CHILD PSYCOLOGY AND PARENTING.

Behavioral Problems of Children

I. Prevention of behavioral problems .

Family Physicians should anticipate and intervene in behavioral problems. 
Factors that predispose children to behavioral problems include mismatch between parental and child temperaments (e.g., quiet, low-activity child with high-energy parent), parental mental health problems (including post-partum depression), poor parental self-esteem, attachment difficulties between parent and child, inconsistency of parental response to the child, unrealistic parental expectations regarding the child's behavior, and developmental delay, especially speech–language delay, which contributes to frustration for both parent and child. 
Also, due to the conflict between the parents, the absence of a parent, and parental abuse of drugs or alcohol are risk factors for behavioral problems. 

II. Stages of behavioral assessment and intervention.

Clarify parental concerns. 
Assess parental knowledge regarding normal developmental stages. Many parental concerns about behavior stem from unrealistic expectations regarding their child's behavior relative to his or her developmental stage.
Assess for family stresses that may affect the child's behavior. Many behavioral problems stem from or are exacerbated by external stressors.
Prenatal alcohol and drug use, early childhood illnesses, and developmental delay can all lead to behavioral problems.
Counsel parents about possible interventions for behavioral problems.

III. Principles of behavioral intervention.

Children deserve and respond to respect from caregivers. Behavioral interventions will not be successful if parents treat the child disrespectfully.
Consistency of response is critical. Behavioral change only occurs in the context of consistent and predictable responses.
Positive reinforcement for desired behavior generally works better than negative reinforcement for undesirable behavior. Positive reinforcement includes active education of the child about expected behavior and its beneficial consequences rather than simply stating what the child should not do. When negative reinforcement is necessary, it should be age and behavior appropriate.
Reassure parents that children need and want parents to exert consistent, reasonable controls on their behavior. Children are frightened when boundaries of acceptable behavior are not well defined and will often accelerate the problem behavior in order to elicit a parental control response.

IV. Specific techniques for intervention.

Many parents lack specific knowledge about acceptable, effective interventions to promote behavioral change. Too often, parents resort to punishments far more severe than the behavior warrants. 

Time out . Separate the child from desirable activities for a brief period (1–2 minutes for preschoolers, up to 15 minutes in school-aged children). “Grounding” adolescents for a day or two may help.
Extinction. Ignore the undesirable behavior, especially if it has previously elicited attention.
Rewards/positive reinforcement . Offer small rewards like inexpensive toys, increased time with one or both parents, increased privileges for positive behavioral change. For example, if the problem behavior relates to bedtime, reward the child for conflict-free completion of the bedtime routine.
Discussion of consequences of and alternatives to the behavior. Respect for children includes teaching them the consequences of and alternatives to unacceptable behaviors. As children get older, reasoning plays an increasing role in behavior modification.

V. Major mental health concerns .

Behavioral problems in children can generally be divided into three categories: 

• (a) problems that are normal for the child's developmental stage and will resolve spontaneously as the child matures;
• (b) problems that began as a normal developmental phase, but have been exacerbated by external stresses and will require some level of intervention to resolve;
• (c) problems that indicate a more serious underlying mental health problem.

Depression in children is generally underdiagnosed.Criteria for depression in children are virtually identical to those in adults, with minor modifications relevant to usual daily activities. Five or more of the following criteria must be present for at least 2 weeks in order to diagnose depression: depressed mood, anhedonia, sleep disturbance (hypersomnolence or disruption of normal sleep pattern), change in weight or appetite (>5% change in body weight over 1 month and/or failure to make expected weight gains), psychomotor retardation or agitation, low energy, feelings of worthlessness or guilt, decreased concentration and increased indecisiveness, or recurrent thoughts of death or suicide. Children with depression may require medication, and this should generally be done in conjunction with a child mental health professional.

Anxiety disorder. 
Virtually every child experiences some level of anxiety at various stages of life. Up to 50% of children may experience anxiety to the extent of true anxiety disorder that adversely affects their daily lives.
Anxiety disorders may present as multiple somatic complaints, a marked increase in nervous habits (e.g., nail biting or thumb sucking), or stereotyped behaviors (e.g., head banging or other repetitive behaviors). 

Conduct disorder represents the extreme end of the spectrum of oppositional behavior.
It is defined as a persistent pattern of behavior (more than –6 months) that violates the basic rights of others, including acts of aggression against people or animals, property destruction, theft, repetitive lying or other deceptions, and serious violations of rules in multiple environments (e.g., home and school). 
Children and adolescents with conduct disorder require prompt identification, aggressive intervention, and substantial support to their families.

VI. Common behavioral concerns seen in family practice.

Feeding problems 
Feeding problems are among the most common concerns. Parents worry about adequate weight gain and spitting up (reflux) in infants, nutrition, food avoidance, and mealtime behaviors in preschoolers, and obesity in school-aged children. 
It is important to remind parents that when food becomes a control issue between parent and child, this confrontation can lead to long-term unhealthy eating habits. 
Parents should offer a diverse range of nutritious foods, supplement with a multivitamin if necessary, demonstrate healthy eating habits, and avoid using food as a reward for other behaviors.

Oral habits 
Oral habits such as nail biting, digit sucking, and pacifier use, are common in preschool-aged children. Some authors hypothesize that these and other stereotyped behaviors are actually serving an important function in the child's development by serving as early coping mechanisms or self-calming techniques during stressful times or negative mood states. Increases in these behaviors often reflect new external stresses in a child's life. 
Identifying and addressing stresses, combined with positive reinforcement of behavioral change and work with the child to develop alternate coping skills, is generally the most successful intervention for these behaviors.

Sleep disorders 
This include trained night-waking, bedtime struggles, nightmares and night terrors, and sleepwalking . 
Trained night-waking (i.e., the child awakens at a consistent time during the night) and bedtime struggles are best addressed by a consistent approach to bedtime that does not involve the parent staying with the child until the child falls asleep, and extinction (i.e., delayed response or no response at all to the child when he or she awakens during the night or protests at bedtime). 
Nightmares occur in virtually all children and are generally indicative of developmental issues and fears. 
Sleepwalking occurs in approximately 15% of children. It too has its onset in early childhood and generally resolves spontaneously in adolescence. Parents should provide a safe environment so that the child does not sustain injury during sleepwalking episodes. 
Both night terrors and sleepwalking have strong familial histories, with 80%–95% of children with these disorders having a positive family history.

Stereotyped behaviors 
Stereotyped behaviors such as tics, head banging, body rocking, or other repetitive movements, can be disconcerting to parents. 
Many toddlers and preschoolers display these behaviors, and stress, negative mood, and fatigue generally exacerbate them. These behaviors usually resolve spontaneously and rarely cause injury to the child. 
Treatment involves reassurance of the parent, teaching other coping mechanisms to the child, and patience.

Masturbation 
This begins as early as 12 months in many children and is completely normal. 
Parents should use the behavior as an opportunity to begin discussion with the child about private behaviors and sexuality. 

Separation anxiety 
Anxiety including school phobia, occurs in many children at various stages of life. 
Prevention includes giving the child accurate, age-appropriate information about expected separations and consistency in daily patterns of separation. 
Treatment involves diminishing stress and establishing firm guidelines about appropriate reasons for missing school.

Disruptive behavior 
This occurs over a spectrum of behaviors, including various manifestations of limit testing, temper tantrums, oppositional defiant disorder, and conduct disorder. Early identification of and intervention for these problems is critical for prevention of long-term mental health problems .
Limit testing occurs at every stage of childhood and adolescence. Physicians should remind parents of the need to set and maintain firm, age-appropriate boundaries on behavior. 
Temper tantrums are common (75%) in children aged 3–5, and their incidence tails off to 4% in children aged 9–12.
Children with this disorder frequently lose their tempers, argue with adults, defy rules, blame others for problems, and have poor social relationships due to anger, resentment, and spitefulness.
Treatment of ODD rests in the domain of behavior modification and often requires family and individual psychotherapy to assist with resolution.

Drug  Use 
Alcohol, tobacco, and other drug use should be screened for routinely during most visits with children over the age of 8 years. 
Prevention is essential, and involves open discussion with parents and children about risk factors, including genetic predisposition (family history of drug misuse), peer pressure, low self-esteem, and poor resiliency to external change and stress. 
Prevention also includes educating children in age-appropriate ways about the adverse effect of using tobacco, alcohol, and other drugs. 

 

FEEDING ISSUES IN TODDLER'S;"THE FUSSY EATER"

When you are feeling at the end of your tether with a fussy eater, take a deep breath, relax and remember this is a normal phase in your toddler's development which will resolve with time. 

By being anxious you can often make the problem worse, particularly if you are expecting your toddler to eat more than she needs. If allowed to do so, toddlers will eat just enough calories for their own requirements, so you should always respect your toddler's decision that she has had enough to eat. You need to resist trying to persuade her to eat more. All this is of course, easier said than done. 

Remember that it is your responsibility to offer your toddler nutritious food but always allow her to choose how much she will eat. If you have older relatives taking care of her during the day when you are away at work, reassure them that she won’t stay hungry and that it is okay if she does not “clean up her plate”. 

How do I know when my toddler is full?

It may seem obvious but your toddler is telling you that she has had enough to eat of a particular food, course or meal, if she is: 

• keeping her mouth shut when offered food 

• saying no 

• turning her head away from the food being offered 

• pushing away a spoon, bowl or plate containing food 

• holding food in her mouth and refusing to swallow it 

• spitting food out repeatedly 

• leaning out of her highchair or trying to climb out 

• crying, shouting or screaming 

• gagging or retching 

What is the best way to cope with my fussy eater?

Most toddlers go through a phase of only eating a very narrow range of foods. This is a normal part of toddler development called food neophobia - being frightened of new foods. Your toddler needs time to learn that these foods are safe to eat and enjoyable. She will learn this by watching you and others eating those foods. Eventually she will widen the variety of foods she eats but some take much longer than others to do this. To help her on her way, and to keep your sanity, follow these tips: 

Eat with your child as often as possible. Toddlers learn to eat foods they are unfamiliar with by watching and copying their parents and other children eating them.

Make positive comments about the food you are eating. Parents are strong role models and if you make positive comments about foods, your toddler will be more willing to try them. 

Arrange for your toddler to eat with other toddlers as often as possible. Invite a friend from her playschool or neighbourhood over for some snacks. Your toddler may eat better when she is with her own age group. 

Develop a daily routine of three meals and two to three snacks around your toddler's daytime sleep pattern and try to stick to it. Toddlers thrive on routine and knowing what to expect. She won't eat well if she becomes over-hungry, and toddlers who are tired will be too miserable to eat. Don't expect her to eat a large meal just before going to bed. Give her a small snack or drink and save her proper meal until later, after she has woken up. 

Offer two courses at mealtimes: a savoury course followed by a sweet course. The savoury course itself can consist of different items, say a small puri with potato and some rice with dal. For the sweet course, try kheer or halwa if she hasn’t eaten any cereal in the savoury course, otherwise choose fruit based desserts. Toddlers often get bored with too much of one taste and will be ready to try something new. Two courses also give your toddler two opportunities to take in the calories and nutrients needed and means there is a wider variety of foods at each meal. 

Limit mealtimes to about 20 - 30 minutes and accept that after this your toddler is unlikely to eat much more. It is better to wait for the next snack or meal and offer some nutritious foods then, rather than extending a meal for an hour trying to persuade your toddler to eat more. Most toddlers eat whatever they are going to in the first 20 minutes. 

Praise your toddler when she eats well because toddlers respond positively topraise. If you only give her attention when she is not eating, she may refuse food just to get some attention from you. Toddlers like attention, even if it is negative. If she doesn't eat well, take the uneaten food away without commenting and accept that she has had enough. 

Give small portions. Toddlers can be overwhelmed by large portions and lose their appetite. If the small portion is finished, praise your toddler and offer her some more. Offer her a second serving if she asks for one or seems eager to eat more. Typically serving sizes should be one fourth that of adults. 

Offer finger foods as often as possible and allow your toddler to make a mess at mealtimes. Toddlers enjoy having the control of feeding themselves with finger foods. Let her try to feed herself with a small fork or spoon if she wants. 

Eat in a calm relaxed environment away from distractions such as the TV, games and toys. Toddlers can concentrate on one thing at a time so distractions make it more difficult for them to concentrate on eating. While a change once in a while helps, constantly trying to distract your toddler by carrying her around the house or to the window or door while feeding her, may make mealtimes seem like a different kind of play time. 

Be aware that if you are eating out, your toddler may not be prepared to try any of the food on offer, as it may all be unfamiliar to her. Take something that she will eat with you to tide her over until her next meal or snack. Packing a small chapatti with cheese spread, a banana or a tomato sandwich in a favourite lunchbox might make it easier for her to eat in unfamiliar surroundings. 

Involve older toddlers in food shopping and preparing for the meal such as putting things on the table. This will encourage a positive attitude to food and mealtimes. 

Involve your toddler in simple cooking and food preparation (if you have the time and patience) – give her a ball of chapatti dough to roll and flatten or pick out some pea pods for her to shell. By handling and touching new foods without pressure to eat them, your toddler will become familiar with new foods and may be more likely to try them. 

Change the venue of your toddler's meals. For example, have a picnic outside. This will make eating a fun experience for your toddler and will allow them to see others enjoying food. 

What shouldn't I do?

Don't rush a meal. Some toddlers eat slowly and rushing your toddler to eat can reduce her appetite. 

Don't pressure a toddler to eat more when she has indicated to you that she has had enough. Never insist she finishes everything on her plate. 

Don't take away a refused meal and offer a completely different one in its place. A toddler will soon take advantage if you do. In the long run it is always better to offer family meals and accept that your child will prefer some foods to others. Always try to offer one food at each meal that you know she will eat. 

Don't offer the sweet course as a reward for eating the first course. You will make the sweet course seem more desirable than the savoury one. 

Don’t punish your child for refusing to eat. She may start disliking food in the long run. 

Don’t bribe and reward your child to finish up her meal. She will expect something in return each time she finishes her meal. 

Don't offer large drinks of milk, squash, fizzy drinks or fruit juice within an hour of the meal. Large drinks will reduce your toddler's appetite. If she is thirsty, give her a drink of water instead. Try to phase out bottles so that all your toddler's drinks, including milk, are given in cups or glasses. 

Don't offer snacks just before or just after a meal. Don't give a snack soon after a meal if your toddler hasn't eaten well at her main meal. It is tempting to do this just to ensure that your toddler has eaten something. However, it is best to have a set meal pattern and wait until the next snack or meal before offering food again. 

Don't assume that because your toddler has refused a food she will never eat it again. Tastes change with time. Some toddlers need to be offered a new food more than 10 times before they feel confident to try it. Or try a different way of preparing food; if she doesn’t take to paneer cubes try grating them into stuffed parathas, she might prefer boiled chickpeas chaat (kabuli chana chaat) instead of chana masala gravy. 

Don’t have varied routines and patterns while feeding your toddler. Be consistent – if you have more than one person taking care of meals for your toddler, make sure that everyone follows the same routine and sets similar limits. Mealtimes which vary from grandparents or a baby sitter to parents will only confuse your toddler. 

Finally, don't feel guilty if one meal turns into a disaster. Put it behind you and approach the next meal positively. Parents also learn by making mistakes. 

What should I do if I am still worried? 

If you are still doubtful, make a list of all the food and drinks your toddler consumes over a week and then review it. If your toddler's diet includes foods from all the food groups (read our article on how to feed your toddler for more information) and some variety within each group then you can reassure yourself that the problem is not as bad as you thought. 

If you continue to worry about how much your toddler eats or if you think she might beunderweight, talk to your doctor -- who may be able to reassure you that there is no problem. Occasionally there are medical reasons why your toddler may not eat and a doctor can assess this. 

Regards,

                                                               

COMMON COLD(BABIES)

One of the saddest things for a new parent is watching their baby suffer through his first cold. Your baby will be uncomfortable, snuffling, and probably will have trouble feeding. 

It's hard to watch, but there's a lot you can do to alleviate the discomfort. And you can be assured that it's called the common cold for a reason, and it's usually not serious. Experts estimate that your baby will get between eight and 10 colds in his first two years alone. That's a lot of tissues and long nights. 

What causes colds? 

Colds are upper respiratory tract infections caused by one of many different viruses. They're most commonly spread when someone with a cold sneezes or coughs and unleashes a cold virus into the air to be inhaled by someone else. They can also commonly be transmitted through hand-to-hand contact, so always wash your hands after blowing your nose. Babies tend to get a lot of colds because they're born with immune systems which function at about 60% of capacity. 

How do colds affect babies? 

Few things are more frustrating than a baby with a cold. A sick baby will probably have a fever (up to 101 degrees F / 38 degrees C), cough, reddened eyes, a sore throat, earache, and runny nose. Your child may also be irritable and lose his appetite. Babies under six months old can't breathe through their noses when they're all stuffed up, so they have trouble breathing and eating. 

Children aren't usually developmentally ready to blow their own noses until about the age of four, so you'll have to help younger children clear the mucus. If the cold persists and is not treated properly, it can lead to more serious bacterial infections like pneumonia, bronchitis, flu or ear infections. If your baby has been sleeping through the night, you'll be reminded of those first few weeks of life. He'll probably wake up several times during the night due to his discomfort and difficulty breathing. Expect to be up with your baby, comforting him and wiping his nose. 

How long do colds generally last? 

Symptoms generally abate after three to 10 days, though in very young babies they may last up to two weeks. Most babies who have some exposure to older children will experience six to 10 colds during their first year; it may seem as if his nose is runny all winter long. If your child goes to a daycare center or a play school, he can experience as many as 12 colds per year! 

Can I help prevent my child from getting colds? 

Breastfeeding is one of the best ways to protect your baby's health, since as long as he's breastfeeding, he's getting your antibodies and your natural immunities. This isn't a foolproof way to protect your baby's health, but when breastfed babies do become ill, their cold symptoms are generally mild. 

You can also try to protect your child by keeping him away from those who are ill and by asking all sick family members to wash their hands thoroughly before handling your baby or his things. 

If you or your spouse smoke, give it up, and refrain from taking your baby to areas where someone has been smoking. Children who live with cigarette smokers have more colds and their colds last longer than their peers who aren't exposed to smoke.

When should I consult the doctor? 

Do so at the first sign of illness if your child is less than three months old. In an older baby, call your doctor if a cold persists for more than three days; if your child's temperature climbs above 102 degrees F / 39 degrees C; or if he has an earache, breathing problems, wheezing, a persistent cough, or a persistent, thick, green mucus running from his nose. 

How do I treat a cold? 

There's little you can do except ride it out. Help your child get plenty of rest and if he has been weaned offer liquids (increase the amount of vitamin C-rich fruit juices). If he's feverish, you can give him paracetamol suspension under a doctor's direction. Don't give him any cold remedies without consulting your doctor. In children under one year of age, over-the-counter cold medications often do more harm than good, and cough medicines have been shown to be no better than a non-medicated syrup for easing symptoms. 

Nonetheless, there are some remedies to ease his discomfort: 

• If your baby is congested, elevate the head of the mattress with an old towel or two. Sleeping at an incline may help relieve your baby's postnasal drip. (Do not use pillows to prop your baby up -- they can pose a suffocation hazard -- or pillows under the mattress.) 

• Because babies are too young to blow their noses, the best way to help them breathe more easily is to wipe their noses. You can also apply petroleum jelly to the outside of your baby's nostrils to reduce irritation. If your child is having trouble breastfeeding with a stuffy nose, you may like to ask your paediatrician to prescribe saline drops to apply to each nostril 15 minutes before a feed. Some parents then use a suction bulb to clear the nose of salt water and mucus. 

However, you can also prepare saline water at home by adding a pinch of salt in about 30 ml of boiled cooled water. Make the solution in a clean bowl and keep it well covered. Saline water drops do not have any side effects and can be easily used several times a day. 

• Try a cool mist vaporiser to moisten the air. Or take your baby into the bathroom with you, turn on the hot water or shower, close the door, and sit in the steamy room for about 15 minutes. Remember to change your baby into dry clothes after the steam bath. 

• If your child has a stuffy nose without any other symptoms, check his nostrils for foreign objects. You never know: even little ones are capable of putting things up there. 

• Add a couple of drops of menthol, eucalyptus or pine oil to a vaporizer to relieve nasal congestion in babies older than six months. 

Colds are a fact of life. Once you've survived your baby's first one, you'll know what to expect with the next. 

SEVEN STEPS TO SHAPE YOUR PERSONAL PLAN(HARVARD HEALTH BEAT) BEAT)

• Select a goal. Choose a goal that is the best fit for you. It may not be the first goal you feel you should choose. But you’re much more likely to succeed if you set priorities that are compelling to you and feel attainable at present.
• Ask a big question. Do I have a big dream that pairs with my goal?
• Pick your choice for change. Select a choice that feels like a sure bet. Do you want to eat healthier, stick to exercise, diet more effectively, ease stress? It’s best to concentrate on just one choice at a time. When a certain change fits into your life comfortably, you can then focus on the next change.
• Commit yourself. Make a written or verbal promise to yourself and one or two supporters you don’t want to let down: your partner or child, a teacher, doctor, boss, or friends. That will encourage you to slog through tough spots.
• Scout out easy obstacles.
• Brainstorm ways to leap over obstacles. Now think about ways to overcome those roadblocks.
• Plan a simple reward. Is there a reward you might enjoy for a job well done?

DENGUE--FEVER(UPDATE)---FROM;W.H.O

Dengue and dengue haemorrhagic fever

Key facts

• Dengue is a mosquito-borne infection that causes a severe flu-like illness, and sometimes a potentially lethal complication called dengue haemorrhagic fever.
• Global incidence of dengue has grown dramatically in recent decades.
• About two fifths of the world's population are now at risk.
• Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.
• Dengue haemorrhagic fever is a leading cause of serious illness and death among children in some Asian countries.
• There is no specific treatment for dengue, but appropriate medical care frequently saves the lives of patients with the more serious dengue haemorrhagic fever.
• The only way to prevent dengue virus transmission is to combat the disease-carrying mosquitoes.

Dengue is a mosquito-borne infection that in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.

Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in the region.

There are four distinct, but closely related, viruses that cause dengue. Recovery from infection by one provides lifelong immunity against that virus but confers only partial and transient protection against subsequent infection by the other three viruses. There is good evidence that sequential infection increases the risk of developing DHF.

Global burden of dengue

The incidence of dengue has grown dramatically around the world in recent decades. Some 2.5 billion people – two fifths of the world's population – are now at risk from dengue. WHO currently estimates there may be 50 million dengue infections worldwide every year.

In 2007 alone, there were more than 890 000 reported cases of dengue in the Americas, of which 26 000 cases were DHF.

The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. South-east Asia and the Western Pacific are the most seriously affected. Before 1970 only nine countries had experienced DHF epidemics, a number that had increased more than four-fold by 1995.

Not only is the number of cases increasing as the disease is spreading to new areas, but explosive outbreaks are occurring. In 2007, Venezuela reported over 80 000 cases, including more than 6 000 cases of DHF.

Some other statistics:

• During epidemics of dengue, infection rates among those who have not been previously exposed to the virus are often 40% to 50%, but can reach 80% to 90%.
• An estimated 500 000 people with DHF require hospitalization each year, a very large proportion of whom are children. About 2.5% of those affected die.
• Without proper treatment, DHF fatality rates can exceed 20%. Wider access to medical care from health providers with knowledge about DHF - physicians and nurses who recognize its symptoms and know how to treat its effects - can reduce death rates to less than 1%.

The spread of dengue is attributed to expanding geographic distribution of the four dengue viruses and their mosquito vectors, the most important of which is the predominantly urban species Aedes aegypti. A rapid rise in urban mosquito populations is bringing ever greater numbers of people into contact with this vector, especially in areas that are favourable for mosquito breeding, e.g. where household water storage is common and where solid waste disposal services are inadequate.

DengueNet: WHO surveillance

Transmission

Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes. Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After virus incubation for eight to 10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not yet been defined.

Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time that they have a fever; Aedes mosquitoes may acquire the virus when they feed on an individual during this period. Some studies have shown that monkeys in some parts of the world play a similar role in transmission.

Characteristics

Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death.

The clinical features of dengue fever vary according to the age of the patient. Infants and young children may have a fever with rash. Older children and adults may have either a mild fever or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash.

Dengue haemorrhagic fever (DHF) is a potentially deadly complication that is characterized by high fever, often with enlargement of the liver, and in severe cases circulatory failure. The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41°C, possibly with convulsions and other complications.

In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock and die within 12 to 24 hours, or quickly recover following appropriate medical treatment (see below).

Treatment

There is no specific treatment for dengue fever.

For DHF, medical care by physicians and nurses experienced with the effects and progression of the complicating haemorrhagic fever can frequently save lives - decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient's circulating fluid volume is the central feature of DHF care.

Immunization

There is no vaccine to protect against dengue. Although progress is underway, developing a vaccine against the disease - in either its mild or severe form - is challenging.

• With four closely related viruses that can cause the disease, the vaccine must immunize against all four types to be effective.
• There is limited understanding of how the disease typically behaves and how the virus interacts with the immune system.
• There is a lack of laboratory animal models available to test immune responses to potential vaccines.

Despite these challenges, two vaccine candidates have advanced to evaluation in human subjects in countries with endemic disease, and several potential vaccines are in earlier stages of development. WHO provides technical advice and guidance to countries and private partners to support vaccine research and evaluation.

More on vaccine research

Prevention and control

At present, the only method of controlling or preventing dengue virus transmission is to combat the vector mosquitoes.

In Asia and the Americas, Aedes aegypti breeds primarily in man-made containers like earthenware jars, metal drums and concrete cisterns used for domestic water storage, as well as discarded plastic food containers, used automobile tyres and other items that collect rainwater. In Africa the mosquito also breeds extensively in natural habitats such as tree holes, and leaves that gather to form "cups" and catch water.

In recent years, Aedes albopictus, a secondary dengue vector in Asia, has become established in the United States, several Latin American and Caribbean countries, parts of Europe and Africa. The rapid geographic spread of this species is largely attributed to the international trade in used tyres, a breeding habitat.

Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal and improved water storage practices, including covering containers to prevent access by egg-laying female mosquitoes are among methods that are encouraged through community-based programmes.

The application of appropriate insecticides to larval habitats, particularly those that are useful in households, e.g. water storage vessels, prevents mosquito breeding for several weeks but must be re-applied periodically. Small, mosquito-eating fish and copepods (tiny crustaceans) have also been used with some success.

During outbreaks, emergency vector control measures can also include broad application of insecticides as space sprays using portable or truck-mounted machines or even aircraft. However, the mosquito-killing effect is transient, variable in its effectiveness because the aerosol droplets may not penetrate indoors to microhabitats where adult mosquitoes are sequestered, and the procedure is costly and operationally difficult. Regular monitoring of the vectors' susceptibility to widely used insecticides is necessary to ensure the appropriate choice of chemicals. Active monitoring and surveillance of the natural mosquito population should accompany control efforts to determine programme effectiveness.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

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WHY ARE WE LIKE THIS????(a copy of my mail)

Dear All,

            With reference to my earlier mail  regarding swine flu+viral fever vaccine.Please be informed this vaccine is already out-of-stock in the market.Our stock is limited to meeting requirement's of the second dose for those who have already taken the first dose.The company says it might release some stock again around 25th of this month,but it is doubtful since it came in the Indian market with 2-lac allocated doses.

             Now,in this scenario it will be wise to start new vaccination with swine flu protection nasal vaccine.Since--- it is unlikely to fall short,

                                                                                                                                                                ----efficiency same for swine flu,

                                                                                                                                                                 ---Only one dose required,

                                                                                                                                                                 ----Much cheaper than the injectable one(450/-)

 Be advised,as soon as winter starts we will dealing with swinflu,in the same way,we are dealing with dengue fever now.But the difference is that swine flu now has a vaccine and can be prevented.It would be very foolish to suffer with swine flu and spend thousands in a hospital when you could have protected yourself for a mere 450/-.

          Regards

               
Dr  Padamjeet  Gulia

THE-ALL-IMPORTANT-QUESTION??(is my milk enough..!!)

How can I tell if my baby is getting enough milk? 

During the first couple of weeks, you may wonder if your baby is getting enough milk, especially if he wants to feed all the time or is unsettled after feeds. Once the first sleepy day or two have passed, your baby should seem to be hungry often. And he probably is, since breastmilk is digested within a couple of hours of consumption. 

Most newborns want to breastfeed eight to 15 times a day after the first three to four days of life, which will probably have settled down to six to eight times a day by the end of the first week. Feed your baby as often as he needs it. Routines have no place in your day while you're getting breastfeeding under way. Unfortunately, weighing the baby in the first few days will probably not reassure you, since newborns normally lose five to 10% of their birthweight in the first three days. However after three or so days, your baby should start to gain weight again and if he is weighed again at five to seven days, you should be able to see that he is starting to grow. Don’t be disheartened if your baby doesn’t show much of weight gain, some babies gain weight soon while others may take a while. If your baby had problems latching on, the weight loss in the initial days may be slightly more. 

There are some ways to gauge if your baby's getting enough milk, and there are signs that he may not be receiving enough. Dehydration in newborns is rare, but it's important to know the signs of a healthy eater so you can alert your doctor if anything seems amiss. These include: 

• Your baby feeding at least six to eight times a day for the first two to three weeks. 

• Your breasts being emptied and feeling softer after feeds. 

• Your baby having a healthy colour and firm skin -- it bounces right back if pinched. 

• The number of wet nappies starting to increase by the fifth day, or producing at least six to eight wet nappies in a 24-hour period. (It's easier to tell if a non-disposable nappy is wet than a disposable.) Your baby's urine should be pale and odourless. 

• Being able to see him swallow while he is feeding. 

• Producing yellowy-mustard stools or frequent dark stools, or the stools beginning to lighten in colour by the fifth day after birth. 

What are the warning signs that my baby isn't getting enough milk? 

Signs that your baby isn't getting adequate milk usually include most of the following: 

• Your baby does not begin to regain his birthweight and put on weight after the first few days. 

• Your breasts don't feel softer after feeds. 

• Your baby is unsettled, cranky or lethargic most of the time. 

• Your baby has dimples in his cheeks or makes clicking noises while breastfeeding. (This is a sign that your baby is not latched on properly and you will need to get expert help from your doctor or infant feeding specialist to make sure that your technique is right) 

• Your baby is wetting fewer than six to eight nappies in a 24-hour period after the five days following birth. The colour of the urine may occasionally be darker and not a cause of worry. You may however bring it to your doctor’s notice. 

• Your baby doesn't have a bowel movement at least once a day or is having small, dark stools five days or more after birth. 

• He becomes more yellow, instead of less, after the first week. 

• He does not develop a rounded face by about three weeks. 

• Your baby's skin remains wrinkled after the first week. 

If you're concerned about any of these signs, call your doctor. 

You will be giving your baby enough milk if: 

• Your baby is latched on well at the breast and feeds on demand 

• Feeding is comfortable and painless 

• Your baby changes rhythm whilst sucking and pauses during feeds, starts feeding again without prompting, and comes off the breast spontaneously when he's finished. 

If your baby is showing these signs, then it is very unlikely that you are underfeeding him. One of the hardest things about beginning a breastfeeding relationship is feeling confident that you are giving your baby enough milk. No doubt you are, but you shouldn't hesitate, in the early days of breastfeeding, to get reassurance and help from your doctor and perhaps speak to a friend who has been nursing for a while. 

Traditionally, fenugreek seeds or methi dana is recommended to increase breastmilk. You may want to soak about half a teaspoon in water overnight and drink the water with the seeds in the morning. It is also essential that you eat awell balanced diet and try not to worry too much about whether you are able to provide adequate milk to your baby.