The seventh and eighth years
Malingering at School
Common Health Problems
Malingering at School
Just when parents begin to think that their children who have reached the age of seven or eight have settled down to school and are getting used to it there comes a fresh set of problems for parents to contend with. The child feels vexed at the "excessive" homework that it has to do and resents being constantly told to study. Gradually, this may result in the child developing a dislike for school.
It is not advisable for parents to pity their children for the amount of homework they have to do. Children are quick learners and are able to grasp things quicker than adults. For example when a family moves from one state to another it is often the children who are the first to grasp the language of the new state. (By the same reason, they are also the first to forget the language when the family moves again). So if children express a dislike for school it is more likely that he or she dislikes the environment or someone specific in school rather than schoolwork itself. The child with problems in school usually tries to think up ways of avoiding school. Commonly, the child may feign illnesses such as stomach pain, headache or fainting spells. The moment the parent allows the child to absent himself from school for the day, these ailments may disappear. Parents are advised to encourage their children to go to school by pointing out examples of the child's idols who have done well academically. (At this point parents should not talk about cine stars or sportsmen who have hardly been to school.)
In many houses parents admonish their children for continuing to pass urine in the bed even when they are four to five years of age. Further, parents wonder why the child who regularly wets the bed at home is able to control his bladder well when he sleeps away from home. The frequent discussion about his or her bedwetting habit is a source of great embarrassment to the child. Is bedwetting due to a physical defect or it is due to a problem in the mind of the child? Let's try to analyse this problem.
Generally due to the immaturity of the nervous system and the bladder reflexes, until the age of four or five years it may be quite normal for children to wet the bed until this age. Persistence of bed wetting beyond this age needs to be investigated and it may be due to a variety or reasons like
- Small bladder capacity
- Lapsing into spells of deep sleep where the normal signals from the nerves indicating a full bladder & asking us to wake up, do not reach the brain.
- Urinary Tract Disorders
- One explanation for why the child does not wet
the bed when he sleeps away from home is that being unfamiliar
surroundings the child does not lapse into deep sleep.
Here are a few simple remedies, which may help to control bed-wetting:
- When the child expresses a desire to pass urine during the day, ask him to control himself for a while. This will help in increasing the capacity of the bladder.
- Encourage the child to have an early dinner, by say 7.30 p.m.
- Make the night meal as dry a meal as possible. Do not give too many fluids to the child at dinner.
- Give even the glass of milk which the child has before going to bed, before 7.30 p.m.
- Before going to bed, the child must be asked to pass urine and sometimes it can even be asked to strain slightly to empty the bladder fully.
- Never criticize the child in public for
bedwetting. This will almost certainly make matters worse. Instead, on
the nights the child does not wet the bed lavish praise on the child and
even give it small gifts. This form of psychotherapy is often useful.
Common Health Problems
There are a number of myths that surround this deadly disease. Some parents think that if their children are very studious and are straining themselves mentally they are likely to develop brain fever. Some others believe has brain fever if the child's head is warm.
Many parents mistake the symptoms of brain fever and may delay treatment, with disastrous consequences. Many parents think that any fever that lasts for a long time is brain fever. In view of all these myths, it is essential to know the facts about brain fever.
Though children of any age group can be affected, school going children are most commonly afflicted. The most dangerous aspect about the brain fever is the rapid speed with which the child's condition worsens soon after the onset of the disease. High fever, unbearable headache, recurrent vomiting, and loss of consciousness occur in rapid succession in cases with brain fever. Never attempt to give any home remedy if any of the above symptoms are present. Rush the child to the hospital. If you delay the child may lose consciousness and then the chances of recovery are slimmer.
Encephalitis, one form of brain fever, is caused by viruses. In Asia it is caused by the Japanese B Encephalitis virus. The virus is found in the blood stream of pigs and the infection is spread from pigs to man by mosquitoes. Sadly there is still no medicine available to treat viral Encephalitis. Though the treatment is mainly supportive it has been found that early treatment significantly improves prognosis. The patients, for whom treatment is delayed, often end up with long-term sequale on recovery. Even if treatment is on time, as many as 20% of children with Viral Encephalitis end up with impairment of sight, hearing or movement. In many cases, these disabilities may be lifelong.
It is therefore, best to observe precautions and guard against the spread of Encephalitis, rampant in North India and in the rural areas of the South India. This can be done to an extent by controlling the pig population in the area and by tackling the mosquito menace. If the pig population in your area is significant it is advisable to inform the local health authorities. It hardly needs to be stressed that stagnant pools of water, the breeding ground for mosquitoes, will have to be cleared. In addition to pigs, horses, foxes and wolves may also harbour the Encephalitis Virus.
The Appendix is a vestigial organ, which is located in our abdomen, and it is an appendage, which reminds us of the ascent of man. Though it is of limited use, inflammation of the appendix, called appendicitis, can lead to problems. There are two types of appendicitis, the acute type and sub-acute type.
In acute appendicitis the child develops severe pain around the umbilical region which later spreads to right side of the lower abdomen. There is also fever and the child looks acutely ill. If not treated early there is a risk of the appendix rupturing or perforating and this may lead to faecal contamination of the peritoneal cavity in the abdomen resulting in severe shock and even death.
In sub-acute appendicitis, the child develops abdominal pain soon after feeds and sometimes there may be diarrhoea also. The child then remains well for a few days or weeks before another similar bout of abdominal pain occurs. Barium meal studies or an ultrasound scan may have to be conducted to diagnose sub-acute appendicitis. Cases of acute appendicitis require immediate surgical removal of the appendix whereas in the sub-acute variety, surgery may be scheduled at a convenient time.
One cause that has been postulated for appendicitis is the incomplete evacuation of motion. Children should never be told to hurry up while passing motion, for this may deter complete evacuation. The Indian type of toilets is more conducive to complete evacuation than the Western toilets. With the western style closets becoming popular in India, there is a risk of increased incidence of appendicitis.
For decades, Malaria has been a scourge in many parts of the world including India. The disease that is transmitted by the bite of mosquito has reappeared after lying dormant for a while.
The parasite Plasmodium, responsible for causing malaria, exists in four species of mosquitoes. Of the four, two species, Vivax and Falciparum are found in India. The Anopheles mosquito is responsible for spreading malaria. It is notable that Dr. Ronald Ross who identified the link between Anopheles and Malaria worked in the Madras Medical College in Madras. The parasite's lifecycle is in two parts, one part of the lifecycle is in man and another part is within the mosquito.
There is usually a gap of about five to six days following the mosquito bite before the patient develops the symptoms of Malaria. The malarial parasite infects the red blood cells and causes them to rupture. Surprisingly, the process occurs at regular intervals of every two days or so corresponding to the destruction caused by the parasite.
Traditionally, patients with Malaria were treated with Chloroquine but now as the organism has developed resistance to Chloroquine, Quinine Sulphate or Mefloquine are used. The WHO has announced that the Chinese drug Qinghaozu is useful in treating Malaria.
Alternate day high-grade fever, severe chills or rigors and severe headache are the symptoms of Malaria. In children, the headache is more pronounced than the chills and some children may also have diarrhoea. Profuse sweating and enlargement of the spleen are other symptoms of Malaria.
Newborn children can also be affected by Malaria. This disease can even spread from the mother to the child via the placenta.
While eradication of mosquitoes is the best way to prevent Malaria, the most practical solution is to protect ourselves from the mosquitoes by using nets, mats, coils etc.
As a precautionary measure, healthy children who live areas prone to mosquitoes can be given chloroquine tablets once a week. This is quite safe, but chloroquine does have a few side effects like vomiting.
Parents are often in a dilemma as to whether to resort to traditional cures or allopathic remedies when their children develop a pox infection. Fortunately, Small Pox has been eradicated from the world. However, Chicken Pox is still a problem with no effective vaccine having been developed against it.
In Chicken Pox, small blister like lesions appear all over the body, mainly over the chest and the abdomen and these lesions may last for about seven or eight days. Though the blisters heal with scabs these scabs do not result in permanent scarring. There is no specific treatment for Chicken Pox. It usually subsides on its own in about a week.
Measles is another form of the skin rash that accompanies fever that commonly affects children, occasionally leading to severe complications. Children with measles have coughing, sneezing, conjunctivitis, mouth ulcers and fever. It is important to see that children with measles do not develop ear discharge, Pneumonia or skin infections.
Children with measles have to be given frequent baths. In fact even the other members at home should maintain themselves hygienically. . It is important not to give the child a head bath soon after, as there is a risk of inducing convulsion and Pneumonia.
This is a disease, which often leads elders to seek the advice of the potter rather than the doctor. This disease, which primarily affects the children, is of two types.
Herpes Zoster is a type of a Pox, part of the Chicken Pox complex of infections. This affects one segment of the body based on the nerve supply and this segment may either be on face, chest, hip, the back or the hands.
The more common form of skin infection is Impetigo, that appears as blisters over the face, abdomen etc. Patients with Impetigo in addition to having a bath daily should also apply prescribed ointment over the affected areas of skin.
It is a common practice for villagers in India to take patients with herpes to the local potter who applies clay or mud on the affected skin. This is dangerous as the clay or mud applied could introduce infections, even causing deadly diseases like tetanus. So this practice should be avoided.
When pregnant women eat
vibuthi (a type of ash, considered sacred), pickles or sour mangoes it is considered natural. However, when children start eating mud or chalk, it is a cause of worry. If this habit is continued for more than a month, children are said to have PICA. Deficiency of Zinc has been postulated to be the cause for Pica. Children, who consume paints that contain lead, are likely to develop neurological disorders. Those who consume mud also introduce the worms in the mud into their intestine leading to digestive problems. Hair or stones may sometimes be retained in the intestines leading to loss of appetite and severe abdominal pain.
Another reason put forward is the lack of proper emotional bonding between the mother and the child.
Since it is slightly older children who develop pica, parents often are unaware that their children have acquired it. So any child with loss of appetite, frequent fatigue and tiredness should be investigated for Pica.
Zinc and Iron tablets are usually prescribed for patients with Pica. Vegetables like Tomatoes, Carrots and Greens, that contain significant quantities of these minerals are also prescribed. Since, pica is often caused by worms, deworming is beneficial.
Children usually develop fits either due to high fever or infection of the brain. Convulsions may also occur because of imbalances in the body's electrolytes like Sodium, Potassium, Magnesium and Calcium.
High Blood Pressure (often due to renal disease) and lead poisoning can induce convulsions. At times, seizure disorder may run in families.
However, the most common cause of fits in the children is high fever. This condition is termed as ”Simple febrile fits”. Children between six months and three years of age are prone to develop febrile fits. The fits usually occur within 24 hours of onset of the fever. In one bout of fever, the fits occur only once. Febrile fits occur only once or twice in a lifetime. It has been discovered that children who have febrile convulsions tend to be more intelligent than other children of the same age. The priority in such cases must be to prevent the occurrence of high body temperature.
Simple febrile convulsions are not a threat to the life of the child. Usually, one need not fear any permanent neurological disability developing in these children. Sadly though, about one fourth of children with simple febrile convulsions go on to develop Epilepsy in their adult life.