confident that you can easily remove it, sweep it out with your finger. Step 4 If the child is not breathing, follow step 3 with mouth-to-mouth breathing (See section on mouth-to-mouth breathing). Step 5 Keep repeating step 1 to 4 till the child improves or you get some medical help. Helping an older child with choking (Heimlich manoeuvre) Stand behind the child and wrap your arms around his waist. Make a fist with one hand and grasp it with the other hand. Put your fisted hand on the upper abdomen just below the breastbone of his chest. Then press into his abdomen with a sudden spring upward jerk. You may have to do this repeatedly (upto a dozen times) for him to bring up the foreign object. As before, mouth-to-mouth breathing may be required if the child is not breathing.

Circumcision

Cutting off the foreskin of the penis is called circumcision. The foreskin or prepuce covers the glans or the soft front portion of the penis. Circumcision is done: 1. As a religious rite. 2. For any complication. 3. For no definite reason. The foreskin is normally adhered to the glans penis in most newborns. If nothing is done, it separates on its own by the age of three or so, in almost all cases. You must therefore instruct people at home not to make any attempt to retract the foreskin. If it is still adhered, you may yourself try to gently push the foreskin behind and clean any stuff between the skin and glans penis. If no separation to the foreskin is noticed by the age of 4 years, you can consult a paediatric surgeon. He may retract it for you without cutting off the foreskin. Some people may wrongly advise you for circumcision because the child has a long foreskin or is wetting the bed or has ballooning of the foreskin on micturition without any other problem. Some reports indicate that urinary tract infections are more common in uncircumcised boys. I am not convinced about it. However, if proper attention is not given to treat a severe diaper rash, secondary bacterial infection may result in scarring of the foreskin. This may result in the foreskin getting permanently adhered to the glans penis and cause urinary infection. Whether this is true or not is again debatable. But in such a situation, the circumcision has to be undertaken because spontaneous retraction is not going to take place. Also, in absence of any proved obstruction in the urinary tract, if a child with adhered prepuce gets a repeat attack of urinary infection, circumcision should be considered. It is also stated by some that cancer of the penis in males and cancer of the cervix in wives of the males who have been circumcised is less common. An editorial in the reputed British Medical Journal has refuted this view (`The case against neonatal circumcision', BMJ, 1979, 1:1163). Some advocate circumcision from a hygienic point of view. This is not tenable because smegma (the cheesy material which collects between the foreskin and glans) can be removed daily while having a bath. If the skin is forcibly retracted, you may find it difficult to bring back to its original place and the penis gets swollen. Your doctor can set it right but if it recurs, he may advise circumcision. The operation may also be advised for pus collection behind the prepuce. Some people may say, `It is a minor operation. What is the harm is getting it done as a routine ? They do not realize that even this operation can cause infections, excessive bleeding and other problems. Finally, I personally believe that if most newborns have an adhered prepuce, nature must have some purpose in keeping it so. In short, I am against routine circumcision. You can get the operation done for religious reasons. Here also, the operation should be done at a later date if the baby was premature or had some complication at birth.

Cleft Lip & Palate

Cleft of the lip with or without cleft of the palate is a common birth defect. With surgery, these defects can be closed with good cosmetic effect. Cleft lip is operated when the baby is about 3 months of age. Some plastic surgeons operating on these children follow a ‘rule of tens' to decide when to operate. They like the child to be atleast 10 weeks of age, weigh 10 pounds (about 4.5 kgs) and have a haemoglobin of 10 grams percent. The child should not have any infection. Surgery for cleft palate is undertaken between the age of 1 and 2 years. These babies can be breastfed though mothers of these babies need extra support. Most babies with only cleft lip (without cleft palate) have no difficulty in breastfeeding. The mother should offer enough of the breast into the babie`s mouth for the breast to close over the cleft so that he can suckle well. The idea is to help the mother use her areola (dark portion of the breast behind the nipple) to fill in the defect and form a seal. Suckling is more difficult in the presence of a cleft palate. The baby may seem to choke sometimes or milk may leak through the nose. The baby may choke less if the mother holds her baby in more upright position while breastfeeding. If the baby is not able to manage direct suckling in one position, the mother should try feeding in a different position. One such position is called `the modified football-hold position'. In this position, the mother sits up on a bed. She makes the baby sit upright opposite her one breast, with his legs along her side and his feet at her back. She holds his head in her hand to offer the breast and uses her other arm to support the baby`s back. A pillow kept under the baby`s bottom may be found helpful. Direct suckling may not work with some babies. The milk should then be pressed and given to the baby in a cup or with a dropper (or by a tube) until the baby is able to suckle well enough at the breast. It has been found that irrespective of the mode of feeding, babies with cleft lip tend to gain weight rather slowly. After a surgery for cleft lip, some surgeons allow the direct suckling from the breast as soon as the baby leaves the recovery room. They believe that unlike bottle-feeding, the soft breast does not damage the stitches. In any case, there is no need for stopping direct suckling for more than a few hours. If for any reason, direct suckling is delayed, the mother should keep expressing her milk every three hours. This milk can be given to the baby with a cup or a bondla (paladai). Breast feeding is now recommended even in the second year of a child’s life. So after the child recovers from surgery for cleft lip, in a week or more, breastfeeding can be started again. Some children who are operated for cleft lip may need another operation later on. After surgery, children with cleft lip and palate would need the help of a speech therapist and an orthodontist, under the guidance of a paediatrician.

Common Cold

Colds are very common. Some children can become very restless with a cold. So we shall discuss the subject at length. But before we do that, please note : No antibiotic helps in common cold. Antithiasmines (anti-allergy medicines) are harmful in common cold. Opening of the nasal passage is all that is needed if the nose gets blocked. Cigarette smoke and overcrowding add to the problem. No antibiotics for colds Common cold is a viral infection. No antibiotics act against these viruses. If you use antibiotics in a child with a cold, you kill friendly bacteria-some of which have been helpful to the system to make a certain vitamins. Moreover, the bacteria, which might not be so friendly but were not causing any problem to the host, may develop resistance against the antibiotic which was unnecessarily used. Later on, if these bacteria should be the cause of infection and you use that antibiotic, it shall have no effect. Also quite a few children can get allergic reactions, stomach upset and loss of appetite with antibiotics. The throat is usually congested in a cold. This does not mean that antibiotics are indicated. Accept cold as an unavoidable nuisance Many different viruses (over 200) can give rise to colds. If your child is exposed to one today, he may get a cold due to another virus after a month or two. In this process he may have developed immunity against the previous virus. Thus your child in the half a dozen or more per year colds he may get, develops an immunity against some of these infective agents. That is why some people like to prefer to the nuisance of cold as a lifelong insurance for the future. And then, after the age of 2 to 3 years the colds become less frequent. However, colds can cause discomfort to children, specially smaller babies below the age of 2 months. If there nose gets blocked because of a cold, they find it difficult to suckle. As they do not often the mouth to breath, if the nose is blocked, they become restless even if they are not feeding. In such cases, urgent steps as discussed below, are to be taken to clear the nasal passage. In infants below 2 months, the cold may rarely be due to a bacterial infection. The baby may also have high fever. Such infants may need antibiotics. When the cold is accompanied with fever, paracetamol as discussed in the section of fever (under home remedies) can be used. In first few weeks the baby may have little mucus like secretions in the nose. You may notice bubbles in his nose as he breathes. It does not cause any problem, but if you feel that the baby has difficulty feeding, you may consider cleaning the nose as described below. Running nose may be due to allergy (see section on allergic rhinitis) As common cold the child has a thin watery discharge from the nose. In both the onsets is marked by few sneezes. But in allergy the sneezing becomes persistence unless the agent which is caused the allergy is removed or antithistamines are given. Allergic ‘cold’ is also seen most often during certain seasons of the year, or on getting up in the morning (due to an allergen in the bedroom) or when the child is exposed to the agent causing the allergy. A constant watery discharge from the nose, throughout the month, is likely to be due to allergy. Typically, the cough due to is noticed during sleep. If the child is lying on his back, the watery discharge from the back of his nose drips down to the throat. Nature does not want this stuff to go into the windpipe and this protective mechanism makes the child cough with the post - nasal drips. Such a child is helped, if you put him to sleep on his stomach. Taking care of the blocked nose If the nose is not too blockaged, your child, specially if he is older may not be bothered. Otherwise a blocked nose does need help. The best tool for this is a rubber syringe (also called nose cleaner) which is available at most of the departmental stores and chemists. It consist of a rubber bulb, shaped like an ancient rubber horn. To this is attached a nozzle which can be also boiled. To use it, press the rubber bulb, keep it pressed, put the nozzle tip into the baby`s nose, and then release the bulb. The mucus gets sucked into the nozzle. Clean the nozzle. Boil it before using it again. If these tool is not available, you can also use a 5 or 10 ml syringe without a needle for the same purpose. If the nose still appears blocked, use the saline nose drops. These can be prepared at home. Add a level teaspoon of salt to a glass of water (about 200 ml). Mix. Boil. Cool. To use these drops effectively, let your child lie down. Turn his head to one side say right side. Put 2 drops into the right nostril. Let the head be kept on the same side for a minute or two. Then repeat the same procedure for the left side. instead of dropper, you can also make a cotton wick. Dip it into this water salt solution. Roll the wick inside the child’s nostril to clear the mucus and to open the nose, he may also sneeze expelling some of the mucus. Cleaning the nose is specially needed before sleep and before feeding the baby. Though saline drops are the safest, even these should be avoided unless the blocked nose is bothering the child. Only if the saline nose drops are not helping the child is in real discomfort , should you take recourse of the readymade nose drops. But you make sure that they are meant strictly for use in children. Generally. these nose drops are to be avoided because after opening the nasal passage for a while they cause increased congestion due to what is called a rebound phenomenon. There are also medicines (oral decongestants) to open the blocked nose. Generally, we avoid these drugs because of their possible side-effects. In older children who does not allow the use of nose drops, one may have to take recourse to such drugs. Sometimes a humid atmosphere might be helpful. If you have a hot water shower in your bedroom, turn it on for about 15 minutes, at the hottest setting. Keep the child with you at a distance from the shower. Your friends might suggest a vapourub be applied to the nose or on the chest. I do not recommend it. Some children get a rash with it. Other may have a shock like reaction if the medicine is applied to the nose. If the child has a thick secretion blocking the nostril, take a wick of cotton, moisten it in the saline water as mentioned above and let this moistened wick be used to soften the secretions. Then use the syringe and the saline drops. An older child can blow the mucus out. But he should not blow too hard, otherwise he may get an earache. Make sure that the child has enough liquids. If the child has lost his appetite, do not force him to eat. An exclusively breasfed baby does not need extra fluids. Use of antihistamines Some doctors use antihistamines to dry up secretions. This is not advisable. The watery secretions are helping the virus to get out (as in a case of diarrhoea). So we should not act against nature’s helpful mechanism. Treatment for sore throat of irritation in the throat Encourages older children to do hot salt-water gargles. Rest All patients with a bad cold, children as well as adults, need rest for themselves, as well as for protecting others. It may not be a bad idea to put up a notice for visitors outside the room of your newborn baby which says. `If you have a cold, please do not enter'. If it is practical even dad and other members of the family with the cold may stay away from the baby. But please do not start giving masks to others or put one on your face to protect the baby. Continue nursing your breastfed baby if you have a cold. All those who happen to handle a child with a cold at home or in a nursery school, must wash their hands to prevent its spread to others. Some people believe that overwork, anxiety and sudden variation of temperature (for e.g. if you have suddenly bring a child into and air conditioned room after he was in the hot sun outside) may trigger a cold which you might have otherwise prevented with the help of your well tuned immuned system. I feel that there is some truth in it. Others also believe that vitamin C helps to prevent and treat cold. People may keep debating this but I would vote for those who say that fresh fruits are good for a person for several proved scientific reasons. So let your child have enough of fruits or fruit juices. Ignore the myth that fruit juices worsen cold. Any food, including a fruit, should be avoided only if you are sure that the child is allergic to that particular food. I would recommend a daily bath if your child with a cold wants it. If not, I advise a sponge with slightly warm water. When do you need antibiotics for a cold Persistent, thick, yellow or green discharge from the nose may point towards the need of an antibiotic specially in infants. But remember that before your child recovers from a cold, the nasal discharge often normally becomes thick, green, yellow or green. This does not require antibiotics. It is the persistent discharge we are talking about. Let your doctor decide about the use of the antibiotics. When must you consult your doctor If your child with a cold has a persistence thick nasal discharge, has fast breathing (more than 50 breaths per minute), is wheezing gets an acute earache, or is refusing to eat or drink and phases little urine, you must consult your doctor. But do remember that all noisy breathing is not due to wheezing. When air passes through a partially blocked nose, you may noticed noisy breathing, while your doctor finds that the chest of the child is completely clear and the sounds conducted from above were giving a false impression that the chest is congested. If your child has a persistent discharge from one side of the nose, then also you should see the doctor, specially if the discharge is foul smelling or mixed with blood. It may be due to a foreign body or due to rare conditions like diphtheria.