Children constitute nearly 40% of the total population. This is the important age group in all societies because disorders in childhood can lead to chronic disease in later life.
It is customary to classify the childhood according to age as
• INFANCY- up to 1year of age
a. neonatal period – first 28 days of life
b. post neonatal period- 28th day to 1 year
• PRE- SCHOOL AGE – 1 to 4 years
• SCHOOL AGE – 5 to 14 years
CAUSES FOR POOR DEVELOPMENTS
- LOW BIRTH WEIGHT
They may be born at term or preterm. They weigh less than tenth percentile for the gestational age. There are many maternal causes for low birth weight like malnutrition, severe anaemia , heavy physical work during pregnancy, pre-eclampsia, malaria , toxaemia, smoking, low economic status, short maternal stature, very young age, high parity, close birth spacing and placental abnormalities. Fetal causes includes chromosomal abnormalities, multiple gestation, intrauterine infections, etc. These infants become easy victims for protein energy malnutrition and infections.
- POOR BREAST FEEDING
Breast milk is the ideal food for the infant. No other food is required by the baby until 6 months of age. Indian mothers secrete 450 to 600ml of milk daily with 1.1g protein/100ml. Prolonged breast feeding protect from early malnutrition and some infections. It contains antimicrobial factors such as macrophages, lymphocytes, secretory IgA, anti-streptococcal factor, lysozyme and lactoferrin which protects against diarrheal diseases , necrotizing enterocolitis ,respiratory infections . It helps in development of jaws and teeth, protects from tendency for obesity, neonatal hypocalcemia and hypomagnesia. Special fatty acids in breast milk lead to increased intelligence (IQ) and better visual acuity. Weaning should be started gradually after 6 months along with supplementary foods because breast milk alone cannot meet the metabolic needs thereafter. If weaning is not done properly , child will have diarrhoea, growth failure, immunodeficiency, kwashiorkor, marasmus, etc. Malnutrition in mother, not breast feeding often and supplementing breast milk affects the quantity and quality of breast milk.
Malnutrition makes the child more susceptible to infections, physical and mental retardations. Poor treatment of diarrhoeal diseases, measles and other infections, poor
breast feeding and bad environment might lead to malnutrition. Some specific deficiencies like vitamin A deficiency leads to blindness; iodine deficiency leads to goiter, cretinism, brain damage; anaemia from iron deficiency; rickets from vitamin D deficiency; scurvy from vitamin C deficiency, etc.
Protein – animal source- milk, meat, eggs, cheese, fish.
Vegetable source- pulses, cereals, beans, nuts, oil-seed cakes, soyabean
Fats – animal source- ghee, butter, milk, cheese, eggs, fat of meat and fish
Vegetable source- seeds like groundnut, mustard, sesame, coconut, cereals , pulses
Poly unsaturated fatty acids (PUFA) – found in vegetable oils like safflower oil, sunflower oil, sesame oil, etc
Vitamin A –animal source – liver, eggs, butter, cheese , whole milk, fish , meat
Vegetable source- spinach and amaranth are the major sources, also green and yellow fruits like papaya ,mango , pumpkin and some roots like carrots. It is also present in fortified foods like vanaspati.
Vitamin D – sunlight . Food source includes only animal origin like liver, egg yolk ,milk, butter and cheese.
Vitamin E – foods rich in PUFA also has vitamin E
Vitamin K – fresh green vegetables, cow’s milk and Human milk
Vitamin B – whole grain cereals, wheat , pulses, nuts , milk, eggs, green leafy vegetables, legumes , fish
Vitamin C – Amla or Indian gooseberry is the richest source , guava is also a source.
Calcium – milk and milk products like cheese , skimmed milk, butter milk , green leafy vegetables, cereals and millets especially ragi.
Iron – iron in animal source like liver, meat, poultry, fish are easily absorbed. Vegetable source includes cereals, green leafy vegetables, legumes, nuts, jaggery and dried fruits.
- INFECTIOUS AND PARASITIC INFECTIONS
Common childhood infections includes diarrhea, respiratory diseases, measles, pertussis, polio, neonatal tetanus , tuberculosis , malaria, intestinal parasites such as ascarides ,hookworm, giardiasis, amoebiasis etc. These infections are more common in children with malnutrition, poor environment, unhygienic food and drinking water.
- BEHAVIOURAL PROBLEMS
Children abandoned by their families present severe social and health problems. Oppositional defiant disorder(ODD) also affects the child. ODD includes frequent and persistent
pattern of anger, irritability, obstinacy, arguing, defiance and vindictiveness towards authoritative figures. Social environment like preschool also has a major part in development of speech, personality and intellectual behaviors. Physical abuse, mental trauma ,poor parenting, poverty and neglect also affects the infants greatly.
- CHROMOSOMAL ABNORMALITIES
Chromosomal abnormalities like down syndrome, angelman syndrome, prader willi syndrome, Edward syndrome, patau syndrome , wolf syndrome, cri du chat syndrome, etc also causes problem in tonicity, mental retardation, poor suckling, weak cry, congenital malformations
- CONGENITAL HEART DISEASES
Its incidence is higher in premature infants, rubella infection to the mother during pregnancy, drugs and heavy alcohol taken by the mother during pregnancy. It includes malpositions of heart , cyanotic and obstructive congenital heart diseases. The most common CHDs are ventricular septal defect(25-30%), atrial septal defect (10-15%), patent ductus arteriosus(10-20%), tetralogy of fallot(6-15%), transposition of great vessels(4-10%).
- MATERNAL HEALTH
A major determinant of child’s health is the health of the mother. Child’s health is adversely affected if the mother is malnourished, too young(<18 years) or too old(>35 years),
had too many pregnancies( >4), too frequent pregnancies(in >2 years).
• Proper nutrition
• Proper hygiene
• Good environment
• Proper care and attention
• Proper prenatal and postnatal care
• Proper treatment of infections and diseases
COMMOM SIGNS AND SYMPTOMS:
- Poor weight gain
- Lesser growth compared relative to peers of similar age
- Scaling skin
- Spoon shaped nails
- Angular cheilitis
- Lack of appetite
- Tiredness, sluggishness, less active
- Poor speech
- Poor intellectual behavior
- Delay in reaching milestones
- Lack of emotions like smiling, making eye contact ,etc
- Hair changes includes lack of lustre, sparseness or thinness, easy pluckability
- Diffuse pigmentation in face, moon face , nasolabial dyssebacia.
- Pale conjunctiva
- Spongy and bleeding gums
- Bow legs , knocked knees
- Epiphyseal enlargement
- Muscle wasting
- Low anthropometric measurements which includes height, weight, head circumference, mid-arm circumference, chest circumference, skin fold thickness
- The child must be treated with constitutional medicines and anti-miasmatic medicines. Miasm is one of the obstacles to cure , it predisposes the infant to certain type of diseases. Psora being the deficiency miasm , all the functions will be in hypo state , so anti-psorics can be thought of in case of hypo assimilation and hypo immunity. Sycotic child is always confused mentally and physically. syphilis being the destructive miasm , it can be thought of in case of congenital anomalies. Tubercular miasm can be thought of if the parents have history of Ill treated tuberculosis. Since tubercular miasm has features of both psora (hypo immunity) & syphilis(destructive), it can be thought of in case of allergic manifestations. besides these there are certain specific medicines like
- For sexual and violently abused children- staphysagria
- For abusive children who insults their parents and authoritative figures- Cina, Lycopodium, Platina, Tuberculinum.
- Ailments from weaning breast milk- belladonna, pulsatilla
- For marasmatic children-Aethusa, Calcarea carbonica, Natrum muriaticum, Silicea, calcarea phos, baryta carb
- Intestinal worms in children- calcarea carb, cina, natrum phos, spigelia, teucrium marum verum
- Learning disabilities- agaricus, baryta carb, calcarea carb, carcinosin, lycopodium
- Park’s textbook of social and preventive medicine
- Davidson’s principles and practice of medicine
- Textbook of pathology by Dr.Harsh Mohan
- API textbook of Medicine
- Homoeopathic medical repertory by Dr.Robin Murphy
- Hutchinson’s clinical methods
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