Thursday, February 26, 2009

feeding a low birth weight infant RE: Feedback via the Ask Health Query to Dr SK. Get answered for free.

My daughter is born at 37th week with weight 1.75kgs. And Doc has done so many tests to find why she is so small for her gestational age. and everything came normal. so we just thought it is just genetics.
===common cause of low birth weight is poor maternal weight gain. other cuasess are some intrauterine infections and some genetic syndromes. even problems of placenta and mother's hypertension may at times cause low birth weight. whatever the cause, that cant be reversed right now, so we should concentrate on treating.
 
 i will pump milk and gives her through bottle. she used to cry for hunger untill she finishes her 2 months. At her 4months oppintment she weighs 3.37kgs.
======= she has remained as a intrauterine growth retarded baby, so as per that her growth potential will be relatively slow. she may remain smaller on growth charts, but should show a consistently rising birth weight, to catchup with other kids of same age by one year. if she doesnt gain weight consistently, we need to evaluate. She has almost doubled the weight by this age, so i feel .. thats no bad. you did enough efforts to have good growth. many enzyme disorders get ruled out when one documents a progressive weight gain.
>
> At her 2 months oppintment doc thought she is not gaining much weight and she put tube in her nose to feed. we kept > untill 2 weeks and she was vomiting a lot so we thought its not good idea and we removed that.
== feeding by tube is always a more reliable option. in many cases i even recommend putting a gastrostomy tube.. with a small operation till weight gain is adequate. if the weight gain is not enough, it may cause further growth failure and child may succumb to many infections and morbidities.
 
 from then on doc advised us to add infant formula to breastmilk.
=== a calculated supervised feeding is always preferable when weight gain is crucial.
 
And now she doesn\\\'t even cry for hunger anymore even if we wait 4 hours. So we feed her every 2 hours. and she takes 40ml in half hour.
=== good. she may not have energy to cry. but do burp well after each feed. keep her semierect or held on shoulders to avoid aspirations/reflux. max feed at one time over 30 minutes should not exceed 60 ml for 4 kg body weight.
 
  
she only sucks while she is sleeping. she doesn\\\'t suck while she is awake
=======suck reflex starts disappearing sooner by this age. in addition she may be getting fatigued with prolonged suck. this classically is  observed in many neurological waeknesses, underlying heart diseases etc all need not be picked up with investigations easily each time.
 
 and she only swallowes what ever drips from the bottle.
===use a smaller spoon or dropper that a botle. save the infants energy wasted in sucking efforts, weight gain will be better.
 
 
 we repented a lot going with that tube option.
===why do you feel so, if you face any probs with doc, discuss with me and we can sort soem solutions. learn the correct method of tube feeding when you opt for it.
 
 from then she doesn\\\'t like milk at all.
=== she does drink.. as you said she swallows drops. if she is alert and active she has least reasons not to drink. common reasons at this age being cheek/ throat infections like fungal candidiasis, inability or weakness to suck.  check again.. she should take better with a small spoon. feed slowly and for long time.
 
 and it is very hard for us to feed when she is awake.
===id it that cos you feel she doesnt suck? whatever trickles from the bottle, she surely will be swallowing as she does in sleep. its another indication to try spoon feeds in propped up posture.
 
 And doctor in USA keep on insisting us to put tube in her stomach to feed. We don\\\'t know whether it is a good idea to go with that option.and doc always asks us to visit so many specilists all the time.
=== its good idea to get rapid weight gain without hassles and other feeding related issues.
>
> she is able to lift her head and she smiles when we smile and her eyes will fallow us. she poops and she is having wet diapers.
======== good.. keep a close watch on milestones. many low birth weight abbies have delayed milestones. its important to pick up earliest as then only it can be modified. so visit a developmental therapist at least 4 times in next 2 months. have the development periodically assessed.
>
> Doc put her on prevacid for acid reflux at 2 months oppintment as she is vomiting once daily.from then on she is having gagging and once in a while cough.
===all this can avoided by feeding her in semierect posture holding her in arms.. and trying feeds with dropper or small spoon and letting the feed trickle along cheeks form the angle of mouth.
>
> 1. can you please let us know whether she is fine with her weight for that age?(she doubled her weight by 41/2 months).
=== she is just ok but needs a close supervision and weight management with feeding.
> 2. when can i start semi solids and fruit juices to her?do we need to go by months or weight to start these?
===by 6 months should be fine.
> 3. what are the foods that make them gain more weight? semi solids? or fruits? or milk as i want to go with only more calories food.
> calculated feeds.. like say well prepared formula feeds.
>
> I would really appreciate all your help.
=== read further details at http://infantfeeding.blogspot.com

>
> Thank you so much
> Ji
> ---------------------------------------------------------------------
> Visitor Ip: 170.35.224.63


feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics


 

> >

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HELPING YOU UNDERSTAND CHILDREN, THEIR HEALTH , THEIR ILLNESS, BEHAVIOUR, TREATMENT AND DOCTOR ! Arvhives 2006
yes! the easily approachable,
friendly and understanding paediatrician.
MBBS, MD, DNB and FCPS
from Seth G S Medical college Mumbai.
Currently working as Lecturer in Pediatrics.
drpeds.blogspot.com
Arvhives 2006

Cough and Cold particularly in Winter RE: Feedback via the Ask Health Query to Dr SK. Get answered for free.

I have a girl baby who is suffering from Cough and Cold. She is two and a half years old. When she got birth she was suffering from Pneumonia. From that period she is suffering Caugh and Cold particularly in Winter. We have used lots of Anti-biotic as per doctor\\\'s advice but she has not got total cure. I want advice how she will get rid of from this disease.

 
the common diseases that resemble cold cough in winter are asthma, bronchiolitis, tonsillitis, adenoids and pneumonias. has the child gaining weight otherwise? if no, its likely to be chronic tonsiloadenoditis. if the symptoms are more in night and early morning, you are closer to asthma. if its only acute event with high fever, you are closer to pneumonia. discuss this with your doctor.


feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics

> Detailed Query: > ---------------------------------------------------------------------
> Visitor Ip: 121.247.229.3
>


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HELPING YOU UNDERSTAND CHILDREN, THEIR HEALTH , THEIR ILLNESS, BEHAVIOUR, TREATMENT AND DOCTOR ! Arvhives 2006
yes! the easily approachable,
friendly and understanding paediatrician.
MBBS, MD, DNB and FCPS
from Seth G S Medical college Mumbai.
Currently working as Lecturer in Pediatrics.
drpeds.blogspot.com
Arvhives 2006

Monday, February 23, 2009

PROLONGED INFECTIONS IN THROAT AND LUNGS RE: Feedback via the Ask Health Query to Dr SK. Get answered for free.

REGULAR PAEDIATRICIANS WHO WE CONSULT HAVE BEEN INSISTING THAT HE IS SUFFERING FROM NORMAL INFECTIONS IN THROAT AND LUNGS. BUT THE CONDITION OF THE CHILD IS NOT IMPROVING AT ALL INSPITE OF USING SEVERAL MEDICINES LIKE AZITHRAL, PCEF ETC., ALONG WITH NEBULISATION, NASAL DROPS.
>
> WHAT COULD BE THE PROBABLE REASON FOR SUCH PROLONGED PERIOD OF ILLNESS? WHAT DO YOU SUGGEST THE MEDICATION SHOULD BE?",""

Two common reasons:
1. unresolved infection with persistant focus as in adenoids and tonsils
2. no infection, but condition like allergy like say asthma or allergic rhinitis.
it would have beene asier fro me if you had mentioned age, number of episodes in last 6 months, presenece of fever with each episode, and anytime if any antibiotic therapy taken for 10 days or more.
 
 

feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics


> Visitor Ip: 60.243.173.227
> ***


Akshay Kumar takes on the two reigning Bollywood Khans. Catch the action on MSN Entertainment! Check it out!
HELPING YOU UNDERSTAND CHILDREN, THEIR HEALTH , THEIR ILLNESS, BEHAVIOUR, TREATMENT AND DOCTOR ! Arvhives 2006
yes! the easily approachable,
friendly and understanding paediatrician.
MBBS, MD, DNB and FCPS
from Seth G S Medical college Mumbai.
Currently working as Lecturer in Pediatrics.
drpeds.blogspot.com
Arvhives 2006

Sunday, February 15, 2009

3.3 year old boy who does not eat anything properly

 have a 3.3 year old boy who does not eat anything properly, and does not take even liquid foods, he looks so week and lean and we are very much worried about him.I agree that this is the most commonest questions.....but still as a parent we cannot see him growing so weak at this stage.His is 12 or 13 Kgs as of now, please suggest what medications have to be followed, I m also attaching his recent picture  
 
all this feeling may also be related to his feeding and diet habits since birth. so accordingly for indian settings 13 kg for 3 years isnt bad.. but surely is low. more commonly with low intake its common to have various vitamin mineral and calcium deficiency. as this has happened over 3 years, it can be changed like magic in 2 months, but surely within an year of dietary reforms and supplements you may find gain in weight.
another common thing that needs to be ruled out in suspected not gaining weight is common infections like throat infections, adenoids, tonsils, TB etc and/or any long standing illness.
please write back at the site with his details of diet per day on ana average, say 15 days back. i will surely eb able to suggets something. also read http://infantfeeding.blogspot.com
also read http://drpeds.blogspot.com/2008/12/1-year-old-not-eating-re-feedback-via.html
 
 

feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics



>
> Visitor Ip: 117.200.17.29
>


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HELPING YOU UNDERSTAND CHILDREN, THEIR HEALTH , THEIR ILLNESS, BEHAVIOUR, TREATMENT AND DOCTOR ! Arvhives 2006
yes! the easily approachable,
friendly and understanding paediatrician.
MBBS, MD, DNB and FCPS
from Seth G S Medical college Mumbai.
Currently working as Lecturer in Pediatrics.
drpeds.blogspot.com
Arvhives 2006

Saturday, February 14, 2009

5 month old with cold

My five month old infant had a cold a week ago (running nose, mild fever 99 degrees). He recovered on his own, without any medicines.
=== its like soem sort fo acute bronchiolitis or rhinitis. in most such cases runny nose settles but coughmay last 10 days.
 
For 6 days now, he has cough whenever he sleeps (day time or night time). It has become more severe for the last two nights. I would say it is wet cough as there is some sound of phlegm. He does not have running nose, fever or any other problem. He takes feeds well (breast fed).
=== well most such coughs get relieved when you make them slep on side. it may be due to stridor, low  calcium, secretions and occasionally asthma at this age. practising side or erect posturefor 2 weeks will settle matters in most cases without meds.
 
He also has nasal congestion...he cannot sleep in a room with the fan running, even if he is not directly in the breeze. Is this ok?
=== again, its liek nose gettingd ried and crusted.. that means there some secretions that are getting thick and stuck inside. while sleeping under fan, make him sleep on one side, let teh fan eb on head end of bed or moisten his nose before sleeping and make him sleep with a pillow so no direct blast gets inside. you may also reduce the fan speed.
 
We use Nasoclear 2-3 times every night - but that does not help for the cough - he wakes up almost every one hour at night and during day time naps every 20 minutes. After feeds, while burping, he invariably coughs.
=== nasoclear(normal saline) is very safe, so you may use any number of times, u may use it as a spray too. keeping nose clean with ear buds does helpoccasionally cough alone can eb due to refluc disease, but i dont find that likely given this situations. burping cough is common, and burping is a good habit.
 
Should this be treated or will it pass on its own?
=== he may need to be evaluated if teh cough is distressing and dosnt relieve on comforting or taking him on shoulder and patting on back.
 
I tried applying Vicks only on the soles of the feet and covering them with socks (a friend told me about this) to stop the cough but not much effect.
==- its good.. children feel comfortable when some mild irritant diverts their attention. but has no effect on cough.
 
We did not apply Vicks on chest or nose as we were scared to try on him.
== well its safer in small quantities especially mixed with water.. but legally i wont say that.
 
Do help, I am worried. By the way, I have a four year old who probably brought the virus from school - she had a viral infection after my infant son had the cold - I had throat congestion also last week.
== get throat tested for strepts, gargling is good habit to keep throat clean. iust surely viral, read www.pediatricianonline.in for more details about treating cold at home.
 


feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics



>>
>
> Visitor Ip: 122.172.38.207
>


Akshay Kumar takes on the two reigning Bollywood Khans. Catch the action on MSN Entertainment! Check it out!
HELPING YOU UNDERSTAND CHILDREN, THEIR HEALTH , THEIR ILLNESS, BEHAVIOUR, TREATMENT AND DOCTOR ! Arvhives 2006
yes! the easily approachable,
friendly and understanding paediatrician.
MBBS, MD, DNB and FCPS
from Seth G S Medical college Mumbai.
Currently working as Lecturer in Pediatrics.
drpeds.blogspot.com
Arvhives 2006

Friday, February 13, 2009

8 month old not feeding

Dear Doctor,
> I have an 11 month baby (I am the father). He sufferred from severe diarrhea and vomiting when he was 8 months old (Seems rota virus).
=== loose motions are common in infants and are commonly due to contamination with feeding or putting hands in mouth. loose motions of long duration may cause loss of absorbing mucosa that may take 2 weeks to heal, thus causing poor intake and poor weight gain. adequate zinc therapy for 14 days as advised by a doctor may help heal gut faster.

 After that, his weight has not really gained well.
=== hard efforts need to be put increasing frequency and quantity of feeds. read details at http://infantfeeding.blogspot.com  the feeds should be smaller with a smaller spoon but calorie rich.


> He is 8.3 kg now.
== its not a bad weight for indian settings, but is surely on lower side at 1 year age. even increased activity by this age make them gain weight slowly.

 He many times throw\\\\\\\'s up (Vomits) whatever he has eaten. So, he is refusing to basically eat anything now... whenever he eats... he eats in small quatities (like 75 ml of milk is enough for him).
=== the thing he needs to learn is chewing. provide small quantities with mashed semisolids.. try this repeatedly. avoid large quantity in smaller duration. if vomiting is 5 times a day, the child may need evaluation for say reflux disease.

> Has frequent throwing in past week created a fear of food in him ?
== its not a fear factor. it may be that he just doesnt like teh type of feed you offer him. at this age kids prefer sticky liquids like say soups porridges etc.

> My wife is really worried. Please suggest ?
== sure., feel free to reply at the site.
> Thanks,

feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics

> Detailed Query:
>


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HELPING YOU UNDERSTAND CHILDREN, THEIR HEALTH , THEIR ILLNESS, BEHAVIOUR, TREATMENT AND DOCTOR ! Arvhives 2006
yes! the easily approachable,
friendly and understanding paediatrician.
MBBS, MD, DNB and FCPS
from Seth G S Medical college Mumbai.
Currently working as Lecturer in Pediatrics.
drpeds.blogspot.com
Arvhives 2006

R5 year, repeated febrile seizure

my girl 5 years 6 months old, weiht 21 Kgs, She has history convulsion.Since 8 months olds, until now, she has 13 times convulsion,
=== in such conditions its important to know the milestones in the child. most often they are likely to be delayed. convulsions withd elayed milestones seem to be refractory at times.
Last convulsion On March 2008, degres 38.4 celcius.We alreday prepare at home, ibuprofen 12.5mg supository, paracetamol 125 mg syrup , and Diazepam supository (this is to be given if she has convulsion).
======= so it was treated as a febrile seizure, usually febrile seizures dont come so often. [;s read about febrile seizures: at http://drpeds.blogspot.com/search/label/febrile%20seizure%20query
>
> Question:
>
> 1.When this convulsion will be go away?
=== when it has been diagnosed and evaluated properly. at times she may need long duration of anticonvulsants. like say clobazam therapy.

> 2. I have read in one literature (fibrile seizure=convulsion is caused by not enough Ca (calcium), so please advise from what kind of food to be given ( contain much calcium) if need calcium?
=== rather low calcium is a common cause of seizure than febrile seizure even if it comes with fever. not food, but cAlcium and vitamin D supplements are more imortant in preventing them.
> 3.Some time she tell us that she has painful in calf of leg and thigh of leg,the paitfil is not continue, but some time come with range.we care of this, because one time when she said pain in his calf , after that she get Pain with 37.7 degres
=== pain in calf is more common with low calcium and/or fever. regular calcium supplements may help this overcome.

feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics



>
>
> M
>




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HELPING YOU UNDERSTAND CHILDREN, THEIR HEALTH , THEIR ILLNESS, BEHAVIOUR, TREATMENT AND DOCTOR ! Arvhives 2006
yes! the easily approachable,
friendly and understanding paediatrician.
MBBS, MD, DNB and FCPS
from Seth G S Medical college Mumbai.
Currently working as Lecturer in Pediatrics.
drpeds.blogspot.com
Arvhives 2006