Honey and nuts not for infants

My 15-months-old son has been diagnosed with Ebstein’s Anomaly with hugely dilated right auricle, ARV, ± 10 mm apical displacement of Tricuspid Valve, fluctuating Grade II and Grade III regurgitation, right to left shunt, and a PFO. A paediatric cardiology registrar at SGNHC has been looking after the case from the fifth day he was born, and although the baby has not shown any perceivable signs of deterioration, I am concerned whether he would need immediate surgery. The registrar says we should take a ‘wait and watch’ approach. What are the chances of mending the ailment through medication or surgery, and what are the cost estimates if the baby should ever need a surgical treatment?

— Saraswati Neupane, Gyaneshwor, Kathmandu

Sounds like your child does have a congenital heart disease called Ebstein’s anomaly. You have been to right place for the follow up. From what you are writing, your child does have some volume loading of the heart but the kid seems to be doing well. If the child is growing well, gaining weight and is not blue the ‘wait and watch’ policy is appropriate. I think that the child may need surgical repair at some stage of his life but this decision will be made only after careful evaluation of the X-ray, ECG and Echocardiogram findings. Regarding the cost of operation, the government has been supporting poor families with kids under the age of fifteen if they need operation. If you can pay for yourself, the cost may range between NRS100, 000 and 150,000. I believe that our registrar will refer the kid to us (the surgeons) when he/she thinks that the time is right to intervene.

— Dr Bhagawan Koirala

My son is almost 10-months-old. My query is regarding the kind of food that he can eat. I have already started giving him meat — chicken. Is this okay? Many of my relatives tell me it is not healthy. What is the ideal food to give a child this age? He also eats a lot more than his cousin who is more than one year old? — Smita Tamang

Normally a 10-month-old child should be able to have any type of food the family has- only that it should be soft in texture and in the right portion. The texture then should gradually be graded to grainier texture over the next couple of months so that the child is able to take lumpy food without choking episodes. Regarding your query ‘Ideal food’, you should try for a balanced diet - with vegetables, meat, fruit, cheese, eggs etc. Any sort of nuts, honey is not advised in that age group. It is fine to give him chicken provided it is well cooked and soft in texture. Eggs should be fully boiled as well. Pureed vegetables and fresh fruits are fine. Just remember that one should introduce one new item of food at any given time and build up the variety list slowly and over a period of week or so.

Your 10 month old should have at least 30 oz. of milk in 24 hrs. If he is breast-feeding, that’s fine but otherwise it is not recommended to give cow’s milk, diary milk to children below 12 months of age. He should be given at least 3 solid meals per day in addition to the milk feeds. How much the child should be given depends mainly on what his growth is like. It would not be appropriate to make him fat and some children do have a problem with over-eating. If this is so with your son, you should try to control the quantity he eats right from early days. Funny enough, my experience tells me that most parents prefer their child to be chubby rather than a active but thin child.

— Dr Kishore Pandey

I would like to know how regularly should one go for gynae check-ups after menopause? If yes, then for how long should the check-ups continue?

—Yashodha Thapa

Even after menopause there is still the possibility of many other gynaecological diseases and postmenopausal problems, so women are recommended to continue regular one yearly gynae checkups for life. Other additional investigations like ultrasound, tumour markers and pap smears may be done on the recommendation of the gynaecologist after the physical check up.

— Dr Kundu Yangzom

I am 32 and do not suffer from any kind of a serious illness. However, lately I have noticed that my heart beats really fast and I feel short of breath. This happens even when I am just sitting and doing nothing. The beating is really very rapid and it feels like my heart is about to jump out of my chest. This has been happening for the last one month. Should I be worried? Do I need to go for a heart check-up? — Amrita Yonzon

Your complaint is known as palpitation, which is the awareness of one’s heartbeat. Your symptom could be due to heart problem or otherwise. The common cause of palpitation in heart problem would be due to rheumatic heart disease where the heart valves are thickened. This can impede the blood flow across the valves or cause leakage of blood when the valves are closed which can result with the symptoms of palpitation. You need to do a heart ultrasound known as ECHO besides blood test after consulting a cardiologist. The other cause could be a rhythm problem for which you will need to do a 24-hour ECG known as HOLTER to rule our abnormal pathway conditions again after consulting a cardiologist.

Now, you may have palpitation from non-heart conditions also like thyrotoxicosis where the thyroid gland, which is situated on the anterior neck, secretes more than normal amount of throxine hormone resulting in palpitation along with other symptoms like finger tremor, diarrhoea, sweating and irritation.

You being a female may have to see a gynaecologist who can rule out female hormonal aspects or the menstrual cycle where excess blood loss results in anaemia causing increased heart rate but not necessarily palpitation. This is again true in excessive ulcer bleeding.

Lastly, psycogenic factors have to be taken into account where the mind plays its own games of fear, anxiety and host of other issues for which you will need to consult a psychiatrist. Thus, from the above try to figure out where you would fit in exactly and accordingly follow up from there.

— Dr Ranjeet Baral