DO NOT USE THE INFORMATION YOU FIND ON THE INTERNET TO TRY TO DIAGNOSE OR TREAT YOURSELF. Print out information of specific interest or concern and bring it with you to your next appointment. Your caregiver will help assess the information and how appropriate it is for you. Always check with your caregiver about information.

Many people look for health information on the Internet.Some information on the Internet is reliable while some is not. Many websites are useful, but others may be inaccurate or misleading. It is important to figure out how reliable it is. How can you tell whether a source of health information on the Internet is trustworthy?

.Ask questions about what you have learned. You can also check different sources. This way you can see if they all agree on what you found. Websites often track visitors’ paths to determine what pages are being viewed. A health website may ask you to “subscribe” or “become a member.” In some cases, this may be so that it can collect a user fee or select information for you that is relevant to your questions. In all cases, this will give the site personal information about you. Credible sites asking for this kind of information should tell you exactly what may done with it. Be sure to read any privacy policy on the site. Don’t sign up for anything that you do not fully understand.

E-mail messages from websites should be carefully evaluated. The origin of the message and its purpose should be considered. Who runs the site. If the person or organization in charge of the website did not write the material, the original source should be clearly listed.

If you use the Internet on a particular website, look for an “about us” page. Check to see who runs the site:Is it a branch of the government, a university, a health organization, a hospital or a business?Does the site have an editorial board? Is the information reviewed before it is posted?If the website is a business, what are they trying to sell you? Could that influence what they say about a particular health problem?

Keep a questioning and skeptical attitude towards health information until you are confident in the source. Things that sound too good to be true often are.To protect your health and safety, you need current, unbiased information based on research.World Wide Web search engines such as Google can be used to find information about medical questions. Some websites are designed to provide expert medical information.Web addresses ending in “.gov” indicate that it is a government sponsored site.Web addresses ending in “.edu” indicates an educational institution.Web addresses ending in “.org” a noncommercial organization.Web addresses ending in “.com” a commercial organization.In addition to identifying who wrote the material you are reading, the site should describe the evidence (such as articles in medical journals) that the material is based on.Opinions or advice should be clearly set apart from information that is “evidence-based” (that is, based on research results).If a site discusses health benefits people can expect from treatment, look for references to scientific research that clearly supports what is said.Remember that testimonials, anecdotes, unsupported claims, and opinions are not the same as objective, evidence-based information.Websites should be reviewed and updated on a regular basis in order to remain current with the latest medical science. Outdated content can be misleading or even dangerous. The most recent update or review date should be clearly posted.

Viral hepatitis is infection and inflammation of the liver caused by a virus leading to jaundice. Different types of hepatitis are caused by different viruses. Your child may have hepatitis A and Hepatitis E transmitted through contaminated food and water, hepatitis B and Hepatitis C are mainly transmitted through blood contacts or contaminated needles. Other viruses can also cause hepatitis.

In monsoon season, chances of hepatitis increases due to contaminated food and water supply. Sometimes there are outbreaks at day care centers, schools or restaurants. Hepatitis A Vaccines are available for prevention of hepatitis A.

Hepatitis A /E are caused by exposure to another person with hepatitis A /E or from swallowing or eating contaminated with the infected person’s bowel movement. This may happen, for example, if someone who does not wash his hands after using the bathroom then prepares food for others to eat. Symptoms may appear 2 to 7 weeks after exposure. Vaccinated children may still have Hepatitis due to other viruses or inadequate take up by the body.

What are the symptoms?

Children under 6 years old often have no symptoms. Teens and adults usually have symptoms.

Symptoms of hepatitis include:

• fever
• loss of appetite
• itchy skin
• nausea, vomiting, and diarrhea
• tiredness
• muscle and joint aches
• yellow color of the skin (jaundice)
• darker yellow or orange color of the urine
• gray-colored bowel movements
• Pain on the right upper side of the abdomen (belly).

Hepatitis A/E usually starts with fever, feeling weak, not interested in eating, nausea and vomiting sometimes with pain in the abdomen. Hepatitis A symptoms usually last less than 2 months, but may last up to 6 months.

What is the treatment?

• The best treatment is to make sure your child drinks a lot of fluids and eats well. Child should avoid eating fatty foods. Child should rest while he or she has fever or jaundice.
• Your child should not take any medicines, prescription or nonprescription, without consulting your Pediatrician OR Pediatric Gastroenterologist.
• Do not give any herbs, vitamins or other supplements without checking with your doctor first. Some may affect the liver or have unexpected side effects. Once your child recovers from hepatitis A/E, the virus usually leaves the body.

Consult Pediatric Gastroenterologist if child is confused, is difficult to wake up, is lethargic (sluggish) or irritable, unable to drink fluids, getting much more yellow, black colour stools, bleeding tendencies, persistent vomiting, blood in Vomitus, abdominal distension, any signs of dehydration such as no urine in over 8 hours or a dry mouth.

Jaundice is defined as yellowish discoloration of eyes, urine with other complications. Jaundice results from infection or inflammation of liver (major digestive organ). In preventable jaundice series we would highlight on common available vaccines and other preventive measures. Pediatric gastroenterologists deal with liver failure in children. Acquired Liver failure is one of the major causes of morbidity and mortality in school going children.

HEPATITIS A is the most common cause of acute liver failure in children in India. Hepatitis A is a serious liver disease caused by the hepatitis A virus. It spreads by eating contaminated food or drinking contaminated water containing HAV virus. Children with hepatitis A often have to be hospitalized (up to about 1 person in 5) Death as a result of hepatitis A (about 3 to 5 deaths per 1,000 children).

But good news is: Hepatitis A vaccine can prevent hepatitis A. Contact  your pediatrician /Pediatric GASTROENTEROLOGIST for details, information given over here is for educational purpose.

To whom vaccine can be given?

All children above 1-2 years of age, Persons who use street drugs, children with chronic liver disease, children who are treated with clotting factor concentrates, who work with HAV in research laboratories or outbreaks of hepatitis A infection in community can receive vaccine.

How to give?

Vaccine is readily available at all practicing pediatricians’ hospitals. Two doses of the vaccine are needed for lasting protection 12 month apart. The vaccine series should be started at least one month before traveling to infection prone area. Persons who get the vaccine less than one month before traveling can also get immune globulin.

Any precautions before taking vaccine?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. But getting hepatitis A vaccine is much safer than getting the disease.Anyone who has ever had a severe (life-threatening) allergic reaction to a previous dose of hepatitis A vaccine should not get another dose. Anyone who has a severe (life threatening) allergy to any vaccine component should not get the vaccine. Anyone who is moderately ill at the time vaccination should wait till they recover. Ask your pediatrician before getting it. The safety of hepatitis A vaccine for pregnant women has not been determined.

Hepatitis B is a serious disease that affects the liver. Liver failure, liver cancer, Liver cirrhosis  all  are  complications of  hepatitis B .Acute illness as well as chronic illness are known with hepatitis B . Children who become infected usually do not have acute illness. Chronic infection is more common among them. Each year about 3,000 to 5,000 people die from cirrhosis or liver cancer caused by HBV.

Hepatitis B virus spreads through contact with the blood or other body fluids of an infected person, sharing needles when injecting drugs, unprotected sex with an infected person and from mother to child during pregnancy. Hepatitis B vaccine can prevent hepatitis B, and the serious consequences of HBV infection, including liver cancer and cirrhosis.

To whom vaccine can be given?

All children should get their first dose of hepatitis B vaccine at birth and should have completed the vaccine series by 6 – 18 months of age. All unvaccinated adults or children at risk for HBV infection should be vaccinated. If you are pregnant and infected from Hepatitis B to reduce risk of transmission to your child some drugs in third trimester may be suggested by doctor. Newly born child should complete vaccination series and immunoglobulin as required to reduce the risk of transmission. Consult Pediatric gastroenterologist if in doubt. Your child may need long term follow up and appropriate early treatment .

How to give?                                                                    

Vaccine is readily available at all practicing pediatricians’ hospitals. About 3 doses of the vaccine are needed for lasting protection. For details contact health care professional. Hepatitis B is a very safe vaccine. Most people do not have any problems with it.

Any precautions before taking vaccine?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. But getting hepatitis B vaccine is much safer than getting the disease. Anyone with a life-threatening allergy to baker’s yeast or to any other component of the vaccine, should not get hepatitis B vaccine. Anyone who has had a life-threatening allergic reaction to a previous dose of hepatitis B vaccine should not get another dose. Anyone who is moderately or severely ill when a dose of vaccine is scheduled should wait until they recover before getting the vaccine. Vaccine site Soreness, mild fever may happen after vaccination.

More than 200 known diseases are transmitted through food and water. Viral hepatitis is one of those food borne illness which can lead to childhood liver failure .Some of the preventable measures are as follows:

1. The risk of food borne disease is minimized by careful attention to selection of foods.
2. Proper cleaning of cooking surfaces used for preparation of raw foods is very important step to avoid infections.
3. Personal hygiene of food handlers mostly mothers during cooking is utmost important. One should trim nails. Use nail paint remover prior cooking. Hands should be washed properly. Clean hands without threads, bangles reduce the source of contamination. Prior food ingestion washing hands with soap and water should be taught to children and should be practiced by all family members .Children usually follow elders. Hence the responsibility. Water source and distributing system should be regularly checked and cleaned. Boiled and filtered water is always preferable.
4. Cooking immediately before serving is often overlooked but important aspect.
5. Value of proper storage in clean containers is reinforced. Manufacturer guidelines should be followed.
6. Raw foods of animal origin require particular attention,e.g. poultry, beef, pork, unpasteurized (raw) milk, uncooked eggs, and uncooked shellfish.
7. Children may be inadvertently infected when mothers/caretaker touch their bottles or toys without washing their hands after handling contaminated foods.
8. Widespread use of hepatitis A vaccine will reduce food borne transmission of hepatitis A virus.
9. In working mother scenario hygiene measures of other child caretakers should be checked periodically.

10.WE SHOULD ALWAYS FORESEEà PREVENTION IS BETTER THAN CURE.

People at greatest risk of severe disease like young infants and people with chronic liver disease, decreased gastric acidity, and acquired or congenital immunodeficiency as well as people who seek to minimize their risk of illness should avoid foods such as uncooked shellfish, raw sprouts, raw milk, or incompletely cooked eggs.

Recurrent abdominal pain (RAP) syndrome is a common cause of repeated belly ( abdominal) pain in otherwise healthy children. It is a common cause for missing school and other activities. Common symptoms of RAP include:Repeated episodes of belly pain – usually around the belly button,Pain that lasts 1 to 3 hours,The child often lies down with the belly pain.,After the pain, the child acts normally.

Pediatric Gastroenterologist may suggest writing down: When the pain comes. How long it lasts.

What helps? Where the pain is located? . Aggravating or relieving factors. Most of time, cause is trivial and pain can be controlled by medicines after appropriate diagnosis.

Your pediatric gastroenterologist may suggest trial of medicines or if necessary blood investigations /sonography.

 Pediatric endoscopy to find the exact cause of abdominal pain is a safe procedure in experienced hands.

Consult Pediatric Gastroenterologist immediately if:

• The pain is worse or more frequent.
• The pain is located in one place (other than the belly button).
• Pain wakes your child up at night.
• Pain comes with eating.
• Unexplained fever.
• Weight loss.
• Diarrhea or constipation.
• Feeling sick to one’s stomach ( nausea) or repeated vomiting.
• Excessive belching.
• Your child looks pale, tired or disoriented during or after the pain.
• Urinary pain or frequent urination.
• Blood in stools (red, dark red, or black stools).

In above circumstances Cause of abdominal pain needs to be explored.

Empirical Treatment may subside pain for a while but recurrences are known.

If no cause identified, pain is likely due to sensitized developing GUT and due to psychological factors.

 Appropriate treatment is possible with early consultation.

 It’s important to highlight few health issues in school going children. First and foremost we should recheck child’s immunization status. Basic vaccination includes: BCG, TRIPLE. OPV, Measles. All basic vaccinations are available with most of Government health centers. We should make sure children are vaccinated before going to school. Additional vaccines like pneumococcal vaccines after discussion with your Pediatrician can be given.

Spread of infections among children is quite common. Basic hygiene measures and cleanliness should be taught and reinforced. We recommend once a month health period at school which teaches children regarding preventive aspects of diseases, health education, health safety, and tips.

Some children need special care. Early identification of children with learning disabilities is important. Poor handwriting, poor spelling, inattention in classes, Hyperactivity, violent or in appropriate behaviour should not be taken lightly and needs due consideration. Bullying is growing problem in schools by senior grade students. Depressed child, change in habit or behaviour should be noted to prevent bullying.

Some children cannot see on blackboard due to refractive errors. Parents should ask specifically for vision problems if any for early diagnosis and appropriate treatment.

Avoid sending children to school with conjunctivitis, severe cough, skin rash with moderate fever, moderate to severe diarrhea with dehydration. It helps not only in early recovery but also prevention of spread of infection.

Jaundice is commonly seen in rainy seasons due to contaminated water or food ingestion .Street food, junk food should be avoided. Recurrent abdominal pain is also important aspect and should not be neglected in school going children. Early consultation with pediatric gastroenterologist and hepatologist is advisable.

Safety measures of walking on street, crossing lanes. Safety measures while playing, should to taught and reinforced to school going children. Parent meetings are important where one to one discussion is possible between teachers and parents. Active involvement of School pediatrician is encouraged in these meetings for health issues. Health record maintenance with separate grading system like A/B/C would improve child’s view towards personal health in long run.

Vomiting and diarrhea are mainly due to problems of stomach and intestines. Vomiting and diarrhea in children are often caused by a virus infection. Vomiting usually lasts a few hours. And diarrhea may last a couple of days in most situations. Other cause of vomiting includes head injury, abdominal injury, infections in other part of body, side-effects of medicines. Proper diagnosis leads to proper treatment. Diarrhea and vomiting is one of the major reasons for childhood hospitalization.

In viral infections of intestines antibiotics are not required. We should keep a watch on urine output. Lower the urine volume more is the dehydration. Unnecessary, stopping breast milk in infants, milk in children should be avoided. ORS should be given add libb. Fruit juices should be avoided. IV fluids are needed for severe dehydration. If your child’s diagnosis is not clear, tests may be needed.

Give your child a normal diet unless told otherwise. Avoid high fat foods. Do not force your child to eat. It is common for a child to have little appetite when vomiting. If vomiting right after nursing, nurse for shorter periods of time more often. If vomiting is better after 3 to 4 hours, return to normal feeding schedule. If your child has started solid foods, do not introduce new solids at this time.

 Replace any fluid losses from diarrhea and vomiting with ORS or clear fluids. Prevent the spread of infection by washing hands. Prevent diaper rash by frequent diaper changes, cleaning the diaper area with warm water on a soft cloth.

Contact Pediatric Gastroenterologist /pediatrician immediately if:

Confusion or decreased alertness, Sunken eyes, Pale skin, Dry mouth, No tears when crying, Rapid breathing or pulse, Weakness or limpness, green or yellow vomit, abdominal pain, Vomiting red blood, Severe headache, bloody Diarrhea, fever uncontrolled by ,medicines.

Colic is a term used to describe when a healthy baby cries or screams loudly, often for a long time (sometimes hours), for no clear reason and cannot be soothed. Crying can happen suddenly without warning at any time, but it often occurs at the end of a day. It is common and affects up to one third of babies in their first 3 months of life.

Colicky babies generally have no pain but don’t understand why it occurs. Colicky crying usually begins in the first couple of weeks after birth. It’s often worst at about 6 weeks and usually stops by 4 months. It’s not caused by bad parenting, being a single parent, or postpartum depression. It doesn’t affect normal development. EXACT CAUSE of infantile colic is not known to modern medicine.

Continuous crying or screaming loudly for no clear reason means a colicky baby. Babies may pull up their legs, arch their back, clench their fists, grimace, or look flushed. Physical examination BY Pediatrician to make sure no other serious medical problem as cause of infantile colic needs to be done. Other tests may also be done or pediatric gastroenterologist opinion may be consulted to rule out congenital problems of developing gut or digestive system which can cause similar kind of problem.

Treating colic can be difficult and frustrating. It mainly involves trying different things that might help. If the baby is breastfed, mother avoiding foods that could stimulate the baby, such caffeine-containing foods (coffee, tea, chocolate) or foods containing substances that may cause an allergic reaction, such as dairy foods and nuts is important.

Try things that usually stop your baby from crying, such as offering a pacifier, singing, walking or driving in the car, or gentle rocking. Hold your baby upright and walk the baby around.  Put your baby on your lap and gently massage the baby’s back.

DO ask for help if you feel unable to cope or are about to lose emotional control. DON’T worry too much about colic. Colic has no effect on a baby’s health or development. DON’T shake a baby .DON’T cover a baby’s face with a pillow or other object to quiet the crying.

In case of emergency  or uncontrollable cry , baby being drowsy , not accepting feed  or excessive irritability or abdominal distension , persistent vomiting , loose motions , fever  ,contact your  health care professional immediately

Irritable bowel syndrome (IBS) is a common chronic digestive disorder that does not have a known cause. IBS affects many people of all ages, including children. IBS is not a disease–it is a syndrome. A syndrome is a group of symptoms that occur together. IBS is thought to be a functional disorder because it is caused by a problem in how the intestines, or bowels, work. This means there is nothing wrong with the way your intestines are made, but there is something wrong with the way things are working. Children with IBS tend to have overly sensitive intestines that have muscle spasms in response to food, gas, and sometimes stress. These spasms may cause pain, diarrhea, and constipation. Children with IBS may also have headache, nausea, or mucus in the stool. Belching, heartburn, trouble swallowing and quickly feeling full with meals can occur. Stress does not cause IBS, but it can trigger symptoms.IBS may cause recurring abdominal pain in children. The diagnosis of IBS is based on having any two of the following:

• Pain that is relieved by having a bowel movement.
• The start of pain is associated with a change in the frequency of stools.
• The onset of pain is associated with a change in stool consistency.

An important part of the diagnosis is that symptoms must be present for at least 12 weeks in the preceding 12 months. In children and adolescents, IBS affects girls and boys equally and may mostly cause diarrhea, mostly cause constipation, or have a changing stool pattern. Increased diarrhea may happen just before menstrual periods. Bloating and a sense of incomplete bowel emptying can occur. An urgent need to have a bowel movement can occur.

Bowel training to teach the child to empty the bowels at regular, set times during the day may also help.In children, IBS is treated mainly through changes in diet. Eating more fiber and less fat may help prevent spasms. Avoid caffeine. Your child’s caregiver may suggest keeping a daily diary of symptoms, events and diet. This may help identify things that trigger symptoms. A trial diet of removing triggers can then be tried. Since milk sugar (lactose) can sometimes make IBS worse, your child’s caregiver may suggest a diet without milk products. If gas and bloating are a problem, a trial diet without these foods may help:Beans,Cabbage,Broccoli,Cauliflower,Brussel sprouts.Avoid chewing gum, carbonated drinks and eating quickly. These cause gas and more discomfort. Treat your child normally. Avoid a lot of attention for the pain. Encourage normal activities and school attendance.

WHEN TO CONTACT PEDIATRIC GASTROENTEROLOGIST?

1. If abdominal pain is severe /awakening child in night/school absenteeism
2. If diarrhea or loose motions severe to cause dehydration.
3. If there is blood in stools/vomiting.
4. Child is not gaining weight.

Almost all children have small, brief episodes of reflux. It’s the most common disorder of

 esophagus in children of all ages .Reflux is when stomach contents go into the esophagus (the tube that connects the mouth to the stomach). This is also called acid reflux. It may be so small that children are not aware of it. When reflux happens often or so severely that it causes damage to the esophagus it is called gastroesophageal reflux disease (GERD).

A ring of muscle at the bottom of the esophagus opens to allow food to enter the stomach. It closes to keep the food and stomach acid in the stomach. This ring is called the lower esophageal sphincter (LES). Reflux can happen when the LES opens at the wrong time, allowing stomach contents and acid to come back up into the esophagus.

Most infants with GER are happy and healthy, even though they sometimes spit-up or vomit. Physiological GER can also occur when babies cough, cry, or strain. When the GER is more severe, it becomes abnormal GER.

When to call pediatric gastroenterologist?If your child has any of the following symptoms:

• Stomach contents coming up the esophagus – even to the mouth
• Belly pain – usually upper.
• Poor appetite.
• Heartburn.
• Sore throat.
• Hoarseness.
• Long-standing cough
• Throat clearing.
• Asthma

INVESTIGATIONS: Endoscopy –A small flexible tube with a very tiny camera is inserted through the mouth and down into the esophagus and stomach. The lining of the esophagus, stomach, and part of the small intestine is examined. Biopsies (small pieces of the lining) can be painlessly taken. Other investigations like Ph monitoring may be asked by pediatric Gastroenterology.

TREATMENT:

• Antacids.
• H2 blockers to decrease the amount of stomach acid.
• Proton pump inhibitor (PPI)..
• Medicines to protect the lining of the esophagus.
• Medicines to improve the LES function and the emptying of the stomach.

In severe cases that do not respond to medical treatment, surgery to help the LES work better is done.

HOME CARE INSTRUCTIONS

• Have your child eat smaller meals more often.
• Avoid carbonated drinks, chocolate, caffeine, foods that contain a lot of acid (citrus fruits, tomatoes), spicy foods and peppermint.
• Avoid lying down for 3 hours after eating.
• Avoid exposure to cigarette smoke.
• Avoid eating 2 to 3 hours before bed.
• If your child is overweight, weight reduction may help GERD. Discuss specific measures with your child’s caregiver.

DOs and DON’Ts

• ✔ DO burp your infant frequently, give smaller and more frequent feedings and keep them upright for 30 minutes after feedings.
• ✔ DO give your child a healthy diet, rich in fruits, vegetables, and low-fat dairy products.
• ✔ DO make sure that your child has a healthy body weight.
• ✔ DO give medicines recommended by your child’s doctor.

􀀻 DON’T give your child refl ux-inducing foods, citrus fruits and juices, coffee, peppermint, chocolate, and spicy foods.

􀀻 DON’T let your child eat large meals.

􀀻 DON’T feed your child too close to bedtime.

􀀻 DON’T let your child lie down just after eating.

FORMULA FEEDS:

Breastfeeding is always recommended as the first choice for feeding your baby. This is sometimes called “exclusive breastfeeding.” Many diseases can be prevented by doing sole breast feed till first 6 months.In some special conditions after consulting your pediatrician you may decide to start the child on top milk/formula feeds. But beware you have to be more hygienic/clean and chances of infections further may increase.

The baby’s mother might not be physically able to breastfeed. The mother might not be present. The mother might have a health problem. She could have an infection. Or she could be dehydrated Some mothers are taking medicines for cancer or another health problem. These medicines can get into breast milk. Some of the medicines could harm a baby. Some babies need extra calories. They may have been tiny at birth. Or they might be having trouble gaining weight. These are some of the conditions where formula feed is needed after consulting pediatrician.

PRECAUTIONS

Make sure you know just how much formula the baby should get at each feeding. Do not add cereal to the milk or formula, unless the baby’s healthcare provider has said to do so. Always hold the bottle during feedings. Never let the baby fall asleep with a bottle in the crib. Never feed the baby a bottle that has been at room temperature for over two hours or from a bottle used for a previous feeding. After the baby finishes a feeding, throw away any formula left in the bottle.

Cleanliness is very important. Everything used to prepare a bottle of formula must be as clean as possible. Wash all supplies in warm, soapy water. This includes bottles, nipples, and rings. Boil water. Then put all bottles, nipples, and rings in the boiling water for 10 minutes. Let everything cool before handling it.If you are going to use well water or bottled water to mix the formula, boil it first. This should also be done if you are worried that your water supply is not safe. If you boil water, make sure it boils for at least 1 minute. Then let it cool before using it for the formula. Wash your hands with soap and water.

Read the directions on the can or bottle of formula you are using. Follow them carefully. If formula came from the refrigerator, warm it up. Hold it under warm, running water or place it in a pan of hot water for a few minutes. Never use a microwave to warm up a bottle of formula. Test the temperature by putting a few drops on the inside of your wrist. It should be warm, but not hot. Find a location that is comfortable for you and the baby. A large chair with arms to support your arms is often a good choice. You may want to put pillows under your arms and under the baby for support. Support the baby’s head in the crook of your arm. Cradle him or her at a slight angle. The baby’s head should be higher than the stomach. A baby should not be fed while lying flat. Hold the bottle of formula at an angle. The formula should completely fill the neck of the bottle. It should cover the nipple. This will keep the baby from sucking in air. Swallowing air is uncomfortable. Let the baby tell you when he or she is done. The baby’s head might turn away. Or, the baby’s lips might push away the nipple. It is OK if the baby does not finish the bottle.Donot forget burping. Take help of your family members . Consult Pediatrician if in doubt.

Food allergies occur from eating something your baby is sensitive to. Food allergies occur in all age groups. It may be passed to you from your parents .Some common causes are cow’s milk, seafood, eggs, nuts (including peanut butter), wheat, and soybeans. A food allergy occurs when the body reacts to proteins found in food. In the most common type of food allergy, the immune system creates chemicals usually made to fight germs ( antibodies). These chemicals cause problems when the protein is eaten. Problems can also happen when the food is touched or bits of food get into the air (such as while cooking) near someone who is allergic. Even very small amounts of a food can cause a reaction. Severe reactions can be sudden and potentially fatal. The type of food allergy can vary from mild to life threatening ( anaphylaxis). It is impossible to predict what the next reaction will be like based on previous reactions.some times passing blood in stool of 8-12 month old kid may be because of cow’s milk allergy.Long standing diarrhea or even constipation may be cause of food allergy. Consult your pediatric gastroenterologist / pediatrician / immunologist for further details.

Symptoms of food allergy:

• Swelling around the mouth.Itchy red rash.Hives.Vomiting.Diarrhea.Severe allergic reactions are LIFE-THREATENING. This reaction is called anaphylaxis. It can cause the mouth and throat to swell. This makes it hard to breathe and swallow. In severe reactions, only a small amount of food may be fatal within seconds.

HOME CARE INSTRUCTIONS

If unsure what caused the reaction, keep a diary of foods eaten and symptoms that followed. Avoid foods that cause reactions. If hives or rash are present:

• Take medications as directed.
• Use an over-the-counter antihistamine ( diphenhydramine) for hives and itch as needed.
• Apply cold compresses to the skin or take baths in cool water. Avoid hot baths or showers. These will increase the redness and itching.

If you/your baby are severely allergic:

• Hospitalization is often required following a severe reaction.
• Wear a medic-alert bracelet or necklace that describes the allergy.
• Carry your anaphylaxis kit with you at all times. Both you and your family members should know how to use this. This can be life-saving if you have a severe reaction. When the epinephrine wears off, it can be followed by a delayed reaction, which can be fatal.Do not drive until medications used to treat the reaction have worn off, unless approved by your caregiver.

WHEN TO CALL PEDIATRICIAN /PEDIATRIC GASTROENTEROLOGIST?

• You suspect a food allergy. Symptoms generally happen within 30 minutes of eating a food.
• Your baby symptoms have not gone away within 2 day or develop new symptoms.
• You want to retest yourself or your child with a food or drink you think causes an allergic reaction. Never do this if an anaphylactic reaction to that food or drink has happened before. There is a return of the symptoms which brought you to your caregiver.

   SEEK IMMEDIATE MEDICAL CARE IF:

You/your baby have trouble breathing, are wheezing, or you have a tight feeling in your chest or throat.Your baby  have a swollen mouth, or you have hives, swelling, or itching all over your body.THIS IS AN EMERGENCY. Call your local emergency service

Becoming overweight and obese is now affecting a lot of people . Number of children who are overweight has doubled in the last 2 to 3 decades. Obese children now have diseases like type 2 diabetes that used to only occur in adults. Overweight kids tend to become overweight adults. This puts the child at greater risk for heart disease, high blood pressure and stroke as an adult. But perhaps more hard on an overweight child than the health problems is the social discrimination. Children who are teased a lot can develop low self-esteem and depression.There are many causes of obesity.

• Eating too much and moving around too little.
• Certain medications such as antidepressants and blood pressure medication may lead to weight gain.
• Certain medical conditions such as hypothyroidism and lack of sleep may also be associated with increasing weight.

Almost half of children ages 8-16 years watch 3 to 5 hours of television a day. Kids who watch the most hours of television have the highest rates of obesity. A health care professional can measure your child’s height and weight and calculate a ratio known as body mass index (BMI). This number is compared to a growth chart for children of your child’s age and gender to determine whether his or her weight is in a healthy range. If your child’s BMI is greater than the 95th percentile your child will be classified as obese. If your child’s BMI is between the 85th and 94th percentile your child will be classified as overweight.There are a number of simple things you can do at home to address your child’s weight problem:

• Eat meals together as a family at the table, not in front of a television. Eat slowly and enjoy the food. Limit meals away from home, especially at fast food restaurants.
• Involve your children in meal planning and grocery shopping. This helps them learn and gives them a role in the decision making.
• Eat a healthy breakfast daily.
• Keep healthy snacks on hand. Good options include fresh, frozen, or canned fruits and vegetables; low-fat cheese, yogurt or ice cream; frozen fruit juice bars; and whole grain crackers.
• Consider asking your health care provider for a referral to a registered dietician.
• Do not use food for rewards.
• Focus on health, not weight. Praise them for being energetic and for their involvement in activities.
• Do not ban foods. Set some of the desired foods aside as occasional treats.
• Make eating decisions for your children. It is the adult’s responsibility to make sure their children develop healthy eating patterns.
• Watch portion size.
• Limit soda and juice. Children are better off with fruit instead of juice.
• Limit television and video games to 2 hours per day or less.
• Encourage play in sports or other forms of athletic activities.
• Avoid all of the quick fixes. Weight loss pills and some diets may not be good for youngsters.
• Aim for gradual weight losses of 1/2 to 1 pound per week.

You are a role model for your kids. Children form habits from parents. Kids usually maintain them into adulthood. If your children see you reach for a banana instead of a brownie, they are likely to do the same. If they see you go for a walk, they may join in.

Normally when the umbilical cord falls off, the area heals and becomes covered with skin BY DAY 8-9 of life. Delay in fall of cord, infections, Granuloma, hernia are few of the common problems needs to be known and acted on.

Umbilical Granuloma is a small red mass of scar tissue that forms in the belly button after the umbilical cord falls off. Baby may have a pink or red stalk of tissue in the belly button area. There may be small amounts of bleeding .Pediatrician may treat it with locally acting drug or tighten its noose by surgical knot. Change your baby’s diapers frequently. Keep the edge of your baby’s diaper below the belly button .Contact Pediatric Gastroenterologist if Pus or foul-smelling drainage comes from your baby’s belly button, high fever, baby vomits repeatedly, belly is distended or feels hard to the touch.

Umbilical Hernia is a weakness in the wall of the abdomen. Hernia forms when a loop of bowel slips into the hernia defect and gets pushed out between the abdominal  muscles. The bowel can be pushed back mostly in place without hurting your child. If the hernia is very large, surgery may be necessary.  If the intestine becomes stuck in the hernia sack and cannot be pushed back in, pediatric Gastroenterology opinion may be consulted. Mostly umbilical hernia resolves by 2 years of age spontaneously.

Passing fluid through umbilicus needs immediate pediatric Gastroenterology opinion. Fluid may be draining from abdominal cavity or urinary bladder. Source needs to be identified. Appropriate treatment is possible.

Sometimes dilated veins are seen surrounding the umbilicus signifying problem in Liver. Urgent Pediatric gastroenterologist opinion should be taken for early diagnosis and treatment of liver disorder.

Everyone needs nutrients for good nutrition. These nutrients include vitamins, minerals, carbohydrates, protein, fat, and fiber. Children have different requirements according to their ages. Let’s discuss on this New Year day regarding proper Nutrition to our children.

Proper nutrition is critical for good health. It’s important for children to grow properly, learn, have energy, and feel good about them. It helps maintain a healthy weight and so avoids obesity-related diseases such as diabetes.

How Do Children Learn to Eat Healthy?

Parents play a big role in helping children develop eating habits. Parents who eat low-fat, low-sugar, high-fi ber foods teach their children to like these foods. Child care providers, friends, and the media also shape eating habits. If parents help children be aware of these other pressures, children will more likely make Healthy choices themselves.

Healthy carbohydrates are found in natural sugars; starches that are in whole-grain foods, beans, peas, and corn; and fiber. Unhealthy carbohydrates include corn sweetener, corn syrup, fructose, honey, sugar, brown sugar, and molasses. Good (unsaturated) fats are in oils (olive, peanut, canola), nuts, avocados.

Eat three well-rounded meals from all food groups: whole grains, vegetables, fruits, oils, dairy (low-fat), and meat (lean) and beans. Try to eat at least five servings of fruit and vegetables a day, about 2½ cups. Eat a serving or two of fruit with breakfast daily. It’s also ok to eat even more fruits and vegetables.

Teens who grow and develop quickly also need snacks.Fruits and vegetables provide extra energy. Healthy snacks include fresh and dried fruits, trail mix, nuts, low-fat yogurt. Try freezing grapes, pineapple, strawberries and bananas for a new taste.

A lunchbox should always include:

At least 2 pieces of fruit (fresh, dried or tinned)

At least 1 serve of dairy food such as yoghurt, milk or cheese

At least 3-4 serves carbohydrate-rich foods such as bread, crispbread, grain and fruit based bars, pasta.

Cut sandwiches into different shapes for younger children and vary the bread from day to day, eg. White, wholemeal, rye, bagel. Freeze yoghurt overnight to prevent bacterial growth.

SOME DOs and DON’Ts

✔ DO limit fast food and junk food.

✔ DO offer water and milk instead of sugary drinks and

sodas.

✔ DO broil, grill, or steam foods instead of frying them.

✔ DO read nutrition labels on foods before you buy them.

✔ DO provide at least 5 servings of fruits and vegetables.

• Don’t force food down the child’s throat.
• Don’t use threat, flattery, or bribes to make the child eat more
• Show your appreciation when he does eat ..
• Encourage him to eat himself.
• Eating with everyone on table is a good habit.
• Prepare appetizing foods and vary the forms in which you give them.
• Don’t make careless remarks regarding food in front of children.
• Do not guide the child too much in what he should/should not eat.
• Don’t insist on few large meals.
• Small helpings are more appetizing than a large heap
• Don’t force a child to eat fast and do not let him sit indefinitely over the food .
• Do not insist that he should eat his food in a particular order.
• Do not scold him at meal times.
  • Don’t sit like this.
  • Don’t eat fast.
  • Don’t take by bites.
  • Nagging is not going to help the child’s appetites.
• At meal times don’t discuss things which may be unpleasant to the child. (Parents should also avoid quarrelling)
• Never use a microwave to warm mixture FOR FORMULAS.

DIET IN LIVER DISEASE:

Sodium is a mineral and helps the body change the amount of water and fluids it holds. Too much sodium can cause the body to hold on to too much fluid. You may need to decrease the amount of sodium in your diet if your body is collecting fluid in your stomach or legs. To decrease the amount of sodium in your diet, do not add extra salt to foods. Also, limit or avoid foods that contain lots of sodium. Avoid or limit drinks containing alcohol such as beer, wine, and hard liquor. It is important to make sure that you are getting enough calories in your diet so that you get your body enough energy and stay at a healthy weight. Include a variety of foods in your diet.Carbohydrates are found in foods such as breads and starches, grains (oats, flour), cereals, and some vegetables (corn, peas). Carbohydrates change the level of sugar in the blood.Advanced liver disease can affect how much sugar is in the blood and make it too high or too low. Eating carbohydrates in the right amount will help control your blood sugar. Eating the right amount of protein every day is also important for liver disease. Vegetable protein is better than animal protein in liver disease. A Pediatric Gastroenterologist or Pediatrician can help you determine how much carbohydrate your child need each day.

DIET IN DIARRHOEA

Continue to feed your child a healthy, balanced diet as usual.Foods that may be better tolerated during illness with diarrhea are:Starchy foods, such as rice, toast, pasta, low-sugar cereal, oatmeal, grits, baked potatoes, crackers, and bagels.Low-fat milk (for children over 2 years of age).Bananas or applesauce.High fat and high sugar foods are not tolerated well.It is important to give your child plenty of fluids when he or she has diarrhea. Recommended drinks are water, oral rehydration solutions.

WILSON ‘S DISEASE:

Wilson’s disease is an inherited disorder of copper metabolism. Copper is an essential metal for production of hemoglobin in red blood cells and for bone development and connective tissues. Wilson’s disease causes too much copper to collect in the body in liver, kidney, brain, eyes. Untreated Wilson’s disease is life threatening. The disease affects approx. 1 in 30,000 people. A mutated gene causes the disease. It’s not contagious.

HOW TO KNOW?

Symptoms are by 3 years of age. Usually, the liver is affected 1st followed by eyes, brain and kidney. Liver involvement can manifest as acute liver failure or chronic liver disease. Yellowish discoloration of eyes, urine, and abdominal distension which is persistent not resolving by routine treatment should direct oneself to think towards Wilson disease. Passing more urine at night, altered sensorium, gallstones, abnormal movement of limbs are some of other manifestations. Sometimes Wilson disease present as abnormal behaviour in children or change in voice. Heart involvement is also known in some patients. Extra deposition of copper is chiefly responsible for organ damage.

WHAT ABOUT DIAGNOSIS?

Urine test for copper, blood test, eye examination are necessary for diagnosis. Liver biopsy may be required after consulting Pediatric Gastroenterologist and hepatologist. Early diagnosis is clue to successful management.

TREATMENT?

De-cupperizing chelators (drugs removing copper from body) are indicated and should be started under supervision of Pediatric Hepatologist. Some vitamins need to be supplemented. Zinc is also used to reduce copper absorption from diet .Special costly medicines (newer chelators) with less side-effects are also available. In some cases with severe liver cirrhosis or liver failure Liver transplant is required. Blood tests, urine test are routinely done on follow up for proper dose adjustment.

DIET CHANGES:

Copper content in a specific food can vary .Don’t use copper containing utensils for cooking or storing food.

Restrict food with high copper like: organ meats, dried beans, peas,chocolates,shellfish,oysters,lamb,pork,salmon,mushrooms,coca,barley,sweet potatos,chocolate milk,soyamilk,candys with coca,soybased beverages,avocado,dates and raisins. For details one should consult Pediatric Gastroenterologist and Hepatologist.

Ulcerative colitis (UC) is an chronic disease of the large intestine in children . In UC, there is body’s hyper-reactive response to the inner lining of the colon or rectum(large intestine). Both boys and girls are equally affected. UC is one of the inflammatory bowel disease (IBD). UC needs long-term medical care. Risk of developing colon cancer is higher than normal.

WHY IT OCCURS?It runs mostly in families .It may be the result of an over-reaction of the body’s immune system.The over-reaction may be caused by food and normal bacteria that are in the intestines every day. The reaction causes white blood cells to fight off what seems to be a threat in the intestine. The white blood cells and the immune system cause the inflammation. The reaction keeps on happening. With time, the inflammation can lead to ulcers and loss of normal function in the lining of the intestine.

HOW IT PRESENTS?

CALL PEDIATRIC GASTROENTEROLOGIST IMMEDIATELY:

Flare up OR NO RESPONSE TO your routine diarrhea treatment.

Has an unexplained fever or new symptoms. Has a decrease in appetite. Is losing weight, persistent fever, Severe rectal bleeding. Severe belly ( abdominal) pain. Swelling of the belly (abdominal distension).Abdominal tenderness to the touch.

Children SOMETIMES  cannot eat or drink. This can happen if a medical problem requires stomach be kept completely empty including constant removal of normal stomach fluids. To do this, a soft, flexible tube is passed through the nose, the back of the throat and down to the stomach.

Sometimes  Liquid food and medication can be given through this tube. Nutrition and medication are an important part of getting better.

The skin around the nose will be cleaned. If possible, sips of water are taken or doctor may ask child to swallow as this helps the tube to pass in the right direction.

RISKS & COMPLICATIONS OF THE PROCEDURE

Most insertions of an NG or feeding tube are quick, painless, and without side effects or complications. However, as with any procedure, there are always possible risks. They include:Failure to successfully place the tube in the stomach or small intestine.Rare incorrect placement of the tube in one of the bronchi (main breathing tubes) of the lungs.Nosebleed.Infection.Allergic reaction to numbing medicine used before the tube is inserted.

After the tube is successfully inserted, it is held in place with tape or other material usually appliedover the nose. Every once in a while, your caregiver will remove the tape, clean the skin, and replace the tape. X-ray abdomen may be done post RT placement.

The tube also  may be use for  connection  to a suction device. If the tube is in the stomach, fluid (such as asaline salt water solution) may be used to flush out the stomach to keep blood or other material from accumulating.

 If the tube is placed in the intestine, liquid food may be passed through the tube to provide nutrition. When the tube is no longer needed, the tape is removed from the nose, and the tubing is easily and quickly pulled out and discarded.

If you are going home with a feeding tube in place, then follow these instructions:

• Keep the tube clamped except when feedings are given.
• The tube will need to be occasionally flushed in order to prevent blockage. Instructions for this will be provided.
• Showering may be done normally while the tube is in place. The tape that holds the tube in place will need to be changed and re-applied.

 Fever is body’s response to illness. It is one of the body’s fight or defense mechanism. The cause of fever needs to be diagnosed for appropriate treatment. Fever should be treated in smaller children due to risk of febrile convulsions. Early consultation is beneficial.

Most common cause of fever in children are viral infections. Bacteria, fungi, parasite, autoimmune process and occasional neoplastic process can give fever. Fever should be treated by paracetamol as adviced by Pediatrician. Paracetamol should not be given more than 4 times a day. Banned medicines for fever like nimusulide should be strictly avoided in children. Child should be encouraged to drink plenty of water. Tepid water sponging in fever is recommended. For fever not subsiding even after medicines Pediatrician should be immediately consulted. Every FEVER doesn’t require antibiotics. Indiscriminate use of antibiotics should be avoided. Sometimes cause of fever is not obvious and this condition is called as P.U.O (PYREXIA OF UNKNOWN ORIGIN) special investigations may be required and would be asked by your health care professional.

Normal body temperature is 97-100 degrees F rectally (36-37.8 C). This can change depending on the time of day, activity level, dress, and the temperature of the surroundings. The axillary (armpit) temperature is about 1 degree F (1/2 degree C) lower than oral; the rectal temperature is about 1 degree F higher than oral.

Several different types of thermometers are available. Oral thermometers have a long narrow bulb; glass rectal thermometers have a short, round bulb. Electronic thermometers are very accurate when used properly. Skin strip thermometers are less reliable, so we do not recommend their use. In a child under 5 years of age, a screening temperature may be taken in the armpit. In children 5 years or older, an oral temperature should be taken WITH DUE PRECAUTIONS.

Be sure the thermometer is clean. It can be washed in cool soapy water and rinsed. For glass thermometers, hold the top and shake it so the mercury is down under the 98 F (36.7 C) mark; to read it, rotate the thermometer until the end of the mercury line is visible. Use one of the following techniques:

• Rectal– Lubricate the tip of the thermometer with petroleum jelly. Place the child on his or her stomach, separate the buttocks, and then insert the lubricated thermometer about one inch into the rectum. Do not force it. Be sure to hold your child while the thermometer is in place. Wait 2 minutes before removing and reading it.
• Oral– Place the thermometer under the child’s tongue as far back as possible. Have the child hold it in place with the lips or fingers while the mouth is closed. Wait 3 minutes before removing and reading.
• Axillary– Place the tip of the thermometer into a dry armpit. Hold the upper arm against the chest for 4-5 minutes before removing and reading the thermometer.

Cirrhosis is the term used to describe a diseased liver. Cirrhosis cannot be cured. But complications of cirrhosis can be reduced by taking proper dietary steps, medicines and procedures required. In simpler terms scarring of liver is called as cirrhosis. Scarring occurs due to persistent insults/infection or damage to Liver. Many children with advanced cirrhosis have jaundice. children with cirrhosis are at increased risk for developing liver cancer. In children, metabolic liver disease, Wilson disease, neonatal cholestasis, Hepatitis B, Hepatitis C can lead to Cirrhosis.Scarring makes it difficult for blood to flow through the liver. As a result, veins in other areas outside of the liver become abnormally expanded. Abnormally expanded blood vessels are referred to as varices. One place where varices are commonly found is in the esophagus, the swallowing tube connecting the mouth with the stomach .when the pressure in the varices reaches a certain level, the varices can burst, which can cause massive bleeding/vomiting. Patients with cirrhosis are at risk of easy bruising and bleeding. Once bleeding starts it can be severe. Liver performs important function to reduce bleeding by producing coagulation proteins. In cirrhosis production of these reduces hence the bleeding tendencies.

Body fluids accumulate as a result of liver scarring and a decreased ability to manufacture blood proteins. Fluid is typically seen in the legs and abdomen (ascites) and sometimes in the lung Ascites causes the abdomen to enlarge as fluid accumulates, which can cause shortness of breath and a feeling of fullness. The fluid provides an environment where bacteria can grow, increasing the risk of infectionHepatic encephalopathy is a condition that develops when the liver is unable to break down toxins normally found in the bloodstream, such as ammonia. In this condition, confusion or even coma are caused by toxins that build up in the blood. In the early stages, there may be mild symptoms, such as difficulty sleeping or sleeping too much. Advanced hepatic encephalopathy can cause confusion, delirium, and even coma. Hepatic encephalopathy can develop suddenly and may become a medical emergency.

Children with cirrhosis should see Pediatric gastroenterologist regularly for monitoring and treatment of cirrhosis complications. Although cirrhosis cannot be cured, several treatments are available to minimize cirrhosis-related complications. Endoscopic variceal ligation may be required every 2 months initially to control bleeding. Band ligation of enlarged vessels helps in reducing the chances of bloody vomiting and is a safe procedure. Ascites (fluid in abdomen) may require tapping for diagnostic analysis. In case of severe breathlessness with distended abdomen large amount of fluid may be removed and is supplemented with albumin. Hepatic encephalopathy earlier diagnosed can be reversed with appropriate treatment.

A healthy pancreas produces digestive enzymes and insulin. The digestive enzymes flow into the small intestine to help break down food. Insulin is released into the blood to control the level of sugar (glucose) in the blood.

Pancreatitis is a condition that occurs when the pancreas, an organ behind the stomach, becomes swollen and painful. Acute pancreatitis occurs as one sudden episode. It is one of the commonly missed causes of abdominal pain in children

After acute pancreatitis the pancreas usually returns to its normal condition. Chronic pancreatitis means ongoing or repeated bouts of pancreatitis in which there is permanent damage to the pancreas.

Trauma / abdominal injury is one of the most common causes of damage to pancreas. Other causes are gallstones, side effects from some medicines, unavoidable bruising during surgery, damage from disease in nearby organs, such as stomach. Gallstones can block the flow of digestive enzymes into the intestines. When the enzymes stay in the pancreas, they irritate it. Congenital, hereditary and autoimmune causes of Pancreatitis are also known in children. Body biochemical abnormalities like calcium, lipids can also cause pancreatitis.

The main symptom is severe pain in the upper abdomen .child stoops forward , associated with vomiting and irritability. occasionally jaundice or fever may follow. Abdominal distension may be seen.

Pediatric gastroenterologist may advice some blood test/x-ray / sonography. If extent of damage is not visible and disease is suspected CT scan may be suggested. Congenital abnormalities of pancreas are better depicted on MRI.

Depending on the clinical condition child may be admitted in PICU or may be managed on OPD basis.

 Main function of pancreas is to digest. Food stimulates Pancreas increasing pain. For 3 to 4 days child may be kept nil by mouth. During the period I v fluids may be given. Once the pain reduces special diet can be started in small amount initially. Medicine for pain may continue. If gallstones caused the pancreatitis and they have not been removed, surgery to remove them may help prevent further attacks.

Most children recover completely, especially if the disease is diagnosed early enough. Early consultation with pediatric gastroenterologist is advisable. Pancreatitis can come back and become an ongoing problem, causing frequent, severe pain. It can permanently damage the pancreas.

Follow the instructions your Pediatric gastroenterologist gives you. Don’t take any other medicines, including nonprescription drugs, without asking your healthcare provider. Follow the diet prescribed.

Thousands of children die every year from unintentional poisoning. Drug, chemical substance (drug or medication) is used in amounts large enough to harm the baby is not only serious condition but also life threatening .It occurs due to various causes.  It is often because the baby or parent  taking the drug does not know enough about the drug . Sometimes overdosing occurs because a person cannot remember if they have taken their medication. A common unintentional overdose in young children involves multi-vitamins containing iron.

Symptoms of overdose depend on the medication and amount taken. They can vary from over-activity with stimulant over-dosage, to sleepiness from depressants. Confusion, dizziness, nausea and vomiting may be present. If problems are severe enough coma and death may result. Diagnosis and management are generally straightforward if the drug is known. Otherwise it is more difficult. At times, certain symptoms and signs exhibited by the patient, or blood tests, can reveal the drug in question.

At home or away from medical care, there may be no immediate problems or warning signs in children. Take immediate action. Poisons may act quickly. If you think someone has swallowed medicine or a household product, and the person is unconscious, having seizures (convulsions), or is not breathing, immediately call for an ambulance. Keep the container so you can read the label on the product for ingredients. Do not cause vomiting unless instructed by medical personnel. Do not induce vomiting or force liquids into a person who is convulsing, unconscious, or very drowsy. Stay calm and in control.

PREVENTION

• Store medicines out of the sight and reach of children, preferably in a locked cabinet. Do not keep medications in a food cabinet.Always store your medicines in a secure place. Get rid of expired medications.
• If you have children living with you or have them as occasional guests, you should have child-resistant caps on your medicine containers. Keep everything out of reach. Child proofs your home.
• Do not take your medication in front of children. Do not tell your child how good a medication is and how good it is for them. They may get the idea it is more of a treat.

When children cannot eat or drink for a short time, they must get their food, water, and medications another way. A tube called an IV is used to give fluids. These can include vitamins, water, salts, sugar, and medications. IV tube usually goes into a vein. The vein used is usually in the hand or arm but may also be in the neck or chest.

Most of children hospitalized need IV lines. It is a safe procedure in experienced hands.

Your child’s caregiver will clean the skin around the vein where the IV tube will be placed. Your child may also receive a tiny shot of numbing medicine in the skin before the tube is put into the vein.

Most IV insertions are quick, painless, and without side effects or complications. However, as with any procedure, there are always possible risks LIKE,

• Failure to successfully place the IV tube in the vein
• Pain
• Puncture of the wall of the vein requiring use of a different site for the IV
• Slight bruising of the skin
• Infiltration – fluid and medicine in the IV fluid leaks through the wall of the vein into the skin
• Infection
• Allergic reaction to numbing medicine injected before the IV is started (if this is done)

In children esp neonates putting Iv-line is difficult  due to small size of veins and  they may require more  time. Parents should understand the pros of putting IVLINE and the cause for which pediatrician is doing so that over anxiety can be avoided.

Call pediatrician if:Bleeding from the IV site develops and will not stop even after pressure is applied for 10 minutes.Red streaking develops above and/or below the IV site.Fever develops.There is loss of sensation and/or weakness in the arm or the leg where the IV had been placed.There is intense pain in the arm or leg where the IV was located.

Injury can be external or internal. Crush injuries, bites, falls against jagged surfaces, gunshot wounds, severe burns and injuries involving dragging can cause wound. Surgical site is also a type of wound which needs care.

Wound care is important post hospitalization at home to prevent pain and infection.

Rest the injured area until the pain and puffiness reduces. Keep the injured area elevated until the pain and puffiness subsides. Use a bandage to protect the wound. If told apply antibiotic cream after you clean the wound. Consider TT(tetanus) vaccination if you don’t remember last time immunized or if would is dirty.

Most skin infections follow breaks in the skin. Do not rub the wound as this may cause bleeding. Apply a new dressing following each cleaning.  Avoid soaking the wound until all sutures are removed. During healing, the wound may itch. Encourage your child not to pick at the healing skin. With appropriate antibiotics and home care, the wound infection should start to  improve within 24 to 48 hours. Do not soak wound, as in bathing or swimming, until it is healed, Avoid work out exercises or sports that may cause sweating heavily. Follow your caregiver’s instructions for how often to change the dressing and packing inside.

Wound failure is a failure of an incision to heal properly following surgery.  It usually happens 7 to 10 days following surgery. The main cause of wound breakdown in the abdomen  is obesity. Wound failure happens to about 2% of surgical wounds. A wound failure often starts as bloody fluid leaking from the wound in the first week following surgery.  An open wound may look terrible to you but it is not dangerous. It is easily handled by your caregiver. It is unlikely that the contents of your abdomen will fall out..

Temperature of 102°F (38.9° C) or higher, pus like drainage from the wound, Severe pain not controlled,inability to move affected parts,contact your caregiver immediately.

Biliary atresia is a blockage in the tubes (ducts) that carry liquid called bile from the liver to the gallbladder. The condition is congenital, which means it is present from birth. Biliary atresia occurs when the bile ducts inside or outside the liver do not develop normally.

 The bile ducts carry salts that help the small intestine break down (digest) fat. Hence bile is important for digestion of milk. In babies with biliary atresia, bile flow from the liver to the gallbladder is blocked. This can lead to liver damage and cirrhosis of the liver, which is deadly if not treated.

Liver is a complex factory in our body which helps in the digestion of food, removing harmful materials from body, manufacturing coagulation factors which help blood to clot so bleeding stops. As liver is damaged these functions are affected .If not treated early child may have bloody vomiting, black color stool and in late stages coma. As food or milk is not digested children don’t grow, jaundice appears with fat and water soluble vitamin deficiency.

Newborns with this condition may appear normal at birth. However, jaundice develops by the second or third week of life. The infant may gain weight normally for the first month, but then will lose weight and become irritable, and have worsening jaundice.Other symptoms are :

• Dark urine
• Enlarged spleen
• Floating stools
• Foul-smelling stools
• Pale or clay-colored stools
• Slow growth
• Slow or no weight gain

When to Contact Pediatric gastroenterologist?

Immediately without wasting time. With late treatment outcome is poor. Biliary atresia is the most common cause of liver transplant in children.

Before starting treatment diagnosis is important .For diagnosis some blood tests, sonography of abdomen , HIDA scan , liver biopsy is required.

An operation called the Kasai procedure is done to connect the liver to the small intestine, going around the abnormal ducts. It is most successful if done before the baby is 8 weeks old. However, a liver transplant may still be needed. Early surgery will improve the survival of more than a third of babies with this condition. The long-term benefit of liver transplant is not yet known, but is expected to improve survival.

More than 50% of mothers with babies or preschoolers work outside the home. The main reason for working is financial need. Some mothers return to work because they enjoy it or need to stay up-to-date in a fast-changing career. The question of returning to work versus staying at home has no easy or correct answer.

If you can provide your child with a consistent nurturing caretaker, there is no evidence that your return to work will cause your child any harm other than increased infections (but usually minor ones, such as colds). Children whose mothers work outside the home develop as well emotionally as do other children. The mother-child bond is not weakened. Benefits for a child whose mother works outside the home include increased independence, responsibility, and maturity. Young children of working mothers often have more opportunities to learn to trust other adults and to negotiate better with peers.

Look for supportive employer and workplace. Avoid sleep deprivation. Provide contact time with your child. Reduce your housework time. Ask other family members for help. Nurture yourself as an individual. Find extra help if you are a single parent.

A mother needs 6 to 8 weeks at home after the birth of her baby to recover physically from childbirth and establish breast-feeding. A preferred maternity leave would extend to 6 months after the birth, at which time the mother will have developed greater confidence in her mothering skills. In addition, by 6 months, the baby should have formed a secure attachment to his mother and be sleeping through the night. Mothers should not feel guilty about returning to work when their babies are 6 months old.

This column has been started to help working mothers and parents for various issues in parenting and educating them about different disorders in children.

After a issue on safety measures let’s look at long standing diarrhea. Diarrhea that lasts for more than 2 weeks is considered long lasting. For someone who has a weak immune system, it may be a life-threatening illness. There are many causes of chronic diarrhea. Causes of chronic diarrhea can be grouped into two categories: diarrhea caused by an infection and diarrhea not caused by an infection. Chronic diarrhea not caused by an infection is not spread to other children

Careful history (ask what has been wrong) and physical exam by Pediatrician or Pediatric Gastroenterologist is essential. Tests may include blood or stool tests. Stool cultures may be used to test for bacteria or to detect parasites. If these initial tests do not reveal the cause of your diarrhea, additional tests may include radiographs (x-rays) and endoscopy. Endoscopy is a procedure in which a tube is inserted into the mouth or rectum by Pediatric Gastroenterologist, to look at the intestine from the inside. It is a very safe procedure in expert hands which gives exact diagnosis and directs proper treatment.

WHEN TO SEEK HELP?

Your child is unable to keep fluids down in spite of treatment.

Vomiting or diarrhea develops and becomes persistent.

Vomiting of blood or bile (green material).

Blood in the stool or the stools are black and tarry.

Reduced urine output in 6-8 hours or there is only a small amount of very dark urine.

Abdominal pain develops, increases or localizes

Child develops excessive weakness, dizziness, fainting or extreme thirst.

Child develops a rash, stiff neck, severe headache or become irritable or sleepy and difficult to awaken.

IF STOOL OUTPUT IS LARGER THAN AMOUNT OF FOOD INTAKE & NO WEIGHT GAIN you need to show to Pediatric Gastroenterologist. Child may have abnormal digestive system since birth or undiagnosed digestive system/ liver /pancreas disorders. Child may have weakened immune system.

Treatment:

Diarrhea caused by an infection can be treated with antibiotics. But the correct diagnosis must be made so the proper medication can be prescribed. Diarrhea not caused by an infection is more difficult to diagnose and treat. Earlier diagnosis is clue to treatment and to avoid complications.ORS is especially recommended for use in children with diarrhea. Foods high in sugar should be avoided because this may worsen diarrhea. Large amounts of carbonated soft drinks, juice, gelatin desserts and other highly sugared drinks should be avoided. Wash hands well. Anti-diarrheal medications are not recommended for infants and children. Do not give aspirin to children.

Normal healthy baby stools are often soft and loose. Babies who are breast feed have frequent stools may be 10 times loose stools in a day during the first 1 – 2 months. Formula feed baby have less stools comparatively but have more chances of diarrhea. Because of this, it may be difficult to tell when your baby has diarrhea. If urine output is good and child is active there is nothing to worry. Most babies have a stool pattern that is typical for them. This pattern may change slowly over time. Look for the following to help decide whether your baby has diarrhea:

• A sudden increase baby stools.
• Sudden change in consistency of stools.
• More than one stool per feeding.
• Stools that appear to be more watery.
• Child is not gaining weight.
• Amount of stools is large and inappropriate to oral intake.

Most diarrheas in children are short-lived. It is usually caused by a virus, and goes away on its own. There is no need of antibiotics. In fact in many babies antibiotics cause more diarrheas.

Other causes of diarrhea include:

• A change in the baby’s diet or the breast-feeding mother’s diet
• Use of antibiotics by the baby or breast-feeding mother

Infants and young children (under age 3years) can dehydrate quickly, so they should be watched very carefully. Dehydration means that the body does not have enough water or liquids.

Signs of mild dehydration:

• Dry eyes and crying with few tears or no tears
• Fewer wet diapers than usual
• Less active than usual or irritable
• Slightly dry mouth

Signs of moderate dehydration:

• Dry skin that is not springy
• Sluggish or lethargic
• Sunken appearing eyes

Signs of severe dehydration:

• No urine output in 8 hours
• Skin that is pinched between fingers fails to spring back to its original shape
• Sunken fontanelle (the soft spot on top of the head) in infants
• Very lethargic or possibly unconscious

HOME CARE

Make sure the child gets plenty of liquids.

• If you are nursing, the doctor will probably recommend that you continue nursing. Breast-feeding helps prevent diarrhea, and it also speeds recovery. So don’t stop breast milk unless told by doctor at any cost.
• If your baby still seems thirsty after or between nursing or feeding sessions, you can add an oral rehydration solution. Don’t use fruit juices /sports drink/cold drink .

To prevent diaper rash:

• Air drying.
• Frequent diaper changes.
• Protective ointments and creams.
• Rinsing the bottom with water.

Call your pediatrician/ pediatric gastroenterologist if:

• A newborn (under 3 months old) has diarrhea
• Diarrhea contains blood, mucus, or puss
• Fever and diarrhea last for more than 3 days
• The child appears dehydrated
• The diarrhea does not go away in older infants or lasts in children for 2 days or longer
• Vomiting continues for more than 24 hours.

Gluten free diet is indicated in celiac disease or confirmed wheat allergy on blood test and small intestine endoscopic biopsy.

Food allowed:

1. Rice
2. Arrowroot
3. Sabu Dana
4. Bajra
5. Makka
6. Jowar
7. Singhara Atta
8. Idly
9. Dosa
10. Vada
11. Mumura
12. Rice Noodles
13. Fresh Meat
14. Fresh Mutton/Chicken
15. Egg / Fish

 Drinks

1. Fresh Juice
2. Fresh Milk
3. Fresh Curd
4. Fresh Lassi
5. Fizzy Drinks
6. Soda
7. Fresh Soup

Desserts:Rice Kheer/Paneer Sandesh/Caramel Custard/Carrot Halwa/Jaggery

CELIAC Food Items Not Allowed:

1. Atta /Maida
2. Suji
3. Rye
4. Barley
5. Noodles
6. Pasta/ Sphagetti
7. Bread/ Bun
8. Soup Stick
9. Sevian
10. Dalia
11. Patty/ Pizza
12. Burger
13. Kulcha
14. Bhujia
15. Upma Sevian
16. Biscuits

Drinks

1. Hot Chocolate
2. Complan
3. Horlicks
4. Boost
5. Bottled Milk Shake
6. Soup Powder
7. Cake
8. Pastry
9. Ice Cream
10. Éclair
11. Chocolate
12. Jalebi
13. Gulab Jamun

Tinned and Canned Preparations

Preparation Containing Baking Powder

Processed meats like Sausages and Kebab