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Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it. Kids with attention deficit hyperactivity disorder (adhd act without thinking, are hyperactive, and have trouble focusing. Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited. But the difference with attention deficit hyperactivity disorder (ADHD is that symptoms are present over a longer period of time. They impair a child's ability to function socially, academically, and at home. Three primary characteristics of Attention deficit hyperactivity disorder (ADHD The three primary characteristics of Attention deficit hyperactivity disorder (ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depends on which characteristics predominate.

Children with Attention deficit hyperactivity disorder (ADHD may be:
Inattentive, but not hyperactive or impulsive.
Hyperactive and impulsive, but able to pay attention.
Inattentive, hyperactive, and impulsive (the most common form of
Attention deficit hyperactivity disorder (ADHD . Children who only have inattentive symptoms of Attention deficit hyperactivity disorder (ADHD are often overlooked, since they’re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.
Inattentive signs and symptoms of ADHD
It is not the children with ADHD which can’t pay attention: when they’re doing things they enjoy or hearing about topics in which they’re interested, they have no trouble focusing and staying on task. But when the task is repetitive or boring, they quickly tune out. Staying on track is another common problem. Children with ADHD often bounce from task to task without completing any of them, or skip necessary steps in procedures. Organizing their school work and their time is harder for them than it is for most children. Kids with ADHD also have trouble concentrating if there are things going on around them; they usually need a calm, quiet environment in order to stay focused.

Symptoms of inattention in children:
Doesn’t pay attention to details
Makes careless mistakes
Has trouble staying focused; is easily distracted
Appears not to listen when spoken to
Has difficulty remembering things and following instructions
Has trouble staying organized, planning ahead, and finishing projects
Gets bored with a task before it’s completed
Frequently loses or misplaces homework, books, toys, or other items
Hyperactive signs and symptoms of ADHD
The most obvious sign of ADHD is hyperactivity. While many children are naturally quite active, kids with hyperactive symptoms of attention deficit disorder are always moving. They may try to do several things at once, bouncing around from one activity to the next. Even when forced to sit still which can be very difficult for them their foot is tapping, their leg is shaking, or their fingers are drumming. Symptoms of hyperactivity in children:
Constantly fidgets and squirms
Often leaves his or her seat in situations where sitting quietly is expected
Moves around constantly, often runs or climbs inappropriately
Talks excessively
Has difficulty playing quietly or relaxing
Is always “on the go,” as if driven by a motor
May have a quick temper or a “short fuse”
Impulsive signs and symptoms of ADHD
The impulsivity of children with ADHD can cause problems with self-control. Because they censor themselves less than other kids do, they’ll interrupt conversations, invade other people’s space, ask irrelevant questions in class, make tactless observations, and ask overly personal questions. Instructions like “Be patient” and “Just wait a little while” are twice as hard for children with ADHD to follow as they are for other youngsters. Children with impulsive signs and symptoms of ADHD also tend to be moody and to overreact emotionally. As a result, others may start to view the child as disrespectful, weird, or needy. Symptoms of impulsivity in children:
Acts without thinking
Blurts out answers in class without waiting to be called on or hear the whole question
Can’t wait for his or her turn in line or in games
Says the wrong thing at the wrong time
Often interrupts others
Intrudes on other people’s conversations or games
Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums
Guesses, rather than taking time to solve a problem
Medical causes of ADHD
The specific causes of ADHD are not known. There are, however, a number of factors that may contribute to, or exacerbate ADHD. They include genetics, diet and the social and physical environments.

Genetics Twin studies indicate that the disorder is highly heritable and that genetics are a factor in about 75 percent of all cases. Researchers believe that a large majority of ADHD cases arise from a combination of various genes, many of which affect dopamine transporters.

Environmental Twin studies to date have suggested that approximately 9 to 20 percent of the variance in hyperactive-impulsive-inattentive behavior or ADHD symptoms can be attributed to nonshared environmental (nongenetic) factors. Environmental factors implicated include alcohol and tobacco smoke exposure during pregnancy and environmental exposure to lead in very early life.

Complications during pregnancy and birth Complications during pregnancy and birth, including premature birth, might also play a role. ADHD patients have been observed to have higher than average rates of head injuries. Infections during pregnancy, at birth, and in early childhood are linked to an increased risk of developing ADHD. and streptococcal bacterial infection.

Insecticides The organophosphate insecticide chlorpyrifos, which is used on some fruits and vegetables, with delays in learning rates, reduced physical coordination, and behavioral problems in children, especially ADHD..

Social The World Health Organisation states that the diagnosis of ADHD can represent family dysfunction or inadequacies in the educational system rather than individual psychopathology. Other researchers believe that relationships with caregivers have a profound effect on attentional and self-regulatory abilities.

Homeopathic treatment of ADHD is constitutional taking a more holistic look at the individual. Every disease is considered as a Mind-Body process where your personality traits are as important as your physical symptoms thus taking into account diet, lifestyle, personality, surroundings and emotional factors. Natural remedies are used to successfully treat the symptoms, helping the person to heal and to reach a state of balance and health. The natural approach is also safe with no side effects. This is very important, especially in the case of children, because of the frequent side effects of prescription drugs and the risk of addiction. Homeopathy offers a wider range of options that conventional medicine.

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Diarrhoeal Illness in Children
Diarrhea management in children
Passage of 3 or more loose stools in 24 hours period is considered diarrhea. A change in consistency and frequency of stool pattern is noticed by parents. It is estimated that on average a child under 5 years of age will have approximately 3.2 episodes of diarrhea per year. The loss of liquids caused by diarrhea can lead to dehydration and disturbances in body electrolytes which may require medical treatment.
What causes diarrhea in children?
Gastrointestinal tract infections – Mostly Viral, also bacterial and protozoal are the cause of diarrhea. Many a times there may be a non-infectious cause of diarrhea (antibiotic induced, lactose intolerance, etc.)
Additional complaints
Child having diarrhea can also have Vomiting, Fever, Abdominal Pain and Decreased Appetite.
What can parents do at home?
ORS (Oral rehydration solution) should be started for child having loose motions. Parents can also start with home available fluids like dal water, sugar-salt solution (Half teaspoon salt+ 8 teaspoon sugar added to a liter of clean 1 liter water). Parents should consult doctor urgently if:
1. Child is becoming very sleepy or irritable
2. Child is having multiple vomiting and is not able to drink ORS
3. Eyes of child look sunken into the orbit.
4. Child is passing blood in stools
Medical management of diarrhea:
World Health Organization emphasizes on 3 points in management of any acute childhood diarrhea. These are ORS, Feeding and Zinc supplementation. Since most of diarrhea episodes are due to viral infections most children recover with ORS and Zinc therapy. Feeding should not be stopped during diarrhea. Doctor examines the child to look for any dehydration (decrease in body water), rule out possible bacterial cause of diarrhea (which might require antibiotics), other causes of loose motions (transitional stooling in newborns, increased gastro colic reflex, toddlers diarrhea etc.). Antibiotics are not required for every case of diarrhea. Stool or blood tests are not required usually but doctor may decide to perform some tests if diarrhea gets prolonged to more than 2 weeks and in some other conditions.
How to Prevent Diarrhea:
1. Hand washing - after playing outdoors, after going to toilets, before having meals.
2. Prevent eating out at places that seem to have doubtful hygiene standards.
3. Exclusive breast feeding for first 6 months of life prevents diarrhoea episodes in young infants; Bottle feeds can prolong a diarrhoea episode and can be a cause of recurrent loose motions in a child
4. Vaccine: Vaccine to prevent diarrhea caused by Rotavirus is available.

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Cold And Cough in Children
Cold and Cough in Children – The common facts
Most of the hospital visits by parents of children, especially younger ones, are for complaints of cold and cough. Parents are usually concerned because of accompanying fever in most of cases. Majority of these episodes of illness are VIRAL in origin and as such medical treatment is symptomatic and no antibiotic is required.
Cold is a VIRAL illness in which symptoms of running nose and blocked nose are common. The first symptom is often sore or scratchy throat, followed by blocked nose and finally runny nose. Around 1/3 cases of cold are associated with cough. Other complaints like fever, headache, body ache and tiredness can also occur. Usually episode of cold and cough lasts about 1 week and 10% cases may last for 2 weeks. Colds occur year –round , but more common in August- October and April- May due to increased activity of RHINOVIRUS. Other viruses like RSV can cause cold between December to April.
Young children (up to 3-4 years of life) have average of 6-8 colds per year and 15% children have at up to 12 cold episodes per year i.e. one per month. The cold episodes decrease with age and by adulthood average of 2-3 episodes per year are reported. Parents should seek medical opinion early if following complaints occur:
1. Child refuses to drink anything for long period of time.
2. Change in behavior of child- either very sleepy or very irritable.
3. Difficulty in breathing.
Antibiotics are not effective in treating colds. They may be necessary if the cold is complicated by a bacterial infection, like an ear infection, pneumonia, or sinusitis. Inappropriate use of antibiotics can lead to the development of antibiotic resistance, and can possibly lead to side effects, such as an allergic reaction.
Simple hygiene measures can help to prevent infection with the viruses that cause colds. Hand washing prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. It may be difficult or impossible to completely avoid people who are ill, although parents should try to limit direct contact.
Some parents ascribe cause of cold to food items like curd, fruits and rice. These are food myths and have no scientific rationale. As previously mentioned young children can have one episode of cold every 1 to 1 ½ months in first few years of life and they are not related to weak immunity. Children who are bottle fed have more chances of getting colds, ear infections and diarrhea episodes. Exclusive breast feeding in first 6 months of life protects little ones from catching frequent infections.

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An easier method of rehydration in children
An Easier Management Of Dehydration In Children

- Prof. Vd. M. P. Prabhudesai
M. F. A. M., A. V. P.
- Vd. Mrs. M. M. Prabhudesai
B. A. M. S. (Mumbai)
Sawantwadi, Dist.- Sindhudurga. Pin - 416510


When we decided to leave Mumbai and settle in Konkan area of Maharashtra, we had certain ideas in our minds. Present study is a humble effort towards one of our ideas, i.e. to make low-cost effective remedies available to poor, needy rural people.
There are many traditional remedies prevalent in our area, which we could know while discussing with traditional birth-attendants and traditional healers, in our area. We heard them telling that patent bregma (i.e. Talu) in infants has an exceptional capacity of absorption and this route may be used in treating dehydration in them. Out of various methods practiced in our area, one is to apply absorbent cotton soaked in breast-milk to patent bregma of dehydrated infants, repeatedly, till the patient recovers.
In February 1989, we got chance to try this method in a dehydrated baby, 28 days old, in which all the available methods for dehydration, including i.v. Infusion, were failed. Along with loose motions it had vomiting as well. It parents were very poor and due to lack of conveyance (only two S.T. buses out in a day) they were unable to shift the child to Govt. Hospital, which is only 30 Kms. from our place. As the parents showed full faith in us we decided to try this simple method. Being encouraged by the favorable results in the patients we tried this method successfully in 33 babies till the end of September 1989.
When we presented the case study in Third International Congress in Traditional Asian Medicine at Mumbai, in January 1990, we received many letters of encouragement and after a personal scientific communication we decided to modify this method a little, because of which we could cover children up to 6 years of age, which is supposed to be the high-risk age group.
In this modification we tried and advised massage to the whole body of the patients with naturally available milk (i.e. cow's, buffalo's, or breast) and milk-soaked cotton-swab was applied to the patent bregmas of younger babies, as well.
An attempt is being made here with positive treatment to present our practical experience during these efforts.

Selection of patient:

During initial trial we selected dehydrated babies up to the age of 1½ year, i.e. before ossification of anterior fontanelle (i.e. with patent bregma); but for modified experiment we preferred children up to 6 years of age, who were suffering from dehydration.
Till now only 72 cases are on record (including 33 cases of initial trial) as the village that we have chosen for service to rural people has total population not exceeding one thousand five hundred only and secondly, it is very difficult to convince the illiterate parents to allow us this unusual experiment on their severely ill children.
We have omitted the children with vomiting of cerebral origin and with fourth degree dehydration.
Thus, for selection of children in this experiment we applied two main criteria as follows-
1. Age of the child under trial should not be more than 6 years; and
2. The child under trial should be dehydrated.

In our initial study we applied absorbent cotton-swab soaked in naturally available milk to patent bregmas of dehydrated babies and before it could become dry, it was replaced by another swab. This was repeated till applied swab remained wet approximately more than one minute.
In the modified method, all children under trial were massaged with naturally available milk, all over the body till its rate of disappearance was markedly diminished and their skin regained its normal luster and elasticity. This procedure was also followed in younger babies with patent bregmas.
As for as possible we preferred breast-milk to apply at Talu in babies with patent bregma and for massage we used any of the naturally available milk.
We omitted re constituted milk for this particular study, which is not easily available in our area.
Especially the children with severe and repeated vomiting were stopped all oral feeds.

The work is going on, but for the purpose of communication, the group of 33 babies of our initial trial (i.e. group one) and the groups of 39 children of our modified experiment (i.e. group two) are being analyzed. The number of patients is comparatively less; as many of the outpatients have not appeared again for follow up examination.
Our observations are as follows-
1. Immediate observation after applying milk-soaked cotton-swab to Talu of dehydrated babies was that the swab becomes dry after some time.
2. Similarly after massaging the whole body with natural milk, it was disappeared in the skin.
3. Both above observations clearly indicate absorption of milk through skin and anterior fontanelle (i.e. Talu) and the rate of absorption was found to be equally proportional to the degree of dehydration.
4. Signs of rehydration were seen in babies under trial, within ten to thirty minutes depending upon degree of dehydration.
5. The milk applied over whole body of the baby, turned into a whitish layer as the signs of dehydration got reduced & we thought this was the marker to assume that dehydration Is under control.

Table showing age-wise classification

Age of patient Male Female
Group One
1. Less than one month
2. Between 1 to 2 months
3. Between 2 to 6 months
4. Between 6 months to 1 year
5. Between 1 to 1½ years
Total 21 12

Group Two
1. Less than 6 months
2. 6 months to 1½ years
3. 1½ years to 3 years
4. 3 years to 6 years 6
3 3
Total 22 17

Table showing degree of dehydration

No Degree Group One Group Two
Male Female Male Female
3. First
Third 11
3 3
7 11
4 2
Total 21 12 22 17

Table showing symptom-wise classification

Group Symptom
Only loose motions Loose motions with vomiting

2. Male Female Male Female
16 8
10 5
6 4
Total 32 18 11 11

Discussion and Conclusion:
According to W.H.O., dehydration is supposed to be No. 1 killer in children less than 6 years of age. So especially in areas where communication or expertise is not available, a simple method to manage dehydration is very much desired. Naturally and easily available substance like milk (cow's, buffalo's or goat's or breast) when properly used especially in remote rural areas can avert the risk and provide relief to patient and parents.
Established ways for rehydartion, at times, fail for lacking in getting proper (and cheaper) route. In attempt to find a route (especially intravenous) aseptic precautions are not that meticulously followed. So the risk of infection is much more and disastrous, on background of dehydrated stage. So more substitute mean and method utilized to compensate the risk will be very much appreciated.
So an attempt was done to try this positive drug, non-blind schedule of scrutiny. The single or double blind pattern was not desired in the emergency situation of dehydration. Placebo or otherwise intervention could not be thought of both ethically and by social circumstances.

This simple method for rehydration has following advantages:

1. This method is very simple and safe. The material required for management is easily and naturally available, almost everywhere and the risk of excess-dosage is not there.
2. It can be tried at home, thus may save many man-hours of parents, anxiously strained and wasted during hospitalization of their child, for i.v. infusion. Even non-earning domestic member of the family can carry out this method at home.
3. It will help to minimize the risk of probable introduction of infectious (like virus B hepatitis, aids etc.) through i.v. route or i.v. infusion fluids, especially where the social and professional meticulosity for asepsis is less.
4. This, being almost a no-cost remedy, will bring down the total cost of treatment, especially desirable in developing countries, like India.
5. Mother's scientifically health-valuable breast-milk, which is otherwise shunted out with psychologically painful stimuli, in case of severely vomiting child; is used in this method. So the mother is satisfied to see her breast-milk is utilized for her baby, & not wasted.
Additionally, it may prevent problem breast-abscess risk.
6. This method is definitely more useful than present O.R.S., especially so in children with total rejection of any oral intake.
7. As it covers the major risk-age-group dying by dehydration, it will be an additional support to M.C.H. scheme to deal with the killer No.1 of children.

We are quite aware of this positive non-double-blind management's limitations. It may have lesser scientific weightage. But the fact remains that within the situation, with limited economic and social aspects, at remote and least communicable areas; especially in rainy season and quality of professional skill and care unavailable, the report has golden merits.
While summing up we wish "best of health to all"

सर्वेऽत्र सुखिनः सन्तु सर्वे सन्तु निरामयाः।
सर्वे भद्राणि पश्यन्तु मा कश्चित् दुःखभाग्भवेत॥

This paper was presented in-
1. Third International Conference on Yoga and Ayurveda (IASTAM) at Mumbai in January 1990
2. Fourth World Congress on Ayurveda at Bangalore in December 1991.

- Prof. Vd. M. P. Prabhudesai
- Vd. (Mrs.) M. M. Prabhudesai
Dhanvatari Ayurvedic Panchakarma Chikitsalaya
Sawantwadi, Dist. - Sindhudurga.
Maharashtra, Pin- 416 510.
Mobile - 9422435323, 9423884321
E-Mail: -

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Phimosis is a commonly diagnosed problem in the Pediatric age group. But unfortunately, more often than not, it is overdiagnosed. Most of the children who are referred to us for surgical correction for phimosis do not need so. A degree of adhesion of the prepucial skin to the glans is natural and expected. The wrong step is manually retracting the prepuce which is often advised by the physicians. This causes small often microscopic tears in the inner prepucial skin which later on causes scarring and true shortening of the prepucial skin. There are many ointments available which help in adhesiolysis of the physiological prepucial adhesion.

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Loss of organ
A mentally retarded boy staying in a orphanage was bought to me with a scrotal swelling. The boy is 14 years old. He looks disturbed because of pain although he was not able to speak. I examined him and found that his scrotum was swollen and very tender.
The ultrasound showed that his testes had rotated and there was no blood supply – meaning it was already dead. His caretaker says its swollen since 5 days. Poor fellow. A normal boy would have come immediately with such a swelling. His mental retardation and absence of parents had led him to loose his organ.
I had to take him up for surgery. On opening his scrotum his testes was totally dead. There was nothing that i could do for an organ that had lost its blood supply for 5 days! In normal circumstances such surgeries taken up immediately after the onset of swelling can save the testes. Most of the times I have observed that if parents are prompt and bring their child in emergency, the testes can be salvaged. If its late, the testes is lost for ever.
See more at:

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माता-पिता की परवरिश का बच्चों की सेहत पर असर
नई स्टडी से पता चला है कि माता-पिता की परवरिश का बच्चों की सेहत पर खास प्रभाव पड़ता हैं। माता-पिता का कठोर व्यवहार बच्चों के आलस्य का कारण बनता है।

हाल ही में 0 से 11 वर्ष तक के कैनेडियन बच्चों पर हुई रिसर्च से यह बात सामने आई है कि जो माता-पिता अपने बच्चो से प्यार से बात करके कोई भी फैसला लेते हैं, उनके बच्चे ज्यादा स्वस्थ और फुर्तीले होते हैं। जबकि जो माता-पिता अपने फैसले बिना किसी सलाह के अपने बच्चों पर थोपते हैं वे बच्चे काफी अकेलेपन महसूस करने लगते हैं और इसका नतीजा बच्चों में आलस्य और मोटापे के रूप में सामने आता है।

लीसा काकीनामी जो कि मैकगिल यूनिवर्सिटी की पोस्ट डॉक्टोरल एपिडेमियोलॉजिस्ट हैं, उनका कहना है कि अधिकतर माता-पिता सही परवरिश की ओर ध्यान नहीं देते हैं और वे इस बात को ज्यादा महत्व भी नहीं देते हैं। अगर बच्चो को संतुलित परवरिश दी जाए तो उन्हें मोटापे और आलस्य जैसी बीमरियों से बचाया जा सकता है।

इस शोध में एक सर्वे में कुछ माता-पिता से बात की और अलग-अलग परवरिश के तरीकों की लिस्ट बनाई और फिर बच्चों के बॉडी मास इंडेक्स (बीएमआई) प्रतिशत से इसका विश्लेषण किया। काकीनामी का कहना है कि घर के माहौल से भी बच्चों की सेहत एवं आदतों को आकार मिलता है।

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Chickenpox is a mild and common childhood illness that most children catch at some point.
It causes a rash of red, itchy spots that turn into fluid-filled blisters. They then crust over to form scabs, which eventually drop off.
Some children have only a few spots, but in others they can cover the entire body. The spots are most likely to appear on the face, ears and scalp, under the arms, on the chest and belly and on the arms and legs.
Chickenpox (medically known as varicella) is caused by a virus called the varicella-zoster virus. It's spread quickly and easily through the coughs and sneezes of someone who is infected.
Chickenpox is most common in children under 10. In fact, chickenpox is so common in childhood that 90% of adults are immune to the condition because they've had it before.
Children usually catch chickenpox in winter and spring, particularly between March and May.

What to do

To prevent spreading the infection, keep children off nursery or school until all the spots have crusted over.
Chickenpox is most infectious from one to two days before the rash starts, until all the blisters have crusted over (usually five to six days after the start of the rash).
If your child has chickenpox, try to keep them away from public areas to avoid contact with people who have not had it, especially people who are at risk of serious problems, such as newborn babies, pregnant women and anyone with a weakened immune system (for example, people having cancer treatment or taking steroid tablets).

Chickenpox treatment

Chickenpox in children is considered a mild illness, but expect your child to feel pretty miserable and irritable while they have it.
Your child is likely to have a fever at least for the first few days of the illness. The spots can be incredibly itchy.
There is no specific treatment for chickenpox, but there are pharmacy remedies which can alleviate symptoms, such as paracetamol to relieve fever and calamine lotion and cooling gels to ease itching.
In most children, the blisters crust up and fall off naturally within one to two weeks.

When to see Dr. B C Shah

For most children, chickenpox is a mild illness that gets better on its own.
But some children can become more seriously ill with chickenpox. They need to see a doctor.
Contact Dr. B C Shah straight away if your child develops any abnormal symptoms, for example:
If the blisters on their skin become infected
If your child has a pain in their chest or has difficulty breathing

Chickenpox in adults

Chickenpox may be a childhood illness, but adults can get it too. Chickenpox tends to be more severe in adults than children, and adults have a higher risk of developing complications.
As with children, adults with chickenpox should stay off work until all the spots have crusted over. They should seek medical advice if they develop any abnormal symptoms, such as infected blisters.
Adults with chickenpox may benefit from taking antiviral medicine if treatment is started early in the course of the illness.

Who's at special risk?

Some children and adults are at special risk of serious problems if they catch chickenpox. They include:
Pregnant women
Newborn babies
People with a weakened immune system

These people should seek medical advice as soon as they are exposed to the chickenpox virus or they develop chickenpox symptoms.
They may need a blood test to check if they are immune (protected from) chickenpox..

Chickenpox in pregnancy

Chickenpox occurs in approximately three in every 1,000 pregnancies. It can cause serious complications for both the pregnant woman and her baby.

Chickenpox and shingles

One you have had chickenpox, you usually develop antibodies to the infection and become immune to catching it again. However, the virus that causes chickenpox, the varicella virus, remains dormant (inactive) in your body's nerve tissues and can return later in life as an illness called shingles.

It is possible to catch chickenpox from someone with shingles, but not the other way around.

Is there a vaccine against chickenpox?

There is a chickenpox vaccine but it is not part of the routine childhood vaccination schedule. The vaccine is only offered to children and adults who are particularly vulnerable to chickenpox complications.

Symptoms of chickenpox

The most commonly recognised chickenpox symptom is a red rash that can cover the entire body.

However, even before the rash appears, you or your child may have some mild flu-like symptoms including:
Feeling sick
A high temperature (fever) of 38ºC (100.4ºF) or over
Aching, painful muscles
Generally feeling unwell
Loss of appetite
These flu-like symptoms, especially the fever, tend to be worse in adults than in children.

Chickenpox spots

Soon after the flu-like symptoms, an itchy rash appears. Some children and adults may only have a few spots, but others are covered from head to toe.
The spots normally appear in clusters and tend to be:
Behind the ears
On the face
Over the scalp
Under the arms
On the chest and belly
On the arms and legs
But the spots can be anywhere on the body, even inside the ears and mouth, on the palms of the hands, soles of the feet and inside the nappy area.
Although the rash starts as small, itchy red spots, after about 12-14 hours the spots develop a blister on top and become intensely itchy.
After a day or two, the fluid in the blisters gets cloudy and they begin to dry out and crust over.
After one to two weeks, the crusting skin will fall off naturally.
New spots can keep appearing in waves for three to five days after the rash begins. Therefore different clusters of spots may be at different stages of blistering or drying out.

Unusual symptoms

Most healthy children (and adults) recover from chickenpox with no lasting ill-effects simply by resting, just as with a cold or flu.
But some children and adults are unlucky and have a more severe bout than usual.
Contact Dr. B C Shah straight away if you or your child develop any abnormal symptoms, for example:
If the skin surrounding the blisters becomes red and painful
If you or your child start to get pain in the chest or have difficulty breathing
In these cases, prescription medicine, and possibly hospital treatment, may be needed.

Causes of chickenpox

Chickenpox is caused by the varicella-zoster virus. You catch it by coming into contact with someone who is infected with the virus.
It's a very contagious infection. About 90% of people who have not previously had chickenpox will become infected when they come into contact with the virus.

How you catch the virus

The chickenpox virus is spread in the same ways as colds as flu. It's contained in the millions of tiny droplets that come out of the nose and mouth when an infected person sneezes or coughs. You can then become infected with the virus by breathing in these droplets from the air.
You can also become infected by handling a surface or object that these droplets have landed on, then transferring the virus to yourself by touching your face.
It takes seven to 21 days for the symptoms of chickenpox to show after you have come into contact with the virus. This is called the ‘incubation period’.
Someone with chickenpox is most infectious from one to two days before the rash appears until all the blisters have crusted over. This usually takes five to six days from the start of the rash.


If you have not had chickenpox before, you can also catch chickenpox from someone with shingles (an infection caused by the same virus). However, it's not possible to catch shingles from someone who has chickenpox.

Diagnosing chickenpox

You or your child should not usually need any medical tests to diagnose chickenpox. You can be pretty sure that it is chickenpox if there are the key symptoms of a mild fever followed by an itchy rash, blisters and scabs.
Chickenpox spots are usually distinctive enough to distinguish from other rashes, although occasionally they can be easily confused with other conditions that affect the skin, such as insect bites or scabies (a contagious skin condition that causes intense itching).
If you're still uncertain about what is causing the symptoms, Dr. B C Shahcan carry out a simple blood test to identify the virus.

When to contact Dr. B C Shah

1. See Dr. B C Shah if you're not sure whether you or your child have chickenpox.
2. Contact Dr. B C Shah urgently if you have been in contact with someone who has chickenpox or you have chickenpox symptoms and:
You are pregnant
You have a weakened immune system (the body’s defence system)
Your baby is less than four weeks old
Chickenpox in these instances can cause serious complications if left untreated. It is essential to seek medical advice so that you can receive any necessary treatment.
3. Contact Dr. B C Shah if you have chickenpox and are breastfeeding. They can advise about whether you should continue breastfeeding your baby.

Having a blood test

Once you have contacted Dr. B C Shah, you may need a test to see if you're already immune from chickenpox.
If you have had chickenpox in the past, then it is extremely unlikely that you will develop chickenpox for a second time. If you've never had chickenpox, or you're unsure whether you've had it, then you may need an immunity test.
This is a blood test that checks whether you are producing the antibodies to the chickenpox virus.
If your blood test result shows that you have the antibodies, you'll be naturally protected from the virus.

Treating chickenpox

There is no cure for chickenpox, and the virus usually clears up by itself without any treatment.
However, there are ways of easing the itch and discomfort, and there are important steps you can take to stop chickenpox spreading.


If your child is in pain or has a fever (high temperature), you can give them a mild painkiller, such as paracetamol. Paracetamol is available over-the-counter in pharmacies. Always read the manufacturer's dosage instructions.
You should avoid giving your child ibuprofen if they have chickenpox. This is because there have been some cases where using ibuprofen and other non-steroidal anti-inflammatory drugs(NSAIDs) has caused serious skin infections.
Ibuprofen should also be avoided if you or your child hasasthma, or a history of stomach problems, such as stomach ulcers.
If you're not sure whether ibuprofen is suitable, check with Dr. B C Shah. If your child is younger than three months old, always speak to Dr. B C Shah before you give your child any kind of pain relief.
If you're pregnant and need to take painkillers, then paracetamol is the first choice. You can use it at any stage of pregnancy. Only take ibuprofen during the second trimester (weeks 14-27 of the pregnancy).
If you're pregnant and you have chickenpox, you should visit Dr. B C Shah as soon as possible. You may need to have antiviral medicine or immunoglobulin treatment to prevent your symptoms from getting worse (see below).

Keeping hydrated

It is important for children (and adults) with chickenpox to drink plenty of water to avoid dehydration. Sugar-free ice-lollies are a good way of getting fluids into children. They also help to soothe a sore mouth that has chickenpox spots in it.
Avoid any food that may make the mouth sore, such as salty foods. Soup is easy to swallow as long as it is not too hot.

Stop the scratching

Chickenpox can be incredibly itchy, but it's important for children (and adults) to not scratch the spots so as to avoid future scarring.
One way of stopping scratching is to keep fingernails clean and short. You can also put socks over your child's hands at night to stop them scratching the rash as they sleep.
If your child's skin is very itchy or sore, try using calamine lotion or cooling gels. These are available in pharmacies and are very safe to use. They have a soothing, cooling effect.
A stronger medicine called chlorphenamine can also help to relieve the itching. It's available from your pharmacist over the counter or it can be prescribed by Dr. B C Shah. Chlorphenamine is taken by mouth and is suitable for children over one year old.

Cool clothing

If your child has a fever, or if their skin is sore and aggravated, dress them appropriately so that they don't get too hot or too cold. Loose-fitting, smooth, cotton fabrics are best and will help stop the skin from becoming sore and irritated.
If your child has chickenpox, avoid sponging them down with cool water. This can make your child too cold, and it may make them shiver.

Stronger treatments
Antiviral medicine

Aciclovir is an antiviral medicine that is sometimes given to people with chickenpox.
Aciclovir may be prescribed to:
Pregnant women
Adults, if they visit Dr. B C Shah within 24 hours of the rash appearing
Newborn babies
People with a weakened immune system (the body’s defence system)
Ideally, aciclovir needs to be started within 24 hours of the rash appearing. It does not cure chickenpox, but it makes the symptoms less severe. You normally need to take the medicine as tablets five times a day for seven days.
If you are taking aciclovir, make sure you drink plenty of fluids. Side effects are rare but can include nausea and diarrhoea.

Immunoglobulin treatment

Immunoglobulin is a solution of antibodies that is taken from healthy donors. Varicella-zoster immunoglobulin (VZIG) contains antibodies to the chickenpox virus.
Immunoglobulin treatment is given by drip. It is not used to treat chickenpox but to protect people who are at high risk of developing a severe chickenpox infection. This includes:
Pregnant women
Newborn babies
People with weakened immune systems
In the case of pregnant women, immunoglobulin treatment also reduces the risk of the unborn baby becoming infected.
As the supply of VZIG is limited, it will only be considered if a high-risk person has:
Been significantly exposed to the virus – significant exposure could be face-to-face contact with someone who has chickenpox
Been in the same room for 15 minutes with someone who has chickenpox
Had a blood test to confirm that they've not had chickenpox before
In some cases, newborn babies may be given immunoglobulin treatment without having a blood test first.

Complications of chickenpox

Complications of chickenpox are rare in healthy children. The most common complication is where the blisters become infected with bacteria.
A sign that the blisters have become infected is when the surrounding skin becomes red and sore.
If you think that your child's blisters have become infected, contact Dr. B C Shah as the child may need a course of antibiotics.
The people who are most at risk of developing chickenpox complications are:


Pregnant women
Babies under four weeks old
People with a weakened immune system
Chickenpox can be more serious in adults than in children. Adults with the virus are more likely to be admitted into hospital. Approximately 5-14% of adults with chickenpox develop lung problems, such as pneumonia. If you smoke, your risk of developing lung problems is much greater.
Although it is more serious in adults, most people will still make a full recovery from the chickenpox virus.

Pregnant women

If you're pregnant, chickenpox can occasionally cause complications.
For example, your risk of developing pneumonia is slightly higher if you're pregnant, especially if you smoke. The further you are into your pregnancy, the more serious the risk of pneumonia tends to be.
If you get chickenpox while you're pregnant, there is also a small but significant risk to your unborn baby.
If you are infected with chickenpox during the first 20 weeks of your pregnancy, there is a risk that your unborn baby could develop a condition known as foetal varicella syndrome.
This syndrome is rare. The risk of it occurring in the first 12 weeks of pregnancy is less than 1%. Between 13 and 20 weeks, the risk is 2%.
Foetal varicella syndrome can cause serious complications, including:
Eye defects, such as cataracts
Shortened limbs
Brain damage
There have been reports of damage to the unborn baby from foetal varicella syndrome when a pregnant woman catches chickenpox after week 20. But the risk at this late stage in pregnancy is thought to be much less than 1%.
However, there are other risks from catching chickenpox after week 20 of pregnancy.
It is possible that your baby may be born prematurely (before week 37 of the pregnancy).
And if you are infected with chickenpox seven days before or seven days after giving birth, your newborn baby may develop a more serious type of chickenpox. In a few severe cases, this type of chickenpox can be fatal.
See Dr. B C Shah urgently if you're pregnant or have given birth in the last seven days and you think you may have chickenpox, or if you've been exposed to someone who has chickenpox.

People with a weakened immune system

Your immune system is your body's way of defending itself against disease, bacteria and viruses.
If your immune system is weak or does not work properly, you are more susceptible to developing infections such as chickenpox. This is because your body produces fewer antibodies to fight off the infection.
You may have a weakened immune system if you take immunosuppressive medication. This is medicine that works by damping down your immune system.
Immunosuppressive medication such as steroid tablets may be used if, for example, you have an inflammatory condition such as rheumatoid arthritis, lupus or certain blood conditions.
If you have a weakened immune system, you're also more at risk of developing complications from chickenpox. These complications include:
septicaemia (blood poisoning)
See Dr. B C Shah urgently if you have a weakened immune system and you've been exposed to the chickenpox virus.

Preventing the spread of chickenpox

If your child has chickenpox, inform their school or nursery and keep them at home while they are infectious, which is until the last blister has burst and crusted over. This usually takes five or six days after the rash begins.
If you have chickenpox, stay off work and at home until you're no longer infectious.
If either you or your child has chickenpox, it is also a good idea for you, or them, to avoid contact with:
Pregnant women
Newborn babies
Anyone who has a weak immune system, such as people who are having chemotherapy (a treatment for cancer) or taking steroid tablets
If you or your child have recently been exposed to the chickenpox virus, you may not be able to visit friends or relatives in hospital. Telephone the ward to check first.

Travelling on a plane

If you or your child have chickenpox, you may not be allowed to fly until six days after the last spot has appeared.
You and your child should be safe to fly once you're past the infectious stage and all of the blisters have crusted over. But it's best to check the policy of your airline first. Inform the airline as soon as chickenpox is diagnosed.
It is also important to let your travel insurer know if you or your child have chickenpox. You need to make sure that you'll be covered if you have to delay or cancel your holiday, or if you need to extend your stay until your child is well enough to fly home.

Stop the virus spreading

Chickenpox can sometimes be spread through contact with objects that have been infected with the virus, such as children's toys, bedding or clothing.
If someone in your household has chickenpox, you can help stop the virus spreading by wiping any objects or surfaces with a sterilising solution and making sure that any infected clothing or bedding is washed regularly.


There is a chickenpox vaccine that is used to protect people who are most at risk of a serious chickenpox infection or of passing the infection on to someone who is at risk.
People who may be considered for chickenpox vaccination include:
healthcare workers who are not already immune – for example, a nurse who has never had chickenpox and who may pass it to someone they are treating if they become infected
people living with someone who has a weakened immune system – for example, the child of a parent receiving chemotherapy
The vaccine is not suitable for pregnant women. Avoid getting pregnant for three months after having the vaccine. The vaccine is also not suitable for people with weakened immune systems.

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Hydrocephalus is a build-up of fluid on the brain. The excess fluid puts pressure on the brain, which can cause it to be damaged.

The damage to the brain can result in a wide range of symptoms, including:
Being sick
Blurred vision

Difficulty walking
Hydrocephalus can usually be treated using a piece of equipment known as a shunt. A shunt is a thin tube that's surgically implanted in the brain and used to drain away the excess fluid.

Cerebrospinal fluid

In the past, hydrocephalus was often referred to as ‘water on the brain’. However, this term is incorrect because the brain is not surrounded by water but by a special fluid called cerebrospinal fluid (CSF).

Cerebrospinal fluid has three important functions:
It protects the brain from damage
It removes waste products from the brain
It provides the brain with the nutrients it needs to function properly

The brain constantly produces new cerebrospinal fluid (about a pint a day), while old fluid is released from the brain and absorbed into the blood vessels. However, if this process is interrupted, the level of CSF can quickly build-up, placing pressure on the brain.

Types of hydrocephalus

There are three main types of hydrocephalus:
Hydrocephalus that's present at birth (congenital hydrocephalus)
Hydrocephalus that develops after birth (acquired hydrocephalus)
Hydrocephalus that usually only develops in older people (normal pressure hydrocephalus or NPH)
These are briefly described below.

Congenital hydrocephalus

Congenital hydrocephalus is present in babies when they're born and can be caused by birth defects, such as spina bifida, or as a result of an infection that the mother develops during pregnancy, such as mumps or rubella (German measles).
Congenital hydrocephalus carries the risk of long-term mental and physical disabilities as a result of permanent brain damage.
Read More .....

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Choking Child
Just after I had gone to bed after a heavy day of plenty of surgeries, I got a call from emergency room. A four year old baby has been rushed into the emergency with sudden inability to swallow & throat pain. In minutes I was there. Parents were in great anxiety & the child was crying continuously. Mother said that she had seen her playing with a two rupee coin and suddenly her condition became an emergency.

So we rushed her to X-ray department and found that the coin was stuck up in her upper part of food pipe. It was too big to go inside and too big to vomit out. It was completely stuck. It was blocking the food pipe and hence she could not even swallow her own saliva. I immediately called the anesthetist and rushed her to the endoscopy department. Although the child has dinner just few hours ago, I had to take her up and relive her from this life threatening situation.

Under general anesthesia, I entered the food pipe. Saw the coin impacted. Under anesthesia the coin had moved downwards. There was not much space in this small child's food pipe for me to manipulate it to come out. I gently pushed it into the stomach taking care that I do not damage her delicate food pipe. Once the coin was in stomach, there was ample of space for me to manipulate the coin & put it into a special wire basket that I introduced it thro my endoscope.

Under vision, I gently pulled put the coin thro the food pipe. The basket had gripped the coin so well that there was no chance that while removing the coin would fall into the windpipe or oral cavity. The parents were greatly relieved. Next morning the child was as playful as before and was discharged.

Parents should be careful about the objects that their children play with. I have removed buttons, parts of toys, coins, button cells and even pins. These are potentially dangerous and can cause sudden accidental catastrophe in the family.

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