Our little ones cannot be expected to recognize the effects of various seasons on their fragile human bodies. Their play and fun cannot be interrupted by blistering sun and sweltering heat or cold winds and pouring rain. Thus, their safety and good health fall on the reliable shoulders of their parents or guardians.

Summers in Gulf start sooner and last much longer than in other parts of the world, without any respite by monsoon rains. In such a scenario, adjusting to the climate by adapting safe habits can go a long way in ensuring the well-being of our children. Hence, to be better prepared for the onslaught of summers, let us get familiar with a few pointers on caring for children during summers, effects of extreme heat, identifying distress signals when to contact your pediatrician, and other related information.

General Advice Caring for Newborns and Infants

• Hot Motor Vehicles – Within 10 minutes, a car can heat up to 19 degrees and become even hotter than the outside temperature. Care should be taken to never leave children in a closed motor vehicle. A continuous rise in temperature may even cause death.
• Young children can be taught about rest periods and taking breaks to hydrate and cool off themselves or parents can ensure that they are regularly hydrated and rested.
• Avoid stepping out at peak hours between 10 am to 2 pm. And if unavoidable, dress the child in light-colored clothes, preferably a full-sleeve shirt and pants, and carry umbrellas, caps for protection.
• Dehydration can lead to loss of nutrients in the body, more so in the case of children. Summer fruits and vegetables are an essential part of your child’s healthy summer diet, which can keep the body hydrated while maintaining vitamin A and vitamin C nutrients in the body. This boosts immunity and protects your child from heatstroke.
• Make sure your child takes a bath regularly, washes hands, eyes, face, and other body parts frequently, and wears clean clothes, to avoid bad body odour, skin rashes, and other illnesses.

Caring for Newborns and Infants

• Clothing – Dress your baby preferably in pure cotton clothes as they are more absorbent than clothes made of synthetic fibers. If your baby’s skin is moist for long periods of time, she is prone to getting a prickly heat rash. Light colors have a tendency to remain cooler and should be preferred. Choose a time of the day when the baby is awake and you don’t expect her to poo, then designate it as nappy free time, as nappies can keep your baby quite warm in hot weather and cause her to sweat at the waist and leg band.

• Bathing – The water should neither be too cold nor very hot, just a little warm or maybe even room temperature for a newborn baby as it is ideal for baby to cool down. This can be checked by dipping your elbow in the water. They can also enjoy water play in small inflatable pool or bathtub but should never be left alone as babies can drown even in few inches of water.

• Feeding – Babies can be expected to wet six to eight nappies in twenty-four hours and they can get dehydrated faster than adults. If the baby is exclusively breastfed and younger than six months, extra water isn’t required but they may feed more frequently or at shorter periods at a time. Shorter feeds produce more foremilk which is thinner and more refreshing than fat-rich hindmilk. On the other hand, if the baby is formula-fed, she might require some water (which has been boiled and then cooled). Older babies on solids require adequate water.

• Skincare – In summers, it is better to use thin massage oils that wash off easily than thick oils which form a residual layer on skin which can trap sweat on the baby’s skin and lead to heat rash. Use of talcum powder isn’t recommended much as the small particles may enter and damage baby’s lungs and lead to breathing difficulties and if used, precautions should be practiced such as not creating clouds of powder, keeping it away from baby, not using it on face and not putting it on moist skin. Heat and humidity can also cause prickly heat rashes in the skin folds of nape of the neck, shoulder, back, nappy area. To provide relief, Calamine lotion can be used or a paste of Fuller’s Earth and rose water can be applied for ten minutes and then washed off.

Caring for Toddlers and Young children

• Nutrition – In summers, stored food often spoils quickly. So, store food at appropriate temperatures and in food grade plastic ware or glass utensils and taste the food to ensure its not spoilt before feeding to the child. While going out, carry the child’s home cooked food as much as possible and avoid all fizzy drinks, tea, coffee, packaged juice and energy drinks as they have excess amounts of sugar and/or caffeine. Children should be encouraged to drink water regularly.

• Skin care – Water resistant SPF30 sunscreen should be applied on all exposed body parts to protect from sun’s ultraviolet (UV) rays as too much exposure can cause sunburn, skin and eye damage or even skin cancer later in life. Too little UV would lead to low vitamin D levels and winters can be utilized for adequate outdoor time under the sun. Toy sunglasses do not protect eyes from UV rays. Wrap-around sunglasses labelled AS 1067 have very good UV protection. Broad rim hats should be preferred over caps as they shade the face, neck and ears in a better manner.

• Daily/ Weekly routine – Familiarity in routine is comforting for children. Disruptions in daily habits lead to disruptive behavior. Entertainment forms that are a cool retreat from the heat can be incorporated in their weekly outings such as air-conditioned gaming centers, libraries, indoor playgrounds in malls, or swimming pools, to give respite from being locked indoors for long times.

Potential Effects of Extreme Heat

• Dehydration – Looking at an energetic and active child, it’s hard to identify dehydration. You can monitor the baby’s urine output and look for other signs like dry lips and mouth, dry tears, no wet diaper for six or more hours, unable to drink water, fever, excessive drowsiness and vomiting.
• Heat exhaustion – The body would record an elevated body temperature, usually less than 104˚F. The skin might feel cool and clammy with goose bumps, despite the heat. The child might feel dizziness and weakness and might faint. She might be irritable and complain of headache, muscle cramps, nausea and/or vomiting
• Heat cramps – painful muscle cramps in the child’s arms, legs, or abdomen.
• Heat stroke – Heat stroke is a medical emergency. The body temperature rises above 104˚ Fahrenheit. The child might exhibit confusion, disorientation and suffer from nausea, vomiting, diarrhea, severe headache and seizures. The skin would appear hot and flushed. She may lose consciousness. You might also notice absence of sweating in spite of the heat.
• Psychological Effect – Child’s mental health is equally important. Restricting them indoors all the time may result in anxiety or restlessness which can be addressed by offering alternative forms of entertainment such as indoor games and activities and ensuring to limit the screen time.

If suffering from heat exhaustion or heat stroke, as a first aid, the child should be brought to a cool, shaded place and cold wet towels or sponges should be applied or the child can be immersed in a tub. She can be given cool fluids that contain salt but avoid pushing fluids unless she is conscious and alert.

When to contact Pediatrician

If your child develops any of the following symptoms, it is best to take advise from your pediatrician, on the next course of action and to decide whether an immediate evaluation is required.

• Feeling faint​ and showing extreme tiredness (e.g., unusually sleepy, drowsy, or hard to arouse)
• Headache and fever
• Intense thirst and not urinating for many hours
• Vomiting and nausea
• Breathing faster or deeper than normal
• Skin numbness or tingling
• Muscle spasms and aches

With small precautions and extra care, the summers in Gulf can also be made an enjoyable time for your little ones just like other seasons.

 

Image Credit: Summer photo created by pvproductions – www.freepik.com

Have you ever compared your baby with the neighbor’s friendly kid and wondered ‘Why doesn’t my baby smile yet’ or ‘My baby is already attempting to stand up, is he strong enough to do it?’ There’s really no need to fret or start comparisons. All babies are unique and their responses and actions vary naturally within specific age ranges for all milestones. And there’s an easy way to put your mind at ease and that is – Developmental Screening of your child at each succeeding stage.

From birth to five years of age, children acquire functional skills that are useful to track their progress and allow identification of potential developmental problems. As a Pediatrician, I apply scientific, standardized Development Screening tools and questionnaires to check four functional areas:

• Gross motor
• Vision and fine motor
• Hearing, speech and language
• Social, emotional and behavioral

I take feedback from parents and use direct observation of the child as well to develop a comprehensive report. These screenings assist in detecting language impairment, mild intellectual disabilities, speech delays, learning disabilities, autistic spectrum, physical disabilities and other disorders, if any. Early recognition and intervention contribute to better management of a developmental delay.  But I assure you that the experience is anything but depressing or stressful, as it may be sounding right now. In fact, as a result of the screenings, I have often observed parents becoming better observer of their child’s development behaviors and changes. It also gives me an opportunity to communicate about the development strengths of the child to their parents.      

To give you a basic idea of which developmental milestone to expect at each age, have a look at the table below. But a word of caution, avoid jumping to conclusion just because one or more milestone appears to be missing. A better alternative is to contact your pediatrician for a detailed investigation.

DEVELOPMENTAL MILESTONES — BIRTH TO FIVE YEARS

Skills	Birth to 12 Months	One Year to Two Years	Two to Three Years	Three to Four Years	Four to Five Years
Cognitive Skills	Follows moving object with eyes. Looks directly at faces and responds to gestures. Places toy in and takes toy out of containers. Beginning of memory—object permanence. Looks for hidden objects. Listens to and follows simple directions.	Imitates adults through actions and words. Names simple objects. Listens to and follows commands and requests. Explores the environment. Acts like “little scientist.” Matches simple objects.	Can name and recognize one color. Matches shapes and objects by function. Stacks objects such as blocks, five high. Responds to simple direction. Has limited attention span. Identifies objects in picture books. Can describe own activity. Begins to understand function of objects in familiar environments.	Can name and recognize six colors. Begins to understand concept of time, including past and present. Understands concept of pretending. Knows own full name and age. Attention span is somewhat longer, but easily distracted. Can match by “family” group or function.	Matches pictures of familiar objects. Draws people figures with recognizable parts. Counts to five. Knows street and town where he lives. Points to and names six colors. Matches commonly related objects. Has extended attention span. Has increased understanding of time, function, and whole and part.
Language Skills	Cries, babbles, and coos. Looks at speaker when spoken to and responds using variety of sounds. Capable of vowel and consonant sounds, often using repetition. Begins to imitate sounds. Begins to use intonation for meaning.	Speaks first words. Able to speak 50 meaningful words to communicate. Identifies and names simple objects. Uses gestures to enhance communication. Indicates possession by using words mine, me. Uses the word no frequently to voice autonomy.	Talks constantly. Refers to self by proper pronouns. Uses plurals. Uses complete sentences consisting of three to four words. Asks questions: why, where, how?	Talks in sentences. Can relate present or past experiences. Uses past tense for verbs. Has extensive vocabulary. Can repeat a song or nursery rhyme. Can understand and use size comparisons. Asks questions for information.	Has basic grammatical structure in use. Uses increasingly complex language. Has large vocabulary base. Understands more complex directions. Uses directions in play. Able to listen to long stories.
Fine Motor Skills	Reaches for objects; grasps and plays with them. Puts objects in mouth. Uses pincer grasp. Shifts objects between hands. Drops objects; picks them up.	Stacks three objects, such as blocks, in a tower. Turns pages (two or three at a time). Turns doorknobs. Throws small ball. Scribbles, paints with large movements, holds brush with whole hand. Drinks from a cup without help. Begins using a spoon. Places round objects into holes.	Can turn pages of book one at a time. Paints using wrist action. Holds crayon with fingers, not whole hand. Moves fingers independently of others. Strings beads. Cuts using scissors, but hasn’t mastered it. Shows hand preference. Manipulates clay by rolling and pounding.	Drives pegs into holes, nails into wood. Can copy circle or cross. Manipulates clay and play dough into recognizable objects. Able to stack objects nine high. Cuts using scissors.	Cuts on a straight line. Copies simple figures. Prints a few capital letters.
Gross Motor Skill	Lifts head. Turns from side to side; rolls over. Sits with back straight and head steady. Able to crouch. Crawls. Pulls self up into a standing position, then walks along furniture, using both hands. Stands without support.	Takes first steps. Walks alone without help. Stands without support. Walks backwards. Walks upstairs using one hand. Jumps using both feet. Pulls and pushes toys. Throws a ball with overhand motion without falling.	Runs well. Kicks ball without losing balance. Stands on one foot. Jumps short distances with both feet. Rides a tricycle, but has not necessarily mastered both steering and peddling. Walks upstairs alternating feet. Walks on tiptoe.	Runs around obstacles. Throws ball overhand, with direction. Hops on one foot. Climbs up slide and slides down unassisted. Walks a line. Can catch ball bounced to her. Masters riding a tricycle.	Turns somersault. Walks up and down stairs unassisted, alternating feet. Jumps forward as many as ten times without falling. Walks backward in a line, heel to toe. Can swing at a stationary ball with a bat.
Social Skills	Smiles spontaneously. Discriminates between familiar people and strangers. Responds to own name. Understands words no-no. Imitates simple actions of others.	Shows emotions such as affection, joy, fear, anger, and jealousy. Recognizes self in mirror. Refers to self by name. Hugs and kisses. Throws temper tantrums. Loves to help put things away. Imitates adult activities. Initiates play.	Better control of temper tantrums. Begins to share toys. Plays near other children (parallel play). Begins real dramatic play. Participates in group activities like circle time.	Plays with others (associative play). Able to share and take turns. Acts out whole scenes in dramatic play.	Plays with other children (cooperative play). Dramatic play resembles reality, including dressing up. Pretending is acknowledged. Acknowledges sex differences.
Self-Mastery Skills	Holds bottle. Feeds self finger foods. Holds cup with two hands; needs assistance to drink from it. Cooperates with being dressed.	Takes off shoes and other clothing; can unzip. Verbalizes needs such as food, drink, and toileting. Eats and drinks well without assistance.	Understands gender identity. Feeds self. Drinks from drinking fountain. Takes off jacket or coat. Toilets with help. Opens doors.	Knows own gender identity. Buttons and unbuttons clothing. Washes hands without help. Pours well from small pitcher. Spreads with knife. Toilets without help.	Laces shoes. Follows instructions given in a group. Uses knife to cut food. Can help set table. Can help in simple food preparation. Knows name of city she lives in.

 

Now that you are familiar with what all you can expect, you may also be curious about what not to expect, in other words – red flags to look out for. Given below is a brief list, but again there’s no need to panic if any such observation is made and a professional consult is always a smart choice.

Red Flags – Early Identification Guide

Area	6 months	9 months	12 months	18 months	2 years	3 years	4 years	5 years
Social emotional	Does not smile or interact with people	Not sharing enjoyment with others using eye contact or facial expression	Does not notice someone new Does not play early turn-taking games (e.g. peekaboo, rolling a ball)	Lacks interest in playing and interacting with others	When playing with toys tends to bang, drop or throw them rather than use them for their purpose (e.g. cuddle dolls, build blocks)	No interest in pretend play or interacting with other children Difficulty noticing and understanding feelings in themselves and others (e.g. happy, sad)	Unwilling or unable to play cooperatively	Play is different than their friends
Communication	Not starting to babble (e.g. aahh; oohh)	Not using gestures (e.g. pointing, showing, waving) Not using two part babble (e.g. bubu, dada)	No babbled phrases that sound like talking No response to familiar words (e.g. bottle, daddy)	No clear words Not able to understand short requests (e.g. ‘Where is the ball?’)	Not learning new words Not putting words together (e.g. ‘push car’)	Speech difficult for familiar people to understand Not using simple sentences (e.g. ‘Big car go’)	Speech difficult to understand Not able to follow directions with two steps (e.g. ‘Put your bag away and then go play’)	Difficulty telling a parent what is wrong Not able to answer questions in a simple conversation (e.g. ‘What’s your name? What do you like to watch on TV?’)
Cognition, fine motor and self-care	Not reaching for and holding (grasping) toys Hands frequently clenched Does not explore objects with hands, eyes and mouth Does not bring hands together at midline	Does not hold objects Does not ‘give’ objects on request Cannot move toy from one hand to another	Does not feed self finger foods or hold own bottle/ cup Unable to pick up small items using index finger and thumb	Does not scribble with a crayon Does not attempt to stack blocks after demonstration	Does not attempt to feed self using a spoon and/or help with dressing	Does not attempt everyday self care skills (such as feeding or dressing) Difficulty in manipulating small objects (e.g. threading beads)	Not toilet trained by day Not able to draw lines and circles	Concerns from teacher about school readiness Not able to independently complete everyday routines such as feeding and dressing Not able to draw simple pictures (e.g. stick person)
Gross motor	Not holding head and shoulders up with good control when lying on tummy Not holding head with control in supported sitting	Not rolling Not sitting independently/ without support Not moving (e.g. creeping, crawling) Not taking weight on legs when held in standing	No form of independent mobility (e.g. crawling, commando crawling, bottom shuffle) Not pulling to stand independently and holding on for support	Not standing independently Not attempting to walk without support	Not able to walk independently Not able to walk up and down stairs holding on	Not able to walk up and down stairs independently Not able to run or jump	Not able to walk, run, climb, jump and use stairs confidently Not able to catch, throw or kick a ball	Not able to walk, run, climb, jump and use stairs confidently Not able to hop five times on one leg and stand on one leg for five second

Red flags at any age:

• Strong parental concerns
• Significant loss of skills
• Lack of response to sound or visual stimuli
• Poor interaction with adults or other children
• Lack of, or limited eye contact
• Differences between right and left sides of body in strength, movement or tone
• Marked low tone (floppy) or high tone (stiff and tense) and significantly impacting on development and functional motor skills

Developmental Screening is encouraged at every stage to ensure that your child is growing, adapting and learning at the pace expected from that specific age group. Even if a child experiences delay, there are several interventions that can assist the child in overcoming or adjusting in order to have a better outcome than can be expected if left to his/her own devices. Please feel free to contact us for a better understanding of developmental screening.

Congratulations! You just became parents and gazing ecstatically at the tiny bundle of joy in your arms, you wonder if you are completely prepared to nurture this tiny life and does your knowledge of each milestone that seems to pass by in a blink, feels slightly inadequate. In preparation, you had read numerous books and browsed innumerable articles on pregnancy and new born care and yet chances are that they hadn’t entirely prepared you for this overwhelming rollercoaster joyride.

It takes a village to raise a child and while that might not be viable in the modern society today, especially given the social distancing norms during a global pandemic; ‘Well Baby Visits’ come to your rescue to help you navigate this exciting and fruitful journey of new parenthood.

Simply said, a Well Baby Visit is a check-up at birth, 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and 24 months, and annually thereafter. But the discoveries you make during this visit is what will keep you happily coming back over and over. With each visit you witness your baby’s growth in evident statistics – baby’s height, weight and head circumference. At a Well baby Visit, no question is a silly question. As a pediatrician, I encourage parents to voice all their concerns, is the baby sleeping enough, is s/he feeding and pooping enough, even the color and consistency of that poop, no kidding! Well Baby Visits are great opportunities to develop insights into
your child’s healthy development. And I would like to know how you’re doing, too. Your health and well-being are just as important as your little one’s are.

Let’s take a quick look at what all parameters I assess during these visits and how they can help you in
understanding the baby’s wellbeing status:

• Developmental milestones: In the first year the baby changes every month. Since there are so many developmental milestones in such a short period of time, I apprise you when to expect each milestone such as tiny smiles, establishes eye contact, supports neck independently, mimics facial expressions, budding teeth, uses her/his thumb and forefinger to pick up small items, crawling and so many more. These observations help to assess their cognitive, emotional and social development.
• Vaccination: Some vaccines are administered at birth and for the others, the parents are given a schedule chart to anticipate and be prepared for the Well Baby Visits that involve the nerve-wracking pricks. I can talk you through the process and ease your concerns about any side effects such as pain or fever, how to manage it and how to sooth the baby. Vaccinations are absolutely essential to prevent illnesses like measles and whooping cough (pertussis) and 12 other serious diseases. It is one of the best things you can do to protect your child and community.
• Baby’s growth: You might faintly notice the growth spurts now and then or on the contrary, imagine the baby isn’t growing at an expected pace. During Baby Well Visits, I plot all measurements on a growth chart and compare it to standard benchmarks to ensure the baby’s growth curve is on track.
• Physical Examination: – A complete head-to-toe examination is performed. If the parents proactively don’t offer questions, I like to ask parents what the baby can do physically appropriate to his/her age, such as lift the head briefly, respond to loud sounds etc. I check if the fontanels (soft spots on your baby’s head) are closing properly. I check for fluid or infection in baby’s ears. I look inside baby’s eyes with ophthalmoscope and as s/he grows, I track eye movements and observe response to voices. The mouth is checked for cleft palate or oral thrush which is an easily treatable yeast infection and for signs of teething such as more than normal drooling or chewing. Skin conditions such as rashes are also assessed. I also look for any abnormal heart sounds (murmurs) or rhythms or breathing difficulties. And by gently pressing the belly I assess any tenderness, enlarged organs or unusual masses. The legs are checked for dislocation or issues with hip joints. And the genitals are checked for tenderness, lumps or signs of infection. Early diagnosis of a health issue goes a long way in better treatment and quicker recovery.

Cruising uncharted waters can be a scary experience and parenthood shouldn’t feel like that. Confident in the knowledge of your baby’s steady growth and development and armed with the healthy statistics charted in Well Baby Visits, you’ll be well assured of your role as the care giver and nurturer.

Your baby is precious and I acknowledge it with my undivided attention and high-quality medical care because the early developmental months and years are the foundation to a healthier and brighter future. Let’s make your Well Baby Visits a reassuring experience and resolve any bumps on the way together.

We hope to see you soon!