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