to operate or not

o operate or not to operate DR GITA MATHAI Fit individuals withstand surgery better. They are also less likely to require surgery for hip, spine and knee problems. To attain this:  Walk briskly for an hour a day every day Do flexion and core strengthening exercises Maintain ideal body weight Almost all of us will have to undergo some sort of surgical procedure at some point in our lives. Most of us (even doctors) are scared of surgery and face it with trepidation. Surgery is unavoidable in cases of severe trauma caused by an accident, acute appendicitis, badly broken bones, acute abdominal emergency and Caesarean sections. Many cases are not life threatening, and the surgery can be postponed to a time and date convenient to the surgeon, the patient and family members. This respite can be effectively utilised to seek a second opinion (preferably from a teaching institution) to see if the surgery really is essential. Also, a physician can be consulted to see if medical treatment is a viable option. Procedures like hip and knee replacement, spinal surgery for back problems and hysterectomy have become common. Before going under the knife, check if a combination of weight loss, physiotherapy, medication or hormonal treatment can do away with the need for surgery. Bypass surgery for blocked heart arteries has become commonplace. Today, interventional cardiologists can clear many of these blocks and place stents (angioplasty) at less expense. Earlier, all surgeries meant that patients were opened up and required prolonged hospitalisation to deal with the extreme pain and to heal properly — post operative complications led to deaths, too. Nowadays, many surgeries can be done through “minimally invasive” techniques. Laparoscopy is one such procedure where doctors insert two tubes through small openings. One of the tubes has a small camera which projects the view of the area on screens inside the operation theatre. That helps doctors manoeuvre the tiny scalpel in the other tube. Many surgeons specialise in laparoscopic surgery. Blood loss in such surgeries is minimal and hospital stay is very much reduced. Laser cutting knives and robotic extensions have made surgeons more efficient and reduced patient suffering. If you need an “elective” surgery as opposed to an “emergency” procedure, you can usually delay it for a month or two while you prepare yourself mentally, physically and emotionally. Postponing it any longer may be counter productive as the disease may progress. If you are a fit 70 something, opting for a knee or hip replacement may make the rest of your life pain free. (Now that life expectancy has increased). If you delay the surgery for too long, you may become incapacitated, medically unfit or complications may set in. Pain and immobility may make your life difficult and you may become a burden to your caregivers. While you wait for surgery, control blood sugar and improve nutrition and exercise to better your muscles, heart and lungs. All this will speed up healing. If you are a smoker, tell your surgeon and try to quit at last two weeks before the procedure. Smokers take longer to recover from anaesthesia, require more time on the ventilator, wound healing is delayed and scar tissue is more likely to form. Regular alcohol consumption results in relative resistance to anaesthesia and higher doses of sedation and painkillers may be required. All allergies and intolerance to medication should be documented and the surgeon and anaesthetist informed. A list of medication for other illnesses such as diabetes, hypertension, asthma or heart disease should be prepared and handed over. Herbal, ayurvedhic or homeopathic medication should be discontinued five to seven days before surgery. Even if they are taken for general health or an unrelated condition and classified as “harmless”, they can interfere with blood clotting and medication for sedation. Anxiety about the surgery, fear of anaesthesia, thoughts about death may cause insomnia, hypertension and palpitations in the days prior to surgery. Surgery is now a safe procedure and techniques are very advanced. If reassurances do not alleviate anxiety, yoga and meditation may help. Alternative medicines or massages do not serve as a substitute for surgery once it has been fixed and deemed to be essential. They can only help the body cope, but do not serve as a substitute. 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

cold sores

Cold sores decoded Your Health DR GITA MATHAI Fever, infections (particularly bronchitis and pneumonia), stress, excessive exposure to sunlight or even menstruation can sometimes lead to the appearance of “fever blisters” or “cold sores”. These are multiple, transparent blisters grouped together — filled with a clear fluid — that are situated near the margins of the lips, the nose or the cheeks. They appear without warning and disappear in much the same way in around two weeks. These lesions are due to infection by one of the Herpes group of viruses. The various members of the Herpes family that can cause infections such as chicken pox, herpes zoster and an STD (sexually transmitted disease). The one causing the fever blister is usually the Herpes Simplex Virus (HSV) type 1 but can also be type 2. Exposure to the virus starts from birth. The rate of infection increases from 0 per cent at birth to 30 per cent by age 30, 50 per cent by age 50 and 90 per cent by the age of 70. Exposure does not necessarily result in blisters. The virus is capable of remaining dormant till the immune system is sufficiently weakened for it to manifest. There is tingling and mild discomfort 2-3 days before the lesions erupt. Children (under five years) may have fever, headache, dizziness and nausea. Although the blisters have not yet appeared, the person can still spread the infection. Soon, the affected area becomes a mild red. Tiny, pimple-like swellings filled with a clear fluid erupt. These usually appear in clusters on the lip itself, the border of the lips, the chin or nose. The blisters then burst and release a clear fluid. This fluid is highly contagious. The blisters then crust over and form scabs, which fall off. The scabs too contain potentially infective viruses. In children (under five) the infection may start in the mouth. Initially there is redness, followed by the appearance of multiple blisters. These rapidly break down and can coalesce, forming multiple painful shallow ulcers. Swallowing becomes painful so the child may refuse to eat or drink. It may be difficult to even swallow saliva. As a result the child drools. The neck may be swollen with enlarged and painful lymph nodes. The unfortunate reality is that the virus never entirely leaves the body once it enters. It establishes permanent residence in one of the branches of the trigeminal nerve, which supplies various areas of the face. In 20 per cent of the people, the virus remains latent in the body and does not resurface. In the majority there are one to three recurrences in a year. Some unfortunate individuals have up to 12 attacks a year. The cold sores usually clear up by themselves within two weeks if left alone. A doctor needs to be consulted if the lesions are still present after a couple of weeks. This may occur if the initial diagnosis is not be correct or secondary infection has occurred. Treatment is most effective if started in the early stages when the tingling occurs but the blisters have not yet appeared. Unless people have frequent attacks, they do not realise that this is the prelude to an attack. Applying creams containing one per cent lemon extract, zinc oxide or the anti viral “cyclovir” group of compounds twice or thrice a day will reduce the symptoms, and speed healing by a day or two. In young children, people with deficient immunity and the elderly, doctors may start anti-viral tablets to speed up the healing process. Cold sores are highly infectious. They are also itchy, pricking and irritating. It is difficult to not touch, scratch or pick at the scabs once they form. The virus then transfers to the hands and gets deposited on any surface it comes into contact with. It survives on tables, walls or clothes for many weeks. The virus can also be transferred through utensils or shared food. Any person who touches these contaminated surfaces and then their face, nose, lips or mouth can develop the infection. Children who place their infected fingers in their mouth develop infection there. It can also be transferred from feeding bottles, pacifiers and toys. Any blisters which recur days, months or years later are equally infectious. One of the best ways to prevent infection is not to touch the infected area, to wash hands frequently, and not share utensils or food. Once the primary infection has occurred, it is difficult to predict or prevent recurrences. 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

breathing

A breath of fresh air

Your Health DR GITA MATHAI

Work your lungs Stand straight with feet shoulder width apart. Take a deep breath for a count of 20, allow air to fill your chest, and then push out your abdomen. Hold it for a count of 20. Breathe out, pushing in your stomach and forcing your diaphragm upwards. Do this for a count of 40. Repeat 20 times Life starts with a baby’s first breath and ends with the last one. We breathe without being conscious of it. It is an autonomous reflex that is so deeply embedded in the brain that it is not possible to commit suicide by holding your breath. Shortness of breath occurs when we become conscious of our breathing and it is no longer automatic. We feel it is insufficient, or that the “air” is not enough. It can occur for many reasons. It may be just a subjective perception; anxiety may make you take short, sharp, ineffective breaths or attention-seeking individuals may have conscious intermittent sighing respiration, which induces anxiety in care givers and bystanders. The respiratory rate can be measured by counting the number of breaths for a full minute. It is 30-60 per minute in babies. It then gradually falls to 12-20 per minute in adults. The rate increases with illness, in anxiety, fear or with exercise. It decreases (8-18/min) and becomes imperceptible and shallow while sleeping. During breathing, air enters through the nose and reaches the lungs through a system of pipes and airways. The lungs have multiple alveoli or sacs where oxygen from the air enters the body and carbon dioxide (a waste product) leaves the body. The lungs expand when air is breathed in. This occurs because the rib cage moves out, the diaphragm (a muscle that separates the chest from the abdomen) moves down and the stomach moves out. With age, the rib cage becomes fixed and the muscles that move it weak. Breathing becomes laboured, inefficient and difficult. Obesity causes mechanical problems. The rib cage and stomach do not move efficiently so the lung capacity is reduced. Fat deposits around the neck can cause obstruction and snoring while sleeping. Difficulty in breathing may be due to problems in the nose itself. It may be blocked with an allergy or a viral infection, there may be obstructive polyps, the septum may be deviated to one side or the sinuses that drain through the nose may be infected. Allergies can be due to dust, paint, cement, cockroaches, house mites, incense sticks, aerosol sprays or vapourising mosquito repellents. Avoiding the allergen may cure the nose block. If this is not possible, tackle it with nasal drops and sprays. Medicated sprays tend to be habit forming and cause rebound congestion. This means they become less effective and have to be used more frequently. It is better to use saline drops or a locally acting steroid like fluticasone. Steam inhalations also help. Antihistamines dry nasal secretions. A deviated septum may require surgical correction. Enlarged tonsils and adenoids can cause mechanical block and snoring in children. Hyperactive airways can constrict and collapse when there is infection, an allergy or exposure to more or less the same allergens that cause nose blocks. This results in a wheezing sound. Breathing becomes laboured and a fear of “asthma” sets in. This constriction can be effectively tackled by direct delivery of medication to the lungs. Nebulizers, spacers, inhalers and rotahalors do this efficiently and effectively. Since these deliver the medication directly to the target organ (lung), the side effects are minimal. Before these systems were developed, only tablets and syrups were available. They had to get absorbed from the intestines and then be carried by the blood to the lungs. This took a long time and the medication also produced side effects. Heart, liver and kidney disease or failure causes fluid build up in the body. The feet and abdomen become swollen and fluid accumulates in the lungs, making breathing difficult. This fluid has to be medically removed for breathlessness to improve. Even though breathing is a reflex, we need to make sure the apparatus functions efficiently. Aerobic exercises such as running, jogging, swimming, cycling and brisk walking increase the oxygen requirements of the body. Breathing becomes rapid and all the muscles need to function to their maximum capacity. Exercising for an hour most days a week keeps our breathing apparatus working in tip-top condition. There are breathing exercises in yoga, Tai Chi and in the martial arts. If performed regularly, they increase lung capacity. These are worth practising every day so that age-induced changes do not reduce respiratory capacity. These exercises complement aerobic activity. 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

cancer the crab that kills

The crab that kills

Your Health DR GITA MATHAI

Cancer is not a new disease. The word cancer is derived from karkinos, Greek for crab. Worldwide, 13 per cent of deaths can be directly or indirectly attributed to cancer. The apparent increase in numbers is due to the population explosion, increased longevity, improved diagnoses and better communication. Everyone knows someone who has cancer. In developed countries, cancer is picked up early because of awareness and subsidised screening programmes. Treatment is effective and a large number of people survive. This is not the case in our country. Here, cancer is diagnosed late because of fear, ignorance or lack of facilities. In the coming decade, 70 per cent of cancer deaths worldwide will occur in developing countries. There are more than 100 types of cancer with different symptoms. The patient may notice the presence of a swelling. The abdomen may get swollen. Lymph nodes may enlarge and appear in various parts of the body. The diagnosis is difficult when the symptoms are vague, like chronic fatigue, weight loss, hoarseness of the voice, difficulty in swallowing or breathing or non-specific muscle and joint pains. All cancers are due to mutations in the genes and damage in the chromosomal structure of the body. These alterations in cell structure allow them to grow rapidly with no regulation. Normally, tumour suppressor genes prevent this abnormal growth. Genetic damage is corrected by inherent repair genes. Cancer sets in when these genes are either damaged or dysfunctional. Genes may be defective from birth. If this is balanced by a normal gene, the person may not get cancer. In others, the abnormal gene may cause cells to grow at a certain age. The cancer then manifests itself. Many members of a family may carry the gene and eventually develop cancer. If the defect is in a particular gene they will all have the same type of cancer, such as breast cancer. If it is in the tumour suppressor gene or repair genes, the affected members will have different kinds of cancer. Not all people who have a defective gene will develop cancer. The environment and lifestyle also play a part in it. Genetic mutations may occur as a result of chronic inflammation or viral infections (Human Papilloma Virus, Hepatitis B virus, Epstein-Barr virus.). It can occur as a result of imbalanced hormones, excessive exposure to ultraviolet light or prolonged contact with or intake of cancer causing chemicals. Although cancer can occur at any age, the risk increases with age and the incidence rises sharply after 65. Other risk factors are unhealthy habits such as tobacco (chewing, snuff, smoking) use, being exposed to second-hand cigarette smoke and having more than two drinks a day (in men; one in women). Consumption of food additives such as sodium monoglutamate, preservatives and some food colours is dangerous. Exposure to chemicals like benzene or working with asbestos are risk factors. Cancer is diagnosed by a comprehensive physical examination, followed by appropriate blood tests, X-rays, scans and biopsies of suspicious lesions. There is no universal test for cancer. Accurate and early diagnosis usually results in successful treatment. The tumour may be surgically removed. This may be followed by radiation and chemotherapy. Pain, infection and other complications may require adjuvant palliative care. Some cancers require stem cell treatment. In others, biological therapy is used whereby the body is taught to recognise and attack cancer cells. Alternative medicine has not been proven to have an effective cure for cancer. But yoga, hypnosis, acupuncture, acupressure or massage can help the patient cope with it. 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

PCOS

he hairy sex Your Health Dr Gita Mathai Poly cystic ovarian syndrome is genetic. Many close female relatives may also be obese and hirsute, with menstrual problems and infertility Obese girls could develop PCOS (above) and exercise might help Girls change physically when they attain puberty, and most mature into attractive women. A few become unrecognisable. They become obese, develop acne and have hairy arms and legs. They sprout facial hair, develop a receding forehead and, if there is a familial tendency, male pattern baldness as well. This in itself is enough to make parents anxious. If, in addition, the periods are also irregular, scanty or excessive, parents often bring the girl for evaluation. Most of these women have poly cystic ovarian syndrome (PCOS). This affects 10 per cent of the women in the childbearing assge group. In addition to the typical physical characteristics, an ultrasound shows multiple fluid filled cysts dotting the periphery of both ovaries. The changes are due to a relative insulin resistance. These women show blood values of high fasting insulin levels of over 10 IU/mL (international units per millilitre), although 25-30 IU /mL is the cut off in men and older people. The ovary responds to this high insulin level by producing more male hormones like testosterone. The brain responds by resetting the pituitary ovarian control axis and its chemical messengers. The eggs in the ovaries remain immature fluid filled sacs and are not released (anovulation). Anovulation, unbalanced hormones, irregular feedback from the brain, all these reasons cause irregular menstrual cycles, relative infertility and, later, recurrent pregnancy loss. PCOS is genetic and probing questions will reveal relatives (male and female) with adult-onset diabetes, obesity, high values of triglycerides and high blood pressure. Many close female relatives may also be obese and hirsute, with menstrual problems and infertility. Unfortunately, although many of these patients seek help during their late teenage years, they are not investigated or diagnosed properly. They are offered placatory advice instead and given iron and calcium supplements. Some are given mysterious proprietary aryuvedic “gyno mix” tonics. Others are assured that the condition will spontaneously resolve itself after marriage. Nothing could be further from the truth. Treatment and lifestyle changes have to be made to correct the cascading biochemical abnormalities. Weight control is the mainstay of treatment. As far as possible, only 1500 — 2000 calories should be consumed a day (20 kcals/kg/day). Carbohydrates should be complex so that digestion and assimilation take time, increasing satiety. At least four helpings of fruits and vegetables should be eaten every day. Dieting alone causes initial weight loss after which there is a plateau and then the weight starts to increase again. To sustain and maintain the correct weight, diet has to be combined with aerobic exercises like walking briskly, jogging or cycling for 45 minutes a day. Medications like metformin,rosiglitazone and pioglitazone either singly or in combination correct the biochemical abnormalities. This is itself may regularise the cycles and restore regular ovulation. Oral contraceptive pills (OCPs) provide oestrogen and progesterone in the correct proportions to artificially produce regular menstruation. The hirsutism and acne also decrease as the pills restore the hormonal balance. However, if the woman wishes to become pregnant, OCPs should be discontinued. Other medication like clomipheneor letrozole should be taken on the appropriate days under strict medical supervision. Surgical treatment can be performed by expert and experienced doctors. Traditionally a “wedge resection” of the ovary was done and then ovulation was induced with medications. Now there are newer techniques. Each ovary can be drilled and punctured 10 -12 times through a laparoscopic puncture wound using a laser fibre or electrosurgical needle. This results in a dramatic lowering of male hormone levels in 80 per cent of cases within days. Many women who did not ovulate initially with letrozole or metformin therapy will do so after ovarian drilling. Interestingly, women who smoke, take snuff or chew tobacco rarely respond to the drilling procedure. Once women with PCOS become pregnant, only half the battle is over. They are more prone to developing gestational diabetes, hypertension in pregnancy and have a poor outcome with abortion or still birth. If they have become pregnant after taking fertility medication, they are more likely to have multiple pregnancies, with twins or triplets. As women with PCOS grow older, their menstrual cycles may become normal. They still remain at risk for diabetes and hyperlipidemia. Both these increase the risk for strokes and heart attacks. They are also at higher risk for uterine cancer. If you have PCOS, remember it can be controlled but not cured. Reduce your risk factors with diet and regular exercise. Keep your weight in the normal range and go for regular annual check ups to detect and reduce your risk factors. 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

painful nerves

ouch a nerve Your Health DR GITA MATHAI One out of every two people in India suffers from neuropathy — a disease caused by changes in the nerve cells. These changes may be age related. The degeneration is accelerated and aggravated if the patient suffers from diabetes, hypertension or has an abnormal lipid profile. Neuropathy can affect all three nervous systems — central, peripheral and autonomous. If the central nervous system is affected, memory and cognitive skills decline. Forgetfulness becomes an accepted way of life. Peripheral neuropathy produces the most obvious, incapacitating, and distressing symptoms. In some, the affected nerves may produce symptoms that are symmetrical (occurring in both limbs) and appear first in the furthest extremity. There may be paraesthesia (tingling, burning or numb sensation), hyperalgesia (abnormally acute pain sensation to innocuous stimuli) or deep aching. The symptoms tend to get worse at night and interfere with sleep. In others, the sensation of and response to pain may be lost. Injuries can occur unnoticed. Infection may set in and be neglected because there is no warning pain. Healing may be delayed as unnoticed micro trauma continues to occur. Ulcers become chronic. The nerves supplying the muscles can also be affected, leading to weakness and atrophy. Muscles visibly shrink, resulting in hammer toes (toes curve downwards) or drop foot (moving toes and ankle become difficult). Weak muscles cannot hold the joints in place efficiently, leading to sprains and fractures. The symptoms of autonomic neuropathy are not as clear-cut. Patients complain about unrelated symptoms such as dizziness, poor balance and frequent falls, fainting spells, nausea, abdominal pain and bloating, attacks of “gas” or sexual (especially erectile) dysfunction. These symptoms are difficult to objectively evaluate or substantiate. The condition is ignored and under-diagnosed. Such patients can die suddenly because of malfunction of the autonomic nerves supplying the heart. Neuropathy is more likely in people with the metabolic syndrome. This is diagnosed when there is increased level of fasting glucose, elevated triglycerides, decreased high-density lipoprotein-C (HDL-C), central obesity, and hypertension. At least three of the five should be present. Thirty per cent of the people affected by peripheral neuropathy are diabetics. Of these, 20 per cent are unaware of their elevated blood sugar level, which is diagnosed during the blood tests done for the evaluation of neuropathy. Smoking or the use of tobacco in any form is an independent risk factor. The cancer-causing chemicals in tobacco enter the blood stream and affect the brain and the lining of the nerves. Alcohol acts as a direct poison on the nerves. It also interferes with the absorption of the B group of vitamins. A neuropathy results, which does not respond to treatment until alcohol consumption is stopped. Diseases of the intestines that cause malabsorption can lead to vitamin deficiency and from there to neuropathy. Surgery to remove portions of the intestine can have the same effect. Keeping blood sugar, weight, hypertension under control and regularising lipid profile reduce the symptoms of peripheral neuropathy. The damage to the nerves is reversible in the early stages. Once neuropathy is established, however, response to treatment is unsatisfactory. Many adjuvant medications have been tried, such as mega doses of vitamins, iron, zinc, calcium, alpha lipoic acid, acetyl-L carnitine. Increasing doses of painkillers like tramadol are also used. Sometimes they are combined with anti histamines like diphendydramnine (Benadryl) and pain modifying drugs. Combinations with anti epileptics such as gabapentin and anti depressants like amitriptyline reduce the intensity of symptoms. None of these treatments has been 100 per cent successful. The pain is still present in 80 per cent of the patients 5-10 years later. The intensity of the pain can be reduced by soaking the legs up to the knees in warm salted water for 10 minutes, half-an-hour before bed. Application of pain relieving ointments that contain capsaicin also provides relief. The ointment should be applied every 3-4 hours. Do not rub the ointment in too vigorously as it will damage the skin. 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

mental illness in children

roubled minds Your Health DR GITA MATHAI The image we have of a mentally-ill person is that he or she runs around unkempt, if not naked, and speaks gibberish. That is not necessarily correct. Mental disorder covers a spectrum of symptoms, from the deranged person unable to care for himself or herself to the unreasonable, paranoid or socially offensive member of society. Most mental illnesses start in childhood. Around 20 per cent of children and adolescents (2-18 years) suffer from psychiatric disorders, which initially manifest with minor symptoms. Parents and caregivers ignore early symptoms, confident that the child will “grow out of it”. Even when symptoms are severe, obvious and socially embarrassing, parents are chary about seeing a psychiatrist because of the perceived social stigma attached to it. Undiagnosed and untreated, the illness becomes a full-blown disease by the time the patient becomes an adult. In children, the symptoms are often vague and difficult to classify as “abnormal”. Shyness, anxiety, speech peculiarities and temper tantrums may appear normal. Also in nuclear families, parents and grandparents may adjust to behaviour that is not normal. Any consistently inappropriate behaviour that occurs often, lasts a long time and repeatedly disrupts the child’s life or family should be taken seriously and investigated. The symptoms that should be taken seriously are hyperactivity with an inability to sit down and concentrate on any task, refusal to eat, difficulties in urination or passing motion, poor school performance, difficulty in sleeping, defying authority, refusing to attend school, outbursts of temper, disobedience, stealing, damaging property, poor social skills with no friends and having nightmares. The illness is already severe if the child hallucinates. Children who suffer from psychiatric problems like anxiety are socially withdrawn and nervous. They may avoid places or activities. ADHD (Attention Deficit Hyperactivity Disorder) affects 3-5 per cent of school children. It is commoner in boys. The symptoms are inattentiveness, overactivity, and impulsive or inattentive disruptive behaviour with or without learning disability. Autistic children withdraw into themselves, lack empathy, dislike or avoid physical contact and have poor language and communication skills. They cannot make friends. Meal times may become stressful because they refuse to eat. There may be extreme mood swings. The exact cause of mental illness is not known. It is probably the result of a combination of factors in a susceptible individual. It does tend to run in families, especially if many members have major or minor psychiatric illnesses. This may also be because a mentally ill parent cannot nurture a child appropriately. It does not, however, mean that children of parents with mental disorders will necessarily develop the disease. Chemicals called neurotransmitters convey signals from one brain cell to another and thereby control all brain activity. If the chemicals are not in proper proportion or sync, the imbalance can lead to symptoms of mental disorder. The imbalance may be hereditary or the result of an injury or illness. Stress in any form, either psychological (loss of a parent) or environmental (war or violence) can also affect the levels of these chemicals and precipitate mental illness. Children with psychiatric problems do not grow up and grow out of their illness. They require appropriate and timely treatment. Although more than 50 per cent of mental illnesses begin by the age of 14, it often stays undiagnosed. If the illness becomes worse, the child may be forced to drop out of school. He or she may have suicidal tendencies, may attempt suicide and actually succeed. The child may become dependent on drugs or alcohol and become sexually promiscuous. Adults can visit a doctor. Children, on the other hand, need to be taken to a doctor after parents recognise the symptoms. They need to be evaluated by a paediatrician and a child psychiatrist. Once a diagnosis has been made, a combination of behavioural therapy, psychotherapy and occupational therapy is used. Medication is required in certain children, but it needs to be used only as a last resort. Major psychiatric problems such as schizophrenia require appropriate medication. Children need a stable home environment to develop normally. They need adequate discipline. Winning your child’s affection by undermining the authority of the other parent or being overly indulgent is detrimental. It sends mixed signals to the child and leads to emotional conflict. Exercise is very important for mental and physical development. Structured outdoor activity for at least half an hour daily is required after the age of three. This helps to regulate neurotransmitters. Television viewing needs to be supervised as well as curtailed. The rapidly flashing images deplete neurotransmitter levels. Children should not watch programmes unsuitable for them as well as violent cartoons. Parents, spend an adequate amount of time with your child. This way you will immediately pick up on any problems. 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