Effects of incontinence in children

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Incontinence is an involuntary loss of urine sometimes feces and it can cause a significant disruption of the quality of life for those it affects. Many children with incontinence can have this problem for many years, but with professional help, it is a condition that can heal when anurologist manages the bladder control inability.

Incontinence causes can cause much embarrassment to the kids to the extent that the shame will prevent them from carrying out the daily activities. Continence care helps a child to achieve and maintain control over the bladder or bowel functions through tips on the way to keep the bladder healthy through a continence observation, identification of suitable course of necessary, emotional support and advice. Incontinence might not be a big issue for children who are under 4 years but for those who have uncontrolled voiding or bowel movement require help to achieve control.

Urinary incontinence

Urinary incontinence is the most common occurrence among children even adults. It causes a complete control of the urination act or an involuntary emptying of the bladder. The other name for this condition is enuresis. Many factors can cause enuresis in toddlers, infants and older. It is essential to understand the working of the urinary system to know how incontinence occurs.

The urinary system has the kidneys, bladder, ureters, and urethra. The kidneys produce the urine and drain it to the bladder through the ureters. The bladder is the storage tank that stows urine until emptying through urinating (micturition). The act of unloading a bladder requires much coordination between the muscles, nerves and the brain. Two important muscles called the sphincter and detrusor play the significant role in urination. A sphincter is a muscle group that remains contracted to enable the bladder store the urine without leaking while detrusor is a large muscle that contracts to squeeze the urine from the bladder when a child goes to the toilet.

During urination, these muscles work together with one relaxing and another one contracting to control a proper flow of urine. Dysfunction in one of the muscles might cause loss of urinary control to a particular depending on an individual. A urethra acts as a canal by letting the urine to pass through it from the bladder as it moves out of the body when voiding. Children must learn to achieve bladder control which some produce earlier than others. It is a cause of continence in some children when others still have challenges to gain control of their bodies. Nonetheless, it becomes abnormal as a child grows older and even reaches adolescence while still having an inability to control bowel or bladder movement through practices such as bed wetting.

Types of Incontinence in Children

Childhood enuresis is in two main categories namely:

Nocturnal enuresis: occurs during sleep and it is the most prevalent type or urinary incontinence among children of around five years. People also call it bedwetting.

Diurnal enuresis: This type of enuresis occurs mostly in younger children and mainly occurs because of certain behaviors. It can also be a sign or other serious problems.

Another way to categorize the problem is by timing the time that a child shows signs of incontinence. A child with excellent bladder control during the day but never achieves a dry night has primary enuresis.

Secondary enuresis is incontinence that occurs in a child who has for at least six months been dry but suddenly develops symptoms after the period. The reason could be a particular behavior that changes the regular habit such as beginning to take more beverages before retiring to bed.

Urinary incontinence is prevalent among children hence parents should not be too hard on children who are unable to control their bladder or bowel. Studies show that up to 20 percent of 5 years old children and 10 percent of seven-year-olds have a habit of wetting their bed. 20% of those who wet their bed also have a degree of daytime incontinence.

Nocturnal enuresis occurs mostly in boys. Diurnal incontinence occurs in higher numbers among girls. Secondary enuresis accounts for about a quarter of the cases that cause loss of continence, and a specific psychological stressor is likely to be the cause.

Effects of Incontinence in Children

Pediatric incontinence is not a severe disorder medically, but it can have a far-reaching impact on the psychology and esteem of the child as well as the family. Wetting a bed for grown children interferes with their socialization aspects. It is not only the child but also the family that suffers significant stress because no one wants other people to know that one of theirs cannot control urine or bowels movement. Patience and understanding are essential when dealing with such children to define the way to solve the issue because it causes the children to suffer these from these repercussions.


Self-esteem is the most significant effect on children because it causes them to refrain from engaging in certain age-appropriate activities like going for sleepovers.


Passing urine or feces is an extremely personal activity in most societies and should take place in privacy. Children will feel embarrassed about accidental leaks and the offending smell that occurs due to incontinence. As a result, they are very anxious when they think about participating in social activities or even going to school. It is not unusual for children with incontinence to avoid situations that might cause them to leak. They might avoid participating in social activities such as interacting with friends or going shopping with parents.

Older children might avoid drinking fluids or taking certain types if they think that they increase incontinence to control the problem. Avoiding some meals could deny the child an opportunity to consume the amount of food or drink that they should attain for proper growth.


Sometimes children might have challenges by the change in their life circumstances because of their incontinence might try denying that they a problem even when overwhelming evidence shows that a problem is existing. For example, a child who wets the bed might blame it on their siblings. The denial is as a result of embarrassment although it could be because there is a lack of accurate or complete understanding about the problem. Some children become hopeless and helplessness about doing anything to control voiding thus causing depression.

Frustration and anger

It is normal for human beings to get frustrated when they feel that it is impossible to achieve something they desire or believe. The children who are unable to maintain continence will show frustration as they think odd when all their peers can control their urge to visit the toilet. They also develop anger about their inability to control their conditions thus becomes a laughing among the peers who might not know that it is an unfortunate occurrence. For instance, kids who cannot wait until the break time are frustrated and angry at their action of asking for permission to leave the class for the toilet.

They can also become irritable if other children make fun of their situation or at their teachers who remind them to go to the toilet before they leak as they feel the reminder exposes their weakness to age mates.


Grieving is a typical response to changes in the life of a person. It refers to the reaction that to a perceived or actual loss as a result of changes. Children with incontinence will grief at some change such taking them to a boarding school or at a place they will sleep over because it is likely to let other people know about their uncontrolled voiding. Grief might feel like depression, but it is a transient state as the child adjusts to the loss. It is essential for parents, teachers and other people who take care of children to look out for grief in children with incontinence because it is a personal experience and they could suffer in silence.


Depression is a mental disorder that persistently causes a depressed mood or a loss of interest to engage in certain activities. Depression can cause impairment in daily life. The persistent feeling of sadness due to an inability to control bladder or bowel can make a child to lose their confidence, concentration, appetite, sleep or energy level. Talk therapy is essential to let the child know he or she is not inferior to others and it is possible to overcome or treat incontinence with time.

Overall psychological impact

Failing to manage incontinence properly can make children who have this condition to get many negative feeling including:


2.Social isolation

3.Loss of control


5.Shame about their body image

Failing to manage incontinence might cause further problems as the negative feelings continue piling up and might end up overwhelming the child with the stress that arises from changes in life and relationship. Their parents or guardians also feel the psychological effect because enuresis is not the norm after a certain age and they bear the cost of care and items that help in controlling the aftermath.

Researchers say that most careers of children with incontinence do not seek professional help. Depending on beliefs and attitude towards incontinence, they may try to hide it in the same way that the child does. Children fail to seek help because they find the behavior hard to understand, accept and ignorant about the right person to share their tribulations. They feel helpless and will do the best to hide it.

An appropriate step by guardians is to move from the denial and seek professional help from medical doctors and behavior therapists because they have solutions as well as ways to achieve the best outcome which is to help children to achieve continence. Specialists also have helpful advice on the appropriate way of attending to toileting needs of children with continence challenges until they attain an ability to hold off their waste products until the right time.

Does being overweight in infancy predicts being overweight in childhood and adolescence?

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Overweight or obese infants and children of less than 5 years got to 40 million showing a significant rise from 32 million in 1990s. The number of overweight or obese kids in the World Health Organization African Region increased from 4-9 million in 16 years. A majority of overweight infants live in developing countries. The rate of increase is higher than the numbers in the first world countries by more than 30%.

Overweight infants and younger children are likely to continue staying obese during their late childhood, adolescence and even adulthood if there is no intervention. This information might shock parent to babies who are relatively small because of most deal with nagging relatives who keep advising them to find ways of increasing the weight of their baby.

Many assume that chubby babies are a sign of proper feeding, strength and health. Additionally, the conventional thinking is that baby fat melts away when a child grows up. More and more research findings show a different outlook. Fat babies are at more risk of becoming overweighed in childhood and adolescence.

Obesity in teen life means that someone who was overweight from infancy will be obese in adulthood which increases the danger to get serious health problems like heart disease, diabetes and even cancer. Children who are still overweight at around eight years will find it harder to reduce their weight than their thinner peers.

Researchers found out that those who got the excess weight at young children are more likely to be eaters of fewer calories during their adolescence than their slimmer peers.Despite eating fewer calories, they still could not cut down the weight they put on while young. It might seem like a suggestion that the fate of the obese at a young age is sealed and that prevention is the most efficient way of controlling this epidemic.

How to Determine If an Infant or Child Is Overweight or Obese

Body Mass Index (BMI) is a measurement that uses height and weight to estimate the body fat of a person. Using a BMI calculator is the simplest way to calculate the BMI because doing it on your own has complications. Kids of ages 2-19 fall into one of these categories in a standard BMI chart.

Underweight: BMI that does not reach the 5th percentile

Normal weight: BMI that reaches the 5th percentile but is less than the 85th.

Overweight: BMI at 85th but below the 95th percentile.

Obese: BMI at or above the 95th percentile

Doctors use weight for length charts for kids younger than two years instead of the BMI to make a comparison of a baby’s weight with length. A child under two who falls at the 95th percentile or more is in the overweight category.

BMI, however, is not a perfect measure of the body fat as it might be misleading in a few cases. For instance, a muscular person could be having a high BMI but not fat. The reason is that extra muscle will increase body weight but not the fatness. BMI could be hard to interpret when children are in the puberty stage as they grow extremely fast at this time. BMI usually is a reliable indicator of the body fat but is not a direct measurement.

A parent should not hesitate to take a child or teenager to a pediatrician for examination if there is a reason to indicate obesity. A doctor asks questions about the eating and activity habits to derive information that helps to determine suggestions on the best way of making positive changes. Sometimes there is a need to order blood tests that will help if there is suspicion about the existence of medical problems that are likely to be the cause of obesity. The results of BMI and health diagnosis could make a pediatrician refer the child to a weight management program or a registered dietician.

Must An Overweight Infant Be Overweight In Childhood And Adolescence?

Many factors might cause an increase in weight for anyone including slim kids, but those with more fat from infancy are likely to retain the excess weight in their later years. Parents underestimate the importance in their obese children but find out when they reach the teenage age that it is not reducing.

Doctors and researchers from various parts have found that there is a link between excess weight in infancy and body weight in childhood and adolescence. For example, the average birth weight for Singaporean-Chinese babies is around 3.2 kg at 40 weeks. Doctor in Singapore agrees that the high birth weight is a danger because it causes a higher BMI in childhood and later in life. However, an individual can gain more lean mass instead of fatty tissue according to a pediatrician at Thomson Pediatric Center at the time of study Dr Yang Linqi.

This problem is not restricted to babies born with more weight but also the smaller infants like those who show signs of weak growth during pregnancy. Nonetheless, those who are born with more weight tend to grow bigger by adding more fat quickly in the early months. It leads to an increase in a central fat deposition in the babies bodies.

A group of researchers in Singapore on studying about baby weight decided also to determine if there is a link between fat babies and fat adults as well as how the pregnancy of their mothers impacted on their growth. The aim of this study on more than 1, 000 infants and children is to gain a better understanding of any relationship between birth and future weight so as for address an uptrend of the overweight children. The outcomes showed that 11 and 12-year-olds born are more likely to become overweight or obese compared to 20-year teenagers.

About four in each five slightly or severely overweight children at seven years stayed that way even after reaching 11-12 years. The figure might go down to four in some years, but it still shows overweight children are unlikely to change.

Reasons for Excess Weight in infants


Dr Christeller Tan who is a pediatric medicine specialist notes that a possible factor is feeding infants with formula milk increased the risk the risk of overfeeding and fast weight that causes childhood obesity. Nutrition produces a direct result in the amount of fat in a newborn baby but also depends on other maternal factors. The fatness stems from the milk feeding practices in the first six months of babies’ life.

Weaning to solid diet for most babies takes place at around the time they turn one. A habitual eating pattern emerges, and it continues throughout the childhood and even to adolescence. Much of the food that people feed their children can trigger an excess weight gain if it has much content of fast fat-filled foods, processed and packaged meals. Some blame it on their busy lifestyles that leave them with little or no time for preparing healthier meals or exercise. Some families make a mistake of taking too large portions at home or when eating out.

2.Hormonal factors

Another popular theory among researchers is that rapid growth by a child in the early years has a long-term impact on the hormonal feedback systems of their bodies. The system that regulates food intake, metabolism and weight according to Dr Tan “can affect the presence of fat deposits.” Weight gain is fastest during their first three months but gradually slows down in the first year of life. Most babies will go on average double their birth weight when they are around three to four months old, and by 12 months, the pressure will be triple. Weighty babies will grow to become fat adults through the accumulation of excess fatness at each stage of the growth years.

3.Maternal factors

Maternal weight gain, obesity, gestational diabetes, excess feeding of milk and delay in weaning are some of the elements of early life that can cause infants and children to become overweight and set a stage for more risk of adverse health status in later years of experience.


Genetic factor also plays a significant role in weight matters. Then genes help to determine the type of body, the way it stores and burns fat. However, genes alone explain the recent obesity crisis. Both genes and habits passed down from one generation to another which is one of the reasons for many members of a family to struggle with excess weight gain. People from the same family are more likely to have the same eating patterns, attitude towards overweight persons and levels of physical activity.

5.Exercise and physical activity

Many kids do not engage in the adequate physical activity. Older children and adolescents should get at least an hour of moderate to great exercise every day including activities that tighten the muscle and bone and aerobics. Kids of two to five years should actively play some times every day.


Sedentary way of life in modern time is not s preserve of adults but also the kids. Instead of playing and exercising, a high number will spend much time playing with electronic devices for a long time without moving. Children are also watching television for a long time. Those who sit in front of a screen for over 4 hours are more likely to become overweight compared to the children who watch TV for two or fewer hours. Children with TV in their bedroom are more likely to stay indoors for long and in the process become overweight regardless of their birth weight.

Dietary Precautions To Prevent Excess Weight And Obesity In Infants

Mothers from a family with a problem that has a history of gaining weight quicky should consider dietary precautions to save the baby from becoming overweight. A child already is overweight should also take these precautions that help to slow the rate of gaining weight but not weight loss.

Breast or bottle feeding a baby

  • Breastfeed exclusively because breast milk keeps babies lighter. Breastfeeding also requires some control to avoid grazing which in feeding at very frequent intervals even hourly. It can make an infant get into the habit of eating when they get upset and use food as their stress reliever.
  • An infant should not hold on to a feeding bottle as a companion whether it is day or night time. Children who carry their bottle around learn to eat frequently and using food as the comforting device.
  • Avoid pushing the baby to finish each bottle because of it possible to sense when the formula reaches her need unless there is a case of being underweight
  • Avoid enlarging the hole of the nipple in a baby bottle because the milk formula will get out too quickly.
  • Do not feed the baby with solid food until after six months of breastfeeding and four for those on milk formula. It includes using biscuits or another type of food in place of a tethering ring
  • Feed a newborn after at least two hours and three hours at 2-6 months. Do not assume sucking is a sign of hunger. The baby could need help with something else.
  • Discontinue breast or bottle feeding by one year of age as delay in weaning is a risk factor for obesity

Solid foods

  • Do not introduce sweets to an infant until 12 months of age
  • Teaching a child from your age to eat to the point of satisfaction without exceeding. Teach a child to stop eating after getting a sense of fullness even when eating alone. A child who starts turning the head, playing or closes the mouth has lost interest in feeding due to fullness.
  • Feed the child slowly without doing anything that hurries the eating pace. A child will start feeling the sensation of fullness after 15-20 minutes. A rapid eating habit that grows into adulthood has a link with obesity
  • Do not feed a child as a way of creating a distraction or an occupation. The appropriate action is to give something to play and create free time.
  • Teach an infant to use human contact but not food to relieve discomfort and stress
  • Feed a child three times a day at six months
  • Avoid using food to reward good behavior as it might create a habit of overfeeding.
  • Do not insist that a child always clears a plate or a jar of baby food.

The second phase for other toddlers starts just before they reach six years and after that their bodies will make more fat cells than the slim kids. The consequence is that overweight children will become obese adolescents with more fat than children who had normal weight when reaching six years. Parents should seek medical help if a child is overweight at age six because it is an indication of carrying excess weight in teenage and adulthood. Intervention in the physical and dietary pattern is vital for parents of overweight infants and toddlers without fear of stigmatization to prevent the risk of getting lifestyle diseases in the future.

Nail clipping and hand washing in school going children does it reduce the risk of intestinal parasites?

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The small intestine is prone to attack by bacteria that make it their home as intestinal parasites. It is even worse when the intestine suffers from food poisoning, nutritional neglect, and antibiotic use or self-sabotage. The over 30 feet small intestine should be almost sterile, unlike the shorter large intestine which holds most of the microbial biomass. An intestine parasite lives in the gut and often reproduces to cause much damage. It might also spread to other body parts. Drinking unsafe water and poor sanitation habits increase the risk of getting intestinal parasites. The best form of defense against these parasites is to maintain good hygiene.

Intestinal parasites prefer living in the guts (intestines) because they find it a comfortable shelter when they can reproduce. They are usually worms such as tape or pinworm or Protozoa like Giardia. The parasites can sometimes stay for long in the intestines without causing infection or showing any symptoms.

Worms are tiny thread-like organisms that find shelter in the rectum. At night they crawl out through the anus to lay eggs on the nearby skin which causes terrible itching. Worms are unpleasant, but they do not cause disease. Eggs from pinworm are very persistent living for up to 14 days outside the body on clothes, bedding or any other objects that come into contact. It is not always that the adult worm becomes visible. Other common types of intestinal parasites are:

  • Amebiasis
  • Dientamoeba
  • Blastocystis hominis
  • Ascariasis

Parasites are in plenty in many places around the world. Much transmission takes place in crowded places such as daycares where some children are carriers of some form of the parasite with unsafe water and poor sanitation increases the risk of spread. These were the best ways to prevent the spread of intestinal parasites:

Nail clipping

Parasites especially roundworms transmit much among school going children when they get into contact with contamination on the soil or feces. The parasite travels to the intestine after getting into contact and consumption of a contaminated substance. They will quickly grow and reproduce in the gut. Symptoms may appear when they become bigger and increase after reproduction.

Intestinal parasites (IP) spread much through fingernails in primary school environments. We all know that nails accumulate dirt and contribute more to spreading infections. Most people take care of their bodies but neglect the small areas like the finger and toenails which are also essential parts of the body. It is imperative to keep them clean, clean by cleaning, cutting and trimming. Most people forget and neglect the system as they consider it as less critical hence let them grow and get infections.

The World Health Organization (WHO) places the number of people with intestinal worms at 10% of the population. Children are more susceptible to the intestinal worms because they usually play in an environment with contaminated soils such as school playgrounds and sandboxes. Older adults with a weakened immune system are also at high risk.

A study to assess the prevalence of intestinal parasites in school going children took place in primary schools of Lahore District. The researchers collected 300 nail samples from primary school children of both genders but at different ages. They found the prevalence of IP from fingernail dirt of both boys and girls. The dirt collected from nails spreads other infections as well thus keeping them clean, and trim is essential.

Appropriate hand hygiene includes thorough cleaning and trimming of fingernails as they can harbor and germs contributing to spread of parasites and worms. In addition to cutting the fingernails short, it is essential to clean the undersides frequently with soap and water. Longer fingernails can harbor more dirt, parasites, and bacteria than shorter nails thus have more potential contributing to spreading of infection.

It is essential to thoroughly clean all the tools for the task such as a nail clipper and file before grooming nails or clipping. Sterilizing equipment before use is especially crucial when using nail tools after someone else especially in commercial salons where many people share them. It helps to prevent infections of the nails which cause swelling on the surrounding skin, pain in surrounding areas and thickening of a finger or the toenail. Some of the diseases might be too serious to heal without medicine or medication by a physician.

These measures help to prevent the spread of intestinal parasites, nail infections, and germs among the children.

  • Trimming the nails often to keep them short
  • Scrubbing the underside of nails with water and soap or a nail brush at every hand wash.
  • Training children not to bite or chew their nail
  • Avoiding cutting of cuticles because they are barriers that prevent infection

According to the U.S Centers for Disease Control and Prevention, clipping the nails weekly reduces the number re-infections by 49 percent.

Hand washing

Regular cleaning of hands with soap reduces rates of intestinal parasite and other infections from occurring by 68 percent. Intestinal parasites and infectious diseases can spread from one person to another by contaminated hands. These diseases include gastrointestinal infections such as those occurring due to Salmonella. Proper washing of hands can help to prevent the spreading of germs like viruses and bacteria that cause the disease.

Some forms of gastrointestinal infections are likely to cause serious infections more so to children or adults with weakened immune systems. When school going children should wash hands to reduce the risk of intestinal parasites It is essential that kids wash their hands thoroughly at these times:

  • After using the toilet
  • Before eating
  • After using a handkerchief or tissue to clean the nose
  • Before and after touching a sick person or child
  • After playing with solid or handling other dirt
  • After treating animals

How do intestinal parasites and other germs spread by hand?

IPs and other pathogens get to the hands and fingernails of school-age children if they touch:

  • Dirty hands of other children
  • Contaminated items or surfaces
  • A cough, sneeze or others body fluids by an infected person

When children touch these unhygienic items and surfaces, they touch their mouth, nose, eyes and it is only a matter of time before they spread to their school and playing mates.

Promoting hand washing with soap together with clipping nails are successful strategies for decreasing intestinal parasite infection or re-infection rates in school-age children. A study published by Mekelle University, Ethiopia in PLOS Medicine concludes as much. To reach this conclusion, researchers did a cluster randomized controlled trial on 367 parasite-negative school going children in Northern Ethiopia after a random assignment to a hand washing or nail clipping intervention. Some of the pupils were in the interventions and others in the non-intervention group for six months.

Field workers in the hand washing intervention visited a household that was part of the study each week encouraging the children in the group and other family members to clean their hands

with water and soap. They insisted on hand washing after visiting a toilet, and before meals. They checked on the use of soap by each household.

Field workers in nail intervention clipped nails of the children in the group each week. After adjustment for factors that are likely to cause infection such as the source of drinking water and latrine use, it is only 14% of children in the hand washing with soap groups get re-infection with intestinal parasites compared to the 29% of those who were not in a hand washing group. These are kids in nail clipping or none of the interventions. The number of children nails clipping groups who got re-infection was 17% while 26% of those who were not in this intervention got re-infection.

A noteworthy finding is that hand washing without nail clipping significantly reduces the rate of anemia in children.

These findings support the importance of implementing of proper hand washing and weekly nail clipping as a measure to maintain public health as a way of reducing parasite infection rates in the resource-limited regions. Although these interventions were efficient under the trail conditions that included intensive monitoring, the researchers did not follow up how hand washing and nail clipping works under the real-life situations.

Why is it important to use water and soap?

Washing hands with water get rid of most of the bacteria. Use of running water is safer than stagnant water in a basin because it gets contamination through use.

There is a debate on whether to use cold, warm or hot water to wash hands. The assumption has been that the hot water can link parasites, bacteria and other contaminants from the hands but there is no evidence to show this and other benefits. Hot temperature of water to wash hands could increase the irritant capacity of soap or damage the natural oils to cause contact dermatitis over time.

Soap is important in hand washing because using it together with water will remove more disease-causing organisms tan just water. People who avoid using soap because it causes their skin to irritate should find a brand that has a different pH. It can be neutral, alkaline or slightly acidic. Some of the perfumes found in soap might also irritate. Replacing soaps that irritate with hand-friendly type will help those who are uncomfortable when washing hands with soap.

Liquid soap is better for hand washing that a bar soap particularly at school or other places where many people use the same one. Bar soap is still better in cleaning hands if there is no liquid soap. There is no proof that antibacterial soap will provide more advantage in clearing intestinal parasite from the hands. If a child follows all the hand cleaning steps, any type will provide the benefits.

Antibacterial soap

When following the hand washing steps outlined above, all soaps are equally effective at removing disease-causing germs.Antibacterial soap is not a necessity and does not offer an advantage over regular soap. The way of storing the soap can affect its cleanliness and by extension the efficiency in cleaning the hands. Keeping the soap for long in areas such as closed sections, or puddle of water can cause the development of bacteria that spread to the hands when someone touches the soap. The hands may smell clean, but in reality, they are not any cleaner. Proper hand washing techniques to reduce the risk of intestinal parasites Proper hand washing takes these steps:

  • Wet the hands clean and running water then turn the tap off
  • Apply soap to the hands and lather it well for about 20 seconds or longer when the dirt is ingrained.
  • Rub the hands together in a rapid movement across all hand surfaces
  • Cleaning the hand surface should include the back of the hands, space between the fingers, wrists and under the fingernails.
  • If possible, it is crucial to remove items such as watches and rings before washing the hands or move to clean under them as microorganisms or parasites might exist under them.
  • Rinse the hands thoroughly under running water to ensure complete removal of all traces of soap
  • Air dries the hands and uses a clean towel to wipe them. Hot air dryers are also good for during the hand.
  • Dry under the skin under any rings as accumulating moisture can cause infection in future.

It is more hygienic for a household with school going children to have a towel for each. They should carry a handkerchief or smaller towel drying their hands at school. These towels and handkerchiefs require frequent washing.

Nail clipping and hand washing are an essential step in reducing the risk of intestinal parasites to school going children, but it is necessary to keep the surfaces, items, and toys they touch clean. The beddings and clothing should also be clean. It is also essential to keep reminding the children about washing their hands after touching dirt and before eating anything. They should even know about the importance of avoiding filthy surfaces as intestinal parasites might spread before they wash their hands.

Breastfeeding could reduce the risk of childhood Leukemia

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Leukemia is a type of cancer that affects the blood or the bone marrow. Bone marrow has the role in producing blood cells. Leukemia can occur when the body has a problem in producing blood cells. It usually affects the white blood cells or leukocytes. Most likely it will attack the people who are over the age of 55, but it is becoming common among the young including the children.

Leukemia is rare, but it is the most common type of cancer to affect the children.

Types of Childhood Leukemia

Leukemia is chronic (slow-growing) or acute (fast-growing) and almost all the childhood leukemias are acute in these main types:

Acute lymphoblastic leukemia (ALL) affects most children of ages 3-5. It starts with an early form of lymphocytes in bone marrow. Most of those who have ALL are children from Hispanic parents, followed by whites and Afro-Americans. More boys than girls contract the childhood cancer.

It occurs even in the first world countries such as the USA where doctors diagnose about 3,000 cases in people under 20 per year.

Acute Myelogenous Leukemia (AML)

AML also called as called acute myeloid leukemia or acute myelocytic leukemia accounts for most of the childhood leukemia cases after ALL. AML starts with myeloid cells forming white blood cells (except lymphocytes) platelets or red blood cells.

Mixed lineage or hybrid leukemia

Hybrid is a rare type of leukemia with cells that have features AML and ALL. Treatment for children with Hybrid leukemia usually get treated like they have ALL, and they respond to treatment like it is the only type that is affecting them.

Chronic leukemias

Chronic Leukemia is one of these two types, but they rarely occur in children.

  • Chronic myelogenous leukemia (CML)
  • Chronic lymphocytic leukemia (CLL)

A child who gets one of them gets similar treatment to adults.

Juvenile myelomonocytic leukemia (JMML)

JMML is a rare type of cancer that occurs in young children of less than 4 years which begins from the myeloid cells. It does not grow slow as CML or fast as AML.

Causes of Childhood Leukemia

Childhood leukemia is the leading cause of deaths in children and teens in countries of the developed world, but there is little information on how the infection starts. Leukemia attacks the white blood cells that help in protecting the body against diseases by fighting off infections. It makes the bone marrow to have too many immature white cells to the extent of crowding out the normal ones with the potential to fight off diseases. The body struggles to fight infections if it does not have enough healthy white blood cells. All affects lymphocytes, a particular type of white blood cell causing it to build up in the spleen, liver and lymph nodes.

Leukemia sets in when a DNA of the immature blood cells mainly the white gets some damage. It triggers a continued growth and division of these cells until they become too many. They cause the health blood cells and their replacement in new cells that the bone marrow produces to start dying after a while.

Abnormal blood cells stay on without dying when they should. They even accumulate to occupy more space. The production of cancer cells increases to the extent of stopping the growth and natural functioning of white blood cells by crowding out the space in blood. In the end, the bad cells will dominate the good blood cells. Siblings of children with childhood leukemia are at a higher risk to develop ALL, but the rate is still low compared to other diseases at just 1 for 500 cases.

Reducing the Risk Of Childhood Leukemia By Breastfeeding

Pediatrics and al health practitioners advocate for exclusive breastfeeding of children for six months as it enhances healthy growth and boosts immunity. The case is not different for leukemia. Researchers in a study at Israel showed that babies who get breast fed for at least the first six months of their life appear to be at a lower risk of contracting childhood leukemia compared to the children who breastfeed fed for fewer months or never breast milk.

A mother's breast milk has infection fighting properties that can reduce occurrence of leukemia and other diseases. Women have no reason to deny their babies this advantage unless there is a complication. Breast milk is available and has essential nutrients to help the development of the baby and maintain the health of the baby through the adulthood. New studies show that there is even now a substantial reason to consider breastfeeding a child even more because of its potential to protect children against leukemia. Researchers analyzed the data from 18 studies.

The act of breastfeeding is a low cost preventive and highly accessible public health measure that the above studies and others found to lower the risk of childhood leukemia. The lead author of the study and a member, School of Public Health at the University of Haifa in Israel Efrat

Amitay said that breastfeeding reduces the risk of “gastrointestinal infection, Sudden Infant Death (SIDS), type 2 diabetes, obesity and ear infection later in life.”

The study gives the mother a substantial reason to breast fed and breastfeeding advocacy another reason to up the intensity of the campaigns. Amitay adds that breastfeeding has a distinct public benefit and that it is something to encourage and facilitate widely.

The research is based on data analysis from 18 studies. Researchers found out the children who fed on breast milk for at least six months had a lower risk of childhood leukemia by 19% than children fed for a shorter period or did receive breastfeeding. The risk of childhood leukemia is less than 11 percent in children child who breastfeeds for a period but less than six months even if it just one time than those who have never breastfed.

Although breastfeeding has various benefits for the baby and even the mother, it was essential to determine if the breastfeeding has any capacity to reduce the risk of leukemia. The study authors reviewed 18 studies involving over 10,000 children with leukemia and over 17,500 healthy children.

Researchers also did a separate analysis of 15 studies to confirm if breastfeeding led to benefit over children who have never taken breast milk. The second analysis did not include three studies from an original group because they did not get data on infants who never breast fed.

Breast feeding is a total food that nature has prepared to supply all the nutritional needs of an infant during the first few months of life. Breast milk is an active substance with antibodies that mother's body manufactures together with other unique qualities that help in promoting healthy flora within the intestines of a baby influencing the development of a child’s immune system. Breast milk provides more benefits because the body of a mother makes antibodies to fight the harmful substances that can attack her and the baby.

Supporting Breastfeeding preventive Role by Identifying Other Childhood Leukemia Risk Factors

All types of cancers including childhood leukemia have become disastrous across the world. It is essential for a parent to be on the lookout for other risk factors that might increase the likelihood of leukemia in their baby. A risk factor is something that affects the chances of contracting a disease such as cancer. Different cancers occur due to various risk facts, but most occur due to genetic risk facts that are part of the substances making up the genes (DNA). Most are an inheritance from the parents, and nothing can change them although there is no link between leukemia to genetic causes.

Lifestyle plays a significant role in the occurrence of cancers, but these factors usually affect the adults who grapple with body weight, diet, tobacco use and lack of physical activity. These factors influence the offset of cancer after many years hence have a minimal part in childhood cancer including leukemia. However, the parents should take concern and even ask for medical advice about the risk of contracting childhood leukemia if these inherited disorders are present.

1. Li-Fraumeni syndrome

This syndrome is a rare condition that occurs due to a change in the TP53 tumor suppressor gene. This change increases the risk of developing several types of cancer including leukemia, brain tumor, adrenal gland, and breast cancer.

2. Down syndrome (trisomy 21)

Children who have Down syndrome have a third extra copy of chromosome 21. Chances of developing acute myloid leukemia (AML) or acute lymphocytric leukemia (ALL) than other children whose overall risk is 2-3%. Down syndrome also has a link to transient leukemia (transient myeloproliferative disorder) a condition that is almost similar to other types of leukemia only that occurs within the first month of life but usually resolves without treatment. It is essential to keep checking the condition of the baby even if transient leukemia clears because it might recur or another type of childhood leukemia can occur. Other genetic disorders like Fanconi anemia and neurofibromatosis can carry a higher risk of leukemia and different types of cancer.

3.Having a sibling with leukemia

The chances of a child contracting childhood leukemia are slightly higher by 2-4 times if a brother or sister got the disease at one time but the risk is still low. It is higher when an identical twin develops childhood leukemia. It makes the other one have 1-5 chances of contracting this disease, and it is even more likely to occur if leukemia occurs within the first year of life. This condition only applies among siblings because the risk of leukemia does not increase in a child if a father or mother develops it in adulthood.

4.Inherited immune system problems

Some inherited conditions can cause a child to have some immune issues at birth that increase the risk of severe infections from a reduction in immune defenses. Such children are at an increased risk of getting leukemia because of having conditions that reduce the immunity such as:

  • Wiskott-Aldrich syndrome
  • Ataxia –telangiectasia
  • Bloom syndrome
  • Schwachman –Diamonds syndrome

5.Lifestyle risk factors

Some studies state that mothers who drink alcohol during pregnancy could compromise on the immunity and increase the risk of leukemia in her child but not many researchers have found this link.

6. Immune system suppression

Chilren who receive intensive treatment with an aim to suppress their immune system especially those who got organ transplants are at more risk of specific disease including ALL and lymphoma.

7. Radiation exposure

Exposure to high radiation levels is one of the risk factors of childhood leukemia within 6-8 years after exposure. The risk of developing AML is also higher after fetus exposure to high level radiation within the first months of development although the extent of risk and timeframe is not clear. The extent of risk to low radiation such as CT scans or X-ray tests are not clear but most doctors those pregnant mothers should not take a chance unless these tests are essential.

8. Exposure to chemotherapy and certain chemicals

Some chemotherapy drugs increase chances of getting second cancer. Chilren who get treatment with these drugs might get childhood leukemia usually AML within 5-10 years after first treatment, and unfortunately, it is harder to treat. Etoposide, teniposide, and chlorambucil are some of the drugs that researchers link to risk of getting leukemia. Exposure to chemicals that like benzene that manufacturers use for making plastics, drugs and dyes might increase the risk of AML and ALL to a small extent. However, benzene causes leukemia in more adults than kids.

Some studies have also found that childhood leukemia has a link to pesticides which can be during pregnancy or early years of life. These researches need additional studies to confirm the findings with more specific information because they were of carrying them out had severe limitations.

The evidence showing that breast milk has antibodies from the mother’s immune system to stimulate immunity in newborns is abundant. Mothers should breastfeed their children much as they can for at least six months to improve resistance against possible infections including childhood leukemia.

Use of legitimate opioid in children may lead to opioid abuse in some adolescent

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An opioid is a class of drugs that are found in opium poppy plant. Doctors often prescribe them to treat moderate to severe pain because they contain chemicals that relax the body and can relieve aches. Most prescriptions are for acute depression but there some physicians who use these drugs to treat diarrhea and coughing.

Most of the prescription opioid is a direct generation from the plant although some are a creation of the scientists from the labs while using similar chemical structure. An opioid can make people feel extreme relaxation and even achieve a "high." It is the reason why teenagers and adults use them for non-medical reasons.

Children are also in danger because those who use prescription opioid in plenty become dependent. Opiate is one of the most addictive drugs that even lead to overdoses and each. Heroine known for its addictive properties and use as a narcotic is an opioid. Many countries never license it as a drug because of its tendency to cause dependence among users.

There is much use abuse among adolescents who use slang term such as vikes, percs, or Oxy to refer to the drug.

Common opioid prescriptions

  • Fentanyl
  • Mmorphine (Kadian, Avinza)
  • Codeine
  • Oxymorphone (Opana)
  • Hydrocodone (Vicodin) oxycodone (OxyContin, Percocet)

The fear among many parents is that their children will be addicted to opioid upon prescription. An explanation by physicians is that kids and teens who take their medicine for a short time according to instructions will not become dependent. For instance, a child who receives an appropriate dose to relieve pain due to a broken bone or surgery is unlikely to suffer from addiction. Unfortunate there are many cases of children who visit the emergency department of hospitals in the USA and other countries with symptoms of opioid dependence and addiction.

It is becoming clear that the opioid dependence that grows to abuse does not discriminate age. The cases are occurring in teens and young adults. The observation is just a small bit of the reality as many young people do not visit an emergency to seek treatment for their addiction. The number of people at the age of 21 or younger who are dependent on opioid has been increasing steadily. Some are 16 or younger. More than 50 percent of these patients are male.

The highest numbers of the people who visit the hospital with opioid dependence or addiction only reach an emergency room because of another acute issue such as an infection, cut or broken bone. Most of them have no other long-term health problems which indicate that they were not ready to seek help for an opioid abuse problem and only went to a hospital because of the emergency.

Only a few of the adolescents inform an emergency room doctor about their problems with sedative abuse. The doctors have a role in identifying those who are likely to have a dependence problem that requires intervention in addition to treating the injury or illness that made the patient seek medical help.

Some researchers believe that a physician should always have the curiosity to find out if any kid who visits an emergency room could be having an underlying problem with opioid use. A doctor should conduct a thorough physical exam and gather comprehensive medical history if he suspects that a kid could be abusing drugs. Urine or other tests will also help to confirm misuse of opioid.

Signs and Symptoms Legitimate Opioid Abuse in Adolescents

Children and teens who are abusing depressants by taking an overdose or more frequently than necessary will show some of these signs and symptoms:

  • Increase tolerance to the drug
  • Inability to reduce or stop the use
  • A desire to keep taking a drug even when it causes health impacts
  • Spending excess time taking drugs and money to buy
  • Sleeping excessively, extreme loss or gain of weighing
  • Withdrawal symptoms after stopping usage

Children who abuse opiates are already dependent on the drug and will show these symptoms if they stop taking them:

  • Extreme physical and mental discomfort
  • Sweating
  • Agitation
  • Anxiety
  • Muscle aches
  • Tremors
  • Nausea and vomiting
  • Diarrhea

The trouble with opioid dependence is that even a minor reliance might cause withdrawal symptoms. Even people with a minor dependence on prescription opioid can suffer from withdrawal. Longtime addicts should consult a medical professional for help on how to quit.

How Legitimate Opioid Abuse Happens

Long-term use of opioid even after a legitimate prescription changes the functioning of the nerve cells in the brain. It also happens to those who need the sedatives to for a long time treatment. Opioid bind and activate opioid receptors on the cells found at many sections of the brain, spinal cord, and other body organs especially those that control feelings of pleasure and pain. Opioid attaches to these receptors to block the sending of pain signals by the brain to the body and release a significant amount of dopamine throughout the body. It is this release that reinforces the act to take to take the drug because the user wants to keep repeating the experience.

The nerve cells become used to having opioid hence the child is at the risk of getting unpleasant feelings and reactions after sudden taking away at the end of treatment. Withdrawal symptoms are the term that medical practitioners use for these reactions. They begin more like having flu. The user gets body aches, fever, chills, sweating and shaking.

It is a reason for doctors to carefully follow if a child’s parents know the right prescription, the time to take and the importance of adhering to the dose. They should also guide the users about the right time to stop taking medicine to reduce chances of getting withdrawal symptoms. Eventually, cells will start functioning normally, but it will take time.

Most of the children who abuse opioid as adolescents also have other dependence problems. For example, they keep on taking drugs even though it could be having harmful effects on their life and other aspects of life. They usually get a strong urge to take opioid even when they do not have much pain because of something called cravings. The natural rewards such as taking chocolate, a relaxing walk or watching a funny movie do not satisfy the adolescent until they take opioid.

Children at a Higher Risk of Legitimate Opioid Abuse

Any kid or adult who uses opioid is at the risk of developing an addiction. The right way to reduce the risk of addiction is to use the tranquilizers according to the prescription by the doctor and avoid using these drugs in an unauthorized way. Taking opioid can be a choice, but some factors might increase the risk of addiction. Children with mental illness or dependence on other drugs are a higher risk for opioid abuse. Other factors that increase risk of dependence include:

1.History of dependence

Children from a family with a history of drug dependence or those who grow in particular social and economic situations could be at a higher risk. Children with parents who abuse opioid are at high risk of abuse from pregnancy until their adolescence. Some of the drugs get into their system, and they experience withdrawal symptoms at birth.

Withdrawal effects after prenatal exposure to opiates will cause worse withdrawal effects than at any other age. There are many cases in the US where mothers to such kids give them for adoption. The children who continue staying with their addicted parents are likely to follow the same path because of neglect. Their parents are unlikely to follow up whether they are taking the correct dosage or healing of the disease or injury that makes a doctor to prescribe opioids. Living with an addict parent might also cause the older children or teenagers to rely on sedatives as their coping mechanism against neglect, anxiety, and expression. The danger is that such parents are unlikely to discover opioid dependence quickly or take fast action after they notice the symptoms of addiction.

2.Misuse of prescription drug

Misuse of prescription opioid can increase the likelihood of dependence leading to substance use disorder (SUD) a medical illness ranging from mild to severe. SUD can grow from temporary to chronic with addiction as the most severe form. A SUD develops in someone after continued misuse for opioid to the point of changing the brain. In addition to health problems, adolescents with substance use disorder will have challenges in meeting responsibilities at school or home. Use of any opioid in a different manner from the doctor’s prescription can cause dependence because this category of drugs is highly addictive. Reliance on the medication can occur even with infrequent use leading to physical dependence s it will still alter the pain center in the brain which brings the dependency.

3.Long-term use of opioid

Someone addicted to opioid wants to get more drugs after the prescriptions run out. It can lead to risky or inappropriate behavior such as lying to a pharmacist to receive a new order, buying opioid from friends stealing medicine from other users or buying from street sellers. Taking prescription opioid for an extended period might cause these risks.

  • Development of tolerance by making the user to need more opioid for similar pain relief
  • The physical dependence that triggers symptoms of withdrawal after stopping opioid use
  • Addiction when a user develops strong cravings and continues taking opioid even when it is causing problems with money, health, and relationships

Taking too much of opioid or mixing with other drugs or alcohol can cause an overdose and even death.

Preventing Legitimate Opioid Abuse among Children

1.Locking the drugs up

Keeping drugs away from the reach of children is essential because the children might take extra tablets or spoonfuls. Increasing the dose beyond doctors is an abuse that could lead to dependence and eventual addiction

It also prevents healthy children from taking medicine that belongs to others. There are reports of instances where children take opioid belonging to their siblings or friends to manage anxiety, pain or sleep disorders without consulting a doctor to determine the cause. They may think that prescription medicine is safer than street drugs because they have the approval from healthcare providers. What they do not know is that abuse of prescription opiates will also lead to serious side effects, overdose or addiction. Parents should lock up the prescription opioid and other medication to ensure that only the child who got the drugs is taking them.

2. Keeping track of the medications

It is essential to prepare a list of medicines in the home especially those that children are likely to abuse and monitor their use. It is necessary to periodically count the remaining tablets in a container to determine if the quantity matches the prescribed dosage. A parent can request a dose of 8-22 hours to allow administering at home for school going children and measure the correct dose. A school nurse can help if the child must take medication at home.

3. Proper disposal upon dose completion

It is dangerous to save opioid for next time use after ending the pain treatment. The prescription regimen ends at healing and dispose of the remaining drug is essential to prevent the same child or others from taking it. Follow any disposal instructions that the manufacturer provides on the label. A pharmacist or healthcare provider can advise on how to get rid of unused medicine if it does not have disposal instructions. Mixing it with undesirable substances such as sawdust, used coffee ground or kitty litter before placing it in a sealable bag for disposal in trash prevents those who would try to retrieve the medicine.

4.Avoid sharing medication

A specific opioid is appropriate for the person who got it from a healthcare professional but not other kids. Other kids might get dangerous drug interactions as well as serious side effects if someone else uses it.

Treatment of Legitimate opioid abuse

A variety of treatments including behavioral therapies and medicine are efficient in helping adolescents with dependence and addiction to stop the habit.

Physicians can prescribe methadone and buprenorphine medicines that work by binding the same opioid receptors in the brain in the same way as a painkiller to reduce withdrawal symptoms and cravings. Another medication is known as naltrexone block the opioid receptors to present the drugs from having any effect.

Therapists use behavioral therapies to treat addiction to prescription opioids for users to modify their attitudes and behavior relating to the use of drugs. They help their patients to increase healthy life skills as they continue with other forms of treatment like medication. Multidimensional family therapy which specializes in adolescents with drug use problems address personal and family influences on abuse patterns to improve overall functioning. Behavioral therapy that helps to manage triggers of drug abuse and stress is also an effective therapy.

Counseling children and teens about the dangers of prescription drugs for recreation helps them to understand the harm of dependence and addiction. They will avoid taking medicine without adhering to prescription dose and confess any drug abuse to get help.

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