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Care of young child

Normal growth of boys and girls

How does the mother know that the child is growing normally??

A serial record of length/ height and weight of a child is the best way of knowing that a child is growing well. This can be done by maintaining a growth chart (see figure of a growth chart below). A growth chart for children upto 2-3 years of age shows a serially maintained record of a child‘s weight, length and head size (circumference) in comparison with the normal range for the child‘s age and sex. For a child older than 2 years growth charts show serial recordings of child‘s height and weight. Since a child grows very fast during first two years of life, his growth should be assessed at every opportunity. This is done conveniently during the visits for routine immunization. And other visits to the doctor. Thus, during the first year, it is recommended that a child‘s growth is assessed at birth, at 6, 10, 14 weeks and 9 months (coinciding with visits for immunization). A 3 monthly record during the first two years is ideal. Subsequently, since the rate of growth slows, measurement of weight and height taken twice during a year and duly recorded on the growth chart suffice to give a good indication about the child‘s growth. It is important to realize that there is a wide range of weight and height that is considered normal for children of same age. Some children are genetically and constitutionally shorter or lighter, while others are taller/ heavier. However, the rate of growth of all healthy children at various ages is similar. If the rate of growth is slower than expected for age, the child needs to be evaluated by a doctor. A well maintained growth chart helps in early detection of growth faltering.

What are the normal weight and height for children of various ages?

Breast milk is the best form of nutrition for the baby. It is fresh, hygienic and ideally suited to meet all his requirements. It protects the baby from getting infections and helps in improving bonding with the baby. Every mother can produce enough milk to meet the requirements of her baby till he is 6 months of age. Even if a woman has twins, her milk flow often increases enough to meet the requirement of both the babies. Mothers should practice exclusive breastfeeding during the first 6 months of life. No other milk, not even water should be given during this period since breast milk will meet all the fluid and nutritional needs of the baby.

 

What are the advantages of breastfeeding for the mother?

The tables given below show the average weight and height, for boys and girls. These provide an idea about the child‘s growth at the moment of recording since 94% children of that age and sex would have height and weight falling within this range.
Height and weight of boys from 0-3 years of age: 2.6 – 3.9 4.7 – 7.0 2.6 – 3.9 6.0 – 8.7 7.1 – 10.0 8.2 -11.1 8.7- 12.8 9.7 – 14.9 10.7 – 15.99 11.4 – 17.0
Age Length/Height Weight
Month Normal range (cm) Normal range (kg)
0 47.6 – 52.9
3 56.3 – 64.3
6 47.6 – 52.9
0 62.0 – 71.8
9 67.1- 74.2
12 71.7– 78.6
18 75.3 - 85.2
24 78.9 – 90.5
30 84.7 – 95.9
36 87.7 – 100.7

Height and weight of Girls from 0-3 years of age: 2.6 – 3.9 4.4 – 6.7 5.6 – 8.4 6.9 – 9.5 87.8 -10.6 8.7- 12.4 9.4 – 13.9 9.9 – 14.8 10.5 – 16.4
Age Length/Height Weight
Month Normal range (cm) Normal range (kg)
0 47.5 – 52.7
3 55.3 – 63.8
6 61.0 – 69.8
9 65.3 – 73.9
12 70.2 – 77.8
18 73.5 - 85.0
24 77.7 – 89.8
30 82.0 – 95.0
36 85.3 – 99.9

 

My baby isn't gaining weight as fast as he was. What should I do?

Most probably there is nothing to worry. Remember that while your baby should continue to gain weight steadily — with the exception of his first few days, when he may even lose a bit before quickly catching up — it won't always be a perfectly smooth climb. Your baby's growth rate will speed up and slow down. If you see that in the growth chart the weight of your baby is not growing consistently, then you should consult a doctor

 

What will the doctor do if my child is not gaining weight properly?

The doctor will give your baby a physical exam and ask you a number of questions to help determine whether there's a problem, and, if so, what the underlying cause might be. If your baby is hitting his developmental milestones pretty much ontime, relating well to you, and looking otherwise happy and healthy, he's most likely doing fine. If the doctor finds that your baby isn't growing at a healthy rate, it's very important to find out why. Proper nutrition — especially during the first three years — is crucial for a child's mental and physical development. If your baby weighs 20 percent below the ideal weight for his height, he'll be diagnosed with "failure to gain weight. "Your baby's doctor may order blood, urine, or other tests as well as monitor your baby's caloric intake for a period of time.

 

Developmental milestones

What are developmental milestones?

Milestones measure baby's growth and development. These milestones provide a guide to parents telling them what to expect from the baby and when to expect it. The sequence of development is same for all children, but the rate of development varies from child to child. For example one child can learn to walk independently as early as 10 months of age, while the other might be able to do so at 15 months. This is the normal range for achievement of this milestone. However, a child has to learn to sit before he can walk, and to hold his neck before he can sit. Since there is a range of period that is considered normal for achievement of a milestone, departures from the norm should not be a reason for undue panic unless confirmed by expert medical opinion..

What are some of the important developmental milestones?

Some important development milestones of a child and the usual time of appearance are as follows:

  1. Smiling when "talked to"- 2 months
  2. Neck holding – 3 months
  3. Recognizes mother – 3 months
  4. Reaches out for an object and holds it in his hand – 5 months
  5. Making sounds like =ma‘ =ba‘etc-6 months
  6. Sitting without support- 8 months
  7. Crawling- 11 months
  8. Standing without support-1 year
  9. Speaks two words with meaning – 1 year
  10. Walking with support – 13 months
  11. Walks upstairs-24 months
  12. Makes simple sentences – 24 months

 

Teething

When will baby’s first tooth appear?

Teething usually starts around five months and continues until the end of the second year. However, the order in which the teeth appear remains unchanged. Lower front teeth begin to appear by the age of 5 to 8 months. Upper front teeth begin to appear at the age of 8 to 12 months. If there is no eruption till 15 months, a doctor should be consulted

What precautions should be taken while the baby is teething?

Teething is a normal phenomenon. During this time babies may feel some irritation in their gums. They may try to put whatever objects they lay their hands on in their mouth to relieve this irritation. This can lead to infection, diarrhoea or fever. Therefore, all the objects that the baby is likely to handle should be washed and cleaned several times a day. A clean and safe teether can also be used to pacify the baby. Baby‘s nails should be clipped and hands washed several times a day. A baby does not require any drugs/ supplements during this period.

 

How do I know my baby is teething?

He bites his hand, cries at night and appears to be drooling a lot. These are the signs you should look for in your baby. You can expect some irritability and restlessness as well. It's understandable that he's fussy. His first teeth must push and cut through the gum tissue and that causes some tenderness and soreness.

 

What if my baby develops his teeth early? Does it mean he'll be healthier or smarter than if they develop later?

There is no connection between the rate of tooth development and intelligence, strength or health of permanent teeth.

 

Can teething cause diarrhea?

Some says that the excess saliva from teething may lead to a mild case of loose stools. At this age, however, changes in a child's diet due to the introduction of solid foods may also be the culprit. Always consult your pediatrician if the diarrhea is green, blood-tinged, or lasts longer than two days.

 

Why does my baby have puffy gums during teething?

Before a new tooth erupts, it can cause a red, swollen, bruised-looking area on the baby's gums. Sometimes the gum actually bulges with the emerging tooth, which you can see faintly beneath the skin if you can convince your baby to open his mouth for long enough.

 

Speech

Why do some children speak later than others?

There is a lot of variation in development of speech. Many children, who are other-wise completely normal, learn to speak late. Lack of environmental stimulation is a common cause of delayed speaking. The more the child is =talked to?, earlier he will learn to speak. An important cause for delayed speech is poor hearing. Therefore, a child who has not started making any vocal sounds by 5-6 months of age or does not speak any word with meaning by 18 months of age should be evaluated by a doctor.

Vision

How can a parent know that the child has a normal vision?

A young infant would watch his mother‘s face intently by 4 weeks of age and smiles in response to his mother‘s gestures by 6-7 weeks of age. Achievement of these milestones indicates that a child has normal vision. A lack of fixation of vision and social smile by 8 weeks should prompt an evaluation by a doctor. Visual defect in an older child can be suspected if the child keeps bumping into the furniture or has trouble following the trajectory of a ball thrown to him/her. Changes in the appearance of the eyes, such as a lazy eye, drooping eyelid or a squint should also be evaluated by a doctor.

Developmental delay

When should a parent concerned about developmental delay in child?

There is a wide range of normality for achievement of all developmental milestones. A child with delay in achievement of mile stones beyond the age indicated below should be assessed by a doctor:

  1. Does not respond when ?talked to?:3 months
  2. Does not seem to recognize mother/ become alert on seeing mother: 3 months
  3. Does not seem to be able to hold its neck: 4 months
  4. Does not hold a rattle: 4-5 months
  5. Does not make any sounds: 5-6 months
  6. Does not sit without support: 8 months
  7. Does not stand holding furniture etc: 9-10 months
  8. Does not walk independently: 15 months
  9. Does not speak any word with meaning: 18 months

Immunization

Why is immunization needed?

Immunization is one of the most important and cost effective way of protecting children against common childhood illnesses many of which can be potentially serious, even life threatening. The illnesses against which vaccination is being offered free of cost by the Government of India include tuberculosis, diphtheria, whooping cough, tetanus, polio and measles. Many States also offer free vaccination against hepatitis B, mumps and rubella. These vaccines are available at various Government Hospitals, Dispensaries and Health Centers. Vaccination is also available against other diseases like chicken pox, typhoid fever, hepatitis A, H influenzae infection etc. These are however not currently being provided by the Government. These can be taken from private Hospitals/ Clinics as per the advice of the Pediatrician

What is the immunization schedule?

The following schedule has been recommended by the Ministry of Health, Govt. of India.

NATIONAL IMMUNIZATION SCHEDULE


BENEFICIARY AGE VACCINE
Infants Birth BCG*, OPV**, Hepatitis B 0**#
6 weeks DPTandOPV, Hepatits B#
10 weeks DPTandOPV , Hepatits B#
14 weeks BDPTandOPV, Hepatits B##
9 weeks Measles vaccine
16-24 weeks DPTandOPV(Booster dose),MMR#
Children 5 years DT vaccine
10years Tetanus toxoid
16 years Tetanus toxoid

*At birth or at the time of DPT/OPVV
** Dose called as Zero dose and can be given till 14 days of age, if missed earlier
#Given in some states, including Del
Abbreviations:
  • BCG: Bacillus calmittee Guerin (for Tuberculosis)
  • DPT: Diphtheria, Pertussis and Tetanus
  • OPV: Oral Polio Vaccine
  • DT: Diphtheria and Tetanus
  • MMR: Measles, Mumps, Rubella

What are the side- effects of immunization?

Most immunizations are free of side-effects. Often side effects are minor and transient in nature. The DPT vaccine is the most common vaccine associated with side-effects. These include pain and swelling at the site of injection and fever in some infants. These last for a few hours to a day or so. One or two doses of paracetamol are adequate in controlling these symptoms. Very rarely an infant may develop persistent uncontrollable screaming or convulsions following DPT. These should be brought to the notice of doctor who would suggest modification in further immunization schedule.The BCG vaccine is followed by development of a small nodule at the site of injection after 2-3 weeks which may become pus filled and later form a shallow ulcer. This heals on its own, usually by 10-12 weeks after injection.This is a normal reaction to BCG vaccine and indicates that the vaccine is working.

What should be done if the immunization gets delayed beyond the recommended schedule?

While every effort should be made to immunize the children as per schedule, delays may occur due to unavoidable circumstances. In such a situation the entire schedule need not be started again since the vaccines received earlier shall still be effective. The remaining vaccines should be given to complete the schedule as soon as possible

What vitamin and mineral supplements are needed for children?

Young children are vulnerable to developing vitamin A and iron deficiency, especially if a balanced diet in adequate amount is not available to them. Govt. of India has made provision for supplying oral Vitamin A to all children under 5 years of age at 6 monthly interval starting at 9 months of age. This dose is adequate to meet the nutritional needs of Vitamin A of young children. There is also provision for oral iron supplementation starting at 6 months of age. This is given for 100 days every year till 5 years of age, starting at 6 months. These supplements are available free of cost at all government hospitals and health centers.In addition, it is essential that children consume salt that has been fortified with iodine to meet the body requirements of iodine. Deficiency of iodine can adversely influence the mental development of a child.

How many times my child should take pulse polio doses?

Pulse polio immunization campaign is a government programme to eradicate polio virus from the world. We will be successful only if all or majority of the children below five years of age gets a dose every time the campaign is running. It is absolutely safe to have your child given OPV dose during each pulse polio campaign.

My child is immunized fully as mentioned by the pediatrician, still any need to take pulse polio doses?

Yes, you should get your child OPV administered during the every pulse polio round even if your child has received routine OPV at the health center

Who should be immunized for chicken pox?

Active immunization is indicated in all children from the age of 12 months onwards. Susceptible healthy contacts should get immunized to prevent virus transmission

What is the dosage schedule of chicken pox vaccine and how is it given?

  1. From 12 months to 12 years of age – 1 dose
  2. 13 years and above – 2 doses with an interval of 6-10 weeks.
  3. nterval of 6-10 weeks. The vaccine is given subcutaneously.

Can hepatitis A be prevented?

vaccine is now available. Primary vaccination protects the person for up to one year and a booster does administered after 6 months, provides predicted protection for at least 20 years.

If my child is vaccinated against hepatitis B, is he also protected against hepatitis A?

No. Each type of hepatitis is different. Vaccination against hepatitis B does not protect form hepatitis A, and vice versa.

If a child is of 9 months of age and has never been vaccinated, can all the vaccines be given to a child on the same day?

all the vaccines be given to a child on the same day? Yes. All the vaccines can be given at the same session but at different injection sites using separate sterile syringes and needles. It is safe and effective to give BCG, DPT, OPV and Measles vaccines and Vitamin A at the same time to a 9 months old child who has never been vaccinated.

If a child has never been vaccinated and is between 1 to 2years of age, which vaccines can be given to the child?

The child should be given DPT-1, OPV-1, Measles and 2ml of Vitamin A solution. Second and third doses of DPT and OPV should be given at one month intervals

Should one re-start with the first dose of a vaccine if a child is brought late for a dose?

Do not start the schedule all over again even if the child is brought late for a dose. Pick up where the schedule was left off. For example: If a child who has received BCG, DPT-1 and OPV-1at 5 months of age, returns at 11 months of age, vaccinate the child with DPT-2, OPV-2 and Measles and do not start from DPT-1 again.

What vaccines should one give to a child who is brought after 5 years of age for the first time?

Give the child only 2 doses of TT

Can immunization be given when a child is sick?

A child with minor illnesses like common cold, cough, fever, passage of a few loose stools etc. can be immunized safely without any complications. It is important that delay in immunization be avoided as far as possible since it leaves a child susceptible to more serious infections. However, immunization should be postponed if a child is suffering from a serious illness as determined by a doctor. At that time it is important to treat the child for his/her sickness. Immunization should be done on recovery.

Toys and playing

What kind of toys should a child play with?

Toys are important tools that facilitate a child‘s development. The toys have to be age appropriate and need not be expensive. A child as young as 2 months of age enjoys watching a rattle, colourful balls etc. By 4-5 months he can hold a rattle and play. A one year old can put things in and out of a basket and enjoys playing with stacking toys like beakers, rings etc. Even a cup and spoon can provide entertainment to a young child while improving his hand coordination. Beyond 1 year of age, pull-along toys are enjoyed by children and so are picture books. An important consideration while choosing toys for children is that they are safe since children tend to take the toys to their mouth. Very often colors used in the toys may be toxic to children. Toys with small loose parts that may come off like a whistle, beads etc are not safe for children. The toys should be washable so that they can be cleaned frequently.

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