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Leukocytes in Urine during Pregnancy
Your developing baby is going to demand a lot from your body and to make sure that your baby's growth and development is taking in the right manner, you will have to visit the doctor for regular check-ups. Many tests will be performed during every visit, however, one of the tests that you will need to take at every check-up is a urinary test. This can help detect the level of leukocytes in the urine, making the doctor able to tell you if you have any infections that will need treatment.
What Are Leukocytes in Urine?
Leukocytes are white blood cells that work side by side with the immune system and defend the body from infections and diseases. They appear when there is damage to the kidneys and urinary system and when foreign materials enter the body.
When leukocytes damage or when they are killed while fighting off infections, they are expelled from the body through the urine, signifying a low level of leukocytes in the urine. The average level of leukocytes that should be present in the urine is between 2 to 5 WBCs/hpf. However, if the level of leukocytes rises and goes above 5 WBCs/hpf, it may be a sign of infection or disease and must be investigated.
What Causes Leukocytes in Urine During Pregnancy?
There are many reasons why the number of white blood cells increases in pregnant women, the most common being when there is some sort of infection in the vagina, which if left untreated can develop into something far more serious. Some of the main causes of Leukocytes in urine during pregnancy are discussed below:
1. Urinary Tract Infection
Leukocytes are usually present in the urine if you are suffering from UTI. When a woman is pregnant, there is an increase in the bladder volume, but the tone will be reduced due to the weight of the baby pushing down on it. It is very difficult in this situation to completely empty the bladder, and so the bacteria may never fully leave the system. Instead, it multiplies.
2. Asymptomatic Bacteriuria
When there are bacteria in the uterus, it is called asymptomatic bacteriuria. About 30% of pregnant women may have a bacterial infection in the urinary tract but show no symptoms. These can cause leukocytes to manifest in the urine. If left unchecked, this causes pyelonephritis in pregnant women, and it is because of this it is important that doctors perform a routine urine test for them.
3. Genital Infection
Sexually and non-sexually transmittable infections may lead to the presence of white blood cells in the urine of a person. Some of the infections that can cause leukocytes to appear in the urine of pregnant women are Chlamydia, vaginal yeast infection, bacterial vaginitis, gonorrhoea and genital herpes.
4. Kidney Infections
Kidney infections, or pyelonephritis, develops when urinary tract infection is left untreated in pregnant women. This is a serious condition that must be treated at the earliest to avoid preterm labour or premature rupture of the membranes. Kidney infections can cause leukocytes to appear in the urine and may cause fever, lower back pain and vomiting. Pregnant women often suffer from this more than others as the growing foetus squeezes against the kidney and bladder as it gets bigger.
5. Cystitis
This is a type of urinary tract infection that leads to the bladder becoming inflamed and causes the number of white blood cells in the urine to rise. The cause of this is bacteria and causes similar symptoms as UTI, but there is also lower back pain and discomfort in the pelvic region. If inflammation is severe, a trace of blood and leukocytes in urine during pregnancy can be found.
Signs and Symptoms of White Blood Cells in Urine while Pregnant
Most often, the signs and symptoms will vary depending on what is causing the rise in leukocyte levels. Some of the main symptoms of leukocytes in urine during pregnancy are:
Burning sensation while urinating
Frequent urination
Unable to empty bladder
Foul smelling urine
Cloudy looking urine
Lower back pain
Weakness and fatigue
A low fever may occur
Nausea and vomiting
Diagnosis
One of the most outstanding causes of an increase in leukocyte levels is due to a urinary tract infection.
1. How To Measure
A urine culture and sensitivity examination should be done to see if any bacteria are present in the urinary system. Your white blood cell count will be taken to help detect any infections that are hidden in the body. Pregnant women are allowed an increase in leukocytes to 5-6 in the field of vision, but this depends on if all other indicators remain unchanged. An increase to 10-20 indicates that there is most likely an inflammation somewhere in the excretory system. If the number goes up to 40-50, then this is an indication that the kidneys have been infected.
2. How To Analyse
If the result of the WBC count is either higher than or lower than the normal count that is needed for your age, then there is most likely an underlying problem. During the first trimester, the test is done every three to four weeks, during the second trimester it is done every two weeks, and by the third trimester, it is done every week. The analysis will require the first urine of the morning to be collected in a jar that has been sterilized to avoid contamination of the sample. Your doctor will also need to know all about your medical history, any medications that you are currently on and your symptoms to accurately identify what is causing the abnormal WBC count. Your WBC will also need to be checked at regular intervals to ensure that the treatment plan you have been put on is working or not.
3. Instrumental Diagnosis
This is usually an ultrasound where the bladder, urinary tract, and kidneys are studied. Any enlargement in the pelvic region will be clearly visible. Ultrasounds can detect the neurogenic bladder, polycystic kidney disease, and obstructive uropathy. A survey monography is also available that will show any change in the contour or positioning of the kidneys. Radiopaque methods are quite popular, and computed tomography can be used, but it does not have any special features or abilities that cannot be provided by an ultrasound.
4. Differential Diagnosis
In this, a clinical analysis of the urine is done where any increase of white blood cells can be seen. These analysis are compared with that of a woman’s general condition and her complaints. An anamnesis is available to help identify the cause of the condition. Sowing is a process that is carried out along with the urine analysis. Here the main pathogen is identified, and the right therapy is selected. Unfortunately, this does not always deliver accurate results. At least 20% of the results are false positives in this research, and so the test must be taken at least thrice before coming to any concrete result.
Effects and Complications
Treatment must commence immediately if you have been found with high levels of leukocytes and the doctors have determined their cause. If, for example, you have been found to have pyelonephritis, your doctors will start you on certain antibiotics that should be taken while carefully following the doctor’s instructions to avoid further complications with the pregnancy.
Eclampsia is another complication that may arise, and it causes a rise in blood pressure. Careful monitoring of your condition during pregnancy can save your baby’s life by avoiding the development of serious complications.
The cause of an increase in leukocytes depends on a person's condition. For example, if cystitis is a problem, it may turn serious as urination can be very painful. Further development of this can turn into gangrenous cystitis, where the pain will be intense, and there is a complete inability to urinate, putting your bladder and peritonitis at risk of rupturing.
Some infections will leave behind a residue of stone and sand as well. It is highly important to treat any problem at the earliest to avoid some very unpleasant and dangerous complications.
How To Treat Leukocytes in the Urine
There is no fixed method of treating the condition of an increased level of leukocytes in the urine. The treatment will vary depending on an individual’s levels of leukocytes as well as based on the cause of the issue.
1. Natural Disinfectants
If the inflammation is not serious, it can be treated with natural disinfectants and diuretics. Most pregnant women will be advised to drink decoctions of chamomile, black currant, and cowberry. The urine will be encouraged out of the body with these, decreasing the chance of developing more serious infections.
2. Antibiotics
If the inflammation is more serious, antibiotics will need to be administered, but the antibiotics used will need to be safe for your baby as well. The antibiotics and the decoctions will help eliminate the infection and prevent more serious complications in your pregnancy.
3. Surgery
If you have an obstruction such as kidney stones or a tumour that is causing the rise in leukocyte levels, you will most probably need surgery to remove the obstruction. Drink plenty of water to try and get rid of the smaller kidney stones, though passing it naturally is quite painful.
4. Sound-waves, Chemotherapy, and Radiation
For larger kidney stones, sound waves can be used to break them up. Chemotherapy and radiation are other options to look at in case of tumours.
Prevention
Here are some ways to prevent the rise of leukocytes in the urine:
Go for regular urine tests.
Drink a lot of water to flush out the bacteria and the toxins from the body.
Urinate often and regularly.
Maintain personal hygiene by washing your hands before you use the restroom, as well as by keeping your genitals clean after you have relieved yourself. When wiping, wipe from front to back.
FAQs
Here are some frequently asked questions about the rise in leukocytes:
1. Can Increased White Blood Cells in Urine Indicate Blood Leukemia?
Yes, an increase in the number of WBC in the urine can indicate the presence of Leukemia, a form of blood cancer. Elevated leukocytes in the urine are used to diagnose Leukemia and Lymphoma.
2. Can Elevated Number of WBCs in Urine Lead to STD Infection?
STDs such as Gonorrhoea and Chlamydia leave traces of elevated quantities of WBCs in the blood which is found through the urine. This is why elevated traces of WBC can be an indication of an STD.
3. Can Leukocytes in Urine Cause Foetal Death If Left Untreated?
There are cases where the rise in the number of leukocytes in the blood are associated with late toxicosis and other rather serious inflammatory problems. Women who have this are plagued with fatigue and increased pressure, and the risk of losing the baby is possible. If the leukocytes esterase in urine during pregnancy and the inflammation is detected on time, then there is no risk, but if left untreated, the child will be at risk, and there are high chances of complications during childbirth.
The most important thing is to identify and treat any rise in levels of leukocytes in the urine. If this is not done, it can have a very negative impact on your health and the life of your unborn child. Rest assured that most often, the abnormal WBC count will be noticed at the earliest as routine urinary tests are a part of the general check-ups for pregnant women. But if treatment is not followed regularly and care is not taken, the situation can worsen. So make sure you don’t miss any of your prenatal doctor's appointments and follow your doctor's instructions carefully when given.
Also Read: CBC (Complete Blood Count) Test in Pregnancy Read more
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6 Simple Ways to Identify Whether Your Gold Jewellery is Real or Fake
Gold is a precious metal, and it one of the safest investment options available out there. If ever you are in need of some cash, you can always sell your gold jewellery. But before you take your valuable possession (gold jewellery or gold coins) to the goldsmith to ascertain its true value, you must find out whether the gold that you own is really 'gold' or just some random metal with a gold plating. It's always wise to check the authenticity of gold metal. You can also test the authenticity of metal at home. We shall acquaint you with some simple ways to identify whether the gold you possess is real or fake.
How to Check Whether Your Gold Jewellery is Real or Not
Here are some simple tests that you can conduct to find out whether the gold jewellery or gold coin that you own is real gold or not.
1. The Nitric Acid Test
One of the easiest ways of establishing whether your ornament is made of pure gold or not is by running a nitric acid test on it. All you need to do is scrape a small section of your jewellery with a nail filer, (preferably the part that remains hidden when you wear the jewellery). Fill a dropper with nitric acid. Gently drop few drops on the scraped part of the jewellery. If the colour of the jewellery does not change at all, it is probably pure gold. But if the colour changes and you see a tinge of green on it, then the jewellery is not made of real gold. Nitric acid does not react with real gold. But it reacts with other alloys such as copper, zinc, sterling silver, etc. You will need to be careful while conducting this test. Conduct this test in a properly ventilated room, and wear gloves and mask.
2. The Bite Test
Biting a gold ornament is another way to test its authenticity. Bite any gold ornament of yours. If it is made of real gold, you will see your bite marks or indents of your teeth marks on it. As gold is a soft metal, you will be able to see your teeth marks. However, exercise caution while doing this test - do not damage your teeth in the process.
3. The Visual Test
You can also identify the authenticity of a gold ornament or jewellery by looking for a hallmark or other authenticity marks on it. The hallmark stamp is mostly placed on the clasp of a chain or bracelet, or inside the inner band of the ring. The purity of gold is expressed in carats like 24K, 22K, 18K, 14K or 10K. The higher the carat weight of the jewellery, the purer it is. Sometimes, due to normal wear and tear, you may not be able to see the mark clearly, in such a situation, you can use a magnifying glass to see it. Alternatively, you can look for the signs of discolouration on your jewellery. If you wear a pure gold ornament, its colour would never change. But if you wear fake gold jewellery, then you will notice the discolouration in it.
4. The Ceramic Plate Test
This is also an effective way of finding out the purity of your gold jewellery. All you need to conduct this test is an unglazed ceramic plate. Simply take your jewellery and drag it along the surface of the plate. As you drag the piece of your jewellery, if you notice a black streak on the place, it indicates that what you own is not real gold. But if there are no marks on the plate, then your ornament is made of pure gold. While doing this test, make sure you drag the piece of jewellery gently, as excess pressure may damage your jewellery.
5. The Magnet Test
A simple way to find out if your gold jewellery is made of real gold or not is by running a magnet test on it. For that, procure a good magnet. Buy a strong magnet from a hardware store. Place your jewellery close to that magnet. The metal gold is not attracted to a magnet. But if your gold jewellery attracts to the magnet, then it may not be made of real gold. If your jewellery does not attract to a magnet, then it's good. However, it cannot be said for sure that it will be made of pure gold because there are other metals also that are used to make fake jewellery, which are non-magnetic in nature.
6. The Heaviness Test
Gold is a heavy and dense metal. Therefore, one of the effective ways of establishing its authenticity is by checking its heaviness or density. Take a bucket of water and drop your gold jewellery in it; if it is made of real gold, it will sink. However, if the jewellery floats, then the chances are that your gold jewellery might be fake. Also, gold does not rust when it comes in contact with water; however, fake gold may rust on coming in contact with water.
Apart from these tests, there are other ways of determining the purity of gold. Fake jewellery may leave marks on your skin or irritate your skin, but that is not true for pure gold. Another way of knowing is by running a sound test. It is assumed that pure metals like gold make tingling, high-pitched sound as opposed to fake metals that have a short and dull sound.
There are many ways to test for the purity of gold. You can also run any of the tests mentioned above to check whether your jewellery is real or fake. However, the best way to know the purity of your gold is by taking it to an authorised metal consultant or a certified jeweller.
Also Read:
How to Invest in Gold in India?
Tips to Clean Silver and Gold at Home
What is Real Purpose Behind Indian Accessories? Read more
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Let's Enjoy the Summer Vacations, Let's Be Kids Again!
Last week, we went for a family outing in a nearby restaurant which has an open play area for kids. It has got swings, trampolines, and some outdoor activities which attracted my toddler very much. While the kids played, my eyes found a computer screen where someone was playing the very famous 90s video game 'Mario'. I was so excited to see that and I wondered how this was possible. The game that I used to play with my siblings in my childhood was just in front of me. Yes, I didn't miss the opportunity and played a few stages of my favourite childhood game. While we were going back home, all my childhood memories came back to me.
When I was around 7-8 years old, I remember watching 'Mowgli' and 'Chandrakanta' with my cousins and sisters. Also, we were crazy about reading comic books especially 'Chacha Chowdhary', 'Billu', and 'Pinky'. I know most of you would have recalled this by now. What golden days those were! We used to wait eagerly for the summer vacations so that we can get a cycle on rent and ride it a long way. Also, I used to visit my nani's house in the village with my mother and that again was a superb experience every summer. Playing cards, visiting the farms, eating mangoes, having fresh cow's milk; just wow!
We played Ludo, snakes and ladders, and chess. Chess is again important for me because I learnt how to play it thanks to my older brother. He used to be a champion amongst all cousins at that time. Oh, once the memories began pouring in, they just couldn't be stopped easily. I am sure you all can connect with my story very well.
Even if we didn't have fancy dolls, we had a lot of friends to play with. How summer vacations have changed entirely today, though! As soon as my daughter's school closed for the summer, I started searching for a summer camp to enrol her in so that she doesn't get bored. It's very difficult these days to keep kids entertained and happy at the same time. I try to practise with my kids, then I also play with them with sets of blocks, puzzles, etc. Then again in the evening, it's necessary that I take them outside to play so that they watch less television and don't stay glued to the phone.
But today also, what's most fascinating for my kids is to meet with their cousins at their uncles' and aunts' houses. And when they all play together, I see my childhood in theirs. It's summer vacations again, so let's reunite with our siblings and let's be children again. Let's keep our smartphones aside and spend some genuine time with our kids, nieces, and nephews, and let's make this summer a memorable one.
Disclaimer: The views, opinions and positions (including content in any form) expressed within this post are those of the author alone. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The responsibility for intellectual property rights of this content rests with the author and any liability with regards to infringement of intellectual property rights remains with him/her. Read more
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Potty Training Twins - 10 Useful Tips
Do you remember that golden moment when you came to know that you are going to have twins? Your happiness would have known no bounds. There's no doubt that twins double the happiness of being parents, but when it comes to raising them together, it's something that will leave you exhausted. Handling two little munchkins at the same time is not that easy, not for all! And when it comes to potty-training them, you're bound to get confused, and that's alright. It may not be a piece of cake, but it is certainly not an impossible mission to achieve. There is no doubt it would require more time and more patience on your part, but you will be able to train your babies. We shall be discussing some useful tips that may make potty training your twins easier and more convenient. Read the post to know more!
Is Potty Training Twins Different from Potty Training a Child?
Yes, of course! It is very different to potty train twins in comparison to training a single child because you are not dealing with one kiddo but two kids of the same age. Potty training two kids of the same age at the same time will be challenging, but we know, being a mother, you will be able to do it. You can make it a fun time for your kiddos. Get two potty seats, preferably similar looking or identical so that babies don’t get confused or squabble over it. You can help your little ones decorate it too using colourful stickers to help them identify their own potty seat.
What to Do If One Twin is Potty Trained Faster Than the Other?
Every child is different and unique and thus may get potty trained at his own time and pace. When you are training your kids, one child can show better progress than the other, and it is very normal. Whenever one child shows the readiness to go to the bathroom, make sure you take the other sibling along. This way the other child will observe and learn what he may be expected to do. You should follow a set routine to train them. You can also make your kids sit on the potty seat every half hour, this way you save yourself from the trouble of going to the bathroom too often.
What Should You Do if One Twin is Ready for Potty Training and the Other Isn't?
We have discussed above that all twins are different and do things at a different pace, same holds true regarding potty training too. You may notice, usually when potty training twin boy and girl, one would show the readiness but others may not be ready. There is no need to hit the panic button because potty training twins (where one is ready and the other is not), is a very common problem that parents of twins face. However, you can follow some of our potty training tips for twins, which are discussed in the next segment.
Helpful Tips on Potty Training Twins
Here are some tips that may help the parents in potty training their twins:
1. Prep Your Children
Before your children are ready for the physical changes, you can prepare them mentally for the coming changes. This means, if you plan to start their training a week from now, you can start talking about how grown up they are now and what grownups are expected to do. You can get them books of their favourite cartoon characters wearing underpants. You can also take them on a shopping trip and buy underpants and potty seats of their choice. All this will help the kids in preparing for the potty training session.
2. Make Sure That the Timing is Right
You have to look for signs of readiness in your child. The average age for potty training twins is around 18 months, but if your kids do not show signs of readiness, there is no need to force them. It is important to introduce the habit in a positive manner. They should not resent the entire process. If your kids are not wetting their diapers for a longer duration or peeing and pooping when you take them on their occasional loo visits, it may be an indication that your kids are ready.
3. Dress Them Appropriately
If you are planning on potty training twins at 18 months or later than that, make sure you dress them appropriately. Dressing your kids in clothes that they won't be able to pull down (if required) on their own is not recommended. Make them wear clothes that they can remove in case of an emergency. Also, if you do not want your kids’ beautiful clothes to get all soiled, do not dress up them in such clothes during this phase. Some parents prefer warmer months for potty training their kids because kids are dressed up in lesser clothes, which can be easily removed. Also, there would be lesser dirty or soiled clothes for washing, in case of mishaps.
4. Make Similar Schedules
You need to follow a similar schedule for your kids, whether it is their feeding, sleeping, or pooping schedule - all have to be in sync. It is seen that if one child shows readiness or goes at a faster pace than the other, the other child may get inspired and may pick up the pace. Also, when kids know what they are expected to do things at a particular time, they prepare their mind accordingly and adjust well to it too. This means if the kids know that they have to sit on the potty seat after drinking milk in the morning, they may become consistent and get into this habit.
5. Be Flexible
Although sticking to the schedule is important to maintain consistency, sometimes, you may have to try different approaches for both the kids. This is because sometimes one approach may not work for both the kids. One may like privacy, whereas the other may be okay with his bodily functions. One may love to listen to your words of appreciation, whereas the other may not sway by your words. Therefore, sometimes you need to understand your kids’ requirements and function accordingly.
6. Be Prepared for the Mess
Potty training is something that you may have to struggle with, especially in the case of twins. Be prepared to deal with the mess because it is normal for kids to have accidents or setbacks. Have ample supplies of clean clothes; protect the things which you don't want to get soiled or dirty, secure the areas with gates or if your kids understand the ‘off-limits’ then you can make these areas off-limits. In short, you need to prepare them mentally and also prepare your house to deal with the mess that may occur.
7. Get Two Potty Seats
Sometimes twins may not settle with sharing, whether it is their potty seats or toys. With just one potty seat in the house, you may notice that your kids may want to use it at the same time and then the squabble would begin. To evade such situations, make sure you get two seats, we suggest identical seats for your kids to save you from the unnecessary trouble.
8. Offer Rewards
Everyone likes rewards, it keeps us pepped up. Your kids are no exception to the rule and therefore if your kids exhibit good potty training behaviour, you should offer rewards for their efforts. The only glitch to this is, sometimes when one child shows progress and keeps getting all the rewards, the other may feel left out, or this may lead to resentment towards the sibling. This may turn out to be a setback for the other child, and he may take longer to get trained. On the contrary, if your kiddos enjoy competition, then rewarding may be a great way of achieving good progress. You can also reinforce positive competition by keeping it healthy. Do not compare or demean the child who is making slower progress. Make it more fun for both the kids.
9. Ask for Help
We do not deny that the potty training phase can take a toll on the mommy, but if you are not able to handle the pressure alone it will be a wise decision to seek help. Ask your partner for help; you can also ask any family member to come and stay with you for that period. If you can afford, hiring a nanny for this phase will the most viable thing to do. This is a temporary phase, and there is no need to feel hassled. Also, do not be too harsh on yourself, if you cannot deal with it, it is absolutely fine. Do not take it as a challenge and test your limits. Seek some help and be a happy mommy for your kiddos.
10. Seek Expert Advice
If your efforts fail after a week to ten days of trial, you can seek your doctor’s advice on the same. Your doctor may help you guide what you may be doing wrong. Your doctor may also see if your kids or kid is suffering from a medical condition such as constipation, which can make potty training as tedious as it may sound. Follow what the expert tells you to do, but you know what may be best for your child. Follow your instinct when in doubt.
Potty training twins can get tedious for new parents. However, we hope that the tips mentioned above will help you to an extent.
Also Read:
Potty Training Twins
How to Potty Train a Girl
How to Potty Train a Boy Read more
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Q. my product didn't received today
Rayan
Mom of 2 children
8 hours ago
A. Hello, Check the status of the product on the page you have placed the order.
If the delivery date is crossed, you may check your SMS in your firstcry registered mobile number.Delay in delivery date reason may be sent by Firstcry team.
Dr Ghouse has added a new answer
Expecting Mom due this month
8 hours ago
Q. hello,
Mera pregnancy ka 9th month 1 hfte me complete ho jaega jb se 9th month start hua hai mujhe 2 bar labour pain jaisa pain feel hua but wo kuch hi time baad shi ho gya. iss condition me kya mujhe kya krna chahiye?
Dr Ghouse
Paediatrician
7 hours ago
A. aapko Apne doctor se jaanch karva lijiye aur advise follow kijiye. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Dr Ghouse has added a new answer
Expecting Mom due this month
8 hours ago
Q. Mera pregnancy ka 9th month 1 hfte me complete ho rha hai lekin 9th month start hote hi abhi tk 2 bar labour pain jaisa feel hua hai but wo kuch time baad khud hi theek ho jata hai aisi condition me mujhe kya krna chahiye?
Dr Ghouse
Paediatrician
7 hours ago
A. Shayad false pains ho sakte hain jaanch karvani hogi. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Rashmi has added a new answer
Trying To Conceive
3 hours ago
Q. what happen if a negative line follwed by faint line
Rashmi
Mom of a 9 yr 8 m old girl
3 hours ago
A. If both the lines are visible that is considered positive yet if you have any kind of a doubt about it then you can always take a blood test and you can take an ultrasound with your doctor that is going to give you better clarity or post the picture which is going to be more clear to us
Rashmi has added a new answer
Trying To Conceive
2 hours ago
Q. Can we start solids to baby boy at 5 month starting
Rashmi
Mom of a 9 yr 8 m old girl
1 hour ago
A. Absolutely not the child has to be six months complete and beginning with the seventh month as that is going to be the right time for you to start giving external food to the child that it is not advisable to give anything other than mothers or formula feeding to the child that’s just enough
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Trying To Conceive
2 hours ago
Q. How to know baby is theething
5 month completed baby still feeds every hour is it ok
Rashmi
Mom of a 9 yr 8 m old girl
2 hours ago
A. You will see that your child will keep biting on anything that comes to your child like it could be finger it could be thumb it could probably be your nipples also when they try to bite really very hard so that is when you know and also the child’s gums are going to be very hard or swelled up
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