Q. How do I know that my child is growing normally?

A serial record of height and weight of a child is the best way of knowing that a child is growing well. This can be done by maintaining a growth chart. A growth chart for children upto 2-3 years of age shows a serially maintained record of a child’s weight, length and head size (circumference) in comparison with the normal range for the child’s age and sex. For a child older than 2 years growth charts show serial recordings of child’s height and weight.

Since a child grows very fast during first two years of life, his growth should be assessed at every opportunity. This is done conveniently during the visits for routine immunisation. and other visits to the doctor. Thus, during the first year, it is recommended that a child’s growth is assessed at birth, at 6, 10, 14 weeks and 9 months (coinciding with visits for immunisation). A 3 monthly record during the first two years is ideal. Subsequently, since the rate of growth slows, measurement of weight and height taken twice during an year and duly recorded on the growth chart suffice to give a good indication about the child’s growth.

It is important to realise that there is a wide range of weight and height that is considered normal for children of same age. Some children are genetically and constitutionally shorter or lighter, while others are taller/ heavier. However, the rate of growth of all healthy children at various ages is similar. If the rate of growth is slower than expected for age, the child needs to be evaluated by a doctor. A well maintained growth chart helps in early detection of growth faltering.

Q. What are the normal weight and height for children of various ages?

The tables given below show the average weight and height, as well as the normal range for boys and girls. These provide an idea about the child’s growth at the moment of recording since 94% children of that age and sex would have height and weight falling within this range As mentioned earlier, a better idea of child’s growth can be had by keeping a serial record of growth parameters rather than by making a one time comparison with the reference standards.

Height and weight of boys from 0-3 years of age: 

Height and weight of girls from 0-3 years of age:

Q. When will my baby’s first tooth appear?

Teething usually starts around five months and continues until the end of the second year. However, the order in which the teeth appear remains unchanged. Lower front teeth begin to appear by the age of 5 to 8 months. Upper front teeth begin to appear at the age of 8 to 12 months.

Q. What precautions should be taken while the baby is teething?

Teething is a normal phenomenon. During this time babies may feel some irritation in their gums. They may try to put whatever objects they lay their hands on in their mouth to relieve this irritation. This can lead to infection, diarrhoea or fever. Therefore, all the objects that the baby is likely to handle should be washed and cleaned several times a day. A clean and safe teether can also be used to pacify the baby. Baby’s nails should be clipped and hands washed several times a day. A baby does not require any drugs/ supplements during this period.

Q. What are developmental milestones?

Milestones are punctuations in a baby's growth and development. These milestones provide a guide to parents telling them what to expect from the baby and when to expect it.

The sequence of development is same for all children, but the rate of development varies from child to child. For example one child can learn to walk independently as early as 10 months of age, while the other might be able to do so at 15 months. This is the normal range for achievement of this milestone. However, a child has to learn to sit before he can walk, and to hold his neck before he can sit. Since there is a range of period that is considered  normal for achievement of a milestone, departures from the norm should not be a reason for undue panic unless confirmed by expert medical opinion.

Q. What are some of the important milestones?

Some important development milestones of a child and the usual time of appearance are as follows:

•       Smiling when “talked to”- 2 months

•       Neck holding – 3 months

•       Recognizes mother – 3 months

•       Reaches out for an object and holds it in his hand – 5 months

•       Making sounds like ‘ma’ ‘ba’etc-6 months

•       Sitting without support- 8 months

•       Crawling- 11 months

•       Standing without support-1 year

•       Speaks two words with meaning – 1 year

•       Walking with support – 13 months

•       Walks upstairs-24 months

•       Makes simple sentences – 24 months

Q. When should I be concerned about developmental delay in my child?

There is a wide range of normality for achievement of all developmental milestones. A child with delay in achievement of mile stones beyond the age indicated below should be assessed by a doctor:

•        Does not respond when “talked to”:3 months

•        Does not seem to recognize mother/ become alert on seeing mother: 3 months

•        Does not seem to be able to hold its neck: 4 months

•        Does not hold a rattle: 4-5 months

•        Does not make any sounds: 5-6 months

•        Does not sit without support: 8 months

•        Does not stand holding furniture etc: 9-10 months

•        Does not walk independently: 15 months

•        Does not speak any word with meaning: 18 months

Q. How can I know that my child is having a normal vision?

A young infant would watch his mothers face intently by 4 weeks of age and smiles in response to his mother’s gestures by 6-7 weeks of age. Achievement of these milestones indicates that a child has normal vision. A lack of fixation of vision and social smile by 8 weeks should prompt an evaluation by a doctor. Visual defect in an older child can be suspected if your child keeps bumping into the furniture or has trouble following the trajectory of a ball thrown to his/her. Changes in the appearance of the eyes, such as a lazy eye, drooping eyelid or a squint should also be evaluated by a doctor. 

Q. Why do some children speak later than others?

There is a lot of variation in development of speech. Many children, who are other-wise completely normal, learn to speak late. Lack of environmental stimulation is a common cause of delayed speaking. The more the child is ‘talked to”, earlier he will learn to speak.

An important cause for delayed speech is poor hearing. Therefore, a child who has not started making any vocal sounds by 5-6 months of age or does not speak any word with meaning by 18 months of age should be evaluated by a doctor.

Q. What is complementary feeding and when should it be started?

Complementary feeding refers to adding semi-solid foods to an infant’s diet who has, so far been accustomed to mother’s milk only. Exclusive breast feeding should be carried out until 6 months of age. After 6 months breast feed is not adequate to meet the nutritional requirement of baby. Hence, he/she should be gradually introduced to semi solid and later to solid food.

Q. Should breast feeding be discontinued after the introduction of complementary feeding?

No, breast feeding should be continued even after starting a solid diet. Babies should be breastfeed as log as possible, even up to 2 years of age and beyond. However, it should be kept in mind that as the child grows older, he receives more and more of his nutritional requirements from other foods. Breast milk increasingly supplements the other foods, rather than be the main source of nourishment.

Q. What are the common complementary foods suitable for an infant?

The choice of complementary food should be decided in cultural and social context. It should be soft, freshly prepared, hygienic and offered in a mashed/ homogenised form to a young infant accustomed only to the milk. While many ready made semisolid foods for infants are available commercially, mothers can prepare healthy food suitable for the baby with resources readily available at home. Most of the packaged foods are much more expensive, and do not offer any advantage over home cooked foods.

Examples of complimentary foods include suji (semolina) cooked in milk, mashed daal, khichdi, thick stew made from boiled and blended rice, pulses and seasonal vegetables, mashed bananas etc

Q. What are the guidelines for feeding   infants upto 1 year of age?

Once a baby completes 6 months of age, complementary foods should be introduced one at a time. In the beginning, offer a small quantity, say a spoonful or two once a day. Over the next few days, gradually increase the quantity till it can replace a milk feed ( roughly 1 katori serving). Introduce another food and gradually increase its quantity in a similar manner. Avoid introducing too many foods at the same time, letting the baby develop a taste for one food at a time. As the child starts teething and gets used to the new food consistency, start chopping the soft food in small pieces rather than mashing it completely. Now the baby can have rice mixed with dal, chapati soaked in dal/vegetables etc. by the time a child is one year old, he should be able to have most foods cooked at home. Usually, a breast fed baby should get at least 3 servings of semi-solid food, about 1 katori serving each by one year of age. The mother should take care to wash her hands and feed the child herself.

Q. What are the guidelines for feeding a child older that 1 year?

During this time, a child should be eating every thing cooked at home. The serving size can be increased upto 11/2 katori each and atleast 5 servings should be offered. Introduce a variety in child’s food which should include cereals, pulses, fresh vegetables and fruits, milk and milk products. A little oil/butter can be added to increase the energy content of foods. The child should be given his own separate plate. As the child grows older, he should be encouraged to eat on his own, though the mother should sit with the child and help him eat. This does not mean forcing a child to eat. Rather, the child should be allowed to develop his own sense of satiety and this should be respected.

A child beyond two years of age should have 3 main meals along with the rest of the family with 2-3 mid-meal snacks which could include milk, fruits, biscuits etc

This is the time for development of healthy eating habits and parents should ensure that their child learns to enjoy fresh, home cooked healthy food.

Q. What can be the causes of food refusal when complementary foods are being introduced?

The child can refuse to take food during weaning period due to:

• He/she is not hungry

• He/she is tired, sleepy or interested in playing at that time

• Dislikes the food being offered

• The child is being rushed because of time constrains

• He/she is uncomfortable because of a wet nappy.

• The food is too hot or remembers a previous food which was too hot.

A child should never be force-fed. Try to find the cause of food refusal and act accordingly. Mother should learn to recognize & respond to signs of hunger in the child. The meal times should be pleasant for the entire family rather than a source of anxiety for the mother & child.

Q. Why is immunization needed?

Immunization is one of the most important and cost effective way of protecting children against common childhood illnesses many of which can be potentially serious, even life threatening[k1] . The illnesses against which vaccination is being offered free of cost by the Government of India include tuberculosis, diptheria, whooping cough, tetanus, polio and measles. Many States also offer free vaccination against hepatitis B , mumps & rubella. These vaccines are available at various Government Hospitals, Dispensaries & Health Centers. Vaccination is also available against other diseases like chicken pox, typhoid fever, hepatitis A, H influenzae infection etc. These are however not currently being provided by the Government. These can be taken from private Hospitals/ Clinics as per the advice of the Pediatrician

Q. What is the immunization schedule?

The following schedule has been recommended by the Ministry of Health, Govt. of India.

NATIONAL IMMUNIZATION SCHEDULE