Beruflich Dokumente
Kultur Dokumente
1
PREGNANCY, CHILDBIRTH AND THE
NEWBORN
Planning A Baby .........................................................
2-4
Pregnancy ...................................................................
5-12
13-17
18-21
22-27
28-36
37-52
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PLANNING A BABY
Safe Motherhood
While the term safe motherhood is now used to suggest
measures to safeguard the health of the pregnant woman and
her baby, ideally, care for a womans health should be a
concern right from her infancy. A girl who is well looked after
in her childhood and teenage years has fewer problems in
pregnancy and childbirth, and is more likely to deliver a
healthy baby.
Take Folic Acid
The regular intake of leafy vegetables and a vitamin called
folic acid during the first six weeks of pregnancy greatly
reduces the chances of your baby being born with spina bifida
(a developmental anomaly affecting the spinal cord).
Conceive At The Right Age
Research has shown that the best time to have a child is when
you are 23 to 27 years old. It is better to avoid getting
pregnant before the age of 18 or after you cross 35. Babies
born to younger mothers are more likely to be premature.
The risks associated with pregnancy and delivery increase
again after the age of 35 years.
Dont despair, however, if you are below 18 years or over
35 years and do get pregnant. Your chances of delivering a
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PLANNING A BABY
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PREGNANCY
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PREGNANCY
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fruits and roasted channa (gram) rather than biscuits and fried
foods.
Pregnant women (and nursing mothers) with a family
history of allergies should avoid eating peanuts and peanut
products in order to reduce the chances of allergy in the baby.
Cut down on the amount of tea and coffee you drink.
The caffeine in coffee can lead to a premature delivery
and lowered birth weight.
A Vegetarian Pregnancy
A balanced vegetarian diet can meet all the requirements of a
pregnant woman.
Gopalan, Puri and Sachdev, in their excellent 1993 article in
Indian Pediatrics, the official journal of the Indian Academy of
Pediatrics, refer to 3 categories of vegetarian diets. They are:
Lacto-ovo-vegetarian diets, which include eggs in
addition to mammalian milk (cow, buffalo and breast
milk).
Lacto-vegetarian diets, which include mammalian
milk.
According to Gopalan, Puri and Sachdev, such a diet
which is the one largely in practice in our country can
meet all the nutritional requirements of a pregnant
mother.
Vegan diets exclude the consumption of all foods of
animal origin except breast milk.
These diets do not include cow, buffalo or other
mammalian milk.
They may not provide some nutrients. Food items that
could correct the deficiency in vegan diets are listed on
the next page.
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PREGNANCY
Vitamin B12
Vitamin D
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PREGNANCY
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MAKING PREPARATIONS
Plastic panties
: 4
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Moses basket
Diaper bag
Bucket
(plastic with lid)
Diaper pins
Macintoshes (big)
Macintoshes
(small, encased
in towelling cloth)
Turkish towels
Bath towel
with a hood
Baby bath-tub
(thick plastic)
Booties
Cotton vests
Frocks (with front
opening) or jhablas
without sleeves
: 6
: 2
: 1
: 1*
: 4 pairs
: 4
: 4
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MAKING PREPARATIONS
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Fold both sides upwards and secure with a closed safety pin
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MAKING PREPARATIONS
Then fold the other side and secure together with a closed safety pin
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1 point
2 points
Heart rate
Absent
Less than
100/minute
More than
100/minute
Respiration
Absent
Slow, gasping
Good or
crying
Muscle tone
Limp
Some flexion
of limbs
Active and
flexed
Reflex
response to
catheter
placed in
the infants
nose
None
Minimal
grimace
Cough,
sneeze or
Colour
Blue or
pale
Body pink,
extremities blue
Completely
pink
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Normal Reflexes
While examining your newborn baby, the paediatrician will
test for certain reflexes like the grasp reflex, the walking and
stepping reflex and the Moro reflex.
For the grasp reflex, the doctor places her finger in the
palm of the baby, who is expected to grasp it firmly. To test
the walking and stepping reflex, the doctor holds the baby
upright so that her feet touch a firm surface. The baby takes a
few steps as if she were walking. If the babys leg comes in
contact with the edge of a table, she steps up onto the table.
A newborn baby can see at birth. She can focus at a
distance of 15 to 20 cms. Thus, she can see her
mothers face while breastfeeding. She can also hear
and can smell her mothers milk. She likes body
contact, especially with her mother. She is alert for
40 to 60 minutes after birth. Then she may go to sleep
for a few minutes or for several hours.
Examination Of The Baby
It is not essential that there be a paediatrician at every
delivery. However, most babies should be checked by a
paediatrician within 24 hours after delivery. Or a paediatrician
may be called earlier if any problem is noticed.
It is normal to worry about your newborn baby. It helps to
remember that many things that may appear abnormal to you
are normal variations in a newborn. (See chapter on
NORMAL VARIATIONS IN A NEWBORN.)
Rooming-In
In all baby-friendly hospitals, the baby is given to the mother
soon after delivery, and kept in her room; she is not sent to a
separate nursery. This is called rooming-in. Normal babies
kept in a nursery are more likely to contract infection from
the attendants or from other infected babies (if any).
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Unless the mother is heavily sedated, she can keep her baby in her bed
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Skin
The doctor will first look at babys skin. Her hands and feet
may appear blue. This blue colour should not cause anxiety as
it disappears without any treatment within a few hours. If the
doctor finds that the rest of the body is pink and that her
breathing is normal, he will reassure you that the baby is
normal.
Some babies have a dark skin that may become darker in
the successive weeks. The nipples and genitals may show a
deeper pigmentation.
Some babies have Mongolian spots. These are patches of
greyish blue colour over the lower back. Sometimes, they are
also seen on the limbs or inside the cheeks. While they may
last for 2 to 3 years, they disappear spontaneously without
affecting the child.
Some may have permanent patches of pigmentation called
cafe au lait spots. In about a quarter of such children, a single
spot less than 3 cm. (about an inch) in size is seen. Such spots
would attract the attention of your doctor, as they may
indicate certain other conditions.
Another interesting condition is the Harlequin colour
change. For a few minutes, one half of the babys body seems
pink and the other half white. This condition is normal and
may last for even a month or a month and a half.
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middle of the bed and put the baby in her lap. If she decides to
kiss the baby, let her do so, as long as she doesnt have a cold
or any other infection. If she does, she should wait at home for
the babys arrival.
Some amount of jealousy is normal and to be expected, but
we must be sensitive and handle it properly. Take the help of
your older child in the care of the younger one getting her
clothes, changing her diapers, etc.
If the older child hits or pinches the younger one, by
chance or intentionally, remove her from the scene so that no
further damage is done. But keep in mind that A child needs
love most when she is least lovable. Hug the older child.
Cuddle her and give her a kiss. Do not make an issue of the
incident by punishing her for hitting the baby. By your action,
the child gets a clear message that hitting others is not
allowed, but also that everyone still loves her as before.
A child may feel bad because she is suddenly deprived of
her possessions her cot, her room, her toys, her fathers
lap or her mothers breast for the sake of the younger one.
Assure her of her place in the family. If the older child, on
seeing the baby breastfeeding, shows a desire to suckle, she
may be allowed an occasional feed.
When parents are unable to handle a childs jealousy
adequately, she may start behaving like a little baby
wetting her bed, sucking her thumb or even speaking like a
little baby. Often, the problem resolves on its own. At times,
however, the situation worsens, and the child may withdraw
and stop communicating. Seek the help of a child psychologist
or a family counsellor in such a case.
HANDLING YOUR BABY
Crying
Do not hesitate to pick your child up when she cries. It
is most important for a baby to have a feeling of
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Do not put oil into the ears and nostrils of the newborn. Oil,
if aspirated into the lungs, can be dangerous. The babys
nose may sometimes be obstructed by thick secretions.
These should be moistened with cotton soaked in water
and then removed gently with a clean cloth. Do not clean
the tongue and mouth of a baby. Avoid pacifiers (dummies);
besides interfering with proper feeding habits, pacifiers
increase the risk of infections (including middle ear
infection) and malocclusion of the teeth.
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Never use surma for the babys eyes. Quite a few such
preparations contain lead, which can be dangerous for
the baby.
Skin Massage
In most Indian families, it is customary to give the baby an
all-body massage with oil or ghee to stimulate the circulation.
I support this tradition; it provides extra body contact. But
I must add that it is not essential, especially if you do not have
extra help.
Bath
I recommend a daily bath in normal circumstances. In
extremely cold weather, daily sponging and a bath twice a
week should be adequate. The face and diaper area need more
frequent cleansing.
In the hospital, you may be shown how to bathe your baby
in a bath-tub and you may follow the same method. Many
Indian women also often bathe babies without a tub. The
woman sits comfortably on the floor with her legs stretched
out in front of her. The baby is laid, on her back or stomach,
between the womans bare legs and then massaged or bathed.
I find this a very simple and practical method and strongly
recommend it.
Never leave the baby alone in water even for a few
moments. Negligence can be fatal.
Some people clean the mouth and tongue of the baby with a
piece of cloth or with glycerine. This is unnecessary and may
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Resuming Sex
Avoid sexual intercourse in the first 6 weeks after delivery.
Do discuss family planning with your doctor. If you do not
believe in modern family planning methods, make sure that
you exclusively breastfeed your child for 6 months and after
that, add other foods gradually, while breastfeeding is
continued and bottle-feeding is avoided.
FREQUENCY OF CHECK-UPS
After seeing the baby at birth, I like to see her 1 and 2 weeks
after discharge from the hospital. At around 10 days, the baby
is supposed to regain her birth weight. I also like to know how
breastfeeding is going and answer any questions that the
mother might have forgotten to ask in hospital. I also like to
see the condition of the umbilical cord at that time.
I would then like to see the child at 6, 10 and 14 weeks for
immunisation (see chapter on IMMUNISATION). I would also
check about breastfeeding and see the milestones of
development that the child has achieved and record her
height, weight and head circumference.
Then I would like to see the child at about 6 months,
9 months, 15 months and 2 years. At 6 months, addition of
complementary foods will be discussed. At 9 months, measles
vaccine will be advised. I also like to see at that time if the
child needs any vitamins, calcium and iron. At 15 months,
MMR vaccine will be advised. Through these visits, I would
observe the growth and development of the child and advise a
booster dose of DPT and OPV at 2 years. At this age, we may
also get a rough idea about the height that the child will
achieve later in life. Then I like to see the child once a year
and guide the parents for a healthy and happy childhood and
adolescence. If you would like your paediatrician to see your
child every month for the first year or two of her life, discuss
it with her and arrange for check-ups accordingly.
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PART
2
THE GROWING YEARS FROM INFANCY
TO ADOLESCENCE
Normal Growth And Development ...........................
60-81
Immunisation ..............................................................
82-88
89-99
100-122
123-138
139-141
142-147
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NORMAL GROWTH
CAREAND
OF DEVELOPMENT
THE NEWBORN
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NORMAL GROWTH
CAREAND
OF DEVELOPMENT
THE NEWBORN
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Fig. 2
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Head Circumference
Your doctor will keep a watch on your childs head
circumference, especially in the first year of her life. The head
measures about 34 cms at birth. The soft spot at the back of
the head cannot be felt after about 2 months of age. The soft
spot in front (anterior fontanelle) may appear to widen after
birth. It usually closes between 6 months and 2 to 3 years of
age. The head circumference is approximately 44 cms at
6 months and 47 cms by 1 year. So you will notice a rapid
increase of about 10 cms in the first 6 months and only 3 cms
in the next 6 months. The circumference of the head is
slightly bigger than that of the chest at birth, but both of them
become equal by the age of 1 year.
Teeth
Twenty milk teeth (temporary or deciduous teeth) appear
between the age of 6 months and 2 years. The first tooth
appears at about 6 months, though the gums start getting
ready for teeth to come out at the age of 3 to 4 months. You
will notice that the child is drooling more, is irritable and
enjoys biting your finger. These temporary teeth fall between
6 and 12 years of age and then permanent teeth keep
erupting. At 12 years, the child should have a total of 28 teeth.
The 4 wisdom teeth come up any time after the age of 18.
An important point worth remembering about teething is
that there is a marked variation in the eruption of teeth.
Though many children around 1 year have about 6 teeth, quite
a few others may be toothless on their first birthday, though
they are otherwise completely normal. Delayed eruption does
not necessarily indicate calcium or vitamin deficiency.
Similarly, some normal babies may be born with a tooth.
Pubertal Growth
The onset of puberty in a girl is heralded by breast budding,
when the breast becomes slightly elevated as a small mound.
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Speech.
NEWBORN BABY
Motor Development
While lying on her back without a pillow, the baby mostly
keeps her head to one side. When put on her stomach, she
raises her head momentarily and makes an effort to turn it to
one side.
With a gentle push to her sole, she may appear to crawl.
In general, she keeps her hands fisted. If you put your
finger in her palm, she grasps it firmly (the grasp reflex).
When made to stand on a firm surface, she takes a few
steps as if she were walking (the walking reflex). The walking
reflex may not be well elicited if the child is not fully awake.
The grasp reflex and the walking reflex disappear in about
2 months.
Perception And Social Response
The newborn wrinkles her forehead and blinks when
subjected to strong light and sound. She may also suddenly
move her arms outwards and start crying. A crying baby
usually stops crying the moment you cuddle her in your arms.
Suckling at the breast offers mutual satisfaction to the mother
as well as the baby. It gives the newborn comfort and a feeling
of security, besides fulfilling her nutritional needs.
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Speech
The lusty cry of a baby due to hunger or any discomfort
may herald the development of speech in due course
of time.
ONE MONTH
Motor Development
While on her back, the child kicks her legs in joy. When put
on her stomach, she lifts her head and turns it to one side to
spare her nose. When held up against your shoulder, she lifts
her head momentarily away from your shoulder. Her hands
are fisted. She can now bring her hand within the range of
her eyes.
Perception And Social Response
If a brightly-coloured rattle or a ring is moved 20 cms in front
of the childs face, she fixes her gaze on it. If you move it from
midpoint to one side, she follows it with her eyes. She may
not respond the first time you show her the rattle; repeat the
action a few times if required. If the baby is lying on her back,
she may follow you, within the range of her eyesight. Her
eyes may move from one side to the other and sometimes it
may appear that she has a squint. This is often transitory and
disappears by the age of 5 or 6 months. At this age, she gives
more attention to black and white pictures.
In a quiet place, shake a rattle about 8 cms away from the
babys ear. She will respond to the sound by wrinkling her
forehead, stopping any activity that she is doing, suddenly
blinking, or by crying. On completing 1 month, the childs
hearing is fully matured. She even seems able to differentiate
between some sounds.
If you are pregnant and are reading these lines, read
a story aloud each night during the last 1 or 2 months of
pregnancy. Then, after your baby is born, read her the
same story when she is awake and about a month old.
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The child turns the head to one side to spare the nose
TWO MONTHS
Motor Development
When put on her stomach (prone), the child lifts her head at
an angle of about 45 and can hold it there for about
10 seconds. When held up against the shoulder, she can now
keep her head up for a little longer. The fist is now kept open
more often.
Perception And Social Response
The child listens to sounds more attentively. She shows a
more mature response by pausing when she hears the rattle
and does not blink or show any signs of fear.
The first smile of the child in response to your smile is
noticed at around 6 weeks of age. This social smile should not
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Dads darling
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Speech
If she is happy after her feed, she may make sounds like ah,
goo and ma.
FOUR MONTHS
Motor Development
The child tends to bring anything given to her to the mouth.
While on her back, she now looks at her hands. It helps her to
get an idea of her body. That is why it is important not to keep
the child wrapped all the time. For the same reason, mittens
should be avoided, especially when the child is awake.
Perception And Social Response
Now, not only does she smile, but she also laughs delightfully.
Her hearing can also be tested better now. Stand behind her
so that she cannot see you. Sound a rattle or a bell at a
distance of 20 to 24 cms from her ear. She will turn her head
towards the direction of the sound. The room should be
otherwise quiet for this test.
Speech
Now, you can hear her laughing. This is her way of
communicating.
FIVE MONTHS
Motor Development
Offer your thumbs to the child as she lies on her back. Let her
grasp them. Give her a little support to make her sit. You will
notice that she will herself come to a sitting position.
Put her on her stomach. If awake and satisfied, she may roll
over onto her back on her own.
Perception And Social Response
The baby can now inspect a new object for a prolonged period.
She may start differentiating strangers from those close to
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her. She may not laugh when strangers approach her or she
may even start crying.
She can now make out from the tone of your voice if you
are annoyed with her.
Speech
Nothing significant happens at this stage as far as speech
development is concerned.
SIX MONTHS
Motor Development
She can now roll over on her own from her back on to her
stomach, when placed on a firm surface.
When placed on her stomach, she tries to reach for a toy
put in front of her, though she may or may not succeed at
this stage.
She can now transfer a rattle placed in one hand to the
other. When made to stand, her legs may be able to bear her
full weight.
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NINE MONTHS
Motor Development
The child may start creeping and crawling at this age.
Children who are kept on their stomach from an early age
while awake, may creep and crawl earlier than others who are
kept mostly on their back or in the lap.
Your child can now raise herself from the lying position and
sit up on her own.
When encouraged to walk and held by her hands, she
attempts to take a few steps forward.
From a sitting position, she can pull herself up by
holding onto some piece of furniture and stand up on
her own.
Perception And Social Response
Now your child may show interest in softer sounds made by a
watch or a musical instrument.
She now enjoys dropping objects again and again on the
ground and wants you to pick them up and give them back
to her.
She now likes to play hide-and-seek.
Speech
She may now properly join two syllables and say dada,
mama, or baba.
TEN MONTHS
Motor Development
The child can now walk more confidently when held by
her hands.
She can also sit from a standing position by taking your
support or the support of a piece of furniture.
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She now rocks on her hands and knees and may crawl all
around the house.
When a small object like a bead or a button or a pellet is
placed before her, she now picks it up with her thumb and
index finger. In earlier months, she would have tried to get at
it with her palm or without the fine coordination movement
that she now exhibits.
Perception And Social Response
She now claps, copies ta-ta or bye-bye, likes to look at
pictures in a book and starts understanding the meaning
of No.
Speech
She repeats da-da or ma-ma after you. When you ask her
about familiar persons or objects by saying, Where is papa?
or Where is the fan? she may now look in the direction of
that particular person or object.
ELEVEN MONTHS
Motor Development
Make your child stand on a firm surface, while supporting her
body. Leave her alone. She may be able to stand on her own
for a few moments. Some children develop this skill after
their first birthday.
She can now also turn the leaves of a book with
thick pages. Holding on to furniture, she can now walk
sideways. When given a crayon and paper, she tries to
scribble on the paper, especially if she is shown how to do so
by someone else.
Perception And Social Response
If you laugh at some action of hers, she will repeat that act
again for you; she is obviously pleased with your appreciation.
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boo game. She purposely drops things down and expects you
to pick them up.
The child now wants to eat by herself. Encourage her
to do this even if she tends to make a mess. She can
also drink from an ordinary glass or a cup. Many
children learn this skill even earlier.
Speech
The child may use some jargon at this age, but she is less
likely to use words with meaning on her own. She may imitate
you or may say mum when she sees water being brought
in a glass.
TWELVE MONTHS
Motor Development
The child may now be able to stand without support, though
she might have done this even before her first birthday. Quite
a few children only stand without support between 11 to 13
months. Some children may even be able to take a few steps
at this age, but most will do it later.
Perception And Social Response
Your childs hand and eye coordination is now much
improved. She can now finger feed herself. If you take a bottle
and drop a few objects into it, she can copy this action well.
She responds to No and may also shake her head for No.
She now enjoys playing simple games like catching cook
with you. While being dressed, she may straighten her arm or
leg to help you. She now feels shy in the presence of
strangers and may cry when you leave home.
Speech
The child can now imitate words like dada or mama spoken
by you. She may be able to say 1 or 2 words with meaning.
She may then say mama while looking at you.
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IMMUNISATION
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IMMUNISATION
Age Recommended
BCG
Birth or 6 weeks
OPV
DPT
Measles
9 months
DT
TT**
5 years
10 and 16 years
** If given for the first time at this age, give 2 doses at 4-week intervals
** For pregnant mothers, 2 doses of M at 4-week intervals
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Age Recommended
BCG
OPV
Birth to 2 weeks
Birth, 6, 10, 14 weeks, 9 months, 15 18 months, 5 years
HB (Hepatitis B)
DPT
Measles
DT
9 months plus
15 18 months
TT
10, 16 years
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The other two vaccines are expensive, but have very few side
effects.
These vaccines are recommended where typhoid is widely
prevalent. Injections of TA or Vi vaccine may be given at
2 years of age, followed by subsequent doses at 3-year
intervals. Oral vaccine can be given at 6 years of age and
repeated at 3 to 5-year intervals according to the
manufacturers recommendations.
In localities where typhoid is not widely prevalent, typhoid
vaccine may be avoided. I recommend hygienic precautions
for prevention of not only typhoid but also other water and
food-borne diseases like hepatitis A and diarrhoea. Proper
hand washing, boiling of water, eating fresh food and keeping
food covered are some of the measures that are recommended
to avoid such illnesses.
CONCLUSION
To conclude, I urge you to take care to keep your child
healthy and follow the general principles of hygiene. Do not
depend wholly upon these vaccines. It is possible that they
might not have been stored properly; this does happen
sometimes. In such cases, you may have a false sense of
security.
Also, all vaccines do not provide cent per cent protection.
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moment they see her. Let the child observe the newcomers.
She will watch them from the comer of her eye and assess
them for a while. After some time, she may herself come
close to them or respond to their friendly gestures. If she
does not, let them wait for another opportunity to gain her
hand in friendship. In case they have brought her a gift, let it
be offered before they leave. If she still remains away from
them, keep the gift on the table and draw her attention to it.
The chances are that she will pick it up, look at it for a while
and then come out of her shell.
At this age, children are normally afraid of sudden noises.
My grandson was afraid of the whistle of the pressure cooker.
This is normal. After a couple of months, they get over this
fear, provided we do not become unduly anxious about these
normal fears. Similarly, your child may start shrieking the
moment you pour water on her head. Take it easy. Let her sit
in the bathtub in your presence. Pour water on her head or let
her pour it herself. If she is still afraid, let her watch you
bathing. Dont give her a head bath for a few days; just pour a
little water on her body. You may soon be able to help her get
over her fear. With such an approach, she is likely to come
around faster, than when you try to force the issue.
Before she completes one year, your child will
indicate that she wants to eat by herself. She will make
a serious effort to do so, and end up making quite a
mess in the process. You may be tempted to come to
her help. She may resist you, but after some time, she
may give up and start depending on you to help her eat.
You will probably not realise that by doing this, you are
sowing the seeds of dependency in her.
If you do not set limits and allow her to act as she likes,
your child may find it difficult to adjust later with people with
whom she has to live or work. Fortunately, most such
children manage to modify their behaviour as they grow older,
when they come in contact with another positive, caring adult
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Nearirg the first birthday, children love to eat by themselves. Encourage this, even
if they make a mess
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set certain guidelines about what things your son should not
buy with the allowance, say for example, junk food.
Ultimately, however, he should be free to use it the way
he likes.
Be careful not to criticise your child in front of others if you
feel he is not coming up to your expectations. Discuss the
problem with your husband and jointly explore the possible
ways of handling the situation.
Do not hesitate to talk to a psychologist or a family
counsellor. I know of a young boy who refused to go to school.
The parents took him to a psychologist who, on probing
deeper, found that the child was afraid of a bully in the school
bus, that he admired his father for his skills in karate, and that
he liked his school teacher. The parents met the teacher, who
then encouraged the boy to join karate classes. His father
started spending more time with him. The bully was tackled.
The boy became proficient in karate, improved in his studies
and ultimately developed a more robust personality.
BEHAVIOUR DURING ADOLESCENCE
(12 TO 18 YEARS)
This is a tumultuous age, difficult both for your teenager as
well as for those who have to interact with him. Rapid
changes, both in physical and sexual growth, are taking place.
By his behaviour, he is hinting to you that he is no longer a
child and that he has become an adult. However, he often
forgets that he is still passing through a phase of transition
and that he has not yet become a fully mature adult.
You may hear him say, Leave me alone. I am no more a
kid. And yet, deep within, he may be expecting your
continued guidance and support. His actions may declare, Get
lost!, yet he often wants his parents to be around and to be
available when he feels confused and is undecided about
certain issues.
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them in their old age, and they feel let down, cheated and
betrayed when this does not happen. They rue the fact that
they went out of their way to bestow their love on her, and
that the child has forgotten her duty and the fulfillment of
their expectations! But love cannot be equated with a
business deal. As parents, we must give love unconditionally
and without expectation.
In such a loving atmosphere, the child feels secure. She is
likely to rush into her parents loving arms whenever she
wants to share her joys and troubles.
Such parents are less likely to be upset if the child does not
come up to their expectations. Armed with such an attitude,
they are more likely to listen to even the unspoken language
of the child when she does not seem to be behaving as they
would otherwise expect.
Listening To Your Children
Active listening is important. A child must be given full
attention. You must stop what you were doing, go over to the
child and get down to her eye level. Use a gentle, caring voice
to describe the feelings and situations you see.
Listening From Within
Let me now give you a personal example. My teenager, who
was studying in another city, had come home over the
weekend to get a book from my friend. As he was about to
leave, I asked him if he had picked up the book. He replied
Where was the time, Papa? I was furious and said, You had
time for your friends, time for the movies, time for a party, for
television and for everything else except the book you had
specially come for. He left.
A few days later, a letter came from him addressed only to
Mummy. In the past, it used to be addressed to Mummy and
Papa. I was used to reading something inspirational daily and
then listening from within. A week after my son left, I felt
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One day, Akhil rightly felt that his teacher had herself not
followed a particular habit he had been taught to follow while
eating. He drew her attention to it and said that she should
stand in the Thinking Corner. Behold, that exemplary teacher
did just that and in doing so, not only reinforced the
importance of a good habit, but also helped Akhil understand
that rules are rules and meant to be followed by all.
Always keep in mind that, for a child, your actions speak
louder than words.
If you tell your child to inform a telephone caller that you
are not at home when you are, it is not fair to expect her not
to lie otherwise. If you are unable to attend the call, ask your
daughter to say, Uncle, Dad is at home. But unfortunately,
he cannot attend to your call just now. Could you please leave
your phone number? Dad will ring you later.
Our children observe us closely. They notice how we
treat our servants, friends and relatives especially
those who are poor or those who do not wield much
influence.
If we treat people with respect, our children are
likely to follow in our footsteps and show respect to all
those they meet.
Parents can also influence their children adversely
with their unhealthy lifestyle.
Late nights, alcohol, smoking, unhealthy food habits,
watching too much television, lack of physical activity,
fights with each other, hatred, touchiness, greed,
selfishness, illicit relationships all these have a
negative influence on the minds of young children.
How a teacher conducts herself both in class and in
society can also have an equally positive or negative effect
on the lives of her pupils.
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Here, let us also mention about the first child, the middle
child and the youngest child. Parents often tend to indulge the
first child, consequently overprotecting him. To correct the
balance, they may overlook the second child, and again spoil
the youngest one.
Most parents are overprotective towards an only child.
Even a minor illness may make them over-anxious. If they
panic, they may not be objective enough to provide the best
possible care during an emergency.
Children brought up in the absence of their parents by
other relatives (say grandparents) or by a single parent,
may also not be provided with the freedom that they
deserve or may not be handled firmly when the situation so
demands.
Additionally, writes Maya Kirpalani, children born
with a congenital illness or a physical deformity may be
either shunned or overprotected by their parents.
Guard yourselves against both these tendencies.
Respect and love your child for what she is. Remember,
she is more than the deformity or the illness. Help her
discover that, too. She is a child of God, given to you so
that you may love, protect and care for her. In rearing
such a child, you will be able to invoke, rediscover and
nurture precious qualities within yourself, which you
might never have known you had more love, more
patience, and more forbearance.
Acceptance does not mean that we forget to give the
required stimulation to the child. Children need stimulation.
They need to be encouraged to realise their full potential.
Under-stimulation is as bad as over-stimulation.
Avoid pushing your child too hard; try to discover what
special interest she has and encourage her in the same. This
is possible if parents spend enough time with their children in
the early years of their lives.
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like her to handle at that particular moment. But after she has
celebrated her first birthday, start getting her used to the
word No. You must mean the word when you say it, but
there is no need to make an issue of it at this age. If the child
persists in doing what you do not want her to continue with,
try to divert her attention. Most children can be easily
distracted at this age.
After the age of 15 months or so, the child will enter into a
phase of negativism when she will tend to do the opposite of
what you want her to do. She will want to assert herself. She
will not eat when and what you want her to eat. Yet, soon
after, she will want to pick food out of guests plates and eat it.
Once you become aware of this temporary phase of
negativism (which may last uptil the age of 3 or 4), you are
likely to handle it with sensitivity.
At this age, she will also start constantly asking questions.
Answer the ones that can be simply answered. Ignore the
complicated ones; she is not really interested in your answers
at this age. However, do listen to her with respect to assure
her that you appreciate her curiosity to know more about the
world around her.
Dont worry if she refuses to share her things with
others at this age. The rudiments of unselfishness and a
desire to share with others often come after the age of 3 or
4 years.
Setting Reasonable Limits
Children like parents who can guide them; they feel more
secure with parents who set reasonable limits, keeping in
mind their age and maturity level.
For instance, if a 2-year-old child wants to eat by herself
and spills the food on the table in the process, make sure that
her spoon is easy to handle, that her bowl is wide enough, that
the chair is placed near the table and is of the right height.
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physical punishment. If the child is 2 years old, then the timeout must be for 2 minutes. A 5-year-old can be given a timeout for 5 minutes. For 2 to 5 minutes, the child is placed in a
comer or a room in which there are no other attractive or
interesting alternatives present to amuse her.
It is true that parents who have had problems in childhood
or who were brought up in an atmosphere of marital discord
may find it difficult to discipline their children. But Howard
refers to recent studies that have shown that mothers who
have had troubled upbringings, but have recognised and
accepted them, have children with normal attachment, while
mothers who remain bitter, have children more likely to show
an insecure attachment pattern.
MANIFESTO FOR A HAPPY FAMILY*
*From a conference for families titled Come Together,
Stay Together, held at Panchgani, Maharashtra, in May
1997.
Every couple should keep these points in mind:
1. A family is an organisation of people who live together
and support each other for the realisation of a common
goal.
2. A sound family is the only real basis for a sound society.
3. The common goal of a family is to create overall hope
and happiness amongst all who come within its sphere of
influence. Securing this objective whilst unfolding the
creative potential of each individual is the main objective
of the family.
4. An ideal family would be one:
a. Where there is unconditional love, in which every
member is accepted and respected for what she/he is,
without any comparisons.
b. Where there is communication and empathic listening
to the said and the unsaid in an atmosphere of peace
and harmony.
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EDUCATION
Lord Asa Briggs, the eminent British historian and
educationist, was invited to India in 1994 to deliver the
Dr. D. S. Kothari Memorial Lecture hosted by Bombay
University. According to him, Education should fulfill the
potential of the individual, who, in turn, should help in the
development of society. I was delighted to read outside a
school in Mount Abu: ENTER TO LEARN, LEAVE TO
SERVE.
When Should Schooling Start?
A state-level committee on Early Childhood Education in
Maharashtra, chaired by Professor Ram Joshi, had opined that
children below the age of 6 should not be subjected to formal
education. They should not be burdened with reading, writing
and arithmetic. It is well known that a 3-year-old child does
not possess finger coordination and should not be made to
write. But certain schools ignore this dictum.
Play School
I suggest that you do not send your child to the so-called play
schools or play groups as they exist in most cities. In a good
play group, the parents, along with their 11/2 to 21/2 year-old
toddlers, go to the group in order to be with other parents.
While the parents make friends, the toddlers play with sand,
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LEARNING
AND
MEETING THE EMOTIONAL
NEEDS
OFSCHOOLING
CHILDREN
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interaction with children from different religions and socioeconomic and cultural backgrounds. Some schools offer
swimming, horse riding, theatre and Nature walks. One learns
discipline, manners and etiquette. But above all, most children
in a boarding school grow up to be independent and
self-reliant.
Of course, the environment of a boarding school with all its
plus points can be created in a home by parents who do not
smother their kids and help them take decisions
independently whenever possible. The choice is yours.
When A Child Is Not Doing Well In Studies
There can be several reasons for the child not doing well in
school. But before we try to find out what these are, you must
pause to see if you have undue expectations from your child.
I have seen both types of parents some expect too much
and some underestimate their childs potential.
After undertaking that exercise, see if any of the following
factors are responsible for her poor performance in school.
Let us first think of a child who is not at peace with herself.
This could be due to psychological factors that need the help
of a counsellor. But quite often, the cause may be such that
the parents themselves can handle it. Sometimes, the help of
the school authorities is needed. For instance, the child may
be subjected to bullying or teasing in the school bus or in the
school by other students. As far as possible, let the child sort
out the problem herself. Or ask her if you could help. She may
have a teacher who is difficult. Prolonged absence from
school due to prolonged or frequent illnesses may be
a contributing factor.
In very rare cases, a child may suffer from psychological
disorders like school phobia or truancy. These children may
either be hostile towards the mother or may be too dependent
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PARENTING ADOLESCENTS
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PARENTING ADOLESCENTS
It is all right for you to sit with your young child while she
is doing her homework. Never do the homework yourself.
Give her some help, but no more than that. Leave older
children to work by themselves. Encourage them to take help
from the school teacher, unless you are sure that you
know the subject and you can meet the needs of the child
in an appropriate manner with encouragement and
without ridicule.
Since her parents are usually the ones who are close to an
adolescent, it is they who will be able to easily perceive subtle
changes in her behaviour.
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PARENTING ADOLESCENTS
It is all right for you to sit with your young child while she
is doing her homework. Never do the homework yourself.
Give her some help, but no more than that. Leave older
children to work by themselves. Encourage them to take help
from the school teacher, unless you are sure that you
know the subject and you can meet the needs of the child
in an appropriate manner with encouragement and
without ridicule.
Since her parents are usually the ones who are close to an
adolescent, it is they who will be able to easily perceive subtle
changes in her behaviour.
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PARENTING ADOLESCENTS
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PARENTING ADOLESCENTS
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PARENTING ADOLESCENTS
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PART
3
FEEDING INFANTS, YOUNG CHILDREN
AND ADOLESCENTS
Feeding The Newborn And Infants ..........................
150-202
203-208
209-211
212-214
215-219
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can decide if you want to keep the baby all the time in your bed
or partly in the cot and in the bed according to convenience.
If you delivered by a Caesarean section under general
anaesthesia, you may be on a drip. Even then, the baby
should be given to you for breastfeeding after about
4 hours of the operation, when you recover from the
effects of anaesthesia. You will need the assistance of a
hospital attendant or a close relative to give your child the
first breastfeed. As you lie on your back, the nurse may
place the baby on a pillow raised to the level of your
breast, so that she can conveniently reach it.
Here it must be mentioned that if your first child was
delivered by a Caesarean section, it is not mandatory that the
subsequent delivery has to be Caesarean. You may raise this
issue with your doctor. But leave the final decision about
whether an operation is needed again or not to him.
Also a word about episiotomy. This is a cut made on your
skin just outside the birth canal for easy delivery of the baby.
It is possible that you needed it and you should accept it if it
was inevitable. However, you could mention to your doctor
that as far as possible, you would like to avoid episiotomy.
Episiotomy may be needed with a first delivery and can often
be avoided in subsequent deliveries.
I touched on this subject because following a Caesarean or
an episiotomy, your doctor may give you sedatives or
pain-killers which can adversely affect your close interaction
with your baby and proper initiation of breastfeeding.
In case your doctor decides to do the episiotomy, he may
prescribe drugs to relieve the pain of the stitches. Doctors
have found that if the baby is given to the mother soon after
delivery for skin-to-skin contact, the mother gets so
engrossed in her baby that stitching is often done without
taking recourse to drugs for suppressing pain.
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breast or try to push the nipple into the babys mouth. Touch
the babys lips, preferably the upper lip, with your nipple. If
the baby opens her mouth a little, do not offer the breast and
the nipple. Again touch her lips with your nipple. As soon as
she opens her mouth wide and shows interest in feeding,
quickly move her on to the breast. Let the babys lower lip be
well below the nipple. This helps to get the babys chin close
to the breast so that her tongue is right under the lactiferous
sinuses containing milk. Then the nipple is positioned above
the centre of the babys mouth, so that it points towards the
palate. As soon as the nipple touches the palate, the baby
starts suckling and when her mouth fills with milk, she
swallows it.
To make sure that your baby is positioned properly at the
breast, check the following points: (Fig. 4).
Your babys entire body, including her neck, shoulder
and abdomen, should be facing you and close to your
body. Her chin should touch the breast.
Her mouth should be wide open with her lips curled
outwards.
More of the areola should be visible above the babys
upper lip and less below the lower lip. But if the areola is
big, more of it may be visible, even if the baby is
positioned properly.
The baby should be taking slow, deep sucks.
After the feed, the baby should appear relaxed and
satisfied.
You should not feel any nipple pain.
You should be able to hear your baby swallow, but this is
not essential.
After offering the breast to the baby, keep your other hand
free to stroke her hair or play with her fingers. Do not put a
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child. Around the age of 9 months, I like to make sure that the
child does not have rickets, so that treatment can be given if
required.
Do I Have To Give Calcium And Iron To My Breastfed
Baby?
Breast milk has enough calcium to meet the normal
requirements of the baby. Even if your baby is teething, you
need not give her calcium. Your milk also has one of the best
forms of iron that is absorbed into the babys system
remarkably well. Till the child triples her birth weight, all her
iron requirements are met by your milk alone.
In one study reported in the Journal of Pediatrics, none
of the infants receiving human milk as the only milk in the
first 12 months of life, without other foods containing iron,
were anaemic at 7 months, compared with 43% of those
breastfed for a shorter period. Good iron status was found
at 12 and 24 months of age. However, we recommend
addition of foods other than your milk after the baby
completes 6 months of age. That provides her extra iron from
other sources as well. I have seen iron-deficiency anaemia in
breastfed children where introduction of other foods was
delayed much beyond 6 months. Such children can become
irritable and develop loss of appetite and may need more
breast milk, iron-containing foods and, at times, iron in
medicinal form.
Does My Child Need Extra Calcium For Healthy Teeth?
No extra calcium is needed in breastfed children born at the
expected time. Caries of teeth are common in bottle-fed
children. Breastfed children can also get caries, but this is
extremely rare. It is generally seen in children who have an
inherent tendency to get caries and who, even after they have
started teething, have a tendency to go to sleep on the breast
after feeding.
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STEP ONE
STEP TWO
STEP THREE
Mother applies the smooth end to her breast and gently pulls the piston
Fig. 5
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A bondla
(also called paladai or jhinook)
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Babies
Also
Be
Fed
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Now take a clean cup. Wash your hands. Hold the cup near
the breast. Put your thumb on the areola above the nipple,
about an inch or 2.5 cms behind the nipple, and your first
finger on the areola below the nipple, opposite the thumb.
Push the thumb and finger inwards towards the chest wall.
Then press the areola between the finger and thumb and
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release. Again push, press and release. No milk will come out
for a few moments. But after you press a few times, drops of
milk will start to come. Press the areola in the same way from
the sides, to make sure that the milk is expressed from all
segments of the breast. Express one breast for about
5 minutes. Then express the other side. Repeat again with
both sides. You can use either hand for either breast (Fig. 6).
What About The Warm Bottle Method Of Removing
Breast Milk?
This is a practical method to relieve engorgement, especially
when the breast is painful and expression by hand is difficult.
Find a large bottle (700 ml to 1 litre) with a wide neck (3 cm in
diameter), if possible. Pour a little hot water into the bottle to
start warming it. Then fill the bottle almost to the top with hot
water. Let it stand for a few minutes to warm the bottle. Wrap
the bottle in a cloth and pour the hot water out. Cool the neck
of the bottle and put it over the nipple, touching the skin all
around to make an airtight seal. Hold the bottle steady. After a
few minutes, the bottle will cool and exert gentle suction that
pulls the nipple into the neck of the bottle. The milk then
starts to flow and collects in the bottle. When the flow of the
milk slows, release the suction and remove the bottle. Pour
out the milk and repeat the process with the other breast.
After some time, the severe pain in the breasts becomes less
and hand expression or suckling becomes easier (Fig. 7).
Fig. 7
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Those who can afford and can safely use milk powder
should prepare the formula in the proportion of 1 level
measuring spoon (placed in the tin) of infant milk powder to
1 ounce (30 ml.) of water.
Skimmed milk or condensed milk should never be given to
infants.
Frequency And Amount Of Milk
Aim at five 4-hourly feeds. Start with an ounce (30 ml.) per
kilo of weight per feed. For instance, if the baby weighs 4 kg.
give 4 ounces (120 ml) of milk every 4 hours omitting the
midnight feed. This is a rough guide. If the baby finishes all
4 ounces, make 41/2 ounces for the next feed. A little milk
should always be left behind. The maximum amount per feed
is 8 ounces.
BOTTLE OR CUP FEEDING
Cup feeding, feeding with an ordinary glass or a paladai,
(also called jhinook, or bondla a traditional small katori
with a long spout) is much safer than bottle-feeding and is
to be preferred. We have had experience of giving milk
with a cup or an ordinary glass to premature babies who
have already developed the swallowing reflex in other
words, babies who were ready to swallow. Unnecessary
fears have been raised that this may lead to aspiration of
milk into the babys windpipe. It is only recommended that
the baby should be propped up a little and offered the milk
from these utensils (other than a bottle) very slowly. These
utensils are easier to clean. Feeding from them is
preferable even to spoon-feeding which consumes more
time than cup or glass feeding. With spoon-feeding, wastage
of milk and the risk of contracting infection from our
fingers are also higher.
Special cups having a spout with a number of holes in it are
not recommended, as they are more difficult to clean.
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of the bulky, starchy stuff to get all the calories she needs.
Adding fats like oil or ghee, protein-rich foods like pulses,
beans, milk and milk products and meat and sweetening
agents such as jaggery or sugar can solve this problem.
Another good way of reducing the bulk and increasing the
energy density of food is by adding Amylase-Rich-Food
(ARF). To make ARF, about 100 gms. of any locally available
cereal or grain (wheat, ragi or bajra) is steeped overnight in
2 to 3 times its volume of water, the excess water is drained,
and the moist, swollen seeds are germinated in a moist, dark
environment for 24 to 48 hours till they sprout. The grains are
then sun-dried for 5 to 8 hours and lightly toasted on a flat
skillet to remove any surface moisture. The sprouts are
removed by hand abrasion and the grains are milled or
powdered. This flour (ARF) is stored in an airtight bottle or
plastic container. The small amount of ARF, for a cost of 20 to
40 paise, will suffice to give a child nutritious gruel for
one month. It need be made only once a month.*
Addition of vegetables and fruits provides the required
minerals and vitamins.
Water can be given to the child once she starts taking foods
other than breast milk and fruits. It should be offered from an
ordinary glass. Children learn to sip from a glass quite easily.
A child should be given her food an hour or two before the
family eats. Let her then also join the family to participate and
be given some food that is not too spicy or too rich in fat,
sugar and salt.
After the age of 9 months (or even earlier in children
who are interested), encourage the child to eat by herself.
Do not be upset if she makes a mess. You may help her,
but she should get a feeling that she is managing by
*Gopaldas T. Technology to improve foods in developing countries. In: Nutrition in
Children. Eds. Sachdev HPS, Choudhury P. New Delhi, Department of Paediatrics,
Maulana Azad Medical College; 1994, pp. 130-131.
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herself. To begin with, offer her foods which she can pick
up with her fingers, like a thin piece of toast or biscuit
(preferably wholewheat), cooked peas, scrambled egg,
dhokla, idli (plain or fried), shreekhand (sweetened curd
cheese), porridge, pumpkin and small pieces of fruits like
bananas, chikoos and papayas.
The child may choke a little while learning to eat. Do not be
scared, but be with her while she eats, in case she gets into
trouble. Let her start getting used to a spoon. Let her dip a
teaspoon into a preparation like shreekhand. A bit will stick to
the spoon and give her the joy of getting something into her
mouth on her own.
A child who was eating well at 6 or 7 months may suddenly
become disinterested in eating. Do not panic. Try some new
preparation. But never force the child to eat more than she
wants. Respect her appetite. Even if half a spoon is left in the
bowl, stop feeding her if she shows any signs of not wanting
to eat any more (keeping her mouth shut, turning her head to
the side or pushing the food out).
What Are The Foods That Should Be Avoided In The
First Year Of Life?
Foods that are more likely to give rise to allergic reactions
should be avoided till the child completes 1 year. These are
artificial milk (cow, buffalo or powder milk), eggs, fish and
citrus fruits like orange and sweet lime.
In families with a strong history of allergy, besides the
above foods, even peanuts, other nuts, chocolate, wheat, corn,
onions, tomatoes, cabbage, and all types of berries should be
avoided. If any member of the family reacts adversely to a
particular food, avoid that as well.
Also avoid fried foods and foods that contain added sugar or
artificial sweeteners or are high in salt. Some authorities also
do not recommend honey to be given below the age of 1 year,
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A good guide that the child is having an optimum quantity of food is her level of
activity and weight gain
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Morning
10 oclock
Noon
: Khichdi 12 katori
or
Rice 1 katori + dal katori
Vegetables
2 oclock
: Bread slice 1
4 oclock
Night
: Khichdi 1 katori
or
_
1
Rice 2 katori
1_
Dal 2 katori
Vegetables
_
1
* Ghosh S. The Feeding And Care of Infants and Young Children. New Delhi,
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General Principles
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A child must sit while eating first in your lap and later on
her own. She should not be allowed to run around the
house while eating.
I do not believe that you should only feed a child when she
asks for her food. Some children get so absorbed in playing
that they will never ask for food, though they start
becoming irritable because of hunger. Children should be
offered food at regular times, but not forced if they eat less
or do not eat at all at one particular sitting.
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Dry fruits are good for children, but they must also be
rationed partly because they are expensive and more
so because some of these, like dates, figs and raisins, can
remain stuck between the teeth, leading to caries. Foods
that may lead to choking in children should be avoided in
those below 3 years. Examples of these foods are peanuts,
raw carrots, other nuts, popcorn, hard candies, berries and
whole grapes.
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introduced into the jar from your childs finger or the spoon
can cause the food to spoil rapidly.
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General Principles
Too much anxiety about your teenagers diet is likely to
cause more problems than help her in inculcating healthy
food habits.
Do have a general discussion about diet with your young
friend. She may be more receptive to advice from your
family physician or her paediatrician. I purposely used the
words young friend. Your teenager is more likely to
respond to your suggestions if you treat her with respect.
I am for regular mealtimes. I am against fast foods or junk
foods. But I know that sometimes I too, have such foods.
And at 67, I am in good health. We do not have to be
fanatical. But we should know, and so should our young
friend, that when we go to a fast food restaurant, we are not
likely to get food which is ideal for our body. But if, during
the day, or even during the course of the week, we
remember to also have leafy or raw vegetables, fruits, and
any whole grain preparations, we can significantly minimise
the harmful effect of such foods.
Teenagers should learn (and so should we) that fruits
(fresh as well as dry), vegetables (leafy, raw, yellow,
red and others), sprouts, whole grain preparations,
nuts, dahi and paneer make better snacks than soft
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Vegetable Group
3-5 SERVINGS
Fruit Group
2-4 SERVINGS
Chapati, Bread,
Rice
6-11 SERVINGS
FOOD GUIDE PYRAMID
Source: U.S. Department of Agriculture.
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person has to change her diet once she gets into a sedentary
mode of living, as is the case with pregnancy. You need to be
aware of what you take in, and when. Just as important as
your diet is also your mental well-being. Most of the time, you
cant physically rush around anyway because of nausea. And
that is part of the role of nausea. If you are vomiting, toxins
are being thrown out of your body. Take sickness as a sign.
Eat small amounts of food every 2 hours. This way, it is easy
to balance your diet between things that are good for you
(fresh fruits, raw vegetables, vegetable juice, dry fruits,
sprouts, nuts, seeds, coconut milk-based dishes) and the junk
you might crave.
Bringing up healthy babies is another matter. Be calm and
be brave. Listen to your convictions and to common sense.
Breastfeed as much as you can and add solids at about
6 months, beginning with mashed banana and then graduating
to steamed apple, mashed potato and cereals such as nachni.
I not only followed this but also prevented my boys from
having any chocolate, sweets and soft drinks until it was time
to go to birthday parties. Then you have very little control.
People called me cruel. I am proud to say that I have two big,
healthy hunks now who go out and ask for nimboo pani
instead of cola, because they like it. A soft drink here, a
hamburger there surely cant cause irreparable damage, you
might say. And you would be right. Anything in moderation
usually doesnt. But with kids, junk tends to become a habit
that even adults enforce upon them. How often have you
heard people say, The kids can have pizza while we eat
dinner? Lets not underestimate our children. We owe them
a healthy start to make their lives richer, more aware and
more vital than many of our own. And the first step is to try
and change our own eating habits. There is no point depriving
children of cola if they see you drinking it every evening.
Feeding children healthy food can be a frustrating
experience. So what are concerned, even nutritionally
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Even the most reluctant eater may eat something prepared by himself
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CHOOSING A PAEDIATRICIAN
PART
4
KEEPING YOUR CHILD HEALTHY
Choosing A Paediatrician ..........................................
222-224
225
226-235
236
237-434
435-443
444-449
Emergencies ...............................................................
450-451
452-456
457-462
463-468
469-472
473-483
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CHOOSING A PAEDIATRICIAN
In days gone by, most children were looked after by the family
physician. Even today, some lucky parents have a doctor
whom they can rely on for most day-to-day childhood
problems.
But most others need to have their children seen regularly
by a paediatrician (a child specialist).
Only The Best For Your Child
Ask your family doctor to refer you to a good paediatrician
ideally one located close to your residence. Your obstetrician
is another source for reference. A close relative, friend or
neighbour may also be able to refer you to a good
paediatrician.
Ask other parents who go to the same doctor whether she
meets these qualifications:
She is competent. She spends enough time with parents
and children, especially on the first visit.
She is a good listener.
She does not ask for unnecessary investigations and
does not prescribe too many drugs. She may even decide
to try the no-medication option.
She is available for emergencies or makes alternative
arrangements in advance.
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CHOOSING A PAEDIATRICIAN
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HOME REMEDIES
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HOME REMEDIES
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HOME REMEDIES
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HOME REMEDIES
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CHOOSING A PAEDIATRICIAN
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CHOOSING A PAEDIATRICIAN
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A pair of scissors
A pair of tweezers
A bottle of some antiseptic solution (like Dettol or Savlon)
Band-aids
Bandages (1-2 inch wide)
Cotton wool
Packets of sterile gauze
Paracetamol (Calpol, Crocin, Metacin, etc.)
A rubber tube
Elastic bandage
Leucoplast
A hand towel
Rubber syringe (to be used as a nose cleaner)
Thermometer
Petroleum jelly
Disposable syringe (5ml) and needle
Phone numbers of the hospital, doctor and a close relative
or a friend
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THE A
Z OF CHILDHOOD ILLNESSES
ABDOMINAL PAIN
If your child has pain in the abdomen, but otherwise looks
well, you can be almost sure that the problem is not serious.
See the doctor if you have cause to be anxious.
CAUSES: Below are given some of the important causes of
abdominal pain in children.
Psychological Factors
Medical Causes
Surgical Conditions
Psychological Factors
SYMPTOMS: School going children often complain of
recurrent pain, usually located around the navel. In most
cases, the pain is not severe and the child does not complain
about it if he is involved in doing something interesting. It
rarely wakes him up from his sleep. He is perfectly all right in
between the attacks, which may last for a few moments or
longer, but rarely for more than half an hour. There may be a
family history of similar pain in other children or in the
parent(s). Usually, these children are quite intelligent.
CAUSES: Consider if there is any reason for the child to
become emotionally upset. Is he being bullied in school? Is
he afraid of his new teacher? Are the examinations causing
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Z OF CHILDHOOD ILLNESSES
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THE A
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Food Poisoning
Food poisoning should be suspected if all those who have
eaten the same food start getting abdominal pain, diarrhoea
and vomiting, with or without fever.
PREVENTION: Children should be discouraged from
eating milk products outside the home.
Food should be eaten the same day it is cooked. If this is
not possible, the leftover items should be rapidly cooled in
cold storage or kept in the deep-freeze compartment of the
refrigerator, and thoroughly heated before consumption.
Make sure that the centre of the food gets heated, leaving no
cool spots.
TREATMENT: Same as for Diarrhoea in the chapter on
HOME REMEDIES.
Sore Throat And Vomiting
SYMPTOMS: Sore throat with enlargement of glands in the
abdomen can cause abdominal pain in children above 2 years
of age. The pain disappears as the sore throat gets treated.
Severe bouts of cough or vomiting leading to soreness
of the abdominal muscles may also present as abdominal
pain. The remedy lies in treating the cause of sore throat,
cough or vomiting.
Tuberculosis Of The Abdomen
Tuberculosis of the abdomen should be considered if the child
who complains of pain in the abdomen has associated features
connected with a possible diagnosis of tuberculosis. These
features include: A history of close contact with an adult
having tuberculosis; loss of appetite and weight; distension of
the abdomen with or without evidence of intestinal
obstruction; and evidence of tuberculosis elsewhere in the
body. For treatment, see section on Tuberculosis.
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THE A
Z OF CHILDHOOD ILLNESSES
Constipation
This is a common cause of abdominal pain in children. The
child does not look ill, nor run fever, but gets intermittent
colicky pain in the stomach. There is no vomiting and the
appetite is usually not affected. The child may have moved his
bowels, but it may have been an incomplete evacuation. For
treatment, see section on Constipation.
Surgical Conditions
Appendicitis
Appendicitis refers to inflammation of the appendix a taillike structure connected to the caecum portion of the large
intestine located in the right lower abdomen. If not detected
early, an inflamed appendix may burst open, leading to a
serious condition called peritonitis.
SYMPTOMS: This condition should be suspected in the
presence of persistent pain in the abdomen, often (though
not always) associated with loss of appetite, vomiting and
fever. The pain mostly begins around the centre of the
abdomen (near the navel) and, after a few hours, gets
localised to the right lower abdomen. The child who is
otherwise active becomes quieter, resists examination of
this part of the abdomen and gets even more pain when his
abdomen is pressed gently over this region. Unattended
peritonitis makes the abdomen feel hard like a board, and
the pain and tenderness (pain when touched) becomes
worse.
TREATMENT: A child with a possible diagnosis of
appendicitis needs the immediate attention of a surgeon
preferably a paediatric surgeon.
Intestinal Obstruction
Intestinal obstruction is a serious surgical condition. Some
of the causes are congenital obstruction (from birth), a
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mass of roundworms obstructing the intestines, intussusception and an obstructed inguinal hernia (discussed
later in this section).
SYMPTOMS: The child with intestinal obstruction has pain
in the abdomen, constipation, distension of the abdomen and
projectile vomiting (vomit shooting out of the mouth with
great force). It may be green in colour (due to the presence of
bile) or may even contain faeces. The child will want to lie
quietly in spite of the pain.
TREATMENT: The urgent care of a surgeon is vital.
Intussusception
Intussusception is a condition in which one portion of the
intestine slips inside the portion next to it. The condition
occurs commonly between the ages of 3 months and 3 years.
SYMPTOMS: There is a sudden onset of pain which lasts for
2 to 3 minutes and then occurs in repeated bouts every quarter
hour or so. The child shrieks with pain and looks frighteningly
pale. While a child usually becomes red in the face when he
cries, in intussusception, the child looks pale, acutely ill, refuses
to eat or drink and appears to be collapsing with continuing
bouts. At this stage, the child may pass blood in the stool.
TREATMENT: A surgical opinion is urgently needed in such
a situation.
Inguinal Hernia
Inguinal hernia with strangulation or obstruction may
present itself in an infant who starts crying suddenly and
the mother notices a hard swelling in the groin (junction
between the abdomen and thigh). No attempt should be
made to press on this swelling; show the child to your
doctor. If unattended, obstructed inguinal hernia can
present with signs of intestinal obstruction (as with
Intussusception). If the treatment is unduly delayed, the
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Z OF CHILDHOOD ILLNESSES
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THE A
Z OF CHILDHOOD ILLNESSES
ACUTE NEPHRITIS
See Acute Glomerulonephritis.
ACUTE WATERY DIARRHOEA
See section in the chapter on HOME REMEDIES (page 226).
ADDICTIONS
In India, just like around the world, addiction to alcohol,
tobacco chewing, smoking and hard drugs is taking its toll on
young people.
Peer pressure and high parental expectations add to the
pressure. Not fully realising that alcohol is also a drug, a
teenager may use it to relax or escape from stress. With time,
the abuse of alcohol can give rise to a feeling of inadequacy,
lowered self-esteem, estranged relationships, impaired
reasoning and judgement, dependence and gradual personality
deterioration. Even beer, which is often thought to be safe to
drink, can impair rational thinking and lead to irrational
behaviour. It can also be responsible for delayed reaction
time, which may increase the risk of automobile accidents.
And then, there is always a possibility of graduating from beer
to harder stuff.
And while puffing a cigarette may seem less hazardous and
life threatening in youth, a single cigarette is said to reduce
the lifespan by 5 minutes. Even if we close our eyes to the
long-term dangers like cancer and heart disease, what about
simple effects like bad breath and staining of teeth? These do
not help in becoming popular with friends! Smoking also has
an immediate effect on our lungs, resulting in frequent attacks
of cough, possible wheezing, poor stamina, and an adverse
effect on performance in competitive sports.
The list of risks that result from exposure to smoking
(active or passive) includes asthma, middle ear infection,
chronic lung disease, sudden infant death syndrome (SIDS),
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Asthma
SYMPTOMS: In a typical case, a 4-year-old child goes to
sleep normally and gets up wheezing in the middle of the
night. He has difficulty in taking in air as well as in pushing it
out. His breathing is faster than usual. When he breathes in,
he has to sometimes take the help of his neck muscles to take
the air in. The normal gap between the two clavicles
(collarbones) tends to dip during inspiration (breathing in).
While breathing out, the child makes a musical hissing sound
termed wheezing. The expiration (breathing out) is more
prolonged than usual. The child finds it easier to breathe
sitting up or wants a pillow or two on his lap to put his head
on for comfort. If the child has had eczema before or has had
similar attacks before this episode or has a strong family
history of allergy or was artificially fed (not breastfed), the
diagnosis is more or less confirmed. It does not mean that a
breastfed child cannot get asthma. The point worth noting is
that artificially fed children are at a much higher risk.
Thunderstorms can precipitate an attack in those
who suffer from seasonal asthma due to an increase in
the amount of airborne pollen.
TREATMENT: Show your child to your doctor as soon as
possible after the first attack to let him decide if it is indeed
asthma. Do not overreact if your child gets an attack of
asthma. You may pass your anxiety on to the child and so
worsen the attack. Follow your doctors advice on handling
the situation. Give the prescribed medication by mouth or by
inhalation, keep the child comfortably warm without covering
him excessively, let there be free flow of air into the room
(switch on the air-conditioner, if you have one) and give him
enough liquids including water. If he has fever, avoid aspirin
and ibuprofen, as they can worsen the attack of asthma.
Paracetamol would be better. Avoid giving cough syrups
(specially those containing codeine). As long as your child is
not in acute distress and is accepting some food and enough
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not have any loose threads that may get entangled with the
childs fingers.
Your doctor may prescribe an oral antihistamine drug
like chlorpheneramine. Cold compresses on the rash may
be found to be soothing. Soothing ointments containing
corticosteroid should be used only in consultation with your
doctor, since they are absorbed into the body through the
skin and may cause side effects. If applied, they should be
used in very small amounts. If the skin gets infected, your
doctor may prescribe an antibiotic. In very severe cases,
cyclosporine, a potentially toxic drug, has been found to
be helpful.
A mother who is breastfeeding may try omitting possible
allergens (see the list of foods at the beginning of this section)
from her diet.
If you need to be on a prolonged milk-free diet, consider
taking some calcium preparation and Vitamin B12. A diet that
includes fruits, vegetables and sprouts is essential. (Also see
the chapter on PREGNANCY.)
Some babies who are allergic to cow milk may tolerate soya
milk better, though some children are also allergic to
soya milk.
Urticaria
SYMPTOMS: This condition manifests as itchy, pink or
reddish raised patches of skin that tend to come and go, to
reappear on other parts of the body. The size of the patches
may vary from 1 millimetre to a few centimetres (giant
urticaria). Itching may be severe or mild.
CAUSES: Urticaria may follow intake of certain foods like
fish, eggs and nuts, or some drugs, or certain infectious
agents. Contact with some plants may also be responsible. At
times, no obvious cause can be determined.
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AND
CONGENITAL
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THE A
Fang marks
from the bite of
a p&www
snake.
Teeth marks are
often absent.
Z OF CHILDHOOD ILLNESSES
Two rows of
teeth marks
from the bite
of a non-poisonous
snake.
Snake bite
affect the nervous system. Besides pain at the site of the bite,
the patient may also manifest weakness of the eye muscles,
resulting in drooping of the eyelids, double vision and squint.
There may be difficulty in swallowing, cough and paralysis of
the muscles required for breathing. The patient may also
complain of pain in the abdomen, loose motions and vomiting.
The blood pressure may drop and the patient may collapse.
The respiratory paralysis can lead to death if the patient does
not receive adequate treatment in time.
Swelling at the site of cobra and krait bites is not common.
Compared to the cobra and krait, a viper bite is usually very
severe and the local swelling is quite marked. Blisters may
form around the site of the bite. The bite of the viper affects
the blood system and prevents clotting. Patients develop
vomiting, the blood pressure falls and bleeding may occur
from different parts of the body. The bleeding may continue if
treatment is not given and the patient may go into a state of
shock.
TREATMENT: Treatment for snakebite must be prompt. If
the snake alive or dead is available, take it to the
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BLEEDING
COMMON CAUSES:
Cuts
See Cuts (page 322).
Nosebleeds
See Nose-Related Problems (page 374).
Vomiting Of Blood (Haematemesis)
This could be due to severe bouts of vomiting without any
bleeding disorder. It can also be due to drugs like aspirin and
certain other pain-relieving drugs, especially if these are
taken on an empty stomach. Liver disease and portal
hypertension can give rise to dilated blood vessels in the
oesophagus and stomach which can bleed.
Blood In Stools
This can be due to a fissure caused by hard motions in a child
with constipation. In such a case, the hard stools are streaked
with fresh blood. A rectal polyp is another cause for passage of
fresh blood in the stools. The typical history is that of a child
who passes drops of fresh blood after having passed a motion.
Spitting Of Blood Or Haemoptysis
This could be due to certain diseases in the lungs. Blood
trickling from the back of the nose and brought out from the
mouth can also be mistaken for haemoptysis.
MANAGEMENT: For cuts and bleeding from the
nose, see sections on Cuts and Nose-Related Problems
respectively.
Take your child to a doctor or hospital immediately in these
situations:
If your child is bleeding persistently or profusely.
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60
50
40
30
or
or
or
or
more
more
more
more
per
per
per
per
minute
minute
minute
minute
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Percentage
Total (%)
Face
9 (18 in infants)
18 each
36
Upper limbs
9 each
18
Lower limbs
18 each
(13.5 in infants)
Perineum
Grand Total
36
1
100
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(CPR)
Timely help can save a life. You must practise the technique
of mouth-to-mouth breathing in advance.
Have someone call for an ambulance or a doctor, while you
start on the procedures.
Check For Breathing, Not Pulse
Look for movement and any sign of breathing, including
coughing. If these are absent, call for an ambulance and start
chest compressions.
Positioning Hands
Compressing and releasing the chest (see steps 5 and 6) helps
force blood out of the heart and into the rest of the circulatory
system. Simply place your hands between the victims nipples
to locate the sternum. For children over age 8, perform
15 compressions before giving 2 rescue breaths.
Mouth-to-Mouth Breathing
Mouth-to-mouth breathing, in which you exhale into the
victims mouth, remains an essential part of CPR. But if
you are unable or unwilling to give the mouth-to-mouth
resuscitation, chest compressions alone should increase the
victims chance of survival, especially if medical help is
imminent.
Steps To Be followed If The Child Stops Breathing
Step 1: Shout for help to get an extra hand and to summon
a doctor.
Step 2: In the case of a child, clear the mouth. Check if
anything is stuck in the mouth or throat. Pull the tongue
forward. Remove any foreign object or food that can be
removed easily with your fingers. If removal seems difficult,
follow the section on choking.
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Step 3: Let the child lie on his back on the ground or any
other firm surface like a strong table. Tilt his head back so
that the tip of his nose faces the roof or sky. Open his
mouth wide.
Step 4: If he is still not breathing, start mouth-to-mouth
breathing. For this, take a deep breath. For an infant, place
your mouth over his mouth as well as the nose, closing your
mouth firmly over them so that no air leaks. Then, blow
gently to make sure that his chest rises a little. Do not blow
with too much force in an infant, because you may rupture
his lungs.
In case of an older child, pinch his nostrils with one hand
and place your mouth only on his mouth. Breathe into the
childs mouth forcefully to ensure some lifting of his chest.
Give 2 such breaths.
If the chest is not moving, follow Step 2 again.
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placed a little below the level of the nipple. Press the bone
about an inch at a rate of about 100 per minute (see
illustration).
If you are alone, give one breath for every five
compressions (or massage).
For an older child, you may need to apply more pressure,
using the heel of the hand. For an adolescent, you may also
need to place the heel of one hand on top of the other hand
and then press down about one and half inches (see
illustration).
Continue this exercise until you can feel the pulse or until
you are sure that the person is dead. It is worth trying this for
half an hour to one hour before you give up.
Mouth-to-Mouth Breathing And Drowning
If the child is not breathing on his own, follow the same
procedure as given above, under mouth-to-mouth breathing.
Do not waste precious time trying to get water out of his
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develop at the back of the neck and the armpits. The total
period of the illness is about a week to 10 days. While the
disease may initially be confused with insect bites or pimples,
the rash of chickenpox keeps changing its characteristics very
fast, while insect bites or pimples do not follow this pattern.
Once all the spots become crusted and no new crops
appear, the patient is no longer infectious. He can infect
others from a day before the spots are first noticed to the day
all the spots are crusted. Once that happens, the child should
be ready to go to school and play with other children.
Unfortunately, in some schools, the child is not allowed to join
till all the scabs or crusts have fallen off. It is to be noted that
whereas the scabs of smallpox, which is now eradicated, could
infect others, those of chickenpox cannot. Interested parents
may consider meeting the school authorities in this
connection so that children are not unnecessarily kept away
from school.
TREATMENT: The spots of chickenpox are very itchy.
A daily bath helps because sweating increases the itching.
Keep the childs nails short. Explain to an older child that he
should avoid scratching because it may leave behind scars.
For smaller children, mittens may be used at night. If itching
is severe, apply cool packs of cloth soaked in water from
boiled and strained neem leaves. Plain calamine lotion applied
to the spot also reduces itching. It is not advisable to use
calamine mixed with other ingredients. Neem leaves may also
be spread on the bed sheet. If the itching is very severe, your
doctor may prescribe an antihistamine preparation to be given
by mouth. If the fever does not bother the child, avoid using
any drug. If required, a paracetamol preparation may be used
to lower the temperature. Never give aspirin to a child
suffering from chickenpox or influenza, because it may lead to
a serious disease called Reyes Syndrome. No diet restrictions
are required. The child should be allowed to eat his usual
healthy nutritious food. If he does not feel hungry, make sure
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soft breast does not damage the stitches. In any case, there is
no need to stop direct suckling for more than a few hours. If
direct suckling is delayed for any reason, the mother should
keep expressing her milk every 3 hours. This milk can be
given to the baby with a cup or a bondla (paladai).
Breastfeeding is now recommended even in the second
year of a childs life. So after the child recovers from surgery
for cleft lip, direct breastfeeding can be started again in a
week or so.
Some children who are operated for cleft lip may need
another operation later on. After surgery, children with cleft
lip and palate may need the help of a speech therapist and an
orthodontist, under the guidance of a paediatrician.
COMMON COLD
Colds are very common. Some children can become very
restless with a cold. So we shall discuss the subject at length.
But before we do that, please note:
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makes the child cough with the post-nasal drip. Such a child
will sleep better on his stomach (however, making a small
infant sleep on his stomach is not considered safe).
Taking Care Of A Blocked Nose
If the nose is not too blocked, your child, especially if he is
older, may not be bothered. Otherwise, a blocked nose needs
help. The best tool for this is a rubber syringe (also called a
nose cleaner), available at most departmental stores and
chemists. It consists of a rubber bulb, shaped like an ancient
rubber horn. To this is attached a nozzle which can also be
boiled. To use it, press the rubber bulb, keep it pressed, put
the nozzles tip into the babys nose, and then release the
bulb. The mucus gets sucked into the nozzle. Clean the
nozzle. Boil it before using it again. If this tool is not available,
you can also use a 5 or 10 ml. syringe without a needle for the
same purpose.
If the nose still appears blocked, use saline nose drops.
These can be prepared at home. Add 1/4 teaspoon of salt to a
glass of warm water (about 200 ml.). To use these drops
effectively, let your child lie down. Turn his head to one side
say the right side. Put 2 drops into the right nostril. Let the
head be kept on the same side for a minute or two. Then
repeat the same procedure for the left side. Instead of a
dropper, you can also make a cotton wick. Dip it into this
water-salt solution. Roll the wick inside the childs nostril to
clear the mucus and to open the nose. If the tip of the wick
touches the back of the nose, he may also sneeze, expelling
some of the mucus.
Cleaning the nose is specially needed before sleep and
before feeding a baby. Though saline drops are the safest,
even these should be avoided unless the blocked nose is
bothering the child. Take recourse to readymade nose drops
only if the saline nose drops are not helping, and the child is in
real discomfort. But make sure that you buy those that are
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and noodles. Avoid giving the child milk products since they
can depress the activity of the colon. Cow and buffalo milk can
also cause milk allergy and anal fissures which may cause
chronic constipation via stool avoidance. Soya-based milk may
be tried in such cases.
Although medicines can be helpful, do not medicate
without consulting your doctor. Bisacodyl suppository
(available as Dulcolax), 5 mg. for under-twos and 10 mg. for
children over 2, may be used. It should be inserted at the
same time each day, preferably after a meal. Use it daily for a
month, 2 times a week in the next month and then once a
week for 3 months.
In severe cases, hospitalisation may be needed to manage
the child and also to investigate for some other rare causes
like congenital megacolon (Hirschsprung Disease) and
hypothyroidism that can give rise to constipation.
CONVULSIONS OR FITS OR SEIZURES
In simple terms, a convulsion or a fit refers to abnormal
involuntary movement(s) of the body with or without
disturbed consciousness. The movements can involve almost
the whole body or just the finger or any other part of the body.
Unconsciousness may be prolonged or may be momentary
and take the form of a stare.
Most causes of convulsions are not serious and disappear
as the child grows older. A few types may need medication for
2 years or more.
MANAGEMENT OF A CONVULSION: Step 1: As a
prolonged convulsion can affect the brain, it makes sense to
control it. Fortunately, most convulsions last a minute or two
and stop on their own. Usually, a drug (diazepam or
phenytoin) is injected into the vein of the child to stop the
convulsion. Sometimes, a different drug may be injected into
the muscles.
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Step 3: Find out the cause of the convulsion and treat it. A
child who had a difficult birth or who has a deficiency of
glucose or calcium in his system may get a convulsion. One
out of 4 children with a sudden rise of fever may get a shortduration fit between the ages of 6 months and 5 years. These
are called febrile convulsions. Some infants and toddlers may
hold their breath and some of these may also get a fit
following a bout of crying. Treatment with iron is found to be
effective in reducing the incidence of breath-holding spells in
some children.
A few serious causes of convulsions are cerebral malaria,
meningitis, encephalitis, poisoning, brain tumour and head
injury. In some cases, the cause of convulsion cannot be
determined and your doctor may make a diagnosis of epilepsy.
If he suspects this diagnosis, he may ask for an EEG
(electroencephalogram) and decide to put the child on a drug
for prolonged use to control the convulsions. Certain drugs
require a blood test to rule out any possible side effect or to
know if the dose of the drug being given is optimum. For
certain types of convulsions, your doctor may ask for other
tests including a CT scan of the brain and a lumbar puncture
(spinal tap) to examine the CSF (cerebro-spinal fluid). For
intractable convulsions that dont respond to drugs, a part of
the brain is removed with good results.
A few newborns and older children get a convulsion once
and never again. Hence, it is important not to panic if your
child gets a convulsion. However, as frequent convulsions can
cause harm to the child, it is important to take fits seriously.
Seizures can also manifest as staring spells, mostly
between the age of 5 and 12 years. Multiple attacks of such
spells could lead to a decline in scholastic performance.
Some children get staring spells which are not due to
epilepsy and do not need any treatment. They are considered
non-epileptic when parents report preserved responsiveness
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Cold
Smoking
Adenoids
Habit of clearing the throat
Sinus infection
Attentionseeking device
Tropical eosinophilia
Measles
Hay fever (see Allergies)
Serious Causes
Pneumonia
Bronchiolitis
Asthma
Tuberculosis
Whooping cough
Congenital heart disease
Foreign body in the bronchi
Tracheoesophageal fistula (rare)
Croup
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Spasmodic Croup
A croup without fever is not a serious disease, but can be very
scary both for the child as well as the parents. The disease
usually affects children between 1 and 3 years of age.
SYMPTOMS: The child goes to bed normally and gets up
suddenly with a barking cough and noisy breathing. He
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CRYING
Crying In A Small Child Who Looks Sick
Such a child should be shown to a doctor. He may have an
infection like an earache, a cold with a blocked nose, a flu-like
illness with headache and body ache, a chest infection like
bronchiolitis or infection of the meninges and raised intracranial pressure due to a tumour. The crying may also be due
to abdominal pain. These conditions are discussed under their
respective headings.
Crying In A Child Who Appears Otherwise All Right
Hunger remains one of the commonest causes of crying. Even
a toddler may cry for this reason. But all crying is not due to
hunger. If in doubt, feed the child. Otherwise, look for other
possible causes.
A child may cry because he is feeling hot or cold, or has a
wet nappy, or wants to be picked up and cuddled or shown
things in the home or has been overstimulated by adults
around him or is just feeling tired. Some small babies
quieten as soon as they are wrapped up in a sheet
or blanket.
Other causes of crying are pain at the site of an injection
or a child having been hit by an older sibling. Do not leave
the latter alone with the baby again, but also do not
punish him.
Infantile Colic
Babies may also have sudden bouts of crying for no apparent
reason. The onset of these bouts is usually between the age of
2 and 4 weeks. They can occur at any time of the day or night
but are more common after about 6.00 in the evening. The
baby suddenly starts crying. Nothing seems to work. The
child screams at the top of his voice, draws his thighs and legs
towards his abdomen, may pass some gas or have a distended
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Also try:
The colic positions - put baby on his tummy across your
knees; hold him against your chest, or hold him on his
tummy across your forearm with his legs on either side
of your arm.
Rocking him with or without soft music in the
background.
Sharing his care with someone else. Never shake a baby
vigorously in anger or irritation you may damage his
eyes as well as his brain. Let someone else handle him if
you are feeling exhausted.
Dicyclomine if your doctor advises it, but not too often. If
elders at home recommend a home remedy, it may be
worth trying it after you have cleared it with your doctor.
I do not recommend the routine use of drugs, or gripe
waters or digestive medicines. I am against the use of
pacifiers. A crying child needs our attention and not a
pacifier. A pacifier also interferes with successful
breastfeeding. It is also a possible source of infection.
Half a teaspoon of sugar water. It has been found
to have a pain-relieving effect on colic. Sugar
water given before a minor painful procedure like a
skin prick has also been found to be helpful. Given
a minute before the procedure, it not only reduces
the duration of crying, if any, but also reduces the
increased heart rate induced by pain. The sugar
water seems to do this by some sort of morphine
effect, because any benefit of sugar water is
negated if the infant is also given naloxone an
antimorphine drug.
CUTS
MANAGEMENT: Step 1: Stop the bleeding if there is any.
Apply pressure on the site with a clean cloth. Sterile gauze
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TREATMENT:
Children
with
encephalitis
need
hospitalisation. There is no specific treatment available. The
child is given full support in the hope that he will come out of
it on his own. Those suffering from encephalitis due to herpes
simplex infection may benefit from an expensive drug named
acyclovir.
PREVENTION: As mosquitoes can carry the disease,
adequate steps may be taken to protect the child from
mosquito bites.
EYE PROBLEMS
Squint
A transitory squint in newborn babies is common and does not
need any treatment. Children with a fold of skin between the
eye and nose (epicanthic fold) or with a wide bridge of the
nose and increased distance between the two pupils may
falsely appear to have a squint. However, a true squint must
be attended to immediately or it may lead to permanent
blindness. An eye specialist should be consulted and his
advice followed. Sometimes, the child just needs glasses. At
times, a squint may follow a serious head injury or a tumour of
the eye. Sometimes, surgical correction may be required.
Refractive Errors Needing Glasses
Every child should be subjected to an eye check-up before
joining school to ascertain if he has a squint or needs glasses.
Infections Of The Eye
Watering of the eye in a newborn without sticky eyes or puslike discharge from the eye is usually due to blockage of the
tear duct connecting the eye to the nose. This is not due to
any infection and generally stops spontaneously before the
child is 6 months old. If you notice a pus-like discharge from
the eye, your doctor will teach you how to massage the area
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between the eye and the nose and advise some eye drops to
be put after cleaning the eye with warm water. If watering
persists after 6 months, an eye specialist should be seen. He
may submit the child to a minor procedure to open the tear
duct. This is quite effective.
Redness of the eye or sticky discharge from the eye could
be due to a bacterial or viral infection. If the redness is
coupled with severe itching in the eye, the cause could be an
allergy. Do not use an antibiotic or cortisone eye drops
without consulting your doctor.
In a newborn with conjunctivitis, you can safely instil a
drop or two of breast milk into the eye, 4 to 5 times a day. It
does help in some cases. If you are in a place where no doctor
is available, you may use an antibiotic eye ointment for
conjunctivitis, but make sure that it does not contain any
corticosteroid. If not indicated, medicines containing cortisone
can be harmful. In persistent cases, your doctor may send an
eye swab to the laboratory to ascertain the causative
organisms and prescribe an antibiotic by mouth.
In rare cases, tuberculosis can manifest in the eye as
phlyctenular conjunctivitis. In this condition, a pimple-like
spot is seen on the outer side of the cornea. Thin blood
vessels are seen radiating from this spot. Further
investigations are needed to confirm this.
If conjunctivitis suddenly starts affecting a large number
of people in the community, it is mostly due to a virus
infection of the eye. It is highly infectious and may be
prevented by immediate hand washing after touching a
patient and by keeping separate hand towels. Antibiotics
are of no use because of the viral origin. If the redness
persists, see a doctor who may prescribe antibiotic eye
drops or an ointment if required. The antibiotic should only
be put in the affected eye every hour or two while the
child is awake. This is advised because the medicine is
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Rigid Foot
In the case of a rigid foot, which cannot be moved up and
down or side to side at the ankle or in the presence of a really
tight Achilles tendon, your doctor may like to show the child
to an orthopaedic surgeon.
Toeing-In and Club Foot
If the feet of a child are turned inwards but have normal
movement at the ankle joints, they need no treatment. It may
be due to a particular position of the baby while he was in the
mothers womb. This condition returns to normal by about
6 months of age. If the toeing-in persists or if it appears rigid,
the child may have a condition called club foot (congenital
talipes equinovarus). This may need an orthopaedic opinion.
Such children need repeated plastering. Sometimes, surgery
is also indicated.
Shoes
Although shoes are a necessary evil in the urban world, it is
an accepted fact that people who remain barefoot have
stronger and more flexible feet compared to those who wear
shoes. They also have fewer problems with their feet. So
allow your child the joy of walking and running barefoot on
safe ground as much as possible.
When you must buy shoes, do not go for fancy, expensive
ones. Shoes are only meant to protect your small child from
injury and cold. Of course, as he grows older, your child will
like to have a smart pair of shoes. Buy him smart ones, but
make sure that they are comfortable. Buy shoes later in the
day when the feet are likely to be a little heavier than in the
morning. The shoe should be a little larger than the exact size
of your childs foot. Keep a margin of about 2 centimetres, but
make sure that the shoe does not come off as the child runs or
walks. Shoes that have become tight should no longer be
used.
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behind the ears and the back of the head and neck, which feel
tender to the touch. The total illness lasts about 5 days. The
rash starts with the face and then spreads downwards to
disappear within 2 to 3 days.
TREATMENT: Treatment is often not required. If fever
bothers the child, he may be given paracetamol. The
important precaution that parents must take is to restrict the
movements of the child having German measles so that he
does not come in contact with a pregnant woman.
PREVENTION: MMR vaccine (against measles, mumps
and rubella or German measles) is available. It is quite
effective and can be given after the age of 1 year. If your child
has been given the measles vaccine around the age of
9 months, MMR vaccine is to be given around 15 months of
age. Rubella vaccine may also be repeated at puberty.
If a woman of reproductive age receives the rubella
vaccine without realising that she was pregnant, no
abortion need be suggested. Studies of such cases do
not show any congenital abnormality in the baby.
GLANDS IN THE NECK AND ELSEWHERE
Lymph glands, like fever, help us fight infection.
SYMPTOMS: Tiny pea-sized glands may be seen behind or
in front of the neck, and also in other parts of the body like the
groin and armpits in young children. They are not painful or
tender. The child is otherwise well. These glands do not
increase in size but, once noticed, remain for months without
causing any harm to the child. They are often secondary to a
minor infection in the head, arms or legs. Your doctor will
probably ask for no tests in such a case and will just
reassure you. More notice is to be taken if glands are
suddenly observed in different parts of the body in a younger
infant, especially if he also looks pale and sickly.
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Local cause
Systemic illness
Local Causes
A sore throat due to a viral or bacterial infection, or infection
of the teeth and gums can cause enlargement of the glands in
front of the neck. Infection of the scalp over the head like
boils and infection secondary to scratching due to lice,
dandruff or chickenpox can cause swollen glands behind the
neck. Small tender glands in this region can also be seen in
viral infections like German measles and big non-tender
glands due to glandular fever (also called Infectious
Mononucleosis).
Glands in the armpits and groin can be enlarged due to a
local infection (injury, boils, cat scratch or chickenpox).
A gland just above the collarbone should be taken more
seriously. It could be due to an infection in the lungs and more
rarely due to a tumour in the chest. Sometimes, it can follow
vaccination with BCG.
Tuberculosis can also present as a glandular swelling in
different parts of the body. In tuberculosis, there is a
significant enlargement of the gland. The swelling often gets
adhered to the overlying skin. Sometimes, more than one
gland is enlarged in the same region and these glands appear
to get matted (stuck) to each other.
Systemic Illness
Viral infections accompanied by a rash (German measles,
glandular fever) can result in enlargement of glands in
different parts of the body.
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cold drinks, ice cream and nuts. The attacks of headache are
often associated with nausea or vomiting. The child is
perfectly all right between attacks.
Migraine aura (which precedes an attack of
migraine) without headache has also been found in
some children. In this condition, the child has distortion
of visual image, frequently consisting of things looking
smaller than they are (micropsia), or seeing bright
lights, or the appearance of distortion of body image
(the Alice in Wonderland Syndrome). A positive
personal history or family history of classical migraine
in such cases may clinch the diagnosis.
Head Injury
A persistent headache following a history of head injury
should not be ignored. Most vomiting after mild head injury is
said to be related to migraine, but a persistent headache or
vomiting could be related directly to the head injury.
Meningitis
Fever, a fixed gaze, or disturbed consciousness should raise
the possibility of a diagnosis of meningitis.
A small infant may have a bulging anterior fontanelle (the
soft spot on the head). Neck stiffness is present in most cases
of meningitis.
Brain Tumour
A persistent headache, lasting day and night, could be
due to a brain tumour. Associated features like persistent
vomiting, squint, loss of balance, convulsions and disturbed
consciousness add to the suspicion of a brain tumour or any
other space-occupying lesion in the brain.
Headaches due to migraine may be preceded by blurring of
vision followed by vomiting. This should not be construed as
suggestive of a brain tumour.
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Persistent vomiting
Persistent lack of alertness, drowsiness or unconsciousness
Inability to move any part of the body
An unsteady gait
Persistent backache
Convulsions
Eye changes resulting in squint, double vision, etc.
Difficult breathing
Bleeding from the nose or ear
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HYPOSPADIAS
In this condition, the opening of the urinary passage is on the
under surface of the penis. Besides, there is usually a
downward bending or curvature of the penis. In severe
degrees of hypospadias, the opening of the urethra may be at
the junction of the penis and scrotum, or even further
backwards, on the scrotum or in front of the anus. In such
cases, the scrotum may be divided by a deep cleft into two
parts (bifid scrotum). If, in addition, one or both the testes are
missing from the scrotum, the surgeon will have to determine
the sex of the child as it may be an intersex condition.
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Doctors get
circumstances:
really
concerned
under
the
following
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Some jaundiced babies are sleepy and may not suckle too
well or too often.
MANAGEMENT: Frequent suckling is the best way to
reduce the incidence of jaundice and to treat it as well.
Bilirubin is present in large amounts in the meconium the
babys first stools. If the meconium is not cleared, the
bilirubin gets reabsorbed into the babys system. Colostrum
(the first breast milk) helps to clear meconium and thus
assists in the prevention of jaundice. If your baby gets enough
breast milk, it helps to clear early jaundice. Giving glucose
water, plain water or other supplements does not help. Such
drinks interfere with breastfeeding and can increase the
jaundice.
The best way you can help your baby with jaundice is by
breastfeeding him frequently, whenever he is hungry
(demand feeding) during the day or at night. If he is unusally
sleepy, try to stimulate him every 2 hours. If he does not
oblige, report to your doctor who may ask you to express your
milk and give it to the baby with a small glass or bondla
(paladai) every 3 hours.
Late Onset Jaundice In A Newborn Baby
Sometimes, jaundice starts at the end of the first week of life in
an otherwise healthy baby and may last up to 3 to 10 weeks of
age. Often, this prolonged jaundice is not serious and is due to
the presence of a harmless substance in the mothers milk.
That is why it is also sometimes labelled breast milk jaundice.
It tends to recur in the next child. This jaundice is harmless and
clears without any treatment. The baby continues to suckle
well and gains weight normally. If the jaundice is very severe,
especially if the baby looks unwell, your doctor may consider
the possibility of the child having some other condition.
TREATMENT: The doctor may suggest temporary
stoppage of breastfeeding to confirm the diagnosis of late
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onset jaundice. This would bring down the levels quickly, but
do not agree to this suggestion too readily. In such a situation,
you have the following options:
Express your milk. Boil it and give it to your baby by a
bondla. Heating breast milk reduces the levels of
bilirubin.
Stop breastfeeding temporarily for 12 to 48 hours and
give breast milk from another HIV-negative mother or
from a breast milk bank*. Keep expressing your milk
and discard it.
Alternate artificial milk feeding and breastfeeding for
24 to 48 hours. I prefer this approach in anxious parents.
Continue breastfeeding normally and give phototherapy
(light therapy).
Replace breastfeeding by artificial milk feeding for 12 to
48 hours while observing the reduction of bilirubin and
the level of jaundice.
The moment the period of 12 to 48 hours is over, you must
start breastfeeding normally again.
Very high levels of bilirubin can cause damage to the brain
of a newborn baby. But no such damage has ever been
reported due to late onset jaundice.
It is important to realise that even if a baby needs
treatment (usually light therapy) for jaundice, you must
continue to breastfeed your baby normally.
Light Therapy
Light therapy (phototherapy) is based on the principle that
exposure of the skin to blue or fluorescent tube light, or
*Breast Milk Bank, C/o Head, Department of Neonatology, Lokmanya Tilak
Municipal Medical College, Sion, Mumbai 400 022.
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Perthes Disease
This presents as in the above condition. An X-ray of the hip
joint points to the diagnosis.
TREATMENT OF A LIMP: This will depend upon the
cause. Most children with a limp attributed to the common
causes listed before settle down without any treatment. In
case of any doubt, it is important to show the child to your
doctor for ruling out any condition that may need
urgent attention.
MALARIA
Common Malaria (Plasmodium Vivax)
SYMPTOMS: A typical case presents with shivering and high
fever, followed by sweating and fall in temperature. The fever
comes on alternate days, and the child looks well in between.
A history of a child living in an area where malaria is common
or the child having returned from such an area aids the
diagnosis. A blood test confirms the diagnosis. The patient
may become anaemic and weak.
In another case, the fever may occur every day. Shivering
or rigours may not be present. If no obvious cause of fever is
to be found and your doctor finds your child has an enlarged
spleen, he may like to rule out malaria.
DIAGNOSIS: It is important that the blood sample for
malaria be taken before treatment is started. This test is not
only important for the confirmation of the diagnosis, but also
helps to ascertain the type of malaria, the precise treatment to
be given immediately and to be followed later.
Falciparum Malaria
SYMPTOMS: Besides shivering and fever, a child with this
type of malaria can become quite sick. He may start losing
alertness, get convulsions and may become unconscious.
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MENSTRUAL PROBLEMS
The first menstruation or period begins somewhere between
10 and 16 years. If you notice signs of enlargement of the
breasts, your daughter would probably have her first period
2 years after that. When you find that she is having a sudden
increase in her weight and height, she can be expected to get
her first period about a year later.
It is important to discuss the normal phase of growing up
with your daughter. If you do not feel comfortable, let another
responsible person a doctor, a counsellor or a relative
discuss it with her.
A few months before the beginning of menstruation, girls
may normally get a white discharge from the vagina. This is
called physiological leucorrhoea and does not need any
treatment.
Absence Of Menstruation (Amenorrhea)
You should meet your doctor if your daughter has not started
menstruating at 16 years of age or has missed her period after
having started menstruating. It is possible that it may be a
normal variation, but merits consultation.
In some families, periods are normally delayed to begin
with. They are also delayed in thin girls who are otherwise
normal, e.g. athletes or those who practise regular dancing. In
athletes who run extensively, low hormone levels related to
onset of menstruation are reported. The same is true of thin
girls having a chronic disease, anorexia nervosa or
malnutrition.
Delayed menstruation could also be due to certain drugs.
Take your daughter to see your doctor anyway as the cause
may be different, requiring investigations and treatment.
Even pregnancy should be kept in mind.
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divided by the median weight for the childs sex and height
multiplied by 100. This may be represented as:
% IBWH =
Actual weight
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has swallowed acids used for cleaning the toilet sink or alkalis
used for washing dishes. In such cases, your doctor will
probably advise giving milk or water.
If your doctor advises you to make the child vomit, give
him a drink of salt water. The best way to make the child
vomit is to give him syrup of ipecac. Unfortunately, it is not
easily available at a chemist. If you can procure a bottle of it,
keep it handy at home. If your doctor is not available and you
have ruled out the ingestion of acids or alkalis, give
3 teaspoons of this medicine followed by a glass of water. If he
does not vomit after 20 minutes, give one more dose.
As soon as the child vomits, collect the vomit in a vessel
and preserve it to be handed over to your doctor for
inspection and testing.
Step 3: After following the first two steps, take the child to
the nearest hospital for further management. You must take
with you the remaining poisonous substance and the amount
removed with your fingers or the stuff vomited by the child.
The doctor would also like to know the possible amount of
poison taken by the child and the likely time when he might
have ingested it.
After taking a quick history and checking your child, the
doctor may decide to send you home, or do a stomach wash to
remove the remaining poison from his stomach, or he may
decide to admit the child in the hospital.
Step 4: If you are sent home with your child, observe him
closely for the next 12 hours for any abnormal behaviour,
convulsions, breathing difficulty, persistent vomiting or
failure to pass urine. If in doubt, consult your doctor or take
your child to the hospital again.
PREVENTION: Prevention of poisoning is discussed in the
chapter on PREVENTION OF ACCIDENTS.
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POLIOMYELITIS
SYMPTOMS: Polio is caused by any one of three types of
viruses type 1, 2 or 3. The extent of the illness varies from
child to child. Fortunately, 90% to 95% of affected children
who get the infection do not manifest any symptoms. A few
may just get a little fever or stiffness of the neck and back.
Paralysis of muscles is seen in less than 1% of cases.
The child may completely recover from the paralysis or
may be left with some degree of handicap. Serious cases may
involve the brain and muscles of respiration.
TREATMENT: If you suspect poliomyelitis, show your
child to the doctor as soon as possible. Those attending to the
child must wash their hands properly, especially after
handling the babys stools.
It is advisable that, 6 weeks after a child recovers from an
attack of poliomyelitis, he is given 3 doses of oral polio
vaccine, irrespective of his previous immunisation status.
PREMATURE BABY
Babies who are born before the expected time are called
premature babies. They normally weigh less than 2.5 kgs.
at birth. But in our country, quite a few babies who are
born at the expected time also weigh less than 2.5 kgs. All
low birth weight babies, especially those below 1.8 kgs. and
those born 2 months before full term need special care in
a hospital.
MANAGEMENT: A warm environment, protection from
infection and adequate nutrition are the most important steps
in the management of a premature baby.
Because of less fat, a premature baby can get cold. For
warmth, the baby is either kept in an incubator or in a heated
room. An incubator can be a source of infection in many
settings. Therefore, some doctors prefer to keep the room
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RHEUMATOID ARTHRITIS
Although many people believe that rheumatoid arthritis only
affects adults, the disease can also affect infants and especially
toddlers. However, the disease is not very common in
paediatric practice.
SYMPTOMS: In a typical case, a toddler starts complaining
of pain in one or more joints. The pain is more marked on
getting up in the morning. Characteristically, the affected joint
feels stiff in the early hours of the day and this stiffness
becomes less marked as the day progresses. The affected
joints become swollen and painful. They are hot to the touch.
The classical presentation is swelling of the small joints of
both hands. But in about half of the cases, only one big joint
like the knee or ankle may be involved. The heart is
usually spared.
The picture is different from rheumatic fever with
involvement of joints (rheumatic arthritis). In this condition,
the swelling in the involved joints persists for days together,
whereas in rheumatic arthritis, the affected joint remains
swollen for only a day or two, while another joint becomes
painful and swollen. The first joint becomes completely
normal while a third one is attacked (flitting joint involvement
in rheumatic fever). Also, morning stiffness is typical of
rheumatoid arthritis as is the involvement of the joints of
the neck.
Your doctor will also keep in mind the other possibilities
for the swelling like injury, local infection, scurvy (due to
Vitamin C deficiency) and haemophilia (a bleeding disorder
due to a defect in the clotting of blood).
He may also order some tests, especially in cases which are
not typical or have less common manifestations like a skin
rash, enlargement of the lymph glands, involvement of
the heart and prolonged unexplained fever without swelling
of joints.
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Vitiligo
Vitiligo is the loss of skin colour, resulting in almost pure
white patches. Any part of the body can be affected, but they
are more common on the hands and face, especially around
the lips and eyelids. The sensation on the skin is normal.
MANAGEMENT: If in doubt, consult your doctor. He will
rule out the diagnosis of leprosy and instruct you to avoid
prolonged exposure of the white patches to the sun. If this is
not possible, cover the parts or apply any ointment containing
zinc oxide. Otherwise, the skin may develop blisters. No
specific treatment is available. Your doctor may prescribe
some local application combined with exposure to sunlight or
ultraviolet light. At times, an oral medicine is also prescribed.
Some patches may recover spontaneously. But generally,
more areas of skin keep getting involved.
Parents must meet the school authorities with a certificate
from a doctor that the disease is not infectious. They should
not pass on their anxiety to the child and thus avoid secondary
emotional problems in an otherwise healthy child.
Warts
SYMPTOMS: Caused by a virus, warts present as rather hard
yellow, brown or black swellings on the hands and toes. They
can also occur on other parts of the body.
TREATMENT: Though many cases are cured
spontaneously, it may take years for this to happen. It is
better to treat them early with the advice of your doctor.
Surgery is sometimes needed. Warts tend to recur, but will
respond again to the treatment.
SLEEP AND SLEEP PROBLEMS
Treat this important feature as a guide and act as per your
instincts with regard to the needs of your child and the rest of
your family.
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Duration Of Sleep
The duration of sleep varies from child to child. If your child is
joyful and active the whole of the next day, you can be sure
that he had a good sleep the night before. If he is irritable and
not his usual self, he either had inadequate sleep or has some
other emotional or physical problems.
A newborn baby seems to sleep most of the 24 hours of the
day, except when he is hungry, wet or uncomfortable for some
other reason. As he does not yet know the difference between
day and night, he may sleep more during the day and less at
night. While this may not be convenient for the mother, she
will then herself choose to sleep more during the day while
the child sleeps, and learn to feed the baby in a lying position
(safe in breastfed babies) in bed without having to get up
to feed. People at home should support her by restricting
visitors.
Some babies may demand extra attention. They are rather
fussy and can give anxious moments to an unprepared
mother. Most (but not all) babies seem to sleep better after
their morning massage and bath, especially if they are
swaddled (wrapped up).
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Do not get up to burp the child. Raise him while you are
lying down. Let him lean against you to burp. If he does
not oblige, do not worry. Quite a few babies can manage
without burping. If you are still concerned, let him lie on
his right side; in this position, the child is more likely to
burp on his own.
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Nightmares
These are seen mostly in preschool children. A child has a
scary dream and then he gets up crying. He is fully awake and
appears afraid. He may recount the dream and once
reassured, go back to sleep.
Night Terror
The child, again a preschooler, suddenly sits up in bed crying.
He is not fully awake and is not aware of your presence. He
screams as if terrified. He may be sweating and have a very
fast heart rate. No effort on your part calms him down.
Fortunately, he settles down after 15 to 30 minutes and goes
back to deep sleep. When he gets up, he does not remember
anything about the whole episode.
Sleep Walking
This is seen mostly in children of school going age. While
sleep walking, the eyes appear glazed. They may mumble
something that may be difficult to comprehend. Generally,
they do not hurt themselves, but care should be taken to
prevent injury. Most such children are otherwise normal and
the condition disappears in a couple of months. In rare cases,
it may continue to adulthood. No treatment seems to help.
Homoeopaths claim to be able to treat this condition.
In general, most sleep problems are sorted out by
common sense, by listening to the child and by attending to
his needs.
SORE THROAT (PHARYNGITIS)
Most sore throats are of viral origin. The back of the throat is
termed the pharynx. Infection of the pharynx and tonsils is
mostly due to viruses. A runny nose, cough, congested throat
and redness or watering of the eyes add to the possibility of
the cause being viral. Such infections do not need any
antibiotics.
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jaws and muscles. Baby teeth keep space for the next
permanent tooth, as it erupts, after the natural exfoliation of
the baby tooth.
If the baby tooth has to be extracted or falls before its time,
the adjoining teeth will start moving into this gap, leaving a
smaller space for the permanent tooth to erupt into at a much
later date.
Therefore, it is important to give the child a good oral
hygiene habit right from the age of 2 years. Ideally, the
mother should develop the habit of wiping her infants teeth
with a swab of wet cotton after he has been given milk or
food, to prevent these from remaining on the tooth surface.
After wiping the teeth with a wet cloth or with a wet cotton
swab, the toddler may be given a toothbrush or toothpaste to
play with. As he grows older, he may start asking for it. Then
he may be taught to brush his teeth properly.
Get Your Child Used To The Dentist
Take your toddler with you when you visit the dentist
yourself for a non-painful procedure. Let him have a look at
the dentists clinic, let him sit in the dentists chair if he wants
to. Some time after his second birthday, take him for a checkup. Then get a yearly check-up done. If he has any caries, let
the doctor attend to them.
The doctor may tell your child about the importance of
rinsing the mouth after each meal and brushing the teeth at
least once a day, especially before going to sleep.
The teeth must be cleaned with a soft brush. The dentist
may teach him to clean the teeth from below upwards for the
lower teeth and from the gums downwards for the upper
teeth. Do not worry if he does not follow this advice. The
important thing is to clean each and every tooth properly.
He may need your help for the first couple of months.
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Use Of Fluoride
Fluoride does guard the teeth against cavities, but it can also
be harmful. It is best to avoid giving oral fluoride preparations
to your child. Find out from your dentist if your citys water
supply has enough fluoride in it. If it does, do not use a
toothpaste containing fluoride. If not, the dentist may apply a
fluoride solution to your childs teeth or prescribe fluoride
toothpaste. In general, the World Health Organisation (WHO)
recommends that no fluoride toothpaste be used below
3 years of age. It could be used once a day between 3 and 6
years and twice a day in older children.
Beware Of Misleading Advertisements
Advertisements that show that your child can eat junk foods
containing sugars and yet remain free of cavities, provided he
uses a particular toothpaste, are misleading. One is surprised
at how such unethical advertisements are allowed on
television. Also, no toothpaste can guard the family against
tooth troubles if they do not follow the basic principles of
dental care.
PREVENTION OF DENTAL DISORDERS: Breastfeeding,
avoidance of sugar, regular brushing, and dental check-ups are
the key factors in preventing dental disorders in children. To
prevent the permanent discoluration of the teeth, the
antibiotic tetracycline should not be given to pregnant women
and to children below the age of 8 years.
Dr. Daftary offers the recommendations of The British
Nutrition Foundation Oral Task Force given in the British
Dental Journal as guidelines to mothers of babies and young
children:
Brush teeth twice a day.
Limit the consumption of sugary foods and drinks to
mealtimes.
Avoid cariogenic snacks and sugared drinks between
meals.
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THUMB-SUCKING
Knowing a few facts might put you at ease if your child sucks
his fingers or thumb or even his toe. The habit is usually
temporary and quite common in normal children. Sucking is a
pleasant experience. If, by chance, the childs finger or thumb
goes into his mouth, he starts sucking it. The habit generally
disappears by the time the child starts eating solids.
If you do not like your child sucking his thumb, start
playing with him and gently take the thumb out from his
mouth without making him conscious of it. If you make an
issue of it, especially between the age of 9 months and
3 years, when the child is passing through a phase of
negativism, you are likely to worsen the situation.
Attend To Any Emotional Factor
In some children, this habit may persist because of some
emotional problem. Make sure that your child gets enough
body contact from you. Breastfed children may also have this
habit, though less often than artificially fed children.
Be extra careful about making a thumb-sucking child feel
secure. Give him attention when he needs it. However, you
need not necessarily start feeling guilty if your child is
sucking his thumb. Though emotional factors are to be kept in
mind, most children continue sucking their thumb as a habit.
How To Break The Habit
Gentle attempts to wean the child from the habit of thumbsucking are preferable to aggressive ones.
It is true that if the habit continues when the child starts
regular school, we should give extra attention to this problem.
Forceful sucking can lead to ulceration of the thumb and
wrong alignment of the teeth.
When your toddler continues to suck, tell him that he is no
longer a baby and he should now leave the habit. Pat him
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Tourettes Syndrome
In the tics referred to above, the child has the same type of
movements all along. In Tourettes Syndrome, the
movements keep changing. Besides the abnormal movements
and symptoms given above, the child with Tourettes
Syndrome may exhibit a chewing movement and thrusting of
the tongue. Some of these children may have other specific
learning disorders and attention deficit hyperactivity disorder
(ADHD), discussed under that section.
TORTICOLLIS
Torticollis, wry neck or stiff neck refers to a condition in
which the patient keeps the head tilted to one side due to a
spasm of a neck muscle.
Torticollis In The Newborn
The typical story is that the mother notices a sudden new
swelling, the size of a big marble, on one side of the neck
when the baby is about 2 weeks old. This is called congenital
muscular torticollis or sternomastoid swelling. The baby is
not much bothered by it, but tends to keep the head tilted to
one side. The swelling disappears spontaneously after 2 to
4 months. If it persists, that side of the face starts looking
different from the other side.
CAUSES: The cause of this condition is uncertain, though
it is often associated with a breech or forceps delivery. In
some cases, a congenital dislocation of the hip also occurs.
TREATMENT: The treatment consists of stretching the
affected neck muscles by slowly moving the childs head away
from the side of the swelling. This is to be done quite
frequently, throughout the day. I often tell the mother to do it
whenever she changes the babys diaper.
If the torticollis persists, your doctor should refer the child
to an orthopaedic surgeon who will decide if surgery is
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Infection
Head injury
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eat or drink and take him to your doctor. Such children may
also have distension of the abdomen and dehydration.
In a condition called pyloric stenosis, the child may present
with white projectile vomiting and failure to gain weight.
An intussusception and appendicitis discussed under
Abdominal Pain are also to be kept in mind.
Infections
An infection of the stomach and intestine (gastroenteritis) is
the commonest infection resulting in diarrhoea and vomiting.
This is discussed at length in the chapter on HOME
REMEDIES.
Suspect hepatitis (see Hepatitis) if your toddler or older
child has developed marked loss of appetite and passes high
coloured urine.
A small baby who stops taking his feeds, vomits and looks
unwell may have septicaemia a serious type of infection. It
may or may not be accompanied by fever.
An infant showing the above symptoms with a bulging soft
spot (anterior fontanelle) on the head, with or without
stiffness of the neck, may have meningitis, needing urgent
treatment (see Meningitis).
Children with whooping cough also tend to vomit after a
severe bout of coughing. Ear and urinary infection may also be
associated with vomiting.
Seasonal vomiting, probably due to a viral infection, may
affect a large number of children in a city. These children do
not have any of the serious features mentioned above and
settle down with symptomatic treatment of the vomiting in
2 to 3 days.
Some other causes of vomiting are poisoning, travel
sickness, gastro-oesophageal reflux and migraine. Some
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PSYCHOLOGICAL CONCERNS
TOILET TRAINING
Do not force an unwilling child below the age of 2 to sit on a
potty or a toilet seat, but attempt the process of toilet training
in a gentle way at an early age.
Most babies will pass a motion or will pee after getting up
from sleep or after a feed. Take advantage of this knowledge.
Take the child near the toilet. Hold him over it. Make a
hissing noise. Wait only for a short while. He may oblige you
by passing urine with or without stools. If he does, you have
saved a nappy and reduced the risk of your child getting a
nappy skin rash. If he does not, let it go.
Some babies who respond may do so because of a
conditioned reflex. In our rural areas (and also in some urban
homes), I have seen the mother (or the grandmother) sit
down on the floor with her legs straightened in front of her.
She makes the small baby sit between her two legs nearer her
ankles. The baby faces her, and her upright feet support the
babys back. The baby often passes urine and/or a motion on
newspaper in this position.
When the child is able to sit independently, buy a brightcoloured potty that sits on the floor. Place it near a wall, and
put the child gently on it as soon as she wakes up or after she
has had her feed. Sit near her or have your maid sit near her.
Give her a kiss if she passes urine or a motion. Do not look
annoyed if she doesnt.
As she starts walking around, you will be able to make out
when she is ready to pass stools or urine. She may suddenly
stop running. Her facial expressions may change. She may
point towards her genitals. Take a cue from her signals.
Quietly remove her diaper and help her sit on her potty. Do
not force her if she does not want to. If she wets her clothes
before you can march her towards the potty, do not scold her.
Give her a kiss when she does oblige by passing the motion or
urine in her potty.
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SWEARING
Small children pick up words like hell, shit, bullshit, sala,
idiot, etc. from adults without even knowing their meanings.
Foul language or dirty words can also be learnt from friends.
Minor swearing is not uncommon among school children. Do
not be too concerned as long as the child does not swear
at others.
Parents who do not swear, even if upset, have a right to tell
their youngster to stop it. If your son or daughter still swears,
deal with him or her firmly. (See the section on Discipline in
the chapter on MEETING THE EMOTIONAL NEEDS OF
CHILDREN.) Some parents will tolerate their son using dirty
words, but not their daughter. They may even say, Girls are
not supposed to use such language! This is not the right
approach. Both boys and girls need to be handled in a similar
manner.
Some parents become furious on hearing dirty words. They
may hit the child in anger or may use even more foul
language. Such an impulsive reaction could have the opposite
effect on the childs behaviour and should be avoided at all
costs.
Ignoring a toddler who uses a dirty word, and firm
handling of your older child is all that is required in most
cases.
HOMOSEXUALITY
Parents fears that their adolescent may be gay are usually
unfounded. Their suspicions are usually aroused by their
children cross-dressing (when a son dresses like a girl, or a
daughter like a boy) or if they behave like the opposite sex. It
is the stereotypical roles assigned to the two sexes that lead
to such false notions. Our society has set norms that suggest
that a boy cannot shed tears and that a girl cannot climb a
tree. This has to change.
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PSYCHOLOGICAL CONCERNS
SUICIDE
Cases of suicide among teenagers are on the rise.
Do not take it lightly if a teenager attempts suicide or talks
about it. Even young school children may seem suicidal.
Although these may simply be attempts to get more attention
from you, take these calls for help seriously.
Sit down and talk to your child. Ask her if she is passing
through a rough time. Is she unduly depressed, hurt, upset,
angry? Does she feel hopeless or uncared for? Has she failed
in a test, lost a friend or a close relative? Is she disturbed
about fights at home? Has she done something she feels
guilty about? Spend more time with a child who seems
withdrawn or depressed.
After A Suicide Attempt
If your son or daughter has attempted suicide, you must get
professional help immediately. Talk to your paediatrician who
may refer the child to a psychiatrist or a psychologist-cumfamily therapist. Do not be ashamed about visiting a
psychiatrist or psychologist. It is important to visit these
professionals before things get out of hand. However, take
these steps under the guidance of your paediatrician or family
physician.
Some schools also have expert counsellors who can be
depended upon. These experts will help build your
youngsters self-esteem. Counselling of parents and the child
is all that is needed in most cases. Youngsters with serious
psychiatric problems may, however, also need some
medication.
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waking her up and also provides some relief from pain after
the child recovers from the effect of anaesthesia.
Observation After Surgery
The surgeon will keep the child in the surgery room situated
near the operation theatre for some time before sending her
to the ward. If your child is less than 6 months old, she will be
kept for about 2 hours to make sure that her physiological
functions, including her breathing and reflexes, are normal.
In the ward, the child may need medication for pain relief.
Your presence and that of your husband or a close relative can
drastically reduce the need for such medication. Your touch
can act like magic. Do not hesitate to hold your childs hand or
stroke her cheeks even if she is connected to medical
equipment. Whenever possible, hold her in your arms, hug
her and kiss her.
Maintain a cheerful atmosphere around the child. If you feel
like crying, do not suppress your emotions, but avoid breaking
down in front of your child. Your child may appear to behave
very unreasonably, but remember that she is probably just
very frightened. Encourage her to share her anxieties with
you so that you can reassure her.
Teenagers should be taken into confidence about the
management of their illness. If your doctor agrees, your
adolescent may be told about her illness, and have the planned
line of management explained to her. You are then likely to
get better cooperation from her during her hospital stay.
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EMERGENCIES
Cuts
Dog bite (see Rabies)
Diarrhoea with dysentery (also see the chapter on
HOME REMEDIES)
Drowning (see Cardiac Pulmonary Resuscitation and
Mouth-To-Mouth Breathing)
Electric shock
Eye problems, including injury to the eye
Fractures (see Bone, Joint and Muscle Injuries)
Head injury
Hernia (see Obstructed Inguinal Hernia discussed under
Abdominal Pain)
High fever (see the chapter on HOME REMEDIES)
Mouth-to-mouth resuscitation
Nose-related problems, including bleeding from the nose
Poisoning
Rabies
Scorpion bite (see Bites And Stings)
Snake bite (see Bites And Stings)
Splinters
Stridor
Unconscious child (see Encephalitis, Head Injury,
Malaria, Meningitis and Poisoning).
Danger Signals In A Newborn
A newborn who appears sick and stops suckling must be
shown immediately to your doctor.
Some other danger signals in a newborn are:
Yellow or green vomit
Convulsions
Excessive crying
Listlessness
Breathlessness
Very hot or very cold skin.
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that God creates all that is good; He did not create conditions
that could be harmful to any of His beloved children... The
mother continued her prayer by understanding that God
controls everything in His universe, even her childs health.
There was no involuntary action stimulated by something
injurious, because He is the only source of all action. In
Science & Health, it says, Mind is the source of all
movement, and there is no inertia to retard and check its
perpetual and harmonious action. Mind, spelt with a capital
M, is another name for God, mentioned in this book.
As the mother prayed with these ideas, she was freed of
her own fears, and became confident of Gods control, power
and love for the child, present right there and then. The
improvement in the childs condition began almost
immediately, and by the next day, he was his usual cheerful,
active self and completely normal.
Eliminate Fear Through The Love Of God
Healings like this one are happening all over the world every
day. The important thing is to let go of fear; then we can
actively trust God. Fear indicates that God is forgotten, or not
appreciated as an ever-present help in trouble. The antidote
to fear is divine Love. We are never afraid in the presence of
those whom we know love us. This love is power, the
strongest power that exists; a power that is tangibly available
here and now.
The fear that is felt about children is because they are
considered to be small, frail, physically immature, vulnerable
mortals. But that is not the way God created them or sees
them. Spirit, spelt with a capital S, is also another name for
God. Therefore, all that He creates is spiritual, without any
physical component. Since God is Mind, what He creates is
mental, in the shape of thoughts, concepts, ideas. That is what
children are; they are the spiritual thoughts of God. They are
held in the divine Mind, sustained by it and retained there in
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or the look of the child causes anxiety, you must get in touch
with your doctor.
How Nature Cures
The principle of Nature Cure is that all diseases of the body
are caused by the presence of unwanted toxic substances in
the body (toxemia) and simultaneously because of the absence
of useful substances in the body (deficiency). Hence, the
logical treatment of such a condition is to remove the
poisonous substances from the body and to supply all the vital
substances to it.
Nature has equipped us with the necessary tools to heal
from disease. We have been endowed with three major
instincts, namely thirst, hunger and fatigue. If we can sharpen
our ability to recognise these instincts and act upon them, we
have already set the healing process into motion. For
instance, when the child is sick, he loses his appetite (so he
stops eating conventional food), he feels tired (so he rests),
but he feels thirsty, so he drinks water. Often, the child may
be feeling so sick that he/she loses the awareness of thirst or
may have such marked nausea or aversion for food and drink
that even drinking water is avoided. In such circumstances,
parental intervention is required and gentle firmness could go
a long way to prevent the disease from being prolonged.
(However, in the case of severe nausea and vomiting
associated with fever, abdominal pain and distention, the child
should not be forced to drink fluids and a doctor should be
consulted as soon as possible.)
Water facilitates the detoxification process. Once the
poisons have left the body, the appetite for food returns and
he starts accepting food, which goes to replenish his body and
restore his health, strength and vigour.
Hence, in order to cure disease, one has to remove the
toxins and replace the vital substances. This understanding
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HOMOEOPATHY: A GENTLE
COMPLEMENTARY SYSTEM OF MEDICINE
Dr. Sunil Anand, Hon. Lecturer, D. S. Homoeopathy Medical
College, Pune and a former Lecturer at the C. M. P.
Homoeopathy Medical College, Mumbai, practises in Pune and
Mumbai.
What Are The Principles Of Homoeopathy?
The founder of homoeopathy was Dr. Samuel Hahnemann
(1755 1843). Through numerous experiments conducted
over several years, he established that any medicine will
cure a particular disease if it is capable of producing
symptoms of the same disease in a healthy individual. For
instance, quinine, which is a derivative of the plant
Cinchona, has the ability to produce chills, sweating and
rigors if taken by healthy individuals. The same drug is
also used in the treatment of malaria, the symptoms of
which are the same as above namely chills, sweat and
rigors. Like cures like is the foundation of the basic
principle of homoeopathy. It is due to this principle that
homoeopathy derives its name from the Latin words
Homoeo (similar) and pathos (suffering).
What Are The Sources Of Homoeopathic Remedies?
To make a broad classification, homoeopathic remedies
comprise of the 3 natural kingdoms.
1. The Vegetable kingdom, which includes plants and flowers.
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HOMOEOPATHY
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HOMOEOPATHY
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are kept away from such foods and activities that would
aggravate the kapha dosha. Hence children prone to frequent
illnesses are advised to avoid too many sweets, ice-cold food
and drinks, buffalo milk, playing in water and sleeping during
the day (applicable to children older than 4 years).
HOME REMEDIES FOR COMMON CHILDHOOD
ILLNESSES
Abdominal Pain
Common Cold
Sips of ginger juice and lime juice given with warm water.
Constipation
Diarrhoea
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Fever
Loss Of Appetite
Throat Infection
Vomiting
Worms
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Shortness of breath
Feeding difficulties
Repeated respiratory tract infections (cough with fever)
Failure to gain weight
Delayed physical milestones delay in crawling, rolling
over, sitting with support
Repeated episodes of cough
Infection of the heart valve or vessel (infective
endocarditis)
Or it may be incidentally detected during routine
examination.
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(4)
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PART
5
KEEPING YOUR CHILD HAPPY AND SAFE
Healthy Habits ...........................................................
486-490
491-507
508-517
518-525
526-527
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HEALTHY HABITS
Adequate sleep
Regular exercise
Right type of food
Personal hygiene
Growing up in harmony with Nature
ADEQUATE SLEEP
In my practice, I see many children who present problems
related to lack of sleep.
The typical story is that of a school going child who has to
catch her school bus at 7.30 a.m. She sleeps at 11.30 p.m. and
is made to get up at 6.45 a.m. There is a mad rush after that
for everything the toilet, the bath, and dressing. The bus is
to arrive any moment. The mother hands her a glass of milk.
She has a few sips and wants to leave the rest. The mother
insists that she finish it. She attempts to and then vomits out
everything. Such children are often brought to me for
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HEALTHY HABITS
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Healthy parents exercise regularly and pass this habit on to their children
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HEALTHY HABITS
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sunshine, and the changing hues of the sky when the sun is
setting.
Yes, let your children learn to appreciate the beauty of
Nature and its wonders. Take them to the planetarium. Help
them appreciate the vastness of the universe. Make them
understand the role of Nature in keeping us alive. It will help
them develop respect for the quiet job done by the
earthworms, the snakes, the birds and trees and all that they
see around them.
Let your child know that, like sunlight, water is our other
friend. Get her used to touching cold water. Bathing with very
hot water is not advised even for newborn babies. If the water
is cold, remove the chill by warming it a little. Gradually, let
children get used to taking cold water baths.
Like sunlight, water is our other friend. Let your child get used to touching cold water.
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FAMILY ISSUES
ADOPTION
For 20 years, I had the privilege to care for and provide
medical relief to children in an orphanage. That also gave
me the opportunity to share the joy of over 300 families
whom I helped to adopt children from this orphanage and
through adoption agencies like the Indian Association for
Promotion of Adoption (IAPA) and the Family Service
Centre.
Here I lay out information on the subject of adoption based
on my personal experience, on Nilima Mehtas book (Ours By
Choice, published by the author, 1992), and information
provided by the IAPA.
To Adopt Or Not To Adopt?
A couple should never adopt a child unless both are keen
to adopt. If you are considering adopting another child,
besides your biological one, take your first child into
confidence.
Private Adoption Or Adoption Through An Agency?
Always adopt through an adoption agency because these
agencies employ men and women experienced in finding a
child best suited to the prospective parents. They also ensure
that the child you adopt is legally free for adoption.
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Waiting Period
After the social worker has helped you with the completion of
the documentation and the formalities, the time of waiting
begins. The agency will locate a child suitable to and
compatible with you; this may take anything between 3 to
6 months or even longer.
Do not be tempted to register with several agencies in the
hope of getting a better choice or a faster placement. The
agencies have their own networking system whereby
they co-ordinate with each other to locate a child suitable
for you.
Is This Your Child?
If you have already pictured your child in your mind, share
this image with the social worker; she will identify a baby who
best matches your expectations and needs.
You will be provided with the birth history and social
background of the child (but not the natural mothers identity,
which is kept confidential as per the law), whenever it is
available. The childs health profile will also be made available.
Show the child to a paediatrician of your choice to confirm
normal physical and mental development and to rule out any
congenital disorder, if you like. The paediatrician will keep in
mind that a child kept in an institution, though normal, may be
below average when compared with one who gets constant
individual attention from her biological parents. But I have
seen that once the child starts getting individual attention
from a loving adoptive family, she achieves her physical and
mental milestones at an unbelievably rapid pace.
Legal Procedures And Costs Involved
When you have decided to adopt a particular child, a lawyer
recommended by the agency or known to you will help you
file all the relevant papers in court. After this, you can take
the child home in pre-adoptive foster care.
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FAMILY ISSUES
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FAMILY ISSUES
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FAMILY ISSUES
Abuse
Is
Not
Only
Western
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FAMILY ISSUES
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FAMILY ISSUES
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FAMILY ISSUES
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If you have twins, your chances of having twins again are high
Prepare In Advance
Your doctor will be able to tell you when you are pregnant if
you are heading for twins. You and your family should
mentally and physically get ready to receive them. You will
need extra help, especially if you already have another child.
Read about breastfeeding twins. With a little support, most
mothers have no problem breastfeeding their twins.
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FAMILY ISSUES
Management
Elsewhere in this book, I have said, Treat every child as a
royal soul. This is especially important in the case of twins,
and more so if they are identical. They may develop such an
affinity with each other that they may not mix with other
children. While you should be pleased that they like each
other, let them develop their own individualities.
Discuss their schooling with the teacher. Let them be
placed in separate divisions in school.
WORKING WOMEN
All women work whether at unremunerated household
work or paid employment outside the home. Mothers
play multiple roles in childbearing, child-rearing and
house-keeping be appreciated.
Working Outside The Home
A woman who works outside the home deserves special
mention. While she is happy to be a homemaker and wants to
continue to play that role, she may also need to work for
economic reasons or to satisfy her personal aspirations. It is
the responsibility of her family as well as that of the employer
to support her so that she can function efficiently and happily.
For this to happen, more awareness needs to be created about
such matters with the participation of men and women.
Working And Pregnant Women
A large study involving nearly 16,000 women in
17 European countries has shown that well-educated
women who work in psychologically demanding
professions are 40% more likely to give birth
prematurely.
The study warns pregnant women not to strain and
push themselves to the limit. They should also find time
to relax.
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FAMILY ISSUES
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PREVENTION OF ACCIDENTS
Accidents do not always happen by accident. This child did get a head injury from a
moving fan on another occasion
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PREVENTION OF ACCIDENTS
Letting a baby sit in the front seat of the car is risky. Avoid it
Letting a baby sit in the front seat of the car is risky. Avoid it.
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PREVENTION OF ACCIDENTS
Diwali Dangers
In general, I am against crackers. However, I appreciate
parents who help the child buy the right type of crackers and
allow them to play with them under supervision.
Burning oil lamps and candles are other sources of burns
during Diwali.
The Loss Prevention Association of India offers useful
suggestions to minimise deaths and injuries due to fireworks.
Buy fireworks from authorised/licensed dealers. Make
sure the packet is intact and instructions for use are
printed clearly.
Have an adult around when children are handling
fireworks.
Never light fireworks inside the house or in confined
spaces. Use open, clear grounds, away from congested
localities.
Do not bend over fireworks light them from the side.
Move away quickly once they are lit and do not return to
them. They may explode in your face.
Never throw lighted fireworks. You may injure a
bystander.
Wear close-fitting cotton clothes.
Keep a first aid box and cold water handy.
Pour water in case of burns. Do not smear ointment,
butter, ghee, grease or any other oily substance on
wounds. If the burns are serious, see a doctor.
Make Your Home Safer
While an electric heater or immersion rod (to heat water) are
convenient appliances, they can prove very hazardous to a
small child in the house. Bare electric wires, an electric iron,
and open electric sockets placed within the reach of a crawling
infant or toddler can be very dangerous.
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PREVENTION OF ACCIDENTS
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PREVENTION OF ACCIDENTS
DOG BITE
If you are a dog lover, you must have made sure that your dog
is regularly vaccinated against rabies and other diseases as
advised by your doctor. But what about the stray dog which is
seen around your building? Have you made sure that, that dog
is also vaccinated? Have your children learnt to stay away
from stray dogs and not to tease them or hit them?
INJURIES FROM SHARP OBJECTS AND DOORS
Children are often inspired by teleserials like Ramayana and
Mahabharat to play with bows and arrows, which can lead to
major eye injuries. Some toy guns available in the market also
release dangerous projectiles.
Sometimes, we do not realise that sharp objects like
knives, scissors and blades lying around the house can be
dangerous for our kids.
Also be careful while closing and opening room doors or car
doors. Severe injuries can be caused to fingers being caught
between doors if we are not cautious enough.
SUFFOCATION
Plastic shopping bags lying around the house can prove
hazardous. An infant or a toddler playing with a bag may put it
on his head and then not be able to remove it. Small children
can also choke on the scraps of balloons that have burst.
Peanuts, tamarind (imli) seeds, buttons and beads are often
aspirated by unwary infants and toddlers or get pushed into
their nostrils. A child may also choke on a thin, raw carrot that
he has bitten off. Never allow a toddler to have foods like nuts
while he is playing, talking, laughing or running around
because he is more likely to choke on them.
There is also a possibility of suffocation when a child tries
to put a rope around anothers neck, or when he tries to wear
a tie around his own.
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PREVENTION OF ACCIDENTS
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A family I know decided to go for a holiday during the offseason. The hotel rates were much lower and the place was
less crowded. They got extra attention all around. Instead of
spending money on a holiday trip during the expensive
summer season, another family decided to install an airconditioner at home. The father took leave from work to be
with the family to have a holiday at home. They played an old
video recording of a family wedding. The children were so
introduced to various relatives. The family saw some
interesting cartoon films and adventure films and played
indoor games. They loved every moment of this time spent
together.
Medical Care On Holidays Spent Away From Home
If you are going to a malaria-infected area, the whole family
should start on a prophylactic drug (see Malaria in THE
A-Z OF CHILDHOOD ILLNESSES).
If you are going abroad, ask your travel agent if any special
vaccines need to be taken.
When you are away from home, avoid taking unboiled
water, cold food items, salads and milk preparations at places
that are not likely to be safe. Drink only packaged water if you
cannot get boiled water.
In general, I am against readymade commercial cereals for
small infants, but you may carry tinned cereal (to which only
water need be added) if you are going to a remote area.
You should also carry your family first aid kit with you.
(See chapter on A FIRST AID KIT).
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IMPORTANT ADDRESSES
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INDEX
A
Abdominal pain, 237-47
causes, 237
Abrasions, 247-8
Accidents, 508-17
Acne, 389
Acquired Immune Deficiency
Syndrome (AIDS), 252-5
myths about, 253-4
prevention of, 254
risk among homosexuals, 252, 442
symptoms, 253
Acute epiglottitis, 319
Acute glomendonephritis, 248
Acute laryngotracheobronchitis, 319
Acute nephritis, 249
Acute stridor, 409
Addiction, 249-51
drinking and, 249, 495-7
how to suspect, 250-l
misconceptions about, 250
parents role, 251
Adequate sleep, 398-9
Adolescent,
behaviour of, 97-9
diet for, 209-11
parenting adolescents, 142-47
pubertal growth, 66-7
Adoption, 491-5
Aids, 252-5
Albinism, 390
Alcohol,
alcoholism, 495
danger during pregnancy
and breastfeeding, 496
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B
Baby-friendly hospitals, 19-20, 26
Bacillary dysentery, 240-l
Bacille Calmette and Gurin (BCG)
vaccine, 82-3, 85-86
Backache, 273-4
Bath for newborn, 47-8
Bed-wetting, 274-6
Behaviour of child
at different ages, 89-99
Birth deformities, 276-7
Birth spacing, 3-4
Bites and stings, 278-82
mosquitoes, 278-9
scorpion stings, 279-80
snake bite, 280-2
spider bite, 278
Bleeding,
causes, 283-4
when to seek attention, 283
Blocked milk duct, 172
Blocked nose, 307-8
Blue baby, 480-3
Boarding schools, 126-7
Boils, 390-l
Bonding,
holistic, 53
with foetus, 54
with unborn child, 54-6
Bondla, 178
Bone,
injuries, 284-5
tumours, 291
Bottle-feeding, 188-93
Bow legs, 287
Boys,
pubertal growth of, 66-7
Brain tumours, 291
Brassy cough, see Croup
Breast,
abscess, 171-2
anatomy, 160
engorgement, 171-2
leaking, 179
Breastfeeding,
adequacy of milk supply, 164, 176-7
advantages to
baby, 153-6
mother, 151-3
and diarrhoea, 181-2
at night, 169
baby refusing to feed, 178
breast size and, 160
check for enough
breastmilk, 176-7
cleft lip and, 304-6
cleft palate and, 304-6
colic and, 154
comfort suckling, 163
convenience, 153
delays conception, 152
during first week, 164
exclusive, 166
expression of breastmilk and, 185-6
helps regain better figure, 152-3
how long to continue, 187-88
in jaundice, 353-4
in second year, 187-88
inadequacy of milk supply, 176-9
mothers diet, 183
mothers illness, 184
positioning during, 161-3
premature babies, 180-l
proper positioning for, 161-3
protection against,
diarrhoea, 154-5
infections, 154-5
pneumonia, 154-5
provides complete nutrition, 153-4
reduces risk of bleeding after
delivery, 152
reduces risk of cancer, 152
secret of successful, 151
sudden stoppage of, 178
surgery in baby and, 185
to twins, 180-l
total duration, 187-88
vitamins, 153
working women and, 179-80
Breastmilk,
allergy to, 182
amount in first days, 164
check for adequacy, 164, 176-7
drug to increase supply of, 177
expression of, 185-6
not enough, 164, 176-7
removal by warm bottle method,
186-7
Breathlessness, 287-9
Bronchial asthma, 256-9
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INDEX
Bronchiolitis, 288-9
Bruxism, 239
Burns, 289-290
C
Caesarean delivery, 159
cafe au lait spots, 28
Calcium
need of breastfed baby, 168
diet rich in, 9
Cancer, 291
risk and breastfeeding, 152
Candida infection, 395
Caput succedaneum, 30
Cardiac massage, 292-6
Cardiac pulmonary resuscitation, 292-6
Cephalhaematoma, 30
Cerebral palsy (CP), 296-8
Chickenpox, 298-300
Child,
sexual abuse, 497-9
shaking is dangerous, 347
specialist, see, Paediatrician
Childbirth, 18-21
Choking, 300-2
Chorea, 384
Chromosome abnormalities, 277
Circumcision, 302-4
Cleft lip and palate, 304-6
Cold,
allergic, 307
antibiotics in, 306, 311
antihistamines in, 309
blocked nose in, 308-9
Colic, 320-l
Colostrum, 150
Colour of eye, of newborn, 31
Comfort suckling, 163
Common cold, 306-11
Congenital abnormalities, 276-7
Congenital dermal sinus, 36
Congenital dislocation of hip, 36
Congenital heart disease (C.H.D.),
473-83
Congenital ptosis, 336
Congenital stridor, 409
Conjunctivitis, 334
Constipation, 311-3
Convulsions, 313-6
causes, 315
crying, 315
febrile due to fever, 315
management, 313-6
Cough, 316-8
causes, 317
important facts, 316
symptomatic relief of, 318
Counselling,
genetic, 6
preconceptional, 53
Cracked nipples, 173
Cradle cap, 31
Craniotabes, 31
Croup, 318-9
causes, 318
treatment, 319
Crying baby, 320-2
colic, 320
fits following crying, 315
hunger and, 320
management of, 321-2
other causes of, 320
sickness and, 320
Cup feeding, 190
Cutis marmorata, 29
Cuts,
management of, 322-4
Cysticercosis, 240
D
DPT (Diphtheria, Pertusis, Tetanus)
vaccine, 83
DT (Diphtheria, Tetanus) vaccine, 83
Daydreaming, 435-6
Death, 499-500
concept among children, 499
questions about, 499
terminally-ill child, 500
what happens after, 500
Deep sleep, 399
Dehydration and urine, 226
Delivery,
drugs during, 21
going out after, 50
kit, 21
place of, 18-9
right place of, 19-20
sex after, 52
Demand feeding, 169-70
Dengue fever, 324-5
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E
Ear infection, see, Earache
Earache, 328-31
Earbud, 47
Eczema, 259-61
Education, 123-38
backwardness in studies, 127-9
homework, 130-l
regular studies, 130-l
sex, 133-8
Elbow,
dislocation, 285
pulled, 285
Electric shock, 331-2
Emergency kit, for delivery, 21
Encephalitis, 332-3
Engorgement of breast, 171-2
Entertainment, 518-22
Eosinophilia,
Tropical, 419-20
Exanthem subitum, 364
Expression of breastmilk, 185-6
warm bottle method, 186-7
Eye problems, 333-6
chalazion, 336
conjunctivitis, 334-5
discharge, 334
glasses, 333
injuries, 335
itchy eyelid, 336
night blindness, 336
ptosis, 336
redness, 334
stye, 335-6
squint, 333
watering, 333
F
Falciparum malaria, 360-l
Fallot, tetralogy of, 481-2
Family planning, 4
Fast foods, 209
Fears, 336-7
Febrile convulsions, 315
Fever, 231-5
Finger tip, injury to, 286-7
Fits, 313-6
Flat nipples and breastfeeding, 174-5
Flat foot, 337
Flu, 351
Fluoride, use of, 413
Foetus,
hearing, 54
Folic acid, 2
Fontanelle, 31
bulging, 365
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INDEX
Food,
healthy food habits, 215-9
poisoning, 242
pyramid, 212-4
right type of, 215-9
Foot problems, 337-8
Foreign body, in ear, 330-l
Foremilk, 170-l
Foreskin, 46
G
G-6-PD deficiency, 267
malaria drugs and, 267
Genetic counselling, 6
German measles, 339-40
Giardiasis, 241
Girl child, 24
pubertal growth of, 66-7
Glands, in neck and elsewhere, 340-2
Glandular fever, 341
Glomerulonephritis, 248
Goats milk, anaemia due to, 266
Gripe water, 154
Growth
and development, 60-81
chart, 60
drugs to stimulate appetite, 62
facts, 60-2
head circumference, 66
height, 64-5
in weight, 62-4
length, 64-5
pubertal growth, 66-7
teeth, 66
Guest articles,
Ayurveda, 469-72
Congenital heart disease, 473-83
Healthy food habits, 215-9
Holistic bonding with the unborn
child, 53-7
Homoeopathy, 463-8
Nature cure, 457-62
Parenting adolescents, 142-7
Prayer and child health, 452-6
Reading to the child, 139-41
H
Haematemesis, 283
Haemophiha, 357
Haemoptysis, 283
Happy family, manifesto for, 120-2
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I
Ideal family, 120-2
Immunization, 82-8
Impetigo, 392-3
Infantile colic, 320-l
Infectious mononucleosis, 341
Influenza, 351
Inguinal hernia, 244-5
Intestinal obstruction, 243-4
Intussusception, 244
Inverted nipple, 174-5
Iron-deficiency anaemia, 263-6
J
Jaundice, 351-6
Joint disorders, 356-7
Joint family, 39-40
Junk foods, 209
Juvenile diabetes, 325-6
K
Kala-Azar, 357-8
Knock knees, 287
L
Labour, drugs during, 21
Lacto-vegetarian diet, 8
Lacto-ovo-vegetarian diet, 8
Laughter, passage of urine
during, 276
Leaking breasts, 179
Learning and schooling, 123-38
Leg aches, 359
Length and height, 64-5
Leprosy, 393-4
Leptospirosis, 358
Leukaemia, 291
Lice, 394
Limp and pain in legs, 359-60
M
Maalishwali bai, 38-9
Malaria, 360-l
Malnutrition, 361-3
Mantoux test, 421
Masturbation, 438-40
Measles, 363-5
measles-like illness, 364
Measles, mumps and rubella (MMR)
vaccine, 87
Meconium, 35
Medicines,
proper use of, 225
Meningitis, 365-6
Meningomyelocele, 366
Menstrual problems, 367-9
Menstruation, 367-9
Mental retardation, 369-72
Middle ear infection, 328-30
Milia spots, 29
Milk,
artificial, 188
breastmilk, 150
Molluscum contagiosum, 394-5
Mongolian spots, 28
Monitor lizard (Goh) bite, 278
Montgomerys glands, 174
Mosquito bite, 278-9
Mosquito repellents, 279
Mother,
advantages of breastfeeding to,
151-3
illness and breastfeeding, 184
Mouth-to-mouth breathing, 292-6
cardiac massage and, 292-6
drowning and, 295-6
steps to be followed, 292-6
Mumps, 372-3
N
Nappy rash, 391-2
Nature,
cure, 457-62
growing in harmony with, 489-90
Nebuliser, 257
Nephritis, 248
Nephrotic syndrome, 373-4
536
525-539.p65
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9/15/2003, 4:01 PM
INDEX
O
Obesity, 375-7
Oral polio vaccine (OPV), 83-5
Oral typhoid vaccine, 88
Otitis extena, 330
Otitis media, 328-30
P
Paediatrician,
qualities of, 222-3
Pain in abdomen, 237-47
Parenting adolescents, 142-7
Patent ductus arteriosus, 475-6
Personal hygiene, 489
Perthes disease, 360
Pertusis, 433-4
Pet animals, 502
Phototherapy for jaundice, 354-5
Physiological jaundice, 352-3
Pica, 266
Pimples, 389
Play school, 123-4
Plugged milk duct, 172
Pneumonia, 377-8
Poisoning, 378-9
Poisonous snake bites, 280-2
Poliomyelitis, 380
Poor appetite, 268-71
Prayer and child health, 452-6
Preconceptional care, 53
Pregnancy,
amniocentasis, 6
antenatal classes, 6
R
Rabies, 382-3
Reading to the child, 139-41
Rectum prolapse, 382
Reflexes in newborn, 26
Rest during pregnancy, 11
Retracted nipple, 174-5
Retractile testes, 425
Rh factor, 355-6
Rh incompatibility, 355-6
Rheumatic fever, 383-4
537
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9/15/2003, 4:01 PM
S
Safe motherhood, 2
Saline nose drops, 308
Sanskaras, 53
Scabies, 395-6
Schooling of children, 123-38
Schools, 123-7
Scorpion stings, 279-80
Scratches, 247
Semi-solid foods, introduction
to infant, 194-202
Setting-sun sign, in newborn, 31
Sex,
after delivery, 52
education, 133-38
when ready for, 137-8
Sexual abuse, 497-9
Shaking the child, 347
Shoes for child, 338-9
Short child, 387-8
Sibling rivalry, 40-2
Skin conditions, 388-96
Sleep and sleep problems, 397-407
Snake bites, 280-2
Sneezing in newborn, 32
Solid foods, introduction
to infant, 194-202
Sonography, 6
Sore nipples, 173-4
Sore throat, 407-8
Spacing, between births, 3-4
Spasmodic croup, 318-9
Spastic child, 296-8
Speech,
delayed development, 80
Spider bites, 278
Splinters, 408
Sponging in fever, 234
Sprains, 285-6
Squint, 333
Stammering, 408
Stealing, 440
Step-parents, 503-4
Stings and bites, 278-82
Stork bites, 29
Strawberry naevus, 29
Stridor, 409
Studies,
backwardness in, 127-8
Stye, 335-6
Suicide, 443
Sudden infant death
Syndrome (SIDS), 155
Sunburn, 396
Swallowing objects, 516
Swearing, 441
Sweating in newborn, 31
T
TB meningitis, 365-6
Tapeworms, 240
Tear duct blockage, 333-4
Teenager, how to handIe, 98-9, 142-7
Teeth
impact of breastfeeding on, 155, 411
in newborn, 32
Teething and care of teeth, 409-14
Television, 523-5
balanced approach, 524-5
ill-effects of, 523-4
Temperature recording in fever, 235
Testes
in adolescent, 426
retractile, 425
shy, 425
torsion of, 245
undescended, 425-6
Tetanus, 414-5
Tetaus Toxoid, 83
Tetralogy of Fallot, 481-2
Thalassemia,
major, 268
minor, 268
Threadworms, 239
Thrush, 415
Thumb sucking, 416-7
Tics, 417-8
Tinea versicolor, 395
Toilet training, 437-8
Tongue, coating on, 33
538
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9/15/2003, 4:01 PM
INDEX
Tongue-tie, 323
Tonsillitis, see, Sore throat, 407-8
Tooth, see, Teething and care of
teeth, 409-14
Torticollis, 418-9
Tourettes syndrome, 418
Toys, 519-22
Tracheoesophageal fistula (TOF), 419
Traditional massage woman, 37-8
Transient synovitis of hip, 359
Trichuris trichuria infection, 240
Triple antigen, 83
Tropical eosinophilia, 419-20
Tuberculin test, 421
Tuberculosis, 420-3
Twins, 504-5
Typhoid, 423-4
U
Umbilical cord, 34
Umbilical granuloma, 424-5
Umbilical hernia, 425
Umbilical problems, 424-5
Undernutrition, see, Malnutrition, 361-3
Undescended testis, 425-6
Urinary infections, 426-8
Urine
in exclusively breastfed
babies, 175-7
laughter and passing of, 276
passed by newborn, 36
Urticaria, 261-2
V
Vaccines, 82-8
Vaginal bleeding,
newborn, 35
unexpected, 368-9
Vaginal discharge
newborn, 35
normal, 428
with smell, 428-9
Vaporub, 309
w
Warm bottle method, of removing
breastmilk, 186-7
Warts, 397
Watering of eyes, 32
Watery diarrhoeas, 226-31
Wax in ear, 331
Weight of children, 62-4
Wet dreams, 135
Wheezing, 432-3
Whipworms, 240
Whooping cough, 433-4
Wilms tumour, 291
Working women, 505-7
Worms,
ascariasis, 238-9
hookworms, 239
roundwomrs, 238-9
tapeworms, 240
threadworms, 239
whipworms, 240
Wrapping up baby, 50-1
539
525-539.p65
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9/15/2003, 4:01 PM