Growth Patterns and Monitoring in Children

The  commonest  question  in  a  parents  mind  is –“Is my child growing well?”A growth  chartplotted at regular intervals is the simplest way to monitor the child’s growth i.e.for a parent to know whether their child is growing wellor there is some problem.

From  birth  to  3years  of  age,  the  baby’s  weight  ,  length  and  head  circumference  needs  to  be measured  and  entered  in  the  child’s  health  card    at  6weeks,  10  weeks,  14  weeks, 6months,  9months,  15  months,  18  months.  Thereafter  every  six  months,  between  the  age  of  3years  to  6years the weight and height should be measured every 6monthly. Beyond 6 years the BMI needs to be calculated every year.The calculation of BMI can be done by using the following formula:

BMI= Weight in kg/(Height in meters)²

Ideally  the  same  weight  and  height  scale  should  be used  for  these  measurements.  Head circumference should be measured by a trained health care worker.

These  measurements  are  to  be  plotted  on  a  growth  chart  to  observe  the  pattern  ofgrowth  and compare with the normal range of growth for same age and sex.These are also known as Road to Health charts.

Please  refer  to  the  icon  for  these  growth  charts.  There  are  a  number  of  curvy  lines  in  each  of these charts. These are reference lines for range of growth for children of our country. These are known as standard growth curves

The  area  between  the  lines -2  and  +2  (or  between  line  of  3  and  97  in  few  charts)  is  the  normal range for children in our country.If the child’s measurement falls in this area then the child is growing in the normal range for that age and sex, also known as the Road to Health. Any reading beyond the two lines is abnormal and needs to be discussed with the doctor.

The  curve  (i.e.  trend)  with  multiple  readings  gives  us  a  much  better  picture  about  the  child’s growth. Children who are growing normally follow a growth curve parallel to one of the standard growth  curves.  Weight  loss  or  failure to  gain weight can be identified by observing the child’s

growth curve over time. When weight “falters” or the growth curve “flattens” and is no longer parallel to the chart line this indicates the need for consulting a Pediatrician.

Refer and plot the child’s weight in the charts(annexed)and monitor your child’s growth.

Milestone Check Of Your Baby

Prenatal Tests @ Which Trimester

Prenatal tests give you information about your health and your baby’s, when you’re pregnant. They help detect any problems that could affect him, like birth defects or genetic diseases. The results can help you make the best health care decisions before and after your child is born.

Prenatal tests are helpful, but it’s more important to interpret what they find. A positive test result doesn’t always mean your baby will be born with a disorder. You must talk with your doctor, midwife, or other health care provider about what the tests mean and what you should do once you have the results.

Doctors recommend some prenatal tests for all pregnant women. Only some women will need other screening tests to check for certain genetic problems.

The following are some of the more common trimester wise tests performed during pregnancy:

First Trimester Prenatal Screening Tests

First trimester screening is a combination of fetal ultrasound and maternal blood testing performed during the first trimester of pregnancy. This screening process can help to determine the risk of the fetus having certain birth defects. Screening tests may be used alone or in combination with other tests.

There are three parts of first trimester screening:

  1. Ultrasound test for fetal nuchal translucency (NT).

  2. Two maternal serum (blood) tests. The blood tests measure two substances found in the blood of all pregnant women: 
    -   Pregnancy-associated plasma protein screening (PAPP-A)--a protein produced by the placenta in early pregnancy. Abnormal levels are associated with an increased risk for chromosome abnormality.
    -   Human chorionic gonadotropin (hCG)--a hormone produced by the placenta in early pregnancy. Abnormal levels are associated with an increased risk for chromosome abnormality.

When used together as first trimester screening tests, nuchal translucency screening and maternal blood tests have a greater ability to determine if the fetus might have a birth defect, such as Down syndrome (trisomy 21) and trisomy 18.

If the results of these first trimester screening tests are abnormal, genetic counseling is recommended. Additional testing such as chorionic villus sampling, amniocentesis, cell-free fetal DNA, or other ultrasounds may be needed for accurate diagnosis.

Second Trimester Prenatal Screening Tests

It's the second trimester, and you've known you are pregnant for some time now. But what can you expect yourself? What tests will you get during the fourth, fifth and sixth months of pregnancy? At an early prenatal visit, you may be asked if you would like genetic testing. Or, if you are aware of a genetic condition in your family or your partner's, you or your partner may opt to get tested before conceiving. Also, your health care professional will talk with you about a variety of prenatal tests to assess the health of the fetus. It's up to you which ones you have done or wants to do. For instance, if you have no intention of terminating the pregnancy if the tests do find a problem, you may want to skip them. However, even then, you may want to have the test so you can prepare yourself emotionally for the possibility of having a special-needs child.

While the tests may get a bit more complicated, it is only because your baby is getting more complex. He or she is growing steadily, forming features that are some combination of you and your mate. While you may have gotten an initial ultrasound during the first trimester to confirm your baby's basic health, it is during the second trimester that an ultrasound may confirm whether your baby is a boy or a girl. Also, this ultrasound will probably be the first in which you can see your baby's features in profile.

Remember, although there is a slight risk of complications with some of these tests, they are routinely performed to help ensure good health for you and your baby. Talk to your health care provider to learn more details about the risks and benefits of these prenatal exams.

There are two types of prenatal tests:

  1. Screening tests and

  2. Diagnostic tests.

Prenatal screening is meant to identify women at an increased risk for the pregnancy to be affected by a disease and Diagnostic prenatal testing is used to confirm whether or not a pregnancy is affected by a given condition.

Serum screening test: This is performed with a blood sample and is usually done between weeks 15 and 18 of the pregnancy (as measured from the start of the most recent menstrual period). The test estimates your risk of having a baby with:

  • An open neural tube defect. When the neural tube fails to close, the baby is born with an opening in the head (anencephaly) or spinal cord (spina bifida). Babies with anencephaly are stillborn or die soon after birth; those with spina bifida need surgery and may be paralyzed. The severity of spina bifida can vary greatly. One way to reduce your risk of having a child with a neural tube defect is to take folic acid (400 micrograms per day) before conception.
  • Down syndrome (also called trisomy 21). An extra copy of chromosome 21 causes Down syndrome characterized by mental retardation, certain facial features and sometimes heart defects.
  • Trisomy 18. An extra copy of chromosome 18 causes this syndrome, which usually proves fatal during the first year of the baby's life and is associated with severe mental retardation.

The blood screen also known as triple test does not look directly at genetic material but instead measures four substances—alpha-fetoprotein, unconjugated estriol and human chorionic gonadotropin and Inhibin A—to determine whether you are at increased risk of having a baby with one of these disorders. During the second trimester, you will probably be encouraged to take a so-called triple test, a blood test that checks these three hormone and the protein levels (Inhibin A) in your blood.

An important part of the triple test is the alpha-fetoprotein screening (MSAFP) test. The MSAFP, which is usually performed between weeks 15 and 20, checks the level of alpha-fetoprotein in your bloodstream. Alpha-fetoprotein is a key indicator of fetal health. All women are typically given this test; it is not just for at-risk pregnancies. If your triple test results come back abnormal, you will be offered an amniocentesis to provide more definitive results. Both tests are typically taken between the 15th and 20th weeks of pregnancy.

A key fact to remember is that this test does not diagnose the disorders—it only screens for the substances and shows if there is an increased risk of a disorder. Further testing is always suggested to make a diagnosis.

Nuchal translucency screening test: A newer type of prenatal screening test that can be done in the first trimester is becoming much more common, although it's still not offered everywhere. This test assesses the risk for the fetus to have Down syndrome or trisomy 18. The first trimester screening has two parts and both should both be performed between weeks nine and 13 of gestation. One part tests levels of maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in the mother's blood. The other measures the nuchal thickening (measure of fetal neck thickness) through a specialized ultrasound. This test detects 85 percent of fetuses with Down syndrome and approximately 90 percent with trisomy 18.

However, remember that it is a screening test and still requires a confirmatory chorionic villous sampling (CVS) or amniocentesis to make the definite diagnosis. However, the primary benefit of this screening test is that it can be performed earlier in the pregnancy and is much less invasive than a CVS or amniocentesis.

Next steps after receiving abnormal screening results

A screening test does not diagnose a condition. It should not be used to make decisions for treatment or pregnancy termination, but rather should be used to determine whether the mother wishes to have diagnostic prenatal testing performed.

If a screening test indicates a higher-than-average risk, your health care professional may want to perform a basic ultrasound, which can help determine the gestational age of the fetus and show if a woman is carrying twins. If either of these factors accounts for the abnormal screen test result, no further testing is needed. Otherwise, a more detailed ultrasound examination may be performed, which allows a look at the baby's brain and spinal cord, as well as other parts of the body. This ultrasound can often identify an open neural tube defect or other malformation associated with an abnormal screening test.

Your health care provider may suggest you consider either amniocentesis or CVS. Both are diagnostic tests to determine whether the fetus actually has the disorder in question.

Amniocentesis is performed more frequently and should be the choice if you're at risk for having a child with neural tube defects (CVS doesn't detect neural tube defects).

Amniocentesis

It is not recommended for all women—mainly due to the fact that the test is invasive and carries a small risk of miscarriage—but it is generally administered to those who are at increased risk for genetic and chromosomal problems. This prenatal screening enables your health care professional to examine fetal cells in the amniotic fluid for any chromosomal abnormalities.

If you are 35 or older when you're due to have your baby, your health care professional will likely discuss the risks of chromosomal abnormalities based on your age and recommend this test. That's because women over 35 have a higher risk of having a baby with Down's syndrome.

An amniocentesis is also recommended if you've already had a child with certain birth defects, or if you have a family or personal history that puts you at risk for certain inherited diseases. You might choose to have this test if you had abnormal blood tests that suggest there might be a problem.

Amniocentesis can diagnose numerous conditions, but as these tests are very expensive, so talk with your health care professional about which ones are necessary based on your history and risk factors.

During an amniocentesis, the doctor inserts a needle through your abdomen into the amniotic sac and removes a small amount of amniotic fluid. The doctor uses ultrasound to guide the needle and avoid inserting it into the placenta. The test can be performed on an outpatient basis in a health care professional's office or in a hospital.

It can be done at any gestational age after 11 weeks, but when it's performed for genetic studies, amniocentesis is usually done between 15 and 17 weeks

If you have amniocentesis, a doctor will use a needle to withdraw a sample of amniotic fluid (the fluid surrounding the fetus) for analysis. The procedure is typically performed during the second trimester, at 15 to 18 weeks.

Amniocentesis or CVS is offered for high-risk pregnancies, which could include any of the following:

  • you will be 35 years of age or older at delivery

  • your family has a known genetic disorder

  • you have had a previous child with a birth defect

  • you and your partner are carriers of the same recessive disorder

  • other indications as directed by your obstetrician

CVS: It is performed at 10 to 12 weeks of gestation and involves analyzing a sample of placental tissue. A thin tube inserted through the vagina and cervix, or the abdomen, and is used to suction out a small tissue sample from the placenta. However, unlike amniocentesis, CVS cannot be used to test for neural tube defects, such as spina bifida and anencephaly. Therefore, it's usually recommended that a woman undergoing CVS also have the prenatal blood test called the maternal serum alpha fetoprotein (MSAFP) screening test, at about 16 to18 weeks of pregnancy. 

CVS is more attractive to some women because it can be done earlier than amniocentesis. Amniocentesis and CVS can be used to prenatally diagnose many, but not all, genetic disorders. 

“Every prenatal screening and diagnostic test has its benefits, risks and limitations. It is very important to discuss these testing options with your doctor and, if possible, a genetic counselor.” 

Third Trimester Prenatal Screening Tests

The third trimester will be an especially busy time for you and your baby. You'll be glowing, putting the last touches on the baby's room and checking with your nurse or doctor almost weekly to keep your baby healthy and kicking.

As far as checkups, exams and medical tests go, the third trimester is different from the first two. Your baby is quite developed. It's beginning to look like it will at delivery. At this stage, it is less sensitive to birth defect-causing chemicals than it was during the first six months. Its size also means it may be more easily checked for physical defects that were previously too small to see.

Since your baby is still developing and is fitting tighter and tighter within the womb environment, it's good to continue having plenty of visits to your doctor. Your health care provider will set up a visit schedule for you, but you can probably expect weekly checkups at this point.

Included in these visits will be an increasing number of pelvic exams.

Your health care provider will be checking for just two things during a pelvic examination: 

  • The baby's positioning and

  • The state of your cervix. 

During the last three months of pregnancy, most babies invert, with their feet pointed at—and kicking endlessly at—your diaphragm and their heads pointed downward toward your cervix. If your baby is not inverted, your health care provider may talk to you about methods for getting the baby to turn, with the last option being planning a Caesarean section for you.

Likewise, your cervix will slowly begin to dilate and get thinner during the last month or so of your pregnancy to make way for delivery. Your OB/GYN or midwife will keep track of your cervical thinning, which is called effacement, and your dilation.

One test you should expect during the third trimester is a group B streptococcus (GBS) test. GBS is a common bacterium that is mostly harmless in children and adults. Its cousin, group A streptococcus, is the one that causes strep throat. In developing fetuses, though, GBS can cause a serious infection. Testing for GBS is relatively simple and involves little more than a vaginal swab to check for the presence of the bacteria. 

If you go past your due date, you can expect to take a fetal non-stress test (NST), which involves little more than donning two belts during a checkup, one to measure your baby's heart rate and the other your contraction rate.

Your provider may order two other tests to ensure that your child isn't experiencing physical problems before birth. One is a biophysical profile, which combines an NST and an ultrasound. It is used to make sure the baby's heart rate, movement, muscle tone and breathing are normal. The second exam is a glucose challenge screening, which tests whether you have developed gestational diabetes.

The ideal time for many tests is of course before you get pregnant. If you are planning a pregnancy, preconception genetic counseling can be quite helpful because it offers an opportunity to make decisions without the pressure of an advancing pregnancy. Potential risks for the planned fetus can be identified and testing strategies can be pursued.

12 to 18 Months Old

Baby Tracker 7

FEEDING YOUR BABY

  • Try to be patient with your baby as he/she can be messy while learning to eat without help.
  • You may have to introduce a particular type of food several times to your baby before he/she starts liking it. So you really need to – try again and again! Accept baby’s “NO” with a smile, do not force feed.
  • Baby should be given three meals daily and 2-3 snacks must be introduced in between meals. Snacks do not mean packaged and processed food, sweets and juices.
  • Avoid adding too much salt and sugar to your baby's food. Babies can be given food with less salt and spices, about 50% quantity of that taken by the family.
  • Make the baby eat together with rest of the family.
  • Try to train your baby on how to use cups, plates, spoons etc. for drinking and eating.
  • Natural, freshly prepared and healthy home cooked food should be given to the baby. There should be no artificial flavors or preservatives in their meals.
  • When your baby stops eating or refuses to have more, you should stop feeding him/her.
  • Do not give small sized food stuffs. Food stuffs that are either hard or small sized (like peas, nuts, pomegranate, berries, grapes ) might cause choking and thus should be avoided. If necessary such things should be ground or blended with other soft food stuffs and given to eat.
  • Train your babysitter/caregiver according to the feeding routine of your child.

DEVELOPMENT OF BABY

  • Baby now walks with help and can throw a ball
  • Baby responds to music. Baby can be introduced to outdoor games and dance.
  • Make a daily time table for your baby's routine activities, which should include minimum one hour of day time nap.
  • Avoid watching scary audio-visuals in front of your kid. Also try to engage your child in mind games or outdoor games instead of watching TV.
  • Make a joint time table where both you and your baby do at least 2-3 activities together like eating, reading, going for a walk,playing etc.
  • Read him /her good educational and motivational stories at bed time, so that every morning he/ she wake up with a positive mind.
  • The bedtime should always be very calm and loving. The blissful bedtime caressing and cuddling provides sense of security and a sound sleep.

YOUR BABY AND FAMILY

  • Try not to hit, punish, slap or yell at your baby especially in front of others.
  • It’s good to be disciplined, however keep rules and regulations simple for young kids.
  • Always praise your child for good behavior; however do not bribe him by giving chocolates etc.
  • Distract your child with something he/she likes when he/she is behaving poorly.
  • Give your child enough time and play with him/her often.
  • Also take your baby for short outings and make sure that the places you are taking them are safe and secure, so that they don't hurt themselves.

SAFETY MEASURES

  1. Your baby must be seated in a car in a safety seat while travelling. 
    ( the car safety seat should be preferably installed at the centre of a rear seat, facing backwards)
  2. Never place a rear-facing car seat in the front seat of a vehicle that has an active air bag. If the air bag inflates, it can push against the car seat and cause a head injury to the baby.
  3. Keep on using the rear facing car safety seats until your baby is two years of age OR exceeds the height / weight limit mentioned by the car seat manufacturer.
  4. Baby should never be seated in the front seat with the air bags.
  5. Never drink and drive ( with the baby or without the baby) and always wear seat belt while driving.
  6. Empty all buckets, tubs, pools etc. after use.
  7. Do not keep heavy or hot things on a table cloth, which your baby may pull over.
  8. Put barriers on electrical plugs and keep your baby safe from all electrical/ hot items.
  9. Always keep the rooms / areas locked where the baby could be hurt, like the bathrooms, kitchen etc.
  10. Keep medicines, cleaning agents, poisonous substances and sharp objects out of reach of the baby.
  11. Barricade the staircase.
  12. Keep guards on the windows and keep the furniture away from them.
  13. Do not keep a gun at home. If its a must then keep it unloaded and locked away. The ammunition should be kept separately and locked too.
  14. Never keep your baby alone and when in kitchen keep your baby in a playpen or a high chair with a safety lock.
  15. In order to avoid accidents like burns/ scalding / drowning while bathing
    a. Always set your water heater at a temperature lower than 120 deg F i.e. 49 deg C approximately.
    b. Always open cold water tap first for filling the bath tub and once the required level is reached close the hot water tap first followed by the cold one.
    c. Before giving bath to the baby check the temperature of the water by inserting your own elbow / wrist first. Ideal bath water temperature for infants is approximately 90-100 degree F i.e. 32-38 degree C.
    d. Never leave the baby alone in the bath tub / basin.
    e. Fill the baby bath tub / basin with not more than 5 inches of water and gently make your baby sit in it. The water level should never be above the baby's waist.
    ( a child can drown in as little as one inch of water and it takes only 3 minutes or less for a baby to drown )
    f. Your baby is curious to explore everything around him/her at this age so train them not to touch taps while bathing. A hot water tap if accidentally opened may lead to severe scalding.
  16. Child will be curious and in a discovery mode , please secure doors, toilets and terraces and balconies to avoid accidents.

9 to 12 months old

Baby Tracker 6

FEEDING YOUR BABY

  • Try to be patient with your baby as he/she can be messy while learning to eat without help.
  • Encourage self feeding. Do not get upset if baby is messy or spills food.
  • Baby should be given 3 meals/ day and in between these meals 2-3 snacks must be provided too. Avoid junk and packaged foods, chocolates, toffees, juices and salty biscuits. Can introduce spices and salt but should be less ie only half the quantity taken by the family.
  • Increase water intake and gradually reduce amount of milk. If breast feeding one feed of milk/curd should be included. 
  • Only healthy food should be given to baby and you should strictly avoid giving soft drink, tea, coffee and flavored milk.
  • Babies might deny eating new   food stuffs at least 10-12 times before they start liking it, you should never force the baby to eat.
  • Try to teach baby on how to use cup, plate and spoons for drinking and eating. Layout the food separately for the child in a plate with katori and spoon.
  • Encourage child to chew on a long carrot/ long cucumber/ chappati roll etc.
  • If on formula feed, now is the time to shift to single toned milk by sipper/small glass. Stop bottle feeding now. 2-3 milk feeds with some cereal added into it can be given to the baby, along with other meals. Reduce the milk intake to about 500ml a day. If large number of milk feeds are given, baby will avoid eating solids and other food items which are essential for baby’s growth. Refer to Nutrition Guide for more info.
  • Peanuts, soy, strawberries, tree nuts, fish and shellfish should be avoided as these can cause allergies to the baby.

DEVELOPMENT OF BABY

  • The baby will cruise/crawl around the house and may try to stand with support of furniture. So please make your house child safe.
  • The baby now listens when spoken to. Baby imitates the actions performed by adults and siblings. So we need to be good role models.
  • The right kind of toys at this stage would be push toys, shape sorters, balls, toy telephone, books, and blocks.
  • Maintain a regular time table for daily activities like bathing, feeding, sleeping and playing.
  • Make the hour before going to bed calm and loving.
  • Talk, sing and read to your baby daily.
  • Check If your baby wakes up at night, but do not pick him/her up immediately.
  • Watch her when the baby explores the entire house.
  • Avoid TV / video / computers instead give him/her toys and play with her.
  • Avoid scaring or yelling at your baby.
  • Demonstrate and speak to your baby in simple words, what you would like the baby to do.

YOUR BABY AND FAMILY

  • As parents are the role model of every child, therefore you should always do things which you want your baby to do. * Be polite and nice to your baby and try to teach him on what to do and how to do things rather than "what not to do". * Don’t keep saying "No" to your baby for everything; except when he/ she is going to get hurt or going to hurt someone else.
  •  Eating with family is very important for the baby. Make meal times a bonding time and also give baby freedom to self feed itself. Baby can be made to sit in a secured high chair and eat from its own plate/katori.
  • Read stories, sing songs to the baby and keep 30 min time for all these activities prior to putting the baby to sleep.
  • Before hiring a baby sitter interview them properly and have few training cum trial sessions, where they handle the baby in your presence. A caregiver should be professionally trained, hygienic, clean, safe, loving and mature.

SAFETY MEASURES

  1. Your baby must be seated in a car safety seat while travelling. 
    ( the car safety seat should be preferably installed at the centre of a rear seat, facing backwards)
  2. Never place a rear-facing car seat in the front seat of a vehicle that has an active air bag. If the air bag inflates, it can push against the car seat and cause a head injury to the baby.
  3. Never drink and drive (neither with the baby nor without the baby) and always wear a seat belt while driving.
  4. Empty all buckets, tubs, pools etc. after use.
  5. Do not keep heavy or hot things on a table, which your baby may pull over.
  6. Put barriers on electrical plugs and keep your baby safe from all electrical/ hot items.
  7. Always keep closed the doors to rooms where the baby could be hurt, like the bathrooms, kitchen etc.
  8. Keep medicines, cleaning agents, poisonous substances and sharp objects out of reach of the baby.
  9. Barricade all staircases.
  10. Keep guards on the windows and keep furniture away from the windows.
  11. In order to avoid accidents like burns/ scalding / drowning while bathing:
    a. Always set your water heater at a temperature lower than 120 deg F i.e. 49 deg C approximately.
    b. Always open cold water tap first for filling the bath tub and once the required level is reached close the hot water tap first followed by the cold one.
    c. Before giving bath to the baby check the temperature of the water by inserting your own elbow / wrist first. Ideal bath water temperature for infants is approximately 90-100 degree F i.e. 32-38 degree C.
    d. Never leave the baby alone in the bath tub / basin.
    e. Fill the baby bath tub / basin with not more than 5 inches of water and gently make your baby sit in it. The water level should never be above the baby's waist.
    ( a child can drown in as little as one inch of water and it takes only 3 minutes or less for a baby to drown )
  12. Do not keep a gun at your home. If it’s a must then keep it unloaded and locked away from the baby. The ammunition should be kept separately and locked too.
  13. Never leave your baby alone and while working in the kitchen keep your baby in a playpen or in a high chair with a safety lock.

6 to 9 months old

Baby Tracker 5

FEEDING YOUR BABY

  • Breastfeeding the baby even now is a good idea, as it supplies all the necessary nutrients to the baby.
  • For mothers who may need to be separated from their infants - pumping and storing of breast milk is a good idea. Consult a pediatrician for advice on expressed breast milk and type of formula/milk feed for baby.
  • Avoid bottle feeding. If not cleaned properly the feeding bottle may gather many bacteria in them and could make the baby ill. If using bottle to feed, it is very important to sterilize the feeding equipments before each feed. After every feed wash the bottle, the teat and the ring with hot and soapy water.
  • Before every feed place the bottle in a container of boiling water and leave it there for about 15 minutes.
  • For preparing a Formula feed also, you must take water which is boiled for some time and then cooled to a comfortable temperature.
  • Always try to make fresh feed each time, and do not use beyond 30 minutes of preparation
  • After 6 months of age, milk alone is not adequate for growth and development of baby. We need to supplement milk with semi solid food and introduce cereals and mashed fruits gradually. Avoid packaged food, salt, juices, junk food items.
  • Refer to the Nutrition Guide for more information.
  • Semi Solid food are to be introduced in the baby only when : 
    -  The baby attains a good control of head and neck and is able to swallow: The baby should be able to move the food to the back of the mouth and swallow it. As baby learns to swallow the food efficiently, the food dribbles less from mouth.
    -  Baby is able to sit up with support.
    -  New food should be introduced to baby one at a time.
    -  Gradually introduce a new food item once in 5-6 days.
    -  Peanuts, tree nuts, strawberries, fish and shellfish should be avoided as these can cause allergies in the baby.
    -  Small objects and small food items like peas, chana, anar seeds, whole grains etc should not be given till 4 years of age as baby can choke on this.

DEVELOPMENT OF BABY

  • The baby now is able to turn head to sound of bell/rattle and transfers objects hand to hand
  • The baby responds to own name and recognizes words like daddy, mama, etc.
  • You must start calling the child by his name and give him mirror to help the baby develop a sense of identity.
  • Banging toys such as drums, pans or pots can be given at this age.
  • Place your baby in such a way, so that he/she can sit and look around.
  • Talk to your baby by making different types of sounds and also copy the sounds baby makes.
  • Read story books and also introduce the baby to music and songs.
  • Offer colorful and musical toys to hold on and play. Toys should not have sharp edges.
  • Let your baby sleep in your room but in a crib or cradle and not on the bed.
  • Buy a baby crib which does not have a drop-side rail and its slats should be less than 2.5 inches apart. Carefully follow the instructions given by the manufacturer before using the crib. Replace the crib immediately if is unstable, has any cracks/damages/ missing parts.
  • Keep only those objects in the crib which do not cause any injury to the baby like comforters & pillows. Bumper pads and toys should be kept out of the crib as they can hurt the baby.
  • Make sure he/she gets a good nap at regular intervals.
  • Baby can be put on a clean floor, on a soft mattress covered with a sheet. This will give baby freedom to move around and also help in Development.

BONDING WITH FAMILY

  • Encourage your partner and siblings to help in taking care for your baby.
  • Outings can now be planned with your friends and family.
  • Before hiring a baby sitter interview them properly and have 1-2 trial sessions where they handle the baby in your presence. A caregiver should be professionally trained, hygienic, clean, safe, loving and mature.
  • Eating with family is very important for the baby. Make meal time a bonding time. Encourage self feeding with a spoon, do not get upset if baby is messy or spills food.
  • Taking care of baby’s teeth:
    This is the right time for eruption of milk teeth. Special care has to taken during this time so that baby has healthy teeth. 
    Use soft muslin cloth to clean the gums of the baby after every meal. 
    Do not give baby bottle when you are putting him to sleep that can lead to eruption of unhealthy teeth.
    If the teeth have already erupted than clean them using soft cloth or baby toothbrush with water only.

SAFETY MEASURES

  • Your baby must be seated in a car safety seat while travelling.( the car safety seat should be preferably installed at the centre of a rear seat, facing backwards)
  • Never place a rear-facing car seat in the front seat of a vehicle that has an active air bag. If the air bag inflates, it can push against the car seat and cause a head injury to the baby.
  • Always keep your home, car and surroundings smoke free as it may cause suffocation to the baby.
  • Never drink and drive (neither with the baby nor without the baby) and always wear a seat belt while driving.
  • Baby should always be kept away from sharp and small objects and also from the toys of other grown up children.
  • Never eat/drink hot food / liquids near your baby or while holding your baby.
  • Your baby is too young for a baby walker, do not use it.
  • Plastic bags should be kept away from the baby as they can suffocate the baby.
  • In order to avoid accidents like burns/ scalding / drowning while bathing :
    -  Always set your water heater at a temperature lower than 120 deg F i.e. 49 deg C approximately. 
    -  Always open cold water tap first for filling the bath tub and once the required level is reached close the hot water tap first followed by the cold one.
    -  Before giving bath to the baby check the temperature of the water by inserting your own elbow / wrist first. Ideal bath water temperature for infants is approximately 90-100 degree F i.e. 32-38 degree C.
    -  Fill the baby bath tub / basin with not more than 5 inches of water and gently place your baby in a propped up position, supporting the baby's head. The water level should not rise above the baby's waist.( a child can drown in as little as one inch of water and it takes only 3 minutes or less for a baby to drown

128 days to 180 days

Baby Tracker 4

FEEDING YOUR BABY

  • Baby at this stage is susceptible to infections as the body defense mechanism is still building , therefore it is advisable that for the first 6 months baby should be fed only with breast milk.
  • No pre lacteal/para-lacteal feeds, no water for initial 6 months. Avoid bottle and pacifiers.
  • Feed only when baby shows some signs that he/she is hungry like:
    -  Putting hand or fingers in the mouth.
    -  Sucking, rooting and fussing.
  • Stop feeding when the baby's tummy is full. The signs which your baby shows are:
    -  Turning away.
    -  Keeping mouth away.
  • Make your baby burp after feeds to release little bubbles of air that become trapped in stomach. These bubbles can make baby uncomfortable and cranky and colicky. By burping your baby, you help to free up room in her tummy, so he/she can settle and feed for longer.
  • Consult your pediatrician regarding feeding options at least 2 weeks before joining work.

BABY DEVELOPMENT

  • By now the baby’s eyes have started following a pen/pencil. The baby now also responds by smiling.
  • By now the baby has started holding head steady and is able to roll from back to the side. Putting baby on its stomach helps development. This should be done one hour after feeding.
  • The baby now vocalizes with 2 or more syllables, and looks/turns head to voices or sound of toys.
  • Toys which are suitable for this age are – unbreakable mirror, soft books with high contrast patterns, activity bars, soft stuffed animals, squeaky rubber toys, colorful teething rings.
  • Encourage babbling and allow the child to move freely under your watch.
  • Shake a bell or a squeaky toy over his head. Encourage him to turn his head and find the sound.
    Sound producing toys are suitable for this age.

BABY MOTHER BONDING

  • Always maintain eye contact while talking with the baby. Encourage partner and siblings to talk or sing to the baby.
  • Place hanging toys on the crib just out of reach of baby’s hands to stimulate him to reach out and grasp the toy.
  • The baby should be carried astride (legs separated), to avoid falling out of your arms.
  • Set a time table to give your maximum time to the baby and practice routine activities like bathing, feeding, sleeping and playing. To make the baby sleep, sing songs or recite poems/stories to the baby.
  • Always put your baby to sleep on his/her back in a safe crib.
  • While in cradle:
    -  Baby's mattress should be lowered before he/ she tries to sit upright
    -  Sides of the crib/ cradle should always be closed/ up so that the baby doesn't fall off. 
    -  Do not use soft & loose bedding or toys such as quilts, pillows-like bumper pads as baby’s movement in crib is hindered.
  • Avoid keeping baby on bed. Baby can be placed on the clean floor, on a soft mattress covered by a sheet. This will encourage development and will avoid falls.
  • Put your baby on her tummy when playing and be watchful.
  • Teething may cause irritation in gum, for relief you should massage the gums with a little coconut oil applied on your fingers. Be careful of getting bitten.

SAFETY MEASURES

  • Your baby must be seated in a car safety seat while travelling.( the car safety seat should be preferably installed at the centre of a rear seat, facing backwards)
  • Never place a rear-facing car seat in the front seat of a vehicle that has an active air bag. If the air bag inflates, it can push against the car seat and cause a head injury to the baby.
  • Always keep your home, car and surroundings smoke free as it may cause suffocation to the baby.
  • Never drink and drive (neither with the baby nor without the baby) and always wear a seat belt while driving.
  • Baby should always be kept away from sharp and small objects and also from the toys of other grown up children.
  • Never eat/drink hot food / liquids near your baby or while holding your baby.
  • In order to avoid accidents like burns/ scalding / drowning while bathing :
    -  Always set your water heater at a temperature lower than 120 deg F i.e. 49 deg C approximately. 
    -  Always open cold water tap first for filling the bath tub and once the required level is reached close the hot water tap first followed by the cold one.
    -  Before giving bath to the baby check the temperature of the water by inserting your own elbow / wrist first. Ideal bath water temperature for infants is approximately 90-100 degree F i.e. 32-38 degree C.
    -  Fill the baby bath tub / basin with not more than 5 inches of water and gently place your baby in a propped up position, supporting the baby's head. The water level should not rise above the baby's waist.( a child can drown in as little as one inch of water and it takes only 3 minutes or less for a baby to drown

60 days to 119 days

Baby Tracker 3

FEEDING YOUR BABY

  • Baby at this stage is susceptible to infections as the body defense mechanism is still building up,therefore it is advisable that for the first 6 months baby should be fed only with breast milk.
  • No pre lacteal/para-lacteal feeds, no water for initial 6 months. Avoid bottle and pacifiers.
  • Feed only when baby shows some signs that he/she is hungry like:
    -  Putting hand or fingers in the mouth.
    -  Sucking, rooting and fussing.
  • Stop feeding when the baby's tummy is full. The signs which your baby shows are:
    -  Turning away.
    -  Keeping mouth away.
  • Burping after feeds will release little bubbles of air that become trapped in stomach. These bubbles can make baby uncomfortable and cranky. By burping your baby, you help to free up room in her tummy, so he/she can settle and will reduce occurrence of infant colic. Putting baby to sleep on its stomach with face turned to the side also helps in reducing gas. Do this after one hour of feeding to avoid vomiting.

YOUR BABY AND FAMILY

  • Encourage partner to be involved in care of baby. Also if baby’s sibling wants to touch or hold baby, do not refuse. Supervise it , the sibling can sit on the bed and hold baby on his lap for few minutes. Always ensure hand washing by sibling/relatives before they touch the baby. This reduces chance of infection.
  • Plan and pen down the important tasks which you need to do or get settled before you go back to work.
    Before hiring a baby sitter interview them properly and have 1-2 trial sessions where they handle the baby in your presence. A caregiver should be professionally trained, hygienic, loving and mature.
  • Feeling sad and upset is very natural when you have to go back to work and leave your baby to a caregiver or babysitter, so try to mentally prepare yourself for this situation.
  • Consult your pediatrician regarding feeding options at least 2 weeks before joining work.

BABY MOTHER BONDING

  • By now the baby’s eyes have started following a pen/pencil. The baby now also responds by smiling.
  • Sound producing toys are suitable for this age.
  • Always maintain eye contact while talking with the baby.
  • Place hanging toys on the crib just out of reach of baby’s hands to stimulate him to reach out and grasp the toy. These should not have sharp edges.
  • The baby should be carried astride (legs separated), to avoid falling out of your arms.
  • Set a time table to give your maximum time to the baby and practice routine activities like bathing, feeding, sleeping and playing. To make the baby sleep, sing songs or recite poems/stories to the baby.
  • Let your baby sleep in your room but in a crib or cradle and not on the bed.
  • Buy a baby crib which does not have a drop-side rail and its slats should be less than 2.5 inches apart. Carefully follow the instructions given by the manufacturer before using the crib. Replace the crib immediately if is unstable, has any cracks/damages/ missing parts.
  • Keep only those objects in the crib which do not cause any injury to the baby like comforters & pillows. Bumper pads and toys should be kept out of the crib as they can hurt the baby.
  • Baby should recognize your touch, so try to comfort your baby by gently touching the head with your hands, hold and cuddle your baby often, build trust and bonding with the baby.
  • When you are doing normal household work try to do it in the room where your baby is playing. Make them lie down on his/ her tummy, in this position your baby will be able to see you and you can also keep a watch. This also helps in baby’s development.
  • Spend more and more time with the baby and try to understand their likes and dislikes.
  • Baby follows a circular routine of feeding, passing stools and urine and sleeping for first few months of life. 
  • Most babies sleep during the day and are awake at night. Parents must be mentally prepared for this routine. Mothers should rest when the baby sleeps otherwise she will soon get exhausted. By three months, baby begins to be awake at daytime.

SAFETY MEASURES

  • Your baby must be seated in a car safety seat while travelling.( the car safety seat should be preferably installed at the centre of a rear seat, facing backwards)
  • Never place a rear-facing car seat in the front seat of a vehicle that has an active air bag. If the air bag inflates, it can push against the car seat and cause a head injury to the baby.
  • Always keep your home, car and surroundings smoke free as it may cause suffocation to the baby.
  • Never drink and drive the car (neither with the baby nor alone) and always wear a seat belt while driving.
  • Baby should always be kept away from the sharp and small objects and also from the toys of other grown up children.
  • Always secure the baby with your hands before changing the clothes or the diapers to prevent the baby from falling as now the baby can roll over on their own.
  • In order to avoid accidents like burns/ scalding / drowning while bathing :
    -  Always set your water heater at a temperature lower than 120 deg F i.e. 49 deg C approximately.
    -  Always open cold water tap first for filling the bath tub and then the hot water one. Once the required level is reached close the hot water tap first followed by the cold one.
    -  Before giving bath to the baby check the temperature of the water by inserting your own elbow / wrist first. Ideal bath water temperature for infants is approximately 90-100 degree F i.e. 32-38 degree C.
    -  Fill the baby bath tub / basin with not more than 5 inches of water and gently place your baby in a propped up position, supporting the baby's head. The water level should not rise above the baby's waist.( a child can drown in as little as one inch of water and it takes only 3 minutes or less for a baby to drown

29 days to 60 days

Baby Tracker 2

TIME PERIOD

Baby is now is 1 month old

FEEDING YOUR BABY

  • Baby at this stage is susceptible to infections as the body defense mechanism of is still building up, therefore it is advisable that for the first 6 months baby should be fed only with breast milk.
  • No pre lacteal/para-lacteal feeds, no water for initial 6 months. Avoid bottle and pacifiers.
  • Feed only when baby shows some signs that he/she is hungry like:
    Putting hand or fingers in the mouth.
    Sucking, rooting and fussing.
  • Stop feeding when the baby's tummy is full. The signs which your baby shows are:
    Turning away.
    Keeping mouth away from nipple
  • Sunlight is a good source of Vitamin D which helps in building immune system. Hence, exposure to sunlight early in the morning for a good amount of time is recommended.
  • Baby passes stool & urine 6-8 times a day and stools are yellow coloured like brinjal seeds.

YOUR BABY AND FAMILY

  • Avoid going out of house except when you need to visit a doctor, specially avoid crowded places.
  • Always wash your hands at regular intervals especially before touching the baby so that he/she does not catch any infection. This should be taken care of by all – siblings/relatives.
  • Always have a handy list of emergency phone numbers with you.
  • Contact your doctor if your baby has fever above 100.4 *F = 38C. Measure by a thermometer kept in the armpit for a few minutes, never put it in the mouth.

BABY MOTHER BONDING

  • Taking the baby to your shoulders against your chest and making him burp after every feed will reduce gas formation and infant colic.
  • Baby has developed social smile reflex by now and also has started responding to your voice, the bell/rattle/clap.
  • Baby should recognize your touch, so try to comfort your baby by gently touching their head with your hands and frequently cuddle the baby.
  • Set a time table for devoting your maximum time to the baby where you practice routine activities like bathing, feeding, sleeping and playing. Make a routine of giving the baby a daily oil massage for 5-10 minutes.
  • If you sing your baby to sleep, it would help in strengthening the bond.
  • To make the baby awake for feeding you can tap, rock, undress, or change the diaper.
  • Hang brightly colored objects across the crib. Red is the first color a baby perceives. So bring lots of red colored toys. These should not have sharp edges.
  • Let your baby sleep in your room but in a crib or cradle and not on the bed.
  • Buy a baby crib which does not have a drop-side rail and its slats should be less than 2.5 inches apart. Carefully follow the instructions given by the manufacturer before using the crib. Replace the crib immediately if is unstable, has any cracks/damages/ missing parts.
  • Keep only those objects in the crib which do not cause any injury to the baby like comforters & pillows. Bumper pads and toys should be kept out of the crib as they can hurt the baby.
  • To make the baby awake for feeding you can gently tap, rock, undress, or change the diaper.
  • Baby should recognize your touch, so try to comfort your baby by gently touching the head with your hands.
  • When the baby is of 6-8 weeks crying is normal, do not get nervous and just try to comfort your baby by talking, making eye contact, making funny faces, patting, stroking. Never shake the baby; this can make him feel more anxious.
  • If you find the baby's crying sounds unreasonable and unmanageable, do not be upset or aggressive towards the baby and call for immediate help of family members and doctor.
  • Baby follows a circular routine of feeding, passing stools and urine and sleeping for first few months of life. 
  • Most babies sleep during the day and are awake at night. Parents must be mentally prepared for this routine. Mothers should rest when the baby sleeps otherwise she will soon get exhausted. By three months, baby begins to be awake at daytime.

SAFETY MEASURES

  • Your baby must be seated in a car safety seat while travelling.( the car safety seat should be preferably installed at the centre of a rear seat, facing backwards)
  • Never place a rear-facing car seat in the front seat of a vehicle that has an active air bag. If the air bag inflates, it can push against the car seat and cause a head injury to the baby.
  • Always keep your home, car and surroundings smoke free as it causes suffocation to the baby.
  • Never drink and drive the car, neither with the baby nor alone. Always wear seat belt while driving.
  • Always secure the baby with your hands before changing the clothes or the diapers to prevent the baby from falling as now the baby can roll over on their own.
  • In order to avoid accidents like burns/ scalding / drowning while bathing :
    -  Always set your water heater at a temperature lower than 120 deg F i.e. 49 deg C approximately.
    -  Always open cold water tap first for filling the bath tub and then the hot water tap. Once the required level is reached, close the hot water tap first followed by the cold one.
    -  Before giving bath to the baby check the temperature of the water by inserting your own elbow / wrist first. Ideal bath water temperature for infants is approximately 90-100 degree F i.e. 32-38 degree C.
    -  Fill the baby bath tub / basin with not more than 5 inches of water and gently place your baby in a propped up position, supporting the baby's head. The water level should not rise above the baby's waist.( a child can drown in as little as one inch of water and it takes only 3 minutes or less for a baby to drown

First month of Life 2 days to 28 days

Baby Tracker 1

FEEDING YOUR BABY

  • Baby at this stage is susceptible to infections as the body defense mechanism is still building up therefore it is advisable that for the first 6 months, baby should be fed only with breast milk. (For more information on breast feeding, please refer to our Breastfeeding guide)
  • No pre lacteal/para-lacteal feeds, no water for initial 6 months. Avoid bottle and pacifiers.
  • Feed only when baby shows some signs that he/she is hungry like:
    -  Putting hand or fingers in the mouth.
    -  Sucking, rooting and fussing.
  • Stop feeding when the baby's tummy is full. The signs which your baby shows are:
    -  Turning away.
    -  Keeping mouth away from nipple
  • Baby loses weight in the first few days of life, don’t worry. By 10th day of life, baby’s weight must be nearly same as birth weight. If it is very less than that, baby may not be getting enough milk. It’s an emergency, you must meet your doctor immediately.
  • Sunlight is a good source of Vitamin D which helps in building immune system. Hence, exposure to sunlight early in the morning for a good amount of time is recommended. 

YOUR BABY AND FAMILY

  • Avoid going out of house except when you need to visit a doctor, specially avoid crowded places.
  • Always wash your hands at regular intervals especially before touching the baby so that he/she does not catch any infection. This care should be taken by all – siblings/relatives.
  • Always have a handy list of emergency phone numbers with you.

BABY MOTHER BONDING

  • Baby should recognize your touch, so try to comfort your baby by gently touching their head with your hands and frequently cuddle the baby.
  • Set a time table for devoting your maximum time to the baby, where you practice routine activities like bathing, feeding, sleeping and playing. Make a routine of giving the baby a daily oil massage for 5-10 minutes.
  • If you sing your baby to sleep, it would help in strengthening the bond.
  • To make the baby awake for feeding you can tap, rock, undress, or change the diaper.
  • Let your baby sleep in your room but in a crib or cradle and not on the bed.
  • Buy a baby crib which does not have a drop-side rail and its slats should be less than 2.5 inches apart. Carefully follow the instructions given by the manufacturer before using the crib. Replace the crib immediately if is unstable, has any cracks/damages/ missing parts.
  • Keep only those objects in the crib which do not cause any injury to the baby like comforters & pillows. Bumper pads and toys should be kept out of the crib as they can hurt the baby.
  • Baby follows a circular routine of feeding, passing stools and urine and sleeping for first few months of life.
  • Most babies sleep during the day and are awake at night. Parents must be mentally prepared for this routine. Mothers should rest when the baby sleeps otherwise she will soon get exhausted. By three months, baby begins to be awake at daytime.

SAFETY MEASURES

  • New born baby should be properly covered to prevent heat loss.
  • Your baby must be seated in a car safety seat while travelling. ( the car safety seat should be preferably installed at the centre of a rear seat, facing backwards)
  • Never place a rear-facing car seat in the front seat of a vehicle that has an active air bag. If the air bag inflates, it can push against the car seat and cause a head injury to the baby.
  • Always keep your home, car and surroundings smoke free as it causes suffocation to the baby.
    Keep your baby away from hot objects, therefore never have hot food / drinks near your baby or while holding your baby.
  • In order to avoid accidents like burns/ scalding / drowning while bathing :
    -  Always set your water heater at a temperature lower than 120 deg F i.e. 49 deg C approximately.
    -  Always open cold water tap first for filling the bath tub. Once the required level is reached close the hot water tap first followed by the cold one.
    -  Before giving bath to the baby check the temperature of the water by inserting your own elbow / wrist first. Ideal bath water temperature for infants is approximately 90-100 degree F i.e. 32-38 degree C.
    -  Fill the baby bath tub / basin with not more than 5 inches of water and gently place your baby in a propped up position, supporting the baby's head. The water level should not rise above the baby's waist.( a child can drown in as little as one inch of water and it takes only 3 minutes or less for a baby to drown

Right Nutrition

Right Nutrition for the child

  • To build muscle mass of the child we must not only focus on feeding a lot of food (which will increase on fat content of the body), but make sure that the kid also plays, dance and exercise a lot. Encourage them to walk/run/cycle to school.
  • We have more of rice and wheat in the food. We must encourage the child to take more of dals (legumes) and vegetables
  • As per Nutrition monitoring bureau majority of kids are malnourished. Weak kids get 25% less proteins, 25% less carbohydrates or energy and 90% less oil, needed to make hormones, vitamin D, cell wall of all cells etc.
  • Increase oil seed intake such as soya beans – which can be roasted and made into flour and the flour can be added to every feed, also add oil to feeds.
  • WHO says that in most of the developing countries like India people are deficient in 5 micro nutrients – iron, folic acid, B12, vitamin D and Iodine. Iodine is now taken care of in our country as we have started adding it to salt.
  • Increase your intake of other nutrients. Iron can be taken care of by cooking in iron vessels, folic acid by eating lot of leafy vegetables and Vitamin D by right exposure to sun light.
  • Milk has some B12, curd has more of it.