Failure to thrive (FTT) is a condition where an infant or child has inadequate growth due to insufficient calorie intake, absorption, or excessive expenditure.
Antibiotics for bacterial tonsillitis (Penicillin, Amoxicillin)
Tonsillectomy if recurrent infections (>7 episodes in 1 year)
Child Abuse
Definition:
Any form of physical, emotional, sexual abuse, or neglect inflicted on a child.
Types:
Physical Abuse – Bruises, fractures, burns
Emotional Abuse – Verbal insults, rejection
Sexual Abuse – Inappropriate touching, rape
Neglect – Lack of food, shelter, medical care
Signs and Symptoms:
Unexplained bruises, burns, fractures
Fearful behavior or withdrawal
Poor hygiene, malnutrition
Sudden academic decline
Nightmares or sleep disturbances
Management:
Mandatory reporting to child protection services
Medical examination and psychological support
Legal intervention if necessary
Breath-Holding Spells
Definition:
A sudden, involuntary breath-holding episode triggered by pain, fear, or frustration, leading to cyanosis or pallor.
Types:
Cyanotic Breath-Holding Spells – Child cries, stops breathing, turns blue, and may lose consciousness.
Pallid Breath-Holding Spells – Child turns pale due to vagal response and may faint.
Signs and Symptoms:
Sudden cessation of breathing
Cyanosis (bluish skin) or pallor
Loss of consciousness for a few seconds
No postictal confusion (unlike seizures)
Management:
Reassurance to parents
Avoid triggers (e.g., sudden emotional distress)
Iron supplementation if iron deficiency is present
Educate parents on handling episodes calmly
Enuresis (Bedwetting)
Definition:
Involuntary urination, usually during sleep, in children aged >5 years.
Types:
Primary Enuresis – Child has never been consistently dry.
Secondary Enuresis – Child had control but relapsed.
Signs and Symptoms:
Involuntary urination at night
Low self-esteem and embarrassment
Sleep disturbances
Management:
Behavior therapy (fluid restriction at night, voiding before bed)
Enuresis alarm therapy
Medications: Desmopressin (DDAVP), Imipramine
Nail Biting (Onychophagia)
Definition:
Repetitive biting of nails, often associated with anxiety or stress.
Signs and Symptoms:
Short, uneven nails
Sore fingertips
Dental problems (misalignment, gum damage)
Management:
Behavior therapy (positive reinforcement)
Habit-reversal techniques
Applying bitter-tasting nail solutions
Thumb Sucking
Definition:
Persistent sucking of the thumb beyond the normal age of 3-4 years.
Signs and Symptoms:
Dental malocclusion (buck teeth)
Speech difficulties
Skin infections around the thumb
Management:
Positive reinforcement (rewards for avoiding)
Thumb guards
Bitter-tasting nail polish
Somnambulism (Sleepwalking)
Definition:
A sleep disorder in which a child walks or performs activities while in deep sleep.
Signs and Symptoms:
Walking or sitting up during sleep
Blank facial expression
Difficulty waking up
No memory of the event
Management:
Ensure a safe sleep environment (locking doors, removing sharp objects)
Establish a regular sleep schedule
Address underlying anxiety or stress
Protein Energy Malnutrition (PEM)
Definition:
A condition caused by deficiency of proteins, energy, or both, leading to severe malnutrition.
Types:
Kwashiorkor – Protein deficiency with adequate calorie intake.
Signs: Edema, moon face, fatty liver, dermatitis
Marasmus – Severe deficiency of both protein and calories.
Signs: Severe wasting, no edema, wrinkled skin, muscle loss
Management:
Gradual refeeding (F-75, F-100 therapeutic milk)
Treatment of infections (antibiotics, deworming)
Micronutrient supplementation (vitamin A, zinc)
Long-term nutritional rehabilitation.
Helminthic Infestation in Children –
Helminthic infestations are common in pediatric populations, especially in developing countries where poor sanitation and hygiene contribute to their spread. These infestations can cause malnutrition, anemia, growth retardation, and cognitive impairment in children.
Definition
Helminthic infestation refers to an infection caused by parasitic worms in the gastrointestinal tract, bloodstream, or tissues of the human body.
Classification of Helminths
Helminths are broadly classified into three major groups:
A. Nematodes (Roundworms)
Ascaris lumbricoides (Roundworm)
Ancylostoma duodenale, Necator americanus (Hookworm)
Enterobius vermicularis (Pinworm)
Trichuris trichiura (Whipworm)
Strongyloides stercoralis (Threadworm)
B. Cestodes (Tapeworms)
Taenia solium (Pork tapeworm)
Taenia saginata (Beef tapeworm)
Diphyllobothrium latum (Fish tapeworm)
Hymenolepis nana (Dwarf tapeworm)
C. Trematodes (Flukes)
Schistosoma species (Blood flukes)
Fasciola hepatica (Liver fluke)
Paragonimus westermani (Lung fluke)
Causes and Risk Factors
Ingestion of contaminated food or water
Walking barefoot in contaminated soil (hookworm)
Poor sanitation and hygiene
Consumption of undercooked meat or fish
Close contact with infected individuals
Signs and Symptoms of Common Helminthic Infections
Type of Worm
Mode of Transmission
Signs & Symptoms
Ascaris lumbricoides (Roundworm)
Ingestion of eggs from contaminated soil, food, water
Stool Examination – Microscopic identification of eggs, larvae, or cysts in stool samples.
Cellophane Tape Test – Used for pinworm (Enterobius vermicularis).
Serological Tests – ELISA, PCR for detecting Schistosoma and Strongyloides infections.
Imaging (CT/MRI Brain) – For Neurocysticercosis (pork tapeworm).
Complete Blood Count (CBC) – Eosinophilia is a common indicator of helminthic infections.
Management & Treatment
A. Anthelmintic Drugs (Deworming)
Drug Name
Used for
Albendazole (400 mg single dose)
Roundworms, hookworms, whipworms, pinworms
Mebendazole (100 mg twice daily for 3 days)
Roundworms, whipworms
Pyrantel Pamoate (Single dose 10 mg/kg)
Pinworm, hookworm
Ivermectin (200 mcg/kg single dose)
Strongyloidiasis, scabies
Praziquantel (40 mg/kg single dose)
Schistosomiasis, tapeworm infections
Niclosamide (2 g single dose)
Tapeworm infections
B. Supportive Therapy
Iron and folic acid supplementation (for anemia due to hookworm)
Vitamin B12 supplementation (for fish tapeworm-induced megaloblastic anemia)
Nutritional rehabilitation
Prevention and Control Measures
Deworming Programs – WHO recommends deworming every 6 months for children in endemic areas.
Handwashing with soap and water after defecation and before eating.
Proper sanitation – Use of latrines, proper sewage disposal.
Wearing footwear – Prevents hookworm infestation.
Avoiding raw or undercooked meat/fish – To prevent tapeworm infections.
Health education – Awareness programs about hygiene and sanitation.
National Deworming Programs in India
National Deworming Day (NDD) – Observed on 10th February and 10th August
Target Group: Children aged 1-19 years
Deworming Agent:Albendazole (400 mg single dose)
Implemented by: Ministry of Health and Family Welfare (MoHFW), Government of India
Key Points
✔️ Most common helminth infection worldwide? – Ascaris lumbricoides (Roundworm) ✔️ Most common helminth infection in school-aged children? – Enterobius vermicularis (Pinworm) ✔️ Which helminth causes iron-deficiency anemia? – Hookworm (Ancylostoma, Necator) ✔️ Which helminth causes neurocysticercosis? – Taenia solium (Pork tapeworm) ✔️ Which worm is transmitted via skin penetration? – Hookworm, Strongyloides ✔️ Deworming drug used in National Deworming Day (NDD)? – Albendazol
Tics
Definition:
Tics are sudden, repetitive, involuntary motor movements or vocalizations that occur unpredictably in children.
Types of Tics:
Motor Tics (e.g., eye blinking, shoulder shrugging, facial grimacing)
Tourette Syndrome – Multiple motor and vocal tics persisting >1 year
Causes:
Genetic factors
Neurochemical imbalance (dopamine dysfunction)
Psychological stress
Brain injury or infections (e.g., Streptococcus-associated PANDAS)
Signs & Symptoms:
Sudden, repetitive, involuntary movements or sounds
Worsening of tics with stress, anxiety, or fatigue
Temporary suppression with conscious effort
Complications:
Social embarrassment
Learning difficulties
Anxiety, depression
Diagnosis:
Clinical evaluation
DSM-5 criteria
MRI or EEG (to rule out neurological disorders)
Management:
Behavioral therapy (Habit Reversal Therapy – HRT)
Medications (Clonidine, Haloperidol, Risperidone)
Cognitive Behavioral Therapy (CBT) for anxiety-related tics
Pica
Definition:
Pica is a disorder characterized by persistent eating of non-nutritive substances for at least 1 month, inappropriate to the child’s developmental stage.
Electrolyte abnormalities (low potassium, high bicarbonate)
Management:
Cognitive Behavioral Therapy (CBT)
SSRIs (Fluoxetine)
Nutritional counseling
Juvenile Delinquency
Definition:
Juvenile delinquency refers to criminal or antisocial behavior by children/adolescents below 18 years of age.
Causes:
Poor parenting, family conflict
Low socio-economic status
Substance abuse
Mental health disorders (ADHD, Conduct Disorder)
Signs & Symptoms:
Frequent rule-breaking
Aggressive behavior, violence
Substance abuse (alcohol, drugs)
Truancy (skipping school)
Complications:
Legal consequences (juvenile detention)
Social isolation
Psychiatric disorders (depression, PTSD)
Management:
Parental guidance and support
Psychotherapy (CBT, behavioral therapy)
Rehabilitation programs
Vocational training and education support
Key Points for Competitive Exams
✔️ Most common eating disorder in teens? – Anorexia Nervosa ✔️ Binge-purge cycle is seen in? – Bulimia Nervosa ✔️ Most common tic disorder? – Tourette’s Syndrome ✔️ Most common juvenile crime? – Theft and vandalism ✔️ Drug used for tics? – Clonidine, Haloperidol