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Parents’ Guide
Tonsil removal for improvement in behaviour of children,Dr Deo Kumar Jha,MD.Pediatrician and Pulmonologist,Delhi-NCR
Sleep disordered breathing(SDB) is a common problem in children.
It has been ignored for years till there has been a facility to diagnose it.
Now,there is a facility for early detection of this common problem by a test called polysomnography.
Enlargement of tonsils and adenoid are the main cause of this disorder in children
The main cause of enlargement of tonsil and adenoids for a prolonged period of time is ALLERGY.
Parents are usually not aware of this problem in their children.
The common symptom is snoring in child with frequent disturbances of sleep.
It is graded by hypoapnea/apnea index(HPI) on polysomnography.
The child gradually develops behavioral changes,attention deficit,cognitive problems,day time sleepiness and later on hypertension.
There are two modes of treatment ,one is watchful observation and second is removal of tonsil.
Study was done on 458 children of the mean age of 6 years.
At the end of 12 months of follow up 394(86%),children were available.
It was observed that there was no significant difference between the two groups for the cognitive function.
There was a significant improvement in day time sleepiness and behavioral problems in the group who underwent adenotonsillectomy(surgical removal of adenoid and tonsil) ,moreover,the quality of life were better in the group who opted for the surgical removal of adenoid and tonsil.
CONCLUSION: In case of mild sleep disorderd breathing ,adenotonsillectomy is not advisable for improvement in attention deficit or cognitive problem.
REFERENCES:
Tonsil, adenoid removal improved sleep quality, some behavioral problems in children with mild sleep apnea. https://www.newswise.com/articles/tonsil-adenoid-removal-improved-sleep-quality-some-behavioral-problems-in-children-with-mild-sleep-apnea. Published Dec. 5, 2023. Accessed Dec. 5, 2023.
Is my child suffering from Asthma,Dr Deo Kumar Jha,MD. Pediatrician and Pulmonologist,Ghaziabad,Noida,Delhi-NCR
Know the fact, directly from expert-Dr.Dev,Child and child chest specialist
Is your child facing repeated episodes of cough-Yes/No
Is the cough more problematic during night-Yes/No
Is the cough more problematic while child is playing-Yes/No
Is the cough more problematic when the child eats or drinks cold items-Yes/No
Is the child facing shortness of breath/difficulty in breathing repeatedly-Yes/No
Is your doctor,preferring to nebulise the child more frequently-Yes/No
Is your child facing more cough and or shortness of breath while season is changing-Yes/No
Is your child having itchy skin rashes any time,in addition to cough and shortness of breath-Yes/No
Is your child having itchy nose,frequent running nose,stuffy nose,nose block more frequently in addition to cough and shortness of breath-Yes/No
Is your child takes more time for the recovery of cough and cold than other children-Yes/No
Is your child having cough and shortness of breath when there is no running nose or sneezing-Yes/No
Is any family member whether he or she lives with the child or does not live with the child ,facing symptoms of any kind of allergy-Yes/No
If the answer of most of the questions are YES, there is maximum probability that, your child is suffering from ASTHMA
Asthma is not a disease to be scared of but should be accepted and then appropriate treatment should be given to the needy child.
Asthma is one of the most common chronic disease of respiratory tract in children.
It affects 10%-30% children worldwide.
It is the most common cause of frequent school absenteeism for children.
It affects mental and physical health of children.
It gives financial burden to the family
After appropriate treatment there is negligible school absenteeism,no challenge to the physical and mental health of child and financial burden to the family is significantly reduced.
Dr Deo Kumar Jha,
MBBS(Gold Medalist)
MD(Pediatrics)
Fellowship in Pediatric Pulmonology,AIIMS,New Delhi
Winter depression in children,Dr Deo Kumar Jha,MD. Pediatrician and Pulmonologist,Ghaziabad,Delhi-NCR
Depression is a state of mind in which the mood of a person is very low and the person is not interested in surrounding and any activities which gives him or her pleasure, to the extent that disturbs his or her normal works.
This is known as affective disorder in Psychiatry or mood disorder.
When it occurs for a particular season in year ,it is referred as to seasonal affective disorder-SAD
This disorder is in increasing trends in last 1-2 decades due to various reasons,in children.
The extreme form of this disorder urges a person to commit suicide.
It should be recognised early and addressed properly to keep the potency of a person at normal level.
It has been observed that ,children are particularly at risk to develop this disorder due to stressful family environment.
Vitamin D deficiency is a contributory factor to develop this disease entity ,
In the last few decades ,in India,children have been observed to be busy in indoor activities and more in screen activities.
On the one hand,this indoor confinement leads to less sun exposure and on the other hand the contents of screen may be depressive
In winter season ,naturally there is less time when there is sunlight, in which children can be exposed while playing.
Adequate vitamin D synthesis in the body occurs when skin is exposed to sunlight.
It has been observed that in winter season ,the level of serotonin is less in the body and melatonin balance is also disturbed.
These lead to increased symptoms of depression.
Sun exposure between 10 am to 3 pm is most effective for vitamin D synthesis from ultraviolet B light
Dr Deo Kumar Jha,
MBBS(Gold Medalist)
MD(Pediatrics)
Fellowship in Pediatric Pulmonology,AIIMS New Delhi
Pediatrician and Pulmonologist,Ghaziabad Delhi-NCR
Facts of inhaler medications-Dr Deo Kumar Jha,MD. Pediatrician and Pulmonologist,Delhi-NCR
Advantages of inhaler medications
ROUTES– This medicine goes through the direct routes ,to a site where its action is required unlike oral medications ,which enters the mouth then goes to stomach,then abosrbed in stomach and enters the blood and the blood takes it to the site where it has to work.So ,any hidrance in the path can lower the amount of drug,whereas in case of inhalational route ,there is little chance of hindrance in delivery of drug.
DOSE– Inhalational medications come in microgram which is invisible to the naked eyes,unlike oral medications, which comes in miligram and in the form of tablets or syrups which anyone can see and the quantitiy is 1000 times more than the inhalational medicines for the same action.
Onset of Action-inhalational medicines starts working within minutes unlike oral medicines which may take an hour to start action
Adverse/Side effects- Since,the quantity of inhalational medicines are very very less and it goes directly to the target site,its adverse effects are almost nil even on long time use
MYTHS- There is a false belief that inhalational medicines cause addiction and patient will always require it and can not remain without it. It is baseless belief as the medicines in inhalational routes are the same as in oral medicines and it is not going to make a patient addicted to it. The need and duration of therapy depends on the severity of the disease
THE DEVICE
1.If spacer with valve is used with or without mask,the drug delivery into the target site is approximately 20% and depostion over the throat is about 10-20%
2. If only MDI is used without spacer the drug delivery is only approximately 10% to the target site and almost 50% gets deposited over the throat
3. In cases of use with nebulizer the drug delivery to the target organ is between 1-5% and 50-60% get deposited over the throat
4. In cases of rotahaler, only 1-5% drugs goes to the target site and almost 60% get deposited over the throat
CONCLUSION– 1.Inhalational medications are better than oral medications for long term use
2. Only MDI should not be used directly.It should always be combined with appropriate spacer/ holding chamber
MMR Immunisation protects child from COVID-19,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR
It has been observed that ,children usually suffer from mild to moderate disease due to SARS CoV 2 infection causing COVID 19,in comparision to adults
Mortality due to COVID 19 in children is less in comparision to adults
Children suffering from COVID 19 require less hospitalisation in comparision to adults
The reason for less severity of this disease in children is not clear
In an observational study done in Delhi,India,researchers included 210 children who were immunised for common childhood diseases and were suffering from SARS CoV2 infection as confirmed by Rapid antigen test and RT-PCR test ,considering the incidence of COVID 19 as 2% in children.Data were collected from Distric Immunisation Officer central district New Delhi regarding immunisation and from CDMO Central district New Delhi regarding various stages of severity of disease in children.Children who received 3 doses of Pentavac containing DPT,HiB,HepB,1 dose of BCG,3 doses of Rotavirus ,3 doses of oral polio,2 doses of fractional injectable polio and 1 dose of MR till the age of 1 year were considered compltely immunised.
It has been observed that ,children who received MR/MMR before 1 year of age had less severity of COVID-19 in comparision to children who did not receive MR/MMR.The similar result was not found in mice study.The reason for less severity of COVID 19 in children immunised for MMR is the component of vaccine virus cross react with SARS CoV2 virus.So antibody against Measles and or Rubella produced after immunisation is also protective against COVID-19.BCG vaccinated children also showed less severity of COVID19 in comparision to non BCG Vaccinated children
Other explanation of less severity of COVID 19 in children is that the children have low immunity so do not react strongly to SARS CoV2 virus
It has been concluded that MMR Vaccination provide neutralising antibody against COVID19 causing SARS CoV2
REFERENCES;
1. Salman S, Salem ML. Routine childhood immunization may
protect against COVID-19. Med Hypoth. 2020;140:
109689.
2. Sidiq KR, Sabir DK, Ali SM, et al. Does early childhood
vaccination protect against COVID-19? Front Mol Biosci.
2020;7:1-6.
3. Gomber S, Arora S, Das S, et al. Immune response to second
dose of MMR vaccine in Indian children. Indian J Med Res.
2011;134:302-6.
Indian Pediatrics,Feb 2022
Air Pollution increases Pneumonia in children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar Ghaziabad
In the period of October-November 2021 ,there is high level of air pollution in Delhi and NCR.
Air pollutants contain particulate matters of different sizes.
Pollutants containing sizes PM2.5 and PM10 are very dangerous.
These pollutants of size pm2.5 and pm10 can enter the respiratory tract of children.
PM 2.5 can easily enter the alveoli and damages it.
High pm2.5 was defined as pm2.5 level more than 10.75 mcg/cubic meter.
In one study published online on 29.10.2021 in Experimental biology and Medicine,out 810 children,220 were included in study and they were divided into two groups,one with high risk group for community acquired pneumonia(126 children) and second group with low risk for community acquired pneumonia(94).Pneumonia was defined by radiographic evidence of opacity consistent with pneumonia.
It was observrd that more cases of pneumonia were diagnosed from the area with high pm2.5 as compared to low pm2.5
The mean level of pm2.5 was 10.75mcg per cubic meter during study period which is lower than the high level set by U.S.Environmental protection agency .
According to the reports by SAFAR(System of air quality forecast and resaearch) Delhi,NCR,the highest level of pollutants including pm2.5,pm10,ovc,so2,co,nitric oxide are being seen in Delhi NCR air between midnight and 10 am in the morning as on 19.11.2021.Air quality index is in very poor category in Delhi,NCR as on 19.11.2021
So, air pollution is a risk factor for pneumonia in children
REFERENCES;1.. Mehta S, Shin H, Burnett R, North T, Cohen AJ. Ambient particulate air
pollution and acute lower respiratory infections: a systematic review
and implications for estimating the global burden of disease. Air Qual
Atmos Health 2013;6:69–83
2. Ostro B, Roth L, Malig B, Marty M. The effects of fine particle components on respiratory hospital admissions in children. Environ Health
Perspect 2009;117:475–80
Cough and cold medicines are killing children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Mohan Nagar,Ghaziabad,Delhi NCR
Cough and cold are the most frequent symptoms seen in children
It has become a trend to keep medicines at home for cough and cold
Many Parents are in habit of giving self medications to their children without any knowledge of dose and frequency of admininstration
Moreover,the dose of medicines keeps on changing in children unlike in adults
Parents are giving cough and cold medications for other purposes also like while air travelling to sedate the baby.
Cough and cold medications containing DIPHENHYDRAMINE ,when given in excessive doses,act as stimulants rather than sedatives.
The preparation containing DIPHENHYDRAMINE has killed many children.
There is evidence that these medications do not lessen the severity or duration of cough and cold.
Maximum deaths have occured in children below 2 years of age
In many homes,children easily access these medicines
THESE MEDICINES SHOULD NEVER BE PRESCRIBED IN CHILDREN BELOW 2 YEARS OF AGE
REFERENCES:Pediatrics: “Pediatric Fatalities Associated With Over-the-Counter Cough and Cold Medications,” “Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications.
Large population of Delhi NCR children have ASTHMA.Dr.Dev,MD,Pediatrician and Pediatric Pulmonologist,Ghaziabad,Delhi NCR
Delhi is among most polluted cities in the world
Air pollution directly affects lung
Lungs of children are most vulnerable as the lungs are growing.
Children breath in more air than adults due to fast respiratory rate as compared to adults
Particulate matters in air particularly PM10 and PM2.5 can enter the airways and PM2.5 can go into alveoli
The level of PM10 and PM2.5 are 15 times higher in Delhi air as compared to set standard by World Health Organisation
The pollutants in air comprise obesogenic compounds responsible for making a child Obese
Obesity is associated with the development of Asthma in children
According to a cross sectional study done in 3 cities in India including the most polluted city Delhi and 2 less polluted cities in South India-Kottayam and Mysore, Published in LUNG INDIA September-October 2021,approximately 30% children in Delhi are suffering from Asthma.
Almost 50% children reported cough and 30% complained of shortness of breath.
Among 4361 children studying in private schools between the ages of 13-14 and 16-17,boys and girls, 3157 successfully completed the ISAAC Questionnaire and performed spirometry.
On the basis of spirometry ,which shows airway obstruction, a diagnostic component of Asthma,almost 30% children were diagnosed as having ASTHMA.
Most of the parents and children are not aware of this disease in children.
They are not easily accepting the diagnosis of ASTHMA in children, but it is a fact and we should do something proactively to control the level of pollution in cities to control the ASTHMA
The study has been published in LUNG INDIA September-October,2021
REFERENCES;. Singh V, Singh S, Biswal A. Exceedances and trends of particulate matter (PM2.5) in five Indian megacities Sci Total Environ. 2021;750:141461
Cited Here | PubMed | CrossRef
2. Central Pollution Control Board, Ministry of Environment, Forest and Climate Change. National Ambient Air Quality Status and Trends. 2019 Available from: https://cpcb.nic.in/upload/NAAQS_2019.pdfLast accessed on 2020 Oct 28
Cited Here
3. The Lancet Planetary Health. . Government indifference over air pollution crisis in Delhi
UPCOMING WAVE OF COVID-19 and Children,Dr.Dev,M.D.,Pediatric Pulmonologist,Ghaziabad,Delhi NCR
The coronavirus disease and or infection has affected all age group of individuals all over the world.
The herd immunity ,means immunity of entire population of an area to fight any disease develops naturally when almost 70% population of that area is infected .
The other way to develop immunity against the disease is,vaccination of the entire population.
It has been in discussion in India for last couple of weeks that,the upcoming wave of COVID-19 will affect only children and there will be large number of deaths among children.
It has been observed till now all over the world that children have been affected lees and mortality has been less as compared to adults.
But fear among parents and among doctors is genuine.
There are two reasons for that.
1. Since the adult population has been widely covered by vaccination,they will either have no disease or less severe disease.Children are left unvaccinated till now ,so the infection will cause various degrees of diseases in children.
2.Although the mortality percentage is less in children as compared to adults,a large population of diseased children will put burden on health care system and as the number of diseased children will be more,there will be less medical care and high mortality
REFERENCES:Interview given by Dr. Bhramar Mukharjee,Professor and chair of biostatistics,Michigan school of Public health,published in TOI,Delhi edition,Friday,25.06.2021