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SERVICES WE PROVIDE

Bringing a new life to an existence is one of the most precious moments of any parent’s life. At KIMS Cuddles, we strive to make those precious moments of a mother even more memorable and cherishing through our services.

Child Growth Care

Our expert pediatricians will work along with you to track and monitor the growth of your child on the basis of his/her age. We help you to understand the areas to be focussed as p...

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Diagnosis Of Child Health Issues

Our Pediatric health care unit diagnoses the health issues of the children to the root cause for effective treatment of the child. We use the best of equipments which provide trans...

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Immunizations And Vaccinations

All immunization and vaccinations are available at our centre for your little one. We follow the vaccines recommended by India Academy of Pediatrics Advisory Committee on Vaccines ...

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Infant Care

Our expert pediatricians are available at every delivery for effective infant care. We are ready to treat any kind of abnormality which occurs. We have the best facility and caring...

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Doctors

photo of Dr. Voleti Murali Krishna

Dr. Voleti Murali Krishna

Consultant Pediatrician

Health Blogs

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12 January, 2024

Allergies and Intolerances in Babies

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As babies embark on their journey of solid food introduction after 6 months, parents often encounter the complexities of allergies and intolerances when new foods are introduced with the hope of acceptance of the fresh food. The child may accept it, throw it out, or spit it if they do not like it. They may also show some discomfort, which could be signs that make it difficult for the mother to understand the acceptance and taste of it. Mothers understand the signs of acceptance and discomfort, and understanding the difference between the two makes it easy for the mother to need to see a doctor because these conditions are different for the well-being of the infant.What are Allergies and Intolerances:We need to start observing the between allergies and intolerances is essential for accurate recognition and management for the child of various age groups. Many parents find it difficult to know the difference between the two as they look quite similar. Immune-mediated food allergies and non-immune-mediated intolerances are examples of adverse food reactions. Nevertheless, there is frequently confusion regarding this distinction and the participation of several pathogenetic pathways. Additionally, there is a mismatch in the real versus perceived prevalence of immune-mediated food allergies as well as extremely common non-immune food reactions. There is a chance that a careless approach to accurately identifying them will result in improper diets that are severely deficient in nutrients.Understanding Signs and Symptoms:We need to recognize that allergies and intolerances rely on observing a few baby signs and symptoms. The common signs and symptoms noticed areSkin reactions (eczema, hives)Gastrointestinal issues (diarrhea, vomiting)Respiratory problems (coughing, wheezing)Behavioral changesFood Intolerance( special dislike for peanuts and vegetables)Common Allergens and Triggers:Certain foods are more likely to trigger allergic reactions in infants from 6 months onwards. These could be found on examination with a routine prescribed investigation. The most common allergens are found to be milk, eggs, peanuts, nuts, soy, wheat, fish, and shellfish. The mother could also observe the foods for triggering factors and where she can note this. She can tell the primary care given upon the visit what foods trigger the above-stated signs and symptoms or if she notices anything different.Lactose Intolerance in Babies:Lactose intolerance is a common form of intolerance, particularly as babies transition to dairy-based foods. Lactose tolerance can be identified during breastfeeding issues when the babies become extremely fussy during feeding and experience vomiting and loose motion, which could be one of the early signs and symptoms of identification. Lactose tolerance can be settled for a few days if the mother excludes dairy from her diet, but still, if this pertains, then investigation prescribed by the neonatologist will help in the identification of the intolerance in detail.Diagnostic Approaches:When allergies or intolerances are suspected, diagnostic approaches become crucial and need to be treated as the top most priority.. Various methods, including skin prick tests, blood tests, and elimination diets, highlighting their benefits and limitations. The results of the test take a longer time. These are special tests run in the labs, which can be costly, but they will help to save the life of a child in the journey. These tests are costly in India and have been performed by special labs which produce accurate results leading to rear findings which can be recorded.Managing Allergies and Intolerances:Once allergies or intolerances are confirmed, managing becomes key to ensure the baby's health and well-being. The allergens which have been identified can be excluded from the foods of the baby. We also need to ensure we adequately educate the parents in reading good labels, warning signs, and a list of ingredients.Parents can effectively manage food allergies and may adhere to a different food choice.Introduction of Solid Foods and Allergenic Foods:The timing and method of introducing solid foods at the age of 6 months can impact the development of the child, and also there can be nutritional deficits. Talking to a nutritionist will help the parents identify which nutrient is lacking by the child in their growth and development and that will be beneficial for the child to not have any compromised health.Breastfeeding and Allergy Prevention:Breastfeeding in allergy prevention is a crucial aspect of managing allergies in babies. Breastfeeding plays a crucial role in allergy prevention for infants. Breast milk contains antibodies such as IgA and IgE and protein based nutrients that strengthen the baby's immune system, reducing the risk of allergies. Exclusive breastfeeding for the first six months is recommended to provide optimal protection against allergic reactions and promote overall health; however, if kids are found to have allergies in the first 6 months, then they are advised special formulas that will help them prevent these allergies.Managing Emotional Aspects:Managing emotional aspects in food allergies involves open communication with family and near ones. This helps to educate oneself and others and practice empathy. Coping with anxiety or fear requires strong support from family and friends, emphasizing safe food environments, and cultivating resilience. The Emotional challenges associated with food allergies enhance the overall well-being of individuals, and community work brings in a lot of love and faith, which helps the family to grow.Allergies and Intolerances: A Lifelong JourneyAllergies and intolerances create a lifelong journey of navigating dietary choices that need to be altered by age and situation. Parenst need to foster constant check with feedback, education, and adaptability to become helpful if they see a parent require any support..Managing symptoms, seeking medical guidance, and fostering understanding in social gatherings are ongoing aspects of life and can't be avoided. Despite these challenges, we must embrace a proactive and informed approach, ensuring a balanced and fulfilling lifestyle.Conclusion:In conclusion, we must understand that child food allergies require a multifaceted approach encompassing education, communication, and follow-up management. Empathy and understanding from doctors, educators, and parents play a pivotal role. Children with food allergies can thrive With well-informed strategies, a supportive environment, and a community, ensuring a healthy and inclusive upbringing.This article was written by:Mrs. Pooja Marathe,B.Sc Home Science, PGD Dietetics, MBA Food Management, Pediatric Nutritionist (India, UK), IYCF (India, USA), Certification in Pregnancy Nutrition (Germany), Maternity & Pediatric Nutritionist & Lactation Consultant.KIMS Cuddles, Sec-bad

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12 January, 2024

Benefits of Breastfeeding Beyond 6 Months

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Breastfeeding is a remarkable journey that goes beyond the initial months of a baby's life. While many mothers may choose to introduce complementary foods around six months, continuing to breastfeed beyond this point offers numerous benefits for both the baby and the mother. In this comprehensive exploration, we will delve into the advantages and considerations of breastfeeding beyond six months, addressing the nutritional, emotional, and developmental aspects of this unique and valuable relationship.The World Health Organization's Recommendations:Before delving into the benefits, it's essential to understand the recommendations provided by the World Health Organization (WHO). This section will outline the WHO guidelines, which recommend exclusive breastfeeding for the first six months of life and continued breastfeeding alongside appropriate complementary foods for up to two years or beyond.Nutritional Benefits for the Baby:Breast milk is a dynamic and ever-changing source of nutrition. Beyond six months, it continues to provide essential nutrients crucial for the baby's growth and development. This part of the exploration will discuss the nutritional benefits of breast milk, including the ongoing supply of antibodies, vitamins, minerals, and customized nutrients that adapt to the baby's changing needs.Continued Immune System Support:One of the remarkable features of breast milk is its ability to bolster the baby's immune system. This section will delve into the antibodies, white blood cells, and other immune-boosting components present in breast milk, highlighting how continued breastfeeding beyond six months contributes to the ongoing protection against infections and illnesses.Balanced Nutrition during the Transition to Solids:As babies transition to solid foods, breast milk serves as a valuable complement. This part of the exploration will discuss how breastfeeding beyond six months supports balanced nutrition during the gradual introduction of complementary foods. It will touch upon the role of breast milk in compensating for gaps in the nutritional profile of solid foods during this transitional period.Enhanced Cognitive Development:Breast milk is not only a source of physical nourishment but also plays a role in cognitive development. This section will discuss the components in breast milk that contribute to brain development, emphasizing how continued breastfeeding beyond six months may have positive implications for cognitive abilities and intelligence.Emotional and Psychological Benefits:The emotional bond established during breastfeeding is unparalleled. Beyond six months, this bond continues to flourish, fostering a sense of security and emotional well-being for both the baby and the mother. This part of the exploration will discuss the emotional and psychological benefits, including comfort, reassurance, and the promotion of a strong mother-infant attachment.Support for Developmental Milestones:Breastfeeding beyond six months aligns with the achievement of various developmental milestones. This section will explore how the physical closeness and comfort provided by breastfeeding support the development of motor skills, speech, and social-emotional milestones. It will emphasize the importance of responsive parenting and the role of breastfeeding in meeting the baby's emotional needs.Introduction of Family Foods and Breastfeeding:As babies begin to explore family foods, breastfeeding remains a vital component of their diet. This part of the exploration will discuss how breastfeeding can support the introduction of family foods, ensuring a gradual and smooth transition to a diverse diet while maintaining a reliable source of nutrition and comfort.Considerations for the Mother:While breastfeeding offers numerous benefits, it's essential to consider the mother's well-being as well. This section will address considerations such as maternal nutritional needs, the impact on fertility, and the balance between breastfeeding and maternal responsibilities or employment. Practical tips for managing extended breastfeeding will also be discussed.Weaning at the Child's Pace:Weaning is a gradual and individualized process. This part of the exploration will emphasize the importance of weaning at the child's pace, respecting their cues and preferences. It will discuss the gradual reduction of breastfeeding sessions and the introduction of alternative sources of nutrition as the child becomes more independent.Cultural and Societal Perspectives on Extended Breastfeeding:Breastfeeding practices vary across cultures, and societal attitudes may influence mothers' decisions regarding extended breastfeeding. This section will explore cultural perspectives on extended breastfeeding, addressing common misconceptions and offering insights into how societal support can impact a mother's breastfeeding journey.Addressing Common Concerns and Misconceptions:Extended breastfeeding may be met with various concerns and misconceptions. This part of the exploration will address common issues, such as concerns about tooth decay, nutritional adequacy, and social perceptions. Evidence-based information will be provided to help parents make informed decisions.Conclusion:Breastfeeding beyond six months is a multifaceted and deeply rewarding experience for both the baby and the mother. This comprehensive exploration has highlighted the myriad benefits, from ongoing nutritional support to enhanced emotional bonding and cognitive development. By understanding the unique contributions of breast milk beyond the first six months and considering individual circumstances, mothers can make informed decisions that align with the well-being of both themselves and their infants. This guide aims to empower mothers with knowledge, support, and a deeper appreciation for the continued journey of breastfeeding.This article was written by:Mrs. Pooja Marathe,B.Sc Home Science, PGD Dietetics, MBA Food Management, Pediatric Nutritionist (India, UK), IYCF (India, USA), Certification in Pregnancy Nutrition (Germany), Maternity & Pediatric Nutritionist & Lactation Consultant.KIMS Cuddles, Sec-bad

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16 September, 2022

Childhood Immunizations

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What are vaccines? Vaccines are given as injection or oral form to produce an antibody reaction against specific bacteria and viruses. This will help your child develop immunity against these dreadful diseases. There are way too many vaccines. Will it weaken my child’s natural immunity? Not at all. Vaccines do not affect the natural immunity of a child in anyway. Can I give my baby only government vaccines? That is your choice but just because a vaccine is not in government schedule does not mean it is not important. There are many factors to be considered before a vaccine is approved by government – financial, feasibility, other logistics. In fact some important vaccines like rotavirus and pneumococcal vaccine which were earlier not given in government centres are now part of their schedule. You can discuss with your Paediatrician about the vaccines and then take an informed decision. What is difference between painful and painless vaccines? Painless and painful vaccine is applicable only to the DPT combination vaccines. This is because of the pertussis component. The whole cell Pertussis or so called painful vaccine has higher chances of high grade fever, pain, vaccine site redness/ swelling, excessive crying. The acellular or so called painless vaccines have less chances of these side effects. Both are effective against the disease. Only in terms of side effects the difference is there. What are the side effects of vaccines? Are they safe? The childhood vaccinations are approved after many years of research and are very safe. The common side effects are: Fever Vaccine site pain Vaccine site redness/ swelling Excessive crying/ irritability Mild rashes – maybe seen after MMR and chicken pox vaccines Serious side effects like an allergic reaction, febrile seizures ARE EXTREMELY RARE What can I do to comfort my baby post vaccination? Your Pediatrician will prescribe paracetamol for pain/ fever/ excessive crying post vaccination. You can use that as required. The side effects can last up to 2-3 days. Don’t massage the baby’s vaccine site. If you find any unusual symptoms in your baby then consult your Pediatrician immediately.

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02 February, 2022

The Ultimate Guide to Taking Care of Toddlers in the Winter

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With the cold weather already here, you may be thinking about whether it’s safe for your toddler to play outside or not. However, no matter if the temperatures outside are decreasing, toddlers during the winter require physical activities because they are great stress relievers for them when they are cooped up inside their house for so many hours. Thus, it is safe for a toddler to play outside during the cold weather. The American Council of Exercise even recommends that the children should receive approximately 60 minutes of physical activity each day. So you may allow your toddler for outdoor play in different intervals by providing them breaks after 10 to 20 minutes.  Here are several other tips that will facilitate outdoor play for your toddlers while keeping them safe. Dressing Them Properly During Cold Weather Toddlers during the winter should be sent outside to play only after dressing them in layers.  The layered dressing will help to keep the body warm of your toddler with scarves, boots, hats, earmuffs, socks or mittens. Additionally, the layers will not only protect your child while they’re playing outside but will also help to retain their body heat through the air pockets present in the different clothes. Though your child may become sweaty through outdoor play, you can always take off one layer. It is even recommended to dress your child in an extra layer as compared to an average adult. Helping Them Keep Warm Indoors Unlike adults, toddlers cannot regulate their body temperature during cold weather. So, you need to take special care to help keep your toddler warm indoors during the cold weather. For this, you should shut off the windows in case it is extremely cold outside and use a room heater or a humidifier to provide a warm and comfortable environment for your toddler. Additionally, you can keep your toddler’s bed warm by using a warm water bottle and keeping it at the side of your toddler while he or she sleeps. Hygiene Concerns With winters just round the corner, comes the season of seasonal flu and cold.  So it becomes necessary to practise the right hygiene for your toddlers and help keep them safe. First of all, you should make sure that your toddler is vaccinated for the flu. Secondly, when your toddler comes home after outdoor play, you should wash their hands properly. You can also provide them with a sanitiser to keep their hands clean.  Additionally, in case any other person in the house is already suffering from cold and cough, do not let your kid stay around that person as there is a higher chance of getting infected with the cold and flu. In the end, another hygiene concern for toddlers during the winter is their dry skin. Tell your toddler not to bathe in very hot water and moisturise their skin after bathing. Tips for Keeping Them Active You should encourage toddlers to be active during the cold weather by playing outside and participating in their outdoor play yourself. There are a plethora of winter activities like outdoor as well as indoor games. You may play indoor games with your child like Ludo, Carrom or even teach him or her during the free time. Also, allow room for physical activity by letting your kids play outdoor with their friends. Keeping Their Ears From Getting Colds There is a higher chance of ear infections in toddlers during winter because of the reduced blood flow to the ear. With the reduced blood flow, the ears lose their capacity to fight off infections. Hence you need to keep your toddler’s ears from getting colds in winter. So let your toddler wear earmuffs or even a woollen hat during the winter that can help to keep frostbite away.  Avoiding Overheating Themselves Toddlers have an amplified sensitivity to temperature changes and hence it may become difficult for you to keep your toddlers warm in winter because there is the risk of overheating. You can avoid overheating your toddlers by regulating the layers they wear during winter. It’s crucial to layer up your toddler while he or she is going outside to play or going for a walk. However, reduce the layers once your toddler is peacefully sleeping in the car or is with you indoors. So, these are some of the tips for toddlers during the cold weather. Hopefully, this guide will help you to keep your toddler warm during the winter season. *Information shared here is for general purpose. Please take doctors’ advice before making any decision. 

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29 January, 2022

Common Diseases and Issues: Caring For a Baby And How To Prevent Them.

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Caring for a baby is very crucial because during the initial first year the baby’s immune system is quite weak. Due to this, there are amplified chances for him or her to develop several common diseases in babies or sickness in infant. But with the right care, you can treat common diseases in babies easily. However, new parents and caregivers may have several questions related to their infants’ healthcare. So this guide will help you to know how to care for your baby and prevent the common diseases in babies and sickness in infant. Now let’s have a look at the common diseases in babies worth one year or less and how to care for them, or how to prevent them earlier only.  Bowel movements Keeping track of the bowel movement of your infant is crucial because this can help you to know if your infant is likely to develop any disease. So the different factors you need to consider regarding the bowel movement of your baby are as follows. Consistency. Initially, the consistency of your kid’s stool will range from loose, runny or soft. However, infant or formula-fed may have stools with a tan yellow shade and firmer as compared to the infants who are breastfed. All you need to consider while checking the consistency of your infants’ stool is that it should not be hard or very dry because this can be a sign of dehydration. Colour. The  Initial bowel movement of a newborn is generally a dark green or black coloured substance known as meconium. However, once the meconium has passed, you can see that the colour of the stools will turn yellowish-green. Frequency. When your baby has reached the duration of three to six weeks, he or she should have one bowel movement per week in case you breastfeed the infant. However, if you formula feed your infant, then the baby will have fewer bowel movements than this. If you find hard stools, you should immediately check with your healthcare provider as this could be a symptom of a sickness in infant known as Constipation Colics In case your baby is continuously crying in the evening and it gets worse through the night, then this could be a symptom of another sickness in infant known as colic. According to the research conducted by the American Association of Paediatrics, approximately 1/5th of the babies between the age of two to four weeks have an amplified risk of developing colic. Being one of the common diseases in babies, the symptoms can include excessive crying or screaming by the babies, passing gas or pulling up their legs. In some cases, the baby might even enlarge their stomachs. Once your baby enters the duration of three to four months, the colic is likely to improve. Though there is no definite reason for developing colic, sometimes a change of diet for the breastfeeding mother or changing the bottle-fed formula of the infants can help. You can even truncate the adverse effects of colic by a pacifier or snugly wrapping your baby in a blanket. Jaundice Due to the buildup of bilirubin, a substance produced by the body during the breakdown of the old red blood cells, your baby might get one of the most common diseases in babies known as jaundice. Jaundice causes a yellowish tinge in your baby’s mouth, eyes and skin. In case the liver of the baby is unable to remove bilirubin from the body in the first few days after birth, the infant may get jaundice.  This sickness in infant should be immediately treated by contacting your healthcare provider. Generally, the infants need no treatment during jaundice but your healthcare provider may sometimes prescribe phototherapy for the infant. *Information shared here is for general purpose. Please take doctors’ advice before making any decision. 

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04 December, 2021

5 Superfoods To Maintain Your Children’s Eyesight

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Maintaining your child’s eyesight begins with a healthy diet. Many food groups are rich in vitamins, minerals, and nutrients that aid in preserving their vision. But carrots come to mind when you think about foods that might help you enhance your vision. You wouldn’t be wrong, would you? After all, while “rabbit food” is high in vitamin A, which is necessary for excellent vision.  However, it isn’t the be-all, end-all of eye-healthy foods. There are other superfoods, including carrots, that will help you maintain your child’s eyesight. Here are 5 superfoods to maintain your children’s eyesight.  Deep Water Fish with Omega-3 fatty acids - Omega-3 fatty acids are mostly found in salmon, tuna, and mackerel. They assist in keeping your child’s eyes lubricated and avoid dry eye syndrome. They can also help lower their chance of getting cataracts and macular degeneration later in life if they eat them regularly.Green leafy vegetables - Lutein and zeaxanthin are abundant in kale, spinach, and collard greens. These carotenoids have strong antioxidative characteristics that help protect your eyes from free radicals. They function as a defensive mechanism to prevent macular degeneration and cataract formation as your youngster grows up, according to your professional eye doctor.Berries and Citrus Fruits for Vitamin C - As a snack, try giving strawberries and oranges as snacks for your kid. These fruits are rich in Vitamin C, which helps improve your child’s immune system and increase their resilience to illnesses and disorders. Include them together in their meals.Nuts with Vitamin E - Almonds, pistachios, and walnuts should all be included in your child’s diet. Vitamin E, which significantly works as an antioxidant, is abundant in these nuts and helps to protect your child’s eyesight. Having nuts on a regular basis has been shown as an excellent home treatment for myopia management.Eggs and carrots Preventing night blindness and dry eyes might be as simple as eating vitamin A-rich eggs. Carrots also have a lot of beta-carotene, which is a precursor to vitamin A. They protect your child’s ocular structural integrity and ensure that their eye components work properly.  When to visit the doctor? Call your doctor if the child mentions frequent pain in the eyes, touches their eyes repeatedly, has chronic tears, or complains of hazy or double vision. In the interim, apply a cold pack to your child’s damaged eye for 15 minutes every hour or so. If you’re going to use an ice pack, cover it in a wet towel to keep the eye from freezing. Taking immediate actions will help your child greatly in avoiding the more significant damage.  *Information shared here is for general purpose. Please take doctors’ advice before taking any decision. 

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13 October, 2021

Fever In Newborn

Authored By: Dr. Aravinda Lochani T

Normal body temperature is 98.6 F or 37 C (+/- 0.5 C). Any body temperature greater than 99.5 F or 37. 5 C is termed as fever in newborns. Fever is the body’s defense mechanism that helps to fight infection or inflammation. How to measure fever: By using a digital thermometer in the axilla (armpit) or with the help of an infrared thermometer which measures the skin temperature (usually measured from the forehead) Causes of fever:  Dehydration (due to poor feeding) Hot environment or proximity to sunlight Wrapping the baby in too many clothes Infection Postvaccination Maternal fever at the time of delivery Symptoms: The baby may be irritable, appear flushed, have either fast breathing or decreased breathing efforts, have dull activity, abnormal tone, and decreased intake of feeds Untreated fever or infection may lead to seizures and has increased risk of mortality.  What to do when your baby has fever: First unwrap the baby and keep the baby in a normal environment (25-28 C). Try to give breastfeed/expressed breast milk as spoon feed to the baby. Recheck the temperature after 20-30 minutes.  If baby’s temperature is normal and baby is feeding adequately, ensure frequent feeds. A properly fed baby sleeps comfortably between two feeding sessions, passes urine 8-10 times in a day and gains weight consistently. If the baby is still having a temperature of > 99.5 F, or having any other symptoms mentioned above, approach the doctor as early as possible for complete evaluation of dehydration/ infection.  KEEPING BABIES WARM (PREVENTING HYPOTHERMIA) Normal body temperature in adults is maintained by metabolism (through brown fat stored inside the body) as well as by shivering. Babies, before they were born, lie inside the mother’s womb, where the amniotic fluid keeps the baby warm. Normal body temperature of newborns measured in the axilla(armpit) is between 36.5 C- 37.5 C. After birth babies tend to become hypothermic due to the cold environment and also because of not able to generate appropriate shivering response. Low body temperature leads to dull activity, poor feeding, increased risk of infections and also increased risk of mortality. How to avoid hypothermia (or low body temperature) in term babies: Immediately after birth baby should be dried fully with a clean towel and placed on the mother’s chest/ abdomen. Breast feeding should be initiated within 1 hour of birth and baby should be roomed in with the mother throughout the day. Breast feeding should be encouraged every 2nd hourly, in the first few postnatal days. Avoid bathing the baby until the cord falls off. Keep the baby always covered with cap, socks, mittens and dress. Keep the baby wrapped properly all the time. Maintain the room temperature between 25- 28 C. Avoid placing the baby near open window or doors where there might be exposure to cold air/draught. The palms and soles of the baby should be as warm as the chest when the skin temperature of the baby is felt by the back of the parent’s hand.  If the soles of the baby feel cold compared to chest, baby is in cold stress and needs to be clothed and wrapped properly If for any reason, baby’s skin feels cold, or baby is dull with decreased intake of feeds, contact the health care personnel. PREMATURE INFANTS: Premature infants are more vulnerable to low body temperature because of: A higher skin surface area compared to weight.Thin skin with no subcutaneous fat which leads to evaporative heat loss.Less brown fat and poor vasomotor control. Inability to establish full feeds at birth due to gut immaturity Therefore premature babies need to be cared for in the Neonatal Intensive Care Unit (NICU), where the babies will be placed under radiant warmers to maintain body temperature. Very premature babies are usually placed inside incubators where the humidity of the baby’s environment can also be controlled to prevent evaporative heat losses through the skin. Premature babies, if they need respiratory support are provided with heated and humidified air through bubble CPAPs or ventilators.  Kangaroo mother care, initiated as soon as the baby is stable also keeps the baby warm.

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01 October, 2021

Dengue Fever In Children: Our Old Enemy

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DENGUE FEVER IN CHILDREN OUR OLD EMEMY In current times of COVID having fever makes all of us anxious specifically if it’s our kids, but currently the scare of Dengue fever making lot of parents and doctors more scared that COVID. As dengue is endemic/epidemic tropical fever (infection still very prevalent in Hyderabad (India) and can lead to very critical disease if not attended immediately. In spite of listening to all stories of dengue fever around us, it really doesn’t hit you until one of your own contracts this deadly disease.  STORY: There are several stories comes in my mind when I think about dengue but when my own daughter had this disease it made me to think about how bad this disease is and what are the complications of this disease, what helps and what complicates these kids and admitting them timely so that they don’t deteriorate is the most important thing about this disease.  STORY OF ONE OF OUR PATIENT COMING TO KIMS CUDDLES: It was a regular day. When I came from my work I found my 10 years old daughter is little dull and having fever of 100F, Generally, once she is back from her basketball classes, she will inform me all events about her day including what happened during her basketball training, but that day she was looking very dull and she straight way went to bed and said I don’t feel like eating, I thought that she might be tired that’s why she is dull and feeling little feverish.  After coming home she usually pay with her pet but that day she was not in mood of playing with him, and it has never happened in past few years they I understood that something is wrong and she is not well. After 1 hour when I checked her she was having high fever of 103F and she was burning all over.  I gave her Paracetamol and gave her little tepid sponging to reduce the fever early. That night she persisted to had intermittent fever throughout the night ranging between 101-104F and I gave almost 4 doses of Paracetamol to her. Next day she started complaining headache and pain around eyes and by the end of the day she started having rash all around the body. Her oral intake was very minimal and her urine colour turned very dark. She became so weak that she was not able to walk and preferring to in bed.  I understood this is not some routine infection and something is not good, I decided to take my daughter to the hospital immediately. Once I reached KIMS Cuddles Hospital, Kondapur, Pediatrician saw him in emergency room, checked his vitals which showed low BP, they immediately put IV cannula gave IVF and did some test and shifted her to Pediatric Intensive Care Unit as she was having Dengue Shock Syndrome (Dengue fever with low BP) My daughter had dengue fever, her packed cell volume (PCV, Blood thickness) was more and his platelets were falling down rapidly, his liver showing some swelling and her body was getting swollen.  Thankfully though my daughter had critical Dengue because of of timely intervention of my Pediatrician & KIMS CUDDLES hospital, my daughter was there in PICU for 3 days and then for 2 days in room. With all intense and appropriate management her fever began coming down. They serially monitored her blood thickness and platelet count. And within a week we were back home.   It’s definitely not an illness that you would want anyone to endure, especially children. And remember the real problem start or child becomes sicker when the fever subsides. Over the time you start recovering the weakness lingers on for a long period which can take a toll on your child’s health and well-being. What is Dengue Fever? Dengue fever is self-limiting viral infection and is caused by a bite of mosquito transmitting virus in body of individual. It’s common in Tropical areas like India. The virus can cause symptoms like fever, headaches, rashes, and pain throughout the body. Dengue Fever Transmission: Dengue fever is transmitted through the bite of an Aedes Aegypti mosquito infected with the dengue virus. When an Aedes mosquito bites a person who has already been infected with a dengue virus, the mosquito can also become a carrier of the virus. If this mosquito then goes on to bite someone else, the person gets infected by the dengue fever. This virus however cannot spread directly from person to person. Dengue Fever Signs & Symptoms: Most of dengue patient get milder symptoms but it can cause serious disease in May in the form of disease called Dengue Hemorrhagic Fever or DHF Dengue Shock Syndrome. This form of dengue can end up being life-threatening and needs to be treated immediately. While symptoms of dengue in kids and those who are experiencing the disease for the first time are mild, older kids, adults, and those who have had a previous infection may have moderate to severe symptoms. Below are some common signs and symptoms of dengue in kids that a parent should look out for High fever, can even be as high as 105 degrees F. Most common initial symptoms are like flue like high-grade fever, runny nose, cough, and weakness. Severe headache- Sometimes kids get retro-orbital pain, joint pain, abdominal pain and severe muscle or body pain.  Change in behavior- Children may exhibit more irritability and fussiness than usual. Poor feeding, lethargy, decreased acceptance of fluids, passing high coloured urine Rashes over the body- A common symptom of dengue fever is an itchy skin rash that appears in patches. Usually rash appears on day 2-3 of fever and sometimes its diffuse and unrecognizable.  Bleeding manifestation, though uncommon, common site of bleeding are nose, gums, sometimes in motion and urine. Mild bruising Abdominal pain Calm and cold peripheries like hand and feet, change in colour of peripheries or dusky peripheries Sometimes some patient might have abnormal movements called as seizures Decrease urine output or passing very high coloured urine Breathing difficulty, mainly during late phase of disease. Generally, the dengue symptoms and signs like fever, rash, and headache often referred to as the dengue triad is characteristic of dengue. Another name for dengue fever is also dandy fever or break-bone fever owing to the severe bone and muscle pain it can cause. Often the pain can be so bad that it can feel equivalent to bones breaking. Diagnosis and Treatment of Dengue Fever The symptoms of dengue fever can be observed from 4 days to 2 weeks post being bitten by an infected mosquito, and generally lasts for about 2 to 7 days. Often the period after the fever begins to subside is crucial for those people with DHF (dengue hemorrhagic fever). Severe bleeding, gastrointestinal problems like nausea, vomiting or severe abdominal pain, and respiratory problems like difficulty in breathing. Also, a drop in blood pressure, dehydration, and heavy bleeding can happen if DHF goes untreated. These symptoms are life-threatening and need immediate medical attention. What are the danger signs or when we should hospitalized children? High spiking fever lasting more than 2 days Poor oral acceptance or dehydration Child not passing urine for more than 8-10 hours Bluish discoloration of extremities or hand and leg getting cold Abnormal behaviour or seizures Bleeding from any site Persistent abdominal pain or vomiting Swelling over body How Is Dengue Fever Diagnosed? Clinical symptoms as discussed above Blood test (as suggested by doctor) Most commonly dose blood test are Complete Blood Test (showing fall in WBC and platelet count with increasing PCV or Hemoglobin), C – reactive protein (to rule out other infection) and Specific Dengue test (Dengue NS1 antigen or Dengue IgM test) Treatment of Dengue fever Currently, there is no specific treatment for dengue fever. However, in most cases, dengue fever goes away within a 7-10 days. Not all dengue fever needs treatment or hospitalization. Almost 80% of patient with mild dengue get treated at home with hydration and as and when required Antipyretics (paracetamol).  Patient with danger signs as explained above needs admission and evaluation. But if someone has severe symptoms, medical attention must be sought immediately, as it could be signs of DHF which can be life-threatening, Hospitalized Management:  Intravenous fluid as per proper Dengue protocol (means IVF fluid are given in particular way) As and when required Paracetamol if temperature >100F Medications to take care of acidity of stomach  Frequently monitoring blood thickness level and platelet count and titrating IVF accordingly And if there is life threatening bleed supplementing with platelet and other blood products transfusion. Other general things to be taken care off Make sure your child is drinking enough fluids and water along with healthy meals. Ensuring that your child sleeps well is essential for his recovery.  A healthy diet and sufficient rest will help strengthen his immunity and destroy the virus. Pain relievers like acetaminophen may be prescribed if your child is experiencing unbearable muscle and joint aches associated with dengue fever.  Pain relievers like aspirin or ibuprofen should be avoided, as they can make bleeding happen. Including generous amounts of immunity building foods in your child’s diet, like citrus fruits, almonds, turmeric, garlic, etc. will help in strengthening your little ones’ immunity and aid in quick recovery. Lastly, efforts must be made to keep the infected child from being bitten by any mosquitoes as this will help in preventing the spread of dengue fever to others. Can Dengue Fever Be Prevented? As there are no vaccinations to prevent dengue fever, the best protection is to ensure that your child does not get bitten by an infected mosquito. Prevention is better than cure when it comes to dengue fever and there are several ways in which you can protect yourself and your family from this illness Use screen meshes on door frames and windows to keep mosquitoes out without compromising on the ventilation aspect.  Ensure good quality screens are installed, which are less likely to rip as mosquitoes can make way into your house even through the smallest possible opening. Also, fix any tears in the mesh or broken and damaged screens as soon as possible.  All un-screened windows and doors must be kept closed. Ensure kids are wearing long-sleeved shirts, long pants, shoes, and socks, whenever they step outside the house. Limit outdoor activities of kids especially in the hours around dawn and dusk when mosquitoes are most active. Keep the kids engage with fun indoor activities like board games etc. Don’t give mosquitoes places to breed in. They lay their eggs in stagnant water, so get rid of any sources of standing water like containers, mugs, basins, and pots, buckets including draining sinks and bathtubs too. Ensure that the water is removed or covered. Taking the above-mentioned precautions to prevent your child from contracting the disease becomes crucial especially due to the lack of a cure or vaccine for dengue fever.

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21 September, 2021

Crying in Babies

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Crying in babies Often crying in babies is a cause of anxiety among family members and a reason for frequent visits to Paediatric emergency. Many a times it will not be associated with any serious problems and requires reassurance to the parents. What are the causes of crying in babies? Hunger cry – hunger is the most common cause and subsides once baby is given feeds. Baby starts playing after feeding. Soiled / wet diaper – Baby’s skin is so sensitive that faecal soiling and urination can cause irritation. Once diaper is changed babies calm down. Before sleep – Babies become fussy before going to sleep and requires some swaddling and mom needs to keep the baby in comfortable position. Excessive feeding – Some parents feed their babies more due to misconception about inadequate feeds, which causes mild bloating of tummy. Improper clothing – Excessive wrapping with many layers of cloth during hot climate or inadequate clothing during winter seasons can lead to crying of babies. Inadequate burping – Burping after feeding for about 10min relieves baby from swallowed air and makes them comfortable. Inadequate cuddling – Often babies require cuddling from mom and feel comfortable. Causes of concern  Nose Block – During times of cold and running nose babies can have congestion of nose which leads to transient nose block. Colic – Usually in the early months of life majority of babies cry without any serious problem. But when the duration of cry is more than 3hours we may have to suspect colic. Pain – Painful diaper rash, Ear ache, injection site pain, any insect bites (eg: mosquitoes) Fever – When your baby is having body temperature more than 100.40f. Constipation – Some babies might pass stool once in 3 to 4days, but it can be painful if it’s hard lumpy stool. Urine infection – Babies may sometimes cry before voiding urine. But persistent crying while passing urine can be a sign of urinary tract infection. Serious bacterial infection – Decreased activity, poor feeding, lethargy, excessive irritable crying and not interested in surroundings can be a sign of serious bacterial infection When do we suspect colic in babies? Inconsolable crying for more than 3hours Baby looks normal in between the bouts of crying Baby crying with legs folded up into abdomen Baby is getting enough feeds, but still cries Myths about crying baby Passing of gas is normal in babies, which is usually misunderstood by parents. Swallowed air while feeding may also contribute to the gas. Flatus does not cause abdomen colic. Regurgitation (spitting up) of feeds in small quantities may be seen in few babies, which is a self limiting condition and does not cause pain How to calm babies while crying? Techniques that can be of some help for calming a crying baby are Wrapping and swaddling the baby Try to feed the baby Talking to baby and singing  Rocking motion, preferably in a rocker Burping the baby Holding up of baby in arms by mom Playing light music What parents can do in case baby is inconsolable? Sometimes babies cry without an apparent cause, so don’t be too anxious. Be patient and visit your nearby Paediatrician  If in case you cannot visit to clinic, make a teleconsultation with your Paediatrician Whenever baby is not feeding well, irritable, running high temperature, breathing fast, not interested in surrounding then you may need to make a visit a Paediatric emergency. Never use any medication such as ear drops, colic drops etc., without Paediatrician advice.

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21 September, 2021

Meningitis

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Meningitis is an infection / inflammation of the meninges – the covering of brain and spinal cord. It is caused by bacteria and viruses commonly. Rarely fungi and non-infectious causes may also cause meningitis. Symptoms – Fever – is present in most cases of meningitis and in small babies and infants sometimes high grade fever maybe the only presenting complaint. Headache Neck stiffness Vomiting’s Irritability – specially in younger children Lethargy Diagnosis – If your pediatrician suspects meningitis she may ask for a brain imaging – CT scan or MRI. But a lumbar puncture is the only way to confirm the diagnosis and also helps in deciding which medication is most likely to help. Lumbar puncture is performed by inserting a very small needle through the child’s back in the space between 2 vertebrae to collect cerebrospinal fluid. It sounds very scary to most parents but it is a rather simple procedure. If a diagnosis of meningitis is missed it can have long term sequelae/ complications. Management – Mainstay of treatment is intravenous antibiotics for bacterial meningitis – duration of antibiotics is usually for 2-3 weeks. Oral antibiotics do not work in meningitis. For viral meningitis treatment is mostly supportive but for some viruses antivirals drugs are effective. Complications – If meningitis is not treated appropriately or timely it can lead to sequelae/complications. Deafness Epilepsy Cognitive impairment – impairment in intellectual functions and day to day activities Weakness of hands or legs Prevention – Meningitis can be caused by many bacteria or viruses. For the common organisms causing bacterial meningitis vaccination is available so be sure to vaccinate your child on time.

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