all work and no play

Play to the top, please

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Your Health - Dr. Gita Mathai

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My parents used to walk to school, a couple of kilometres both ways, in a chatty gaggle that built up a lifetime of friendships. Today's children take automated transport and barely have the time to talk for they are usually cramming - for unit tests, weekly exams or quarterly evaluations. They live and study in a pressure-cooker, their stress levels build up in junior school itself, and by the time they reach the public exams, many are not only physically unfit but may have reached breaking point. Many do not know how to study, or why they cannot recall what they have studied!

Schools contribute to this environment. The 11 o'clock and lunch breaks are reduced from the mandatory half and one hour. This means that children barely have time to gobble their lunch and go to the toilet (no time to play). The games period is usurped for extra classes. Weaker students are coached after school hours or sent to a tuition circuit. There is no time for hobbies, extracurricular activities or sports.

All this is counterproductive. Being a "topper" does not ensure admission to college and the ability to shine in your chosen career. For college, you only need to make the "cut off" grade and good grades do not ensure success in your career After five years, your school marks cease to be relevant. A child who has hobbies and plays a sport is more likely to be a well-rounded individual and be equipped with the character requirements for success.

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Children need to be physically active to cope with studies and the rigours of life. Unlike their inactive counterparts, they have a normal BMI (body mass index), lower body fat, are mentally sharper, and have better cardiovascular health. They tend to concentrate on studies and tasks better and grasp concepts faster. Their performance in reading and mathematics is demonstrably superior to their inactive counterparts.

Studies have shown that school-going children require an hour of physical activity. Since it is difficult to change the academic mindset, it becomes the responsibility of parents to try to ensure that this happens.

The exercise can be split into two or more segments but at the end of the day the minutes should have added up to an hour. It can be cycling, running, skipping, stair climbing, dancing or swimming. It requires parental involvement.

Parents may feel that taking a break for activity cuts into cramming time and is counterproductive. Actually, long study sessions without a break means that brain power is wasted trying to stay focused. The chemicals required for processing information become depleted. Periodic breaks allow chemicals to accumulate. Endorphins released from muscles during exercise boost this process. Adequate sleep is as important for efficient brain functioning. School going children require 8-11 hours of sleep.

Review of study sessions once or twice a few days apart, or even after a bout of physical activity are important to "grease" and establish brain pathways for efficient recall. Repeating the lesson loudly, reinforces the lesson through sight and sound.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Send questions on health to yourhealthgm@yahoo.co.in

D for Dumb

Dial D for Dumbness

http://www.telegraphindia.com/1160912/jsp/knowhow/story_107601.jsp

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Your Health - Dr. Gita Mathai

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Infants and toddlers who come to my clinic are often cranky. Instead of the old techniques of carrying them around, distracting them with toys, or my aquarium, today, more and more parents tackle these behaviour problems by immediately handing the child their smartphone. The child can barely walk or talk, but their podgy fingers swipe the screens expertly as they stare unblinkingly at the coloured images flashing on the screen. Parents think that this is a reflection of the intelligence of their toddler. This is far from the case. It is a disturbing and dangerous trend.

All electronic devices, cell phones, tabs or laptops emit MWR (micro wave radiation). Long-term exposure to this radiation is carcinogenic. There is still speculation about exactly how much radiation is safe, with conflicting reports and claims.

A child's thin skull bones allow greater penetration of MWR. His or her nervous system and brain tissue absorbs about two times more MWR than that of adults. His or her bone marrow absorbs ten times more radiation.

It is recommended that children under the age of two should not use cellphones at all. In all age groups, it is better to place cell phones a few inches away from the ear. They should be carried in backpacks or purses and not in pockets. In the case of laptops, computers and tablets, the minimum safe distance from the body is 20cm.

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Tablets are even more popular than cellphones as pacifiers for children. They have a larger variety of passive and interactive programs. The screen is larger (more radiation), it is also held closer to the face (brain). Children soon learn to video themselves. They replay their own videos in a narcissist fashion. This negates the need for friendship or social interaction. They become self absorbed, and since they are always in control of the happenings on the tab, they are unable to control their impulses. They do not interact with their peers or adults. Children learn and mature by watching adult social reactions to situations.

They become experts at swiping and tapping movements, usually with the dominant hand. Children constantly on these devices develop no dexterity or motor skills. They remain clumsy. They do not use their imagination to make believe and play. With no story telling or reading, lateral thinking, problem solving and the ability to learn maths and science are affected.

As the child becomes older, television replaces family interaction, play and even study time. Studies have documented that increased television viewing time delays and decreases development of language, vocabulary and social skills. Some imitate the exaggerated facial contortions and staccato speech of cartoon characters.

Children under two years of age should not watch television at all. Those older than 3 years who watched an hour or more a day were found to fare poorly academically. Their educational achievements by the age of 26 are behind those of their peers. This is because with television, everything is readily visible, and requires no analysis, reading or language skills. These areas of the brain lack stimulation and develop poorly.

There are educational programmes on television, specifically designed for children. These are seldom watched. Instead the focus is on mindless serials, and cartoons with unrealistic situations, which can desensitise the child to violence.

Dependence on media for entertainment leads to social isolation and regression of skills essential for survival and success. In addition, after school, homework, tuition and relaxation with television, there is no time physical exercise. This has led to an epidemic of unfit or obese children who develop lifestyle diseases in their twenties.

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

ear aches

A pain in the ear

http://www.telegraphindia.com/1160905/jsp/knowhow/story_106287.jsp

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Your Health - Dr. Gita Mathai

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Earaches are what the word describes - a pain in the ear. What the word fails to convey is just how debilitating the attack can be. This is especially true in young children, whose inability to localise the discomfort can lead to prolonged, unexplained crying with fever.

The pain is most often due to a problem in the middle ear (otitis media). This is a small space with three bones (ossicles), the malleus, incus and stapes. The confined space is closed to the outside by the eardrum. Infections cause a build up of secretions (viral) and pus (bacterial), which is unable to escape. This causes excruciating pain. It can press on the ear drum, causing it to bulge. It can eventually burst, discharging the fluid.

The ear, nose and throat are all connected by the Eustachian tube that is situated behind the throat. An infection in any three can cause an earache. Allergies, or viral and bacterial infections can cause the nose to be blocked. In children the inner tonsil (adenoid) may become infected. This can swell, blocking the Eustachian tube.

In bottle-fed infants, milk can enter the Eustachian tube, which is shorter and straighter in infants. This can be caused by the infant sucking too rapidly from the bottle (unlike the breast where the flow is naturally regulated), lying flat while sucking (not at the recommended 45° angle), being put to sleep with a feeding bottle or holding the bottle and feeding themselves.

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Once infection sets in, there is fever and severe pain. The eardrum bulges and can be seen by physicians using an "otoscope". The child may be irritable and refuse to eat as any movement of the jaw aggravates the pain. There may even be temporary loss of hearing or balance. If the infection is not treated adequately and in time, it can recur or become chronic. It can even spread to the base of the brain.

The skin of the external ear canal can become infected because of excessive dampness caused by swimming, rain, allergies, eczema, or if the ear canal is damaged by hearing aids, buds, hairpins or even earphones.

The pinna of the external ear can get infected. This occurs in people who participate in contact sports such as wrestling and boxing, if small scratches occur to the ear or if the skin is pulled off. People may also have multiple ear piercings, with some holes being in the cartilage of the ear. Infection and damage can occur, especially if the procedure was unsterile. The infection can spread rapidly and affect the whole ear. It can become a bag of pus. Even if the pus is drained surgically, the ear may become deformed with multiple bumps forming a "cauliflower ear."

To prevent ear infections:

♦ Use a cup and spoon to feed children. If you must use a bottle, prop the child up at 45° angle. Do not use pacifiers.

♦ Yearly immunisation prevents flu, which predisposes children to ear infection. Common bacteria (Haemophilus influenza,
Streptococcus pneumoniae) which cause ear infection in children can also be prevented by immunisation.

♦ Avoid exposure to cigarette smoke. Even second hand smoke on hair and clothes precipitates infection.

♦ Do not damage the ear by placing foreign objects in it.

♦ Dry out the ear canal with a hair drier after swimming.

♦ If flying causes ear ache, use decongestant nose drops before boarding the flight.

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

dengue

http://www.telegraphindia.com/1160822/jsp/knowhow/story_103646.

Banish the bite

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Your Health - Dr. Gita Mathai

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Mosquito borne diseases usually arrive with the monsoon. And this year is no exception; there is a resurgence of dengue. And it is we who are to blame. If each citizen took his or her social responsibility seriously, our country would not need to be a marked in red on the WHO maps for dengue!

The disease is spread by the Aedes egypti mosquito, an attractive insect, recognisable by its tiger striped legs (unlike the boring grey of the Culex and Anopheles mosquitoes). It is a friendly insect, which does not stray far from its place of birth. It loves humans and their environment. Unlike the dawn and dusk attacks of other mosquitoes, it bites in the daytime too. It is ferocious when it attacks its prey. One bite is not enough. It either attacks the person repeatedly or bites several human beings in the vicinity. That is why several members of the family can get dengue at the same time.

Four to 10 days after the bite, the affected person suddenly develops a fever. He or she may also suffer from a red rash, headache, pain behind the eyes, in the joints and the abdomen, nausea, vomiting and throat pain. At this stage, it is difficult to distinguish dengue from other fevers.

Within a few days, the white blood cell and platelet counts drop. The liver enzymes can start to rise. The person starts to develop antibodies to the virus which are are detectable in 50 per cent of patients by days 3-5 after onset of illness, and in 99 per cent by day 10.

Keep dengue away

• As little as 2ml of water is enough for mosquitoes to lay eggs. Check your immediate environment for garbage like old tires, bottle caps, even leaves. • Tanks and ponds should be stocked with small, larva-eating fish like guppies. • Pouring a little kerosene or oil on stagnant water creates a thin film on the surface that prevents larvae from breathing. • Put up mosquito-proofing nets on windows and ventilators. Keep doors shut. Sleep inside mosquito nets. • Application of mosquito repellents on clothing (not skin) is effective for a few hours. Patches (mosquito tattoos) contain pure citronella extract and can be placed on clothing. Equal volumes of vanilla extract and water applied on the skin repels mosquitoes for an hour.

A person usually recovers spontaneously from the first attack of dengue. Immunity develops to that particular strain of virus (there are four strains) and lasts for a lifetime. Unfortunately, if there is a subsequent attack of dengue (a different strain), the body's immune reaction produces a severe response.

Complications are more likely in patients under the age of 12 and over the age of 60 years. The white blood cell and platelet counts drop. This can lead to bleeding from various places. If the bleeding occurs in the brain, it can be fatal. The liver becomes enlarged and the liver enzymes elevated. As more toxins are released into the blood, the blood vessels become permeable. Fluid leaks out of the blood vessels and accumulates in the abdomen and in the lungs. The circulating plasma volume is reduced and shock may develop. Eventually, as organs like the liver, heart and kidney do not get enough blood, they can fail.

There are no antibiotics that cure dengue. Treatment is mainly supportive, to reduce the temperature, (paracetemol 10-15mg/kg per dose every 4-6 hours in children and 500mg in adults). Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided.

Plenty of fluids should be given. In critically ill patients, admission to hospital and IV fluids and transfusions (of platelets) may be required. The exact criteria for platelet transfusion varies, and must be carefully done, as there is inherent risk associated with the transfusion of blood components.

There is as yet no vaccine against dengue. Ridding the house and its surroundings of the Aedes mosquito is the key to controlling dengue. Each individual needs to play a proactive role in this.

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 toyourhealthgm@yahoo.co.in

breast milk

Best for baby

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Your Health - Dr. Gita Mathai

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Last week (August 1-7) was breast feeding week, and the entire world was involved in the great “latch on” — a word that best describes the way mammalian babies find their mothers and derive nutrition. Mothers gathered in public places and demonstrated that it was possible to breast feed babies, in public, discreetly and elegantly, and there was nothing “indecent” about it.

Breast feeding, though natural, is a failing art. It needs to be actively promoted, and not just for one week a year.

Breast milk is rich in fat and omega 3 fatty acids. It also contains the fat digesting enzyme lipase, so that all the fat is digested and absorbed. It also contains immunoglobulins (IgA), which protect the child against common viral, bacterial and gastrointestinal diseases. The composition and quantity of milk changes and regulates itself as the child grows older.

All mammals produce milk and the composition for each species is specific. Cow’s milk is best for calves and goat’s milk for kids. Human milk cannot be replicated in a factory, despite best efforts by the infant formula industry. The companies have tried various nutritious additives but it is not the “real thing.”

Manufacturers have tried to base the composition of formula milk on a human mother’s milk, analysed at approximately one to three months postpartum. Still, there are significant differences in the nutrient content of these products. For formula, purified cow’s milk, whey and casein are used as the  protein source, a blend of vegetable oils as the fat source and lactose for carbohydrates. Each manufacturer tries to add different vitamins and minerals to claim superiority over other products. None contain trace elements and immunoglobulins. It does not protect the child against disease. The fats are also not digested well and the stools of formula fed babies are foul smelling.

WHO (World Health Organization) recommends that infants  be exclusively breast fed for the first six months. To do this efficiently, the mother should be given a peaceful environment, an adequate diet and plenty of fluids. Drinking a glass of water before and after feeding ensures adequate flow of milk.

The baby has to search for the nipple, find it and latch on. Placing the nipple against the baby’s cheek can do this. Pushing the nipple into the mouth is counterproductive. The baby should be held at an angle of 45 degrees. Lying down and feeding the  baby is not a good idea.

Breast milk is always available on demand, it is sterile and at the right temperature. Our Indian clothes, with dupattas and sari pallus make breast feeding discreet.

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 toyourhealthgm@yahoo.co.in·    

http://www.telegraphindia.com/1160815/jsp/knowhow/story_102445.jsp

frozen shoulder

Frozen shoulder? Just roll it

http://www.telegraphindia.com/1160725/jsp/knowhow/story_98489.jsp

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Your Health - Dr. Gita Mathai

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The shoulders are joints with a wide range of motion. That helps us painlessly perform a variety of tasks such as combing hair, applying soap to the back or hooking undergarments. If the movements of the shoulder are restricted due to pain, life becomes difficult.

This may occur because the joint is strained from overexertion, the tendons of the muscles surrounding the joint are inflamed, the joint itself may be unstable and dislocated, or because of neck problems. Most often though, no real disease process can explain the pain and it is called a "frozen shoulder."

Women between 50 and 60 years of age are prone to developing frozen shoulders, especially if they also suffer from hypothyroidism or diabetes. It affects the non-dominant shoulder and is seldom bilateral, but the pain restricts even the simplest two-handed tasks. Men can also develop "frozen shoulders", but it is milder and less common.

A frozen shoulder usually starts as lack of free movement in a normal shoulder joint, with no recollection of overuse or injury. The pain then comes in fits and starts, tends to be worse at night, and interferes with sleep, as turning from side to side produces discomfort. This stage lasts for around three to four months.

Later, during the sticking or freezing phase, all movements are restricted by pain. The shoulder is held fixed to prevent involuntary movement. Subconsciously, use of the affected arm reduces. The muscles around the joint get wasted due to disuse. The rounded contour of the shoulder changes and becomes flattened. Just as suddenly as it starts, it spontaneously, inexplicably improves.

The entire cycle takes around 30 months. In seven per cent of sufferers, it does not fully resolve, and pain and functional disability remain for many years.

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A frozen shoulder is usually diagnosed clinically. The normal procedure is to get X-rays, CT and MRI scans done. However, X-rays may only reveal thinning of the bone due to disuse.

Once the shoulder has become relatively immobile, treatment is essentially symptomatic. During the initial painful stages, treatment is directed at relief. The patient has to determine the limit of activity or exercise, pushing their limits a little further each day. All pain free activities are allowed and all painful activities curtailed.

At home, external application of a capsaicin gel followed by ice offers relief. Professional physiotherapy, with alternating heat and cold therapy, passive movements, low load, prolonged stretches and strengthening exercises are helpful. Physiotherapy provides greater benefit when it is combined with intracapsular steroid injections. Non-steroidal anti-inflammatory drugs (NSAIDs) supplemented with other analgesics may be helpful. Long-term use of these drugs is not advised, as it is detrimental to the kidneys.

If functional disability persists despite physiotherapy and medication for six months, an orthopaedic surgeon can perform manipulation of the joint under anaesthesia. Arthroscopic (surgical) release of the capsule can also be done.

It is better to be patient and manage the symptoms rather than go in for surgery immediately as most people recover spontaneously.

Anyone can develop a frozen shoulder. This makes preventive measures a practical necessity to prevent pain and disability occurring.

Yoga has exercises that prevent frozen shoulder from developing if started young, performed regularly and continued lifelong. Shoulder rolls, arm elevations, arm rotations, the plank pose and a complete suryanamaskar all help to maintain the integrity, position and health of the shoulder joint.

The Chinese Tai-Chi exercises confer similar benefits.

These traditional exercises can be combined with biceps curls, triceps curls and lateral lifts using small one or two kilo "baby" dumbbells.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

blisters and boils

Bubble trouble

http://www.telegraphindia.com/1160718/jsp/knowhow/story_97197.jsp

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Your Health - Dr. Gita Mathai

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A blister is a very superficial lesion, which occurs when the surface layer of the skin gets separated from the deeper layers. Fluid or blood can accumulate in this space. This raises the surface of the skin. A small, translucent or blood-filled bump forms, which may or may not be painful. Blisters can occur singly, in clusters or all over the body.

Single blisters occur on the feet - if shoes are tight or ill fitting - or the hands, if repetitive movements are performed with tools. Exposure to extreme temperatures (both freezing and boiling) can cause a blister.

Blisters can cause throbbing pain because of pressure. The clear liquid or blood that accumulates inside remains uninfected as long as the skin over the blister is intact. Care should be taken to make sure the skin does not break. The protective skin should not be pricked. If you don't disturb it, a blister will usually disappear on its own within a few days. Antibiotic treatment is not required.

Before wearing a new pair of shoes or using tools, take a bar of soap (traditionally, Lifebuoy is used) and rub it on the dry skin. It prevents blisters forming due to friction. Sports people or those in the NCC or military can also wear thick socks.

Bites of bed bugs, scabies mites, mosquitoes and spiders can also cause blisters. These tend to itch. Scratching can lead to the skin breaking, which in turn can cause a secondary infection. In the case of a spider bite, there is a clear blister in the centre surrounded by a red area. It tends to burn, not itch. After a few days, the area in the centre becomes black and the skin sloughs off.

A herpes virus infection also leads to blisters. Multiple blisters, usually on the face, occur and recur in clusters in the same area with the Herpes simplex infection. They are precipitated by other unrelated, incidental infections such as a flu or fever. Their appearance is preceded by a pricking sensation. They last a few days and then disappear spontaneously, only to reappear with the next infection.

Herpes genitalis, a sexually transmitted infection, produces blisters in the genital area. These are extremely painful. The first infection needs to be aggressively treated with antivirals. Despite this, the virus continues to live in the nerve roots in the pelvic area. The ulcers recur painfully every few months. Eventually, the attacks become less frequent and then cease altogether.

Herpes zoster occurs several years after a childhood attack of chicken pox. It causes painful blisters along the distribution of a single nerve. The pain and the blisters take around 10 days to disappear. Although the attacks do not recur, the pain can persist for months or years as "post herpetic neuralgia." The initial attack can be shortened with antiviral medication and the pain lessened with medication. A vaccine is in the pipeline for the prevention of Herpes zoster.

The herpes virus also causes chicken pox. A few days after fever, a rash appears and blisters begin to break out all over the body. They are painless and will subside harmlessly if left alone (not scratched). Attacks occur as epidemics particularly in schools. The disease is contagious from before the appearance of the rash till the blisters have scabbed and fallen off. The duration and severity of the attack can be reduced with antiviral medication. The Varicella vaccine can be administered after the age of one and again at the age of 10 years to prevent chicken pox.

The Coxsackie virus produces highly infectious "hand, foot and mouth'' disease, with blisters in these areas, particularly in young children. It disappears on its own in 7-10 days with no treatment.

So if you have blisters, make sure you don't scratch or burst them and visit the doctor only if they are painful.

Dr Gita Mathai 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 toyourhealthgm@yahoo.co.in