Thursday, October 06, 2005
There are many reasons why children will not take medicines, they don't like the taste, they are too unwell and irritable to be co-operative or just because they can say NO! As a result, parents have to be really creative to get the medicines down the throat of their children.
Here are some helpful tips:
Mask the taste: Sweet tasting foods may help, common things that may work are grape & apple juice, sometimes orange juice maybe used for slightly bitter medicines. Remember NOT to get too anxious and do not mix the medicine in large quantities since the child may not consume the entire contents of the juice.
Avoid the bitter taste buds by giving the medicines in the cheek pouch (with a dropper)
Children make decisions about medicine based on what it looks like. Changing the color of the medicine with food coloring may help get it down the child.
Mouth dissolving tablets can be more convenient and give the child less chance to throw up.
If your feverish kid throws up whatever he swallows or refuses to take medicine at all, find out whether the medication is available in suppository form (now Paracetamol and Domperidone is available in India in rectal form too!). The dosage is based on a child's weight, but always check with your pediatrician before administering.
Is your child a Lion King fan? Get some Simba stickers, draw a jungle scene on a piece of paper, and let him attach a sticker each time he swallows a dose. It's even more effective if your pediatrician participates: When your child has finished all his medication, he can bring his completed artwork along on his follow-up visit to the doctor as proud proof of his accomplishment.
Let the child hold the cupful of medicine, allowing him a sense of control helps. One pediatrician puts her toddler twins' medicine into toy teacups, enabling them to take it on their own.
In a crisis, call your doctor and ask if you can substitute another type of medicine. For instance, you may be able to obtain a better-tasting antibiotic made by a different company. Sometimes, the brand-name version of a drug has a more pleasant taste; in other cases, the generic is preferable. Often, a child may actually dislike the consistency of a medicine, not the taste; in this instance, a thicker or thinner liquid may do the trick.
Promise a party/ treat when the child gets well, and tell her that by not taking the medicine the party is going to get late.
However while trying to get in the medicine do remember these tips:
1. In general, medicine isn't absorbed as quickly when it's paired with solid food or milk, but if this is the only way you can get your child to take the medicine, it's fine.
Some exceptions: penicillin G and erythromycin lose their potency when mixed with acidic foods like orange juice, or soda.
2. Check with your pharmacist to make sure it's okay to crush a tablet. Some medications may irritate the stomach if you destroy the protective coating, or they may fail to do the job they're meant to do.
3. Don't freeze the medicine or warm it up to make it more palatable. Temperature changes may alter the efficacy of the medication.
4. Don't call the medicine candy. Emphasize to your child that you are giving him medicine, not a treat. And store all medications out of sight and reach.
5. If you can't convince your little one to cooperate, let your doctor know he isn't getting the prescribed medication.
Lots of help from: Parents.com website
Friday, August 12, 2005
I was not very sure as to the best possible treatment for the 7 month old kid and thought to surf the net to find the best and the safest treatment for head lice.
Here is what I found, a very recent article (BMJ Aug 2005) suggests that the best treatment for headlice may infact be what our mothers used to do with us ... wet hair combing with a fine tooth comb! Regular use of this technique (four times over 2 weeks) on conditioned hair (with a hair conditioner) had almost 60 % chances of curing head lice. This compared well with various chemical treatments wherein the cure rate was a very poor 20 % only!
In India, the most well advertised product is probably a shampoo (MEDIKER) , that contains 0.23 % premthrin. This may be safe for small children (even 6 months old) however according to studies it is unlikely to be very effective.
What would be more useful would be 10 minutes application of a 1 % permethrin lotion (like SCABPER by Shalaks) after washing and shampooing the hair. This should be repeated once after 6 days for better results. In case of resistant lice, I would still go the grandmother way and ask for the wet hair and fine tooth comb treatment !
The products mentioned in the above discussion are in NO way endorsed by Dr. Gaurav Gupta. There maybe similar products of equal or better efficacy. Dr. Gaurav has no financial interests in any of the above products.
Sunday, July 10, 2005
Common Facts & Myths about Enuresis
First the stats
Almost 10 % of 10 year old kids wet the bed occasionally, you are not alone!
After the age of 5 years only 15 % children wil become dry every year without treatment.
In most cases treatment of bedwetting should begin between 6-7 years only, anything before that and there is good chance that your kid will grow out of it.
Bedwetting is a develpomental issue, something the child does during sleep without prior knowledge. Do NOT blame / punish the child or yourself. Your kid is not being lazy or stubborn, he really does not know. What the child needs is reassurance and encouragement.
Bedwetting tends to run in families, so if it is true, telling the child 'daddy used to do this' may help increase their self esteem.
TREATMENT Options simplified:
Before going to the doctor
Sleep half an hour early - a less tired child is going to sleep 'light' and therefore is more likely to wake up to go to the bathroom.
Lots of water in the day, restricted fluid at bedtime (not more than half a glass 2 hours before sleeping), avoid caffeine (carbonated fizzy drinks)
Star chart and positive reinforcement - Put stars (or stickers) on a calendar in the child's room for every dry night. IF the child remains dry continuously for a few days, give him some small reward (if this does not work for around 15 days, get a doctor's opinion)
Just what the doctor ordered
Remeber that any bedwetting beyond 6-7 years can have a lot of social consequences like other kids making fun of the child, difficulty in sleeping over with friends and relatives etc. More importantly only about 1 in 6 kids every yeare will outgrow this problem after this age spontaneously, therefore get it treated.
3 major treatment options are:
DDAVP - It is a hormone that is usually present in th body and this leads to a decreased urine production at night. It is said that a deficiency of this hormone may lead to bedwetting, therefore treating the child with a tablet or a nasal spray may be useful for preventing bedwetting. This is especially very effective for 'emergencies' like social occasions nightouts etc. where rapid control is needed. The only problem is that long term treatment is needed since on stopping this medicine there is a high chance that bedwetting will recur.
Bedwetting alarms are now available at leading pharmacies in India too, and over a period of around 3 months they are very useful in decreasing/ stopping bedwetting altogether. For quicker relief these may be combined with DDAVP.
Imipramine tablets are a cheaper treatment option however these have significant side-effects like nervousness, tiredness and intestinal problems.
Remeber for most kids bedwetting is nothing more than an inconvenience or at worse a social problem.
WHEN TO WORRY?
If a previously dry child starts bedwetting
Daytime bedwetting in an older child amy be because of Diabetes, Urinary tract infection or psychological problems like sibling rivalry etc.
Any other associated symptoms like urgency while passing urine, fever, abdominal pain etc.
Based on an article in medicinenet
Thursday, June 23, 2005
2. Present a blase, everything-is-routine attitude, and your child will be more relaxed during pediatrician visits. Trying to reassure her before she gets a shot is not terribly effective, especially for children under 8.
3. Let the doctor and nurse handle your child. Don't cling to her. The doctor and nurse know what they are doing, and their competence will instill confidence in your child.
4. Understand that the injection will most likely be given in the thigh because the fat in the thigh eases the discomfort of the shot.
5. Make a fun little noise to distract her from her shot.
6. Put special adhesive bandages over the injection site. Most pediatricians and hospitals apply child-friendly bandages, such as ones with Pok?mon or Elmo pictured on them.
7. Give stickers as a reward.
8. Praise your child when you leave the pediatrician's office. Don't say, "I know how awful it is to get a shot." Instead, say, "You acted so grown-up in the doctor's office. I am so proud of you."
9. Keep some fun adhesive bandages in the bathroom cupboard. If she wants a fresh bandage over the injection site, give her one.
Friday, May 27, 2005
I have recently posted a blog on the recent Meningococcal scare in North India, yesterday American Academy of Pediatrics has come out with new recommendations for Meningococcal vaccination, and I am reproducing thier policy statement here
AAP ENDORSES NEW MENINGOCOCCAL VACCINE GUIDELINES
For Release: May 25, 2005 - Immediately
The American Academy of Pediatrics (AAP) has released a new policy statement recommending routine meningococcal vaccination for certain age groups. The guidelines call for the quadrivalent meningococcal vaccine (MCV4) for:
- Young adolescents (11-12 years of age)
- Adolescents at high school entry or 15 years of age (whichever comes first) for those who have not previously been vaccinated
- All college freshmen living in dormitories
- Other groups at high risk such as those with underlying medical conditions or travelers to areas with high rates of meningococcal disease
The recommendations will help prevent meningococcal disease, a potentially fatal bacterial infection. Although rare, meningococcal disease is dangerous because the disease progresses rapidly, and within hours of the onset of symptoms it may cause permanent disability or death.
Meningococcal disease is the most common cause of bacterial meningitis in U.S. toddlers, adolescents and young adults. Symptoms include high fever, headache, stiff neck, confusion, nausea, vomiting and exhaustion, and a rash may appear. Lifestyle factors thought to contribute to the disease include direct contact with an infected person, e.g., exchanging saliva, often through kissing; crowded living conditions, e.g., dormitories; and active or passive smoking. Vaccination is the best method of preventing meningococcal disease.
Meningococcal infections can be treated with drugs such as penicillin. "Still," says AAP President Carol Berkowitz, MD, FAAP, "about one in every ten people who get the disease dies from it, and many others are affected for life. That is why preventing the disease through use of meningococcal vaccine is important for the high-risk groups."
The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) determined that establishing the target age at 11 years may give lasting immunity through college. Studies have determined that the disease peaks in 16- to 18-year-olds, supporting vaccination of 15-year-olds.
Saturday, May 14, 2005
What is meningococcal disease?
Meningococcal disease is a serious illness caused by bacteria. It is the leading cause of bacterial meningitis in children 2-18 years of age. Meningitis is an infection of the brain and spinal cord coverings. Meningococcal bacteria can also cause infection in the blood. Apart from epidemics, at least 1.2 million cases of bacterial meningitis are estimated to occur every year; 135,000 of them are fatal. Approximately 500,000 of these cases and 50,000 of the deaths are due to meningococci. In developing countries, the mortality rate from bacterial meningitis is often higher (20-40%) than in developed countries. Of those who live, another 10 percent lose their arms or legs, become deaf, have problems with their nervous systems, become mentally retarded, or suffer seizures or strokes.
Anyone can get meningococcal disease. But it is most common in infants less than one year of age, and in people with certain medical conditions.
People living in crowded locations are at a higher risk. This includes slum dwellers, college students living in dormitories, military personnel living in barracks, religious gatherings etc.
How is meningococcal disease spread?
Meningococcal disease is spread by intimate or direct exposure to someone who has the disease. Intimate or direct exposure includes being touched or kissed, sharing eating utensils, or contact with any fluids from the body of the person who has the disease.
What are the symptoms of meningococcal disease?
Symptoms are usually sudden and begin like the flu: fever, feeling generally unwell, headache, vomiting, and in some cases a stiff neck.
People with this disease are visibly sick and may be confused, excited, or drowsy. Sometimes a reddish-purple rash that may look like bruises appears. The rash is flat and smooth, does not itch, and may spread quickly once it starts.
Because the disease spreads quickly in the body, it is important to go to a doctor or an emergency room immediately if you have a fever greater than 101 degrees and a severe sudden headache along with any of these symptoms:
• neck or back stiffness,
• mental changes (feeling edgy or confused),
Who should get meningococcal vaccine?
Meningococcal vaccine is not routinely recommended for most people.
People who should get the vaccine include:
• Military recruits
• Anyone traveling to, or living in, a part of the world where
meningococcal disease is common, such as
• Anyone who has a damaged spleen, or whose spleen has been
removed, and certain immunological diseases
• Lab workers who are routinely exposed to meningococcal bacteria
According to the latest
Meningococcal vaccine is usually not recommended for children under two years of age. But under special circumstances it may be given to infants as young as three months of age (the vaccine does not work as well in very young children). Ask your health care provider for details.
Should my children receive meningococcal vaccine?
Meningococcal vaccine is only indicated for close contacts of patients with the disease; also it may be given in epidemic situations in a well defined community.
On the basis if this it is premature to consider meningococcal vaccine to children other than those at high risk (as mentioned above).
How many doses are given?
• For people two years of age and over: one dose
(Sometimes an additional dose is recommended for people who
continue to be at high risk. Ask your doctor or nurse.)
• For children three months to two years of age who need the
vaccine: Two doses, three months apart.
Who should not get the vaccine?
• People who have ever had a serious allergic reaction to a previous dose of the vaccine.
• People with moderate or severe illnesses should usually wait until they recover.
What are the possible side effects from meningococcal vaccine?
• redness or pain where the shot was given
• fever in a small percentage of people
Where can I get this vaccine?
Call your doctor,
For more information:
Centers for Disease Control and Prevention:
Meningitis Foundation of
Advisory Committee on Immunization Practices:
Medline Plus Health Information:
Michigan Government website
Information collected, edited and reviewed by Dr. Gaurav Gupta, Pediatrician, Charak Child Care, Mohali.
Friday, April 29, 2005
The good news is that almost all cases of nosebleeds in an otherwise healthy child are medically not serious.
So why does my child get a nose bleed?
The nose has a thin lining (mucosa) that covers blood vessels lying inside the nose. This can often break if a child digs his nose, puts some foreign object in the nose, has cold or allergy or sneezes heavily, or suffers an injury to the nose. Another common reason is dry air that leads to the nasal mucosa getting crusted and bleeding.
Why does this happen in the summers?
As mentioned above, dry weather (either summers or winters) can cause nasal bleed.
Are there any serious causes of nasal bleeds?
Rarely, a nose bleed may suggest something amiss with the body's blood clotting ability. You may find the child having easy bruisability over the rest of the body in this case. Also any nasal bleeds after trauma need to be seen by an ENT specialist. Rarely, high blood pressure can cause nose bleeds.
How do I manage nose bleeds in my child?
Ask the child to lean forward and spit out the blood.
Apply pressure to the soft part of the nose and pinch it for 10 minutes.
If after 10 minutes there is till persisting bleeding, insert a gauze piece covered with vasocontrictor nasal drops (like nasivion/ otrivin etc.) and press for another 10 minutes.
If the bleed still persists go to a doctor, while still keeping the nose pinched.
DO NOT press on the bony part of the nose;
DO NOT apply a cold washcloth on the forehead;
DO NOT pack the nose (as when trying to remove the pack the bleeding invariably restarts).
How can i prevent recurrent nosebleeds?
Apply some amount of petroleum jelly on the center wall inside the nose with a cotton applicator an ear bud will do just fine)
HUMIDIFY your room, a lot of AC and/or dry weather can cause recurrent nosebleeds. A desert cooler is a much better option in the summers.
Put saline drops / warm water in the nose before blowing, and continue saline drops for a few days after an episode of nasal bleed.
Get any nasal allergies treated.
Never blow your nose with excessive force.
Sometimes taking Vit C/ Zinc supplements may help in reducing recurrent nasal bleeds.
Friday, April 08, 2005
The following information is by Dr. Barton Schmitt, and taken from the Virtual hospital website. This may come as a shock, but it is estimated that almost 30% of toddlers and preschoolers masturbate. Masturbation is self-stimulation of the genitals for pleasure and self-comfort. It is a normal, healthy activity at any age. During masturbation, children usually rub themselves with their hands. Girls may rock against an object such as a stuffed animal or pillow. Children usually appear dazed, flushed, and preoccupied while they are masturbating. These children have discovered masturbation during normal exploration of their bodies and it continues because it feels good. Masturbation becomes frequent only if the child is pressured to stop. That invites a power struggle.
Try these approaches instead:
• First, set realistic goals. It's impossible to eliminate masturbation. All that you can control is where it occurs. Accept it in the bedroom or bathroom or at nap time.
• Second, ignore masturbation at naptime or at bedtime. Don't check on your child at these times.
• Third, distract your child from masturbation at other times. Try a toy or a new activity. If this fails, send your child to his room. You can't ignore it, or your child will feel he can masturbate anywhere. Your child will catch on to privacy and modesty somewhere between the ages of four and six.
• Fourth, be sure no one punishes your child for this. It's counterproductive.
• Finally, if you're having trouble accepting this normal behavior, talk with your child's doctor.
Please remember that there is no sexual element in preschooler masturbation, it is just a pleasurable sensation generated by self-exploration, do not let your guilt, feeling about sex influence your atitude towards the child. Try to be nonchalant about the whole thing, and inform the child that it is inappropriate to carry out this activity in public. In a way, it would be equivalent to thumb-sucking or any similar activity that the child indulges in while he is bored or alone.
You can get more information about common pediatric disease at Charak Clinics
Wednesday, March 23, 2005
Take these steps to help prevent decay, advises the American Academy of Pediatrics:
- Never put your child to bed with a bottle.
- Only give your baby a bottle during meals.
- Teach your child to drink from a cup/ sipper as soon as possible, usually by age one.
- Keep your baby's mouth clean
- Use water and a soft child-sized toothbrush for daily cleaning once your child has seven to eight teeth.
- By the time your toddler is 2, you should be brushing his teeth once or twice a day, preferably after breakfast and before bedtime. Once you are sure your child will not swallow toothpaste, you should begin using one that contains fluoride.
It has been a long time since the last post.....
Nowadays we are seeing a lot of kids with painful mouth ulcers in our OPD, this causes misery not only to the child but the entire family as thechild is unable to eat even though he/she is feeling hungry!
Here are a few tips to treat this common condition:
Rinse the child's mouth 3 or more times a day with salt solution (1/2 teaspoon salt to 8 oz. water).
Clean sores frequently with 2% hydrogen peroxide/ chlorhexidene solution on a cotton applicator (an ear bud may be used as an alternative).
If your child's canker sore is caused by a rough tooth or braces, consult your dentist. The sore won't heal until the cause is eliminated.
Your doctor may prescribe:
Topical anesthetics like xylocaine jelly 2 % to relieve your child's pain.
A mixture of Digene and Benadryl can be applied locally on the ulcer (with a cotton ear bud/applicator) to heal it
Rarely in case of severe disease an oral steroid solution may be prescribed by the doctor.
DIET & FLUIDS
Avoid Spicy Food.
Encourage your child to drink as many fluids and eat as well-balanced a diet as possible while healing.
To minimize pain, let your child sip liquids through straws.
Foods that cause the least pain are cold milk, yogurt, ice cream, and custard.
OK TO GO TO SCHOOL?
When appetite has returned and alertness, strength, and feeling of well-being will allow. Keep the child's eating and drinking utensils separate until sores heal.
CALL YOUR DOCTOR IF
Your child's temperature rises to 102F (38.9C) or higher.
Ulcers don't improve in 3 days despite treatment.
Pain is unbearable and isn't relieved by treatment.
A child with aphthous ulcers loses weight.
For more details read Mdadvice
Wednesday, March 09, 2005
Question: MY CHILD WAS GIVEN THE CHICKEN POX VACCINE AND THE DOCTOR AND I DID NOT KNOW SHE HAD THE CHICKPOX THE SAME DAY SHE GOT THE VACCINE. SHE STILL BROKE OUT WITH THE CHICKPOX EVEN THOUGH SHE HAD THE SHOT. MY CONCERN IS WAS THEIR ANY HARM IN GIVING HER THE VACCINE WHEN SHE HAD THE CHICKEN POX?
Answer: There is no need to worry. The chicken pox vaccine is not going to cause any problem to your child. At best it may cause the chicken pox to be milder, at worst it may not make any difference.
In fact we recommend chicken pox vaccine to contacts of an active patient with chicken pox, as it may prevent / reduce the severity of chicken pox in the family member.
I hope this helps!
Wednesday, February 16, 2005
Have a set bedtime and bedtime routine for your child.
Bedtime and wake-up time should be about the same time on school nights and non-school nights. There should not be more than about an hour difference from one day to another.
Make the hour before bed shared quiet time. Avoid such high-energy activities as rough play, and stimulating activities such as watching TV or playing computer games just before bed.
Don't send your child to bed hungry. A light snack (such as milk and cookies) before bed is a good idea. Heavy meals within an hour or two of bedtime, however, may interfere with sleep.
Avoid products containing caffeine for at least several hours before bedtime. These include caffeinated sodas, coffee, tea, and chocolate.
Make sure your child spends time outside every day whenever possible and is involved in regular exercise.
Keep your child's bedroom quiet and dark. A low-level nightlight is acceptable for children who find completely dark rooms frightening.
Keep your child's bedroom at a comfortable temperature during the night (less than 75 degrees).
Don't use your child's bedroom for time-out or punishment.
Keep the television set out of your child's bedroom. Children can easily
develop the bad habit of “needing” the TV to fall asleep. It's also much more
difficult to control your child's TV viewing if the set is in the bedroom.
Source: Nelson Textbook of Pediatrics
Monday, February 07, 2005
The major problem in steam lies with the fact that no one likes taking it! Uncooperative children risk getting burnt if they do not take steam properly.
Here are a few tips on how to give safe and effective steam to your child;
- Use a steamer with a closed top- this way there is a negligible chance of the child getting burnt in case of a spill.
- Do not force the child to take steam, it is invariably preferable to try and earn their co-operation than to try and force them.
- Keep the steamer near the bedside (on the floor) with the steam jet directed towards the child's face while they are sleeping.
- For a smaller child (upto 6-8 months), keeping the baby in your lap while you take steam with a blanket/ cloth covering your face and the child is useful. Remember not to put the baby's face very close to the steam as there skin is very sensitive.
- For an older child another option is to switch on the hot and cold water in the bathroom to create a sauna like effect and get the child inside and play with him/ tell him a story etc.
- Keeping the steamer on in the bedroom is not very effective for giving steam as the room size is likely to be large. However this technique can be used in addition to the ones described (to reduce the dryness) above especially when you are using a heater/ warm air blower in the room.
Friday, January 14, 2005
What You Need to Know: How children react to disaster depends on their age. When exposed to a calamity or emergency children experience a variety of emotions and need your special attention. Two typical DISTRESS reactions in children are "a-typical behaviour" or doing things they have never done; e.g. a normally friendly child becomes shy;
SYMPTOMS BY AGE
1-5 Years: Bed-wetting, fear of darkness, clinging to parents, night terrors, stammering, loss of appetite, fear of being left alone, confusion.
What You Can Do: Talk reassuringly, hold and hug the child, give frequent attention, encourage him/her to express his feelings through play or words, allow to sleep in your room till they have overcome their anxiety.
5-11 Years: thumb-sucking, irritability, whining, fighting at home or school, fighting with younger sibling for parental attention, school avoidance, nightmares, withdrawal from friends, poor concentration at school, regressional behaviour, headaches or other physical complaints, fear about safety.
What You Can Do: Be patient, arraneg their play sessions with friends or adults, encourage discussions with friends and adults, temporarily reduce your expectations at school or home, give more structure to time at home including non-demanding chores, rehearse safety measures for future disasters (discuss in detail how you will cope if a similar disaster affected you in the future).
11-14 Years: Lack of sleep, poor appetite, rebellion at home, refusal to do chores, school problems like fighting, withdrawal, attention-seeking behaviour or loss of concentration; physical symptoms like headache, vague pains, upset stomach, and loss of interest in peers.
What You Can Do: Involve them with same age group activities, help to resume lost routine, encourage group discussions, give stuctured responsibilties which are non-demanding, temporarily relax expectations and give extra individual attention.
When is Professional Help Needed ?
Remember, children are adept at realising the concerns of their parents and this is especially true at the time of a crisis. As parents, you should admit your concerns to your children, and also stress your abilities to cope with the situation.
Compiled with the help of New York State Office of Mental Health.