TAKING CARE OF YOUR BABY IN SUMMER.

With summer setting in, these simple tips will help in keeping your baby cool and comfortable.

• Dress your baby in cool cottons
Ensure that your baby is dressed in cool cottons in a comfortable and easy-to-wear style. Avoid clothes made of synthetic fabrics as they retain heat and are very uncomfortable for the baby. It may even result in prickly heat and heat rashes. Choose long sleeved light weight garments to avoid the sun's direct rays on your baby's delicate skin. Use a sunscreen recommended by your doctor to prevent tanning. If you are using a sun hat for your baby, make sure it is a wide rimmed hat and fits comfortably. Hats with elastic support may constrict blood circulation and are best avoided.

• Stay indoors during the peak heat hours (10 am - 5 pm)
It is wise to stay indoors when the effect of the heat is the most. If at all you need to step out in the sun, ensure that your baby is well protected. Take your baby out for walks early in the morning or late in the evening. Remove any excess padding from the stroller or pram as they can get very hot and prevent air circulation.

• Limit diaper usage to minimum and switch to cloth nappies instead
As far as possible avoid diapers -- many babies get heat rashes on their waist as the sweat collects around the synthetic waistband of the diaper. Instead switch to cloth nappies in good absorbent cotton. The cloth nappies will not only keep your baby cool but will also prevent heat and nappy rash.

• Increase fluid intake
Increase intake of fluids in the form of lassi, milk shakes, fresh fruit juices (not the bottled variety), and coconut water (both refreshing and nutritious).

If your baby is less than six months old and if you are exclusively breastfeeding, you do not need to give extra water, even in hot weather. Studies carried out in hot climates, like India, have shown that babies allowed to breastfeed whenever they want, do not become dehydrated. Breastmilk is itself mostly water and in hot weather, babies tend to go to the breast more often, for short feeds. This way they get extra foremilk, which is thinner and more refreshing than the fat rich hind-milk. So let your baby have as many extra feeds as she wishes and she will get plenty of water. However, it may be wise to offer bottle-fed babies some boiled cooled water in hot weather.

• Do not feed ice-creams, popsicles, and fruit juices from roadside vendors.
Avoid feeding your baby outside food (especially from roadside vendors) and water. Always carry food and water for your baby with you whenever you are out with your baby. Invest in quality food grade plastic ware to store your baby's food. Taste your baby's food before you feed her to ensure that it is not spoilt. This is particularly true in the hot summer months when stored cooked food spoils very quickly.

• Do not use massage oils, petroleum jelly or other moisturisers
In the hot summer months, it is safer to avoid massage oils as they can cause prickly heat or infantile eczema if not washed off properly. However, if you would like to continue massaging the baby in summers too, you could switch to olive oil or coconut oil, traditionally referred to as cooling oils. Ensure that it is washed off completely and not left on your baby's skin. Also avoid excessive use of moisturisers and lotions on your baby.

• Avoid using talcum powder excessively to keep your baby cool
Many mothers apply loads of talcum powder on the baby just after a bath assuming that this will keep the baby cool. This is not the case as powder on wet skin can cake up and cause a lot of irritation and discomfort. Limit its use, especially in the diaper and neck region. Take care when using talc on the baby's body to make sure it is not inhaled. Use it sparingly and rub it in well.

• Simple home remedies for prickly heat
The hot humid weather causes prickly heat-rashes on the nape of the neck, shoulder, back, diaper area and in the skin folds. A simple remedy for prickly heat is to apply buttermilk or curd mixed with water on the prickly heat. You can also apply a paste of Fuller's Earth (multani mitti) and rose water. This has cooling and healing properties. Wash off after ten minutes. Calamine lotion is also very effective, but check with your doctor before using it on your baby. It is safer to avoid commercial prickly heat powders as they may further irritate your baby's sensitive skin.

• Let your baby cool off with some water-play
Summers are an ideal time to let your baby indulge in some water-play. You can put your baby in his bathtub or a small inflatable baby pool with a little bit of water and some bath toys. Let him splash around for some time. The baby will love splashing the water all around and on you as well. Always do this only when you are with your baby and never leave your baby unwatched even for a minute. It is safer to avoid public swimming pools as the hygiene levels may not be maintained effectively.

• Avoid taking your baby to an air conditioned room right after a bath.
It is better to avoid taking your unclothed baby to an air conditioned room right after a bath. Switch on the AC only after your baby is fully clothed and his hair dry. It is wise to dress your baby in thicker cotton clothes and inner vest if you plan to keep him in the AC all day. Babies can quickly catch a chill or cold if they are not well protected.

• Do not let the blast of cold air from the AC or cooler hit your baby directly
ACs and coolers are great for keeping the house cool, but whenever your baby is sleeping or playing, ensure that the blast of cold air is not hitting your baby directly. Also avoid taking your baby into warmer areas immediately after she has been in an air conditioned environment. Switch off the AC beforehand and let the baby adjust to the temperature change before taking her out.

• Do not use cheap fancy goggles or eye shades for your baby
A fad among several new parents is to use fancy goggles/eye shades for the baby. While opinion on infants using shades is divided, it is best to speak to your doctor. If at all you really want to buy shades for your baby, buy them from a proper branded shop. Avoid plastic shades that are sold on roadside or toy shops as they do not offer proper UV protection and can harm your baby's eyes.

BABY--DEVELOPMENT MILESTONES.

Bio-Energy is the source of our health and Vitality;A point of view.

Our bio-energy is the source of our health and vitality. In Traditional Chinese Medicine health is defined as a harmonic flow of ‘Chi’ or ‘Qi’ dynamically regulating all biological functions. From the Chinese perspective not only the human organism but the whole world and the entire cosmos are interwoven with the subtle vibrations of this life force. This energy flows within, without and through us governing our organs and tissues and connecting us with our environment (natural and man-made), mother earth as well as the universe. Everything in the universe, organic and inorganic, is composed of this ‘Chi’ or ‘Qi’. As biological energy it is driving, nourishing and regulating all living matter. Based on their different origins, the Chinese tradition basically knows two types of energy – inherited and acquired Qi. ·  • The inherited Qi, also called ‘Prenatal Qi’ or ‘Original Qi’, is received from the parents at conception. It is stored in the kidneys and partly responsible for an individual’s constitution. • The acquired Qi – ‘Breath Qi’ and ‘Nutrition Qi’ – is extracted in the lungs from the air we breathe and created in stomach and spleen from the food we eat. Original Qi, Breath Qi and Nutrition Qi together form the True Qi – the equivalent of what in modern terms is called bio-energy. In our organism, this ‘True Qi’ is in constant motion, ascending and descending throughout the complex network of meridians, entering and leaving through its windows or acupuncture points – and – as long as all these activities are in accordance with the natural biorhythms within and without, then our bodies are flushed with soundness and wellness.  An abundance of ‘True Qi’ or life force is thus the sine qua non for good health and vitality. Therefore in the world’s oldest medical manual, the 2.500 years old Yellow Emperor’s Classic of Internal Medicine or “Huang Di Nei Jing” it is said:  “A person with strong ‘Qi’, will not be brought down by illness.”  In its nature, ‘True Qi’ is like water – soft yet strong, circulating freely and balanced through a complex network of rivers, streams and brooks interlacing the organism.  True Qi is vitalizing our bodies similar to water irrigating the fields and fertilizing the soil. It is the source of human health and vitality, the source of movement and transformation, protecting and warming our bodies, governing the function of our organs and maintaining the physical integrity, metabolic function and supply systems of our organism. In a healthy person with abundance of this vibrant bio-energy available and living in harmony with her- or himself, others and the environment, it circulates freely. A disturbance of this cyclical flow of energy results in disharmony leading to sickness and disease. Each disturbance expresses itself in various forms of illness. Any part or organ in our body with deficient energy supply cannot function properly. Also as people get older, all functions of the organism, including the metabolism, slow down. Less energy is produced and available to protect the body against disease and repair damage and injury. If ‘Qi’ is missing or its flow blocked, humans become increasingly prone to illness. It is thus extraordinarily important that sufficient Qi is present in the body, and that its flow is unhindered. Then humans are healthy. Health is soundness and wellness, is equivalent to free vibration and free flow of energy – Panta rhei – everything flows.  PANTA RHEI – ENERGY FOR TRUE PREVENTION From its earliest beginnings Traditional Chinese Medicine (TCM) recognized, that every organism is a continuously self-regulating and self-optimizing “functional system” which responds to a multitude of external and internal influences. As said, the organism requires large amount of free flowing energy to do so – and only an energy rich organism is capable to defend itself against such influences, repair and correct any damage and rebalance energy & function.  Pathological developments can take place at any time and at any place within such complex systems as the human organism. Only in case of disease do humans usually become aware of the energy required for recuperation.  Since ancient times, Traditional Chinese Medicine always put the emphasis on prevention of illness and maintenance of health rather than treatment of disease. In the world’s oldest medical manual, the 2.500 years old Yellow Emperor’s Classic of Internal Medicine or “Huang Di Nei Jing” it states: “If one takes medicine only after one has fallen ill, if one endeavors to restore order after unrest has broken out, that is, as if one would wait with digging a well until one is weakened from thirst.” Based on this philosophy, physicians in ancient China were paid, if their patients were feeling well and healthy. The focus was on the wellness of the patient rather than on treatment of illness. And the principle of this true prevention was based on free vibration and free flow of energy, on – Panta rhei – everything flows.  Just as the Nobel Price Laureate Albert Szent-Györgyi (1960) said:  “In every culture and in every medical tradition before ours, healing was accomplished by moving energy.” In Primary Prevention lies the greatest potential of Energy Medicine – preventing ‘many patients’ from traveling the long path of trial and tribulation into degenerative disease, guiding them back to radiant health and vitality instead. Consequently the essence of primary prevention consists of timely intervention when disorders border between health and disease.  At this stage of un-wellness, the possibilities of prevention and total recuperation of the individual are very high. This is the aim of meridian diagnostic and therapeutic concepts in Energy Medicine. As the majority of patients fall into this category, which our present health care delivery system cannot address, the implementation of a prevention-orientated Energy Medicine offers a huge potential to dramatically improve public health. Energy Medicine already enables us to diagnose and analyze disruptions in the energy status and flow and understand some of their underlying biophysical dynamics. Further research will heighten our awareness and deepen our comprehension how bio-energy can actually transform matter and create an entirely new body structure. From here the true therapeutic potential of Energy Medicine will unfold, allowing to: ·  • Dissolve energy stagnations & open energy blockages • Activate the body’s own vibrational capacity • Harmonize the energy flow • Recharge the body’s energy reserves. With Energy Medicine there is a revolution taking form, redefining how the future Modern Scientific Medicine is going to view health and disease. Energy Medicine marks the beginning of an exciting era opening our hearts and minds to a new paradigm where mysterious ancient healing traditions meld with vanguard medical research and health science to – as the Nobel Prize Winner Albert Szent-Györgyi (1960) said – once more ‘accomplish healing by moving energy’. Healing Balances Energy: We all have storage centers in our bodies that store Energy and energetic patterns. They are called Chakras. We can have energetic Patterns stored from events that happened yesterday as well as from many years back in the past. Some of these patterns will be happy memories and some of them will be unpleasant and painful memories of something that happened to us.  Sometimes we stash them away deep into some recess in our Chakras and in our Emotional body (the energy field around us, our second energy body), and try to forget about them, but they don’t really go away. Dis-ease is a manifestation of unbalanced and stagnant energetic blockages. Healing, then is a way of balancing and increasing the Energy flow and open (delete) energetic blockages. This can happen completely naturally as soon we stimulate the meridian system to it’s normal way.  Almost all chronic or therapy resistant diseases have blocked or disturbed meridian energy flow. It leads to permanent energy leakage in the corresponding organs and consequently to malfunction.  “When a bug is in the software the hardware doesn’t work proper but its not death. Is the bug fixed (overwritten), the hardware is functioning normal again.“  Same in our body and the meridian system. Is the energy flow re-established the organ is functioning proper. Even long term diseases can go back to normal when the energy is increased over a certain period of time.  The Maintenance of the Meridian System is one of the most important tasks to keep health / vitality and avoid disease.

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SNORING..ALMOST AN EPIDEMIC.

Facts about snoring

• Habitual snoring is seen in 44% of males and 28% of females between 30–60 years of age in the general population. Occasional snoring is almost universal.
• Snoring means there is high resistance in the upper air way canal. It can be a sign of obstructive sleep apnea, which occurs when the upper airway canal resistance is severe and the patient gets episodes of low breathing or absent breathing during sleep.
• Snoring may be present with or without sleep disruption.
• Sleep apnea is a disease and indicates interrupted sleep.
• Uncontrolled snoring may lead to high blood pressure and can lead to heart diseases and paralysis.
• Snoring is associated with carotid artery atherosclerosis.
• Snoring can be a cause of sleeplessness.
• Snoring can lead to marital dissatisfaction.
• Snoring is more common in people who have truncal obesity with a BMI>30.
• Snoring is common in people with large neck circumference.
• Fifty percent of patients of sleep apnea have high blood pressure which is often most elevated in the morning.
• Snoring is common in man with collar size > 43.18 cms (17") and in women with collar size > 40.64 cms (16").
• Low thyroid state can precipitate OSA (obstructive sleep apnea) in the persons of snoring
• Snoring is associated with increased traffic accidents.
• Snoring is associated with sudden death.
• Sleep studies are needed to evaluate snoring and sleep apnea.
• Look for snoring and sleep apnea in patients who awaken with a chocking, gasping, smothering; who have restless sleep; have episodes of cessation of breathing; morning headache, reduced libido and impotence, pass urine in the morning more than 4 times, have history of high blood pressure, cardiovascular diseases, cerebrovascular diseases, renal diseases, type 2 diabetes.

CHILD PSYCOLOGY AND PARENTING.

Behavioral Problems of Children

I. Prevention of behavioral problems .

Family Physicians should anticipate and intervene in behavioral problems. 
Factors that predispose children to behavioral problems include mismatch between parental and child temperaments (e.g., quiet, low-activity child with high-energy parent), parental mental health problems (including post-partum depression), poor parental self-esteem, attachment difficulties between parent and child, inconsistency of parental response to the child, unrealistic parental expectations regarding the child's behavior, and developmental delay, especially speech–language delay, which contributes to frustration for both parent and child. 
Also, due to the conflict between the parents, the absence of a parent, and parental abuse of drugs or alcohol are risk factors for behavioral problems. 

II. Stages of behavioral assessment and intervention.

Clarify parental concerns. 
Assess parental knowledge regarding normal developmental stages. Many parental concerns about behavior stem from unrealistic expectations regarding their child's behavior relative to his or her developmental stage.
Assess for family stresses that may affect the child's behavior. Many behavioral problems stem from or are exacerbated by external stressors.
Prenatal alcohol and drug use, early childhood illnesses, and developmental delay can all lead to behavioral problems.
Counsel parents about possible interventions for behavioral problems.

III. Principles of behavioral intervention.

Children deserve and respond to respect from caregivers. Behavioral interventions will not be successful if parents treat the child disrespectfully.
Consistency of response is critical. Behavioral change only occurs in the context of consistent and predictable responses.
Positive reinforcement for desired behavior generally works better than negative reinforcement for undesirable behavior. Positive reinforcement includes active education of the child about expected behavior and its beneficial consequences rather than simply stating what the child should not do. When negative reinforcement is necessary, it should be age and behavior appropriate.
Reassure parents that children need and want parents to exert consistent, reasonable controls on their behavior. Children are frightened when boundaries of acceptable behavior are not well defined and will often accelerate the problem behavior in order to elicit a parental control response.

IV. Specific techniques for intervention.

Many parents lack specific knowledge about acceptable, effective interventions to promote behavioral change. Too often, parents resort to punishments far more severe than the behavior warrants. 

Time out . Separate the child from desirable activities for a brief period (1–2 minutes for preschoolers, up to 15 minutes in school-aged children). “Grounding” adolescents for a day or two may help.
Extinction. Ignore the undesirable behavior, especially if it has previously elicited attention.
Rewards/positive reinforcement . Offer small rewards like inexpensive toys, increased time with one or both parents, increased privileges for positive behavioral change. For example, if the problem behavior relates to bedtime, reward the child for conflict-free completion of the bedtime routine.
Discussion of consequences of and alternatives to the behavior. Respect for children includes teaching them the consequences of and alternatives to unacceptable behaviors. As children get older, reasoning plays an increasing role in behavior modification.

V. Major mental health concerns .

Behavioral problems in children can generally be divided into three categories: 

• (a) problems that are normal for the child's developmental stage and will resolve spontaneously as the child matures;
• (b) problems that began as a normal developmental phase, but have been exacerbated by external stresses and will require some level of intervention to resolve;
• (c) problems that indicate a more serious underlying mental health problem.

Depression in children is generally underdiagnosed.Criteria for depression in children are virtually identical to those in adults, with minor modifications relevant to usual daily activities. Five or more of the following criteria must be present for at least 2 weeks in order to diagnose depression: depressed mood, anhedonia, sleep disturbance (hypersomnolence or disruption of normal sleep pattern), change in weight or appetite (>5% change in body weight over 1 month and/or failure to make expected weight gains), psychomotor retardation or agitation, low energy, feelings of worthlessness or guilt, decreased concentration and increased indecisiveness, or recurrent thoughts of death or suicide. Children with depression may require medication, and this should generally be done in conjunction with a child mental health professional.

Anxiety disorder. 
Virtually every child experiences some level of anxiety at various stages of life. Up to 50% of children may experience anxiety to the extent of true anxiety disorder that adversely affects their daily lives.
Anxiety disorders may present as multiple somatic complaints, a marked increase in nervous habits (e.g., nail biting or thumb sucking), or stereotyped behaviors (e.g., head banging or other repetitive behaviors). 

Conduct disorder represents the extreme end of the spectrum of oppositional behavior.
It is defined as a persistent pattern of behavior (more than –6 months) that violates the basic rights of others, including acts of aggression against people or animals, property destruction, theft, repetitive lying or other deceptions, and serious violations of rules in multiple environments (e.g., home and school). 
Children and adolescents with conduct disorder require prompt identification, aggressive intervention, and substantial support to their families.

VI. Common behavioral concerns seen in family practice.

Feeding problems 
Feeding problems are among the most common concerns. Parents worry about adequate weight gain and spitting up (reflux) in infants, nutrition, food avoidance, and mealtime behaviors in preschoolers, and obesity in school-aged children. 
It is important to remind parents that when food becomes a control issue between parent and child, this confrontation can lead to long-term unhealthy eating habits. 
Parents should offer a diverse range of nutritious foods, supplement with a multivitamin if necessary, demonstrate healthy eating habits, and avoid using food as a reward for other behaviors.

Oral habits 
Oral habits such as nail biting, digit sucking, and pacifier use, are common in preschool-aged children. Some authors hypothesize that these and other stereotyped behaviors are actually serving an important function in the child's development by serving as early coping mechanisms or self-calming techniques during stressful times or negative mood states. Increases in these behaviors often reflect new external stresses in a child's life. 
Identifying and addressing stresses, combined with positive reinforcement of behavioral change and work with the child to develop alternate coping skills, is generally the most successful intervention for these behaviors.

Sleep disorders 
This include trained night-waking, bedtime struggles, nightmares and night terrors, and sleepwalking . 
Trained night-waking (i.e., the child awakens at a consistent time during the night) and bedtime struggles are best addressed by a consistent approach to bedtime that does not involve the parent staying with the child until the child falls asleep, and extinction (i.e., delayed response or no response at all to the child when he or she awakens during the night or protests at bedtime). 
Nightmares occur in virtually all children and are generally indicative of developmental issues and fears. 
Sleepwalking occurs in approximately 15% of children. It too has its onset in early childhood and generally resolves spontaneously in adolescence. Parents should provide a safe environment so that the child does not sustain injury during sleepwalking episodes. 
Both night terrors and sleepwalking have strong familial histories, with 80%–95% of children with these disorders having a positive family history.

Stereotyped behaviors 
Stereotyped behaviors such as tics, head banging, body rocking, or other repetitive movements, can be disconcerting to parents. 
Many toddlers and preschoolers display these behaviors, and stress, negative mood, and fatigue generally exacerbate them. These behaviors usually resolve spontaneously and rarely cause injury to the child. 
Treatment involves reassurance of the parent, teaching other coping mechanisms to the child, and patience.

Masturbation 
This begins as early as 12 months in many children and is completely normal. 
Parents should use the behavior as an opportunity to begin discussion with the child about private behaviors and sexuality. 

Separation anxiety 
Anxiety including school phobia, occurs in many children at various stages of life. 
Prevention includes giving the child accurate, age-appropriate information about expected separations and consistency in daily patterns of separation. 
Treatment involves diminishing stress and establishing firm guidelines about appropriate reasons for missing school.

Disruptive behavior 
This occurs over a spectrum of behaviors, including various manifestations of limit testing, temper tantrums, oppositional defiant disorder, and conduct disorder. Early identification of and intervention for these problems is critical for prevention of long-term mental health problems .
Limit testing occurs at every stage of childhood and adolescence. Physicians should remind parents of the need to set and maintain firm, age-appropriate boundaries on behavior. 
Temper tantrums are common (75%) in children aged 3–5, and their incidence tails off to 4% in children aged 9–12.
Children with this disorder frequently lose their tempers, argue with adults, defy rules, blame others for problems, and have poor social relationships due to anger, resentment, and spitefulness.
Treatment of ODD rests in the domain of behavior modification and often requires family and individual psychotherapy to assist with resolution.

Drug  Use 
Alcohol, tobacco, and other drug use should be screened for routinely during most visits with children over the age of 8 years. 
Prevention is essential, and involves open discussion with parents and children about risk factors, including genetic predisposition (family history of drug misuse), peer pressure, low self-esteem, and poor resiliency to external change and stress. 
Prevention also includes educating children in age-appropriate ways about the adverse effect of using tobacco, alcohol, and other drugs. 

 

FEEDING ISSUES IN TODDLER'S;"THE FUSSY EATER"

When you are feeling at the end of your tether with a fussy eater, take a deep breath, relax and remember this is a normal phase in your toddler's development which will resolve with time. 

By being anxious you can often make the problem worse, particularly if you are expecting your toddler to eat more than she needs. If allowed to do so, toddlers will eat just enough calories for their own requirements, so you should always respect your toddler's decision that she has had enough to eat. You need to resist trying to persuade her to eat more. All this is of course, easier said than done. 

Remember that it is your responsibility to offer your toddler nutritious food but always allow her to choose how much she will eat. If you have older relatives taking care of her during the day when you are away at work, reassure them that she won’t stay hungry and that it is okay if she does not “clean up her plate”. 

How do I know when my toddler is full?

It may seem obvious but your toddler is telling you that she has had enough to eat of a particular food, course or meal, if she is: 

• keeping her mouth shut when offered food 

• saying no 

• turning her head away from the food being offered 

• pushing away a spoon, bowl or plate containing food 

• holding food in her mouth and refusing to swallow it 

• spitting food out repeatedly 

• leaning out of her highchair or trying to climb out 

• crying, shouting or screaming 

• gagging or retching 

What is the best way to cope with my fussy eater?

Most toddlers go through a phase of only eating a very narrow range of foods. This is a normal part of toddler development called food neophobia - being frightened of new foods. Your toddler needs time to learn that these foods are safe to eat and enjoyable. She will learn this by watching you and others eating those foods. Eventually she will widen the variety of foods she eats but some take much longer than others to do this. To help her on her way, and to keep your sanity, follow these tips: 

Eat with your child as often as possible. Toddlers learn to eat foods they are unfamiliar with by watching and copying their parents and other children eating them.

Make positive comments about the food you are eating. Parents are strong role models and if you make positive comments about foods, your toddler will be more willing to try them. 

Arrange for your toddler to eat with other toddlers as often as possible. Invite a friend from her playschool or neighbourhood over for some snacks. Your toddler may eat better when she is with her own age group. 

Develop a daily routine of three meals and two to three snacks around your toddler's daytime sleep pattern and try to stick to it. Toddlers thrive on routine and knowing what to expect. She won't eat well if she becomes over-hungry, and toddlers who are tired will be too miserable to eat. Don't expect her to eat a large meal just before going to bed. Give her a small snack or drink and save her proper meal until later, after she has woken up. 

Offer two courses at mealtimes: a savoury course followed by a sweet course. The savoury course itself can consist of different items, say a small puri with potato and some rice with dal. For the sweet course, try kheer or halwa if she hasn’t eaten any cereal in the savoury course, otherwise choose fruit based desserts. Toddlers often get bored with too much of one taste and will be ready to try something new. Two courses also give your toddler two opportunities to take in the calories and nutrients needed and means there is a wider variety of foods at each meal. 

Limit mealtimes to about 20 - 30 minutes and accept that after this your toddler is unlikely to eat much more. It is better to wait for the next snack or meal and offer some nutritious foods then, rather than extending a meal for an hour trying to persuade your toddler to eat more. Most toddlers eat whatever they are going to in the first 20 minutes. 

Praise your toddler when she eats well because toddlers respond positively topraise. If you only give her attention when she is not eating, she may refuse food just to get some attention from you. Toddlers like attention, even if it is negative. If she doesn't eat well, take the uneaten food away without commenting and accept that she has had enough. 

Give small portions. Toddlers can be overwhelmed by large portions and lose their appetite. If the small portion is finished, praise your toddler and offer her some more. Offer her a second serving if she asks for one or seems eager to eat more. Typically serving sizes should be one fourth that of adults. 

Offer finger foods as often as possible and allow your toddler to make a mess at mealtimes. Toddlers enjoy having the control of feeding themselves with finger foods. Let her try to feed herself with a small fork or spoon if she wants. 

Eat in a calm relaxed environment away from distractions such as the TV, games and toys. Toddlers can concentrate on one thing at a time so distractions make it more difficult for them to concentrate on eating. While a change once in a while helps, constantly trying to distract your toddler by carrying her around the house or to the window or door while feeding her, may make mealtimes seem like a different kind of play time. 

Be aware that if you are eating out, your toddler may not be prepared to try any of the food on offer, as it may all be unfamiliar to her. Take something that she will eat with you to tide her over until her next meal or snack. Packing a small chapatti with cheese spread, a banana or a tomato sandwich in a favourite lunchbox might make it easier for her to eat in unfamiliar surroundings. 

Involve older toddlers in food shopping and preparing for the meal such as putting things on the table. This will encourage a positive attitude to food and mealtimes. 

Involve your toddler in simple cooking and food preparation (if you have the time and patience) – give her a ball of chapatti dough to roll and flatten or pick out some pea pods for her to shell. By handling and touching new foods without pressure to eat them, your toddler will become familiar with new foods and may be more likely to try them. 

Change the venue of your toddler's meals. For example, have a picnic outside. This will make eating a fun experience for your toddler and will allow them to see others enjoying food. 

What shouldn't I do?

Don't rush a meal. Some toddlers eat slowly and rushing your toddler to eat can reduce her appetite. 

Don't pressure a toddler to eat more when she has indicated to you that she has had enough. Never insist she finishes everything on her plate. 

Don't take away a refused meal and offer a completely different one in its place. A toddler will soon take advantage if you do. In the long run it is always better to offer family meals and accept that your child will prefer some foods to others. Always try to offer one food at each meal that you know she will eat. 

Don't offer the sweet course as a reward for eating the first course. You will make the sweet course seem more desirable than the savoury one. 

Don’t punish your child for refusing to eat. She may start disliking food in the long run. 

Don’t bribe and reward your child to finish up her meal. She will expect something in return each time she finishes her meal. 

Don't offer large drinks of milk, squash, fizzy drinks or fruit juice within an hour of the meal. Large drinks will reduce your toddler's appetite. If she is thirsty, give her a drink of water instead. Try to phase out bottles so that all your toddler's drinks, including milk, are given in cups or glasses. 

Don't offer snacks just before or just after a meal. Don't give a snack soon after a meal if your toddler hasn't eaten well at her main meal. It is tempting to do this just to ensure that your toddler has eaten something. However, it is best to have a set meal pattern and wait until the next snack or meal before offering food again. 

Don't assume that because your toddler has refused a food she will never eat it again. Tastes change with time. Some toddlers need to be offered a new food more than 10 times before they feel confident to try it. Or try a different way of preparing food; if she doesn’t take to paneer cubes try grating them into stuffed parathas, she might prefer boiled chickpeas chaat (kabuli chana chaat) instead of chana masala gravy. 

Don’t have varied routines and patterns while feeding your toddler. Be consistent – if you have more than one person taking care of meals for your toddler, make sure that everyone follows the same routine and sets similar limits. Mealtimes which vary from grandparents or a baby sitter to parents will only confuse your toddler. 

Finally, don't feel guilty if one meal turns into a disaster. Put it behind you and approach the next meal positively. Parents also learn by making mistakes. 

What should I do if I am still worried? 

If you are still doubtful, make a list of all the food and drinks your toddler consumes over a week and then review it. If your toddler's diet includes foods from all the food groups (read our article on how to feed your toddler for more information) and some variety within each group then you can reassure yourself that the problem is not as bad as you thought. 

If you continue to worry about how much your toddler eats or if you think she might beunderweight, talk to your doctor -- who may be able to reassure you that there is no problem. Occasionally there are medical reasons why your toddler may not eat and a doctor can assess this. 

Regards,

                                                               

COMMON COLD(BABIES)

One of the saddest things for a new parent is watching their baby suffer through his first cold. Your baby will be uncomfortable, snuffling, and probably will have trouble feeding. 

It's hard to watch, but there's a lot you can do to alleviate the discomfort. And you can be assured that it's called the common cold for a reason, and it's usually not serious. Experts estimate that your baby will get between eight and 10 colds in his first two years alone. That's a lot of tissues and long nights. 

What causes colds? 

Colds are upper respiratory tract infections caused by one of many different viruses. They're most commonly spread when someone with a cold sneezes or coughs and unleashes a cold virus into the air to be inhaled by someone else. They can also commonly be transmitted through hand-to-hand contact, so always wash your hands after blowing your nose. Babies tend to get a lot of colds because they're born with immune systems which function at about 60% of capacity. 

How do colds affect babies? 

Few things are more frustrating than a baby with a cold. A sick baby will probably have a fever (up to 101 degrees F / 38 degrees C), cough, reddened eyes, a sore throat, earache, and runny nose. Your child may also be irritable and lose his appetite. Babies under six months old can't breathe through their noses when they're all stuffed up, so they have trouble breathing and eating. 

Children aren't usually developmentally ready to blow their own noses until about the age of four, so you'll have to help younger children clear the mucus. If the cold persists and is not treated properly, it can lead to more serious bacterial infections like pneumonia, bronchitis, flu or ear infections. If your baby has been sleeping through the night, you'll be reminded of those first few weeks of life. He'll probably wake up several times during the night due to his discomfort and difficulty breathing. Expect to be up with your baby, comforting him and wiping his nose. 

How long do colds generally last? 

Symptoms generally abate after three to 10 days, though in very young babies they may last up to two weeks. Most babies who have some exposure to older children will experience six to 10 colds during their first year; it may seem as if his nose is runny all winter long. If your child goes to a daycare center or a play school, he can experience as many as 12 colds per year! 

Can I help prevent my child from getting colds? 

Breastfeeding is one of the best ways to protect your baby's health, since as long as he's breastfeeding, he's getting your antibodies and your natural immunities. This isn't a foolproof way to protect your baby's health, but when breastfed babies do become ill, their cold symptoms are generally mild. 

You can also try to protect your child by keeping him away from those who are ill and by asking all sick family members to wash their hands thoroughly before handling your baby or his things. 

If you or your spouse smoke, give it up, and refrain from taking your baby to areas where someone has been smoking. Children who live with cigarette smokers have more colds and their colds last longer than their peers who aren't exposed to smoke.

When should I consult the doctor? 

Do so at the first sign of illness if your child is less than three months old. In an older baby, call your doctor if a cold persists for more than three days; if your child's temperature climbs above 102 degrees F / 39 degrees C; or if he has an earache, breathing problems, wheezing, a persistent cough, or a persistent, thick, green mucus running from his nose. 

How do I treat a cold? 

There's little you can do except ride it out. Help your child get plenty of rest and if he has been weaned offer liquids (increase the amount of vitamin C-rich fruit juices). If he's feverish, you can give him paracetamol suspension under a doctor's direction. Don't give him any cold remedies without consulting your doctor. In children under one year of age, over-the-counter cold medications often do more harm than good, and cough medicines have been shown to be no better than a non-medicated syrup for easing symptoms. 

Nonetheless, there are some remedies to ease his discomfort: 

• If your baby is congested, elevate the head of the mattress with an old towel or two. Sleeping at an incline may help relieve your baby's postnasal drip. (Do not use pillows to prop your baby up -- they can pose a suffocation hazard -- or pillows under the mattress.) 

• Because babies are too young to blow their noses, the best way to help them breathe more easily is to wipe their noses. You can also apply petroleum jelly to the outside of your baby's nostrils to reduce irritation. If your child is having trouble breastfeeding with a stuffy nose, you may like to ask your paediatrician to prescribe saline drops to apply to each nostril 15 minutes before a feed. Some parents then use a suction bulb to clear the nose of salt water and mucus. 

However, you can also prepare saline water at home by adding a pinch of salt in about 30 ml of boiled cooled water. Make the solution in a clean bowl and keep it well covered. Saline water drops do not have any side effects and can be easily used several times a day. 

• Try a cool mist vaporiser to moisten the air. Or take your baby into the bathroom with you, turn on the hot water or shower, close the door, and sit in the steamy room for about 15 minutes. Remember to change your baby into dry clothes after the steam bath. 

• If your child has a stuffy nose without any other symptoms, check his nostrils for foreign objects. You never know: even little ones are capable of putting things up there. 

• Add a couple of drops of menthol, eucalyptus or pine oil to a vaporizer to relieve nasal congestion in babies older than six months. 

Colds are a fact of life. Once you've survived your baby's first one, you'll know what to expect with the next.