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Childhood troubles

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

MY son is two years. Over the last year, he has developed asthmatic symptoms. Initially he catches a cold which later on develops into severe cough and wheezing. This prevents him from sleeping soundly. The doctor prescribes the use of the nebuliser (with salbutamol). This is very effective and on continued use, the cough goes away. Is the use of nebuliser healthy? Is it harmful in the long-run? Is there any other way to prevent its occurrence? The cough and wheezing happens every time there is a change in season. Name withheld

Answer: Hyper-reactivity of the airway is called asthma. Your son has the classic symptoms of asthma cough and wheeze at night (often set-off by a viral infection) and responsiveness to bronchodilator therapy (Salbutamol). There are different degrees of this problem and the medication used must be titrated appropriately.

If your son gets the problem only a couple of times in the year, (with a change in the season for example) then it is appropriate that you treat him episodically with Salbutamol to relieve symptoms. If he has more frequent attacks say more than once a month, he will benefit from being on regular preventive therapy with inhaled Chromoglycate or inhaled steroids.

They may be given through a spacer device or with a nebuliser, if he is not old enough to cooperate. All drugs have their side effects but not using the drug may do more harm and it is only under such circumstances that the drug must be prescribed.

Many children with childhood asthma outgrow their symptoms in adolescence and medicines may no longer be needed then. The fact that a child has been started on medicines for asthma does not vitiate his chances of outgrowing the symptoms later.

MY daughter is two years. For the past five to six months she has constipation.We give her laxose five ml twice daily before food, which does not help. Pediatricians in Bangalore and Mangalore prescribed medication but the effect lasted only as long as it is taken. One doctor prescribed dulcolux supposit (paediatric 1 mg) if she did not pass motion for three to four days. This helps but i am afraid that this might become a habit. All blood and motion tests show negative results. Though she tries to pass motion very hard, she passes only a small quantity. Also the motion is hard. I give her fruit juice atleast once in two days and green vegetables daily. Her weight is around nine kg. Is she under weight? Her food intake is normal. Prasanna

Answer: Constipation is the infrequent passage of hard dry stools. This act of defecation is often excruciatingly painful and children tend to hold back their stools to avoid the pain. This retention causes it to dry out further and a vicious cycle begins.

It is said that the low fibre content in the modern diet is responsible. Use of more roughage in the diet or carbohydrates can prevent it. This is where leafy vegetables, whole wheat breads and fruit juices play a role.

The treatment of the condition is with laxatives. Lactulose or mineral oils or stimulant laxatives like Dulcolax may have to be used for up to six months. Parents need to be reassured that their child is not "addicted" to the medication. Stopping medication too early often results in relapse, frustration and loss of confidence in the therapy.

Regarding your question about weight: Weight in the first two years is related to the birth weight. It is difficult to comment on her present weight without reference to her growth chart. If her food intake is good and she has plenty of energy and is growing cheerfully, these are good omens.

MY grandson aged 14 years lives in the US. For about two to three years he has a habit of looking side upwards with his pupils and he stretches his neck sideways off and on. While eating he produces some sounds with his tongue pressing his mouth. The doctors there say that these are symptoms of Tourette Syndrome, which may eventually affect the brain and they want treatment to be started. Is this advisable. Name withheld

Answer: We doctors often use big terms to impress. If that does not do the trick, of course we begin to explain in Latin! If I told you that your grandson has a "tic disorder" you would not think me very clever, so I call it "Gilles de la Tourette Syndrome".

The name tells you nothing. In this instance, it is named after Georges Gilles de la Tourette who described the symptom complex in 1885. The syndrome consists of multiple motor tics and one or more vocal tics.

I assume from your short write up that he has had no problems around the time of his birth and that he has no learning difficulties or attention deficits. Such children don't all need medication. One third of children recover completely spontaneously and another third get better as they approach adulthood.

Drug therapy is considered only if the symptoms are functionally disabling. Remember, drugs may alleviate the symptoms, but not using the drugs will not aggravate the disorder or hasten the natural course of the illness.

Haloperidol-like drugs or antidepressants like Prozac are often used. These medicines have their side effects and must be taken on prescription and only under the supervision of a doctor familiar with the use of these drugs.

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