Friday, April 30, 2010

Functional Constipation

functional constipation; you need to work hard a bit to train regarding her potty habits, so that she passes it well at least once a day.
Avoid fruit juices, in place try to give meshed fruits as such, cos they contain good amount of fibres like cheeku, papaya and mango. No dal ka pani, give dal as such. Curd is really good for tummy, add it wherever possible.
You can also try giving some honey may be one tsf in night time milk. That may help; take some branded one only like dabur. Still if it gets something serious and persistent you need to talk with your doc for some short term laxatives, which may help.
Most of this functional constipation is transient which improves with age, so don’t worry.

Stool Concerns in Kids

Bile is secreted by liver, which is green in color, when it passes down, gradually from small intestine to large intestine, color changes from green to yellow due to other intestinal secretions. But if transit time (time it takes to cross both intestines) is less, it doesn’t get time to change to yellow, and stool passed as green in color. So green stools just means that intestinal motility is increased.

It may or may not be infection.
If it is associated with high grade fever, vomiting or associated with blood or mucus in stool, then
it’s probably due to infection, which needs stool examination, otherwise you can wait it to settle down by itself.

Usually such stools if it was because of infection may follow to persist for some weeks, esp in top feed children, because of secondary lactose intolerance (acidic stools) afterwards. Such problems are not common if child is exclusively breast feed in first six months. For this, you just need to wait for some time to settle down gradually. But if this extent for long period, you need to discuss with your doctor too, which may need repeated stool tests. In most cases, it settles of its own.


Regarding parasitic infestation in children, cos they are not common here.
Common infestations in these small kids are pin worm and round worm infestations. Usually comes when something coated with dust particles goes in. I understand it’s difficult to prevent such infestations, few precaution are like this :

1. It’s advisable to wash hands of children esp between 1-3 years at least 5 times a day. (Children of this age will keep on putting hands and everything in mouth, which you can’t prevent every time).

2. Be persistent in washing kid’s hands before eating food and also after passing stool. (I know you do that every time for yourself, but make it also for the kid, so he develops this habit from early age)

3. Always eat fruits and vegetable after proper washing them (Never Never without washing, as it’s the most common source of these worms).

4. Avoid things available in market which are open esp. in India like golgappe, open fruit chat etc.

These are few small things which you must be following; just need is to sustain these habits.

Common symptoms of worms in children are abdominal pain, itching in perianal region.
Regarding regular deworming, as such there are no guidelines; still it’s advisable to get your children dewormed every 6 monthly in age group 1-5 years.

Deworming before the kid turns a year old is strongly not advised, also talk to your doctor before doing it.

Less Sleep In Kids

Regarding less sleep, you must understand one thing that sleep patterns are different for different children, some sleep more and some sleep less. I have seen many gifted children, who don’t need more sleep. It’s their nature, their sleep demand is less. But what is important to us is whether your child has any sleep disorder or not. So to differentiate it, we need to see her growth and development. Cos, sleep disorders will cause serious impact on the growth of your child.

Ok, if she is growing otherwise well, and doesn’t seem irritable all the time in the day, probably she is getting enough sleep. I feel it will take some more time for her to get adjusted to sleep pattern, what you expect from her. Till than you need to struggle bit more.....hey, why don’t you try some newer techniques, as you seems to have good interest in child psychology. May be something like making some fancy tent over her bad, or sleeping early, so some soft music while sleeping, it may work. What I feel you should not run for how long she sleep, try to make her relax as much as possible, it will automatically solve the problem.

Breast Pump Review - Medela Swing type

It was in my 3rd trimister that I came to know about a breast pump. I came across a discussion in a forum about expressing the BM using a pump, storing it and using it later. Thought "Ok, this is for working moms, since I am gonna stay at home I don't really need it" and then totally forgot abt it. I initially thought once I deliver the baby, I'll automatically produce milk and the baby will latch on easily. But, I was totally wrong.

Breastfeeding was not that simple n easy as I'd thought. I had cracked nipples, wasn't producing enough milk for the first few days and when the milk production was good enough baby wasn't latching properly. So I ended up having lumps in my breasts which were even more painful. My gyny suggested me to use a breast pump. I could get only a manual pump in our town which looked like an auto horn just as Sree mentioned in her review. It took 1.5hrs for me to pump just 4oz of milk :(( and after each pumping session I almost collapsed. So finally decided to go for an electric pump. Called up Sree and she suggested me to go for Core. Finding an electric breast pump in our town was out of question (none of my family members've heard abt a breast pump till then) and so I asked my aunt in hyd to get one for me. She couldn't find this Core breast pump and hence my next option was Medela. Though it was a bit expensive (around 10K) for my requirement, since I wasn't sure about other brands I had to go for this Medela Swing type Electric breast pump. This brand was suggested earlier in the forum by many of our friends.

This breast pump was absolutely one of the best purchases I've ever made. It made my job easier. I expressed almost 8oz in less than 20min. It can be used both electrically and battery-operated. I mostly used with the battery operated mode. It has a 2-phase pumping programme, phase 1 is the stimulation phase where the nipple is stimulated just like when the baby is sucking rapidly. Once the milk let down starts phase 2 - Expression phase begins in which the pump speed slows down. It is portable, easy to clean n sterilize. For the first one month I used this pump almost everyday. Finally my baby got adjusted to latching and I slowly reduced expressing milk. I prefered to feed him directly than using a bottle. The only draw back I found with this was, it makes some noise in the stimulation phase.

I haven't made use of this pump to its full extent, because I'm a stay-at-home mom. Once the latching issues were resolved, I used to express only when I had to go out for shopping or when I needed some rest. I used this for 4 months and passed it on to one of my friends who is a working mom. She has been using this for the past couple of months and had no issues till now. And yeah, this comes with a one-year warranty. I got this from Mothercare, Hyderabad. I would recommed this to working moms who express milk at a regular basis.

Thanks to all my TIA friends and especially Sree for their suggestions.

Thursday, April 29, 2010

Tearing/Crusting Eyes -- Infants

Kanti Pusulu -- Yellowish wet/dry crusting around the eyes of the babies is one of the common things that might be encountered in India. Some doctors actually give some antibiotic drops to the newborns in anticipation of any infection from the mother but in India, only when there is a problem do they give the drops.

There can be several reasons for tearing/crusting in an infant.

Make sure that the kid is not near any irritant or allergic object which is causing the tearing and crusting. If the tearing is accompanied by red shot eyes, runny nose or cough it might likely be an allergic reaction but this is indeed very rare in infants...

When there is such an occurrence, make sure the eyes are cleansed every once in a while before the discharge is crusted in the corners of the eye.
**Wipe the eyes clean with warm water cotton balls and clean them delicately.
**Do not let the kid rub the eyes excessively.
**Contact doctor immediately if there is any redness or swelling in the eye.

The reasons can be
* a blocked tear duct.
* a bacterial infection.
* a viral infection.

While the other two require medical intervention and confirmation that it indeed is an infection.. we can at home try some remedies to open up the blocked tear ducts as per my doctor.

A simple tip to stop tearing and crusting is
***When LO had crusting of the eyes, doc suggested me to press slightly on the nasal ridge and the place where the eye sockets meet the nose. Gently massaging the area between the eyebrows and eyes, around the eye sockets. It did help instantly. I was told to repeat the same gentle tapping massaging around the eyes and nose for about 20 times in the day, say 6 to 8 times rounds each time, 3 times a day.. ideally feeding times as the baby wont usually mind us doing that :).

If anyone at home has conjunctivitis be it bacterial or viral just keep everything separately including towels and bedsheets and if possible do not let them come near the infant. If it is you (the mom) who is infected take enough care not to stare into the eyes and take care of hygiene as much as possible.

If it is in the newborn stage, before 3 months of age, then it is most likely something to do with blocked tear ducts or nasal bone development or something like that, just the crusting and tearing, so do not worry...

watch out for external objects, redness, foul smelling crusts and keep the surroundings absolutely clean.

Thanks Renu for reminding me this one... LO had this as a newborn, so kind of missed my notice to update here.

Breast Pump Review (Indian Market) -- Core

Renu did a great job in summarizing her experience in buying and using the pump, I will do mine.

Pumps in India that are available to common man are like auto horns and are as crude in extraction milk.. it is not wrong if I say the pain getting milk out with that is a 100 times more than the delivery pains itself. No matter what people say there is not much awareness still about breastfeeding and the importance of it in India. We hear more instances of no milk or very less milk in India, especially in the middle class or rich social strata.. the poor have no choice but try their best and I sometimes envy the kids for their luck to be able to feed on the purest form of feeding, fresh milk from mom.

I feel that a breastfed kid is truly the luckiest kid but no issues, the formulas available are just about equal if not more good for the kid. The cleaning, sterilizing, the pain, the agony, nothing is a match to the BM feeding.

There are still a lot of misconceptions about pumping, no one really asks us to go for them, unless we are aware ourselves I hardly know any hospital which suggests the use. The nipple shield, the auto horn pump, manual extraction but not the pump.. strange.. but thanks to the world being a global village, a lot of us know what our counterparts in the west use and by our own choice we go for it..

The ones available in the market are from Germany, Singapore/Malaysia, and US.. Pigeon also has one but I havent really checked on it. I chose Core, the German made product, dual mode operation, with 2 contains costing somewhere around 3K, cost effective and good to use. The cleaning equipment and suction material are good. The sucking feel that comes with the pump is said to enhance the supply by giving the baby suckling feeling. The suction works good. However, it works good with real full potential only in an electric socket or a brand new battery setting. So, even when there is battery support feature, I had to rely completely on the AC option.

My mom and uncle had gotten it for me when I was is the hospital and there were not much choices in the store, but I am told time and again by moms in US that Medela is the best option.

Per my experience, Core is good, affordable, compact but then again I havent used Medela to compare to it.. Let us wait for Keerthi's review on it.

I also saw Pigeon and Tolly Joy pumps but did not either like the features, pump, or the accessories that come with it. Tolly Joy and Pigeon give you around 6 months to 1 year warranty but Core comes with no warranty whatsoever. I used it and passed it on to my friend, she is using it currently and will hopefully pass it on to another mother just changing the containers.. no issues so far (tw).

Wednesday, April 28, 2010

Breast Pump options - (Indian Market) Apple, Pigeon, JustBorn

Buying and using breast pumps abroad is easy and a normal everyday task because there is a lot of awareness and help. Medela is one good brand everyone suggests but buying it in India falls into an expensive item list.

Challenge I - People who sell pumps, they themselves do not know the total functionality. in one shop, they didn't tell me how to clean the pump. In other shop, they showed the cleaning process, but didn't show me how to release the vaccuum. Manual available is most of the times not suited for the needs.

II - Our parents do not know about it to be able to advice. The count of experienced mothers is also very less. So, you get near to zero knowledge transferred from tried & tested people (again...its for me. But thanks to sree, she helped me out)

III - No privacy place in office for pumping, so you can't pump at work place, no pumping zone in short.

IV - Not all offices have fridges, or we feel a little shy to keep the milk in cafeteria fridge. I did work in big branded companies, but no office maintained fridge for employees. All the refrigerators are maintained by cafeteria people for their purposes.

V - Even if offices do have fridges, commute is another headache. My ped suggested not to keep the extracted milk outside for more than 1hr & refrigerated milk for more than 15-20mins. So, in Hyd, i do not think any one can reach home from office in less than 20mins :)

VI - They are costly as per our thinking. I did debate over whether to buy one or not, because after spending much money, i didn't want it to go waste bcoz i cant pump at work.

having all these challenges considered, i at one point, thought let the life go on its own way. No pumps, nothing. Let me go work and let the kid be managed how yesteryear's kids got managed when their moms worked. But, now i say a big NO. Please, Please do buy breast pump and make use of it as it is the best thing anyone has ever invented for working moms and babies and moms with babies having latching concerns.

I work between 9-3pm and the commute is of 1hr each side. So, all in all, its more than 8hrs. At present, i'm pumping everyday after i return from work. As soon as i return, i take a quick bath and get back to the pumping routine. I'm able to get about 6oz during the session. My kid drinks close to 5oz per feed when she is absolutely hungry.

before work, i make sure that i nurse the kid. If the kid is in deep sleep and not interested to take milk, i pump.

Because i nurse the kid before leaving, its mostly one feed before i return that is between 12:30 to 1PM. I return home between 4 to 4:30, pump the milk first and go ahead with nursing again. What an easy way to get away with lumps.

With the help of breast pump, kid is rarely on formula. For the people who are away from kid for more than 9-10hrs, 1 formula feed might be needed. But thats is till the baby completes 4mths, after that anyway in India, we introduce them to cerelac (I do)

So, finally i suggest do not have a second thought on buying breast pump even though you are not pumping at work. Just go ahead and you will easily be able to draw the routine based on your baby needs and your body style.

Which breast pump to choose:

  • If pumping is a daily routine, do not choose manual one. Go for electric. Manual is very stressful. To tell you people. i bought one manual and two electric pumps (with this money, i could have got medala). Using manual pump for 3 days, my hand muscles pained like hell.
  • Go for the one which has speed rotator, so you can adjust it and get near to child sucking pattern.
  • Test it on your palm. Test the pressure the machine is releasing. Keep the shield on palm & ON the machine. If the shield is stuck to your palm, then its enough.
  • Check the containers as well. Few will come up with their own range of containers. so, if need to buy the containers only which suit the pump, check for their availability and quality before you buy it. If they dont set properly in the slot given, the equipment doesnt work well, so go for the ones which can be set with any other feeding bottle that is available in the market. Also, since it is an expensive item you can pass it on to your friends or relatives and they can just throw away the old containers and by the new ones.
  • Go for electronic or dual mode both battery and current operated ones, usage however is good and has good results when done in an electric socket.
My Experience on pump:
I bought one manual pump which is Apple (600rs). Sorry Apple, couldn't use it with the stress you are causing. I'm basically a person who can take strain pushing the comfort to back chair. Still, i couldn't do away with it. Its so much stressful.

I bought one electric pump - Pigeon (2,200rs). I'm almost mad with it. It is basically a battery operated one, which is compatible with power adopter as well. It didnt come with one though. I bought one for it. It worked Okay for first 1wk-10days. and then, it started slowing down. Air pressure is very very less. And there is no speed rotator as well. I had hard time pumping the milk. So, warranty undi kada ani shop ki teesukuni velthe, he said as long as it is working it does not come under warranty limits anta. Its working, but not meeting my needs. Its almost waste. He also said that it is my fault that i didn't take enough precautions in cleaning the pump and water might have gone inside. What the hell?? Machine loki water velthe, poorthiga pani cheyyakoodadu kanee, performance enduku tagguthundi...dont know.

I landed up with JustBorn pump(2000rs) which is my darling now :) Its meeting all my requirements. It has speed rotator, massaging nipple shield, power adopter, compatible with any branded bottle feeder (johnsons, hello baby, wipro...) It is compact in size aswell. I'm 200% satisfied with it.

Monday, April 19, 2010

Pneumococcal Vaccine

Pneumococcal vaccine is basically for prevention of pneumonia in children below 5 years primarily.
Pneumonia in children is caused by many infections including viral and bacterial. One third of pneumonia is caused by pneumococcus in children. Out of many strains of pneumococcus, this vaccine prevents half of those caused by pneumococcus.
So, in simple words, this vaccine will be able to prevent one sixth (1/6th) cause for pneumonia, even after vaccination, 5/6th causes still remains uncovered for which no vaccine is available.
So, In India, here comes cost factor, single dose will cost around 3000/- Rs, you need 4 doses for primary vaccination, so, we have to see, is that much cost is worth spending.
Because of less cost effectiveness, we don’t usually advise it for everyone here in India, but if someone can afford that, no harm.
Since you are living in a developed country, so cost will not be a problem for you. So, u can take that for your children, as advised by your doctor.

Frequent Cold and Cough

Cough and cold are not uncommon in such small children, esp. when they go out to crowded places.
To prevent such infections, we can just suggest good balanced diet (including fruits), good general hygiene (washing hands at least 3-4 times a day & try to avoid outings unnecessarily, if possible. I understand many things you can’t avoid, still, if cold and cough starts, avoid things like cold drinks, ice creams and ice, as it may worsen the situation. If things don’t improve in initial 2-3 days, you must discuss with your doctor, nothing less than this. I don’t think there are any medicines, which can prevent the onset of such infection in children. Its only with age, when they grow up, their immunity improves and things get better.

Chewing Food

Sometimes it’s really difficult make children understand the importance of chewing foods rightly, that to such a small child.

Still try some simple tips, may be that may help:
1. Explain to your child the importance of chewing their food. Let them understand, if they will not chew food enough, they are likely to produce more sounds from rear, may be an embarrassment will make him chew more.
2. Make a game of it for younger children. Have the kids chew their food 15-20 times before swallowing and taking another bite. If he follows that for a meal, his incentives are valid. May be incentives help him to learn the habit.
3. Make sure you all eat one meal together. While eating, bring up the subject of chewing and let your kids see you slowly eating the food before swallowing.
I am sure; gradually they will start eating food better. Here incentives work a lot. If they follow give incentives, if they dont, may be don’t talk him for some time, any sort of mild reproach nothing harsh, so they do understand mom is not happy with what I do.

Capillary Hemangioma

- Infantile haemangioma is a benign condition affecting skin blood vessels.
- They usually develop shortly after birth.
- Over 80% of infantile haemangioma occur on head and neck area.
- They grow to 80% of maximum size in the first three months and most stop growing at 5 months, but some may keep growing for up to 18 months, after that they starts regressing, which may take as long as 3-10 years.
- Most of them have a natural course and don’t need any treatment.
- Only if they are very large in size may leave a thin scar in some cases.
- These are more commonly seen in preterm and low-birth weight babies, but can occur in normal babies too.
- Actual cause for it is still not clear.
- If they are very large in size.
- If they are ulcerating.
- If affecting vision, hearing, breathing or feeding (internal haemangioma)
- If they doesn’t start resolving by school age.
So, I feel you should not worry for them, as they naturally regresses.

Diaper Rash

Nappy rash is common in some children ESP when the skin remains wet for longer time. So, in India, we advise to avoid branded nappies as much as possible (use them only when going out, at home you can use something homemade like we use in India, made of cotton, more ventilation, try it doesn’t remain wet for longer time). These home made one are really good esp. till the time she recovers from these rashes. Use whatever cream advised by your doctor. Understand the basic principle, the skin need more ventilation, it should be more airy not wet.