1. My child is 2 years old, and he does not speak anything. Do I need to worry?
While most children generally have a vocabulary of more than 20 words, and are able to join and make sentences of two or three words by the age of two, speech can be delayed in some normal children, especially if there is a family history of delayed speech. If you can observe that the child’s hearing is normal, and that the child can understand and obey simple commands; and if the child can make you understand it’s needs by way of gestures, then you can reassure yourself, and the child can be given a few more months to start speaking clearly. If these parameters also appear delayed, then the child needs further evaluation. Getting the child to interact with other children, say at a playschool, is a good stimulus for the child to start speaking. (Dr. Naveen Kini)
2. My first child has become cranky, hostile and destructive after my second one was born. Any tips on how to handle the situation?
The coming of the second child can be a very traumatic event for the first born, especially if he/she is less than 5 years. The child suddenly feels ‘dethroned’ and ignored, and finds the newborn to be a competitor for the love and attention of the parents. This situation can be avoided to a large extent. Prepare the child for the new arrival at least 6 months in advance. Tell him that he will get a brother/sister to play with, who will love him, and who he must take care of. Tell him that mummy and daddy may initially be busy taking care of the child, but it does not mean that you love him any less. After the child is born, involve the child in the day to day care like fetching diapers, shaking rattle etc. and don’t forget to thank him each time. Instruct all close relatives to first talk to the elder one, before turning their attention to the younger one. Scold the younger one once in a while (he/she will not realise it anyway!), make the elder one feel important.
3. What is your opinion about the use of ‘Walkers’ and ‘Pacifiers’?
The ‘Walker’ is, at best, a device to keep the toddler out of trouble while the mother does her household chores. In fact, it encourages careless walking. A child must fall down once or twice while learning to walk, to realise ‘if I’m not careful, I’ll get hurt’. The best pacifiers a child can use are its own fingers, as they are relatively the easiest to keep clean. The pacifiers available in the market can easily cause loose motions and teeth problems, and are not recommended.
4. My child is five years old, and is still bed-wetting at night. How do I tackle this problem?
Let me start by assuring you that bed-wetting, or enuresis, is a problem which slowly goes away with age. Simple measures can reduce the severity, and save the child a lot of embarrassment. First of all, get the child thoroughly examined and investigated, to rule out urinary tract infection and other problems. Reduce fluid intake to the absolute minimum about 3 hours before the child goes to bed. Make the child pass urine just before sleeping. Wake the child up once around 12.30 to 1.00 am, make the child walk to the toilet (don’t carry the child, he/she has to wake up), and pass urine. Older children, children who pass urine many times in the night, etc. may be helped by using a ‘enuresis blanket’, a device which sounds a loud alarm at the first sign of getting wet (unfortunately not freely available). Short term control of bed-wetting, for children going for sleep-overs or camps, can be achieved with medications and nasal sprays.
5. My 4 year old son is asthmatic and needs to take inhalers everyday. Of late, he has become very uncooperative, and refuses to take them, and so his cough and wheezing has come back. I’m very disturbed, and end up scolding and shouting at him daily, but it seems pointless. How do I handle him?
This is a common and distressing problem faced by parents of children whose illnesses require treatments which depend a lot on the cooperation of the child. Unfortunately scolding, shouting, beating etc. have only temporary effects on these children, and they end up becoming more adamant and rebellious. One method I can suggest is what is called ‘positive reinforcement’. Display a chart prominently in the house, and mark on the chart with a particular symbol or ‘star’ each time the child cooperates and takes the medicines properly. Assign a small reward to a certain number of stars (make sure that it’s a reward, not a bribe). Negative marking (a different coloured star) may be marked more discretely on the chart for the days that the child does not oblige, and make sure he understands that this cancels one or more of the brownie points or stars earned earlier. Praise the child lavishly in front of visitors and his peers whenever he accumulates his ‘good stars’, so that the child feels he has achieved something, and will work that much harder to get more rewards. I have seen parents try the same methods in children with habit disorders like thumb-sucking, nail-biting, body-rocking, constipation etc. with considerable success.
6. My child has completed 4 months and I am under intense pressure from everyone at home to start solid food. What is the ideal time, and what do I start with?
Recent research has shown that exclusive breast feeding for the first 6 months reduces the occurrence of gastroenteritis and allergies in the child, and now the Indian Academy of Pediatrics has recommended that babies should be weaned only after completing 6 months of age. Even working mothers can manage to follow these guidelines by expressing breast milk into sterile containers, and storing the same in the refrigerator.
Most mothers spend sleepless nights fretting about their infants eating habits. Many hours are spent each day trying to make an infant consume a certain quantity of food, which is deemed ‘necessary’ for the child. Weaning practices have various cultural differences, and a first time mother gets a confusing bombardment of well meaning but sometimes inappropriate advice from relatives and friends, which only increases her frustration. Here are some suggestions which should be considered.
• Eating should be a pleasurable experience for the child, which he/she eagerly looks forward to.
• No child wilfully goes hungry, you only have to give it sufficient time to digest the previous meal.
• Variety is the spice of even an infant’s life, so keep changing the order, quantity and flavour of the meal.
• Do not compare children, each child will have unique likes and dislikes, which should be respected!
Fruits, mashed vegetables, ragi gruel, rice with dal, curd rice, kitchdi, pongal, ready made cereals like Cerelac, Farex etc. are some examples of weaning food. Find out by trial and error what your baby likes, and feed only when and as much as he/she wants.
7. Can you give me a few tips on dental care in children?
One of the biggest misconceptions about childcare is the belief that you do not need to bother about the temporary or ‘milk’ teeth because they are going to fall out anyway. In fact, care of the gums and teeth should start the moment the child appears to be teething. Gently massage the gums with your fingers. Paracetamol may be used if there is pain. Chewing on carrots and other vegetables is not recommended, as they can soften and break off, posing a choking hazard. A clean, firm ‘teether’ maybe used.
The moment the teeth begin to appear, start brushing them with a soft baby toothbrush, initially without toothpaste. Once the baby gets used to the idea, and learns to spit out, toothpaste may be used. Brush twice a day, morning and night. Older children who eat a lot of sweets and chocolates should brush more often. Make it a point to have the child gargle vigorously with water after drinking fruit juices and aerated drinks, as the sugar and acid in the drinks can damage the teeth enamel. Routine dental checkups with a Pedodontist should begin at 1 and 1/2 years of age, and every six months thereafter.
8. My child suffers from severe constipation. Medicines seem to give him only temporary relief. Where am I going wrong?
Constipation in children is a habit disorder which needs to be tackled on three fronts for successful reduction i.e. diet, change of bowel habits and medications. The problem usually starts when the child is predominantly on a fiber deficient diet like milk and milk products. It is compounded by irregular bowel habits, where the child is too busy in play and other activities, and has no time to pass stools. The net result is hard stools. Passing hard stools causes pain, and so the child develops an aversion to the same, and thus a vicious cycle ensues leading to increasing constipation. These are some solutions:
• First of all a thorough examination is required to rule out medical and surgical causes of constipation.
• Introduce fiber containing food like fruits, vegetables, whole wheat, ragi, pulses, and also plenty of liquids.
• See that the child compulsorily passes stools at least once a day.
• Hard stools which have already accumulated in the rectum have to be removed by using suppositories for 3 to 5 days.
• Stool softeners and laxatives should be given daily till such time that the child overcomes the fear of passing hard stools, and can confidently sit down and pass soft stools easily. A few months of treatment may be required in some cases, especially children who pass blood in the stools, usually caused by a tear in the rectum.
9. I live abroad, but visit India very often. Each time my child is here, he develops a severe reaction to mosquito bites, and is scratching all the time. Any suggestions?
It is quite likely to be an allergic reaction to insect bites, especially mosquitos. See that the child is fully clothed while going outside. Apply mosquito repellent cream on the exposed parts. Employ rigorous anti mosquito measures like nets, repellents, screens etc. to keep the house mosquito free. Clip, and file the nails, and also clean the under surface of the nails, to minimise the chances of infection. Oral antiallergics may be given to reduce itching.
10. My daughter spends most of the time in front of the TV, and hardly ever plays outside. How do I handle this situation?
This is a very common situation faced by parents, and a leading cause of obesity in children. Not only are the children inactive while watching TV for long hours, they also steadily add to their calorie intake by munching on snacks and junk food. The problem usually starts when overanxious parents and grandparents use the TV as a means of distracting the child to make him/her eat. This very soon becomes a routine, and before you know it the child is spending 7 to 8 hours each day in front of the ‘idiot box’. Tackling this situation needs cooperation from all family members.
• See that meals are served only at the dining table. This rule should apply to all family members, not just the child.
• Cut down the time spent by the child in front of the TV (and computer) to a maximum of 90 mins a day.
• Encourage more physical activity and outdoor play. Parents participation in outdoor activities will be heartily appreciated by the child.
• See that the child is tucked up in bed by 9.00 pm, and not sitting beside you needlessly watching the soaps.
• Occasional indulgence for a few hours may be allowed on special occasions, and as a reward for good behaviour.
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