How to choose the 'RIGHT' child specialist? (Part -2)

This is in continuation of the previous article wherein we had discussed the role of a pediatrician and the training needed to become a pediatrician (child specialist). Now coming to some more important questions
When Should You Look For A New Pediatrician?
Parents may seek a new pediatrician for several reasons.
The most common is that they are expecting a first child.
They may have moved to a new area,
They maybe unhappy with their prior child specialist.
Whatever your reason for looking for a pediatrician, it is important to choose one as soon as possible and not wait for your child to be ill. During pregnancy, it is wise to find a pediatrician by the beginning of the third trimester, or seventh month, of gestation.
Finding The Right Pediatrician: Where Do You Start?
Many people spend more time choosing a stock broker than they do picking a doctor for their children!
You should plan to meet with several pediatricians before choosing one, so be sure to give yourself enough time. Begin by compiling a list of candidates to interview.
You may get their names in a number of ways:
Ask friends, family, coworkers and neighbors you trust.
Contact your insurance plan for eligible pediatricians; many plans have Internet web sites.
Call local hospitals, many of which have referral services.
If you are expecting, ask your obstetrician.
You may also ask your primary care physician or another physician you trust.
Some Internet sites that may be useful in finding pediatricians in your community in India:
Pediatric on call
Indian Academy of Pediatrics - This website offers a list of registered pediatricians
Setting Up An Interview
In the west, most pediatricians offer free interviews, although some may charge for this preliminary visit. This is actually a good idea since in an emergency you would know where to rush your child to in case of any problems.
How do you decide whether the pediatrician is 'right' for you?
Screening begins with the initial telephone call: Before deciding to visit the pediatrician, you may gather some useful information from the office staff, including:
What are the doctor's office hours?
Does the pediatrician accept your insurance?
Are laboratory facilities on site? If not, where would your child be sent for these?
Don't forget to notice how easy or difficult it is to get through on the telephone.
Also, decide if you are more comfortable in a small office practice, or in a larger hospital based practising pediatrician.
Meeting The Pediatrician: Questions to Ask
It is useful to come to the interview with a list of questions. Be prepared not only to listen to the responses, but also, to pay attention to the way you feel about your interaction with the doctor.

Communication between the pediatrician, parents and child are
key

Some things to think about are:
How well does the doctor listen?
Do your questions get cut off, or do you feel rushed?
Does the doctor treat you as a partner in the care of your child?
Do you feel a sense of trust in the doctor?
Does the pediatrician ask you important information about your home or family?
The safety of your home environment, presence of other children or pets, and family health problems can all affect the health of your present or expected child.
Look around you:
Does the office seem clean and organized?
Is the staff courteous?
Is there a separate waiting area for sick and well children?
Check credentials:
Remember that you want a doctor who is knowledgeable to handle both common and unusual health problems.
What is the pediatrician s educational background?
How long has she been in practice?
Is he certified by IAP (check the listing at Indian Academy of Pediatrics website)?
How does she keep up-to-date with medical knowledge?
Does she have any special medical interests?
Determine the doctor's availability:
Children get many acute illnesses, and it is important to know how available your pediatrician is to see your child, on the same day if necessary.
How do you reach him for routine questions or urgent problems?
Does he have specific telephone call-in times?
Can you reach him by e-mail?
Does he have a web site?
What if your child becomes ill? If your child is ill, will she usually be seen in the office?
When would she be referred to the emergency room?
If your child needs to be hospitalized, what hospital would the doctor use, and who would be responsible for your child's care?
Who covers the pediatrician when he is away?
What type of staff is in the office?
Are there nurses, nurse practitioners, resident physicians or medical students on staff in the office?
Will any of these staff care for your child?
Are you likely to see different providers at each visit?
How much time will the pediatrician spend with you and your child at a typical visit?
Care of newborns:
When is the first newborn exam in the hospital?
Will your pediatrician be doing it?
When is the first newborn office visit recommended?
Is there office staff supportive and knowledgeable about breast-feeding?
How often are subsequent visits?
What is the physician's recommended vaccine schedule?
After the first visit, recommended checkups in the first 2 years are at 1.5, 2.5, 3.5, 6, 9, 12, 15, 18 and 24 months.
Explore the doctor's attitudes about things that are important to you:
If you use complementary or alternative health methods, or traditional health practices, ask about the pediatrician s knowledge and acceptance of these.
If you have important cultural, religious or moral beliefs related to your child s health care, express these to the pediatrician and observe the response.
When does he prescribe antibiotics?
I personaly that this is a very important point and you need to tell your doctor if you are comfortable in getting a prescription without antibiotic, many doctors will give antibiotics because they believe that the parents want it!
Going To The Interview As A Family
It is useful to go to the visit with your spouse or partner, so that you may both get a sense of the interaction. Also, if you are interviewing the pediatrician after childbirth, you may want to bring your child along to the visit. It could be helpful to see how the doctor and your child relate to each other. However, if you are considering leaving another physician to whom your child has become attached, you may want to be careful about how and where your child meets a new doctor. Remember that your choice of pediatricians is not permanent. If at any time you are not satisfied with your child's care, discuss your concerns with the pediatrician. If the problem continues, it may be time to find a new doctor.
This article is largely copied from the original article here by Dr. Daniel Neuspiel; however it has been suitably modified for an Indian perspective.
For more information on Child care log on to Charak Clinics

HOW TO CHOOSE A PEDIATRICIAN ?

Choosing a pediatrician is an important event that should actually begin even before the child is born. As a general pediatrician, I frequently speak with both current and expecting parents about choosing a pediatrician. Many parents are not aware of the importance of selecting the right doctor for their children, or of how to go about doing it. Let us first begin by asking the basic question:
Why Choose A Pediatrician To Care For Your Child?
The role of a pediatrician involves all of the following:

Screening and evaluating babies and children for appropriate growth and development, and assessing abnormalities and disabilities, if any.
Vaccination of babies and children, and advice about specific disease
prevention.
Advice on feeding, diet, food supplements, and other nutrition concerns.
Assessing illnesses and treating them, including admission to hospitalisation for serious diseases. Coordination of care for children receiving treatment from different specialists, and responsibility for the child's overall health.
Health education for the family.
Pediatricians have the most comprehensive medical training
to respond to these needs.

Source: Mehta child care

How Are Pediatricians Trained?
A Pediatrician is a 'qualified' Child Specialist. In India this means that after doing his basic MBBS (5 years) a pediatrician has to undergo an additional training (for 2-3 years, on-the-job training) in dealing exclusively with children. This residency training prepares pediatricians to help meet the needs of healthy children in such areas as normal growth, development, nutrition and behavior. After completing the training an exam needs to be passed to become a Pediatrician. A normal physician has less pediatric training than pediatricians, and may not be able to provide the same quality of care to a child as a pediatrician. Some pediatricians have additional subspecialty training beyond residency.
In the next part we will discuss the 'ideal qualities' to look for in a pediatrician!

Diwali: firecracker safety tips for children

The "festival of lights" Diwali is upon us in India. It is also a "festival of firecrackers" and millions of firecrackers are burnt every year throughout the country celebrating the victory of 'good over evil'. Unfortunately this needles cause of noise and air pollution also has another problem............. firecracker injuries
Here are a few tips to reduce the chance of your child having a firecracker injury:

• Did you know that most injuries are caused by 2 types of firecrackers, the rocket and the 'anaar'? Avoid the use of the these 2 crackers
• Never, ever leave children unsupervised when they are playing with crackers.
  Do not light fireworks inside your home.
• Buy good quality licensed fireworks of reputable vendors. Follow the instructions on the label while lighting them.
• Before you start the evening, fill a couple of buckets of water in case the untoward happens.
• Wear cotton clothes only while playing with crackers, keep the silk and satin for the pooja!
• Close-fitting clothes of thick material are a safer bet than loose or flowing garments.
• Do not allow your kids to keep fireworks in their pockets.
• Store crackers away from candles, diyas, fire or heat sources.
• Light one firework at a time.
• Do not relight crackers that haven't burst. Soak the 'dead' crackers in a bucket of water.
• Do not let kids play with used crackers or the previous year's crackers.
• Don't hold the firecrackers while lighting them.
• Instruct your kids to light 'anaar' and 'rockets' from the side without bending over them and quickly moving away before they burst.
• Hold sparklers away from the body.
• Prevent your kids from engaging in dangerous pranks like lighting crackers on their palms, throwing sparklers at each other or making fireworks themselves.
• Burn loud and noisy crackers away from infants and small children.
• Get your kids to invite their friends over and burst fireworks together. Hire a professional to organize a 'group' celebration. Not only can you prettier firecrackers but a safer Diwali too!
  For more on firecracker safety check out Indiainfo and Charak Clinics

Preventing/healing sore nipples

Preventing/healing sore nipples

Make sure your baby is sucking the right way. If the sucking hurts, your baby's mouth may not be positioned correctly.
Let your nipples air dry between feedings. Let the milk dry on your nipples.
Offer your baby the less sore of your two nipples first. Your baby's sucking may be less vigorous after the first few minutes.
Change nursing positions.
If possible, position any cracked or tender part of your breast at the corner of your baby's mouth, so that it gets less pressure during feeding.
Wash your nipples daily with warm water. Don't use soap or lotion that may contain alcohol, which can dry the skin.
Avoid bra pads lined with plastic.
Express milk until your let-down reflex occurs. This will help make your milk more available so your baby sucks less hard.
Breast feed often to prevent engorgement. Engorgement can make it hard for your baby to latch on.

For more information on breastfeeding check charak clinics and family doctor

Heat burns: First Aid

Health Tip: Handling Burns
Would you know what to do if a family member got a thermal burn?
That's the term for a burn caused by contact with open flame, hot liquid, a hot surface, or other source of high heat.
Do you know the 4 C's of burn care (Univ of Missouri)?
Cool the wound, Clean the wound, Cover the wound and Call the doctor

The Shriners Hospitals for Children suggests these steps (HealthDayNews) :

Get the victim away from the heat source as quickly and safely as possible.
Cool the burn with cold water ( not ICE/ icewater).
Cover the area with a sterile pad or clean sheet.
Maintain the person's body temperature and
take the victim to the nearest medical facility.
Do not apply oils, sprays or ointments to a serious burn.

Some other do's and dont's:

For eye burns, seek medical opinion immediately, do NOT put eye drops/ ointments
In case of a small burn, you may apply an antiseptic cream before seeking medical advice
If the burn is larger than the size of the palm (in adults) do seek out a doctor
DO NOT puncture blisters, they are sterile and prevent infection
In case of limb burns, remove constricting things like rings, bangles, belt, boots etc. as it may be difficult to remove them later due to swelling

Five essential tools for your PC online

Hi,
This is still the 'daily dose for kids by docgaurav'; and there is only one reason for this particular article to be here.......coz it is my blog!

FIVE Essential Software for PC on the Internet
Today the worth of a PC has been enhanced manifold with the availability of the Internet. However with every silver lining comes a dark cloud, and the easy availability of the Internet has lead to an increase in virus attacks and security breaches. Not a day goes by when we do not hear about hackers disabling major websites, or causing a loss of millions of dollars by unleashing virus attacks.
You maybe wondering where you fit in all this? You are probably a single PC user having an Office / Home PC, keeping your accounts and games on the PC, a little bit of academic research and surfing the net for some fun. Why would a hacker/ virus be bothered with you? Unfortunately nowadays no one is safe, as many net users have found to their dismay. We in India are especially prone as many of the virus attacks may occur through pirated software that abound on an average Indian PC. Opening an email attachment can easily spread a virus to your computer, destroying your precious data. So how do you ensure protection of your PC from the online threat?Here is a list of software that MUST be installed on your PC if you are connected to the Internet.
1. LATEST UPDATE of your WINDOWS Operating System: Easiest and probably the single most effective way of making your computer safe. If you are a ‘genuine’ WINDOWS user then you can order the CD from the Microsoft website, or download the updates from their website. However since this is a large download (upto 256 MB for Windows XP service pack 2), it might be better idea to purchase a computer magazine that would be carrying the latest update (for example the DIGIT magazine Sept 2004 CD & DVD have the latest Windows XP service pack 2). If you do not upgrade the Windows Operating System, even the latest Antivirus may not be able to prevent certain types of security breaches in your computer.
Category: FREE; Website: windowsupdate.microsoft.com
2. Antivirus: Most people know about these, however it is extremely important not only to have a good antivirus but also to update it on a frequent basis (daily to once a week). Run the virus scan frequently to check for any hidden virus.
Category:
PAID; McAfee (www.mcafee.com); Norton Antivirus (www.symantec.com)
FREE; AVG Antivirus (www.grisoft.com); Avast (www.avast.com); Bitdefender (www.bitdefender.com); H+BEDV antivirus (www.free-av.com)
3. Spyware removal tools: Spyware are certain programs that get installed on your computer without your knowledge and permission. They slow down the computer, the Internet and also may lead to more junk (spam) mail in you email. They may even track your internet usage (spy on you!) and report this information back to their owner without your knowledge. How do they come to your PC? Most likely as ‘bundled’ software with some FREE programs or with some pirated software. Use spyware removal tool and run and update it frequently (just like the antivirus) to help your PC run smoothly for years!
Category:FREE: Ad-aware (www.lavasoft.de), Spybot Search and Destroy (www.security.kolla.de),
4. Firewall: These are software used to prevent unauthorized people (hackers) from gaining access to your computer. They work by checking the flow of information from Internet to your PC and vica versa (somewhat like a wall around a fort with gates and guards checking every passerby!). You would be surprised at the number of times your computer is “scanned” while you are surfing the internet. Another advantage with a firewall is that they prevent unauthorized programs (like spyware) in your computer from sending information outside without your knowledge. The risk of a virus-like attack is substantially reduced with the addition of a firewall. Interestingly WINDOWS XP Service pack 2 update contains a free firewall
Category: PAID: Mcafee Internet Security Suite (www.mcafee.com); Norton Internet Security (www.symantec.com)
FREE: Zonealarm (www.zonelabs.com); Kerio (www.kerio.com); Outpost (www.agnitum.com); Sygate personal firewall (www.sygate.com)
5. Others: These software may not directly protect your computer online but make your Internet browsing much more fun
a. Downloadable Toolbars: Yahoo and Google have downloadable toolbars that allow you to search the internet from your web browser instantaneously. Apart from the ‘search’ function they also have interesting features like “auto-complete form” (a real time saver) feature of the Google tool bar, and the anti-spyware feature, popup blocker and a host of other features of the Yahoo toolbar.
Category:
FREE: Yahoo (toolbar.yahoo.com); Google (www.toolbar.google.com)

b. Spam Filters: These are programs that make your life easier by scanning incoming mails (on Microsoft Outlook, Outlook Express etc.) on your computer and automatically separate the junk mail from the important ones. A real time saver tool for the regular e mail user
Category:PAID: Cloudmark Spamnet (www.cloudmark.com); Mcafee Spam killer (www.mcafee.com); Norton Antispam (www.symantec.com/antispam)
FREE: Spam assassin (www. Spamassassin.org); Spamihilator (http://www.spamihilator.com)

I hope that this article stimulates some of you to take action to protect your PC. To paraphrase ‘even if one PC stays uninfected after taking action on the basis of this article I would feel vindicated’
Dr. Gaurav Gupta
gauravg@sify.com
www.charakclinics.com

Winter tips: Colds and FLU

It is going to be winter in the northern hemisphere; and the winter chill not only cheers, but brings about snotty noses, colds and coughs too!
New York-Presbyterian Hospital offers some information to help you sort through the facts and fictions of colds and flu.
To begin, colds and flu are different. A cold is usually an upper respiratory tract infection. Symptoms include a sore throat, head congestion, sinus pain, and low-grade fever. Flu symptoms usually include a higher fever, a sore throat, cough and body aches.
A cold usually lasts two to three days while a flu can last as long as a week. Flu can lead to more serious health complications, especially in the elderly and people with asthma.
Here are some facts about colds and flu
The best way to prevent a cold is to wash your hands and to avoid people with colds.
You can't catch a cold by staying outside in the cold too long. You catch a cold by touching something that's been touched by someone infected with a cold or by breathing in moisture that's been coughed out by someone with a cold.
People get colds more often in the winter because they spend more time indoors in contact with one another.
Antibiotics cannot cure a cold or flu, which are caused by viruses.
The best way to defend against the flu is to get a flu shot.
There is no vaccine against the common cold.
If you have the flu, don't go to work. If you go to work, you'll expose your colleagues to flu infection. Stay home where you can rest and recover.
Flu shots cannot give you the flu. They may cause mild flu-like symptoms, but this is rare.
If you are not sure whether you needit read this article on FLU vaccine

SAMPLE MENU for a 1 year old Indian Baby

SAMPLE MENU for a 1 year old Indian Baby

6:00 AM MILK (100-125ML)

8:00 AM SUJI KHEER / PORRIDGE

10:00 AM EGG YOLK (SOFT BOILED)

12:00AM YOGHURT: 100-125 ML

2:00 PM KHICHRI SEMI SOFT CONSISTENCY

4:00 PM FRUIT JUICE WITH SUGAR
FRUIT STEW WITH SUGAR

6:00 PM SUJI KHEER/CUSTARD/COMMERCIAL
FORMULA (THIN CONSISTENCY)

8:00 PM VEGETABLE SOUP WITH BUTTER/
GHEE (50 ML) MASHED POTATO/
BANANA

10:00 PM MILK (100 ML)

General principles of discipline

Parents' are sometimes caught in a dilemma on the issue of disciplining the child. Not only do we find parents having differences, but also not being clear about age-appropriate 'punishments'.
There are a few guielins that need to be remembered while disciplining a child. While every child is different, most children need to be given consistent, clear rules and expectations about behavior.
The following are some general principles about discipline:

Discipline needs to begin as soon as the child is mobile - pulling up and
crawling.
Young infants rely on their parents to provide a safe environment.
Discipline should be age-focused and should teach age-appropriate behaviors.
Try to recognize and praise desirable behavior.
Be a good role model for your child.
After the discipline occurs, hug your child. Make sure the child knows it is the behavior you are not happy with, not the child.
Physical punishment is not needed or appropriate.
Rewards for good behavior should be immediate.

Decrease unwanted behavior: It is important to remember not to reward a child or give positive reinforcement for an inappropriate or undesired behavior. For example, if a child is having a temper tantrum, giving him/her a cookie to be quiet is rewarding the child for this behavior. In order to help decrease the chance of unwanted behavior, consider the following:
Do not reinforce the behavior; simply ignore the child.
The behavior may have to result in an unpleasant consequence, such as punishment.
Active punishment has two forms, including the following:
Denying the child privileges or desired activities, such as decreasing TV time or no dessert
Undesirable or uncomfortable activities can be required of the child, such as doing chores or having "time-out"
The behavior can result in natural consequences. For example, a child who will not eat may go to bed hungry.
It is generally accepted that spanking and other forms of physical punishment are not helpful. These types of discipline teach the child aggressive behaviors and poor conflict management.
Methods of discipline:
Discipline methods often depend on the age of the child, and how much the child understands his/her behavior. The following are some suggestions for discipline techniques for each age group:
Infants and toddlers: Safety is the main concern.
Infants will respond to a loud, firm voice saying "no."
Provide a safe environment that decreases the chances of things being broken by the child.
After saying "no," direct your child to an acceptable behavior, such as a toy.
Do not reward inappropriate behavior. Ignore temper tantrums, but confront other problems, such as biting or hitting.
Praise and reward appropriate behavior.
Preschoolers: Preschoolers need clear and consistent rules.
This age group needs time to prepare for the next activity. Give your child a warning before it is time to stop playing.
Preschoolers need lots of explanation as to why things are being done.
Use time-out for inappropriate behavior (make them sit in a corner or their own room for approximately a minute per year of their age, for example in a 3 year old child the time-out period needs to be 3 minutes).
Use praise for appropriate behavior.
School-aged children:School-aged children need the above rules and guidelines plus the following: Give your child chances to explain his/her side and opinion and opportunities to express their feelings and concerns.
Give your child choices when possible and appropriate.
Give your child chances to help solve problems together regarding their behavior.
Adolescents: This age group needs patient and understanding parents as they test all limits.
Adolescents need to be told the long-term outcomes of inappropriate behaviors.
Adolescents need to be involved with limit-setting, based on their maturity.
This article has been published from an excellent pediatric resource at cincinnatichildren's hospital website.
For more information on kids plesae visit us Charak Clinics

Weaning food recipes

There was a time when a pediatrician would not be caught dead writing about "weaning food recipes"! In India, the joint family system used to take care of these issues quite effectively. With the advent of Nuclear families however I get more and more requests on when & how to wean, what foods to use and avoid etc.
Lets start with the principles of weaning:

1. Start at around 6 months, definitely not before 4 months.
2. Weaning means not only shifting from exclusive breast feed to other foods, but also involves the introduction of the "chewable" food concept, which means that we need to give semi-solid foods so as to acclimatize the child to chewing and swallowing.
3. Start with a single new food item, so that in case your child vomits/does not like it you know what food to avoid for a little while.
4. The quantity would be around 1-2 teaspoons initially, twice a day. Preferably the mid morning (9-11:00 AM feedtime) & evening (5:00-7:00 PM) time.
5. Increase quantity over a week and then try something new.
6. In case the child does not accept the new food, RELAX, take 2 deep breaths and try something else. Re-introduce the same food after a month and there is every chance that the child may take it!
7. Start with food items like watery daal (arhar/ moong) with a little bit of daal in it (the "chewable food" concept)
8. Other items that may be added include suji kheer, dalia (porridge), mashed potato, mashed banana, liquid khichdi, boiled and mashed apple and pear, soups of potato, tomato etc.
9. Thicker things like mixed vegetables, egg, chicken soup may be introduced by around 9 months
10. The aim is to get the child on home-made foods (without special preparations) by the age of 1 year

Any foods to avoid?
Hmmm... Do not add any salt initially but later you may give a mild taste to the bland food that is being cooked. A little bit of sugar is quite alright though. Always avoid seeds for small kids as they may get stuck in the throat. No outside food/ water as far as possible.

How long should breast feed be continued?
For around 2 years, give or take a few months

What about CERELAC, FAREX and other commercial weaning foods?
There is no advantage of these commercial weaning foods over home-made foods. The disadvantage is that there would always be some added preservatives (even though they may safe in kids) and that an year down the line you would have to wean your child off these weaning foods!
The only reason these may be preferred would the time saved in preparation of home-made weaning foods for a working mother.

Do remember that weaning is new time for everyone, and just like not many people like to change a routine, the kids too have an "adjustment period" before the weaning can be successful. Be patient, and enjoy the experience since it is a UNIQUE one!

More on weaning recipes in the future

Breast feeding cuts Asthma Risk

There is more good news for parents that have been exclusively breastfeeding, a recent published by AAAAI clearly shows that Babies who are exclusively breast-fed for their first four months of life have a reduced risk of asthma during their first four years. Researchers analyzed data about 4,089 infants and found that asthma rate was 6.4 percent among 4-year-old children who'd been exclusively breast-fed for the first four months or longer, compared with 9.1 percent of those who'd been exclusively breast-fed for less than four months.The important thing to note is that these kids had been given NOTHING but breast feed for the first 4 months. The study also found that continued partial breast-feeding after exclusive breast-feeding also helped protect children against asthma.
Given the trend of increasing asthma in Indian kids, this study shows a simple way to try and reduce this epidemic disease.
SOURCE: American Academy of Allergy, Asthma and Immunology, news release, Sept. 16, 2004

The FLU vaccine: What is it?

Hi,
Does your child have ASTHMA (or whatever you prefer to call it: weak chest, chest allergy, bronchitis, allergic bronchitis etc.)?
Does he/she have recurrent colds, coughs etc. in the winters?
Does he/she have a hole in the heart?
Then the FLU vaccine is probably RIGHT for your kid.
What is the flu?
It is a cold like viral illness with more fever, bodyaches, and less running nose. If severe this can lead to pneumonia like illness.
One of the commonest reasons why young children (less than 2 years) get admitted in India is Pneumonia. It is interesting to find that many of these pneumonia are viral in origin (meaning do not respond to antibiotics), and it is estimated that almost 25-50 % of these may be due to the Influenza virus.
Who should get the Flu shot (vaccine)?
As per the US CDC recommendations 2004, ALL CHILDREN between 6 months to 2 years should be given the flu shot!
Adults over the age of 65 years (& probably even above 50 years as well), and those with chronic heart or chest problems like asthma should also get this vaccine.
What will the vaccine do?
In simple terms, it will reduce your child's chances of getting cold-like illnesses, and may reduce the chances of needing hospitalisation due to respiratory problems. Children with asthma and heart diseases are likely to benefit even more.
How much does the Flu vaccine cost?
In India till recently only a single brand of this vaccine was available (VAXIGRIP by Aventis), however this year GSK have come up with a competing brand (FLUARIX) and thus the prices have started falling, ask your pediatrician for details
What is the dosage for this vaccine?
The flu vaccine is UNIQUE in the fact that it has to be taken every year, and also because each year you get a different vaccine! Yes, every year WHO (World health Organisation) and other health bodies research the different types of viruses that cause Flu and then each year a 'fresh' batch of vaccine is prepared.
Two doses of the Flu vaccine are given in the first year (for children less than 9 years), and one every year thereafter. In children 6 months-3 years only half the dose (0.25 ml) is given Intramuscularly. The vaccine is NOT recommended below 6 months age.
For more on routine immunisations in India, visit Charak Clinics

Kids say the Funniest Things!

Hi,
I would not copy and paste an email unless it was really funny (and had something to do with kids)!
I find the following anecdotes hilarious, but they also point to a sense of innocence that seems to be rapidly disappearing in the modern world with its information overload!
Enjoy these and do share some of your own stories about your little 'adults'
10 reasons why we love children
1. A kindergarten pupil told his teacher he'd found a cat, but it was dead. "How do you know that the cat was dead?" she asked her pupil. "Because I pissed in its ear and it didn't move," answered the child innocently. "You did WHAT?" the teacher exclaimed in surprise. "You know," explained the boy, "I leaned over and went 'Pssst!' and it didn't move."
2. A small boy is sent to bed by his father. Five minutes later....."Da-ad...." "What?" "I'm thirsty. Can you bring drink of water?" "No, you had your chance before Lights out." Five minutes later: "Da-aaaad...." "WHAT?" "I'm THIRSTY. Can I have a drink of water??" "I told you NO! If you ask again, I'll have to spank you!!" Five minutes later......"Daaaa-aaaad....." "WHAT!" "When you come in to spank me, can you bring a drink of water?"
3. An exasperated mother, whose son was always getting into mischief, finally asked him "How do you expect to get into Heaven?" The boy thought it over and said, "Well, I'll run in and out and in and out and keep slamming the door until St. Peter says, 'For Heaven's sake, Dylan, come in or stay out!'"
4. One summer evening during a violent thunderstorm a mother was tucking her son into bed. She was about to turn off the light when he asked with a tremor in his voice, "Mommy, will you sleep with me tonight?" The mother smiled and gave him a reassuring hug. "I can't dear," she said. "I have to sleep in Daddy's room." A long silence was broken at last by his shaky little voice: "The big sissy."
5. It was that time, during the Sunday morning service, for the children's sermon. All the children were invited to come forward, one little girl was wearing a particularly pretty dress and, as she sat down, the pastor leaned over and said, "That is a very pretty dress. Is it your Easter Dress?" The little girl replied, directly into the pastor's clip-on microphone, "Yes and my Mom says it's a bitch to iron."
6. When I was six months pregnant with my third child, my three year old came into the room when I was just getting ready to get into the shower. She said, "Mommy, you are getting fat!" I replied, "Yes, honey, remember Mommy has a baby growing in her tummy." "I know," she replied, "but what's growing in your butt?"
7. A little boy was doing his math homework. He said to himself, "Two plus five, that son of a bitch is seven. Three plus six, that son of a bitch is nine...." His mother heard what he was saying and gasped, "What are you doing?" The little boy answered, "I'm doing my math homework, Mom." "And this is how your teacher taught you to do it?" the mother asked. "Yes," he answered. Infuriated, the mother asked the teacher the next day, "What are you teaching my son in math?" The teacher replied, "Right now, we are learning addition." The mother asked, "And are you teaching them to say two plus two, that son of a bitch is four?" After the teacher stopped laughing, she answered, "What I taught them was, two plus two, THE SUM OF WHICH, is four."
8. One day the first grade teacher was reading the story of Chicken Little to her class. She came to the part of the story where Chicken Little tried to warn the farmer. She read, ".. and so Chicken Little went up to the farmer and said, ' The sky is falling, the sky is falling! '" > >The teacher paused then asked the class, "And what do you think that farmer said?" One little girl raised her hand and said, "I think he said: 'Holy Shit! A talking chicken!'" The teacher was unable to teach for the next 10 minutes.
9. A certain little girl, when asked her name, would reply, "I'm Mr. Sugarbrown's daughter." Her mother told her this was wrong, she must say, "I'm Jane Sugarbrown." The Vicar spoke to her in Sunday School, and said, "Aren't you Mr. Sugarbrown's daughter?" She replied, "I thought I was, but mother says I'm not."
10. A little girl asked her mother, "Can I go outside and play with the boys?" Her mother replied, "No, you can't play with the boys, they're too rough." The little girl thought about it for a few moments and asked, "If I can find a smooth one, can I play with him?"

The problem with kids is not that they misinterpret what has been told to them, but often remember (and repeat) EXACTLY what has been said

Tonsillectomies! To do or not to do, that is the question

Tonsillectomies have long been the 'bread and butter' of the ENT surgeons. When they are indicated, they are a great help for the kids and parents, however it has been seen that a lot many tonsillectomies are NOT NECESSARY!
So how do we decide when a tonsillectomy is indicated?
A tonsillectomy is generally done for recurrent 'sore throat' or throat infections. However in most children it has been shown that there is no significant decrease in the number of Upper respiratory infections (URI) after undergoing tonsillectomies (Sept 11, 2004, BMJ).

Only those children who get a documented (seen by a doctor, preferably)
attack of URI of 6-7 times in 1 year, or 5 episodes per year for 2
consecutive years, or 3 episodes per year for 3 consecutive years should
probably be taken up for tonsillectomy.

Among other reasons for tonsillectomies would be extremely large tonsils interfering with sleep (Obstructive Sleep Apnoea) detected by snoring, irregular sleep, daytime sleepiness, and mouth breathing. Also if a child has very severe URI's with long lasting symptoms tonsillectomy may be undertaken sooner

Breast Feeding, Breast Feeding and more Breast Feeding

You must be wondering as to the repetitions in the title?
It is to emphasize the importance of breast feeding for our precious babies!
There are a lot of misconcpetions and myths about this common topic, and each day a good part of the consulting time is spent in trying to convince mothers of newborns to EXCLUSIVELY BREASTFEED FOR 6 MONTHS!
Exclusively means NO WATER, NO JANAM GHUTTI, NO CERELAC/FAREX other baby foods, NOTHING BUT MOTHER'S MILK by mouth.
Sounds difficult, Impossible, theoretical?
Let me give you a small personal example. I have recently been blesssed with the cutest nephew possible. My bhabhi complained to me initally that he had dry skin. Use of non-drying soap, lactocalamine and even mild steroid creams had temporary benefit. He also was quite irritable and kept on rubbing his face and eyes repeatedly. They have a strong family history of asthma, and other allergies. However on asking I found that she was feeding the child Lactogen 1, because the child was born 'weak'. After some initial reluctance she accepted my suggestion to try and stop the formula COMPLETELY.
Voila! The dryness diappeared completely, and has not returned since. As a pleasant side-effect my Bhabhi is now much more impressed with the skills of the 'doctor at home' .
This is only a small part of what exclusive breastfeeding can do your for your baby!
Among the many benefits of breastfeeding, research has shown that the practice improves infants' immune responses, prevents chronic disease, contributes to better cognitive skills (higher IQ), stimulates bonding between mother and child and promotes healthiness in premature infants. Mothers who breastfeed also have a lower risk of breast cancer. Constipation, Diarrhoea, Ear infections, Pneumonia, Colic and chances of later allergy and asthma are reduced. Nowadays it is felt that breastfed infants are less likely to be obese, have lower cholesterol and thus less chances of heart problems. Add to this the fact that Breast milk is free of infections, at the right temperature and easily and plentifully available, and you have a winner.
No formula in the world can come close to breast milk!
As long as a mother is physically able, the American Academy of Pediatrics recommends that babies be breastfed for at least a year, while the World Health Organization recommends the practice for two years.
So what do you need to start breastfeeding?
A willingness to be a part of this beautiful experience;
An encouraging Obstetrician (pre-delivery) and Pediatrician (after delivery);
Especially in the Indian context a helpful and encouraging mother-in-law!
That is it, now you are ready to give your baby the best possible start in its life

Love in the Hands of Discipline

Just the other day I was asked to comment about self mutilation in normal teenagers. During the course of my research on the web I realised how little people understood the importance of self esteem and was aghast at the worthless advice given in this context on most websites! A positive self esteem will help your child take on challenges, achieve better, live happier, make friends and cope in acceptable ways with the stresses of living. Most websites I saw will have you believe that if you criticize your child you lower their self esteem and by praising them you increase it. But the truth is far from such 1 -2 -3.

Growing and maturing means constantly dealing with change. Not just changes in the surrounding but also within one's body. Keeping up can be a pain (mostly literally) for children as they cope first with crawling, then walking, running, and then taking resposibility for their own lives. A positive self esteem in such a scenario does not come automatically. It needs to be nurtured by parents who understand that they must share their pain as well as their glory with the kids they are bringing up.

Give Credit where it is due: Consistently applaud genuine EFFORTS made by your child. Help them understand how to convert efforts to results. A corollary is that you should let them feel proud of how they are shaping up, rather than keeping credit for parenting them well. Let them know it is up to them to be good or bad, happy or sad, appreciated or despised.
Do NOT Praise Excessively: Don't tell them they are the best at an activity when they are not. Kids are internally programmed to learn and will benefit much more from a realistic feedback than unbound praise. Remember the rest of the world will give them accurate feedback and you don't want to lose credibility.
Train them to Earn Their Rewards: When they ask you for a favour or even money to buy a candy, let them plan for it, work for it and "earn" it. It will give them a sense of self worth money can't buy.
Give Them Responsibilities: In keeping with their age, let them be responsible for clothing themselves, clearing the dinner table, making the beds, putting away their toys or whatever else. Let them feel useful in the household.
Let Them Fall and Rise Up: This is a tough one especially since we want to protect them from all hurt. Still don't rush to help them out of their predicaments. Help them figure out a way of getting out of their tangles.
Give Choices: In matters where you can risk it, let them make their own decisions and ask them to justify them to you. Display your trust in their judgement. Let them set their bedtime, playtime and TV time. Let them work out the effect of their choices and learn from mistakes. The best gift you can give them is to praise their judgement.
Discipline, Discipline, Discipline: Never be afraid to discipline your child. Be reasonable, be consistent and don't let your temper run away with you. Beyond that, set limits, make sure they are adhered to. Limits give kids a sense of security and also build self esteem.

Too much of love will not spoil your kid, but how you express it may well decide whether or not your child will turn out to be a fine and balanced grown up.
You will find more information of self esteem here

Help, My teeth just got knocked out!

Just the other day my cousin had a traffic accident. She fell of her 2 wheeler, and though she escaped serious injury one of her tooth came out.
Luckily for her she had the presence of mind to notice it and she immediately carried it to the nearby dentist who fixed it back and wired it in. Hopefully in the next 2-3 weeks the tooth will set in and she will be fine.
If however you are in a similar predicament with no dentist nearby, I would suggest that you 'store' the tooth till you reach the dentist.
Putting the tooth in water, or whatever liquid is available, is better than letting it dry out, but water can damage the cells of the tooth within minutes.
Milk is largely free from harmful bacteria, and the cells on the tooth are less likely to absorb milk and ultimately burst, which can happen far more quickly in water.
With proper care and quick action, the dentist or endodontist may be able to place the tooth in the socket so it can re-attach itself and function for many more years.
Source: Medicine Net

Is your child an (under) achiever?

Just like children can make up their minds to be sick, they can make up their minds to do badly at school. Since the time Psychologists started earning their keep in schools, there has been a debate about whether parental ambitions push children to depression by over-pressurising them to succeed or do kids perform badly because they are not being pushed enough by grown-ups. We are lucky to have finally gotten the "spare the rod and spoil the child" adage out of contention for best parenting advice award, but how much pressure is good pressure is a question that still haunts us.

There are myriad reasons why a child does how he does in school. There is no denying that genetically some children will be more blessed than others. But since we can't mess around with that much (yet!) let us turn to other factors. Kids who train in music (either vocal or any instrument) are shown to develop better concentration and generally improve their grades. Of course this result cannot be expected if the child is spending 6 hours daily at school, 4 hours at tuitions, 2 hours on homework and is then started on another hour of music. For such kids, sleep may be all they need for better grades.

Importantly what is happening to many poor performing students at school may be partly the result of LABELLING. According to the ongoing research at Princeton University Department of Psychology, a kid who performs badly at school may react in two ways. One is to assume that he will perform better in the future or conversely to assume that failure will be repeated frequently. The second type of response leads to what is called "learned helplessness". What this means is that the child eventually stops trying and consistently does poorly thereafter. Thus as teachers, parents and significant adults in the life of a child, we must determine that the child is giving his very best to every attempt. If failure does occur, it is important to help the child understand the factors for it and then overcome it before the next attempt. If you tell children "You are lazy" or "You are worthless", they will soon start believing it, and acting it out.

Achievement is more than just genetic intelligence. It is about the right attitude, knowing the trade as well as its tricks and feeling passionate about success. And parents have to share these secrets with their child.

Care for your pearly whites!

Do you know the single most common chronic childhood illness?
It is Tooth Decay.
It is estimated that more than half of children aged 5-17 years have it!
Dentists have a saying, 'Snack and sip all day, risk decay.' Constantly bathing the teeth in sweetened beverages and unhealthy snacks is like providing an all-you-can-eat buffet for the bacteria in your mouth -- the bacteria that cause tooth decay.
So here are some meal and snacking tips to keep tooth decay at bay:

• Decrease intake of Fizzy drinks like Coke and Pepsi and high sugar snacks; they are no good for your teeth.
• Sugary foods and drinks consumed as part of a meal are less harmful than when they're consumed as a snack. That's because saliva production increases during meals and helps neutralize acid production and rinse food particles from the mouth.
• Limit between meal snacks.
• Brush teeth twice daily with fluoride toothpaste and floss daily, it is extremely important to brush at night to avoid cavities.
• Encourage your children to eat more fruits and vegetables, less sweets.
• Regular dental visits starting at 1-2 years and done 6 monthly are important to get your child to appreciate dental hygiene.
• In case you find any evidence of plaque or suspicion of tooth decay, consult your dentist.

More information on this subject can be had from the American Dental Association link on oral health.

Vaccinations:How do they work?

Hi,
I am starting a series (hopefully!) dealing with common vaccination related questions. Hope that they will be useful, comments and questions are appreciated!
How do vaccinations work?
The main purpose of our Immune system is to fight infections. Every day, the body is bombarded with bacteria, viruses and other germs. When a person is infected with a disease-causing germ, the immune system mounts a defense against it. In the process, the body produces substances known as antibodies against that specific germ. The antibodies eliminate the germ from the body. The next time the person encounters the germ, the circulating antibodies quickly recognize it and eliminate it before signs of disease develop.
This is why a child who has had chickenpox will only rarely develop the disease again. The immune system has memory. The next time the child encounters the virus that causes chickenpox, the antibodies destroy the virus before disease causes sickness. Medical experts estimate that the immune system can recognize and effectively combat hundreds of thousands, if not millions, of different organisms, or more.
A vaccine works in a similar way. However, instead of one natural infection, for immunity to develop after a vaccine it usually takes several doses over several months or years. The vaccine contains an inactivated (killed), weakened form of the germ, or a germ component. When introduced into the body, the dead or harmless germ causes an immune response without causing the disease. The immune system develops antibodies that will effectively kill or neutralize the germ if exposed to it in the future. The antibodies circulate in the bloodstream. Vaccination protects a child against infection with a germ without the child ever suffering through the disease.It does this by creating antibodies that fight foreign proteins (antigens) that cause disease.
There are two types of vaccines: live attenuated (weakened) and inactivated forms.
Live attenuated vaccines are produced by ‘weakening’ a bacteria or virus so that it can replicate and produce immunity without causing disease. Examples of live vaccines would include Measles, Mumps, Rubella (MMR), Chicken pox, Yellow fever and Polio drops.
Inactivated vaccines are made of bacteria or viruses that have been modified or killed with heat or chemicals. Repeat administration of booster doses are often needed to maintain immunity with inactivated vaccines. Inactivated vaccines would include Diphtheria, Pertussis, Tetanus (DPT), Hepatitis A, Hepatitis B, Hib, Typhoid, Rabies, Influenza, Pneumococcal, Meningococcal etc.
When these vaccines are given, the immune system starts producing antibodies against the respective diseases. Thus when an actual infection occurs, our immune system ‘remembers’ the previous dose of antigen (given by way of vaccination) and starts fighting the disease immediately, protecting us from the disease!
More information on how vaccines work can be got by clicking on these links;
UNICEF vaccine & National Network for Immunization information

Playing Sick

How often have you heard your kid say "I can't go to school today, I have a stomach ache!" and wondered whether to be concerned? Children have very fertile imaginations when it comes to excuses, including imagining themselves ill. Most such cases are no more than a simple lie to avoid an unpleasant situation. How you should respond as a parent depends to some extent on the age of the child as well as the situation he is avoiding. For a 3 -5 year old avoiding day care or school your best strategy is to distract them instantly, by just a tickle or a mock fight. Then make brushing and dressing sound exciting. For an older child who usually enjoys his routine and is acting out-of-character, it is important to first get them to leave the bed and freshen up. Then ask indirect probing questions to learn the reason for this act. Be sure never to ridicule the child or openly call his bluff. Play along and win his confidence. His concern may be a notebook he can't find, or a bully who has challenged him. These simple things can overwhelm young children. Try to resolve the real issue. This way you would have given him an important coping tool he can use all his life.
Gaining the confidence of a malingering child is critical for another reason -a closely related condition technically known as a "psychosomatic disorder". Extremely young, sensitive or reserved children are more likely to develop psychosomatic illness. Here too the kid is complaining of, say, a stomach ache for which there is no "medical" reason. But this is not the same as malingering. The difference is that the child is in fact truly experiencing physical symptoms like pain, even though there is no physical reason for it. This kind of behaviour is not routine and must not be taken lightly. How can you tell if the child has a "real" illness or his problem has a psychological root? There may be small signs. Most important one being, does this illness at this point, serve some purpose for the child? Has the situation around the child changed lately? This may be the birth of a sibling, parental discord or move of residence/ school. Does it start when he needs attention desperately or when he is supposed to do an unpleasant activity? Has the child observed a patient of the same condition? Does having this symptom save him from an anxiety producing situation?
Obviously such behaviour is as much a cause of concern for a parent as any other type of disorder and a paediatrician must be consulted. Once we know that it is indeed a psychosomatic disorder, treatment consists of change of environment and lots of emotional support to reduce anxiety. Most importantly, remember that just because a symptom has a psychological reason behind it does not mean it will go away on its own!
Bringing up physically and emotionally strong children is no easy task. But a good dose of attention, affection and criticism along with a trusty Paediatrician can go a long way. :)

First day at school! Tips to reduce anxiety

I know a 4 year old kid who started day 1 of school crying! On day 27 of school he was crying too, in fact things had gotten worse! So much so that his mother actually thought of dropping a whole academic year and restart next year. Fortunately saner council prevailed and on day 28 the mother was instructed NOT to accompany the child to school. Over the next month or so the boy actually slowly started adjusting to school and finally learnt to like it and enjoy. Later he went to med school and is writing this article today. Of course not all kids behave this way, my wife apparently had a lovely first day at school she waved back happily to her parents from the school gates and never looked back!
I suppose children fall somewhere between these 2 extremes!
Most mothers are aware of horror stories about starting school by the time their child is a toddler. Here are a few tips to ease the transition

• Talk to kids about school before classes begin. It may be helpful to describe what will happen during the school day.
• Consider bringing children to their school before the school year starts. If possible, show them around the school, including their classroom, the playground, the lunch room and the rest room.
• Getting children into a routine may help them get ready for school. Allow children to participate in decisions, such as what clothes to wear and what to have for breakfast or lunch.
• For children who are especially anxious about starting school, taking a few reminders from home, such as photos, may help put them at ease.
• Once school starts, make plans to spend time with classmates outside of school to encourage friendships.
• After school, talk to children about their day and give them positive feedback about what they say.
• Finally, parents should let children know that it is OK to be a little nervous about starting school, because everyone gets a little nervous when doing something for the first time.

For most kids, school is a very positive experience, though it’s certainly true that some kids have more difficulty than others when they start school. Usually, this anxiety passes within the first couple of days or weeks.
But if a child seems to be having difficulty adjusting -- makes lots of calls home during the day or has physical symptoms like headaches and stomach aches – then it may make sense to speak to the child's teacher or talk to a pediatrician or family doctor, who may make a referral to a mental health professional (child psychologist). Usually, these kinds of consultations tend to be relatively brief, and may involve some sort of play therapy to help understand a child's anxiety.

Source: Reuters Health eline, 8th August, 2004

School bags may be hazardous to your health!

School bags can hurt your (child's) back!

In India school time invariably means huge school bags (back packs) stuffed with heavy books. In spite of various recommendations from time to time no steps have been taken to reduce this back-breaking load for children.
Here are a few tips to prevent back pain due to heavy school bags

• Because narrow straps can dig into shoulders, choose a backpack with wide, padded shoulder straps and a padded back.
• Make sure that only books that are needed are carried, ask the child to prepare the bag according to next day’s time-table at night…too often in a hurry in the morning the child carries all the books resulting in a heavier bag.
• Parents can minimize the risk of injury by making sure that children do not over-pack their backpacks. A child should never carry a pack that weighs more than 10 percent to 20 percent of his or her weight.
• Children should be taught always to use both shoulder straps. Using only a single strap can strain muscles and may increase curvature of the spine
• Another recommendation is to use all compartments of the backpack. Place the heaviest materials nearest to the center of the pack.
• Use a small school bag, this will prevent a child from cramming it with useless items
• Periodically remind your child to clean out trash and remove old papers and homework.

These tips are based on the latest American Academy of Pediatrics recommendations as published in Archives of Pediatrics and Adolescent Medicine, August 2004

What's in a NAME? ........A lot if its my baby!

Hi,
Normally I create original content for my website, but today is an exception.
I keep on getting requests by parents for helping them name their child. Since the Internet is a great source of information for finding out about almost anything, I decided to provide a collection of links for naming your baby. A brief description is provided for many of the websites that I have personally visited. I have limited myself to Indian baby names at the present, since that is where most of my requests originate from. As usual suggestions are more than welcome!
Indiaexpress: Small list of Sanskrit names with meanings categorized alphabetically. Fast loading with a clean interface
Babynamesindia: A collection of around 3000 names (claim to be one of the largest collections of Hindu names), lots of invasive ads, but the site loads at a fair speed
Nameandfame: An interesting site, lots of names including mythology, around the world and a ‘rare names’ section, nice tips for naming babies, and trivia like the commonest names in Bangalore! Fast loading, has interesting tips, though the design could be better. A valuable resource nevertheless!
Indiaparentinglinks: Nothing in the world of Internet is unique; it’s all been done before! A collection of links to various baby names sites (worldwide). Has its own set of baby names too, but not really unique in any aspect.
Indiaparenting: A slickly designed website, needs free registration though.
Nriol: Extensive baby names collection including the common and the uncommon too
Sanyal: A small collection of names, all names load on a single page and no meanings given
Sulekha: An Indian name search engine, nice design and well executed, has interesting choices like unusual names, multiple syllables in name search etc., definitely recommended!
Shaivam: Interested in Hindu holy names? The site has a lot of really difficult to pronounce mythological names, with a South Indian bias. Good collection nevertheless. But if you are looking for a ‘regular’ name give this one a miss!
Sysindia: A decent collection of South Indian Names, no meanings though!
Indiaserver: Has a combination of Hindu & Muslim names.
Indastro: Good collection of baby names, no meanings though. Also has baby name collections from different countries
Indianchild: A small collection, interesting names, has a collection of Sikh names too, plus a page on Naamkaran ceremony
Iomx: Too many ads, not too many names, not recommended
Indiayogi: If you want an online (paid) astrologer consultation for naming your baby look no further
Yahoo directory: Baby names from the world!
Indianastrology: Baby names, horoscopes through email and more!
Pdom: If you want to book a website for your babies’ name, this is the place to go. Did you know the most common 100 Indian surnames? Visit for some trivia, but not if you are seriously name hunting.
Jnjbaby: A very pretty site, with lots of interesting material on pregnancy and baby care like individual immunization schedule for your baby, SMS reminders for vaccination etc. A good collection of baby names, marred by lots of popups ads. Recommended
If you want to read from paper books rather than from the computer here are a few recommendations:
Penguin book of Hindu Names by Maneka Gandhi
What's In Your Name? Indian Baby Names and Their Roots
by Vimla Patil, Naishadh Patil
Babies' Names from the Indian Sub-continent (Family Know How Series)
by Vimla Patel
In case these books are not available in your nearby bookstore you can always purchase them online from Amazon

Kids say the darndest things!

Being a pediatrician has its positives, you can mix with business with pleasure!
What I mean is that in an office practice most of the children that I see are either mildly ill or scheduled for a healthy visit, and it can be fun interacting with them.
Plus they come up with some real 'truthful' answers! Check these out

Question to a 5 year old: Do you go to school?
Answer: No
Why not???
Because its the summer holidays!

Question to a 2 year old: So how was your birthday?
Answer: ( after some cajoling by parents): Happy!

Question to 5-6 year old: So do you stay in chandigarh?
Answer: Nope.......
Puzzled redirect question: So where do you stay?
Answer (matter of factly): At my home

As I say,
ask a dumb question........................
get a kid's intelligent answer!

Question and Answers on Jaundice and Your Newborn

Hi,
For all the 'new' parents, the american academy of pediatrics has come up with some new guidelines for jaundice in the newborns, and given below is the common frequently asked questions for the same.
The following Frequently Asked Questions" (FAQs) are from the American Academy of Pediatrics (AAP).
Published on 25th June 2004
--------------------------------------------------------------------------------

Congratulations on the birth of your new baby!
To make sure your baby’s first week is safe and healthy, it is important that:

Your baby is checked for jaundice in the hospital.
If you are breastfeeding, you get the help you need to make sure it is going well.
Your baby is seen by a doctor or nurse at 3 to 5 days of age.
Here is some information about jaundice. (Please note: A Spanish version will be available late July 2004.)

Q: What is jaundice?
A: Jaundice is the yellow color seen in the skin of many newborns. It happens when a chemical called bilirubin builds up in the baby’s blood. Jaundice can occur in babies of any race or color.


Q: Why is jaundice common in newborns?
A: Everyone’s blood contains bilirubin, which is removed by the liver. Before birth, the mother’s liver does this for the baby. Most babies develop jaundice in the first few days after birth because it takes a few days for the baby’s liver to get better at removing bilirubin.


Q: How can I tell if my baby is jaundiced?
A: The skin of a baby with jaundice usually appears yellow. The best way to see jaundice is in good light, such as daylight or under fluorescent lights. Jaundice usually appears first in the face and then moves to the chest, abdomen, arms, and legs as the bilirubin level increases. The whites of the eyes may also be yellow. Jaundice may be harder to see in babies with darker skin color.


Q: Can jaundice hurt my baby?
A: Most infants have mild jaundice that is harmless, but in unusual situations the bilirubin level can get very high and might cause brain damage. This is why newborns should be checked carefully for jaundice and treated to prevent a high bilirubin level.


Q: How should my baby be checked for jaundice?
A: If your baby looks jaundiced in the first few days after birth, your baby’s doctor or nurse may use a skin test or blood test to check your baby’s bilirubin level. A bilirubin level is always needed if jaundice develops before the baby is 24 hours old. Whether a test is needed after that depends on the baby’s age, the amount of jaundice, and whether the baby has other factors that make jaundice more likely or harder to see.


Q: Does breastfeeding affect jaundice?
A: Jaundice is more common in babies who are breastfed than babies who are formula-fed, but this occurs mainly in infants who are not nursing well. If you are breastfeeding, you should nurse your baby at least 8 to 12 times a day for the first few days. This will help you produce enough milk and will help to keep the baby’s bilirubin level down. If you are having trouble breastfeeding, ask your baby’s doctor or nurse or a lactation specialist for help. Breast milk is the ideal food for your baby.


Q: When should my newborn get checked after leaving the hospital?
A: It is important for your baby to be seen by a nurse or doctor when the baby is between 3 and 5 days old, because this is usually when a baby’s bilirubin level is highest. The timing of this visit may vary depending on your baby’s age when released from the hospital and other factors.


Q: Which babies require more attention for jaundice?
A: Some babies have a greater risk for high levels of bilirubin and may need to be seen sooner after discharge from the hospital. Ask your doctor about an early follow-up visit if your baby has any of the following:

A high bilirubin level before leaving the hospital
Early birth (more than 2 weeks before the due date)
Jaundice in the first 24 hours after birth
Breastfeeding that is not going well
A lot of bruising or bleeding under the scalp related to labor and delivery
A parent or brother or sister who had high bilirubin and received light therapy

Q: When should I call my baby’s doctor?
A: Call your baby’s doctor if:

Your baby’s skin turns more yellow.
Your baby’s abdomen, arms, or legs are yellow.
The whites of your baby’s eyes are yellow.
Your baby is jaundiced and is hard to wake, fussy, or not nursing or taking formula well.

Q: How is harmful jaundice prevented?>
A: Most jaundice requires no treatment. When treatment is necessary, placing your baby under special lights while he or she is undressed will lower the bilirubin level. Depending on your baby’s bilirubin level, this can be done in the hospital or at home. Jaundice is treated at levels that are much lower than those at which brain damage is a concern. Treatment can prevent the harmful effects of jaundice.

Putting your baby in sunlight is not recommended as a safe way of treating jaundice. Exposing your baby to sunlight might help lower the bilirubin level, but this will only work if the baby is completely undressed. This cannot be done safely inside your home because your baby will get cold, and newborns should never be put in direct sunlight outside because they might get sunburned.


Q: When does jaundice go away?
A: In breastfed infants, jaundice often lasts for more than 2 to 3 weeks. In formula-fed infants, most jaundice goes away by 2 weeks. If your baby is jaundiced for more than 3 weeks, see your baby’s doctor.

Find more information on neonatal jaundice from Charak Clinics

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Does your child R.A.P. ?

Hi,
This article does NOT refer to the musical preferences of today's kids. Rather it deals with another common problem that almost 10-20% of school-going children have.. RAP or Recurrent Abdominal Pain.
Does my child have it?
Almost all kids have abdominal pain at some point of time, however RAP is defined as 3 episodes of abdominal pain over 3 months or more, interfering with daily activities like going to school etc.
What causes RAP?
Only around 10 % of RAP are caused by organic (physical) causes, the rest 90% are functional. This means that once the physical examination & basic lab tests are normal, you can be pretty confident that there is nothing wrong in the child's abdomen.
It is interesting to note that an Indian study has shown that children with functional RAP are likely to belong to a nuclear family, have history of marital fights between parents, irritable bowel syndrome and chronic painful disorders and maternal dysmneorrhoea in the family. School tantrums (before going to school) , absenteeism and punishments in shchool were more common among these children too. Generally sleep was not afffected in these kids. There was however no difference in school performance from their peers. All this indicates that family and school stressors may play a significant role in causing RAP.
What tests are needed to confirm the diagnosis?
In most cases only complete blood count, Stool & urine examination (three times each), and maybe an X ray/ Ultrasound abdomen will suffice to confirm the diagnosis. More expensive & invasive tests are not indicated routinely.
What is the treatment?

Reassurance is the KEY for the parents (and the child). Telling them that there is nothing wrong physically with the child is very important. Of course this does not mean that the child is lying, the pain is real, but the cause is not in the abdomen. Sometimes, simple distraction by telling the child that the parent has been 'taught' how to take care of the problem (like blowing on the abdomen) can bring about wonderful results. A psychological evaluation for stressors maybe useful. Medicine use should be avoided as far as possible.

Welcome to India, traveler: Vaccination & health tips

Are you an NRI visiting India after a long time?
Or are you a tourist wanting to see the some of the most beautiful history in the world?
Please come to see the Taj Mahal, Forts of Rajasthan, Ajanta & Ellora caves, beaches of Goa & Kerala & so much more!
But before you reach here please remember to check with your pediatrician as to the status of the following vaccines for your kids.
Hepatitis A vaccination (Avaxim, Havrix, Travel shot) is recommended for both adults as well as kids traveling to India. The first dose of hepatitis A vaccine should be administered at least 2 (and preferably 4) weeks prior to departure. The first dose of the hepatitis A vaccine series provides rapid protection against hepatitis A. Travelers should complete the vaccine series as recommended to ensure long-term protection, using an accelerated schedule if necessary. 
Typhoid vaccination is also a good idea since it is transmitted by contaminated food & water.
Both typhoid & hepatitis A vaccines are NOT routinely given in the US and other developed countries but these diseases are very common in India and other developing countries.
It is assumed here that your child is already on a regular vaccination schedule featuring DPT, Hib, Hepatitis B, MMR vaccines and may even have received optional vaccines like Chicken Pox etc. 
Yellow fever vaccine is NOT required unless you are coming from a yellow fever endemic countrylike the Sub-sahara africa or Central America. India does not have yellow fever.
Cholera vaccine may be needed if there is an ongoing cholera epidemic in the area you wish to travel (generally cholera occurs in the monsoons months of June to September in epidemic form, transmitted by unclean water). Japanese Encephalitis maybe indicated only in special situations like epidemics, while Rabies vaccine maybe taken if likely exposure to animals. 

Remember that all vaccines should be ideally taken at least 4-6 weeks before travelling for maximum effect

Malaria prophylaxis should be started before arriving in India and continued after reaching back. Use personal mosquito repellants creams (containing DEET), mosquito nets, insect sprays and electronic repellants in malaria endemic region. Not only will these protect you from Malaria but also Dengue, Filaria and Japanese encephalitis as well.
 
Common tips for the visitor:

• Drink bottled water of reputed brands like Bisleri, Aquafina, etc.
• Packaged fruit juices & cold drinks maybe consumed.
• Avoid cut fruits, tap water, spicy food, roadside vendors, ice cubes, fountain drinks even with all the temptation to just ‘taste’ the local delicacy.
• In case bottled water is unavailable carry 1 micron filter, and iodine tablets for purifying the water.
• Carry vomiting medications like Metaclopramide (Perinorm)/ Ondansetron (Emeset); ORS solutions; Abdominal pain medications like Meftal spas, and antibiotics for traveller’s diarrhea ‘delhi belly’ like Ciprofloxacin while traveling to remote tourist spots. In bigger towns almost all these medicinces are easily available over the counter.
• While in hot tropical areas consume lot of fluids to avoid heat stroke, stay in the shade, use sunscreens and hats and sunglasses.
• Wear long sleeved shirts, long pants to prevent insect bites
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Carry all your prescription medicines, and the prescription too

Once again all travelers coming to our beautiful India Namaste, Dhanyavad plus have a safe and enjoyable trip!  

See latest CDC information on travel to india

Chicken Pox vaccine: To give or not to give

About the CHICKEN POX Vaccine:

Varicella vaccine has been available since in Japan since 1985, and in the US since 1995, and is approved for use in healthy children 12 months of age or older, and susceptible (i.e., no evidence of having had chickenpox in the past) adolescents and adults.
Varicella vaccine is highly effective in protecting against severe chickenpox.
More than 6 million doses of varicella vaccine have been given since it was licensed in March 1995.
It is recommended by the American Academy of Pediatrics  that all children be routinely vaccinated at 12-­18 months of age and that all susceptible children receive the vaccine before their 13th birthday.
The Indian Academy of Pediatrics has the following statement on its website for both Chicken pox & Hepatitis A vaccines;

At present IAP committee on Immunization consider these vaccine as additional vaccines. However, both are excellent vaccines- highly efficacious and very safe.

A history of chickenpox is considered adequate evidence of immunity, with no vaccination needed.

Isn't my child better off getting chicken pox and having permanent natural immunity than risking side effects and getting only partial immunity from the vaccine?
Answer: Probably not. Some doctors may still advise you to wait and see whether your child gets chicken pox by age 10 before having her vaccinated, but there's not much logic behind this advice any longer. The idea was that the vaccine was still pretty new (it came out in 1995 in the US, 1985 in Japan) and we didn't know much about its effectiveness or side effects, whereas chicken pox itself was generally thought to be a mild disease that most kids got through with only a little itching.It's true that the vaccine won't guarantee that your child will never get chicken pox — about 10-15 percent of those vaccinated may still get a very mild case, with no fever and fewer than 10 blisters. And experts can't be sure that the immunity it offers is permanent. But we do know that the chicken pox vaccine has been used in Japan for about 25 years with no evidence of fading immunity. We also know that shingles (a painful and disfiguring rash caused by the same virus) is less common and less severe in people who have been vaccinated than in those who actually had chicken pox as kids.
And as with all vaccines, a certain number of children will experience mild side effects. Up to 20 percent of children will have pain where they received the shot, about 10 percent will have a low fever, and about 4 percent will have a mild rash. But there has never been a serious adverse reaction linked to this vaccine.
On the other hand, chicken pox is not always a mild illness. Of the 3 to 4 million U.S. children each year who come down with it, one in 1,000 will develop complications such as severe pneumonia or a brain infection called encephalitis, and about 50 will die. Children with chicken pox are also more susceptible to "flesh-eating" streptococcus infections, although those infections are quite rare.
This information came to you courtesy the babycenter!
As of now 2 brands of Chickenpox vaccines are available in India, Varilrix by GSK & Okavax by Aventis. The basic difference according to manufacturer’s literature is that while Varilrix requires 2 doses after 13 years age, Okavax can be given in a single dose for all ages.

So what is my Opinion regarding the vaccination?
Answer: If you can afford it, take it! Recent data suggests that Chicken Pox vaccine may be more effective if taken at 15-18 months rather than 1 year, so ask your pediatrician to give it at 15 months.   
More india specific vaccine information at Charak Clinics

Chicken Pox facts

So you wanted to know about chickenpox!
Here are a few facts on this common comunicable disease
• Chickenpox is caused by a virus called the varicella zoster virus.
• Chickenpox is usually mild but it may be severe in infants, adults and persons with an impaired immune system.
• Almost 100 children die every year in the US, whle more than 10,000 are hopsitalized due to severe chicken pox.
• Chickenpox is highly contagious, approximately 90% of persons in a household who have not had chickenpox will get it if exposed to an infected family member.
• The virus spread from person to person by direct contact, or through the air.
• Chickenpox develops within 10-¬21 days after contact with an infected person.
• Chickenpox has a characteristic itchy rash which forms blisters that dry and become scabs in 4¬5 days. An infected person may have anywhere from only a few lesions to more than 500 blisters on their body during an attack (average 200-400).
• Chickenpox is contagious 1¬2 days before the rash appears and until all blisters have formed scabs.
Effective medications (e.g., acyclovir) are now available to treat chickenpox in healthy and immunocompromised persons.
Facts on chicken pox courtesy CDC via medicinenet
Next time: chickenpox vaccine to be or not to be!

Fever is a friend for my baby: Fever facts & myths

What is fever?
Any temperature above the maximum normal value is called fever. The human body temperature varies from 98 to 99 F, average 98.6 F (37 C). Practically any temperature measured above 99 F may be considered to be fever.
How is fever measured?
Mercury thermometers are still one of the best ways to measure temperature. Not only are they inexpensive, but also reliable. Newer techniques include digital thermometers (good), ear thermometers (good, but need practice, also expensive) & skin thermometers (not recommended).
What are the areas used for placing the thermometer?
Armpits, groin in small babies, & below the tongue in older children (5-7 years onwards). Special rectal thermometers give the most accurate readings. You should inform the doctor as to the site from where you have checked the temperature. As a rule of thumb you may add 1 degree to the temperature measured at the armpits for detecting fever.
My child has fever. When do I need to show a doctor?
The smaller the baby, the more is the likelihood of serious problems. In any child below 3 months, definitely consult a doctor. In case the baby is unduly lethargic, refusing to feed, vomiting or has a high grade fever, any child of 1 to 2 year needs to be shown to a child specialist. In an older child or adult any fever lasting more than a week definitely merits a medical consultation.
What are the causes of fever?
It may be a common cold, or even cancer! This means that a lot of conditions including infections, inflammations (swellings) & other rare diseases like cancers etc. may cause fever. Only a detailed history, examination & relevant investigations if needed may point to the exact cause.
What are the investigations needed?
These will depend on the exact cause suspected. Remember in young children more tests may be needed because we need to rule out serious illnesses more aggressively. A general set of tests may include Blood counts (TLC, DLC), ESR, Widal (typhoid), Malarial parasite, urine routine & culture (especially in girls), and many others like chest x ray, abdominal USG, Blood culture, ECHO as per the history & examination findings.
What is the treatment?
Recent studies indicate that both Ibuprofen (Brufen, Ibugesic) & are equally safe & effective in treating high fever. Nimesulide is not recommended for children less than 1 year.
The safest & probably most effective treatment would be sponging with tepid water (not too hot & definitely not cold).
Fever Facts & Myths
All fever need treatment. FALSE
Most fever are viral in origin and will get better with time, do not use medicines to treat temperature if it is below 101 F (~ 38 C), especially if the child is active and playful.
Untreated fever will keep on getting higher. FALSE
In fever the body’s thermostat has changed & set to higher level. In a vast majority of cases the fever will settle at a slightly higher level even without treatment. The primary purpose of fever medicines is to make the child (& parent) more comfortable.
We should try to bring the temperature back to normal with treatment. FALSE
FEVER IS A FRIEND. There is no need to bring the temperature to normal as fever helps the body fight infections better. It helps in increasing the body’s defense mechanisms like hormones, infection controlling cells, enzymes, chemical reactions within the body to counter inflammation effectively.
Certainly no bodily harm is likely to come to a child by a fever of even 103-105 F!
High fever in children leads to seizures. PARTLY TRUE
Actually it is not the height of fever but the rapidity of fever rise that determines whether a child prone to febrile seizures will actually have a fit or not. In a child with definite febrile seizures nothing bad is likely to happen even if he has recurrent seizures, he will likely outgrow them by the time he is 5-6 years old.
For more information of febrile seizures click here

Monsoon Hungama: My child & the rain

Monsoon is the time of getting drenched in puddles & rivulets of water, tea , pakoras, and maybe a few holidays from school!
What fun, but it is also a time when a few common diseases strike children.
Dirty water can be a big risk for children, leading to diarrhoea, vomiting & dehydration. Treatment would involve adequate fluids like ORS, neembu paani, salty Lassi (Buttermilk), light juices, curd, bananas etc. Antibiotics should not be taken without a doctor's consent.
Poor quality of water can also lead to Typhoid & hepatitis A, prevention lies in using a filter or boiling the water. Please ensure that your child has taken vaccination for both these vaccine preventable diseases. Remember Typhoid vaccine is needed every 3 years. Hepatitis A vaccine is not the same as Hepatitis B vaccine and needs to be given separately. Avoid eating cut fruits, chaat or drinking juice from roadside vendors.
Foods To Eat: The monsoon brings with it the magnificence of mangoes, the aroma of roasted corn and the sweet tasting jamuns, enjoy them.
Small boils & pustules are very common in rainy seasons, prevent them by regular baths especially after playing in th rains. Treatment with antiseptic creams usually suffices, though a doctor's opinion should be taken in case of no improvement.
Malaria is another side-effect of the abundance of stagnant water during the monsoons. Avoid having stagnant water in your house. Empty the water coolers, the unused flower pots etc. Use a mosquito repellant & a Mosquito net if possible. Some of the other diseases you will prevent by these measures include brain fever (viral encepahlitis like JE), and Dengue fever.Any high grade fever should prompt a visit to your Pediatrician.
So enjoy this season with tea, bhuttas, hot snacks & by following some of these common precautions.

Cough Syrups: The PLACEBO effect

In case you are wondering about the title; a Placebo is a medicine that has no active ingredient, but is prescribed by doctors to encourage the patient's expectation to get well.
Also it also plays an important role in drug trials to find out if a particular medicine is more effective/ has more side-effects than if no medicine was given.
As pediatricians most of us are aware that the innumerable cough syrups available in the market are not very effective in reducing children's cough. In the July issue of 'Pediatrics' Medical Journal, an interesting study has shown that two of the most commonly used medicines in cough mixtures, namely dextromethorphan & diphenhydramine, are no better than sugar syrups (placebo, right!) in treating cough caused by common cold.
So what should a parent do?
Confirm with a child specialist that your child has an upper respiratory infection; try using home made "daadi maa ke nuskhe" (grandmother's recipes) like Ginger & honey (adrak, shahad) based concoctions, or try hareera (traditional cough mixture).
Common Cough tips:
Avoid ice, extremely cold drinks;
Try to rest the throat by not shouting;
Warm saline gargles if possible,
Saline nasal drops;
Plenty of fluids to maintain hydration
Humidification of air;
Avoid dust & smoke,
No antibiotics without the pediatricians consent, and try not to 'pressurize' him into writing an antibiotic prescription ! :-)
What is the best way to heal a cough?
Give it TIME to heal. In case it does not go within a week reconsult the doctor.