Monthly Archives: October 2014

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Injury prevention and Safety in children

Injury Prevention in Children

Every day around 1000 children die worldwide. Most of these deaths can be prevented by taking simple injury prevention measures. Huge number of children becomes seriously injured for life. In developing countries like ours where we lose so many children to infectious diseases; it adds to the mortality burden of country. More than 90% of these injuries are unintentional.

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Common Causes:

RTA ( road traffic accidents), fall from height, burns, poisoning, drowning are the main causes of death in children due to injuries.

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Road traffic accidents (RTA)

It is the leading cause worldwide. various methods which can help in preventing these deaths are Proper use of seat belts and child restrainer devices , wearing helmets, driving and walking in designated lanes, driving within speed limits and to avoid drunken driving.

Fall:

Fall from beds are very common and most baby survive with only bruises and scratches. But still more than 100 children die daily due to fall from height. Many of these deaths can be avoided by using well fitted window panels, child proofing doors and windows and play areas.

Burn:

Burn injuries from hot water or flames are commonly seen in young children. Preventive measures which can help are smoke alarms, temperature regulators, using fire crackers under supervision of adults.

Poisoning:

Another common cause of death in young children is poisoning. Daily numerous calls are received by poison cell. Accidental poisoning can be prevented by child proofing cabinets, keeping toilet cleaner out of reach of children, keeping kerosene oil safely and all the medicines away from children.

Drowning

Drowning is another cause of death in coastal areas. But many small children can drown head down in buckets or bathtub.So to prevent these deaths, we need to store water only in closed container and keep tub empty.

Poverty

Children living in poor economical conditions are more likely to be living in unsafe environment. They might be living close to road with high traffic, poor and unstable construction, illegal electricity connection etc.

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Prevention

Child deaths have decreased significantly over last decade (in western countries) due to following measures:

  • Enforcing laws for child safety like having child proof cabinet for storage of medicines and floor cleaners etc.
  • Structural modification in public places like proper railing for child safety in stairs, well fitted windows, fencing around pools, life guards etc.
  • Public awareness campaigns
  • Better emergency care
  • Proper storage of flammable objects
  • Parental guidance
  • Better disaster management

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In India major issue is with enforcing laws rather than making them. Authorities should be more vigilant and we should also know our social responsibility.

Right to safety

All children have the right to a safe environment and deserve protection from injury. With proper awareness, environmental modifications and good emergency care, it can be achieved.

 

Regards

Dr Rahul Varma

 

Potty-Training-Toilets

When is the right time to start Toilet training in children?

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Training the children for toilet is a big issue for parents. It is perceived as a big developmental milestone. But the real problem starts when we start comparing our kids with others. Every child has different pace of developing milestones. And few accidents regarding Susu (Urine) and potty (Stool) once in a while should be dealt with patiently. Compassionate and encouraging attitude towards toddlers will help us better, than showing frustration and anger.

What is the age when our baby will be ready?

  • First action which suggests that your baby is ready to train is when baby start to tell you while doing susu or soon after that before you take notice. And when baby is praised for telling the same, they will soon be telling you before doing.
  • Most babies should be ready by 2 years but some may take time until they turn 3.
  • Girls are ready earlier than boys of similar age
  • Control over susu comes before potty
  • Other features which indicates that your baby is ready for toilet training are
    • Telling you that his nappy is wet
    • Pulling at wet or dirty nappies
    • Baby does not want to wear nappies any longer
    • Shows interest in others using toilet

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Patience is the Key to success in this case too. Most problems arise when we start too early or we want our baby to be trained before certain major event in our life. eg arrival of 3nd baby, family marriage, long planned vacation, before going to play school. If we try to put pressure on child it will only worsen the case and increase your frustration levels.

How to train your baby

  • Teach your child meaning of words needed to define urine, stool, dry, wet , it’s coming. Choose words you are comfortable with eg susu, potty, wet (geela), dry (suukha), etc. Clear words and constantly same words to be used by everyone at home will make it easier for baby.
  • Need to have thing with you which are needed like toilet seat (different types are there, choose which ever you are comfortable with), footstool near the seat so that baby can climb up, proper lighting in the area, something to hold on while sitting on toilet seat so that baby will feel safe and relaxed.
  • Keep the area safe. Keep toilet cleaner, household cleaner and other toiletries out of range of children.
  • Talk to your child, if you are comfortable you can let your baby go along with you and tell them all the steps you are doing like cleaning flushing etc.
  • Learn the signal which baby gives before, keep your toilet ready (because your baby won’t be able to hold on for long), loose cloths which can be easily removed.

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Few important things you need to know:

  • Never start toilet training when something new is happening and child is trying to adapt. eg change of home, grandparents leaving home, arrival of 2nd baby, you are very stressed out etc
  • Give your child time to get familiar with stuff in toilet (so that they are not scared). Eg let him touch the toilet seat, feel it.
  • Encourage an appreciate child’s behavior and things when they tell in time. Hug them or cuddle them and say something like “You are good baby”. And always support them if they do in their pants.
  • Never embarrass or punish your Child. It will only worsen the situation.
  • Remember it is very difficult skill to learn for child and it will take time. The more you support your child easier it will be for them.
  • Hygiene: Girls should be taught to wipe front towards back to avoid chances of getting the potty into vagina and Boys should be taught to shake penis after susu to get rid of any drops.
  • Teach your child to wash hand every time and also assist them in early stages of cleaning.

 

“Toilet training works best when there is no pressure for either the parent or the child”.

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  • If you are stressed out or getting angry seeing that your baby is not learning, it is best to leave it for few days and do not pressurize your child. Punishment will never help.
  • Some baby will hide at some weird place and do susu or potty. Like behind the sofa, or curtain or cupboard. You need to be patient and support them and no Punishment.
  • Most babies will make a mess after doing potty; they may soil their hands and spread it. Do not punish them but also do not pretend to be happy about it. Child should know that it is not good in non threatening way.
  • Constipation can make things worse as doing potty becomes painful and child try to avoid passing stool and is afraid to sit on potty seat. Give warm bath, it may relax the muscles.
  • If a child who has been dry, start to wet again then look for causes of stress or visit a doctor to rule out urinary infection. Features suggestive of urinary infection include:
    • Increased frequency, pain during susu
    • Blood in susu

Consult a doctor if even after age of 4 years child is wetting pants to rule out Urinary infection, bladder abnormalities like Vesico ureteral reflux and behavioral issues like BED-WETTING.

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To Summaries

  • Toilet training is not easy and child needs your support during this difficult phase to learn this new skill.
  • Go slowly at your child’s pace,not as per your need or wish.
  • Praise child at every step and encourage him/her.
  • Do not get dishearten by few accidents (susu & potty) after child had been dry.
  • Punishment has no place in toilet training.

 

Regards

Dr Rahul Varma

Smartphones and Tablets are not meant for babies; they interfere with optimum brain development. Read on to know more

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Smartphones and tablets are not meant for babies (< 2 years)

In today’s environment we all can see small babies and toddlers playing with phones. Whether you are at mall, driving in car, waiting somewhere , smartphones have become like babysitter for many parents. Parents feel excited to see their small babies handling touch screen phones so efficiently. Touch screen smartphones with their great picture quality, colorful images and good sounds appeals to babies. But are they really good for optimum brain development for young kids?

Answer:

Till now there is NO research done to know the connection between infant learning and smartphones. For older children with use of interactive elements it may help in learning concepts such as sequencing and cause and effect relations. But for small babies who are still in very young age of brain development, it’s long term effect is not known.

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Recommendations:

All the doctors are of the opinion to reduce screen time for small babies. Screen time includes time spent on TV, videos, laptops, phones etc. American Academy of Pediatrics (AAP) has made a clear stance that “NO screen time for kids less than 2 years”. Main reason being association of Language learning delays, poor reading skills and short term memory are seen more often in children with more screen time.

Facts:

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.

After a certain age technology and screen time can be used judicially for better interactive teaching. Older children can do lot more and screen time can help them in understanding concept better along with reading from textbook. But not for very small babies.

Another excuse which most parents give is that there baby will never eat food if we take phones out of there life. Just to remind them that before invention of smart phone kids used to eat well.  And Honestly speaking we have started spending more time on social networking like facebook and whats app which have lead to more exposure in children. Because it’s we who cannot live without phone rather then kids.

Regards

Dr Rahul varma

 

 

Newer Guidelines with few changes in IAP Immunization Schedule, October 2014

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“Few Changes in Immunization schedule for 2014″

1. at 9 months MMR in place of Measles, 2nd dose @ 15 months, no dose @ 5 years
2. Live Hep A single dose only , Killed to have 2 doses
3. Rotavirus, DTP vaccine , same stand as before
4. Typhioid-TCV cojugate can be started @ 9months with booster @ 2 years (No need to re vaccinate every 3 years).
5. Cervical Vaccination in 9-14 years, only 2 doses 6 months apart.

New IAP Vaccination Guidelines as per october 2014

For Parents , it is best to discuss with your child specialist. Your doctor is in best position to prepare vaccination schedule for your child as per latest recommendation.
 http://indianpediatrics.net/oct2014/785.pdf

Regards

Dr Rahul varma