Bone and Joint infections are generally termed as Musculoskeletal disorders. Musculoskeletal disorders are any disease that affects the joints, ligaments, nerves, muscles, and bones. These are commonly caused due to the infection, injury, or it can be inherited and develop as a part of a child’s growth. At times they occur for no known reason at all.A child’s bones grow continually and thus reshape them after every few years. The old bone tissue is gradually replaced by new bone tissue making the difference. Most of the disorders affecting the bones of a child occur in a growing child musculoskeletal system. These disorders may get worse or better as the child grows.Musculoskeletal conditions in children and teenagers are becoming more common now. They require conscious observation and understanding to avoid and treat their symptoms. This World Pediatric Bone and Joint Day (October 19th) let us have awareness about the impact of musculoskeletal conditions in children. Common Bone and Joint Infections observed in children  Here is the list of common bone and joint infections seen in children: Rheumatoid arthritis (RA) Post-Streptococcal Reactive Arthritis (PSRA) Septic Arthritis (Joint Infection) Bone fractures Muscular dystrophy Developmental dysplasia of the hip Tendinitis Osteoporosis (bone infection) Symptoms to recognise Musculoskeletal disorders As children cannot communicate with the issues directly, it is important for the parents to catch up their signs. The following are the common symptoms a child tend to show while going through musculoskeletal disorders.  Fever and Warmth  Redness near the infected area Pains, Swellings Infants may show irritable and lethargic behaviour Refuse to eat, or vomit Limited movement of the infected area  Treatment Procedures available for Bone and Joint Infections in Children A timely diagnosis plays a crucial role in the better treatment process for children. If ignored or not recognised for long, these infections tend to evolve into chronic disorders. The following mentioned procedures have proven to show good results for the immediate diagnosis.  Antibiotics to control the infection and spread to other parts of the body.  Medication to help manage pain and swelling of the infected area without further damage  In case of severe damage, surgery can help clean out the affected areas in and around the affected bones.  It is estimated that nearly 48% of adults and 10% of children have a musculoskeletal condition. However, the myth that children do not contract musculoskeletal disorders has to be removed. Diagnosing and treating them timely will help you save them from severe health conditions in future.   *Information shared here is for general purpose. Please take doctors’ advice before taking any decision.

Coughing and choking is a common event causing respiratory complications in children under the age of 3-4 years. Children under the age of 2 years are particularly vulnerable to aspiration of foreign bodies. Children with neurodevelopmental abnormalities are also at risk. This predisposition is due to multiple reasons. Young infants have varying developmental abilities and try to explore surroundings by mouth. Young children have poor ability to grind and swallow food particles. They have small airways which are more prone for obstruction. Also, the force of cough in young children is less effective in dislodging foreign bodies from airways compared to older children/adults. The most commonly ingested foreign bodies include nuts, seeds and  vegetables. Aspirated inorganic foreign bodies include coins, pins, Jewellery and toys. SYMPTOMS The symptoms of foreign body aspiration depend on the age of the child,  characteristics of the foreign body and duration. The foreign body can lodge and obstruct upper airways (larynx/trachea- less common) or may pass on to lower airways (bronchi-more common). The symptoms can range from asymptomatic state to severe breathing difficulty. These include:  Initial coughing , choking and gagging Sudden onset difficulty in breathing following such event  Noisy breathing (stridor) Inability to speak or cough If delayed presentation  Noisy breathing Breathing difficulty Recurrent pneumonia Blood in sputum DIAGNOSIS History is the most important clue in establishing diagnosis A negative history may be misleading; Unwitnessed events do happen Always enquire about the presence of small objects in the surroundings of the child and about feeding habits Physical examination may reveal hyperinflation of chest or loss of lung volume, decreased breath sounds on involved side and wheezing Chest radiographs may help in diagnosis Radio-opaque foreign bodies are visible; However, they are less common Radiolucent foreign bodies are not visible Findings suggestive of foreign body aspiration include Hyperlucency of involved lung due to partial obstruction of airway Collapse of the lung due to complete obstruction of airway Mediastinal shift Expiratory films may be helpful in revealing trapped air CT scan may be considered in occasional cases with diagnostic dilemma or  prolonged history In cases where history and examination is not conclusive, flexible bronchoscopy may help in establishing the diagnosis. COMPLICATIONS OF MISSED FOREIGN BODY Recurrent or persistent pneumonia Chronic cough Hemoptysis Bronchiectasis (Abnormal dilatation of airways) Lung fibrosis TREATMENT In children with near total obstruction from upper airway, prompt removal by five back blows and chest thrusts in young infants or Heimlich maneuver in older children will be lifesaving Prompt rigid bronchoscopy and removal of the foreign body is recommended  Flexible bronchoscopic removal also can be done by experienced personnel Complications of bronchoscopic removal of foreign body include pneumothorax, bronchospasm, bleeding, desaturation and airway edema; These are rare less common PREVENTION Educating parents and caregivers regarding prevention strategies to prevent such events in young children  Avoid giving foods at high risk of choking to young children Training children to chew slowly, eat while seated and to avoid running or playing during eating Age appropriate toys should be used and small toys or toys that are easily  disassembled should be avoided 

Asthma in children Asthma is a chronic inflammatory disease of airways. It is a heterogenous disease with various phenotypes which include – allergic asthma, non-allergic asthma, adult -onset asthma and asthma with obesity.  SYMPTOMS Children with asthma have repeated episodes of respiratory symptoms including Cough  Chest tightness Noisy breathing (wheezing) Shortness of breath / breathing difficulty 2. These symptoms change with time and in severity also  3. Symptoms are more at night or in the early morning  4. Episodes are often triggered by  Viral infections Seasonal change Exposure to cold Exercise Allergen exposure Irritants  5. These episodes may start in early childhood or in older children also 6. They often have multiple such episodes with frequent hospital visits and respond to inhalation treatment 7.They may have associated allergies including eczema, allergic rhinitis or food allergy 8. There may be family history of asthma or allergy  DIAGNOSIS Characteristic respiratory symptoms suggestive of asthma  Low forced expiratory volume in one second (FEV1) with spirometry (Lung function tests) Low FEV1/FVC ratio (FVC-Forced vital capacity) with spirometry Excessive variability in lung function  – Measured by bronchodilator reversibility or average diurnal variability  Few children may need other test like allergic testing, CXR as per clinical condition CONSEQUENCES IF NOT TREATED ADEQUATELY Recurrent respiratory symptoms requiring frequent hospital visit / hospitalization Can develop life threatening asthma attack Impaired growth  Loss of school because of frequent respiratory exacerbations Poor lung growth and risk for chronic lung disease because of recurrent respiratory symptoms Economic burden MANAGEMENT  Prevention – Avoid triggering agents Precautions during season change Avoid contact with persons with acute respiratory infections Avoid cold air/food Avoid known allergens  Inhaled medications As the main pathology is in airways, inhaled medications are the primary treatment modality Two types of medications are available – one for acute symptom relief and other for controlling ongoing inflammation of airways  The choice of drugs depends on the age of the child and frequency of symptoms The drugs can be taken either by nebulization or by Metered-Dose Inhaler (MDI) MDI treatment is preferred in the long term as they are safe, effective and can be used outside home settings as well Reliever medications For acute symptom relief – Bronchodilators which increase the size of the airways and provide immediate symptom relief; Action is short lasting Include salbutamol and Levosalbutamol Controller medications Inhaled steroids which control the ongoing inflammation of airways and decrease the frequency of asthma attacks Include – Budecort, Beclomethasone, Fluticasone, Ciclesonide Allergic rhinitis Antihistamines – cetirizine, fexofenadine  Intranasal steroids – Mometasone, budesonide and beclomethasone Other medications Anticholinergics – Ipratropium, tiotropium Leukotriene receptor antagonist (LTRA) – Montelukast and Zafirlukast Long acting beta agonists (LABA) – Salmeterol and Formoterol Oral corticosteroids Omalizumab and other biological agents  POOR SYMPTOM CONTROL DESPITE THERAPY Look for proper technique; Use of spacer in every child and mask in younger children Compliance to therapy – check the number of canisters used with time, doses left in the canister Identifiable triggers Comorbidities – Obesity, rhinitis, rhinosinusitis and  gastroesophageal reflux Review the diagnosis of asthma  ACUTE ASTHMA ATTACK Every child should have a written asthma action plan Identified by increased respiratory symptoms including cough, chest tightness, difficulty in breathing with viral infections or exposure to trigger Give reliever medication every 6 hourly at home; Continue controller medication Supportive treatment including paracetamol for fever and antihistamines for running nose If improvement in symptoms, give reliever medication for 1-2 days and stop If there is no improvement in symptoms in 48 -72hours or if any further worsening, visit a nearby hospital immediately and exacerbation treated as per the severity of symptoms Most children with asthma do well with inhaled therapy if compliance is good; Only few children may need advanced therapies

Leprosy, also known as Hanson’s disease, is an infectious disease that causes disfiguring skin sores and nerve damage in legs, arms, and skin areas. It is an infectious disease caused by the spread of Mycobacterium leprae. Although leprosy is usually seen in adults, detecting new cases in children reveals bacteria’s active circulation. Pediatric Leprosy Children are believed to be the most vulnerable group to infection with Mycobacterium leprae, bacteria responsible for leprosy. This is highly due to their immature or nascent immunity to the bacteria and exposure to interfamilial contacts. The child proportion among newly detected leprosy cases is a strong indicator of continued transmission of the disease and requires high awareness.  Know everything about pediatric leprosy, its causes, and prevention & treatment measures to curb the spread.  Possible sources of infection in children The exact mode of transmission for the spread of leprosy is still not proven. However, the infection by nasal droplets and direct contact with skin are best known to be the major routes for the transmission. Also, one of the most significant sources of infection in infants is through familial contact with leprosy. The risk of developing leprosy in an infant is four times when there is neighbourhood contact. Yet, this risk increases to nine times when the contact is intrafamilial or approximately too near.  But, there are cases where there is no leprosy contact anywhere near the infant and still affected by it. Thus, the exact reason or the source of transmission can not be decided.  Prevention through nutrition  Leprosy is mostly is seen in countries where the nutrition requirements are low. It is for the same reason that leprosy is also called the disease of poverty. Healthy and proper nutrition during pregnancy and after birth will help you prevent pediatric leprosy. Including superfoods like Broccoli, wheat germ, spinach, fish, coconut, and soy foods will help prevent leprosy. These superfoods contain all essential nutrients, proteins, vitamins, immune-stimulating polysaccharides, antioxidants, trace elements that will slow the spread of bacillus bacteria.  Leprosy symptoms  Leprosy primarily affects the skin organ and nerves outside the brain and spinal cord. These nerves are called the peripheral nerves, which play an active role in sensation, movement and motor coordination. It also extends to strike eyes and the thin tissue lining the inside of the nose on the longer run. The significant symptom of leprosy is disfiguring skin sores, bumps, or lumps that don’t go away after several weeks or months. The skin sores are pale-coloured. However, all of these symptoms are not just displayed right after the contraction. It usually takes about 3 – 5 years for all or some of the symptoms to appear after the contraction.  The instances sighted have symptoms developed after 20 years, making it quite challenging to identify the disease in the early stages.  Other severe effects  Nerve damage can also further lead to, Loss of feeling in arms and legs Weakness of muscles  Early diagnosis and treatment is a fundamental strategy to prevent leprosy transmission. Recognizing any signs of skin damage, delayed or deformed healing should be considered as a quick alert. Seek the doctor’s support to avoid further transmission in your child.  *Information shared here is for general purpose. Please take doctors’ advice before taking any decision.