YOU CAN DO IT MOM!

Breastfeeding – The Best Feeding

Breast milk is nature’s gift to the newborn and is beneficial to the mother too. Breastfeeding though a natural process, has acquired a new dimension in the present day context. Women working full time, pre-term deliveries, lack of nutrition, lack of proper understanding of the process of breastfeeding, physiological and psychological causes stand as a barrier towards mothers breastfeeding their babies.to breastfeed.

The main barriers towards breastfeeding are:

Anxiety – Lack of knowledge of the breastfeeding process leads to anxiety and misapprehension in many mothers. They expect breastfeeding to be smooth and without any issue right from the moment the baby is born.  If this does not happen, anxiety sets in. This anxiety is compounded by the extended family that encourages the mother to resort to other means of feeding the baby.

Lack of proper support system- with the emerging nuclear family system there is no proper support for the nursing mother. If the mother is working, inadequate support system at workplace also discourages breastfeeding.

Peer Influence – With women in peer groups not resorting to breastfeeding, the new mother feels that she may be missing  something important for the baby and resorts to other means of feeding.

Inappropriate information – With access to multiple sources of information, there is a possibility of getting wrong and inappropriate information.

Impatience – The instant two minute generation has lost patience and perseverance.

All this can be corrected if there is proper understanding.

Exclusive breastfeeding is the best feeding for the baby during the first six months. As soon as the baby is born, the mother’s milk that is secreted is called the colostrum and this is the ideal food for the baby’s developing stomach. It is concentrated in carbohydrates and proteins and low in fat and is easily digested. This colostrum helps excrete excess bilirubin, which prevents jaundice in newborns.

Other benefits of Breastmilk are:

ü  Breastfed babies have less infections and diseases. Breastmilk is a 'dynamic' fluid that is constantly changing to meet the challenges a baby faces. For example, soon after birth, the baby receives its IgA - an immunoglobin that helps the baby to fight infections.  As a result, it has been shown that even if these babies should get a cold or upper respiratory infection, breastmilk will help them overcome it quickly when they are breastfeeding or help them in surmounting these infections from the immunological boost they received through mothers' milk, as they grow up into adulthood.

ü  Breastfeeding has been shown to cut down risks of diabetes, certain cancers, otitis media, Necrotizing enterocolitis among other infections in the baby.

ü  Dentists have also reported that a breast fed baby's mouth is well exercised for development of teeth. Also these baby’s have lesser dental problems.

ü  Breastmilk is tailor-made (species-specific) for the baby to suit its particular needs. For example, the milk that a preemie baby's mother makes will be very different from the milk from a term baby's mother and one of the reasons for this is to help easier digestion of milk for the immature baby's gut.

ü  The skin-to-skin contact that a baby gets while breastfeeding helps in the emotional and psychological contentment of the baby.

ü  The breastfed baby leads the process of feeding and is not 'fed' by a clock or by external determinants. This means that the baby learns to control food intake from the birth stage and this has been shown to cut down the risks of obesity at a later stage in life.

ü  A recent study has shown that the longer a baby breastfeeds, the better the brain development.

ü  Better IQ than non breastfed babies.

ü  Readily available no need for any preparation.

For the mom:

ü  A health baby means less anxiety, and if you are working less number of off from work and focus on career.

ü  Decreased postpartum bleeding.

ü  Earlier return to pre-pregnancy weight.

ü  Delayed resumption of ovulation.

ü  Reduced risk of ovarian cancer and reduced premenopausal breast cancer.

Woman must learn about breastfeeding even before the baby's born.  Pregnant woman must consider taking a breastfeeding class (offered by many centers) some time during last trimester.  

The hormonal changes pregnancy brings to the breasts are sufficient preparation for most women. Also breast size has nothing to do with ability to nurse successfully. For example, it's not true that smaller-breasted women make less breast milk.  It’s not uncommon for a woman to have flat or inverted nipples and not realize it. Neither of these circumstances will prevent the woman from breastfeeding, but they may present some additional challenges in the beginning. If a woman has any question about nipple shape, they should specifically ask their doctor.

Mothers must start feeding the baby as soon as possible after delivery.

 Is baby getting enough to eat? The following will help :

Ø  Baby feeds frequently

Ø  10-15 on each breast per feeding

Ø  Adequate wet diapers

Ø  Adequate stools

Ø  Baby is gaining weight

Complementary Foods

The WHO recommends exclusive breastfeeding until 6 months of age, with the addition of complementary foods and continued breastfeeding until 2 years of age and beyond. Woman must  not feed complementary foods before 6 months as it can displace breast milk, and there is no growth advantage over exclusive breastfeeding. Exclusive breastfeeding for the first 6 months of age is sufficient for the health and growth of infants. Infants will continue to breastfeed at least 4-6 times a day beyond 6 months of age until they are on a full adult diet by 1 year of age. After 1 year, breastfeeding depends on maternal and toddler’s preferences

Nursing Mothers

Ø   Must stay Well Nourished

Ø  Must  follow same healthy diet followed during pregnancy

Ø  Breast feeding burns 300-400 additional  calories per day

Ø  If the mother is not well nourished, supply of breast milk may decrease

Reasons to Suspend or Avoid Breastfeeding

• Treatment with a medication that transfers into the breast milk
• Level of risk to environmental exposures at work or in the field
• Solvents
• Chemicals
• Fuels

For the working mom:

§        During the last trimester of your pregnancy, enrol for prenatal class that counsels on breastfeeding. During the first few weeks after delivery, get your baby to feed from your breast. Depending upon your work life and the number of holidays you get post pregnancy, work out a feeding plan. Invest in a good breast pump and learn to express and store the milk. Feed your baby the expressed milk and from your breasts alternatively. Initially it may be trying for both you and your baby, but things will settle down quickly. Make your baby comfortable with the feeding plan before you resume work. Take the right amount of nutrition and nutritional supplements. If you have issues with breastfeeding, you always have the guidance of professional lactation consultants who will help you resolve your issues.

1.       REMEMBER: Making the right start is crucial to successful breastfeeding. If you have issues, with breastfeeding, talk to your doctor and get professional help. But never give up. Breast milk is nature’s gift to the newborn and the mom. Make the best use of it and give a smart start to your baby’s life. GO ahead YOU CAN DO IT MOM!

Dr.Subramanian M.D

Partner with your Practitioner

Mother’s day greetings to all!  Motherhood is an exciting and exhausting journey. Along the journey, many mothers tend to ignore A VERY IMPORTANT aspect –Health.  Due to the multitude of tasks and issues a mother faces, health tends to become the least important. Make health a priority and to make a beginning, let us look at the important aspects of health that every mother should know.

Pregnancy:  You become a mom the moment you conceive. This antenatal period is crucial for both the mother and the baby. Through this period, generally mothers are excited and follow the doctor’s advice. Yet, one can never overemphasize the importance of adhering to medical advice.  Remember to take the supplements and other medications prescribed and be regular to check –up. What is more important at this stage is to adhere to what the doctor says and not to seek information from unreliable sources. Prepare yourself for labor, delivery and bonding with the baby. Register yourself for classes conducted by qualified professionals and get a head start. If you are lucky your pregnancy will be smooth. But some are not so lucky. If you are one, this should not put you down; with medical advances you are most likely to overcome the issues.

Post Natal period: Baby is born! This post natal period means issues of adjustments. Be assured that you have what it takes to handle the issues within you!  Though you will be in fatigue, make sure you breastfeed your baby as early as you can after delivery. This means a lot to both you and your baby.  While it is beneficial to the baby in many ways, it is also helpful to you. It reduces your risk of developing beast cancer and has many potential benefits. Focusing on the baby tends to put your health on the sidelines. Make it a point to take the vitamin supplements and good nutrition. Some women may go through post postpartum issues; make sure they do not overwhelm you. If needed seek professional help.

As the baby grows, your responsibilities also grow and you will have to cope up with professional, household issues along with the pressure of trying to do the best as a mom. This may mean fatigue, depression etc.  Keep realistic goals/ expectations and work towards them to avoid exhaustion. It is advisable to undergo annual health check-ups to keep a tab on your health.

Peri menopause: As you are busy with life, your body starts making changes for the future. The stage is getting set for menopause. This preparation period is called perimenopausal phase. You may have irregular periods, heavy to scanty bleeding etc. You could also face menopausal symptoms like hot flashes, palpitation. Understand that all this is caused by fluctuating hormone levels in the body. Discuss the issues with your doctor and take the medicines/supplements if prescribed. Cruise along this phase as you are about to embark on menopause.

Menopause: Not having periods continuously for a year marks the end of your menstrual cycle and you are in menopause. Menopause reduces your hormone levels which in turn reduces your bone density and puts you at risk for osteoporosis and other health issues. There will be physical changes in your body and emotional challenges as well. Mother Nature takes care in most cases. Yet it is recommended to see a doctor and discuss the issues and the doctor shall guide you with needed interventions.

Irrespective of which stage of your life you are in, the following are important health concerns:

• ·         Anemia
• ·         Low calcium
• ·         Breast Cancer
• ·         Cervical Cancer
• ·         Hormonal imbalance
• ·         Hypertension
• ·         Diabetes
• ·         Depression
• ·         Cardio vascular issues

All the above can be taken care of if you are regular to your annual health check-ups, take right nutrition and are physically active. It may sound daunting yet if you love to be a mom you should love taking care of yourself!! So partner with your healthcare practitioner and be in control of your health. A healthy mom means a healthy and happy home.

Dr.T.S.Sabeeha DNB

International Nurses Day

“She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.” Thus goes the famed report from The Times on “The Lady with the Lamp”, Florence Nightingale. As we commemorate this pioneering woman’s birthday as International Nurses Day, I take this opportunity to thank the numerous nursing staff who have stood by me and have provided excellent medical care and support for my patients. 

The above description attributed to Florence Nightingale holds good for every nursing staff around the globe. With their dedication, care and expertise, they keep a constant vigil on those in need of care putting to hold their personal issues. Leaving their homes and many of them leaving their cities, they work with total dedication With duties stretching as far as even 12 hrs, they never tire. Be it an intensive care unit or a general ward, out-patient care or home care, they treat their duty with equal importance in all the settings and strive to bring relief to those who suffer. The confidence, hope and happiness that lights the face of the patients and their immediate caregivers on seeing a nurse is the pride of the profession. While this is so, there are instances where their effort and presence is either ignored or belittled. It is to the nurses credit that they take both the bouquets and brickbats equally.

As a medical professional, I also appreciate their technical proficiency a fact much less known to the commoner.  Their solid back –up means a lot to us the doctors. Knowing that our patients are cared for by these dedicated staff gives us confidence. I want the general public to understand and appreciate their role in the healthcare process. As in any profession, despite the best efforts there are issues that need to be improved  and this cannot be seen as a  lack of professional proficiency on the part of the nurses. Perfection is an eternal goal and let us all strive towards it.

 I finish with the words of two my NICU staff nurses at St.Isabel’s hospital:

Sheeba, “To me, nursing means CARE. Total care". 

Vadhana, ”Nursing means patience, tolerance and dedicated care”.

Their words say it all!!

Dr.Subramanian M.D

WORLD MENINGITIS DAY

Increase in Meningitis Fatalities a cause for concern say Experts

Health Organizations around the world to observe World Meningitis Day

Mumbai, April 17, 2012:  Every year on World Meningitis Day, health organizations all over the world come together to warn the public about the dangers of meningitis and encourage prevention through vaccination. The World Meningitis Day falls on April 24.

Instituted in 2009 by the Confederation of Meningitis Organizations (CoMo), World Meningitis Day aims to bring medical experts, survivors and parents from around the world to raise awareness about meningitis. 

On the occasion of World Meningitis Day, the Indian Academy of Pediatrics (IAP) seeks to alert the parents about the impact of pediatric infectious diseases and highlight the benefits of vaccination in preventing avoidable deaths from such diseases.

Meningitis is the inflammation caused by a viral or bacterial infection, of the membranes surrounding the spinal cord and brain. While viral meningitis heals on its own, bacterial meningitis has the potential to get acute without timely intervention. Those most at risk are children under the age of five.

Acute bacterial meningitis strikes with little or no warning and can be fatal making it  a medical emergency that requires aggressive therapy. Initial symptoms of bacterial meningitis include sudden onset of fever, headache, stiff-neck, dislike of bright light, nausea, vomiting and drowsiness. Laboratory tests in addition to the initial clinical signs of meningitis are important for early diagnosis in order to avert the acute stage of meningitis. Those who survive often suffer from irreversible brain damage, mental retardation, epilepsy and deafness.

Infectious diseases such as Meningitis, Pneumonia, Diphtheria and Pertussis kill many children in India and around the world. Over the years, the Indian Academy of Pediatrics (IAP) has been spreading awareness about infectious diseases that affect children.

Dr. -------------- says, “Infectious diseases like meningitis and pneumonia attack infants because of their low immunity and can prove fatal if not diagnosed and treated on time.” Pneumococcal conjugate vaccine that protects children from 13 disease-causing strains and vaccine for haemophilus influenza type b (Hib) are both available in India.

A study of 26 pyogenic (pus producing) meningitis patients at the Christian Medical College, Vellore, showed that 69% of them were pneumococcal; 27% were Hib and 4% were N. Meningitis.

Dr. …….says, “In spite of the appropriate use of antibiotics, the mortality rate due to acute bacterial meningitis has been noticeably high in India (16-32%). Increasing incidence of antibiotic resistance also underscores the importance of prevention through vaccination.”

For further information on Meningitis, please visit:

1)      http://comoonline.org/about-us/

2)      http://www.who.int/gho/epidemic_diseases/meningitis/en/index.html

3)      http://www.pediatriconcall.com/fordoctor/diseasesandcondition/immunization_vaccination/pneumococcal_vaccine.asp

4)      http://www.neurology-asia.org/articles/neuroasia-2011-16%281%29-047.pdf

5)      http://www.cdc.gov/vaccines/vpd-vac/pneumo/fs-parents.html

DO WE NEED A LACTATION CENTER AT ALL??

Hi!!!!!!!!!!!!!!
I never knew I will be asked this question. As a matter of fact, I started MILC center (our Lactation Center) as I felt there was a need for such a center. So I was  taken aback when a good friend of mine asked me why our society needs lactation centers? The person asking me the question did not have the opportunity to see the variety of problems faced by lactating mothers. 


 Talking about problems in  a conservative and breastfeeding friendly society made me wonder - Are problems not there or are we just sweeping them under the carpet and claiming to be a breast-feeding friendly society, hospital and center.


Feeding problems exist. They are common. Many are minor issues. If corrected early by simple guidance and support they would not spiral into a major lactation failure. Some issues are major and need specialist guidance from day 1.


My friend shot back- We never had these during those days. So are these problems more frequent these days? Or is it because we are copying the western culture and tending to look at breast feeding as a choice for the mother rather than as right of the child?


Now I knew she was  listening. She was just waiting to be convinced. So I strategically answered the question.

• Yes- More and more mothers are ready to discuss these problems as they feel empowered to do so. 
• I feel that most mothers do feel breast feeds are the babies right. They understand the advantages of breast feeding. Hence we seldom have to convince mothers regarding this. But most mothers want a definitive evidence that their baby is adequately breastfed. There are a few objective signs which we do explain. But due to social pressure and anxiety they often develop self doubts leading to wrong conclusions, decisions and inappropriate actions. These mothers need that extra- effort from the health care system to keep them in right tract. This is provided by the Lactation consultant now. 
• With improved antenatal care and infertility centre growing rapidly, more and more mothers with medical disease conceive. These pregnancies have higher rate of complications making establishment of breast feeding early difficult,leading to problems. These mothers benefit a lot from lactation consults.
• Preterm care has taken large strides. These babies often require special feeding techniques and appropriate transition to breast feeding at later date which can be achieved only if a lactation consultant is involved in the team.
• Thus I don't think the problems are just a mimic of the western world. we have our own unique problems and we need to address these issues rather than turning a blind eye to these.  

Madam friend was convinced!! What started as an argument turned into an educating discussion for her. Still I need to share some evidence with her. Will do so with you all in the future.


Authored by: Dr.S.Subramanian. M.D

Newborn Screening

What is newborn screening?

Newborn screening is the practice of testing every newborn for certain harmful or potentially fatal disorders that aren't otherwise apparent at birth. In India these tests are not yet done as a part of routine procedure. However, your health care provider will give you the details during your last trimester if you ask for the details.

How is it done?

All of the screens are performed on one tiny sample of blood obtained by pricking the baby's heel. After the infant's heel is pricked, the drop of blood that forms is placed on an absorbent card and allowed to dry. Once it is dried, it is mailed directly to to a special newborn screening laboratory. The sample is usually taken on the day of discharge from the hospital or no later than 48 hours of age.


Why is it done? 

Many of the disorders are  metabolic disorders and interfere with the body's use of nutrients. These nutrients are needed  to maintain healthy tissues and produce energy.  Other disorders that screening can detect include problems with hormones or the blood. In general, metabolic and other inherited disorders can hinder an infant's normal physical and mental development in a variety of ways. Parents can pass along the gene for a certain disorder without even knowing that they're carriers.

What do the results mean?

With a simple blood test, doctors often can tell whether newborns have certain conditions that could eventually cause problems. Even though these conditions are considered rare and most babies are given a clean bill of health, early diagnosis and proper treatment can make the difference between lifelong impairment and healthy development. If the results come back positive then one needs to further evaluate the child. Understand that screening is not a confirmatory diagnosis and requires further investigations. This would mean that your child would be probably referred for further lab tests or would be referred to a specialist in the specific field.

Should I Request Additional Tests?

If you answer "yes" to any of the questions below, talk to your doctor and perhaps a genetic counsellor about additional tests:

• Do you have a family history of an inherited disorder?
• Have you previously given birth to a child who's affected by a disorder?
• Did an infant in your family die because of a suspected metabolic disorder?
• Do you have another reason to believe that your child may be at risk for a certain condition?

Neonatal Intensive Care - A World Within

Coming from a neonatologist, I don't think this article would surprise you much. However there are a few misconceptions that need to be cleared. For many, the restrictions of the Neonatal Intensive Care Unit (NICU) with regard to flow of attenders and strict asepsis, makes the place unacceptable. For some, the multiple lines and tubes that are inserted into the very small child, makes the place look like a torture chamber rather than a therapeutic center.
To all these concerns,  we have only one answer- We do so because these policies and methods of therapy provides the child in question the best chance of survival. The policies of a good NICU is always in keeping with the latest medical evidence coupled with a human facet to care of the child. In fact we are more and more realizing the role of parents in the recovery of their child.

I have decided to answer some of the FAQ regarding NICU.

What are the indications for keeping a child in the NICU?
Any newborn requiring more than just a routine care is usually kept in the neonatal intensive care. Some hospitals have a graded care system where there is a nursery where newborns, who require a little bit of monitoring are kept and NICU where intensive monitoring and therapy is done. Some hospital have both the nursery and NICU merged.

Why is that such small require  lot of equipments?
Smaller the baby, more immature are their organ systems. They are not capable of functioning by themselves. Thus their dependency is more on the intensive care personnel. Thus they require warmers and incubators to maintain their temperature and humidity. They also require small but accurate amounts of fluids to be infused into their veins. This means we require accurate infusion pumps. They require frequently to be put under photo therapy to reduce their neonatal jaundice.Monitoring these babies is an ongoing process. So they require monitors that display many parameters including ECG, blood oxygen levels (SpO2), etc. These babies often require frequent imaging modules to look into their bodies- thus X-Ray machines and ultrasound/Echo machines are also required on standby. Add to this the breast pumps and breast feeding chairs, computers, lobby etc, we have a busy and working unit.

Why is that we are unable to show our near and dear our baby in the NICU? Why are the NICU rules so stringent?

Newborns and especially pre-terms are extremely vulnerable to infections. Thus even the doctors and nurses handle the babies with extreme care. Their entry and exit into the unit is also monitored. In general more the traffic through the NICU more the chances of infection for all the babies. It is understandable also then that if we allow more relatives for one baby then we need to hold the same for others. Thus more the traffic and more the risk of infection for your and every other baby in the NICU. Hence NICU policies are very strict with regard to visitors


Why does care for such small babies cost so much? Why NICU stay costs so much for parents?

We already discussed the need for so many equipments in NICU. Added to this is the need for medical personnel (staff nurses and doctors) who are trained in Neonatal care. A sick newborn requires one and at times two nursing staff round the click. Thus running an Neonatal intensive care is an expensive yet important affair. Medications like surfactant also cost a lot. Disposables like syringes, needles etc are used frequently to prevent infections due to reuse. Hence the cost of NICU care is high.

What are the outcomes for babies who are treated in the NICU?

Presently outcomes for babies treated in the NICU is good. Neonatology itself started being recognized as separate branch of medicine only by 1960's. The outcome (in terms of survival and medical problems among babies that survive) were quite poor initially. With more and more research, understanding of this science has became better. This has now reflected in better outcomes. More and more smaller babies are surviving with lesser long term medical problems.

These improvements are relative to what was earlier (say, 10 years back). But it is a medical fact that babies that required intensive intervention in the newborn period have long term medical problems (eg: issues with brain development, issues with eye- ROP and refraction errors, hearing problems, growth failure etc). Many of these problems are being addressed by the medical fraternity. Still one needs to be on the guard and do regular follow-up these children until 4 to 5 years.

Authored by : Dr.S.Subramanian.

FEBRILE SEIZURE

What is a febrile seizure?

A febrile seizure is also called a febrile convulsion. Any illness that causes a fever (high temperature) can cause a febrile seizure. Most occur with common illnesses such as ear infections, coughs, colds, flu, and other viral infections.

Who has them?

Typically it happens in children between 18 months and 3 years. It is rare in children less than 6 months or more than 6 years. About 3 in 100 children have a febrile seizure sometime before their 6th birthday.

How does a febrile seizure look like usually?

The child's eyes may appear to roll backwards. The child may become unconscious. The body may go stiff, then generally twitch or shake (convulse). It may only last for few seconds, and is unusual for it to last more than five minutes. The child may be sleepy for some minutes afterwards but within an hour or so the child will usually appear a lot better when their temperature has come down. Febrile seizure does not recur within 24 hours or within the same febrile illness.

What first-aid should I do for a febrile seizure?

• Note the time it started.
• Lie the child on his/her side with the head in line with the body or slightly lower (the recovery position).
• Do not put anything into the mouth or shake the child.
• When the seizure stops, try to lower the child's temperature to make him/her more comfortable. To do this take off the clothes (if the room is warm). After the child has recovered enough to swallow, give a drink and some paracetamol or ibuprofen.

What should happen after immediate first aid?

The child should be seen by a doctor as soon as possible after a seizure to rule out serious illness. However, call the doctor and rush the child to the emergency department if:

• The child does not improve quickly once a short seizure is over.
• A seizure lasts more than five minutes (this includes small twitching movements even if large jerking movements have stopped).
• Another seizure starts soon after the first one stops.
• The child has difficulty breathing.
• The child was not fully conscious before the seizure or one hour afterwards.
• You suspect a serious illness is the cause of the fever

What is the treatment for febrile seizure?

No treatment is usually needed for the seizure itself if it stops within a few minutes.

(However, treatment may be needed for the infection causing the fever.)

Sometimes if the seizure lasts longer and the doctor may give a medicine to stop it. For example, the doctor may administer a medicine called diazepam into the rectum (back passage) or a medicine called midazolam may be administered intravenously. These drugs are absorbed quickly and stop a seizure.

Is a febrile seizure dangerous?

Febrile seizures are not usually dangerous. Full recovery is usual. Most illnesses which cause fever and febrile convulsions are the common coughs, colds, and virus infections which are not usually serious. However, the illness that causes the fever is sometimes serious, for example, pneumonia.

Can febrile seizures be prevented?

It may seem logical that if you keep a child's temperature down during a feverish illness it may prevent a febrile seizure. Therefore, if a child appears hot, then the following will help to reduce the temperature:

• Keep the child very lightly dressed, or take off clothes if the room is warm.
• Give paracetamol, (for example, Crocin, Calpol etc), or ibuprofen.

Authored by :Dr.S.Subramanian M.D

TOP 10 MISCONCEPTIONS

1. Crying newborn means inadequate milk. Give the baby more milk. Newborns cry due to various reasons. It includes being too cold or too hot, disturbance in sleep, before and after passing urine and motion, wanting to be held etc. Hunger is just one of the many causes for a newborn to cry. In fact, cry is the only form of communication of a newborn.  Hence not all cry should be interpreted as a cry for hunger. As long as the child is passing adequate amounts of stool and urine and is gaining weight normally one need not worry about feeds.
2. Newborns need water to hydrate them and gripe water or traditional medicines to digest milk.  Mother's milk has the right balance of water and nutrients for the baby. Hence in there is no need for giving extra water for babies on exclusive breast feeding until 6 months of age. Following this on starting other solids you would be advised to give water for the child. Mother's milk is the most easily digestible food a baby can have. There is no need for any medications or digestive tonics to aid in digestion for newborns. Colic pain is not a digestive problem. Giving over the counter colic medicines can be detrimental to your child. Avoiding these medicines may be the best thing you would do to your child.
3. Vibrations felt in the chest in the child with noisy breathing means the child has a chest cold or a lung infection. The respiratory air passages are a single continuous passage from the nose to the lungs. As it goes down to the chest the passage branches into smaller ones. Thus any turbulence in airflow in the upper part of the airway would be felt in the lower airway. This is felt through the thin chest wall of a young infant and often mistaken as chest cold. Usually it is the nasal block due to common cold that causes such vibrations in chest.
4. Fresh cow's milk is better than packet milk for an infant. Both are inappropriate for an infant less than 1 year. While the fresh cow's milk is unprocessed milk, packet milk is to certain extent processed in the sense, it is pasteurized and comes with variable fat content. Pasteurization prevents infections from being transmitted through the milk from the cow to humans. Thus it is safer. Also if we choose to take low fat milk then it is better. However both are not recommended for children less than 1 year. The protein in cow's and packet milk is too large and is often allergenic and is not tolerated by the intestine of a young infant. Often this lead to allergic reaction in the intestine of the infant.
5. Inhaler usage in asthma is addictive. Definitely NO. Let us understand as to what happens to asthma as the child grows (natural history of the disease). Asthma is a disease of the airway of the lungs. The airways basically over-react to the environmental substances (called allergens). They narrow down and thus making it difficult for the child to breath. This is episodic and is reversible. Among children who develop symptoms before the age of 2 years, 70% would stop having wheeze by 5 to 6 years of age. Among the rest 15% would stop having wheeze by 12 years and the rest (15%) would continue to wheeze well into adulthood. This does not change with treatment. Inhalers basically control the reaction of the airway. Thus the medications only control the symptoms thus preventing your child from getting severe attacks. Depending on the natural history in your child, your child may require it for few years or for life long. That time alone would tell. It has nothing to do with the inhalers. Blame it, if at all, on the genes!
6. A plumpy looking child is a healthy child. This is very common. Many mothers like their child to be plumpy looking and cute!! They say that their baby was cute and plumpy at birth. But is lean and thin as he/she grows up. Actually body propositions change as child grows. Head size to body size is higher in a newborn than an older child. As the child grows the head to body proportion becomes smaller. This gives the child a leaner and less plumpy look. In fact children who maintain same body proportions as they had as infants may be abnormal, and may need to be evaluated for the cause of obesity and persistence of infantile body proportions.
7. Fever is bad. Even mild raise in body temperature should be brought down with medications. Fever is usually a body response to an infection. Infection is nothing but invasion of the body by various microorganisms. As a response, the body immune system is activated. One of the important aspects of this is raise in body temperature. As the body temperature raises the body immune cells become more active and are capable of functioning better. Thus fever, to certain extent is good. However fever may cause problems when it is very high. It causes a feeling of ill health, dehydrates the child. In a child who has a tendency it does precipitate a seizure. One must remember that the fit does not depend on how high the fever is but on how rapidly it increases the body temperature. Often children develop fit at a low temperature of 100 F. Also 90% of fits happen only the first 24 hours of fever and rarely beyond 48 hours of fever. Thus the idea of treating fever per say should be only to provide comfort to the child rather than to get the temperature to normal.
8. Treatment of cold early with antibiotics prevents progression of the disease. Most colds are viral infections. They usually last for 7 to 10 days. Adding antibiotics early in disease will not change the duration of illness nor will it decrease the severity of the illness. It would infact cause antibiotic resistance among the bugs in the child and when needed the antibiotic will not act and the child will end up being treated with higher and stronger antibiotics.
9. A mother with cold should not nurse her child. Else she may pass on her illness to her baby. Cold in mothers are mostly viral as is the case with anybody else. The mother would be transmitting the disease through inhalation to everyone in close contact 2-3 days before she develops the first symptom. The baby is the most intimate contact and is often infected. But when the mother nurses the baby she provides antibodies specifically against the microbe she is infected with and thus provides protection to the baby. Thus the baby does not develop severe disease. So nursing the baby is actually the most logical thing to do. If she does not nurse, she would only be giving the baby the infection and not the protection for the same.
10. Vaccines protect my child against all illness. Once completely vaccinated my child would not get a major illness. The disease against which we vaccinate your baby is only a small percentage of the disease causing organisms known to us. However the vaccine prevented disease are diseases which are common and often are a cause of serious health problems in the community. Thus protecting your child against these diseases are important, one needs to understand that there are other diseases for which we do not have effective vaccines as yet. Also the protection offered by the vaccines are variable for different diseases. For example while DTP provides 98% protection, chicken pox provides 95% and typhoid vaccine provides only 50%. So even among the diseases for which vaccines are available there is no 100% protection.

Authored by :Dr.S.Subramanian  M.D