Limb pains
A very common complaint of children is pain in the limbs. It may be a part of a viral illness in which case the child will also have fever, apathy etc. Some children complain of pain in the calf muscles, bones and joints, particularly at night time. This pain is present in both the limbs and is called “growing pains.” It is common amongst school going children. It is a benign condition, which outgrows with age as the child reaches adolescence. In case of severe pain, local massage, hot fomentation and analgesics may be required.
Heart problems in childhood
They are mainly of two types, congenital (from birth) and acquired (“rheumatic heart disease” described earlier is the commonest in this category). All types of congenital heart problems are by and large, thanks to the modern advances and wonderful cardiac surgeons in India, treatable. For rheumatic heart disease, future prevention is very important which usually consists of giving a monthly injection of long acting penicillin, at least till the child is 18 years old and maybe much longer also.
So the parents must without fail take these injections regularly, because if the child has a second attack of rheumatic fever, it may cause more damage to the heart. There may be some turbulent sounds coming from the heart heard by the stethoscope called “heart murmurs”. If your doctor detects some murmur in the heart of the child and tells you that it is innocent or benign, there is nothing to worry about. Children frequently have these types of murmurs, even when the heart is completely normal. These are produced due to turbulence of the blood flow across normal heart valves. Many of these murmurs will disappear with time, but even if they persist there is no cause for alarm.
Convulsions/coma
The term to a layman usually implies some spasmodic twitching of the muscles of the body like those of the face, limbs etc. But there are many types of seizures without any muscle twitching. An example is “absence seizures” (common above the age of 5 years) in which the child temporarily loses contact with reality and just has a staring, dazed look. Typically it lasts for a few seconds, after which the child comes out of his “absence” and resumes his normal functioning. The child has loss of memory for the seizure episode; i.e. he is not aware that some time is lost or that he had gone into a trance like state. So seizures needn’t always be associated with twitching.
A type of convulsion associated with fever and occurring in the age group of 6 months to 5 years in an otherwise normal child is termed “Febrile Convulsion”. These fits are benign, always associated with rising fever, subside spontaneously within 10-15 minutes and post-fit, the child is normal. Children will outgrow these fits (they subside, as the child becomes older than 5 years), and they have no ill effects on the development of the child.
No investigations are required for such fits and also no long-term treatment with anticonvulsant is required. When the child is having fits, the doctor may give some injection (usually that of a drug called diazepam) to stop the fits. For preventing febrile convulsions, as soon as the child starts having fever, you can give Syrup Paracetamol and Syrup Diazepam to your child (for exact dose and schedule, consult your doctor) and then take the child to your doctor.
Convulsions that are recurrent are termed “Epilepsy”. There maybe a positive family history of epilepsy (paternal or maternal side). For diagnosing epilepsy and its exact nature, your doctor may order a test called EEC Fortunately, there are excellent drugs, called anti-convulsants, available to control epilepsy so that the child doesn’t suffer from recurrent fits. These drugs are usually to be taken for a period of 3 years. The type of drug and the dose required is decided on an individual basis and your doctor will guide you in it.
If the child has been fit free during these 3 years or had only an occasional fit, then chances are good that he may not become an adult epileptic. Some precautions are to be observed for any person suffering from fits. Common sense dictates that the child should not be left unattended (i.e. without supervision) in places, where if he has a fit, there is a danger of physical injury to the child. Obviously, therefore the child should not be allowed to go to high places (e.g. rooftops) alone, should not be allowed near fire or water unattended, should not drive motorcycle alone etc.
But he can attend school, play any game he likes, pursue his hobbies etc. The child should not be made to feel inferior to his peers. He should lead as normal a life as possible. Parents should not become over protective but rather have a positive approach towards the disease and inculcate the same in the child. Some of the greatest personalities (whose statures we can’t even dream of achieving) like Caesar, Napoleon, and Einstein etc. suffered from epilepsy, which just goes to prove that greatness and excellence has no relation with epilepsy. So, why your child should feel handicapped in any way, if he is suffering from epilepsy?
Some convulsions are secondary to an insult to the brain e.g. meningitis, low blood sugar, calcium etc. Fortunately, by and large, these types of convulsions are transient and lasts a few days only. Once the underlying insult to the brain is treated, the convulsions also regress. Of course for these few days, the child may be put on an anticonvulsant, but usually secondary convulsions don’t require long-term therapy. An exception is convulsions secondary to brain trauma, which may require a prolonged anticonvulsant therapy.
Worm infestations
Practically all children suffer from it sometime or the other. Worms have been blamed for all type of problems like teeth grinding, loss of appetite, poor weight gain, diarrhea, chronic or recurrent pain in abdomen, listlessness or irritability in the child etc. Worms usually don’t cause all these problems unless the worm load is very heavy. Rather than blaming worms, one should diligently search for other causes. For example if the child is having chronic diarrhoea or pain in abdomen, it is quite possible that it is not due to worms but to some other intestinal problem/ infection.
Worms, particularly small thread like worms can cause peri-anal itching, particularly during night-time. Some worms like hookworms suck small amount of blood from the intestines and over a prolonged period of time can cause anaemia in the child. The larvae of some worms migrate through the lungs and at that time they can cause cough and wheezing. Worm infestation is treated nowadays with a single dose therapy, with gratifying results. People believe that worm medicine should not be given in cold weather, should be given only before going to bed etc.
These beliefs are not true. Worm medicine can be given at any time. In a country like India, it is advisable to periodically de-worm your child twice a year at 6 month interval. Parents often query that even after giving the worm medicine no worms come out (i.e. was the medicine ineffective?). The medicine is very effective. Worms are seen in the stools only if they have become big. But eggs of the worms and larva cannot be seen by the naked eye, which are also killed by the medicine and comes out in the stools.