An Easier Management Of Dehydration In Children

- Prof. Vd. M. P. Prabhudesai
M. F. A. M., A. V. P.
- Vd. Mrs. M. M. Prabhudesai
B. A. M. S. (Mumbai)
Sawantwadi, Dist.- Sindhudurga. Pin - 416510

Introduction:

When we decided to leave Mumbai and settle in Konkan area of Maharashtra, we had certain ideas in our minds. Present study is a humble effort towards one of our ideas, i.e. to make low-cost effective remedies available to poor, needy rural people.
There are many traditional remedies prevalent in our area, which we could know while discussing with traditional birth-attendants and traditional healers, in our area. We heard them telling that patent bregma (i.e. Talu) in infants has an exceptional capacity of absorption and this route may be used in treating dehydration in them. Out of various methods practiced in our area, one is to apply absorbent cotton soaked in breast-milk to patent bregma of dehydrated infants, repeatedly, till the patient recovers.
In February 1989, we got chance to try this method in a dehydrated baby, 28 days old, in which all the available methods for dehydration, including i.v. Infusion, were failed. Along with loose motions it had vomiting as well. It parents were very poor and due to lack of conveyance (only two S.T. buses out in a day) they were unable to shift the child to Govt. Hospital, which is only 30 Kms. from our place. As the parents showed full faith in us we decided to try this simple method. Being encouraged by the favorable results in the patients we tried this method successfully in 33 babies till the end of September 1989.
When we presented the case study in Third International Congress in Traditional Asian Medicine at Mumbai, in January 1990, we received many letters of encouragement and after a personal scientific communication we decided to modify this method a little, because of which we could cover children up to 6 years of age, which is supposed to be the high-risk age group.
In this modification we tried and advised massage to the whole body of the patients with naturally available milk (i.e. cow's, buffalo's, or breast) and milk-soaked cotton-swab was applied to the patent bregmas of younger babies, as well.
An attempt is being made here with positive treatment to present our practical experience during these efforts.

Selection of patient:

During initial trial we selected dehydrated babies up to the age of 1½ year, i.e. before ossification of anterior fontanelle (i.e. with patent bregma); but for modified experiment we preferred children up to 6 years of age, who were suffering from dehydration.
Till now only 72 cases are on record (including 33 cases of initial trial) as the village that we have chosen for service to rural people has total population not exceeding one thousand five hundred only and secondly, it is very difficult to convince the illiterate parents to allow us this unusual experiment on their severely ill children.
We have omitted the children with vomiting of cerebral origin and with fourth degree dehydration.
Thus, for selection of children in this experiment we applied two main criteria as follows-
1. Age of the child under trial should not be more than 6 years; and
2. The child under trial should be dehydrated.

Method:
In our initial study we applied absorbent cotton-swab soaked in naturally available milk to patent bregmas of dehydrated babies and before it could become dry, it was replaced by another swab. This was repeated till applied swab remained wet approximately more than one minute.
In the modified method, all children under trial were massaged with naturally available milk, all over the body till its rate of disappearance was markedly diminished and their skin regained its normal luster and elasticity. This procedure was also followed in younger babies with patent bregmas.
As for as possible we preferred breast-milk to apply at Talu in babies with patent bregma and for massage we used any of the naturally available milk.
We omitted re constituted milk for this particular study, which is not easily available in our area.
Especially the children with severe and repeated vomiting were stopped all oral feeds.

Observations:
The work is going on, but for the purpose of communication, the group of 33 babies of our initial trial (i.e. group one) and the groups of 39 children of our modified experiment (i.e. group two) are being analyzed. The number of patients is comparatively less; as many of the outpatients have not appeared again for follow up examination.
Our observations are as follows-
1. Immediate observation after applying milk-soaked cotton-swab to Talu of dehydrated babies was that the swab becomes dry after some time.
2. Similarly after massaging the whole body with natural milk, it was disappeared in the skin.
3. Both above observations clearly indicate absorption of milk through skin and anterior fontanelle (i.e. Talu) and the rate of absorption was found to be equally proportional to the degree of dehydration.
4. Signs of rehydration were seen in babies under trial, within ten to thirty minutes depending upon degree of dehydration.
5. The milk applied over whole body of the baby, turned into a whitish layer as the signs of dehydration got reduced & we thought this was the marker to assume that dehydration Is under control.

Table showing age-wise classification

Age of patient Male Female
Group One
1. Less than one month
2. Between 1 to 2 months
3. Between 2 to 6 months
4. Between 6 months to 1 year
5. Between 1 to 1½ years
1
1
4
8
7
1
1
3
3
4
Total 21 12




Group Two
1. Less than 6 months
2. 6 months to 1½ years
3. 1½ years to 3 years
4. 3 years to 6 years 6
4
9
3 3
5
6
3
Total 22 17

Table showing degree of dehydration

Sr.
No Degree Group One Group Two
Male Female Male Female
1.
2.
3. First
Second
Third 11
7
3 3
2
7 11
7
4 2
7
8
Total 21 12 22 17

Table showing symptom-wise classification


Group Symptom
Only loose motions Loose motions with vomiting

1.
2. Male Female Male Female
16
16 8
10 5
6 4
7
Total 32 18 11 11

Discussion and Conclusion:
According to W.H.O., dehydration is supposed to be No. 1 killer in children less than 6 years of age. So especially in areas where communication or expertise is not available, a simple method to manage dehydration is very much desired. Naturally and easily available substance like milk (cow's, buffalo's or goat's or breast) when properly used especially in remote rural areas can avert the risk and provide relief to patient and parents.
Established ways for rehydartion, at times, fail for lacking in getting proper (and cheaper) route. In attempt to find a route (especially intravenous) aseptic precautions are not that meticulously followed. So the risk of infection is much more and disastrous, on background of dehydrated stage. So more substitute mean and method utilized to compensate the risk will be very much appreciated.
So an attempt was done to try this positive drug, non-blind schedule of scrutiny. The single or double blind pattern was not desired in the emergency situation of dehydration. Placebo or otherwise intervention could not be thought of both ethically and by social circumstances.






This simple method for rehydration has following advantages:

1. This method is very simple and safe. The material required for management is easily and naturally available, almost everywhere and the risk of excess-dosage is not there.
2. It can be tried at home, thus may save many man-hours of parents, anxiously strained and wasted during hospitalization of their child, for i.v. infusion. Even non-earning domestic member of the family can carry out this method at home.
3. It will help to minimize the risk of probable introduction of infectious (like virus B hepatitis, aids etc.) through i.v. route or i.v. infusion fluids, especially where the social and professional meticulosity for asepsis is less.
4. This, being almost a no-cost remedy, will bring down the total cost of treatment, especially desirable in developing countries, like India.
5. Mother's scientifically health-valuable breast-milk, which is otherwise shunted out with psychologically painful stimuli, in case of severely vomiting child; is used in this method. So the mother is satisfied to see her breast-milk is utilized for her baby, & not wasted.
Additionally, it may prevent problem breast-abscess risk.
6. This method is definitely more useful than present O.R.S., especially so in children with total rejection of any oral intake.
7. As it covers the major risk-age-group dying by dehydration, it will be an additional support to M.C.H. scheme to deal with the killer No.1 of children.

We are quite aware of this positive non-double-blind management's limitations. It may have lesser scientific weightage. But the fact remains that within the situation, with limited economic and social aspects, at remote and least communicable areas; especially in rainy season and quality of professional skill and care unavailable, the report has golden merits.
While summing up we wish "best of health to all"

सर्वेऽत्र सुखिनः सन्तु सर्वे सन्तु निरामयाः।
सर्वे भद्राणि पश्यन्तु मा कश्चित् दुःखभाग्भवेत॥

This paper was presented in-
1. Third International Conference on Yoga and Ayurveda (IASTAM) at Mumbai in January 1990
and
2. Fourth World Congress on Ayurveda at Bangalore in December 1991.


Contact:
- Prof. Vd. M. P. Prabhudesai
- Vd. (Mrs.) M. M. Prabhudesai
Dhanvatari Ayurvedic Panchakarma Chikitsalaya
Sawantwadi, Dist. - Sindhudurga.
Maharashtra, Pin- 416 510.
INDIA.
Mobile - 9422435323, 9423884321
E-Mail: - dr_murali13@yahoo.co.in
vdmrsmadhuri@gmail.com