Immunization

Immunization is a topic of concern to many new parents. Every parent should know about immunization and its importance to bring up a healthy child. Immunization is an important aspect of preventive health care. It should be given in early days of life because it is proved to prevent many diseases when it is given in specific months. That's why there is a schedule made for it and given to the new parents. This prevents the parents from missing the particular vaccine that is due.

There are different forms of immunization, but they all function through stimulation of immune system in order to enhance the resistance to a particular mechanism of infection. The different forms available are oral drops and injections. The injections are usually intradermal or subcutaneous. The dosage is the same through out world wide. There are certain countries which do not insist giving BCG, while Asian countries insist in giving it soon after birth or at least in the first month of baby's life.

Vaccines are available for a wide range of diseases from congenital to infectious diseases. To mention a few, they fight against diseases like polio, hepatitis, influenza, diphtheria, whooping cough, tuberculosis, tetanus, rubella, mumps and measles. The baby's immunization plays an important role in providing individual protection initially and in later days' population protection as well. Thus, immunization brings about a healthy population.

The parents should have knowledge about the need, benefits and limitation/contra-indication of each and every vaccine. Immunization rarely has side effects but parents should however be warned about it. There are do's and dont's or expected or undesirable outcome for each vaccine. Parents are advised by their respective health care provider regarding this.

Bacillus Calmette Guerin (BCG) :
It is given against tuberculosis.
Dosage: 0.1mg, Route: Intra-dermal, Frequency: At birth (< 1 month)
Do's or dont's: Do not rub the site.

Oral Polio Vaccine (OPV) :
It is given against polio virus.
Dosage: 2 drops, Route: Oral, Frequency: 3 doses (at 1 1/2, 2 1/2, 3 1/2 months) and booster between 18 to 24 months of age.
Contra-indication: Diarrhea, vomiting
Undesirable outcome: Signs of allergic reaction, signs of paralysis, high fever and any unusual behavior.

Diphtheria, Pertussis, Tetanus (DPT) :
It's given against the three killer diseases mentioned above.
Dosage: 0.5ml Route: deep intra-muscular (anterioateral aspect of thigh), Frequency: 3 doses (at 1 1/2, 2 1/2, 3 1/2 months) and booster between 18 to 24 months and 4 to 6 years of age.
Contra-indication: High grade fever.
Expected outcome: High pitched cry, crying continuously for 2 or more hours (due to pain at the injection site), fever.
Undesirable outcome: Signs of allergic reaction, high grade fever causing continuous seizures, altered consciousness.
Do's: Rub gently and apply hot fomentation, administer anti-pyeritic analgesic as prescribed by the physician.

Mumps, Measles, Rubella (MMR) :
It's given against the three infectious diseases mentioned above.
Dosage: 0.5ml, Route: Deep sub-cutaneous or intra-muscular, Frequency: 9 to 15 months and booster in 4-6 years of age.
Expected outcome: Mild fever and rash, pain and stiffness in joints, slight swelling of glands (rare).
Undesirable outcome: Signs of allergic reaction, seizure, behavioral change.

Hepatitis B Vaccine (HBV) :
It's given against hepatitis B infection.
Dosage: 0.5ml, Route: intra-muscular, Frequency: 3 doses (at birth, 1 and 6 months) and booster at 10 years or after.
Expected outcome: Pain and soreness.

Haemophilus influenzae type B vaccine (Hib) :
Its given against pneumonia and meningitis.
Dosage: 0.5ml, Route: intra-muscular, Frequency: 3 doses (2, 4 and 6 months ) and booster between 12 to 15 months of age.
Expected outcome: Pain, redness, swelling and soreness at the injection site.

There are lot more optional vaccines available for your baby but these are basic ones that has to be administered on time. Be knowledgeable about your baby's immunization and prevent them from these killer diseases.

Bacille calmette-Guerin (BCG) vaccine

Bacille calmette-Guerin (BCG) vaccine is a attenuated tubercle bacilli given at birth for the babies. This vaccination gives 80% protection against tuberculous. Albert Calmette, a French bacteriologist and Camille Guerin, a veterinarian are the founders of BCG and it is named after them. This vaccine is proved to be a safest vaccine which prevents pulmonary tuberculosis and tuberculous meningitis in children. Thus vaccination programs greatly reduce the morbidity and mortality associated with infectious diseases.

Any vaccine should be given at the right age of life to produce immunity in course of time against that particular disease for which it's given. BCG is given soon after birth or in the first week of life. Some countries do not insist giving this vaccine but most developing countries have BCG as a part of their regular immunisation schedule. BCG and OPV are given as a part baby care in many hospitals.

BCG vaccine is given intradermally at the deltoid region. It comes in an ampule. The dosage is 0.1 mg in 1 ml at birth and the frequency varies as per countries vaccination schedules. BCG vaccine usually causes pain but it should not be massaged. It does not require any hot formentation. It does not cause any fever. The only side effect is, it produces a scar. This scar acts as a proof of your previous immunisation with BCG.

There are other advantages of taking BCG. Now BCG is used for the treatment of bladder and colorectal cancers, psoriasis, type 1 diabetes, leprosy and meningitis. They are more associated with adult diseases. The rare complication is the abscess formation when it is given as a sub-cutaneous injection by mistake.

BCG is a safe vaccine for your baby. Vaccinate your baby as early as you can because it is proved to be more effective when it is given in the first few days of life. Let your baby cry now with the small tiny poke and keep smiling all through his life.

Baby's feeding schedule

A new born baby depends on his parents to meet all his needs. The new parents explore their baby's every single movement and try to give their best for them. The baby does not come with any standard protocols for feeding. He completely leaves that responsibility to his parents to make the best decision for him. Babies should be fed on demand, or every two hours, or whenever the baby wets. The frequency of feeds must be increased if the baby has diarrhea or fever to improve their hydration.

The mom to be should be taught prenatally to understand the baby's feeding schedule. Otherwise, the first time parents may find certain things new and difficult. Most mothers and all doctors advice breast feed as the best feed for babies. Babies must be exclusively breast fed for the first six months preferably. If the mothers milk is inadequate for six months, formula feeds can be started along with breast feeds from the third month onwards.

Each baby will follow different schedules. The time and frequency of feeds is determined by the baby from the beginning. The feed lengths can be fairly long for certain babies and so do the intervals between each feed. This is called baby-led feeding or demand feeding. This is normal and it is common in the first few days of baby's life. This gives an excellent opportunity for the mother to rest. As the milk volume increases, feeds become more frequent and a little shorter. Some babies take very little feeds on demand and fall asleep when they are being fed. In such cases, the baby should be woken up at the end of two hours and be fed.

If the mother opts to bottle feed the baby, the schedule is made more perfect because you will know the amount of feeds the baby takes each time and when to give the next feed accordingly. Here, both the mom and dad can be involved in feeding the baby. Though bottle feeds are not advised these days, some conditions like mother's ill health or work status may lead to use of bottle feeds. It's better to use expressed milk (if no contraindications)as far as possible than cow's milk or other formulas to avoid allergies and problems with digestion.

Once your baby has reached four or six months, you can still continue with breast or formula feeds and start trying semisolid foods. This is called the period of weaning. You can start with something like rice cereals or oatmeal which is easy for him to swallow. He should be able to grip the spoon with his mouth and exhibit swallowing action. Initially most babies tend to suck or push the food out using their tongue. This is normal and soon they will learn to eat.

At six to eight months of age, the baby is ready to try different food items. He will be teething and will want to bite anything he gets in his hand. This is a good time to start soft solids and slowly solid foods too. Breast feeding and formula feeding should be continued. Half boiled vegetables and fruits can be tried now. Give enough time while introducing new foods each time. Check for his likes and dislikes. Do not force any food, feed them only when they are hungry.

By eight to twelve months, your baby will be ready for breakfast, lunch and dinner. You will now know his routine. Start with baby's first feeds at eight months and second feeds by ten months. This is available in markets under the labels 'baby's first foods' or 'baby's second foods'. If he is used with your regular meals like pasta or rice, provide him separately a plate and spoon with food and make him sit and eat with you. Though there will be spilling and wasting, he will learn the technique and ethics of eating from his parents and sibling. See that you don't give him any solids which is hard for him to chew and swallow. This is the best time to stop breast feeds or formula and start with full strength cow's milk.

When he is one, he will eat one-third of everything you eat. He will start asking you to buy everything he sees in a shop to eat. Some children might not eat more but now they are big enough to tell you they are hungry when they are really hungry. Never force them to eat unless they have not gained adequate weight for their age.

If your baby is not following this schedule still it is normal. Individual babies develop their own unique pattern of feeding and, provided the baby is thriving, there is no need to change it.

Failure to thrive

It is normal that the birth weight of a newborn decreases initially but then starts to increase gradually in course of time. Each baby grows in its own pace and you need not be worried as long as they show some amount of growth in their height and weight every month. Ideally, the baby grows very fast in the first year of their life compared to the toddler stage where they are very playful and dodge from eating. Thus, it is expected for an infant to gain weight and height against age as given in the growth chart.

Failure to thrive (FTT) is not a disease but a symptom of an underlying disease. There need not be always a disease behind it because FTT can be present due to different reasons. It is important to identify or diagnose the cause of FTT in order to correct the problem. Infancy is a stage where growth happens at its peak, not just externally (physically) but also internally (mentally). Hence, diagnosing FTT and treating them at the earliest is good for their future as well as to survive the period of infancy.

The reason why an infant fails to thrive are as follows:

1. Poor socio-economic status (especially in under developed and developing countries).
2. Poor hygienic methods used by the mother or the significant care taker.
3. Poor knowledge about nutrition and hygiene of the mother or care taker.
4. Poor child care due to family situations.
5. Child abuse.
6. Congenital problems like cleft lip or cleft palate.
7. Certain cardiac, respiratory or endocrinological problems demanding more nutrients to meet their basal metabolism.
8. Mal-absorption causing chronic diarrhea in celiac disease, chronic liver disease and cystic fibrosis.
9. Intolerance to milk protein causing profuse vomiting.
10. Allergies to certain foods like milk or egg which is the main source of body building.
11. Certain infections caused by worms or parasites leading to poor appetite.
12. Other water borne infections like cholera and air borne infections like tuberculosis.

Diagnosing failure to thrive:

The medical professionals use growth chart and the history to diagnose FTT. It is not a single result of weight loss that decides FTT, three consecutive readings of weight loss is necessary to confirm the diagnosis. There is an obvious decrease in body mass especially over the cheeks, axilla, chest, abdomen, sacrum, buttock, arms and legs which are identified by checking the head, chest, mid-arm and mid-thigh circumference and the height by checking their length.

The other symptoms includes

1. Baby not being active or is very lethargic and does not have strength to shake his hands or legs.

2. Baby reaches all milestones little late than expected. The head control is not attained in 3 months and the baby starts to crawl only by 8 months.

3. Baby not feeding on well at the breast on its regular feeds, skips at least 3 consecutive feeds.

4. Baby crying unusually for longer time. The cry may be shrill or sometimes weak due to lack of energy.

5. Baby not playing and being withdrawn.

6. Baby will have poor eye contact.

7. Baby having diarrhea or vomiting soon after feeds indicating intolerance or malabsorption.

8. Physical examination showing cleft lip or cleft palate.

9. Blood and urine analysis proving some infection.

10. History indicating poverty, poor hygiene and knowledge of the care givers.

The good news is, babies diagnosed with FTT do well when they are cared adequately. Imparting knowledge to care givers of infants about immunization, well balanced diet and hygiene can make a big difference. Treating problems either congenital or acquired by surgery or medicine also solves certain problems. Identifying and avoiding the foods that causes intolerance or allergies is important.

There are government agencies which provide nutritious food to the economically backward people and the families who need help should be informed about this. Those who can afford can be referred to dietitians who can counsel regarding good nutrition. More than anything, good parental bonding (love and warmth) is necessary for the infant to grow physically and emotionally which is the magic that prevents FTT.

How to maintain a good oral hygiene for your child?

Kids' teeth well taken care of, starting from the growth of child tooth will ensure a beautiful smile as they grow up. Teeth give shape and frame to the face. It is important to care for them since childhood. It is easy to keep your children's teeth healthy when you teach them the importance of dental hygiene and make them practice it as everyday routine. Sweeteners and acids from sodas and other junk foods destroy the enamel of the teeth leading to dental plaque and caries.

Firstly, a good oral hygiene is necessary to keep the teeth healthy. You can start brushing your baby's teeth when 6 to 8 teeth pop out. A soft baby tooth brush can be used and it can be given in your baby's hands (without paste) for them to explore and get the hang of it. Take them with you when you are brushing your teeth every morning and they will learn from what they see.

Your child can be taught about the techniques of brushing when they are big enough to understand. Make it a 'must' that they have to brush twice daily.

Teaching techniques of oral hygiene:
1. Ask them to hold tooth brush at a 45 degree angle between brush and the gums and teeth.
2. Make the kids brush teeth in rotatory motion.
3. Start brushing from the lower left jaw moving from incisor to molars.
4. Continue with the right lower jaw followed by left and right upper jaws.
5. Brush the outer surface of the teeth first, then covering the biting and inner surfaces of the teeth.
6. Continue the cycle twice or thrice every time you brush your kid's teeth.
7. The gums should not be neglected while brushing.
8. Clean the tongue at the end of brushing with the same soft tooth brush or a tongue cleaner.
9. Floss at least once daily, kids may find this annoying. But parents should teach them the importance of having the teeth flossed.
10. Have the kid rinse or gargle his mouth after brushing to prevent bad breath, plaque and caries.

Always use a soft tooth brush for children (and adults) to prevent damage of enamel. Have a check on their brushes and replace them at the first sign of wear.

Secondly, take your child to the dentist every six months to do scaling (if necessary) and to prevent any problem regarding the oral cavity at the beginning itself.

Thirdly, there are some general instructions to keep your kids' teeth healthy. They are
a. Use only kids' tooth paste for kids.
b. Use tooth paste with fluoride.
c. Give them fluoridated water to drink as far as possible.
d. Examine their mouth every day to check whether they have brushed effectively.
e. Make sure your kids brush their teeth after taking candies or any sweets especially before going to bed.
f. Tell them not to place ice cubes or ice-creams directly on their teeth.
g. Make sure you give them milk everyday.
h. Make them chew and eat their food.
i. Other food products for a healthy teeth which are rich in calcium include yogurt, cheese, ice-creams, tofu, beans, broccoli, mustard and turnip greens, okra, soy and rice beverages, sardine, salmon, tuna and orange.

A healthy and sparkling teeth will make your child give a confident smile and add extra beauty to their innocent face.

How to identify that your child is having an asthmatic attack?

Asthma is one of the common diseases in children. Studies say that asthma is the number one reason for poor attendance in schools. Most children get asthma (wheezing) due to allergies, and not because of any pathologic causes. Hence, asthma in children resolves by its own or can be overcome by avoiding those causitive factors.

Asthma is an intermittent, reversible, obstructive airway disease. It affects both children and adults. There are about 6 million children affected with this chronic disorder. Asthma can be life threatening when not treated properly. Death due to asthma is rare in children. It generally affects the normal day to day life activities and is the third leading cause of hospitalization during childhood.

Asthma in children are caused by allergens like animal dander, pollen, dust, food, and mold. If the child suffers asthma due to any of the above mentioned allergens, then it is called allergic asthma. The children with this type of asthma will definitely have a family history of allergies. Exposure to any such allergens triggers an asthmatic attack. Children with allergic asthma will usually overcome the condition by adolescence.

Asthma may not be related to specific allergens in children. Certain factors like common cold, respiratory tract infection, environmental pollutants, chemicals, food preservatives, exercise, play, and emotions can trigger an attack. This type of asthma is called as idiopathic or non-allergic asthma.

Some children develop a mixed kind of asthma which is the most common form of asthma. It has characteristics of both allergic and nonallergic asthma. Cigarette smoke, exposure to cold air and irritating gases, and viral infections are some of the common stimulants of asthma in children.

Asthma being an airway obstructive disease, it is caused by one or more of the following reasons:
1. Contraction of muscles surrounding the bronchi, which narrows the airway;
2. Swelling of membranes that line the bronchi; and
3. Filling of the bronchi with thick mucus.
The exact mechanism of these changes is not known, but most of what is known involves the immunologic system and the autonomic nervous system.

The three common symptoms of asthma are dyspnea, cough, and wheezing. An asthmatic attack starts at night, with a cough and a tight sensation in the chest, followed by slow labored, and wheezy breathing. The child assumes an upright position and uses all the accessory muscles of respiration. The obstructed airflow causes dyspnea. The cough is tight and dry at first, later it loosens and produces thin mucus containing small, round, gelatinous masses.

Chest x-ray taken during the acute attack shows hyperinflation and a flattened diaphragm which confirms the diagnosis. Sputum and blood studies disclose eosinophilia and an elevation in immunoglobulin E. Bronchodilators and anti-inflammatory drugs are helpful in treating asthma in children. Bronchodilators like epinephrine, terbutaline and ipravent are given in the form of inhalation during an active episode.

Chromolyn sodium, a mast cell inhibitor prevents anaphylaxis, thereby resulting in bronchodilation and a decrease in airway inflammation. This is more helpful between attacks or when asthma is in remission. Corticosteroids reduces inflammation and swelling, and is given in the form of intravenous injection.

The only way to prevent asthma attacks in children is to identify the allergen and avoid them. Seeking treatment at the initial stages of asthma will prevent the progress of the disease. Asthma becomes fatal with age because the number of deaths increases with age.

How to introduce new foods to children?

Introducing new food to children is not an easy task and not something to be taken for granted. As anybody can be allergic to anything, we must be very careful while introducing a new food product, especially to children because that is the first time they are being exposed to something new.

a. Try only one new food at a time. You can give the same new food every alternate days for a week and make sure your child is not allergic to that specific food. The next thing you can watch out by doing this is, whether your child is digesting the food well which means there is no vomiting and no diarrhea.

b. Do not force them to eat more while introducing a new food. Just place them in a plate or bowl and let them feel the consistency themselves and taste slowly. Once they take a few mouthful they will automatically eat if they like or stop eating if they don't like. If they do not like the food on the very first day, don't urge them to complete. They will get an aversion and will never try that food again.

c. You eat with them, the same food you are trying for your child.

d. Always taste the food yourself before serving your children because you can make adjustments if something is more or less.

e. Make the food look attractive and add certain ingredients which they like. For example, if you want to introduce pancake to your child and if you know your child likes cashew/raisin add them to it, you can also make pancakes of different shapes like star, or alphabets or numbers which they may find it interesting.

f. You can explain the nutritional value of that particular new food. If you are trying a new milk product, you can explain them saying milk is rich in calcium which will make you grow taller and stronger where you can play basket ball easily.

g. Do not mix the new type of food with any other food while introducing.

h. Never mix any medication with the food you are introducing.

i. Explain the taste of the food before you give them.

j. Consider their likes and dislikes.

k. Do not try to introduce a new food product when your child is sick or in a very bad mood.

l. Serve them at right temperature.

m. Do not mimic or fake the new food product with the ones they like. If they dislike this new product, they will not eat the older one as well. Don't give them false ideas.

n. Make the menu colorful and nutritious. Eg, If you have already introduced rice and spinach, add carrot as a new food. This will make the menu not only colorful but also nutritious. Now you are giving carbohydrate, iron and vitamin A to your child.

These are a few tips to introduce a new food to your child.

Caring an asthmatic child

Children accept and deal better with diseases than adults. But it is the parent's and the pediatricians responsibility to help the child to adapt to asthma. Anything can cause asthma in children; foods, pollens, dust mites, cockroaches, smoke, animal dander, temperature changes, respiratory infection, activity and stress. The common symptom is coughing in the absence of respiratory infection, especially at night. A parent should know the triggering agent, the symptoms and avoid status asthmaticus (which is a medical emergency).

When your child is diagnosed with asthma, it is important to explain him about the disease process in simple terms. They can be instructed to inform the parents or teachers (if at school) when they have symptoms of asthma. The symptoms may start with localised itching in front of the neck, shortness of breath, cough, wheezing, chest tightness, tiredness, restlessness and sternal retraction. Younger children assume a tripod sitting position and older children will sit upright with shoulders hunched and arms braced to facilitate the use of accessory muscles of breathing (they will refuse to lie down). Also the child will speak in short broken phrases. These symptoms should provoke the parent to take necessary action immediately.

To help a child with asthma,
1. The parents should be thorough about the disease condition, the medication and emergency measures. They must identify what is triggering the asthmatic attack, what kind of symptoms their child is presenting and avoid such stimulants.

2. As asthma is a life long disease, it is better to teach everything about the disease to the child when the child is big enough to understand and act accordingly.

3. Keep emergency medications, nebulizer and oxygen masks, tubing's and cylinders ready at home.

4. Keep the room air humid and keep the child's room very clean. Do vacuum and dust his room when the child is not home.

5. If the pollen is causing the problem, keep the doors and windows closed both at home and while travelling in a car. Encourage the use of mask while taking the child out for a walk or to the park.

6. If he is allergic to some kind of food, don't cook that at home because the child may tend to eat and crave for it.

7. If it's pet's dander, try not to have a pet a home. Avoid them from handling neighbourhood pets as well. Encourage them to wash hands well and blow out the secretions from nostrils if they handle pets.

8. Avoid them playing near the bush where there can be insects that might stimulate an attack.

9. Protect them from sudden temperature change with warm cloths covering the chest and neck, also use caps to avoid cold air entering through ears and scarf to cover the nose and mouth. Apply vicks vapour rub for chest, neck, nose, behind the ears and back to keep him warm and comfortable in cold season. Restrict them from playing in the rain.

10. If you are a smoker, stop smoking at home and avoid taking them to places where people smoke a lot. It's not on the cigarette smoke but also the smoke from kitchen or vehicles can stimulate an episode. Use exhaust fans while cooking and avoid taking the child to polluted areas. Even a strong perfume or washing solution can trigger an attack.

11. Avoid letting them play with children who has respiratory infection. It is also better to avoid swimming pools.

12. Don't let them play or do any activity till they get exhausted. Any stress can also stimulate an attack.

13. Give them steam inhalation and chest physiotherapy at home at least twice a week. This will bring out secretions and it's also good for lungs.

14. Instruct the child about identifying symptoms, use of appropriate medication, use of neutralizer and keeping them clean.

15. Teach deep breathing and effective coughing exercises and help them to do whenever possible. This helps to bring out secretion from the lungs.

16. Give them plenty of fluids and explain it's importance.

17. Ensure they take a well balanced diet.

18. Inform the health care providers and the school personnel about the child's condition.

19. Ensure he takes adequate rest and sleep.

20. Allow them to take control of self-care measures as they get older and help them whenever necessary.

You might have to make a lot of life style changes initially to get the child get accustomed with his routine. It is easy to adapt to a particular life style than to change, so a child easily gets along. Keep watching for long term medication side effects and other complications caused due to asthma. Make the best use of recent treatments and help your child to stay healthy.

How to care for a child with migraine headache?

Migraine is a severe form of headache that affects a person periodically and repeatedly. Migraine headaches in children are similar to those of adults in signs and symptoms, and treatment. Familial tendency is the most common cause of migraines in children. About 10% of children get migraine headaches. Though migraine headaches are considered benign, they bring about a lot of hassle in day to day life activities. They are one of the leading cause of sick leave at schools.

The classic migraine attack can be divided into three phases in children. They are: the aura, the headache, and the recovery phase.

The aura phase occurs 30 minutes before the actual headache where the child will experience visual disturbance (light flashes), nausea, sensitivity to bright lights, loud noises, and strong odors. The child may complain of dizziness and tingling sensation over the face and hands. Some children talk irrelevantly due to mild confusion and loss of attention. The child may look pale and tired.

Aura is followed by the headache phase. Here, the child suffers a severe throbbing headache and will search for a dark room to rest. The headache is usually one sided over the temple and is profound around the eyes. It is relieved by vomiting.

The recovery phase is a period of exhaustion with associated muscle aches in the neck and scalp. The child tends to sleep longer during this post headache phase.

Boys and girls are equally affected during childhood. The girls continue to have migraine attacks after menarche but the episodes decreases in boys.

The diagnosis is made with the help of a detailed history, physical examination, fundoscopic examination of the eyes and the neurologic function tests. A familial history and a unilateral, pulsating, and throbbing on and off headache supports the diagnosis of migraine. On physical examination, the child may look pale and ill, have dark circle under the eyes, and be irritable. Symptoms like photophobia, abdominal cramps, diarrhea, sweating, and swelling will be noticed during an actual attack of migraine.

CT scans and opthalmic examination should be taken for children to rule out the presence of tumor or any other problem (if any). The management is divided into symptomatic and preventive approach. Pain relief is the first goal in symptomatic approach and it is done with analgesics, abortives and prophylactics. Identifying and avoiding is the next step to put an end to the migraine headache. The triggers are usually milk products like cheese, chocolates, nuts, preservatives and caffeine. Avoiding stress and illness also prevents the child from having an episode of migraine headache. Preventive drugs are propranolol, antidepressants, barbiturates, and tranquilizers, but they are avoided for children.

The child must be brought for follow up check ups if the child is treated with any medication. The child should be monitored for side effects periodically, and any adverse effect must be reported to the doctor immediately. Keeping a record of the circumstances surrounding the attack (like activities, food, and feelings) will definitely help to identify and prevent the migraine attacks.

How to care for a autistic child?

Autism is a developmental disorder seen in every 4-5 children of 10,000 live births. It presents with socialization, communication and behavioral problems that needs long term attention. It causes physical, emotional, social and financial stress on parents. However, parents who take things in positive sense easily cope and give their best to their children. Irrespective of the child having mild or severe developmental disability, they need be closely observed and cared.

Parents are trained to take care of their autistic children in a special way, not only as a child but also as they grow because this is a life long problem.
1. Parents have to know the characteristic features of autism which will help them to identify and act accordingly.
The characteristic features are:
a. They don't like to be cuddled.
b. They don't get attached with others and they are not just aware of others presence.
c. They give importance to non living things like toys, books etc.
d. They don't play with other children.
e. They have poor eye contact and inappropriate gestures.
f. They repeat words or sentences without understanding it's meaning.
g. They cry unnecessarily in a loud high pitched intonation for no reason.
h. They use the word 'I' instead of 'you' and vise versa.
i. They are stubborn and adamant.
j. They throw tantrums anywhere they like.
k. They have certain Stereotypic behaviors.
l. They are aggressive and many times harm themselves.
m. They have poor response to loud noise and good response to soft noises.
n. They are very insensitive to pain.
o. They always look preoccupied or act as if deaf.

2. After knowing the characteristic features, the parents should learn or get trained themselves the way they should handle their child in different situations.

3. The first thing they should teach their child is to take care of their basic needs. The basic things include meeting their nutritional, hygienic and eliminational needs. This is taught to them slowly by parents with the guidance of health care providers. And this goal is achieved by bringing a routine in their life, that is a specific time for everything.

4. The specific things they are taught as routine for the day are
* Brushing the teeth soon after they get up in the morning.
* Meeting their eliminational needs.
* Taking a shower.
* Dressing up by themselves (including buttoning and unbuttoning).
* Having breakfast and replacing or washing their utensils (depending on the home practice).
* Going to school with parents or some responsible person with necessary materials they learn.
* School routine goes on with regular break, nap, play and activity time.
* Evening routine starts with washing face, doing home work, play and dinner.
* Going to bed on time.

5. These children easily pick up the routine and any deviation will cause them inconvenience. The parents should prepare the children previously when there is going to be a change in routine like going to stay in somebody else's home or going for a picnic.

6. Try to keep them occupied with any activity they knew in new situations.

7. If they throw tantrums in public places, try to divert them and get them involved in some other task.

8. Older children are made to learn a job to live an independent life. Select a particular occupation which they can manage depending upon their capability.

9. Teach their job very slowly and correctly, so that they do it properly. If they once learn it wrong, it's very hard to correct them.

10. Use short simple sentences and commands to teach them. Have patience and make them repeatedly do a particular task until they do it perfectly well.

11. Provide them a reward each time they do something correctly and keep encouraging them.

12. Though they don't fall sick all of a sudden, it's better to keep money exclusively to meet the medical expenses. Have them insured to meet long term goals.

Meeting a speech therapist, learning a vocational job and getting a job for them is not that easy and does not happen under one roof. There will be a lot of preparations and adjustments to be made and requires decision making which will pose added pressure and stress to life. Parents may even have to leave the other children with somebody else for months to stay with the autistic child in care centers while they are learning to meet the basic needs. Talking to other parents in support group, working together with speech and occupational therapist, meeting a psychologist and clergy man will help these parents to manage life in a better way.

How to prepare your child for a hospital stay?

Each child differs in his understanding to accept and adapt to the changes in the environment. The child's attachment to his parents, the way he is brought up (independent or dependent), age, health status, previous hospital experience, level of anxiety everything matters when you prepare your child for a hospital stay. It isn't that easy as we think.

When you prepare a infant or a toddler for a hospital stay, the child feels a sense of separation. He feels insecure in a new place like a hospital and gets an idea that his parents are going to leave him in the hospital forever. Also he feels that his sibling is going to play with his favorite toys etc. So he expresses the feeling of separation from their loved ones or loved things. In such cases, the parents should explain him clearly that they are going to stay with him during the hospital stay, bring his favorite toys to the hospital and also let his siblings and friends visit during visiting hours if permitted. Children do not understand much when you explain about surgery or tests but still it is the parents responsibility to explain their child in a pleasant way. Do not scare him.

If you are preparing a pre-schooler, he is concerned about different things. He doesn't understand much about the disease and need for hospital stay. If he is in the state of understanding, explain him that hospital stay is for some kind of correction and not a punishment. Never tell him you will be hospitalized if you are mischievous. Be truthful to them. Explain with pictures which gives better understanding. Start preparing him at least 3-5 days before the day of hospitalization. Explain the procedure in simple terms and the need for it.

In case of a schooler, he is big enough to understand what is going on in him and around him. He'll be concerned about missing school and friends. Some might feel ashamed of telling their friends about the problem they have and the reason for hospitalization. Talk to your child and make it clear that diseases and hospitalization are nothing to be ashamed of. Consult a psychologist if needed. Send leave letters to school ahead of time, also talk to the concerned teachers about your child's problem. Explain your child little more deeply about the need of hospital stay and the procedures he has to undergo. A better explanation gives a better co-operation.

If your child is an adolescent, he will be very understanding and will know the need for hospitalization. But still he'll be very anxious about the process. A good reassuring explanation will relieve his fear. Encourage him to ask questions and clear his doubts with you or a doctor. Help him to feel at ease.

Other general tips include:

1. Explaining and preparing the child well ahead of time before hospitalization which ensures enough time is given to them to accept the change.

2. Start packing things and get ready for hospitalization a day earlier with the child. Ask him to take his favorite toys, books or CDs for you to pack.

3. Spend a quiet time with him and talk about the hospital stay in a soft tone. It is better to know what is about to happen in advance.

4. Ask them what they feel about the particular procedure and hospitalization, then you explain the rest for him.

5. Teach them relaxation techniques like deep breathing and diversion.

6. Give him a gentle hug or back rub when is needed.

These are simple ways to prepare your child for a hospital stay. If you have made any promises, make sure you do it. Visit your child with friends and family, and make the stay enjoyable.

how to identify apraxia in children?

Apraxia is inability to do a coordinated or skillful task that is commonly performed by a normal person. It is a neurological disorder and does not involve the muscular system. The muscles do not show any sign of weakness or paralysis, yet they are unable to use a familiar object, or imitate a particular movement, or respond to a command. The parents being close with their children, can find the problems in them very easily. Mothers have the habit of comparing their children with the children of their neighbors, friends or family members who is of the same age. Thats how they identify many things (even the things that a doctor could miss) and this is something to be appreciated in them.

Identifying different signs of apraxia in children under various classifications:
1. Ideational apraxia where parietal-occipital portion of the brain is affected. Here, the child may not be able to complete a particular task from the idea with which he started. He might have taken a comb in his hand to comb his hair but instead he will be rubbing the comb to his hand as though he has forgotten or is thinking what to do. Their actions are very slow and disorganized, but eventually they complete the task they started. Similar problems can be seen in brushing the teeth.

2. Ideo-motor apraxia where the parietal lobe of the brain is affected. The child will not be able to do something which you command him to do, in spite of his good sense of hearing and muscle strength. If you tell him to go and bolt the door, he will go to the door and just hold the knob or just do something else standing near the door but will never bolt them. He never accomplishes the task given to him. They will be able to do the same task automatically when it is not commanded.
Other examples: Commanding him to cut a paper using scissors.
Commanding him to unbutton his shirts.

3. Kinetic apraxia where the frontal lobe of the brain is affected. The child's movements are very coarse and clumsy. They cannot use a spoon or even hands to eat in a neat way while the children of his age will be able to do so.
Other examples: Poor handwriting and drawing
Poor way of coloring a picture
Inability to walk in a straight line
Inability to tap the foot or wave good-bye

4. Speech apraxia occurs when Broca of brain is affected. It comes under kinetic apraxia where the child is unable to utter words fluently or pick up a language quickly.
For example: They mispronounce or repeat or even stammer
They have improper coordination of lips, tongue and jaw.

5. Limb apraxia is connected with ideomotor apraxia where the child is unable to do fine movements using his limbs when is commanded to do so.
For example: Opening a lid of a bottle
Holding a pencil or pen
Thread a needle
Making a salute
Jump up and down in a place

6. Buccofacial or oral apraxia is also associated with ideomotor apraxia. It is also called as non speech apraxia. Here, the child will be able to talk but not use his facial muscles in an effective way when they are commanded.
For example: Blow a whistle or candle
Lick the lips
Stick out the tongue
Suck a drink using a sipper or straw
Wink an eye

7. Constructional apraxia is where the child is unable to carry out simple things which the child of his age could do.
For example: Drawing a picture of an apple

8. Oculomotor apraxia does occur but rare. Here the child is unable to respond or coordinate the movements of the eyeball.

All these signs can occur at an early age (infant) or may even start abruptly as a preschooler or schooler. They are usually accompanied with language problems. In infancy, the child does not reach the milestones at the right time. There might be delay in head control, or giving a social smile (limited facial expression). They might have their first words spoken very late and have excessive salivation when trying to speak.

When you find a delay in your child's speech or action, consult a doctor as early as you can. A team of neurologist, neurosurgeon, nurse, psychologist, speech therapist and occupational therapist can definitely help your child to get out of this problem.

How to identify OCD in toddlers?

Children between the ages 1 to 3 years are classified as toddlers. This is the stage for children to learn their routine. This routines and rituals should not be confused with obsessive compulsive disorder. OCDs are associated with words, ideas, thoughts and actions. The toddlers at this stage do a lot of exploration and learn a lot of new things. By learning so, they tend to do those things repeatedly as though they have achieved something great. Again this act should not be misunderstood as OCD.

Parents being in the close circle of their children at this stage should be clear in assessing and identifying the abnormalities from normalcy. The child may want to change her clothes when something spills on it, don't panic; this is just a mannerism that they have learnt from you (parents) or a teacher from their play school to keep themselves neat and clean. Some children might want a particular toy by their side while going to sleep, this is again something not to be worried about. Children like particular toys and they are comfortable with routines.

On the other hand, those parents and grand parents who have OCD should have a watch on their children's activities. OCD is said to be a heredity disease but this doesn't mean that the children of all OCD parents will get it. They are at risk. The OCD in toddlers cannot be assessed and diagnosed completely at this stage because they are in the learning process of life. Their habits and behaviors tend to change in course of time. The parents have to keep an eye on them continuously as they are grow. If the symptoms persist, say till the age of eight to ten, then they must seek a good psychiatrist.

One in two hundred children have some kind of compulsions. No vigorous treatment is necessary at this stage because they have not yet learnt to do something with rationale. As they grow, and when they come to a stage where they can sort out the right things from wrong (or know what they are doing does not make any sense) is the best time to seek treatment. Start the treatment with behavioral therapy and move on to drugs only if needed. Children do not need treatment if it does not affect their studies or their daily activities.

Assessing obsessive compulsive disorder in Children:
1. Doing the homework again and again.
2. Arranging the dolls or toys in a perfect row and not playing with it.
3. Arranging the closet repeatedly till it looks extra-ordinarily neat.
4. Checking repeatedly whether the parents and sibling have slept.
5. Using the toilet for longer time.
6. Using soap and toilet tissues lavishly until they 'feel' they are clean.
7. Not touching certain surfaces at home or anywhere which they feel is dirty and wash hands repeatedly if they touch those areas.
8. Spending hours in front of the mirror involved in combing hair to keep every strand in place.
9. Thinking other's toys are the dirtiest on earth and segregating himself/herself from other children and play.
10. Feeling insecure that he/she will die or acquire some diseases when there is no actual chance of getting the disease. They express a kind of fear they have to their parents regarding doing or not doing something.
11. Collecting unusual or unwanted things like clipped nails or used bandages.
12. Assess the child for behavioral change after a stressful incident which may trigger the existing condition.
13. Assess the child after a streptococcal infection which may also trigger the symptoms of OCD.
14. OCD can be associated with other psychiatric conditions like autism, anxiety and schizophrenia. Not all autistic children suffer OCD.
15. Avoiding kisses (thinking saliva contains germs and wash their face again and again till its clean) or wanting six kisses from each person in a family is also a sign of OCD.

Behavioral therapy works great on children, expose them to situations they fear and explain nothing happens in doing so. Introduce them to children who undergo similar problems, so that they feel they are not alone and will learn to overcome their thoughts and actions from each other.

Identifying speech delay in toddlers

Parents wait for their children's first words. Mama/dada are the usual first words of a child and it is uttered when they are between five and ten months of age. Speech and hearing are closely related to each other. Some children start to speak early and some children a little late depending upon certain factors. A child starts to speak early when there is always someone talking to him/her and not left alone. There is also old lady's tale that girls speak quicker than boys.

However, there is an age limit within which a child must talk, though it can vary slightly from child to child. The mile stones goes on like this:
* The newborn cries soon after birth with a loud screech which itself is a good sign.
* The newborn is able to hear loud voices or noises when he is completely awake and turn their eyes and head towards that side. They also give a social smile.
* The infant can recognize the voice of his parents or the care giver in 1 to 3 months and respond to them with a smile.
* By 3 to 6 months, the infant can laugh and imitate the sounds (not words) made by the parents.
* In 4 to 8 months, the baby can make cooing sounds like using one syllable like ga, ma, pa, goo, ba etc.
* Following that between 5 and 9 months, he start to use more syllables in the form of a tune. Eg: lalalala, babababa, gagagaga
* Now by 5 to 10 months, the child starts to grasp certain words used by the parents or immediate care givers like mummy, daddy, tata.
* In 6 to 10 months, the infant will use those words to meet his needs knowing somebody will attend to him. Eg: He will use the words mama/dada in a cry when he wants milk or wants the nappy to be changed.
* In 9 to 15 months, he may start calling the parents mama/dada and ask for something by pointing to that object.
* By 12 to 20 months, the toddler must speak at least 4 to 6 common words. They usually say mama, dada, no, milk, juice, pen, papa, come.
* The words become meaningful sentence now by using two or three words in 18 to 22 months. They usually say more milk, want ice cream.
* By 2 years, they can speak in sentence with two or three words and use wide range of vocabulary (50+).
* In 24 to 36 months, he should be able to converse 2 or 3 simple sentences which should be understood by unknown people.
* Between 2 and 3 years, he should be able to name at least four colors and pictures, use at least two objects appropriately and obey commands.
* By the end of 3 years, he should speak fluently with at least 200+ words and should be well understood by a stranger.

If your child has not met the above mentioned milestone as a toddler, it is important to seek treatment at the earliest. The earlier the treatment, the better the results. Parents can identify the problem of speech delay by 18 months in their child. You actually need not wait till 3 years to go for a particular treatment like speech therapy.

As a parent, you can assess your child for
* delayed milestones
* fine motor skills
* concentration and attention span
* grasping power and ability to understand a command
* stammering speech
* reaction to a particular stimuli
* act outs
* agitation and irritability
* tantrums
* mental retardation or autism
These are some of the factors that can be associated with speech delay in toddlers. Observing and notifying this will help the medical professional to collect proper history for diagnosis and treatment.

Assessment tools used by the professionals are;
* Language development survey (LDS)
* Communicative Development Inventories (CDI)
* Assessing Linguistic Behavior (ALB)
* Communication and Symbolic Behavior Scales (CSBS)
* Infant-Toddler Language Scale (infant)
* Assessment Evaluation and Programming System (AEPS)

LDS and CDI are taken by the parents of the affected child to screen them for the word use, sentence use, gesture and prelinguistic communication. ALB, CSBS and infant tools are used by the affected child with parents help. This is mainly used in evaluation of prelinguistic communication in depth. AEPS is a test done by the child independently and this is used to assess the child's language and developmental skills which helps in actual plan of action.

Parents play a major role in treatment of speech delay. Talking to them continuously (not letting them stay alone), asking simple questions, talking in one particular language, teaching through colorful pictorial books and not depriving them from their pleasurable activity when they don't do well are simple tips which can improve your child's health.

Items required for your first baby

Baby comes as a bundle of joy to the awaiting parents. Fortunately, the first baby enjoys the privilege of having the best and new things. Baby is not a miniature adult to just get adjusted with what ever available. There are a lot of things you need to keep ready to receive him to this world and make it a wonderful place for him to live.

The baby needs warmth, comfort and entertainment to grow more happily and productively. Marketers have studied the needs of the baby and the care giver (mother usually) and designed many items in a very affordable rate meeting the health, sanitation, growth, development and safety needs of the baby. The things you want to buy for your first baby will definitely be endless but the essentials narrow the big list. Let us see the essential things needed for the baby.

Warmth: The baby lies in a warm mothers womb for 40 weeks and he cannot abruptly adjust himself to the surrounding very easily. The mothers hug which we call as kangaroo care (skin to skin attachment) is the best way that provides maximum warmth. Apart from that, we need a few more materialistic things.

Receiving blankets:
They are thin blankets used for swaddling the baby. The baby has to be swaddled for at least 2 weeks despite the temperature being maintained at 68 degrees.

Baby blankets:
This is a thick blanket which is used to keep the baby warm and covered, when the baby is sleeping or while the baby is taken out for a walk or to the doctor's office (to cover the car seat or stroller and t avoid entry of dust), or even to cover yourself and the baby while breast feeding.

Warm clothes:
The baby has to be dressed according to the season. However, it is important to have some warm clothes that covers the baby's whole body which can be used in the initial days of life and during winter.

Comfort: The baby sleeps for at least 20-22 hours a day. This is the basic comfort need of the baby and it is disrupted when there is some kind of disturbance like the baby is wet or not fed properly or poor ventilation or even an uncomfortable bed. So those things necessary to promote sleep is very much needed for the baby.

Crib and mattress:
A baby definitely needs a comfortable place to sleep. It is usually the mother's side for the first few months, then the child must be practiced to sleep in a crib.

Swing:
This is an optional comfort device that is needed for the baby. Though the swing seems to be like a play device, many babies sleep as the swing sways and plays music.

Bouncer:
This is a very useful one for the baby. Once the baby's head control is achieved, the baby can be made to sit in the bouncer and enjoy the toys fixed to it. It is a wonderful device where the baby can be made to sit and be fed. It also acts like a burp chair that prevents aspiration.

Changing table:
Though this is not an absolute necessity, it is comfortable for the mother to give bath, change nappies and dress the baby without much strain. It also gives you some room to keep baby clothes, powder, lotion, soap, oil and nappies as well.

Baby carrier:
This is also not a must-buy product for the baby, but it is more convenient to carry the baby wherever you go and keep your hands free. It is more useful for the dads to carry their babies easily.

Humidifier:
It is necessary to keep the air humid especially when the baby has cold, to sleep comfortably.

Car seat:
An absolute necessity to take your baby out safely.

Stroller:
It is useful in many ways, especially the ones which are convertible that allows the baby to sit or lie down, and that can fix the car seat to it.

Baby formula: Breast feeding is the best feed for the baby. Those mothers who can't breast feed their babies due to certain illness or those who secrete less milk can be ready with baby formula.

Feeding bottles: You will need to buy at least 5 pairs of feeding bottles of different nozzle sizes to use at different stages. Buying 5 pairs will keep you off from washing and sterilizing frequently.

Bottle warmer and sterilizer: The bottle warmer is specially useful while preparing feeds for the baby at nights. And sterilizer also makes life easy and saves time.

Diaper and baby wipes: It is better to purchase less packs of newborn diapers because they out grow very fast from that stage. The rest depends upon the baby's growth and you will need countless. Baby wipes should be alcohol and fragrant free preferably.

Bath tub: It is good for the baby to sit and have a warm and refreshing bath in the tub where the baby can move his arms and legs freely. It also gives them a chance to play.

High chair, milk storage bags, bottle brushes, breast pump, pacifier, baby shampoos, soaps, lotions, creams, powders, baby washing solution to clean bottles, diaper champ, baby detergent to wash clothes, baby monitor, bath towels, baby grooming set which includes small comb, tongue cleaner, small soft brush, scissors, nail clipper, buds, and a large number of bibs, wash clothes, socks, caps are some of the other things needed for your baby.

Medical need items: There are certain emergency medical items which has to be kept at home and out of reach from children. They are as follows:
1. Thermometer
2. Mucus sucker or nasal aspirator
3. Spirit
4. Neosporin
5. Cotton
6. Antiseptic wipes
7. Tylenol syrup for cough and fever
8. Medicine dropper
9. Measuring cup or ounce glass
10. Prescribed medication for abdominal colic or indigestion.

Entertainment: The baby definitely needs some entertainment to grow mentally. The newborn will usually concentrate on bright colored, big and sound making play things. As they grow their interest change depending on the sex of the baby. Whether boy or a girl they must be provided with play items that gives them some kind of a learning and safe exposure.

It is always necessary for the parents to involve themselves in their play and make sure there are no small objects that will choke the children. The items like pack and play, walker and entertainment center are useful to them. There are a lot more a baby needs! Parents to be can start their shopping well ahead of time and select the best for your child.

Diarrhea in infants

Diarrhea is one of the common ailments during infant period. The causes vary from teething, gastrointestinal infections, antibiotics, change in mother's diet if the baby is breast fed to malabsorption. Diarrhea must resolve by its own within 5 days, if not an actual investigation and treatment is necessary. Diarrhea is the major cause for high infant mortality rate (IMR) throughout the world.

The most common causes of diarrhea in infants is the viral gastroenteritis caused by poor hygiene. They are explained in simple words as 5F's which are food, finger, formite, flies and feces. When we take care of these 5F's for our children, we can definitely prevent diarrhea and death related to diarrhea.

Treating diarrhea: Infants who have diarrhea can be compared to a pot which has a hole at the bottom. This comparison is given to make you understand that whatever the infant takes is going to go out of the body and the body does not have adequate fluids needed. To prevent dehydration we must keep rehydrating the infant to prevent other complications. However, whatever is given is going to go out, some of the nutrients are absorbed by the body during the process of digestion.

Rehydration is the best treatment for diarrhea in infants. Every time the child defecates a feed should be given. The feed must preferably be liquid that can be quickly and easily absorbed and digested by the body, and what the child is already used with. If the baby is breast fed, the mother should continue to breast feed.

Oral rehydration therapy (ORT) is the world health organization approved rehydration therapy used for both adults and children. They can be made at home as well as be bought over the counter. The amount of oral rehydration solution (ORS) given to the infant depends upon his weight and age. But the infant can be encouraged to take how much ever he can if he likes it.

Home preparation of ORS: Take 1 liter of boiled and cooled water or safe water, add 40 grammes of sugar and 3.5 grammes of salt, mix well. This can be made with lemon or orange juice instead of plain water.

ORS packets which are readily available can be made according to the instructions given in the sachet. They are also available in different flavors. They should not be stored for more than 24 hours. Again hygienic handling is important to prevent the growth of organisms.

Good hygienic practices and rehydration are the best treatments for diarrhea.

Child Personal hygiene

Good personal hygiene is the base for a disease free life. The habits of personal hygiene are learnt since childhood from our parents. It is the sole responsibility of the parents to teach their children about the habits of good personal hygiene which they practice all through their life.

Hygiene starts at birth and continues life long. The first thing a nurse does once a baby is born is something called 'baby care'. It is nothing but cleaning the eyes, umbilical cord and ultimately the whole body. This is done to prevent infection through eyes and umbilical cord. Though we cannot say this a personal hygiene(because it is not done personally), the baby is completely dependent on us and it is the parents responsibility to keep the baby in good hygiene until the child learns self care.

In the first year of the child, the mother should be keen about changing the nappies regularly once the child wets them. Not changing them regularly will produce irritation and rash to the baby's skin. A bath in the morning and evening is a must for them. The bath time is the best time to assess the baby's body and every body part should be taken care. Care under the chin, behind the year, nape of the neck, arm pits, groin, between the buttock, genitals and between toes and fingers. By the end of the first year, the baby will know taking bath and wearing an underwear is a expected behaviour from him.

Small children can be disciplined. Teaching the correct things at this stage will help them to learn better. They imitate what you do and look at you as a role model. Parents should do everything what you expect from the child. It starts with brushing teeth and cleaning tongue every morning and before going to bed, washing your face and legs when you come back after an outing, washing hands with soap and water after playing with muddy ball in the park or after handling a pet, washing hands before and after eating, taking bath regularly and changing cloths daily, washing hands after toileting and goes on.

Older children should do all the above mentioned things on their own. And they should be checked whether they are doing them properly. Immediate correction should be made if any. When you notice them not cleaning the umbilicus or arm pits or pubic region, or if they try to wear the same under wears correct them then and there. If you don't correct them now then it's going to be too late. Make sure they keep their bed and belongings clean.

Adolescents are mature enough to take care of themselves but as they are still children for their parents they can be taught the necessary things. The important care at this stage is menstrual hygiene for girls. They can be taught how to wear pads and change them regularly. Make them have a warm shower twice during those days it is not only hygienic but also soothes the back, also make them change their under garments after bath. They can be insisted to wash their own cloths and keep their unit clean. They can be involved in taking care of the general cleanliness of their home like vacuuming and height dusting, this will make work easy for parents.

These are simple things our children should know about personal hygiene to keep them healthy and happy