AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Around 90% of children witness domestic violence in their lives which impacts their mental health. It leaves a life-long negative impact on their fragile minds.

Domestic Violence And Its Impact On The Child

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

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Children Under 10 And Hepatitis - A Mystery To Be Solved

Introduction

On April 5th, 2022, the WHO was notified of a surge in cases of severe acute <a href="https://www.merisehat.pk/disease/hepatitis-a&amp;e">hepatitis</a>, of an unknown cause. The hepatitis cases were diagnosed in children 10 years and younger across the U.K and led to several hospitalizations. After thorough laboratory testing, hepatitis viruses A, B, C, E, D, and E were ruled out as the cause of these cases. However, investigations are still ongoing to understand the cause of these cases.

Similar cases of unexplained hepatitis and liver inflammation were reported in the U.S., Denmark, Ireland, Netherlands, and Spain. Researchers are suspecting that although the definitive cause of the cases is yet to be elucidated, it may be because of an infectious pathogen or exposure to contaminated food, drinks, or toys. However, an infectious cause is more likely because many of the cases tested positive for <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> and adenovirus. According to a recent report on the illness, the adenovirus may be an underlying cause of the disease. Also, it may be a new variant of the virus that is more severely impacting younger children with weak immunities.&nbsp;

Over the last two years, children may not have been exposed to common viral pathogens because of the COVID-19 outbreak, making them more susceptible to adenovirus and other similar viral infections. To date, 108 cases of mystery hepatitis have been reported according to a recent update by the UK Health Security Agency.

&nbsp;

Understanding Unknown Hepatitis In Children

The most common symptoms of the disease include diarrhea, vomiting, abdominal pain, and yellow discoloration of the skin. While researchers are further investigating other potential causes, out of all the reported cases so far, 77% of the children tested positive for adenovirus, which leads to a stronger suspicion of the illness being linked to the respiratory virus. Similarly, out of the five cases reported in Alabama, three children developed acute liver failure and tested positive for adenovirus. Although no deaths occurred, two of the children required liver transplants. Later in April, the CDC alerted health authorities to test the children for adenovirus, and further recommended testing whole blood instead of plasma alone.&nbsp;

&nbsp;

Adenoviruses are a group of viruses that typically cause respiratory illnesses, and infect the lining of the lungs, airways, intestines, nervous system, and urinary tract. The virus is a common cause of cough, sore throat, fever, diarrhea, and pink eye. Although the infection is more common in children than in adults, anyone can get infected. Studies have shown that every child gets infected with it at least at some point by the time they&rsquo;re 10 years old.&nbsp;

The infection typically causes mild symptoms that disappear after a few days. However, the symptoms are more serious in people, especially children with weak immune systems.&nbsp;

&nbsp;

The virus is commonly lingering in places with large groups of children, for example, schools, daycare centers, and summer camps. The viruses are very contagious and can spread via airborne droplets and with close contact with contaminated surfaces. Thus, the virus spreads through the coughs and sneezes of infected people. What&rsquo;s more, the droplets that contain the virus can also fly onto surfaces. So, if your child touches these surfaces, a toy, or any other object held by someone who has touched their nose, mouth, or eyes, they can get infected.&nbsp;

The virus spreads faster amongst children because they are more likely to touch their faces and put their hands in their mouths. Parents can get infected while changing the diaper of an infected child. The virus can also spread through food prepared by someone carrying the virus if they didn&rsquo;t wash their hands after going to the bathroom. The virus is also rampant in water, especially in swimming pools that aren&rsquo;t chlorinated. However, this does not happen too often. The adenoviruses can cause the following illnesses and present with symptoms:

<ul>
	<li>Bronchitis &ndash; Fever, chills, cough, and runny nose&nbsp;</li>
	<li>Respiratory Infections &ndash; Swollen glands, sore throat, cough, runny, and stuffy nose</li>
	<li>Croup &ndash; Difficulty breathing with high-pitched sound and barking cough</li>
	<li>Ear Infection &ndash; Fever, irritability, and ear pain&nbsp;</li>
	<li>Pink Eye &ndash; Red eyes, tearing, discharge, feeling that something is in the eye</li>
	<li>Pneumonia &ndash;&nbsp;Trouble breathing, cough, and fever&nbsp;</li>
	<li>Stomach And Intestinal Infections &ndash; Stomach cramps, diarrhea, vomiting, fever, and headache&nbsp;</li>
	<li>Meningitis And Encephalitis (Swelling Of The Brain And Spinal Cord) &ndash; Nausea, vomiting (rare), fever, and stiffness in the neck</li>
	<li>Urinary Tract Infections &ndash;&nbsp;Frequent urination, burning and painful urination,&nbsp;blood in the urine&nbsp;</li>
</ul>

If your child has any of these symptoms, it is important that you check with the pediatrician immediately. If your child is under 3 years of age and has symptoms, for example, difficulty breathing, swelling around the eyes, fever that is not going away after a few days, and signs of dehydration, consult a doctor right away. Even though the viruses typically cause respiratory infections, adenovirus 41 can cause gastroenteritis in children with respiratory symptoms. Therefore, there may be a link between this particular type of adenovirus and mysterious hepatitis. Currently, there is no vaccine against the virus.

&nbsp;

Conclusion

The Centers for Disease Control and Prevention (CDC) is currently investigating 180 cases that were identified in the U.S. since last year, October. The focus of the investigation is to conclude whether there has been an increase in hepatitis, or if an existing pattern has been revealed because of improved diagnostic techniques. An alert was issued for doctors nationwide to be on the lookout for children with hepatitis which can cause liver damage and liver failure.&nbsp;

However, the previous theory remains that the measures implemented to cope with the pandemic may have limited children&rsquo;s exposure to the adenovirus. But now&nbsp;that most pandemic restrictions have been lifted,&nbsp;the virus is catching up. The adenovirus is a virus that otherwise commonly causes the common cold in children. In addition, hepatitis linked to this type of adenovirus is almost exclusively seen in immunocompromised children only. Though, many of the cases initially reported by the CDC did not have such conditions.&nbsp;

While monitoring the mysterious hepatitis cases, the CDC is also investigating whether COVID-19 may be playing a role. They are also investigating other pathogens, risk factors, and medications. Although, there has been no overall increase in the incidence of severe hepatitis in children compared to pre-pandemic rates.&nbsp;

According to a recent report, most of these children recovered with only supportive care in the hospital. The care centered around maintaining fluid levels, nutrition, and monitoring of blood clots. In only a minority of the cases, the children underwent liver transplant surgery.&nbsp;

&nbsp;

[1] Marsh, K., Tayler, R., Pollock, L., Roy, K., Lakha, F., Ho, A., Henderson, D., Divala, T., Currie, S., Yirrell, D. and Lockhart, M., 2022. Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022. Eurosurveillance, 27(15), p.2200318.

Staff Writer

Ismail Munir

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

A Guide To Deal With Head Lice In School-Going Children

Head lice. A name that rings familiar to so many of us. A name that fills us up with dread. Especially when it&rsquo;s the start of a new session at school, knowing you&rsquo;ve just spent the entire vacation trying to get your kid&rsquo;s head free of lice. The dread is also because those tiny bloodsuckers are a nuisance; they will spread from one person to another in a jiffy and before you know it the entire household is scratching their scalps as they are gripped by lice infestation.

There are so many other emotions associated with lice infestation. There&rsquo;s mourning for the loss of blood. Then there are those little moments of celebration when you are able to catch them &ndash; and kill them. But, most of all, there&rsquo;s shame. You hesitate going out. And kids, who are frequently targeted by head lice, also fall prey to bullying at school. Not just by other students, but also by parents of these other children who complain about how their little one is exposed to head lice!

So, if your child is under attack by head lice, here&rsquo;s how you can deal with it effectively and efficiently. 
&nbsp;

Understanding Head Lice Treatment In Children

The parasitic insect known as the head louse, or Pediculus Humanus Capitis, can be found on people&#39;s heads, brows, and eyelashes. It&rsquo;s important to note that the presence of head lice does not indicate inadequate personal hygiene or an unsanitary living situation. These insects mostly move directly from one person&#39;s hair to another&#39;s hair. However, they don&rsquo;t cause any bacterial or viral illnesses<a href="#accordion">[1]</a>.&nbsp;

There are a number of over-the-counter and prescribed drugs that may be used to treat head lice and their eggs. You need to be careful while handling drugs; carefully follow the treatment recommendations to get rid of the parasite. In addition to this, you may employ natural or at-home cures. However, there is minimal to no clinical support for their efficacy. 
&nbsp;

<ul>
	<li>A tingling sensation or movement in the hair.</li>
	<li>Itching as an allergic response to a head louse bite.</li>
	<li>Irritation and trouble falling asleep since head lice are most active at night.</li>
	<li>Headaches due to constant scratching.&nbsp;</li>
	<li>Secondary bacterial infection of the skin due to excessive scratching. 
	&nbsp;</li>
</ul>

<h5>Identifying The Peak Season&nbsp;</h5>

To begin with, you need to know when exactly it is during the entire school year that your child is getting affected by head lice. This will help you and, by extension, your child to be better prepared to deal with it.&nbsp;

Children who are 5-13 years old are frequently targeted and they may be spreading it to their family members unknowingly. In that case, adults need to be on alert from August through October and again in January when lice infestations are at their worst.

According to a study, sales of pediculicides follow a clear seasonal pattern, peaking between weeks 34 and 40 of the calendar year, i.e., from mid-September till the end of October. It was concluded that even though the frequency of pediculosis capitis varies throughout the year in Germany, it peaked during the late summer and early fall<a href="#accordion">[2]</a>. 
&nbsp;

<h5>The Comb-Out Method&nbsp;</h5>

The comb-out method is utilized to clear the remaining head lice and nits following head lice medication. It may also be used to monitor the presence of nits and lice. However, the comb-out procedure rarely successfully eliminates head lice on its own.

The comb-out approach is as follows:

<ul>
	<li>Step 1: Wet your child&rsquo;s hair.</li>
	<li>Step 2: Divide your child&#39;s hair into tiny portions and brush each portion using a fine-tooth comb (also known as a louse or nit comb).</li>
	<li>Step 3: Wipe the used comb on a moist paper towel after every comb-through. Pay close attention to all surfaces of the paper towel, comb, and scalp. If there&rsquo;s any lice or nit present, it will be there on the comb after you pull it through the hair.</li>
	<li>Step 4: Keep going through your child&#39;s hair by repeating steps 2 and 3 until you&#39;ve finished, i.e., the comb comes out clean. 
	&nbsp;</li>
</ul>

<h5>1.&nbsp;Permethrin Lotion (1%)</h5>

<ul>
	<li>It doesn&#39;t require a prescription.</li>
	<li>Shampoo your child&rsquo;s hair, towel dry it, and then apply the lotion. Leave it for 10 minutes and then rinse.&nbsp;</li>
	<li>Avoid shampooing for the next 24-48 hours.</li>
	<li>It will only kill lice and not their eggs.</li>
	<li>Repeating treatment is advised if live lice are discovered between days 9 and 10.</li>
	<li>It is appropriate to use in kids who are 2 months and older.</li>
</ul>

&nbsp;

<h5>2. Pyrethrin-Based Product (Shampoo Or Hair Mousse)</h5>

<ul>
	<li>It doesn&#39;t require a prescription.</li>
	<li>You can apply it to dry hair and then rinse 10 minutes later.&nbsp;</li>
	<li>Avoid shampooing for 24-48 hours after a wash</li>
	<li>It kills lice but not their eggs.</li>
	<li>Repeating treatment is advised between days 9 and 10.</li>
	<li>It is suitable for usage in kids who are 2 years of age and older.</li>
</ul>

&nbsp;

<h5>3. Ivermectin Lotion (0.5%)</h5>

<ul>
	<li>It doesn&#39;t require a prescription.</li>
	<li>You can apply it directly to dry hair and then rinse 10 minutes later.&nbsp;</li>
	<li>Avoid shampooing for 24-48 hours following it.</li>
	<li>It kills lice but not their eggs.&nbsp;</li>
	<li>One application is sufficient.</li>
	<li>Ivermectin in veterinary preparations should not be used for this purpose.</li>
	<li>Children and infants aged 6 months and older are permitted to use it.</li>
</ul>

&nbsp;

<h5>4. Malathion Lotion (0.5%)</h5>

<ul>
	<li>It needs a prescription.</li>
	<li>Apply it to dry hair and leave it for 8-12 hours. After that, rinse off the application and avoid shampooing for 24-48 hours.</li>
	<li>It eliminates both lice and their eggs.</li>
	<li>Repeating treatment&nbsp;is advised if live lice are discovered after 7-9 days.</li>
	<li>It is suitable for kids aged 6 years and older.</li>
	<li>It has a strong smell and should be handled with care since it is flammable.</li>
</ul>

&nbsp;

<h5>5. Spinosad Topical Suspension (0.9%)</h5>

<ul>
	<li>It requires a prescription.</li>
	<li>You can apply it to dry hair and then rinse 10 minutes later.&nbsp;</li>
	<li>Avoid shampooing for 24-48 hours following it.</li>
	<li>It eliminates lice as well as their eggs.</li>
	<li>Repeating treatment is advised whenever live lice are discovered after 7 days.</li>
	<li>It is authorized for use in kids 6 months as well as older.</li>
</ul>

&nbsp;

<h5>6. Ivermectin 3-mg Tablet</h5>

<ul>
	<li>It requires a prescription.</li>
	<li>It is recommended for use in treating head lice in adults and other illnesses in kids. However, it should only be used if all other options have failed.</li>
	<li>Repeating treatment&nbsp;is advised whenever live lice are discovered after 9&ndash;10 days.</li>
	<li>It is suitable for usage at any age, provided that the user weighs at least 33 pounds.</li>
	<li>Ivermectin in veterinary preparations should not be used for this purpose. 
	&nbsp;</li>
</ul>

<ul>
	<li>Pay close attention to the written instructions on the packaging.</li>
	<li>Never allow kids to administer medication themselves. An adult should administer medication. Keep the medications locked and out of reach of children.</li>
	<li>Always rinse the medication off over a basin rather than in the shower or bathtub. This should be done to prevent the medication from running off the head and onto other regions of skin.</li>
	<li>Always use warm water to remove the medication (not hot water).</li>
	<li>Never cover a child&#39;s head.</li>
	<li>When a youngster has medication in their hair, never leave them unattended.</li>
	<li>Keep medications out of children&#39;s eyes.</li>
	<li>Always consult the child&rsquo;s doctor before starting a second or third medication &ndash; or even a repeated treatment&nbsp; of the same medication. Perhaps, the doctor will change it.</li>
	<li>Always voice concerns that need to be addressed by the doctor. For e.g., if the lice persist despite using medications. 
	&nbsp;</li>
</ul>

<ul>
	<li>You cannot stop head lice from invading the head. However, you can stop them from spreading.</li>
	<li>Frequent wet or dry combing can help in early detection.&nbsp;Avoid using medicated lotions and sprays to minimize head lice as they may cause scalp irritation.</li>
	<li>Also, it may be challenging to stop the spread of head lice amongst children due to the close contact at schools and childcare institutions. However, that is no reason for your kid(s) to skip school or for you to wash their laundry on a hot cycle.</li>
</ul>

&nbsp;

There is very little probability of indirect dissemination from personal items. However, the following tips may help stop the spread of head lice:

<ul>
	<li>Place your clothes on a hanger that is separate from the children&#39;s clothes.</li>
	<li>Do not exchange hats, brushes, combs, or scarves.</li>
	<li>Avoid resting on any furniture, including pillows or mattresses, that has recently been used by a head-lice carrier. 
	&nbsp;</li>
</ul>

It's okay to feel upset when you discover lice while combing your child’s beautiful locks. But, there’s no need to panic. It’s not your fault and it’s definitely not your child’s fault. Head lice can be found everywhere in the world, including in households, schools, the countryside, and urban areas. Your child is not in danger of any significant health issues as a result of head lice. Don’t delay the treatment, but make sure you do your research before opting for any method to stop the lice from spreading. Only use medications that are recommended by a pediatrician and termed safe to use for this purpose.&nbsp;

Key Points

<ul><li>Head lice are insects that reside in human hair.</li><li>An itching head is a major sign of head lice. If you look closely near the scalp, you might also spot white or dark-brown eggs.</li><li>You can cure head lice at home by utilizing moist combs or anti-lice treatments.</li><li>Children frequently get head lice and they can spread quickly.</li><li>As a caregiver, it’s your responsibility to check your entire family for head lice and notify your child's daycare or school if you suspect your youngster has them. </li></ul>

[1] Veracx A, Raoult D. Biology and genetics of human head and body lice. Trends Parasitol. 2012;28(12):563–71.

[2] Bauer E, Jahnke C, Feldmeier H. Seasonal fluctuations of head lice infestation in Germany. Parasitol Res. 2009;104(3):677–81.

[3] CDC - lice - head lice - treatment. Centers for Disease Control and Prevention.

Neelam Asad

Iqra Mazhar

Could My Child Be Diabetic?

<a href="https://merisehat.pk/disease/diabetes-a-complete-overview">Diabetes</a> is one of the most common diseases on this planet. People all over the world suffer from it. However, the fact that a greater majority of its victims are adults means the prevalence of this disease in children often goes unnoticed. The reason for this negligence is that often many cases of diabetes in children go undiagnosed due to the lack of apparent symptoms. 
&nbsp;

Understanding Diabetes In Children

Diabetes, simply referred to as &lsquo;sugar&rsquo; in Pakistan, is an increase in blood glucose levels due to insulin-related problems. That is, the body is not producing enough insulin, or it could be that the body has completely stopped producing insulin<a href="#accordion">[1]</a>.

How is the production of insulin related to high blood sugar levels? Think of it this way. After a person consumes carbohydrate-containing foods, their body breaks it down into glucose in the stomach, and eventually, the broken-down glucose is sent to the bloodstream for use by the body. Insulin is important because it&rsquo;s the only hormone responsible to break down glucose and allowing other cells of the body to consume it for energy.&nbsp;

When insulin does not function effectively, it may lead to diabetes. The problem is triggered when the production of insulin is hindered greatly to the extent it fails to target all the glucose in the body, or when the biochemical is not produced at all by the body. Either way, it leaves a higher concentration of glucose in the bloodstream.&nbsp;

A third possibility also exists &ndash; that is, the body does produce insulin, but the cells do not react to it in the way they should. This phenomenon is known as insulin resistance and it is commonly found in type 2 diabetes. The result is that the pancreas receives the message about the high blood sugar present in the body and the organ starts producing more insulin, overworking itself until it stops producing insulin altogether. 
&nbsp;

Type 2 diabetes is also known as adult-onset diabetes. Despite the name and its common prevalence in people of older ages, children suffer from this, too, and the numbers keep on increasing due to obesity and inactive lifestyle<a href="#accordion">[1][2]</a>. Especially when the person is overweight and has central obesity (lots of belly fat).

Children with diabetes type 2 mostly get diagnosed during their teens. Thus, it is believed to occur due to the hormonal changes that the body goes through during puberty. Every human is different and their bodies take their own sweet time to understand, accept, and adjust according to these changes. So, naturally, it will be confused in the case of insulin production, too.&nbsp;&nbsp;

With 1 in 4 adults, i.e., 26.7% of people in Pakistan having diabetes, it is safe to assume that the genetics of the country is filled with diabetes. The prevalence of type 2 diabetes is around 11.77% in Pakistan<a href="#accordion">[3]</a>. Simply by extension, it is believed that the instances of diabetes in children would be high too but, unfortunately, there is no robust evidence regarding the number of affected children in Pakistan. 
&nbsp;

Diabetes is a life-altering disease. It can turn out to be very limiting for people of younger age groups with symptoms like increased hunger and thirst, frequent infections, and fatigue.

Adult-onset diabetes is a lot easier to manage because the health and lifestyle changes are much easier to adapt to. On the contrary, the body of children at this age is still developing; consequently, they face multiple issues, including heart diseases, eye problems, and even potential nerve damage.&nbsp;

Unfortunately,&nbsp; these issues also progress faster in children with type 2 diabetes than in type 1, making it harder to control<a href="#accordion">[5]</a>. Children are also known to deal with poor kidney function and bad eyesight.&nbsp;

All of this requires strict control of blood sugar levels, which becomes challenging, especially for parents when children don&rsquo;t cooperate. 
&nbsp;

Obesity is not the only condition related to diabetes. When a person is diagnosed with insulin resistance, they may have several other conditions as well. It is common to experience metabolic syndrome with early age type 2 diabetes. This is characterized by: <ul><li>Increased blood pressure</li><li>Low LDL (high-density lipoproteins)</li><li>High triglycerides</li><li>Increased blood sugar level</li><li>Large waist size </li></ul>

Polycystic ovary syndrome (PCOS) and diabetes go hand-in-hand in girls and women. If a girl is exhibiting symptoms like irregular periods, weight gain, and excess body and facial hair, it&rsquo;s possible that she might have PCOS. Hormonal imbalance is the root cause of PCOS, hence, there is a greater probability that the body stops responding to insulin or produces inadequate amounts of it. And, vice-versa, if the child is diabetic, then they are more susceptible to PCOS than other girls their age<a href="#accordion">[4]</a>. 
&nbsp;

The most ideal approach to managing diabetes is to let the kid in on the action, i.e., make them aware of their condition, inform them how their choices will be different from other kids of their age, and the lifestyle changes they need to incorporate to lead a productive life. This is best done by taking one day at a time rather than unloading the information all at once and overwhelming the child.&nbsp;

Empower them from a young age by letting them make their own choices. For example, let them choose which finger to prick for checking blood sugar levels or decide where they feel comfortable taking their insulin shots. This can be slowly built up as they age. They can be trained into taking care of themselves. As teenagers, they can be taught about carb counting and different ways to maintain their dietary intake for optimum results<a href="#accordion">[6]</a>. 
&nbsp;

When it comes to risk factors of type 2 diabetes in children, they are not too different from those experienced by adults. Some of the common risk factors include:

<ul>
	<li>Obesity</li>
	<li>Age &ndash; Most young patients with diabetes type 2 are diagnosed during their early teens</li>
	<li>Activity &ndash; Sedentary lifestyle has been associated with increased insulin resistance</li>
	<li>Family history</li>
	<li>Mother with gestational diabetes</li>
	<li>Ethnicity &ndash; African American, Asian American and Latino are generally more at risk 
	&nbsp;</li>
</ul>

<ul><li>Type 2 diabetes is getting very common day by day, especially in children, due to a sedentary lifestyle.</li><li>The best approach for type 2 diabetes in children is to allow them to take control of their bodies as well.</li><li>The key to managing it all is weight maintenance, physical activity, and dietary intake.</li></ul>

[1] Gavin ML, ed. What is type 2 diabetes? (for parents) - nemours kidshealth. KidsHealth.

[2] Prevent type 2 diabetes in Kids. Centers for Disease Control and Prevention.

[3] SA, Meo & Zia, Inam & Bukhari, Ishfaq & Arain, Shoukat. (2016). Type 2 diabetes mellitus in Pakistan: Current prevalence and future forecast. JPMA. The Journal of the Pakistan Medical Association. 66. 1637-1642.

[4] Type 2 diabetes in children. Mayo Clinic.

[5] Holland K. Type 2 diabetes in children. Healthline.

[6] Child type 2 diabetes: Symptoms, causes &amp; treatments. WebMD.

Umna Salah

Madeeha Syed

A Short Guide To Local Addictions

Overview

Drug addiction is defined as &lsquo;a neuropsychological disorder leading to intense and persistent urge to use a substance.&rsquo; It overrides a person&rsquo;s self-control and his or her awareness of harmful effects by altering their brain function.&nbsp; 
Addiction is thus identified as a brain disorder and not a personal failure on the part of the individual. Much of the conversation around drug addictions needs to be remodeled based on these principles.&nbsp; 
When we talk about substance abuse in Pakistan our mind immediately conjures up a very particular image of cachectic men huddled in street corners trying to have their most recent hit. This, however, is not the whole picture.&nbsp; 
&nbsp;

Guide to Local Addictions

In recent years, drugs have become not only much more readily available but also cheaper. The youth of Pakistan from all classes and social strata has found themselves using one thing or another at some point. Those who manage to stay away from it have still been impacted by it in some way. Road accidents, broken <a href="https://merisehat.pk/article/love-in-a-long-term-relationship">relationships</a>, lagging behind in school and sports, overall health suffering as a result of these addictions, are just a few examples. Factors such as gender, age, class etc influence this and so does peer pressure and accessibility.&nbsp; 
 
Some of the most common local addictions we have are as follows, this list however is in no way comprehensive:&nbsp; 
&nbsp;

The most popular, most easily available, and a favorite amongst those who indulge. The psychoactive substance here is THC (tetrahydrocannabinol). Two forms of cannabis are available; hashish (hash) and charas (weed). The difference between both is the form they come in and the concentration of THC.&nbsp;

Hash has a more concentrated form of THC. It&rsquo;s either smoked by rolling in a cigarette or inhaled as a vapor by heating it up in a bong. Bhang is a mixture of cannabis and milk and is also widely consumed. Then there are cannabis teas, capsules, vapes and edibles.

It has been labeled as a gateway drug which means that the individuals indulging in this are open to experimenting with harder drugs in the future.&nbsp;

Locally, several cases have been reported where people (both children and adults) started out with smoking cannabis and ended up with addictions to harder drugs such as heroin and crystal meth.&nbsp;

In some areas the country, it&rsquo;s a part of the local culture, and happy occasions like weddings even call for it.&nbsp;

The main effects of cannabis are a feeling of euphoria and relaxation. Then there might sense of time slowing down, increased appetite, heightened senses and even paranoia and anxiety. All of these vary dramatically depending on the form, method and the person using it.&nbsp; 
&nbsp;

Pakistan has the largest cigarette-smoking populations in the world. In the era of harder drugs being accessible, cigarettes aren&rsquo;t even considered a taboo. People of all ages, genders and social strata partake in this and nicotine addiction is a major issue our population suffers from.&nbsp;

Nicotine is considered to be the culprit when it comes to forming a habit of smoking. However, it has been postulated that it is the unique combination of other chemicals added to cigarettes that may actually be facilitating the process.&nbsp;

Cigarettes contain over 7,000 chemicals and most of them are carcinogenic, what we fail to focus on is the fact that they also contain monoamine oxidase inhibitors (MAOIs). This compound is used in antidepressants and this is what leads to the characteristic &lsquo;smoker&rsquo;s high&rsquo;. A smoker&rsquo;s high is when you have increased serotonin in your brain making you feel happier.

Nicotine has other detrimental effects on the body, such as an increased heart rate and blood pressure, your blood vessels shrinking and of course the very obvious toxins introduced into the lungs. All this works together to wreak havoc on the body of the smoker while making sure that they never stop. Then there is the problem of second-hand smoke (which is very harmful for those inhaling it) which is a whole different beast of its own.&nbsp; 
&nbsp;

This is a sweet or savory mixture of crushed areca nut, tobacco, catcechu, paraffin wax, slaked lime and spices such as turmeric, cardamom, cloves, saffron. This is pretty much casually consumed by people usually belonging to the lower socio-economic classes.&nbsp;

They believe that it helps with digestion and killing germs. It also leads to a sense of euphoria, sweating, salivation, palpitation, feelings of warmth, alertness, tolerance to hunger, and a higher stamina for work.&nbsp;

Apart from the nicotine addiction this causes, gutka is a major cause of cancers of the lip, mouth, tongue, throat and esophagus. Supari is areca nut consumed on its own and is also linked with oral cancers some of which simply don&rsquo;t have a cure, such as oral submucous fibrosis. 
&nbsp;

This is derived from the poppy plant (papaver somniferum). Pakistan is a part of the golden crescent where, along with Afghanistan and Iran, 90 percent of the world&rsquo;s non-pharmaceutical grade opium is produced.&nbsp;

It is then transported through the region which makes it so readily available that can get it for as cheap as Rs10, which is cheaper than getting food here. Pakistan has therefore been called the most heroin-addicted country in the world. The active compound in the drug is morphine which has a soporific effect, hence the name. This is the main ingredient in many opioids, including heroin.&nbsp;

It can be smoked, eaten, taken as a pill or most commonly; injected. Sometimes in desperation and sometimes as a sign of brotherhood, needles are shared among the addicts. Around 92percent of PWID (people who inject drugs) were reported to practice &lsquo;booting&rsquo; or &lsquo;registering&rsquo; where blood is first jerked into the syringe and then this mixture is injected back into the system. These syringes are then shared.&nbsp; 
 
This leads to the rise of blood-borne infections and the main reason behind the HIV/AIDS crisis in the country. Hepatitis B and C are also on the rise and have the same etiology. Practices such as &lsquo;flashblood&rsquo; [khoon bozee] where another&rsquo;s opium laden-blood is injected into the body in times of scarcity, or to share the high, worsen this issue.&nbsp;

 
Harmful on its own, it is also added to marijuana joints and a mixture of marijuana, opium and heroin is also injected by some. People suffering from this particular affliction develop intense physical and psychological dependence on the drug. This has implications far and wide starting from health, work, family and ending with an added burden on the healthcare system.&nbsp; 
 
When brought to hospitals on account of either accidents or poor health requiring pain management, the bodies of these addicts fail to respond to the prescription drugs leading to severe physical and psychological distress. Helpless doctors try everything in their power to mitigate the condition but the only thing that works is what they have gotten used to. 
&nbsp;

Pakistan is one of the top 10 countries in the world where people are addicted to opioid analgesics or narcotics. These are strong prescription drugs used for pain management. Taking these in order to achieve feelings of general relaxation, happiness and a high which makes one feel as if they are weightlessly floating through life is what leads to addictions. 
 
Abusing these drugs can lead to severe adverse effects, however, the least of this is nausea, vomiting, reduced peristalsis hence constipation and the worst being respiratory depression leading to death.&nbsp; 
&nbsp;

This is an illegally brewed alcoholic drink made by fermenting sugar cane or wheat husk. Mostly consumed by teenagers, this is essentially a poison. The process happens in remote fields and has no check and balance. The hazardous effects of this are the usual alcohol-mediated liver damage but what&rsquo;s worse is that it leads to a loss of eye-sight as well.&nbsp; 
&nbsp;

Methamphetamine is a highly addictive nervous system stimulant and a recently growing addiction in a younger, more educated demographic. It can either be smoked, injected, snorted or taken by mouth. The feelings derived from this are your usual sense of euphoria but, most commonly, it leads to irritability and paranoia on the part of the user. 
 
People have reported increased focus and no loss of inhibition on this as well but most of this data is purely anecdotal. We know that this is a highly dangerous compound and can lead to strokes, convulsions and even death. It&rsquo;s also very difficult to treat meth addiction. 
&nbsp;

Bottom Line

Pakistan&rsquo;s Drug Abuse Control Master Plan 2010-14 had the lofty aspiration of making the country drug-free by 2020, this has clearly not been executed. A pragmatic approach is needed.&nbsp;

The Lancet (a weekly peer-reviewed general medical journal) reported a government official saying that the relapse rate in Pakistan is 90 percent. The UN Office of Drugs and Crime (UNODC) published a Technical Summary Report back in 2013 which reported that 6.45 million people (aged 15-64) in Pakistan were using drugs.&nbsp;

Things are much graver now and worsened by the fact that treatment and rehabilitation efforts are underfunded. Treatment centers that are cheap are overburdened, while others charge too much for an everyday man to afford. Tertiary care hospitals with psychiatry wards refuse to admit drug addicts and consider it a waste of time and resources. There is also a lack of training and staff. Much of the responsibility is relegated to the social welfare systems which fail to accommodate the sheer weight of the issue.&nbsp;

The best way to proceed would be a coordinated effort where treatment by the health department and rehabilitation by the social welfare system is provided. However, we are still lacking such efforts. Developing an effective response will require an in-depth understanding of the issue. We must raise awareness, fund efforts, stabilize the socio-economic condition of the region strict border control, conduct studies and surveys to assess the real magnitude of the issue (the last national survey dates back to 2013).&nbsp;

Dr. Safia Mehmood

A Detailed Guide To Breastfeeding – Beyond The Basics

Breastfeeding is an incredible natural process. Your baby gets all the nutrients they require during the first 6 months of their lives outside the womb.&nbsp;

&nbsp;

You can either give your baby milk straight from your breast or you can pump it for later use. The process of breastfeeding is also known as &ldquo;Nursing&rdquo;.&nbsp;

&nbsp;

In terms of texture and nutrients, breast milk is the best food for newborns. Most importantly, it is clean, hygienic and it contains antibodies that prevent many prevalent pediatric diseases.&nbsp;

&nbsp;

There are multiple benefits of breastfeeding. A majority of certified lactation consultants say &ldquo;It helps to restore the mother&#39;s uterus, stabilizes the baby&#39;s blood sugar, colonizes the baby&#39;s gut with beneficial bacteria for healthy digesting, and it encourages mother-baby bonding.&rdquo;

&nbsp;

According to WHO, nursing is the best source of nutrition for babies and infants<a href="#accordion">[3]</a>. It aims to increase awareness and ensure that at least 50% of babies born by 2025 are exclusively breastfed for the first 6 months.&nbsp;

&nbsp;

Understanding Benefits and Methods of Breastfeeding

Breastfeeding latching is how your baby is attached to your breast to get the milk. It&#39;s crucial to achieve a healthy latch. But the thing is it&rsquo;s often assumed that the process comes naturally when, in fact, both mother and baby need to practice for good latching.&nbsp;

&nbsp;

Since it might not go smoothly at first, how do you know your baby&rsquo;s got a good latch?

&nbsp;

A good latch gives you a sense of ease and ensures that your baby receives the <a href="https://merisehat.pk/article/milk-a-nutritional-powerhouse">maximum amount of milk</a>.&nbsp; 
&nbsp;

As a new mom, it&rsquo;s always best to consult a breastfeeding expert for advice on how a successful latch should be practiced.&nbsp;

&nbsp;

A successful latch can be recognized through these signs:

<ul>
	<li>The latch is painless and comforting.</li>
	<li>Your body should rest against your infant&#39;s chest and abdomen so their heads are straight and not tilted to one side.</li>
	<li>The chin of your infant rests on your breast.</li>
	<li>The entire breast, rather than just the nipple, is exposed when your baby&#39;s mouth opens widely.</li>
	<li>Your baby&rsquo;s lips should turn outward.</li>
	<li>Your baby&rsquo;s tongue should rest beneath your breast.</li>
	<li>Swallowing is audible or visible.</li>
	<li>Your baby&rsquo;s ears move slightly. 
	&nbsp;</li>
</ul>

Try these things if you&#39;re having difficulties getting a good latch:

<ul>
	<li>Go somewhere calm and quiet.</li>
	<li>Hold your child close to your breast.</li>
	<li>Let your child take charge. Support your infant&#39;s neck, shoulders, and hips with your hands. Offer your breast, but allow your child to discover your nipple independently. 
	&nbsp;</li>
</ul>

The following tips and tricks can help you get a good latch:

<ul>
	<li>Rub your nipple on your baby&rsquo;s lips. Your baby will automatically open their mouth.</li>
	<li>Position your nipple slightly over the top lip of your infant.</li>
	<li>Check whether the baby&#39;s chin is resting against your chest.</li>
	<li>Make sure your baby&rsquo;s bottom lip covers the complete nipple.</li>
	<li>Your baby&#39;s lips must be positioned to resemble those of a fish. Your infant should chin-first lead into the breast before latching onto it.&nbsp;</li>
	<li>Your breast should fill your baby&#39;s mouth and their tongue should be extended outward cupping your breast.</li>
</ul>

&nbsp;

Important!

<ul>
	<li>Repeat the nursing procedure if your baby only latches on the tip of the nipple or if the latch hurts you.&nbsp;</li>
	<li>Never pull out the nipple from your baby&#39;s mouth quickly and/or abruptly.&nbsp;</li>
	<li>Gently disengage the latch by placing a clean finger in the corner of your baby&#39;s mouth. 
	&nbsp;</li>
</ul>

Following is a list of some of the efficient nursing positions to help mothers. However, not&nbsp; every position will work for everyone.&nbsp; 
&nbsp;

1. Cradle Hold

The traditional breastfeeding position is called the cradle hold. The infant feeds in such a position that its stomach rests against the mother&#39;s body. Some women find it challenging to learn this position. Additionally, newborns can grow too big to maintain this position and the mother needs to substitute it for another position.

&nbsp;

2. Cradle-Cross Grip

For newborns, the cross-cradle is typically the optimal latch. It&rsquo;s similar in style to the cradle hold. The mother supports the infant with her arm and doesn&#39;t touch the breast the child is nursing from. This grip gives the mother better control over the baby&#39;s latch. Babies who have trouble getting a deep latch might benefit from this posture.

&nbsp;

3. Slouching Or Laying Down

This position encourages a baby&#39;s natural feeding reflexes as well as enables the mother to feed from a relaxed position. Some mothers position the baby with their toes pointed downward. Others feel that the baby is more comfortable when it is somewhat reclined.

&nbsp;

4. Sitting Baby

A newborn can breastfeed while sitting too when they are old enough to hold their heads up. This position has great appeal for babies who wriggle when they feel constrained.

&nbsp;

5. Side-Lying

It is the perfect breastfeeding position for women recovering from surgery. Moms who are tired from nursing at night can also go for this position. But, typically side-lying is preferred by women who co-sleep with their infants because those who don&rsquo;t would initially find it extremely cumbersome. It&rsquo;s a challenge to arrange themselves in this posture correctly. Even small babies could have trouble lying on their sides. 
&nbsp;

Do you feel hungry whenever you are breastfeeding your newborn? It&rsquo;s quite normal and there&rsquo;s a reason for it: the process of producing breast milk is exhausting for the body. While breastfeeding you require more calories overall and a larger intake of some specific nutrients.

&nbsp;

In fact, it&#39;s said that nursing increases daily energy requirements by roughly 500 calories<a href="#accordion">[2]</a>. In particular, a lactating mother needs more of:&nbsp;

<ul>
	<li>Vitamin B12</li>
	<li>Protein</li>
	<li>Vitamin D</li>
	<li>Vitamin E</li>
	<li>Vitamin A</li>
	<li>Vitamin C</li>
	<li>Zinc</li>
	<li>Selenium</li>
</ul>

&nbsp;

Eating a range of nutrient-dense foods is crucial for both your and your child&#39;s health. Choosing meals high in the nutrients mentioned above will help guarantee that both of you receive all the macro and micronutrients required at this stage. For this purpose, you can include the following in your diet: 
&nbsp;

Seafood And Fish

➔ Seaweed

➔ Salmon

➔ Sardine

➔ Shellfish 
&nbsp;

Poultry And Meat

➔ Lamb

➔ Chicken

➔ Beef

➔ Organ meats (such as liver) 
&nbsp;

Vegetables And Fruits

➔ Tomatoes

➔ Berries

➔ Bell Peppers

➔ Kale

➔ Broccoli

➔ Cabbage

➔ Garlic 
&nbsp;

Seeds And Nuts

➔ Walnut

➔ Almond

➔ Chia seed

➔ Hemp seed

➔ Flaxseed 
&nbsp;

Healthy Fats

➔ Olive oil

➔ Avocado

➔ Egg

➔ Coconut

➔ Full-fat yogurt 
&nbsp;

Fiber-Rich Starches

➔ Potato

➔ Sweet Potato

➔ Butternut Squash

➔ Beans

➔ Oat

➔ Lentils

➔ Buckwheat

➔ Quinoa 
&nbsp;

Other foods

➔ Tofu

➔ Dark Chocolate

➔ Kimchi

➔ Sauerkraut

&nbsp;

There&rsquo;s no doubt that specific supplements can assist in restoring your store of specific vitamins and minerals. Even after taking a healthy diet, supplements are still the most crucial aspect of nutrition during breastfeeding.

&nbsp;

New mothers lack crucial nutrients for a variety of reasons, such as:&nbsp;

<ul>
	<li>Improper diet</li>
	<li>Greater energy requirements to produce breast milk</li>
	<li>Caring for your infant</li>
	<li>Spending many nights (sometimes consecutively) with little sleep</li>
</ul>

&nbsp;

However, it&rsquo;s imperative to do your research before selecting supplements, as many contain chemicals and herbs that nursing women shouldn&#39;t consume. Consult your healthcare practitioner to find the supplements which are best suited for you.&nbsp; 
&nbsp;

Although it’s important to take a balanced diet while you are nursing, there are some things that mothers should consume only in limited quantities to protect their babies. These include: 1.	High-mercury fish2.	Herbal supplements3.	Alcohol4.	Caffeine5.	Processed foods

For some mothers, it&#39;s normal to experience engorged (extremely full) breasts for 2-5 days post birth, as your milk production increases. However, if you breastfeed (or pump) your child every 2-3 hours, your breasts shouldn&#39;t feel engorged.

&nbsp;

Engorgement causes breast infections or uncomfortable and painful breasts. They&rsquo;ll become even more painful and engorged the longer you delay breastfeeding or pumping.&nbsp;

&nbsp;

You can prevent it by:

<ul>
	<li>Using heated compresses. Try to express your milk manually or with a pump if you can&#39;t nurse your baby immediately. Placing your thumb over your areola and a finger beneath it is one method for expressing milk.</li>
	<li>Putting your thumb and fingers back against the wall of your chest, gently yet firmly. Then force your milk out by squeezing your fingers together.</li>
	<li>Massaging your breasts. 
	&nbsp;</li>
</ul>

Some mothers experience a brief period of discomfort at the start of a breastfeeding session. The discomfort should subside once their baby has latched on properly. While your baby feeds, you could feel a slight tug on your breasts, but nothing more than that and even that slight tug shouldn&#39;t hurt.

&nbsp;

If you experience persistent discomfort during breastfeeding, you should stop and move your baby to improve the latch. Your infant should have most of your nipple-areola (the ring surrounding the nipple) in their mouth.&nbsp;

&nbsp;

Each time your infant sucks, it would sting or feel like a pinch if the baby is still improperly latched on. This can eventually result in hurtful, sore, and cracked nipples.&nbsp;

&nbsp;

But incorrect attachment is just one of the reasons why a lactating mom experiences pain during or after nursing. Talk to your doctor or a lactation consultant to ensure that your baby is properly latching on and that nothing else is wrong. 
&nbsp;

The following are common causes of breast pain:

&nbsp;

<h5>The Milk Duct Is Blocked</h5>

Occasionally, milk ducts become blocked and the spot is painful to touch. You might also develop a lump under the skin due to blocked ducts. In order to relieve pain and clear the duct:

<ul>
	<li>Use warm compresses or warm showers to soothe the region.&nbsp;</li>
	<li>Religiously massage the region several times a day. Make sure to time it so that it coincides with your child&rsquo;s feed. After the massage, start nursing your child right away.</li>
	<li>During feeding, position your baby&#39;s chin properly to face the obstructed area. This will hasten the emptying of that portion of the breast.</li>
	<li>While your infant is nursing, gently massage the lump. It&rsquo;s unlikely that the lump would disappear in the first attempt; it takes 2-3 feedings at least for the blockage to clear.&nbsp;</li>
	<li>You can gently massage the area for a few minutes using a manual (hand) or electric pump to help draw out the blocked milk.</li>
	<li>Between feedings, use cold compresses (ice wrapped in a small cloth).</li>
	<li>If the lump is still there after a few days and/or is accompanied with a fever, chills, pains, or red streaks, it&rsquo;s time to consult a doctor.</li>
</ul>

&nbsp;

<h5>Mastitis&nbsp;</h5>

Breast tissue inflammation is called mastitis and can sometimes occur due to an infection.

&nbsp;

You might have mastitis if your breasts are tender, show red streaks, or have a firm, red region. Some women also feel unwell and they have flu-like symptoms like fever and chills. Call your doctor immediately if you suspect you have mastitis.&nbsp;

&nbsp;

Continue breastfeeding or using a pump to remove the milk from your breasts while you wait.

&nbsp;

Before nursing:

<ul>
	<li>Use warm compresses</li>
	<li>Light massage</li>
	<li>Use cold compresses&nbsp;</li>
</ul>

&nbsp;

Note: You might need antibiotics to treat mastitis brought on by an infection. 
&nbsp;

<h5>Oral Thrush</h5>

Oral thrush is a yeast infection that occasionally affects babies. Their lips, tongue, or inner cheeks turn pale or the condition causes yellowish areas and broken skin at the corners of their mouth.&nbsp;

&nbsp;

If the infection spreads to your breast, it might result in:

<ul>
	<li>Severe breast pain during or after feeding.</li>
	<li>Intense breast or nipple pain that continues even after your baby has successfully latched or after you&rsquo;ve stopped nursing.</li>
	<li>The nipples are broken, irritable, burning, pink, red, glossy, flaky, or covered in a rash with tiny blisters&nbsp;</li>
</ul>

&nbsp;

<h5>Flat Or Inverted Nipples</h5>

Women who already have flat nipples (nipples that don&#39;t get as upright as they need to whenever a baby is nursing) or inversion of nipples (nipples that turn in rather than stick out) may find it difficult to breastfeed or experience nipple pain frequently. If either of these situations applies to you, speak with your doctor or a lactation counselor about making nursing simpler and less painful. 
&nbsp;

<h5>&nbsp;</h5>

<h5>Before Feeding</h5>

<ul>
	<li>
	Initially, breastfeed on the less painful side and switch your nursing positions.
	</li>
	<li>Make sure your baby is properly latched onto your breasts. Alternatively, you could discharge your breasts more easily perhaps through pumping.</li>
	<li>A nipple shield might be helpful if you have sore nipples. Visit a lactation specialist or your doctor about this.&nbsp;</li>
	<li>Nipple shields are placed over the areola and nipple to cover sensitive or cracked nipples throughout a feeding. However, they should only be taken on doctor&rsquo;s recommendation because they occasionally influence milk production.</li>
	<li>Gently break the suction. You can do this by inserting one of your clean fingers between the gums on the side of your baby&rsquo;s mouth.</li>
	<li>Gently rub some breast milk over your nipples after a feeding and allow them to air dry. 
	&nbsp;</li>
</ul>

<h5>During A Feed</h5>

<ul>
	<li>
	Before you actually nurse your baby, massage the painful area gently.
	</li>
	<li>Before feeding, apply moist or dry heat to your breasts, like take a warm shower, or apply a heating pad or warm towel).&nbsp;</li>
	<li>Yeast loves moisture; you&#39;ll need to keep your nipples dry if you have a yeast infection in your breast. Stay hydrated and get proper sleep.</li>
	<li>After feedings, apply cool compresses or ice packs to engorged breasts.</li>
	<li>Make sure the space where you feed your baby is cozy and comfortable. A chair with armrests could provide that little extra support mothers need while nursing.&nbsp;</li>
	<li>Pillows and footstools are useful, too. Some ladies prefer &quot;husband&quot; back pillows with arms on each side or wraparound nursing pillows. 
	&nbsp;</li>
</ul>

What? You didn&rsquo;t think that was possible for this natural phenomenon? Having the correct equipment can be helpful if you intend to breastfeed your newborn. It pays to be ready because the first few days with your infant are typically pretty chaotic. You might be unsure which nursing products you require and which you can ignore as your needs are likely to change over time. There are some kits you might wish to have on hand, regardless of whether you go home immediately after giving birth or have to spend a few days in the hospital. Check out this handy list to see if you missed anything:

<ul>
	<li>Nursing bras, nursing vest tops, and night bras&nbsp;</li>
	<li>Nursing pajamas or nightdresses</li>
	<li>Breastfeeding helping pillow</li>
	<li>Washable or disposable nursing pads</li>
	<li>Muslin cloths</li>
	<li>Nipple or soothing cream for sore and burning nipples</li>
	<li>Nipple formers for inverted or flat nipples&nbsp;&nbsp;</li>
	<li>A book about breastfeeding</li>
	<li>Contact details of a lactation consultant, breastfeeding specialist, or helpline 
	&nbsp;</li>
</ul>

A lactation consultant or nursing professional may suggest using the following if breastfeeding doesn&#39;t go as planned:

<ul>
	<li>Nipple shields if your child has trouble latching on or even if you have sore nipples. Nipple shields should generally be viewed as a temporary fix. Consult a lactation consultant or nursing professional at your earliest convenience if issues or pain arise.</li>
	<li>A breast pump alleviates engorgement and assists you to produce/store enough milk.</li>
	<li>Cooling hydrogel pads are soothing for some new mothers after giving birth, especially when their milk production begins. 
	&nbsp;</li>
</ul>

Breastfeeding is one of the healthiest practices for moms and babies. Despite the fact that your body controls the composition of breast milk properly, research has revealed that everything you eat impacts the contents of breast milk<a href="#accordion">[1]</a>. In general, there are no forbidden foods. However, it is advised that women consume a balanced and diversified diet while lactating.&nbsp;

&nbsp;

The BF process may not be rocket science, but it needs proper counseling and practice. And while each pregnancy is unique and a lot of the experiments you do with your first child don&rsquo;t necessarily apply to your second or third, a lot of mothers enjoy this procedure once they&rsquo;ve &lsquo;gotten the hang of it&rsquo;. The fact that it&rsquo;s not their first time and they don&rsquo;t have to learn everything from scratch takes the stress out of it.&nbsp; 
&nbsp;

<ul><li>The healthiest nutrition for newborns and young children in breast milk.</li><li>The BF process requires proper counseling and practice.</li><li>For a good latch, it is important to adopt a proper latching process.</li><li>Although a balanced diet is always recommended to all nursing mothers, there are still certain foods that should be avoided, such as fish and alcohol. </li></ul>

[1] Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni M. Impact of maternal nutrition on breast-milk composition: a systematic review. Am J Clin Nutr. 2016;104(3):646-662. doi:10.3945/ajcn.115.120881

[2] Kominiarek MA, Rajan P. Nutrition Recommendations in Pregnancy and Lactation. Med Clin North Am. 2016;100(6):1199-1215. doi:10.1016/j.mcna.2016.06.004

[3] WHO, 2022. WHO. Breastfeeding.

All Work No Play Makes Jack A Dull Boy And Jill A Dull Girl

Physical activity is very important for a child&rsquo;s health. Children and adolescents who are active now are more likely to be active adults later. That&rsquo;s why it is imperative to promote an active lifestyle among children at an early age.

On one hand, a lack of movement is associated with obesity, <a href="https://merisehat.pk/disease/depression">depression</a>, and <a href="https://merisehat.pk/disease/anxiety">anxiety</a>, while on the other hand,&nbsp;physical activities have a positive impact on the social and psychological aspects of an individual&rsquo;s personality.&nbsp;

The sad reality is that more people are adopting a sedentary lifestyle these days. Staying indoors and spending time at home has become a norm. Children, especially, have become couch potatoes because they spend most of their time on their computers or tablets. This makes them dull and declines their cognitive skills or stamina. The only physical activity they indulge in is physical education (PE) at school, which unfortunately is optional, and not every child enrolls in it.&nbsp;

&nbsp;

Understanding Importance Of Childhood Physical Activity

It&rsquo;s unfortunate that despite knowing its benefits, there is a lack of physical activity among children in Pakistan. Parents play a crucial role in teaching their children the importance of physical activities. However, most of them are uninformed and are unable to persuade their children to indulge in healthy activities. So, parents should first acquaint themselves with the subject, before they talk to their children and encourage them to take up physical sports.

&ldquo;Active 1 + FUN&rdquo;, for instance, is one family-based intervention that has proven to be helpful. It&rsquo;s the parent&rsquo;s choice whether they prefer online materials or real-time interactive workshops to meet their child&rsquo;s basic psychological needs<a href="#accordion">[1]</a>. Parents exploring fun activities with their children can be a good bonding moment between the two, which can also enhance cooperation between them.&nbsp;

&nbsp;

Promoting physical activity among adolescents and children is very important for their growth and development. Additionally, it improves academic and cognitive performances. The World Health Organization emphasizes that children between the ages of 5 and 17 should spend at least 60 minutes per day on high-intensity physical activities, but only 20% of the children follow this rule of physical activity<a href="#accordion">[3]</a>. Furthermore, it was seen that girls between the ages of 13 and 15 lack physical activity in their daily routines compared to boys, and only 15.5% of them engage in it.&nbsp;

There are multiple reasons why children are inactive. For one, social norms and patriarchal ideologies in Asian countries deprive girls of taking part in sports activities or any other activities that require physical training. This has led to false perceptions perpetuated among teenage girls who think that games are only for boys.&nbsp;

Secondly, girls are more inclined toward social media, trending movies, and TV shows, while boys prefer online gaming<a href="#accordion">[4]</a>. However, the tide has been fast shifting and we now see both girls and boys enjoying sports and indulging in online gaming.&nbsp;

Unfortunately, for many children, they continue to lead a monotonous life, which involves school, homework, and lazing around at home in their free time.

&nbsp;

Circumstances are not always favorable for most children, considering the inflation and other constraints in our country. Here are some budget friendly activities that can be done:

<ul>
	<li>Drawing: Chalks can be a fun activity for children. Children can draw a maze on the floor or play hopscotch like the kids from the 90s. This activity is an encouragement for creativity and fitness.</li>
	<li>Dancing: The simplest way to get the kids moving is to play music and make them dance to the tunes. Parents can also engage in the activity with their kids. Studies show that dancing improves a person&rsquo;s health, calms them, and helps them sleep better at night<a href="#accordion">[5]</a>. Also, dancing is quite useful in reducing anxiety and depression<a href="#accordion">[6]</a>.</li>
	<li>Board Games: Board games are a great way to promote early learning in children. They help them identify colors,&nbsp;and develop hand-eye coordination and math skills.&nbsp;</li>
</ul>

&nbsp;

<h4>"Exercise is vital to managing stress. Find out your stress level with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>today!"</h4>

<ul>
	<li>Limit Screen Time: Parents should limit their children&rsquo;s screen time, which includes video games, tablets, and smartphones. If children are under the age of 5, their screen time should be less than 1 hour per day. Moreover, screen time is not recommended for kids under 2 years.</li>
	<li>Organised Sports: Organised sports, like football or cricket, are not enough to keep your children healthy. It&rsquo;s important to encourage them to stay active every day &ndash; a walk in the park and jumping rope are low-cost exercises that they can opt for.</li>
	<li>Skip The Elevator: When parents are out with their kids, they should encourage them to use the stairs instead of the elevator.&nbsp;</li>
	<li>Make Them Help Out: Whether it is grocery shopping or doing house chores, letting the children help ensures they are not only active but also learn essential life skills.</li>
</ul>

&nbsp;

<ul>
</ul>

<ul>
	<li>Growth: Exercise is as important as food for children to grow. It helps to build stronger muscles and bones. A healthy bone density or bone mass reduces the risk of bone-related diseases, such as osteoporosis, later in life.</li>
	<li>Better Fitness: Exercise helps build physical strength, which has multiple benefits for growing children. For example, they can walk longer distances and not get tired, they are more active, and they perform everyday tasks without getting lethargic. Additionally, exercise promotes stability and flexibility.</li>
	<li>Motor Skills: Physical activity builds motor skills that help children master basic movements. Motor skills include all tasks like feeding themselves, writing, and getting dressed.</li>
	<li>Posture: Children are habitual of slouching and exercise can improve their posture through core strength. Moreover, it protects the spine from deformity&nbsp;and reduces pain due to bad posture.</li>
	<li>Cognitive Development: Exercise helps in brain development. During exercise, the nerve cells in the hippocampus and the prefrontal cortex of the brain multiply to form new connections<a href="#accordion">[7]</a>. This improves concentration and memory, which are the basic needs of every child.</li>
	<li>Mental Health: Although most children dread exercising, it helps in relieving stress and anxiety<a href="#accordion">[8]</a>. The endorphin rush promotes a better mood.</li>
</ul>

&nbsp;

<ul>
</ul>

<ul>
	<li>Physically active kids are happier kids.</li>
	<li>Exercise strengthens the bones and muscles, and prevents the children from gaining excess weight. Consequently, it reduces the risk of other diseases, like diabetes, osteoporosis, and cancer.</li>
	<li>Physical activity is also beneficial for mental health.</li>
	<li>Exercise also enables children and adolescents to have a better outlook on life. They are confident and have better cognitive and stress management skills.</li>
	<li>The release of endorphins during exercise positively correlates to happiness in children.</li>
</ul>

&nbsp;

[1] Ha, A.S., Ng, J.Y., Lonsdale, C., Lubans, D.R. and Ng, F.F., 2019. Promoting physical activity in children through family-based intervention: Protocol of the “Active 1+ FUN” randomized controlled trial. BMC Public Health, 19(1), pp.1-12.

[2] Habib, M.B., Nazeer, M.T., Mahfooz, M. and Safdar, M.S., 2022. Physical activity in Pakistani perspective: issues, implications, and recommendations. Journal of the Pakistan Medical Association, 72(2), pp.322-328.

[3] Imtiaz, A., ulHaq, Z., Afaq, S., Khan, M.N. and Gillani, B., 2020. Prevalence and patterns of physical activity among school aged adolescents in Pakistan: A systematic review and meta-analysis. International Journal of Adolescence and Youth, 25(1), pp.1036-1057.

[4] Lu, A.S., Baranowski, T., Hong, S.L., Buday, R., Thompson, D., Beltran, A., Dadabhoy, H.R. and Chen, T.A., 2016. The narrative impact of active video games on physical activity among children: a feasibility study. Journal of medical Internet research, 18(10), p.e6538.

[5] Gyrling, T., Ljunggren, M. and Karlsson, S., 2021. The impact of dance activities on the health of persons with Parkinson’s disease in Sweden. International Journal of Qualitative Studies on Health and Well-being, 16(1), p.1992842.

[6] Adam, D., Ramli, A. and Shahar, S., 2016. Effectiveness of a combined dance and relaxation intervention on reducing anxiety and depression and improving quality of life among the cognitively impaired elderly. Sultan Qaboos University Medical Journal, 16(1), p.e47.

[7] Bidzan-Bluma, I. and Lipowska, M., 2018. Physical activity and cognitive functioning of children: a systematic review. International journal of environmental research and public health, 15(4), p.800.

[8] Alves, J.M., Yunker, A.G., DeFendis, A., Xiang, A.H. and Page, K.A., 2021. BMI status and associations between affect, physical activity and anxiety among US children during COVID‐19. Pediatric obesity, 16(9), p.e12786.

Humza Khizer

ADHD: Unsolicited Opinions Or Facts?

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders. It is diagnosed in the early years of life, and continues to exist until adulthood<a href="#accordion">[5]</a>.

&nbsp;

Individuals diagnosed with ADHD have trouble focusing and directing complete attention to one objective. They may submit to urges frequently, exhibiting a lack of discipline. In reality, it&rsquo;s not in their hands to control their impulsive behavior (act without thinking about consequences), or being restless or overactive<a href="#accordion">[5]</a>.

&nbsp;

What is concerning is the negative stigma associated with a disorder. It&rsquo;s mainly why it took a long time to recognise ADHD as a disorder because the symptoms were often attributed to bad behavior, especially in kids who were easy targets for disciplinary action.

&nbsp;

Moreover, earlier studies would characterise and generalize ADHD by specific traits only, such as a short attention span and impulsiveness. This ableist behavior not only hindered the progress of the disorder but also demoralised countless individuals whose struggles were disregarded callously.

&nbsp;

Even now, when ADHD is the most researched neurodevelopmental disorder, it faces countless unwarranted opinions that do not hold any basis; societal taboos and bizarre rumours demoralize and shame individuals diagnosed with the condition. But NOT ANYMORE. This article has been drafted to debunk all the common &lsquo;logo ki baatein&rsquo;, and challenge the stigma that prevents individuals from reaching out.

&nbsp;

Understanding ADHD

This might be a no-brainer (pun intended), but any neurodevelopmental disorder means it is actually in someone&rsquo;s head.

&nbsp;

However, we all know such a statement alludes to how ADHD is not an authentic illness, and should not be dealt with proper treatment options. Statements along similar lines dampen the progress towards a more inclusive world, where pain and discomfort are not only associated with physical factors but also undergo assessment through nonphysical aspects.

&nbsp;

While critics would argue how the new renaissance of political correctness has seen a rise in cases of ADHD, historians would refute this by quoting medical journals and publications of this neurodevelopmental disorder, from as early as 1775. These references are now supported with more advanced and substantial theories<a href="#accordion">[2]</a>. Such profound and elaborate research has proven how ADHD deserves the recognition and status of any other physical ailment, as it causes impactful changes in an individual&rsquo;s life.

&nbsp;

It is easy to distinguish individuals with ADHD from those without, as this disorder causes social anxiety, emotional turmoil, academic struggles, and difficulty in performing occupational tasks<a href="#accordion">[12]</a>.

&nbsp;

The &ldquo;ADHD tag&rdquo; is not an elaborate scheme to garner more attention. Rather, it is a complex, intricate, and sometimes, permanent disorder that brings about a range of symptoms that individuals must learn to manage throughout their lifetime.

&nbsp;

ADHD runs in families. There&rsquo;s a 57% chance that a kid of a parent diagnosed with ADHD also inherits it. And there is a staggering 70-80% probability for a twin to have ADHD, if the other twin has been diagnosed with it<a href="#accordion">[2]</a>.

&nbsp;

Repeated brain scans for numerous cases have been studied to concentrate on the contrasts in the progression of the brain, and how the patterns affect people&rsquo;s functioning. For example, cortical diminishing in the front-facing areas, decreased volume in the inferior frontal gyrus, and decreased grey matter in the parietal, temporal, and occipital cortices<a href="#accordion">[8]</a>.

&nbsp;

One would assume that the high prevalence of a neurodevelopmental disorder, especially in children, would prompt individuals to participate in academic and research-based investigations. But nope. People find more creative ways to blame it on factors that have little to almost no contribution to the development of ADHD. Associating a mental disorder with poor parenting practices is not even a myth, but a shallow attempt to trivialize the severity of ADHD.

&nbsp;

Scientists are now holding hereditary and genetic makeup as probable factors responsible for ADHD.

&nbsp;

Other neurological factors have also been listed. For example complications during birth and gestational periods, visible signs of brain damage, exposure to poisons and harmful substances; and history of infectious contaminations as the primary drivers of ADHD, as opposed to social variables which includes poor nurturing.

&nbsp;

Investigations of twin children with ADHD show that the family conditions of such children contribute extraordinarily little to their singular distinctions in ADHD symptoms<a href="#accordion">[2]</a>.

&nbsp;

However, it should be noted that even though nurturing practices have yet not been deduced to cause ADHD, they can add to the deterioration of coexisting and coinciding issues, like oppositional defiant disorder (ODD) or conduct disorder (CD). And conflicting parental discipline, along with an unequal maternal and paternal contribution, can create a debilitating environment for the improvement of ADHD symptoms<a href="#accordion">[6]</a>.

&nbsp;

To summarise, a child&rsquo;s tendency to be impatient while waiting for their turn in a queue, to answer a question, or a child&rsquo;s inability to remain seated throughout a class are not testaments to their poor upbringing. But they could be an indication of complex chemical activity that compels the brain to react and respond in that manner.&nbsp;

&nbsp;

This is less of a stigmatized myth and more of a disappointing result of institutional sexism in medicine, a field that was previously dominated by men and demonstrated the male body to be the natural form of human life. Such a presumption prevented earlier doctors from witnessing the different symptoms of ADHD in boys and girls. There is such an indubitable disparity that the ratio of boys diagnosed with ADHD to girls is 9:1<a href="#accordion">[13]</a>.

&nbsp;

The symptoms that are typically exhibited, such as inattentiveness or talkativeness, are frequently credited to gendered stereotypes. Therefore, they are often neglected. Consequently, unsatisfactory and sub-par accomplishments and fickle mood swings tend to influence these young girls&#39; performance in school and familial situations<a href="#accordion">[3]</a>.

&nbsp;

Such gender bias in the diagnosis of any disease, including ADHD, could be detrimental to the marginalised group. If any symptoms of ADHD are not managed responsibly and professionally, young girls could transition into women with their untreated symptoms. Not only would they be forced to endure the struggles of an average adult, but they would have to deal with a persistent sense of underachievement and failure, be more at risk to go through substance abuse, have a higher chance of developing eating disorders, or facing financial difficulties due to poor organization and impulsivity<a href="#accordion">[1]</a>. They might struggle as mothers themselves. And, if they have children with ADHD, they&rsquo;d unfortunately not be able to immediately grasp or bring to anyone&rsquo;s notice the same symptoms as something that should be treated professionally.

&nbsp;

It is vital to not only exclusively broaden research tests and work on the existing methods of diagnosis, but to also spread public awareness regarding ADHD.

&nbsp;

Contemporary medicine has suggested how deceiving and falsely titled the name of such a multifaceted neurodevelopmental disorder is. Because it is associated with distinctive and loud traits; any symptom that is not eponymous with the name is not considered a serious factor.

&nbsp;

Doctors have now declared that there are 3 types of ADHD, where one is validated by hyperactivity; the other two, such as the inattentive presentation or the combined presentation are corroborated through different signs and symptoms<a href="#accordion">[9]</a>.

&nbsp;

Those diagnosed with the inattentive presentation type of ADHD exhibit repeated loss of trail of thought, frequent careless or inattentive mistakes, difficulty in remembering key points or important dates, lack of consistency, and being messy and unorganised. But these are not the only symptoms of ADHD<a href="#accordion">[11]</a>.

&nbsp;

Likewise, hyperactive-impulsive ADHD prompts the individual to go through a surge of inexplicable energy, but they may also demonstrate other alarming symptoms such as being frustrated easily, going through unchecked mood swings, being extremely impatient, interrupting people, or not being able to remain quiet for a prolonged time<a href="#accordion">[11]</a>.&nbsp;

&nbsp;

Puberty-induced growth spurts will allow children to grow out of their teenage wardrobes, but the same cannot be said about neurodevelopmental disorders such as ADHD.

&nbsp;

With early diagnosis and regular medications and therapies, symptoms may become manageable. Again, this is not the case for all. Longitudinal studies were carried out to observe different children diagnosed with ADHD at a young age. They found that there is a high probability of ADHD continuing from youth to pre-adulthood in approximately 50% - 80% of all cases, and into adulthood in 35% - 65% of all cases<a href="#accordion">[10]</a>.

&nbsp;

One research, that lasted 16 years, was conducted among groups of young men with ADHD. It concluded that a staggering 77% persisted in having full or sub-threshold DSM-IV ADHD<a href="#accordion">[3]</a>.

&nbsp;

Another notable investigation studied a target population of girls aged 6-12 years diagnosed with childhood ADHD. They discovered after 10 years of follow-up, most members of the sample population kept on having higher rates of ADHD and coexisting disorders, including but not limited to, recurrence of suicidal and intrusive thoughts, as compared to women without ADHD<a href="#accordion">[7]</a>.

&nbsp;

Because ADHD is disguised, it cannot be improved or modified
through physical therapies, such as bandages, stitches, or plasters. It is
easier and more convenient for people to judge and believe misconceptions when
they or a loved one is not the one dealing with it 24/7. But we owe it to our
better judgment, our ability to question, and our will to learn more about a
disorder that ostracises individuals simply because they were diagnosed with a
neurodevelopmental disorder, that too through no fault of their own. If you
suspect someone might have ADHD, it’s best to consult licensed practitioners
and authentic medical journals for facts, rather than indulging in idle talk.

<ul><li style="margin-bottom: 0in; border: none;">ADHD is a neurodevelopmental
disorder that affects countless individuals. It can be categorised into the
impulsive-hyperactive presentation, inattentive
presentation, or combined presentation.<o:p></o:p></li><li style="margin-bottom: 0in; border: none;">ADHD is a real disorder and
can have debilitating impacts on an individual’s life, if it’s not treated.<o:p></o:p></li><li style="margin-bottom: 0in; border: none;">Risk factors include
hereditary qualities, neurological factors, pregnancy-related complications, and brain damage. Lack of adequate
parenting does not cause ADHD.<o:p></o:p></li><li style="margin-bottom: 0in; border: none;">Girls are diagnosed less
frequently than boys, but this is because girls are referred to professional
therapists and practitioners less frequently. They also develop different
symptoms.</li><li style="border: none;">Most people do not grow out of
ADHD; only their symptoms are better managed through continuous treatment.&nbsp;</li></ul>

[1] Adelizzi, J. (1998). Shades of trauma. Plymouth, MA: Jones River Press.

[2] Barkley, R. A. (2015). History of ADHD. In R. A. Barkley, Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th ed (pp. 356-390). New York, NY: Guilford Press.

[3] Biederman, J., Faraone, S., Mick, E., Williamson, S., Wilens, T., Spencer, T., . . . Zallen, B. (1999). Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 966-975.

[4] Biederman, J., Petty, C. R., Woodworth, K. Y., Lomedico, A., Hyder, L. L., & Faraone, S. V. (2012). Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. The Journal of clinical psychiatry, 73(7), 941-950.

[5] Centers for Disease Control and Prevention (CDC). (2021, September 23). What is ADHD?

[6] Ellis, B., & Nigg, J. (2009). Parenting Practices and Attention-Deficit/Hyperactivity Disorder: New Findings Suggest Partial Specificity of Effects. Journal of the American Academy of Child & Adolescent Psychiatry 48(2), 146–154.

[7] Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of consulting and clinical psychology, 80(6), 1041-1051.

[8] Matthews, M., Nigg, J. T., & Fair, D. A. (2014). Attention deficit hyperactivity disorder. Current topics in behavioral neurosciences, 16, 235–266.

[9] Morin, A., & Cunnigham, B. (2014). 8 common myths about ADHD. Understood.

[10] Owens, E. B., Cardoos, S. L., & Hinshaw, S. P. (2015). Developmental Progression and Gender Differences among Individuals with ADHD. In R. A. Barkley, Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th ed (pp. 223-255). New York, NY: Guilford Press.

[11] Pugle, M. (2022, June 6). 8 Myths About ADHD, Debunked. Everyday Health.

[12] Roberts, W., Milich, R., & Barkley, R. A. (2015). Primary Symptoms, Diagnostic Criteria, Subtyping, and Prevalence of ADHD. In R. A. Barkley, Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th ed (pp. 51-80). New York, NY: Guilford Press

[13] Skounti, M., Philalithis, A., & Galanakis, E. (2007). Variations in prevalence of attention deficit hyperactivity disorder worldwide. European journal of pediatrics, 166(2), 117–123.

Zarlish Kazmi

Monkeypox In Children

Being a parent is not easy, especially during a pandemic. You are left worrying about the safety of your child, often from a disease that is not fully understood. The <a href="https://www.merisehat.pk/disease/covid-19">COVID pandemic</a> brought with it several uncertainties for both adults and children.&nbsp; 
&nbsp;

Although the novel coronavirus was once thought to only cause severe infections in the elderly and adults, cases in children soon became widely prevalent across the world. Moreover, it has been known to cause long COVID and multisystem inflammatory syndrome in children (MIS-C)<a href="#accordion">[1].</a>&nbsp; 
&nbsp;

But COVID is not the only disease that parents are concerned about right now. Several diseases are now causing outbreaks across the world. From hepatitis to <a href="https://www.merisehat.pk/disease/monkey-pox">monkeypox</a>, parents have a lot to look out for.&nbsp; 
&nbsp;

On 23rd July 2022, the World Health Organization declared the ongoing <a href="https://www.merisehat.pk/disease/monkey-pox">monkeypox outbreak</a> a Public Health Emergency of International Concern<a href="#accordion">[2]</a>. As per WHO&rsquo;s estimates, more than 30,000 monkeypox cases have been reported globally since the start of this year<a href="#accordion">[3]</a>.&nbsp;A majority of the cases occurred in the European region, but several other countries have also recorded infections.&nbsp; 
&nbsp;

Researchers believe that the reported number of cases is likely an underestimation as most countries lack surveillance mechanisms and are inadequately equipped to diagnose the infection. The number of cases has been high in non-endemic regions, which is alarming to say the least.&nbsp; 
&nbsp;

While a majority of the cases have had an atypical presentation, with a greater incidence seen among gay men, it occurs in children, too. According to the WHO, more severe infections are seen among children. Furthermore, the case fatality ratio of monkeypox is higher among young children<a href="#accordion">[4].</a> 
&nbsp;

Monkeypox is a zoonotic viral disease that primarily occurs in tropical rainforest areas of Central and West Africa. Monkeys, squirrels, and rats are considered natural hosts of the monkeypox virus.&nbsp; 
&nbsp;

The virus is transmitted to humans whenever there is a close contact with an infected animal or contaminated materials. Human-to-human transmission results from exposure to infected bodily fluids, respiratory droplets, fluid from the lesions, or sharing of bedding and surfaces that are contaminated with the virus.&nbsp; 
&nbsp;

Moreover, the transmission of the virus from the mother to the fetus via the placenta and during birth is also possible.&nbsp; 
&nbsp;

The incubation period for monkeypox ranges from 5-21 days. During the prodromal stage, a person might experience fever, headache, enlarged lymph nodes, muscle aches, back pain, and fatigue.&nbsp; 
&nbsp;

Approximately 1-3 days after the fever, a rash begins to appear on the face, hands, and feet. In 70% of cases, the rash affects the oral mucous membranes; 30% of cases have a rash on the genitals, and 20% on the conjunctivae<a href="#accordion">[4]</a>. 
&nbsp;

The rash initially begins as a flat macule that evolves into a papule (vesicle filled with clear fluid), and then a pustule filled with yellowish pus. Eventually, the pustules will crust and fall off. In severe infections, the skin lesions can merge, causing the skin in the area to slough off.&nbsp; 
&nbsp;

However, the current outbreak has led to atypical symptoms in people. The symptoms include:

<ul>
	<li>Few or just a single lesion</li>
	<li>Absence of skin lesions</li>
	<li>Anal pain and bleeding</li>
	<li>Skin lesions at different stages of development (as seen in chickenpox)</li>
	<li>Skin lesions appearing before the onset of fever and other symptoms&nbsp; 
	&nbsp;</li>
</ul>

Monkeypox is typically a self-limiting disease. However, immunocompromised children might have complications, like secondary infections, pneumonia, sepsis, and a corneal infection causing vision loss and encephalitis.&nbsp;

&nbsp;

Understanding Monkeypox In Children

The signs and symptoms of monkeypox in children are similar to that seen in adults. Fever, swollen lymph nodes, and a rash are common in younger people. The rash looks like a pimple or blister and appears on the face, mouth, or on extremities.&nbsp; 
&nbsp;

Since several other diseases also cause a rash in children, it is possible to confuse monkeypox with other illnesses, including:

<ul>
	<li>Chickenpox</li>
	<li>Hand, foot, and mouth disease</li>
	<li>Measles</li>
	<li>Scabies</li>
	<li>Molluscum contagiosum</li>
	<li>Herpes</li>
	<li>Allergic skin rashes 
	&nbsp;</li>
</ul>

The beginning of a new school year has increased the risk of monkeypox among children. Since the virus can stay in the environment for long periods, contaminated toys and surfaces in school and daycare settings typically lead to further cases among children. Especially in areas where monkeypox cases have been reported during the outbreak.&nbsp; 
&nbsp;

According to the CDC, the following children are at risk of severe disease<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>Children under 8 years of age</li>
	<li>Immunocompromised children and adolescents</li>
	<li>History of skin conditions, such as eczema or atopic dermatitis</li>
	<li>Children and adolescents with atypical symptoms involving the genitals, eyes, or face</li>
</ul>

&nbsp;

While the majority of monkeypox infections are mild in children, ensure that the lesions are kept covered. Scratching the rash or touching the eyes can spread the infection further and cause more severe illness in children. It is also important to frequently change the bedding if your child is infected.&nbsp; 
&nbsp;

Although most monkeypox cases are self-limiting, severe cases require immediate treatment The CDC recommends tecovirimat for children and adolescents at risk of severe disease<a href="#accordion">[5]</a>. Remember, treatment should only be started after consultation with a doctor. 
&nbsp;

Along with medications, vaccines are also available to protect children who might have been exposed to the virus. The smallpox vaccine has shown to be 85% effective at preventing monkeypox<a href="#accordion">[4]</a>.&nbsp;Recently, the US Food and Drug Administration (FDA) approved the emergency use of the JYNNEOS vaccine in people with a history of exposure to monkeypox and children at high risk of infection<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

The following measures can help protect your child from contracting monkeypox:

<ul>
	<li>Practice frequent handwashing</li>
	<li>Avoid contact with infected individuals or suspected cases</li>
	<li>Stay up to date with other childhood vaccinations</li>
	<li>Get your child vaccinated against monkeypox in case of exposure&nbsp;</li>
</ul>

&nbsp;

Due to a low number of cases from the recent outbreak, there is limited data available on monkeypox in children. Although children can get monkeypox, researchers believe the risk remains low. Moreover, several other diseases can also cause rash in children. However, if you live in a country where monkeypox cases have been reported, it's best to get your child’s rash checked by a pediatrician.&nbsp;

<ul>
	<li>Monkeypox is a zoonotic viral disease that results from an infection with the monkeypox virus. Human-to-human transmission results from exposure to infected bodily fluids, respiratory droplets, fluid from the lesions, or bedding and surfaces contaminated with the virus.</li>
	<li>Signs and symptoms of monkeypox include fever, headache, swollen lymph nodes, and a rash that typically begins on the face. In children, the rash resembles a blister or pimple and appears on the face, inside the mouth, or on the hands and feet. However, several other diseases can also cause a rash in children. These include chickenpox, hand, mouth, and foot disease, allergic skin rash, scabies, measles, and molluscum contagiosum.&nbsp;</li>
	<li>Children under 8 years of age with skin conditions such as eczema or those who are suffering from immunocompromised illnesses are at a higher risk of severe infection and complications of monkeypox.</li>
	<li>Monkeypox should be considered in a child presenting with rash, especially if there&#39;s a history of contact with an infected individual, or if one lives in a region with recent monkeypox cases.&nbsp;</li>
	<li>The FDA recommends the use of the JYNNEOS vaccine in adults as well as those under 18 years of age and at high risk of monkeypox infection. Other preventive measures such as frequent hand washing and avoiding contact with confirmed or suspected cases can reduce the risk of infection in children.&nbsp;</li>
</ul>

&nbsp;

[1] Howard-Jones AR, Burgner DP, Crawford NW, et al. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022;58(1):46-53. doi:10.1111/jpc.15811

[2] Who director-general declares the ongoing monkeypox outbreak a public health emergency of international concern. World Health Organization.

[3] WHO Health Emergency Dashboard. World Health Organization.

[4] Monkeypox. World Health Organization.

[5] Clinical considerations for Monkeypox in children and adolescents. Centers for Disease Control and Prevention.

[6] FDA. Monkeypox update: FDA authorizes emergency use of JYNNEOS vaccine to increase vaccine supply. U.S. Food and Drug Administration.

Nimrah H. Sattar

Healthier Ways Of Disciplining Children

Raising children is a behemoth task and is not for the weak of heart. The adverse impact of certain parenting techniques and styles has been well documented and we are globally arriving at the conclusion that &lsquo;soft parenting&rsquo; is really the only thing that can help you raise a happy and healthy child. Even in communities that were previously known for being stern with kids, we are observing a shift towards healthier practices.&nbsp;

The discussion on these practices started sometime in the mid-20th century and is now almost the norm but still not as prevalent as we&rsquo;d like it to be. Soft parenting or healthier ways of discipline children calls for adults who are emotionally well regulated. It is criticised for raising &lsquo;snow flakes&rsquo; and most proponents of &lsquo;tough love&rsquo; don&rsquo;t believe in its efficacy. However, expert opinion states that there needs to be a healthy balance of both. 
&nbsp;

Healthier practices

American Academy of Pediatrics suggests 10 best strategies in order to effectively practice healthier ways of disciplining children:

&nbsp;

<ul>
	<li>Lead By Example: If you want your children to behave in certain ways then the best way to go about it is showing them. Children learn more from observing how their parents behave instead of simply following directions.&nbsp;</li>
</ul>

For example, if a whole jar of jam smashes on the floor, responding with calm words and deliberate, slow action shows them that there&rsquo;s no need to lose their cool. Similarly, the way you talk to your spouse, especially in tough circumstances, shows your kids how to talk to their peers and siblings.&nbsp;

&nbsp;

<ul>
	<li>Set Boundaries: It helps when you can talk to your child and communicate exactly what is expected of them. The best way to go about it is to physically get on their level, so it doesn&rsquo;t seem like they are being given orders. This has been shown to help kids understand these limits better and not be afraid of the parental figure. Calmly explain to your child what they are and are not allowed to do. A simple &lsquo;No.&rsquo; does wonders in most cases and so do clear directions.</li>
</ul>

&nbsp;

<ul>
	<li>Listen To Your Child:&nbsp;This is another great way to address misbehavior if you have noticed a pattern or repeated offences. For example, in cases where your child is being rude or physically hurtful to a younger sibling they feel jealous of. Sit your child down and ask them why a certain behavior is being repeated over and over again and how you can help them feel better.</li>
</ul>

Chances are they&rsquo;ll let you know right away and you can then find a solution together. Children tend to honestly communicate how they feel when provided a safe space to do so. Another important thing to do in this case is letting your child know that uncomfortable emotions are natural but the ways we express them might be good or bad. Discuss with them some healthy tools to deal with these emotions.

&nbsp;

<ul>
	<li>Communicate Consequences: The reward and punishment principle has great implications. Communicating the consequences of unsavory behavior to your child can really help drive change. The most important thing in this case is to follow through with these warnings. In the age of every little facility being provided to children, it&rsquo;s not too hard to follow either. For instance, you can tell the child that their iPad will be taken away if they are not being nice to their siblings. Or they will not be allowed access to their toys if they use foul language. However, it&rsquo;s important to remember that these consequences aren&rsquo;t grave such as being denied meals or kind parental attention.</li>
</ul>

&nbsp;

<ul>
	<li>Be Attentive: Being attentive and present in your child&rsquo;s life is the best way to drive good manners. You can model what you want to see and they&rsquo;ll copy you. Being around also ensures nothing slips by you and you can weed out anything you don&rsquo;t want to see early on.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Praise The Good Behavior: Reprimanding bad conduct is not all that goes into discipline. Positive feedback and encouragement also goes a long way to drive good habits. Start giving your child little chores to do when they are of age, for example asking them to put their toys away when they are done playing. When your child follows through with these and acts in a way you would like to see more of, praise them. Be specific about it and let them know they did a good job.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Ignore Some Bad Behavior: In many cases, when you can be sure that your child won&rsquo;t end up hurting himself, ignoring bad behavior is one of the best strategies. This lets the child figure out the consequences of their actions on their own and therefore showcase responsibility in the future. For instance, if they break a certain toy they can&rsquo;t play with anymore. Taking no notice of it means they know that they can&rsquo;t continue to do so before they run out of toys to play with.</li>
</ul>

&nbsp;

<ul>
	<li>Anticipate Bad Behavior: This ties in with the second step of setting clear boundaries and limits. In cases where you know that your child might be prone to a tantrum, such as playdates where fights over a certain toy will break out, warning your kid beforehand does wonders. Explain to them calmly that you understand how they might feel about this situation and how they can mitigate those feelings when in the thick of it. Make it clear that you expect them to behave amicably when this happens. This lets them know that the parent is aware of their discomforts already hence the need to create a havoc is eradicated. The most common reason behind temper tantrums is exhaustion and hunger, well-timed naps and meals help alleviate this.&nbsp; 
	&nbsp;</li>
</ul>

<ul>
	<li>Redirection: Boredom is perhaps one of the biggest reasons children end up misbehaving. It gives them something to do and it gets them attention. Redirecting this energy into healthier tasks such as coloring books, story books, board games, sport activates etc. is a great way to discipline your child. 
	&nbsp;</li>
</ul>

<ul>
	<li>Time-outs: This is perhaps the most effective tool in disciplining kids. Calling a time-out when your child misbehaves leaves them with space to ponder over their actions. A good rule of thumb is one minute per year of age. Another great way to go about this is telling your child to go take a time-out and come back when they can manage to conduct themselves properly and be in control of their emotions. This works especially well in case of tantrums.&nbsp; 
	&nbsp;</li>
</ul>

Bottom line

Parenting is a tough job at the best of times and at the same time it can be the most rewarding. There are a ton of parenting apps available that can help you throughout your journey as well. It really does take a village but it&rsquo;s the only way the village can thrive. So, be generous, kind and smart about it. Be gracious with yourself and your child, understand your own triggers and learn to manage your emotions well. This ensure that you show up as the best version of yourself for your kids. If you do make a mistake, which you inevitably will, apologize to your child for it. Similarly, ensure that you follow through with real moments of love and connection after a tough day or after you have had to reprimand your kid. This lets the child know that you have their best interest at heart and are always a safe and secure place they can return to.&nbsp;

Unmasking The Unseen Wounds: How To Recognize Signs Of Emotional Abuse

Emotional abuse is a subtle but devastating form of mistreatment that can leave deep psychological scars. Unlike physical abuse, its wounds are not visible, but its impact can be just as severe. Recognizing signs of emotional abuse is crucial in order to protect oneself or others from its detrimental effects. This article sheds light on the intricacies of emotional abuse, its manifestations, and offers guidance on how to recognize its hidden signs. 
&nbsp;

Understanding Emotional Abuse

Emotional abuse is a pattern of behaviour designed to undermine an individual&#39;s self-esteem, confidence, and sense of self-worth. This type of abuse doesn&#39;t involve physical harm, but it can be just as damaging, if not more so, because its effects are internal and insidious. Perpetrators of emotional abuse often manipulate, belittle, and control their victims, leaving them feeling powerless and trapped. 
&nbsp;

Signs Of Emotional Abuse

<ol>
	<li>Constant Criticism: A hallmark of emotional abuse is relentless criticism. An abuser might criticize every aspect of their victim&#39;s life, from appearance to choices, in an effort to erode self-confidence.</li>
	<li>Isolation: Emotional abusers often isolate their victims from friends and family, making them solely dependent on the abuser for emotional support. This isolation creates an environment where the victim feels trapped and unable to seek help.</li>
	<li>Gaslighting: <a href="https://merisehat.pk/article/how-to-recognise-gaslighting-and-get-help">Gaslighting</a> involves distorting reality to make the victim doubt their perception of events. Abusers may deny their actions, manipulate situations, or even question the victim&#39;s sanity, causing confusion and self-doubt.</li>
	<li>Undermining Achievements: An emotional abuser may belittle their victim&#39;s achievements or downplay their successes. This tactic is used to make the victim feel inadequate and unworthy of recognition.</li>
	<li>Control And Manipulation: Abusers exercise control over their victims by making decisions for them, monitoring their activities, and even dictating their thoughts and emotions. Manipulation is employed to maintain dominance and subjugate the victim&#39;s autonomy.</li>
	<li>Humiliation And Insults: Public humiliation, name-calling, and insults are tactics used to demean the victim and lower their self-esteem. This behaviour reinforces the abuser&#39;s power dynamic.</li>
	<li>Emotional Withdrawal: Abusers may intentionally withhold affection, attention, or emotional support, causing the victim to constantly seek validation and approval.</li>
	<li>Threats And Intimidation: Emotional abusers may use threats, intimidation, or even violence to maintain control. This creates an atmosphere of fear and submission. 
	&nbsp;</li>
</ol>

Recognizing emotional abuse can be challenging due to its subtle nature. Victims may initially dismiss or downplay the signs, attributing them to stress or misunderstandings. However, paying attention to one&#39;s emotional state and seeking external perspective is vital.

<ol>
	<li>Trust Your Instincts: If something doesn&#39;t feel right in a relationship, it&#39;s important to trust your gut feelings. If you find yourself constantly anxious, fearful, or emotionally drained, it might be a sign of emotional abuse.</li>
	<li>Observe Patterns: Look for consistent patterns of behaviour, rather than isolated incidents. Emotional abuse is characterized by repetitive tactics aimed at maintaining control.</li>
	<li>Seek Support: Share your experiences with a trusted friend, family member, therapist, or counsellor. Their outside perspective can help you better understand if you&#39;re in an emotionally abusive situation.</li>
	<li>Document Instances: Maintain a record of instances where you&#39;ve felt belittled, controlled, or manipulated. This documentation can serve as evidence if you decide to seek help or take legal action. 
	&nbsp;</li>
</ol>

Emotional abuse can be incredibly damaging, leaving long-lasting scars on an individual&#39;s self-esteem and mental well-being. Recognizing the signs of emotional abuse is the first step toward breaking free from its cycle and seeking help. Trust your instincts, seek support, and prioritize your emotional well-being. No one deserves to be subjected to emotional abuse, and everyone has the right to live a life free from manipulation, control, and mistreatment.

Two words: domestic violence. In all probabilities, the first person to spring to our minds and the focus of the entirety of the thought process that follows is the victim. Were they physically attacked? Did they suffer any injury? In more extreme cases, did they survive? A handful of us would consider if they suffered psychologically or emotionally.&nbsp; 
&nbsp;

But most of us would overlook the single most important person in the whole scenario - the child(ren) who are witnessing those two adults, people they are close to; one engaged in an act of violence, with the other at the receiving end, cowering or simply motionless. We don&rsquo;t take into account the kind of injury these kids receive, how they&rsquo;re scarred physically and mentally. 
&nbsp;

Before diving deep into the topic about the <a href="https://merisehat.pk/article/how-does-familial-conflict-or-domestic-violence-affect-children">impact of domestic violence on a child</a> we should first understand what domestic violence really is.&nbsp;

&nbsp;

Domestic violence is also known as &#39;intimate partner violence&#39; and it can be defined as a set of behavior in a relationship that is used to assert control and power over a close partner or spouse.&nbsp; 
&nbsp;

Domestic violence comes in many forms &ndash; physical, psychological, sexual, economic, and/or emotional &ndash; and the aim of such acts is to dominate over one&#39;s partner and to threaten them<a href="#accordion">[1]</a>. 
&nbsp;

The individual (male or female) who initiates violence does so by threatening, abusing, frightening, humiliating, terrorizing, or injuring their partner. The least it does is to rob the victim of their self-esteem and confidence.&nbsp; 
&nbsp;

<h5>What It&rsquo;s Not</h5>

Apologizing afterwards does not absolve the perpetrator of the crime. Abuse in any form is NOT love.&nbsp;

&nbsp;

Understanding The Impact Of Domestic Violence On Children

There is no denying that the primary victim is the one tremendously at risk of the negative consequences of the violence, but these abusive episodes negatively impact the children too, who share the same environment.&nbsp; 
&nbsp;

Caregivers, whether it&rsquo;s the mother or the father who endure domestic violence, become unavailable and distant from their kids. Their unresponsiveness to the child&#39;s demands paves way to a range of unresolved emotions in the young one who starts to feel neglected.

&nbsp;

<ul>
	<li>Serious psychological aftermath in children who are exposed to it.</li>
	<li>The place these children call home, the place meant to nurture them with affection, love, and care along with providing safety, becomes a breeding ground of insecurity and fear as a consequence of domestic violence.&nbsp;</li>
	<li>It leaves a lasting impact on their mind and personalities; the events get imprinted on their memories and stress becomes a core component of their lives.&nbsp;</li>
	<li>Children who live in an environment where domestic violence is common develop a certain set of traits such as being short-tempered, becoming habitual at lying, being frustrated, and being emotionally distracted<a href="#accordion">[2]</a>.&nbsp;</li>
	<li>When these children become adults, all their life choices including relationships are greatly influenced by this past trauma. Their beliefs stem from the fear of abandonment, sadness, excessive worry, guilt, and lack of empathy they experienced in their childhood. 
	&nbsp;</li>
</ul>

Hence, when children witness violence at home, they are not merely passive onlookers; rather, they are a part of the equation, the indirect (and perhaps unintentional) victims of it. And this &lsquo;past&rsquo; continues to haunt them throughout their lives. So, the physical and mental health of children living in such households is as much a matter of concern as that of the primary victim.

According to the Centers for Disease Control and Prevention (CDC), where domestic violence is a norm, there are 40% &ndash; 60% chances of children also receiving abuse. It&rsquo;s important to mention here that these rates are 15 times higher than the average<a href="#accordion">[2]</a>.&nbsp;

It is estimated that roughly 10 million people in the United States are affected by domestic violence. A study revealed that 1 in 15 children were exposed to domestic violence, and 1 out 3 experienced the act of violence themselves<a href="#accordion">[3]</a>. In Pakistan, around 70-90% of women experience domestic violence, which is a significant number<a href="#accordion">[4]</a>.

&nbsp;

Kids who witness intimate partner violence at their homes exhibit a range of symptoms:&nbsp; 
&nbsp;

<ul>
	<li>Increased episodes of insomnia&nbsp;</li>
	<li>Bed wetting</li>
	<li>Verbal, cognitive, and motor issues</li>
	<li>Indulgence in activities of self-harm&nbsp;</li>
	<li>Experience learning difficulties&nbsp;</li>
	<li>Aggressive behavior&nbsp;</li>
	<li>Antisocial behavior</li>
	<li>Experience depression and anxiety&nbsp; 
	&nbsp;</li>
</ul>

Children of different age groups react differently to such tense situations. 
&nbsp;

<ul>
	<li>Preschool Children: When these kids experience domestic violence, they revert to a few years and adopt activities that they did when they were younger. For instance, they start thumb-sucking, bed-wetting, crying, and whining.&nbsp;</li>
</ul>

They may also present with symptoms of separation anxiety such that they may have difficulty sleeping and wake up startled from their sleep<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>School-Going Children: These children often feel deeply ashamed and guilty of the circumstances at home, because they blame themselves for the domestic violence. They have low self-esteem and frequently experience headaches and stomachaches.</li>
</ul>

Children in this age group don&#39;t participate in the class actively. They also lag behind in studies because of their inability to concentrate<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

<ul>
	<li>Teenagers: Teens who witness domestic violence react in a plethora of negative ways. They miss school and fight with family members. They also have trouble making friends, and suffer from very low self-esteem.&nbsp;</li>
</ul>

Affected teens tend to get involved in risky activities, such as using drug or alcohol, and having unprotected sex. They get involved in fighting and bullying, which puts them at risk of getting caught by the law. Teen boys are more likely to get involved in this kind of behavior, as they react more outwardly to the domestic violence at home. Whereas, teenage girls often become socially withdrawn and experience depression by keeping their feelings to themselves<a href="#accordion">[5]</a>.

&nbsp;

These children are likely to become offenders or victims as adults, repeating the cycle that they were part of.&nbsp;Rarely, they are able to break themselves free from the cycle of abuse and violence. In those rare instances, they adopt a healthy and holistic approach towards life and relationships, because they don't want someone else to go through the terrible phase of domestic violence that they went through as a kid.&nbsp;

The impact of domestic violence on a child is evident in the short as well long term. In the subsequent paragraphs, the article sheds light on what are the challenges faced by these kids.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Anxiety&nbsp;</h5>
	</li>
</ul>

Children who have witnessed domestic violence are hypersensitive about their surroundings. They feel like they are living on an edge or walking on eggshells, as they fear that any action of theirs could trigger another episode of domestic violence at home. It is not surprising that these children somehow manage to blame themselves for all the violence. This belief in return bruises their self-esteem and robs them of their self-confidence<a href="#accordion">[3].</a>&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Depression&nbsp;</h5>
	</li>
</ul>

Staying in a toxic household where domestic violence is common triggers anxiety in children and their mental health deteriorates. The young ones struggle with sadness, low mood, difficulty concentrating, and other symptoms that hint towards depression. As they grow older, these children become depressed adults. This unfortunate situation continues, unless a therapeutic intervention is made by a therapist<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Post-Traumatic Stress Disorder&nbsp;</h5>
	</li>
</ul>

One of the most detrimental effects of domestic violence is that children develop post-traumatic stress disorder (PTSD). Just witnessing violence is enough to make them enter a downward spiral of PTSD which includes stress, insomnia, having frequent nightmares, experiencing flashbacks, and being unable to concentrate<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Physical Effects&nbsp;</h5>
	</li>
</ul>

Domestic violence has a physical effect on the health of children. These children frequently experience headaches and stomachaches that are linked with episodes of violence at home.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Physical Abuse</h5>
	</li>
</ul>

Caregivers, who are either offenders or endurers of domestic violence, are not able to provide their child with the safety they need from his or her parents. In fact, such parents can even hurt their children in multiple ways either emotionally, verbally, or physically. In this way, children become the primary victim of violence. It shatters their personality, and breaks them from within<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Aggressive Behavior&nbsp;</h5>
	</li>
</ul>

As mentioned earlier, it is not unexpected that children from violent households become aggressive and are often short tempered. They become reckless and get involved in multiple risky activities like skipping school and getting in trouble with the law.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Health Issues</h5>
	</li>
</ul>

As adults, these children develop a myriad of health problems such as obesity, hypertension, diabetes. These health problems are usually linked with chronic stress and abuse, which is the case of children living in an environment where domestic violence is sadly prevalent.&nbsp;

&nbsp;

It is integral to help our children recover if they have been an (in)direct victim of domestic violence<a href="#accordion">[5]</a>:

<ul>
	<li>Leave the abusive relationship for the safety of children.</li>
	<li>Help the children open up about their fears.</li>
	<li>Educate them about healthy relationships, and help them differentiate what is a healthy relationship and what is not.</li>
	<li>Help them learn about boundaries. Teach them that no one is allowed to touch them or make them feel uncomfortable. Similarly, they should not make others feel uncomfortable by doing any unacceptable activity.&nbsp;</li>
	<li>Find a therapist who can be a counsellor and a support system to back the child, and help them navigate through their journey as they unlearn the negative effects that violence had on them.</li>
	<li>Get the affected child cognitive behavioural therapy (CBT), as it is known to be an effective treatment option for people undergoing depression or anxiety due to any cause.&nbsp;</li>
</ul>

&nbsp;

There are multiple organizations that offer services to children who are negatively impacted by violence, abuse, or neglect. These organizations include: 
&nbsp;

<ul>
	<li>Center For Violence And Injury Prevention - Funded by the Centers for Disease Control and Prevention (CDC), this organization aims to promote healthy young adults by advancing violence prevention strategies backed by evidence<a href="#accordion">[6]</a>. 
	&nbsp;</li>
	<li>American Professional Society On The Abuse Of Children - This is a nonprofit organization that offers services to children who receive maltreatment at their homes<a href="#accordion">[7]</a>.&nbsp; 
	&nbsp;</li>
	<li>American Psychological Association - This is for children who have experienced youth violence, abuse, or maltreatment<a href="#accordion">[8]</a>. 
	&nbsp;</li>
	<li>Protection And Help Of Children Against Abuse And Neglect (PAHCHAAN) &ndash; It is a not-for-profit child&#39;s rights and protection organization working to enhance and better the future of several families in Pakistan, by providing family support, provision of necessary training and knowledge for parents and alternative carers<a href="#accordion">[9]</a>.&nbsp; 
	&nbsp;</li>
	<li>Sahil &ndash; This is an Islamabad-based organization working on child protection, especially child sexual abuse, by providing free counselling and legal aid for victims of sexual abuse<a href="#accordion">[10]</a></li>
</ul>

&nbsp;

Domestic violence is a painful dilemma not only for the primary victim but also for the child that witnesses it. To mitigate the mental and physical damage that domestic violence causes to these children, seek help from mental health professionals. They can help children overcome their fears and challenges and enable them to live life as healthy individuals.&nbsp;

&nbsp;

<ul>
	<li>Domestic violence is also known as intimate partner violence, and comes in multiple forms. In the setting of domestic violence, one partner threatens and overpowers the other by one or all means: emotional, psychological, sexual, and physical.</li>
	<li>Children coming from a background of domestic violence have disrupted personalities, and their mental health is in a feeble state.</li>
	<li>These children become anxious and depressed. They can also suffer PTSD, and experience physical effects after episodes of violence.</li>
	<li>Children who have been indirect victims of domestic violence find it hard to concentrate and suffer academically.</li>
	<li>These children also become aggressive and get involved in reckless activities.</li>
	<li>Support from caregivers and seeking professional treatment by a therapist are ways to overcome the negative effects of domestic violence.</li>
	<li>There are several national and international organizations that offer services ranging from counselling to legal advice, to children facing these issues.</li>
</ul>

&nbsp;