FITTING? DON'T TOUCH THAT SPOON

 

 

 I remember the first time I saw someone having a fit, it was scary, almost traumatic. I was in a reading room in med school preparing for a test, when all of a sudden, I heard a thud right behind me. Startled, I sprang out of my seat, turning back to see one of my friends on the floor, convulsing. The fit lasted a few minutes after which his friends helped him up and out of the reading room. The incident ended my reading-in that reading room- then and subsequently, for good. Being around someone having fits can be a scary experience, especially when it’s a close friend or relative. It sometimes looks like the person is about to die and nothing can be done to help.

 

Fits are caused by abnormal electrical activity in the brain leading to involuntary movements of the limbs with a change in the sufferer’s consciousness. Some causes in this environment include:

·   Febrile illnesses; illnesses that markedly raise body temperature for example malaria and respiratory tract infections(in which case it is known as a febrile convulsion and it’s seen in children aged 6months to 6 years)

·    Infections of the brain(encephalitis) and the brain coverings(meningitis)

·    Epilepsy; a condition in which a person has  recurrent seizures,

·    Head injury e.g. from trauma

 

One of the first things that people do when someone around them starts fitting is to look for a spoon or any other object available to put in the person's mouth. It’s believed that this will prevent the person from swallowing his tongue or biting it. This is a dangerous move as putting a spoon/any object in a fitting person's mouth can lead to injury to the persons gum, damage to the teeth and  they could even swallow the object(the spoon) leading to injury to the person’s throat and obstruct breathing. The person trying to help can also get injured in the process. Although a person convulsing, can bite the tongue, the injury caused by this is less than what happens when objects are put in their mouth.

Most seizures last for a short time(seconds to minutes), and a good way to help is to move away furniture(or any other object) that can injure the person e.g.  tables with sharp edges, chairs. Also, loosen any tight clothing around their neck and if possible, lie them on their side. Place something soft under the person's head to stop their head from hitting the floor, but do not restrain them. Finally seek medical intervention.

Don't cause more harm by trying to be helpful. Don't touch that spoon.

What you need to know about your child's diarrhoea

''Doctor, my child has been passing frequent watery, foul smelling stools for the last 3 days'' - is a very common complaint in the out patient children's clinic. Sometimes the children look well, but many times they look very ill and severly dehydrated. Children are at a greater risk of life threatening dehydration than adults when they have diarrhoea, because a larger proportion of their body weight is made up of water, and they use up water more because of their higher metabolic rate. When diarrhoea starts, children are also at risk of malnutrition, as nutrients are lost with water in stools.

According to the World Health Organisation, Diarrhoea (which is when a person passes 3 or more watery stools in a day), is the 2nd commonest cause of death among children under the age of 5years globally. It causes more deaths than malaria, AIDS and Tuberculosis combined. These deaths are caused by severe dehydration and malnutrition

Children can develop dehydration very quickly and its important to act fast to keep them hydrated and well nourished. The following is a list of home care to be given before a child gets to the hospital.

Do !

1. Give a lot of fluids

• Oral Rehydration Solution(ORS) is a prepackaged powder which contains all the electrolytes that your childs body needs to replace what is lost. It can be purchased in any local pharmacy. Mix with clean water(usually 1 litre) according to the instructions on the pack and give your child to drink. It should also be given to children who are exclusively breastfed.
• If you do not have ORS at home and cannot get it immediately, you can prepare Salt Sugar Solution. This is prepared by mixing is 6 level teaspoons of sugar, 1/2 level teaspoon of salt and 1 litre of clean water.
• Other home fluids that can be used to prevent diarrhoea are Salted yoghurt, salted chicken or vegetable soup, salted rice water or clean water.

2. Continue feeding; A lot of people stop feeding their children when they have diarrhoea, fearing that it will make it worse. Diarrhoea leads to loss of nutrients from the body and malnutrition, its outcome is also worse in children who are already malnourished. A strong and well nourished child recovers faster and better from a diarrhoeal episode.

• If your child is less than 6months of age and is being exclusively breast fed, increase frequency of breastfeeding and length of time spent breast feeding your child.
• If your child has started other meals with breast milk, continue breastfeeding as above and encourage your child to eat as often as he/she wants. Small frequent feeds can be given.

Don't !

1. Do not give anti motility drugs. A common example in this environment is Diastop. These drugs may reduce pain and reduce the volume of diarrhoea, but they delay elimination of the organism from the child's body, thus prolonging their illness and this can be harmful especially in children under the age of 1year.
2. Do not stop feeding
3. Do not give antibiotics; Do not give your child over the counter antibiotics for their diarrhoea. Its common for parents to buy flagyl and septrin for their children with diarrhoea, this is a dangerous habit. The commonest cause of acute watery diarrhoea in children is rotavirus. Indiscriminate use of antibiotics may lead to resistance and some are harmful to children. Antibiotics should be given under a doctor's guidance.
4. Do not give sweet drinks like soft drinks, sweet fruit drinks, sweet tea. Foods or drinks with a lot of sugar can worsen diarrhoea.

Other intervention methods like Zinc supplementation and Rota virus vaccination will be given in a health centre. Its important to institute these intervention methods at home as soon as diarrhoea starts and take your child to a hospital for assessment.

Reference: UNICEF/WHO, Diarrhoea: Why children are still dying and what can be done, 2009