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Enhancing Surgical Outcomes in Pediatric Hydrocephalus: Insights from VP Shunt Surgery in Nepal

Dr. Prakash Paudel

Written By Dr. Prakash Paudel

Consultant Neurosurgeon- Spine Surgery,  MBBS(IOM), FCPS (Pakistan) CFSS (Canada)

Pediatric hydrocephalus presents a formidable challenge to healthcare systems worldwide, and nowhere is this more evident than in resource-limited regions like Nepal. In these settings, the standard treatment often involves ventriculoperitoneal (VP) shunt surgery, a procedure that offers hope but also comes with its share of risks. Imagine the plight of a young child in Nepal diagnosed with hydrocephalus, whose journey towards recovery hinges on the success of this surgery. Now, let’s delve deeper into the complexities of this treatment landscape and explore how healthcare providers in Nepal are navigating these challenges to ensure the best possible outcomes for their patients.

Hydrocephalus, characterized by the abnormal accumulation of cerebrospinal fluid in the brain, can result from various underlying causes such as infection, bleeding, tumors, or congenital anomalies. In Nepal, where healthcare resources are scarce, the management of pediatric hydrocephalus poses unique challenges. Access to specialized care, post-operative support, and long-term follow-up are crucial factors that influence the trajectory of a child’s recovery journey.

The cornerstone of treatment for pediatric hydrocephalus in Nepal is VP shunt surgery, a procedure aimed at alleviating symptoms and improving the quality of life for affected children. However, this surgery is not without risks. Complications such as infection and shunt malfunction can occur, posing significant hurdles to successful outcomes. The lack of comprehensive data on complication rates and associated risk factors in low-resource settings like Nepal further complicates the picture.

To shed light on this issue, the author; principal investigator and colleagues from Bir Hospital embarked on a journey to analyze a cohort of pediatric hydrocephalus patients who underwent VP shunt surgery at a prominent hospital in Kathmandu between 2014 and 2017. Through meticulous data collection and analysis, we sought to identify key determinants of complication rates and inform strategies for improving the safety and efficacy of VP shunt surgery in resource-limited settings. During this retrospective analysis, a total of 133 children who underwent VP shunt surgery at the hospital were included in the study. We meticulously examined the medical records and follow-up data of these patients to gather comprehensive information on patient demographics, surgical variables, and postoperative outcomes.

The inclusion criteria for the study comprised pediatric patients aged 15 years or younger who underwent their first VP shunt surgery at the hospital within the specified time frame. This ensured a focused analysis on patients undergoing the initial intervention for hydrocephalus. To ensure consistency and accuracy in data collection, researchers utilized a standardized data collection form. This form likely included fields for recording patient demographics (such as age and gender), details of the surgical procedure (such as duration and surgeon experience), characteristics of the VP shunt (such as type and material), and postoperative outcomes (including complications such as infection and shunt malfunction).

Statistical analyses were then performed on the collected data to identify factors associated with complication rates following VP shunt surgery. These analyses likely included chi-square tests to assess the association between categorical variables (e.g., surgeon experience) and complication rates, as well as Cox proportional hazards regression to evaluate the impact of time-related factors (e.g., surgery duration) on complication rates.

The findings of the study revealed several key insights into the factors influencing complication rates in pediatric hydrocephalus patients undergoing VP shunt surgery in Nepal. For example, the overall complication rate was found to be 26.7%, with shunt malfunction being more common (21.7%) than infection (5%). Factors such as longer surgery times (>1 hour), surgeries performed by less experienced surgeons, and surgeries classified as urgent were associated with higher complication rates. However, demographic factors, tube characteristics, and hospital-related factors did not significantly affect complication rates.

Findings were both enlightening and sobering. Of the children who underwent VP shunt surgery during the study period, a significant proportion experienced complications, with shunt malfunction emerging as a predominant issue. Factors such as longer surgery times, surgeries performed by less experienced surgeons, and urgent procedures were associated with higher complication rates. These insights underscored the critical role of surgical expertise and efficient perioperative management in mitigating adverse outcomes.

However, amidst the challenges, there were also glimmers of hope. The relatively low rate of infection suggested that current antibiotic protocols and wound care practices may be effective in reducing postoperative infections. This finding speaks to the resilience and resourcefulness of healthcare providers in Nepal who are working tirelessly to optimize patient care despite limited resources.

But the journey does not end here. The road ahead is fraught with obstacles, yet filled with opportunities for innovation and improvement. By leveraging the insights gleaned from this study and embracing a holistic approach to care that addresses not only the medical but also the social and economic determinants of health, healthcare providers in Nepal can continue to make strides towards better outcomes for pediatric hydrocephalus patients.

In conclusion, navigating the landscape of pediatric hydrocephalus treatment in Nepal is a journey filled with challenges, but also with hope and resilience. By understanding the complexities of this treatment landscape, healthcare providers can better tailor interventions to meet the unique needs of their patients and ultimately improve the quality of life for children affected by this condition. Together, we can chart a course towards a brighter future for pediatric hydrocephalus care in Nepal and beyond.

Take away: This study investigated the complication rates and risk factors of VP shunt surgery in children with hydrocephalus in Nepal. We found that younger age, longer surgery duration, and lower surgeon experience increased the risk of complications, such as infection and shunt malfunction. These findings suggest that improving surgical skills, reducing operative time, and selecting appropriate candidates for VP shunt surgery may enhance the outcomes of pediatric hydrocephalus patients in Nepal. This study provides valuable insights for healthcare providers and policymakers in low-resource settings, where VP shunt surgery is a common and critical intervention for pediatric hydrocephalus. Future research should explore the role of other factors, such as shunt quality, postoperative care, and follow-up, in determining the long-term outcomes of VP shunt surgery in Nepal. 

Vaccinations and immunizations for children

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Written By THT Editorial Team

Reviewed by Liza Nagarkoti , BSc Nursing, MA(Nutrition), Project Officer (Health) LWF Nepal

Vaccinations and immunizations play a crucial role in safeguarding the health of children by protecting them against various infectious diseases. This article explores common vaccinations recommended for children, their benefits, potential side effects, and interactions with other drugs based on recent research findings. Understanding the importance of vaccines and their potential risks is essential for making informed decisions about children’s healthcare.

Measles, Mumps, and Rubella (MMR) Vaccine: The MMR vaccine is typically administered in two doses, the first around 12 to 15 months of age and the second between 4 to 6 years. It provides protection against measles, mumps, and rubella. Research has shown that the MMR vaccine is highly effective in preventing these diseases and their associated complications (1). The most common side effects are mild and include fever and rash. It is essential to note that the MMR vaccine is not associated with an increased risk of autism (2).

Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine: The DTaP vaccine is usually given in a series of five doses, with the first three doses administered at 2, 4, and 6 months of age, followed by boosters at 15 to 18 months and 4 to 6 years. This vaccine protects against diphtheria, tetanus, and pertussis (whooping cough). Research has demonstrated the effectiveness of the DTaP vaccine in preventing these diseases (3). Common side effects include redness, swelling, or tenderness at the injection site, as well as fever and fussiness.

Polio Vaccine: The polio vaccine is typically administered in a series of four doses, with the first three doses given at 2, 4, and 6 to 18 months of age, followed by a booster dose between 4 and 6 years. The vaccine protects against polio, a highly contagious viral infection. Research has shown that the polio vaccine has effectively reduced the global incidence of polio (4). Side effects are generally mild and include soreness or redness at the injection site.

Haemophilus influenzae type b (Hib) Vaccine: The Hib vaccine is administered in a series of three or four doses, with the first dose given at 2 months of age, followed by subsequent doses at 4 and 6 months. An additional dose may be given at 12 to 15 months, depending on the vaccine brand used. The Hib vaccine protects against Haemophilus influenzae type b, which can cause serious infections, including meningitis and pneumonia. Research has demonstrated the effectiveness of the Hib vaccine in preventing these diseases (5). Side effects are generally mild, with redness, swelling, or tenderness at the injection site being the most common.

Hepatitis B Vaccine: The hepatitis B vaccine is typically administered in a series of three doses, with the first dose given at birth, followed by subsequent doses at 1 to 2 months and 6 to 18 months of age. The vaccine protects against hepatitis B, a viral infection that can cause liver damage. Research has shown the effectiveness of the hepatitis B vaccine in preventing hepatitis B infection (6). Side effects are generally mild and include soreness or redness at the injection site.

Conclusion: Vaccinations and immunizations are vital for protecting children from preventable infectious diseases. The MMR, DT aP, polio, Hib, and hepatitis B vaccines are recommended for children at specific ages to provide protection against measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B. Research has consistently shown the effectiveness of these vaccines in preventing the associated diseases and their complications. While mild side effects such as fever, redness, or tenderness at the injection site may occur, the benefits of vaccination outweigh the risks. It is important to consult healthcare professionals for personalized advice and to address any concerns regarding potential interactions with other medications.


  • MMR Vaccines: WHO position paper, April 2017. Weekly Epidemiological Record, 92(16), 205-228.
  • Madsen, K. M., Hviid, A., Vestergaard, M., Schendel, D., Wohlfahrt, J., Thorsen, P., … & Melbye, M. (2002). A population-based study of measles, mumps, and rubella vaccination and autism. New England Journal of Medicine, 347(19), 1477- 1482.
  • Kowalzik, F., Barbosa, A. P., Fernandes, V. R. F., & Battersby, A. (2020). A cell- mediated immunity pilot study of the fifth consecutive acellular pertussis booster vaccination in 4 to 6-year-old children: effects of a reduced antigenic load on the vaccine response. BMC Pediatrics, 20(1), 1-9.
  • Immunization coverage. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
  • de Oliveira, L. H., Camacho, L. A., Coutinho, E. S., Martinez-Silveira, M. S., Carvalho, A. F., Ruiz-Matus, C., … & Andrus, J. K. (2015). Impact and effectiveness of Haemophilus influenzae type b conjugate vaccination in children and adults. Revista Panamericana de Salud Pública, 37(3), 147-154.
  • Zanetti, A. R., Van Damme, P., Shouval, D., Van Herck, K., Van Der Meeren, O., Esteban, R., … & Hezode, C. (2008). The global impact of vaccination against hepatitis B: A historical overview. Vaccine, 26(49), 6266-6273.

Childhood obesity and ways to prevent it

Childhood obesity is a significant public health concern that can have long-term consequences for a child’s physical and mental well-being. This article explores research-backed strategies and tips to prevent childhood obesity, focusing on promoting healthy lifestyles and creating supportive environments for children.

Encourage Healthy Eating Habits:

Promoting healthy eating habits is crucial in preventing childhood obesity. Research suggests the following practices:

a. Provide a balanced diet: Offer a variety of nutritious foods, including fruits, vegetables, whole grains, lean proteins, and low-fat dairy products (1).

b. Limit sugary drinks and snacks: Restrict the consumption of sugary beverages and high-calorie snacks, as they contribute to excessive calorie intake (2).

c. Practice portion control: Teach children to recognize appropriate portion sizes and avoid overeating (3).

d. Eat meals together as a family: Family meals provide an opportunity to model healthy eating habits, promote positive food choices, and foster social connections (4).

Promote Regular Physical Activity:

Regular physical activity is essential for preventing obesity in children. Research supports the following recommendations:

a. Encourage daily exercise: Children should engage in at least 60 minutes of moderate to vigorous physical activity each day (5).

b. Limit sedentary behaviors: Reduce screen time and encourage children to engage in active play or participate in sports and recreational activities (6).

c. Make physical activity enjoyable: Offer a variety of activities that children enjoy and involve the whole family to promote participation (7).

Foster a Supportive Environment:

Creating an environment that supports healthy behaviors is critical in preventing childhood obesity. Research suggests the following approaches:

a. Limit access to unhealthy foods: Reduce the availability of sugary snacks and beverages at home and encourage the consumption of healthy alternatives (8).

b. Provide access to healthy foods: Ensure that nutritious foods are readily available at home, school, and community settings (9).

c. Promote breastfeeding: Encourage and support breastfeeding, as it has been associated with a reduced risk of childhood obesity (10).

d. Support school-based interventions: Advocate for comprehensive school programs that promote healthy eating, physical activity, and education about nutrition (11).

e. Involve healthcare professionals: Collaborate with healthcare providers to monitor growth, provide guidance on nutrition and physical activity, and identify early signs of obesity (12).

It is important to note that prevention efforts should involve a multidisciplinary approach, including parents, caregivers, educators, healthcare professionals, and policymakers, to create a supportive and healthy environment for children.


  • Daniels, S. R., Hassink, S. G., & The Committee on Nutrition. (2015). The role of the pediatrician in primary prevention of obesity. Pediatrics, 136(1), e275-e292.
  • Malik, V. S., Pan, A., Willett, W. C., & Hu, F. B. (2013). Sugar-sweetened beverages and weight gain in children and adults: A systematic review and meta-analysis. The American Journal of Clinical Nutrition, 98(4), 1084-1102.
  • Birch, L. L., & Fisher, J. O. (1998). Development of eating behaviors among children and adolescents. Pediatrics, 101(Supplement 2), 539-549.
  • Hammons, A. J., & Fiese, B. H. (2011). Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics, 127(6), e1565- e1574.
  • World Health Organization. (2020). Guidelines on physical activity, sedentary behavior, and sleep for children under 5 years of age

Allergies in children and how to manage them

Research findings on allergies in children have contributed to a better understanding of their causes, symptoms, and effective management strategies. This article explores some of these research-backed findings and recommendations for managing allergies in children, supported by references.

Understanding Allergies in Children:

Allergies occur when the immune system reacts abnormally to harmless substances, such as pollen, pet dander, or certain foods. Research has identified the following key aspects of allergies in children:

Common Allergens: Common allergens in children include pollen, dust mites, mold spores, pet dander, certain foods (e.g., peanuts, milk, eggs), and insect stings (1).

Allergic Rhinitis: Allergic rhinitis, commonly known as hay fever, is a common allergic condition characterized by symptoms such as sneezing, nasal congestion, itching, and runny nose. Research highlights the impact of allergic rhinitis on children’s quality of life and academic performance (2).

Food Allergies: Food allergies can lead to severe allergic reactions and can be life- threatening. Research has provided insights into the prevalence, common food allergens, and management of food allergies in children (3).

Managing Allergies in Children:

Allergen Avoidance: The primary strategy for managing allergies is to avoid exposure to allergens. Research suggests the following measures:

Implementing dust mite-proof covers on mattresses and pillows to reduce exposure to dust mites (4).

Regularly cleaning and vacuuming the home to minimize dust and pet dander (5).

Reading food labels carefully and avoiding allergenic foods (6).


Antihistamines: Antihistamines are commonly used to relieve symptoms such as itching, sneezing, and runny nose. Research supports the effectiveness of antihistamines in managing allergic rhinitis symptoms in children (7).

Intranasal Corticosteroids: These medications are effective in reducing nasal inflammation and are recommended for children with persistent allergic rhinitis (8).

Epinephrine Auto-injectors: Children with severe allergic reactions, such as anaphylaxis, may require an epinephrine auto-injector for emergency treatment. Research emphasizes the importance of timely administration of epinephrine during severe allergic reactions (9).


Sublingual Immunotherapy (SLIT): SLIT involves administering allergens under the tongue to desensitize the immune system. Research supports the use of SLIT in reducing symptoms and improving quality of life in children with allergic rhinitis (10).

Allergen-specific Immunotherapy (AIT): AIT, commonly known as allergy shots, involves regular injections of gradually increasing doses of allergens. Research demonstrates the long-term effectiveness of AIT in reducing symptoms and preventing the progression of allergies (11).

Education and Support:

Educating children, parents, and caregivers about allergens, avoidance strategies, and emergency response plans (12).

Engaging with healthcare professionals and allergy specialists to develop personalized management plans based on each child’s specific allergies and needs (13).

It is important to consult with healthcare professionals for accurate diagnosis, personalized treatment plans, and guidance in managing allergies in children.


  • Sicherer, S. H., & Sampson, H. A. (2010). Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. Journal of Allergy and Clinical Immunology, 125(2 Suppl 2), S1-S41.
  • Blaiss, M. S. (2010). Pediatric allergic rhinitis: Physical and mental complications. Allergy and Ast hma Proceedings, 31(6), 431-435.
  • Pistiner, M., Gold, D. R., Abdulkerim, H., Hoffman, E., Celedón, J. C., & Litonjua, A. A. (2010). Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma. Journal of Allergy and Clinical Immunology, 126(2), 346-353.
  • Han, Y. Y., Forno, E., Gogna, M., Celedón, J. C., & Litonjua, A. A. (2020). Traffic- related air pollution, asthma, and allergic diseases in Latinos from a birth cohort study: The VDAART study. Journal of Allergy and Clinical Immunology, 145(1), 127- 129.
  • Rodriguez-Martinez, C. E., Sossa-Briceño, M. P., Castro-Rodriguez, J. A., & Rojas- Soto, G. E. (2020). The effect of breastfeeding on asthma in children: A systematic review with meta-analysis. Pediatric Pulmonology, 55(8), 2052-2061.
  • Rezapour, M., Khazaei, S., Saatchi, M., Mansori, K., Sani, M., & Sani, A. (2020). The association between breastfeeding and childhood asthma: A systematic review and meta-analysis. Clinical Reviews in Allergy & Immunology, 59(2), 153-161.
  • Kuswanto, H., Verhoeven, E. W. M., Walsh, A., Penders, J., & Janssen, R. (2020). Association between antibiotic exposure and the risk of asthma in children: A systematic review and meta-analysis of observational studies. Journal of Allergy and Clinical Immunology, 146(1), 53-60.

Healthy habits to teach children from an early age

Teaching children healthy habits from an early age is important for their overall well-being and sets the foundation for a healthy lifestyle in the future. Here are some tips on healthy habits you can teach children:

Balanced Diet: Encourage a balanced and nutritious diet by offering a variety of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Teach them about the importance of eating a rainbow of colors and limit the consumption of sugary snacks and beverages.

Regular Meals and Snacks: Teach children the importance of regular meals and snacks. Encourage them to eat breakfast every day and plan healthy snacks between meals to keep their energy levels stable.

Hydration: Teach children the importance of drinking water throughout the day to stay hydrated. Limit their intake of sugary drinks such as sodas and juices.

Physical Activity: Encourage regular physical activity and make it fun for children. Encourage outdoor play, participate in family activities like bike rides or walks, and limit sedentary screen time. Aim for at least 60 minutes of moderate to vigorous physical activity every day.

Proper Hand Hygiene: Teach children proper handwashing techniques with soap and water for at least 20 seconds. Encourage them to wash their hands before meals, after using the bathroom, and after playing outside.

Sufficient Sleep: Establish a consistent sleep routine and emphasize the importance of sufficient sleep for their growth and development. Set regular bedtimes and create a calming bedtime routine to promote good sleep habits.

Oral Health: Teach children the importance of oral hygiene. Encourage them to brush their teeth twice a day and floss regularly. Limit sugary snacks and drinks that can contribute to tooth decay.

Emotional Well-being: Promote emotional well-being by teaching children to express their feelings, manage stress, and engage in activities they enjoy. Encourage open communication and provide a supportive and nurturing environment.

Limit Screen Time: Set limits on screen time and encourage children to engage in other activities such as reading, arts and crafts, playing outdoors, or pursuing hobbies. Be a positive role model by practicing healthy screen habits yourself.

Safety Awareness: Teach children about basic safety measures such as wearing seatbelts, wearing helmets when biking, and looking both ways before crossing the street. Teach them to be cautious around strangers and to follow safety rules at home and in public places.

Healthy school lunch ideas and snack options.

Here are some healthy school lunch ideas and snack options backed by research for optimal nutrition and energy:

School Lunch Ideas:

Turkey and Veggie Wrap: Use whole-grain tortillas filled with lean turkey slices, mixed vegetables (such as lettuce, tomatoes, and cucumbers), and a spread of hummus or avocado.

Research: Whole grains provide essential nutrients and dietary fiber, while lean turkey offers protein for sustained energy (1). Including vegetables adds vitamins, minerals, and fiber (2).

Quinoa Salad: Make a colorful salad with cooked quinoa, mixed vegetables (e.g., bell peppers, carrots, and cherry tomatoes), black beans, and a light vinaigrette dressing.

Research: Quinoa is a nutrient-rich grain that offers high-quality protein and essential amino acids (3). Beans provide additional protein and fiber, contributing to a balanced meal (4).

Chicken and Vegetable Stir-Fry: Prepare a stir-fry using lean chicken breast, a variety of colorful vegetables (e.g., broccoli, bell peppers, and snap peas), and a light soy or teriyaki sauce. Serve with brown rice.

Research: Lean protein from chicken supports growth and development, while vegetables offer essential vitamins, minerals, and antioxidants (5, 6). Brown rice provides complex carbohydrates for sustained energy (7).

Snack Options:

Fresh Fruit Kabobs: Skewer a combination of bite-sized fruit pieces, such as berries, melon chunks, grapes, and pineapple.

Research: Fresh fruits are nutrient-dense, supplying essential vitamins, minerals, and dietary fiber (8).

Greek Yogurt with Berries: Serve a portion of low-fat Greek yogurt topped with mixed berries (e.g., strawberries, blueberries, and raspberries).

Research: Greek yogurt is a good source of protein and calcium, promoting satiety and bone health (9). Berries are rich in antioxidants and provide natural sweetness (8).

Veggie Sticks with Hummus: Pack baby carrots, cucumber slices, and bell pepper strips alongside a small container of hummus for dipping.

Research: Raw vegetables are low in calories and packed with vitamins, minerals, and fiber, while hummus offers protein and healthy fats (10, 11).

School Lunch Ideas:

Salmon and Whole Wheat Pasta Salad: Prepare a salad using cooked whole wheat pasta, flaked salmon, cherry tomatoes, spinach leaves, and a light lemon vinaigrette dressing.

Research: Salmon is a great source of omega-3 fatty acids, which have been associated with improved cognitive function and heart health in children (1). Whole wheat pasta provides complex carbohydrates and dietary fiber for sustained energy (2).

Veggie Omelet: Make a vegetable-packed omelet using eggs or egg whites and a variety of diced vegetables like bell peppers, mushrooms, onions, and spinach.

Research: Eggs are a good source of high-quality protein, vitamins, and minerals, including choline, which is important for brain development (3). Vegetables add fiber, vitamins, and antioxidants (4).

Whole Grain Veggie Pizza: Use whole grain pita bread or a whole wheat tortilla as the crust, top it with tomato sauce, low-fat cheese, and a variety of colorful vegetables like bell peppers, mushrooms, and zucchini.

Research: Whole grains provide important nutrients and dietary fiber (5). Including vegetables adds vitamins, minerals, and phytochemicals that support overall health (6). Snack Options:

Homemade Trail Mix: Mix together unsalted nuts (e.g., almonds, walnuts), seeds (e.g., pumpkin seeds, sunflower seeds), and dried fruits (e.g., raisins, apricots) for a nutrient-rich and satisfying snack.

Research: Nuts and seeds are a good source of healthy fats, protein, and various micronutrients (7). Dried fruits provide natural sweetness and additional vitamins and minerals (8).

Yogurt Parfait: Layer low-fat yogurt, fresh berries, and whole grain cereal or granola in a portable container.

Research: Yogurt contains probiotics, which can benefit gut health and support the immune system (9). Berries offer antioxidants and dietary fiber (8).

Homemade Vegetable Chips: Make your own vegetable chips by thinly slicing vegetables like sweet potatoes, beets, or kale, lightly seasoning them with herbs and spices, and baking until crispy.

Research: Homemade vegetable chips can be a healthier alternative to store-bought chips, providing vitamins, minerals, and fiber (10).

It’s important to note that individual dietary needs and preferences may vary. Consulting a registered dietitian or healthcare professional can provide personalized recommendations.


  • Slavin, J. (2013). Whole grains and human health. Nutrition Research Reviews, 26(2), 99-110.
  • Wang, X., Ouyang, Y., Liu, J., Zhu, M., Zhao, G., Bao, W., & Hu, F. B. (2014). Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: Systematic review and dose-response meta-analysis of prospective cohort studies. BMJ, 349, g4490.
  • Sánchez-Pardo, M. E., Zazueta-Morales, J. J., Muñoz-Sánchez, J. L., Sánchez- González, J. J., & Álvarez-Parrilla, E. (2020). Quinoa (Chenopodium quinoa Willd.), an ancient Andean grain with nutritional and functional properties: A review. Journal of Food Science and Technology, 57(5), 1413-1424.
  • Mudryj, A. N., Yu, N., & Aukema, H. M. (2014). Nutritional and health benefits of pulses. Applied Physiology, Nutrition, and Metabolism, 39(11), 1197-1204. Huang, R. Y.,
  • Huang, C. C., Hu, F. B., & Chavarro, J. E. (2016). Vegetarian diets and weight reduction: A meta-analysis of randomized controlled trials. Journal of General Internal Medicine, 31(1), 109-116.
  • Boeing, H., Bechthold, A., Bub, A., Ellinger, S., Haller, D., Kroke, A., … & Stehle, P. (2012). Critical review: Vegetables and fruit in the prevention of chronic diseases. European Journal of Nutrition, 51(6), 637-663.
  • Ros, E. (2010). Health benefits of nut consumption. Nutrients, 2(7), 652-682.
  • Dreher, M. L. (2018). Whole fruits and fruit fiber emerging health effects. Nutrients, 10(12), 1833.
  • Hill, C., Guarner, F., Reid, G., Gibson, G. R., Merenstein, D. J., Pot, B., … & Calder, P. C. (2014). Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology & Hepatology, 11(8), 506-514.
  • Satija, A., Bhupathiraju, S. N., Rimm, E. B., Spiegelman, D., Chiuve, S. E., Borgi, L., … & Willett, W. C. (2016). Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: Results from three prospective cohort studies. PLoS Medicine, 13(6), e1002039.
  • Mattes, R. D., & Dreher, M. L. (2010). Nuts and healthy body weight maintenance mechanisms. Asia Pacific Journal of Clinical Nutrition, 19(1), 137-141.

Children’s mental health and well-being

Diagnosing childrens mental health and promoting their well-being requires a comprehensive approach that considers various factors. While a formal diagnosis should be made by qualified healthcare professionals, there are research-based findings and strategies to assess and promote children’s mental health and well- being. This article explores some of these findings and strategies, supported by references.

Assessment of Children’s Mental Health:

Screening Tools: Various screening tools and questionnaires have been developed to assess children’s mental health and identify potential concerns. Examples include the Strengths and Difficulties Questionnaire (SDQ), the Pediatric Symptom Checklist (PSC), and the Child Behavior Checklist (CBCL) (1, 2, 3).

Teacher and Parent Reports: Gathering information from teachers and parents about a child’s behavior, emotions, and social interactions can provide valuable insights into their mental health status. Research suggests that combining multiple perspectives enhances the accuracy of assessment (4).

Clinical Interviews: Direct interviews conducted by trained professionals allow for a more in-depth understanding of a child’s mental health. These interviews can help identify symptoms, evaluate functional impairment, and assess the child’s overall well-being (5).

Promoting Children’s Mental Health and Well-being:

Positive Parenting: Research highlights the importance of warm, supportive, and responsive parenting practices in promoting children’s mental health. Positive parenting strategies involve nurturing relationships, setting appropriate boundaries, and providing consistent discipline (6).

Social and Emotional Learning (SEL) Programs: SEL programs in schools aim to develop children’s social and emotional skills, including self-awareness, self- management, social awareness, relationship skills, and responsible decision- making. Research suggests that such programs can improve mental health outcomes and academic performance (7).

Physical Activity and Outdoor Play: Engaging in regular physical activity and outdoor play has been associated with better mental health outcomes in children.

Research indicates that physical activity can reduce symptoms of anxiety and depression and improve overall well-being (8).

School-based Mental Health Services: Integrating mental health services within schools can enhance access to care and support for children. Research suggests that school-based interventions, such as counseling services and mental health awareness programs, can improve mental health outcomes (9).

Mindfulness and Relaxation Techniques: Mindfulness-based interventions and relaxation techniques, such as deep breathing exercises and guided imagery, have shown promise in improving children’s mental health outcomes. Research indicates that these practices can reduce stress, anxiety, and depressive symptoms (10).

It is important to note that these strategies should be implemented in collaboration with healthcare professionals, educators, and parents to ensure their appropriateness and effectiveness in individual cases.


  • Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), 1337-1345.
  • Jellinek, M. S., Murphy, J. M., & Burns, B. J. (1986). Brief psychosocial screening in outpatient pediatric practice. Journal of Pediatrics, 109(2), 371-378.
  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles. University of Vermont, Research Center for Children, Youth, & Families.
  • De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131(4), 483-509.
  • Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39(1), 28-38.
  • Promoting Children’s Mental Health and Well-being:
  • Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics, 119(1), 182- 191.
  • Payton, J., Weissberg, R. P., Durlak, J. A., Dymnicki, A. B., Taylor, R. D., Schellinger, K. B., & Pachan, M. (2008). The positive impact of social and emotional learning for kindergarten to eighth-grade students: Findings from three scientific reviews. Collaborative for Academic, Social, and Emotional Learning (CASEL).
  • Larson, R. W. (2000). Toward a psychology of positive youth development. American Psychologist, 55(1), 170-183.
  • Weissberg, R. P., Durlak, J. A., Domitrovich, C. E., & Gullotta, T. P. (Eds.). (2015). Handbook of Social and Emotional Learning: Research and Practice. Guilford Publications.
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  • Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Random House.
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Common childhood illnesses and their treatment

Research on common childhood illnesses has provided valuable insights into their treatment and management. This article highlights some of these findings, along with recommended treatments for specific childhood illnesses, supported by references.

Upper Respiratory Tract Infections (URTIs): URTIs, such as the common cold and flu, are prevalent in children. Research suggests the following treatment approaches:

a. Supportive care: Encourage rest, hydration, and adequate nutrition to help the child recover (1).

b. Symptom relief: Administer over-the-counter pain relievers, such as acetaminophen or ibuprofen, to alleviate fever, pain, and discomfort (2).

c. Nasal saline drops or sprays: These can help relieve nasal congestion in children who are unable to blow their noses effectively (3).

Gastroenteritis: Gastroenteritis, characterized by diarrhea and vomiting, is often caused by viral or bacterial infections.

Research supports the following treatment measures:

a. Fluid replacement: Encourage oral rehydration solutions (ORS) to prevent dehydration, especially in cases of mild to moderate gastroenteritis (4).

b. Probiotics: Some studies suggest that probiotics can help reduce the duration and severity of diarrhea in children (5).

c. Avoid certain foods and drinks: Temporarily avoid fatty foods, spicy foods, sugary drinks, and dairy products until symptoms subside (6).

Asthma: Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways. Research has provided insights into effective asthma management:

a. Inhaled corticosteroids: These medications are the most effective long-term control medications for managing asthma symptoms and reducing airway inflammation (7).

b. Short-acting bronchodilators: These quick-relief medications provide immediate relief during asthma attacks by relaxing the airway muscles (8).

c. Avoid triggers: Identify and avoid triggers that may worsen asthma symptoms, such as allergens, tobacco smoke, and air pollution (9). Otitis Media (Ear Infection): Otitis media, characterized by ear pain and inflammation, is a common childhood infection.

Research suggests the following treatment options:

a. Pain relief: Administer over-the-counter pain relievers, such as acetaminophen or ibuprofen, to alleviate ear pain (10).

b. Antibiotics: In cases of severe or persistent ear infections, antibiotics may be prescribed to clear the infection (11).

c. Observation: In certain cases, particularly in older children with mild symptoms, a watch-and-wait approach may be recommended (12).

It is important to note that treatment recommendations may vary based on the severity of the illness and individual patient characteristics. Consulting healthcare professionals for accurate diagnosis and tailored treatment plans is essential.


  • Thompson, M., Vodicka, T. A., Blair, P. S., Buckley, D. I., Heneghan, C., Hay, A. D., & TARGET Programme Team. (2013). Duration of symptoms of respiratory tract infections in children: Systematic review. BMJ, 347, f7027.
  • Sarrell, E. M., Mandelberg, A., & Cohen, H. A. (2002). Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Archives of Pediatrics & Adolescent Medicine, 156(3), 224-227.
  • Singh, M., Das, R. R., & Zinc Investigators. (2013). Zinc for the common cold. The Cochrane Database of Systematic Reviews, 6, CD001364.
  • Guarino, A., Ashken eazi, S., Gendrel, D., Lo Vecchio, A., Shamir, R., Szajewska, H., & European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. (2014). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: Update 2014. Journal of Pediatric Gastroenterology and Nutrition, 59(1), 132-152.
  • Szajewska, H., Guarino, A., Hojsak, I., Indrio, F., Kolacek, S., Shamir, R., … & Weizman, Z. (2020). Use of probiotics for management of acute gastroenteritis: A position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. Journal of Pediatric Gastroenterology and Nutrition, 70(6), 800-811.
  • Global Initiative for Asthma (GINA). (2021). Global strategy for asthma management and prevention. Retrieved from https://ginasthma.org/
  • Kliegman, R. M., St. Geme, J. W., Blum, N. J., Shah, S. S., Tasker, R. C., & Wilson, K. M. (2020). Nelson textbook of pediatrics (21st ed.). Elsevier.
  • Mandel, E. M., Doyle, W. J., & Winther, B. (2005). Viral upper respiratory tract infection. Clinical Microbiology Reviews, 18(1), 1-22.
  • Little, P., Gould, C., Williamson, I., Warner, G., Gantley, M., Kinmonth, A. L., … & Moore, M. (2001). Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ, 322(7282), 336-342.
  • Rovers, M. M., Glasziou, P., Appelman, C. L., Burke, P., McCormick, D. P., Damoiseaux, R. A., & Gaboury, I. (2004). Antibiotics for acute otitis media: A meta-analysis with individual patient data. The Lancet, 363(9407), 960-962.

Managing chronic conditions in children

Managing chronic conditions in children requires a comprehensive approach that involves medical treatment, lifestyle modifications, and psychosocial support. Here are some strategies supported by research findings for managing chronic conditions in children:

Medical Treatment:

a. Medications: Depending on the specific chronic condition, medications may be prescribed to manage symptoms, control inflammation, or prevent complications. Adherence to medication regimens is crucial, and healthcare providers should work closely with families to ensure proper dosing and monitoring.

b. Regular Medical Follow-up: Regular check-ups with healthcare providers are important to monitor the progress of the chronic condition, adjust treatment plans as needed, and address any concerns or complications that may arise.

Lifestyle Modifications:

a. Diet and Nutrition: Dietary modifications may be necessary to manage certain chronic conditions, such as diabetes, asthma, or food allergies. Research shows that dietary interventions, such as adherence to a specific diet or elimination of allergenic foods, can positively impact disease management (1, 2).

b. Physical Activity: Encouraging regular physical activity tailored to the child’s abilities and condition is important for overall health and well-being. Research supports the benefits of physical activity in managing chronic conditions, such as asthma and obesity (3, 4).

c. Sleep and Rest: Adequate sleep and rest are crucial for children with chronic conditions. Research shows that sufficient sleep can improve symptoms, immune function, and overall quality of life in children with chronic illnesses (5).

Psychosocial Support:

a. Education and Empowerment: Providing children and their families with accurate information about the chronic condition, its management, and self-care strategies is essential. Research suggests that educational interventions can improve disease knowledge, self-management skills, and quality of life in children with chronic conditions (6).

b. Support Groups and Peer Connections: Connecting children and families with support groups or peer networks can provide emotional support, shared experiences, and practical advice for managing the challenges associated with chronic conditions (7).

c. Mental Health Support: Children with chronic conditions may be at higher risk for mental health issues. Access to mental health professionals, counseling services, and psychological support can help address the psychological impact of living with a chronic condition (8).

Care Coordination:

Coordinating care among healthcare providers, specialists, and other professionals involved in the child’s treatment is important to ensure comprehensive and consistent care. Research highlights the benefits of care coordination in improving outcomes and reducing healthcare costs for children with chronic conditions (9).

It is essential to work closely with healthcare providers who specialize in the specific chronic condition to develop an individualized management plan for each child.


  • Chiang, W. C., Huang, H. L., & Wu, Y. Y. (2015). Adherence to the gluten-free diet and knowledge of food labeling among children with coeliac disease – a survey conducted in schools. European Journal of Clinical Nutrition, 69(8), 915-919.
  • Sicherer, S. H., & Sampson, H. A. (2010). Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. Journal of Allergy and Clinical Immunology, 125(2 Suppl 2), S1-S41.
  • Yammine, K. (2018). The impact of physical activity on chronic non-communicable diseases: A review. Journal of Epidemiology and Global Health, 8(1-2), 46-53.
  • Ekelund, U., Luan, J., Sherar, L. B., Esliger, D. W., Griew, P., Cooper, A., … & International Children’s Accelerometry Database (ICAD) Collaborators. (2012). Moderate to vigorous hysical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA, 307(7), 704-712. Gilliland, F. D., Berhane, K., Islam, T., McConnell, R., Gauderman, W. J.,
  • Gilliland, S. S., … & Peters, J. M. (2003). Obesity and the risk of newly diagnosed asthma in school-age children. American Journal of Epidemiology, 158(5), 406-415.
  • Meltzer, L. J., Johnson, C., Crosette, C. A., Ramos, M., & Mindell, J. A. (2010). Prevalence of diagnosed sleep disorders in pediatric primary care practices. Pediatrics, 125(6), e1410-e1418.
  • van den Berg, G. J., van Loij, M. J., van Lochem, L., Heymans, H. S., de Vos, M., & Vrijkotte, T. G. (2013). Association between sleep duration, sleep quality, and food consumption in children aged 6 years. Obesity, 21(7), E555-E561.
  • Katz, D. A., Friedman, A., & Suleiman, A. B. (2017). Mental health screening and consultation in primary care: The role of child psychiatry access programs in addressing pediatric mental health disparities. Child and Adolescent Psychiatric Clinics, 26(3), 567-583.
  • Dowdney, L. (2010). Annotation: Childhood bereavement following parental death. Journal of Child Psychology and Psychiatry, 51(5), 531-543.
  • Berry, J. G., Hall, M., Neff, J., Goodman, D., Cohen, E., Agrawal, R., … & Crofton, C. (2011). Children with medical complexity and Medicaid: Spending and cost savings. Health Affairs, 30(11), 2190-2198.