Shaken baby syndrome (Shaken impact syndrome) is a serious form of abuse inflicted upon a child. It usually occurs when a parent or other caregiver has shaken a baby out of anger or frustration, often the baby will not cry.


Babies have very weak neck muscles that cannot fully support their proportionately large heads. Severe shaking causes the baby's head to move violently back and forth, resulting in serious and somethings fatal brain injury. These forces are exaggerated if the shaking is interrupted by the baby's head hitting a surface.


Is a serious brain injury caused by forcefully and violently shaking a baby? Other names for this condition include abusive head trauma, shaken impact syndrome, and whiplash shaken syndrome. it can result from as little as five seconds of shaking.


Babies have soft brains and weak neck muscles. They also have delicate blood vessels. Shaking a baby or young child can cause their brain to repeatedly hit the inside of the skull. this impact can trigger bruising in the brain, bleeding in the brain, and brain swelling. Other injuries may include broken bones as well as damage to the baby's eyes, spine, and neck.


The shaken baby syndrome is common in children under age 2, but it can affect children up to ae 5. Most cases of shaken baby syndrome occur among infants that are 6 to 8 weeks old, which is when babies tend to cry the most. Playful interaction with an infant, such as bouncing the baby on the lap or tossing the baby up in the air, won't cause the injuries associated with the shaken baby syndrome. Instead, these injuries often happen when someone shakes the baby out of frustration or anger.


Symptoms of Shaken baby syndrome:

Symptoms include:

. Difficulty staying awake

. Body tremors

. Trouble breathing

. Poor eating

. Vomiting

. Discolored skin

. Seizures

. Coma

. Paralysis


Deceleration of the head when it impacts a surface can cause the following:

Subdural hematoma, which is a collection of fo blood between the surface of the brain and the dura.

This occurs when the veins that bridge from the brain to the dura are stretched beyond their elasticity, causing tears and bleeding.

Subarachnoid hemorrhage, which is bleeding between the arachnoid and the brain.

Direct trauma to the substance itself, caused when the brain strikes the inner surface of the skull.

Shearing off or breakage of nerve cell branches in the cortex and deeper structures of the brain caused by violent motion to the brain.

Further irreversible damage to the brain substance from the lack of oxygen if the child stops breathing during shaking.

Further damage to the brain cells when nerve release chemicals that add to oxygen deprivation to the brain.


Retinal hemorrhages ranging from a few scattered hemorrhages to extensive hemorrhages involving multiple layers of the retina.

Skull fractures resulting from impact when the baby is thrown against a hard or soft surface.

Fractures to other bones, including the ribs, collarbone, and limbs, bruising to the face, head and entire body.


Diagnosis:

. Encephalopathy, brain swelling

. Subdural hemorrhage, or bleeding in the brain

. Retinal hemorrhage or bleeding in a part of the eye called the retina.

The doctor will order a variety of tests to check for signs of brain damage and to help confirm the diagnosis. These tests may include:


. MRI scan, which uses powerful magnets and radio waves to produce detailed images of the brain

. CT scan, which creates clear, cross-sectional images of the brain

. Skeletal X-ray, which reveals the spine, rib, and skull fractures

. Ophthalmic exam, which checks for eye injuries and bleeding in the eyes


Irreversible brain damage from shaken baby syndrome can occur in a matter of seconds. Many babies experience complications, including:

. Hearing loss

. Seizure disorders

. Development delays

. Intellectual disabilities

. Cerebral palsy, a disorder that affects muscle coordination and speech


Prevened:
Shaken Baby Syndrome is preventable. You can avoid harming your baby by not shaking them under any circumstances. It's easy to become frustrated when you can't get your baby to stop crying. However, crying is a normal behavior in infants, and shaking is never the right response.

It's important to find ways to relieve your stress when your child cries for extended periods. Calling a family member or a friend for support can help when you feel yourself losing control. Some hospital-based programs can teach you how to respond when infants cry and prevent the injuries associated with the shaken baby syndrome. Make sure your family members and caregivers are also aware of the dangers of shaken baby syndrome.

Shaken Baby Syndrome is completely preventable. Taking care of a baby can present challenges, especially for first- time parents. However, it is important to remember that it is never acceptable to shake, throw or hit a baby.

Asthma is one of the most common health problems affecting around 2 crores of people in India and around 33 crores in whole world level. The death and disability from asthma is seen more in children from the age group 2-14. In asthma the bronchial tubes or air ways get affected. There is a cascade of bio reaction that occurs in the air tubes or respiratory tract of an asthma affected person. The lungs play the major role for gas exchange in our body. Each and every cell of our body gets their oxygen to stay alive. The air goes through the nasal passage and air tubes and reaches at lungs where it absorbs to the blood and finally goes to every cell. When you breath sending oxygen to your whole body and releasing carbon dioxide from the body. The whole function of air exchange is carried out by the respiratory system. The respiratory system consists of different parts or segments those takes the active part in respiratory function. The respiratory function starts from the nose or nostrils and end at lungs.
The pathophysiology of asthma can be explaned as in 2 process –
1) bronchial inflammation,
2) broncho constriction

The bronchial inflammation – in everyday life we exposes thousands of foreign substances which are very minute in size and invisible to naked eyes. Those floats in airs and when we ingest them go inside our body and makes their way into the bronchial passage. The WBC or white blood corpuscles are one component of the complex immune system. There are 5 types of WBC neutrophile, eosinophile, basophile, Lymphocytes, monocytes. Among them the lymphocytes plays a major role in allergic reaction. The lymphocyte are divided into 2 types – the T lymphocytes or ‘T cells’ , the B lymphocytes or ‘B cells’. The T cells and B cells travel everywhere in our body passing through the blood vessels. Their role is to recognize a foreign particles present in the body and then to attack them. When they reach in bronchial airways the T lymphocytes check each and every cell to confirm it whether it is a safe cell or a foreign cell. When the T lymphocytes find a foreign cell then release some chemicals called cytokines. Those cytokines activate the B lymphocytes to convert plasma cell. The plasma cell produces one antibody, IgE anti body that moves and attach to the IgE receptor of mast cell present on the mast cell surface. The mast cells are the specialized cells distributed in various body parts of our body like over skin, inside the respiratory tract, inside the GI tract etc. Those mast cells contains some tiny protein granules called the histamines.
When an antigen or allergen get inside our body and reach in our air space it attached to the IgE antibody of mast cell. When the antigen and antibody unites the mast cell releases its histamines to the surrounding spaces. Those histamines have the pro inflammatory properties. So when they attach to the epithelial cells of bronchial tube with its H1 receptor that present on every cell surface the inflammation starts. So this causes the inflammation of bronchial airways. Due to the btronchial inflammation there is also mucus secretion around the areas.

Bronchial constriction – the bronchial inflammation causes the thickening of the mucous lining of the air tubes and in addition to that over secretion of mucus from the hyperactive mucus glands makes the bronchial spaces narrower and that causes bronchial constriction.
Besides that when there is an inflammation in the bronchial mucous lining the afferent nerves ending of the parasympathetic nerve fiber present in the bronchial airways sends some impulses to the vagus center of the brain stem and then down the vagal efferent pathway to again reach the bronchial small airways and secrets acetylcholine from the nerve ending that stimulate the smooth muscles fibers surrounding the bronchial tubes to be tighten more and more that result bronchial constriction and broncho spasm.

Homeopathy treatment for asthma –
The homeopathy treatment helps to treat the asthma in 2 ways – It controls the acute asthmatic condition by both oral medicines and homeopathy nebulizer (Dr Satapathy’s homeo nebulizer).The acute symptoms of asthma like coughing, chest tightness, wheezing sound, shortness of breath are immediately required to control as quick as possible so the person can breathe freely. There are many homeopathy medicines when selected as per the totality of symptoms of the person can able to control the acute asthma symptoms effectively and rapidly. The medicines for acute symptoms can be given repeatedly even 30 minutes to hour interval till the symptoms are not getting fully recovered. There is no specific medicine for any specific health issues in homeopathy. One medicine can be given in different health problem when the symptoms of the diseased person are fully matched homeopathically with the medicinal symptoms. For example a severe dry cough which worsen on lying posture with gagging or vomiting, suffocative sensation and more cough after drinking cold water can be given one homeopathy medicine ‘spongia’, another person with same dry severe cough but get relief after drinking little cold water will be given another medicine ‘cuprum met’. So here for the same health problem of cough there is two different medicines in which one get relief from tsaking cold water but another get worse, which is the key characteristic symptoms to select the specific homeopathy medicines. Similarly in all asthma symptoms that may be cough or wheezing sound or tightness of chest the medicines are not same for each individual symptom. The selection of medicines is totally depend upon the symptoms of the patient. But it is hundred percentages true that homeopathy has effective medicines for all acute symptoms. If the correct medicine with accurate potency is given it give immediate relieve to the disease. So besides the diagnosis of disease the diagnosis of medicine is highly essential to cure one disease in homeopathy. Unlike other therapist a homeopath has dual responsibility i.e. to diagnosis the disease and then to diagnosis the remedy. But at the same time the mother tincture form of homeopathy medicines have specific effect on a specific health problem like Justecea adathoda mother tincture is generally given for dry cough whatever the characterized symptom present. But the specific homeopathy remedy is generally given in raw form i.e. in mother tincture form or in very lower potency. The alkaloid or active principle of each and every homeopathy medicine has some key therapeutic property. In this regards homeopathic nebulizer developed by Dr.Satapathy do act in same principle and is given to all asthma patients as a common supplementary treatment to control the severity of asthmatic situation. With all the indicated homeopathic acute remedies, Dr.satapathy’s homeo nebulizer offers a rapid and long lasting relief to the acute symptoms of the asthma.
The control of the acute symptoms of the asthma won’t give a long lasting relief. It is the management of acute symptoms for a time period. Because though the symptoms can be well managed by the acute homeopathic remedies for a limited time period , but there is chance of reappearance of asthma symptoms if the patient again being exposed to the triggers. It is because the person’s immune system is still in hyperactive state so whenever he get exposed towards any allergens the symptoms again reappear. The immune system of an asthmatic person is very sensitized to many allergens and when get contact with them develop the asthmatic symptoms. Just to control the symptoms will not cure the asthma in a long term basis because his hypersensitive immune system again will react adversely when again get expose to the same allergen. So for a long term cure it is highly required to modify the hypersensitive immune system of the asthmatic person to a normal functioning immune system. A proper constitutional homeopathy medicines basing upon the homeopathy way of case history taken which covers the common clinical symptoms with their modalities , physical general symptoms, mental general symptoms, miasmatic back ground, past history of any health issues either physical or psychological background, family history of any diseases, if all those taken into consideration then the constitutional homeopathy medicine comes from those symptom similarities basis is the specific medicine for that particular person. If that medicine is given for a considerable time it will help to modify the hypersensitive immune system to normal functioning immune system. This type of homeopathy treatment is called as classical homeopathy treatment. From my 24 years of clinical experience I feel both acute homeopathy treatment along with classical approach of treatment is much more beneficial than alone acute treatment or alone classical treatment.
In spite of that there are many factors those also put bad impact on the immune system and convert its healthy functioning nature to hypersensitive nature. Factors that affect the immune systems are faulty life style, faulty food habits, lack of physical activities, constantly staying in a overstressed condition, side effects of various chemical drugs, obesity, smoking, rise of pollution, suppression of any skin disease, hereditary condition and so many life style changes also responsible for making our immune system hyperactive. So with homeopathy treatment a healthy life style, healthy food habits, healthy mind set up is mostly desirable to cure asthma permanently and forever.

DYSLEXIA ALSO KNOWN AS READING DISABILITY, IS A COMMON LEARNING DISORDER IN CHILDREN. IT IS CHARACTERIZED BY DIFFICULTY IN READING DUE TO PROBLEMS IDENTIFYING SPEECH SOUNDS AND LEARNING HOW THEY RELATE TO LETTERS AND WORDS.


Diagnosis of Dyslexia is based on signs/symptoms related to reading/ learning n academic performance of the children.

डिस्लेक्सिया के कुछ प्रमुख लक्षण :

देर से बोलना सीखना,
नए शब्दों को सीखने/बोलने में दिक्कत,
कविताएं सुनाने में अटकना,
वाणी अस्पष्ट होना.

अपनी आयु के समान बच्चो से पढ़ाई में पिछड़ना,
स्पेलिंग (शब्दार्थ) लिखते समय गलती करना,
लिखावट (हैंड-राइटिंग) अस्पष्ट होना,
सुनी गई बात को समझने और रिप्लाय (उत्तर) देने में परेशानी,
त्वरित निर्देशों को समझ नही पाना,
किसी भी क्रिया को करने की प्रक्रिया स्टेप बाए स्टेप फॉलो नही कर पाना.


By applying specific therapeutic strategies and special education techniques,children with Dyslexia can lead a normal productive life.

Diarrhea management in children
Passage of 3 or more loose stools in 24 hours period is considered diarrhea. A change in consistency and frequency of stool pattern is noticed by parents. It is estimated that on average a child under 5 years of age will have approximately 3.2 episodes of diarrhea per year. The loss of liquids caused by diarrhea can lead to dehydration and disturbances in body electrolytes which may require medical treatment.
What causes diarrhea in children?
Gastrointestinal tract infections – Mostly Viral, also bacterial and protozoal are the cause of diarrhea. Many a times there may be a non-infectious cause of diarrhea (antibiotic induced, lactose intolerance, etc.)
Additional complaints
Child having diarrhea can also have Vomiting, Fever, Abdominal Pain and Decreased Appetite.
What can parents do at home?
ORS (Oral rehydration solution) should be started for child having loose motions. Parents can also start with home available fluids like dal water, sugar-salt solution (Half teaspoon salt+ 8 teaspoon sugar added to a liter of clean 1 liter water). Parents should consult doctor urgently if:
1. Child is becoming very sleepy or irritable
2. Child is having multiple vomiting and is not able to drink ORS
3. Eyes of child look sunken into the orbit.
4. Child is passing blood in stools
Medical management of diarrhea:
World Health Organization emphasizes on 3 points in management of any acute childhood diarrhea. These are ORS, Feeding and Zinc supplementation. Since most of diarrhea episodes are due to viral infections most children recover with ORS and Zinc therapy. Feeding should not be stopped during diarrhea. Doctor examines the child to look for any dehydration (decrease in body water), rule out possible bacterial cause of diarrhea (which might require antibiotics), other causes of loose motions (transitional stooling in newborns, increased gastro colic reflex, toddlers diarrhea etc.). Antibiotics are not required for every case of diarrhea. Stool or blood tests are not required usually but doctor may decide to perform some tests if diarrhea gets prolonged to more than 2 weeks and in some other conditions.
How to Prevent Diarrhea:
1. Hand washing - after playing outdoors, after going to toilets, before having meals.
2. Prevent eating out at places that seem to have doubtful hygiene standards.
3. Exclusive breast feeding for first 6 months of life prevents diarrhoea episodes in young infants; Bottle feeds can prolong a diarrhoea episode and can be a cause of recurrent loose motions in a child
4. Vaccine: Vaccine to prevent diarrhea caused by Rotavirus is available.

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