Dr. Ramakanth Reddy

Depression in Children: What is Depression?

Depression can strike a child at any age. A mood disorder, depression is characterized by a persistent sad or empty feeling, irritability, and a loss of interest in everyday activities. Unlike normal sadness or grieving, most bouts of depression last for weeks, months, or even years. A smaller number of children and adolescent suffer from bipolar disorder-bouts of depression interspersed with periods of elevated (manic) mood (bipolar disorder).

Although depression is usually not considered life-threatening, it can lead to thoughts of and attempts at suicide.

Symptoms

• Persistent feelings of sadness, apathy, or hopelessness lasting more than two weeks.

• Diminished interest in most daily activities, particularly pleasurable ones.

• Decreased appetite and subsequent weight loss; increased appetite and weight gain.

• Lack of sleep (insomnia ), frequent awakening throughout the night, or conversely, an increased need for sleep.

• Anxiety; diminished ability to think or concentrate.

Diagnosis

Because there are no reliable laboratory tests to diagnose depression, physical examination and psychological evaluation are essential.

• Expression of either of the first two symptoms of depression (see Symptoms box), in conjunction with other symptoms, for a period of two or more consecutive weeks.

• A positive family history of depression or a prior depressive episode helps establish the diagnosis.

Treatment

• Psychotherapy is as effective as drug treatment in mild cases. Psychotherapy may also be used in conjunction with drug therapy.

• Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), are mainstays of treatment.

• Exposure to bright light, known as light therapy, may be effective, particularly when depression is related to seasonal changes (seasonal affective disorder).

• In secondary depression, the underlying cause is addressed, although antidepressant therapy may also be prescribed.

The danger of dehydration and heat stroke

Dehydration and heat stroke are two very common heat-related diseases that can be life-threatening if left untreated.

What is dehydration?

Dehydration can be a serious heat-related disease. It is also a dangerous side effect of diarrhea, vomiting, and fever. Children and people over the age of 60 are particularly susceptible to dehydration.

What causes dehydration?

Under normal conditions, we all lose body water daily through sweat, tears, breathing, urine, and stool. In a healthy person, this water is replaced by drinking fluids and eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting, dehydration happens. It also happens if an individual is overexposed to the sun and not drinking enough water. This is caused when the body loses water content and essential body salts, such as sodium and potassium.

Occasionally, dehydration can be caused by medicines, such as diuretics. These deplete body fluids and electrolytes. Whatever the cause, dehydration should be treated as soon as possible

What are the symptoms of dehydration?

The following are the most common symptoms of dehydration. However, each individual may experience symptoms differently. Symptoms may include:

• Thirst

• Less-frequent urination

• Dry skin

• Fatigue

• Light-headedness

• Dizziness

• Confusion

• Dry mouth and mucous membranes

• Increased heart rate and breathing

In children, additional symptoms may include:

• Dry mouth and tongue

• No tears when crying

• No wet diapers for several hours

• Sunken abdomen, eyes, or cheeks

• Listlessness

• Irritability

• Skin that does not flatten when pinched and released

The symptoms of dehydration may resemble other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

Thrush (Oral Candida Infection) in Children

What is thrush in children?

Thrush is a mouth infection that is common in babies and children. Symptoms include white or yellow velvety patches in the mouth. Thrush is caused by a type of fungus called Candida. Candida is found naturally on the skin and in the mouth. But if Candida grows out of control, it can cause thrush. Thrush is not a serious problem for a healthy child. It can be treated with antifungal medicine.

What causes thrush in a child?

Candida yeast is common in the everyday environment. It only causes a problem when it grows out of control. This can happen if a child:

• Has taken antibiotics
• Uses inhaled corticosteroids, such as for asthma
• Uses a pacifier often
• Has a weakened immune system

Which children are at risk for thrush?

A child is more at risk for thrush if he or she:

• Had a very low birth weight
• Passed through the birth canal of a mother with a yeast infection
• Has taken antibiotics
• Uses inhaled corticosteroids, such as for asthma
• Uses a pacifier often
• Has a weakened immune system
• What are the symptoms of thrush in a child?

Thrush causes milky white or yellow patches to form on the tongue or inner cheeks. These patches can be painful and may bleed. Some babies have no pain from thrush. Others may have pain and be fussy and refuse to feed. It may hurt when your child swallows. Thrush can also cause cracked skin in the corners of the mouth. Symptoms can occur a bit differently in each child. The symptoms of thrush can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is thrush diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. This will include looking in your child’s mouth.

The Growing Child: School-Age (6 to 12 Years)

Children progress at different rates. They have different interests, abilities, and personalities. But there are some common milestones many children reach from ages 6 to 12.

What can my child do at these ages?

As your child grows, you’ll notice him or her developing new and exciting abilities.

A child age 6 to 7:

• Enjoys many activities and stays busy

• Likes to paint and draw

• Practices skills in order to become better

• Jumps rope

• Rides a bike

A child age 8 to 9:

• Is more graceful with movements and abilities

• Jumps, skips, and chases

• Dresses and grooms self completely

• Can use tools, such as a hammer or screwdriver

A child age 10 to 12:

• Likes to sew and paint

What does my child understand?

As children enter into school age, their skills and understanding of concepts continue to grow.

A child age 6 to 7:

• Understands the concept of numbers

• Knows daytime and nighttime

• Knows right and left hands

• Can copy complex shapes, such as a diamond

• Can tell time

• Understands commands that have 3 separate instructions

• Can explain objects and their use

• Can repeat 3 numbers backward

• Can read age-appropriate books

A child age 8 to 9:

• Can count backward

• Knows the date

• Reads more and enjoys reading

• Understands fractions

• Understands the concept of space

• Draws and paints

• Can name the months and days of week, in order

• Enjoys collecting objects

A child age 10 to 12:

• Writes stories

• Likes to write letters

• Reads well

• Enjoys using the telephone

How will my child interact with others?

An important part of growing up is learning to interact and socialize with others. During the school-age years, you’ll see a change in your child. He or she will move from playing alone to having multiple friends and social groups. Friendships become more important. But your child is still fond of you as parents, and likes being part of a family. Below are some of the common traits that your child may show at these ages.

A child age 6 to 7:

• Cooperates and shares

• Can be jealous of others and siblings

• Likes to copy adults

• Likes to play alone, but friends are becoming important

• Plays with friends of the same gender

• May have occasional temper tantrums

• Is modest about his or her body

• Likes to play board games

A child age 8 to 9:

• Likes competition and games

• Starts to mix friends and play with children of the opposite gender

• Is modest about his or her body

• Enjoys clubs and groups, such as Boy Scouts or Girl Scouts

• Is becoming interested in boy-girl relationships, but doesn’t admit it

A child age 10 to 12:

• Finds friends are very important; may have a best friend

• Has increased interest in the opposite gender

• Likes and respects parents

• Enjoys talking to others

How can I encourage my child's social abilities?

You can help boost your school-aged child's social abilities by:

• Setting limits, guidelines, and expectations and enforcing them with appropriate penalties

• Modeling good behavior

• Complimenting your child being cooperative and for personal achievements

• Helping your child choose activities that are suitable for his or her abilities

• Encouraging your child to talk with you and be open with his or her feelings

• Encouraging your child to read, and reading with your child

• Encouraging your child to get involved with hobbies and other activities

• Promoting physical activity

• Encouraging self-discipline and expecting your child to follow rules that are set

• Teaching your child to respect and listen to authority figures

• Encouraging your child to talk about peer pressure and setting guidelines to deal with peer pressure

• Spending uninterrupted time together and giving full attention to your child

• Limiting television, video, and computer time 

9-12 months old babies learn to walk easily.

What foods contain lactose?

• Milk

• Cheese

• Yogurt

• Ice cream

• Sherbet

Items on a food label that contain lactose:

• Milk

• Milk solids

• Skim milk powder

• Cream

• Buttermilk

• Malted milk

• Whey lactose

• Curds

• Margarine

Some foods that may have hidden sources of lactose:

• Breads

• Candy

• Cookies

• Cold cuts

• Hot dogs

• Bologna

• Sauces and gravies

• Dessert mixes

• Cream soup

• Frostings

• Chocolate drink mixes

• Salad dressing

Living with lactose intolerance

• Take small amounts. In most cases you don’t need to remove all dairy foods from your diet. You may be able to eat or drink small amounts of dairy products without having any symptoms. It can be helpful to keep a food diary. Keep track of what you eat and drink, and write down when you have symptoms.

• Try lactose-free and reduced-lactose products. There are many lactose-free and lactose-reduced dairy products available, including milk, ice cream, and cheeses. These can allow you to still enjoy dairy products. Ask your healthcare provider or dietitian about these products.

• Take lactase enzyme supplements. These supplements are available over the counter. Taking the advised dose with your first drink or bite of a dairy product can help prevent symptoms. Talk with your provider about these supplements.

Sources of Calcium for a Lactose Intolerant Diet

Calcium and vitamin D are needed for strong bones and teeth. If you are not using milk or milk products, you may not be getting enough calcium and vitamin D from your diet. Ask your provider or dietitian for more information about your body's calcium and vitamin D needs.

The following are good sources of calcium:

300 mg calcium

• 4 ounces canned salmon

• 1 cup calcium-fortified orange juice

• 1/4 cup almonds

• 1 cup yogurt

150 mg calcium

• 2 ounces canned sardines

• 1/2 cup turnip greens, kale, or collards

• 1/2 cup tofu      

• 1 1/2 cups dried beans

100 mg calcium

• 2/3 cup broccoli

• 1/2 cup okra

• 5 ounces shrimp

• 2 cups cabbage

Make sure you trim your baby's nails whenever he/she is asleep, so that he/she does not hurt or scratch himself/herself.

Newborn Multiples

Care of multiple birth babies

Often, multiples are born small and early. They may be initially cared for in a special care nursery called the neonatal intensive care unit (NICU).

In the NICU

The NICU combines advanced technology and trained healthcare professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or an NICU, and babies must be transferred to another hospital.

In most cases, you can be with your babies in the NICU at any time. The staff of the NICU will give you instructions on special hand-washing techniques before entering the area. In some cases, you may need to wear a mask. Occasionally, during a procedure, or when the hospital staff are making "rounds," parents may be asked to wait for a few minutes before coming into the area. Although most NICUs permit visitation of babies by other family members, limiting visitors is a good idea. Many sick and premature babies are very susceptible to infection. Siblings should be carefully checked for signs of colds or other illness. They should also be helped with hand-washing before visiting their baby brother or sister.

Most parents find that becoming involved with their babies' care gives them a sense of control. It also helps them bond with their babies. This is also important for the babies. It helps the babies feel secure and loved. Once the babies' condition is stable, parents are encouraged to hold and rock them. Staff in the NICU can show you how to care for your babies in many ways. Learning these aspects of care is helpful in preparing you to take your babies home.

Once babies are able to feed, grow, and stay warm, they can usually be discharged. Other babies who are healthy at birth may need only a brief check in a special care nursery.

Breastfeeding multiple birth babies

• Breast milk is the perfect food for your baby. It gives your baby many advantages compared with formula. Your milk contains just the right amount of nutrients. And it is gentle on your baby's developing stomach, intestines, and other body systems. It also has the best nutrients for brain and nervous system development and overall growth and development.
• Getting used to breastfeeding more than one baby will take extra patience and persistence. How soon you and your babies can begin to breastfeed will depend on the maturity of your babies' brains and body systems. A baby's gestational age influences the development of stable body systems and the development of the reflexes needed for oral feedings. A baby's physical condition may also affect when direct breastfeeding can begin.
• Lactation specialists can help mothers of multiples learn techniques for breastfeeding their babies separately and together, and to increase their milk supply. Mothers whose babies are unable to breastfeed because they are sick or premature can pump their breast milk and store the milk for later feedings.
• Families with more than one baby need help from family and friends. The first two months are usually the most difficult as everyone learns to cope with frequent feedings, lack of sleep, and little personal time. Having help for household chores and daily tasks can allow the mother the time she needs to get to know her babies, for feedings, and for rest and recovery from delivery.

What is Nephrolithiasis?

Nephrolithiasis, commonly known as kidney stones or renal calculi, typically occurs in adults, but it can happen in children as well. Some doctors say there is anecdotal evidence that more children are getting this condition, probably because of consuming too much salt. Kidney stones can occur even in babies. A renal stone is a crystal. Kidney stones form when high amounts of certain substances accumulate in the kidneys, forming a stone. Certain stones are caused by other diseases but many are related to diet and nutrition.

Types of Kidney Stones

• Calcium stones are the most common type, usually caused by high intake of certain substances, such as salt.

• Cystine stones can form in people who have cystinuria, an inherited disorder, marked by increased formation of stones in the bladder, kidney and ureter.

• Struvite stones most often occur in women who have UTI

• Urica acid stones can occur with gout or after chemotherapy.

Symptoms

• Intense pain in the lower back and/or in the sides

• Frequent, painful urination,Nausia,vomittig,

• Blood in urine and/or cloudy urine

• Urinary tract infections secondary to kidney stones accompanied by fever

What is diarrhea?

Diarrhea is when stools (bowel movements) are loose and watery. Your child may also need to go to the bathroom more often.

Diarrhea is a common problem. It may last 1 or 2 days and go away on its own. If diarrhea lasts more than 2 days, your child may have a more serious problem.

Diarrhea may be either:

• Short-term (acute). Diarrhea that lasts 1 or 2 days and goes away. This may be caused by food or water that was contaminated by bacteria (bacterial infection). Or it may happen if your child gets sick from a virus.

• Long-term (chronic). Diarrhea that lasts for a few weeks. This may be caused by another health problem such as irritable bowel syndrome. It can also be caused by an intestinal disease. This includes ulcerative colitis, Crohn’s disease, or celiac disease. Giardia may also cause chronic diarrhea.

What causes diarrhea?

Diarrhea may be caused by many things, including:

• Bacterial infection

• Viral infection

• Trouble digesting certain things (food intolerance)

• An immune system response to certain foods (food allergy)

• Parasites that enter the body through food or water

• Reaction to medicines

• An intestinal disease, such as inflammatory bowel disease

• A problem with how the stomach and bowels work (functional bowel disorder), such as irritable bowel syndrome

• Surgery on the stomach or gallbladder

Children who visit some foreign countries are at risk for traveler's diarrhea. This is caused by having food or water that is not safe because of bacteria, viruses, or parasites.

Severe diarrhea may mean a child has a serious disease. Talk with your child's healthcare provider if symptoms don’t go away. Also talk with the provider if symptoms stop your child from doing daily activities. It may be hard to find out what is causing your child’s diarrhea.Imbalances of salt and water in the body can lead to problems ranging from cystic fibrosis to diarrhea to kidney failure. Dr. Guggino and his team study the channels that move salt and water– and what goes wrong with them in disease.

What are the symptoms of diarrhea?

Symptoms can occur a bit differently in each child. They can include:

• Cramping

• Belly (abdominal) pain

• Swelling (bloating)

• Upset stomach (nausea)

• Urgent need to use the bathroom

• Fever

• Bloody stools

• Loss of body fluids (dehydration)

• Incontinence

The symptoms of diarrhea may look like other health problems. Severe diarrhea may be a sign of a serious disease. Make sure your child sees his or her healthcare provider for a diagnosis.

How is diarrhea diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may have lab tests to check blood and urine.

Other tests may include:

• A stool culture to check for abnormal bacteria or parasites in your child’s digestive tract. A small stool sample is taken and sent to a lab.

• A stool evaluation to check the stool for blood or fat

• Blood tests to rule out certain diseases

• Imaging tests to rule out structural problems

• Tests to check for food intolerance or allergies

• A sigmoidoscopy. This test lets the healthcare provider check the inside of part of your child’s large intestine. It helps to tell what is causing diarrhea, stomach pain, constipation, abnormal growths, and bleeding. It uses a short, flexible, lighted tube (sigmoidoscope). The tube is put into your child’s intestine through the rectum. This tube blows air into the intestine to make it swell. This makes it easier to see inside.

How is diarrhea treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Dehydration is the major concern with diarrhea. In most cases, treatment includes replacing lost fluids. Antibiotics may be prescribed when bacterial infections are the cause.

Children should drink lots of fluids. This helps replace the lost body fluids. If your child is dehydrated, be sure to:

• Offer drinks called glucose-electrolyte solutions. These fluids have the right balance of water, sugar, and salts. Some are available as popsicles.

• Avoid juice or soda. They may make diarrhea worse.

• Not give plain water to your baby

• Not give too much plain water to kids of any age. It can be dangerous.

• Keep breastfeeding your baby. Breastfed babies often have less diarrhea.

• Keep feeding your baby formula, if you were already doing so

What are the complications of diarrhea?

The greatest complication of diarrhea is dehydration. This is more likely with young children and those with a weakened immune system. Dehydration can be mild, moderate, or severe. Mild dehydration is the loss of fluid. Moderate or severe dehydration puts stress on the heart and lungs. In the worst cases it can lead to shock, which is life-threatening.

What can I do to prevent diarrhea?

Proper handwashing can reduce the spread of bacteria that may cause diarrhea.

A rotavirus vaccine can prevent diarrhea caused by rotaviruses. Ask your child's healthcare provider which vaccines are right for your child.

When you travel, make sure anything your child eats and drinks is safe. This is even more important if you travel to developing countries.

Travel safety tips for drinking and eating include:

• Not drinking tap water or using it to brush teeth

• Not using ice made from tap water

• Not drinking unpasteurized milk (milk that has not gone through a process to kill certain bacteria)

• Not eating raw fruits and vegetables unless you wash and peel them yourself

• Not eating raw or undercooked meat or fish

• Not eating food from street vendors or food trucks

Talk with your child's healthcare provider before traveling.

When should I call my child's healthcare provider?

Call your child's provider if your child is less than 6 months old or has any of the following symptoms:

• Belly pain

• Blood in the stool

• Frequent vomiting

• Doesn’t want to drink liquids

• High fever

• Dry, sticky mouth

• Weight loss

• Urinates less frequently (wets fewer than 6 diapers per day)

• Frequent diarrhea

• Extreme thirst

• No tears when crying

• Sunken soft spot (fontanelle) on baby’s head

Key points about diarrhea

• Diarrhea is loose, watery stool. Your child may also have to go to the bathroom more often.

• It may be caused by many things, including bacterial infection or viral infection.

• Dehydration is the major concern with diarrhea.

• In most cases, treatment involves replacing lost fluids.

• The rotavirus vaccine can prevent diarrhea caused by that virus.

• Proper handwashing can help prevent diarrhea.

• When you travel, make sure anything your child eats and drinks is safe.