and
Child Care
Mother
and
Child Care
Utpal Kant Singh
MD PhD FRCP(Lond) FIAP
Associate Professor
Department of Pediatrics
Patna Medical College, Patna
Rajiniti Prasad
MD
Assistant Professor
Department of Pediatrics
BP Koirala Hospital
Dharan, Nepal
Ranjeet Kumar
MD
Consultant Pediatrician
Sishu Arogya Kendra
Boring Road, Patna
Shivani Suman
Department of Medicine
Cambridge University Hospital
Cambridge, UK
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Mother and Child Care
2003, Utpal Kant Singh, Rajiniti Prasad, Ranjeet Kumar, Shivani Suman
All rights reserved. No part of this publication should be reproduced, stored in a
retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of
the authors and the publisher.
This book has been published in good faith that the material provided by
authors is original. Every effort is made to ensure accuracy of material, but the
publisher, printer and authors will not be held responsible for any inadvertent
error(s). In case of any dispute, all legal matters to be settled under Delhi
jurisdiction only.
First Edition: 2003
ISBN 81-8061-197-3
Typeset at
Printed at
to
Rita Singh
Preface
With growing awareness, care of mother and child has improved
but still a lot is left to be desired. Mother and Child Care is our
endeavor to provide a reference handbook for scientific dealing
with problems of mother and child without neglecting beneficial
traditional beliefs. This book builds on our previous publication
Hand Book of Infant Feeding and also updates practice in care
of pregnant and lactating ladies.
What to do and what not to do during pregnancy and what to
feed and how to feed after delivery is a dilemma shared commonly
by pregnant ladies, nursing mothers, doctors and other health care
personnel. The problem is further compounded by a range of factors
like false social myths at one extreme to modern day demanding
life-style at the other extreme, especially if accompanied by social
ailments like smoking, alcohol consumption and drug-addiction.
This book attempts to provide valuable knowledge about
pregnancy and the necessary care that should be taken during
uncomplicated pregnancy and pregnancies complicated by co-presence of diseases or co-consumption of drugs or substance abuse.
We have attempted to update entire information on breastfeeding,
alternative feeding and weaning. Additionally, the common problems of breastfeeding and bottle feeding has been dealt in a
question-answer format for better understanding. This book also
provides chapters on common neonatal problems like neonatal
jaundice, neonatal skin care, immunization, physical and mental
development, child abuse, nutritional value of food and nutritional
requirements during pregnancy.
It may be mentioned that this book is not meant to be
encyclopedic in its content but is tailored to provide necessary
information regarding mother and child care.
viii
Contents
1. Introduction
12
16
18
22
27
31
10. Breastfeeding
35
57
61
65
68
70
75
79
18. Weaning
84
19. Immunization
90
92
96
97
98
24. Vitamins
99
104
107
111
147
151
30. Emergencies
155
Index
161
Introduction
C
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Pregnancy and
Baby in Womb
C
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correct medical term is Embryo until the end of the second month.
The head, trunk and facial features are beginning to develop as is
the heart.
2nd Month
During the second month, the babys bones begin to form. The
fingers and toes develop along with ears, ankles and wrists. Eyelids
develop but remain sealed. By 7 weeks, the baby will be about 2.5
cm long.
3rd Month
The correct medical term in this month for baby is fetus. The
toes and fingers develop soft nails. The kidneys are also developing.
The baby will also have development of facial features, i.e. tongue
and mouth. Twenty buds appear for future teeth. By the 12th week,
the baby is fully formed and is about 8cm long.
4th Month
By the fourth month, the babys sex may be determined. The baby
will sleep and wake and swallow. The heart beat is strong and fast,
about twice that of an adult. The skin is pink and transparent with
a small amount of hair on the head and eyebrows. The length is
about 18cm.
5th Month
The fifth month is the period of rapid growth. The baby has a regular
asleepawake schedule and will turn from side to side and
sometimes head over heels. The baby may even suck his /her thumb
and will be about 25cm long.
6th Month
The rapid growth of the baby continues. Fine soft hairs, called
lanugo now cover the skin which is red and wrinkled. The length
is about 30cm and baby moves vigorously.
7th Month
The babys growth is very rapid and he/she can open and close
his/her eyes. The baby exercises by stretching and kicking. The
bones are hardening, but the skull remains soft and flexible to aid
birth. The length is about 35 cm.
8th Month
The baby becomes bigger and heavier, therefore does not have the
room to move around much but may kick strongly. Babies in this
month are usually in head down position ready for birth and about
40cm in length.
9th Month
The baby in this month gains about 200-250 gm weight per week.
He is curled up in the fetal position with knees up against nose
and thighs tight against the body. The fine hairs on the body have
disappeared.The baby may then descend into the pelvis getting
ready for birth. Forty weeks is full-term and birth can happen
anytime between 37th and 42nd week of pregnancy.
Developments in Mothers During Pregnancy
1st Month
Though not much differences are seen, the body is changing too.
She may have a tingling sensation and slight discomfort in her
breasts. The period is missed and the nipples may be more
prominent.
2nd Month
The uterus (womb) is now about the size and shape of a pear.
Morning sickness may be experienced. Breasts may be felt larger
and have blue veins visible on them. The uterus, as it gets larger,
pushes the bladder which may result in frequent passage of urine.
Weight gain may only be about 500 gm to 1 kg at this time.
3rd Month
Morning sickness, if it has happened, starts improving. The waist
line, breasts and stomach grow larger and the mother may need to
wear maternity clothes. Nipples may become dark due to extra
pigmentation in the skin. The weight may be increased by 1-2 kg.
4th Month
With the growth of the baby, the size of the uterus increases and
relieves the pressure on the bladder. Thus the frequency of the
passage of urine improves. By the end of this month, the mother
may feel slight movements of the baby, sometimes called
quickening. This feels like a fluttering or slight bubbling. Weight
gain during this month may be about 1-2 kg.
5th Month
The uterus by 5 months almost reaches the mothers tummy button.
The gain in weight varies from 2-3 kg. The heart beat of the baby
can be heard and mothers may start to feel the movement.
6th Month
The uterus will now be above the tummy button. The baby will be
very active and mothers may even feel a heel or elbow as a lump
after pressing on the abdomen. The weight continues to increase.
7th Month
The baby continues to grow, so will the uterus. Breasts also get
increased in size. There may be a feeling of uterine contractions by
mothers called Braxton Hicks contraction. They are quite normal
but worth mentioning to health professionals.
8th Month
The uterus reaches to just under the ribs which may cause a little
discomfort and occasional shortness of breath. Mothers may notice
a slight leakage of clear or yellowish fluid from breasts called
colostrum. Small bulges may appear on the abdomen made by
babys heel or elbow.
9th Month
As the babys head moves into the pelvis (engagement), any breathlessness of the mother will improve but she may again experience
frequent passage of urine because of pressure on the bladder by
the head. However, in some cases, engagement of head does not
happen until labor has started. There may be feelings of a mixture
of fatigue, anxiety and joy. This is all normal but may be discussed
with health professionals.
After the birth of the baby, every mother wants to look at her
baby to make sure he/she is fine and healthy. The baby, should
also be examined by a doctor at this time to detect any health
problems which might need immediate treatment.
C
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A pregnant woman may have mixed feelings. She may feel happy
and proud but at the same time, may be anxious and uncertain. In
fact, during pregnancy, feelings may change frequently, from one
day to the next. This mixture of feelings is quite normal, while
adjusting to pregnancy and to the idea of parenthood. It is important
to discuss your feelings openly with ones life partner, health care
professionals, family and friends. After all emotional well-being is
important to good health.
Importance of Antenatal Care
The pregnant women should be educated about good care of health
because caring for herself during pregnancy means good care for
the baby. Once, pregnancy is confirmed, visit your doctor, midwife
or public health nurse once a month, so that blood pressure, weight
and general health can be checked. During the last weeks of
pregnancy, your visits should become more frequent so that the
doctor, midwife or public health nurse can keep a watchful eye on
your unborn baby.
The care, women receive before the baby is born, during pregnancy, is called antenatal care. Women who start antenatal care
early can plan for a comfortable pregnancy and delivery of a healthy
baby. It is important to remember that every pregnancy is different.
Exercise and Work
Some exercise is good during pregnancy, as it will help to keep
body in its best physical condition and contribute to overall muscle
tone and good posture. Everyone has different needs, so contact
the health care professional before engaging in any strenuous
activity or sport.
Sexual Intercourse
As a general rule, there is no reason to stop having sex during
pregnancy, however if there is a history of miscarriage, health care
professionals advice should be followed. Some women find
fluctuation in interest of sex during pregnancy, the middle trimester
is usually the time of most vitality. Women, as long as they feel
comfortable and do not experience any bleeding or cramps whilst
making love, sexual intercourse will not harm your baby. In late
pregnancy, it may be helpful to experiment with different and more
comfortable positions. It is advisable to always discuss this with
health care professional.
Teeth
Some women find that they are more susceptible to dental problems
during pregnancy, so it is important to contact your dentist and as
usual brush your teeth thoroughly at least twice a day. It is also
worth remembering that dental care throughout pregnancy will
safeguard your fetus.
Hair and Skin
During pregnancy, the body goes through some complex hormonal
changes that can affect physical appearance. The skin may darken
and some women may have problems with ones complexion. Skin
and complexion changes usually clear up after delivery without
medications.
The hair may develop a shine and grow faster and thicker. Some
women find their hair becomes excessively oily. After delivery,
some hair losses are expected. This is due to changing hormonal
levels. Do not worry. New hair growth will occur within a few
months.
Clothes
The pregnant woman should choose clothing that is loose,
adjustable and practical. Bras should give your breasts firm support,
without constricting them or flattening the nipples. Do not wear
belts, garters or other elastic garments. Shoes should be low but
not completely flat and should provide support and comfort.
Travel
If possible, try to avoid long trips, especially during the early and
late months of pregnancy. In unavoidable circumstances, avoid
sitting in the same position for long period of time. Women are
advised to move around and stretch occasionally so that you are
more comfortable and prevent stiffness.
If you have to travel by car, sit tall and place your seat belt so
that the lap part is as low as possible on the hips. It is also a good
idea to have a carry cot harness fitted in the back seat so that it is
ready when the baby is born.
Some airlines have restrictions on touring pregnant women and
may require medical approval to travel. So it is advisable to let the
airline know about your pregnancy while booking tickets.
10
Diet in Pregnancy
Diet is important on three counts: the health of the mother herself,
her developing fetus and the alleviation of minor disorders of
pregnancy. Some women will not be conversant with the main food
in terms of protein, fat and carbohydrates, fibre, vitamins and
minerals but can readily understand food groups. Pregnant women
should be explained about regular intake of food which ensures
regular supply of nutrients to the unborn baby.
During pregnancy, a woman should look after herself and eat
regular, well-balanced meals. Make sure you have a portion of meat
or fish, eggs or high protein vegetables (beans or lentils) at lunch
time and dinner. There should be an intake of plenty of fresh fruit
to ensure a good intake of vitamins. Try to drink at least one pint of
milk everyday or alternatively have yogurt or cheese to meet the
calcium requirement.
Weight Control
The pregnant woman should expect to gain about 10-12 kg in weight
during pregnancy. Women should not make any deliberate
attempts to lose weight without first consulting a doctor.
Precautions
Wash thoroughly fruits and vegetables before use
Always wash your hands before and after handling meat,
covered containers in fridge and fruits and vegetables.
Avoid unpasturized milk and its products.
Wash your hand before and after taking meals.
Discomfort in Pregnancy
The amazing number of changes the body goes through during
pregnancy in order to accommodate and develop the baby, is hardly
surprising as women might, at certain times, feel tired or have a
slight discomfort. Some women, of course, feel and look absolutely
marvellous throughout pregnancy and positively glow with good
health but it is unusual to experience some of the following
discomforts.
Backache
Backache during pregnancy is due to changes in your posture and
the relaxation of your ligaments. When picking something up, bend
11
your back properly, i.e. bend knees and crouch down keeping your
back straight instead of bending forwards from waist.
Morning Sickness
In the second month of pregnancy or before, pregnant women may
experience some early morning nausea or vomiting. This usually
disappears by itself, but if persistent, consult your doctor. This can
be prevented by taking small amounts of feed frequently, drinking
plenty of fluids and avoiding heavy meals and fatty foods.
Swelling of Ankles
The added weight of your baby during the second half of pregnancy, increases pressure on veins of legs. To avoid this pressure
try to stay off your feet as much as possible. However, if ankles are
swollen, lie down with legs slightly raised. If your hands and face
get swollen, inform your doctor at once.
Heart Burn
Heart burn is common during later half of pregnancy. This is a
feeling of burning sensation in the stomach, often rising to the
throat. This can be avoided by eating little and often and less spicy
or fatty meals. If the heart burn becomes severe, consult your doctor
for help.
Constipation
Constipation can be avoided by eating a well-balanced diet with
plenty of high fiber diet such as whole grain cereals, whole meal
bread, fruit and vegetables. It is also important to drink plenty of
fluids.
Piles
Piles are varicose veins which occur in the back passage. They can
cause itching or soreness and may bleed. Avoid constipation as
advised above and if bleeding is intractable, consult doctor.
Leg Cramps
The cramp in the backs of thighs and calves may occur during the
last weeks of your pregnancy. They can be relieved by massaging
legs and bending feet upward to stretch the calf muscles.
Care of Body
During Pregnancy
C
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13
If you have problems with these joints or with your back, consult
your obstetric physiotherapist and your doctor.
Abdominal Muscle
Abdominal muscles are naturally stretched with growth of the baby.
Strong exercises such as sit-ups and double leg lifts will cause
more stretch and should be avoided.
To get up from lying down, always bend your knees, press them
together and roll onto your side before sitting up-reverse to lie
down.
Pelvic Floor Muscles
These are the main support muscles on the floor of the pelvis and
are very important during pregnancy, labor and postnatal months.
Pelvic floor muscle exercises should be practised from pregnancy,
so that it can be done subsequently during labor and after birth.
Close and draw up in the back passages as if you are trying to
keep bowel closed. Then close and draw up in the birth canal. Hold
this contraction for 4 seconds, then relax slowly. Try to make a
habit of doing this 4 times after each time you empty your bladder.
Stopping and starting when emptying the bladder can be used as
an occasional test of these muscles.
General Exercises
It is good for you to continue with most of your usual sports and
activities but some can damage joints which are loosened during
pregnancy, hence avoid taking up new strenuous exercises.
Squatting position is comfortable for some women and useful
during labor, start practising as follows:
Hold something strong, such as heavy furniture, stand with the
feet about half a metre apart and toes turned out, then bend your
knees keeping heels on the floor. Hold this position for a moment
or two and then stand up. Gradually lengthen the time 5-10 minutes
twice a day.
Minor Problems
Cramp
This is due to various biochemical changes during pregnancy and
changing pressure in the abdomen. Wearing very high heeled shoes
14
and sitting cross-legged can make cramp worse. Some women find
that it helps to exercise the feet before going to bed-rotate the feet
ten times in each direction. Try to stretch your legs straight and
pull your toes hard up just before you go to sleep. Another tip is to
raise the foot end of the bed on a couple of bricks.
Swollen Ankles and Varicose Veins
Women with swollen ankles and varicose veins are advised to rest
lying down with legs supported in a raised position, then exercise
your feet up and down and in circles. Avoid standing for long
periods and consider wearing tight leg support.
Numb Fingers
This may be a problem in the morning and is due to extra fluid in
the body, increasing pressure at the wrist. Wearing wrist supports
tightly at night will solve your problem.
If swollen ankles and/or fingers are accompanied by puffy face,
headaches or flashing light, consult your doctor immediately.
Rib Flare
This is due to the growing baby pushing the ribs out of their normal
position. Try to change position frequently and avoid sitting on
low chairs and other positions, which bring the ribs close to pelvis.
Sitting cross-legged (tailor fashion) with hands on head also gives
some relief.
Emotional Changes
The hormonal changes in pregnancy lead to emotional ups and
downs and sometimes forgetfulness. After the birth of the baby
these problems will get better.
Stress, Tension and Relaxation
Some women feel extremely tired, others develop aches and pains
which are not due to specific illness but are related to tension.
Stress and tension cause an increase in blood pressure, heart
rate and rate of breathing which can lead to feelings of panic as
well as overloading the systems of the body. Learning a relaxation
technique and using it regularly has been shown to reduce mildly
15
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17
Diabetes Mellitus
and Pregnancy
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The fetus obtains glucose from the mother via placenta by a process
of facilitated diffusion. From 10th week of pregnancy, there is a
progressive fall in the maternal fasting glucose level but in the third
trimester the mother begins to utilize fat stores which were laid
down during the first two trimesters resulting in rise of blood free
fatty acids and glycerol. The fetoplacental unit alters the mothers
carbohydrate metabolism in order to make glucose readily
available. The placenta manufactures human placental lactogen
(HPL) which produces a resistance to insulin in the maternal tissues.
This results in glucose intolerance which is also contributed by
increased level of estrogen, progesterone and cortisols in last month.
Moreover insulin is produced approximately two or three times of
normal. The extra demands on pancreatic beta cells can precipitate
glucose intolerance or overt diabetes in women whose capacity for
producing insulin was only just adequate prior to pregnancy. If a
mother was already diabetic before pregnancy, her insulin needs
may be increased.
Gestational Diabetes
Some women are at special risk of developing diabetes during
pregnancy and may be identified when history reveals one or more
of the following:
i. Diabetes in a first degree relative.
ii. Recurrent abortion
iii. Unexplained stillbirth
iv. Congenital abnormality
v. Baby weight more than 97th centile for gestational age
vi. Previous gestational diabetes or impaired glucose intolerance
vii. Persistent glycosuria
viii. Weight gain more than 20 percent of normal.
19
20
21
Postnatal Care
Mother
The carbohydrate metabolism returns to normal very quickly after
delivery of the placenta and insulin requirements will fall rapidly.
The woman can resume her pre-pregnancy regimen.
A diabetic mother who is breastfeeding may need to increase
her carbohydrate intake by 50 gm a day and may need insulin
adjustment. Although small amounts of insulin may enter breast
milk, these are destroyed in the babys stomach. Women are advised
to change their pads frequently in order to keep wound clean and
dry.
Baby
Birth asphyxia is common in both macrosomic and growth retarded
babies. Babies are usually prone to injuries. Hence babies should
be examined carefully for injuries and congenital malformations
by doctor.
After birth, the babies are prone to hypoglycemia because of
continuing increased secretion of insulin by -cells of pancreas. Thus
all babies should be fed as early as possible and observed for
hypoglycemia during first 48 hours of birth.
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23
24
Spontaneous abortion
Abruptio placentae
Stillbirths
Premature delivery
Anemia
Malnutrition
b. Fetus
25
Management
1. Antenatal urine toxicological analysis
2. Screening for syphilis and HIV
3. Counseling of pregnant mothers about
a. Screening of STDs
b. Monitoring of maternal and fetal well-being.
c. Drug counseling
d. Support and referral for rehabilitation
e. Emphasis on social service needs
4. Postpartum education and parenting skills
5. Need for frequent obstetric and neonatal care.
Alcoholism and Pregnancy
Alcoholism in women is common in affluent families and lower
socioeconomic groups. Women who are chronic alcoholics, may
also have a greater risk for abruptio placentae, spontaneous
abortion and stillbirths. The adverse effects of alcohol on fetus are
related to the gestational age at which exposure occurs, the amount
of consumption, binge drinking and individual susceptibility. There
is no documented safe level of alcohol ingestion, thus women are
advised to abstain from alcohol during pregnancy.
The exposure of fetus to alcohol can result in devastating effects,
i.e. fetal alcohol syndrome (FAS). The incidence of FAS is 0.5 to 3.0
per thousand live births and is considered as leading cause of
mental retardation. Women who consume greater than 2 ounces
of absolute alcohol per day, FAS occurs in about 30 to 40 percent of
the offspring.
Clinical Manifestations of Fetal Alcohol Syndrome
1.
2.
3.
4.
26
HIV/AIDS in Mother
and Children
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1. In utero (pregnancy)
2. Intrapartum (labor and delivery)
3. Postpartum (Breastfeeding)
5-6
13-18
12-14
28
30
C
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S/N
Effects on fetus
1. Antimetabolites
and cytotoxic drugs
33
Contd...
S/N
Maternal therapy
7. Anti-diabetic
Tolbutamide
Sulfonyl ureas
8. Corticosteroids
9. Diuretics
10. Sedatives
11. Anti-tuberculous
a. R-cin
INH
b. Ethambutol
c. Streptomycin
d Ethionamide
e. Pyrazinamide
12. Anticoagulants
a. Dicoumerol
b. Warfarin
Effects on fetus
Teratogenic
Hypoglycemia
Prematurity
Cleft palate
Perinatal mortality
Adrenal crisis
Insulin
Electrolyte disturbances
Thrombocytopenia
Liver damage
Congenital defects,
difficulty in initiating
breathing, carebral
depression, hypothermia,
inactivity, and poor feeding
Fetal hepatotoxicity
Bleeding diathesis
Ideal regimen
INH + R-cin +
Ethambutol
Minor congenital
malformations
(supernumerary nipples,
congenital dislocation
of hip, hydrocele,
strawberry marks
skin tag)
Deafness and vestibular
dysfunction
Abortion and congenital
malformation
Teratogenic
Fetal death
Severe bleeding
Hypoplasia of nasal bones,
Stripped calcification of
epiphysis
Prednisolone
Heparin
Contd...
34
Contd...
S/N
Maternal therapy
13. Analgesics
a. Salicylates
b. Morphine and
Pethidine
14. Anesthetic agent
a. General
anesthesia
b. Local
anesthesia:
for paracervical
block
c. Spinal
anesthesia
14a.Anti-emetics
Metoclopramide
Domperidone
15. Vitamins
a. Vitamin-K
b. Vitamin-D
c. Vitamin-B6
d. Vitamin-A
e. Vitamin-E
16. Thalidomide
Effects on fetus
Bleeding diathesis
Bilirubin encephalopathy
Methemoglobinemia
Platelet dysfunction
Respiratory depression
Paracetamol
Respiratory dipression
and difficulty in initiating
breathing
Accidental injection to fetus
may cause apnea, hypotonia,
bradycardia and intractable
seizures
Fetal hypoxia
Increasing risk of jaundice
(Bupivacaine)
Teratogenic
Nitrous oxide
Nalorphine
Spinal anesthesia is
recommended for
cesarean section
Pyridoxine
Hemolysis, hepatotoxicity
Vitamin B-complex
Severe neonatal jaundice
Infantile hypercalcemia
Supravalvular aortic stenosis
Inhibition of lactation
Renal malformation, neural
tube defects, hydrocephalus,
increasing risk of abortions
Teratogenic
Phocomelia, hemangioma,
microtia, duodenal and anal
atresia congenital cardiac
defects and mental
retardation
Chromosomal abberation
Leukemia
Use Minimum Drugs during Pregnancy
Breastfeeding
C
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10
36
Breastfeeding
6.
7.
8.
9.
10.
11.
12.
13.
14.
37
For Mother
1. Psychological satisfaction: Nursing the baby gives the mother
psychological satisfaction and a sense of fulfillment.
2. Breastfeeding is more convenient for the mothers. It saves her
hours of valuable time as there is no bottle to clean and sterilize,
38
3.
4.
5.
6.
7.
Breastfeeding
39
How to Breast-feed?
This is a new skill. So, the mother should learn from attending
midwife, nurse or doctor. The following hints will give some basic
ideas.
A. First find a comfortable position, either sitting upright, wellsupported or lying down.
B. Then turn your baby towards yourself with head and shoulders
opposite your breast and the nose opposite the nipple. Support
the baby with a hand across the shoulders, not behind the head.
C. Now brush your babys lips against your nipple to get her to
open her mouth really wide, then draw the baby to the breast
quickly. If the baby is correctly positioned, there will be more of
your areola (the brown skin around your nipple) showing above
the top lip than below the bottom lip.
Start each feed on alternate sides. Let your baby decide when he
or she has finished the first breast before switching to the second.
Sometimes babies only need one breast at a feed.
Many babies develop a pattern of feeding but you need not let the
baby wait for a feed, nor restrict the length of the feed.
A Good Start
No matter how mothers choose to feed their baby, spending some
time quietly holding them in skin-to-skin contact straight after the
birth is very important because it
i. helps to calm your baby
ii. keeps him/her warm
iii. steadies your babys breathing
iv. gives mothers time to bond with baby
v. helps get breastfeeding off to a good start.
If mother and baby are both well, mother should hold her baby
straight away. Ask midwife or nurse to dry the baby first. A blanket
over both mother and baby will help to keep baby warm.
If mothers have a cesarean delivery or have to be separated from
their babies for a while after delivery, skin contact should be made
as soon as possible.
Guidelines for Successful Breastfeeding
1. Education and motivation of the pregnant mothers about
40
breastfeeding.
2. Treatment of cracked or retracted nipple before delivery.
3. Practise exclusive breastfeeding. First feed should be mothers
milk only. Dont give any prelacteal feeds such as honey, ghee,
water, glucose, etc.
4. Explanation regarding correct position of the baby against the
breast.
5. On demand feeding schedule.
6. Nutritious diet to mothers.
Feeding Schedule
The feeding schedule should not be too rigid. The requirements of
the baby are minimal during the first few days of life, so the small
amount of milk secreted in the initial few days are sufficient for the
baby. Babies are sleepy in the initial few days, so require arousal by
gentle tickling. There should be semidemand schedule. Baby should
be fed on demand and when he does not demand for more than
three hours, he should be fed. At least 8-12 feeds per day should be
given and there should be at least two night feeds in early life.
A baby can digest a full feed of breast milk in about an hour and
half to two hours (half the time taken for a formula fed babies to
digest full feed). Breastfeeding on demand thus means frequent
feeding; but this will not deplete milk resources. Various studies
have shown that mothers who breast-feed their babies on demand
produce more milk than those who feed their babies at regular but
less frequent intervals.
Several studies have shown that babies, breast-fed on demand
get an average of nearly ten feeds a day, compared to an average of
just over seven feeds in babies fed every 3 to 4 hours. The more
frequent feeding did not mean a compromise in the overall amount
of milk being consumed by the baby. The babies fed on demand got
an average of 73ml per feed (725 ml per day). While those fed at fixed
intervals got only 68.8ml per feed (502 ml per day). As a result, after
two weeks the babies on demand feeding gained significantly more
weight than the others. Furthermore the longer gaps reduce mothers
milk supply. The fat and energy content rises during the course of a
feed and an average hind milk has twice the fat and energy of
fore milk. Therefore, complete emptying of the breast is essential.
Breastfeeding
41
42
Cyclophosphamide
Cyclosporine
Doxorubicin*
Methotrexate
Amphetamine**
Cocaine
Heroin
Marijuana
Phencyclidine
Potent hallucinogen
* The Committee on Drugs strongly believes that nursing mothers should not
ingest drugs of abuse, because they are hazardous to the nursing infant and to
the health of the mother.
** Drug is concentrated in human milk.
TABLE 10.3: Radioactive compounds that require
temporary cessation of breastfeeding*
Compound
Copper 64(64Cu)
Gallium 67(67Ga)
Indium 111( 111 In)
Iodine 123(123I)
Iodine 125(125I)
Iodine 131 (131I)
Contd...
Compound
Breastfeeding
Radioactive sodium
Technetium 99m (99 mTc), 99mTc
Macroaggregates, 99 mTc 04
43
None
None
None
None
None
None
None
None
None
None
Colic, irritability, feeding and sleep disorders, slow
weight gain
None
None
None
None
None
Contd...
Contd...
Antipsychotic
44
Chlorprothixene
Clozapine**
Haloperidol
Mesoridazine
Trifluoperazine
Others
Amiodarone
Chloramphenicol
Clofazimine
Lamotrigine
Metoclopramide**
Metronidazole
Tinidazole
Reported Effect
Acebutolol
5-Aminosalicylic acid
Atenolol
Bromocriptine
Aspirin (Salicylates)
Clemastine
Ergotamine
Lithium
Phenindione
Contd...
Contd...
Breastfeeding
45
Drug
Reported effect
Phenobarbital
Primidone
Sulfasalazine
(Salicylazosulfapyridine)
Acetaminophen
Acetazolamide
Acitretin
Acyclovir**
Alcohol (ethanol)
None
None
None
With large amounts, drowsiness, diaphoresis, deep
sleep, weakness, decrease in linear growth, abnormal weight gain; maternal ingestion of 1 g/kg
daily decreases milk ejection reflex
None
None
None
None
None
None
None
See Table 10.5
Suppresses lactation
None
Allopurinol
Amoxicillin
Antimony
Atropine
Azapropazone (apazone)
Aztreonam
B1 (Thiamin)
B6 (pyridoxine)
B 12
Baclofen
Barbiturate
Bendroflumethiazide
Bishydroxycoumarin
(dicumarol)
Bromide
Butorphanol
Caffeine
Captopril
Carbamazepine
Carbetocin
Carbimazole
Contd...
46
Drug
Cascara
Cefadroxil
Cefazolin
Cefotaxime
Cefoxitin
Cefrozil
Ceftazidime
Ceftriaxone
Chloral hydrate
Chloroform
Chloroquine
Chlorothiazide
Chlorthalidone
Cimetidine**
Ciprofloxacin
Cisapride
Cisplatin
Clindamycin
Clogestone
Codeine
Colchicine
Contraceptive pill with
estrogen/progesterone
None
None
None
None
None
None
None
Sleepiness
None
None
None
Excreted slowly
None
None
None
Not found in milk
None
None
None
Rare breast enlargement; decrease in milk production and protein content (not confirmed in several
studies)
None
None; follow up infants serum calcium level if
mother receives pharmacologic doses
Increased bowel activity
None; sulfonamide detected in infants urine
Crying, poor sleeping patterns, irritability
Cycloserine
D (Vitamin)
Danthron
Dapsone
Dexbrompheniramine
maleate
with d-isoephedrine
Diatrizoate
Digoxin
Diltiazem
Dipyrone
Disopyramide
Domperidone
Dyphylline**
Enalapril
Erythromycin
Estradiol
Ethambutol
None
None
None
None
None
None
None
None
Withdrawal, vaginal bleeding
None
Contd...
Contd...
Breastfeeding
Drug
47
None
Folic acid
None
Gadopentetic (Gadolinium) None
Gentamicin
None
Gold salts
None
Halothane
None
Hydralazine
None
Hydrochlorothiazide
Hydroxychloroquine**
None
Ibuprofen
None
Indomethacin
Seizure (1 case)
Iodides
May affect thyroid activity; see iodine
Iodine
Goiter
Iodine (povidone-iodine, e.g. Elevated iodine levels in breast milk, odor of iodine
in a Vaginal douche)
on infants skin.
Iohexol
None
Iopanoic acid
None
Isoniazid
None; acetyl (hepatotoxic) metabolite secreted but
no Hepatotoxicity reported in infants.
Interferon-
Ivermectin
None
K1 (vitamin)
None
Kanamycin
None
Ketoconazole
None
Ketorolac
Labetalol
None
Levonorgestrel
Levothyroxine
None
Lidocaine
None
Loperamide
Loratadine
None
Magnesium sulfate
None
Medroxyprogesterone
None
Contd...
Contd...
48
Drug
Mefenamic acid
Meperidine
Methadone
Methimazole (active
metabolite of carbimazole)
Methohexital
Methyldopa
Methyprylon
Metoprolol**
Metrizamide
Metrizoate
Mexiletine
Minoxidil
Morphine
None
None
None
None
Moxalactam
Nadolol**
Nalidixic acid
Naproxen
Nefopam
Nifedipine
Nitrofurantoin
Norethynodrel
Norsteroids
Noscapine
Ofloxacin
Oxprenolol
Phenylbutazone
Phenytoin
Piroxicam
Prednisolone
Prednisone
Procainamide
Progesterone
Propoxyphene
Propranolol
Propylthiouracil
Pseudoephedrine**
Pyrimethamine
Quinidine
Quinine
Riboflavin
None
None
Drowsiness
None
None
None
None
None
None; infant may have measurable blood
concentration
None
None
Hemolysis in infant with glucose-6-phosphate
Dehydrogenase (G-6-PD) deficiency
None
Contd...
Breastfeeding
49
Drug
Rifampin
Scopolamine
Secobarbital
Senna
Sotalol
Spironolactone
Streptomycin
Sulbactam
Sulfapyridine
None
None
None
None
None
None
Caution in infant with jaundice or G-6-PD
deficiency and ill, stressed, or premature infant;
appears in infants milk
Caution in infant with jaundice or G-6-PD
deficiency and ill, stressed, or premature infant;
appears in infants milk
None
None
None
None
None; negligible absorption by infant
Irritability
None
None mentioned; drug not used in United States
None
None
Possible jaundice
None
None
Sulfisoxazole
Sumatriptan
Suprofen
Terbutaline
Terfenadine
Tetracycline
Theophylline
Thiopental
Thiouracil
Ticarcillin
Timolol
Tolbutamide
Tolmetin
Trimethoprim/
sulfamethoxazole
Triprolidine
Valproic acid
Verapamil
Warfarin
Zolpidem
None
None
None
None
None
*Drugs listed have been reported in the literature as having the effects listed or
no effect. The word none means that no observable change was seen in the
nursing infant while the mother was ingesting the compound. Dashes indicate
no mention of clinical effect on the infant. It is emphasized that many of the
literature citations concern single case reports or small series of infants.
**Drug is concentrated in human milk.
TABLE 10.7: Food and Environmental Agents: Effects on Breastfeeding
50
Agent
Aflatoxin
Aspartame
None
Caution if mother or infant has phenylketonuia
Bromide (Photographic laboratory) Potential absorption and bormide transfer
into milk; see Table 10.6
Cadmium
None reported
Chlordane
None reported
Chocolate (theobromine)
Irritability or increased bowel activity if
excess amounts (< 16 oz/d) consumed by
mother
DDT, benzene hexachlorides,
None
Dieldrin, aldrin, hepatochlorepoxide
Fava beans
Hemolysis in patient with G-6-PD
deficiency
Fluorides
None
Hexachlorobenzene
Skin rash, diarrhea, vomiting, dark urine,
neurotoxicity, death
Hexachlorophene
None; possible contamination of milk from
nipple washing
Lead
Possible neurotoxicity
Mercury, methylmercury
May affect neurodevelopment
Methylmethacrylate
None
Monosodium glutamate
None
Polychlorinated biphenyls and
Lack of endurance, hypotonia, sullen,
expressionless
Polybrominated biphenyls
Facies
Silicone
Esophageal dysmotility
Tetrachloroethylene cleaning
Obstructive jaundice, dark urine
Fluid (perchloroethylene)
Vegetarian diet
Signs of B12 deficiency
Breastfeeding
51
3. Avoid taking strong tea or coffee. Instead, take about a litre and a
half of milk.
4. If it agrees with you, form a habit of taking thin butter milk that is
not too sour.
5. Early in the morning, drink a litre of water with added lemon
juice. Drink two glasses of water or milk before breastfeeding the
baby.
6. Form a habit of going to bed early.
7. Use lemons and oranges freely in your daily diet.
8. Massage the breasts lightly every day.
9. Maintain a positive and optimistic frame of mind and concentrate on the thought that your breasts are going to produce plenty
of milk.
Some Common Problems Associated with Feeding
1. Hiccups: Hiccups are very common and occur regularly after
meals in the early months. Keeping the baby erect on shoulder
for sometime will solve the problem.
2. Regurgitation : Regurgitation is the spilling of stomach contents
gently out of the babys mouth. It is due to ingestion of air along
with milk. Burping and tapping the baby gently on the back is
sufficient.
3. Vomiting: Vomiting is the expulsion of stomach contents with
force to propel them at least few inches away from the mouth. An
occasional vomiting is not of concern but recurrent vomiting
should alarm the parent to consult a doctor.
4. Stools: Initially baby passes stool after each breast-feed, thus 6-10
stools in first month of life is normal.
5. Dehydration fever: At around 3rd or 4th day of life baby may
develop fever and drowsiness but after additional and frequent
breastfeeding, fever comes down to normal and baby begins to
feed normally. Additional water may be given.
6. Underfeeding: Underfeeding results in failure to gain weight. It is
common in top fed/formula fed due to ignorance, over dilution
and economic constrains.
Breastfeeding the Best Investment
Breastfeeding has been the most natural response of a mother to
satisfy the emotional and nutritional needs for her infant. This natural
food has proved to be the complete and protective food for the baby.
That this can even save us money, is perhaps not thought of. It
52
Third
month
Fourth
month
Fifth
month
Sixth
month
76
26
20
660
38
26
20
840
38
26
20
1020
38
26
20
1200
38
26
20
1200
38
26
20
1200
924
1104
1284
1284
1284
Total
6662
*This cost does not include the time cost to purchase, prepare and administer
bottle feeds and cost of sickness that may occur.
Breastfeeding
53
54
Breastfeeding
55
56
mg/day. Fluorosis, with teeth mottling, may occur if the total intake
of fluoride exceeds 0.25 mg/day.
Protein and Energy
At 3 to 4 months of age, the intake of breast milk is about 750-850
ml/day (more in boys than in girls). At this stage, an average intake
of 150 ml/kg/day provides 1.5 gm/kg/day of protein and 85-105
kcal/kg/day, which are compatible with normal growth.
Breastfeeding is good for you and your baby. It will keep your
baby healthier.
Breastfeeding is recommended for the first year of life.
In the first month, the baby will need from 8 to 10 feeds per day.
Supplements are not usually needed during 1st 6 months.
Burp your baby often during feeding. More, if she is passing a lot
of gas.
Try different feeding positions to find the one that works best for
you and your baby.
Feeding and stools will be less often as your baby grows.
Breastfeeding
Promotion Network
of India
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Grass-roots
Professional bodies
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Contd...
Level of area
Government
NGO groups
1. Collaboration with other NGOs who are working and willing to work on breastfeeding and
complementary feeding.
2. Working with public service groups like Rotary
clubs on World Breastfeeding week celebration.
Consumer groups
Politicians and
policy makers
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Lack of confidence
Worry, stress
Dislike for breastfeeding
Rejection of baby
Tiredness
Babys Condition
i. Illness
ii. Physical abnormality
Breastfeeding factors and mothers psychological factors are
common and often go together. If the first breast-feed is delayed
past few days, it is more difficult to establish a good milk flow,
which may affect the amount of milk the mother produces later.
Infrequent feeding, no night feeding and short or interrupted
feedings lead to less prolactin production and hence reduced milk
supply. Scheduled feeding interferes with the supply and demand
of milk production. The use of bottles and pacifiers may lead to
nipple confusion and addition of any other fluids/foods before six
months, would lead to less suckling stimulus, which in turn, will
lead to less prolactin production and hence, reduced milk supply.
The lack of confidence in the mother about her ability to produce
enough milk sets about a cycle of poor confidence, less secretion of
oxytocin, apparent poor milk supply, worried mother, crying baby
and introduction of bottle/artificial feeding. Promotion of infant
formula and free samples can further undermine mothers
confidence in her milk supply. Stress and worries also lead to poor
oxytocin reflex.
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All mothers and babies are different. Try not to worry about what
others are doing. The following answers would help the mothers
to reassure themselves
Can All Women Breast-feed?
Almost every women can breast-feed, but it can sometimes take a
little while to get it right. Be patient and ask your midwife or health
visitor for help if you need it.
Does Breast Size Matter?
No. All sizes and shapes make milk.
Can Flat or Inverted Nipple be a Problem?
Not necessarily but you will need extra help in learning to position
your baby.
Do I Need to Prepare my Breasts for Breastfeeding?
The production of milk is a natural process. You dont need to do
anything but it is a good idea to try and keep your skin soft and
supple so avoid soaps and sprays that have a drying effect.
Do I Need to Watch What or How Much I Eat?
Eat and drink when you feel you need to. Sometimes you may find
you are hungrier and thirstier because breastfeeding uses up
calories and fluid.
Can I Go out Without the Baby?
Yes. You can always express some of your milk and leave it for
someone else to feed your baby. Ask about expressing milk and
storing it.
66
67
be produced through the second week of the infants life. Milk truly
starts flowing on day 3 onwards.
Breastfeeding should be initiated within first half an hour of
birth.
Baby Wants to Suckle Only one Breast and not the Other, What
should Mothers do?
Breast preference is known. The baby may not want to suckle one
of the breasts if it finds easier to suckle the other breast or does not
get milk from the first. This may happen if your nipple is sore or
the breast is engorged. Expressing some milk before starting
breastfeeding will help you. You should start breastfeeding from
the breast that the baby likes to suckle and wait for the milk from
the other breast to flow, then the baby will find suckling easier and
satisfying. You should not give up easily.
When I Feed the Baby, There is a Gush of Milk and My Baby
Chokes. What Should be Done to Solve this Problem?
Some mothers have a strong let down reflex so when the baby
suckles, there is a gush of milk, which is too much for the baby to
handle and thus he/she chokes. Express your milk a few second
first and offer the baby your breast.
Look What Breastfeeding Does for You !
Saves money
Reduces the risk of early breast cancer
Helps you lose weight
Less-offensive nappes
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Jaundice in Newborn
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Physiological Jaundice
This is seen in approximately 60 percent term and 75 percent of
preterm babies. The postulated causes are physiological immaturity
of liver, polycythemia and reduced life span of red blood cells. In
term babies, this appears between 32 to 72 hours of age, peaks on
4th or 5th day and usually disappears by 10 day and in preterm by
14 days. Physiological jaundice is a harmless condition. There
should not be any anxiety for parents.
Pathological Jaundice
Pathological jaundice refers to jaundice in newborns that appear
within 24 hours of delivery or persists for more than 14 days. Parents
are advised to contact their doctor immediately.
Breast Milk Jaundice
Breast milk jaundice may manifest as persistence of physiological
jaundice or it may appear for the first time at the end of first week.
The maximum intensity is usually seen between 10 to 14 days and
may last for 6-10 weeks. The etiology is multifactorial and includes,
dehydration during first few days due to inadequate lactation,
delayed colonization of gastrointestinal tract, high concentration
of unsaturated fatty acids in breast-milk and defective conjugation
due to presence of 3-alpha 20-beta pregnanediol.
Blood Group and Rh-incompatibility
Incompatibility of blood groups and Rh-type are the commonest
cause of jaundice during first 24 hours of birth and is the most
common cause of insult to developing brain leading to kernictenes.
In central nervous system bilirubin gets deposited especially in
Jaundice in Newborn
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cost effective way to prevent skin colonization and interrupt nosocomial transmission.
1. Chlorhexidine and a waterless, alcohol based product are agent
of choice for handwashing.
2. The routine use of plain soap for hand washing should be
avoided as it may result in dispersal of bacterial colonies and
increase the risk of transmission.
3. The baby should be handled only after proper hand washing.
Umbilical Cord Care
Hygienic umbilical cord care can reduce umbilical colonization,
infection, neonatal tetanus and sepsis in developing countries. The
recommendations for umbilical cord care are the following:
1. The diaper should remain folded and away from stump to
facilitate drying.
2. The application of emollients such as oils, gelly, etc. to stump
should be avoided.
3. The umbilical stump should be washed morning and evening
with antiseptics such as chlorhexidine, spirit and povidone
iodine.
4. There is no role of antimicrobial application on stump.
5. There should not be dusting of umbilical stump with commercial
talcum powders.
Bathing
Bathing the newborn has many potential hygienic, cultural,
aesthetic and interpersonal benefits. Bathing newborns after birth
is unnecessary and, if not performed properly, may cause more
harm than good. This may be accompanied by hypothermia and
increased crying with increase in oxygen consumption and
respiratory distress. Guidelines for bathing newborn infants include
the following:
1. The first bath should be delayed until after vital signs have been
stable for several hours.
2. Mothers and health care workers should have clean hands,
before and during bath to prevent exposure to pathogens.
3. Excessive vernix may be removed, but in general, is best left on
skin.
81
4. For first bath in term baby, use a dilute (1:20) aqueous solution
of chlorhexidine (0.25%), followed by thorough rinsing with
plain water. The preterm baby should be bathed with sterile,
lukewarm water for removal of maternal bodily fluids.
5. For routine bathing during first 2-4 weeks of life, plain warm
water should be used for premature infants whereas immersion
bathing up to three times per week in term infant may be more
soothing and have more positive effects on skin.
6. A mild neutral pH soap without additives should be used if
necessary in high soiled areas.
7. Rubbing or scrubbing during bathing may injure the epidermis
and should be avoided.
8. The skin should be rinsed well after bathing especially in preterm and after using antiseptics.
Emollition
The newborn skin is drier and has reduced water-holding capacity
compared to children and adults. The hydration of skin is important
for maintenance of its integrity and function as a barrier. The agents
that can be used as emollients are vegetable oils rich in essential
fatty acids such as sunflower-seed oil, mustard oil and safflower
oil. The benefits of emollient applications include:
1. Temperature maintenance of baby
2. Nutrition through transcutaneous absorption of lipids
3. Enhanced neurologic development and promotion of motherinfant bonding
4. Normalization of transcutaneous water losses and resolution
of dermatitis
5. Improved skin hydration and surface lipid content
6. Decreased invasive infections in preterm infants.
The use of barrierenhancing emollients in care of neonatal
skin is now recommended and practised routinely in many NICU
especially for preterm baby and in all infants with dry, flaking or
fissure skin. The application should be done in a gentle, uniform
manner because frictional forces during application may cause skin
injury.
Excess oiling without proper bathing is harmful because of
increased colonization of bacteria and enhanced susceptibility to
seborrhoeic dermatitis and cradle cap.
82
83
Contd...
5.
6.
7.
8.
9.
Agents
Gentian violet
Boric acid
Lindane
Glycerin
Methylene blue
Weaning
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Weaning
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Foods
Major nutrients
Functions
Milk
Meat
Pulses
Protein
Body building
Cereal
Starches
Fat/oil
Sugar
Carbohydrates and
Fat
Energy giving
Vegetables
Fruits
Protective
Weaning
87
Tips
Mothers should introduce one food at a time.
Let your baby go at his own pace do not compare him to his
little friend!
The child should not be fed forcibly. Dislike of any particular
food by baby should be removed from babys diet.
Variety should be introduced in the childs diet to make it more
appealing.
Color, flavor, texture and shape of the food can be given special
consideration, so as to attract childs attention in older children.
Parents should not show personal prejudices and dislikes
towards any food.
The baby will only eat when he is hungry, so if he shakes his
head, spits food out and so on, just stop. It is important that
meal times are seen as relaxed enjoyable times.
Communicate with child during meal times.
It is not always necessary to cook separately for the child, as
the family meals can be easily modified in consistency, spicing
etc. for the amount needed to feed the child.
Feed slowly and patiently and minimize distractions during
meals.
Encourage the child towards self eating.
Hygiene and Care
When a child starts complementary food, there is increase in the
risk of diarrhea. Care should be taken to prepare and handle food
hygienically. It is advisable to feed the child fresh food and keep
food away from flies, insects and pets. Cooked food should be used
within a few hours.
Foods to Avoid
Meat, eggs, dairy foods, cows milk, bread/cereals containing wheat
(gluten) should not be included in babys diet at 6 months of age.
How to Start ?
The following tips will help those early weaning sessions go more
smoothly.
1. Avoid starting weaning at awkward times such as holidays or
during hot weather when your baby may become fidgety.
88
2. Choose a time when you are not in a hurry and your baby is not
too hungry the middle of the day is often best.
3. Get every thing you need ready before you start and remember
to put a bib on your baby.
4. Put your baby on your lap or in his baby seat.
5. Give your baby most of his milk feed, then after a little solid
food on the end of a small plastic spoon. If he spits it out, scoop
it up and try again but do not force.
6. Once your baby is taking one to two tablespoons of food at
feeding time, offer him a second solid feed each day.
Solid Foods
4 to 5 months: Begin solid foods with rice cereal mixed with
formula.
5 to 6 months: Add strained vegetables one at a time.
6 to 7 months: Add strained fruits and juice
7 to 8 months: Add strained meats.
Serve solids from a spoon, never a bottle.
Offer one new food at a time. Wait at least 3 days before trying
another one.
As more solid foods are eaten, less breast-milk or formula is
needed.
Feeding Your Child (from 1 to 5 years)
Your child needs 3 meals a day, along with healthy snacks. A childs
serving size is about one tablespoon for each year of age. Each day
your child needs.
6 or more serving of bread, cereal, rice or pasta.
3 or more serving of vegetables
2 or more serving of fruits
3 to 4 serving of milk, yogurt, or cheese
2 to 3 serving of meat, poultry, fish, dry beans, and eggs
As a parent you should:
Provide a variety of health foods. Avoid foods that children
can choke on such as nuts, grapes, carrots, and round candies.
Serve meals and snacks at about the same time each day.
Keep meal times pleasant.
Teach good table manners.
Weaning
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Vaccine
Birth
6 weeks
10 weeks
14 weeks
9 months
BCG, OPV
DPT, OPV
DPT, OPV
DPT, OPV
Measles
Ages
Vaccines
Infants
At birth
6 weeks
10 weeks
14 weeks
9 months
BCG, OPV
DPT, OPV
DPT, OPV
DPT, OPV
Measles
Contd...
Immunization
Contd...
Beneficiaries
Ages
Vaccines
Children
15-18 months
Pregnant women
4 - 5 years
10 years
15 years
16-36 weeks
MMR
1st booster dose of DPT, OPV
DT
TT
TT
TT two doses 4 weeks apart
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Development: Physical
and Mental
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The average age, when most children are doing one thing or another
is discussed in this chapter. Each child is different; if your child is
not doing any activity at the age listed, there is no need to worry.
You should wait for sometime, keep a watch on the child and you
may find the activity appears after sometime as there is a wide
normal variation. But if your child is late in doing several activities,
you should consult your doctor. Children born early need extra
time to catch up. For example a 2 month-old baby who was born
one month early can be compared to a 1 month-old time baby.
Catching up goes on until about the age of 2 years.
Growth of Body and Mind
Tip: Love, hold and talk with your baby from birth through
childhood. Read stories and play soft music often.
1 Month
2 Months
3 Months
Holds head up.
Lifts head and chest when lying on tummy.
5 Months
6 Months
7 Months
Moves object from one hand to the other.
Pats and smiles at image in mirror.
Knows parents and care givers.
8 Months
Sits well alone.
Stands for a short time holding on for support.
Creeps (pulling body with arms and leg kicks).
9 Months
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10 Months
11 Months
12 Months
15 Months
18 Months
2 Years
Runs: jumps: throws ball.
Puts on clothes: washes hands with help.
Says 50 words: uses 2 to 3 word sentences.
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3 Years
4 Years
5 Years
Dental Health
A bottle should not be used as a pacifier or sleep aid.
Before the first tooth comes in, parents should clean the infants
gums twice a day with a clean cloth.
Parents should brush their childs teeth twice daily until school
age and then supervise brushing, use a small pea size amount
of fluoride tooth paste.
Follow your childs development, if any delay consult your Physician.
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You are the most important person in your childs life you are his
daily role model. Help him learn social and emotional skills.
Gain your childs trust by talking, listening and paying attention.
Meal time is a good time to talk to your children and find out
whats going on in their lives.
Limit TV viewing and watch TV with your child.
Be aware of what your child finds on the Internet.
Begin teaching no smoking early.
Teach him to get along with others. Help him learn to solve
problems by peaceful means and not fight.
Help your child with homework and visit with teachers often.
Tell your child that you love him, praise him often. His own
self-respect depends on you and others nurturing his self value.
You are your childs best role model set a good example.
Warning Signs for Suicide
1. Suicide threats or previous attempts.
2. Giving away prized possessions or making a will.
3. Personality or behavior changes:
Rejection of parents
Emotional state: guilt, anxiety, thoughts of being bad
Recent failure in school or brushes with the law
Loss of interest in usual activities.
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Your child needs daily physical activity through play and sports to
stay fit. Good exercise habits learned early can help your child; to
become an active and healthy adult, who are less likely to be
overweight or to have high blood pressure, heart disease and many
other diseases.
Physical Activity Tips
Have your child walk or ride a bike to school and/or to visit
friends when it is safe. When on a bike he must bear a bike
helmet.
Plan physical activities with family or friends.
Limit the time for watching TV/Internet to less than 2 hours
per day.
Should go to a playground, park, gym or swimming pool.
Get the child involved in sports and exercise programmes in
his school and cheer him on.
Parents should set a good example and must do regular physical
exercise.
Exercise should be fun.
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Vitamins
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Vitamin B1 (Thiamine)
Important for health of nerves and muscles, including heart. Helps
prevent fatigue and irritability.
Sources in diet: Pork, whole dried beans and peas, sunflower seeds,
nuts.
Symptoms of deficiency: Beriberi (nerve changes, sometimes edema,
heart failure).
Symptoms of overdose: None known.
Daily allowance: 1.5 mg.
Vitamin B2 (Riboflavin)
As an antioxidant, riboflavin protects cells from oxidative damage.
Supports good vision and is needed for healthy hair, skin, and nails.
Necessary for normal cell growth.
Sources in diet: Liver and other organ meats, poultry, brewers yeast,
fish, dried peas, beans, nuts, sunflower seeds, cheese, eggs, yogurt,
milk, whole grains, green leafy vegetables, nori seaweed.
Symptoms of deficiency: Skin lesions.
Symptoms of overdose: None known.
Daily allowance: 1.7 mg.
Vitamin B3 (Niacin, Nicotinic Acid, Nicotinamide)
Important for healthy skin and digestive tract tissue. Stimulates
circulation.
100
Source in diet: Liver and other organ meats, veal, pork, poultry, fish,
nuts, brewers yeast, dried beans, dried fruit, green leafy vegetables,
whole grains, milk, eggs.
Symptoms of deficiency: Pellagra (sensitivity to light; fatigue; loss of
appetite; skin eruptions; sore and red tongue).
Symptoms of overdose: Flushing of face, neck and hands; liver
damage.
Daily allowance: 19 mg.
Vitamin B5 (Pantothenic Acid)
Pantothenic acid is an active part of coenzyme A (CoA), important
in energy production and utilization. It supports adrenal glands to
increase production of hormones to counteract stress. Important
for healthy skin and nerves.
Source in diet: Nuts, beans, seeds, dark green leafy vegetable,
poultry, dried fruit, milk. Highest source: Royal jelly (from honeybees).
Symptoms of deficiency: Fatigue, sleep disturbance, nausea.
Symptoms of overdose: None known.
Daily allowance: 6 mg.
Vitamin B6 (Pyridoxine)
Helps body protein to build body tissue and in metabolism of fat.
Facilitates release of glycogen from liver and muscles. Helps in red
blood cell production, fluid-balance regulation.
Sources in diet: Sunflower seeds, beans, poultry, liver, eggs, nuts,
green leafy vegetables, banana, dried fruit.
Symptoms of deficiency: Nervous and muscular disorders.
Symptoms of overdose: Unstable gait, numb feet, poor hand
coordination, abnormal brain function.
Daily allowance: 2 mg.
Vitamins
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Vitamins
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Vitamin E (D-Alpha-Tocopherol)
Antioxidant to prevent cell membrane damage.
Sources in diet: Vegetable oils and their products, nuts, seeds, fish,
wheat germ, whole-grain products, green leafy vegetables.
Symptoms of deficiency: In human, diseases of the pancreas and liver
as well as various forms of chronic diarrhea, anemia.
Symptoms of overdose: Perhaps fatal in premature infants given
intravenous solution. There are no known symptoms of oral
overdose.
Daily allowance: 10 mg (alpha-tocopherol equivalents).
Vitamin K (Phylloquinone)
Necessary for normal blood clotting.
Sources in diet: Dark green leafy vegetable; cabbage, polar bear liver
(actually fatal amounts).
Symptoms of deficiency: Severe bleeding on injury; internal
hemorrhage.
Symptoms of overdose: Liver damage, anemia (from synthetic forms).
Daily allowance : 80 mcg.
Egg
It is fashionable to eat only egg whites nowadays because the yolk
contains some fat and the egg white does not. The yolk actually
contains as much protein as the egg white, as well as the majority
of the vitamins and minerals. If you feel the need to limit the fat in
your diet, you do so by eliminating other foods, not by throwing
away what is in many ways is the best part of the egg.
Caloric Value of
Common Foods
Food group
Milk and milk products
Buffalos milk : 1 cup
Buffalos milk skimmed : 1 cup
Cows milk : 1 cup
Cows milk skimmed : 1 cup
Milk condensed, sweetened : 1 tsf
Curdbuffalos milk : 1 cup
Cereal and cereal foods
Wheat chappati (15 gm flour)
Wheat parotha (60 gm flour and 2 tsf fat)
Rice milled, boiled 1 cup
Pulses
Bengal gram roasted100 gm
Chana dal, Urad dal, Mung dal, Masur dal,
Tur dal 1 cup cooked
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Calories
206
78
160
70
62
182
40
256
138
369
105
77
120
120
34
100
132
Contd...
105
Contd...
Food group
Fish
Mackerel 100 gm
Prom fret fried 100 gm
Prawns 100 gm
Salmon 100 gm steamed
Calories
136
205
104
199
45
36
Vegetables
Cauliflower cooked : cup
Potato boiled : 1 medium
Spinach cooked : cup
15
83
23
Fruits
Apple : 1 medium
Banana : 1
Grapes : 22-24
Guava : 1 medium
Mango : 1
Orange : 1 medium
Papaya : 1/3 medium
Peach fresh : 1 medium
Pear : 1
Pineapple : 1 slice
Pomegranate : 100 gm
66
132
72
51
122
68
50
32
84
44
90
Dried fruits
Currants : cup
Raisins seedless : 1 tsf
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Nuts
Almonds : 12-15
Cashew nuts : 6-8
Coconut, fresh : 1 piece
90
88
54
Contd...
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Contd...
Food group
Calories
46
86
Sugar, etc.
Glucose : 1 tsf
Honey : 1 tsf
Brown sugar : 1 tsf
Sugar granules : 1 tsf
45
64
56
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CALORY CONSUMPTION
Activity
Sleeping
Sitting
Walking (3.5 mph)
Calisthenics
Swimming (basic)
Cycling (10 mph)
Jogging (5 mph)
Skiing (moderate to steep)
Running (7.5 mph).
Nutrition in Pregnancy
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108
Pregnant
Lactating women
51 and over
+300
+500
1850
+20 gm
277
59
44
+30 gm
1200
1200
175
200
30-60
18+
450
450
1200
1200
Average daily intake 1875-5625 mg
Average daily intake 1875-5625 mg
800
150
10
300
800
5000
6000
4000
+0.4
+0.3
+0.6
4.0
150-300
500-900
0.8
100 mg
+2
+0.5
+0.5
+0.5
4.0
150-300
500-900
0.5
1000
+5
1.0
1.2
2.0
3.0
150-300
500-900
0.4
1000
13
5-10
60
200
12
70-140
0.05-0.2
2-3
1.5-4
2.5-5
0.15-0.5
0.05-0.2
20
0.05-0.2
2-3
1.5-4
2.5-5
0.15-0.5
0.05-0.2
15
0.05-0.2
2-3
1.5-4
2.5-5
0.15-0.5
0.05-0.2
25
Adapted from Gooharelt and Shils, Modern nutrition in Health and Disease,
(5th ed), p 263.
Nutrition in Pregnancy
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Number of servings
Nonpregnant Pregnant
Lactating
woman
woman
woman
1. Protein foods
Animal
Vegetable
2. Milk and milk products
3. Breads and cereals?
4. Fruits and vegetables
a. Vitamin C-rich fruits and vegetables
b. Dark green vegetables
c. Other fruits and vegetables
2
(1)
(1)
2
4
4
(1)
(1)
(2)
4
(2)
(2)
4
4
4
(1)
(1)
(2)
4
(2)
(2)
4-5
4
4
(1)
(1)
(2)
*The daily food guide meets the RDA for pregnancy for all nutrients except iron,
folacin and energy. Approximately 400 additional kcal are needed to meet energy
needs. Daily supplementation of 30-60 mg iron and 400-800 mcg folacin are
recommended during pregnancy. In addition to daily food guide, 2T (30 ml) of
fats and oils should be included each day.
One serving is 2 oz (60 gm)
Should include at least one serving of legumes.
? Whole-grain products should be emphasized to provide additional magnesium,
zinc, folacin and vitamin B6.
TABLE 26.3: Food allowances for pregnancy and lactation*
Pregnant
woman
Pregnant
Lactating
Teenage girl woman
3-4 cups
4-5 cups
4-5 cups
4 oz
3-4/week
4 oz
3 -4/week
4 oz
3-4/week
cup
1 medium
-1 cup
cup
1 medium
-1 cup
cup
1 medium
-1 cup
1 serving
1 serving
1 serving
4 slices
To meet
calorie needs
1 serving
1 serving
1 serving
4 slices
To meet
calorie
needs
1 serving
1 serving
1 serving
4 slices
To meet
calorie
needs
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Breakfast
Snack
Lunch
Snack
Evening Meal
Snack
Recipe No. 2
(Pregnant woman)
Breakfast
Mid morning
Lunch
Fresh salad
Chapati 4 medium (80 gm) preferably made of wheat mixed
with Bengal gram 4:1 or wheat mixed with soya flour 4:1 or
Rice (80 gm) 4 karchi (preferably steamed with pulses or green
vegetable)
Pulse/gram (60 gm) 2 katori or meat or fish or chicken (90 gm)
Curds 125 gm (1 bowl)
Green vegetables 250 gm (2 bowls)
Cooking oil 10 gm (2 tsf)
Evening tea
Dinner
Same as lunch
Bedtime
Fruit
Common Illnesses
During First Five Years
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Abscess
Abscess is a collection of pus, and its formation represents bodys
defence mechanism. By separating infected pus from surrounding
healthy tissue, the spread of infection is prevented. A child with an
abscess my feel unwell and feverish, but other symptoms depend
on where the infection is, sometimes an abscess points to an area
where it can burst. If this occurs internally it results in further spread
of the infection, but when it bursts on the surface of the skin the
pus escapes and the condition spontaneously improves. To speed
up the healing of an abscess, it may require an incision to allow the
pus to drain out. Few cases may require antibiotics.
Adenoids
The adenoids are organs for prevention of infection of the upper
airways and they are positioned on either side of the air passages
behind the nose and throat. Their main function is to prevent
infection of the upper airways and in most children they do this
effectively. However, they can become enlarged and this can have
two effects. Firstly, they may block the nose so that the child
constantly has to breathe through the mouth. Secondly, they may
obstruct the Eustachian tubes, which connect the nasal passages to
the middle ears. If this occurs, fluid from the middle ear each side
cannot drain into the throat and this results in poor hearing and
frequent ear infection. Such cases may require adenoidectomy to
improve hearing and breathing.
Allergic Rhinitis
Allergic reaction of the lining of the nasal passages which causes a
blocked or runny nose and, sometimes, watery eyes and sneezing
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Breath Holding
Like temper tantrum, breath holding spells are usually calls by
frustration. Attacks sometimes start towards the end of the first
year but they are more common in the second or third year. They
rarely occur in children over five. During an attack the child cries,
breathes in and fails to take another breath for some time. The
symptoms, which develop depend on the interval between breaths.
Initially the child goes blue and stiffens, and she may become
momentarily unconscious. Normal breathing usually starts again
spontaneouslythe child takes another breath and her color
gradually returns. If it does not, call a doctor at once. Breath holding
attacks are frightening for parents, particularly as there is little that
can be done once an attack has started. However, some parents
find that giving the child a shake or a light slap makes her take
another breath more quickly. Try to prevent an attack by avoiding
situations, which are likely to be frustrating for your child and
distract her when she looks as if she is about to start screaming,
although this is not always easy. It is also important for the child to
learn that these attacks do not mean that she gets what she wants,
or this will encourage her to behave in this way. Breath holding
attacks gradually disappear with growing age.
Bronchiolitis
Viral infection of the small breathing tubes of the lungs is called
bronchiolitis. It usually occurs in children under two and is most
common in the first year of life. At the beginning of the illness the
child may have symptoms of a cold (a runny nose and sneezing),
but as the infection moves down to the lungs she develops other
symptoms such as coughing, wheezing and rapid breathing. She
may also have difficulty getting her breath (particularly when
feeding) and her lips may turn blue when she coughs. Unfortunately, there is no treatment for bronchiolitis, although sometimes
antibiotics can prevent secondary infection. Bronchiolitis gets better
by itself in a week or so. Babies with bronchiolitis can develop
feeding problems and quite severe breathing difficulties. If you
notice these symptoms it is essential to consult the doctor; he may
suggest that the baby goes into hospital for observation and
treatment.
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Bronchitis
Infection of the large breathing tubes of the lung is called bronchitis.
The child with bronchitis has a cough and fever. She may also be
breathing faster than usual and wheezing. If your child shows these
symptoms, consult the doctor at once. Antibiotics are sometimes
used to prevent the development of secondary bacterial infection
in bronchitis. Some children find cough mixtures soothing and
occasionally an anti-wheeze drug from the doctor may help. A child
with bronchitis may lose her appetite, but it is important to see
that she has plenty to drink. There is no permanent damage to the
lungs and the condition gets better over a few days.
Bruises
Leaking of blood under the skin produces bruises. They are usually
caused by a knock or fall and will gradually disappear without
treatment. Problems of clotting mechanism may result in excessive
bruising and requires doctors opinion.
Chickenpox
Chickenpox is a viral infection characterized by little blisters, which
appear in crops on the body first, then the face and scalp and finally
the limbs. The spots are itchy and easily broken, forming crusts or
scabs. When the rash begins, the child often has a fever, which
may last for three to four days. Paracetamol elixir is helpful to
reduce the temperature. There is no specific treatment; just keep
the child as comfortable as possible and try to stop him from
scratching the spots because this can lead to secondary infection
and scarring. The itching can be reduced by dabbing the rash with
calamine lotion. Baring a few most of the scars disappear with time.
Phimosis and Circumcision
Surgical removal of front part of the foreskin of the penis is called
circumcision. It is usually performed for religious and social
reasons, rather than medical ones. In a baby the foreskin is fused to
the tip of the penis and cannot be pulled back. As the penis grows
during infancy, the foreskin gradually separates from the glans so
that it can be drawn back in many boys by early childhood. If the
child has a very tight foreskin or suffers repeated infections
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thrive, develop diarrhoea and may suffer from anaemia and vitamin
and mineral deficiencies. The condition only develops after the child
has been exposed to foods containing gluten. If a child with celiac
disease avoids all foods, which contain gluten, the symptoms
disappear and the damaged bowel returns to normal, but the special
gluten free diet must be followed throughout life. Gluten sensitivity
can also be associated with many other disorders, including blisters,
mouth ulcers, pitted and discolored tooth enamel, diabetes,
convulsions, fatigue, depression and, in adults, fertility problems.
Raised levels of gluten antibodies are more common in people with
insulin dependent diabetes, thyroid gland inflammation, and
Downs syndrome. Some children suffer from one or more gluten
sensitivity disorders but have no signs of bowel damage.
Confirmatory diagnosis requires positive endomysial antibody test
followed by a biopsy of the small intestine.
Cold
Viral infection of the nose and throat can produce runny or blocked
nose, cough, sore throat and fever. Young children with colds often
go off their food for a few days. Antibiotics dont help, but vitamin
C may speed recovery. Paracetamol elixir can reduce a high
temperature and ease a sore throat. In young babies a blocked nose
can make feeding difficult, which may require nose drops.
Cold Sore
Blisters on and around the mouth is the typical presentation of cold
sore. The blister, which may be painful, bursts, crusts over and
heals without treatment within ten days and without a scar. Stress
like cold or chest infection, exposure to strong sunlight can result
in recurrence of cold sore since, it is caused by herpes simplex virus.
Colic
Tummy ache occurring in spasms is known as colic. Infantile colic
makes a baby draw up his knees and cry. It may occur a number of
times a day, but in between the baby appears well. This type of
colic, which occurs in both bottle and breast-fed babies, can be quite
trouble some for the first three months of life or longer, especially
in the evening. It may help to give the baby plenty of time at the
breast and in your arms when he finishes feeding. The habit of
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the face, body and nappy area. This is a form of eczema known as
seborrhoeic dermatitis. The scales on the scalp can be removed by
daily shampooing and gentle combing after they have been
moistened overnight with an oily preparation such as olive oil.
Patches on the face or body usually clear up on their own.
Croup
Barking cough and noisy breathing with or without fever is called
croup. Croup is usually caused by an infection in the voice box.
Other causes include an inhaled foreign body, allergy and even
excitement or upset. More usual in winter, it is most common in
toddlers. The symptoms can develop quite suddenly and can be
frightening. Moistened air may help the condition and this can be
provided in the home by taking the child into a steamy bathroom
or by boiling a kettle in the room. However, medical advice must
be seeked.
Cyanosis
Blue appearance of the lips, fingers and toes is known as cyanosis.
The blueness is caused by reduced amounts of oxygen in the blood
and tissues and occurs with some diseases of the heart and lungs.
If cyanosis develops, call your doctor urgently or take the child
straight to a hospital. Sometimes a childs hands and feet go blue
when they get too cold, but this is not serious and normal color
returns with warming. Breath holding spells may also produce
cyanosis but another breath restores normal color.
Cystic Fibrosis
Cystic fibrosis is an inherited disease and causes repeated lung
infections and difficulties with absorbing nutrients from food.
Although both the parents of a child with cystic fibrosis are
physically healthy, they each carry the abnormal cystic fibrosis gene
and have a one in four chance of producing an affected child in
each pregnancy. Researchers can now identify people who carry
the cystic fibrosis gene and they can also use chorionic villus
sampling to identify affected babies. The condition is usually
diagnosed when a child fails to thrive or has recurrent chest
infections. Helping measures include diet attention, physiotherapy
and regular medical treatment.
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Dandruff
Excessive scaling of dead skin, usually on the scalp or on the
eyebrows is called dandruff. Dandruff appears as small whitish
scales of skin, which come loose when the hair is brushed or
combed. The scaling is sometimes accompanied by itching, which
may be intense at times. In severe cases, the skin and hair become
excessively greasy, patches of scalp redden, and a fluid oozes from
tiny openings that appear, forming hard, yellow crusts. The skin
on the face, especially on the forehead, cheeks and eyebrows,
becomes reddened, and scaling occurs in the skin of the ears and
on the front of the chest, over the breast and collar bone. Occasionally, dandruff may be associated with other skin conditions,
such as eczema and impetigo, or an infection of the outer ear canal.
Contrary to popular belief, dandruff is not an infection. It is part of
a condition that doctors call a seborrhoeic tendencyan over
production of sebum, the oil secreted by glands in the skin.
However, recently it has become clear that some cases of dandruff
are linked with a micro-organism called pityrosporum. An
antifungal shampoo called ketoconazole is available on prescription
from your doctor. The shampoo kills the pityrosporum and can
often make a significant improvement to the dandruff. There is no
cure for dandruff, which may disappear for good at any age, or
disappear for a while and then return for no apparent reason.
However, regular washing with baby shampoo may treat the
condition. Avoid excessive shampooing or massaging of your
childs scalp as this may over stimulate the skin and make the
condition worse. Some medicated and antidandruff shampoos are
suitable for young children and may be used occasionally.
However, others are not and could make the dandruff worse. Only
severe cases of dandruff require medical treatment. Consult a doctor
if your child has severe flaking, itching and cracking of the scalp,
or if there is also hair loss.
Dental Decay
A sticky layer called plaque coates the teeth after eating. Bacteria
break down sugar in plaque and produces acid which eats into
enamel and encourages decay. Some children are less prone to
decay, perhaps because they form less plaque, have different
bacteria, more resistant enamel, a better diet or take in more
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fluoride. Once decay reaches the tooths nerve, the child has
toothache. Help to prevent dental decay by reducing the amount
of added sugar in your childs diet and by brushing the teeth with
fluoride toothpaste. Never let your baby go to sleep while drinking
a bottle of milk or juice because the resulting pool of liquid round
a sleeping babys front teeth does not get washed away by saliva
as it does when she is awake.
Diabetes
Insulin controls the sugar level in the blood and tissues and its
deficiency because of insufficient production by the pancreas results
in childhood diabetes. This results in a high blood sugar level, which
makes the child feel thirsty, drink excessively and pass a lot of urine.
The child may also lose weight and feel unwell. Treatment with
insulin injections daily enables to blood sugar level to return to
normal, while a special diet and regular monitoring of the amount
of sugar in the urine or blood can help to control the condition.
Diarrhea
Frequent passing of loose watery motions is called diarrhoea. In
childhood it usually occurs with gastroenteritis, an infection of the
bowel. Dehydration will happen if the child is losing more fluid in
the diarrhoea than the intake. You should therefore give plenty of
fluids, especially to young babies, who become dehydrated very
easily. Its best to give small amounts of fluid frequently. If you are
breastfeeding, continue but give more feeds than usual and drink
plenty yourself. A bottle fed baby can have extra fluids as boiled
water. Suggestions for older children, including babies on a mixed
diet, include water, weak tea, or thin vegetable soup. Oral rehydration salts may be recommended. Alternatively, prepare a homemade oral rehydration mixture by adding one level teaspoons of
sugar in a glass of water. Both shop-bought and home-made oral
rehydration mixtures provide energy in the form of sugar, as well
as replacing minerals lost in the diarrhoea, and correcting the acidity
balance in the childs body. Less acute forms of diarrhea may result
from sensitivity to certain foods, respiratory infection, anxiety and
other problems of the bowel. In such cases the child does not usually
become ill suddenly, but may fail to gain weight in the normal
way. Contact your doctor without delay if your child cant keep
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fluids down; has diarrhoea severely for twelve hours, or mildly for
twenty-four hours; or has repeated vomiting, or blood in the faces.
Easily digested foods for a child recovering include stewed apples,
ripe bananas and brown rice. Restoration of normal population of
helpful bowel bacteria can be achieved by giving live yogurt or
commercially available preparations.
Diphtheria
Diphtheria is a serious and highly infectious bacterial disease, which
causes inflammation of the nose and throat. This inflammation may
become so severe that it interferes with the childs breathing. Every
child should be protected against diphtheria by immunization,
which is part of the triple vaccine (tetanus, whooping cough and
diphtheria) given in the first few months of life.
Dyslexia
Difficulty in reading or learning to read is known as dyslexia, which
may be accompanied by spelling and writing problems. Affected
children do not show back wardness in other school subjects and
many of them are of average or above average intelligence dyslexic
children usually benefit from extra specialized help with reading
and spelling. Use of precisely tinted lenses has been shown to be
very helpful in recent research.
Earache
Inflammation of the external ear canal is called otitis externa. It is
caused by a bacterial, viral or fungal infection. The inflammation
causes pain or itchiness in the ear canal and sometimes a discharge.
Appropriate anti-infective agents may be required for the treatment.
It is important that the ear canal is kept dry until the infection clears,
so take care when washing the childs hair and do not allow him to
swim. Inflammation of the middle ear is called otitis media. The
illness can be caused by a bacterial infection and may be accompanied by a cold or tonsillitis. The child is usually unwell and
feverish and may complain of earache or headache; he may also be
slightly deaf. As the inflammation progresses the middle ear fills
with fluid and this causes the pain and deafness to worsen.
Sometimes the only indication of infection in a young child is that
he repeatedly pulls or rubs his ear. If your child has any of these
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Fifth Disease
(Slapped Cheek Disease or Erythema Infectiosum)
It is a viral disease characterized by fever and rash that may last
for ten days. Its incubation period is about sixteen days. The cheeks
look as if they have been slapped, and there may also be a blotchy
rash on the forearms, lower legs and slightly on the trunk. The
rash may itch and it feels worse when the skin is hot. Other
symptoms can include a cold, sore throat, headache and diarrhoea.
Calamine lotion and paracetamol can be helpful but no specific
treatment exists.
Flat Feet
In comparison to adult, infants and young children have fatter,
wider and flatter feet. In young children fatty pads create a fullness
on the undersurface of the foot so that the arch is not visible. This is
quite normal. As the child grows older this fatty pad will disappear
and the arch is revealed. Childs feet hurting during exercise
requires doctors opinion.
Food Sensitivity
A wide variety of symptoms, including flushing, tummy ache,
diarrhoea, vomiting, wind, joint pain, rash, headache, fatigue,
weakness, palpitations, cough, runny nose, convulsions, depression,
nerve disorder, blister, mouth ulcers and pitted and discolored teeth
can be produced by food sensitivity. Factors encouraging it include
a family history of any allergy, bottle feeding, a missing digestive
enzyme, gastroenteritis, repeated antibiotics, and a poor diet. There
are four main types. The first is a non-allergic immune reaction,
which often result from a common food such as wheat, milk and
yeast, and many other foods can act as triggers. This may alter the
level of an antibody called IgG and perhaps IgE too, but it isnt
actually allergic. Non-allergic immune reactions begin within
seventy two hours of eating the foods. The symptoms tend to be
vague. One explanation for this reaction is the leaky gut
phenomenon, in which some sort of damage to the intestinal lining
allows poorly digested food particles to pass into the bloodstream
and trigger an immune reaction. The second type of food sensitivity
involves a reaction to a toxin (for example, from food poisoning
bacteria), an additive (such as tartrazine, the flavor-enhancer
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Glue Ear
Sound waves may be prevented from reaching the inner ear if the
middle ear is filled with glue like fluid in condition known as glue
ear. There is no pain or fever, but the childs hearing is impaired.
Glue ear affects one or both ears and usually follows an infection
of the middle ear (otitis media) in association with a blocked
Eustachian tube. This blockage is often caused by enlarged
adenoids. Treatment includes antibiotics and nasal decongestants,
but if these fail an operation may be necessary. The adenoids are
removed and the glue is sucked out through a slit made in the
eardrum. A tiny plastic tube called a grommet is inserted into the
slit to allow air to pass into the middle ear and the fluid to drain
out. In a few months eardrum heals and the grommet falls out on
its own. Precaution should be taken to keep the ear dry till the
grommet remains in place.
Growing Pains
Pain in the legs or arms is a common childhood complains. In spite
of being otherwise well the pain may make the child sleepless. The
cause is unknown but may relate to swelling of the muscles after
strenuous exercise. Whatever the cause, growing pains are not
serious and disappear in time. Massaging the limbs and putting a
warm hot water bottle on or near them may ease the pain. Consult
your doctor if pain is persistent or is associated with problems.
Hare or Cleft Lip
It is a congenital abnormality in which normal continuity of the lip
is breached. It can vary from a small notch in the upper lip to a
complete cleft that extends into the nostril. Treatment is surgical
correction around 10-12 weeks age.
Headache
Headache during childhood can be due to variety of reasons like
pain the tooth, ear or fever. Treatment for the complaint itself
normally relieves the headache. Recurrent headaches, when the
child is well in between, may have an emotional basis or may be
migraine, and you should consult your doctor. A headache in
conjunction with a temperature, vomiting, drowsiness and
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down but the child should be made to drink plenty of water. There
is no specific treatment but paracetamol can be used to bring down
the temperature. Secondary infections require antibiotics. However,
the most effective measure against measles is vaccination at the
age of 9 months.
Meningitis
Inflammation of the covering of the brain and spinal cord due to
vial or bacterial infection is known as meningitis. Symptoms include
fever, headache, vomiting, aversion from light, drowsiness, painful
neck stiffness, excessive thirst, rash, cold hand and feet, convulsions,
irritability and lack of interest in the surroundings. The soft spot
(fontanelle) on his head may be fuller than usual, and he may have
a convulsion. One characteristic of bacterial meningitis is that its
rash does not fade on applying pressure. A child with these
symptoms should see a doctor urgently. If there is any suspicion of
meningitis, admit the child to hospital for examination of CSF (brain
fluid) and administration of antibiotics if the cause is bacterial.
Sometimes severe spread of bacteria and its toxin (septicaemia)
occurs before producing symptoms of meningitis. Its treatment is
on the same line as for meningitis.
Mouth Infections
Not infrequently, yeast infection produces white patches on the
tongue and the inside of the cheeks in babies, better known as oral
thrush. It can also occur on the babys bottom and cause nappy
rash. Thrush is not serious but it can cause discomfort when sucking
or feeding. The infection may have been passed on by the mother
at the time of birth, or have come from thrush on her nipples if she
is breastfeeding, or can develop after taking a course of antibiotics.
It can also arise if bottles have not been sterilized properly.
Antifungal drops can clear the mouth infection. Children
occasionally develop mouth ulcers, which usually appear on the
gums or the insides of the cheeks. They are caused by a viral
infection and should disappear within a few days. Less commonly,
herpes simplex viruses, which also cause cold sores, may be
responsible for a severe mouth ulcer. The child becomes unwell
and feverish, with small blisters on the tongue, gums, palate and
insides of the cheeks, which burst to leave painful ulcers. Eating is
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pressure for at least five minutes to allow a clot to form. The child
should sit up and lean forwards so that no blood drips down the
throat. Try to stop the child touching or blowing her nose as this
can lead to more bleeding. Frequent nosebleeds require doctors
advice.
Obesity
Weight put on during early months of life is normal since, it is lost
during activity filled later years. Remember also that most toddlers
have little pot belies and this does not mean that they are
overweight. However, fat or obese children are more likely than
those who are average weight to become fat adults-a condition,
which increases the risks of heart disease, high blood pressure and
diabetes. You should avoid giving children too many stodgy, highcalorie foods such as ice cream, sweets, cakes, crisps and fizzy
drinks. Medical advice should be taken if obesity assumes
problematic proportion.
Phobias
Fear without a rational basis is known as phobia. The fear may be
intense and could be for anything, e.g. fear of ghost or animals in
the room. Phobias may represent hidden anxiety of a child
concerned about family or other problems. But, usually children
grow out of it with age. Usually sympathy and reassurance is all
that is required but persistent cases may require specialists advice.
Pica
Habit of eating inedible things is known as pica, and requires
doctors opinion. But, this should not be confused with the normal
act or normal infants and toddlers putting all kind of things into
their mouth out of natural inquisitiveness.
Pigeon Toes
Many children have their feet positioned in such a way that they
are turned inwards, which may force the child to trip over their
feet during running. No treatment is required as most cases get
corrected spontaneously by the age of seven years. However,
refractory cases may require orthopedicians advice.
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Prickly Heat
In hot and humid conditions, blockage of the sweat glands in the
skin may result in an itchy rash or very small blisters of sweat. This
condition is known as prickly heat. It can be prevented by using
cotton cloths and keeping the child cool. Since, the condition
improves on its own in a few days, so most cases dont require
may treatment.
Pyloric Stenosis
Repeated vomiting with each attempt of feeding along with a state
of constipation represents a condition known as pyloric stenosis.
The condition may occur any time between birth to upto 4 months
and results due to narrowing of the outlet of the stomach. The exact
reason behind the narrowing is not known but this outlet
obstruction prevents milk and food leaving the stomach normally.
As the quantity of milk filling the stomach increases, the baby
automatically vomits, which may be projectile. The result of
repeated vomiting is that the baby receives insufficient nourishment
from her food and loses weight. Despite this, she usually feeds well.
Treatment is either surgical or non-surgical with atropine sulphate.
Both options are very effective.
Rickets
Deficiency of vitamin D produces rickets. Most common cause of
rickets is the lack of exposure to sunlight. Sunlight enables the skin
to make vitamin D, which is also obtained from fatty foods such as
milk, fish, liver and cod liver oil, and what helps to control the
amount of calcium in the body. Calcium helps build strong bones
and teeth and, as a result of calcium deficiency, children with rickets
have soft bones which may become deformed, there may be some
swelling at the wrists and ankles. Prevention requires exposure to
sunlight and treatment requires vitamin D supplementation.
Ringworm
Fungal infection of the skin result in very itchy red scaly circles
known as ringworm. The scalp, body, groin, nails and feet may all
be affected. When it affects the feet it is known as athletes foot.
Ringworm on the body is sometimes contracted from an infected
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for a sore throat. Tonsillitis usually gets better after three to four
days.
Toothache
Toothache can be caused by decay of a tooth (caries), inflammation
of the root of a tooth (a tooth abscess) or a gum infection. Sometimes
pain caused by inflammation of the ear or jaw bone can feel like
toothache. A child with toothache should be seen by a dentist first,
but if the dentist can find nothing wrong with the childs teeth,
consult your doctor.
Travel Sickness
The tendency to feel ill or vomiting during traveling is known as
travel sickness. It is the movement, which causes the sickness, so it
can occur in a plane, boat, car or even on a merry-go-round. If your
child readily vomits in such situations, encourage her to sit still
during journeys, preferably by an open window and looking in
the direction in which she is traveling. Antihistamines may be
helpful in preventing travel sickness, but they should be taken at
least half an hour before the start of the journey. One useful tip for
preventing travel sickness is to give your child ginger tea made by
boiling 50 gm of freshly cut ginger in 600 ml of water for 10 minutes
and sweetening it as per taste.
Tuberculosis
Infection with bacteria called mycobacterium tuberculosis results
in this disease. It can affect other parts of the body, such as the
lungs, brain, neck lymph nodes (glands), bones and kidneys.
Treatment for the disease is with antituberculosis drugs continued
for some months. It is acquired either through close contact with
some one who has TB of the lung or by drinking milk from infected
cattle. Immunization with BCG vaccine can be used to protect from
this disease.
Tummyache
There are many reasons for tummyache. Children can have
tummyache with something as simple as a sore throat or cold. This
is because the lymph nodes (gland) in the abdomen become
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Urticaria
Sometimes itchy wheals and blotches on the skin can be produced
by an allergic condition known as urticaria or hives. The allergic
factor can be any thing like drugs, pollens, certain foods, infection
and even cold whether and water. The rash usually clears up after
a few days, but calamine lotion may be soothing and antihistamines
can reduce itchiness.
Vaginal Infection
Due to the effect of the mothers hormones, thick white or blood
stained vaginal discharge may occur in newborn girls. This is
normal and usually disappears in first few weeks. In young girls
the skin of the vulva and vagina is very delicate so that irritation or
infection can easily cause inflammation and discharge. Tight
trousers and rough textured tights should be avoided as they rub
against the skin. Some types of bubble bath also cause irritation,
occasionally the bottom scratching associated with threadworms
can damage the vulval skin and cause a slight infection. If a child
has a sore vulva, with or without a discharge, it may be helpful to
use milk soap for washing, avoid bubble bath and see that she wears
cotton pants. Hormone cream may be used to increase skins
resistance to irritation. Discharge due to bacterial infection requires
antibiotics.
Vomiting
Expulsion of stomach contents is known as vomiting, however, it
should not be confused with regurgitation of small amount of milk
after feeds in babies, which is normal. Vomiting can result from
any reason like bowel obstruction or infection. Medical advice is
warranted if vomiting is persistent or associated with features of
serious illness like diarrhoea or feeling difficulties, headache, and
pain abdomen. Treatment is that of the under lying cause.
Warts
Warts are bad looking small growths on skin, which may be
uncomfortable but are usually not serious. They are caused by virus
and their usual site of occurrence include fingers, hands, elbows
and face. They usually disappear spontaneously but helpful
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Excessive Crying
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Excessive Crying
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the tantrums have passed. Age related in ability can make the baby
cry because she can do things she wants too. The parents can help
the baby by distracting or by providing a helping hand without
taking over the babys job.
Around the age of one year the child remains so very much
excited with new experiences that he hardly relaxes inspite of being
totally exhausted. This may lead to tiredness and crying. The child
can be helped by making him relax and sleep by providing calm,
quite and soothing surrounding at the bed time.
Teething can also result in crying and irritability. The baby can
be helped by rubbing the gums with the little finger or by giving
the child something to chew like carrot specially if it has been
chilled. Giving teething medicines should be avoided.
First AID
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Often first aid is the most important treatment that one can provide
in case of an eventuality. Every home should have a first aid box
kept unlocked and at a place inaccessible to children and easily
accessible to adults.
Contents of a First AID Box
Animal Bites
Serious bites warrant medical advice, however, superficial bites
may need only wound cleaning and sterile dressing application.
But, tetanus booster is a must irrespective of the seriousness of the
wound.
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Blisters
Burn or friction are the usual cause of blisters. Never prick a blister
as it forms a protective layer between the skin and damaged area,
which protects against infection. Cover the blister with a nonadherent dressing kept in place with sticking plaster. Burst blisters
should be kept clean and dry to prevent infection.
Convulsions
A convulsing child should never be left alone. In case he vomits
and chokes, put him in the recovery position and loosen his clothing.
Dont try to restrain him. Arrange to have medical advice as soon
as possible.
Crushed Fingers
Put the hand under cold water or apply cold compresses to reduce
swelling and pain. After the child has been comforted to an extent,
cover his hand loosely with a piece of clean cloth to avoid further
knocks. Doctors advice may be taken if the condition remains
painful for prolonged period.
Cuts and Grazes
First aid of miner cuts and grazes warrants cleaning the wound
with warm water and wiping from the middle outwards. Use each
swab once only to help prevent cross infection. Pat the skin round
the cut or graze, dry and cover with a dressing or sticking plaster.
For heavy bleeding following steps should be taken:
Keep the child still and firmly press the would with clean hand
or a piece of clean cloth and at the same time raise the injured
area till bleeding stops.
If there is a bone protruding, or a piece of glass or sharp object
in the wound, press around the edges of the wound, not directly
on to it. Dont remove anything from a wound as it may be
acting as a plug to stop the bleeding.
Cover the wound with a bandage to prevent infection.
Consult a doctor as soon as possible as the wound may need
stitches or the child might be going into shock.
First AID
153
Eye Injuries
Do not allow your child to rub the eye. Washing the eye with clean
water can remove small objects such as grit or dirt. Foreign body
in the eye should be removed gently with the tip of a clean cloth. If
the injury has been caused by a chemical, put the childs head on
one side and flush the eye with cold water. Be sure to wash from
the inside corner of the eye outwards. This ensures that chemicals
are not washed across the face and possibly into the other eye.
Apply an eye pad and seek eye specialists advice as soon as
possible.
Foreign Body in the Ear
If an insect has gone into the ear, lie the child on his side and gently
pour warm water into it so that the insect floats to the surface. If
this doesnt work, get medical help. Dont pour water into the ear
if the child has grommets fitted or if there is a foreign body other
than an insect, as it could cause the object to swell. Dont try to
remove the object yourself as you may wedge it in more firmly.
Take the child to an ENT specialist as soon as possible.
Foreign Body in the Nose
Make the child blow through the affected nostril while other one is
covered. If this fails in dislodging the object, consult an ENT
specialist.
Heatstroke
Watch for signs of overheating like raise temperature, restlessness,
flushing and ill looks. Remove the clothes of the child and keep
him cool and still and make him drink plenty of water. Consult a
doctor as soon as possible.
Insect Bites and Stings
Cover the bites to prevent your child scratching, as this only makes
the irritation worse. Calamine lotion is very soothing for insect bites.
A bee or wasp sting can be very painful and alarming. If you can
see the sting, pull it out with a pair of tweezers, but if you cant or
its too deep-dont try to squeeze it out or youll cause more pain
and inflammation. A piece of cotton wool soaked in a solution of
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Emergencies
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Emergencies
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by lying the child face up and giving five short sharp thrusts
to the upper abdomen (between the navel and breastbone).
Repeat the sequence of back thrusts, chest thrusts, back slaps,
abdominal thrusts.
For a baby, follow the five back slaps with five chest thrusts
and repeat the sequence of back slaps with chest thrusts. Do
not do abdominal thrusts on a baby.
Give mouth-to-mouth ventilation if breathing stops.
Drowning
Get your child out of the water, if possible. If it is not, give
emergency first aid in the water.
1. Empty the childs mouth and, if breathing has stopped, give
mouth-to-mouth ventilation.
2. Send someone to call a doctor or ambulance and carry on with
mouth-to-mouth ventilation until help arrives. Be prepared to
start heart massage.
Electric Shock
Dont touch the child as the shock can be transmitted to you.
1. Switch off the source of electricity at the mains immediately or
pullout the plug. If this is not possible, break the electrical contact
with something which does not conduct electricity, such as a
wooden broom, and push your child away from the wire or
socket. If there is water around, do not stand in it as water
conducts electricity.
2. Check your childs breathing and, if he is breathing but
unconscious, place him in the recovery position your child may
need to be treated for burns or for shock so take him to the
nearest hospital.
Dislocations and Fractures
When a bone moves away from its position in a joint, it is called
dislocation. When a bone breaks partly or completely, it is known
as fractures, it may be difficult to distinguish between a fracture
and a dislocation, so follow the same emergency procedure for both.
Dont move the child unless you have to, especially if you think he
might have injured his back or neck. Make him comfortable and
get medical help. The affected limb should be immobilized before
moving the child.
Emergencies
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Index
A
Abdominal muscle 13
Abscess 111
Abuse
cocaine and pregnancy 24
during pregnancy and fetus 22
fetal impact of opiate 23
maternal impact of opiate 23
opiate and pregnancy 23
Acebutolol 44
Adenoids 111
Alcohol 8
Alcoholism and pregnancy 25
Allergic rhinitis 111
Allergy 112
Amphetamine 42
Anemia 112
Antenatal care 7, 20
Antianxiety 43
Anticonvulsant therapy 16
Antidepressants 43
Antipsychotic drugs 44
Appendicitis 113
Areas of concern in breastfeeding 35
Areas of work 58
Aspirin 44
Asthma 113
Atenolol 44
B
Baby in womb 2
Babys condition 63
Babys development in womb 2
Back 12
Bed wetting 114
Benefits of bilirubin 75
Blood in urine or bowel motions 115
C
Caffeine and pregnancy 26
Caloric value 104-106
Carbamazepine 17
Carbohydrate 54
Care of body 12
Chickenpox 117
Choking 157
Cleft palate 118
Clemastine 44
Clinical manifestations of
fetal alcohol syndrome 25
neonatal 23
Clubfoot 118
Cocaine 42
Coeliac disease 118
Cold sore 119
Colic 119
Color blindness 120
162
Fat 54
Feeding schedule 40
Fetus 3
Fever 127
First AID
Dandruff 124
Dehydration fever 51
Dental decay 124
Detection of diabetes in pregnancy 19
Development
in mothers during pregnancy 4
physical and mental 92-95
Diabetes 125
Diabetes and pregnancy 19
effects on fetus and neonate 17
Diapering and diaper dermatitis 82
Diarrhea 125
Diet 10
Diphtheria 126
Discomfort 10
Dislocations and fractures 158
Doxorubicin 42
Drowning 158
Drugs of abuse 42
Dyslexia 126
Earache 126
Eczema 127
Eczema and allergic diseases 37
Electric shock 158
Embryo 3
Emergencies 155
Emollition 81
Emotional changes 14
Energy 54
Enough breast milk 62
Enzymes 55
Epilepsy and pregnancy 16
Ergotamine 44
Erythema infectiosum 128
Exercise 7
Exercises general 13
Index
G
Gastroenteritis 129
Gestational diabetes 18
Glands 140
Glue ear 130
Goals 57
Grass-roots 59
Growing pains 130
Growth factors and hormones 54
Jaundice
breast milk 76
in newborn 75
management 77
pathological 76
physiological 76
prevention 78
Laryngitis 133
Leg cramps 11
Lithium 44
I
Immunization 90-91
Impetigo 132
Infant formula industry 59
Influenza 132
Intrapartum 16, 27
Iron 55
163
M
Marijuana 42
Maternal medication 45
Measles 133
Methotrexate 42
Mid night feeds 41
Minor problems 13
Morning sickness 11
Mothers psychological factors 63
Mothers physical condition 63
Mouth infections 134
Mouth-to-mouth ventilation 155
Mumps 135
N
Nappy rash 135
Neonatal skin care 79
NGO groups 60
Nosebleeds 135
Not enough milk 61
Numb fingers 14
Nutrition in pregnancy 107-110
Nutritional components
of breast milk 53
P
Pelvic floor muscles 13
Pelvic joints 12
164
Phencyclidine 42
Phenindione 44
Phenobarbital 45
Phimosis and circumcision 117
Phobias 136
Physical activity tips 97
Pica 136
Pigeon toes 136
Piles 11
Placental abruption 17
Poisoning 159
Policy and planning 59
Postnatal care 16, 21
Postpartum 27
Practical approach for health
professionals 62
Precautions 10
Pregnancy 2, 7
care 7
diabetic 20
drugs 31-34
Preparation of babys feed 68
Preparing the feed from powder 68
Preparing with ready-to-feed 68
Prevent child abuse and neglect 98
Prickly heat 137
Primidone 45
Production of breast milk 50
Professional bodies 59
Protection against infections 36
Protein and energy 56
Protein 53
Public health issues 30
Pyloric stenosis 137
S
Scalds and burns 157
Scoliosis 138
Sexual intercourse 8
Shock 159
Sickle cell disease 138
Slapped cheek disease 128
Sleep walking 139
Smoking and pregnancy 26
Sore throat 139
Spacing of pregnancy 38
Squint 139
Sterilizing the equipment 68
Storage of breast milk 50
Stuttering 140
Styes 140
Success of BPNI effort in India 59
Successful breastfeeding 40
Suffocation/smothering 159
Sulfasalazine 45
Sunburn 140
Swelling of ankles 11
Swollen ankles 14
Questions 70-74
Quickening 5
Quinine 31, 32
Target groups 58
Teeth 9
Tension and relaxation 14
Testes 141
Tetanus 141
Thalassemia 141
Threadworms 142
Tobacco 8
R
Radioactive compounds 42
Reduction of
exposure of fetus at delivery 29
Index
Tongue tie 142
Tonsillitis 142
Toothache 143
Travel sickness 143
Travel 9
Tuberculosis 143
Tummyache 143
U
Umbilical cord care 80
Underfeeding 51
Urinary tract infections 144
Urticaria 145
V
Vaginal infection 145
Vitamins 55, 99-103
D 55
K 55
Vomiting 51, 145
W
Warning signs for suicide 96
Warts 145
Wax in ears 146
Weaning
age of introduction 84
feeding practice 86
foods 86
hygiene and care 87
solid foods 88
tips 87
Weight control 10
Whooping cough 146
165
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