Medicine for fever

Not all fevers are harmful. In fact , fever can be considered to be body's response to get rid of organisms faster. It helps in killing the organisms earlier. On the other hand, fever is associated with some unpleasant feelings and symptoms, such as body-ache. Some children have a tendency to develop convulsions with fever. Any fever should be treated promptly in children prone to develop convulsions in association with fever. Tepid sponging with tap water is one of the methods that the care giver can employ immediately, along with antipyretic therapy. Paracetamol is the best medicine for moderate to high fever. It is preferable after food as the side effects of acidity (gastritis) can be lesser. Tepid sponging aims at dissipation of heat through evaporation . Antipyretic like paracetamol should administered with sponging.

How to measure body temperature

Modes of temperature measurement:

Axillary temperature: Dry the armpit so that there is no moisture there. Place the thermometer in the child's armpit [axilla] for 2 min. Check the height of mercury column in the thermometer.

Oral temperature: May be taken if the child is more than 5 years of age. Younger children may bite or break the thermometer.Even in older children it is cumbersome and many children do not co-operate. Place the thermometer's bulb-end in the mouth for two minutes.Check the height of mercury column for determining the oral temeperature.

Rectal : This is mainly used by health care professionals. Digital / tympanic thermometer. Forhead thermometer : The strip is kept over forehead. It is a convenient method that can be used even when the child is not co-operating. There is no risk of injury and can be used in children aged three years or younger.

cold items

Cold is caused by hundreds of viruses and by allergy. Hence it is common. Apart from the inconvenience it causes, it is not really harmful. It is a self-limited illness that lasts for about 3-5 days. Since it is self-limiting, cold does not need any trearment. Antibiotics are of no use. Steam-inhalation may help. If the child had nose block, nasal saline drops may be used. If the child has allergy, antihistamines may be required. These medications should be taken only on the advice of your doctor. Avoiding exposure to dust, pollen, pollution, etc, can prevent cold occuring due to allergy. Other types of cold cannot be prevented.

Food restrictions

Most diarrheas are self limiting in 3-5 days. Hence drugs apart from oral rehydration solution are not necessary. Breat feedig should be continued in diarrhea. Breast feeding does not increase the duration/ frequency of diarrhea. Breast milk, in fact , provides water and nutrition to the child and decreases the occurrence of diarrhea by providing the child with immune substances. Most breast fed babies prefer it, as it is easy to digest. Food-restrictions are not necessary in diarrhea. As noted earlier, breast feeding can be continued. Child can be offered whatever food he wants to take in addition to the fluids. Due to illness, a child's appetite may be poor. Food should not be forced on him/her. This will lead to vomiting. Instead, it is prudent to offer small amounts more frequently.If food is not restricted , the weight loss during diarrhea can be minimized.

How should Diarrhea be treated?

Most diarrhea episodes are self-limited and are caused by viruses.The most dreadful consequence of diarrhea is dehydration. Hence the management of diarrhea concentrates on prevention and treatment of diarrhea.The child should be given plenty of fluids so that his/her stool losses are replenished.Plain water is not a good solution, as the losses of electrolytes need to be replenished too. Oral rehydration fluid is the best solution to offer. Home-made fluids such as buttermilk, dal water, rice, kanji, coconut water and lemon juice are satisfactory substitutes. Breast fed infants should be nursed frequently and should be offered breast milk. A close watch should be kept on the child's activity and behavior. A note should be kept of the number of stools passed as also the number of times he/she has passed urine. This gives an idea about the child's hydration status. After starting home available fluids, it is better to consult a doctor medicines that claim to relieve diarrhea by decreasing the peristalsis are harmful and should never be used in infants and children. Antibiotics have a role in certain cases of severe dehydration fluids may have to be given through the intravenous (injection) route.

How does diarrhea occur

Infection of the gut is the commonest cause of diarrhea in infants and children. The harmful organisms enter the gut. In the gut they can injure the lining of the gut or make intestines secrete more fluids and electrolytes into the lumen of the gut and these are passed out as loose stools.Most diarrhea episodes can be prevented through personal hygiene, provision of safe water supply and proper sanitation and food hygiene. Some of the important measures that can help prevent diarrhea are enumerated:

• Ensure safe drinking water: This can be ensured by a variety of measures including boiling, treatment with certain chemicals or using certain filters. Ensure that water is kept covered and nobody puts his/her hands in stored water.


• Wash hands before preparing and cooking food.


• Wash uncooked vegetables and meat thoroughly before they are processed for cooking.


• Store food in clean utensils that are covered so that flies and insects do not contaminate the food.


• Serve food in clean utensils.


• Everyone should wash hands with soap and water before meals.


• Every one should wash hands with soap and water after defecation.


• Avoid eating out. If this is not possible choose restaurants carefully. Prefer those restaurants that have high standards of hygiene.


• Take measures to maintain clean surroundings.

About Appetite stimulants or tonics

Appetite stimulants available in the market have several side effects. And more important is the fact that an ill child with poor appetite requires his/her illness to be treated. A pampered child with food fads and "poor appetite" requires to be counseled and managed. Neither appetite stimulants nor tonics have any role. Child can be offered whatever food he wants to take in addition to the fluids. Due to illness, a child's appetite may be poor. Food should not be forced on him/her. This will lead to vomiting. Instead, it is prudent to offer small amounts more frequently. If food is not restricted , the weight loss during diarrhea can be minimized. Teething does not cause diarrhea. Teething begins at around 6-7 months. This is also the period when child starts putting everything in his/her mouth. This habit allows diarrhea causing germs to enter the infant's intestines and cause diarrhea. This is also the time when supplementary food in addition to breast milk is added to the infant's diet. If proper hygienic precautions are not taken while preparing, handling, storing and offering food, the infant can develop diarrhea.

About fruits and vegetables

For a vegetarian family it is necessary that the child takes vegetables. For these are the only source of calories and proteins for him/her. However, they cannot be forced on him/her. You should make efforts to find out what preparation of a particular vegetable he/she relishes. The same principle holds true for fruits. A child in a non-vegetarian family may get his/her calories and proteins from the non-vegetarian foods. However, it is healthier to have vegetables and fruits in the long run. The best way to convince a child to have fruits and vegetables is by whole family following the advice that they tend to give to the child. Sweets taken in moderation are not bad for health. However, their intake should not compromise his/her major meals or snack intake. Children usually do not wish to take spicy food. However, his/her requirements of balanced diet are met and if the does not have any problem with spicy food; there is no reason to make him/her stop it.

Handle a child who likes only junk food

Usually parents employ this is an escape machanism so that the child does not trouble them but slight firmness from the parents is all that is required. Secondly the whole family has to participate in the management of this problem. The parents and other family members should also avoid junk food. A balanced diet is the goal. However, there is no need for a regimental/strict attitude. Some "off days" are allowed, say for special occasions and parties, but within milits. Breast milk is given exclusively till 6 months of age. Thereafter breast milk is continued and complementary foods are introduced. Milk is a good source of nutrition. However , many children do not like to take animal milk. It is not a mandatory or essential item of diet. The same nutrients can easily be given through other foodstuffs. In addition, if the child does not want to have milk, instead of insisting that he take the white liquid , you can still provide the goodness of milk by making preparations made from milk (say sheera cooked in milk).

How to ensure good eating habits

Introduce appropriate complementary foods at 6 months of age. Avoid bottle feedig. Do not force food down a child's throat. Respect child's "no". Do not go on coaxing him/her. If a child does not like a particular food, do not insist that the child must have it. Taking one food out of the diet will not adversely affect child's nutritional status. There are several substitutes available. Avoid junk foods. This is applicable to the whole family. Do not give chocolates before meals. Let the whole family eat together. A child may not eat because of sick or because he has food fads.If there is suggestion of an illness in the form of loss of weight , decreased activity, apathy;take him to your doctor for assessment. Do not try to feed him/her forcibly.His illness needs to be treated. That will automatically result in improvement in appetite.The child may have developed certain food fads.It is necessary to break these so that the child can continue to receive good nutrition.It is in his/her long-term interest that he takes proper diet.Avoid forced feeding : This could be counter-productive. Offer him/her nutritions foodstuffs that he/she is fond of. Avoid ego clashes with your child.Encourage the child to sit and eat with the whole family.Let him/her not use this tactic to have his/her way in other matters.If he seems to be doing it for some secondary gain, ignore him/her.He is likely to come around when he feels hungry.

Sports activities and general habits

Expose them to various sports and outdoor activities.Encourage them in the field of their interest.Do not force into too many extra-curricular activities.Do not fill the child's day and weaken them with too many activities.The child should be allowed to choose a suitable program for a limited time period every day.Every child requires 8 hours of sound sleep.Both parents should talk to the child, answer their questions and perform various activities together with the child. Breast feeding can be continued through second year without any impact on proper eating habits.It is however crucial that additional foodstuffs are introduced at 6 months of age.A bottle fed baby gets his/her nutrition with ease through the bottle.Hence such a baby may be reluctant to leave the habit.In addition , children derive the pleasure of sucking on the teat; which they are very reluctant to give up.

Type of punishment

Hitting is not an acceptable form punishment .It does not work because

• The effect is only short lived.


• It sets a bad example for the child (if he/she can hit, why can't I?).Children who are hit tend to be aggressive.


• Parents are usually not in control when they hit, and may harm the child, even if they regret it later.

Acceptable forms of discipline are:

Time out: Giving a child a quiet corner or ignoring him/her till he/she controls him/her self.He/she needs to be in a safe but boring place.The timing of time out is 1 minute per year of life, up to 5 years. i.e.3 minutes for a 3 year old. Natural consequence: Telling a child that if he/she breaks his/her toy, he /she will not have a toy to play with. Make sure you follow through and let him learn through his/her actions.Lecturing him/her will not help.

Logical consequence: Telling the child that if he does not complete his/her homework and watches TV instead, he/she will not be able to go down to play.

Withholding privileges: Telling the child that if he takes away hi brother's toy, he will not be allowed TV time or computer time.Make sure you never take away a basic need such as food.Also make sure that you follow through.

How to deal with temper tantrums

Anticipate and prevent times when your child is most likely to have tantrums.For instance keep mealtimes regular if being hungry makes him/her cranky.If you know it is hard for your child to control him/her self in a shop, avoid long shopping trips with your child.Let your child make simple choices as often as he can.If you are going out,the child does not have a choice whether to accompany you or not,but he can choose which shoes he wants to wear.Do not enter into a power struggle.Firm but patient handling of the child's temper-tantrums is necessary through distraction.If stubbornness continues over long periods despite the methods used above, you need to find out if something is bothering the child at home or at school and then consult a pediatrician/child psychologist.We have to distinguish between punishment and discipline.While we do not want to break a child's spirit by punishing him/her, it is important to teach him/her self-control through discipline.Punishment is a negative consequence for not following rules,and is a very small part of discipline.

Treatment for bed-wetting

Bed wetting can be managed with the help of drugs, devices and sound advice.The child should be made to pass urine before going to sleep at night.His/her water intake after dinner may be restricted. If he continues to pass urine during sleep, he may be woken up and made to walk to the bathroom and pass urine.The days he/she is dry, he/she should be encouraged.However, he/she should not be scolded, criticized or made to feel inferior even when he fails to keep him/her self dry.Certain exercises and drugs can also help the child gain control and stop bed-wetting.There is no ideal behavior as each child is unique and each person has different understanding of what is ideal.Temper tantrums are a common and normal part of growing up.Between the ages of one and three a child is learning to do many things independently.But sometimes he/she tries to do more than his/her skills will allow him/her to.He/she is also learning to make choices , but he/she does not know how to cope when he/she can't get his/her own way.Added to this is his just emerging language skills that do not allow him/her to express exactly what he/she wants to say. No wonder then that he/she bursts into wails in frustration!

How to handle a difficult child

Some children may not cooperate with this process of training.Do not get upset.Do not try impose your will and discipline.If it appears that the child is finding it difficult at some point of time, stop the process.Do not interrupt your child's play for toilet training.Toilet training should be a pleasurable experience for your child and not an exhausting task with parents and the child seeking to overpower one another.Slowly start from where you have left off the process.Reward the child for his/her compliance.Children may take over 6 months to learn the process, hence do not be in a haste.Never ridicule the child or punish unnecessarily.Consult your doctor in difficult times.Although normal children achieve complete control at varying ages, bed-wetting beyond 6 years of age needs attention by pediatrician.

General habits and behavior

However, it takes long to get " completely dry" as urine is passed many times a day.Failures are inevitable, especially when he is absorbed in play.He still wets nappies at night, as he cannot wake up for this event.Do not get disgusted with the failures.When he wakes up from a nap,take him/her to sit on the potty but if he does not comply or gets up immediately, ignore him/her, leave him/her without a nappy near a pot and tell him/her to sit on it when he/she feels the need.If he succeeds, gently approve of him/her.If he/she plays about makes a puddle, do not scold him/her.He/she will have occasional successes and then a few more. Slowly you can take him/her to the toilet and be there while he/she sits on the seat so that he/she is not scared of falling in. Slowly you get fewer and fewer 'accidents'.As he/she gets used to holding his/her urine during the day, it will sink in at a subconscious level and he/she will begin to stay dry at night.By the time he/she is three years he/she will be well trained and you do not need to mop his/her urine any more.

General habits and behavior

Introduced late in the second year, he will be able to go to it him/her self manage his/her clothes with minimal help and get on and off the pot alone.All these stages take about 6 months to be completed. Night time training can be delayed till later age.If the child appears stressed / frustrated at any point, the process is discontinued and restarted after an interval of 1-2 months.The child is then taught how to remove and wear pants and use the potty chair him/her self.Boys can be taught urination in standing position.About bladder training: Though the child senses a full bladder , he/she has no time to alert you or to go to the pot before he/she urinates.In case of the bowels, he/she has enough time to go to the pot and get ready.However, he will slowly learn that urine too can go in the potty when he/she passes urine along with a bowel movement.You know that he/she is ready for training when he/she begins to cross his/her legs,clench his/her muscles to stop it.He controls it for a few seconds but may urinate with the first step he/she takes to the pot.Around 2 years the child will tighten his/her abdominal muscles and gain a better control for many more minutes.At this stage you can give him/her a potty.

General habits and behavior

Begin by asking him/her regularly and without any pressure if he wants to use the potty.Keep it at an easily accessible place from where it can be got quickly.If he/she resists try again later.At around 18 months the toddler recognizes the sensations that go away when he/she passes urine and stools.He may clutch to the table or chair, stop playing, and looks at the puddle that he/she has made.Soon he/she becomes aware that he/she is about to pass urine or a motion rather than knowing if later the job is done.He gives an advance warning by standing still, looking at you and making sounds.At this stage he is ready for training .You may give him/her the potty but it is he/she who will choose to pass the motion in the pot.If he/she is ready to co-operate, you can help him/her easily.If he/she is regular with his/her bowel movements, leave him/her without a nappy or any such covering during that time.If he/she says 'no' , do not force him/her.He would do just the opposite if you try to force him/her and a new power struggle will begin.If he/she succeeds show a quiet approval.If he/she fails - suggest that he/she may possibly use it tomorrow.

General habits and behavior

Toilet training can be started after 24 months of age. Before that the child's nervous system is not fully developed to learn toilet training. By 18 months, the child can indicate the need to pass urine but cannot hold it and the child wets clothes. By 2-2 1/2 years, the child stops wetting clothes during daytime. By 3 1/2 - 4 1/2 years, most children are dry by day and night. By this age ,they can also initiate and interrupt the flow of urine voluntarily.Bowel control is achieved before bladder control.About bowel training : At about one year , the child is not ready to use a pot but will sit on one.Make the baby sit on the potty when you have made him naked for a bath.Some children are keen to try but if they use it to gain power over you, ifnore it and try later.Do not get angry with him/her if he /she does not empty his/her waste in it.He / she will repeat the same response if he / she gets a negative response.When he succeeds, show appreciation to reinforce his /her behaviour.

Learning at school

At about 5 years most children are ready to begin formal schooling.A child at this age is usually able to take care of his/her basic needs, knows how to play with other children , and is ready to follow some basic rules and routines of school.Between the age of 3 and 5 years a child learns the important skill of making friends and being part of a group.A plygroup can provide a child an excellent opportunity to learn and practice this skill. They help in the development of interactive and communication skills. The key word of course is 'play'. Play alone is a child's work at this stage.Although many play activities like painting, listening to stories etc contribute to school readiness, the child is not yet ready for the formal structure of school at this age. It should not start before completion of 3 years of age.The children through play, learn that learning is pleasurable.They learn to communicate, socialize, express and interact through the play. Competitive study should begin by 4th standard or 10 years of age because by then they are well initiated into the formal system of education.It should be without competition and comparison.

Vaccination Schedule

Vaccination can start soon after birth.For example, BCG and oral polio vaccine can be given on the first day itself. The doses of various vaccines are scheduled in such a manner that the child gets maximum protection when he needs it and with minimum side effects.However, there are situations when vaccination may have to be postponed. In such an event the vaccine dose can be given at a later date.In this sense, the vaccination schedule can be considered to be flexible.

Vaccines differ in their ability to protect children.For example, BCG vaccine mainly offers protection from severe forms of disease while tetanus toxoid offers almost 100% protection from tetanus. Vaccines are effective in protecting from various diseases.The protection can be absolute or partial and it may be short lasting or long lasting. The vaccine benefits most children. However, it is not effective in each and every child.

Vaccination

Vaccines are preparations that help children from developing various infections.Each vaccine protects against one particular germ. If there is a combination vaccine depending upon the preparation it may protect against 2-3 germs and diseases.Thus, several vaccines are required to protect children from various infectious germs.Like all drugs, Every vaccine has side effects.Most commonly encountered side effects are mild and transient such as pain at the local site, fever and rash.Considering the severity of the disease that the vaccines tend to protect the child from, vaccines in general, can be considered as being safe.The minimum vaccines every child must take are: The Government's Universal Program of Immunization offers the following vaccines: BCG, oral polio vaccine, measles vaccine and DPT vaccine.These protect from major killer diseases like tuberculosis, poliomyelitis , measles , diphtheria, pertussis (whoopng cough) and tetanus (lock jaw).The vaccines covered under this program can be considered as the minimum vaccines that the child must take.

Special care of Nappy area

Nappy area is prone to collection of moisture due to sweating , water left behind after bath or urine being allowed to remain in contact with the groin area.

The nappies shold preferably be made of cotton .It makes soiling visible enabling the caregiver a clear indiation to change the nappy.The plastic disposable nappies are heavier, too.

Nappy area should be properly dried.Talcum powder can be applied to absorb the remaining moisture.

Ideal sleeping position

• Let the baby sleep supine ( on his back) on a firm , tight-fitting mattress in a crib that meets safety standards.


• remove pillows, comforters, stuffed toys & other soft products.


• Make sure that your baby's head remains uncovered during sleep.


• If using blanket , tuck a thin blanket around the crib mattress only as far as the baby's chest.


• Adults other than parents and other siblings should not share bed with an infant.

Applying kajal and Surma etc...

Kajal and surma are used for beautification. It is a myth that they protect the eyes. Using kajal or surma is fraught with many dangers:

• If hands are not washed properly , there is a chance that baby's eyes may get infected.


• cornea may get injured during putting kajal and surma.


• If some slightly large particles are present, they will constantly irritate the baby due to the foreign body sensation that it may result in.


• Some of the particles can block the tear - carrying ducts.

For these reasons, kajal and surma should not be used in newborns and young infants.

Kind of clothing

Use clean , dry, soft cotton clothes for the baby.In winter woolen clothes can be used over cotton ones. Sun-dry baby's clothes.Do not use clips, safety pins, buttons for baby's clothes.Cover baby's head with a cap when it is really hot.Use your common sense and judgement to decide how many clothes the child should wear.Over-wrapping will result in fever while inadequate wrapping may take the baby cold.Additional measures will be required in premature & low birth weight babies to keep them warm.Use of radiant light ( 40, 60 or 100 W ) kept about 1.5 feet above the baby will help. Light should be focused over baby's chest & abdomen. Avoid focusing over the eyes because this can damage the retina. Baby's temperature needs to be checked very frequently to avoid overheating and burns.

Adding salt and Sugar

It is safe to add salt to infant's diet to provide taste.Like us, infants also do not like salt-free food.

Certainly, Children like sweet taste as well.Adding sugar increases the caloric content of food and makes it more palatable.However, sugar should not be added to water.Brushing of teeth should be encouraged after eating a sugary substance to prevent dental caries. Unprocessed honey is not permitted especially if stored for long periods.Harmful bacteria can grow as honey offers a good culture medium.The child should be eating the regular family food by about 12 months.It must be understood that this is a gradual process that should begin from 8-10 months of age.The child should be offered foodstuffs from the family diet those are less spicy right from that age.Tonics are not necessary. A child aged 6 months may require supplements of iron to take care of his rapid growth.If prepared properly, commercially available infant foods provide adequate nutrition to the infants.They do not offer any additional advantage over homemade preparations and are more expensive than homemade infant food preparations referred to above . No doubt, commercially available preparations are more convenient to prepare.But, finally your child should learn to make the family diet by the age of one year.

Extra nutrition

An infant should be exclusively breast fed till the age of 6 months.Thereafter other foods, in addition to the breast milk, should be offered to him/her.An infant should be exclusively breast fed till the age of 6 months.Thereafter other foods, in addition to the breast milk, should be offered to him.Initially child should be offered liquids like rice kanji, dal, fruit juices and vegetable soups.Thereafter, he may be offered semisolid items like mashed banana, mashed potato, porridge (suji), khichdi, etc.Once the child starts accepting one item and liking it, slowly.Increase the amount and also offer it more frequently, say, 3-5 times in a day.Introduce another new item after 5-7 days in a similar manner.Animal milk can be given after 6 months of life. If adequate food can be given through breast milk and other foodstuffs referred to above, introduction of animal milk can be delayed up to 12 months of age.

Frequent amount of food

Start with only one item at a time.The same item may be given on two occasions every day.At other times, the infant should continue to receive breast milk.Start with 2-3 teaspoonfuls and increasse the amount and frequently gradually.A new item should be continued for a week. Please pay attention to the following details.Maintain hygeine: wash hands before cooking and giving food.Always keep the food covered.Always taste the infant food before it is given to him/her.The care giver comes to know if the food is too salty or too spicy.This way she knows what the infant likes to take.Do not introduce new items more frequently.If there is diarrhea or other manifestations of intolerance, the offending foodstuff can be easily identified.If the baby does not like a particular food item, it should be withheld for a week and then tried again.Do not feed forcibly.

Develop child's interest in eating

Every one needs to eat to satisfy his/her hunger.Hence , one should not attempt to force the child to eat a particular food at a particular time.

A toddler who is playing would not like to stop that pleasurable activity and start eating.Especially if he is not hungry.A young infant would like to put his hands into the plate to explore and satisfy his natural curiosity.This should be encouraged.If he is able to take hold of a morsel and put it in his mouth, it is an achievement for him that he will relish.The child should be offered variety of foodstuffs and one should remember to serve him foodstuffs that he likes.

The caregivers should not run after a child to coax him eat.If the parents do this, the child learns to say 'no' so that he can play fora longer time.One should not be too obsessive about the quantity and the frequency of feeding of the child as long as the child is otherwise healthy and well.