Dr Sane's Clinic

03/09/2021

03/08/2021

How much water do children need?

A question often asked by parents.
A child on breast feeds does not need any additional water till six months of age.
And this is irrespective of environmental temperature.
After that it depends on activity, sweating and climate.

How do we know whether the child is taking enough water ?
He / she should pass urine at least four times a day and except the first urine in the morning it shouldn’t be dark in colour.( Exception : some medicines cause dark coloured urine)

21/07/2021

Most people have mild or no side effects after taking a COVID-19 vaccine

16/07/2021

COLIC IN BABIES 😫😩👶
Colic is the frequent extreme fussiness., excessive and prolonged crying for no apparent reason which happens during the same time of the day... usually evenings..
Colic in babies makes the parents overwhelmed, frustrated and resentful since no form of consoling at times seems to pacify the baby.
Things to hence remember are...
1.BABIES tend to have colic from the second week of life till around 3.5to 4months of age.... around..25%of them have severe colic.. which is also definitely going to disappear by the 4to 5months..of age
2.Ensure a good breast feeding position so that the air swallowing during feeding is as less as possible..
3 In top fed or formula fed babies... do maintain the exact dilution of the formula and in case the baby is on bottle feeding due to lactation failure..see that you do not use a bigger measure bottle for small feeds...we have many anti colic valve bottles available too..
3.Always burp your baby after every feed...if the baby goes into deep sleep post feeding.. just carry your baby and walk for 10 mins patting the back gently... this makes them very comfortable..
4.Check your food ( Mother's food) .. like excessive consumption of dairy products specially milk by the mother..may cause colic...try substracting it from the diet n see if it makes a difference...
5.Overstimulation...if it's happening around the
baby...too many loud noises,loads of visitors ( pandemic has decreased the visitors though) ..just try n decrease the overstimulation.
6.Tummy time..once the baby is around 4 wks.. trying tummy time is a good option..but not immediately post feed..after the burp or may be 30 minutes later n should be supervised...
7.Playing soft music could make a change sometimes..good for the baby and the parent 😊
8.Stay cool n calm...easier said than done but that's the key.. your stress sends negative vibrations and if you stay calm as a parent you take actions to console in a better way..Hold the baby as close to you when inconsolable..Take turns of handling the baby.. allocate.it to close family members too
9.The COLIC if makes you frustrated always since the baby is inconsolable...a visit to the paediatrician is must for a thorough check up to rule out any illness... causing the pain..and definitely to allay the anxiety as a parents.
10.The treatment for colic is studied time n again...some medications like... probiotics.. antispasmodic s. have been in use..but always consult your paediatrician before starting them.
11Remember....This too shall pass n COLIC will be gone forever.. It's not a disease just a physiological manifestation of the developing intestinal system of the baby 👍
And once the challenge has surpassed...Pat your back...for surviving...the first challenge of parenthood...😊
THE POST CONTRIBUTED BY DR NEETA SABOO.

13/07/2021

Obesity :'THE OTHER PANDEMIC!

India has the second-highest number of obese children in the world after China, according to a study, which means that 14.4 million kids in the country have excess weight. Healthcare experts have attributed the rise in obesity to unhealthy food choices and lack of physical activities among children and even adults.

Lifestyle diseases like hypertension type 2 diabetes are more commonly on the rise and obesity features predominantly in them.

Is my child overweight?
With the pandemic looming and the inevitable lockdowns , this is now a very common concern among parents especially in city homes with limited moving space and increased screen times.

However, Parents should not make changes to a child's diet based solely on perceptions of overweight. All pre-schoolers exhibit their own individual body structure and growth pattern. Assessing obesity in children is difficult because children grow in unpredictable spurts. It should only be done by a health care professional, using the child's height and weight relative to his previous growth history.
Regular monitoring of his weight and height parameters should be done on non-ill visits or vaccination visits.

How to prevent obesity in children a few tips .

1) AVOID eating in front of a screen.
This includes TV, LAPTOPS ANS MOBILES. Doing this, blunts our sense of satiety and leads to over eating.

2) Moderation is key.
In children, we like to advocate weight maintaince, more than weight loss.
Very heavily restrictive diets are not recommended and in fact may backfire, leading to rebelling and overeating .

3) Balance out your meals
After an occasional lunch or dinner , make sure the rest of the meals in the day are lighter.
Also , good healthy eating should be a family affair.
Do not make special food for the child. This may lead to feelings of being singled out..

4) LIMIT SNACKING AND MAKE IT FUN.
Make the most of snacks. Continuous snacking may lead to overeating. Plan healthy snacks at specific times.
Avoid sugary juices and aerated beverages .Prefer home-made drinks like nimbu pani, chaas lassi , soups or coconut water etc .

Eat fruits instead. Or healthy snacks like murmura. Paneer shallow fried cutlets , whole wheat rolls etc.

5) BUY SMART.
When shopping for snacks , take the kids along if you. can. Older kids can help pep for meals and snacks too. Buy fewer high-calorie, low-nutrient foods. Help children understand that sweets and high-fat treats (such as candy, cookies, or cake chocolates) are not everyday foods.

5) Encourage your child to try more varieties of food

6) PHYSICAL ACTIVITY to be encouraged.
With the lockdown situation and kids not being able to play down , weight issues are increasing .
However, the kids and do simple activities like dancing to their favourite music, doing some floor exercises or even yoga.
Going for walks with the whole family is fun too !
The post is contributed by Dr Shivani Sud Thakur

10/07/2021

This information is true for first few months only.Weight gain usually slows after 3 months.

08/07/2021

What is happening now?
: current fevers in children.

Recently we have encountered many children with fever in our clinic. What we are witnessing are many children with Influenza and RSV (Respiratory syncytial virus). These are viral infections.
Both cause short lasting fevers (typically 3-4days) of moderate intensity with cough and cold. Some children also have symptoms of stomach upset. Many family members do get affected with varying severity.
Vaccination is moderately effective in prevention of influenza (usually recommended in children less than 5 years and adults above 65 years). No such vaccine is available for RSV infections.

06/07/2021

Fever: some useful facts : part 2
Is fever a friend or enemy?
Fever is body’s response to infection and is meant to control the infection.
The raised temperature makes it difficult for viruses and bacteria to survive and multiply.
It also alerts the patient to take rest, and thus helps in recovery.
Fever also activates our immune system and makes it more efficient.
Off course, fevers come with uncomfortable feelings of body aches and headaches.
It also increases metabolic demands and puts strain on body organs such as heart and lung.
In very young children it can also be associated with convulsion.

04/07/2021

Fever: some useful facts : part 1
Come monsoon and it rains infections! After a lull of almost one year we have suddenly witnessed spurt of fever cases in our clinic. There are cases of dengue, malaria typhoid and upswing in cases of influenza and other viral infections.
A few facts:
1.Usual fevers are short lasting , typically 3-4 days (usually less than a week).
2. Fevers may be high to begin with but by 3rd or 4rth day the intensity should be decreasing.
3. Usual fevers are accompanied by other symptoms like cough/cold/loose motions etc.

27/06/2021

Interesting data on birthday in family and subsequent COVID infection:

This is an interesting study from US which showed that having birthday in family increased the chances of having COVID in next two weeks. The chances were 3 times more if the birthday happened to be of a child than an adult.
Realise that the researchers didn’t actually study whether the birthday was celebrated or not. But, found the association from study of database.
We know that maintaining social distancing is the best way to protect ourselves from COVID. Most experts believe that studies like this caution us against letting our guards down even for a family function.

06/06/2021

Look for these three things in your toddler!

In last two posts we have discussed bad effects of excessive screen time.
How will I know as a parent that my child is having effects of screen addiction?
Here are the clues for your 18 months old child!
1.Is your child ‘pointing’ when wants somethings?
2.Does your child look at something that YOU point out to him?
3.Does your child look in your eyes/ at face when you talk to him/her?

Most important: Even if your child has one or all of these it doesn’t demonstrate abnormality! it means you must meet your doctors and express the concerns!

05/06/2021

The COVID Pandemic has seen the entire generations in seemingly never ending.. SEASON OF SCREENS...
The children of today are growing up with a vast array of electronic devices at their fingertips thus.. increasing the screen time by leaps and bounds...
Screen time in children has put in varied questions n has made parenting even more challenging...So how do we deal with THIS....
Let's look at some guidelines....

1.Toddlers and children less than 2 yrs of age.. They should not be exposed to any media usage except for an occasional video call to the near and dear ones.. Social interaction is of utmost importance in this age group...as excessive screen n media usage would lead to hyperactivity.., speech and language delay and poor social skills.The fast moving screen activity and rapid changes of pace seems to stimulate multiple senses and hence leads to decreased ability to concentrate and temper tantrums..
2.Children between age group of 2 to 5 yrs...They should be exposed to informative and high quality media usage only for an hours time... The guideline.also says..LESSER THE BETTER....
3 Older children...more than 5 yrs of age...As the child grows it becomes more challenging...but the word..BALANCE is important here.... It's important to balance screen time with other activities for the child's overall development. It includes outdoor play activities, school work, family time,proper meal times adequate amount of uninterrupted night time sleep of 8 to9 hrs, outdoor fun activities..
If any of these activities start getting replaced by the SCREEN TIME..then it's labelled as excessive screen time...Then this needs monitoring and management..
4 As the child grows further one size fits all approach doesn't work... We will need to monitor the social media usage..the sites they visit by increasing our social interaction with them.. Designing a HOME MODEL which suits the Family n its a win win situation for Allll...
I would like to classify the screen time into...... *Passive screen time... which is spent sitting on the couch watching videos and non informative programs..
*Interactive screen time.... wherein you interact with your family n friends to connect and chat for a small amount of time..
*Constructive screen time... wherein the children learn new art..forms...e.g. music.,dance, yoga, learning a new language.online and.many more creative things..

Setting up of HOME Rules...
1.Involve children in rule setting..they feel privileged n they definitely abide by the same
2.The most important...ABIDE BY THE RULES YOURSELF..Be a ROLE MODEL..
3.Exclude education time.
4.Removing access later is far harder than denying in the first place..so think before you reward..
5.Monitor and enforce with calm demeanor
6.Preview programmes apps..games before allowing.
7.Avoid distracting content and violent media usage.The quality of media is more important than the screen time.
8.Digital Detox... switching off or not looking at them during interactions... Night time deadlines...
9.Replacing SCREEN TIME...with. GREEN TIME... hiking.. gardening... playing outdoors with the children makes them more energetic and empathetic too..
10.Playing indoor board games... reciting stories..riddles n puzzles.. cooking together...and many more fun activities..
To summarise...
Managing your child's use of screens and media will be an ongoing challenge.But by developing household rules and revisiting them as your child grows you can definitely ensure a safe experience of PARENTING..
Contributed by Dr Neeta Saboo

02/06/2021

Uncommonly recognised problems of Pandemic

Speech yes but no language!

This COVID pandemic has changed the world. It has thrown; hopefully temporary open a new way of life. Some uncommonly recognised problems that we see in children as response to these changes are Anxiety, obesity and Loss of social skills.
While cause former two can easily be guessed, the third and possibly most damaging one has startling reasons.
2year boy came for catch up vaccination, his first out of home visit since lockdown eased (~7-8 months). Possibly after 1 years
Parents were naturally worried about delay in vaccination. While assuring them that better late than never I noticed that the child was continuously watching something on ‘smart-phone’. When I questioned the parents, they told me that both of them were working from home and the smart phone was the only way to keep the child quiet.
They told me he can recite numbers from one to hundred and also alphabets but does not interact. This is very worrying presentation of a child who has limited social and communication skills.
We, as paediatricians are seeing many children like this and this is worrying because after a critical age which some authorities put at 30 months it becomes extremely difficult to acquire new language skills.
This pattern of development occurs due to less social interaction and too much screen time.
In next posts I will write about recognising this social and communication delay in a child and guidelines about screen time for children.

31/05/2021

Covid appropriate (& child friendly!) behaviour at home.

We are constantly bombarded with reminders of COVID appropriate behaviour in society. (SMS: Social distancing, masks and sanitisation). Is there any ‘COVID appropriate’ behaviour at home?
Last 18 months of pandemic have taken massive toll on our physical and mental health. Our children are hidden victims of the pandemic.
Lack of schooling, restricted socialising opportunities and travel has definitely affected them. Increased screen time is also likely to affect their emotional development.
In this background we want to suggest some COVID appropriate child friendly.
1) Take out quality time for your child from your busy schedule.
2) Do at least a few activities together. You may play, read, do gardening, drawing, painting together.
3) Take ‘a short(or long) break’ from Covid every day. This means that unless vitally important no one should talk, chat, post, watch news about COVID during this time.
4) Let the dinner time be ‘togetherness’ time and not screen time.
In the next post I will discuss some obscure problems caused by the pandemic .

27/05/2021

Should breast-feeding mothers take COVID vaccine?
surely yes!
Vaccination not only protects you but also your child.
The vaccine is not a 'live virus' vaccine and hence there is no chance of the vaccine virus passing through breast milk to your infant.

25/05/2021

Is Influenza vaccination needed for ALL the children this season?

On 23rd May the honourable chief minister of Maharashtra interacted with medical fraternity along with members of task force. It was very fruitful meeting. At the end of the meeting there was suggestion that influenza vaccine be given to all children this year.
The logic behind the suggestion was that influenza vaccination would decrease health care burden. The hospital beds that would be occupied by influenza patients would be free to take care of COVID affected children.
Is this really so?
Most important fact to be understood is Influenza vaccine doesn’t protect children from COVID-19.
1) Which group of children are severely affected, so would need hospital admission? It is documented that children under 2 years of age are high risk group for severe disease along with children with having chronic diseases like (Including and not limited to) severe asthma, diabetes.
2) How many children get admitted due to influenza every year? Most of the admissions due to influenza infections occurs under 5 years of age. Above 5 years of age incidence of influenza related admissions is negligible (Ref: Plos medical journal published online 2016)
3) With no schools, chances of getting influenza infection is further less this year.
That is the reason Indian Academy of Pediatrics considers offering vaccine to all children under 5 years of age.
While vaccine is safe such recommendation is bound to create panic in parents and artificial scarcity.
I feel parents may consider this view point before rushing in to vaccinate their children.
From Team Dr. Sane’s clinic

23/05/2021

What should I do if I become COVID positive? a Paediatrician's perspective.
Time and again we get frantic calls informing us that one of the parents is turned COVID +ve and advised home quarantine. Instant reaction then is to shift the children to grandparents; often the grandparents or relatives who are not staying with the family.

THIS SHOULD BE AVOIDED IF POSSIBLE. WHY? Here is the explanation.

When one member of the family is infected with the virus in all likelihood the other members are infected. This is particularly true for second wave which is affecting clusters.
When we shift child from such a house to new caretakers (grand-parents, aunt) we are exposing new susceptible and often vulnerable (more high risk) contacts to the infection.
So, shift only if parents are so sick that they cannot take care of the child. Shift preferably if both grand-parents have been fully vaccinated.

20/05/2021

How should I protect my child from the third wave?

This SARS-co-V 2 virus is teaching us every day. We are possibly just recovering from 2nd wave and already there are speculations about third wave. There are also suggestions that this third wave may affect mainly children.
Every day we get anxious parents enquiring about how to protect their children from the third wave.
First let us look at few known facts: It is well known that Covid-19 doesn’t cause severe disease in children. So, even if the third wave mainly affects, the infection is likely to be milder. However, because of mutations in the virus a certain degree of uncertainty remains.
These two waves have taught us that Covid-19 affects children mostly when there is some immediate contact with symptomatic or asymptomatic Covid -19 patient. Usually this contact is from within the family. This situation is likely to remain at least till schools re-open.
Knowing these facts here are a few ‘Mantras’ to protect our children:
1) Our children will be protected if we protect ourselves. This is called cocoon protection.
Like a cocoon we form a protective ring around our child-(IQ-SMS policy )
We can achieve these by vaccinating (Immunizing) ourselves (parents and grand-parents) as quickly as possible.
Isolating ourselves (Quarantine) if ill. However young infant shouldn’t be separated from mother.
And by Social distancing, Mask and Sanitizer use.
2) If and when the children go to play, mix with other children they must use Mask and Sanitizers.
3) Become responsible citizen, don’t send your child to play if any member of your family is sick with fever or throat pain.
4) Immunity boosters, Vitamins, tonics from different ‘pathies’ have not proved to be useful.