Anaemia in babies: What should parents do?
Dr Shakuntala Lavasa

The recent National Family Health Survey report revealing the harsh reality of about 80 per cent children being anaemic even in prosperous states like Punjab and Haryana shows that there is need for new strategies to save children from this significant morbidity.

Anaemia is a state of low hemoglobin in the body, which may be caused due to many factors.

The most common cause is iron deficiency. A baby born with a normal weight has sufficient stores of iron to last him the first  four to six weeks.

In India, a majority of children are born with low birth-weight for which the mother’s malnutrition is also one of the important factors.

Such children have low stores of iron and they need supplementation of iron surely from the age of two weeks.

The iron in human milk is certainly better absorbed than that found in the milk of cow, buffalo, etc.

Mother’s milk must be continued in all infants for innumerable scientific advantages to the baby as well as the mother.

The home-made food appropriate for the age of the baby should be supplemented. Parents often do not accept the fact that grains and pulses have more iron and other nutrients, and these need to be given rather than the top-feeding of diluted milk by the bottle.

Bottle-feeding even in the best circumstances results in several maladies, the
most dangerous being diarrhoea which forms the vicious cycle with malnutrition
and anaemia.

In the first year of life, most babies visit the doctor for well-baby checkup and at least five times for vaccinations. Doctors can always detect anaemia and take corrective measures if they are vigilant.

What parents do not realise is that they do not take the advise on anaemia seriously. They feel that it is just a tonic that is prescribed which they give irregularly and stop at their own convenience.

Anaemia has to be accepted as a disease, and the treatment has to be given with calculated doses.

The expected haemoglobin rise is calculated and the treatment should continue for additional three months even after the haemoglobin level is appropriate. This is essential to replenish the stores in the body.

Careful paediatricians have a side-lab in their clinics where haemoglobin can be assessed just in 10 minutes and the treatment is evidence based. Parents don’t have to make additional trips from their doctor’s clinic to a distant lab.

In the second year of life, the child has to gain just 2 kg of weight and, therefore, his requirements are not as much as he needed in the first year to become 10 kg from the 3 kg at birth.

There is a natural reduction in the food consumption pattern, but parents expect
their children to eat more all the time — “chalo doodh to pee lo at least; nahin,
peena padega”.

They insist on milk all the time, filling the little one’s stomach with milk rather than grain-based food.

The nutritional requirement, therefore, becomes a perpetual struggle between the two, with children learning to refuse. At times, force-feeding becomes an attention-seeking device. These wrong trends result in avoidable undernourishment.

When they are as young as two, the children go to school, which is surely a form of child abuse by parents.

Separation anxiety and the stress of discipline, even if it is a play school, is a subject requiring national attention. All this can also result in malnutrition.

The writer is a Chanidgarh-based senior consultant paediatrician.
Email: slavasa@ yahoo.com

Reconstruction of worn-out dentition
Dr H.S. Chawla

Teeth do wear out with age. This is called attrition of teeth, which is a normal phenomenon. Attrition of teeth is desirable as it flattens the occlusal table of teeth, thus protecting against undue lateral pressure with cusped teeth for the weak muscles of the aged and also other age-related changes in the teeth.

In a few individuals, attrition is much more marked and rather severe. This is pathological and dangerous. The hard outer covering of the teeth — the enamel —gets abraded.

The reasons for teeth getting ground prematurely

Bruxism: This means involuntarily grinding your teeth at night. This is the main reason of occurrence of excessive attrition. You yourself might not be aware of grinding your teeth while you sleep.

Sometimes the others in the family or your partner might complain of a creech-creech sound emanating from you. Many a time this noise is quite marked. Another sign is that you get up with fatigued jaws.

Bruxomania: This is grinding of teeth during the day. Here again you are altogether oblivious of the habit. It’s only when you are made aware of your habit that you realise what you have been doing.

Effects of undue grinding of teeth

It leads to the development of sensitivity to hot and cold things. Dentin, which underlies the outer enamel, gets exposed because of excessive enamel wear.

The dentin being more innervated elicits sensitivity to hot and cold. The second effect is the exposure of blood supply of the tooth (pulp) to the oral environment.

Prevention

Abstain from day-time grinding: The first step is to check if you are a day-time grinder of teeth.

If the back teeth of your upper and lower jaws are in contact with one another when you are not eating or chewing, you are probably a day-time grinder.

You should examine your teeth, and see if these are unduly abraded. Examination by a dentist would establish the diagnosis.

For prevention, the first step is to try to inculcate a habit of keeping a gap of 3 to 4 mm between upper and lower back teeth all the time.

You have to make a conscious effort to do this. If you try hard enough, you will get into the habit.

Refrain from grinding your teeth at night

This habit can be checked by biofeedback, meaning thereby that you should repeatedly (at least 20 times) tell yourself before sleeping: “I am not going to grind my teeth, and will keep space between my upper and lower teeth”.

Invariably, along with this therapy, you also need to wear a mouth guard. Mouth guard is made of a soft material that covers the teeth and is worn at night.

It does not let the teeth of opposing jaws come directly in contact, and hence they do not get ground.

Treatment of worn-out dentition

Restoring teeth to their original height first requires practice with a removable splint placed over the teeth to accustom the patient to the look and feel of an increase in the vertical dimension of the face and new bite height.

Later, as the patients adjust to this new height, the individual reconstruction
of every tooth is carried out. The height of each tooth is increased to a pre-
determined span.

Benefits of reconstruction of the worn-out teeth

Since reconstruction increases the vertical dimension of the face, it markedly improves sagging musculature. It does give a facelift, along with restoring teeth to their original glory.

The writer is a former Professor and Head, Oral Health Sciences Centre,
PGI, Chandigarh.
Email: chawlahs @gmail.com

Handling the irritable bowel syndrome
Dr R. Vatsyayan

Of the number of diseases that have been affecting the gastrointestinal tract, the irritable bowel syndrome or the IBS forms a considerable part of the medical practice in India and abroad.

Interfering with normal functioning of the bowels or the intestines, it is a condition which is characterised by either dominant symptoms of diarrhoea or constipation and sometimes of a state when the patient has both of these alternately.

Varying from person to person, IBS presents a number of symptoms such as abdominal discomfort, pain and cramps, gas, bloating and unstable bowel pattern.

Ayurveda attributes IBS as a sequel to “mandagni” or the weakening of the digestive fire which is deranged due to a number of factors.

These include irrational fasting, eating during indigestion, over-eating or irregular eating and more often consuming food which is unsuitable, heavy, sticky or is too cold, too unctuous and too dry.

Habitual suppression of natural body urges, abuse of laxatives and continuous anxiety can also unhinge the “agni” which ultimately results in a condition where a person becomes unable to digest even the simple food.

Modern medicine also believes that certain psychological commotions like anxiety, stress, anger, feeling troubled and remaining overwhelmed and excited badly affect the intestinal movements.

Though the bowels may not work right in the IBS, they look perfectly normal if they are checked with X-rays, ultrasound and colonoscopy.

Experts are of the view that the normal communication between the gut and the brain is either heightened or is disrupted in the IBS as in the case of just a little gas passing through the intestines may shoot pain signal to the brain.

A mangled message from the brain to the intestines may direct them to over-contract, resulting in diarrhoea. If these muscle contractions are almost standstill, then constipation ensues.

Many times physical symptoms of the IBS are besieged by psychological presentations. Patients of the IBS may look uneasy and irritated and usually remain preoccupied with the thought of incomplete evacuation or gas formation.

Other symptoms like general weakness, pain in calf muscles and low self-esteem, which are clinically unfounded and are purely of psychological origin, seem to be put on the forefront.

The unending stress of the disease makes the mind more aware of the sensations that arise in the abdomen and the patients many times indulge in over-medication and this vicious cycle continues.

The IBS has not shown to lead to any other serious disease. Depending upon the symptoms, each patient needs a different type of treatment.

Since anxiety is most common symptom in IBS, managing it more with counselling sessions and reassurance than giving tranquilisers leads to better results.

Relaxation techniques to cope stressful conditions also make a huge difference. Regular walk or mild-to-moderate workouts are always useful to regulate intestinal functions. The IBS may look so simple but it is undoubtedly a complex disease.

The writer is a Ludhiana-based senior ayurvedic consultant.
Email: yourhealth@rediffmail.com