Parenting Tips from a Pediatrician

The role of parents is one that is both fun and challenging. Right from infancy up until adulthood, the love, care, support and guidance that they provide is unparralled, as they would settle for nothing  than the best .While most of parenting is guided by the ‘sixth sense’, a few guidelines will help them deliver holistic care. Dr. Bhramara Madduri, Consultant Pediatrician and Neonatologist at Royal Bahrain Hospital, provides us with a few guidelines that can help parents nurture their young ones and feel good at the end of the day that they have done their bit.

Dr. Bhramara points out that holistic health is important, to let a child grow to his/her full potential. “Firstly, exclusively breast feed the baby for the first six months of life. Secondly, ensure that you schedule regular health visits for development assessment and vaccinations at birth, then once every 2 months until aged 1 year, then once every 6 months until 2 years old, then once every 5 years until aged 15. Visits during the preadolescent and adolescent years should discuss issues related to growth and puberty, psychological needs and such things. Additionally, we encourage pre-school screening for visual and hearing problems.”

In addition to that, Dr. Bhramara advises parents to teach their children to lead healthy lifestyles with healthy eating habits that include fruits, vegetables, nuts and cereals daily while discouraging fast food, packaged food, and sugary food. “Inculcate the habit of drinking ample amount of water.”

A healthy lifestyle also includes adequate physical activity. “Outdoor play, yoga, sports, swimming, dance, cycling and such activities from the very beginning ensure a healthy lifestyle in the future. Also hobbies like reading, music, drawing, painting or some form of creative art, to foster balanced right/left brain development.”

Dr. Bhramara also lists out a few things that parents should avoid. “Avoid letting them spend a lot of time on the TV or internet, limit it to 1 hour a day.” Another practice that is highly discouraged is self-medicating. “When in need seek expert advice. Also, be generous with praises, while reducing the ‘Don’t’s and Nos’ and involve them in decision making.”

Dr. Bhramara sums it up with a last phrase “An age old saying goes ‘Provide loving care for the first 5 years, discipline them for the next 10 years, and befriend them from when they are sixteen onwards’ .”

Dr. Bhramara Madduri, [MD, MRCP (UK)] is a Consultant Pediatrician and Neonatologist at Royal Bahrain Hospital. For more information or to book your appointment, call 17246800 or (toll free) 8000 1090 or plan your visit at www.royalbahrainhospital.com.

50th Baby Milestone!

Last Wednesday, on the 14^th of December, Royal Bahrain Hospital celebrated the birth of the 50^th baby in the hospital’s state-of-the-art maternity ward. During the celebratory cake cutting ceremony, Dr. Ravi Preet, Chief Operating Officer at the hospital commented that “We’re very pleased with reaching this milestone. To have arrived at this point shows the fruit of our hard work.”

It was only back in August, when the first baby was born, and to have reached the 50^th baby in less than five months shows how fast news about the hospital’s high-end maternity department has spread.

The newborn Bahraini boy was born on Wednesday afternoon, and medical staff reports that he and the mother are well and healthy. Her doctor was Dr. Kiran Bijlan [MD, BGO], Specialist Gynecologist, who is currently working at Royal Bahrain Hospital.

The family has expressed their happiness and gratitude to the hospital staff for their services. The mother says “Dr. Kiran was very good, I was very pleased with her support and work throughout the process, especially as it was my first baby. It went by very smoothly thanks to her.”

In celebration of this milestone, Royal Bahrain Hospital has gifted the new baby with some privileges, including three months’ worth of free consultations with the pediatrician, a substantial discount on vaccines and laboratory investigations, in addition to a baby kit for the newborn.

Dr. Abdul Gaffar, Medical Director of Royal Bahrain Hospital cheerfully added in that “Our hospital aims to provide services for people of all walks in Bahrain, and we’re very happy to celebrate this baby, and wish to have the privilege of having more births in the future.”

Save Your Child from Eczema

Atopic Dermatitis is the most common skin disease in children. In Bahrain, between 15% and 20% of children have AD.

According to Dr. Husain Mahdi, Consultant Dermatologist at Royal Bahrain Hospital, children often get atopic dermatitis (AD) during their first year of life. Symptoms are the development dry and scaly red patches appear on the skin, usually affecting the cheeks, scalp, and forehead. “In severe cases the itch is so intense that a child cannot sleep.” Says Dr. Mahdi. “The danger is that scratching may lead to a bacterial skin infection.”

A child’s risk of getting AD is increased if any of the family members have AD, asthma, or hay fever. Therefore, because atopic dermatitis can be long lasting, it is important to learn how to take care of the skin. Treatment and good skin care can alleviate much of the discomfort and complications. “Contrary to popular belief, foods no not cause AD, even though some studies suggest that food allergies make AD worse.” Dr. Mahdi advises parents to speak with a dermatologist before keeping certain foods from their children, since certain foods are needed for growth and natural development.

Researchers continue to study what causes this complex disease, and currently they believe that many things interact to cause AD. These things include our genes, where we live, and the way our immune system works.

Treatment cannot cure AD, but it can control AD. A treatment plan often includes medicine, skin care, moisturizers, mild soaps, and lifestyle changes, which can help prevent flare-ups
“A dermatologist will create a treatment plan tailored to the patient’s needs.” States Dr. Mahdi. “Medicine and other therapies will be prescribed as needed to control itching, reduce skin inflammation, treat infection and reduce new lesions.”

However, parents must know that if a child has skin lesions, you must take him or her to see a dermatologist. This is because some skin conditions can look like AD, but without the right diagnosis, the treatment may not work.” 

Dr. Husain Ali Mahdi [BSc, MD, CABD] is a Consultant Dermatologist at Royal Bahrain Hospital’s Royal Aesthetic Center. To book your appointment, call 17246939 or visit www.royalbahrainhospital.com

Newborn Baby Health III: Weight and Diapers

Having a newborn baby, especially if it’s your first, could cause parents a lot of stress if they don’t know what’s medically normal. Which vaccination should my baby have? Is my baby growing at a normal rate? How does one avoid diaper rash? Dr. Suresh Chandran will tell you what to look out for in your newborn, and when it’s necessary to see a doctor.

In terms of vaccination, the first vaccination starts at birth with BCG, which protects against Tuberculosis and HBV, as well as against Hepatitis B.

A baby’s growth and development is very important. Every parent should note that their baby’s weight should double after 5 months, and should by triple its original weight after 1 year. For example, if your baby was born at 3kg, then he or she should be at least 9kg after 12 months. For the first year of your child’s life, be sure to visit a pediatrician regularly to monitor weight and head circumference, which help in detecting problems early. You should also monitor mental and motor milestones, which help to diagnose condition early on.

Although an uncomfortable topic, checking your baby’s urine and stool is very important. To put it briefly, keep an eye out for reddish urine, which is an uncommon complaint, due to the type of breast milk the baby receives in the first few days. This should clear up within five days, but if it doesn’t, it is important to consult a doctor. Frequency is another indicator, whereby the normal rate is six to ten times a day. Make sure to change your baby’s diaper as often, in order to avoid skin rash.

In terms of stool, always remember frequency and color. Babies will pass stool after every breast feed. Pale stool is a sign of serious liver disease, while blood is literally the red sign to seek medical attention. Blood could be due to bleeding from the gut or a deficiency.

The most important thing to remember is to never be embarrassed or afraid to ‘bother’ your doctor with questions about your baby. A watchful parent is better than a neglectful parent, especially within the first few years of a baby’s life.

This concludes Dr. Suresh’s series on newborn health. Dr. Suresh Chandran [MD, MRCP, MRCPCH (UK), DCH, FRCPCH (Lond), CCST] is the Consultant Neonatologist available exclusively at Royal Bahrain Hospital from September 10th until September 17th. Call 1724 6800 to book your appointment now.

Newborn Baby Health II: Skull and Skin

Having a newborn baby, especially if it’s your first, could cause parents a lot of stress if they don’t know what’s medically normal. Does my baby’s skull feel normal? Is that skin color natural? Dr. Suresh Chandran will tell you what to look out for in your newborn, and when it’s necessary to see a doctor.

Common illnesses found in the skull: According to Dr. Suresh, ‘caput’ is probably the most common finding in a neonatal skull, which is the swelling of the skull. You will notice the swelling across the midline which is soft to the feel. Normally, this resolves itself within a few days. However, if you notice a swelling not across the midline, which lasts from weeks to months, then you must definitely take your baby to a doctor. This type of swelling occurs if blood collects in the deep layers of the skull, and it could cause anemia at birth, jaundice, calcification and hardening over the skull bone.

Jaundice means the yellowish discoloration of skin and mucus membrane, and it’s quite normal as all babies get jaundice in the first week. This happens because the hemoglobin is changing from fetal to adult type. Adequate hydration, urine output and bowel movements are essential for the clearance of bilirubin (which is released by the dying fetal red cells) from the body. This discoloration will appear after the third day, but if it appears within the first two days and persists beyond two weeks. If detected early, then a simple treatment with blue light and adequate feeding will suffice. However, if the baby remains jaundiced beyond two weeks need to see a doctor and have a number of investigations done.

In some occasions, the jaundice could be breast milk jaundice, where the baby would have high yet safe levels of jaundice that last up to three months. This is diagnosed by exclusion, and usually mothers have a given history of previous babies with prolonged jaundiced.

Look out for Dr. Suresh’s next article in this series on newborn health. Dr. Suresh Chandran [MD, MRCP, MRCPCH (UK), DCH, FRCPCH (Lond), CCST] is the Consultant Neonatologist available exclusively at Royal Bahrain Hospital from September 10th until September 17th. Call 1724 6800 to book your appointment now.

New Baby? No Worries!

Having a newborn baby, especially if it’s your first, could cause parents a lot of stress if they don’t know what’s medically normal. Is my baby too fat or if his temperature is too high or if she's eating correctly? Dr. Suresh Chandran will tell you what to look out for in your newborn, and when it’s necessary to see a doctor.

Weight: On average, most babies weigh 2.5kg if they’re born on term (after completion of 37 weeks),  but if they weigh significantly lower, then the baby may be labeled as a growth retarded baby and should require a doctor’s attention for the first few months. If a baby weighs more than 4kg, then the baby is labeled LGA (large for gestational age), usually a result of a diabetic mother. At this weight, risks include birth injuries and low blood sugar (hypoglycemia), and should require immediate medical attention, monitoring and early feeding.

Temperature: Temperature is usually a problem in preterm babies (born before the full 37 weeks) or growth retarded babies. Normally, babies born at term have a special fat called ‘Brown Fat’ which is used to generate heat. Preterm and growth restricted babies do not have this fat and are susceptible to hypothermia (i.e. low temperature). Dr. Suresh advices that these babies need to be well-clothed, with a cap and mittens, to avoid heat loss in their head and limbs. He also advises that since we’re in a warm country, cotton clothes and close monitoring of the baby’s temperature should be maintained, to avoid overheating.

Feeding: Early introduction and a mother’s wellbeing are crucial to initiating let down. Breastfeeding should be continued for as long as 24 months, since the high quality protein it does contain is richer in quality than formula or cow’s milk. Milk should be producing at the rate of 600-800ml of milk per day through infancy, and you should check if the baby is drinking enough by monitoring weight gain and satiation cues. For example, alternate breasts every other feed and if the baby continues to suckle after the supply has run out, in order to avoid baby’s exhaustion and weight loss.

Look out for the next article in this series of three articles. Dr. Suresh Chandran [MD, MRCP, MRCPCH (UK), DCH, FRCPCH (Lond), CCST] is the Consultant Neonatologist available exclusively at Royal Bahrain Hospital from September 10th until September 17th. Call 1724 6800 to book your appointment now.

My Baby Has A Fever!

As a pediatrician, the most important question that I ask any parent when they bring in their infant complaining of fever is:  “What do you mean when you say that your baby has fever?”

Most parents would answer that they touched their baby’s skin and it felt warm. This is not an accurate estimation of fever. Fever should be measured by a thermometer and I advise the parent to purchase a thermometer to measure their baby’s temperature.

There are different types of thermometers; the most common is the digital thermometer which is placed in the baby’s axilla or the aural thermometer which is placed in the baby’s external ear. The digital thermometers have been found to be an accurate tool to measure temperature.

What is fever?

Fever is an increase in body temperature that exceeds 38 C when measured from the rectum or 37.5 C when taken from the axilla. Temperatures are not usually checked from the mouth of children less than 2 years.

Estimation of fever by touch is not accurate because babies can be actually warm from excessive clothes but do not have an increase in body temperature. Therefore, the best way to be sure is to take the baby’s temperature.

When should I be concerned about fever?

Parents should consult a pediatrician immediately if the baby is less than 3 months old and if the baby is not feeding well. Older infants and children should also be examined by a pediatrician immediately if there is decreased feeding, a rash, abnormal movements noted, vomiting and the presence of headache in young children.

What should I do for my baby till I see a pediatrician?

The first step is be remove excessive clothing and wraps around the infant and check the temperature again. This may reduce the temperature. Another useful tip is to place wet towels over the baby’s head. Avoid giving the infants less than 3 months paracetamol till they are seen by a pediatrician.

Dr. Dunia Al-Hashimi [MBBS, DCH, CABP, MSc Hospital Administration] is the Consultant Pediatrician at Royal Bahrain Hospital. For more information or to book your appointment, call 1724 6800 or plan your visit at www.royalbahrainhospital.com.