INFANT AND TODDLER

EXCESSIVE CRYING

Normally all infants cry for some or the other reason. In the first month of life, crying is most important as infants have quite few effective methods for communicating their requirements. Studies have shown that infants typically show an increase in their crying level across first three months, with a peak around 6-8 weeks of age. Since crying is considered as normal communicative signal of a child, developmental changes in children who cry within the normal range is common. However, some infants exceed the usual pattern of crying, such as crying for long, hard and inconsolable during their growth period.

Excessive crying refers to the crying that continues for longer than usual time for a given child after every possible attempt to meet routine need of an infant or toddler.

CAUSES

Colic: Excessive crying infants are often at risk leading to developmental problems. Unexplained, excessive or persistent crying in the first 3 months of life that occurs in a healthy infant is labeled as infant colic. Colic is extremely common and occurs in up to 40 percent of all infants. It usually starts somewhere between the third and sixth week after birth and ends when a baby is three to four months of age.

Immunization: Your child may be fussy, cry more than usual, and have a fever after receiving an immunization, especially diphtheria, tetanus, and pertusis.

Teething:  

Teething symptoms may begin about 3 to 5 days before a tooth breaks the skin, although symptoms are present for 1 to 2 months. The most common symptoms of teething include swelling, tenderness, or discomfort in the gums at the site of the erupting tooth, drooling, biting fingers or toys, irritability or difficult in sleeping.

Constipation:  A crying episode that occurs when passing a stool normally will stop when the stool is passed, but in severe case crying period extends.

Diaper rash:  Irritated skin around the thighs, genitals,buttocks, or abdomen makes a child cry persistently, especially when the diaper is wet or soiled.

Medical disorders: Some disorders are uncomfortable but not immediately dangerous to the child. 

Such less serious causes of crying include

·    Gastro-esophageal reflux

·    Hair wrapped around a finger or toe (hair tourniquet),

·   A scratch on the surface of the eye (corneal abrasion), insect bite, anal fissure and Otitis.

Serious disorders include:  

·   A blocked intestine caused by intussusception ( part of the intestine folds into another section of intestine)

·   volvulus (twisting of the intestine),

·   Heart failure,

·   Meningitis and

·   Head injuries that causing bleeding into the skull.

Infants with such severe disorders often have other symptoms (vomiting or fever), which alert parents regarding presence of serious problem. However, sometimes excessive crying is itself the first sign.

COMFORTING MEASURES

· Comforting techniques, such as swing your baby, breast-feeding, or using pacifier after breast-feeding.

·  Place a child in a safe, quiet place and leave alone for 15 to 20 minutes. Sometimes children can relax and soothe themselves. Be sure to stay close by.

·  Talk child to doctor before giving any nonprescription medicines or herbal remedies as a comfort measure. Products including alcohol or sugar in them are not recommended to infants and toddlers.

·  Don’t get angry at your child for crying. Never shake or harm child. Shaking a child in anger or playing rough, such as throwing a baby up into the air and catching can cause shaken baby syndrome.

MEDICAL ATTENTION:

Call /visit pediatrician during the day or night if any of the following occur:

•     The baby has cried for more than two hours.
•           If crying could be the result of an injury or fall.
•      The baby has a fever of ≥100.4ºF (38ºC).
•      The infant refuses to eat or drink anything for more than a few hours, vomits excessively, is not urinating well, has bloody stools, or has a change in behavior, including lethargy or decreased responsiveness.

Persistence of crying beyond the first 3 months predicts a higher prevalence of behavioral and emotional disorders in children with excessive crying than in children without excessive crying. It is therefore important to offer timely help through developmental counseling, physiotherapy, or even parent-infant psychotherapy.

GROWTH AND DEVELOPMENT

Growth is the progressive increase in size of a child. Development is progressive achievement of various skills /abilities such as head support, speaking, learning, expressing the feelings and interaction with others. Growth and development go together but with different rates.

There are multiple areas of growth and development that occurs throughout infancy and early childhood. 

Types of Development

Children grow and change in different areas of development 

Physical: A baby's growth is dramatic during this first year. There are changes found in child's body such as weight gain and height of the child.

Cognitive development: Brain cells develop during In-utero but the connections that allow a child to utilize knowledge do not occur till birth. Babies make progress in being able to learn and remember.

Emotional and social development: Babies shows emotions and interaction with people by expressing how they feel with facial expressions and by making sound.

Language:  Newborn starts listening to and absorbing the basic and distinct sounds of language of parents and care takers. This process forms the foundation for speech and understanding.

Sensory and motor skills: Newborns have all five senses they quickly learn to recognize your face, the sound of your voice, and how you smell. Your newborn's sense of touch is especially developed, particularly around the mouth. Vision also develops quickly but is believed to be weakest of the senses. Motor skill develops as the child’s muscles and nerves work together. Babies become strong enough to sit. Some will stand, and others will begin to take their first steps.

Emotional and social development: Babies shows emotions and interaction with people by expressing how they feel with facial expressions and by making sound.

FACTORS THAT INFLUENCE GROWTH AND DEVELOPMENT

Child growth and development are influenced by both external environmental factors known as exogenous factors and internal environmental factors known as endogenous factors.

1.        External environmental factors (exogenous) are:

·         Food/Diet

·         The geographical environment

·         Socio-economic factors

·         Educative factors

·         Exercises

·         Chemical emissions, radiation, trauma and

Diet: it is very important factor influencing growth and development because diet plays role from the womb. Thus, maternal malnutrition will pass on to the nutritional status of physical and mental health. Deficiency of nutrients such as protein and minerals will lead to enzyme and hormonal disorders, coagulation disorders, impaired skeletal mineralization and overeating can lead to obesity.

Geographical environment:  In A microclimate local atmospheric zone where the climate differs from the surrounding area (air, sun, light, temperature and atmospheric pressure) affects mainly in the first 5 years of life.

Socio-economic factors: sanitary conditions, various parasitic morbidity, housing, stress, financial situation affects the growth and development of a child.

Educational factors: This includes family climate where a family dominated by calm and optimism will encourage the child’s actions, the child will develop better than others who grow up in dysfunctional families or with conflict states.

Exercises: this includes baby massage and gymnastics for infant and subsequently for other age appropriate exercises have a positive role on growth and development.

Pollutants, radiation or trauma: Have negative impact on the physique and weight development.

2  Internal environmental factors (endogenous) are:

·  Genetic factors: This is an important factor influencing   on the weight development and intellectual development.

·   Hormonal factors: this factor is particularly important in the stature-weight and intellectual development.

Disturbances in the synthesis and release of the hormones will have a negative effect on child’s development causing dwarfism, gigantism, myxedema etc.

In addition to exogenous and endogenous factors, growth and development can be interfered negatively by pathological factors like chronic diseases (cystic fibrosis, chronic renal insufficiency)

DEVELOPMENTAL MILESTONES 

Young children accomplish certain developmental "milestones" over the course of their first few years like rolling over, sitting up and uttering first word. These are all milestones that indicate that a child is developing normally.  

All babies are different and develop at their own speed, so there are growth differences in similar age groups and some develop in one area first and then go ahead for other.

Visiting doctor ensures normal growth and development. 

 

GROWTH MEASUREMENT  

The most common ways for measuring growth include:

Basic body measurements including weight, height & length and head circumference from birth to three years of age

Calculation of BMI (body mass index) and child-specific BMI charts for children over 2 years.

NUTRITION IN INFANTS AND TODDLERS

Good nutrition is essential for growth and development that occurs during an infant’s first year of life. When the developing infants are fed with appropriate nutritional foods, their health is promoted.

Infants and toddlers grow and develop rapidly during the first few years of life. So they need the right combination of calories and nutrients to help keep them healthy.

Breastfeeding supplies everything a baby needs to grow and develop for the first six-12 months of life. It also helps protect the baby against infection and reduces the risk of allergy. It is recommended that babies are breastfed exclusively to around six months and continued until at least twelve months of age. Introducing infant formula feeding is to complement with breastfeeding when required.

At 6 months

Nutritional needs at this age are increasing rapidly and solid foods should be introduced to complement their milk requirement.  

Foods include: iron-fortified baby rice, iron-fortified infant cereal, cooked and pureed vegetables and fruit, such as pumpkin, potato, apple and pear, mashed ripe banana, pureed meats, such as beef, lamb or chicken. Introduce foods one at a time, starting with thin purees and changing texture when baby becomes more adapted to eating solids.

At 7-8 months

When baby starts picking up small objects and putting them to their mouth, try giving finger foods, such as toast fingers, cooked baby carrots or cooked pasta, encouraging them to feed themselves. Offer a mixture of pureed and finger foods to suit their needs.

At 8-12 months

Baby is starts to crawl. Introduce Meat, fish, chicken and vegetables finely chopped to provide texture. Offer other foods like: soft fresh fruit, white bread, plain crackers, yogurt and custard.

At  12 months

Baby still needs about 2 feeds of breast milk or infant formula each day with other foods. Offer them small meals and snacks regularly throughout the day, as well as eating smaller amounts of family meals if appropriate.

Breast milk or infant formula and water are the only drinks baby needs for the first 12 months. After 12 months, full-fat cow’s milk can be introduced with other nutrients.

Toddlers

A toddler is a child between the age of one and three. The toddler years are the time of great cognitive, emotional and social development.

Toddlers grow in spurts and their appetite fluctuates as they eat a whole meal one day and then hardly anything the next. It is normal and as long as you offer them healthy nutritional foods to fulfill their requirements.

NUTRIENTS REQUIRED

These are the nutrients that every child should have in their diet:

PROTEIN

Protein helps to build cells, break down food into energy, fight infections, and carry oxygen. 

Protein foods include:

Meat

Poultry

Fish

Eggs

Nuts, Beans

Dairy products

CARBOHYDRATES

Carbohydrates are the most important source of energy helping the body in building and repairing tissue. Carbohydrate foods include:

Breads

Cereals

Rice

Crackers

Pasta

Potatoes

FATS

Fats are a high source of energy and are easily stored in body. Fat containing foods are:

Dairy products

Cooking oils

Meat

Fish

Nuts

CALCIUM

Calcium is essential in building healthy bones, teeth, muscle heart and brain.     Foods containing calcium are:

Milk

Cheese

Yogurt

Ice cream

Egg yolks

Broccoli

Spinach

IRON

Iron is necessary for a child to build healthy blood that carries oxygen to cells all over the body. Foods containing iron include:

Red meats

Liver

Poultry

Shellfish

Whole grains

Beans

Nuts

Iron-fortified cereals

FOLATE 

Folate (B vitamin) is important for healthy growth and development of cells. Folate containing foods include:

Whole-grain cereals

Lentils

Chickpeas

Asparagus

Spinach

Black or kidney beans

Brussels sprouts

FIBER

Fiber helps in reducing GI problems. Fiber foods include:

Whole-grain cereals

Chickpeas

Lentils

Kidney beans

Seeds

Nuts

Raw vegetables and fruits

VITAMIN-A

It helps in growth, eyes sight, and healthy skin.

Foods containing Vitamin-A includes:

Carrots

Sweet potatoes

Apricot

Spinach

Broccoli

Cabbage

Fish oil

Egg yolk

VITAMIN-C

It helps forming and repairing RBC, bones, and tissues. It helps gums stay healthy and strengthens blood vessels minimizing bruising from falls and scrapes. In addition helps in wound healing, boosts immune system and helps the body absorb iron from foods. Foods containing Vitamin-C include:

Citrus fruits

Papaya

Strawberries

Tomatoes

Potatoes

Melon

Cabbage

Broccoli

Cauliflower

Spinach

CROHN'S DISEASE

Crohn's disease (CD) is a long-term condition that causes inflammation of lining of the digestive system.

Inflammation can affect any part of the digestive system, from the mouth to the back passage, but most commonly occurs in the last section of the small intestine (ileum) or the large intestine (colon).

SIGNS AND SYMPTOMS

Diarrhea: Diarrhea is a common problem for people with Crohn's disease. Severe intestinal cramping also can contribute to loose stools.

Fever and fatigue: Many people with CD experience fever, likely due to inflammation or infection leading to tiredness.

Abdominal pain and cramping: Inflammation and ulceration can affect the normal movement of content in digestive tract and may lead to pain and cramping including nausea and vomiting.

Blood in your stool: High possibility of blood in stool and occult blood is observed

Mouth sores: Mouth ulcers similar to canker sores.

Reduced appetite and weight loss: Abdominal pain and cramping and the inflammatory reaction in the wall of bowel can affect both appetite and digestion and absorption of food.

Perianal disease:  Experiencing pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula).

CAUSES

The exact cause of CD is unknown. However, research suggests a combination of factors may be responsible. These include:

Immune system:  It is possible that a virus or bacterium may trigger CD. When immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the normal cells in the digestive tract too.

Heredity: Crohn's is more common in people who have family members suffering disease, so genes may play a role transferring disease. However, most people with CD don't have a family history.

RISK FACTORS

·         Age:  Crohn's disease can occur at any age, but develops the condition in younger age.  Mostly Crohn's disease is diagnosed before they're 30 years old.

·         Ethnicity: Although CD can affect any ethnic group, whites and people of Jewish descent have the highest risk.

·         Family history: higher risk if close relative, such as a parent, sibling or child suffering from the disease. As many as 1 in 5 people with Crohn's disease have a family member with CD.

·         Previous infection: Previous infection may trigger an abnormal response from the immune system.

·         Smoking: smokers usually have more severe symptoms than non-smokers.

·         Environmental factors: Crohn's disease is most common in westernized countries such as UK, and least common in Africa.

TREATMENT:

·         Currently there is no cure for Crohn's disease, so the aim of treatment is to relieve inflammation and symptoms and to avoid surgery.

·         Treatment with steroid medication such as corticosteroids.

·         Medication to suppress the immune system (immunosuppressants) and to reduce inflammation anti-inflammatory drugs.

·         In some cases, surgery required to remove the inflamed section of intestine.

COMPLICATIONS:

Crohn's disease may lead to one or more of the following complications:

Intestinal inflammation,

Bowel obstruction,

Ulcers,

Fistulas,

Anal fissure,

Malnutrition,

Colon cancer,

Other health problems and medication risk.

IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) is a disorder affecting large intestine in which the bowel overreacts to a mild stimulus in case of eating or in the presence of gas leading to spasm. It is also known as spastic colon.

IBS is common problem affecting as many as one in five of our population. It is most common in people of 20s and 30s, and affects more women than men.

Symptoms of IBS

·        Abdominal pain and may be relieved following a bowel movement

·         

·        Diarrhoea, constipation, Cramping

·         Bloating sensation

·         Excessive belching and flatulence

·         Stool with mucous

·         Occasional heartburn, nausea and vomiting also occur.

·         Serious condition includes:

·         Rectal bleeding

·         Abdominal pain that progresses or occurs at night and

·          Weight loss

Causes of IBS

It is not known exactly what causes irritable bowel syndrome, but a variety of factors play role in causing IBS.

The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from stomach through intestinal tract and to the rectum. 

In irritable bowel syndrome, the contractions may be stronger and last longer than normal, causing gas, bloating and diarrhea. 

Or the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools.

Abnormalities in your gastrointestinal nervous system also may play a role, causing greater than normal discomfort when your abdomen stretches from gas or stool.

Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhea or constipation.

The influence of family history on IBS risk may be related to genes, shared in a family.

Factors that Triggers IBS

Stimuli that can trigger symptoms in people suffering IBS include:

·         Foods: The role of food allergy or intolerance in irritable bowel syndrome is not  clearly understood, but a wide range of foods which could trigger IBS are chocolate, spices, fats, beans, cabbage, cauliflower, milk, coffee, carbonated beverages and alcohol.

·     Stress: Most people with IBS find that their signs and symptoms are worse during periods of increased stress.

·       Hormones:  women’s are more prone to have Irritable bowel syndrome, studies have shown that hormonal changes play a role worsening the symptoms during menstruation cycle.

·      Other illness: Sometimes other illness, such as an acute episode of infectious diarrhea (gastroenteritis) or too many bacteria in the intestines (bacterial overgrowth) can trigger IBS.

Diagnosis of IBS

A diagnostic test that may be carried out to rule out this disorder includes blood test, stool analysis, x-ray and endoscopy of the bowel.

Treatment of IBS

·         Dietary changes includes following healthy diet

·         Stress management by life style changes, meditation, relaxation therapies and exercise.

·         Symptomatic treatment includes anti-spasmodic, laxatives,          anti diarrhoeal drugs.

·         Antidepressants can block the brain’s perception of pain in the gut.

·         Analgesics or sedative drugs may be prescribed if indicated.