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Baby’s Teeth

  1. When do milk teeth appear?
    Children have 20 milk teeth. These start to appear at any time between 6months to 1year. They continue to erupt until the child is 3 yrs to 31/2 yrs.
  2. When do milk teeth fall?
    Milk teeth shed (fall) when the permanent teeth below them are ready to erupt. Only the lower two front teeth fall at approximately 6yrs of age. Every year thereafter, the child will lose roughly two to four milk teeth. The milk molars shed between 10 and 13 years.
  3. When should I take my child for the first dental visit? I don’t think he/ she has any problems.
    The first dental visit should coincide with the eruption of the first milk tooth or the latest by the child’s first birthday. You can then be counseled on appropriate oral hygiene measures and infant feeding habits. This can go a long way in preventing severe early childhood caries
  4. My baby has just started teething and is very irritable!
    Babies often experience sore gums, increased drooling, loss of appetite, and disturbed sleep when they cut their milk teeth. They may become cranky and want to chew on a plaything or their fingers to get relief. Chewing on unclean objects/ fingers may lead to diarrhea, fever. This is not caused by teething and you must contact your pediatrician if the child is unwell. You can try relieving your baby’s distress by

    1. Gently massaging gums with a clean finger
    2. Giving the baby a cold teething ring to chew on
  5. How soon should I start cleaning my baby’s teeth?
    Twice a Day, The sooner you start the better!

    • From birth until one year of age, wipe the gum pads and teeth with a clean damp cloth
    • Introduce a soft baby brush by one year. This can be used with a pea-sized amount of non-fluoridated toothpaste
    • By two years a Smear of fluoride toothpaste (1000 ppm) – can be started
    • At Four years a pea-sized amount of fluoride toothpaste, pushed into bristles to be used
    • The municipal water supply in India is not fluoridated. These recommendations hold good when non fluoridated/ optimally fluoridated water is consumed. This is true in most parts of the country.
  6. Can my child brush his/ her own teeth?
    • Small children do not have the dexterity (motor skills) to brush their teeth effectively.
    • It is recommended that a parent/care giver, brush a child’s teeth until the child is at least 6 years of age.
    • In older children, brushing must be supervised
    • Brushing after meals and after snacking is a must
    • Flossing once a day is advisable
  7. Can bottle-feeding causes cavities in my baby’s teeth?
    When the baby falls asleep whilst feeding, the last mouthful of milk is not swallowed. This milk pools around the teeth. Teeth soaked in milk coupled with a lack of proper brushing causes decay. The upper front teeth and molars are the ones to be affected the most.
  8. Why do cavities occur in a child so young?
    Inappropriate feeding patterns after the first baby tooth begins to erupt cause severe ECC:

    • The child put to bed at afternoon nap time and at night with a nursing bottle holding milk or sugar-containing beverage (juices, infant formula, soda, etc.).
    • Unrestricted nocturnal breastfeeding (Non-nutritive Suckling) after the first primary tooth begins to erupt can be harmful if accompanied with no brushing.
    • Repetitive use of a no-spill training cup (sipper), especially at sleep times. These liquids can cause rapidly progressive, severe destruction of tooth structure. The child sleeps whilst feeding and liquid pools around the teeth. This liquid provides an excellent environment for cavity-forming bacteria.
  9. How can I prevent severe early childhood caries in my child?
    • Breastfed infants: From birth, the infant should be held while feeding. A baby who falls asleep while nursing should be burped, to make sure milk is swallowed, and then placed in bed. Unrestricted night time feeds should be avoided after the first primary tooth begins to erupt. Night feeds cannot be avoided in infants who cut their milk teeth early (3-6 months). Wiping the teeth with a clean soft cloth made wet with boiled water, after every feed, is recommended. Though cumbersome, this can prevent a lot of heartaches (not to mention toothache) later.
    • Bottle-fed infants: Do not put your baby to sleep with a bottle. You should wean your baby from the bottle at 12 to 14 months of age. Encourage your baby to drink from a cup as they approach their first birthday. – Repetitive consumption of any liquid from a bottle or a no-spill training cup (sipper) should be avoided.
    • Oral hygiene measures should be implemented by the time of eruption of the first primary tooth.
    • An oral health consultation visit with a pediatric dentist within 6 months of the eruption of the first tooth and no later than 12 months of age is recommended to educate parents and provide anticipatory guidance for the prevention of dental disease.
    • An attempt should be made to improve the dental health status of the mother/primary caregiver. This lessens the infant’s risk of developing severe ECC.
  10. Why do milk teeth need to be treated? Won’t they fall anyway?
    Until the age of 12 – 14yrs, the milk teeth are the only teeth the child has. Therefore it is imperative that you seek treatment for them. The milk teeth are required for

    • Chewing
    • Growth and development of the jaws
    • Guide the permanent teeth when they are ready to erupt.
    • Speech
    • Aesthetics
      Untreated and infected teeth will cause recurrent episodes of pain, tooth infection, difficulty in chewing, poor nutrition etc. Decayed front teeth may lead to a self-conscious child with poor self-esteem. Early extraction of milk teeth will cause crowding and eruption problems in the permanent teeth. These will eventually take a toll on the child’s general health.
  11. What kind of treatment will my child require?
    Tooth decay (dental caries), is the most common of all childhood dental diseases. Treatment would depend on the extent of decay and how long the milk tooth is expected to function in the mouth. Treatment may include but not be limited to fillings, root canal treatment, pediatric crowns (caps), space maintainers, habit-breaking appliances, preventive dental treatment, orthodontic treatment, etc.
  12. How can further tooth decay be prevented?
    Every child’s preventive dental needs would vary depending on the family’s dietary habits, oral hygiene habits, tendency to develop cavities, etc. We work with you to devise a customized preventive dental program for your child. This will consist of

    1. A good oral hygiene regimen.
    2. Fluoride Varnish applications
    3. Pit & Fissure Sealants
    4. Dietary modifications
    5. Regular Dental Visits
  13. How often should a child see the dentist? Why visit the dentist twice a year when my child has never had a cavity?
    • We recommend a twice-a-year check-up for most children. Regular dental visits help your child stay cavity-free. Some children need more frequent dental visits because of increased risk of tooth decay, unusual growth patterns, or poor oral hygiene.
    • Periodical teeth cleanings remove debris that builds upon the teeth, irritate the gums and cause decay. Fluoride treatments renew the fluoride content in the enamel, strengthening teeth and preventing cavities. Hygiene instructions improve your child’s brushing and flossing, leading to cleaner teeth and healthier gums.
    • Regular checkups can detect a cavity early (long before your child complains of pain and needs extensive treatment). Tooth decay isn’t the only reason for a dental visit. Your child may need additional fluoride, dietary changes, or sealants for ideal dental health. Orthodontic problems can be identified and timely treatment suggested.

Constipation

Development

Diarrhoea

Eating Habits - Why does my child not eat?

Eating Habits - Junk Food

Growth

Inhalers - Correct use

Monsoons come with relief from the summer heat but also bring with them a risk of infections. Apart from the regular viral colds and coughs the risk of getting lung problems, wheezing, water, and mosquito-borne diseases increases. Through this update, we will identify symptoms of diseases that increase during monsoons and also will suggest measures to keep your child protected.

Viral Infections: Children have a higher risk of getting colds and coughs and in those with a history of asthma can have an attack of asthma. Contact your doctor if you have the following symptoms

    • Fever
    • Cold and cough
    • Breathlessness

Prevention:

    • Hand washing
    • Avoid contact with sick persons
    • Avoid crowded places
    • Good nutrition

Mosquito-borne diseases: Monsoon is the time when the breeding of mosquitoes increases due to the collection of water. Diseases like Malaria and Dengue are the most common mosquito borne diseases which become rampant during this season. These diseases if not treated timely can lead to serious consequences. Contact you, doctor, if you have the following symptoms

    • High-grade fever with or without chills
    • Red eyes
    • Severe body ache and weakness
    • Rashes
    • Bleeding from any site
    • Swelling on the body
    • Excessive drowsiness

Prevention:

    • Use of mosquito repellents both in the day and night
    • Prevention of breeding of mosquitoes by reducing stagnation of water
    • Informing your local Municipality in case of patients with Malaria/ Dengue
    • Fumigation

Water borne diseases: Infections like Diarrhea, Dysentery, Jaundice, and Typhoid increase during monsoons because of vectors like flies and contaminated food and water. It is best to avoid food and water from outside during monsoons. Vaccination against diseases like Typhoid and Jaundice is a definitive way to prevent these diseases. Contact your doctor if you have the following symptoms

    • High grade Fever
    • Frequent loose stools
    • Blood in stools
    • Very dark urine
    • Nausea and weakness

Prevention:

    • Food Hygiene
    • Hand Washing
    • Vaccination

Rat Borne Diseases: Diseases like Leptospirosis also increase during monsoons. It spreads due to presence of rat urine from an infected rat in stagnant rain water. Wading through water without protective clothing/ shoes especially if there are cuts and wounds on the skin predisposes a person to get Leptospirosis. Contact your doctor if you have the following symptoms

    • Fever
    • Red eyes
    • Vomiting and loss of appetite
    • Jaundice
    • Lethargy and swelling in the body
    • Headache and drowsiness

Prevention:

    • Avoiding walking through stagnant rain water
    • Rat control
    • Informing Mumbai Municipality if there is a case of Leptospirosis

A healthy newborn baby might look strange at first. Before being born, a baby is surrounded by liquid in the uterus but when the baby comes out it is covered in a thick white substance and bloody fluid. The baby is also in a curled-up position, because there’s not much space to move around. Your newborn might prefer to keep his or her arms and legs bent and close to the body, like they were when he or she was in the womb. The arms and legs should move equally on both sides of the body.

A healthy newborn’s skin is usually pink. But sometimes the skin can look slightly blue, especially in the hands, feet, and around the lips. That is normal. Your baby might have some bruises, red spots, or scratches on his or her skin after being born. This is nothing to worry about.

Head – A newborn’s head usually looks big compared to the rest of the body. Newborns have several “soft spots” on their heads where the bones have not yet grown together. Some babies are born bald, while others have hair. Often, the hair that a baby is born with will fall out within a month or so and be replaced by new hair.

Chest and belly – You might notice that your newborn has some swelling in the breast area. Sometimes the breasts might even leak a milky fluid. This is because of hormones from the mother’s body. This swelling or leaking usually goes away within a few days or weeks. Your newborn’s belly will probably be round and stick out a bit. After the umbilical cord is cut, a small stump will stay attached to your baby’s belly button……The stump will fall off on its own within a week or two.

Genitals – In both boys and girls, the genitals often look puffy or swollen after birth. If your baby is a girl, you might notice some discharge from the vagina. It is usually white in color but can sometimes be bloody. This is normal. It is caused by hormones in the mother’s body, and will go away on its own. In newborn boys, the foreskin (the skin covering the tip of the penis) is usually tight and should not be pulled back. This skin will be removed surgically if you choose to have your baby circumcised.

Cord care: aseptic care is routine in the clamping and cutting of the umbilical cord, additional topical care beyond dry-cord care is not needed. It requires medication if there is foul odor/ redness or swelling near the umbilicus.

  • Other normal phenomena
  • Stool frequency
  • Hiccups
  • Noisy breathing
  • Sneezing/ occasional cough
  • Crying
  • Stretching
  • No awareness of day/ night rhythm
  • Frequent feeding in both day and night up to 5 months of age

Newborn screening

Hearing loss  — Universal screening for hearing loss is recommended to detect infants with hearing loss.

Metabolic and genetic disorders  — In addition, screening for disorders that are threatening to life or long-term health in asymptomatic newborns is recommended so that interventions can be initiated to prevent or reduce morbidity and mortality. Universal screening of newborns for congenitally acquired infections, metabolic disorders, and genetic disorders, including phenylketonuria, congenital hypothyroidism, galactosemia, toxoplasmosis, and hemoglobinopathies is recommended.

Feeding — Infants should be fed early and frequently to avoid low blood sugar. Breastfeeding is recommended because of its increased benefits for both the infant and mother compared to formula feeding, except when medically contraindicated, such as in infants with mothers with human immunodeficiency viral (HIV) infection or in some cases of maternal drug abuse or certain medications that the mother may be on.

  • Breastfed infants should be fed as soon as possible after delivery, preferably in the delivery room. They should receive 8 to 12 feeds per day. Rooming-in, skin-to-skin contact, frequent demand feedings in the early postpartum period, and lactation support increase the rate of successful breastfeeding.
  • Healthy infants who are fed formula should be offered standard 20 cal/oz iron containing formula. They are fed on demand, but the duration between feedings should not exceed four hours. The volume of feedings should be at least 0.5 to 1 oz per feed during the first few days of life.

Weight loss  — Weight loss is normal after delivery, particularly in the breastfed infant. However, weight loss beyond 7 percent requires medical attention and should be evaluated with a complete feeding assessment. Normal infants stop losing weight by five days of age and typically regain their birth weight by 10 to 14 days.

Infection control:

Minimal handling

  • Hand washing
  • Only gentle oil massage with coconut/olive oil
  • No application of kajal/ other substances for massage/ oil instillation in nose/ ears etc.
  • No other oral feeds (including water) except breastfeeds

Maternal Diet :

  • Healthy nutritional food
  • No restrictions
  • Adequate calories
  • Vitamin supplementation
  • When to Consult Doctor
  • Refusal of feed
  • Fever (Recorded)
  • Lethargy
  • Excessive crying
  • Cough/ breathlessness
  • When in doubt

Children and Screen time

Children and TV often go hand in hand. Understand the effects of too much screen time — and how to enforce reasonable limits.

Are you concerned about how much time your child spends watching TV or movies, playing with a Smartphone or computer, or enjoying video games?

Although some screen time can be educational, it’s easy to go overboard. Consider this guide to children and TV, including what you can do to keep your child’s screen time in check.

The effects of too much screen time

The American Academy of Pediatrics discourages media use by children younger than age 2 and recommends limiting older children’s screen time to no more than one hour a day. Too much screen time has been linked to:

  • Obesity. The more TV your child watches, the greater his or her risk is of becoming overweight. Having a TV in a child’s bedroom also increases this risk. Children can also develop an appetite for junk food promoted in TV ads, as well as overeat while watching TV.
  • Irregular sleep. The more TV children watch, the more likely they are to have trouble falling asleep or to have an irregular sleep schedule. Sleep loss, in turn, can lead to fatigue and increased snacking.
  • Behavioral problems. School students who spend more than two hours a day watching TV or using a computer are more likely to have emotional, social and attention problems. Exposure to video games is also linked with an increased risk of attention problems in children. Watching excessive amounts of TV at age 4 is linked with bullying at ages 6 through 11.
  • Impaired academic performance. Elementary students who have TVs in their bedrooms tend to perform worse on tests than do those who don’t have TVs in their bedrooms.
  • Violence. Too much exposure to violence through media — especially on TV — can desensitize children to violence. As a result, children might learn to accept violent behavior as a normal way to solve problems.
  • Less time for play. Excessive screen time leaves less time for active, creative play.

How to limit screen time

Your child’s total screen time might be greater than you realized. Start monitoring it and talk to your child about the importance of sitting less and moving more. Also, explain screen time rules — and the consequences of breaking them. In the meantime, take simple steps to reduce screen time. For example:

  • Eliminate background TV. If the TV is turned on — even if it’s just in the background — it’s likely to draw your child’s attention. If you’re not actively watching a show, turn off the TV.
  • Keep TVs and computers out of the bedroom. Children who have TVs in their bedrooms watch more TV than children who don’t have TVs in their bedrooms. Monitor your child’s screen time and the websites he or she is visiting by keeping TVs and computers in a common area in your house.
  • Don’t eat in front of the TV. Allowing your child to eat or snack in front of the TV increases screen time. The habit also encourages mindless munching, which can lead to weight gain.
  • Set school day rules. During school week- Don’t let your child spend all of it in front of a screen. Also, avoid using screen time as a reward or punishment which makes screen time seem even more important to children.
  • Talk to your child’s caregivers. Encourage other adults in your child’s life to limit your child’s screen time, too.
  • Suggest other activities. Help your child find other things to do, such as reading, playing a sport, helping with cooking or trying a board game.
  • Set an example. Be a role model reduce your own screen time.
  • Unplug it. If screen time is becoming a source of tension in your family, unplug the TV, turn off the computer or put away the smart phones or video games for a while. You might designate one day a week or month as a screen-free day for the whole family. To prevent unauthorized TV viewing, put a lock on your TV’s electrical plug.

 

Become an active participant

When your child has screen time, make it as engaging as possible:

  • Plan what your child views. Instead of flipping through channels, seek quality videos or programming. Consider using parental control settings on your TV and computers. Preview video games and smartphone applications before allowing your child to play with them.
  • Watch with your child. Whenever possible, watch programs together — and talk about what you see, such as family values, violence or drug abuse. If you see a junk food ad, explain that just because it’s on TV doesn’t mean it’s good for you.
  • Record programs and watch them later. This will allow you to fast-forward through commercials selling toys, junk food and other products. When watching live programs, use the mute button during commercials.
  • Encourage active screen time. Have your child stretch or do yoga while watching a show. Challenge your family to see who can do the most jumping jacks during a commercial break. Choose video games that encourage physical activity.

It can be difficult to start limiting your child’s screen time. It’s worth the effort, however. By creating new household rules and steadily making small changes in your child’s routine, you can curb screen time and its effects.

  1. What is swine flu?
    Swine flu is a type of influenza A virus that has been spreading all over the world since 2009.
  2. What are the symptoms of ‘swine flu’?
    Most patients usually have common complaints of cold and cough and may have added the following symptoms

    • Fever
    • Cough
    • Sore throat
    • Chills & fatigue
    • Diarrhea and vomiting (possible)
    • Rhinorrhea
    • Headache
    • Body aches & joint pains
  3. Is there a way to differentiate swine flu from the regular viral colds and coughs?
    No. Only doing a test can differentiate
  4. For how long an individual remains ‘infectious’ to others?
    The risk of the spread of illness to contacts starts 3-4 days prior to the onset of symptoms and persists for at least 7 days after the onset of symptoms. Children may spread the virus for a longer period.
  5. After infection, for how long an individual remains protected?
    A person stays immune and hence protected from getting an infection with the same virus for 8-12 months after contracting swine flu.
  6. Is swine flu a dangerous illness? Why is the media talking so much about deaths with Swine Flu?
    Most patients with Swine Flu have a mild illness indistinguishable from any other viral illness. However, in some patients with poor immunity, it can be rapidly progressive and can result in death. There are many reasons for the high media coverage of this pandemic. Initially when the swine flu pandemic was detected the disease was an unknown entity with the potential to spread rapidly and cause mortality like flu pandemics in the past.
  7. Should all suspected/confirmed cases be hospitalized?
    No. Only serious cases with lower respiratory system/pneumonia and individuals with high risk conditions need hospitalization.
  8. Who should be investigated?
    Priority for testing should be given to:

    • Those who require hospitalization;
    • Those who are at high risk for severe complications
  9. Where can we do the tests?
    There are only 21 laboratories for testing A (H1N1) in the entire country. Samples are collected at district hospitals of different states and send to nearby IDSP/ICMR centers having facility for Influenza virus testing. The complete list can be found at the following URL: http://mohfw.gov.in/showfile.php?lid=3075. Some private labs are also conducting this test. The test in private laboratories costs 5000-6000.
  10. What are the medicines available to treat swine flu and who should take them?
    Most patients require only symptomatic treatment. There are some antiviral medicines available, but they should not be used indiscriminately.
  11. What are the non-pharmaceutical interventions to avoid the spread of disease?
    Close Contacts of suspected, probable and confirmed cases should be advised to remain at home (voluntary home quarantine) for at least 7 days after the last contact with the case. The monitoring of fever should be done for at least 7 days. Prompt testing and hospitalization must be done when symptoms are reported.

Preventive vaccination

  1. What are the available vaccines against influenza?
    Both inactivated injectable and live attenuated nasal influenza vaccines are available in the
    market.
  2. How effective are flu vaccines? Are flu vaccines 100% effective against the disease?
    No. Efficacy of the vaccine may be about 70% to 80%, especially in the geriatric age group.
  3. Who should receive the influenza vaccine?
    According to IAP, the following group of individuals should be offered the vaccine:

    1. Children with certain high-risk conditions and diseases (like chronic cardiac, pulmonary (excluding asthma), hematologic, renal, liver diseases, diabetes mellitus, congenital or acquired immunodeficiency (including HIV infection), and children on long term salicylates therapy, etc)
    2. Health care professional including pediatricians;
    3. Laboratory personnel and healthcare workers;
    4. On-demand of anxious parents after one-to-one discussion.

Travel and Health - Pre-travel health evaluation

Travel and Health - Travelling within the country

Travel and Health - Travelling abroad and vaccines

Travel and Health - Yellow fever vaccine

Temper Tantrums

Vaccines - Importance of vaccines + Vaccines in first 4 months of life

Vaccines - Other compulsory and recommended vaccines

Weaning

Principles of Weaning

Foods introduced during weaning

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