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Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention. [ABSTRACT FROM AUTHOR]

Air pollutants are known to trigger asthma and wheezing-associated lower respiratory infections in children, but evidence regarding their effect on hospital admissions in India is limited. We conducted a time-series study over a period of five years to assess the role of ambient air pollutants in daily asthma-related hospital admissions in children in Mysore, India. Daily asthma and wheeze (associated with lower respiratory infections) admissions were modelled using a generalised additive model (GAM) to examine the non-linear effects and generalised linear models (GLM) for linear effects, if any. Models were adjusted by day of the week and lag days, with smooth terms for time, maximum temperature, and relative humidity, and they were stratified by sex and age group. Of the 362 children admitted, more than 50% were boys, and the mean age was 5.34 years (±4.66). The GAMs showed non-linear associations between NO2, PM2.5, and NH3. For example, a 10 µgm−3 (or 10%) increase in NO2 increased admissions by 2.42. These non-linear effects were more pronounced in boys. A linear effect was detected for PM10 with a relative risk (95% CI) of 1.028, 1.013, and 1.043 with admission. Further research is needed to explore whether these findings can be replicated in different cities in India. Air pollution needs to be controlled, and policies that focus on lower cut-off levels for vulnerable populations are necessary. [ABSTRACT FROM AUTHOR]

The studies conducted a decade ago showed that the Ponseti method, suffers from many execution-related issues-particularly in low and middle-income countries including poverty, physical distance, lack of transportation etc. The society has undergone many changes, including improvements in literacy, connectivity (both transport and digital), etc., in the last decade. Therefore, this study is designed to identify the contemporary apprehensions, concerns, and challenges of parents seeking CTEV treatment for their child through the Ponseti Method in India. A descriptive cross-sectional study of 200 parents of the children undergoing treatment at a multi-specialty hospital is carried out using an interview guide. The semi-structured interviews were conducted telephonically and recorded. The statistical analysis shows that a male child is presented late than a female child. The physical distance is associated with child discomfort during the casting and bracing phase, with the travel method affecting the follow-up. The increase in travel time may result in increased casts due to a lack of regular follow-up. Parents' income level is also strongly associated with regularity of follow-up and child discomfort during treatment. The patients traveling long distances in public transport are the most vulnerable group regardless of gender. The children in such cases are more likely to experience discomfort during the casting and bracing phase with a lack of regular follow-up. Expert doctors and brace unavailability in the local area remain vital challenges for the parents. [ABSTRACT FROM AUTHOR]

Children are growing from young children to babies and then to teens and puberty at different point of life. The young child needs a healthy and animating state at any level that facilitates his or her physical, social, emotional, enthusiastic and moral growth. Throughout the administration of child work, territories that are subtler, such as the creation of emotions or psyche, are routinely saved. India is the world's leading source of child labour and ignorance. A quarter of the worlds are all young workers in India, and a child is busy with every third family unit of our country. In nearly any exercise in the non-formal section children are utilized in India. Whatever the case, the large majority of them are used in the food or agricultural industries, much as in many countries that are creating. A remarkable amount of these children are fortified jobs in Indian. [ABSTRACT FROM AUTHOR]

Screen dependency disorder is on a rising trend and being less researched, the study tried to find out the prevalence and pattern of screen viewing (SV) among children less than two-years of age. Data was collected through in-person interviews from their mothers. Increasing child-age and type of family were significantly associated with higher prevalence of SV. Smart phones had similar usage rates as TVs. Parental knowledge and practices were found to influence the SV and screen-time in children. Modifiable factors like parental knowledge on SV, parental SV practices can help in designing health promotion strategies and recommendations on SV. [ABSTRACT FROM AUTHOR]

NAFLD was earlier believed to be the disease of adults only however in 1983, the existence of this disease was seen in paediatric population. Nearly four decades have passed since the first description of the Paediatric NAFLD (P-NAFLD), yet it is one of the areas which is given least priority in the country. The P-NAFLD is reversible and can be prevented by lifestyle and behaviour modification and hence there is a need to this review highlights the importance of P-NAFLD in the country and need for formulating strategies for prevention and control of P-NAFLD in the country. All published articles in the MEDLINE database on P-NAFLD in India were included. The important findings were summarized and critically analysed. The existing review suggests, the prevalence of P-NAFLD is uncertain in the country. NAFLD is a phenotypic product of complex interaction of heredity (nature) and environment (nurture). This review summarizes the importance of P-NAFLD in India and discusses the predisposition of these risk factors in Indian children. Further population-based studies on prevalence and incidence are required on general paediatric population to quantify the magnitude of the disease in India for better management of the condition. [ABSTRACT FROM AUTHOR]

Introduction: Deficiencies of micronutrients play a role in human immunodeficiency virus (HIV) infection and its severity. Identifying the micronutrient status would guide supplementation, thus altering the disease progression and severity. Material and methods: A cross-sectional hospital-based study was conducted in Southern India on hundred HIV-infected children. Estimation of serum micronutrient levels (zinc, copper, and iron) and comparison of the deficient micronutrients with clinical stages, immunological categories, CD4 counts, and nutritional status was performed. Results: Among 100 HIV-infected children, zinc deficiency was the most common (62%), whereas copper and iron deficiency was present in 2% and 1%, respectively. Mean age of children was 11.20 ± 3.14 years, 52% were girls, 24% were malnourished, 76% were receiving antiretroviral therapy (ART), and four had CD4 counts < 200/mm2 indicating AIDS. Using Kruskalwallis test, serum iron levels (p = 0.000) and CD4 levels (p = 0.001) were significantly associated with clinical stages, while serum zinc levels (p = 0.043) and CD4 levels (p = 0.000) were significantly associated with various degrees of immune classification. Mean micronutrient levels did not correlate significantly with CD4 counts less than and greater than 350 by unpaired t test. Zinc deficiency did not correlate with clinical staging, immunological classification, nutritional status, and receipt of ART on multiple logistic regression analysis. Conclusion: In HIV-infected children, zinc deficiency was the most common and it did not correlate with clinical staging, immunological classification, nutritional status, and receipt of antiretroviral therapy. Hence, supplementation of zinc would be required along with initiation of ART. [ABSTRACT FROM AUTHOR]

• Hair cortisol concentration was associated with childhood adversity in one year olds in rural India. • Saliva cortisol slope and area under the curve did not show this association. • This is the largest study of hair cortisol in young children. • This is the first study to report hair cortisol from a low/middle income country. The majority of the world's children live in low- and middle-income countries and face multiple obstacles to optimal wellbeing. The mechanisms by which adversities – social, cultural, psychological, environmental, economic – get 'under the skin' in the early days of life and become biologically embedded remain an important line of enquiry. We therefore examined the contribution of childhood adversity through pregnancy and the first year of life to hair and salivary cortisol measures of early life stress in the India SPRING home visits cluster RCT which aims to improve early childhood development. We assessed 22 adversities across four domains: socioeconomic, maternal stress, family-child relationship, and child and summed them to make a cumulative adversity score & quintiles, and four subscale scores. We cut 3 cm of hair from the posterior vertex and took three saliva samples from morning till late afternoon on each of two days (total six samples). We analysed both for cortisol concentration using ELISA techniques. We used multiple linear regression techniques to assess the relationship between cumulative adversity and log hair cortisol concentration and saliva diurnal slope and area under the curve. We assessed 712 children for hair, and 752 children for saliva cortisol at 12 months of age. We found a strong positive relationship between adversity and hair cortisol; each additional adversity factor was associated with hair cortisol increases of 6.1% (95% CI 2.8, 9.4, p < 0.001) and the increase from adversity quintile one to five was 59.4%. Socioeconomic, relationship and child scales were independent predictors of hair cortisol (socioeconomic 6.4% (95% CI -0.4, 13.6); relationship 11.8% (95% CI 1.4, 23.2); child 7.9% (95% CI -0.5, 16.9). We did not find any association between any measures of adversity and either of the saliva cortisol outcomes. This is the largest study of hair cortisol in young children, and the first in a low- and middle-income country setting. Whilst the short-term diurnal measures of cortisol did not appear to be linked with adversity, chronic exposure over several months appears to be strongly associated with cumulative adversity. These findings should spur further work to understand the specific ways in which adversity becomes biologically embedded, and how this can be tackled. They also lend support to ongoing action to tackle childhood adversity in communities around the world. [ABSTRACT FROM AUTHOR]

Background: This study investigated health-related quality of life outcomes for children with cochlear implants in India using the Glasgow Children's Benefit Inventory questionnaire. Cochlear implantation is associated with improved language outcomes. Some studies show this gives higher quality of life after implantation. Previous research demonstrates that India presents unique circumstances that impact perspectives regarding cochlear implantation. Method: Children (aged under 18 years) who had undergone cochlear implantation were recruited from Vani Pradan Kendra, an organisation for individuals with hearing loss based in Bangalore, India. Demographic data including age, sex, duration of hearing loss and age at implant were collected, and the children's parents or caregivers completed the Glasgow Children's Benefit Inventory questionnaire. Results: Sixty-nine children (mean age: 8.0 ± 3.89 years) were recruited, and all reported improved quality of life after cochlear implantation. There was no effect of age, gender or education on reported benefits. However, a younger age at implant and longer experience with an implant were associated with greater quality of life improvements. Conclusion: Cochlear implantation leads to improved quality of life, with greater improvements associated with earlier implantation. This supports early intervention in children with profound hearing loss. [ABSTRACT FROM AUTHOR]

Hepatitis A virus (HAV) causes an enterically transmitted viral disease mainly affecting children and endemic in many developing countries, including India. There is an epidemiological shift with an increased incidence of symptomatic cases among children. This study was conducted to assess the seroprevalence of HAV among young children aged below 5 years and the need for universal immunization. This cross-sectional study was conducted at two tertiary care hospitals in Northern India, from Apr 2014 to Jul 2015, among healthy children aged between 1 and 5 years. The sample size was calculated based on the prevalence of HAV seropositivity of 40% among children aged <10 years [16–60%] and alpha error of 5%. Analysis of serum IgG against HAV was performed by enzyme-linked immunosorbent assay method, and results were analyzed. A total of 1084 children aged between 12 and 60 months were enrolled, with male-to-female ratio of 1.86:1. A total of 471 children (43.5%) were found to be positive for IgG against HAV. The seroprevalence of HAV was lower among younger children aged 12–23 months (odds ratio [OR] = 0.73, 95% confidence interval [CI] = 0.52–0.87, p = 0.03), which was statistically significant. Seropositivity of HAV was lower among boys and families consuming safe drinking water and having improved sanitation facilities. The study observed lower seropositivity against HAV among younger children, making them susceptible of contracting the disease. Possible underlying risk factors were younger age, unsafe drinking water, poor sanitation, and low education status of parents. Therefore, vaccination may be recommended as optional vaccine at one year of age, along with improved public health efforts for safe drinking water, hygiene practices, and food safety. [ABSTRACT FROM AUTHOR]

Aim: The present study was conducted to determine the prevalence of harmful oral habits among 4-13-year-old children in relation to their age and gender, in a dental college hospital in Central Kerala, India. Methods: A retrospective survey was conducted in 1034 children (478 males and 556 females) aged between 4 and 13 years. The participants were checked for the prevalence of oral habits in relation to their age and gender. Information regarding oral habits was obtained with the help of a questionnaire and clinical evaluation using mouth mirror and water tests. Chi-square test was used in the statistical analysis. Results: Overall prevalence of oral habits was 72.7% in the study participants. Nearly 47.1% of the children had only one habit, whereas 19.1% had two habits and 5.5% had three or more habits. Mouth breathing was the most commonly reported oral habit (29.4%), followed by tongue thrusting (23.5%), nail biting (20%), thumb-sucking (17%), pencil biting (8.7%), bruxism (4.9%), and lip/cheek biting (4.5%). Nail biting was reported significantly more in females and bruxism significantly more in males. Prevalence of thumb-sucking was very high in younger children (4-8 years) compared to older children (9-13 years). Conclusion: The prevalence of oral habits among 4-13-year-old children is very high in Central Kerala, compared to children in other Indian populations. Since oral habits can be intercepted and prevented, creating awareness regarding the adverse outcomes of oral habits is highlighted. [ABSTRACT FROM AUTHOR]

Background: Obsessive–compulsive disorder (OCD) is a common psychiatric illness in children and adolescents. Till date, the sample sizes in the Indian studies have been relatively small. Methodology: The present study is a retrospective chart review of a large sample of children and adolescents diagnosed with OCD in a tertiary care center Objectives: The objectives of this study were to characterize the clinical profile and to evaluate outcome of OCD in children and adolescents Results: Fear of contamination and washing/cleaning compulsions were the most common presenting symptoms. Most of the patients were male with two-thirds having a comorbid disorder. Major depressive disorder was the most common comorbid disorder. The rates of attention deficit hyperactivity disorder, disruptive behavioral disorders, and tic disorders were low when compared to Western studies. One-third of the patients received adequate trial of serotonin reuptake inhibitors and 36% received cognitive behavior therapy. Fifty-four percent of patients had a poor outcome with hospitalization, longer duration of illness, earlier onset of OC symptoms, and family history of OCD being the predictors of poor outcome. Conclusion: The present study of a large sample of patients with juvenile OCD highlights the low rate of comorbid disruptive behavior disorders as reported in the earlier Indian studies and a favorable short-term outcome in approximately 56% of the patients. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess the prevalence of sleep disorders among children aging between 4 and 9 years using Hindi version of Pediatric Sleep Questionnaire (PSQ). Methods: This study had two parts first, translation and validation of PSQ into Hindi language, and second, assessment of the prevalence of sleep disorders using PSQ Hindi version. Hindi PSQ was distributed in randomly chosen primary schools in a semi-urban area. The children were requested to get them filled by their parents. When the questionnaires were returned, responses were analyzed. Results: Most of the items of the Hindi version had perfect agreement with original questionnaire in a bilingual population (κ=1). Totally, 435 children were included in the field study having average age of 6.3 years. Obstructive sleep apnea was reported in 7.5% children; symptoms suggestive of restless legs syndrome were reported by 2%-3%; teeth grinding by 13.9% and sleep talking by 22.6% children. Conclusion: PSQ Hindi version is a validated tool to screen for sleep disorders among children. Sleep disorders are fairly prevalent among young children in India. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Broselow™ Pediatric Emergency Tape indicates standardized, precalculated medication doses, dose delivery volumes, and equipment sizes using color-coded zones based on height-weight correlations. The present study attempted to provide more evidence on the effectiveness of the Broselow™ Pediatric Emergency Tape by comparing the tape-estimated weights with actual weights. We hypothesized that the Broselow™ Pediatric Emergency Tape would overestimate weights in Indian children aged<10 years, leading to inaccurate dosing and equipment sizing in the emergency setting. METHODS: This prospective study of pediatric patients aged <10 years who were divided into three groups based on actual body weight: <10 kg, 10-18 kg, and >18 kg. We calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape bias. Concordant results were those with a mean percent difference within 3%. Standard deviation was measured to determine precision. Accuracy was determined as color-coded zone prediction and measured weight concordance, including the percentage overestimation by 1-2 zones. RESULTS: The male-to-female ratio of the patients was 1.3:1. Total agreement between color-coding was 63.18% (K=0.582). The Broselow™ color-coded zone agreement was 74.8% in the <10 kg group, 61.24% in the 10-18 kg group, and 53.42% in the >18 kg group. CONCLUSIONS: The Broselow™ Pediatric Emergency Tape showed good evidence for being more reliable in children of the <10 kg and 10-18 kg groups. However, as pediatric weight increased, predictive reliability decreased. This raises concerns over the use of the Broselow™ Pediatric Emergency Tape in Indian children because body weight was overestimated in those weighing >18 kg. [ABSTRACT FROM AUTHOR]

Growth chart committee of Indian Academy of Pediatrics (IAP) has revised growth charts for 5-18-year-old Indian children in Jan 2015. The last IAP growth charts (2007) were based on data collected in 1989-92 which is now >2 decades old. India is in an economic and nutrition transition and hence growth pattern of Indian children has changed over last few years. Thus, it was necessary to produce contemporary, updated growth references for Indian children. The new IAP charts were prepared by collating data from nine groups who had published studies in indexed journals on growth from India in the last decade. Growth charts were constructed from a total of 87022 middle and upper socioeconomic class children (m 54086, f 32936) from all five zones of India. Data from middle and upper socioeconomic class children are likely to have higher prevalence of overweight and obesity and hence growth charts produced on such populations are likely to "normalize" obesity. To remove such unhealthy weights form the data, method suggested by World Health Organization was used to produce weight charts. Thus, the new IAP weight charts are much lower than the recently published studies on affluent Indian children. Since Indian's are at a higher risk of obesity-related cardiometabolic complications at lower body mass index (BMI), BMI charts adjusted for 23, and 27 adult equivalent cut-offs as per International obesity task force guidelines were constructed. IAP now recommends use of these new charts to replace the 2007 IAP charts. [ABSTRACT FROM AUTHOR]

Objective: To assess the co-morbidity of obsessive-compulsive disorder (OCD) and other anxiety disorders in child and adolescent mood disorders. Methods: A total of 100 patients aged < 18 years with mood disorders according to the DSM-IV-TR were screened for OCD and other anxiety disorders using Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version. Results: The prevalence of co-morbid anxiety disorders was 22%; OCD was present in 4%, and subthreshold obsessive-compulsive symptoms were present in 2%. Among others, 8% had panic disorder, 7% had generalised anxiety disorder, 3% had separation anxiety disorder, and 1% had social phobia; multiple anxiety disorders were present in 3% of patients. Conclusion: Co-morbid anxiety disorder was found in one-fifth of children and adolescents with mood disorder. [ABSTRACT FROM AUTHOR]

Childhood malnutrition remains common in India. We visited families in 40 urban informal settlement areas in Mumbai to document stunting, wasting, and overweight in children under five, and to examine infant and young child feeding ( IYCF) in children under 2 years. We administered questions on eight core WHO IYCF indicators and on sugary and savory snack foods, and measured weight and height of children under five. Stunting was seen in 45% of 7450 children, rising from 15% in the first year to 56% in the fifth. About 16% of children were wasted and 4% overweight. 46% of infants were breastfed within the first hour, 63% were described as exclusively breastfed under 6 months, and breastfeeding continued for 12 months in 74%. The indicator for introduction of solids was met for 41% of infants. Only 13% of children satisfied the indicator for minimum dietary diversity, 43% achieved minimum meal frequency, and 5% had a minimally acceptable diet. About 63% of infants had had sugary snacks in the preceding 24 h, rising to 78% in the second year. Fried and salted snack foods had been eaten by 34% of infants and 66% of children under two. Stunting and wasting remain unacceptably common in informal settlements in Mumbai, and IYCF appears problematic, particularly in terms of dietary diversity. The ubiquity of sugary, fried, and salted snack foods is a serious concern: substantial consumption begins in infancy and exceeds that of all other food groups except grains, roots, and tubers. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in Nutrition Rehabilitation Centers (NRC). Design: Review of data. Setting: 12 NRCs in Uttar Pradesh, India. Participants: Children admitted to NRCs (Jan 1, 2010 - Dec 31, 2011). Intervention: Detection and treatment of SAM with locally-adapted protocols. Outcomes: Survival, default, discharge, and recovery rates. Results: 54.6% of the total 1,229 children admitted were boys, 81.6% were in the age group 6-23 months old, 86% belonged to scheduled tribes, scheduled castes, or other backward castes, and 42% had edema or medical complications. Of the 1,181 program exits, 14 (1.2%) children died, 657 (47.2%) children defaulted, and 610 (51.7%) children were discharged The average (SD) weight gain was 12.1 (7.3) g/kg body weight/day and the average (SD) length of stay was 13.2 (5.6) days. 206 (46.8%) children were discharged after recovery (weight gain ≥15%) while 324 (53.2%) were discharged, non-recovered (weight gain <15%) Conclusions: NRCs provide life-saving care for children with SAM; however, the protocols and therapeutic foods currently used need to be improved to ensure the full recovery of all children admitted. [ABSTRACT FROM AUTHOR]

Introduction: Data on the efficacy of hydroxyurea (HU) in Indian children with sickle cell anaemia (SCA) is limited. Hence, we have evaluated the efficacy of fixed low dose HU in Indian children. Methods: The study cohort consisted of 144 children (<18 years of age) with SCA having severe manifestations (≥3 episodes of vasocclusive crisis or blood transfusions, or having ≥1 episode of acute chest syndrome or cerebrovascular stroke or sequestration crisis) who were started on fixed low dose HU (10 mg/kg/day). They were followed up for two years and monitored for the hematological and clinical efficacy and safety. Results: There was significant increase in the fetal hemoglobin level (HbF%), total hemoglobin and mean corpuscular volume. Vasoocclusive crises, blood transfusions, acute chest syndrome, sequestration crises and hospitalizations decreased significantly. Baseline HbF% had significant positive correlation with HbF% at 24 months. There was significant negative correlation between baseline HbF% and change in HbF% from baseline to 24 months. No significant correlation was found between HbF% at baseline and clinical event rates per year after HU. No major adverse events occurred during the study period. Conclusion: Fixed low dose HU is effective and safe in Indian children with SCA. [ABSTRACT FROM AUTHOR]

Justification: Severe acute malnutrition (SAM) is a major public health issue. It afflicts an estimated 8.1 million under-five children in India causing nearly 0.6 million deaths. The improved understanding of pathophysiology of SAM as well as new internationally accepted growth charts and newer modalities of integrated intervention have necessitated a relook at IAP recommendations. Process: A National Consultative Meeting on Integrated Management of Severe Acute Malnutrition was held in Mumbai on 16th and 17th October, 2010. It was attended by the invited experts in the field. Extensive discussions were held as per the program. The participants were then divided into six groups for detailed discussions. The groups deliberated on various issues pertaining to the task assigned and presented recommendations of the groups in a plenary session. The participants made a list of recommendations after extensive discussions. A Writing Committee was formed and was entrusted with the task of drawing a Consensus Statement on the basis of these Recommendations. After multiple deliberations, the following Consensus Statement was adopted. Objectives: To critically evaluate the current global evidence to formulate a consensus among stakeholders regarding diagnosis and management of SAM. Recommendations: An integrated management of malnutrition is likely to yield more dividends. Thus, management of SAM should constitute an important component of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program. Determination of SAM on the basis of Z-scores using WHO Growth charts is considered statistically more appropriate than cut-offs based on percentage weight deficit of the median. Considering the fact that many children with SAM can be successfully managed on outpatient basis and even in the community, it is no more considered necessary to advise admission of all children with SAM to a healthcare facility. Management of SAM should not be a stand-alone program. It should integrate with community management therapeutic programs and linkages with child treatment center, district hospitals and tertiary level centers offering inpatient management for SAM and include judicious use of ready-to-use-therapeutic Food (RUTF). All sections of healthcare providers need to be trained in the integrated management of SAM. [ABSTRACT FROM AUTHOR]

Fever with rash is common among children and are seen by both dermatologists and pediatricians. Most of them are benign viral exanthems without much clinical significance. This article gives an overview of the infectious and noninfectious causes of fever with rash in children and how to diagnose them, with special emphasis on the Indian scenario as well. It also differentiates them from fever with rash caused by drugs. This review emphasizes that although benign in many cases, it is necessary to identify the signs of serious illnesses to prevent mortality or sequelae. [ABSTRACT FROM AUTHOR]

Objectives: To develop age and gender specific waist circumference references for urban Indian children aged 3-16 years. Design: Cross-sectional study. Setting: Urban preschools and schools of Bangalore. Participants: 9060 children (5172 boys and 3888 girls) in the age group of 3-16 years. Methods: Weight, height, and waist circumference were measured using standard anthropometric methodology. Percentiles for waist circumference and Waist/height ratio (W/Ht) for each age and gender were constructed and smoothed using the LMS method. Results: Mean waist circumference increased with age for both girls and boys. The upper end of curve in boys continued to increase, whereas in the girls it tended to plateau at 14 years. The waist circumference of the Indian children from the present study was higher than age and sex matched European children. The proportion of children with W/Ht ratio greater than 0.5 decreased as their age increased. Conclusions: These curves represent the first waist and waist height ratio percentiles for Indian children and could be used as reference values for urban Indian children. We suggest that for a start, the 75th percentile of waist circumference from this study be used as an 'action point' for Indian children to identify obesity (as a tautological argument), while retaining the cut-off of 0.5 for the W/Ht ratio; however this underlines the need to derive biologically rational cut-offs that would relate to different levels of risk for adult cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Diaphragmatic hernia is migration of abdominal viscera into the thoracic cavity through a defect in the diaphragm. In children, it is mostly congenital; traumatic diaphragmatic hernia being less common. This study aimed to review our experience with traumatic diaphragmatic rupture (TDR) and to identify the clinical findings and diagnostic modality that may help in early diagnosis and prompt therapy. Methods: The study involved 11 children (1--18 years old) with TDR who were hospitalised between 1993 and 2005. In addition to clinical examination, a plain X-ray of the chest and abdomen, an ultrasound, barium studies, and a computerised tomography (CT) scan were used to evaluate the patients. Results: All of the diaphragmatic ruptures occurred on the left side, with 10 occurring in the posterolateral part and 1 near the oesophageal hiatus. Two of our patients presented 7 and 10 days after the injury, and 1 patient presented 1 year after the trauma. Conclusion: TDR should remain a diagnostic possibility in children. These patients are best assessed using a CT scan. New research on stem cells and tissue-engineered bioprosthetics may pave the path for better future therapies in these cases. [ABSTRACT FROM AUTHOR]

Lamotrigine is a newer antiepileptic drug useful as oral adjunctive therapy in refractory epilepsy. Indian data on use of lamotrigine is limited. This study was conducted to evaluate add-on lamotrigine in Indian children with epilepsy. Twenty children (median age 90 months) receiving lamotrigine as add-on therapy for mean 26.7 (19.1) months, were followed for a median period of 7.9 (6-10) months. Follow-up was done every two weeks. The most common seizures types were either generalized tonic-clonic (6, 30%) or myoclonic (8, 40%). The average dose used was 3.86 mg/kg/day (with concomitant valproate). Good response (>50% reduction) or complete seizure control was seen in 72% patients. Side effects were seen in 27.5% patients and were 'mild' in more than half of these. Lamotrigine was stopped in two patients due to adverse reactions, which resolved on stopping the drug. Lamotrigine was observed to be an effective, add-on, broad-spectrum antiepileptic with 'mild' side effects in Indian children. [ABSTRACT FROM AUTHOR]

Objective: To examine the validity of accelerometers for characterizing habitual physical activity patterns in Indian children. Design: Cohort study. Setting: Holdsworth Memorial Hospital, Mysore. Subjects: Children (N=103, mean age 6.6 years) selected from an ongoing birth cohort study. Methods: Physical activity was measured over 7 days using accelerometers (MTI Actigraph) and concurrent parent-maintained activity diaries. Actigraph counts per minute representing sedentary (<10), light (<400), moderate (<3000) and vigorous (≥3000) activity were determined using a structured activity session in a separate group of 10 children. In 46 children chosen for validating accelerometers, time spent in different activity levels according to diaries was determined. Energy Expenditure (EE) was calculated from diaries using a factorial method. Results: Ninety-eight children wore the monitor for ≥4 days. Total counts and time spent in different activity levels were similar in boys and girls (P>0.2). Among 46 children chosen for comparisons, time spent in sedentary (r =0.48, P=0.001), light (r=0.70, P<0.001) and moderate activities (r=0.29, P=0.054) according to diaries correlated with those derived from counts, and total Actigraph counts correlated with EE (r=0.42, P=0.004). Bland-Altman analysis showed systematic bias, and wide limits of agreement between these methods for time spent in different activity levels. Conclusions: Accelerometers are a well tolerated and objective way of measuring activity behavior in free-living children. Though accelerometer counts correlate with time spent in activity of varying intensity and energy expenditure derived from parent-maintained diaries, wide limits of agreement show that the limitations of accelerometers need to be recognized in interpreting the data that they generate. [ABSTRACT FROM AUTHOR]

Lead pollution is a substantial problem in developing countries such as India. The US Centers for Disease Control and Prevention has defined an elevated blood lead level in children as ≥10 μg/dl, on the basis of neurologic toxicity. The US Environmental Protection Agency suggests a threshold lead level of 20–40 μg/dl for risk of childhood anemia, but there is little information relating lead levels <40 μg/dl to anemia. Therefore, the authors examined the association between lead levels as low as 10 μg/dl and anemia in Indian children under 3 years of age. Anemia was divided into categories of mild (hemoglobin level 10–10.9 g/dl), moderate (hemoglobin level 8–9.9 g/dl), and severe (hemoglobin level <8 g/dl). Lead levels <10 μg/dl were detected in 568 children (53%), whereas 413 (38%) had lead levels ≥10–19.9 μg/dl and 97 (9%) had levels ≥20 μg/dl. After adjustment for child's age, duration of breastfeeding, standard of living, parent's education, father's occupation, maternal anemia, and number of children in the immediate family, children with lead levels ≥10 μg/dl were 1.3 (95% confidence interval: 1.0, 1.7) times as likely to have moderate anemia as children with lead levels <10 μg/dl. Similarly, the odds ratio for severe anemia was 1.7 (95% confidence interval: 1.1, 2.6). Health agencies in India should note the association of elevated blood lead levels with anemia and make further efforts to curb lead pollution and childhood anemia. [ABSTRACT FROM AUTHOR]

We assessed 513 children (2-6 y = 252; 7-12 y = 261) who visited the pediatric outpatient of a rural medical college hospital, for sleep problems using 'BEARS' tool. Sleep problems detected in the BEARS domains for preschool (2-6 years, n=252) and school children (7-12 years, n=261) were as follows: bedtime problems (33.3% vs 14.9%, P<0.001), excessive daytime sleepiness (32.5% vs 1.9%, P<0.001), awakening during night (25% vs 11.87%, P<0.001), regularity and duration of sleep (19.84% vs 4.98%, P<0.001), and sleep disordered breathing (4.8% vs 5%, P=0.1). We conclude that sleep problems are common among rural Indian children and should be routinely screened for during health visits. [ABSTRACT FROM AUTHOR]

We report a 15-year-old boy with autosomal recessive complicated hereditary spastic paraplegia with a thin corpus callosum (HSP-TCC). The involvement of the corpus callosum was characteristic with the genu and body predominantly affected with relative sparing of the splenium. HSP-TCC is being increasingly recognized over a wider geographical area than earlier believed. We now report a case of HSP-TCC from the Indian subcontinent. [ABSTRACT FROM AUTHOR]

Red ants' sting anaphylaxis was rarely reported from India. But angioedema due to ingestion of fried 'flying red fire ants' in children is almost never reported from India and also very rarely reported from outside India. We report a case of recurrent non allergic angioedema following ingestion of fried flying red ants. [ABSTRACT FROM AUTHOR]