WHERE THERE IS NO DOCTOR HEALTH AND SICKNESSES OF CHILDREN
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COMMUNITY HEALTH CELL
Ch-21
47/1. (First floor) St. Marks Road,
Ranp«l»r»- 560 001.
CHAPTER
Health and Sicknesses
of Children
This is a reprint from
Where 'There Is No Doctor
(Indian adaptation)
published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
341
CHAPTER
Health and Sicknesses
of Children
WHAT TO DO TO PROTECT CHI LDREN'S HEALTH
NUTRITIOUS FOOD,
CLEANLINESS,
AND VACCINATIONS
ARE THE THREE IMPORTANT ‘BODY GUARDS’ THAT
KEEP CHILDREN HEALTHY AND PROTECT THEM AGAINST MANY SICKNESSES.
Chapters 11 and 12 tell more about the importance of nutritious food,
cleanliness, and vaccination. Parents should read these chapters carefully and use
. them to help care for—and teach—their children. The main points are briefly
repeated here.
Nutritious Food:
It is important that children eat the most nutritious foods they can get, so that
they grow well and do not get sick.
The best foods for children at different ages are:
° in the first 2 months: breast milk and nothing more.
■ from 2 months to 1 year: breast milk and also other nutritious foods—such
as-mashed-up cereals, beans,cooked vegetables, eggs, meat, and cooked fruits
■ from 1 year on: each meal should include body-building and protective
foods—especially milk and foods made from milk, beans, lentils, nuts,
fruits, vegetables, eggs, chicken, fish, and meat, These should be balanced
with plenty of energy foods like rice, maize, wheat, potatoes, or cassava.
■ Above all, children should get enough to eat.
■ All parents should watch for signs of malnutrition in their children and
should give them the best food they can.
342
Cleanliness:
Children are more likely to be healthy if their village, their homes, and they
themselves are kept clean. Follow the Guidelines of Cleanliness explained in
Chapter 12. Teach children to follow them—and to understand their importance.
Here the most important guidelines are repeated:
■ Bathe children and change their clothes often.
■ Teach children always to wash their hands when they get up in the morning,
after they have a bowel movement, and before they eat or handle food.
■ Make latrines or 'outhouses'—and teach children to use them.
■ Do not let children go barefoot; have them wear sandals or shoes.
■ Teach children to brush their teeth; and do not give them a lot of candies;
sweets, or carbonated drinks.
■ Cut fingernails very short.
■ Do not let children who are sick or have sores, scabies, lice, or ringworm sleep
with other children or use the same clothing or towels.
■ Treat children quickly for scabies, ringworm, intestinal worms, and other
infections that spread easily from child to child.
■ Do not let children put dirty things in their mouths or let dogs lick their
faces.
■ Keep pigs, dogs, and chickens out of the house.
■ Use only pure or boiled water for drinking. This is especially important for
babies.
DO THIS
Vaccinations:
Vaccinations protect children against many of
the most dangerous diseases of childhood
whooping cough, diphtheria, tetanus, smallpox,
polio, measles, and tuberculosis.
Children should be given the different
vaccinations during the first months of life, as
shown on page 1 75. Polio drops should be first
given no later than 2 months of age, because the
risk of developing infantile paralysis (polio) is
highest in babies under 1 year old.
Important: For complete protection, the DPT (diphtheria, whooping cough,
tetanus) and polio vaccines must be given once a month for 3 months and once
again a year later.
Tetanus of the newborn can be prevented by vaccinating mothers against
tetanus during pregnancy (see p. 296).
Be sure your children get all the vaccinations they need.
343
CHILDREN'S GROWTH-AND THE 'ROAD TO HEALTH'
A healthy child grows steadily. If he eats enough nutritious
food, and if he has no serious illness, a child gains weight each
month.
1
A child who grows well is healthy.
A child who gains weight more slowly than other children, stops gaining weight,
or is losing weight is not healthy. He may not be getting enough of the right kinds
of foods, or he may have a serious illness, or both.
Two good ways to check whether a child is healthy and is getting enough
nutritious foods is to check his mid-arm circumference(p.132)i every month and
to weigh him each month and see if he gains weight normally. If a monthly record
of the child's weight is kept on a Road to Health Chart, it is easy to see
at a glance whether or not the child is gaining weight normally.
On the next page is a typical Road to Health Chart. This chart can be cut out
and copied. Or larger, ready-made cards can be obtained (in Hindi. English and all
other Indian languages from:
The Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi - 110 016
INDIA
(The strip for measuring the arm circumference is also available at the above
address)
Similar charts are produced in local languages by the Health Departments in
many countries.
It is a good idea for every mother to keep a Road to Health Chart for each of
her children under 5 years of age. If there is a health center or 'under-fives clinic'
nearby, she should take her children, with their
charts, to be weighed and to have a 'check-up' each
month. The health worker can help explain the
Chart and its use.
To protect the Road to Health Chart, keep it in
a plastic envelope, like this:------------------- ---------- -------
348
How to Read the Road to Health Chart
The 2 long curved lines on the chart ------------mark the Road to Health that a child's------------weight should follow.
The line of dots marks the child's weight
from month to month, and from year to
year.
In most normal, healthy children, the
line of dots falls between the 2 long curved
lines. That is why the space between these lines is called the Road to Health.
If the line of dots rises steadily, month after month, in the same direction as
the long curved lines, this is also a sign that the child is healthy.
A healthy child who gets enough nourishing food usually begins to sit, walk,
and speak at about the times shown here.
Typical chart of
THE HEALTHY,
WELL-NOURISHED
CHILD
Walks 10 steps
Jn the healthy,
well-nourished
child, the
weight rises
steadily. The
dots usually lie
inside the lines
that mark the
Road to Health.
349
A malnourished, sickly child may have a chart like the one below Notice that
the line of dots (his weight) is below the Road to Health. The line of dots is also
irregular and does not rise much. This shows the child is getting worse.
Typical chart of
THE UNDERWEIGHT
OR MALNOURISHED
CHILD
Reasons for special care
A child with a chart like the one above is seriously underweight. This may be
because he is not given enough nourishing food. Or because he has some chronic
disease like tuberculosis or malaria. Or both. He should be given the most
nourishing food available, and rf possible, he should be taken to a health worker
frequently until his chart shows he is gaining weight and returning toward the
Road to Health.
350
A typical ROAD TO HEALTH CHART SHOWING A CHI LD'S PROGRESS:
This baby was
healthy and gained
weight well for the
first 6 months of
life, because his
mother breast fed
him.
At 6 months, the
mother became
pregnant again and
stopped breast
feeding him. The
baby was fed little
more than corn and
rice. He stopped
gaining weight.
poorly
breast
fei
at 6 months
At 10 months he
developed chronic
diarrhea and began
losing weight. He
became very thin
and sick.
| diarrhea [
When the child was 13
months old, his mother
learned how important
it is to give the child
nourishing food. He
began gaining weight
fast. By age 2 he was
back on the Road to
Health.
diarrhea begins
at 10 months
Road to Health charts are important. They help mothers know when their
children need more nutritious food and special attention. They help health
workers better understand the needs of the child and his family. They also let the
mother know when she is doing a good job.
351
REVIEW OF CHILDREN'S HEALTH PROBLEMS
DISCUSSED IN OTHER CHAPTERS
Many of the sicknesses discussed in other chapters of this book are found in
children. Here some of the more frequent problems are reviewed in brief. For
more information on each problem, see the pages indicated.
For special care and problems of newborn babies, see p. 316 to p. 318.
Remember: In children, sicknesses often become serious very quickly. An
illness that takes days or weeks to severely harm or kill an adult may kill a small
child in hours. So, it is important to notice early signs of sickness and attend to
them right away.
Malnourished Children
Many children are malnourished because they do not get enough to eat.
For a fuller discussion of the foods children need, read Chapter 11, especially
page 141. For babies, see pages 141 and 142.
THESE TWO CHILDREN ARE MALNOURISHED
SERIOUS
sad
underweight (he may
gain weight for a while
because of swelling)
dark spots,
peeling skin,
or open sores
swollen feet
COMMUNITY WEALTH C*LL
Banqal-
. r?nrg\
352
Malnutrition may cause many different problems in children, including:
In mild cases:
In more serious cases:
♦ slower growth
♦ swollen belly
♦ thin body
♦ loss of appetite
♦ loss of energy
• paleness (anemia)
♦ desire to eat dirt (anemia)
♦ sores in corners of mouth
♦ frequent colds and
other infections
♦ night blindness
♦ little or no weight gain
♦ swelling of feet
(sometimes face also)
♦ dark spots, 'bruises', or open
peeling sores
♦ thinness or loss of hair
♦ lack of desire to laugh or play
♦ sores inside mouth
♦ failure to develop normal
intelligence
♦ 'dry eyes' (xerosis)
♦ blindness (p. 271)
A comparison of 'wet' and 'dry' malnutrition, their causes, and prevention is
given on page 132-33.
Signs of malnutrition are often first seen after an acute illness like diarrhea or
measles. A child who is sick, or who is getting well after a sickness, has an even
greater need for nutritious food than a child who is well.
Prevent and treat malnutrition by giving your children
enough body-building and protective foods like milk,
beans, lentils, fruits, vegetables, eggs, meat, and fish.
Diarrhea and Dysentery
(For more complete information see p. 183 to 191.)
The greatest danger to children with diarrhea—especially if
they are also vomiting—is dehydration, or losing too much
liquid from the body. Give Rehydration Drink (p. 182). If
the child is breast feeding, continue giving breast milk, but
give Rehydration Drink also. In summer, small children may
become dehydrated due to sweating too much. Give them lots
of boiled and cooled water to drink.
The second big danger to children with diarrhea is
malnutrition. Give the child nutritious food as soon as he will eat.
Fever (see p.87):
In small children, high fever (over 39°) can easily cause fits
353
or damage the brain. To lower fever rapidly, take the
clothes off the child, soak him with cool water, and fan him.
Also qive him acetaminophen or aspirin in the right dosage
(see p.414) and give lots of liquids.
Fits (Convulsions) (seep. 216):
Common causes of fits or convulsions in
children are high fever, dehydration, epilepsy,
and meningitis. If fever is high, lower it
rapidly (see p. 88). Check for signs of
dehydration (p. 181) and meningitis (p.225).
Fits that come suddenly without fever or
other signs are probably epilepsy (p. 216),
especially if the child seems well between them. Fits or spasms in which first the
jaw and then the whole body becomes stiff may be tetanus (p. 222).
Meningitis (seep.225):
This dangerous disease may come as a complication
of measles or another serious illness. Children of
mothers who have tuberculosis may get tubercular
meningitis. A very sick child who lies with his head
tilted way back, whose neck is too stiff to bend forward,
and whose body makes strange movements (fits) may have
meningitis.
Anemia
(seep. 146):
Common signs in children:
° pale, especially inside eyelids, gums, and fingernails
• weak, tires easily
o likes to eat dirt
Common causes:
■ diet poor in iron (p. 146)
■ chronic gut infections (p. 198)
■ hookworm (p. 195)
■> malaria (p.227)
Prevention and Treatment:
♦ Give iron-rich foods like dark green vegetables, beans, lentils, groundnuts
(Peanuts), meat and eggs. Also give them jaggery which is rich in iron instea
of the more commonly used white sugar.
354
Treat the cause of anemia and do not go barefoot if hookworm is common
Also do not wash hands with clay or mud. They have worm eggs in them.
♦
♦ If you suspect hookworm, a health worker may be able to look at the child's
stools under a microscope. If hookworm eggs are found, treat for hookworm
(p.412).
♦ If necessary give iron salts by mouth (ferrous sulfate, p. 424).
Worms and Other Parasites of the Gut (see p. 193):
If one child in the family has worms, all the family should be treated. To
prevent worm infections, children should:
♦
♦
♦
♦
♦
Observe the Guidelines of Cleanliness (p. 167).
Use latrines.
Never go barefoot.
Never eat raw or partly raw meat.
Drink only boiled or pure water.
Skin Problems (seeChapter 15):
Those most common in children include:
■ scabies (p. 241)
■ infected sores and impetigo (p. 242 and 243)
■ ringworm and other fungus infections (p. 246)
To prevent skin problems, observe the Guidelines of
Cleanliness (p. 167).
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• Bathe and delouse children often.
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♦ Control bedbugs, lice, and scabies.
♦ Do not let children with scabies, lice, ringworm, or infected sores play or
sleep together with other children. Treat them early.
Sore Eye (Conjunctivitis) (seep. 263):
Put an antibiotic eye drops, (p. 41 3) inside
the eyelids many times a day. Do not let a child
with sore eye play or sleep with others. If he
does not get well in a few days, see a health worker.
Coldsand the 'Flu' (seep.200):
The common cold, with runny nose, mild fever,
cough, often sore throat, and sometimes diarrhea is a
frequent but not a serious problem in children.
355
Treat with aspirin or acetaminophen (p. 414) and
lots of liquids. Let children who want to stay in bed do
so. Good food and lots of fruit help children avoid
colds and get well quickly.
Penicillin, tetracycline, and other antibiotics do no good for the common cold
or 'flu'. Injections are not needed for colds.
If a child with a cold becomes very ill, with high fever and shallow, rapid
breathing, he may be getting pneumonia (see p. 208), and antibiotics should be
given. Also watch for an ear infection (next page) or 'strep throat' (p. 356).
HEALTH PROBLEMS OF CHILDREN
NOT DISCUSSED IN OTHER CHAPTERS
Earache and Ear Infections:
Earache may be due to wax in the ear. This wax is
normal. To keep ears clean, wipe them gently with a
stick wrapped in cotton after bathing. If there is
too much wax, a health worker can remove it.
Ear infections are common in small children. The
infection often begins after a few days with a cold or a
stuffy or plugged nose. The fever may rise, and the child
often cries or rubs the side of his head. Sometimes pus can
be seen in the ear. In small children an ear infection some
times causes diarrhea. So when a child has diarrhea and
fever, be sure to check his ears.
Treatment:
♦ It is important to treat ear infections early. Give an antibiotic like penicillin
(p. 397) or sulfadiazine (p.402). In children under 3 years of age, ampicillin
(p. 399) often works better. Also give aspirin or acetaminophen for pain.
♦ Carefully clean pus out of ears with a matchstick wrapped in cotton. If possible.
dip the stick in rubbing alcohol before putting it inside tne ear, but do not put
plug of cotton, leaves or anything else in the ear.
♦ Children with pus coming from an ear should bathe regularly but should not
swim or dive for at least 2 weeks after they are well.
Prevention:
♦ Teach children to wipe but not to blow their noses when they have a cold.
♦ Do not bottle feed babies—or if you do, do not let a baby feed lying on his
back, as the milk can go up his nose and lead to an ear infection.
♦ When children's noses are plugged up, use salt drops and suck the mucus out
of the nose as described on p. 201.
356
Infection in the ear canal:
To find out whether the canal or tube going into the ear is infected, gently pull
the ear. If this causes pain, the canal is infected. Put drops of water with vinegar
in the ear 3 or 4 times a day. (Mix 1 spoon of vinegar with 1 spoon of boiled
water.) If there is fever or pus, also use an antibiotic.
If the child has severe pain behind the ear and has high fever, seek
medical help at once. This may lead to meningitis.
Sore Throat and Inflamed Tonsils:
These problems often begin with the common
cold. The throat may be red and hurt when the child
swallows. The tonsils (two lymph nodes seen as
lumps on each side at the back of the throat) may
become large and painful or drain pus. Fever may
reach 40°
Treatment:
♦ Gargle with very warm salt water (1 teaspoon
of salt in a glass of water).
♦ Take aspirin or acetaminophen for pain.
♦ If pain and fever come on suddenly or continue
for more than 3 days, see the following page.
♦ If the child has tonsilitis very often, it is best to have the tonsils removed
by a small operation.
Sore throat and the danger of rheumatic fever:
For the sore throat that often comes with the common cold or flu, antibiotics
should usually not be used and will do no good. Treat with gargles and aspirin.
However, one kind of sore throat—called strep throat—should be treated with
penicillin. It is most common in children and young adults. It usually begins
suddenly with severe sore throat and fever, often without signs of a cold or cough.
The back of the mouth and tonsils may become very red, and the lymph nodes
under the jaw may become swollen and tender.
Give penicillin (p. 397) for 10 days. If penicillin is given early and continued
for 10 days, there is less danger of getting rheumatic fever. A child with strep
throat should eat and sleep far apart from others, to prevent their getting it also.
Rheumatic Fever:
This is a disease of children and young adults. It usually begins 1 to 3 weeks
after the person has had a strep throat (see above).
357
Principal signs (usually only 3 or 4 of these signs are present):
fever
joint pain, especially in the
wrists and ankles, later the
knees and elbows. Joints
become swollen, and often hot
and red.
curved red lines or lumps under the skin
in more serious cases, weakness, shortness of breath, and perhaps heart pain
Treatment:
♦ If you suspect rheumatic fever, see a health worker. There is a risk that the
heart may become damaged.
♦ Take aspirin in large doses (p. 414). A 12-year-old can take up to 2 or 3
tablets of 300 mg. 6 times a day. Take them together with milk or a little
bicarbonate of soda, to avoid stomach pain. If the ears begin to ring, take less.
♦ Give penicillin (see p. 397).
Prevention:
* To prevent rheumatic fever, treat 'strep throat' early with penicillin—for 10
days.
♦ To prevent return of rheumatic fever, and added heart damage, a child who
has once had rheumatic fever should take penicillin for 10 days at the
first sign of a sore throat. If he already shows signs of heart damage, he
should take penicillin on a regular basis or have monthly injections of
benzathine penicillin (p. 399) perhaps for the rest of his life. Follow the
advice of an experienced health worker or doctor.
URINARY TRACT INFECTION FOLLOWING STREP THROAT
Sometimes the germs which cause strep throat or tonsilitis, can also affect the
urinary tract in children. In such cases, after about two weeks the strep throat or
tonsilitis is followed by high fever, pain in the renal area. The child may also have
swollen feet, face and hands. The child passes less urine. The urine may be clouded
or bloody. The pulse rate is high.
Treatment:
'
*
The child needs complete bed rest He should not leave his bed at all till he is
completely cured.
Measure the amount of urine he passes everyday. Give the child only the came
amount of water to drink.
Reduce the amount of protein in his food. Do not give him any milk, dal and
food containing proteins. Cooked rice with a little ghee can be given.
■ Do not give the child any salt at all.
’ Give penicillin injections (see p.398).
Danger signs: If any of the following signs appear, send for medical help^at once
• Increase in pulse rate.
•
358
Swelling increases.
The child stops passing urine.
difficulty in breathing
This condition is not dangerous if the child has complete bed rest with a low protein
and salt free diet
INFECTIOUS DISEASES OF CHILDHOOD
Chickenpox:
This mild virus infection begins 2 to 3 weeks after
a child is exposed to another child who has the disease.
Signs:
spots,
blisters,
and scabs
First many small, red, itchy spots appear. These
turn into little pimples or blisters that pop and finally
form scabs. Usually they begin on the body, and later
on the face, arms, and legs. There may be spots,
blisters, and scabs, all at the same time. Fever is
usually mild.
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Treatment:
The infection goes away in a week. Bathe the child daily with soap ana warm
water. To relieve itching, apply cool clothes soaked in water from boiled and
strained dalia. Cut fingernails very short. If the scabs get infected, put gentian
violet or an antibiotic ointment on them.
Measles:
This severe virus infection is especially dangerous in
children who are poorly nourished or have tuberculosis.
A child usually gets measles ten days after being near a
person with measles. It begins with signs of a cold-fever,
runny nose, red sore eyes, and cough.
The child becomes increasingly ill. The mouth may
become very sore and he may develop diarrhea.
After 2 or 3 days a few tiny white spots like salt grains
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appear in the mouth. A day or 2 later the rash appears[
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first behind the ears and on the neck, then on the face and body, and last on the
arms and legs. After the rash appears, the child usually begins to get better. The
rash lasts about 5 days.
359
Treatment:
♦ The child should stay in bed, drink lots of liquids, and be given nutritious
food. If a baby cannot breast feed, give breast milk in a spoon (see p. 323).
♦ For fever and discomfort, give acetaminophen (or aspirin).
♦ If earache develops, give an antibiotic (p. 397).
♦ If signs of pneumonia, meningitis, or severe pain in the ear or stomach
develop, get medical help.
Prevention of measles:
Children with measles should keep far away from other children. Especially try
to protect children who are poorly nourished or who have tuberculosis or other
chronic illnesses. Children from other families should not go into a house where
there is measles. If children in a family where there is measles have not yet had
measles themselves, they should not go to school or into stores for 10 days.
To prevent measles from killing children, make sure all
children are well nourished. Isolate children with measles.
Do not let other children come near them.
German Measles
German measles are not as severe as regular measles. Theylast 3 or 4 days. The
rash is mild. Often the lymph nodes on the back of the head and neck become
swollen and tender.
The child should stay in bed and take aspirin if necessary.
Women who get German measles in the first 3 months of pregnancy may give
birth to a child who is damaged or deformed. For this reason, pregnant women
who have not yet had German measles—or are not sure—should keep far away
from children who have this kind of measles. If a woman has German measles
in the first 3 months of pregnancy, she should have an abortion.
Mumps:
The first symptoms begin 2 or 3 weeks after being exposed to someone with
mumps.
Mumps begins with fever and pain on opening the
mouth or eating. In 2 days, a soft swelling appears
below the ears at the angle of the jaw. Often it comes
first on one side, and later on the other.
Treatment:
The swelling goes away by itself in about 10 days,
without need for medicine. Aspirin can be taken for
pain.and fever. Feed the child soft, nourishing foods and
keep his mouth clean.
360
£
Complications:
In adults and children over 11 years of age, after the
first week there may be pain in the belly or a' Pa'^l
■ swelling of the testicles (men) or the breasts (of women).
Persons with such swelling should stay quiet and put ce
packs or cold wet cloths on the swollen parts to help
reduce the pain and swelling.
If signs of meningitis appear, get medical help (p. 225).
Whooping Cough:
Whooping cough begins a week or two
after being exposed to a child who has it. It
starts like a cold with fever, a runny nose,
and cough.
Two weeks later, the whoop begins. The
child coughs rapidly many times without
taking a breath, until he coughs up a plug of
sticky mucus, and the air rushes back into his
lungs with a loud whoop. While he is coughing,
his lips and nails may turn blue for lack of air.
After the whoop he may vomit. Between
coughing spells the child seems fairly healthy.
Whooping cough often lasts 3 months or more.
Whooping cough is especially dangerous in babies under 1 year of age, so
vaccinate children early. Small babies do not develop the typical whoop so it is
hard to be sure if they have whooping cough or not. If a baby gets fits of
coughing and swollen or puffy eyes when there are cases of whooping cough in
your area, treat him for whooping cough at once.
Treatment:
♦ in the early stage of whooping cough, before the whoop begins,
tetracycline (p. 400)<erythromycin (p. 400), or ampicillin (p. 3.99) may
help. It is especially important to treat babies under 6 months at the first
sign.
♦ In severe cases of whooping cough, phenobarbital (p.4’22) may help,
especially if the cough does not let the child sleep or causes convulsions
♦ To avoid weight loss and malnutrition, the child should get nutritious food
and should eat soon after he vomits.
Complications:
A bright red hemorrhage in the white of the eyes may be caused by the
coughing. No treatment is necessary (seep.270). If fits or signs of pneumonia
(p. 209) or meningitis (p. 225) develop, get medical help.
Protect your children against whooping cough.
See that they are first vaccinated at 2 months of age.
361
Diphtheria:
This begins like a cold with fever, headache,
and sore throat. A yellow-gray coating or
membrane may form in the back of the throat,
and sometimes in the nose and on the lips. The
child's neck may become swollen. His breath
smells very bad.
If you suspect that a child has diphtheria:
*■ Get medicalhelp quickly. There is a special antitoxin for diphtheria.
♦ Put him to bed in a room separate from other persons.
♦ Give penicillin.
♦ Have him gargle warm water with a little salt.
♦ Have him breathe hot water vapors often or continually (p.205).
♦ If the child begins to choke and turn blue, try to remove the membrane from
his throat using a cloth wrapped around your finger.
Diphtheria is a dangerous disease that can easily be prevented with the DPT
vaccine. Be sure your children are vaccinated.
Infantile Paralysis (Polio, Poliomyelitis):
Polio is most common in children under 2 years of age.
This virus infection begins like a cold with fever,
vomiting, and sore muscles. Sometimes that is all there is
to it. But sometimes a part of the body becomes weak or
paralyzed. Most often this happens to one or both legs. In
time, the paralyzed limb becomes thin and does not grow
as fast as the other one.
Treatment:
Once the disease has begun, no medicine can take away
the paralysis. Antibiotics do not help. Calm the pain with
aspirin or acetaminophen and by putting hot soaks on the
painful muscles. Do not massage the muscles when the
child is having polio. This may cause more damage.
Prevention:
Keep the sick child in a separate room, away from
' other children. The mother should wash her hands after
each time she touches him. The best protection against polio is the polio vaccine.
See that children are vaccinated against polio,
with 'polio drops' at 2, 3, AND 4 months of age.
Avoid giving children injections or vaccinations during the rainy season or during
a polio epidemic.
362
A child who has been crippled
by polio should eat nutritious
food and do exercises to
strengthen remaining muscles.
During the first year some
strength may return.
Help the child learn to walk as
best he can. Fix 2 poles for
support, like these, and later
make him some crutches.
HOW TO MAKE SIMPLE CRUTCHES
363
PROBLEMS CHILDREN ARE BORN WITH
Dislocated Hip:
Some children are born with a dislocated hip—the leg has slipped out of its
joint in the hip bone. This is more common in girls. Early care can prevent lasting
harm and a limp. So all babies should be checked for possible hip dislocation at
about 10 days after birth.
1.
Compare the 2 legs. If one hip is dislocated, that side
may show:
■The upper leg partly covers this part of the body on the
dislocated side.
There are fewer folds here.
The leg seems shorter or turns out at a strange angle.
2. Hold both legs with
the knees doubled, like
and open them
wide like this.
If one leg
stops early
or makes a
jump or
click when
you open it
wide, the
hip is
dislocated.
Treatment:
Keep the baby with his knees high and wide apart:
or by pinning his legs
like this (when the
baby sleeps)
In places where women carry their babies with their legs spread on their hips,
often no treatment is necessary.
364
Umbilical Hernia (Belly Button that Sticks Out):
A belly button that sticks
out like this is no
problem. No medicine or
treatment is needed.
Tying a tight cloth or
'belly band' around the "
belly will not help.
Even a big umbilical
hernia like this one is not
dangerous and will often
go away by itself. If it is
still there after age 5, an
operation may be needed.
Get medical advice.
A 'Swollen Testicle' (Hydrocele or Hernia):
If a baby's scrotum, or bag that holds his testicles, is
swollen on one side, this is usually because it is filled with
liquid (a hydrocele) or because a loop of gut has slipped into
it (a hernia).
To find out which is the cause, shine a light through the
swelling.
If light shines through easily,
it is probably a hydrocele.
If light does not shine
through, and if the swelling
gets bigger when the baby
coughs or cries, it is a hernia.
Sometimes the hernia
causes a swelling above
and to one side of the
baby's scrotum, not in
You can tell this from a
swollen lymph node
(p. 10T) because the
A hydrocele usually goes away
in time, without treatment.
If it lasts more than a year,
get medical advice.
A hernia needs surgery (see
P-215).
hernia swells when the
baby cries or is held up
right and disappears
when he lies quietly.
365
MENTALLY SLOW, DEAF, OR DEFORMED CHILDREN
Sometimes parents will have a child who is born deaf, mentally retarded (slow),
or with birth defects (something wrong with part of his body). Often no reason
can be found. No one should be blamed. Often it just seems to happen by chance.
However, certain things greatly increase the chance of birth defects. A baby is
less likely to have something wrong if parents take certain precautions.
; 1. Lack of nutritious food during pregnancy can cause mental slowness or birth
defects in babies.
To have healthy babies, pregnant women must eat nutritious food (see p. 128).
C.r<cr"\
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2.
Lack of iodine in a pregnant woman's diet can cause
cretinism in her baby.
/
The baby'.s face is puffy, and he looks dull. His tongue hangs
out, and his forehead may be hairy. He is weak, feeds poorly,
cries little, and sleeps a lot. He is retarded and may be deaf. He
will begin to walk and talk later than normal babies.
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A
1
v J J
To help prevent cretinism, pregnant women should use
iodized salt instead of ordinary salt (see p. 152).
if you suspect your baby may have cretinism, take him to a
health worker or doctor at once. The sooner he gets special
medicine (thyroid) the more normal he will be.
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3. Smoking or heavy drinking of alcoholic drinks during
cretinism
pregnancy causes babies to be born small or to have other
problems (see p. 178). Do not drink heavily or smoke—especially during pregnancy.
4. After age 35, there is more chance that a mother will have a child with
defects. Mongolism or Down's disease, which looks somewhat like cretinism, is
especially common in babies of older mothers.
It is wise to plan your family so as to have no more children after age 35 (see
Chapter 20).
5. Many different medicines can harm the baby developing inside a pregnant
mother.
Use as little medicine as possible during pregnancy— and only those known to
be safe.
6. When parents are blood relatives (cousins, for instance), there is a higher
chance that their children will be defective or retarded. Cross-eyes, extra fingers
or toes, club feet, hare lip, and cleft palate are common defects.
To lower the chance of these and other problems, do not marry a close relative.
And if you have more than one child with a birth defect, consider not having
more children (see Family Planning, Chapter 20).
366
If your child is born with a birth defect, take him to a health center. Often
something can be done.
For cross-eyes, see p. 269.
If an extra finger or toe is very small with no
bone in it, tie a string around it very tightly —
It will dry up and fall off. If it is larger or has
bone in it, either leave it or have it taken
off by surgery.
♦ If a newborn baby's feet are
turned inward or have the wrong
shape (clubbed), try to bend
them to normal shape. If you can
do this easily, repeat this several
times each day. The feet (or
foot) should slowly grow to be
normal.
If you cannot bend the baby's
feet to normal, take him at once
to a health center where his feet
can be put in casts. For the best
results, it is important to do this
CLUB FOOT
WITH CAST
within 2 days after birth.
If a baby's lip or the top of his mouth
(palate) are divided (deft), he may have
trouble breast feeding and need to be fed
with a spoon or dropper. With surgery,
his lip and palate can be made to look
almost normal. The best age for surgery
is usually at 4 to 6 months for the lip,
and at 18 months for the palate.
7. Difficulties during birth sometimes result in brain damage that causes a child
to be spastic or have.fits. The chance of damage is greater if at birth the baby is
slow to breathe, or if the midwife injected the mother with an oxytocic (p. 312)
before the baby was born.
Be careful in your choice of a midwife-and do not let your midwife use an
oxytocic before the baby is born.
367
The Spastic Child (Cerebral Palsy):
legs crossed
like scissors
A child who is spastic has tight, stiff muscles that
he controls poorly. His face, neck, or body may
twist, and his movements may be jerky. Often the
tight muscles on the inside of his legs cause them to
cross like scissors.
At birth the child may seem normal or perhaps
floppy. The stiffness comes as he gets older. He may
or may not be mentally slow.
There are no medicines fhat cure the brain damage
that makes a child spastic.
But the child need special care. To help prevent
tightening of the muscles in the legs or in a foot, treat
as for Dislocated Hip (p. 363) and as for Club Foot
(p.366), if necessary.
Help the child to roll over, sit and stand — then
learn to walk as on p. 362. Encourage him to use both
his mind and body as much as he can. Help him learn
(see next page). Even is he has trouble with speaking
he may have a good mind and be able to learn many
skills if given a chance. Help him to help himself.
To help prevent mental retardation or birth defects in her child, a woman
should do these things:
1. Do not marry a cousin or other close relative.
2. Eat as well as possible during pregnancy: as much meat, eggs, fruit, and
vegetables as you can.
3.
Use iodized salt instead of regular salt, especially during pregnancy.
4.
Do not smoke or drink heavily during pregnancy (see p. 178).
5.
While pregnant, avoid medicines whenever possible—use only'those
known to be safe.
6.
While pregnant, keep away from persons with German measles.
7.
Be careful in the selection of a midwife—and do not let the midwife use
an oxytocic before the child is born (see p. 312).
8.
Seek medical help, if the baby starts becoming yellow(Jaundice)
9.
Do not have more children if you have more than one child with the
same birth defect, (see Family Planning, p. 329).
10 Consider not having more children after age 35.
368
Retardation in the First Months of Life:
Some children who are healthy when they are born do not grow well. They
become mentally slow because they do not eat enough nutritious food. During
the first few months of life the brain develops more rapidly than at any other
time. For this reason the, nutrition of the newborn is of great importance. Breast
milk is the best food for a baby (see The Best Diet for Babies, p. 141).
HELPING CHILDREN LEARN:
As a child grows, he learns partly from what he is taught. Knowledge and
skills he learns in school may help him to understand and do more later.
School can be important.
But a child does much of his learning at home or in the forest or fields.
He learns by watching, listening, and trying for himself what he sees others
do. He learns not so much from what people tell him, as from how he sees
them act. Some of the most important things a child can learn—such as
kindness, responsibility, and sharing—can only be taught by setting a good
example.
A child learns through adventure. He needs to learn how to do things for
himself, even though he makes mistakes. When he is very young, protect a
child from danger. But as he grows, help him learn to care for himself. Give
him some responsibility. Respect his judgment, even if it differs from your
own.
When a child is young, he thinks mostly of filling only his own needs.
Later, he discovers the deeper pleasure of helping and doing things for
others. Welcome the help of children and let them know how much it means.
Children who are not afraid ask many questions. If parents, teachers, and
others take the time to answer their questions clearly and honestly—and to
say they do not know when they do not—a child will keep asking questions,
and as he grows may look for ways to make his surroundings or his village a
better place to live.
The book Where There Is No Doctor ts available
at Rs 29/- plus postage. Multiple copies of reprints
of various chapters are also available.
Please write to:
Publications Officer
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
Rs. 2.00
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