Attention Deficit Hyperactivity Disorder (ADHD)

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Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects the brain. In Australia, 1 in 20 children have ADHD with a greater prevalence in males than females1. 

There are three common symptoms in ADHD: 

1. Inattention

2. Hyperactivity and 

3. Impulsivity. 

As ADHD predominantly affects children, it is crucial there is careful consideration prior to diagnosis as young children undiagnosed with ADHD are likely to show behaviours similar to the symptoms exhibited in ADHD patients2. Given the sensitivity in diagnosis, there are now three kinds of ADHD: 

• predominantly hyperactive-impulsive type
• predominantly inattentive type and 
• combined type3.

As ADHD is a complex disorder, there are multiple causes of ADHD. These can include drug exposure during pregnancy, genetics, exposure to lead and lack of early attachment4. Treatment of ADHD commonly involves pharmacological approaches along with behavioural therapies such as cognitive therapy, social training or family counselling4. Professor Yoland Lim Health Care has known about the potential benefits of effective management of this and other conditions for many years and it is only more recently where promising scientific results show the effect of acupuncture on the management of ADHD in children alongside pharmacological and behavioural approaches5,6.

References

[1]The Royal Children’s Hospital Melbourne

[2] ADHD Australia

[3] Brain Foundation Australia

[4] Betterhealth.vic.gov.au

[5] DOI: 10.1186/1745-6215-12-173

[6] DOI: 10.1007/s11655-011-0701-7

Constipation in children is a common occurrence particularly around the time of toilet training or starting solids[1]. Constipation occurs when there is difficulty in passing stool rather than the frequency[2]. This is because bowel movement varies between individuals. Therefore it is important to observe for consistent bowel motion patterns, hardness of stool and whether or not there is pain during the passing of stool. 

Signs of constipation in children can include[3]:

• stomach pain which comes and goes
• decreased appetite 
• becoming irritable, upset or refusing to sit on the toilet 
• ‘holding-on’ behaviour such as squatting and crossing legs 

Common causes of constipation in children consist of not having enough fibre in the diet, holding back bowel movements, not eating enough solid foods and taking certain medications such as some cough medications[3]. 

To prevent and manage constipation in children it is important to ensure proper toileting behaviour and education at a young age. These can include:

• encouraging children to sit on the toilet for five minutes after meals
• encouraging and supporting the child for toilet sitting such as using a star chart and 
• ensuring feet are supported with their knees just above the hips when sitting on the toilet[4]

Furthermore, implementing a diet high in fibre and fruit (particularly prune or pear juice) and encouraging the intake of plenty of fluids may help with resolving problems with constipation[5]

In some cases where changing of the diet and modifying behaviour involving a toileting program are not effective, stool softeners and laxatives may be advised by your medical practitioner or paediatrician, to ensure for appropriate dose and number of doses per day is advised[6]. 

References

[1] The Royal Children’s Hospital Melbourne (2018, February) Constipation rch.org.au/kidsinfo/fact_sheets/Constipation/

[2] Better Health Victoria (2012, July) Constipation and children betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

[3] Health Direct (2019, December) Constipation in children healthdirect.gov.au/constipation-in-children

[4] Waterham et al (2017, December) Childhood constipation racgp.org.au/afp/2017/december/childhood-constipation/

[5] Children’s Health Queensland Hospital and Health Service (2019, August) Constipation in children childrens.health.qld.gov.au/fact-sheet-constipation/

[6] Consolini et al (2018, July) Constipation in Children msdmanuals.com/home/children-s-health-issues/symptoms-in-infants-and-children/constipation-in-children

Difficulty feeding is an umbrella term encompassing a variety of feeding or mealtime behaviours perceived as problematic for a child or family[1]. These behaviours may include[2]:

• Falling asleep when feeding
• Refusing to eat or drink
• Eating only certain textures, such as soft food or crunchy food
• Problems chewing
• Cries or fusses when feeding 
• Spitting up or throwing up a lot 
• Trouble breathing while eating and drinking

Although these behaviours can be considered to be part of a typical feeding development[1], there are effective approaches to help tackle feeding difficulties[3]. For example, if your child is not eating whole meals, reducing the amount of food given at mealtimes may be effective. Additionally, creating a positive eating environment, serving new foods and following your child’s lead may all serve to combat difficulties in feeding. However, if your child is consistently refusing to eat, only eating a very small range of foods or you are concerned about growth and overall nutrition, seeking a review from a medical practitioner should be considered. 

References

[1] The Royal Children’s Hospital Melbourne. Feeding Development and Difficulties rch.org.au/feedingdifficulties/difficulties/What_is_a_feeding_difficulty/

[2] American Speech-Language-Hearing Association. Feeding and Swallowing Disorders in Children asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/

[3] Raising children. Toddler not eating? Ideas and tips. raisingchildren.net.au/toddlers/nutrition-fitness/common-concerns/toddler-not-eating

During 2022 there has been an outbreak of Foot and Mouth Disease (FMD) which infects animals, in Bali, Indonesia. It also has been found in animals in other parts of Asia, Africa, and South America. This only affects cattle, sheep, goats and pigs with severe consequences for animal health and trade[1].At time of writing Australia is free of FMD[2].

Australia is endeavouring to ensure that this does not enter our country, hence the stringent biosecurity measures. At international arrivals, incoming passengers are asked whether they have been around animals or farms, to asses whether there is any chance of contaminated equipment or clothing being carried in. If FMD crosses our boarders this could decimate Australia’s livestock industry. Farmers are advised to keep looking out for symptoms of blisters in the mouth, drooling and limping in their animals.

FMD is caused by a “virus of the family Picornaviridae, genus Aphthovirus, of which there are seven serotypes (O, A, C, SAT1, SAT2, SAT3, and Asia1)”.[3]

Although a human was apparently reported to have FMD, it was last reported in 1966, and 1834. Essentially it is extremely rare in humans.

FMD is completely different from the condition Hand Foot and Mouth (HFM) that is known in humans.

HFM is “caused by a virus (usually from the coxsackie group of enteroviruses, particularly coxsackie virus A16)”.[4]It often affects children (mainly under 10 years old) and is passed onto one another quite easily through contact. Common symptoms include: 

• fever
•  sore throat
• small, blister-like lesions that may occur on the inside of the mouth, sides of the tongue, palms of the hands, fingers, soles of the feet and ‘nappy’ area
• children are often irritable, tired, and may be off their food.”[5]

If your child or anyone you know have these symptoms, please see your medical practitioner. Diagnosis is made by your doctor based on talking to you and having a good look at the lesions and skin changes.

Preventing HFM is by hand washing, not sharing eating utensils, and cleaning and washing surfaces and toys, and good sneeze etiquette.

Treatment is usually supportive, and treating symptoms and making our children feel comfortable. Professor Yoland Lim Health Care have a range of supportive management strategies which assist in wellbeing, ranging from Fong Yang Therapy, phytomolecular medicine, and binaural therapy.

References

[1] agriculture.gov.au/about/news/media-releases/media-statement-foot-and-mouth-disease-confirmed-in-bali

[2] agriculture.gov.au/sites/default/files/documents/fmd-free-country-list.pdf

[3] ncbi.nlm.nih.gov/pmc/articles/PMC1119772/

[4] betterhealth.vic.gov.au/health/conditionsandtreatments/hand-foot-and-mouth-disease

[5] betterhealth.vic.gov.au/health/conditionsandtreatments/hand-foot-and-mouth-disease

Reflux or gastro-oesophageal reflux (GOR) is common in young children and is characterised by the contents of the stomach being brought up back (regurgitated) either into the oesophagus or the mouth. As the valve at the top of the stomach is quite loose in babies, GOR typically occurs around 2 to 3 weeks of life and peaking between 4 to 5 months. 

It is during growth where the valve usually becomes stronger resulting in the reflux getting better[1]. Signs and symptoms of reflux include[2]:

• Frequent regurgitation or vomiting especially after meals
• Wet burps or wet hiccups
• Failure to gain weight
• Choking or wheezing

While in many babies and young children, GOR resolves on its own without treatment or medication, it can be very worrying for parents. Following scientific evidence, there are key strategies to consider[3]:

• Using a feed thickener or thickened formula 
• During bottle feed, keeping your baby upright if possible 
• Eliminating environmental tobacco smoke from your baby (i.e. not smoking around your baby or allowing other people to smoke around your baby)

Furthermore, there is little to no evidence to suggest that starting solid feeds early will help with reflux. Therefore, it is vital to continue to adhere to the Australian Infant Feeding Guidelines and introduce solids at around 6 months of age[3].  

References

[1] The Royal Children’s Hospital Melbourne (2018, May) Reflux (GOR) and GORD rch.org.au/kidsinfo/fact_sheets/Reflux_GOR_and_GORD/

[2] KidsHealth (2015, January) Gastroesophageal Reflux kidshealth.org/en/parents/gerd-reflux.html

[3] Children’s Health Queensland Hospital and Health Service (2016, November) Fact sheet – Reflux childrens.health.qld.gov.au/fact-sheet-reflux/