Reduced milk production can be due to pain through breast pump, infection, or poor latching, any breast surgeries you’ve had, stress, high blood pressure, insulin dependent diabetes, obesity, or thyroid. If your baby was born prematurely, it might be a while before your little one gets the knack of proper feeding. And because your baby takes a while to adjust to breastfeeding it too impacts your milk supply. Do not feel guilty about low milk supply as most of the factors are out of your control. Following are the ways which will help you to increase your breast milk production: <ul><li>Evaluate Your Baby’s Latch: Make sure the baby is latching on your breasts correctly.</li><li>Continue to Breastfeed: Your body works on the principle of demand and supply. As you keep feeding, it will produce enough milk. If your milk supply is low, try to express at least 8 times in 24 hours and at least once overnight. Milk producing hormones are secreted the highest at night, so do not skip the night-time expressing.</li><li>Stimulate Your Breasts: Use a breast pump or a hand expression technique to stimulate your breasts after you finish breastfeeding your baby. The extra stimulation will tell your body that you need more breast milk.</li><li>Use a formula supplement: When the milk flow is low or slow, the child may refuse to suck so you can use a formula supplement.</li><li>Make Healthy Lifestyle Changes: Smoking, taking a combination of birth pills, stress and fatigue can also adversely affect milk production.</li><li>Breastfeed Longer at Each Feeding: Your newborn should be breastfeeding for at least 10 minutes on each side. If (s)he falls asleep, try to wake him/her up gently to continue nursing. The more time your baby spends at the breast, the more stimulation you're getting.</li><li>Breastfeed From Both Breasts at Each Feeding: During the first few weeks, breastfeeding from both sides during each feeding will help to build up a stronger supply of breast milk.</li><li>Try to Keep Your Baby Awake During Feedings: Yes! When you are feeding your baby try to keep your child awake and actively sucking so that there is stimulation which helps in milk production.</li><li>Spend Some Time in Direct Skin-to-Skin Contact: The&nbsp;kangaroo care technique that is skin to skin connection between the newborn and mother stimulates their bodies and has a very positive impact on the baby and the mother.</li><li>Eat Well: Eat some milk boosting food such as oatmeal (porridge or upma), spinach, fenugreek, garlic, apricot.</li><li>Drink Plenty of Fluids: Breast milk is made up of about 90 percent water. Drinking about 6 to 8 glasses of water or other healthy liquids such as milk, juice, or tea proves beneficial.</li><li>Try to Get Some Rest: Exhaustion and stress can have a negative effect on your milk supply. Try to take a nap when the baby is sleeping, and know that it's OK to ask for help.</li></ul>

It is very rare that mothers have to deal with less breastmilk production. Nevertheless, there are always ways to deal with it.

Low Breastmilk Supply

Ravina Sewani

The feeling of blocked or clogged ears is either due to water or sir getting stuck in the ears. Water in the ears:When water enters in an ear due to any reason, the ear feels clogged/blocked. If there's too much water in the ears, surrounding sounds also get muffled. It is important to remove the water from ears because otherwise it can cause infections. You can get the water out of your child's ear, these are a few steps to follow:<ul><li>First dry out your child's ear using a soft towel. Do not push the towel deep into the ear canal.</li><li>Ask your child to tilt their head on the side of the ear which has water stuck in it and let gravity to do the work. Slightly pull their earlobes; this will straighten the ear canal helping in draining the water.</li><li>If the clogging of the ear persists, you can get ear drops prescribed by your child's doctor.</li><li>Do not use cotton swabs as they will push the dirt deep into the ear. Warn your children to not stick their finger in their ear.</li></ul> Air in the ears:The ears tend to feel full and clogged when a person is sick, or when altitudes change. To relieve from this feeling, one needs to pop their ears. Here is how you can help your child:<ul><li>Yawn: Instruct your child to yawn as many times as possible as yawning helps in opening up the ear canal hence helping the ears to pop.</li><li>Swallow: Give water to your child or a candy to suck on as swallowing activates the muscles that open up the ear canal.</li><li>Valsalva maneuver: Take a deep breath and pinch your nose shut. Keep your mouth closed and gently exhale through the nose. If your child is too young, this technique to pop the ears is not advised as it carries a minute risk of rupturing the eardrum.</li><li>Toynbee maneuver: Pinch the nose shut and with your mouth closed, try swallowing. If your child has difficulty doing this, a mouthful of water will help in swallowing.</li><li>If nothing works, consult your child's doctor.</li></ul>

The feeling of blocked or clogged ears is either due to water or sir getting stuck in the ears.

Blocked ears

Samiksha Choithani

One way to make sure that your child is latching properly during feeding is by observing the following pattern in your baby’s stool during the first week after birth: <ul><li>1 day after birth – 1 wet diaper, greenish-black stool colour, stool smears</li><li>2 days after birth – 2 wet diapers, greenish-black stool colour, 1-2 stools</li><li>3 days after birth – 3 wet diapers, yellow and soft stool, 2-4 stools</li><li>4 days after birth – 4 wet diapers, yellow and soft stool, 3-5 stools</li><li>5 days after birth – 5 wet diapers, yellow and soft stool, 3-5 stools</li></ul> If you observe a similar pattern is similar, there is no need to worry. If that is not the case, there are ways to improve latching and efficiently feed your baby.

Improper latching leads to an underweight child. Hence it is important to make sure that your child is latched well.

Proper latching during breastfeeding

Infants and toddlers tend to get a heart attack but in very rare cases. Some children are also born with congenital heart defect, which means that a child is born with a heart structural problem. Congenital heart defects can be simple or complex and may or may not need treatment or surgery. There are about more than 25 different types of congenital heart defects and only a professional expert can decide whether a child needs surgery or not. Congenital heart defects are the cause of heart attacks in babies and children. Symptoms of congenital heart defect:<ul><li>Pale grey or blue skin colour</li><li>Rapid breathing</li><li>Swelling in the legs, abdomen or areas around the eyes</li><li>Shortness of breath during feedings, leading to poor weight gain</li><li>Easily becoming short of breath during exercise or activity</li><li>Fainting during exercise or activity</li><li>Swelling in the hands, ankles or feet</li></ul> Diagnosis:Serious congenital heart defects are often diagnosed before or soon after your child’s birth. If you notice that your baby has any of the signs or symptoms above, call your child's doctor. CausesResearchers aren't sure exactly what causes most of these defects, but they think genetics, certain medical conditions, some medications and environmental factors, such as smoking, may play a role. Types of heart defects:<ul><li>Holes in the heart: Holes can form in the walls between heart chambers or between major blood vessels leaving the heart.</li><li>Obstructed blood flow: When blood vessels or heart valves are narrow because of a heart defect, the heart must work harder to pump blood through them.</li><li>Abnormal blood vessels: Several congenital heart defects happen when blood vessels going to and from the heart don't form correctly, or they're not positioned the way they're supposed to be.</li><li>Heart valve abnormalities: If the heart valves can't open and close correctly, blood can't flow smoothly.</li><li>An underdeveloped heart: Sometimes, a major portion of the heart fails to develop properly.</li><li>A combination of defects: Some infants are born with several heart defects.</li></ul> Risk factors:<ul><li>Pregnant mother with Rubella</li><li>Diabetic mother</li><li>Certain medications; it’s better to give a list of medications a mother takes to her doctor before she tries to get pregnant.</li><li>Drinking alcohol during pregnancy</li><li>Smoking</li><li>Heredity: Genetic testing can detect such disorders during fetal development.</li></ul> Complications:<ul><li>Heart failure: This serious complication may develop in babies who have a significant heart defect.</li><li>Slower growth and development: Children with more-serious congenital heart defects often develop and grow more slowly than do children who don't have heart defects.</li><li>Heart rhythm problems</li><li>Cyanosis: If because of your child's heart defect, oxygen-poor blood mixes with oxygen-rich blood in his or her heart, your child may develop a grayish-blue skin colour, a condition called cyanosis.</li><li>Stroke: Although uncommon, some children with congenital heart defects are at increased risk of stroke.</li><li>Emotional issues: Some children with congenital heart defects may feel insecure or develop emotional problems because of their size, activity restrictions or learning difficulties.</li></ul> Prevention:It may not be possible to prevent congenital heart defects as the exact causes are not known. But here are a few things to do to reduce the risks of such defects:<ul><li>Get a rubella vaccine</li><li>Control chronic medical conditions like diabetes</li><li>Avoid drinking and smoking</li><li>Take a multivitamins with folic acid</li></ul> Heart Attacks or Heart Failure in children: Causes:<ul><li>Over-circulation failure: When blood mixes inside the heart due to a congenital heart defect.</li><li>Pump failure: When the heart muscle becomes damaged and no longer contracts normally. This can be due to a viral infection as well apart from the problems with the heart muscles and arteries. Children with muscular dystrophy may eventually also develop problems with their heart muscle.</li><li>Low blood (anaemia) can also result in heart failure.</li></ul> Symptoms:<ul><li>Trouble breathing</li><li>Poor feeding or growth</li><li>Excessive sweating</li><li>Low blood pressure</li></ul> Diagnosis:If your physician suspects that your child may be experiencing heart failure symptoms, a chest X-ray may help determine if the heart is enlarged. You also may be referred to a paediatric heart specialist.&nbsp;Additional tests can include an electrocardiogram (EKG or ECG) to evaluate the heart rhythm or an ultrasound of the heart (echocardiogram) to evaluate heart structure and function. Treatment:<ul><li>If heart failure is caused by over-circulation due to a congenital heart defect, surgery is often necessary to repair the defect. Often, your physician may initially treat your child with medications, which sometimes requires hospitalisation. Other dietary changes such as low-salt and low-fat diets may be discussed. Following appropriate treatment, your child’s condition and symptoms may improve. This is called compensated heart failure. Then your child can get a surgery done as and when the doctor guides.</li><li>If the heart failure is caused by pump failure, your child may require a pacemaker. A pacemaker reminds the heart to maintain a normal heart rate. The small, battery-operated devices are like tiny computers and are implanted under your child’s skin with a small wire connected to the heart. This requires a surgical procedure. In other cases of pump failure, different kind of surgeries might be needed.</li></ul>

Here are Heart Defects Symptoms, Causes, Diagnosis, Types, Risk factors, Complications, Prevention, and Treatment.

Heart Defects and Heart Failure in Children

Palak Vyas

This is how you can help your child if (s)he is afraid of injections: The fear of injections is seen in both children and adults. Infants don't have fear of injections. But a child who is 4 or 5 years old, is scared of injection because he/she understands that injections cause pain. Tell the truth: Be honest with your child. Do not lie to your child ever that injection is not going to hurt because it actually does and when they experience it they will lose trust on you. Try explaining to them the importance and benefits of injections and vaccinations. Explain it to them that it's for a safety purpose. Tell them it's going to hurt but just for a few seconds.&nbsp;Don’t give them too much time to ponder: A child might get anxious and terrified if you tell them a lot beforehand. Do not share more details about the visit. You can tell your child just before you are about to leave for the visitor if your child needs some preparation time, tell accordingly.&nbsp;Using distraction and anaesthetic cream: Numbing/anaesthetic cream can be used to ease their pain. While the doctor gives the injection, hold your child’s hand, make some funny faces, tell jokes, sing a song, etc. In short, distract them from pain.&nbsp;Leave them alone with the hospital staff if required: Sometimes when children are around their parents, they throw tantrums. The moment you leave the room, they behave properly. So leave your child with the hospital’s staff, if need be.&nbsp;Ensure immediate relief: Rub the injection site gently after injection. Use cold compressor apply an ice pack wrapped in a cloth. A small reward won’t harm: You can reward your child with a sticker, candy, his/her favourite ice-cream, bravery card or anything creative or innovative thing you can think of. Do not bribe them by saying, “You can have a treat if you get this vaccination”. Instead, you can say, “We can get a treat when your vaccination is done.” In rare cases, some children can get a syncope attack. In a syncope attack, there is a temporary loss of consciousness usually because of reduced blood flow to the brain. So the doctor always makes such a child sit or lay down on the bed before giving the injection. Make sure the child is fed properly before seeing the doctor.

Many children are afraid of injections, sometimes adults too.

Handling child who is afraid of injections

<ul><li>If the child gets sick again and again, the parent considers it as weak immunity but this is not true because every time a child falls sick, (s)he gets back to normal on their own so the immunity is fine. The immunity is weak when the child doesn’t heal and stays sick for long extended periods.</li><li>As a child grows, (s)he does not stay at one place or with just one person. This leads to a child getting exposed to outside environment and a lot of new people. Due to this, the chances of catching infections again and again are very high. And so the child falls sick frequently.</li><li>This does not mean that the immunity is less. In fact, the child should not be given medication again and again. The infection will be cured within a week as a child’s body learns to fight against outside germs. Fighting against germs will only make your child’s immunity stronger.</li><li>A child’s immunity completely develops by 5 to 7 years.</li></ul> To increase your child's immunity:<ul><li>Breastfeed your baby.</li><li>Encourage exercise:&nbsp;It enhances immune system through stress-reduction. Thus encouraging your kids to opt for age-appropriate exercise regularly, will&nbsp;make them physically fit and support their immunity. Regular moderate intensity exercise increases child’s immunity.</li><li>Give them nutritious diet: Deficiencies of Vitamins A, C, E, B6 and Folate, are also associated with reduced immunity. Micro-nutrients such as Zinc, Selenium, Iron and Copper are also important in developing a healthy immune system. Thus, a properly balanced diet with all required nutrients is extremely important, especially in the growing years when the immune system is still maturing.</li><li>Inculcate healthy sleep habits: Sleep is a restorative process that plays a critical role in the proper functioning of the immune system. It is important to develop and follow a healthy and optimum sleep pattern for your children.</li><li>Serve more fruits and vegetables.</li><li>Develop a good habit of washing hands: You should pay particular attention to their hygiene before and after each meal and after playing outside, handling pets, blowing their nose, using the bathroom, and arriving home from daycare. When you're out, carry disposable wipes with you for quick cleanups. To help kids get into the hand-washing habit at home, let them pick out their own brightly coloured hand towels and soap in fun shapes, colours, and scents.</li><li>Keep your babies away from second hand smoke: If you or your spouse smokes, quit. Cigarette smoke contains more than 4,000 toxins, most of which can irritate or kill cells in the body.</li></ul>

Your child getting sick again and again does not mean that (s)he has a weaker immunity.

Increasing child’s immunity

Wool is a clothing material containing natural oil called lanolin, which is the cause of many children's wool allergies. Children who are allergic to lanolin will show allergic reactions to other products containing lanolin. Symptoms:<ul><li>Skin Irritation - rashes and hives</li><li>Eye irritation - redness, itching and puffiness of the eyes</li><li>Nasal Problems - runny nose, sneezing, nasal congestion</li><li>Narrowed airways</li><li>Trouble in breathing</li><li>Drop in blood pressure</li><li>Asthma</li><li>Ear and lung infections</li><li>Anaphylaxis (in more severe cases)</li></ul> Diagnosis:<ul><li>Wool allergies are sometimes misunderstood with wool sensitivity. To know whether your child is allergic to wool or just sensitive, you can try to make him/her wear a layer of clothing between their skin and the wool clothing. If your child does not experience any allergic symptoms, it's clear that your child is only sensitive towards wool. Your child can use wool products as long as they don’t come into contact with their skin.</li><li>Wool allergy is confirmed when your child develops an allergic reaction even if the wool didn't come in direct contact with your child’s skin. To confirm the allergy, you need to take your child to a doctor who will ask for your child’s medical and health history, your family’s medical history, and perform either a skin-prick or blood test.</li></ul> Wool Allergy Sources:<ul><li>Wool clothing - sweaters, scarves, bonnets, socks and gloves</li><li>Wool wax</li><li>Cosmetic products and personal products with lanolin</li></ul> Treatment:There's no permanent cure for wool allergy. Your child can, however, be given antihistamines and allergy shots to subdue the symptoms of the allergy. Guidelines to soothe your child’s skin after an allergic reaction:<ul><li>Keep the skin clean and moisturised with a gentle, fragrance-free lotion</li><li>Let the skin be exposed to air as much as possible</li><li>Avoid hot baths or showers, which may further irritate the skin</li><li>Try to stop scratching, which can make the rash worse</li><li>As a precautionary measure, avoid using woollen clothes or products containing lanolin for your baby.</li></ul>

Wool allergies are quite common but are often confused with wool sensitivity hence it is important to get a proper diagnosis done by an allergist.

Wool allergies

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

Choking occurs when your baby takes more milk into its mouth than (s)he can swallow at a time. Excess milk spills into the airway and blocks the flow of air, which leads to choking. It can be a frightening sight for any mother to see her baby coughing and sputtering milk while struggling to breathe. Reasons behind choking during breastfeeding:<ol><li>Milk oversupply- When a mother produces excessive milk, the milk releases from the milk ducts in a forceful and almost explosive manner. This is called Milk Ejection Reflex. The baby is not able to swallow that much amount easily and starts choking up.</li><li>Improper latch</li></ol> You might be producing excessive milk if you notice:<ul><li>The baby is choking, gagging.</li><li>The baby is trying to clamp the nipple to slow down the flow.</li><li>The baby is trying to pull away from the breast.</li><li>The baby is refusing to nurse and is spitting up frequently.</li></ul> What to do:<ul><li>When you find your baby choking on milk, there are methods that can dislodge the milk from blocking the airway. Since babies have delicate bodies, it must be done with caution.</li><li>Turn your baby upside down and give them intermittent back blows and chest thrusts combined with gentle taps to the back, to open up the airways. The chest thrusts should be given with two or three fingers on the lower half of the breastbone, while supporting the head with the other hand. This should be continued until the block is removed.</li><li>It’s important to note that if the baby doesn’t recover and becomes unconscious, (s)he should be rushed to the nearest hospital, while still continuing the dislodging procedure.</li></ul> Prevention:<ul><li>Try and slow down your supply: Say if you are nursing with the right breast, then press your left nipple of the left breast with your right hand’s palm toward ribs and count till five. This signals your body to slow down the flow.</li><li>Stick to a single breast for a few feeds: This way one of the breasts gets fully emptied and this also slows down the flow in the other breast.</li><li>Baby’s latch: Ensure that the baby is latched properly. If the baby is latched properly, the milk should directly get into the baby’s throat and not his mouth. So when the latch is not proper, there is more risk of the baby’s mouth getting filled up with milk more than it can take and that is when your baby might end up choking.</li><li>You can recline on a surface and then feed the baby in your arms. This is a good nursing position.</li><li>While breastfeeding, if the other breast feels uncomfortable, you can express some milk from it and apply a cool compress to relieve the discomfort. As you continue this procedure, express lesser milk, until there is no need to do so.</li></ul>

A breastfeeding child chokes when (s)he takes more milk in mouth than (s)he can gulp down.

tongue tied health concerns

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