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Does your child needs an antibiotic?
Unnecessary Antibiotics Can be Harmful.
What are antibiotics?
Antibiotics are among the most powerful and important medicines known. When used properly they can save lives, but used improperly, they can actually harm your child. Antibiotics should not be used to treat viral infections.

Bacteria and viruses
Two main types of germs- bacteria and viruses- causes most infections. In fact, viruses cause most coughs and sore throats and all colds. Bacterial infections can be cured antibiotics, but common viral infections never are. Your child recovers from these common viral infections when the illness has run its course. Make a habit of asking your doctor why your child is given antibiotics?

Resistant bacteria
New strains of bacteria have become resistant to antibiotics. These bacteria are not killed by the antibiotic. Some of these resistant bacteria can be treated with more potent antibiotics which may need to be given by vein (IV) in the hospital, and a few are already untreatable. The more antibiotics prescribed, the higher the chance that your child will be infected with resistant bacteria.

How bacteria become resistant?
Each time we take antibiotics, sensitive bacteria are killed, but resistant ones may left to grow and multiply. Repeated use and improper use of antibiotics are some of the main causes of the increase in resistant bacteria. These resistant bacteria can also be spread to others in the family and community. Talk to your doctor and understand that antibiotics should not be used for viral infections.

When are antibiotics needed and when they are not needed?
These complicated questions are best answered by your doctor and the answer depends upon the specific diagnosis. Here are few examples:
Ear infections: There are several types. Most need antibiotics, but some do not.
Sinus infections: Most children with thick or green mucous do not have sinus infections. Antibiotics are needed for some long-lasting or severe cases.
Cough: Children do not need antibiotics for cough.
Fever: Antibiotics are not for fever but for bacterial infections.
Sore throat: Most cases are caused by viruses. Only one main type, “ strep throat”, requires antibiotics. This kind must be diagnosed by lab test.
Colds: Colds are caused by viruses and may sometimes last for 2 weeks or more. Antibiotics should never be used for cold. Same home care remedy as hot lemon water, warm honey water often soothes the throat.

Are over the counter cough mixtures are helpful?
Over the counter cough mixtures are not helpful in children. More over these preparation contains medicines which make the child drowsy, irritable with dry mouth and throat. This will cause more deterioration in his illness. A child on cough mixtures will cough more and the duration of cough prolongs.

The infection may change
Viral infections may sometimes lead to bacterial infections. But treating viral infections with antibiotics to prevent bacterial infections does not work, and may lead to infection with resistant bacteria. Keep your doctor informed if the illness gets worse or lasts a long time, so that proper treatment can be given, as needed.

The signs if you see, you must take your child to a doctor:
Lethargy, convulsion, vomits every thing, does not swallow, very high fever, rash, breathing fast, acute onset of noisy breathing, not passing urine for more than 12 hours or if you are worried.

 

As a parent you are in best position to note your child's development and milestones given below can be used as guidelines. No two children develop at same rate, every child develops at his own pace. You can talk about this to your Paediatrician in your next visit

 
6 WEEKS

Gross Motor
When child is pulled to sit, his head lags considerably but not completely.
Your child intermittently raise his chin off the couch in prone position.
Hands
The child keep his/her hands open most of the time.
Vision
Your child fix eyes on objects and follows a moving person up to 90 degrees?
General understanding
Your child smile at the mother in response to overtures.
 
12 WEEKS

Gross Motor 
If your child is held upright is he able to support his head for few minutes.
Your child can hold chin and shoulders off couch and weight is borne on forearm in prone position.

Hands
Your child keep hands frequently loosely open?
Vision
Your child follow-dangling toy from side to side (180 degrees)?
Your child promptly looks at object in midline.
Hearing
Your child turn head to sound.
Vocalization
Your child respond when spoken to and makes squeaks of pleasure.

20 WEEKS

Gross Motor
Your child put his/her weight on forearms when lying in prone position.
Your child put his feet to mouth in supine position?
When child is pulled to sit, there is no head leg.
Hands
Your child able to grasp object voluntarily?
General understanding
Your child smile at his/her mirror image?
28 WEEKS

Gross Motor
Your child sit with hands on couch for support.
Your child roll from supine to prone.
Hands
Your child feeds self with biscuit.
Cubes
Your child transfer cube from hand to hand?
General understanding
Your child imitate simple acts.
Your child respond to name(s).

Speech
Your child speak syllabels like da,ba,ka

36 WEEKS

Gross Motor
Your child sits without support for few minutes.
Your baby crawls
Hands
Your child picks up objects of size of currant between tip of finger and thumb.
Cubes
Your child compares two cubes by bringing them together.

 

44 WEEKS

Your child will creep with abdomen off couch.
Your child will put object in and out of container.
Your child will say one word with meaning.
Dressing
Your child will hold arms out for sleeve or feet out for shoe.

1 Year

Gross Motor
Your child walks one hand held.
Your child says two or three words with meaning.
Your child walks on hands and feet like a bear when prone.
Your child understands the meaning of where is book? where is shoe?
18 Months

Your child walks upstairs one hand held.
Your child makes tower of three cubes.
Your child takes off his shoes by himself.
Your child feeds himself without much spilling.

2½ Years

Your child jumps with both feet.
Your child knows full names.
Your child knows whether he is a boy or girl?
Your child helps to put things away.
Your child names at least one colour.
Your child makes a tower of eight cubes.

4 Years

Your child goes downstairs, one foot per step.
Your child can button clothes fully.
Your child names pictures in books.
Your child can tell you what action is taking place in a picture.
Your child uses action words(Verbs).
Your child copies cross.
Your child plays imaginative plays with doll.

5 Years

Your child skips on both feet.
Your child can tie shoelaces.
Your child can copy a triangle.
Your child can name four colours.
Your child can react well when you leave him with a friend or baby sitter.
Your child can name a coin correctly.


The first three years of life are a time of amazing learning for young children and for the people who care for them every day. In these years, most children develop new skills in a predictable order they crawl before they walk and they point before they use words to tell you what they want.
But every child is unique.
Every child develops at his own pace and reacts to people and the world in his own way.
Every child has his own style of communicating with you.
It is important to remember that every child develops in his own style and at his own pace. However, if you are concerned about your child's development and would like to request an evaluation (developmental assessment), please contact Prof. Pushpa Raj Sharma for special appointment.
Chicken pox
Chickenpox is a highly contagious illness by the varicella zoster virus and occurs most commonly in late winter or early spring. Chickenpox is spread by both direct contact with an infected person and through air borne spread of respiratory secretions. Since infected persons are contagious for 1-2 days before they even develop a rash, your child may have been exposed to someone with chickenpox without knowing. You can also get chickenpox after having direct contact with someone who has shingles or herpes zoster, a reactivation of chickenpox.
Symptoms begin with a low grade fever, loss of appetite and decreased activity. About two days later, your child will develop an itchy rash consisting of small red bumps that start on the scalp, face and trunk and then spread to the arms and legs (but may also occur in the mouth and genitalia). The bumps then become blisters with clear and then cloudy fluid, and then become open sores and finally crust over within about twenty four hours, but your child will continue to get new bumps for about four more days.
All of the chickenpox lesions should be crusted over after about six days at which time your child will no longer be contagious. It may take another one to two weeks before all of the scabs finally heal. Once your child has had chickenpox he should have lifelong immunity.
There is no effective treatment for children who develop uncomplicated chickenpox, but if your child is given the Varivax vaccine within 72 hours (and sometimes up to five days) of being exposed to someone with chickenpox, it may help prevent him from becoming infected.
The usual treatments are aimed at making your child more comfortable, and can include pain relievers, plenty of fluids, oatmeal baths, calamine lotion, and oral Benadryl for severe itchiness. Also keep your child's fingernails cut short and allow him to wear loose fitting clothing.
Treatment with acyclovir, an antiviral medication that can help to decrease the symptoms of chickenpox, should be considered for children at risk of developing a severe case of chickenpox. This includes children with pulmonary
disorders, on steroid medications, or with immune system problems.

Croup
Croup, also called laryngotracheobronchitis, most commonly affects children between the ages of six months and three years, usually during the late fall, winter and early spring. Symptoms, which often include a runny nose and a brassy cough, develop about 2-6 days after being exposed to someone with croup.
One of the distinctive characteristics of croup is the abrupt or sudden onset of symptoms. Children will usually be well when they went to bed, and will then wake up in the middle of the night with a croupy cough and trouble breathing. The cough that children with croup have is also distinctive. Unlike other viral respiratory illnesses, which can cause a dry, wet, or deep cough, croup causes a cough that sounds like a barking seal.
Another common sound or symptom of croup is inspiratory stridor, which is a loud, high-pitched, harsh noise that children with croup often have when they are breathing in. Stridor is often confused with wheezing, but unlike wheezing, which is usually caused by inflammation in the lungs, stridor is caused by inflammation in the larger airways.
The pattern of symptoms in children with croup is also characteristic. In addition to beginning in the middle of the night, symptoms, which are often better during the day, worsen at night, although they are usually less intense each night. Symptoms also become worse if your child becomes anxious or agitated.
The symptoms of croup are caused by inflammation, swelling and the buildup of mucus in the larynx, trachea (windpipe) and bronchial tubes. Since younger infants and children have smaller airways, it makes sense that they are the ones most affected by croup. In contrast, older children will often just develop cold symptoms when they are infected by the same virus.
Children with croup will usually also have a hoarse voice, decreased appetite and a fever, which is usually low grade, but may rise up to 104 degrees F.

Croup Assessment
Because of the characteristic signs and symptoms of croup, this diagnosis is usually fairly easy to make. You can often tell a child has croup while they are still in the waiting room or before you enter the exam room, therefore, testing is usually not necessary.
Specifically, an xray is usually not required, and is usually only done to rule out other disorders, such as ingestion of a foreign body. When an xray is done, it will usually show a characteristic 'steeple sign,' which shows a narrowing of the trachea.
When assessing a child with croup, it is important to determine if he is having trouble breathing. Fortunately, most children have mild croup and have no trouble breathing, or they may only have stridor when they are crying or agitated. Children with moderate or severe croup will have rapid breathing and retractions, which is a sign of increased work of breathing. They may also have stridor when they are resting.
The croup score is an easy and standardized way to figure out if a child has mild, moderate or severe croup, which can help to dictate what treatments are necessary. The croup score is based on a child's color, level of alertness, degree of stridor, air movement, and degree of retractions, with 0 points given if these findings are normal or not present, and up to 3 points given for more severe symptoms.

Inspiratory Stridor
  • None (0 points)
  • When agitated (1 points)
  • On/off at rest (2 points)
  • Continuous at rest (3 points)
Retractions
  • None (0 points)
  • Mild (1 points)
  • Moderate (2 points)
  • Severe (3 points)
Air Movement/Entry
  • Normal (0 points)
  • Decreased (1 points)
  • Moderately decreased (2 points)
  • Severely decreased (3 points)
Cyanosis (Color)
  • None (0 points)
  • Dusky (1 point)
  • Cyanotic on room air (2 points)
  • Cyanotic with supplemental oxygen (3 points)
Level of Alertness (Mentation)
  • Alert (0 points)
  • Restless or anxious (1 points)
  • Lethargic/Obtunded (2 points)
In general, children with a croup score of less than 4 have mild croup, 5-6 have mild/moderate croup, 7-8 have moderate croup, and greater than 9 have severe croup.
If you are unsure how severe your child's symptoms are, call your Pediatrician.

Skin infections or impetigo

Symptoms
Children with impetigo usually develop honey colored crusted lesions, usually beginning in areas where the skin has been broken, irritated or damaged. The nostrils, especially in kids with a runny nose, are commonly affected. Untreated infections can quickly spread to other areas on the child's body.

Bullous impetigo cause much larger skin lesions that look like blisters that quickly rupture and commonly affects a child's trunk or buttocks.

Diagnosis
Although cultures can be done, diagnosis is usually based on the typical appearance of the rash.

Treatments
For small areas of infection, an over-the-counter or prescription strength topical antibiotic may be all that is needed, in addition to washing the area with warm soapy water. For more extensive or persistent infections, an oral antibiotic might be needed.

What You Need To Know
  • the most common strains of bacteria that cause impetigo include group A beta-hemolytic streptococci (GABHS) and Staphylococcus aureus.
  • impetigo is spread by direct contact with infected lesions. Children are usually no longer contagious once they have been on antibiotics for 24-48 hours and there is no longer a discharge or you are seeing signs of improvement.
  • folliculitis is a similar infection that involves hair follicles
  • glomerulonephritis, which can cause hematuria (bloody urine) and high blood pressure, is a rare complication of having impetigo.
  1. Hepatitis B vaccine (Hep B). If possible all infants should receive the first dose of hepatitis B vaccine soon after birth or before hospital discharge; The second dose should be given at least 4 weeks after the first dose. The third dose should be given at least 6 months after the first dose.
    However, the first dose can be given at 6 weeks along with DPT, second dose at 10 weeks along with second dose of DPT and third dose could be given at 9 months along with measles vaccination.
  2. Tetanus and diphtheria toxoids (Td). It may be administered at the age of 5 years.
  3. Haemophilus influenzae type b (Hib) conjugate vaccine. If not given as mentioned as in the schedule during first year, only two doses are required at the interval of two months if given after one year.
  4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4-6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11-12 year old visit.
  5. Typhoid Vaccine ( Vi antigen): First dose age 2 years and booster doses at every 3 years.
  6. Japanese Encephalitis Vaccine. This vaccine can be used for children residing and frequently visiting endemic Tarai region. It is given at one year or any time after one year on 0,7 and 30 days.
  7. Meningococcal AC vaccine. The first dose is given at 2 years and booster doses are given every three years

What should be your child’s diet?

The following food pyramid shows the type of diet and frequency of meal. Remember the child’s stomach is small and they can not take large meal therefore give them small frequent meal.
Feeding Recommendations During Sickness and Health
Up to 5 Months
of Age

 Breastfeed as often as the child wants, day and night, at least 8 times in 24 hours.

Do not give other foods or fluids.
Breastfeed for at least 10 minutes each time


6 Months up to 12 Months

Breastfeed as often as the child wants.

Give adequate servings of:
rice with dal, jaulo, halwa, roti with milk and sugar, khichadi, lito, papaya, mango, banana

3 times per day if breastfed;
5 times per day if not breastfed.


12 Months up to
2 Years

Breastfeed as often as the child wants.

Give adequate servings of:
rice with dal, jaulo, halwa, roti with milk and sugar, khichadi, lito, papaya, mango, banana
or family foods 5 times per day.

2 Years and Older

Give family foods at 3 meals each day. Also, twice daily, give nutritious food between meals, such as:
puffed rice with oil, roti, papaya, banana, mango, chiura, popcorn, roast soya beans

What to do for diarrhoea?


1. GIVE EXTRA FLUID (as much as the child will take)

Breastfeed frequently and for longer at each feed.
If the child is exclusively breastfed, give ORS or clean water in addition to breastmilk.
If the child is not exclusively breastfed, give one or more of the following: ORS solution, food-based fluids (such as soup, rice water, and yoghurt drinks), or clean water.

It is especially important to give ORS at home when:
the child has been treated with Plan B or Plan C during this visit.
the child cannot return to a clinic if the diarrhoea gets worse.

MIX AND GIVE ORS.

Up to 2 years 50 to 100 ml after each loose stool
2 years or more 100 to 200 ml after each loose stool

Give frequent small sips from a cup.
If the child vomits, wait 10 minutes. Then continue, but more slowly.
Continue giving extra fluid until the diarrhoea stops.


2. CONTINUE FEEDING

3. Take your child to the health worker if:
lethargic, or convulsion occurs, or does not take orally,or blood in the stool or vomits evry thing or develops high fever or does not passes urine for 4 hours.

Find out your childs growth using growth charts.

How to use these growth charts?
Growth charts are an important way to monitor your child's growth. This guide will provide you with all of the information you need to use and interpret the growth charts to follow how well your child is growing. Find the age of your child and plot it on these growth charts. If they are following a curve or parallel to that curve then it indicates they are growing. They should never grow below the third percentile. If they fall bellow the third percentile of suddenly fall from their growing line consult your doctor.
Growth chart index
View all of the growth charts for infants and older children to plot their height, weight and follow how well they are growing.
Boys: Birth to two years
Growth chart for boys from birth to age three years, with height and weight growth curves combined on one easy to use colorized sheet.
Girls: Birth to three years
Growth chart for girls from birth to age three years, with height and weight growth curves combined on one easy to use colorized (pink) sheet.
Boys two to twenty years
Growth chart for boys from two to twenty years, with height and weight growth curves combined on one easy to use colorized (blue) sheet.
Girls: two to twenty years

Growth chart for girls from two to twenty years, with height and weight growth curves combined on one easy to use colorized (pink) sheet.


When should you start LITO to your child? How you should feed LITO to your baby?

Never start solid food before completing 6 months of age. This is because they can not swallow solid at this age and if you make it thin so that your child can drink the calorie content will be too low. When you feed thin “LITO” you child will loose weight, urinate more frequently and will be constipated. You should start solid only when your baby can swallow, can sit with support, hold head erect and turn round. The best way to tell the right period for the solid food is when your child seems to be asking for it. He is not likely to say, "Mom can I please have solid foods?" It is more likely that when you are eating he will look at you as if to say, "How come you aren't giving me some of what you are having?" This communication will likely be in the form of fussiness when you are eating. This is a good time to begin solid foods, or you can begin anytime you want using the guidelines stated above.

I recommend starting with rice cereal. Cereal should never be given in bottle. Rice cereal can be prepared at home by cooking rice and pureeing it in a blender or making a pate using cup and spoon. As your child is taking milk by sucking, and it is the first time child is on a thick feed s/he will try to push it by protruding tongue. Therefore your baby's first rice cereal meal should be thin. Once baby can swallow the feed you must go on increasing its thickness. The cereal you have prepared must not fall if you keep it in your finger. When your child is able to swallow this thick cereal then only you should go on increasing the amount of solid feed. Usually the amount of feed should be equal to the number of teaspoon with the age of your child in month (it is the uncooked powder not the cooked meal).

It is not necessary to buy the costly cereals available in the market. Your child will need nearly two weeks to learn to swallow the solid. You can use rice that is prepared for the family meal. For first few days only small amount is needed. With the rice cereal, place your baby in a propped up position, and move the spoon towards his mouth. The first few days he will tend to push the cereal right back out with his tongue. This is because babies have a thrust reflex causing their tongue to thrust back out anything that is put in their mouths. Within several days your baby will begin to get the idea of closing his lips around the spoon and swallowing. Once he does, you can begin to monitor the amount of food he needs. In order to determine this, (which is not a pre-determined amount, but varies from child to child) keep moving the spoon towards his mouth and look for signs that he is losing interest. If he turns his head away, clamps his lips shut, or appears bored, it is time to stop. Otherwise, keep moving the spoon to his mouth as long as he keeps opening it and looking happy.

It is better to continue breast feeding even after you start solid. Formula deeding is never necessary if you have breast milk. It is not necessary to give water after each solid feed. You may feed breast milk after the solid. After your baby has done well with rice cereal, you can begin feeding him DAL or other meal. Other solids can be introduced once he has been eating cereal for a week or two and is tolerating it well (as long as he is at least four months old). The next foods to be introduced --mostly peas, green beans, squash, sweet potatoes, potatoes, and carrots. Give your baby only one new food at a time. Be sure to wait three to five days before starting another one to determine if he has any reaction to a food, such as a rash, stomach pain, vomiting, or diarrhea.

Always try thick solid. After nine months give your child the LITO in a separate plate while you are eating. Let him play with this and keep himself in his/her mouth. Let him/her see and practice eating him/her self.