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Category : Child Health
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Case study Enuresis in children
ABSTRACT: Nocturnal enuresis (NE) is involuntary urination that occurs at night during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology. There are a number of treatment options available for NE; such as drug therapy, bladder training, positive reinforcement, and the enuresis night alarm. It requires patience, persistence and motivation. Several behavioural approaches can be used for treatment such as enuresis night alarm therapy and various skills oriented components. A thorough homoeopathic case taking and treating with an individualised homoeopathic remedy of single dose gives an assured result. Case with marked peculiar symptom can be made basis of prescription and not all cases requires repertorization.
Keywords: Nocturnal enuresis, bedwetting, enuresis, homoeopathy, single dose, peculiar symptom.
Nocturnal enuresis (NE) is defined as “involuntary voiding of urine that occurs while sleeping that can happen at an inappropriate and socially unacceptable time and place” and due to which its negative impact occurs on the quality of life of the affected children and their families. It is most common in boys, with a ratio of three boys for every girl until the age of 15. Enuresis should be differentiated from continuous or intermittent incontinence or dribbling. The bed is usually soaking wet in enuresis, compared to incontinence in which there is loss of urine without normal emptying of the bladder.
More than 85% children attain complete diurnal and nocturnal control of the bladder by five years of age. The remaining 15% gain continence at approximately 15% per year, such that by adolescence only 0.5-1 % children have enuresis. Up to the eleventh year, enuresis is twice as common in boys as it is in girls; thereafter, the incidence is similar or slightly higher in girls.
Enuresis is called primary when the child has never been dry and secondary when bed wetting starts after a minimum period of six months of dryness at night.
Enuresis may be comorbid with mood and emotional disorders and also has a high level of comorbidity with attention deficit hyperactivity disorder (ADHD). Part of emotional disorder such as anxiety, expression and insomnia are experienced by persons who have elimination disorders related to distress and social stigma
Enuresis classified on the basis of the time of occurrence into the following three subtypes:
• Nocturnal Enuresis: Passing urine during sleep.
• Diurnal Enuresis: Leakage of urine during waking hours.
• Monosymptomatic or uncomplicated NE: Normal voiding at night with absence of symptoms.
• Polysymptomatic or complicated NE: Bedwetting at day time with symptoms urgency, frequency, constipation and encopresis.
• Nocturnal and diurnal Enuresis, also known as nonmono-symptomatic enuresis.
- NE is hereditary, children whose parents were not enuretic have only a 15% incidence of bedwetting and when one or both parent were enuretics, the rates increases to 44% and 77% respectively
- From the difficulty in waking up when the bladder is filled.
- excessive nocturnal urine production and nocturnal bladder hyperactivity
- Can be drinking late in the evening or not passing urine before going to sleep, resulting in excessive urine volume.
- Another cause may be a low amount of antidiuretic hormone during the night which controls the production of urine.
Goals of treatment
The following are goals of management for NE
• To stay without bedwetting on particular occasions such as sleepover at night or day.
• To decrease the frequency of wet nights.
• To decrease the impact of enuresis on the child and family.
• To avoid recurrence of bedwetting.
For achieving the above goals lifestyle and behavioural changes play an important role.

Primary management of enuresis is behavioural modification and positive reinforcement and it should be start with educating the child as well as parents about the condition, which can be achieved through :
-Behavioural Management.
-Night urine alarm therapy.
-Pajama (Under wear) Device
-Mechanism of action of Night urine Alarm Device
-Waking schedule

A female patient of age 10 years visited our A. M. Shaikh Homoeopathic Hospital on 22/07/2019 with her father who described her case in detail with the presenting complaint of Bed wetting since 5 years.

History of presenting complaint
Patient came with the complaint of bed wetting at night and daytime as well; there is no single dry night since 5 years.At times she passes urine 2-3 times at night and once during her day/evening sleep.
No H/O Night terrors or Nightmare.
Treatment history:
Has consulted an allopathic paediatrician for the above mentioned complaint and was on treatment for 3years with no desirable improvement, so wilfully seeking homoeopathic treatment.
Past history: No H/O any major illness or any remarkable events occurred since birth.
Family history: Nothing significant. No family history of enuresis.
Neck holding - 4th month
Monosyllable speech – 7th month
Crawling – 9th month.
Sitting without support by 10th month.
Walking without support – 14th month.
Normal speech with meaningful words – after18 months.
Personal History:
Diet : Vegetarian,
Appetite :Not adequate, hardly eats a roti at times.
Thirst : 1 – 1.5 ltrs / day,
Micturition : D/N : 3-4/2-3,
Stools : Once/day, Regular, Soft.
Desires : Spicy food.
Life Space Investigation :
 Birth history : Full term normal hospital delivery. Mother had absolutely healthy pregnancy throughout the term. Mother was not a known case of Hypertension, Diabetes Mellitus, Hypothyroidism. No H/O any insult (injury) at birth.
 Post delivery – till date. : Patient is born and brought up in Kadoli, Belagavi. No remarkable events since birth.
 She is good in studies, mingles with people easily. She gives debate and speaks freely without fear in-front of people and she has won in almost all the debate she has participated yet she is timid. She cannot takes / tolerates the pain when other people are quarrelling (reaction sympathetic). She is that sensitive she cannot even tolerate the fight in movies and serials. If she sees any beggar on road she tends to lend her tiffin.
General Physical Examination :
Patient is moderately built and moderately nourished, No pallor, cyanosis, icterus, clubbing, oedema, lymphadenopathy, Temperature : 98.6º F. (Afebrile), Thermals : Hot, Height :129cms, Weight :26kgs, Birth Weight : 2.75kgs, Pulse rate :84 bpm, Respiratory cycle : 18cpm.
Clinical diagnosis :Primary enerusis.
Totality of symptoms :
 Bedwetting at night and daytime.
 Desires spicy food.
 She cannot tolerate when other people are quarrelling (reaction - sympathetic), She is that sensitive she cannot even tolerate the fight in movies and serials. If she sees any beggar on road she tends to lend her tiffin
 Hot patient.
Analysis of symptoms :
Common symptoms Uncommon symptoms
Bed wetting. She cannot tolerate when other people are quarrelling.
Timid but speaks in public.
Desires spicy food

Prescription: Causticum200 HS 1dose
Basis of prescription : This case has been prescribed without repertorization as we found the substantial / peculiar symptom ( sensitive to emotional disturbances) for prescription while case taking.
Follow up’s : (written as it is expressed by father)
 29/07/2019
Father said patient has passed urine only twice during her sleep since last week.
Complaints are better by 50%.
Prescribed Placebo BD for 15 days.
 19/08/2019
Patient has passed urine during day sleep only once since past 10days.
No bedwetting at night since 10 days.
Appetite has improved, father said she herself asks and have food.
Patient is better by 75%.
Prescribed Placebo BD for 15 days.
 03/09/2019
Bedwetting only once at day sleep and no bedwetting at night since 1 month.
Feeling generally better.
No fresh complaints.
Prescribed Placebo BD for 15 day.
Conclusion : Enuresis can be successfully treated with detailed homoeopathic case taking with individualised homoeopathic medicine along with encouragement, a positive attitude and motivation are important components of treatment to become dry. Punishment and criticism has no role to play in care. Children with enuresis get always benefit from a caring attitude of parents. A positive approach by the physician and care taker is also important role to play for putting confidence and to increase compliance.
References :
1. Ghai. O. P, BaggaArvind, Pual. V.K; Ghai essential paediatrics; 8th edition revised and enlarged; CBS Publications and distributors Pvt. Ltd.; NewDelhi; 2013, P-504.
2. Kliegman, M. Robert, Stanton, F. Bonita. Geme, St. Schor; Nelson Textbook of Paediatrics; 20th edition; ELSEVIER; Philadelphia; 2016;
3. Sleep and hypnosis : a Journal of Clinical Neurosciences and Physiopathology.
From :
Dr Shashank H S
Dept of Paediatrics
PG Part 1
A M Shaikh Homoeopathic Medical College , PG Research Centre & Hospital, Belagavi.

Under the guidance of :
Dr Nahida M Mulla. M.D (HOM); MACH
Prof. and HOD Paediatrics
A M Shaikh Homoeopathic Medical College , PG Research Centre & Hospital, Belagavi.

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Shaken Baby Syndrome
Shaken baby syndrome (Shaken impact syndrome) is a serious form of abuse inflicted upon a child. It usually occurs when a parent or other caregiver has shaken a baby out of anger or frustration, often the baby will not cry.

Babies have very weak neck muscles that cannot fully support their proportionately large heads. Severe shaking causes the baby's head to move violently back and forth, resulting in serious and somethings fatal brain injury. These forces are exaggerated if the shaking is interrupted by the baby's head hitting a surface.

Is a serious brain injury caused by forcefully and violently shaking a baby? Other names for this condition include abusive head trauma, shaken impact syndrome, and whiplash shaken syndrome. it can result from as little as five seconds of shaking.

Babies have soft brains and weak neck muscles. They also have delicate blood vessels. Shaking a baby or young child can cause their brain to repeatedly hit the inside of the skull. this impact can trigger bruising in the brain, bleeding in the brain, and brain swelling. Other injuries may include broken bones as well as damage to the baby's eyes, spine, and neck.

The shaken baby syndrome is common in children under age 2, but it can affect children up to ae 5. Most cases of shaken baby syndrome occur among infants that are 6 to 8 weeks old, which is when babies tend to cry the most. Playful interaction with an infant, such as bouncing the baby on the lap or tossing the baby up in the air, won't cause the injuries associated with the shaken baby syndrome. Instead, these injuries often happen when someone shakes the baby out of frustration or anger.

Symptoms of Shaken baby syndrome:

Symptoms include:

. Difficulty staying awake

. Body tremors

. Trouble breathing

. Poor eating

. Vomiting

. Discolored skin

. Seizures

. Coma

. Paralysis

Deceleration of the head when it impacts a surface can cause the following:

Subdural hematoma, which is a collection of fo blood between the surface of the brain and the dura.

This occurs when the veins that bridge from the brain to the dura are stretched beyond their elasticity, causing tears and bleeding.

Subarachnoid hemorrhage, which is bleeding between the arachnoid and the brain.

Direct trauma to the substance itself, caused when the brain strikes the inner surface of the skull.

Shearing off or breakage of nerve cell branches in the cortex and deeper structures of the brain caused by violent motion to the brain.

Further irreversible damage to the brain substance from the lack of oxygen if the child stops breathing during shaking.

Further damage to the brain cells when nerve release chemicals that add to oxygen deprivation to the brain.

Retinal hemorrhages ranging from a few scattered hemorrhages to extensive hemorrhages involving multiple layers of the retina.

Skull fractures resulting from impact when the baby is thrown against a hard or soft surface.

Fractures to other bones, including the ribs, collarbone, and limbs, bruising to the face, head and entire body.


. Encephalopathy, brain swelling

. Subdural hemorrhage, or bleeding in the brain

. Retinal hemorrhage or bleeding in a part of the eye called the retina.

The doctor will order a variety of tests to check for signs of brain damage and to help confirm the diagnosis. These tests may include:

. MRI scan, which uses powerful magnets and radio waves to produce detailed images of the brain

. CT scan, which creates clear, cross-sectional images of the brain

. Skeletal X-ray, which reveals the spine, rib, and skull fractures

. Ophthalmic exam, which checks for eye injuries and bleeding in the eyes

Irreversible brain damage from shaken baby syndrome can occur in a matter of seconds. Many babies experience complications, including:

. Hearing loss

. Seizure disorders

. Development delays

. Intellectual disabilities

. Cerebral palsy, a disorder that affects muscle coordination and speech

Shaken Baby Syndrome is preventable. You can avoid harming your baby by not shaking them under any circumstances. It's easy to become frustrated when you can't get your baby to stop crying. However, crying is a normal behavior in infants, and shaking is never the right response.

It's important to find ways to relieve your stress when your child cries for extended periods. Calling a family member or a friend for support can help when you feel yourself losing control. Some hospital-based programs can teach you how to respond when infants cry and prevent the injuries associated with the shaken baby syndrome. Make sure your family members and caregivers are also aware of the dangers of shaken baby syndrome.

Shaken Baby Syndrome is completely preventable. Taking care of a baby can present challenges, especially for first- time parents. However, it is important to remember that it is never acceptable to shake, throw or hit a baby.

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Nocturnal enuresis commonly called bedwetting or sleepwetting is involuntary urination while asleep after the age at which bladder control usually occurs. Nocturnal enuresis is considered primary (PNE) when a child has not yet had a prolonged period of being the cry. Secondary nocturnal enuresis(SNE) is when a child or adult beings wetting again after having stayed dry.

Most bedwetting is a developmental delay, not an emotional problem or physical illness. Only a small percentage(5% to 10%) or bedwetting cases are caused by specific medical situations bedwetting is frequently associated with a family history of the condition.

Bedwetting children and adults can suffer emotional stress or psychological injury if they feel shamed by the condition. Treatment guidelines recommend that the physician counsel the parents, warning about psychological damage caused by pressure, shaming, or punishment for a condition children cannot control. Bedwetting is the most common childhood complaint. Most girls stay dry by age six and most boys stay dry by age seven. By ten years old 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%.

The bladder is a muscular receptacle, or holding container, for urine. It expands as urine enters and then contracts to push the urine out. In a person with normal bladder control, nerves in the bladder wall send a message to the brain when the bladder is full, the brain then sends a message back to the bladder to keep it from automatically emptying until the person is ready to go to the bathroom. But people with nocturnal enuresis have a problem that causes them to urine involuntarily at night.

What causes Enuresis?

They do have some theories though, on what may contribute to someone developing the condition:

Hormonal Problems:

A hormonal called antidiuretic hormone, or ADH, causes the body to produce less urine at night. But some people's bodies don't make enough ADH, which means their bodies may produce too much urine while they're sleeping.

Bladder problems:

In some people with enuresis, too many muscle spasms can prevent the bladder from holding a normal amount of urine. Some teens and adults also have relatively small bladders that can't hold a large volume of urine.


Teens with enuresis often have a parent who had the same problem at about the same age. A scientist has identified specific genes that cause enuresis.

Sleep problems:

Some teens may sleep so deeply that they don't wake up when they need to urine.


using caffeine causes a person to urinate urine more.

Medical conditions:

medical conditions that can trigger secondary enuresis include diabetes, urinary tract abnormalities (problems with the structure of a person's urinary tract), constipation, and urinary tract infections. Spinal cord trauma, such as severe stretching of the spinal cord resulting from a fall, sports injury, auto accident, or another event may also play a role in enuresis, although this is rare.

Psychological problems:

Some experts believe that stress can be associated with enuresis. It's not uncommon to feel stressed out during the teenage years, and things such as divorce, the death of a friend or family member, a move to a new town and adapting to a new school and social environment, or family tension can feel overwhelming.

Doctors don't know exactly why, but more than twice as many guys as girls have enuresis. It is often seen in combination with ADHD.

Classification of bedwetting:

Primary nocturnal enuresis:

Primary nocturnal enuresis is the most common form of bedwetting. Bedwetting counts as a disorder once a child is old enough to stay dry, but continues either to average at least two wet nights a week with no long periods of dryness or to not sleep dry without being taken to the toilet by another person.

Secondary nocturnal enuresis:

Secondary enuresis occurs after the patient goes through an extended period of dryness at night (roughly six months or more) and then reverts to nighttime wetting. Secondary enuresis can be caused by emotional stress or a medical condition, such as bladder infection.

Psychological definition:

Psychological may use a definition from the American Psychiatric Association's DSM-IV defining nocturnal enuresis as report urination into bed or clothes, occurring per week or more for at least three consecutive months in a child at least years of age and not due to either a drug side effect or a medical condition. Even if the case does not meet these criteria, the DSM-IV definition allows psychologists to diagnose nocturnal enuresis if the wetting causes the patient clinically significant distress.

The homeopathic remedy for Nocturnal enuresis:


Is useful when involuntary urination is worse in winter and better in summer. It is also for children who tend to wet their pants when they cough or sneeze or even laugh.


Is very beneficial in the case where along with the bedwetting problem child depicts symptoms of worm manifestations irritation of the nose, causing constant symptoms desire to pick, or press into it, extreme ill humor, heightened irritability and most commonly gritting teeth during sleep.


It is found to be an excellent remedy for bed wetting in children. Its action is mainly on the urinary bladder. Painful urination. Constant nocturnal bedwetting. The urine looks cloudy. Enuresis with dreams and nightmares.


Enuresis in the first part of the night with dreams as if urinating in the urinals. Otherwise also must hurry when the desire comes or the urine escapes. It is especially useful in heavy sleepers who wet the bed in the first sleep.


The child needing this homeopathic remedy has involuntary urination during sleep during which he or she may pass enormous quantities of clear urine. They can also have red sand in their urine. The typical lycopodium patient craves sweets, likes hot drinks and has aggravations from 4-8 pm fo many complaints.


Nocturnal enuresis a general remedy.


The child requiring this remedy often suffers from urine discharges that are involuntary. The urine can dribble while sitting or walking and at night in bed (according to the older authors particular in young girls). The typical child needing the homeopathic remedy Pulsatilla is often changeable and fickle and can be a bit weepy. They tend to love fuss and company.


Use it when the well-selected remedies fail to act. Bedwetting of psoric patients. Wets the bed especially during full moon.

Secale cor:

Enuresis in old people due to enlargement of prostate glands.


Enuresis in sickly girls during the first sleep. Urine is very offensive.

Verbascum thaps:

Nocturnal enuresis of long standing.

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Scope of Homeopathy Treatment in Asthma
Asthma is one of the most common health problems affecting around 2 crores of people in India and around 33 crores in whole world level. The death and disability from asthma is seen more in children from the age group 2-14. In asthma the bronchial tubes or air ways get affected. There is a cascade of bio reaction that occurs in the air tubes or respiratory tract of an asthma affected person. The lungs play the major role for gas exchange in our body. Each and every cell of our body gets their oxygen to stay alive. The air goes through the nasal passage and air tubes and reaches at lungs where it absorbs to the blood and finally goes to every cell. When you breath sending oxygen to your whole body and releasing carbon dioxide from the body. The whole function of air exchange is carried out by the respiratory system. The respiratory system consists of different parts or segments those takes the active part in respiratory function. The respiratory function starts from the nose or nostrils and end at lungs.
The pathophysiology of asthma can be explaned as in 2 process
1) bronchial inflammation,
2) broncho constriction

The bronchial inflammation in everyday life we exposes thousands of foreign substances which are very minute in size and invisible to naked eyes. Those floats in airs and when we ingest them go inside our body and makes their way into the bronchial passage. The WBC or white blood corpuscles are one component of the complex immune system. There are 5 types of WBC neutrophile, eosinophile, basophile, Lymphocytes, monocytes. Among them the lymphocytes plays a major role in allergic reaction. The lymphocyte are divided into 2 types the T lymphocytes or T cells , the B lymphocytes or B cells. The T cells and B cells travel everywhere in our body passing through the blood vessels. Their role is to recognize a foreign particles present in the body and then to attack them. When they reach in bronchial airways the T lymphocytes check each and every cell to confirm it whether it is a safe cell or a foreign cell. When the T lymphocytes find a foreign cell then release some chemicals called cytokines. Those cytokines activate the B lymphocytes to convert plasma cell. The plasma cell produces one antibody, IgE anti body that moves and attach to the IgE receptor of mast cell present on the mast cell surface. The mast cells are the specialized cells distributed in various body parts of our body like over skin, inside the respiratory tract, inside the GI tract etc. Those mast cells contains some tiny protein granules called the histamines.
When an antigen or allergen get inside our body and reach in our air space it attached to the IgE antibody of mast cell. When the antigen and antibody unites the mast cell releases its histamines to the surrounding spaces. Those histamines have the pro inflammatory properties. So when they attach to the epithelial cells of bronchial tube with its H1 receptor that present on every cell surface the inflammation starts. So this causes the inflammation of bronchial airways. Due to the btronchial inflammation there is also mucus secretion around the areas.

Bronchial constriction the bronchial inflammation causes the thickening of the mucous lining of the air tubes and in addition to that over secretion of mucus from the hyperactive mucus glands makes the bronchial spaces narrower and that causes bronchial constriction.
Besides that when there is an inflammation in the bronchial mucous lining the afferent nerves ending of the parasympathetic nerve fiber present in the bronchial airways sends some impulses to the vagus center of the brain stem and then down the vagal efferent pathway to again reach the bronchial small airways and secrets acetylcholine from the nerve ending that stimulate the smooth muscles fibers surrounding the bronchial tubes to be tighten more and more that result bronchial constriction and broncho spasm.

Homeopathy treatment for asthma
The homeopathy treatment helps to treat the asthma in 2 ways It controls the acute asthmatic condition by both oral medicines and homeopathy nebulizer (Dr Satapathys homeo nebulizer).The acute symptoms of asthma like coughing, chest tightness, wheezing sound, shortness of breath are immediately required to control as quick as possible so the person can breathe freely. There are many homeopathy medicines when selected as per the totality of symptoms of the person can able to control the acute asthma symptoms effectively and rapidly. The medicines for acute symptoms can be given repeatedly even 30 minutes to hour interval till the symptoms are not getting fully recovered. There is no specific medicine for any specific health issues in homeopathy. One medicine can be given in different health problem when the symptoms of the diseased person are fully matched homeopathically with the medicinal symptoms. For example a severe dry cough which worsen on lying posture with gagging or vomiting, suffocative sensation and more cough after drinking cold water can be given one homeopathy medicine spongia, another person with same dry severe cough but get relief after drinking little cold water will be given another medicine cuprum met. So here for the same health problem of cough there is two different medicines in which one get relief from tsaking cold water but another get worse, which is the key characteristic symptoms to select the specific homeopathy medicines. Similarly in all asthma symptoms that may be cough or wheezing sound or tightness of chest the medicines are not same for each individual symptom. The selection of medicines is totally depend upon the symptoms of the patient. But it is hundred percentages true that homeopathy has effective medicines for all acute symptoms. If the correct medicine with accurate potency is given it give immediate relieve to the disease. So besides the diagnosis of disease the diagnosis of medicine is highly essential to cure one disease in homeopathy. Unlike other therapist a homeopath has dual responsibility i.e. to diagnosis the disease and then to diagnosis the remedy. But at the same time the mother tincture form of homeopathy medicines have specific effect on a specific health problem like Justecea adathoda mother tincture is generally given for dry cough whatever the characterized symptom present. But the specific homeopathy remedy is generally given in raw form i.e. in mother tincture form or in very lower potency. The alkaloid or active principle of each and every homeopathy medicine has some key therapeutic property. In this regards homeopathic nebulizer developed by Dr.Satapathy do act in same principle and is given to all asthma patients as a common supplementary treatment to control the severity of asthmatic situation. With all the indicated homeopathic acute remedies, Dr.satapathys homeo nebulizer offers a rapid and long lasting relief to the acute symptoms of the asthma.
The control of the acute symptoms of the asthma wont give a long lasting relief. It is the management of acute symptoms for a time period. Because though the symptoms can be well managed by the acute homeopathic remedies for a limited time period , but there is chance of reappearance of asthma symptoms if the patient again being exposed to the triggers. It is because the persons immune system is still in hyperactive state so whenever he get exposed towards any allergens the symptoms again reappear. The immune system of an asthmatic person is very sensitized to many allergens and when get contact with them develop the asthmatic symptoms. Just to control the symptoms will not cure the asthma in a long term basis because his hypersensitive immune system again will react adversely when again get expose to the same allergen. So for a long term cure it is highly required to modify the hypersensitive immune system of the asthmatic person to a normal functioning immune system. A proper constitutional homeopathy medicines basing upon the homeopathy way of case history taken which covers the common clinical symptoms with their modalities , physical general symptoms, mental general symptoms, miasmatic back ground, past history of any health issues either physical or psychological background, family history of any diseases, if all those taken into consideration then the constitutional homeopathy medicine comes from those symptom similarities basis is the specific medicine for that particular person. If that medicine is given for a considerable time it will help to modify the hypersensitive immune system to normal functioning immune system. This type of homeopathy treatment is called as classical homeopathy treatment. From my 24 years of clinical experience I feel both acute homeopathy treatment along with classical approach of treatment is much more beneficial than alone acute treatment or alone classical treatment.
In spite of that there are many factors those also put bad impact on the immune system and convert its healthy functioning nature to hypersensitive nature. Factors that affect the immune systems are faulty life style, faulty food habits, lack of physical activities, constantly staying in a overstressed condition, side effects of various chemical drugs, obesity, smoking, rise of pollution, suppression of any skin disease, hereditary condition and so many life style changes also responsible for making our immune system hyperactive. So with homeopathy treatment a healthy life style, healthy food habits, healthy mind set up is mostly desirable to cure asthma permanently and forever.

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Understanding Cerebral Palsy
सेरेब्रल पाल्सी अथवा प्रामस्तिष्क घात मुख्यतः मस्तिष्क पर किसी प्रकार की चोट अथवा असामान्य विकार की वजह से शिशुओ मे होती है . यह एक नॉन प्रोग्रेसिव डिसॉर्डर है जिसमे मस्तिष्क का जो भाग शतिग्रस्त हुआ है वह समय के साथ वैसा हे रहता है एवम आगे उसका षरन नही होता है.

भारत मे एक हज़ार लाईव बर्थ मे से ३ % शिशुओ मे c.P होता है और संपूर्ण भारत मे २५ लाख से ज़्यादा CP मामले वर्तमान समय मे है.

सेरेब्रल पॉल्ज़ी के लक्षण:

१. सीबरल पॉल्ज़ी से पीड़ित शिशु का शारीरिक विकास सामान्य बच्चो की अपेक्षा विलंब से होता है
२. ६ माह की आयु तक सोशल स्माइल नही देते
३. ध्वनि के प्रति प्रतिक्रिया व्यक्त नही करते
४. ८ माह के होने पर भी सिर और गर्दन नही संभाल पाते
५. हाथों और पैरो की मांसपेशिया अत्यधिक कड़क अथवा ढीली होती है
६. हाथों की मुट्ठी कसी हुई रहती है
७. हाथों की पकड़ कमजोर होती है
८. १२ माह का होने पर भी बच्चा स्वयं अपने शरीर का संतुलन नही बना पता
९. रीढ़ की हड्डी आगे की और झुकी हुई होती है, बच्चा आगे की और झुककर बैठता है
१०. पैर तिरछे प्रतीत होते है

Dr. Pooja Pathak

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Understanding Dyslexia (learning disability)

Diagnosis of Dyslexia is based on signs/symptoms related to reading/ learning n academic performance of the children.

डिस्लेक्सिया के कुछ प्रमुख लक्षण :

देर से बोलना सीखना,
नए शब्दों को सीखने/बोलने में दिक्कत,
कविताएं सुनाने में अटकना,
वाणी अस्पष्ट होना.

अपनी आयु के समान बच्चो से पढ़ाई में पिछड़ना,
स्पेलिंग (शब्दार्थ) लिखते समय गलती करना,
लिखावट (हैंड-राइटिंग) अस्पष्ट होना,
सुनी गई बात को समझने और रिप्लाय (उत्तर) देने में परेशानी,
त्वरित निर्देशों को समझ नही पाना,
किसी भी क्रिया को करने की प्रक्रिया स्टेप बाए स्टेप फॉलो नही कर पाना.

By applying specific therapeutic strategies and special education techniques,children with Dyslexia can lead a normal productive life.

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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 theyre 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 cant pay attention: when theyre doing things they enjoy or hearing about topics in which theyre 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:
Doesnt 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 its 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, theyll interrupt conversations, invade other peoples 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
Cant 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 peoples 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 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 1 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 1 years
Total 21 12

Group Two
1. Less than 6 months
2. 6 months to 1 years
3. 1 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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