Constipation is a common problem in children. As with other common problems, the parents get flooded with advices and information from well meaning friends and family that it gets difficult to differentiate what is right from what is not.
Is my child constipated?
Constipation is not determined by the number of bowel movements alone. The number of bowel movements a child has, varies with the age of the child and also from child to child. One may pass stools twice a week, another twice a day and both may be completely normal. So when do you say that your child is constipated?
Your baby is said to be constipated :
In the first month , firm stool less than once a day.
If the baby passes well formed/ hard stool and the baby wriggles, cries or is in obvious discomfort.(Many babies have some grunting and drawing up of legs during bowel movement which is quite normal)
If the child passes painful hard pebble like stool.
If the surface of the stool is streaked with blood.
If the child has tummy pain/ discomfort.
My baby is breastfed, can she still get constipated?
Breastfed babies are rarely constipated, although she may have a bowel motion only once a week or 10 days. This is because breast milk is almost completely digested , promotes growth of good bacteria in the gut and acts as a natural laxative. However a breastfed baby can still get constipated if they are not getting enough milk or for other medical reasons (discussed below).
Formula fed baby in the other hand can get constipated as formula is difficult to digest. Normally they pass stool less frequently (once a day or so) than breastfed babies (who pass bowel motion as frequent as 5 to 6 times a day), their stool is smelly and pasty when compared to the soft, less offensive and seedy stool of breast fed babies.
Why is my baby constipated?
A little understanding of formation of stool can give you a clear picture of why constipation occurs. Normally food is digested as it travels along the intestine, nutrients are absorbed and the roughage reaches the colon. A normal stool is the result of having enough water left in the roughage, the urge to defaecate felt when the bowel is distended with stool, the muscles of intestine and abdomen cooperating for straining. Constipation can occur if any of the above is compromised.
Causes of constipation :
Constipation is sometimes set off when they are switched from breast milk to formula or to cow's milk.
If the baby gets inadequate breast milk.
When the child is not getting enough water/ fluids in his diet.
When the child is not getting enough fibre (whole grains, vegetables and fruits).
Sometimes related to psychological problems/ behavioural issues.
During minor illness when the child gets dehydrated.
Anal fissure- A constipated child passes hard , pellet like stools which while passed tears the child's delicate rectal and anal mucosa, causing fresh bleeding and much pain. This pain causes the baby to hold faeces in fear of pain, causing the stool to get harder and starts a vicious cycle.
If the constipation is severe and resistant, your doctor may want to rule out other rare medical reasons like Hirschsprung's disease, thyroid levels, calcium levels and neurological problems.
What am I supposed to do when my child gets constipated?
1. If baby is breastfed continue to breastfeed as often as possible.
2. If baby is bottle feed, discuss with your doctor about changing over to the kind of formula that may be easy to digest .Try smaller and more frequent feeds.
3. Formula fed babies can be offered sips of water.
4. Delay introduction of solids, particularly rice or banana.
5. A warm bath may sometimes help the baby to pass stool.
6. For older babies, avoid constipating foods like rice, banana, cooked carrot and switch over to fibre rich foods like barley and oat. Add pureed prune, peach, peas or apricots to loosen the bowel.
7. For older kids, diet modification is the most important step. Make the kid drink enough water. Avoid undiluted juice or fizzy drink. Introduce plenty of fibre rich food- wholemeal bread, beans, lentil, peas, vegetables preferably with skin, dried or fresh fruits, nuts and seeds. Remember that even a high fibre diet require water for their intestinal sweeping.
8. Get your kid to exercise and move about. Babies can be helped by bicycling their legs or gently massaging their abdomen.
9. Discuss with your doctor regarding use of laxatives or suppositories. They can help by easing the passage of stool and thereby helping the child to tide over the fear of having to pass a painful, hard stool.
10. If severe, your child may need an enema.
What can I do to prevent my kid get repeatedly constipated?
A proper diet with enough water and fibre is often helpful. Avoid aggressive toilet training. Encourage your child to have bowel movements at a set time everyday, preferably in the morning. Explain your child that he should not ignore his urge and must go whenever he wants to, no matter where he is or what he is doing. Make it a stress free routine. Use star charts. Don't let the child get ashamed about his constipation. If constipation persists, consult your doctor.
My baby is getting iron fortified formula, can this be a reason for his constipation?
Contrary to popular opinion, iron fortified formula is not related to constipation. Nevertheless it is important to prevent iron deficiency anaemia.
Sunday, 30 November 2008
Saturday, 29 November 2008
Breath holding in children.
A Breath holding spell is one of the most terrifying episodes to watch in the life of a parent. It is very distressing to watch when a child gets upset, turns blue, limp and pass out. It can happen in 4% of babies and toddlers.
What exactly is a breath holding spell?
Breath holding occurs when the child is surprised,upset or physically hurt. The child cries and apparently the long phase of breath exhalation associated with such crying produces the same response as to when one holds his breath for a long time- involuntary but severe enough for the child to turn blue and pass out. Sometimes the child may have an episode sever enough to cause twitching, arching of back and have seizure like movements.
Another form of breath holding (Pallid spell or reflex anoxic seizure) where the child, following an unpleasant event goes pale and limp and may have brief seizure like movements.
Is my baby too young for such spells?
Breath holding spells usually begin from 6 months of age, reach a peak during toddler years and is usually outgrown by around 5 years of age. Sometimes babies as young as 2 months can have such spells. Sometimes the grandparents can recall similar episodes in the parents when they were young.
Should I worry about my kid's breath holding spell?
Breath holding spell will cause no permanent damage.
But first your doctor will want to differentiate it from from seizure disorder. Breath holding spells usually follows an upsetting event, the twitching that occurs with breath holding is usually brief, minimal and non rhythmic. Genuine seizures are spontaneous (without any preceding event or crying), rhythmic and more severe. In less clear cut cases, your doctor may proceed with tests like EKG, EEG to rule out other causes.
What should I do when my child has a breath holding spell?
When your child gets upset, try to distract him immediately or talk to him in a non stressed tone. If your child develops a spell, don't panic. Take him to a safe environment to avoid injury. Make him lie down on the floor or in his crib. Try to avoid injury by taking her away from risky places like stairs, non strapped high chairs or near water.
There is nothing much you can do to prevent a spell. Avoid confronting situations if possible that might provoke a spell. Enforce discipline by being consistent on the standards you set for them. Avoid fatigue and hunger which may make them cranky. Do not shower too much attention on him following an episode, deal it in a matter of fact way (so that your kid's behaviour does not get reinforced by the attention he gets).
Discuss with your doctor about starting your kid on iron as the condition is sometimes found to be associated with iron deficiency anaemia.
Rest assured that this will usually be a forgotten thing , by the time he turns 5.
What exactly is a breath holding spell?
Breath holding occurs when the child is surprised,upset or physically hurt. The child cries and apparently the long phase of breath exhalation associated with such crying produces the same response as to when one holds his breath for a long time- involuntary but severe enough for the child to turn blue and pass out. Sometimes the child may have an episode sever enough to cause twitching, arching of back and have seizure like movements.
Another form of breath holding (Pallid spell or reflex anoxic seizure) where the child, following an unpleasant event goes pale and limp and may have brief seizure like movements.
Is my baby too young for such spells?
Breath holding spells usually begin from 6 months of age, reach a peak during toddler years and is usually outgrown by around 5 years of age. Sometimes babies as young as 2 months can have such spells. Sometimes the grandparents can recall similar episodes in the parents when they were young.
Should I worry about my kid's breath holding spell?
Breath holding spell will cause no permanent damage.
But first your doctor will want to differentiate it from from seizure disorder. Breath holding spells usually follows an upsetting event, the twitching that occurs with breath holding is usually brief, minimal and non rhythmic. Genuine seizures are spontaneous (without any preceding event or crying), rhythmic and more severe. In less clear cut cases, your doctor may proceed with tests like EKG, EEG to rule out other causes.
What should I do when my child has a breath holding spell?
When your child gets upset, try to distract him immediately or talk to him in a non stressed tone. If your child develops a spell, don't panic. Take him to a safe environment to avoid injury. Make him lie down on the floor or in his crib. Try to avoid injury by taking her away from risky places like stairs, non strapped high chairs or near water.
There is nothing much you can do to prevent a spell. Avoid confronting situations if possible that might provoke a spell. Enforce discipline by being consistent on the standards you set for them. Avoid fatigue and hunger which may make them cranky. Do not shower too much attention on him following an episode, deal it in a matter of fact way (so that your kid's behaviour does not get reinforced by the attention he gets).
Discuss with your doctor about starting your kid on iron as the condition is sometimes found to be associated with iron deficiency anaemia.
Rest assured that this will usually be a forgotten thing , by the time he turns 5.
Thursday, 27 November 2008
Teething.. Ouch!!
Teething is one of those milestones that makes you aware that your baby is gradually going to leave his babyhood (with his melting toothless grin) behind. It can be unpleasant for the baby and his parents, so its better to be prepared with information as to what to exect and what can be done.
When can I expect my baby's teeth to appear and in what order?
Baby is born with his full set of 20 milk teeth burried in his gums (an occassional baby has one or two present at birth!). You can expect the first tooth to erupt at around 6 months. Some babies start cutting teeth as early as 3 months and with some you may have to wait uptil almost a year. The lower central incisor is usually the first to erupt, these are followed by the two upper incisor.,Once the teeth start to come through, they appear at the rate of around one a month (Around six teeth when he smiles for his first birthday pictures). Teething is usually complete by around two and a half years.
Four central incisors- around 6-7 months
Four more side incisors - around 8 months
Four back molars - 10-14 months
Four canines- around 16-20 months.
Four more back molars appear at - 24-30 months
What can I expect when my baby is teething?
Excessive drooling of saliva:
As the child is teething there is an increased flow of saliva that cause drooling. Sometimes the drool may be cause a rash(drool rash) around his mouth. Drooling and discomfort can even precede teething by a couple of weeks.
Fussiness:
Baby can become fussy, cranky and refuse/ resort to continous feeding.
Biting:
To ease his discomfort, he may start biting of anything that he can get hold on, nibble on his toys, your fingers and sometimes the nipples that feed him (ouch!).
Swelling:
As you run your clean finger along your baby's gum, you may notice an erupting tooth or a small swelling with a blue blister (eruption haematoma)
Feeding:
Some babies find suckling uncomfortable . He might start to nurse, but then pull off and cry or fuss and not want to nurse anymore. Other babies nurse nearly constantly because the nursing is soothing to them.
Night waking:
Babies that were previously sleeping through the night may now wake up frequently and struggle to go back to sleep (trying times for the parents)
There are conflicting reports regarding the association of fever and diarrhoea with teething. High fever should prompt you to take your baby to the paediatrician who may want to look for other causes for fever.
How can I help when my baby is teething?
Offer your baby something cold and hard to chew on- my favourites are frozen banana, frozen or refrigerated wet wash cloth, crushed ice packed in a piece of clean cloth, popiscles, teething ring or a cool spoon. Avoid gum numbing creams or if necessary use them judicially.
Baby's saliva should be gently patted dry , avoid wiping them with rough cloth, it may lead on to rash in a baby with sensitive skin. Pacify your fussy baby by indulging him and distracting him. He may prefer to have cold apple puree or yoghurt that are soothing to his gums.
When should I be concerned?
If your baby runs a high temperature, or frets and cries inconsolably, call a doctor.
If your baby has no sign of a tooth erupting by the end of his first year bring it up to the doctor during his health visit.
When can I expect my baby's teeth to appear and in what order?
Baby is born with his full set of 20 milk teeth burried in his gums (an occassional baby has one or two present at birth!). You can expect the first tooth to erupt at around 6 months. Some babies start cutting teeth as early as 3 months and with some you may have to wait uptil almost a year. The lower central incisor is usually the first to erupt, these are followed by the two upper incisor.,Once the teeth start to come through, they appear at the rate of around one a month (Around six teeth when he smiles for his first birthday pictures). Teething is usually complete by around two and a half years.
Four central incisors- around 6-7 months
Four more side incisors - around 8 months
Four back molars - 10-14 months
Four canines- around 16-20 months.
Four more back molars appear at - 24-30 months
What can I expect when my baby is teething?
Excessive drooling of saliva:
As the child is teething there is an increased flow of saliva that cause drooling. Sometimes the drool may be cause a rash(drool rash) around his mouth. Drooling and discomfort can even precede teething by a couple of weeks.
Fussiness:
Baby can become fussy, cranky and refuse/ resort to continous feeding.
Biting:
To ease his discomfort, he may start biting of anything that he can get hold on, nibble on his toys, your fingers and sometimes the nipples that feed him (ouch!).
Swelling:
As you run your clean finger along your baby's gum, you may notice an erupting tooth or a small swelling with a blue blister (eruption haematoma)
Feeding:
Some babies find suckling uncomfortable . He might start to nurse, but then pull off and cry or fuss and not want to nurse anymore. Other babies nurse nearly constantly because the nursing is soothing to them.
Night waking:
Babies that were previously sleeping through the night may now wake up frequently and struggle to go back to sleep (trying times for the parents)
There are conflicting reports regarding the association of fever and diarrhoea with teething. High fever should prompt you to take your baby to the paediatrician who may want to look for other causes for fever.
How can I help when my baby is teething?
Offer your baby something cold and hard to chew on- my favourites are frozen banana, frozen or refrigerated wet wash cloth, crushed ice packed in a piece of clean cloth, popiscles, teething ring or a cool spoon. Avoid gum numbing creams or if necessary use them judicially.
Baby's saliva should be gently patted dry , avoid wiping them with rough cloth, it may lead on to rash in a baby with sensitive skin. Pacify your fussy baby by indulging him and distracting him. He may prefer to have cold apple puree or yoghurt that are soothing to his gums.
When should I be concerned?
If your baby runs a high temperature, or frets and cries inconsolably, call a doctor.
If your baby has no sign of a tooth erupting by the end of his first year bring it up to the doctor during his health visit.
Wednesday, 26 November 2008
Toddler's diarrhoea.
Not many diagnoses in medicine become a 'diagnosis of exclusion'- which literally means ' a diagnosis that is made when all other possible causes are ruled out'. In most cases this is by a series of expensive tests and examinations, but sometimes an experienced doctor can reach this diagnosis in his office after a thorough discussion and examination. One such condition is 'Toddler's diarrhoea'.
Toddler's diarrhoea typically occurs in the age group of 1 to 4 years. The child has a long standing diarrhoea, sometimes upto 5 bowel movements per day! The stool is smelly and pale and may have undigested food particles ( which is why this condition is also known as "peas and carrots" diarrhoea). The child is well, has normal growth and apetite and is active (if not, the doctor looks for an alternate diagnosis). Laboratory investigations do not have any positive findings. It is found to be more common in boy babies.
The cause for this condition is not fully understood. Despite the presence of undigested food particles (peas and carrots!) the condition is not related to malabsorption. Key factor is considered to be rapid transit time of the child's immature intestinal system. Infact this condition has been classified under motility disorders of intestine.
Other scary names for this condition are 'Irritable bowel disease of infancy' and 'Chronic non specific diarrhoea'.
Your doctor will reassure you after checking the child's growth charts and excluding food allergy and often that is all is needed. He will suggest that you restrict fruit juices and increase fat content of the child's diet. Sometimes this condition is related to stress in the family or at school that must have to be looked in to. The condition resolves by itself by the age of 5.
Toddler's diarrhoea typically occurs in the age group of 1 to 4 years. The child has a long standing diarrhoea, sometimes upto 5 bowel movements per day! The stool is smelly and pale and may have undigested food particles ( which is why this condition is also known as "peas and carrots" diarrhoea). The child is well, has normal growth and apetite and is active (if not, the doctor looks for an alternate diagnosis). Laboratory investigations do not have any positive findings. It is found to be more common in boy babies.
The cause for this condition is not fully understood. Despite the presence of undigested food particles (peas and carrots!) the condition is not related to malabsorption. Key factor is considered to be rapid transit time of the child's immature intestinal system. Infact this condition has been classified under motility disorders of intestine.
Other scary names for this condition are 'Irritable bowel disease of infancy' and 'Chronic non specific diarrhoea'.
Your doctor will reassure you after checking the child's growth charts and excluding food allergy and often that is all is needed. He will suggest that you restrict fruit juices and increase fat content of the child's diet. Sometimes this condition is related to stress in the family or at school that must have to be looked in to. The condition resolves by itself by the age of 5.
Prams can harm baby psychologically, research says.
There has been a study in UK which suggested that non-parent facing prams had a negative impact on child's development when compared to parent facing prams. Here is the link.
http://www.guardian.co.uk/society/2008/nov/21/baby-development-buggies-sutton-trust
Well prams are non existent in some parts of the world and when I was getting used to walk around with my baby in pram, I realised how independent, mobile and productive it made me feel.
Agreed that parent facing prams are bulky and little uncomfortable to push. Also twin prams can only face forward. I dont seriously think that pram is the only issue which makes the young child spend much of his time in isolation. There are families where babies are hardly ever talked to even if they are at their homes. An interactive mother can and will keep interacting irrespective of the child's position- talking to the kid, child turning around to catch what she says, the mother stopping and walking around the pram to kneel in front of the kid if necessary, I have seen them doing all this. Also most kids spend very little time on the pram and are content watching the world during that time.
On the other hand research completed several years ago show that young children feel more reassured and were more interactive when they were looking at their parents' face, so its not at all a new idea. A child in a parent facing pram can still look around at the world in addition to their parents and a mother is more likely to start a conversation by taking a cue from the kid (wow, thats a real big orange truck isnt it? ) and the child is happy when his point of interest has been noted and is being discussed.
The research also indicates that carrying a baby in a sling or walking them are still more advantageous. I guess its only common sense that children will benefit from facing the parent but this should be balanced with comfort , ease , availability and price (and they are large issues as well).
http://www.guardian.co.uk/society/2008/nov/21/baby-development-buggies-sutton-trust
Well prams are non existent in some parts of the world and when I was getting used to walk around with my baby in pram, I realised how independent, mobile and productive it made me feel.
Agreed that parent facing prams are bulky and little uncomfortable to push. Also twin prams can only face forward. I dont seriously think that pram is the only issue which makes the young child spend much of his time in isolation. There are families where babies are hardly ever talked to even if they are at their homes. An interactive mother can and will keep interacting irrespective of the child's position- talking to the kid, child turning around to catch what she says, the mother stopping and walking around the pram to kneel in front of the kid if necessary, I have seen them doing all this. Also most kids spend very little time on the pram and are content watching the world during that time.
On the other hand research completed several years ago show that young children feel more reassured and were more interactive when they were looking at their parents' face, so its not at all a new idea. A child in a parent facing pram can still look around at the world in addition to their parents and a mother is more likely to start a conversation by taking a cue from the kid (wow, thats a real big orange truck isnt it? ) and the child is happy when his point of interest has been noted and is being discussed.
The research also indicates that carrying a baby in a sling or walking them are still more advantageous. I guess its only common sense that children will benefit from facing the parent but this should be balanced with comfort , ease , availability and price (and they are large issues as well).
Tuesday, 25 November 2008
Food allergy.
Food Allergy
What is food allergy?
Food allergy can be divided in to two types: First category is when your body's immunity fight against a particular food and this can include reactions that are prompt (peanut allergy) or those that take several hours to evolve The other type is called food intolerance and includes the non immune adverse reactions.
How common is food allergy?
Food allergy is supposed to occur in around 6 % of babies and kids and around 3% of adults.
Common foods causing food allergy?
The foods most commonly causing food allergies and intolerances are: cow's milk,eggs, nuts, gluten ( found in wheat, rye, barley and possibly oats), fish, shellfish, citrus fruits, and soya.
What are the possible symptoms?
Symptoms can range from itching, shortness of breath, vomiting, wheezing to in some unfortunate incidents severe block of airway or fall in BP that may be fatal.
Food intolerance usually cause tummy pain, vomiting and bloating.
Sometimes headache, lack of attention, poor concentration and behaviour issue also might have a dietary link.
How to help your doctor diagnose your child's food allergy?
1. Take a complete list of the suspected foods.
2. Note the method of preparation (eaten raw/ cooked), any spices added(example:MSG)
3. Discuss the allergic episode in detail: Amount of food taken, How soon the child developed the symptoms, what exactly were the symptoms, how long did the child have the symptom, previous similar episode when the child was given the same/ similar food, previous treatment.
4. Discuss with your relatives to know if any one else in your family suffered similar allergy.
5. Growth chart of our kid, weight gain/loss.
How is your child diagnosed?
1. Blood tests: to measure the concerned immunological parameters
2. Skin tests : Inject a small quantity of the extract of the suspected food (allergen) and looking for reactions.
3. Food diary: You will be asked to maintain a food diary to have a note of food taken and any reaction observed.
Keep watch.
Avoid the suspected food allergen .
Educate yourself to read the food label to see if allergen is included.
Whenever your child eats at school, picnic or parties inform the concerned people about your kids' food allergy.
Seek medical care promptly when needed.
Educate yourself about how to use an epipen and when possible teach your kid too.
When a particular food is avoided, see to it that another food of equal nutritional value is added to the diet, so that your kid does not suffer from nutritional deficiency. A dietician can help you with this.
Exclusively breatfeed your baby for the first 6 months.
Will my child grow out of it?
Up to 90 per cent of children will outgrow cow's milk and egg allergy and cow's milk protein intolerance, for example, while only about 10-20 per cent may outgrow nut allergies. So it depends on what your kid reacts to.
What is food allergy?
Food allergy can be divided in to two types: First category is when your body's immunity fight against a particular food and this can include reactions that are prompt (peanut allergy) or those that take several hours to evolve The other type is called food intolerance and includes the non immune adverse reactions.
How common is food allergy?
Food allergy is supposed to occur in around 6 % of babies and kids and around 3% of adults.
Common foods causing food allergy?
The foods most commonly causing food allergies and intolerances are: cow's milk,eggs, nuts, gluten ( found in wheat, rye, barley and possibly oats), fish, shellfish, citrus fruits, and soya.
What are the possible symptoms?
Symptoms can range from itching, shortness of breath, vomiting, wheezing to in some unfortunate incidents severe block of airway or fall in BP that may be fatal.
Food intolerance usually cause tummy pain, vomiting and bloating.
Sometimes headache, lack of attention, poor concentration and behaviour issue also might have a dietary link.
How to help your doctor diagnose your child's food allergy?
1. Take a complete list of the suspected foods.
2. Note the method of preparation (eaten raw/ cooked), any spices added(example:MSG)
3. Discuss the allergic episode in detail: Amount of food taken, How soon the child developed the symptoms, what exactly were the symptoms, how long did the child have the symptom, previous similar episode when the child was given the same/ similar food, previous treatment.
4. Discuss with your relatives to know if any one else in your family suffered similar allergy.
5. Growth chart of our kid, weight gain/loss.
How is your child diagnosed?
1. Blood tests: to measure the concerned immunological parameters
2. Skin tests : Inject a small quantity of the extract of the suspected food (allergen) and looking for reactions.
3. Food diary: You will be asked to maintain a food diary to have a note of food taken and any reaction observed.
Keep watch.
Avoid the suspected food allergen .
Educate yourself to read the food label to see if allergen is included.
Whenever your child eats at school, picnic or parties inform the concerned people about your kids' food allergy.
Seek medical care promptly when needed.
Educate yourself about how to use an epipen and when possible teach your kid too.
When a particular food is avoided, see to it that another food of equal nutritional value is added to the diet, so that your kid does not suffer from nutritional deficiency. A dietician can help you with this.
Exclusively breatfeed your baby for the first 6 months.
Will my child grow out of it?
Up to 90 per cent of children will outgrow cow's milk and egg allergy and cow's milk protein intolerance, for example, while only about 10-20 per cent may outgrow nut allergies. So it depends on what your kid reacts to.
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