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Cervix Dilation during Labour and Birth
The tenure of pregnancy is a beautiful episode in the life of the parents-to-be and especially the mother. While giving birth to a new life has its own set of challenges, it is certainly a memorable experience. Giving birth to a child is an intricate process which requires multiple organs of the mother’s body to function in tandem. The cervix is one such important organ that plays a crucial role in the labour and birth process.
What Happens to the Cervix In Pregnancy?
Cervix, most commonly known as the neck of the uterus, is a tube-like structure that is present in between and joins the vagina to the uterus. The narrow opening of the cervix during early pregnancy is closed by thick, gelatinous mucus which is secreted by the cervical glands. This is the first change that the cervix undergoes during pregnancy. It undergoes multiple changes as the pregnancy progresses, especially during the process of labour.
What Happens to the Cervix During Labour?
While it remains closed for the most part of the pregnancy, the cervix softens and elongates as the pregnancy progresses and undergoes significant changes in the last month of labour.
Before the last month of pregnancy, the cervix is around 4 centimetres long. It begins to shorten in the ninth month of pregnancy and moves from the posterior position into the anterior position, pointing forward. The cervix begins to become thinner and gets pulled up into the lower part of the uterus. This process is known as effacing or effacement.
Effacement is calculated in percentages and is an important sign of the body preparing for labour.
The stage of effacement is followed by dilation of the cervix. This is the stage where the cervix opens up to allow the baby’s head to pass through it. The cervix starts dilating during contractions and dilates up to 10 centimetres during delivery. Once the dilation is complete, the baby is pushed out through the cervix.
Cervical Dilation During Birth
Cervical dilation is the stage of labour where the contractions lead to the opening of the cervix which allows the baby to come out. Following are the changes which are experienced by the cervix during the course of pregnancy.
The cervix remains closed during the initial stages of pregnancy to protect and support the growth of the foetus and uterus of the mother.
At the time before labour, the cervix moves into anterior position from being posterior to align with the vagina and point forward.
During the labour, cervix flexes to contractions and intrauterine pressure of the uterus.
The wall of the cervix becomes thinner during labour, allowing it to achieve effacement.
As the pregnancy progresses and reaches its end, the cervix begins to ripen. The amniotic fluid content inside the cervix increases during the labour, allowing it to reach vascularity.
To deal with the contractions, the cervix starts to soften and change colour which allows it to stretch and become thin. This is necessary for the delivery of the baby.
To allow the head of the baby to pass through, the cervix dilates from 0 to 10 centimetres during labour.
The dilation of the cervix is measured in percentages. The size of dilation during various stages of labour are as follows:
Latent phase: 0-3 centimetres
Active labour: 4-7 centimetres
Transition: 8-10 centimetres
Full dilation: 10 centimetres. The baby is delivered shortly after the cervix achieves this stage of dilation.
Problems With the Cervix
At the time of labour, certain complications may arise during the dilation of the cervix.
If the length of the cervix is less than the usual 3 centimetres during labour, it can lead to incompetent cervix and cause complications such as premature delivery.
Pre-labour contractions cause the cervix to shorten and widen as a normal process. In case the cervix shortens without contractions, it leads to an incompetent cervix which can result in premature labour.
In case the cervix shortens without contractions, the cervix is stitched surgically to hold it in the closed position. This procedure is known as cervical cerclage and is undertaken only under rare circumstances.
At times, the opening of the cervix might be tightly shut and does not dilate or open. This is a situation where the woman’s cervix is stenotic. This might happen due to several reasons such as previous surgery, infection or genetic abnormalities in the woman.
In case of any severe problems or complications, the doctor will take the necessary steps to ensure that the process of delivery is not hindered and is as normal as possible.
What are Cervical Tears?
Minor cervical tears during the delivery are not uncommon, especially in case of the birth of the first child. The chance of cervical tears is higher when the delivery is assisted by instruments such as forceps or vacuum. However, such tears can occur even during normal delivery of the child.
Other reasons for cervical tears include precipitate labour, a rigidity of the cervix due to previous surgeries and delivery through a very vascular cervix.
During contractions, the mother might experience severe cervix dilation pain which is not unusual. However, if vaginal bleeding accompanies the pains, it is an indication for the doctors to examine the cervix for tears.
Unless severe, the tears will not require any special surgery or treatment and will heal by itself with time.
Tips to Relax During Labour
Labour is a time where the body is stressed and going through phases of anxiety. The whole process can be tiring, and cervix dilation during pregnancy can take a toll on the mother. It is therefore important to relax, to ensure that the labour is smooth.
Here are tips that will help you relax during labour:
Stay calm. Tell yourself not to panic during the process. Having a family member beside you will help.
Meditation and positive thinking will help you to relax and stay calm.
If the contractions which facilitate the opening of the cervix during pregnancy are too painful, ask for pain relief medication to your doctor.
Put your body in a position where it feels comfortable. Change positions if necessary.
Breathe continuously in between the pushes. This will replenish you with oxygen and provide energy to the body.
Your body is designed to bear the pain associated with giving birth and hence it will automatically recover naturally and safely, once the process is complete.
The process of labour is a tiring process, and cervix dilation can be painful. It is best to think about your bundle of joy which is about to come into the world and the happiness the baby will bring into your life. Understanding cervix dilation and being prepared for it mentally will help you pass through the phase with relative ease.
Once the delivery is complete, give yourself sufficient rest and allow the body to recover before you start performing your daily chores again.
Also Read:
A Guide to Speeding Up Your Labour
Cervix Position in Early Pregnancy Read more
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Your Baby This Week : 14 Month Week 4 Old
” Do you notice your child hit or push other kids? Dont worry too much. When your child pulls another childs hair or hits her, he is probably only fascinated by the response it evokes or is simply imitating someone elses behaviour. The best way to tackle this is to redirect your childs attention and firmly say no. This might take a few tries, but be patient, your child will grow out of this phase too. “
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Martial Arts for Children
Young kids are usually bursting with energy. A great way to productively channelise this packed energy is to enrol them in martial arts training. Some parents fear that martial arts may encourage aggression and violence in kids. But this concern is baseless and has no logic.
Martial arts like Kung Fu, Aikido, Taekwondo are not only fun activities for young boys and girls, but they may also help promote physical fitness and mental strength in children. In fact, children who have attention-deficit hyperactivity disorder (ADHD) have reported considerable benefits by joining these training classes.
The lessons of respect, discipline, and concentration that a kid learns from these classes ultimately may groom and shape his personality. These lessons may also carry over to school life, helping him to perform better academically and achieve success.
What are Martial Arts?
Martial arts are a traditional system of combat practices which aim at training the body, mind, and spirit to function in sync. To simply put it they can be perceived as fighting arts. Martial arts endeavour to strike a harmony between the mind and body along with teaching effective methods of self-defence.
Martial arts for children promote the all-round development of a kid by developing the mental abilities, spiritual strength of the child along with his physical capabilities.
At what Age can a Child Start Martial Arts Classes?
According to experts, six years is an appropriate age for teaching martial arts. By that age, a kid should have ideally developed enough muscle strength and control to apply the various techniques of martial arts like punches, kicks and so on.
Nonetheless, there are certain schools that offer martial arts training for even younger kids. But then the emphasis may be more on entertainment than organized training. Hence, their programs are generally game based. Some institutes also run classes for preschool kids. The focus is more on developing skills like hand-eye coordination and improving the attention span.
Does Learning Martial Arts Promote Violence?
Some parents may be hesitant to enrol their kids for martial arts classes because of the fear that it can make their kids violent and hostile. But experts say this is a misconception. On the contrary, martial arts may help in making a child more self- disciplined, respectful and social. The child learns to exercise self-control while effectively defending himself with the self-defence techniques of martial arts.
Significance of the Belt in Martial Arts
The progress in martial arts classes is assessed and awarded by the belt system. A kid is required to clear many skill levels and is awarded a coloured belt after he completes a level. Thus, a trainee begins with a white belt and after completing different ability levels finally attains the black belt. A kid is evaluated for the next new level usually after every three months.
Benefits of Martial Arts Training for Kids
The numerous benefits of martial arts training for kids are listed below:
Develops Self-Discipline: A kid in a martial arts training class carries out the various actions of martial arts at the command of his master. They learn to follow orders. It helps in disciplining the body as well as the mind.
Enhances Physical Fitness: The training sessions require the kids to do several warm-up exercises like stretches, jumping jacks, push-ups and so on. After the initial warm-up session, the kid's practices many martial arts routines which may involve punches, kicks, strikes, and blocks. This not only toughens the muscles and tones the body but also improves the agility and flexibility of the child.
Teaches Self-Defense Techniques: Martial arts are basically combated techniques and teach the kids various self-defence methods. The skills may differ with a different style of martial arts. But they all largely aim at training a kid to protect and defend himself in the face of unexpected danger.
Learns Respect: A typical martial arts class begins and ends with the kids bowing to their master. This way they learn humility. They are taught to show regard for everyone, conduct themselves in a dignified manner and treat other students equally and respectfully.
Boosts Confidence: Kids training in martial arts gains in self-confidence. They are surer of themselves because of the knowledge that they are capable of handling any situation. The system of awarding a belt on completion of a skill level keeps the kids motivated and ensures that they diligently work hard to achieve their set goals.
Promotes Team Spirit: The kids enrolled in a martial arts class learn to function and work together with their corresponding students in the class. There may be conflicts, a difference of opinions. They learn to resolve these and instead help each other to learn and practice together.
Cultivates Social Skills: The kids learn to interact with their fellow students. They acquire team spirit as they train together. The class is a great place to meet and mingle with other kids from different backgrounds.
Improves Posture and Balance: While performing the different techniques of martial arts, kids need to maintain proper balance and a correct posture. Only then will they be able to execute the various movements correctly. Any slip in this regard can result in injuries, cramps or accidents.
Increases Concentration: Mental benefits of martial arts are many. Martial arts teach kids to discipline their minds and focus on their body movements as well as that of their target’s. Each movement involves concentration, strength, and self-control. They need to pay attention to their master’s instructions and follow the commands carefully.
Improves Coordination: Martial arts training improves the hand to eye coordination as it strikes a synchronization between the body and mind.
Tackle Bullies: Many institutions offering martial arts training also teach their students how to deal with bullies. The kids learn to handle and effectively tackle bullies in anti-bully workshops.
Better Blood Circulation and Breathing: The various warm-up exercise and the strenuous physical activity helps improve the blood circulation and the respiratory health of the kids.
Different Forms of Martial Arts Training for Kids
There are different forms of martial arts training for kids but some of the best ones are:
Karate: It is a form of martial arts that originated in China. The word Karate means ‘empty or open hand’. A kid learns striking, punching, kicking and blocking with arms and legs.
Judo: Judo is a traditional martial arts form of Japan. It is structured as a competitive sport and involves throwing of your partner by utilizing the techniques of balance and leverage.
Taekwondo: It originated in Korea and it means ‘the art of striking or blocking with fist or foot’. It emphasizes on self-defence techniques and improving focus by breathing techniques and meditation.
Aikido: Aikido is a Japanese noncompetitive form of martial arts. It teaches to avoid conflict and unnecessary use of force.
Kung Fu: Kung Fu is a popular Chinese martial arts form. It is a more rigorous and demanding form of karate.
Jiu-Jitsu: Jiu-Jitsu originated in Japan. It uses the methods of close combat and utilizes the strength and the weight of the opponent against himself.
Tang Soo Do: This martial arts form originated in Korea and is quite similar to Karate and Taekwondo.
Tai Chi: Tai Chi is a Chinese martial art and is popular for its defence techniques and health benefits.
Martial arts training may help in facilitating the mental, spiritual and physical development of a child. It is sensible to select an institute that follows the inherent principles of martial arts training in its original form than those that try to dilute or alter them. Therefore, it may not be wise to send your child for a class that blends Kung Fu with kickboxing. Read more
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First Trimester Scans
Getting your first scan in your pregnancy can be quite exciting. Getting a scan of the belly is a very special moment, especially for first-time mothers, and is something surreal as it gives them the surety that they indeed have a little being growing inside their belly! No wonder you see so many couples cherish the image of the first scan!
Ultrasound Scan During the First Trimester
The first trimester is a critical period, and adequate monitoring and support are needed to ensure that the pregnancy is sustained and progresses normally. This is also the period during which and potential issues are identified and addressed. First trimester screening results can guide the health provider towards taking precautions which ensure that the baby and the mother stay healthy.
Types of Ultrasound Scans in the First Trimester
On an average, for a normal pregnancy, four scans might be needed in the first trimester.
Dating and Viability Scan
The first one is a dating and viability scan, which can take place between the 6th and the 9th week.
Nuchal Translucency Scan
The other one is the early morphology scan or NT scan, which is done between the 11th and the 13th week of the pregnancy.
Transvaginal Scan(TVS)
A TVS may be needed for a clear image of the baby in the very early stages of pregnancy, as embryo is too small to be visible otherwise. Transvaginal scans are completely safe, and can be performed at all stages of pregnancy.
Abdominal Scan
This scan is done by around the 10th week. The ultrasound device probes the lower stomach to get a view of the baby. A gel is applied on the tummy for better movement of the device.
Why would you need the Early Pregnancy Scan?
An early pregnancy scan, which is also known as the dating or viability scan is important for four main reasons:
To confirm the pregnancy
To check whether the pregnancy is viable
To establish an estimated due date
Diagnosing and preventing birth defects
Preventing Birth Defects
Screening during the first trimester works like a prenatal test to provide early information about the baby's risk of having certain chromosomal conditions like Down’s syndrome and Trisomy 18.
Down syndrome causes lifelong mental and social development impairment, while Trisomy 18 is a fatal condition in which the child may not live beyond the age of 1.
Since screening in the first trimester is done much before any other prenatal screening tests, it is an indicator that can give you a direction to decide on further diagnostic tests as the pregnancy progresses, especially in cases of high-risk pregnancies. A first trimester scan for Down syndrome can also prepare the parents for the possibility of looking after a child with special needs.
However, the first trimester scans do not evaluate results for other birth defects like spina bifida. This is done later in the pregnancy.
There are some cases when an early scan is particularly important. These include:
Women suffering from irregular periods might find it hard to figure out a due date, which a scan can clarify
Women with a history of miscarriage or miscarriages
Cases of suspected ectopic pregnancy
To verify the heartbeat of the foetus
How is the Ultrasound Scan performed in First Trimester Pregnancy?
The first trimester screening or the first trimester combined test involves the following two steps:
A blood test
An ultrasound exam
There are two ways in which a first trimester ultrasound exam is done:
TVS (or) Transvaginal Scan
A transvaginal scan is usually done when the scan needs to be done before the pregnancy is 10 weeks along. The reason for this is because the baby is too small to be picked up by an exterior scan or ultrasound.
A transvaginal scan is done using a probe which is introduced into the vagina. The probe emits sound waves which bounce off the baby. These waves are then captured by the probe, which magnifies them and produces an image on the computer screen. While a TVS may feel awkward and uncomfortable, it is not painful unless one is tense. Taking deep breaths and relaxing as the probe is inserted is sure to help ease the discomfort.
When is it Usually Performed?
Medical experts usually recommend that the first scan during pregnancy be done in the 6th week of pregnancy. This one will most probably be a TVS or transvaginal scan. After that, the next scan of the first trimester is usually recommended between the 11th and the 13th week of pregnancy, which is mostly an abdominal scan. Exceptions might be made in high-risk cases, and more scans might be recommended. One point to note here, is that first trimester screening is optional, and the test results only indicate an increased risk of birth defects and do not confirm it.
How to prepare yourself for First Trimester Scans?
Unlike an abdominal scan, a TVS does not need you to have a full bladder, and is thus an easier procedure to prepare for. You will be required to undress from your waist down, and lie down with your knees bent, much as you would for an internal exam. Consider wearing a two-piece outfit so that you only need to remove your lowers. You will also be asked to empty your bladder just before the scan.
What is analysed in the First Trimester Pregnancy Scans?
The first one, or the 6-week scan is done for the following reasons:
To check whether the embryonic sac is embedded inside the womb
To check for an ectopic pregnancy
To check how many fetuses the woman is carrying
To check the heartbeat of the foetus
To predict an accurate expected due date
The next scan, which is usually done between the 11th and the 13th week is mostly an abdominal scan. As we mentioned before, the screening during the first trimester usually combines the results of two tests- blood and ultrasound tests. Here is what they indicate:
Nuchal Translucency Test
The first trimester ultrasound scan is used to measure the thickness of the area behind the baby’s neck. If the thickness is above limits, it can be an early indicator of Down's syndrome.
Blood Tests
Beta human chorionic gonadotropin (beta-hCG), which is a hormone made by the placenta, and pregnancy-associated plasma protein A (PAPP-A), is a protein in the blood measured during the tests. High levels of beta-hCG might indicate birth defects while low levels of PAPP-A might also indicate the same.
There are certain cases in which the doctor might ask for multiple scans in the first trimester. These include:
Cases of spotting and bleeding during pregnancy
Cases of multiple pregnancies with more than one foetus
Cases in which the woman is over 35 years of age and pregnant for the first time
Cases of pregnancy complicated due to cysts, fibroids or any other medical disorders
What can I see during the Early Pregnancy Scans?
First Pregnancy Scan at 5 Weeks
Not much can be seen during the scan at this stage. The doctor might be able to see a small gestation or pregnancy sac which looks more like a black hole. That is because it is filled with fluid. At this stage, an ectopic pregnancy can be ruled out owing to the location where the sac has implanted in the uterus.
At 6 Weeks
If you are taking a first pregnancy scan at 6 weeks, you will notice that there might be a small white circle seen in the gestation sac, which is the yolk sac. This is attached to the embryo and provides it with nutrients. At this stage, the length of the embryo can be measured to calculate the due date.
At 7 Weeks
A small little embryo can be seen, and the heartbeat can usually be heard.
At 8 Weeks
The embryo becomes clearer to notice on the scan, and measures about 1 to 2 cm.
At 10 Weeks
The baby grows fast and can measure about 3 cm during this time. The heartbeat can be both seen and heard.
At 11 or 12 Weeks
This is when you’ll be due for your NT scan. The baby will measure about 5 to 6 cms from crown to rump. This scan is used to check:
Thickness of the Nuchal Translucency
The position of the placenta
The urinary bladder and stomach of the foetus
Foetal spine and limb issues
Abdominal wall defects
The blood circulation to the uterus
Can I figure out whether I have Twins?
Twins or multiple pregnancies can be seen from about six weeks onwards, but the doctor may miss them at such an early stage. This happens because sometimes, while the heartbeat is visible in one sac, it might not be visible in the other. In several cases, twins are conceived, but only one embryo grows and develops. This is called the vanishing twin phenomenon and is quite common. In the case of twins, the scans can also determine whether the twins share a placenta or a sac, or have individual ones.
What if the results show a problem?
It is okay to be a bit nervous, especially if it’s your first pregnancy, and of course, if the initial tests do indicate something wrong, then it is natural to be worried. However, the advantage of an early scan is that if anything unusual is noticed, it your doctor is sure to address the issue before it becomes a cause for concern.
In certain cases, the indicators can be a sign of a serious condition like Down’s syndrome. The doctor may offer some specific further tests, which can give a clearer picture of to whether or not your baby has a chromosomal abnormality. But since these tests do carry a small risk of miscarriage, an ultrasound is always done beforehand. If an ectopic pregnancy is detected in the scans, surgery might have to be performed to terminate the pregnancy before it becomes dangerous for the mother.
If the problem is more serious, like the pregnancy not being viable, then it can be a hard call, depending on how risky is the condition, and the pregnancy needs to be terminated in the initial stage itself.
While the very first scan during a pregnancy is not compulsory, it is highly recommended, especially if you’ve conceived with difficulty. The scan between the 11th to 13th week is especially important and is one you should not miss on any account, as it can be an important indicator of the baby’s health and the viability of the pregnancy.
Also Read: Twin Pregnancy: Symptoms & Early Signs Read more
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Childhood Fears and Phobia
Children tend to get scared easily and their fears keep changing over time. Being afraid of something is a normal reaction in children since it also teaches them to keep themselves safe. However, there is quite a difference between what a child experiences as fear and when a child has a phobia.
Common Childhood Fears
Here are some of the childhood fears by age that children experience.
Fears of Babies and Toddlers
Sudden loud sounds or extreme movements can cause the baby to be afraid.
A large object suddenly looming into their view could scare them.
Any strangers that attempt to converse with them could cause them to be afraid.
Being separated from parents or changes in their room or surroundings could make them feel in an unknown environment, making them scared.
Fears of Preschoolers
Nearly all fear in kids begins from being afraid of the dark. Some adults tend to get scared of the dark as well.
Any noises that occur at night could get them scared.
Scary masks or weird sounds of monsters and ghosts could cause kids at this age to be afraid.
Most kids like dogs but some of them could get afraid of an overexcited dog.
Fears in Children during School Years
This is where the child starts getting scared of large insects or reptiles like spiders and snakes.
A thunderstorm or earthquake can result in them getting extremely scared.
Being alone at home, especially overnight, could make the child quite afraid.
When it comes to school, angering the teacher, failing a test, or getting rejected by their childhood crush all manifest within children as fear.
Scary TV shows or news incidents of extreme danger can make them afraid.
Seeing injuries or illnesses, doctors and injections, are the usual ones most children are afraid of.
How to Remove Fear from your Child's Mind?
You can help your kids overcome their fears with the following tips.
For Babies and Toddlers
Parental presence can instantly make your baby feel safe from any strange situation.
Establishing a routine can make them understand what actions to expect and when.
In early months, it is important to limit the number of people taking care of the baby so that he has a chance to find a safe place for himself.
For Preschoolers
Most kids at this age are highly imaginative. Hence, even the smallest fear can become a large one fuelled by their own imaginations.
If your kid is afraid of a particular place or so, go to that place with them so that they can see it properly without being afraid.
In case of being afraid of the dark, ask your child to walk towards the other room while counting numbers loudly. You can also count along with him so that he knows he isn’t alone.
If he is afraid of any animal or an overactive dog, make sure the dog is tied down and play with it first. Once the dog is a little calm, you can then bring your child closer and let him play with it.
Ask your child to draw what he feels afraid of. Once they are done expressing, they can start understanding that monsters and ghosts are all inside their head and are not real.
For Children in School Years
Talk to your child about his fears since he would be able to communicate them well.
Ask him what the worst he thinks that could happen is. Then let him know of a real-life incident which wasn’t as bad as he thinks it would be.
When it comes to natural disasters, let your child read books on the precautionary measures they need to take. This will make them feel prepared and not be caught off-guard.
Any other fears can be best overcome by supervised action. If they constantly keep feeling afraid, getting them relaxed or taking a nap can alleviate it to quite an extent.
What is a Phobia?
When fear gets out of hand, becomes excessive, unreasonable, and permanent, and even the slightest situation or possibility of a situation can manifest a feeling of extreme anxiety that is debilitating, this is termed as a phobia. Most of the time such fears stay for multiple months to over a year before becoming a phobia.
How Common is a Phobia among Children?
Many children are known to have one or the other type of a phobia. It is estimated that nearly 9-10 percent of people in the world suffer from a phobia of some sort.
What Causes a Phobia in Children?
Common causes of phobias in kids are:
1. Factors Related To Life Events
Any events that occur in a child’s life that have a major impact on him could result in manifesting as a phobia in him. These could be as normal as the beginning of a new grade in school or shifting to a new place, or as unfortunate as a family member’s death, extreme illness or parental divorce.
2. Factors Related To Family
In certain cases, phobia of certain aspects can be inherited from one of the parents by the kids. Even though it may not always be genetic, kids are extremely observant. On seeing any family member suffering from a phobia, they could be led to believe that they need to be afraid of it as well.
3. Factors Related To Biology
Neurotransmitters within the brain are responsible for communicating with each other, which also results in forming emotions and feelings. Two major entities here are serotonin and dopamine, which are responsible for making a human feel happy and at peace. If they go out of balance, your child can suddenly start feeling afraid of anything at all.
Common Types of Phobias in Children
Here are some of the common types of phobias
1. Specific Phobia
In specific phobia, the child starts feeling afraid of an extremely specific entity, mostly without reason. This could be a particular place such as a closet, or a particular person such as their teacher, or a type of people like taxi drivers, and so on.
Signs And Symptoms
The child may attempt to avoid the entity of phobia or start anticipating that something bad is going to happen without reason. At times, when the object of fear is present, the actions of the child will be completely out of sync and disrupted.
2. Panic Disorder
In such a disorder, a particular event or object could suddenly trigger panic within the child. The cause or the trigger may not be apparent immediately, but the consequence of the panic can be seen in the child’s behaviour. This is majorly present in adolescents and young adults.
Signs And Symptoms
When in panic, the heart rate starts increasing rapidly and your child may start sweating or trembling. Breathing reduces and there might even be discomfort in the chest. In certain situations, the panic can get too strong to handle making them feel dizzy or call out saying that they are going crazy or they are going to cry. On the other spectrum, they can even freeze completely on the spot and go numb.
3. Agoraphobia
This is the same fear of stepping outside your comfort zone but multiplied to gargantuan proportions. The child starts feeling afraid of the outside world and unknown people completely. Any place unknown to them or any stranger can cause them to be triggered and go into a state of panic.
Signs And Symptoms
Children will refuse to leave their homes under any condition or refuse to meet or talk to any stranger or guest in the house. If forced to do so, they may panic or scream out in refusal.
4. Social Phobia
Social anxiety disorder is yet another name for this and is quite rare. This is majorly termed as a fear of interacting with people in a crowd or even fear of children in certain cases.
Signs And Symptoms
Children are filled with mortal fear when it comes to introducing themselves to other people or asking questions in a classroom, going on the stage, or even peeing in a public washroom with other people present. They will also go to extreme measures to avoid being in a situation, lying or even falsely falling ill to skip a particular event or so.
How Can Phobia Be Diagnosed in Kids?
Phobias are usually diagnosed by psychiatrists by undertaking a mental health evaluation of the child. Certain disorders might be apparent on the first visit, some others might take multiple visits and tests to be diagnosed.
How to Treat a Phobia in your Child?
Treatment of a phobia is highly dependent on the child’s age and the extremity of the fear. Most of the times, counselling and cognitive behavioural therapy can help them combat their phobia by themselves. In extreme cases where panic attacks get out of hand, psychiatrists may recommend some medicines that help your child calm down. Parental support is extremely necessary through this phase.
How can you Prevent your Child from Developing Phobia?
Preventing phobias is not exactly a possibility in today’s age. Steps can, however, be taken to nip the fear in its bud before it has a chance to develop into a phobia. Proper parenting plays a vital role in making this happen.
The spread and variety of fears and phobias can seem unnerving to parents. Childhood fears psychology is a developing science and understanding it can take quite some time. Staying vigilant, having open conversations with kids, and building strong bonds of trust are great ways in helping kids combat their fears.
Also Read: School Phobia in Kids Read more
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Paediatric Medulloblastoma
Cancer in children is an unfortunate but harsh reality that some parents must deal with. Though cancer may sound like a death knell for some people, there have been rapid advances in medicine that offer hope. This is because people with cancers that were fatal a decade ago have a high survival rate when the cancer is detected early. This article is going to focus on paediatric Medulloblastoma which is a type of brain cancer in children.
What is Medulloblastoma?
Medulloblastoma is a cancerous brain tumour that can begin while the child is still a foetus. It affects the bottom region of the brain that specializes in motor/cognitive functions and often spreads down to the spinal cord. If the tumour disseminates without being checked, it can lead to death. Fortunately, there have been many advances in medicine, mainly on the surgical front, and has helped to raise the survival rate to 70-80% (early treatment).
How Common is Medulloblastoma in Children?
Medulloblastoma is relatively rare when compared to the other illnesses suffered by children. This can be gaged by the fact that there are many types of brain tumours that afflict children at the rate of about 2.5-4 per lakh children. Out of these brain tumour cases, eighteen percent of the cases are attributed to medulloblastoma. 60% of Medulloblastoma cases end up as clinical trials due to vast potential in finding new treatments options that can manage a cancerous tumour.
Stages of Medulloblastoma Tumour
The responsible tumour is categorized into stages to help assess what treatment option is best suitable for the child.
1. Standard Risk Tumour
These are tumours that are still in their nascent stage and have not spread to other parts of the brain or spinal cord. In most cases, these tumours can be completely removed or removed to such an extent that only slightly more than half an inch remains.
2. High-Risk Tumour
These tumours have normally spread to other parts of the brain and spine. Tumours that are more than 1.5 cm even after surgery are also put in this group.
3. Recurrent Tumour
This tumour is one which re-appears despite treatment. Just like other cancers, this is possible for medulloblastoma as well. While your child being successfully treated is a source of joy, it is good to have follow-ups to see if a tumour has grown again. Early detection means that a recurrent tumour can be successfully nipped in the bud.
Lumbar Puncture: Signs and Symptoms
Medulloblastoma mainly affects the Cerebellum and so results in a deterioration of those functions handled by it such as:
Poor Vision
Reduced motor function which can affect complex actions such as writing.
Poor balance accompanied by dizziness and difficulty in moving from one room to another.
Once the medulloblastoma spreads to, the symptoms can change with problems that crop up such as:
Inability to control the excretory system and unintended releasing of the bowels.
Pain in the back.
Diagnosis
If your child displays any of the above symptoms, please head to a reputed hospital as a clinic would be ill-prepared to handle such a case. The doctor who is referred is a paediatric oncologist who specializes in these matters. The following tests are done to understand what type of a tumour your child is dealing with and the appropriate treatment required.
Neurological Exam
This constitutes a physical examination where the doctor will assess the motor function of your child. A review will also be done of your child’s family history to investigate the extent of the disease.
MRI Scan
Using radio waves and magnetic fields, the doctors can map out the brain in high resolution without subjecting the brain to ionizing radiation.
Biopsy
This is when a small sample of the tumour tissue is extracted from the body to be examined by a pathologist. This can be done mainly through surgery.
Lumbar Puncture
In this procedure, your child would be given an anaesthetic after which an injection is inserted into the spinal canal to collect the fluid. This spinal fluid is analysed and checked for tumour markers and cancer cells.
Risk Factor Associated with a Higher Risk of Medulloblastoma
While the exact cause of Medulloblastoma has not been discovered as of now, doctors have been able to identify some groups that have a higher risk of getting Medulloblastoma. This includes:
Gender
Boys have a slightly higher chance of developing a malignant (cancerous) tumour with a ratio of 1.8:1 when compared to girls.
Age
80 % of all cases of Medulloblastoma occurs in children who are yet to complete 15 years of age. Out of this, about 50% of the cases took place in children who were less than 6 years old.
Genetics
Though most medical studies have confirmed that there is no genetic connection, some people who have Gorlin’s syndrome or Turcot syndrome may develop Medulloblastoma.
Treatment
Below are some of the treatment options available. All o the risks and side effects so please discuss with your oncologists in detail so that you can make an informed decision.
Surgery
This procedure involves removing a part of the skull (craniotomy) to get to the tumour. There has been a quantum leap in the surgical equipment used such as cortical mapping which helps surgeons steer clear of sensitive regions of the brain.
Radiotherapy
This employs the use of radiation to kill the cancerous cells. One of the major drawbacks of this procedure is that it cannot differentiate between cancer cells and healthy cells, killing all in its path. Proton therapy is a popular therapy that is used as its precise delivery of radiation causes minimal damage to the surrounding tissue.
Chemotherapy
This is the use of drugs or medicines to finish of the tumour cells. It is used as a second line of attack to kill any remaining cancer cells after surgery. Many use this form of treatment in addition to radiotherapy as well. It is administered through IV or a pill form.
Stem Cell Transplant
This form of therapy involves the removal of stem cells from the child’s body prior to chemotherapy/radiotherapy and its subsequent re-introduction. This method becomes handy when children need to go through rigorous amounts of radiation or chemotherapy. High doses of radiation is known to destroy the stem cells, therefore the absence of stem cells during the therapy will prevent its destruction and can then be safely infused into the child’s body.
Immunotherapy
This type of cancer treatment works on the principle of using your child’s antibodies to destroy the cancer cells. It is relatively safe and has fewer side effects when compared to traditional cancer killers like radiation and chemotherapy. However, much of this is still in the clinical trial phase and will take some time to before it is available for everyone.
Side Effects of Treatment
For a child with Medulloblastoma, life expectancy can often depend on the severity of the side effects. Methods such as radiation for instance, may be too strong for a child of a tender age to handle.
Paralysis
Aggressive chemotherapy treatments such as the Milan protocol are known to cause paralysis in children from the neck down. While minimizing the tumour, the treatment can also cause the nerve cells in the brain and spine to die.
Skin Problems
Radiotherapy leaves many patients with dark, dry and itchy skin once treatment begins. This will linger on until a few weeks after treatment. Some of the remedies for this include:
Avoid putting perfumes that has contact your child’s skin.
They can wear loose garments and avoid anything too tight.
Apply a good moisturizer on their skin every day to combat the dry skin.
Temporary Side Effects
Radiotherapy and Chemotherapy have many short-term side effects such as hair-loss, dry mouth, fatigue and tiredness. Your child will quickly recover from these once the afore-mentioned therapies are completed.
Long-term Side Effects
Cancer survivors from radiation and chemotherapy may have long term neurological damage. This could affect their memory, cognitive ability and problems with growth.
Taking Care of a Child with Medulloblastoma
Palliative Care
While treatment goes on, your child would go through side effects of the symptoms that can be painful and traumatising. Most cancer centres come equipped with physiotherapists, dieticians and counsellors who can help improve the quality of life of your child. Relaxation techniques, proper nutrition as well emotional support can ensure a satisfactory recovery.
Terminal Care
If the tumour has progressed too far with little chance of recovery, it is important to have an open conversation with the doctors involved. Many of them have been trained to deal with these situations and would provide valuable council during this time. Keeping your child out of pain should be the primary objective along with ensuring that their lives continue to be as normal as possible. This means arranging for part time school if possible and being allowed to be socially active.
Early diagnosis of the disease can often lead to a good prognosis. As a parent, it is important that you guide your child through this difficult time in their life. Apart from the treatment itself, palliative care can significantly strengthen not just your child but your entire family.
Also Read:
Meningitis in Children
Brain Tumours In Kids Read more
Dr Ghouse has added a new answer
Expecting Mom due in 4 months
4 hours ago
Q. hello everyone, please suggest me, am getting pain in lower abdomen right side, anybody plz tell me why am getting pain pls
Dr Ghouse
Paediatrician
4 hours ago
A. this needs proper examination to find out problems like appendicitis. 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
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Expecting Mom due in 2 months
3 hours ago
Q. hi mam for 2days I am seeing my baby bumb decreasing is it cause of worry?
Rashmi
Mom of a 9 yr 8 m old girl
3 hours ago
A. I don’t know how the bumps of your child decreasing that’s not fair to me second you have not mentioned the current age of your child to do it and there is no clarity in the query it would be difficult for me to help us so if you don’t mind can you please repost with all the necessary details associated with your question
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Trying To Conceive
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Q. Hello I had my period missed for April month and today I got my period. Is it normal to have period after 1 month or is there anything I should be worried about? Iam worried please let me know if that's ok or should I consult my doctor
Read moreDr Ghouse
Paediatrician
1 hour ago
A. consult your doctor for any evaluation required. 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
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Guardian of 0 children
1 hour ago
Q. hllo am in 34 week of pregnancy,cramps in my hand and foots,my pulses is very fast,i feel tiredness internally,are these symptoms are normal
Dr Ghouse
Paediatrician
1 hour ago
A. get investigations particularly hemoglobin level. 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
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Guardian of 0 children
1 hour ago
Q. i feel some fever internally also
Dr Ghouse
Paediatrician
1 hour ago
A. please check the temperature and get the investigations. fever can be because of different reasons most of the times viral bacterial sometimes due to less immunity there can be recurrence better to treat only with paracetamol if the fever more than 100degr
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53 mins ago
Q. Now I am having pain till then my miscarriage has been done at home
Rashmi
Mom of a 9 yr 8 m old girl
50 mins ago
A. I’m sorry I’m unable to understand your query as you haven’t given any detail about it so whatever the situation is you should get a check with your gynaecologist the doctor would be able to give you better help in whatever treatment of precaution you need to require further
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