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Friday, May 24, 2013

Circumcision -Risks and Benefits


Circumcision is the removal of the foreskin-the skin that covers the tip of the penis. 

There are medical benefits and risks to circumcision. 

Benefits: circumcision protects against 

1.)urinary tract infections
2.)penile cancer 
3.)sexually transmitted diseases.

Circumcision changes the bacteria ecosystem of the penis, perhaps explaining why the procedure reduces the risk of HIV infection,  

Benefits to the partner:

Circumcision has also been shown to reduce the risk of contracting HPV, or human papillomavirus, which can cause cervical cancer if a man infects his female partners with the virus, and herpes simplex virus type 2, better known as genital herpes.

Risks 
1.)pain
2.)risk of bleeding 
3.)infection. 

These risks are higher for older kids and men. so it's better to do as early as possible if we are sure about the procedure . This can be done safely in new born period  also 

American Academy of Pediatrics to conclude in 2012 that the benefits outweigh the risks.(benefits>risks) 


Parents need to decide what is best for their kids based on their religious, cultural and personal preferences.

Thursday, May 23, 2013

ROTARIX - ROTAVIRAL VACCINE


What is ROTARIX?


                                                                     
ROTAVIRUS image jama


ROTARIX is a vaccine that protects your baby from a kind of virus (called a rotavirus) that can cause bad diarrhea and vomiting. Rotavirus can cause diarrhea and vomiting that is so bad that your baby can lose too much body fluid and need to go to the hospital.
Rotavirus vaccine is a liquid that is given to your baby by mouth. It is not a shot.


Who should not take ROTARIX?

Your baby should not get ROTARIX if:
                He or she has had an allergic reaction after getting a dose of ROTARIX.
                He or she is allergic to any of the ingredients of this vaccine. A list of ingredients can be found at the end of this leaflet.
                A doctor has told you that your baby’s digestive system has a defect (is not normal).
                He or she has a history of a serious problem called intussusception that happens when a part of the intestine gets blocked or twisted.
                He or she has Severe Combined Immunodeficiency Disease (SCID), a severe problem with his/her immune system.

Tell your doctor if your baby:
                Is allergic to latex.
                Has problems with his/her immune system.
                 


If your baby has been having diarrhea and vomiting, your doctor may want to wait
before giving your baby a dose of ROTARIX.



What are possible side effects of ROTARIX?

The most common side effects of ROTARIX are:
                Crying
                Fussiness
                Cough
                Runny nose
                Fever
                Loss of appetite
                Vomiting.

Call your doctor right away or go to the emergency department if your baby has any of these problems after getting ROTARIX, especially if symptoms occur in the first 7 days after the first dose, but even if it has been several weeks since the last vaccine dose because these may be signs of a serious problem called intussusception:
                Bad vomiting
                Bad diarrhea
                Bloody bowel movement
                High fever
                Severe stomach pain (if your baby brings his/her knees to his/her chest while crying or screaming).




How is ROTARIX given?



ROTARIX is a liquid that is dropped into your baby’s mouth and swallowed.

                                                             




Administration of ROTARIX

Your baby will get the first dose at around 6 weeks old.

The second dose will be at least 4 weeks after the first dose (before 6 months old).

Be sure to plan the time for your baby’s second dose with the doctor because it is important that your baby gets both doses of ROTARIX before your baby is 6 months old.

The doctor may decide to give your baby shots at the same time as ROTARIX.
Your baby can be fed normally after getting ROTARIX.


What are the ingredients in ROTARIX?
ROTARIX contains weakened human rotavirus.

                            ROTARIX is a registered trademark of GlaxoSmithKline


Tuesday, May 14, 2013

National Vaccination Reminder Service

National Vaccination Reminder Service 


The IAP Immunizeindia national vaccination reminder service was successfully launched in July 2012 and many parents are registering for the service everyday. 

Hundreds of SMS reminders are already being sent every week.



As illustrated in the images below registration the service is very easy, by simply sending SMS to the national shortcode 566778 from the parent's mobile phone-


Immunize <Space> <Baby’s pet name or first name> < Space> <Baby’s date of birth>

Example

Immunize Rekha 25-03-2012

the following

Three free of cost and timely reminders will be sent for each vaccination, for 12 years, as per the IAPCOI vaccination schedule.

An example of a reminder that is sent to the phone is - "Vaccination OPV2 Measles dose is due for Rekha this week. Please do not forget to take your baby to the doctor.”
Reminders do not advertise, recommend or promote any vaccine brands or products. Reminders also never mention the name of any doctor. This is a non-profit, free service, supported only by grants and donations from individuals and institutions.

  They will get timely reminders to visit you for immunization of their child.
Let us use the service to increase immunization rates and fulfill our mission of serving the children of India. 


IMMUNISATION SCHEDULE -new time table




Asthma in children

Asthma in Children

Asthma is a chronic disease that causes the airways  -that carry air in and out of your lungs - to become sore and swollen. 

 Children have smaller airways than adults, which makes asthma especially serious for them.

 Symptoms & signs 

wheezing, 
coughing, 
chest tightness and 
trouble breathing

Symptoms are more common in the early morning 

causes of asthma

Allergens - mold, pollen, animals
Irritants - cigarette smoke, air pollution
Weather - cold air, changes in weather
Exercise
Infections - flu, common cold


 Asthma is treated with two kinds of medicines

1.)quick-relief medicines to stop asthma symptoms 
2.)long-term control medicines to prevent symptoms.

10 ways to protect your kidneys


Best way to protect your kidneys:

By Dr. Willie T. Ong (Internist and Cardiologist)

Most people know how to protect the heart, but do you know how to care for your kidneys? 

The kidneys' job is to help remove various toxins (drugs and food wastes), and expel them through the urine.

As we grow older, our kidneys will also start to age. A problem with kidney disease is that majority of patients have no warning symptoms.

Here are 10 ways to protect your kidneys:

1. Limit your salt intake -
Too much salt is not only bad for your blood pressure, it's also bad for your kidneys. Many die of kidney disease, which can be partly attributed to a high salt intake and fondness for fish sauce, soy sauce, plain salt and salted fish. Even instant noodles, chips and nuts are teeming with salt. The problem with salt is that it encourages the body to retain water, and can increase your blood pressure (which damages the kidneys).

2. Don't load up on high protein foods such as meat and steaks --A high protein diet makes the kidneys work twice as hard. Pretty soon, your kidneys could get tired and some of the weaker kidney cells can die. A friendly reminder to people on a high-protein Atkin's Diet or South Beach Diet. The time-tested doctor's advice of moderation in everything will serve you well. Eat a balanced diet of rice, vegetables, fish and fruits and you can't go wrong.

3. Keep your blood pressure at 130/80 or lower -- If your blood pressure is above 140 over 90, this can cause kidney damage within five years. The kidneys are said to be "happiest" with a blood pressure of 130/80 or lower. To help control your blood pressure, you should limit your salt intake, reduce weight and take medicines for high blood pressure, if needed.

4. Keep your blood sugar below 120 mg/dl -- Diabetes and high blood pressure are the two leading causes of kidney failure. A person with uncontrolled diabetes for 5-10 years may develop significant kidney damage. Consult your doctor and keep your blood sugar under control with diet, exercise and maintenance medicines.

5. Drink 8 glasses of water a day -- Doctors usually advise people to take in 8 glasses of water a day, but this really depends on your age and condition. If you're sweating a lot and work outdoors, you may need to drink more than 8 glasses a day. However, if you are above 65 years of age, you may do well with just 6 glasses a day. Drinking enough water also prevents the formation of kidney stones.

6. Watch your intake of pain relievers and other drugs -- Taking pain relievers like mefenamic acid, ibuprofen and the coxibs (like celecoxib) for a prolonged period of time may cause kidney damage. Because of this, we should limit taking these medicines to only a week, or just take them as needed. For those with chronic arthritis, try to look for other ways to relieve the pain such as using a hot water bag, pain reliever ointments, or the safer paracetamol tablet.

7. Be careful with tests and procedures using contrast dyes -- Some tests, like CT Scans and MRIs, and angiograms, use a contrast dye which helps doctors delineate the organs better. The problem with such dyes is that they can cause kidney damage. To be safe, I would strongly advise you to consult a kidney specialist before undergoing such procedures.

8. Don't drink too much Vitamin C -- Excess vitamin C (ascorbic acid) can lead to the formation of kidney stones in predisposed individuals. If you need to take vitamin C, a dose of 500 mg or less is safer.

9. Don't rely on food supplements to protect your kidneys -- The above tips are so far the best tips to care for the kidneys.

10. Get a kidney check-up --Simple tests, such as a complete blood count, BUN and creatinine, and a urinalysis are the first screening tests for the kidneys. Finding a trace of protein in the urine can alert the doctor of possible kidney disease.


Bottomline is: Kidney diseases are expensive and difficult to treat. Let's take the necessary steps to protect our kidneys today.

thank you @ravan181 sir for sharing the link 

Iron supplementation can increase I Q of your children

In observational studies anemia and iron deficiency are associated with cognitive deficits , suggesting that iron supplementation may improve cognitive function. 

Iron can improve cognitive domains: concentration,intelligence ,memory, psychomotor skills and scholastic achievement. 

If the child is anemic, iron supplementation can improve I Q by 2.5 points. 


So if your child is poor in studies or getting worse in scholastic performance consult your pediatrician for signs of anemia and iron deficiency . 
(ref . Nutritional journal jan2010 ) 

Sunday, May 12, 2013

PICA in KIDS

PICA in KIDS 

PICA means  eating NON NUTRITIVE  substances PERSISTENTLY by kids 

Commonest substances are :

        Clay, Charcoal, Paint, Mud, Ashes and sometimes plaster 

During 1-2 years kids will try to taste anything and everything available to them. This called "Oral Phase" of development and "Mouthing" is normal up to some stage 

But some kids continue to eat non nutritive substances which may cause some ill effects 

Reasons (may be ) :
  There is no clear cut reason behind this persistent eating .few causes are

Nutrition deficiencies 
          Iron, zinc, calcium
Child abuse or neglect 

What are all the risks of PICA 
     
    Lead poisoning 

     Dental injury

Worm infestation (mud and sand contain lots of worm eggs )

Iron deficiency anaemia 

Bowel obstruction - kids may eat their own hair and it will collect in the stomach which cause a condition called as BEZOAR 

Management /Treatment 

 Both Medical treatment and psychological treatment needed 

  iron deficiency anaemia should be treated with iron supplements .Zinc and Calcium also can be given

Deworming done with albendazole drug 

Lead level in the blood should measured and should be treated accordingly 

Surgical Treatment : sometimes hair and plastics may cause blockade in the intestine , stomach which may need surgical removal 

Saturday, May 11, 2013

Oral Thrush in Babies



    Sometimes babies may have whitish curd like layer in the mouth and tongue. On wiping this will lead to bleeding. This is due to yeast or fungal infection

Candida albicans is the name of the yeast which causes above lesion known as THRUSH /ORAL THRUSH
Yeast is a normal inhabitant in the mouth .But whenever local damage occurs they started to grow profusely.


The conditions which favors the growth are 
    -intake of antibiotics
    -any illness
   -bottle feeding
   -hormonal changes 

Thrush – An elevated white patch that look like curds are seen inside the mouth, roof of the mouth, tongue and gums

No need to worry about the thrush .consult your pediatrician and he will prescribe antifungal mouth lotion (clotrimazloe – candid mouth
lotion) 

Never attempt to wipe the patches .it may lead to bleeding

Friday, May 10, 2013

NOSE BLEEDING IN CHILDREN (EPISTAXIS)

Epistaxis/Nose bleeds


Nose bleeds(epistaxis) are common in childhood .

Though it is frightening it is easily manageable 

Most common site of bleeding is an area in the anterior part of nasal septum where many blood vessels are meeting.

The mucosa in that area is thin and easily accessible for children for inserting fingers and nose picking

Causes:

Trauma – either fall or hit by others

Nose picking-most common cause

Dry air

Inflammation

Sinusitis/allergic rhinitis

Management:

Mostly bleeding will stop spontaneously in few minutes.

Donot panic on seeing the bleed.

Calm the child

Compress the Nares and ask the child to breathe through mouth

Ask the child to lean forward so that the blood will not enter back in to the throat

If bleeding is profuse apply Oxymetazoline drops

Consult an ENT surgeon who will pack the nose and will arrest the bleeding

Saline nasal drops may be applied to prevent dryness

Thumb sucking in kids

Thumb Sucking

Thumb and finger sucking is normal in infancy and toddlerhood

no need to worry upto 4 years of age . If the habit persists beyond 5 years then we have to intervene

Babies acquire the habit of thumb sucking from the womb life itself . Thumb sucking gives pleasure , soothing , secure feeling and sense of satisfaction to the babies

thumb sucking wont cause much harm to the baby and no need to worry

Minimal side effects of thumb sucking are :

infection
Callus formation in the thumbs
teeth mal alignment

How to prevent thumb sucking in child >5 years

Ignore and don't pay attention to the act

Engage him in other activities such as play , drawing etc ,..

Don't scold or criticise about the habit .but tell him that thumb sucking is a habit of babies

the application of bitter substances over the thumb will not help to abolish the habit

permanent teeth erupts from 6 years of age and its better to get rid of the habit beyond 5 years

how to use pacifier in babies?

                                                         how to use pacifier in babies?                                                         
PACIFIER USE IN BABIES


sucking is a basic need of all babies. in fact babies start sucking their thumbs in the womb itself. it gives a comfort and a sense of satisfaction to the babies

thumb sucking may have some ill effects such as
                               infection
                               teeth malocclusion

we can use a pacifier in babies to prevent thumb sucking

         
 precaution while using pacifiers




-if the baby is hungry don't comfort the baby by pacifier , instead feed the baby


 -clean the pacifier properly


-don't dip the pacifier in honey (it may result in caries teeth)


 -use commercially available pacifier only home made pacifiers may lead to choking


-remove th pacifier when  the baby is sleeping


BENEFITS OF USING PACIFIER IN BABIES

     pacifiers decrease the risk of SIDS(sudden infant death syndrome) ; some babies die during sleep due to some unknown reasons. by using pacifier we can prevent the risk of SIDS

     Non nutritive sucking can be estabilished in preterm babies and sick babies with pacifiers

Update on 16/05/13

Newer study : cleaning the pacifier by parents by sucking reduces allergy and eczema in babies latter 

Infants with a diverse gut microbial flora are less likely to develop eczema and allergy.

CONCLUSIONS: Parental sucking of their infant’s pacifier may reduce the risk of allergy development, possibly via immune stimulation by microbes transferred to the infant via the parent’s saliva 
-
-

Thursday, May 9, 2013

TEETH/TOOTH DEVELOPMENT IN KIDS



Normally teeth develop from three  steps

1.Mineralization
2.Eruption
3.Exfoliation 

Mineralization of tooth starts in the crown and progresses towards the root . mineralization starts when the baby is in the womb , at around 4-6 months of intra uterine life 


Eruption starts at 6-7 months of age . eruption starts in the the center of mouth (incisors ) and spreads outwards

After the first tooth , rest of the eruption occurs at the rate of one tooth every month.Number of teeth in an infant is age in months minus 6 (10 month old infant will have 4 teeth)


Exfoliation begins at 6 years of age and continues through 12 year of age

By three years of age  kids will have  full set of milk teeth (20 in number)



Timing of eruption of teeth

Primary teething :

Birth         nil

6-7 months     central incisors

10 months    lateral incisors

12-18 months    canine teeth

2-3 years second molars


SECONDARY TEETHING


6 years        first molars

8 years   central and lateral incisors

9 years     Biscupid(anterior)

10 years     Biscupid (posterior)

11-12 years  canines

12-13 years   second molars

17-25 years  third molars (wisdom teeth)



Wednesday, May 8, 2013

DO 's and DONT 's in kids with fever

Do's and Dont's in kids with fever

1.Give adequate nutritious diet without any restrictions

2.Give plenty of liquids(hot water, vegetable soup)

3.keep the kid in a well ventilated room

4. Give a safe fever reducing drug such as Paracetamol ; never use Nimusulide or Aspirin ; However Ibubrufen can be given after Pediatrician opinion

5.Give paracetamol according to weight (as told by your Pediatrician )

6. Do sponging with tepid water if fever is high or not coming down with paracetamol

7. Consult your doctor for correct diagnosis and treatment

Dont's
1. Don't give fever reducing drug if there was no fever or only mild fever .

2.Do not panic because most fevers are viral in nature and will come down by its own

3.Do not cover the kid with a sweater or blanket . It will further raise the heat

4.Do not starve the kid and do not restrict regular diet

5.Do not start antibiotics without consulting your Pediatrician . Most fevers are viral in nature and will not respond to antibiotics

6.Do not give paracetamol with in 4 hours of previous dose . If the fever is not coming down then you can sponge the baby with wet towel

Sun protects the Heart -How ?

A new research revealed that Exposing skin to sunlight may help to reduce blood pressure, cut the risk of heart attack and stroke - and even prolong life.

Researchers have shown that when our skin is exposed to the sun's rays, a compound is released in our blood vessels that helps lower blood pressure.

The findings suggest that exposure to sunlight improves health overall, because the benefits of reducing blood pressure far outweigh the risk of developing skin cancer.

The study has been carried out by the University of Edinburgh.

Production of this pressure-reducing compound - called nitric oxide - is separate from the body's manufacture of vitamin D, which rises after exposure to sunshine.


The results showed that blood pressure dropped significantly for one hour following exposure to UV rays

Tuesday, May 7, 2013

PERIODS OF GROWTH IN KIDS


                             
PERIODS  OF  GROWTH  IN  KIDS

 

Neonate :up to 28 days

Infant : up to one year

Toddler: 1-3 years

Early childhood (pre school )– 3-6 years 

Middle childhood(school going)
            6- 12 years for boys
            6-10 years for girls

Late childhood (prepubescent)
            12-14 years for boys
           10-12 years for girls

Diaper Rash /Diaper Dermatitis

Diaper Dermatitis
diaper dermatitis /diaper rash is the most common skin problem in babies.

it is a type of irritant contact dermatitis
(Contact of urine,motion irritates the skin)

It occurs in 50% of diaper wearing babies

Main reason for the diaper rash is not changing diaper properly or frequently

Urine and motion irritates the baby skin if the diaper is not changed after soiling

Fungal infection also occurs if not treated promptly , commonest germ to grow is Candida albicans .

How to prevent and treat the rash
change the diaper often
keep the baby free from diaper for few hours
keep the bottom dry
Use water repellent barrier cream containing zinc oxide

Anti fungal agent to be used if there is an evidence of fungal lesion

Generally any diaper rash lasting more than 3 days should e treated with anti fungal drugs such as Nystatin , Clotrimazole, Miconazole