What's new in the latest 2011 Immunization Schedule for Indian Children by the Indian Academy of Pediatrics?

The Indian Academy of Pediatrics (IAP) is the parent body of more than 16,500 pediatricians (as of 2007) in India, and is responsible for establishing standardized guidelines for various childcare issues. The latest guide-lines provide some important changes that child specialists and parents need to be aware about, regarding vaccination of their children.

Here is a list of altered recommendations in the 2011 guidelines

1. Hepatitis A has been rightfully preponed to age 1 year (from 1.5 years previously) for the first dose. The second dose is 6 months after the first dose.
2. An additional dose of Chicken Pox vaccine (Booster) is recommended at 5 years age. This is probably as per the US guidelines, and due to the fact that lots of breakthrough cases were being witnessed after CP vaccination. For children who have not taken CP vaccination, two doses can be given at three months interval. Adults above the age of 13 years can take two doses at a month gap.
3. MMR booster is now clearly recommended at 5 years. While this is the same recommendation as before, the fact that soon a combination vaccination of CP & MMR is likely to be made available in India, would make this a more convenient option.
4. The confusing recommendation of some (newer, more expensive) vaccinations to be given after"one to one" discussion with parents has been removed. This makes it easier for pediatricians to recommend the vaccines, and the parents to decide as per their paying capacity (since we do not have Insurance cover for vaccines in India yet), about the decision to take the vaccine or not.

This appears to be a well thought out, comprehensive and scientific set of recommendations that have simplified the Immunization guidelines for Indian Children. Parents should take printouts of this guideline and encourage their pediatricians to follow the same, since vaccination schedules tend to vary across India.

The guidelines are not only less confusing, but also have moved towards International standards now, making it easier to vaccinate children in this era of global movement.

Suggested Reading

IAP 2011 Immunization Boooklet

TIPs - The most common question asked by parents to pediatrician? Diet in Diarrhea !

This is probably the commonest query any pediatrician gets asked in their practice.

Surprisingly the answer to this question is very variable even amongst the pediatricians.

Here is what the present scientific evidence suggests

1. Do not starve your child. While this may reduce the immediate loose stools, it will make them weaker and more prone to recurrent diarrhea.In fact, the American Academy of Pediatrics states that 'most children should continue to eat a normal diet including formula or milk while they have mild diarrhea.'

2. For mild diarrhea, avoid any significant changes in diet.

3. Dehydrated children require rehydration (replacement of lost fluid). After being rehydrated, many children will be able to resume a normal diet.

4. Most children with diarrhea tolerate full-strength cow's milk products. It is not necessary to dilute or avoid milk products (except in children with known allergies to cow's milk).

5. Recommended foods include a combination of complex carbohydrates (rice, wheat, potatoes, bread), lean meats, yogurt, fruits, and vegetables.

6. Foods to avoid include fatty foods, very sweet juices & carbonated (fizzy) drinks as these are more difficult to digest.Do not start any new foods (that the child has not taken previously) during a diarrhea episode. During vomiting, avoid the temptation to feed large quantities of food/ drink. Give small frequent clear fluids/ soups/ ORS every few minutes to avoid dehydration.

Here is what you need to do

For mild diarrhea in children below 6 months, continue breast feeding/ formula feeding.

For older children, increased intake of clear fluids like coconut water, ORS, and a normal diet would help. Many children develop mild and temporary lactose intolerance. Continuing dairy foods may make the diarrhea last longer, but it can also allow a faster return to a regular diet. Hence milk intake may be temporarily restricted if there are explosive stools, lots of redness around the anus, and excessive gas, stomach pain etc. It would be appropriate to let your pediatrician suggest this rather than doing this routinely each time a child has diarrhea. You may add easily digestible foods like banana, apples (not juice), rice, khichdi, daal (Pulses), yogurt/ curd, potato (not fried), and toast.

Finally, remember that a full appetite is often the last behavior to return after any illness. Children should be allowed to take their time returning to their normal eating habits. No specific diet is recommended for diarrhea, but children usually tolerate bland foods better.

TIP:

While lots of ready to drink ORS are available in the Western Countries (like Pedialyte), however the same is not easily available in India. Electral ready to drink ORS solution is now available in green apple and mango flavor at some of the larger cities.

Suggested reading

http://pediatrics.about.com/od/diarrhea/a/06_brat_diet.htm

http://www.uptodate.com/contents/patient-information-acute-diarrhea-in-children

http://www.nlm.nih.gov/medlineplus/ency/article/002466.htm

TIP - When should I start plain cow's milk for my baby?

The short answer - The American Academy of Pediatrics clearly recommends NOT using cow's milk till the child is at least 1 year old. We can switch over to cow's milk between 1-2 years age slowly in most children.

The slightly longer version - Cow's milk is for the calves! While this may sound simple enough it hides quite a few important facts that would help us make the choice between cow's milk and formula.

In India, there is often an obsession for starting "fresh cow's milk" as a healthy & superior alternative to formula milk. However it must be remembered that cow's milk was created by mother nature for the calves. Thus it has far higher content of protein (since calves grow much faster than a human baby), higher phosphorus and lower sugar (lactose) than human milk.

In fact the formula milk is man's way of artificially trying to replicate mother's milk from the cow's milk. Thus we reduce the things that are in excess in cow's milk, add the things that are deficient in cow's milk, and try to make this as close as physically possible to mother's milk.

While this formula milk is still inferior to mother's milk, it is generally speaking a far better choice than cow's milk.

Of course since this is an expensive option, full fat cow's milk (& NOT toned/ slim milk) may be a reasonable alternative for these babies, where affordability may be an issue.

TIP - How do I choose "Dr Right" pediatrician for my precious baby?

If you already have a baby, the choice may be obvious for you and quite simple.

However for the first time parents, or when moving to a new location, this may be a cause of significant anxiety.

Here are some tips to help you begin your search for the "right" Pediatrician.

1. Start searching for a pediatrician preferably a couple of months before the delivery. Some babies have no respect for the 'due date' and you do not want to be caught off guard in this situation. Talk to your friends, relatives, ob/gyn & your family doctor.

2. It is very important that your pediatrician should be located close to you, at an easily accessible location, since you are likely to visit him quite often (usually more often than you think!) especially for the first born. Remember that even in the best case scenario, you would have close to 10 visits in the first year itself, so having a convenient location would make your life easier :)

3. Have a face to face meeting with your pediatrician if possible. Many pediatricians may charge for this, so ask in advance. Your level of comfort is important since they are going to be handling your most precious possession ! Try to find out their attitude regarding vaccinations, breast feeding, antibiotic use etc. if possible. You should know the working hours, emergency contact location, and appointment schedules of the clinic, since these vary considerably in practice. Which hospital does your pediatrician admit children too? Do they attend to the emergencies themselves? Try finding about the experience and qualifications of the Pediatrician too, either by asking politely, or by looking around in the clinic. Finally since in India, almost all consultations are self-paid, you would want to be comfortable with consultation charges.

4. Even though the pediatrician is the most important person in making your decision, you would want to see if the reception staff is polite, helpful and if the waiting area is child-friendly.

Remember that choosing a pediatrician is possibly the start of a relationship that could last 18 years or more! Give yourself enough time and data to make an informed choice.

More reading here

1. http://www.babiestoday.com/articles/basic-care/picking-your-pediatrician-50/3/

2. http://pediatrics.about.com/od/choosingapediatrician/Choosing_a_Pediatrician.htm

3. http://www.parents.com/baby/care/pediatricians-medicine/checklist-choose-the-right-pediatrician/

4. http://kidshealth.org/parent/system/doctor/find_ped.html

The Internet Parent (TIP) - Guide to common childcare & parenting questions

Today I am starting a new project that should (hopefully) consist of the common questions that I am asked in my Pediatric Practice.

I will try to post a question every day, and would love to have feedback / queries from parents (& would be parents) too !

While many such resources are available online, only a few are from pediatricians, and almost none from an Indian Pediatrician.

I hope to fill this gap, and try to not only educate parents, but myself in the process, and have fun.
While I would like to provide standard advise as far as possible, we all know that no two children are alike, and no single formula (one size fits all approach) exists for parenting.

As a parent and as a pediatrician, my brief would be to provide accurate information, clear common myths, and where ever possible share my experience, so that we are able to bring up healthy and happy children.

Remember, health is not defined as just the absence of disease, but a state of complete social, mental and physical well -being (by WHO).

I would love to be a part of making your children healthy !