Category Archives: child immunity

immunological disorder

My newborn’s vaccination schedule. Why do infants need so many vaccines so quickly?

  • Newborns need multiple vaccines because infectious diseases can cause more-serious problems in infants than in older children.
  • While maternal antibodies help protect newborns from many diseases, this immunity begins to disappear as quickly as one month after birth. In addition, children don’t receive maternal immunity from certain diseases, such as whooping cough. If a child isn’t vaccinated and is exposed to a disease, he or she might become sick and spread the illness.
  • Avoid altering your child’s recommended vaccination schedule. Research shows that it’s safe for infants and young children to receive multiple vaccines at the same time, as recommended by ( IAP) Indian Academy of Pediatrics and (CDC) the Centers for Disease Control and Prevention’s vaccination schedule.
  • Remember, newborns and young children can be exposed to diseases from family members, care providers and other close contacts, as well as during routine outings — such as trips to the grocery store, nearby park and family functions etc. Many vaccines can be given even if your child has a mild illness, such as a cold or mild fever. Consult your child’s doctor regularly to keep your child’s vaccination status up to date.

stay healthy and stop the spread of vaccine preventable disease


Dr. Rahul Varma

Tips to keep children healthy in this chilly winter season.

 baby its cold

Weather is cold for kids

It is really getting cold and temperature is dropping down significantly. Cold wave is sweeping northern India. This change in season is welcomed by most but it also bring along with them few health hazards (more so for the kids).


Few tips which can help your kids to continue to have good health during next few weeks are:

  • Respiratory illnesses are more common along with FLU infection. Protect by taking all the universal precaution along with flu vaccination (esp for small kids and old age).
  • Drink lots of warm fluid like warm haldi milk, warm water, tea, coffee etc.
  • Honey can be given daily to kids at night.
  • Wash your hands regularly. After coughing, sneezing, sharing toys, before meals etc
  • Frostnip and Frostbite: children are more prone to these. Make sure mittens are dry and warm; and nose is not too red. Kids should be properly dressed and should not be allowed to spend too much time outside.
  • Snacking before going out in cold will give extra calorie to body to keep it warm.
  • Proper clothing: one layer extra for children, along with caps and socks are must for kids. Floor inside the house is also very cold even after wearing socks, its better to have shoes also for kids at home.
  • If it is very chilling and windy day; and if you are feeling uncomfortable outside, it is better to keep your kids inside.
  • You are planning a road trip over the holidays: Important to have some snacks for kids, extra layer of clothing, snugly fitting cap and gloves for kids, first aid kit.
  • If you are planning some winter sports activity; makes sure to have all the protective gears on.

Winter kids

Staying home and reading books to your kids along with tea/ coffee; and enjoying the beautiful weather is an awesome feeling. But only if you and your kids are healthy.


Dr Rahul Varma

“Healthy Kids, Happy Family”

Typhoid Fever: things we should know



Typhoid Fever (


Typhoid Fever is so commonly heard off in our country. (I think most common as well as most over diagnosed disease in India).


Cause: It is caused by bacteria called Salmonella Typhi (S.Typhi) typically living in humans and are shed through a person’s feces (poop) or urine (pee). Bacteria get into blood and spreads quickly inside leading to high grade fever within a week or two.

Without treatment, typhoid fever may last a month or more and become very serious, even life-threatening. Even after treatment during recovery phase a person can transmit this disease to others.

  food infected

Cause of Spread: 

  • Due to unclean water intake, unhygienic food and poor sanitation facilities.
  • Drinking water (and other drinks) and eating food handled by someone who has typhoid or is still a carrier.
  • Infected people can pass it on to others by touching them with unwashed hands.
  • Contaminated water by sewage, more so in area with poor sanitation and inadequate water treatment

Typhoid fever is named after a lady called typhoid mary who was suffering from this disease and used to serve food in USA leading to epidemic of this disease in that area.

tm                       typhoid-mary-article  

Symptoms: Severity depends upon vaccination status, age, general health etc


  • Mild to High grade Fever
  • Stomach pain
  • Body pain, weakness
  • Diarrhea or constipation
  • Poor appetite
  • Reddish spotted rash




Complications: Intestinal perforation (rare)



Salmonella_typhimurium- gram negative bacilli under high magnification of 15000 X

  • History and examination
  • Blood tests :
    • Typhi Dot IgM: during first few days of fever
    • Widal test: after 5 days of fever (It gives false report before that). Unfortunately this test is most misused test in India. And many false positives reports are given by various labs even on first day of illness.
    • Blood Culture is gold standard: But in most cases antibiotics have been started early so yield of this test is low. And beside it is costly, so many quacks start treatment rather than testing. This treatment is often incomplete and in inadequate doses leading to drug resistance and disease recurrence.



  • Antibiotics: important to give for proper duration and in adequate doses. Please do not stop medicine on your own once child starts feeling better after 2- 3 days.
  • Some Cases might not respond to oral medication and need for Intravenous medication along with fluids might arise.

Plant for treating Typhoid Fever

Stopping the Spread


Prevent the spread to others: Wash hands regularly. People with typhoid fever should avoid preparing food. Children should stay away from school until doctor certifies them to join back school.

How to prevent Infection


Vaccination: It is Available and routinely given around 2 years of age and every 3 years after that. Even if your child is vaccinated (Vaccine is not 100% effective and loses its effectiveness over time)

  • Sanitize water.
  • Cook all food.
  • Avoid raw food.
  • Wash hands frequently


Feel free to contact your child doctor for any queries or contact us at MAYA CLINIC.


Dr Rahul Varma

” Healthy Kids, Happy Family”


Immunize for a healthy future: know, check, protect.

Immunization week 2014

 WIW banner Google plus


World Immunization Week – celebrated in the last week of April (24-30) – aims to promote one of the world’s most powerful tools for health – the use of vaccines to protect people of all ages against disease.

The theme of the World Immunization Week 2014 campaign is “Are you up-to-date?”. The slogan and calls to action to be used on global materials are “Immunize for a healthy future – Know. Check. Protect.”


Know, Check, Protect




  • why you need to get vaccinated
  • which vaccines you need
  • how, where and when you should get vaccinated
  • where you can go to find out more

check final


  • whether you and family have had all the vaccines you need
  • when you need booster doses
  • whether you need any vaccines before travelling




  • yourself and your family: get vaccinated


Details regarding latest Immunization schedule in INDIA.




Dr Rahul Varma

“Healthy kids, Happy Family”


Atopic Dermatitis in Children


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ECZEMA: Very common skin problem in children.

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Atopic dermatits is a most common form of Eczema.

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It usually begins in Infants (less than 1 year old child). It improves as the child grows older and resolves by the time child starts going to school or reaches puberty. Some children may develop chronic disease.

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Sensitive skin which is more easily irritated by sweating, heat , rough clothing and some detergents, soaps etc. Some may have allergies to food, pets, dust mites.

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Red, dry, itchy patches on skin. Itching may be severe and constant; with frequent scratching, skin may develop blisters, oozing, crusting.

Affects mainly face, scalp arms, legs.

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No Cure , but can be controlled with good skin care

  • Bathing: gentle soap, limit time.
  • Topical (Skin) Medicines: topical steroids needed in severe cases or during flare up
  • Moisturizers: apply moisturizer 30 minutes after you apply any topical medicines. This allows it to seal the medicine. Eg vaseline or any petroleum jelly.
  • Anti histamines: anti allergic medicines to decrease itching. It can make child sleepy.
  • Environmental Triggers: Avoid food, pets, dust mites that can trigger this conditions.
  • Skin Infections: chances of secondary infections are there so your child might need topical antibiotics as well.

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When to call doctor:

Mild to moderate cases can be managed by your child specialist but in severe cases or if no improvement than need to consult dermatologist or skin Specialist.

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Dr. Rahul Varma


How long will this diarrhea (or loose motions) last in my child?


Diarrhea from a viral infection usually lasts several days to 2 weeks, regardless of the type of treatment.



Acute watery Diarrhea (Acute Gastroenteritis)
Diarrhea is the sudden increase in the frequency and looseness of stools. Mild diarrhea is the passage of a few loose or mushy stools. Severe diarrhea is the passage of many watery stools. The best indicator of the severity of the diarrhea is its frequency.

The main complication of diarrhea is dehydration from the loss of too much body fluid. Symptoms of dehydration are a dry mouth, the absence of tears, infrequent urination (for example, none in 12 hours), and a darker, concentrated urine. The main goal of diarrhea treatment is to prevent dehydration.


Diarrhea from a viral infection usually lasts several days to 2 weeks, regardless of the type of treatment. The main goal of treatment is to prevent dehydration. Your child needs to drink enough fluids to replace the fluids lost in the diarrhea. Don’t expect a quick return to solid stools.

What all can be given during Diarrhea?

Increased fluids and dietary changes are the main treatment for diarrhea.

Frequent, watery diarrhea

  • Fluids

Encourage your child to drink lots of fluids to prevent dehydration. Any fluid with both salt and sugar given in adequate amount is fine but we need to avoid only sugary drinks like juices etc. Salt helps in better absorption into the gut. Milk and water are both fine. However, if your child refuses solids, give your child just milk, rather than water. Offer short and frequent meals.

ORS (roughly 10 ml/kg per stool ) or simply as much as possible. Encourage child and offer ORS after every motion.

Avoid fruit juices, because they all make diarrhea worse.

  • Table foods

Keep giving your child table foods while he has diarrhea. The choice of food is important. Banana, curd, dalia, khichri, dal and rice , nimbu pani , sikangi etc. Starchy foods are digested best. Examples of such foods are dried cereals, grains, bread, crackers, rice, pasta, and mashed potatoes. Soft-boiled eggs and yogurt are easily digested and provide some protein.


How long will it last?

Mild diarrhea (loose stools)

Follow a regular diet with a few simple changes:

  • Eat more foods containing starch. Starchy foods are easily digested during diarrhea. Examples are cereal, breads, crackers, rice, mashed potatoes, and pasta.
  • Drink extra water. Avoid all fruit juices and carbonated drinks.
  • Milk and milk products are fine.
  • Avoid beans or any other foods that cause loose stools

What is the treatment and precautions?

There is no effective, safe drug for diarrhea. Extra fluids and diet therapy work best.

WHO recommends only 2 things: ORS and Zinc.

  • ORS
  • Zinc: 20mg/kg once a day for 14 days for children more than 6 months.
  • If you are breastfeeding, then keep breastfeeding on demand,
  • Probiotics

Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy ones.

Yogurt is the easiest source of probiotics. Give your child 2 to 6 ounces (60 to 180 ml) of yogurt twice daily.

Probiotic supplements in granules, tablets, or capsules are also available in health food stores.

  • Common mistakes

Fruit juices, cold aerated drinks, glucose water, Kool-Aid and soda pop, should be avoided because they contain no salt and too much sugar. Use only the fluids suggested here.

Fruit juices (especially apple and grape) should be avoided because they are too concentrated and make the diarrhea worse.

Clear fluids alone should be used for only 4 to 6 hours because the body needs more calories than clear fluids can provide. Milk is a good well balanced fluid for diarrhea.

The most dangerous myth is that the intestine should be “put to rest.” Restricting fluids can cause dehydration.


  • Prevention

Diarrhea can be very contagious. Always wash your hands after changing diapers or using the toilet. This is crucial for keeping everyone in the family from getting diarrhea.

  • Diaper rash from diarrhea

The skin near your child’s anus can become irritated by the diarrhea. Wash the area near the anus after each motion. Cleaning should be done softly and by patting only (do not rub with pressure). Then protect it with a thick layer of petroleum jelly or other ointment (Zinc based). This protection is especially needed during the night and during naps. Changing the diaper quickly after stools also helps.

  • Overflow diarrhea in a child not toilet-trained

For children in diapers, diarrhea can be a mess. Place a cotton washcloth inside the diaper to trap some of the more watery stool. Use diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under running water in the bathtub.

  • Vomiting with diarrhea

If your child has vomited more than twice, follow your doctor’s recommended treatment for vomiting instead of this treatment for diarrhea until your child has gone 8 hours without vomiting.


When should I call my child’s doctor (Pediatrician)?


  • There are signs of dehydration (no urine in more than 10-12 hours, very dry mouth, no tears).
  • Any blood appears in the diarrhea.
  • The diarrhea is severe (more than 8 stools in the last 8 hours).
  • The diarrhea is watery AND your child also vomits repeatedly.
  • Your child starts acting very sick.
  • Oral intake almost zero i.e. child not even taking plain water

What should parents avoid giving their children if they have diarrhea or are vomiting?
Do not give your child sugary drinks, such as fruit juice or sweetened fruit drinks, carbonated drinks, sweetened tea, broth or rice water. These have the wrong amounts of water, salts and sugar. They can also make your child’s diarrhea worse.
Talk to your doctor before giving over-the-counter medications to stop diarrhea. If your child’s diarrhea is very serious, do not offer plain water. Drinking only water may lead to low blood sugar or low sodium levels in your child’s blood.

For any other query , feel free to contact us at MAYA CLINIC or talk to your child specialist.


Dr Rahul varma


Myths and facts about Vaccination


A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent stimulates the body’s immune system to recognize the agent as foreign, destroy it, and “remember” it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters.

Below mentioned link will give you relevant knowledge .

Vaccination: Myths and Facts


“Healthy kids, Happy Family”


Dr. Rahul Varma


How to pacify crying baby


Crying baby   

Baby has virtually all the emotions which we have; they feel sad, happy, angry, frustrated, they want your attention; but they have only one way of communicating with you and that is crying. If the baby cries the moment you put her to bed but calms down in your arms or in your lap; then in all probability baby is fine. Because if baby is seriously hungry, no matter what you do, she/he will not stop crying unless feeding is given.

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Tips for comforting a crying baby

  • Offer a feeding.
  • Change the diaper (look for urine and motion, whether baby is wet).
  • Sleeping or fatigue, child might get cranky. Goes to sleep when you put her back.
  • Hold, swaddle and rock the baby (NEVER SHAKE the baby). Sometime baby just want to be in your arms and seeking your attention.
  • Change the noise level of surrounding i.e. if quiet room can play some music.
  • Darken the room and reduce stimulation.
  • Just take the child to open area for fresh air i.e. balcony or for a walk.
  • If baby still does not calm done and crying, better take the child in your car for a drive (most of the kids of this generation love the long drive); but if still baby is crying, change the direction of your car and drive to hospital and meet pediatrician/ child specialist in hospital.
  • Most important thing is to try to relax, it happens with absolutely every parents once in a while that baby give you sleepless night.

For any queries feel free to contact us at Maya Clinic and also you can read more on other blogs on our website.


Stay healthy and happy


DR. Rahul Varma


Asthma in children

child-asthma     ASTHMA_kid

In this disease airways are hyperreactive, which means that there is narrowing of airways which leads to difficulty in breathing.

By definition, Asthma is a chronic inflammatory disorder of the airways, characterized by recurrent, reversible, airway obstruction. Airway inflammation leads to airway hyperreactivity, which causes the airways to narrow in response to various stimuli, including allergens, exercise, and cold air.

Most common symptoms of Asthma is Wheezing but all asthmatic children do not wheeze. Most common symptoms of recurrent airflow obstructions are

  • Recurrent wheeze (wheeze is heard by stethoscope but sometimes audible whistling sounds )
  • Recurrent isolated cough
  • Recurrent breathlessness
  • Nocturnal cough
  • Tightness of chest

Signs are (examination by doctor):

  • Generalized rhonchi (wheezing sounds heard with a stethoscope)
  • Prolonged expiration
  • Chest hyperinflation (on X ray of Chest)


The Ten Commandments of Asthma


  • Asthma is a chronic condition with episodic symptoms. There is a need for continuous preventer drugs for certain grades of asthma. The drugs used for asthma ‘control’ asthma but do not ‘cure’ asthma.
  • A majority of children outgrow their symptoms as they grow older.
  • There are lots of myths and misconceptions regarding inhaled therapy which need to be cleared. Medications given using inhaled route have their own merits and advantages.
  • Discuss the selected regime and address concerns regarding usage of medications with your doctor.
  • Discuss the usage and maintenance of the inhaler device selected.Carry the inhaler device at each follow up visit.
  • It may take some time taken to note improvement and need for compliance with the prescribed preventer drugs cannot be over-emphasized.
  • Dealing with triggers / precipitants like dust, pollen, fur, smoke, exercise etc can go a long way in controlling the symptoms, and preventing asthmatic attacks. Diet has a small role in causation of symptoms.
  • Maintain a diary of events and carry it at each follow up visit. Record days that there are events such as daytime cough, nocturnal cough, wheeze, reliever medication use, doctor/hospital visits, school absenteeism due to symptoms etc.
  • Learn how to manage acute exacerbations/ sudden asthmatic attacks at home prior to doctor contact.
  • Go for the follow up visit 2-4 weeks after institution of preventer regime. Subsequent visits may be planned 2-8 weekly according to the severity or earlier in case of recurrences, or as your specialist plans.

The eleventh commandment (During follow up)

  • Identify any lacunae in understanding and clarify all doubts in subsequent meetings.


Advantages of the inhaled route (MDI pump and nebulizers) are

  • ‘Smaller dose’: Contrast the milligram (mg) concentration of syrups and tablets with the microgram (mcg) concentration of the same drug in the inhaled form.
  • ‘Target delivery’ – ‘Quicker action’: Drug is delivered directly to the site of action. Reliever drugs, therefore, act faster.
  • ‘Safer’: Smaller dose and thus, much better safety profile than with oral therapy. This is particularly relevant for steroids.

Misconceptions which need to be cleared

  • Is inhaled therapy addictive?  I want to emphasize that addiction liability is a property of the drug rather than device / route. Example that alcohol, though oral, is still addictive. None of the asthma medications are known to cause dependence.
  • Is inhaled therapy strong? No, as discussed earlier, smaller dose is needed (microgram concentration) of drugs used.
  • Is inhaled therapy expensive? The inhaler device is a one-time purchase. Only drugs need to be purchased subsequently. A few inhaled drugs may be slightly more expensive than oral drugs on a per dose basis but these in the context of the child’s well being, safety and reduced doctor / hospital visits are better option.
  • Are inhalers easy enough for children to use? MDI pumps used with spacer can be given to small children also with ease and technique is very easy.

Typical features of this disease

  • Afebrile episodes (most cases)
  • Personal atopy or skin allergy
  • Atopy / Asthma in a parent or sibling
  • Exercise / Activity: In a smaller child, laughing or crying may provoke symptoms.
  • Triggers: These are usually inhaled irritants or aeroallergens (page 10).
  • Seasonality: Sudden temperature changes, flowering season and harvesting time are risk situations. This feature can be judged only after observation over a sufficient time period.
  • Later onset of symptoms (usually around 3 years of age)
  • Relief with bronchodilator (asthalin )± short-course oral steroid

In children, asthma is a clinical diagnosis, made by evaluation over time, either retrospectively or prospectively.

Investigations help in confirming or ruling out alternative diagnoses, rather than in diagnosing asthma.

Asthma Poster

Classification of asthma, Treatment protocol and whether asthma is well controlled or poorly controlled can be read in detail by reading the below mentioned link.

As per management of asthma, there are plenty of medicines which can be given by different routes . So discuss in detail with your Child Specialist / Pediatrician regarding what is best for your child.

Most of the children outgrow this disease with proper treatment and live symptom free life. There are plenty of sports persons who had asthma and they still compete at international level.

Our positive mind set along with caring attitude and emotional support for children can give them symptom free childhood.

If you are interested in reading in detail regarding this disease (that to especially in Indian scenario), than read the guidelines of Indian Academy of Pediatrics. Below is the link for that.


For any queries feel free to contact at Maya Clinic or discuss with your child specialist.

“Healthy kids, Happy family”


Dr Rahul Varma


Hand, Foot, and Mouth Disease (HFMD)



Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth (herpangina), and a skin rash.

Cause: Viral (Enterovirus group), most common Coxsackievirus A16, Enterovirus 71 etc.

Signs & Symptoms:

  • usually starts with a fever, poor appetite, a vague feeling of being unwell (malaise), and sore throat.
  •  1 or 2 days after fever starts, painful sores develop in the mouth (herpangina). They begin as small red spots that blister and that often become ulcers. The sores are often in the back of the mouth.
  • A skin rash develops over 1 to 2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.
  • Young children, may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.
  • Persons infected with the viruses that cause hand, foot, and mouth disease may not get all the symptoms of the disease. They may only get mouth sores or skin rash.


Clinical diagnosis, no investigation needed. Depending on how severe the symptoms are, samples from the throat or stool may be collected and sent to a laboratory to test for the virus.


The viruses that cause hand, foot, and mouth disease (HFMD) can be found in an infected person’s:

  • nose and throat secretions (such as saliva, sputum, or nasal mucus),
  • blister fluid, and
  • feces (stool).

An infected person may spread the viruses that cause hand, foot, and mouth disease through:

  • close personal contact,
  • the air (through coughing or sneezing),
  • contact with feces,
  • contaminated objects and surfaces.

This is why people should always try to maintain good hygiene (e.g. handwashing) so they can minimize their chance of spreading or getting infections.

You should stay home while you are sick with hand, foot, and mouth disease. Talk with your child specialist if you are not sure when you should return to school. The same applies to children returning to daycare.

Hand, foot, and mouth disease is not transmitted to or from pets or other animals.


There is no vaccine to protect against the viruses that cause hand, foot, and mouth disease.

A person can lower their risk of being infected by

  • Washing hands often with soap and water, especially after changing diapers and using the toilet.
  • Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
  • Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.

If a person has mouth sores, it might be painful to swallow. However, drinking liquids is important to stay hydrated. If a person cannot swallow enough liquids, these may need to be given through an IV in their vein.


There is no specific treatment for hand, foot and mouth disease. However, some things can be done to relieve symptoms, such as

  • To relieve pain and fever: Crocin
  • Using mouthwashes or sprays that numb mouth pain

Parents who are concerned about their children symptoms should contact their child specialist/ Pediatrician.


Health complications from hand, foot, and mouth disease are not common.

For further reading you can go to the below mentioned link.

Stay healthy and prevent infections




Dr. Rahul Varma