Childhood obesity:

Obesity is considered as most widely spread physical disorder of the human body and has become a vast problem as a obese children. In the modern era, decrease in the physical activity, change in the dietary patter, especially most of the people adopting junk food like bread, chips etc, can increase the risk of obesity and obese children.

Definition:- If an excessive fat accumulates in the body it is known as Obesity. A person is considered to be obese children, if the body weight is more than 25 percent in boys and more than 32 percent in girls.

Obese children:- childhood obesity or obese children is defined as, if 120 percent more weight compare its height ratio is known as childhood obesity.

Obese children are usually measured by using skin fold measurement, mainly the amount of fat present in the sub scapular region, calf and triceps reason. In this triceps and calf or triceps and sub scapular, or calf alone have been used with children and adolescent to find out obese children. If the skin fold in boys is more than 10-25 and 16-30 in girls is present it is considered as normal.

The problem associated with  childhood obesity are:-

Obese children has more risk of getting Type 2 Diabetes mellitus, which is increasingly diagnosed in children now days. Type 2 diabetes is previously considered that it is found only in adolescence. Type 2 diabetes is caused due to increased risk of pediatric hypertension.

* Bulimia: It is an eating disorder, may associated with obese children.
* Respiratory problems such as restriction in the chest wall, causes breathlessness; airway obstruction, etc were found in obese person or in obese children.
* Liver may damage in obese children.
* Sleep apnea: a condition in which there occur a difficulty in breathing during sleeping,
* Cardiac disorders such as Cardiomyopathy may occur in obese children. Cardiomyopathy is a problem associated with heart muscles, in which there is a need of an extra effort to pump the blood from the heart; obesity increases the risk of coronary heart disease,atherosclerosis, and diabetes.
* Other body system disorders involve gallstones, arthritis and hernia.
* Orthopedic problems also associated obese children.
* Obesity increases stress on weight-bearing joints.
* Obese children will have low self-esteem, which affects the Child relationship with his/her peer group.
* Obese children may get psychological problems and affects social relationship as well.
* Low life expectation is also seen in obese children. etc

Causes of children obesity:-

If the amount of intake is more than the amount of energy expenditure, the body will store excessive energy as fat. If this process continues more and more fat will get accumulate in our body and that causes obesity. The following are the causes which lead  obesity in obese children.

Genetics/Hereditary : If the parents are having obesity in their family that is the main cause of the obesity in infants and obese children. And some of the genetic disorders that too were the cause of the obese children.

Food : food is the primary factor to cause obesity. Whatever food we select those decide our physical development and our mental development as well. Foods that rich in high fat and sugar rich foods cause obesity.

Sedentary life style : It decreases physical activity of a child, increases the accumulation of fat and other things in the body. The children who spend more time in watching the television, playing video games, spending more time inside the room with less energy expenditure are more prone to develop obesity.
Alcohol intake increases the risk of obesity. Alcohol increases the calories in liquid form in addition to a full diet.

Assessment of obese children:-

Obese children can be assessed by the estimation of total body weight, measuring skin-fold, and by measuring body weight. If body weight is higher than normal by 20 percent may be considered as obese.

Prevention of obesity:-

It is the more important responsibility of all the parents to prevent the obesity in its early stage. According to one proverb “Prevention is than to cure”, so it is better to prevent the development of obesity than its cure. The following are the remedies that help you to prevent and cure the obesity in children.

Nutritional therapy for obese children : Principles of nutritional therapy are as follows.

* Eat regularly.
* Do not skip meals.
* Eating regular meals which are low in calories,
* Avoiding high calorie foods frequently.
* Measure foods to determine the correct portion size.
* Avoid concentrated sweets, such as sugar, candy, honey, pies, cakes, cookies, and regular sodas in obese children.
* Increase the intake of more green leafy vegetables, fruits and adapting to the vegetarian diet will reduce  obesity risk in obese children and keeps the person or child in healthy condition.

Exercise : is an essential part of a weight-control program. Exercise increases energy loss, hence it increases appetite, but in a later stage it has an opposite action. Exercise increases body fat distribution, hence it reduce the waist-hip ratio as exercise is continues. Maintain a regular exercise program for successful weight loss  in obese children.

Behavior Modification: It involves self-monitoring, stimulus control, and rewards.

Drug Therapy: Drugs have been used in the treatment of the obesity but only as adjuncts to a good diet and exercise program. There are two categories of drugs used to treat obesity. They are as follows,

Appetite-suppressing drugs. Eg- Adipex-P, Fasting.
Nutrient absorption-blocking drugs. Eg- Xanical.

Surgery is  performed to reduce childhood obesity.

* Lipectomy : It is performed to remove unsightly flabby folds of adipose tissue in obese children.
* Liposuction: Here excessive fatty tissue is removed by using the method of suction. The areas involved in this procedure are chin, abdomen, waist and upper thighs of obese children.

* Gastrointestinal Surgeries: like a Vertical banded gastroplasty- It consist of construction a small pouch with a restricted outlet along the lesser curvature of the stomach in obese children. This reduces the gastric capacity and hence will reduce the obesity in obese children. It’s advantages involves, this procedure is easy to perform , more normal anatomy and physiology can maintained in children.
* Roux-en-Y: Gastric bypass procedure involves constructing a proximal gastric pouch whose outlet is a Y-shaped limb of small bowel. This reduces gastric capacity, some malabsorption. It has advantage as it helps in large weight loss in obese children.

Pertussis:-

Pertussis is also called as whooping cough. Pertussis is an  important communicable disease caused by bacteria,  results in uncontrollable, violent cough. Especially children are affected with pertussis.  As the sound comes during cough and taking air in, is called as whooping cough.  Nearly 5000 to 10000 children in united states are dieing every year because of pertussis.

Causes of pertussis:-

Bordetella pertussis, the bacteria causes pertussis infection. Pertussis is the disease of upper respiratory tract, if not treated causes permanent disability in children and may lead to death. Pertussis transmitted when an infected person sneezes or coughs, the bacteria spreads to air, and the person who inhales pertussis infected air droplets becomes infected with pertussis. Hence pertussis is an infectious disease easily spreads from person to person. Cough, sneezing, runny nose are the early symptoms of pertussis. After the pertussis bacteria multiplies in body, severe cough starts. Children experience weakness, fatigue and discomfort as the cough becomes severe. The continuous cough leads to impaired breathing and the children make whoop sound after coughing, is called whooping cough. Whooping sound is absent in infants less than 8 months. Some children vomits along with small amount of sputum. Coughing and vomiting simultaneously may lead to chocking in infants. Pertussis infection usually lasts for a period of 6 weeks. Whooping cough affects not only children but elder people can also get infected with pertussis. Now the incidence of pertussis is reduced as children are immunized during infancy, and higher rate pertussis is seen in  adolescents and elders.

Symptoms of pertussis:-

* Runny nose, sneezing
* mild fever up to 102 °F.
* Severe, continuous cough
* difficulty in  breathing
* both night and day cough,
* vomiting with sputum and cough,
* dry cough develops after some days,
* presence of whooping sound after cough while taking breath,
* generalized weakness and fatigue,
* Some children will have diarrhoea,
* Choking may occur in infants.

Diagnosis of pertussis:-

The initial diagnosis is the physical examination and history collection. The symptoms of pertussis are similar to pneumonia and the careful examination is needed to diagnose pertussis.

* Sputum test for bacterial culture,
* Nasal secretions test in laboratory,
* Chest x ray is also taken to differentiate from pertussis.
* Blood test is done to check elevated white blood cells.

Treatment of Pertussis:-

Antibiotics such as erythromycin and amoxicillin are the choice of drugs for pertussis treatment. Analgesics and antipyretics  are given to reduce fever and body ache. Incentive care should be taken to treat the infants infected with pertussis, and careful monitoring of progress of diseases and prognosis of treatment is needed. Hospitalization is needed in severe pertussis infected children. An oxygen tent with high humidity is used for infants have breathing difficulty. Intravenous fluids administration is also done to maintain water and electrolyte balance. Sedatives  may be given by the pediatrician for young children to avoid crying and induce sleep. Expectorants, and cough suppressants are  not helpful in treating pertussis.

Prevention of pertussis:-

The DPT vaccine ( diphtheria, pertussis,tetanus) or only pertussis vaccine Helps lot in preventing pertussis. Immunization schedule n most of countries  recommended for DPT-vaccine in infancy itself. The booster shot of pertussis is given after some months in infants. In adults also booster dose of pertussis is given to prevent pertussis in adolescents and adults. Pertussis affected children should follow the measures to prevent spread of pertussis infection by wearing face mask, or avoiding school for some days. The vaccination also given to elders aged above 65 years to prevent pertussis.

If the buttocks are delivered first it is called as breech delivery. only 3 to 4% pregnancies are with breech presentation at birth. Breech position is an abnormal position and vertex presentation is normal birth presentation.

Most breech birth or breech presentation occur at the 32 week of gestation and at this time head of fetus is not turned down.  The main causes of breech presentation or birth are

* Prematurity is the main cause of breech presentation. Increased amniotic fluid or polyhydraminos,
* Fetal abnormalities such as hydrocephaly, anencephaly, and congenital abnormalities of fetus,
* Maternal abnormalities such as Uterine abnormalities.
* Placental abnormalities, Uterine fibroid and
* Multiple pregnancy.

Types of breech presentation are:-

* Frank breech presentation : baby’s buttocks comes first, and breech baby’s legs are flexed at the hip and extended at the knees (with feet near the ears). Nearly 65 to 70% of breech  delivery are in the frank breech position.

* Complete breech delivery: the baby’s hips and knees are flexed so that the baby is sitting cross legged, with feet beside the bottom. This is not common as frank breech position.

* Footling breech delivery : one or both feet come first, with the bottom at a higher position. This is footling breech position is rare at term but relatively common with premature fetuses.

* Kneeling breech delivery :  The breech baby is in a kneeling position, with one or both legs of breech baby are extended at the hips and flexed at the knees. This Kneeling breech delivery position is not common type of breech delivery.

Common injuries to breech babies during breech delivery:-

Umbilical cord prolapse : Is the common abnormality of breech delivery. As soon as the amniotic sac ruptures, the umbilical cord expels out. Due to umbilical cord prolapse the breech babies  receives less oxygen and becomes oxygen deprived.

Head injury : Injury to fetal skull or brain occurs as the late coming head of baby struggles to come out of maternal pelvis. Cranial lacerations, and intracranial hemorrhage may occur. Squeezing of abdomen causes damage to internal organs of breech baby.

Severe hemorrhage is the main complication to mother. Breech birth or breech delivery is one of the causes of maternal mortality. Hysterectomy is indicated in some mothers when uterine rapture occurs. External cephalic version is done in some mothers before labor starts.

Even most of the experienced doctors have stopped conducting birth canal breech delivery and they will plan for cesarean section to prevent injury to new born baby and to avoid maternal complications. It is confirmed that elective cesarean section is done by concerning fetal and maternal well being.

Ear infections:-

Infection of middle ear in children ( 1 to 3 years of age ) is called as ear infection in child.

The children are at high risk of getting upper respiratory tract infection. The upper respiratory tract infection can cause ear infection in children, especially in
children.

Causes of Ear infections in children:-

Upper respiratory tract infection,

Excess wax accumulation can cause ear infection.

Low immunity in children, causes ear infections.

Cold and sinus infections,

Throat infections causes ear infections.

Symptoms of ear infections:-

children will complaint pain in ear.

If the children can’t talk, he will try to show discomfort in ear.

child may not get sleep,

Mild to moderate fever,

Lack of activeness,

Complaint increased pain during chewing.

Are main symptoms of ear infections in children.
Treatment of Ear infections in children:-

After diagnosis of ear infection,

Antibiotics such as erythromycin are given to the children.

Provide rest to the baby,

Don’t give solids to eat if pain is severe.

Provide protein rich diet to child, such as pulses, etc. ..

Infant constipation:-

Difficulty in passing stools or passing hard stool infrequently is known as Constipation. When an infant failed bowel movement for more than three days is said to be Infant constipation. Infants passes nearly three to four stools a day. Constipation is not the main complaint with mother milk fed infants. Formula fed infants usually passes stool not frequently. Infant constipation is common with formula fed newborn. Toddlers normally passes stool two times a day.

Causes of infant constipation:-

Normally the colon absorbs the water from the digested food and bowel movement helps in expelling the fecal matter or waste from the body. The excess absorption of water from colon, reduced bowel movement, Less fibre food are responsible for constipation. The less water content in formula or mother’s milk, Infrequent feeding of newborn or infant reduces bowel movement and stool becomes sticky and hard. This is the mechanism of constipation in newborn or infant.

When bowel movement decreases, fecal material remains in colon for long time, and water removal process of colon increases and excess water is observed. The stool mass becomes excessively dry and hard and leads to constipation in newborn, infant and children.

Constipation in newborns occurs with high nutrient milk feeding to baby,

Formula fed infant bowel movement becomes low and leads to bowel constipation.

Infants or newborns starts weaning food may get bowel constipation.

Transition from weaning food to table food leads to infant constipation.

Newborn constipation : Constipation seen in newborns is called as newborn constipation. Usually newborns passes feces within 24 hours of birth.

Naturally sluggish colon with decreased motility.

Insufficient food to stimulate normal propulsive activity of colon, is what happens with newborn and infants. Toddlers who refuses to take food becomes constipated because of this cause.

Consuming low residue Diet, Mother milk fed to newborn is a low residue diet leads to newborn constipation.

Starting weaning or providing solids to infant leads to infant constipation because of low bowel movement as is not adopted to pass solid food. This infant constipation is relieved later.

Neurological damage : Damage of nerve which supplies colon makes rectum and anus not to relax and evacuation is not possible. The result is newborn or infant constipation.

Anatomical obstruction in the lower digestive tract or bowel abnormality also leads to bowel constipation.

Presence of tumor in the bowel or lower intestinal tract.

Constipation symptoms:-

Identifying Child constipation is very difficult as the child doesn’t express it is constipated. Child constipated for more than three days may complaint lower abdominal pain and irritable bowel. Infants and grown children complaints difficulty in passing stool and cries. Newborns can’t express they are constipated and the severe constipated newborn cries and becomes very irritable. Toddler constipation can be identified easily by parents as the constipated toddler can explain the symptoms.

Treatment for constipation:-

Diet modifications and medications are the main treatment methods of newborn constipation.

* Rectal examination is indicated for constipated newborns.
* Laxatives can be used with feeding of infant
* Modification of formula feeding
* Weaning shouldn’t include much solids, after weaning give plenty of fluids,
* Treat underlying cause of constipation in case of child constipation.

When home remedies of constipation fails in relieving constipation, medications are preferred.

* Laxatives are the medical remedy for constipation in toddlers and children.
* Corn syrup in the formula is given to infants and newborns.
* Fruit juices are highly beneficial in relieving constipation.

Fiber rich food is given for grown children or toddler to relieve constipation and is not possible with newborns.

Lactulose is the non-absorb-able sugar product that stimulates colon bacteria and produces water into the fecal mass by inflow. Is the common treatment for newborn, infant toddler and child constipation, suggested by pediatric gastroenterologists for constipation remedy. Diarrhea may be seen as side effect with Lactulose.

Glycerin suppositories are used as remedy for cor constipation when all efforts fails. The suppositories softens hard stool and favours easy defecation. Glycerin attracts small amount of water into stool and relieves constipation. Insertion of suppositories to rectum also stimulates defecation and helps in relieving constipation.

Newborn problems:-

Newborn problems are common in newborns as the anatomical and physiological development is not completed. Some common Newborn problems are discussed here. The common problems are:

Fetal distress : Fetal distress is the common newborn problem seen in most of the babies. It usually occurs when fetus fails to receive enough oxygen. abnormal heart rate is an indicator of fetal distress. Fetal heart rate is monitored during delivery to prevent fetal distress. When the fetal heart rate decreases, it is corrected by administering oxygen to  woman , increasing the amount of  intravenously fluids, and turning the woman on her left side. When fetal distress is identified, all the measures should be taken to deliver the baby soon, such as forceps delivery, a vacuum extractor, or  Cesarean section. Amniotic fluid becomes green after the membranes have ruptured the fetus may be suffering from lack of oxygen.

Breathing Problems: some newborns doesn’t start to breathe soon after birth, even though no problems were detected before delivery. Cardiopulmonary resuscitation is provided to correct the breathing problem.

Newborn jaundice : yellow colour of  skin  in most of  newborn babies is common and is called physiological jaundice. Frequent feedings helps in treating and in severe cases bilirubin lights are used.  Some of the jaundice are pathological and need proper medical care. Exposing the baby to sunlight is beneficial in treating physiological jaundice.

Newborn injuries : Most of the injuries occurs to newborns during delivery.

Feeding problems : Most of the babies born with low birth weight, refuses or fails to get feed from the mother. This becomes a greater worry to mother. The continuous efforts may make the baby to drink mother’s milk.

Shoulder Dystocia : is a shoulder injury of newborn,  the newborn problem occurs when the shoulder of baby compresses against pubic bone of mother.

Vacuum extraction of baby:-

Forceps delivery is used to conduct assisted delivery. Vacuum extraction is the method of extraction of baby with the help of vacuum, is the form of assisted delivery.

Facts related to Vacuum delivery:

There is less injury to fetal skull with Vacuum extraction and as compared to Forceps delivery vacuum extraction is the better method.

Vacuum Extraction device has a plastic Vacuum cup attached to handle.
when the vacuum is applied the cup sticks to the skull of the fetus then the health worker will pull using the handle, applying a gentle pressure.

Vacuum extraction is less beneficial, when the fetal head is in optimal position.

Mild anesthesia is given to mother during Vacuum extraction. Mother should actively participate to expel the baby.

Episiotomy is not always necessary, to deliver the baby using vacuum extraction.

There is no much skull injury with vacuum extraction.

Big bump is formed on fetal skull where vacuum cup is attached.

No need of preparations like forceps delivery, no need of preparations such as bladder catheterization.

• IN normal pregnancy, the fetal umbilical cord contains three umbilical blood vessels. Two umbilical arteries, and one umbilical vein. Even one umbilical artery is needed to handle blood supply to placenta.

• The cause of single umbilical artery is unknown.

• Normal fetus will have three blood vessels. But 1 to 5 % babies will have only two blood vessels, one umbilical artery, and one umbilical vein. This is called single umbilical artery.

• The ultrasound scan confirms the single umbilical artery. If the fetus doesn’t show any abnormalities, the baby will take normal birth.

• Some studies says the 25 % single umbilical artery baby may have chromosomal abnormalities. If single umbilical artery is confirmed during ultrasound scan,  tests such as Amniocentesis and others are done for further diagnosis.
• Single umbilical artery baby may have or may not have any other abnormalities.

Placenta previa:-

Placenta previa is the pregnancy disorder characterised with improper placement of placenta in the lower uterus, covering the cervix completely
or partially. (placenta is the structure which nourishes the growing fetus)

One in 200 pregnancies will report placenta previa.

Three types of placenta previa:-

1. Complete placenta previa : Placenta completely covers the uterine mouth, and cervical OS.

2. Partial placenta previa : Cervix is partially covered by placenta.

3. Marginal placenta previa : Placenta marginally extends up-to cervix.

The causes of placenta previa :-

* Abnormal placental formation,
* Multiple pregnancy,
* Abnormal uterus,
* Scarred lining of the uterus.

Placenta previa commonly occurs in mothers who have

* Fibroid uterus, or uterine surgery to remove fibroid,
* Abnormal uterine development,
* Increased number of pregnancies or Multi-parity.
* Multiple pregnancy mother,
* Scarring of uterine wall because of previous pregnancy, abortions, uterine surgery, or cesarean suction.

Diagnosis of placenta previa:-

The important diagnosis made for placenta is Ultrasound scanning. The scanning reports uterus is soft and relaxed, and in some cases the fetus may be mispositioned.

Symptoms of placenta previa:-

* Sudden, painless, bleeding in the birth canal,
* Usually Bleeding occurs at the end of second trimester.
* Heavy bleeding occurs, and bleeding may stop itself.
* Bleeding may recover after some days or a week.

Treatment of placenta previa:-

* If the previa is complete, absolute bed rest is necessary.
* When bleeding is severe intensive medical care is necessary.
* Monitor vital signs.
* After severe bleeding, blood transfusion is very important.
* Cesarean suction is needed for the delivery of baby, when mother have placenta previa.

Having more than one fetus in the womb is called multiple pregnancy. Multiple pregnancy may refer to mother having twins, triplets inside her womb.
Multiple pregnancies are high in united states. The babies born with multiple pregnancy may be identical (same), or fraternal (different).
Facts related to Multiple pregnancy:-

• In multiple pregnancy the single egg is fertilized by the sperm.
• The multiple pregnancy babies have risk of premature birth.
• The mother need to have more nutrient to serve two growing fetus.
• Multiple pregnancy mothers should meet their doctor frequently to have health check up.
• Mother should get training to take care of two babies.

Causes of multiple pregnancy:-

• Women marries after 30 years of age have more chance of multiple pregnancies.
• Women taking more fertility drugs can have multiple pregnancy.
• Family history of Multiple pregnancy can also be the cause.