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Wednesday, September 24, 2014

Homeopathy for Children (Paediatric Disorder)

article taken from Homeobuzz  sep issue which is very informative

                                                                PAEDIATRIC DISEASES

Neonatal jaundice is defined as bilirubin level of more than 85 umd/ I (5md/I) and is detected by blanching the skin with digital pressure so that it reveals underlying skin and subcutaneous tissue.
  • Maturity of liver
  • Normal load of bilirubin
  • Adequlity and quantity of glucornic conjugate for conversion of lipid soluble (indirect) bilirubin to water soluble (direct) bilirubin for proper excretion
  • Normal biliary passages
  • patency and motility of intestines
Only the indirect bilirubin crosses the immature blood barrier and leading to kernicterus or brain damage
Types of infantile jaundice
Jaundice in infants is seen of the following types mentioned as below-
  • Immature liver which includes jaundice of prematurity & physiological jaundice.
  • In creased load of bilirubin
  • Rh incompatibility
  • ABO incompatibility
  • Hereditary spherocytosis
  • Glucose 6- phosphate dehydrogenase deficiency
  • Enclosed hemorrhage cehalhaematoma
  • Infants of diabetic mother (polycythemia)
  • Polycythemia (SFD)
  • Increased free bilirubin – decreased serum albumin as in prematurity and neonatal sepsis
  • Bilirubin displacement from albumin by some allopathic drugs such as- sulphonamides etc.
  • Enzyme abnormality (glucornyl transferase)
  • Reduced activity – Anoxia , infection , hypothermia etc.
  • Blocking of enzyme action – drugs like vitamin K analogues.
  • Absence or decrease quantity
  • Genetic type (Criggler-Najjar syndrome)
  • Prematurity
  • Obstructive jaundice-
  • Intrauterine and neonatal viral infections causing hepatitis
  • Congenital atresia of bile ducts
  • Choledochal cyst
  • Inspissated bile syndrome
  • Metabolic diseases like glactosemia
  • Other causes
  • Congenital familial nonhaemolytic jaundice
  • Breast milk jaundice
  • Hypertrophic pyloric stenosis
Physiological jaundice- This type of jaundice occurs in about 50%of infants and it usually appears on about 4th day and lass from a few hours to 7 days and usually doesn’t exceed above 12mg% and in cases of breast fed babies it can go up to 16mg%
Mechanism of physiological jaundice
Following mechanism can occur-
  • Increased bilirubin load on liver
  • Raised erythrocyte volume
  • Increased enterohepatic circulation of bilirubin
  • Decreased erythrocyte survival
  • Defective uptake of bilirubin from plasma
  • Decreased ligandin
  • Increased binding of Y protein by other anions
  • Decreased hepatic uptake
  • Defective bilirubin conjugation
  • Decreased UDPG activity
  • Defective bilirubin excretion
The symptoms are divided into two phases as follows-
Phase 1- In the phase jaundice appears on the 4th day and lasts for 5days in term infants and 7 days in preterm infants when there is rapid rise in serum bilirubin to 12 and 15mg% respectively
Phase 2- In this type there is a decline to about 2mg% occurs which lasts for about after which normal values are reached
Pathological jaundice
This type of jaundice has the following presentation-
  • Jaundice in first 24hrs
  • Increase in total bilirubin >0.5 mg/ dl/hr
  • Total bilirubin >15mg/dl
  • Direct bilirubin >2mg/dl
Pathological jaundice can be caused because of the below mentioned causes-
  • Increased production
  • Rh& ABO incompatibility
  • Hereditary spherocytosis
  • Non spherocytosis hemolytic anemia
  • Sepsis
  • Large bowel obstruction
Haemolytic disease of the new born
This type of jaundice can be because of
  • ABO incompatibility- In this type the jaundice develops in first 24hrs with serum bilirubin level exceeds 12mg per 100ml in first 24hrs. jaundice disappears in 3-7 days. There are no signs of liver enlargement ,spleen enlargement and anemia.
  • Rh incompatibility- In this type jaundice is present since birth or appears within 48hrs. Symptoms associated are- anameia,enlarged liver andspleen, increasing drowsiness, restlessness, head retraction , twitching and convulsions may develop and  indicate kernicterus.
  • Haemolytic jaundice due to congenially abnormal erythrocytes (Hereditary spherocytosis) – jaundice severity increases when too much blood is lysed
  • Obstructive jaundice- Congential atresia of bile duct can cause appearance of jaundice after 7-10 days after birth and which progressively gets worse.The patient present with the following symptoms stools cly colored and urine dark and contains bile pigments and salts, enlarged liver and spleen with mild anemia. Hemorrhages may occur from the intestine.
  • Investigations of a neonatal jaundice case.
Following things can be investigated  in order to rule out physiological and pathological jaundice.
  • Time of onset
  • Colour of urine and stool
  • General factors – Feeding difficulties, sepsis if any , breast feeding or not
  • Delivery - preterm , any drugs, blood transfusion
  • Previous babies with jaundice
  • IIIness suggestive of viral infection
  • Drugs eg- sulphonamides or anti- malarial causing hemolysis in G-6-PD deficiency
  • Family history of jaundice or anemia , neonatal or early infant death due to liver dysfunction suggesting galactosaemia
Following  lab investigations can be done-
  • CBC, Hb & Reticulocyte count
  • RBC morphology
  • ABO& Rh grouping of mother and baby
  • Coomb’s test of mother and baby
  • Serum bilirubin , both direct and indirect
  • TSH
  • USG OF abdomen and liver scan
  • Serum albumin and other LFT’S
  • Blood culture if sepsis
                                         REGURGITATION AND VOMITING IN THE NEWBORN
It is defined as a non forceful explusion of gastric contents from oesophagus or stomach through the mouth without nausea or forceful abdominal contractions.
Regurgitation can be caused by the following –
  • Physiologic – Initially it is referred as “sitting up”and the frequency lessens with age.
  • Faulty feeding techniques- Some of the feeding techniques like lack of buring , eructation of air when suine, prolonged feeding through small nipple, weak caloric formula, bottle propping all these can lead to aerophagia
  • GORD- Symptoms between 3rd and 10th day. Infant when laid supin suffers from regurgitation which can be prevented if the child is held u for 30 minutes after feeding
  • Congenital oesohageal obstruction- Oesophageal atresia  with or without trachea-oesophageal fistula. Soon after the birth the child suffers from excess mucus at mouth choking , cyanosis.
  • Increased abdominal pressure at birth – Conditions like neonatal ascites , bilateral renal masses.
Vomiting in infants can be because of the following causes
Mechanical causes-Some of the commonly found congenital anomalies of GI tract which can cause vomiting are- lleal , jejuna or duodenal atresia, imperforate anus, intestinal stenosis , pyloric stenosis, stomach torsion etc.
Some of the reflexes which causes vomiting such as-
  • Stimulus from GI ract- This can be caused by mucus or meconium i.e swallowing of amniotic fluied or meconium can cause unexplained vomiting in first 2-3 days
  • Gastritis from acute parentral infection, severe respiratory infections, or bacterial gastroenteritis, eptic or duodenal ulcer.
  • Stimuli from urinary tract-conditions like UTI in infant and uremiua
Following investigation can be done in order to rule out cause of vomiting-
·         Feeding history-  Time of onset of vomiting, history of frothing, choking, cyanosis, failure to gain weight
·         Appearance of vomitus- Gastric  aspirate with bile more than 20ml in new born suggestive of intestinal obstruction
·         Bilious- Definte sign of obstruction below ampulla of vater
·         Non- bilious- Obstruction above ampulla
·         Uncurdled milk-Oesopahgeal atresia
·         Blood – Peptic or stress ulcer, sepsis, chalasia, haemorrhagic disease, swallowed maternal blood
·         History of polyhydraminos- Oesophageal atresia, other GIobstructions, History of meconium stained liquor in gastritis.
·         Site and degree of abdominal distension- Generalized if jejuna or ileal , epigastric if duodenal
·         Stool- Thick, tenacious meconium-meconium ileus
·         Malaena
Following examination can be done-
·         Abdominal examination such as pyloric lump, stomach peristalsis in hypertrophic pyloric stenosis,rubbery bowel loops in meconium ileus, scaphoid abdomen in diaphragmatic hernia, absent peristalsis in ileus should be done in order to rule out the cause
·         Chest examination- Mediastinal shift to right with cyanosis suggests diaphragmatic hernia.
Some other investigations also can be done –
  • USG
  • Urine-Routine, amino acids, culture
  • Blood CBC and culture.
Radiological investigation can revel-Hyperperistalsis in early stages
  • string sign- A thin streak of barium extending between pyloric antrum and duodenal cap, representing the narrowed pyloric canal
  • Beak sign- An abrut cut- off of barium column in the pylorus, forming a very small curved point
  • Shouldering – indentation of barium filled antrum as a result of hypertrophic pyloric muscle
Infantile  convulsions
·         It is defined as any convulsion occurring in infancy (Birth -2 yrs of age)
febrile –This is the commonest cause in childhood and is seen between the age of 6 months and 5 years. It is of two types-
·         simple typical – It is generalized clinic, lasts for less than 15 minutes and then does not recur again within 30minutes , recovers fully after ½ -1 hour without neurological deficit. Simple seizures may lead to epilepsy in 1% of children.
·         Complex or atypical seizure- This lasts for longer than 15 mins , may go into status, may be focal, may have residual neural deficit.
Intracranial causes
·         Traumatic – Birth injury, subdural haematoma
·         Vascular- Cerebral arterial embolism or thrombosis, intracerebral hemorrhage, cortical thrombophlebitis etc.
·         Infection – Encephalitis, meningitis, cerebral abscess, parasitic brain disease
·         Incrased intracranial pressure- Tumour, hydrocephalous, Reye’s syndrome
·         Degeneration of brain
·         Malformations of brain
·         Tumors of brain – Astrocytoma,  medulloblastoma, leukemic deposits.
·         Hypertensive- Acute and chronic nephritis, congenital abnormalities of kidneys with renal rickets
·         Toxic- lead encephalopathy, convulsant drugs e.g. camphor , phenothiazine , steroids; kernicterus
·         Allergic- Vaccine sensitivity
·         Collagen disease like SLE
·         Eilepsy
·         Metabolic
·         Anoxia
·         Tetanus
A proper history should be taken considering the following below mentioned points-
1. Age – According to the age various types of diseases are seen
·         New born – Intracranial birth injury, perinatal as phyxias, intracranial hemorrhage , tetanus neonatorum, tetany of new born, hypoglycaemia.
·         6 months to 3 -4 yrs- febrile convulsions, CNS infections etc.
·         3-10 yrs-Idiopathic epilepsy, febrile convulsions uto 5 yrs , residual cerebral damage from early trauma , infection etc.
2. Recurrent or non recurrent
·         Recurrent or chronic-
·         Intracranial infections
·         Intracranial hemorrhage
·         Toxic
·         Anoxic
·         Metabolic disturbances
·         Acute cerebral oedema
·         Cerebral thrombosis
·         Non Recurrent-
·         Febrile convulsions
·         Tetany
·         Hydrocephalous
·         Uremia
·         Migraine
·         Lead poisoing
·         Parasitic disease of brain
3. Birth injury- Any sort of previous convulsion or any difficulty experienced by mother or baby in the perinatal period
4. Family predisposition – In idiopathic epilepsy and in febrile convulsions
5. Recent immunization procedures
6. Head injury
7. Relation to meals- Sometimes there is a tendency for convulsions in child after taking meal in early morning
8. History of past encephalopathy
9. History of other systemic disease such as cardiovascular, nephritis, bleeding disorder etc.
·         Loss of consciousness
·         Unilateral attacks
·         Fever
·         Blood pressure
·         Tautness or bulging of the fontanelle, and rigidity or objection to flexion of neck
·         Stridulous breathing
·         Pronounced asymmetry of face and / or cranium – This may provide outward evidence of cerebral agenesis, a facial naevus of intracranial haemangioma etc.
Lab investigations should be done in order to rule out the cause are mentioned as below-
·         Urine – To exclude the renal factors
·         CSF- Useful for diagnosing meningitis , encephalitis
·         Imaging- Radiograph , brain scan, CT scan, MRI scan etc.
·         EEG
·         Blood chemistry
“ But there’s a story behind everything. How a picture got on a wall. How a scar got on your face. Sometimes the stories are simple, and sometimes they are hard and heartbreaking . But behind all your stories is always your mother’s story , because hers is where yours begin.” --- Mitch Albom

                        LIQUID DILUTIONS
Indigestion of teething children; violent , sudden vomiting of a frothy, milk-white substance; or yellow fluid , followed by curdled milk and cheesy matter.
Chronic diarrhea of children with great emaciation. Children thirsty , but swallow with difficulty even a teaspoonful of water.
Watery, light, very offensive stools (in children), stools like soapsuds, with usually strong-smelling urine. Diarrhoea of children during dentition.
Constant vomiting of milk in a suckling; waxy face; blue rings round eyes; child does not cry; mother has little milk.
Guernsey gives the following excellent direction: “If a child is suffering from watery diarrhoea, is crying and complaining very much, biting his fists and is sleepless, Acon .Will usually settle this trouble in a short time.”
A child , constipated from birth, screams all the time he is being held to stool, cannot pass it, even after enema; yet when not trying passes in bed without knowing.
Constipation of infants [ Collins., Psor., Paraf] and old people from inactive rectum, and in women of very sedentary habit.
Gastric and remittent fevers, and fevers of children, with great thirsty and the characteristic white tongue.
Craves sugar; child is fond of it, but diarrhea results from eating  Cholera infant in dried-up, mummy-like children , stools green , slimy, noisy, flatulent, egg. at night.
Dysentery of old people; diarrhea of children , especially when very offensive ( Carob v ., Pod . Psor)
In summer complaint of children there is cadaverous smell of flatus and of stool. Desires company; child holds onto its mother’s hand.
Diarrhoea, of a sour smell, or fetid , of yellowish, in infants.
Vomiting of infants.
Infant wants to nurse all the time and vomits easily.
Discharge of mucus and of blood instead of faces during the evacuation, with cries (in children).
Diarrhoea : from cold, anger or chagrin; during dentition; after tobacco; in child – bed from downward motion (Bor., Sanic.,)
Gastric troubles of children who are always wanting dainties; irritable on waking, bad taste, white tongue.
Diarrhoea :of children with sour smell (Cal., Mag.C –child and stool have a sour smell , Rheum); clay- colored stool (Cal., Pod.).
Stool and anus- Diarrhoea in infants: child is quiet all day, but screams and tosses about all night ( sever cutting, griping pain in bowels.) infantile diarrhea, general coldness, blueness of face.
Daily colic in infants about 5A.M. (at 4 P.M. –Col Lyc)
Constipation of infants.
Diarrhoea: preceded by cutting, doubing-up colic; occurs regularly every three weeks; stools green, frothy, like scum on a frog-pond; white tallow- like masses are found floating in stool; the milk passes undigested in nursing children.
Children: during difficult dentition are unable to digest milk; it causes pain in stomach and passrs undigested; puny, rachitic, who crave sweets. Constipation of infants during dentition; only passing small quantity; stools knotty, like sheep’s dung, crumbling at verge of anus.
Constipation in infants, with spasmodic pains at every attempt at stool, indicated by a sharp, shrill cry; much rumbling and flatulent colic.
Cyclic vomiting of infants.[Cup. ars., Iris]
Diarrhoea: with pain in abdomen; sudden; slimy, white or green (in an infant); bilious, always preceded by sudden urging and griping in abdomen; then stool omitted for two days, then stool partly costive, partly loose, with pain in abdomen.
Acidity in children fed with excess of milk and sugar.
Frequent but ineffectual and anxious effort to evacuate (in infants), or sensation as if anus were contracted or closed.
Diarrhoea of children : during teething; after eating; while being bathed or washed; of dirty water soaking napkin through (;with gagging.
Diarrhoea; sudden , imperative (Aloe, Sulph); stool watery, dark brown, foetid; smells like carrion; involuntary. < at night from 1 to 4 A.M. ; after severe acute diseases; teething ; in children ; when weather changes.
Clinical experience has added to these; sour stools of infants, with sour smell of body and vomiting of sour milk.
Used as a laxative in ordinary  practice , senna has proved an excellent remedy in the colic of infants, with incarcerated flatulence and sleeplessness. infantile colic when the patient seems full of wind
Infantile diarrhea…., worse from boiled milk , and rapid exhaustion.
Infant vomits curdled milk, Aeth.
Constipation: no desire; stool large , hard (BRY., Sulph) ; in round , black balls (Chel., Op,. Plb); from inactive rectum ; frequent desire felt in epigastrium (Ign-in rectum, Nix); painful, of infants and children , after Lyc. and Nix.


Homeobuzz sep 14 issue


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