Milk is a great food and contains lot of calcium, protein etc, EXCEPT IRON. On it’s own, Milk is fine till the age of 4-6 months, by which time child can be exclusively breast or formula fed.
After that solid food should be introduced to give them other nutrients and Iron. Babies who continue to rely mainly on Milk, become severely Iron deficient, leading to Anaemia. We regularly see children, mainly from South-East Asia who are given milk, mostly breastmilk even after 1 year of age as the main source of food. They are pale looking and severely constipated as there is no fibre in the milk which makes our Stool.
Children should be weaned off milk by the age of 4-6 months and offered variety of food including nuts, egg, fish, pulses, rice, fruits and vegetables. THE DIET SHOULD BE BALANCED, and they should continue to have about 500 mls of milk every day. Ideally by the age of 1, they should be eating Breakfast, lunch & dinner and having a Glass of milk, morning and evening (not bottle). Bottle should be thrown away as soon as possible as it leads to lot of teeth issues.
Bedwetting or Nocturnal Enuresis is a very common condition. Upto 10% children at the age of 5 and 5% children upto the age of 10 can bed wet. Some also have accidents during the day. If the child has never been dry, we call it ‘Primary Nocturnal Enuresis. If they have been dry and then start bedwetting again, it’s called Secondary NE. The causes of both can be different.
There are two main causes of bedwetting.
- Very dilute urine due to lack of a hormone called ADH (Anti diuretic hormone). Kidneys can’t concentrate the urine and thereby kids produce a lot od very dilute urine. There may be a rare condition called Diabetes Insipidus (different from Diabetes Mellitus, which can also sometimes lead to polyuria, which is excessive urination due to sugar in the urine), in which the body can’t just concentrate urine. Sometimes Desmopressin, which helps kidneys concentrate urine, helps.
- Bladder instability or hyper irritability. As soon as the urine reached bladder from kidneys via ureter, one needs to ‘GO’ as the bladder muscles (detrusor) starts contracting. These children have to rush, otherwise it comes out, day or night. Sometimes, a medicine called Oxybutanin, helps these children by just calming the bladder down.
- Usual strategies like plenty of water during the day, none after 6-7 pm, double voiding, avoiding constipation, bladder training at weekends, bedwetting alarms at night etc, should be tried.
We sometimes do an Ultrasound scan of the renal tract to rule out any structural abnormalities, though they are rare. We also have to rule out a urine infection and Diabetes Mellitus by checking the urine.
Isolated neutropaenia is a common incidental finding in primary care. It is most often caused by acute viral infection. Benign ethnic neutropenia is common in people of black African and Afro-Caribbean ethnicity
Severity of neutropenia
Mild: 1.0-1.5×109 neutrophils/L
Moderate: 0.5-0.9×109 neutrophils/L
Severe: <0.5×109 neutrophils/L