In Asia diarrhea and dysentery accounts for 25-50 % of mortality in children between 1 and 5 years. The cause of the diarrhea could be bacterial or viral. Among the viral infections rotavirus is one of the most common infections
Almost every child below the age of 5 years gets the rotavirus infection . This virus has a worldwide prevalence. It is a major cause of vomiting and diarrhea resulting in severe dehydration.
Symptoms: The diarrhea can happen up to 20 times a day and can last for more than a week. The stools can be extremely watery and large. Vomiting can be severe enough to prevent any fluid intake and the child could need hospitalization for intravenous fluid administration.
How does it spread? It spreads by direct or indirect contact with the infected person. Stools can be highly infective. The virus can survive on toys and other hard surfaces and can thus spread by touching these objects. It can be easily acquired in hospitals from other patients.
Treatment: There is no definitive medicine to kill the virus. Treatment is mainly supportive to replace the fluid loss and reduce the vomiting.
Prevention: Hand washing should be practiced religiously by the family members and the child should be excluded from daycare till the diarrhea resolves. Toys and surfaces should be washed with soap and water and 70 % ethanol can be used as a disinfectant to clean the surfaces.
Vaccination : An oral vaccine is available in the market. It contains live attenuated (non disease causing) rotavirus strain . It is administered as a oral solution after the age of 6 weeks . 2-3 doses are recommended depending on the brand of the vaccine. The vaccination should be completed before the age of 6 months. Currently Rotarix and Rotateq are the 2 brands used worldwide and Rotarix is available in India. The vaccine are generally safe with only a few minor side effects reported. The vaccine can be given along with the other vaccines like DPT ,HiB, Hepatitis B and OPV/IPV at the age of 6,10 and 14 weeks.
The B vitamins are 8 distinct vitamins that play a very important role in cell metabolism. They have numbers B1,B2,B3,B5,B6,B7,B9 and B 12.
Function : Each of these play an important role in the function of different systems of the body
B1 or thiamine is important for nerve tissue and cardiac function
B2 or riboflavin is important for keeping the mucus lining of oral cavity and skin healthy
B3 or Niacin is very important for brain function and skin integrity
B5 or Pantothenic acid is needed for skin function
B6 or Pyridoxine is important for bone marrow function
B7 or Biotin is needed for normal growth in children
B 9 or Folic acid is needed for normal function of blood cells and nervous system
B 12 or Cobalamine is needed for bone marrow and nerve cell functioning
B vitamins are mainly obtained from unprocessed foods like grains and lentils. Vegetables like potato, beans,lentils and fruits like banana are also good sources. Liver, tuna, egg and turkey have high concentration of B vitamins especially B12. B12 is not available from any plant products and so some vegetarians can be deficient in this vitamin.
Signs of deficiency
Severe deficiency is not commonly seen in children except in children with chronic intestinal problems or illness like cancers. The signs can be varied depending on which particular vitamin is lacking. Commonly observed signs are cracked lips, raw painful tongue ulcers, skin rashes, diarrhea and anemia on a blood test. Neurological problems like weakness, numbness can also result.
Is B complex supplementation necessary?
The B vitamins are water soluble and excess is usually passed in the urine. So they are not stored in the body (except B12 ) and need to be replenished daily.
A healthy person/child eating a balanced diet with starches, egg/meat /lentils and some veggies and fruits can get the adequate daily requirement and does need supplemental vitamins.
Supplementation can be useful in conditions where extra caloric expenditure is encountered like chronic illness, diarrhea and mal-absorption and pregnancy. Folic acid supplementation is very important in pregnant women in the first trimester.
Developmental Milestones for a baby at one(1 ) year of Age
Here are some other milestones to look for at one year of age:
- Gets to sitting position without assistance
- Crawls forward on belly by pulling with arms and pushing with legs
- Assumes hands-and-knees position
- Creeps on hands and knees supporting trunk on hands and knees
- Gets from sitting to crawling or prone (lying on stomach) position
- Pulls self up to stand
- Walks holding on to furniture
- Stands momentarily without support
- May walk two or three steps without support
Milestones In Hand and Finger Skills
- Uses pincer grasp
- Bangs two cubes together
- Puts objects into container
- Takes objects out of container
- Lets objects go voluntarily
- Pokes with index finger
- Tries to imitate scribbling
- Pays increasing attention to speech
- Responds to simple verbal requests
- Responds to “no”
- Uses simple gestures, such as shaking head for “no”
- Babbles with inflection
- Says “dada” and “mama”
- Uses exclamations, such as “oh-oh!”
- Tries to imitate words
- Explores objects in many different ways (shaking, banging, throwing, dropping)
- Finds hidden objects easily
- Looks at correct picture when the image is named
- Imitates gestures
- Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
Social and Emotional Milestones
- Shy or anxious with strangers
- Cries when mother or father leaves
- Enjoys imitating people in play
- Shows specific preferences for certain people and toys
- Tests parental responses to his actions during feedings (What do you do when he refuses a food?)
- Tests parental responses to his behavior (What do you do if he cries after you leave the room?)
- May be fearful in some situations
- Prefers mother and/or regular caregiver over all others
- Repeats sounds or gestures for attention
- Finger-feeds himself
- Extends arm or leg to help when being dressed
Each baby develops in his own manner, so it’s impossible to tell exactly when your child will perfect a given skill. Although the developmental milestones listed in this book will give you a general idea of the changes you can expect as your child gets older, don’t be alarmed if his development takes a slightly different course. Talk to your pediatrician if your baby displays any of the following signs of possible developmental delay in the eight-to twelve-month age range.
- Does not crawl
- Drags one side of body while crawling (for over one month)
- Cannot stand when supported
- Does not search for objects that are hidden while he watches
- Says no single words
- Does not learn to use gestures, such as waving or shaking head
- Does not point to objects or pictures
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