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A - Z of Childhood Illnesses

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On this page: Dengue Fever Diabetes Mellitus Diphtheria Down's Syndrome Earache & Ear Infections Otitis Media Otitis Externa Electric Shock Encephalitis Eye Problems True versus apparent squint Refractive errors Congenital ptosis Night blindness Fears Flu (Influenza) Foot Problems Flat Foot Toeing-in and club foot

Dengue Fever

A recent outbreak of dengue fever in Delhi has made me write about this disease. Dengue fever is not common but it can spread fast. Most children recover without much of a problem. A few children may develop a bleeding tendency which can become fatal if not treated. This viral disease is spread by a daytime biting mosquito. As has been rightly pointed out by Dr. K. K. Datta, Director of the National Institute of Communicable Diseases, the Aides mosquito which spreads the disease, in an indoor breeder thriving on clean, stagnant water filled in coolers and flower vases. Hence, all coolers not in use should be kept dry and water in flower vases should be changed frequently. It can also breed in stored water. The container for storing water should be covered with a tight-fitting lid. To avoid getting bitten by mosquitoes, see the section on Bites and Stings. In infants and toddlers, the disease presents like any other viral illness with fever lasting 1-5 days, running of the nose, a mild cough and congestion of the throat. Older children may have more annoying symptoms. The incubation period of the disease is 1-7 days. There is a sudden onset of high fever with severe headache and pain in the muscles or joints. The child may get a rash during the first day or two of fever. The child then develops a marked loss of appetite. This may be associated with nausea, vomiting and enlargement of the glands in different parts of the body. The fever may last for about a week to reappear again after a day or two. The second episode of fever is rather mild. Severe weakness during the illness and also after recovery is quite characteristic. Treatment No antibiotic is helpful in this disease. Aspirin should never be given as it can increase the bleeding tendency. The child only needs rest, frequent small meals and paracetamol and sponging to relieve pain and bring down the high fever. However, hospitalization is a must when the disease reaches the dengue haemorrhagic fever (DHF) stage with bleeding manifestations, enlargement of the liver and low count of platelets in the blood.

Diabetes Mellitus

This disease in children is also called juvenile diabetes. A few points relating to it need to be stressed. Children can get this disease. Children often have Type 1 diabetes. Type 1 diabetes is inherited from both parents. If either of them do not have the disease or do not carry the genes for diabetes (we can come to know about it from the family history), then their children are not likely to get the disease. On the other hand, if one child has juvenile diabetes, there is a possibility that your other child may also get it. This type of diabetes is almost always treated with insulin injections. With proper management, almost normal growth and activity of the diabetic child can be assured. If not properly managed, the child can go into coma and later in life develop complications affecting his eyes, kidney, heart, and nerves. A typical case Although it can affect even infants, generally the onset of the disease is around 5 years of age. The child drinks a lot more water, passes urine more often, may start wetting his bed or clothes, eats more than usual but still does not gain weight, or even starts losing weight. There may be a history of vomiting, pain in the abdomen, dehydration and the need to admit the child to a hospital. In some children, the disease presents for the first time with severe pain in the abdomen, vomiting and drowsiness If not treated, they may lapse into unconsciousness. A family history of diabetes in a brother or sister of the child or a history of diabetes in both the parents or their elders should further make one suspect diabetes. If there are such symptoms, your doctor will ask for a urine and blood test to confirm the diagnosis. Treatment Depending on the condition of your child, the doctor may decide the child needs hospitalization. Once the diagnosis is confirmed, he will start with injections of insulin. Insulin is needed to help your child utilize the sugar in his food. In this condition, there is much more sugar in your child's blood but it is not utilized because of lack of insulin. Later on, your doctor will teach you how to give the injection and do simple tests for the urine and blood at home. As your child grows older, he will be able to manage the injections himself. It is important to keep a check on his sugar levels because less amount of sugar (due to an excessive dose of insulin) as well as high blood sugar can lead to unconsciousness. Your doctor will teach you what to do if such a situation arises. Diet as well as exercise is important. The diet should not vary too much on different days. We should aim at giving almost the same amounts of food at each meal. Your doctor will advise you about a healthy diet. A young child would need snacks in between meals. Avoid junk foods and let your doctor advise you about healthy snacks like peanuts and other nuts, chana and fruits. Your child can take part in competitive sports as well but the doctor will guide you how to go about it. Mood disturbances are not uncommon in this condition A child who was behaving perfectly, as a model to be emulated, may suddenly become withdrawn or depressed. Do not hesitate to seek expert help for such a situation.

Diphtheria

This disease is rarely seen in children coming from higher socio-economic groups and among those who have received the proper dose of DPT (triple antigen) vaccine. I have included this disease for two reasons. Firstly, most cases diagnosed as diptheria are not so. Unnecessary panic is created in such a situation. Secondly, if the child does have diptheria, it must be treated urgently failing which serious complications can occur. Diptheria mostly affects the throat, larynx (the vice box) and the nasal passage. Following a day or two of low-grade fever, the child complains of a sore throat. Examination of the throat reveals a dirty white or greyish membrane extending from the nostrils and throat to the palate. Glands below the jaw may swell up. Swelling of the neck may also occur. The child has difficulty in swallowing. If the larynx is also involved, hoarseness of voice and noisy breathing is noticed. Fortunately, effective treatment is available. Once the diagnosis is suspected, your doctor will get a throat swab examined by a pathologist and accordingly give treatment.

Down's Syndrome

Children with Down's syndrome can present with mild delay in achieving milestones of development or they may be severely mentally retarded. Most such children have a very pleasing personality and get along well with people they come into contact with. They are able to look after themselves and a few may have gainful employment, generally under supervision. When to suspect Down's syndrome Your doctor may be able to suspect it at birth. These children have a few typical features like almond - shaped eyes slanting upwards, a fold of skin at the junction of the eye and the nose, a single transverse crease of the palm, a biggish tongue, generalized hypotonia (limpness) and some other features. A heart defect may also be present. You may suspect it because the child may have difficulty in suckling at the breast and may be slow in learning new skills when compared to his siblings or other children. The diagnosis is confirmed by doing a blood test which reveals abnormality of the chromosomes in child. While it is true that the risk of getting a child with Down's syndrome increases with rising maternal age, only 35 per cent of Down's births occur to women aged over 35 years So younger women can also get a child with this syndrome. Management Loving care and training can help most of these children to learn many skills under a programme for early intervention. Your doctor will refer you child for such training. Drugs will not be of any help unless the child has proven deficiency of the thyroid hormone or has an infection to which they are more prone than normal children. Those having a heart disease may or may not require surgery. At times congenital abnormalities of the intestinal tract may also need attention. In case you decide to have another child, certain tests, including amniocentesis, discussed under the section of pregnancy can guide you as to whether your second child would be affected by the same condition or not. Fortunately, all the children with Down's syndrome that I have seen so far had a normal sibling. But the possibility that the second child may also be affected does remain.

Earache & Ear Infections

The common causes of earache are: Middle ear infection (Otitis Media) External ear canal infection (Otitis Externa) A foreign body Wax Toothache Middle ear infection (Otitis Media) It is important to treat this infection seriously. Recurrent ear infections can lead to deafness. As the brain is situated near the ear, infection from the ear can spread to the meninges covering, the brain, leading to meningitis. Deafness in an early age can also hinder the normal development of speech in your child. The typical story of a child who gets middle ear infection goes like this: `Doctor my child had a cold for a few days. In the middle of the last night, he started crying vigorously. He was rubbing his ear and he had high fever. He remained restless throughout the night. This morning a lot of pus came out from his ear following which he stopped crying.' Our middle ear is connected to our throat and nose by the eustachian tube. This tube is rather short in small children and infection from the throat and nose can easily spread through this to the middle ear. When that happens, the child develops high fever and earache. The pain is more while feeding and when the child is lying down because of the pressure changes that occur. While lying down or while feeding, the pus is under pressure in small middle ear. The pain becomes less the moment the drum connecting the middle ear to the external canal burst open discharging the pus into the canal. Middle ear infection is seen more commonly in children who are bottle-fed when compared to breastfed children. If the child is bottle-fed, he should not be fed lying flat on the bed as milk can go up and lead to an ear infection. The risk of an infection spreading through the eustachian tube is also more if the nose is blocked due to a cold or if the child blows his nose when he has cold. We should only wipe his nose and never ask him to blow it when he has a cold. For treatment of blocked nose, read the section of `Common Cold'. Hearing is only temporarily reduced in some cases of ear infection. It mostly returns to normal after the infection comes under control. Sometimes, a fluid may remain behind the eardrum even after a cold. This is a clear fluid. In 90 per cent of the cases, this also gets absorbed spontaneously within about 2 months. Treatment The mainstay of treatment of the middle ear infection is antibiotics given in proper doses for 10 days. No eardrops should be put in the ear. We should aim at keeping the ear dry. That helps in healing of the perforation of the eardrum through which pus had come out. To dry the ear, clean the pus nearer the ear lobe with clean linen. To dry the inside of the ear canal, insert small wicks made from a new newspaper. Let it soak the pus. Keep changing the wick every 2 minutes till the ear looks clean and dry. Do it 3 times a day. The child should not be allowed to go swimming till he recovers from the ear infection. For recurrent ear infections, attend to the nutrition of the child. Your doctor may consider putting the child on some long term antibiotics. If the symptoms suggestive of enlarged adenoids are present, removal of adenoids may be considered. But each step should not be taken in a hurry. Similarly, if the fluid behind the eardrum persists for a prolonged period, you may be offered tiny tubes to be put in the eardrum to keep draining the middle ear. Doctors are divided on whether these tubes (also called gromet) give definite benefit or not. In older children one should definitely wait because we can easily assess if the hearing is improving or not. In infants and toddlers, the decision sometimes tilts in favour of using these tubes because prolonged hearing loss can affect development of speech around this age. External ear canal infection (Otitis Externa) In this condition the child complains of earache or points towards his ear but does not have any cold or cough. Fever is often absent. If present, it is usually not high. The child does not look too sick. On examination, the ear canal may look red and we may notice a small boil inside. This may burst discharging a small amount of pus. Such a infection can occur without any obvious cause or warning. However, putting a pencil or fingers or a cotton bud meant to clean the ears, can lead to such an infection. The ear wax present normally in our ear protects the external canal against moisture and germs. Putting anything inside the ear can result in irritation of the skin and removal of the normal wax which can predispose the child to infection. The dictum is 'never insert a cotton bud or anything else into the child's ear'. Swimming can also result in otitis externa in some children. Except for severe cases, there is no severe pain or high fever. Itching and mild pain are common features. Most cases of otitis externa get better on their own. Sometimes antibiotic drops may be required. Rarely antibiotics may have to be given by mouth. Do not allow swimming for 8 to 10 days. After recovery, make sure that your child does not swim for more than an hour at a stretch. Let him remove his ears covered by wearing a cap. If the problem keeps recurring, put 2 to 3 drops of acetic acid into the ears after a swim and before going to bed. Foreign body in the ear. An insect may go into a child's ear. Do not try and remove it until you have put a few drop of warm coconut oil into the ear. If it does not come out easily, wash it out with warm (boiled and cooled) water filled in a syringe. Use the syringe for flushing the ear without a needle. Similarly, a grain or any other foreign body may be lodged inside the ear. If it can easily be removed it, you may attempt to do so. Otherwise, you may have to see your doctor. If this is not possible, you can try to flush it out with a syringe filled with warm saline water. Flushing with water should not be undertaken if the child had otitis media in the recent past. Hard wax As mentioned above, our ear is normally lined with a thin layer of wax which protects it from germs and moisture. Sometimes it can get hardened and cause earache or even deafness. You may consult your doctor about the wax. If that is not possible, put 3 drops of coconut oil inside the ear at night for 3 nights. As the wax softens, flush it with warm water and a syringe as mentioned above. Repeat this several times. But stop immediately if the child complains of pain or dizziness.

Electric Shock

Prevention of accidents due to electric appliances has been mentioned under the heading of `Prevention of Accidents'. Here we shall deal with what to do in case an accident does take place. Steps to be taken Switch off the power or pull our the plug. If it is not possible, remove the wire from the child with any piece of wood. If that is not handy, roll up a magazine or use a jacket or a rope. Never use your bare hands. If the child is alert and has no burns, just hug him. If burns are seen, consult your doctor for dressing of the wounds and also to rule out damage to any internal organs. In case of severe burns or damage to the organs, the child may need to be hospitalized. In extreme cases, the child can have cardio-pulmonary arrest. His heart stops breathing and the child stops breathing. In that case, do not waste a moment. Start mouth-to-mouth breathing discussed under that heading. Some children can get severe convulsions with resultant injuries including fracture of the spine. Such children should be handled carefully and shifted to the hospital under careful medical supervision.

Encephalitis

Encephalitis refers to the inflammation of the brain which may manifest as a mild illness or may result in severe dysfunctioning of the brain causing death or permanent disability. When to suspect encephalitis? The onset is usually sudden with high fever, persistent headache and vomiting. A temporary headache with high fever or a few vomits at the onset can be associated with any fever. So all children with such symptoms should not be thought of as having of encephalitis. Later the child may start having convulsions, develop mental confusion or become unconscious. Paralysis of the eye muscles, blindness and speech disturbances may develop. Treatment Such children need hospitalization. There is no specific treatment available. The child is given full support in the hope that he will come out of it on his own. Those suffering from encephalitis due to herpes simplex infection can benefit from a drug named acyclovir. As mosquitoes can carry the disease, adequate steps may be taken to protect the child from mosquito-bites.

Eye Problems

Squint True versus apparent squint A true squint must be attended to immediately. Otherwise, it may lead to permanent blindness. An eye specialist should be consulted and his advice followed. Sometimes the child just needs glasses. At times, a squint may follow a serious head injury or a tumor of the eye. Sometimes a surgical correction may be required. A transitory squint in newborn babies is common and does not need any treatment. Children with a fold of skin between the eye and nose (epicanthic fold) or with a wide bridge of the nose and increased distance between the two pupils may falsely appear to have a squint. Refractive errors needing glasses All children should be subjected to an eye check-up before joining school to ascertain if the child has a squint or needs glasses. At your request, your doctor can also test the child's eyes for colour blindness. Parents sometimes ask about surgery or the use of lasers for correcting refractive errors. For the present, I would advise that they be satisfied to get the child a pair of spectacles. Surgical or laser correction could wait and be done in the near future. Infections of the eye Watering of the eye in a newborn without sticky eyes or pus-like discharge from the eye is usually due to the blockage of the tear duct connecting the eye to the nose. This is not due to any infection and generally stops spontaneously before the child is six months old. If you notice a pus-like discharge from the eye, your doctor will teach you how to massage the area between the eye and the nose and advise some eye drops to be put after cleaning the eye with warm water. If watering persists after 6 months, an eye specialist should be seen. He may submit the child to a minor procedure to open the tear duct. Redness of the eye or sticky discharge from the eye could be due to a bacterial or viral infection. If the redness is coupled with severe itching in the eye, the cause could be an allergy. You may be tempted to use antibiotic of cortisone eye drops. It is advisable to consult your doctor before doing so. In a newborn with conjunctivitis, you can safely instil a drop or two of breastmilk into the eye, four or five times a day. It does help in some cases. If you are in a place where no doctor is available, you may use an antibiotic eye ointment for conjunctivitis but make sure that it does not contain any corticosteroid. If not indicated, medicines containing cortisone can be harmful. In persistent cases, your doctor may send an eye swab to the laboratory to know about the causative organisms and prescribe an antibiotic by mouth. Rarely tuberculosis can manifest in the eye as `phlyctenular conjunctivitis'. In this condition, a pimple-like spot is seen on the outer side of the cornea. Thin blood vessels are seen radiating from this spot. However, if we notice such a condition, we should not jump to conclusions. It is commonly, though not always, related to tuberculosis. It is commonly, though not always, related to tuberculosis. If conjunctivitis suddenly starts affecting a large number of people in the community it is mostly due to virus infection of the eye. It is highly infectious and may be prevented by immediate handwashing after touching a patient and by keeping a separate hand towels. Antibiotics are of no use because of the viral origin. If the redness persist, see a doctor who may prescribe antibiotic eye drops or an ointment if required. The antibiotic should only be put in the affected eye every hour or two while the child is awake. This is advised because the medicine is quickly washed out with the watering of the eye. Unaffected members of the family should not use the medicine. Eye injuries The television serial, Ramayana and Mahabharat, might have given inspiration to many for righteour living but it also led to eye accidents, sometimes even blinding, from flying arrows of children playing with toy bows and arrows. Diwali is another occasion when we see crackers taking their toll in different ways including severe injures to the eye. The interesting games of gulli-danda and boxing can also claim their victims. The commonest injury to the eye is caused by a small foreign body like a grain of sand getting stuck to the conjunctiva covering the white of the eye or the lids. Wash the eyes with plenty of water. If it does not come out take a wick made from cotton moisten it and clean the speck from the conjunctiva. If you cannot see it and the eye is irritated and watering profusely the speck may be stuck under the upper lid. To turn this lid up, ask the child to look down, put a matchstick(or use the finger of one hand) over the lid. Catch the eyelashes of the upper lid with your thumb and index finger and quickly turn the lid up over the stick. The foreign substance is generally seen on the upper lid below the eyelashes. Remove it with moist cotton or a corner of a clean piece of cloth. If some chemical has gone into the eye, keep washing the eye with water till you see a doctor. If the eye has been punched and the child cannot see (ignore the transitory loss of vision after an injury) see the doctor soon. If the child's vision is not affected, put an eye ointment into the eye, ask the child to gently close the eye. and put a thick pack of gauze on it and keep it in place with leucoplast or a bandage till you see your doctor. If the foreign substance is over the cornea (cornea covers the and the coloured portion of the eye called iris) do not try to remove it yourself. Let the doctor handle it. Problems of the eyelids A boil like painful swelling near the eyelid is due to stye (hordeolum). At one stage, there may be more than one stye. Hot water fomentation thrice a day with application of an antibiotic eye ointment after the fomentation clears the infection. The use of an ointment must be continued for another three or four days even after the stye subsides. A stye should be differentiated from a chalazion which result in a firm, non-painful swelling in the lid. It can disappear on its own but may also require a simple surgery. Sometimes the margin of the eyelid present with persistent itchy scales which stick together during sleep. The eyelid should be cleaned with warm water gently and the scales removed. Then an antibiotic eye ointment is applied. This condition, called blephritis, tend to recur. Occasionally, local application of corticosteroid is needed. Congenital ptosis This condition which refers to dropping of the upper eyelid could be familial. It needs surgical correction. Mild ptosis is operated before the child joins regular school. Ptosis which interferes with vision should be corrected earlier as per advice of an eye specialist. Night blindness Inability to see properly in the dark may be the first indication of vitamin A deficiency. It is easily cured by a diet rich in vitamin A and the use of vitamin A. If ignored, it can lead to severe damage to the eye and permanent blindness. Preventation is possible by breastfeeding the baby (preferably for 2 years) and giving him dark green leafy vegetables and red or yellow fruits and vegetables. Some of these children may also have associated roundworm infestation which should also be treated.

Fears

Fears are normal. However strong and irrational fears which are termed phobias can interfere with a child's normal activities. An infant is usually fearful of strange faces, loud noises, animals, a dark room and pain. A 6-month old infant can differentiate between known and unknown faces but is not able to understand that the unknown faces may not pose any threat to him. About the age of two, most children start accepting unfamiliar people without any fear. School children are afraid of death, darkness, animals, high places, thunderstorms, lightening and kidnappers. Nobody should laugh at a fearful child. Help him get over the fears by providing support. Hold the child's hand in a dark place. If he is afraid of -say snakes, let him first see pictures of snakes. Let him then see someone holding a nonpoisonous snakes, Let the child then touch it if he is willing Gandhiji was taught by his maid to recite god's name (Rama) whenever he felt fearful of the dark. You may consider this approach if you feel comfortable . However, if your child is suffering from a phobia, you may like to consider taking the help of a counsellor.

Flu (Influenza)

Influenza is a virus infection which spreads rapidly from one person to another. If more than one member of the family has bodyache, headache, fever, discharge from the nose, loss of appetite, severe weakness and upset stomach, we are most likely dealing with flu. This disease is seen more often during winters. The patient having flu is infectious to others from the day before the onset of symptoms until the time he recovers from fever and other symptoms. No antibiotics need be given. For relief of symptoms, paracetamol can be given every 4 to 6 hours. A child may be allowed to eat as per his inclination. In case of poor appetite which is common during the illness, enough liquids including fruit juices, soups, coconut water and plain water should be given to ensure adequate urine output. For lowering the fever and also otherwise, sponging the whole body with a little warm water is very comforting. The child may need more body contact . He may show anger, annoyance and be very irritable. Presence of one or both parents is very helpful. The child should stay at home for a couple of days even after the fever settles, because flu can make a child feel very weak. As similar symptoms can be present in certain serious disease, you must consult your doctor if the symptoms persist or the look of the child causes anxiety.

Foot Problems

Flat foot Many children are given special shoes for 'flat feet'. Most such children have normal feet which apparently look flat during infancy and pre-school age. If doubt about this condition persists after 3 years, do see a bone specialist(orthopaedic surgeon). Normally, our foot has an arch. If that is not evident we are said to have 'flat feet.' infants normally have a pad of fat which hides the arch, secondly, young children's feet have very flexible bones and joints. So the feet of such children flatten when they stand, even though you can see the arch if you lift them on their toes. Parents of such children need reassurance. No special shoes of treatment is needed. In a rigid foot, which cannot be moved up and down or side to side at the ankle or in the presence of a real tight Achillies tendon, your doctor may like to show the child to the orthopaedic surgeon. Toeing-in and club foot If the feet of a child are turned inwards but have normal movements at the ankle joints they need no treatment. It may be due to a particular position of baby while he was in the mother's womb. This condition returns to normal by about 6 months of age. If the toeing-in persists or if it appears rigid, the child may be having a condition called ‘club foot' (congenital talipes equinovarus). This may need an orthopedic opinion. Such children need repeated plastering. Sometimes surgery is also indicated. Shoes We do need shoes and we do need diapers. But it may be important for you to know that your child's feet are better off without shoes, as is his skin which is better without diapers. In other words, shoes and diapers are necessary 'evils' in our modern world. It is an accepted fact that people who remain barefoot have stronger and more flexible feet compared to those who wear shoes. They also have fewer problem with their feet. So dear mom, allow your child the joy of walking and running barefoot on safe ground as much as possible. When you go to buy shoes, do not go for fancy expensive shoes. Shoes are only meant to protect your small child from injury and cold. Of course, as he grows older, your child will like to have a smart pair of shoes. Go for one which is smart but make sure that it is comfortable. Buy the shoes later in the day when the feet are likely to be a little more heavier than in the morning. The shoe should be larger than the exact size of your child's foot. Keep a margin of about 2 centimeters. But make sure that the shoe does not come off as the child runs or walks. Shoes that have become tight, should no longer be used. Shoes should be flat and flexible. For teenagers, cushioned soles may be preferred. Avoid high heels as far as possible. Wide shoes are better than pointed ones. Leather or canvas shoes without plastic material are good for your child's feet.