travellers diarrhoea

Travelling? Take precautions for traveller's bug

Unfortunately, 40-60 per cent of travellers are prone to sundry infections

By Dr Gita Mathai

• Published 21.11.18, 1:51 AM
• Updated 21.11.18, 1:51 AM

• 2 mins read
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Viruses from the enterovirus and rotavirus family, bacteria, especially E.coli and protozoa-like giardia can cause traveller's diarrhoeaImage: Wikimedia Commons

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The holiday season has started and elaborate plans are being made for pilgrimages, trips to holiday resorts and visits to exotic locations. Unfortunately, 40-60 per cent of travellers will be exposed to disease-causing “bugs”, which result in sundry infections. Of these, 'traveller's diarrhoea' is the most common and incapacitating. It forces sightseeing and travel to be put on hold, as the search for a toilet becomes a priority.

The diarrhoea usually sets in within two to seven days of travel. It is watery and may be associated with other symptoms like nausea, vomiting, abdominal pain and urgency. The good news is that it is self-limiting. It usually subsides within two or three days with or without treatment. One of the critical features of the traveller’s diarrhoea is that local hosts are immune to it. Their intestines have developed resistance over the years to the offending organism.

Viruses belonging to the enterovirus and rotavirus family, bacteria (especially E.coli) and protozoa-like giardia can all cause traveller's diarrhoea. In 70 per cent of the patients, no one agent has been found to be responsible. There is therefore no universal cause and no common cure.

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Although the disease is self-limiting and usually subsides on its own, it is essential to prevent complications like dehydration. Fluids, such as correctly reconstituted, commercially available packets of ORS (oral rehydration solution), homemade ORS (1 litre of water, 1/2 tsp salt and 6 level tsp of sugar), salted rice gruel, khichdi, bananas, lightly salted buttermilk and lime juice with sugar and salt can be consumed for hydration. Alcoholic drinks and caffeinated, carbonated beverages are not recommended. It is also best to avoid milk. Keep in mind that rehydration will not reduce the frequency or quantity of the stool. It will only prevent complications.

The frequency of diarrhoea can be reduced with anti-motility agents such as loperamide (imodium). More than 4-8 tablets should not be used as it can cause dizziness and bloating. These tablets are not advised for children under six years of age. Antibiotics are not routinely prescribed, as often the diarrhoea is due to viruses or protozoa which do not respond to these medications. Also, inappropriate antibiotic treatment does not reduce the frequency and duration of diarrhoea. It is only likely to produce side effects like monilial overgrowth and resistant organisms. Superinfection with some of these organisms can be life-threatening. If the diarrhoea persists for seven days or more, antibiotics may be required with a medical consultation. A short three-day course is usually sufficient. Taking random antibiotics before travel to prevent diarrhoea will also not work.

If the diarrhoea persists for 10 days or more after travel, it needs to be investigated. If it is associated with belching, bloating and large unformed stools, it may be due to giardia. If there is blood and mucous, organisms like shigella or cryptococcus may be responsible. If the diarrhoea persists a month or more, and no infectious agent can be found, it may be due to a non-infectious cause or a complication that has set in, such as IBS (inflammatory bowel disease) or milk allergy.

Here are precautions you can take to reduce the likelihood of diarrhoea —

• Drink only boiling hot tea or coffee. Avoid juice as ice used in it may not be sterile.
• Drink bottled water or water that has been boiled for three minutes. Even teeth have to be brushed with bottled water in some countries.
• Avoid cut fruits and vegetables such as in salads.
• Some diarrhoeas due to rotavirus, cholera and typhoid can be avoided with timely immunisation.

bringing up a child

https://www.telegraphindia.com/health/why-discipline-is-important-for-your-child/cid/1674194?ref=health_health-page

Why discipline is important for your child

Many parents these days are clueless about how to bring up a child

By Dr Gita Mathai

• Published 6.11.18, 9:43 PM
• Updated 6.11.18, 9:43 PM

• 2 mins read
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Stuffing food down a child’s unwilling throat is a recipe for disasterImage: Wikimedia Commons

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Many parents these days are clueless about how to bring up a child. There is no support from a rambling family — grandparents, widowed aunt, unmarried uncle — and domestic help is not only hard to get but also unreliable. That is a huge problem for working mothers.

Feeding the child — when and how much — usually becomes an area of conflict. Parents often have unrealistic expectations but stuffing food down a child’s unwilling throat is a recipe for disaster. And starting the day with a glass of milk — especially one fortified with protein powder — is not a good idea. It fills the stomach, suppresses appetite and provides a sense of satiety which often stays the whole day, making the child refuse breakfast.

Instead, start the day with exercise. Let the child run on the terrace or in the garden for 20 minutes and then get him or her ready for school. Keep at least 30 minutes in hand for breakfast. Feeding the child because “there is no time” will lead to retching, vomiting and refusal of food. Meals need to be savoured, this takes time. There should be a fixed place for eating — in front of the television, iPad or mobile phone results in mindless eating, obesity and lifestyle diseases in later life.

Regular exercise is a must. Twenty minutes of aerobic activity morning and evening goes a long way towards improving memory, productivity and helping the child fight fatigue. It is a good idea to put the child into structured sports training or martial arts. Such children are less likely to experiment with smoking, drinking and drugs. They are also less likely to be hooked on to the Internet, suffer acute depression or attempt suicide.

There is a lot of misinformation in the media about immunisations. These injections have been developed to protect children from disease. It is necessary to immunise against diphtheria, pertussis, tetanus, polio, H. influenza, pneumococcus, rotavirus, hepatitis B and A, flu (every year), typhoid (every three years), chicken pox, measles, mumps, German measles and HPV (human papillomavirus). Some of these diseases can be fatal or leave the child with lifelong disability. Polio can cause paralysis of limbs, mumps sterility, chicken pox deafness and blindness, hepatitis B permanent liver damage, H. influenza and pneumococcus brain fever and ear impairment.

Children can be demanding, but they lack the maturity to discern between good and bad. Therefore, parents should not always give in to their requests. The approach to a child should be consistent, firm, affectionate and authoritative, not authoritarian. If something is “no” then it should remain so despite temper tantrums, pleading and “recommendations” from grandparents.

We tend to support our children and give them a sense of entitlement to opportunities they do not deserve by bending rules and paying bribes. If parents do not obey rules, they cannot expect their children to do so. (A typical example is the crash helmet rule.) Pushing them into unsuitable professional areas because of parental pressure and bribes results in failure and frustration.

Children who lead a disciplined, orderly life and are allowed to develop their interests are likely to become successful in their endeavours and realise their potential. Children who are trained to be diligent, methodical and have self-control are more likely to grow into happy adults than their careless or undisciplined peers.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in