Ravina Sewani

Palak Vyas

A 'tongue-tie' (also known as ankyloglossia) limits the tongue's mobility due to an unusually short/thick frenulum (a piece of skin) that connects the tongue tip to the floor of the mouth. As the mouth parts develop in the fetus during the 1st trimester, a failure of the frenulum to separate completely from the base of mouth results in tongue tie. The severity ranges from being mild to a complete loss of mobility of the tongue. Causes: The causes of tongue tie are still unknown. Symptoms:<ul><li>Baby can’t latch well</li><li>Baby tends to chew more than suck</li><li>Baby doesn’t gain weight</li><li>Baby is fussy when trying to feed</li><li>Baby makes a clicking sound while feeding</li><li>Tongue can’t move far from side to side</li><li>Tongue can’t reach the upper gums or roof of the mouth</li><li>Tongue can’t stick out past the gums</li><li>Tongue has a V shape or heart shape at its tip when it’s sticking out</li><li>Older children may have difficulties pronouncing certain words with 't; 'th; 'd', 'dh', 's', 'Z', 'r', or 'II in it.</li><li>There is a higher possibility of dental problems (tooth decay, gingivitis, space between the bottom front teeth) in older children.</li><li>Gagging or choking on foods as your child starts to eat solids.</li><li>A hard time with basic things, like licking an ice cream cone.</li></ul> Diagnosis:A physical exam is all it takes to see what’s going on. The doctor will:<ul><li>Ask how feeding is going.</li><li>Check your child’s tongue, mouth, and teeth.</li><li>Use a tongue depressor, which is like a big popsicle stick, to look under your child’s tongue and check the range of motion.</li><li>The doctor may ask older kids to move their tongue around and make certain sounds, like of an r or l</li></ul> Treatment:The lingual frenulum generally loosens over time and it can be cured on its own most of the times. But if the problem persists, a lactation consultant can help with breastfeeding and a speech-language therapist can help with speech therapy. If there is any severe complication, then your doctor may suggest some surgical procedures like frenectomy or frenuloplasty. Frenectomy: This is a simple surgical procedure wherein the doctor uses sterile scissors to cut the frenulum free. It is a quick procedure. The baby hardly feels any pain during or after the surgery as there are few blood vessels in the lingual frenulum. The procedure can be done with or without sedation. Frenuloplasty: If the lingual frenulum is too thick, the doctor might need to do some additional repair and this is an extensive procedure known as Frenuloplasty. General anaesthesia is given by the doctor. The wound is usually closed with sutures. Complications are similar to frenectomy - Bleeding, infection, damage to tongue or salivary glands. In this procedure, the doctor will:<ul><li>Give your child drugs so they sleep through the whole thing</li><li>Use special tools to cut the frenulum</li><li>Put in a few stitches that dissolve on their own as the wound heals</li><li>After the surgery, the doctor might suggest a few tongue exercises to increase the movement of the tongue.</li></ul> Prevention: Tongue tie cannot be prevented.

Here are Tongue Tie Symptoms, Causes, Diagnosis, Treatment, and Prevention.

All about Tongue tie

Samiksha Choithani

Dr Heena Hasan

Potty training can usually start between 18 to 24 months of age. But, do not take stress if the child doesn’t learn, it may take time and there is no perfect age to start potty training. Just mark these indications that shows your child is ready for potty training:<ul><li>Child is asking questions about toilet</li><li>Child talking about potty seats</li><li>The child may be talking about underwear</li></ul>Ask these questions to yourself before you start potty training:<ul><li>Can my child sit on a potty seat and get back up without my help?</li><li>Can my child follow basic instructions?</li><li>Can my child tell me when it's time to go for potty?</li><li>Can my child pull down diapers or underwear without my help?</li><li>Is the diaper dry for at least 2 hours?</li></ul>If the answer to the above questions is yes, then your child is ready for potty training.These suggestions may help to identify when the child indicates to go to the washroom:<ul><li>Start noticing the face when the child wants to pee or poop, check the red face and grunting sounds or if the child indicated by touching their pants.</li><li>Notice the time when the child goes for potty and pee. This will help to establish routine for potty.</li><li>Praise your child when they indicate it correctly and do not wet the pants.</li><li>Potty time should be want-to instead of have-to, do not push your child even when they do not feel the urge of going to the washroom.</li></ul>

Potty training can usually start between 18 to 24 months of age. Look for the indications which your child gives, it will help you identify when the child is ready for potty training.

Potty training a child

Few allergic reactions are known to worsen existing conditions like asthma and a few are known to cause asthma problems.Not all children develop asthma due to allergies. Children with a family history of asthma or children with eczema are at a higher risk of developing asthma.Asthma is a chronic inflammatory condition of the smaller air passages in the lungs. The common triggers of asthma:<ul><li>Cold or flu</li><li>Allergens like dust or pollen</li><li>Cigarette smoke or other irritants</li><li>Gastrointestinal reflux</li><li>Stress, continuous crying or laughing, physical activities are also known to trigger an asthma attack.</li></ul> Diagnosis of asthma is based on symptoms, family history and medical history of your child, previously known allergies, etc. followed by medical asthma tests which may include x- ray, blood tests or allergy tests. Please note, it is important to get your child diagnosed of asthma problem only by a healthcare expert. Symptoms of Asthma include:<ul><li>Coughing</li><li>Wheezing</li><li>Shortness of breath</li><li>Uncomfortable tightness in the chest</li></ul> Seek medical attention immediately if you notice these symptoms in your child:<ul><li>Gasping for breath or trouble speaking</li><li>Deep breath/inhalation that shows the abdomen sucked in</li><li>Increased rate of breathing</li><li>Given the close link between allergies and asthma, it is important to identify the source of allergy and manage it effectively.</li><li>Allergy shots (Immunotherapy) may be advised if your child's asthma is due to allergens like pollen or pet dander.</li><li>Asthma treatment is based on the severity and frequency. An inhaler with a holding chamber/spacer may be prescribed by your child’s paediatrician for a quick relief during an asthma attack. Always seek medical help if you think your child might have asthma.</li><li>According to studies, omega 3 fatty acids from fish oil are known to reduce inflammatory conditions like asthma in children. For children with fish allergies, an alternative source for omega 3 fatty acids is algae.</li></ul>

Asthma and allergy are closely related hence it is important to take proper precautions.

Asthma and Allergy

Dr Chintan Solanki

Autism is a neurodevelopmental disorder which affects children. It mainly affects a child’s social communication which includes language as well as an emotional response to any situation. Children with autism also show some repetitive and restrictive behaviour. One-third of all children who have autism, suffer from intellectual disability, meaning they have a low IQ or mental retardation. Autism is not a life-threatening problem. Its severity ranges from mild to severe and early diagnosis and intervention can help in a better way.Children with autism have a trouble understanding what others think and feel. They cannot express themselves properly either with words, facial expressions, or gestures. Children with autism develop uneven skills. They might have a problem in communicating but they might be good at maths, art, or music. Symptoms:<ol><li>Lack of eye contact</li><li>Repetitive behaviour, example repeating phrases or rocking back and forth</li><li>Higher sensitivity to sounds, sights, smells, touch which might seem ordinary to others</li><li>Not looking at things when someone points at something</li><li>Not paying attention to what the other person is saying</li><li>Trouble adapting to changes</li><li>Some might also get seizures</li></ol> The symptoms usually appear before the child turns 3 or sometimes are evident from birth. Causes: Though the exact causes are not clear, here are a few factors which increase the chances of autism:<ul><li>Genetics of the child</li><li>Older parents</li><li>Pregnant woman exposed to drugs</li><li>Maternal metabolic conditions - like diabetes and obesity</li><li>Autism runs in the family</li></ul> Risk Factors: Children of all races can get autism but certain factors increase the risk. They are:<ul><li>Child's sex: Boys are about four times more likely to develop autism than girls.</li><li>Family history</li><li>Other disorders</li><li>Preterm birth</li><li>Parents' ages: More research is required but children born to older age parents are more likely to develop autism.</li></ul> Diagnosis: 2 step diagnosis for children Step 1: Developmental screening - The doctor will examine whether your child's basic skills like leaning, speaking, behaviour, and movement are on track or not. These developments should be routinely checked at the age of 9 months, 18 months, 24 months, and 30 months. Step 2: If your child shows signs of a problem on step 1 screenings, (s)he might have to undergo a hearing, vision, and genetic testing. By now, you will be advised to work with a child psychologist. Prevention: There is no way to prevent autism development in children. But mothers can live a healthy lifestyle, avoid drugs and alcohol during pregnancy. These will reduce the chances of autism development. Treatment:The treatment patterns which work for one child might not necessarily work for others. Your child's doctor will specially design a treatment plan for your child.&nbsp;Autism cannot be cured but the following treatments are helpful: Main treatment is Psycho-social intervention. It includes different types of behaviour therapy, cognitive therapy, speech therapy, social skill therapy and special school arrangements. Medicines can help to counter different symptoms like irritability, hyperactivity, depression or some of the repetitive behaviours. Behaviour therapy: Behaviour therapy is a collective term for several types of therapies used to treat mental health disorders. The treatment focuses on unhealthy behaviours and aims to change them. Behavioural therapy can be used to treat depression, anxiety, panic disorders, anger issues, autism, ADHD, etc. The several types of behavioural therapies are – cognitive behavioural therapy, cognitive behavioural play therapy, aversion therapy, system desensitisation.&nbsp;Cognitive therapy: It is based on the concept that the way we think about things affects us emotionally. It is based on present thinking rather than past experiences. Speech therapy: Speech-language therapy addresses challenges with language and communication. It can help people with autism improve their verbal, nonverbal, and social communication. The overall goal is to help the person communicate in more useful and functional ways.Goals of speech therapy include improving the spoken language, learning nonverbal skills such as signs or gestures, or learning to communicate using an alternative method (such as pictures or technology). Examples of the skills that speech therapy may work on include:<ul><li>Making clearer speech sounds</li><li>Matching emotions with the correct facial expression</li><li>Responding to questions</li><li>Matching a picture with its meaning</li><li>Modulating tone of voice</li><li>Alternative Augmentative Communication (AAC) - for some children with autism, it's easier to communicate through pictures or technology rather than speaking.</li></ul> Social Skills Therapy: Social skills therapy work on improving communication with friends, family members, at school, and more. Your child's psychologist might arrange group therapy for this particular skill development. Depending upon your child's autism intensity, your child's psychologist will layout the treatment plan for your child. Moreover, your child's doctor might also suggest parent training for you and your spouse. Safety precautions: Secure your house, irrespective of the child's age. Keep sharp objects away, keep harmful objects out of reach. You can use monitoring technology to stay assured about your child's safety. FAQs regarding ADHD: Can autism be cured?Autism is a lifelong disorder. The improvement depends on many factors like severity of the problem, time of diagnosis, IQ of the child and the interventions done. Children with normal IQ and mild to moderate autism can live a normal life with timely intervention. Any food can help with autism?There is no evidence that any particular food can help better autism. Do all children with autism have a low IQ?No, only one-third of all autistic children have low IQ. Many children with autism have some extra skills and more than average IQ. To whom should I consult for autism?If you see any symptoms of autism in your child, it is best to consult a psychiatrist. For an initial consultation, you can visit your child’s paediatrician as well. Can a child with autism live a normal life?Yes, many autistic children can live a normal life provided their IQ is normal and the intervention for social communications is done properly. Is autism a genetic problem?Yes, there are pieces of evidence that genetic factors are involved in aetiology (causes) of autism but it is not the only factor. There are others like immunological, neurological and developmental factors also involved. Can a child with autism go to a normal school?If the IQ of a child is normal, (s)he can definitely go to a normal school.

Here are Autism Symptoms, Causes, Treatment, Precautions, Risk factors, Prevention, Diagnosis, and FAQs.

All about Autism

<ul><li>Moulds are small fungi and its spores float in the air and can thrive in moist environments - indoor or outdoor. It has a strong odour and develops a spongy layer on the surface which makes it easy to identify moulds.</li><li>Allergic reactions to mould are similar to hay fever symptoms so it is important to get the allergy diagnosed by a healthcare expert. The spores of mould may also cause symptoms of asthma in very sensitive children.</li><li>To prevent mould allergy in children, keep your surroundings clean. Treat the dampness or leaks at home if any, as this will reduce the humidity and hence prevent the formation of moulds in the house.</li><li>If your child is allergic to moulds, it is advisable to wear a mask at places where mould formation is known to take place or at places where humidity is high.</li><li>Treatment includes using antihistamine or medications for nasal problems.</li></ul> Symptoms:<ul><li>Itching</li><li>Rashes</li><li>Vomiting</li><li>Diarrhoea</li><li>Swelling of the lips or tongue or face</li><li>Throat constriction</li><li>Difficulty in breathing</li><li>Allergies may sometimes also cause a life-threatening reaction called anaphylaxis which constricts the airway passage and requires immediate medical attention.</li></ul> Diagnosis:<ul><li>Always get your child diagnosed by a healthcare expert and never on your own. Never self-assume that your child has peanut allergy. Commercial home test kits for self-diagnosis are not recommended as they may not be of the required standards.</li><li>Your child’s paediatrician may recommend that your child undertake tests like skin prick test, blood test or food/drug challenge. It is important that these tests are performed under medical supervision as these tests might trigger an allergic reaction. Along with these tests, your child’s paediatrician will also examine your child's medical/family history, existing conditions like asthma and eczema.</li></ul>

Allergy triggers to moulds in your child can be prevented by maintaining the hygiene around you.

Mould allergy

Some babies find it difficult to latch in the initial phase of breastfeeding. This may be due to the shape of the nipple, or if the nipple is not completely engorged. Premature babies or the ones who had a difficult birth may also find it difficult to latch.Nipple shield is a silicon shield that gives a definite shape to the nipple making it easy for the baby to latch. If you are using nipple shields, do clean them with warm water (sterilise them) after every feed. Advantages:<ul><li>Nipple shield should be the last option but use it to get started rather than avoiding breastfeeding completely.</li><li>Helps mothers to stick on breastfeeding and avoid bottles too early.</li><li>Heals and protects the nipples when they are sore.</li></ul> Disadvantages:<ul><li>Avoid long term use of nipple shield as it gets tiring and difficult to clean after every feed. There is nothing more hygienic and convenient than a bare breast.</li><li>A baby may get less milk if the shield is used incorrectly.</li><li>Once the habit of a nipple shield is developed, it gets difficult to wean it.</li></ul>

Nipple shields are useful for babies for whom latching is difficult.

Using Nipple shields or not?

Dr Aliraza Khunt

<ul><li>Eating inedible things is because of nutrition deficiency.</li><li>The child can develop such kind of tendency to keep sucking or eating odd things may be due to the deficiency of micro-nutrients.</li><li>Now, if there is any deficiency and the parent comes to know and gives him/her supplements, the child can easily get rid of the habit, because it was out of deficiency of say iron or calcium.</li><li>But when the habit continues, sometimes the parent glorifies this behaviour of child in front of people, e.g. “see how my child eats mud without anyone noticing him/her, (s)he has mastered this trick”. When this happens,&nbsp;the child gets the attention and enjoys it and doesn’t want to leave the habit.</li><li>The child does it again and again just to seek attention. Whereas in other cases, if the parent punishes the child very harshly, the child gets into the rebel mode and repeats this unwanted action again and again to harass his/her parents.</li><li>What a parent can do is just be compassionate and distract the child, get the child into activity where his/her hands are occupied and in such way gradually the child will get rid of the habit.</li><li>Another underlying reason for kids to develop such tendencies can be the pica syndrome. It is a psychological disorder where children develop such harmful eating habits.</li></ul>

Many children develop a habit of eating things like - limestone, pencil lead, mud, paper, chalk, or clay. Kids don't do this out of habit but because of the deficiency of nutrients in their body.

Eating inedible things like chalk, clay and sand

Wheat allergy is an allergic reaction to foods containing wheat. Allergic reactions can be caused by eating wheat and also, in some cases, by inhaling wheat flour. Wheat is found in many foods, including some you might not suspect, such as soy sauce, ice cream and hot dogs. Wheat allergy sometimes is confused with celiac disease, but these conditions differ. Wheat allergy occurs when your body produces antibodies to proteins found in wheat. In celiac disease, a specific protein in wheat — gluten — causes a different kind of abnormal immune system reaction. Symptoms of wheat allergy:<ul><li>Swelling, itching or irritation of the mouth or throat</li><li>Hives, itchy rash or swelling of the skin</li><li>Nasal congestion</li><li>Headache</li><li>Difficulty breathing</li><li>Cramps, nausea or vomiting</li><li>Diarrhoea</li><li>Anaphylaxis</li></ul> Causes:Exposure to a wheat protein triggers the body's immune system for an allergic reaction. Your child can develop an allergy to any of the four classes of wheat proteins — albumin, globulin, gliadin and gluten. Sources of wheat proteins:<ul><li>Breads and bread crumbs</li><li>Cakes, muffins and cookies</li><li>Breakfast cereals</li><li>Pasta</li><li>Semolina</li><li>Soy sauce</li><li>Meat products, such as hot dogs</li><li>Dairy products, such as ice cream</li><li>Natural flavourings</li><li>Modified food starch</li><li>Vegetable gum</li><li>Cosmetics</li></ul> Risk factors:<ul><li>Family history: The chances of your child being allergic to wheat are higher if there is someone in the family who is allergic to wheat.</li><li>Age: Wheat allergy is most common in babies and toddlers, who have immature immune and digestive systems.</li></ul> Difference between Wheat Allergy and Celiac Disease:Wheat allergy involves an allergic response to any of the four proteins in wheat. Whereas, celiac disease is caused by gluten (a type of wheat protein). Celiac disease does not cause an immune response but rather causes a problem with the absorption of food in the intestines. Diagnosis:Symptoms of wheat allergy and celiac disease are overlapping hence an allergist can determine whether an allergy is present or not. You will be required to give your child's medical history, family's medical history combined with a skin-prick or a blood test. Prevention:<ul><li>Develop a habit of reading the food labels for ingredients and allergy information.</li><li>Teach your child to mention about the allergy whenever (s)he goes to visit someone.</li><li>Inform your child’s school about your child’s allergy. You can also give the medicines prescribed by your child’s doctor to the school which they can use in case of sudden allergic reactions.</li><li>Be careful about the possibility of cross-contact; especially when visiting a restaurant.</li><li>Always keep the allergy medication handy for your child.</li></ul> Treatment:<ul><li>The best way to prevent allergies of any sort in children is to avoid the source of the allergen.</li><li>In allergies, paediatricians usually prescribe antihistamine medicines for mild allergic reactions. Whereas for severe allergic reactions like anaphylaxis, your child’s paediatrician will prescribe an adrenaline auto-injector (AAI).</li></ul>

Some children can develop allergic reactions towards wheat and need to be fed on a different cereal.

Wheat allergy

Eczema is a non-contagious chronic skin condition wherein the child suffers from severe itching, redness, scaly rashes on arms, legs, hands or face. Eczema is also known as atopic dermatitis. Family history of allergic diseases like asthma and hay fever increases the chance of eczema in children. Causes:It is not known that what exactly causes eczema. It might be due to the difference between how each individual's body reacts to things. Symptoms of Eczema:<ul><li>Rashes on the body or in just a few areas. They may be oozing or dry.</li><li>In babies, rashes are found usually on the face and scalp.</li><li>In young children, rashes are found in the folds of elbows and knees.</li><li>Children tend to rub their skin against the bedding to relieve itching.</li></ul> Prevention:<ol><li>Use fragrance-free moisturiser. Do not let the child’s skin dry out. Apply moisturiser as often as needed. Once the child takes a bath, pat dry the child and apply the moisturiser on damp skin.</li><li>Avoid irritants. Use chemical-free detergents and soaps for your child’s clothes and bathing respectively.</li><li>Prefer 100% soft cotton fabric for the child.</li><li>Short baths at room temperature are advisable compared to long hot-water baths.</li><li>Do not use dyes or perfumes.</li><li>Avoid using fabric softener on a child’s clothes.</li><li>Look for any food/pet/pollen/dust allergies. These too can trigger eczema.</li><li>Overheating temperature, sweating and stress can also worsen the situation.</li></ol>&nbsp;Diagnosis:There are no specific tests to confirm eczema. Doctors usually examine rashes, rule out skin allergies, ask for child's and family's medical histories to conclude eczema. Treatment:Doctors can prescribe two types of medication:<ol><li>Topical: cream and ointment</li><li>Oral: pills in liquid medicine</li></ol>

conjunctivitis health concerns

Following article(s) will help solve your concern.