Autism
Autism is a neuro-chemical dysfunction of the brain of unknown cause. It alters the child’s ability to
communicate and socialise. It comes on before the child is 2 ½ years old and may be associated with
learning disability. It may however be difficult to ascertain the child’s intellect because of communication
difficulty. Autistic children are often withdrawn, they need “sameness” and often get very upset when even
small environmental changes are made. They may have problems with language development and in
playing with others.
Boys are affected more than girls and genetics play an important part. In twin
studies, if there is an affected identical twin, then the other twin will have an 80% chance of being affected
and with non-identical twins, this falls to 20%. Brain injury, perhaps occurring during pregnancy has also
been mooted as a possible cause. Relatives of autistic children will often have difficulty processing
language.
There is some evidence that serotonin is found in a higher concentration in children with autism.
It used to be thought that autism was due to poor parenting and although this is not the case, some parents
may show some mildly autistic features.
What to look for:
Symptoms of autism come on before 2 ½ years of age. They tend to be withdrawn, like playing on their
own and experience difficulty when playing with other children. There may have delayed language
development and some may never develop language at all. Eye contact may be poor and they are likely to
have difficulty with games that involve taking turns. They have trouble with pretend and imaginative play.
They may indulge in repetitive movements such as rocking. Over half the children with autism will have some degree of learning disability.
What to do:
A child with symptoms of autism needs to be seen by a Paediatrician who may make a referral to a
Neurologist or Psychiatrist with experience in treating such children. Other conditions mimic autism so
your doctor may well want to do some tests which will include a thorough physical examination, along with
an IQ and hearing test, a brain scan and EEG (an electroencephalogram, a painless recording of the
electrical brain waves). Your doctor may also want to do some blood tests to look for metabolic problems
(problems with the way your child’s body handles nutrients and other body chemicals), a screen for poisons
and also chromosome tests.
If it is confirmed that your child does suffer from autism, there are several types of treatment.
A) Behaviour therapy, where your child is helped to learn new patterns of behaviour when interacting
with others and unlearn unhelpful behaviour patterns.
B) Educational therapy, where a very structured school setting may help your child to communicate
better and to learn social skills.
C) Medical therapy, with various types of medicines, including anti-depressants and haloperidol
which may cause a significant improvement.
Ask to see a paediatrician if:
Your child is withdrawn and is having difficulties communicating with others. If your child has never
learnt to speak or his speech is delayed. If your child has poor eye contact, has difficulty playing
participation games with other children, has problems with sharing and give and take or has problems with
symbolic play.
Friday, 25 November 2011
Monday, 24 October 2011
Croup
Croup
Croup is a virus infection of the voice box (larynx) and windpipe (trachea) and usually affects children up to the age of 5 years. Croup often begins like a normal cold then the child develops a harsh, barking, “croupy” cough - often at night-time. The voice is hoarse and the child may develop a noise when breathing in (stridor). The stridor is due to narrowing of the trachea caused by the virus infection. At first, the stridor may only be noticed when the child is active. Croup may last for 3-4 days.
WHAT TO DO
Paracetamol may be given if the child has a fever. Antibiotics do not help as croup is caused by a virus infection.
A mild attack of croup will often settle by nursing the child in a warm humid room, such as the bathroom, with the hot water taps are on. The child should never be left alone in the bathroom with the hot water taps on.
Humidifiers in the bedroom may help.
Croup will often become worse at night and the child may be more settled if someone stays with them. They may also breathe more easily if they are sitting up or lying against 2-3 pillows for support.
TAKE YOUR CHILD TO A DOCTOR OR HOSPITAL URGENTLY:- IF
Sucking in of the breast bone occurs on breathing in and the child is:
( having to work harder to breathe.
( If stridor develops when the child is at rest.
( If your child looks sick or becomes restless.
Emergency room treatment for croup is nebulised Pulmicort (Budesonide) 2mg.
Monday, 10 October 2011
September 2011 News Letter
Dr Richard Primavesi
117A Harley Street
0207 224 4668
Seasonal flu immunisation
This year’s flu vaccine is identical to last year’s which has been given to millions of children and adults without significant side effects.
I wholeheartedly recommend it for all children over 6 months of age.
If your child had two flu immunisations last year then he only needs one dose this year.
If not then he should have 2 doses separated buy at least four weeks.
- Seasonal flu immunisation appointments available from the first week of October 2011
- I recommend to all children from the age of 6 m and upwards
- Will need 2 doses separated by 2 m if first time
- Can do parents and other members of family at same time
Childhood obesity
Continues to be a much discussed issue
Worries that two much concern by teachers may have led to the increase in the cases of anorexia in preschool children
By direct and indirect (bullying) mechanisms
Many parents are concerned that their child’s picky eating may be an early sign of anorexia nervosa – if they still indulge in junk food then it is not.
Please contact me on 02072244668 or richard@healthychild.co.uk if you have any concerns.
We now have a blog which gives information on recent health updates for children. Please visit the website at:
Friday, 23 September 2011
Travel Immunisations
Hepatitis B
The disease hepatitis B can be contracted from being bitten or scratched at school ( this is why hepatitis B immunisation is given to all children in America at birth and has been for more than 10 years ).It can also be acquired at birth from and infected mother or from breast feeding. There is a 10-20% mortality from acute liver damage and then it can cause liver cancer and progressive liver damage for life .For this reason it is an important cause of death in developing countries.
The immunisation which is very safe and effective is given at time zero, 1 month and at 6 months (it is recommended to children from 1 years old only). A fourth dose is generally given in 5 years.
It can be safely combined with hepatitis A (both are killed, mercury free vaccines) and given using the same time schedule.
Hepatitis A is usually a less serious disease than B rarely causing death but is much more easily caught usually from contaminated water or food.
I have been giving hepatitis B immunisation at my clinic to children now for over 7 years and I now give both as combined hepatitis A and B immunisation particularly if foreign travel is considered.
Hepatitis A
Hepatitis A is spread though contaminated food and water and can cause inflammation of the liver and jaundice. It occurs throughout the world and vaccination is advised when good standards of hygiene cannot be guaranteed. One dose may give protection for one year. To increase the length of protection to at least 10 years, a second dose will be required. It is recommended to children from 1 years old only.
Typhoid Fever
Typhoid fever is also spread through contaminated food and water and can result in severe illness in some individuals. It can occur worldwide and vaccination is recommended for travellers to areas where sanitation and hygiene is very poor. The vaccine can be given from 18 months of age and lasts for 3 years.
Yellow Fever
Yellow fever is spread by mosquitoes. It is a serious, sometimes fatal, illness. It occurs in parts of tropical South America and sub-Saharan Africa . The vaccine can be given from 9 month of age, lasts for 10 years and should be given at least 10 days before travel. Yellow fever vaccination is mandatory for travel to some countries.
You will not be allowed to enter these countries without a valid international certificate of vaccination.(The yellow fever vaccine can only be administered at a registered yellow fever clinic)
Meningococcal meningitis
Meningococcal meningitis is a bacterial infection that is spread by droplets form an infected person’s nose and throat. It occurs most frequently in sub-Saharan Africa and vaccination is particularly recommended for those who are going to live and work for more than 4 weeks. Vaccination against the meningococcal strains A,C,W and Y is mandatory for entry to Saudi Arabia
Rabies
Rabies is fatal disease spread by the saliva of infected animals. It is present in many countries but is as higher risk in some developing countries. If you are travelling in rural areas of high-risk countries away from medical care, then you should consider vaccination before you go and avoid touching any local animals, even if they appear healthy. If you are bitten abroad you should seek medical attention immediately -even if you have been vaccinated. The course consists of 3 injections over 3-4 weeks.
Japanese Encephalitis
Japanese Encephalitis is a life- threatening viral disease which affects the brain. The virus is spread by mosquitoes in South East Asia and the Far East . The risk of infection is greatest during , or just after, the wet season. The vaccine is recommended for travellers who will be staying for a month or longer, especially if travel will include rural areas. Vaccination can be given from one year of age and 2 or 3 doses are given over 2-4 weeks.
Diphtheria/tetanus/Polio
Everyone should have completed a course of the these vaccinations . Ensure that boosters are up-to-date before travelling to certain destinations.
- Polio: for travel to areas where polio still occurs such as Africa and
- Diphtheria: for travel to developing countries or Eastern European destinations.
- Tetanus: for travellers to remote locations or locations without access to good medical care
Tick –Borne Encephalitis
Tick –Borne encephalitis is a viral infection spread by ticks and occurs in the summer months in forested areas of central of eastern Europe and Scandinavia . Vaccination is recommended for those who will spend prolonged periods in infected areas or those who will be camping or working in forest during the summer months.
Malaria Prevention
Malaria is a serious disease that is transmitted by mosquito bites. It can occur in many tropical destinations. There is no vaccination available, so prevention consists of a combination of preventive medication and avoidance of mosquito bites.
Avoid being bitten by insects wherever possible; use insect repellents, wear light, loose clothing and sleep under a mosquito net if your accommodation is not air-conditioned. Seek advice on the most appropriate anti-malarial medication to suit your needs from your doctor.
Remember that anyone who has visited a Malarious country should mention this to their doctor if they develop a high fever up to two years after travelling.
How to take Malarone paediatric tablets:
In order to prevent malaria, it is important that the child starts taking Malarone paediatric tablets 1 or 2 days before travelling to a country or countries where there is a risk of catching malaria through being bitten by infected mosquitoes. Malarone Paediatric tablets should be taken each day while in these countries and for 7 days after returning home. If the trip will include visits to some areas or countries where malaria is a problem and also to some where it is not a problem, it is important to continue to take malarone paediatric until 7 days after leaving the last area or country where malaria can be caught.
Usually, malarone paediatric tablets should not be taken for more than 28 days.
| Weight (kg) | Number of Malarone Paediatric tablets |
| 11-20 21-30 31-40 | 1 Malarone Paediatric tablet daily 2 Malarone paediatric tablets as a single dose dialy 3 Malarone paediatric tablets as a single dose daily |
Bed-wetting
Bedwetting (Nocturnal Enuereis)
Bedwetting, also called nocturnal enuresis, occurs when a child accidentally passes urine at night during sleep, after the age that he would be expected to be dry. It is not something that the child does on purpose. Doctors often separate bedwetting into two types, primary enuresis and secondary enuresis. In primary enuresis, the child has never been dry at night. In secondary enuresis, the child was dry at night for one year but has suddenly and unexpectedly started to wet the bed again. In general, boys are about three times more likely to have problems with bedwetting than girls and the problem tends to run in families.
Primary enuresis (never being dry) is probably caused by some delay in a child’s development, since the percentage of children with this type of bedwetting decreases with age. At age 5, the % for males is 7% and for females 3%; at age 10 the % for males is 3% and 2% for females. One % of males at 18 is still enuretic. Persistent bedwetting may be the result of inadequate and inappropriate toilet training. Psychological factors may play a part, especially if the child spent his toddler years living through times of unusual stress. Children of immigrants, children who live in overcrowded conditions and those who come from families with psychiatric illness are all at risk from primary enuresis. Some experts believe that primary enuresis is related to a slower development of nerves and brain centre that allow a child to control urination. Others believe that the child’s bladder may be smaller than normal for size. Still others blame a reversed pattern of urine production, so the child’s body makes more urine at night than during the day.
In secondary enuresis (bedwetting after being dry), stress is often to blame, although it is important to exclude a urinary tract infection. Usually the child begins bedwetting when a sudden change occurs in their world. Almost any change in the environment, good or bad, can be a trigger. This includes a new baby, a death in the family, parental or marriage problems, a new home or school. It may be related to sexual abuse.
What to look for
In most children with bedwetting, soaked sheets and wet pyjamas are things that parents will see. Still, it is wise to look for signs of a urinary tract infection. He may urinate more often than normal during the day or complain of an uncomfortable or “burning” feeling when urinating, and the urine may look cloudy or have a very strong smell. Other symptoms include fever, chills and pain in the back or lower abdomen.
 |
What to do
If your child is younger than 6 years old, just give him time. Let him know that about 1 in 5 of his classmates have the same problem and that almost all children outgrow bedwetting before the age of 10. To help your child achieve his first dry night, try these suggestions :-
· Encourage and praise him for dry nights. Never punish, scold or blame.
· Remind your child to urinate before going to bed. If he doesn’t feel the need to urinate, tell him to “try” anyway.
· Limit liquids in the last two hours before bedtime.
· Use real cloth underwear rather than nappies or plastic pants. “Grown-up” or “trainer” pants help remind your child to stay dry.
· To make clean up easier, use plastic sheets or place a large plastic bag under cloth sheets.
If your 6 year old is still bedwetting, you may want to ask your doctor for suggestions. By this age, most children can use an incentive with gold stars or small rewards for each dry night. During the day your child can practice holding his urine for a few extra minutes rather than running to the bathroom right away. He can also try starting and stopping his stream as he urinates, to help strengthen and control muscles around the urethra. By this age, your child can help with a morning clean up after a wet night. This is important as it empowers him.
After age 7, your doctor may recommend a personal enuresis alarm. An alarm uses sounds or vibrations to wake your child if he wets his underwear. It is important that he wakes up completely and quickly as soon as the alarm rings so that a conditioned response develops between having a sensation of urine in the urethra and waking. This will require you to wake him as soon as you hear the alarm. Some doctors prescribe a nasal spray or oral Desmopressin at night, a drug that is similar to the body hormone that switches off urine production.
Call your doctor if
Your child is wetting the bed at night and is age 6 or older, and never had a dry night, or started bedwetting after having many dry nights. Also call your doctor if your child has pain, discomfort or a “burning” feeling when urinating, has urine that is cloudy or smelly, has a fever, chills, pain in the back or abdomen or often runs to the bathroom during the daytime and always seems to be thirsty.
MMR Vaccination
Measles, Mumps and Rubella Immunisation
I believe that MMR (triple dose: PRIORIX GSK) immunisation has a reasonable safety profile from the available evidence at the moment. Two of my three children have been given the MMR immunisation. The Department of Health recommends MMR immunisation. Information can be obtained on their web site at http://www.doh.gov.uk/cmo/cmoh.htm
Some of the concerns about MMR immunisation stem from the research of a group at The Royal Free Hospital led by Dr Andrew Wakefield, who have suggested that both the measles infection and measles vaccination can be associated with an increased risk of Crohn’s disease (an inflammatory disease of the bowel), and that MMR vaccine may be associated with the development of autism (a disorder frequently diagnosed in the 2nd year of life).
MMR was introduced into the UK immunisation programme in 1988, since when around 10 million immunisations have been given to children at the age of 13-15 months as well as at 4 years of age and no obvious statistical relationship between MMR and autism or Crohn’s has been established. This said, I understand as a parent your concerns given the present media attention to MMR and the fact that it may be considered unnatural to get infected with three live, albeit attenuated viruses, all at once.
I believe that giving the measles, mumps and rubella immunisation separately provides an acceptable way of immunising against these three conditions. There is, however, little evidence in the literature that they are safer when given singly. It has been suggested that they are marginally less effective when given singly because the immune response obtained is not so great. However, it is just the sheer volume of the immune response when all are given at the same time which has given cause for concern. The single measles, rubella and mumps immunisations do not have a UK product licence but do in France , France and USA
(Currently the Mumps Vaccine is unavailable. It has been off the market for about 2 years now.)
The other disadvantage of giving the immunisations separately is the time it takes for the full immunisation programme to be completed. I recommend a period of six months between immunisations as by this time the acute antibodies to an infection have fallen back to normal levels. (Dr Andrew Wakefield at The Royal Free Hospital recommends one year. There is some evidence that having the wild measles and mumps within a year of each other in childhood predisposes to Crohn’s disease). These are both empirical times.
My experience with giving the immunisations singly over the past 4 years is that they are at least as effective at inducing protective antibodies as the MMR. Also if I had given as many MMRs as I have given completed single immunisations I would have expected between 6 and 10 children to be admitted to hospital with fever induced fits .So far none have needed admission or had fits, neither have any children had measles, mumps or rubella after or whilst waiting immunisation.
POSSIBLE REACTIONS TO MEASLES, MUMPS AND RUBELLA IMMUNISATIONS
Allergic reactions to the individual components of the measles, mumps and rubella immunisations
After any immunisation one can have an acute allergic reaction to it and so following immunisation I ask you to wait for about 10 minutes (or one hour if there is a suspicion that your child is egg allergic). It is also possible to have an allergic type reaction 24 – 48 hours after the immunisation with swelling at the site, fever and irritability. This should be treated with regular a Calpol
The infective elements of the reaction tend to occur later than this:
Measles
With the measles vaccine there is a 1:10 chance of a modified measles like illness at 5–12 days after immunisation with fever, rash, irritability and diarrhoea. You should treat this with regular Calpol and Nurofen as it is said that 1 in 1000 children will develop a febrile convulsion or fit following the measles (or MMR) immunisation.
With both the measles and rubella components the child may very rarely develop a rash of small bruise-like spots in the six weeks after immunisation.
Mumps
A modified mumps infection following the mumps immunisation is less common than with measles and occurs later, 2–3 weeks after the immunisation, with pain and swelling in the parotid glands (the glands just beneath the ear), fever and irritability. There is generally no rash. Again Calpol or Nurofen should be given regularly.
Rubella
Following the rubella immunisation there is not usually very much in the way of an infective reaction but more often there is a post viral “reactive arthritis” with pain and swelling in the joints which occurs 2–3 weeks after the immunisation.
The strains of the viruses given singly are exactly the same ones as in the MMR so your doctor will have come across the various components to the reactions if your child develops these. However please let me know if you think your child has had any reaction to any of the given vaccines on 02072244668 in hours or on 07765162004 out of hours.
Tuesday, 6 September 2011
Flu Vaccination
Flu Vaccination
Influenza is an illness capable of affecting the entire respiratory tract from the nose and throat down to the bronchial tubes and lungs. It is caused by a group of 3 viruses (influenza A, B or C). Unfortunately these viruses keep changing from year to year, forming new outer coats which our immune system can’t recognize. This means that even if you or your child had influenza in the past, this year’s virus may be different enough to infect either of you again.
Influenza spreads very rapidly by direct contact with nasal mucus from an infected person or by inhaling droplets coughed or sneezed into the air. The virus is fragile and does not survive for long in the air or on surfaces of furniture, kitchen or bathroom facilities. Illness usually begins 1 to 3 days after exposure.
I recommend flu immunization for all children between the ages of six months and sixteen.
I have been offering annual flu immunization to all children that I see in my clinic now for over 5 years.
The reason for this is that the individuals that are particularly at risk from the complications of influenza are the very young and old. In the UK it is offered to the old but not young .In most other developed countries it is offered to both old and young for instance the USA
Children over the age of six months may receive flu vaccine (though from ages 6 to 35 months it is given at a reduced dose).
For children under the age of 13 years, who have not been vaccinated previously, or who have never before been ill with flu, a second dose four weeks later is advised for full protection.
An annual immunization needs to be administered because the types of influenza most likely to cause an out break each year changes and so the vaccine has to be specially prepared every year to combat the most likely influenza types to cause an outbreak. The manufacturers have got better at doing this year on year.
If you would like to make an appointment for your family to be immunized this year then please contact us 0207 224 4668.
Tuesday, 16 August 2011
Healthy Child Clinic
Services We Provide
Code of Practice
Location: The Clinic is located at 117a Harley Street London W1G 6AT 02072244668 info@healthychild.co.uk Nearest tube stations: Regents Park Baker Street Buses: 30,27,18,453 to Harley Street |
Hepatitis B Immunisation
Hepatitis B immunisation
There is a 10-20% mortality from acute liver damage and then it can cause liver cancer and progressive liver damage for life .For this reason it is an important cause of death in developing countries.
The immunisation which is very safe and effective is given at time zero, 1 month and at 6 months. A fourth dose is generally given in 5 years.
It can be safely combined with hepatitis A (both are killed, mercury free vaccines) and given using the same time schedule.
Hepatitis A is usually a less serious disease than B rarely causing death but is much more easily caught usually from contaminated water or food.
I have been giving hepatitis B immunisation at my clinic to children now for over 7 years and I now give both as combined hepatitis A and B immunisation particularly if foreign travel is considered.
Chicken Pox
Chicken Pox
Another immunisation which is given routinely in the
For these reasons I recommend vaccinating against chickenpox after the age of 1 year. Children between 4 and 6 years of age should be given a second dose of the vaccine, as well as any other individual who has previously been given one dose.
It is a live vaccine and it should be separated from any other live vaccine at least 1 month.
The vaccine used is called VARIVAX and is made by Merck Sharp and Dohme. The company licensed to sell VARIVAX in the UK
Possible side effects of VARIVAX:
As with any vaccine, VARIVAX can have side effects.
Very common side effects are pain at the injection site and fever.
Much less commonly (1:100) may develop a chickenpox like illness with spots often appearing around injection site.
Glue Ear
Glue Ear
What happens in glue ear is that enlarged adenoids and excessive secretions at the back of the throat cause blockage of the Eustachian tube. The air in the middle ear then gets absorbed and is replaced with sticky fluid (the glue of glue ear). In this situation the tympanic membrane is retracted and quite often swollen and inflamed. The fluid in the middle ear can act as a culture medium so just one bacterium there will grow rapidly and white cells will come in to attack the bacteria. As the pus builds up the negative pressure then becomes positive and the ear becomes extremely painful. Without antibiotic treatment there may be a tympanic rupture after which the pain is greatly eased.
The sort of symptoms that would make you consider treatment are problems with speech development, problems with hearing, problems with balance, and pain and discomfort in the ear which may lead to behaviour disturbance (this can be difficult to be sure of objectively). The other indication is recurrent ear infections particularly if these lead to perforation.
Initially it may be enough to asses the effect of removing diary products and the use of a homeopathic treatment and Otovent.
Thereafter a a two month course of low dose antibiotic, such as Amoxycillin taken once a day 125 mg orally, and Flixonase taken one snort to each nostril once a day also may be assesed.
If this is unsuccessful then referral may be made to an ENT surgeon for consideration of insertion of grommets and adenoidectomy. Before embarking on treatment however it is important to ascertain whether the glue ear is causing any significant symptoms and to appreciate that although the immediate effect of grommet insertion under GA may be very dramatic there is little difference between treated and non treated ear within 3 months..
When to call us
1 Delayed speech
2 Behaviour disorder – it can be very disorientating to have only partial hearing
3 Balance problems.
4 Recurrent ear infections – especially with tympanic membrane rupture
5 Poor hearing – either noticed at home or on formal hearing testing.
Monday, 18 July 2011
Eczema
Eczema is a skin condition characterised by excessive dryness and itching. The condition often flares-up, resulting in the appearance of red, scaly, bumpy, rough patches on the body. It is common to see eczema in children who have allergies, hay fever, asthma or close family members with eczema. The majority of children will outgrow the condition over time but until they do, their skin will require extra care daily and additional treatment when flare-ups occur.
Caring for a child with eczema
Keep the skin moist : Since the skin of children with eczema is unusually dry, one of the most important things for you to do is to keep the skin well moisturised. This will help to prevent flare-ups of the condition. Twice daily, lotion such as E45, Eucerin, Keri, Nivea or Vaseline, needs to be applied to the skin (even when the rash is not present!). Applying lotion after a bath is helpful. Pat the skin dry, then apply the lotion to the child’s entire body sealing in water the skin absorbed during the bath.
The whole principle of treating eczema is to avoid substances that break down the natural barrier layer - soaps, detergents, shampoos, and use substances that build it up - oils, moisturisers and barrier creams.
Some agents may cause senstitivity, and these should be avoided if possible
· Fabric softners
· Washing Powders – use high temperature wash and long rinse cycle, minimum amounts of non biological detergent
· House dust mite – ensure bedroom as house dust mite free as possible, covers for pillow, duvet and mattress
· Staphlaureus – a bacteria that commonly colonises broken skin.
Tacrolimus (attached to Tacrolimus macrolide web page) 0.03% is a highly effective safe substitute and does not have the skin thinning and potential growth suppression effects of Hydrocortisone. It can safely be used on the face
Bathing : A bath or shower with lukewarm water will soothe the skin. Many soaps irritate the skin of a child with eczema. If you need to use soap to cleanse the skin use minimal amounts and choose one that is super-fatted such a Dove. It may be better to use a bath oil substitute (Oilatium or Balneum) instead of soap.
Itching : Scratching further irritates eczema, causing the rash to become more severe. Also, scratching opens the skin which can make infection more likely to occur. Keep the child’s fingernails cut short. It may be helpful to put cotton mitts or socks on the hands of infants at bedtime to prevent scratching. Almost all children complain about itching more at nighttime, some children will have difficulty sleeping because of itching. Keeping skin moist with lotion will help but there may be times when an antihistamine (anti-itch) medication such as Piriton (Chlorphenamine), is needed to give the child relief. It can be given every six hours to relieve itching.
The most common side effect of Piriton (Chlorphenamine) is drowsiness. If your child seems to be too drowsy while taking the Piriton (Chlorphenamine), then cut back slightly on the dose.
Flare-ups : When the skin develops a rash as described in the first paragraph, consult your doctor. A steroid cream may need to be applied to the rash to reduce inflammation. Hydrocortisone cream 1% is most commonly used and is available without a prescription. Hydrocortisone cream is a steroid cream. This type of medicated cream should be applied to the skin sparingly, it does not need to be lathered on to be effective. In fact, overuse of steroid creams can cause serious problems. The steroid cream is usually applied to the rash twice per day. Do not use a steroid cream for longer than one week on the face or in the genital area, unless directed by your doctor.
Continue to apply the moisturiser (E45, Eucerin etc) to the skin twice daily by alternating it with the steroid cream. If the rash is not improving, contact your doctor to have the child re-evaluated. Stronger steroid creams may need to be prescribed, but it is wise to start with the least potent medication first.
Call your doctor if :
. Signs of skin infection appear: increasing redness, swelling, tenderness, pus
drainage, red streaks on the skin, fever in association with these other signs.
. The rash becomes worse, changes in its appearance or if new symptoms
develop along with the rash.
. If there is no improvement after one week of treatment.
Wednesday, 13 July 2011
Tuberculosis
Tuberculosis
Tuberculosis (TB) is a contagious infection, usually attacking the lungs although it can spread to other body organs (Miliary TB) and is caused by mycobacteria (usually Mycobacterium tuberculosis). Like many other illnesses it is passed from person to person through airborne droplets from coughs, but also in the mucus that the affected person may cough up (this may be bloodstained). Children usually catch TB from another household member. Less often outbreaks can occur in school or nursery.
Tuberculosis is common and a third of the world’s population suffer from it. It has increased significantly in developing countries over the last eight years. Someone with TB may not have any symptoms because the body’s immune defences can wall-off the bacteria. However the bacteria are not completely killed and if anything happens to lower the body’s immune defences such as malnutrition, a severe illness, or a course of oral steroids, then infection can reactivate and TB infection can spread through the body. The lungs are usually affected but in the later stages, bacteria can spread through the blood to the lymph nodes, brain and joints.
What to look for
Although extensive lung infection in TB can occur without any symptoms, of all the age groups, infants are most likely to show signs of illness with difficulty breathing, dry cough, fever, poor appetite and night sweats. There may also be failure to thrive. Older children may wheeze, have an abnormally fast breathing rate, lose weight or feel tired or short of breath.
A child’s TB infection may be first discovered by a skin test (tuberculin, Mantoux, Heaf). Countries such as America where BCG (immunisation against TB) is not performed, then the tuberculin test is done at a month, at 5 and at 14 years of age. If at any time this test is positive, then the child should be assumed to have come in contact with TB and a six month course of anti-tuberculosis therapy should be given.
In countries where the BCG is given routinely, then this should produce a positive skin test (this will usually be 2-4mms). If the skin test is strongly positive causing an area of induration and redness greater than 1cm, then BCG vaccinated children should be considered to have been infected and should receive a course of treatment. At the same time as the course is given, a chest-x ray will be taken to look for evidence of TB. Other family members will also be tested and if found to be positive, will need to be treated with anti-tuberculosis medicine.
Call your doctor if
Any family member has been found to have a positive anti-tuberculin test or diagnosed as having TB. Likewise if your child has wheezing, fever, night sweats, poor appetite or shortness of breath or has, for a long time, felt weak or tired. Likewise if your child is failing to put on weight, this should be another reason to get your child checked over.
Immunisation
Under the age of 3 months the BCG – intradernal injection of live attenuated TB bacteria can be given without skin testing - after 3 months need to do a Mantoux skin test and return after 48 hours.
Subscribe to:
Posts (Atom)