Dr Kaberi Gupta Koul

Speech Delay in children: when to consult?

Speech delay occurs in 5 to 10 percent of children.

Red flags to look for in the child if he is:

1. not babbling by 12 to 15 months of age.
2. not comprehending simple commands by 18 months of age.
3. not talking by 2 years of age
4. not telling a simple story by 4 to 5 years of age
5. Speech is largely unintelligible after 3 years of age.
6. is greater than 1 year late in comparison to normal pattern of speech development.

Whom to approach?

Your pediatrician should be the first person to asses on the first instance of concern.

What are the causes?
There could be various causes of speech delay like hearing loss, autism, global developmental delay, psychosocial deprivation, selective mutism, ear and brain infections, birth infections and defects, birth asphyxia, hormonal problems like hypothyroidism, severe jaundice at birth and very rarely side effects of medicines.

How is the assessment done?

Assessment involves ruling out hearing loss first. Even if the child appears to hear okay hearing assessment should be done.
Full development assessment is done to rule out delay in other milestones too.
Above mentioned medical causes should also be ruled out.
If possible intellectual assessment should be done by an appropriately trained person.
Speech consists of two parts receptive speech which is what a child can understand and expressive speech which is what a child can speak. Some children are late bloomers, that is they have normal receptive speech but delayed expressive speech. Such children can be monitored.

Treatment:
Treatment of speech disorder is a multipronged approach involving treatment of medical disorders, speech therapy, correction of hearing loss and full rehabilitation of the developmentally delayed child. Early detection and treatment prevents speech delay in many children.

Childhood obesity epidemic post Covid:

Overweight and obese children have become a norm at my clinic as we are now almost 18 months into the pandemic. Half of my consultation times goes into weight and lifestyle management of the whole family ( Most of the time it's the whole family suffering from weight issues). Just a few pointers to help with this new crisis:

1. How do we know whether the child is obese/overweight?
BMI is a reasonable screening tool which is calculated taking into account the weight according to the height of child. Anything between 85th and 94th centile is considered overweight and above 95th centile is considered obese.

2. Causes are mainly increased food intake with junk as a major component, inactivity, hereditary tendency, hormonal problems, depression.

3. Parents if possible should visit the pediatrician for the management.

4. The aim of weight loss in 6 to 11 years old is about 0.5kg/ month and 1kg/week in older children and adolescents.

5. Children should have 1 hour of moderate to vigorous physical activity along with their family if possible. Exercise and physical activity schedule should be flexible involving play activities for younger children, cycling, rope climbing, walking, or taking part in sports if circumstances permit and the child is inclined.

6 All junk food like crackers, chocolates, ice creams, sugary drinks, frozen foods, fries stuff should be avoided if possible or may be consumed sparingly.

7. Eating food with TV, mobiles, laptops should be avoided and family food time should be encouraged. Recreational screen time should be limited to less than 2 hrs for children above 2 years and none for less than 2 years.

8. Issues like depression, low self esteem should be approached with compassion and child should not be ridiculed for his weight. Weight loss even if minor should be applauded to provide positive self esteem.

9. Lack of proper sleep also leads to obesity and good sleep hygiene should be encouraged.

10. Obesity in childhood can lead to increased incidence of type 2 diabetes, heart diseases as adults. Non alcoholic fatty liver is also a common problem which can lead to liver scarring and other liver problems. Some blood tests may be required to monitor for these problems which should be done if recommended by the doctor.

Obesity is a lifestyle disease which is not too hard to manage....should not be taken casually by parents. Good food and exercise habits last a lifetime and should be cultivated early.

School reopening in times of Corona:

The schools are reopening from next month for the primary sections and maybe soon for kindergarten. It sounds a great repreive for both children and parents after one and a half years of this devastating pandemic. The schools are offering a hybrid model of online and physical classes. The big question: Should we or should we not send our children? As a pediatrician I have put up a few pros and cons of sending the children:

Pros:
1.Have been seeing a lot of children suffering from problems arising due to home isolation like obesity, attention deficit issues in younger children, early menarche, behavioural issues, educational decline and an obnoxious amount of screen time. Going back to school would help in reversing these problems.
2.Physical activity has been compromised greatly...starting schools would be a start towards inactivity related issues ....
channelise energy and improve in sleep with less screen time.
3.Parents are awaiting the reprieve from constant monitoring and the constant guilt of not being able to help much due to their ongoing work commitments.
4.Overall getting back to school would be a start for the household towards getting back to a normal life.

Cons:
1. With the constant threat of a looming third wave.....and unvaccinated children....are we ready to take a risk with such a deadly disease?
2. Although corona disease is mild in children.....but children have had a low exposure and with so much unknown in the pediatric population....is it advisable to send unvaccinated children to school?
3.Vaccination coverage with first dose in adult population is around 50%....with children known to bring infections home....are we ready to take risk with the adults and many vulnerable elderly people?
4. Multisystem inflammatory syndrome...a known life threatening complication of Corona infection in children....it's full impact would come in picture after full exposure....are we ready to face it in the unvaccinated children.
5.Is it technically feasible to make the children wear masks for hours and ensure social distancing?
6.With households having pregnant women who inherently suffer from low immunity and with lot of them unvaccinated.....is it advisable to expose them to infection from children?

Guess at the end of the day it's an individual decision for each family taking into consideration their own circumstances after weighing the pros and cons.

Does the MMR vaccine protect against COVID in children?

MMR...is a vaccine given to children at 9 months and 15 months of age to protect against three diseases Measles, Mumps and Rubella. Recent research has shown that there is about 30% structural similarity between these viruses and covid19 . So vaccination against MMR gives a non specific immunity against covid in children.
Large scale trials need to be conducted to get more insight into this hypothesis.
But I guess there is no harm in getting your child inoculated with a vaccine which is very much part of the vaccination schedule. Anyways all children who are lagging behind in their vaccinations due to the pandemic should catch up and get the injections done.

Measles vaccine may protect children against Covid-19, finds study by Pune researchers The study, conducted by BJ Medical College in Pune, also showed that the measles vaccine had an effectiveness of 87.5% against the SARS-CoV-2 virus.

COVID management in children and newborns:

Covid is at its all time high in India...sadly children are also getting affected in significant number.
I am getting lots of queries these days regarding the management of covid in children with the whole household getting affected.

Fortunately children usually get mild symptoms like any other cold and flu which can be managed at home with the usual paracetamol, cold and cough medications. Some children also get symptoms of stomach upset like loose motions and vomiting which can also be managed at home with ors, fluids, probiotics. Ensure good nutrition and supplements if the child is a fussy eater.

Danger signs would be breathing difficulty, lethargy, disorientation, decreased urine output and poor oral intake. In such cases the child needs to be seen in a hospital setting for testing and management.

If the parents and households members are Covid positive and the children asymptomatic then the usual covid precautions of mask, social distancing and handwashing should be observed.

If the mother is covid positive with mild symptoms she can continue breast feeding wearing a mask after adequate handwashing or using sanitizer with 60% alcohol. At all other times a distance of 6 feet should be maintained between mother and newborn. She can also express her breast milk which can be given by another caregiver using same precautions.

Any child with underlying medical condition like heart disease, asthma, kidney disease, immunocompromised, undergoing chemotherapy, obesity are at higher risk and should remain in touch with their pediatrician for prevention and management.

Isolation of a covid positive child is for 10 days after the covid positive report or appearance of symptoms. Covid negative report is not required if the symptoms have resolved.

Take care ....this too shall pass.

The government has opened physical classes for all age groups. We have very less information about the impact of covid both immediate and long lasting in pediatric population compared to adults. Complications like multisystem inflammatory syndrome have been in news for past year although uncommon. Social distancing and masks are tough to be taken care in pediatric population. Vaccination is gaining momentum at a fast pace and trials for vaccination in children are on going. Soon vaccination should be available for all school going children. Although pandemic has taken a huge toll on the mental health in children....is another 4 to 5 months of on going social isolation a big price to pay to avoid unknown greater risks and complications?

Bengaluru sees spurt in U-10 children testing Covid +ve | Bengaluru News - Times of India As the number of Covid-19 cases surge in Bengaluru, more children aged below 10 are turning positive. This month, 472 kids in that age bracket have t

Celiac Disease......a rising disorder amongst the wheat eating population of North India.

Celiac Disease is a common disorder with an incidence of about 1in100 children/adults in India as well as worldwide.

It is basically inflammation of digestive tract in response to ingestion of gluten present in wheat, barley and rye.

I frequently get children with a long history of recurrent loose motions, constipation, growth failure, severe anaemia and loss of appetite who are later diagnosed to have celiac disease.

Has genetic inheritance in some cases.

Simple to diagnose with a blood test and full recovery occurs with gluten free diet.

So if you know a child who suffers from similar symptoms do visit your pediatrician for testing and treatment.

The winter season is on. Influenza and COVID are both on rise. I get a lot of questions from worried parents regarding influenza and to distinguish it from covid. Although most of the symptoms are common except loss of taste or smell which is more common in covid.
The best approach would be not to worry, get the flu covered with vaccination, get tested for corona if risk factors and contact with a covid person are present.
Take plenty of fluids, healthy diet with lot of citrus fruits, curd, high protein diet and sunshine for Vitamin D. Additional nutritional supplements can be taken for fussy eaters.
Social distancing, sanitizers and mask continue till vaccination.

Also keep your and kids morale high in these difficult times.

Keep Your Child Safe from scalds and burns

What is a scald burn?
Scald is a burn from close contact with hot liquid or steam. Scalds are the most common type of burn affecting young children. Young children have thinner skin than older kids and adults, so they burn easier. Children ages 4 and under are at the most risk for scald burns, because they like to explore and do not know what can hurt them. Kids change so fast that parents and caregivers sometimes don’t know their child can reach hot liquids and foods that would have been at a safe distance only a short time before. Scald burns are most likely to happen at home when a child knocks over a cup of hot liquid, gets splashed by hot liquid carried by an adult, grabs a pot off the stove or pulls on hanging tablecloths or placemats. Your child’s skin can be burned by:

Hot water
Coffee
Tea
Soup
Hot tap water
Hot liquids from the microwave
Scald burns and their treatment are painful. Long-term scarring can happen. The good news is that most scald burns can be prevented.

How do I keep my baby to 1-year-old safe?

Set your water heater to 120° F (49º C) or lower, or between low and medium. If you can’t control the heater, install anti-scald devices on your faucets and showerheads. These stop the water from flowing when it is hotter than 120º F.
Always check the temperature of the water before putting your child in a bath. Use a bath thermometer, or test the water with your wrist or elbow to see that it feels “just warm”.
Do not leave your child alone in the bathtub or sink. Babies must be watched by an adult the whole time they are bathed.
Heat baby bottles in warm water, not in the microwave. Microwaving bottles can cause hot spots of breast milk or formula that can scald your baby’s mouth. Warm baby food on the stove instead of the microwave for the same reason.
Do not hold your baby while you cook.
Do not use an exersaucer or walker near counters or tables. Babies can reach up and pull hot liquids onto themselves.
Keep hot drinks away from the edges of tables and counters.
If you’re holding something hot, don’t hold your baby too.
Never carry hot drinks or dishes when your child is near.
Avoid drinking hot liquids while pushing your child in the stroller. Only use the cup holder on your stroller for cool liquids.
If you need to use a humidifier or vaporizer, use a cool-mist model rather than a hot-steam one.

How do I keep my 1- to 4-year-old safe?

Always be with your child in the kitchen and bathroom.
Teach your child to turn the cold water on first, before the hot water. Teach him to turn the cold water off last, after the hot water.
Place your child’s back to the faucet in the bathtub so she can’t turn the water on.
Use a child safety gate to keep your child out of the kitchen while you are cooking.
Use the back burners on your stove if you can. Or, turn pot and pan handles towards the back of the stove where your child can’t reach them.
Keep electric cords from appliances on the counter, out of your child’s reach.
Do not use tablecloths — children try to pull themselves up on them.
Let hot foods cool in a safe.
Avoid drinking hot liquids while walking with your child. Only use the cup holder on your stroller for cool liquids.
Test heated liquids and foods to make sure they are warm, not hot, before giving them to your child or putting them within her reach.
Teach your toddler what the word “hot” means.

How do I keep my child age 5 and over safe?

Don’t let your child use the microwave without help from an adult.
Eat only at the table. Do not let your child hold hot food and drinks over his lap on the couch or in the car.
Teach your child what causes burns and how to avoid burns.

If your child gets a scald burn:

Remove any clothing over the scald or that got wet to stop continued burning.
Cool the burn with tap water for 10 to 20 minutes. This reduces the depth of the burn.
Cover the burn in a dry, clean, non-stick bandage or cloth.
Do not use ice, butter, lotions or oil on burns.
Take your child to the doctor for burns on hands, feet or ge****ls that cause blisters or burns that cause the skin to be open and blackened.

INFANTILE COLIC/ Incessant crying baby

An enigma/ mystery still unresolved......the do's and dont's:

Hey friends....here I am talking about one of the most frustrating, tiring and exhausting problems faced both by the parents and the pediatricians around the world.

Infantile colic is best described to parents as 'PURPLE' crying: peak of crying, unexpected, resists soothing, pain like faces, long lasting, evening.

It occurs in about 20%of babies.It starts at around 2weeks of age, peaks at 6 weeks and tapers off by 3 to 4 months of age. It is one of the commonest causes of emergency visits to the pediatrician.

Cause? None proven yet with significant evidence although various theories have been put up from gastrointestinal causes like altered gut flora/ motility, lactose intolerance, cow's milk protein allergy to non gastrointestinal problems like immaturity of the brain, poor parent and baby interaction, overstimulation of the baby.

Management/treatment :

1: Exclusion of organic causes which constitute about 5% of total.....like fever, gastroesophageal reflux, ear infection, brain fever, urinary infection, hernia, rashes .

2. Head to toe physical examination of the baby to rule out organic causes.

3. Behavioural therapy and counselling of parents is the first line and cornerstone of management. Parents should be made aware of the benign nature of the problem and that it would subside on its own . They should be made aware of the different types of crying of the baby...like hunger cry, wet diaper cry, comfort seeking cry which would help them distinguish it from colic. Some techniques work in few babies....although there is no research based evidence behind it.
Parents can try the '5s' technique of swaddling, side/stomach, shhh sound, swinging the baby with jiggling movements, suckling(letting the baby suck on breast or pacifier). Creating white noise, reducing excessive stimulation, rocking movements might help some babies.
Parents should be made aware that it is no fault of theirs to prevent low self esteem and confidence building measures should be encouraged.

4. Cow's milk intolerance is one of the rare causes and can be treated by eliminating dairy from mothers diet or putting the babies on hydrolysed formulas in case they are formula fed. Colic has equal incidence in both breast fed and formula fed babies. A two week elimination diet followed by reintroduction and return of colic in babies confirms the diagnosis. This is also transient in most cases and lasts for 3 to 6 months.

5. Other medicines like gripe water, colicaid drops, probiotics haven't been proven to be of much benefit.

Hope this write up helps some parents out there...would continue posting! Thanks !

Hey friends....we are all going through difficult times, things are tough...but as appropriately said....Tough times do not last but tough people do. So guys take care of yourself, practice social distancing, hand wash repeatedly, eat healthy, practice yoga and meditate.
I have been getting lots of queries regarding vaccinations....I am posting here WHO guidelines regarding the same.

I am injured .Do I need a tetanus shot? All patients with injury do not need tetanus vaccination. WHO guidelines for tetanus vaccination: