When you should worry about your newborn baby

Being a parent is a very difficult task. As babies can not talk and share their pain and problem.

So it becomes very difficult to understand when these little one are suffering from serious problems.

Today we will see the condition which can cause the serious problems in the newborn babies if timely treatment is not received.

Following are the conditions when you should worry about your newborn and consult a paediatrician or neonatologist immediately:

1. Not feeding well- When you observe that if previously well feed baby is not feeding well, then it’s time to consult your doctor immediately, as it might be due to infection or underlying systemic illness.
2. Temperature- The normal temperature of the baby is between 36.5-37.5 degree celsius and it feels warm to direct touching by hand, the temperature below 35.5 degree celsius it known as hypothermia, and above 37.5 degree celsius is known as hyperthermia, If any time you feel the skin temperature of the baby is less than or above the normal or when the thermometer is available the temperature of the baby is below 35.5 degree celsius or above 37.5 degree celsius then it’s time to consult a doctor immediately. Because the baby might be having infection in the body.
3. Convulsion- Convulsion or seizure is a little bit difficult to understand in newborn, because of it’s different patterns, in the newborn it doesn’t look like the seizures in the adults, newborns might be having staring look, cyclical movements of limbs on one side or on both the sides or repeated movements like lip smacking or involuntary movements, unresponsive child or irritable child. When you observe such things, it can be a convulsion in the baby and it’s better to consult a doctor and make sure about the it.
4. Yellowish discolouration of the skin-  It is called as Icterus and it is nothing but jaundice, there is a condition called physiological jaundice it occurs at around 3-5 days of life and you should not  be worry about it as it is self limiting condition and it will resolve in around 7-10 days and it doesn’t need any treatment most of the time, but when you observe the yellowishness is more and it includes the palm and soles of the baby and when this yellow discolouration is occurred before 24 hrs of birth or after 7 days of birth then you should consult a doctor because your baby might need a treatment for the same.
5. Bluish discolouration- The bluish discolouration of the fingers is called the acrocyanosis, it is normal most of the time as it can be present after birth and on exposure to cold. But when the lips, face or trunk becomes the blue then it is concerning as it can be a sign of systemic diseases, which might be due to heart related problem called as cyanotic heart disease or other systemic problem which needs immediate attention.
6. Increased Respiratory rate- Even though the babies normally have the increased respiratory rate, but it should not be more than 60 breaths/minute and they should not have signs of respiratory distress as grunt, intercostal or subcostal recession. When you observe the respiratory rate is increased in the baby and it is more than 60 breaths/minute along with there are signs of respiratoryh distress  it might be due to the baby is feeling breathlessness which can be the result of respiratory system problem or heart problem or it can be due to the infection etc. So it is very important to consult a paediatrician as timely taken stapes can save the life of the baby.
7. Lethargy- Lethargy is nothing but baby becomes less responsive, Normally the newborn are playful, active, have loud cry, breastfeed well but when the babies develop infection or illness they tend to be lethargic, they don’t respond well, don’t feed actively, even have shrill cry and have less activity, then it’s the time to visit the clinic.
8. Bleeding- Bleeding from any site including from umbilical stump, stool or echymotic patches on the skin or from any other site is an absolute emergency, and you should consult a doctor immediately as it can be due to infection or bleeding disorder which can fetal to baby.
9. Abdominal distension- Normally abdomen of the babies is little bit distended as abdominal muscles of the babies are lax, but when that distension becomes excessive it can be due to underlining causes like not able to pass meconium, enlargement of the abdominal organs, perforation of the intestine, infection, excessive collection of fluid in the abdominal cavity etc, which has to be diagnosed as early as possible as these are the fatal but treatable conditions. So immediate diagnosis and treatment is necessary.
10. Excessive weight loss- It normal to lose up to 10% of body weight in the first 7 days after birth as this is due to water loss from the body, and the birth weight is achieved back in 10-12 days of age. But if you observe that your baby is not gaining weight and losing weight excessively i.e. approximately more than 10%, then it is the time to rule out the systemic and other pathological conditions.
11. Vomiting- Babies do have regurgitation after feeding few times a day which is a normal condition, as it can be due to lack of or inappropriate or faulty burping technique and this regurgitation doesn’t cause all the feed to come out unlike the vomiting where babies vomit all the feed out. And if this happen excessively then it should be concerning and need medical attention.
12. Loose motions- Excessive loose motions in newborn is different from adults as newborn babies normally can pass stool for 5-6 times a day, even if it is more or less is normal as long as the babies are playful, active and feeding well and doesn’t need any treatment for it but if baby is passing more than 8-10 episodes of loose motions in a day and having abnormal colour of the stool or becomes lethargic or not feeding well then you should be worried about your baby and consult a doctor.
13. Reduced urine output- Normally babies pass urine 10-12 times per day, when they are feed properly, but when it reduces significantly it might be due to faulty feeding technique, kidney diseases or infection.

I hope this information is useful for you, as it can be life saving if appropriate decision is taken at appropriate time.

Along with this you should not be worried all the time. 

At the same time it is also very important to enjoy the parenthood.

So wish you all the best and take care of your little one.

ADHD IN BRIEF

ADHD is a behavioural problem, can be seen in children as well as in adults but  mostly present in the children, such children face multiple problems such as difficulty in focusing in the classroom, hyperactive or impulsive behaviour.

Cause of the disease is unknown, it might be genetic, some research says it is  dopamine related and some research says it is due to structural brain defect such as less gray matter volume.

The diseases can not be cured but it can be managed well if treatment is received in time and if the patient is well compliant.

ADHD means what?

You might have herd about the condition called ADD which means attention deficit disorder, the old term used for ADHD.

ADHD is neuro developmental disorder and most common prevalent mental disorder.

The worldwide pooled prevalence is According to a national 2016 parent survey, estimated number of children ever diagnosed with ADHD is 6.1 million (9.4%). 

This number includes:

• 388,000 children aged 2–5 years
• 2.4 million children aged 6–11 years
• 3.3 million children aged 12–17 years.

Boys are more commonly diagnosed as they exhibit the typical presentation of hyperactivity instead girls can be hyper talkative.

What are the signs and symptoms?

To know the signs and symptoms healthcare provider should ask the relevant questions to the care taker, teacher or adult family member who is a caretaker of the child at home.

Signs and symptoms can be mild to severe which includes

1. Can not control impulsiveness
2. daydream a lot
3. forget and lose things easily 
4. talk too much unnecessarily 
5. Do silly mistakes
6. Can not wait for their turn
7. Have difficulty in sitting at one place
8. Get easily distracted 
9. Unnecessarily wriggle or twist the body from side to side
10. Disturb people when they are talking

Diagnosis:

After detailed history and examination only the trained health care provider can diagnose this condition by using American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM 5).

Along with this the patient should have reduced quality of life, school performance and work.

Treatment:

After diagnosis the most important step comes is the treatment, parents of the child are very concern about the right treatment for their child.

Mostly there are two treatment recommendations:

1. Behavioural therapy
2. Pharmacological therapy

To know what suits best to your child, parents must have to work in association  with the health care provider, teacher and caretaker.

1. Behavioural therapy:

American academy of psychiatry recommends the training of the parents in behaviour management as the first line management before prescribing the medication in the children who are less than 6 years old, and those who are above  6 years old should be given medication along with behavioural therapy.

Behavioural therapy include:

1. Parental training 
2. Behavioural therapy for children 
3. Classroom intervention 

Pharmacological treatment-

There are two types of drugs used

1. Stimulants: These are the drugs most commonly used.

1. Non stimulants

Prognosis: At 25 years of age, 15-20% children meet full criteria of ADHD and 60-65% are in partial remission.

DSM 5 Criteria

DSM 5 criteria is used by the health care provider for diagnosis of ADHD(Attention deficit hyperactivity disorder).

Note: Do not use this to diagnose ADHD at home, when in doubt always consult a health care provider, because healthcare provider only can diagnose this condition perfectly by carefully taking history and examining the patient.

 A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning

or development, as characterized by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least

6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

a. Often fidgets with or taps hands or feet or squirms in seat.

b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)

d. Often unable to play or engage in leisure activities quietly.

e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

f. Often talks excessively.

g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).

h. Often has difficulty waiting his or her turn (e.g., while waiting in line).

i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Specify whether:

314.01 (F90.2) Combined presentation: If both Criterion A1 (inattention) and Criterion A2

(hyperactivity-impulsivity) are met for the past 6 months.

314.00 (F90.0) Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.

314.01 (F90.1) Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity- impulsivity) is met but Criterion A1 (inattention) is not met over the past 6 months.

Specify if:

In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.

Specify current severity:

Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and

symptoms result in only minor functional impairments.

Moderate: Symptoms or functional impairment between “mild” and “severe” are present.

Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Reference:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.