Childhood Illness

Should I have my baby boy immunized against chickenpox? I have heard that sometimes it gives them chickenpox.

The short answer is “Yes you should have him immunized for chickenpox”. Of course it means an extra needle and the very low risk of side-effects that all immunizations have.

Chickenpox (varicella) is one of the most infectious of the infectious diseases with about 90% of household contacts, who have not had chickenpox, catching it if one person in the house develops it. While more than half of cases occur in children under 10-years-of-age, 25% happen in people over 15. Ask anyone who contracted chickenpox when 15 or older and they will tell you that it is a miserable disease with intense itching.

Also 1 in 100 people (adults or children) will develop a secondary pneumonia requiring antibiotics and often hospitalization. Some children develop an involvement of the brain called encephalitis. Overall the complication rate of chickenpox is 5 to 10% and one in 400 children being hospitalized.

What are the risks to the chickenpox immunization? About 10% will develop a fever and half it will be quite high (greater than 38.degrees Celsius or 101.3 degrees Fahrenheit). One in5 children will develop slight swelling, pain or tenderness around the injection site. This clears up without any need for treatment. About a fortnight after the immunization approximately 4% will develop some chickenpox lesions around the injection site and about the same number will develop them somewhere else on the body. However, the number of these lesions is 5 or less. Compare this with more than 300 chickenpox lesions in naturally caught chickenpox and each of those 300 itches!

Both my older brother and sister had escaped chickenpox through primary school. I developed it when I was 9 years-old. Of course they both caught it from me during their summer break. My illness was relatively mild but my brother and sister itched horribly and they were not impressed with their kid brother! My last 2 children also caught it in adolescence, the older one did not sleep for 2 successive nights because of itch and this was despite excellent nursing care from his mother and generous medication from his father.

Eczema atopic & seborrheic dermatitis

My doctor says my 10-week-old son has eczema and prescribed some cream. What is eczema and will he have it all his life?

Eczema means a scaly rash. Most doctors mean “atopic eczema” when they say “eczema”. There are other scaly rashes that are called eczema. A similar rash to atopic eczema that affects babies is seborrheic dermatitis. As both these types of eczema (atopic eczema and seborrheic dermatitis) improve on corticosteroid creams, knowing which form of eczema it is may not seem important. However, the course of these 2 conditions will be very different. Atopic eczema is part of atopy and babies who have it may develop asthma, hayfever and an undue tendency to allergies. Seborrheic dermatitis tends to disappear by 2 years, only to reappear in adolescence as dandruff.

It is important to emphasize that your child may grow out of his eczema and never have any of these other conditions in later life, no matter which of these 2 scaling rashes he has.

Eczema does not produce permanent scarring by itself. It is itchy and if scratched, it may become infected and require antibiotics. If this secondary infection is severe it may cause scarring. Babies with eczema in the nappy region (usually due to seborrheic dermatitis) may have recurrent and very difficult to control nappy rash. This will require antiseptic baths as well as the corticosteroid creams- this needs medical attention and advice.

Gastro-oesophageal reflux in babies

Our 2-month-old baby cries a lot and the doctor has diagnosed reflux and given an antacid. The baby vomits a lot and seems unhappy but is growing satisfactorily. Can you explain reflux to me?

The full name for this condition is Gastro-oesophageal-reflux. Other kinds of reflux can occur elsewhere in the body. I don’t blame your doctor for using the shortened name and I will too for this answer. In this condition stomach contents pass back up (reflux) from the stomach into the gullet (oesophagus).

Such reflux is common in babies as they take a large quantity of fluid for their size. If an adult was to take the same amount of fluid per kilogram body weight, he/she would drink 7 + litres per day.

This huge intake of fluid puts a lot of pressure on the valve-like mechanism that normally stops fluid from passing from the stomach and back into the gullet. Forty percent of babies vomit after feeds because of this reflux and in most cases it does not cause a problem. There are 3 complications of reflux that do cause problems:

The acid made in the stomach may cause irritation to the lower part of the gullet. This is painful and makes the baby irritable. It seems this is what your doctor suspects.

The refluxed stomach contents may come up to the point where the gullet and the windpipe branch of the lower throat. This causes a potential for those contents to be inhaled. The first part of the windpipe has a trapdoor (epiglottis) which closes when we are eating, vomiting or refluxing. If this fails then we can inhale the refluxed material causing chest disease. This is quite rare in normal babies – only 1 in 500 refluxing infants have this complication.

The baby may bring back so much of his/her milk, that not enough is consumed. This would make the baby hungry and demanding. After some time growth would be noted to be inadequate. This complication is extremely rare- in 40 years of paediatric practice, I don’t think I have ever seen it.

Reflux disappears spontaneously as the baby drinks less per kilogram and adopts the upright position. The average age of it stopping is 10 months but there is a wide range of ages at which it stops. Most adults have occasional episode of reflux when we are aware of fluid coming back up into our throats – we just swallow it and do not worry.

Our 6-year-old son has lots of bruises on his arms and legs. He is still active but I am terrified that he has leukaemia. What should I do?

I am not surprised that an active 6-year-old boy is collecting many bruises. Because you are terrified, I suggest you see your local doctor who will do a blood test to exclude it and other possible causes for excessive bruising.

Bruising by itself is not a common way for leukaemia to show up. Other signs of leukaemia are anaemia with paleness and being less active, an unusual number of infections or unusual types of infections such as mouth ulcers, bone pain or tenderness and sometimes lumps may be found in the neck – although there are many other causes for these.

If the bruising is excessive and he is otherwise well, he may have Idiopathic Thrombocytopenic Purpura (or ITP for short). This will show up in the blood test and is treatable.

Even in the unlikely case that it is leukaemia nowadays the most common type can be cured in 80-90% of cases but I doubt that your son has leukaemia

When a child should attend Emergency Room

When is a child sick enough to go to the Emergency Room?

A sick child can be an enormous concern to a parent. The normal young child can have up to 12 colds in a year so what are the signs that should prompt you to go through the unpleasantness of attending an emergency room? In my opinion the main ones are:

Drowsiness

Refusing to drink at all

Vomiting everything

Excessive irritability

Marked pallor

Struggling for breath

I could make a list that would go on and on for instance convulsions or coma but these are so obvious that I have not included them or other signs that would prompt any parent to seek urgent attention.

The child who is active &/or drinking well is unlikely to have a serious illness, whereas the combination of drowsiness, severe irritability when disturbed, absolute refusal to drink (not just less drinking) and vomiting is a particularly worrying one.

The experienced parent is able to recognize the pattern of minor illnesses and give Tylenol for discomfort, keep up the fluids and rest for their child. Unfortunately, when we first have children none of us are experienced and will often consult the doctor with minor ailments but it is the doctor’s job to look after such children as much as the sicker ones.

If a doctor is patronizing or otherwise makes you seem silly he/she probably does not

have children or is stressed by their job or some other factor. If you are worried it is better to put up with such an attitude than to be sorry that you did not see the doctor.

Baby with difficulty in breathing (bronchiolitis)

My 4-month-old niece has just been admitted to hospital with bronchiolitis. She looks very distressed and is struggling to breathe. What is bronchiolitis and can my baby catch it – we visited when my niece had a cold 4 days ago?

Bronchiolitis in babies is a viral infection of the smallest airways in the chest (called bronchioles). It causes at least 1% of children under 2 years of age to be admitted to hospital and is one of the major reasons for the children’s wards of hospitals to be very busy over late autumn and winter. It is most commonly due to an infection by the Respiratory Syncitial Virus (RSV). This virus is highly infectious and can survive outside the human body for eight hours. So, if you touch a surface that has been sneezed or coughed upon you will pick up the virus on your hands. If you then rub your eye or nose you will infect yourself. Except in babies or asthmatics this will only mean an adult or older child will develop a cold or “chest cold” but the carrier of the RSV is a walking time bomb for any baby you handle. This is why hand washing is an obsession for nurses, doctors and other staff who handle children. It also means that it is likely that your baby probably has become infected with RSV but remember every child under 2-years becomes infected with RSV. Only 1-2% have to be admitted with bronchiolitis the other 98-99% just develop a bad cold.

The infection of the bronchioles causes swelling of the lining of these small tubes. This makes it difficult to move air in and out and the baby has to breathe harder and their oxygen levels may fall. As drinking from the breast or bottle is the hardest work a young baby has to do, they may become too tired to take in their daily requirement and many hospitalised bronchiolitics become dehydrated. Fortunately the body’s defence mechanisms against infection mean that on about the 4^th or 5^th day of hospitalisation most babies will start to become better but they may need intense medical/nursing care before this happens.

The hospital management of bronchiolitis is to give oxygen if the oxygen levels in the blood are low and extra fluid by a tube through the nose into the stomach or by a drip into a vein if dehydration is likely or has occurred. One patiently waits for the baby’s defence systems to fight off the infection. Death from bronchiolitis is extremely rare unless a pre-existing heart or lung condition compromises the baby.

Please remember to wash your hands before handling a baby so that you are not responsible for transmitting RSV infection.

Bedwetting in a 6-year-old

How can I stop my son’s bedwetting? He is 6-years-old and wets about 6 nights in 7. His older brother was dry from about 4 years of age but I wet until I was about 10 years and was very embarrassed by it. I want to save my son that embarrassment.

We all wet the bed when we were babies. We first learned to not pass urine (even though our bladders were full) while awake when it was socially inconvenient to do so. Later we learned how to hold on while asleep. The time when a child learns these skills varies from one child to another just as some children will learn to ride a bicycle later than others.

The usual age at which a child is dry both day and night is 4 years but 25% of children are still wetting the bed at 5. Each year about 10% of these children will learn the skill and stop wetting the bed. Late control often runs in families and does not represent disease. There is no association between bed-wetting and general intelligence.

A somewhat more serious situation is the child who has been completely dry for some time then starts to wet again. Such a child should see a doctor to check for illness – the most common being urinary tract infection- or emotional disturbance. The emotional disturbance may appear trivial to an adult e.g. changing school.

As bedwetting is difficulty in acquiring a skill threats, punishments and bribes are doomed to fail. A not-promised reward for a dry night is fine. The parent’s attitude should be matter-of-fact: “Oh, you have wet the bed, just put your sheets in the washing machine.”

When the child is motivated (parental motivation does not count) to stop, the best method is the bedwetting alarm that makes a buzzer sound as soon as the child starts to wet. However, the child must “psyche” up him/herself, so when the buzzer goes they wake up. Hence, the child’s motivation to stop is essential.

There are some drugs that bring temporary control for a sleepover or school camp but these do not cause a permanent cure as the alarm can