fatigue and tiredness

Tackling tiredness Your Health DR GITA MATHAI “I am tired; every part of my body aches and I cannot manage my daily activities. I feel weak all the time.” This seems to be an international refrain, for which every system of medicine has tonics, supplements and treatment. As patients seek relief, it is important to distinguish whether it is muscle pain or fatigue they are complaining of. Fatigue is a feeling of tiredness or exhaustion. It is not lack of strength but lack of energy. Weakness, on the other hand, means that muscles are performing below par and extra effort is required to move the body. If the muscles are also painful, the perceived weakness may actually be due to discomfort. Painful movements tend to be feeble. A feeling of weakness can occur from sudden unaccustomed overexertion like walking a long distance or doing extra housework. This is normal. Spontaneous recovery occurs within a few days. If it persists, it needs evaluation. It may be due to a basic muscle or nerve problem, malfunctioning of the thyroid gland or, rarely, due to exotic illnesses such as myasthenia. A physical examination and blood tests can be done to detect these abnormalities. Fatigue can occur because of constant overwork and inadequate sleep. Adults require 7-8 hours of sleep. Although you may feel that you can manage with less, fatigue eventually sets in. Also, the sleep, though theoretically of sufficient duration, may not be restful, with frequent wakening. To overcome this problem, sleep at a fixed time every day and remove electronic equipment from your bedroom. If this does not work, poor sleep may be due to obesity or sleep apnoea and need evaluation. If too little food is eaten, the body is tired. If too much food, especially high calorie snacks, is eaten the blood sugar fluctuates and fatigue sets in. A diet with carbohydrates, fats and proteins in balanced amounts needs to be eaten. Caffeine boosts energy, but too much of it or a sudden withdrawal can produce fatigue. Anaemia (haemoglobin less than 12gms /dL in women and 13gms/ dL in men) decreases the oxygen carrying capacity of blood, resulting in tiredness. The cause of anaemia needs to be investigated and treated and iron supplements given. Worry or chronic stress produces a desire to “just lie down.” If it is due to an intolerable but unchangeable situation at home or work, professional help should be sought. It may require psychotherapy, medication or a combination of both. Exercise is a double-edged sword. It helps relieve stress and depression but too little or too much can both cause fatigue. Muscles need to be conditioned constantly and stamina needs to be built up. As little as 20 minutes of aerobic exercise three times a week can tackle fatigue. For fitness, the recommendation is 40 minutes a day 7 days a week. Any illness, especially viral infections such as a cold and flu, can cause a feeling of tiredness. This usually disappears a week or two after the illness clears up. Diabetes, hormonal imbalances associated with perimenopause, vitamin deficiencies (particularly vitamin D3), electrolyte imbalances — particularly low potassium levels — can all produce long lasting tiredness. These can be detected by appropriate blood tests. Treatment makes the fatigue disappear. Some prescribed medication such as anti hypertensives, statins and steroids can cause tiredness. If the symptoms started after a new medicine it is important to inform your doctor. Sometimes the fatigue persists for six months or more. It is debilitating and worsened by rest. In addition there may be muscle or joint pain (but no tenderness to touch), impaired short-term memory, sleep which is unrefreshing, frequent sore throat and headache. This is typical of chronic fatigue syndrome (CFS). The exact reason is not known but it can follow a viral infection. It is a diagnosis of exclusion, when tests for other diseases are negative. It is sometimes confused with fibromyalgia, which is also a long-standing illness with pain in the muscles and joints. Unlike CFS, there are certain points on the body pressing which elicits pain. Tests in fibromyalgia are usually normal. Both CFS and fibromyalgia are treatable. • Applying moist heat alternating with ice relieves pain temporarily. • Painkillers such as paracetemol and ibuprofen can be used. It is better to avoid more powerful medication as they may be habit forming and have side effects. Also medication should not be taken for more than 10 days at a time. • Some antidepressants help. This is because long standing stress associated with the illness depletes the chemical serotonin in the brain. The medication elevates serotonin levels. It also helps with sleep and that itself may produce an improvement. • Exercise also elevates serotonin levels naturally. Gradual graded gentle exercise like walking and swimming tones and conditions the muscle and is beneficial. Too much rest aggravates the symptoms. • Yoga and massage therapy are beneficial. 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

aging

eating the clock

Your Health DR GITA MATHAI

Today’s world belongs to the young. They get the jobs, the accolades for their appearance, the attention. This has led to an obsession with preserving youthful good looks, not only in India but all over the world. People want to ward off the changes of aging — the wrinkles, weak muscles and sagging skin. Initially, it was women who tried to delay, or at least conceal the inevitable, but now anti-ageing products have become a multimillion-dollar industry targeting both sexes. Many products are targeting an exclusively male clientele. A host of creams on the market claim to protect your skin from the ravages of time. Their cost varies from Rs 500 for a small tube to Rs 40,000 for a jar. Some claim to contain such exotic things as placental extract, aloe vera, retinol or derivatives obtained from stem cells. Others contain gold and heavy metals. Advertised as remedies that work in a few weeks, the models in their advertisements are photo shopped and airbrushed. It is this computer editing (and not the cream) that miraculously “wipes” the age lines away. Wrinkles and blemishes form from the dermis, the layer under the skin. It is a moot point whether sufficient quantities of cream actually penetrate that deep. Perhaps the best bet (and cheapest too) is to do what our grandmothers did, and apply a mixture of equal quantities of coconut oil, rice bran oil and sesame oil. Wash off with a mild soap after 10 minutes. Men are particularly conscious of receding hairlines. They are going in for hair transplants, hair dye and facials. Different dyes have to be used for facial hair and that on the head. The face is very sensitive, so try out the dye on a small area first to see if there is an allergic reaction. A variety of unregulated “revitalising, anti-aging testosterone boosting” health supplements are advertised for men to improve libido and increase muscle mass. It is best to avoid them. They are of doubtful efficacy and may contain heavy metals. Some are dangerous, especially in combination with allopathic medication for diabetes, hypertension or heart disease. Cosmetic procedures such as botox injections, liposuction, sculpting of specific areas, breast reduction or augmentation or uplift are very popular. These are major surgeries not to be taken lightly. Botox, if administered inexpertly, can have serious side effects. If we really want to combat ageing, we should take as much care of our internal health as we take over our physical appearance. The perquisites for healthy ageing are the absence of chronic illness and an adequate income. Stress levels should be kept to a minimum and the outlook on life should be positive. It is best to quit smoking and drink in moderation. It may not be possible to avoid a chronic illness. Even with hard work and astute investments, finances may go into a tailspin. Stress can, however, be kept under control and a positive outlook on life maintained with regular exercise, yoga and meditation. You should be strong enough to keep addictions (alcohol, cigarettes and drugs) under control. Remain active mentally by continuing to work as long a possible. Doing crosswords and solving puzzles also helps. People are always looking for a miracle pill that they can pop to live longer and look younger. The first drug reported to delay ageing was a growth hormone, which is now sold illegally. It has to be taken as an injection, has serious side effects and no proven anti-ageing benefits. A naturally occurring enzyme in the body called SIRT1 increases the life of cells and retards ageing. It is switched on naturally by calorie restriction and exercise. Certain chemicals like resveratrol present in red wine are found to activate this enzyme. Calorie restriction, 40 minutes of exercise daily, meditation and yoga will improve vitality and reduce the appearance of ageing. More important, a healthy body will help you enjoy the years you have left. 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

tummy troubles

Tummy trouble Your Health DR GITA MATHAI Nobody likes to hear about bowel movements. The only exception is the bowel movements of infants – their bowel movements are avidly studied, followed and discussed. Since no two children pass stools of the same colour, consistency and frequency, there is a lot to discuss. Young parents and caregivers have an anxious time trying to differentiate the “normal” from an illness. Babies float in amniotic fluid in the uterus. Some of it is swallowed, which is why babies pass a black and sticky motion (called meconium) soon after birth. Within a few days the colour changes, gradually becoming the usual golden yellow stool. In 2-3 per cent of newborns as the change in colour occurs around day four there may be frequent watery stools – a “transitional diarrhoea.” This is normal and requires no treatment. Exclusively breast-fed babies pass soft golden yellow semisolid motions. The frequency varies from once a day to up to 10-12 times a day. As long as the consistency and colour are normal, there is no need to worry. Formula-fed infants have beige stools, which are more solid and occur only once or twice a day. Breast-fed babies are less likely to develop diarrhoea than formula-fed infants. If breast milk is inadequate and artificial feeding has to be done, a sterilised stainless steel bowl and spoon are safer than a feeding bottle. If bottles and nipples are used, they must be cleaned thoroughly and then sterilised by boiling for 10 minutes. The signs that signal danger in diarrhoea are: • Watery motion • Projectile motion that shoots out at a distance • Change in colour to green • Blood or mucous in the stool • Dehydration. This can be picked up by sunken eyes, depressed fontanel ( the gap in the skull bones at the front of the head), loss of skin turgor, lack of tears and failure to pass urine for 3-4 hours. • Fever • Vomiting Diarrhoea in children may be infective, and be caused by a variety of viruses, and parasites. Of these, the rotavirus has been proven to cause 35 per cent of the diarrhoeal deaths in children before the age of five. The maximum mortality occurs in children less than a year old. Diarrhoea may have non-infective causes such as a total or relative lactose or sugar intolerance, allergy to certain foods, fructose in fruit and fruit juices, sorbitol or mannitol in artificially sweetened juices. It may have a surgical cause such as appendicitis or intussusception. The diarrhoea may also be a manifestation of disease elsewhere in the body, like an infection in the urinary tract. If it lasts for two weeks or more, it may be caused by malabsorption, endocrine abnormalities (especially thyroid), tumours, and pancreatic or liver disease. Investigations have to be done to diagnose the problem accurately. In any diarrhoea, it is important to prevent dehydration as that is responsible for most fatalities. Fluid loss should be replaced. Children can be given commercially available, correctly reconstituted ORS (oral rehydration solution), salted buttermilk, rice kanjee with salt or watery kitchdi. It is best to avoid fruit juices and aerated cola drinks. Anti diarrhoeal medications such as loperamide and lomotil, which are available over the counter, should not be given to children. Antibiotics will not work unless there is a bacterial infection; they do not work against viruses. If prescribed, they should be given in adequate doses for the duration prescribed and not discontinued as soon as there is symptomatic improvement. If there is lactose deficiency, stopping milk temporarily, and substituting it with soya milk will help control the diarrhoea. Chronic diarrhoea or frequent recurrent attacks can result in slight zinc deficiency, which perpetuates the diarrhoea. Zinc supplementation causes a reduction in the frequency of the stools, weight gain and an improvement in general health. Before preparing food for a child or feeding him or her, you should wash your hands with soap or use a hand sanitizer. The child should also be taught the importance of washing her or his hands before eating. Children should not return to school for 48 hours (two days) after a diarrhoeal illness. In India, diarrhoea is responsible for 13-14 per cent of the deaths in children under the age of five. Of this, rotavirus is responsible for 34 per cent of the deaths. Rotavirus infection can be prevented with timely childhood immunisation. The vaccine is given orally. The schedule should be started in the second month for maximum benefit. Proper sanitation, sewage disposal and safe drinking water are not available in most of India. Until these deficiencies are rectified, bacterial and parasitic diarrhoea will remain a major health problem, especially for children. Of the infective causes, only cholera and rotavirus infection are preventable with immunisation. 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

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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