What is Apgar Score:

It is a score on a scale of zero to ten to describe the well being of the baby at various points of time after birth.

What is its significance:

It is one of the parameters useful in deciding whether or not the baby requires special help and if so,of what kind.We used to predict baby's future brain development on the basis of Apgar scores but recent studies show that such predictions are not accurate.

When can the baby be held:

If everything is well,you may lie the baby on your abdomen soon after birth.If the baby has any problem or a low apgar score and needs assistance then the same takes precedence.

Can the baby be breast-fed immediately after birth:

Yes.The doctor will help you lie the baby on your abdomen.You may handle and cuddle it.The baby may touch your nipples with its lips or suckle.

Should the baby be breast or bottle fed:

Breast feed is by far the superior of the two.It requires no preparation,is hygienic,readily available at proper temperature with no dangers of error in preparation.Breast milk offers the baby a balanced nourishment for its special needs.Risk of diarrhoea,eczema and colic is considerably less with breast milk.Breast feeding also helps establish an emotional bond between you and the baby.

How should one nurse the baby:

Be comfortable and relaxed.You may nurse in sitting or lying position.Touch the nipple to the lips of the baby.Do not try to force the nipple into its mouth.Baby itself shall root for the nipple and grasp it in its mouth.Most of the milk sacs lie under the areola of the breast - the dark circular area around the nipple.Make sure that the areola is in the baby's mouth.Baby's gums squeeze the areola resulting in the flow of milk.

Describe the position during breast feeding:

As earlier mentioned, you may breast feed either sitting or lying in a bed. You may sit on a chair of average height. Have a back support and you may rest your feet on a foot- stool. Or you may squat on a bed or carpeted floor.Hold the baby in one arm.Support its head with the V of your elbow.Position the head in such a way that the breast is accessible to the baby's mouth.However make sure that its nostrils are not covered or obstructed by the breast or the clothes.Your other hand should be free for supporting the breast. For nursing in lying position, lie either on your left or right side. Ensure that the breast is accessible to the baby's mouth and both of you are comfortable.

How long should baby nurse:

About 25-30 minutes are sufficient.Baby gets most of its milk requirement in the first 5-7 minutes.However it may continue to suck for a longer time.

Shall I offer one or both breasts:

During first few weeks milk in one breast is enough for the baby.Larger babies may need milk from the second breast.At all ages offer alternate breasts at alternate feeds.Both breasts will get the stimulus of suckling which is essential for milk formation.Sometimes the baby is unable to accept enough milk from the breast.Milk retention may lead to engorgement and painful breasts. Make sure that at least one breast is emptied at each feeding.If necessary manually express milk to empty the breast.

When and how often one can feed:

Most babies develop their own schedule within a few days.Feed the baby on demand or when it cries.Some babies may cry every hour but feeding every hour is not healthy.A modified demand schedule is recommended.Feed the baby when it demands but not earlier than 2.5 to 3 hours.In other words, the time interval between commencement of any two consecutive feeds should be at least 2.5 to 3 hours.Similarly,during day time if your baby is sleeping for longer than 5 hours,wake it and feed it. During night,you may let the baby sleep through if it does not demand milk.

What about night feed:

Babies require the 2 A.M feed till they reach a weight of about 5 Kgs.Thereafter you may gradually omit the night feed.

My baby cries within 1-2 hours of a feed:

If the baby cries within 2 hours of a satisfying feed,it is usually not due to hunger but some other reason.Excessive heat and cold,too much clothing,a wet nappy,a prick from a loose safety pin or illness may result in such crying.Some babies want to be cuddled or play with their mother.

Does baby need water:

Water supplements are not required during winter months or in conditioned environments during summer months.In situations of high ambient temperature or excessive water loss,your baby may get thirsty.Breast fed babies may be given an extra breast feed.Bottle fed babies are given boiled and cooled water.

How to burp the baby:

Hold the baby against your shoulder or lean it forward in your lap.You may or may not massage gently from below upwards till the baby burps. Do not tap or beat the back.To relieve the baby of the discomfort caused by air swallowed with milk it should be burped both during and after the feed.

Is a special diet required while nursing:

Continued attention to good nutrition is important for successful breast feeding. There are no specific foods which mothers must eat or not eat while nursing. Occasionally you may find that a particular food affects you, the baby or both, which then should be removed from your diet. Consume water and milk liberally.

What about breast care during nursing:

Cleanliness is important.Avoid cracks,infection and irritation.Wash with soap and water once or twice a day.At all times keep the nipples dry.

When will the baby start gaining weight:

By about the age of two weeks.Babies lose weight during the first few days after birth.A loss of upto 10% of birth weight is acceptable as normal.The baby will regain birth weight by the age of 10-14 days.Thereafter the weight gain averages 25 grams a day.

What is satisfactory growth for baby:

Full term babies generally double birth weight by 6 months and triple it by one year. Premature babies gain about 6-7 Kgs - the same as the average gain during the first year for a full term baby. The length increases by about 10-12 inches during the first year. Head circumference is normally 34-35 cms at birth. It increases to about 44 cms at 6 months and 47 cms by one year. Head circumference is slightly greater than chest circumference at birth but the two become equal by the age of 1 year.

Can bottle feeds be given between breast feeds:

Sucking from the breast is very different from sucking at the bottle and takes considerably more effort.Bottles of any kind undermine establishment of breast feeding.

If one can not breast feed:

Under certain circumstances,which are very uncommon,your Obstetrician or Pediatrician may have to advise you to bottle feed rather than give breast milk.

How to bottle feed:

You may buy any of the standard full cream infant milk powders.The bottle and the nipples,should be boiled in water for at least five minutes.Nipples and caps should be scrubbed with hot soapy water and rinsed well by forcing water through nipple holes.

Prepare the formala in recommended strength with strict hygienic care.

Make sure the milk flows through the nipples in a series of drops. Pour a few drops on the back of your hand to check that it is not too hot before you offer it to the baby.While feeding,keep the nipple full of milk to reduce swallowing of air.After feeding burp the baby. Pour out any milk left in the bottle and rinse it thoroughly with cold water.

When should vitamins and iron be started:

Breast fed infants are given supplements of vitamin D at age 3 weeks.Iron supplements are begun usually by age 3 months.

Babies born prematurely or with low birth weight require vitamin and iron supplementation from birth.

Most commercial infant milks are fortified with vitamins and minerals. Check with your pediatrician before starting your baby on vitamins or iron.

How long can baby be breast fed:

For as long as both you and the baby enjoy and find it satisfying and nourishing. Some mothers feed their infants well past the age of 2-3 years. However,remember that breast milk should supply only the milk part of the infants' diet and should not replace other foods.

When should solid foods be started:

The age for starting solid food is very variable and one of the most widely discussed subjects.Opinions vary from one to the other extreme. Ultimately the choice of food is an individual matter between you and your baby.You are the best judge on what and how much to give. Any medical advice is at best a guideline.

The aim of starting solid food is to meet the baby's increasing needs of calories, proteins, iron, other minerals and vitamins, which milk alone cannot supply. The important consideration in choice of food is its acceptability, easy digestibility and lack of untoward effects. Food should be given initially in liquid or semi-liquid and mashed form.Begin with small quantities and increase gradually as tolerated by the baby. Start one new food at a time. Let the baby get used to it- usually in 7-10 days before starting another new item. Home-cooked preparations are generally preferred to precooked commercial ones.

Suggestions regarding starting of solid food at various ages are outlined in subsequent section.

How does one know that baby is growing normally:

A happy contented and playful baby is the best sign of normal growth and good health.

Your pediatrician will regularly check the baby's weight, length / height and head size, and plot these on a growth chart. Baby's growth can be easily compared to other normal children of its age on growth charts.Each child develops its own growth trend and follows it subsequently.

What if the baby is weak or thin:

Many normal babies are thin but otherwise active both physically and mentally. Their small size is probably constitutional or inborn and nothing need be done about it.

What should be the temperature in baby's room:

Baby's room should be slightly warmer than what is comfortable for you. In absolute terms, this is about 70 degree F both during day and night.

Is humidity also required:

Yes.Humidity helps in two ways.First it helps maintain and regulate baby's temperature. Secondly, humidity keeps the surface of the airway moist. The secretions do not harden or solidify.Loose secretions are easily breathed out or coughed out. Dry secretions result in difficult or noisy breathing and dry cough.

In later section, role of humidity and methods of creating humidity are discussed.

Does baby need to be taken outdoors:

Sun bathing for a couple of hours a day is good for the baby. Unfortunately, out doors with clean environment are difficult to find.A terrace with good supply of sunlight may be used.

How long should baby sleep:

Newborn babies sleep longer than they are awake. Most babies meet majority of their sleep requirement during night. A few will do so during the daytime. Sometimes day sleepers change over and become night sleepers. But as a mother you can not try to enforce any sleep schedule.

What position is suitable for sleeping:

Here again,babies have their own preferences. Some studies suggest that the respiratory and digestive systems work better when the babies sleep on their right side. This position is also recommended for babies with colic due to swallowed air.

What care is needed for umblical cord:

Usually the umblical cord drops off by the tenth day of life. At this time,there might be slight fluid discharge and bleeding.Clean the navel with cotton applicator or Johnson's bud moistened in alcohol.This may be done two or three times a day until the navel has healed.

Which diapers are best for the baby:

For our climate,the cloth diaper is recommended. It is least irritating for the baby's skin. It can be washed and rinsed easily.It is economical.

Absorbent, disposable diapers are also suitable but relatively expensive. Wearing of plastic panties over cloth diaper results in sweat collection producing skin infections and rashes especially during hot weather.

Please explain diapering the baby:

Diapers must be changed often and without delay to prevent skin problems.Wash the genitals from front to back with warm water and pat dry with a towel. If your baby had a bowel movement,do not remove the diaper at once, but fold the soiled portion under.Wipe the buttocks with cotton or toilet tissue;wash with soap and water;rinse and dry. Then put on a new diaper.

Cleanliness and proper diapering as explained above are essential for a good perineum.

A nappy rash is most commonly due to ammonia formed from urine soaking the wet nappy.

Check your baby's diaper frequently. Every time your baby urinates or has a stool,wash the skin with tap water. Dry it well.Then leave the diaper off for a short while to let the skin breathe freely.Apply a fresh diaper loosely.If the skin is very dry, you may occasionally apply vaseline (any drug store has this ointment). Do not use any kind of medical ointment,unless prescribed by a doctor.

If rash still persists then consult the pediatrician.

What are normal Bowel Movements for the baby:

This is variable. But each baby develops his own frequency of bowel movements. A deviation from this may be a sign of disease. Some babies pass stool after each feed. Others pass less often. A few babies pass stool once a week only. Breast fed babies pass stool more frequently than bottle fed babies. Constipation means hard,pellet like stool-not infrequent ones. Diarrhoea means frequent, very watery,loose stools-not the soft semi-liquid ones typical in breast fed babies.

What is the normal stool for the baby:

For first 2-3 days the baby passes a thick,dark-green tar-like stool. Gradually,the stool becomes yellow or of mustard colour. Stool of breast fed baby is semi-liquid, yellow or mustard coloured with seedy particles. It resembles a thin,moong curry.Stool of bottle fed babies is yellow and less liquid and more paste-like.

How to bathe the baby:

Baby should usually be bathed before feeding. For a bath following items are needed:-

Linen: Soft wash cloth,small soft towel, large soft baby towel(for baby to lie on);

Clothing: Diapers,Pins,Shirt and Vest;

Tray Items: Cake of mild soap,Baby powder,Baby oil, Cotton balls;

Procedure: Bathe your baby in a tub containing three inches of comfortably warm water.The room should be warm and free of drafts. Lower him to a sitting position in the water, supporting the head and back with your hand and arm. Wash the baby gently with a mild soap and wash cloth. Lift the baby and dry the skin with a soft towel.Corners of the eyes may be cleaned with a soft cotton ball and cool, previously boiled-water. Clean the outer parts of ear and nose with a moist wisp of cotton. For girls, use a small amount of oil on cotton to clean the genitilia, always from front to back.

What can be done to avoid accidents:

(A) Burns: When bathing the baby,make sure the water is not too hot.Do not drink hot liquids with baby in your lap.

(B) Falls: (i) Be certain that spaces between the crib bars are three eighth of an inch or less in width.

(ii) Make sure that crib sides are secure.

(iii) Lower the crib mattress as the infant begins to sit or stand.

(iv) Use gates for stairways.

(C) Toys: Should be large so that they are not swallowed.Should not have sharp points or edges.

(D) Sharp Objects: Keep pins,scissors out of reach of the baby.Use diaper safety pins with plastic shields.

(E) Poisons: Medicines and Poisons should be kept out of sight and out of reach.Keep a 1 Oz. bottle of Ipecac syrup in your medicine cabinet in case of an emergency but consult the pediatrician before you administer it.

(F) Electricity Outlets: Use safety plugs in electricial wall sockets.Keep appliances out of child's reach.Broken wall switches with open wires should be immediately repaired.

Doctor,my baby gets frequent colds:

This is a common complaint of young mothers.Infants easily catch infections especially viral ones, since they have little resistance in their body.Studies have shown that each infection helps produce antibodies so that upon subsequent exposure to the disease,the child escapes illness or gets it in a mild form. However,no infection or fever should be neglected.It may not be a cold but a urine infection or some other illness. Occasionally a baby may have a weak defence system. This can be checked by tests and if confirmed,can be treated.

My baby has very noisy breathing/Is chesty:

New born babies are per force nose breathers. This means that they mainly breathe through the nose and very little through the mouth. With age mouth breathing is also acquired. But till such time,blocking of nasal passages results in difficulty in breathing. Breathing also becomes noisy.In small babies sounds are easily conducted from the nose to the chest. Noises produced in blocked nasal passages seem to come from the chest. The baby appears chesty.Difficult breathing;noisy breathing;chesty baby-These are few of the frequent complaints for which pediatricians are consulted. Your pediatrician when presented with such a baby shall exclude any disease by a careful history and examination.The disease may be rhinitis, pharyngitis or pneumonia. Once a disease process has been excluded,proper management of these babies is very important. Especially during feeding ,babies with blocked nasal passages may have difficulty. They may swallow excess air,may vomit during or after feeding or may inhale milk or vomitus-leading to severe aspiration pneumonia.

Treatment consists of three parts:-

1. Humidity 2. Saline Nasal drops 3. Suction of nasal secretions.

1. Humidity: A relative humidity of 60-85% in babies environment keeps nasal secretions loose.These can then be breathed out or swallowed.The passage remains clear.Humidity may be generated by one of the following methods:

(a) Cold mist maker. (b) Steam maker/Electric kettle. (c) Evaporative-wet towels, wide mouthed water containers. (d) During summer-by use of desert coolers.

2. Saline Nasal drops: Sometimes, humidification of environment is not enough to soften the secretions in the nasal passages. Saline nasal drops can be used under these circumstances. Remember to instil the saline nasal drops in one side at a time.1-2 drops are instilled into one side. 20-30 minutes later the nasal passages are mopped clean with a piece of cloth or suction. Repeat the procedure on the other side. Saline drops may be prepared at home as follows:-To half cup water, add a pinch of salt. Boil in a small metal container for 5 minutes and allow to cool. In a separate similiar container boil a rubber/glass medicine dropper for 5 minutes and allow it to cool. Fresh saline solution should be made everyday. The transparent portion of the dropper should not be handled. Hold only the rubber -portion for instillation.

3. Suction of nasal secretions:- If nasal secretions are a source of discomfort inspite of use of humidity or saline nasal drops,they need to be sucked out. For use at home two devices are available-DeLee Infant Mucus Extractor and Bulb Infant Mucus Extractor. The Bulb Infant Mucus Extractor is easy to use but unfortunately is not freely available.If you obtain one it is simple to use. Squeeze the bulb between the thumb and fore-finger. Snugly fit the tip of the bulb into the nostril. Release the bulb. By negative pressure,the secrections will be sucked out to the tip of the bulb.Remove the bulb. Wipe the nostrils clean. The manouver may be repeated as required.The De-Lee Trap is easily available.The mother puts the green tube in her mouth.Gentle suction is done to ensure patency of the catheter tubes. Now place the tip of other tube in the baby's nostrils. Push it in gently. Do not use force. Suctioning of secretions may now be done.ALWAYS SUCK IN NEVER BLOW OUT-this may lead to choking of the baby. During and after the procedure the tubes may be rinsed with plain water.

It is to be emphasized thet nasal passages must be clear at the time of feeding the baby.

Are antibiotics bad for my baby:

Used indiscriminately antibiotics are bad. This is true perhaps for all medicines. Unnecessary use decreases the efficacy and can have its own harmful side effects.

At the same time antibiotics are very useful when given for right indications. Hence they may be life saving in diseases like pneumonia,meningitis or bacillary dysentry.

For common cold, antibiotics,more often than not,are not required. But if the pediatrician finds a focus of infection he may choose to prescribe one.

The practice of self medication with antibiotics is totally indefensible. More so is the frequent changing of antibiotics for the same illness in the absence of a sound medical reason for doing so.

My baby has colic:

Colic is the spasm of intestines. It produces pain of varying intensity.Mild colic makes a baby fretful or cry for a few seconds or minutes. A severe colic will lead to crying extending upto several minutes. The legs are bent the fists clenched. The baby's face becomes red or flushed. As the colic passes baby is tired and exhausted and may go to sleep or another colic may follow. Exact cause of colic is not known.Air swallowed during feeding gets trapped in the food pipe.Till it is expelled, it may lead to intestinal spasms. Colic due to swallowed air is best prevented.Three steps are necessary:- 1. Minimize swallowing air during feeding. 2. Burp after feeding so that swallowed air may be eructated. 3. Put baby to sleep in right lateral position

i.e. on its right side. In cases of severe colic antispasmodics are given to relieve immediate pain. Colimex, Spasmindon are

some of these medicines. Antispasmodics act by reducing the propulsive activity of the intestine. If used frequently or in

excess these may result in abdominal distension.Therefore use these medicines only when it is absolutely essential.

Should I use Gripe Water/Mugli Ghutti:

Since these are not allopathic drugs, there are no scientific data on their usefulness or harmful effects, if any.

My baby's eyes water excessively:

This is common in many babies. A narrow tube carries tears from the inside of the eye into the nose cavity. If it has not yet opened up excessive tears flow from the eye itself.It will open usually by the time the baby is six weeks old.Gently massage the area from the inside of the eye towards the bridge of the nose 3-4 times a day. This will aid in opening the tube.

Can the baby's vision be tested:

Eye to eye contact with you,following you with eyes as you move around the house, blinking to strong light are indicative of visual maturity. A formal testing is possible only at a later age.

My baby squints:

Infants do not develop co-ordinated eye movements until about 4-5 months of age.If the deviation perists for several months or squint develops for the first time after the age of 6 months, it should be investigated and promptly treated.

Can the baby's hearing be tested:

A new born baby will respond to noise by startle or eye blinking. At 3 months it will turn its face to look for the sound making object. By 1 year it will be responding to its name.Again formal testing is possible only at a later age.

My baby is Constipated:

Costipation is treated by modification of diet. Foods with fibre and residue are encouraged e.g Cauliflower, Cabbage, Spinach, Potato, Papaya, Cheekoo, Water-Melon, Mango Jam, Marmlade ,Honey, Fruit Juices etc.Foods with low residue content should be avoided e.g Milk, Curds, Banana, Rice, Egg White, Apple. If constipation still persists, consult your Pediatrician.

My baby has frequent stools:

Frequency of stool varies from baby to baby. Breast-fed babies may have bowel-movements once a week or 10-12 times per day.Bottle-fed babies open bowels less often.

Abnormal signs are :- Change in frequency e.g:from 2 to 6 per day; change in consistency; persistant green colour; presence of mucus or blood;an irritable baby;weight loss or no gain.

What are white patches on tongue and palate:

These could be milk sticking to tongue and would come off by themselves or if scrapped gently. Sometimes a fungus infection,called thrush,can produce such dirty white patches over a red unhealthy tongue. It is quite common during first 3 months of life. Treatment consists of local application of medicines prescribed by your pediatrician.

What is Jaundice of the Newborn:

Seven out of ten newborn babies develop jaundice. It appears on third day,peaks on fourth and disappears by fifth

or sixth day. We call it physiological jaundice as it is a normal body phenomenon. It requires no treatment unless the jaundice is excessive.

If jaundice appears within 24 hours of baby's birth, it is not normal and requires immediate treatment.

What is Breast Milk Jaundice:

Breast fed babies have prolonged jaundice. It may last for 3-4 weeks. It is harmless. The pediatrician however should rule out other causes of jaundice which may require different management.

What are Birth Marks:

A greyish slate coloured mark over the back and buttock region is called mongolian spot. It is quite common and harmless. Purple red or frank red birth marks are hemangiomas. They contain blood vesseles. Most disappear by themselves.

Brownish, coffee-coloured marks are called cafe-au-lait spots. If small and less than 6 in number they are best ignored.

What is PKU Screen:

PKU stands for Phenylketonuria. This is an inborn disease.It leads to slow growth and mental retardation.Early diagnosis of this disease may be made by urine examination at age 1 and 2 months. If urine test is positive,a confirmatory blood test is done.

Hb/Retic Count Urine:

Test for anemia and urine infection are done at ages 9 months, 3 years and 4 years as these are the vulnerable periods.These tests lead to early diagnosis and treatment of babies with a problem.

How to Administer Medicine to Newborn baby:

Liquid medicines should not be put directly into the mouth. It is preferable to place them in the well of the cheek. Turn the baby's face to one side.Pour the drops or liquid on the inner surface of the cheek. Keep the face turned to side until the medicine has been swallowed. When large volumes of a liquid medicine have to be administered,piece-meal administration may be done.

Guidelines for care of babies at various age groups are outlined below :-

FEEDING :- Milk is nearly the only food during this period. Breast milk is preferred to non-breast milk. Breast-fed babies need supplement of vitamin-D from age of three weeks. Humanized milk powders (Tin-milks) are fortified with minerals and iron.Babies given this milk do not need vitamin supplements on a routine basis.

As discussed earlier, the frequency of feeding is best controlled by modified demand schedule. Breast-fed babies do not usually need water supplements. In warm weather where excessive water loss through sweating may occur,an additional breast feed may be given. Non-breast fed babies are given boiled and cooled water.

DEVELOPMENT :- Spontaneous smile is an early milestone in your baby's development. Baby will smile on its own. Such smile signifies a comfortable and satisfied baby. At 6 weeks or so the baby will smile in response to your smile.

You will notice that the baby keeps its head turned to one side. This is called tonic-neck-posture. Later the baby will assume a symmetrical posture on its own.Its control of its arm and leg movements is limited. When pulled to sitting position, its head will lag behind. Neck control is achieved by the age of three to four months.

Between the ages of two and three months, the baby will follow you with eyes through an arc of 180 degrees.

HABITS :- Halfway through this period, the baby will develop a fairly regular schedule of feeding and sleeping.But do not hurry the baby if it does not have one.Let it develop one of its own in its own time.Some new mothers are anxious whether their baby's needs are being met. Not being experienced themselves,they may try to impose on their baby a pre-conceived schedule learnt from a friend or from a book.This is not advisable.Let the baby develop at its own pace.

In the 24 hour period,most babies take 5-6 feeds.When baby weighs 5 Kgs it may sleep through the 2 A.M. feed.

Babies at this age sleep more than they are awake.Most are night-sleepers and awaken during the day.The reverse pattern is seen in a few babies.Here again,it is better to let it be as it is than to try to change.

Crying is the only language the babies know for expression of their needs.These should be met as soon as possible after being expressed.It is not advisable to leave the baby crying for long periods. Satisfying their needs does not spoil them.In fact it leads to greater emotional stability.As your experience in baby-care increases, you will be able to distinguish various types of cries in relation to baby's needs.Your response will be that much more appropriate and satisfying for both you and the baby.

FOURTH AND FIFTH MONTHS

FEEDING :- Milk feeds are continued. For many babies milk alone is sufficient to meet all their requirements till the age of 4-6 months.Solid food need not be added to the menu of such babies. Two parameters should be met for this schedule. The baby should be contented and the weight gain should be satisfactory.

Beikost(Foods other than milk) is introduced when the baby is either not completely satisfied with milk alone or is not gaining weight satisfactorily.In an exclusively milk fed infant, beikost should be started at an age not later than 6 months.

Cereals,apple,banana,potato are some of the commonly used first foods for babies.A solid feed may be introduced at any one of the three day time feeds - mid-morning,afternoon or evening. The first and the last feeds of the day continue to be milk feeds.Commonly,solids are introduced at the morning or afternoon feeds. However, any number of permutations and combinations are possible in respect of schedules for introduction of solid foods to babies.These vary from person to person, family to family,region to region,country to country and in their own way each one is appropriate and most suited for a particular baby. In areas of high socio-economic level, one generally finds a trend of longer duration of milk feeds and late introduction of solid foods as seen in western countries. As one moves eastwards,the duration of periods of exclusive milk feeds decline and early introduction of solid foods is noted.

Let me confess that as Pediatricians,we possess scientific information about only a few aspects of infant feeding.About many more aspects, we are still searching for answers.Therefore it is best not to be dogmatic about the subject.

On a few matters, however,well tested knowledge exists.These are outlined below :- (a) Most babies will grow well on milk alone upto the age of 4-6 months.They may not need any other solid food except supplements of vitamins and minerals. (b) New foods should be introduced one at a time.Let the baby get used to a new food for 5-7 days before adding another new food. (c) Tongue movements and swallowing mechanisms are not well co-ordinated in small babies.Therefore give foods in small quantities and in mashed form.As babies grow older their swallowing mechanisms mature and foods in coarser forms or larger quantities will be accepted.(d) In a few babies,foods like egg,meat,fish,orange,tomato,nuts,chocolates,strawberries are more likely to produce allergic manifestations during the first six months of life than later.

In more specific terms,the first foods commonly introduced are cereals, mashed banana, mashed boiled potato or apple juice.Commercial pre-cooked cereals may be used.Home made cereals like semolina or porridge are equally acceptable. Start with 1-2 tea spoons of cereal. Mix with milk or water to a paste like consistency.Feed the baby in small portions. It is better to let the baby lick small amounts of this paste than to gulp down in large swallows. A feed of cereal may be topped with a small milk feed. The quantity of cereal is increased by 1-2 tea spoons every 5-6 days according to the baby's apetite. 12-15 tea spoons may be accepted at one feed.Many mothers will split the cereal portion equally between two feeds.The amount is increased gradually according to the baby's needs.Mashed banana or boiled potato are started in quantities of half to two tea spoons.Milk or butter may be added. Apple juice is introduced in quantities of one fourth to half ounce diluted with equal amount of boiled water. Gradually the volume is increased and dilution is discontinued.

Those babies who have started taking solid food do not require vitamin or mineral supplements.Breast-fed babies are given iron supplements in addition to vitamin-D after the age of 3 months.

DEVELOPMENT AND HABITS :- Baby's neck control is better now. When pulled to sitting position,its head does not lag. It is also making attempts to move its arms and legs purposefully. It may seek to reach various objects and hold them momentarily. Encourage this. When lying, the baby now has a symmetrical posture.The head is kept in midline. As a result a small area of baldness may appear over the back of head. Hair will again grow in this area later when baby begins to sit up. When placed on its abdomen, the baby will raise its head supported on its arms. Soon it will turn from its abdomen to its back.Later, it shall be able to turn from the back to its abdomen.

Visual attentiveness has also increased.The baby will follow you through with its gaze as if it recognizes you.At other times it may make visual efforts to seek you.On seeing food,it will become excited.

SIXTH MONTH

FEEDING :- By the age of six months the baby should be eating all types of cereals lentils,fruits and vegetables. Rice, dal-curry, mashed dal,chapati,bread,mashed vegetables, stewed fruits, sweets prepared from lentils, fruits or vegetables may all be offered.With eruption of teeth about this age the gums swell up and slight pain may be present.Babies like to chew. Semihard foods like crackers may be offered.

DEVELOPMENT :- When pulled to sitting position, it will sit on its own for a short time. Pulled to standing position the baby will support its weight on its legs. It will reach out for objects and transfer them from hand to hand. For grasping objects the outer side of hand or the radial side is used.

It is also begining to vocalize coherent sounds. Polysyllabic vowel sounds like ba-a-a are made.

The usual age for the eruption of teeth is 5-9 months. Supplements of calcium and vitamin-D may be given if these are not adequately provided in the diet.

HABITS :- The feeding schedule has become fairly regular.A firm sleep-pattern has also developed. There is also more regularity in bowel movements.

The baby has great affinity and preference for its mother at this age. For all its activities - feeding,playing or sleeping the baby needs proximity of its mother. A mother whose child is fretful when she leaves the room may sometimes comfort it by maintaining vocal contact.

FEEDING :- The baby shall accept more and more of the family table food.Encourage this. Start with soft foods.Offer coarser foods later on.

The first feed in the morning and last feed in the evening may be entirely milk feed. The other 3 meals - mid-morning, afternoon and evening should be increasingly derived from meals cooked for the rest of the family with suitable modifications in consistency and seasoning for the baby. New foods like egg yellow,egg white,meat and fish may be offered in this order.

When baby starts to sit independently, a seat and chair (special baby chair) may be provided at the dining table. Baby learns to eat at meal-time,learns to eat family food and learns to interact with other members of the family.

Milk intake in excessive amounts is harmful after this age. A daily intake of 18-20 ounces of undiluted milk and milk products is adequate.Milk is wholesome food but consumption of too much of it to the exclusion of other foods can adversely affect baby's growth. Additionally milk has low level of nutritional iron. Babies whose diet predominently consists of milk develop milk anemia. Such babies are fretful and irritable and catch infection more frequently than other babies.

Source of milk may be breast milk or humanized dairy milk or dairy milk. You may wish to continue breast feeds for a longer time. This is acceptable. However, make sure that the baby is taking other solid food as well and is not depending totally on breast milk.

DEVELOPMENT :- By 7 months,the baby sits on its own without support,by 9 months it stands independently; by 10-11 months it may start to crawl from place to place.About the age of 1 year,some babies may walk with support. Early crawlers walk late.On the other hand non-crawlers learn to walk early.

Greater maturity of finer movements of hand also occurs during this period. The baby can hold objects between thumb and forefinger in a pincer grasp. It may point at or poke at an object with its forefinger.

Monosyllables like ma-ma are vocalized.At 1 year these may be spoken meaningfully. Additionally the baby may wave good-bye.

Eruption of teeth occurs continually in this age period. Lower inner incisors, upper inner incisors, lower outer incisors and upper outer incisors appear in this order.First molars appear next at about 12 months followed by canines at 18 months and second molars at 24 months.Great variability exsists in regard to time of appearance of teeth.

HABITS :- With increasing dexterity of its hands and feet, the baby is becoming more self-sufficient.It may want to hold the bottle or cup or spoon while feeding. It will also explore its immediate environment more energetically. Therefore there is need to protect babies from hazardous objects like electricity outlets, household poisons or medicines.

At 5-6 months, the baby develops the habit of grasping objects and bringing them to its mouth. Thumb, fingers or hands are the common targets of such attention at this age. After the age of 9 months,with increasing mobility,the range of objects taken to mouth increases. Objects from floors may also be picked and mouthed. This habit increases risk of infections especially diarrhoeas.It is important during this period to keep the baby's environment and floor as clean as possible.

As the variety of foods in the baby's menu and their coarseness increases,ingestion of food requires use of cups, spoons, glasses etc.Encourage the baby to acquire the skills to use these. Providing a place for the baby at the dining table, as mentioned earlier,also helps the baby towards this goal.

A 9 month old baby is very fearful of strangers - doctors and nurses are included.Separation from mother results in crying. Prolonged separation may lead to anxiety, apathy reduced apetite and lack of growth.These responses should be kept in mind when planning a separation between yourself or the baby for medical or other reasons.

FEEDING :- After the baby is 18 months old,a change in its eating habits will be noticed. It will not eat as much and will not gain weight as fast as before. At some meals the baby may not want to eat at all. This is a normal change.The baby is not growing as fast now and therefore does not need as much food as before. At birth an average baby weighs six and a half pounds.In first 12 months - upto the age of 1 year - the increase in weight amounts to 14 pounds. It now weighs 21 pounds.From 12-24 months the baby will gain about 5 pounds - nearly 1/3 of the gain in first 12 months. It makes no difference if the baby is playing harder or is more active.It still does not need as much food as before because the rate of its growth has slowed down.Its body cells cannot grow faster than this.

Bribing,coaxing or forcing the baby to eat food when it is not hungry will lead to a lot of harm and little good.Two good meals or three small meals are enough in a day. The baby's apetite has decreased normally.Do not slow it down further by giving snacks to the baby. If a baby eats in between meals,it may not want to eat at meal-time. Give baby nutritional food. Give baby food at meal times. Let the baby decide whether it wants to eat or not.This way your problems will be lesser and your baby's health will be better.

Every meal should contain at least one good protein source such as dal or lentils,cheese,eggs,meat or chicken.

DEVELOPMENT :- Early in the second year the baby will begin to walk with support. Later it will walk on its own. Hand movements become more complex.By the end of second year,the baby will be able to draw random lines on a paper. The gait becomes steady.Walking and running are under full control. Stairs may be climbed one step at a time.Baby may stand on one leg for a few moments.

By 15 months,the baby speaks about 10-12 words.By 18-21 months,two word sentences may be formed.Later three word sentences are spoken. Short delays in speech milestones are common and are not a cause for concern provided hearing of the baby is normal.

Teeth start appearing at about 6 months of age.By the age of 2 years,the baby has between 16-20 teeth.

HABITS :- By 18 months,the baby begins to understand commands.It can distinguish between parental approval and disapproval. Consequently the habit of mouthing objects is gradually lost in response to discipline enforced by care-givers.

During second year the baby becomes increasingly autonomous. It demonstrates self-discretion and initiative. It is learning to use the words yes and no apropriately. Often the baby is unable to make up its mind between the two.It may say 'no' when it means 'yes' and vice-verca.You should be aware of this. Do not try to excessively enforce compliance with your wishes.It is also not advisable to seek to alter this normal behaviour through punishment or otherwise.

Second year is also the year during which toilet-training is aquired. By the age of 18-24 months, most babies will be able to express their toilet needs. They should be helped to follow the accepted social patterns.But the learning should be at the baby's own pace. Any other pace will be counter-productive and only delay the acquisition of self-sufficiency.