NEW BORN BABY INTELLIGENCE-ALL ABOUT IT

INTRODUCTION:
A NEW BORN BAY' INTELLIGENCE DEPENDS UPON ITS INHERENT ABILITIES,&MANY OTHER EXTERNAL INFLUENCING FACTORS..ANY OR MANY OF THE FOLLOWING FACTORS MAY INTERFERE WITH THE THE BRAIN DEVELOPMENT &ITS INTELLIGENCE.
1)GENETIC MAKE UP
2)GOOD APGAR SCORE AT BIRTH.
3)INTRACRANIAL HEMORRHAGE.
4)CORD AROUND THE NECK PRIOR TO DELIVERY.
5)FETAL DISTRESS.
6)GOOD HEAD CIRCUMFERENCE AT BIRTH.
7)NO MATERNAL ANEMIA/HYPERTENSION/ MALNUTRITION.
8)GOOD VISION AT BIRTH.
9)GOOD HEARING CAPABILITY AT BIRTH.
10)EXTREMELY GOOD CRY AT BIRTH
(OPENS THE PATENCY OF ALL BRAIN BLOOD VESSELS)
11)GOOD THYROID STATUS (EU THYROID) IN MOTHER &BABY.
12)ENVIRONMENTAL STIMULATION-A CONTINUOUS PROCESS.



G E NE T I C M A K E U P
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GENES ARE ULTRA(ELECTRON )MICROSCOPIC STRUCTURES.WHICH CARRY &PROPAGATE THE INTELLECTUAL CAPABILITY,OF ONE GENERATION TO ANOTHER GENERATION ALONG WITH MANY OTHER QUALITIES GOOD OR BAD ABOUT THE INDIVIDUALS CONCERNED.EDUCATION &INTELLIGENCE ARE NOT THE SAME .
AN EDUCATED PERSON NEED NOT BE INTELLIGENT&VICE VERSA.BUT EDUCATION DOES INCREASE THE INTELLECTUAL LEVEL.MANY UNEDUCATED MAY BE MORE INTELLIGENT THAN THE EDUCATED SO THE INTELLECTUAL TRAIT IS CARRIED FROM ONE GENERATION TO ANOTHER &OFTEN REFLECTED IN A CUMULATIVE MANNER,THROUGH THE GENES,CARRYING
TO POSITIVE PRINT IN THE NEXT GENERATION.TECHNICALLY THEY ARE REFERRED AS RNA,&DNA.THE FIRST GENERATION INDIVIDUAL MAY BE INTELLIGENT IN ONE WALK OF LIFE THE SECOND GENERATION COULD BE INTELLIGENT IN ANOTHER FIELD.THE THIRD GENERATION WILL HAVE INTELLIGENCE OF ITS OWN PLUS THE PREVIOUS TWO GENERATIONS INTELLIGENCE.THIS IS HOW THE INTELLIGENCE TREE KEEPS GROWING.

G O O D A P GA R S C O R E A T B I R T H.
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THIS MEANS THE CRY, COLOUR, ACTIVITY,REFLEXES,HEART RATE RESPIRATORY RATE ARE NORMAL WITHIN 10 Mts OF BIRTH&THAT THERE IS NO ASPHYXIA WHICH MEANS1)THE BRAIN BLOOD VESSELS ARE NOT PATENT ,OR NOT FULLY OPEN ,2)THERE IS NO ENOUGH OXYGEN SUPPLY TO THE BRAIN CELLS,3)THERE IS POOR GAS EXCHANGE IN THE LUNGS,WHICH MIGHT NOT HAVE EXPANDED FULLY.ULTIMATELY O2 SUPPLY TO BRAIN DECIDES THE NUMBER OF NEURONAL CELLS TO BE ACTIVE OR INACTIVE THE INACTIVE CELLS IF NOT PROPERLY OXYGENATED WITHIN 10-20 Mts WILL DIE & BECOME A SCAR THAT WILL LEAD ON TO THE DEVELOPMENT OF A CEREBRAL PALSY,LEADING TO MENTAL RETARDATION.

CEREBRAL PALSY MEANS ,PARALYSIS, OR MALFUNCTION,&PARTIAL OR TOTAL LOSS OF FUNCTION OF NEURONS AT CEREBRUM TO LACK OF BLOOD SUPPLY LEADING TO INSUFFICIENT OXYGEN ,TO NEURONS LEADING TO AN ALTERATION OF MUSCLE TONE&LOSS OF INTELLECTUAL FUNCTION LEADING TO,MENTAL RETARDATION OF VARIABLE DEGREES FROM POOR ACADEMIC PERFORMANCE TO TOTAL IDIOCY,OFTEN WITH INCREASED SPASTICITY OF ALL MUSCLES(ALSO KNOWN AS LITTLE'S DISEASE)(LITTLE WAS AN OUTSTANDING ORTHOPEDIC SURGEON IN THE WHOLE OF EUROPE WHO DISCOVERED THAT CEREBRAL PALSY IS DUE TO ASPHYXIA NEONATORUM &NOT PRIMARILY AN ORTHO CONDITION--THANKS TO DR LITTLE WHOSE OBSERVATION WAS BETTER THAN AN OBSTETRICIAN OF YESTER YEARS.


INTRA CRANIAL HAEMORRHAGE:
MANY NEW BORN BABIES SUFFER FROM THIS DISORDER, MAINLY DUE TOA A DEFICIENCY IN THE COAGULATION MECHANISM(FACTOR DEFICIENCY),AND THIS IS DUE TO A GENETIC DISORDER.THE HEMORRHAGE AGAIN IS VARIABLE AS PER THE QUANTITY OF THE DEFECT.INTRAVENTRICULAR HEMORRHAGE IS THE SEVEREST OF ALL,PRODUCING VERY MANY CNS COMPLICATIONS,SUCH AS FITS,SPASTICITY OF MUSCLES ,PARALYSIS,INTELLECTUAL DEFECT OF VARIABLE DEGREES.

FETAL DISTRESS:

OCCURS DURING ANTIPARTUM OR AT INTRAPARTUM PERIOD.SEVERE FETAL DISTRESS LEADS TO RESPIRATORY OR METABOLIC ACIDOSIS.CAN OCCUR IN THE FOLLOWING CONDITIONS:

1)INTRUTERINE GROWTH RETARDATION.
2)POST DATED GESTATION.
3)MATERNAL DIABETES MELLITUS
4)RHESUS SENSITISED PREGNANCY.
5)PREVIOUS H/O OF STILL BIRTH.
6)MATERNAL HYPERTENSION
7)FETAL HYPOXIA.
8)MATERNAL FEVER.
9)MATERNAL HYPERTHYROIDISM
10)FETAL ANEMIA, ARRHYTHMIA
11)PLACENTAL TRANSFER OF DRUGS
12)SLEEP STATE
13)PREMATURITY.

ALL THE ABOVE LEAD TO LESS BLOOD SUPPLY TO BRAIN RESULTING IN LESS OXYGEN SUPPLY TO CEREBRAL NEURONS THAT CAN JEOPARDISE THE INTELLECTUAL DEVELOPMENT

GOOD HEAD CIRCUMFERENCE AT BIRTH
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A BABY SHOULD HAVE AT LEAST 35 CM OF HEAD CIRCUMFERENCE.AT BIRTH.
1-2 CM LESS OR MORE ,MAY BE CONSIDERED AS VARIATIONS.ANYTHING LESSER MAY MEAN MICROCEPHALY &ANYTHING MORE MAY MEAN HYDROCEPHALUS, & NEEDS SERIAL MEASUREMENT FOR ASSESSMENT.&BOTH WILL AFFECT THE INTELLIGENCE GROSSLY.IN MICROCEPHALY IT IS NON DEVELOPEMENT,&IN HYDROCEPHALUS IT IS NEURONAL CELL DESTRUCTION BY THE SURROUNDING CSF PRESSURE THUS THE INTELLIGENCE DEVELOPMENT IS AFFECTED EVEN AT FOUNDATION LEVEL OF THE FUTURE CONSTRUCTION.

MATERNAL ANAEMIA/HYPERTENSION'S/MALNUTRITION.
MATERNAL ANAEMIA WILL LEAD TO FETAL ANAEMIA RESULTING IN POOR DELIVERY OF OXYGEN TO DEVELOPING NEURONAL CELLS THROUGH HEMOGLOBIN.AN ANOXIC CELL IS A WEEK CELL.HYPERTENSION WILL LEAD TO EXESS BLOOD FLOW&HEMORRHAGIC TENDENCY RESULTING IN CELL DEATH. MALNUTRITION WILL AFFECT CELL ANABOLISM AS PROTIEN IS NECESSARY FOR CONSTRUCTION&CARBOHYDRATE FOR FUEL.ALL THESE CONTRIBUTE FOR A POOR QUALITY NEURONAL CELL GROWTH &DEVELOPMENT OF INTELLIGENCE IS VERY DIFFICULT IN SUCH A DAMAGED CELL.

GOOD VISION AT BIRTH.
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EYE IS SAID TO BE THE WINDOW OF THE BRAIN.MOST OF THE INFORMATION ENTERS INTO THE BRAIN VISUALLY&IS STORED LIKE A COMPUTER CHIP.INTELLIGENCE IS NOTHING BUT A COLLECTION OF INFORMATION,STORED, &RE UTILISATION OF THESE INFORMATION WHEN NECESSARY. OF THE NATURES FIVE GIFTED SPECIAL SENSES ,VISION IS BY FOR THE BEST.CHILDREN ARE GIVEN AUDIO VISUAL STIMULI TO IMPROVE THE INTELLECTUAL CAPACITY,DURING THEIR ATTEMPT TO LEARN.VARIOUS CONGENITAL EYE DEFECT MAY CONTRIBUTE DEFECTIVE VISION,LEADING TO INTERFERENCE WITH INTELLIGENCE FORMATION Eg :CONGENITAL CATARACT IN RUBELLA SYNDROME.

GOOD HEARING CAPABILITY :
WHEN DOES A NEWBORN START HEARING? WHEN CAN IT START SEEING?
BOTH ARE PRESENT AT BIRTH.IN FACT CAN HEAR &APPRECIATE SOUND WHEN IT IS IN UTERO WHEN A PREGNANT MOTHER SINGS THE BABY IS SUBJECTED TO THE VIBRATION TRANSMITTED THROUGH THE AMNIOTIC FLUID&THUS GETS USED TO SOUND APPRECIATION,UNLESS THERE IS A NEUROLOGICAL DEFICIT,OR A HYPOTHYROID STATE, AS SOON AS THE BABY IS BORN IT CAN OPEN THE EYES &SEE THE SURROUNDINGS AS IT WAS IN A DARK WORLD FOR NINE MONTHS&APPRECIATE THE PHOTIC STIMULATION OF THE EXTERNAL WORLD.BERA IS THE LATEST SOPHISTICATED TEST TO FIND OUT IF A BABY IS DEAF,THE TEST FINDS OUT IF THE SOUND WEAVES REACH THE BRAINCELLS.
USUALLY AT AGE 30 DAYS A NEW BORN BABY IS ABLE TO 1)VISUALISE AN OBJECT&FIX THAT OBJECT2)OR VISUALISE A SPOT FROM WHERE A SOUND IS COMING.3)IT CAN EVEN COMMUNICATE WITH AN OBJECT WHICH IS MAKING/CREATING A SOUND BY MAKING THROTY SYLLABLES .IF ALL THE THREE ABOVE FINDINGS ARE NOT PRESENT UPTO 90 DAYS A PEDIATRICIAN SHOULD SEE THE BABY.

EXTREMELY GOOD CRY AT BIRTH:
IT IS A SENSIBLE PRESUMPTION THAT IF A BABY CRIES VERY LOUDLY FOR A PROLONGED PERIOD &IF REPEATEDLY KEEPS CRYING THERE IS A THEORETICAL POINT THAT ALL BLOOD VESSELS IN THE BRAIN OPENS &BLOOD SUPPLY TO NEURONES MADE EASY. AT BIRTH ALLTUBES/DUCTS/VESSELS ARE NOT PATENT.SO THE ESTABLISHMENT OF PATENCY OF ALL BRAIN BLOOD VESSELS IMPERATIVE FOR ITS ULTIMATE INTELLECTUAL CAPABILITY DUE TO BETTER BLOOD SUPPLY THAT YIELDS BETTER OXYGEN WHICH IS THE MAIN FOOD FOR ALL CELLS ,SPECIALLY THE NERVE CELLS.

SO WE CAN PRESUME THAT A BABY AT BIRTH CRYING LOUDLY AT BIRTH IS DIFFERENT FROM A BABY NOT CRYING MUCH. THIS OF COURSE CAN BE PROOVED BY A RETROSPECTIVE STUDY.THE MORE LOUD THE BABY CRIES ,MORE PINK THE COLOUR WILL BE INDICATIVE OF BETTER LUNG FUNCTION/EXPANSION,BETTER OXYGEN CO2 DISSOCIATION, BETTER BLOOD SUPPLY TO ALL ORGANS OF BODY,INCLUDING BRAIN.IF THE OPPOSITE BEFALLS ,DEVELOPEMENT OF MENTAL RETARDATION IS A STRONG POSSIBILITY..

CORD ROUND THE NECK:
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ABOUT 5-10% OF BABIES NECK GET ENTANGLED IN THE UMBILLICAL CORD WHILE FLOATING IN THE AMNIOTIC FLUID INSIDE THE SACK.SOMETIMES IT MAY LEAD TO A STRANGULATING EFFECT CAUSING FETAL DISTRESS SPECIALLY WHEN THE CORD GOES TWICE OR THRICE AROUND NECK..THIS CAN LITERALLY CAUSE ASPHYXIATION
IN UTERO OR PERINATALLY WHEN COMES OUT PER VIA NATURALIS.DEPENDING ON THE TIGHTNESS OF THE CORD AROUND THE NECK THE OUTCOME IS ALSO VARIABLE.MOST SUCH BABIES ARE BORN WITH VERY LOW OR ZERO APGAR SCORE WHEN IT BECOMES A CHALLANGING TASK FOR THE NEONATOLOGIST TO REVIVE &
RESUCITATE THE BABY. ONLY AN EXPERIENCED PERSON ALONE CAN SUCCESSFULLY RESUCITATE SUCH BABIES TO 100%

GOOD THYROID STATUS IN MOTHER &BABY
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THYROID IS A DUCTLESS GLAND PRODUING THYROXIN A HORMONE INTRICATELLY INTEGRATED WITH INTELLIGENCE.NO THYROID MEANS NO INTELLIGENCE .ALSO IT HAS INFLUENCE OVER ALL THE BODY TISSUES. ITS ABSENCE WILL SELECTIVELY CAUSE BRAIN &BONE DAMAGE IN THE FORMATIVE YEARS.THYROID DIFFICIENCY CAN BE CLINICALLY DIAGNOSED IN 3-6 MONTHS AGE GROUP BABIES.&IS FULLY RECTIFIABLE BY CONTINUOUS THYROID TREATMENT.

Rh-INCOMPATIBILITY.
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IF MOTHER IS Rh NEGATIVE, &FOETUS Rh POSITIVE,ABOUT 2-10 % BABIES CAN DEVELOP BLOOD GROUP INCOMPATIBILITY, LEADING TO RBC DESTRUCTION, &CONSEQUENT IRRVERSIBLE BRAIN DAMAGE WITH JAUNDICE ,MUSCLE SPASM, FITS, &MENTAL RETARDATION.

ENVIRONEMENTAL STIMULATION:MOST IMPORTANT CONTINUOUS PROCESS.
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A CHILD'S BRAIN DEVELOPEMENT DEPENDS ON THE FOLLOWING GROSS FACTORS APART FRI=OM THE AFORESAID CAUSES.:-
1)BRAIN MASS MUST GROW &THE SKULL BONES MUST ALLOW THIS ENLARGEMENT/EXPANSION &ACCOMODATE BIGGER MASS BY SUITABLY INCREASING THE INNER SKULL SPACE.
2)THE VARIOUS NUTRITION FACTORS &THYROXIN HELP INTHE BRAIN MASS INCREASE.
3)BY APPROPRIATE STIMULATION OF ALL FIVE SPECIAL SENSES THE CORTICAL NEURONES STORE THE INFORMATIONS RECIEVED FROM TIME TO TIME IN THE FORM OF A' FUNCTIONAL' LAYER ,COMPARABLE TO A COMPUETOR CHIP.THE STIMULI RECIEVED KEEP INCREASING IN NUMBER &QUALITY AS TIME PROGRESSES. BEFORE LEARNING WORDS &SENTENCES BABY LEARNS THE SYLLABLES,LIKE A B C ,WITH PHONATION,THIS SYSTEMATIC WAY OF LEARNING IS A MUST TO SHOW GROWTH &PROGRESS.

STORY OF WOLF RAMAN
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THIS IS A TRUE STORY OCCURED AT VELLORE-TAMILNADU-INDIA.
PUBLISHED ALL OVER THE WORLD IN ALL NEWSPAPERS 50 YEARS BACK.
A CHILD AGED ABOUT 5 WAS FOUND MAKING NOICE &JUMPING LIKE WOLF IN A JUNGLE SPOTTED BY FEW HUNTERS, WHO BROUGHT CHILD FROM JUNGLE TO CMC HOSPITAL.VARIOUS SPECIALITY DOCTORS FROM VARIOUS PARTS OF THE WORLD
POURED INTO CMC TO SEE &STUDY THE BABY.INTER NATIONAL SYMPOSIUM WERE CONDUCTED..EXCEPT FOR THE EXTERNAL FEATURES OF A HUMAN CHILD BOYHAD ALL THE CHARECTERS OF ANIMALS ONLY &DIED IN HOSPITAL IN ABOUT 2MONTHES PROBALY DUE TO ENVIRONMENTAL SEPERATION

DISCUSSION:
THIS CHILD MUST HAVE BEEN ABDUCTED FROM A VILLAGE BY A WOLF/FOX,OR MUST HAVE BEEN ABANDENED BY A MOTHER AFTER AN ILLEGITIMATE PREGNANCY.THIS CHILD NEVER HAD ANY STIMULATION FROM HUMANS AT ANY TIME..WHAT WAS STRICKINGLY OBVIOUS WAS IT POSSESSED ALL THE CHARECTERS OF ANIMAL&NOTHING FROM HUMANS..
THIS EXPLAINS HOW AN ENVIRONE MENT IS IMPORTANT IN SHAPING FOR ITS INTELLECTUAL STIMULATION,FOR ITS ULTIMATE BRAIN GROWTH QUQLITATIVELY EMOTIONALLY FOR ITS INTELLECTUAL OUTCOME.
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SRM Specialty Hospital
SRM University
Ramapuram – Chennai
Tamilnadu – India

Neonatal Resuscitation New Concept

STATISTICS

1.Asphyxia > 900000/- year W.H.O 2000-2003.
2.23% of Neonatal deaths are Asphyxia Lancet 2005
3.4 million Neonatal death – World wide.
4.Neonatal death 20% China – 2005 developed countries have protocols/programmes like CME.
5.CPincidence – 2 per 1000 population
6.Asphyxia – Mortality More than morbidity.
7.CP- Prevalance 4 per 1000 live births.
8.One – out of 4 ‘bad’ babies – CP

ASPHYXIA
1. What is Asphyxia literally?
2. Is it a misnomer here?
3. Is it a CNS depression due to
bio-chemical metabolic change?
4. Can we call all cyanosis as
asphyxia?
5. What is asphyxia Neonatorum?

Pertinent Questions-NRT
►What is it?
►Where is it done?
►How is it done?
►Who can do it?
►What are the required Equipments?
►What is Asphyxia Neonatorum?
►Is “Asphyxia” a right word here?
►What are the ill effects of failure of NR (Littles’ disease)
►Can we correct it to 100% if so how?

Good Old Dictum – ABC

What is A/B/C?
If no cry or respiration
a) Intubations by ET tube.
b) Oxygen by catheter / mask / hood
c) Ambu bag inflation / deflation.
d) Positive pressure ventilation.
e) Neonatal intensive care unit admission
Is it all necessary?
Does it yield the desired fruit?
If not why should we dothe same?
Why should not we change for better?

New Technique (Designed by author)

“Old Order changeth,
Yielding place to new”
PNEUMONICS : TTDS (Forget ABC)
•T : Thirupathi
•T : Thirumala
•D : Devasthanam
•S : Sanctorum

Further Expansion

T FOR TACTILE - EMBRACES
a. Tapping Baby’s back
b. Tapping Baby’s soles
c. Tapping Baby’s Toes
d. Squeezing Baby’s Ear Lobe with gauze
e. Pushing left index finger into baby’s left molar
f. Squeezing chest through Axillae
g. “Feel of Bite” Sense: Massester Muscle Tone.

T For Tracheal - Embraces

•NG Tube Stimulation through Nose / Mouth.
•NG Tube Stimulation at Tracheal opening.
•Tracheal Suction without ET Tube
•Aim 1. Stimulation by touch
2. Suction of Aspirated
Amniotic fluid, Meconium,
Vernix casseosa

D For Drugs - Embraces
Drug stimulation by following drugs.
a.Glucose 10 – 20 %
b.Soda Bicarb 7.5% 99%
c.Beclamathasone inhaler by Special tubing + Thoracic Squeezing in Rhythmic fashion – 0.75%
d.Adrenalin
e.Deriphylline
f.Dexamethasone – Inj – If necessary

TTDS – Success rate 100% - If
1.FH was present 5 minutes before delivery
2.No cord around the neck more than Twice.
3.No cardiac / Pulmonary / CNS / Tracheobronchial anatomical abnormality.
4.No Hiatus hernia.
5.No birth weight below 1200 gms
6.No RDS / Foetal aspiration syndrome / HMD.
7.No previous H/O foetal death
8.No Maternal diabetes / hypertension / drug withdrawal
9.No Spinal shock due to spinal anaestheria
10.No Apgar score at 0 in first 5 mts.
11.No “feel of bite” at any time during resuscitation .
12.No Placenta Previa

A. Resuscitation Team - Work Assignment

1. Baby receiving
2.Baby positioning – Neck rest – head down
3.Warmer light
4.Suction machine – On / off
5.Chest compression / Tactile Stimulation.

B. Time Keeper
1.Notes birth time
2.Announces every minute by counts.
3.Announces HR / RR - Every Minute
4.Pulse Oxymeter Reader every minute
5.Venesection instruments.
6.umbilical cathetrisation – IV drip.

C. Equipment Procurement
1.Soda Bicarb
2.25% Glucose
3.Deriphylline
4.Dexamethasone
5.Beclamethasone Inhaler
6.Laryngoscope
7.suction catheters / Sterile Hand gloves - Size
8.NG tube size 5,8
9.Butterfly needle – No. 24

10. 20 ml / 5ml syringe
11. Needle No. 26.
12. Vitamin K
13. Styptochrome
14. Calcium
15. Diazapam
16. Epsolin
D. Resuscitator / commander / Chief coordinator (Doctor)

Baby Crying Score (designed by author as per the cry duration in seconds / minutes)

n0 - No cry at Birth and at any time
n1- 3 Average cry (5-10 Sec after each stimulus)
n4- 6 Good cry (> than 15 sec after stimulus interruptedly for 2 hrs)
n7- 9 Very Good luxurious cry > 30 seconds after each stimulus for 6 hrs or more.

Score 5 & above – Excellent cry - brain blood vessels – open fully.
If no cry - asphyxia develops? (cyanosis)
Asphyxia – causes CP / MR / Low academic performances
Behaviour problem like ADHD

Trump card of Neonatal Resuscitation if there is substandard cry

§Tracheal Suction
§Thoracic Squeezing
§Correction of Hypoglycemia
§Correction of Acidosis
§If child cries immediately after NaHCo3 it means uncorrected metabolic acidosis - now corrected

Drug Dose

ØFirst Shot : NaHCo3 (5ml) + 10% Glucose (5 ml) intra umbilically
ØSecond shot : If there is no satisfactory cry repeat same after 5 minutes.
ØRepeat Every 5 minutes for 3-5 times according to necessity.

Aggressive Neonatal Resuscitation Indication

Born as if still birth.
Born with low Apgar Below 5 after 5 minutes
Obvious Cyanosis
No cry for 5 minutes after delivery.
Gross Hypotonicity generalized
HR < 60 / Minute
RR < 16 / Minute
Precious Child

Procedure

Continuous chest compression & Tracheal Suction
Beclamethosone inhalar through tube
NaHCo3 + 25% Glucose – Large dose
Umbilical Venous Cathetrization
Defibrillation – When all measures fail.

Author’s

►Professional Experience : 45 years
►Pure Pediatrics experience : 35 years
►100% success rate in NRT : 20 years

Thank You

neonatal resusitation technique-new concept

CHILD PSYCHOLOGY FOR PARENTS.

PRACTICAL PEDIATRIC PSYCHOLOGICAL COUNSELLING FOR PARENTS.
We have to concentrate on 4important points only:
1)children hate parental control.
2)children have interest in socialisation.
3)bad society /bad friendship often turns good into spoiled children.
4)child gives priority to fraternal control than maternal.


PARENTAL CONTROL.
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EVERY CHILD STARTS LEARNING RIGHT FROM BIRTH SOMETHING EVERY HOUR &EVERY DAY
Parents have to provide suitable opportunity,for environmental stimulation for such learning&it is a continuous process,never ending as long as brain functions keep steering
in the normal way.Generally child wants to be independent age 2.They want to eat themselves,though they will do it in a clumsy way. they get used to in due course.
The 2-3 year age group is bestowed with boundless energy&they can be controlled only when their energy level comes down,after a physically tiresome play..When father returns home child will take the privilege of playing with father in an aggressive way.Father is expected to control his emotions.Sizable number of fathers return home fully boozed.Drunken man can not be expected to know how to behave with a child.The result is a gradual demoralisation of child ending up in a child with low I.Q.,OR LOW ACADEMIC PERFORMANCE,or become a school dropout.Beating such children will not only worsen the situation,but may lead to a psychological breakdown situation There after it is not retrievable most often&that is the end.
so prophylaxis is better than cure.

SOCIALISATION;
Animals are social&man is a social animal.From early child hood he wants to play with other children.or pet animals.This is not practicable in U.S.A..(Playing with pet animals is contraindicated)The culture in India differs in this respect with U.S.A


children US see other children only in parties once a month.otherwise there imprisoned inside
4 walls.only person to see is mother.few children are privileged to go to daycare centers.
JAMBOREE where they see other children&many play equipments..In major hospitals,specially teaching institutions,there is a department known as occupation therapy..meant for mentally &physically retarded children.Even normal children can be exposed to this department&can be found beneficial in sharpening the mental make up of children without any doubts

BAD FRIENDSHIP

Tell me your friend,I will tell your character,is an old proverb.Child grownup child,early adolesents dont know how to select good friends.It is the duty of parents to advise them about their friends&how to choose good from the bad.Children naturally make friendship with high scoring children only if they themselves are high scorers.this HAS TO BE CONFIRMED BY PARENTS,NOW &THEN

parents SHOULD ORGANISE PARTIES ONCE IN A WAY FOR THE CHILD'S SAKE.This provides an opportunity

to study the character of the child's "friends circle".
This should be maintained till child enters college ADOLESCENT AGE IS ONE OF THE MOST DIFFICULT PART OF A CHILD'S DEVELOPMENTAL STAGE.&IS OFTEN A CHALLENGING TASK.

Boy or girl,they are very defiant often &parents have to make right decision to have a good command &control over the child.If not they should seek the help of school teacher or headmaster, or a senior educated relative or even police as the last measure.If child is brought

up well &moulded properly from early childhood.all these things may not be necessary


CHILD IS MORE OBEDIENT TO FATHER THAN MOTHER
In the absence of father ,he very obedient to mother.When father returns home at 6 pm,he is relatively less obedient to mother.This should be considered as a sign of intelligence.&no abuse or threat to be used,towards the child.Obedience is one the most important mental faculty
required to be developed gradually.As age advances,different technique to be used to inculcate discipline.Abusing &beating should never be resorted to ,at any age,as it would only further deteriorate there situation.Parents should approach intellectually to control stubbornness.If they do not know let them go to a pediatric psychologist.Small threatening measures like "TIME OUT" may be practiced whenever they do a wrong thing,&to make them understand,what is right.Intelligence level keeps on increasing every year.&by about age 5 they should obey 100%IF CONTRARY IS FOUND,CONSULT PSYCHOLOGIST.Children like parents always to be smiling &playful towards them(irrespective of their own mental conflicts This may be difficult though.on such occasions parents require PATIENCE.Keep the children always in playful activity,or some kind of useful,intellectual occupation,so that children become less mischievous,or less boisterous.All these are easy to preach but difficult to practice.

NEWMUMS DOUBTS ABOUT HER NEW BORN-CLARIFIED

1)CRY
GENARALLY THIS IS A NORMAL SIGN OF LIFE.SOMETIMES IT IS ABNORMAL &NEEDS DOCTOR'S DIAGNOSIS.
SEE MY ARTICLE-CRY-60 CAUSES IN THIS BLOG.
VISIT MY ARTICLE ENTITLED- 4-8 PM SYNDROME IN THIS BLOG.
2)VOMITING.MOSTLY ,IT IS REGURGITATION DUE TO IMPROPER BURPING.WHEN BABY SWALLOWS MILK,IT DOES ALONG WITH SOME AIR ALLWAYS.THAT HAS TO COME OUTBY BURPING.(PUT BABY ON SHOULDER &TAP GENTLY ON BACKTILL GASS COMES UOT 2-3 TIMES..IF IT IS VOMITING IT MAY BE DUE TO STOMACH INFECTION DUE
TO AMNIOTIC FLUID SWALLOWING.RARELY IT MAY BE BRAIN RELATED.ALSO IT CAN BE DUE TO IMPROPER (LESS) DEFECATION OF MECONIUM(MECONEUM ILEUS SYNDROMEWHEN VOMITING CAN LAST FOR 3-5 DAYS.RELIEF OBTAINED MEDICALLY /SURGICALLY.
3)CONSTIPATION:FIRST BLACK STOOL(MECONEUM)PASSED UPTO 3DAYS.GOLDEN YELLOW COLOUR FROM FOURTH DAY..IF NO MOTION LOOK FOR VOMITING /ABDOMINAL DISTENSION.SUSPECT CONGENITAL DEVELOPEMENT PROBLEM OF INTESTINES.SOMETIMES ATRESIAS.SOMETIMES HISPRUNG'S DISEASE.SOMETIMETIMES PASSING MOTION ONCE IN 10-15 DAYS CAN BE NORMAL!(ILLINGWORTH)
4)STRAINING:DURING DEFECATION/MICTURITION.THIS IS NORMAL.BAY IS EXPLORING NEW KNOWLEDGETHAT STRAINING RELIEVES BOWEL/BLADDER!.
5)URINATION:URINE IS HOT.--NORMAL
6)FEEDING50% OF BABIES DONT FEEDPROPERLYDUE TO:
A)LACK OF BREAST FEEDING TECHNIQUE&POSITION.
B)RETRACTED NIPPLES.
C)INSUFFICIENT HYDRATION&MATERNAL NUTRITION
D)SOMETIMES OBSTRUCTION TO MILK FLOW DUE TO THICK COLOSTRUM(TAMIL-SEEM-PAAL)
7)UMBILICAL STUMP:USALLY FALLS ON SEVENTH DAY.SOMETIMES MAY STAY UPTO21 DAYS!,WHEN IT IS REMOVED SURGICALLY.BEWARE OF UMBILICAL SEPSIS.DONT RUSH TO GIVE BATHBEFORE 15 DAYS.CAN GIVE SPONGE BATH INSTEAD.CLEAN AXILLA,GENITALS,NECK ONLY.
8)BATH:GIVEN 3 DAYS AFTER FALL OF UMBILICAL STUMP.NO OIL BATH.NO SOAPNUT POWDER USE.NO NEED FOR BATH IN WINTER.DAILY BATH NOT REQUIRED.HEAD BATH ONCE A MONTH IF THERE IS BAD ODOUR.
9)WATER FEEDS GIVEN TWICE DAILY BETWEEN FEEDS.
10)DONT DO OILING TO EAR /NOSE.
11)CASTEROIL/PURGATIVES USE-CONTRAINDICATED.
12)SKIN -OILING.INDICATED IF SKIN IS DRY.
13)TOILET POWDER USE- CONTRAINDICATED.
14)PHYMOSIS:FORESKIN -PENIS MAY HAVE PIN HOLE MEATUS.MAY RQUIRE DILATATION OF FORESKIN
ONLY.
15)BLOOD PER VAGINA-DE TO EXCESS OESTROGENWITHDRAWAL.NO TREATMENT NECESSARY.
16)BREAST ENLARGEMENT,IN EITHER SEX.:ALSO DUE TO HIGH MATERNAL ESTROGEN IN CIRCULATION.
NO TREATMENT REQUIRED.
17)LACRIMATION SOMETIMES DUE TO NASOLACRIMAL DUCT OBSTRUCTION.SOME TIMES NORMAL.
SOMETIMESREQUIRES,MEDICAL PHYSIOTHERAPY/SYRGERY.
18)BLEEDING DIATHESIS:BLEEDING PER NOSE/MOUTH.DUE TO COAGULATION FACTER DEFFICIENCY.
DIAGNOSIS FIRST-TREATMENT NEXT.
19)HEARING:B E R A -SUPER SPECIAL HEARING TEST AVAILABLE FOR NEWBORNS.
20)VISION:CONFIRMED WITHIN 30 DAYSBY PEDIATRITICIANS.

BABY-CRY-TREATMENT TIPS

BABY CRY TREATMENT TIPS:TO JUNIOR PEDIATRICIANS
1)NEVER EXAMINE WITHOUT SEDATION.
2)CAN BOLDLY SEDATE WITH TWO DRUGS,IF NOT SEDATED WITH SINGLE DRUG.
3)AVOID USING TRICHLORYL(TRICHLOPHOS),AS IT MAY PRODUCE RENAL FAILURE IF REPEATED.
4)SAFEST SEDATIVE DRUGS;PHENERGAN,PHENOBARBITONE,DIAZAPAM,LARGACTIL.
5)IF CHILD CONTINUES TO CRY FOR MORE THAN 6 HOURS/DAYS,IF CAUSE IS NOT KNOWN,BRING DOWN TACHYCARDIA BY A DOSE OF DIGOXIN+FRUSAMIDE.I.V..IF THE HEART RATE COMES DOWN,BABY WILL GO TO SLEEP ONLY TO GET UP FRESH TO PLAY ACTIVITY.THE PRESUMPTIVE DIAGNOSIS HERE IS C.C.F.DUE TO VIRAL
MYOCARDITIS.NEEDLESS TO SAY IT MAY REQUIRE OTHER TREATMENT FOR CORRECTING THE CAUSATIVE FACTORS.

BABY-CRY-60 CAUSES

ANY OR MANY OF THE FOLLOWING COULD BE THE CAUSE FOR A BABY'S CRY.COMPLETE &THOROUGH EXAMINATION OF THE NAKED BODY FROM HEAD TO FOOT HELPS DIAGNOSIS.
PERCENTAGE CONSTITUTION.:

A)FIRST 5 =95% B)NEXT 15- =4%.C)NEXT-4O=1%

CAUSES:60 IN NUMBER.

1)HUNGER
2)SLEEP
3)DIAPER CHANGE.
4)ATMOSPHERIC TEMPERATURE
5)DISTURBING ENVIRONMENT-
Eg;TOO MUCH SOUND,PEOPLE TALKING TOO LOUD,CROWDED PLACE.
-------------------------------------------------------
6)VOMITING SENSE
7)GASTRO ESOPHAGEAL REFLUX
8)ACIDITY
9)INTESTINAL COLIC
10)OBSTIPATION/CONSTIPATION
11)URETHRITIS
12)ASOM(MILK ENTERING EARS FROM MOUTH)
13)FOREIGN BODY EYES.
14)ITCHING SENSE
15)ALLERGIC NASAL OBSTRUCTION
16)ALLERGIC BRONCHITIS.!
17)MILK INTOLERANCE.
18)LACTOSE/GALECTOSE INTOLERANCE.
19)ACUTE BRONCHIOLITIS/WHEEZY BRONCHITIS.
20)IRRITATING JEWELLERY/COSTUMES.
--------------------------------
21)FUNGAL INFECTION
22)HEAD LICE/LICE-EYE LASHES.
23)CONGENITAL HEART DISEASE
24)HARE LIP/CLEFT PALATE.
25)HISPRUNG'S DISEASE
26)ANAL STENOSIS
27STRICTURE URETHRA
28)URINARY TRACT INFECTION
29)UROLITHIASIS
30)HAEMATURIA
31)AMINOACIDURIA
32)MAPLE SYRUP URINE DISEASE
33)JET LAG(SLEEP DISTURBANCE)
34)LOW HUMIDITY-UK/USA.CAUSING DRYNESS OF RESPIRATORY MUCOSA.
35)OSTEOMYELITIS
36)PYOGENIC ARTHRITIS.
37)LACK OF MOTHER'S WARMTH-BONDING.
38)IMPROPER BURPING
39)CHILL BLAINS.
40)PUNGENT ODOURS
41)DENTAL ERUPTIONS(AGE AROUND 6 MONTHS)
42)WORM COLIC.
43)CRYSTA LURIA
44)RENAL COLIC
45)CHOLISISTITIS
46)HEPATITIS
47)CRYING CONVULSIONS
48)PRURITIS ANI
49)TORTION TESTIS
50)DIAPHRAGMATIC HERNIA
51)MYOCARDITIS/CCF
52)EMPYEMA
53)SHAKEN BABY SYNDROME
54)SPRAIN NECK(VORUM VIZHUDAL-TAMIL--AGE BELOW 6 MONTHS USUALLY)
55)FRACTURE CLAVICLES(MISHANDLING)
56)INSECT BITE
57)SCORPION STING (SKIN COLDNESS DUE TO PERIPHERAL CIRCULATORY FAILURE)
58)LONELINESS/FEAR COMPLEX
59)FEVER/HYPERPYREXIA
60)BATTERED BABY SYNDROME.