Dr. Nishant Mahajan

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
• 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.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Get immunized at the earliest. Stay safe.

Meningococcal meningitis is a form of bacterial meningitis. Meningitis is a disease caused by inflammation and irritation of the meninges, the membranes surrounding the brain and spinal cord. In meningococcal meningitis this is caused by bacteria invading the cerebrospinal fluid, circulating through the central nervous system.

Meningococcal disease causes life-threatening meningitis and sepsis conditions. In the case of meningitis, bacteria attack the lining between the brain and skull called the meninges. Infected fluid from the meninges then passes into the spinal cord, causing symptoms including stiff neck, fever and rashes. The meninges (and sometimes the brain itself) begin to swell, which affects the central nervous system.

Even with antibiotics, approximately 1 in 10 victims of meningococcal meningitis will die; however, about as many survivors of the disease lose a limb or their hearing, or suffer permanent brain damage. The sepsis type of infection is much more deadly, and results in a severe blood poisoning called meningococcal sepsis that affects the entire body. In this case, bacterial toxins rupture blood vessels and can rapidly shut down vital organs. Within hours, patient's health can change from seemingly good to mortally ill

Complications following meningococcal disease can be divided into early and late groups. Early complications include: raised intracranial pressure, disseminated intravascular coagulation, seizures, circulatory collapse and organ failure. Later complications are: deafness, blindness, lasting neurological deficits, reduced iq, and gangrene leading to amputations.

Prevention:
Vaccination plays the most important role in preventing such a deadly disease. For information on vaccine, contact your doctor at the earliest.

Protect yourself and your family against the killer disease - brain-'meningitis.

Constipation is a very common problem among toddlers and children. It takes place when the child's stool is dry, hard and unusually large, and the frequency of bowel movement is low and inconsistent. Although it is not a serious cause for concern, constipation in children should be recognised and treated early so that it does not develop into a chronic long-term ailment.

Constipation in children is seldom directly caused by any disease or medical disorder, which is known as idiopathic constipation and may be cause by a number of factors:

1.Diet: This is the primary cause of constipation in children. If the child's diet has low water and fibre content and heavily features sugar and processed foods, stool becomes hard and bowel movement gets restricted.

2. Deliberate withholding often children may consciously avoid visiting the toilet, which may make them feel constipated. This may be due to embarrassment, especially in public spaces or they might be too engaged in playing to not go to the toilet, altogether. Some children do it out of fear when a previous toilet experience has been particularly painful.

3. Lack of physical activity: the digestive system is boosted through regular exercise. Lack of physical activity, thus, inhibits regular bowel movement.

4. Illness and medication: infections and illnesses, especially ones pertaining to the stomach cause the child to become constipated. Many medicines and supplements also affect the digestive system and can lead to constipation.

What are the ways to manage constipation in children?

Constipation in children is treated differently than in adults as their diets and patterns of bowel movement are dissimilar.

The primary treatments for constipation in children are:

1. Stool softeners and laxatives

The administration of bowel movement enhancing medication is the simplest way of treating constipation in children. There are various kinds of stool softeners and laxatives that are safe for children and must always be used under the supervision of a paediatrician.

2. Dietary adjustment

Making changes to the child's diet by including high fibre foods (such as fresh fruits and vegetables, whole grain breads, cereals, etc.) can help cure constipation. Compelling the child to intake ample fluids in the form of water or milk is also necessary. Sugary drinks must be avoided.

Is your child undergoing Primary Immunodeficiency Disorders (PIDDs)? If you are tired of seeing your child suffering with regular cold and cough which could be solely due to a lack of nutrients in the diet, resulting in low immunity of the body. Adopting healthy habits by cutting back on junk food while including healthy items will help raise your child’s immunity levels immensely.

Some of the best foods to include in the diet to increase the immunity of your child are mentioned below:

1. Eggs, pulses, lean meats and other healthy protein: Immunity buildup may be disrupted if there isn’t enough protein in your diet. Milk protein in cow’s milk or dairy products like butter and cheese, animal protein in lean meats such as chicken and ovo-protein in eggs are highly beneficial and raise immunity levels.

2. Fish for immunity build up: Fish is a great immunity builder and also helps in making the brain work more efficiently. Fish meat contains lean proteins as well as essential omega-3 acids which help properly regulate many functions within the body raising immunity.

3. Stay healthy with yogurt: There are a lot many flavored varieties of curd or yogurt that your child may like and which is also considered as a power food source. It helps reduce gastrointestinal illnesses. However, try and go for the less flavored ones as they would have lesser amounts of processed sugar.

4. Oats and Barley for your rescue: The reason why oats and barley are healthy alternatives, especially for children is because they are composed of beta-glucan (fibre containing antioxidants and antimicrobial properties). This helps in avoiding constipation thus cleaning the intestine and hence avoiding the buildup of harmful bacteria within the body.

5. Fruit toppings are delicious: Fruits are not limited to mangoes, apples and bananas only. Darker the color of the fruit, greater is the nutritional value. Berries, peaches, melons, pomegranates etc, can and should also be included in your fruit intake as they are healthy as well as tasty.

6. Vegetables can be tasty too: Growing children require leafy green vegetables for physical and mental development as they contain zinc, iron and folic acid. Foods like fenugreek leaves and spinach are an example of vitamin rich food items. You can include spinach and other vegetables in a clever manner by making the food interesting so that children would want to eat it willingly.

7. Carrots to fight infection: Carrots are beneficial for good eyesight and protection from infections. With carrot intake it becomes quite difficult for the bacteria and germs to ender the blood vessels. This can be made into a salad or craved figuring to make it interesting to the kids. If you wish to discuss about any specific problem, you can consult a pediatrician.

Complementary feeding is for infants who are shifting gradually to table food from mother's milk by time they are one year old. 
There are 3 principles which are to be adhered so that the transition is easy for the baby.
1. Easy things first: This means that easily digestible food is to be administered first and then we can move on to complex food substances.
2. Start something new, one at a time: when introducing the baby to a new food item, the same food should be given at stretch for around ten days at about the same time.
3. New things in the morning: Before 1 o'clock. In case the child has a pain in the abdomen, vomits or has an allergic reaction to any food, this will leave you with enough time to handle the situation.

Supplementary food has to be served in a bowl or a glass or given orally with a spoon, never through a feeding bottle. You are allowed to create a distraction in order to feed the baby but force feeding is not allowed.

Start with soup first: Dal (split green gram: moong) water and soup made out of any 3 vegetables. Begin with clear soup and then gradually shift on to puree of the vegetables. After 10 days, you could start giving fruit in the morning. Best fruit to start with is banana. In the beginning, banana can be given with warm milk. You can give mango in the summers. And give an apple by boiling it after peeling off the skin. This is called stewed apple.

Rice is very easy to digest, so you can start feeding rice also. Hence precooked rice, mashed khichdi, pulaw, kheer can be given to bring about variety. Other cereals like wheat, barley, ragi, oats and corn can also be the choice there on. From 9 months, the child can be given 3 meals a day comprising of (1 cereal, 1 fruit and 1 misc. Keep in mind not to add sugar and salt in the food. Also no nuts, no non vegetarian food, no citrus fruit should be given. This can cause allergy. 

Wheat is also known to cause allergy, hence it should be given only after 6 months. The amount of food served, should be decided by the child based on his hunger and habit.

Happy eating, happy weaning!

Get immunised today.

Children might vomit after meals due to various causes. While they may not be life threatening or potentially harmful to the child, getting to the bottom of the problem to deal with it is better, so as to prevent it from becoming a chronic problem is definitely vital.

Listed below are some of the most common reasons children might throw up:

1. Gastroenteritis: This may be virus, bacteria and parasite induced. The best way to deal with it is to eat clean food and wash hands with an antiseptic soap prior to each meal. It is usually seen in combination with diarrhoea.
2. Allergies: Some children who throw up might do so as it is allergy induced. To diagnose the cause of food induced vomiting, the allergens must be noticed as soon as possible as there might be more than one food ingredient causing the reaction in the child. Each time the child throws up, the parents must note down all the food ingredients consumed by the child. This helps the paediatrician in better diagnosing the underlying cause of vomiting. In children up to the age of 4, foods such as rice, poultry, milk and soy often act as triggers and it is called ‘food protein induced enterocolitis syndrome’ (FPIES).
3. Backing up of food: Anti peristalsis or the backward movement of food along the digestive tract might happen in children for a host of reasons. The digestive tract has muscles which prevent the backward flow of food and instead, force the food downwards i.e. from mouth to anus. Due to children having weaker musculature in their digestive tract, regurgitation might be a frequent occurrence.
4. Reflux: Swallowing large amounts of air while eating can make the child bloated leading to reflux. Reflux can also take place if the baby is being overfed.

If the child is frequently throwing up after meals, keeping them hydrated is of utmost importance. Unless a doctor prescribes them anti-vomiting medicines, they shouldn’t be administered to children. If you wish to discuss about any specific problem, you can consult a pediatrician.