Our Best Services for your Kids
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Q1. What is junk food? How much and how often junk food can be allowed for a child in a week?
Junk food comprises of foods high in dietary fats, sugar, salt, or those which are nutritionally inappropriate. Most of the ultra-processed foods (foods that are commercially prepared by mixing several ingredients and adding additives such as sugars, flavors, and colors) are junk foods as either they are nutritionally poor or high in sugar, salt, or fat. Sugar-sweetened beverages, carbonated drinks, and caffeine-containing drinks are also categorized as unhealthy foods under the broad acronym JUNCS (Junk foods, Ultraprocessed foods, Nutritionally inappropriate foods, Caffeinated/colored/carbonated foods/beverages, and Sugar-sweetened beverages). Table 1 lists the common junk foods. Children and adolescents should avoid consumption of foods and beverages categorized as JUNCS, as far as possible. Alternatively, limit consumption of these foods at home/outside to not more than one serving per week; serving not exceeding 50% of total daily calorie requirement for that age.
Q2. As working parents, we are dependent on breads, cornflakes, etc. Are they healthy?
Many parents look for quick solutions to feeding the children, especially when both are working. Most of the ready-to-eat foods are not as healthy as they are often claimed to be. Some of the examples to explain this fact are as follows: Cornflakes have a low-fat content, but the sugar, flavor, and corn syrup added to the flakes make it an unhealthy choice. Cornflakes are made up of malt, fructose corn syrup, and sugar, which make them very high in refined sugars. Corn syrup used in corn flakes has been found to have high levels of fructose in them. They might be low in fat but the sugar content promotes fat storage. Similarly, bread is relatively low in essential nutrients. It is rather high in calories and carbs but low in protein, fat, fiber, vitamins, and minerals. Its excessive intake, especially white bread containing simple carbohydrates, can lead to unwarranted weight gain and predisposition to chronic ailments such as diabetes and heart disease. Even most brown breads predominantly have refined flour and are processed in same way as white bread.
Q3. How is junk food harmful to body?
Junk food can be harmful in many ways; some problems may appear early and others in due course of time. Most of these foods have poor nutritional quality due to high carbohydrate and fat content. Mostly they are high in sugar or salt as well. On the contrary, they are low in proteins, vitamins, minerals, and other micronutrients. This nutritionally imbalanced diet often leads to rapid weight gain and obesity. As the intake continues over a longer duration, it may affect the lipid profile of the body thereby predisposing to more severe illnesses such as diabetes, heart disease, and high blood pressure. Some of the additives used in ultra-processed foods may also increase the risk of cancer. Microbial contamination due to poor hygiene can lead to gastrointestinal infections such as diarrhea, typhoid, and hepatitis. High sugar content of junk foods and drinks may lead to dental caries. Food additives and coloring agents may cause allergies. Caffeinated drinks cause increase in the heart rate and sometimes abnormal rhythm of heartbeat. Regular over consumption of caffeinated drinks may cause psychiatric and sleep disturbances.
Q4. What are healthy food options for babies, toddlers, and young children?
All babies till 6 months of age should be exclusively breastfed. Any sorts of ghutti, water, top milk, honey, juices, or tea are not permitted. Beyond 6 months, some common homemade food options are provided in Table 2.
For infants 6 months to 1 year For toddlers and children Khichri, dalia, sooji kheer, mashed potatoes/banana/ boiled vegetables, upma, mashed idli, and curd
For toddlers and children
Dal, rice, chapatti, vegetables, curd, chilla (dal and besan), egg, fruits, idli-dosa with homemade batter, upma/seviyaan/poha (with vegetables), milk fruit smoothies without sugar, cooked beans, and roasted/ boiled chicken/fish
These are just some of the examples. Fresh homemade foods, low in sugar, salt and saturated fats, and high in proteins should be preferred.
What should be the energy intake from various types of foods?
Total calories in a healthy meal should be divided as 15–30% from fats, 10–15% from proteins, and 55–75% from carbohydrates. Free sugars should be <5% and there should not be any trans fat. Recommended salt intake up to 12 months is <1 g salt, 1–3 years <2 g, 4–6 years <3 g, 7–10 years <5 g, and for ≥11 years 6 g per day.
Q5. My baby likes juices and shakes. Are they healthy and how much can I give?
Pre-packaged juices and shakes are not healthy foods to be offered to children. Regarding juices, it is always better to give whole fruit rather than fruit juice. Eating whole fruit has advantages, including more fiber content, more nutrient content, and lesser chances of microbial contamination, which can happen while extracting juices. Regarding how much juice to give, the recommendations are: Fruit juices should not be offered to children less than 2 years. For children 2–5 years, up to 125 mL of only fresh homemade fruit juices with no added sugars can be given, per day. In children older than 5 years, the amount can be increased till 250 mL per day, but it should be fresh, homemade, and without added sugars. Canned and packaged fruit juices are not advisable. For milk-shakes, whole fruit mashed with milk at home without any added sugar can be given but milkshake powders or juice extracts should not be used. The best beverage to offer any child is clean pure water
Q6. I have started adding milk supplements to my toddler’s milk. I heard that they give lot of energy, vitamins, and minerals. Is this true? What is the right age to give them?
Malt-based milk supplements are very commonly used in India. While the primary ingredient is malt, mostly barley, or cereal derivative, the secondary ingredient is invariably high content of sugar. It is the free sugar which becomes a matter of concern for us. It is not only addictive but leads to all associated problems such as weight gain, dental caries, and risk for chronic lifestylerelated ailments. Milk supplements belong to ultra-processed food category and should best be avoided. Advertising has often portrayed the supplements as full of energy, vitamins, and minerals. The quantities of micronutrients present in these drinks may give some benefit to children who have their deficiency, but have no role in healthy kids. Even for providing the vitamins and minerals, the same amount can easily be obtained from other foods which are not only cheaper but also do not have associated ill effects as with these drinks. Results of improved calcium clearly indicate that it is just the milk that was responsible for it.
Q1. I have heard that screen time has an effect on children. What is meant by screen time?
Screen time is the total time spent per day in viewing screens such as mobile phone, TV, computer, tablet, or any hand-held or visual device. Screens have become an essential part of our life. Parents, teachers, and health professionals are concerned about the increase in children’s screen time. Just like the balanced food that we eat, screens need to be properly chosen and to be consumed in the right quantity and at the right time. The way we use the screens determines whether it is healthy or unhealthy. Screen time spent for educational or prosocial activities such as schoolwork, interacting with friends and relatives, and creating art or music or relaxation is termed positive or healthy, while watching inappropriate TV shows, visiting unsafe websites, or playing violent video games are few examples of negative or unhealthy screen time.
Q2. For how long can my child use screens? Should I limit screen time?
Children below the age of 2 years should not be exposed to any type of screen with the exception of occasional video call with relatives. Screen time for children between the age of 2 and 5 years should not exceed 1 hour; the lesser, the better. For older children and adolescents, it is important to balance screen time with other activities that are required for overall development. These activities include an hour of physical activity (play time), adequate duration of sleep (recommended sleep time varies with age, for example, adolescents require 8–9 hours of uninterrupted sleep at night), and time for schoolwork, meals, hobbies, and family time. If any of these activities is displaced due to screen use, then it is called excessive screen time and it should be reduced.
Q3. What is the effect of using screens for a prolonged time on my child?
There are multiple ill effects of excessive screen time on child: Physical health: Obesity, sedentary lifestyle, disturbed sleep, headache, eye strain, neck, back, and wrist pains Mental health: Delayed speech, hyperactivity, aggression, violence, desire for instant gratification, poor concentration, FOMO (fear of missing out), FOBLO (fear of being left out), cyberbullying, media addiction, distorted perception of sex by exposure to pornography, drug use, self-harm, anxiety, and depression Social: Reduced socialization and social anxiety Scholastic: Decreased academic performance
Q4. All children seem to be using the screens nowadays. Are there any benefits of the digital devices?
When screens are used in moderation in a balanced and healthy way, they have many benefits:
Encourage learning and knowledge Act as a tool for communicating with friends and family and promote social interaction Healthy co-viewing and co-playing using digital platforms improve child and parent bonding, recreation, and relaxation. Smartphone Apps such as Saathiya, Calm, and digital platforms such as NIMHANS online yoga class encourage kids to adopt healthy behaviors and kindle device promotes reading Channels like youTube and blogging platforms give opportunities to children to display their talents Customized computer programs can improve social behavior in children with autism and study skills in children with learning problems.
Q5. What is the right age to introduce computer, mobile, and television for my child?
For children <2 years, social interaction is required for healthy brain development. Use of digital devices in this age group can result in delayed speech, hyperactivity, and poor social skills. Hence, screens should be avoided for children <2 years. At 2 years, you could introduce digital devices such as computer and television but you should view the screens along with the children and prefer educative interactive programs for a short duration of time. Adolescents could be given ordinary mobile phones and preferably not smartphones mainly to maintain contact with you when they are outside home. Older children and adolescents may be allowed for the use of smartphones for educational and recreational purposes under parental monitoring for limited duration.
Q6.Children waste a lot of time on Facebook, WhatsApp, Snapchat, Twitter, and Instagram. They even interact with strangers there. Should children be allowed on social media? What is the right age to use social media?
Social interaction is vital for a child’s healthy development. Social media are online platforms that are used by children and adolescents to connect with friends and family, share media content, and form social networks. Some of the popular platforms include Facebook, Twitter, WhatsApp, Instagram, Skype, YouTube, and Snapchat. In recent time, online multiplayer games, such as PUBG and Clash of Clans, are becoming important social media spaces for young people, where they connect with other gamers and chat while playing.
Advantages of Social Media
Fosters a sense of connection and belonging especially for shy children who are hesitant to interact with others in person Promotes collaborative learning through sharing of online educational material and creativity through graphics and videos showcasing talents and achievements of young people Serves as a social support platform for children with chronic diseases and their parents, e.g., with thalassemia, diabetes mellitus, and rare diseases Gives a platform for advocacy to young people, e.g., for climate change and child rights
Specific Disadvantages of Social Media
Exposure to inappropriate content such as pornographic websites and fake news Social media anxiety when the children get anxious and assess their self-worth by the number of “likes” or positive responses that they get on their posts Indulging in risky online behavior such as forming friendships with sexual predators Cyberbullying that is repeated intentional posting of demeaning and derogatory posts and/or pictures Sexting that is posting of sexually explicit material on chatting platforms Exposure to targeted advertising and marketing Breach of privacy results when the child posts personal details, revealing pictures, details of bank accounts, and credit cards online
Q1. This is my first baby. She keeps on crying. How do I know that my baby is crying for a feed?
Babies cry for various reasons besides hunger-like discomfort due to a soiled diaper or feeling hot or cold or simply they want to be picked up and cuddled. Mothers slowly learn to pick up early feeding cues indicating that baby is hungry; for example, bringing her hands to mouth, turning her head towards breast when picked up, lip licking and sucking movements, or generalized fussiness. If these feeding cues are missed, she may start crying vigorously due to hunger. So when your baby cries, check whether the diaper is soiled and change it, ensure that nothing else is bothering the baby and This is my first baby. She keeps on crying. How do I know that my baby is crying for a feed? Q1 then put the baby to the breast. If she is hungry, she will feed. Let her feed for as long as she wants to at one breast so that she gets both the thin watery milk, at the beginning of the feed to quench her thirst, followed by the thicker and fatcontaining milk, that satisfies her hunger. Once satiated, she will fall asleep and come off the breast by herself. If she continues to cry after coming off one breast, feed on the other. Otherwise feed on the other side at the next feed to maintain milk output from both breasts.
Q2. My mother says that if I breastfeed lying down, then milk will enter in the baby’s ears. Is that true?
Well, breastmilk is unlikely to enter baby’s ears through the tube that connects baby’s middle ear to the throat during breastfeeding. When mother lies down and breastfeeds then milk does not pool in the baby’s mouth due to the mechanics involved in breastfeeding. It is far more likely to occur with bottle feeding. Moreover, breastmilk contains lot of anti-infective and immunity boosting factors which actually protect baby from developing middle ear infection. Hence mother can safely breastfeed baby in the lying down position.
Feeding in sitting position
When you sit and feed, then sit with your back straight and well supported. You need to hold your baby close to you, at the level of your breast and turned towards you in such a way that her tummy touches yours and her face is towards your breast with her nose opposite the nipple so that she can take both the nipple and surrounding black part (called areola) into her mouth to latch on to the breast and effectively draw out the milk.
Feeding in lying down position
When you lie down and feed, ensure that you are lying on your side and your baby is facing you the same way as in the sitting position. This correct positioning of yourself and your baby for effective suckling at the breast is the key to successful breastfeeding. So, go ahead and continue to feed your baby in the correct lying down or sitting position!
Q3. My sister-in-law has been diagnosed with tuberculosis (TB) chest few weeks before delivery. Can she breastfeed?
We understand that this must be a cause for concern for the family. Be assured that TB is not transmitted through breastmilk. Transmission from mother to baby most commonly occurs after birth due to exposure to TB bacteria in respiratory droplets, which are generated when a mother with active lung TB talks, coughs, or sneezes. The transmission of TB from mother to the baby can rarely occur in the womb for which doctors do certain tests on the infant such as an X-ray chest, abdominal ultrasonography, and stomach aspirates for TB bacteria to rule out this possibility.
How to protect the child?
If your sister-in-law has been taking anti-TB medications regularly for at least 2 weeks or more before delivery, she is less likely to transmit the infection to the baby and she can safely breastfeed. She should maintain cough hygiene by placing tissue or cloth over the mouth while coughing and sneezing, and wear mask, wash hands, and dispose tissue or cloth properly after soiling. She should also take antitubercular medicines regularly under doctor’s supervision. Her doctor will help protect the baby by prescribing some anti-TB medicine which may be given once a day to the baby for 6 months under supervision and prescription. The Bacillus Calmette–Guérin (BCG) vaccine is also given at birth as is usual for all babies.
When not to breastfeed?
Only if a mother is noncompliant with her medications or is suffering from multidrug-resistant TB, then she should not directly breastfeed or be in direct contact with her baby until appropriate drug treatment is administered and she is no longer infectious. Meanwhile her expressed breastmilk (EBM), collected with all hygienic procedures including respiratory (wearing a mask) and hand hygiene could be fed to the baby by cup or wati or katori and spoon by a noninfected caretaker.
Q4.The current evidence shows that corona virus is not transmitted by the breastmilk
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, causing coronavirus disease 2019 (COVID-19), has taken pandemic proportions. All ages are vulnerable to get infected by this highly infectious virus. The coronavirus spreads through droplets, released during coughing and sneezing, and aerosols. The virus enters in the body through eyes, nose, and mouth directly when a person is very close to the patient or through contaminated hands and wipes coming in contact with the face. World Health Organization recommends exclusive breastfeeding for infants born to COVID-positive mothers without significant risk to the infants. The mother must maintain respiratory hygiene, wear mask, and wash hands frequently with soap and water or sanitize hands with alcohol-based sanitizer (having more than 70% alcohol), especially before and after breastfeeding. New studies claim that breastfeeding even protects baby against coronavirus infection by secreting antibodies produced by the mother against coronavirus. Breastfeeding keeps baby healthy, develops good immunity in them against several serious infections, and helps in achieving adequate growth and development.
Q5. It is summer. Can I give water to my baby between breastfeeds?
Breastmilk contains enough water. The breastmilk composition is such that milk flowing in the first few minutes contains more water. This is called foremilk. Milk secreted towards the end of the breastfeeding is rich in fat and is called hindmilk. It is said that foremilk quenches thirst and hindmilk fills the belly. Water content of the breastmilk is regulated by the dryness of the infant’s oral mucosa. If baby needs more water, then breasts will secrete higher amount of water during breastfeeding and vice versa. This kind of dynamic water regulation for the infant is not possible with the formula/powder milk. The formula milk feed is always prepared with a fixed amount of water whereas breastfeeding provides exact amount of water required by the infant.
Q6.I have fever, cold, and cough since yesterday, should I stop breastfeeding?
I see that you are concerned about breastfeeding your baby. Fever, cold, and cough, which are quite common, are generally caused by viral infections. Such viruses are not transmitted through breastmilk and breastfeeding is quite safe. The viral infection is transmitted through droplets generated during coughing and sneezing. You may take medicines for fever (tablet paracetamol) and other medicines as advised by the doctor, along with warm saline gargles and cough lozenges. These medicines do not harm the baby. You must, however, wash your hands with soap and water before handling the baby and use a face mask to prevent transmission of respiratory droplets. So, you can continue breastfeeding that will also help in preventing infection to the baby as antibodies produced by the mother are secreted in the breastmilk.
It is good to know that you want to continue breastfeeding. Ideally an infant should be exclusively breastfed (nothing else to be given, not even water) for 6 months followed by continued breastfeeding for at least 2 years along with semisolid family foods. Breastfeeding makes a baby to grow healthy and strong. Several organizations, both government and private, support mothers by granting full pay maternity leave for 6 months. You may check with your employer about your entitlement for the same. Even if you have to rejoin work after 2–3 months, you can continue to breastfeed your baby by any of the following methods:
Q1. How should I keep my baby warm at home?
Please make sure that the room is neither unduly cold nor warm. You know the room temperature is OK for your baby if you feel comfortable. To keep the room warm, keep the windows and doors shut. This avoids draught of air. You may use room heater or 200 Watt bulb, especially during winters, to provide additional warmth. However, you must ensure that the baby is placed not too close to the heater or bulb. Kangaroo care is a simple and effective method to keep your baby warm (Fig. 1). Does my baby need additional clothing? Babies <2.5 kg need to be kept warm. The general rule is to add an extra layer of clothing to the baby than what the adults are wearing. The head should always be kept covered. In winter, one may add gloves, sweater, and socks. How do I know my baby’s temperature is normal? The best way to know that all is well with the baby is to look at the color of the soles/ feet. Normally, the soles/feet should be pink. If they have shades of blue or appear off white, it tells us something is wrong.
Q2. Advise me about bathing, massaging, and exposing to sunlight.
It is a safe practice to postpone bathing till your baby has attained a weight of 2.5 kg. During this period, the emphasis is on wiping or sponging the baby. This needs to be done daily. Also remember to use lukewarm water. It should be checked by dipping your finger ensuring that it is neither unduly warm nor cold. Sponge the baby from head to toe. This should be immediately followed by drying with clean towel and putting clothes on the baby. Is massage good for my baby? Oil massage is good for your baby. It should be done gently. Avoid vigorous rubbing, turning the baby upside down or putting oil into ears, nose, or any openings. Remember any maneuver which upsets the baby is not OK. One may use coconut oil or olive oil. It is better to avoid irritant oils such as mustard oil. Can I use fan and/or AC? One can use fan or AC, especially during summer. Ensure that the baby is kept away from the blast of air. Ensure the temperature of AC is not <26°C. What about exposing to sunlight? Sunlight coming inside the room is encouraged but keeping the baby exposed to sun is not. Direct exposure to sunlight is avoided as it may lead to temperature fluctuations and may mask jaundice.
KEYPOINTS 1. A preterm/low birthweight is at risk for temperature fluctuation and needs additional support. 2. Good practices include avoiding bath till weight of 2.5 kg, keeping baby and mother together, providing Kangaroo mother care (KMC), additional clothings during winter, and keeping the head of the baby covered always. 3. A normal baby has a temperature between 36.5 and 37.5°C.
Q3. What is Kangaroo mother care (KMC)? How do I practice it?
If your baby is low birth weight (<2.5 kg) or born preterm, KMC is the best method of caring for the baby. KMC means keeping the baby continuously between the mother’s breasts, in skin-to-skin contact for prolonged period and feeding with only mother’s milk. Benefits to Mom Kangaroo mother care (KMC)
The baby with a diaper, cap, and socks is placed in skin-to-skin contact between the mother’s breasts. The baby’s head should be partially extended and turned to the side so that the baby can breathe well. The baby must be flexed (hips and arms bent) and well supported. The baby may be held in this position with a binder. The mother with her baby in KMC can either sit in a chair or lie down on a bed with many pillows to maintain a semi-reclining position of about 30–40°. The mother should wear clean clothes and wash hands well for KMC
Q4. When to start and stop KMC?
Kangaroo mother care is started as soon as your baby is stable. Your doctor will let you know when to start. Once the baby is placed in KMC position, the baby should remain so for as long as possible and at least for 1 hour. Ideally, a baby should receive KMC for 24 hours/day. This may not be possible for only the mother and other family members can also provide KMC. When do I stop KMC? Generally, as the baby grows and gains weight (usually around 2.5 kg), he/she starts wriggling out every time KMC is given. This is an indication that baby no longer needs KMC. It can, however, be continued during night and also if the baby is sick.
KEYPOINTS 1. Kangaroo mother care is simple, safe, and an effective way to care for low birthweight babies. 2. Kangaroo mother care saves lives, prevents complications in newborns, and also has benefits for mother. 3. Kangaroo mother care is keeping the baby in continuous skinto-skin contact on the mother’s chest for prolonged period with exclusive breastfeeding. 4. Any family member can provide KMC when mother is unable to do so.
Q5. What is the best way to feed my baby?
The best way to feed your baby is breast milk. It is the birthright of every newborn baby. For you, it is a wonderful experience and a miracle of nature. Breast milk provides ideal nourishment and a special bonding experience that many mothers cherish.
Breastfeeding
Challenges
Q6. Should I give formula feeding?
There is no role of giving formula feeding routinely for any baby. Commercially prepared infant formulas are alternatives to breast milk. They are to be used if the mother has no milk, or inadequate milk or has a medical illness or drug treatment which makes mothers milk not a choice for feeding. Use of formula milk should be only on advice of the doctor. With support and counseling almost all moms are able to exclusively breastfeed their baby.
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