Jaundice
Most commonly it is due to an infection of the liver called “Hepatitis”. The liver is usually infected by the hepatitis viruses A, B, C and E, out of which A is the most common. The mode of spread of Hepatitis-A is feco-oral. This means that it can occur by contaminated water, fingers, flies, contaminated food etc. Hepatitis B and C are also common and the mode of spreadis by intimate sexual contact, i.v. drug abusers, and blood transfusions and from a pregnant mother to her baby.
The eyes may become yellow and the urine becomes dark yellow along with a decrease in the appetite of the child, apathy, right sided pain abdomen and nausea/vomiting. As opposed to Hepatitis-A; hepatitis B and C can become chronic and lead to liver failure and sometimes cancer of the liver. Hepatitis-E is rare and similar to A.
Treatment of Jaundice and Hepatitis:
It is a common misconception that some sort of liver tonic e.g. Liv-52, Stimuliv etc. is a necessary medicine to treat jaundice. The truth is that these liver tonics are of questionable benefit. Liver is a very versatile organ capable of regeneration of the dead liver cells by its own and doesn’t require liver tonics to keep itself fit and fine. Similarly, there is a misconception that fried, fatty food is contraindicated in liver disorders and should not be given to the child. This stems from the fact that in some children fatty food can cause more nausea.
So often parents feed the child only high carbohydrate diet (e.g. Glucon-D) and even if the child asks for fried food, it is avoided, sometimes for weeks. This is not appropriate, because if the child cannot tolerate it, he will not ask for it. Even the sight of fatty food will repulse him. So if the child asks for it, it means that he will be able to tolerate it and so there is no harm in giving it. Finally many parents, even educated ones, go to “jaundice specialists”(quacks), who dip the hands of the child in water. The water, as if by magic turns yellow and the quack smugly tells the parents that the jaundice of the body has been “removed” into the water. In fact it is nothing else but a fraud.
Liver is the centre of control for diseases:
It appears that parents and some doctors, too, have the erroneous notion that a liver problem is responsible for all sorts of indigestion, failure to gain weight, poor appetite, thinness, chronic and recurrent pain in abdomen etc. Whenever a child has these problems, the doctor often tells the parents that it is due to a liver problem which generates a lot of anxiety in the minds of the parents, while it is rarely true.
The liver is normally palpable in a child up to 3 years and doesn’t signify a liver pathology. Liver problems usually manifest as jaundice, deep yellow urine and nausea/ vomiting with a marked decrease in appetite. Therefore to blame the liver for all troubles is injustice being meted out to a versatile and “innocent” organ of the body.
Cervical lymph nodes (neck glands)
Parents are quite worried over small pea-sized swellings, which they feel in the neck, behind the ear, at the back of the scalp etc. These swellings are due to lymph nodes (as parents correctly point out). Some of them are anxious that it may not be a tumour or T.B. glands. If the glands are freely mobile, less than 1 cm in diameter and not painful, it is reassuring and the only policy to be followed is a “wait and watch” policy. Parents should report if there is any increase in the size of the glands. Most of these glands persist due to some old illness of the scalp or of the mouth. There are no associated systemic complaints with these glands and are brought to notice only because one day, the parents happen to feel them.
Head injury
Head injuries are very frequent in children. They may topple down from the bed, trip and fall while running; fall down from a height etc. Fortunately most of the head injuries in children are trivial. However following a head injury, parents should always consult a doctor. If there is a change in the level of consciousness, persistent vomiting, irritability or drowsiness, convulsions; immediate medical help should be sought.
External injuries like bruises or a swelling of the skull at the site of injury are of less concern than the possibility of a brain injury. Parents are anxious about the external visible swelling following the bump. Actually it is nothing else but a collection of blood below the scalp and nothing has to be done for it, certainly not aspiration or incision, as it subsides on its own in a few weeks.
Ear aches
This is also a very frequent complaint amongst childhood. It usually follows a respiratory infection like cough, cold etc. It is also more common in bottle-fed babies, particularly when they are nursed lying down. It is due to a collection of fluid behind the eardrum, which causes pain. Relief is achieved by spontaneous perforation of the eardrum with exudation of the pus. The treatment is antibiotics and analgesics. Parents are worried that the perforated eardrum may not heal and may lead to hearing problems later on. Fortunately in the vast majority of cases, these fears are unfounded as the eardrum heals completely with no residual hearing loss.
CSOM: It means chronic otitis media. Some children have chronically draining ears which do not respond to the common antibiotics. Any ear discharge that is persistently present even after 3 months is termed CSOM. It usually follows a perforation of the ear drum and a chronic infection of the middle ear. This infection causes pus to come out of the perforated eardrum outside the ear. The treatment of it requires a different kind of antibiotics, which are usually given for a period of 2-3 weeks till the ear is dry.
After that the child may have to be put on a single daily dose preventive antibiotic for 3 months so that the ear infection does not recur. This is done so that the ear drum can heal and all focus of infection from the middle ear is removed. If it still does not work, then the option is surgical closure of the ear drum. In CSOM, some doctors also prefer instillation of local ear drops in the ear for a period of 7 – 14 days, a thing which is not ordinarily done in an ordinary acute ear infection (called ASOM).