ASK THE DOC
Jacob Puliyel, Consultant Paediatrician, St. Stephen's Hospital, New
Delhi, replies to this week's queries. |
MY grandson is two and a half years and is
still being breast-fed. But if he takes any dairy product, he gets red
rashes around his mouth. He eats normal south Indian food, except for
dairy products. What is this problem and is there a remedy? Lakshmi Rengachari
Your grandchild has a form of food hypersensitivity — cow's milk
allergy. The child's immune system mistakenly sees the milk protein as
dangerous and fights it off. Children who are allergic to cow's milk
may be allergic to goat's milk and some develop allergy to soya milk
Half of all people who have food allergy
outgrow their allergy with time, often by three to five years. There is
at present no cure and the advice is simply to avoid the problematic
foods. Mothers who are breast-feeding babies with milk protein allergy
are advised to reduce their own intake of the dairy products. They need
to take dietary advice on how to get the calcium and other nutrients
from other food sources.
MY son is six and a half years old and still
wets the bed every day. He had bladder reflux when he was three and a
half and was on prophylactic antibiotic for two and half years. Could
this condition lead to bedwetting? He is now free of reflux. Rama
Your child has what is called nocturnal enuresis. A urine examination
will rule out the presence of urinary-tract-infection, which sometimes
results in bedwetting. The child's past history of reflux is not
related to the present problem.
Nocturnal enuresis may be helped by giving
small rewards for dry nights in the form of star charts and more
substantial rewards for longer dry periods. On the other hand blaming
the child for wetting the bed or scolding him is counterproductive, as
it further erodes his ego strength. Voiding before bed is important.
Often, putting on an alarm to wake and void again after two or three
hours of sleep helps.
For other aids like the enuresis alarms and
medicines you will have to meet your paediatrician. Even with no help,
most children out-grow the problem by 10 years of age.
MY daughter is three years old. She is
suffering from recurrent wheezing from the age of one. We have been
using the inhaler for two years and also giving her predone syrup
occasionally under doctor's guidance. She is also suffering from
epilepsy for the past three months. I want to know whether it is due to
the use of inhaler (derinidine) or syrup predone. Is there any other
treatment that we can giver her? Mohan Rangan
At the outset, I must confess I am not familiar with the medication she
is getting called "derinidine inhaler" unless it is a typographic error
for Terbutaline inhalers.
Many inhaled medicines given for asthma can
cause children to have tremors (become shaky) all over the body
especially of their hands. Theophyline-like drugs, used in asthma, can
cause seizures in toxic doses. Oral Predone is unlikely to be the
culprit for causing the convulsions.
It seems most likely that the recent onset
epilepsy in your child is not related to her long-standing
reactive-airway problem. It is appropriate you treat her asthma with
inhaled medicines — especially an inhaled steroid if she gets wheezy
It is also appropriate to treat the epilepsy
with anti-convulsion medication (assuming that the convulsions are not
simple febrile seizures, which do not need long term medication.) Your
paediatrician will be able to guide you about this.
MY son is two years and two months. He is
normally a very active and healthy child. When he was around one year
and eleven months, he suddenly felt dizzy and vomited. He seemed to be
smiling only to his left, within a few minutes he was all right. The CT
scan and EEG reports showed everything was normal. The doctor termed it
as mild form of fits (complex partial seizures). He was prescribed with
Tegrital (2.5ml twice a day) for one month and subsequently with
Valparin (2.5ml thrice a day). These symptoms appeared once in 15 days
and within the next 15 days it was accompanied with vomiting. Since the
symptoms did not disappear he was prescribed Frisium 5 (half a tablet
in the morning and half in the night) when it occurs more than twice a
day. At such times he becomes very tired. Still this condition
persists. Will this affect the kid's development? Is it permanently
curable? Name withheld
Your child has had focal seizures with transient weakness of the face
muscles. Tegretol and Valparin are each appropriate drugs for focal
I am, however, concerned that over a period
of less than three months, your son has been switched from Tegretol to
Valparin to Frisium in quick succession, without first trying to adjust
the dosage of the first line drugs. I would suggest that you should
consult with a paediatrician or a paediatric neurologist with
experience in managing seizures.
It is reassuring that your two-year old son
is an active and healthy child. The chances are excellent that with two
years or so of treatment, he will be "permanently cured".
MY son is six. He is very weak and thin
(weight 14 kg, height 103cm). A doctor recommended growth hormone
stimulation before and after taking the medicine arkamin (10 micro
gram). What is this therapy? Are there any side effects to it? Parental
height is 5.2" and 5". Ranjit Singh
you for including the parent's height, as it is very helpful to answer
your question. Children take after their parents, and your son is well
on his way to being as tall as you are.
Growth hormone (GH) is prescribed to children
who are growth hormone deficient. The GH levels can be tested after a
provocation test (stimulation test). Clonidine (also marketed as
Arkamin) is one of the drugs used to provoke GH level rise in the
If there is no measurable GH in the blood after this stimulation, GH
deficiency may be diagnosed. Remember that children who take after
their parental height are not GH deficient.
If your child is not GH deficient, giving GH
will result in a sudden spurt in his height but he will stop growing
early, and his final height will not be much improved. Even if GH is
not deficient, some doctors advise GH treatment. They suggest that one
or two inches may be added to the final height by using the hormone.
The costs must be borne in mind before setting out on such a venture.
The child will need injections at least three times a week for many
years. This will cost approximately Rs. 2,00,000 a year.
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