GUIDE TO NUTRITION EXERCISE AND HEALTH

Chapter – 7 

Children Health

Childhood vaccines are one of the great triumphs of modern medicine.  Dr. Ezekiel Emanuel

Infant and childhood death has fallen worldwide thanks to better public health measures – clean water, sewage, immunization, better nutrition and better medical care.  However, in most developing countries, lots of children are still dying from preventable and treatable diseases.  In developed countries childhood obesity is becoming a big problem.

Some of the steps you can take to keep your children healthy are:

• Healthy eating habits

Like adults children should eat a variety of nutritious foods.  Their diet should include plenty of vegetables and fruits, whole-grain cereals, low-fat dairy products, eggs, fish, poultry and lean meats.  Sugar and salt added snacks and drinks should be avoided.  All the newborns and infants should be breast-fed.

• Physical activity

Children should get 60 – 90 minutes physical activity most of the days of the week. The activity can include house hold chores, playing sports, running, and bicycling or otherplayground activities.

• Limiting screen time

Watching too much television, or lap-top or cell-phone, contributes to obesity.  Pediatricians recommend no more than 2 hours of screen time for children over age 2 and none for children under 2.

• Getting enough sleep

All children should get a good night sleep otherwise they end up being drowsy and irritable the following day.  Here are some ways you can cope with bed-time resistance.

• Set a regular time for sleep and stick to it.
• Avoid active play right before bed time.
• Establish a relaxing bed time routine-like reading a story.
• Avoid drinks with caffeine.
• Do not keep the room too warm or too cold.
• Don’t put a T.V,computer, or other electronic media in your child’s bedroom.

Preventing Common Childhood Infections

A child’s immune system constantly encounters, fights, and develops resistance to microorganism that causes disease.  By adulthood the immune system has built up a defense against a wide range of infections.  Most childhood infections are caused by viruses and bacteria that infect the airways or the digestive system.

• Childhood Immunization

Many once-common childhood infections can now be prevented by routine vaccinations.  A vaccination is usually a shot or oral drop, that helps prevent the development of specific disease.  Some vaccinations require a single shot; others require a series of shots or oral drops over time.  Your child’s doctor can suggest the exact timing that is best for each vaccination.  New vaccines are always being developed.  Your child’s doctor will have the latest recommendations.  Follow his/’her advice and get your child vaccinated.  Vaccines available at present are:

For Children

• Diphtheria
• Hepatitis B
• Hemophilus influenza type-b (Hib)
• Human papillomavirus (for cancer)
• H₁N₁flu
• Human papilloma virus for cervical cancer
• Influenza
• Measles
• Meningococcal bacteria (for meningitis)
• Mumps
• Pertussis (Whooping cough)
• Pneumococcal bacteria (for pneumonia)
• Rabies ( mad dog bite)
• Rotavirus (for diarrhea)
• Rubella (German measles)
• Tetanus
• Tuberculosis
• Typhoid fever
• Varicella (Chicken pox)

For Adults-

• All above plus the followings:
• Anthrax
• Shingles (Herpes Zoster)
• Yellow fever
• A malaria vaccine is under trial.

Preventing Common Cold and Flu

The common cold and flu are respiratory disorders that are caused by different viruses.  The two types of illnesses have similar symptoms.  In general, the flu is worse than common cold.  There is a vaccine for flu but not for common cold.  The primary way in which the cold and flu viruses are spread is in air borne droplets from an infected person’s cough or sneeze.  When your child is sick, keep him/her home from school to avoid spreading the infection.  To reduce the risk of your children getting a cold or flu, teach them the following precautions and habits:

• Cover your nose and mouth when you cough or sneeze.
• Wash your hands often with soap and water or alcohol sanitizer.
• Avoid touching your eyes, nose, or mouth.
• Avoid contact with people who are sick.

Preventing Diarrhea and Dehydration

Diarrheal disease is a leading cause of childhood death in the world-especially in the developing countries.  Diarrhea is also a major cause of malnutrition among the children of these countries.  The major causes of diarrhea are contaminated food and water.  Rotavirus and E.coli are the two main causative agents of diarrhea are developing countries.

The most severe threat posed by diarrhea is dehydration.  During a diarrheal episode, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost.  Dehydration occurs when these losses are not replaced.

The degree of dehydration is rated on a scale of 3.

1. Early dehydration – no sign or symptoms.
2. Moderate dehydration:

• Thirst
• Restlessness or irritable behavior
• Decreased skin elasticity
• Sunken eyes.

3. Severe dehydration

• All the above symptoms become more severe.
• Shock, with diminished consciousness, lack of urine output, cool, moist extremities, a rapid feeble pulse, low or undetectable blood pressure and pale skin.
  

Death can follow severe dehydration if body fluids and electrolytes are not replenished(ORS or IV fluids)in time. 

Treatment

You have to replace water and electrolytes with Oral Rehydration Salts (ORS or ORT) or through an intravenous drip.

Prevention:

• Continue breast feeding as long as possible = 9-12 months or longer.
• When mixing baby formula used boiled water.
• Wash fruits, vegetables thoroughly before cooking.
• Cook all the fish, poultry and meat well.
• Give only pasteurized milk and drink to children. No raw milk.
• Children should wash their hands after going to toilets and before eating.
• People who handle food should frequently wash their hands with soap and water.
• Refrigerate leftover food promptly.
• Avoid street food.
  

Vaccine

Rotavirus is the main cause of diarrhea and dehydration among children 6 -24 months. Vaccines against rotaviruses are available.  The vaccine is effective.  Get your children vaccinated for rotaviruses.  Currently, two oral, rotavirus vaccines are available.

Parasitic diseases

Approximately 2 billion people are infected with soil-transmitted parasitic diseases worldwide.  It is a common infection in children in developing countries.  Safe and effective medicines are available to control the infection.

The main species of parasites that infect children and adults are roundworm, the hook worm, the pin worm, and the whip worm.

Transmission

Eggs of these parasites are passed in the feces of the infected people.  Adult worms live in the intestine where they produce thousands of eggs each day.  In areas that lack adequate sanitation (like outdoor defecation), these eggs which are passed in the stools, infect the soil.  These eggs can be ingested by children and adults in following ways:

• Eggs that are attached to vegetables (growing close to the soil) are ingested when the vegetables are not washed, peeled and fully cooked.
• Eggs are ingested from contaminated water sources.
• Eggs are ingested by children who play in the contaminated soil and then put their hands in their mouth without washing them.

In addition, hook worm eggs hatch in the soil, releasing larvae that mature into a form that can actively penetrate the skin.  People become infected with hook worm primarily by walking barefoot.  There is no person-to-person transmission of hook worm infection.

Symptoms

The symptoms depend on the number of worms in the body of the infected person.  People with light infections usually have no symptoms.  Heavier infections can cause a range of symptoms including diarrhea, abdominal pain, general malaise and weakness and impaired mental and physical development.  Hook worms which is quite common, cause chronic intestinal blood loss that can result in anemia (low hemoglobin).  One of the most common causes of anemia in children and adults in developing countries is hook worm infection.

Nutritional effects

Soil transmitted parasites impair the nutritional status of the people in multiple ways.

• The worms feed on the tissues of the infected person (host), including blood, which leads to loss of Iron and protein.
• The worms increase malabsorption of nutrients like Vitamin A.
• They cause loss of appetite, diarrhea and dysentery, leading poor nutritional intake and physical fitness.

The nutritional impairment caused by soil-transmitted parasites has a significant impact on the mental and physical development of children. 

Prevention and treatment

• WHO (World Health Organization) recommends periodic medicinal treatment (deworming) of all at risk individuals, especially children in all endemic areas (where infection is common). All the individuals in the area should be treated with deworming medicine once a year and twice a year if the infection rate is more than 50%.
• Health and hygiene education of all the individuals – including children (wearing shoes, washing hands, washing vegetables, cooking them well, drinking safe water etc.)
• Provision of adequate sanitation (toilet) so that people do not defecate outside.

Deworming medicine

The WHO recommended medicines – albendazole (400 mg) and mebendazole (500 mg) – are effective.  They have been extensively used and are safe with no side effects.  It is important that all school children in endemic areas should be dewormed once a year.  They should be also taught the hygiene to avoid getting the infection.

Malaria

Malaria is a life-threatening disease caused by mosquito-borne parasite.  Half of the world’s population (3.2 billion people) is at risk of malaria.  The topic has been discussed in previous chapter.  All children, in endemic area should sleep under a drug-treated mosquito net.  Prevention is better than cure.

The classic symptoms are high fever with chills, rigor, sweats and headache.  They may come and go. Fever may appear every other or every third day.  Pallor and jaundice caused by destruction of the red blood cells may be also present.  Pregnant mother with malaria can pass it on to the baby.

Malaria can be fatal in children.  Every year millions of children die from malaria.  If in doubt seek prompt treatment.

Saheb Sahu, M.D., F.A.A.P., MPH.