My ear hurts.....

It can be difficult to tell, but if your child has a cough or runny nose and then suddenly develops a fever for three to five days, it may be caused by an ear infection. Ear infections are among the most common illnesses of early childhood. Three out of four children have had at least one ear infection by age 3, according to the National Institute on Deafness and Other Communication Disorders. Dr KD Gupta, Consultant ENT Surgeon with Sir Gangaram Hospital discloses, “The ear cavity internally opens into the upper part of the mouth cavity - one on each side by a tube like structure. This tube allows ventilation of the ear cavity. In young children the tube is short, wide and straight and this allows easy spread of infection from nose, nasopharynx (upper part of mouth cavity). This is the reason that young children are prone to ear infections.”

However he is quick to mention that children most affected are between 3 to 7 years of age. This is because babies are often fed improperly (whether breast fed or bottle fed). Dr. Gupta even points out, “ During feeding a baby's head should be raised. If babies are fed lying flat, milk regurgitates easily from the mouth into the ear and an infection sets in.”

Symptoms

Ear infections can be hard to detect, especially if your child is too young to say, "My ear hurts." Children with ear infections may:

• Tug or pull at their ears
• Cry more than usual
• Have trouble sleeping
• Fail to respond to sounds
• Be unusually irritable
• Develop a fever
• Develop fluid that drains from the ears
• Have headaches

Treatment options

Your child's treatment decision depends on several factors including:

• Your child's age
• History of previous infections
• Whether your child has any underlying medical problems

Most ear infections safely clear up on their own without any antibiotics.

“By 7-10 years of your baby the Eustachian tube (the tube mentioned earlier) becomes larger, narrower and less straight. Hence there is a less chance of ear infections,” Dr Gupta adds.

Normally, treating the pain, steam inhalation and allowing the body time to heal itself suffice. Curing the infection may need a dose of antibiotics. When giving antibiotics to young kids, follow the dosage, schedule and your doctor’s advice strictly.

Watch out

Dr. K.D. Gupta warns that recurrent infections can impact hearing. He says, “Children with persistent ear infections do run the risk of hearing loss. If a child turns the volume of TV high and does not respond properly are warning signs for parents warranting an evaluation of the ears of the child by an ENT specialist.”

Prevention

• Protect your child from secondhand smoke. Keep your child at bay from smoke. Stay in smoke-free environment.
• Breast-feed your baby for at least six months. Breast milk contains antibodies that offer protection from ear infections.
• Ask your child's doctor about the pneumococcal vaccine (Prevnar). Studies indicate that it slightly reduces the risk of ear infections as well.
• Try to limit the use of any group childcare. Children in childcare settings can easily spread germs to each other.
• Washing your hands often. Hand-washing stops infection from spreading by killing germs.

Fighting tooth and nail

Accidents happen without notice! Same with dental emergencies, but if you are updated on ways to handle an emergency situation, it can spell the difference between a ‘lost’ and reclaimed ‘tooth’.

Handling dental emergencies

1. Broken tooth
Seeing your child with a broken tooth can be a gut-wrenching sight. Keep patience and do the following—

• Carefully rinse the tooth in water. Make sure that you do not touch the root of the tooth with your hands. The root is the portion of the tooth embedded in the gum and not normally seen.
• Attempt to place the tooth back in its socket and secure with a wet wrap. If this is not possible or if you are afraid that your child might swallow the tooth, place it in a glass containing either saliva or milk.
  See your dentist immediately.

2. Chipped tooth
Check to see if your child is experiencing pain or sensitivity in the tooth. If so call your dentist to seek dental treatment immediately. In case your child is fine, contact your dentist to see whether or not your child should be seen. In most cases of chipped teeth, you can simply schedule a future appointment to replace the lost portion of the tooth with a porcelain veneer or with bonding material.

3. Bitten Tongue or Lip
Clean the area gently with a cloth and then apply cold compresses to reduce the swelling. If the bleeding does not stop, go to a hospital emergency room immediately.

4. Objects Caught Between the Teeth
Try to gently remove the object with dental floss and avoid damaging the gums. Do not use a sharp instrument. The best item to use is a plastic toothpick that has an angulated tip. If not successful in removing the object, visit your dentist.

5. Toothache
Rinse your mouth with warm water to clean out the area. Make sure there is no food or any other object lodged around the tooth. Use dental floss to clean the area thoroughly.
Never put aspirin or any other painkiller on the gums or around the painful tooth because it can burn the gums, thus causing more harm than good.

Preventing dental injuries

The best way to prevent a dental emergency is to properly protect your child. Increasingly, dentists are recommending that children engaged in sports wear mouth guards. Once only used in football and ice hockey, mouth guards are now being recommended for other sports as well. Most mouth guards are made of plastic and cover the lower teeth.

Not only do mouth guards protect teeth but they also protect lips, gums, and cheeks. Commonly there are two types of mouth guards:
Another way to reduce the risk of dental injury is to watch out for situations that commonly lead to injury. These are some of the more common:

• Trips and falls - Falling into furniture and down stairs often causes dental injury. This is most likely to occur when children are first learning to stand using furniture to maintain balance. If you have a baby childproof your home before he learns to walk.
• Water fountains - Often kids injure teeth by ramming them into the spout of water fountains as they drink. Sometimes kids behind them accidentally bump into them causing them to injure their teeth.
• Forks and Spoons - Believe it or not, some injuries are self-inflicted when people, not paying attention, crack or chip their teeth with spoons or forks as they eat.
• Bottle Caps - Tell your child to never open a bottle cap by teeth.

If you have young children at home make sure that your dentist has after hours coverage, which means there will be a qualified dentist available to take care of emergencies and keep the phone number handy.

Dr. Ramesh Mathur, Chairman Max International Dental Academy

Living with autism

Two-year-old Minal hardly spoke for her age. She is fond of symmetry, babbles few words, which her mother can comprehend and is a stickler for symmetry. Most of her waking hours are spent in stacking her toys in a specific fashion. When she is not stacking her toys, she is flapping her arms like a bird, and if she hears her name, she avoids eye contact. Minal is autistic.

Autism is greatly misunderstood. “It is a developmental disorder in young children that affects three important aspects--development skills,social skills, communication skills and these children have repetitive or restrictive activities”, says Dr. Raghuram Mallaiah, neonatolgoist at Fortis La Femme hospital, New Delhi. The symptoms of autism are present in the child from birth, but they become apparent between 18 months to 3 years—a time when social development begins to occur and language skills are learnt. “Diagnosing autism is difficult”, mentions Dr. Mallaiah. Not only, is it a complex condition to diagnose, but also there exists low awareness levels on this disorder. A number of children with autism may have normal IQ and the only problem that is apparent is their poor social skills and language development skills or repetitive and obsessive behaviour. Since genetic and blood screening is incapable in divulging autism, investigations by a trained psychologist only could offer clues on it.


Causes
“Autism is multifactorial, but a larger number of evidences have begun to nudge towards the genetic link, as more than one child is born with autism in one family”, informs Dr. Mallaiah. There has been a good deal of debate if autism is linked to MMR vaccine. Dr. Mallaiah says, “ The evidence to support the link is very weak and the most likely explanation was the fact that MMR is given at 15 – 18 months, round about the time when autistic behaviour starts becoming apparent to parents. There have been large studies that have denied these associations. The medical fraternity on the whole would recommend all children to be vaccinated.”

Spectrum
Incidence of autism in developed countries where there is better awareness of the condition is said to be about 1-2/1000 children. These numbers include milder forms of autism too, says Dr. Mallaiah.

Earlier autism was dismissed in India. "From one in 10,000 children ten years ago, the prevalence is 3-4 per 1,000 live births now," says Mythili Chari, Founder-Director of the Institute for Remedial Intervention Service (IRIS) and member of the Expert Committee (Mental Retardation) under the Rehabilitation Council of India. Mythili adds wryly. "Those who dismissed it as a low-incidence disorder are now being forced to sit up and take notice.”

In India concrete steps towards autism happened with the Action of Autism—a society set up by Merry Barua in 1991. Parents can detect traits of autism in their children, if the child shows two or more of the following symptoms, says she.

1. Absence of warm and joyful expression
2. Does not respond to his/her name
3. Refrains from making eye contact
4. Babbles incoherent phrases, has unusual voice quality, tone and pitch.
5. Does not show and tell.
6. Indulges in repetitive behaviour.
7. Has a special fondness for symmetry

“Autism can’t be treated with medicines”, says Mythili. Dr. Malliah agrees, but, behavioural and speech therapy help moderate the severity of symptoms. “Children with autism do not benefit with learning by rote method. They need instructions based on applied behaviour analysis with a strong focus on structured teaching and experiential learning”, says Barua. Caring for a child with autism is resource intensive and often these children need to work upon the skills they possess. “However, these children might need special care and attention through out their lives”, says Dr. Mallaiah.

Societies for autism in New Delhi

Open Door
url: http://www.autism-india.org/afa_opendoor.html

School of Hope
CPWD Complex
Near Chinmay School
Vasant Vihar
New Delhi 110 057
tel: 26143853, 26151572
e-mail:tamana@mantramail.com

Action For Autism
Pocket 7 & 8
Jasola Vihar
New Delhi-110025
Tel: 91-11-65347422
Tel: 91-11-40540991, 40540992
Email: actionforautism@gmail.com
url: http://www.autism-india.org/index.html