I remember moving through the adult wards in medical school and the sight of the interns checking the blood sugar of their patients, from one bed to another without missing any ! Such is the place of diabetes in adult medicine, a very common condition among adults.
In children however, diabetes is not a very common occurrence such that doctors often miss the diagnosis when it occurs in children of resource poor countries. Diabetes in children may disguise as appendicitis, cerebral malaria,urinary tract infections, pneumonia or even typhoid enteritis.
A high index of suspicion is required for diagnosis of diabetes in children.One may need to routinely check the blood sugar of every child that present in the hospital for early diagnosis, treatment and prevention of complications of childhood diabetes.
I have made it a point of duty to bring this to the fore for this week because, it appears there is an increase in its occurrence amongst children seen in my facility in the last few years. This increase is such that in the last one year we have seen three cases, two of whom were initially managed as typhoid enteritis.
I hope to use this medium to educate us about this condition
What is Diabetes?
Diabetes simply means high blood sugar. It occurs when the sugar in the body (sugar is the end product of almost every thing we eat) is not available for energy generation and also not converted to the storage form, usually the insulin in such a person is not available or insufficient for this conversion, making lack of insulin or insufficient insulin the reason for this excess blood sugar.
Why do people have diabetes?
The reasons why people have diabetes is not entirely clear; however, some of the reasons may include:
Genetic abnormalities, infection, and diet.
Family history: children of diabetic parents should be routinely checked as they are often at higher risk.
Infections: some infections are capable of destroying pancreas, the insulin producing organ in the body, such infections include Mumps, tuberculosis, measles, other viral infections
Diet: western diet that predispose to Obesity may in turn predispose to a type of diabetes. Early exposure to "Canned" food with preservatives can trigger allergy/autoimmune reactions that may destroy insulin producing organ (this is hypothetical).
Here is a good news ; Human breastmilk is protective, it is cheap and unadulterated. Vitamins such as C, D and E vitamins are also protective.
Minerals like zinc ,selenium are also protective .
What are the signs of diabetes in children?
Weight loss: This though not universal and may be subtle is a very common sign, any unexplained weight loss in childhood must be investigated and the investigation panel must include blood sugar, please see your doctor or seek his or her opinion if your child is losing weight, you may even politely request for blood sugar check.
Frequent urination: if you notice that your child is urinating more frequently or too frequently please beckon on your doctor,. Some of these children may even start to bed wet newly.
Some children may start to drink water more often.
Some will eat more than before. !
Wounds on their body may not heal on time.
Some may have boil more often .
What to do if any of the above signs is seen?
See your doctor, preferably a paediatrician.,
the complications( stroke, blindness, kidney damage to mention a few) of diabetes are serious and may be life long, these complications are avoidable if diabetes is treated promptly.
To learn more..... Stay tuned.
Leave your questions, comments or suggestions in the comments box.
It was another breastfeeding week on 1st to 7th August, 2017. This year's theme challenged us to work together to make breastfeeding sustainable. It requested the support of every man, woman, manager, policy maker, NURSE, doctor, health attendant, Husband and everybody.
Breastfeeding is a BIG task, it drains energy, you may have witnessed or heard about women fainting after breastfeeding; such is the energy it consumes and this shows that the level of support needed by a breastfeeding woman is unquantifiable/ enormous.
If you did not talk to someone last week about breastfeeding , you didn't do too well, you still have the chance to do that before it is too late or better still forward this piece of information to them.
Can we have Breastfeeding celerebrated every week just to lay emphasis on the importance of breastfeeding?
I need not bore us on why breastfeeding or breast milk is important, its rich contents and the protections it offers are superior.
What I want us to pay attention to is helping the breastfeeding women around us do it well, any form of encouragement done properly will be appreciated; a thumbs up, a pat, money, food, space, breastfeeding leave with pay , a space in your establishment for brastfeeding mothers to breastfeed are just some of the supports that will make the breastfeeding mother do it well.
If you look around well enough this task is often left for the aged women in the community who themselves need support, they pass down traditional practices (big kudos to them), some of these practices are very helpful. That they are willing to help always is commendable. However, we are now in an era when we know better and our knowledge should set us free, set our community free also.
My major concern today are the challenges and myths of breastfeeding.
I have been in a nursery bay where HOT water was prescribed, to help uterus contracts and breast milk flows. Right in the hospital, even in labour wards you see people including healthcare practitioners prescribe bland PAP etc as a form of galactogogue. These are based on traditions and psychology; they have little scientific basis.
The challenges of breastfeeding are numerous, I will mention a few:
1. Milk not flowing: this is common in the first 3 days after birth, it is a normal finding in most mothers and will soon flow, as a mother, you need to relax, eat well and drink a lot fluids, be happy, ensure you are not in any form of pain as this can cause delay in milk flow.
Please my fellow doctors, DO NOT PRESCRIBE HOT WATER FOR THESE WOMEN, doing so has no established basis ,tell me how much hot water can a woman who should be well hydrated drink? The breastfeeding mother should take about 3litres of water daily, normal (water at room temperature) will do. If the lack of milk flow extends beyond the 3rd day with all the above mentioned stuffs clearly addressed pleas see your doctor (pregnant woman doctor (Obstetrician) or babies doctor (Paediatrician)).
Palm wine is not a special fluid, if you are not interested don't drink, don't blame your inability to produce enough milk on lack of palm wine, a lot of people get unneccessarily worried because of this temporary problem to the extent that such worry inhibit their milk flow.
Pregnant women and breastfeeding mothers need GOOD FOOD,simple well prepared meal, No mandatory Pap .
The list below is a well illustrated 10 steps to
SUCCESSFUL BREAST-FEEDING Every facility providing maternity services and care for newborn infants should accomplish the following: 1 Have a written breast-feeding policy that is routinely communicated to all health care staff. iiTrain all health care staff in the skills necessary to implement this policy. iii Inform all pregnant women about the benefits and management of breast-feeding. iv Help mothers initiate breast-feeding within a half hour of birth. v Show mothers how to breast-feed and how to maintain lactation even if they should be separated from their infants. vi Give newborn infants no food or drink other than breast milk unless medically indicated., please babies do not need water while breastfeeding exclusively, herbal concoction is not needed, brestmilk is all in all in the right proportions. vii Practice rooming-in (allow mothers and infants to remain together) 24 hr a day. viii Encourage breast-feeding on demand. ix Give no artificial teats or pacifiers (also called dummies or soothers) to breast-feeding infants. x Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.
2. Pain while breastfeeding , this could be a normal finding initially but breast feeding should soon be itch free, free flowing , if the pain is disturbing lasting more than few hours after delivery, please prescribe pain killer for these women also encourage them to breastfeed more often during this period, yes the reasons for this pain may inlude
A) Breast engorgement..... Breast is overfilled, overstretched and painful, mother will need to Breastfeed more often to prevent this very painful challenge, give pain killer if one develops , other treatment modalities include warm compress, warm shower etc
B) Breast abscess.... Please never allow it get to this level, if this develops see a doctor fast. The woman will have pains, fever and may have chills.
C) Sores on the nipple(s)..this should not be, it is usually due to bad techniques of breastfeeding, the technique is about the most important thing , if the nipples have sores, the treatment is more breastfeeding to avoid engorgement and one can also express the milk and give through cup till the sores heal, the proper techniques must be emphasized. These techniques are usually taught during the antenatal vists and in the post natal ward after delivery (make it a point of duty to learn the proper technique, such that you can help yourself and people around you).
The technique is illustrated below properly.
Babies are designed to breastfeed and every mother is built to provide beast milk but the techniques must be right, everything must come together at the point baby attaches to the breast.
Get in a comfortable chair with great back support to feed your baby. Using a stool to rest your feet on will help with good posture and prevent you from straining your neck and shoulders.
Use your breastfeeding support pillow if you have one. (And if you don’t, use whatever kind of pillows you can find to help support you and the baby). A good breastfeeding pillow can make a huge difference in getting the baby in a proper position to latch on well.
Make sure your baby is tummy-to-tummy with you at all times.
Make sure you bring your baby to you, and do not try to lean onto the baby. Not only will this cause severe strain on your neck and shoulders, but it can affect the baby’s position.
Remember to keep your baby’s ear, shoulder, and hip in alignment, which will make swallowing easier.
The baby’s nose should be opposite the nipple.
You might need to hold your breast to help guide the nipple to your baby’s mouth. Grasp the breast on the sides, using either a “C” hold or “U” hold. Make sure you keep your fingers far from the nipple so you don’t affect how baby latches on.
Aim the nipple toward the baby’s upper lip/nose, not the middle of the mouth.You might need to rub the nipple across the top lip to get your baby to open his/her mouth.
The baby’s head should be tilted slightly back. You do not want his chin to his chest.
When he opens his mouth wide with the chin dropped and tongue down, he should latch on to the nipple. If he does not open wide, do not try to shove the nipple in and wiggle the mouth open. It is best to move back, tickle the lip again with the nipple and wait for a wide open mouth.
Try to get as much of the lower portion of the areola (the area around the nipple) in the baby’s mouth.
The baby’s chin should indent the lower portion of your breast.
Look to see if the baby’s bottom and top lip are flanged out like fish lips. If they are not, you may use your finger to pull the bottom one down and open up the top one more.
Positioning your baby to feed
There are many different positions that can work while breastfeeding. It is important to find one that is comfortable for both you and your baby. Make sure to utilize the tips in the above list to help ensure your position is correct.
Cross-Cradle Hold:
This position is often the most helpful for moms right after birth and until they get more confident in getting their baby latched on correctly. It feels awkward for many moms at first, but once they see how it allows them to use both their hands more effectively, moms get more comfortable with it.
You will use the arm on the opposite side you will be feeding from to hold and support your baby, while you use the hand on the side you are feeding from to support your breast.
Lay your baby next to you, tummy-to-tummy, with your opposite hand supporting the back of his head. You want to make sure you are holding at the neck, so you are just guiding the head. You will use the other hand (on the same side the baby is feeding from) to hold and navigate your breast and nipple. Once the baby is securely latched on, you can move your arms to the cradle hold.
Numerous other methods exist, check and learn.
3.Lastly for today, is a 3rd challenge
Breast leakage: innocuous, the milk overflows , stain wears and can be smelly, More hygiene needed, it resolves on its own.
The myth are numerous and challenges enormous the scope of today's blog can not exhaust them all. We shall revisit some other ones later .
Here I rest my case for this week, help mothers breastfeed, give the needed support.
Leave your comments , questions and suggestions in the box below.
Scary as it goes, convulsion or fits (seizure) is the commonest scary experience for mother to witness a child have, they chant all sorts of names. Jesus, Jehovah, doctor, Yepa, Oh! Ha! Just to mention a few.
I have witnessed them pee themselves but that is fine. What bothers me and affect these children more than the convulsion are the wrong interventions and the insults we inflict on them during this process.
This brings us to today's blog tittle.
"Care and Prevention of Febrile Convulsion in Children"
What is Febrile convulsion?
It is a convulsion (fit) or seizure in children when they are having fever, occurs usually in children between the age 6 months and 60 months (5yrs).
Convulsion may be characterized (but not restricted to) by abnormal movement of any part of the body usually jerking, pedaling, abnormal blinking of the eyes, upward rolling of the eyes, stiffening of the body, etc.
It is quite a common place in children.
Fever is defined as elevated body temperature, subjectively and rather unreliably checked by placing the back of the palm on the forehead in this part of the world.
The reliable method is by using a thermometer, a specimen is shown below.
Off mode
Default value when switched on.
Reading after measurement
Temperature greater than 37.5 Celsius measured from the armpit (there are other places one can check) is referred to as fever.
What are the causes?
The causes are mostly from infections, that may affect any part of the body except the brain. These include but not limited to :
Malaria
Catarrh and cough (flu, pneumonia)
Infection in the throat (tonsillitis and pharyngitis)
Infection in the passage for urine (urinary tract infections)
Infection in the ear (Otitis)
Like I said, infection anywhere in the body except the brain may be a cause . If the infection is in the brain, the outcome is worse and the associated fit is not called febrile convulsion.
What to do during a febrile illness to avoid febrile convulsion?
1. Have a thermometer to measure your children temperature. This can be done by anybody and everybody.A digital thermometer displays the temperature of the body on its screen.
Switch on the thermometer and simply put in the ampit for 2 minutes or till it alarms, Check the number displayed thereafter,If lesser than 37.5 Celcius, no problem, Values greater than 38 Celsius are particularly disturbing and requires care that may include
a) Complete exposure of the child
b) Fanning
c) Bathing with lukewarm water
d) Toweling with wet napkins (wet with warm water)
e) Administration of Paracetamol (only if the above methods fail and temperature is greater than 38 Celsius).
Paracetamol should not be used routinely in any child to prevent fever (it damages the liver and the kidney if used excessively).
Such child should at least be reviewed by a family physician or a paediatrician(babies doctor)
What to do during convulsion
Convulsion for one minute is like eternity to an helpless mother, so any form of intervention will do. Anything done to stop the convulsion is usually welcomed and appreciated though most of these interventions are needless and harmful as we shall soon see , the following are recommended steps of interventions
1. Remove all clothing and allow proper ventilation
2. Put to lie on the left side
3.Follow steps a to e of prevention written above
4. If available, insert a rectal diazepam. This is a gel that can be placed in the body through the anus and hastens abating the seizure
4. It is also Paramount to see a doctor (babies doctor)
May I quickly add that febrile convulsion usually does not leave a child damaged, There is no long term outcome. It is our wrong interventions during this period that damage these children.
What not to do.
1. Do not pee on the child. This is rather a common practice. Please, do not do it. The danger is the child run a greater risk of aspirating the urine(breathing in urine) and suffer lung infections and may even die from choking.
2. Do not give COW Urine,sounds funny or you say barbaric, people do it, and it is a very common practise.
The first problem here is cow urine, the second is that it is used alongside onion and garlic making a concoction that potentially lowers the blood sugar making the child to have more convulsions and subsequently suffer permanent brain damage.
3. Do not put their leg(s) in fire, Yes, people do it,in the last one month, I have seen a couple of cases.
The fact here is that fire can only worsen convulsion, It does not stop it,the child is then left with a damaged foot, prolonged hospital stay, more psychological effect the extent of which can not be quantified.
4. Do not insert spoon, or anything in their mouth while convulsing, you may remove their teeth , injure the mouth structures and the child may choke.
5. Don't give anything by mouth while a patient is convulsing or sleeping after convulsion, It is dangerous.
Most of the above interventions are instituted by Neighbours, grandparent, friends etc but not by the mother who is at the time of event practically " brain dead".
This is a case where doing nothing ( if u do not know what to do )is far better than doing useless stuff.
Please share this information , it will definitely help some poor children somewhere.
Leave your comments , suggestions , additions and questions in the comment box below.
I have chosen to speak out to the public through this medium having kept quiet for so long .
The last straw of events happened this weekend, another baby lost to a very preventable death, through needless hot formentation of the remnant of the baby's cord a means through which, though rare, an infection, a kind that sort of eat up the flesh around the cord occurs , This I must agree is rare occurrence but usually a fatal one.
Before I continue with my rant, may I be permitted to educate us on the universally acceptable means of caring for a newborn umbilical cord remnant.
What is an umbilical cord?
It is a thin rope of fleshy white gelatin that attach a baby to the placenta. It serves as a means of communication between the baby and the placenta (the mother).
It is a passage through which digested food from the mother, oxygen and other essentials of life are passed to the baby. Some of the baby's wastes are also passed through it to the mother for removal.
A baby is delivered of the mother only when the cord is severed after expulsion of the baby through whatever means Vaginal or abdomen (in case of caesarian cut).
The remnant of the severed cord is clamped (tied) as it contained blood vessels and will bleed out all the baby's blood if left unclamped (not tied). This remnant will naturally degenerate and drop off the baby, usually between day 4 and 7 though may rarely remain intact for longer time (maximum 28days), after which it is considered prolonged (Seek medical attention if it has not dropped after 2 weeks).
It usually will drop without leaving any appreciable wound, but may rarely leave an innocous fleshy outgrowth (Seek medical care if you see this).
Picture of a newborn showing the cord immediately after severance
Why is the need for special care of the cord?
The process that leads to eventual dropping of the cord produces dead tissue that is slightly foul smelling and must be cleansed off.
The dead tissue is a good medium for bacteria infection and other disease causing agents to grow and multiply so we must clean to prevent this. What are the ways by which we can care for the cord?
1. Normal baby bath twice daily (where necessary) with warm water containing one to two drops of savlon , towel dry after.
2. The remnant of the cord should not be tucked in to the diaper as it may be readily contaminated with baby's urine and stool.
3. The cord can be swabbed with methylated spirit (alcohol swab) 3 to 6 times daily at regular interval, triple dye or bacitracin, if available, may be applied daily.
4. WHO ( World Health Organisation ) recommends application of chlorhexidine gel (Available in health centres and some pharmacy shops) or savlon cleaning)
5. After the umbilical cord has dropped off, cleaning with methylated spirit should continue for one or two days after which no special care is needed.
<script data-cfasync='false' type='text/javascript' src='//p246585.clksite.com/adServe/banners?tid=246585_470444_0'></script>
What is fobbiden?
1. Application of cow dung, yes I said cow poo, it is rather a common practice (though has reduced drastically) to see people apply this mess on their baby's cord. This is a dangerous practice as many of such children die of infection and/or tetanus.
2. Hot formentation... This is the cause of my early rant , it is a rampant practise in this part of the world and rather unfortunate as both the very educated and the uneducated are involved.
What is more disheartening is that this is like a tradition passing from one generation to the other.
We have to stand right and stop this right away( Say no to Cord formentation)
It is cruel as many of these children cry ceaselessly and helplessly while going through this torture
The baby is a well formed human , no internal wound of any sort that will be healed with your hot formentation, so stop it.
Picture of one of the scores of affected children
Another victim of our gruesome traditional practice
4.Application of mentholatum, Robb or Dustin powder is also very dangerous.
Anything other than the above mentioned methods of care can be potentially dangerous , ask from babies doctor before you do them.
Yes that you did it for your baby and you got away with it does not make it right.
I may have been hot formented but I (we) am(are) here to stop these barbaric practises .
