Bedwetting or nocturnal enuresis, refers to the unintentional passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence. For infants and young children, urination is involuntary. Wetting is normal for them. Most children achieve some degree of bladder control by 4 years of age. Daytime control is usually achieved first, while nighttime control comes later.

The age at which bladder control is expected varies considerably. Some parents expect dryness at a very early age, while others not until much later. Such a time line may reflect the culture and attitudes of the parents and caregivers.

Factors that affect the age at which wetting is considered a problem include the following:

The child's gender: Bedwetting is more common in boys.
The child's development and maturity
The child's overall physical and emotional health. Chronic illness and/or emotional and physical abuse may predispose to bedwetting.
Causes

No one knows for sure what causes bed-wetting, but various factors may play a role:

A small bladder: Your child's bladder may not be developed enough to hold urine produced during the night.
Inability to recognize a full bladder: If the nerves that control the bladder are slow to mature, a full bladder may not wake your child, especially if your child is a deep sleeper.
A hormone imbalance: During childhood, some kids don't produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
Stress: Stressful events, such as becoming a big brother or sister, starting a new school, or sleeping away from home, may trigger bed-wetting.
Urinary tract infection: This infection can make it difficult for your child to control urination.
Sleep apnea: Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep.
Diabetes: For a child who's usually dry at night, bed-wetting may be the first sign of diabetes.
A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.

Symptoms

Wetting during the day
Frequency, urgency, or burning on urination
Straining, dribbling, or other unusual symptoms with urination
Cloudy or pinkish urine, or blood stains on underpants or pajamas
Soiling, being unable to control bowel movements
Constipation
Most kids are fully toilet trained by age 5, but there's really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.

When to see a doctor: Most children outgrow bed-wetting on their own, but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.

Consult your child's doctor if: 

Your child still wets the bed after age 7
Your child starts to wet the bed after a few months or more of being dry at night
Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring
Self-Care at Home-
Here are some tips for helping your child stop wetting the bed. These are techniques that are most often successful

Reduce evening fluid intake.
The child should urinate in the toilet before bedtime.
A system of sticker charts and rewards works for some children.
Make sure the child has safe and easy access to the toilet.
Some believe that you should avoid using diapers or pull-ups at home because they can interfere with the motivation to wake up and use the toilet.

Bedwetting - 7 Possible Reasons Behind It

Cochlear Implant is an electronic device replaced with the inner ear (cochlea) of the patients who are unable to send sound waves to the brain.

The surgery is performed on the patients who have the problem of hearing loss due to the damaged hair cells in the inner ears. The implant helps the patient to hear which are not responding to other hearing aids.

Conditions for Cochlear Implant:

Cochlear implants help people to hear with clarity. They are not like hearing aids, which make the sound louder, but it helps send sound waves to the brain and replaces the damaged hair cells in the inner ear. Following are cases where it is beneficial:

People who find it difficult to hear clearly with hearing aids.

Those with moderate hearing loss in both ears.

Patients with 50% or fewer score in the sentence recognition test.

Patients with 60% or less score in sentence recognition test with hearing aids on.

It is suggested to opt for cochlear implants in both ears. The reason is to give the patient a better perspective of sound direction and clarity in understanding the words.

How does the Cochlear Implant work?

Cochlear Implant is an electronic device with an embedded sound processor that has to be worn outside ears or on the body. Following steps are involved in cochlear implant:

The sound captured by the processor is converted digitally by the processor and sent to the coil inside the ears of the patient.

The implant converts digitally coded sound waves to electrical impulses.

The electric impulse simulates the hearing nerve of the patient.

Then sends these impulses to the brain.

Benefits of Cochlear Implants:

The cochlear implant is a blessing for people who have been suffering from hearing loss for a very long time. It provides aid to people who have not benefited from hearing devices. The benefits of the cochlear implant are:

Hear better.

Studies have shown that people with cochlear implants have better sentence recognition scores instead of hearing aids.

The patient can concentrate better in the crowd and can hear conversations across the table.

Reconnect with the missed sounds.

Enjoy music on the phone.

Cochlear Implant improves the quality of life of people with hearing loss. It gives them an aid to understand and engage themselves in a conversation. However, it takes time to learn the interpretation of the sound signals that are received from cochlear implants. But, the patient can learn and lead a normal life with the implant. The factors which affect the benefits of Cochlear implants are:

The extent of hearing loss

The duration of the hearing loss and the condition before implantation

Damage to inner hair cells

Other health issues

The practice and rehabilitation time have been done in practice after implantation

The cochlear implant is performed in the patients after taking extensive tests determining the condition of the patients. It is activated after 2-6 weeks of surgery to give the surgery site a time to heal. Most people are discharged from the hospital after surgery and are prepared for the use of an implant. There are training sessions and classes for patients who have just gone for cochlear implants.

Cochlear Implant - How Do They Help?

Infantile spasm is a seizure-related disorder that is witnessed among infants and young children. The average age for getting affected with infantile spasm is four months, but some kids might experience this disorder within a month of the birth. This disease can have a subtle appearance, and as such it is difficult to recognize as a serious condition. While a full seizure in an adult is scary, the one observed among infants can be as little as a minor head drop, along with minor body shakes. This might appear to be that serious, but infantile spasm is more serious as compared to a full body convulsion in adults. Unfortunately, an infant suffering from infantile spasm is at great risk of developmental disability, if the condition is not detected and treated early.

Anticonvulsant Medication:
There are very few medicines that are approved by the FDA for treating infantile spasms. The two medicines that are widely used by doctors include Adrenocorticotropic hormone (ACTH) and Vigabatrin.

ACTH: This is the oldest approved medicine by the FDA that was first discovered in the year 1958. This injection needs to be pushed twice in a day. Children tend to gain weight and feel hungry when this injection is injected.
Vigabatrin: Vigabatrin is very well tolerated by young kids and has a successful track record of treating infantile spasms. Studies have proven that Vigabatrin can tackle tuberous sclerosis and plays an important role in improving developmental outcome.
Second line therapies:

Pyridoxine: Dependency on Pyridoxine as a cause of infantile spasm is very rare. High dosage of oral administration of pyridoxine has fetched good results for patients, who do not suffer from pyridoxine related seizures.
Valproic acid: Valproic acid has the best anecdotal rate of success. However, doctors do not recommend this medicine for kids less than 2 years of age because of possible complications.
Clonazepam: This is one of the earliest non-steroid medicine for the treatment of infantile spasm. Some of the popular medicines used are nitrazepam, benzodiazepines, and clonazepam.
Ketogenic Diet: This is a decade old practice that has come back to popularity again. Studies have shown that ketogenic diet can help 20-35 % patients of infantile spasm to keep the condition under control.
IVIG: High dosage of IVIG has been reported to be very helpful in tackling infantile spasms. The dosage ranges from 100-200 mg/kg/dose ranging for about 2-3 weeks at stretch.
Surgery: The final part of the therapy includes a surgery that removes the abnormal part of the brain. It should only be considered for patients who have not responded to therapies including Vigabatrin and ACTH. It should also be investigated whether the patient has any structural abnormalities of the brain.


Infantile Spasms - How They Can Be Treated?

Diabetes is a chronic metabolic disorder that results in higher level of blood sugar in the body. It is assuming epidemic proportions and India has become the new diabetic capital with more than 50 million diabetic people. The main problem with diabetes is that it does not completely go away and there is a whole myriad of issues that it brings along with it. Heart attack, stroke, eyesight problems, delayed wound healing, nerve damage and impotence. Therefore, diabetes and by that we mainly mean blood sugar level has to be managed so that there is a delay in onset of the associated conditions and/or reduced in severity.

Ayurveda refers to diabetes as Prameha (excessive urination) and Madhumeha (sugary urine) and has identified close to 20 forms of the disease. According to Ayurvedic belief, each disease is caused due to imbalance in kapha, pitta, and vata doshas and diabetes is caused by all these, predominantly by kapha. With any stream of medicine, management of diabetes involves two tracks   one is lifestyle changes and the second is medications.

Lifestyle changes include the following:

    Diet: Reduce the amount of rice, sugar, potato, sweet fruits, maida, deep fried foods, and red meat. Protein-rich foods like lentils, soya, green leafy vegetables and fish should be increased. Diet plan should change to small, frequent meals instead of binge eating.

    Exercise: Include 30 minutes of regular exercise into your daily routine if you have a diabetic predisposition.

    Others: Avoid smoking and alcohol, ensure sufficient sleep, avoid sleeping during day time, improved foot and eye care, periodically check sugar levels and manage stress levels.

Medication

Ayurveda has a whole lot of home remedies which have proven to be very effective against diabetes:

    Jambhul: Eugenia Jambolana whether eaten raw or juice extract has been shown to have beneficial effects in managing sugar levels and cholesterol.

    Gymnema sylvestre: Used to manage diabetes for over 2000 years, it reduces sugar cravings and is being touted as the future for diabetes treatment.

    Bitter gourd (Momordica charantia): It has 3 components that give it strong antidiabetic properties. The charantin reduces blood sugar levels; the polypeptide has insulin-like effects; and lectin that again has hypoglycemic effects.

    Bel (Aegle marmelos): Also known as wood apple, leaves of the plant are shown to have antidiabetic properties. 5 to 10 leaves can be chewed on a daily basis to help control blood sugar levels.

    Fenugreek (Trigonella foenum graecum): Consuming 10 g of fenugreek seeds soaked in water increases the amount of insulin produced, thereby increasing sugar breakdown.

    Neem: Chewing about 4 to 5 leaves in the morning on an empty stomach helps to control blood sugar levels. Alternately, neem leaves powder is available which can be dissolved in water and consumed.


Diabetes - 6 Natural Remedies that Will Help You Manage it

The sense of hearing is a complex one. The ears are divided into three parts: the outer ear, the middle ear and the inner ear. While the outer ear sends the sound to the middle of the ear, the middle ear sends the same to the inner ear through the conductor. The inner ear in turn sends the auditory signal to the brain where the signal is processed and gives rise to a sense of hearing. 

Problems in hearings can arise if there is a problem in any of these parts. However, more often than not it is the middle or inner ear that is affected. However, there may also be situations when there are problems in both the middle and the inner ear. In that case, it is known as a mixed hearing loss. 

What is Mixed Hearing? 

Loss If there is damage to the middle ear, it may precipitate a conductive hearing loss. Now, in addition to that, if there is a sensorineural problem, then it gives rise to mixed hearing. So, in the case of a mixed hearing loss, all the parts of the ear and even the brain may be involved. There may be damage to the outer ear, middle ear, inner ear, as well as the auditory nerve. 

Causes of Hearing Loss 

Since mixed hearing loss may result from damage to any part of the ear, it is necessary that the causes be grouped into different categories. 

  Sensorineural Hearing Loss 

Sensorineural loss may result from drugs, different illnesses, head trauma, malformation of the inner ear etc. Genetic predisposition may also precipitate such problems. 

  Conductive Hearing Loss 

Such type of hearing loss may result from excessive deposition of earwax, ear infections, perforation in eardrums, malformation of the middle or outer ear, as well as problems with the fluid in the middle ear. 

Symptoms of Hearing Loss 

Reduced hearing in either or both ears is considered to be delineating symptoms of mixed hearing loss. 

Treatment 

Since mixed hearing loss can result from sensorineural failure as well as damage to outer or middle ear, treatment needs to be divided into different groups too.   To treat Conductive Hearing Loss, doctors can use surgical or medical options. 

  For sensorineural hearing loss, doctors usually prescribe hearing aids. This indicates that treatment for mixed hearing loss may include treatment for conductive hearing loss as well as that for sensorineural hearing loss. So, it is usually a combination of both medical and surgical options. Physicians may prescribe both medicines and hearing aids or resort to surgical interventions and also prescribe hearing aids. Sometimes, physicians use special hearing aids or implants to treat mixed hearing loss. 

Conclusion 

In case a person is sensing reduced hearing in one or both ears, he/she needs to seek medical advice. It may be a symptom of mixed hearing loss. Getting in touch with an experienced physician is the first step towards that.

Mixed Hearing Loss - How To Treat It?

ADHD is one of the commonest behavioral disorders that are found in mostly school going kids. In fact, this kind of trouble might affect kid's ability quite adversely. There are a few signs with the help of which ADHD in kids can be easily detected and some of the commonest ones are emotional turmoil, unfinished tasks, squirm and fidget, low focus careless mistakes and other related ones. 

Both interpersonal relationship and schooling success can be hampered to a great extent with this kind of mental disorder. This is why the kids facing the mentioned signs need to be thoroughly diagnosed medically so that the doctors can recommend best treatments that can provide fastest recovery and that too safely and easily. 

Best tips for tackling ADHD in kids
1. Setting behavior limits: If you make your kids learn how to lead a disciplined life, then appropriate behavioral limits are established. Arrogant child is mostly exposed towards ADHD. 

2. Staying calm: Child anger should be efficiently controlled otherwise. ADHD cannot be cured. If the kids remain calm and quiet, then only their concentration level will increase, and they can show productive outcomes. 

3. Setting pressure free structure: sensible routines and scheduled charts are to be prepared so that unwanted risks can be easily avoided. If the kids are under tremendous pressure, then they might face different kinds of behavioral troubles. 

4. Allow kids to make wise choices: If you let your kids free, then only they will be able to take right decisions. Kids with a cool mind can take wise decisions that are very much appropriate for upgrading their performances. 

5. Advocating child: Child advocating is highly needed for maintaining a good and healthy balance. But too much strictness should be avoided so that your kids' behavior can be controlled with ease.  This should be done either by parents or tutors so that they can choose the best direction in life. 

6. Avoid muting any headstrong child: Communicate with your child so that a proper interaction can be maintained. If your child remains silent for too long, then they might face different behavioral troubles. 

7. Acquiring knowledge about ADHD: Both parents and kids should have equal knowledge about ADHD and then only the probable signs can be easily avoided, and the necessary treatments can be known. 

8. Being persistent: Persistent behavior is to be maintained, and if you find any deviation in your kids, then you should take them to a doctor.

Parenting in Attention Deficit Hyperactivity Disorder

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