Thursday, April 30, 2015

Office management of Constipation in Children - 4 Simple & Important points for Child Specialists & parents

Q: Which is preferred first line medicine for constipation in children.. liquid paraffin vs sodium picosulfate vs lactulose vs macrogol 4000 vs PEG ??? also the dose of each drug ??? any contraindications to their use ?? most important question --  how long to use ??
other advise apart from plenty of water intake, fruits ,veggies, milk restriction ???

90% of constipation in children is functional.before that we have to R/o organic cause .
Steps in management.
1.Consumption of dietry fibres and fluids.
2.Timed pattern of stooling:15 to 30 mts after feeding utilising the gastro colic reflux.
3.Then comes pharmacotherapy in the order of 

a).PEG 3350
b).Lactulose 1-3ml/kg/day in divided doses(maximum dose should not cross the adult doses (i.e 30 ml) ANother option is Sodium Picosulfate as a second line therapy. It is a stimulant with an excellent safety profile and better tolerated with good effect.
4.Duration: 2 to 4 wks and reassess

Source: Discussion on

Wednesday, April 29, 2015

How to calm an overactive child - some simple yet sensible tips

I have an overactive child, and have found it quite difficult to control her sometimes. Here are some sensible tips that may be helpful for us parents of overactive children.

Hyperactive children may fidget, have difficulty concentrating, be unable to sit still or generally be overexcited. A child who is hyperactive does not always mean that they have Attention Deficit Hyperactivity Disorder (ADHD), but they may have certain tendencies that contribute to difficulty in maintaining focus. Medication for hyperactivity is often over-prescribed[1]. Instead, diet changes, routines and calming activities can help to calm a hyperactive chil

Method 1 of 5: Creating a Calm Environment

  1. Calm Hyperactive Children Step 1.jpg
    Create a calming kids-only space. Dedicate a corner of a room, a nook, or other small space to making a space that the child can sit in by themselves. Put pillows, stuffed animals, books or other cozy items in this space. This is not a time-out space where they go when they are in trouble. Instead, this is a space where they feel safe and can get a chance to relax.[2]
  2. Calm Hyperactive Children Step 2.jpg
    Play calm music. If you play music in your house, choose more soothing music like classical or meditative music, rather than upbeat pop or hard rock. Too much noise can be a trigger for some children to become hyperactive, and eliminating or changing the type of noise can be helpful in calming children.
  3. Calm Hyperactive Children Step 3.jpg
    Minimize screen time. Too much exposure to television, video games, computers and phones can trigger hyperactivity. These devices often have rapidly moving images, bright colors and loud sounds that are the opposite of calming. Limit screen time or eliminate it altogether.[3]
  4. Calm Hyperactive Children Step 4 Version 2.jpg
    Give a mini-massage. Hyperactive children in particular respond well to touch and affection. Give the child a little massage on their back, feet or hands to help them calm down.[4] Physical touch and affection can stimulate endorphins, which can be very calming and healing.
  5. Calm Hyperactive Children Step 5 Version 2.jpg
    Speak in a calm voice. Instead of shouting or talking loudly, reduce the volume of your voice by speaking to the child calmly. They may need to stop what they’re doing to hear you, which can help interrupt their hyperactivity.
  6. Calm Hyperactive Children Step 6 Version 2.jpg
  7. Source

Tuesday, April 28, 2015

What is preferred form of taking medicine - Tablet, Softgel, Liquid, Powder or Capsules

There are many medicine doses forms available for products like Vit D. Here is an interesting article that talks about these treatment options.

I quote the following from this article --

Tablets are the most shelf-stable choice and retain their potency over a longer time than liquids, powders and most capsules. Tablets don’t offer the flexibility of dosing that liquids and powders do.

Capsules advantages are their ability to break down quickly in the stomach. drawbacks are not air-tight, their shelf-life is shorter than tablets.

Softgels offer superior shelf-life profiles to capsules, liquids and powders

Chewables tend to be lower potency when compared to comparable products in tablet and capsule form. They also usually have some sugar and flavorings added

Powders must be mixed into a liquid, shake or a food. Powders do offer great flexibility with dosing Liquid supplements shelf life is shorter than with other formats. They often require refrigeration Even when the bottle is shaken before each use, dispersion of ingredients is imprecise and less consistent .

Wednesday, April 22, 2015

Update on Child Health in India - World Immunization Week April 24 - 30 2015

Dear Colleagues,

Greetings! You are an important advocate for child health in India and it is with great pleasure that we are writing to you. This is the second of a series of periodic emails through which we would like to share research, media, and other efforts ongoing in India around child health and disease prevention. We hope that you will share these updates with your colleagues and networks, and that they will be useful tools as you continue addressing the urgent child health needs in India.

Government Launches Mission Indradhanush
As 2014 came to a close, the Ministry of Health and Family Welfare (MoHFW) announced the launch of Mission Indradhanush – a campaign to vaccinate all unvaccinated and partially vaccinated children and pregnant women by 2020 under the Universal Immunization Programme (UIP). Mission Indradhanush is focusing on interventions to expand UIP coverage to more than 90% of children, up from 65%.

The Government has identified 201 high focus districts across the country, where it will organize special catch-up campaigns to rapidly increase full immunization coverage to help reduce morbidity and mortality due to vaccine-preventable diseases. These diseases include: diphtheria, whooping cough, tetanus, polio, tuberculosis, measles, and hepatitis B. Read more.

You can join the movement by tweeting #FullyImmunizeEveryChild and sharing this graphic with your network. For updates, follow @Vaccinate4Life.

The Value of Vaccines
Vaccines are considered to be one of the most cost-effective solutions in the history of health and development. In 2012, some of the world’s leading health economists ranked childhood
immunization among the top three most cost-effective solutions to advance human welfare.

Importantly, vaccines don’t just save lives. They also prevent illness, hospitalization, disability, and unnecessary human suffering. They provide indirect benefits to individuals and society, including improvements in cognitive development, educational attainment, and labor productivity.

We created a new brochure, for use in your advocacy efforts, about the power of vaccines in India.

National Health Policy
The Draft National Health Policy, recently shared by the MoHFW on its website includes several points that may impact new vaccine introduction. Key among them are the need for a national epidemiological evidence base for decision-making and monitoring, better reporting of Adverse Event Following Immunization (AEFI), and evaluating compensation for AEFI cases. The MoHFW solicited comments on the draft policy though the end of February.

Upcoming Child Health and Immunization Events
&#8226                       Harnessing Power of Immunization: Opportunities & Challenges for New Vaccines
25-26 April, 2015 in Kochi, India
&#8226                       World Immunization Week (Next Week!) 24-30 April, 2015
&#8226                       ASVAC 2015 - Asian Vaccine Conference 12-14 June, 2015 in Hanoi, Vietnam

Continuing the Momentum
The Government of India’s continued commitment to child health is inspiring. Each great stride helps save more lives and prevent illness. Your voice plays an important role in demanding that the same level of momentum and commitment remains. Through advocacy YOU can become a champion.

Here are 10 ways you can advocate during World Immunization Week (24-30 April):
1                                            Brief a state or district level government official, elected representative, political leader or other key stakeholder
2                                            Write an Op-Ed or an article
3                                            Speak to a journalist
4                                            Write a letter to a policymaker to call for new vaccines and/or investment in strengthening the system
5                                            Organize or participate in a child health or immunization event
6                                            Build awareness amongst colleagues and friends
7                                            Use social media to promote immunizations at a local and/or global level (e.g. #vaccineswork)
8                                            Educate families, students, and others about risks of disease and what can be done
9                                            Share success stories with this advocacy network
10                                        Display advocacy materials illustrating value of vaccines prominently at your practice or place of employment

Thank you for your dedication to child health and survival in India.

Dr. Mathuram Santosham
Professor, Johns Hopkins Bloomberg School of Public Health (JHSPH)
Senior Advisor, JHSPH International Vaccine Access Center (IVAC)

A 5 year old child swallowed a coin - now in stomach on X ray - what to do?

Q: A 5year old boy has just been rushed to my OPD with a swallowed coin. The child is playful & active, and the coin was swallowed 1-2 hours back. An xray reveals that the coin has reached the stomach. How to proceed?

Guest Answer - Posted at Docpelxus by Dr Kirthy Proamd R.
Coin ingestion in children is very common. Most paediatric surgeons at institutions see atleast around twenty coin ingestions a year. They all pass out in the stool. There is no necessity to give laxatives too, as this can cause the FB(foreign body to get stuck at some kink in the bowel. If an ingested coin remains in the stomach for more than 72 hrs in an xray, then u may consider endoscopic extraction. many ppl even wait upto seven days for spontaneous passage in stool. ofcourse parents need to check the stool for passage of FB, so as to avoid unnecessary xrays. urgent removal of coin is necessary when its stuck in esophagus and causing retching. many occasions when a coin is stuck in the esophagus and child is ASYMPTOMATIC, overnight waiting for it to spontaneously pass to stomach and confirming on xray is sufficient as it then passes out.
Most foreign bodies pass out on their own... seen large clips(hair clips-even fla ones) triangular glass pieces, lockets, safety pins all come out on their own.
In sharp foreign bodies dangerous is foreign bodies with both ends sharp.. like a needle...
one edge pointed and other broad end objects do not cause problem...courtesy fluid dynamics...when the flowing liquid has to take a foreign body along, its always the broad end that moves forward...physics...
in non-sharp foreign bodies... dangerous is button batteries.... try n get them out as quickly as possible... endoscopy or paeglec flush therapy in hospital... this is because the button-battery has a rubber seal holding the the metalic round plates together with dangerous chemicals like mercuric chloride inside... the older the battery the faster the rubber ring melts in the gastric acid and chance for the the button battery to open up and cause havoc of multiple perforations in the intestines.....
Magnets also may come out many times if small but sometimes there is a risk of two powerful pieces of magnet getting attracted through different bowel loops and then causing slow necrosis of intervening bowel walls.. seen one case
So most often it is just "Masterly Inaction and Careful Follow-up"
Sorry if this is little exhaustive to your question.... but sure will help u get an overview
Seen all these personally during my training under my teachers and my practice of Paediatric Surgery in the last ten years
Thank you

Wednesday, April 01, 2015

What is the ideal age of surgery for common pediatric surgical conditions?

Inspite of advances in pediatric surgery, anesthesia and good pre and post operative care, still many a times, babies are referred quite late for surgery, just because the referring doctor & the parents are not updated about the age at which a particular pediatric condition is corrected.
For parents, there baby is always small, and they avoid operations as much as possible, but it is our duty as doctor to guide them properly, as the age of operation matters in many pediatric surgical conditions.
Some commonly seen anomalies and their ideal age of operation.
Inguinal hernia- as soon as diagnosed.Congenital hydrocele- wait n watch till 1.5 to 2 yrs age, if doesnot resolve, needs surgery.Umbilical hernia- after 3 yrs , if no signs of irreducibilty before.Undescended testis- 6 mths... must complete orchiopexy by 6 mths age.Phimosis- if physiological , wait till at least 3 yrs, treat with steroids and then possible surgery if recurrent infections only.Hypospadias- between 6 mths to 15 mths is ideal age for repair.Tongue tie- between 10 mths to 1 yr.Cleft lip- 3 mthsCleft palate- 10 mthsPolydactyly - if with pedicle/ stalk- at birth to prevent gangrene n complications.Antenatally diagnosed anomalies- conselling by pediatric surgeon from antenatal period helps prevent postnatal panic,and parents are prepared mentally and financially for the treatable anomalies.