KidsDoc Monthly Newsletter from AllForKids

October & November-2009, Vol-1, Issue-21

By Dr. M.Vijayalakshmi M.D(Peds), M.D(USA), FAAP, DAA
Content Sources: Centers for Disease Prevention and Control(CDC), American Academy of Pediatrics


Latest from AllForKids

AllForKids will be conducting a free spirometry camp third Saturday of every month, Please call 0484-645 2772 to register.

Annual Influenza Vaccination (Flu Shot) for 2009-10 is now available at AllForKids. Please call ahead for appointments



Reading And Writing

Numerous behaviors are appropriate at certain ages but may cause for concern at later ages. Some of the common behavior problems seen in children between ages 2-4 years are

  1. Breath holding : Breath holding is a way toddlers attempt to control their parents and their environment. Usually the child suffers a fall or has a tantrum which triggers excessive crying followed by a brief period when the child holds his breath and may turn blue and faint or rarely have a seizure. It typically lasts for less than a minute and the child spontaneously recovers.

    These children need to be tested for Iron deficiency that is hemoglobin estimation in the blood. Many of the children respond well to Iron therapy.

    There is no increased risk for epilepsy in later life. Parents are advised to ignore the child whenever possible and without reinforcement it usually disappears.

  2. Temper tantrums: One of the most challenging task as a parent is to deal with a temper tantrum. It is most common between 1 to 3 years of life and most often happens when the child is hungry, tired ,sleepy or sick. The child may scream, kick, roll on the floor and throw things and may hit the parent.

    Parent response to this behavior is very important. Screaming at the child and hitting him will only increase the defiant behavior. Parents need to be calm and either distract the child or walk away and ignore the child for a few minutes.

    Toddlers generally understand more than they can express. As language skills improve, tantrums tend to decrease.

  3. Lying: Lying is often used by 2-4 year olds as a method of playing with language. Children in this age group often don't yet understand that lying is wrong and dishonest. Lying is a form of fantasy and children usually make up stories of certain events. Older children lie to cover up something they did wrong and o avoid getting punished.

    It is important to tell the child from an early age that telling the truth is a good thing and show appreciation when the child is honest. Reading them stories which highlight the importance of honesty is also very helpful.


      These include head banging , body rocking, thumb sucking, nail biting, hair pulling, teeth grinding etc. which are regarded as tension discharging phenomenon.
    • 1.Thumb sucking : It is normal in infancy and toddler years till about 2 to 3 years. Then it becomes a great cause of concern for the parents. It is a form of self soothing behavior.
      The best strategy is to provide praise for alternate behaviors and to ignore it when possible and concentrate on the positive aspects of the child`s behavior.
      The application of bitter solution on the thumb may not deter the child and they soon learn to wash it or wipe it and carry on the thumb sucking. If it persists beyond age 4 the alignment of the teeth may be affected and a dental evaluation is necessary.
    • 2.Nail biting : It is usually seen in preschool children when they are stressed or bored. Many adults are also chronic nail biters. It is a difficult habit to break. In children there is a definite risk of infections and worm infestations. Positive reinforcement may help.
    • 3.Teeth grinding( Bruxism ):It is quite common and can begin in the first 5 years of life. It seems to be associated with daytime anxiety. Most parents wrongly attribute it to worm infestation In most children it disappears after a few years. But it could lead to teeth enamel damage and temporomandibular joint pain(jaw).
      Bedtime should be made relaxing and enjoyable by reading or talking to the child about the events of the day and providing reassurance.

  4. Head banging and Body rocking: It is seen in infancy in some children but can persist in some children who are neglected or have developmental delays. As the child grows older he learns to inhibit some of these movements in social situations. But children with mental retardation may have persistent symptoms.


Many sleep problems in children result from insufficient sleep quantity that is not enough hours of sleep for age or due to poor sleep quality which means that the sleep is disrupted or fragmented.

Both of these can present as excessive daytime sleepiness or decreased alertness. It could also present as mood disturbance, hyperactivity and inattention in class. So it very important to have a good sleep routine.

NIGHT MARES: Usually children between age 4-5 can wake up crying after a bad dream and give an account of the dream. It is more common when the child is hungry, sick or has had a traumatic experience.

NIGHTTERRORS: Most common between age of 4-8 years. Usually the child sits up screaming and crying inconsolably and cannot be woken up. They usually fall asleep after a few minute and do not remember anything the next day. If it is recurring at the same time every day, one of the interventions that work is to wake the child about 15 minutes before the event is expected and then let him go to sleep. Once the sleep cycle is altered the night error does not happen.

It can be very frightening to the parent. Usually it disappears after the age of 8 yrs.


Many bacterial and viral infections in children cause fever with rash. The rash causes the parents to panic but fortunately most of them are transient and resolve in a few days.

Measles: Better vaccination coverage has significantly reduced the incidence of this viral disease but it can still occur in some children as young as 6 months. The symptoms include high fever for 2-3 days, cold ,watery eyes and cough .After 3-5 days a reddish rash appears on the face and quickly spreads to the entire body. Most children recover but some could develop complications like ear infection, diarrhea, pneumonia and encephalitis


Measles vaccine at 9 months and 2 doses of MMR at 15 months and at 4 years of age is very effective for prevention.

Hand Foot and Mouth disease.: It is a viral infection affecting mainly children under 10 years of age. The child has a mild fever, fatigue and sore throat for 2-3 days and the blisters appear inside the mouth and palms and soles. The child may have trouble swallowing. It usually resolves in 1 week and no antibiotics are needed.

There is no vaccine against this virus and hand washing is useful in prevention of spread of the illness

Hand Foot and Mouth disease.

Chicken pox: This viral infection is now seen almost throughout the year. It develops 2-3 weeks after exposure to a person with chicken pox. Initially the child may have fever, headache, stomachache and lack of appetite for 2-3 days and then rashes appear usually on the head, face or chest. The rash becomes a blister in 1-2 days and then starts healing and scab forms. The child may get multiple crops of rashes all over the body for 3-4 days. It may take upto 2 weeks to heal completely.

Chicken pox vaccine is about 95% effective in preventing chicken pox. It is to given after the age of 1 year.


Scarlet fever: This is one of the bacterial infections that causes rash. Scarlet fever is caused by a bacteria called Group A Streptococcus. Usually children have a fever with sore throat or tonsillitis and a few days later develop a red rash starting in the neck and spreading all over the body. The rash feels rough like sandpaper. It can last up to a week and then there can be peeling of the skin especially of hands and feet.

Scarlet fever needs to be appropriately treated with antibiotics to prevent rheumatic fever which can cause cardiac problems.

Scarlet fever


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