Wednesday, June 26, 2013

How to tell the difference between sinus infections and colds in children?

Parent Plus Copyright © 2013 by the American Academy of Pediatrics
When your child has a runny nose, cough and fever, it can be hard to tell whether it’s just a common cold or a more severe illness like a sinus infection. Here are some tips to help you handle your child’s illness and know when your child should visit the pediatrician.
Know the odds. While colds are common, fewer than one in 15 children gets a bacterial sinus infection during or after a cold.
Differentiate the symptoms. Children with a cold have a runny nose with mucus that starts clear and then becomes cloudy or colored. Colds may include a fever that lasts one to two days, but symptoms improve on their own in 10 days. There are three types of sinusitis:
  • Persistent: Runny nose, daytime cough (can worsen at night) or both last for 10 days and do not improve.
  • Severe: Fever over 102.2 degrees Fahrenheit lasts for at least three days in a row. Mucus is thick and cloudy or colored.
  • Worsening: A cold starts to improve, but fever returns or daytime cough or runny nose gets worse.
Talk with your pediatrician about whether to medicate. Kids with persistent sinusitis can either be observed to see if they improve on their own, or they can take antibiotics if they are particularly uncomfortable. All kids with severe or worsening sinusitis should take antibiotics to help them recover faster.
Consider the drawbacks of antibiotics. Side effects of antibiotics can include vomiting, diarrhea, upset stomach, skin rash, allergic reactions or yeast infections.
And remember, whenever you have a question about your child’s illness, talk with your pediatrician.
© 2013 American Academy of Pediatrics. This Parent Plus may be freely copied and distributed with proper attribution.

Saturday, June 15, 2013

Upcoming illnesses - have you heard of NOMOPHOBIA, RINGXITY ??

New Mobile Illnesses

Up till now the debate has been whether mobile radiations can cause brain cancer or not. But of late a new spectrum of diseases related to mobile use has come to the notice of medical profession and it is anticipated that ten years from now they will take an epidemic shape.
1.      Computer vision syndrome – it happens in 90% of the cases who use computer for more than three hours at a stretch. It leads to drying of eyes and headache. Prevention is to take a 20 seconds break after every 20 minutes and look by a distance of 10 feet for these 20 seconds.
2.      Blackberry thumb –This is a pharyngitis inflammation of the thumb leading to pain. This can be prevented by alternatively using fingers while texting using Blackberry phone.
3.      Stiffneck occurs due to constant use of mobile in one hand with neck flexed. The prevention lies in alternative shift of phone from one hand to another.
4.      Cellphone elbow is a pain in the elbow because of the stretching of ulnar nerve  because of use of mobile phone in a flexed position. The prevention lies in using hands free set.
5.      Nomophobia – It is present in 50% of the mobile users and is a type of mobile addiction. In literal meaning it means ‘no mobile phobia’ which means that all the time one is having a fear of losing the phone.
6.      Ringxity – It is a resultant anxiety of not getting a phone in the last 30 minutes. It is present in the 30% of the mobile users.
7.      Phantom ringing – It is present in 20-30% of mobile users and presents as someone feels that mobile is ringing when actually it is not.
8.      Social site addiction – With the use of smart phone, one is addicted to facebook, internet, Twitter and other applications. They can end up in insomnia, fragmented sleep, etc.
9.      After TV facebook is the number two cause of relational disharmony within the family and is present in 20% of the houses.
10.     Smart phone is a cause for parent-child conflict in 30% of the cases. Often children get up late and end up going to school unprepared. On an average, people spend 30-60 minutes in the bed playing with the smart phone before sleep.
Here are a few steps that may help to reduce these upcoming dreaded diseases !
1.     Electronic curfew means not using any electronic gadgets 30 minutes before sleep.
2.     Facebook holiday – One should go for a facebook holiday for 7 days every three months.
3.     Social media fast – Once in a week, one should avoid use of social media.
4.     One should use mobile phone only when mobile. One should not use computer for more than three hours in a day.
5.     Mobile talktime of not more than two house a day.
6.     One should not recharge mobile battery more than once in a day.
7.     Mobile can also be a source of infection in the hospital setup, therefore, it is disinfected everyday.
Full Disclosure : I suffer from Phantom Ringing Syndrome on a regular basis, and sometimes from CVS - Computer Vision Syndrome too :)

Friday, June 14, 2013

Fish Medicine for asthma

The fish cure for asthma is back in the news. The Bathini Goud family, living in Hyderabad, claim that they can cure asthma by making people swallow a 2-inch live fish filled with medicine. They claim that
they have been using this treatment for over 160 years.
As per their claim the medicine is stuffed inside the mouth of a live murrel fish, 5-6 cm in size. This fish with medicine is slipped into the mouth of the asthmatic patient, which can easily be swallowed as the fish is slippery. This needs to be taken for three consecutive years.
The medicine is administered on a specific day Mrigashira Kanthi Nakshatra, which normally coincides with arrival of monsoon rains in the first or second week of June. Three doses are given to the patients after every 15 days.
The Goud family never discloses ingredients of their drug. They provide the medicine free of cost. Some people went to the Court of the Andhra Pradesh on 27.01.2013 but the court declined to interfere
and pass any orders regarding the administration of substances popularly known as Fish Medicine. They reasoned that although the treatment had no medicinal value, analysis had shown the samples to
not be harmful. They said that “if people flock to have a substance out of faith the courts cannot interfere”.
My opinion (Dr KK Agarwal)
Asthma is classified as mild intermittent asthma, moderate persistent asthma and severe persistent asthma. The distinction between intermittent and mild persistent asthma is important because current guidelines for moderate persistent asthma call for initiation of daily control medicine. For moderate persistent asthma, the preferred long-term controller is low-dose inhaled steroid.
Mild intermittent asthma is the largest segment of asthmatic patients and they do not require long term treatment. These are the people who may never require steroid inhalers. Over a period of time, these
asthmatics may show improvement. Many mild intermittent asthmatics who are allergic to a particular
protein may improve over a period of time.
Homeopaths, Ayurveda physicians, naturopaths and others who claim that they can cure asthma, they work only on patients with mild intermittent asthma. If they can demonstrate their results in severe asthma, then their methods can be believed to be of use.
The very fact that anybody has claimed does not mean that it is not scientific or scientifically validated. If they can prove their claim, there is no reason why they should not get Noble Prize. We have seen a similar claim by a person who gives a medicine for jaundice in Chandni Chowk and another person in Agra who claims that the can cure any type of cancer with a herb mixed with Bakri ka doodh (goat milk).
- See more at:

Comment: Being a child specialist with specific interest in Asthma & childhood allergies, I am frustrated many times with the Indian mentality to deride the use of Inhalers & any long term allopathic medicines in the treatment of asthma. The 'lack of faith' in inhalers & the increasing incidence of the disease, has lead to the increasing popularity of these unconventional & unscientific cures.
I would be extremely happy if a local medical college would try to conduct some sort of a trial on the use of this medication in asthma patients. I have had a few patients who have tried this in my practice, and have not found anything that could be explained solely by magical remedies.

Wednesday, June 12, 2013

Parenting Tips - Why preschoolers (~ 3-4 year old kids) defy their parents

My preschooler has been showing a lot of defiance, and found these tips from Babycenter very practical & quite useful, hope parents of 3 year old will find them helpful too ....

Your preschooler refuses to leave his friend's house, ignores your request to put away his toys, and pushes his trucks down the stairs despite your repeated instructions not to. Why is he being so defiant?
Less dependent on you than he was as a toddler, your preschooler now has a stronger and more secure identity. He may even be developing a bit of a rebellious streak.
"Defiance is how a preschooler asserts himself," says Susanne Ayers Denham, a professor of psychology at George Mason University in Fairfax, Virginia.

What you can do about defiance

Be understanding. When you ask your preschooler to come in for lunch and he yells, "Not now!" and then cries when you make him come in anyway, try to put yourself in his shoes. Give him a hug and tell him you know it's tough to leave his friends, but lunch is ready.
The idea is to show him that instead of being part of the problem, you're actually on his side. Try not to get angry (even if the neighbors are checking out the show your child's putting on). Be kind but firm about making him come in when he must.
Set limits. Preschoolers need – and even want – limits, so set them and make sure your child knows what they are. Spell it out for him: "We don't hit. If you're angry, use your words to tell Adam you want the toy back" or "Remember, you always have to hold my hand in the parking lot."
If your youngster has problems abiding by the rules (as every preschooler does), work on solutions. If he hits his little sister because he's feeling left out, for instance, let him help you feed or bathe the baby, then find a way for him to have his own special time with you. If he gets out of bed because he's afraid of the dark, give him a flashlight to keep on his nightstand.
Reinforce good behavior. Rather than paying attention to your preschooler only when he's misbehaving, try to catch him acting appropriately. A simple "Thanks for hanging up your coat!" or "It's so helpful when you share with your baby sister!" will go a long way toward encouraging your preschooler to do more of the same.
And although you may be sorely tempted to give your child a verbal lashing when he engages in less-than-desirable antics, hold your tongue.
"When a child behaves badly, he already feels terrible," says Jane Nelsen, author of thePositive Discipline series of books. "Where did we ever get the idea that in order to make children do better, we first have to make them feel worse?" In fact, doing so may only produce more negative behavior.
Remember, too, that disciplining your preschooler doesn't mean controlling him – it means teaching him to control himself. Punishment might get him to behave, but only because he's afraid not to. It's best for your child to do the right thing because he wants to – because it makes the day more fun for him or makes him feel good.
Use time-outs — positively. When your preschooler's ready to bust a gasket because he isn't getting his way, help him cool off. Rather than a punitive time-out ("Go to your room!"), take him to a comfy sofa in the den or to a favorite corner of his bedroom.
Maybe your child would even like to design a "calm-down place" himself – with a big pillow, a soft blanket, and a few favorite books. If he refuses to go, offer to go along with him and read a story.
If he still refuses, go yourself – just to chill out. You'll not only set a good example, you might get a much-needed break. Once you both feel better, that's the time to talk about appropriate behavior.
Empower your preschooler. Providing opportunities for your youngster to make his own choices allows him to strut some of his newfound autonomy in a controlled environment.
Instead of demanding that he put on the jeans you've selected, for instance, let him choose between two pairs you've laid out. Ask if he'd like peas or green beans with dinner, and which of two stories at bedtime.
Another way to help your youngster feel more in control is to tell him what he can do instead of what he can't. Rather than saying, "No! Don't swing the bat in the house!" say, "Let's go outside and practice batting." If he wants an ice-cream cone before dinner, tell him he can choose between a slice of cheese or an apple.
Choose your battles. If your fashion-savvy preschooler wants to wear his green camouflage sweatshirt with his orange striped shorts, what do you care? If he wants waffles for lunch and peanut butter and jelly for breakfast, what's the harm? Sometimes it's easier to look the other way – when he splashes in a mud puddle on the way home, for example, or stuffs his puppet under his bed instead of putting it on the proper shelf.
Distract and divert. Avoid situations that might spark your preschooler's defiant streak.
Why risk taking him to a fancy restaurant when you could just meet your sister for a picnic in the park? How realistic is it to expect him to behave in a clothing store or sit quietly during an hour-long community meeting?
If you find yourself in a tricky situation, use distraction to avoid a head-on collision with your child. If you're walking through the mall and spy a toy store that tends to send your kid into a frenzy, quickly steer him in a different direction or divert his attention ("Wow, Jason, look at that fountain! Want to throw in a penny and make a wish?").
Respect his age and stage. When you ask your preschooler to make his bed or sweep the porch, make sure he knows how.
Take the time to teach him new tasks, and do them together until he really gets the hang of it. Sometimes what looks like defiance is simply the inability to follow through on a responsibility that's too difficult.
Finally, respect the unique world your preschooler lives in, especially the way he perceives time (or doesn't). Rather than expecting him to jump up from a game at preschool to get in the car, give him a few minutes' notice to help him switch gears. ("Aaron, we're leaving in five minutes, so please finish up.")
There's no guarantee that he'll break away from his fun without complaint – in fact, he'll probably grouse all the way home. But as long as you're patient and consistent, your youngster will eventually learn that defiance isn't the way to get what he wants.

Swap stories and advice about behavior and discipline with other parents in the BabyCenter Community.

New Quadrivalent Influenza Vaccine Gets FDA Nod

The US Food and Drug Administration (FDA) today approved a 4-strain inactivated influenza virus vaccine from Sanofi Pasteur (Fluzone Quadrivalent) for use in children aged 6 months or older, adolescents, and adults.
Fluzone Quadrivalent is the "first and only" 4-strain influenza vaccine option for children as young as 6 months, Sanofi Pasteur notes in a statement.
Fluzone Quadrivalent joins 2 other quadrivalent vaccines already approved in the United States. They are Fluarix Quadrivalent (GlaxoSmithKline), approved for adults and children aged 3 years or older, and FluMist (MedImmune), approved for adults and children aged 2 years or older.
Fluzone Quadrivalent will be available in the US for the upcoming 2013-2014 influenza season in preservative-free, prefilled syringes and single-dose vials for intramuscular administration, the company said.
Until this year, seasonal influenza vaccines included only 1 B strain. Fluzone Quadrivalent vaccine includes 2 A strains and 2 B strains to help protect against influenza disease, Sanofi Pasteur notes in a statement.
"Epidemics of influenza B occur every 2 to 4 years in all age groups. Influenza B is a common cause of influenza-related morbidity and mortality in children and has been associated with pneumonia and other respiratory illnesses, nervous system disease, muscle pain and inflammation, and other complications," the company explains.
"Protection against the type B flu strain may be an especially important factor that health care providers consider when immunizing children since influenza B causes a substantial number of illnesses, hospitalizations and deaths in the pediatric population," said David Greenberg, MD, Sanofi Pasteur vice president US scientific and medical affairs.
The most common local and systemic adverse reactions seen with Fluzone Quadrivalent include pain, erythema, and swelling at the vaccination site; myalgia, malaise, headache, and fever (irritability, crying, and drowsiness in young children).
Fluzone Quadrivalent vaccine should not be administered to anyone with severe allergic reactions to any vaccine component, including egg protein, or to a previous dose of any influenza vaccine, the company said.
Comment: The addition of another strain should help further improve the efficacy of the Influenza vaccine, making it more useful. A longer lasting immunity (at present yearly boosters are recommended) would be on the top of my wish list for this vaccine too.

Tuesday, June 11, 2013

Checklist for a doctor’s consultation - what you should ask during your physician visit

Consultations nowadays are stressful affairs. Gone are the times when we spent minutes chatting up to our family doctor, sharing inconsequential trivialities  about family life before embarking on the details of nature of our visit. This makes it very important to manage your time properly during the 5 minutes (if you are lucky) that you have when interacting with your doctor. 
 When you go to a doctor, make sure that you have reviewed your checklist.
1.      You know the credentials of your doctor and his name.
2.      Write down the history of your illness and a brief summary of your illness before you plan a visit to the doctor, so that you don’t miss anything when you are with the doctor.
3.      Arrange all your previous records date-wise and not according to hospital or doctor.
4.      You must ask the following questions to your doctor:
a.       About your diagnosis
b.      A brief about your investigations
c.       Detailed information about drugs prescribed: Whether to be taken on empty stomach or full stomach; with water or with juice; morning, afternoon or evening dose and strength; if brand substitution is allowed or is a generic version available?
d.      When to come for review or follow up?
e.       If you are late for review by one day, should you continue with the prescribed medicine or stop taking them?
f.        How long will the medicines need to be taken?
g.       What happens if you miss a dose?
h.      What happens if you take double dose by mistake?
5.      You should ask your doctor about your personal life (any restriction in diet, exercise, sexual life, effects of drug on driving, sleeping or wake time etc.)
6.      Also ask your doctor to update your vaccination status so that you don’t miss out on any important vaccination.
7.      Ask your doctor about any prevalent seasonable disease in the society so that necessary precautions can be taken in time.
8.      If you are suffering from a contagious disease, ask your doctor for precautions so that others do not get it.
9.      Ask about SOS signals and when to call a doctor.
10.  Regarding diet, specifically ask about precautions for eating out.
11.  Also ask your doctor to write drugs for emergency drugs in the society, first aid kit etc.

Thursday, June 06, 2013

How to manage a newborn with antenatally diagnosed hydronephrosis?

I had a newborn with antenatally diagnosed Hydronephrosis, how do I follow him after birth was the question that I was looking to answer
Here is what I got from an excellent Indian article, which though a bit dated (2001) offers simple & lucid steps to manage this problem

Read the entire article here