Blog

Feeding after 6 months(weaning): what every parent should know

By drabhijit on October 28, 2020 1

Feeding during the first six months of life is easy, and every parent is aware. It is either Breastmilk or formula milk depending on the individual situation. But after 6 months, feeding becomes tricky, and most of the time, parents don’t have a sound idea about what to feed and how to feed.

Common questions parents have in their mind during weaning are:

What to feed?
How to feed?
What to start with?
How to check tolerance?
What if my baby doesn’t tolerate?
What about water?
My baby don’t have any teeth, even then solid food?
How to check my baby is getting the required nutrition?

In this post, I will try to answer each one of the standard listed queries.

What to feed during weaning?

6 Food group is needed for baby’s nutrition and development. Namely-

Cereals: like rice, wheat, oats, suji, puffed rice, etc.
Pulses: like dal (Masur/masoor, moong, etc.)
Veggies
Fruits
Animal protein: fish, meat, and egg
Milk

All the six food groups are equally crucial for the better growth and development of your baby. So, a balanced diet comprised of all the food groups in the right proportion is necessary.

Note: Fish is a good source of protein and essential fatty acids. So regular consumption of fish ( at least twice a week) is recommended for better brain development.

How to feed?

The feed should be semi-solid in consistency (a gravy or gruel like). It should not be too liquid that it quickly falls from the spoon, or It should not be too thick that it doesn’t fall from the spoon when tilted.

Weaning tips: What parents should remember while feeding.

1) Baby should be hungry: so don’t give feed for at least 3hours before trying for a semi-solid meal

2) Feeding in sitting position: never feed in a supine position.

3) Make the event entertaining but avoid too much distraction.

4) Talk to your baby while feeding

5) Try a small amount at a time

6) Give feed in the middle part of the tongue, not over the front: as babies have a natural reflex to spit when anything is given in the front part of the tongue.

7) Give 30 minutes maximum time for the event. Don’t cut short or prolong it as both are harmful to your kid. Have patience as it is the time to make your baby learn a good feeding habit.

Which baby food to start with at six months? All about weaning food

Home-cooked food (well boiled and mashed )

Never use a mixer for grinding foods. As we aim to let, the baby learn the food items he/she should regularly take for lifelong. The Mixer grinder machine alters the texture and consistency of food.

Start with one food at a time. If the baby accepts and tolerates well, gradually increase the amount of food. Then add another food item.

Remember, once or twice, the refusal doesn’t warrant stopping the food. A particular food should be tried at least ten times before discarding it from the food list.

Baby food at six months:Examples

Well-cooked smashed rice: add butter, salt, and or little sugar to make it tastier
Add dal to it if tolerates well.
Add different veggies
Try mashed potato or banana
Give rice milk or bread milk, or suji milk in gruel like consistency.
Try to add fish to the diet at least twice weekly for non-vegetarian

How to check tolerance?

Usual symptoms of food intolerance are:

Repeated vomiting
Abdominal distention
Repeated loose stool
Rash

After giving a new food item, if one or more of the above symptoms occur, indicate a probable food intolerance.

Note: above symptoms may be due to any other associated illnesses. So it may be a mere association. Consult your doctor/pediatrician in a situation like this.

What if my baby doesn’t tolerate solid food?

As a parent, your goal while feeding is to teach your child what is right and what is wrong. 6 to 12 months of life is the best time to teach your child what to eat and how to eat.

My baby gets choked while feeding grainy foods?
If a baby is being fed in a supine position and your liquid food has few grains, then it is very likely that the baby will get choking episodes. But if a semi-solid food in the right consistency is being fed in a sitting position, choking is least likely to happen. Also, the cooperation of the baby is needed. When the baby is not cooperating, and you are force-feeding, then the likelihood of choking episodes increases.

What about water? How much water should a six-month-old need?

Water( Boiled and cooled) is needed after six months. The amount of water varies according to age, weight, sweat production, environmental temperature, and any associated illness. The amount of water that maintains the color of the urine to very light yellow and in good volume is the right amount of water for your child.

Parents often wonder-My baby doesn’t have any teeth, so how can he/she take semi-solid food?

Semi-solid food doesn’t need teeth. The later someone starts giving solid food, the more difficult it becomes to teach your child a good feeding habit.

How to check my baby is getting the required nutrition?

A regular check-up with your pediatrician to know the increase in length and weight of the child is normal or not. As mentioned earlier, items from all the six food groups are needed in the right proportions for proper growth and development.

How many meals should a 6 month old have?

The baby should be eating at least 3 meals and 2 snacks apart from breastfeeding. The amount of feed during each meal will depend on the age of the baby.

Half -a-Katori for a six months old baby to three fourth Katori in one-year-old baby.

Why baby needs solid food after six months?

After six months breastfeeding or formula feeding is not sufficient to provide, adequate energy, vitamin A, iron for the growth and development of the child. So a denser food in the form of a semi-solid food is needed for proper nutrition.

TAKE HOME MESSAGE

There is a lack of awareness about feeding after six months.

Earlier, solid food started for your child better is the chance of getting a good feeding habit in your child.

Items from all the six food groups are needed in right proportions for a healthy child

Basic principles of complementary feeding should always be kept in mind

Let the child be hungry.
Feeding in sitting position
Never force-feed
Semi-solid, home-cooked food should be given and the ready-made commercially available foods should be avoided.
Start with a small amount of food during the daytime and see the tolerance.
If the baby accepts and tolerates the food well, increase the amount of the feed and add a new food
Spitting out of new food is a natural reflex in babies, so try to put the food in the tongue’s inner part

Feeding after six months requires a lot of patience. If you try feeding with these basic knowledges you will definitely get a positive result .

Writing this for #CauseAchatter with Blogchatter to spread awareness about Child health .

drabhijitmisra.com Disclaimer: All health information provided on this blog is for general awareness and doesn’t in any way replace a doctor’s professional medical advice. Kindly consult your doctor in case of any decision regarding your health, and diet. The information provided is for awareness. This is not meant as professional medical consultation. Healthcare is an individual decision and needs careful discussion and professional consultation before taking any decision. The author is sharing his professional knowledge. This post is meant as educational and awareness information and all decisions to be taken at own risk after consulting their own doctor in person. Health information is constantly being updated and while the author tries his best to keep updated information, the author and the website shall not be held liable for any reliance placed on such content for any reason whatsoever.

Pain abdomen in children: What to do and when to worry?

By drabhijit on September 30, 2020 0

Pain abdomen is one of the familiar problems children face. Often, parents get very anxious and visit either an emergency or a doctor with this complaint. More commonly, abdominal pain is a recurrent symptom and is not associated with any physical disability or mortality.

To get quick relief, parents give various medicines starting from a digestive enzyme to anti-colic medications to herbal and ayurvedic remedies. Which might be harmful. Some drugs suppress the pain and underlying illness and therefore delaying the detection of the serious disease.

How common is pain abdomen in children?

Up to 28% of children complain of abdominal pain once a week, and 2% seek medical attention. Almost 20% of children seek medical attention for chronic abdominal pain by the age of 15 years.

Causes of pain abdomen: pain abdomen in children can be due to a minor problem like indigestion or flatulence, although sometimes it can be as serious as acute appendicitis or intestinal obstruction.

Causes of abdominal pain:

Infection in the abdomen: like Gastritis, Enteritis, Appendicitis, Hepatitis, Pancreatitis, Peritonitis, Colitis, Urine infection, etc. They are usually associated with fever
Infection outside abdomen: Pharyngitis and pneumonia are the 2 common pediatric infections that can present with severe acute pain abdomen
Food intolerance: like cows’ milk, egg, nut, soyabean, colored foods, outside cooked foods
Toxic substance ingestion: from toys, play dough, nail polish etc.
Intestinal obstructions: need urgent surgical interventions
Constipation
Giardiasis, amoebiasis, worm infestation
Others: gall bladder stone, renal stone etc.

Chronic or Recurrent abdominal pain: at least 3 episodes of pain over at least 3 months severe enough to affect the child’s normal daily activities.

Many a time pain abdomen in children do not have any anatomic abnormality or infection of the abdomen. They are called functional or non-organic abdominal pain.

ROME IV criteria of different types of functional abdominal pain

Functional dyspepsia

Fullness after meals
Early satiety
Pain or burning in the upper abdomen not associated with defecation
After proper evaluation, the symptoms cannot be fully explained by another medical condition.

Abdominal migraine

Sudden attacks of intense, periumbilical, midline, or diffuse abdominal pain lasting 1 hour or more
Episodes are separated by weeks to months
The pain interferes with normal activities
Stereotypical pattern and symptoms in a particular patient
The pain is associated with 2 or more of the following

v Anorexia

v Nausea

v Vomiting

v Headache

v Photophobia

v Pallor

After proper evaluation, the symptoms cannot be fully explained by another medical condition

Irritable Bowel Syndrome

At least 4 days of Abdominal pain per month associated with one or more of the following:

v Related to defecation

v A change in frequency of stool

v A change in form (appearance) of stool

If the child is constipated, the pain does not go with a resolution of constipation (children in whom the pain resolves have functional constipation, not irritable bowel syndrome)
After proper evaluation, the symptoms cannot be fully explained by another medical condition

Abdominal Pain-NOS

Sudden or continuous abdominal pain that does not occur solely during physiologic events (e.g., eating, menses)
Irritable bowel syndrome, functional dyspepsia, or abdominal migraine criteria is not met.
After proper evaluation, the abdominal pain cannot be fully explained by another medical condition.

When not to worry too much:

Pain on and around the umbilical area and vague in character
Pain not disturbing sleep
Pain not associated with fever, vomiting, or altered stool habits
The active and playful child

When to worry or seek medical attention, urgently (RED FLAG SYMPTOMS):

A localized pain in other than the umbilical area
Pain associated with fever, vomiting, or altered stool habits
Pain abdomen with jaundice
Pain abdomen with urinary discomfort
Pain abdomen with significant abdominal distention
Pain disturbing sleep
Problem affecting normal daily activities of the child
Chronic pain with weight loss

What parents need to do:

Dietary modifications: If a new food (like a health drink or cow’s milk or nuts or soybeans, etc.. ) has been started in the diet, parents can avoid giving those things for few weeks and see the response. If the pain is due to food intolerance, it will decrease over the next few days after stoppage of the food.
- Avoid giving junk foods: like burgers, pizza, sweets, chocolates, chips, fries, etc.
- Give more water to drink.
- Give home-cooked, light foods in small amounts and more frequently.
Clean hands: maintain a clean hand by:
- trimming nails regularly
- washing hands before feeding
- Avoid applying nail polish.
- Avoid nail-biting habits.
Toilet training: ensure regular voiding of urine (3 to 4 hourly) and daily bowel movements. Put your child daily at a fixed time in the loo for at least 10 minutes, even if no urge is mentioned.
Ensure normal physical activity: regular physical activities to be ensured. Spend more active playtime.
Regular deworming after consultation with the pediatrician.
Cognitive-behavioral therapy: especially for recurrent or functional abdominal pain after consulting a therapist.
Medications: Don’t self medicate. As some medicines will suppress the pain, and therefore, underlying serious illnesses like appendicitis or abdominal infections will get masked temporarily to get worse later. Some OTC drugs like dicyclomine or paracetamol can be given after a doctor’s consultation.

TAKE HOME MESSAGE:

Pain abdomen in children is common, and many a time it is recurrent or chronic.
The majority of cases are harmless and do not need extensive treatment.
A parent should look for the enlisted red flag symptoms to seek urgent medical attention.
Parents should practice right hand and food hygiene to minimize the occurrence of the problem.
Do not self-medicate; seek an expert advice when needed.

Vomiting in children: What to do? When to worry? #CauseAchatter

By drabhijit on July 30, 2020 0

Vomiting is a common problem in children and small babies. Parents become anxious and often rush to the Hospital for this problem.

You should know that vomiting is a protective reflex of our body to let out harmful or excessive content in the stomach.

In small babies letting out milk and curd is very common. But most of the time it is regurgitation and not vomiting. Babies swallow air while feeding, and it is responsible for regurgitation most of the time. Vomiting is forceful, throwing of stomach content. Whereas regurgitation is effortless passive coming out of stomach content into the esophagus and mouth. It is not associated with any distress in the baby, and infants are often hungry immediately after an episode.

So it is not necessary to aggressively stop the vomiting always. Although it may be an indicator of underlying severe disease.

What can mother’s do to minimize regurgitation in babies

Proper attachment at the breast to prevent swallowing of air
Proper burping after a feed
Also positioning the baby approximately 30° towards head end helps to minimize regurgitation

Parents don’t need to worry about regurgitation if the baby is passing urine regularly, is active, playful, and baby is gaining weight as expected.

Vomiting can be due to something as benign as indigestion to as severe as an infection like meningitis.

Common causes of vomiting in children are:

Food intolerance and indigestion
Excessive and forceful feeding by caregivers
Belly Infection likely gastroenteritis
Other acute infection like UTI, septicemia, and meningitis
Intestinal obstruction or blockage
Lesions in the brain like a brain tumor

Complications of vomiting

Complications can arise if vomiting is not treated properly :

Dehydration
Electrolyte abnormalities
Failure to thrive in case of chronic vomiting
Aspiration of vomitus leading to pneumonia and breathing problem
Bleeding from the torn esophagus, if severe retching

What to do if your child is vomiting?

Wait for 20 to 30 minutes before giving anything to eat again
Give sips of ORS and water repeatedly
Give a small amount of easily digestible foods or milk more frequently
Ondansetron can be given as per doctor’s prescription. Remember not to give anything at least 20 to 30 minutes after giving this medicine to make it work
Watch for signs of dehydration
Visit your doctor or Hospital if any of the danger signs present

When to worry? ( Danger symptoms)

Repeatedly vomiting and not able to hold anything
Not passing urine for more than 6 hours
Other signs of dehydration: like no tear, while crying, dry mouth and very irritable child
Associated with fever
Associated with abdominal distention
Green color vomiting or blood mixed vomiting
Baby is lethargic
Repeated episodes of intense vomiting
The child is not gaining weight as expected in case of chronic vomiting

Always consult with your pediatrician if any of the danger symptoms is present in your baby.

Take away message:

Vomiting in children is very common. Regurgitation in small babies should be differentiated from vomiting. Parents don’t need to worry If the child is active, playful, passing urine regularly, and have no danger symptoms.

Parents should watch for the signs of dehydration and visit the doctor as necessary.

Colic in babies: What to do? When to worry? #CauseAchatter

By drabhijit on June 28, 2020 0

Excessive cry in babies, especially when inconsolable, is a nightmare for parents and pediatricians.

A cry is a normal physiological response. It is an excellent indicator that a child is in need, but a very poor indicator of what actually they need.
The reason behind excessive cry can be as simple as diaper irritation to as dangerous as a brain infection like meningitis.

Whenever a baby cries, parents feel that either they are hungry or they are in pain.
What we have to remember that crying is a normal physiological thing. And a baby has a crying curve just like a growth curve.

What is colic?

As per updated ROME IV criteria:
An infant who is less than five months of age at the start and stop of symptoms. The infant has recurrent and prolonged periods of crying, fussing, or irritability reported by caregivers without a specific reason. Infant colic cannot be prevented or resolved by caregivers. There is no evidence of infant failure to thrive, fever or illness.

PURPLE Crying in Colic

Parents should know about the concept of P U R P L E crying in colic.
The peak of crying: a typical colicky baby starts crying at around 2 weeks and gets worse with time until 2 to 3 months. And then it gradually declines by the end of 5 months.
Unexpected: most of the time it is sudden
Resists soothing: it does not respond to usual baby calming methods
Pain like faces: baby will make pain like faces
Long-lasting: each episode can be as long as 4 to 6 hrs
Evening: it has a tendency to occur in the evening

Why should we know and manage excessive cry/colic better?

Although colic is considered to be benign

It is a severe burden for families. Mentally and physically.
The impossible burden on health professionals and the health system. Parents are anxious and visit health care facilities, fearing the worse. An overburdened system cannot cope with this. Repeated counseling helps in many cases. That’s why awareness is crucial.
Colic is strongly associated with maternal depression, guilt, and disharmony in the family.
It can lead to Doctor shopping, harmful medications.
It is a common cause of early breastfeeding cessation.
Crying beyond the usual colicky period can be linked to later sleep problems, allergic disorders, family dysfunction, and behavioral problems.

What is the suspected Etiology of colic?

Despite years of research, the etiology is still not clear, and there are many proposed theories :

Postulated gastrointestinal mechanisms have included increased intraluminal gas, gut dysmotility, and visceral pain, but none is proven. Gastro-oesophageal reflux, cow’s milk protein allergy, lactose intolerance, and overload can also contribute.
Mother related factors: Maternal age, smoking, alcohol consumption, antenatal maternal stress and anxiety, and poor feeding techniques
Baby related factors: Difficult infant temperament, immaturity of the central nervous system, or an early form of migraine.
Environment-related factor: Lack of family support, family stress, and altered parent-child interaction
Perhaps infant colic can be best regarded as an exacerbation of normal infant behavior by a mixture of physiological and psychosocial factors.

When to worry about excessive cry?

If any of the underlying symptoms are noticed in a baby, then you should visit a doctor as soon as possible.

Fever: most of the time, crying associated with fever is an indicator of infection with a few exceptions like fever after vaccination.
Lethargic baby or not feeding well: if the baby is less active than usual and or not accepting feed as earlier there’s a strong possibility of a serious disease.
Not gaining weight: if the baby is not gaining weight as per his / her age.
Repeated vomiting or arching: which might indicate a GERD ( gastroesophageal reflux disease).
Explosive diarrhea with perianal excoriation: suggests underlying lactose intolerance.
Blood mixed stool with diarrhea and not thriving well: may indicate a Cow’s milk protein allergy.
What to do? How to manage colic?
There is no cure or definitive treatment of colic parents can do the following things
Exclude other causes of excessive cry: before labeling it, colic parents must visit a doctor to ensure that it is colic and nothing else.
Know in detail about the disease: parents and all caregivers must understand the nature of the disease and its course. PURPLE cry to be remembered
Learn methods to deal with periods of excessive cry: various techniques, also known as “5S”, can be applied to calm the baby like swaddling the baby, side positioning, gently swinging, suckle(feeding the baby ), shh.. sound. Sometimes it might not help.
Low allergy diet in exclusively breastfed baby: mothers excluded cow’s milk, eggs, peanuts, tree nuts, wheat, soy, and fish from their diet
Switching to a hydrolyzed preparation in formula-fed babies after consultation with a doctor.
Drugs/medicines: some probiotics, lactase drop supplementation, etc. can be tried with a doctor’s consultation.

Take home message:

• Infantile colic is a benign condition improving with time.
• There are no associated abnormality in most cases and no long term sequelae in both baby and mother.
• Learning about the disease and coping methods to deal with this temporary issue is the best way to manage it.

This is a series of posts to create awareness about common shild health concerns as a part of #CauseAchatter initiative by Blogchatter.

Green stools in babies: What to do? When to worry? #CauseAchatter

By drabhijit on May 30, 2020 0

Green stools in babies? In this post, I will be giving you a quick overview of the reason behind this common worry parents have.

In newborn babies and during early life, stools can be of varied colors. And amongst them, the green stool can be one of the types. When parents notice green stool in their kids, they tend to worry and rush to their pediatrician for advice. Green stool in babies can be a normal finding or can be an indicator of a severe intestinal infection.

Here is a guide about green stool in babies and when parents should need to worry about it.

Why green stool occurs?Normal physiology of stool color:

Stool color is influenced by what you eat and the amount of bile (a yellow-green fluid secreted by the gall bladder that digests fats) in your stool. It also depends on the travel time taken by the food in the digestive tract. When bile pigments travel through your gastrointestinal tract, they are chemically altered by enzymes, changing the pigments from green to brown.

Causes of green-colored stool

1) Decreased transit time of food in the gut: In other words, foods are passing faster through the digestive tract. It may be a normal phenomenon in breastfed babies or may be due to an infection like diarrhea.

2) Food with green pigment: like plenty of green leafy vegetables or food or drinks with green additive color.

When is green stool bad?

When to worry: if any of the underlying features are present, parents should visit the doctor/pediatrician.

Associated blood in stool: stool is bright red or black. It may indicate any serious enteric infection like dysentery or severe food allergy. Please note that a dark green colored stool might look black in the naked eye. You may rub a little stool in a white cloth to see whether it is dark green or black.
Not gaining weight: if there is growth faltering, there is a high possibility of underlying serious illness
A decrease in urine output means the baby is not passing at least 4 to 6 times a day.
Associates fever: may indicate an infection.
Not accepting feed well: baby is not taking his or her usual feed.
Significant abdominal distension: if the abdomen is distended and is tense
Repeated vomiting: baby is not able to keep the usual feed

When green stool is not dangerous

When not to worry: if the baby is passing greenish stool and

Active and playful as usual
Feeding well
Passing urine as usual
Not having any of the above mentioned “to worry” complaints

How to cure Green-stool?

What mothers can do:

Proper latching: This means baby is well attached to the breast. If a baby is bottle-fed, the baby should be kept in a semi-reclined position during feeding and bottle to be tilted upwards.
Mother to take care of her heath and feeding: as mother’s health and digestion directly or indirectly affect the baby’s health.

Check out this book edited by me

COUGH IN CHILDREN: WHAT TO DO? WHEN TO WORRY?

By drabhijit on April 30, 2020 0

Cough in children: what to do? When to worry?

Cough is one of the most common complaints children suffer. Not only it cause discomfort to the child, it also elicits stress and sleepless nights for their parents.

2 out of every 3-child aged 0 to 4 years visit their paediatricians at least once a year with cough.

Most of the time cough in children are results of acute viral infection and therefore self limiting and benign. Sometime it may be the indicator of a serious underlying problem. Overall most of the time cause is acute viral infection. 10 % of the time it is asthma . 1 to 3% of cases cause is a pneumonia and rest causes are very uncommon.

Cough is divided into acute or chronic depending on the duration of symptom.

Acute cough: less than 2 weeks

Chronic cough: more than 2 to 4 weeks

Most of the time acute cough is due to acute viral infection and they do not need any medication or any investigation. So if the child is active, playful and having undisturbed sleep at night you should not worry.

However if the cough is not decreasing by the 3^rd week and becoming more severe in frequency and intensity, earlier investigation is warranted.

When to worry?

Cough in newborn or small babies
Sudden onset cough
Chronic cough( i.e. more than 2 weeks)
Associated with fever, weight loss, night sweats, blood mixed sputum etc.
Cough with feeding
Continuous unremitting or worsening cough

What to do?

Ensure adequate hydration: give more water

Saline nasal drops: to unblock the nose as needed

Don’t give antitussives(cough medicines) on your own: most of the times over the counter antitussive medications are not effective in children. They can do more harm than good to your child.

Don’t give antibiotics on your own: which may be harmful .

Give paracetamol: if associated fever or severe pain in throat

Consult your doctor : it any of the above mentioned enlisted above in “when to worry” column present

So to conclude: cough in children is a very common symptom and most of the time it is self-limiting and do not need any treatment. You should not worry if your child is active, playful, feeding well, and having undisturbed sleep. But you must visit your pediatrician if any of the “when to worry” symptoms present.

This is part of the Blogchatter initiative #CauseAChatter.

See the other posts here

Covid 19 in children

By drabhijit on November 14, 2021 0

For the last two years, the whole world has been fighting against covid 19. Although many a thing is clear about coronavirus, many are yet to solve. Children are one of the worst sufferers in this regard. Schools are closed, parents are scared to send their children to playgrounds with other kids, and the fear of the third wave is coming. A lot of misinformation is circulating in social media about kids being badly affected in the third wave. In this post, I will try to answer common questions parents usually have about covid 19 in children

Are children more prone to covid 19?

No. Children show less severe symptoms compared to adults.

Do children will be badly affected in the third wave?

Unlikely.

As per ICMR data, almost 4% of children were affected in the first wave and nearly 6% in the 2nd.

As children are not at all vaccinated, their chances of getting an infection will be higher. And the percentage may be higher, but it is doubtful that children will be primarily affected in the 3rd wave. Adults will again be affected most in the 3rd wave.

If children are not going outdoor, how will they be affected ?

Children will get infected by adult members of the family. Some children who are going for coaching classes or playgrounds can get an infection from there.

What are the common symptoms of covid 19/ Coronavirus infection in children?

Most children will be asymptomatic or mildly symptomatic.

Few will have

Fever,cough, sore throat, headache and body aches, runny nose,loose stool, vomiting, pain abdomen

Very rarely children can have severe symptoms like breathing difficulties,convulsions, shock, bleeding

How to differentiate between covid 19 symptom or other illness ?

There is no such. So it is better to get tested. Consult your pediatrician. He can guide you on when to test. If any family member is affected or fever persists for three or more days, testing is essential.

What test is needed in children

COVID RTPCR is the gold standard. Nasopharyngeal swabs are taken for the test. Rapid antigen test can also be done. Covid 19 antibody test is sometimes done in some cases.

Can nasopharyngeal swabs test safe for small babies

Yes. In an expert hand, it is very safe and cause minimal discomfort

If a child is positive, can they be treated at home?

Yes.

Most of the children with covid 19 will be asymptomatic or mildly symptomatic, so they can easily be treated at home. But this decision should be taken after consultation with your pediatrician, and strict monitoring is a must for home treatment.

What are the things to be done during home treatment

Monitoring is most important. Temperature charting, counting daily passing of urine if possible check Spo2 and looking for development of any new symptom or danger symptoms.

PARACETAMOL can be given for fever 4 to 6 hrly.

More fluid and water to be given. Cough remedies like honey,tulsi can be given, a saline nasal drop can be used for nasal blockage as needed.

Always keep in touch with your pediatrician during home care.

What are the danger symptoms of covid 19 in children

Fever for four or more days

Reappearance of fever

Breathing difficulties

Low Spo2

Cold, clammy hands and feet

Not passing urine regularly

Convulsions etc

In general, if any child with covid 19 is active, playful, passing urine normally, and doesn’t show any danger symptoms can safely be treated at home under the supervision of a pediatrician.

How can we keep children safe?

As children are yet to get vaccines, we have to be more careful about them. Three things that are always helpful in this pandemic are SMS

Social distancing

Mask and

Safe hands

We have to follow those strictly. Also, we have to remember adults, even if vaccinated, can transmit the infection to children. So Adults should follow the safety rules always. Also, if any adult is showing any milder symptoms like sore throat and cough, coryza,

they should be isolated and to be kept away from children and senior citizens

Children should also follow safety rules while going out

Should I put mask on my children?

Yes, all children six year and above can safely wear a mask when taught. The Indian academy of pediatrics recommends even children two years old can wear masks under adult supervision. Always make them wear a mask at home first to get them adjusted.

Which mask is better

N95 masks are best, but any mask like a surgical three-layered masks or cloth mask also serves the purpose well when properly worn

What about the COVID vaccine in children

Many vaccines are in the pipeline for approval for children. Already few are recommended for 12 years or more children.

Vaccines will be approved very soon for younger children also. But the availability of vaccines will be a concern even after approval. We have to remember vaccines are not the only way to prevent infection. Other safety measures should be strictly maintained to keep your child safe even when vaccinated.

[Read more…]

Constipation in children: solution guide to parents

By drabhijit on April 29, 2021 0

Constipation is very common and also mismanaged problem of children. A detailed knowledge of the problem and how to tackle is needed to overcome it. Parents often practice various unsuccessful modes of treatment but for a short period of time.

How constipation becomes a disease

All start with a single event of painful stool passage following stool withholding (that can be due to change in place, eating habits, illness, drugs etc.). This withholding makes the stool stay in the rectum for prolonged period. It leads to harder and wider stool. This wider diameter and harder stool is more painful to pass, so the child again try to withhold it and thus the vicious cycle continues. When a short course laxative is given or a suppository is applied only a small amount of stool is passed without clearing the entire rectum. This leads to a chronic problem.

Why we need to know about constipation

1)      Almost 30 % of paediatric patients suffer from constipation. That means 1 in every 3rd child has this problem
2)      If not detected and treated early it becomes chronic and long-term problem
3)      Off and on treatment don’t cure the issue

What is constipation

Difficulty or delay in passage of stool sufficient enough to cause distress to the patient is called constipation.

This is more of subjective definition. To overcome it, now we have ROME IV diagnosis for constipation: presence of 2 or more of the following criteria for more that 4 weeks

i)        2 or less stool per week
ii)       1 or more fecal soiling per week after acquired toilet training
iii)      History of excessive stool retention
iv)       Painful stool passage
v)        Presence of hard mass on abdomen
vi)     Passage of large diameter stool that can obstruct toilet

What are the symptoms of constipation?

Common symptoms of constipation are
1)      Child is not passing stool daily: stool frequency varies from age to age. But in general, every child should pass soft stool daily. A constipated child pass less than 2 stool per week.
2)      Fecal incontinence: that is passage of stool in the undergarments.
3)      Stool retentive posture: child is attaining bizarre posture, hiding in the back, legs often crossed trying hard to retain or withhold stool (parents often think their child is trying hard to pass the stool but it is the opposite)
4)      Painful and hard passage of stool, sometimes bleeding after stool
5)      Presence a small skin tag near anal opening, known as sentinel pile
6)      Presence of hard or soft indentable masses in the abdomen
7)      Passing of large diameter stool

Types of constipation

A) Functional: common, almost 90 % of cases are due to it
B) Organic: due to diseases like Hirschprung, Hypothyroid, cystic fibrosis, coeliac disease etc..

Do we always need any investigation to diagnose constipation?

No, as most cases are due to functional constipation.

What are the red flag signs of constipation?

Delayed passage of first stool/meconium, onset in early infancy, failure to thrive, abnormal neurological examination, developmental delay, ribbon or pellet stools, bilious vomiting, uniform abdominal distention.

How to treat constipation in children:
4-pronged treatment is needed.

1)Counselling: parents must know the cause of it, course of the problem, how to treat, duration of treatment and need for regular follow up. Until parents and caregivers are well versed with all the aspects of it, treatment is likely to fail.

2)Toilet training:
Age when toilet training should start: 2 yrs of age
How: Rule of1 to be followed
by 1 person (only one caregiver should be responsible for training)
1 routine: 5 to 10 minutes after meals
1 place: a fixed toilet, preferably Indian style sitting is better
1 word like pooh, potty etc

Only one caregiver should make the child sit in a fixed toilet for 5 to 10 minutes after a meal and say a fixed word like potty
Treatment of anal fissures is must to make the defecation painless

3)Diet, Fibre and water intake
Dietary modifications and adequate water intake are needed to have a successful treatment.
However, parents should know that only dietary modifications are not sufficient enough to treat childhood constipation.
Diet: Diet rich in fibre like whole cereals, pulses, vegetables and fruits to encourage. Restrictions on milk, fruit juice, junk and ready to eat food has to be taught.

4)Drugs: Medicines are needed to treat constipation. As mentioned earlier, dietary modifications and toilet training are not sufficient to overcome this issue.

Which drug: Either polyethylene glycol preparation (powder or syrup) or Lactulose. Both are equally effective in treatment of constipation. Parents should know 3 things before starting drug therapy

1)      Disimpaction of stool is must before starting maintenance therapy: a paediatrician or gastroenterologist will know after examination who will need disimpaction treatment
2)      Long term therapy is needed: most cases of paediatric constipation needed 15 to 18 months of treatment before drug can be stopped
3)      Regular follow up with a paediatrician or gastroenterologist is must: to monitor progress, dose of drug and when to stop. Medicines are stopped gradually over 3 to 6 months period.

Common causes of treatment failure:

1)      Starting maintenance dose of medicines before disimpaction
2)      Premature stoppage of medicines
3)      Not doing regular follow up
4)      Not treating associated disease like anal fissure
5)      Organic cause of constipation

TAKE HOME MESSAGE

1) Constipation is very common in children
2) Most cases are due to functional constipation
3) Parents should know proper age and methods for toilet training to prevent constipation
4) Dietary modifications and toilet training are not sufficient enough for its treatment
5) Very safe and effective drugs are available for its treatment
6) Long term treatment is must, often 15 to 18 months
7) A regular follow up is needed to cure this problem

Leprosy: a curable disease

By drabhijit on February 25, 2021 0

Leprosy, also known as Hansen’s disease is caused by the bacteria Mycobacterium leprae that primarily affects the skin, peripheral nerves, eyes, and the upper respiratory tract resulting in skin lesions, neuropathy, deformities and disabilities.

The infection is said to spread through droplet infection. The disease develops gradually and can ultimately cause significant disability such as inability to use hands and feet if not diagnosed and treated on time.

Leprosy is a curable disease with effective treatment. Currently, the recommended treatment for the disease is 6 months of multidrug therapy (MDT) for paucibacillary and 12 months of multidrug therapy for the multibacillary variant.

Leprosy is a public health problem. It was eliminated globally in 2000 and India though declared itself free from leprosy in 2005, new cases continue to occur. According to the World Health Organization (WHO), over 2 lakh new leprosy cases were detected globally in 2016. India today accounts for more than half of all leprosy patients in the world.

Though the incidence of the disease has declined manifold, it is still happening with India contributing more than half of the global leprosy burden. According to official figures from 159 countries from the 6 WHO Regions, there were 2,08,619 new leprosy cases registered globally in 2018.

To fight leprosy, everyone should be aware of its symptoms and should visit a specialist as soon as any symptom is noticed. It is also important for all the patients to be mindful of the nature and course of the disease as adherence to the treatment is a must to cure the disease.

Treatment of leprosy is long, and few patients sometimes develop certain side effects after starting treatment. Proper counseling regarding the treatment and adherence to treatment, therefore, has to be ensured to get the desired result.

This is not all. Government and non-government sectors should work hand-in-hand to provide the necessary support for early diagnosis and treatment of the disease. They should also focus on stopping stigma & discrimination to mainstream those affected by leprosy & their families.

Disclaimer

Disclosure:This is a sponsored article. But all information provided is written and owned solely by the author.

Paediatric Food Allergies: What Parents Must Know

By drabhijit on February 1, 2021 0

Food allergies are common in children, and it is increasing. Children with food allergies can manifest very mild symptoms like rash and itching, although sometimes it can be severe, like breathing problems and anaphylaxis. Vomiting, recurrent abdominal pain, and growth faltering can also be features of food allergies.

How common are pediatric food allergy?

As per western data, almost 1 in 10 children have food allergies. Indian data is lacking, but some studies suggest that nearly 19% of children and adolescents are sensitive to 1 food item.

What are common food allergies in children?

The following eight food items account for more than 90% of pediatric food allergies.

Cow’s milk
Egg
Fish
Shellfish
Wheat
Soya
Peanuts
Tree nut

Peanut allergy is less common in India, but we see many cases of lentil or dal allergy.

Why are food allergies increasing?

Although the exact cause is not established, various theories are there.

Increase in urbanization and industrialization
Change in food habits
More awareness about hygiene
More use of antacids
Vit D insufficiency
Genetic predisposition etc

Whether food allergies are permanent?

No, some food allergies we gradually outgrow with age. But some food allergies persist lifelong

Types of food allergies

Food allergies are typically two types.

IgE mediated: here, children develop symptoms within minutes of ingesting food, easy to diagnose.

Non-IgE mediated: here symptoms can be delayed by hours to days, difficult to identify and diagnose.

What are the symptoms of food allergies?

Symptoms are different for IgE and non-IgE mediated food allergies.

IgE mediated: itching, urticaria or wheals on the skin, swelling of lips, breathing problems, severe cases can have hypotension and shock. Even death can occur if not treated aggressively.

Non-IgE mediated: vomiting, recurrent pain abdomen, diarrhea, blood mixed stool, growth faltering, abdominal distention.

Are food allergies and food intolerance the same?

No. Food intolerance is the physical manifestation due to indigestion of a particular food item if consumed in large amounts. That sometimes means your child will get symptoms but sometimes not after ingesting a specific food. Usual manifestations of food intolerance are bloating sensations, vomiting, loose stool. In contrast, food allergies are immune-mediated manifestations against a particular food. Even a small amount of food can be dangerous, and it develops every time food is taken.

Are food allergies genetic?

Food allergies can be transmitted in families. Still, you should visit your doctor before avoiding the food for your child.

How do we diagnose food allergies?

Various methods are available to diagnose a food allergy.

For IgE mediated food allergy:

Skin Prick Test (SPT): here, the skin is pricked to know the sensitivity of your child to a particular food. It is less expensive but invasive.

Specific IgE testing: here blood test is done to know the presence of antibodies in your child against a particular food. More expensive but non-invasive

For non-IgE mediated food allergy:

Endoscopy of various parts of the gastro-intestinal tract depending on your child’s symptoms.

Elimination diet and oral challenge: here, the suspected food is stopped from your child’s diet for 2-4 weeks. And then, it is gradually reintroduced to check the reappearance of symptoms.

If an allergy test shows a positive result, does it mean my child is allergic?

No, not necessarily. A positive result in an allergy test means only that your child is sensitized to those allergens/food items. Allergy is there only if your child shows signs and symptoms of allergy after ingesting a particular food each time. Only an expert will be able to help you in this regard.

Does the mother have to stop the allergenic food if breastfeeding?

There are chances of a child getting the components of offending food through breast milk. So a mother should avoid the allergic food. But parents should consult a pediatrician before making a decision.

How do we treat food allergies?

To date, the best is to avoid the allergic food. But as explained earlier, some food allergies kids will outgrow with time, and some will persist lifelong. So, parents should not decide about when to stop and when to start the allergic food. They should consult a pediatrician or an allergist.

Drugs: certain drugs like antihistaminics, oral steroids, and adrenaline are used to treat symptoms of allergy (never self-medicate as these drugs can be dangerous if wrongly taken)

Immunotherapy: it should always be done by an allergist or an expert in a setup with all the resuscitation facilities.

Hidden allergens:

There are hidden allergens in various food items we are not aware of. Always try to read the label of the food item before giving it to your child. Suppose your child is allergic to cows’ milk, and you have given him/her a biscuit that contains milk. So he/ she might develop a severe allergic reaction after taking the biscuit. If you don’t read the food label carefully, you will miss it. Also, various cosmetics and beauty products sometimes contain milk or nut oil.

TAKE HOME MESSAGE

Food allergies are common in children and increasing.
Manifestations of food allergies can be different.
Never self-diagnose and stop food to your child suspecting food allergy.
Allergy test positive does not always mean a food allergy.
There are some food allergies that kids outgrow, but some don’t
Always consult a pediatrician or an allergist before avoiding a food.
There are hidden allergens in various food and cosmetics; always read the label carefully.

Blog

Common questions parents have in their mind during weaning are:

What to feed during weaning?

6 Food group is needed for baby’s nutrition and development. Namely-

How to feed?

Weaning tips: What parents should remember while feeding.

Which baby food to start with at six months? All about weaning food

Baby food at six months:Examples

How to check tolerance?

What if my baby doesn’t tolerate solid food?

Parents often wonder-My baby doesn’t have any teeth, so how can he/she take semi-solid food?

How to check my baby is getting the required nutrition?

How many meals should a 6 month old have?

Why baby needs solid food after six months?

TAKE HOME MESSAGE

Share this:

How common is pain abdomen in children?

Causes of abdominal pain:

ROME IV criteria of different types of functional abdominal pain

Functional dyspepsia

Abdominal migraine

Irritable Bowel Syndrome

Abdominal Pain-NOS

When not to worry too much:

When to worry or seek medical attention, urgently (RED FLAG SYMPTOMS):

What parents need to do:

TAKE HOME MESSAGE:

Share this:

What can mother’s do to minimize regurgitation in babies

Common causes of vomiting in children are:

Complications of vomiting

What to do if your child is vomiting?

When to worry? ( Danger symptoms)

Take away message:

Share this:

Excessive cry in babies, especially when inconsolable, is a nightmare for parents and pediatricians.

What is colic?

PURPLE Crying in Colic

Why should we know and manage excessive cry/colic better?

What is the suspected Etiology of colic?

When to worry about excessive cry?

Take home message:

Share this:

Green stools in babies? In this post, I will be giving you a quick overview of the reason behind this common worry parents have.

Why green stool occurs?Normal physiology of stool color:

Causes of green-colored stool

When is green stool bad?

When green stool is not dangerous

How to cure Green-stool?

Share this:

Cough in children: what to do? When to worry?

When to worry?

What to do?

Share this:

Share this:

How constipation becomes a disease

Why we need to know about constipation

What is constipation

What are the symptoms of constipation?

Share this:

Share this:

How common are pediatric food allergy?

What are common food allergies in children?

Why are food allergies increasing?

Whether food allergies are permanent?

Types of food allergies

What are the symptoms of food allergies?

Are food allergies and food intolerance the same?

Are food allergies genetic?

How do we diagnose food allergies?

If an allergy test shows a positive result, does it mean my child is allergic?

Does the mother have to stop the allergenic food if breastfeeding?

How do we treat food allergies?

Hidden allergens:

TAKE HOME MESSAGE

Share this:

Hours & Info for Booking appointment