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Ask the Doc

Dr. Jacob Puliyel, Consultant Paediatrician, St. Stephen's Hospital, New Delhi, replies to this week's queries:

MY son, three years and eleven months old, has been prescribed seroflo inhaler for consistent cough in the night and some times during the day. The doctor suggested the inhaler because I was asthmatic. How safe is the drug for my son's allergy or asthmatic symptoms? Is there any way to find out if he has asthma? Ram Prakash

Answer: Children with asthma have difficulty breathing out, as their air tubes are partially closed and this results in an audible wheeze. Not all nocturnal cough is asthma but some children manifest with nighttime coughing. The associated wheeze helps confirm the diagnosis of asthma.

Occasionally the diagnosis is made with breathing tests called spirometry, or with Peak Flow measurements. If the use of a bronco-dilator improves the child's ability to breathe out by 15 to 20 per cent, it is evidence of `reactive airway disease' or asthma. The fact that you, as the father, have asthma suggests that your son could have inherited that atopic tendency.

However the choice of Seroflo as first line treatment for mild to moderate asthma is unusual. Ordinarily, the standard protocol is to use inhaled steroids or cromoglycate as first line preventive treatment. Inhaled steroids have been shown to reduce the long-term damage to the lungs by inflammation of the airways. Seroflo, on the other hand, is best used if the asthma is so severe and inhaled steroids alone have not brought relief. It may be advisable for you to consult with another paediatrician who is used to treating reactive airway disease in children.

MY nine-month-old daughter has had a persistent wheeze since August and was treated intermittently with Asthalin and nebulisation. Her paediatrician now suggests that we begin inhalation treatment with Seroflo 125. Is she too young for this treatment or is it advisable to begin as early as possible? Also, how can we confirm whether or not she has asthma? Name withheld

Answer: Asthma is a diagnosis we tend to make after the age of one year and sometimes after the age of two. The diagnosis is given to children who get repeated reactive airway disease and who get relief with the use of bronco-dilator medicines. Or else it may be diagnosed on the basis of a wheeze provoked by exercise or some drugs. Your child at nine months is far too young to be able to do these tests. When children under one year of age get a viral infection, especially with a virus called Respiratory Syncytial Virus (RSV), they react with wheezing and cough and breathlessness. They respond to the usual asthma medicines. Many of them get better with time; not all grow up to become asthmatic children. Regarding the use of Seroflo, I would strongly advise against use of this drug under the age of four years. There are many other anti-asthma medicines that can be used safely by very small children but the manufacturers do not recommend Seroflo for children under four years.

MY daughter is nine months old. At the time of feeding (solid food) she spits it out and I have a tough time feeding her. (This habit of spitting has developed very recently. She was all right till eight months). Is this normal or new to my baby? I am worried that she may not grow properly if she does not eat well. What should be the time gap between two feeds? Is there any chart/timetable for baby feeding? She keeps sucking her thumb, but when I try to feed her she refuses. Is this normal? Ankita

Answer: You have not told me the child's weight and I presume that she is of normal weight (that she is about two and a half times her birth weight.) Thumb sucking is a pleasurable activity for the child and not a sign that the child is hungry. Food refusal is common as you approach the age of one year. The appetite comes down naturally at around this time, as weight gain slows down. Parents resort to force-feeding in the mistaken belief that the child is not getting sufficient nutrition. There is no need to feed the child by the clock. Two semi-solid meals and three milk feeds may be all that she requires. Even if this is not achieved, do not worry if the child's weight is adequate. Please remember force-feeding is harmful. Meal times need to be pleasant experiences for the child.

MY son, eight years, is in the third standard. He is an only child. The problem is that he is slow i.e. to understand, in writing, not being able to communicate in a meaningful manner what he thinks, needs to be taught even the small things he has to do, lack of initiative to do on his own. However, he has an excellent memory and score centums or 90+ in his CBSE school subjects. His vocabulary in English is also good. In order to help him mingle with other children, we put him in cricket as well swimming classes since last one year. The feedback we get from all his coaches/teachers is that he is slow in his activities and does not have the maturity for his age. Should we consult a psychiatrist? Is there a problem with the child? Name withheld

Answer: Yours is a very difficult question to answer because it is difficult to get a good picture of the child's problem. On the one hand he is reported as being `slow in understanding and communication' and on the other you say he scores 90+ and his vocabulary is excellent. You ask if you should show him to a psychiatrist. Is it possible that he may be a normal boy though slightly introverted? Are parental aspirations for this only child excessive and is he being pushed into activities like cricket and swimming for which he has no passion and so he shows no interest in it? By all means show him to a paediatrician. Get a thyroid function test done, as thyroid deficiency can cause slowness. If the thyroid functions are normal, you have your work cut out. Find out what he is good at and continuously praise him for that. Celebrate and encourage all the things he does well. Ignore all the things he does not enjoy doing. Then sit back and see him blossom. Applaud him all the way.

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