|Posted on April 16, 2021 at 12:45 AM|
Happy to say that my family and myself have overcome COVID19 without major hiccups. I am penning this here to let people know just how contagious this disease is, and also to urge and motivate more people to get themselves vaccinated against this deadly virus.
I have been one of the more paranoid doctors, who has veered towards extreme caution ever since this pandemic began, sometimes to the point of irritation. So for the last 13 months, I have been going to my clinic wearing blue OT Scrubs, with two masks on my face (an N95 mask and a surgical mask on top of it), and a plexiglass face shield above both, to complete the attire! It is no wonder that the babies take one look at me, and begin their non-stop screaming, which continues till they leave the clinic! I examine sick and well babies in two separate rooms. Every surface in both rooms is disinfected after each patient, and I sanitize my hands at least 30 times in a day! I reprimand my staff and patients if I see them touching their masks. At home, all the help, and even visitors have to wear masks and sanitize their hands before entering the house. I think by now you have got a fair idea of my obsession and carefulness. This has partly stemmed from the dread of the virus attacking my octogenarian parents.
At the slightest hint of a cold, I have got my wife, daughter and myself tested for COVID. Three times, to be precise, and all of us turned out to be negative each time. This made us more determined to continue following the measures that we had put in place. Ironically, the only 2 persons who got the COVID bug, were my parents, despite the precautions. Thankfully, it was at a time when the COVID curve was flattening, and so we managed to get them both to hospital immediately, and they slowly recovered.
In 2021, as soon as the vaccines were made available to healthcare workers, we (my wife and I) took two doses of Covishield vaccine. 15 days after the 2nd dose, we checked our antibody levels to spike proteins (an indicator of immunity). The measurement of this is not really required, but I wanted to be sure, especially since we are both in our fifties. Our levels were way above the 15 AU/ml level, which denotes a good antibody response to the vaccine.
This was followed by a huge sense of relief and euphoria, and is probably when we let our guard down a bit. We decided to travel to Goa on a holiday, using tickets carried forward from last year that were about to expire. And somewhere in the airport, on the flight, the hotel or in one of the restaurants that we visited there, we seem to have caught the bug.
5 days after reaching back from Goa, I developed a slight stuffy nose and body ache, which I attributed to my allergies. It is only when my wife developed a fever the next day, that the antennae went up, and we got the RTPCR done. Both of us tested positive for SARS-COV-2, and our daughter was negative (she turned positive on retesting after 4 days). Our shock and dismay at testing positive was considerably reduced when we received a call from a BBMP doctor, Dr Shailaja, telling us "Please do not panic, we are there for you". It felt reassuring just to hear that statement, despite being a health care worker, and I am sure such calls provide instant comfort and reassurance to everyone in this situation.
Since then we have isolated at home, trying our best to stay out of each other's hair. Thankfully, we do not have any co-morbidities, and have been largely symptom free, most likely as a result of the prior vaccination. On the advice of our intensivist friend, we checked our CRP, D-dimer and IL-6 levels on the dreaded day 7, which were normal. We have been monitoring our oxygen saturation after a 6 min walk, twice a day, and the values have consistently been above 95%. I have been passing time with online consultations, Netflix, household work like sweeping and mopping, and trying to appear helpful in the kitchen, before I am shooed away from there.
Here are some take-home messages from this experience of ours:
1. The pandemic is far from over, and people like us who were very careful earlier, become fresh targets for the virus as we start becoming complacent.
2. Vaccination may not prevent us from getting the disease, but studies from all over the world concur that all vaccines provide almost 100% protection from severe disease, that is, it prevents us from getting major lung involvement and hospitalization. This protection is very likely to cover disease caused by the mutant variants of the virus that are appearing, and those that will appear in future.
3. Fear of the rare serious side effects should not be a reason to defer or refuse the vaccination, as the benefits far outweigh the risks. To put it in perspective, the incidence of serious blood clots in recipients of AstraZeneca (Covishield) vaccine (which thankfully has not been reported much in our country) is 4 per million in the UK, while risk of the same in women taking certain types of oral contraceptive pills is 6 per thousand the world over.
4. Doctors are more prone to get the infection outside their clinics, than inside, because we tend to relax our vigil once we leave them.
I will be returning to my clinic soon. Despite having received 2 doses of the vaccine, and suffering from the disease, I will still be wearing my 2 masks and face shield. This is because there is so much about this virus that we don't know yet, particularly whether it can infect you again. But the one thing we do know is that vaccines give protection against severe disease, no matter which vaccine you choose. Throughout our COVID19 illness and quarantine, we did not have to take any antibiotic, antiviral, steroids or immune boosters, because we had taken the one thing that actually boosts immunity against the virus, the vaccine! I therefore urge all of you out there, especially my doctor colleagues, to please take the vaccine as soon as possible. This, along with more sensible behavior and continued following of SMS (Sanitization - Mask - Social distancing) can help tame this virus, and get our lives back to normal. Give the vaccination drive a shot in the arm, by taking a shot in the arm!
|Posted on March 9, 2020 at 9:50 PM|
There are so many myths, misconception, recommendations and restrictions floating around about the Coronavirus epidemic, which has led to widespread confusion and panic. Let me try and set if few facts straight.
• Coronaviruses are a large family of enveloped RNA viruses. They circulate in humans, in whom they usually cause the common cold, and in various other animals like camels, bats and birds. It is only when the coronaviruses of animals develop the ability to infect humans that they cause epidemics, because humans do not have pre-existing immunity against them
• The new Coronavirus has resulted from man’s interference with nature. In the seafood market at Wuhan, live animals which would never ever have met in the wild, like pangolin, bats and snakes were kept in close proximity. This enabled the coronaviruses in them to exchange genetic material, and form a new virus. This novel (new) coronavirus has been named SARS-CoV-2, and the disease caused by it is named COVID 19 (COronaVIrus Disease 19). This virus is similar to the coronaviruses that caused the SARS (2003) and MERS (2012) epidemics, and is the 7th Coronavirus to infect humans. Studies suggest that this virus is a recombinant virus between the bat coronavirus and an origin-unknown coronavirus; however, this is yet to be confirmed.
• Human transmission occurs via respiratory droplets produced when an infected person sneezes or coughs. The virus has been detected in blood, urine and saliva, but the contribution to transmission by the presence of the virus in body fluids is unknown. There is mounting evidence to suggest that even people who do not suffer from any symptoms, but carry the virus in the nose and throat, can transmit the disease to others. Mother to child transmission during childbirth, and transmission via breast milk, is considered unlikely
• The median incubation period (from when the virus enters the body, to the appearance of symptoms) has been estimated to be 5 days
• The virus attaches itself to receptors in the cells of the nose and throat, and causes symptoms similar to the common cold. In some, it travels down to the lungs, and causes severe viral pnuemonia
• The present COVID 19 epidemic, similar to the earlier coronavirus epidemics like SARS and MERS, is very mild in children. According to the data published by The Chinese Center for Disease Control and Prevention, only 2% (of the 72,314 cases from 31 December 2019 to 11 February 2020) were aged 19 years or younger. The majority of confirmed cases (87%) were aged 30 to 79 years.
• The only way to prevent infection is to avoid exposure to the virus.
• Masks do not prevent the entry of this virus into your body. Masks are recommended to be worn by people who have symptoms, to prevent dispersion of virus when they cough and sneeze
• Avoid touching the mucous membranes (the moist inner surfaces) of the eyes, nose, and mouth with unwashed hands.
• Wash hands often with soap and water for at least 20 seconds, or an alcohol-based hand sanitiser containing at least 60% alcohol. Remember, alcohol can get absorbed from the skin, especially in children with lacerated (wounded) skin, and is to be used only if there is no ready access to soap and water.
• Maintain a distance of at least 1 metre (3 feet), from those who have a fever, or are coughing or sneezing. See that the room is well ventilated, and ensure air circulation by using ceiling or pedestal fans, air conditioners etc.
• Practice respiratory hygiene (i.e., cover mouth and nose when coughing or sneezing, discard tissue immediately in a closed bin, and wash hands). Note that handkerchiefs and towels are not recommended.
• Seek medical care early if you have a fever, cough, and difficulty breathing.
• Share your previous travel and contact history with your doctor
• Avoid the consumption of raw or undercooked animal products, and handle raw meat, milk, or animal organs with care. Consumption of well-cooked meat is safe.
• Early recognition of new cases is the cornerstone of prevention of transmission. Immediate isolation of all suspected and confirmed cases is recommended for at least 14 days, either at home or at hospital, depending on the severity of symptoms.
• There is currently no vaccine available. Vaccines are in development, but it may take up to 12 months before a vaccine is available
• No specific treatments are known to be effective for COVID-19 yet; therefore, the mainstay of management is supportive care to relieve symptoms, and to support organ function in more severe illness. Various antivirals are being trialled in patients with COVID-19, however, there are no data to support their use. Clinical trials with Remdesivir (which shows in vitro activity against SARS-CoV-2) have started in the US and in China.
|Posted on November 25, 2019 at 9:55 AM|
No sooner does a child reach the 9th standard (or sometimes even earlier!) than the parents go into a familiar ‘anxious about child’s future’ mode. Whispers of “board exams”, “crucial year” and “sacrifices for the future” begin to fill the air, and discussions about tuitions, training institutes for professional courses, and expenses involved replaces ordinary conversation at home. Most privileges, entertainment and physical activities of the child are cut off, and the child is made to follow an exhausting routine of early morning special classes, regular school, post school tuitions (or coaching classes), and finally tons of homework from everywhere. The tired child finally manages to crawl into bed late into the night, but early the next day the routine repeats. Sundays and holidays offer no respite, and they are resigned to this punishing schedule for every day of two to three years, or more. To make matters worse, some children are packed off to residential coaching centres, many a times in another state a long distance away, where they have to endure the added misery of poor living conditions, bad food, homesickness and even physical punishment!
As a doctor looking after children for the last 27 years, and one who has been seeing and treating an increasing number of teens for psychosomatic (stress-related) symptoms, I want to stand up for the scores of children quietly undergoing these impractical and potentially harmful schedules at present, and in future. The long-term effects of these regimens on the physical and mental wellbeing of the child can be profoundly detrimental.
I remember that my friends and I had to do some hard studying to do too, and had some privileges taken away during our 10th and 12th exams, but then we also had enough time for sleep, exercise and outings to theatres and restaurants. No day was complete without a game of cricket or football after school, and regular sessions of STP (Summane Time Pass) and visits to CTR or Rice Bowl for Masala Dosa or Fried Rice, in between study sessions!
Parents tend to think that tuitions and coaching classes are the only options available to ensure success in examinations and “ to stay ahead of the game", partly because of fearmongering by schools and coaching institutes, and peer pressure from other parents. As a parent, I fully understand this anxiety, and the desire to see their children do well in life. I agree that it’s a different world out there now, but then the requirements for success in examinations, or for that matter, in any chosen future career, have remained the same. Topmost on the list remain good communication and interpersonal skills, a healthy and relaxed mind and body, and empathy and compassion for all creatures. They also need to learn how to handle both success and failure, and how to help themselves as well as others in times of need. Sadly, very few of today’s schools and coaching centres tackle these vital issues. The overemphasis on marks and outcome, combined with overwork and lack of social exposure of these young and impressionable minds, make them ill prepared for the realities of the world that they are so eager to join and succeed in. They forget how to have fun as teenagers should, and their childhood passes by quickly without them learning the essential interpersonal and other life skills that games and peer interactions will teach, which can be a disadvantage in the future career of the child.
Children in the late teens dread mainly 2 scenarios, one, suffering ridicule amidst their friends and peers, and two, disappointing or not meeting expectations of their parents and society. All their stress is derived mainly from trying to avoid these two outcomes, and not from the fear of examinations or worry about the future. Some children may be able to cope, but many find the very thought of failure, combined with the added effects of lack of sleep and exercise, and the seeming endless volumes they have to study increasingly stressful. This inability to handle stress can manifest as symptoms like inability to sleep, increased heart beats, stomach cramps, vomiting, headache etc, and these children end up taking multiple rounds of medicines for them without much relief. Feelings of hopelessness and desperation can soon set in, and these children often resort to the extreme measures that we keep reading and hearing about in the media.
To ensure your child’s wellbeing and a favourable outcome in examination, here are some actions that you can undertake as a parent:
• Firstly, try not to overly emphasize the importance of board exams and choosing of a future career. This only makes the child anxious and insecure, and prevents the child from fulfilling his/her true potential.
• Find out what your child is good at, and guide your child towards a career that the child may excel and be happy in. Many centres now offer career guidance and counselling, and parents would do well to make use of these facilities. Forcing a child into an unsuitable career line, will relegate the child to a lifetime of struggle and boredom
• Some parents are of the opinion that “my child is a weak student” or “he/she is not intelligent” and hence requires tuitions and special classes. It is common knowledge today that many of yesteryears toppers have the back-benchers of their class as their bosses! A so called “weak student” can be bestowed with one or more of 9 different kinds of intelligence (Logical-Mathematical, Linguistic, Visual-Spatial, Naturalist, Musical, Existential, Bodily-Kinesthetic, Inter-personal and Intra-personal), and thankfully today’s world offers excellent career opportunities for utilizing each one of them, and an enormous array of careers to excel in.
• Create a pleasant and relaxed atmosphere at home, that is conducive to learning. Avoid unnecessary interference and nagging about the study schedule and progress. Make rules, but be a little flexible in the implementation, accommodating the inherent rebellious nature of the teen.
• Ensure adequate physical activity. A child should have at least an hour of exercise every day (be it walking, dancing, cycling, swimming, outdoor games etc.) even during the examination period. It is during these periods of physical activity that the brain rests, and rejuvenates. A relaxed brain is capable of retaining and understanding more than a tired and overworked brain!
• See that your child gets the minimum required sleep every day. Most parents would be surprised to hear that a 16-year-old child requires 8 and a half hours of sleep each night to keep the mind rested and healthy. Occasional all-nighters are allowed, but when sleep deprivation occurs regularly, the sleep deficit tends to accumulate, and effect the memory, comprehension and oratory ability of the child.
• Each one-hour session of study should be followed by a 5 - 10 min period of relaxation, where the child just relaxes his eyes, mind and body to ease away the built-up tension. Yoga, music, reading of newspapers, small walks etc. should be encouraged, but electronic media and eating in between meals is best avoided.
• Make sure that no junk and high calorie food is stocked in the house. Studying children tend to munch on snacks unconsciously, and put on unwanted weight which they find very difficult to shed later.
• Avoid comparing your child with friends and siblings. Acknowledge the child’s potential and limitations, and encourage the child to put the best possible effort into studies, without worrying about the outcome of the examination. Parental attitude of ‘Que Sera Sera’ (whatever will be, will be) may be least stressful on the child’s psyche, and a reassurance in times of self-doubt and panic.
• Keep communication channels open with your child. Make it a point to speak (non-patronisingly) to the child at least once a day for a few minutes. Assuring the child of your unconditional love and support, whatever be the outcome in the examinations, will remove a huge burden off the child’s shoulders. Again, make sure you prepare them for any outcome, adverse or favourable.
• It is absolutely essential that all parents keep a close watch for unusual behaviour in their children, like becoming quiet and withdrawn, unprovoked crying, weight loss, destructive anger, night terrors etc. which are tell-tale signs of emotional and psychological distress. Seeking help at this stage will go a long way in preventing many unfortunate and avoidable outcomes.
• In such extreme situations, parents would do well to remember that deferment is always an option available. A period of time off for relaxation and introspection can help a stressed child to gather his/her wits and thoughts together, and leisurely decide their future course of action.
Our children are our future, our wealth, our everything. Nothing is more important than their happiness and their health. A confident and adventurous child can eke out a successful career in any field, and as parents, our only job is to point them in the right direction. For, like Khalil Gibran famously wrote nearly a hundred years ago,
“Your children are not your children.
They are the sons and daughters of life's longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you.
You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them,
but seek not to make them like you.
For life goes not backward nor tarries with yesterday”
|Posted on June 21, 2019 at 11:35 AM|
The most common topic of discussion at young mother get-togethers, and social functions is invariably about feeding. More specifically, about how the children don’t eat, how fussy they are with what they want to eat, how it takes hours for a child to finish a meal, about how skinny or overweight they are becoming and so on. Many mothers are at their wits end, having tried everything suggested by elders and peers. They end up spending hours running behind a child, coaxing, cajoling and sometimes even bribing or threatening the child to eat. Such disharmony and stress can easily be avoided by following some rules when initiating feeding, and changing the rules of feeding in children who are giving you trouble.
RULE #1 - The child is the boss!
The more a child is forced, the more he/she is going to resist. Any compulsion is usually met with rebellion. Any food forced down the throat promptly comes out, putting to waste the meticulous effort put in by the mother (or grandmother)! Therefore, make it a point to respect the child’s wishes. Stop when the child says enough, and postpone the meal if the child says NO. There is absolutely no harm done in letting a child to miss a meal or two, the subsequent hunger makes the child relish the food, and realize the fact that “if I don’t eat, I will get hungry”
RULE #2 - No distractions during feeding
This literally means “NO ELECTRONIC MEDIA DURING MEALTIME”. Eating in infants will be initiated only on a ‘high chair’, and meals will be served to children only at the dining table or in the kitchen. Older children will eat on their own, and demands to be fed or the TV to be switched on should be met with firm refusal. Similarly, infants should not be taken to the balcony, garden etc. for distraction during meals. And for it to be followed by the little ones, this rule should apply to everyone in the house!
RULE #3 – Feed the child in sitting position
Feeding of infants should always be undertaken with the child sitting, where gravity helps retention of food, rather than with the child lying down, as there is a risk of vomiting and aspiration of food into the lungs and ears in this position. A sitting child is more aware of his/her surroundings, and actively participates in the feeding exercise.
RULE #4 - Space out the meals
Give your children sufficient time to get hungry. Do not follow a rigid meal regimen, and insist that the child follows it like clockwork! Spacing out meals, and allowing your child to miss a meal if required, will give sufficient time for the child to digest the previous meal, and get hungry enough to eat the next. A hungry child needs no appetizers or distractions!
RULE #5 – Bring in variety
Nothing is disliked more by children (and infants) than the prospect of eating the same food repeatedly. If your child does not like rice, serve him food made from wheat, ragi, corn etc. Some kids like spice, while others may have an inclination for a sweet tinge in the food. Make sure each meal has a significant portion of fruits and vegetables (the more colourful, the better), and after the age of 1, dairy products like milk, cheese and paneer. Non-vegetarian food can be introduced by 8 to 9 months, if culturally indicated.
RULE #6 – Let the child eat on its own
As soon as the infant is sitting steadily, offer finger food on a plate (a concept called baby led weaning). Slowly introduce a spoon, so that the child develops the dexterity to transfer larger amounts of food into the mouth. Tolerate the initial mess and apparent disinterest. Let eating be a complete sensory experience for your child where he/she sees and hears the food being prepared, smells the interesting ingredients, feels the different textures with their little fingers before actually tasting the food in the mouth. This hand-mouth co-ordination is important in developing future skills like handwriting, drawing etc. Older children, above the age of 2, should compulsorily feed themselves
RULE #7 – No snacking in between meals
Eating high calorie snacks, biscuits and sweets are the commonest reason why children are not interested in their regular meals. These junk items provide them with empty calories, enough to meet (and usually in excess of) their daily calorie requirements, but are of very low nutritional value. A single packet of chips, can provide up to 500 calories, almost 1/3rd to 1/4th the daily calorie requirement of a young child. Throw out all the chocolates and cold drinks from the fridge, do not store ice cream in the freezer, and avoid bringing fried items home. Substitute them with healthy fruits and vegetables, that too only at meal time.
RULE #8 – Delay gratification
Parents are often guilty of trying to satisfy their child’s every whim. An infant is breast fed the second it starts crying. When the child complains about the food cooked for dinner, pizza is immediately ordered online. A small tantrum on the road earns the child a whole bar of chocolate! A lot of research over the last few decades has pointed out the demerits of such ‘instant gratification’. An example of this is the “Marshmallow test” of 1960 and 70s. Learn to say ‘NO’, and let your children experience that bit of unhappiness in the safety of their own family. They come out realizing that the world didn’t end because they didn’t get what they wanted!
Human beings are set apart from other animals by their superior intelligence and analytical power. But sometimes we tend to dissect and de-construct problems a little too much, and thus complicate matters further. Feeding of children is one such matter which will benefit from our non-interference. Let hunger be the main drive for eating in children, and let the child decide how much to eat out of the food provided. That is what the mother of a young one in every species other than ours does!
|Posted on October 2, 2018 at 6:40 AM|
Recent news articles in the newspapers about defective polio drops manufactured by a pharma company have created confusion and apprehension in the minds of the public. Let me clarify a few facts
What is the controversy?
India has reached zero transmission status of Wild Polio Virus (WPV) Types 1, 2 and 3 (which cause the paralytic disease Polio in children). But even then, regular surveillance is conducted to watch out for recurrence of this virus (called the AFP Surveillance Program). They routinely check stool samples of children for polio viruses (both disease causing and vaccine strains). During one such surveillance, the vaccine strain (Polio vaccine virus (Sabin) Type 2) was detected in the stools of children in Uttar Pradesh. This was traced back to the contamination of Bivalent OPV produced by a manufacturer, who has since been severely penalised.
Since WPV Type 2 has been declared as eradicated, and had not been detected since 1999, India has shifted from Trivalent Oral Polio Vaccine, tOPV, (containing Sabin Types 1, 2 and 3) to Bivalent Oral Polio Vaccine, bOPV (containing only Sabin Types 1 and 3). The reason for this is, with WPV Type 2 transmission already having been successfully interrupted, the only type 2 poliovirus which still causes paralysis, on very rare occasions, is the Sabin Type 2 serotype component in Trivalent OPV.
What is the significance of this discovery?
Since the switch from Trivalent OPV to Bivalent OPV in India in April 2016, all children who have been vaccinated exclusively with OPV from that date onwards, do not have immunity against Polio Virus Type 2.
The strain discovered in the stool sample was Polio Vaccine Virus (Sabin) Type 2, which is a live attenuated (has lost the capacity to cause disease) version of Wild Polio Virus Type 2. This strain per se is harmless, and the only danger is the small chance of it mutating and regaining back its virulence (the capacity to cause disease).
Who are the children at risk?
The contaminated batches of Bivalent OPV were used in the government immunisation programs (this OPV manufacturer does not supply to the private doctors) of the states of Uttar Pradesh, Maharashtra and Telangana. The government has immediately discontinued the use of the vaccine in these areas, and stepped up surveillance and mop up immunisation.
Which are the children who are not at risk?
Any child who has received two doses, or at least one dose of the Injectable Polio Vaccine (IPV), which contains all the three strains of the polio virus, will have immunity against Polio Virus Type 2. IPV is, and has been since 2016, routinely administered in government hospitals and PHCs in two doses at 6 and 14 weeks. In the private sector, IPV is no longer available as a standalone vaccine (Imovax Polio, Polprotec), and is presently available only as a component of a combination vaccine, Hexaxim and Infanrix Hexa (DTaP + IPV + HepB + Hib), and EasySix (DTwP + IPV + HepB + Hib). Any child who has received any of the above vaccines will be protected from Type 2 polio virus.
What do we do now?
• All children from the involved states who have received the contaminated batch will be given IPV, if they have not received it already
• All children born after April 2016, who have received only OPV, should take at least one dose of IPV from a nearby Government facility as early as possible.
• All children who have taken at least two doses of IPV, need not do anything more. They should continue to take other vaccinations as recommended by their doctor, and also take part in the Pulse Polio immunisation programs to ensure that our country remains free of Polio.
• Children less than 6 weeks, who have not received any vaccine yet, should get at least 2 doses of IPV, from either the government or the private sector doctors, in addition to the Oral Polio Vaccine (OPV). The administration of OPV should not, on any account, be discontinued or defered because of this unfortunate incident.
|Posted on June 5, 2018 at 1:20 PM|
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)
Nipah virus (NiV) is a zoonotic virus (it is transmitted from animals to humans) and can be transmitted through:
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).
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:
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.
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.
|Posted on April 20, 2018 at 9:55 AM|
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!
|Posted on July 9, 2017 at 10:15 PM|
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.
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..
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 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
• 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.
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'
|Posted on August 30, 2015 at 8:30 AM|
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.
|Posted on May 2, 2014 at 2:05 AM|
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!