FAQ

1) Breastfeeding:-

Breastfeeding is one of the options for feeding your baby after birth. The decision is individual, of course, but here are some reasons to opt for breastfeeding: the milk is optimally designed for your baby, it’s sterile, always available at the correct temperature, protects against many infections and other diseases, and helps develop a mother-child bond.

2) Why Do Babies Cry?

• A crying baby is a terrible thing for anyone within hearing range. The baby’s distress is intolerable to everyone around. Relatives, neighbors’, and even strangers give advice about how to calm the baby. But why do some babies cry excessively? That’s one of the most difficult questions in all of pediatrics.
• Babies often cry because they are hungry. It is surprising how many parents bring in their children for excessive crying caused by this. A readjusted feeding schedule, or addition of additional feeding, has a dramatic effect. Babies over the age of six weeks often cry because they do not like being left alone. Discomfort like being too warm, or too cold, or exposed to a strong breeze, being in a wet nappy, etc, can also make a baby cry.
• Babies between the age of one and three months are often cranky for a part of the day. Usually, these crying spells occur in the evening or night, and may last for one to three hours. During these bouts, the baby refuses to feed, and cries continually. Since we did not know what ailed the baby, we assumed it to be abdominal pain, and labeled it infantile colic. We now believe that these bouts are caused by a disturbance in the relationships in a baby’s family, worry and tension in the mother, excessive concern for the baby’s health, or a combination of some or all of these. This type of crying responds well to reassurance that the baby is actually well, and to relieving the worries of the mother. The crying spells usually stop entirely once the baby is three months old.
• Crying may be owing to pain. The pain of an ear infection, or a fracture due to an injury, or infection deep in the body, may manifest only as excessive crying. Serious illnesses like meningitis, pyelonephritis may come to notice first because the baby cried excessively. Maltreatment by someone in the family should be thought of — battered babies cry excessively in the early stages.
 

3) Infantile Colic

A) What To Do?

• Worrying is about the worst thing to do. A baby’s unexplained crying is often a reaction to stress in the people around. Your worrying may cause, or worsen, your baby’s colic.
  Feed baby in a sitting posture. This helps burping, and baby ingests lesser amounts of air.
  When the baby cries, soothe her and put her to sleep. Don’t overstimulate her by singing loudly, dancing with her, etc.
  All crying may not be colic. Check for a wet diaper, an open safety pin, ants in her clothes, etc.
  If your baby never cries, but is screaming in agony today, it is a good idea to contact your pediatrician.
  Behavior Modification
  Infantile colic is a harmless condition, and time limited as well. It is neither a disease, nor a manifestation of faulty care. Once the parents and other caregivers realize this, there is often a reduction in the baby’s crying. Colic is often a reflection of parental anxiety.
• Specific behavioral therapy has also been evaluated. Responding to crying by holding, patting, and putting to sleep reduces crying. Increased carrying of the baby during the day has no effect. Reducing the stimulation of the baby has also been tried — not lifting, jiggling, or patting, and reducing talking and noise. This is based on the belief that the baby’s immature nervous system is unable to take the stimuli of the outside world. No intervention works in all babies, which just shows that not all babies cry for the same reason.
• Some babies cry a lot. There can be a lot of reasons why babies cry , and not everything should be attributed to colic. Colic actually means pain in the abdomen owing to muscular spasm of some structure inside. There is no way of knowing whether a baby has pain or not.

B) What Is Colic?

• An otherwise healthy baby who cries for 3 hours or more a day on at least 3 days in a week is said to have colic. Crying typically occurs in the evening, and the baby feeds and grows normally.
• Just because we can define it doesn’t mean we know what it is. It is a very common condition, probably affecting 10-20% of all babies. The problem starts in the first few weeks of life, and it resolves by the age of 4-5 months. It is more common in formula fed than in breast fed babies, in first born children, and we do not know accurately what causes such behavior.
• Theories abound. The baby may have painful gut contractions. Breast milk contains a high concentration of lactose; inability to digest this may cause discomfort and crying. Cow milk allergy is one theory, and the protein involved can be found in breast milk. The child may have gas, or some other discomfort. Emotional turmoil, anxiety, depression, and household tension are known to contribute to colic. Or, these babies who cry so much may just be at the extreme end of the normal crying behavior of babies.

C) Do Drugs Help?

• Drugs that have been in use for a long time are anticholinergics. These are drugs that relieve spasm of the gut, and were popular because we thought that the crying was owing to pain in the tummy. One popular drug of this class is dicyclomine. It is effective in some babies, but it can cause sleepiness, coma, constipation, seizures (fits), breathing difficulty, and limpness. These side effects, often serious, have led to the drug being out of favor now.
• Simethicone is another drug commonly available, often in a combination with dicyclomine. It reduces the gas in the stomach, but has not been found to have a significant effect on a baby’s crying.

D) Feeding Modification.

• All kinds of dietary changes have been made to cure the crying. The two changes that have some benefecial effects are replacing cow’s milk with soya milk, or with whey hydrolysate. Other changes like casein hydrolysate, low lactose milk, etc, do not seem to work.

E) Home Remedies.

• One study in children with colic tried out a 12% solution (that’s 12 grams of sugar in 100 millilitres of water). It did reduce crying somewhat. surprisingly, it was found not to have any harms.
• Another substance that has been reported to help sometimes is herbal tea. These herbal teas contain chamomile, vervain, liquorice, fennel, and balm mint. And, of course, all kinds of traditional remedies are given to children. Many of them help, if the parents believe in them. There is a strong placebo effect in the treatment of colic.

 





4) FAQ regarding discharge from hospital.

A) Problems For The Baby With An Early Discharge

• Several problems that are common in babies appear only after two or three days. Babies that are sent home early after birth are at risk. These problems, not recognized and treated quickly, can have terrible consequences.
• Jaundice. This can often increase to very high levels without treatment, leading to mental retardation, deafness, seizures, and even death.
• Failure of breastfeeding, or premature cessation.
• Dehydration, and nutrition problems.
• Missed identification of birth defects. Some birth defects become obvious only after a day or two. Some of these can be catastrophic.
• Delayed vaccination. Some vaccines are given in the maternity homes itself. Early discharge may prevent this, and the child may remain unprotected against serious diseases.

Increased infections in the mother. And fatigue, as you take up the work of the home, and anxiety, as there is no one at home to ask about the baby’s care, and …

B) Safety Measures

Ensure the good health of your baby before checking out of the maternity hospital.
If you join a health management plan, make sure they don’t force early discharge on you. Ditto for health insurance.
Don’t, of course, harass the doctor for discharge. Rest and recovery for you, and observation of the baby are important. The world can wait.

C) What's The Right Time?

• Once upon a time, women would stay in the maternity home for a week after a delivery, resting and recuperating, while the hospital staff took care of the baby. These few days of rest and relative peace were invaluable for a new mother, as she also learnt about baby care from the nurses and other health professionals. Breast feeding was established under expert guidance, the baby was observed for the many problems that newborns can have, and the mother was spared the fatigue of domestic chores.
• Nowadays, however, a week’s stay seems like a luxury. There are other children at home, leave is scarce, the insurance plan allows only a short stay — more and more babies are being sent home soon after birth.
• Haste can be dangerous. Though there is less disruption of family life, and saving on costs, an early discharge after childbirth can be risky. There are several conditions of the baby that can appear after 24 or even 48 hours, and may be difficult to detect at home. Lifelong disabilities, and even death, can result from these.
• So when is it right to go home? No one can answer that, because every baby and mother is different. However, what is important is that the hospital staff is sure that the baby is normal, has adapted well to life in our world, and is likely to be normal in all ways at home.

D) Criteria For Safe Discharge

A normal child means a child born after a full nine months pregnancy, and who was born normally, and established respiration and other body functions after birth. This baby should be able to maintain body temperature in a crib, have normal breathing and heart rate, and be free of obvious birth defects. The hospital staff would like to ensure that the baby is taking breast feeds well, and tolerating the feeds. Urine and motions should have been passed at least once each. It usually takes 48-72 hours to ensure all this.

Apart from this, your doctor would probably like to have the baby examined by a child specialist. Discharge also depends upon your ability to care for the baby at home, the support available at home, and the access to health care personnel in case of problems.

It is always possible to pressurize a doctor to discharge you. With health insurance plans and managed care becoming more and more aggressive about cost cutting, these decisions are often not be in our hands anyway. However, we need to be aware of the problems, and not contribute to them. It’s inconvenient to stay in hospital, but compromising a baby’s safety is a terrible risk to take.

E) Common Causes Of Deep Jaundice

Exaggerated physiological jaundice.
Hemolytic anemias.
Prematurity.
Some drugs.
Infection (Sepsis).
Dehydration.
G-6-PD Deficiency.
Thyroid Deficiency.

Risks Of Deep Jaundice

Subtle brain damage.
Cerebral palsy.
Weakness of parts of the body.
Seizures (epilepsy).
Deafness.
Mental retardation.
Death.

F) Jaundice In Newborn Babies.

• Jaundice occurs in almost half of all normal full term babies. In preterm babies (those that have spent less than 37 weeks in the womb, also called premature babies), the incidence approaches 80%. So what is jaundice and why is so much attention paid to it?
• Jaundice is a yellow color of the skin and eyes, caused by the accumulation of a substance called bilirubin. Bilirubin comes in two flavors – conjugated and unconjugated. Conjugated bilirubin is water soluble and the baby passes it in urine. Unconjugated bilirubin collects in the body and causes problems.

G) Where Does It Come From?

• Bilirubin is a product of the destruction of red blood cells. This is a natural, ongoing process, as the red blood cells have a normal life span of 120 days. The hemoglobin inside is degraded to bilirubin, and reaches the liver. The liver conjugates the bilirubin to a water soluble form that can be removed from the body in the urine.
• Babies don’t bother to do all this before birth. They simply dump the bilirubin across the placenta. After birth, however, this convenience is no longer available, and the baby’s liver has to take up this task. It takes the liver a few days to activate the enzymes and processes to deal with it; meanwhile bilirubin accumulates in the body. This is known as Physiological Jaundice of the Newborn.

H) Is This A Problem?

• While bilirubin in the skin makes the baby look yellow and sick, this is not really dangerous. What worries the doctor is the possibility of brain damage, which occurs when the level of bilirubin rises very high in the blood. When bilirubin gets deposited in the brain, the baby can have permanent problems like deafness, seizures, weak muscle tone, and severe mental retardation. Very high bilirubin levels can cause death.
• Jaundice usually becomes noticeable on the third day, when blood levels reach 5 milligrams per 100 milliliters. This appears as a yellow tinge to the face. Around this time, the liver starts functioning, and bilirubin levels fall, causing the jaundice to fade. If bilirubin continues to accumulate, jaundice appears on the chest, abdomen, and finally the feet.
• How much bilirubin is dangerous? Earlier, a level of 20 milligrams per 100 milliliters was considered dangerous. In the last two decades, research has found higher levels to be safe in normal babies, and we are less aggressive about treating jaundice. Bilirubin toxicity occurs at lower levels of serum bilirubin in premature babies, babies who were asphyxiated at birth, and babies with infection or other diseases. These factors are considered when making treatment decisions for a baby with jaundice.

I) Treatment

• Drugs do not have much of a role to play. The mainstay of therapy is phototherapy – the exposure of the baby’s unclothed body to high intensity light. This changes bilirubin to water soluble products, which the baby can excrete in the urine.
• If the bilirubin levels continue to rise and reach dangerous levels, a procedure known as exchange transfusion must be carried out. It involves the changing of the baby’s blood with blood from a donor. This reduces the serum bilirubin levels to about a third of the level before the procedure. It is usually carried out in the sterile environment of an operation theater, and in expert hands, the risks are low.

 





5) FAQ regarding Powders,oils, bathing, Soaps And Cleansers ?

• Should powders be used on babies? They absorb moisture, and can be somewhat useful in humid climates. They are also usually perfumed, which can leave a baby pleasant smelling.
• However, powders can block the sweat pores of a baby’s skin. This can lead to the formation of miliaria and infections. More dangerous is the possibility of the powder being inhaled. Baby powder inhalation is a common mishap that occurs when it is being sprinkled. Baby powder aspiration is a serious problem, and sometimes leads to hospitalization and even death.
• Powder application has little benefit, and can cause considerable harm. Better avoided.

A) Oils

• Oils are useful as emollients, to soften and smoother the skin. Coconut oil and olive oil are commonly used, and are good for dry skin. Nut based oils like almond and peanut oils should be avoided.
• Some oils contain volatile chemicals, which can irritate the skin and cause contact dermatitis. In hot weather, oils can block skin pores and cause problems.
• In general, the skin of a newborn should be left alone, except for cleaning with safe water. Use of “Baby Care” products can expose a baby to dozens of chemicals. The side effects, toxicity, and skin absorption of most of these substances are not adequately known.

B) Bathing your baby

• The skin is a barrier between the body and the outer world. It protects us from various viruses, bacteria, and other infections. The skin also provides protection from hot and cold ambient temperatures, and from loss of water (dehydration). While adult skin usually deals with the outside world easily, a baby’s skin is delicate and immature. It is easily damaged/disturbed, and its functions may suffer.
• Bathing is a good way to clean a baby, and to remove blood and other substances after birth. However, at the time of birth, a baby is making the change from the temperature controlled environment of the uterus to the outer world. Giving a bath immediately after birth puts a strain on the baby, and hypothermia occurs often. The first bath should be given after a few hours, when the baby has stabilized its temperature.
• An early bath is recommended if the mother is suffering from infections like hepatitis B or AIDS. Washing off the maternal blood quickly is one of the measures to protect the baby from the infection. On the other hand, low birth weight babies should not be bathed in the first few days, especially if they are premature.

C) Soaps And Cleansers

• A baby’s skin is usually acidic. This acid nature has a purpose – it reduces the number of bacteria living on the skin. Bathing agents that make the baby’s skin alkaline or neutral, even for a short time, allow bacteria to grow.
• Most soaps are composed of fats and a strong alkali, and should be avoided. Babies do not sweat, so soaps are not terribly useful. Soaps also remove fats from the skin surface, leaving it dry and irritated. Plain warm water often suffices for a baby’s bath.
• Synthetic detergents with a pH close to the skin’s natural acidity are now available. They are milder and less irritating than regular soaps. They leave the skin’s natural acidity more or less intact after the bath, and thus do not promote bacterial growth.
• Most cleansing agents will dry a baby’s skin. Conditioners like lanolin, paraffin, or glycerin can be added to the soaps to keep the skin soft and supple.
• Even the best cleansing agents and products will do some harm to a baby’s delicate skin, and should be used minimally. Clean, warm water is the best for bathing a baby.

E) FAQ Regarding baby sleep.

A) Night Time Sleep Promoting Strategies

• Wake the child frequently during the daytime for feeding.
  Do not wake the child during the night for feeding.
  Do not entertain the child during night feeding. No humming, singing, or playing.
  After 6 to 8 months, baby can be given a toy in her cot.
  Try to get her out of the habit of sleeping with you after a few months.
  The last evening feed should be given late — at least 10-11 p.m.
  When the baby has started eating, give a meal late in the evening. A full stomach promotes sleep.

B) Babies And Sleep

• That’s a day in the life of a baby. Except for a few minutes when they’re hungry, babies sleep all the time. Indeed, babies can even be fed while sleeping. Problems arise for the parents when a baby doesn’t sleep enough.

C) What Is Normal Sleep?

• A normal newborn baby will sleep for two to four hours after feeding. At time of birth, babies have no concept of day and night, but gradually learn to sleep through the night with only two or three feeds. This usually takes a few weeks. By the time a baby is three months old, she should be able to sleep for 6-7 hours at a stretch at night.
• Formula fed babies (using animal or tinned milk) sleep better than breast fed babies. This is perhaps because breast milk is more easily and quickly digested, making baby hungry earlier. When breast feeding, it is unwise to impose any schedule. Whenever a baby is hungry is feeding time.

D) Why Doesn't My Baby Sleep?

• If a baby is not sleeping after feeding, or gets up very soon, perhaps she is not getting enough milk. Other causes of poor sleep are environmental noise, disease, fear of dark, fear of separation from parents, child abuse, and change in the family or caretaker. Corrective action regarding the cause gives better results than drugs in the treatment of infant sleep problems.
• What if your baby doesn’t sleep at night, or continues to wake at night for feeding? There is no one solution for this. A generally accepted fact is that sedative drugs are the wrong path; behavioral interventions are more likely to be successful.
• As children grow older, they sleep less and less. Most children give up their morning nap by the time they are 2 years old. Putting the baby to sleep as per habit often creates problems. Very often, the baby doesn’t go to sleep because she was put to bed for a long nap in the afternoon.
• Children also vary in their need for sleep. Some children seem to manage with very little sleep, making their parents anxious (and tired). Most children give up their afternoon naps by the time they are 5-6 years old. However, if your child is sleeping little, and appears tired in the day, or is not growing well, it is cause for concern.

 





7) FAQ regarding teething.

A) Timing Of Milk Teeth Eruption

Lower central incisors 5-7 months

Upper central incisors 6-8 months

Lower outer incisors 7-10 months

Upper outer incisors 8-11 months

Lower first molars 10-16 months

Upper first molars 10-16 months

Lower cuspids 16-20 months

Upper cuspids 16-20 months

Lower second molars 20-30 months

Upper second molars 20-30 months

B) Teething

It does not produce fever, colds, or loose motions. As the teeth pierce the gums, there is some pain and swelling, and the child may be fussy. The child may also produce saliva in larger amounts, and may drool. The assumption that a child’s fever or diarrhoea is because of teething, often prevents medical care, sometimes with dangerous outcomes.

C) Management Of Teething

Nothing much needs to be done. Some children go through teething with no trouble at all, but some children have soreness of the gums at the time, and become very irritable. A rubber ring to chew on is enjoyed by some children.

There are no medicines that can make teething easier, and probably none are required.

Teeth At Birth

Known as natal teeth, and seen in one in two thousand babies. They are usually attached loosely to the gums, and do not have deep roots. They can make feeding difficult for both baby and mother, and may need to be removed.

There is a risk of these teeth getting detached on their own and being swallowed (perhaps into the windpipe — very dangerous).

Late Eruption Of Teeth

There is a wide variation in the time when teething is expected to start (see sidebar).

However, if no teeth have appeared by the age of 13 months, it is considered delayed teething. Delayed teething often runs in families, but may be caused by defects of the thyroid and parathyroid glands, poor nutrition, vitamin D deficiency (rickets), or calcium deficiency. Some children have no identifiable cause for delayed teething.

An individual tooth may be delayed because of obstruction to eruption. This could be because of crowding of teeth, or hardening (fibrosis) of the gums.




8) FAQ regarding bedwetting.

A) Some Diseases Causing Bedwetting

Diabetes insipidus (which causes production of large amounts of dilute urine).

Diabetes mellitus.

Kidney diseases.

Some nervous system or spine disorders.

Urinary tract infection.

Irritable bladder.

Constipation.

Bladder stone.

B) When To Treat Bed Wetting

• Parents tend to get worried about the problem when children are 4-5 years old. The child is usually not bothered till the age of 7-8 years. That’s when treatment should be given — when the child is concerned, and wants to stop wetting the bed.
• Treatment of bed wetting is always strenuous, and sometimes expensive. Unless the child is strongly motivated, success is very unlikely. It is not sensible to force treatment on a child who is not motivated to stop wetting the bed.
• A determined child, and a supportive family are the most likely to resolve this problem quickly.

C) Bedwetting (Nocturnal Enuresis) In Children

• All babies wet their beds, of course, but what we are talking about is passing urine during sleep at an age when control is expected. About 20% of children at age 5 wet their beds, and about 15% of them achieve control every year. Most of these children are boys.
• There are two types of nocturnal enuresis. Primary nocturnal enuresis refers to children who have always been wetting their beds at night. Secondary nocturnal enuresis refers to those children who had achieved control, but have again started wetting their beds. The second type is likely to have an underlying physical or psychological disorder.

D) Where's The Problem?

The main problem, in children with primary nocturnal enuresis, is that they do not awaken when the urinary bladder is full. This is perhaps due to a delay of maturation of the nervous system. Scientific studies have found these children to be difficult to wake from sleep. Some of these children have small bladders, and a few may have urgency of urination– inability to hold the urine when the bladder is full.

Normally, urine production at night is less than daytime, under the influence of a hormone called ADH (anti diuretic hormone). It is suspected that children who wet their beds do not have enough ADH at night. This has not been proved. Some children habitually drink a lot of water or other fluids, and produce a lot of urine.

E) Looking Into The Problem

Children with primary enuresis do not often benefit from a series of laboratory tests. Only a few of them have an underlying disease (see box) as the cause of their bedwetting. Children whose bedwetting is caused by any of these disorders will benefit from treatment aimed at it.

During a consultation for this problem, a child specialist will examine the child carefully for any signs of these diseases. Only a few children will need investigations in a laboratory.

It is important to assess bladder capacity. This can be done by having the child drink liquids, and then measure the urine output when he says he needs to go. The normal capacity, in ounces, is the age in years plus 2. That is, a child of 5 years should have a capacity of seven ounces (1 ounce = approximately 30 ml). The normal adult bladder capacity is 12-16 ounces.

If the bladder capacity is normal, treatment is likely to be successful. Treatment is more difficult in children with small bladder capacities, though parents are often happy to find this problem (it’s the bladder’s fault, not their child’s!)

F) Treatment of bed wetting

What Doesn’t Help

Punishments. The child is not doing it on purpose.

Humiliation. Ditto.

Teaching the child to “hold it till morning”.

Keeping the child thirsty.

Diapers. They give the wrong message.

G) What About Drugs?

Two drugs are commonly used for the treatment of bed wetting. They are both effective, but only while the child is taking them. Nearly all children go back to wetting the bed once they stop the drug. There is no drugstore shortcut to curing bed wetting.

Desmopressin:-This is a synthetic form of the hormone ADH (anti diuretic hormone), and reduces the production of urine. It is available as tablets, to be taken at bedtime, and is effective for 10-12 hours. About 70% of children benefit, and about a quarter are completely dry while taking the drug. It has a high relapse rate after stopping treatment, but is useful for short term use (for example, when the child has to attend a camp).

Imipramine:-This drug is taken an hour before bedtime. About 70% of children benefit from its use; they have lesser wet nights a month, and lesser wetting accidents per night. Most children relapse after treatment is stopped. The drug has frequent and serious side effects.

H) Comparison Of Treatments

For Bed Wetting

Cure rate Relapse rate Risks

Alarms 70% 10% None
Parent
awakening Up to 90% 20% None
Imipramine 10-60% 90% Serious
Desmopressin 12-65% 90% Mild

I) Treatment Of Bedwetting

(Nocturnal Enuresis)

Bed wetting can be a terrible problem for a growing boy (or girl, of course, though the disorder is comparatively uncommon among them). As he grows up, there are more and more opportunities and requirements for him to spend nights away from home, and the child with this problem has to find excuses all the time. Even within the home, the teasing and humiliation can be merciless.

If an underlying cause is found, treatment directed to it can usually stop the bedwetting. Urgency (the inability to hold back the urine when the bladder is full) can be helped by drugs. Similarly, bladder stones can be removed, urinary infections treated, and constipation relieved. Treatment of diabetes is often difficult in children, but is essential.

A medical evaluation by a pediatrician is helpful. Many of the diseases that lead to excessive urine production can be identified. Sometimes, a few laboratory tests may be needed. Only a few children have an underlying cause for bedwetting.

While treating the problem, it is very important to preserve the child’s self esteem. Punishments, public ridicule, and teasing can lead to long lasting mental scars.

G) General Treatment

Set the correct goal. The child has to learn to wake up at night and go to the toilet to pass urine. Children who try to learn to “hold it till morning” will rarely be successful. Similarly, attempts to make less urine by reducing liquid intake in the evening will also be unsuccessful.
The basic defect is the lack of perception of a full bladder, or a failure to wake up with this sensation. A child is fully cured of bed wetting only when he learns to wake up and go to the bathroom.

Make it easy.The bathroom should be nearby and easy to reach. A nightlight can be a great help. Some children do well with a plastic urinal near the bed, or a potty seat.

Involve the child.All too often, the child starts thinking of the enuresis as his parents’ problem. Let the child know that only he can solve the problem. Involve him in the midnight or morning cleanup, which can be a good disincentive against wetting the bed.

Avoid excessive fluids The child should not have a large amount of fluids after dinner. Caffeine containing drinks (colas and coffee) stimulate the production of urine.

Empty the bladder This sounds obvious, but some children need to be reminded to use the toilet before going to bed.A device like a written notice near the bed can help.

Incentives Rewards should be given for the child’s staying dry by waking in the night and going to the toilet. Staying dry by holding the urine till morning is a less satisfactory achievement, because these children have not overcome the primary problem.

Maintain a record This is the only way to measure progress. A diary or calendar should be used to record dry nights and wet ones.

K) Parental Waking

This has been found to be very effective. The parents have to awaken the child a few hours after he has fallen asleep, and encourage him to walk to the bathroom and pass urine there. It is very important that the child should awaken fully, and be able to walk independently to the bathroom.

The parents should try the minimal stimulus that wakes the child (turning on the light, calling the child’s name, using a whistle or rattle, shaking the child’s shoulder, etc). If the child is difficult to wake or confused, try again after 20 minutes.

The child should be awakened each night at the parents’ bedtime for several nights. This should be done till the child awakens quickly to sound, after which self awakening should be tried. A more intensive parental awakening program, described by Azrin and Thienes, has been reported to have a success rate of 92%.

Alarms

Alarms have the highest success rate of all bed wetting therapy, and have been used for several decades now. They sound an alarm when the child first passes urine, and wake the child. Over time, it is believed, the child learns to anticipate the alarm, and wakes up when his bladder is full.

Some children sleep so deep that the alarm is not able to wake them. A parental waking program for a few days, so that the child learns to wake up to sound, can help such children.

For more information on causes and basics of bed wetting, visit the Bed wetting page.




9) FAQ regarding infection

A) Preventing Infections.

• Hand washing. This is very, very important. Staff must be educated about this. Hands must be washed after changing diapers, and before serving or preparing food.
• Keeping sick children away. Children with an illness should not be allowed in the class while infectious to others. The problem is, many diseases like chicken pox and whooping cough are infective before they are diagnosed.
• Vaccination. Available against many diseases now.
• Washing of toys frequently.
• Antibiotics.For infections like meningococci, which can be very dangerous. All children who have been in touch with an infected child should be treated for infection.

B) Infections At Daycare & School

Your child spends several hours each day in a classroom with 20-70 other children. At any time, one or more will be probably be sick, and other children in the classroom are at risk. What can schools do to lessen these risks?

In kinder, gentler days, children who were sick would be allowed to stay at home for a few days. These days, most parents are terrified of the backlog of work that builds up, and send even acutely sick children to school. Apart from being bad for the sick child, such acts are a hazard for the other children.

Are infections really common in schools? Yes, suggest careful studies carried out at several places. Children who attend school and daycare facilities have a higher incidence of diarrhea, respiratory infections, and other diseases.

C) Why Infections Are Common

Children are naturally susceptible to infections at young ages. In addition, they are unaware of safe practices like hand washing and sneezing into a handkerchief. Because of this, infections spread rapidly in day care centers and schools.

The staff of a school (or even a day care center) are often ill informed, or careless, about infection reducing practices. They may not wash their hands after changing a diaper, or before preparing and serving food. Small children often do not wash hands well after visiting the toilet.

A contributory factor in some places is overcrowding. Combined with poor ventilation and sunlight, this can increase the risk of any infection many times.

D) How Are Infections Spread?

Large respiratory droplets.

A sick child’s coughing produces these large drops of secretions, which contain germs. Being heavy, they settle on nearby surfaces, including hands, napkins, toys, etc. Several viral and bacterial infections are spread in this way. Among them are respiratory syntactical virus, adenoviruses, Neisseria meningitidis, Hemophilus influenza, and Streptococci pneumoniae.

Small respiratory droplets.

These are produced similarly, but being light, they float in the air for a long time with their deadly cargo of disease producing germs. They can be breathed in by children in the class, leading to disease. Measles, chicken pox, whooping cough, and tuberculosis are spread thus.

Enteric spread.

This means spread by the sick child’s feces. The child who doesn’t wash hands well, or the staff member who changes diapers for small children, can carry germs on their hands. Typhoid fever, jaundice, and diarrhoea are spread thus.

Direct contact.

Some diseases like scabies, head lice, fungal skin infections, bacterial skin infections, and conjunctivitis (pink eye) are spread by direct contact with an infected person.

Biting. This is quite rare, but dangerous. Hepatitis B has been known to be transmitted by bites. Also possible are hepatitis C and AIDS. Bites can also cause infections at the site of the bite.




10) FAQ regarding pet..

A) Preventing Animal Related Disease

• Vaccinate pets against rabies.Keep the vaccination up to date, and make sure of a reliable source for the vaccine.
• Children should wash hands thoroughly after petting, bathing, or other activity with a pet. Also get them into the habit of washing hands before every meal.
• Never approach an animal while it is feeding, sleeping, or injured.
• Female animals are irritable and prone to attack after they have delivered babies. Be wary of these fiercely protective mothers.
• If bitten or scratched by a pet, wash the wound immediately with plenty of soap and water. Then take the child to the doctor for evaluation. Remember, there is no cure for rabies once it has developed.
• If a child has asthma, ideally, it is time to say good bye to pets. If this can’t be done, keep the animal out of the bedroom, and shampoo frequently.
• If there is a family history of allergic diseases, take steps to spare the baby exposure to allergens. This includes removal of pets. This should be done several months before the baby is due, for animal allergens can persist in the indoor environment for months.
• Some dogs like dobermans, rottweilers, German shepherds and pit bulls, are bred and trained to be aggressive. These dogs are not suitable for children.
• Wild animals should not be kept as pets. Monkeys, hedgehogs, and other unusual animals can be dangerous and should not be given to children.
• Avoid reptiles for pets, because children can get salmonella infection from them even without close contact.
• Clean bird cages frequently, and wear gloves when doing so. This prevents psittacosis.
• Young children and babies should never be left alone with animals. Children should be taught not to tease pets, and never to put their faces near the animal’s mouth.

B) Health Risks Of Pets

Children love pets. They play with them, sleep with them, and practically live with them. A child with a pet has a faithful, dependable companion, and is envied by his friends. But these “best friends” carry risks of diseases.

1) Allergic Diseases

• The tendency to allergic diseases like asthma, rhinitis, and eczema is inherited, but children who are exposed to allergens develop the allergy quicker and more strongly. Exposure to allergens early in life is a risk factor for the development of sensitization and allergic disease.
• Cats release an allergen, fel d 1, into the environment which can provoke and worsen asthma. Similarly, dogs, too, release an antigen. These are two of the commonest antigens involved in childhood allergic diseases. 66% of children sensitized to cat antigen have been found to have either asthma, eczema, or rhinitis.
• These antigens can persist in the home environment for months after the animal is removed. If there is a family history of allergic disorders, the animal should be removed from the home several months before the baby is born. About a third of childhood asthma can be attributed to allergen sensitization, and this may not become obvious for some months after a pet is acquired.

2) Infectious diseases

• The scratch of a cat can cause Cat Scratch disease. It is caused by bacteria called Bartonella henselae, and is sometimes difficult to diagnose because of unusual features (it usually shows up as enlargement of the lymph nodes and fever).
• Cats and dogs are often host to worms, which can infest children, especially those under 3 years. Many of these worms cannot live normally in humans, and cause abscesses, pneumonia, blindness, and seizures and other brain disease, among several other manifestations.
• Psittacosis (Ornithosis) is an infection acquired from birds like parrots and macaws. Also known as Parrot Fever, it is a pneumonia caused by bacteria called Chlamydia. It is acquired by humans while cleaning the bird cage, or handling a sick bird. This infection can cause illness ranging from mild influenza like illness to life-threatening pneumonia. Infections by Chlamydia do not respond to the antibiotics usually given for pneumonia.
• Microsporum canis is a fungal infection that animals (mainly cats) can pass on to humans, which manifests as ringworm. This is an important cause of ringworm in children, especially of the head and neck.
• Other diseases that cats carry and can infect children with are Toxoplasmosis, and diarrhoea owing to Cryptosporidium parvum.
• Reptiles as pets carry a specific health hazard — salmonellosis. Salmonella are bacteria, and can be transmitted to children sharing a home with snakes, turtles, salamanders, and other reptiles. These bacteria cause abdominal cramps, bloody loose motions, and fever, and are difficult to treat with antibiotics. Cats and dogs can also transmit this infection.

3) Animal Bites

Animals have many germs in their mouth that can cause disease in humans. The germs exist in the animals’ saliva, and it is important to It is a false belief that pet dogs do not bite their owners. Most dog bites occur from pets or neighborhood dogs. PREEXPOSURE PROPHYLAXIS FOR rabies involves three doses of antirabies vaccine at 0, 3, & 27 days. this allieviates need for antirabies immunoglobulis in category 3 bites and decreases postexposure doses to only two at day 0 & 3. Cats, on the other hand, do not bite unless provoked.

realise that a lick can also transmit the disease. Also, animals frequently lick their claws; a scratch may be as bad as a bite.

The most dangerous infection transmitted by animal bites is rabies (hydrophobia). This is a viral infection, and is almost 100% fatal. It can be prevented by vaccinating the bitten person immediately after the bite, and all pets should be vaccinated against rabies.

Dogs and cats usually will not bite humans without cause. An animal which bites a child without provocation has a possibility of being rabid, and the child should receive the anti rabies vaccine as soon as possible. Rabies can be transmitted by most warm blooded animals.

The most common infection transmitted by animal bites is Pasteurella multocida. This germ exists in the mouth of healthy animals like cats and dogs, and can cause infections at the site of a bite. Rarely, it has been known to cause serious infections like meningitis. Most commonly, animal bites will result in redness, pain, and swelling around the wound, pus and abscess formation, redness of the involved lymph vessels (lymphangitis), and fever. Apart from P. multocida, other germs involved may be Pasteurella canis, Pasteurella septica, streptococci, staphylococci, moraxella, and neisseria. Cat bites can also transmit Cat Scratch disease.

4) Other Problems

• Pets often carry fleas and ticks, and these can transfer to children. They cause severe itching, allergies, and can transmit some dangerous diseases. Good pet hygiene is important to avoid these problems.
• Dog bites can be very violent, and fractures and other tissue injuries can occur, especially in young children. Dog bite injuries in children often occur on the head and neck, and deaths are known. These usually result from injury to the large blood vessels in the neck.




11) FAQ regarding School & bag..

A) Minimizing School Bag Damage

The bag should not be more than 10% of the child’s own weight. A child weighing 30 Kg should not carry more than 3 Kg on his back.

Choose a schoolbag with broad, padded straps. Narrow straps can squeeze nerves or blood vessels, and also chafe the skin.

Satchels and bags with one strap cause asymmetrical distribution of weight on the spine. This can lead to long term back pain and other problems.

The child should always use both straps of the school bag. Slinging the bag over one shoulder causes spine damage.

Bend at the knees with the back straight when lifting the bag. Lift with the legs, not the back.

B) Is The Bag Too Heavy?

If the child needs help to lift it onto the shoulders.

If the child leans forward when walking with it.

If the child pants for breath after walking a short distance with the bag.

If the child complains of shoulder and back aches and pains.

Heavy Schoolbags & Backpacks

Do you sometimes feel schools are training children to be porters when they grow up? You’re not alone. All over the world, parents, doctors, and educationists are worrying about the weight that children have to carry, and the effect it has on their backs, shoulders, and general health.

An average school day consists of eight periods or classes, usually of different subjects. Each subject requires the child to carry a textbook and several notebooks. Added to the several kilograms of books and notebooks are lunchboxes, water bottles, and sports equipment. Children end up carrying huge burdens on their backs, and it is no wonder that so many of them have aching backs and shoulders.

C) Problems Caused By Heavy Bags

Lifting heavy burdens for a long time or distance isn’t good for anyone, least of all children. A recent study found that half of the schoolchildren studied had pain in the back or shoulders. The researchers also found that children in lower grades carried heavier bags.

Carrying a heavy bag on the back causes forward leaning and bad posture, which can lead to improper weight bearing on the spine, and pains and aches in the back and shoulders. Carrying a backpack weighing 15% of body weight makes a child or adolescent unable to maintain proper standing posture. Children could get into bad habits like poor posture and slouching.

Forward bending at the back (also called kyphotic posture) makes the work of breathing harder. Children carrying bags weighing more than 10% of their body weight have been found to have poorer lung function.

Children who use one strap bags (which put weight on one shoulder only) have particular problems. These bags cause sideways deviation of the spine (scoliosis) because of the asymmetric weight distribution, and this can cause long lasting back aches and damage.

D) Strategies To Lighten The Load

Bags in the good old days were lighter because educational standards were lower, and there were not so many extracurricular activities available. We can’t reduce educational standards or deprive children of their sports and other recreation, but efforts from teachers, school managements, and parents can help to great extent.

Provide lockers to children in school. This will allow them to leave sports equipment, and certain books and notebooks in school.

Buy two sets of textbooks, and keep one set each in school and at home. For a small additional expense, the weight carried to and fro each day is significantly reduced.

Tell students in advance which books will be needed and which can be left at home. Some subjects have more than one book, and several notebooks.

Teach the child to put down the bag when waiting at the bus stop, in the assembly, etc.




12) FAQ regarding television, multimedia..

A) Health Effects Of Television

• Promotes laziness and overeating, especially fatty foods, leading to obesity.
• Fat children grow up into fat adults.
• Obesity can cause diabetes, heart disease, high blood pressure, and early death.
• Late night television watching, or very stimulating or scary programs in the daytime, can cause reduced and poor sleep.
• Poor and insufficient sleep leads to poor school performance, depression, and poor self esteem.
• Television doesn’t just promote obesity — it also causes eating disorders in adolescent and teenage girls. Watching the superthin models and actresses has a known impact on young girls’ psyche.
• In Fiji, television was introduced in 1995, and the only channel showed programs of American, British, and Australian origin. Girls who watched television were 50% more likely than others to see themselves as fat. Symptoms of eating disorders like anorexia and bulimia have increased five fold since then.

B) Television And Children

For three decades now, the issue of television viewing and its effects on our children’s bodies and minds has been hotly debated. Much research has been conducted, and now we know.

C) How Much Of A Problem Is It?

Children in America (well, that’s where most of the research has been done) watch an average of three hours of television programs a day. This is apart from other uses of the television set, like watching movies on disc, and games. It is estimated that children spend about the same number of hours before the television as at school. So much time spent with television promotes sloth, obesity, poor school performance, and poor activity and fitness. It also reduces social interaction, both within the family and with friends.

Television viewing, especially in the evening is a cause of sleep disturbance, like bedtime resistance, anxiety, sleep onset delay, and reduced sleep duration. A television set in the child’s bedroom contributes heavily.

Frequent exposure to violence in television programs has been repeatedly found to be linked to real life aggressive behavior among children. Most programs that children watch, including cartoons, contain violence. Older children and adolescents often watch music videos, which show weapon carrying, alcoholic drinks, smoking, and drug abuse quite often.

There is other content on television, of course, like news, information, education, and general knowledge. Some programs teach children about the world around us, friendship, cooperation, and even school subjects. These programs are an oasis of relief in a world full of violence, sexuality, and advertisements for cigarettes and alcoholic drinks.

D) What Can We Do?

• Watch television with the child. Presence of a parent inhibits the watching of certain programs. Besides, we can switch channels if the content gets unsuitable for children.
• Discuss the content with the children afterwards. This helps them draw the right conclusions.
• Restrict the television watching to an hour or two each day. Encourage the child to select informational and educative programs.
• Be knowledgeable about the effects of television on children, including violent/aggressive behavior, poor body concept and self image, early sexual activity, and substance abuse (alcohol and drugs). Forewarned is forearmed.
• Encourage reading, sports, hobbies, volunteer activities, and other pastimes.
• Serve as good role models for our children by not watching too much television ourselves.
• We should write to television channels, producers, and directors about unsuitable content in a show or specific episode. Also to politicians to prohibit unsuitable programs and advertisements.
• The temptation is strong, but we shouldn’t use the television as a baby sitter.
• Laying down the law about television can lead to confrontation in the family. A calm explanation about why certain programs are off limits will have better results, and the children will learn family values.
• Best of all, of course, is to give our children so many alternatives that television gets neglected. We can take them to the library, museums, parks, games, social activities and other places where much can be learnt. This requires a massive outlay of time and effort from us, of course, but aren’t our children worth it?




13) FAQ regarding Body Mass Index (BMI) & obesity..

A) FAQ regarding Body Mass Index (BMI)

This is a measure of appropriateness (or otherwise) of a person’s body. The body mass index (BMI for short) is calculated by dividing the weight (in kilograms) by the square of the height (in metres). For those who enjoy formulas:

Weight in Kilograms = BMI Height x height in metres

The significance is the same as in adulthood. A value of over 25 indicates overweight, and 30 plus is obesity.

B) Obesity Strategy

• An imbalance between dietary intake (overeating) and activity (laziness) is the cause of most fat children.
• Obesity runs in some families. Rarely, there may be an underlying endocrinal or genetic disorder.
• Obesity is resistant to treatment. Prevention is very important.
• Lifestyle activities like cycling and walking are more likely to be followed long term than other forms of exercise.
• Drastic dieting during the growth period is wrong. Children should be encouraged to maintain a steady weight so that they grow well.

C) Obesity & Overweight In Children

This is an increasing problem all over the world, and the World Health Organisation (WHO) has declared obesity a global epidemic. Doctors can’t do much about it, and programs based in schools and specal obesity clinics haven’t achieved much success either. Obesity and overweight must be prevented rather that treated — in the home, by the family.

The Problems

Fat children have a lot of problems — physical, psychological, and social. They get teased and bullied in school, and find it difficult to make friends. Children as young as six years learn that overweight is undesirable and start experiencing social rejection and isolation. The burden of being obese affects educational achievement and social relationships. These problems can often persist into adulthood.

Fat children often grow up into obese adults, especially if there is a family tendency to obesity. Obese people are at high risk for a number of health problems — heart disease, high blood pressure (hypertension), joint problems (osteoarthritis), asthma, diabetes, and even some types of cancer. As obesity increases in children, the adult type of diabetes is being seen among them.

D) Why Is Obesity Becoming Common?

Lifestyles are changing. Children play computer games instead of outdoor sports, go to school on autovehicles instead of bicycles, and spend a lot of time watching television. Foods rich in fat and calories are becoming popular with children.

This is why treating overweight and obesity is difficult for doctors. Lifestyle and environment are hard to change. Teaching children healthy eating habits, and encouraging active leisure activities, are important in avoiding the problem.

E) Why Is Obesity Becoming Common?

Diet. Drastic dieting is bad for growing children, and is not followed anyway. A hungry child is an unhappy child; it is better to teach them healthy eating. Salads, fruits, and vegetables can be eaten freely, while calorie rich foods like chocolates, fried food, etc, should be avoided.

Physical activity.Reduction of sedentary activities like television and computer games, and encouragement of active sports is useful. These measures, along with aerobic exercises, help in controlling and reducing obesity.

Therapies like fiber supplementation and appetite suppressant drugs do not help, and are not recommended for children.

Parental support.Slimming is more successful if the program is controlled by the parents. Parents can change family behaviors and eating patterns, and they should take responsibility for the eating and exercise of children.

Schools And Obesity ProgramsSchools seem to be ideally placed to fight the obesity epidemic sweeping our children. Children spend several hours a day there, and are greatly influenced by teachers. A health education program in school, coupled with the facilities for healthy activity under supervision which most schools have, should be a potent way to control obesity.

Unfortunately, it doesn’t work. Special programs need a lot of effort in the training of teachers and other staff, and time set aside from the already crowded time table for health education. After all this, all that is achieved is an increase in knowledge about nutrition and obesity; eating behaviors, obesity, lipid profiles, blood pressure, and activity levels don’t change much.

One recent program involved ten schools, and found that teachers, parents, and children cooperated perfectly. They also learnt a lot about nutrition. However, the children’s eating habits changed very little. They ate a little more vegetables, but less fruits. Ironically, the program was named APPLES. (Honest. It stands for Active Program for Promoting Lifestyle Education in School).




14) When To Rush To Your Doctor

No response to fever medication (high fever).

A child less than 3 months old.

Seizures (fits).

Breathing difficulty.

Fever more than 3 days.

Child dull, abnormally sleepy.

A rash.

Refusal to eat and drink.

Confusion, delirium, or excessive crying.

Repeated vomiting, or profuse diarrhoea

14) Fever In Children

Managing a child with fever

Fever isn’t all bad. It is a defense mechanism of the body, and actually helps us fight disease. Some germs, for example, do not grow well at higher temperatures, and the defense systems of the body perform better.