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A - Z of Childhood Illnesses

C

On this page: Congenital Heart Disease (C.H.D.) Transposition of the great arteries Tetralogy of Fallot Pulmonary and aortic stenosis Patent ductus asteriosus Constipation Convulsions Or Fits Cough Croup Spasmodic croup Acute laryngotracheobronchitis Acute epiglottitis Crying Infantile colic Cuts

Congenital Heart Disease (C.H.D.)

Our heart is made up of four chambers. The upper ones are the right and left atrium separated by a wall named interatrial septum. The lower chambers are the ventricles, the right and the left, separated by the inter-ventricular septum. When we use the term ‘a hole in the heart', we refer to a defect in the wall separating the two sides of the heart. When the ‘hole' is in the inter-atrial septum, the patient is said to have an atrial septal defect. In the septum, the patient is said to have an atrial septum defect. In the ventricular septal defect, the defect is in the wall separating the two ventricles. The left side of the heart has oxygen-rich, pure blood (or 'red blood'). The right side of the heart has oxygen poor impure blood (or 'blue blood'). Normally, the pressure on the left side of the heart is more than the right. So the flow of blood in septal defects (hole in the heart) is from the left to right. The `red blood' from the left ventrical is pumped to the body through a big vessel called the aorta. So in septal defects the patient does not have cyanosis. (Cyanosis refers to the blue colour of the skin and mucous membranes). Transposition of the great arteries Cyanosis occurs if the big vessel (aorta) carrying blood to the body arises from the right ventricle. So the body gets oxygen poor `blue blood'. On the other hand, the other big artery, called the pulmonary artery which normally has its origin from the right ventricles arises from the left ventricle. The pulmonary artery supplies blood to the lungs. This conditions, in which the position of the great vessels is reversed is called the ‘Transposition of the great arteries'. Babies with this condition are usually found to be blue soon after birth and need urgent attention. Tetralogy of Fallot The more common conditions which is called ‘the blue baby' is ‘Tetralogy of Fallot'. Besides other abnormalities, the child has a big defect between the two ventricles and obstruction in the valve of the pulmonary artery. Pulmonary and aortic stenosis A child can have obstruction limited to the valve at the origin of the aorta or the pulmonary artery resulting in aortic or pulmonary stenosis respectively. Patent ductus asteriosus Outside the heart there may be a communication between the aorta and the pulmonary artery. This is called ‘patent ductus arteriosus'. This communication is normally present in the infant when he is in the mother’s womb. With the birth of the baby, it is supposed to get closed. If it doesn’t, the child is said to have a patent ductus arteriousus'. When to suspect C.H.D.? Your doctor may hear a murmur (a rumbling sound heard over the region of the heart) on the routine examination of your newborn baby. Some of these murmurs may be of no consequence even if they persist. Some may disappear without causing any problem. Others may be because of congenital heart disease. If the defect is of a significant nature, your baby may have difficulty in taking his feeds. He may seem to be getting easily tired and may start sweating over the forehead. Recurrent chest infections could also be due to C.H.D. You may also notice rapid beating of the heart, swelling of the body poor appetite and failure to gain weight. The child may get easily fatigued or appear blue. At times these children may become unconscious. But do bear in mind that the above symptoms may not necessarily be due to a heart defect. However, you must consult your doctor in case of any doubt. If your doctor also suspects the possibility of C.H.D. he would ask for an ECG, a chest X-ray, and an echocardiogram. Sometimes your doctor may consult a specialist who may ask for cardiac catheterisation, in which a catheter is passed from a vessel in the groin upto the heart and then a dye is injected. Management of C.H.D. Some ventricular septal defects close spontaneously with age. Some cases of C.H.D. can be tackled with a balloon like device to dilate the obstructed valves or vessels at the time of cardiac catheterisation. A calm shell device can also be introduced into the heart to close an atrial septal defect. Similarly, an umbrella device can occlude the patent ductus. But many cases of C.H.D., specially the serious ones, still need surgical repair. Other medical management includes: Proper treatment of any chest infection. Treatment of heart failure, if present. Prevention of any further heart complication in these children which can follow any dental or mouth surgery. Prevention of dehydration because lack of fluids can cause clotting of blood in the brain of a `blue baby' Treatment of anaemia which can cause added burden on the heart. Restriction of activity (only if your doctor advises) and regular check-ups with your doctor.

Constipation

Abnormally infrequent and difficult passage of motions is not common. But when it happens it can be quite troublesome. A child may pass hard motions because of which he may get fissures or cuts near the anus. These can be very painful. The child starts thinking that the passage of motions causes pains. He now purposely starts withholding his stools because of that. The stools become drier and firmer making it more difficult for the child to evacuate. Soon a vicious cycle starts, Sometimes the child soils his underclothes when liquid waste leaks around the solid waste. Normal infrequent motions Some exclusively breastfed babies pass normal motions once after 2-3 days and sometimes even less frequently. The motions are never hard. This is normal and requires no treatment. Treatment of constipation Eating sufficient fruits, vegetables, sprouts, whole grains and fluids help in the prevention as well as the treatment of constipation. Regular bowel habits and a relaxed pace for morning routines also helps to avoid constipation. A glass of water on getting up in the morning is helpful. Warm water with a teaspoon of honey is preferable. Many children may get a normal urge to pass a motion after drinking milk or after breakfast. The child should be relaxed while sitting on the toilet. A younger child may be encouraged to sit for about 15 minutes. He can be engaged by the mother or others with something interesting like a toy or a book or a puzzle. If he does not evacuate, he should not be forced to do so. The diet should have more of the fibre in form of fruits like figs (fresh as well as dry), raisins, plums, apricots and prunes; vegetables specially leafy vegetables, raw vegetables, peas and beans; sprouts; wholewheat flour chapati and bread and unpolished rice and enough liquids. Medicines can be helpful. But none should be given without the advice of your doctor. In severe cases hospitalization may be needed to manage the child and also investigate for some other rare causes that can give rise to constipation.

Convulsions Or Fits

In simple terms a convulsion or a fit refers to an abnormal involuntary movement(s) of the body with or without disturbed consciousness. The movements can involve almost the whole body or just the finger or any other part of the body. Unconsciousness may be prolonged or may be momentary and take the form of a stare. Most causes of convulsions are not serious and they disappear as the child grows older. A few types of may need medication for two years or more. Management of a convulsion Step 1. As a prolonged convulsion can affect the brain, the doctor would first like to control it. Fortunately, most convulsions last a minute or two and stop on their own. Usually, a drug (diazepam or phenytoin) is injected into the vein of the child to stop the convulsion. Sometimes, a drug may be injected into the muscles. You must not give the child anything by mouth while he is having a convulsion. If your child has a tendency to get convulsions, specially with high fever, your doctor may advise rectal administration of diazepam. It is quite effective if used soon after the child is found to have fever. For this purpose, the same drug, which is given into the vein is used. Diazepam by mouth has also been found helpful to prevent convulsions with fever. It is also to be started with the onset of fever. However, rectal administration is more effective than oral. Until the child with continuous convulsions is seen by the doctor, do not panic. There is no use making the child smell a shoe or onions. If he is still convulsing, put a spoon wrapped with a piece of cloth in between his teeth to prevent tongue-bite. Let him lie with his head a little lower than his body and turn him to one side to prevent aspiration of any vomit. (Do not lower the head if there is history of head-injury prior to the onset of convulsion.) It is no use holding the child to stop convulsion. Only make sure that he does not hurt himself. If you find that his skin and lips are turning blue and he has stopped breathing, start mouth-to- mouth breathing. Step 2. Note the condition of the child after the convulsion has stopped or after the effect of medicine given to control the convulsion is over. A child may normally sleep for sometime after a fit. If he looks perfectly normal after the fit, we are probably dealing with a less serious cause of convulsion for which hospitalization is not needed. However, a child with convulsion following a recent head injury often needs observation in a hospital. In any case, let your doctor take the final decision about hospitalization. A child who does not look well after a convulsion or in between two convulsions need extra attention. Step 3. Find out the cause of the convulsion and treat it. A child who had a difficult birth or who has a deficiency of glucose or calcium in his system may get a convulsion. One out of four children with a sudden rise of fever may get a short-duration fit between the age of six months and five years. Some infants and toddlers may get a fit following sobbing after a bout of crying. A few serious causes of convulsions are cerebral malaria, meningitis, encephalitis, poisoning and head injury. In some cases, the cause of convulsion cannot be determined and your doctor may make a diagnosis of epilepsy. If he suspects this diagnosis, he may ask for an EEG (electroencephalogram) and decide to put the child on a drug for prolonged use to control the convulsions. Certain drugs require a blood test to rule out any possible side-effect of the drug or to know if the dose of the drug being given was optimum. For certain type of convulsions, your doctor may ask for other tests including a CAT scan of the brain and a lumbar puncture (spinal tap) to examine the CSF (cerebro- spinal fluid). It may be noted that we have seen a few newborns and older children who get a convulsion once and never again. Hence, it is important not to panic if your child gets a convulsion. However, as frequent convulsions can cause harm to the child, it is important to take fits seriously. Step 4. Attend to psycho-social factors. Meet the school authorities. Tell them that your child is prone to fits. If required, take a letter from your doctor so that the teacher knows what to do if the child gets a fit in the classroom or on the playground. Children who suffer from epilectic fits can go for sports like swimming but under supervision. In general, they should be treated as any normal child and not be overprotected.

Cough

Cough in children is often due to viral infections which affect the nose and throat. These settle down within a few days without causing any problem. Yet we cannot ignore the fact that 15 per cent of deaths in India during infancy and from 1-5 years of age are due to infections of the respiratory system that includes the lungs. Six Important Facts To Be Kept In Mind If Your Child Has A Cough If a child with a cough is breathing over 50 times a minute, he is at risk. Immediately consult the doctor. You can reduce the risk of respiratory infections by making sure that your baby is exclusively breastfed for about six months and continues breastfeeding after that. A child with a cough and cold should be encouraged to eat and to drink plenty of liquids. A child with a cough and cold should be kept warm (not hot) in an environment free from cigarette smoke. A good doctor helps you to find the cause of cough and treat the same rather than to prescribe cough syrups and expectorants. Cough per se is a helpful phenomenon. Do not try to unduly suppress it. If your child is breathing normally, coughs and colds can be treated at home without drugs. Most medicines sold for cough and colds are useless and possibly harmful. Possible causes of cough Serious Causes Pneumonia Bronchiolitis Asthma Tuberculosis Whooping cough Congenital Heart Disease Foreign body in the bronchi Tracheoesophageal fistula (rare) Croup Less Serious Causes Cold Smoking Adenoids Habit of clearing the throat Sinus infection Attention seeking device Tropical Eosinophilia Measles Hay fever The above causes are discussed under individual headings in the chapter on common illnesses. Symptomatic Relief of Cough As mentioned earlier, cough is a helpful mechanism. Do not try to unduly suppress it. Let your child drink plenty of liquids including water. Steam is helpful (see section on colds). For symptomatic relief of cough, extract the juice from a dozen or more leaves of the tulsi plant. Give a teaspoon of this juice mixed with honey or jaggery, four times a day. If the cough is very troublesome, you can make the following mixture at home. For smaller infants, avoid honey. Avoid alcohol for those having rapid breathing. Honey is to be avoided in smaller infants because some severe infections have been reported with infected honey in this age group, though personally I have ever come across such an infection in my practice. Honey - one part Lime juice - one part Brandy or gin - one part Give 1/2 teaspoon to 1 teaspoon of this mixture four times a day. Alcohol may also be omitted in families for whom it is taboo. In that case, check the composition of the cough syrup that you propose to give in place of the home remedy. Most of the cough syrups available in the market contain alcohol.

Croup

The term croup refers to an unusual type of hoarse cough. Doctors term it as 'brassy' or 'croupy' cough. It is often though not always accompanied with stridor (noisy breathing), hoarsness of voice and difficult breathing. Cough is due to an inflammation of the larynx (voice box) and trachea (windpipe). The inflammation may be due to a self-limiting virus infection but could also be due to a serious bacterial infection. The common causes of croup are : Diptheria involving the larynx (discussed under 'Diptheria') Spasmodic croup Acute laryngotracheobronchitis Epiglottitis Spasmodic croup A croup without fever is not a serious disease but can be very scary - both for the child as well as the parents. The disease usually affects children between 1 and 3 years of age. The child goes to bed normally and gets up suddenly with a barking cough and noisy breathing. He appears very anxious. He has no fever. As the dawn sets in, the child appears normal. He may get similar attacks again. The disease occurs due to a viral infection. Allergy and psychogenic factors may play some role. There may be a history of similar episodes in other members of the family. Treatment Steam inhalation is the best treatment for this condition. If you have hot water in your bathroom, sit with your child for about 20 minutes in the bathroom a little away from a hot shower or a bath - tub or a big bucket filled with hot water. With the first attack, it is advisable to consult a doctor to rule out any serious disease. Till the doctor comes, let the child sit up and give him plenty of liquids including water. Acute laryngotracheobronchitis This is also a virus infection. In this, fever is a prominent feature besides sudden appearance of croupy cough and noisy breathing. Unlike the spasmodic croup, the child's condition rapidly deteriorates. The child appears extremely restless and scared. Acute epiglottitis This is the most serious type of croup. Besides the symptoms mentioned above the child has difficulty to swallow and drools. Within a few minutes or hours the condition may worsen. Breathing may become very difficult. The child may become blue or even unconscious. Acute epiglottitis is a bacterial infection needing urgent attention. It affects the lid covering the trachea (epiglottis). Children affected need hospitalization and are given oxygen, intravenous fluids and antibiotics.

Crying

`Tears of Joy' A thoughtful parent, let's say a father does something absolutely unexpected for a teenager, say his daughter. The daughter is dumbfounded, looks at her dad's face for a moment and rushes to embrace him. Tears trickle from her eyes. Touched by this response from his daughter, the unashamed father also bursts into tears. What a scene! May our world be blessed with more such tears a joy and love. Crying in a small child who looks sick Such a child should be shown to a doctor. He may be having infections like an earache, a cold with a blocked nose, a flu-like illness with headache and bodyache, a chest infection like bronchiolitis or infection of meninges and raised intra-cranial pressure due to a tumor. It can also be due to abdominal pain. These conditions are discussed under their respective headings. Crying in a child who otherwise appears all right `Even the mother doesn't feed her baby unless he cries' is a popular saying. Hunger remains one of the commonest causes of crying. Even a toddler may cry because of this reason. But all crying is not due to hunger. If in doubt, feed the child. Otherwise, look for other possible causes. A child may cry because he is feeling hot, or cold, or has a wet nappy, or wants to be picked up and cuddled or shown things in the home or is overstimulated by adults around him or is just feeling tired. Some small babies quieten as soon as they are wrapped up in a sheet or blanket. Other causes of crying are pain at the site of an injection or a child having been hit by an older sibling. Do not accuse the sibling unnecessarily. Even if you quite sure that he was the cause of crying, hug your older child because it is often said that `a child needs love most when he is least loving; give him more body contact, appreciate when he is helpful but do not leave him alone with the baby as far as possible. Infantile colic We also come across babies who for no rhyme or reason have sudden bouts of crying. The onset of these bouts are usually between the age of 2 and 4 weeks. They can occur anytime of the day or night but are more common after about 6.00 in the evening. The baby suddenly starts crying. Nothing seems to work. The child screams at the top of his voice, draws his thighs and legs towards his abdomen, may pass some gas or have a distended abdomen. These attacks which happen more in the evening usually stop by the time the child is 3 months old. (Evening colic or Three months' colic). Such babies can test the patience of their parents. Try the following remedies: Don't allow the child to cry unnecessarily. If a child keeps crying, he swallows more air which probably makes him cry more because of anger and distension of the abdomen. You may be told not to pick up the child every time he cries because you may spoil him. I disagree. I believe that a small child's need has to be meet- be it for hunger or more human contact. You will have enough time to discipline him. I am all for discipline as I have discussed at length in the chapter `How to keep your child happy'. But first we must make the child feel secure, loved and wanted before we make him `learn to behave'. Children can cry because of habit. Even small infants can take advantage of our 'goodness'. So if the child is playing on his own, you do not have to pick him up or talk to him. If he suddenly starts crying while you are in the kitchen, you need not leave everything behind and rush to him, unless you hear an unusual cry. Take care of the milk, which is on the boil in the kitchen, then go to pick him up and meet his need. You do not have to be unduly apologetic for the delay. An older child can learn to manipulate, if you or other relatives let him have his way all the time. (See `Sleep-Related Problems'). Change the diet of a breastfeeding mother. Can certain foods eaten by a breastfeeding mother upset her baby? Possibly not. However, it may be worth omitting milk, egg, fish, peanuts, soya preparations, wheat, caffeine, garlic, onion and cabbage from your diet for a few days. If you find a marked improvement in the child, you can again try and introduce these food items in turn and see if you can find a correlation between any particular food eaten by you and the appearance of colic in your baby. Try the colic positions Put the baby on his tummy across your knees; hold him against your chest, or him on his tummy across your forearm with his legs on either side of your arm. Rock the child with or without soft music in the background. Let someone else handle him if you are feeling exhausted. But never shake him vigorously in anger. You can damage his eyes as well as brain in such fits of anger. If required, your doctor may advise some medication. Do not use the medicine too often without the advice of your doctor. If the elders at home recommend a home remedy, it may be worth trying it after you have cleared it with your doctor. I do not recommended the routine use of drugs, or gripe water or 'digestive' medicines, I am against the use of pacifiers. A crying child needs our attention and not a pacifier. A pacifier also interferes with successful breastfeeding. It is also a possible source of infection.

Cuts

Management : six steps Step 1. Stop the bleeding if present. Apply pressure on the site with a clean cloth. Sterile gauze available in packets with the chemist is preferable. Keep pressing at the site for at least five minutes. If the bleeding reoccurs, press again. Most bleeds can be stopped with this simple method. If the bleeding is not severe, wash your hands with soap and water before touching the child. Step 2 Remove any dirt, or any other foreign material like pieces of glass from the wound. Dirt can lead to infection and formation of pus. Before doing that, wash your hands and wash the skin around the wound with boiled and cooled water. Then clean the wound with some water. Soap is to be avoided as it can damage the tissues. If boiled water is not available, place the part under running tap water or pour water from a glass or flush the wound with warm water from a syringe. Step 3. Dress the wound with a sterile gauze or a clean cloth. But before that, bring the edges of the wound together. If any antibiotic ointment like neosporin or soframycin is available, put it on the wound before applying the gauze. Keep it in the place with a clean cloth or bandage. Do not tie the bandage too tightly. Change it as soon as it is wet or becomes dirty. Check the wound daily and change the gauze piece. After a few days, a scab is formed and the dressing can be removed. If the gauze or bandage gets stuck to the wound, pour water on it (preferably boiled and cooled) for easy removal. Step 4 Stitches may be required if the edges of the wound cannot be brought together, if the wound is deep or is more than half an inch long. Let your doctor decide. If you think that stitches may be needed, it is better to see your doctor within eight hours of the injury. Step 5 If a booster dose of DPT or DT is due and the child is around the age of two or five years, give one shoot of DPT or DT. If he is around ten years, give an injection of tetanus toxoid. If your child has received his immunizations in time, he does not need an extra dose of tetanus toxoid. Step 6 If the bleeding continues, you must seek medical attention. (See 'Bleeding').