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.

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.

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.

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: http://www.cdc.gov/Features/GlobalHandwashing/)

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.