ABSTRACT
JUSTIFICATION: Screen-based media have become an important part of human lifestyle. In view of their easy availability and increasing use in Indian children, and their excessive use being linked to physical, developmental and emotional problems, there is a need to develop guidelines related to ensure digital wellness and regulate screen time in infants, children, and adolescents. OBJECTIVES: To review the evidence related to effects of screen-based media and excessive screen time on children's health; and to formulate recommendations for limiting screen time and ensuring digital wellness in Indian infants, children and adolescents. PROCESS: An Expert Committee constituted by the Indian Academy of Pediatrics (IAP), consisting of various stakeholders in private and public sector, reviewed the literature and existing guidelines. A detailed review document was circulated to the members, and the National consultative meet was held online on 26th March 2021 for a day-long deliberation on framing the guidelines. The consensus review and recommendations formulated by the Group were circulated to the participants and the guidelines were finalized. CONCLUSIONS: Very early exposure to screen-based media and excessive screen time (>1-2h/d) seems to be widely prevalent in Indian children. The Group recommends that children below 2 years age should not be exposed to any type of screen, whereas exposure should be limited to a maximum of one hour of supervised screen time per day for children 24-59 months age, and less than two hours per day for children 5-10 years age. Screen time must not replace other activities such as outdoor physical activities, sleep, family and peer interaction, studies and skill development, which are necessary for overall health and development of the children and adolescents. Families should ensure a warm, nurturing, supportive, fun filled and secure environment at home, and monitor their children's screen use to ensure that the content being watched is educational, age-appropriate and non-violent. Families, schools and pediatricians should be educated regarding the importance of recording screen exposure and digital wellness as a part of routine child health assessment, and detect any signs of cyberbullying or media addiction; and tackle it timely with expert consultation if needed.
Subject(s)
Pediatrics , Screen Time , Adolescent , Child , Consensus , Educational Status , Humans , Infant , SchoolsABSTRACT
A 5-year-old girl presented with abdominal pain, intermittent jaundice and a gall bladder lump. Clinical examination and preoperative imaging suggested the diagnosis of a type I choledochal cyst (CDC). During surgery, this was found to be a hydatid cyst (HC) occupying the head of pancreas causing obstruction to the common bile duct (CBD). A pancreatic HC mimicking a CDC and presenting with CBD obstruction is unusual.
Subject(s)
Choledochal Cyst/diagnosis , Echinococcosis/diagnosis , Pancreatic Diseases/diagnosis , Pancreatic Diseases/parasitology , Child, Preschool , Diagnosis, Differential , Female , HumansSubject(s)
Adrenal Hyperplasia, Congenital/diagnosis , Genitalia, Female/surgery , Unnecessary Procedures , Adolescent , Adrenal Hyperplasia, Congenital/complications , Adrenal Hyperplasia, Congenital/surgery , Diagnostic Errors , Female , Genitalia, Female/pathology , Humans , Male , Vomiting/complicationsABSTRACT
During the 3rd week of intrauterine life there is a communication between the intraembryonic gut and the yolk sac. As the development proceeds this communication narrows into a tube known as the vitellointestinal duct (VID). With the establishment of placental nutrition this duct usually becomes obliterated by the end of the 7th week of intrauterine life. In about 2% of humans this duct persists and gives rise to a group of anomalies of which Meckel's diverticulum is the commonest and complete patency of the duct is the rarest.1 We report a case of a 4-month-old infant who presented with umbilical polyp, discharge from the umbilicus, significant dehydration and failure to thrive because of complete patency of the VID.
Subject(s)
Congenital Abnormalities/diagnosis , Intestinal Polyps/surgery , Umbilicus/surgery , Vitelline Duct/abnormalities , Anastomosis, Surgical , Congenital Abnormalities/surgery , Dehydration/diagnosis , Dehydration/etiology , Digestive System Surgical Procedures/methods , Failure to Thrive/diagnosis , Failure to Thrive/etiology , Follow-Up Studies , Humans , Infant , Intestinal Polyps/diagnosis , Male , Rare Diseases , Risk Assessment , Tomography, X-Ray Computed , Treatment Outcome , Umbilicus/physiopathology , Vitelline Duct/surgeryABSTRACT
A 5-month-old infant presented with cleft palate, febrile urinary tract infection and abnormal movements. His urinary stream was poor and investigations revealed posterior urethral valve and grade V vesicoureteric reflux. This baby was investigated for seizure activity and on MRI of the brain was found to have a large arachnoid cyst, splaying the occipital horns and compressing the posterior aspect of third ventricle leading to dilatation of the ventricles. This seems to be a very unusual coexistence of three abnormalities in one patient for which no plausible explanation can be given. It appears to be a chance finding.
Subject(s)
Abnormalities, Multiple/diagnosis , Arachnoid Cysts/complications , Cleft Palate/complications , Urethra/abnormalities , Abnormalities, Multiple/pathology , Arachnoid Cysts/diagnosis , Arachnoid Cysts/pathology , Humans , Infant , Male , Urethral Obstruction/diagnosis , Urethral Obstruction/etiologyABSTRACT
A 3.5-year-old girl presented with skin lesions beginning as a small pustule that progressed to very painful large ulcer with rolled up edges and irregular borders. At presentation, active ulcers were present over the left elbow. There were healed ulcers with scarring present on the chest, back, both thighs and abdominal wall. This child had negative antinuclear antibody, cytoplasmic antinuclear cytoplasmic antibody, antiphospholipid antibodies and tests for hepatitis B and C. She did not have any symptoms to suggest ulcerative colitis. Her colonoscopy was absolutely normal. Histopathology from her skin lesion was consistent with pyoderma gangrenosum.
Subject(s)
Pyoderma Gangrenosum/diagnosis , Child, Preschool , Diagnosis, Differential , Female , HumansSubject(s)
Brain/pathology , Cerebellar Diseases/diagnosis , Cerebellar Diseases/genetics , Developmental Disabilities/diagnosis , Developmental Disabilities/genetics , Eye Abnormalities/diagnosis , Eye Abnormalities/genetics , Kidney Diseases, Cystic/diagnosis , Kidney Diseases, Cystic/genetics , Magnetic Resonance Imaging , Motor Neuron Disease/diagnosis , Polydactyly/diagnosis , Abnormalities, Multiple , Cerebellum/abnormalities , Consanguinity , Dilatation, Pathologic , Fourth Ventricle/pathology , Humans , Infant , Male , Motor Neuron Disease/genetics , Polydactyly/genetics , Retina/abnormalitiesABSTRACT
A 4-year-old male child presented with severe growth failure and developmental delay. He had hypertrophy of calf muscles and the thyroid profile showed low levels of T3, T4 and markedly elevated level of thyroid-stimulating hormone thus confirming the presence of hypothyroidism. This combination of hypothyroidism and hypertrophy of muscles is classically described as Kocher-Debré-Semelaigne syndrome. This child was started on 50 µg of levothyroxine.
Subject(s)
Congenital Hypothyroidism/diagnosis , Hypertrophy/diagnosis , Muscular Diseases/diagnosis , Child, Preschool , Humans , Male , Muscle, Skeletal/pathology , PhenotypeABSTRACT
A 12-year-old girl presented with significant vomiting, and generalised muscular weakness. She had normal anion gap metabolic acidosis, hypokalemia and alkaline urine. Vomiting generally leads to metabolic alkalosis but this patient had acidosis which suggested either renal tubular acidosis (RTA) or diarrhoea. Investigations showed distal RTA. There was no family history of similar illness. Abdominal ultrasound showed features of the superior mesenteric artery syndrome, but a barium study showed no duodenal obstruction, making this an unlikely cause of symptoms. Weight loss as a result of the renal condition may have caused loss of mesenteric or retro-duodenal fat and explain the ultrasound appearance.
Subject(s)
Acidosis, Renal Tubular/complications , Superior Mesenteric Artery Syndrome/complications , Acidosis, Renal Tubular/diagnosis , Acidosis, Renal Tubular/drug therapy , Child , Diagnosis, Differential , Female , Humans , Superior Mesenteric Artery Syndrome/diagnosis , Ultrasonography, DopplerSubject(s)
Dermatomyositis/pathology , Child , Dermatomyositis/complications , Humans , Male , Muscle Weakness/complications , SkinABSTRACT
Neuroregression in infants has varied aetiology and vitamin B12 deficiency is one of the uncommon causes. Infantile vitamin B12 deficiency is encountered in malnourished infants or in offspring of strict vegan mothers. We present two cases, both infants of 10 and 8 months of age, whose mothers had vitamin B12 deficiency. On admission, the patients were apathic, hypotonic and lethargic. Serum vitamin B12 levels were below normal limits. On cranial MRI, T2-weighted images revealed frontoparietal cortical atrophy. Both the infants responded to vitamin B12 treatment.
