Children are like flowers do not leave them to chance !

Many years ago child was regarded as a miniadult with no special understanding of childs biology and specific requirements . Stalwarts all over the world realised the childrens biology , biochemistry , disease manifestations and pharmacological responses were specific to their body size and organ maturity . Thus Pediatrics as a speciality was born and started being taught as a separate subject . Now this speciality is advanced to the extent that there is fetal medicine for the unborn bany still in the womb , neonatal medicine for chikdren below one month , the medicine for first 1000 days of life , preschool child , school child and adolescent medicine . Parents must be aware of peditrics and its superspecialities . They must take children to pediateicians even in good health so that preventive advise regarding nutrition , vaccination etc can be given timely to ensure adequate growth and development till puberty to make a chikd into healthy productive adult . Vaccination is the most effective public health strategy which goes on till adukthood and parents must not miss any vaccination for children and at later age as well . Parents must ensure mothers milk timely weaning , nutritious food , cleanliness , sun light , outsoor sports , vaccinations, child safety measures and early medical attention by pediatrician whenever needed . If this is done we will build happy and healthy society !

VACCINATIONS during COVID time.

Most of the times parents ring up to ask weather they should postpone the vaccine because of danger of Covid 19. If you say no , they would again question " but will it be alright to take a risk of Corona ?" If you say yes wait for a few days , again the question will be " wont it harm if I delay"? All the concerns are genuine . The answers could be like this , do not postpone the vaccines unless you or your doctor are in qarantine so obviously you cant go . but if both are ok there is no reason to delay unless medical conditions like fever , diarrhea or any other illness warants a delay. How to ensure safety? Doctor must have sanitised the clinic and must have scheduled the children requiring vaccination in a different time slot not coinciding with diseased children. Doctor must have spaced the appointments , so you must go at appointed time only. The person taking child must wear a well fitting mask , any child above 5yrs old should also wear a well fitting mask. Dont take extra attendant. Do call the doctor from parking so that the clinic door windows are open and you can walk in straight without touching any object. Carry sheet from home which you can spread on designated area and sit down with the child. In the clinic do not talk . whatever questions are can be asked before reaching clinic on phone or after coming out on phone. The child should also be well conselled to keep quiet. Generally soothers are no good but at this time they should be used so young babies do not cry.Becase crying diseminates virus at high velocity even from asymptomatic patient. The spirit swab used for vaccine must be disposed of as biomedical waste in doctors clinic before you come out with baby. Paracetamol can be given for fever and pain after vaccination. So you vaccinated your child on time with all precautions. Now relax and keep consulting doctor as a part of TELEMEDICINE which is safe and eqqually effective.

PRACTICAL TIPS ON GROWTH OF CHILDREN.

Height :-

At birth average ht is 50cms

It should increase as follows 

1st 6 months   2.5 cms every month

Next 6 months  1.25 cms per month

1st year of life + 25 cms per year

1 to 2yrs     +12.5 cms per year 2 to 12yrs  +6.25 to 7.5 cms per year.

Birth height doubles at 4 yr of age & trebbles at 13yrs of age.

2to 4 yrs  ht in inches = ( Age in yrs x 2.5 ) +30 inches.

4 to 11 yrs in inches = ( age in year x 2) + 32 inches.

Height of adult in centimeters = twice that of child at 2yrs of age in cms + 2cms.

Weight

Initially birth wt is lost but is regained by 10th day.

It increases one ounce per day upto 6 months 

doubles birth wt 5 to 6 months

second half of 1st year 15 gm per day increase

birth wt trebbles by 1 year, quadruples by 2.5year of age.

weight in pounds 

3 to 12 months = Age (months)+11

4 to 8 yrs = 6 xage in years +12

8to 12 yrs = 7x age in yrs +5

weight after 1yr = ( age in yr +3 ) x5

Head Circumference :-

At birth 1.25 to 2.5 cms larger than chest. 1st 2 months same than smaller .

Chest :-

Barrel shaped at birth  transverse diameter i= Ap diameter

1 st year transverse is 25 % more than Ap

6th year Transverse 33% more than Ap

Upper segment : lower segment 

Upper segment is crown to symphysis pubis and lower segment is symphysis to sole.

At birth  Mid point is 1.8cms above umbilicus

At 2 yrs it is just below umbilicus because extremities grow more rapidly than trunk.

At 16yrs mid point is near symphysis pubis.

Sitting height at birth 70 % of total length.

                       at 3yrs 57%of total  length

                       at puberty 52% of total length

There are medical conditions in which sitting ht to total ht ratio falls.

Sutures & Fontanelle

Anterior fontanelle is 2.5cms x 2.5cms at birth , it closes between 9to 16 months 

Main sutures fuse by 6months.

Premature closure of sutures and fontanelle can be dangerou for growing brain which grows greatest in first year of life and 80% of total growth of brain is in first 4 years of life.

Melinisation begins after 3 months and is complete by 3yrs.

Heart is transverse in young infant , apex of heart is in 4th intercostal space , by 8 yrs it comes in 5th intercostal space. Upto 1yr heart is 55% of width of chestin adults it is 50% width of chest.

Urine  1st day is 15cc , 10th day is 100 to 300 cc.

There is no air in GIT upto 6hrs of life meconium is passed upto 3 days , transitional stools 4th to 7 days and later loose slimy green .

Tonsils  increase in size upto 5yrs of age and are mistakenly diagnosed by inexperienced doctors as enlarged tonsils and children are unnecessarily operated upon making children loose precious defense organ of body.

Pulse rate in new born to 1 year  per minute 120 & Bp 85/60

                                         2ys 110 , 4rs 100 , BP same  as above.

                                         6yrs 100  BP 90/60 , 8yrs 90 , BP 95/64

                                         10yrs 90 & BP 100/65 , 12 yrs 90 & BP 110/70.

       Ossification of centers , at birth 5 centers are present 2 in knee and 3 in ankle in talus , calcaneus  and cuboid   . At 6 months 2 carpal bones capitate and hamate appear.

Thus it is very important for a pediatrician to examine the child keeping all dynamic growth of child in mind and parents must realise that child is not just mini adult . Child needs pediatric expert.            

Parents towards children.

Parents are overambitious when it comes to children.
Firstly they start running for treatment of infertility even though the partners have been together for very less time as per the medical norms to call it infertility.
When the lady conceives they are overenthusiastic about having a male baby and ready for female feticide.
After the birth they want the child to be a superman therefore want to leave no stone unturned for that.
They try to interfere with the normal development. For example they try to toilet train the little baby by taking him to sink to pass urine where
as the actual age for toilet training is two years. They make the baby to sit with support as early as three months whereas actual age of sitting with support is 6 months..
whenever someone visits parents very enthusiastically ask the little baby to say bye to visitors whereas the actual age to say bye is 9 months.
They want to introduce walker prematurely. They force the children as young as 18 months to the school . Actually the age for mature grasp , holding the pencil and scribbling , making a line , vertical stroke and circle is all much later, making a triangle is learnt at 5yrs of age.
At all ages children are victims of parental anxiety , anger & foul language for not coming first.
In summer vacations forcing them to join hobbey classes weather the like it or not.Parents keep the time table of children so tight that there is no opportunity  for exploring creativity , self learning , learning from environment , grandparents or anything they like.
Throughout childhood they are grilled towards a career oriented path chosen by parents ,running for tutions rather than enjoying the school life Admission into professional college by hook or crook is the sole aim.
parents mostly  have an authoritarian approach "finish this milk before you step out ,I will see how you dare do this " if not this approach of bribe is there. "no tv for you if you do not come first.
punishment rather than logic " just be locked in the bathroom till you say sorry. Projecting father as terror "ok let your  father come he will slap you tight " Taunts " money doesn't grow on  trees , how dare you waste money"
In these trying times of lockdown ,parents are most anxious about syllabus completion , online classes.
So much so that some parents are on anti anxiety medicines.
All parents  always wish the best for their children but unknowingly they harm children's personality development by these unintentional mistakes.

Children are like flowers do not leave them to chance.

Children are like flowers do not leave them to chance.

So much can be done to keep them healthy and to make them good human beings.

All parents do every thing possible for children .

Yet diseases are increasing , stress in children is increasing ,drug abuse is increasing

crime is increasing,and so many other undesirable things are n rise.

where are we  going wrong n upbringing of our flowers.

Its time to ponder     and review.

we are responsible for vaccinating them , for giving them clean environment

for inculcating clean habits in them, for value based education rather than just

improving their percentage, for teaching them human dignity,,for their skill development.

LETS DO I NOW.

ARISE AWAE AND DREAM NO MORE.

DO NOT FORGET THE ROUTINE Vaccinations !

The routine vaccination to protect a baby starts when the baby is in mothers womb. The mother gets two shots of Tetanus toxoid in pregnancy so that newborn does not suffer from Neonatal tetanus which is a fatal disease and is still found in many developing countries.
BCG vaccine to prevent Tuberculosis or at least its complications is given at birth preferably . It can be given at later age also in susceptible population,
Polio drops are given at birth and at least three times in first year ,
repeated as boosters at 18months and 5 yrs of age.
Hepatitis B vaccine is given at birth and repeated at 1 and 6 months of age,
The DPT (diphtheria , whooping cough, tetanus ) vaccines are also given three times in first year and repeated at 18 months and 5 yrs of age. This booster is also repeated at 10yrs and at college going.
The whooping cough component in vaccine comes as acellular form
and is preferred by many.    The inject able polio   vaccine is combined with DPT and is available separately also.
The injectable Polio is additional to oral polio and is not to replace oral polio vaccine. The success of eradication of Polio from India is due to Pulse polio program by oral polio vaccine.
Measeles vaccine is given at 9 months of age, The MMR that is Measles Mumps and Rubella   at 15 months of age and repeated at 5 years and 15 years of age,  
Though there are vaccines available for Rotavirus diarrhea, some strains of pneumonia, Chickenpox , Hepatitis A and Hib meningitis and influenza for specific situations but the MOST essential vaccines should never be missed.                                                    

Children are like flowers they need tender care!

 Today while going through my old papers i found a handwritten note of a child to me whose parents
used to bring him to me for his aliments.
I still remember how he had secretly handed over the note to me while sitting on the examination couch
away from attention of his parents.
The note read like this"Doctor jee , please don't let my parents know that I am writing to you.
Please give strict instructions to my parents to let me eat what I like and not be a bully all the
time for everything. I promise to you I will eat healthy food and pizza only sometimes but only
if my parents are not kill joy. They have no other talk with me except Don't do this and do this.
Doctor please trust me , strict instructions to my parents can make me alright."
I can not remember what I might have done but I do believe that parents cant take children for
 granted and bully them all the time. Your children are only through you , they are not for you to
 fulfill all your unfulfilled dreams. They are like flowers , fresh , fragrant and full of joy giving abilities
provided they get loving tender care !

Enteric fever

Enteric fever or Typhoid fever is reemerging with resistant bacteria .
Its certainly a disease of in sanitation.
It is transmitted by 5 Fs  ie FLIES < FLUIDS < FECES < FINGERS.and FOOD
Open defecation as is still practiced in many parts of the world results in flies and also contamination of drinking water. Hand washing frequently can be a very scientific method of prevention of infection.
Cut fruits and open food can attract flies contamination resulting in typhoid.
Its a fever which can result into many complications and is getting difficult to treat as bacteria are acquiring resistance.
It can be best prevented by practicing sanitation and hygiene.
Its best prevented by very effective vaccine available against ths disease.
Children are precious inculcate practice of  sanitation and hygiene to avoid many dreaded diseases of insanitation.

Diseases of Insanitation .

I thought to myself that let me educate my countryman with a new approach.
Instead of telling the "dos" and "donts",let me just inform them about the consequences of in-sanitation. We know that majority of killer diseases like diarrhea, dysentery,typhoid,hepatitis, malaria, dengue, tuberculosis,measles ,swine flu, diphtheria,polio, tetanus etc are infectious diseases and all of them are preventable by our own efforts even at individual levels.
The prevention of all of them starts as soon as the baby is conceived.Taking two doses of tetanus vaccine during pregnancy and a safe institutional delivery will prevent neonatal tetanus which certainly is a very cheap prevention of this killer disease.Later in childhood and also in adult life regular immunisation will prevent it throughout life.
Starting mothers milk soon after birth and exclusive breast feeding for at least 6months of life will prevent diarrhea and dysentery.our insanitary habits of introducing bottle feeding out of fashion and many other unjust reasons is killing so many due to diarrhea!Even those who survive are surviving at high cost to individuals and community. Doctors often prescribe antibiotics and many other medicines which are in fact detrimental. Injudicious use of antibiotics is a major concern in drug resistence besides the economic factors and health hazards.
Another insanitation results from giving apple ,anar and palak juice to the baby . one can imagine theunhygeinic method of making these unnecessary juices which no baby needs.
The disease producing microbes are all over in our atmosphere due to our dirty habits. The indiscriminate disposal of human and animal excreta,the waste from homes , the leftover organic and inorganic matter in front of shops, homes ,after sabzi mandis, the fecal contamination of leaking pipes ,the un flushed excreta of blocked toilets, the ditches with stagnant water etc are store houses for germs like hepatitis, typhoid , shigella , ecoli , many parasites which the naked eyes can not see but they are in the air every where clinging to us looking for opportunity to invade us for their survival. The result is all the above diseases. Diarrheas , hepatitis , typhoid , dysentery are waterborne, malaria and dengue are also indirectly waterborne as the mosquitoes survive in stagnant water.
Typhoid is due to , dirty fingers , dirty fluids and flies which survive on feces .look at the cost of treatment of typhoid ,germs are getting resistant. The vaccine is available but how many parents do it regularly? Indiscriminate spitting and similar dirty habits spread the germs of tuberculosis. BCG vaccine at birth prevents tuberculosis to some extent.
Hepatitis of many varieties is waterborne and comes in epidemics killing so many. For some forms we have the preventive vaccines which also has to start right from birth.
Even HIV AIDS can be termed as disease of in sanitation of mind.
Why create diseases threw our dirty habits then research for cure and prevention?
ARISE AWAKE and dream no more fight in sanitation on war footing to save the human misery and economic burden.

Thalassemia minor.

I came across a few people who were diagnosed as thalassemia minor since their childhood but did not know the implications of this diagnosis. Now they are in their process of settling in life.
They have to be put wise or else it could be disastrous.
Any mild anemia can be due to Thalassemia minor and can not be detected unless tested for.
In India commonest anemia is nutrition deficiency anemia therefore doctors put the child on iron without any tests. If the underlying disease is thalassemia than iron load can be dangerous rather than improving the anemia.
The test for this condition is hemoglobin electrophoresis which is easily available.
If found to be having this condition , one should not take iron and MOST IMPORTANT IS NOT TO MARRY A PARTNER WITH THALASSEMIA MINOR. OTHERWISE CHILDREN BORN OF SUCH PARENTS WILL SUFFER FROM THALLESIMIA MAJOR . Thallasemia major is a very serious condition , where child can not live without weekly blood transfusions and methods of bringing out iron overload from the body.
The best is to go in for tests rather than matching Janam patri before marriage.
mind you this condition is pretty common in certain parts of world including Punjab in India.

Vaccinations for children in first year of life..

BCG vaccination should be given at birth , it is to prevent Tuberculosis. It can be given at any age if it is missed at birth. in two months it will be followed by a scar. If not , it needs re vaccination.
Polio drops are also administered at birth and are given at 6 week onwards in five doses one month apart in the first year of life. inject able polio is also available which can also be administered from 6 weeks onward along with oral polio.
Polio does not have cure , it results in crippling , but the prevention is simple and effective.
DPT vaccination protects against Diphthria , Whooping cough , and Tetanus. This is injected intra muscularly three times along with polio.
This is available as a pentavalent vaccine also in which polio and hepatitis vaccinations are also combined in the same injection. by this a single shot gives protection against 5 diseases. Diphthria is a serious disease affecting heart muscle , breathing muscles and is rapidly progressive towards death. So is Tetanus , a disease resulting into muscular paralysis and death. Whooping cough too is full of dreaded complications.
Hepatitis B vaccination is also administered at birth , after one month and after 6 months of the first dose. This protects against the dreaded life threatening Hepatitis B disease of the liver.
At 9 months of age Measles vaccination is given intramuscular , to prevent measles which is a contagious disease and is a biggest killer in first year of life in malnourished children. These vaccinations have to be followed with boosters in next few years or else the immunity will be lost. I shall deal with further vaccinations in my next blog. PREVENT DISEASES BY TIMELY VACCINATIONS.

Practical Issues in health of children .

I published " tips for parents to deal with anemia" in health education section of widely circulated news paper in North India.
To my surprise , the problem of Anemia is common even in children of doctors, even the doctor mothers! The reason being their inability to convince their elders in the family ,to do things which they consider as scientific , who are the care takers for their children when they are away for work.
There are many emails from such doctors asking me to suggest to them how to deal with this problem .
I did not ever imagine that financial independence and even post graduate education of women could not empower them to do the right things for their own children.
The children of pediatrician mothers are wearing charms and are putting black spot on cheek to ward of evil and are visiting temple for measles to be over !
How should we transform education into everyday practice , is the real issue rather than making people just literate!
Health education for children needs to convince grand parents and other care takers on the scientific approach. There are many issues but at present I am too shocked to address the problem fully.

Anemia in Children: Tips for Parents

ANEMIA IN CHILDREN , WHAT SHOULD PARENTS DO?

National Family Health Survey reported that about 80% children are anemic even in the grain producing states Punjab and Haryana. We need new strategies to save children from this significant morbidity.

Anemia is a state of low hemoglobin in the body, the causes can be many.
The most common is iron deficiency . A normal weight new born is born with sufficient stores of iron to last him first 6 months of life if all goes well with him.
. In India majority of children are born low birth weight and premature for which mother,s malnutrition is also one of the important factor.
Such children have low stores of iron and they need supplementation of iron surely from the age of 2 weeks. The iron of human milk is better absorbed than other milks.
Mothers milk must be continued in all infants for innumerable scientific advantages to the baby as well as mother.
The home made food appropriate for the age of the baby should be supplemented. Parents often do not accept the fact that grains and pulses have more iron and other nutrients, these need to be given rather than the top feeding of diluted milk by bottle. Bottle feeding even in best circumstances result into several maladies the most dangerous being diarrhea which forms the vicious cycle with malnutrition and anemia.
In the first year of life most babies visit for Well baby checkup and or at least five times for vaccinations.Doctors can always detect anemia and take corrective measures if vigilant
. What parents do not realize is that they do not take advise on anemia seriously. They feel that it is just a tonic which is prescribed which they give irregularly and stop at their own inconvenience. Anemia has to be realized by parents and doctors as a disease , the treatment has to be given with calculated doses , expected hemoglobin rise is calculated and the treatment would continue for additional 3 months even after the hemoglobin is appropriate. This is in order to replenish the stores in the body.
The careful pediatricians have a side lab in their clinics where hemoglobin can be assessed just in 10 minutes with just a prick and the treatment is evidence based. Parents don't have to make additional trips from clinic to the lab for the results and revisits for the prescription based on same results.
In the second year of life child has to gain just 2kg of weight therefore his requirements are not as much as he needed in the first year to become 10kg from the 3kg at birth.
There is a natural reduction in food consumption pattern but parents expect children to eat more all the time and " chalo dudh to pee lo atleast , nahin peena padega" They insist on milk all the time filling the little stomach of children with milk rather than grain based food, do force feeding , the nutritional requirement becomes a perpetual struggle between the two , children are learning denial and at times the force feeding becomes an attention seeking device. These wrong trends can continue throughout resulting into undernourishment and anemia.
As young as 2 go to school, which is surely a form of child abuse by parents ,separation anxiety and stress of discipline even if it is a play school is a subject requiring a national attention , can also result in malnutrition due to several factors even though they are fed in the school.
The school going children are always in a rush in the morning . Its a sight to see parents holding a half finished glass of milk even on bus stand. Its universal that all children go to school without proper breakfast.Its also a scientific fact that breakfast should be like a king and early so that brain gets glucose for proper function. The first meal of child is in the school in the break at 11am which is too little for several things including food. The schools have started insisting on healthy food but the reality is different. Parents ought to be educated and in turn educate children that food is mainly for nutrition , enjoyment is a state of mind. A child who breaks fast at 11am , is again confronted by parents forcing food at 2 after the school. The class 8 onward children are again at a rush at this time for forced tut ions by overambitious parents. Its a hard fact that even younger children and children from weaker section of society are going for tut ions.
Children are perpetually in fabricated indoors from home to school to tuition to television , video games , computer even though it is essential.
Such circumstances result into low immunity making them susceptible to ailments resulting in low utilization of iron due to stress of infections.
when majority of children go to school without breakfast , why can the first period not be devoted to eating the food brought from home rather than waiting till 11am. thus children would surely be hungry at 2pm after school .
Parents find it difficult to tackle the food fad ism of children . It is the parents who unknowingly are responsible for such habits in children besides the peer pressure of course. Now a days in well to do homes it is a common sight on the dinning table that instead of appreciating the flavor and presentation of food it is the " not for me " attitude of mothers which children are facing at each meal. Imitation of finicky attitude is child's natural reaction. Thus they also learn to be choosy. Dieting means eating balanced food and utilizing it by sports and active life style rather that becoming the couch potatoes. Undernourishment is low as well as overweight. even obese children could be anemic.
Parents ought to realize that children at all ages need balanced diet , especially so during the period of growth spurts till adolescent age. It is these healthy teens who will be healthy mothers and would not produce low birth weight newborns breaking the cycle of nutritional anemia.
In the name of nutrition and exercise young children are going to gyms rather than playing outdoors and are consuming protein powders prescribed by trainers which is a wrong trend and must be stopped.
Iron deficiency even without anemia results in fatigue , restlessness , poor attention span , learning disabilities , poor arithmetic and linguistic abilities , irritability , hyperactivity and pica ( tendency to eat mud and other abnormal objects).
There is a myth prevalent in parents that mud eating is due to deficiency of calcium , they resort to self prescribing and injections for this by self style doctors.
The fact is this that the iron deficiency is an easily preventable disorder by partnership of parents and doctors. The iron administered in oral form is best absorbed and corrects anemia effectively , inject-able iron is not needed in general.
Anemia is prevalent in spite of ongoing strategies of nation , its time to make new strategies.A lot can be achived by partnership of parents and doctors.