Welcome To Kanchi Kamakoti CHILDS Trust Hospital

Puberty and its impact

One principal reason cited for disturbances during adolescence has been the physiological changes associated with puberty. This perspective tend to see adolescents as individuals driven by dyscontrol by "Ranging Hormones" in their blood streams. The onset of sexuality is an area that has broad overlap with puberty. They are contemporans and both have traditionally been seen as impetus to adolescent problem behaviours.

Coping with Stress

The myth of "Turbulent Adolescence" may be crumbling, but this does not diminish the stress, albeit normative that adolescents face. These include expectations of achievement, preparation for adult roles, skills acquisition, decision making, identity formation and inter personal activities. Social achievement probably is the matrix that best represents the aspirations and tribulations of adolescence. It is in simple terms the need to build identify, relationships, career goals and anticipatory ambitions.

Culture and smear for AFB is done on request

High Risk behaviour

Academic under achievements and high school dropouts have been reported in this age group. This can set up a vicious spiral of further high risk behaviour. It can also predispose towards a significant lowering of self-esteem and emotional disturbances. Suicide and deliberate self-harm possibly are the most dreaded consequences of high risk behaviour in teenagers.

Conclusions

The adolescent is a peculiar mix of inexperience, biological readiness, marginal status and cultural confusion. The adolescent with an inbetween status where there is a depletion with an inbetween status where there is a depletion of childish content and lack of adult prerogatives is particularly vulnerable to the experiencing of lacunae. This the teenager seeks to fill in by striving for creative objectives and a search for beauty and harmony in life. However it has been noted that when skills and challenges are equally balanced but there is a lack of flow of experiences there is a resultant apathy and disorganization. In any case the natural impulse of an adolescent appears to be towards meaningful and enriching experiences which meet a natural need and foster growth and development.

The need of the hour is to understand phase of growth and the problems that they encounter so that we adults can solve them and make their life more happier.

ANAESTHESIA

WHAT IS ANAESTHESIA?

The word Anaesthesia is used to describe a state when you feel no pain, either in the whole of your body or just part of it. The word comes from two greek words meaning loss of feeling or sensation.

WHAT DOES THE ANAESTHESIOLOGIST DO?

Discuss type of anaesthesia with you and find out what you would like, helping you to make choices.

Discuss the risks of anaesthesia with you.

Agree a plan with you for your anaesthetic and pain control.

Responsible for giving anaethesia and for the well being and safety throughout the surgery.

Manage any blood transfusions you may need.

Plan your care, if needed, in the Intensive Care Unit

Make your experience as pleasant and pain free as possible

WHAT ARE THE TYPES OF ANAESTHESIA?

General anaesthesia

Regional anaethesia

Local anaesthesia

What should I use to clean my baby's teeth?

A toothbrush will remove plaque bacteria that can lead to decay. Any soft-bristled toothbrush with a small head, preferably one designed specifically for infants, should be used at least once a day at bedtime.

When should I take my child to the dentist for the first check-up?

In order to prevent dental problems, your child should see a pediatric dentist when the first tooth appears, or no later than his/her first birthday.

Are baby teeth really that Important to my child?

Primary or "baby," teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt.

What is the difference between a pediatric dentist and a family dentist?

Pediatric dentists are the pediatricians of dentistry. A pediatric dentist has two to three years specialty training following dental school and limits his/her practice to treating children only. Pediatric dentists are primary and specialty oral care providers for infants and children through adolescence. including those with special health needs.

How often does my child need to see the pediatric dentist?

A check-up, every six months is recommended in order prevent cavities and other dental problems. However, your pediatric dentist can tell you when and how often your child should visit based on their personal oral health.

How can parents help prevent tooth decay?

Parents should take their children to the-dentist regularly, 'beginning with the eruption of the first tooth. Then, the dentist can recommended a specific' program of brushing, flossing, and other treatments for parents to supervise and teach their children. These home treatments, when added to regular dental visits and a balanced i.e., will help give your child a lifetime of healthy habits.

When should my child first see a dentist?

"First visit by first birthday" sums it up. Your child should visit a pediatric dentist when the first tooth comes in, usually between six and twelve months of age. Early examination and preventive care will protect your child's smile now and in the future.

Any advice on teething?

From six months to age 3, your child may have sore gums when teeth erupt. Many children like a clean teething ring, cool spoon, or cold wet washcloth. Some parents swear by a chilled ring; others simply rub the baby's gums with a clean finger.

ADVICE TO PARENTS ON CHILDHOOD ASTHMA

IS THE PREVALENCE OF ASTHMA INCREASING?

Yes. Several epidemiological studies have shown that the prevalence of this condition is increasing in industrialized countries and India is no exception. The prevalence has increased in many parts of the world to the extent of 20.30%

WHAT IS THE RECENT UNDERSTANDING OF ASTHMA?

Asthma is no more considered to be solely due to allergy (atopy). It is classified as a hyper reactive disorder of the airways with inflammation of the airways (destruction of the epithelium and thickening of the mucosal lining of inner part of the airways).

WHAT IS A TRIGGER FACTOR?

Symptoms of asthma may be precipitated or exacerbated by various factors, which are called the "triggers". They include respiratory infection (mainly viral and occasionally fungal or bacterial), industrial irritant fumes, automobile exhaust fumes, weather charges, humidity and passive smoking. Endocrinal and emotional factors do playa role apart from hypersensitivity to drugs like aspirin and NSAID (non steroidal anti-inflammatory drugs) in some children.

IS IT DIFFICULT TO DIAGNOSE ASTHMA IN CHILDREN?

The diagnosis of asthma is not easy in young children. Only by careful elicitation of medical history and clinical examination diagnosis of asthma is made possible.
Diagnosing asthma in children, particularly pre-school children is still a major hurdle in practice, because they cannot be subjected to "pulmonary function tests" or assessed regarding their peak expiratory flow rate (a tube-like instrument which is easy to carry is used to assess this, by asking the child to forcibly exhale).

WHY ASTHMA IS NOT EASILY RECOGNIZED IN YOUNGER CHILDREN?

Only one third of the children have classic symptoms of asthma - cough, breathlessness and wheezing. Majority of the cases are not identified because of the atypical presentations.

Often the diagnosis of asthma in pre-school children is made by the nocturnal cough, sleep disturbance and feeding difficulty that is associated with sub-clinical wheezing which the parents are unwilling to accept. Because of the misconception about the aetiology of asthma, its course and prognosis, it remains an under treated disorder in children. Reluctance on the part of the parents to accept that their children have asthma (in view of the social stigma associated with the disorder) has prompted the physicians to find out other names for asthma, one being "Hyperactive Airway Disease."

HOW TO USE PEAK FLOW METER?

As we measure the Blood Pressure using BP apparatus, Peak Flow Meters provide objective ways to assess the child's condition during impending attacks. It measures the expiratory flow of air from your child's lungs. Its value reduces when the airways are narrowed and serves as an early indication which parents themselves can easily detect at home.

Reduction in Peak flow values can precede the onset of cough & wheeze and can therefore identify the onset early. Your child has to stand and blow forcibly into the Peak flow meter after taking a deep breath. The maximum value of three recordings is taken and expressed in liters / minute. Ideally, the recordings are done in the morning, afternoon and evenings. A decrease in value of more than 15 percent as compared to the Child's usual value suggests airway narrowing. Standard Peak flow values for age height & sex are available for comparison. It may be a good idea to have a Peak flow meter at home if your child frequently wheezes. E.g.: Suppose your child normally blows around 100 liters / minute, if his value decreases to less than 85 liters / minute, the problems of wheezing have set in.

WHAT ARE THE GOALS OF ASTHMA THERAPY IN CHILDREN?

The goals of therapy in childhood asthma are to control the asthmatic symptoms and to allow the child to lead a normal lifestyle as possible. Essentially this means the child's ability to take part in competitive sports, to sleep through the night undisturbed and to attend school regularly with the use of anti-inflammatory drugs, which help to preserve the lung function. The parents and children are to be educated on the preventive aspects in the control of asthma.

WHAT ARE THE ADVANTAGES OF THE AEROSOL DRUGS?

The advantages of the aerosol drugs are: (1) they are delivered to the site of need (namely the tracheobronchial tree) (2) their side effects are minimal or negligible as the dose required is in micrograms; and their action is instantaneous like and intravenous injection.

WHAT ARE THE DRUGS AVAILABLE TODAY FOR THE MANAGEMENT OF ASTHMA?

Though' a variety of drugs are available for the management of asthma mainly two groups are popular. One is called the relievers-beta2 agonists that are used to relieve an impending attack of asthma; the other group is called the preventors (sterioids and cromolin), which are used to reduce the inflammation in the airway, therapy reducing their hyper responsiveness to asthma triggers. These drugs are now available in the form of aerosols (suspension of solid or liquid particles in gas).

WHY THE AEROSOL THERAPY IS NOT READILY ACCEPTABLE AND UNPOPULAR IN OUR COUNTRY?

Parents are reluctant to use these drugs in children because of the (a) initial expense; (b) widespread misconception and myths among parents that these aerosols are habit forming in the long run; and (c) difficulty in convincing the parents that the preventive aerosols are to be used even when the child is asymptomatic (does not have the symptoms of asthma).

WHAT ARE THE OTHER ASPECTS OF ASTHMA MANAGEMENT?

Drug therapy forms only a part of the management of asthma in children. Yoga, swimming, aerobic exercises play a major role. Effective dust proof measures especially in the bedroom will reduce dust mites, which will help .to curb the triggers. Covering the pillows and bed with polythene or rexin cover, swabbing the floor with wet cloth or vacuum cleaner are some of the preventive steps suggested for the house dust prevention. However sun drying or steaming (laundry) of bedroom linen alone will eliminate the house dust mites.

The suggestion to remove the family pet from the home is difficult to enforce as any parents do not comply with request. So also is the avoidance of passive smoking.

BRAIN FEVER

(MENINGITIS AND ENCEPHALITIS)

WHAT IS BRAIN FEVER?

It is the fever caused by infection of either the covering of the brain (meningitis) or the brain itself (encephalitis) or both (Meningo encephalitis)

WHAT ARE THE COMMON CAUSES?

Most common - viral infection e.g. Japanese Encephalitis. Herpes etc., can or occur following dog bite - Rabies

Bacterial infection - Bacteria from infection of any part of the body, especially throat and can -enter the blood stream and entire brain or directly enter into the brain from discharging ear infection.

Fungal - Rare

Parasitic e.g. Malaria

RISK FACTORS

Poor nutrition
Crowding
Lack of immunity
Absence of breast-feeding
Improper immunization
Contact with known case
Dirty surrounding with pigs around
Lack of mosquito control measures

MANIFESTATIONS

Initial symptoms are non-specific

Early Fever	Vomiting
Headache	Restlessness / irritability
Nausea	Emotional outburst

Decreased appetite

Later

Photophobia

Neck pain

Neck. rigidity

Seizures

Paucity of movement

Unsteady gait

Coma, Death

Consequences in 10 -50% cases

Mental retardation

Convulsion

Delay in acquisition of language

Visual impairment

Hearing loss

Behavioural Problem

Hence Prevention is Better than Cure

HOW TO PREVENT?

Early recognition of symptoms and immediate medical intervention.

Treatment of persons in contact.

Vaccination / Immunization

	All children should be immunized with Hib vaccine beginning at 2 months of age
	Meningococcal vaccine for immune deficient and Pneumo-coccal.
	Meningococcal vaccine for contacts during outbreak.

Exclusive breast-feeding till 6 months of age and along with solid food thereafter till 2 years.

Mosquito control

	Use of mosquito nets
	Regular spraying by respective authority
	Cleaning of the surroundings
	Avoiding stagnation of water in the surroundings
	Segregation of pigs.

HOW TO TREAT?

	Antibiotics will cure bacterial Meningitis if started early.
	Antiviral drugs - Acyclovir helpful for Herpes
	Supportive therapy is crucial

MEDICAL GENETICS
	Rapid advances have occurred in the field of genetics in the past decade be it cloning, gene sequencing or gene therapy, with great implications in diagnosis and management of human disease. The burden of genetic disorders is enormous not only as regards to mortality and morbidity but also in term of emotional, social and financial aspects.

WHAT ARE GENES?
	Genes are basic units of heredity. They are concerned with protein synthesis. The formation and function of every structure in the body is controlled by genes. As per the Human genome project there are around 80,000 genes in the human genome. All the genes are contained in one set of chromosomes in every cell. Genes are composed of DNA (Deoxy ribonucleic Acid), which codes for the production of amino acids. The amino acids are then joined to form proteins. The DNA consists of 4 nucleotide bases, phosphates and sugar deoxyribose) arranged like a twisted ladder. Changes in the DNA sequence of nucleotide bases are known as Mutations. When DNA is exposed to mutagens like high-energy radiation like. UV, X-rays or radioactive rays or chemicals - these changes may occur:

WHAT ARE GENETIC DISORDERS?
Genetic disorders can be divided into the following categories:
	Single gene disorders
	Chromosomal disorders
	Polygenic or multifactorial inheritance defects
	Mitochondrial inheritance

Besides these there are chronic diseases with strong genetic basis like cancer, diabetes, malformations etc.

HOW TO DIAGNOSE GENETIC DISORDERS?
The way a patient is investigated and managed for a genetic disorder depends on the condition and mode of inheritance.
	Thorough history recording including consanguinity, defects or health of family members for at least 3 generations
	Pedigree construction
	Detailed physical examination including authropometry
	Relevant basic investigations
	Cytogenetic / DNA analysis
	Accurate diagnosis
	Genetic counseling
	Follow up

CAN GENETIC DISORDERS BE PREVENTED?
The proverb "Prevention is better than cure", applies even to genetic disorders.
	Avoid exposure to radiation, toxic chemicals, dietary toxins etc. to prevent gene mutations.
	Avoid marriage among close relatives. Avoid pregnancy at too an young age or too late.
	Avoid marriage among two families with same genetic disease.
	Avoid marriage between carriers of same genetic disease.
	Encourage good eating habits to include anti mutagens in diet.
	If there has been any genetic disease in the family give particulars to your doctor, so that carrier test or prenatal diagnostic tests may be planned.
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