Date:30/10/2005 URL: http://www.thehindu.com/thehindu/mag/2005/10/30/stories/2005103000330700.htm
Coping with childhood illnesses
My son is 11 years. When he was three or four, he was treated for Primary Complex (PC). In his ninth year, he would run temperature up to 104� for a week. This happened every month and he was admitted to hospital twice. We were then informed that the PC was again positive and he was under treatment for six months. For the past six months, he gets fever for 2-3 days, with cold, leg pain, mouth ulcer and mild headache. But after this, he is alright. Weight loss is around 1-1.5 kg. His weight is now 29.5 kg. Kindly advice.
Dr. Jacob Puliyel, Consultant Paediatrician, St. Stephen's Hospital, New Delhi, replies:
Children get 6-8 episodes of upper respiratory infection annually, and 10 to 15 per cent children get up to 12 such infections in a year. As such, the fact that your child gets a "cold" every two months is not alarming. It is not an indication that he has tuberculosis again. His weight of 29.5 kg is normal and 10 per cent of normal children will weigh less than him. It would seem that your child is quite normal and you need not worry about him.
Q: My 13-year-old child still bed wets. All medical checks were undergone and there were no problems. What should my son do in order to avoid this embarrassing situation? The doctor says that he is a deep sleeper and does the bed wetting in unconscious state. Please advice.
A: Your son has what is called "nocturnal enuresis". This is not very uncommon even at his age. In every group of 100 boys who are 13 years old, there will be two boys who have bed-wetting. It is an involuntary act and it does not help to punish him or humiliate him. However, there are some ways to overcome the problem. Not drinking much fluid for three hours before bedtime and emptying the bladder before going to bed may help. Use of incentives like star charts and small rewards for dry nights benefits some. Use of a conditioning devise — an alarm that rings when the child wets a special sheet — produces good results. Finally, two drugs may be used on prescription from your doctor — Imipramine tablets taken at bedtime or a nasal spray of desmopressin. But these have side effects and must be taken only on prescription.
Q: My daughter is 11 but was not given the Rubella vaccine in childhood. Is it possible to give the vaccine now or should it be later?
A: Rubella is a mild infection causing a rash and some enlargement of lymph nodes (glands) in the neck. However, maternal infection during pregnancy can cause serious damage to the baby, which may develop congenital cataract, deafness, heart defects and mental retardation. So it is important to vaccinate girls before they reach childbearing age. Eleven years is an appropriate age to vaccinate your daughter who has not been vaccinated earlier.
Q: I am 24 and my baby was born two months ago. I had a normal delivery but the baby had a shouldre dustocia (Erbs palsy). A child specialist, neurologist and orthosurgeon, who examined the child, say recovery will take time and they recommended physiotherapy, which was started when the baby was 21 days old. The treatment now is 21 days of stimulation and 10 days rest. The child is also being given the syrup Predone. How much time will it take for recovery? Will he able to work with his right hand?
A: Erbs palsy is due to injury to the nerves that occurs as the baby is born especially if the shoulder is difficult to deliver. The nerves are usually stretched and full recovery occurs in most babies The only treatment needed is intermittent splinting and, after seven to 10 days, physiotherapy in the form of gentle massage and passive movement of the limb. Your baby is only three weeks old. If the paralysis persists without improvement for three to six months, it may be because the nerve is not merely stretched but has been lacerated (broken). Neurosurgery and end-to-end anastomosis then offers hope for partial recovery at that stage.
Q: My niece is 12 and is yet to attain puberty. She is learning vocal music and her voice is very deep. She has a pencil-thin moustache on her upper lip. A child specialist said all would be okay after her puberty. Do we need to have any medical or any other procedure at this juncture? Or should we wait for some more time until her puberty?
A: The type of hair growth on the upper lip is entirely normal in girls of her age. I agree with your paediatrician that no treatment is indicated now. It would help, if the child were not made to feel self-conscious about this.
Q: We have a girl of five years. She refuses to eat rice. She eats one kind of "tiffin" one day but refuses it the next day. She does not eat anything at night except a banana and a cup of milk. The next morning she seems to be hungry and has a cup and a half of Complan. She looks frail but her body weight for her age seems normal. Please advise.
A: Excessive parental anxiety about a child's weight and health often leads to food forcing. This may take the form of the use of distraction, so food can be pushed in. Some children are allowed to dictate exactly what they like to eat. This is also a manifestation of food forcing. Food forcing leads to negative conditioning and the child develops a dislike for food. It would appear that this is beginning to take place in your family. Under the circumstances it is important for parents to believe the weight chart. Your child has normal weight for her age, so she is not frail. Once you are convinced about this, you could give up food forcing. The child can be asked to eat with everyone else at meal times. If she says she is not hungry, she need not eat, but no snacks must be allowed in between meals. This will help normalise her eating habits and help her grow with a healthy attitude to food.
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