Deepak,3 month old male baby, of middle soccioeconomic class persented to us with poor feeding and irritable behavior. Born to nonconsaguinious marraige ,by NVD, CIAB, with unevevntfull 3 month home staying,

Baby put on broad spectrum antibiotics and relavant investigation sent. All parameters are normal except leucopenia.
Since baby in delhi (Dengue zone)so we send sample for Dengue NS1 as cause for letharginess. we surprise by knownig it is postive. It is repated twice for confirmation it postive again.

Local epidemics / disease pattern must be kept in mind for any unusual presentation even in small baby.

Case Report May-August, 2011/Vol 31/Issue 2
May-August, 2011/Vol 31/Issue 2 -146- J. Nepal Paediatr. Soc.
Wiskott Aldrich Syndrome, often Missed: A Case Report and
Review
Kumar MK1, Narayan R2
1Dr. Mani Kant Kumar, MBBS, MD. Assistant Professor, 2 Dr. Raghvendra Narayan, MBBS, MD. Associate Professor.
Both from the Department of Paediatrics, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India.
Address for Correspondence: Dr. Mani Kant Kumar,

Abstract

Wiskott-Aldrich syndrome is an X-linked recessive disorder characterized by thrombocytopenia, eczema
and recurrent infections. We report a 15 month old boy who had presented with lower gastrointestinal
bleed, recurrent infections and eczema. Blood picture revealed microthrombocytopenia, high IgA and
IgE, and low IgM and Normal IgG levels. A diagnosis of Wiskott-Aldrich Syndrome was made, which was
missed by many paediatrician even after prolonged hospital stay before admission in our Institute. The
recent progress in understanding of the pathophysiology and treatment are discussed.
Key words: Wiskott-Aldrich syndrome, Eczema, Microthrombocytopenia


Introduction
Wiskott-Aldrich Syndrome (WAS) is an X-linked recessive disorder characterized by a triad of thrombocytopenia with decreased mean platelet volume, eczema, and increased susceptibility to pyogenic and opportunistic infections1. Immunologically, there is poor antibody response to polysaccharide antigens, progressive decrease in T cell number and function, and a characteristic immunoglobulin profi le refl ected in low IgM, elevated /normal IgA, elevated IgE and normal/ low IgG levels2.

The rapid destruction of abnormally shaped platelets is the primary cause for severe thrombocytopenia in WAS patients3. The immunodefi ciency in WAS is primarily associated with T- and B-lymphocyte dysfunction. The protein encoded by the WAS gene (WASP) is a hematopoietic specifi c regulator of actin nucleation in response to signals arising at the cell membrane4. Mutations impairing but not abolishing WASP expression can cause X-linked thrombocytopenia (XLT) and is considered an attenuated form of WAS because it is
characterized by low platelet counts with minimal or no immunodefi ciency5.

Purpose of reporting this case to increase awareness among paediatrician of developing countries regarding high index of suscpicion and to think other possibilities if any patient not improving to the exetent expected inspite of adequate treatment. Here we are reporting a case with Wiskott-Aldrich syndrome from Bihar, India and recent progress in understanding the pathophysiology of the disease and treatment are discussed.


Case Report

A 15-month-old boy, born by spontaneous vaginal delivery of a non-consanguineous marriage presented with second episode of bleeding per rectum. There was no history of decreased urine output, no abdominal pain, no swelling over body, no family history of similar illness
in family. There was history suggestive of recurrent sinopulmonary and soft tissue infections, eczematoid rashes which was started form scalp and gradually progressed to all over body since early infancy which was treated by many paediatricians. First episode of bleeding per rectum occurred 2 months back, during fi rst episode initially treated by a paediatrician as case of dysentery but no improvement in the bleeding then he referred this case to another hospital, where he was diagnosed as case of Hemolytic Uremic syndrome. Patient was hospitalized for 40 days and managed with 6 times fresh whole blood transfusion, broad spectrum antimicrobials and was discharged on request when J. Nepal Paediatr. Soc. -147- May-August, 2011/Vol 31/Issue 2 asymptomatic for 5 days. After 15 days of discharge
patient again developed bleeding per rectum then brought to our institute. Investigation during fi rst episode revealed Hemoglobin 7.5 gm/dl, TLC 12400/cmm, DLCP 58, L40, E02, Platelet count 20,000/cmm, general blood picture (GBP) - microcytic hypochromic anemia, no
fragmented RBC, Tiny platelets, no immature cell, blood urea 18mg/dl, Creatinine 0.6 mg/dl, urine was normal normal on routine examination and microscopy, inspite of 6 times fresh whole blood transfusion predischarged platelet count was 36,000/cmm.

On admission in our hospital he was afebrile, alert and active. He had mild pallor pulse rate 92 per minute, respiratory rate of 32 per minute, weight 5.5 kg (less than 3rd centile), length 70 cm (less than 3rd centile), sparse hair and eczematoid rash over the scalp, neck, skin folds of upper and lower limbs. His head circumference was 43 cm (normal for age) and chest circumference 41 cm. There were no congenital malformations. Respiratory, cardiovascular and central nervous system were within normal limits while the liver was palpable 1
cm below the costal margin. Laboratory investigations revealed hemoglobin (Hb) of 9.6gm/dl, total leukocyte count 11,800/cumm and platelet count 25,000/cumm. PT (Prothrombin time) was 13 seconds and aPTT was 31 seconds. General blood picture revealed normocytic
hypochromic with microthrombocytopenia. Blood urea was 16mg/dl and creatinine was0.6mg/dl and Urine was normal on routine examination and microscopy, urine culture was sterile. Immunoglobulin profi le showed high IgA (179mg/dl, normal less than 83 mg/dl for age ), low IgM (95mg/dl, normal >145 mg/dl), High IgE (1560unit/ ml normal 1.4- 52.3 unit/ml for age) and normal IgG (1378 mg/dl), HIV serology was negative.

Patients was managed with oral antimicrobials, multivitamins, one time@ 20ml/kg fresh whole blood transfusions(because platelets concentrates not available in our blood bank) and IV immunoglobulin at rate 400mg/kg, he improved gradually, and pre discharged platelets count was 55,000/cumm. Parents were counselled regarding available treatments options and after 7 days of hospital stay he was dischared on Co-trimoxazole prophylaxis, multivitamins & iron supplementation, emmoliants as advised by dermatologist with advice of monthly IV Ig replacement therapy. He was on regular monthly Immunoglobulin replacement therapy in follow up and doing well, and
has gained weight 2 kg over past 5 months.


Discussion


The present case demonstrated characteristic clinical triad of Wiskott-Aldrich syndrome-intermittent bleeding because of thrombocytopenia, progressive eczema since early infancy and recurrent sinopulmonary bacterial infections. Immunoglobulin profi le showed high IgA, low IgM, High IgE and normal IgG. Small platelets size and low platelets count clinched the diagnosis in favour of Wiskott - Aldrich syndrome. At a later age when T cell functions are affected, opportunistic infections may occur. Children who survive the fi rst 8-10 years are at risk for the development of lymphoid malignancies. The diagnosis of Wiscott Aldrich Syndrome is based on the demonstration of increased serum IgA and IgE and decreased serum IgM levels, absence of isohemagglutinins, and poor anti-body response to polysaccharide antigens in males with characteristic constellation of clinical features2. Wiskott-Aldrich syndrome is a complex and severe X-linked disorder characterized by microthrombocytopenia, eczema, immunodefi ciency, and increased risk in developing
autoimmunity and lymphomas.

WAS affects 1 to 10 of every 1 million male newborns and their life expectancy is approximately 15 years. The protein encoded by the WAS gene (WASP) is a hematopoietic specifi c regulator of actin nucleation in response to signals arising at the cell membrane4,5.
Among clinical manifestations, hemorrhages are frequent (80% incidence) in WAS and range from non– life-threatening (epistaxis, petechiae, purpura, oral bleeding) to severe manifestations, such as intestinal and intracranial bleeding. Death of WAS patients
is caused, in 21% of the cases, by haemorrhages6. Bleeding is the result of severe thrombocytopenia with reduced platelet size, which is the most common fi nding in WAS and XLT patients (100% incidence). Thrombocytopenia occurs irrespectively of the severity
of the mutation and is possibly caused by instability of mutated WASP in platelets7. Despite intensive research, the mechanisms underlying WASP related thrombocytopenia and hemorrhages are not completely understood. Megakaryocyte numbers have been
reported to be normal in the majority of WAS patients, whereas proplatelet formation depending on actin polymerization and formation of branching structures is conserved when tested in in vitro and ex vivo cultures8. Peripheral destruction of platelets in the spleen is thought
to play an important role in thrombocytopenia because a substantial correction of the platelet count and size after splenectomy has been reported. The accelerated destruction could be caused by an intrinsic defect of WASP-defi cient platelets, showing an increased surface
exposure of phosphatidylserine, or could be mediated by autoimmune reaction because of the presence of antiplatelet antibodies reported in patients and in the murine knockout model9. May-August, 2011/Vol 31/Issue 2 -148- J. Nepal Paediatr. Soc. The typical skin lesions in WAS patients resemble acute or chronic eczema in appearance and distribution. Eczema develops in 80% of the patients6
and is heterogeneous in severity and persistence. The causes of eczema in WAS patients are currently unknown. WAS patients often have elevated IgE levels and develop allergies therefore suggesting an atopic origin10. Recently, an imbalance in cytokine production toward the Th2 type has been described in WAS patient’s T-cell lines and might contribute to the pathogenesis of eczema and allergy11. WAS-associated autoimmune complications are frequently observed. The incidence of autoimmunity in classic WAS is high in the US and European populations (40%-72%), whereas a lower incidence was reported in Japan (22%)6,10,12. The most common manifestations are autoimmune hemolytic anemia, cutaneous vasculitis, arthritis, and nephropathy. Less common autoimmune manifestations include infl ammatory bowel disease, idiopathic thrombocytopenic purpura, and neutropenia. Patients frequently have multiple autoimmune
manifestation at the same time. Development of autoimmunity have a poor prognosis12. Until now, the mechanisms of WAS-associated autoimmunity have not been clarifi ed. It has been proposed that autoimmunity could be the result of a bystander tissue damage
originating from the chronic infl ammatory state that is established after incomplete pathogen clearance13. Moreover, autoimmunity is associated with a higher risk of a later development of tumors and an increased risk of mortality6. Two distinct surveys report a tumor
incidence of 13%6 and 22%10 in WAS patients. Tumors can arise during childhood (especially myelodysplasia) but are more frequent in adolescents and young adults. WAS-associated tumors are mainly lymphoreticular malignancies, with leukemia, myelodysplasia, and
lymphoma (often Epstein-Barr virus [EBV]–positive) resulting in up to 90% of the cases. WAS-associated malignancies have a poor prognosis because less than 5% of patients survive 2 years after diagnosis6, and result in up to 25% of death cases13. WASP is a
key regulator of actin polymerization in hematopoietic cells. As a cytoskeletal regulator, it is necessary for induction of normal immunity. WASp functions as a bridge between signaling and movement of the actin fi laments in the cytoskeleton. WASp has several welldefi
ned domains (pleckstrin, cofi lin, verprolin, SH3) that are involved in signaling, cell locomotion, and immune synapse formation. In vitro studies with T cells, platelets, phagocytes, and dendritic cells of patients with Wiskott-Aldrich syndrome reveal defects in the
formation of microvilli, fi lopodia, phagocytic vacuoles, and podosomes, respectively; these structures depend on cytoskeletal reorganization of actin fi laments.

Researchers also identifi ed many different mutations that interfere with the protein binding to Cdc42 and Rac GTPases, among other binding partners, most of which are involved in regulation of the actin cytoskeleton of lymphocytes14,15. The actin cytoskeleton
is responsible for cellular functions, such as growth, endocytosis, exocytosis, and cytokinesis. Mutations of WASP are located throughout the gene and either inhibit or dysregulate normal WASp function. WASp facilitates the nuclear translocation of nuclear factor kappa-B (NFkB) and was shown to play an important role in lymphoid development and in the maturation and function of myeloid monocytic cells. In mice, WASp was found to be essential for NF-ATp activation, and for nuclear translocation of p-Erk, Elk1 phosphorylation, and c-fos
gene expression in T cells. These defects in mutated forms of WASP are the likely etiology of defective IL-2 expression and T-cell proliferation in Wiskott- Aldrich

Syndrome.

Research has shown phenotype-genotype correlation. Classic Wiskott-Aldrich syndrome, X-linked thrombocytopenia, and X-linked neutropenia occurs when WASp is absent, when mutated WASp is expressed, and when missense mutations occur in the Cdc42-binding site, respectively16. Pre-natal diagnosis is possible using DNA technology, either by direct identifi cation of mutation or by linkage.
Treatment is directed mainly at control of bleeding through transfusions of blood and platelets, and control of infections with antibiotics and Immunoglobulin replacement. Splenectomy improves the platelet number but makes the patient susceptible to sepsis, requiring
life long prophylaxis with antibiotics17. Immunoglobulins given intravnously may be helpful in prophylaxis of both viral and bacterial infections, but do not improve thrombocytopenia. Eczema is diffi cult to manage and may persist even after long term use of local steroids.
Currently, the only curative therapeutic option for WAS patients is hematopoietic stem cell transplantation (HSCT). When a related human leukocyte antigenidentical donor is available, HSCT leads to more than 80% survival rate. On the other hand, transplantation using the bone marrow of a mismatched related donor results in a decreased survival rate18,19,20,21. When a suitable related donor is not available, bone marrow or cord blood transplantation from a matched unrelated donor is a valid therapeutic option, leading to a 71% to
81% survival rate19,20,22. A better outcome for matched unrelated donor and mismatched related donor HSCT in patients younger than 5 and 2 years of age, respectively, has been reported, suggesting that transplantations should be performed early in life19,20,23.
J. Nepal Paediatr. Soc. -149- May-August, 2011/Vol 31/Issue 2 The fi rst reported case of sucessful BMT for WAS in India from Christian Medical College and Hospital, Vellore24. The implementation of new therapeutic strategies, such as transplantation of autologous genecorrected hematopoietic stem cells, is highly desirable because it will avoid rejection and graft-versus-host disease and could be applicable to all WAS patients lacking a suitable bone marrow donor, allowing the timely treatment of the disease. The rationale for
gene therapy is also supported by the observation of frequent spontaneous somatic revertants conferring selective advantage to WASP expressing cells25. At present, retroviral vectors based on the murine Moloney leukemia virus have been used for the treatment of
patients with SCID-X1, ADA-SCID, and X-CGD26,27,28. Recently, a gene therapy trial for WAS was initiated in Germany using a murine Moloney leukemia virusderived retroviral vector encoding the full WASp cDNA. Preliminary data from the fi rst 2 patients 18 months
after gene therapy indicate amelioration of the clinical phenotype with correction of thrombocytopenia and resolution of eczema and autoimmunity29. Dupre L et al have demonstrated that lentiviral vector encoding a 1.6-kb fragment of the human WAS endogenous
promoter (w1.6WLV) is able to successfully restore WASP expression in CD34_ HSCs, T cells, B cells, and DCs, and to correct TCR-driven activation in T-cell lines derived from WAS patients30. However gene therapy using a lentiviral vector is still in experimental phase in
animal model for the treatment of WAS. WAS patient should be immunized except live vaccine because a protective antibody response often obtained.


Conclusion


We should have high index of suspicion of WAS if any patient presented with bleeding manifestation with history of recurrent sino-pulmonary infection and eczema especially at centres with limited resources in developing country, because early diagnosis and
treatment has better prognosis.


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How to cite this article ?

Kumar MK, Narayan R. Wiskott Aldrich Syndrome, often Missed: A Case Report and Review. J Nep Paedtr Soc
2011;31(2):146-150.

Sarthak,6 month/M/ch/ product of nonconsgiaunous marraige persented to us with complain of anemia and ,hepatosplenomagaly. baby was investigated throughly and it is found that baby with IGM postive for C M V.

After 2 month of apprentely asymptomatic period baby developed right hand bluish discoluration, to conform etiology CT angio done it ifound that there is fusiform swelliing of whole subclavion ,brachial and radial artery with nonvisuliation of radial artery

Radiologist make diagnosis of Kawasaki diseseas
Baby put on LMW heparin with IVIG.

NUTRITIONAL NEEDS OF CHILDREN

There are two fundamentally different kinds of food needs- energy requirements & structural requirements. The body requires energy for many activities such as beating of the heart, breathing, digestion of the food & voluntary muscular activity. Energy is also needed for growth. This energy requirement expressed in calories is obtained chiefly from carbohydrates & fats.

1. Energy Requirements: The amount of energy needed in terms of calories varies from individual to individual & is dependant upon a number of variables, none of which can be considered independently but rather are part of a constellation. It differs with size. A large child requires more energy producing foods than a small child. It differs with the rate of activity of the body processes while at rest, i.e. with a basal metabolic rate. The faster the rate of basal metabolism, meaning the faster the heart beat, respiration etc. The greater the number of calories used in a given time & conversely, the lower the rate, the lower the number of calories needed.
The energy requirement differs too with the amount of voluntary activity. A very active child requires more calories per day than a quiet one. The same child will need more calories during a day of vigorous activities than during one of quiet activities.
Energy requirements differ also in accordance with the efficiency of the body in using foods. Some bodies are more economical in the use of foods than others. In some cases food is more easily digested & absorbed than in others. In all individuals some food value is lost in bowel elimination, but the amount varies considerably from child to child. Finally, the need for calories depends on the rate of growth. The fast growing child will need more calories than the slow growing child. During the periods of his life when the impetus to grow is more intense, infancy & early adolescence, the amount of energy required for growth will be greatest.
In proportion to their weight, children’s food needs are greater than those of adults because of children’s relatively greater basal metabolism, their tremendous activity & their growth. Boys generally catch up with their fathers in need for calories at 13 years & exceed them by 16 percent at 18. By 10 years of age girls already exceed their mothers by 11 % & at 13 by 16 % in their energy needs.

2. Structural Requirements: the structural requirement covers the need for materials which go to make up tissues & to regulate the functions of those tissues. The necessary food elements or nutrients are 40 in number. They include amino acids from proteins, at least one digestive product of carbohydrates (glucose), some unsaturated fatty acids or acids (derived from the digestion of fats), minerals & vitamins. The body needs all these in adequate amounts for the building & repair of its tissues & for these tissue’s daily activities. Since all foods do not contain all of these nutrients, a balanced diet of “protective” foods, i.e. foods rich in the essential nutrients, is necessary.

3. Importance of Minerals: Minerals serve as constituents of tissues. Calcium & Phosphorus are responsible for the rigidity of the bones & teeth. The softer bones of children contain less minerals than the firmer bones of adults. The process of hardening called ossification demands Calcium & Phosphorus in generous quantities. An inadequate amount of these minerals may result in poor teeth & poorly formed bones. Poor teeth are a barrier to good health & attractiveness. Poorly formed bones detract from the attractiveness of an individual & limit his physical efficiency.
Minerals serve as regulators of body process. The part played by minerals in the beating of the heart & in the activity of the nerves has been mentioned. For coagulation of the blood the body needs calcium in the blood. Phosphorus takes part in the chain of events in muscle activity & in the transfer of energy. The digestive juices such as salivary, gastric & intestinal juices, depend upon minerals for their acidity or alkalinity. Minerals regulate the flow of liquids by means of which substances are absorbed, passed to and from body cells & excreted through kidneys or intestines.

4. Importance of Vitamins: The vitamins, as regulators of body processes, have a vital role to play in keeping children well & furthering their development. The vitamins now recognized as contributing to the health & growth of children are Vitamin A, D ,C, K, Thiamine, Riboflavin, Niacin, B-6, Folic acid & B-12. Vitamin K aids in the formation of prothrombin, which is associated with the mechanism of blood clotting.

VITAMIN –A : is a necessary part of the visual process & thus is associated with the ability to see in dim light. Vit-A is also necessary for maintaining the health of epithelial tissue, namely, the tissue of skin, covering of the eye, the lining of respiratory, alimentary & genitourinary tracts. Deficiency of Vit –A structurally impairs “the body’s first line of defense”. In addition it is necessary for the orderly development of bones & teeth. It is also essential for the formation of enamel of teeth.
Source of Vitamin A - Milk, Butter, Liver, Fish Liver Oils and Egg Yolk.

VITAMIN –D : IS essential for the normal growth & mineralization of the bones & the teeth. The body cannot make proper use of the Calcium & Phosphorus supplied by food unless Vit- D is present.
Source of Vitamin D - Fish Liver Oil, Milk, Butter, and Yeast.

Thiamine (Vit- B 1) : Is one of the vitamins in the B-Complex. Thiamine is essential for the maintenance & normal function of the nervous system. It has been found that Thiamine is necessary to carry carbohydrate metabolism through an essential step.
Source - Cereals, Grains, Beans, Nuts, Pork and Duck.

RIBOFLAVIN (Vit-B 2) : Plays an important role in the internal environments in which the body cells live, where it is involved in the life processes of active cells. Riboflavin is essential to growth & to normal nutrition at all ages. A deficiency produces characteristic changes in the lips, tongue & skin.
Source - Dairy products, offal and leafy vegetable.

NIACIN: Is involved in the life processes of the cells. It prevents Pellagra, with its characteristic skin lesions, digestive & nervous disturbances, provided all other essentials are included in the diet.
Source - Found in many food stuff including plant, meat, (particularly Offal).

VITAMIN –B 6 : Is a member of the enzyme system in certain metabolic processes, including those of neural tissue. Arrested growth & disturbances in functioning of the nervous system have been noted to follow deprivation of B 6 in infancy. Also alteration in tryptophan metabolism in pregnancy has been relieved by administration of B 6 .
Sources - Widely found in animal and plant food stuff.

FOLIC ACID : Has been found to play an important part in the body’s blood forming activities. It is effective in the treatment of certain types of anaemia.
Sources - Found in green vegetables, spinach and Broccoli.

VITAMIN –B 12 (Cyanocobalmine ) : Plays an essential metabolic role & is essential for the prevention or treatment of pernicious anaemia, a disturbance of red blood cell formation.
Sources - It is found in Meat, Fish, eggs and milk but not in plant. It's also found in papayas, cantaloupes, strawberries, broccoli, Brussels sprouts, tomatoes, asparagus and parsley.

VITAMIN C : Is essential to the health of intercellular material which acts as cementing substance in holding the cells of a tissue in their precise positions.
Sources – Lemon, orange, amla, potatoes.

5. Functions of Proteins : Proteins make up a part of all body cells & participate in nearly all life processes; therefore, they are necessary for growth. Through digestion they are broken down into amino acids which are used by the body in building its tissues; bones, muscle, nerves, skin, blood etc. Eight of these amino acids cannot be manufactured in the body & so must be supplied in the diet. Deficiencies in particular amino acid may lead to specific types of injury e.g. when Argimine is deficient there is a decrease in the number of sperms & their motility.
Proteins are necessary for the manufacture of enzymes used in the hormones of the endocrine glands, such as thyroxin of the thyroid gland, epinephrine of the adrenals & insulin of the pancreas. They function in regulating the flow of fluid in & out of cells.

6. Functions of carbohydrates & fats : carbohydrates & fats as the chief sources of energy, are necessary for growth, & they furnish energy for the growth process. Carbohydrates & fats also furnish the body with adipose tissue, which serves as a protection against the loss of heat, act as a cushion to the abdominal organs & is a potential source of body energy. Certain fats perform another important function i.e. they are carriers of vitamin A & D. Glucose, a digestive product of carbohydrates is a constant constituent of the blood.

7. Role of Water: The human being lives in water, even though it is not an aquatic species. Water is a part of every tissue in the body, even of the proverbially dry bone. In children the percentage of water in tissues is higher than in adulthood. Matured bone contains nearly half its weight in water. About 75% of muscle & 80% of the grey matter of the brain are water. No cell can carry on its activities when it is absolutely dry & most cells must be constantly bathed with fluid in order to do their work. These cells have their food brought to them & their waste products removed by the water route, the blood. Many of these waste products are eliminated through the urine. Water serves as a regulator of body temperature. Evaporation from the skin, perspiration, provides one of the most important methods of removing surplus heat from the body. Water protects internal organs. The central nervous system is bathed by the cerebrospinal fluid. Fluid also lubricates joints, thereby making movements at joints easy. Water is therefore tremendously important in life. Rubner estimated that a man could lose most of his stores of glycogen & of fat & even half of his protein without serious danger to life, but a loss of 10% of body water is serious & a loss of 20% is scarcely to be endured.

Dr. Nahida M.Mulla.M.D.
Vice Principal,
Professor of Repertory & PG Guide,
HOD Repertory.
HOD Paediatric OPD,
A M.Shaikh Homoeopathic Medical College, Hospital & PG Research Centre, Nehru Nagar, BELGAUM (Karnataka)

Mobile : 09448814660

Build self confidence & self-esteem in your children:
Simple ways to build your child’s self confidence and esteem for a happier child and better parent/child relationships.
All Parents want their children to be confident. Reassurance is something we are all aware of as a parental tool to build confidence, but there are other techniques you can utilize to help build your children’s confidence level. There are three simple, yet very important things to remember:
# 1. Praise.
Praise your children daily on a job well done, or a situation you observe them handling appropriately. Let them know that you approve, and why. When your youngest child colors a nice picture and is eager to show it to you, be sure to praise them. But, also be sure to pick out a singular aspect of the picture to comment on. This tells even the youngest of children that you are interested in what they have accomplished. Praise should go beyond your acknowledgement of the piece of art; it should say to the child that you have paid attention to the details in the picture as well. With this method of praising, and singling out particular reasons a child’s confidence can soar.
# 2. Reliability and Consistency.
Children of all ages not only want to know, but need to know that they can depend on their parents or guardians to be consistent. If you have set rules for a specific dinnertime, be consistent. Do not let the teenager (or any member) of your household upset a family routine or set rule due to a preference, such as eating at friend’s house at the last minute, or being late for dinner due to a game. While there will always be exceptions to this practice, if you are consistent in any given family situation or rule your children will know they can rely on you. Although this strategy might not be popular in your home at first, your family will eventually accept and expect certain rules. They will learn to respect your decisions through your dependability as well. Through the child’s confidence in you his own confidence grows.
# 3. Trust
Trust, as we all know is “earned”. You can and should start building trust between you and your children as early as toddler hood. Nothing builds confidence in humans like trust. Be sure to remain consistent (as mentioned above) when you allow your children to venture forth in new areas. It is not always easy for a parent to feel sure of their children’s abilities, albeit a new bike, or riding that bike to the neighborhood store. Start with small and realistic steps that are agreed upon and carried out. Each success is the essential ingredient to building trust between child and parent.
Building self esteem in kids:
A child’s self esteem is one of the single most important things you can help your child to develop. A good self esteem helps a child to be confident, try new things, get along well with other children, do well in school and countless other things. The way a child feels about himself affects nearly every aspect of his life and children look to adults to learn about who they are. If a child is ignored, for example, he will feel unimportant and will act out in either two ways, he will behave badly to attract attention to himself or he will fade into the woodwork, believing that he is not important enough for anyone to take notice of him. Both examples show evidence of low self esteem.
If you want to build good self esteem in your child, you need to start when they are babies. Children begin to learn about themselves from the very beginning and if you start out right, the rest will be easy. Talk to your baby and praise her often, even for tiny victories like learning to drink from a cup, give your baby applause and let her know she is spectacular. When children see that they can accomplish things it boosts their esteem, especially if it is noticed and praised by adults.
Ask your child for his opinion on things: “What do you think of that movie we just saw?” “What restaurant do you like best?” If you ask for their opinion, they will feel important and valuable. Include your child on family decisions and always consider his input. Don’t ever ridicule your child or tell him that his idea is silly, instead, even if the idea is a little silly, you could say, “That’s a different way of looking at it!” or “How creative!”
Basically, you should treat your child with the respect that you would give to any other person and give plenty of praise and acknowledgement of his status as an important part of the family. Your child will gain friends more easily when he feels comfortable with himself and you will have the peace of mind of knowing he feels good about himself.
Oh, how delicate the thing called self esteem can be! As adults, most of us have noticed that if we are told something often enough, we might end up believing it. If those things happen to be negative, it can be so destructive!
It is very damaging for a child to hear negative things about him or herself. Unfortunately, these things often come from avenues other than their peers or the school bully. Haven’t we overheard parents saying things like “take that outfit off, you look awful!” Or saying within hearing range of a child “Johnny will never make anything of himself. He won’t even sit down to do his homework.”
Too many people simply don’t stop to think of the impact their words might have on an impressionable child. If a young teen experiments with makeup, as an example, words to the effect of “wipe it off, you look like a tramp!” will damage for a very long time while saying “I think a lighter shade of that color would look even prettier” builds self esteem because their efforts have been noticed.
It is hard to determine at exactly what age a child starts “taking it all in” and building what is to be their own self image in their mind. Certainly by the time they’re old enough to understand what “if you keep being too lazy to understand that math work, you’ll never make anything of yourself in life” means. If they start believing that life will be a waste, it will be an uphill battle to build self esteem and the desire to succeed in life. It could make much difference to hear instead “I know you’re having trouble with that math work, Billy. Why don’t we sit down together and figure it out? You’re very smart and I know that between us, we can conquer it.”
How a child views himself relies greatly on those he trusts. The parents. There will be enough peer pressure and bullies over the years; and what the child hears from a parent needs to counteract negative things others will say. It only takes a few short breaths to say “I’m so proud of you!” or “You look great today!”
I recently had an interview with a delightful girl of 15. She had been having some problems in many areas of life. She finally mentioned that she was dating and had been for a while. I took the plunge and asked what led to that decision. She thought for a moment and answered, “Oh, that’s easy. My mother told me that no boy would ever want to go out with me.”
Make your children feel good about themselves. It takes little effort to voice the things you admire about a child. Something like “that shirt really brings out the color of your eyes beautifully” just might make the difference between a terrific day or lousy day for them. If there is a decision they can help with, it’s a perfect opportunity to voice something you admire. “Will you help me choose curtains for your room? You have great taste in things like that.”
Remember, a confident child is assured in love and patience. A confident child is a happy child.
Dr. Nahida M.Mulla.M.D.
Vice Principal,
Professor of Repertory & PG Guide.
HOD of Paediatric OPD.
A.M.Shaikh Homoeopathic Medical College, Hospital & PG Research centre, Nehru Nagar, Belgaum – 590010 (Karnataka)

Mobile: 09448814660.