Challenges in Rural Child Health: Experiences of a pediatrician in Rural Haryana- Dr Preeti Joon

Working as a senior resident at the prestigious institute AIIMS Delhi gave me the opportunity to serve in rural areas; carefully observe the behavioral changes in the pediatric population along with the changing disease spectrum which now parallels the trends seen in tertiary care centers.

Common non-infectious ailments seen in OPD can now be attributed to a sedentary lifestyle and eating calorie-dense food. On the other hand, kids come with a peculiar habit of eating sand, licking walls and slippers, eating chalk, flour, paper, chewing clothes -what we call " Pica" - eating non-nutritive substances is one of the common behavioral problems in infancy as well as among school - goers. Parental ignorance is seen regarding sound dietary habits and they often misattribute it to calcium deficiency.

Consuming large quantities of beverages adds on a lot of calories causing weight gain, later on obesity at a very young age; in addition to this, consuming sugary drinks in a large quantity per day can lead to " osmotic diarrhea" which is often concluded by parents as infective diarrhea. Gastritis is a very common yet less acknowledged problem of growing kids which usually presents as heartburn. Daily one-hour physical activity for children in the form of running, and playing outside reduces gastritis. Skipping breakfast or giving juice, and milk in the morning without proper breakfast is another common cause of gastritis which can also lead to constipation.

In a patriarchal society like Haryana, gender bias even today plagues female child health even when affordability is not an issue. I remember an instance where parents were not willing to initiate therapy for seizure disorder for a girl child believing she couldn't suffer one. Such a pernicious, medieval mindset is at times harder to treat than the physical ailment itself.

Autism spectrum disorders are quite common and are often missed by parents who then bring children at 8-9 years of age resulting in a delay in therapy. Lack of good health centers, poor socioeconomic status, and initial treatment by quacks are other factors contributing to delay in treatment.

Itching is very common in children with scratch marks, which are often diagnosed as scabies, is related to an unhygienic lifestyle, which is treatable as well, so parents should not miss that as it is infectious. Parents requesting antibiotics against medical advice in seasonal flu is very common, which should be completely avoided unless a child is having some life-threatening condition, as rampant misuse of antibiotics is creating antibiotic resistance, so counseling is the key here, and explaining danger signs is of paramount importance. Worm infestation in all age groups is common, but children are more prone to it due to a lack of awareness regarding self-hygiene, so periodic deworming should be done with Albendazole.

A common complaint that brings parents to OPD is of their child having a poor appetite, out of innumerable medical causes, common ones can be tracked down to bad eating habits.

Yielding to the tantrums of kids by offering chocolates, chips, biscuits, and candies is itself the major cause of poor appetite as it causes iron deficiency. Another very important yet ignored aspect is of mental health of children. Due to increasing domestic violence, broken families, or other stressors, panic attacks are on the rise in the early adolescent age (10-13 years), where children present with common complaints of shortness of breath, chest pain, fast heartbeat, anxious looks which primarily warrant the attention of a psychiatrist and child psychologist. Panic attacks are often mistaken by parents as difficulty in breathing where they do not accept that it is psychological, again counseling and proper guidance are important here. Bad toileting habits can cause urinary tract infection which presents as frequent, little quantity, painful, burning urination. Infants present as crying during urination.

The way forward is simple but not necessarily easy with revamping required at the individual as well as societal levels.

Good parenting strategies with dedicated government efforts in the form of vaccination campaigns, educational campaigns, emphasis on schools as sites of inculcation of healthy behaviors for life,  and more generous healthcare expenditure will help in improving the outlook on child health which should be a top priority as today's healthy children will form the backbone of tomorrow's prosperous India.- 

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