Friday, September 17, 2010

child had a fall from bed or height. what to do? when is head injury serious? any to worry?

often there are no issues if the child didnt fall from more than 2 feet or on sharps or was not dropped with force.
if there are no issues for 48 hours usually all is ok.
but very rarely some issues creep if some internal damage like say chronic subdural hemorhage has set in.
commonly kids with mild form of head trauma may develop some irritability or vomiting for few hours. if it lasts longer or if the child develops any neurological symptom like say sleepiness , lethargy, irritability or persistant vomit, it warrants a brain scan and further action.

head injury in child is significant if its a fall from more than 3 feet or its showing some symptoms.
Symptoms may be of local injury at the site of trauma,like abrasion, bruise, lacration, cuts, fracture or bleeding. can be at head, body, spine or back.

It can also cause some internal complications like internal bleeding in brain, chest or abdomen or at times thigh or muscle hematomas/fractures.

Head injury is problematic if it causes some internal problem like internal bleed, hematoma or increased pressure with or without concussions/ contusions and other shake injuries.

A major problem is expected if there is persistant vomiting, drowsiness, sleepiness, irritability,convulsion/fit altered sensorium or unconsciousness with or without weakness, headache, hypertension and bradycardia, which a doctor is keen on looking for.

The child may require some investigations including CT scan to check for major ailments asmentioned above.

Saturday, February 13, 2010

how to treat fever in children? tips and tricks

Child health specialist pediatrician Mumbai says:
Any rise in temperature is a discomfort.. and above 101F it becomes intolerable... and hence requires treatment.

'Highest level of tolerable temp' has no clinical significance as some children show symptoms of hyperpyrexia even at 103 F. and it varies from person to person.

Dr kondekar is available for private consultations at Shushrusha Hospital Dadar(w) Mumbai, monday to friday 7 to 9 pm appointment by sms 9869405747 
The question is whether do we need to treat the fever?

fever upto 101F should be watched.. as it may get cured spontaneusly and it can cure the disease at times.
High fever in children, can at times turn lethal; so observing without treatment is no wise.

How do we manage:

1.Switch on Fan /AC, not directed towards pt, air in room should be free flow.

2.take clothes off.. no blankets... a common question always asked is what to do if child is shivering...? The answer is child may shiver.. we may give blanket for 1o min only.. as shivering doesnt last longer and fever starts rising after shiver if a blanket is given. Also shivering is protective while fever may be harmful. SO do take the vlanket off by 10 min... can repeat same.

3. Give an oral antipyretic. In viral infections and malarial fever , the myalgia plays a significant role... so its better to use a combination with ibuprofen or only ibuprofen.. more symptomatic relief. wait for 10 min.

4. Fever coming down : observe. keep opne, turn to side, increase area of heat loss by radiation. ...Fever not coming down: start sponging. continuous or intermittent.

5. Sponging tricks : Keep fan on. dont get scared of shivering. Dont use ice or cold water (why? : its not required ! and it has a risk of ppting hypothermia in children.. children are scared of cold when febrile) use a wet hanky /turkish towel, make it wet.. remove excess water.. spread it over the trunk and tummy... cover maximum surface area, faster relief; till it dries off or becomes hot.. then change the towel, repeat same till temp comes down. Forehead sponging: Most of the times not reqd.. as it carries undue emphasis from movies.. and covers small area. Please dont restrict sponging only to forehead.

TricK: make scalp wet, let the forehead towel cover eyes.. that avoids pricking sensation in eyes.

6. wait another 10 minutes.. temp same or falling... observer and continue. If temperature rising.. try injectable paracetamol... by this we are just increasing the dose of PCM, changing route is only bcos child wont be in a position to take oral; one may try rectal.. equally effective.
There are different fever medicines tylenol, motrin, combiflam,inbugesic, meftal are few trade names, some are combination medicines. some doctors discourage combination medicines. They are available but should not be taken without a prescription by a doctor as some do have side effects in some individuals. 

7. Treat the cause of fever !!

Why prompt relief of fever reqd?

Annoying symptom, discomfort, feb seizure... hyperpyrexic brain damage.


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Tuesday, January 12, 2010

constipation in newborn or infant

Constipation in newborn or infant although more common in formula fed babies, it may also be seen in exlusively breastfed babies. It may be related to high phosphate and protein content of feeds by baby or mother diet.
A simple way to help in addition is avoid cow or buffalo milk or goat milk if any given to child or baby. If the baby is formula fed, add intermittent water sips between feeds, or replace one feed with water for a week. stools get hard when water content of feeds or stools get lesser or the phosphate content rises.

if the child is growing well along growth charts, then this may be a concern at times if it is asociated with bulging abdomen and in addition if the child makes faces, or appears irritable during feeds or cries at times with abdominal distension, child may be given small amount glycerine suppository (1gm Hallens)  by his doctor, alternate day for a week or teo to evacuate colon of the hard stuff, simultaneously working towards making the feeds with enough volume by maing one complete feed full liquid/thin for 10 days. sometimes manual removal of feces may be done by your doctor.

constipation at times is a surgical problem due to soem congenital gut anomalies which may require prompt surgical consultation or a sonography of abdomen.
Dr kondekar is available for private consultations at Shushrusha Hospital Dadar(w) Mumbai, monday to friday 7 to 9 pm appointment by sms 9869405747 

constipation is a chronic problem in school children, formula feds and who have rich milk intake and low calcium intake.
easiest way to improve is
1. wash of stacked piles of stools by repeated bowel wash/ enema not more than 3 a week under medical supervision till tummy distenstion goes off.
2. improve water intake not to dilute stools but more to prevent bowel tendency to retain water sensing some lack of water in body. water intake may be increased to 1.5 times of prior intake, again under medical supervision.
3. avoid constipating diet like milk, pomegrande and like others, and thos e containing high proteins
4.add softening diet like ripe bananas, rice, stool softenere
5. rest all medicines dont do much help in chronic constipations.
6. its always prudent to rule out any bowel obstruction by performing a sonography or barium meal as your doctor may suggest.

Above management is true for dietary constipation, improving activity and exercises add to the good mobility of bowel.

Dr Santosh Kondekar Mumbai

preventing febrile seizures

If the seizure had been with the fever, at the rise of fever and with no more than 1 day fever history; it is more likely to be a febrile seizure. however in developing countries hypocalcemia and tuberculosis is so common that they may get precipitated with fever as convulsions.

treatment remains same even if second opinion is taken. if the seizures are febrile by definition as above; main therapy is to prevent the fever from coming and also from rising it beyond 99 with prompt therapy. regardiung how to manage fever, please read details at my blog

if there is associated calcium deficiency or rickets or evidence or suspicion of infection like tuberculosis, it is prudent to evaluate in this direction continuing treatment for fever which may be an added antibiotic after an expert consultation.

SOme patients do need neuroimaging like MRI scan or EEG (brain graph), to decide further therapy. repeated febrile seizures may be started on drugs like clobazam for short or long term depending on clinical settings and reports.

what is more important for parents is the precautions one is supposed to take to prevent seizure from complicating at home and also learning to treat the seizure or convulsion at home.

As soon as you notice a seizure, turn the child on one side so that he wont aspirate secretions, loosen the clothes donot hold the patient tight. donot spray water or any other thing on face. keep rectal diazepam suppository handy which your doc may teach you how to use it in an emergency , that can help tackle seizure by introducing the medicine in correct dosage in the child's rectum through anus. This tricks needs to be learnt by parent or care taker. its prudent to give such therapy at home; after medical advice demosntration after a thorough consultation in individual case.

if the seizure is not tackled properly it may cause some permanant damage. seizure in a child whose milestones are delayed, usually is because of some permanant damage at brain. exntent of damamge decided extent of normalcy.

discuss with yoru doctor regarding possibility of meningitis

common cold: Treating running nose!

common cold: Treating running nose!
caring for kids, their health and illness: Child health specialist pediatrician Mumbai
Treating running nose is no big deal... but treating its complications and PNDrip (postnasal drip) is a headache for the practitioner. In fact, I had seen pediatricians admitting and sedating for 3 days to get rid off. combination decongestants for patient and family.


Running nose:

A very common problem; watery or thick.. continuous or intermittent..
with fever or without fever, yellow white.. (pardon the allergic once, they come with paroxysmal sudden sneezing and are more easy to treat... oral atihistaminics or nasal antihistaminics and or steroid inhalors.. but you too pls do read below)

watery or thick.. :

Clean nostrils with ear buds/bulb ( no ENT will advice, but i do, by cleaning I mean cleaning the alae nasae- the outer part), periodically, if its thicker.. use saline drops (nasomist spray) : no of drops + no of months of age till 8 months.. then 10 drops for all, wait 2 seconds after each drop.. then clean with ear buds once the drops are over. why more drops? - Bcos you want to douche the whole nasopharynx and clean the nose; the sticky secretions along nasopharynx will be dragged to oropharynx and then swallowed.
If its running continuously, one may prefer putting decongestant nasal drop like flucold drops.. or nasovion mini drops, ( i will avoid xylometazoline and oxymetazolien drops in children as much possible ) use only 2 to 4 drops at any age.. nose will dry within 20 minutes provided drops are put after drying the nose with ear buds.. small dose bcos we want local action. Dont keep it TDS ( 3 times a day), can be used SOS (as and when required). TDS use makes nose dry.. and the worst nose block will happen and child will be very irritable crying refusing to feeds etc. (discuss with your doc in details).

Treatment of noseblock:

commonest cause; inadvertant or TDS use of decongestant or sleeping in front of / facing fan.... stuffy nose.
saline drops: I use nasomist /normal saline drops/spray procedure as above. But keep it TDS, keep nose wet, avoid drying by air/drugs. Stop decongestant drops. If child is cranky, do a mechanical nasal suction tiding over the crisis.. the thick secretions may be difficult to suck by syringe. Give A soothing nebulisation following suction, Clinical indicator: Irritability settles, child sleeps.

Treatment of Any of above with fever ; with or without PND: combination cold syrups
Add a simple antipyretic, paracetamol: regular dose, round the clock for 2 days. If running nose, give combination with decongestant TDS orally, I find syp xxxx more effective. (though many parents complain that the taste isnt good.. let me teach you feeding medicines without having taste of it)
For PND: a good saline nebulisation with prior nasal suction and saline drop wash of nose. continue oral PCM and decongestant drops combination for 3 days.
At times a short course chemotherapy with azithromycin may help if it lasts more than 72 hrs.

The risk in any common cold or flu is the chance of it spreading down to cause bronchitis or pneumonia or bronchiolitis, though not so common. keep a watch on refusal to feed , breathless ness and worsening cough. Discuss with your doc accordingly regarding further plan.           

Persistant runny nose for more than 10 days.. suspect adenoids.
Unilateral runny nose is often due to foreign body in nose or sinusitis.
Stuffy nose with headache is due to sinusitis/allergy very often.
Runny nose with itching .. and eye itching.. is allergic, if it is aproxysmal and sudden.
Throat pain, ear pain may be a part of bacterial complications.
PND may cause burning in throat and best tackled by gargling and nebulisation.

what a parent would like to know about his kid from a doctor

what a parent would like to know about his kid from a doctor

caring for kids, their health and illness
Always ask: Layman questions:

what is my child suffering from?
Is it common? how common?
Is it serious? How serious?
nothing to worry... some thing to worry.. or critical?
any danger to life or ability?
Does it require medicines- /hospitalisation? how long? will it require a change of medicines? whats its chance?
Effect within how many hours... if no relief then what?
what i am supposed to do to keep it in check?
what parameters to monitor?
when should i consult back? or when to worry?
Anything to prevent the same?
Can it be this and that?
can he have day to day food and activities in this period?
Most of your questions are answered by your doc in first visit unless he has a very busy schedule.. and if you cant get answer even after asking these quieries then better change your doc.

also read: ask your doctor a contingency prescription (click on the link)
Avoid medical terminologies unless the child is suffering from a permanant or known disease.

The more you fall in medical terminologies; more you get confused and the more you can complicate management by correlating many things together unless you or a family member is a doctor.

The reports will confuse you more...
and many times they dont need to lead to any conclusion and you worry - what your child is having can be dangerous..
Believe in your pediatrician, clear all misunderstandings !!
ask him clinical queries-
be more concerned about child (health and disease), diet and medicines rather than biochemistry and pathophysiology.
Leave the interpretation of tests to your pediatrician
make a list of queries and get answered from your doc in single sitting.. or another for another list.
We respect your doubt to get the management confirmed by another pediatrician; you are welcome.

also learn danger symptoms before you write to me.

Your time with the doctor is valuable. Here are some tips to help improve your experience.
1. Know what medications you are taking. Have an updated list or bring in your medication. What you are actually taking may not match what the doctor has in his records. Herbal supplements and vitamins should also be on your list.
2. Have a written list of the 3 most important things you want addressed by your doctor. Also have a list of questions you would like answered for each of the items on your concerns. If it helps, you may write down your symptoms.
3. For important discussions, bring a family member with you. An extra set of ears can help reinforce what the doctor is trying to tell you.
4. Avoid talking about the health of other people. The doctor's primary concern during a visit is to you

Advice prepared by Dr santosh Kondekar, Mumbai india, THE ONLINE CHILD SPECIALIST