Can I take antibiotics while I am breastfeeding my baby?

Yes,

Most antibiotics are quite safe during breastfeeding, even though small amounts may be secreted in the Breast Milk.

The only potential side effect in infants whose mothers are breast-feeding and taking antibiotics such as penicillins, cephalosporins, macrolides, and aminoglycosides are changes in their intestinal flora (bacteria that are normally present in the intestines). This may lead to loose stool and diarrhea in the infant, but these side effects are temporary.

You have to be careful only for a couple of antibiotics (which your doctor is anyways unlikely to prescribe) during breastfeeding.

Flagyl / Metronidazole is excreted in large quantities in breast milk and may lead to loose stools/ fungal infection in infants and is hence better avoided, or the milk discarded for 24 hours after a course of this medicine.

Chloramphenicol is a rarely prescribed antibiotic that CANNOT be taken during breast feeding, since it can lead to bone marrow suppression & serious liver damage. The good news is that this antibiotic is in any case very rarely prescribed nowadays.

For more information about antibiotic and other medicine safety during breast feeding read here

1. http://today.msnbc.msn.com/id/21308045/ns/today-today_health/t/taking-antibiotics-safe-while-breast-feeding/

2. http://www.babycenter.com/0_drug-safety-during-breastfeeding_8790.bc

3. http://www.safefetus.com/

4. http://pediatrics.about.com/cs/breastfeeding/a/bfing_drugs_2.htm

When can I fly with my newborn baby ?

Ideally your healthy newborn should be around 2-3 months old before being exposed to the recycled air, germs and the large number of people on flight.

However for most healthy babies, 2-3 weeks is a reasonable time frame in case you cannot wait.

Get her examined by your pediatrician, including the ears, and carry medicines like Crocin (Acetaminophen) for any fever/ pain/ irritability, and you should be good to go !

Many parents worry that the changes in air pressure that happen when you fly can harm their baby's ears. It's true that "popping ears" during takeoff and landing can be a bit painful for some infants, but it won't cause any lasting damage. Your baby will feel more comfortable if he has something to suck on during takeoff and landing, so you may want to breastfeed or give him a bottle or pacifier. You can give him some infant pain reliever (such as acetaminophen) if his ears really seem to bother him.

Get more tips for traveling with babies here

1. http://www.babycenter.com/404_at-what-age-is-it-safe-for-my-baby-to-fly_7258.bc

2. http://pregnancy.about.com/od/newbornbabies/a/babyairplane.htm

3. http://www.ivillage.com/babies-it-safe-travel-plane-newborn/6-n-137695

My child is swimming - how do I prevent Swimmer's Ear?

It's summertime, and everyone seems to be hitting the pool.

While swimming is not as prevalent in India, as some of the western countries, it is fast catching up, with the mushrooming societies, wherein a swimming pool is a must. While swimming is a great low impact exercise, it can lead to a few minor medical problems.

Swimmer's ear (also known as otitis externa) is an infection of the outer ear canal that can cause pain and discomfort for swimmers of all ages, more so in children. Symptoms of swimmer’s ear usually appear within a few days of swimming and include Itchiness inside the ear, Redness and swelling of the ear, Pain when the infected ear is tugged or when pressure is placed on the ear, and in advanced cases pus draining from the infected ear. This is not the same thing as a middle ear infection (fluid in the ear).

If you can wiggle/ move the outer ear without pain or discomfort then your ear condition is probably not swimmer's ear.

Swimmer’s ear can occur when water stays in the ear canal for long periods of time, providing the perfect environment for germs to grow and infect the skin. Germs found in pools and at other recreational water venues are one of the most common causes of swimmer’s ear. Swimmer’s ear cannot be spread from one person to another. Swimmer's ear can often be treated with antibiotic ear drops, after consulting your doctor.
Now coming to its prevention,

DO keep your ears as dry as possible.

• Use a bathing cap, ear plugs, or custom-fitted swim molds when swimming to keep water out of your ears.

DO dry your ears thoroughly after swimming or showering.

• Use a towel to dry your ears well.
• Tilt your head to hold each ear facing down to allow water to escape the ear canal.
• Pull your earlobe in different directions while your ear is faced down to help water drain out.
• If you still have water in your ears, consider using a hair dryer to move air within the ear canal.
  • Be sure the hair dryer is on the lowest heat and speed/fan setting.
  • Hold the hair dryer several inches from your ear.

DON’T put objects in your ear canal (including cotton-tip swabs, pencils, paperclips, or fingers).

DON’T try to remove ear wax. Ear wax helps protect your ear canal from infection.

• If you think your ear canal is blocked by ear wax, consult your health care provider rather than trying to remove it yourself.

Source

Suggested reading - Tips for healthy swimming

So have a great time swimming, but follow the above tips for a safe summers!

Top 5 things NOT to do for a Pediatrician - to save money and health !

Research among pediatricians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Source

I believe that these are excellent tips.
All of us should follow these as far as possible, diligently and conscientiously, not only for a more scientific practice, but also as the Hippocratic Principle goes "First, do no harm".
Avoiding unnecessary CT scans would reduce the radiation exposure to the developing brain of the children, while avoiding antibiotics would reduce chances of side-effects, antibiotic resistance, and even possibly allergies and reduced immunity in children (studies have correlated multiple antibiotic use with increased risk of allergies, and increased risk of recurrent infections).
Finally, it is amazing to note the stigma attached to the diagnosis of asthma in our country. Not only are parents / pediatricians unaware of the diagnosis, convincing them regarding the use of inhalation therapy is a uphill task. Inhalation is the BEST treatment for asthma, as millions of children and hundreds of studies have clearly demonstrated. It is safe, effective and does not lead to significant side-effects. Its use MUST be encouraged amongst doctors and parents alike.

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

List of Top Pediatric Hospitals in the USA - 2011

Published below is a list of the top Pediatric hospitals in the USA published by US News & World report. All the hospitals were scored in 3 areas: reputation among pediatric specialists, clinical outcomes, and care-related indicators of quality such as nurse–patient ratios, surgical volume, and the availability of specialized programs. For this publication, US News & World Report solicited data from 177 hospitals and received responses from 100. The magazine also asked some 1500 pediatric specialists to name the 5 best hospitals where they would send children with serious or difficult problems without regard to cost or geography.

Here are the top 3 in each category:

Cancer

1. Children's Hospital Boston and Dana-Farber Cancer Institute
2. Children's Hospital of Philadelphia
3. St. Jude Children's Research Hospital, Memphis, Tennessee

Diabetes and Endocrinology

1. Children's Hospital of Philadelphia
2. Children's Hospital Boston
3. Children's Hospital of Pittsburgh of UPMC

Gastroenterology

1. Cincinnati Children's Hospital Medical Center
2. Children's Hospital Boston
3. Children's Hospital of Philadelphia

Heart and Heart Surgery

1. Children's Hospital Boston
2. Children's Hospital of Philadelphia
3. University of Michigan C.S. Mott Children's Hospital

Kidney

1. Children's Hospital Boston
2. Seattle Children's Hospital
3. Cincinnati Children's Hospital Medical Center

Neonatology

1. Children's Hospital of Philadelphia
2. Children's Hospital Boston
3. Cincinnati Children's Hospital Medical Center

Neurology and Neurosurgery

1. Children's Hospital Boston
2. Children's Hospital of Philadelphia
3. Johns Hopkins Children's Center, Baltimore

Orthopaedics

1. Children's Hospital Boston
2. Children's Hospital of Philadelphia
3. Children's Medical Center–Texas Scottish Rite Hospital for Children, Dallas

Pulmonology

1. Children's Hospital of Philadelphia
2. Cincinnati Children's Hospital Medical Center
3. Children's Hospital Boston

Urology

1. Children's Hospital Boston
2. Children's Hospital of Philadelphia
3. Riley Hospital for Children at Indiana University Health, Indianapolis

Hospitals appearing on the 2011 to 2012 honor roll are as follows (repeated numbers indicate a tie):

1. Children's Hospital Boston

1. Children's Hospital of Philadelphia

3. Cincinnati Children's Hospital Medical Center

4. Texas Children's Hospital, Houston

5. Children's Hospital Colorado, Denver

5. Johns Hopkins Children's Center, Baltimore

7. Seattle Children's Hospital

8. Children's Hospital Los Angeles

8. Children's Hospital of Pittsburgh of UPMC

8. New York–Presbyterian Morgan Stanley-Komansky Children's Hospital

8. St. Louis Children's Hospital–Washington University

Read more here

http://www.medscape.com/viewarticle/742874?src=mpnews&spon=9 (requires free registration)

While we do have list of medical colleges ranked (a bit arbitrarily in my opinion) that is published annually by an Indian Periodical India Today, a similar study in India would be very informative and illuminating.

What are some good Internet Resources for Information about Newer Vaccines?

I understand the need for getting the latest unbiased information about the newer vaccines, since many mass media (like newspapers, TV channels etc.) are filled with horror stories regarding drugs and vaccines. Most of these reports, at least in the Indian media, are sensationalized, over simplified and have inaccurate conclusions with the intention of boosting sales. These lead to avoidable panic, and sometimes serious delays in providing appropriate vaccinations to children.

However since the internet is a very democratic medium, and virtually anyone can (& does) provide their opinion online, it can be tough for a parent to search for accurate information online. Here are a few websites that provide excellent, well researched and peer -reviewed information (checked by experts) online.

1. Indian Academy of Pediatrics - Committee on Immunization - provides latest recommendations for vaccinating children in India.
2. WHO - Immunization - WHO Position papers on vaccines
3. CDC - Vaccination
4. Immunization Action Coalition - Educational material for parents
5. Children's Hospital of Philadelphia - Information for parents, especially regarding vaccine safety
6. PATH - Excellent updated information about vaccination from different resources
7. National Network for Immunization Information

Suggested Reading

IAP Guide book on Immunization 2011 (Page 161)

Latest Indian Academy of Pediatrics (IAP) recommendations 2011 for vaccinating children in India

Iap Guide Book on Immunization Iap Immunization Time Table 2011

Finally we have the latest guidelines from the Indian Academy of Pediatrics, the official & the largest body of Pediatricians in India.

Unfortunately, in India a lot of Pediatricians, especially from the smaller cities and towns seem to be following somewhat random schedules, that are not only outdated but may lead to decreased vaccine efficacy.

I would encourage parents to download this chart, and use this as a guide for getting their children vaccinated in India

The Internet Parent series - Help, is my baby having a seizure?

Here is the typical scene - you maybe feeding your infant and you suddenly notice that he has tremors in one leg. You have heard horror stories of infant seizures, and are hence obviously concerned. So is this really a seizure?

Seizures can be tough to diagnose in an infant. However here are some clues that would suggest if your child is having a seizure, or more likely a normal behaviour like tremulousness.

1. Can the movements be controlled by touching/ holding the arms /legs gently? If so, these are more likely to be normal tremors. Seizures cannot be reduced/ stopped this way.

2. Do these movements occur only at specific times, like changing diapers (or feeding as in this case)? This would be again more likely to a normal behaviour since seizures cannot be started this way).

3. Is the child developing normally? If your baby is otherwise behaving and developing normally even after repeated movements, this would make seizures less likely.

4. Are these episodes occurring both during sleep and while the infant is awake? If so this is more likely to be a seizure.

Finally, it is more likely that bilateral (both arms or leg together) movements that are symmetrical and persistent may be seizures.

While these are some useful pointers in trying to rule out seizures, given the fact that seizures can be very subtle in newborn and infants, anytime you have a doubt regarding an abnormal movement, it is a good idea to discuss this with your pediatrician.

It may be a good idea to videotape an abnormal episode (with your mobile/ camera) since this can provide invaluable information to your pediatrician too !

Suggested Reading:

1. http://pediatrics.about.com/od/weeklyquestion/a/04_baby_tremors.htm

2. http://www.epilepsy.com/info/family_parents_newborn

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 !

Latest American Academy of Pediatrics Recommendations (2011) for Limiting Sun Exposure in Children & its relevance to indian children

Specific recommendations for pediatricians for Limiting Sun Exposure in Children include the following:

• Health-supervision practices should include advice about UVR exposure, such as avoiding sunburn and suntan, wearing clothing and hats with brims, using sunglasses, and applying sunscreen. If possible, outdoor activities should be scheduled to limit exposure to peak-intensity midday sun (10 AM to 4 PM).
• When a child or adolescent might sunburn, he or she should use sunscreen to reduce the known risks for sun exposure and sunburn, including the increased risk for skin cancer. Sunscreen with a sun-protection factor (SPF) of at least 15 should be applied every 2 hours and after swimming, sweating, or drying off with a towel. People may prefer avoiding sunscreens containing oxybenzone, as these may have weak estrogenic effects when absorbed through the skin.
• Although all children need counseling about UVR exposure, this is particularly true for children at high risk for the development of skin cancer, including those with light skin, nevi, and/or freckling; and/or a family history of melanoma.
• Skin cancer prevention is a lifelong effort, and beginning in infancy, at least 1 health maintenance visit per year should include advice about UVR exposure. All children are at risk for adverse effects of UVR exposure on the eyes and immune system, although not all children sunburn. Especially appropriate times for counseling about UVR exposure include during the spring and summer in northern states, before anticipated sunny vacations, and during visits for sunburns.
• Because outdoor physical activity should be strongly encouraged, this should be promoted in a sun-safe manner.
• Sun-protection practices tend to wane in early childhood. Beginning at age 9 or 10 years, it may be helpful for pediatricians to discuss sun protection with children, together with parents, to encourage joint responsibility for the child's sun protection.
• Infants younger than 6 months should be kept out of direct sunlight and covered with protective clothing and hats. When sun avoidance is impossible, parents may apply sunscreen only on exposed areas. Absorption of sunscreen ingredients may be higher in preterm infants.
• Pediatricians should become familiar with chemical photosensitizing agents. People using these oral or topical agents should limit sun exposure and avoid all UVA from artificial sources. When sun exposure is inevitable, they should wear fully protective clothing and high SPF sunscreen that also blocks UVA wavelengths.
• Breast-fed and formula-fed infants and other children should receive vitamin D supplementation in accordance with guidelines, for a total intake of at least 400 IU of vitamin D daily. Children at risk for hypovitaminosis D may need laboratory testing of 25-hydroxyvitamin D concentration.
• Deliberate UVR exposure to artificial sources and overexposure to sun with the goal of increasing vitamin D concentrations or for other reasons should be avoided.
• Pediatricians should advocate for adoption of sun-protective policies (eg, shaded playgrounds, outdoor time before 10 AM, and allowing hats at schools and child care facilities).
• Pediatricians should support and advocate for legislation banning use of tanning parlors by children younger than 18 years.

Source (needs free registration)

Comments:

These are impressively detailed and well thought out recommendations. Being a tropical country we have a very high rate of UV exposure via sunlight in our children in India. The good news is that being dark-skinned we are naturally protected against high rates of skin cancer by the high melanin content in our skin. However there are a few important points regarding sunscreen usage that should be of interest to everyone.

Sunscreens of around SPF 15 are generally as effective as the higher SPF (& more expensive) ones. However liberal use 15-30 minutes before and repeated use after every 2 hours, swimming, bathing, toweling etc is important.

Avoid Sunscreens below 6 months if possible (though they can be used in sun exposed areas if needed), and avoiding Sunscreens with oxybenzone if possible. The US FDA approves Zinc Oxide and Titanium Dioxide for usage in Sunscreens.

For more information about sunscreens and children safety & UV radiation hazard read theAAP policy statement here

My Radio Talk on Big 92.7 FM

Just gave a talk on the common ear problems in children, including ear pain and infections and tips on ear cleaning, to the Chandigarh edition of BIG 92.7 FM.
Some photographs from the event, I enjoyed it.
I have been planning for an audioblog/ podcast, want to spread the word around - however unsure of the potential audience, and of course the time for the same ...
Any comments would be really appreciated