The Child dr - CHILDREN & COVID-19 Our Role? - smilestones child development centre
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the
Child dr
A child health journal for parents.
A monthly
magazine on
Child Health
AUGUST 2021
ONLINE
CLASSES
NUTRITION
STRESS
CHILDREN
& COVID-19
Our Role?
FOOD FOR EYES
BREAST
FEEDING
1
From Editorial desk
Dear parents,
We are happy to get into touch with all parents through this the Child
dr E-magazine.
This monthly e-magazine has been started based on the idea of
Dr. P. Sudhakar. MD(Ped).PGD-DN, Senior Consultant Pediatrician
and Developmental Pediatrician to clear the doubts and answer
the questions arising in parents mind about their kids health in a
simplified scientific way.
This magazine is a pure scientific magazine and will discuss about
Children’s health needs and health conditions. It will cover articles
written by Pediatricians and experts involved in Child health and
education to help parents to get the scientifically proven information
in a simplified language.
We have included a special space for Kids to have their own doubts
cleared named as KIDDY’S Corner which will be managed by kids
themselves. KIDDY’S corner will look their health issues in their
perspective and will get the right answers from experts.
This first issue concentrates on the child health care pertaining to this
pandemic.
We request your esteemed support for this E-magazine in a bigger
way by sharing this magazine to your friends and social groups.
Let us be a part of spreading the scientific awareness about child
health issues in India.
Editorial team
A child health journal for parents from
Smilestones Child Development Centre.
Please send your queries to thechilddrmagazine@gmail.com.
We will publish your queries with answers
from experts in next month issue.
2
S.No Content Page No.
01 Nutrition for children in pandemic period 04
02 Fever in children during COVID times 09
03 Pregnancy and Pandemic- FAQ’s 12
04 COVID and Teen Psychology 15
05 Chat with your Pediatric Dentist 17
On-line Classes-Rewards, Regrets, Revelations
06 20
and Remedies
07 Telehealth for Developmental issues 23
08 COVID and Breastfeeding 25
09 Food for Eyes 27
3
Nutrition for Children in
Pandemic Period
Dr. Elizabeth K E, MD, DCH, Ph D, FIAP, FRCPCH (Lon.)
UNICEF Consultant, Kerala State
Former Prof. & HOD Pediatrics & Superintendent, SAT Hospital,
Govt. Medical College, Trivandrum
State President, IAP Kerala, 2016,
National President, IAP Nutrition Chapter, 2017, 2018
Introduction
We have now come to an
era, which none of us could
even imagine, in our worst
nightmare dream. Many
got isolated and jobless,
with no social contacts.
COVID 19 pandemic has
thrust upon mankind, a
lot of restrictions, socio-
economic changes, and
lifestyle related transition.
No doubt, we were fast moving towards socio-economic progress, lifestyle
changes and thereby a cultural and nutritional transition. However, now
everything has slowed down and shut down, including schools. Children and
parents are destined for long home stay. Lot of psychological and emotional
stress and distress have gripped both adults and children of all age groups.
Parents seem to be overworked, overburdened due to the pressure of work
from home and household work. In addition to this heavy burden, they have the
added stress of copping up with children’s online classes and their tensions.
The socio-economic and socio-cultural transition, the pandemic fatigue and
disease morbidity and mortality have caused irreparable damage in several
families. Starvation, wrong food choices and picky eating have resulted in growth
retardation and micronutrient deficiencies in the affected individuals. Many
children have become orphans and homeless. Even exclusive breastfeeding
during first 6 months of life has seen setbacks. Immunization is another area
that showed setbacks.
4
Another cultural phenomenon, that has creeped in is, the buying OTC tonics
and other preparations, and multivitamins and minerals, the so called immune-
boosters. Overdose is resulting in hypervitaminosis of some like fat soluble
vitamins like ADEK and heavy metal poisonings.
In the initial months, it seemed fun to cook and stay at home. The Junk food,
which was available outside homes or brought to dining tables and living rooms
got warm welcome into the ordinary family kitchens through YouTube and the
WhatsApp university. Now the online delivery platforms, like the Swiggy and
Zomato, are bringing these to doorsteps on a 24/7/365 timeframe. Sedentary
lifestyle and overeating have resulted in escalation of overweight and obesity
in pandemic proportions. It is perceived that overweight/obesity, which was
increasing 2% per year, became 20% in the pandemic year of 2020. What is in
store for 2021 is yet to be revealed.
Fixing mealtimes and family exercises, which are the need of the hour, will
have to be popularized. Ensure 7-8 hours of sleep and limit the screen time.
Practicing 108 is a good Mantra for Success
1 hour – Exercise,
0 – Junk Food on 5-6 days/week and
8 hours – Sleep.
5
A Ten-point Agenda for healthy eating, giving due importance
to the first 1000 days of life - 9 months in utero to + 24 months,
till the second birthday is given below.
1. Adolescent & Pre-pregnancy Achieve minimum 45 Kg weight &
Nutrition 145 cm height with enough calcium
Ensure better quality and and iron stores.
quantity food to Adolescent Ensure weekly Iron and folic acid
Girls & Prospective Mothers and (IFA) tablets and Calcium.
micronutrient supplementation. Provide folic acid (FA) prior to
consumption in all planned
pregnancies.
2. Maternal & In-utero Nutrition Community kitchen/ Take home
Ensure one extra meal to the rations exclusively for this group,
mother during pregnancy in vulnerable communities.
and lactation. Give nutritional Periconceptional Folic Acid, (1 mg/
supplements like iron, folic acid day), starting at least 1month prior
and calcium. to conception to be continued and
followed by Iron and Folic acid tablets
(Iron 60 mg & Folic acid 0.5 mg).
Calcium (500 mg) tablets for 180
days during pregnancy, starting from
14 weeks of gestation and without
stopping it has to be continued for
180 days during early lactation period.
3. Young Infant Nutrition Implement the strategy - BIG
Ensure initiation of breastfeeding “BIG - Breastfeeding,
soon after birth, within an hour, Immunization, Growth monitoring”
followed by exclusive responsive Achieve minimum 1 Kg weight gain
feeding, minimum 8 times during by 6 weeks of age, Doubling of birth
the 1st 6 months of age and weight by 4-5 months of age.
continued breastfeeding till 2
Give vitamin D drops 400 IU/ day
years of age and beyond.
to all postnatal babies and other
micronutrients as per need.
6
4. Complementary feeding Implement the strategy - BIG
Ensure semisolids on completion “BIG - Breastfeeding,
of 6 months, belonging to Immunization, Growth monitoring”
different food groups, adding Achieve tripling of birth weight before
one by one, after 6 months one year of age (around 10 Kg).
of age, along with continued
Continue Iron and Folic acid and
breastfeeding.
vitamin D Supplements.
Biweekly IFA is advised to all children
between 6 months of age to 5 years
of age ( under the Lifecycle approach
of Anemia Mukt Bharat.
5. Toddler’s Family pot feeding Implement the strategy - BIG
(Kitchen based feeds) “BIG - Breastfeeding,
Empower for family-pot feeding Immunization, Growth monitoring”
by one year of age. Ensure age- “Quadrupling of birth weight by 2
appropriate food from the family years of age.
pot and continued breastfeeding
Ensure minimum
till 2 years of age and beyond.
5 food groups,
5 colors,
5 times a day
6. Under-five feeding with Ensure a ‘safety net’ by way of food
Safety net. supplementation, group eating/take
Ensure Rainbow diet with home rations and small frequent
strategies for bridging energy, feeds using the ‘Akshayapatra’
protein, and micronutrient gaps. concept.
Ensure the rainbow diet colors; Akshayapatra is a vessel, which is
GYOR- green, yellow, orange, red never empty. Having a ‘Kid’s food
- vegetables and fruits, Brown- corner’ (KFC) is another alternative,
whole grains, Purple- protein so that child can point to food, when
sources like pulses, nuts, and he/she wants.
non-veg items and White- milk Ensure liberal fibre in food and at
and milk products. least 6-8 glasses of water to prevent
constipation.
7
7. School age & Adolescent Time management, discipline
Nutrition in lifestyle like getting up on
Ensure Balanced Rainbow time, personal hygiene, avoiding
diet with all food groups with constipation, taking Breakfast, liberal
emphasis on not missing fiber in diet and 8-10 glasses of water.
breakfast and mid-day meal. Mid-day meal program to be
continued as take-home rations.
8. Micronutrient and Implement Rainbow Revolution-
Antioxidants Sufficiency Kitchen Garden, terrace farming, group
Ensure a Balanced Rainbow diet farming- cultivating and consuming-
including dietary diversity, food colored vegetables and fruits.
fortification & specific nutrient Rainbow diet with 7 colors and 7
supplementation. Ensure supply food groups; GYOR- Green Yellow
of IFA, Vitamin A, Zinc to the Orange Red for Vegetables, Fruits
beneficiaries as the National and antioxidants, B- Brown for Whole
programmes. grains Multi-grains, Roots and Tubers
as energy source, P-Purple for pulses,
nuts and non-veg for protein rich
food, and W-White for Milk products
9. Diet during Illness Recoup lost weight & achieve catch
Ensure one extra easily digestible up growth after illness
& nutrient rich diet during
convalescence from any disease,
for at least 2 weeks or lost
weight is regained.
10. Non- Nutritional Monitor weight and height at home,
Interventions observe developmental milestone
Ensure Social support, with developmental observation
developmental stimulation, charts, Implement WASH- water,
Food hygiene, hand washing, sanitation and hygiene practices,
periodic deworming, Healthy undertake BCC- behavioral change
eating practices, Physical activity, communications, Family, and group
Limited non-academic screen exercise programs to suit all ages,
time with parental involvement. empowering to read food labels and
Optimize academic screen time. making available healthy food choices
in the schools and in the food outlets.
8
Fever in children during covid times
FAQs
Dr. Janani Sankar DNB, PhD, MNAMS
Senior Consultant
Kanchi Kamakoti CHILDS Trust Hospital, Chennai
IAPCCB President 2019
CIAP EB Member 2021
The COVID pandemic in the last one and half years has led to panic among
parents whenever their child is down with fever.
I have tried to answer a few queries which are commonly asked by parents of
children with fever.
1. Is the fever due to COVID different from other fevers?
SARS COV2 is a virus like any other virus and fever due to COVID is like any
other viral illness. So we cant differentiate the illness with just fever alone.
All that glitters are not gold and all fever is not COVID but we need to be
watchful as the pandemic is not yet over for us.
2. When should I bring my child to the doctor when he has fever?
Parents should bring the child to the hospital when the child has following
symptoms
9
• Fever has been high grade (>101F) for more than 2-3 days
• Refusing to feed
• Unusual drowsiness
• Reduced Urine Output
• Vomiting
• Abdominal pain
3. How do I treat the fever at home?
• easure the temperature using a digital thermometer. keep it in armpit
M
for minimum 2 minutes or till you hear the beep sound.
• If the temperature recorded is more than 100.4 F give paracetamol in
the prescribed dosage.
• The dose should be repeated again only after 4-6 hours.
• Avoid substituting drops for syrup (common mistake leading to
hospitalization of children).
• Avoid Mefenamic acid containing syrups.
4. What should be the diet that should be given when the child has fever?
• Child can be given the normal diet.
• Give plenty of liquids.
• Avoid spicy food.
5. If the parents are COVID positive what precautions should we take for
the child?
• If parents are positive child need not be tested when they have no
symptoms.
• Child can be kept at home along with the parents.
• Parents have to wear masks and use hand sanitizers.
• Avoid close contact with the child.
• If the child develops fever he or she should be taken to the hospital and
needed testing to be done.
• Do not send the child to grandparents or other relatives houses.
6. What if my child becomes COVID +?
COVID illness is usually very mild in children. Symptomatic treatment with
paracetamol is more than sufficient. But follow your Pediatrician’s advice in
management.
107. W
hat special precautions should
I take if my child is on regular
medications for a chronic
illness?
Every chronic illness has its own
issues and morbidity risk pattern
(complications arising due to the
illness) based on the nature of
the chronic illness. If your child
is on regular medications report
immediately to your treating doctor
in case of fever or any unusual
symptoms.
8.
What are the general measures to be followed to prevent COVID
infection in children?
As vaccines are not available for children less than 18 years of age at this stage,
adopting the following suggestions will help in prevention.
• All adults above the age of 18 years should get vaccinated.
• Follow strict hand hygiene.
• Avoid close contact with positive adults at home.
• If close contact cannot be avoided with positive adults insist on proper
use of mask for adult and the child.
9. Is breast feeding allowed if the mother is COVID positive?
Yes, Mother can continue to breast feed even if she tests positive. She needs
to follow the protocols strictly – Hand Hygiene and wearing of mask during
breast feeding.
10. Is it true that the third wave will affect children more than adults?
It is just hypothetical that the third wave may affect children as they are only
ones who are not vaccinated. However, the infection is still mild in children and
the spread to children can be prevented if the adults are vaccinated.
11Safe Pregnancy during Pandemic
(Antenatal visits and Vaccination)
Dr. Ramya Kabilan MD (Obs & Gynec).,Dip.Lap
Consultant Gynaecologist and
Laparoscopic Surgeon
What are the symptoms of COVID-19
in a pregnant women ?
Roughly two-thirds of pregnant women
with COVID-19 have no symptoms at all,
and most pregnant women who do have
symptoms only have mild cold or flu-like
symptoms. Pregnant women who catch
COVID-19 are at slightly increased risk
of becoming severely unwell compared
to non-pregnant women, particularly in
the third trimester.
In this pandemic period is there a
need for pregnant women to be extra
cautious than others ?
No, studies show that pregnant women
are at the same level of risk for COVID 19 infection like any other healthy
adults, but they are at slightly increased risk of becoming severely unwell if
they do catch COVID-19. And are more likely to have pregnancy complications
like preterm birth or stillbirth.
Do I need to restrict the visitors coming to meet me for greeting or a
casual visit ?
Yes, Pregnant women who have not received two doses of vaccine should limit
the contacts with people from outside especially if they have not completed
their two doses of vaccine. These measures are to prevent getting infected
with COVID 19 virus especially during the last 3 months of pregnancy period.
12How to plan my visit to obstetrician for regular antenatal health checkup
during this pandemic ?
You need to attend routine antenatal care, but to a minimum, as per your
doctor’s suggestion may be at 12, 20, 28 and 36 weeks of gestation, unless
you need to quarantine yourself for covid symptoms.
How do I plan my antenatal checkup if any one of my family member get
COVID infection ?
If someone in your household has possible symptoms of COVID – 19 or
confirmed infection please self-quarantine yourself and delay your visit for 14
days.
What is your main advice for a safe pregnancy?
I would suggest rule of 5 S to be followed for safe pregnancy
1) Stay at home but keep yourself mobile and drink adequate water to
reduce the risk of blood clots in pregnancy.
2) Stay active with regular exercise.
3) Supplements of Folic acid, vitamin D and other vitamins along with a
healthy balanced diet to help support a healthy pregnancy.
4) Social distance, Hand hygiene, social distance and mask like any other
individual to be followed strictly
5) Scan in time - Attend all of your pregnancy scans and antenatal
appointments unless you are advised not to do by your doctor.
Contact your maternity team if you have concerns about the wellbeing of
yourself or your unborn baby.
Does a pregnant woman has to take any special diet to prevent COVID-19
infection?
No special diet has been proven to have any preventive effect against COVID
– 19 infection.
Does COVID-19 virus infection during pregnancy affect the fetus ?
As per the ICMR (Indian Council of Medical Research) there are currently no
data suggesting an increased risk of miscarriage or early pregnancy loss in
relation to COVID-19.
There is no evidence currently that the virus has killing effect on the unborn baby
but we need to wait for long term data for this and about 95% of newborns born
to COVID 19 positive mothers have been in good condition at birth. However,
13Covid-19 in pregnancy increases the chances of preterm birth, which in turn
may increase the possibility of hospitalization for the neonate.
There is emerging evidence from immunological assessment that in-utero
transplacental infection to the fetus ( mother to unborn baby ) may occur but
so far the effects on the newborn babies are very minimal.
There are discussions on the time of vaccination, whether to take the
vaccine at the early pregnancy or at a point closer to the delivery date. Is
there a specific time ?
Covid 19 vaccine can be taken at anytime during pregnancy. The earlier the
vaccine lesser is the risk of complications.
Your advise on vaccination for covid infected pregnant women ?
In case a woman has been infected in current pregnancy, she should be
vaccinated soon after delivery.
Which CVOID vaccine is best for pregnant woman?
Any vaccine is good to have. All available vaccines are considered to be equally
safe and effective.
What are the general guidelines for covid positive pregnant women ?
The main symptoms of covid 19 are high temperature, new/continuous cough,
loss of smell and taste. If you have any of these symptoms consult with your
doctor and get tested.
Asymptomatic covid patients must follow strict home quarantine for two weeks
from the date of test positive, eat a balanced diet, be in a well ventilated room,
stay mobile, take vitamin D supplementation along with the recommended
medicines, consider online fitness routine such as pregnancy yoga, monitor
temperature and oxygen levels. If o2 falls below 94 % then report to your
treating doctor immediately.
14Covid and Teen Psychology
Dr. R. Venkateswaran MD FICAP (CMC, Vellore)
Consultant Child and
Adolescent Psychiatrist
What is the impact?
Covid 19 pandemic is causing a huge impact on mental health of adolescents
worldwide. Preliminary evidence from China shows that the rate of depression,
anxiety and post-traumatic stress disorder among teenagers is 43.7%, 37.4%
& 10% respectively. There has been an increase in mental health problems
from 20% to 39% after pandemic. There is paucity of data on teen violence,
relationship problems, internet gaming disorders and developmental problems.
Who is vulnerable?
Teenagers with pre-existing mental health problems including depression/
anxiety or evolving personality disorders and those with background
developmental disorders like Autism, ADHD and Learning disability were likely
to have mental health concerns during the pandemic.
Any pandemic like the COVID-19 can influence the mental health of the
teenagers in multiple ways as described below.
1. Adjustment to the current pandemic/lockdown: As they are used
to a very rewarding life style in the form of peer interaction, sports
and other activities; them being restricted to home environment can
result in stress. This can lead to negative coping like increased eating
or increase in use of gadgets. It is also results in behavioral changes
like aggression and deliberate self-harm. However, this is not pervasive
and depends on environment. These symptoms improve as the overall
situation improves.
2. Chronic stress secondary to the pandemic or severe acute stress
from the loss of loved ones can cause clinical psychiatric conditions
like depression, anxiety, post-traumatic stress disorder. In these cases,
symptoms are more severe, more pervasive, and can cause more
dysfunction if not properly identified and intervened.
153. Covid infection itself can cause neuropsychiatric manifestations which
may be abrupt and severe.
How to cope?
Improving emotional intelligence helps in better coping.
1. Self-awareness: This can be improved by educating teens to be mindful
about their emotional states by regular self-feedback. It should also
be emphasized that it is completely normal to experience negative
emotions (“feel the emotions”). They will be able to develop a sense of
control by being aware of their emotions.
2. elf-regulation: They should be trained to use proper ways to regulate
S
their negative emotions (like abdominal breathing, mindfulness
meditation, positive visual imagery and physical activity) so as to avoid
negative coping (eating, gadget use) and interpersonal problems,
which may in turn worsen their mood, resulting in a vicious cycle.
3.
Problem solving: It’s very helpful to divide the problem into two
categories: things they can do something about, and then things they
cannot do anything. They can develop the habit of listing out different
problems and find pros and cons of each.
4.
They should also develop interpersonal skills and verbalizing their
frustration should be encourage rather than reacting to it.
Parents should develop the habit of acknowledging teens feeling rather than
underplaying it or criticising them. They should understand that teens are in
toughest phase of their life in once in a life time crisis period.
16A chat with your Pediatric dentist
Dr. Roshan Rayen, MDS, FICCDE (USA)
Senior consultant Paediatric dentist
Director, RAYEN DENTAL CARE CENTRE
Joint Director, KIDZ N TEENZ Health care
Parental conversation
with front desk:
Can I have an online
consultation for my
four year old child with
Pediatric dentist?
Front desk:
Yes of course madam
definitely it is possible,
but you need to share
a few pictures of your
child’s teeth and mouth
before the online consultation and the consultation is for twenty minutes. If it
is a second opinion and you have taken X rays if any please do share that also
through whatsapp
Online consultation is fixed by the front desk with the Pediatric dentist through
whatsapp audio/video call or a conference call with the parent, front desk and
Pediatric dentist
Consultation starts:
My child is four year old and has multiple cavities in his teeth? I have been
postponing the dental treatment due to the covid pandemic? Can we go ahead
with the dental treatment for my son?
Doctor:
Yes definitely possible. in the dental office we strictly follow all the sanitisation
and covid sterilisation protocols as recommended by the WHO (world health
organisation guidelines)
............................................................................................................................
17Parent:
Can you please elaborate a few of them?
Doctor:
1. Appointments are spaced out comfortably for each patient with lot of
buffer time between each family
2. Fresh disposables and drapes given for each child and accompanying
parent
3. UV light disinfection of each dental operatory for 15 minutes between
each appointment
4. HEPA air filter running continuously for viral disinfection and air
purification
5. Open to atmosphere ventilation between each session of 3-4
appointments
6. Rubber dam usage in the child’s mouth to avoid aerosols going inside
the child’s mouth
7. Apart from this we also do regular sterilisation and disinfection of our
dental instruments so you can feel pretty safe to come and have your
dental treatment carried out safely and comfortably at our dental clinic
............................................................................................................................
Parent:
octor, big thanks for the very neat and simple explanation given to me. Now
D
I feel safe to bring my child to dental clinic
Do I need to do RT-PCR test before the dental appointment
Doctor:
Good question madam
According to WHO guidelines for any dental procedures performed in a dental
clinic it is not necessary. But if it done in a hospital based set up, it is mandatory
to have a RT-PCR done two days before the dental surgery is planned as most
of the dental procedures under general anaesthesia are pre planned. Hope this
helps madam
............................................................................................................................
Parent:
Is there a change in treatment plan pertaining to pandemic situation?
Doctor:
Definitely not, whatever method we used to do dental treatment before is
what we do now also with more added safety measures for the doctor, the
child and the assisting dental nurses
............................................................................................................................
18Parent:
Any extra medicines given for my child during this time?
Doctor:
There is no added precautionary or preventive medicines given during or after
the dental treatment, only regular medicines needed for that dental problem is
prescribed. But we ensure that the child or the accompanying parent does not
have a cold or cough during the appointment
............................................................................................................................
Parent:
Can I postpone the dental treatment to later date in case my financial situation
does not allow me to carry the dental work as per your recommendation?
Doctor:
Yes, definitely possible in this kind of tough time. We apply SDF (silver diamine
fluoride and fluoride varnish) to arrest the decay process by 70-80% so that
the child becomes symptomatically better and we can postpone the treatment
by 6-12 months with periodic follow up in place. The only disadvantage is the
blackish discoloration of the cavity affected teeth.
............................................................................................................................
Parent:
Thanks a lot doctor for this wonderful piece of information. I will see you soon
in person for my child.
Doctor:
Most welcome madam.
19On-line Classes-Rewards, Regrets,
Revelations and Remedies
V Padma
Principal
D A V Girls Senior Secondary School,
Gopalapuram, Chennai - 86
When schools closed on 24th March, good in the beginning, with the
2020, it was the fag end of the death rate being low and number of
academic year 2019-20. The year infections raising at a slow pace.
was over for class X, with all board
examinations completed for CBSE But, very soon we realized
students. The class XII had a few that things were not going to be
examinations pending. the same for a very long time now.
Slowly it dawned on us that we were
It was a new experience, not going to meet children in school
with lock downs announced and all to complete the assessment process
of us going into the confines of our for the year. Children rejoiced at
homes, puzzled about what was being promoted without going
happening, not knowing what to do, through the chore of preparation
searching for masks and sanitizers, for an examination or the anxiety of
hoarding everyday requirements and waiting for results.
what not. Mothers loved the time
they had with the little ones bringing As days went by, when the
out their culinary skills, family time anxiety and scare did not come
was enjoyed, we could understand down, when we saw the world
each other better etc., etc., etc., reeling under a new threat, we
understood that we are not going
For professionals, except the to have children in school for their
health care professionals, it was a academic transactions. Thus began
welcome break. We enjoyed staying the preparation for online classes.
at home, enjoyed less of driving, We experimented with classes X
hence less polluted city, better air to and XII and slowly moved on to the
breathe, more time for hobbies rather other classes also. It was a novel
than the mundane routine of running experience for all, teachers and
to work place. It indeed looked very students alike.
20We were overjoyed when also realized that though the child
children could become our teachers had logged into the class, he/she was
when it came to technology. We not present in front of the system
worked on our curricular plan keeping attending classes. The joy that we
in mind the new normal, lesser felt, when children were better than
working hours, different teaching us technologically, became a regret.
methodologies, learning technology We found that eliciting an answer
and what not. The novel experience from them was the toughest of the
kept us in good stead for some tasks. Older the children, tougher
time. Children enjoyed their time, was it to make them communicate
they were happy that they need not with us. They were reluctant to
be in uniform, they need not rush to answer questions, share what they
school, they need not wake up early felt and learn what they need to learn.
in the morning, they could spend
more time with their siblings. The novelty of watching the teacher
handling a large number of children
Teachers entered the waned.
students’ homes virtually due to
online classes. Initially, the parents Some parents started commenting
were thrilled at watching their ward and passing judgements against the
being taught. They were appreciative teachers in the class, when the class
of what was happening in the class. was on. It was quite embarrassing
for the teachers to handle the
As time passed by, we situation. Some parents felt that their
realized that children had lost their ward should be heard and be given a
routine, which is very important for chance to participate individually in
them. We, teachers understood that the class every period.
the influence that we had on our
students had become very less. We The working hours of the school
found it difficult to make them switch was very less, the content was also
on their cameras, to speak to us. We reduced as per the guidelines of the
board. However, the teachers could
21not have the attention of the students the communication channels open.
even when they were in class. We Listening is the most important
could not make them do any written part of communication. A non-
work or monitor their learning at judgemental listening, without an
home. Parents became unhappy intent to answer/argue should be
and frustrated, when assessments adopted by parents. A kind ear will
were planned. We had a tough do a lot of good to the speaker. It will
time explaining to the parents that help the listener pick up problems
we wanted to assess the level of empathetically as and when
understanding of the children and they arise and help them at the
not whether the parents have taught appropriate moment. Accept that
them or not. children need a routine to follow to
grow up into responsible, productive
As parents and teachers, we need adults. Irrespective of whether the
to understand that we need to adapt classes are online/offline, guide
to this kind of teaching and learning them for a healthy routine, by you
in future. Even when we reopen following it.
schools offline, we may, at least for
a few days/months/years, go back Let us understand that academic
and forth and have a hybrid model of learning is an important part of
education. childhood experiences. Allow the
children to learn, understand by
Hence, we need to find ways and himself/herself. They have the
means of coping with it and making privilege of learning from mistakes.
the best out of what is available. Kindly do not take their lack of
While the school on its part, is ready performance as your weakness.
to hand-hold with the child in matters Assessments are an important part
of any facet of child development, of learning. Being fair, honest and
we request the cooperation of the sincere in assessments and following
parents too. rules and regulations, is important to
Now the situation is such that, understand morality and values.
the parents have a good influence We, parents and teachers have a
over the children. Teachers have great responsibility of making the
no influence what so ever, as the future of the nation and the world.
interaction between the students No small task, but a pleasurable task
and the teachers have become very and a very important task in it. Let us
less. So, we request the parents to work as a team to help our students
be friendly parents and not friends. grow into individuals and members
A friend cannot set boundaries or of the society about whom all of
lay rules of conduct and etiquette. A us are going to be happy about and
parent can and should. Please keep proud of.
22Telehealth for Developmental issues
(A new experience in Pandemic)
Dr. Gita Srikanth
BCBA (Board Certified Behavior Analyst)
MA in ABA (Ball State University, USA)
Founder Chairperson: We CAN
Co-founder: ProACT LLP
The years 2020 and 2021 have been defining in many ways and have changed
our perception of life significantly. The pandemic pushed us to reinvent our
social and professional interactions and changed our mindset on how this was
possible. If anyone had suggested telehealth for early intervention for children
with autism a few years back, then the response would have a resounding “no”.
But here we are 18 months into the pandemic, reinventing intervention online.
One of the objectives of behavior analytic intervention, is to work closely with
the family of the child with autism, to align goals and expectations with them
and to make them an integral part of the intervention program. Though parent
training and home goals were always part of the programs, telehealth has moved
parents into the zone of primary therapist. This is especially true when the child
is very young and has received a diagnosis in the last 18 months. Parents had to
take on the role and many of them have slipped seamlessly into it.
At We CAN, the process of telehealth intervention begins with a few sessions
with the family on understanding autism, some basic behavior principles like
reinforcement, the beginnings of communication, imitation and play. The
Behavior Skills Training (BST) approach is used to ease the family into the role
of therapist. Concurrently, the family is primed to observe the child for what
may function as motivators for him, what does he prefer to do when he is free
and what may be relevant goals for the child, based on the training sessions.
Of course, telehealth also means that certain teaching goals are harder to
implement, and we have rearranged priorities based on this.
Parents may opt for live sessions where the behavior analyst is watching the
session synchronously and giving inputs to the parent or they may opt to record
the sessions that can be viewed with them for inputs later. The goals are clearly
defined, the parent is equipped to run the given program and capture data, the
time and duration of the sessions are fixed, making the process efficient and
productive.
23Some of the takeaways for us of telehealth intervention:
1.
Telehealth keeps the family connected to and involved with the
intervention process.
2. Families get a richer understanding of the skills and deficits of the child.
3. The intervention is provided in the most natural environment making
learning contextual and practical.
4. Self-help goals can be incorporated effectively into teaching goals since
home is where these skills can be practiced.
5.
Families can receive access to evidence-based services no matter
where they live, at a time that is convenient for them.
6. Educational background/language is not a barrier to parents. Everyone
can empower themselves to be effective trainers for their children.
7. Telehealth has made us as interventionists, more sensitive to the needs
of the family and more accepting of the challenges they face and of
their emotional states.
In many ways, telehealth and online services can never replace the intensity
of in-person services or the subtle behavioral observations that can be made
while directly working with a child. But it is certainly a workable model in a
country like ours where there are not enough quality services available.
A World of Difference:
The ultimate autism
handbook for mindful
parenting
The book is an attempt to make
parenting a child with autism a
journey that is one of learning, joy
and mindfulness while using evidence
based practices.
The book is available on Amazon
India, UK, USA, Singapore and
Australia. It can also be sourced from
Flipkart and ebook readers.
24COVID and Breast feeding
Indian Academy of Pediatrics – Chennai City Branch :
Breastfeeding awareness message
Theme 2021
Protect Breastfeeding: A shared responsibility
• Breastmilk is the most essential liquid for infant’s survival, nutrition and
development.
• Continuing the breastfeeding is the best way during this COVID Pandemic.
• Continue Breastfeeding without fear during COVID pandemic but follow
the rules of 3Ws
o Wear a mask during feeding,
o Wash hands with soap before and after touching the baby,
o Wipe and disinfect surfaces regularly.
• Are you COVID positive with mild symptoms – Continue breastfeeding
because the antibodies for the virus will be released to your baby through
breastmilk. So, your baby is safe.
• Are you sick due to COVID infection – if you are able to express milk and
ask a non-infected member to feed the baby using a clean paladai or cup
and spoon.
• Are you very sick due to COVID infection – get your doctors advice for other
feeding methods but never forget the rule of 3 Ws.
• If you are positive for COVID and your baby is negative for COVID maintain
a distance of 6 feet between your beds and follow the rules of 3Ws. But
never stop Breastfeeding. Use medical mask than a cloth mask.
• Vaccination for breastfeeding woman is recommended. Take vaccine
without any fear.
Indian Academy of Pediatrics strongly recommends the continuing of
Breastfeeding during the pandemic whether you are infected or not.
_____________________________________________________________________
Awareness message compiled by Dr. P. Sudhakar. MD(Ped).PGD- DN
_____________________________________________________________________
Dr. K. Venkatesh Dr. P. Sudhakar
President- IAP CCB Secretary - IAP CCB
25KIDDY’S Corner
Hai friends,
I am WINTER (it is not my real name). Happy to share with you all that I am
going to be the editor of the KIDDY’S Corner section of this monthly Magazine
theChild dr.
Friends I feel it will be good to discuss our health problems from our own
perspective. If we discuss our problems openly it will definitely help us to get
help from our parents and experts.
Pls share your health queries and suggestions to me without any hesitation
and I will get the appropriate replies after getting the answers from experts in
the respective field.
My special thanks to my cousins Mel and Shel for modelling to this my maiden
write up.
Kids please don’t forget to give your support as well as feedbacks for my effort.
Yours loving
WINTER
26Food for Eyes
We all know that we are sitting in front of desktop or tabs for attending online
classes for many hours for the past 2 years and this may affect our vision (of
course our parents keep on remind us the rules of screen time only when
we play with mobiles ). Jokes apart it’s very unfortunate that we children are
suffering a lot of issues due to increased screen time that too for studying
purpose.
We all know that recently the number of vision problems in children are on the
rise. I have heard that researches done on vision problems in children states
that every class room will have 2 to 4 children with spectacles. So, we need to
be alert about these vision problems and the ways to prevent it.
Vision problems are easily preventable or at least kept in control by following
3 rules
1) Right food.
2) Bright light.
3) Less Screen time.
In this edition I am going to discuss the healthy food habits to keep our vision
sharp.
Our eyes have many important structures like
• Cornea(the transparent layer forming the front of the eye.)
• Lens (it focuses the light rays that pass through it (and onto the retina)
in order to create clear images of objects that are positioned at various
distances)
• Retina (a layer at the back of the eyeball containing cells that are sensitive
to light and send signals to the brain, where a visual image is formed)
and many more.
So like other organs eyes also need proper nutrition for a proper function.
27I am surprised to learn a lot that our eyes need lot of nutrients to keep itself
healthy which includes Vitamin A, C, E, Zn and Omega fatty acids in a major
way and Vitamin B complex in a minor way. Yes, without eyes we can’t see the
beauty of this world. So our eyes deserve the right nutrition for various functions
like cell function, cell life, stability of the screen and pigment formations.
Now we will look at what kind of vegetables, fruits and food we should take
regularly to save our vision.
So first let us see the vitamin rich vegetables and fruits.
While googling I came to know that all fruits and vegetables may contain all
vitamins, only the proportion varies. So, we will discuss the major components
only here in this small write up.
Vitamin A :
Fruits : Orange, Papaya, Mango
Vegetables : Carrots, Pumpkins, Dark green leafy vegetables (amaranth,
spinach), Sweet potatoes., and Tomatoes
Food : Cod liver oil, Milk, Butter Egg and Liver,
Vitamin C :
Fruits : Indian gooseberry Orange, Lemon, Kiwi, Strawberries
Vegetables : Tomatoes, Green leafy vegetables, Potato, Tomatoes, green and
red pepper
Food : cod liver oil, Milk, Butter Egg and Liver,
Vitamin E
Fruits : Avocado,
Vegetables : Green leafy vegetables, Sunflower seeds
Nuts : Almonds and peanuts
Oils : Sunflower, Saffola and Soybean Oil
Zinc
Nuts : all nuts
Nonvegetarian food : crab, loyster, meat
Food : pulses, whole grains
Omega 3 fatty acid
Fish : salmon (kaala fish), mackerel (kilangan fish), tuna (Churai fish) and
sardines (mathi fish)
Nuts & seeds : flaxseed, chia seeds, and walnuts)
Plant oils : such as flaxseed oil, soybean oil, and canola oil
28Finally we all eat ready to eat cereals often. So, whenever you eat them please
check with your own eyes whether it has all these vitamins to keep your eyes
healthy.
So friends, to protect our vision we need to have a plate full of vegetables,
fruits, egg, milk and nuts on a daily basis and fish two days in a week.
Here I am offering my suggestion for your daily food plate for your eyes
29Smilestones Child Development Centre
#35, Puliyur 2nd Main Road, Trustpuram,
Kodambakkam, Chennai - 600 024.
Ph: 044 - 4854 3948, 94450 51166 / 83002 30491
Email: smilestoneschennai@gmail.com
www.smilestonescdc.com
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