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| Sunday, 24 July 2005 |
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Health guide
Children with heart defects : Treat them like any other by Dr. D.P. Atukorale
Sucking is difficult for a child who suffers from shortness of breath and he will often tire of it before he is satisfied. Chronic heart failure often leads to loss of appetite. Meals may become less of a problem if they are small and given at shorter intervals and preferably with a spoon as soon as the child is old enough for it. Most children with heart defects can be left outside to sleep in a pram like other children, but they feel too cold or warm sooner than the other children and react by crying. Cyanotic children become more cyanotic when they cry. This does not mean that there is any cause for alarm. The child should be comforted just like other children no more, no less and if possible the reason for the tears should be found and removed. Even perfectly healthy children can get blue lips if they cry violently. These children with pronounced symptoms are usually slender. It may take a longer time for them than normal children to acquire the muscular strength needed for sitting and walking. But there is no reason why their muscles should not be trained through games and exercise along the same lines as ordinary children of their age. Vaccination The ordinary vaccination routine should be followed like in other children. Physical activity As a main rule, children with heart defects may play and exert themselves as much as they can although some may lose their breath and tire themselves sooner than their friends. Cyanotic may become more cyanotic. But these symptoms as such are not signs of danger. Like other children, the young heart patients will feel the need to rest after they have exerted themselves and there is no reason to fear that they put too much of strain on the heart as long as they can rest when they feel like it. The activity of young children consists of many short spurts combined with an equal amount of resting periods to catch their breath. Accordingly their handicap at this point will be less conspicuous than later on. At school age when the combination of athletics, sports and games and ambitions put increasing demands on stamina and performance, their lack of endurance will become more obvious. In athletics or competitive sports, many ten-year-olds will be ready to press themselves to the utmost in order to be "one of the team". This competitiveness particularly as to physical performance plays an important part in the development of the child's self-respect. Exaggerated physical expectations or demands may become the source of many disappointment. Instead of telling the child to resign to his fate, one is well advised to help him find other activities which are better suited for him. Just as is the case in completely healthy children, a certain amount of encouragement should be given to these children with heart defects but there must be a reasonable balance between the expectations and the child's possibility of fulfilling them. It is of course, crucial for the parents that they need not worry every time their child puts himself to the test. In certain exceptional cases participation in sports, particularly competitive sports, is discouraged and this information should be given by the physician and not by the parents. Parents should avoid imposing such limitations just to be on the safe side. Although there is no reason to fear that the children should over tax their strength, it is obvious that seriously handicapped children may need a certain amount of consideration from their surroundings. If the family goes for a walk they must set the pace so that the child can manage without tiring himself/herself out completely. If the heart child cannot walk as far as the other children, he can ride in a cart which is of course, better than being left out at home. `At school, the teachers should be informed if the heart defect means that the child is in any way handicapped. If the child participates in games and athletics, he must be permitted to rest whenever he feels the need. The child should never be made to feel more ill than he actually is. Once he has grown up he can rarely expect special treatment any way. For some children, it may be reasonable to arrange transportation to school and back. A few severely disabled heart children will need tutoring at home. Children with pronounced cyanosis don't tolerate the cold in a place like Nuwara Eliya too well and they may be allowed to stay in the classroom during the interval during cold days. Normally the ordinary infectious children's deceases such as measles or chicken pox do not cause worse trouble than other children. The same goes for ordinary colds that all children suffer from time to time. In case of high fever, the small children should be lightly dressed so that they can get rid of the excess heat. Cyanotic children should be allowed to drink as much as possible, so should all children who have high fever as dehydration may worsen their general condition. If an infectious disease is complicated by pneumonia, a child whose circulatory system functions badly is worse off than other children, it may be necessary to treat these children in hospital. Prevention of endocarditis Endocarditis means an infection inside the heart. Bacteria which have entered the blood may settle on rough surfaces of the heart, for instance on a deformed valve. Here they may grow and eventually force their way into the heart tissue and damage it as well as cause other complications. This type of infection is rare and today it can most often be treated effectually with drugs like parenteral penicillin and other antibiotics, but the treatment is long and may be complicated. If penicillin is given prophylactically in situations when there is a chance that bacteria may enter the blood stream, as in case of dental and ENT surgery, the small risk of acquiring endocarditis can be minimised. Penicillin is not necessary in case of ordinary fillings. Usually prophylactic antibiotic treatment is unnecessary after ordinary heart operations, Endocarditis should be considered in cases of unexplained fever of more than a few days duration and proper investigations such as blood cultures should be carried out before the G.P. starts on antibiotics. You & your baby With Dr.Hemantha Dodampahala, Consultant Gynaecologist and Obstetrician, De Soyza Maternity Hospital Pre-mature or pre-term labour means the delivery of a baby before completion of 37 weeks. Pre-mature delivery is one of the significant contributors towards the neonatal mortality in Sri Lanka due to lack of special care facilities in the state run hospitals. The facilities are only available in tertiary, general and teaching hospitals. No one can point at a particular cause for one to go in for pre-mature labour. There is no definite cause but diseases like uncontrolled diabetes, hypertension, renal and certain chronic medical disorders may give rise to pre-term labour. Sometimes it may be due to infections in the lower genital tract in the vagina, which is called bacterial vaginosis. Trauma may also be another cause. On the other hand it also could be due to increased pressure in the amniotic fluids which can lead to the rupture of the membranes and then subsequent contractions. Futher it can be due to a recurrence during the infection which would lead to the assumption and assume that the same bacteria colony will cause pre-term labour. Separation of placenta and abnormalities in the foetus will also lead to pre-term labour. If a pregnant woman develops contractions before the 36th week and the pain is progressive, dischargeds or pass water, then she may go for pre-term labour. It is advisable to admit her to a hospital where she can be given further care. A tertiary care hospital, equipped with proper neonatal care facilities will be the best choice. The doctor will assess the situation and will predict the delivery. If the neck of the womb is enlarged and the labour pains get severe, then you are likely to have a pre-term labour. But, if the neck is opening and if the contractions are well developed, then there is a chance for supressing the labour. It can be done by giving a tablet or a drip. In the meantime, the patient will be given antibiotics and steroid injections to improve the maturity of the lungs. This injection will also reduce the risk of bleeding in the brain and the guts of the baby. It needs at least 24-hours for this injection to react. With the treatment, the patient will have a safe delivery. Pre-mature babies will have many problems like respiratory distress, as low body weight, low sugar, iron and electrolyte levels. Immature gut can also lead to various problems in the baby's health. These babies are also highly susceptible to develop bleeding inside the brain, which is called 'intra venticular haemorrhage. Remeber, pre-mature babies will take sometime to recover. *** The bedwetting problem Reassuring news for all parents whose young children suffer from enuresis - commonly known as bedwetting By the age of three-and-a-half, 75 per cent of children are dry at night, yet at five years of age about one in seven children still wets the bed. Bedwetting, or enuresis, occurs in both sexes though in school children it is most common in boys. Don't be distressed if your child continues to wet the bed long after he is dry by day. He does not do it because he is naughty, lazy or unintelligenty. He may be a heavy sleeper or his bladder cannot hold a whole night's urine. Even over-enthusiastic early toilet-training, over strict discipline or family friction may cause betwetting. Have as few rules as possible and don't expect too much from the child. Aim to keep a happy, relaxed atmosphere in the home. If your child reverted to bedwetting after the arrival of a new baby, try giving him or her more of your time, attention and affection. Encourage your husband to interest his son or daughter in family's activities. Washing wet clothes is wearying but don't become cross with the child. Avoid asking, "Why can't you keep dry?" or you'll make him or her more tense and prolong the bedwetting. Restrict fluids from tea time but don't forbid them. Offer an orange at bedtime instead of a drink. Encourage a small child to empty his bladder before getting into bed or an older one when he's finished reading in bed. It's worth potting a toddler when you go to bed, though it rarely prevents a wet bed later that night. Try to support, not punish, your child and never ridicule him or discuss the problem in his hearing. It is quite a lot of trouble and needs careful supervision but has a fairly high success rate. - Babycare Guide Holistic healing Dr. Danister's reply to Dr. Pathirathna In the series of self guide on Ayurveda, the main objective is not to teach Ayurveda or its fundamentals to scholars or to train practitioners. Therefore no effort was made to analyse basic principles of Ayurveda in a classical manner and academic way. The key idea behind this self guide is to educate and create awareness among the general public for an informative elaboration about Ayurveda. This is not a place to raise arguments or gear controversies which lead the readers to utter confusion. In medical sciences, sectarian view is an accepted notion and it explicitly demarcates fundamental differences among medical systems. That is why the mutual understanding and meaningful dialogue between systems are needed for better health and quality of life. It is suggested that no medical system is superior than the other, and no system is possible to be interpreted by another. No system is perfect and unique. But Ayurveda has its own features and characteristics. The real fallacy about Ayurveda is found, not in concepts but in practice. There are plenty of quacks practising by the name of Ayurveda and traditional medicine in this country without any basic knowledge or qualifications. General public is ignored about the genuine practitioners of Ayurveda because its cultural identity and reputation. In some, other side of this fallacy is very dangerous. There are practitioners who are qualified in Ayurvedic medicine who attempt illogically and irrationally prescribing Allopathic medicines for their livelihood. That is the real fallacy about Ayurveda. Myths of biomedical notion are invading Ayurveda by the name of scientific clarification. The Ayurvedic terminology is very much difficult to be articulated in terms of modern chemistry or physics. The nature of matter and energy exist in biological intelligence in the human organism, is a holistic theory. It is the vital force subsisting from subatomic level to cosmic level. Of these rational therapy is divided into two; viz. pharmaceutical and surgical. There is no contrary on surgery which is updated and upgraded by the modern medical technology by adding sophisticated features. But Ayurveda is concerned very much about the wholesome efficacy (visshuddha prayoga) without any side or adverse effects. Ayurveda does not recommend unwanted surgeries which causes lifelong ill-effects. Ayurveda does not deny acquiring outside knowledge and practices suited with its principles. It has been growing throughout the history by strengthening and augmenting its base with the help of contemporary sciences in the similar paradigm. It is too stupid to state that somebody must learn those sciences for understanding tridosha. Because during the last 100 years, science has exceptionally changed its body of knowledge and all older theories have become myths and folklore. May be in the future, modern science will be able to create a module for comprehending Ayurveda in terms of advanced chemistry, molecular biology and nuclear physics. Basically nature has its own power of repairing or restoring a disturbed organism. Rishis have instituted a system of Ayurveda on the basis of nature's intelligence captured in the human organism.With all these limitations modern science is a pond of endless searching. But Ayurveda has only three searches. viz. Searching healthy lifestyles for quality of life, wholesome practices for wealth and good conduct for ones next life. |
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In general, infants who suffer from congenital heart diseases should be
treated like healthy infants. Infants who show pronounced symptoms of their
defect will have problems in particular in connection with meals.