SOME ACUTE AND CHRONIC DISORDERS
Here I have discussed those disorders which should be noticed by parents and should be treated properly.
WHEEZING
Wheeze is a sound created during respiration and is a pointer to some infection or/and obstruction in the nasal passage, chest and lungs. There is a feeling of choking and dyspnoea (breathlessness) tightness of the chest—especially on lying down more so and at night. Use nebulisers or nasal drops to clear the respiratory the morning tract. In some cases, antibiotics like Ampicillin, Amoxyline etc., may be required, but dosage must be guided and determined by a doctor and never of your own.
In any case, another attack should be warded off. Spasms may be caused while dusting and cleaning carpets, furniture, walls and floor by odours from the kitchen, gas leakage, and smoke/ smoking. Complaint is more commonly found in children if it is allergic to some ingredient; it has to be guarded properly.
MARASMUS
This a severe wasting disease of infants when their body falls below ¾th of the expected age. The skin shrivels, the infant gives an aged look and looks much older, is apathetic and pallid, and his body temperature remains much below normal.
CAUSES
• Wrong feeding and malnutrition
• Protein deficiency
• Repeated vomiting and diarrhoea
• Metabolic disorders
• Severe disease of the heart, kidneys, lungs, or urinary passage
• Some chronic parasitic or bacterial disease
• Lack of breastfeeding, arising due to maternal rejection of an infant, or the child may himself refuse to take breast milk.
The treatment can be started only after the underlying cause is discerned or located. But, in all cases, regardless of the cause, start giving fluids and nourishment, apart from good nursing and care. If the disease continues and lingers on for longer without being detected and treated, it may prove fatal.
POLIO OR INFANTILE PARALYSIS (POLIOMYELITIS)
This situation occurs due to an infectious Virus (disease) that affects the Central Nervous System. The virus is excreted in the faeces of an infected person, thus, the disease is very common where there is extremely poor sanitation. But break out of disease in epidemic form often occurs even where there are hygienic conditions, where people have not been immunised from the disease during infancy. Symptoms commence 7-12 days after infection, but in most cases, paralysis may not occur. There should be no degree of confusion as to the types of paralysis, which are explained as follows.
Abortive Poliomyelitis: Only the intestines and throat are infected, and general symptoms are influenza or stomach upset.
Non-paralytic Poliomyelitis: In this type, symptoms are accompanied by stiffness of muscles—in particular, muscles of the neck and back.
Paralytic Poliomyelitis: It is not very common.
Bulbar Palsy: Here, breathing is affected due to the involvement of muscles of the respiratory system.
Symptoms of a milder form of the disease are followed by weakness and, ultimately, paralysis of the muscles. The best form of treatment is by giving Polio drops to the infant in earlier months. Once the infection sets in, the symptoms cannot be treated or reversed except by resorting to supportive methods.
RICKETS
In this condition, a child’s bones do not harden and are ill/ malformed due to Vitamin D deficiency. Vitamin D helps Calcium salts to get deposited in the bones so that the bones can become rigid. Lack of Calcium absorption results in softer bones which bend and get reshaped. Renal rickets surfaces due to impaired renal function—the bones are malformed due to the excretion of bone-forming minerals in the urine. If this condition occurs in adults, it is called Osteomyelitis. The best and cheapest source of Vitamin D is sunshine, which, if unavailable, may be compensated through related Vitamin. Consult some doctors about actual treatment, dosage, frequency and duration of medication. Mothers deprived of sunlight are also victims of this disease (called Osteomyelitis).
PNEUMONIA/BRONCHO-PNEUMONIA/PNEUMONITIS
The disease ( Pneumonia) is caused by bacteria, due to which there is inflammation of the lung. Air sacs fill up with pus so that air is excluded, and the lung becomes solid (also called—consolidation). The symptoms depend upon the number of lungs involved and the virulence (intensity) of bacteria, but the most common symptoms include pain in the chest and cough; apart from that, there are shadows in the x-ray (of the chest). Bronchopneumonia is the commonest form which is quite a serious type. In lobar pneumonia, whole lobes of either or both the lungs are affected due to strains of streptococcus pneumonia. Still, hypostatic pneumonia develops in dependent parts of the lung in those who are otherwise ill, chilled or immobilized.
Whatever the type of infection, no case should be handled by a layman due to its serious complications. The bacteria that cause pneumonia or any other type are sensitive to antibiotics, and timely treatment can ensure a quicker recovery. But Pneumonitis is often caused by viruses/unknown agents resistant to antibiotics but may respond to corticosteroid therapy which also needs to be treated by a physician. The parents must not take upon themselves the onus of treating an infant as even a slight delay or mishandling may prove abortive and ultimately result in the infant’s death.
DIPHTHERIA
It is an acute, highly contagious infection caused by Corynebacterium diphtheria, which generally affects the throat but occasionally other mucus membranes and the skin. The disease is spread by direct contact with a patient, carrier, or contaminated food. After an incubation period (latent period) of 2-6 days—sore throat, weakness, and mild fever develop. Later, a soft grey membrane forms across the throat, constricting the air passages and causing difficulty in breathing and swallowing, a tracheostomy (a surgical operation in which a hole is made into the trachea—windpipe through the neck to relieve obstruction in breathing) may be necessary. Bacteria multiply at the sight of infection and release a toxin into the bloodstream, which damages the heart and nerves. Death from heart failure or general collapse can follow within four days, but prompt administration of antitoxin and penicillin arrests the disease; complete recovery requires prolonged bed rest. An effective immunisation program has now made diphtheria rare.
As soon as any abnormal symptom is detected, the patient (whether an infant, child or even elderly person) must be treated by a doctor, but even a slight delay in treatment may result in instant death. A layman must not handle such cases but only by a doctor, preferably in a hospital where all requisite facilities are fully and easily available.
MEASLES (RUBELLA, MORBILI)
It is said that measles appear at the infancy stage but, in some cases, it may surface in elderly people also. It is a highly infectious disease that tends to appear in epidemics every 2-3 years and mainly affects children.
Progress of the disease is as follows:
• After 7-14 days of the incubation period, symptoms like a cold, followed by a high fever, develop along with the appearance of small red spots on the inner side of the mouth.
• On the 3rd to 5th day, a slightly elevated pink rash develops— first behind the ears, then on the face and other parts, and lasts for 3-5 days.
• The patient continues to remain infectious throughout this period.
• In most cases, symptoms disappear and subside but the patient becomes susceptible to infections of the middle ear and pneumonia.
• Complete recovery is generally seen within 2-4 weeks.
The child must be immunised by vaccination. Unless and until the patient does not have pneumonia, there is hardly any danger to life, but more complicated cases need medical care and proper treatment. Though, in the general progression of the disease, hardly any medicine is called for. But, other children and attendants should be careful about the spread of infection. The children must be kept away from the ailing patient.
MUMPS (INFECTIOUS PAROTIDS)
It is a common virus infection that affects children, mainly between 5-15 years of age; though some adults have also been seen to be suffering from this infection, it is quite a rare occurrence. The onset and progress of diseases is as follows:
• Symptoms appear 2-3 weeks after the exposure.
• Fever, headache, and vomiting may be the forerunning symptoms that might precede a typical swelling of the parotid salivary glands.
• Gland, on one side of the face, swells up days before the other but, at times, only one side gets affected.
• Almost all the symptoms disappear within 3-5 days, but the patient remains infectious until the swelling has fully disappeared.
• The infection may spread to other salivary glands and from there to the brain, testicles and pancreas.
• In adult males, mumps may cause sterility even and render them impotent.
• In fact, mumps may not appear if the infant was immunised at infancy. If mumps appear despite immunisation, their period of invasion and intensity is much less, and no medicine is called for, except control of high fever. Efforts should be made to ensure the infection does not spread to other vital organs. Paediatric drops of Paracetamol, given 6 hourly, will control fever and pain but no medicine should preferably be applied over swelled part(s).
MENINGITIS
Meningitis is inflammation of the meninges due to infection by bacteria or viruses responsible for T.B., syphilis and/ or pneumonia.
SYMPTOMS
• Intense headache and fever
• Loss of appetite
• Intolerance to sound and light
• Rigidity of muscles, especially of the neck
• Convulsions
If bacteria cause meningitis, it can be treated with sulphonamides or antibiotics, whereas viral meningitis does not respond to treatment/drugs. In the latter condition, complete restin-bed, quiet and darkness is the only treatment. This condition may be complicated by cerebrospinal fever, for which read the following information. Both conditions are quite serious and must be treated in a hospital only, not at any other place, by a non-medico or a layman.
CEREBROSPINAL FEVER
It is also called a ‘Spotted Fever’ and is a type of meningitis caused by Neisseria Meningitis. The bacteria are transmitted by sneezing and coughing. The disease occurs mostly in overcrowded conditions, and children are mainly the victims than the adults.
After an incubation period of 3-5 days, symptoms develop and appear suddenly when there is fever, severe headache, stiffness in the neck’s muscles and a rash of small red spots on the trunk. Quite often the ailment enters a chronic stage when blindness, deafness and mental deterioration of serious nature may develop. If given in time, treatment is possible with sulphonamide or Penicillin drugs but otherwise, death may occur. This disease should also be treated in a hospital under the care and supervision of a qualified doctor(s) and staff but never by a layman.
WHOOPING COUGH (PERTUSSIS)
In most cases, whooping cough is a well-known disease that occurs during childhood. If a child has already been given ‘DPT vaccine’ (which is given in a combined form), such an immunization will reduce the incidence and severity of attack and if the attack comes, its duration and severity/intensity would be far less. It is believed that an attack also usually confers immunity.
SYMPTOMATIC CAUSES AND PROGRESS OF DISEASE
• It is a contagious disease caused by infection of mucus membranes by the bacterium Haemophilus pertussis.
• It primarily affects children, though elderly children or adults could also be the victims.
• After an incubation period of 1-2 weeks, mild fever, cough, catarrh and loss of appetite develop and persist for 1-2 weeks.
• Cough becomes paroxysmal when short bouts of cough follow in almost quick succession and are followed by involuntary drawing in of the breath which produces the whooping sound.
• After each paroxysm, there is vomiting and bleeding from the mouth and nose. This state lasts for about 2 weeks, and the child remains infectious throughout.
• The foregoing stage lasts for 2-3 weeks, after which symptoms start declining, but the cough may persist for another few weeks.
• During an attack, the child may turn blue even, which indicates a lack of oxygen and poor blood circulation.
Though whooping cough is seldom serious and generally poses no danger to life, the child remains exposed and susceptible to T.B. and pneumonia, which complications can create further health problems. As soon as the above-mentioned initial symptoms are noticed, consult a doctor for prompt and requisite treatment but never administer any drug or home remedy of your own. There are quite effective medicines in other therapies also, which will be discussed under relevant headings, which may be referred to as and when necessary.
STOMACH/INTESTINAL WORMS
There are four types of worms—tapeworms, threadworms, roundworms and hookworms—all of which owe their origin to one parasite or the other—which exist in the intestines or stomach; children generally suffer from round and thread worms.
GENERAL SYMPTOMS
• Flow of saliva from the mouth
• Itching in and around the anus
• Canine/Voracious appetite
• Despite eating frequently and large quantity of food, they remain hungry.
CAUSES
• Eating contaminated and unhygienic food.
• Unclipped and dirty nails through which contaminated food items and parasites gain entry into the digestive tract
• Not washing the hands with soap before and after taking food.
• Constipation.
• Frequent diarrhoea or dysentery. The mucus in the stools encourages the parasites to gain entry into the stomach and intestines.
Drugs that kill such worms are called ‘Anthelmintics’. The actual drug to be used will depend on the type of worms that infect a child. Nowadays more effective drugs like Tinidazole, Metronidazole, Dioxanide Furate, Furazoladine, Piperazine citrate/ Phos, Mebendazole, Pyrantel Pamoate, Nichosamide, Praziquantel etc. are used according to available symptoms but actual dosage and drug can and should be determined and monitored by only a doctor. Generally, one dose of ‘ Decaris’ (Paed. dose) will suffice for a child but should be repeated after 15-45 days as worms remain during this period. Full caution must be used as all drugs are not meant for children. There is no need to give any laxative when a Paediatric dose is given but all said and done, seek proper guidance from a doctor only. First of all take preventive measures and then administer the required drug. Some companies combine more than one drug to make it more effective.
PREVENTIVE MEASURES
• Remove constipation and thoroughly wash the anus with free water.
• Clip the nails of the child and keep the nails neat and clean so that no food particles could get stuck up within the nails.
• Do not eat raw, stale and semi-cooked vegetables nor eat rotten fruits.
• Keep a high standard of personal hygiene.
• Children should be discouraged from eating anything outside their homes.
• Wash hands thoroughly before going out/after coming in and after and before eating. Whenever a child comes from outside, he must wash his hands before taking anything.
• Avoid fried food, junk food, juices, cold drinks, chats, fruit chats etc.
• Exposed and dust-laden eatables and drinks/juices must not ever be eaten/drunk.
If the anti-worm drug is taken and there is a relief, it must not imply that total immunity has been achieved forever. If the abovementioned precautions do not form the basis of routine exercise, worms will reback, and this process will continue. It is the duty of parents to guide their children about proper and necessary precautions and impress upon their wards that personal hygiene is not a one-day affair, it must form part of their active habits. Parents have been seen to be apathetic in this respect as they themselves do not follow rules of general cleanliness and hygiene. The elders must act themselves first so that their children can emulate them. Children imitate quite easily and repeat what their elders do without knowing the consequences. You cannot preach or sermonise a little child—you can do yourself when the infant cannot do anything by himself but endeavour to motivate, guide and persuade when he can pick his mother’s actions. If a child is taught how to keep himself neat and clean, such teachings get in-built and last a lifetime, thus paving the way for a healthy life of your child. There is no better teacher than a mother, who is expected first to practise herself and then guide and motivate her child.
MALARIA
It is claimed that malaria, like smallpox, has also been eradicated, but there are still confirmed and declared ‘Malaria zones or belts’ in our country where the recurrence of malaria still exists.
Malarial infection is caused by the presence of the parasite known as protozoa of the genus ‘Plasmodium’ (P. vivax, P malariae, P. Ovale, P. Falciparum) transmitted into the red blood cells; malarial disease is transmitted by the female mosquito ( called Anopheles). Malaria is mainly confined to subtropical and tropical zones/areas.
Parasites in an infected person’s blood are taken into the mosquito’s stomach as it feeds. Here they multiply and then invade the salivary glands. When the mosquito bites an individual, parasites are injected into the bloodstream and migrate to the liver and other organs, where they multiply. After an incubation period from 10 days to 10 months, parasites return to the bloodstream and invade the blood cells.
Rapid multiplication of the parasites results in the destruction of the red blood cells. This causes a short bout of shivering, fever and sweating, and the loss of healthy blood cells results in anaemia. When the next batch of parasites is released, symptoms reappear. The interval between fever attacks varies in different types of malaria—in quarantine malaria (or fever). caused by P. malariae, it is three days, and in treating malaria (P. Ovale or P. Vivax), two days, and in malignant tertian ( or quotidian) malaria ( P. falciparum), the most severe kind, from a few hours to two days. Preventive and curative treatment relies on chloroquine, amodiaquine and chloroguanide.
In order to ensure whether one is suffering from malaria or not, requisite blood is called for. But if the patient is already loaded with quinine, the clinical investigation may reveal a negative result. Dosage, safeguards and duration and frequency of medicine should be under the expert guidance of a doctor only. In some cases, the indiscreet dose of quinine may damage liver functioning also though it is quite another matter that doctors prescribe high doses of quinine in liver infection also. A layman cannot decide under which malarial condition what dose and what precautions are necessary; hence, always consult your doctor. If the patient is an infant/debilitated elderly person, such medical advice is all the more necessary. Heavy and continuous dosages of the malarial drug(s) may cause jaundice and/or many other liver or digestive problems.