Tuesday, June 24, 2014

Screen your child for Autism - Online & for FREE ! Use the MCHAT tool

Have you ever suspected that your child may be autistic?
The following "red flags" may indicate your child is at risk for an autism spectrum disorder. If your child exhibits any of the following, please don’t delay in asking your pediatrician or family doctor for an evaluation:

No big smiles or other warm, joyful expressions by six months or thereafter
No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
No babbling by 12 months
No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
No words by 16 months
No meaningful, two-word phrases (not including imitating or repeating) by 24 months
Any loss of speech, babbling or social skills at any age

Now you can easily screen your child for Autism with a simple questions based online testing software called MCHAT
Here is the link to the MCHAT test


Remember, this is a screening test, and not a diagnosis. Please discuss any abnormal results with your doctor.

Thursday, June 12, 2014

Self stimulation behavior in infants & toddlers & preteen children. Differentiating it from masturbation

An interesting case - Dr Newton Luiz.

This 2  yr old girl was brought by her concerned parents because of her strange behaviour, which consisted of swinging her body rhythmically on the sofa or bed. It started about a year back, and became a daily habit, and now happens many times a day. It goes on for a long time, and the child starts sweating and grunting and breathing irregularly. She gets upset if she is forcibly stopped. When told not to do it again, she promises sincerely, but forgets and does it again. She is a good child, cooperative, playful, with normal intelligence.

All infants explore their own bodies, and note that the genitalia are more sensitive and pleasurable to touch, so they touch these areas repeatedly. If the infant is permitted to move around naked, or if there is a mild bacterial or fungal itch at the genitalia, the infant scratches the area frequently, and the pleasurable sensation that results can lead to habitual self-stimulation. This is easy to manage: keep the child clothed, and treat any local infection if present.
Occasionally older children aged 2-10 years, especially girls, discover by accident that rubbing their genitalia against a pillow or the bed is pleasurable. They do it repeatedly and for prolonged periods, and there may be a blank expression on their face, sweating and grunting. One 7 year old girl was brought to me fearing that it was a type of epileptic seizure, due to the vacant stare. If they are forcibly prevented from continuing they may get very angry, as they do not feel that they are doing anything wrong or shameful; in fact, they even do it in public. The pleasure is physical but not sexual.
Note that self-stimulation is NOT the same as masturbation. In the latter, which occurs from adolescence onwards, the act is usually associated with a sexual fantasy, and the person is well aware that such behaviour is not approved of and should not be done in public.
Masturbation is very common in males, both adolescents and adults. Remember 95/75/55...95% have done it at some time or the other. 75% do it occasionally as adults, e.g. when separated from their spouses. 55% do it frequently.
Masturbation is often associated with severe guilt, especially in adolescents. This manifests as fears that it will damage the health physically, resulting in future infertility or impotence, intellectual disability, general ill-health etc. It is not harmful, for the same reason that coitus is not harmful to the health.
Compulsive masturbation is a different story. Just as physical strain and overwork can cause exhaustion, frequent masturbation can cause physical and mental exhaustion, with lethargy, general malaise and temporary impotence. It is harmful – not because of the masturbation, but because of the compulsive nature. Adolescent boys frequently ask how one can get rid of compulsive masturbation. Here’s what I tell them:
(As Dr MKC Nair used to say) “If you have an itch anywhere, you have a right to scratch there, but do not keep scratching and create an ulcer. An excessive interest in masturbation is more common when one is bored and does not have enough variety in one’s life. This is obviously not desirable. The right solution is to deliberately involve oneself in creative activities. Life is meant to be enjoyed: study hard, play well, take part in sports and cultural activities, move around with friends, watch a little TV – let there be variety in your life. Don’t spoil the best years of your life by getting hooked onto one activity”.       

Do not say that masturbation is ‘abnormal’ or ‘unhealthy’; it isn’t. But do not say that masturbation is ‘normal’ or ‘healthy’, as this will put pressure on the minority who are not interested in masturbating.

Source - As discussed on the Adolescent India forum via email

Thursday, June 05, 2014

Gopinath Munde’s death linked to Princess Diana’s accident!

Surprising as it may sound, there is a very important common reason behind the death of Lady Diana & Gopinath Munde, the recently sworn BJP Cabinet minister. No, this is not a conspiracy theory blog, and I am not trying to insinuate any hanky panky here. The reason why they both died is because they were sitting in the back seat of the car and not wearing seat belts. Remember, the drivers of both the vehicles (& even the bodyguard in case of Lady Di) were not killed. In case of Mr Munde, in fact, the car was also barely scratched, while he had a fracture in the neck & bleeding in the abdomen, leading to his death before reaching the AIIMS Advanced Trauma Center, that was located less than 3 km away in the National Capital of New Delhi.
In India, the road safety record is generally abysmal. As per this article in The Hindu Newspaper,
The numbers say it all. Every four minutes a life is lost in a road accident in India with 1,40,000 deaths recorded in 2012 alone. In the past decade, over a million people have lost their lives in road accidents in the country and over 5 million have been left seriously injured or permanently disabled. 

This is more than the population of many countries !
While road safety measures are a long term and holistic solutions, we can reduce the number of deaths & injuries by some simple measures ourselves.  Please remember these FOUR WORDS
This is almost nonexistent for the rear passengers in cars in India – because we believe in government & the destiny, (not necessarily in the same order J). Since the law, as it stands today, only insists on seat belts for people in the front seats, and air bags are practically nonexistent for the rear passengers in most vehicles, wearing a seat belt in the back seat may prevent your near & dear ones from being a victim themselves.
For kids to be able to do this, it is very important to start early. We started putting our daughter in the car seat when she was a few weeks old, believe me it is the safest age to do so. Once they are used to it, kids really enjoy the view (since the chair is at a height enabling them to see outside the car window), and the fact that this is their own space, where they can do what they want. Not only are they less prone to injury, but are not likely to interfere & distract the driver as well, improving the overall safety of passengers as well.
Start wearing your seat belts NOW ! 
Read more poor Indian road safety here

Which water filter to buy in India? and why ??

I just did some basic research since I was planning to buy one water filter.

There are 3 basic types of water purifiers
1. RO - Reverse Osmosis
2. UV - Ultraviolet 
3. UF - Ultrafilteration

Each can be either storage type or non storage type, and may have automatic water filing (connected by a pipe to water source) or manual water filing

Here are the benefits / problems with RO filters
A reverse osmosis system physically removes contaminants and dissolved minerals in your water by forcing them through a filter. Some of the benefits of installing a whole-home or point-of-use reverse osmosis system are:
Tasteless water – If you find your water has a funny taste, a reverse osmosis system can help by removing the source of the taste.
No chemicals – Reverse osmosis systems are more environmentally friendly than other water filtration systems because they don’t use any chemicals.
Soft water – Reverse osmosis systems remove the minerals that cause hard water. So if you install a whole-house system, you can benefit from fewer corroded pipes.
Removes odors and unusual colors – Some water contaminants and dissolved minerals can cause strange odors and colors in your water. Reverse osmosis systems remove these minerals and pollutants.

It’s not all sun and daisies for reverse osmosis systems, though. They can be inefficient, returning as little as 5 to 15% of the water that is filtered (with the rest going down the drain.)
Recommended uses: If you have a home with a well or get water from bore wells/ ground source that needs filtration, a whole-home reverse osmosis system may be a good idea. Also, if the water in your home tastes or smells funny, you can install a point-of-use system under your sink for cleaner, better-tasting drinking water.

COMING TO UV systems
UV radiation from ultraviolet water systems alone is not suitable for water with high levels of suspended solids, turbidity, color, or soluble organic matter. These materials can react with UV radiation, and reduce disinfection performance. Water turbidity makes it difficult for the ultraviolet radiation to penetrate water. If your water supply has these characteristics, a sediment prefilter (5 micron or less) should be installed before your UV water purification system to remove particulate matter prior to UV water disinfection.

Ultraviolet radiation can be used as a pretreatment or polishing step to sterilize and disinfect water. UV systems are typically used to pre-treat a water supply that is considered biologically unsafe (lake or sea water, well water, etc). The UV disinfection process is a non-chemical method for destroying microorganisms by altering their genetic material, and rendering them unable to reproduce.

There are several advantages of using UV rather than a chemical disinfection solution (such as chlorination):

No known toxic or significant nontoxic byproducts
No danger of overdosing
Does not require storage of hazardous material
Adds no smell to the final water product
Requires very little contact time
FINALLY UF systems : Like Tata Swach & Pure-it, use gravity to filter water through a filter. Ultrafiltration (UF) is a variety of membrane filtration in which hydrostatic pressure forces a liquid against a semipermeable membrane. Suspended solids and solutes of high molecular weight are retained, while water and low molecular weight solutes pass through the membrane.

For Groundwater / borewell supply or where the water tastes funny / has an odour - USE RO
For water from canal, generally clean and good taste - Use UV or UF.
If you are require larger quantities of water faster - prefer UV, if you want non electric simple very cheap and effective filter - use UF

I have used TATA Swach UF filter when I was staying alone, and now am using Aquaguard Classic UV Filter.
There is generally no reason to have RO + UV + UF filters that are being sold nowadays, unless you are consuming hugely contaminated water.
Read more here

Dr Gaurav Gupta

Monday, June 02, 2014

My child has white spots on her nails! Does she require calcium? Article by Dr Nathani

White spots on nails or leukonychia are fairly common in children and a cause of much alarm Leukonychiain parents. The first question that pops up in parents’ minds is that is it because of calcium and zinc deficiency and with easy availability of these supplements over the counter, the child is immediately started on these supplements. Every medication or supplement that a person ingests has effects and potential side effects. If we need medications then it is worth risking the side effect.
The most common cause of white spots on nails is a mild to moderate injury to the nail bed when the nail is growing. Now if you don’t remember that your child had an injury consider this: Nails grow very slowly, toenails more slowly than fingernails (about 5-6 mm a month!). It could have been a long time back that there was some trivial trauma to her nails and most probablyW, neither the child, nor you noticed it. Not very commonly, white spots can also be due to some allergies to locally applied substances like nail polish or local infection. It is only when the white spots occur in almost all nails that it is a cause of worry since there could be an underlying serious disease.
What should I do about these white spots?
Well, give it time! As the nail grows from the base to the tip, the white spots will go away and unless, the child is injured again will not return. It takes about six weeks for the nail to grow from the base to the tip in children. You should see your pediatrician if:
  1. The white spots persist for more than two months.
  2. The white spots keep reappearing.
  3. They occur in many different nails simultaneously.
  4. The nails and fingers look abnormal like yellowish discoloration or redness etc.

Dr Nathani is a practising Pediatrician in Mumbai. She is also a travel physician and operates the Mumbai branch of Travelsafe Clinic.