school days

Back to school
YOUR HEALTH DR GITA MATHAI

It is that time of year again. Stressed out parents are standing in serpentine queues in front of book, shoe and clothing stores as they attempt to cope financially, emotionally and physically with the dawn of another school year. The transition from “Cartoon Network” holidays to “tuition filled” school days is traumatic. Without adequate and timely preparation, stress levels in parents and children can skyrocket.

There is usually a whole month before a new session starts. So take some steps at least a week before school begins.

Establish a routine. Wake the child up at 6 am and encourage 20 minutes of aerobic physical activity. Running up and down on the road in front of the house will wake up all “sleepy heads”, ensuring that they are “alive and kicking” for the rest of the day. This also sharpens the intellect, improves memory, boosts academic performance, instils discipline and reduces stress.

Unfortunately many schools do not have structured compulsory PT or games periods, especially in the higher “examgoing classes”. Games periods, usually scheduled only twice a week, are often usurped for “annual day” practices or to complete the academic syllabi.

Get the immunisation card verified. Even the most meticulous parent can get caught out with an incomplete immunisation card in these days of “package immunisation deals”. The schedule is complex with combined shots, varying intervals between doses and boosters that finally finish in the 16th year.

Many ailments acquired in school — like jaundice, typhoid, chicken pox, measles, German measles and mumps — are preventable with timely and adequate immunisation. This reduces the number of “lost” school days. Jaundice (hepatitis A and B together) requires five injections. Typhoid boosters have to be given every three years. The newer pneumococcal vaccine protects against pneumonia and repeated ear infections. The meningococcal vaccine prevents a type of brain fever. Influenza vaccine too is available.

Organise teeth, eye and ear checkups. Visual defects and hearing are correctable impediments to academic excellence. It may be a simple blocked ear as a result of wax build up or something more sinister. Poor eyesight, uncorrected with the proper prescription glasses, may result in difficulty in reading alphabets, numbers and copying from the board.

The school bag should be a backpack with padded straps that fit well on both shoulders. The weight of the school bag should not be more than 10 per cent of the total weight of the child. Greater weight alters the centre of gravity, which can cause loss of balance and also result in accidents.

School uniform material should not be of more than 40 per cent polyester (the rest being cotton). This is suitable for our climatic conditions. Undergarments and socks should be made of pure cotton and washed daily. Sweaty socks, “air dried” and worn again, can cause fungal infections of the feet. Shoes should be made out of natural material like leather or cloth. Damaged, torn, worn out, ill-fitting (too large or small) shoes can damage growing feet irreparably.

Transportation to and from school should be safe. Packing 20 or more children into a vehicle (other than a bus) is not a pleasant, safe or advisable way to commute.

Television viewing should be restricted to two to three hours (a movie) on Saturdays. Watching 2-3 hours of cartoons and other mind numbing channels on a daily basis can result in academic underachievement.

These apart, ensure that the child eats a balanced breakfast. Milk (200ml) is not a substitute and should be given after breakfast. If the child refuses to eat, 1 ounce (30gm) of cooked ragi (or finger millet), with milk and sugar added, can be given as a substitute.

A preferably home cooked nutritious snack, like carrot halwa, peanut barfi, kesari, bhajis, samosas and bondas, should be given at “breaks”. Carbohydrate-overloaded, salted, preservative-laden packaged eats or “instant” snacks should be avoided.

Many children attend tuition straight after school. A banana and another snack should be eaten after school is over and before this grind starts. A tired, hungry child will find it difficult to concentrate. Also, a child needs approximately 1.5 litres of water for a school day.

Have realistic expectations from your child. Each child is different, with talents and interests that are individual. There is no point in trying to fit all children (even siblings) into the same common mould. Failure to perceive this causes stress and depression in parents and children alike. Before berating and blaming a child for academic underachievement, reflect and introspect.

Attend all parents-teacher meetings regularly. The regular physical presence of concerned parents prevents bullying, ragging, victimisation and favouritism. Volunteer to help with annual days, plays and sports days. Teachers will remember your actions and your child will benefit.

School days should be remembered as “fun days” and not fear and tension filled “bamboo stick” days!

pandemic

Rest is best

Your Health
DR GITA MATHAI

It is the wrong time of year for “flu” (influenza), but the World Health Organization (WHO) has issued a warning that we are on the verge of a swine flu pandemic. This is serious news indeed because the WHO does not like to cause unnecessary panic. Its gradation of influenza varies from phase 1 where the infection is present and circulating only in animals like birds and pigs, to phase 6, the highest level,where the virus has spread to another geographic region and its transmission is increased and sustained. With the scare posed at phase 5 — where a pandemic is imminent — its fears seem justified as the H1N1 virus that causes swine flu has been identified in Mexico, the US, Canada, the Netherlands, Israel, the UK, Denmark, Germany and Spain.

Influenza pandemics occur with devastating regularity. The first wave of Spanish flu occurred in 1918, affected 50 per cent of the world’s population and killed 50 million people. Asian flu in 1957 killed one million and Hong Kong flu in 1968 another one million. The seasonal flu epidemics kill around half a million people a year. In contrast, only 25 million deaths are attributable to HIV and AIDS worldwide.

Flu starts like a common cold, with symptoms like fatigue, fever, headache, runny nose, watery red eyes and muscle pains that set in one or two days after contact with another infected individual. It spreads from one person to another by direct transmission. As an infected person coughs, sneezes or spits, the virus particles are transmitted in the air. The inhaled droplet particles are 0.5 to 5 µm in diameter. A single particle can cause an infection. Each cough or sneeze expels 40,000 droplets into the environment. These can also get deposited on surfaces, contaminating walls, doors, paper, coins and other surfaces. They can be transmitted through unwashed hands from one person to another. High ambient temperatures and ultraviolet radiation kill the viruses rapidly in 5-15 minutes. However, if the virus is expelled enveloped in mucous discharge, it can survive for up to 48 hours. Crowding, with close contact, lack of ventilation and low temperatures in winter facilitate the spread of influenza.

Flu is usually a mild disease from which patients recover spontaneously. Serious illness, complications like secondary bacterial pneumonia and death can occur in the very young and the elderly (extremes of life), pregnant women, those with HIV or heart disease, and in smokers.

The diagnosis is mainly clinical, based on the characteristic signs and symptoms during an epidemic. Rapid diagnostic tests and viral cultures are available and can confirm the diagnosis with an accuracy of 75-90 per cent.

The virus causing influenza is a RNA virus — a virus that has ribonucleic acid as its genetic material — with five genera (family subdivisions). The commonest disease causing ones belong to A, B and C. They are given names like H1N1, H5N1, depending on the human antibody response. These viruses live in birds and animals like pigs. They can suddenly mutate and become virulent enough to cause disease in humans. Since the human population hasn’t been exposed to this new form of the virus, it doesn’t have any immunity. The disease then spreads rapidly in the susceptible population, causing a pandemic.

Outbreaks of influenza usually occur in winter. Since winter occurs at different times in the northern and southern hemispheres, there are two major epidemics a year. In addition, in the tropics an epidemic also occurs during the rainy season. These are the times when usually there is less sunlight and people tend to crowd together indoors. Air travel among regions and hemispheres has blurred these typical occurrences.

To contain an epidemic

Wash your hands with soap after visiting a sick person. Wash your hands several times a day, especially after handling money.

Clean surfaces like door knobs with a disinfectant.

Use a face mask.

Cover the face while coughing or sneezing.

Avoid spitting.

Immunisation is available against the influenza virus. The WHO tries to predict the strain that is likely to cause an infection that year and passes on this information to the pharmaceutical companies. They then have around six months to develop the vaccine. It is 75 per cent effective in preventing influenza.

In people who develop it after immunisation, the disease is less severe and runs a shorter course with reduced complications. The injectable vaccine is available in India. It is recommended for the young, the elderly, the diabetics and those with heart disease. A nasal spray vaccine is available in other countries.

If you are unfortunate enough to contract flu, stay at home and rest. Recovery will be faster and you will not be spreading the virus to the general public. Take paracetamol for the fever, aches and pains. Generally aspirin and other salicylic acid preparations should be avoided. Though they are generally safe medication, they can cause dreaded complications if given with flu. Specific antiviral medication like oseltamivir (Tamiflu) can be taken under medical supervision for prophylaxis and also to reduce the duration and severity of the illness.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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feeling the pulse

Feel your pulse Your Health DR GITA MATHAI Our heart works to keep us alive. As it beats, pressure waves travel along the blood vessels as a “pulse” which can be felt at the wrist, in the armpit, on either side of the neck, in the thigh, behind the knee and in the foot. The pulse rate is an indication of the heart rate. The wrist is the easiest place to measure the pulse. Place the tips of the index, second, and third fingers on the palm side of the other wrist, below the base of the thumb. Press lightly with the fingers. The pulse can be distinctly felt as a steady beat. The rate is usually counted for 30 seconds, and then the value obtained multiplied is by two. The pulse is expressed as the rate in one minute. The rate varies at the different stages of our life. It is normally: • 100 to 160 in children less than 1 year old, • 70 to 120 in children between 1 and 10 years, • 60 to 100 after that, • 40 to 60 in trained athletes. It can go up to 200 with exercise, anxiety or fear. For running, jogging, swimming and other forms of aerobic exercise to be efficient, the “target heart rate” has to be achieved. This is 60-80 per cent of the predicted maximum heart rate (the highest rate achieved during maximal exercise, and calculated by deducting your age from 220). So if you are 35 years old, your predicted maximum heart rate is 185 and target heart rate is 60-80 per cent of this — 111-148. As athletic conditioning improves, the target heart rate is achieved within a few minutes. Once the exercise is stopped, the rate returns to normal equally fast, usually within two minutes. Newspapers and television all over the world have been publicising the benefits of regular exercise. In spite of knowing that exercise is good for us, 70 per cent of adults over the age of 50 years do not get adequate exercise. To ensure that the exercise is efficient and adequate, the target heart rate should be achieved and maintained for a minimum of 30 minutes for five days a week. (A slow stroll in rubber slippers while gossiping vociferously obviously will not do the trick). Pure yoga, Tai-Chi or other stationary exercises are good for acquiring muscle strength and improving balance and posture. But they have to be combined with active movement for efficient heart protective exercise. Before the discovery of stethoscopes, electrocardiograms and X-rays, physicians had little evidence to go on, except the pulse rate. By feeling the wrist they were able to arrive at a variety of diagnoses. Anxiety and excitement increase the rate, producing a rapid, throbbing pulse. This is the basis on which patients sometimes say, “The doctor felt my pulse and diagnosed pregnancy!” An overactive thyroid gland, anaemia and heart diseases have the same effect. Coffee, tea and many cola drinks, containing caffeine, increase the heart rate if taken in sufficient quantities. The pulse may be slow in well-trained athletes, if the thyroid levels are low, and if there are diseases of the heart, especially heart blocks. Certain medication used to treat high blood pressure also slow the heart rate. A resting pulse rate of more than 76 doubles the risk of heart disease. To lower the rate to desirable levels check with your doctor and then start exercising. If your life has been sedentary, the intensity of exercise should be graded and increased gradually. You should feel a warm glow as you start the exercise and should be able to speak a complete sentence at all times while exercising. It is important to have a five-minute slow walk to “warm up” and a similar one to “cool down” at the end to give the heart time to adjust. This prevents muscle injury as well. Although 30 minutes is the minimum recommended, it does not all have to be done at one stretch. It can be broken up into five or 10-minute slots and done several times a day. The other way to exercise adequately is to buy a pedometer, clip it on and try to complete 10,000 steps a day. As age advances, it becomes important to remain fit and maintain a healthy heart. Studies have shown that fitness levels can be calculated by measuring the pulse rate. Individuals with a low resting pulse rate, rapid acceleration to target levels and quick recovery are likely to live longer and have active and healthy lives. The amount and intensity of the exercise is important. It is, also, never too late to start. At any age from five to 100, it is important to start moving and keep on doing so. Adults who have taken up regular exercise even after the age of 70, have remained independent and mobile, and have reduced their risk of dying before the age of 90 by nearly 30 per cent. DR GITA MATHAI IS A PAEDIATRICIAN WITH A FAMILY PRACTICE AT VELLORE. QUESTIONS ON HEALTH ISSUES MAY BE EMAILED TO HER AT yourhealthgm@yahoo.co.in

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