Tag Archives: pediatrician

Bed wetting: how to deal with this very common illness

Bed wetting: how to deal with this very common illness

bedwetting

“Bedwetting is a topic people often shy away from. Parents may be embarrassed to broach the subject with their child specialist/pediatrician, and doctors typically assume that if a child is wetting the bed, the parents will inquire about it. Parents need to be proactive and talk with their child’s pediatrician.”

bw

Bedwetting (sometimes called nocturnal enuresis) is a common condition that affects many children and young people. Although most children grow out of it, this may take many years and some may need help to become dry at night. It can be very distressing and have a considerable impact on the child or young person. It can also be very stressful for their family.

bed-wetting Bedwetting-Boy-D1

Although bedwetting is rarely caused by a serious medical disorder and often resolves itself, it’s a condition that can create anxiety, embarrassment, and shame. These feelings are heightened when the child is invited to a sleepover —by relatives, friends and during family marriage.

The combination of several factors is the usual culprit that leads to bedwetting: an increased production of urine during the night, a small bladder capacity, poor arousal from sleep, and constipation.

kidneybrainboy

Parents should keep two issues in mind.

  • First, bedwetting is common, and children should not be punished for it.
  • Second, parents should always remember that bedwetting is a medical problem — it happens because a child’s brain and bladder are not communicating with each other at night.

 

What Parents Need to Know

Most frequently asked questions about bedwetting.

  1. Does bedwetting run in families?
    Most children who wet the bed have at least one parent or close relative who had the same problem as a child. Approximately 45 percent of children wet the bed if one parent wet the bed as a child, and 75 percent wet the bed if both parents were bedwetters.
  2. Is bedwetting more common in boys or girls?
    Prior to age 13, boys wet the bed twice as often as girls. By the time adolescence rolls around, these numbers equal out. Interestingly, girls are more likely than boys to have other bladder symptoms, such as urgency, frequency, or daytime wetting.
  3. Does bedwetting go away on its own?
    Every year, 15 percent of children older than 5 who wet the bed become dry with no intervention. Although children usually follow the same pattern as their family members, this is not always the case. Because there is no way to predict when a child will overcome his wetting, I recommend that children start a bedwetting program if they’re motivated to become dry.
  4. How can I tell if my child is motivated to work on becoming dry at night?
    There are four signs you can look for to see if your child is ready to work on becoming dry:

    1. He starts to notice that he’s wet in the morning and doesn’t like it.
    2. He tells you he doesn’t want to wear Pull-Ups/ diapers anymore.
    3. He tells you he wants to be dry at night.
    4. He doesn’t want to go on sleepovers because he’s wet at night.
  5. Do you recommend restricting fluids in the evening to keep children dry?
    Some people think restricting fluids after dinner helps children stay dry. Although this helps some children, it doesn’t work for most — if a child limits fluids, he may wet the bed with four ounces of urine instead of six, but he’s usually still wet. My approach to restricting fluids is practical. If a child tells me that limiting fluids helps him stay dry, I give it my “OK.” Otherwise, I generally don’t recommend this approach. Stopping tea, coffee, milk at night do help.
  6. What is the best way to treat bedwetting?
    Behavioral Therapy is best approach with help of bedwetting alarm; it yields the best results. Bedwetting alarms are now available in India. This device teaches the child’s brain to pay attention to his bladder while sleeping. Bedwetting alarms have two basic parts. (1) a wetness sensor that detects urine and (2) an alarm unit that produces a loud sound when a child wets the bed.
  7. How does the bedwetting alarm work?

alarm   images

The alarm’s sensor has the ability to detect small amounts of moisture. When a child wets the bed, the urine in his underpants turns on the alarm. When the alarm goes off it awakens the child so he can go to the bathroom and finish urinating in the toilet. After weeks of hearing the alarm, the child’s brain learns to pay attention to the full bladder signals and he wakes up before wetting the bed.

9. Are drugs an effective way to treat bedwetting?

The medication that is prescribed most frequently is called desmopressin (brand name: DDAVP). Desmopressin is a manufactured form of the hormone the brain produces to decrease urine production at night. The effects of desmopressin only last for a short period of time, and children usually relapse when medication is stopped. For this reason, doctors generally recommend this for sleepovers, vacations, or special occasions.

Words of Encouragement for Children

images (2)

Following are the strategies to help ease your child’s anxiety.

  • Do not punish or shame children for being wet at night.
  • Remind children that bedwetting is no one’s fault.
  • Let children know that lots of kids have the same problem.
  • Let children know if anyone in the family wet the bed growing up.
  • Maintain a low-key attitude after wetting episodes.
  • Praise children for success in any of the following areas: waking up at night to urinate, having smaller wet spots or having a dry night.
  • Encourage children to go on sleepovers.

Treatment:

  • Behavior therapy is main stay of treatment. Positive attitude and patience on part of parents is the biggest virtue on basis of which successful treatment depends.
  • Have a proper schedule; give dinner 2 hours prior to sleep and wake child once after going to sleep for toilet. Eg. If child sleeps around 11 pm, then dinner should be taken by 9 pm. Child should be asked to go to toilet before going to sleep and put an alarm around 1 am – 2 am. Waking child only once during night gives best result as repeatedly waking child during night have a bad impact on child’s behavior and may make child stubborn.
  • More than 70 to 80% children recover with this lifestyle only; but parents and every member of family need to support the child and encourage him. He should not be taunted or scolded. Otherwise all the hard work put by parents will go waste if you beat your child or scold your child in between sometimes.
  •  Do not discuss about bedwetting with others (relatives and friends) in front of child. Child feel embarrassed and it has devastating effect on child’s psychology.
  • Remember he/she is your child and not doing it deliberately. If you guys do not control your anger and frustration, your child will never come out of it. And your  personal or professional anger or frustration should not disturb your relationship with your child.
  • Drinks containing caffeine (such as cola, tea and coffee) should be avoided.
  • Milk should be given during day only and not during evening or night.
  • The child or young person should be given advice on the importance of using the toilet regularly during the day and you should encourage use of the toilet at regular intervals (around four to seven times a day, including just before bed). This should continue alongside any other treatment for bedwetting.
  • Reward System: Rewards should be given for agreed behavior  rather than dry nights, for example, they may be given for drinking the correct amount during the day, using the toilet before sleep, helping to change wet sheets, and, if appropriate, taking tablets or using an alarm correctly. These should be agreed with the child or young person beforehand. Systems that punish or take away rewards should not be used.
  • Punishment is absolutely NO. All your gains will vanish if you keep punishing child even once in a while. If punishment continues, your child will become more stubborn and as they grow old more behavior issues creep up like aggressive behavior, anti social behavior, drugs etc.
  • Desmopressin treatment:  A drug called desmopressin should be offered  to treat bedwetting under supervison of child specialist,
    • If fast or short-term improvement is the priority.
    • Other drugs like anticholenergic along with desmopressin and Imipramine can also be given but only after consulting someone who is expert in this field as these drugs need to be used with caution.

 

Feel free to contact Maya clinic for further queries regarding this topic.

At Maya Clinic, we have Child Development and Behavior Specialist; Dr. Smitha Sairam. She can be consulted with prior appointment only.

Stay Healthy

Regards

Dr. Rahul Varma

Your baby: birth to 3 months

baby

Once the shock, relief and exhaustion of delivery have worn off a bit, you will probably find that caring for your new baby is a lot of work; wonderful, but still work.

Early feelings of parents are of mixed emotions:

They are happy, a bit scared, it takes time for the feeling of being mom /dad to sink in. Most of first time parents are scared of holding on to baby in their lap, just relax, Babies are not frail and enjoy your baby. Babies thrive on touch, so early contact and bonding is important. Lots of mothers are working these days, due to financial necessity and demanding careers and it puts huge pressure on them. But as a mother you should remember that’s it’s the quality time you spend with your child that will matter.

All of your baby`s senses are working:

  • Touch , motion:  baby calms done when holding, swaddling and rocking movement
  •  Smell: they prefer smell of their mother`s body.
  • Hearing: Baby prefers speech that is slow and musical- the way parents seem to naturally talk to them.
  •  Vision: baby can see at birth, but are they are near sighted. And their eyes are very sensitive, so they tend to keep them closed in normal light but open them when lights go down.

Individual Personality:

harperasleep

Every baby has his own personality. Some are calm, other are more excitable. Some are regular in their eating, sleeping and bowel habits: others are more erratic. Some can handle lots of stimulation: others need a quieter environment.

Feeding: 

Breast feeding is best possible option for baby; on demand feeding, day and night. Sucking is important pleasurable activity of baby along with getting nourishment for growth. Baby sometimes make sucking movement while in sleep also, it`s absolutely fine and does not mean that baby is necessarily hungry.

Bowel movement (potty):

Baby`s bowel pattern is very variable. At birth baby passes black to dark greenish motion (also called meconium) which changes to normal yellow color by day 3 to 4 of life. Baby can pass semi -loose motions, 10 to 12 times per day during 1st few weeks of life (also called transition stool). After around 4 to 6 weeks; pattern of motion again change. You will realize that same baby during his/her 1st year of life will have very variable motions; some time loose watery 8 to 10 times per day and sometimes well formed stool after 4 to 5 days even. So whole range is normal, and for all practical purpose forget about stool, if your baby is sucking well on breast and passing urine more than 10 times per day.

Many times baby cry during or just before passing motion or urine: this is mostly normal and do not warrant any cause of concern.

Sleeping:

images (3)

On an average baby can sleep from 12 to 18 hours. Practically speaking in initial few months, baby wakes up when hungry, passed urine or motion and goes to sleep again. Mostly awake in night and sleeping in day. Baby do not have orientation regarding day or night, they are least bothered when sun is going to rise. The main reason why your newborn baby is giving you sleepless nights for 1st few months; is when child was inside mother`s womb, she was surrounded by water (amniotic fluid), so when mother was doing her routine activity during day, that fluid used to move and give rocking movement to baby; whereas when in night mother lie down to sleep, that water become still and baby wakes up.  Every baby has different sleeping pattern (just like adults), so it`s best not to compare your child with anyone else.

Crying:   

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 will not stop crying unless feeding is given.

images (4)

Tips for comforting a crying baby

  • Offer a feeding.
  • Change the diaper (look for urine and motion, whether baby is wet).
  • 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.

Other issues of regarding baby`s health will be dealt over next few articles. For any queries feel free to contact us.

Stay healthy and happy

Regards

DR. Rahul Varma

 

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

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”

vaccination

Vaccine Vaccination-cartoon

http://www.immunize.org/askexperts/experts_general.asp

Answer to All your queries regarding vaccination could be found on this link.. thats the most authentic website regading vaccination worldwide..

However some changesin vaccination schedule could be there as per your pediatrician ..

For any queries,  u can post on blog or simply call at 9818034550 or meet at maya clinic. Regards

Dr. RahulVarma

Stay healthy and protect your child from vaccine preventable diseases.

Swine flu

Swine flu

this is the latest regarding swine flu, which u can read by clicking on the link provided (from the most reliable source as well).

I strongly suggest that u go for flu vaccine as early as possible, as it takes 2 weeks for antibodies to develop. and the strain which is going around is the same as last year so present flu vaccine is effective against it.

Regards

Dr. Rahul

stay healthy 

” healthy family , Happy family”

constipation

CONSTIPATION

  • Pain or crying during the passage of a stool (bowel movement or BM) OR
  • Unable to pass a stool after straining or pushing longer than 10 minutes OR
  • 3 or more days without a stool (Exception: Breastfed and over 1 month old)

Imitators of Constipation: Normal Variations

  • If breastfed and over 1 month old: Infrequent stools every 4-7 days that are soft, large and pain-free can be normal.
  • Before 1 month old, infrequent stools usually means an inadequate intake of breastmilk.
  • Grunting or straining while pushing out a stool is normal in young infants. (Reason: difficult to pass stool lying on back with no help from gravity) Infants commonly become red in the face during straining.
  • Brief straining or pushing for less than 10 minutes can occur occasionally at any age.
  • Large stools – Size relates to amount of food consumed and stool frequency. Large eaters have larger stools.
  • Hard or dry stools are also normal if passed easily without excessive straining. Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

Causes:

  • High milk or cheese diet
  • Low fiber diet
  • Postponing stools
  • Slow intestinal transit time (genetic differences)

Home Care Advice for Constipation

  1. Normal Stools:
  • Once children are on a regular diet (age 1 year), the normal range for stools is 3 per day to 1 every 2 days.
  • The every 4 and 5 day kids all have pain with passage and prolonged straining.
  • The every 3 day kids usually drift into longer intervals and then develop symptoms.
  • Passing a stool should be fun, or at least free of discomfort.
  • Any child with discomfort during stool passage or prolonged straining at least needs treatment with dietary changes.

2. Diet for Infants Under 1 Year:

  • For infants over 1 month old only on breast milk or formula, add fruit juices 1 ounce (30 ml) per month of age per day. Pear or apple juice are OK at any age. (Reason: treating a symptom)
  • For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums).
  • If on finger foods, add cereal and small pieces of fresh fruit.

3. Diet for Children Over 1 Year Old:

  • Increase fruit juice (apple, pear, cherry, grape, prune) (note: citrus fruit juices are not helpful).
  • Add fruits and vegetables high in fiber content (peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, dates) 3 or more times per day.
  • Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Popcorn can be used if over 4 years old.)
  • Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.

4. Stop Toilet Training: Temporarily put your child back in diapers or pull-ups.

  • Reassure him that the poops won’t hurt when they come out.
  • Praise him for the release of stools.
  • Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training.

5. Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the

toilet for 10 minutes after meals, especially breakfast.

6. Warm Water for Rectal Pain: Warmth helps many children relax the anal sphincter and release a stool. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus. Move it side to side to help relax the anus.

7. Flexed Position:

  • Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a stool). It’s difficult to have a stool while lying down.
  • Gently pumping the lower abdomen may also help.

8. Call Your Doctor If:

  • Constipation continues after making dietary changes
  • Your child becomes worse

!