An uncommonly diagnosed common problem in kids - Helping children with voiding dysfunction!

My child wants to go the toilet repeatedly!
She rushes to the toilet, and sometimes passes urine in her underwear!

This is a fairly common complaint in Pediatric Office Practice.

It is the tendency of the Pediatrician & the parent to blame this on a lazy, inattentive child who is simply too busy to stop whatever they are doing. However this can very easily be a sign of voiding dysfunction. Repeated wetting can lead to lower self esteem in a child, so this condition should not be left undiagnosed and untreated.

I am going to use this forum to provide links to some important and helpful articles that are great learning resources for parents & pediatricians.

This is an excellent primer for pediatricians regarding a common problem that we encounter in our practice, voiding dysfunction. Unfortunately we rarely investigate this thoroughly, beyond the usual urine examination, and do not seek specialist consultation, especially in India. This is due to two reasons, first a lack of awareness of the problem of voiding dysfunction, and secondly, since we lack qualified/ interested Pediatric urologist in our country.

Hopefully these articles will educate us regarding this relatively common condition.

"In a study of 7-year-old Swedish schoolchildren, 20% reported needing to get to a bathroom quickly. Additionally, it was reported that 6% of girls and 3.8% of boys continued to have problems with daytime wetting at this age. Upadhyay et al. (2003) found that half of children with dysfunctional voiding symptoms had a history of urinary tract infections."

http://www.medscape.com/viewarticle/507163

http://emedicine.medscape.com/article/1016198-overview

(Please note: Both these articles require free registration)

Dysfunctional voiding refers to an abnormality in either the storage or emptying phase of micturition and is associated with urgency, frequency, incontinence, and UTIs. It is important to distinguish dysfunctional voiding from enuresis. With enuresis, there is normal voiding with complete expulsion of urine at a socially less acceptable time or place. Enuresis occurs more frequently at night (nocturnal), can occur during the day (diurnal), and is usually self-limiting.

Recommended Audience - Pediatrician, Pediatric Urologist, and Family Physicians. While parents can read the article, they may find it technically demanding.

My child is swimming - how do I prevent Swimmer's Ear?

It's summertime, and everyone seems to be hitting the pool.

While swimming is not as prevalent in India, as some of the western countries, it is fast catching up, with the mushrooming societies, wherein a swimming pool is a must. While swimming is a great low impact exercise, it can lead to a few minor medical problems.

Swimmer's ear (also known as otitis externa) is an infection of the outer ear canal that can cause pain and discomfort for swimmers of all ages, more so in children. Symptoms of swimmer’s ear usually appear within a few days of swimming and include Itchiness inside the ear, Redness and swelling of the ear, Pain when the infected ear is tugged or when pressure is placed on the ear, and in advanced cases pus draining from the infected ear. This is not the same thing as a middle ear infection (fluid in the ear).

If you can wiggle/ move the outer ear without pain or discomfort then your ear condition is probably not swimmer's ear.

Swimmer’s ear can occur when water stays in the ear canal for long periods of time, providing the perfect environment for germs to grow and infect the skin. Germs found in pools and at other recreational water venues are one of the most common causes of swimmer’s ear. Swimmer’s ear cannot be spread from one person to another. Swimmer's ear can often be treated with antibiotic ear drops, after consulting your doctor.
Now coming to its prevention,

DO keep your ears as dry as possible.

• Use a bathing cap, ear plugs, or custom-fitted swim molds when swimming to keep water out of your ears.

DO dry your ears thoroughly after swimming or showering.

• Use a towel to dry your ears well.
• Tilt your head to hold each ear facing down to allow water to escape the ear canal.
• Pull your earlobe in different directions while your ear is faced down to help water drain out.
• If you still have water in your ears, consider using a hair dryer to move air within the ear canal.
  • Be sure the hair dryer is on the lowest heat and speed/fan setting.
  • Hold the hair dryer several inches from your ear.

DON’T put objects in your ear canal (including cotton-tip swabs, pencils, paperclips, or fingers).

DON’T try to remove ear wax. Ear wax helps protect your ear canal from infection.

• If you think your ear canal is blocked by ear wax, consult your health care provider rather than trying to remove it yourself.

Source

Suggested reading - Tips for healthy swimming

So have a great time swimming, but follow the above tips for a safe summers!

Top 5 things NOT to do for a Pediatrician - to save money and health !

Research among pediatricians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Source

I believe that these are excellent tips.
All of us should follow these as far as possible, diligently and conscientiously, not only for a more scientific practice, but also as the Hippocratic Principle goes "First, do no harm".
Avoiding unnecessary CT scans would reduce the radiation exposure to the developing brain of the children, while avoiding antibiotics would reduce chances of side-effects, antibiotic resistance, and even possibly allergies and reduced immunity in children (studies have correlated multiple antibiotic use with increased risk of allergies, and increased risk of recurrent infections).
Finally, it is amazing to note the stigma attached to the diagnosis of asthma in our country. Not only are parents / pediatricians unaware of the diagnosis, convincing them regarding the use of inhalation therapy is a uphill task. Inhalation is the BEST treatment for asthma, as millions of children and hundreds of studies have clearly demonstrated. It is safe, effective and does not lead to significant side-effects. Its use MUST be encouraged amongst doctors and parents alike.