Indraprastha Apollo Hospital (Only on Appointments)

Hello friends,

I am Dr. Lata Bhat. I am a child specialist and new-born consultant. See, I am especially trained to handle the problems of a new-born, today I am going to talk on a topic related to the new-born aur ye bahut hi common topic hai aur vo hai Jaundice in the newborn. What is jaundice? Jaundice is yellowing of the baby’s skin and eyes. Ye bahut hi common hai aur isliye hota hai kyuki babies mein bilirubin, jo ki ek peele colour ka pigment hota hai, vo bahut hi high ho jata hai due to break down of red blood cells. Agar ye jaundice bade bachcho mein ho ya adults mein ho, so the liver processes the bilirubin aur liver isko aise change kar deta hai taki ye intestine mein ja kar ke explicit ho jaye, body se remove ho jaaye. But a baby’s liver is not mature enough to remove the bilirubin. Lekin good news ye hai ki jo jaundice hai new born ka, in most cases, vo dheere dheere apne aap hi kam ho jata hai. Aam taur pe jaundice kya hota hai? Day 2 pe, Second day of life pe aata hai, dheere dheere badta hai and peak hota hai between 4 to 7 days of life aur uske baad ye kam hona shuru ho jata hai and it disappears within 2 to 3 weeks. So, agar ye jaundice three weeks ke baad bhi rahe, then you must contact your doctor and further investigations need to be done. Aur dusri baat ye dhyan rakhne wali hai ki agar ye jaundice high ho toh iski treatment jaruri hai kyuki it can affect baby’s brain and can cause long term problems such as deafness, physical disability or some other disability related to brain damage. Isliye jo humare professional bodies hai National Neonatology Forum of India aur American Academy of Kids, unhone ye recommendations diya hai ki har bachche ko ek baar at the time of discharge, examine kiya jaaye aur uske baad between 3 to 5 days again hume bachche ko dekhna chaiye.

So, ab hum baat karenge what are risk factors of developing higher level of jaundice in the newborn babies. First is premature babies, babies born before 37 weeks or babies who are not getting enough breast milk or formulae feed, kyuki hum bachche ko kam feed denge toh unko dehydration ho jaate hai jiske wajah se jaundice badh jaata hai. And third risk factor is babies whose blood is incompatible with the blood type of the mother, baby ka blood group aur mother ka blood group compatible nahi hai. Iske alawa agar bachche ko bruising hui ho at the time of birth ya koi internal bleeding hui ho, liver problem hai, infection hai ya koi enzyme deficiency hai aur baby ke red blood cell mein koi abnormality hai toh bhi unka risk of developing jaundice high ho jata hai. Ye sab jan na isliye jaruri hai kyuki, inn situations mein hum aur bhi jyada cautious ho sakte hai aur doctor se frequently mil sakte hai. Ab hume ye baat karna hai ki aap ghar mein ek bachche ko kitna piliya hai ye kaise pata kare? Toh ye jaundice humesha face se shuru hota hai, aankhon se shuru hota hai uske baad dheere dheere chest, abdomen, thighs, legs aise neeche neeche aata hai. Toh agar apko doubt ho toh ek finger lagake halke se baby ke skin ko press karenge toh vo portion yellow dikhega. Toh that is the sign of jaundice. Aur agar aap daily dekhenge isko dekhna daylight mein hai, artificial light mein ya tube light mein nahi dekhna hai, aap din ki roshni mein bahar jake dekhenge subah sham toh aapko difference pata lag jayega ki ye kitna progress hua hai, kitna deep hua hai aur uske hisab se aap apne doctor ko contact kar sakte hai.

Aapko kab apne doctor ke paas le jaana hai? Agar aapko lage ki jaundice pahle din hi aa gaya hai, within 24 hours aa gaya hai, ya fir jaundice tezi se badh raha hai aur bahut jyada intense yani ki bahut jyada dee ho gaya hai aur iske alawa jab bahut jyada jaundice ho jata hai toh ye brain ko cross karke brain ko bhi affect karta hai, so uss samay baby can feed poorly, baby sust lagega ya baby ki high pitch cry hogi ya sometimes baby develops fever because usko feed kam mil raha hai. Toh important points jo hume yaad rakhne hai har halat mein ki most mothers are discharged by 72 hours from the hospital, so day 3 pe jab discharge hota hai toh uske baad agle 48 ghante mein ya 3 se 4 din ke beech mein aap aapne doctor ke paas apne baby ko check up ke liye le jaaye. Agar bachche ka skin peela lag raha hai toh jaundice toh hai hi, lekin jab tak blood test nahi karenge, uska level nahi pata lagega, kai baar nahi pata lagta hai ki bachche ko treatment ki jarurat hai ya nahi. Toh isliye blood test ki jarurat padh sakti hai. And in some cases, additional blood test may also be needed to find out the cause of jaundice.

Now coming to treatment, hum jaundice ka treatment kaise kare? Toh hum saare pediatricians standard charts follow karte hai jo ki internationally accepted hote hai, usme vo baby ka age, after birth aur baby ke bilirubin ke levels ke hisab se batata hai ki agar bachche ki umar itni hai, bachche ka bilirubin level itna hai, toh treatment ki jarurat hai ya nahi. Aur agar treatment ki jarurat hai toh should we give futa therapy or should we go for exchange transfusion. Accordingly hum treat karte hai. Futa therapy mein the child is placed under a blue spectrum light aur usko koi aur kapda nahi pahnaya jaata except diaper and we have to cover the eyes. It’s very effective mode of treatment. Aur agar jaundice bahut high hai then we have to go for exchange transfusion. And in this the baby’s blood is exchanged with a donor blood. Aur iss se jaundice ka level kam ho jata hai. Now as we all know that prevention is better than cure, toh hum sabko pata hona chaiye ki, can the new born baby jaundice be prevented? So the answer is No, there is no real way to prevent jaundice but yes we can prevent the jaundice from becoming very high. So, agar during pregnancy, you should get your blood group tested, aur after birth baby ka bhi blood group pata hona chahiye. If there is a mismatch between the baby’s blood group and mother’s blood group, yani ki mother agar negative ho aur baby positive blood group wala ho ya mother O ho aur baby A ho ya B ho toh hume close watch rakhna chahiye, kyunki there are chances of baby developing jaundice, especially after the first pregnancy. In the second subsequent pregnancies. Second thing is you have to keep a close watch on the baby and feed the baby adequatly. Taki agar jaundice develop bhi ho toh jaldi jaldi badhe na and jaise apko suspecion lage ki baby ko jaundice hai aur badh raha hai and baki saare signs jo meine bataye hai, vo hai toh aap apne doctor ko immediately contact kariye. Thank you very much for your patience hearing. If you are having any further queries, you can contact me through Lybrate.

Thank You!

Hi,

I am Dr. Lata Bhat, Pediatrician. Today I will talk about long term health effects of premature birth. Which means a baby who is born too soon before 37 weeks of delivery. These babies who are born too soon can have some health issues in the long run also. So, today we are going to discuss only the long term effects. In India, about 12% of babies are born too soon. They can have health effects in the longer run. Now you must remember not all babies are going to have a problem. Most of them are normal. Those babies who are born prematurely like before 34 weeks, the more premature they are, the more problems they are going to have. And if they are very sick in ICU, then they can also have more problems. The only way to deal with the problem is to prevent prematurity and to take care of the problem early.

Detect the problem as early as possible. Thus, premature birth affects the baby's brain and that is why they can have developmental issues. They can have delayed physical developments, vision, communication issues, they can also have ADHD. Can the preterm baby have the lungs problem? Some of the babies especially those born below 30 weeks can have long term breathing problems like asthma but many of these babies can recover. So, the only way to deal with the problem is where the proper newborn intensity care is available and with a trained newborn specialist. The problems have to be detected early by a person who is a pediatrician and can identify the problems. The timely intervention will help in preventing these problems. For any further query, contact me through Lybrate.

Thank You!

Hi,

I am Dr. Lata Bhat, Pediatrician. Today I will talk about the myths surrounding a newborn baby's upbringing. I will talk about the prevalent myths in our country and enlighten you about the facts.

Myth 1: Newborn baby should not be fed the first breast milk.
Fact: First breast milk known as colostrum is very good for your baby. It is highly nutritious and strengthens the immunity of your baby.

Myth 2: Lots of people give honey and jaggery to the baby.
Fact: We should not do that. Only breastfeeding is required. In fact, raw honey might lead to the infection in your baby.

Some people are worried about the head shape of the baby. This is normal for the first few months in the baby. There is no need to use any cap and pillow or any massage of the head.
In our country, there is a tradition to apply kajal to the newborn baby's eye which can increase the size of the baby's eyes. Fact is that your baby's eye size and eyesight are genetically determined. And kajal can sometimes lead towards the infection in the eyes. Oil massage is given to the baby and it is believed that it strengthens the baby's muscles and bones. Oil massage just moisturizes the skin. So, you should give gentle oil massage to the baby. There is no need to give additional milk to the baby.

Baby should have only breast milk. Breast milk is best for your baby. Another common question asked is - Should we give water to the baby while hiccups? Just give breastfeed to the baby. We should give breastfeed till 6 months and start cereals after 6 months. Few people say that we should hold or pick the baby when he/she is crying. Baby needs a lot of care and skin contact with its parents. There is a lot of confusion regarding the number of stool passes by the baby and the consistency of the stool. Babies can pass stools sometimes once in a week and sometimes 20 times per day. Both ranges are normal until the baby is not passing hard stools. In case of any other query, you can contact me directly via lybrate.com.

Thank You!

Hello. I am Dr. Lata Bhat. I am a child specialist, specially trained to take care of the behavior and development of children, in England as well as in India. I have a center called Palak Child Development Centre at Mayur Vihar phase II, Delhi; where we deal with children with behavior and development issues such as autism, hyperactivity, learning disability, physical disability, speech delay etc. And I am also a senior consultant at Indraprastha Apollo Hospital, Delhi.

Today I am going to talk about myths regarding autistic spectrum disorder. I have dealt with lots of kids with autistic spectrum disorder in the last more than 15 years and have come across lots of myths associated with this condition. The incidence of this condition is on the rise. It's about 1 in 68 children. So, we need to sensitize ourselves, our children and the society at large regarding this condition because in future we will be dealing with more and more such children and adults. I would like you all to know what is the right information and what is incorrect information or myth regarding this condition.

So, coming to number 1 myth, the myth is they don't want friends. However, this is wrong. They want to have friends as much as we all do. They are they struggle with social skills. So, they may look unfriendly or shy at times. Another myth is, they can't feel or express emotions. They communicate and perceive emotions differently than us. But they do feel emotions. So, they have to be taught how to express emotions. Another myth is they can't understand emotions. Actually, the main core problem of this condition is that they have a problem with non-verbal communication and it affects their understanding of unspoken communication. So, for example, if we just make an expression of sad or happy, they may not understand or we use sarcasm just by changing the tone of our language they will not understand. We have to be more direct in our communication and we can use visual cues to teach them communication.

One has to understand how to express their emotions and how to communicate. They are very compassionate and empathetic as well. Another myth is that they have an intellectual disability. It's incorrect. Many of them have normal or very high IQ. They can have exceptional mathematical skills, exceptional memory or maybe exceptionally good in music and so on and so forth. Coming to another myth, there is a myth that they have typical personalities. Like for example, the character portrayed by Shahrukh Khan in the movie 'My name is Khan' or the character portrayed by The Rain Man movie. However, they have different characteristics and personalities and this can change from time to time. Now another myth is it affects only children. It absolutely wrong because the autistic children grow up to be autistic adults. However, we can teach them the skills regarding social communication and help them in communicating better. Another myth is about bad parenting. In the early 1950s, there was a hypothesis of refrigerator mother hypothesis; means the mother lacks emotional warmth so the child develops autistic spectrum. However, this has been proven to be absolutely incorrect because autism spectrum disorder is a genetic condition and it is there since birth. Although, we diagnose it later on it is genetic and is there from birth. Thank you so much for your patient hearing. For further queries, you can contact me on Lybrate.

Good evening,

I am Dr. Lata Bhut, I am a pediatrician specially trained to handle a developmental problem in children and running Palak Child Development Centre in Mayur Vihar, Phase- 2, Delhi.

Today I am going to talk about Autistic spectrum disorder, earlier I spoke about how to suspect a child for high-risk Autism based on signs and symptoms, today I am going to talk about the evaluation and management of such children. Autism is a social communication skills disorder where this impairment nonverbal and verbal communication both and there repetitive behavior patterns which impaired child day to day functioning. Speech delay is the commonest presentation although they can be some intellectual disability in some children. So early intervention is very important because in earlier years especially below the age of 3 years brain has compass fantastic capacity to rewire in response to environmental stimulation and 1 to 3 years is the best age to teach speech and language to a child. So American Academy of Pediatrics recommends starting early intervention starting specially below 2 years of age and do not wait till the diagnosis made because diagnosis may take some time, so all children should be scream for Autism between 18 to 24 months of age using a screening tool by a pediatrician and once a pediatrician suspects a child to be high risk for Autism, child should be referred to a development pediatrician or even if the parents suspect the child to be at risk for Autism they can come directly to the child development centre or to developmental pediatrician and the child is handled by multidisciplinary team of developmental paediatrician, paedia technologies, clinical psychologist, occupational therapies, special educators, speech and language therapist and parents are a part of the Core Team. In the diagnosis hearing assessment is very important because there is speech delay and other tests are done based on the clinical features and decide by the doctor, a detailed evaluation is done by the team using Autism diagnosis tools and once a diagnosis made or even before that early intervention is started once we suspect Autism. Early intervention involves intensive behavior modification therapy to teach nonverbal communication, speech, improve cognition, improve the independent self-help skills of the child and to enumerate the problematic behavior of the child. Occupation therapy, especially by the therapist trained in sensory integration, aims to develop self-help skills and fine motor skills and to enumerate the problematic sensory behaviors because if the child problem is sensory issues then the child can have difficult behavior, difficulty in learning and also in feeding. A special educator aims to give remedial education to help in academics and speech therapist in to develop speech of the child. It has to be individualized, goal-oriented, the intensive systematic model where we review it time to time because a development of change time to time, parents are a part of a Core Team. At least 25 hours per week of therapy should be given which means some hours at the center and followed by at least one and a half and two hours at home therapy should be done. And coming to the medications there is no medication to cure or Autism, although we can give medicines to enumerate the problematic behaviors and prognosis the earlier we start the better it is.

For any further queries, you can contact me on Lybrate.

Good afternoon, I am Dr Lata Bhat, a developmental Pediatrician in Delhi. We take care of developmental disorders in children like Autism, Hyperactivity, ADHD, learning and physical disability. Today I will talk about Autism.

Autism is a spectrum disorder that means there is a wide range of presentations.

Why did I choose to speak on this topic? The incidents are alarmingly high. It is a sort of epidemic and if not addressed, it can lead to a disaster.

The cause is Genetic. If one child has got Autism then the siblings also have the maximum chance to suffer from the same disease.

How does it affect the children?

Autism affects the communication of the child. It affects the speech, language as well as the non- verbal communications. Communication is the exchange of thoughts, ideas between the two or more people. Speech is delayed.

How do the parents or a care taker suspect the child?

Initially, the norms of the communication come first and then the speech.

Preterm Labor and Birth

Good Evening. I'm Dr. Lata Bhat. I'm a Neonatology and I take care of the developmental problems of children. So today I want to talk a bit about pre-term babies who're born before 36 weeks. Normal babies are born from 37-40 weeks of gestation after the mother becomes pregnant and babies who're born before 36 weeks have some problems. Babies who're born from 34-36 weeks donot have that much problem but those who're born before 34 weeks, especially those born below 28 weeks have lot of problems and especially babies who're less than 1.5kg or less than 1kg. But in good centers in India, like my center also, we do save babies, about 600 or 700 or 800gm babies and also thos born in about 25-26 weeks of gestation and there is a success rate of about 90%.

Now, globally about 15 million babies are born pre-term and out of this 25% are born in India. So imagine the burden of pre-term babies in India and the facilities that exist in India are abysmal as compared to the number of babies who're born pre-term, and we've to remember out of all the number of deliveries about 12.5% are born pre-term which is a huge number. About 27 million babies are born annually and out of this about 3.6 million babies are born pre-term.

So now considering the problem all the prospective parents and everybody should know what causes prematurity. Because however much educated a gynecologist maybe or a pediatrician maybe there is no full proof method to predict or prevent it but there are certain factors which contributes more to prematurity. So early recognition and timely transfer to higher center with better facilities is very important. Now in India it happens due to complex factors, it happens in poor people as well as rich people. Pregnancy in adoloscent people, whose womb is no yet ready to take babies or if the mother is underweight, there are recurrent infections in the mother, under-nutrition or impropoer nutrition, then substance abuse by the mother, in vitro fertilisation, if the mother has diabetes during pregnancy, mother has uncontrolled blood pressure during pregnancy, infections during pregnancy, especially urinary tract infection or genital infection, Sexually Transmitted Diseases.

These are the conditions where we can definitely predict that baby can be born pre-term, and also in case of multiple pregnancies, especially if the mother has twins or triplets then risk of pre-term birth is more. Now stress also leads to pre-term birth. In the current lifestyle there is stress, everybody is career oriented so we're facing a lot of infertility, people are taking treatment for infertility, having in vitro fertilisation that is also leading to pre-term birth. Now, once we know there are a lot of factors how do we prevent it. First is prevention then comes treatment. For prevention, as I told you before conception we've to think that mother's nutrition should be good, she should be well nourished, mother's age should be appropiate, she should not be a teenager or an adolescent, that is more than 22-23yrs of age. Then pregnancy planning, birth spacing, then we've to think about preventing sexually transmitted diseases, we've to give vaccines which are recommended for adoloscents, then genetic counselling, screening for diabetes, if there is substance abuse you've to stop it, stop smoking, prevent stress and all these things. And also proper ante-natal care by a proper gynecologist where they screen for everything and do regular ultrasound examination of the mother and they train the mother to handle the pregnancy well

Now, despite doing everything if we're not able to avoid pre-term labour then one has to plan to deliver at a center where there are facilities, there is trained new born consultant who'll be attending the delivery and they have all the facilities to take care of the baby after birth. And supposing if sill the baby is born in a center where there are no facilities then a proper transport should be arranged. We should not just pick up the baby and shift to a center because temperature mainatainance is very important, we've to take care the baby is getting continuous glucose, baby is receiving oxygen and is properly transported. Even during transport if these things are not taken care of the baby's brain development can be affected. If transient dip of oxygen, even for a few seconds or for few minutes if the baby is not receiving any glucose or if there is very rigorous transport the baby can suffer haemorrahage in the brain.

So new born babies, especially a pre-term babies can be very very delicate and so transport should be done in a proper manner and then once you've gone to a center where they're saving babies, you've to first maintain the temperature, take care of the breathimg, if require breathing support, if require oxygen then maintanance of blood sugar, prevention of infections, hen regular screening to lok for the eye problems, brain problems and once the baby survives at the time of discharge these babies may stay in a hospital for a long time and after discharge you should listen carefully to what the doctor is telling because a proper follow up is what will give a quality outcome in the long run. Because we just don't want to save lives and give them long term problems like hearing, speech, vision or physical disability.

All these are preventable and to a certain extent correctable. If you follow properly the pediatrician and if possible the developmental pediatrician. So that's very important. So the take home message is try to prevent pre-term birth by knowing the factors which cause it and if its inevitable get your delivery done in a center that has facilities to take care of the pre-term babies and after the baby survives follow up all the instructions given by your doctor and pediatrician.

So, if you've any further doubts related to a pre-term baby or any baby you can consult me through librate.com where we can chat or telephonic conversation or you can contact me at Child Developmental Clinic which is at Poorvanchal Plaza, Shop No-106, Mayur Vihar, Phase-2.

Here are Symptoms of ADHD and how to handle the Children suffering with ADHD.

Good afternoon, I am Dr. Lata Bhat. I am a pediatrician who is specially trained for newborn care and developmental problems of children. Today, I am going to talk about one of the conditions which is very common. It is known as ADHD- attention deficit hyperactivity disorder.

Many of you may have read about it in the newspapers or online. About 8-10% of schoolchildren have this problem. Now this is not a disease, so you need not be scared of this problem. All you need to know is to understand the kids and provide support and this is essential both by the parents and teachers. These kids have generally poor concentration, very easily distractible that means even if a door bell rings or a horn or if somebody is playing music or television or if somebody in the surroundings is talking and laughing their concentration gets distracted. They may or may not be hyperactive because the core component is lack of concentration which affects their studies. But they may be impulsive which means they may act without thinking. They may land up into frequent fights because of that. They may have certain behavioral issues which teachers and parents may find difficult to handle. They may have learning disability which can be because of lack of concentration or it can be specific learning disability.

Now, there is no need to get worried about it. All you need to do is to contact a developmental pediatrician, get the right assessment done. Then come to the management of these children. First and foremost, is how the parents and teachers handle the children are very important. They need a lot of attention, so kindly give it but it should be positive attention. Always praise and encourage for whatever good they do, never criticize. If there is a bad behavior, you first explain to them and then if it’s a very small kid you can sometimes just track them so that they get distracted from the bad behavior and calm down. There is something called household roles.

You can fix certain household roles, routines so that children can understand the do’s and dont’s which itself takes care of 50% of the problems. Still if they behave badly, you can count up to 10 and then there is something called time-out. Time-out means 1 minute per year of each, if it’s a 5 year old child then 5 minutes; it means that lights off, TV off, nobody is talking to them, physical, visual and verbal attention- all three are not given by anybody in the house and the child is made to sit in a corner. At the end of it, you hug the child and tell them that the child is very good but the behavior was bad so that the child does not lower his self-esteem because self-esteem of a child is supreme. Your behavior should always uplift the self-esteem of your child.

Secondly, what you have to remember is never criticize or compare him with any other child and all the adults should follow the household rules consistently. Coming to studies, they have a very short attention span. So set short targets for studies and give breaks in between. They need 1:1 attention for studies which means somebody has to sit with them while they are studying at home either the tutor or the parent. In school, the teacher should make sure that they are sitting in the front row, close to teacher, away from doors and windows and give them a little extra attention. Apart from this, you also need to remember that you have to decrease the TV, video, mobile and computer watching. These lead to hyperactivity. You also need to limit the amount of chocolates and fast food intake. Remember, by understanding the condition, you and the teacher can really make a difference to the child’s future.

For any other further information, you can contact me on lybrate.com.