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A - Z of Childhood Illnesses

G H I J K L

On this page: German Measles (Rubella) Glands In The Neck & Elsewhere Headache Head Injury Concussion versus Compression Hydrocephalus Hypertension Jaundice Light therapy (phototherapy) Blood-group incompatibility Exchange transfusion Hepatitis Joint Disorders Bacterial infections Rheumatic fever Rheumatoid arthritis Haemophillia Limp & Pain In The Legs Translent synovitis of the hip Perthes' disease

German Measles (Rubella)

German measles can be serious in a pregnant woman All women who are likely to have children should be familiar with this disease. German measles does not cause much problem for the patient but if it affects a pregnant woman, her baby may develop certain deformites, specially if she acquires the infection in the first three months of pregnancy. As the deformites may be serious (involving the brain, eyes and heart), all pregnant women should stay away from a know case of German measles. If you are pregnant and you have come in contact with a patient who has had an illness with fever and rash, but you are not sure if it is German measles, the best thing for you would be to speak to your doctor. He may order you to have blood tests to confirm. At times the blood test needs to be repeated. If your doctor concludes that you have been recently infected with German measles, he may suggest an abortion. As mentioned earlier, the risk to the baby is more if the infection takes place in the first three months of pregnancy. You should then discuss the issue with the doctor along with your husband and then decide whether or not to have an abortion. When to suspect German measles? A typical case of German measles presents with fever, rash and painful glands in the neck. The fever is not very high The rash is also not so severe as in measles. The distinctive feature is the enlargement of glands behind the ears and the back of the head and neck. They feel tender to touch The total illness lasts about five days. The rash starts with the face and then spreads downwards to disappear within two to three days. The disease more common in schoolgoing children. From a few days before the rash appears, to a week thereafter, the child is infectious. Treatment of German measles Treatment is often not required. If fever bothers the child, he may be given paracetamol. The important precaution that parents must take is to restrict the movements of the child having German measles so that he does not come in contact with a pregnant woman. Prevention of German measles MMR vaccine (against measles, mumps and rubella or German measles) is now available. It is quite effective and can be given after the age of 1 year. If your child has been given measles vaccine around the age of 9 months, MMR vaccine is to be given around 15 months of age. Rubella vaccine may also be repeated at puberty. If it is given to a woman who is later found to be pregnant when she had received rubella vaccine, no abortion need be suggested. Cases like this which have been studied so far had not resulted in any congenital abnormality in the baby.

Glands In The Neck & Elsewhere

Lymph glands, like fever, help us fight infection. Most parents bring their child to us after they have noticed glands behind or in front of the neck. Sometimes enlarged glands are also found in other parts of the body like the groins and armpits. Tiny, small pea-sized glands are often found in the above places in young children. They are not painful or tender. The child is otherwise well. They are often secondary to a minor but once noticed, remain for months without causing any harm to the child. They are often secondary to a minor infection in the head, arms or legs. Your doctor will probably ask for no tests in such a case and will just reassure you. More notice is to be taken if glands are suddenly observed in different parts of our body in a younger infant, specially if he looks pale and sickly. Serious attention also needs to be given if there is rapid enlargement of a gland or glands or if a `big pea'-sized or a still bigger gland remains persistently enlarged. Common causes Local cause A sore throat due to a virus or bacterial infection or infection of teeth and gums can cause enlargement of glands in front of the neck. Infection of the scalp over the head like boils and infection secondary to scratching due to lice, dandruff or chickenpox can cause swollen glands behind the neck. Small tender glands in this region can also be seen in viral infections like German measles and big non-tender glands due to glandular fever (also called Infectious Mononucleosis). Glands in the armpits and groins can be enlarged due to a local infection (injury, boils, cat-scratch, chickenpox). A gland just above the collar-bone should be taken more seriously. It could be due to an infection in the lung and rarely due to a tumor in the chest. Tuberculosis can also present as a glandular swelling in different parts of the body. In tuberculosis, there is a significant enlargement of the gland. The swelling often gets adhered to the overlying skin. Sometimes more than one gland is enlarged in the same region and these glands appear to get matted (stuck) to each other. Systemic illness Viral infections accompanied with a rash (German measles, glandular fever) can result in enlargement of glands in different parts of the body. Tuberculosis can present as a localized glandular swelling or as a more generalized disease. Rare causes Maligant disorders like leukaemia and lymphomas and infection like AIDS are to be kept in mind in any persistent glandular swelling, especially if associated with unexplained fever, severe anaemia, tenderness in the bones and bleeding from any part of the body. Management In any persistent of significant enlargement of glands, your doctor will probably ask for a blood test, a skin test (Mantoux Test), and a chest X-ray. If required, an ultrasonography of the abdomen may be asked for. If no definite cause is found, a biospy of the gland may have to be undertaken. Most glands secondary to local causes or glands due to viral infections get better on their own. Sometimes, antibiotics may be required to treat the local cause. Occasionally, the gland becomes severely inflammed with redness being noticed on the overlying skin. It is painful and the child has fever. Besides antibiotics, such children may need hot fomentation and even surgery to remove pus from the swelling.

Headache

A headache can be serious if: the child has persistent headache without an obvious cause or following a head injury. the headache is associated with persistent vomiting, squint. loss of balance or disturbed consciousness. the headache is followed by convulsions or by loss of consciousness. How to know that the child has a headache? While the older child can explain, smaller ones may be fretful or bang their heads persistently. However, occasional banging of the head in a toddler is often behaviour-related. Common causes Common infections Infections due to a viral or bacterial infection can cause a headache. Usually, the child also has fever and bodyache. Paracetamol relieves this type of headache for a couple of hours till the child recovers from the infection. The child is otherwise alert and may have an obvious case of a viral fever with running nose or he may have a bacterial infection like acute tonsillitis. Psychogenic factors and fatigue Schoolgoing children under undue stress, sleep deprivation and emotional disturbances can have frequent headaches. Eye strain A child complaining of headache towards the end of the day may need his eyes to be checked-up. Sinus infection In persistent infection of sinuses (hollows present in our bones nearer the nose), the headache is typically noticed on waking up. Migraine If there is a family history, this condition should be considered Whereas adults often have a headache which affects one half of the head, children may complain of a generalized headache in migraine. A few persisting factors are stress, bright sunlight, cheese, chocolates and nuts. The attacks of headache are often associated with nauseal or vomiting. The child is perfectly all right between the attacks. Head injury A persistent headache following a history of head injury should not be ignored. Meningitis Fever, a fixed gaze, or disturbed consciousness should raise the possibility of a diagnosis of meningitis. A small infant may have a bulging anterior fontanelle (the soft spot on the head). Neck stiffness is common in all cases of meningitis. Brain tumor Persistent headache, lasting day and night, could be due to a brain tumor. Associated features like persistent vomiting, squint, loss of balance, convulsions and disturbed consciousness add to the suspicion of a brain tumor or any other space-occupying lesion in the brain. High blood pressure This is a rare cause of headache. Treatment In routine cases, take the child in your lap and press his head gently. If he does not object, apply a little balm on his temples. Paracetamol may also be given. Attend to any emotional factors. Make sure he has food at regular intervals. Hunger can add to the problem. Check his hours of sleep. For temporary headaches associated with fever, paracetamol and treatment of infection with suitable drugs, if required, should be enough. For a persistent complaint, specially associated with other worrying symptoms mentioned earlier, take your child to the doctor soon so that the proper diagnosis can be made at an early stage.

Head Injury

To worry or not to worry Many parents become very tense if their child hurts his head. I do not blame them because they might have heard (and rightly so) that even minor head injuries may, at times, lead to serious problems. But they must also keep in mind that most head injuries (at times even serious-looking ones) pass off without any complication. When not to worry The most important advice that I can give you is to observe the child closely after a head injury. If he looks alright to you after the injury, there is no need for you to panic. If he is normal even after 48 hours of the accident, the risk to your child is almost nil. The accident was probably meant to help him learn some lesson for the future. However, you may like to just jot down the date and time of the head injury in the child's personal file or diary for any future reference. When to worry You need to worry if the following conditions are present: Persistent vomiting. Persistent lack of alertness, drowsiness or unconsciousness. Inability to move any part of the body or an unsteady gait. Persistent backache. Convulsion. Eye changes resulting in squint, double vision etc. Difficult breathing. Concussion versus Compression A word about a head injury called concussion. In this condition the whole brain is shaken after the head is hit hard. The child becomes unconscious for a brief period and becomes normal within a few minutes. He may also complain of slight headache, nausea and giddiness and have one or two vomits. Such cases should not cause anxiety. Compression of the brain can be serious The real problem arises if there is swelling of the brain and the injury leads to compression of the brain due to bleeding between the skull and the brain. This may cause the worrying symptoms mentioned above. If the look of the child makes you uneasy, do consult your doctor immediately or take the child to the casualty department of a nearby hospital. First Aid While you are waiting for your doctor, attend to any external injury. If you notice any bump on the head, it is due to external bleeding between the scalp and the skull. Apply gentle pressure with ice in a hand towel or any piece of cloth for fifteen to twenty minutes. If there is a cut on the scalp, attend to it as advised under the section on `cuts'. If you suspect that the child might have also injured his neck, do not move his neck and wait for your doctor or the ambulance to arrive and let the experts carry the child safely to the hospital. Careless handling of a child with injury to the neck can result in serious damage to the spinal cord. Hospitalization and tests If your doctor is now in the picture, let him or her decide if X-rays of the skull or a brain scan are needed. If the soft spot (anterior fontanelle) in a small infant is open, doctors may decide to go for a simpler procedure called sonography of the head. But please remember that most cases of head injury neither need hospitalization nor any X-rays. Observation of the child in most cases for a day or two at home or in the hospital and examination by your doctor serves the purpose in majority of the cases. But if one or more of the serious symptoms given above are present, do not delay matters and let the doctor decide the right course of action for your child. Vigorous shaking of the child can be dangerous Mention may be made here of the possibility of a rare injury to the brain and eyes following vigorous shaking of the child. This can happen if an angry parent takes recourse to this method to stop a small child crying continuously.

Hydrocephalus

This condition is suspected if the child's head appears to be much bigger than other children of his age. But we must remember that some children have a biggish head which is normal. However, if in doubt, consult your doctor. After examination, the doctor may measure the head circumference after intervals to see if the growth is more rapid than normal. If so, he/she may decide to get the child investigated. A sonography of the head or a CT scan may confirm, or rule out the diagnosis of hydrocephalus. The term hydrocephalus refers to a condition in which there is abnormal accumulation of cerebrospinal fluid, within the brain. With surgery the child can have a normal life. Untreated children can develop complications like convulsions and mental retardation.

Hypertension

Contrary to popular belief, children can get hypertension or high blood pressure. Of course, it is not common. Sometimes a wrong diagnosis is made if the blood pressure is measured with a cuff a smaller than normal size. This cuff is wrapped round the arm of the child to measure the pressure. Also if the child is excited, the higher pressure must be confirmed by taking a few more readings. Usually hypertension is accidentally discovered when the child is examined for a routine check-up. Of course, it can also present with symptoms typical of disorders of the kidney, heart, central nervous system and endocrine system. Thus, the child may have blood in the urine, breathlessness on exertion, eye disturbances, headaches or even a stroke. Quite a few children suffering from hypertension are found to be overweight. Management Confirmation of raised pressure by frequent blood pressure readings in a relaxed atmosphere. Investigations to rule out the case of hypertension and if proved, treatment prescribed for the same. If the cause is not found, a diagnosis of essential hypertension is made. If the child is overweight, all efforts are made to regulate the child's diet and to see that he takes active part in sports or other forms of exercise. Salt is restricted in the diet. Canned and fast foods are to be avoided as they have a high amount of salt or fat. If your doctor decides that the child should have long term medication for keeping the blood pressure in check, do follow the advice seriously because high blood pressure, if not treated, can cause complications with damage to the blood vessels of the eyes, kidney and brain. It can also lead to heart failure.

Jaundice

While most children getting jaundice recover without much of a problem, some of them may need serious attention. Doctors get really concerned under the following circumstances: Jaundice appearing within 24 hours after the birth of a baby. A child with jaundice who appears unusually sick, drowsy and anaemic or one who develops altered behaviour, or a bleeding tendency, or swelling of the body, or persistent vomiting with dehydration. Physiological jaundice in a newborn baby Most jaundiced babies have what is known as normal or physiological jaundice. The jaundice normally appears after 30 hours of birth, gradually deepens and disappears on the tenth day. This happens due to slight immaturity of the baby's liver. The child generally does not require any treatment. If the jaundice is severe, your doctor may like to rule out certain other causes of jaundice like an infection or rare causes like thyroid deficiency or galactosaemia. The level of jaundice is known by estimating the level of serum bilirubin (the yellow pigment produced by the breakdown of red blood cells). In physiological jaundice, the bilirubin level usually does not exceed 20 mg/dl. In Indian and other Asian children, it may reach 25 mg/dl without causing any problem to the child. In case of high levels, your doctor may like to estimate the level of haemoglobin and may again test for bilirubin. A rise of 0.5 mg/dl of bilirubin or more per hour or a falling haemoglobin level may need some intervention. Children who are born normally without any problem are usually quite safe but those who are born premature or had lack of oxygen, low blood sugar or accumulation of acids in the body (acidoses) need extra care. Some jaundiced babies are sleepy and may not suckle too well or too often. Frequent suckling is the best way to reduce the incidence of jaundice and to treat it as well. Bilirubin is present in large amounts in the meconium- the first stools of the baby. If the meconium is not cleared, the bilirubin gets reabsorbed into the baby's system. Colostrum helps to clear meconium and thus assists in the prevention of jaundice. If your baby gets enough breastmilk, it helps to clear early jaundice. But giving glucose water, plain water or other supplements does not help. Such drinks interfere with breastfeeding and can increase the jaundice. The best way you can help your baby with jaundice is to breastfeed him frequently, whenever he is hungry (demand feeding) during the day or at night. If he is sleepy, try to stimulate him every 2 hours. If he does not oblige, express your milk and give to him with a bondla (paladai) every 3 hours. Late onset jaundice in a newborn baby Sometimes jaundice starts at the end of the first week of life in an otherwise healthy baby and may last upto 3-10 weeks of age. Often this prolonged jaundice is not serious and is due to the presence of a harmless substance in the mother's milk. That is why it is also sometimes labelled as breastmilk jaundice. It tends to recur in the next child. This jaundice is harmless and clears without any treatment. The baby continues to suckle well and gains weight normally. If the jaundice is very severe, especially if the baby looks unwell, your doctor may consider the possibility of the child having some other condition. The doctor may suggest temporary stoppage of breastfeeding to confirm the diagnosis of late onset jaundice. This would bring down the levels quickly but do not agree to this suggestion too readily. In such a situation, you have the following options: Express your milk. Boil it and give it to your baby by a bondla. Heating this breastmilk reduces the levels of bilirubin. Stop breastfeeding temporarily for 12 to 48 hours and give breastmilk form another source. Keep expressing your milk and discard it. Alternate artificial milk feeding and breastfeeding for 24 to 48 hours. Continue breastfeeding normally and give phototherapy. Replace breastfeeding by artificial milk feeding for 12 to 48 hours while observing the reduction of bilirubin and the level of jaundice. The moment the period of 12 to 48 hours is over, you must start breastfeeding normally again. Very high levels of bilirubin can cause damage to the brain of a newborn baby. But no such damage has ever been reported due to late-onset jaundice or breastmilk jaundice. It is important to realize that even if a baby needs treatment (usually light therapy) for jaundice, you must continue to breastfeed your baby normally. Treatment Light therapy (phototherapy) This treatment is based on the principle that exposure of skin to blue or fluorescent tubelight, or daylight, converts bilirubin in a manner that it can be eliminated more easily from the body. The baby is put under the light without clothes with his eyes covered to prevent damage. The light is kept approximately 45 cms above the infant. To avoid undue separation from your baby, you can request the nursing staff to bring the phototherapy unit next to your bed. If that is not possible, you should keep going to where the unit is kept and breastfed your baby whenever he is hungry. You must remove the cover from the baby's eyes while breastfeeding. Some babies may get loose motions while under the lights. This is normal. Others become a little irritable to begin with. Some may develop the so-called `dehydration fever' due to loss of water from the body. You may be tempted to give water to the body for this reason. This should be avoided. Frequent breastfeeding will provide the required amount of fluids in most cases. For daylight, do not draw the curtains in your room. Direct sunlight can cause sunburn. But keeping the baby in the sun early in the morning for about 10 minutes, where possible, is advisable. This also helps in conversation of pro- vitamin D in the baby's skin to vitamin D. Jaundice due to blood-group incompatibility Rh incompatibility and ABO incompatibility between the mother and the foetus can result in jaundice of the newborn baby. Five per cent of the Indian population is Rh negative. In the case of a baby who is Rh positive, Rh positive foetus red cells can enter the Rh negative mother's circulation. If that happens, antibodies are produced in the Rh negative mother's blood against these Rh positive cells. If these antibodies cross over to the foetus, they destroy the Rh positive foetal red blood cells in excess resulting in rapid appearance of jaundice. Such cases need frequent breastfeeding, light therapy and may also need an exchange transfusion discussed below. Your doctor will get your blood tested during pregnancy to know if you are Rh negative. If so, your baby will be observed closely for appearance of jaundice and for the rate of rise of billirubin and his level of haemoglobin. If you have not been affected by the blood of your baby, you will be given a special injection within 24 to 72 hours after delivery to prevent any trouble to your next day. ABO incompatibility is a relatively milder disease. The common combination is an O group mother and A or B group foetus. Exchange transfusion An exchange transfusion is undertaken mostly in Rh incompatibility if the haemoglobin estimation of the cord blood of the baby is low or his cord bilirubin is high or if the bilirubin levels after birth cross the safe levels. It may also have to be undertaken in certain other situations like a premature baby whose bilirubin levels rise rather rapidly or babies with jaundice who also have added problems like infection, low blood sugar etc. Other causes of jaundice in a newborn baby Infections in a newborn baby are rare. Conditions like hypothyroidism and galactosaemia can also cause jaundice in the newborn. Any jaundice which persists for over two weeks may need detailed investigations especially if the child has white stools. It may be due to the flow of bile being obstructed. Jaundice in older children The two common causes of jaundice in older children are infections or drugs affecting the liver. Certain drugs given for tuberculosis and epilesy can cause jaundice. The common infections causing jaundice are hepatitis and malaria. In malaria the child with jaundice may have very low haemoglobin. He is often very anaemic and may need blood transfusion.

Hepatitis

Most cases of hepatitis or inflammation of the liver are due to viral agents (Hepatitis A, B, C, and E virus). Hepatitis A and E is due to infection by the oral route. The other two are caused by infection due to an infected needle or blood and also with sexual intercourse. A mother having hepatitis B can also pass it on to her newborn through the placenta. The usual onset is with loss of appetite and vomiting. Fever may or may not be present. The child then develops high-coloured urine and yellow eyes. The jaundice deepens. The skin also becomes yellow. After about 2 weeks of the onset, the appetite starts returning, the urine colour becomes lighter and the child usually recovers after a total duration of about 3 weeks. Your doctor may ask for a urine examination and some blood tests specially to rule out hepatitis B. Complications with hepatitis A and E are not common. But hepatitis B and C can lead to liver failure or persistent infection and even carcinoma of the liver. Treatment of hepatitis There is no specific treatment for hepatitis. The child is advised rest at home till the jaundice clears and the appetite returns to normal. Unnecessary dietary restrictions are placed by some doctors. In my experience a child who is allowed to eat what he likes recovers faster. Such a child is less likely to feel weak. If the child is not hungry, encourages him to have fruit and rice preparations. If he is vomiting, give him small feeds at more frequent intervals. Drugs for vomiting should be avoided. If vomiting is severe, intravenous fluids may be needed. Sugar-cane juice is not essential. In fact, we have seen children getting new infections from this juice if it is brought from outside. If you are very keen about cane sugar, let the child chew on a piece of sugarcane. Similarly, drinks which are enriched with glucose are not required. In case of fever, try to avoid drugs. Even a relatively safe drug like paracetamol can be harmful for the liver. Sponging with slightly warm water may be resorted to liver tonics are not required. Any vitamin B complex preparation may be given for a month. If the child has much itching, you may apply calamine lotion on the skin and your doctor may prescribe some oral medication.

Joint Disorders

Sprains affecting joints are discussed under the heading of `Bones, Joints and Muscle Injuries'. Limps and pains in the legs are also discussed under separate headings. Here we shall discuss conditions given rise to pain and swelling of the joints. These are grouped under the heading of arthritis. Causes of arthritis Bacterial infections Acute bacterial infection and tuberculosis can result in arthritis. The former is termed as septic arthritis. It presents with sudden onset of fever (usually high) and painful swelling with restriction of joint movements. It usually affects the hip, knee or ankle joints. In tuberculosis, the swelling may increase gradually and persist for days and weeks. Acute septic arthritis needs immediate treatment with intravenous antibiotics. Rheumatic fever This gives rise to temporary swelling or pain in the joints. Involvement of joints due to this condition are discussed separately under the headings of `Rheumatic Fever'. Rheumatoid arthritis It usually affects pre-school children or adolescents. Seen more commonly in female children, rheumatoid arthritis may involve one joint (usually the knee or ankle) or the child may present with swelling of several joints. Bilateral symmetrical involvements of small joints of the hands is characteristic. Joint of neck may also get affected. The child often has more marked stiffness of the joints on getting up in the morning. Haemophillia Children with clotting defects can also present with swelling of a joint. A history of bleeding tendency in the child or family history aids in the diagnosis. Treatment of joint disorders Your doctor must be consulted immediately with any swelling of the joint(s). Some of these conditions require urgent treatment. Others may require a prolonged course of management.

Limp & Pain In The Legs

Common causes Tight shoes, a nail or a stone in the shoe, painful glands in the groin, injury to the foot or lower limb with a cut, splinter, sprain or a fracture, growing pains, and a flu-like illness with pain in the limbs. Uncommon causes Early polio, rheumatic fever, scurvy (due to vitamin C deficiency), congential heart, dislocation of hip, slipped femoral epiphysis, transient synovitis of the hip, Perthes' disease, infection of a joint with a viral or bacterial infection, and cerebral palsy. Growing pains (leg aches) This is quite common. One out of four normal children complain of pain in the legs which lasts for months or years. The child feels better if the legs are pressed. The pain is more marked at night while the child is lying in bed. He runs about normally during the day. It does not interfere with his normal activities. He has no limps. There is no localized swelling, warmth, or tenderness. The pain is rather diffused. The movements at the joints are normal. We do not know the exact cause of this symptom. It may be a subconscious way of the child getting attention of the parents and getting more body contact. The pain usually disappears by the time the child leaves school through several mothers of these children tell me that they continued to have such aches even in adulthood. Transient synovitis of the hip This is preceded by a minor viral cold or a minor injury. After few days of rest, the limps disappears. It is usually seen between 2 to 7 years of age. Perthes' disease This presents as in the above condition. An X-ray of the hip joint points to the diagnosis. Treatment of a limp This will depend upon the cause. Most children with common causes listed above settle down without any treatment. In case of any doubt, it is important to show the child to your doctor for ruling out any condition that may need urgent attention.