screening infants

Born well, now be well

---

Your Health - Dr. Gita Mathai

---

• 

The infant (and under-five) mortality rate in India has seen an impressive decline, from about 80 per 1,000 live births in 1991 to 35 in 2016. The main contributors to this decline are West Bengal, Tamil Nadu, Kerala, Punjab and Himachal Pradesh. These are also the states that have enthusiastically adopted the small family norm. This enables parents to avail good antenatal care, safe delivery and immunisations to prevent death from common childhood infections.

Now, it is time to worry about other diseases that affect the mortality and quality of life of these children. These are mainly haemoglobinopathies (haemoglobin disorders), bleeding disorders, inborn errors of metabolism, endocrinopathies, and congenital deafness. Many of these diseases are inherited. One or more parents may carry the gene, which may not be expressed in the parent. Relatives may be affected, or else have mild forms of the disease. In some cases, it is a sporadic mutation and the child is the only one exhibiting the problem.

Congenital hearing loss can be tested by the newborn hearing screening test (NBST). Though seven per cent of newborns have hearing loss, this test is usually not done. When the child is three months to a year old, parents realise that he or she does not respond to sounds. The impact of hearing loss is less if it is treated before the child starts to speak.

Sometimes children are born with ambiguous external genitalia but they may not be brought for treatment till they are older. It is usually due to congenital adrenal hyperplasia (CAH). If the disease is severe then other symptoms such as diarrhoea, vomiting, dehydration, low blood sugar levels and shock can produce a life-threatening medical emergency.

There are other defects for which children are screened at birth in developed countries. These require collecting blood on a filter paper from a heel prick, amniotic fluid, buccal smear, skin or hair, within 24-48 hours of birth. The disorders that can be detected are phenylkentonuria (PKU), congenital hypothyroidism, haemoglobin disorders such as sickle cell disease, the thalassaemia group of diseases, galactosaemia, tyrosinaemia and other biochemical diseases, cystic fibrosis and so on. The cost of the test varies from Rs 2,500 to Rs 10,000, depending on the number of diseases screened for. That depends on prevalence in that area, family history, marriages between close blood relatives and medical advice.

Congenital hypothyroidism requires immediate treatment with medication so that the child may have normal physical and mental development. PKU, tyrosinaemia and galactosaemia need immediate alterations in the diet to prevent brain, eye, heart and kidney damage. Haemoglobin disorders require constant monitoring, transfusions, and specialised management.

Newborn screening and early intervention can vastly improve the quality of life as well as development of children. Make sure you get the relevant tests done as early as possible. After all, it is always better to know the enemy you are fighting.

bad breath

To banish bad breath

---

Your Health - Dr. Gita Mathai

---

·      

Bad breath makes us self-conscious. About 25 per cent of the population feel that they have bad breath, when actually they don't. Another 10 per cent really have foul breath but fail to recognise it. It is an embarrassing problem and even close family members will seldom tell you that you have it. To check, cup your palms, hold it over your mouth and nose, breathe out and then smell your breath. You will get a fairly clear idea of the odour.

Most of the time, bad breath originates in the mouth. There may be untreated cavities. There may be food stuck in between the teeth. Bacteria feast on this food, breaking it down and releasing gases. Plaque may have formed between gums and teeth. This causes gum infection. Sometimes, if the gums are pressed, pus can be seen. Coffee and alcohol also cause overgrowth of mouth bacteria.

Brush teeth twice a day, morning and evening. Rinse your mouth well after every meal. A mouthwash can also be swirled around in the mouth for 30 seconds after every meal. Try to drink 2-3 litres of water in summer. Water cleanses the mouth and washes out food debris and bacteria.

Food containing spices, onions or garlic can produce halitosis even after the mouth is rinsed and teeth brushed. These condiments contain sulphides, which are released as they are digested. The sulphides are absorbed into the blood stream and released in the breath.

Gastrointestinal reflux disease (GERD) can cause belching and foul smelling breath. Diabetic ketoacidosis produces a fruity odour. Kidney and liver disease can cause a smell like ammonia. Intestinal obstruction causes the breath to smell like faeces. Now there are theories that various types of cancer release characteristic odours.

Sinusitis, post-nasal drip, blocked nose with mouth breathing, tonsillitis and adenoids cause bad breath. Lung infections like bronchitis, lung abscesses, bronchiectasis all result in halitosis, as toxins released by the bacteria in the lungs are breathed out.

Tobacco use destroys teeth and causes bad breath. It does not matter if the tobacco is chewed, smoked or used as snuff.

Sometimes children are put to sleep with a milk bottle in their mouth. This results in dental caries, a coated tongue and foul breath (bottle mouth). They may have sinusitis or adenoids. Children sometimes place objects like erasers, twigs, crayons or toys in the nose. Once the object is stuck there, there is a discharge and a foul smell. They child may not remember placing the object there or may deny it.

If correcting your oral hygiene does not get rid of bad breath:

• Consult a dentist to ensure nothing is wrong with your teeth and gums.

• See a physician to rule out GERD, diabetes, liver and kidney disease.

• Consult an ENT surgeon to rule out nasopharyngeal problems.

• Maintain a food diary to see if any particular item causes the odour.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

summer heat

Keep your cool in summer

https://www.telegraphindia.com/1170417/jsp/knowhow/story_146630.jsp

---

Your Health - Dr. Gita Mathai

---

• 

We are going to have a long, hot, dry summer, with above average temperatures and no rain. A few deaths from heat stroke have already been reported.

Our body organs function best at an internal temperature of 98.4°F. If the body temperature rises above this, the brain immediately sends chemical signals to the four million sweat glands all over the body. They secrete sweat, which covers the body in a thin film. As this evaporates, body temperature drops.

Sweating is not effective in cooling down children under the age of four as their sweat glands are immature. The process is inefficient in the elderly, in obese individuals and those with diabetes or on certain medications such as anti-depressants and anti-hypertensives. You require water to sweat so dehydration can reduce the amount of sweat formed. This is particularly true in athletes. Clothes made of synthetic fibres also trap the sweat next to the body, making it lose its cooling ability. If there is more than 60 per cent humidity in the atmosphere, sweat cannot evaporate.

If sweat fails to cool the body down, heat exhaustion sets in, with symptoms of weakness, headache, giddiness, palpitations and painful cramps. If this is not recognised, the body’s core temperature continues to rise and can reach as high as 105°F. This can result in confusion, disorientation, seizures and even death.

To prevent heat stroke, in summer, try to stay indoors as much as possible, preferably going out only before sunrise and after sunset. Confine exercising outdoors to the same time. Even swimming in the hot sun can lead to heat exhaustion and stroke.

The key to hydration is to drink plenty of fluids even before you feel thirsty. The best liquids are tender coconut water, lightly salted limejuice and buttermilk. Aerated cola drinks may feel good but are actually hypertonic. They aggravate dehydration. The ill effects of heat are also intensified by tea, coffee and alcohol. 

A person suffering from heat exhaustion should be moved to a shaded spot or indoors under a fan or to an air-conditioned room. He or she should be given plenty of fluids, preferably with salt added. The body should be sponged with tepid water and ice packs placed on the armpits, groin and temples.

Summer is also the season for profuse sweating and prickly heat. Sweat pores can become blocked by dead skin cells, dirt or talcum powder. As the sweat tries to escape, it forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). Eventually, they turn red (miliria rubra), become itchy, and evolve into a brown scaly rash.

Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. Common areas are the forehead, the upper back, chest, arms and inner thighs — in areas where there are body folds and poor air circulation. It is aggravated by friction between the skin and tight-fitting, non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area. This can become secondarily infected with bacteria or candida.

To prevent prickly heat, bathe twice a day after adding a teaspoon of baking soda to a bucket of water. Do not apply soap directly on the skin but use a loofah. Even though advertising portrays prickly heat talc as a soothing option, it will only block the pores further and aggravate the condition. So do not use prickly heat talc, or any other talc, to get relief from prickly heat.

Dr Mathai is a paediatrician. Mail your questions to yourhealthgm@yahoo.co.in

young heart attacks

Young at heart attacked

https://www.telegraphindia.com/1170410/jsp/knowhow/story_145446.jsp

---

Your Health - Dr. Gita Mathai

---

• 

Heart attacks are accepted as part and parcel of aging, with men over 45 and women over 55 aware that any chest pain they feel may signal an attack. Now, however, the scenario in India is changing. Heart attacks are occurring in men in their twenties and thirties. Since many are unaware that they are at risk, they fail to recognise the symptoms and get help in time. Therefore, 25 per cent of these first attacks unfortunately turn fatal.

The most common symptom of a heart attack is crushing chest pain which can radiate to the neck, jaw, arm or back. It may be accompanied by nausea, vomiting, pallor, dizziness, sweating and an inability to stand. The heartbeat and pulse may be irregular. It can be mistaken for acid dyspepsia, GERD (gastro-esophageal reflux disease), pain in the chest wall, pleural infection, gall bladder disease or eso- phageal spasm.

If a person is suspected of having a heart attack, an ECG (electro cardiogram) is done, which usually shows characteristic changes. Blood tests for cardiac enzymes and blood troponin show elevated levels if the cardiac muscles are damaged. A chest X-ray can be taken to estimate the size of the heart. An echocardiogram delineates the damaged and non-functioning areas of the heart. Cardiac catheterisation is used to visualise the blocked arteries. This helps to determine whether the blocks can be treated by placing stents into the arteries or if a bypass surgery is needed. After recovery, heart function can be evaluated with a treadmill test, cardiac computerized tomography (CT) or magnetic resonance imaging (MRI).

India was an agrarian society where villagers laboured hard in the fields from sunrise till sunset. People developed preventable infectious diseases and died young. Now, education has changed their lifestyle. Many villagers have migrated to cities. Tobacco use is rampant. Exercise is minimal. Food habits have changed, with precooked, high fat, fast food being consumed as the norm. The consumption of fresh fruits and vegetables is minimal.

Many apparently healthy, young, adult males lead sedentary lifestyles. They work long hours and do night duty in an attempt to succeed in their profession. Though many offices have gyms, they are underutilised due to lack of awareness and time, and fatigue. Their weight gradually creeps up. They deposit fat around the stomach. In no time at all, their waist measures more than the ideal 32 inches and the BMI (weight divided by height in meter squared) is more than 25.

Food habits are often bad, with irregular eating times and dependency on oily fried snacks and trans fat filled fast food. Chronic lack of sleeps causes the blood pressure to go up. All this may precipitate diabetes and cause a deranged lipid profile. These abnormalities may be missed as no check ups are done. Many young men decide to have their first check up at 40 when it may already be too late.

Many are smokers, which adds substantially to the risk. Other precipitating factors are sudden emotions as while watching sports, excessive alcohol consumption, heavy fatty meals or sudden unaccustomed physical effort.

To prevent sudden death from a heart attack, the habit of aerobic exercise should be inculcated in children from first grade itself. This should be continued into adult life and in the work place. If you cannot spare an hour, or the recommended 150 minutes a week, run quickly up the stairs and down again slowly for 10 minutes a day. Avoid smoking and excessive binge drinking. Pay attention to your diet and consume 4-6 helpings of fresh fruits and vegetables daily.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

mental illness

Mad? What lunacy!

---

https://www.telegraphindia.com/1170320/jsp/knowhow/story_141581.jspYour Health -

 Dr. Gita Mathai

---

• 

Chronic illnesses come in many forms - arthritis, hypertension, diabetes, kidney failure - requiring a lifetime of regular medication. No one feels ashamed to admit that he or she suffers from these diseases. Mental illness, on the other hand, is hidden from the world and admitted to with shame. Such people are derisively called "lunatics", as though the moon was responsible for their behaviour!

Chemical imbalances in the blood cause diseases such as diabetes, and similar imbalances in the brain are responsible for mental illnesses. Both can be corrected and health maintained with with medication.

Almost 20 per cent of Indians (children, adolescents and adults) require treatment for mental illness. The number is apparently greater in urban areas. Some (adults and adolescents) suffer from major psychiatric illnesses such as schizophrenia, bipolar disorder and post-traumatic stress disorder, depression, anxiety, dementia or obsessive-compulsive behaviour.s.

In schizophrenia, the person has disorganised speech and behaviour and is out of touch with reality. Depression is diagnosed when instead of feeling low occasionally, there is social impairment and a loss of interest in activities. In anxiety, feelings are exaggerated and compounded. Constant worry prevents work and function. Bipolar people have violent mood swings, from hyperactive manic states to depression. Obsessive-compulsive disorder is characterised by repetitive unreasonable behaviour over which the person has no control. Post-traumatic stress disorder is a failure to recover fully after a terrifying event. An accident or a violent blow to the head can affect parts of the brain, leading to mental illness.

Children too can have a gamut of psychiatric disorders. But, as they grow physically, mentally and emotionally, it sometimes becomes difficult to draw a line between the outer edges of normalcy and psychiatric illness.

Children with anxiety respond to changed situations with fear and physical symptoms like sweating and a rapid heart rate. ADHD (Attention Deficit Hyperactivity Disorder) is one of the most publicised disorders, and sometimes over diagnosed. These children cannot concentrate and are disruptive..

Mental illness can affect anyone at any time. It can be inherited. Even if a person is prone to mental illness genetically, it is often triggered by life situations and environmental stress. Antenatal factors like exposure to alcohol, drugs, illnesses or medication can affect the baby. .

Most mental illness can be controlled but not cured. Medication will gradually relieve the symptoms and help the person to cope. Drugs must be taken regularly. Decisions about increasing or reducing dosage must be left to professionals. Dosages vary from person to person even for the same diseases. Psychotherapy helps the person to talk through problems. Occupational therapy, physical exercise yoga and meditation may also be helpful.

To help prevent mental illnesses:

• Children should be taught to regularly exercise out of doors for at least an hour a day
• All children need peer companions. Friendships should be encouraged
• Kids need to be weaned off isolationist computer and video games
• They should be allowed to watch only restricted television programmes.

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

noise pollution

Noise: Silent killerhttps://www.telegraphindia.com/1170227/jsp/knowhow/story_137960.jsp

---

Your Health - Dr. Gita Mathai

---

• 

  Normal conversation takes place at 55 decibels, anything above 85 decibels is harmful to our ears

Pollution comes in many forms - as additives and pesticides in our food, toxic fumes from factories and vehicles in the air we breathe, as green house gases in the atmosphere - and we are very aware of most of them. However, most of us remain blissfully unaware of is noise pollution and its myriad ill effects.

What exactly is noise pollution? Normal conversation takes place at around 55db (decibels); anything above 85db is harmful to our ears. You are immediate environment is too noisy if you have to speak loudly to make yourself heard, or turn up the volume of the television. Now, of course, you also have apps on your mobile phone that can tell you how much noise pollution you are putting up with.

In order to hear well, the fine hair called cilia in the cochlea (a part of the inner ear) has to be functioning well. Loud noises damage the cilia, resulting in hearing loss. This is usually symmetrical and affects both ears equally. It can affect only one ear if phones or music systems are held only on one side. This type of hearing loss, unlike presbycusis (age-related hearing loss) is 100 per cent preventable but not reversible. Progression can however be prevented.

Noise induced hearing loss happens so gradually that people do not realise it. Warning signs are when they find that following conversations becomes difficult, and, they have to ask people to repeat themselves. Sometimes, sounds in another room may be missed. There can be ringing in the ears (tinnitus) and loss of balance (vertigo). At this point, it is best to get the hearing professionally evaluated.

External sounds in the environment also affect our nervous system by releasing hormones and chemicals to produce a "flight or fight" reaction. If the sounds are prolonged, the body remains in a state of tension. Blood pressure can go up and heart disease can result.

Noise pollution has also been proven to cause nausea, anxiety, jitteriness, and anger. Arguments and fights can break out. Rhythmic beats can produce hysterical reactions in susceptible people. This can result in "pseudo possession" with them going into a trance and performing bizarre acts.

Sound is subconsciously considered a source of power. Vehicular traffic produces continuous sounds with motors revving and honks blaring. Some buses have "air horns" which they blow continuously while driving through traffic. Macho men drive motorcycles with silencers removed to increase the sound. The db at political rallies is not for the fainthearted. Our festivals, marriages and deaths are very noisy, with blaring music, and firecrackers.

Many people listen to music when they exercise. The "beat" of the song is adjusted. When the tempo is fast, people ran faster and when the tempo slowed they do too. Their effort and heart rate sync automatically with the music.

All this environmental noise enters our homes. We can reduce this by lining the walls with cupboards or bookshelves. Plants and shrubs also reduce noise. Televisions and smartphones can be silenced so that their continuous ringing and disruptive "pings" are at a minimum. Noise cancelling earphones can be used while travelling or if you work with loud machinery.

Noise pollution was less before automation and digitalisation. Despite this, Indians in the last century spent time in silent meditation. Today, it might be difficult to find a silent space, but, by using earplugs or noise cancelling earphones, it is possible. Ten minutes of silent meditation, especially if combined with deep breathing (20 times) three or four times a day, will do wonders to negate the impact of our noisy society.

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@ yahoo.co.in

washing hands

Firm with worms

---

Your Health - Dr. Gita Mathaiwww.telegraphindia.com/1170220/jsp/knowhow/story_136680.jsp

---

• 

Quite often, families that come to me complain that the children have "worms". They usually base the diagnosis on poor or perverted appetite (pica) and perianal itching, especially at night. Some actually see small white worms in the stool. This is not surprising as soil-transmitted worm infestation affects 50 per cent of our population! Practising something as basic as washing our hands and feet, regularly and properly, can save us and our children from such infections.

In fact, infectious agents cause over 60 per cent of diseases in India; 90 per cent of these can be prevented by hand washing. This is particularly true of respiratory illnesses such as the common cold, diarrhoea, parasitic infestations, influenza, and even serious illness like jaundice, typhoid and meningitis.

Germs (bacteria and viruses) enter our houses all the time - we carry them in from the road, our workplace and the children carry some in when they return from school or play. Germs cling to our hands when we go to the toilet, or touch mud or dust. Worms enter our bodies through our bare feet if they come into contact with contaminated soil. Pets - particularly cats, dogs and birds - harbour mites, parasites, bacteria and viruses, which cause diseases.

Sneezing and coughing ejects particles containing viruses and bacteria into the air. These eventually settle on walls, furniture and dust. People carrying germs can touch surfaces like walls, lift doors and banisters accidentally and contaminate them. As and when we touch these articles, the germs can enter our bodies. And they are always carried by our hands.

So washing the hands is an easy preventive measure, if performed correctly. Always use soap and scrub your hands well because soap destroys the cell walls of micro-organisms and the scrubbing dislodges and removes germs.

Washing hands after using the toilet may seem like elementary hygiene, yet a recent survey showed that only 67 per cent of Indians questioned actually washed their hands with soap. The reasons sited were many: Scarcity of running water or any water at all, lack of a toilet or absence of plumbing.

Doctors who do not wash their hands after examining each patient on their hospital rounds are liable to transmit infections from the first few patients to all the rest. This cross infection occurs in 5-15 per cent of hospitalised patients. The people most likely to suffer are young children, the elderly, and the immunocompromised (those suffering from cancer and HIV). They come to hospital with one illness and eventually have to stay much longer as they develop complications of other hospital-acquired infections. These are more severe, caused by super-resistant bugs and can be fatal.

The habit of washing hands has to be inculcated in children from a young age. Hands must be washed

• before eating

• after using the toilet

• after playing

• after touching pets and

• feet must be washed if you have been outside barefoot.

There is an urban myth -the 30-second rule - which states that if food falls on the ground and is picked up within 30 seconds, it is unlikely to be contaminated or cause disease. This is untrue, even if the floor is shiny.

Houses should be mopped regularly with disinfectant solution. Banisters and other surfaces that are touched by a lot of hands should also be wiped down. Sunshine is God's natural, non-chemical disinfectant gifted to us freely. We need to use it to dry our clothes, and allow it to enter our homes to maintain a germ-free environment.

HANDY TIPS

The correct way to wash your hands:

• Wet your hands thoroughly and then apply soap
• Rub your hands vigorously together and scrub the entire hand for at least 15 seconds.
• Rinse well and then dry your hands.
• If no water is available, use hand sanitizer. Take 3ml of the liquid and rub it all over both hands.

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India.
Mail your questions to yourhealthgm@ yahoo.co.in