2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 23,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 9 sold-out performances for that many people to see it.

Click here to see the complete report.


Guides for management of dengue fever

In an attempt to dispel myths and create awareness about the ongoing dengue outbreak in the city, IMA, HCFI and Indian Oil Corporation have released a set of guidelines for the management of the disease.

Simple Dengue Fever:

Over ninety-five percent people suffer from simple dengue fever, which is not as threatening as severe dengue fever.
In simple dengue fever there is no capillary leakage, the person requires only oral fluids, 100 ml per hour, and is advised to visit a local doctor
Additionally, the patient is recommended to drink 500 ml water at the time of diagnosis. Only those patients with dengue fever who have vomiting should be given intravenous fluids

Severe Dengue Fever:

Those suffering from severe dengue develop capillary leakage and intravascular dehydration. Also, they suffer from a rapid fall in the platelet count along with rapid rise in their hematocrit levels They will have rapid fall in platelets along with rapid rise in hematocrit levels
Persistent vomiting, nausea, extreme exhaustion and lethargy are some of the symptoms of dengue. Along with these symptoms, a victim might suffer unrelieved abdominal pain and mental irritability and confusion.
These people require close daily observation.
Dengue patients are kept under close observation and are recommended to consume 1500 ml fluids (20 ml per kg) immediately
And in case, when they cannot consume liquids orally, then intravenous fluids are a must

Formula of 20 to identify high-risk cases of Dengue fever:

If there is a rise in pulse by 20
Fall in upper blood pressure by 20
Rise in hematocrit by 20 percent
Rapid fall in platelets to less than 20,000
Petechiae (red spot) count of more than 20 in one inch after tourniquet test
If the difference between upper and lower blood pressure is less than 20, then such cases should be given 20 ml of fluid per kg immediately and then shifted to nearest medical center for medical assistance

What you need to do in case symptoms are prevalent?

The follow-up tests are required to witness the rise in hematocrit and significant fall in the level of platelets.
The tests are required to be screened simultaneously.
Platelets transfusions are not required unless there is active bleeding and platelet count is less than 10,000
Keep a tab on hematocrit levels are crucial as their count decides the adequate requirement of fluids required by the body

It is important to remember the following:

Capillary leakage only occurs when the fever is on the verge of subsiding.

The initial 48 hours, including 24 hours after fever is over, are crucial, and the patient requires plenty of fluids as a sub-treatment
Signs of itching or rash usually occur post the capillary leakage period is over

When is urgent admission required?

If the patient is unable to consume or tolerate the consumption of liquids
Pregnant women

Patients with underlying comorbid conditions
Infants or elderly people
Patients suffering from uncontrolled diabetes

Prevention of influenza in school going children

It has been proved by several studies that frequent hand washing,(at  least 5 times a day) use of sanitizer, especially after touching contaminated surfaces does prevent influenza in children. Beside this, it is also advisable to immunise your children with influenza vaccine before the influenza season, that is just before winter.

Raj rani

Prevention of diarrhoea in summer

Now in India weather is very hot and with that comes  the germs (viruses, bacteria and parasites) that can cause diarrhea and vomiting. The youngest children, less than 2 years, are most vulnerable to diarrheal diseases. Fortunately if we take proper precautions we can prevent these diseases. So today we will talk about the measures for prevention of diarrheal diseases.

Prevention in infant

Breast feeding is natural protection for most of the diseases especially diarrhea. World Health Organization recommends that babies should be exclusive breast fed until 6 months of age.

Those who are not breast fed should be fed with breast milk substitute that is infant formula milk. It is important that certain precautions should be taken in preparing the feeds when formula milk is used. The bottles and nipples should be sterilized in a commercial sterilizer (follow the manufacturer’s instruction) or boiled in a pan. The water that is used for preparing the feeds should be boiled even if you are using bottled water. After boiling the water it should be cooled for less than 30 minutes (to not less than 70c) and then should be mixed with measured amount of powder. The reason is that the milk powder may not be sterile, however when it is mixed in hot water the germs in it will be killed. The prepared feed should be cooled down quickly in running cold water or in a pan of cold water. If not consumed within 2 hours it should be thrown away. The prepared formula feeds can be refrigerated for 24 hours. After taking out from refrigerator it can be warmed in a bowl of hot water and then used.

Babies can get germs from the hands of those who touch them; so those who handle them should wash their hands with soap and water or use hand sanitizer before touching them.

Prevention in older children

Using Safe water is most important to prevent diarrheal diseases. Bottled water is usually safe but be sure to check the seal that it is not tampered with. If one is not sure about the water supply then it should be boiled. If boiling is not possible then micropore filtering or disinfecting agents like iodine tablets should be used especially while one is travelling outside the country. Bottled or properly packed beverages are usually safe; again the seals should be checked.

When one is eating in restaurants and is not sure whether proper food hygiene precautions are taken in that place, then be sure that the food you eat is well cooked and steaming hot. The food items that are not cooked like salads should be avoided.

One can get diarrhea from home made food also if one does not take certain precautions. While buying food from stores check the “use before date”. The frozen food should be brought home within one hour of buying and should be placed in the refrigerator immediately. Food once thawed should not be frozen again. Raw food and ready to eat items should be kept separately. Food especially poultry, meat, and fish should be cooked thoroughly. No part of it should remain pink. Uncooked eggs should not be eaten unless they are pasteurized. Cooked food if not consumed immediately should be cooled quickly(within 1 to 2 hours) and kept in the refrigerator. Do not keep hot food in the refrigerator, as with this the temperature in the refrigerator will rise and thus bacteria will grow in the other food items. Cooked food can be kept in refrigerator for 2 days. In the freezer as long as it remains frozen, but the texture and taste will change with prolong storing. Food once taken out of the refrigerator and warmed or kept out for a length of time should not be kept back in the refrigerator.

In the kitchen the sinks, work tops and utensils should be cleaned thoroughly. Dish clothes should be washed in hot water frequently or disposables ones should be used. Hands should be washed after touching uncooked food. The knife and chopping board which is used for cutting uncooked food should be thoroughly washed. It is better to use separate knife and chopping board for cutting salads and fruits. If you are taking the cooked food to be eaten outside home then it should be transferred in a cool bag with ice trays. Lastly hand washing is must before eating. Taking above measures will keep the germs away from you and your loved ones to a great extend. 

Risk of using mobile phones

During the last decade, use of mobile phones has become such a common thing that one cannot imagine life without this. However question always remains that does long term use of this is harmful in any way, especially for children.

Several studies have shown that long term use of cordless and mobile phones triples the risk of glioma, one of the most common brain tumours. Risk is more for those who use mobile phones for more than 25 years and also for those who have started using these before age of 20 years.

So should we give the mobiles phones to children or not? Mobile phones can save lives as one can contact help immediately whenever one needs. Parents can contact their children when they go out with their friends or are late in coming back from school due to traffic jams or some other activities. In such circumstances, It is such a relief to know that one’s child is safe.

However we need to take precautions such as asking our children to use hands-free phones with the loudspeaker features and text messaging instead of phoning.



vaccination schedule in india


Almost all the parents realize the importance of vaccinations. This is the only way we can prevent so many life threatening diseases.

In India , although Govt. of India has a vaccination program, where vaccinations are given free of cost, unfortunately all the available vaccinations are not given because of financial constraints. This leaves so many children vulnerable to many serious diseases.

In India, at present 2 types of vaccination schedule are followed.

Table 1! This is recommended by Govt. of India and is followed in government hospitals and dispensaries.

Table 2! This is recommended by Indian Academy of Pediatrics. This is followed in private hospitals and private Pediatric clinics.

Table 1: EPI schedules as recommended by Govt. of India

Birth -15 days – BCG + OPV (ZERO DOSE)
6 weeks – OPV1 + DPwT1 + Hep B1 + Hib 1*
10 weeks – OPV2 + DPwT2 + Hep B2+ Hib 2*
14 weeks – OPV3 + DPwT3 + Hep B3+ Hib 2*
9 months Measles Vaccine
15 months-18 months – 1st booster of OPV/ DPwT + MMR*
5 years -6 years – 2nd booster of DPwT
10 years – Tetanus Toxoid
16 years – Tetanus Toxoid




Table 2 recommended by Indian Academy of Pediatrics

Birth – 15 days BCG + OPV (zero dose) +HepB1
6 weeks – 8 weeks IPV1# + DPwT1 + HepB2 + Hib1 + Rotavirus1 + PCV1
10 weeks- 12 weeks IPV2 + DTwP2 + Hib2 + Rotavirus2 + PCV2
14 weeks – 16 weeks IPV3 + DTwP3 + Hib3 + Rotavirus^^ + PCV3
6 months


7 months

HepB3 + OPV1 +influenza vaccine 1st dose.

Influenza vaccine 2nd dose and thereafter one dose every year before the winter season.

9 months (completed) MMR vaccine + OPV2
12 months Hepatitis A1
15 months MMR1 + Varicella* + PCV booster
18 months IPV booster1 + DTwP booster1 + Hib booster1 + Hepatitis A2
2 years Typhoid1 (give repeat shots every 3 years)
5 years OPV5 + DTwP booster2 +MMR^ + Varicella*
10 – 12 years Tdap/Td (Every 10 years then give Td)+ HPV**


DTwP is recommended. DTaP should be given in certain specific conditions only.

#IPV can be replaced with OPV when IPV is not feasible.

**HPV is given only in females (3 doses at 0,1-2 months and 6 months interval) ^^Rotavirus 3rd dose may be required only with one brand. ^MMR 2nd dose can be given at any time 4-8 weeks after the first dose *Varicella 2nd dose can be given anytime 3 months from the first dose PCV= Pneumococcal conjugated vaccine, IPV= Injectable polio vaccine, Tdap = Tetanus toxoid + adult dose of pertussis and diphtheria toxoid, HPV= Human papillomavirus

Repeated respiratory infections

Hello Doctor,

Today I found out this website while searching for the efficacy of saline nebulization in babies. Your suggestions are very practical and helpful.

My baby who is 7 months old is having cough, nasal blockage and also runny nose for one week. She had upper respiratory tract infection which had to be treated with antibiotic 20 -25 days back. She had the similar kinds of symptoms for that initially. So I am really scared whether the same infection is developing again or not. On the last week check up her doctor said clear chest. Then how can I prevent or help her to get out of this cold and cough episodes? Is saline nebulisation safe or effective in this condition? Last time her cough got better with nebulization with bottled saline water. Does it have any side effect? Or can I give in this condition?

One more observation that I notice whenever she catches cold/cough her stool color, texture and frequencies also get changed. It becomes little loose, sometime mucusy, more in quantity and also increases in times. I can not clearly make out that which comes first the diarrhea or cold.

Please suggest

Warm Regards

Dear BM

After 6 months of age, the babies do start getting viral infections repeatedly. Your baby had a viral infection 20days ago. She recovered, as her system developed immunity against that particular virus, but after 20 days another virus attacked her. There are many viruses in the atmosphere that produce cold, cough and fever and these attack children whenever they come across them. By taking many hygienic precautions you can reduce the no. of microbes around you but you will not be able to get rid of them, so you cannot prevent these infections.

There is no medicine that can get rid of these viruses. After 6 to 7 days child recovers from these infections by building immunity against these viruses.( the ability to do so resides in every normal individual).Your job during this time is to see that child is 1. Comfortable 2.is getting enough fluids 3.is breathing normally. If child has difficulty in breathing, then she will need nebulizer. If saline helps, that can be given, if it does not help then along with saline nebulizer with asthalin and budecort will have to be used. If child’s breathing is not relieved with these measures then she may need hospitalisation.

Nebulization with saline has no side effects. you can use it whenever your child needs it.

The viruses that attack your child, not only attacks respiratory system but attacks the gastroentero system also, producing diarrhoea. In this case also you should just take care that your child gets enough fluids.

I am glad you like my blogs. Do read my book on childcare also. You will find this useful also.It is available for free at easybabycare.net.


Raj Rani