Urinary infection in children: what need to be done?

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  Definition of urinary tract infection (UTI) is  growth of significant number of organisms of single species  in urine sample along with Symptoms. ( First aid for urinary pain in children. )

Types of UTI and common symptoms

Simple UTI: mild fever, irritable, Pain during urination, increased frequency and urgency

Complicated UTI: High grade fever, vomiting, stomache, dehydration and toxic looking child

Symptoms present less often are: heamturia, voiding issues, bed wetting , failure to thrive may also be present

 

Risk factors:    Girl child , poor hygiene, Vesicoureteral reflux (VUR), Voiding dysfunction, obstruction in urinary tract

Urine collection: mid stream clean catch sample gives most accurate report in home settings

Urine routine , microscopy s/o UTI: pus cells in urine sample, along with positive nitrate and leucocyte esterase .

Gold standard test is urine culture.. as its report takes aroung 48 hours to come, we can start antibiotics after sending urine sample for culture in consultation with doctor and wait for culture report for further plan of action.

Treatment:

Plenty of fluids, oral antibiotics and other supportive care as advised by your doctor

Plan of action as per age ( preferably in consultation with pediatric nephrologist)

  • Less than 1 years: Ultrasound, MCU and DMSA scan
  • 1-5 years of age: ultrasound and DMSA, ( if DMSA is abnormal than MCU to be done)
  • More than 5 years: Ultrasound only ( if abnormal  further work up)

In high risk cases ,we might need prophylaxis to prevent repeated episode of urinary infection.

Whenever in doubt consult pediatric nephrologists

Regards

Dr Rahul Varma

Erb’s palsy ( common injury to baby during birth)

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Erbs palsy  ( brachial plexus injury)

One of the common type of birth injury which happens in newborn baby while delivery. (happens mostly in assisted deliveries like vaccum or forceps). In this injury there is damage to nerves supplying shoulder and arm; which in turn leads to decrease in movement of that shoulder. Nerves are 5th and 6th cranial nerve (part of brachial plexus nerves) , which are damaged while passing through a point called Erb’s point.

One way that the brachial plexus nerves are affected is when the baby is passing through the birth canal at an awkward angle, with the head being turned to one direction while the arm is being pulled in the opposite direction.

1-2 babies per 1000 newborn delivery worldwide are affected.

Various risk factors involved in this condition are

  1. Large size baby/ good weight of baby.
  2. Assisted delivery .eg use of forceps or vacuum
  3. Excessive pulling/ traction on shoulders during delivery
  4. Gestational diabetes mellitus
  5. Prolong labour

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Symptoms:

  • Not able to move upper limb well. Especially shoulder joint. Affected arm is hanging by side of body and may be bent at elbow.
  • If not able to move even fingers; (not able to grip , your fingers properly) then it suggests severe injury and involvement of lower plexus of nerves too.
  • Can have collar bone fracture along with it, which might be worsening the movement of that side.
  • It often looks like that baby has paralysis of the affected side

 

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Types of Nerve Injuries

There are four types of nerve injuries.

  1. Neurapraxia: nerve is stretched, not complete tear. (so recovers early within 3 months).
  2. Neuroma: more serious damage to nerves
  3. Rupture: nerve is torn; will need intervention(as it will not heal on its own)
  4. Avulsion: is complete tear and most serious of all. ( luckily it is very rare)

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Treatment:

  • Multidisciplinary approach will decide the plan of care for baby: will include pediatrician, need help from neurologist, orthopedic and neuro physiotherapist.
  • Intermittent immobilization and positioning to prevent contractures
  • Gentle massage (as advised by physio)
  • Surgery if severe damage to nerve or complete tear of nerve.
  • Electric stimulation may help

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Prognosis:

  • It depends on degree of damage: likely most of the cases are mild.
  • If the hand grasp/ grip is good and finger movement is present: it suggests good prognosis.
  • It may take few months to few years to recover.

Be in regular follow and adhere to advice of your doctor.

Regards

Dr Rahul varma

Anemia: more common in children than we think.

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Anemia is very commonly seen in young children who are mainly on milk based diet (As milk is poor source of iron). Breast milk has small quantity of iron but it is readily absorbed in body; so for first 6 months of life iron deficiency is not prominent. But after 6 months, when top milk is started, it can lead to anemia if proper iron supplementation or appropriate weaning food is not given.

That is the very reason you will see all the infant formula feeds and cereals fortified with iron these days. As iron is needed to make Hemoglobin; which is oxygen carrying component of red blood cells (RBCs).

 What is the right Quantity of Iron needed by my Kid?

  • From birth till 6 months: Adequate iron is there in mother’s breast milk. No need for supplementation unless baby is preterm or suffering from any illness.
  • 7 -12 months: 11mg per day. It can be given by using infant formula feeds or cereals fortified with Iron or using iron supplement drops.
  • Toddlers: 7 mg/day; Kids aged 4-8 years need around 10 mg per day. Older kids between 9- 13 years need around 8 mg/day.
  • Adolescent boys need 11 mg /day and girls 15 mg/day of iron. Girls need more during their adolescence as more blood is lost during menstruation.
  • Special need in athletes and children involving extreme physical activities need even more iron.

How deficiency develops?

  • Infants and young children mainly on cow’s milk develop iron deficiency as cow’s milk is low in iron and it also makes child less hungry and there is a less likelihood of child eating iron rich foods.
  • Cow’s milk also decreases absorption of iron and can irritate lining of intestine causing minor intestinal bleeding and gradual loss of Iron in stool.
  • Worm infestation
  • Iron requirement is more than normal in certain conditions like preterm babies, menstruating adolescent girls, children involved in extreme physical activities.

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What are Effects of iron Deficiency?

  • Irritability
  • Poor appetite
  • Poor growth and development
  • Behavioral problems
  • Fatigue and weakness
  • Pale skin and mucous membranes
  • Rapid heartbeat or a new heart murmur (detected in an exam by a doctor)

If any of the above symptoms is there in your child, consult your child specialist / Pediatrician and discuss regarding iron deficiency and need for supplementation. Excess of iron is also bad, so it should be taken in appropriate doses only after consulting your child doctor.

Common source of Iron in Diet

Both animal and plant source foods are available which are rich in Iron

  • Red meat
  • Dark poultry
  • Tuna
  • Salmon
  • Eggs
  • Tofu
  • Enriched grains
  • Dried beans and peas
  • Dried fruits
  • Leafy green vegetables
  • Blackstrap molasses
  • Iron-fortified breakfast cereals

How to avoid Iron Deficiency in your child

  • Limit the intake of milk: 500 to 700 ml a day after 1 year of life and focus on staple diet.
  • Continue serving iron-fortified cereal until kids are 18-24 months old.
  • Avoid giving iron supplements with milk as leads to poor absorption.
  • Serve iron-rich foods alongside foods containing vitamin C — such as tomatoes, broccoli, oranges, and strawberries — which improves the body’s absorption of iron.
  • Avoid serving coffee or tea at mealtime — both contain tannins that reduce iron absorption.

Once Iron is started in Iron deficient child; within 2 -3 days you will see significant improvement in diet.

Regards

Dr Rahul Varma

Why Doing Away With the Gadgets Is Important for Your Kid

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Steve Jobs did not allow his kids to own and use an iPad at home. He feared that the iPad would turn his kids into addicts of the device. He should know. After all, he was the founder of Apple Inc. and the father of the digital revolution. Most, if not all, Silicon Valley techs and engineers limit and shield their kids from technology and prefer to send their kids to schools where the focus is on hands on learning and computers are not easily accessible.

Why do the people at the pinnacle of digital change shield their kids from this technological marvel? The reasons are too many and varied, but everyone agrees on some common pitfalls of early exposure to technology.

Children learn better from real life experiences rather than screen time. It is more so if activities involve moving and doing. Various surveys and studies show that on an average 12-month-old baby is exposed to up to 2 hours of screen time a day.

Young age (< 2 years) is very critical for learning of new concepts. Most of the learning involve 3 dimensional Sensory- motor experiences which cannot be replicated on a 2 dimensional screen. Active play involves better hand – eye coordination , fine motor skill development.

Example:  Compare a ball in real life and a ball on Screen.

Infants are still developing concept of 3 dimensional vision. For a small baby  watching on screen a BALL is just a flat, shaded circle. In real life if we roll a ball across floor it proceeds in a single motions and gradually slows and stops finally. But on Screen same action cannot be done; it will be broken up. Small babies may stare at bright colors and motions on screen but their brain is not capable of making sense or meaning out of these amazing pictures. By  the age 2 years brain has developed enough and baby can understand things better. Due to all this confusion it is better to avoid screen time in small babies.

Distorted sense of reality:

Early exposure to technological marvels such as tablets, smart phones and computers are detrimental to the physical and mental growth of children. They give children a distorted view of reality and interfere with the natural development of the child’s brain

Co-ordination and dexterity:

Children as young as 3 and 4 when exposed to the iPad may become experts at swiping the screen, but lag behind in developing dexterity in their fingers that comes by playing sports or musical instruments.

Concept of space:

Young children have still not developed a sense of space and each new walking, bending and climbing experience helps to develop a sense of space. Early exposure to the iPad interferes with this development and gives children a distorted sense of depth and space.

Social Skills:

Various studies have shown that children growing on iPads or other similar screen devices tend to lag behind in development of real time social skills. Regular activities such as developing social skills and making friends become a task for such children. Such children do not spend time with their own thoughts and imagination and require constant stimulation.

Emotional skills:

Development of internal mechanism of self-regulation is an important milestone in a child’s emotional development. Constant and continuous use of such devices to distract and control the behavior of children impedes their ability of self-regulation.

Maths and Science:

Playing with blocks in real time develops visual-motor skills and sensorimotor skills in children that are the base of all learning. Application of maths, science and logic in the classroom and outside comes naturally for kids whose basic skills are well – development. Playing with real blocks and puzzles is frustrating for young minds who are used to manipulating objects by swiping the screen.

The list of the evils of early exposure to screen only gets longer with time. There has been very little systematic research and the technology is still quite new to fully understand its complete effects. For now, the safest thing to do is keep that tablet away from your kids or at least stop using it as a baby sitter.

Snoring in Children

 

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As uncommon and abnormal as it may seem, snoring in babies is not always a red flag for your baby’s health. Many babies produce noises like whiffing, snuffing and snoring while sleeping. If your baby snores rarely or occasionally, then it’s not a cause of concern. But if it has become a chronic habit of your little angel to snore, then consulting your Pediatrician is always advisable.

But before you start panicking, let’s understand the causes of snoring in babies.

Causes of Snoring in Babies

  • Cold and flu infections: This is the most common cause of snoring in babies. As your baby’s airways are very small and narrow when they are few months old, mucous secretions during a cold or flu infection easily block her nose and throat. As a result, your baby may snore while she is suffering from cold or throat infections.
  • Allergies: Your baby may be allergic to down filling in the mattress or pillows or allergic to pet hairs if you have a dog or cat. This may obstruct the airways of your baby while she sleeps and become the cause of snoring.
  • Enlarged tonsils or adenoids: Adenoids are lymph nodes at the junction of nose and throat which may enlarge due to various infections. Similarly, tonsils are lumpy lymph tissues located at the back of throat, which can also enlarge due to repetitive infections. Although the rate in newborn babies, with time these can contribute to obstruction in breathing which can in turn cause snoring.
  • Deviated Nasal Septum: Nasal septum is the bone that separates both the nostrils and in case of a deviated septum, this bone may be structurally misaligned obstructing one of the nostrils. This could be a cause of chronic snoring in your baby.
  • Laryngomalacia: In very young babies, the cartilage that keeps the nasal airways open may remain underdeveloped for some time after birth. As a result, your newborn may snore frequently until this cartilage develops properly.
  • Throat abnormalities: Cystic formations in the throat or abnormal palate movement can also cause snoring in babies.
  • Sleep Apnea: This is a condition wherein your baby experiences obstruction in breathing for several seconds, causing lack of oxygen and acute breathlessness. This may happen multiple times during sleep and can cause loud snoring in your baby.

How to correct snoring in your baby?

Once you have identified the cause of snoring in your baby, in consultation with her pediatrician, you can start with the corrective measures to alleviate your baby’s snoring.

You can take the following steps to correct snoring:

If your baby is suffering from cold, flu or allergies; use a humidifier in your baby’s room and put saline nasal drops in your baby’s nose to help her breathe better while sleeping.

Also remove any allergens or allergy-causing agents from your baby’s room to avoid any breathing obstructions.

Change your baby’s position or put a pillow under her head when she’s asleep to help keep her airways open.

If your baby is suffering from sleep apnea, enlarged adenoids and tonsils may be responsible. You can either reduce this enlargement with medicines or can even get them surgically removed once your baby is a little older.

Throat abnormalities and deviated nasal septum can only be corrected surgically and you should consult your Pediatrician/ ENT specialist for complete corrective action.

Thus, if your little one snores, the next time she dozes off, rest assured that it’s nothing to worry about. With proper care and as she grows, this problem can be easily resolved.

 

Regards

Dr Rahul Varma

Ways to Get Your Toddler’s Attention and Keep It

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You might have experienced this- you are reading aloud a book to your 15-month- old kid and halfway through she wanders away across the room towards the bookshelf. Well! This is a perfectly normal behaviour for her. Psychologists explain that toddlers are innately distractible. They cannot stick on with one thing as long as an older child or adults can. After a couple of minutes, they venture in search of other things. Besides, another reason for your toddler to not comply with your instructions is that she is taking the first step towards becoming her own person. She is walking her way to independence and may tend to do exactly the opposite of what you might have suggested to her.

Read on to find simple ways to get attention of your toddler and have them be seated for a couple minutes to play with a toy or draw etc.

  • First and foremost, is your time. If you want results, it require good quality time. Take time out from your social networking and other stuff and focus on your child’s future. Father’s too have equal responsibility to take out time.
  • Get down to their level to talk to them. Squat down or pick them up, make an eye contact to get their attention to what you have to say.
  • Put in confident good humor in your language. Use silly voices, make up tunes to sentences or sing your instructions to them. For example, if you want to tell them, ‘It’s time to take a bath’, just sing it to them. This will intrigue them to listen to you. Always remember, yelling instructions may get the work done, but no one enjoys the process of doing it.
  • Never impose your choice of play or activity on them. Let them choose what they want for themselves. This makes them pay more attention to things they do while enjoying the task.
  • Television or videos are a complete ‘No No’ in the first two years of a child’s life. In fact, TV, rattles and other noise-making toys overwhelm a child’s attention rather than encouraging the child to actively flex his/her muscles to focus. On the contrary, give them toys that are more open-ended so that they can curiously engage in them with more than one special sense.

Children enjoy games. Engage with them in fun-filled games so that they learn to pay attention. Here are few games you can play with your children:

  • Make hand puppets or finger puppets and use them to give simple instructions (like clap your hands, spin around, etc) to your child. It paves the path for the budding independence of the child as it is a friendly puppet that is instructing them.
  • Go on a treasure hunt with them. This way they learn to follow two- to three-step instructions as well.
  • Mimic voices. Draw the child’s attention to the distantly heard voices and then both of you can mimic it one by one.
  • Use flashlight to focus on different objects in a dark room and let them name them.
  • Last but not the least, model good behavior. Listen to them respectfully and they will learn to be good listeners.

A long attention span is vital for creative, athletic and academic achievement. Attentive listeners make the best friends, spouses and parents. The basic skills of focusing and concentrating learnt in the first few years of life go a long way to help them deal with difficult problems of life and pursue their dreams.

Worried About Your Child’s Obesity? Watch the Kilos Melt Away With This Action Plan!

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Childhood Obesity is on the rise! As a parent, it is not easy to accept the fact that your child might be obese or even overweight. The body mass index (BMI) uses height and weight to calculate whether a child falls into underweight, average, overweight or obese categories. Even if your child is a little overweight, it is easier to shed the extra pounds as compared to adults. (Moreover in young kids we just want baby to maintain that weight and do not allow the child to gain weight further and with time as the age grows child will fall in normal weight category)

Obesity, be it in children or adults, has multiple risk factors associated with it. It affects the entire body and causes our body functions to go haywire.

Most common associated risks with obesity are:

  1. Increased risk for type II diabetes due to insulin resistance;
  2. High risk for respiratory conditions such as asthma;
  3. Abnormal sleep patterns and snoring issues;
  4. Depression and low self- esteem due to the body shape and always stared upon;
  5. Risk of high blood pressure;
  6. Joint problems due to large weight

In current time, childhood obesity is spreading like an epidemic through all the cultures. The action plan to get rid of this menace includes:

1. Get rid of calorie-rich temptations

Avoid giving your child extra calories such as chocolates and fried chips for snacks. Instead try fresh fruits or vegetables with dips for snacking.

2. Decrease extra sugar

Try not to put extra sugar in milk or any other food that you might serve to your child.

3. Regular scheduled meals and adequate portion size

Having small meals and snacks in between the meals decreases production of fat and increases metabolism. Try child-size servings instead of adult-size. Add juices, smoothies, beans, pulses, five portions of fruit and vegetables.

4. Do not eat out too often

Outside food might contain too much oil, butter, salt and sugar. Basically, nothing beats homemade food! So avoid eating out.

5. Exercise

Exercising is the best way to lose weight. Make it interesting for your kids. Play sports with them, go bike riding or on any other activity they like.

6. Decrease sedentary lifestyle

Children’s life these days has become sedentary because of increased use of electronic devices such as TV, iPads, Tablets, etc. Lifestyle surrounding these gadgets must be avoided.

7. Lead by example/ Be a role model

Be the change you want to see in your child. Behave like you want them to in front of you. This is true especially for diet and exercise. If your kids see you eating healthy food and exercise regularly, they will try to follow your footsteps.

So, kick start these above mentioned activities and watch your kids transform from being overweight to being healthy and fit.

Avoid use of video games: Buy a Bicycle instead

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Although the makers of the video game industry claim that video games are nothing but fun and entertainment, most pediatrician and health researchers attribute increased incidences of violence as well as childhood obesity to the rising exposure to video games.

Most video games contain graphic imagery and direct or indirect violence. In fact, the top preferred games are loaded with violence and objectionable content like shooting people, stealing stuff, running over objects, destroying objects, etc. What should you do as a parent if the only thing your child want to do all vacation is shoot down people in Counter Strike?

When young and impressionable minds of children are subjected to such content, they are invariably influenced and conditioned. The soaring numbers of violent incidents, such as gun violence, bullying and other forms of violence prevalent in schools, are believed to have been inspired from mind-numbing hours of video game playing. Child psychologists believe that prolonged exposure to such games leads to the child developing an indifference to violence.

Several studies conducted indicate that children who spent hours on video games in their childhood grew up to indulge in various forms of violence or had some criminal charges against them. Parents give in to their child’s demands and pamper them with the state-of- the-art gaming devices such as Play stations, X Box, etc. Evidently, such games hamper real life activities, like studying, playing outdoors, making new friends that seem dull in comparison to the colorful gaming world. Children develop a need for immediate gratification and become restless and cranky if things do not turn out the way they planned.

Other physical effects include poor eyesight from staring at screens for so long, laziness, obesity and many more. Bring a radical change to the video game trend and invest in a bicycle for your child instead.

Children are living a couch potato lifestyle and are rarely stepping out to play and they do not get enough physical exercise. A bicycle will ensure that your child gets plenty of fresh air and exercise. Indeed, parents should encourage their children to play outside daily for a fixed amount of time. This is vital for a child’s complete growth and development, as regular cycling is proven to activate muscle growth and increase stamina.

Some studies also indicate that cycling works positively to boost mental health by reducing stress and anxiety. Cycling for as little as half an hour improves blood circulation, aids in weight loss and leaves you feeling happier and less tensed. Incorporate cycling breaks, even during exam time, to help your child relax and grasp better. It helps improve muscle strength, stamina and bone strength. It also helps them grow taller!

Physical activities done outside of home are going to do wonders in over all growth of your child.

Additionally, several research studies conclude that riding a bike can protect one from serious conditions like cardiovascular diseases, stroke, some cancers, depression, diabetes and so on.

So, gift your child a bicycle and help him create real-life memories with a real social network!

 

Why Pocket Money for Your Teen Makes Sense Even Today

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The idea of offering pocket money to children, especially teenagers, has been going on since ages. Many parents wonder whether or not it will be beneficial to provide pocket money to their kids and how much is the right amount. Are you also puzzled whether you should give your child pocket money? If your answer is yes, then we have some reasons as to why it makes sense to give your teen pocket money even today!

Different parents have different opinions regarding pocket money. But if done correctly, pocket money can prove to be a good thing for your teen.

Here are some advantages of giving pocket money:

1. Independent feeling

Teenagers are ‘mini adults’, so considering them grown up, in this case, will make them feel independent. In addition, this will teach them to manage their own money. Generally, most teenagers love the opportunity of managing their finances independently and do learn to handle their money wisely.

2. Value for money

A lot of teenagers these days do not realize the value of money, as their parents buy almost everything for them. By offering monthly pocket money, they would have to purchase items on their own. This will encourage them to buy their desired items by themselves, the preparation of which will give them a real-life experience, thereby making them aware that things do not come for free. Hence, they will value money.

3. Learn from mistakes

In the beginning, your teen might get overwhelmed by the money and spend it all right away. If the money is over in a week, then he/she will have to stay broke until it is time for the next payment.

4. Saving skills

Educate your teenagers to save a fraction of their pocket money each time and put it away for future or emergency use. If this is done each month, then by the end of the year, they will have a lump sum of money on hand, which they can use to treat themselves.

It is vital for you to understand the consequences of giving pocket money to your teenagers. No matter how well your teen manages the money, it is crucial for you to track and intervene when needed. How much to give??? and from when to start?? Only you as a parent know the answer. Finally, it is important that the money is not just given away but is earned. Ask other parents their opinion and how much they offer and lastly be consistent as you are the one they learn from.

5 Skills Your Child Must Know at 5

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Today, the world has become very competitive and everyone wants their kids to excel in just about all competitions. However, in this race many a times as a parent we forget to keep a tab on the developmental milestones of our child.

There are yearly milestones that a child attains as it grows and these milestones are very important to ensure the growth of your child. As many psychosomatic disorders are seen in children too, these milestones help in spotting them early on and taking steps to preventing worsening. Here we are going to talk about few skills that a child should know by the time he/she turns 5.

Communication skills:

By the age of 5, children should have good command on their language. They should be able to speak clearly and their pronunciation should be perfect. They should be able to speak complex and compound sentences and tell a simple story using full sentences. They should be able to strike a conversation and learn to wait for their turn to speak in group talks.

Social and emotional skills

By the time a child turns 5, they learn to make friends and make efforts to please them. They can tell difference between real and make-believe things. They start showing concern and sympathy for others. They like participating in activities like singing, dancing or acting. They start becoming independent for e.g. they can go alone to your next door neighbour’s place, won’t need you to come along anymore. As they become more social, they like to participate in activities that involve other kids.

Cognitive skills

At 5, kids are creative and enthusiastic problem solvers. They start asking analytical questions and also give imaginative ideas for how to do a task, or make something. They become aware of things being used daily like food, money etc. They can easily count 10 or more things and can even do simple addition and subtraction. They have understanding of shapes and can even copy them. Five-year-olds understand and use words related to position, such as “under” or “behind.” They can even use instruments like thermometers, weighing scale etc.

Physical skills

Physically, five-year-olds are full of energy and look out for active games and environments. They are able to balance and coordinate movements, therefore can ride a bike with training wheels, swim, jump rope etc. They have better control and are able to change the direction, speed and quality of their movements. The flexibility of their fingers is also, improved to great extend and hence they have improved control over writing and painting tools and even manage zippers and buttons.

Creative skills

Five-year-olds are able to compose and arrange music within specified guidelines. They can enact simple plays and perform puppet shows. They can create realistic art with recognizable subjects and more detailed settings.

If your child is completely lacking one or more of these skills, then it might be a good idea to visit a child developmental specialist or pediatrician to rule out developmental disorders or focus on training in a special way to develop certain basic survival skill sets.