Category Archives: child immunity

immunological disorder

why is the incidence of jaundice in newborn baby rising?

Jaundice: why is the incidence of jaundice in newborn baby rising ?

Over the years , we all have seen lots of newborn baby diagnosed with jaundice on 3rd or 4th day of life, which turn out to be of great concern for most parents. First thing that comes to mind (esp. of grand parents ) that in old days jaundice was not so high, why is it now ? are doctors over diagnosing it ? is our baby kept unnecessarily in nursery?

Jaundice-In-Newborns 

I will try to answer these question in this article and will not go into too much technical details.

Facts: Jaundice is universal phenomenon i.e. it occurs in every baby who is born.

  • Normal trend is that Jaundice starts from day 2 or 3 and rises till 7th day and decreases gradually by 14th day of life. If its goes beyond a certain level then we need to treat , otherwise it will decrease on its own with time.
  • Sunlight can not decrease jaundice. Enough scientific data is there, as it requires particular wavelength of light to be given from close range in order to decrease it. Still some of the doctors (  who have not updated their knowledge ) might suggest sunlight exposure, which is incorrect. However giving sunlight exposure to your baby has various other advantage most important being Vitamin D3, hence it is advisable to give sunlight but not for jaundice.

Important points for parents:

  • Do not panic , it is very normal for babies to have jaundice  and it is easily treatable by giving Photo therapy in most cases.
  • But if there is significant delay in starting photo therapy and bilirubin level rises very high it can cause brain damage which cannot be reversed.
  • It cannot be predicted at birth how high jaundice will go i.e.most likely  you will be told about jaundice by your child doctor on day 3 or 4 of life (that unfortunately ,usually coincide with the timing of your discharge from hospital) .
  • There is no way that it can be prevented as it is a normal (or physiological) phenomenon.
  • As the treatment is so simple and risk if not treated is so high, its always better to be cautious and over treat rather then under treat.
  • Sunlight do not have any effect on jaundice as the distance is too far away and particular wavelength of light is required to decrease it.
  • Have faith in your doctor , not everyone is there to make money, most of the child specialist are honest and have soft corner for children.

Phototherapy charts

Given above  is the chart most commonly used by newborn specialist  and Pediatrician.

 

Further details  regarding Jaundice (if you wish to know in details,  otherwise you can skip it):

  • We as a doctor  has various cut off values for bilirubin level . ( Bilirubin levels is tested in blood which helps in assessing the severity of jaundice). These cut off guide us to decide whether your child need treatment or the level of bilirubin is with in normal limits and baby can be sent home. These cut off values varies as per , how old is your baby, what was birth weight, how mature your baby was i.e. born as per date or before that, blood group of baby and mother etc.
  • In most of the babies who are born on time and are good size babies and whose blood group matches their mother, jaundice is less likely to go above danger level (however photo therapy may be needed).
  • As the baby grows older, his liver starts functioning better and he can tolerate higher  level of jaundice. For eg a bilirubin level of 12 at 36 hours of life is more alarming than level of 15 at 60 hours of life.
  • Best thing which you as mother can do for your baby is breast feed, as feeding gets better child is able to metabolize and tolerated  bilirubin levels better.
  • This jaundice is newborn babies (indirect bilirubin is high)technically different from what usually occurs in adults (direct bilirubin is high). And it is not very dangerous unless until levels become too high.  A very high level of indirect bilirubin can cause brain damage, and once that damage occurs , its difficult to treat and child`s brain functions are hampered for life.
  • As medical science has evolved , we are able to diagnose more cases and start photo therapy early and actually prevent lots of cases of brain damage, which were there is past. (enough scientific data is there to suggest decrease in incidence of bilirubin induced brain damage).
  • Besides today most of us wants to have one baby or at the max 2, and do not want to take risk and want our children in best health.
  • Treatment of Jaundice is Photo therapy and in rare cases of very bilirubin Exchange transfusion.
  • Photo therapy:Special wavelength lights are given to babies from a particular distance. If level is high , we might give light from both side i.e.  one above the child hanging and one below the child. We give it continuously, interrupted only for feeding. We keep monitoring bilirubin levels and do repeat blood tests 12 to 24 hours usually but in some cases more frequently. It usually take around 48 hours to get jaundice in lower range but time taken to control jaundice is very variable.MK-BY847_LEDBAB_G_20121119162220 Baby-with-Jaundice-getting-Phototherapy
  • Exchange transfusion: In this we change the whole blood of baby gradually over few hours and replace it with blood from blood bank after cross matching. Its relatively serious process and is our last option when bilirubin levels are very high and neurological damage is suspected.

If you really want to go in for further detail then this is the link to know in detail regarding Jaundice.

Its virtually impossible to write everything here, so for any queries , feel free to contact us or your pediatrician. Its your right to discussion , the plan of care of your baby with treating pediatrician or Newborn specialist.

Stay healthy

Regards

Dr Rahul Varma

“ Healthy kids, happy family”

 

what is Complementary feeding (Weaning Diet ) ?

Complementary feeding: (weaning food)

It is defined as any non breast milk food or nutritious foods given to young children in addition to breast milk.( i.e. it is to complement breast milk, not to replace it.)

Age of Introduction: after 6 months

Attributes of Complementary feeds:

  • Soft and flowing
  • Thicker than Breast milk
  • Bland in taste
  • Homogeneous ( based on cereal or root staple foods)
  • 1 to 2 times a day to start with
  • Gradually increase frequency and quantity

Foods appropriate for complementary feeds:

  • Pulses (lentil, beans, peas), meat milk, vegetable oil and sugar
  • To increase dietary energy levels : oil, ghee, sugar
  • To increase quality of protein: milk product and animal food
  • Calcium: Milk
  • Iron: Meat, chicken, fish
  • Rich in Vitamin & Minerals: Vegetable and fruits

 

Conclusion:

Anything which is free flowing and well mashed and easy to swallow and calorie dense can be given. And you should always consult your Pediatrician at the start of weaning diet/ complementary feeding, so that he or she can guide you in best possible , culturally acceptable option.

Stay Healthy and eat healthy, For any queries do feel free to contact us.

regards

Dr. Rahul Varma

Latest Immunization Schedule (IAP 2012)

Vaccination-cartoon VaccineLatest Immunization schedule (IAP 2012)

  • As parents we all have queries regarding immunization of our children.
  • Above mentioned hyperlink will tell you regarding latest immunization schedule in India as per Indian Academy of Pediatrics. It also have few salient features regarding important vaccines.
  • If any queries regarding immunization schedule , you can write to us, or consult your family Pediatrician.
  • There might be slight change in schedule as per requirement of your child.

Healthy kids, Happy family

Dr. Rahul Varma

Common Feeding Problems

 

Feeding problems occur for a number of reasons, many of which vary according to age. Most of these challenges can be met through proper breastfeeding instruction from your doctor. It may come as a surprise, then, if your baby develops a resistance to feeding weeks or even months after you thought this was no longer a problem. 

Tastes Change

One thing to consider when this happens is whether the taste of your breast milk has changed. Breast milk taste can change for a number of reasons, including the following:

  • New or different food in your diet
  • Medication you are taking
  • Pregnancy in the mother, which sometimes causes nursing babies to wean themselves a few weeks or months after the mother conceives
  • Strenuous exercise, which can lead to a temporary buildup of lactic acid
  • Breast infection, such as mastitis
  • Change in the taste of your skin caused by using lotion, cream, or oil on your breasts

Avoiding the new food, changing or stopping your medication if possible, exercising less strenuously, or refraining from applying oil or lotion to your breasts may be all that is necessary to encourage your baby to breastfeed at his normal rate again. If you have mastitis, seek treatment from your doctor right away and encourage your baby to breastfeed in order to drain your breasts. Once the infection has been treated and has passed, the taste of your breast milk will return to normal. You may be able to help your baby adjust to the new taste of your breast milk during pregnancy if you are persistent and patient and hold off on offering formula as an alternative.

If your baby starts to engage in frenzied short feedings that seem to signal frantic hunger, it may simply mean that your let-down reflex is occurring more slowly than she would like. If this is the case, try massaging your breast and expressing a little milk before you begin a feeding. This way, your milk will flow faster from the very beginning of the feeding and your baby will feel more satisfied.

Stress

If you do not believe that the taste of your breast milk has been altered or that your let-down reflex is causing the problem, consider whether you are experiencing a high level of tension or stress. Such emotional discomfort can be communicated to your baby, preventing her from settling down to feed well. Of course, we cannot always eradicate stress from our lives, but for the moments preceding breastfeeding, do your best to put upsetting thoughts out of your mind. Relaxed sessions not only will help your baby get more milk but may decrease your own stress level. Breastfeeding your baby and holding her skin to skin often promote a sense of well-being. Meanwhile, consider ways in which you might improve the general tenor of your day-to-day life.

Illness

It is also possible that your baby’s own condition may be making it harder for her to breastfeed. Decreased interest in feeding—possibly accompanied by lethargy, fever, vomiting or diarrhea, cough, or difficulty breathing—may indicate an illness. Consult your pediatrician or family physician if your baby resists feeding or you have any concerns that your infant may be sick.

Illness in your infant may affect your baby’s feeding pattern and desire to nurse, thus decreasing the amount of breast milk she receives. If she has a cold, clogged nostrils may make it difficult for her to breathe while feeding, or an ear infection may make nursing painful. Clearing the infant’s nasal passages with a bulb syringe prior to feeding may help with temporary nasal congestion. Teething can cause gum pain when nursing. Thrush can make nursing painful and requires a pediatrician’s attention.

Spitting Up

Some babies take in a great deal of milk but then spit up what appears to be a large part of it after each feeding. Spitting up is common during or after feeding, and some babies spit up more easily than others. There is generally no need to be concerned, however, that your baby’s spitting up is preventing her from getting enough milk.

Spitting up (as well as hiccups) can be minimized by keeping your breastfeeding sessions as calm, quiet, and leisurely as possible. Avoid interruptions, sudden noises, bright lights, and other distractions. Try to hold your baby more upright during and right after feedings, and attempt to burp her after she finishes each breast. Don’t jostle or play vigorously with her immediately after she has breastfed.

If she vomits forcefully a number of times or if you notice blood or a dark green color when she vomits, call your pediatrician right away.

Occasional small spit-ups or wet burps are generally more a laundry problem than a medical one. Fortunately, spit-up breast milk is less likely to smell sour or cause clothing to stain than infant formula. If you are worried that she is spitting up too much, consult your pediatrician, who will monitor her weight and check for any signs of more serious illness.

Dehydration

As always, the best way to be sure your baby is getting enough milk is to monitor her physical condition, her weight gain, and the content of her diapers. It is very important to call your pediatrician if you notice that your child is not showing usual interest in feeding, she has a dry mouth or eyes, or she is producing fewer wet diapers than usual. These may be signs of dehydration. Severe dehydration, while uncommon in adequately breastfed infants, can be extremely dangerous or even life-threatening and is most likely to occur when a young baby refuses to feed or is experiencing frequent vomiting or diarrhea.

 

regards

Dr Rahul

 stay healthy

Picky Eaters

Between 20% to 50% of kids are described by their parents as picky eaters.

Why do babies turn into picky eaters? What are the signs? And what can you do about it?

Understanding the Signs

The symptoms of a picky eater can seem pretty obvious: Your baby may push away the spoon or turn his head from it. She might close her mouth as you try feeding her, spit out food, or become cranky or tired at mealtime.

Yet these signals don’t necessarily mean your baby is picky. They can also be signs your little one is simply full, distracted, or not feeling well.

A baby can seem picky for dozens of reasons — or no reason at all. He may have an immature digestive system, which will cure itself with time. She might be teething, have an infection, food allergy, or just may not be ready for solid foods yet.

As long as growth and weight gain are normal, there’s usually no reason to worry about a fussy baby who prefers a limited diet. But if you find yourself worried about infant feeding problems, talk to me at maya clinic and try the following tips.

Tips to Help Tame a Picky Eater 

Never force feed. If your little one turns her head from the spoon, she’s telling you clearly she’s had enough — even if it seems she’s had very little. Trust that your child will eat what she needs. If you force baby to eat despite signs he says “no more,” your little one may start associating eating with tension and discomfort — and become even more fussy.

Try different textures. Even babies have food preferences. Some enjoy wet foods, others may prefer finger foods. Some may want to graze through a half dozen mini-meals, while others may favor liquids over solids for a time.

Transform the tempo. Some babies want to eat fast, others slow. Could you be frustrating your little one with the wrong feeding tempo? There’s only one way to find out: Try slowing down the next feeding, or picking up the pace.

Minimize distractions. Make food the focus of mealtime. Turn off the TV, remove toys and books, and help your little one focus on one thing: Eating.

Keep meal length reasonable. It’s tempting to let a picky eater take as long as she wants to eat. Although you shouldn’t rush mealtime, don’t let it go on much longer than 20-30 minutes.

Let baby touch his food. You probably wouldn’t eat a food you’ve never seen before without first looking it over. Your baby is the same, so let your little one touch a new food before you offer it.

Follow your baby’s timeline. Most babies begin eating solid foods between four and six months, but some may start a little earlier, others later. As with crawling, walking, potty-training, and just about every other infant milestone, there’s no perfect time, there’s your baby’s time.

Let your baby participate. By about nine months, many babies are interested in trying to feed themselves. Although your picky eater is likely to make a mess waving around the mealtime spoon, letting him take control is important to a child’s growth and development.

It’s natural for babies to slow down their feedings. As they reach the end of their first year, babies’ growth tends to slow and so too can their calorie needs. Be patient; growth spurts are on the way.

Keep trying, gently. Some babies may need to try a food eight, 10, even 15 times before they enjoy it, so be patient and continue to revisit a rejected food over time.

Don’t let on that you’re frustrated or angry. React emotionally to a picky eater and even a 1-year old will understand her power over you. Realize that you want your baby to eat for her own well-being, not to please you and that baby’s rejection of a food is not a rejection of you.

Understand who’s responsible for what. It’s your job to feed your baby, but it’s your baby’s responsibility to decide what and how much to eat. Children will always eat when they’re hungry. Remember that so long as a child is growing and gaining weight and you are feeding them healthy options, there’s little need to worry about a baby who’s a picky eater.

regards

Dr Rahul

stay healthy

“healthy kids, Happy family”