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A - Z of Childhood Illnesses

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On this page: Short Child Skin Conditions Acne Albinism Impetigo Molluscum contagiosum Vitiligo Warts Sleep & Sleep Problems Sore Throat (Pharyngitis) Streptococcal sore throat (tonsillitis) Stammering Stridor

Short Child

In the chapter on growth and development, I discussed about the normal height of children. If the height of a child is less than the expected height, the following are the expected causes: Small size of parents A child may take after his mother or father. The child may have a sudden increase in height as he enters his teens. Small size at birth Children with low birthweight and length are likely to remain small, especially if they are born at the expected time (small for date babies). Chronic infections Undiagnosed and untreated chronic infections like a urinary infection can be responsible for poor gain in weight and height. Bronchial asthma and congenital heart disease (C.H.D) If severe, bronchial asthma as well as C.H.D can cause shortness of stature. Less common causes Hormonal disorders like hypothyroidism, though uncommon, must be diagnosed and treated promptly Certain chromosomal disorders and hereditary disorders affecting the skeleton can also result in stunted growth. Treatment Besides treatment of an obvious cause for shortness, there are no specifics measures to increase height. Swimming and exercises are desirable but one should not expect that the child’s height will increase by such methods. The same is true for a healthy diet. Of course, if a child has been ill-fed from an early age, his height and weight is going to be affected. But pushing the child to eat more does not help. Vitamins and iron unless indicated for specific reasons, are not helpful in increasing the height. Similarly, drugs to stimulate appetite like cyproheptadine and anabolic steroids are of no use. In fact, they can be harmful. A growth hormone is sometimes given, if indicated, under the close supervision of a paediatrician or an endrcrinologist.

Skin Conditions

The secret of a healthy skin A healthy skin protects us from several diseases. Adequate sleep, exposure to morning sunlight for about ten minutes, a daily bath clean clothes, breastfeeding for smaller children and a healthy diet for an older children that includes coconut water, fresh fruits, leafy and raw vegetable, avoidance of unnecessary drugs and a happy state of mind, helps in keeping the skin healthy. Basic care of your child’s skin The skin basically consist of two layers. The outer layer is called the epidermise and the inner layer is the dermis. In general, smaller children tend to have a dry skin compared to older ones. So it is not advisable to use too much of soap on the childs skin. Expensive soap is not required. Any bath soap which does not smell shall serve the purpose. Soap may be used two or three times a week. Infections of face and buttocks are more common. These areas should be washed more frequently. No talcum powder is advisable. That includes special baby powders. They irritate the nostrils and lungs and tend to cake in the skin folds. Baby creams and oils are not necessary. If the skin is too dry, coconut oil may be used. Apply it on the small area of the skin. If it does not give rise to a rash you can use it for the rest of the body. If the child develops a rash, try some other less expensive oil. Acne Acne or pimples is a disease of adolescents. It is due to hormonal changes at this age resulting in more oily secretions. Although a healthy diet and a clean skin is desirable for all children, do not nag a child having acne about personal hygiene and food all time . There is no evidence that fried foods or chocolates are the cause of acne. However, if you explain to the child the basic cause of acne, he is more likely to listen to your advice about avoiding junk food as far as possible. The basic rules for a healthy skin are mentioned above. You can share it with your young `friend'. Acne affects the face and the upper chest or back. Washing the face once in the morning and once at night with an ordinary bath soap is enough. Instruct your child not to keep touching the pimples and not to squeeze them. He will listen if you explain that pinching the pimples can lead to permanent scarring. Regarding medication, it is better to take the advice of your doctor of a skin specialist and to avoid indiscriminate use of over-the-counter medicines. Treatment should be continued as per the advice of your doctor. Most cases improve within the month or two. They can recur. Fortunately, most cases improve with age. Albinism Children with this inherited condition have white hair, white skin, blue eyes (blue iris) and diminished eyesight. However, they can manage to read and write. They also have photophobia (intolerance to bright light). It is not too uncommon-occurring in 1 in 20,000 population. A person with albinism who marries a healthy unrelated person can have a child without albinism. No treatment for this condition is available. Most individuals can lead a satisfying life. Severe cases can develop blindness and skin cancer later in life. Boils Boils are due to the collection of pus under the skin. It may show up as a painful or as a red, hot, and tender swelling under the skin called an abscess. The basic treatment is drainage of pus. Give hot water fomentation to the area every three to four hours. To give hot fomentation, place a thick layer of gauze pieces (sterile gauze pieces are available with most chemists) over the swelling. Pour warm water over it. Let the wet gauze remain in place for about 15 minutes. Then remove the wet pieces and dress with dry gauze and bandage. This may be needed for a few days. When the head of the boil opens and starts discharging pus, continue the hot compress till all the pus comes out. As with acne, do not squeeze the boil to take out the pus. Let it come out on its own with the help of moist heat. If you do not notice any relief within three to four days, consult your doctor. At times the pus has to be drained out with the help of a cut. Sometimes your doctor may dress the wound and may even prescribe some antibiotic to be taken orally. Diaper rash (nappy rash) This rash, confined to the nappy, is commonly seen in newborn babies and in older infants with frequent loose motions. It is seen less commonly in breastfed babies. It is more common with those babies using disposable diapers. A naked baby does not get a diaper rash. To avoid the baby making mess, we use a diaper. If it is not changed soon after it becomes wet, the prolonged contact of the skin with urine or stool leads to redness over lower part of the abdomen, groin, the genital area and the buttocks, This is more likely to happen with a disposable diaper. Sometimes the moisture in the area can attract a fungus. Fungus infection leads to redness over the area mentioned above except the buttocks. To prevent the diaper rash, use cotton diapers instead of the disposable ones. Even when your are travelling, use a cotton diaper and cover it up with a plastic cover. Try to change the diaper as soon as it is wet. Clean the soiled diaper area with plain water and dry it. Make sure that no moisture is left in the groin or in skin creases. Some babies get up if the diaper is changed during the night but they do not get the rash even if the diaper is not changed. If your baby develops the rash, expose his skin to air as often as possible, especially for sometime after he has passed urine and/or stool. This is often enough to solve the problem If the rash persists, use an ointment containing zinc and castor oil. Your chemist can make it or any readymade preparations can be used three times a day. If the rash persists, you should see your doctor. He may have to treat it with anti fungal preparation. Rarely, a local preparation containing steroids may also be needed. Eczema See Allergies. Impetigo Impetigo, like boils are also due to certain bacteria-causing infections of the skin. They present as blisters which burst open and form sticky yellowish crusts. They can spread to different parts of the body but are usually confined to the skin around the mouth and the buttocks. They are infectious and can spread to other parts of the body or to close contacts. A local antibiotic cream is all that is needed in mild cases. At times your doctor may have to prescribe an antibiotic to be given orally. The child's clothes should be changed frequently. Leprosy When to suspect leprosy 'How can my child get leprosy? This was the reaction of a mother in my consulting room whose child was diagnosed to have leprosy. It is true that leprosy is more common in certain areas and in the poor socio-economic groups. But it can affect a child from any background. However, most cases of suspected leprosy are simply white patches of no significance and need no treatment. Some of these are due to a fungus infection which can be treated easily with local applications. Diagnosis of leprosy when made earlier makes all the difference to its treatment. That is why our discussion here is limited to the diagnosis of an early case, with loss of sensation over the affected part. If you see a light-coloured patch on the skin which looks different from the surrounding area, test for loss of sensation with cotton. First, touch the normal-looking area with the child's eyes open. Then touch the doubtful area. After that ask him to close his eyes where you have touched. If he cannot feel anything over the light coloured area, repeat the test with a pin. Do not prick hard. If in doubt, see your doctor. If it turns out to be leprosy, do not get unduly upset. We now have very effective drugs for the disease. But do remember that leprosy can affect the rich as well as the poor. History of close contact with a case of leprosy is helpful to make a diagnosis. But I have seen leprosy even in absence of such a history. Patches of leprosy should be differentiated from ringworm and vitiligo discussed below. A very common type of white spots are noticed in children who play a lot in the sun. Mostly seen on the cheek in children with darker skin, they can also be seen elsewhere. They tend to come and go, and disappear after a couple of months. No treatment except 'patience' is of any help. Some believe that such white spots no harm in giving your child treatment for same. Incidentally it may be mentioned that such patches (and also white lines on the nails) are not due to calcium or other deficiencies. Lice Children often bring it from friends in school or get it from a maid or any other person at home. But please do not blame your dog, if you have one. This parasite is not transmitted by pets. Lice cause severe itching and irritability. Eggs of the louse, the parasite that initiates the itching, are seen sticking to the hair like grains of sait. Your doctor will prescribe a local application which is quite effective. It is important to treat all members of the family, who have even the slightest itching. After a few days of treatment, the hair should be combed with a fine toothed comb to remove all nits. All clothes, combs or brushes that come in contact with the hair should be washed clean with hot water. Bacterial infection of the scalp may result following scratching which may also need to be treated. Small pea-sized glands at the back of the neck are often due to lice. Once enlarged, they may take long to disappear. No treatment for these is required. Molluscum contagiosum This is a virus infection. It is a contagious skin disease which can spread from one part of the body to another. It presents as firm, pearly, skin-coloured swellings of 1 to 5 mm in size. The centre of the swelling appears depressed, from which a cheesy material can be expressed. The disease can get better on its own but may persist for months or even years. The swelling can be tackled by removing the cheesy material with a needle or by currettage. They can recur. In order to destroy the swellings, all those having the disease in the family should be treated. Ringworm and a few other fungus skin infections Ringworm is a fungus infection that presents as small, somewhat raised rings on the skin with a pale center. Itching may be present but is not marked. It can spread from one child to another. Generally, local treatment and personal hygiene is all that is required. In rare cases, your doctor may prescribe a medicine to be taken daily, especially if the nails are also affected. The patches differ from leprosy because of the surrounding ring and no loss of sensation. The nails appear discoloured and thickened. Tinea versicolor presents as dark brown or whitish spots on the upper part of the chest and back. They are also surrounded by a border which is rather irregular and not so well-raised as in ringworm. A local application twice a day for about a month clears it completely. It may come back again when the treatment needs to be repeated. Candida infection (which also causes a common fungus infection of the mouth called thrush) may affect the groin, armpits and neck. It presents as moist red areas of skin, and responds well if the affected parts are kept dry, and are given exposure to air and antifungal treatment. Scabies If more than one member of the family is having itching all over the body - more marked on the wrist, between the fingers and no the penis and scrotum, your are probably dealing with scabies. The child may even bring it from a close friend. Besides personal hygiene, all members of the family having even the slightest itching should be treated. Preparations for a local application containing benzyl benzoate or gamma benzene hexachloride are quite effective. In older children the medicine is applied all over the body below the neck, especially between the fingers and toes and the groin. Bathing should be avoided for 24 hours after applying the medicine. Smaller infants may also have the disease above the neck and so the medicine in 1:1 dilution should also be applied to the face and head. The treatment should be repeated after a week. The disease can spread from clothes and linen, which should be boiled and dried in the sun before use. Sunburn You return from the picnic by the seaside and notice intense redness of the skin over the chest and back of your little one. An older child may even complain of pain and a burning sensation is these parts which were exposed for prolonged period to sunlight while playing in the sand or swimming in the sea. After a day or two the skin may peel off. This is sunburn. Recovery takes place within a few days without any specific treatment. Frequent baths with baking soda added to water helps. Fair-skinned children are more easily affected. Some lotions, recommended for application before going out in the sun, contain drugs which may; not be safe for children. The best precaution is to ensure that children do not stay in the sun for too long. Urticaria See Allergies Vitiligo Vitiligo is the loss of colour of the skin resulting in almost pure white patches. Any part of the body can be affected but they are more common on the hands and face, specially around the lips and eyelids. The sensation on the skin is normal. If in doubt, consult your doctor. He will rule out the diagnosis of leprosy and instruct you to avoid prolonged exposure of the white patches to the sun. If this is not possible, cover the parts or apply any ointment containing zinc oxide. Otherwise the skin may get blisters. No specific treatment is available. Your doctor may prescribe some local application combined with exposure to sunlight or ultraviolet light. At times an oral medicine is also prescribed. Some patches may recover spontaneously. But generally more and more areas of the skin keep getting involved. Parents must meet the school authorities with a certificate from a doctor that the disease is not infectious. Parents should not pass on their anxiety to the child and thus avoid secondary emotional problems in an otherwise healthy child. Warts Warts present as rather hard yellow, brown or black swellings son the hands and toes. They can also occur on other parts of the body. They are caused by a virus. Though many cases are cured spontaneously, it may take years for this to happen. It is better to treat them early with the advice of your doctor. Sometimes surgery is needed. The warts tend to recur but respond again to the treatment.

Sleep & Sleep Problems

This is a very important subject. Please read it carefully. But do treat what is written as a guide. Very often the best guide may be your natural instinct. There -fore, choose the best way out 2s per your own needs and the needs of your youngster and the rest of your family. Let me first mention the points that are discussed in detail below: The duration of sleep differs at different ages and from child to child. You should normally expect a fewer sleepless night in the first months of your child's life. After about 3 months of age, most babies settle down to a schedule convenient for you and the family. While older children may sleep in a separate room, your young infant would sleep better with you. Close relatives, specially the father, should be involved in helping the baby to sleep well. Most sleep problems are temporary. Duration of sleep The duration of sleep varies from child to child. If your child is joyful and active the whole of the next day, you can be sure that he has had a good sleep the night before. If he is irritable and not his usual self, he either had inadequate sleep or has some other emotional or physical problems. A newborn baby seems to be sleeping most of the 24 hours of the day except when he is hungry or when he is wet or is uncomfortable for some other reason. As he does not yet know the difference between day and night, he may sleep more during the day and less at night. They may not be convenient for the mother. But once she understands the reasons behind it, she may then herself choose to sleep more during the day while the child sleeps, and learn to feed the baby in a lying position (safe in breastfed babies) in her bed without having to get up to feed. People at home may also support her by restricting the visitors. While most babies can be handled, some babies demand extra attention. They are rather fussy and can give anxious moments to an unprepared mother. Most (but not all) babies seem to sleep better after their morning massage and bath, especially if they are wrapped up. In the second month, the baby is more awake and after about 6 weeks, may start responding when you try to catch his attention. Around 3 months of age the pattern of sleep is more likely to change and most babies shall sleep for longer hours at a stretch during the night. They are more awake during the day and may have a nap for an for an hour or two in the morning and again in the afternoon. This pattern continues until the first birthday. They may then have a nap only in the afternoon until the age of 3 years when they may stop having a nap during the day. Most children would now need sleep for about 10 to 12 hours at night. The difficult first months To understand the basis o this observation, you should have some idea about 'light sleep' associated with rapid eye moments (REM) and 'deep sleep' also called non-REM sleep. A newborn's sleep period begins with drowsiness leading to light sleep followed by deep sleep. Light sleep is marked by rapid movement of the eyes and dreaming. Upto the age of 3 months, half a baby's sleep time comprises of light sleep. Compared to this, the toddlers, older children and adults have deep sleep for upto three-fourths of the total sleep periods. So if a small baby below 3 months, sleeps for 16 hours, he has deep sleep for 8 hours. For the other 8 hours, he is sleeping but has a light sleep. Older children on the other hand, who sleep for 12 hours, may have light sleep for only 3 hours. From a light sleep the baby is likely to wake up more easily. A child passing through this stage of sleep may be put down on the bed by the mother with the impression that she has gone to sleep. But as he has not yet gone into a state of deep sleep. But as he has not yet gone into a state of deep sleep, he is likely to get up soon after he is sput down and start crying. Therefore, it is important that we continue to give the child body contact till he crosses the barrier of light sleep and moves into the realm of deep sleep. Also, as we mentioned earlier, babies are not yet able to distinguish between day and night. Therefore, they may sleep more during the day but bother the mom more during the night. And then, in the mother's womb, all the needs of the foetus were being met promptly. Hunger satisfied. Warmth assured. Familiar heart sounds to entertain. After he is born, the baby needs about three months to 'understand' that his demands should be reasonable and that mom also needs rest. From this we learn, that whether we like it or not, most babies will like their mothers to dance to their tune' for the first few months. The good news is that those mothers who respond promptly to the needs of the baby in the first few months are rewarded in the long run. The older babies, thus reared, are quieter, calmer and feel secure compared to babies who are left to cry. They start trusting people around them which helps them in the long run, in the development of their personality. The so-called 'three months’ colic discussed elsewhere, is another problem which bothers quite a few babies in their early months. Once you know about these possible factors which may make life difficult for you and your baby, you will be able to cope with such a situation with the right frame of mind. This may also send signals to other members of the family to give you a helping hand as often as possible. Unfortunately, some well-meaning people send wrong messages like these to the mother: 'Do not pick up the child the movement he starts crying. He will get spoiled. Let his lungs expand by crying. 'Listen to such people with respect but follow your own instincts. Cry if you feel like. Do not feel ashamed to ask for help if required. But have patience. A crying child is indicating that he needs you. If you fulfil his needs, you gradually start understanding him better. You learn to discriminate faster whether his cry is for a feed or for comfort. In due course of time, this approach helps you to pick up the cues that he gives you faster-even cues related to his readiness for such areas as bladder training, inculcation of healthy habits or to make him learn to choose between right and wrong. A breastfeeding mother finds it easier to cope with this difficult period. The 'three months' colic is less frequent in breastfed babies compared to those who are artificially-fed. The body contact which breastfeeding automatically provides helps the baby to feel more secure in the arms of the mother. Suckling during breastfeeding also helps in increased production of a hormone called prolactin. This has a calming effect on the mother and helps arouse the mothering instinct in her. This hormone is produced in greater quantity during sleep. So mothers who are used to feed the baby during sleep are able, not only to provide immediate gratification to the hungry baby or a baby needing comfort suckling, but they also help themselves by providing more prolactin. After having made the point that a crying baby should not be left crying, I must sympathize with mothers who have to spend sleepless nights in this process. The following guidelines might be found helpful. Get in to the habit of sleeping while the baby sleeps, as mentioned earlier. Do not switch on the lights when the child gets up at night. The idea is to gradually let him learn that nights are meant for sleeping and not for playing. Feed him in a lying position if he is hungry. Pat him to sleep if he is just squirming. Give him body contact if he has moved away from you. Do not get up to burp the child. Raise him while you are lying down. Let him lean against you to burp. If he does not oblige, do not worry. Quite a few babies can go without burping. If you are still concerned, let him lie on his right side. In this position the child is more likely to burp on his own. If a child has wet his diaper, see if he can remain asleep without changing it. After the first few weeks, quite a few babies can tolerate a wet diaper without getting upset and without getting a diaper rash. If the baby does get annoyed or if the whole bed gets wet, try putting a double diaper. Tie it firmly. This may work. If not, keep such diapers handy which do not need to be pinned and can be tied easily in the dark. The important rule is not to spend too much time in changing the diaper so that both you and the baby can go back to sleep as soon as possible. All 'noises' do not wake up a child. Many babies sleep quite well with some background music or human conversation. Of course, sudden loud noise may startle them specially if they are in a period of 'light sleep'. Where should your child sleep This decision should be left to you and your husband. Together you should decide what works best for you and your baby. Do not blindly follow the textbooks specially those which take it for granted that children are meant to sleep in a separate room right from an early age. The baby can sleep next to you in your bed or in a cradle or in a cot kept in your room or in an adjacent room. Toddlers can sleep on a mattress in your room or in a bed in an adjacent room. Older children can sleep in a bed or on a mattress in a adjacent room. You should consider this point when your baby is born. I believe that babies who sleep with the mother in her bed soon after the birth have less sleep problems and behavioural problems later in life. In the hospital, you should insist that your baby sleeps next to you and is not kept away in a nursery with other babies. You can, if you want, ask for a cot which can remain near your bed. The baby can be placed in it as per your convenience. Most mothers have been found to sleep better with the baby in their room once they have understood that that was the best way to help bonding with their baby. Of courses, you can always seek help from the nursing staff as and when required. If allowed, it is, of course, a real boon to have a close relative in attendance. Most modern hospitals encourage such an arrangement. After going home, many mothers have found the following sleeping arrangements quite practical : The baby sleeps in your bed until he is one year old. In the second year he sleeps on a mattress spread on the floor by the side of your bed. After he is three, he sleeps in a separate room, on his own, or along with his older brother or sister, in two separate beds. Teenage siblings of the opposite sex sleep in separate rooms. The above arrangements are based on the knowledge that children develop separation anxiety if they are separated from the mother figure. Between one and a half years and three years, they learn that even if the mother is not to be seen, she is around somewhere. Hence, it is important to give enough body contact to the child in his first year of life, meet his needs (vocalized mostly by crying) promptly, help him build trust in you and gradually wean him from your bed to another convenient sleeping arrangement in your room and then to another room, preferably adjacent to yours. Once the child is shifted to his room, he can be brought to your room, if he is not feeling well or if he feels scared for some reason. But he should be soon placed back in his room. Ideally, the older child should be taken to his room for sleeping by the mother or the father. You may read him or tell him a story. Many mothers find it helpful to say a small simple prayer together and the child is gently lulled to sleep. Older children are likely to go in to a 'deep sleep' faster soon and can be left properly covered. Some children are happier if a dim light is kept switched on all through the night. If you want the child to go to sleep early, see that he does not sleep during the day. If he is already doing that, take him our during those hours when he sleeps during the day. Take him to an interesting place or a garden for a few days to break his habit of sleeping during the day. In your bed, the infant can sleep between you and a wall. Otherwise, you can get bed-railings which can protect the child from falling down. For a very small infant, raising the mattress near the edge of the bed by putting a pillow underneath it serves the purpose. A doubt might be put in your mind that the baby may get smothered by you or your husband if he lies in your bed. This does not happen. However, if the mother or the father is heavily drunk or drugged, it is important for the baby to sleep separately. Support from others Anticipating 'difficult' days ahead, relatives, specially the husbands, who care for the pregnant mother can prepare her in advance to cope better with the difficulties that the mother may have after the baby is born. After seeing my own three grandchildren and reading the literature on the subject, I feel that newborn babies recognize the voice of adults who have been talking to them when they were in their mother's womb. If the husband is staying elsewhere, let the mother's mother, at whose home the pregnant mother often stays in our country, play this role. After birth, let her also handle the baby so that the baby starts getting used to her. If the husband is around, let him be fully involved. Indian husbands are often blamed for leaving the care of the children to their wives. But I find that more and more modern husbands are sharing the chores any playing an important part in bringing up their children. By doing this, they do not lose anything. They gain the gratitude of their wives and bond better with their children as they grow. Children should also be allowed to sleep with a relative or a maid during the day. Later on, it becomes easier for the child to sleep with such a person when the mother is not well or when the time has come to wean the child away from the mother during the night. What about intimacy between the husband and wife? As discussed in the chapter, 'Care of the Newborn,' fathers can become jealous. Even if they don’t, a mother has to remain conscious of her husband's needs for attention and for intimacy. For this reason and for the normal development of the child, while a woman must be ready to meet her husband's needs, she should avoid having sexual intercourse with children around (even if asleep) who are no longer toddlers. For that reason also, older children should sleep in another room. Psychologists with whom I have discussed the subject tell me that children who watch adults having intercourse either can become terrified or can develop undue curiosity about the same. Moreover, children have to graduate from the parents' room to another room to prepare themselves for moving to the outside world. Most sleep problems are temporary Yes, this is true. Exceptions may be made for babies whose needs for attention in infancy have not been met. For instance, I have actually seen such a bad situation in a crowded orphanage and in a hospital where mothers are not allowed to stay with a sick child (yes, such hospitals still exist on our planet, though their number is dwindling). When separated from the mother, these children cry, so that their needs can be met. when nobody responds, they cry hoarse but finally give up. They become withdrawn. People around them are not sensitive enough and feel that the child has settled down. They do not realize that they have become instrumental in stunting the personality of the child. Toys may give them material comfort which may lead to interest later in the material side of life. But toys cannot replace the warmth of a human touch or a smile or a little tete-a-tete with a known person. Earlier, we have said that children should have enough sleep and that they should go to bed early. But this routine may have to be changed it the father comes home from work late in the evenings and again leaves for work early in the morning. A child must spend time with his father. In such a case, it may be essential to make the child sleep during the day or allow him to remain asleep for a longer time in the morning. The presence of the father definitely helps in prevention as well as in management of common sleep problems. Common Sleep Problems Among common sleep problems are the following: Getting up too frequently at night. Nightmares. Night terrors. Sleep walking. Most problems associated with sleep can be prevented by caring parents who promptly attend to the needs of the during his early months of life and keep a watch on the factors which may contribute to sleep disturbances. Breastmilk is digested fast and so a child may demand frequent feeds in the early months. Parents who do not appreciate this fact may allow the child to cry unnecessarily. Flies and mosquitoes can be a nuisance. A mosquito net may be helpful. Extremes of temperature must be taken care of. If a heater is used in a room, a kettleful of water should be kept on the boil all through the night to maintain the humidity of the room, otherwise , the child's secretions in the nose get dried up, causing discomfort. If the child has a stuffy nose, it should be cleaned and nose drops used as mentioned under the heading of 'Cold'. Physical discomfort in the form of a wet diaper or during teething can add to the discomfort. Excessive activity during the day may also delay the onset of sleep. Any sickness must be attended to especially ear infection and itching associated with eczema or threadworms which come out from the anus at night and cause itching over the buttocks. Certain stimulating drugs and caffeine can be responsible for difficulty in sleeping. Children who are sleeping well in the early weeks of life. may suddenly give the mother sleepless nights around the age of three weeks, six weeks and three months. During these periods, some babies have growth spurts when they need to suckle more often to meet their normal demands of milk. On such occasions, you should not presume that your milk is not enough and that you must add artificial milk. This temporary phase passes as you let the baby suckle more often. Some mothers try to given the child a heavy meal at night or a feeding bottle in the hope that he would sleep better. This is not desirable and often does not work. Outside milk given in the early months of life can lead to rapid development of infections and allergic diseases. A heavy meal may come in the way of the child going to bed soon. If you have tried everything and you still feel that you have a difficult child at home do consult your doctor. If he certifies that the child is normal, do consider the possibility that your child may need more body contact. He may need to breastfeed for many more months and may have to sleep longer in your room compared to other average children. Any emotional factor at home or school should be attended to. Violent and scary movies on television must not be seen by children. Nightmares These are seen in preschool children. A child sees a scary dream and then he gets up crying. He is fully awake and appears afraid. He may recount the dream and once reassured go back to sleep. Night terror The child, again a preschooler, suddenly sits up in bed crying. He is not fully awake and is not aware of your presence. He screams as if terrified. He may be sweating and have a very fast heart rate. No effort on your part calms him down. Fortunately, he settles down after 15 to 30 minutes and goes back to deep sleep. When he gets up, he does not remember anything about the whole episode. Sleep walking This is seen mostly in children of schoolgoing age. While walking, the eyes appear glazed. They may mumble something which may be difficult to comprehend. Generally, they do not hurt themselves but care should be taken to prevent injury. Most such children are otherwise normal and the condition disappears in a couple of months. Rarely, it may continue to adulthood. No treatment seems to help. Homeopaths claim to have treatment for this condition. In general, most sleep problems are sorted out by a common sense approach, by listening to the child and by attending to his needs.

Sore Throat (Pharyngitis)

Most sore throats are of viral origin The back of our throat is termed the pharynx. Infection of the pharynx and tonsils is mostly due to viruses. A runny nose, cough and redness or watering of the eyes add to the possibility of the cause being viral. Such infections do not need any antibiotics. Streptococcal sore throat (tonsillitis) A streptococcal sore throat needs to be handled carefully because if untreated, this can be lead to rheumatic fever with involvement of the joints and the heart. In such a case the patient has fever, a sore throat, pus points on the tonsils, enlargement of lymph nodes below the jaw but no running nose, cough or redness of eyes. Your doctor may like to take a throat swab and do a blood test (ASO titire) to further substantiate the diagnosis. Such children are given a course of penicillin or erythromycin. Antibiotics, if needed, must be given for 10 days.

Stammering

A child between two or three years who has learnt to speak sentences may notice something interesting and want to tell mom all about it. It has to be told quickly. The effort to reproduce everything fast leads to mixing up of words. The child tends to 'stammer'. The parents ask him to speak slowly, carefully and say What`s the hurry? Don't stammer People will laugh at you. The child becomes conscious of speech. The stammering then gets worse or the child stops talking. If your child starts stammering avoid the temptation to correct the speech at that time. Such children often do not stammer if they are asked to recite a poem or sing a song which they have learnt by heart. Encourage that. This gives them confident and the stammering stops on its own after a couple of months. If you find that there is no improvement after having waited for two to three months, you can consult a speech therapist. Tell all the members of the family and the school teacher not to make any attempt to correct your youngster's speech. Let the expert handle the situation. The result with such help are excellent. In a rare case, stammering may be inherited. It does not improve spontaneously and instead starts getting worse. Such children must be put under the care of a speech therapist as soon as possible.

Stridor

The term stridor refers to noisy breathing. Congenital stridor Noisy breathing which is present from birth in child who is feeding normally and looks well in all respects can be ignored. It resolves spontaneously and does not need any treatment. It is noticed usually after the first week or two and appears to get worse until the age of 3 to 6 months. After the child crosses his first birthday. it usually decreases, to disappear around 18 months. The voice of the child is not affected. Acute stridor If a child develops a sudden onset of noisy breathing, you must seek immediate medical attention. Stridor of acute origin is discussed at length under the heading of croup. Acute stridor could also be due to a foreign body, smoke or severe allergy.