Q: My daughter is normal but my son, who was born two years later, had defects in almost every organ in the body. He died a few days after birth.

A:Congenital defects can occur for several reasons — some known, others speculated on. They occur in almost 30 per cent of pregnancies. The baby is usually affected in the first three months. Many spontaneously abort at that time but some proceed to full term.

Pregnancy is diagnosed after a missed period but conception actually occurs around two weeks before. A viral infection during early pregnancy is a common cause. It may have produced so little fever that it was not picked up. It can also occur if you took medications in very early pregnancy, have diabetes, are obese, a smoker (passive smoking as well) or drink alcohol. It can also occur if you are married to a close relative.

Girls have two X chromosomes, one from the mother and another from the father. Defects in one are balanced by the other X. Boys have an X chromosome and a Y chromosome so there is no question of one balancing the other, therefore boys are more likely to exhibit congenital defects.

For a healthy pregnancy, get your weight and diabetes (if you have it) under control, avoid medications, walk 40 minutes a day and take a daily dose of 5mg of folic acid.

Growing pains

Q: My six-year-old daughter complains of pain in both legs every night. She wakes us up and makes us massage her legs. So our sleep is disturbed.

A:Pain due to infection or inflammation is aggravated by pressure and it does not occur in both limbs. Pain that is relieved by massage and deep pressure, and occurs in both legs is most likely just “growing pains”. This occurs in 25 to 40 per cent of children between the ages of 5 and 10 years. It sometimes runs in families.

It can be treated by regularly soaking the legs in warm salted water at night, for 10 minutes or so. If the pain is very severe, a dose of 10mg/kg of paracetamol can be given. Sometimes a relative deficiency of iron, the B complex group of vitamins, zinc or calcium can aggravate the pain. Regular supplements of these may help.

Vitamin D

Q: I would like to use the sunlight for my vitamin D requirements but want to know how I can do so.

A:An hour of direct sunlight on bare skin between the hours of 11am and 2pm is likely to provide sufficient vitamin D for your needs. The total exposure time required is less in fair individuals. But this means exposure to direct sunlight and not through tinted glass, flowing clothes and sunscreen.

Coeliac disease

Q: My daughter had recurrent bouts of diarrhoea and did not gain any weight. She weighed just 9kg on her second birthday. Her doctor diagnosed coeliac disease after doing an anti-tTG test and placed her on a diet free from gluten found in wheat, barley, among others. She has shown some improvement but I am upset because it apparently means a lifetime of diet restrictions.

A:For a long time physicians in India thought that coeliac disease occurred only in the West and that Indians were immune. Now it is known that 1 per cent of all races (with the exception of the Japanese) and both sexes are affected. It produces diarrhoea and failure to gain weight. These symptoms are found in so many other diseases that it often takes 6-8 years before the diagnosis is made. The diagnosis is suspected on the basis of symptoms and the anti-tissue transglutaminase (anti-tTG) test and then confirmed and staged with an intestinal biopsy. It is important to make an accurate diagnosis as it is an autoimmune disease and there are implications for other organ systems as well.

Stretch marks

Q: I am a 22-year-old man who developed stretch marks on my arms and shoulders after I started attending a gym. It looks very ugly.

A:Stretch marks occur due to rapid weight loss or gain, or when the skin in a particular area is stretched as with pregnancy or weight lifting. The elastic fibres in the connective tissue snap and then heal with the formation of scar tissue. This gives rise to the wavy stretch marks where the skin is of a lighter colour. These marks fade over time if left alone. They can be partially prevented before they occur by applying a mixture coconut oil and sesame oil. Mix 250ml coconut and 250ml sesame oil and store in a bottle. Apply this mixture 10 minutes before bathing. After that apply baby oil at night. There are many proprietary preparations advertised for stretch marks. Most of them do not work efficiently. Some cosmetologists do laser surgery to remove the marks. This works but is expensive.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in