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Wednesday, December 26, 2012

Parent`s Query Corner


Parents queries corner published in Healthy Life Magazine in Issue December 2012 

    1. My child is 10 months old and yet he has no teeth eruption, what shall  I do  and is there something to be worried about ?

Answer:
Normally the time for first tooth eruption is at 5-7 months of age in lower jaw. Well in some cases there may be delay in primary tooth eruption, but one can wait till 12 -13 months of age. First you can examine the baby for signs of tooth eruption by gently rubbing your finger over the gum along the jaw bone inside the mouth and feel for any hard nodule or examine the mouth under good light for any white spots on the jaw ridge which are the positive signs for tooth eruption . If so then we can wait as he will have tooth eruption soon, but if he has not even a single tooth eruption by the age of 13 months  then he must be investigated for certain diseases  like hypothyroidism , calcium and vitamin D deficiency and some local oral causes or  bony causes. In that case you should visit your pediatrician or a dental doctor and investigate your baby . But as of now for your baby, you need not  panic and you  can still wait for few months and baby can be given some vitamin and calcium supplements .

2.  My  baby is 1 year old and she keeps having loose motions many times. During the episode of diarrhea she always develop’s nappy rashes . How should I prevent these nappy rashes and what do you suggest  doctor?

Answer:
This is the frequently seen problem in our day to day OPD in children with diarrheal diseases, so the first and foremost important thing is to avoid putting Nappy to the baby in daily routine care at home, as by doing so the mother becomes  care free for hours and hour and the baby skin is in contact with the stool/urine and the area is moist, since baby skin is very sensitive it causes local reaction in the skin after which the child develops nappy rashes and  as the word itself is self explanatory Nappy rashes- i.e. rashes caused by Diapers, so instead one should use regular cotton cloth nappies at home and use of diapers should be restricted only if one is going outdoors. Another important thing is that the anal area should be cleaned softly with mild Luke warm water. Area should not be rubbed and keep the area clean and pat dry.  One can apply diaper rash free cream or some emollient cream as well if they have developed rashes or redness in that area and consult your pediatrician later. Avoid washing her underwear’s or  nappy  cloth with strong detergents  and make sure it is dried properly before use.

3.  I have a 5 months old baby girl and this is my first child, so could you please suggest me that when should  I  start weaning in her and until when should I breast feed her?

Answer:
Congrats for your lovely motherhood, You have been blessed with a princess. As your concern this is the right time when you can start weaning her. Start with simple homemade food like dal pani, thin Jaulo, litto, sarwotam pitho Or formula feeds available in the market as cerelac, farex / lactogen milk, and gradually go on increasing the volume, types and number of feed. Later  you can add on with fruits like small yellow banana, boiled apple, boiled mashed vegetables, egg white and so on. Introduce one item at a time like: slowly keep on adding one newer food every week as per the child tolerance, because by this you can know if child is allergic to some particular kind of food and his tolerance to that food. Slowly increase calorie by adding one spoon of ghee or oil to food and dense feed as you start feeding him from the family pot by the age of 20 months  to  2 years. If wanted start cow or buffalo milk only after one year of age that too non -diluted and continue breastfeeding preferably till 2 years of age after which you can completely switch over to top feeds.

4.   I have a 10 year old son who is very prone for  allergy cough and noisy breathing, he catches  cold very easily especially during the changing season’s  and winter. We have to go for a frequent doctor’s visit when he lands up taking frequent antibiotics and nebulization. So could you please guide us with some preventive aspect so as to decrease his illness?

Answer:
Good that you asked me this question and this is the right time when you should take special precaution for him to prevent him from frequent cold, cough and allergy as winter is inn. The worst thing in these children is they will develop noisy breathing soon as wheeze possibly if they have additional family history of atopy or asthma. The most important thing is these children is to prevent them from dust, smoke, pet animal  fur’s, hard perfumes/odours, coloring agents in food, cold drinks, iced foods. He should use regular mask while travelling on road, use blankets with cover which is washable, and avoid contact with pets. The most important of all is by vaccination which is available as Influenza vaccine and pneumococcal vaccine and consults your pediatrician for this. During the episode get a timely check up before his symptom  worsens by your regular pediatrician and preferably keep  some emergency drugs for immediate relief as per your doctor’s suggestion.

Developmental Milestones related to Child’s Growth and Development


An article published in Healthy Life Magazine in Issue December 2012 


The best experience that any parent‘s come across watching their little one growing from a small dependent kid to a mature independent individual. 

Developmental milestones are a set of functional skills or age-specific tasks that most children can do at a certain age range.  Although each milestone has an age level, the actual age when a normally developing child reaches that milestone can very quite a bit. As Every child is unique! 

Child growth only refers to the child getting bigger in size while Child development refers to how a child becomes able to do more complex things as they get older and it mainly occur in four domains like: gross motor, fine motor, language, social-personal.

The individual level of functioning  of a child depends upon its level of growth and development in his childhood and it depends on both Genetic (nature)  and Environment (nurture), hence biological psychological and social factors play a major role to shape development  of any child.
Your baby will go through many changes in terms of growth and development during the first year of life before you know that your tiny helpless newborn will be a person in his own right. And growth being  an indicator for overall well being, chronic disease and interpersonal and psychological stress, it is very important for the parents to know some age specific milestones for a normal full term baby which is given in short as below:

Age of a child
Age appropriate milestones
New Born
Sleeps most of the time and drink milk.
Continue Exclusive Breast feeding.
6-9 Weeks         
Starts smiling and turn head towards sound.
10-13 Weeks
Neck holding, Cooing sound, recognizes mother.
14-19 Weeks
Head control present.
Smiles and plays with hand and feet.                           
Grasp rattle and rings and bring to mouth.
20-24 weeks
Sits with support.
Kicks and roll over.
Enjoy mirror.
6-7 Months
 Start sitting without support.
 Transfer object from one hand to other.
 Speaks Ma, Ba.
 Teething starts (lower central incisor).
 Start Weaning.
8 Months 
Starts crawling.
Hold toys with crude grasp.
Stranger anxiety develops.
Upper central incisor teeth erupts.
9 Months
Stands with support.
Waves bye – bye.
Speaks – Mama, Baba.
10-12 Months
Walk with support.
Responds to oral command.
Lower lateral incisor teeth erupts.
12-15 Months
Stands without support
Tries to feed himself
Sits on toilet
Speaks 2 words with meaning
Upper lateral incisor teeth erupts
15-18 Months
Walk without support
Make tower of 2-3 cubes
Feed himself with spoon
18-24 Months 
Runs
Feed himself with cup
Scribbles on paper, Make tower of 4-6 cubes
 Speak 8-10 words with meaning
2-3 Years 
Walk upstairs slowly
Draw a lines, Make tower of 8-9 cubes,                        
Makes simple sentence, point to body parts, name pictures
Start toilet training
Start feeding child from the family pot
3-4 Years 
Ride a tricycle, Walk downstairs, Broad jump.
Can dress himself and brush teeth.                    
Draw a circle, Knows gender, Give name, Name colors, Group play
Can post pond his toilet.
4-5 Years   
Walk up and down steps with alternate feet.
Copy a square (box).
Can undress himself , throw ball over head, role play present, Locate person and place.
Tells story, goes to toilet alone.
5-6 Years
Skips.
Copies triangle, counts till 10-15.
Knows number of fingers, Names a week.
Repeat five digits, Ask questions regarding meaning of the word.


Thus, milestone is the phases in the growth and development in all domains that any child grows
through from a dependent kid to an independent individual.
Every baby develops at his own pace and that the age listed above are not set in stone for development of the healthy baby who was born at full term. But a baby who was born prematurely would meet these milestones a bit later than a full term baby. There are certain diseases where child growth and development may be abnormal like: preterm babies, IUGR babies, metabolic disorders, malnutrition, genetic disorders, chronic systemic disorders, CNS abnormalities i.e.cerebral palsy etc. In these children the milestones could be delayed, abnormal or sometime even the regression of the attained milestones could be seen. In case of the above child may be subnormal, abnormal or they may not be able to do their normal day to day activities.
Now parents being the first teacher of any child and since they play a supreme role in the proper growth and development of any child it’s very important for any parents to watch closely the normal and it should strike them if there is any deviation from the normal like abnormal or delay in their milestones and ask these to their pediatrician when they visit them for vaccination especially during the first year of life. That’s why the time when you vaccinate your child is the right time when you can have your baby’s milestones checked in the Well Baby Clinic.
Now as a pediatrician we play an important role in examining the child for their age appropriate milestones when they come to us regularly for the vaccination till five years of life especially during the first year and advice parents for any abnormality seen so that the timely investigations early diagnosis and treatment can be done to prevent further deterioration and complication and giving a chance to every single child to live a normal and healthy life.
Note: As a Pediatrician I would request to all the parents to consult their pediatric doctor while vaccinating your kids, to examine for their age appropriate milestones.

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