Thursday, September 4, 2014

Common Cold in children : Concerned Parents

A child may catch cold several times in a year. Common cold is a benign condition but raises a level of anxiety and concern in parents and is pretty much obvious. After all children are as delicate as they look.
Cough is a common symptom that causes a big concern in parents and commonly they are worried about their child having a chest infection - Pneumonia. Another symptom that worries parents is noisy breathing that may be a simple nasal blockade but can be due to Asthma, Croup and other conditions.

The common cold are symptoms caused by a number of different viruses. More than 100 virus cause cold but  rhinovirus, the type of virus responsible for the greatest number of colds. Other are enteroviruses (echovirus and coxsackieviruses) and coronavirus.

Common Cold common symptoms

Children under 6 years get average six to eight colds per year.

Although  colds occur during the fall and winter months,in any geographic location, it can occur though out the year. It is transmitted from person-to-person, either by direct contact or by contact with the virus in the environment. Colds are most contagious during the first two to four days.
Droplets containing viral particles can be exhaled into the air by breathing or coughing. Rhinoviruses are not usually transmitted as a result of contact with infected droplets, although influenza virus and coronavirus can be transmitted via small droplets. Cold viruses are not usually spread through saliva.

What are the Common Cold Symptoms?
In children, nasal congestion is the most prominent symptom.
Children can also have clear, yellow, or green-colored nasal discharge;
Fever (temperature higher than 100.4ºF or 38ºC) is common during the first three days of the illness.
Sore throat
Decreased appetite.
Red and swollen nasal area
Neck lymph nodes may become slightly enlarged.

What are the Complications of Common Cold?
Most children who have colds do not develop complications.
However, parents should be aware of the signs and symptoms of potential complications.
Ear infection — 5 - 15 percent of children with a cold develop a bacterial or viral ear infection.
If a child develops a fever (temperature higher than 100.4ºF or 38ºC) after the first three days of cold symptoms, an ear infection may be to blame.
Asthma - noisy breathing also referred to as wheezing, called Reactive airway disease in smaller children
Pneumonia- high grade fever, lethargy, fast breathing, cough and child looks toxic.

 Symptomatic treatment —
1. Plenty of fluids - hydration
2. Warm clothing and warm environment.
3. Nasal care- Cleaning and in older children - steam inhalation with soother can be helpful. Steam inhalation in small children should be avoided as it can cause burns.
Saline nasal drops can be used in case of nasal stuffiness and blockade
4. Adequate rest - speciially children in daycare centres and school should be let to stay warm at home.
5. Antipyretics- High fever can cause discomfort and irritability. Dose of Antipyretics can be given for fever exceeding 100.4 F PRN.
6 Children may present with wheezing
   - Such children may require immediate doses of Nebulization with Salbutamol and if improves can be discharged on oral beta2 agonist

Usually Antibiotics are Not needed as Viruses don't respond to antibiotics. So requesting doctor for an antibiotic and administering over the counter antibiotics are not recommended.

When to seek Medical Help?
Refusal to drink or feed
Inconsolability and undue irritability
Lethargy (decreased responsiveness - Sick/toxic looking);
Difficulty breathing,
Fast Breathing
High grade fever greater than 101ºF (38.4ºC) lasts more than three days.

Such children need immediate medical attention regardless of time - night or day

Monday, September 1, 2014

The deadliest disease in today world

Many times we have debated on list of deadliest diseases. But if we look into the root cause, we can easily figure out the cause of most deaths in the world is poverty. More people die of hunger, starvation and poverty than wars and accidents.

In our scenario, newborns are brought in distress into our Neonatal Unit. Almost everytime the problem is same, the parents are economically broke and there isn't much they can do for their newborn, as they cannot afford NICU and medication charges. Many times we arrange Free beds but the problem is not solved with it. Even after the baby is discharged, he needs care and need to be nurtured.

The poverty is such severe that people come to Health Centres for Delivery, just to get Rs 1000 that government provides the mother under Safe Delivery program. Most of the time, we find, the parents are unprepared economically for any unexpected events at the time of delivery. If the newborn or the mother gets sick, the patients are unprepared for it. Only bearing a child is not a solution, the parents should be responsible enough and capable enough to bring up the child under atleast fair condition. A 16 year old father is in crisis after his wife delivers a preterm newborn, and this is the face of real scenario back here.

Most people here are dying of poverty. They are dying of simple diseases like Diarrhea, Pneumonia and treatable conditions like Neonatal sepsis. Malnutrition is omnipresent and is an amplifier of the risk of death and often itself is a cause of death. A small amount of saving for the time of crisis, a little aid from government can save thousand of lives of the future human resource of the nation, the children. Carelessness is even deadlier and unawareness is deadliest. Unaware of simple signs and symptoms of illness, often there is delay in seeking medical attention and such a delay can cost heavily. Health awareness and Education programs will certainly be helpful in poorer communities. A theme of Keeping a backup plan and a saving before delivering a baby should be promoted, as often people are unaware of the scenario that can arise.

Sunday, August 31, 2014

Pediatric OPD is a Challenge: Treating the Child and Meeting Parents expectations

" A concerned mother brings her 3 yr child to the Outpatient Clinic, the child has had fever for 1 day, running nose and cough for 2 days. There are no other serious complains and findings on examination are all normal, expect for running nose and low grade fever. A case of common cold that is very common in childhood.
The mother is really concerned about the child contracting a Pneumonia , well there were no symptoms as such and pediatrician counsels her on that, but she wants an antibiotic for safe-side. Doctor explains the condition and hazards of erroneous use of Antibiotics, she is convinced.
She is equally concerned about the cough. She has been giving the child Anti-tussive from Over-the-counter prescription that is pandemic in our country. Doctor advice her to stop the drug as current research does not recommend its use in below four years children. She is not convinced this time, in-spite of counselling"
In such a Scenario either doctor keeps trying to convince her, either he loses the follow-up or he has to go with the flow an prescribe Anti-tussives and Vitamins as the trend is in Private practice.

Pediatrics is a bit different subject to doctors in many sense. Specially in Pediatric out patient department or in private clinics, doctors will often find a mildly ill child but more skeptical parents who might constantly test you with their queries and doubts.
Pediatrics is different in that , not just treatment of the sick child is important but also meeting of the parents expectations, counselling them well and taking them in confidence. Often doctors meet lot of patient who already on Antibiotics for Viral URTI , so the dilemma sets in- to continue or to stop the medication. The trend in the private practice is so wide-spread that antibiotics are prescribed for cases without any indications. The fault is not just in doctors here but in parents as well who often switch doctors when doctor prescribes less drugs. However its what the nature of care-taker is, they always want to be on the safe side, while unknowingly they may be harming the child.

Erroneous and Erratic use of Antibiotics have led to Antibiotic resistance.There was a time when Penicillin was Jack of All, a shot of it could treat almost everything,today plain Penicillin rarely can treat any condition. These are the outcomes.

Meeting the Expectations of Parents-
What parents generally expect is that their child should be well with a day of treatment, which is rarely a possibility, because most antibiotics take at-least 24-48 hours to get working.  Counselling about the need and expected time of resolution can convince the parents to be more patient.
They want all their Queries fulfilled and all their doubt cleared. Because they are on behalf of a child patient who cannot express many things and they are guardian to such delicate human beings. Show then the empathy and that you care equally for the welfare of the child. Be patient and answer all the queries they have. Doctors should put themselves in the place of parents and try to fulfill their queries.
They may search for your qualifications and experience , face them confidently and without hesitations. Getting angry at it will not mask the thing, but will cause you to lose a rapport and trust.
They always want best among the pediatrician to treat the child, so they may test you with several questions, doctor must let them know that you are equally good and take them in confidence.
And last of all, ethically don't give up and prescribe medications to satisfy the parents, do it only when you know it is required. And the question is " Is this a possibility?"

I may not be totally right as I have a long journey to go, if you have a different opinion, I welcome your feedback.

Friday, August 29, 2014

What the child feels about Doctor ?

What child feels about Medical books and Medical Education

What child thinks about being Sick

What shocks the child most

How child feels when the doctor is on Leave

What child really hates

Some Parents are more Childish

Thursday, August 28, 2014

Pavilizumab Prophylaxis for RSV Bronchiolitis: Recommendation

Palivizumab is a humanized monoclonal antibody directed to an epitope in the A antigenic site of the F protein of RSV. It is a composite of primarily human antibody sequences (95%) and murine antibody sequences (5%). Palivizumab provides both neutralizing and fusion-inhibitory activity against RSV, resulting in inhibition of RSV replication. Although resistant RSV strains have been isolated in laboratory experiments, no resistant clinical isolates have been identified at this time.

Her are some updates- UPDATE on RSV prophylaxis

The updated policy recommends that RSV prophylaxis be considered in:
  • infants and children younger than 2 years of age who have required medical therapy for CLD within the 6 months prior to the start of RSV season; patients with severe CLD may benefit from prophylaxis with palivizumab through 2 RSV seasons
  • infants born at or prior to 32 weeks gestation
  • infants born between 32 and 35 weeks gestation with known risk factors, such as birth within 6 months of RSV season, child care attendance, school-age siblings, exposure to environmental pollutants, airway abnormalities, or severe neuromuscular disease
  • infants and children younger than 2 years of age with hemodynamically significant CHD, particularly patients with pulmonary hypertension or cyanotic heart disease, and those who require medication for congestive heart failure.
Source - AAP through Medscape