ParentEdge Guide to your Child’s Health and Nutritional Needs. by ParentEdge

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With expert perspectives, informed insights and practical tips Spark Interest. Kindle Imagination. Fire Intellect

Dear reader What you hold in your hands (or see on your screen!) is a treasure trove of information, tips, and insights into various aspects of your child’s health and nutritional needs. The content of this ebook is, in fact, a compilation of the various blogs contributed by experts in the field to the ParentEdge blog roll - www.parentedge.in/blog. We also have a few blogs from parents like you and me, detailing their experiences with their children. Our blogs have one objective—to give you practical information and make parenting today’s kids a little bit easier for you. Much like our magazine, ParentEdge (www.parentedge.in). ParentEdge is a magazine for parents with school going children. It covers a range of topics that are relevant to raising today’s children, and discusses how parents can contribute to their children’s intellectual, emotional, and physical well-being and growth. ParentEdge also aims to expose parents to global trends in parenting, and to partner with them in the holistic development of their children. ParentEdge is available all over India in various bookstores, through direct subscription, and online as well. You can visit our website for more information. For now, flip through this ebook to understand what it takes to be a parent today. Feel free to write in with any queries, suggestions or feedback you may have—you can email us at editor@parentedge.in. Happy parenting! Kritika Srinivasan Editor, ParentEdge December 2014

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Table of Contents Blogger Profiles

Blogs on Nutrition Do you Know how to Read Nutrition Labels? The Power of Breakfast Monitor the Junk in your Child’s Diet Fats and Oils The Dangers of Excess Salt Consumption Say Yes to Honey! Why is Iron Important for Children? Understanding the Role of Fibre My Experiment with Millets

5 6 8 10 12 14 16 18 20 22

Blogs on Health Is your Child Sleeping Enough? All about Allergies – Parts 1, 2, and 3 The Common Cold Fever in Children Apprehending Asthma The Conundrum of Swollen Tonsils and Adenoids Fighting the Flu through Vaccination Decoding the Doctor’s Prescription Why Abhor the Antiobiotic?

24 25 27 33 35 37 39 41 43 45

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Blogger Profiles Dr. Krishna Mahathi

Dr. Krishna Mahathi holds diplomas in Pediatrics and in the Management of Allergies and Asthma. Years of working and interacting with children and parents have given her insight into developmental disabilities. She wishes that there was more awareness and acceptance of the issues that differently-abled children face, and hopes that through her blogging, she can enable children and their families to make sensible and informed choices.

Meera Srinivasan Meera Srinivasan has a background in Nutrition and Food Technology, and comes with more than 15 years of experience in the food industry. As an involved parent of a 13-year old girl, she is passionate about increasing awareness on nutrition and health among children and parents.

Sudha Kumar Sudha Kumar is a marketing professional and runs a marketing services firm, Prayag Consulting (www.prayag.com). She has made her foray into publishing through ParentEdge. Over the last two decades, she has learnt a thing or two about being a working mom. That said, her views on parenting continue to evolve, as she learns from her experiences, reading, and now, from her children!

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Blogs on Nutrition

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Do you Know how to Read Nutrition Labels? – Meera Srinivasan

From my experience, even among the educated, ‘Nutrition Literacy’ is far from where it should be, and learning to read nutrition labels can be a good starting point. Most of us walk into a grocery store and add items to our basket, blissfully unaware of what nutrition it actually delivers. In fact, many of us hardly ever stop to read the label and even if we do get around to looking at it, we may not be sure what the numbers imply. Here are some pointers that will help you decide if the product falls in the ‘healthy’ or ‘not-so-healthy category’, and how often you or your child should consume it.

No label, don’t buy

Check for the nutrition label on the food pack you buy. Today, all food manufacturers in the country have to declare the following on a label (Nutritional facts per 100 g or 100 ml or per serving of the product): •• •• •• •• ••

Energy value in kcal Total carbohydrate and sugar The amount of protein Fat in gram (g) or ml, and Vitamins and minerals for which a health claim is made

Match nutrition information to the quantity you eat

Next check if the nutrition information is given per 100 g or per serving. For instance if: Net weight grams = grams declared on the nutrition label, the package is a one serve pack. Say net weight is 30g and the nutrition label gives information for a serving size, then the numbers you see on the label is the nutrition you get from the pack. Net weight (g or ml) > grams/ml declared on the nutrition label, then you need to be more careful. A good example for this is the fruit drinks/juices segment , where nutrition facts are often shown per 100 ml even when a typical serve size is 200 ml. So if you are not alert to this fact, you might assume that your child is consuming only half the calories /sugar! Net weight (g) < grams on nutrition label, then you need to pay attention again. The single serve snack packs that we buy frequently for children weigh approximately 30 g while nutrition information is given for 100 g, so we need to do some simple division here else you might be left wondering how a small packet can deliver so many calories!

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Stay away from large snack packs

They weigh more than 100 g, but nutrition information is presented for 100 g. Unfortunately, current labeling norms do not mandate serving size, and even if they did, when was the last time you were able to convince your child to close the packet after eating 15 chips? So, it is wiser to stick to the single serve /smaller packs!

Deciphering the calories further

What is declared on the pack is the total calories you get from the product. But it is important for you to know where these calories are coming from. To arrive at the number of calories from fat multiply the amount of fat (given in grams) by 9; for carbohydrates and proteins, multiply by 4. As a rule of thumb, if you find that approximately 50-60% of calories is coming from fat, you should definitely control the consumption of this product.

Sugar watch

The number declared against carbohydrates indicates ‘total carbohydrates’, which includes complex carbohydrates (like those found in cereals), simple sugars as found in fruit, milk, cane sugar and fibre. Check if the product contains added sugar. Some responsible fruit beverage companies do differentiate between the added sugar and the sugar coming from the fruit but many do not. So, if you are not able to figure out, take a look at the ingredient list on the pack – if the ingredient list includes ‘sugar’ in addition to water and juice concentrate, you can be certain that sugar has been added to make the product.

Fat Facts

There are good fats and bad fats. But in our country, companies are not required to provide a break-up of the fat in foods unless they make health claims like ‘low fat,’ or ‘low cholesterol’. As a result, one can never be sure of the type of fat used in the packaged food. One way to find out is to look at the ingredient list for words like ‘partially hydrogenated fat’ or ‘shortening,’ as these products have a higher proportion of bad fats (trans fat). In the absence of any of the above information it might be best to avoid products which are high in fat content. Trust you find these pointers useful. Next time when you go to the grocery store, do look for the nutrition label and ingredient list on pack. If you are not happy with the information given, or after doing the math, you realise this should not be in your basket, put it right back on the shelf and do yourself and your kids a favour!

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The Power of Breakfast – Meera Srinivasan

In my interactions with children, I have noticed that many are unable to eat a good breakfast before they leave for school. The reasons could vary from schools starting early in the north, to getting up late for the teens (when sleep becomes more important than meals!) or a fussy eater who just cannot manage to eat in the morning. I would like to use this occasion to reiterate that the popular saying ‘Eat breakfast like a king, lunch like a prince and dinner like a pauper’ does exist for a good reason!

Breakfast and school performance

If adults need to eat breakfast to perform well through the day, kids need it even more. Regular intake of food is a must for their growing bodies and brains! If children get into the habit of skipping breakfast, their body can get used to the “semi- starvation state” and they can go for long periods without food. This state can lead to many physical and behavioral problems and also affect school performance! Study after study confirms this simple but important fact- children who eat breakfast, perform better in school. They are able to pay more attention, have better short term memory retention, more energy to face the day and likely to have fewer days of absence from school!

It is important to ‘break the fast’

Many teens (particularly girls) are under the impression that skipping a meal can help them lose the extra kilos and since breakfast can be easily sacrificed – often it is this meal that they sacrifice. Actually skipping breakfast can lead to excessive eating at the next meal, indulging in high calorie snacks, leading to weight gain than weight loss! Studies show that overweight and obese children are less likely to ‘break the fast’ than their thinner counterparts!

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Meeting nutrition needs

For school going children it is a meal which is under the “mother’s control” till they come back from school after a long day and should be seen as an opportunity to feed them essential nutrients like calcium and protein. If children miss breakfast, they may not meet their daily nutritional needs!

Tips to make kids eat breakfast! Wake them up early: this may sound hard, but that is only till a routine establishes since most kids do not have an appetite early in the morning as there is hardly any time between waking up and eating at the table. If children are up for an hour or so before breakfast time and do their morning chores, they may be ready to eat. In exceptional cases, maybe a little exercise may help, like walking the dog or a short walk with an adult in the house. Get their buy in: many kids don’t like to eat breakfast, so give them options the night before so they are mentally ready in the morning. For example — how would you like your egg, what chutney would you like, what paratha etc. As they have exercised their choice, they may feel more inclined to eat what’s on the table! Space the milk and the meal: make children drink their glass of milk as soon as they get up so there is less to eat at the breakfast table. Offer variety to make it interesting: breakfast probably gets less attention in terms of planning and detailing compared to dinner on a week day. Being the most important meal of the day, offer children variety –in our country with so many options available this may be easy to implement ….aloo paratha or poha could easily offer variety in the south and idly /dosa in the north!

Sit with your kid: plan your day better so you can spare the ten minutes to sit with your kid when she is eating breakfast – and also ensure adults at home eat breakfast! If adults skip breakfast, children will follow suit! Teen trouble: while the tips above may work easily with younger children –getting teens to eat a good breakfast may be tough – you could offer to make a wrap with veggies and cheese with left over chapattis, cheese toast on the go, a smoothie with nuts/dried fruits and say a banana, are some options that you could try. Mid-morning snack: if all fails – ensure your child has a more filling mid-morning snack – a sandwich along with a banana or even the food that was cooked for breakfast – can be prepared and sent like “finger food” Working Mothers: Getting kids to eat breakfast and a healthy breakfast at that, can be unnerving for working mothers – a bit of planning, some preparation during the weekend (batter, homemade chutneys) and having the right products at home (whole wheat bread, peanut butter, cheese slices, fruits, nuts, a good breakfast cereal) can make the task easier! Breakfast is indeed the king of meals – so give it the required attention!

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Monitor the Junk in your Child’s Diet – Meera Srinivasan

While I was debating whether I needed to write a blog on junk food and its implications, as a lot has been said and is already known about this topic, reading an article made me realize that probably over messaging on this topic can be justified! The news item was about an eleven year old girl in Mumbai undergoing bariatric surgery (weight loss surgery, a part of the stomach is removed) to manage her obesity. She weighed a staggering 98 kgs and was actually born a healthy child; a clear case of poor lifestyle and a bad diet! Yes, we could probably brush this off as a one off case, in a country where numbers have to be big to make any impact. But the numbers are rising – to quote from the news article – ‘22 adolescents have been operated at this facility since its inception in June last year and this number is equal to the total number from the last twelve years put together! Also numerous studies show increasing rates of overweight and obesity in children in metros and report numbers as high 20-30 per cent! Many adolescents are reported to have high cholesterol levels, diabetes and hypertension.’ So we can no longer dismiss this as an aberration!

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So who coined the word ‘junk food’ and what qualifies as junk food? The word “junk food / empty calories” is believed to have been coined by Dr. Michael Jacobson, who co-founded Centre for Science in the Public Interest (CSPI), way back in 1972. One of his goals was to help people take informed decisions on what they eat. Now the term is used to describe foods, which have little nutritional value and are high in baddies – sugar, salt and bad fat. Foods that usually fall in this category are fried/salted snack foods, candy, sweet desserts, fried fast food, and sugary aerated drinks or ready to drink juices with hardly any fruit in them. These foods are high in calories but have little of the goodies like protein, vitamins or minerals. More on the baddies… Bad Fat duo: Not all fat is bad but the two types of fat we need to watch out for are saturated fat and trans fat. Saturated fat is present in dairy products like full fat milk, butter, cheese, ghee, paneer, red meats. Trans fat is found in products made with partially hydrogenated fat, typically found in food items from local bakeries, street and fast food joints. Sugar and Salt: Sugar adds only extra calories to your child’s diet and no other nutritional value. Salt along with flavours makes the junk food addictive! Savoury snacks are usually high in salt and a 200 ml serving of an aerated drink can easily over shoot your child’s daily requirement of sugar! With the onslaught of advertisements and increased access to ready to eat snacks and street food, restricting junk food has become a huge task. Here are some tips which can help… •• Read nutrition labels of packaged foods you buy and check for amount of baddies. •• Stop stocking junk – chips, namkeen ghee-laden mithai, sweets, candies, and aerated drinks. Buy smaller packs or packs for one time use. •• Important for older family members to eat healthy and if you live in a joint family, to discuss and agree on eating habits of your child as elders may have a different opinion. •• Take the help of your pediatrician or a dietician to explain consequences of poor eating to your child if you are worried about her eating habits or weight, as the child may be more receptive to an outsider’s advice. •• Talk to your child’s school if junk food or aerated drinks is served in the school canteen. •• Talk to your child’s peer group mothers/parents about limiting junk food in birthday parties and sleep overs – if the peer group abides, your child will complain less! •• Do a project with your child on junk foods and collect facts and make a collage or scrap book to increase awareness. •• Ask older children to cook with you or show them the difference in oil used in say, frying vs. baking. •• Pizzas, burgers, bhel puri, etc. if made at home can be easily made healthier by making small changes – whole wheat base, rich tomato sauce, veggies as toppings in pizzas, baked vegetable patty, whole wheat bun for burgers and addition of sprouts, groundnuts, some grated carrots in a bhel puri. •• Finally ensure daily play or sports for your child. We need to limit junk food but not restrict it completely as this may back fire and make the child crave for it. It is a journey and not a one-time activity, but benefits are plenty if we start explaining to our children the need to monitor junk consumption early on in their lives!

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Fats and Oils – Meera Srinivasan

I am continuously bombarded by friends, relatives and patients with queries on oils and fats – What oil should I use? Should I change my oil? Should I avoid fat to lose weight? Is eating ghee ok? Is butter good for growing children? Since then, I have realized that most people seem to know only the brand of oil they buy and not the oil type! And many people still think all fats are bad .…..so I thought it will be good to summarize key messages in a blog for wider consumption! First some facts before we get to tips. •• Remember the Good, the Bad and the Ugly? Fats too can be classified along these lines– based on how these fats affect our cholesterol levels. Many of us may be aware that we have good and bad cholesterol in our body, but unaware that this is linked to good and bad fats in the diet! Did you know that the good fat in our diet decreases bad cholesterol, bad fat increases the bad cholesterol and the ugly not only increases the bad cholesterol but also decreases the good one? •• The good fats are called PUFA and MUFA; you may have heard these names – they stand for polyunsaturated and monounsaturated fats respectively. The bad fat is saturated fat (SAFA) and the ugly one is trans fat (TFA). •• All fats and oil have some amount of PUFA, MUFA and SAFA — there is no “magic oil” that exists which has no bad fat – but we can definitely choose oils which are higher in good fats and lower in bad fat. •• Fat should not be avoided, as some fats needed by the body come only from the food we eat. Rightly called essential fats, they are commonly known as omegas and are receiving the much needed attention these days! •• All of us need fat – 25-30% of the energy from foods should come from fat. For example, in a 2000 kcal diet per day 600 calories can come from fat (1 gram of fat = 9 kcal). Of this, at least 2/3rds should be from good fats (400 calories). •• To complicate things further – we have something called visible and invisible fat! Fat can be ‘visible’ (oils, butter, cream in milk), or ‘invisible’ as present in cereals, nuts, fruits and vegetables. So, even if you do not add any fat/oil in your cooking, your family will still get some fat but not enough!

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Tips to increase good fats and decrease bad fats

•• Include ground nut, sesame and rice bran oil in your grocery list as they are good sources of MUFA. Rice bran oil is good for frying as it offers better heat stability. But strangely in our country olive oil hogs the limelight as a source of this good fat compared to locally available oils! It is not the olive oil which does the trick but the Mediterranean diet, of which olive oil is one component! The complete diet includes olive oil along with lots of legumes, fruits, vegetables, fish and wine! •• PUFA is the source of omegas (3 and 6) for the body – the most widely used source of PUFA is sunflower oil thanks to all the advertising the past few decades – but there are better choices in this group – mustard, soya bean and canola (which is mustard oil without the pungency) as they offer both the omegas vs. sunflower which gives only omega 6. •• Foods rich in omega 3 are walnuts, flax seeds (now available easily as seeds or powder) oily fish like mackerel, salmon, sardines and fresh tuna. Oily fish like mackerel are cheaper and healthier than the more popular ones like seer or pomfret! •• Full fat milk, butter, cheese, ghee, paneer, red meats (mutton, beef, pork), coconut oil are high in saturated fat. To reduce SAFA consumption, switch to double-toned/low fat milk or skim the fat in regular milk before use. A small spoon of ghee will do no harm but using ghee liberally even for a child is not advisable. Butter, cheese and paneer are hot favourites among children but cheese can be seen as a lesser evil as it delivers protein and calcium. Cook more lean meat -chicken, fish to satisfy the meat palate! •• Trans fat is present in products which use partially hydrogenated fats – products from local bakeries –biscuits, buns, cakes, street food, fried snacks and fast foods usually have trans fat. So indulge in these treats occasionally! •• Use a combination of oils, for example groundnut with canola, rice bran or sesame with soya bean. •• Switch butter with peanut butter on toast, cashewnuts with walnuts in cereals/cakes and add groundnuts liberally to salads, bhel, to increase good fats! •• My favourite tip in my articles and blogs –read nutrition labels and ingredient lists of packaged foods you buy to understand the type of fat used and the amount of fat per serving. •• Trust this short piece will help you understand fats and oil beyond brands names and make you thirsty for more details.

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The Dangers of Excess Salt Consumption – Meera Srinivasan

How many of us can claim to know the amount of salt we add in our cooking or the amount our family consumes in a day? How many of us know there is a daily recommended intake for salt? How many of us actually even think about our salt intake? When we adopt health trends, it is always about shifting from rice to roti, eating oats for breakfast or reducing oil intake. Salt rarely makes it to this list! In our country the positives associated with salt are plenty-preservation, iodine delivery, gargling for germ kill and in fact in some religious practices salt is given as a blessing! So they clearly outweigh the negatives. In fact the word ‘salary’ is thought to originate from the word “salarium” which means ‘salt’ as Roman soldiers were paid part of their salary in salt! Of course Indian cinema is replete with “I have grown up eating your salt” kind of dialogues. Hence to communicate that salt is classified as one of the four bad nutrients along with sugar, saturated fat and trans fat when consumed in excess, by the World Health Organisation, can be an uphill task indeed!

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So are we consuming more salt than required? – The answer is YES! The National Institute of Nutrition, Hyderabad, puts the consumption of salt anywhere between 8-30 grams per day per person though there is no reliable data on how much we actually consume. Yes it is a huge range and most people unfortunately think their salt intake is fine! In an online survey done by Unilever, 96% of the respondents mentioned that their salt intake is satisfactory! So what is the recommended intake of salt? Both World Health Organsiation and National Institute of Nutrition recommend 5 grams of salt per person per day and this translates to just 1 tsp! The body actually requires the element “sodium” from the salt and this requirement translates to only 2 grams as salt is ~30% sodium! Guaranteed in our country where consumption of salt rich foods – pickles, pappads, chutneys, namkeens is very popular, plus eating out and takeaways being a frequent affair – we are bound to be well above the mark! So why should we be worried about excess consumption? Diabetes and heart diseases get enough attention but not ‘hypertension’. Unfortunately hypertension is not the end but the beginning of a host of health issues – it is responsible for 57% of all stroke incidents and 24% of heart diseases! There are also other complications with kidneys, eyes, water retention etc. Well, all these may sound like adult related issues but do not forget that healthy childhood is the foundation for healthy adulthood! These facts are worrying but the good news is simple steps at home can easily bring down our salt intake – thankfully in our country salt added during cooking contributes to 50% of our salt intake, unlike the west where it comes from processed foods, so to exercise control is in some sense easier! •• It is good to know how much salt your family consumes. One person is allowed one tsp of salt a day – but remember salt (sodium) is naturally present in foods we eat as well (milk, rice, wheat, fruits and vegetables, rice) – so for a family of four it will be good to target 2- 3 teaspoons of salt per day in all the cooking you do! •• Keep track of the salt used in your cooking using a standard teaspoon for couple of days and slowly reduce the salt -pinch by pinch! Studies show that slow reduction is hardly noticed and your family will get used to the new level soon! •• Remove salt at the table and do not encourage adding salt before tasting. •• Restrict namkeens, pickles as occasional treats. •• Some food products carry sodium content on label – but please remember to do the math to check your salt intake – some namkeens, pizzas, garlic bread can have more than 300 mg of sodium per serve which translates to 1 gram of salt which is 20-25% of your daily intake and in some products can easily cross the 50% mark! •• For young children train their palate to less salt so they taste the natural flavours and get used to a healthy level of salt. So, hope this article has made you reflect a bit on salt consumption in your family and will help you take the required small steps in the right direction. The blogger would like to thank Unilever for sharing its “Salt and Health” workshop proceedings held in in September 2012, Bangalore.

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Say Yes to Honey! – Meera Srinivasan

Being a nutritionist I have always wondered about the health benefits of honey–should I look at it as just another source of sugar? Or should I view it differently given the kind of associations that Ayurveda and other indigenous medical traditions have with honey? To solve this predicament, I thankfully got an opportunity to research on this topic. Here are a few insights I have gained since then! Honey has clearly survived time; one is not merely talking about centuries here. Honey has been recognized for its medicinal properties since 6000 BC. So there is documented reference for use of honey for at least 8000 years now – be it in stone age paintings, Sumerian tablets, Egyptian papyri, Vedas, the Holy Koran, the Talmud, old and new testaments of the Bible! This got me thinking that there must be something special about honey- beyond the chemical composition that modern science has deciphered! But for some science now … Honey naturally contains small amounts of vitamins, minerals, trace elements like chromium, selenium, manganese, needed by the body as catalysts for many reactions; some enzymes which help in digestion also give honey its anti-microbial properties and actives which are more commonly referred to as antioxidants. The fact that all this is naturally present and honey is minimally processed (no artificial colour, flavor, preservatives) makes it definitely a healthier sweet spread for children. Source of honey does impact its “biological activity” and hence the benefits. But all honey do contain actives irrespective of the source. Nevertheless it may be better to buy honey that claims to be minimally processed and indicates where it is sourced from.

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It is a natural energy booster for children/adults before, during or after play /exercise and some studies show that it can be better than glucose as it gives sustained energy for athletes rather than a quick spurt. This is because of the sugar composition in honey -it has a combination of both fast and slow burn sugars. So it will be a great idea to replace sugar with honey in beverages for children – be it banana milkshake, or a fruit smoothie. Honey has both antimicrobial (ability to fight germs) and anti-inflammatory properties (reduce inflammation/soothe membranes) – hence it helps to fight common infections –cold, cough, sore throat. Many holistic practitioners prescribe honey for cough/cold and some studies done in children show that it is better in suppressing cough than the common cough suppressants! Hence grandmother’s concoctions of ginger and honey for cold, honey and pepper for sore throat and cough and various concoctions of spices and honey have definite scientific basis! Here is another fact that I learnt – because of a certain enzyme in pure honey, when applied topically on wounds honey can act as an antiseptic! It has been used even in treatment of burns! Moving down to the digestive system, the natural enzymes present in honey can enhance the digestion of food substances especially sugars and starch. As a sweetener, honey has advantages over sugar, providing some nutrients which help in digestive processes. Honey is also a source of prebiotics, different from probiotics as prebiotics are substances which facilitate the growth of good bacteria, while probiotics is the good bacteria itself! Many trials have shown that consuming honey has a positive effect on the growth of beneficial bacteria in the gut. Considering the abuse our digestive system takes on these days, honey can be the simple natural remedy to maintain gut health. It is also being used in treatment of heartburns, ulcers, and reflux in modern medicine! A spoon of honey is even recommended after a heavy meal…! The relation between honey and weight loss is the most debated- though I was not able to find a scientific article on this, many lifestyle websites and references in traditional medicine (Amish, Ayurveda) talk about the role of honey in fat burn and generally boosting metabolism. So honey as part of a weight loss regimen can aid people in their weight loss efforts – a tsp. of honey in some warm water in the morning! For girls in their teens honey can be the simplest thing to do when it comes to beauty treatments. It has the ability to absorb and retain moisture, helping the skin feel fresh and supple. The anti-germ properties can help in treating acne. Honey can be applied on the face, and allowed to dry (fifteen minutes or so) and washed away with warm water – beauty tips cannot get easier than this! The last on the list but an important one, honey is referred to as Yogavahi in Ayurveda. It means that it can penetrate deep tissues in the body. Hence many Ayurveda doctors recommend mixing herbal medicines in honey to help the medicine reach the deeper tissues. There are over 600 recipes in Ayurveda which use honey. So after my research I have started using honey a lot more- be it for treating a cold or sore throat, replacing sugar partly in cakes or granola bars, as a spread for toast, parathas, in breakfast cereals, in milk, green tea or just giving the family a spoonful of honey! Here is a website that can help you get started on your honey exploration – http://www.honey.com/

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Why is Iron Important for Children? – Meera Srinivasan

Though I believe in a balanced diet, there are times when we need to focus on specific nutrients, as their deficiency can be a cause of concern. Iron is one such nutrient that can really contribute to a child’s growth and performance. A review of middle and high income families showed that anaemia due to iron deficiency is prevalent among anywhere between 14 to 88% of the population. Also, many teenage girls are at risk for iron deficiency when they hit puberty. So this is an issue that can very well be present in our households!

Why is this happening and why is iron so important?

The answer to the first question is probably known to all of us—it is because children these days tend to eat more ‘energy dense food’ (empty calories), which are not necessarily ‘nutrient dense’. Iron is a nutrient that is needed to make haemoglobin, the oxygen-carrying component of blood (red blood cells). Red blood cells circulate throughout the body to deliver oxygen. So if your child does not get enough iron, his body will not get enough oxygen to perform its routine functions. This can translate into a lack of energy, feeling tired quickly and even inability to focus and study! Iron is key for mental growth and development of children. Even relatively mild forms of this deficiency can result in lower stamina, poor school productivity and reduced concentration in older children! Children who are anaemic as toddlers can have impaired performance in tests of language and motor skills, equivalent to a 5 to 10 point deficit in IQ! Last, poor iron status means poor immunity, and children will be more prone to infections. So it’s important for kids and teens to get enough iron in their daily diets.

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What are some common symptoms of iron deficiency anaemia?

•• •• •• •• •• •• ••

Fatigue or weakness Poor appetite Shortness of breath Dizziness or complaints of feeling lightheaded Headache Irritability Frequent infections

The symptoms may not appear immediately, because the body’s iron store is depleted slowly, but as anaemia progresses, some of these symptoms start appearing. So if you are generally concerned about your child’s eating habits, it may be worthwhile to check his iron status and if your child has any of these symptoms, do talk to your doctor. A simple blood test to check for iron status and prescription of iron supplements if needed is all that the situation demands.

Iron in everyday diet

The daily recommended intake for children who are 4-9 years old is around 13-16 mg of iron and for adolescents, between 21-28 mg. This may not seem high and you will be surprised to know that the body’s requirement is much lower, only around 0.5 mg for children and 1.5 mg for adolescents! However, our diets are unable to meet even this low requirement, as iron from our diets is poorly absorbed. Hence this gap between what is required and what is recommended. Iron from meat sources, known as ‘haeme iron’ is more easily absorbed by the body than iron from plant foods. So if your family habits allow meat dishes you can relax. Just ensure that your child eats meat at least 2-3 times a week.

Other foods which are good sources of iron

•• Two eggs can give almost 7 -12% of the recommended iron intake depending on the age of your child •• Pulses and lentils like rajmah, back eyed beans (lobhia/karamani), soyabean, dried peas, horse gram •• Dried fruits like dates; you can add date syrup to milk and cereals •• Almonds and cashewnuts •• All green leafy vegetables – spinach/palak/keerai/soppu •• Iron fortified cereals/biscuits: This is not on top of my list as the form of iron used in processed foods is not readily absorbed by the body.

Tips to increase iron intake or absorption

•• If your child is a milk lover, limit his/her milk intake to a maximum of 700 ml, as excess calcium can interfere with iron absorption •• Serve iron-rich foods along with foods contacting vitamin C like oranges/ orange juice, tomatoes •• If older children are in the habit of drinking tea, ensure a gap of a couple of hours after a meal as compounds in tea can affect iron absorption! Give your child’s health a boost by addressing her iron status.

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Understanding the Role of Fibre – Meera Srinivasan

Definitely children in urban India are undergoing a worrying “nutrition transition”. There is clear evidence to show that their diets have become higher in fat and refined processed food with little consumption of fruits and vegetables. This shift is leading to numerous health concerns at a fairly young age – cholesterol, weight, diabetes…! Generally it is good to discuss the complete diet, than single nutrients, but for some nutrients like iron and fibre we need to make an exception so the role of these nutrients is better understood!

So what is dietary fibre? Why is it important?

Dietary fibre comes from plant food like whole grain, fruits and vegetables. It is the part of plant food which resists digestion or absorption by the body. You may wonder if fibre resists digestion and also does not add to the calorie intake, what is its function in the body? The fact is, a diet rich in fibre can do wonders – the benefits range from regular bowel movements, satiety, less chance of overeating, maintaining body weight, to lowering cholesterol levels and blood glucose response after a meal. Actually overwhelming scientific evidence has led many health bodies around the world to approve health claims on fibre! There are two types of fibre, one which is soluble and the other insoluble, and both are important. Both types are found in food, but some foods could be a better source of either one. Soluble fibre forms a gel in the body, which can delay the emptying of the stomach. It is also usually associated with its ability to lower cholesterol, and growth of friendly bacteria. Insoluble fibre absorbs water and adds bulk which helps the wastes to pass more quickly though the body and key to preventing constipation. Soluble fibre is found in barley, oats, nuts, rajma, channa, peas, apples, pears, flax seeds. Insoluble fibre is found in whole grain cereals – wheat bran/whole wheat flour, brown rice, nuts, seeds, dates and vegetables.

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How much fibre for children?

The recommended intake for fibre in our country is 40g per day based on a 2000 calorie diet, but we do not have specific recommendation for children. Guidelines form other countries indicate 18 g for 4-8 years, 20—25 g for 9-13 years and around 22-28 g 14-18 year olds. These numbers show that the amount required is not small and most Indians do not meet their daily requirements for fibre.

Tips to increase fibre intake in children

We all know it is not possible to know the number of grams of fibre we are feeding our children. Also not many kids will crave to eat foods rich in fibre! So it is a challenge, but here are some tips that can ensure your child is getting enough fibre every day. •• Consciously evaluate the source of fibre at every meal. If you feel one meal is poor in fibre, ensure you balance it out in other meals – for example if you plan a white bread cheese toast in the morning, please ensure there is some fruit for snack, more veggies at lunch, some rajma/channa for dinner. •• Switching from maida to whole wheat – buying whole wheat/multigrain bread, making whole wheat muffins or pancakes, whole wheat base for pizzas, buying a good aata for rotis and parathas are easy to execute! •• Oats porridge may not be a favourite with kids but making granola bars with rolled oats, wheat flakes, nuts and seeds with honey and brown sugar as a binder is an exciting way to get your child to eat whole grain and seeds. Cereal bars made with oats are available in the market as well. •• Millets like ragi are difficult to polish, thankfully because of its size –so using this could be an interesting way of adding fibre – ragi porridge for young children or ragi roti/dosa. •• Swap couple of meals with brown rice – like Chinese fried rice, the soya sauce can help you mask the colour of brown rice! •• Cook more rajma, channa, peas and whole pulses – green gram, black gram than plain lentils (spilt dals). •• Incorporate nuts and seeds like sunflower, flax, watermelon, cucumber seeds in your child’s diet – roasted nuts/seeds are easy to add to cereals, salads, parathas, fillings in sandwiches – the quantity maybe be less but they are good sources of fibre! •• Ensure adequate fruits and veggies in your child’s diet – variety is important, but if you child is fussy ensure he has his favourite vegetable or fruit in one meal. •• Look at ways of adding vegetables and fruits to food you make – be it roti, dosa, soups, sandwiches– grated carrots, shredded cabbage, chopped greens, fruits in milk/cereal. •• Takeaways, fast food or high fat foods are usually low in fibre so limit their intake. •• Finally all the above will work only if your child drinks enough water – 4-6 glasses of water a day is a must to keep the digestive system healthy! So get your child used to a fibre sufficient diet now, so you lay a better foundation for healthy adulthood.

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My Experiment with Millets – Sudha Kumar

Much is being written about how millets have somewhere gone missing from, and why we need to reintroduce them, into our diet. In fact, ParentEdge carried a really informative article ‘Discover the goodness of millets’ in its Nov-Dec 2013 issue. I have been experimenting with millets for some time now and I thought I’d share some of my experiences. Having settled down in Bangalore, we were introduced to the benefits of ragi more than 15 years back. Jowar, a commonly used grain in North Karnataka, entered our diets as jolada rottis (difficult to make I must warn because it is gluten free!) later. More recently, I have incorporated bajra through khichdis (very easy to make). However, after reading the article in Parentedge and realizing their many benefits, I have started incorporating millets into the menu at home more consciously. And in this post, I’m sharing some simple millet-based recipes which taste pretty good, and are easy to make.

Samai/ Sama/ Moriya Dosa/Idli

Samai or little millet is an astonishing source of iron (something I learnt from the ParentEdge article). Its other advantage: it looks good (unlike other millets). In fact, idlis made from little millets look and taste no different from rice based idlis. To make samai idli, just substitute rice with samai. So you soak 3 measures of samai and 1 measure of urad dal, grind and leave to ferment overnight. Adding a few methi seeds makes the idlis softer. Another couple of ways to use samai- make khichdi- like the sabudana khichdi- soak samai in water for about half an hour. Allow cumin seeds to splutter in some oil, add ginger, green chillies, haldi powder add the little millets, water and salt and cook for 10 minutes or until cooked. You can garnish with roasted peanuts, coriander leaves. Samai can also be made into dal based khichdis or simply used to substitute rice in a meal.

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Bajra (Kambu/ Pearl Millet) Khichdi

Being a die-hard fan of the late Tarla Dalal, I came across this recipe first in her book on Rajasthani cooking. Easy to make and pretty tasty too, I have altered the proportion of bajra and dal to suit our tastes. Coarsely grind bajra in a mixer, add moong dal in proportions that can vary from 3:1 to 1:1 ( I use 1:1). Combine the cleaned bajra and dal, add around 3 or 3 Â˝ measures of water (the millets need more water to cook), salt to taste and pressure cook. Once done, splutter jeera, hing , green chillies and curry leaves in some ghee and add to the cooked khichdi. Mix well and serve hot. Bajra khichdi tastes good with kadhi. Bajra rotis, being gluten free, may need some patience and experience to get them right. I make them small and, rather than roll, use my palms to flatten into small, thick rotis. You can also try making small puri sized bajra aloo rotis (embellished with some masala like coriander, chillies, jeera powder and haldi).

Thinai / foxtail millet adai

Thinai is loaded with fibre (all millets are, but this one even more!). The small brown grains can be used as a rice substitute in the traditional south indian recipe â&#x20AC;&#x201C; Adai ( dal+ rice dosa). The addition of thinai makes the adai crisper and like with all millets, enhances the taste. I have also tasted yummy foxtail millet (and ragi) cookies though I have not tried them myself. Thinai pongal or South Indian version of Khichidi is also widely recommended- but please remember to soak the thinai for at least 3-4 hours else the grain retains its crispy texture which does not work very well for pongal.

Millet dosa

This is easy- just add any millet you like- bajra, ragi, samai, thinai together ( you can also add a bit of rice if you wish- if you do use rice, try using red rice). Combine the millet mix and urad dal in the same 3:1 ratio. Throw in a couple of teaspoons of methi seeds- soak for 6 hours or so, grind with salt to taste, leave overnight. Make it like regular dosa. For ragi dosa, you can sprout ragi (takes a few days) and use instead of rice. Tastes good, but use it within 1-2 days- it ferments quicker than rice dosa dough.

Ragi/ finger millet Roti

A traditional recipe of my adopted state Karnataka, it is as an easy to make and delicious breakfast. The ingredients include ragi flour, finely chopped onions, chopped coriander, finely chopped green chillies, grated coconuts and salt to taste. Add the masala to ragi flour and add water sparingly to make stiff yet soft dough. Divide dough into small balls- pat into round roti like shapes on a nonstick tawa. Add some oil and cook both sides. Serve hot. So, there you have it- some simple ways to add the goodness of millets to your diet. Do try, add your variations and share your experiences!

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Is your Child Sleeping Enough? – Meera Srinivasan

I have come across a few articles in ‘The Hindu’ — ‘We sleep to clean our brains’ , ‘Sleep deprived teenagers may be at risk of long term damage to the wiring of the brain’. To add to my growing concern and curiosity, recently a friend gave me a book on parenting (Nurture Shock, Bronson and Merryman) which has a chapter titled the ‘The Lost Hour’. That’s when I decided I really need to blog on ‘sleep’ because as parents, many of us may not be giving ‘sleep’ the attention it actually deserves!

Highlights from this enlightening chapter – ‘The Lost Hour’

There is research to show that around the world children are getting an hour less to sleep than what they got thirty years ago! Well it may seem rather inconsequential but apparently, this is affecting IQ points, causing moodiness, depression, and also in some cases fuelling ADHD and binge eating! Things that we definitely cannot ignore! Of course we all are aware of what is fuelling this lost hour – televisions (24/7 and hundreds of channels), computer time, and mobiles in bedrooms and of course academic pressure in schools is as taxing or worse! Now sleep scientists are saying inadequate sleep could cause permanent damage as a child’s brain continues to develop till the age of 21 and much of the work happens when the child is asleep! In an interesting study done with fourth and sixth graders where children got instructions to go to bed earlier or later by 30 minutes for three days, results on standard computerised test used to rate a child’s performance and ability to maintain attention in class, showed that losing one hour of sleep is equivalent to losing two years of cognitive maturation i.e. the sixth graders performed like fourth graders! Other studies are finding similar results and even late weekend bedtimes for preschoolers can affect standard IQ test results by 7 points. So there seems to be a correlation between sleep and school performance!

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So what is happening actually?

When children do not get sufficient sleep, they are tired; the neurons lose their plasticity and ability to form new connections required to encrypt memory. So this could mean –difficulty in improving vocabulary, memorising tables, history dates ..! The brain needs a constant supply of glucose to function and with sleep loss, the body’s ability to obtain glucose from the blood gets affected. This in turn hampers the functioning of the frontal part of the brain which is responsible for ‘executive function’. So tired children have difficulty in studying and probably find tasks like watching television or playing mindless games easier! The sleep pattern for children is different from adults – children spend 40% of their sleep time in deep slumber without dreams and during this stage their brains are shifting what they have learnt during the day to efficient storage regions! Actually the more they learn during the day, the more they need to sleep at night!! Another interesting finding is that positive memories get processed in the deep slumber stage, so lack of it means a child will retain/remember more of the bad memories than the nice ones Finally there is a link between sleep deprivation and obesity. This happens as hunger stimulating hormones are activated more than the one that suppress appetite. Also there is an increase in the level of stress hormone, which is known to stimulate fat accumulation. Hormones required for breaking down fat are secreted in the beginning of sleep and if sleep is disrupted the process does not work! Clearly SLEEP MATTERS especially for children! We may be trying to address concerns in all other areas but ignoring this important need! So don’t try to add one more activity that you think might help your child –get her to bed early you may do her brain a favour! ————————

So how much is enough?

3-6 year olds need 10-12 hours of sleep, children in the age group of 7–12 years need 10- 11 hours and 12-18 year olds need 8-9 hours of sleep. ZZZZ………………

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All about Allergies – Parts 1, 2, and 3 – Dr. Krishna Mahathi

Part 1: About Allergies

It has been my lot to demystify certain concepts that people have. Until few years ago people would give me a quizzical look when I told them that I was a daughter of an allergy specialist. It was hard for them to digest that “allergies” could be taken seriously, let alone be treated. Even to physicians treating allergies was the pursuit of the dilettante. Observing the strain on productivity that living with an allergic condition can cause and the variety of invalid methods used to handle them often fuels a lengthy narrative from me. So let me explain some issues in order to make ‘allergies’ more understandable. Allergy is a condition when a substance that is not harmful in itself can bulldoze the body’s defense mechanism into a tussle that produces discomfort in some select individuals only. So how does this happen? Well, our genes take the credit for resulting in some of us having a tendency to react adversely, and this predisposition is termed ‘atopy’. Any substance (this is usually a protein) that can fuel an irritated response from the immune system (which we generally refer to by the term inflammation)can be called an ‘allergen’. The inflammatory response is orchestrated by cells in the immune system called ‘lymphocytes’ and the discomfort produced is mediated via counter proteins (remember allergens are proteins) called ;immunoglobulins’ that release several chemicals into the body. The common mediators are ‘histamine’ and ‘leucotrienes’ and they are responsible for the overt manifestations of the allergic reaction. This is also the reason why the reaction can be treated effectively with medications that counter these biochemicals (antihistamine and antileucotrienes, steroids, etc.), if used judiciously. What are the ways in which an allergy can present itself? The allergic reaction can manifest in different forms depending on which part of the body presents the allergen to the immune system; the commonest problems manifested are in the skin ( where it is called atopic dermatitis),the respiratory system( termed rhinitis if involving the nose and asthma if the damage proceeds to the lungs)and eyes (conjunctivitis). Ear and sinus infections can occur as a complication of allergic rhinitis. In rare cases there may be a gastrointestinal involvement,

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accompanied by erratic bowel movements or a migraine. Occasionally, the hyper-responsiveness can rapidly affect many systems of the body. An itchiness starting with the skin, can aggravate into breathing complications and lowering of blood pressure, endangering life itself .This type of reaction is scientifically termed ‘anaphylaxis’ .I’m sure all of you have seen or heard instances of an insect bite or seafood feast that led to an admission to the intensive care unit. It’s surprising how much immunological memory is built around things that are unnoticed at the time. Subsequent exposure to the same allergen brings about a quicker and stronger reaction, and therefore an atopic individual is definitely susceptible to a life threatening crisis at any time. Are children more prone to allergies? Children have an immature immune system; added to this, if they are genetically predisposed to allergies, they will definitely be more prone to them. However, the good news is that they can overcome some allergies as they grow up. This is the reason why pediatricians ask parents to wait for a while before introducing proteins like egg into the diet. Some more observations… If you think that allergies are more common now than in your grandparent’s time and it’s a fashionable term that came in with westernisation you are not entirely wrong. In medicine, the hygiene hypothesis states that a lack of early childhood exposure to infections, symbiotic microorganisms (like probiotics) and parasites brings about a susceptibility to allergic diseases by suppressing the natural development of the immune system. Therefore in countries like ours allergies are likely to take precedence over infections as we improve our sanitation. It is also a fact that environmental pollution and overcrowding accelerate the severity of the immune response because pollutants constantly irritate the skin and other protective barriers of the body. The environmental scenario in terms of the pollen and home furnishings is a little different in the western countries and this is why the response is different. If you notice symptoms at a particular time every year it is simply because some allergens are seasonal like pollen and fungi. And finally how is your doctor going to help your child manage his allergy? Once your child’s atopic status is diagnosed, the physician may refer him to a trained allergist or perform certain tests that will help detect the allergens that are affecting him. This involves detailed questioning and some investigations. He will be given a plan of action that teaches him to deal with an allergic reaction himself. Lifestyle modifications may be advised as well. Medications can moderate the damage caused and prevent progressive damage.

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Part 2: Indoor and Outdoor Allergens

In this blog, I wish to share some information on how we can combat common allergy triggers in our day-to-day lives. Everything that makes one sneeze or itch is not an allergen. Cigarette smoke, automobile exhausts, perfumes and chemicals in household products (bleaches to mosquito coils) are actually irritants. These are substances, which while not corrosive, cause a temporary or reversible inflammation of living tissue (such as eyes, skin, or respiratory organs) by a chemical action at the point of contact. Allergens, on the other hand, act on one’s immune system with the power to produce persistent, prolonged and progressive damage to the body. The most common indoor immune triggers are house dust mites (yes, there is a tiny living creature involved!), cockroaches, moulds and animal proteins from pets. Dust mites, though a close relatives of ticks and spiders, are too small to be seen without a microscope. Dust contains the faeces and decaying bodies of these mites, and it’s the proteins present in this dust mite “debris” that are the culprits in dust mite allergy. They eat skin cells shed by people, and thrive in warm, humid environments. In most homes, bedding, upholstered furniture and carpeting provide an ideal environment for dust mites. House dust is easily trapped in these, which hold moisture well. •• Wash all sheets, blankets, pillowcases and bedcovers in hot water – at least 50°C – to kill dust mites and remove allergens. If bedding can’t be washed hot, expose them to sunlight on a clean dry surface.

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•• Maintain a relative humidity below 50 percent. •• Use a damp or oiled mop or rag rather than a dry one to clean up dust. This prevents dust from becoming airborne and resettling. •• Use a vacuum cleaner with a double-layered micro filter bag or a High-Efficiency Particulate Air (HEPA) filter to help decrease house-dust emissions from the cleaner. Stay out of the vacuumed room for about two hours after vacuuming. •• Buy washable stuffed toys. Wash them often in hot water and dry thoroughly. Also, keep stuffed toys off beds. •• Remove knickknacks, table top ornaments, books, magazines and newspapers from your bedroom so that dust does not collect on them. •• If possible replace carpeting with tile, wood, linoleum or vinyl flooring. Cockroaches will always be formidable enemies and I don’t think we can totally get rid of them because evidence suggests that the species existed even before we did! If you see one cockroach in your home, there are probably at least 800 hiding nearby. They thrive on food, paints, wallpaper pastes, newspapers, and book binding material. To keep them at bay these are few things you can do: •• Spray the repellent (experts say that poison baits and boric acid are better than the sprays) under the sink and in wall and floor cracks. Open windows and doors to get fresh air during and after spraying. •• Do not stack newspapers or books and bags for too long. •• Keep food and garbage in containers with tight lids. Never leave food out in the kitchen or anywhere else. Clean up all food crumbs and spilled drinks right away. •• Fix leaky faucets and drain pipes. Moulds (these are a group of fungi that produce spores) live everywhere—on logs and on fallen leaves, and in moist places like bathrooms and kitchens. For those with allergies its best to avoid contact (stay away from locked up rooms) and keep the house dry: •• Use an exhaust fan or open a window in the bathroom to get rid of the moisture. •• Scrub solid items such as floors, cabinets and furniture with a cleaning detergent mixed in hot water, or with a commercially available diluted bleach solution. Rinse and dry items completely. •• Although our pets bring us so much comfort their dander (skin flakes), as well as their saliva and urine, can cause an allergic reaction. There is no allergy risk-free pet (even aquariums can grow moulds) so it is better to limit contact whenever possible if one is diagnosed as allergic. •• Flour and grain dust, seeds, latex and chemical dyes are also triggers to atopic individuals. It is good to inform your doctor if your work and living involves an exposure to these substances and get yourself tested to see if you are allergic to them. •• The frequent outdoor malefactors are pollen, moulds, certain plant products. and insects. •• During the pollen season it is better to avoid the outdoors during peak pollen-producing times (typically in the early morning) and change your clothes, shoes, bathe and wash your hair as soon as you come in for the day. Change your air conditioning filter often, at least once a month during pollen season. It is possible to monitor the local pollen count (the number of grains of pollen per cubic meter of air) in some areas, which can guide you to schedule outdoor activity avoiding days where there is a likelihood of aggravation of symptoms. •• Honeybees, bumblebees, hornets, wasps, yellow jackets, bed bugs and fire ants are insects that are notorious for causing life-threatening allergic reactions. The proteins in the saliva of these insects are the allergens. If there are insect infestations in your area, it is better to eradicate them. •• Plants like poison ivy and chemicals like nickel, cosmetics and some topical medications can set off a local reaction on the skin which we call allergic contact dermatitis. There is much that can be done besides medication to manage your allergies. “An ounce of prevention is worth a pound of cure.”

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Part 3: Food and Drug Allergy

Not all adverse reactions to food and drugs are allergies; that is, they are all not a hypersensitive upheaval of the bodyâ&#x20AC;&#x2122;s immune system. Studies suggest that only around 8% of children under three have diagnosed food allergies (the prevalence in adults is 1.5%) while 25% of parents believe that their children have them. However, food allergy is a concern because it is a major contributor to lifethreatening anaphylaxis, as are drugs. The good news, however, is that the likely offenders are few. It is also essential to know that food allergies run in atopic families. So those with atopic dermatitis or asthma that are difficult to manage benefit from treating the co-existing food allergies. Letâ&#x20AC;&#x2122;s look at non-allergic intolerance to certain foods at first. Some fish when consumed release histamine (the chemical mediator of anaphylaxis) enzymatically (reported with tuna and mackerel) causing nausea, vomiting, itch and flushes, leading to a collapse. Some people have a similar episode if they eat cheese, eggplants and spinach due to the histamine content. Some foods rich in a chemical called serotonin (bananas, avocados, pineapples and tomatoes) cause a similar scenario. So this is an intolerance to the content that cannot be overcome and the immune system is not producing any antibodies. Lactose intolerance in an inherited lack of the enzymes that digest milk and its products, causing abdominal discomfort. Gluten-sensitive enteropathy (more commonly called, celiac disease) is an autoimmune inflammatory disease where the body produces antibodies to the proteins of its own small intestine (and not the foreign antigen like in allergy) upon the ingestion of gluten, a component of wheat protein, in genetically susceptible persons. Sometimes monosodium glutamate (MSG) if added in excess causes flushing, burning and a crawling sensation on skin which resolves within two hours (The Chinese restaurant syndrome).

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Although any food can cause allergy in children, cowâ&#x20AC;&#x2122;s milk, wheat, soya beans, eggs (this is why we give the yolk that is rich in fat first instead of the white of the egg that has protein) and peanuts are commonly implicated. They thankfully outgrow some of these allergies, but nuts and allergy to fish, along with crustacean seafood, are a lifelong problem. Elimination of the allergen for a few years in children whose immune system is still adapting and evolving can help to lose reactivity. I also want to emphasise the protective role of breastfeeding here. Breastfeeding exposes the baby to various proteins from the motherâ&#x20AC;&#x2122;s diet so the baby learns to tolerate them on his own. It is also good to give children different varieties of food in the early years of their lives (except if you have a family history of allergies where the opposite holds). In practice, allergists also report frequent intolerance to yeast and citrus fruits. There is also a condition called oral allergy syndrome where the atopic individual actually has a hypersensitivity to pollen, develop itching and redness around their mouth when they eat certain fruits and vegetables during that season. So the aeroallergen is the culprit here and not food. Allergists confirm a diagnosis of food allergy usually on clinical grounds after a detailed food history and gathering of other relevant facts. Sometimes the patient is put on a diet of least allergenic food and selected foods are reintroduced one by one. The only control measure in food allergy is strict elimination and this requires education of all family members and caregivers (and those who take them to restaurants) to read food labels and know alternative names of the food to be avoided. Milk allergy can be managed with soy based formula substitutes, casein hydrosylate or amino acid based formula. Food additives (contrary to popular belief) contribute little to allergies and more towards neurochemical imbalances (causing hyperactivity, irritability etc.) in children. It is also essential to address vitamin deficiencies and nutritional supplementation while handling food allergy. The most important thing however remains recognising signs of a severe reaction and subsequently being on guard and armed with appropriate medications as advised by the doctor. Medicines too can work adversely if prescribed for the wrong diagnosis (that is why we donâ&#x20AC;&#x2122;t advise self-medication), in the wrong dosage or when combined with other drugs (including traditional medicines) and certain foods. The use of a sub-standard medication whose composition and ingredients do not meet the correct scientific requirements can be ineffective and often dangerous. These are not classified as allergies. In case of drugs doctors are usually cautious while prescribing aspirin, sulfa-based drugs, penicillin group of antibiotics, anticonvulsants and sedatives, anesthetics, insulin preparations, particularly those from animal sources, dyes(contrasts) that are injected into blood vessels before taking x rays, blood products and vaccines. It is mandatory to report any adverse effects that one has with a medication, than simply discontinue it and classify the problem as allergic or otherwise. If you have been diagnosed with a drug allergy make it a point to mention this in your medical records.

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The Common Cold – Dr. Krishna Mahathi

My adored English teacher in primary school inspired most of us in her class to become fascinated with poetry. I remember one particular poem “The Common Cold” written by A.P Herbert that she taught us, and I always take my cue from it while speaking to my patients and their caregivers. So here goes… The Common Cold, the Common Cold The doctors really must be told It’s really time that they controlled The horrors of the Common Cold It’s quite true that colds and coughs are humdrum to us doctors. They arrive when the weather conditions allow viruses to thrive, and will continue to spread as long as there is going to be clustering and companionship. Watching the patterned episodes does make a physician think that it’s not much of a hassle. Personally, only after I became a parent could I see how a blocked nose (nothing to doctors…) could make a child out of sorts, uncomfortable and cranky. We do take charge though, when we see a change in the scenario, like when the common cold becomes the flu. I love the doctors – they are dears; But must they spend such years and years Investigating such a lot Of illnesses which no one’s got? When everybody, young and old Is frantic with the Common Cold And I will eat my only hat If they know anything of that I think an interlude of common cold is tackled very well by the body’s natural defences and we are recharged after rest and a little TLC (Tender Loving Care!). This does hurt the wee little ego we doctors manage to develop after our long abiding study of the human body, that the body can take care of itself. But I have to contradict the poet a bit here. Research in the medical field is slow and tedious and these days we make statements only based on clear sustained evidence.

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For instance, we know that warm water, juice, clear broth ,ginger teas or warm lemon water with honey help loosen secretions in the air passages and prevent dehydration. That’s why they bring relief. The age old chicken soup remedy definitely works. It acts by inhibiting the movement of “neutrophils” (immune system cells) that participate in the body’s explosive defensive response. Second, it temporarily speeds up the movement of mucus secretions, helping relieve congestion and shortens the time viruses are in contact with the nose lining. Chicken soup also improves the function of protective cilia, the tiny hair like projections in the nose that prevent contagions from entering the body. Several over the counter medications give symptomatic relief and are therefore listed as cures. For example the popular Vicks VapoRub doesn’t relieve nasal congestion. But the strong menthol odour of VapoRub tricks your brain. As a result, you feel like you’re breathing through an unclogged nose. There is also a lot of speculation over the role of vitamin C in cold. One proven effect of vitamin C is in preventing colds among people engaged in extreme physical exercise in extremely cold conditions. Although for the average child who suffers about 28 days of cold illness a year, taking daily high-dose vitamin C would still mean 24 days of cold illness. But our patients aren’t always happy to pay a consultation fee to hear us telling them to relax, and we are deemed ineffective. Mark with what long and patient care The doctor studies what is rare He cannot do too much for you If you have something strange and new Nor can he quite conceal his bliss If it should chance to end in ‘is’ But there are fortunately few Who suffer from the strange and new I do not know a single case Of Indian Itch or Persian Face Nor do I think that I have met A man with sleeping sickness yet

Doctors usually don’t like to miss out on anything serious. We know that all colds aren’t benign and the situation might be harbingers of complications. Paediatricians are therefore, always on the lookout for the infection spreading to the eardrum (that’s “otitis” for you), the sinuses (‘sinusitis”) or the airways leading to croup or “bronchiolitis” in kids. There is also a bacteria called “streptococcus” which, entering through the throat (the event is termed“pharyngitis”) can, when untreated, affect the heart’s valves (heard of rheumatic fever or “carditis”?). Doesn’t the doctor deserve to pat himself on the back if he picks up on one of these early? There are certain disorders with immunity wherein a cold can endanger life.The doctors examine your child looking out for these things as well. But all of us have one disease We all sniff, snuffle, cough and sneeze This is the universal plague And here I find the doctor vague I guess somewhere all doctors renounce the need to be acknowledged for our efforts or for refraining from superfluous prescribing. So like A.P Herbert many will claim…. But if, in fact, you chance to meet A specialist on Harley Street And say to him “Look here. Behold! I have – again — the Common Cold” The gentleman will only stare He really does not seem to care He then remarks, without remorse “Oh, Well, the thing must take its course” I hope this gives an insight to most doctors’ seemingly perplexing behaviour. So if your child catches the common cold this season do see your doctor, keep calm and see him or her again if your child is not better by three days. Your doctor will brief you on the warning signs that suggest a different diagnosis. Meanwhile (like your parents must be saying), go to bed and take plenty of fluids.

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Fever in Children – Dr. Krishna Mahathi

Thermoregulation is the name given to the process that allows the human body to maintain its core (or internal) temperature even when the surrounding temperature is very different. Normal body temperature of a healthy individual is considered to be 98.6 degree F (37 degree C), and is lowest in early morning (around 6 a.m.) and highest in late afternoon (4 to 6 p.m.). Also, body temperature rises normally in response to certain conditions, such as physical activity and the humidity in the environment. Body temperature is controlled by a region of the brain called hypothalamus by adjusting heat conservation, production, and loss. There are two ways in which this system can malfunction. In an excessively hot environment (heat stroke) or an adverse reaction to some medications (synthetic hormones, antidepressants, cocaine etc.) the body overheats through undesirable retention or overproduction of heat that it cannot dissipate. This is called hyperthermia and is different from fever. In fever or pyrexia, the setting of the hypothalamic thermostat itself changes and the body increases its own temperature through both actively generating and retaining heat. If the body is invaded by infection, allergens or malignancies, the body’s defences need extra help, they send out chemicals (pyrogens) that travel up to the hypothalamus altering its ‘set point” to increase body heat. Increasing the heat allows for a number of things. The white blood cells multiply and travel faster to the site of invasion and chew up the attackers more efficiently. Toxins that the bacteria or virus produces may be neutralized by the heat as certain proteins unravel with any changes in temperature. High temperature by itself disables certain bacteria. Once the battle is won the temperature setting goes back to normal. Understanding this mechanism allows us to intervene rationally when your child has a fever. Firstly, it is important to record temperature correctly. Remember that rectal temperature is the closest value to the body’s core value. A rectal temperature above 37.5 – 38.3 °C (99.5–100.9 °F) usually warrants attention. Always wait for 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there’s no gum or candy is in your child’s mouth. An armpit temperature is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature. Forehead temperature and plastic strip thermometers are not reliable. Glass thermometers have been replaced by digital thermometers which are accurate.

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Severity of temperature does not always indicate severity of the infection. The illness is probably not serious if your child is interested in playing and is eating and drinking well with a normal skin colour. Fast breathing, refusal to drink fluids, a rash, lethargy or irritability signal severe infection. Infants under 2 months old should not be given any medication for fever without being evaluated by a doctor because their immune system is very fragile. For older children you can wait for about a day to investigate the underlying cause. Please seek immediate emergency care if you notice breathlessness, continuous vomiting or loose stools, inconsolable crying, difficulty waking up and relating to surroundings, refusal to move, a stiff neck, bad headache, purple spots that look like bruises on the skin, blue lips, tongue, or nails, or severe abdominal pain. Between six months and six years children risk having fits if the temperature shoots up over 101 degree F. So if there is no reduction in temperature with a dose of medication it’s better to consult the doctor rather than panic or repeat/substitute medication. In the event of a fit, remember that though the typical symptoms — rolling of the eyes, twitching, and even vomiting — are disturbing to watch, febrile seizures rarely harm a child and don’t predispose him to become epileptic. If he has one, keep him on the floor and away from sharp objects, and turn his head sideways so that his tongue doesn’t obstruct his breathing. Report to the hospital if it lasts more than five minutes or occurs more than once in a day. Now, for medication. The use of aspirin in a child with a viral disease has been associated with a very serious illness called Reye syndrome and therefore it is not recommended in children. Paracetamol can be given six to eight hourly and not more frequently than that. The dose is calculated according to the weight so please calculate and recheck the strength of the composition before administering (the dose is different with drops, syrups and tablets). In children older than two years, ibuprofen can also be administered. Prophylactic anti-seizure medications are safe and effective if given correctly, in a child with frequent febrile fits. Along with medicines it is very, very important to replenish fluids in the body. When the child shivers, don’t hesitate to wrap him up and let him rest in spite of the temperature being high. Wait a while for the dose of paracetamol to take effect (it usually takes an hour) and once he starts sweating, loosen clothing and turn on the air conditioner if he asks for it. There is no need to sponge a child with ice or cold water or use cologne. These are, in fact, counterproductive. Just a bath with lukewarm water will do if the child feels comfortable. Allow the child to rest as much as he or she likes. Take time to reassure and comfort your child and breathe easy.

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Apprehending Asthma – Dr. Krishna Mahathi

We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right – one after the other, no slipups, no goofs, everyone pitching in.” ― Atul Gawande, surgeon and journalist. I feel compelled to discuss the challenges a paediatrician faces with managing asthma. My moment of truth came when a close friend of mine broke down as I was nebulizing her nephew. I knew that she had outgrown wheezing episodes as a child and I expected her to be reassuring by virtue of her experience. When I asked her to explain herself she said, “The fear you feel when it becomes increasingly difficult to breathe, it’s horrible…I know what the child must be going through, can’t help feeling bad for him.” That’s when I guessed that it’s this panic that actuates so much of absurd behaviour and decision making. So let me share some facts to allay some of it. First of all being asthmatic means you have airways that are hypersensitive and prone to becoming narrowed because the surrounding tissues get bloated as a part of the rabble rousing response of the immune system when it encounters some triggers. Asthma attacks come and go, with wide variation in the symptoms at different times. Many people with asthma have problems only occasionally but others struggle with it every day. There is no cure, the focus should be on control, and it can be achieved. What we aim for when we say control, is generally •• An ability to live an active, normal life (which means performing daily activities, play, and participation in sports without difficulty) •• Prevention of chronic and troublesome symptoms •• Zero school absenteeism because of asthma related symptoms •• Avoidance of symptoms during the night •• Stopping the need for urgent visits to the doctor, emergency department, or hospital •• Prescription and adjustment of medications to control asthma with little or no side effects

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Secondly, not all wheezing is asthma. About half of infants and toddlers with repeated episodes of wheezing with shortness of breath or cough (even though these illnesses usually respond to asthma medications) will not have asthma by the age of six. Because of this, many paediatricians use terms like “reactive airways disease” or “bronchiolitis” when describing such children instead of labelling them as asthmatic. No one really knows the exact reasons why more and more children are developing asthma in recent times. Some experts suggest that children spend too much time indoors and are exposed to more and more dust, air pollution, and second-hand smoke. Some suspect that children are not exposed to enough childhood illnesses to direct the attention of their immune system to bacteria and viruses and therefore, develop allergies (the so called “hygiene hypothesis”). We also find many parents hesitant to give inhaled asthma drugs or liquid medications delivered with an asthma nebulizer, also known as a breathing machine. I wish parents would take the time to educate themselves (the resources being so accessible) and have clear concepts in their minds because only then can they motivate children to be regular with medications and not feel selfconscious while taking them. This is very crucial. Asthma in children is handled using very specific guidelines, depending on the severity and duration of symptoms. The medications given fall into two categories. One category includes drugs taken daily that are meant to control asthma in the long term and reduce the frequency of asthma attacks (controller or maintenance medications). The other category is medications that provide instant relief from symptoms (rescue medications).Steroids are a vital part of the list too. Very short oral courses (three or five days) or long term inhaled preparations seldom cause alarming side effects and there is no need for trepidation. In general, doctors start with a high level of therapy during an asthma attack and then decrease treatment to the lowest possible level that still prevents asthma flare-ups and allows your child to have a normal life. Every child needs to follow a customized asthma management plan based on the severity and triggering factors so do not compare it with another. So the essential parts to managing your child’s asthma are Identifying and Controlling Asthma Triggers, knowing when to anticipate flare ups and having a clear plan of action to handle it, being regular with medicines and periodically updating your knowledge with your doctor. This can take time and energy to master, but it’s worth the effort!

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The Conundrum of Swollen Tonsils and Adenoids –Dr. Krishna Mahathi

“Never in the history of medicine have so many physicians owed so much economic security to a single operation as tonsillectomy.” (Lyman Richards, Quoted in The New York Times,1953) Tonsils, located at the back of one’s throat and adenoids, present high up behind the nose are part of the immune system and help protect the body from infection by trapping germs coming in through the mouth and nose. They are collections of tissue producing cells that attack the invading microorganisms and counteract their toxins by forming antibodies. They swell up temporarily whenever there is active infection.

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Though tonsils were removed frequently in earlier times the present scenario has changed because doctors believe that the positive role of tonsils in helping the owner for a lifetime cannot be ruled out (even though there is no proven evidence as of now). We also know that speech is the miracle brought about by the various oro-pharyngeal tissues modulating the laryngeal jet of air and therefore contributory role of these tissues to good voice cannot be ignored. As of now the operation is beneficial when done for few specific indications, namely, repeated attacks of tonsillitis (The American Academy of Otolaryngology defines repeated infections in children as seven episodes in one year, or five episodes in each of two years, or three episodes in each of three years) and evidence of chronic infection (unresponsive even after the bugs are identified and treated with a full course of medication ). A certain bacteria called “streptococcus” if housed long enough in this tissue may affect many organs of the body and sometimes the ENT surgeon might consider removing the tonsils. Bleeding and malignancy can occur in the tonsils even in adults necessitating tonsillectomy. Please remember that the surgery is never done during active infection and is not an emergency. Complications are not threatening except for bleeding. However it should be emphasised that having the tonsil removed doesn’t mean that you will never get a sore throat again! With adenoids the situation is knotty. Swollen adenoids are quite annoying as they cause mouth breathing (leading to foul breath), nasal congestion (affecting speech) and snoring, can be severe enough to stop spontaneous breathing (called obstructive sleep apnoea) as well as recurrent ear and sinus infections. More serious long-term effects, typically secondary to obstructive sleep apnoea, include behavioural and learning difficulties, poor attention span, hyperactivity, and very rarely, a drop in a child’s intelligence quotient. In later years, there can elevated blood pressure and heart problems. It also contributes to stunted growth. Therefore with considerably swollen adenoids, an adenoidectomy (with tonsillectomy in cases of coexisting tonsillar hypertrophy) is the typical management strategy for patients. However, potential complications (bleeding, damage to bones of the face and neck although rare) and the absence of a complete resolution of symptoms have prompted the investigation of nonsurgical alternatives especially in children. Researchers have established the evidence of a pathophysiologic link between swollen adenoids and allergy. This has led to the widespread use of nasal sprays containing medications that reduce inflammation (called corticosteroids) in the management of this ailment. Administering them directly through the nose reduces the possibility of damage to other tissues and has no harmful long term effects. It also pays to address the allergic tendency. I hope this post helps to comprehend the problem to some extent and those of you who are dealing with it, I hope it helps you to decide conclusively on a satisfactory course of action from those that your doctor suggests.

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Fighting the Flu through Vaccination – Dr. Krishna Mahathi

“When we think of the major threats to our national security, the first to come to mind are nuclear proliferation, rogue states and global terrorism. But another kind of threat lurks beyond our shores, one from nature, not humans – an avian flu pandemic.” – Barack Obama, June 2005 I remain a proponent of vaccination irrespective of the controversies that keep coming up. I think anybody who has seen a child with a tetanus infection will be. India continues to have killer infectious diseases and though I admit that there is a need for the health ministry to delve into the storage and administration of vaccines with a little more vigilance I cannot agree with withholding any of the mandatory vaccines. The Indian Academy of Paediatrics makes recommendations only after a review of current published literature on various parameters that include need for the vaccine, its efficacy and safety. Having said that I do acknowledge that there are contentious issues involved – we cannot inject a plethora of microorganisms and chemicals into the bodies of our young children without considering the strain on their immune systems. Therefore, while certain vaccines are imperative, others can be administered as per the physician’s recommendation. The vaccination for influenza falls into the second category. Flu is a seasonal occurrence and yet pandemics occur because a virus emerges and starts spreading easily because we have no preexisting immunity. This is one characteristic of the flu virus, which mutates rapidly into new forms. So we have H1N1, H3N2 and so on. Sometimes two flu viruses can attack the same animal and their proteins get mixed up and re-assorted to form new forms. That is why we can never predict what the next pandemic will bring forth-a benign selection or a lethal one. Once a fully contagious virus emerges, its global spread is inevitable. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but they cannot stop it.

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A flu vaccine takes two weeks to produce an effective protective response in the body. Protection decreases by about 50% over the next six months (the decrease is less for older adults), and remains stable for two to three years. Antibodies made by the immune system in response to vaccination with one strain of influenza viruses can provide protection against different, but related strains. But eradicating flu altogether is not possible. Serious side effects with modern vaccines are extremely unusual. Some people experience a slight soreness at the point of injection, which resolves within a day or two. People who have never been exposed to influenza, particularly children, may experience one to two days of a slight fever, tiredness, and muscle pain.

What does this mean in terms of choice?

Vaccinations will not protect against all forms of the flu unless the same viruses that are contained in the vaccine infect the child. Considering the nature of the flu virus, this is not likely to happen. Since we do not know which virus will attack next we cannot be complacent thinking that since we have been exposed to milder attacks we are protected from danger. Other precautions cannot be sidelined during the episodes just because a child has been vaccinated. But vaccination can offer some protection from the flu becoming life threatening and from being prolonged. There are certain vulnerable groups in whom influenza has a propensity to become lethal. Annual vaccination is compulsory for them, so that even if they are infected, the infection will not become lifethreatening. This group includes: •• Children under age two (but not under six months of age where the immune system is unlikely to produce a sufficient response by itself) •• All people 65 years and older •• Residents of nursing homes and chronic-care facilities (regardless of age) •• Adults and children who have chronic heart or lung problems, such as asthma, heart malformations •• Adults and children who have chronic metabolic diseases, such as diabetes and obese children •• Children and teenagers who are on long-term aspirin therapy •• Children with blood related disorders •• Pregnant women who will be in their second or third trimester during flu season or women who are nursing •• Anyone who is immunocompromised (HIV-infected persons, cancer patients, organ transplant recipients) •• Anyone in contact with the above groups, such as teachers, care givers, healthcare personnel, and family members •• Travellers to foreign countries For the others, it is a question of choice based on finance and the surrounding environment. Anyone wanting to forego the discomfort and inconvenience of an influenza attack may receive the vaccine by choice. Simply put, you lose nothing by vaccinating your child but you cannot expect complete protection from influenza. I haven’t vaccinated my ten-month-old with a flu shot yet but she will get one before she enrols in her playgroup.

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Decoding the Doctor’s Prescription - Dr. Krishna Mahathi

My mother pasted this poem on my cupboard the day I enrolled into medical college: “Celebrated authors across the land Wield the pen like a magic wand But the words of greatest admiration Are written by the hands writing a prescription” I often look at it with a sigh and complain that medicine is a profession everybody practises and that there are a host of non-medical specialists who confidently volunteer to give their opinion. Initially I was intrigued as to why I received calls from parents asking if I was sure that they should give their child the medicine the way I have prescribed it. Friends call to double check on their pediatrician’s prescription. I now realise that parents behave in this way because children are so vulnerable to the effects of a medication error. Furthermore, children may not be able to recognize and communicate the initial signs and symptoms of a medication adverse effect. After I received my degree, I pasted this alongside my mother’s words: God and the Doctor they alike adore But only when in danger, not before; The danger o’er, both are alike requited, God is forgotten, and the Doctor slighted. I want to use this opportunity to explain what goes on in a good pediatrician’s mind while he prescribes – it is not an effortless process that is not thought through! First, we prescribe a specific dose depending on the weight of the child. It is therefore possible for two kids of the same age to get slightly different doses. Drug dosage depends also on the formulation.

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For example, let us consider Paracetamol given for fever .Paracetamol drops come in a composition of 100mg per ml, a syrup of 125 mg per 5 ml, a double strength of 250 mg per 5ml and a tablet of 500 mg. So if a child of ten kilos needs a 10mg/kg dose of paracetamol she can be prescribed one ml of drops (or 12 drops), 5ml of syrup, 2.5 ml of a double strength syrup or one fourth of a tablet. It is always important to read the labels right (and be good at mathematics!). Secondly, every drug is metabolized (broken down and acted upon by enzymes) by the body to an “active ingredient” .Effects of the drug become apparent when a certain amount of the active ingredient accumulates in the blood. This amount has a specific range which in medical terms is called “the therapeutic window”. An excess diverts the ingredient to be acted upon by several body rescue systems producing unwanted and sometimes toxic products, and a deficiency will produce no benefit. After that the compounds are predominantly cleared away by the liver and kidneys along with all other body waste. That is how a drug’s effect weans off and hence we write a twice or thrice daily schedule aiming to make the active ingredient available for longer periods of time. Paracetamol is extensively metabolized by the liver and it will be almost two hours before the effects are apparent. Over a period of four to six hours the effect wears out. This is why we insist that the drug be given no more than four times a day. There will be no additional benefit and it will become a toxic load for the immature liver to handle. Genetic and environmental factors contribute to a wide inter- and intra-individual variability in drug metabolism. It is well known that smoking, charcoal broiled food or cruciferous vegetables (like broccoli and cabbage) induce the degradation of many drugs , whereas grapefruit juice increases the oral availability of some by inhibiting their elimination. Apiaceous vegetables (carrots, parley, celery, and fennel) lead to lower liver enzyme activity. Energy deficiency, and especially a low intake of protein, will cause a decrease in clearance and elimination of some drugs, which can be accelerated by a protein-rich diet. Tea (normal-strength black and green tea) ups liver enzymes degrading certain drugs. Protein deficiency is associated with greater vulnerability to toxic reaction of drugs, thanks to impaired detoxifying capacities. Body reserves of antioxidants such as vitamins A and E, beta-carotene and zinc which are protective also effect drug metabolism. So you need to be well nourished for your medicines to help you too. Drug and drug interactions can involve prescription or nonprescription drugs and affect each other’s efficacy. Types of drug-drug interactions include duplication (where both their effects are amplified), opposition (antagonism where one makes the other ineffective), and alteration of what the body does to one or both drugs, since most drugs are broken down and inactivated (metabolized) by certain enzymes in the liver. Some drugs affect these liver enzymes, either increasing or decreasing their activity, and may cause another drug to be inactivated more quickly or more slowly than usual. So please check with your physician before taking any new medicine. In addition, medication administration is typically dependent upon a parent or caregiver. The secret is in believing that the child needs the medicine. A child can sense any doubts in your mind and will resist no matter what you do, unless you sincerely believe you’re doing what is best. Be confident and determined. If you aren’t convinced the medicine is necessary, talk to your doctor first, rather than trying half-heartedly to get it into your child. Give liquid medicine along the side of the mouth, about halfway down. If it goes directly to the center of your child’s palate, it will trigger a gag. Place tablets on the back of the tongue or they will be spit out. Never refer to medicine as candy because you’re setting up a potentially dangerous confusion. Tell it like it is. Don’t punish a child who refuses to take medicine. Just insist and plow ahead. And when the mission has been accomplished, don’t forget the hug and congratulations on a job well done for both of you! As for mom, she has not lost her enthusiasm for her job in spite of two decades of private practice. She holds on to the belief that medicine is an art more than a science and that one must always feel lucky to be chosen by the divine to act as a channel for Him to heal a disease. Like many things we discover to be true years after we ridiculed them, I hope I discover that she is right!

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Why Abhor the Antiobiotic? -

Dr. Krishna Mahathi

“Half knowledge makes issues of non-issues and the converse that is more dangerous.” I write this on behalf of the paediatric or rather medical fraternity because I feel compelled to reason about one frequent accusation made at us. We are often derided and boycotted for prescribing antibiotics. I think the issue is primarily a campaign of ignorance fired by apprehension. In order to analyse the scenario objectively I think it’s important that we learn some of the facts. First of all we need to remember that antibiotics are substances which were initially derived from certain fungi, bacteria, and other organisms, that can destroy or inhibit the growth of other microorganisms predominantly bacteria. Though they are synthetically manufactured now they are still not hazardous chemicals or radiation that can have a permanent effect on the body. The only life threatening event that can happen is an allergic reaction but that rule holds for any medicine and is not specific to antibiotics. I agree with the popular opinion that antibiotics are unnecessary in many cases. Most colds and diarrhoeal episodes are caused by viruses and therefore antibiotics, being drugs used against bacteria and some related microorganisms, do not have additional benefit. These infections are usually mild and self-limiting. But viral infections could lead to situations where the body’s immunity can be compromised making it vulnerable to a harsh attack by multiple pathogens. If the doctor senses such a possibility then he or she will prescribe an antibiotic. I would suggest spending time discussing and learning the nature of the illness and properties of the prescribed drug with your doctor and not blindly refusing it. Parents need not worry about giving a child an antibiotic, it will do its work just like it does in an adult. But dosing should be precise(so please don’t give them half or quarter of the adult dose inadvertently) and the side effects will be a little more difficult to endure because children are more sensitive to discomfort. Antibiotics do not lower immunity, only taking them wrong gives rise to superbugs that will be a big challenge to the body’s resistance. Here are some things to keep in mind if you are considering putting your child on a course of antibiotics:

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Sometimes antibiotics are combined with other medications without informing the treating doctor. Every doctor has enough to update and research in his own chosen field and cannot authentically opine on remedies from alternative streams he doesn’t practice. So think twice before combining medications as drugs modify each other’s metabolism. In the era of complimentary healthcare we are happy to see improvement irrespective of the source but urge you to try remedies backed up with evidence of effectiveness and long term safety on human subjects and not just immediate relief of symptoms. We also see people popping in antibiotics that worked for them sometime in the past without consulting their doctor .While it may be unavoidable in some extreme situations it is prudent however to wait and check with your doctor and report symptoms. There are illnesses that appear benign to begin with but need more care than just antibiotics. Taking medication to bring down the fever, taking a cough syrup and replenishing salt and fluid in diarrhoea are all more important than the antibiotic .Do this first and see your doctor and let him prescribe the antibiotic instead of asking him to make sense of your self-medication. Frequently antibiotics are not given in the dose prescribed. People hesitate to give a whole spoon of medicine to a little child or give two doses of the baby’s medicine to the older child. Doctors constantly practice acceptance of the fact that our prescriptions are edited by several people before they are applied half-heartedly and quickly labelled ineffective. Please remember that antibiotics are prescribed with consideration to several factors like the nature of the pathogen, the organ attacked and the body’s general health. The same antibiotic can be prescribed at double the regular dose in serious infections like meningitis so that the drug reaches the target organ (in this case the brain) in sufficient concentration quickly. The decision to inject the antibiotic is also taken in order to reach the disease site quickly in the appropriate amount. It is necessary to take them at the prescribed intervals so that steady levels are maintained in the target site, so don’t skip doses or postpone them. If a child spits out most of his medication there is no harm in giving it to him again. The costliest mistake while taking antibiotics is discontinuing the drugs as soon as one finds relief without persisting with the whole course. The duration is based on the life cycle of the pathogen (so all the multiplying bacteria are destroyed) and the diseased organ. For example urinary tract infections require longer courses because the bacteria causing them multiply quickly in the affected regions and have a tendency to spread to the kidneys. Exposing the body repetitively to suboptimal doses of antibiotics promotes the growth and spread of organisms that are resistant to them and this is most harmful. When these organisms are transmitted to healthy people there will be no adequate response to recommended drugs and elaborate tests need to be done to choose the suitable antibiotic. We lose out on precious time while the infection spreads drastically. We create a situation that makes effective, economical medications worthless and wonder how well known remedies failed us and how a simple illness could turn so damaging. The side effects of most antibiotics are unavoidable simply because they work and affect normal tissues reasonably. These can be managed by taking supplements and precautions as suggested by your doctor. Antibiotics deserve credit for what they truly are-trenchant, dependable and in some cases lifesaving.

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