Malnutrition in Pakistan is an oft-discussed topic and yet there remains very little accurate information on child health. Myths and misinformation are widespread. Many parents who might be unaware of or unable to access reliable sources can inadvertently end up doing more harm than good in raising their children.
That is why it is so important to counter the misinformation and propaganda and educate parents about the importance of good health practices backed by sound research. If correct sleeping and eating habits are instilled from childhood, children have a better chance of growing up healthy and staying disease-free. And if parents stop insisting on medicines to treat every illness, there will be fewer incidences of antibiotic resistance amongst them.
This is what Dr Anokhi Khanum, a foreign-trained child specialist who practices at Apple Tree Pediatrics in Karachi, informed parents in her interactive session on child health at the Alliance Francaise on Saturday.
Dr Khanum spoke from her 20 years of experience practising evidence-based medicine both at home and abroad. She highlighted how the world is now shifting to a model of preventive care and relying less on prescriptions and traditional medicines.
Good health begins with a good night’s sleep
Our circadian rhythm, or sleep cycle, follows the sun. It’s responsible for regulating the body’s hormones, immune system and growth. In children, the natural rhythm is 7.30am to 7.30pm. At around 7pm, the sleep hormone melatonin starts being released—this is the ideal time to send them to bed.
“I always get questions from parents about how to stimulate their child’s immune system,” Dr Khanum said. “My answer: put them in bed on time. Children who don’t sleep properly often get sick very quickly.”
She then went on to explain how diabetes and cardiovascular disease begin in childhood and how necessary it is to make sure that children are getting proper sleep to prevent these disorders from an early age.
More play and fewer screens
According to the World Health Organisation (WHO) guidelines for children under five years of age, there needs to be at least 30 to 180 minutes of physical activity per day and no screen time for children to develop properly.
“We as pediatricians have reached a compromise and made it zero screen time under two years,” Dr Khanum said. “Screen time is very passive and doesn’t teach children any motor or social skills. There is a difference between talking to children and talking at them.”
She said that parents need to teach their children how to interact socially and ensure they are learning motor skills. The WHO recommends activities such as reading, storytelling, singing and puzzles for quality sedentary time between parents and children.
Healthy diets don’t mean just milk
On the topic of fussy eaters, Dr Khanum had an interesting question to ask parents: “What would you do if I gave you a cockroach right now to eat? A worm, a lizard? Are you going to eat that stuff? That’s exactly how your child is feeling when you introduce a new food.”
She explained how a child’s taste buds develop slowly as they grow up and the best way to get them to try something new is to be persistent and patient. Dr Khanum also cautioned against giving powdered milk and food supplements to healthy children.
She lamented the nation’s fixation with milk, adding that for children older than one year, two glasses of pasteurised cow milk are enough for a day. Any more than that would diminish the child’s appetite for solid foods which were important for growth. She recommended five portions of fruits and vegetables per day for growing children, advising to stick to fruits over fruit juices.
Treating common childhood diseases: colds, fever and diarrhoea
Diarrhoea and pneumonia are among the leading causes of death in children in the country. It is no wonder that most parents rush to get their child antibiotics when faced with these. However, Dr Khanum clarified that most diarrhoea cases in children were of viral origin and did not require antibiotics.
“It’s normal for diarrhoea to go up to one week. Keep the child hydrated with ORS. There’s no need to give them energy drinks. If your child has vomited, give him ORS after half an hour,” she said.
Dr Khanum then elaborated on the red flags of diarrhoea: blood or mucus in stool, excessive lethargy, headache, dizziness and diarrhoea lasting more than a week. In case of any of these signs, she advised an immediate review with a paediatrician.
A visit to the hospital was also advised for warning signs of fever such as lethargy, rashes, poor drinking, nasal flaring, rapid breathing and fever persisting for five days or more with no other symptoms.
“Fever is not a disease, it is a symptom. It stimulates your immune system. Fever is your body’s way of fighting. You don’t need to treat it unless there are red flags,” Dr Khanum said.
To bring down fever she recommended Paracetamol and Brufen, warning parents to steer clear of any medications consisting of mefenamic acid as it is not licensed for use in children.
She also advised against using cough syrups and nebulisers. For colds, she described how home remedies such as ginger lemon tea, turmeric in milk and honey (in children above one year of age) were sufficient along with frequent nose cleaning.