obesity

Keep fat away Your Health DR GITA MATHAI Forty odd years ago, when I started practicing medicine, we seldom checked if people under 45 years of age had elevated blood sugars or an abnormal lipid profile. We made cursory enquiries about “family history of diabetes” and that was it. This was before the era of health insurance and master health check ups. So most people were not even aware whether their family members actually did have diabetes. The processed food industry was also in its infancy, and packaged foods with unhealthily high levels of trans fats, salt, chemicals, fructose and sugar were either not available or prohibitively expensive. Times have changed. We are now a prosperous nation, and most of us consume calories in excess of our physical requirement. We also have a sedentary lifestyle. The emphasis is on long hours of study or work with physical activity an unwelcome intruder. Mechanised transport has replaced walking, and even the bicycle is not as popular as it used to be. Now, many people over 25 are obese. They have a BMI higher than 30 (obese), and definitely above 23 (overweight). Many have deranged lipid profiles. Some have blood sugar values which are in the “higher normal” range. Women are more affected than men by these changes in lifestyle; 60-70 per cent have menstrual irregularities. When they try (often unsuccessfully) to conceive, they are told that they have PCOS (polycystic ovarian syndrome.) All these patients have the cardio-metabolic syndrome, a disorder of energy utilisation and storage. It is diagnosed if at least three out of the following five conditions are present. • Central abdominal obesity is present if the waist:hip ratio > 0.90 (male) or > 0.85 (female). The waist circumference alone can be used and should be less than 94cm or 37in (male), or 80cm or 32in (female). • The blood pressure is 130/90 or more on three or more occasions. • High blood sugar levels, with a fasting blood glucose test result of 100 milligrams per deciliter (mg/dL), or 5.6 millimoles per litre (mmol/L), or more. • High cholesterol, with a level of the blood fat called triglycerides of 150 mg/dL (1.7 mmol/L) or more and the level of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol —less than 40 mg/dL (1.04 mmol/L) for men or less than 50 mg/dL (1.3 mmol/L) for women. • A BMI of 30 or more. • Additional findings which should raise suspicions of metabolic syndrome are fatty liver, gall stones and high CRP (C Reactive Protein). As we age, we are more prone to develop the cardio-metabolic syndrome. Normally, the food we eat is broken down into simple sugars, which are absorbed, utilised for energy or stored in tissues. In order for the glucose to be broken down, adequate amounts of insulin need to be produced by the pancreas. Metabolic syndrome is due to a type of insulin resistance where more and more insulin needs to be produced to keep the sugars under control. This insulin resistance leads to abdominal obesity, high uric acid levels, abnormal lipid profile and eventually (when supply fails to keep pace with demand) frank diabetes. In women it is one of the causes of PCOS. Metabolic syndrome X results in a 20 per cent higher risk for stroke and heart attacks. The risk factors for developing metabolic syndrome should be tackled in childhood. Despite heavy academic schedules, 30 minutes of non-stop active exercise is essential from the age of five. This should be maintained all through life. Keep a watch on the waist circumference, weight and BMI. Losing as little as 15 per cent of the additional body weight can reverse many of the changes responsible for the metabolic syndrome. Eat a sensible high fibre diet, low in fat and processed food with at least 4-6 helpings of fruits and vegetables. Try to use only half litre of oil a month per family member. Avoid ghee, vanaspathi and palm oil. Smoking or being around smokers increases the risk of insulin resistance. After 3-6 months of dieting, walking and other lifestyle changes, if the abnormal biochemical values do not return to normal, your doctor can help you with medications to help your body fight the insulin resistance. Metformin helps the body to efficiently utilise glucose and reverses some of the insulin resistance. The statin group of drugs corrects the lipid profile. Blood pressure can usually be brought to normal with medication. Since no particular group of drugs has been proved to be superior to another, your physician will be able to prescribe what is best for you. Prevention of heart attacks and strokes may require a nightly dose of (75mg) aspirin. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

tackling the flu

How to fight the flu Your Health DR GITA MATHAI October to March is flu season, the time when many fall victim to the sniffles. Flu is actually an infection that affects the nose, throat and lungs. It is usually due to a locally active virus that belongs to Influenza group A or B. Since the groups contain a large number of viruses, different strains cause infections every year. Rarely, the flu is due to an internationally virulent strain that rapidly spreads across the globe, such as swine flu or avian flu. Young children, the elderly, pregnant women and those who are suffering from chronic illnesses that have compromised their immune system are particularly vulnerable. This leaves out only teenagers and young adults who are in robust health! The infection follows anywhere between two and 10 days after exposure to the virus. Initially, it may be confused with a common cold. Colds affect people several times a year whereas flu occurs once in several years. Also with flu, several people are affected within a short space of time, either in school, college or the workplace. Flu usually starts abruptly, with a runny nose, cough, fever (over 100°F), chills, dizziness, flushed face, headache, backache, leg and muscle pains. There may be nausea, vomiting and lack of energy. The symptoms are similar to that of a common cold and it may be difficult to distinguish between the two. In the case of flu the symptoms appear with no warning and are severe from the beginning. The first symptom is often fever. In adults the temperature is usually lower than in a child. Colds start slowly and gradually. The fever as well as aches and pains begin to fade on days 2-4, but this is followed by the appearance of new symptoms such as a dry cough, rapid breathing, sneezing and sore throat. These symptoms also usually last 4-7 days. The flu can make asthma, breathing problems, and other long-term illnesses worse. Recovery from the flu may not be complete for weeks. The fever and other symptoms may disappear only to be followed by tiredness, depression, inability to cope with work and lethargy. Secondary lung infection can cause the fever to return. The appetite may remain poor. The flu virus lives in the respiratory tract. Coughing, sneezing or even talking expels the viral particles in the air. They remain suspended as they are very light and can be breathed in by others. They also tend to settle on surfaces such as tables, walls, telephones and computer keyboards. Others touching the surfaces transfer the particles to their respiratory system and acquire the infection. In closed spaces such as metros, aircraft, shopping malls and classrooms, the infection spreads like wild fire. A large number of people are affected in a very short space of time. The flu becomes an epidemic. The virus that causes flu mutates rapidly, changing all the time. Recovery from one episode does not provide protection against a second attack from a different strain. The second attack may be milder if there is some genetic material that is common between the strains. Young healthy adults recover from flu with no long-term after effects. Children and the elderly can develop complications such as pneumonia, bronchitis, sinusitis or ear infections. These are virulent bacterial infections that gain a foothold because the respiratory system is weakened by the viral attack. Recovery from the flu takes time. Bed rest, plenty of fluids and paracetemol for the pain is usually all that is required. Aspirin should not be used in flu. In children and teenagers it can cause a rare fatal reaction known as Reye’s syndrome. Some anti viral medications such as oseltamivir (Tamiflu) or zanamivir (Relenza) can be taken. They have to be started early on in the illness in adequate dosages. They can shorten the duration of illness and reduce the complications. Tamiflu is taken orally and Relenza is inhaled. These medications have side effects. They can induce nausea and vomiting. They are contraindicated in asthmatics. Rarely, they can cause delirium. Inadequate dosing can do more harm than good. The virus can become resistant to the medication. Every year the pharmaceutical companies release “flu vaccine.” A new vaccine is released every year with the three most common strains likely to cause an epidemic that year. It can be an injectable vaccine or a nasal spray. Protection is more than 90 per cent. Washing hands frequently with soap or an alcohol-based hand sanitiser prevents the virus from being carried on the hands. The nose and mouth should be covered while coughing or sneezing. A tissue, which can be discarded, is more hygienic than a cloth handkerchief. If neither is available then sneeze into the crook of the elbow. Crowded places increase the risk of transmission, so it is best to avoid them if possible during the flu season. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

the season to be jolly

’Tis the season to be jolly

Your Health DR GITA MATHAI

Tipsy tips  Eating fried and greasy food coats the lining of the stomach and delays alcohol absorption. Drinking water and fruit juice will help “wash” the alcohol and chemicals out of the system, relieving the headache. Black coffee initially stimulates the nervous system, and may help with drowsiness, but the headache rapidly returns. The holidays have started, and even though each state rings in its new year on a different date, India will join the rest of the world in celebrating the arrival of 2014 on January 1. The New Year is ushered in with parties at clubs, hotels and resorts or in friend’s houses. Alcohol flows freely and there are several dangerous pitfalls for the unwary. The safe limits for drinking are four units of alcohol for men and three units for women. Women have less muscle reserve than men; so that makes them more susceptible to the side effects. The recommended safe limits are based on alcohol units, so it makes little difference whether you drink beer, wine or whisky! One unit is equal to 10ml of pure alcohol. While calculating intake, one unit of alcohol is about equal to half a pint of ordinary strength beer, lager, or cider, a small pub measure (25ml) of spirits and a standard pub measure (50ml) of fortified wine such as sherry or port. The alcohol content of spirits vary depending on the type (whisky, brandy, rum). An accurate calculation can be done by using the formula percentage of alcohol by volume of a drink equals the number of units. Pregnant women, those planning to become pregnant and teenagers (under 21 years) should not drink at all. No one can really “hold their liquor”. Binge drinking (as can occur during parties) is particularly dangerous. Even in the most seasoned drinkers, it reduces reaction time and clouds judgement. This can result in road accidents. Self-control is rapidly lost and may result in fights. Balance is affected and injuries can occur from tripping and falling. Blood pressure can shoot up, resulting in a stroke. The increased calorific intake from alcohol and accompanying snacks can push diabetes out of control. Actions and decisions taken under its influence can appear ludicrous in the hard light of a sober morning. Certain chemicals such as benzodiazepines or gam- mahydroxybutyrate (GHB, the date rape drug) can be slipped surreptitiously into alcohol or even soft drinks. They are tasteless, so the unsuspecting victim may pass out, or be assaulted, with no memory of the occurrence. January 2 is a working day for many, so recovery from a hard night of partying is a priority. The best way to avoid a hangover is not to drink at all. While partying, eating fried and greasy food coats the lining of the stomach and delays alcohol absorption. The headache that follows heavy drinking is due to dehydration and the additives (flavouring and colouring agents) in the alcohol. Drinking water and fruit juice will help “wash” the alcohol and chemicals out of the system, relieving the headache. Black coffee initially stimulates the nervous system, and may help with drowsiness, but it aggravates the dehydration and the headache rapidly returns. If attending a party with a group of friends outside the house, one person should not drink at all and be the designated driver who will take everyone home safely. Also, the sober person can make sure no one drinks too much, passes out, behaves inappropriately or is in any danger. All those cakes, sweets and pastries served at this time will throw diets and diabetes out of control. A piece of cake about one and a half square inches packs in a whopping 340 calories, a ladoo 240 calories and 20 nuts 100 calories. Just an extra sweet a day can push up your weight by a kilo in 10 days! An hour of exercise uses up between 250 and 300 calories, depending on the intensity, type of exercise and your body weight. One or two “extra” sweets a day cannot really be worked off with exercise alone. Also, this is the holiday season so regular exercise schedules tend to fly out of the window. The start of the New Year should be a time for introspection and resolutions to make the year ahead a healthier one. Don’t postpone your annual health evaluation, blood tests or cancer screening. Try to attain your ideal body weight. This means a BMI (weight in kg divided by height in metre squared) of 23. Exercise regularly (an hour a day is ideal) with 40-45 minutes of walking, jogging, running, cycling or swimming, followed by 15 minutes of stretching or yoga. Try to get a 365/365 score. Don’t miss a single day. Try to cross train – that is, try walking one day, swimming another and cycling on the third day. Not only does exercise then lose its monotony, but also becomes more effective and efficient. Beginning the New Year exhausted and in an alcoholic haze is probably not the ideal start for the next 364 days of your life. 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

feeding baby

Bringing up baby Your Health DR GITA MATHAI Every week I receive a ton of letters from anxious parents: is my baby’s weight ideal, is my child growing properly, is my parenting faulty? This week I’ll attempt to answer the most common questions. The birth weight of normal Indian children is on average 3-3.4kg. It depends on the health of the mother, with relatively bigger babies born to diabetic or pre-diabetic mothers, and smaller babies to mothers with hypertension. Preterm babies and twins also tend to weigh less at birth. The birth weight should ideally double at the end of the fifth month and triple at the end of the first year. This means that a child who weighed 2.5kg at birth will be around 7.5kg at the end of the first year. He or she will appear diminutive next to a child who was 3.5kg at birth and is therefore 10.5kg on the first birthday. Trying to force feed a child to gain more than expected is counterproductive. They may just regurgitate the extra food or develop an aversion to eating. There is no point in feeling guilty that you are a “bad mother” if your child is not the same size as your friends’ child. For the first 120 days, the child should preferably be exclusively breast fed. After that, weaning on to semisolid food should be started. Home cooked cereals are best. Although packaged ready-to-use cereals may appear attractive and time saving, they may contain preservatives, flavouring or excessive sodium. These are not advisable or healthy. One new home-cooked food, such as pureed vegetables or fruits, should be introduced every two weeks. Biscuits are not healthy or advisable. Patience and persistence is the key to successful weaning. The child should be eating a normal adult diet at the end of the first year. About 400-500ml of undiluted milk is all that is required after that age in a day. Teach your child to drink it without additives like tea, coffee or other “healthy” drinks. Unfortunately, demand for a “tonic” to make the child grow fatter or improve the appetite may result in steroid or cyproheptadine drops being administered. These chemicals do increase the appetite, but at a tremendous cost to the health of the child. Steroid drops increase the weight of the child owing to fluid retention. The face may become moon shaped and hairy. They suppress the immune system, so the child may get frequent infections, which may then escalate and become life threatening. Children need five meals a day — breakfast, a snack at 10-11am, lunch, a snack on returning from school, and dinner. Do not send them to tuitions hungry or to school without breakfast. Do not withhold food as punishment. (A snack does not mean packaged chips and biscuits). The ideal weight from the ages of 2-20 years can be measured with the BMI. This is the weight divided by the height in metre squared. The normal is between 18-23. Ideally, in children, the BMI can be read off charts available in most immunisation booklets. A healthy child should be between the fifth and 95th percentiles. Once the child becomes 5ft in height, the formula for ideal body weight (IBW) in males: 50kg + 2.3kg for each inch over 5ft. For females, IBW = 45.5kg + 2.3kg for each inch over 5 feet. India has progressed from being a country with malnourished children to one where the majority is overweight or frankly obese. If your child falls into that category restricting food or dieting is not an answer. Instead, healthy eating should be incorporated for the whole family, with 4-6 helpings of fruits and vegetables a day, no fried or ready to eat snacks, restricted sweets and deserts and NO aerated cola or flavoured drinks. This has to be combined with exercise. Physical activity is required from birth itself. Even before a baby crawls it should passively grasp, push and pull. Once a child begins to walk it should be active for at least three hours a day. This should be spread out with skipping, jumping hide and seek, playing ball and running. Just seating them in front of the TV (even if they would like to) is not a solution, nor is it helpful. School age children need to be physically active for an hour a day. This can include structured activity like coaching in a specific sport, cycling or running. This time spend makes them physically and mentally stronger. They are able to concentrate, work past fatigue and develop a sense of self worth. Habits like healthy eating and exercise inculcated in childhood remain throughout life. This definitely reduces the incidence of chronic diseases as they grow older. Also, in the process of rearing healthy children, you may change your diet and exercise habits, and become fit too! 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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illness explained

Why you fall ill

YOUR HEALTH / DR GITA MATHAI

An illness is always unwelcome but before knowing how to keep it away, we have to know what causes it. Ancient people believed that diseases were due to an imbalance between “heat” and “cold,” or because of possession by “spirits”. Today we know that diseases are caused by infectious agents (bacteria, viruses, intermediate organisms), genetic make up, nutritional excess or deficiency, immunological status, metabolic causes and faults at the cellular level. Almost all diseases fall into these basic groups, with some overlap, irrespective of the organ system where symptoms first manifest themselves. The body’s reaction to these external and internal forces determines the intensity and the duration of the disease. The body may be defective from birth, so much so that it may be incompatible with survival. Such a child may die in utero, soon after birth or in early childhood. Severe heart, kidney, liver and nervous system defects and multiple congenital abnormalities fall in this category. Today, many defects can be surgically or medically tackled, resulting in a normal lifespan. Many infectious diseases can now be cured with appropriate antibiotic, antiviral and anti-parasitic agents. However, overuse, self-medication and misuse of drugs has resulted in the emergence of some “super strains” of bacteria that may be lethal. Many infectious diseases can be prevented by immunisations started in childhood and continued in adult life. Examples are diphtheria, whooping cough, tetanus, small pox, polio, typhoid, chicken pox, jaundice (owing to Hepatitis A and B) H infuenzae (ear infection, meningitis), meningococcal meningitis, Pneumococcus (ear infections, pneumonia, meningitis), measles, German measles, mumps, HPV (which is responsible for some cancers), seasonal flu and Herpes Zoster. Unfortunately, 60-70 per cent of Indian children are incompletely immunised. Either the schedule itself is not finished or the boosters are not given. Sometimes vaccines that have to be given when the child is older are missed altogether. The elderly seldom take the immunisations they require. Diseases occur when the body’s cells refuse to obey centralised commands. They are suppose to regenerate and die in sequence, but if the balance is not perfect, diseases occur. When the regeneration slows down, hair falls out, bones become weak and memory suffers, among other things. If proliferation overtakes degeneration, cancers occur. The metabolic functions of the body are controlled by endocrine glands and enzyme reactions. These can fail or malfunction for genetic reasons, infections or age. This results in a gamut of diseases such as diabetes, hypertension and thyroid problems. In some people the body fails to recognise its own cells. It perceives some cells as alien and attacks them with a vengeance, destroying them and setting off cascading reactions with deleterious effects all over the body. This produces the spectrum of auto immune diseases such as rheumatoid arthritis and system lupus erythymatosis (SLE) and can lead to the destruction of bones, joints and many organ systems. Irrespective of the disease, patients want an immediate cure. In the case of an acute infectious disease, with proper diagnosis and adequate treatment a total cure is possible. But this takes time. Impatient and frustrated, patients may “doctor shop.” This can result in frequent changes in the antibiotic used or the addition of disease modifying steroids to rapidly eliminate symptoms. This does more harm than good. Meanwhile, many acute diseases “run their course” and are cured anyway. Chronic diseases such as arthritis, diabetes, COPD (asthma), seizures or cancer are often frustrating. There seems to be no cure in sight, and a lifetime of medication appears depressing. People are often tempted to try out other systems of medicine or natural cures. These, anecdotally or through advertisements, appear to have fewer side effects and offer a cure. Often, the basic defect is still present and the medication just has a placebo effect. When receiving treatment, do not mix up systems of medicine. Allopathic medicine encourages an evidence and diagnosis-based approach. Many other systems have a symptom-based approach to diagnosis and treatment, even though the same symptom (like jaundice) can appear in many disease processes. The medication taken under various systems can produce drug interactions. These may be difficult to diagnose and tackle. Our body needs to be nurtured from birth. We should restrict the number of chemicals we consume. This means avoiding processed infant foods, snacks with trans fats, coloured and caffeinated beverages, alcohol and nicotine in tobacco products. Genetics and the environment may make our bodies prone to certain diseases but with a healthy diet, an hour of exercise a day and adequate sleep, we can often offset these deleterious effects. 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

looking after baby

Baby steps Your Health DR GITA MATHAI New mothers are under a great deal of stress because of lack of support in nuclear families, especially since the traditional caregiver — the grandmother — is more likely to be a working woman these days. The deluge of contradictory advice, paucity of reliable information and lack of a clear road map don’t make things easier. Here are a few things that new mothers should know. During pregnancy walk for a half hour in the morning and evening. The baby’s head is the heaviest part of its body, and walking will help gravity pull it down to the lowest part of the birth canal. It will also strengthen the calf and thigh muscles, making it easier to push out the baby during delivery. Many gyms offer special exercise or yoga classes for pregnancy and childbirth. As the skin stretches over the distended abdomen, the elastic fibres under the skin break and tear. This leaves indelible brown or white marks on the abdomen called stretch marks. To avoid them, apply oil on your tummy, thighs and back everyday from the time your stomach starts to grow. The nipples may develop painful cracks and fissures once the baby starts to feed. Oil (coconut, olive, sesame or a mixture of the three) needs to be applied, left on for 10 minutes and washed off with a delicate body wash. Food and drinks with artificial colours, preservatives and other chemicals should be avoided. Restaurants tend to use ajinomoto (and not just in Chinese food) so home cooked food and fresh juice is best. Avoid alcohol and cigarettes as well as second hand smoke from a spouse or parent. Vapourising mosquito repellents should be avoided. A mosquito net and an electric bat to hit recalcitrant mosquitoes are safe and effective alternatives. It is better to stick to one doctor during the entire pregnancy. Folic acid, iron and calcium supplements are essential. Urinary tract infections are common and need to be treated. Diabetes or hypertension that were pre-existent or developed during pregnancy needs to be controlled. Poor control can mean small babies or sudden death of the baby during pregnancy. Any medication for long term illnesses such as a seizure disorder or a psychiatric illness should be continued. The appropriate consultants should be informed about the pregnancy so that they can change the medication or adjust the dose. If you see a new doctor, mention you’re pregnant. It is best to not travel during early pregnancy. If travel is unavoidable, trains are probably better than planes. If you are planning to have the baby in a different city, be there a month before the anticipated date. Babies are notorious for arriving early and in the middle of the night. Wear loose clothes in natural fibres and flat sandals. Stay away from heels. Put the new born to the breast as soon as possible. Although the first milk secreted appears watery and inadequate, it contains essential immunoglobulin to protect the baby against infections. As the baby sucks more and more milk will be produced. If at this point artificial feeds are introduced, the baby loses interest in sucking. Without the stimulation, breast milk will decrease. Drinking a glass of water before and after feeding keeps the milk flowing adequately. Breastfed babies do not need water until weaning starts. The umbilical cord usually falls off between 7-10 days after birth. It needs to be kept dry and exposed to air till then, so the diaper needs to be tied below the umbilicus. Basin baths should be avoided until the stump is healed. Do not apply soap directly to baby’s skin. Soap up a soft wet towel and use that. Clean and dry the folds in the neck and groin properly. Do not use powder (even baby powder) on children. Talcs contain magnesium trisilicate and may be contaminated with cancer causing asbestos. If inhaled, the fine particles can cause wheezing and lung damage. Application in the groin area in girls has been linked to ovarian cancer. Babies need fresh air and sunshine. They should be taken outside within a week of their birth for limited periods of time. Exposure to crowded places or travel is not advisable until the first three immunisations are complete. 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 Share on email

autism spectrum disorder

Rain man Your Health DR GITA MATHAI Fifty years ago the “autism spectrum of diseases” was practically unheard of in India. We lived in large joint families where one child or another may have been “difficult”, “hyperactive” (read: naughty), refused to study but eventually did assimilate into society. The rest of the family looked after the physical and financial needs of the person. He was just the uncle who was “weird” and perhaps did no work. The advent of the nuclear family changed this. Today, one in 85 children is diagnosed with autism spectrum disorder. Four out of five such children are boys. Most autistic children are only diagnosed by the age of three. This is when many of them start some sort of structured education and need to interact with their peers and the autistic behaviour becomes evident. There may still be a delay in diagnosis as the severity of the symptoms and the manifestations vary from child to child. The symptoms may be subtle but appear in infancy. The child may not smile, make eye contact, or babble happily. They may resist cuddling and withdraw into themselves. They may show little or no interest in surroundings. The reaction to toys may be bizarre. They may be focused on just a portion of the toy, like the wheel of a toy car, with no desire to see how it works. Some actually lose speech and other milestones they had already developed. The ability to interact with other people may be defective or absent. Their behaviour may be inexplicably disruptive and aggressive. Children need to be evaluated if • They do not smile by the time they are six months old • Do not mimic sounds or facial expressions by nine months • Do not babble by one year • Do speak at all by 16 months • Do not speak two word phrases by 24 months These symptoms are suspicious but not diagnostic. The diagnosis of autism is based on the presence of at least six specific symptoms from the DSM (Diagnostic and Statistical Manual of Mental Disorders). A qualified professional must make the diagnosis as it has major implications for the future of the child. Autism may exist alone or may be part of a wider spectrum of diseases. The child may also have genetic abnormalities, seizure disorders or tuberous sclerosis (multiple tumours in the brain). Once enrolled in school, they have learning difficulties. Though they might repeat what they learn and appear to grasp it quickly, they cannot understand the logic or concept; so they are unable to apply what they learn in daily life. They may be unable to understand certain concepts altogether. Some may be savants with exceptional musical, mathematical or artistic talents. This is easier for parents to accept as they would rather have a child who is a genius and not one with learning disabilities. Families are understandably upset with the diagnosis of autism. Unfortunately the exact reason for autism is not known though there appear to be several contributory genetic and environmental factors. If the families of autistic children are carefully studied, there may be several members with one or another symptom in a mild form. They may lack social skills, be abrupt or rude or have learning disabilities. There may be just a small defect in the genes of each individual and they may be compounded in the child. Modern day additives, pesticides and other pollutants in the environment and in the food eaten during pregnancy are suspected but not proven to play a role. There was a great deal of hype in the media postulating a link between autism and vaccines particularly MMR (measles mumps rubella). This is a disproved hypothesis. Failure to immunise the child places it at risk of contracting serious preventable infectious diseases. Older parents are more likely to have autistic children. There is no miracle drug to cure autism, but coexistent medical conditions should be treated. Careful nurturing and education can integrate many autistic persons into mainstream society. Many children with mild forms when helped do seem to “outgrow” it during their teenage years. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services