Leading Paediatric Hospital in India

Causes

Many causes can lead to bed-wetting.

• Improper development of child’s urinary bladder
• Inability of the urinary bladder to hold urine during night times
• Immature nerves of the bladder
• Situations that cause stress to the child like joining a new school.
• Staying away from home
• Arrival of a newborn sibling in the family
• Less production of anti-diuretic hormone that slows urine production during night times

Other symptoms include:

• Sleep Apnea (child’s breathing interrupted in sleep)
• Urinary tract infection
• Diabetes
• Chronic constipation
• Abnormalities in Spinal Cord
• Defects in the urinary system or neurological system

One should consult the doctor if the child is wetting the bed even at 7 years of age, the child is complaining of pain or burning sensation during urination, swelling of feet and ankles is seen, the child is wetting his pants even during the day or if the child is misbehaving at school.

Diagnosis

• The doctor does a general physical examination of the child.
• A history of bed wetting, mealtimes and sleep time is noted by the doctor.
• To check if there is any urinary tract infection or diabetes, a urine analysis is done.
• If any problem in the bladder or kidney is suspected, x-rays and imaging studies are done.

Treatment

If bed wetting runs in the family, then the child will stop it at the same age as the parents did when they were children. The level of treatment depends upon how the child is feeling about bedwetting. If the child is embarrassed about wetting the bed, a more aggressive treatment is given by the doctor.

A battery-operated device known as a moisture alarm that detects moisture can be purchased from the local pharmacy. This device is connected to a moisture-sensing pad attached to the pyjamas of the child. The minute the child starts urinating, the wetness causes the device to sound an alarm which wakes the child up or the parent in time so that the child can urinate in the toilet. One needs to be patient when trying out the moisture alarm which gives good results after 12 weeks.

If the doctor finds that the bladder is too small, then to increase the bladder capacity medications like hyoscyamine (Levsin) or anticholinergic drug like Oxybutynin (Ditropan) is prescribed. The side effects that can occur include flushing the face and a dry mouth.

To increase the level of Antidiuretic hormone that helps in making less amount of urine during the night, the drug prescribed is desmopressin. This drug however should NOT be given to the child when he or she has taken a lot of fluids, or the child is feeling nauseous with a headache. The most serious side effect of this drug is a seizure.

To change a child’s sleeping and waking patterns, an antidepressant drug known as imipramine (Tofranil) is prescribed. An overdose of this drug can be dangerous hence it is prescribed only when other medications fail.

Coping and support

One should never punish a child for bed wetting as it is an involuntary action and not intended by the child. If the bedwetting is due to some stress factor one should talk to the child and calm his or her fears.

For easy cleaning, it is recommended that the mattress be covered with a plastic cover. The child should be made to wear absorbent underwear that absorbs urine well.

Night lights along the way to the bathroom will help the child reach the bathroom without tripping in the middle of the night.

One should avoid giving children drinks like cola, chocolates and snacks with caffeine in the evenings as reports say that they increase urination.

An Overview

Asthma is not a condition of recent times. Its existence dates back to ancient Egypt. The word Asthma comes from the Greek word, “aazein” which means to pant or exhale with mouth open. In the early 20th century, Asthma was regarded as a psychosomatic disorder. It was only in the 1960s that the inflammatory nature of Asthma was first recognized.
Asthma is a condition in which the airways in the Lungs get inflamed due to trigger factors like pollen dust, mould, air pollution, cigarette smoke, common cold, flu, cold weather and exercise. Asthma in children affects their schoolwork, play, and sleep. Children feel much troubled by the symptoms of Asthma and when it is left untreated it leads to Asthma attacks that can be dangerous.
During an Asthma attack, the mucus in the Lungs gets clogged in the airways causing the air tubes in the Lungs to tighten and swell. During such an attack, the child experiences symptoms like wheezing, cough with mucus, breathing problems, congestion and tightening of the chest, chest pain, difficulty in talking, sleep problems, and fatigue.

Treating Asthma

There are several medications to treat the symptoms of Asthma. To stop Asthma attacks, a bronchodilator may be prescribed. The bronchodilator when used opens up the blocked airways in the lung and helps in easy breathing. To prevent Asthma attack, anti-inflammatory medications are prescribed by the doctor that has to be taken daily. These medications prevent the airway from swelling and thus prevent Asthma attacks from occurring. You must take all medications only after consulting your doctor.

Life with Asthma

Life for a child with Asthma can be challenging at times. You must inform the school authorities, teachers, school nurses and coaches if your child is Asthmatic. Your child can feel embarrassed to use the bronchodilator in front of other children. It is important to let your child know the importance of using it. It is better that you tell your child’s classmates as well so that they do not make fun of your child when he has to use the bronchodilator. You must let your child know that being Asthmatic is not a disability; it is just a health condition that can be dealt with easily. Giving all the emotional support you can for your child will make it easier for your child to deal with Asthma better.

Using a peak flow meter

A peak flow meter is a device that helps to measure the amount of air that is coming out of the Lungs. In people with Asthma, the air coming out of the Lungs is low. With the help of this device, you can check your child’s airflow from the Lungs and determine how serious the Asthma attack is. The peak flow meter device has a meter scale with an indicator on it. Make sure the reading on the device is at zero. The child has to blow into the mouthpiece of the device after taking a deep breath. The reading on the meter scale is shown by the indicator. This way the readings are taken two more times and the highest of the three readings is noted. When Asthma is in complete control, the reading taken gives you the ‘personal best score’. It is the best reading that you take in two weeks after Asthma control. You can now compare the daily scores you record on the peak flow meter to the personal best score. This will give you an idea of whether your child’s condition is improving or not.

The peak flow zone system has three zones of different colours like the traffic light system that indicate how your child is doing. The peak scores are put into one of the three zones to study the severity of the Asthma your child is having.

• Green zone: When your child gets a score that is 80% to 100% of your personal best score then it shows that your child’s Asthma is under control. In this stage, the child does not show any symptoms but it is recommended that the child should take its preventive medication.
• Yellow zone: When your child gets a score that is 50% to 80% of the personal best score then the readings fall in the yellow zone which indicates that the condition of your child’s Asthma is getting worse. The child shows symptoms like wheezing and coughing. You should consult your doctor for advice.
• Red Zone: This zone indicates a medical emergency where the scores are below 50% of the personal best score. In this condition, the child’s fingernails and lips turn bluish in colour. The child will have severe breathing problems, coughing and wheezing. There is no time to lose in this condition. The child must be taken to the hospital immediately.

Avoiding Asthma Attacks

To keep your child safe from Asthma, it is important that you recognize the trigger factors causing Asthma in your child. You must keep your child away from irritants and trigger factors like pollen, dust, pet dander, mould, food preservatives, tobacco smoke, certain perfumes and deodorants, Aspirin, sinus infections, exercise, changes in temperature, emotional situations, Heartburn and certain viruses.

Once you recognize the trigger factors you must take steps to avoid them. If pollen dust is causing the problem, then close your windows and doors to avoid pollen from getting in. To prevent mould, keep areas of the kitchen and bathroom clean and dry. You can use a dehumidifier to keep the humidity low thus preventing the growth of mould. To avoid dust and dust mites, wash your draperies regularly in hot water that is above 130 F. Chemically treated carpets keep the dust mites away. Stuffed toys generally catch dust. Try to keep them away from dust. Do not let pets enter the house or the area where your child stays as pet dander can trigger an Asthma attack. Do not let your child get exposed to any air pollution or tobacco smoke.

Causes and Risk Factors

There are a variety of causes of Obesity in children; the most common reasons include:

• Genetic factors: Your child may be obese if she or he is from a family of obese people. Your child would carry the genes involved in making them obese.
• Hormonal imbalances: Abnormalities in hormonal production and secretion may make your child obese.
• Lack of physical activity: Children who do not perform regular physical activities have lowered chances of burning out the fats. Too much time spent immobile piles up the extra fat and makes your child obese.
• Unhealthy eating patterns: Eating high-calorie foods such as processed foods, candies, desserts, etc. would make your child gain excess weight.
• Psychological factors: During emotional situations to cope with the stress, or to kill boredom, few children may overeat. This would make the child obese.
• Socioeconomic factors: Low-income families may have less access to healthy food. This can also be one of the reasons that can make your child obese.

Symptoms

To conclude if your child is obese, you must make sure to get the height and weight of the child measured. These measurements allow for the calculation of the body mass index (BMI) to consider the body physique of your child. If your child’s weight is more than what the expected weight is, it is considered that your child has excess amounts of fat stored.

Complications

Childhood Obesity can showcase the complications related to physical, social and emotional well-being:

Physical complications:

• Asthma
• Early puberty
• Sleep disorders
• Type 2 Diabetes
• High cholesterol
• High Blood Pressure
• Metabolic syndrome
• Non-alcoholic Fatty Liver Disease

Emotional and Social complications:

• Depression
• Low self-esteem
• Behavioural problems

Diagnosis

Your doctor will analyse your child’s BMI to understand if your child is obese for his or her age and height.

Your child’s percentile is determined by using a growth chart. It reveals the information by comparing your child’s weight with the children of the same age group.

The BMI for age between 85th and 94th percentile indicates overweight.

The BMI for age 95th percentile or above indicates obesity.

In addition to BMI calculation and charting weight on the growth charts, your child’s doctor would evaluate your:

• Child’s eating habits
• Child’s physical activity level
• Family’s history of Obesity and weight-related health issues such as diabetes

Blood tests

Your child’s doctor may order blood tests if your child is obese, the tests would include:

• A cholesterol test
• A blood sugar test
• Tests to check the hormonal levels

Treatment

For initiating the treatment, your doctor will first determine the cause and eradicate it. Your doctor might ask you to start the physical activity that cuts down your calories. You will be asked to follow a well-planned dietary program. Drugs and surgery are restricted to severe cases of childhood obesity.

Healthy eating patterns

It is believed that even smaller changes may make big differences in your child’s health.

• You must limit food that contains high fat and calories.
• You must limit sweetened beverages in your child’s diet.
• You must serve appropriate portions of food to your child.
• You must include fresh fruits and vegetables in your child’s diet rather than chips and junk food or snacks.

Family support for child’s well-being

Parents play a crucial role in helping their children who are obese. You must talk to your child directly, and encourage him or her:

• You must be sensitive in understanding your child’s needs and make him/her comfortable to choose the physical activity of his/her own interest.
• You must find reasons to praise your child’s efforts and encourage him/her by celebrating when there are any accomplishments in weight loss.
• You must be patient enough and never stress your child to reduce weight in less time.

Cleft Lip and Palate - The Visible Anomaly

A cleft lip is the presence of one or two longitudinal abnormal fissures or splits in the upper lip. The slit can be a small opening in the lip or it can be a wide opening that goes from the lip to the nose.
A cleft palate is a fissure in the roof of the mouth which occurs due to abnormality of the two palatal shelves in joining together to form the complete palate.
In some children, the front (hard) and back (soft) portions of the palate fail to join. In some children only one part of the palate is open.
There can be a cleft lip without cleft palate or cleft palate without cleft lip or both can occur together simultaneously. The deformity occurs during early development when the baby is still growing inside the mother.
Clefting occurs when there is insufficient tissue for the proper formation of the upper lip and palate or when the tissue fails to join properly. Cleft lip and cleft palate can occur on both sides of the mouth as they develop separately.
These are among the most common birth defects which may be associated with various genetic conditions. These affect the way the baby’s face looks and can lead to problems associated with eating, speaking and listening.
In most of the cases, it is not known as to why cleft lip and cleft palate occur. However, it is believed that these congenital defects occur due to genetic and environmental reasons. If anyone in the family such as parents, siblings or relatives has already had any of these conditions, then there is a higher risk for the baby to be affected by Clefting.
If the mother had taken some of the anticonvulsants or antiseizure medicines or medicines to treat Cancer, Psoriasis or Arthritis during her pregnancy, then these medicines may cause cleft lip or cleft palate.

Complications

In children with cleft lip and cleft palate, depending on the severity of deformation, various problems are encountered.

In the absence of separation in the palate, liquids and food can enter the nose from the mouth. Specially designed feeding bottles with nipples are now available to stop fluids and food from flowing back into the nose. Even manmade palates are available to help these children with cleft palate to feed properly until proper surgical treatment is provided.

Fluid build-up can occur in children with cleft palate making them more prone to middle ear infections. These infections can cause loss of hearing if not treated. To aid regular fluid drainage from the middle ear, special tubes are needed to be placed in the ear drums. These children need regular exams at least once a year to check for any ear problems.

Children with cleft palate may face problems in their speech as their sounds are not carried on well and may take on a nasal pitch. In most children surgery can fix this problem, and, in some children, the assistance of a speech pathologist may be needed who can work with these children to resolve the problems.

Children with clefts are more inclined to suffer from dental problems due to malformed, missing, extra or misplaced teeth. In addition, children with cleft palate are likely to have defective bony upper gum part that holds the teeth. This defect may prevent proper development of the upper ridge, displace and rotate permanent teeth and hinder the appearance of teeth. Most of these problems can be corrected through surgery.

Due to differences in appearance from normal children and because of the stress from the intensive medical treatment, these children with clefts may experience social, behavioural and emotional problems. A Psychologist or social worker can help your child, you and your family to overcome these difficulties.

Treating Cleft lip and palate

In most of the cases, cleft lip and cleft palate are found at the time of birth; but now mostly diagnosed during ultrasound exams of the mother during pregnancy prior to baby’s birth. If the ultrasound exam indicates a cleft, the doctor may take a sample of the fluid from the mother’s womb to check for any genetic abnormalities.

After birth, these defects can be diagnosed through physical examinations of the mouth, nose, and palate. Sometimes other diagnostic tests may need to be carried out to rule out other abnormalities.

As the condition of cleft lip and cleft palate is associated with a number of oral health and medical problems and may involve a series of reconstruction surgeries, a team of medical specialists and doctors are necessary for the proper care of the children who have these birth defects.

The team may consist of the following depending on the care required which may start in infancy and continue till adulthood.

• Cosmetic/plastic surgeon to assess and conduct necessary operations of the lip and/or palate
• Otolaryngologist (an ear, nose, and throat doctor) to render appropriate treatment for hearing problems.
• Oral surgeon to position various segments of the upper jaw in place and to enhance the function, improve the appearance and repair the cleft of the gum
• Orthodontist to straighten and align the teeth in position.
• Dentist to render required dental care.
• Prosthodontist (A type of dental specialist) for making cosmetic restoration and replacement of teeth.
• Speech pathologist to evaluate feeding and speech problems
• Speech therapist to assist the child in improving speech
• Audiologist (a specialist in communication disorders stemming from a hearing impairment), to monitor, evaluate and attend to any hearing problems.
• Nurse to provide necessary medical and health assistance.
• Psychologist/social worker/counsellor to provide required support to the family and to the child.
• Geneticist, a specialist in the subject of genetics, to assess, diagnose and manage cleft lip and cleft palate patients and help parents understand the chances of having more children with these conditions

Depending on the extent of deformation, a cleft lip may need one or two surgeries which may be performed when the baby is 3 months old.

Cleft palate generally requires many surgeries over a long period even extending to 18 years. The initial cleft lip major surgery to repair the palate is done when the age of the baby is between 6 and 12 months. This surgery is carried out to create a functional palate, to decrease the risk of fluid build-up in the middle ears, and to aid in the proper development of the teeth and facial bones. Around the age of 8 years, these children may require bone grafts to fix the upper gum so as to hold permanent teeth and stabilize the upper jaw.

To correct any problems related to speech, 20% of the children with cleft palate may require further surgeries. Subsequently, braces are required to straighten the teeth.

Further surgeries may be needed to improve the look of the lip and nose, bridge the gap if any between the nose and the mouth and reposition the jaw.

Final repairing surgeries of the scars may be carried out only in adolescence when the facial structure is completely formed.

Understanding Congenital Heart Diseases

Babies may be born with a defect in Heart, which could be simple defects or complex. Examples of simple defects are a hole in the Heart or a defect in the valves of the Heart. A hole in the Heart causes the mixing of oxygen-laden blood with deoxygenated blood. A defective Heart valve may interfere with the blood supply to various parts of the body. A complex Heart defect may involve a simple defect coupled with abnormal connections of the blood vessels from and to the Heart, or a major defect in the structure of the Heart.

Congenital Heart Disease can be diagnosed before birth, right after birth and even in adults. Most of the babies may not have symptoms at all. Many kinds of tests may be carried out by a qualified Paediatric Cardiologist to know what Congenital Heart Disease your baby has. These tests also show the condition of your baby’s Heart.

• Electrocardiogram (ECG): Measures the activity of different parts of your baby’s Heart. Also shows how various parts of the Heart are working.
• Pulse Oximetry: Measures the amount of oxygen present in your baby’s blood.
• Echocardiogram: Provides the doctor the sound images of your baby’s Heart.
• Chest X-ray: The doctor can evaluate how well your baby’s Heart is growing and whether any fluid is present in the Lungs.
• Cardiac Catheterisation: A dye is used in the Heart to know clearly about the Heart problem your baby has.

Babies may have one or several Congenital Heart Diseases, and the treatment depends on the type of disease. These are generally treated in one or more of the following ways:

• Medicines: Medicines may be prescribed to reduce the stress on the Heart.
• Surgery: Some babies may need to undergo one or various types of surgeries. Some may need one or several over months or years to repair Heart structures. Some may need it immediately as soon as they are born and some may need it after some time.
• Cardiac Catheterisation: Some defects of the Heart such as holes can be closed using catheters by inserting balloons.
• Ablation:  Some defects of the Heart rhythms can be corrected by inserting tubes or small sections of the Heart causing problems that can be destroyed using radiofrequency energy or intense cold.
• Heart Transplant: When there are no other treatment options, Heart Transplant may be considered as the last resort.

Normal development of your baby through proper care

Because of the Heart problem your baby has, the normal development may be hampered but there is a good chance for your baby to crawl, talk, walk, and play normally like other children do. Once the Heart problem is fixed, the chances for your baby to grow strong and healthy are good.

Caring for your baby with Congenital Heart Disease includes understanding the basics about congenital Heart disease, medicines to be used, nutrition to be provided, keeping an eye on the signs of trouble and encouraging the kid in self-management which would make him or her more confident and positive.

Be not afraid, you will not hurt your baby

Many parents are afraid that they will hurt their sick baby if they try to handle it. Your baby needs your love and care. You do not hurt your baby if you cuddle and care even though your baby is sick. For you and your baby, talking and playing are very important. Your baby needs the same attention as that for any baby.

Feeding your baby

Because of Heart disease, babies may become tired easily. If your baby becomes tired during feeding, then feed the baby in small portions as often as possible. The Heart defect may make the Heart of your baby exhausted and as such your baby needs extra energy to work harder. Feeding your baby in small amounts as many times as possible does not tire your baby.

Breastmilk is the best food for your baby and protects your baby from any infections. Even though it may not be easy to breastfeed because your baby may become tired, to prevent any infection that could worsen your baby’s condition, breastfeeding is essential. You may need to give baby formula food for extra calories required by your baby. If you are facing any problems regarding breastfeeding, you need to consult your doctor who may recommend you to a specialist in lactation. If you have to feed your baby with special baby food formula or need to use it along with your breast milk, a Nutritionist or Paediatric Dietician can advise you of the right formula for your baby.

Do not be over-protective

Help your child to lead a normal life and do not try to be over-protective as this might isolate and alienate your baby which may hamper normal development in the long run.

Older kids need to be informed as to what happened to them when they were infants, why medicines need to be taken, why to visit the doctor regularly and why they need to be treated. Encourage your kid to become involved in physical activities with other children and obtain relevant advice from your doctor.

Seeking help

You can seek help from various sources such as your doctor or hospital about the kinds of care they can offer. You may also approach social workers or counsellors to know more about the respite programs and home care services to cope with caring for your baby.

You can also obtain required help and support from parental support groups and share what you are going through with parents facing similar problems.

Causes

Usually, Cancers, including DSRTC are caused due to mutations in the DNA (changes in the DNA structure). These mutations lead to the abnormal division of the cells producing many abnormal cells. However, the exact cause of these mutations is not known.

Symptoms

Desmoplastic Small Round Cell Tumour usually does not produce symptoms in the early stage. The first sign is the formation of a hard mass in the abdomen which grows very large before the patient can identify it. The patient also feels pain in the abdomen. The other signals include:

• Swelling of the abdomen (abdominal distention)
• Fatigue (extreme tiredness)
• Fluid in the abdomen (ascites)
• Back pain
• Loss of appetite and weight loss
• Gastrointestinal blockage
• Anaemia
• Thyroid and other hormonal problems

It is a good idea to consult a doctor if you notice the above symptoms as they may indicate that you or your child might be having DSRCT.

Risk factors

The below patients are at an increased risk for  Desmoplastic Small Round Cell Tumour:

Age: Desmoplastic Small Round Cell Tumour (DSRCT) is more common in young children but may also occur in people of any age group.

Gender: Desmoplastic Small Round Cell Tumour is more common in men compared to women.

Diagnosis

As the condition is rare, it is mostly misdiagnosed.

If you have symptoms that signal DSRCT, your doctor will examine you and take a medical and family history. One or more of the below tests are performed to check if you have DSRCT and if it has spread.

Treatment

Below treatment options below are available to treat Desmoplastic Small Round Cell Tumours (DSRCT)

1. Surgery: This is the first-line treatment for DSRCT and is very successful. It involves the removal of the Tumour by an operation.
2. Chemotherapy: Some of the desmoplastic Tumours respond to chemotherapy, but most of them relapse. Chemotherapy is used in patients for whom surgery is not effective to remove the Tumour. These drugs are given in low doses as a long-term therapy.
3. Radiotherapy: Using high-energy radio waves, the Cancer cells are destroyed without damaging the healthy cells.
4. Targeted therapy: In this technique, certain medications are used which specifically target Cancer-specific genetic material of the cells helping your body to fight the disease.
5. Other methods such as Embolization and Chemoembolization are available which kill the Cancer cells by cutting down the circulation.

Self-management

Coping with the condition is quite difficult for patients with Cancer. Therefore, caretakers should be more helpful in providing emotional support to the patient.

The patient should eat healthy foods such as fruits and vegetables regularly. Additionally, legumes, grains, cereals, and low-fat foods should be taken.

Symptoms

A child with Down’s Syndrome can be identified generally by the common features that are present in most of the children with Down’s Syndrome. The Down Syndrome symptoms are as follows. They are:

• Flattened facial features with a small head and a protruding tongue
• Eyes slant upwards and ears are unusually shaped
• Hands are short and broad with a single crease line in the palm

Fingers are shorter than normal

• Muscle tone is poor
• Excessive flexibility
• Mental retardation
• Growth is slower than in normal children

Health problems and complications

The Down Syndrome child is more likely to develop infections like pneumonia as their immune system is weak. The other problems that can develop are;

• Obesity
• Sleep Apnea
• Thyroid problems
• Hearing loss
• Poor vision
• Skeletal problems
• Gastrointestinal blockage
• Dementia
• Mental retardation

Coping and support

It is natural for parents to be filled with grief and fear. It is important for such parents to talk with their family physician and join a support group where they can meet similar parents who can give them advice and support.

Beating the odds

The first person in the world with Down’s Syndrome who swam across the English Channel was Karren Gaffney at 23 years of age. Not only did she have trisomy 21 but also she had a hip dislocation and an atrophied left leg. Her limitations did not limit her from achieving her goals. She successfully swam across 9 miles of Lake Tahoe in 6 hours and 15 minutes. Having completed her Associate Science Degree and Teacher’s Aid certificate, she is now the founder and director of The Karren Gaffney Foundation which works for the inclusion of Down’s Syndrome children in schools, communities, workplaces and families.

Diagnosis

Down’s Syndrome diagnoses are as follows:

Screening is done from the 11th week of pregnancy to the 13th week of pregnancy which consists of nuchal screening tests and blood tests.

In a test called the nuchal translucency screening test, a region in the back of the baby’s neck is checked with ultrasound. Fluid more than normal collects in this region if there are abnormalities in the second trimester of pregnancy.

A procedure known as amniocentesis may be done in which a sample of amniotic fluid is taken out with the help of a needle inserted into the uterus of the mother. This fluid gives an idea about the chromosomes of the foetus.

Between the 9th to 14th weeks of pregnancy, the chorionic villus sampling may be done. During this procedure, cells from the mother’s placenta are analysed to detect any abnormalities in foetal chromosomes.

In a procedure called as percutaneous umbilical blood sampling, blood is drawn from the vein in the umbilical cord and tested for any defects in the chromosomes.

Treatment

Surgery may be necessary for Down Syndrome treatment.

For babies who have intestinal blockages and swallowing problems, surgery is done after which the baby may not have any further problems.

For eye problems, like cloudy eyes or crossed eyes, corrective surgery may be required. For teething delays, the Paediatric dentist has to be consulted.

Some Down’s Syndrome children may develop Cancer, like Leukaemia.

Down’s Syndrome children are also more prone to infections of the Lungs which causes breathing problems.

Digestion problems in these children lead to constipation.

There will be delays in growth, development, speech and walking skills.

Regular health check-ups are necessary to diagnose and treat various health problems effectively.

Caring for a baby with Down Syndrome

The Down Syndrome baby may have difficulty in breastfeeding, but it is not impossible. The mother has to consult the doctor, therapist, nurse or other mothers who have breastfed Down’s Syndrome children and can give advice.

For Down’s Syndrome children, every state has special intervention programs in which the child is taught how to improve his or her motor skills, social skills, language, and self-help skills by special therapists.

The team that helps in special care consists of Paediatric cardiologist( deals with Heart defects), Paediatric Endocrinologist (deals with endocrine gland problems like Thyroid problems), Paediatric Gastroenterologist (deals with stomach and intestinal problems), developmental Paediatrician (checks into developmental delays), physical therapist(helps in improving muscle coordination), Audiologist( deals with hearing problems), occupational therapist (deals with developing social skills) and speech pathologist( helps in improving speech). With therapy, Down’s children become adults who work and live independent lives.

Causes

The exact cause of Hip Dysplasia is not known, but it is believed to be developmental i.e., it develops during the time of birth, after birth, or during birth. Genetics also play a role, but it is not a direct cause. If you have a family history of Hip Dysplasia, then you are 12 times more likely to develop the same.

Signs and symptoms

Symptoms are not seen until you grow old if you have Mild Dysplasia. The signs and symptoms vary by age group; you may notice that one leg is longer than the other. Pain is normally not observed in infants, but it is the most common symptom in young adults and adolescents. When you change the diaper, one hip may be less flexible than the other. Once your child begins walking, a limp may develop. Few people may also experience instability in the hip.

Risk factors

It is commonly seen in girls. The risk is higher in babies born in the breach position or with foot deformities.

Surgery

Surgery is the only possible treatment option for older children and adults. If the condition is mild, it is treated arthroscopically in which long-handle tools and tiny cameras are inserted through small incisions.

In severe cases, the position of the hip socket is also corrected. Periacetabular osteotomy is performed in which the socket is cut free from the pelvis and then repositioned to match up better with the ball.

Hip replacement surgery is also recommended if the dysplasia has severely damaged your hips.

Self-Management

To reduce pain and manage the symptoms quickly, you have to make certain lifestyle modifications apart from undergoing treatment through surgery or medications.

• Try to reduce weight if you are obese
• Eat calcium-rich food

Complications

Hip Dysplasia can damage the soft cartilage that rims the socket portion of the hip joint; this condition is called a Hip Labral Tear.

Osteoarthritis is a common complication developed by people with Hip Dysplasia. There may be a risk of developing a difference in leg length, limitation in function and decreased agility if left untreated.

Diagnosis

Hip Dysplasia is difficult to diagnose if it is bilateral because both the legs would be symmetrical. Doctors often use a combination of physical exams and ultrasound or X-rays to diagnose Hip Dysplasia. The doctor would move your baby’s leg to different positions to check if the hip joint fits together well.

If your doctor suspects that you have Hip Dysplasia, he or she would recommend going for imaging tests such as CT scan and MRI scan.

Treatment

The Hip Dysplasia treatment depends on the age and extent of the hip damage. For infants, the doctor would suggest soft braces such as a Pavlik harness that holds the ball of the joint firmly into the socket for several months.

For infants older than six months, the doctor would move the bones into the proper position and then hold them for several months with a full-body cast.

Causes

The reason some infants are born with HD is that when the foetus develops inside the womb, the nerve cell ganglion also develops simultaneously along the intestine through the anus. But in infants with HD, the nerve cell development stops too soon. Now, why the nerve cells stop developing is unclear.

HD can also be inherited from parents. Children with Down Syndrome are at higher risk of developing HD.

HD affects 1 in every 5,000 newborns and is found more commonly in male infants than in females. It is certain that HD is not caused by anything that the mother does or eats during pregnancy.

Symptoms

Parents should suspect HD in their infants if the baby is constipated and had no bowel movement within 48 hours. The belly may be swelled up and the baby may have excessive gas. The baby may vomit a brown or green-coloured vomitus. When the doctor inserts a finger into the rectum, there could be explosive excretion of the collected stool. The baby may show signs of Jaundice, have poor appetite, and poor weight.

In older kids, symptoms include:

• Difficulty passing stool without laxative (medicine that loosens stool) or enemas (flushing water through the anus)
• Excess gas
• Swelling of the abdomen
• Diarrhoea with blood
• Frequent infection of the colon
• Decreased growth
• Anaemia, resulting in a lack of energy

Diagnosis

Hirschsprung disease diagnosis in infants and kids begins with questioning parents about the symptoms they observe and the bowel movement of their kid. Based on these details, the doctor may order tests to confirm HD.

X-Ray starts with injecting a solution of barium into the intestine through the anus. The barium fills the Large Intestine and shows it clearly in the X-Ray. If HD is the cause, then the end segment of the Large Intestine is narrower than normal. But just before this narrow region the intestine will look bulged. This bulging is due to the presence of stool in the large intestine, confirming HD.

A test called Manometry is more often done in older children and adults. During this procedure, the doctor inflates a balloon inside the rectum; in normal conditions, the rectal muscle relaxes but in HD the rectal muscle does not relax.

A biopsy is the most accurate test, where the doctor takes a small sample of the Large Intestine and checks it under the microscope, if no nerve cells are seen then HD is confirmed.

Treatment

Surgery is the best way to treat HD. Surgery involves the removal of the segment of the Large Intestine, which does not have the nerve cells (ganglia) and then the healthy part of the colon is joined with the anus. This surgery is called the pull-through procedure. Hirschsprung disease surgery can be done in two steps.

Step 1 Involves cutting the healthy colon from the affected colon. Then the healthy colon is moved into the opening of the abdomen where a small pouch (stoma) is created by folding the intestine. The stoma usually lies outside the body collecting stool. This pouch must be emptied several times a day.

Step 2 is done after a few months when the surgeon removes the pouch and the affected colon and connects the healthy part of the colon with the anus. This surgery can be done as a single-step surgery only if the baby is healthy and the Large Intestine does not contain stool. This surgery is done through the anal opening without making any cuts in the abdomen.

After surgery

After surgery, kids usually feel good as they can pass stool and gas more easily than before. Older kids should learn to take care of their stoma pouch and clean it often. Many kids often feel embarrassed about being different from others, it is the duty of parents to explain to them and make them understand.

In the beginning after surgery, the stools are usually loose but as time goes by constipation is more likely to be a major problem.

It is recommended that parents talk to their dietician about food plans for their kids. Giving food with high fibre and fluid will help kids with constipation.

Some kids find it difficult to pass stool without laxatives. The major complication after surgery for HD is the development of a condition called Enterocolitis. This is a serious infection of the colon resulting in severe Diarrhoea. In this condition, kids often require intravenous fluid and antibiotics. Enterocolitis is very common in the first few years after surgery later it occurs rarely after 6 years.

About Jaundice

Jaundice is a disease that usually affects newborns in their first week of life. It is also called Yellow Fever because it turns the baby’s skin, whites of eyes, sole, palm of hands, and mouth yellow in colour. Jaundice affects almost about 90% of newborns.
Jaundice is caused when there is excess bilirubin (a waste product from the Liver) in the blood that is produced by the baby’s liver after birth. Jaundice in its mildest form is harmless. Remember, Jaundice is NOT a Liver Disease. Liver Disease may sometimes result in Jaundice.

Causes

To know how Jaundice affects a Newborn we need to know what bilirubin is. Bilirubin is a reddish-yellow pigment that is found in the bile. Bile, in turn, is found in the liver that plays a vital role in digesting fats. Bilirubin is produced during the breakdown of old red blood cells (RBC). To maintain a relatively stable level of bilirubin, the body normally excretes it through urine and stool. However, in Newborns the body cannot process bilirubin, and it starts building up in the body leading to Jaundice.

Newborn babies may not be able to process bilirubin. In a Newborn baby, the life span of RBCs is much shorter than the normal 120 days in adults. Therefore, excess RBCs are broken down, resulting in excess bilirubin.

The Liver, which has to do the job of removing the excess bilirubin is still developing in newborns and may not be able to remove so much of bilirubin. An excess amount of bilirubin is absorbed back from the intestine, before it is excreted, causing u.

When the baby is still in the mother’s womb the job of removing waste from the baby’s body is carried out through the placenta. But once the baby is born, it becomes independent and the baby’s body has to carry out all the functions.

It might take some time for the baby’s body to start working and to effectively remove all wastes from the body. Due to this, in the early days of your baby’s life, some waste may build up in their body and one such waste product is bilirubin, which causes Jaundice.

Symptoms

Jaundice usually starts around the second or third day of the baby’s life. The symptoms begin at the top head and progress downward. Symptoms of Jaundice are best noticed in daylight or fluorescent light. A few symptoms are listed below:

• Yellowing of face, whites of the eyes, then chest, stomach, and legs.
• May pass very little or no urine in the first 24 hours after birth.
• Forceful vomiting after every feeding.
• Gently pressing the baby’s skin usually should show a white colour but it shows yellow colour in babies with Jaundice.

Complications

In different babies, the duration of Jaundice is different. Usually, a newborn develops Jaundice within 2-3 days after birth, and then after a few days, the level of bilirubin goes back to normal. However, some infants, who have very high levels of bilirubin, may experience neurological problems and Brain damage. Therefore, regularly checking the level of bilirubin is very important to prevent it from reaching high enough to hurt the baby.

Outlook

Jaundice is not a serious health problem in most healthy babies. It just comes and goes, and many do not even require any treatment. Parents should be well aware of the condition and should take proper medical assistance at the required time to avoid complications.

The doctor must recognise the risk factors for Jaundice so that providing follow-up and support is possible when the baby leaves the hospital. The doctor should also educate parents about aftercare procedures.

Diagnosis

If the baby looks Jaundiced during the first few days after birth, doctors will perform some tests to diagnose and confirm Jaundice.

A little sample of the baby’s blood is drawn to check the levels of bilirubin in the blood. A blood bilirubin test is mandatory if the baby develops Jaundice within 24 hours.

The colour of urine and stool is also tested. If the urine is yellow due to the presence of bilirubin, it indicates liver disease. Babies with liver disease can also have Jaundice.

Similarly, liver disease prevents the excretion of bilirubin in stools therefore stools of babies with liver disease are pale in colour.

Treatment

If the blood test of the baby shows very little increase in bilirubin level, then he/she may not require any treatment, the doctor will just advise feeding him/her more often so that the baby produces more urine and the bilirubin is excreted in urine.

The baby can also be exposed to sunlight which helps to reduce bilirubin levels. If bilirubin levels are very high and it is increasing very fast, then the baby may be subjected to light therapy called Phototherapy.

During Phototherapy the baby’s eyes are covered and he/she is placed naked under white, green or blue light. The light helps to break down the bilirubin in the baby’s skin. Sometimes, the baby may also be placed on a special light-producing blanket called bili-blanket.

Phototherapy is carried on for 1 or 2 days. Due to Phototherapy, the baby may experience dehydration and loose stools, which are quite normal as this is the way the body removes excess bilirubin.

The doctor will watch the baby carefully and try to prevent or treat these problems. If phototherapy doesn’t work then the baby might require exchange transfusion, where some of the baby’s blood is removed and fresh blood is transfused.

Causes and risk factors

The sphincter present between the oesophagus and stomach is not fully matured, thus allowing the contents to flow backwards towards the mouth.

The risk of acid reflux increases if babies have excess milk and are on a completely liquid diet or if they sleep flat on their stomachs most of the time.

Other conditions such as Gastroesophageal Reflux Disease (GERD), Pyloric Stenosis, food intolerance, and Eosinophilic Esophagitis also cause Infant Reflux.

Symptoms

Due to reflux, your baby may have the following symptoms:

• Unable to gain weight
• Refuse to eat
• Spit up green or yellow fluid
• Excessive vomiting, worse after eating
• A chronic cough, especially after eating

Complications

Usually, Infant Reflux resolves without causing any complications. However, if the underlying cause is GERD, your baby may have poor growth. Infants who spit up frequently are at increased risk for GERD.

Diagnosis

Your doctor begins the diagnosis of Infant Reflux with a physical examination. Your doctor may ask you about the child’s symptoms. The diagnosis includes:

Ultrasound: to detect pyloric stenosis

Esophageal pH test: to monitor stomach contents coming backwards to the Esophagus

Blood and urine tests: to determine causes of vomiting and poor weight gain

X-Ray: to detect abnormalities in the digestive tract

Upper Endoscopy: to evaluate the inner lining of the upper gastrointestinal tract (GI) using an endoscope (a small device that has a camera and light and is inserted into the upper GI)

In infants and children, this procedure is performed by administering anaesthesia.

Management

In the case of bottle-fed infants, reflux can be controlled by modifying the feeding schedule. You should take care of your infant by following certain measures:

• Provide your baby with smaller, more frequent feedings instead of larger feedings.
• Make your baby burp regularly, at least one or two hours after feeding. This helps to relieve gastric pressure and prevent reflux.
• Avoid overfeeding as the baby is more likely to develop reflux if the stomach is full. This is due to the reason that pressure on the lower esophageal sphincter increases if your infant’s stomach is full making the contents move backwards to the esophagus.
• Hold your baby upright while feeding.
• Check bottle and nipple size before feeding. Your baby may swallow air if the nipple on the bottle is small.

Your doctor may suggest repositioning surgery, which involves straightening the shaft of the penis. Surgery would be successful at an early age, usually between 3 to 18 months. The hypospadias repair surgery involves the removal of tissue grafts from the foreskin of the penis and the reconstruction of the urinary channel in the normal position. Surgery would take 2 to 3 hours, and the condition may rarely require further procedures.

Causes

There is no definite cause for Juvenile Fibromyalgia. However, it is believed that a few factors might be involved in causing this condition such as genetics, infections, and physical or emotional trauma.

In patients with fibromyalgia, nerve stimulation causes an abnormal increase in certain chemicals related to pain signals or neurotransmitters in the Brain. It leads to increased sensitivity to pain and hence the patients overreact to pain signals.

Symptoms

Musculoskeletal pain is the most common symptom observed in children with JFM. The pain would be dull and occur on both sides of the body, above and below the waist. The patients also experience other fibromyalgia symptoms like disturbed sleep, morning stiffness, headache, pain in the abdomen, irritable bowel symptoms, depression, anxiety, tight muscles and sometimes swelling.

Risk factors

JFM occurs more often in girls than boys, and the reason is unknown. If your child is being diagnosed with other musculoskeletal problems like osteoarthritis or rheumatoid arthritis, then he /she may be at risk of developing JFM. The family history of fibromyalgia also increases the risk of JFM.

Complications

Due to pain and lack of sleep, your child may not be able to concentrate well at school. It may in turn lead to anxiety and depression.

Diagnosis

First, the doctor would ask about the symptoms, medical history, and family history. Then, he/she would perform a physical examination test to check the presence of tender points and severity of pain.

There is no lab test to diagnose the condition; however, the doctor would suggest blood tests that include complete blood count, erythrocyte sedimentation rate, and thyroid function tests.

Treatment

The main aim of the treatment for Fibromyalgia is to reduce pain and improve the quality of life. Medications are usually prescribed for pain and to improve sleep. Anti-depressants and anti-seizure drugs are sometimes prescribed to reduce fibromyalgia symptoms. Your doctor would suggest taking your child to a physical therapist who provides an exercise program with aerobics, strengthening, and stretching exercises.

Cognitive Behaviour Therapy is also suggested in which pain is managed using adaptive coping skills. The doctors would suggest the parents attend some classes regarding how to support their children’s coping skills.

Self-management

Self-care plays a major role in managing this condition:

• Limit anxiety and stress
• As fatigue is one of the main symptoms of fibromyalgia, get proper sleep at night by limiting daytime napping
• Eat healthy foods, limit caffeine intake
• Exercise regularly - do not stop if there is pain as doing it gradually and regularly often decreases the symptoms

Juvenile Idiopathic Arthritis is the inflammation of one or more joints persisting for at least six weeks in children under the age of 16 years. JIA is most seen in girls. The researchers believe that the genetic propensity of Juvenile Arthritis in children is the same as in adults.

Anatomy of joints

Joints or articulations are the areas where two bones connect. Joints can be mobile or immobile. But, most of your joints are movable. Joints consist of the following:
•    Cartilage: The cartilage is a type of tissue that covers the bone surface at the joint. It protects the joint by reducing the friction.
•    Synovial membrane: The synovial membrane lines your joint and secures it into a joint capsule. It helps by secreting the synovial fluid that lubricates the joint allowing free movement.
•    Ligaments: The ligaments are tough, elastic bands that surround the joint. It provides support and limits the movement of the joint.
•    Tendons: The tendons present on each side of the joint attach to the adjoining muscles and control the movement of the joint.

Causes 

The actual cause of JRA is unclear. While the research says that it might be an autoimmune disorder. In Autoimmune Disease, the immune system is unable to differentiate between the healthy and pathogenic cells. So, the immune system attacks the healthy cells.

In juvenile rheumatoid arthritis, the immune system releases chemicals that affect the healthy tissues in your body leading to inflammation and pain in the joints. The incidence of JRA is increased by certain gene mutations which make you more susceptible to environmental factors such as viruses.

Symptoms

The symptoms of JRA include:

• Persistent and severe joint pain
• High recurrent fever
• Swollen, red, or warm joints
• Stiffness in the joints
• Rashes appear with fever
• Low back pain
• Limited movement of the joints
• Limping

Types of JRA

Three types of JRA include:

• Periarticular JRA: Periarticular Arthritis affects five or fewer smaller joints of wrists and knees. If this type of JRA occurs in children over the age of 7, then it is most likely to spread the disease to other joints.
• Polyarticular JRA: The Polyarticular JRA affects five or more joints irrespective of the size of the joints.
• Systemic onset JRA: The Systemic onset JRA is the rare type of JRA. It affects only about 10 per cent of people with arthritis. It involves a sudden onset of high fever with persistent rashes.

Complications

If juvenile arthritis is left untreated, it may lead to severe complications. These include the following:

• Eye inflammation (Uveitis)
• Anaemia
• Stunted growth
• Joint Destruction
• Asymmetrical limbs
• Swelling around the Heart
• Long-term recurring pain

Diagnosis

Your doctor diagnoses JRA in your child by taking a medical history and performing a physical examination. Your doctor may also suggest certain diagnostic tests which include:

• Erythrocyte sedimentation rate (ESR):
• An elevated ESR indicates inflammation. This test is performed to rule out other conditions and assess the degree of inflammation.
• C-reactive protein (CRP) test: In the body, the C-reactive protein is released by the liver in response to inflammation. Therefore, a CRP test is ordered to assess the inflammation.
• Rheumatoid factor: The rheumatoid factor is the antibody which is usually present in children with rheumatoid arthritis.
• Anti-nuclear antibody: Anti-nuclear antibody is produced by the immune system in children with Autoimmune disorders.
• X-rays and Magnetic resonance imaging (MRI): X-rays and MRI scans are suggested to rule out other conditions such as infections and fractures.

Treatment

Your doctor may recommend certain medications to relieve pain and progression of the disease. Juvenile rheumatoid arthritis treatment includes:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen and naproxen are prescribed to reduce pain, inflammation, and swelling.
• Disease-modifying antirheumatic drugs (DMARDs): If the NSAIDs fail to relieve the symptoms, then your doctor may recommend DMARDs such as methotrexate and sulfasalazine. These drugs are used to decrease the progression of the disease.
• Tumour Necrosis Factor (TNF) blocker: TNF blockers such as etanercept and adalimumab are given to reduce pain, swelling, and morning stiffness.
• Corticosteroids: Corticosteroids such as prednisolone control the progression of the symptoms and prevent serious complications. However, corticosteroids may increase the risk of infections and interfere with normal growth. So, these drugs should be used for a short duration.
• Your doctor may also recommend Physical Therapy and Occupational Therapy for your child. In severe conditions, surgery may be required for the treatment of Juvenile Arthritis, to improve the movement at the joints.

Self-management

Performing physical activities and eating healthy foods may benefit the children with JRA. The doctor may recommend certain tips to manage JRA that include the following:

• Exercising regularly: Performing physical activity thrice weekly may strengthen your muscles and improve joint flexibility. Low-impact exercises such as walking, and swimming may be beneficial.
• Applying cold or heat: Doing a hot water bath or applying heat or cold to the affected joints may relieve morning stiffness.
• Eating healthy food: In children with Juvenile rheumatoid, weight changes are common. Therefore, a healthy diet may help to maintain normal body weight.

Causes

The main cause of childhood Schizophrenia is not clear. But it develops as the same way like in adult Schizophrenia.

Juvenile Schizophrenia and other types of Schizophrenia are Brain disorders. Genetic variations and environmental changes may cause Schizophrenia.

Brain chemicals called Neurotransmitters contribute to childhood Schizophrenia.

Symptoms

The early signs and symptoms of Juvenile Schizophrenia include developmental problems like late walking, late crawling, and language delays.

These symptoms are often confused with pervasive developmental disorders. Therefore, your doctor may rule out other developmental disorders in your child.

Symptoms in Teenagers

The common symptoms of Schizophrenia in teens are social withdrawal, trouble sleeping, typical behaviour, lack of motivation, and depressed mood.

As the children with Schizophrenia grow the signs and symptoms would be more typical. The symptoms may include hallucinations, delusions, disorganized thinking, and abnormal motor behaviour.

Risk factors

The following factors increase the risk of Juvenile Schizophrenia :

• Older age of the father
• Abnormal immune system
• Family history of Schizophrenia
• Malnourishment while in the womb
• Exposure to certain viruses, toxins

Diagnosis

The doctor would ask about your child’s medical and psychiatric history and then perform a physical examination followed by psychological screening tests. Your doctor asks about your child’s progress at school. This entire process can help to diagnose Schizophrenia and to rule out other problems that could be the reasons for the symptoms.

The diagnostic testing involves:

Screening:  Your doctor would order blood tests to rule out other disorders that show similar symptoms of Schizophrenia. Your doctor would also order imaging studies such as an MRI or CT scan of the head. This helps in understanding the abnormalities in the Brain structure. An electroencephalogram (EEG) is used to look for abnormalities in Brain functions.

Psychological evaluation

During this evaluation, your doctor may ask about your feelings, thoughts, and behaviour patterns. Your doctor would also evaluate your child’s ability to think and function.

Treatment

The main treatment options for childhood Schizophrenia  include:

Medications: your doctor would prescribe antipsychotic medications which are beneficial in treating and managing symptoms such as delusions, hallucinations, and lack of motivation.

Your doctor would determine the lowest possible effective dose of antipsychotics for you to reduce the side effects caused due to the medications.

You must also use antidepressants or anti-anxiety medications as well.

Psychotherapy

Individual therapy:  Psychotherapy called Cognitive Behavioural Therapy would help your child to understand the symptoms and effects of the disease and help in sticking to the treatment plan.

Family therapy: Family therapy contributes to improving the communication between the family and the affected child. It provides support and education to the family on how to care for the child.

Causes

The exact cause of KD is yet to be unleashed. However, few researchers/doctors suggest that KD might be caused by some bacterial or viral infection. The disease usually lasts for 2 weeks to a few months.

It is also said that genetic disposition can also cause KD; individuals of Japanese descent are more likely to get the disease, no matter where they are now on the globe.

The already existing history of KD in a family increases the risk of KD in the next kid. Few say that KD might be an autoimmune disease, where one’s own immune system acts against own mucus membrane, lymph node, Heart, and walls of blood vessels.

People who fall under the risk category for KD are kids below 5 years of age, male sex, and Asians, especially Japanese are affected more than other races.

Symptoms

Kawasaki Disease symptoms are as follows:

• Swollen blood vessels all over the body
• Persistent fever for more than 5 days
• Redness of the eyes
• Swollen lymph nodes in the neck
• The disease may also manifest as rashes that develop on the stomach chest, and genitals
• Red, dry, and cracked lips
• Sore throat
• Swollen tongue, white coating and red bumps on it
• Swelling may also be present in the palm and sole, and they appear purple-red in colour

Other symptoms are:

• Joint pain
• Diarrhea
• Vomiting
• Abdominal pain

Risk factors

Certain sexual behaviours may increase your risk of epididymitis which includes sexual contact with a partner who has sexually transmissible infections (STIs), and a medical history of STIs. The other risk factors of epididymitis include:

• History of prostate or urinary tract infections
• History of genital-urinary surgeries
• Uncircumcised penis
• Prostate enlargement
• Use of urinary catheter
• Having unprotected sex

Complications

KD is usually treated, if doctors are successful at diagnosing it at the earliest. But few kids who go unattended have to face complications like

• Vasculitis, an inflammation of the blood vessels all over the body. This can result in serious consequences when the coronary artery (the artery that supplies blood to the Heart) is affected
• Inflammation can result in aneurysms (abnormal ballooning of artery due to weak blood vessel walls)
• Inflammation of the muscle, valve, inner lining, and outer lining of the Heart that can cause Arrhythmias, a condition of abnormal Heartbeat
• Abnormal functioning of Heart valves
• Dehydration
• Limited movement of joints due to untreated inflammation

Diagnosis

There is no specific test to diagnose KD, therefore diagnosis starts with evaluating the symptoms of the kid and questioning parents about the symptoms and the duration of their presence.

Doctors usually check for the above-listed symptoms in kids. Sometimes, he also performs other tests to check the function of the Heart, tests include

• Electrocardiogram: Done to check irregular Heartbeat
• Echocardiogram: Done to check the Heart structure, valve function, Heart muscle motion, and size of Heart and coronary artery
• A nuclear stress test is done to check the flow of blood in the arteries, which is tracked by injecting a radioactive substance into the bloodstream
• Urine test: To rule out other diseases
• Blood test: Elevated white blood cells and anaemia indicate KD

Treatment

KD is usually a self-limiting disease that gets resolved on its own, and many kids do not require any treatment within 4-8 weeks. But 15-20% of kids will suffer some damage to the coronary artery (artery to Heart) and 2% it might result in death due to Heart attack. Treatment of these kids should be done as early as possible.

A high dosage of aspirin can help decrease aneurysms, fever, joint pain and swelling, and rashes. Aspirin also helps in the thinning of blood thereby preventing the formation of blood clots.

An intravenous injection of gamma globulin can prevent the damage happening to coronary arteries. In severe cases of coronary artery damage, surgery may be required to correct the problem.

Children who are diagnosed with no damage to coronary, require no treatment but it is advised that parents should take their kid to a Paediatric cardiologist for at least 1 year.

Kids with mild coronary artery damage should visit the doctor regularly for 1 year and later once every 3-5 years according to the doctor’s advice.

Children with severe coronary artery damage should have regular check-ups and follow medications properly.

Recovery after treatment

KD cannot be prevented as the cause of the disease is still unknown. However, after treatment, kids usually recover fully within 24 hours or a few days of treatment. But it is always good to make children take complete rest until they feel strong enough to return to school. Complications after treatment are usually rare.