PART 4: KEEPING YOUR CHILD HEALTHY
You can manage some of your child’s common childhood illnesses like diarrhoea and fever yourself. However,
consult your doctor if your child’s looks make you anxious or
if the symptoms persist.
Diarrhoea is Nature’s attempt to rid the system of the offending agent that is responsible for it. Watery
diarrhoeas are mostly due to infection by a virus. No antibiotic
acts against this virus. In fact, antibiotics can be harmful
in such a situation.
However, while diarrhoea helps by ridding the system of the offending agent, it also allows important salts and
water to be drained from the body. This can result in dehydration
if not managed well.
Severe dehydration can have serious consequences. The passage of a lesser amount of urine is one of the
significant symptoms of dehydration and it is more important to
count the number of times the child passes urine rather than the number of watery motions.
There is no cause for concern as long as the child
passes light-coloured urine frequently. The number of motions
is not that important. One child may pass several small
motions, but continue to remain active and pass urine frequently.
Another may pass only a few large watery motions, but become listless, stop passing urine or pass very
little dark, concentrated urine during the course of 6 to 8 hours.
The latter child needs attention.
Do not put a diaper on your infant if she has diarrhoea;
this will allow you to watch the colour and frequency of urination. Remember that a watery stool can give the appearance of
urine and may mislead you.
Such watery diarrhoeas can take even upto a week to get better. In some children, the diarrhoea gets better
within a day. In other children, it may take longer.
Frequent motions in an exclusively breastfed child are normal. At times, these motions are watery, frothy and
green, or may contain mucus. This is not diarrhoea and needs no treatment.
If your child develops diarrhoea, start the following
treatment immediately. Do not wait for the signs of dehydration to develop. Even if the child has developed mild, moderate
or severe dehydration, do not panic but start the treatment suggested below. Most cases of dehydration can be
managed at home, but if the child looks sickly, listless and
passes too little urine, she may need intravenous fluids and hence
a doctor must be consulted.
But while you wait for the doctor, start the treatment prescribed below.
- A child with diarrhoea needs food and fluids. Do not starve the child; this results in malnourishment and
consequent lowered resistance to fight the disease. It
is true that some amount of food given in diarrhoea is lost in the motions,
but a moderate amount is absorbed into the system even in the presence of acute watery
diarrhoea. Let the child eat or drink what she likes. Breastfed children should continue breastfeeding, as
breast milk supplies the essential nutrients and
includes all that is required for rehydration. If the child is
older and is having a few breastfeeds and more of other foods and liquids, increase the frequency of breastfeeding.
Breast milk also has anti-infective factors that may
help fight bacterial as well as viral diarrhoea.
- If your child’s appetite is diminished, encourage
her to have small frequent drinks of any liquid she may prefer — breast milk, soup, juice, coconut water, dal water,
barley water, buttermilk or weak tea, with plain water
in between. In general, rice preparations and potatoes are better tolerated in diarrhoea. A khichdi of rice and dal
with curds is an excellent combination. Banana is good in diarrhoea.
- Rice cunjee and ‘water,
salt and sugar solution’ are the most important ‘medicines’ for the treatment of
diarrhoea and dehydration. In watery diarrhoeas, no other medicine is needed. Such liquid preparations
prevent dehydration and also help rehydrate the child.
Of course, the best rehydration solution for an infant is mother’s milk. If the child has
become so weak that
she cannot suckle, express the milk by hand and give it with a spoon.
- Rice cunjee is made by cooking a handful of rice
powder with water for 10 minutes to make a thin liquid. To
this, add one level teaspoon of salt and more water to make it up to 1 litre (5 glasses of 200 ml each). Alternatively,
powdered pop rice can be used (without further cooking) with added salt and water.
- Water, salt and sugar solution is made by taking: 1 litre of boiled and cooled water (one milk bottle =
1 level teaspoon of salt
8 level teaspoons of sugar
In the absence of a proper measuring vessel, 1 litre of water can be measured with the help of a 500 ml milk
bottle. Two such bottles provide 1000 ml (1 litre). Otherwise,
take a 200 ml glass of water and add a pinch of salt and one teaspoon of sugar to it. To this solution, add fresh lime juice
to taste. This will provide the child potassium which is lost
along with water and salt. The sugar in this solution helps in the absorption of salt. (Rice also serves the same
since it releases the required sugars once it is digested.)
Remember that salt is essential. A solution of water and sugar
will not serve the purpose. However, too much salt can be
harmful. The best way to safeguard against this risk is to taste
the water and salt solution before adding sugar to it. The
solution should not taste saltier than tears. Once the above
solution is made, keep it in a refrigerator or a cool place. Make a
fresh solution if the whole lot is not consumed within 12
hours. Whenever possible, boil the water and cool it before
adding salt and sugar. Once the solution is ready, do not boil
it. Though boiled and cooled water is preferable, it is not essential. Use
the available water. Adding a little lime
cordial to water can make it reasonably safe for drinking.
For children less than 2 years, aim at giving 1/4 to 1/2 cup of the above solution after each watery stool. For older
children, offer 1/2 to 1 cup after each
watery stool. If a child does not take much at a time or tends to vomit, give 2
teaspoons every 5 minutes, day and night. The idea is to make sure
that the child passes enough light-coloured urine without becoming puffy. A child who has been given too much
fluid (which happens very rarely) will develop puffy eyes.
Fortunately, vomiting associated with diarrhoea is
mostly a transient phenomenon. If the child vomits, wait for 10 minutes or a little longer and then start offering a few sips or
a few spoons of the fluids mentioned earlier every 5 minutes.
Do not be in a haste to start giving medicines to check
vomiting. These drugs can sometimes have quite annoying side effects.
Instead, an older child may be allowed to suck on a little ice.
It often helps. Consult a doctor if the vomiting persists.
- Readymade WHO oral rehydration formulas are
available in the market to be added to 1 litre of water. There are also some smaller packets to be dissolved in one glass
(200 ml) of water. I am against the use of packets that
do not follow WHO or governmental recommendations. Most of these packets have too much glucose in them,
which is likely to worsen the diarrhoea. So check the packet before you buy it.
The above-mentioned solutions are not meant to stop the diarrhoea. Let Nature take its own course. The above
advice is only meant to prevent dehydration. If the loss of
fluids due to diarrhoea (with or without vomiting) is more than the intake, the child can show signs of dehydration. At
times, the losses can be so great that the child may need
administration of fluids by vein. As mentioned before, such a child
looks weak, is listless and passes little or no urine.
Occasionally, she may develop fast breathing. Such a child should be
given urgent medical attention.
Milk In Diarrhoea
As mentioned earlier, breastfed children must continue
to be breastfed.
It is a well-known fact that artificially-fed children
are more prone to diarrhoea. But if a child wants milk, do not hesitate to give it to him.
If the child is not keen, stopping milk ‘for about 12
hours may be preferable. The milk may be diluted for a day or two. But after that, give undiluted milk even if the loose
In cases where loose motions continue, some doctors change over from animal milk to soya milk preparations.
I do not recommend this because, in acute diarrhoeas,
intolerance to animal milk is often a temporary feature. Soya milks are only to be considered in persistent, proven intolerance
to animal milk. Sometimes, a pathologist may report the presence of reducing substance in the stool, but do not
change the child’s diet without consulting your paediatrician.
All children lose weight during an episode of diarrhoea.
They regain the lost weight soon after recovery. The process of recovery can be hastened by offering an extra meal to a
child recovering from diarrhoea.
Drugs in diarrhoea are discussed in the section on
Bacillary Dysentery in Abdominal
Pain in the
chapter on THE A-Z OF CHILDHOOD
ILLNESSES. For the moment, suffice it to say
that drugs often cause more harm than good in the management of diarrhoea. They should only be considered if the
diarrhoea is accompanied with blood and/or obvious mucus in the
In conclusion, note carefully that you can handle almost
all cases of diarrhoea at home with food and fluids and without the aid of drugs.
Most cases of fever can be managed at home. It helps to remember that fever is a friend; it helps your child
fightinfection. The high temperature helps release substances
in our body that attack the disease-causing organisms. Such
a defence mechanism either helps cure the disease or
limits its spread. To some extent, it may be fair to sa that fever
is the fire in which the invading germs are likely to get
Veterinary doctors tell us that the chance of animals
dying from sepsis (severe systemic infection) is twice as
great if you bring down their fever.
Wait Three Days...
A 3-day waiting period is recommended before starting medication to allow other symptoms - if any - to
develop. On the first day, a doctor is not likely to reach any
conclusion as to the cause of fever. If the child develops a thin, watery
discharge from her nostrils and starts coughing because
this discharge falls down her throat from the back of her
nostrils, then a doctor knows that he is dealing with a viral
infection in which antibiotics can be harmful. After 3 days of
waiting, the child is more likely to develop clinical features that
may point to the cause being either viral or bacterial. If it is
viral, a doctor would like to observe the child without
undertaking any investigation and without giving any antibiotic. If
a bacterial cause is suspected, he may either start an
antibiotic if required or order some investigations.
Avoiding the use of drugs during these 3 days also
allows the body to handle the infective agent by its own
defence mechanism. At this stage, even if a doctor feels that antibiotics must be started, the drugs are likely to
work better, hand in hand with the body that is all set to
take care of the offending agent.
Consult Your Doctor...
- If the fever persists for more than 3 days.
- If the febrile child (a child having fever) behaves
in a manner that is disturbing. For example, if she is not
fully alert, or is looking in one direction and has a fixed
gaze, seems persistently listless or irritable, or has
vomiting, or has unusually fast breathing, or has the typical
features of malaria with alternate days of fever with rigors. If
instinct tells you that she is not her normal self and the look
of her causes anxiety, do seek professional help. But if she is active, playful and alert, there is no cause for
- If the patient is less than 2 months old. Before
contacting the doctor, see if the little one is active and taking
her feeds normally. Also check that she has not been overheated from being wrapped up in too much clothing.
If the baby is not suckling well, take her to the doctor
even if the fever is not very high.
Management Of Fever
- With many fevers, the child’s appetite goes down.
Some children may not even like to drink water. This can lead
to dehydration. Make sure therefore that the child has
enough liquids. Offer it in different forms — plain water,
soup, fruit juice, coconut water, etc. While I am against colas and
other aerated drinks, allow her to take these if she has been consuming them in the past. The idea is to give enough
fluids so that your child continues to pass light-coloured urine.
- If the child demands regular meals, give her these,
even if the fever is very high. Some people hesitate to give
the so-called ‘cold’ things like bananas to a febrile
child. If the child has been taking bananas before and has been enjoying them without showing any signs of allergy to
them, I would strongly recommend bananas — whatever the temperature may be. A child may feel weak during the
febrile period because of not eating well, but this
should be taken care of as soon as the child starts eating. Vitamins, including the B complex group of vitamins or
so-called tonics, are not necessary.
- High fever makes most children uncomfortable. Don’t
try o lower the temperature if the child is okay with it,
but make all attempts to keep the child cool if she is
irritable, cranky or restless because of high fever. These would involve keeping clothing to a minimum; putting
preferably cotton clothes on her; keeping the windows open and
using the fan. Switch on the air-conditioner if you have one.
Let the child cover herself if she wants to.
At times, a child with high fever has cold feet and
hands. This is physiological, No attempt should be made to warm these parts with hot water bottles or any other device.
- If you decide to lower the temperature, a quick bath
with warm water or sponging of the whole body with water is preferable to the use of drugs. Sponging should not be
done with cold water or alcohol. I recommend slightly warm water. However, if the climate is such that your child
would prefer tap water or stored water, go ahead and use it.
In a case of hyperpyrexia, where the temperature goes above 105° F, or for heat stroke, a cold-water bath or shower
is given for rapid cooling.
- If you must use a drug to lower the temperature,
choose paracetamol (Calpol, Crocin, Metacin, etc) over aspirin; aspirin can cause a serious side effect (Reye’s
Syndrome) in children with influenza or chickenpox. This disease results in ‘swelling’ of the brain and damage to the
liver. If paracetamol must be used, give it in a proper dose
(10-15 mg./kg./dose). Give 4 hourly if required.
- If a child is prone to convulsions with the sudden
rise of fever, paracetamol may be started with the first sign of fever. As the drug may take time to start acting,
sponging should also be started. Unfortunately, in children with fever-associated convulsions (febrile convulsions), the
convulsions may appear even before anyone notices that the child has fever. Usually, these convulsions last for
a short duration. Most children get just one convulsion
and this does not recur even if the fever remains high
during the subsequent period.
Some children as well as adults normally have a warm
head or warm palms. They are otherwise normal and the thermometer does not record a temperature of more than
98.4° F (37° C). In other cases, normal temperature in
a child who is otherwise fit can range from 96° F to 100.8° F.
Temperature can be recorded in the mouth or the armpit or in the rectum (with a special rectal thermometer). If
you are reporting to your doctor, tell him how you have recorded
the temperature - whether in the mouth, armpit or rectum. Do not try to guess the temperature yourself by
adding or subtracting in case you have not recorded the
temperature in the mouth.
The new strip thermometers (to be placed on the
forehead) often give false readings and are not recommended. The digital thermometers are satisfactory.
By the time your child goes to school, train her to
accept the thermometer in the mouth to record temperature. The thermometer is placed below the tongue. The child keeps
it in place with her lips and holds it with her hands. In the beginning, an adult can hold the thermometer in his/her
hand while the child is learning to keep it in place under her tongue.
If use of a thermometer is not possible, use the back of your (the baby’s caretaker’s) hand to screen for a
significant fever. If the skin is cool, record zero; if warm, note a
+ for low fever, ++ for high and +++ for very high fever. I recommend this method to most of my patients.
11 February, 2013