Shivam Hospital

Hi,

I am Dr. Suresh Keshan, Pediatrician. Today I will be talking on vaccinations as a modality of prevention for childhood diseases. I will address the common concerns the parents have regarding the vaccinations. One of the things parents ask, are the vaccines really effective? Are they really prevent diseases? The answer to this the evidence-based medicines which show medicines have reduced the disease burden in the society a lot. 10 years ago, we use to see a lot of cases of polio mellitus. And people who are working on this with paralysis. Now, with the medications, polio has been eradicated. And hardly, we are seeing any child who is affected due to polio. Similarly, if you see the cases which are pertaining to infectious diseases like measles etc, also decreased a lot. That is the reason, vaccines are must for prevention. The problem is there are a lot of charts are available for vaccines. Each and every hospital has got its own chart. Parents are a little bit confused about the exact list of vaccination. This list is definitely available on the website. But that doesn't mean that one vaccination is mentioned on one chart but not on another one, so you will not go for that vaccine. So, it has to be discussed with your doctor. Some of the parents have a complaint, in spite of the vaccination, their child has got the disease. For eg, the child is vaccinated for typhoid and later on, the child got the same. So, the vaccines are not 100% efficacy. So, the preventive rate of efficacy differs.

This education should be given by doctor to the parent. Because once the organism is there in the body, but the disease has not yet come is known as the incubation period of the disease. So, in that case, also parent may label the vaccine failure while actually, it is not a failure as organisms were already there in the body. Another thing that there is no cut off age for vaccines. Sometimes parents ask that my child has to get the vaccine within 1 year but now he is 2 years. so, should it be given or not. So, yes, the vaccine has to be given. All the vaccines have no cut off age. You can give the vaccine in adulthood also. And the age which is prescribed in the chart for eg 6 weeks then it is an indicative age. So, you can't give medicines before 6 weeks. Another thing I would like to highlight is pain or painless vaccines. Only one vaccine is there which has got pain or painless and i.e. DPT. So, what is the difference between the 2? The difference is not giving the vaccine. The vaccine is pricked and injection has to be given to the child. Injection needle will definitely give pain and discomfort to the child.

The side-effect can be fever, there maybe pain at the local side, redness, irritability. So, all these side-effects are not present in the painless variety. They are most likely going to happen in the pain variety or the one vaccine which is with the side-effect. There is a cost difference but we will talk about efficacy wise. So, all 3 doses cannot be painless. Now other thing parents feel about the brand of the vaccine. So, vaccines are interchangeable. So, if you get a vaccine for A brand and another doctor is giving B brand, it is perfectly OK. One thing parents need to ensure that the vaccines are made to prevent diseases. So, companies are not going to make vaccines of the illnesses which are mild or which are infrequent in nature. Vaccines are made to prevent a particular virus or bacteria. It will not prevent the disease or symptoms. For eg, diarrhea, now there is rotavirus to prevent. Similarly, you can say about polio. If I have given the vaccine for polio then my child will not get paralysis. But paralysis can happen because of so many causes. So, this concept has to be clear in the parent's mind.

Then parents will think that some vaccines are there which are compulsory or optional. I do not know where this concept has come. Vaccines are the prevention of disease. It is like an assurance. So, if you do not take the vaccine, your child is at risk. So, all the vaccines which are recommended are to be given. The problem is the cost part. For eg, one vaccine cost 4000/-. Because of economic thought, it becomes optional in a parent's mind. So, irrespective of the price, vaccines have to be given. Affordability is a separate thing. There are certain vaccines which have to be given in teenage and adulthood. These are flu vaccine which has to be administered yearly. If one is prone to any infection then the flu vaccine has to be given. Hepatitis-B, typhoid, chickenpox, cervical cancer vaccines have to be given. I hope I have answered day today query which we also face in our clinic when we vaccinate the child.

Now we will talk about some myths or misconceptions which are there in the parent's mind. Just want to educate the parents about fact and reality. One thing parents have them in mind that teething causes a lot of problems like diarrhea, fever. So, most of the parents think that teething is related to some or the other problem. Teething is a natural process. It may cause some irritation of the gums. Therefore, the child may feel irritation and start biting hard things in the mouth. But it is a benign given by nature. It does not lead to any fever or infection. Because the child starts biting a lot of things and that is the reason infection goes inside the child's mouth and may result in diarrhea. Another myth is drinking cool things like juices, cold water, these kinds of things actually cause infection, therefore, these should be avoided. Infections are caused by viruses or bacteria. Some parents think ki curd thandi hai and bacha bimar ho sakta hai, so there is nothing of that sort. Whatever things the child loves, can be given to the child. For diarrhea, most of the parents think that milk is the culprit.

Therefore, they tend to avoid milk. Obviously, there is no rationale for holding milk from a child who is suffering from diarrhea. There is no evidence behind this thing. If diarrhea lasts for 5-7 days then maybe lactose intolerance may occur. So, after certain tests, milk can be avoided. Parents also complain about the liver. A healthy liver means a healthy body. But if parents are thinking that all the problems are happening because of the liver then it is not like that. In the vast majority of cases, the liver is perfectly healthy. So, there is no concern related to loss of weight, poor eating. Liver infections are not that common. In case it occurs, they will cause, nausea, vomiting, yellow colored urine. And parents also think that some liver tonic has to be given. It doesn't make any sense to give liver tonic. Another concern parents think that the child's immunity is low because my child is having a frequent cold and cough.

What should be done to boost immunity? The immunity of any child is healthy. There is nothing wrong with child immunity. There are very rare chances when immunodeficiency is there in the child or the child is severely malnourished. That particular time, the immune system may be compromised. So, decreased immunity is not the correct way of thinking. Infection does occur in the child because they get to expose to so many things. And they get multiple infections but this is very much normal for a child. Another thing which we see that kids are more prone to bronchitis which means they are having recurrent cough without any fever. There may be wheezing in the chest also. This has to be blamed on our lifestyle partially and the environmental changes which occur. The children are prone to allergies. So, in result, the child can have recurrent cough and cold.

The last point I will talk about is allergies. With the change in the lifestyle, the incidences have gone up. Therefore, the child has got a skin allergy. There is hardly any food substance which is causing allergy. Because of this, a lot of other tests are coming into the market today. Quite a few of them are commercial. Ultimately the results which are coming out, they have positive and negative results. So, there may be the substances which are not causing allergies or may turn out to be positive in the test. Or the substance which is actually causing the problem may turn out negative into that. Allergy testing by and large do not need the expectation of the parents which is there. It is better to have a clinical association between the allergen and the symptom. So, if you eliminate the allergen, then the symptom should go away. Thank you all for listening to this video. I really hope this will be helpful to all of you.

Thanks!

Hi, I am Dr. Suresh Keshan, Pediatrician. Today I will be speaking on general childcare and the things which parents mostly have questions about while they visit our clinic. It will not be a technical medical session but informative session which will inform the parents about the common anxiety questions that parents have theirs in mind. The first and foremost I want to tell all the parents that natural love and affection that you give to your child is priceless and precious and nothing can substitute that. Today in the digital world, a lot of literature is available because of which parents are a little bit confused that what should they to for child upbringing. The main thing they need to remember is as long as there is love and affection from the parents for the child and family atmosphere is loving and caring, the child care can never go wrong. So, they don't have to put extra efforts, no need to read a lot rather whatever comes naturally to them is the best care for the child. I am now talking about the pregnancy and birth of the child. The thing which faces is an inclination towards a baby boy of the parents. It can be because of the culture present in India. Now in the modern era, the female child is also getting acceptance in India. Mindset is getting change in India over a period of time.

The main thing I want to tell you that the gender of the child totally depends upon the father. Because he is the one who passes the chromosome that is Y and X which determines the gender of the child. Mother just take care of the child in the womb. Another common problem which parents face when the child is born, they feel it is very gentle, fragile, delicate. The newborn is very strong, its defense mechanism is very well developed. So, the parents should never have the anxiety in the mind that the newborn is delicate or require some special care or requires to be kept away from infections and to be kept in a sterile place. We just need to follow the normal hygienic rules. Breast milk is the thing which is encouraged so that the baby can get the optimal nutrition from the mother and it also helps the baby in building immunity. Once the baby is born, the next step is vaccinations. In India, vaccination acceptance has become very good. The parents themselves come and ask about the various vaccinations. In India, we have hardly seen the cases of measles, chickenpox, tetanus and this is happening because of the success of vaccination. So, we advise the parents to go to the Dr and get the child vaccinated. Parents often ask about like my kid is of 5 years and the vaccination is for 2 years old kid, so is my child can take this vaccination or not. There is no cut off for the vaccination. At any age, you can give the vaccination. Now I will speak on parental expectations from the child. In this competitive world, parents think that their child should always be on top. The child should excel in every activity.

So, they need to see that these expectations are realistic in nature and does not put unnecessary pressure on the child to live upon the parent's expectations. So, just take the things at ease and let the child develop on its optimal potential. Another problem we face is working parents where both the parents are working. This mainly causes a lot of guilt in mother because as per our Indian culture a female should always look after the home and kids. So, they should not be much worried as the caretaker are always available for the child to take care of them. The caretaker can be from your home or you can hire someone from the outside. Studies have also shown if the mother is working, the child is no way hampering the mental, emotional and psychological development. In fact, it is proved that if the parents are working then the child is more autonomous, free, good in nature. independent and faster. Because this is how a kid learns to manage to do and learn the things themselves. Another common concern is the feeding of the child. So, what is homemade and you are giving to the child is best. The child should not be dependant on outside food. Homemade food always gives the best nutrition to the child.

The child will never suffer from any malnutrition or decrease in the immunity. The child will also not suffer from any growth factor lacking. So, whatever you are eating at home, are all balanced. Another problem we face in the clinic that parents say that their child is a poor eater. The child always refuses on taking anything. They think that the child is starving. 2 important things are there. 1st is that this thing is created by parents themselves by putting the pressure on the child to eat. Because if we see in villages, mothers are not much bothered about her child. They see that whatever they offer to the child, he eats. No complaint from any mother who is living in a village. But the mothers who all are living in urban areas, are complaining that her kid is not eating. Because the mother always pays a lot of attention to child eating. Another example, if you see that your child went to the neighbor's house or your friend's house, they will eat everything. But when he is in your home, he will not eat. So, the reason is that pressurized feeding makes it unenjoyable for kids. So, let the child enjoy the meal. Another concept is that what is the healthy weight and height. Parents feel that their kid is slim. In today's world, nutrition factors are a burning issue. The child should never be overweight. Because it may lead to obesity. They should see whether the child is healthy or not. Never compare your child with any other child. The common problem which parents feel about is a fever. Fever in a child is mostly viral in nature. Most of the fevers go in 3-5 days. Parents start monitoring the fever. So, don't be much worried and take the child to the Dr. All the fevers are benign in nature and nothing will happen to the child. Another problem parents often face is crying of the child. And parents are not able to understand what they need to do about.

The baby's sleep pattern is mot adaptive to the sleep pattern when he was inside the womb. During the pregnancy, the mother remains active in the daytime and because of this baby feels comfortable in the daytime. But in the night total opposite happens. And this is the only reason that the baby sleeps more in the daytime and less in the nighttime. Sleep patterns correct after 3 months of baby birth. Crying in the baby is mostly due to hunger which parents tend to recognize very fast or it can also be because of wet diapers. But one more thing happens when a baby cries for a prolonged period in the evening. This is a benign condition and may take 3-4 months to get corrected. So, at this time parent need to counsel themselves and this period will also pass soon. Another ques is how much a baby should sleep. A newborn baby should sleep for about 14-18 hours a day. Slowly and steadily it gets decreases. I will try to summarise the problems that parents are facing. The purpose is to solve the common problems of the parents and I hope you have enjoyed and gained information from this particular talk. Thank You!