Breast-feeding– Nurse on demand during the day and night. Baby should wet and poop a lot. Feed from only one side at one time and don’t forget to alternate sides. Drink lots of fluids. Eat or drink a balanced diet as per your choice, and if you need to take medicines, take only what your Obstetrician prescribes.
Breast feeding is the most natural way of feeding and is best for both mother & baby.
Strict back or side sleeping: Please, snuggle your baby at necessary to get the baby to accept this position. It is important to lower the risk of sudden infant Death Syndrome (SIDS)
Cord care– Just leave it alone. Keep the diaper folded down to keep urine off the cord as much as possible, but don’t worry about it. Come to hospital if it gets smelly or there is redness or discharge from or around it. Cord usually falls off by end of first week.
Eye Care- A persistently sticky eye with redness indicates conjunctivitis. This may be treated with medicated eye drops prescribed by your Doctor. Persistent watery eye discharge particularly if it is from one eye, is often due to a blocked tear duct. This is treated by massaging the site where the tear duct is located i.e. between the eye and the root of the nose (better to ask your doctor to demonstrate the exact site). This helps to open up the tear duct. Kajal / Surma application is best avoided because of risk of injury or infection to the eye.

Mouth Care– if the mouth is thickly coated, glycerin may be used to clean the mouth. A persistent white curdy coating indicates a fungal infection and requires treatment after consulting your Paediatrician.
Nose Care- A blocked nose or a stuffy nose is common and normal in young infants. Normal saline nasal drops are commercially available and can be used as required to clear up a stuffy nose in your baby.

Ear Care– Routine cleaning of the ears is not required. Use of an ear bud is not recommended and can be harmful. If a lot of wax accumulates in the ears, you can consult your doctor for ear drops to dissolve the wax.

Nappy Care– Use of cotton diapers is preferable. Cotton diapers need to be washed with a simple detergent or soap & dried in sunlight. Huggies or other commercially available diapers are convenient but expensive and in general, their use is best restricted for an outing or an occasional night. While using these, please keep in mind that they need to be changed every 2 to 3 hrs especially during summer & monsoon months. Babies are at higher risk of developing rash in nappy areas. Nappy rash creams are occasionally necessary to prevent/ treat simple nappy rashes. If rashes severe and spreads to the thighs, it may indicate an infection and will require treatment from a Paediatrician. Keep the nappy area clean and dry to avoid rashes.

Skin Care- A baby should be bathed with a mild non-medicated soap. Other skin care products like shampoos, creams and powders are not recommended. Transient skin rashes are common and may be treated with baby lotion. The scalp often has scaly rash resembling dandruff called ‘cradle cap’. Which tends to settle in the first few months, in severe cases, consult your Child Specialist.

Massage- Although not medically necessary, an oil massage is a social custom in many families. It may be done provided a few precautions are followed. Oil should not be put on the face, in the nose and ears, the breast of newborn baby should not be massaged and the foreskin of the penis in a male infant should not be pulled back. If the baby develops any reaction to the oil e.g. peeling rashes or boils, the massage should be discontinued. Any natural oil like coconut oil, olive oil, desi ghee etc are generally well tolerated.

Genital Care
Girls- During the daily bath and after each stool, the baby needs to be cleaned with plain lukewarm water and sterile cotton wool. The labial folds are to be separated gently for cleaning. The cleaning should always be from ‘Front to back’, so that the stool is not pushed forward to the urinary area, which can lead to urinary infection.

Boys- the penis should be washed from outside during the bath,. Pulling back foreskin during the bath is not required. The foreskin of the penis is usually tight in infancy, and forcibly pilling back the skin is harmful. The foreskin gradually loosens over the first few years of life in 97 % of boys. Some parents may wish to get their baby circumcised for religious reasons. If so, they should discuss with their Paediatrician regarding the correct time and procedure to get it done.
Stool and urine pattern: a newborn baby should pass urine at leas 7-8 times a day or after each feed. Most infants on breast feeds pass 8-10 golden yellow semi-solid stools every day. It is not uncommon for some infants to pass a stool as infrequently as every 4-5 days. This does not need active treatment
Vitamins– Routine supplements of vitamins are not necessary for full-term breast fed infants. Exposing the baby to the morning sun for 10-15 minutes is a good way of giving the baby natural vitamin D.

Breast-feeding– Nurse on demand during the day and night. Baby should wet and poop a lot. Feed from only one side at one time and don’t forget to alternate sides. Drink lots of fluids. Eat or drink a balanced diet as per your choice, and if you need to take medicines, take only what your Obstetrician prescribes.
Breast feeding is the most natural way of feeding and is best for both mother & baby.
Strict back or side sleeping: Please, snuggle your baby at necessary to get the baby to accept this position. It is important to lower the risk of sudden infant Death Syndrome (SIDS)
Cord care– Just leave it alone. Keep the diaper folded down to keep urine off the cord as much as possible, but don’t worry about it. Come to hospital if it gets smelly or there is redness or discharge from or around it. Cord usually falls off by end of first week.
Eye Care- A persistently sticky eye with redness indicates conjunctivitis. This may be treated with medicated eye drops prescribed by your Doctor. Persistent watery eye discharge particularly if it is from one eye, is often due to a blocked tear duct. This is treated by massaging the site where the tear duct is located i.e. between the eye and the root of the nose (better to ask your doctor to demonstrate the exact site). This helps to open up the tear duct. Kajal / Surma application is best avoided because of risk of injury or infection to the eye.

Mouth Care– if the mouth is thickly coated, glycerin may be used to clean the mouth. A persistent white curdy coating indicates a fungal infection and requires treatment after consulting your Paediatrician.
Nose Care- A blocked nose or a stuffy nose is common and normal in young infants. Normal saline nasal drops are commercially available and can be used as required to clear up a stuffy nose in your baby.

Ear Care– Routine cleaning of the ears is not required. Use of an ear bud is not recommended and can be harmful. If a lot of wax accumulates in the ears, you can consult your doctor for ear drops to dissolve the wax.

Nappy Care– Use of cotton diapers is preferable. Cotton diapers need to be washed with a simple detergent or soap & dried in sunlight. Huggies or other commercially available diapers are convenient but expensive and in general, their use is best restricted for an outing or an occasional night. While using these, please keep in mind that they need to be changed every 2 to 3 hrs especially during summer & monsoon months. Babies are at higher risk of developing rash in nappy areas. Nappy rash creams are occasionally necessary to prevent/ treat simple nappy rashes. If rashes severe and spreads to the thighs, it may indicate an infection and will require treatment from a Paediatrician. Keep the nappy area clean and dry to avoid rashes.

Skin Care- A baby should be bathed with a mild non-medicated soap. Other skin care products like shampoos, creams and powders are not recommended. Transient skin rashes are common and may be treated with baby lotion. The scalp often has scaly rash resembling dandruff called ‘cradle cap’. Which tends to settle in the first few months, in severe cases, consult your Child Specialist.

Massage- Although not medically necessary, an oil massage is a social custom in many families. It may be done provided a few precautions are followed. Oil should not be put on the face, in the nose and ears, the breast of newborn baby should not be massaged and the foreskin of the penis in a male infant should not be pulled back. If the baby develops any reaction to the oil e.g. peeling rashes or boils, the massage should be discontinued. Any natural oil like coconut oil, olive oil, desi ghee etc are generally well tolerated.

Genital Care
Girls- During the daily bath and after each stool, the baby needs to be cleaned with plain lukewarm water and sterile cotton wool. The labial folds are to be separated gently for cleaning. The cleaning should always be from ‘Front to back’, so that the stool is not pushed forward to the urinary area, which can lead to urinary infection.

Boys- the penis should be washed from outside during the bath,. Pulling back foreskin during the bath is not required. The foreskin of the penis is usually tight in infancy, and forcibly pilling back the skin is harmful. The foreskin gradually loosens over the first few years of life in 97 % of boys. Some parents may wish to get their baby circumcised for religious reasons. If so, they should discuss with their Paediatrician regarding the correct time and procedure to get it done.
Stool and urine pattern: a newborn baby should pass urine at leas 7-8 times a day or after each feed. Most infants on breast feeds pass 8-10 golden yellow semi-solid stools every day. It is not uncommon for some infants to pass a stool as infrequently as every 4-5 days. This does not need active treatment
Vitamins– Routine supplements of vitamins are not necessary for full-term breast fed infants. Exposing the baby to the morning sun for 10-15 minutes is a good way of giving the baby natural vitamin D.

Breast Feeding is “Good for the Mother, Perfect for the Baby!”

• Helps a baby’s brain develop optimally.
• Protects against cold, allergies and other infections.
• Is the only food a baby needs for the 6 months of life?
• The preparation and motivation of the expectant mother in order to establish breast feeding successfully needs to begin birth of the baby, during the Antenatal check ups.
• Inverted and cracked nipples must be managed during pregnancy itself, so that problems are resolved before delivery of the baby.
• The mother should be guided & encouraged to put the newborn baby to the breast as soon as possible after the birth (preferably within first hour).
• According to the baby-Friendly Hospital Initiative (BFHI) guidelines, breast-feeding should be started within half an hour of a normal delivery and within 4 hours of caesarean section.

Benefits of breast feeding:

• Emotional bonding of mother with child and increased sense of well-being.
• Always available and best nutrition for newborn.
• Uncontaminated food at the correct temperature for the baby.
• High level of protective antibodies.
• Promotes brain growth in the baby.
• Reduces incidence of diarrhoea, respiratory and ear infections for your baby.

For the mother:

• Reduces post delivery bleeding.
• Helps mother in shedding excess weight and fat gained during pregnancy.
• Reduces incidence of breast abscess, breast engorgement and breast carcinoma.
• Reduces chances of next pregnancy in the immediate period.

Steps to successful breast feeding:

• Before delivery, tell your doctor you intend to breast feed your baby.
• Start breast feeding your baby, as soon as he/she delivered.
• Know about benefits of breast feeding to both mothers and baby.
• Learn how to maintain lactation by expressing even when separated from your baby for some periods like sickness.
• Do not give your newborn any other food drink, other than breast milk, unless indicated by your pediatrician.
• Practice “Rooming-in”-keep your baby with you the whole day. (this will help bonding and understanding baby’s needs.)
• Let your baby suckle “on demand” Breast feed him whenever he/she cries.
• Do not give artificial teats or pacifiers (dummies/ soothers) to breast-feeding infants.
• Consult your doctor on adequate care of breasts and nipples during pregnancy. Wash breasts during daily bath with clean water. After breast feeding, wipe breasts with clean cloth or allow them to dry naturally before dressing.
• Maintain your personal and baby’s hygiene for good health.

Misconceptions/ myths in breast feeding
Some mothers may have following misconceptions about breast feeding like:

• You need to give sugar water (dextrose) or formula to take care of your baby’s nutrition, in the first few days.
• Baby’s feeding pattern has to be regulated.
• Mothers should not nurse their baby while lying down.
• Mother’s milk has no food value after 12 months.
• Baby can have allergy to mother’s milk.
• Cow’s milk and formula feeds are also as good as human milk.
• It is Ok to give formula milk just once a day.
• Baby should be allowed to cry otherwise he/ she will get spoilt; mother should not pacify him/her.
• Babies should sleep at night and feed during day time.
• All babies should pass stools every day.
• These misconceptions are not correct and may harmful to baby if followed.

Breast Feeding.
How to know mother’s milk is enough for the baby:

• Baby passes urine more than 4 times in 24 hours for first 3 days, and 7-8 times in 24 hours, subsequently.
• Baby gains weight adequately- 30g/day for first 3 months,
• Baby sleeps peacefully after a feed.

Some reasons for inadequate milk:

• Giving your baby top feeds, dextrose & sugar water, and formula feeds, etc.
• Changing to other breast mid-feed.
• Mother’s diet has inadequate fluids, less fresh fruits/not taking a balanced diet.
• Mother is tired/exhausted/inadequate sleep.
• Painful breasts.

Managing Problems during breast feeding:
Baby not sucking:

• Stuffy nose, improper position, too warm or cold surroundings, respiratory infection, earache.
• Nipple confusion due to bottle feeding or use of soothers/ pacifiers.
• Mother having painful & engorged breasts, stressed mother-loud talk / arguments, long separation from baby, excessive hunger in baby.

Sore / painful Breasts:

• Improper position, Improper latching-baby’s lips should cover most of brown areola surrounding the nipple. Baby sucking will then not be painful to the mother.
• Improper & forceful expression of breast milk.
• Tight brassieres.
• Breast engorgement/ abscess.
• Cracked nipple or local infection.

Some instructions for Working Mothers:

• Express milk and store in fridge for baby’s feed in her absence.
• Increase night time feeds.
• Wake up 15-20 minutes, using alarm, before time of morning feed.
• Sit with baby for 20-30 minutes immediately after coming home.
• At least 4-6 months maternity leave.

Children are often fussy eaters. Do you feel that your child does not eat anything? Does not open mouth while feeding? Eats at the neighbor place but not the food you lovingly prepared. Is your child dependent on maggi, chips, noodles, candies and fruity? Is he/she drinking milk the whole day? Does not eat any vegetables or dal / sabji except for potato? “Not eating” is not a disease; it does not need medicine or tonics. Actually there is no medicine known as tonic parents and caretakers insist on such type of prescription which is not appreciable.
These are few things we should keep in mind while feeding children:–

• It takes around 5-20 trials of a food item before a child likes it, so while introducing a new food item we should be patient. We must not assume that the child will like it the very first time, it takes time to develop a new taste.

• If the child vomits, do not get upset, wipe his / her face and restart feeding. Some children develop this habitual vomiting to avoid eating; mothers should not get anxious about it.

• Children who are dependent only on milk can also be fed with food mixed with milk like porridge, rice, banana and suzi. The quantity of milk can be gradually reduced and solid food increased..

• Do not always mix vegetables with potatoes let the child have other green vegetables, fruits and pulses.

• Parents should not get worried if the child does not eat. If the child is not sick he has enough reserves to remain empty stomach for at least a day.

• You can feed children in attractive plates and utensils (e.g. with cartoons) which will make eating an enjoyable process for them.

• Do not put on the TV while eating. Children should be encouraged to eat on the dining table.

• Bottle feeding should be discouraged else child will not learn to chew the food.

• Some children eat biscuits, chocolates and chips a lot and so are not hungry when food is served to them. These things should be offered only after children finish the food as a reward.

• It takes time to get rid of bad eating habits sometimes it may take few days. Initially the child may resist but do not give up on your efforts. Always try to inculcate good eating habits in children for their good health. Your confidence and efforts will make them disciplined too.

We as a policy do not encourage phone consultation as it can be dangerous because the Doctor has not examined the child. Still a specialist pediatrician is contactable 24 hours on the NICU mobile no: 9501300776 or our EPABX no 01814679999 ext: 915. It is our humble request to use this facility sparingly and to be patient if the doctor concerned is busy in the care of sick babies in NICU or PICU
Phone no : 0181-4679900-99
E-mail : care@ankurkidshospital.com
Address : ANKUR Hospital, 663,
Guru Teg Bahadur Nagar,
Near Guru Ravi Dass Chowk,
Jalandhar

1. EMERGENCY ROOM
A Consultant Pediatrician, is available 24 hours to look after all Emergencies, should such a need arise. The Emergency Room meets the immediate medical needs of the Patients. Emergency medicine doctors and nurses specialize in treating patients who are suffering from a serious illness or injury that could get worse if not treated quickly. A Pediatric Surgeon is available on call for urgent surgeries. A Fully equipped Ambulance service is available for the transportation of Sick patients round the clock. Trained nursing staff accompanies the ambulance every time.

2. FACILITIES FOR SICK NEWBORNS
Neonatal Intensive Care Unit (NICU) is a unit of the hospital specializing in the care of ill or premature newborn infants. When a high risk newborn is delivered anywhere in the vicinity of Jalandhar and we are contacted, a fully equipped neonatal transport team travels to the town to transport the baby from the delivery table to ANKUR’s NICU. We are particularly trusted for ventilator care of newborns when babies at other centers need neonatal ventilation.

3. EMERGENCIES IN OLDER CHILDREN
The Pediatric Intensive Care Unit (PICU) at ANKUR Hospital is a four-bed unit caring for sick children, older than a month. In PICU we have state of the art equipments and technology including advanced ventilators, cardiac monitors, defibrillators etc.

Children are very prone to fall from bed, stairs etc. Most of the times injuries are mild but they can be serious also and it is very important to detect them in time so that early treatment can be started.

An injury to the brain is likely when

• There is continuous vomiting,
• Child Loses consciousness,
• Has seizures,
• Sleeps excessively, or ,
• Complains of headache (-a small child may cry excessively),
• There is bleeding from nose or ear despite no evidence of direct injury
• Development of black eye

Some types of head injury may even have symptoms appearing later (up to 24 hours).

A fall with an injury to the head is an emergency where the child has to be examined by a pediatrician. In some cases CT scan head may be needed. Do not administer any pain killers or sedatives to the child without consulting the doctor

Children get cough due to an irritation in the airway. The focus of irritation can be anywhere from the nose, ears, throat, the trachea (windpipe), bronchi, or the lungs themselves. Most coughs accompany the common cold, which is a viral infection of the ear, throat and nose. Once cough starts, the irritation usually persists over a week. Cough can be caused by bacteria, viruses, allergies, foreign body or drugs. Cough occurring again and again, usually suggests an allergy of the airway.

Long standing coughs (more than 15 – 20 days) are rare and usually suggest a long standing disease like Tuberculosis.

A child with cold and cough needs urgent evaluation by a doctor if

• There are chest retractions (in drawing of chest wall during inspiration)
• There is head bobbing (movement of head with each breath) & nasal flaring
• Excessive & inconsolable cry
• Lethargy & drowsiness
• Not feeding
• Bluish lips, tongue & nails

When a baby passes stools more frequently that his usual routine, or when the stools are more fluid than his usual stools, he is said to be suffering from diarrhea.

Diarrhea in children younger than 5 years is usually caused by viruses. Such a diarrhea is self limiting. It is usually watery, and there is no blood or mucus in the stools. Irrespective of the cause loose stools result in loss of fluid and salts from the body-known as dehydration, which can cause considerable harm. It is important to consult your doctor when your child has diarrhe

A child with loose stools needs urgent evaluation by a doctor if

• Not passing urine even after 4 hrs (2 hrs in newborns)
• Not taking feeds or oral liquids
• Lethargic or excessive cry

For the first twenty-four hours or so of any illness that causes vomiting, keep your child off solid foods, and encourage her to suck or drink clear fluids, such as water, sugar water (1.2 teaspoon [2.5 ml] sugar in 4 ounces [120 ml] of water), Popsicles, gelatin water (1 teaspoon [5 ml] of flavored gelatin in 4 ounces of water), or preferably an electrolyte solution (ask your pediatrician which one), instead of eating. Liquids not only help to prevent dehydration, but also are less likely than solid foods to stimulate further vomiting.

Here are some guidelines to follow for giving your child fluids after she has vomited.

• Wait for two to three hours after the last vomiting episode, and then give 1 to 2 ounces (30-60 ml) of cool water every half hour to one hour for four feedings.
• If she retains this, give 2 ounces (60 ml) of electrolyte solution alternated with 2 ounces of clear liquids every half hour.
• If this is retained for two feedings, add half-strength formula or milk (depending on age), and continue increasing the quantity slowly to 3 to 4 ounces (90-120 ml) every three or four hours.
• After twelve to twenty-four hours with no additional vomiting, gradually return your child to her normal diet, but continue to give her plenty of clear fluids.

In most cases, your child will just need to stay at home and receive a liquid diet for twelve to twenty-four hours. If your child also has diarrhea, ask your pediatrician for instructions on giving liquids and restoring solids to her diet.

About 60-70 % of newborns develop physiological jaundice on the second or third day of life. The yellow discoloration (icterus) is first detectable on the face and trunk, sparing palms and soles. The jaundice deepens by 4th to 5th day of life. Physiological jaundice does not need any treatment. It does not indicate any infection. If the jaundice presents within the first 24 hours of life & when it is deep and intensely stains the trunk, or also stains palms and soles; or if it persists beyond 2 weeks; you will need to consult your baby’s Paediatrician for appropriate investigation and management.

Some mothers give bottle “only ONCE a day”  as the elders feel that it would be easier to switch them over from breast to bottle finally and so that baby gets a sound sleep at night. Both these arguments are highly flawed. Bottle can cause dangerous infections to your baby and it is not something that is indispensable (no animal in nature uses bottle to feed its babies; bottles were invented hardly 100 years back and human race is million years old) . Babies should be exclusively breastfed till 6 months and thereafter semi-solid and solid food should be added to the diet. Top milk even if needed can be given with glass. Secondly, it gives Moms, not babies, a sound sleep! In fact, breast-feeding at night gives baby extra time for sucking. And since more Prolactin is produced at night, it is important to keep up adequacy of flow of breast milk. It also enhances mother-infant bondin

Babies usually have a sleep wake cycle that is opposite of mother. This is because when in womb they go to sleep when mother is moving around due to rocking motion and wake up when mother lies down.  Help your baby understand the difference between night and day. Make sure the room is dark at night and there are no noises. Giving the baby a gentle massage followed by warm bath at night time is a good idea to induce sleep at night

1. Keep all medicines out of your child’s reach in a closed cupboard
2. Check all electricity wires fordamage
3. Fit safety sockets on all electricity points
4. Lock away all pins, needles, scissors, matches, knives
5. Never leave a child unattended in kitchen, bathroom or on terrace
6. Keep aerosol cans, sprays, toilet cleaners, acids etc out of your baby’s reach
7. Don’t leave plastic bags lying around, they can cause suffocation
8. Do let him/her play with a toy having small parts, coins, buttons etc as these can be ingested or inhaled
9. Do not give nuts to the child

Fever is not the disease by itself; it is only one of the symptoms. Generally infections caused by viruses or bacteria are the cause in children.

It is very important to record the exact temperature of your child when you suspect fever and convey the information to the pediatrician. There are many ways to measure temperature

1. Rectal: a special rectal thermometer is used. This is the actual core temp. of the body and you do not need to subtract or add anything to the value obtained. This is the best method to measure baby’s temperature
2. Oral: in children above 3 years of age, oral temperature can be measured just like an adult.
3. Axillary: In babies above 3 months of age, axillary temperature can be checked. In children above 1 year, one needs to add 1 F to the measured value to get the exact temperature

Best way is through oral rehydration fluids and Zinc supplementation. Most children with mild diarrhea can continue to eat a normal diet including formula or milk. Breastfeeding can continue. If your baby seems bloated or gassy after drinking cow’s milk or formula, call your pediatrician to discuss a temporary change in diet.

Children with moderate diarrhea may need special fluids. These fluids, called electrolyte solutions ORS, have been designed to replace water and salts lost during diarrhea. They are extremely helpful for the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. Use only commercially available fluids—brand-name and generic brands are equally effective. Your pediatrician or pharmacist can tell you what products are available.

If your child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again.