Marijuana use has some common signs among most of its users. If your child is high on Marijuana, they might seem dizzy and have trouble walking; seem silly and giggly for no reason; have very red, bloodshot eyes; and have a hard time remembering things that just happened. When the early effects fade, over a few hours, the user can become very sleepy.

Parents should be aware of changes in their child’s behaviour, although this may be difficult with teenagers. Parents should look for withdrawal, depression, fatigue, carelessness with grooming, hostility, and deteriorating relationships with family members and friends. Besides, changes in academic performance, increased absenteeism, lost interest in sports or other favorite activities, and changes in eating or sleeping habits could be related to drug use. However, these signs may also indicate problems other than use of drugs.

In addition, parents should be aware of signs of drugs and drug paraphernalia, including pipes and rolling papers; odor on clothes and in the bedroom; use of incense and other deodorisers; use of eye drops; clothing, posters, jewelry, etc. promoting drug use.

Facts about marijuana addiction
Marijuana is often rolled in paper, so it looks similar to a cigarette and smoked. When anyone smokes, it releases harmful chemicals into your lungs. Many people do not know that marijuana smoke contains more tar and more than 400 chemicals with some cancer-causing than tobacco smoke.

* Some people addicted to marijuana have a hard time quitting and have to find treatment. Some people who use a lot of marijuana every day and then quit suddenly may have sleeping problems, anxious, irritation or nervousness without the drug. Or they may have an upset stomach or lose their appetite. These symptoms rarely last more than a few days.

* To get the maximum effect, people who smoke marijuana often inhale more deeply and hold the smoke in their lungs longer than tobacco smokers do. This increases the risk of cancer.

* Smoking marijuana irritates your lungs and has been linked to chronic cough and bronchitis. It may also make asthma worse.

* In people at high risk of developing schizophrenia, Marijuana may bring on symptoms earlier.

* Using of marijuana for a long time may make it harder to pay attention, remember things and learn.

* If you smoke Marijuana, the effects last for several hours. But the main active ingredient is stored in your fat cells and can stay in your body for days or weeks!

Dr Sat Parkash

New parents always want to take best possible care of their babies. Sometimes they cannot deliver the best care simply because they do not have experience. Very often, parents ask physician about cleaning of baby’s ear. Is it really necessary to clean the ear? How to clean them safely or how often we should do that? These are frequently asked questions asked by new parents.

Outer part of the ear can be cleaned while giving bath to the baby. It is to be done by soft, clean cotton cloth. But do not use any cotton bud or finger tips. Wax inside ear is protective and natural and rarely needed to clean it. But if there is excess accumulation of wax which impairing hearing or if there is pain, itching, tinnitus, you may need to clean them. Sometimes few drops of olive oil are put inside ear to make the wax soft, it is also now a days not recommended.

Soft clean cotton cloth to be rolled to make a wick and only that can be inserted inside ear to clean the inner aspect of the ear. Please do not insert any cotton bud inside ear, if you use cotton bud that will push dirt deep inside and moreover you may injure the membrane of ear or introduce infection. Doctors may use medicine to soften the hard wax but do not use these by yourself. Consulting a pediatrician will dictate you what to do and what not to do. Take care of your sweet baby.

Prof M Karim Khan

The death of a newborn is a very painful experience for the mothers who have taken the ordeal of pregnancy for 9 months or so. The causes of newborn death in Bangladesh are manifold like poverty, lack of medical check up, home delivery etc.

Bangladesh has one of the highest newborn deaths in the world. It is about 37 per thousand live births per year. Nearly 4 million babies die after delivery each year throughout the world out of which 98% die in developing countries including Bangladesh. Out of total deaths 45% die within first four weeks of life and 30% die within one year.

In order to decrease this huge number of deaths every year, a pragmatic coordinated approach is needed by all concerned, it is not possible for the government to solve this gigantic problem all alone, both government and non governmental organisations should make every effort in a combined way to mitigate this human tragedy.

MDG-5 is to reduce child mortality by two thirrd by the year 2015. It is heartening to note that the under 5 mortality in Bangladesh has come down significantly in the last decade, from 88 to 66 per 1000 live births per year.

But the main contributing factor affecting the high under-5 mortality is the bulk of the new born deaths that occur within the first 28 days of life. So it is imperative that we need to address the problems that affect the new born deaths more seriously in a coordinated way at the grass root level i.e. in the non urban areas, where a large proportion of deliveries take place in the home setting, compounded by meager medical facilities and man power within the vicinity.

We all know that the main cause of newborn death in Bangladesh is home delivery, lack of trained personals and medical facilities, delayed referral, transportation problem etc. To address these problems the most important thing is to produce skilled birth attendants (SBA) who will be trained to do the following things:

1) Conduct normal deliveries
2) Identify the danger signs
3) Quick referral and transportation to higher centers

At the same time we should put emphasis on:
1) Improve obstetric and neonatal care at thana and district level
2) Control population boom
3) Compulsory birth and marriage registration
4) Improve women education
In a country like Bangladesh institutional delivery is not possible, we need to utilise our human resources by producing more SBA’s in order to bring down neonatal mortality.

This is a huge task which needs to be jointly addressed by all.

A most common primary intraocular (inside the eyes) malignancy of childhood arises from primitive retinal cells of the eye. About 90% cases are diagnosed less than 3 years of age.

A common presentation is white pupillary reflex, some with squint and some with inflammation of the eye. In our country, most of the patients present with advance stage when the tumor extends externally.

In advance stage though the chance of saving eye is less but when other eye is examined and if a small lesion is detected, can be treated by focal therapy (Photocoagulation with Laser). Early detected is very important in that respect.

When treating retinoblastoma, it is first and foremost important to understand that it is a malignancy. When the disease is contained within the eye, survival rates exceed 95% in the western world.

However with extra ocular spread survival rates decreases to under 50%. Therefore, in deciding on a treatment strategy, the first goal must be preservation of life then preservation of eye and finally preservation of vision.

The modern management of intraocular retinoblastoma currently incorporates a combination of different treatment modalities including chemotherapy, photocoagulation with Laser, cryotherapy, radiation therapy and surgery like enucleation (removal of globe).

Metastatic disease is managed with intensive chemotherapy, radiation and bone marrow transplantation. Among all of this treatment options — the best, cheap and less hazardous option is photo-coagulation with Diode Laser if tumor is detected in early stage with a very small lesion. If laser is applied, eye can be saved, even useful vision can be preserved.

The treatment of children with retinoblastoma requires a team approach including an ocular oncologist, pediatric ophthalmologist, pediatric oncologist and radiation oncologist.

The chemo, radiation therapies are very expensive. Comparing all modalities, the photocoagulation therapy with Diode Laser is cheaper. This facility is available at the government set-up in Sylhet MAG Osmani Medical College Hospital. The facility is available on courtesy of WHO. Expert manpower is available there and moreover the service is offered at free of cost.

The facility of laser photocoagulation can save valuable life of a child and also rescue a family from a danger point. Children with intraocular retinoblastoma who have access to modern medical care have a very good prognosis for survival.

Children are exposed to serious health risks from environmental hazards. Over 40 percent of the global burden of disease attributed to environmental factors falls on children below five years of age, who account for only about 10 percent of the world’s population.

Environmental risk factors often act in concert, and their effects are exacerbated by adverse social and economic conditions, particularly conflict, poverty and malnutrition. Timely action needs to be taken to allow them to grow up and develop in good health, and to contribute to economic and social development.

Polluted indoor and outdoor air, contaminated water, lack of adequate sanitation, toxic hazards, disease vectors, ultraviolet radiation and degraded ecosystems are all important environmental risk factors for children and in most cases for their mothers as well.

Particularly in developing countries like Bangladesh, environmental hazards and pollution are a major contributor to childhood deaths, illnesses and disability from acute respiratory disease, diarrhoeal diseases, physical injuries, poisonings, insect-borne diseases and perinatal infections.

Childhood death and illness from causes such as poverty and malnutrition are also associated with unsustainable patterns of development and degraded urban or rural environments.

Major environment-related killers in children under five years of age

Diarrhoea kills an estimated 1.6 million children each year, caused mainly by unsafe water and poor sanitation.

Indoor air pollution associated with the still-widespread use of biomass fuels kills nearly one million children annually, mostly as a result of acute respiratory infections. Mothers, in charge of cooking or resting close to the hearth after having given birth, are most at risk of developing chronic respiratory disease.

Malaria, which may be exacerbated as a result of poor water management and storage, inadequate housing, deforestation and loss of biodiversity, kills an estimated one million children under five annually, mostly in Africa.

Unintentional physical injuries, which may be related to household or community environmental hazards, kill nearly 300000 children annually: 60000 are attributed to drowning, 40000 to fires, 16000 to falls, 16000 to poisonings, 50000 to road traffic incidents and over 100000 are due to other unintentional injuries

Health-damaging exposure to environmental risks can also begin before birth. Lead in air, mercury in food and other chemicals can result in long-term, often irreversible effects, such as infertility, miscarriage, and birth defects.

Women’s exposure to pesticides, solvents and persistent organic pollutants may potentially affect the health of the fetus. Additionally, while the overall benefits of breastfeeding are recognised, the health of the newborn may be affected by high levels of contaminants in breast milk. Small children, whose bodies are rapidly developing, are particularly susceptible — and in some instances the health impacts may only emerge later in life.

Furthermore, children as young as five years old sometimes work in hazardous settings. Pregnant women living and working in hazardous environments and poor mothers and their children are at a higher risk, as they are exposed to the most degraded environments, are often unaware of the health implications, and lack access to information on potential solutions.

WHO recognises the need to educate and train health care providers at all levels in the prevention, diagnosis and management of children’s diseases linked to environmental risk factors. Efforts are undertaken to enable those “in the front line”, the health professionals dealing with children and adolescents’ health, to recognise, assess and prevent diseases linked to, or triggered by environmental factors.

With low-cost solutions for environment and health problems can be applied in many cases. For instance, simple filtration and disinfection of water at the household level dramatically improves the microbial quality of water, and reduces the risk of diarrhoeal disease at low cost. Improved stoves reduce exposures to indoor air pollution. Better storage and safe use of chemicals at community level reduces exposures to toxic chemicals, especially among toddlers, who explore, touch and taste the products found at home.

Hygiene and sanitation

Washing hands with soap before food preparation, before meals and after defecating significantly reduces the risk of diarrhoeal disease.

Air pollution

Good ventilation in the home, clean fuels and improved cooking stoves decrease indoor air pollution and the exacerbation and development of acute respiratory infections.

Disease vectors

As children usually go to bed earlier than adults at the time mosquitoes become active, the use of insecticide-treated mosquito nets and the screening of windows, doors and eaves provide a very effective means of protecting them against malaria.

Chemical hazards

Ensure safe storage, packaging, use and clear labelling of cleaners, fuels, solvents, pesticides and other chemicals used at home and in schools.

Children are our future, numbering over 2.3 billion worldwide and representing boundless potential. Child survival and development hinge on basic needs to support life; among these, a safe, healthy and clean environment is fundamental.

Dr Md Rajib Hossain

Childlessness may be a tragedy for the married couple and a of marital upset, personal unhappiness and ill health. Infertility often plays a major role in breaking the marital bridge and important cause of separation between partners.

According to the experts, infertility is considered when a couple is unable to achieve conception after one year of unprotected coitus. If you have been trying to conceive for more than a year, there is a chance that something may be interfering with your efforts to have a child.

Infertility may be due to a single cause in either you or your partner or a combination of factors that may prevent a pregnancy from occurring or continuing.

In any series of infertile marriage, the main etiological factor is found in the female in about 40 percent of cases; about 35 percent of the husbands concerned have some degree of infertility. In 10-20 per cent of cases a combination of factors operates and rest has unexplained infertility.

In majority of cases female infertility is due to the obstruction in fallopian tube, loss of motility of tube, polycystic ovarian syndrome diabetes, thyroid disorder etc. Whereas in case of male, factor implies a lack of sufficient numbers of competent sperm, resulting in failure to fertilise the normal ovum. Other important causes are varicocele, genetic predisposition, occupational and environmental factor.

Sexual inadequacy is one of the important factors contributing to infertility. It is important to realise that the age of a woman is a factor to be considered and there should not be any delay in offering suitable treatment for the couple.

Over the past decades, there has been much improvement in the treatment of both infertile female as well as the male. Assisted conception is one of them. It is the facilitation of natural conception by some form of scientific interventions.

In Bangladesh assisted reproduction technology has become a promising one. Technologies available in the country include IUI (Intrauterine Insemination), IVF (In Vitro Fertilisation) and ICSI (Intra Cytoplasmic Sperm Injection).

In vitro fertilisation (IVF) is the most effective ART technique. IVF involves retrieving mature eggs from a woman, fertilising them with a man’s sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilisation. IVF often is recommended when both fallopian tubes are blocked. It is also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor infertility, male factor infertility and ovulation disorders.

Intracytoplasmic sperm injection (ICSI) technique consists of a microscopic technique (micro-manipulation) in which a single sperm is injected directly into an egg to achieve fertilisation in conjunction with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilisation.

IUI technique attempts to assist the implantation of the embryo into the lining of the uterus. With this advancement it is possible to treat the vast majority of subfertile couple successfully and give them the child they so desire.

Many parents often wonder why their babies drool or why they drool more than some of others? Is there anything that can be done for these babies? Is excessive drooling harmful or is it just a symptom of other clinical conditions?

Drooling means saliva coming out from mouth. Typically infants do not have the ability to swallow saliva efficiently. Until their muscles in the head, face, mouth, jaw and neck develop, infants tend to drool or salivate.

By the time a baby is between 4 to 6 months old they gain better head and neck control, and they can handle better their secretions. At this time, parents expect their babies’ drooling to diminish, but unfortunately it tends to continue due to teething. Six months is the average age for the first tooth eruption. Care for drooling due to teething includes good oral hygiene. Take care to avoid choking when a child uses any of these objects.

Besides teething, excess salivation or drooling may be due to helminthic infestations. In that case, children have to take anti-helmihthic drugs.

Fungal infection is other major cause of drooling. In such case, nystatin drop or miconazole oral gel is the solution.

Other causes of drooling includes nausea, mouth sores, an abnormality of the airway, protruded tongue, pain in the throat or certain infections. Cerebral palsy or developmental delay is one of the major cause of drooling.

Occasionally, a child does not develop muscle tone and coordination with age as expected. Instead they develop hypotonia or low muscle tone which results in symptoms such as delayed speech development, persistent drooling, problems in feeding, difficulty with the introduction of new foods and difficulty drinking from a cup. Children with these symptoms should be evaluated by their doctors.

Parents can help their baby develop and improve his oral motor skills by allowing him to suck. All babies have a natural need to suck during the first 6 months of life and parents can help satisfy this need through the use of a pacifier. Some parents are cautious about introducing a pacifier because they are afraid that it will become a habit. But it will not become a habit if you discontinue the pacifier at 6 months of age when an infant naturally overcomes the need to suck.

If baby develop a sudden onset of drooling or excess salivation along with difficulty feeding, labored breathing, stridor (a high pitched inspiratory sound), changes in the sound of his cry, a weak cry, insufficient weight gain, irritability, fever, mouth sores or developmental delay, this would call for an evaluation by child specialist as soon as possible, although these occur rarely.

It is normal for newborns to drool. If a baby is seemingly healthy like eating well, gaining weight, free from respiratory symptoms and without fever there is no need to be concerned.

Do you know when to be concerned about your child’s weight? Of course, all children gain weight as they grow older. But extra pounds — more than what is needed to support their growth and development — can lead to childhood obesity. Childhood obesity is a serious medical condition that affects children and adolescents.

It occurs when a child is well above the normal weight for his or her age and height. Childhood obesity is particularly troubling because the extra pounds often start kids on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol.

Causes
Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little.

Children, unlike adults, need extra nutrients and calories to fuel their growth and development. But children who eat more calories than needed gain weight beyond what is required to support their growing bodies.

Risk factors
Many factors — usually working in combination — increase your child’s risk of becoming overweight like diet, inactivity, genetics, psychological factors, family factors, socioeconomic factors and so on.

When to seek medical advice
Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know just by looking at your child if his or her weight is a health concern.

If you are worried that your child is putting on too much weight, talk to a physician. S/he will evaluate if your child’s weight is in an unhealthy range.

Complications
Obese children can develop serious health problems, such as diabetes and heart disease, often carrying these conditions into an obese adulthood.

Overweight children are at higher risk of developing Type 2 diabetes, Metabolic syndrome, High blood pressure, Asthma and other respiratory problems, Sleep disorders, Liver disease, Early puberty or menarche, Eating disorders, Skin infections

The social and emotional fallout also can hurt your child, especially resulted in low self-esteem and bullying, behavior and learning problems and depression.

Healthy eating
Parents are the ones who buy the food, cook the food and decide where the food is eaten. Even small changes can make a big difference in your child’s health.

* When buying groceries, choose fruits and vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. And never use food as a reward or punishment.

* Limit sweetened beverages, including those containing fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods.

* Sit down together for family meals. Make it an event — a time to share news and tell stories. Discourage eating in front of a screen, such as a television, computer or video game. This leads to fast eating and lowered awareness of how much you are eating.

* Limit the number of times you eat out, especially at fast-food restaurants. Many of the menu options are high in fat and calories.

Physical activity
A critical component of weight loss, especially for children, is physical activity. It not only burns calories but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults.

To increase your child’s activity level:

* Limit recreational screen time to fewer than two hours a day.

* Emphasise activity, not exercise.

* Find activities your child likes to do.

* If you want an active child, be active yourself.

* Vary the activities.

Prevention
Whether your child is at risk of becoming overweight or currently at a healthy weight, you can take proactive measures to get or keep things on the right track.

* Schedule yearly well-child visits. Take your child to the doctor for well-child checkups at least once a year.

* Set a good example. Make sure you eat healthy foods and exercise regularly to maintain your weight. Then, invite your child to join you.

* Avoid food-related power struggles with your child.

* Emphasise the positive. Encourage a healthy lifestyle by highlighting the positive — the fun of playing outside or the variety of fresh fruit you can get year-round, for example.

* Be patient. Many overweight children grow into their extra pounds as they get taller. Realise, too, that an intense focus on your child’s eating habits and weight can easily backfire, leading a child to overeat even more, or possibly making him or her more prone to developing an eating disorder.

Coping and support
Parents play a crucial role in helping children who are obese feel loved and in control of their weight. Take advantage of every opportunity to build your child’s self-esteem.

Consider the following advice:

* Find reasons to praise your child’s efforts.

* Talk to your child about his or her feelings. Help your child find ways to deal with his or her emotions that don’t involve eating.

* Help your child focus on positive goals.

Is your child free from polio? Polio (also called poliomyelitis) is a contagious, historically devastating disease that has plagued humans since ancient times. It is catastrophic for the individual and heartbreaking for the family.

Most polio victims are children under five years of age. A portion of the victims die or become permanently crippled. It is the main cause of childhood paralysis in South-East Asia. But only two drops of polio vaccine can prevent this serious disease.

In order to eliminate polio and create awareness about polio, National Immunisation Day will be observed in Bangladesh today. On this day children over 5 years of age will receive oral polio vaccine.

Polio virus can strike at any age, but affects mainly children under five. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.

Once established in the intestines, poliovirus can enter the blood stream and invade the central nervous system — spreading along nerve fibres. As it multiplies, the virus destroys nerve cells (motor neurons) which activate muscles. These nerve cells cannot be regenerated and the affected muscles no longer function. The muscles of the legs are affected more often than the arm muscles. The limb becomes floppy and lifeless – a condition known as acute flaccid paralysis (AFP). More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the motor neurons of the brain stem — reducing breathing capacity and causing difficulty in swallowing and speaking. Without respiratory support, bulbar polio can result in death.

Amongst those paralysed, 5%-10% die when their breathing muscles become immobilised. Although polio paralysis is the most visible sign of polio infection, fewer than 1% of polio infections ever result in paralysis. Poliovirus can spread widely before cases of paralysis are seen.

As most people infected with poliovirus have no signs of illness, they are never aware they have been infected. After initial infection with poliovirus, the virus is shed intermittently in faeces (excrement) for several weeks. During that time, polio can spread rapidly through the community Poliovirus is spread through person-to-person, fecal-oral contact. Where hygiene and sanitation are poor, young children are especially at risk.

Young children who are not yet toilet-trained are a ready source of transmission, regardless of their environment. Polio can be spread when food or drink is contaminated by faeces. There is also evidence that flies can passively transfer poliovirus from faeces to food.

There is no cure for polio, it can only be prevented through immunisation. Polio vaccine, given multiple times, almost always protects a child for life. Full immunisation will markedly reduce an individual’s risk of developing paralytic polio. Full immunisation will protect most people, however individuals can still contract the disease due to the failure of some individuals to respond to the vaccine.

Dr Abu Sayeed Shimul…