Atopic Dermatitis

Good Daily Skin Care
Bath or shower daily in warm (not hot) water for 10 to 15minutes maximum. Use minimal soap.

• Use mild soap/ soap free agent
• Pat dry after bathing
• Soap application: genitals, axilla, groins
• Clip all nails

Apply a thick, non fragranced moisturizer all over twice daily. first applied right after the bath after gently patting the skin dry.

Avoidance of Triggers

• Worsened by cold and dry weather, harsh detergents, and fragrances.
• Avoid products that have added fragrances or additives (this includes lotions, detergents, fabric softeners, perfumes) and look for products that are labeled fragrance free.
• Try to avoid those that seem to clearly cause flares of skin disease.

Treatment of Eczema Flares

• Treat the red, itchy, and rough areas with the topical medicines until they are smooth and itch free.
• Always apply steroids to the areas that need them before applying a moisturizer all over.
• Anti-itching drugs in night time

Meet your Doctor

• If there are areas of crusting, scabbing, or oozing or sores that do not heal.(sign of infection)
• If using the topical medications as prescribed and the eczema has not improve

Add lukewarm water to fill the tub completely (about 40 gallons of water).

Depending on the size of the tub/amount of water used, add ¼ to ½ cup of common bleach solution to the bath water. Any sodium hypochlorite 6% solution will do (for example, Chlorox liquid bleach); the goal is to make a modified Dakin's solution with a final concentration of about 0.005%.

Stir the mixture to ensure that the bleach is completely diluted in the bath water.

Have patients soak in the chlorinated water for 5 to 10 minutes.

Thoroughly rinse skin clear with lukewarm, fresh water at the end of the bleach bath to prevent dryness and irritation.

As soon as the bath is over, pat the patient dry. Do not rub dry, as this is the same as scratching.

Immediately apply any prescribed medications/emollients.

Repeat bleach baths 2–3 times a week or as prescribed by the physician.

The following restrictions apply
    Do not use undiluted bleach directly on the skin. Even diluted bleach baths can potentially cause dryness and/or irritation.

Do not use bleach baths if there are many breaks or open areas in the skin (for fear of intense stinging and burning).

Do not use bleach baths in patients with a known contact allergy to chlorine

Atopic Dermatitis (Eczema) in Children

What is Eczema?
Eczema is a skin disorder that makes children itchy and dry flaky skin. Many times,a kid can have patchy dry skin.

What are the common symptoms of Eczema?

• Severe Itching
• Red, pink patches with patches
• Dry Flakes or scaly skin lesion

Can it Occur in Family?

• Yes

What is the common area of the body which can be affected

• Front of arms & legs
• Cheeks
• Scalp

(However, DIAPER AREA is usually spared)

Do we need any skin test or allergy test to diagnose Atopic dermatitis or Eczema

• NO
• Your child specialist can diagnose it clinically

At home, how can we avoid any flare-up of Eczema

• Avoid too hot or too cold (Extreme temperature change)
• Avoid Harsh soap (look for pH of 5.5)
• Avoid scented products or perfumes
• Avoid synthetic clothes like polyester

How to ManageEczema
The best part is that almost more than 50 % of the kid with Eczema outgrows with age.

Treatment:

• Wet Wrap Therapy
• Good quality Moisturizing cream
• Steroids (only under doctors observation)
• Anti-itching oral medicines

Can Atopic Dermatitis or Eczema be preventable
To some extent, yes? If your kids are at higher risk of developing dry skin or Eczema, then you can start using moisturizing creams soon after your baby is born.

Viral Gastroenteritis (Stomach Flu)

Recommended Foods
Infants: Breast milk or normal infant formula
For older children —Normal food is usually best. This could include:

Foods to Avoid (Infants and Children)

Note: Don’t dilute milk

Consult doctor immediately

Asthma Trigger Control

Triggers are things than can make your asthma worse. Know your triggers so you can stay away from them and prevent asthma flare-ups.	What to do to avoid your triggers
SMOKE: Smoke can make asthma worse.	Do not allow smoking in your home or car.
COLDS: Illnesses can trigger asthma.	1. Wash your hands often. 2. Keep your hands away from your face. 3. Avoid contact with people who are sick. 4. Get a flu vaccine shot every year.
DUST MITES: These tiny bugs live in bedding and carpeting and are too small to be seen	1. Put a dust mite cover on your pillow and mattress. 2. Wash sheets and blankets in hot water. 3. Wash stuffed animals frequently. 4. Vacuum carpet weekly with a HEPA vacuum.
MOLD: (WHITE FUNGUS)Mold can grow in warm humid areas.	1. Clean moldy surfaces with hot soapy water. 2. Fix leaking faucets & pipes. 3. Use a dehumidifier in a damp basement.
ANIMALS: Some people are allergic to animals.	1. Do not have pets in your home. 2. If you can’t keep the pet out of the home, then keep it out of the bedroom & keep the door closed. 3. Avoid contact with pets and wash your hands if you pet them
COCKROACHES & MICE: Some people are allergic to droppings from these pests.	1. Do not leave food or garbage uncovered. 2. Keep food out of bedroom. 3. Call PEST CONTROLLER.
EXERCISE: Exercise can trigger asthma. Talk to your provider so you do not avoid exercise.	1. Take your rescue inhaler before you exercise if advised by your doctor. 2. Warm up and cool down after exercise. 3. Cover your nose and mouth with a scarf during cold weather.
POLLEN: Trees, grass and weeds can trigger asthma during the spring and during the fall.	1. Keep your doors and windows shut during allergy season. 2. Ask your DOCOR about allergy medicine.

BABY BATHING

Routine bathing in the hospital should not be done to prevent cross infection and hypothermia better be sponged.Bathing can be delayed till the cord falls & should not last more than 5 minutes.

Initial bath, sterile or potable clean water is sufficient.Soaps and cleansers are best avoided initially for few days.

CAVITY PREVENTION

Most of the time cavities are due to a diet high in sugary foods and a lack of brushing.
Every time someone eats, an acid reaction occurs which lasts approximately 20 minutes. During this time the acid environment can destroy the tooth structure, eventually leading to cavities.

Tips for cavity prevention:
Limit frequency of meals and snacks.
Encourage brushing, flossing, and rinsing.
Avoid sticky foods.
Choose nutritious snacks.

Toilet training & Diet advise

12-month Discourage active toilet training until after 18-month visit.

24-month Evaluate the child's readiness. Discuss night time enuresis if the child has daytime control.

Toilet training tips:

Dietary advice to prevent constipation:

1. Adequate fluid: one litre or more water or other non-milk liquids per day.

2. Preferred food:

Avoid:

Infants with constipation who are older than six months.

Dietary recommendations for children:

Constipation

Symptoms:

Aim:

Dietary advice to prevent constipation:

Preferred food:

Avoid:

Infants with constipation who are older than six months.

Dietary recommendations for children:

CORD CARE

• Normal umbilicus: Dried with in 6-8 days; healed within 12-15 days
• The umbilical cord must be kept open and dry.
• The nappy should be folded well below the umbilical stump.
• Dry the cord after bath by application of alcohol/spirit if required.
• Do not use any other antiseptic or antibiotic powder.
• Mild infection: Cleanse with alcohol

SAFE DIET FOR KIDS TEETH

Serve balanced diet

Fluoridated toothpaste should be introduced when a child is 2-3 years of age.

Avoid nursing children to sleep or putting anything other than water in their bed-time bottle.

Dental Hygeine in CHILD

Tooth Brushing

When do you need to consult a Neonatologist?

Fetal Reasons

• If your level II (Anomaly Scan) showed any congenital anomaly, then you must consult with a neonatologist who can counsel you regarding future related problems after birth.
• If the antenatal scan revealed hydronephrosis/hydrocephalus/echogenic mass in the heart/cyst in the abdominal cavity lung.
• If your blood tests revealed any evidence of congenital infections (e.g., CMV/herpes/syphilis/toxoplasma etc.)

Neonatal Reasons

• Your baby is not gaining weight
• Jaundice is persisting, or stool color is clay-colored with dark urine.
• Born premature & not achieving their milestones.
• If your baby is excessively crying/irritable on breastfeeding with lots of gas and or vomiting or you are suffering from breast pain/nipple injury.
• Any kids who required NICU (Neonatal ICU) stays for any reason.
• Any newborn baby who received ventilatory support.
• Persistent rashes over face/scalp/body and not responding to usual treatment.
• If you have any chance to deliver a premature baby.
• If your baby’s birth weight was less than 2500 grams.
• Vomiting after each feed and not improving
• For neuro developmental monitoring

Febrile convulsion

A febrile convulsion (‘febrile’ means high body temperature) is a type of fit that children can have if they get a high temperature. Around one in 20 children will have at least one febrile convulsion. About one in four children who have a febrile convulsion will also have a close relative who has fits/seizures

Age of presentation: 6 to 60 months.

Most children only ever have one febrile convulsion. About three in every ten children will have another febrile convulsion during a separate illness.

After the convulsion has stopped, children usually fall into a deep sleep. They can be confused and upset when they wake up.

Home treatment: Be calm

FLU VACCINE

"Take 3" Actions to Fight the Flu

Vaccinate

Stop Germs

Antiviral Drugs if your doctor prescribes them.

GROWING PAIN IN KIDS

Influenza in children&Vaccine

What's Influenza or Flu?
FLU is a respiratory viral infection caused by influenza viruses. However,it's a self-limiting illness and does not require hospitalization.

Then why has my pediatrician recommended the FLU vaccine?
Because it can cause significant health problems in individualhigh-risk children to avoid school absenteeism,it's better to get FLU Vaccine yearly. And if at your high-risk home persons like grandparents, pregnant mother, any person on steroid can catch FLU illness from kids. So, to prevent the spread of disease,it's mandatory to vaccinate all kids.

Is there any Nasal Flu vaccine?
Nowadays,it's not recommended. Only injectable (Intramuscular) Vaccine is available.

What's the dosing schedule of the FLU vaccine?

Iron Rich Food

Common Iron Rich Foods

Common Vitamin C Rich Foods

• Cabbage (Patta Gobhi)
• Drumstick Leaves (Saijan Patta)
• Coriander Leaves (Dhaniya)
• Gooseberry (Amla)

Enhancer :
iron, present in meat, poultry, fish, and seafood

Vitamin C, present in fruits, juices, potatoes, Fermented or germinated food

Inhibitor:?
Tea, coffee, cocoa, Calcium, particularly from milk and milk products

Age	Texture	Frequency	Average amount of each meal	Amount of raw green leafy vegetables (to be cooked and added to food) (g/day)
6-8 months	Start with thick porridge, well mashed foods	2-3 meals per day plus frequent breast feeds	Start with 2-3 table spoon full	25
9-11 months	Finely chopped or mashed foods, and foods that baby can pick up	3–4 meals plus breastfeed. Depending on appetite offer 1–2 snacks	½ of a 250 ml cup/bowl	25
12-23 months	Family foods, chopped or mashed if necessary	3–4 meals plus breastfeed. Depending on appetite offer 1–2 snacks	3/4 to one 250 ml cup/bowl	40

If baby is not breastfed, give in addition: 1–2 cups of milk per day, and 1–2 extra meals per day.

Good sources of important nutrients

Zinc: Liver, flesh of animals, birds and fish, egg yolk.

Vitamin A: The darker the colour the more vitamin A

• Breast milk, liver of all kinds, egg yolk
• Orange-coloured fruits/vegetables - mango (but not oranges). Carrot, pumpkin, yellow sweet potato, red /orange peppers (but not tomatoes).
• Dark-green leaves - spinach, amaranthus, kale, cassava leaves, sweet potato leaves, pumpkin leaves, broccoli.

Vitamin C: (cooking destroys some vitamin C)

fresh fruit - guava, orange, lemon, mandarin, mango, berries, melon, banana, tomato, peppers, green leaves and vegetables - spinach, amaranthus, kale, cassava leaves, sweet potato leaves, cabbage, broccoli, cauliflower baobab pulp fresh starchy roots and fruits are good sources if large amounts are eaten - potato, sweet potato,cassava, plantain.

Calcium:milk and milk products - cheese, yoghurt fish eaten with bones - small whole fish, pounded dried fish, canned fish

Neonatal Jaundice

• 80 % of Neonates develops jaundice during first 2 weeks.
• Common causes- Prematurity/Mother Blood group Negative or O +ve/G6PD deficiency/Thyroid problem
• Only 10% require Phototherapy Lights
• Bilirubin Value more than 20 mg/dl might require blood change & hearing test (BERA)

Must get your newborn kid test for Blood-group/Thyroid/G6PD/Hearing

Learning Disability @2.5 to 4 years

• Trouble with articulation, persistently mispronounces word
• Trouble using correct verb tenses, plurals, or pronouns
• Trouble rhyming, playing sound or word games
• Knows colors, but cannot name them when asked
• Difficulty telling an event or story in order or sequence
• Difficulty cutting with scissors, tying shoes, or blowing nose
• Clumsy, messy eater, poor at skipping, trouble learning motor skills
• Overreacts or avoids sounds, touch, fabrics, foods, smells or lights

warnings signs vary with each child and all signs may not be present

Learning Disability@ 5 to 8 years

• Persistently mispronounces words, and slow word finding when talking
• Phonological awareness – Misses or changes sounds in words that are heard, spoken, or read
• Reading and Spelling – Difficulty learning to sound-out words for reading and spelling
• Reading is slow, effortful, & unpleasant
• Errors when reading – e.g. says “was” for saw.
• Handwriting – Awkward pencil grip, presses too hard on paper when writing, hand fatigues
• Trouble concentrating at home and school; wears out before a task is done
• Repeated difficulties or frustrations lead to lower self-esteem

MDI inhalers

How should I use an inhaler?
There are two types of inhalers — Metered dose inhaler (MDI) and Dry powder inhaler. Follow the instructions below for the type of inhaler prescribed.

If you use more than one kind of inhaled medicine at a time, the reliever medicine (such as asthalin) should be taken first to open the airways then use budecort or beclomethasone. This helps the other medicine(s) go deeper into the lungs, so they will work better

Metered dose inhaler (MDI) A metered dose inhaler is used with a spacing device, also called a spacer or holding chamber. It helps the mist reach deeply into the lungs. As small kid are not able to hold their breath for 10 seconds, they need to use a spacer with a mask.

Prepare the inhaler:

• Remove caps from the inhaler and the spacer.
• Shake the inhaler well (about 5 seconds) to mix the medicine and propellant.
• Insert the inhaler into the spacer.

Using a spacer without a mask

• Put the mouthpiece into your mouth, over your tongue, between your teeth and close your lips around it.
• Breathe out slowly all the way.
• Press down on the inhaler as you start to breathe in slowly and deeply through your mouth.
• Hold your breath for 10 seconds(or count 1 to 10) to let the medicine stay in the lungs and airways.
• Exhale slowly.
• Wait about 1 minute between 2 puffs of the rescue medicine. There is no need to wait between puffs of the controller medicine.

Using a spacer with a mask

• Put the mask over nose and mouth.
• Press down on the inhaler.
• Keep the mask sealed around the nose and mouth and breathe in and out for 3 to 5 breaths.

How do I know when an MDI is empty?

Don’t Run Out On a calendar, keep track of the number of doses you use in a day and subtract it from the number on the inhaler. Throw it away and get a new one when you reach zero. Some inhalers have counter windows so you know how many doses are left.

How do I care for the spacer? Remove medication inhaler from the spacer and set aside. Wash all parts of the spacer with mild soapy water and rinse thoroughly. Air dry the spacer, making sure it is dry before the next use.

MDI inhaler spacer – mask

Before using the inhaler for the first time it must be primed. Prime the inhaler by re¬leasing 1 to 2 sprays (or per the manufacturer’s direction) in to the air, and away from your face. If the inhaler has not been used for 7 days, you may need to prime it again

• Remove cap on the medication inhaler and shake vigorously about 10 times (5 seconds).
• Insert the inhaler into the spacer device with mask.
• Pull the mask on to the face, covering the mouth and nose so the mask fits snuggly. Check for a tight seal.
• Push down once on top of the inhaler to release 1 puff/spray of the medication into the device. Keep the mask in place while the child takes 6 breaths (30 to 60 seconds). It is okay if your child is crying during this process; they will still get the medication into their lungs.

Release only 1 puff/spray of medication into the chamber at a time. If additional puffs are ordered, wait 1 minute before giving another puff especially for rescue medication(eg-asthalin).

Clean the spacer at least once a week.

Remove the mask (if removable) and the rubber end that holds the metered dose inhaler onto the spacer. Wash all parts of the spacer with mild soapy water and rinse thoroughly. Air dry the spacer, making sure it is dry before the next use.

Tips

• Rinse your mouth with water and spit it out after using a steroid (controller) inhaler.
• If you use more than one kind of inhaled medicine at a time, the reliever medicine (such as asthalin) should be taken first to open the airways then use budecort or beclomethasone. This helps the other medicine(s) go deeper into the lungs, so they will work better.

Nebulizer

What is a nebulizer?
A nebulizer treatment (“neb ”) gives medicine as a fine mist that is breathed into the lungs through a mask or a mouthpiece. You will have a nebulizer machine and a nebulizer cup to put the medicine in.

How to use a nebulizer machine
Hold the neb cup in an upright position for the whole treatment. The treatment will last about 10 minutes. Use either a facemask or a mouthpiece to deliver the medicine. Just blowing the medicine at the nose and mouth does not get the medicine into the lungs. Sometimes more than one medicine will be used. Check with your doctor about mixing the medicines together.

Face mask – a face mask should be used for younger children.

Mouthpiece – for older kids a mouthpiece can be used. Place the mouthpiece over the tongue and between the teeth. You should be able to see the mist at the opposite end disappear as the medicine is inhaled.

How should I care for the equipment?
Clean the parts of the nebulizer according to the directions that come with the machine.

SUN SCREEN

• Use at least SPF 15 and more (More the better)
• For the best protection, apply sunscreen generously 30 minutes before going outdoors.
• Don’t forget to protect ears, noses, lips, and the tops of feet.
• Avoid applying around eyes.
• Reapply after your child swims or exercises.

few serious sunburns can increase your child’s risk of skin cancer later in life

THUMB SUCKING

• Children usually give up digit sucking by the age of four.
• If the child continues past the age when their permanent teeth start to erupt, they may develop crooked teeth and a malformed roof of their mouth. This can also affect the position of the upper and lower jaw and can also affect speech.

Suggestions to break the habit:

• Wait until the time is right (low stress).
• Motivate your child (show examples of what could happen to their teeth and fingers/thumbs).
• Use a reward system (small incentives will encourage your child to stick with it).

TONGUE TIES

• Between 4% and 10% of infants are born with some degree of tongue restriction, which can affect their ability to breastfeed.

Symptoms:

Baby symptoms: Frequent feedings, Shallow latch on breast, Sucking callous on lip, kids becomes fatigued quickly during feedings.

Mother complaining of- Painful breastfeeding, Breast still full of milk after feedings, Nipple trauma (Cracking, Bleeding, Creasing, Flattening).

Treatment: Frenectomy ( Removal of a frenum, which is a small fold of tissue that restricts the movement of tongue)

Travelling Tips

• Up-to-date on routine vaccines, such as measles/mumps/rubella, Chicken Pox, and seasonal flu/Hepatitis A/Rabies/yellow fever.
• Frequent handwashing with soap and water.
• Eat and drink safely.
• Keep away from animals.
• Avoid sharing body fluids.
• Zika infection during pregnancy can cause serious birth defects. Therefore, pregnant women should not travel to these country.
• Must Get Travel health insurance.

ROLE OF PARENTS IN TELEVISION (TV) VIEWING

• Start taking active interest in monitoring TV viewing from early childhood, so that the good habits are formed early rather than taking a confrontational attitude later on.
• Fix TV viewing hours per day / per week and adhere to them strictly. Maximum of 2 hours of TV viewing (including computer/video games) should be permitted on weekdays.
• Make sure that there is enough time spent on exercise, sports or other physical activity. TV viewing comes only after sports and studies.
• Approve the programs for viewing with your child as to what he/she should see & what he/she should not see. Settle the issue with mutual discussion. Use passwords/child lock to block the programmes which are not suited for child viewing.
• Educational (Discovery, National Geographic), sports, entertainment and children’s programs should be included to various extents in the weekly programme so as to widen the child’s exposure. Use TV news as a medium of discussion to increase the child’s general knowledge.
• While watching an advertisement, tell the child that what is shown is not necessarily correct. So be careful while buying and always evaluate the product before purchase.
• Children and adults tend to over eat while watching TV. Mothers use the medium to encourage the child to eat more. This habit leads to obesity in later life. While watching food advertisements discuss the good values and other aspects of nutrition.
• While viewing violent shows explain and reassure the child that violence is faked for TV and in real life it happens rarely.

Discuss consequences of violent action in real life:

• Invariably the aggressor is punished at the end.
• Discuss the pain and suffering of the victims and their families
• Help children think of non-violent solutions to the episode in the serial.

• Be a role model for your children by limiting your own TV viewing.
• The ideal distance to watch television is about 3 ½ meters and should be in a straight line.
• The lights should preferably be behind the TV set.

Vaccination in Children

Vaccination at Birth
Your baby must get all three vaccines on day one of life.

• BCG
• OPV
• Hepatitis

Vaccination during 6 weeks/10 weeks & 14 weeks (or 2/4/6 months of age)
Starting from 6 weeks, your baby needsa total of eight vaccines

• DPT + HBV + IPV + HiB (Hexa)
• Rotavirus Vaccine
• Pneumonia Vaccine

There are two types of DPT combinationsin the market:DTaP (Acellular - Painless & Fever less)– Diphtheria and tetanus toxoids, and acellular pertussis, and another is DTwP(Whole Cell - Painful with Fever)– Diphtheria and tetanus toxoids, and whole-cell pertussis. It is approved for use as a three-dose series for children six weeks through four years of age. Both have good efficacy. However, DTaP vaccines have fewer local, systemic, and febrile reactions than DTwP vaccines. IAP (Indian Academy of Pediatrics)has approvedboth vaccines can be used for the kids.

https://iapindia.org/pdf/Indian-Pediatrics-December-2020-issue.pdf

Which one is better for my kid – I am Confused?
First of all, your kid should get all the vaccines. Both are excellent and productive vaccines; however, if you want less pain, swelling, and fever, you may opt for a painless (DTaP ) one. But if there is any history of Progressive or unstable neurologic disease (e.g., infantile spasms, uncontrolled seizures, progressive encephalopathy),it's better to get a painless (DTaP ) one.

Should I get the Pneumococcal 13 or Pneumococcal 10 vaccine?
Few data are available to support the choice between the two currently available pneumococcal conjugate vaccines (PCVs), ten-valent PCV (PCV10) and 13-valent PCV (PCV13). PCV10 and PCV13 are similarly highly immunogenic when used in 2 + 1 schedule. The choice of vaccine might be influenced by factors such as the comparative magnitude of the antibody responses, price, and the relative importance of different serotypes in different settings.You must opt for anyone; however, if your baby is premature, then a vaccine with better coverage should be the choice.

Itchy vulva (Pruritus vulvae)

Cause

• Irritation of the outer vagina from bubble bath, shampoo or other soap.
• Poor toilet hygiene -due to back-to-front wiping.
• Occasionally secondarily infection & urinary infections.

Treatment
Hygiene

• DO NOT OVERWASH THE AREA. Wash very gently.
• Do not use soap/shampoo for washing. Use __________________________
• Do not use bubble bath, perfumed soaps or creams.
• Pat dry the vulva with a soft clean towel after bathing rather than rubbing.
• Change underpants frequently if soiled.
• Urinate (pee) before the bladder is full, avoid 'hanging on' and rinse the vulva with water after urinating.
• Use soft white unscented toilet paper.

Baking Soda-Warm Water Soaks: if itching persistent

• Add 2 ounces (60 ml) baking soda per tub of warm.
• Soak for 20 minutes to remove irritants and to promote healing.
• During soaks, be sure --spreads her legs and allows the water to cleanse the genital area  for 2 days.

Cream: After soaks, apply Cutisoft 1% cream twice for 1 or 2 days.

Consult doctor if:

• Irritation persists on treatment over 48 hours.
• Vaginal discharge or bleeding occurs.
• Passing urine becomes painful.
• Your child becomes worse.