Cleft palate or palatoschisis is a common genetic abnormality that leads to a horde of problems and is presently a growing challenge to medicine practitioners. The major developmental stages affected due to this particular irregularity include feeding, speech development, dentition and maxillofacial growth which are rather important to the normal overall developmental pace of an individual. Even though the cleft palate deformity was defined centuries ago, no fixed management algorithm exists for patients suffering from the condition in the present day scenario.

Cleft palate may be successfully fixed using reconstructive surgery. Multiple specialists are involved in the reconstruction surgery including plastic surgeons, otolaryngologists, nutritionists, oromaxillofacial surgeons and speech pathologists. Some hospitals also consider psychological therapy for the patient and the family to help get through the emotional trauma and the issues faced due to developmental backlogs.

The treatment for cleft palate usually begins around 9 to 12 months of age. If left untreated, it may cause major deformities. It takes about some years before the whole procedure is completed although it depends on the type and severity of the deformity.

The process involves the administration of anaesthesia after which the palate repair closes the inner, middle and final layers and at the same time realigning of the palatal muscles in a technique called anintravelarveloplasty is conducted. This ensures that the muscles are adjusted in a normal position which facilitates the best functioning of the palate during feeding, swallowing and speaking. It is possible that the child might require more than one surgery to completely close the palate.

Some of the risks involved during the process include:
1. Abnormal reactions to the medications
2. Bleeding
3. Problems in breathing
4. Need for more surgery
5. Infection

Although complicated and time consuming, cleft palate must be given immediate attention to avoid serious developmental issues. The reconstruction surgery and therapy combined ensures a normal development for the child in the longer run, given the surgery was done at the correct time. The child would be required to remain at the hospital for about 5-7 days. Complete recovery takes a time period of 4 weeks. Keeping the wound of the surgery clean is of the utmost importance and it should not be strained.

How to Surgically Treat Cleft Palate

Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders presenting for treatment in children and adolescents. ADHD is often chronic with prominent symptoms and impairment spanning into adulthood. ADHD is often associated with co-occurring disorders including disruptive, mood, anxiety, and substance abuse. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry and neuropsychological data. Consideration of all aspects of an individual s life needs to be considered in the diagnosis and treatment of ADHD. 

Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for ADHD and comorbid problems. Pharmacotherapy including stimulants, noradrenergic agents, alpha agonists, and antidepressants plays a fundamental role in the long-term management of ADHD across the lifespan. 

The management of ADHD includes consideration of two major areas: non-pharmacological (educational remediation, individual and family psychotherapy) and pharmacotherapy. 

I personally support Psychotherapy. Specialized educational planning based on the child s difficulties is necessary in a majority of cases. Since learning disorders co-occur in one-third of ADHD youth, ADHD individuals should be screened and appropriate individualised educational plans developed. Educational adjustments should be considered in individuals with ADHD with difficulties in behavioral or academic performance. Increased structure, predictable routine, learning aids, resource room time, and checked homework are among typical educational considerations in these individuals. Similar modifications in the home environment should be undertaken to optimize the ability to complete homework. For youth, frequent parental communication with the school about the child s progress is essential. 

Symptoms in children and teenagers 

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of six. They occur in more than one situation, such as at home and at school. The main signs of each behavioural problem are detailed below:

Inattentiveness: having a short attention span and being easily distracted making careless mistakes   for example, in schoolwork appearing forgetful or losing things being unable to stick at tasks that are tedious or time-consuming appearing to be unable to listen to or carry out instructions constantly changing activity or task having difficulty organising tasks 
Hyperactivity and impulsiveness: being unable to sit still, especially in calm or quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger 
These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline. 

Related conditions in children and teenagers 

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as: 

anxiety disorder   which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness 
oppositional defiant disorder (ODD)   this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers 
conduct disorder   this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals 
depression 
sleep problems   finding it difficult to get to sleep at night, and having irregular sleeping patterns 
autistic spectrum disorder (ASD)   this affects social interaction, communication, interests and behaviour 
epilepsy   a condition that affects the brain and causes repeated fits or seizures 
Tourette s syndrome   a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics 
learning difficulties   such as dyslexia Symptoms in adults In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD. 
ADHD is a developmental disorder; it's believed that it can't develop in adults without it first appearing during childhood. But it's known that symptoms of ADHD often persist from childhood into a person's teenage years, and then adulthood. Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood. By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives. The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD. But some specialists say that the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children. For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms. 

Some specialists have suggested the following list of symptoms associated with ADHD in adults: 

carelessness and lack of attention to detail 
continually starting new tasks before finishing old ones 
poor organisational skills 
inability to focus or prioritise 
continually losing or misplacing things 
forgetfulness 
restlessness and edginess 
difficulty keeping quiet and speaking out of turn 
blurting out responses and often interrupting others 
mood swings, irritability and a quick temper 
inability to deal with stress 
extreme impatience 
taking risks in activities, often with little or no regard for personal safety or the safety of others   for example, driving dangerously 
Additional problems in adults with ADHD As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include: 

personality disorders   conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others 
bipolar disorder   a condition that affects your moods, which can swing from one extreme to another 
obsessive-compulsive disorder (OCD)   a condition that causes obsessive thoughts and compulsive behaviour 
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job. If you notice any of the above in your child or yourself , it is worth making the effort and spending some time and money to have your child and or yourself assessed on a priority basis as ADHD causes neural changes in the brain. 

Attention Deficit Hyperactivity Disorder (ADHD) - A Guide!

Has your child been coughing frequently? Is the cough chronic in nature, making your child breathe rapidly and does he/she complain about a tightened chest? These symptoms signify that your child is having asthma. Asthma is a medical condition characterized by paroxysmal wheezing respiration dyspnoea. It is common in children and an affected child experiences difficulty in breathing, and a whizzing sound is produced, especially during expiration. Asthma may lead to severe health complications and needs immediate diagnosis and treatment.

Diagnosis: The diagnosis of asthma is based on the symptoms, medical history and a physical examination of the child.

The different modes of asthma diagnosis are as follows:

    Medical history and symptoms: You must tell the doctor about any history of breathing trouble with your child or whether there are chances of other inherited health conditions. You must explain your child's symptoms properly, which may include coughing, wheezing, chest pain or tightness and others if observed.
    Physical examination: A physical exam will be carried out in your child where the doctor will listen to his heart and lungs, and look for eye or nose allergies.
    Medical tests: A chest X-ray of the child has to be carried out, along with a simple lung function test known as spirometry. This test measures the amount of air present in the lungs and determines how fast it can be exhaled. Spirometry enables a doctor to determine the severity of the asthma. Some other tests are also carried out for the identification of asthma triggers. They include allergy skin testing, blood tests and X-rays to know if sinus infections are affecting the asthma. An asthma test determines the amount of nitric oxide in your child's breath.

Treatment: Based on your child's severity of asthma symptoms and his medical history, the doctor will provide you with an action plan to treat the same. This action plan explains all the medications your child requires, the dosage and schedule of the medicines. The plan also includes points on what to do when the asthma worsens and when an emergency treatment is required. Anti-inflammatory drugs are prescribed to children who require bronchodilator medication. All asthma medicines used by adults can be used in case of children but in lower dosages.

You should give the asthma medications to your child using a home nebulizer or a breathing machine. A nebulizer delivers asthma drugs by transforming them from liquid to a mist. The child gets the drug by breathing it via a face mask.

In order to control and manage asthma in children, they must avoid the triggers and should keep away from any source of smoke. A doctor must be consulted to know about the best diagnosis and treatment methods.

Asthma in Children: Diagnosis and Treatment

Chromosomal abnormality happens when a cell has too many or too few chromosomes. The most common form of chromosomal anomaly is Down s syndrome. If a parent has a chromosomal anomaly, she/he will pass it on to the child. PGD or Pre-implantation Genetic Testing aims to select only the embryos with normal chromosomal count and only these embryos are implanted to achieve a healthy pregnancy and bring down the number of children affected with a chromosomal anomaly.

The risk of Aneuploid pregnancy:

The older a woman is when she tries to conceive (aged 35 or more), the higher the risk of Aneuploid pregnancy (carrying a baby with genetic or chromosomal abnormality). Most of these pregnancies end in miscarriages and the few that come to term produce babies with chromosomal abnormalities.

Causes of Chromosomal Abnormality:

Usually, chromosomal abnormalities occur due to an error in the cell division. Meiosis refers to the cell division, which the sperm and the egg undergo during the development procedure. Normally, meiosis breaks the chromosomal material into two equal halves, so that each of the parents contributes 23 chromosomes to the pregnancy. However, when the number of chromosomes in the cell goes up or down than the normal, it results in genetic/chromosomal anomalies.

PGD Procedure for a Chromosomal Anomaly:

If a couple elects to go for Pre-implantation Genetic Diagnosis, they have to undergo ICSI Cycle. ICSI cycle initiates a fertilization cycle to produce embryos. When the embryos reach upto day 5 and blastocyst are formed, they are biopsied and further sent to genetic lab for detecting the chromosomal abnormalities. The embryos are incubated for the entire duration of the genetic screening. Only the embryos that the genetic test clears are implanted. PGD never reveals the gender of the embryo.

PGD can help detect the single genetic disorders that may lead to the following ailments:

  Cystic fibrosis
  Muscular dystrophy
  Tay-Sachs
  Sickle cell anaemia
  Thalassemia
  Turner syndrome

PGD is a revolutionary science that can help root out incurable disorders linked to genetics. It ensures that pregnancy is sustained until term and a healthy baby is born.

Suffering From Genetic & Chromosomal Anomalies - Know About PGD!

Asthma is an inflammatory disease, which affects the airways of your lungs (respiratory tract that pumps oxygen into the lungs). It is long term in nature. It is characterized by shortness of breath, coughing and wheezing. It occurs a few times a day or a few times a week depending on the person it affects. Sometimes it worsens during the night.

What triggers Asthma?

Airborne particles such as dust mites, mould spores, pollen and cockroach waste.
Infections in the respiratory system such as a common cold.
Cold air can also trigger asthma.
Physical or outdoor activities which make you pant such as running, skipping, jogging and jumping can cause shortness of breath, thus triggering asthma.
Pollutants and irritants in air such as smoke.
Some medications can also trigger asthma.
Stress and nervous attacks (panic attacks) also trigger asthma.
How to manage asthma better by changing your lifestyle:

Try to avoid keeping animals in your houses such as dogs, cats and rabbits. Many times animal fur, waste, urine and saliva contains particles which can cause allergic reactions and make you cough uncontrollably. This, in turn, triggers asthma attacks. If you have pets try keeping them away from your bedroom.
Dust mites also cause allergies which trigger asthma. So wash your carpets, rugs, bed-linen and pillowcases in hot water.
Bugs and insects such as cockroaches are not only unhygienic but can also trigger asthma. Cockroach droppings near your bed, kitchen and food are dangerous and you should call an exterminator to get rid of these bugs.
Sometimes, the heavy fragrance also aggravates your respiratory tract and triggers shortness of breath. Avoid using heavy perfumes, deodorants and room fresheners.
Pollution also triggers asthma. Dust particles come out from the vehicles and mix with the air. If this air is inhaled, it might trigger uncontrollable asthma. So try to cover your mouth with a cloth when you step out of your house.
Asthma can be very severe and can bring many hurdles in your day to day activities. Changing your lifestyle and certain habits can reduce asthma to a great extent.

Lifestyle Changes to Manage Asthma Better

What Causes Early Childhood Trauma? + How to Identify this Condition?

The problem of early childhood trauma refers to disturbing experiences that take place in children during 0-6 years of age. The traumas that young children experience can be the effects of natural disaster, war or accidents or that of intentional violence like sexual abuse, domestic violence or physical abuse.

What Does this Condition Impact Childhood?

Traumatic events have a significant impact on your child's life and can break his sense of safety. The problem has been linked with a decrease in the size of the brain cortex. This is the part of the brain that controls several complex functions like thinking, consciousness, memory, attention, awareness, and language. The changes that occur as a result can affect your child's IQ as well as his or her ability to control emotions. As a consequence, he or she may harbor feelings of danger and become more afraid or it may manifest in other personality issues which are not very obvious.

How do you identify this condition?

Generally, children who suffer from traumas face problems in regulating their emotions and behaviors.

They may display signs like:

- Fear of new situations
- Being clingy to their parent(s) or somebody close
- Become easily frightened
- Display aggressive and/or impulsive behavior
- Are difficult to comfort
- Display deterioration in behavior and functioning
- Easily forget newly attained developmental skills
- Difficulty in sleeping

Depending on the age during which your child may go through a traumatic event, he or she can exhibit signs relevant to his or her age.

For instance:

Children aged 0-2 years may also display reactions like poor verbal skills, memory problems, excessive temper, experience nightmares, etc.

On the other hand, children aged 3-6 years can face difficulties in learning as well as develop poor skill and learning disabilities, face problems in social interaction, may be unable to trust people and so on.

If this condition remains unattended or unresolved for longer, it may create personality issues and can deeply impact the individual's relationships, or equations in the society, as they grow up and even after they become adults. In fact, many behavioral problems can be traced back to childhood trauma.



What Causes Early Childhood Trauma? + How to Identify this Condition?

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