Dr. Naveen D. Kini

Childcare through childhood and beyond... 

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Nipah Virus infection

Posted by Naveen Kini on June 5, 2018 at 1:20 PM Comments comments (0)

Nipah virus infection is a new disease that is causing fear and panic in our country, and along with it has come the usual chain of misconceptions, and useless remedies. Here are the up-to-date facts about the disease, and the preventive measures that are recommended by the World Health Organisation (WHO)


Transmission


Nipah virus (NiV) is a zoonotic virus (it is transmitted from animals to humans) and can be transmitted through:

  • Contaminated food i.e. fruits or fruit products (such as raw date palm juice) contaminated with the urine or saliva from infected fruit bats
  • Directly between people (human to human transmission)
  • Transmission can occur via unprotected exposure to secretions or unprotected contact with the tissue of infected animals (such as pigs).

NiV was first identified during an outbreak that took place in Kampung Sungai Nipah, Malaysia in 1998 (and hence the name). The natural host of the virus are fruit bats of the Pteropodidae Family, Pteropus genus.


Signs and symptoms


Human infections range from infection with no symptoms, acute respiratory infection (mild or severe), to fatal encephalitis (inflammation of the brain).

  • The incubation period (interval from infection to the onset of symptoms) is believed to range from 4 to 14 days
  • Infected people initially develop influenza-like symptoms (fever, headaches, muscle pain, vomiting and sore throat)
  • This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis
  • Some people can also experience severe respiratory problems, including acute respiratory distress (breathing difficulty), suggestive of pneumonia
  • Disorientation and seizures (fits) occur in severe cases, progressing to coma within 24 to 48 hours of onset.


Diagnosis


Initial signs and symptoms of Nipah virus infection are nonspecific, and the diagnosis is often not suspected at the time of presentation. The main diagnostic tests used are:

  • Real time polymerase chain reaction (RT-PCR) from bodily fluids
  • Antibody detection via enzyme-linked immunosorbent assay (ELISA)


Treatment


There are currently no drugs or vaccines specific for Nipah virus infection. Intensive supportive (ICU) care is recommended to treat severe respiratory and neurologic complications.


Prevention


  • Keeping bats away from sap collection sites with protective coverings (such as bamboo sap skirts)
  • Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption (there is no need to stop consumption of all fruits!)
  • Fruits with sign of bat bites should be discarded
  • Close unprotected physical contact with Nipah virus-infected people should be avoided
  • Regular hand washing should be carried out after caring for or visiting infected people
  • Health-care workers should implement standard infection control precautions at all times, like wearing gloves, face masks and protective clothing.
  • Samples taken from people and animals with suspected Nipah virus infection should be handled by trained staff working in suitably equipped laboratories.


I would like to reiterate that none of the concoctions that you read about on social media will have any role in prevention of this illness. Till medications and vaccinations are available, resorting to the above measures, and not giving in to rumours and panic, will help us doctors and the government bring this disease under control.

Common summer ailments, and how to avoid them

Posted by Naveen Kini on April 20, 2018 at 9:55 AM Comments comments (0)

Summer is here, and the little ones are at home driving the exasperated parents up the wall, trying to keep them occupied. Movies, day trips, vacations, IPL matches and restaurant visits are all on the calendar, just to keep them out of mischief! As parents, the last thing you would want is an illness which keeps your dear one away from all the fun. Here is a list of common disorders of this season, and simple methods to avoid them.


Food poisoning and water borne illnesses are the easiest to contract in this season. Notable in this category are Acute Gastroenteritis (which causes vomiting and diarrhoea), Hepatitis A (which causes jaundice) and Typhoid fever. The single most effective preventive method is hand washing before each meal. Also, be choosy and careful about the stuff that you eat outside. Any dish that is cooked on high flame, and served immediately, is reasonably safe; whereas dishes which involves preparation with the hands (chaats), which contain unsterilized water (fruit juice) or those which have exposed to dust and flies (cut fruits like watermelon) are major contributors to the prevalence of these diseases.


Children playing outside in the blazing sun are prone to Dehydration, and sometimes even Heat Stroke. Other contributory factors include wearing many layers of dark clothing, and inadequate fluid intake and rest. Make sure that your young sportsman, and the even the younger runabouts, drink at least 8 to 10 glasses of water and electrolyte containing fluids (ORS and tender coconut water) when they are out in the sun. A sunscreen (SPF 30 or more) is a must in children of all ages to prevent Sunburn, another common affliction.


Conjunctivitis, or eye infection, is a common and irritating condition. It rapidly spreads in families and places where children tend to congregate (like summer camps). The spread can be minimised by strict washing of hands, and regular cleaning of the eye discharge with saline water. Antibiotics are usually not required, as most of the cases are caused by viruses.


Viral infections like Mumps, Chicken Pox and Influenza are prevalent in summer too, and prior vaccination can prevent them. The regular rains in Bengaluru are ensuring that the Dengue virus continues to be threat, and therefore anti-mosquito measures such as the nets and repellents should continue to be used.


Skin rashes caused by the heat (heat rash or miliaria) and sweat (fungal infections) can be recurrent problems in children in this season. Regular and thorough bathing, and wearing light and loose fitting clothing can avert them.


Swimming is a favorite summer activity, so make sure that you select the pool carefully. Many of the above illnesses can be acquired from a poorly maintained and contaminated pool!


Make sure that your children get adequate sleep (at least 9 to 10 hours}, drink plenty of liquids and eat nutritious food. Reduce electronic media exposure to 1 to 2 hours in a day. Make outings a family affair, so that the joyful memories of summer remain etched in your child’s mind forever!

Parenting style and child development

Posted by Naveen Kini on July 9, 2017 at 10:15 PM Comments comments (1)

Parents in India are at an undesirable crossroad these days. Many are torn between the orthodox approach to parenting that they have been subject to during their formative years (where togetherness, discipline, obedience and boundaries played an important part) and the demands of bringing up a child in this modernistic society (where the future seems to be getting increasingly competitive, nuclear, liberal and exploding with information).They are juggling multiple roles of being an employee, spouse, parent and sometimes, a caretaking son/daughter for their parents, without clear-cut guidance and informative literature to direct them. This often results in an unequal struggle between accepting modern viewpoints on education, entertainment and nutrition, and trying to retain the cultural and social flavor that India is proud of. Despite multiple constraints, most parents do an admirable balancing act, to ensure that their children learn to "get along without them", and face the new world as confident, balanced and empathetic individuals.


As W. E. B. Dubois said “children learn more from what you are, than what you teach". Most often, the style of parenting adopted by parents closely reflects their own childhood experiences, observations and perceived deficiencies. That said, there can be no rigid definitions of good and bad parenting, and most parents usually develop a successful blend that suits their distinctive home environment.


Developmental psychologists have researched how parents affect the development of their children, and have proposed that there are links between parenting styles and their effects on children, which in turn may decide eventual adult behaviour.


In the early 1960s, psychologist Diana Baumrind suggested that the majority of parents display one of three different parenting styles; Authoritarian, Authoritative and Permissive. Later, Maccoby and Martin also suggested adding a fourth, Uninvolved or Neglectful. Recent research has outlined another increasingly prevalent style, Helicopter parenting!


Let's take a closer look at each of these parenting styles and the impact they can have on a child's behavior.


Authoritarian Parenting


In this style of parenting, children are expected to follow the strict rules established by the parents, without being explained the reasoning behind these rules.

 

• Such parents are more inclined to tell, not ask, the child to perform a specific task.

• No 'ifs, ands or buts' are entertained, and resistance is met with certain punishment.

• The approach is strictly "Do as I say!" and is usually followed by the dreaded "or else" which invokes fear in the child.

• The children are given very few choices, and decisions about their life are wholly made by the parent.

• These parents usually are reserved by nature, and restrict the amount of warmth and nurturing they bestow on the child.




Children of authoritarian parents are prone to having


low self-esteem (feelings of being good for nothing)

• being fearful or shy (they seldom venture on stage, or speak out against injustice or bullying)

• associating obedience with love (giving in to unreasonable demands of others)

• having difficulty in social situations (poor interaction with relatives and peers)

• and possibly misbehaving when outside of parental care, say in a hostel..


Authoritative Parenting


A second major style identified by Baumrind was the authoritative style.


• Like authoritarian parents, these parents too establish rules and guidelines that their children are expected to follow, but are much more democratic in the enforcement of them.

• They are willing to listen to questions, and respond to them clearly and coherently.

• These parents expect a great deal of their children, but they provide warmth, feedback, and adequate support.



• They are assertive, but do not intrude in their child's routine affairs, or restrict their natural curiosity and playfulness.

• The disciplinary methods that they adopt are designed to support, rather than punish the child.

• They have the ability to listen and talk openly and directly with the child, without being judgemental or condescending, thus providing the child with a deeper understanding of the society and world around them.

• The child’s day is structured, with a planned bedtime and clearly understood household rules.


It is this combination of expectation and support that helps children of authoritative parents develop skills such as independence, self-control, and self-regulation. This type of parenting creates the healthiest environment for a growing child.


Permissive Parenting


Permissive parents, sometimes referred to as indulgent parents, have very few demands to make of their children. These parents are responsive but not demanding, tend to be lenient and try to avoid confrontation.


Typically, such permissive parents

• Do not have set limits or rules.

• Often compromise their rules to accommodate the child’s mood

• Display a willingness to be the child’s best friend, rather than the parent

• They often bribe the child with large rewards to perform essential tasks like homework, and sometimes complete the task for the child

• Dangerous acts like underage driving and alcohol consumption are often turned a blind eye to




Permissive parenting can have long-term damaging effects. In a study published in the Scientific Journal of Early Adolescence, it was found that teens with permissive parents are three times more likely to engage in heavy underage alcohol consumption.


Other damaging effects of permissive parenting include

insecurity in children because of a lack of set boundaries

poor social skills (such as sharing and empathy) resulting from the lack of discipline

self-centeredness

poor school performance as there is hardly any motivation to excel

• frequent clashes with authority when things don't go their way

obesity can be another unfortunate result of parental indulgence


Uninvolved (or Neglectful) Parenting


Psychologists Eleanor Maccoby and John Martin have proposed this fourth style characterized by few demands, low responsiveness, and very little communication. While these parents fulfil the child's basic needs, they are generally detached from their child's life.


Typically uninvolved parents

• might make sure that their kids are fed and have shelter, but offer little to nothing by way of guidance, structure, rules, or even support.

• spend long periods of time away from home leaving the child alone, often lying or making excuses for not being there.

• seldom display emotions, and lack warmth in their interactions with the child.

• have no idea who the child’s friends or teachers are, and are uninvolved in the child’s life outside the home.




Neglectful parenting is one of the most harmful styles of parenting, because the children have no foundation of trust with their parents. A small child uses a parent as an anchored secure base from where he/she ventures out to test the surroundings, only to return back shortly for reassurance or approval. When the child does not receive the attention or love that it anticipates, the confused child reacts by

• being clingy, showing anger or avoidance.

• These children will have a harder time forming relationships with other people, particularly children their age.

• They tend to lack self-control, have low self-esteem, and are less competent than their peers.


Examples of each of the four parenting styles


Let us consider the case of a 3 year old snatching a toy from a friend:


An authoritarian parent would demand that the child return the toy immediately!

An authoritative responds sensitively, but firmly saying, "I understand you would also like to play with this doll, but your friend is playing with the toy now. Perhaps in a few minutes, you can take a turns at playing with the toy, but for now, please give it back"

A permissive parent chooses not to intervene, and believes that the child should be able to express himself, and is probably thinking “It’s just a doll, anyway!”

The uninvolved parent makes no attempt to rationalize or justify the behaviour, nor does he/she intervene.


Or, when a 5-year-old requests an additional slice of pizza, after eating his share:


An authoritarian parent promptly refuses the request, because that violates the no-extra-helping rule.

The authoritative parent responds to his child's hunger but does not give in to the demand. This parent might say, "You have had enough of high calorie food for the day, but you may have an apple, or a chapathi with dal"

The permissive parent allows the child to eat many more slices of pizza, and anything and everything he/she wants, without any limits or restraints.

The uninvolved parent may not offer a response at all to the child's hunger, and will expect the child to fend for itself.


Helicopter parenting


The term "helicopter parent" was first used in Dr. Haim Ginott's 1969 book, Parents & Teenagers, by teens who said their parents would hover over them like a helicopter. The term soon became popular enough to become a dictionary entry in 2011! Also called "Overparenting", it means being involved in a child's life in a way that is overcontrolling, overprotecting, and overperfecting, and that is in excess of responsible parenting,"



• In toddlerhood, a helicopter parent might constantly follow the child, always playing with and directing his behavior, hardly allowing him time to be by himself.

As the child grows, such a parent may insist on ensuring that a child has a particular teacher or coach, selecting the child's friends and activities, or providing disproportionate assistance for homework and school projects.

• In high school or college, these parents interfere in tasks that the child is capable of sorting out on his own (for instance, calling a teacher about minor fights, insisting on dropping the child to school or managing exercise habits)


Helicopter parenting can develop from a fear of dire consequences (fear a low grade, fear of not making the team, or not getting a certain job), from feelings of anxiety, overcompensation (adults who felt unloved, neglected, or ignored as children can overcompensate with their own children) and peer pressure from other parents (when parents see other over-involved parents, it can trigger a similar response)


Engaged parenting has many benefits for a child, but when overdone, it can lead to

• decreased confidence and self-esteem (my parent doesn't trust me to do this on my own)

poor coping skills (will have difficulty in dealing with the stresses of life such as loss, disappointment, or failure)

• increased anxiety and depression


Limitations and Criticisms of Parenting Style Research


• Links between parenting styles and behavior are based on correlation, which cannot establish definitive cause-and-effect relationships.

• The child's behavior can impact parenting styles. Parents of difficult or aggressive children may simply give up on trying to control their kids.

• In many cases, the expected outcomes in the child's behaviour do not materialize; parents with authoritative styles will have children who are defiant or who engage in delinquent behavior, while parents with permissive styles will have children who are self-confident and academically successful

• Children raised in dramatically different environments can later grow up to have remarkably similar personalities. Conversely, siblings who share a home and are raised in the same environment can grow up to have very different personalities

Cultural factors also play an important role in parenting styles and child outcomes. Authoritative parenting, which is so consistently linked with positive outcomes in European and American families, has not been shown to be related to better school performance among African American or Asian youngsters.

• In the Indian scenario, joint families, and presence of grandparents, who provide emotional, moral and often financial support, significantly affect the outlook and behaviour of the child.


This write up aims to sensitise parents on the outcome that various approaches to parenting can have on the psychosocial development of their children. No single style will hold good for all situations, and therefore learning on the go is an essential part of parenting. The authoritative style of parenting is generally linked to positive outcomes such as strong self-esteem and competence. However, other important factors including culture, family structure and social influences also play an important role in moulding children's behavior.


As a parting shot, these few lines from Diane Loomans poem "If I Had My Child to Raise Over Again" never fail to ring a bell…


(I would) 'build self-esteem first, and the house later'

'do less correcting and more connecting'

'take eyes off the watch, and watch with the eyes'

'do more hugging and less tugging' and

'stop playing serious, and seriously play'

Healthy eating and your child

Posted by Naveen Kini on August 30, 2015 at 8:30 AM Comments comments (11)

Not a day passes in the clinic without a mother complaining "my child just doesn't eat, doc. Please do something!'', and the grandparents standing behind nodding sagely. In fact, feeding related queries are the commonest that I get, and the most difficult ones to answer satisfactorily. A young mother tends to get totally confused by conflicting advice from various sources including family members, friends, the internet, social media, peers etc., and is also influenced by deeply rooted traditional practices, myths and misconceptions about feeding. Spending more than an hour per meal trying to make a child eat seems to be the norm rather than the exception, and a cause of worry for many parents. This is my attempt to make life a little easier for them.


Healthy feeding practices should always be started in infancy, and the best way to begin is to exclusively breast feed the child till the completion of 6 months of age. Cow's milk is best left for the calf, and the feeding bottle on the departmental store shelf! Exclusive breast feeding provides the child nutrition tailor-made to his/her needs, enhancing brain development and improving immunity (and therefore lesser instances of ear and respiratory infections, and diarrhoea)





Weaning at 6 months provides a wonderful opportunity for parents to really get to know their child. Harness the natural curiosity and eagerness of the child to experience new tastes and textures in food, so that eating remains an activity that gives the child immense pleasure. Most feeding problems start at this stage, and if not approached rightly, making eating a stressful experience for the child. Preconceived notions, inaccurate advice and personal anxiety are some of the factors that have to be set aside, to enjoy this phase of your child's development.


These are some tips:


• Respect the child's wishes, and do not force something upon him/her that is not liked.




• Do not distract the child to make him/her eat. Feeding should always be at a designated place such as the 'high chair' or dining table, and not in front of the TV, or outside the house in the garden or on the road.




 

 

• Stop just before the child is full, and do not try and finish the whole bowl. 


• Don't feed the child the same meals over and over again. Even 8 month olds can get bored very soon. 


• Try different flavours and textures. A child can be fed most of the things that you regularly eat, by the age of 1 year. Common weaning food suitable for infants include mashed fruits and vegetables, ragi gruel, khitchdi, pongal, rice with dal, etc. and also the readily available commercial cereals, if unavoidable.



 

 


• Encourage the child to slowly eat with his own hands, either using his fingers or a spoon. Ensure that eating becomes a complete sensory feast for the child, in that the child can hear the sounds of the food being prepared, see the various colours, smell the flavours and feel the different textures before actually tasting the meal. Also, this acquired skill called 'hand-mouth co-ordination' is very important for developing hand dexterity, and future skilled work, especially hand-writing and drawing.

 

How many meals should my child have?

 

Having 3 or 4 small meals a day, particularly breakfast, lunch, evening snack and dinner, is always better than skipping a meal, and having one large meal a day. Breakfast is particularly important, as you are 'breaking' a long overnight 'fast'.  Having a small meal in the morning will go a long way in preventing binge eating later in the day. That said, it is a common fact that some children, especially the ones facing some stressful situations in school, do not tolerate breakfast well. They end up having stomach pain and even vomiting if forced to eat, and are best left alone till they get used to the school environment. Make sure you send a healthy snack, which the child can eat later if desired.

 

What should my child be eating?

 

Most parents ponder over this deeply, and this is a topic hotly discussed the world over. The recommendations of the USDA (United states Department of Agriculture) have been the most widely followed for many decades, and most of us are familiar with the 'Food Pyramid' concept published in the year 1992


 


This was basically a pyramid-shaped diagram representing the optimal number of servings to be eaten each day, from each of the basic food groups. 


The drawbacks of the pyramid were: 


• With an overstuffed breadbasket as its base, the Food Pyramid failed to show that whole wheat, brown rice, and other whole grains are healthier than refined grains.


• With fat relegated to the “use sparingly” tip, it ignored the health benefits of plant oils—and instead pointed to the type of low-fat diet that can worsen blood cholesterol profiles and make it harder to keep weight in check.


• It grouped healthy proteins (fish, poultry, beans, and nuts) into the same category as unhealthy proteins (red meat and processed meat)


• It overemphasized the importance of dairy products.

 

MyPlate is the current nutrition guide published by the USDA, a food circle (i.e. a pie chart) depicting a place setting with a plate and glass divided into five food groups. It replaced the USDA's MyPyramid guide in June 2011

 

MyPlate illustrates the five food groups that are the building blocks for a healthy diet using a familiar image -- a place setting for a meal, namely Fruits, Vegetables, Protein, Grains and Dairy products.

 

The basic messages that the MyPlate guide tries to convey are:

 

• Make half your plate fruits and vegetables.

 

• Make at least half your grains whole grains.

 

• Go lean with protein.

 

Reduce sodium (salt) in foods like soup, bread, and frozen meals.

 

• Switch to fat-free or low-fat (1%) milk.

 

• Drink water instead of sugary drinks.

 

• Find a balance between food and physical activity.

 

• Enjoy your food, but eat less. Avoid oversized portions


 

 


  

To put it more simply:

 

• See that at every meal that you child eats, half the plate should contain fruits of all colour, and a variety of vegetables. (Potatoes and French fries don't count!)



 


• See that grains (rice, chapathi, roti etc) fill only a quarter of your plate. Substitute polished grains with whole grains. For example, eat more of red rice than white rice. Use whole wheat atta for chapathis. Eat whole grain pasta, and wheat bread instead of the regular bread, which is made of maida. Popcorn, with very little butter and salt added, can be a healthy whole grain snack

 

 

 


• The other quarter should be a source of protein, such as dal, sambar, pulses, nuts, seeds, egg or meat. Choose lean meat like fish and poultry, over red meat and processed meat (salami and sausages).



 

 

 

• Get your daily dose of calcium from dairy products like milk, curds (yogurt), cheese, milk shakes, paneer etc. Not-so-lean children above the age of 2 years can be offered low fat or skimmed milk, and limit the quantity to 1 to 2 glasses a day. In children who cannot tolerate milk for whatever reason, use non dairy sources of calcium like tofu, fish (sardines,salmon), spinach, peas, okra, beans, sesame seeds, almonds, figs, oranges etc

 

• Keep fats and oil to a minimum. Use vegetable oils, which are rich in the healthy MUFA (Mono Unsaturated Fatty Acids) and PUFA (Poly Unsaturated Fatty Acids), like sunflower, olive or rice bran oil, for cooking. Avoid solid fats which like butter, ghee or animal fat, which contain unhealthy Saturated Fatty acids. Shallow fry instead of deep frying.

 

For more details on the entire ChooseMyPlate concept, log on to the ChooseMyPlate website

 

Children who are born small (particularly the ones who weighed less than 2 kgs), or born prematurely, are particularly vulnerable to faulty feeding practices, born out of the natural desire of the parents to see them tall and chubby. These are the babies that actually require careful follow up and growth monitoring, to ensure that their weight remains within the normal limits. More and more evidence is now available, showing that these babies are very prone to obesity, heart disease, diabetes, blood pressure and stroke (The Barker Hypothesis)


 

 


Healthy eating habits usually continue on to adulthood, and it is therefore very important to start young. Remember, as parents you are the role models for your child, and setting a good example with your diet is the best way to begin.

Motherhood: how you can get it right the first time

Posted by Naveen Kini on May 2, 2014 at 2:05 AM Comments comments (1)

Motherhood, the birthright of every woman, a condition that is cherished and anticipated like none other, can sometimes become a nightmarish, painful experience for some women. It can take the joy out of an event that has been eagerly anticipated by the whole family, which usually sets the benchmark for all the good times the future has in store. Take the case of this unfortunate lady.

 

Manjula (obviously not her actual name) slowly walks into the clinic with her first born baby, her mother and mother-in-law, with a duck-like waddling gait, and a face that looks ready to burst into tears any moment. She has been made to wear a sweater and a muffler (at the peak of summer!) and is obviously dehydrated, in severe pain from the stitches lower down and seriously sleep deprived. The mother-in-law, with her "I have delivered 5 children, and know what to do" attitude, has decided that Manjula is incapable of producing breast milk, and is insisting on bottle feeds. Sure enough, on questioning, Manjula breaks down and starts weeping, and says that she feels like a complete failure. Her baby bawls incessantly the whole day, her nipples are sore from the constant feeding for hours at a stretch, and she can't remember when she last had a good night's sleep. She is being bombarded by confusing and conflicting advice by well meaning relatives, making her feel inadequate and depressed. I try to cheer her up by saying that these are only starting problems, and it only gets better from now on. I tell her that she will not face the same difficulties in her next pregnancy, and her immediate and vehement response is "Oh no, never again. This will be my one and only child!"

 

What is it that drives young women to get fed up and disillusioned about something as natural and emotionally fulfilling as pregnancy? And can certain steps be taken before hand to ensure a comfortable and enjoyable experience throughout pregnancy and lactation? Here are my views:

 

Up-to-date knowledge, adequate preparation and corrective action against foreseen problems has been the success formula of most good managers, and the same can be applied to pregnancy, childbirth and breast feeding. Most young women have very little knowledge of what motherhood actually involves, and are mostly depending on the experiences of close relatives and friends for information. Many a times the suggestions given may not be appropriate for her, and so when unanticipated problems occur, the woman is at a complete loss, and panic begins to set in. It is therefore very important to plan each pregnancy thoroughly, arm yourself with the latest knowledge about the complete birthing process and have regular periodic checkups to ensure everything is going smoothly. And there is no other person better suited to guide you throughout this period than your doctor!

 

The first and most important decision a young couple have to make is when to start a family. This decision should be taken only after considering the physical, emotional and financial readiness of both partners, and not because of pressure from anyone else, as is often the case. Unplanned or unwanted pregnancies will surely put a strain on the relationship, with undesirable consequences.

 

During pregnancy, the most important initial requirement is a visit to the gynaecologist, to make sure that all is well. Repeated ultrasound scans, blood and urine tests and blood pressure measurement will be required to ensure the well being of both mother and child. Do not hesitate to ask questions to your doctor, as he/she is the person best qualified to answer them.

 

I would like to specially mention about care of the nipples. Many women have retracted or even inverted nipples, which can hinder breast feeding. It is important that this fairly common condition is looked for and treated before delivery, so that breast feeding is easily established soon after birth. Syringe extraction of the nipple will help most women; severely inverted nipples may require to be set right by a small surgery.

 

Watch what you eat! The temptation to let go and binge on high calorie food is great, and usually encouraged by relatives. But it is easy to get carried away, and before you know it you will have put on a huge amount of weight. Being overweight can not only cause problems during birth, but also after delivery, this can lead to feelings of unattractiveness and guilt, and sometimes depression. A healthy diet with plenty of fruits and vegetables, and adequate amount of sleep and daily exercise is a good way to start off a pregnancy.

 

Chalk out the hospital you are going to deliver at before hand, and plan how you are going to get there in an emergency situation. Keep a trusted friend or relative informed. Visit the hospital and familiarize yourself with the place, procedures and staff, including the pediatrician who will be taking care of your baby. It is always more comforting to deliver in a known and trusted environment.

 

Breast feeding should be started soon after delivery, and unless indicated otherwise, the child should be fed on demand. Most babies will soon settle down into a pattern of feeding and sleeping, which is easily recognizable, and should be respected. Take care to see that the breast is not offered as a pacifier the moment the baby starts crying, because constant and prolonged suckling can cause chapped and sore nipples. 15 to 20 mins per breast per feed is a good thumb rule for comfortable breast feeding. Do not forget to burp the baby properly after each feed. Continue exclusive breast feeding till the baby completes 6 months of age, as it is very important for the all round development of the child.

 

Not all babies are made the same way, and some may be cranky, irritable, voracious feeders, poor feeders and occasionally, the real "cry baby" who can drive a first time mother up the wall! Night after night of sleeplessness, combined with the pain, the anxiety, the expectations and sometimes caustic remarks of so called well-wishers, can make even the strongest of girls break down and cry. When all the usual measures fail, I advise, once in a while, a practice that is quite the rule in the west, but not acceptable to most Indians, that of 'letting the child cry itself to sleep'. Young first-time mothers too are entitled to some 'me time', and so periodic indulgences like a pizza or ice cream, a visit to the parlour or movie, or anything else that can help the mother relax, should not be frowned upon. On the other hand, practices like restriction of fluids, wearing warm clothing when not climatically warranted, bland and insipid food etc. are unnecessary, and can be potentially detrimental to breast feeding. Fathers can do their bit by helping in the routine care, and supporting and shielding the mother from unwanted interference.

 

Sometimes, despite the best efforts of both family members and doctors, some women feel that their world is falling apart, and feelings of hopelessness and detachment can set in. These symptoms can be signs of 'post partum depression', a well known condition that can occur in the first 6 months after delivery. This condition should be diagnosed and treated aggressively, to ensure the well being of both mother and child. The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire that helps to identify women who have this condition.

 

Childbirth and motherhood are completely natural and usually uncomplicated phenomena. Minor hiccups should not deter women from enjoying both thoroughly, and they should take the help of both doctors and technology to make the experience as smooth as possible. For the few who have a difficult time in the first few months, just take heart in the fact that your little bundle of joy will soon compensate you with hours of pure and unconditional love, which will make all those sleepless nights worth it!

 

Hazards of technology use in young children

Posted by Naveen Kini on March 14, 2014 at 3:25 PM Comments comments (4)

The American Academy of Pediatrics and the Canadian Society of Pediatrics state infants aged 0-2 years should not have any exposure to technology, 3-5 years be restricted to one hour per day, and 6-18 years restricted to 2 hours per day here. Children and youth use 4-5 times the recommended amount of technology, with serious and often life threatening consequences (Kaiser Foundation 2010, Active Healthy Kids Canada 2012). Handheld devices (cell phones, tablets, electronic games) have dramatically increased the accessibility and usage of technology, especially by very young children (Common Sense Media, 2013).


In fact, some researchers are asking for a ban on the use of all handheld devices for children under the age of 12 years. Following are 10 research-based reasons for this ban.


1. Rapid brain growth

Between 0 and 2 years, infant's brains triple in size, and continue in a state of rapid development to 21 years of age (Christakis 2011). Early brain development is determined by environmental stimuli, or lack thereof. Stimulation to a developing brain caused by overexposure to technologies (cell phones, internet, iPads, TV), has been shown to be associated with attention deficit, cognitive delays, impaired learning, increased impulsivity and decreased ability to self-regulate, e.g. tantrums (Small 2008, Pagini 2010).


2. Delayed Development

Technology use restricts movement, which can result in delayed development. One in three children now enter school developmentally delayed, negatively impacting literacy and academic achievement (HELP EDI Maps 2013). Movement enhances attention and learning ability (Ratey 2001. Use of technology under the age of 12 years is detrimental to child development and learning (Rowan 2010).


3. Epidemic Obesity

TV and video game use correlates with increased obesity (Tremblay 2005). Children who are allowed a device in their bedrooms have 30% increased incidence of obesity (Feng 2011). One in four Canadian, and one in three U.S. children are obese (Tremblay 2011). 30% of children with obesity will develop diabetes, and obese individuals are at higher risk for early stroke and heart attack, gravely shortening life expectancy (Center for Disease Control and Prevention 2010). Largely due to obesity, 21st century children may be the first generation many of whom will not outlive their parents (Professor Andrew Prentice, BBC News 2002).


4. Sleep deprivation

60% of parents do not supervise their child's technology usage, and 75% of children are allowed technology in their bedrooms (Kaiser Foundation 2010). 75% of children aged 9 and 10 years are sleep deprived to the extent that their grades are detrimentally impacted (Boston College 2012).


5. Mental illness

Technology overuse is implicated as a causal factor in rising rates of child depression, anxiety, attachment disorder, attention deficit, autism, bipolar disorder, psychosis and problematic child behavior (Bristol University 2010, Mentzoni 2011, Shin 2011, Liberatore 2011, Robinson 2008. One in six Canadian children have a diagnosed mental illness, many of whom are on dangerous psychotropic medication (Waddell 2007).


6. Aggression

Violent media content can cause child aggression (Anderson, 2007). Young children are increasingly exposed to rising incidence of physical and sexual violence in today's media. "Grand Theft Auto V" portrays explicit sex, murder, rape, torture and mutilation, as do many movies and TV shows. The U.S. has categorized media violence as a Public Health Risk due to causal impact on child aggression (Huesmann 2007). Media reports increased use of restraints and seclusion rooms with children who exhibit uncontrolled aggression.


7. Digital dementia

High speed media content can contribute to attention deficit, as well as decreased concentration and memory, due to the brain pruning neuronal tracks to the frontal cortex (Christakis 2004, Small 2008. Children who can't pay attention can't learn.


8. Addictions

As parents attach more and more to technology, they are detaching from their children. In the absence of parental attachment, detached children can attach to devices, which can result in addiction (Rowan 2010). One in 11 children aged 8-18 years are addicted to technology (Gentile 2009).


9. Radiation emission

In May of 2011, the World Health Organization classified cell phones (and other wireless devices) as a category 2B risk (possible carcinogen) due to radiation emission (WHO 2011). James McNamee with Health Canada in October of 2011 issued a cautionary warning stating "Children are more sensitive to a variety of agents than adults as their brains and immune systems are still developing, so you can't say the risk would be equal for a small adult as for a child." (Globe and Mail 2011). In December, 2013 Dr. Anthony Miller from the University of Toronto's School of Public Health recommend that based on new research, radio frequency exposure should be reclassified as a 2A (probable carcinogen), not a 2B (possible carcinogen). American Academy of Pediatrics requested review of EMF radiation emissions from technology devices, citing three reasons regarding impact on children (AAP 2013).


10. Unsustainable

The ways in which children are raised and educated with technology are no longer sustainable (Rowan 2010). Children are our future, but there is no future for children who overuse technology. A team-based approach is necessary and urgent in order to reduce the use of technology by children.


All of us would do very well to review the way our children use technology. Supervise and advise them about the perils of overusage, and keep a watchful eye on misuse.

 

Parenting lessons that children have taught me!

Posted by Naveen Kini on March 28, 2013 at 11:05 PM Comments comments (9)

2013 marks the completion of 20 years in practice as a paediatrician for me, and along the sometimes stressful, but mostly fun filled journey, there have been a few lessons I have learnt. Many of these were not taught during my training to become a paediatrician, though I frequently wish they were. A few tips are from friends and books, but most of them have been picked up on the job from the children I have seen, interacted and treated, and from my own two children. I’m sure these points will help parents in deciding what is good and what is not for their children, and help them become more ‘child friendly’ and less 'stressed out’

 

The important lessons that I have learnt, and those that each parent should know are:

• Firstly, and most importantly, acknowledge and respect your child as an individual in his/her own right, and recognize, nurture and develop any unique talent and ability from early childhood. It is unfair to compare the child with any other, especially siblings and relatives, and even more so, to do it in public. Accept whatever shortcomings the child has, and encourage the strong points.

 

• Do not burden the child with expectations. It is incorrect to expect a child to be a genius at maths just because the father and grandfather are mathematicians. Children who are not strong in logical (mathematical) intelligence may be rich in other forms like musical, visual, verbal, interpersonal and kinaesthetic intelligence; identify and support it early, and gently guide them in the field they want to pursue. Deciding for them beforehand may condemn the child to a lifetime of boredom and dissatisfaction in the wrong career.

 

• Complaints like ‘stomach pain', ‘headache’, ‘lack of appetite’ are very often stress-induced, related to the anxiety that the child feels in situations where he/she finds it difficult to cope. Always keep a lookout for such symptoms, and immediately take steps to help the child de-stress and relax. See that a minimum amount of time is allotted for play and physical activity, even while preparing for examinations, as this gives the child much needed mental relaxation and enjoyment.

 

• Accept and respect the feelings of a child. It is OK for a child to have feelings like jealousy, dislike, anger, sorrow etc. Instead of saying “you should not feel that way” or “don’t get angry” or " why are you scared of such a silly thing" etc, find out why the child feels so, and give the child an opportunity to explain his/her emotions before passing hasty judgement. Respect the child’s feelings, and the respect you will get back will be tenfold! Similarly, never ridicule a child's opinion, however silly it may seem. Your opinion matters immensely to the child, and a harsh negative comment can trigger insecurity and resentment.

 

• Many parents get stressed out on complaints like “my child does not eat” (the commonest), “my relatives are scolding me because my child is thin”, “my child is not yet speaking, while my neighbour's child of the same age is” etc. This can be avoided by getting rid of certain stereotypes and beliefs about child rearing that are fixed in your mind. Remember that all advice and suggestions given by well meaning relatives and friends, sometimes followed for generations, need not necessarily be correct. Advice such as ‘bottle feeding a child is a must’, ‘a child who does not want to eat should be force-fed’, ‘skinny children are unhealthy’ etc. are incorrect and should not be believed. Do not hesitate to ask ‘why?’ and ‘why not?’ before you actually follow someone’s advice.

 

• How many parents actually talk to their children, and try to get to know them better? Most of us are so busy with our work and personal interests that we have hardly any time to spend with our children. Remember the many instances when your child has pestered you to play with him/her, wanted to show you something or wanted you to read a book? The stock answer probably was “not now, I’m busy” or “ask mummy/daddy to do it”. This is just an attempt by the child to communicate with you, to tell you his/her feelings and to feel wanted. Do not push them away, or postpone the act for later, for these are not moments that you will get back! Talking, or more importantly, listening to the child (communicating) reassures the child that the parent cares, and as the child grows he/she will feel free to ask questions about sensitive topics like puberty and sexual behaviour, and also bring to your attention instances of bullying, abuse etc. if the need arises.

 

• “My child does not listen to me, doctor, it’s like talking to the wall!” is a common complaint. Children may appear to not be listening to what you say, but they do observe you keenly. Parents are the role models for kids, and everything the parents say or do is believed by the child to be true or correct. Set good examples for your children, be it in behaviour, personal hygiene, habits or attitude towards servants and subordinates. The child will always ‘do as you do’ and not ‘do as you say’

 

• Temper tantrums are common especially in infants and toddlers, and many parents usually give in to them to avoid embarrassment or sometimes believing that the child will soon outgrow the behavior. What you need to do is to stress on basic discipline from a very young age. Make a few rules and then stick by the rules consistently, and see that the rules are followed by all members of the family so that the child gets the right message. Learn to say "NO", and stick to it. Do not give in to emotional blackmail, especially while dealing with a child with a weight problem, or overuse of electronic media. At the same time, give clear reasons for any refusal, and not “because I say so”.

 

• “Doc, my child is impossible to manage, and I end up whacking him many a time!” is another common concern. Rest assured that it is OK to punish a child when the situation demands. Only make sure that the child understands that you are only punishing the act, and not the child, and that you will continue to love the child in spite of the act. Unconditional love is the best gift that parents can give a child, and does wonders for the child’s confidence and self esteem. Never say things like “I will not love you” or “I will send you away if you don’t behave” even casually or jokingly; the damage done on the child’s psyche will be very difficult to undo.

 

• “Doctor, I’m scared to allow my children to go outside and play, or (in the case of older children) to go out with friends. I’m scared that they may get hurt, or get into bad company.” Over-protectiveness is one trait that parents should control and suppress. Let the child make some mistakes, and learn from them. Give children some ‘space’, and refrain from doing all their chores, constantly checking on them, and hovering over them when they are with their friends (helicopter parenting). Tell the child that you trust him/her completely, and the child will work hard to maintain that trust. Interfere with the child’s activities only if you must, and be more of a ‘friend’ than a parent to the child.

 

• Care less for what others will say about your child, and more about how your child will feel about what you say, and how you say it.

 

• Lastly, stop comparing your childhood with that of your child. The children just ‘switch off’ when they hear the words “When I was your age…..” or “You should be thankful for………” Accept that the world has changed rapidly and that the things that were considered ‘luxuries’ during our childhood are ‘necessities’ now. Do not stop your child from using social media, mobile phones etc. but rather explain to your child the need to be careful and discrete when using these mediums of communication.

 

Move with the times, adapt and be a parent your child will be proud of! And remember, it is never too late, and you are never too old to change.

 

 


Dengue, a malady of our own making!

Posted by Naveen Kini on October 13, 2012 at 9:15 AM Comments comments (10)

Year after year, we read in the papers about the deadly Dengue virus causing death and despair in our city. Every year we go through the same cycle of panic – fear - knee jerk blood tests - admission to hospital and medication - public hue and cry and very soon back to our usual indifference and complacence. Very few of us bother to find out details about the cause, and more importantly, the prevention of this disease. So here I am trying to explain this disease in as simple terms as possible.

 

The Cause

 

Dengue is caused by a Flavivirus, and has at least 4 types. The virus is transmitted by the bite of mosquitoes, mainly the species Aedes aegypti. This mosquito breeds in fresh water, and bites during the day.

 

The Disease

 

Contrary to popular knowledge, primary Dengue Fever is a relatively harmless disease, caused due to the child being infected by the virus for the 1st time. The child may have any, or a combination, of symptoms like high fever for 3 to 5 days, severe headache, eye pain, back pain, muscle pain, vomiting and rashes.

 

The immune system of the child reacts to this infection by producing antibodies. Most children produce neutralising antibodies, which help the child to limit the severity of the disease, and also help to fight it if the virus attacks again.

 

A few children react to the initial infection by producing antibodies of a different kind, which have disease enhancing effects instead of protective effects. If this child is again infected with the Dengue virus, these antibodies help the virus to multiply faster, which can result in Dengue Hemorrhagic Fever (DHF), wherein the child develops bleeding, low platelets and breathing difficulty and if it progresses, Dengue Shock Syndrome (DSS), a potentially fatal condition if not treated early and aggressively.

 

Treatment

 

Dengue fever is usually a self limiting disease, and treatment is directed towards reducing fever, relieving pain and ensuring that the child takes adequate fluids. Please note that antibiotics play no role in the treatment of this disease.

 

Early recognition and prompt treatment of bleeding and low blood pressure remains the mainstay of treatment of Dengue Hemorrhagic Fever, and Dengue Shock Syndrome, and with aggressive treatment most children recover from these two deadly conditions.

 

A few pointers for parents:

 

• The commonest fever that children get at this time of the year is still nonspecific Viral Fever, and there is no need to panic the moment the child develops fever.

 

• See that your child takes frequent small sips of liquids during fever, to ensure adequate hydration (the child should be passing urine at least 4 to 5 times in 24 hrs).

 

• Watch out for danger signs like breathing difficulty, bleeding, poor feeding, reduced urination, continuous vomiting, drowsiness etc. If you see any of these symptoms, rush the child to the nearest major hospital Pediatric ICU. You can contact your paediatrician on the way, or later, and not waste precious time if he is unavailable or busy.

 

• However, don't rush your child for admission to hospital at the first sign of fever, as you may end up occupying a hospital bed that may be required for another child whose need is more urgent.

 

Prevention

 

This is where I come to the heading of my article. Dengue fever is flourishing in India because of the apathy of our people, and the indifference of our authorities. Why is it that we treat this beautiful city of ours and in fact this whole country, with such callous disregard? We do not hesitate to throw garbage into our drains and gutters, giving no thought to the consequences. Each one of us bothers only about our house and our front and backyards, and are oblivious to the fact that keeping the neighbourhood and city clean is our responsibility too. Why is it that it takes a major catastrophe (like the plague in Surat) before citizens start becoming aware of the importance of preventive measures, and that we need a reason, like a monetary fine, to start obeying rules which are there for our own benefit! We all seem to suffer from this 'hurry epidemic' and take unnecessary shortcuts to achieve meaningless goals, and in the process, compromise on our own safety and that of our children. Spare a moment to think about why the same virus has been unable to make inroads into countries like Singapore, Japan etc. which share more or less the same type of tropical climate as ours. It finally boils down to us, the people! We needed to change our attitude, our sensitivity and our response to situations at times of need, to ensure that we do not go through the same torture year after year.

 

Here are a few things that each one if us can do to control this deadly disease:

 

• Look around your house and immediate neighbourhood for potential breeding places for mosquitoes. Aedes mosquitoes breed in clear stagnant water, so look for discarded tyres, coconut shells, discarded buckets, storage bins etc. and see that they are promptly emptied.

 

• Educate your friends, family and employees about anti mosquito measures. Dress the child up with thick clothing, shoes and mittens while going to areas where the child is likely to be bitten by mosquitoes. Apply mosquito repellent creams to the exposed parts not covered by clothing. At home, use mosquito repellents, nets, window meshes etc.

 

• Aedes mosquitoes bite mainly during the day, so see that you take adequate anti mosquito measures during the daytime too.

 

• If you have to inevitably store water in containers, add a few drops of any vegetable oil to the water, so that it forms a thin film on top of the water.

 

• Form local associations to collectively encourage, direct and assist the civil authorities, instead if condemning them and demotivating them further.

 

• Assist the authorities in proper disposal of waste. Resist the temptation to discard garbage into drains, which causes stagnation of water, thus inviting mosquitoes to breed and multiply.

 

• Make a resolution to educate at least one person in your circle about the importance of preventive health care like proper disposal and segregation of garbage, proper purification and storage of water, personal hygiene, care of toilets etc.

 

• Teach your child by setting an example, not by preaching! Your child will then spread the message to his peers.

 

• Deal with someone who does not follow the rules with patience and repeated insistence. Old habits die hard, but they too can be made to come around with your perseverance.

 

We citizens owe this much to our city and country. Let us not just sit back and curse the various authorities, while this deadly virus is happily breeding in our own backyard. So wake up, shake away the cobwebs from your mind, and do something about the problem. We may not be able to get instant results, but each small effort put in by individuals can make a BIG difference to society. The lives of our little ones are at stake here!

 

This article is dedicated to the memory of Master Manjunath, a child who has been under my care for the last 10 years, who succumbed to DSS and internal bleeding last week, despite all our efforts.

Care and First Aid of infants and toddlers - certain things you must know!

Posted by Naveen Kini on April 5, 2012 at 12:45 PM Comments comments (5)

This blog entry is prompted by a tragic incident that occurred the other day. A 7 month old child was brought into the outpatient clinic by the frantic grandfather, saying that he found the child unconscious in the house. The child had been crawling around the house just a little while back, and had been fed about an hour ago. Immediate CPR (Cardio-Pulmonary Resuscitation) was started, and the child was shifted to the PICU, where the heart beat was revived and child was put on a ventilator. An X-Ray showed a small part of a toy stuck in the throat and larynx of the child, which was the reason for the breathing difficulty and collapse. Unfortunately too long a period had elapsed between collapse and revival, as a result of which the child had suffered irreparable brain damage.

 

Such tragic events bring to the forefront the utmost importance of awareness about preventive measures, and the knowledge of what needs to be done in an emergency situation. I would like to highlight a few of the measures that all parents and caregivers should know and practice.

 

1. An infant habitually mouths whatever object it gets hold of. It is the child's way of getting to know the look and feel of the new exciting world around it. Therefore the first and most important precaution is that any object within reach of the child should be bigger than the diameter of the child's mouth.

 

2. No object with sharp and irregular edges should be available to the infant.

 

3. The same applies to breakable items, or toys with small, detachable parts.

 

4. Only items which can be easily and thoroughly cleaned can be given to the infant. As a corollary, the most easily cleanable, soft, non-detachable harmless item that the child can mouth is its own finger!

 

5. A steady and sturdy crib, with barriers of at least 1.5 to 2 feet on all sides, is the only safe place where you can leave an infant who is turning over and trying to stand. The next best place is the floor.

 

6. Make sure you put away the medicine bottles, measuring cups etc. after administering the daily medicines.

 

7. The practice of giving the car key, the pen from your pocket, your necklace, a chocolate etc. to a crying child should be strongly discouraged, as they are all potential choking hazards, and sources of contamination and food poisoning.

 

8. Force-feeding an un-interested child to complete the bowl of cereal that you have prepared, is a potential risk for vomiting and aspiration of the feed into the lungs.

 

9. Keep hot milk or water in spill-proof flasks, and not in open containers that can be toppled by the infant. The practice of keeping the infant on your lap while drinking coffee and other hot beverages is to be strictly avoided.

 

In the unfortunate occurrence of a mishap or accident, the immediate first-aid measures provided to the child will go a long way in ensuring a favourable outcome, and preventing any permanent damage. In most countries, the presence of trained paramedical personnel, and efficient emergency services, take some burden off the parent's shoulders. In India, it is prudent to be forewarned and forearmed. Some of the measures are highlighted below.

 

A. All parents, grandparents and caregivers should be familiar with the basics of CPR (Cardio-Pulmonary Resuscitation), and resuscitation of a choking infant and child. Brief videos for each of the above are available on my Facebook page

 

www.facebook.com/drnaveenkini

 

The same videos are also available as a downloadable application for Apple (iPhone) and Android phones under the name CPR.Choking

If possible, attend basic life support classes, which are conducted from time to time in the major hospitals, where you can practice the manoeuvres on mannequins, or plastic dummies. In fact, if a sufficient number of people are interested, a class can be arranged in the clinic itself.

 

B. Mark out the location of the nearest hospital having a Pediatric Intensive Care Unit (PICU), and memorise the nearest route to the same.

 

C. Visit the hospital before hand, and find out the exact location of the PICU, or in some hospitals Emergency or Casualty departments, so that when needed, vital time is not wasted searching for the same.

D. In the event of an emergency, take the child straight to the PICU, and not to any nearby hospital or clinic. It is the best equipped place to handle any emergency, and the only place where trained staff and doctors are available round the clock.

 

E. In a child with a pre-existing medical problem, keep all records handy in a place where you can easily find them. Keep a detailed list of all the medications the child is currently on, and of drug allergies, if any.

 

F. Enrol the support of a neighbour, friend or relative who is available nearby most of the time, especially in the case of parents whose places of work are far away from home.

 

G. Inform the school authorities too of any medical conditions in the child, and give them the address and contact numbers of the hospital you would like them to take the child to, in the case of any emergency.

 

H. Lastly, and most importantly, do not panic. Vital time is lost, and more harm than good comes out of tackling situations in a haphazard, illogical way.

 

This article is dedicated to the memory of Ankur, and also to his parents, who even when struggling to deal with such a grave personal tragedy, insisted that I write about the same in my blog, so that other parents may never have to face what they have faced.

10 questions that most parents are seeking answers for

Posted by Naveen Kini on February 10, 2012 at 3:20 AM Comments comments (1)

1. My child is 2 years old, and he does not speak anything. Do I need to worry?

While most children generally have a vocabulary of more than 20 words, and are able to join and make sentences of two or three words by the age of two, speech can be delayed in some normal children, especially if there is a family history of delayed speech. If you can observe that the child's hearing is normal, and that the child can understand and obey simple commands; and if the child can make you understand it's needs by way of gestures, then you can reassure yourself, and the child can be given a few more months to start speaking clearly. If these parameters also appear delayed, then the child needs further evaluation. Getting the child to interact with other children, say at a playschool, is a good stimulus for the child to start speaking.

 

2. My first child has become cranky, hostile and destructive after my second one was born. Any tips on how to handle the situation?

The coming of the second child can be a very traumatic event for the first born, especially if he/she is less than 5 years. The child suddenly feels 'dethroned' and ignored, and finds the newborn to be a competitor for the love and attention of the parents. This situation can be avoided to a large extent. Prepare the child for the new arrival at least 6 months in advance. Tell him that he will get a brother/sister to play with, who will love him, and who he must take care of. Tell him that mummy and daddy may initially be busy taking care of the child, but it does not mean that you love him any less. After the child is born, involve the child in the day to day care like fetching diapers, shaking rattle etc. and don't forget to thank him each time. Instruct all close relatives to first talk to the elder one, before turning their attention to the younger one. Scold the younger one once in a while (he/she will not realise it anyway!), make the elder one feel important.

 

3. What is your opinion about the use of 'Walkers' and 'Pacifiers'?

The 'Walker' is, at best, a device to keep the toddler out of trouble while the mother does her household chores. In fact, it encourages careless walking. A child must fall down once or twice while learning to walk, to realise 'if I'm not careful, I'll get hurt'.

The best pacifiers a child can use are its own fingers, as they are relatively the easiest to keep clean. The pacifiers available in the market can easily cause loose motions and teeth problems, and are not recommended.

 

4. My child is five years old, and is still bed-wetting at night. How do I tackle this problem?

Let me start by assuring you that bed-wetting, or enuresis, is a problem which slowly goes away with age. Simple measures can reduce the severity, and save the child a lot of embarrassment. First of all, get the child thoroughly examined and investigated, to rule out urinary tract infection and other problems. Reduce fluid intake to the absolute minimum about 3 hours before the child goes to bed. Make the child pass urine just before sleeping. Wake the child up once around 12.30 to 1.00 am, make the child walk to the toilet (don't carry the child, he/she has to wake up), and pass urine. Older children, children who pass urine many times in the night, etc. may be helped by using a 'enuresis blanket', a device which sounds a loud alarm at the first sign of getting wet (unfortunately not freely available). Short term control of bed-wetting, for children going for sleep-overs or camps, can be achieved with medications and nasal sprays.

 

5. My 4 year old son is asthmatic and needs to take inhalers everyday. Of late, he has become very uncooperative, and refuses to take them, and so his cough and wheezing has come back. I'm very disturbed, and end up scolding and shouting at him daily, but it seems pointless. How do I handle him?

This is a common and distressing problem faced by parents of children whose illnesses require treatments which depend a lot on the cooperation of the child. Unfortunately scolding, shouting, beating etc. have only temporary effects on these children, and they end up becoming more adamant and rebellious. One method I can suggest is what is called 'positive reinforcement'. Display a chart prominently in the house, and mark on the chart with a particular symbol or 'star' each time the child cooperates and takes the medicines properly. Assign a small reward to a certain number of stars (make sure that it's a reward, not a bribe). Negative marking (a different coloured star) may be marked more discretely on the chart for the days that the child does not oblige, and make sure he understands that this cancels one or more of the brownie points or stars earned earlier. Praise the child lavishly in front of visitors and his peers whenever he accumulates his 'good stars', so that the child feels he has achieved something, and will work that much harder to get more rewards.

I have seen parents try the same methods in children with habit disorders like thumb-sucking, nail-biting, body-rocking, constipation etc. with considerable success.

 

6. My child has completed 4 months and I am under intense pressure from everyone at home to start solid food. What is the ideal time, and what do I start with?

Recent research has shown that exclusive breast feeding for the first 6 months reduces the occurence of gastroenteritis and allergies in the child, and now the Indian Academy of Pediatrics has recommended that babies should be weaned only after completing 6 months of age. Even working mothers can manage to follow these guidelines by expressing breast milk into sterile containers, and storing the same in the refrigerator.

Most mothers spend sleepless nights fretting about their infants eating habits. Many hours are spent each day trying to make an infant consume a certain quantity of food, which is deemed 'necessary' for the child. Weaning practices have various cultural differences, and a first time mother gets a confusing bombardment of well meaning but sometimes inappropriate advice from relatives and friends, which only increases her frustration. Here are some suggestions which should be considered.

• Eating should be a pleasurable experience for the child, which he/she eagerly looks forward to.

• No child wilfully goes hungry, you only have to give it sufficient time to digest the previous meal

Variety is the spice of even an infant's life, so keep changing the order, quantity and flavour of the meal

• Do not compare children, each child will have unique likes and dislikes, which should be respected!

Fruits, mashed vegetables, ragi gruel, rice with dal, curd rice, kitchdi, pongal, ready made cereals like Cerelac, Farex etc. are some examples of weaning food. Find out by trial and error what your baby likes, and feed only when and as much as he/she wants.

 

7. Can you give me a few tips on dental care in children?

One of the biggest misconceptions about childcare is the belief that you do not need to bother about the temporary or 'milk' teeth because they are going to fall out anyway. In fact, care of the gums and teeth should start the moment the child appears to be teething. Gently massage the gums with your fingers. Paracetamol may be used if there is pain. Chewing on carrots and other vegetables is not recommended, as they can soften and break off, posing a choking hazard. A clean, firm 'teether' maybe used.

The moment the teeth begin to appear, start brushing them with a soft baby toothbrush, initially without toothpaste. Once the baby gets used to the idea, and learns to spit out, toothpaste may be used. Brush twice a day, morning and night. Older children who eat a lot of sweets and chocolates should brush more often. Make it a point to have the child gargle vigorously with water after drinking fruit juices and aerated drinks, as the sugar and acid in the drinks can damage the teeth enamel. Routine dental checkups with a Pedodontist should begin at 1 and 1/2 years of age, and every six months thereafter.

 

8. My child suffers from severe constipation. Medicines seem to give him only temporary relief. Where am I going wrong?

Constipation in children is a habit disorder which needs to be tackled on three fronts for successful reduction i.e. diet, change of bowel habits and medications. The problem usually starts when the child is predominantly on a fiber deficient diet like milk and milk products. It is compounded by irregular bowel habits, where the child is too busy in play and other activities, and has no time to pass stools. The net result is hard stools. Passing hard stools causes pain, and so the child develops an aversion to the same, and thus a vicious cycle ensues leading to increasing constipation. These are some solutions:

• First of all a thorough examination is required to rule out medical and surgical causes of constipation

• Introduce fiber containing food like fruits, vegetables, whole wheat, ragi, pulses, and also plenty of liquids

• See that the child compulsorily passes stools at least once a day

• Hard stools which have already accumulated in the rectum have to be removed by using suppositories for 3 to 5 days

• Stool softeners and laxatives should be given daily till such time that the child overcomes the fear of passing hard stools, and can confidently sit down and pass soft stools easily. A few months of treatment may be required in some cases, especially children who pass blood in the stools, usually caused by a tear in the rectum.

 

9. I live abroad, but visit India very often. Each time my child is here, he develops a severe reaction to mosquito bites, and is scratching all the time. Any suggestions?

It is quite likely to be an allergic reaction to insect bites, especially mosquitos. See that the child is fully clothed while going outside. Apply mosquito repellent cream on the exposed parts. Employ rigorous anti mosquito measures like nets, repellents, screens etc. to keep the house mosquito free. Clip, and file the nails, and also clean the undersurface of the nails, to minimise the chances of infection. Oral antiallergics may be given to reduce itching.

 

10. My daughter spends most of the time in front of the TV, and hardly ever plays outside. How do I handle this situation?

This is a very common situation faced by parents, and a leading cause of obesity in children. Not only are the children inactive while watching TV for long hours, they also steadily add to their calorie intake by munching on snacks and junk food. The problem usually starts when overanxious parents and grandparents use the TV as a means of distracting the child to make him/her eat. This very soon becomes a routine, and before you know it the child is spending 7 to 8 hours each day in front of the 'idiot box'. Tackling this situation needs cooperation from all family members.

• See that meals are served only at the dining table. This rule should apply to all family members, not just the child.

• Cut down the time spent by the child in front of the TV (and computer) to a maximum of 90 mins a day.

• Encourage more physical activity and outdoor play. Parents participation in outdoor activities will be heartily appreciated by the child.

• See that the child is tucked up in bed by 9.00 pm, and not sitting beside you needlessly watching the soaps.

• Occasional indulgence for a few hours may be allowed on special occasions, and as a reward for good behaviour


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