Learning difficulties in children

by Nilma DOLE

Grade 9 student, Sahan* was a restless boy studying at a leading school in Colombo. He performed poorly in academic studies and was only interested in arts where he was obsessed with scriptwriting for drama productions.

His parents and teachers were very worried and they suspected if the teenager was mentally retarded. That was when Dr. Indika Mudalige of the Sri Lanka College of Psychiatrists was called in to assess Sahan's condition. The doctor conducted a series of theoretical and practical tests to determine not only the student's intelligence but behavioral patterns too.

"After various assessments I deduced that the child was exceptionally brilliant because he scored 130 percent on the IQ test that was given," said the doctor. The only problem was that Sahan didn't seem interested in academic studies and wasn't guided in the right direction except 'forced' to study. "We then gave him counselling and told him that he was exceptionally brilliant and it was then that he was motivated to do studies and he went on to excelling in academia."

According to Dr. Mudalige, there are many reasons for learning difficulties in children. "Sometimes it is hereditary and other times it is due to genetic factors. In more recent times, autism has been known to be linked to environmental pollution," he said.

In addition to this, learning difficulties can account to several factors in the home front too. Often parents try to scold and discipline the child thinking they are behaving badly but it might be a condition so it is best to look at the doctor.

"At an early age, if your child doesn't reciprocate your feelings then it is a cause for concern," stated Dr. Mudalige. For example, if a mother smiles and the child doesn't react to it could be the start of child autism. "Children who play with a certain part of a toy like a spinning top. If you ask them to draw a sketch of a man, they might just draw circles repeatedly," said the doctor.

He said that you needn't reward the child with something as they are excited and happy playing with a trivial toy. "They sometimes don't colour within the line and will use only one colour. Even when playing they might just play with one toy so these are all signs that the child needs help in learning," he said. "At the Mental Health Unit of the Kalubowila Teaching Hospital we work with children having special needs by training their family members and relatives to give them a better home environment including giving exercises so that these children respond," he said.

"For example, mothers are encouraged to blow soap bubbles to attract the attention of the children." The shocking fact is that in Sri Lanka, one in 150 children have some sort of learning disability which encompass dyslexia, autism and ADHD (Attention Deficit Hyperactivity Disorder).

Speaking to the Sunday Observer more about child learning difficulties was Professor in Psychiatry at the Faculty of Medical Sciences, Sri Jayawardenapura University, Prof. Samudra Kathiarachchi said, "Even in normal children (who don't have any conditions), parents try to push them to do academic studies instead of tapping creative talents.

This is upsetting because society has glorified academically-oriented careers instead". She added, "What they don't realise is there is nothing wrong with those who didn't perform academically.

For example, a child might fail at mathematics but they might be a good artist or a versatile writer." She said that it was upsetting to know that children label themselves as a failure in the early stages because they can't achieve their parent's expectations. So children shouldn't be demotivated just because their parents want them to shine academically, they should do what their heart desires and do it passionately.

Learning difficulties tend to occur if the parents neglect or do not know what is wrong with the child shunning it away as bad behavior. "The solution is that they might be slow learners but they'll get there," she said.

As for the future, Prof. Kathiarachchi said that there needs to be more people who can get into occupational therapy to help children with learning difficulties. "We need funds to train more people in occupational therapy and even with the School of Occupational Therapy (part of the Health Ministry) not many are interested in this field and we are still in dire need of trained people." It might not seem like a profitable career but the lives you touch and the children you heal is more than its weight in gold!

* Name changed to protect individual's privacy

Dengue and its implications

by Dr Syamasis Bandyopadhyay

The feared Aedes aegypti's claim to fame is shocking, they torment the lives of nearly two fifth of global population! According to the World Health Organisation, 2.5 billion people are at risk of suffering from dengue fever. Aedes aegypti, by the way, is not a cult or mafia organisation: it is a species of mosquito.

Dengue is a mosquito-borne infection that causes typical flu-like illness. Sometimes it causes potentially lethal complications like Dengue Hemorrhagic Fever (DHF) and dengue shock syndrome. It is commonly seen in tropical and sub tropical countries.

Getting Infected

Dengue is spread when the female Aedes aegypti bites an infected person - and then bites a healthy individual. These mosquitoes are smaller in size and live within 90 mts of human dwelling place so that their food is assured. The Aedes aegypti mosquito can be recognised by white markings on its legs and a marking of the form of a lyre on the thorax.

Complications

Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) are complications of dengue where the platelet or clotting factor of the blood reduces at an alarming level, resulting in bleeding. Along with all the other symptoms of dengue, there occurs bleeding from nose, gums and other openings of the body, and bruising or appearance of bluish red marks as a sign of internal bleeding. As the DHF progresses, the body loses the circulating blood volume and goes into a serious condition called Dengue Shock Syndrome (DSS) where the patient has weak pulse, extreme weakness, altered level of consciousness, bleeding with stool (melena), vomiting, nose bleed, abdominal pain, etc. The risk of DHF and DSS increase with subsequent dengue infections.

Dengue diagnosis

Anyone presenting with the symptoms of high fever, severe joint pains and rash should be screened for dengue. Especially after visiting a dengue infested zone, any fever should raise a high suspicion. Blood works remain the cornerstone for dengue diagnosis. There is a delay in between the infection and development of dengue antibody. So the dengue test done three to four days after manifestation of symptoms yields appropriate result. There may be changes in white cell count as well. Since this is a mosquito-borne infection, malaria should also be ruled out.

Dengue symptoms

1. High fever often shooting up to 104 degrees F and more. 2. Rashes all over the body, mainly the arms. 3. Pain behind the eyes and headache. 4. Severe pain in bones and joints (no wonder dengue is also called break bone fever). 5. Transient flushing pink colour on face. 6. Swelling of glands in the neck and groin.

The fever and other symptoms of dengue rise rapidly, and lasts about four days. Thereafter there is an abrupt drop in temperature and sweating, followed by a period of normal temperature and an apparent feeling of well-being for a day. The temperature shoots up again, and characteristic rash appears. The palms and soles appear bright red and swollen up.

Taking care of dengue

In most cases, uncomplicated cases of dengue can be well-managed at home, provided the treatment is carried under expert medical supervision.

There are no specific vaccines for dengue. It is treated symptomatically. The principal aim is to control the abrupt temperature fluctuation, maintain adequate hydration and provide relief from joint pain and abstinence from exertion.

1. Patients should have plenty of fluids like water, fresh fruit juice, coconut water, light soup, ORS solution, etc. It is better to avoid cola and other fizzy drinks, which may contain harmful chemicals.

2. Since dengue is a viral illness, antibiotics are of no use. But doctors may prescribe it if there are signs of secondary bacterial infection.

3. Paracetamol can be taken to bring down fever and provide relief from debilitating joint pain.

4. Aspirin and non steroidal anti inflammatory medicines like Ibuprofen should not be taken since they increase the risk of bleeding.

5. Patients should be kept within mosquito net to avoid the risk of mosquito bite and spreading of infection.

6. Infants, children, elderly and those with low immunity should stay away from the dengue patient till the infection is cleared.

7. Sufficient rest facilitates rapid recovery.

When to rush to the hospital In case the patient develops any symptom of DHF or DSS, they should be rushed to the hospital. A delay in treatment leads to significant mortality. Once in hospital, immediate fluid replacement will be done to prevent hypovolemic shock (acute condition due to low volume of blood circulating in the body) along with other supportive treatments.

In most cases, patient recovers rapidly once the shock is reversed although they may need a few days of hospitalisation. If platelet count is very low, infusion of platelet is done and in case of severe blood loss, transfusion of whole blood is given. Once at home, the fluid level maintenance and rest is very important.

Can dengue recur?

Yes, with four subtypes of the virus prevalent, dengue can recur and the risk increases for those with weak general health. Balanced nutritious diet, regular exercises to increase stamina and general well-being and steps to avoid infection reduces the chance of recurrence.

Dengue prevention

The key to preventing dengue lies in preventing the breeding of mosquitoes. Aedes aegypti lays eggs in clean, stagnant water. So never allow water to stagnate in and around your house. Unused tyres, construction sites, water tanks, even the household flower vase are favourite breeding ground for these mosquitoes. Make sure the water tank is cleaned at least once in a fortnight; flower vase water is frequently changed. It is wise to keep buckets and other water containers upturned when not in use. Use mosquito nets and repellents. Electronic machines are safer than coils (which may cause respiratory distress). Reduce furniture clutter to minimise the chance of being bitten. Involve your community in the mosquito-eradication drive as well.

The writer is Consultant Internal Medicine &

Rheumatologist

Courtesy: BPositive

The aroma of hair

by Dr Raani Rao

Medical aromatherapy harnesses the therapeutic potential of essential oils to relax, rejuvenate, balance, restore, revitalise and revive the mind, body and spirit. It is a fragrant alchemy and the art of healing the body, by invoking its sense to heal itself through indirect stimulation of the immune system.

Essential oils

Essential oils form the base of the discipline of aromatherapy. These oils are plant essences extracted from flowers, trees, fruits, bark, grasses and seeds. Each essential oil has distinctive therapeutic, psychological and physiological properties which either help prevent illness or are curative in nature. There are many essential oils. Oils that are applied to the skin are believed to be absorbed into the bloodstream. The components of the various oils are believed to aid in a variety of health, beauty and hygiene conditions.

An essential oil is a liquid that is generally distilled (most frequently by steam or water) from the leaves, stems, flowers, bark, roots, or other elements of a plant. Essential oils, contrary to the use of the word 'oil,' are not really oily at all. Most essential oils are clear, but some oils such as patchouli, orange and lemongrass are amber or yellow in colour.

Essential oils are antiseptic, antiviral, anti-inflammatory, antidepressant, analgesic and more. They provide a system of healing, which is not only in total bio-chemical harmony with the body but is also non-invasive. They stimulate the immune system, circulatory system and neurological functions.

How aromatherapy works

Essential oils work their way into the body either through the nose (olfactory membranes) or through the skin. Each fragrance molecule attaches itself to specific receptor cells at the nerve endings. The molecules absorbed, generate electrical impulses that are transmitted to the limbic system of the brain. The limbic system is directly connected to areas in the brain that control vital life signs like heart rate, breathing, blood pressure, memory, stress levels, hormone balance etc. This enables these impulses to be transmitted to the various parts of the body depending on their type and function. This results in profound physiological and psychological effects like mental and physical relaxation. The methods of application of essential oils vary with the kind of ailment, other medicinal intake and the response rate of the patient. Massage, inhalation and ingestion are the modes of application.

Hair care

Healthy hair requires essential nutrients on a daily basis. Keep in mind that unhealthy hair is caused by many factors: heat (irons, blow drying, curlers etc), UV rays (sun, tanning beds etc), mechanical devices (combs, brushes etc), chemicals (hair colour, perms, relaxers, pool chemicals etc), or poor diet.

Use natural hair care products and sulphate free products. Before purchasing any hair product read the ingredients first. Identify those that are harmful and avoid using them. Unfortunately, most commercial products contain substances that cause more harm than good. The continued use of such products will eventually weaken your hair to the point where it will break easily and fall out. If you colour your hair, you might want to consider a natural dye or no-ammonia hair colour.

Essential oils, unlike drugs, are not harmful to the body.

Aromatherapists, along with trichologists (those who help with the hair and scalp), have researched essential oils for their ability to stimulate hair growth in atrophied hair follicles. Hereditary factors do bear a part in the balding pattern but, reducing the ageing factor in the whole body by keeping the cell function healthy and vigorous, can delay the balding process.

Hair management

When towel drying your hair, don't rub it vigorously - blot it instead. This extra care is required as the hair tends to break easily when wet. Never brush your hair when wet. Always use a wide tooth comb to avoid pulling the hair out. If you use a hair dryer, use "thermal protector" to protect against heat. Protect your hair against sun's rays by using a conditioner with U.V. protectors built in. Exercising improves your body's circulation, which in turn improves hair. So work out for healthier hair.

Foods

Foods rich in Essential Fatty Acids help improve the texture of dry and brittle hair. Foods high in B vitamins help hair health and growth; those high in Vitamin C improve circulation to the scalp.

Vitamin E foods increase oxygen uptake and improve circulation, thereby improving hair health and growth. Zinc stimulates hair growth by improving immunity. Carbohydrate and sugar destroy B vitamins and decrease minerals, leading to unhealthy hair. Consult with a qualified dietician to discuss a specific regimen that best fits your needs.

The writer is an Aromatherapist

Courtesy: BPositive