Dr. C.N. Kamalarathnam is professor and head of the department of neonatology, Institute of Child Health, Egmore, Chennai

My eight-year-old son has lost his appetite. He often complains of stomach aches and nausea. Help!
— Harika Reddy, Hyderabad

If your son is of healthy weight and height, this particular problem might be transient. Changing his daily diet might help. But if it doesn’t, a medical examination may identify underlying problems such as anaemia, sore throat or dental issues.

Abdominal pain can be caused by various factors such as giardiasis which is an intestinal infection. Symptoms include abdominal pain, diarrhoea and fatigue. If this is the case, metronidazole can treat the infection. If a diagnosis rules out intestinal infection, iron deficiency could be the reason. Administering oral iron supplements and de-worming him will improve his appetite in a week.

Other morbidities such as glossitis which is inflammation of the tongue can also prevent him from consuming food normally. Underlying symptoms such as fever or loss of weight may presage tuberculosis. Medical diagnosis is needed to rule out every possible cause.

On the other hand, it could also be selective eating leading the child to feign abdominal pain. Consult a doctor. Don’t ignore these symptoms.

A few months ago, my nine-year-old daughter attained puberty. Back in our days, a girl would begin menstruation when she was 14-15. As a mother, I think it is too early for her to begin menstruating. Should I be worried?
— Jeevana N., Mangalore

Almost 80 percent of girl children living in cities are attaining puberty around age 11, which is two years earlier than in the past. Puberty attained before the age of eight is called precocious puberty though this is not the case here.

Attainment of puberty at a young age always has a secondary cause. One of them is the trend of daughter following in the mother’s steps in relation to attaining puberty. Another is the nutrition given to the child. Dietary changes can accelerate onset of puberty and adolescent development. For example, children in the 1970s and ’80s had an average height of 5’4 at age 16 but nowadays, children grow much taller than that. Such changes happen over a few decades due to dietary and gene changes. Moreover sedentary lifestyles of children could also impact menarche. Medically, we treat children with menarche cases before eight years to postpone puberty for a few years. With proper evaluation, this therapy can be considered for girl children with early puberty.

Due to the Covid-19 pandemic outbreak, I was afraid to take my one-year-old daughter for vaccination. Should I continue the immunisation schedule from the vaccine we stopped or should I consult a doctor?
— Meenakshi Vinayak, Coimbatore

Vaccines train our immune system to fight infections by injecting an inactivated germ into the body. During the lockdown months, most medical clinics were closed and it was difficult to access health facilities. But it’s very important to follow the child immunization schedule. You can continue from the last vaccine taken. Missing vaccines will not create a problem.

My son started teething when he was six months old and used to suck his thumb while sleeping. He is one and a half years old now, but this habit has continued and his teeth have started to jut out. I have tried all home remedies. Please advise.
— Sharmila Ramu, Bangalore

Thumb sucking is a common phase of child development. Some children facing development challenges and experiencing socio-emotional insecurity resort to thumb sucking to derive emotional comfort. Usually children outgrow this habit. But if it persists beyond infancy, it will cause proclination of the teeth. It is better to wean children off this habit before they turn six. Otherwise, behavioural therapy will be required. Try distracting your child with another activity, and correct her kindly but firmly.