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A - Z of Childhood Illnesses

U V W X Y Z

On this page: Umbilical Problems Umbilical granuloma Umbilical hernia Undescended Testes Urinary Infection Vaginal Discharge Vomiting Wheezing Whooping Cough (Pertusis)

Umbilical Problems

Umbilical granuloma You may notice that after the umbilical cord of your newborn has fallen off, a red moist swelling is left behind. This is the umbilical granuloma. The standard practice is to touch it with a silver nitrate stick to dry it. But a simple method propagated by Dr. Nirmala Kesree and her colleagues from Davangare, in Karnataka works quite well. Just put a crystal of rock salt (cleaned with boiled and cooled water and dried) on the swelling. Keep it in place with leucoplast or a band- aid. The swelling disappears within a few days in most cases. If no improvement is noted by use of these methods, a minor surgery may have to be undertaken. Umbilical hernia This is quite common and does not need any treatment in most cases. This hernia becomes more prominent after the child cries. Crying results in increased intra-abdominal pressure. This pushes the abdominal tissue through the umbilicus because of a small gap in the abdominal muscles in that region. This hernia should be left alone. You may be advised by others to put a coin on the swollen part and tie it up. This is not required. In fact, if a leucoplast is used to keep the coin in place for a number of days, your child may get an itchy rash on the skin. The swelling generally disappears by the time the child enters his second year. In rare cases surgery may be required. I have never felt the need of it.

Undescended Testes

Soon after the birth of a male child, both the testes can be felt lying inside the scrotum. Sometimes, the scrotum may appear `empty' on one or both sides. The reason could be varied. In the foetus, the testes lie inside the abdomen. They come down just before the expected time of delivery. If the baby is born before the expected time, it may take sometime before we can feel the testes. Some testes are called `shy' testes or `retractile' testes. These are normally present in the scrotum but as soon as the scrotum is touched, especially if touched with cold hands, the testes tend to go up into the abdomen making the scrotum appear empty. Such a testes or testes do not need any treatment. The child has normally functioning testes. If one or both testes are really missing from the scrotum, we should wait until the child is one year old. If after that, the testes cannot be felt on one or both sides, it is advisable to see a surgeon, preferably a paediatric (children's) surgeon If the surgeon is convinced that the child has undescended teste(s), surgery will be advised to bring the teste(s) down and to fix it into the scrotum. If both the testes are not felt, and the clinical examination reveals some doubt, the doctor may then ask for a test to determine the sex of the child. There are two possible risks involved in leaving the testes inside the abdomen. The first is infertility and the other is the development of cancer of the testes. Here a passing reference may be made about uneven testes in an adolescent. He should be told that one teste can be lower than the other and that is quite normal.

Urinary Infection

The importance of diagnosis Remember the following important facts about urinary infection. It is not an uncommon disease. While proper diagnosis and treatment can help, carelessness in its management can lead to malnutrition and kidney damage. A routine examination of urine may suggest a possibility of infection but it must be confirmed by urine culture for colony count of bacteria. The diagnosis is clinched if the count is 1 lakh colonies or more per ml of a single organism. If the count is of this order, a sensitivity test must be done to select the right drug for treatment. The diagnosis is considered in a child with unexplained fever, frequency of micturition, painful urination or unexplained loss of weight or failure to gain weight. The urethral opening (opening of the urinary tract above the vagina) is quite near the anal opening in a female child. Parents should clean the anal region after the passage of stools, in the backward direction, away from the urethral opening. Children should be trained accordingly. Collection of urine sample Urine for culture must be collected in a sterile bottle, collected from the hospital. A sample must be taken as per direction of the hospital. A morning sample is not essential. The sample must be taken to the laboratory immediately after collection. If that is not possible, it should be kept in a refrigerator. Treatment Once a diagnosis is confirmed, the child is given the appropriate drug. A close follow-up is essential. Urine culture is done 1 week and 2 weeks after the start of treatment. If the urine is normal, a culture is done once a month for 3 months, once in 3 months for 1 year and then twice a year as long as possible. In all male children, a sonography for the urinary tract and a cystoureterogram (an X-ray taken after putting a dye into the bladder) is undertaken a month after the diagnosis is made and treatment has started. The same tests are conducted in female children below the age of 5 years, if they get repeated urinary tract infections. If any abnormality is found in these two tests, an intravenous pyelogram should be done. In this test, the dye is given into the vein and its excretion is followed in the kidneys, ureter and bladder. Children who get 3 infections in a year are put to a single small dose of a drug, every night, for 2 years or more. Rarely, surgery is indicated in cases of persistent infection or where abnormalities of the urinary tract need to be tackled surgically.

Vaginal Discharge

Normal discharge Newborn babies and older girls (when they are likely to start getting their periods) often have a clear, white, odourless discharge without any itching or burning. This is normal and needs no treatment except frequent changing of undergarments. Discharge which smells or gives rise to irritation and burning In adolescents, this sort of discharge needs to be correctly diagnosed and the child should be shown to a gynaecologist. In younger children, it is often due to lack of proper cleanliness, a bubble bath, nylon undergarments or thread worms. Rarely it could be associated with a foreign body in the vagina, fungus infection, diabetes, masturbation or sexual abuse. If the child also complains of burning while passing urine, a urine-examination should be undertaken.

Vomiting

Vomiting in normal children I have seen quite a few small infants as well as older children who vomit once or more during the course of the day but remain well otherwise. It seems that they have a rather more sensitive vomiting centre in the brain. They vomit even if they seem to have no problem. They vomit if they are excited, unhappy, fearful or because of any illness. The vomiting becomes less frequent as these children grow and then stops without any special treatment. Parents must not show undue anxiety when the child vomits. This may make matter worse. A typical scene is witnessed when a child is getting late for his school bus and his mother wants him to finish his glass of milk. He tries to gulp it in a hurry and brings most of it out. Giving solids before the child is ready for them, or forced feeding in children are other common causes. In such situations, the child should never be forced. Other children should be put to bed early at night so that they get up well in advance, before the school bus arrives. If the child hates to drink milk in the morning, do not insist that he must have it. Even if there is enough time, an occasional child does not want to eat anything in the morning. In general, I would like children not to go to school on an empty stomach. I would suggest offering the child some fruit or fruit juice. If he refuses that, give him some healthy snacks (fresh fruits, dry fruits, nuts or a sandwich made with wholewheat bread) to take to school for his short recess. Heavens will not fall if a child refuses to eat anything in the morning. Some infants swallow a lot of air while feeding and bring out milk quite often after a feed. Some are helped by burping. Others vomit as soon as they are lifted up for being burped. Check the position of these babies at the breast so that they have enough of the areola (the dark portion of the breast behind the nipple) in their mouth. If bottle-fed change over to cup feeding (which is better than spoon feeding). If you must bottle feed, check that the hole in the nipple is not too small. Some babies bring up curds after each feed or after some of the feeds. They are otherwise well- thriving, active and passing urine normally. This is called possetting and is normal. Nothing should be attempted to set it alright. May be you can buy some more bibs! When to worry? If your child is dehydrated following vomiting, you must get in touch with your doctor. He may like to treat the cause and give intravenous fluids if required. A dehydrated child looks sick and passes too little, dark urine. You should be equally concerned if he shows lack of alertness or behaves as if he was not fully conscious. It could be due to meningitis. Three common causes NEEDING ATTENTION Obstruction of the intestinal tract due to surgical conditions, infection, and head injury remain the commonest causes of vomiting needing attention. Surgical conditions If a small baby brings out green vomit, we must consider the possibility of the child having intestinal obstruction. Do not give this child anything to eat and drink and take him to your doctor. Such children may also have distension of the abdomen and dehydration. In a condition called pyloric stenosis, the child may present with white projectile vomiting and failure to gain weight. An intussusception and appendicitis discussed under `Abdominal pain' are also to be kept in mind. Infections An infection of the stomach and intestine (gastroenteritis) is the commonest infection resulting in diarrhoea and vomiting. This is discussed at length under the section on home remedies. If your toddler or older child has developed marked loss of appetite and passes a high coloured urine, suspect hepatitis, which is discussed separately. A small baby who stops taking his feeds, vomits and looks unwell, may be having septicemia- a serious type of infection. It may or may not be accompanied by fever. An infant having the above symptoms with a bulging soft spot (anterior fontanelle) on the head, with or without stiffness of the neck, may be having meningitis, needing urgent treatment. (Also see meningitis). Children with whooping cough also tend to vomit after a severe bout of cough. Ear and urinary infection may also be associated with vomiting. Seasonal vomiting, probably due to a viral infection, may affect a large number of children in a city. These children do not have any of the serious features mentioned above and settle down with symptomatic treatment of vomiting in 2-3 days. Some other causes of vomiting are poisoning, travel sickness and migraine. Some children with allergy to artificial milk can get a severe attack of vomiting with even little intake of milk. Many drugs, like antibiotics and drugs for diarrhoea and other illness may cause vomiting. Head injury One vomit after a head injury in a child who is otherwise well can be ignored. If the child continues to vomit, the doctor must be consulted. Blood in vomit Some children can bring out a streak of blood with a forceful vomit. This need not cause undue anxiety. But if it becomes a common feature, your doctor would consider the possibility of conditions like `hiatus hernia'. Of course, if bleeding is also noticed from other sites, a bleeding disorder has to be kept in mind. Treatment Treatment depends upon the cause. No drug for vomiting should be given without the advice of your doctor. If your doctor decides to give a medicine for checking vomiting, do not give anything by mouth for an hour. By then the drug starts acting and you can give small amounts of a drink or the child's favourite fruit or food. Do not give too much at a time. Give small amounts but offer it at frequent intervals. An occasional child may get a peculiar side-effects due to the commonly used drugs for vomiting. He rolls his eyes upwards and his whole body goes into tonic spasms. Fortunately, almost all cases recover after the drug is stopped Some patients are given another medicine to counteract the effect of the earlier drug.

Wheezing

What is a wheeze? A wheeze is a high-pitched whistling sound associated with breathing due to narrowing of the air passage. This is to be differentiated from noisy breathing due to partial blockage of the nose or due to the collection of phlegm in the windpipe or its branches. Common causes It is said that all that wheezes is not asthma. It is true. But it is equally true to say that most cases of recurrent wheezing are due to asthma. A viral infection called bronchiolitis affecting smaller infants can also present as a wheeze. In older children, tropical eosinophilia is also a common cause. (See section on tropical eosinophilia). A foreign body in the airway or a gland (due to tuberculosis or any other cause) pressing on the airway can also give rise to a wheeze. Management If you suspect that your child is wheezing for the first time in his life, let a doctor confirm it. So please do not give any medicine on your own. Your doctor can hear the wheeze well with his stethoscope if the child is not crying. So hold your child up in your arms with his head on your shoulder. Do not undress him. Let the doctor listen to his back first and then notice his breathing. If your doctor confirms that it was a wheeze, he may give the child an injection, or a medicine with a nebuliser, or by mouth (see section on Asthma) and wait for the response. If he finds dramatic improvement, he may suspect that the child has asthma. If you know that your child gets recurrent wheezing, you must follow the advice given by your doctor. You may also like to read the section on asthma. If he considers that trophical eosinophilia should be ruled out, he may ask for a blood test.

Whooping Cough (Pertusis)

A typical case In a typical case, the child with whooping cough gets severe bouts of cough. He coughs and coughs, his face becomes red, he grasp something for support and then makes a funny kind of sound (whoop), as if he was taking a deep breath in, through the partially-closed upper end of his wind-pipe. The whole episode is often followed by a vomit. Children who have had whooping cough vaccine as a part of DPT, either do not get the disease or get it in a milder form without the typical whoop and the vomit. A contact with a case of whooping cough aids in making the diagnosis. Stages of the disease A child may get the symptoms after a week or two of catching the infection from another patient (incubation period of the disease). First stage The child gets a cold-like illness with a cough which gradually gets worse at night. This stage lasts for about 10 days. Second stage The severity of the cough increases and within 2-4 weeks, he gets the typical bouts of cough with the whoop as described above. In between the attacks, the child appears comfortable. This stage lasts for about a month. Third stage This is a phase of recovery. The attacks become less severe and the whoop and vomits stop. This stage may last 2 weeks although some amount of cough may persist for months. Serious aspects of the disease Frequent vomiting can lead to dehydration and malnutrition. Pneumonia and convulsions are serious complications. The disease is to be taken more seriously in children less than 6 months of age. Unlike other diseases, the child does not get protection against whooping cough from the mother and the risk of complications is higher in infants. Management This is a disease where I would not like to delay the use of antibiotics. The drug of choice is erythromycin which is started as soon as the diagnosis is made. The drug is more effective if started early in the course of the disease. Some believe that it does not help the patient but reduces the infection to others. I beg to differ and feel that it is helpful and should be given in full dose for a period of 2 weeks. I have also found a drug, salbutamol, commonly used for the treatment of asthma to be of help in reducing the severity of the bouts of cough. A calm, smokeless environment is of great help to the small baby. The mother's lap is a great comfort for the baby. A feed given soon after a vomit is often retained. If people in contact with the baby are given erythromycin for a period of 10 days they are likely to be protected to a significant extent.