Ravina Sewani

Milk production is in abundance during the early days, which is good. But as soon as the baby settles in – in most cases – the flow regulates on its own. Sometimes though, the breastmilk volume may still be high and there may be a very forceful spurt of milk with a forceful let down. This may cause problems for you and your baby. Usually babies develop a breastfeeding pattern within the first month. If after a month, your baby is still restless during the feeding, or pulls off your breast, coughs, chokes, gulps quickly, has painful cries, holds on to your nipple with a bite like hold, oversupply might be the issue here. You, on the other hand, might experience engorgement, have bouts of mastitis, or you may feel a strong let-down, and leaking breasts. Due to oversupply, a condition called Milk Ejection Reflex occurs in which the milk is released from the milk ducts in a forceful and in an almost explosive manner. Oversupply could be either due to your body making more milk, or when you don’t empty your one breast fully before offering the other, or thyroid. You can handle this situation by trying a reclined position while you breastfeed, you can try using nursing pads, and express little milk before feeding. You can use breast pumps and store the milk. Just be careful that your child does not choke while breastfeeding. If none of the methods work, you should consult your lactation consultant.

It is possible to have an oversupply of milk.

Oversupply of breastmilk

Palak Vyas

Circumcision is a small surgery where the skin covering the tip of the penis is removed surgically. The decision to get your baby circumcised depends on cultural, religious, medical or personal reasons. Let the paediatrician or neonatologist decide if the child is ready for circumcision or not.<ul><li>Your baby’s penis may be sore for a few days after the procedure.</li><li>You have to be careful while bathing and changing diapers until it heals completely. Do not use any bathing products. You can use warm water to clean the area.</li><li>Whenever you change the diaper, use a new dressing as per your child’s paediatrician’s advice.</li><li>Use a dab of petroleum jelly on the penis so that there is no friction with the diaper.</li><li>Healing after the surgery can take up to 7-10 days.</li></ul> Inform your child’s paediatrician if you see any of the following signs:<ul><li>Bleeding that continues</li><li>Fever</li><li>Infection</li><li>Redness that gets only worse</li><li>Pus filled blisters</li><li>If the child does not urinate within 12 hours after the circumcision.</li></ul>

Circumcision is not necessary but the decision depends on personal beliefs.

Undergoing circumcision in boys

<ul><li>Pet allergy is body’s immune response against animal’s dander (dead skin in animal fur), animal’s saliva, or animal’s urine. The body perceives all of these as a threat and triggers an allergic reaction in your child.</li><li>A pet with a lot of fur or feathers on its body holds a greater chance of triggering an allergic reaction in your child.</li><li>If your child has been diagnosed of pet allergy by your child’s paediatrician, it is better to not own a pet. If your child loves animals, you can take him/her visit your friend’s or relative’s pets once in a while.</li><li>If your child is allergic to other things as well, then your child may show immediate symptoms after coming in contact with some animals.</li><li>Pet allergies are known to self-resolve after avoiding animals for some time. But if this is not the case, it is better to not own pets at all.</li><li>Pet allergens are airborne so use an air filter in your house to keep your child from contacting these allergens. Keep the carpets at the minimum in your house.</li><li>Keep your pet’s belongings and cage clean and free of fur.</li><li>Keeping pets outdoor might help a bit but does not solve the problem entirely.</li><li>Treatments include prescription of antihistamines and nasal sprays by your child’s paediatrician.</li></ul> Symptoms:<ul><li>Itching</li><li>Rashes</li><li>Vomiting</li><li>Diarrhoea</li><li>Swelling of the lips or tongue or face</li><li>Throat constriction</li><li>Difficulty in breathing</li><li>Allergies may sometimes also cause a life-threatening reaction called anaphylaxis which constricts the airway passage and requires immediate medical attention.</li></ul> Diagnosis:<ul><li>Always get your child diagnosed by a healthcare expert and never on your own. Never self-assume that your child has peanut allergy. Commercial home test kits for self-diagnosis are not recommended as they may not be of the required standards.</li><li>Your child’s paediatrician may recommend that your child undertake tests like skin prick test, blood test or food/drug challenge. It is important that these tests are performed under medical supervision as these tests might trigger an allergic reaction. Along with these tests, your child’s paediatrician will also examine your child's medical/family history, existing conditions like asthma and eczema.</li></ul>

Children love pets. But sometimes, the pet dander may cause allergies in children.

Pet allergy

Samiksha Choithani

Dr Heena Hasan

Eating excess junk food like pizza and pasta can cause constipation as they are made of refined flour. The child, who is already suffering from constipation avoids going to the toilet because it is painful. Because of this, the stool stays in the stomach and gets harder and it gets more painful when the child goes to the toilet next time. This cycle continues. Make sure the child eats enough fibrous foods like fruits and vegetables so the stool gets softer and passes out easily. . For 0-1 year:Constipation among infants is not a serious problem. The child is constipated when (s)he misses passing the stool for less than thrice a week or when they pass thick/hard stool. Babies who are exclusively breastfed may not pass bowel movements every day. So, do not worry much. If your child is happy, does not cry much and does not have a gas problem, be rest assured about constipation. If you feel that your child's belly is very firm than usual, it could be a sign of constipation. In that case, you can try the following:<ul><li>Adjust your diet so that the baby gets healthier breast milk.</li><li>If your baby is below 6 months, gently massage the his/her stomach and gently move his/her legs in the bicycle movement.</li><li>If your baby is older than 6 months, you can try giving him/her semi-solid foods and fruit juices to improve bowel movements.</li></ul> Also, do not worry about the variance in the colour of the potty. The colour of the potty changes during the first year due to diet and the introduction of new foods to babies. The colours of potty may vary from black, mustard yellow, green, orange. If the colour is white or grey or chalky, it indicates the baby is suffering from liver problems and in this case, you should consult a paediatrician. For 2-6 years:If you are a parent of a toddler, keep a check on potty routine. At times children skip potty as they are more interested in playing or watching their favourite cartoon and hence avoid going for potty. Even change in routine makes them uncomfortable about going to potty. If constipation persists, you can try the following:<ul><li>Give them a glass of warm water once or twice a day if they regularly skip potty.</li><li>Give them carrot and green leafy vegetable soup.</li></ul>Also, give your child proper potty training. Set a fixed time of the day when they are supposed to go for potty. This will help maintain a regular bowel cycle. If constipation persists for more than a week, it is better to consult your child's paediatrician.

The problem of constipation in children worries a lot of parents. There are a few ways in which you can address this problem.

Constipation among infants and toddlers

Dr Aliraza Khunt

Fever in itself is not a disease. Instead, fever is the body’s immunity fighting against a virus or bacteria which has invaded the human body. So when a pathogen attacks our body, our immune system activates and increases blood circulation in the body. The activation of the immune system and increased blood circulation leads to a rise in the body’s temperature. This is how our bodies are naturally designed to fight against diseases whenever there is any external attack on the body. Fever is not our enemy, it is our friend. Toddlers and infants easily catch fever because they are always in contact with germs. If your child is eating fine, sleeping for appropriate hours, and urinating 7-8 times a day, then there is nothing to worry about. The fever will come down easily after 2-3 days. If the fever lasts for more than a week, and your child does not eat, sleep, and urinate properly, it is advisable to visit your child’s paediatrician. Sometimes, infants and toddlers might suffer from fits during high fever. This is when it becomes very much essential to bring down the fever. Children also feel pain or ache during fever due to which it is important to lower down the fever in children by giving medication. Common Causes of Fever:<ul><li>Respiratory tract infections</li><li>Flu</li><li>Tonsillitis</li><li>Cold and cough</li><li>Ear infections</li><li>Teething in infants</li></ul> How to be sure whether a child has fever or not?<ul><li>Most of the parents touch their child’s forehead and if they find it a little warm, they consider it as fever. Scientifically this is termed as delusion of fever.</li><li>Delusion of fever might result due to several reasons:</li></ul>- Mother’s hand being cold because of working with water on and off. Also, hands are usually cold as they are quite away from our hearts.- As infants barely have hair on their head, their head feels a little warmer than adults.- As a child’s brain is developing, there is blood circulation going on and that is the reason their head can feel hotter compared to the rest of the body.<ul><li>If the temperature of a child's head is 98.5 or 99 degree Fahrenheit and if mother’s hands are at 90 or 92 degrees Fahrenheit, then too the mother can find a child’s forehead way hotter even if the child’s temperature is actually normal.</li><li>So never assume there is fever just by touching your child’s forehead, always use a clinical thermometer to stay assured.</li></ul> Diagnosis:Thermometer reading:<ul><li>Digital thermometers are the most reliable and the easiest to use. Place it in the armpit of your child for 1-2 minutes and it will clearly show temperature readings. There is a beep sound that comes when the temperature stops rising. Take that reading and you would accurately know your child’s temperature.</li><li>Scientifically, if the axillary (armpit) temperature reaches 100.4 degrees Fahrenheit or is more than that, it is considered as a fever.</li></ul> Treatment:Medicine for children having fever:<ul><li>Safest option for relieving a child’s fever is paracetamol. Paracetamol is easily available in the market. Choose any medically acclaimed brand which has a good taste so that the child can easily take it. Or you can simply ask your child’s paediatrician.</li><li>Dosage is usually mentioned on the bottle. Dosage depends upon the age and weight of the child. Paracetamol comes in two different preparations. One is the regular preparation and the other is DS- (double strength) preparation.</li><li>Regular paracetamol syrup contains 120-125 mg of paracetamol in 5 ml. Whereas DS paracetamol syrup contains 240-250 mg of paracetamol in 5ml.</li><li>Usual dose that needs to be given is 10-15 mg of paracetamol per kg of a child's weight.</li><li>For example, if your child is say 8 to 10 kgs in weight, 5ml of regular paracetamol is enough. As the weight increases, dosage should also be increased.</li><li>For every 2kg of weight increase, 1ml of syrup should be increased.</li><li>For a child who is 12 to 14 kg, 5 ml of DS paracetamol can be given. Otherwise the child will have to take 7 to 8 ml of regular paracetamol which is more than required.</li><li>Paracetamol is considered the safest medication for children. Certain reports say giving 20 mg per kg of child’s weight is also allowed in a few cases. In a whole day, giving 60 to 80 mg of paracetamol per kg is also considered harmless.</li><li>If it is required, you can give paracetamol after every 4 hours. There are certain diseases in which the fever subsides for 10 to 12 hours, once you have given paracetamol. In such cases there is no issue. But there are other types of diseases where the fever keeps coming back frequently. Here, once you give the medication, the fever subsides for a while but there are toxins in the blood therefore as the effect of medicine subsides; there is rise in temperature again. In such a case you need to give paracetamol after every 4 hours as per required.</li><li>It is very rare that the child’s fever doesn’t subside after taking paracetamol. In most cases children respond well to this medicine yet there can be a few cases where a child’s fever is not affected at all even after taking paracetamol. In that case, you will have to give some other fever medication after consulting your child’s paediatrician.</li><li>If paracetamol does not seem to work for your child, you can try either of these two combinations:</li></ul>i. Combination of paracetamol and ibuprofen. It is commercially known as ibugesic plus or Combiflam.ii. Combination of Paracetamol and mefenamic acid. At times when giving Paracetamol doesn’t show any improvement, you can use mefenamic acid - Meftal, which is also a very popular medicine for fever. <ul><li>Apart from medicines, you can also use cold packs to decrease your child’s temperature.</li><li>Keep in mind to not use cold refrigerated water cold packs for fever, instead use normal tap water. Soak the cloth in the water, drain excess water and place it over the child’s hands, legs, and forehead. Temperature will eventually subside.</li></ul> Home Remedies:<ul><li>If the temperature is below 102˚ F the fever is normal, just give plenty of fluids (liquid) and extra rest.</li><li>If the fever is between 102˚ F to 105˚ F give a warm bath or sponge your child with lukewarm water, this will help to reduce the temperature.</li><li>Make the child wear light clothes and use a light blanket.</li><li>Complete rest and good sleep can help the child recover soon.</li><li>Increase the water intake as much as possible.</li></ul> Prevention:<ul><li>Make sure your child(ren) wash hands properly and regularly.</li><li>Make them to avoid touching their mouth, eyes, and nose constantly.</li><li>Maintain hygiene in your child's surrounding.</li><li>Avoid sharing cups/glasses/spoons.</li></ul>

Here are Fever Causes, Diagnosis, Treatment, Home remedies, and Prevention.

All about Fever

Rashes are common among infants. Rashes can occur because:<ul><li class="ql-align-justify">If the diaper is wet for too long</li><li class="ql-align-justify">Allergic reaction</li><li class="ql-align-justify">Bacterial Infection</li><li class="ql-align-justify">Milk drops falling around baby’s neck</li></ul> Take these measures to cure/avoid rashes:<ul><li class="ql-align-justify">Wash your hands before and after changing a diaper</li><li class="ql-align-justify">Keep a periodic check on baby’s diaper</li><li class="ql-align-justify">Use medicated cotton and plain water to poop off your baby’s skin</li><li class="ql-align-justify">Use a mild cleanser</li><li class="ql-align-justify">If you use wipes, choose mild ones or without fragrance and alcohol</li><li class="ql-align-justify">Make sure that the area is completely clean and dry before using another diaper</li><li class="ql-align-justify">Let the baby go diaper free if the rashes are extreme</li><li class="ql-align-justify">Clean the neck after every feed</li></ul> If your child has rashes solely due to diapers, then:<ul><li>First of all, you can change the brand, as the allergy can be due to a child's sensitive skin. Different babies have different types of skin sensitivities.</li><li>Apply good moisturiser on the skin before using diapers.</li><li>With every diaper change, clean the area properly.</li><li>You can also use specially designed creams for diaper rashes.</li><li>Even then if the rashes continue, limit the use of diaper to minimum.</li><li>Use cotton underwear instead.</li><li>Rash associated with diarrhoea, needs treatment for diarrhoea.</li><li>Severe cases may need mild steroid based cream under doctor’s supervision.</li></ul> Follow the above measures for mild rashes. In case, the rashes do not improve overtime, contact your paediatrician for appropriate anti-bacterial or skincare ointments and medicines.

Dealing with rashes properly helps soothe a child.

Treating baby rashes

Perfume allergy or alternatively known as fragrance allergy is the body's allergic reaction towards fragrances used in perfumes, deodorants, detergents, cosmetic products, soaps, shampoos, and cleaning products. The allergy is towards the ingredient of the fragrance rather than the fragrance itself. Because fragrance is found everywhere, it is quite difficult to keep your child away and protected from fragrance at all times. Fragrance allergy is one of the main causes of allergic contact dermatitis (ACD). Allergic contact dermatitis causes eczema and blistered skin at the contact points. After the acute phase, the skin turns scaly and takes some weeks to be repaired. Some children are sensitive to fragrances while some are allergic to them. Both are different from each other. Fragrance/Perfume Sensitivity:Perfume sensitivity, is a reaction to something that irritates your body. Sensitivity doesn’t necessarily trigger an immune system response. There might be a rash on your baby's skin which goes away after a few hours. The body usually gets rid of the irritant via sneezing so your child might sneeze a bit. A few mild symptoms of a perfume sensitivity can include:<ul><li>sneezing if the perfume is sprayed near the face and airways (nose, mouth, and throat)</li><li>itching, running, or stuffiness of nose</li><li>nasal mucus dripping down the back of the throat</li><li>persistent cough</li><li>headaches</li><li>nausea</li></ul> Fragrance/Perfume Allergy:An allergy towards a fragrance/perfume means that your body identifies the ingredient in the perfume as a foreign substance. The body then releases an inflammatory reaction to help fight off the substance as if it’s a bacterial or viral invader. This immune system response develops itchiness or a rash. Symptoms of Fragrance Allergy:<ul><li>mild to severe headache</li><li>burning sensation on skin</li><li>skin irritation, itching, and rashes</li><li>sneezing, coughing and runny nose</li><li>breathing difficulties, dizziness, and fatigue</li><li>muscle aches</li><li>watery, red, and itchy eyes</li><li>wheezing</li><li>inability to concentrate</li><li>swelling</li><li>nausea and vomiting</li></ul> Fragrance allergy also triggers migraine attacks in children suffering from migraines. Here are some severe, emergency symptoms to watch out for:Swelling in mouth, lips, or tongueAnaphylaxis Prevention:<ul><li>Try your best to keep your child away from the sources of fragrance.</li><li>Use fragrance less products for your kids.</li></ul> Diagnosis:A patch test is the best way to confirm an allergic reaction towards fragrance, and it is commonly performed in a dermatologist’s office. Patch testing helps to identify which substances may be causing an allergic reaction in a patient. Treatment:<ul><li>Medications</li><li>Topical creams</li><li>Light therapy: Blue or red light can help eliminate any bacteria irritating your child's skin or to reduce the immune system response.</li><li>Moisturising lotion or cream</li></ul>

Allergic reactions to fragrance/perfume are common than we know. Proper precautions will make your child's life easier.

Perfume allergy

Cleft is a split in the lip that can be immediately identified during the birth of a baby. A cleft lip is a split in the lip. Cleft lip and cleft palate can affect one or both sides of the mouth. Cleft lip and cleft palate can occur independently of each other or can occur together. A cleft lip is caused due to many reasons - it can be hereditary, exposure to substances like cigarettes, alcohol or medications, diabetes or obesity during pregnancy. Babies having cleft lip can breastfeed comfortably, however babies with a cleft palate may have difficulty in sucking.&nbsp;Consider this while feeding a baby with cleft lip (Without cleft palate):<ul><li>The baby may find it difficult to seal nipple with the mouth. If there is a hissing sound, it indicates that air is entering in the mouth.</li><li>Try to reposition the breast and baby’s mouth to form a vacuum.</li><li>The nipple should be behind the tongue; this will help the baby to hold the nipple in its mouth.</li><li>You can adjust and change positions to identify the one that works the best for your baby</li></ul> A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate. Consider this while breastfeeding a baby with cleft palate:<ul><li>Hold your breast in such a way that baby can get a good grip and latch properly.</li><li>The cleft can be repaired with surgery after 6-12 months but before that do not stop breastfeeding your child.</li><li>Breast milk is very helpful as it does not cause irritation on delicate tissues of the nose and throat and can help to reduce ear problems. Try to avoid formula milk.</li><li>Take help from nurses or specialists to feed the baby with a cleft palate. There are alternate methods like bowl and spoon-feeding, use a breast pump to get the milk in a bowl and feed the child with a spoon.</li></ul>

A cleft occurs because the tissues of the baby’s face and mouth don’t fuse (link) properly.

Breastfeeding a child with cleft lip/palate

There is nothing wrong in using breast pumps. Breast pumps are useful and come handy when you are travelling or for a working mother or when a child is having difficulty to latch on the breast. If you have decided to use a breast pump, follow these simple instructions:<ol><li>Clean all parts of the breast pump.</li><li>Wash your hands.</li><li>Find an isolated place where you can sit in peace and pump.</li><li>While you start pumping, think about your child, this will trigger hormones and will help to generate sufficient milk.</li><li>Make sure the shield of the pump is centred over the nipple.</li><li>Once you start pumping it may take a couple of minutes to start the flow.</li><li>Switch the breasts every 5 minutes; ensure each breast gets a total stimulation of 15 minutes.</li><li>After using the pump wash it with warm soapy water.</li><li>The milk extracted using a breast pump is safe for 4 to 6 hours at room temperature.</li></ol> In case after using breast pumps, you are experiencing problems such as - less milk supply or sore nipples, it is better to consult a doctor.

eye watering health concerns

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