Diarrhoea is one of the most common childhood diseases all over the world. While infectious gastroenteritis (i.e. diarrhoea caused by germs) is the commonest condition leading to loose stools, or the "trots" as this is called in some parts of the world, non-infectious conditions such as the traveller's diarrhoea and diarrhoea due to food poisoning are also the causes in a small percentage of children.
When your small child gets loose motions, it is more often than not of the infectious variety, and in over 80% of such cases, the offending germ is a VIRUS, a type of microbe that is normally only visible when seen through the lens of an electronic microscope. Viruses, unlike bacteria, cannot be "killed" by using common antibiotics; rather, one has to bide one's time and wait till the body's own fighting power overwhelms them and leads to recovery of the individual.
Diarrhoea, by itself, is not necessarily a dangerous thing; the problems it causes are due to the loss of water and vital electrolytes from the body into the stools. This loss of vital fluid and electrolyes is called "dehydration".
Therefore, the most important thing that parents can do is to prevent the occurrence of dehydration by a two-pronged strategy:
a) Remove the cause of the diarrhoea by taking the child to a medical facility and check-up and treatment by a pediatrician or a trained pediatric assistant or nurse and
b) Give the child sufficient electrolyte enriched fluids (=containing salt and sugar) so that on-going losses are faithfully replaced and there is no net loss of fluid from the body.
To give the salt -sugar water, take a 2-finger pinch of salt and add it to a medium glass full of clean water (approximately 200 mL); next, add 1 teaspoon of sugar to the same and stir the mixture thoroughly with a clean spoon. Once the sugar has dissolved properly, the "Oral Rehydration Salts" (ORS) solution is ready. This solution can be given repeatedly, till the child is taken to a medical facility, or, in milder cases, till the diarrhoea gets resolved.
The ORS should be given with a spoon in infants and with a cup or glass in older children. For infants, each large stool is considered equivalent of 40-60 mL, and hence, the baby should be given at least a quarter cup of ORS between each pair of loose stools.For older children, the quantity needed should be half to three-quarters of a glass per stool. A similar allowance can be made for vomits passed in the interim.
All through the rehydration, the child must continue to be fed, whether breast milk or top milk or other foods. Feeding the child prevents the child from losing weight and becoming undernourished.
Thursday, April 03, 2008
Monday, January 14, 2008
Managing fever at home
Introduction:
Most parents get alarmed when their precious ones (read kids) are down with a high temperature. Fever is actually a mere symptom of the war between the harmful agent and the human body. In this tussle, which human often wins, fever arises because the immune process which is activated tries to fight back and defeat the insulting/attacking agent.
In pediatric practice, fever is the most common presenting symptom of patients brought to me. While appropriate control of fever is important, it is also imperative to discover the cause of the fever, as it is only then that one can hope to eradicate it before it produces any further symptoms or damage.
The mainstay of treatment is, in brief:tap water or slightly warm water sponging for the entire body; oral medication, mostly in the form of paracetamol; and identification and elimination of the underlying cause.
Description:
Having outlined the essentials of fever management in the previous post, let me go ahead and tell you exactly what needs to be done when your precious child has fever. For the purpose of this discussion, I will exclude babies less than one year of age in whom fever can be an emergency and medical attention by a doctor or a trained nurse or medical assistant is of paramount importance.
First of all, you should know that the normal body temperature varies between 97 and 99 degrees Fahrenheit depending upon the age of the person and the climate and environment in which the person resides. The mean normal body temperature is 98.6 F. A temperature rise of more than 1 degree F from this mean is defined as fever.
Considering this basic point, please remember that a slight body warmth in the middle of the day, or after you have brought the child in from the outside heat, or after the child returns from active play is NOT fever. Neither is the body said to be "febrile" if the child has an ear temperature (taken with the ear-thermometer) of about 99.8 F or less. The internal body temperature is about 1 F higher than the temperature of the arm-pit (axilla), which, in turn, is 1 F higher than the temperature of the skin over the toes or lower legs.
A rise in body temperature in an otherwise well-looking child may or may not mean that worse problems are on their way, and hence, careful monitoring is necessary in every child with fever. Fever is generally due to infections, but may be secondary to other forms of inflammatory diseases, systemic (general) diseases and occasionally, a disturbed central nervous system (read "brain").
The best treatment for fever is SPONGING. To sponge means to continuously wipe the child's torso and upper half of the legs with a hand towel dipped repeatedly in lukewarm or tap water. Sponging is a serious type of treatment that overcomes the disadvantages of giving medicines; however, it can prove to be difficult if the child is restless or refuses to cooperate. Using lukewarm water helps to get him/her to allow you to remove his/her clothes and to mop the torso without the fear of this causing a chill or any other form of discomfort. Try and keep at the sponging for a time that is proportional to the original temperature rise. Approximately, it takes at least half an hour of sponging to reduce the temperature by 1-1.5 degrees F. During this procedure, keep giving sips of water or electrolyte rich fluids to the child as he/she feels more thirsty than usual with fever.
Many care-givers think that a tepid water bath can be used instead of sponging. No, it cannot be an effective substitute since the mechanism of reduction of fever as outlined above requires the water to evaporate off the skin of the child. Hence, there is no substitute to sponging.
Keep monitoring the warmth of the skin by pushing your hand in between the child's back and the mattress; this is one area of skin that is not being sponged and hence reflects the actual fever position. Alternatively, you may check his/her temperature with a thermometer placed in his/her mouth/ear.
If the original temperature is between 99.6 and 102, sponging alone might prove to be effective. If, however, the temperature is higher, you might have to place an ice-bag above his/her head and also administer a fever medicine like paracetamol (Crocin, Adol, Metacin, Calpol) in a dose of 3-6 ml as often as needed (but with an interval of 4-6 hours between successive doses). For older children who are heavier, these brands have adouble strength formulation also available, at least in India, where I live (Crocin DS, Metacin Soorsa, Calpol Plus).
As of 2011, evidence is clear that paracetamol, along with sponging, and treatment of the underlying cause of the fever, is one of the best methods to control fever.
Other effective fever medicines include Mefenamic Acid (Meftal - p, Ponstan), Ibuprofen (Motrin Jr, Ibugesic, Flamar) and Nimesulide (Nise, Nimulid) - the last one being not licensed for use in the U.S.A. and many other developed countries because of the fear of some side-effects. In fact, nimesulide pediatric preparations have now been removed from almost ALL countries including India. However, combinations of nimesulide and paracetamol are available. I strongly discourage the use of this combination. Since the time this entry was made, the use of all these other anti-pyretics has been reduced owing to their propensity to cause many side-effects.
In addition to the foregoing, let the child rest, eat only light and soft food that is easy to digest and allow him/her to do restful activity like reading, viewing television etc.
However, the most important thing to do is to go as early as possible, but definitely not later than 48 hours, to a doctor. He/she will examine the child, perhaps order some tests (investigations) and try and arrive at the cause of the fever. Unless the cause is found and treated appropriately, the fever may not subside in almost 30% of the cases. The other 70% may, if they have a mild problem, resolve on their own without a diagnosis.
A word of caution here: if the child is frankly sick, that is, he/she does not look well, or, if he/she has symptoms like a severe headache, excessive crying, serious coughing, watery loose motions, etc., see that doctor right away. Waiting for 48 hours in such cases can be dangerous.
Before you post your queries here, please read through all the replies to previous comments. Your answer may already be there. Thank you.
Entry updated May 2013
In pediatric practice, fever is the most common presenting symptom of patients brought to me. While appropriate control of fever is important, it is also imperative to discover the cause of the fever, as it is only then that one can hope to eradicate it before it produces any further symptoms or damage.
The mainstay of treatment is, in brief:tap water or slightly warm water sponging for the entire body; oral medication, mostly in the form of paracetamol; and identification and elimination of the underlying cause.
Description:
Having outlined the essentials of fever management in the previous post, let me go ahead and tell you exactly what needs to be done when your precious child has fever. For the purpose of this discussion, I will exclude babies less than one year of age in whom fever can be an emergency and medical attention by a doctor or a trained nurse or medical assistant is of paramount importance.
First of all, you should know that the normal body temperature varies between 97 and 99 degrees Fahrenheit depending upon the age of the person and the climate and environment in which the person resides. The mean normal body temperature is 98.6 F. A temperature rise of more than 1 degree F from this mean is defined as fever.
Considering this basic point, please remember that a slight body warmth in the middle of the day, or after you have brought the child in from the outside heat, or after the child returns from active play is NOT fever. Neither is the body said to be "febrile" if the child has an ear temperature (taken with the ear-thermometer) of about 99.8 F or less. The internal body temperature is about 1 F higher than the temperature of the arm-pit (axilla), which, in turn, is 1 F higher than the temperature of the skin over the toes or lower legs.
A rise in body temperature in an otherwise well-looking child may or may not mean that worse problems are on their way, and hence, careful monitoring is necessary in every child with fever. Fever is generally due to infections, but may be secondary to other forms of inflammatory diseases, systemic (general) diseases and occasionally, a disturbed central nervous system (read "brain").
The best treatment for fever is SPONGING. To sponge means to continuously wipe the child's torso and upper half of the legs with a hand towel dipped repeatedly in lukewarm or tap water. Sponging is a serious type of treatment that overcomes the disadvantages of giving medicines; however, it can prove to be difficult if the child is restless or refuses to cooperate. Using lukewarm water helps to get him/her to allow you to remove his/her clothes and to mop the torso without the fear of this causing a chill or any other form of discomfort. Try and keep at the sponging for a time that is proportional to the original temperature rise. Approximately, it takes at least half an hour of sponging to reduce the temperature by 1-1.5 degrees F. During this procedure, keep giving sips of water or electrolyte rich fluids to the child as he/she feels more thirsty than usual with fever.
Many care-givers think that a tepid water bath can be used instead of sponging. No, it cannot be an effective substitute since the mechanism of reduction of fever as outlined above requires the water to evaporate off the skin of the child. Hence, there is no substitute to sponging.
Keep monitoring the warmth of the skin by pushing your hand in between the child's back and the mattress; this is one area of skin that is not being sponged and hence reflects the actual fever position. Alternatively, you may check his/her temperature with a thermometer placed in his/her mouth/ear.
If the original temperature is between 99.6 and 102, sponging alone might prove to be effective. If, however, the temperature is higher, you might have to place an ice-bag above his/her head and also administer a fever medicine like paracetamol (Crocin, Adol, Metacin, Calpol) in a dose of 3-6 ml as often as needed (but with an interval of 4-6 hours between successive doses). For older children who are heavier, these brands have adouble strength formulation also available, at least in India, where I live (Crocin DS, Metacin Soorsa, Calpol Plus).
As of 2011, evidence is clear that paracetamol, along with sponging, and treatment of the underlying cause of the fever, is one of the best methods to control fever.
Other effective fever medicines include Mefenamic Acid (Meftal - p, Ponstan), Ibuprofen (Motrin Jr, Ibugesic, Flamar) and Nimesulide (Nise, Nimulid) - the last one being not licensed for use in the U.S.A. and many other developed countries because of the fear of some side-effects. In fact, nimesulide pediatric preparations have now been removed from almost ALL countries including India. However, combinations of nimesulide and paracetamol are available. I strongly discourage the use of this combination. Since the time this entry was made, the use of all these other anti-pyretics has been reduced owing to their propensity to cause many side-effects.
In addition to the foregoing, let the child rest, eat only light and soft food that is easy to digest and allow him/her to do restful activity like reading, viewing television etc.
However, the most important thing to do is to go as early as possible, but definitely not later than 48 hours, to a doctor. He/she will examine the child, perhaps order some tests (investigations) and try and arrive at the cause of the fever. Unless the cause is found and treated appropriately, the fever may not subside in almost 30% of the cases. The other 70% may, if they have a mild problem, resolve on their own without a diagnosis.
A word of caution here: if the child is frankly sick, that is, he/she does not look well, or, if he/she has symptoms like a severe headache, excessive crying, serious coughing, watery loose motions, etc., see that doctor right away. Waiting for 48 hours in such cases can be dangerous.
Before you post your queries here, please read through all the replies to previous comments. Your answer may already be there. Thank you.
Entry updated May 2013
Thursday, September 06, 2007
News on my new clinic
I am returning to the blog after almost ten days ... eventful days with most of my spare time spent in supervising how my new clinic premises are getting renovated/refurbished. Before I go any further, let me say that my present clinic was becoming too small to take the input of patients and other visitors; this is hardly surprising as it measures just 100 sq. ft. in size! Out of this, almost 5 sq.ft. is lost in a structural beam, 10 are lost in a staircase that connects to the loft inside my clinic, and of the remaining 85, 40 sq. ft. is the size of the waiting area and 45, the size of the inner cabin where I consult. LOL.
Now, with a sizeable contribution from my better half, I have purchased a new "pagdi" premises near J.J. Hospital. The new shop is on the ground floor, and is almost 250 sq. ft. in size, a major increase over the older place where I presently sit. The renovation work is in progress and is expected to complete in less than a month. Inshallah, I should then shift my normal practice to this place, while the Late Zubedabai Y. Kagalwala Memorial Child Welfare Center will continue to operate from my present premises.
A little more about the charitable venture: it has started since July 27, 2007. In the nearly one and a half months, I have seen about 20 new cases and about 15 old ones. As against my normal fees (of around Rs. 400/- for the first consultation, I charge just Rs. 100/- for this in the charitable version. With this, I hope to earn the good wishes and prayers of my poorer patients and blessings from my late mother's benevolent soul.
That's all for now.
Now, with a sizeable contribution from my better half, I have purchased a new "pagdi" premises near J.J. Hospital. The new shop is on the ground floor, and is almost 250 sq. ft. in size, a major increase over the older place where I presently sit. The renovation work is in progress and is expected to complete in less than a month. Inshallah, I should then shift my normal practice to this place, while the Late Zubedabai Y. Kagalwala Memorial Child Welfare Center will continue to operate from my present premises.
A little more about the charitable venture: it has started since July 27, 2007. In the nearly one and a half months, I have seen about 20 new cases and about 15 old ones. As against my normal fees (of around Rs. 400/- for the first consultation, I charge just Rs. 100/- for this in the charitable version. With this, I hope to earn the good wishes and prayers of my poorer patients and blessings from my late mother's benevolent soul.
That's all for now.
Friday, August 31, 2007
How can a lactating mother increase her breast-milk?
I have seen many mothers who get frustrated when they are faced with the prospect of feeding an extremely hungry baby; and knowing that, at that point of time, they are simply unable to get that much milk out ...
I have some suggestions on how to make your breasts respond to the increased demand of the baby; please go through them carefully. Although none of them are guaranteed to get you the results, I can assure you that your milk output will DEFINITELY GO UP!
1. Be positive about your milk and about your baby. Have confidence in your own self. Try and forget about the worldly problems that you face each day of your life and immerse yourself in the love you have for the child.
2. Take a small glass bowl and fill half of it with cold-pressed sunflower oil. Add to this about six to seven drops of fennel seed oil (available with aromatherapy stores). Heat the oil mixture a little. Sit in a quiet room and expose your breasts. Rub a little of the oil mixture into your palms and massage both your breasts - one in the clockwise and one in the anti-clockwise direction. Maintain the massage for at least 15 minutes. Do this at least once a day, and preferably twice to get results.
3. Keep nursing the baby. When it is sucking at your breast, pour, from a small container, with your other hand (the one that is free), a thin stream of dairy milk slowly over your breast so that its trickle rolls over the breast and over the nipple into the baby's hungry mouth. This will enable the baby to suckle without fighting your nipple and the happiness that this causes in you will, in turn, increase your milk production as well as let-down.
4. There are herbal preparations that can increase the flow of milk when used regularly. Ask your doctor for details.
Hope this helps the harried mom.
I have some suggestions on how to make your breasts respond to the increased demand of the baby; please go through them carefully. Although none of them are guaranteed to get you the results, I can assure you that your milk output will DEFINITELY GO UP!
1. Be positive about your milk and about your baby. Have confidence in your own self. Try and forget about the worldly problems that you face each day of your life and immerse yourself in the love you have for the child.
2. Take a small glass bowl and fill half of it with cold-pressed sunflower oil. Add to this about six to seven drops of fennel seed oil (available with aromatherapy stores). Heat the oil mixture a little. Sit in a quiet room and expose your breasts. Rub a little of the oil mixture into your palms and massage both your breasts - one in the clockwise and one in the anti-clockwise direction. Maintain the massage for at least 15 minutes. Do this at least once a day, and preferably twice to get results.
3. Keep nursing the baby. When it is sucking at your breast, pour, from a small container, with your other hand (the one that is free), a thin stream of dairy milk slowly over your breast so that its trickle rolls over the breast and over the nipple into the baby's hungry mouth. This will enable the baby to suckle without fighting your nipple and the happiness that this causes in you will, in turn, increase your milk production as well as let-down.
4. There are herbal preparations that can increase the flow of milk when used regularly. Ask your doctor for details.
Hope this helps the harried mom.
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