Aditi, a class 4 student was good at studies. She could grasp things quickly and remember them. Her teachers and parents were quite happy with her progress. However, as the mode of education became virtual, her teacher observed that Aditi was on occasions staring blankly at the screen before returning to normal. Her teacher attributed this change in behaviour to the teaching method from offline to online. Soon, her mother also noticed that Aditi was not paying attention to the class and staring blankly at the wall or screen. Although Aditi would become normal within a few seconds, her parents noted that she could not recall some of the lessons from school and look confused when asked about certain things. Thinking that Aditi is daydreaming and losing interest in her studies, her parents decided to consult a paediatrician. After speaking to Aditi and the parents, the Paediatrician was concerned that Aditi’s

symptoms suggested more than daydreaming but were, in fact, suggestive of absence seizures. An EEG was requested which confirmed the diagnosis and Aditi was commenced on the right medication. Absence seizures are sudden episodes of a short blank out which often affects children between the age of 4 to 14. Kids suffering from absence seizures may stare at blank space and return to a normal level of alertness within few seconds. In most cases, absence seizure is mistaken with daydreaming or lack of attention and there is a high chance of ignoring the symptoms. In some kids, absence seizures may take months or years to get recognised.

Symptoms of absence seizure

• Appearing motionless
• Staring blankly at walls or other objects
• Lip smacking
• Fluttering eyelids
• Abruptly stopping a conversation
• Sudden hand movements

Children suffering from absence seizures may show a lapse in attention for 10-20 seconds.
However, once they become normal, they do not remember the incident. Few children may
face many seizure episodes on a daily basis which may not get recognised. This will affect
the learning and daily activities of kids.

Causes of an absence seizure:

These types of seizures are caused by abnormal electrical impulses from nerve cells in the brain. In many cases, it occurs due to genetic predisposition. Differentiating between absence seizures and daydreaming
There are many key differences between daydreaming and absence seizures. We have listed some of the major ones below:

Absence seizures:

• They occur suddenly, without any warning.
• Unlike daydreaming, this absence of seizures cannot be interrupted.
• An episode of absence seizures ends on its own in about 10-20 seconds.
• The child stares blankly and stop talking in the middle of a speech
• Child’s inability to pay attention for few seconds
• The eyes may turn upwards and eyelids flutter.

Daydreaming:

• This is more often found when the child is bored a lot. For instance, a child daydreams in his long class at school.
• Daydreaming comes on slowly and can be interrupted.
• Daydreaming usually goes till the child is interrupted like the teacher or his friends noticing him and calls for his attention.

Do not mistake absence seizures with other problems:

Correct diagnosis is crucial as absence seizures are often mistaken with other types of seizures. A specialist might suggest an electroencephalogram (EEG) as it is one of the safe and painless ways to diagnose absence seizures. The child will also be given anti-seizure medications.

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Shreya, an 8-year-old girl, began complaining about stomach aches one morning. As Shreya did not like online classes, Shreya’s mother thought her daughter was making excuses and ignored the complaint. When Shreya began crying due to intense pain, her mother thought it could be a case of indigestion and she resorted to home remedies to treat it. As the Covid cases were increasing during that time, her mother was hesitant to take the child to the hospital. But the pain increased, even more, the next day and Shreya began vomiting and she even developed a slight fever. Concerned about her daughter’s condition, she immediately fixed an online appointment with us. During the online consultation, Shreya’s mother informed us about the stomach ache and vomiting. As kids mostly complain about these symptoms, we asked the mother to press Shreya’s abdomen at some points and observe the way she responds to it. After a careful inspection, when she pressed the lower abdomen of the child, Shreya began to experience severe pain and the doctor had a strong feeling that the pain was due to appendicitis. Upon our advice, the child was immediately brought to the hospital where we performed surgery on time and removed her appendix. It certainly was a brave act by Shreya’s mother to be attentive and careful at the same time and it was because of her mindfulness that we were able to detect the problem on time and treat it successfully.
In most incidents, the initial symptoms of appendicitis such as stomach ache, fever, and loss of appetite are usually confused with other ailments. Also, in most cases, parents may not take such complaints from their kids seriously, as this keeps happening frequently. Therefore, diagnosing appendicitis in children may become difficult. Appendicitis starts as pain around the child’s belly button and spreads to other parts of the abdomen especially the right lower area. This occurs when the inside of the appendix is blocked by something, leading to an infection. The blockage can happen due to stool, parasites, or a twist in the appendix as well. The appendix then gets sore and inflamed. and bacteria in the appendix begin to increase quickly. As the soreness and swelling get worse, the blood supply to the appendix is cut off.

Symptoms of Appendicitis in Children
Each child may experience different symptoms. Below are few common symptoms of
appendicitis:
• Loss of appetite
• Fever
• Vomiting
• Nausea

• Elevated white blood cell count
• Difficulty in passing gas or stool
• Abdominal swelling
• Constipation or diarrhea
Appendicitis can occur at any age although most commonly seen in children in the age group of 8 to 16 years. In younger children, the symptoms may be a little nonspecific and it is important to maintain a high index of suspicion to make an early diagnosis. If a kid experiences noticeable tummy pain when moving, coughing, sneezing, or touching the abdomen, it is important for the parents to immediately consult the doctor. For babies younger than 2 years of age, appendicitis can lead to vomiting, a bloated abdomen, and fever, though diarrhea is not very uncommon.
Is appendicitis serious?
Appendicitis is a serious medical condition that needs to be assessed, investigated, and managed appropriately to avoid complications such as a perforated appendix or collection of pus.
When should you consider stomach ache seriously among kids?
In case your kid experiences any of the following signs along with stomach aches, make sure to schedule an appointment with the doctor to understand the cause of pain your child is going through.
• Recurrent stomach pain with no clear cause
• Blood in stool
• Constipation that is becoming frequent
• Diarrhoea
• Pain when urinating
• Fever and cough
• Unexplained weight loss
• Pain that is waking your kid up from sleep or begins to affect their daily lives Symptoms like these certainly need an urgent assessment. In case you think your kid has appendicitis, book an online consultation, see the doctor or go to the emergency room right away.

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The COVID lockdown has turned our homes into a school, office and restaurant all at the same time. Our lives which were perfectly boxed into morning rush, school time, office time, going out time, family time has all just merged into one blur.

While on one hand we try to do our best to keep our kids safe from the dangers outside by keeping them indoors, constantly sanitising, handwashing, on the other hand, we have to suddenly balance a multitude of roles all at the same time -cooking , cleaning, teaching, entertaining, office calls , keeping kids out of the way during the office calls , being the referee in the kids fights to list a few.

In all this it is sometimes inevitable that the little one escapes from our watchful eyes and gets into an accident.

• Climb things they shouldn’t
• Pull things over
• Open a cabinet and get their little fingers stuck
• Running around at home and slipping on the tiled floor
• Use the bed as a trampoline and bounce off
• Find medicine (colourful pills) and just decide to try them out
• Run into the bathroom and run the tap: slipping/ hot water scalds

Dr. Suruchi Goyal, Consultant Pediatric and Pediatric Endocrinology, Columbia Asia Hospital Whitefield explains that she got the idea while she was in the middle of a teleconsulting from home and when her 10-year-old decided to convert the living room into a board zone and started skate boarding. Just a glance up from the laptop set her mind racing to the injuries that could happen: a broken bone, a cut lip, a head injury and in a split-second doctor was beside her child to get her off the skateboard and avert the crisis!

With children being cooped up indoors, their minds appear to be coming up with ingenious ways of entertainment, Dr. Suruchi Goyal shares few things that you could do to keep them safe and entertained at the same time.

1. Doors and windows seem to attract children the most: robust stoppers so that their fingers don’t get trapped when they slam shut. At the same time for homes on higher floors, child proofing of the locks on windows with no grills is highly recommended. Doors to terraces must remain locked at all times except when the child is taken up with an adult.
2. All medicines should be in a locked medicine cabinet.
3. Cleaning liquids are generally stored in the under-sink cabinet in most houses, keep it locked, they are too bright and smell fantastic, enough to incite the curiosity of the adventurous toddler.
4. Large appliances and furniture like television, cupboards etc must be secured to the wall or placed on stands made for them. It doesn’t take much for a child to pull them on themselves in an attempt to climb on them.
5. Trip hazards: Toys, slippery carpets etc are all trip hazards leading to head injuries,cuts on the lips etc.
6. Drawers should be child proofed
7. Corners need to secured too: it is just too easy for a toddler to bump into them or 2 fighting children to be hurt by them leading to cuts and lacerations.
8. Bathrooms and kitchens especially hot liquids and surfaces should be out of their reach.

These are few ways that our houses can be secured to prevent our little ones from getting injured whilst spending more time indoors.

How much ever we try it is impossible to be 100% secure and accidents tend to happen. In case an injury does happen, it is best to get them assessed in the hospital by your child’s doctor or in case of severe injuries attend the emergency room for assessment.

Dr. Sandhya B, Consultant- Plastic Surgery, Columbia Asia Hospital Whitefieldshares the emergency tips for parents while kids get injured at home. Scalds burns due to spillage of hot water, milk or oil first needs to be cooled immediately with running water from a tap for 4-5 minutes. Do not apply ice on the burnt area. Likewise, do not apply toothpaste, ghee, honey on the affected area and do not break the small blisters at home.  To soothe the area, you can apply petroleum jelly or aloe Vera gel. Cover the affected area with a clean gauze or bandage and seek medical advice. Most of the scalds are superficial burns which will heal in 10-12 days with appropriate topical antiseptics prescribed by your doctor. However large areas of burns in your child may need hospitalisation and collagen dressings to facilitate healing and prevent complications.

For gashes and bruises rinse the wound with water and apply ice to stop bleeding. Gently apply firm direct pressure on the wound using a gauze or clean towel over the cut until the bleeding stops.  Small superficial cuts on the face can be sealed with steristrips or tissue glue in the emergency room.  large cuts or deeper cuts with persistent bleed may need suturing of the wound. Another common injury encountered in children are the finger nail bed injuries due to jammed doors or draws. Cover the broken finger with a clean gauze and rush to the emergency room. These injuries can be quite significant sometimes necessitating an emergency surgery to salvage a partially amputated finger.

Understandably it is worrying to take your child into the hospital when all the advice around you is to keep them indoors and the hospital is the last place you want to be. Remember hospitals will take the adequate precautions to attend to your child and keep them safe and get them home as soon as possible.

Inputs by Dr. Suruchi Goyal, Consultant Pediatric and Pediatric Endocrinology& Dr. Sandhya B, Consultant- Plastic Surgery, Columbia Asia Hospital Whitefield

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