29-1 Diseases of ChildrenSome of the common illnesses of children are discussed in de-tails elsewhere in your manuals. To know more about them,refer to the section as has been listed below:1. Anaemia II Manual Page 19-102. Chicken Pox II Manual Page 20-63. Colds, Coughs I Manual Page 2- 9 to 2-114. Conjunctivitis or Pink eye II Manual Page 23-75. Diarrhoea or Dysentery I Manual Page 4-196. Diphtheria III Manual Page 29-57. Ear infections and injuries I Manual Page 2-228. Fevers I Manual Page 9-49. Fits and Meningitis II Manual Page 22-810. Malnutrition III Manual Page 28-11. Measles III Manual Page 29-312. Pneumonia I Manual Page 2-1613. Polio III Manual Page 29-414. Scabies and skin diseases II Manual Page 20-715. TB of children III Manual Page 29-516. Tetanus III Manual Page 29-617. Whooping Cough III Manual Page 29-618. Worms I Manual Page 4-26
29-2 Children’s IllnessesWhen children fall sick, it scares those who are taking care of them.How does one make out if there is something to worry or not?This list will help you check if things are O.K or not. 1. Is a breastfed child continuing to breastfeed? If she is feeding normally, there is nothing to worry. 2. When the child is not crying, is the abdomen soft? Does she allow you to press on the abdomen without wincing or cry- ing more? DO NOT worry if the abdomen is soft and the child allows you to press on the abdomen. 3. Does the baby move all her arms and legs on her own? Are the two pupils equal and do they reduce in size when a light is shone into the child’s eyes? If the answers are “yes”, her brain and spinal cord are working fine and there is nothing to worry. 4. IS the tongue moist and pink when the child is weeping or crying? Does the child’s skin go back easily when it is pinched up on the abdomen? Is the soft spot on the head normal (not bulging or sunken in) ? If the answers are yes, there is no emergency. 5. Can we be sure? To be sure you can also measure the vital signs. The heart rate (you can put your hand on the chest and count) or the Pulse normally should be: Babies (less Older than one children year) Heart Rate per 110 to 130 90 to 120 minute Breathing Rate 30 to 50 25 to 40 per minute Temperature 36.5 to 37.5 36.5 to 37.5 degrees C degrees C If the.... vital signs are within this range, DO NOT WORRY.
29-3Dangerous Diseases of ChildrenChildren fall sick because of many different reasons. But there aresome major diseases that take the lives of many children. If they donot kill the child, these diseases weaken the child so much that shegets many other illnesses.Some of the dangerous diseases of children which we must knowabout are: 1. Measles 4. Pertusis (whooping cough) 2. Polio 5. Diphtheria 3. T.B 6. Tetanus1. MeaslesMeasles is a serious virus infection and can be very dangerous in children. It lessens the child’sresistance to other diseases.How does Measles spread?It spreads by sitting or playing with other people who have measles and the child gets ill after twoweeks.Signs of Measles What to do in Measles?It starts with fever, running nose, watering Continue breast-feeding. If the childeyes, and dry cough. The child usually does cannot suck, take out breast milk andnot like to eat food. The mouth may also give by spoon. become red and sore. After 3 or 4 days, a few Help the child by giving soups and tiny white spots appear semi-solid foods that are nutritious inside the cheeks. Later, like porridge, khichdi etc. a few red spots are seen on the head, face , ears, If cough becomes worse and leads to neck and these slowly Bronchitis or Pneumonia, start spread downwards on COTRIMOXAZOLE / the body. AMOXYCILLIN.In a week or so the rashes go away and the If child gets diarrhoea, Sugar Saltskin peels off. Measles reduces the defence Solution may be given.of the child to other diseases and the childmay get Pneumonia, Malaria or T.B later. PARACETAMOL may help lessen the fever. How to avoid Measles? • Before the age of 9 months, the vaccine is not useful in a child. After 12 months, the risks of getting measles becomes very high. So, it is impor- tant to give Measles vaccine between the age of 9 and 12 months. Measles injection is given under the skin on the right shoulder. Make sure that mea- sles injection is not given in the buttocks of the child as it is not as effective. • Vitamin A helps build up the child’s strength against Measles. Give Vitamin A, 2 lakh units to children every six months. (for children below 1 years of age, only 1 lakh units must be given).
29-42. Polio3 children out of every 4 who get Polio are from India. It is spread byfood and water that gets mixed with the shit of people withPolio virus. Polio is caused by 6 different viruses. By givingPolio drops we can protect children only against three of them.Polio is most common in children less than 2 years of age. Theillness starts with fever, vomiting, diarhhoea and pain in themuscles. Most children become well but the leg or hand of afew of such children becomes weak or gets paralysed (losesmovement). Slowly the paralysed part becomes thin and short. Polio affected leg is thinner and loses movementWhat to do if Polio attacks the child? Once the part becomes paralysed, no medicine can cure it. However, sometimes the child can get back some or all of the strength of the affected part even without medicines. Antibiotics do not help. PARACETAMOL may help against pain. Soaking the part in warm water also lessen the pain. Take Caution If the child has pain in the muscles with fever & vomiting: • DO NOT massage or exercise the muscles • DO NOT give any injections to a child when you suspect Polio or if there is an outbreak of Polio in the area. It could be Polio and the chances of affecting the part for life (paralysis) are much higher if massage, exercise or injections are given. Left to itself, the chances of the Polio virus going away without harm are more. How to Protect against Polio? Polio vaccine drops given at 1 ½ months, 2 ½ months and 3 ½ months help to protect the child against Polio. Nowadays, the government runs a programme called “Pulse Polio” that is trying to remove Polio once and for all from the world. In this programme, all children below 5 years are given 2 drops of Polio vaccine at least twice a year until they become 5 years. Helping children with Polio Make them walk and do exercise once the fever and diarrhoea is bet- ter. Even if the leg has become weak, give support with braces, crutches etc. This will keep their muscles from being wasted totally.
29-53. T.B of childrenT.B can be dangerous (see Phase I Manual Page 2-19). It is more dangerous for childrenwho stay near T.B patients. In those who have not got resistance to T.B, the T.B bacteriacan affect the brain linings (Meningitis), the brain, the liver, lungs or may even weakenthe spinal bone. In children, it spreads to different parts of the body.BCG is the vaccine given at birth to help children avoid such forms of T.B. Although it isnot seen to help against adult forms of T.B, BCG is also known to protect the child for lifeagainst leprosy.T.B in children needs to be treated early. A mix of 3 BCG to protect against T.Bmedicines is to be given. Refer to a T.B specialist or achild doctor if a child has : BCG is to be given at birth or Mild fever for 2 to 3 weeks that does not get after that at the earliest. An better with antibiotics (germkillers) and injection of BCG is given in- Loss of weight along with side the skin on the left shoul- Stiffness of neck der. Place of injection swells Fits up and the skin breaks open Unconsciousness after two weeks. Later, this Swelling of abdomen etc heals on its own and leaves a Breathing difficulty paper thin mark for life.4. DiphtheriaIt is a dangerous disease but is rarely seen these days. It is caused by a bacteria that affectsthe throat and nose. It spreads by air during coughing, sneezing etc.What are the signs of Diphtheria?The child starts with fever, cold, body weakness and sore throat. The most important sign isthat the pulse rate is much faster. (We had learnt earlier that the pulse increases by 10 per minutefor every degree F of temperature. But in Diphtheria, the pulse rises much more). When the throat is checked with the torch, we can see a yellow grey membrane covering the tonsils and back of throat. The breath smells bad. The child looks very ill and has difficulty in breathing. RUSH TO A DOCTOR. It may be too late to treat later on.How to avoid Diphtheria? IMPORTANT TO NOTE3 doses of DPT (Triple Vaccine) at 1 ½ Once Diphtheria is suspected in amonths, 2 ½ months and 3 ½ months child, rush all other children in thecan protect a child against Diphtheria. family to a doctor for treatment.The injection must be given in the front Diphtheria spreads very fast and canpart of the child’s thigh. be dangerous to other children also.
29-65. Whooping Cough (Pertusis)Whooping Cough is caused by a bacteria and is spread bycoughing or sneezing in children below 5 years of age.Signs of Whooping Cough What to do inStarts like a cold with little fever, running nose, Whoopingcough, redness of eyes and repeaeted sneezing. Cough?This can last for 7 to 10 days and at this stage it AMOXYCILLINcan spread very fast to other children. can be given at the earliest for 14 days. CODEINE may beThe “whoop” starts two weeks later. The child given to stop the dry cough which maycoughs again and again within a few seconds otherwise cause the blood tubes towithout taking a breath until she coughs out a burst.thick plug of mucus. At the end of this, the air Children who are in contact with pa-rushes into the lungs with a loud “whoop”. tients of Whooping Cough must also beWhile coughing the fingers and lips may turn given AMOXYCILLIN for 14 days.blue. This stage may last up to 3 months.The repeated coughing may cause the blood To avoid Whooping Coughtubes of the brain and eyes to burst. This may DPT in 3 doses must be given at 1 ½lead to blindness and to death. Pneumonia is months, 2 ½ months and 3 ½ months.also common and may kill small babies.6. TetanusA germ living in the soil and in the shit of animals (or of people) may enter the body through awound to result in Tetanus. Wounds made by dirty thorns, nails, glass, by knives and bullets orby animal bites are more likely to lead to tetanus. Children whose cord is cut by a dirty blade,bamboo, knife, etc. that is not boiled have higher chances of getting Tetanus.Signs of Tetanus How to avoid Tetanus? A wound (may be still fresh or has All wounds must be washed with boiled (and healed) followed 10 to 15 days later cooled) water. Do not let dust get into them. by difficulty in swallowing. The jaw gets stiff (‘lock jaw’). Tetanus Injection (TT) as part of DPT or on its Stiffness of neck & other parts of own must be given at 1 ½ months, 2 ½ months the body. and 3 ½ months. This is again given as a booster Fits (or convulsions) that are pain- dose at 1 ½ years of age. After this, one injection ful. of TT every five years can avoid Tetanus from Moving or touching the person the dirtiest of wounds. may make all the muscles tighten. Newborn children begin to cry all DPT injections are usually followed by fever the time and are unable to suck 5 and pain at injection site for a day or two. Ad- to 10 days after birth. vise the mothers beforehand or else they may not bring The cord is seen to be dirty with their children for immunisation again. PARACETAMOL pus and has a bad smell. may be given to the child to bring down fever and pain. REFER ALL suspected Tetanus patients immediately to a hospital. They will need injections and special care to stay alive.
29-7IMMUNISATIONChildren can be saved from getting 6 killer diseasesthrough vaccination. Also called “immunisation” (de-veloping “immunity” to the disease), the governmentruns a Universal Immunisation Programme (UIP) to givevaccine to all children against some diseases. The aim isto cover at least 80% to 90% of all children before the ageof 1 year. The diseases for which children must be immunised are: 1. T.B 2. Diphtheria 3. Pertusis (whooping cough) 4. Tetanus 5. Polio 6. Measles National Immunisation Schedule Against When is Number How is it Vaccine Which Remark it given? of Doses given? Disease? Pregnancy Injection in If mother already immunised, T.T muscles of (4th and 8th Tetanus 2 doses shoulders or only 1 dose at 8th month is month) needed. buttocks * Skin breaks open and then Injection Childhood One time heals after BCG. At Birth BCG inside skin on * Also saves from leprosy; but T.B only left shoulder. not effective for adult T.B. Diphtheria * Child may get fever for 1-2 1 ½ months Pertusis Injection in days after each injection. DO D.P.T muscles of 2 ½ months (whooping Three front of childs NOT WORRY. 3 ½ months cough) * More than 1 month gap is O.K thigh. but it is difficult to remember. Tetanus Nowadays Pulse Polio gives polio drops again and again at 1 ½ months all schools at least 2 times a O.P.V 2 drops given 2 ½ months Polio Three by mouth. year for all children below 5 3 ½ months years. of age Children who have taken polio drop earlier MUST also take. Before 9 months child is Injection One time protected by mothers 9 months Measles Measles under skin on antibodies; so must be given only right shoulder only after 9 months DPT(as DPT As in DPT & Booster at these ages help tide 1 ½ years above) One Polio above. over danger till 5 years old Polio Polio
29-8 Questions on Immunisation answered1. How does immunisation work? Two out of five children die of illnesses when they are very young. To save these small children from attack by infec- tions of all kinds, we need to give their bodies some sol- diers to fight these infections. Immunisation is one such way in which we get children ready to fight against main diseases. Through vaccines Immunisation is like show- that we give the child, we build up a memory against the ing the photo of the robber different germs of different diseases. So next time germs of to the police. Next time thepolio, measles or tetanus enter the body, the body’s police is able to know it at once and police sees the robber, thedestroy these germs. If no vaccines were given, it would take many weeks for the police will know the face ofchild’s body to react to the germs. This might be too late for diseases which could kill the robber and catch him.the child.2. How can I be sure that my 3. Can my child get problems because ofchild will not get the disease if vaccines?I get her vaccinated? Injections like DPT vaccine almost always give some fever and If the vaccines have been kept properly and body ache for 2 days. However this is only for a short time.they have been given as per guidelines, the Other vaccines also rarely give problems. Sometimes the injec-chances of getting the disease be- tion itself can give the disease though this is againcome much, much lesser. There very, very rare. Remember that the chance of a childare still some germs of the same getting the disease is much, much more if not im-diseases that can attack despite munised than getting the disease from the immuni-the child being immunised. But sation itself. So, make sure that you get every childthis would be very rare. immunised and advise every mother to immunise their children against killer diseases.4. Can children become 5. Can I give my child vaccine when sheimpotent (losing sexual is ill?function) because of Unless a child is serious enough to be admitted, onevaccine? should not stop giving vaccines. For mild infections and fe-NO! When we talk of “impotent vaccine” vers one should not stop or delay giving vaccines. Polio vac-we mean that the vaccine has become use- cine may not work that well if the child has diarrhoea but still,less because of being opened up or not be- the child must be given. An extra dose may be given.ing kept properly. It does not mean that itis for making a person impotent.6. What if I cannot give the next dose of vaccine at the right time?2 to 3 months between DPT and Polio vaccine is good for building the defence of the child. However, itis more difficult to remember. Also, the full course will have to be taken if there is a delay of 6 months ormore. Hence, we must stick to schedules of one month intervals for DPT and Polio. All children MUST get immunised Unless 90% to 95% of all children get immunised, the disease will be around in some people. There is danger of it spreading again to others. In order to get rid of the disease forever – like how we got rid of small pox and are now trying the same for polio - we need to get at least 95% of people to take the vaccine. All of us must do our part in getting our people to take the vac- cine at the right time.
29-9 Know the Answers Diseases of ChildrenI. Please mark if “right” or “wrong”: 1. If a child keeps crying, her abdomen must be pain- ing and we must rush her to the hospital. 2. The pupils of the eyes reacting to light is a sign that the brain is functioning normally. 3. In children’s Pneumonia, the breathing rate is between 30 and 50 breaths per minute. 4. Measles rash starts from the chest and spread upwards towards the face and head. 5. AMOXYCILLIN can be given to cure Tetanus. 6. Only DPT vaccine can lead to problems in chil- dren.II. Please fill in the blanks: 1. TT injections must be given in the _____ month and the _____ month of pregnancy to save the mother and child from Tetanus. 2. Whooping Cough bursts the _________ tubes in the _____________ which can lead to _____________ and ________________ in children. 3. Measles can lead to serious ________________ and ______________. So, we must give the Measles vaccination between ______ and _____ months of age to avoid Measles. 4. BCG must be given at ________ to save a child from dangerous forms of _____________________ diseases. 5. Diphtheria is seen by a ________________ or ______________ colour membrane on the ________________. The most important sign is to count the ____________ which is very ______________. 6. Vitamin _____ helps to build up the defence of a child against Measles and _________ units must be given to children every 6 months.