Dr. Sulochana Oberai

Depression in children is not a very uncommon phenomenon. But if the feeling of sadness persists over a period of time with little or no change to their behavior, then it can be seen as a symptom of depression. Children who are suffering from depression need immediate and utmost care as negligence may cause severe long term effects on the child. Read on to find more about them.

Symptoms:
Symptoms that indicate childhood depression vary. Some of the different symptoms which indicate depression are:

1. Social withdrawal
2. Irritability
3. Feeling of worthlessness
4. Difficulty in concentrating
5. Reduced ability to function during events
6. Continuous feelings of sadness
7. Physical complaints

Causes:

1. Depression in children can be caused due to the combination of a multitude of reasons.
2. Children from a family history of depression are more likely to be suffering from depression.
3. Similarly if the parents suffer from depression then it is more than likely that the child will also suffer from depression.
4. Children from conflicted families or children and teens who are prone to substance or alcohol abuse can suffer from depression.
5. Reasons such as physical health, environment, genetic vulnerability or biochemical disturbance can lead to depression.

Treatment:
The treatment process of depression in children is similar to that of adults and can be treated with psychotherapy and medication. If your child is depressed consult a general physician who after his or her diagnosis may refer you to a psychiatrist. The medical specialist will recommend psychotherapy.

In some instances, a child suffering from depression maybe be suicidal. Parents are advised to be vigilant and observe certain behavioral changes that the child may have adapted to or suddenly switched to.
Some of the signs are mentioned below:

1. Changes in eating, sleeping or activities
2. Isolating oneself even from family
3. Talking of suicide, feeling helpless or hopeless
4. Increased risk taking behavior
5. Substance abuse
6. Giving away possessions

Sessions at first and then opt for antidepressant medication if no significant progress is seen. The best results often result from a combination of prescribed medication along with multiple sessions of psychotherapy.

In India 61 million people are victims of diabetes. Diabetes disease is related to metabolic, in which oxidation of carbohydrates and glucose is not fully detected. Diabetes mellitus is a chronic metabolic disorder in which the body fails to convert sugars, starches and other foods into energy. Many of the foods you eat are normally converted into a type of sugar called glucose during digestion. The bloodstream then carries glucose through the body. The hormone, insulin, then turns glucose into quick energy or is stored for futher use. In diabetic people, the body either does not make enough insulin or it cannot use the insulin correctly. This is why too much glucose builds up in the bloodstream.

The main reason is irregular meal, mental stress, lack of exercise. There are two major types of diabetes:

Type 1

• This is popularly known as juvenile onset diabetes. 
• Here, the body produces little or no insulin. It occurs most often in childhood or in the teens and could be inherited.
• People with this type of diabetes need daily injections of insulin. They must balance their daily intake of food and activities carefully with their insulin shots to stay alive.

Type 2

• Also known as adult onset diabetes, this occurs around 35 to 40 years. The more common of the two types, it accounts for about 80 per cent of the diabetics.
• Here, though the pancreas produce adequate insulin, body cells show reduced sensitivity towards it.
• Type 2 diabetes is usually triggered by obesity. The best way to fight it is by weight loss, exercise and dietary control.
• Sometimes, oral medication or insulin injections are also needed.

Symptoms of diabetes

• Extreme thirst and hunger
• Frequent urination
• Sores or bruises that heal slowly
• Dry, itchy skin
• Unexplained weight loss
• Unusual tiredness or drowsiness
• Tingling or numbness in the hands or feetsymptoms of diabetes

The role of diet in diabetes
Meal of diabetic patient is depending on calories. Which decides on it s age, weight, gender, height, working etc. Depending on each person s different   different dietary chart is created. We must take special care of time and amount of food in diabetes. Here we are giving diet chart for general diabetes patient.

Diabetes diet chart:

• Morning at 6:   teaspoon fenugreek (methi) powder + water. 
• Morning at 7: 1 cup sugar free tea + 1-2 mary biscuits.
• Morning at 8.30: 1 plate upma or oatmeal + half bowl sprouted grains + 100ml cream-free milk without sugar
• Morning at 10.30: 1 small fruit or 1 cup thin and sugar free buttermilk or lemon water
• Lunch at 1: 2 roti of mixed flour, 1 bowl rice, 1 bowl pulse, 1 bowl yogurt, half cup soybean or cheese vegetable, half bowl green vegetable, one plate salad
• 4 pm: 1 cup tea without sugar + 1-2 less sugar biscuits or toast
• 6 pm: 1 cup soup
• 8.30 pm: 2 roti of mixed flour, 1 bowl rice, 1 bowl pulse, half bowl green vegetable, one plate salad
• 10.30 pm: take 1 cup cream free milk without sugar.

When you feel hungry intake raw vegetables, salad, black tea, soups, thin buttermilk, lemon water. Avoid it: molasses, sugar, honey, sweets, dry fruits. Foods you must avoid!

1. Salt: salt is the greatest culprit for diabetics. You get enough salt from vegetables in inorganic form, so reduce the intake of inorganic salt.
2. Sugar: sucrose, a table sugar, provides nothing but calories and carbohydrates. Also, you need calcium to digest sucrose. Insufficient sucrose intake might lead to calcium being leached off the bones. Substitute sucrose with natural sugar, like honey, jaggery (gur), etc.
3. Fat: excessive fat intake is definitely not a good habit. Try and exclude fried items from your diet totally. But, remember, you must have a small quantity of oil to absorb fat-soluble vitamins, especially vitamin E.
4. For non-vegetarians: Try and stop the intake of red meat completely. Try to go in for a vegetarian diet. If you cannot, decrease the consumption of eggs and poultry. You can, however, eat lean fish two to three times a week.
5. Whole milk and products: Try to switch to low fat milk and its products like yogurt (curd). Replace high fat cheese with low fat cottage cheese.
6. Tea and coffee: Do not have than two cups of the conventional tea or decaffeinated coffee every day. Try to switch to herbal teas.
7. White flour and its products: Replace these with whole grains, wholewheat or soya breads and unpolished rice.
8. Foods with a high glycemic index: Avoid white rice, potatoes, carrots, breads and banana -- they increase the blood-sugar levels. 

Advice for diabetes patient:

1. 35-40 minute faster walk every day.
2. Diabetic person should eat food between times intervals like take breakfast in morning, lunch, some snakes and dinner.
3. Avoid oily food.
4. Intake more fiber foods in meals. It increases glucose level gradually in blood and keeps control.
5. Do not take fast and also don t go much party.
6. Diabetic person should eat food slowly.

Calorific requirement:

1.  An obese middle aged or elderly patient with mild diabetes 1000 -1600 kcal.
2.  An elderly diabetic but not over weight  1400 -1800 kcal.
3.  A young active diabetic  1800 -3000 kcal.
4.  Daily intake of carbohydrate: 1/10th of total calories approximately  180gm.
5.  Daily intake of protein: 60gm to 110gm.
6.  Daily intake of fat: 50gm to 150gm.