In this essay I detail some of the chronic illnesses afflicting 21st century children and advise how parents can help to alleviate their pain and suffering

In 1990, the under-five infant mortality rate in India was 126 per 1,000 live births. Almost three decades later in 2018, it has reduced to 39 deaths per 1,000, according to a report of the United Nations Inter-Agency Group for Child Mortality Estimation.

Thanks to advances in medical technology and improved healthcare facilities, children around the world are living beyond their first and more birthdays as against millions of children dying of curable illnesses such as bronchitis, chickenpox, diarrhoea, malaria etc, a few decades ago. With governments launching mass immunization programmes, many chronic childhood diseases have been eradicated and/or prevented.

However, advances in medical science have a downside. The number of children with chronic diseases caused by genetic or environmental factors or a combination of both, or prenatal exposure to toxins such as cigarette smoke and alcohol surviving into adult life with health complications and disabilities has risen. This places great emotional and financial strain on families obliged to care for chronically ill children and adolescents.

In this essay I detail some of the chronic illnesses afflicting 21st century children and advise how parents can help to alleviate their pain and suffering.

Respiratory diseases

Some chronic respiratory ailments such as asthma manifest in early childhood. Keeping a clean house and avoiding dusty outdoor environments, vaporizing mosquito repellents, cigarette smoke and strategic use of broncho-dilating medication (as prescribed) helps control and recovery in young children. Inhalers and nebulizers are more effective than oral medication. In some children, asthma attacks are aggravated by cow’s milk.

Asthmatics struggle with breathing difficulties because of poor coordination of their respiratory muscles. Child asthmatics can greatly benefit from regular steam inhalations, yoga breathing exercises and structured aerobic workouts such as cycling, running and swimming. Also teaching children to play a wind instrument will improve their lung capacity. Martial arts (karate, kung fu, silambam) training also helps alleviate breathing difficulties.

Obesity/malnutrition

Malnutrition and obesity lead to lifelong morbidity. Childhood and adolescent obesity results in early onset of puberty, diminished stature, diabetes, hypertension, and cardiac diseases which can be fatal. Child malnutrition in the midst of plenty is becoming common in middle class India, as children are fed transfat and sugar-filled snacks in lieu of nutritious home-cooked meals. This leads to lethargy, weak bones and anaemia.

Diarrhoea

Chronic diarrhoea is caused by food allergies, intolerance to milk and wheat, inflammatory bowel disease or parasitic infestation. After clinical tests and diagnosis, immediate medical treatment should be administered to children. If infants are exclusively breastfed for 180 days and then partially breastfed along with semi-solids for one year, they are likely to be resistant to chronic diarrhoea.

Diabetes

Children and adolescents can suffer from Type 1 as well as Type 2 diabetes. Type 1 diabetes usually follows viral infections, some of which can be prevented with appropriate immunization. Type 2 diabetes is usually the fallout of obesity. If diabetes is unchecked, complications such as kidney malfunction set in during adolescence. Regular exercise and healthy meals can help keep sugar levels of children in check.

Brain ailments

Mental retardation, malformations of the brain (anencephaly, meningo-myelocoele), and cerebral palsy require a lifetime of care. Folic acid prevents some of these developmental malfunctions. Folic tablets of 5 mg a day should be taken as soon as the decision to have a child is made. The neural tube, which eventually grows into the brain and spinal cord, starts to develop 16 days after fertilization of the egg. During pregnancy, special care should be taken to control gestational diabetes, weight, and hypertension.

Moreover any childhood signs of mental illnesses such as depression and schizophrenia should be immediately brought to the attention of a medical professional. Early intervention with counselling, occupational therapy, and appropriate medication will go a long way to help integrate them into mainstream society.

Epilepsy often manifests in childhood. Sometimes it manifests as febrile seizures which occur only when the child has a fever. In other cases, it is part of the spectrum of a seizure disorder. It might be precipitated by illness or trauma or be hereditary. Seizures can be well-controlled with medication. Remember to dose the child on time as the medication works only for a limited number of hours. Delayed dosing might cause seizures to recur. And don’t abruptly stop medication. The child has to be gradually weaned under medical supervision. This duration is usually five years after the last documented seizure.

Guide to prevention of chronic illnesses in children

• Avoid matrimonial alliances with close relatives as recessive genetic diseases are more likely to manifest in children born from such relationships.

• Don’t consume alcohol or smoke during pregnancy. Also avoid passive inhalation of cigarette smoke.

• Avoid medications except for iron, folic acid and calcium supplements during pregnancy unless specifically prescribed by a qualified medical practitioner. Always inform the doctor that you are pregnant.

• Treat gestational diabetes and hypertension promptly.

• Exclusive breastfeeding for the first six months of an infant’s life builds immunity and prevents many chronic diseases which manifest in childhood.

• Ensure timely immunization and vaccinations.

• Feed your child a healthy diet without transfats, excess sugar or preservatives.

• Encourage children to participate in aerobic exercises such as running, swimming, or cycling for at least 30 minutes per day.

(Dr. Gita Mathai is a well-known Vellore-based pediatrician and author of Staying Healthy in Modern India)