A child specialist from chandigarh, punjab, mohali, India, talks about pediatric and medical news and other related issues like asthma, allergies, immunizations, vaccinations, comon illnesses, diseases, health news, office practice, charak clinics etc.
This is from a recent interview of mine that will be published in a health magazine in the USA
COLIC
Colic is NOT a disease or a specific diagnosis.
In fact Colic is a description of a particular behaviour pattern rather than a diagnosis.
. Why it happens
We do not know for sure, but amongst its causes include…
• Reflux
• Formula Allergy –Milk Protein Allergy
• High need babies with sensitive nervous system/ disposition
• Food allergies – through mother
• Lactose Intolerance
• Abnormal gut flora
• Who’s at risk
Mother who are depressed
Smokers
Excessive stress/ anxiety among parents
Dysfunctional Families with poor emotional support at home
Overfeeding the babies
Giving undiluted juices that may lead to excessive gassiness
• How it affects families
Anxiety, stress, lack of sleep, and higher risk of infant abuse.
• Any other points you’d like to share about colic
Recent studies suggest reflux may have a larger role to play in colic than previously suspected.
There maybe an organic basis to colic in many cases. A recent study (Acta Pediatrica 2007) suggests that gut hormones (motilin & ghrelin) may be raised in infants with colic.
Reference: http://www3.interscience.wiley.com/journal/119918935/abstract?CRETRY=1&SRETRY=0
Recently we had a conference of the “Science of Vaccinology” organized by the Vaccination group of Indian Academy of Pediatrics. (www.iapcoi.com)
It was certainly a learning experience with a lively interaction with leading national faculty.
An interesting discussion that occurred was about the role of Pre-exposure Prophylaxis with Rabies Vaccine. This means giving Rabies vaccination to all children or at least all children likely to come in contact with dogs BEFORE a dog bite. Initially most pediatricians were against the idea, because of the following reasons.
Logistics of giving extra vaccines doses
Parental resistance for more vaccines
We do not see a lot of cases of Rabies in practice
However, the experts countered by giving some really impressive points in favor of Routine PEP (Pre-exposure Prophylaxis) with Rabies vaccine to most children.
Rabies is 100 % fatal disease with no treatment. In India, about 15 million people are bitten by animals, mostly dogs, every year and need postexposure prophylaxis. Since 1985, India has reported an estimated 25 000–30 000 human deaths from rabies annually.
Rabies is endemic in India, a large number of pet and stray dogs have it. The dog population of India is around 25 to 30 million animals. Most of these are ownerless or stray dogs. The dog population of India is around 25 to 30 million animals. Most of these are ownerless or stray dogs. About 70% of the victims are children younger than 15 years. Children tend to be bitten in the hands and face, making the bite more dangerous since the rabies virus can reach the brain quickly from these areas.
Even dogs given rabies vaccine, may have rabies, since the vaccine is not very effective. More than 30 % dogs with rabies vaccination in India still have rabies virus in their brain during autopsy.
By giving PEP, you avoid the need for Rabies Immunoglobulin (RIG), which is compulsory for all Class III bites (meaning bites in which blood comes out). RIG is expensive, needs to be injected locally around the wound site, and may not be easily available. Equine RIG is cheaper than human RIG, but may lead to severe reactions. If this is NOT given then there is a small but definite chance that a person may get Rabies even after vaccination.
If you give PEP, all you need are two doses at the time of any dog bite, hence compliance is easily assured.
What is the Schedule for giving Rabies Vaccine?
BEFORE DOG BITE Pre-exposure Prophylaxis (PEP)
Three doses: Day 0, 7, and 28
* Then if a Dog Bite within 10 year – Two doses: Day 0 and 3
* Dog Bite between 10-20 year – Three doses: Day 0, 3 and 7
* Dog bite after 20 years – Full Course
AFTER DOG BITE Post exposure Treatment (after dog bite, no previous rabies vaccine)
Rabies vaccine – 5 doses: Day 0, 3, 7, 14, 28
If bleeding occurs from the site of the dog bite then it is a serious (Class III) bite – So additionally Rabies Immunoglobulin (RIG) local injection in the wound (as much as possible, preferably the entire dose)
If RIG is Not Available, document this fact, and consider 2-1-1 schedule.This means 2 doses of Rabies vaccine on Day 1 at different sites (to get a faster antibody response), and then one dose on day 7 and day 21.
Licks on mucus membrane/ cuts etc. without blood loss (Class II bites) - Only Rabies vaccine 5 doses would suffice
Points to remember
* There is NO SINGLE DOSE rabies vaccine available anywhere in the world!
* The dog’s vaccination status is not to be considered, since more than 30 % dogs with rabies vaccination in India still have rabies virus in their brain during autopsy.
It is commonly seen that many doctors give 3 doses (day 0,3 and 7) in cases where the dog is traceable, and if the dog remains alive after 10 days, they do not give the 4th and the 5th doses. However, it is recommended that since rarely dogs can live longer after rabies disease, this practice should be discouraged. Also, a dose at 28 days will turn this post exposure prophylaxis into a PEP thus reducing the number of vaccinations needed in case of a recurrent dog bite.
Lesson learnt by me:
* I would consider suggesting PEP to at least the parents of children who have dogs/ cats as pets.
* Also monkey bites (but not rat bites) need rabies prophylaxis.
This information is loosely based on the discussion that we had in the Science of Vaccinology session.
It may not reflect the official position of the IAP.
