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  Disclaimer
The information contained on this site is sourced from standard textbooks on Pediatrics. However, it is neither meant to be complete nor an exhaustive account of the diseases or their treatments. It is only intended to be a patient information resource supplementary to the information given to them by the treating doctor. The hospital shall not bear any responsibility for any adverse outcomes arising out of self treatment of holding back treatment or consultation or any change in treatment from that advised by the treating doctor. Additionally on this website, we clearly refrain from giving any medical advice on intake of medicines for any disease condition whatsoever, which we consider dangerous.

Emergency Services

How does one contact Chaitanya?

We have 24-hours helpline manned by a receptionist and a specialist pediatrician available 24 hours. Our patient get 24 hour backup for all minor and major problems with and during treatment. Phone: 0172-5088088, or 0172-2604613
Fax: 0172-5004043
E-mail- info@chaitanyahospital.org
Address
Chaitanya Hospital, Sector-44C, Chandigarh, India.

You will be immediately connected to a pediatrician who will be pleased to help you with your emergency and arrange transport to Chaitanya if required.

What emergency facilities are available at Chaitanya?

1. EMERGENCY ROOM
A Postgraduate Medical Consultant-a Pediatrician, is available 24 hours to look after all Emergencies, should such a need arise. The Emergency Room meets the immediate medical needs of the Patients. Emergency medicine doctors and nurses specialize in treating patients who are suffering from a serious illness or injury that could get worse if not treated quickly. A Pediatric Surgeon is available on call for urgent surgeries. For disfiguring injuries to children, a plastic surgeon is available on call.. A Fully equipped Ambulance service is available for the transportation of Sick patients round the clock. A doctor and nursing staff accompanies the ambulance every time.

2. FACILITIES FOR SICK NEWBORNS
Neonatal Intensive Care Unit (NICU) is a unit of the hospital specializing in the care of ill or premature newborn infants. NICU at Chaitanya provides care to the neonate by a committed team of specialty physicians, staff, equipments and facilities. Chaitanya Hospital boasts of the only Neonatal Specialist in the region. When a high risk newborn is delivered anywhere in the vicinity of Chandigarh and we are contacted, a fully equipped neonatal transport team travels to the town to transport the baby from the delivery table to Chaitanya’s NICU. We are particularly trusted for ventilator care of newborns when babies at other centers need neonatal ventilators.

3. EMERGENCIES IN OLDER CHILDREN
The Pediatric Intensive Care Unit (PICU) at Chaitanya Hospital is a six-bed unit caring for sick children, older than a month, who need very close observation and intensive treatment for critical illness, from doctors, nurses and other members of the PICU team. In PICU we have the most up-to-date equipments and technology to help our child patients including advanced ventilators, cardiac monitors, defibrillators etc.

4. WHEN THE CHILD NEEDS SURGERY
Children hurt themselves, and wound require specialists in plastic and cosmetic surgery so that they do not carry ugly scars of childhood accidents into adulthood. When they fracture a bone during play, they need an orthopediacian to care for them, and other surgical emergencies, require a specialist trained in operating upon children-a pediatric surgeon.

Emergencies

What does one do in the case of emergency involving children?
We encourage parents to contact us immediately in case of an emergency, and arrange for early transport of the child to hospital. Most harm occurs during the first hour of onset of an emergency and most gratifying results are seen when treatment is started in the first hour. We call this the golden hour. We would again emphasize the need for early consultation in case of an emergency…

FALL FROM BED/CHAIR/SOFA/STAIRS

Children usually tip and fall during running fast, fall from bed and stairs. Externally some bruising, bleeding, a swelling or laceration is usually seen.

There may or may not be some effect on the brain.

An injury to the brain is likely when
  • Child start vomiting,
  • Loses consciousness,
  • Has seizures,
  • Sleeps excessively, or ,
  • Complains of headache (-a small child may cry excessively),


  • Some types of head injury may even have symptoms appearing later.

    A fall with an injury to the head is an emergency where the child has to be examined by a pediatrician.

    Your child’s doctor may decide to go for a CT scan or that such a test is not required based on the results of the neurological examination.

    NOSE BLEEDING
    When a child hurts his nose and he begins to bleed, or in hot summer months when bleeding starts spontaneously, the child has to be put in a sitting position, bending forward, enough to allow blood to drip out of his nose. The nose has to be pinched with two fingers, long enough to stop the bleeding.

    Once the bleeding stops, the child needs to be brought to hospital for examination, and necessary treatment. Some bleeds require medical treatment; some need intervention by an ENT surgeon, while still others may need a neurosurgeon, when the blood is mixed with watery liquid from the brain.

    NEVER PUT THE CHILD WITH A NOSEBLEED ON HIS BACK!

    Q. What should we do in a case of frequent nosebleeds?
    Your child is almost certain to have at least one nosebleed—and probably many—during these early years. Some preschoolers have several a week. This is neither abnormal nor dangerous, but it can be very frightening. If blood flows down from the back of the nose into the mouth and throat, your child may swallow a great deal of it, which in turn may cause vomiting.

    Causes of nosebleeds
    There are many causes of nosebleeds, most of which aren’t serious. Beginning with the most common, they include:
  • Colds and allergies: A cold or allergy causes swelling and irritation inside the nose and may lead to spontaneous bleeding.
  • Trauma: A child can get a nosebleed from picking his nose, or putting something into it, or just blowing it too hard. A nosebleed also can occur if he is hit in the nose by a ball or other object or falls and hits his nose.
  • Low humidity or irritating fumes: If your house is very dry, or if you live in a dry climate, the lining of your child’s nose may dry out, making it more likely to bleed. If he is frequently exposed to toxic fumes (fortunately, an unusual occurrence), they may cause nosebleeds, too.
  • Anatomical problems: Any abnormal structure inside the nose can lead to crusting and bleeding.
  • Abnormal growths: Any abnormal tissue growing in the nose may cause bleeding. Although most of these growths (usually polyps) are benign (not cancerous), they still should be treated promptly.
  • Abnormal blood clotting: Anything that interferes with blood clotting can lead to nosebleeds. Medications, even common ones like aspirin, can alter the bloodclotting mechanism just enough to cause bleeding. Blood diseases, such as hemophilia, also can provoke nosebleeds.
  • Chronic illness: Any child with a long-term illness, or who may require extra oxygen or other medication that can dry out or affect the lining of the nose, is likely to have nosebleeds.


  • Treatment
    There are many misconceptions and folktales about how to treat nosebleeds. Here’s a list of dos and don’ts.

    Do. . .
    1. Remain calm. A nosebleed can be frightening, but is rarely serious.
    2. Keep your child in a sitting or standing position. Tilt his head slightly forward. Have him gently blow his nose if he is old enough.
    3. Pinch the lower half of your child’s nose (the soft part) between your thumb and finger and hold it firmly for a full ten minutes. If your child is old enough, he can do this himself. Don’t release the nose during this time to see if it is still bleeding.

    Release the pressure after ten minutes and wait, keeping your child quiet. If the bleeding hasn’t stopped, repeat this step. If after ten more minutes of pressure the bleeding hasn’t stopped, call your pediatrician or go to the nearest emergency room.

    Don’t . . .
    1. Panic. You’ll just scare your child.
    2. Have him lie down or tilt back his head.
    3. Stuff tissues, gauze, or any other material into your child’s nose to stop the bleeding.

    Also call your pediatrician if:
  • You think your child may have lost too much blood. (But keep in mind that the blood coming from the nose always looks like a lot.)
  • The bleeding is coming only from your child’s mouth, or he’s coughing or vomiting blood or brown material that looks like coffee grounds.
  • Your child is unusually pale or sweaty, or is not responsive. Call your pediatrician immediately in this case, and arrange to take your child to the emergency room.
  • He has a lot of nosebleeds, along with a chronically stuffy nose. This may mean he has a small, easily broken blood vessel in the nose or on the surface of the lining of the nose, or a growth in the nasal passages.


  • If your pediatrician sees your child during a nosebleed, she probably will repeat the nose-holding routine described in Step 3. (If the nose is full of blood clots, it may be suctioned clean first.) The doctor also may use nose drops that constrict the blood vessels, or put cotton soaked with medication inside the child’s nose. The doctor may decide to examine your child’s nose with a special light to find the origin of the bleeding. If a blood vessel is found to be causing the problem, the doctor will touch that point with a chemical substance (silver nitrate) to stop the bleeding.

    If the bleeding still cannot be controlled, the nose may have to be packed with gauze. Your child won’t like this—it is uncomfortable— but it may be necessary. The packing is generally left in for at least twenty-four hours.

    If your doctor thinks it’s necessary to explore the cause of the bleeding further or to make sure your child didn’t lose too much blood, a blood test will be ordered. It’s extremely rare that a child will need a blood transfusion to replace lost blood.

    Prevention If your child gets a lot of nosebleeds, ask your pediatrician about using salt-water (saline) nose drops every day. Doing so may be particularly helpful if you live in a very dry climate, or when the furnace is on. In addition, a humidifier or vaporizer will help maintain your home’s humidity at a level high enough to prevent nasal drying. Also tell your child not to pick his nose. If he picks it at night or in his sleep, put him to bed wearing thin cotton gloves or socks over his hands and pinned to his pajama sleeve.

    Common Problems in children

    FEVER

    What is Fever?

    A fever is a body temperature that is higher than normal –usually above 100oF for most children.

    Your child's normal body temperature varies with his age, general health, activity level, the time of day and how much clothing he is wearing. Everyone's temperature tends to be lower early in the morning and higher between late afternoon and early evening. Body temperature also will be slightly higher with strenuous exercise.

    What does fever mean?

    Fever means infection.

    Infections can be caused by viruses or by bacteria and rarely by other agents.

    Bacteria cause infections that will usually go on till they are treated by an antibiotic. An example of a disease caused by bacteria is a boil-damaging tissue and forming pus. When bacteria affect the lungs they cause pneumonias, when they affect the gut they cause infective diarrheas-with pus and blood, and dysentery-bloody diarrheas. The drugs to treat bacterial diseases are called-antibiotics.

    Viral infections are self limited and usually get well in 5 to 7 days. Common cold is a common example of a viral illness. Measles, chickenpox, mumps, German measles etc are some viral infections that have eruptions on skin. Most diarrheas in young children under 5 years are usually viral. Sometimes viral illnesses cause minor chest infections and rarely a severe infection called Bronchiolitis.

    Antibiotics have no role to play in viral infections, and they may occasionally cause harm.

    What's the best way to take a child's temperature?

    While you often can tell if your child is warmer than usual by feeling his forehead, only a thermometer can tell if he has a fever and how high the temperature is. There are several types of thermometers and methods for taking your child's temperature.

    Rectal: If your child is younger than 3 years of age, taking his temperature with a rectal digital thermometer provides the best reading.

    Clean the end of the thermometer with rubbing alcohol or soap and water. Rinse it with cool water. Do not rinse with hot water. Put a small amount of lubricant, such as petroleum jelly, on the end.

    Place your child belly down across your lap or on a firm surface. Hold him by placing your palm against his lower back, just above his bottom.

    With the other hand, turn on the thermometer switch and insert the thermometer 0.5" to 1" into the anal opening. Hold the thermometer in place loosely with 2 fingers, keeping your hand cupped around your child's bottom. Do not insert the thermometer too far. Hold in place for about 1 minute, until you hear the "beep." Remove the thermometer to check the digital reading.

    Oral: Once your child is 4 or 5 years of age, you may prefer taking his temperature by mouth with an oral digital thermometer.

    Clean the thermometer with lukewarm soapy water or rubbing alcohol. Rinse with cool water.

    Turn on the switch and place the sensor under his tongue toward the back of his mouth. Hold in place for about 1 minute, until you hear the "beep." Check the digital reading.

    For a correct reading, wait at least 15 minutes after your child has had a hot or cold drink before putting the thermometer in his mouth.

    Ear: Tympanic thermometers, which measure temperature inside the ear, are another option for older babies and children.

    Gently put the end of the thermometer in the ear canal. Press the start button. You will get a digital reading of your child's temperature within seconds.

    While it provides quick results, this thermometer needs to be placed correctly in your child's ear to be accurate. Too much earwax may cause the reading to be incorrect.

    Underarm (Axillary): Although not as accurate, if your child is older than 3 months of age, you can take his underarm temperature to see if he has a fever.

    Place the sensor end of either an oral or rectal digital thermometer in your child's armpit.

    Hold his arm tightly against his chest for about 1 minute, until you hear the "beep." Check the digital reading.

    FEBRILE SEIZURES

    What do I do if my child has a febrile seizure?
    In some children, fevers can trigger seizures. A febrile seizure usually happens during the first few hours of a fever. The child may look strange for a few moments, then stiffen, twitch, and roll his eyes. He will be unresponsive for a short time, his breathing will be disturbed, and his skin may appear a little darker than usual. After the seizure, the child quickly returns to normal. Seizures usually last less than 1 minute but, although uncommon, can last for up to 15 minutes.

    If my child has a febrile seizure, what should I do immediately to prevent injury?
  • Place her on the floor or bed away from any hard or sharp objects.
  • Turn her head to the side so that any saliva or vomit can drain from her mouth.
  • Do not put anything into her mouth; she will not swallow her tongue.
  • Call your pediatrician.


  • How is the child likely to be treated?
    If your child has a febrile seizure, call your pediatrician right away. He or she will want to examine your child in order to determine the cause of your child's fever. It is more important to determine and treat the cause of the fever rather than the seizure. A spinal tap may be done to be sure your child does not have a serious infection like meningitis, especially if your child is younger than 1 year of age.

    In general, physicians do not recommend treatment of a simple febrile seizure with preventive medications. However, this should be discussed with your pediatrician. In cases of prolonged or repeated seizures, the recommendation may be different.

    Anti-fever drugs like acetaminophen and ibuprofen can help lower a fever, but they do not prevent febrile seizures. Your pediatrician will talk to you about the best ways to take care of your child's fever.

    If your child has had a febrile seizure, do not fear the worst. These types of seizures are not dangerous to your child and do not cause long-term health problems. If you have concerns about this issue or anything related to your child's health, talk to your pediatrician.

    Remember !
    While febrile seizures may be very scary, they are harmless to the child. Febrile seizures do not cause brain damage, nervous system problems, paralysis, mental retardation, or death.

    COUGH
    Children get cough due to an irritation in the airway. The focus of irritation can be anywhere from the nose, ears, throat, the trachea (windpipe), bronchi, or the lungs themselves. Most coughs accompany the common cold, which is a viral infection of the ear, throat and nose. Once cough starts, the irritation usually persists over weeks.Cough occurring again and again, usually suggests an allergy of the airway.

    Long standing coughs are rare and usually suggest a long standing disease like Tuberculosis.

    ALLERGIES

    What causes allergies?
    The causes of allergies are not fully understood. Children get allergies from coming into contact with allergens. Allergens can be inhaled, eaten, injected (from stings or medicine), or they can come into contact with the skin. Some of the more common allergens are:

  • pollens
  • molds
  • house dust mites
  • animal dander and saliva (cat, dog, horse, rabbit)
  • chemicals used in industry
  • some foods and medicines
  • venom from insect stings
    The tendency to have allergies is often passed on in families. For example, if a parent has an allergy problem, there is a higher than normal chance that his or her child also will have allergies. This risk increases if both parents are allergic.

    EAR-ACHE
    Ear ache in children usually caused by a viral infection, and needs prompt treatment. Untreated, it may result in damage to the ear drum. . Otitis media with effusion (OME) is the most common. About 90% of children have OME at some time before school age, most often between ages 6 months and 4 years. OME often follows colds and viral infections or actual ear infections and will usually clear up on its own without treatment.

    Acute otitis media (AOM) includes intense signs and symptoms of infection and inflammation and is the most common bacterial illness in children for which antibacterial agents are prescribed.

    TONSILLITIS

    My child has tonsillitis. How did he ‘develop’ tonsils?
    The tonsils are oval-shaped, pink masses of tissue on both sides of the throat. The adenoid is similar to the tonsils and is located in the very upper part of the throat, above the uvula and behind the nose. Both the tonsils and the adenoid are part of your body's defense against infections.

    They are normal body parts in all human beings.

    Will he need to have his tonsils removed?
    In years past, it was very common for children to have their tonsils and the adenoid taken out. Today, doctors know much more about tonsils and the adenoid and are more careful about recommending removal.

    Tonsillitis is an inflammation of the tonsils usually due to infection. There are several signs of tonsillitis, including:
  • Red and swollen tonsils
  • White or yellow coating over the tonsils
  • A "throaty" voice
  • Sore throat
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes ("glands") in the neck
  • Fever


  • Symptoms of enlarged adenoid

    It is not always easy to tell when your child's adenoid is enlarged. Some children are born with a larger adenoid. Others may have temporary enlargement of their adenoid due to colds or other infections. This is especially common among young children. Constant swelling or enlargement can cause other health problems such as ear and sinus infections. Some signs of adenoid enlargement are:

  • Breathing through the mouth instead of the nose most of the time
  • Nose sounds "blocked" when the child talks
  • Noisy breathing during the day
  • Snoring at night


  • Both the tonsils and the adenoid may be enlarged if your child has the symptoms mentioned above, along with any of the following:

  • Breathing stops for a short period of time at night during snoring or loud breathing (this is called "sleep apnea").
  • Choking or gasping during sleep.
  • Difficulty swallowing, especially solid foods.
  • A constant "throaty voice," even when there is no tonsillitis.


  • How infection of tonsils is usually treated?
    If your child shows any of these signs or symptoms of enlargement of the tonsils or the adenoid, and doesn't seem to be getting better over a period of weeks, talk to your pediatrician. In many children, the tonsils and adenoid become enlarged without obvious infection. They often shrink without treatment.

    According to the guidelines of the American Academy of Pediatrics, your pediatrician may recommend surgery for the following conditions:
  • Tonsil or adenoid swelling that makes normal breathing difficult (this may or may not include sleep apnea).
  • Tonsils that are so swollen that your child has a problem swallowing.
  • An enlarged adenoid that makes breathing uncomfortable, severely alters speech and possibly affects normal growth of the face.

    In this case, surgery to remove only the adenoid may be recommended.
  • Your child has repeated ear or sinus infections despite treatment. In this case, surgery to remove only the adenoid may be recommended.
  • Your child has an excessive number of severe sore throats each year.
  • Your child's lymph nodes beneath the lower jaw are swollen or tender for at least six months, even with antibiotic treatment.
  • Though it is not as common as it once was, some children need to have their tonsils and/or adenoid taken out. If your child needs surgery, make sure he or she knows what will happen before, during, and after surgery. Your pediatrician can help you and your child understand the operation and make it less frightening in the process.

    LOOSE STOOLS: diarrhea

    What is diarrhea?
    When a baby passes stools more frequently that his usual routine, or when the stools are more fluid than his usual stools, he is said to be suffering from diarrhea.

    Diarrhea in children younger than 5 years, is usually caused by viruses. Such a diarrhea is self limiting. It is usually watery, and there is no blood or mucus in the stools. Irrespective of the cause loose stools result in loss of fluid and salts from the body-known as dehydration, which can cause considerable harm. It is important to consult your doctor when your child has diarrhea.

    What is the best way to treat diarrhea?
    Most children with mild diarrhea can continue to eat a normal diet including formula or milk. Breastfeeding can continue. If your baby seems bloated or gassy after drinking cow's milk or formula, call your pediatrician to discuss a temporary change in diet. Special fluids for mild illness are not usually necessary.

    What special fluids can be given for moderate illness?
    Children with moderate diarrhea may need special fluids. These fluids, called electrolyte solutions ORS, have been designed to replace water and salts lost during diarrhea. They are extremely helpful for the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. Use only commercially available fluids—brand-name and generic brands are equally effective. Your pediatrician or pharmacist can tell you what products are available.

    If your child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again.

    Reminder–do's and don'ts

    DO

  • Watch for signs of dehydration which occur when a child loses too much fluid and becomes dried out. Symptoms of dehydration include a decrease in urination, no tears when baby cries, high fever, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes.
  • Keep your pediatrician informed if there is any significant change in how your child is behaving.
  • Report if your child has blood in his stool.
  • Report if your child develops a high fever (more than 102°F or 39°C).
  • Continue to feed your child if she is not vomiting. You may have to give your child smaller amounts of food than normal or give your child foods that do not further upset his or her stomach.
  • Use diarrhea replacement fluids that are specifically made for diarrhea if your child is thirsty.


  • DON'T
  • Try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.
  • Prevent the child from eating if she is hungry.
  • Use boiled milk or other salty broth and soups.
  • se "anti-diarrhea" medicines unless prescribed by your pediatrician.


  • VOMITING

    What's the best way to treat vomiting?
    In most cases, vomiting will stop without specific medical treatment. You should never use over-the-counter or prescription remedies unless they've been specifically prescribed by your pediatrician for your child and for this particular illness.

    When your infant or young child is vomiting, keep her lying on her stomach or side as much as possible. Doing this will minimize the chances of her inhaling vomit into her upper airway and lungs.

    Watch for dehydration

    When there is continued vomiting, you need to make certain that dehydration doesn't occur. Dehydration is a term used when the body loses so much water that it can no longer function efficiently. If allowed to reach a severe degree, it can be serious and life-threatening. To prevent this from happening, make sure your child consumes enough extra fluids to restore what has been lost through throwing up. If she vomits these fluids, notify your pediatrician.

    Modify your child's diet

    For the first twenty-four hours or so of any illness that causes vomiting, keep your child off solid foods, and encourage her to suck or drink clear fluids, such as water, sugar water (1.2 teaspoon [2.5 ml] sugar in 4 ounces [120 ml] of water), Popsicles, gelatin water (1 teaspoon [5 ml] of flavored gelatin in 4 ounces of water), or preferably an electrolyte solution (ask your pediatrician which one), instead of eating. Liquids not only help to prevent dehydration, but also are less likely than solid foods to stimulate further vomiting.

    Here are some guidelines to follow for giving your child fluids after she has vomited.
    1. Wait for two to three hours after the last vomiting episode, and then give 1 to 2 ounces (30–60 ml) of cool water every half hour to one hour for four feedings.
    2. If she retains this, give 2 ounces (60 ml) of electrolyte solution alternated with 2 ounces of clear liquids every half hour.
    3. If this is retained for two feedings, add half-strength formula or milk (depending on age), and continue increasing the quantity slowly to 3 to 4 ounces (90–120 ml) every three or four hours.
    4. After twelve to twenty-four hours with no additional vomiting, gradually return your child to her normal diet, but continue to give her plenty of clear fluids.

    In most cases, your child will just need to stay at home and receive a liquid diet for twelve to twenty-four hours. Your pediatrician usually won’t prescribe a drug to treat the vomiting.

    If your child also has diarrhea, ask your pediatrician for instructions on giving liquids and restoring solids to her diet.

    When to see the doctor?
    If she can’t retain any clear liquids or if the symptoms become more severe, notify your pediatrician. She will examine your child and may order blood and urine tests or X rays to make a diagnosis. Occasionally hospital care may be necessary.

    ANAEMIA

    What is anemia and how can I tell if my child is anemic?
    Anemia is a condition that occurs when there are not enough red blood cells or hemoglobin to carry oxygen to the other cells in the body. The body's cells need oxygen to survive. Your child may become anemic for any of the following reasons:

  • Her body does not produce enough red blood cells.
  • Her body destroys or loses (through bleeding) too many red blood cells.
  • There is not enough hemoglobin in her red blood cells. Hemoglobin is a special pigment that makes it possible for the red blood cells to carry oxygen to all the cells of the body, and to carry waste material (carbon dioxide) away.


  • What are the signs and symptoms of anemia?
    Anemia causes the following signs and symptoms:

  • Pale, gray, or "ashy" skin (also, the lining of the eyelids and the nail beds may look less pink than normal)
  • Irritability


  • Mild weakness

  • Tiring easily


  • Children with severe anemia may have the following additional signs and symptoms:
  • Shortness of breath
  • Rapid heart rate
  • Swollen hands and feet


  • Also, a newborn with hemolytic anemia may become jaundiced (turn yellow), although many newborns are mildly jaundiced and do not become anemic.

    Children who lack iron in their diets may also eat strange things such as ice, dirt, clay, and cornstarch. This behavior is called "pica." It is not harmful unless your child eats something toxic, such as lead paint chips. Usually the pica stops after the anemia is treated and as the child grows older.
    If your child shows any of these symptoms or signs, see your pediatrician. A simple blood count can diagnose anemia in most cases.

    What does one do to Prevent anemia in the child?
    Iron-deficiency anemia and other nutritional anemias can be prevented easily. Make sure your child is eating a well-balanced diet by following these suggestions:

  • Do not give your baby cow's milk until he is over 12 months old.
  • If your child is breast-fed, give him foods with added iron, such as cereal, when you begin feeding him solid foods. Before then, he will get enough iron from the breast milk. However, feeding him solid foods with too little iron will decrease the amount of iron he gets from the milk.
  • If you formula-feed your baby, give him formula with added iron.
  • Make sure your older child eats a well-balanced diet with foods that contain iron. Many grains and cereals have added iron (check labels to be sure). Other good sources of iron include egg yolks, red meat, potatoes, tomatoes, molasses, and raisins. Also, to increase the iron in your family's diet, use the fruit pulp in juices, and cook potatoes with the skins on.


  • With proper treatment, your child's anemia should improve quickly. Be sure to contact your pediatrician if you think your child might be anemic.

    My baby is afraid of strangers and never wants to leave my side. Is this normal?

    Between the ages of eight and twelve months, your child sometimes may seem like two separate babies. First there’s the one who’s open, affectionate, and outgoing with you. But then there’s another who’s anxious, clinging, and easily frightened around unfamiliar people or objects. Some people may tell you that your child is fearful or shy because you’re “spoiling” her, but don’t believe it. Her widely diverse behavior patterns aren’t caused by you or your parenting style; they occur because she’s now, for the first time, able to tell the difference between familiar and unfamiliar situations. If anything, the predictable anxieties of this period are evidence of her healthy relationship with you.

    Separation anxiety: An emotional milestone

    Anxiety around strangers is usually one of the first emotional milestones your baby will reach. You may think something is wrong when this child of yours who, at the age of three months, interacted calmly with people she didn’t know is now beginning to tense up when strangers come too close. This is normal for this age, and you need not worry. Even relatives and frequent babysitters with whom your baby was once comfortable may prompt her to hide or cry now, especially if they approach her hastily.

    At about the same time, she’ll become much more “clutchy” about leaving you. This is the start of separation anxiety. Just as she’s starting to realize that each object is unique and permanent, she’ll also discover that there’s only one of you. When you’re out of her sight, she’ll know you’re somewhere, but not with her, and this will cause her great distress. She’ll have so little sense of time that she won’t know when—or even whether—you’ll be coming back. Once she gets a little older, her memory of past experiences with you will comfort her when you’re gone, and she’ll be able to anticipate a reunion. But for now she’s only aware of the present, so every time you leave her sight—even to go to the next room— she’ll fuss and cry. When you leave her with someone else, she may scream as though her heart will break. At bedtime, she’ll refuse to leave you to go to sleep, and then she may wake up searching for you in the middle of the night.

    How long it will last?

    Separation anxiety usually peaks between ten and eighteen months and then fades during the last half of the second year. In some ways, this phase of your child’s emotional development will be especially tender for both of you, while in others, it will be painful. After all, her desire to be with you is a sign of her attachment to her first and greatest love—namely you. The intensity of her feeling as she hurtles into your arms is irresistible, especially when you realize that no one—including your child herself— will ever again think you are quite as perfect as she does at this age. On the other hand, you may feel suffocated by her constant clinging, while experiencing guilt whenever you leave her crying for you. Fortunately, this emotional roller coaster eventually will subside along with her separation anxiety. But in the meantime, try to downplay your leave-taking as much as possible. Here are some suggestions that may help.

    1. Your baby is more susceptible to separation anxiety when she’s tired, hungry, or sick. If you know you’re going to go out, schedule your departure so that it occurs after she’s napped and eaten. And try to stay with her as much as possible when she’s sick.
    2. Don’t make a fuss over your leaving. Instead, have the person staying with her create a distraction (a new toy, a visit to the mirror, a bath). Then say good-bye and slip away quickly.
    3. Remember that her tears will subside within minutes of your departure. Her outbursts are for your benefit, to persuade you to stay. With you out of sight, she’ll soon turn her attention to the person staying with her.
    4. Help her learn to cope with separation through short practice sessions at home. Separation will be easier on her when she initiates it, so when she crawls to another room (one that’s baby-proofed), don’t follow her right away; wait for one or two minutes. When you have to go to another room for a few seconds, tell her where you’re going and that you’ll return. If she fusses, call to her instead of running back. Gradually she’ll learn that nothing terrible happens when you’re gone and, just as important, that you always come back when you say you will.
    5. If you take your child to a sitter’s home or a child care center, don’t just drop her off and leave. Spend a few extra minutes playing with her in this new environment. When you do leave, reassure her that you’ll be back later.

    If your child has a strong, healthy attachment to you, her separation anxiety probably will occur earlier than in other babies, and she’ll pass through it more quickly. Instead of resenting her possessiveness during these months, maintain as much warmth and good humor as you can. Through your actions, you’re showing her how to express and return love. This is the emotional base she’ll rely on in years to come.

    Children’s Growth

    Growth Charts
    Growth Chart

     Growth Chart

    Reading growth Charts
    Note that boys and girls grow at different rates, and hence there are different growth charts for them. In the appropriate graph above, look at your child’s’ age in the x-axis. Follow the line vertically upwards to meet the weight of the child as you have recorded. (In the green band showing the weights). The nearer a child is to the centre of the band, his weight is at par with the largest majority of children in this age group. Above and below are children who are proportionately advanced or lagging in weight.

    Development

    What are some of the developmental milestones my child should reach by three months of age?
    By the time your baby is three months of age, she will have made a dramatic transformation from a totally dependent newborn to an active and responsive infant. She’ll lose many of her newborn reflexes while acquiring more voluntary control of her body. You’ll find her spending hours inspecting her hands and watching their movements.

    Here are some other milestones to look for.

    Movement milestones
  • Raises head and chest when lying on stomach
  • Supports upper body with arms when lying on stomach
  • Stretches legs out and kicks when lying on stomach or back
  • Opens and shuts hands
  • Pushes down on legs when feet are placed on a firm surface
  • Brings hand to mouth
  • Takes swipes at dangling objects with hands
  • Grasps and shakes hand toys


  • Visual and hearing milestones
  • Watches faces intently
  • Follows moving objects
  • Recognizes familiar objects and people at a distance
  • Starts using hands and eyes in coordination
  • Smiles at the sound of your voice
  • Begins to babble
  • Begins to imitate some sounds
  • Turns head toward direction of sound


  • Social and emotional milestones
  • egins to develop a social smile
  • Enjoys playing with other people and may cry when playing stops
  • Becomes more communicative and expressive with face and body
  • Imitates some movements and facial expressions


  • What are some of the developmental milestones my child should reach by seven months of age?
    From age four to seven months, the most important changes take place within your child. This is the period when he’ll learn to coordinate his emerging perceptive abilities (the use of senses like vision, touch, and hearing) and his increasing motor abilities to develop skills like grasping, rolling over, sitting up, and possibly even crawling.

    Here are some other milestones to look for.

    Movement milestones
  • Rolls both ways (front to back, back to front)
  • Sits with, and then without, support of her hands
  • Supports her whole weight on her legs
  • Reaches with one hand
  • Transfers object from hand to hand
  • Uses raking grasp (not pincer)


  • Visual milestones

  • Develops full color vision
  • Distance vision matures
  • Ability to track moving objects improves


  • Language milestones

  • Responds to own name
  • Begins to respond to “no”
  • Distinguishes emotions by tone of voice
  • Responds to sound by making sounds
  • Uses voice to express joy and displeasure
  • Babbles chains of consonants


  • Cognitive milestones

  • Finds partially hidden object
  • Explores with hands and mouth
  • Struggles to get objects that are out of reach


  • Social and emotional milestones

  • Enjoys social play
  • Interested in mirror images
  • Responds to other people’s expressions of emotion and appears joyful


  • DELAY IN MILESTONES

    PROBLEM INDICATORS IN 3 MONTH OLDS

    Although each baby develops in her own individual way and at her own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention. If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.

  • Doesn’t seem to respond to loud sounds
  • Doesn’t notice her hands by two months
  • Doesn’t smile at the sound of your voice by two months
  • Doesn’t follow moving objects with her eyes by two to three months
  • Doesn’t grasp and hold objects by three months
  • Doesn’t smile at people by three months
  • Cannot support her head well at three months
  • Doesn’t reach for and grasp toys by three to four months
  • Doesn’t babble by three to four months
  • Doesn’t bring objects to her mouth by four months
  • Begins babbling, but doesn’t try to imitate any of your sounds by four months
  • Doesn’t push down with her legs when her feet are placed on a firm surface by four months
  • Has trouble moving one or both eyes in all directions
  • Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
  • Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings
  • Still has the tonic neck reflex at four to five months


  • PROBLEM INDICATORS IN 7 MONTH OLDS

    Because each baby develops in his own particular manner, it’s impossible to tell exactly when or how your child will perfect a given skill. The developmental milestones listed in this book will give you a general idea of the changes you can expect, but don’t be alarmed if your own baby’s development takes a slightly different course. Alert your pediatrician, however, if your baby displays any of the following signs of possible developmental delay for this age range.

  • Seems very stiff, with tight muscles
  • Seems very floppy, like a rag doll
  • Head still flops back when body is pulled up to a sitting position
  • Reaches with one hand only
  • Refuses to cuddle
  • Shows no affection for the person who cares for him
  • Doesn’t seem to enjoy being around people
  • One or both eyes consistently turn in or out
  • Persistent tearing, eye drainage, or sensitivity to light
  • Does not respond to sounds around him
  • Has difficulty getting objects to his mouth
  • Does not turn his head to locate sounds by four months
  • Doesn’t roll over in either direction (front to back or back to front) by five months
  • Seems inconsolable at night after five months
  • Doesn’t smile spontaneously by five months
  • Cannot sit with help by six months
  • Does not laugh or make squealing sounds by six months
  • Does not actively reach for objects by six to seven months
  • Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180 cm] ranges by seven months
  • Does not bear some weight on legs by seven months
  • Does not try to attract attention through actions by seven months
  • Does not babble by eight months
  • Shows no interest in games of peekaboo by eight months


  • Feeding Children

    Children should be started on solids in the sixth month. A light rice gruel, kheer, soups etc. are good way to start in the early stages. These foods are called complementary foods- foods that are offered to the child, as breast milk is continued.

    It is common for the young infant to take considerable time –around 30-45 minutes, in taking a meal. It is usually most successful, when it made to look like a play routine-rather than a tedious ‘task’.

    Different tastes and texture need to be introduced serially once the child has taken a liking for a few food items and the volumes have been built up.

    It is also, not uncommon for the child to be loving a certain food one day and completely reject it the next day. A little imagination, and creativity helps in maintaining the tempo of feeding.

    Most pediatricians, the world over, have dropped the term-weaning, which is understood to have a negative connotation-in the sense of stopping breast feeding which is not desirable, rather than adding on other foods over and above the ongoing feeding schedule.

    Immunization

    Q. Why does my child need to be immunized?
    Immunizations have helped children remain healthy for more than 50 years. But many parents still have many questions about them, including the following:

    Q: "Why are vaccines needed if the diseases they prevent are not as common anymore?"
    A: Vaccines are still needed because the bacteria and viruses that cause these diseases still exist. Vaccines have protected children and continue to protect children from getting these diseases. In the United States many diseases are not as common or widespread as they used to be thanks to better nutrition, less crowded living conditions, better sanitation, antibiotics, and, most importantly, vaccines.

    Vaccines also are needed to protect children from diseases that may be brought into the United States from people who have visited or are visiting from other countries. Many vaccine-preventable diseases are still common in many parts of the world. Travelers may be carriers of these diseases without them knowing they are infected. Influenza is an example of a disease that is transmitted between countries every year.

    Q: "Do vaccines even work? Most of the people who get these diseases have been vaccinated."
    A: Yes. Vaccines work extremely well. Millions of children have been protected from serious illnesses such as polio, whooping cough, measles, tetanus, and diphtheria because parents have had their children immunized. Most childhood vaccines are 90% to 99% effective in preventing disease. They are even more effective in reducing disease severity. Occasionally a few children may not develop the desired protection after receiving a vaccine.

    But to not vaccinate your child gives them no protection from the possibility of getting one of these deadly diseases.

    Q: "I've heard that some children have serious side effects from vaccines. Are vaccines safe for my child?"
    A: Vaccines are safe, and severe reactions to vaccines are very rare. Mild reactions to vaccines do occur, but they do not last long. There may be some swelling, redness, and discomfort where the shot was given. Your child may have a low-grade fever and be fussy afterward. Symptoms of more serious reactions are much less common. Call your child's pediatrician right away if your child has a

  • Very high fever (>103°F)
  • Generalized rash (including hives)
  • Large amount of swelling around the shot or in the limb used for the shot


  • Your child's pediatrician can decide whether your child should receive future doses of the same vaccine.

    Children with certain health problems may need to avoid some vaccines or get them later. For example, children with cancer, those taking steroids for lung or kidney conditions, or those who have problems with their immune systems in most cases should not receive vaccines like the measles, mumps, and rubella (MMR) or chickenpox vaccine. These are not safe for children with these health problems because the vaccine is made with weakened live viruses. For children with seizures, the pertussis part of the diphtheria, tetanus, and pertussis (DTaP) vaccine may need to be delayed.

    Ask your child's pediatrician when the vaccine can be given.

    Remember, immunizations are an important part of your child's total health care. Immunize your child on time, and keep your child's immunization record up to date. Make sure you take your child to the pediatrician's office or a health clinic on a regular basis.

    Adverse events following immunization

    Most children complain of some pain, redness and mild swelling at the site of injection, this is common. Though nothing needs to be done in most cases, it is usually helped by, application of ice. Hot fomentation etc is not recommended.

    Some vaccines particularly DPT, cause a fever that may last more than a few hours, and they need some medicines for fever.

    Screening

    To ensure a healthy life for your child we at Chaitanya follow your baby’s health from intrauterine life till he discharged from hospital, not only for manifest problems, but various rare conditions. These tests are the norm in most developed countries.

  • Antenatal Anomaly screen
  • Postnatal Dysmorphology Screen
  • Metabolic screen
  • Hearing screen


  • Antenatal Anomaly screen

    Level II ultrasound scan done at 5 months for all mothers to-be screens any defects in formation of various organs. It always helps us to prepare for the new arrival keeping his special needs,should an anomaly be detected.

    Postnatal Dysmorphology Screen

    A specialist screens all newborns after birth with a critical eye to search for any abnormality, malformation, or any major or minor defects in most internal organs. If you have a baby discharged from Chaitanya, rest assured, we have taken great pains to ensure that your baby is well, or that you have been informed about any future problems likely to arise from any findings of this examination.

    Metabolic screen

    The human body is made up of a vast number of complex chemical molecules. Sometimes some defects creep in, in the structure of these molecules. This results in defects that have wide ranging impact over the whole body system. These limit the body’s ability to handle some items in milk, like some amino acids, which are converted to damaging molecules. If the defect is known at birth, avoidance of offending items make the difference between health and irreversible disease.

    Some hormones like the thyroid hormone support brain growth. Defects in this hormone, causes a major impact on the brain development of the child. If known at birth it is eminently treated.

    When we look at defects in chemical structure of the body, we call it metabolic screening. We routinely screen all newborn, delivered in our hospital for three major defects-hypothyroidism, G-6-PD deficiency and, 17-OHP.

    HEARING SCREEN

    We offer hearing screen by a qualified audiologist.

    Why do newborns need hearing screening?
    Although most babies can hear normally, 2 to 3 of every 1,000 babies are born with some degree of hearing loss. Without newborn hearing screening, it can be difficult to detect hearing loss in the important first months and years of your baby's life. About half of the children with hearing loss have no risk factors for it.

    Newborn hearing screening can detect possible hearing loss in the first days of a baby's life. If a possible hearing loss is found, further tests will be done to confirm the results. If a hearing loss is confirmed, treatment and early intervention can start promptly. Early intervention helps babies with hearing loss and their families learn important communication skills.

    That is why the American Academy of Pediatrics recommends that all babies receive newborn hearing screening before they go home from the hospital.

    Importance of good hearing

    Babies learn from the time they are born. One of the ways they learn is through hearing. If they have problems with hearing and do not receive the right treatment and early intervention services, babies will have trouble with language development. For some babies early intervention services may include the use of sign language and/or hearing aids. Studies show that children with hearing loss who receive appropriate early intervention services by age 6 months usually develop good language and learning skills.

    Screening tests

    There are 2 screening tests that may be used.
  • Auditory brainstem response (ABR)—This test measures how the brain responds to sound. Clicks or tones are played through soft earphones into the baby's ears. Three electrodes placed on the baby's head measure the brain's response.
  • Otoacoustic emissions (OAE)—This test measures sound waves produced in the inner ear. A tiny probe is placed just inside the baby's ear canal. It measures the response (echo) when clicks or tones are played into the baby's ears.
    Both tests are quick (about 5 to 10 minutes), painless, and may be done while your baby is sleeping or lying still. Either or both tests may be used.

    If hearing loss is found

    This depends on the type of hearing loss that your baby has. Every baby with hearing loss should be seen by a hearing specialist (audiologist) experienced in testing babies and a pediatric ear/nose/throat doctor (otolaryngologist).

    Special hearing tests can be performed by the audiologist who, together with the otolaryngologist, can tell you the degree of hearing loss and what can be done to help.

    If the hearing loss is permanent, hearing aids and speech and language services may be recommended for your baby. The Individuals with Disabilities Education Act (IDEA) requires that free early intervention programs be offered to children with hearing loss, beginning at the time the child's hearing loss is identified.

    The outlook is good for children with hearing loss who begin an early intervention program before the age of 6 months. Research shows these children usually develop language skills at par with those of their peers.

    Timing is everything

    Some parents think they would be able to tell if their baby could not hear. This is not always the case. Babies may respond to noise by startling or turning their heads toward the sound. This does not mean they have normal hearing. Most babies with hearing loss can hear some sounds but still not hear enough to develop full speaking ability.

    Your baby will have the best chance for normal language development if any hearing loss is discovered and treated by the age of 6 months—and the earlier, the better.
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