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Friday, May 22, 2015

Hidden Disabilities

I am writing this post to sensitise my dear readers about disabilities in people (here, I will stay with children, since this blog is about them) that are not obvious, but need attention all the same.

First of all, disabled people are also people. Just because a child is deaf, or visually challenged, does not mean he/she has no other aspects to his/her character; such a child can, and does, have emotional needs, ambitions, desires, etc. They still experience pain when hurt; they still laugh, cry, express anger, feel depressed, agonise, enjoy, and so on. We must look beyond the disability and express not just sympathy, but also try and understand what they need and how they must be integrated into society.

This post is about children whose disabilities belong to one of the following categories:

a) They are not routinely symptomatic, but can develop symptoms when stressed - e.g. a child with epilepsy, or one with allergy
b) A child who is physically normal but has neuro-developmental issues - e.g. a child with attention-deficit-hyperactivity disorder (ADHD), a child with autism spectrum disorder (ASD), or a child with behavioural issues related to a neurological disease (e.g. a child with sensory perception disorder (SPD)
c) A child with visible disability, but who is ignored or misunderstood - e.g. a dyslexic child is punished for getting poor grades because the teacher and parents think he is faking, or is naughty, or anti-social.

What is needed here is to understand that such children are all children with special needs. They need understanding of their condition. A sensitive healthcare policy at the national level, a sensitive person who is bearing the brunt of facing such a child, and a sensitive family are all important, nay, pivotal, to the well-being of such a child.

What such children can undergo are the following:

a) aggravation of their medical problem if they are not understood
b) violence and injury at the hands of disciplinarians, peers and parents
c) misdiagnosis leading to improper treatment
d) humiliation and ridicule - sometimes worse than physical violence
e) loss of opportunity/time/ etc. because the society has not begun to modify their environment for such children.

To prevent these from happening, let us all decide to try and be more empathetic towards children with hidden disabilities; let us be sensitive and non-judgemental towards them; let us be sincere and honest about our knowledge gaps and try and learn more about these problems; and, if we are caring for such children, let us be more caring and careful while dealing with them.

I welcome your comments. Thank you.

Sunday, April 27, 2014

Taming the Throat

Throat infections come in different forms in children, and toddlers are especially vulnerable to them. While bacteria cause major infections, viruses are not to be left behind in the frequency with which they occur and the misery which they cause. The commonest throat infection is the SORE THROAT, or what is called as PHARYNGITIS. Caused by bacteria or viruses, this infection is so common all over the globe that it ranks as the COMMONEST respiratory tract infection among children.

A child with pharyngitis will usually have a soreness of the throat, be unable (to some degree) to swallow food, liquids, or even his own spit, have fever, body pains, throat pain (expressing itself as a feeling of "pins and needles" when he attempts to swallow something) and, sometimes, a cough. 

Most of the times, such infections are imported through day-care or nursery schools. A pediatrician would, when asked to examine such a child, look at the back of the child's throat, his tonsils, his neck glands, take his temperature, and then take a call on what level of urgency and which kind of treatment is thought necessary. Bacterial sore throats would need to be investigated by a throat swab to look for "strep" and if positive, the child would receive oral penicillin or other alternatives (if the patient is allergic to penicillins). The duration of treatment must be up to 10 days to completely eliminate the germs from the body. If the sore throat is deemed to be viral in nature, an antibiotic is not usually required, but the child must be given good supportive care such as rest, increased intake of liquids, steam inhalation if there is blockage of the air passages, etc. 

The next form of throat infection is something that rarely occurs nowadays, but it has not yet been eradicated from the US of A. This is whooping cough, an illness that is pretty ancient. It is caused by the pertussis bacteria. This was a killer disease in pre-vaccination times, but, thankfully, with universal immunisation of children with the pertussis vaccine, it occurs rarely. However, it can still be potentially fatal, especially when it occurs in smaller infants less than 3 months of age.

The child with a whooping cough has a whoopy sound at the end of each bout of cough. The bouts can be really long, very tiring, and be very taxing on the rest of the body. The huge cough bouts can exhaust the child; they can cause haemorrhages in the conjunctivae of the eyes, tear chest muscles (the ones involved in breathing), paralyse the nerve that supplies the voice box (and cause difference in the voice) and so on. 

Patients with whooping cough are diagnosed with blood tests and with a nose swab that is cultured in the microbes laboratory to discover the pertussis bacteria. Treatment is with an appropriate antibiotic (though it does not much work) and with cough syrups that can suppress the cough. In addition, nutrition must be looked after as well as addressing the fluid needs of the child.

The last common infection I am going to discuss is infection of the tonsils, or tonsillitis. We all have several tonsillar tissues in our throats, but the one I am referring to are the pair located just behind the tongue on either side of the mid-line. When the child is an infant, they can swell up especially in bottle-fed babies; when a toddler, they can get infected by cross contamination in a day-care school or the nursery. 

A child with tonsillitis presents in much the same way as the one with pharyngitis; however, the pain and discomfort is usually greater with tonsillitis. Usually, the child with tonsillitis has enlarged neck glands in addition to the swelling of the tonsils. 

Treatment is once again with antibiotics used for at least 7-10 days. Some children keep getting repeated attacks of either pharyngitis or tonsillitis. In the latter case, they sometimes become candidates for a form of surgery where the doctor removes the tonsils (most of the time with the other pair of tonsillar glands - the adenoids - that are situated high in the roof of the mouth). There is a clear trend nowadays to NOT REMOVE THE TONSILS as they have a key role to play in defending the body against bacteria, viruses and other offending organisms.

I hope you liked this primer on throat infections. If you have to ask any questions, feel free to ask me through the comments section.

Wednesday, April 02, 2014

Rules for Using Antibiotics

When it comes to treating bacterial infections, antibiotics are THE main form of treatment. Most patients have heard the word "anti-biotic" but do not clearly know what they are and how they work.
To make a long story short, antibiotics are made from bacteria themselves; they are special agents that prevent the multiplication of, or actually stop the growth of other bacteria, or even kill them. As you know, anti- means against, and bio- means related to life; hence, antibiotics are "against life".
Some examples of antibiotics which are frequently used by Paediatricians for sick children are the penicillins, drugs like erythromycin, drugs like the tetracyclines, and so on. To this list must be added some synthetically derived chemcals that also perform as well as the antibiotics - they too can either stop the growth of, or actually kill, disease causing germs (bacteria). As the term implies, antibiotics do work to stop bacteria, but they do not act of other forms of microbes like viruses, fungi, etc. For these other types of disease-causing life-forms, we have anti-viral drugs, anti-fungal drugs, and so on. These medicines are not our focus, so I will, simply, move on.
Patients and their care-givers are never too happy to receive antibiotics, since these are often bitter, induce side-effects like nausea, vomiting, loose bowels, etc. in addition to rarer but more troublesome side-effects like falling hair, blisters in the mouth, rashes on the skin, and so on. Also, antibiotics must, once begun, be continued for the entire prescribed duration. This increases the risk of side-effects even more.
It is therefore imperative to know what rules and principles govern the use of antibiotics. Here is a basic list. I hope readers go through this basic list and then seek more information should they desire it through a comprehensive source such as an internet search or access to a text-book of pharmacology.
1. Use an antibiotic only after consulting a physician.
2. Never use an antibiotic for a period longer than that told to you by the physician. A shorter period than that advised will probably not hurt the child, but it, still, is not the correct thing to do. Most common illnesses need use of an antibiotic for about 5-7 days, though the period can vary from just one day to as many as 42 days, or even longer, depending upon the characteristics of thei llness as well as the drug being used.
3. Store an opened bottle of antibiotic inside the refrigerator, or, if that is not available in your home, in a dark and cool area of the house, such as in the bathroom wall cabinet, or a special drug cabinet, or whatever. Exposure to heat can cause denaturation of the active medicine inside the bottle, so that, at the very least, it may change colour, or at the very worst, it can cease to be effective.
4. Do not repeat an old prescription thinking that :what worked for the patient the last time will also work this time. This almost always never happens, as illnesses that look alike in appearance and manifestation may actually be two different illnesses, needing different medicines.
5. Even worse, do not use antibiotics used by other friends or neighbours; for the same reason, of course, but also because as they may not be related to the patient genetically, the same medicine may not just not work; it may even prove to be harmful to you or your child.
6. Antibiotics should not be used for viral illnesses, fungal infections and so on, as, clearly, they won't work in such illnesses.
7. Dosing and frequency of use should be strictly adhered to, as germs and antibiotics complement each other: for example, if the recommended dose is 5 ml twice a day, do not arbitrarily change it to, say, 3 times a day. This can prove to be disastrous to the child.
These are the basic rules. There are many others, such as whether to have them before a meal or after, which other medicines to avoid taking WITH it, and so on. Do ask the treating physician about the relevant questions and be guided by the light of knowledge.
Thank you for the read. Do leave your comments.

Friday, February 21, 2014

The most effective prevention against diseases

Returning to this blog after several months, I found, happily, that people continue to visit my blog as before. I decided to re-enter the world of advising lay people and this entry is a step in that direction. 

Most readers would agree that there are many measures to prevent diseases; some include making major changes in life-style, some involve taking expensive vaccines or medicines; some involve relocating oneself from a harmful environment, and still others call for expensive investigations to detect the harbingers of an illness that is yet to affect you. However, the most beneficial and most inexpensive method to thwart diseases - specially infective illnesses, which are a significant cause of illness and death all over the world - is correct hand-washing

As doctors, we all do it countless numbers of times every day during our busy office practice. Surgeons wash their hands so thoroughly that they sometimes spend minutes on this pre-op preparation. It stands to reason, therefore, that the medical fraternity is convinced that hand-washing is extremely important. The reason is simple: our bodies are colonised by billions of bacteria, some harmless, but many, the cause of skin infections as well as more deadly internal infections that have the potential to kill. 

About 2.2 million children under the age of 5 die each year from diarrheal diseases and pneumonia, the top two killers of young children around the world. Handwashing is not only simple and inexpensive, but remarkably, handwashing with soap can dramatically cut the number of young children who get sick. Handwashing with soap could protect about 1 out of every 3 young children who get sick with diarrhea and almost 1 out of 6 young children with respiratory infections like pneumonia. Although people around the world clean their hands with water, very few use soap to wash their hands. Washing hands with soap removes germs much more effectively. (From:

The Center for Diseases Control, USA has several articles on hand-washing, and THIS ARTICLE forms the important backdrop. THIS ONE is the one that details when and how hand-washing must be done. Be sure to click on the "Show me the Science" link on the left to better understand the rationale behind hand-washing. 

I hope this entry helps you to understand how important this simple method of disease prevention is. Be blessed.

Monday, December 16, 2013

Antibiotic abuse

Most parents and care-givers expect the doctor to prescribe an antibiotic whenever they take their child to the doctor for symptoms of cough and cold, a runny nose or a sore throat. In fact, during my practice, I had to face their (the patents') angry glances when I told them that the antibiotic was not only unnecessary, but likely to produce harm than good.

The CDC calls the misuse/overuse/abuse of antibiotics as one of the greatest scourges of the modern world. The reason for this is simple to understand.

The first thing to know is that most common infective illnesses are caused either by bacteria or by viruses. While bacteria are life forms and when attacked by antibiotics, are likely to get killed, viruses are pure genetic material that multiply inside human cells and thus cause illness. Treating a bacterial illness with an antibiotic may make sense if the child has been seen by a qualified doctor; managing a viral illness with the same kind of medicine is useless as viruses are not "life" forms in the way we understand life.

Well, then, you might ask, why all this hullabaloo over using antibiotics for viral illness? The reasons are twofold. The first is that antibiotic overuse may create an environment inside your body that makes bacteria get used to those antibiotics ... so that you need stronger and stronger antibiotic agents the next time you have the same illnesses that needed simpler antibiotics the last time around.

In addition to this problem of antibiotic resistant germs making their home in your body temple, there is one other major problem caused by the ill-advised use of antibiotics, which is the occurrence of SIDE EFFECTS.  As antibiotics are medicines, they can produce side-effects as varied as rashes, loose motions, fever, vomiting, body aches and so on. These side-effects are usually temporary, but can drain the little ones' energy and cause problems that may need a consultation with the HIGHER specialist. 

Thus, my advise to you all is this: try and resist an antibiotic prescription, and if you do need it, or think you need it, re-visit the child's doctor for him/her to endorse the need for it; use the entire course without interruption (usually, antibiotics are used for a fixed duration of between 6-10 days, but there are a few which are only needed to be given for 3 days, and some that are needed for longer than 10 days. The last bit of advice is to never keep the unused portion of a liquid antibiotic for future use as such antibiotics lose potency beyond the specified storage period of about 3-7 days.

An additional bit of caution: never use antibiotics prescribed for your friend/cousin/neighbour's child. This is simply disastrous.

I hope this post has helped to clarify the position about the captioned topic. Thank you for reading.

Friday, May 24, 2013

How to raise a genius child

I am posting this because of a personal request by Ms. Allison Morris to share this with the readers of this blog. I do not entirely endorse the point of view expressed by the site, because I believe bringing up a well-rounded child may be important, but should not be the only goal for parents. It is rather more important not to pressure the child at a tender age and let him/her grow at his/her natural pace. However, here is the link to the site:

Do go through the site and post your comments below in the comments section.

Saturday, April 06, 2013

How to Wean the infant off frequent Night-time feeds

Many parents have approached me with this very common problem faced by them: the baby has grown beyond her first birthday, and is still waking up the mother for breast feeds or top feeds almost three or more times during the night.

The problem is accentuated by the fact that many middle-class families have working mothers who need the rest at night time. Being woken up by an irritable, fretful child can be very taxing for both the parents and sometimes even the older children in the house or the grand-parents in case of an extended family.

Such a problem needs to be first understood from the child's perspective. The child wakes up her mother not because she is really hungry, but because she is habituated to fall asleep while suckling or needs to suckle every few hours. It is important to remember that mother's milk is no longer very nutritious by the time more than a year has passed in the age of the baby. If the mother does not discipline the child at this age, the problem may not go away until the child has grown older, much older.

So, how does one go about it? Imagine that a child is waking her mother up four times in the night: at 11, then 1, then 4 and finally at 6 a.m. When she wakes up at 11 p.m., feed her immediately. At 1 a.m., let the child cry for 5-6 minutes and then feed her. Ditto at 4 a.m. At 6 a.m., feed her immediately. The next night, the child will learn to wake at about 5-10 minutes past 1 a. m. Delay this feed by 5 more minutes the next night, and so on till one feed (the 6 a.m. one), gets pushed on to the morning. Repeat this till both the night feeds have been eliminated.

The following two changes may help prevent frequent wakings AND development of the urge to demand night time feeds: the first is letting the baby sleep in her own separate bed/cot/.crib from mid-infancy; the second is having a separate baby room so that the baby learns from early on (say from around the age of 10-11 months) to sleep alone. 

I hope the above write-up helps my readers.

On the face of it, the words "let the baby cry" may sound inhuman or cruel, but, believe me, there is no other alternative. People have tried giving sleeping medication or even opium to the baby ... but surely you aren't going to try that, are you?

Thursday, February 28, 2013

Something about vaccine preventable diseases

Those caring for children are often at their wits' end when it comes to knowing when to give which vaccine, what the side-effects of these vaccines are, what to do if one misses a vaccination appointment, and so on and so forth.

In this post, I am going to talk a little bit about vaccines, and expand the concept to include other important life-habits that work just like vaccination, but without the pain, when it comes to preventing disease.

When we talk about immunisation, we are talking about giving preventive vaccines to our loved ones to avoid the occurrence of diseases. The problem is that no vaccine is one hundred percent effective in preventing the occurrence of the disease it is supposed to prevent. However, many modern vaccines do come close enough to the ideal, in that, they are effective in more than 95% of those vaccinated. 

Vaccines are of several kinds, but the most useful  classification is to divide them into those that prevent life-threatening illnesses and those that prevent non-life-threatening diseases. The former category includes vaccines against major killers of the 20th Century and before such as poliomyelitis, measles, tetanus, diphtheria, whooping cough and tuberculosis. To this may be added the small pox vaccine, which is no longer given now as the disease has become "extinct", and the hepatitis B vaccine, though the last one kills the affected persons in just about 1-2% of the cases. 

The latter category includes vaccines against different illnesses: these are Hepatitis A, Chicken Pox, the rotavirus, influenza viruses, and some others. 

Then there are vaccines against illnesses that are geographically limited but serious illnesses nevertheless; many such vaccines are in the list of vaccines that need to be given to travellers within that country. These include the vaccines against Japanese encephalitis, yellow fever etc.

Next in the category of vaccines are simple preventive medicines that help prevent diseases like malaria. If you are travelling to a malaria-infested country like India, Bangladesh, or any tropical country in Africa or Asia, you should seek advice on taking medicines starting one week before entering that country and should continue ingesting these until 4 weeks after you have left that country.

Good hand washing, eating hygienic food and basic personal cleanliness are also "vaccines" that help prevent water and food-borne illnesses; in the same way, covering one's nose and mouth while among huge crowds is a simple preventive step to avoid air-borne diseases to some extent. 

Wednesday, February 13, 2013

Some advice on discipline

This is an excerpt from my book CHILD CARE: From Birth to Eighteen.

Here are some tips on how to discipline your children:

  1. If she misbehaves at the dinner table, declare a time-out for her, ask her politely to leave the table and sit against a wall or a corner with her back towards you. Deduct the time-out from the time allotted to her for the meal.
  2. If she breaks an object willfully, restrict her from approaching you for a specific time-period.
  3. If she shouts back at you or argues with you impolitely, tell her that she may not speak with you for a specific time-period and quarantine her from the living/sitting room area and ask her to study something and “give you her lessons” after a certain time.
  4. Privileges like watching a favourite TV program, eating a favourite snack, doing a favourite activity, going out on a Sunday evening, getting a hug when she returns from school, buying her a favourite dress, letting her go “down” in the compound to play, and many more can all be restricted depending upon the situation and upon the consensus between both the parents.
  5. Do not shout, make angry faces, physically beat or become violent while punishing. It encourages rebellion and aggressiveness in the child. Also, it does nothing to reduce the occurrence of the same mistake again. In fact, the child become “immune” to repeated corporeal punishment and a stage is reached where the parent gets “tired” of punishing and the child mocks him/her and challenges him/her to “do what you want”.
  6. As far as possible, explain why your child is being punished in easy-to-understand language and follow up with the information of what the child could have done/could do to avoid the occurrence/ prevent repetition of the mistake.
  7. Be role models yourself and behave in an exemplary way so that the child hesitates to do what she would otherwise have done.
  8. Be consistent in punishing and as far as possible, be both parents available while deciding on the quantum and nature of the punishment.
  9. Never issue empty threats like “Let your dad come and then we will see” if you do not intend to follow up on your threats. Else, the child will lose faith in you and start making fun of you.

Tuesday, July 12, 2011

Keeping Children Safe

Keeping children safe in the home is one of the most important jobs for a parent or grandparent. Children are by nature exploratory. They will look in cabinets, open doors and put anything in their mouths. There are ways to protect children in the home from getting into hazardous substances.

Cleaning products are the easiest chemicals in the home to keep out of the reach of children. Every homeowner has some type of cleaning solution, but that does not mean it should be kept around his or her child. Cleaning products such as Clorox, dish detergent and laundry detergent should be kept in a high cabinet, preferably one that has a lock of some sort on it. There are numerous types of locks that parents can get at any hardware store to put on a cabinet. The locks are childproof and will not allow children to open the door. Cleaning supplies should never be kept with other household objects that the child is allowed to play with. gives parents tips and ideas on how to keep all hazardous materials out of the reach of children. They suggest that if locks cannot be placed on cabinets and drawers, then the bottles that chemicals come in should be sealed with a childproof lid.

Loose insulation in homes is a major hazard for not only children, but all family members. Exposure to the poisonous asbestos fibers is the only known cause of mesothelioma cancer, a disease that attacks the lining of the body’s major organs. A mesothelioma prognosis is rather grim, usually giving only one or two years of survival. For this reason, older homes should have the insulation replaced every few years so that there is little asbestos build-up.

Cleaning products are not the only hazardous materials that children can come in contact with. Medications need to be properly stored as well. Children should not be told that vitamins or medicines are candy. This will give them the idea that all medicines are candy. Do not store medicines in a bottle that resembles a candy bottle. Always have a childproof lid on any medications in the home. Medicines that adults take on a daily basis need to be kept in a locked medicine cabinet, out of the reach of children. Even medicines that are for children can cause poisoning. It is easy for children to overdose on medications that they can get their hands on easily.

Keeping children away from chemicals in the home is easy to do. Simply keep substances locked up and on a high shelf so that children cannot reach them.

The above is a guest post by Jillian S. McKee of

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