Stool habit of your kids

After birth babies excrete black, sticky stool. This is called meconium. Usually, the stool colour returns to normal (yellow) within 2-3 days. Everything about babies is diverse and different to that of adults. Those babies who are exclusively breastfed after birth may pass stool at the time of feeding or after feeding. This is a normal body reflex. There are many breastfed babies who may excrete out stool 10-15 times or more within 24 hours, while there are other breastfed babies as well who may pass stool after every 2-3 days or more(even after 5-7 days).Do not assume instantly that the frequent stool is because of diarrhoea, and that the less frequent stool is because of constipation. Both these cases can happen even in healthy babies. If there is diarrhea, the stool will be more watery, the urine output will be decreased, and the other signs of dehydration would appear. If there is constipation, the stool will be dry, hard and difficult to pass, which is unusual in case of newborn. In case of formula fed babies, stool frequency will be much less than that of breastfed ones and their stool would be formed ie not as liquid as that of the breastfed ones. If your baby feeds well, gains weight normally, then you have nothing to worry about this type of stool character. However, if no passing of stool is associated with vomiting, tense, shiny and distended abdomen, abdominal pain, then consulting your physician is a must. Usually, at the age of 1.5-2 months, the babies’ stool frequency decreases. Normally, the stool colour may vary from yellow to brownish green to greenish. Again, if baby is fed with iron fortified formula, then stool colour may become dark. For those babies who first pass their stool 2-3 days after birth (usual time is within 24 hours),their parents should consult a physician because congenital hypothyroidism may be one of its prime causes.

When convulsion strikes your child

There are many causes of convulsion in children. The common causes for convulsion alongside fever are febrile convulsion, meningitis, encephalitis, cerebral malaria, etc. The prime reason for convulsion only (without fever) is epilepsy. Whatever the reason is, this is harmful for children and a cause of fear among parents. Parents do not know what to do when their children suddenly have convulsion at home. Parents’ being at a loss in this case is very natural. This article is aimed to make the parents braver, so that they can handle this situation smartly and without wasting a single minute. The first thing is, the baby having convulsion has to be taken to the nearby hospital immediately. Meanwhile, some things have to be done at home while making arrangements to get into a hospital. Lay your child down sideways (left or right). During convulsion, a frothy secretion or vomitus may come out through the child’s mouth or nostrils. Wipe it off with a clean cloth. Be careful when inserting your finger into your child’s mouth for cleaning, as the child will have no sense then and may bite vigorously. Therefore wrap a clean cotton cloth around your finger, with many turns, so that the cloth can protect the finger from being bitten off during cleaning purpose. During convulsion or immediately after convulsion, in no situation should you try to insert water, milk or any kind of food into the baby’s mouth. During convulsion, in many instances the babies teeth gets stuck together or the tongue gets bitten, and a lot of people try to separate the teeth with hard objects; most commonly used is the handle of a spoon. This is not wise. After convulsion, if the child becomes unconscious, parents often block off the nostrils with an intention to bring the child back to consciousness. This is strictly prohibited. During convulsion the prime purpose should be to perform those tasks which help the baby to breathe normally and protect them from getting injured.  If fever coexists, try to control it by sponging or using paracetamol suppository. Even If there are no more convulsions after the first one, by no means should this be neglected. Consult your physician because this might happen again in the future. During convulsion, don’t make the mistake of taking your child to the physician’s private chamber since this is a medical emergency; it is almost impossible to treat convulsions outside hospital settings.

Vitamin K(Injection Konakion mm) after birth

An injection is fed into the mouth of the baby right after being born. We have seen this or are already aware of it. However what this is or why this is fed, this most of us do not know. This is a vitamin K injection, which is available in markets under the name of injection Konakion mm, injection K1, etc. To put it simply and briefly, after a child is born, there are many instances where there might be bleeding tendency of the child due to transient deficiency of vitamin K; in medical terms this is known as vitamin K deficiency bleeding (VKDB) and to counter this, vitamin K is given as a preventive measure. Therefore every child has to have vitamin K after birth. American Academy of Pediatrics, Canadian Pediatric Society, the UK National Health System, and so on, all of them have recommended this. Even though there are debates about the routes of administration, each and every one unanimously agree that vitamin K should be given. You can choose any route in accordance with the facilities available. If the child is not born in a hospital, i.e. if the delivery takes place at home, or if there isn’t a facility for intramuscular injection, or if the parent does not want intramuscular injection, in that case injection Konakion mm (2mg/0.2 ml) has to be given orally in 2 doses. The first one should be given right after birth (usually within 6 hours after birth) and the second one should be given when the baby is 4-7 days old. The practice of a third dose is also done by many pediatricians when the baby is a month old. Therefore, an easy way to remember about the timing of three doses is-4 hours,4 days, 4 weeks. At least no parent should forget about giving the first 2 doses. This has been all about oral administration. If there is a facility for intramuscular injection, then half of the injection Konakion mm (2mg/0.2 ml), i.e. 1 mg, will be good enough as a single dose. Parents who fear injections, I directly want to say to them- if you use an insulin syringe for injection, your baby will not feel even a hint of pain. Those babies who are born in a hospital, or those who are admitted to a hospital after birth, they are given this injection routinely. Therefore this article targets those babies who are delivered outside a hospital (ex- home delivery), which, even now, is a common phenomenon in Bangladesh.

Diaper/Nappy Rash

Nowadays mothers prefer to use modern accessories to bear up their child; accessories which save them time, energy etc.  However mothers often do not think whether this is good for their babies or not. For example, ‘urine alarm’ is a good thing to use; but I want to discuss some things about diapers in this article. Diapers have both good and bad effects depending on its use.  For instance, during winter mothers might sometimes fail to notice when their babies have wet their beds (urination).  In this case diapers may provide temporary assistance; and there is no alternative to this when travelling. Therefore it can be understood that diapers really come in handy, but for a short time only. However there are a lot of mothers who like to use diapers for their children all the time. Using it all the time is not healthful because urine, and sometimes stool, remain in contact with skin for long periods of time. This daily regular contact creates allergies on the skin, the effects of which are reddening of the skin on the area where the diaper was worn, itching, etc. This is called diaper rash. This creates a really painful situation for the kids. Here superadded bacterial or fungal infection might occur, which will only make the diaper rash more complicated. Moreover exposure of this area to light and air is important, which does not happen if diapers are used. Therefore diapers shouldn’t be used all the time. In instances where there aren’t any alternatives to diapers, it has to be ensured that the diaper is changed as frequently as is possible. Now, what should you do if diaper rash does happen? The first step to be taken is to stop using diapers right there and then. Secondly, allow the diaper area air dry, leaving diaper off as much as possible. Irritants such as soap and detergent should not be used for a temporary period. A cream containing antifungal plus steroid (miconazole plus hydrocortisone) can be used locally, two to three times daily for five to seven days. Along with this, barrier cream/ointments containing zinc oxide can help in preventing the dermatitis by providing a protective layer against urine and stool.

Your child with fever

Fever is a very common symptom for various illnesses in children. Fever occurs when an infective process is going on inside the body. The specific treatment for the cause of fever is not our topic for discussion; here we want to focus on how to control the high body temperature of the child, at home. Very often fever is associated with shivering, chills or rigor, and hence the common mistake that many parents make is they cover their child with more and more cloths. This is wrong. The first step to be taken during fever is the removal of cloths or making them loose so that heat can be liberated from the body. Fans can be switched on at a medium pace. Secondly, sponging with luke warm water is most effective. Many parents only pour water on the head during fever, but it will not help in minimizing the body temperature. So sponging of the whole body along with pouring water on the head together will only be good enough. Sponging has to be continued until body temperature returns to normal; doing it one or two times is not effective. Thirdly, oral medication like Paracetamol can be given in 4 hour intervals- that is a maximum of six times in 24 hours. Nobody should use medication (other than paracetamol) like Diclofenac, Endomethacin, Ibuprofen etc, without consulting their physician, because these drugs can cause serious adverse effects. Paracetamol is effective as well as safe. Simultaneous application of above mentioned measures will help control fever. A child should be given extra liquid (an exclusively breast fed baby should be given breast milk more frequently) during fever. Urine output should be cautiously monitored because a decreased output indicates that the child is getting dehydrated. Lastly, one thing should be done by every parent before consulting the doctors about fever, and that is the maintenance of a four-hourly(at least) temperature chart. This will help the physician to interpret the nature of the fever .Unless a child is very sick with fever, he/she can be taken care of at home. A viral fever usually resolves within three to five days. If the child is getting worse or if the fever is not improving, then you must rush to the hospital.

Help your baby belch after breast feeding

Mothers, very often, make two common mistakes after having breastfed their babies. One is, they lay their babies immediately on the bed after feeding, and the other is, they do not assist their babies to belch. While being breastfed, a baby swallows air along with the breast milk. It is a normal phenomenon. However babies should be assisted to expel out this air because excess air in abdomen may create abdominal distension & discomfort, pain, hiccups etc. Moreover vomiting ensues after hiccup, particularly in a child who is kept lying immediately after feeding. So, a baby should be kept upright for about 20-30 minutes after feeding. Secondly, the baby should be assisted to belch. The mother herself can perform this procedure. The belly of the child has to be kept in contact with your shoulder or knee. Then using the palm of one hand, a few slaps (say 15-20) have to be given on the babies’ back, opposite to that of the belly. Most of the babies will belch. While you are placing the baby over your knee, the baby’s head end should remain upwards; otherwise the stomach content may regurgitate. Another factor is important while using this maneuver and that is the proper support of the baby; if mishandled, the baby may fall and suffer from severe trauma. Even after all these measures, some babies might not improve adequately. In that case some medications containing ‘Simethicon’ are sometimes used by the pediatrician, along with all these.

Watering of eye(s) after birth

There are many causes of watering of eyes after birth. In our day to day paediatric practice we find a common cause of watering of eyes, and that is nasolacrimal duct obstruction. Nasolacrimal duct is nothing but a connection between the eyes and the nose, through which tear drains into the nose. Usually it affects one eye, but it may affect both. After birth, this duct may not be well developed, so tears cannot drain into the nose properly, resulting in excess watering of the eye(s).This simple issue sometimes gets the parents tensed. Hopefully this article will come as a relief for them. Simple massage can solve this problem over time. After washing y hands, place your thumb in between the inner corner of the affected eye and the root of nose. Then move the thumb mildly obliquely downwards pressing firmly over the skin. This massage will help to establish the patency of the duct. Usually the problem resolves within nine months to one year of age, so massage should be continued till then. At least four massage sessions per day is good enough; ten presses should be given in each massage session. In nasolacrimal duct obstruction, tears remain clear and watery .If watering  persists after nine months of age or there are other problems like redness of eyes, sticky tear, pus discharge, swelling of eye lids, light sensitivity, co-existence of foreign body sensation in eye, an ophthalmologist should be consulted (considering another cause of watering of eyes).

Food allergy during exclusive breastfeeding

Though general people do not have adequate knowledge about food allergy, it is nevertheless an important issue. It is hard to summarize, but let’s give it a try. Let’s talk about the exclusively breastfed babies first of all- they can suffer from food allergy as well. For this case, change in maternal food intake is very important. The particular food, from all the food the mother consumed, which is causing the allergy, is difficult to identify. There are some common foods which we all know to be instigators of food allergy. The mother can exclude one food after another from her diet to find out whether the allergy diminishes in her child. For instance, a mother consumes cow’s milk and considers this to be causing food allergy in her child. Now, for a week or two, the mother will have to refrain from consuming it or any other milk product. Now if the child gets cured, then it can be concluded that the milk was actually the allergy causing agent. However if there is no improvement whatsoever, then the mother can go back to having milk and other daily products. After that, in the same way, the mother will have to temporarily avoid another food from her diet. In this way, if the mother patiently avoids one food after another, she will be able to find out the allergy causing agent. If there is a family history of allergy then babies have higher chances of getting food allergy. Now the question arises- how can the mother assume that her child has food allergy? Exclusively breastfed babies, if they have food allergy, show some symptoms, namely vomiting, diarrhea (including bloody diarrhea), abdominal pain, itching, hives, flushed skin/rash, face, tongue or lip swelling, coughing and wheezing, breathing difficulty, insoluble cry, unconsciousness, etc. The mother will have to cautiously look out for some things, such as- 1) Do family members have allergies to any certain food 2) If the mother consumes a food recently, does it affect her child. Some of the generally accepted allergy causing foods are-cow’s milk and milk products, egg white, citrus fruits, nuts, wheat, barley, berries, chocolates, shellfish (lobsters, shrimp, prawn, crab), Hilsa fish, pumpkin, soya, beef, brinjal, yeast, tomatoes, carrots, okra, apples, pears and some vegetables.

Food allergy after six months of age

6 months after birth, when babies start having extra food (complementary food) along with breast milk, they might get attacked with food allergy in the process. This is related to the newly introduced food.  When discussing about complementary food, it was mentioned ‘introduce single ingredient food at a time’. This will help in identifying the allergy causing food. After introducing a new food, it must be taken into account how your child reacts to the food- whether introducing the new food has brought out any symptoms of food allergy in him/her. If there aren’t any symptoms then you can consider it to be a safe food. Consequently, one food after another should be introduced like this. It is a good practice introducing a new food after a 7 day gap. Some of the foods which generally cause allergy have been listed in the previous article. There are some practices that you can follow to prevent food allergy- 1) not feeding cow’s milk and dairy products to a child aged below a year 2) not feeding the white portion of an egg(egg white) to a child aged below 2 years 3) not feeding peanuts, nuts, fish, shellfish to a child aged below 3 years. Food allergy usually happens within  few hours after the child is fed, and the symptoms are noticeable enough to understand that it’s happening. If first degree relatives (mother, father, brother, sister) have allergy, then there are increased risks of the baby having food allergy as well. However, even if there aren’t any family history of allergy, the child can still have food allergy. If food allergy does happen, then some medication might be required temporarily, but the best solution whatsoever is to eliminate the allergy causing food from the food menu for a while.

Feeding after six months-complementary feeding

Up to six months of age a baby is exclusively breast fed. Then a baby is given other food in addition to breast milk, which is known as complementary feeding. Complementary feeding is providing right food at the right time in right amounts; hygienically prepared, stored and fed; providing sufficient energy protein, micronutrients, and prepared from locally available, affordable and culturally acceptable foods. Don’t get nervous, it is very easy to prepare. Using a balanced amount of rice cereal, pulse, soya been oil, fish/egg/chicken, any  one vegetable (potato/papaya/green banana/pumpkin etc), hotchpotch(khichuri) can be cooked which is a good complementary food. Initially it may be hard for the baby to start having complementary food. This is because a baby, who is habituated with exclusive breast feeding up to six months of age, may not accept a new food all of a sudden. Therefore the baby should be introduced with the new food very slowly and steadily. For example, you may start with a single food type at a time (e.g., mashed  ripe banana) and then gradually increase the quantity. Start second weaning food (hotchpotch) after a week. Feed daily at the same time of feeding, while increasing the amount each day; For instance, if 1 spoonful of hotchpotch is fed during noon today and the rest is plain breastfeeding, then 2 spoonfuls of hotchpotch with a breastfeeding session has to be fed the next day at noon, and 3 spoonfuls the day after that and so on. In a week or two the baby will be consuming a whole bowl of hotchpotch. If you hope that your baby will consume a whole bowl of hotchpotch at the beginning, then you will just be having false hopes. The last question which arises is-how many times should the baby be fed? Up to 12 months of age-3 times a day, 12 months to 2 years-five times a day (3 meals, 2 snacks), 2years and above-family food 3 times and 2 times snacks, and by 3 years breastfeeding would have stopped.