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A - Z of Childhood Illnesses

P Q R S

On this page: Pneumonia Poisoning Poliomyelitis Premature Baby Prolapse Of The Rectum Rabies Rheumatic Fever Rheumatoid Arthritis Rickets

Pneumonia

Pneumonia can be due to several causes. Bacterial pneumonia is common. It must be treated promptly. When to suspect You must suspect this condition if the child's breathing is faster than usual. A breathing rate of 50 or more per minute in an infant, 40 more between 1 and 5 years and more than 30 in older children should be taken seriously. Pneumonia may start with fever, a stuffy nose or cough. In an infant the temperature is around 39 C. He is restless, has fast breathing and looks quite sick. He may also develop cyanosis with blue lips and nails and noisy breathing. The spaces between the lower ribs may go in when the child breath The fever in an older child is even higher (40.5 C or more). He may also have chills and cough out bloodtinged sputum. He may also complain of pain on the affected side of the chest while breathing in. A child with the above symptoms must be shown to the doctor. An X-ray of the chest may help. Antibiotics result in marked improvement within 2-3 days. But the medicine must be continued as per your doctor's advice and the course be completed. Hospitalization may be needed, specially in an infant with breathlessness.

Poisoning

Prevention of poisoning due to substances like kerosene, medicines kept at home for killing bugs, drugs used by adults etc., is discussed under the heading of `Prevention of Accidents'. Here we shall deal with the steps to be taken if you suspect that your child has been handling some poisonous substances or has consumed them. Steps to be taken Remove the poisonous substance from his system. If he has some of it in his mouth, remove it with your fingers. If the child can understand, ask him to spit it out. Preserve this stuff along with the poisonous substance that is in his hand or is lying near him. Your doctor would need to check its contents. If the child has spilled some poisonous substance on his body, remove the cloths and pour water (not hot) on his skin as you would in managing a case of burns. If the poison has gone into his eye, wash it with water. Keep washing the eye for about 15 minutes. After having taken these first steps, ring your doctor and ask him if you should make the child vomit. His advice is needed because vomiting is not advisable if the child has swallowed acids used for cleaning the toilet sink or alkalis used for washing dishes. In such cases your doctor will probably advice giving milk or water. If your doctor advises you to make the child vomit, give him a drink of salt water. The best way to make the child vomit is to give him syrup of ipecac. Unfortunately, it is not easily available at a chemist. If you can procure a bottle of it, keep it handy at home. If your doctor is not available and you have ruled out the ingestion of acids or alkalis, give 3 teaspoons of this medicine followed by a glass of water. If he does not vomit after 20 minutes, give one more dose. As soon as the child vomits, collect the vomit in a vessel and preserve it to be handed over to your doctor for inspection and testing. After following the first two steps, take the child to the nearest hospital for further management. You must take with you the remaining poisonous substance and the amount removed with your fingers or the stuff vomited by the child. The doctor would also like to know the possible amount of the poison taken by child and the likely time when he might have ingested it. After taking a quick history and checking up for your child, the doctor may decide to send you home, or do a stomach wash to remove the remaining poison in his stomach, or he may decide to admit the child in the hospital. If you are sent home with your child, do observe him closely for the next 12 hours for any abnormal behaviour, convulsions, breathing difficulty, persistent vomiting or failure to pass urine. If in doubt, consult your doctor or take your child again to the hospital.

Poliomyelitis

Poliomyelitis is caused by either of the three types of viruses-type 1 2 and 3 Hence, it is advisable that six weeks after a child recovers from an attack of poliomyelitis, he is given three doses of oral polio vaccine, irrespective if his previous immunization status. Polio affects the muscles. The extent of the illness varies from child to child. Fortunately, 90-95 per cent of affected children who get the infection do not manifest any symptoms. A few may just get a little fever or stiffness of the neck and back. Paralysis is seen in less than 1 per cent of cases. The child may completely recover from the paralysis or may be left with varying degrees of handicap. Serious cases may involve the brain and muscles of respiration. A suspected case of poliomyelitis must be by your doctor as soon as possible. If required, your doctor may advise close observation of the child in a hospital. Those attending on the child must wash their hands properly, specially after handling the stools of the baby.

Premature Baby

Babies who are born before the expected time are called premature babies. They normally weigh less than 2.5 kgs at birth. But in our country quite a few babies who are born at the expected time also weigh less than 2.5 kgs. All low birthweight babies, specially those below 1.8 kgs and those born 2 months before full term need special care in a hospital. Management A warm environment, prevention from infection and adequate nutrition are the most important steps in the management of a premature baby. Because of less fat, a premature baby can get cold. For warmth, the baby is either kept in an incubator or in a heated room. An incubator can be a source of infection in many settings. Therefore, some doctors prefer to keep the room warm with the help of a heater. A temperature of 28C -30C is maintained in the room. The aim is to keep the baby's armpit temperature between 36.5C to 37C (98F to 99F). The baby's head and feet must be well covered. Another good way to keep the baby warm is to let the baby sleep with the mother. She can also carry the baby next to her body, inside her clothes, between her breasts - what is called the 'kangaroo position'. The baby should be sponged and not given a bath till he weighs 2.5 kgs. A baby with proper temperature has pink and warm soles and palms. Blue or cold palms and soles may indicate that either the baby is having some infection or is not being kept adequately warm. The premature baby is more prone to infections. For prevention of infections, all those who handle the baby must thoroughly wash their hands with soap and water. Visitors should be avoided. But the mother must be allowed to handle the baby. If the baby is too premature, you must at least touch the baby often as per advice of your doctor. Your skin-to-skin contact with the baby is helpful for you as well as for him. For proper nutrition, your breastmilk is the best for your premature baby. (See section on infant feeding.) Here it may also be mentioned that premature babies who are breastfed turn out to be more intelligent than such babies who are artificially-fed. Jaundice and eye problems are more common in a premature baby. Your doctor will keep a close watch on the baby in case any intervention is necessary.

Prolapse Of The Rectum

Parents of a toddler or a preschool child can get unduly. scared to notice the rectum coming out of the anus as a red mass. It may go back on its own or may need to be pushed back. In some cases, no cause is found and the condition improves spontaneously after it happens a couple of times known causes are related to whipworms, giardiasis, severe diarrhoea, constipation, severe bouts of cough and malnutrition. Whatever the cause, this needs to be treated by your doctor. Treatment For temporary relief, take a handkerchief or any clean piece of cloth. Dip it in warm water and gently push the mass inside with your index finger wrapped with the warm wet cloth. If it still tends to come out, bring the buttocks together and strap them with a bandage (x-shaped) which is kept in place with sticking plaster. Improve the nutrition of the child and discourage him sitting on the toilet for a prolonged period. In rare cases, surgery may be needed.

Rabies

This is a very serious disease that gives to difficulty in swallowing, convulsions and death. It results from the bite of an infected animal like a dog, a cat, a bat or a fox. Bites from all these animals should be taken seriously and the following steps should be undertaken. Steps to be followed Tie the animal up if possible for close observation for a period of 10 days. If the animal is healthy after this period, there is no cause for concern. This is true of a cat or a dog. But a bite from a wild animal like a bat or a fox should be taken very seriously. If it is possible, such a wild animal is to be killed immediately and its brain examined to see if it is infected with the rabies virus. If the wound is bleeding, check the bleeding by firm constant pressure. Then wash the site with soap and water for at least 10 minutes. This is most important. Contact your doctor immediately. In the meanwhile check if the pet animal has been immunized or not. Your doctor may ask certain questions. For example, did the pet dog or cat bite the child under provocation? was it a direct bite or through the clothes? Which portion of the body was bitten? What is the immunization status of the pet animal? If the bite is from a wild animal, your doctor is likely to give preventive injections for tetanus as well as for rabies. In the case of pet animals, he may decide, depending upon the answers to the above questions, whether to start the injections straightaway or to wait for a few days while the pet animals is under observation. What is true and false about rabies? The Plants and Animal Lovers Society (PALS) Mumbai and The Welfare of Stray Dogs (WSD) of Mumbai have brought out a pamphlet about rabies. The questions and answers given below are taken from this piece of communication. Q. What exactly is rabies? What part of the body does it affect? A. Rabies is a fatal viral disease which affects the central nervous system. It causes inflammation of the brain, leading to death. Q. How is rabies spread? A. It is transmitted when infected saliva enters the broken skin. This means through the bite of a rabid animal, or through its lick on an existing cut or wound. The disease is not airborne and has very rarely been spread by aerosols. It can be spread by all warm-blooded animals (especially mammals), but for humans, dogs are the most important source of infection. Q. Is it curable?. A. Once the symptoms are developed, it is not curable. However, it can be successfully prevented by prompt post- exposure treatment. Q. What is the duration of the disease?. A. The 'incubation period' is roughly 10 days to 1 year. It depends on several factors including the site of entry of the virus into the body. Generally, the closer the bite is to the brain, the quicker the progress of the disease. Once clinical signs appear, the disease progresses rapidly to death, generally within 5 to 7 days. Q. What are the signs?. A. First, there are vague, non-specific signs such as fever, nausea or pain. Thereafter, canine rabies can take one of two forms: ‘Furious' rabies or 'Dumb' rabies. In the 'Furious' form, there is great restlessness, abnormal behaviour, salivation, weakness of the back, legs and paralysis. The dog is hyperexcitable and aggressive, biting even imaginary objects. In the 'Dumb' from, dogs show incoordination leading to paralysis, and want to hide in dark places. In both forms there are changes in the voice and inability to swallow. In the last stage, paralysis causes respiratory failure, leading to coma and death. Q. Does a dog showing these signs definitely have rabies? A. Not necessarily. Of course, if all the sings are present there is a strong possibility of rabies. However, certain neurological or other disorders can also show several of these symptoms. Drooling can be caused by foreign bodies or ulcers in the mouth or even by poisoning. People also tend to interpret provoked biting as rabid behaviour. Hence, diagnosis should be carried out only by experts. Q. How is rabies diagnosed? A. Either clinically or by laboratory examination. For clinical diagnosis the veterinarian looks for a combination of symptoms, as the animal's history and habits, its attitude towards its owner (in the case of pets)and towards other dogs. Laboratory examination of brain tissue is carried our after death. Blood tests (i.e. ELISA) can be carried out on living animals but are not commonly performed. Please remember that a lay person is not qualified to diagnose rabies and may cause much barm by attempting to do so. Q. Is it true that rabid dogs cannot bear the sight of water? A. No; it is more a case of being unable to drink water due to painful spasms and paralysis of the muscles which assist swallowing. This condition also causes drolling, since the dog cannot swallow his saliva. Q. Do all stray dog carry rabies? A. No. However, they are very vulnerable. Since most of them are still unvaccinated and unlikely to get post-exposure vaccinations after a bite. Q. Can pet dogs get rabies? Should they be vaccinated? A. Yes! Unvaccinated pets who roam freely are at very high risk. Official sources indicate that about half of human rabies deaths are caused by the bites of pets. Pet dogs should be vaccinated every year. Q. What about cats? A. Pet cats should also be vaccinated every year. Neither pet dogs nor pet cats should be allowed to roam freely. Q. If I am bitten or licked by an animal suspected of rabies? what should I do? A. Act quickly. (a) As soon as possible wash the wound for at least 10 minutes with soap and water. The importance of washing cannot be overemphasized. It removes 94.4 per of the viral particles. (b) Next, disinfect the wound with Dettol, Cetavelon, Betadine or spirit. (c) Consult a doctor and start your post-exposure vaccination course. If any unknown dog makes an unprovoked attack, take the full course. If a known dog makes a provoked attack, take 3 vaccinations at least. In either case the dog should be observed for at least 14 days. This is because in dogs, death generally occurs within 10 to 12 days after the virus reaches the salivary glands. If the animal shows no signs within this period it is more or less safe to assume that he will not have transmitted rabies. Q. Can an animal who shows no signs of rabies transmit the disease? A. In real life it is extremely unlikely that a dog who shows no signs will transmit the disease. There is a 'carrying' stage called the incubation period, from the time when the virus enters the body and starts multiplying, up to the time it reaches the brain and the animal starts showing signs. Transmission during this period has been very rarely observed and only under laboratory conditions. Q. Can puppies be born with rabies or get it through their mother's milk? A. They cannot be born with it, but the virus could be found in the mother's milk. However, puppies of a rabid bitch are at higher risk through their moher's licks or bites. Q. If I am bitten by a rabid animal, will I definitely get rabies? A. No. In fact human beings have relatively low susceptibility to rabies. According to statistics, on average only 15-20% of people who have been bitten by proven rabid animals and received no post-exposure treatment die from rabies. However, please do not ever neglect your post-exposure treatment. With rabies, you should not take a chance. Q. What is the rate of human rabies deaths in India? A. The rate is estimated to be 1,7-3.3 per 1,00,000 inhabitants (about 25,000-30,000 deaths per annum). In Mumbai there were about 50 deaths a year until 1992. In 1993, it dropped to 26 and in 1994 to 22, largely due to implementation of vaccination as a preventive measure. Q. What should I do if I see a rabid-looking stray dog? A. Call the Municipal Dog squad and ask them to catch the dog immediately and isolate it for observation. Please do not attempt to touch or kill it. Prevention of dog bite You must educate your child not to provoke a dog. Thus, he should not touch puppies in presence of their mother; should not run when he sees an unfamiliar dog and he should not disturb a dog who is eating or sleeping.

Rheumatic Fever

Rheumatic fever can be a serious disease as it can involve the heart and if not detected and treated in time can lead to chronic heart disease. The disease follows a sore throat with painful and tender lymph nodes under the jaws. This sore throat is caused by a specific bacteria. It should be distinguished from a sore throat due to a virus infection in which the patient also has cough and runny nose without enlargement of the neck glands. Typical case The child of schoolgoing age (5 years to 15 years) has a sore throat as mentioned above. One to 3 week later he presents with flitting joint pain and swelling. It usually affects the big joints. By flitting pain we mean that the joint involved becomes normal in a day or two while another gets affected. Then the second becomes completely normal while a third is found to be painful and swollen. Besides this typical problem with joints, the patient has fever. He may get a rash on the trunk which comes and goes. He gets nodular swellings on the back of the head or on the elbows and legs and the doctor may find that this heart is affected. Some cases present with abnormal involuntary movements of the body the limbs (chorea). Your doctor may find some other features. He shall ask for some blood tests. He may also order for an ECG (electrocardiogram) and a chest X-ray. In a chronic case, with involvement of the heart, an echo-cardiogram may needed. Treatment Bed rest, treatment for a sore throat and aspirin is the commonly prescribed regimen. Let your doctor decide how long your child should stay at home. The more important point that you must remember is that further attacks of bacterial sore throat in children who had rheumatic fever must be prevented. For that, the doctor shall ask you to give the child a medicine to be taken regularly for a number of years. This is essential because further attacks can affect the heart adversely. In case of an extraction of a tooth, or surgery inside the mouth, the doctors would also put the child on a medicine just before and for sometime after it. You must therefore tell the surgeon that he child had rheumatic fever in the past so that he can do the needful.

Rheumatoid Arthritis

Many people believe that rheumatoid arthritis is a disease that affects only adults. This is not true. It can affect even infants but the age group of children which most commonly gets the disease is the toddlers. However, the disease is not very common in paediatric practice. Typical case A toddler starts complaining of pain in one or more joints. The pain is more marked on getting up in the morning. Characteristically, the affected joint feels stiff in the early hours of the day and this stiffness becomes less marked as the day passes. The affected joints become swollen and painful. They are hot to touch. The classicals presentation is swelling of the small joints of both hands. But in about half of the cases, only one big joint like the knee or ankle may be involved. The heart is usually spread. The picture is different from rheumatic fever with involvement of joints (rheumatic arthritis). While in rheumatoid arthritis, the swelling in the involved joints persists for days together, in rheumatic arthritis the affected joint remains swollen for only a day or two, while another joint becomes painful and swollen. The first joint becomes completely normal while a third one is attacked (fitting joint involvement in rheumatic fever). Also morning stiffness is typical of rheumatoid arthritis as is the involvement of the joints of the neck. Your doctor would also keep in mind the other possibilities for the swelling like injury, local infection, scurvy (due to vitamin C deficiency) and haemophilia (a bleeding disorder due to defect in the clotting of blood). He may also order some tests specially in cases which are not typical or have less common manifestations like a skin rash, enlargement of lymph glands, involvement of the heart and prolonged unexplained fever without swelling of joints. Treatment Keep in close touch with your doctor because the treatment may have to be prolonged. Fortunately, most cases recover completely, though some may grow into severe arthritis or cause damage to the eyes. The commonest prescribed drug is aspirin. Your doctor will adjust the dose for your child. Aspirin should not be taken on an empty stomach. It should be taken with food or milk and with enough water. Hot water compresses are helpful. Encourage the child to move the joints after the hot compresses. Let him avoid swimming when the water in the pool is cold. Otherwise, swimming later in the day. When the water is warmer, is helpful.

Rickets

This is a disease of the bones that can affect children who do not get any exposure to the sunlight. Our skin has a pro- vitamin D. In presence of sunlight, it gets converted into vitamin D which protects the child from getting rickets. Typical case An older infant or a toddler is brought with bowing of the legs. The doctor finds widening of the ends of his long bones, near the wrists or ankles. The eruption of teeth is delayed. The forehead appears rather prominent. The anterior fontanelle (the soft spot on the head) is widely open. The child seems to be prone to frequent infection. Some children get tetany (fits due to calcium deficiency). An X-ray of the wrist shows classical evidence of rickets. While being aware of the above finding, you must remember that all these features can be seen normally in individual children. Thus, bowing of the legs in absence of other features of rickets in an infant is normal. The legs erupt later in some children who are otherwise normal. The anterior fontanelle may sometimes normally close towards the end of the second year. The head may look big because of the bigger size of the head of the parents. So let your doctor decide whether the child has rickets or not. Treatment Your doctor would give vitamin D to your child. In most cases, the improvement is rapid and the X-rays return to normal. You must make sure that the child's skin is exposed to the morning sunlight for 10 minutes every day. Rickets is extremely rare in breastfed children. In my thirty years of practice, I have seen it only in four breastfed case. In three cases, the child, even though advised, was not exposed to sunlight for fear of his getting a dark skin. We could not figure out the cause in one child. All improved with vitamin D and exposure to sun. Do not give more vitamin D to your child than what is prescribed by your doctor. He may get vitamin D poisoning. Also make sure that the child does not get sunburn due to prolonged exposure to sun.