1

theChild dr

AUGUST 2021

CHILDREN& COVID-19Our Role?

A monthlymagazine onChild Health

A child health journal for parents.

NUTRITION

BREAST FEEDING

FOOD FOR EYES

ONLINECLASSES

STRESS

2

From Editorial deskDear parents,

We are happy to get into touch with all parents through this the Child dr E-magazine.

This monthly e-magazine has been started based on the idea of Dr. P. Sudhakar. MD(Ped).PGD-DN, Senior Consultant Pediatrician and Developmental Pediatrician to clear the doubts and answer the questions arising in parents mind about their kids health in a simplified scientific way.

This magazine is a pure scientific magazine and will discuss about Children’s health needs and health conditions. It will cover articles written by Pediatricians and experts involved in Child health and education to help parents to get the scientifically proven information in a simplified language.

We have included a special space for Kids to have their own doubts cleared named as KIDDY’S Corner which will be managed by kids themselves. KIDDY’S corner will look their health issues in their perspective and will get the right answers from experts.

This first issue concentrates on the child health care pertaining to this pandemic.

We request your esteemed support for this E-magazine in a bigger way by sharing this magazine to your friends and social groups.

Let us be a part of spreading the scientific awareness about child health issues in India.

Editorial team

A child health journal for parents from Smilestones Child Development Centre. Please send your queries to thechilddrmagazine@gmail.com. We will publish your queries with answers from experts in next month issue.

S.No Content Page No.

01 Nutrition for children in pandemic period 04

02 Fever in children during COVID times 09

03 Pregnancy and Pandemic- FAQ’s 12

04 COVID and Teen Psychology 15

05 Chat with your Pediatric Dentist 17

06 On-line Classes-Rewards, Regrets, Revelationsand Remedies 20

07 Telehealth for Developmental issues 23

08 COVID and Breastfeeding 25

09 Food for Eyes 27

3

Introduction

We have now come to an era, which none of us could even imagine, in our worst nightmare dream. Many got isolated and jobless, with no social contacts. COVID 19 pandemic has thrust upon mankind, a lot of restrictions, socio-economic changes, and lifestyle related transition.

No doubt, we were fast moving towards socio-economic progress, lifestyle changes and thereby a cultural and nutritional transition. However, now everything has slowed down and shut down, including schools. Children and parents are destined for long home stay. Lot of psychological and emotional stress and distress have gripped both adults and children of all age groups. Parents seem to be overworked, overburdened due to the pressure of work from home and household work. In addition to this heavy burden, they have the added stress of copping up with children’s online classes and their tensions.

The socio-economic and socio-cultural transition, the pandemic fatigue and disease morbidity and mortality have caused irreparable damage in several families. Starvation, wrong food choices and picky eating have resulted in growth retardation and micronutrient deficiencies in the affected individuals. Many children have become orphans and homeless. Even exclusive breastfeeding during first 6 months of life has seen setbacks. Immunization is another area that showed setbacks.

Dr. Elizabeth K E, MD, DCH, Ph D, FIAP, FRCPCH (Lon.)UNICEF Consultant, Kerala State Former Prof. & HOD Pediatrics & Superintendent, SAT Hospital,Govt. Medical College, TrivandrumState President, IAP Kerala, 2016, National President, IAP Nutrition Chapter, 2017, 2018

Nutrition for Children inPandemic Period

4

Another cultural phenomenon, that has creeped in is, the buying OTC tonics and other preparations, and multivitamins and minerals, the so called immune- boosters. Overdose is resulting in hypervitaminosis of some like fat soluble vitamins like ADEK and heavy metal poisonings.

In the initial months, it seemed fun to cook and stay at home. The Junk food, which was available outside homes or brought to dining tables and living rooms got warm welcome into the ordinary family kitchens through YouTube and the WhatsApp university. Now the online delivery platforms, like the Swiggy and Zomato, are bringing these to doorsteps on a 24/7/365 timeframe. Sedentary lifestyle and overeating have resulted in escalation of overweight and obesity in pandemic proportions. It is perceived that overweight/obesity, which was increasing 2% per year, became 20% in the pandemic year of 2020. What is in store for 2021 is yet to be revealed.

Fixing mealtimes and family exercises, which are the need of the hour, will have to be popularized. Ensure 7-8 hours of sleep and limit the screen time. Practicing 108 is a good Mantra for Success

1 hour – Exercise, 0 – Junk Food on 5-6 days/week and 8 hours – Sleep.

5

A Ten-point Agenda for healthy eating, giving due importanceto the first 1000 days of life - 9 months in utero to + 24 months,

till the second birthday is given below.

1. Adolescent & Pre-pregnancy Nutrition

Ensure better quality and quantity food to Adolescent Girls & Prospective Mothers and micronutrient supplementation.

Achieve minimum 45 Kg weight & 145 cm height with enough calcium and iron stores.

Ensure weekly Iron and folic acid (IFA) tablets and Calcium.

Provide folic acid (FA) prior to consumption in all planned pregnancies.

2. Maternal & In-utero Nutrition

Ensure one extra meal to the mother during pregnancy and lactation. Give nutritional supplements like iron, folic acid and calcium.

Community kitchen/ Take home rations exclusively for this group, in vulnerable communities. Periconceptional Folic Acid, (1 mg/ day), starting at least 1month prior to conception to be continued and followed by Iron and Folic acid tablets (Iron 60 mg & Folic acid 0.5 mg).

Calcium (500 mg) tablets for 180 days during pregnancy, starting from 14 weeks of gestation and without stopping it has to be continued for 180 days during early lactation period.

3. Young Infant Nutrition

Ensure initiation of breastfeeding soon after birth, within an hour, followed by exclusive responsive feeding, minimum 8 times during the 1st 6 months of age and continued breastfeeding till 2 years of age and beyond.

Implement the strategy - BIG

“BIG - Breastfeeding, Immunization, Growth monitoring”

Achieve minimum 1 Kg weight gain by 6 weeks of age, Doubling of birth weight by 4-5 months of age.

Give vitamin D drops 400 IU/ day to all postnatal babies and other micronutrients as per need.

6

4. Complementary feeding

Ensure semisolids on completion of 6 months, belonging to different food groups, adding one by one, after 6 months of age, along with continued breastfeeding.

Implement the strategy - BIG

“BIG - Breastfeeding, Immunization, Growth monitoring”

Achieve tripling of birth weight before one year of age (around 10 Kg).

Continue Iron and Folic acid and vitamin D Supplements.

Biweekly IFA is advised to all children between 6 months of age to 5 years of age ( under the Lifecycle approach of Anemia Mukt Bharat.

5. Toddler’s Family pot feeding (Kitchen based feeds)

Empower for family-pot feeding by one year of age. Ensure age-appropriate food from the family pot and continued breastfeeding till 2 years of age and beyond.

Implement the strategy - BIG

“BIG - Breastfeeding, Immunization, Growth monitoring”

“Quadrupling of birth weight by 2 years of age.

Ensure minimum

5 food groups,5 colors,5 times a day

6. Under-five feeding with Safety net.

Ensure Rainbow diet with strategies for bridging energy, protein, and micronutrient gaps. Ensure the rainbow diet colors; GYOR- green, yellow, orange, red - vegetables and fruits, Brown- whole grains, Purple- protein sources like pulses, nuts, and non-veg items and White- milk and milk products.

Ensure a ‘safety net’ by way of food supplementation, group eating/take home rations and small frequent feeds using the ‘Akshayapatra’ concept.

Akshayapatra is a vessel, which is never empty. Having a ‘Kid’s food corner’ (KFC) is another alternative, so that child can point to food, when he/she wants.

Ensure liberal fibre in food and at least 6-8 glasses of water to prevent constipation.

7

7. School age & Adolescent Nutrition

Ensure Balanced Rainbow diet with all food groups with emphasis on not missing breakfast and mid-day meal.

Time management, discipline in lifestyle like getting up on time, personal hygiene, avoiding constipation, taking Breakfast, liberal fiber in diet and 8-10 glasses of water.

Mid-day meal program to be continued as take-home rations.

9. Diet during Illness

Ensure one extra easily digestible & nutrient rich diet during convalescence from any disease, for at least 2 weeks or lost weight is regained.

Recoup lost weight & achieve catch up growth after illness

10. Non- Nutritional Interventions

Ensure Social support, developmental stimulation, Food hygiene, hand washing, periodic deworming, Healthy eating practices, Physical activity, Limited non-academic screen time with parental involvement. Optimize academic screen time.

Monitor weight and height at home, observe developmental milestone with developmental observation charts, Implement WASH- water, sanitation and hygiene practices, undertake BCC- behavioral change communications, Family, and group exercise programs to suit all ages, empowering to read food labels and making available healthy food choices in the schools and in the food outlets.

8. Micronutrient and Antioxidants Sufficiency

Ensure a Balanced Rainbow diet including dietary diversity, food fortification & specific nutrient supplementation. Ensure supply of IFA, Vitamin A, Zinc to the beneficiaries as the National programmes.

Implement Rainbow Revolution-Kitchen Garden, terrace farming, group farming- cultivating and consuming-colored vegetables and fruits.

Rainbow diet with 7 colors and 7 food groups; GYOR- Green Yellow Orange Red for Vegetables, Fruits and antioxidants, B- Brown for Whole grains Multi-grains, Roots and Tubers as energy source, P-Purple for pulses, nuts and non-veg for protein rich food, and W-White for Milk products

8

Fever in children during covid timesFAQs

The COVID pandemic in the last one and half years has led to panic among parents whenever their child is down with fever.

I have tried to answer a few queries which are commonly asked by parents of children with fever.

1. Is the fever due to COVID different from other fevers?

SARS COV2 is a virus like any other virus and fever due to COVID is like any other viral illness. So we cant differentiate the illness with just fever alone.

All that glitters are not gold and all fever is not COVID but we need to be watchful as the pandemic is not yet over for us.

2. When should I bring my child to the doctor when he has fever?

Parents should bring the child to the hospital when the child has following symptoms

Dr. Janani Sankar DNB, PhD, MNAMSSenior Consultant Kanchi Kamakoti CHILDS Trust Hospital, ChennaiIAPCCB President 2019CIAP EB Member 2021

9

• Feverhasbeenhighgrade(>101F)formorethan2-3days• Refusingtofeed• Unusualdrowsiness• ReducedUrineOutput• Vomiting• Abdominalpain

3. How do I treat the fever at home?

• Measurethetemperatureusingadigitalthermometer.keepitinarmpitfor minimum 2 minutes or till you hear the beep sound.

• Ifthetemperaturerecordedismorethan100.4Fgiveparacetamolinthe prescribed dosage.

• Thedoseshouldberepeatedagainonlyafter4-6hours.• Avoid substituting drops for syrup (common mistake leading to

hospitalization of children).• AvoidMefenamicacidcontainingsyrups.

4. What should be the diet that should be given when the child has fever?

• Childcanbegiventhenormaldiet.• Giveplentyofliquids.• Avoidspicyfood.

5. If the parents are COVID positive what precautions should we take for the child?

• If parents are positive child need not be testedwhen they have nosymptoms.

• Childcanbekeptathomealongwiththeparents.• Parentshavetowearmasksandusehandsanitizers.• Avoidclosecontactwiththechild.• Ifthechilddevelopsfeverheorsheshouldbetakentothehospitaland

needed testing to be done.• Donotsendthechildtograndparentsorotherrelativeshouses.

6. What if my child becomes COVID +?

COVID illness is usually very mild in children. Symptomatic treatment with paracetamol is more than sufficient. But follow your Pediatrician’s advice in management.

10

7. What special precautions should I take if my child is on regular medications for a chronic illness?

Every chronic illness has its own issues and morbidity risk pattern (complications arising due to the illness) based on the nature of the chronic illness. If your child is on regular medications report immediately to your treating doctor in case of fever or any unusual symptoms.

8. What are the general measures to be followed to prevent COVID infection in children?

As vaccines are not available for children less than 18 years of age at this stage, adopting the following suggestions will help in prevention.

• Alladultsabovetheageof18yearsshouldgetvaccinated.• Followstricthandhygiene.• Avoidclosecontactwithpositiveadultsathome.• Ifclosecontactcannotbeavoidedwithpositiveadultsinsistonproper

use of mask for adult and the child.

9. Is breast feeding allowed if the mother is COVID positive?

Yes, Mother can continue to breast feed even if she tests positive. She needs to follow the protocols strictly – Hand Hygiene and wearing of mask during breast feeding.

10. Is it true that the third wave will affect children more than adults?

It is just hypothetical that the third wave may affect children as they are only ones who are not vaccinated. However, the infection is still mild in children and the spread to children can be prevented if the adults are vaccinated.

11

Dr. Ramya Kabilan MD (Obs & Gynec).,Dip.LapConsultant Gynaecologist and Laparoscopic Surgeon

Safe Pregnancy during Pandemic(Antenatal visits and Vaccination)

What are the symptoms of COVID-19 in a pregnant women ?

Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms. Pregnant women who catch COVID-19 are at slightly increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester.

In this pandemic period is there a need for pregnant women to be extra cautious than others ?

No, studies show that pregnant women are at the same level of risk for COVID 19 infection like any other healthy adults, but they are at slightly increased risk of becoming severely unwell if they do catch COVID-19. And are more likely to have pregnancy complications like preterm birth or stillbirth.

Do I need to restrict the visitors coming to meet me for greeting or a casual visit ?

Yes, Pregnant women who have not received two doses of vaccine should limit the contacts with people from outside especially if they have not completed their two doses of vaccine. These measures are to prevent getting infected with COVID 19 virus especially during the last 3 months of pregnancy period.

12

How to plan my visit to obstetrician for regular antenatal health checkup during this pandemic ?

You need to attend routine antenatal care, but to a minimum, as per your doctor’s suggestion may be at 12, 20, 28 and 36 weeks of gestation, unless you need to quarantine yourself for covid symptoms.

How do I plan my antenatal checkup if any one of my family member get COVID infection ?

If someone in your household has possible symptoms of COVID – 19 or confirmed infection please self-quarantine yourself and delay your visit for 14 days.

What is your main advice for a safe pregnancy?

I would suggest rule of 5 S to be followed for safe pregnancy

1) Stay at home but keep yourself mobile and drink adequate water to reduce the risk of blood clots in pregnancy.

2) Stay active with regular exercise.3) Supplements of Folic acid, vitamin D and other vitamins along with a

healthy balanced diet to help support a healthy pregnancy.4) Social distance, Hand hygiene, social distance and mask like any other

individual to be followed strictly5) Scan in time - Attend all of your pregnancy scans and antenatal

appointments unless you are advised not to do by your doctor.

Contact your maternity team if you have concerns about the wellbeing of yourself or your unborn baby.

Does a pregnant woman has to take any special diet to prevent COVID-19 infection?

No special diet has been proven to have any preventive effect against COVID – 19 infection.

Does COVID-19 virus infection during pregnancy affect the fetus ?

As per the ICMR (Indian Council of Medical Research) there are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19.

There is no evidence currently that the virus has killing effect on the unborn baby but we need to wait for long term data for this and about 95% of newborns born to COVID 19 positive mothers have been in good condition at birth. However,

13

Covid-19 in pregnancy increases the chances of preterm birth, which in turn may increase the possibility of hospitalization for the neonate.

There is emerging evidence from immunological assessment that in-utero transplacental infection to the fetus ( mother to unborn baby ) may occur but so far the effects on the newborn babies are very minimal.

There are discussions on the time of vaccination, whether to take the vaccine at the early pregnancy or at a point closer to the delivery date. Is there a specific time ?

Covid 19 vaccine can be taken at anytime during pregnancy. The earlier the vaccine lesser is the risk of complications.

Your advise on vaccination for covid infected pregnant women ?

In case a woman has been infected in current pregnancy, she should be vaccinated soon after delivery.

Which CVOID vaccine is best for pregnant woman?

Any vaccine is good to have. All available vaccines are considered to be equally safe and effective.

What are the general guidelines for covid positive pregnant women ?

The main symptoms of covid 19 are high temperature, new/continuous cough, loss of smell and taste. If you have any of these symptoms consult with your doctor and get tested.

Asymptomatic covid patients must follow strict home quarantine for two weeks from the date of test positive, eat a balanced diet, be in a well ventilated room, stay mobile, take vitamin D supplementation along with the recommended medicines, consider online fitness routine such as pregnancy yoga, monitor temperature and oxygen levels. If o2 falls below 94 % then report to your treating doctor immediately.

14

What is the impact?

Covid 19 pandemic is causing a huge impact on mental health of adolescents worldwide. Preliminary evidence from China shows that the rate of depression, anxiety and post-traumatic stress disorder among teenagers is 43.7%, 37.4% & 10% respectively. There has been an increase in mental health problems from 20% to 39% after pandemic. There is paucity of data on teen violence, relationship problems, internet gaming disorders and developmental problems.

Who is vulnerable?

Teenagers with pre-existing mental health problems including depression/anxiety or evolving personality disorders and those with background developmental disorders like Autism, ADHD and Learning disability were likely to have mental health concerns during the pandemic.

Any pandemic like the COVID-19 can influence the mental health of the teenagers in multiple ways as described below.

1. Adjustment to the current pandemic/lockdown: As they are used to a very rewarding life style in the form of peer interaction, sports and other activities; them being restricted to home environment can result in stress. This can lead to negative coping like increased eating or increase in use of gadgets. It is also results in behavioral changes like aggression and deliberate self-harm. However, this is not pervasive and depends on environment. These symptoms improve as the overall situation improves.

2. Chronic stress secondary to the pandemic or severe acute stress from the loss of loved ones can cause clinical psychiatric conditions like depression, anxiety, post-traumatic stress disorder. In these cases, symptoms are more severe, more pervasive, and can cause more dysfunction if not properly identified and intervened.

Covid and Teen PsychologyDr. R. Venkateswaran MD FICAP (CMC, Vellore)Consultant Child and Adolescent Psychiatrist

15

3. Covid infection itself can cause neuropsychiatric manifestations which may be abrupt and severe.

How to cope?

Improving emotional intelligence helps in better coping.

1. Self-awareness: This can be improved by educating teens to be mindful about their emotional states by regular self-feedback. It should also be emphasized that it is completely normal to experience negative emotions (“feel the emotions”). They will be able to develop a sense of control by being aware of their emotions.

2. Self-regulation: They should be trained to use proper ways to regulate their negative emotions (like abdominal breathing, mindfulness meditation, positive visual imagery and physical activity) so as to avoid negative coping (eating, gadget use) and interpersonal problems, which may in turn worsen their mood, resulting in a vicious cycle.

3. Problem solving: It’s very helpful to divide the problem into two categories: things they can do something about, and then things they cannot do anything. They can develop the habit of listing out different problems and find pros and cons of each.

4. They should also develop interpersonal skills and verbalizing their frustration should be encourage rather than reacting to it.

Parents should develop the habit of acknowledging teens feeling rather than underplaying it or criticising them. They should understand that teens are in toughest phase of their life in once in a life time crisis period.

16

Parental conversation with front desk:

Can I have an online consultation for my four year old child with Pediatric dentist?

Front desk:

Yes of course madam definitely it is possible, but you need to share a few pictures of your child’s teeth and mouth before the online consultation and the consultation is for twenty minutes. If it is a second opinion and you have taken X rays if any please do share that also through whatsapp

Online consultation is fixed by the front desk with the Pediatric dentist through whatsapp audio/video call or a conference call with the parent, front desk and Pediatric dentist

Consultation starts:

My child is four year old and has multiple cavities in his teeth? I have been postponing the dental treatment due to the covid pandemic? Can we go ahead with the dental treatment for my son?

Doctor:

Yes definitely possible. in the dental office we strictly follow all the sanitisation and covid sterilisation protocols as recommended by the WHO (world health organisation guidelines)............................................................................................................................

A chat with your Pediatric dentist Dr. Roshan Rayen, MDS, FICCDE (USA)Senior consultant Paediatric dentistDirector, RAYEN DENTAL CARE CENTREJoint Director, KIDZ N TEENZ Health care

17

Parent:

Can you please elaborate a few of them?

Doctor:

1. Appointments are spaced out comfortably for each patient with lot of buffer time between each family

2. Fresh disposables and drapes given for each child and accompanying parent

3. UV light disinfection of each dental operatory for 15 minutes between each appointment

4. HEPA air filter running continuously for viral disinfection and air purification

5. Open to atmosphere ventilation between each session of 3-4 appointments

6. Rubber dam usage in the child’s mouth to avoid aerosols going inside the child’s mouth

7. Apart from this we also do regular sterilisation and disinfection of our dental instruments so you can feel pretty safe to come and have your dental treatment carried out safely and comfortably at our dental clinic

............................................................................................................................

Parent:

Doctor, big thanks for the very neat and simple explanation given to me. Now I feel safe to bring my child to dental clinic

Do I need to do RT-PCR test before the dental appointment

Doctor:

Good question madam

According to WHO guidelines for any dental procedures performed in a dental clinic it is not necessary. But if it done in a hospital based set up, it is mandatory to have a RT-PCR done two days before the dental surgery is planned as most of the dental procedures under general anaesthesia are pre planned. Hope this helps madam............................................................................................................................

Parent:

Is there a change in treatment plan pertaining to pandemic situation?

Doctor:

Definitely not, whatever method we used to do dental treatment before is what we do now also with more added safety measures for the doctor, the child and the assisting dental nurses ............................................................................................................................

18

Parent:

Any extra medicines given for my child during this time?

Doctor:

There is no added precautionary or preventive medicines given during or after the dental treatment, only regular medicines needed for that dental problem is prescribed. But we ensure that the child or the accompanying parent does not have a cold or cough during the appointment............................................................................................................................

Parent:

Can I postpone the dental treatment to later date in case my financial situation does not allow me to carry the dental work as per your recommendation?

Doctor:

Yes, definitely possible in this kind of tough time. We apply SDF (silver diamine fluoride and fluoride varnish) to arrest the decay process by 70-80% so that the child becomes symptomatically better and we can postpone the treatment by 6-12 months with periodic follow up in place. The only disadvantage is the blackish discoloration of the cavity affected teeth.............................................................................................................................

Parent:

Thanks a lot doctor for this wonderful piece of information. I will see you soon in person for my child.

Doctor:

Most welcome madam.

19

When schools closed on 24th March, 2020, it was the fag end of the academic year 2019-20. The year was over for class X, with all board examinations completed for CBSE students. The class XII had a few examinations pending.

It was a new experience, with lock downs announced and all of us going into the confines of our homes, puzzled about what was happening, not knowing what to do, searching for masks and sanitizers, hoarding everyday requirements and what not. Mothers loved the time they had with the little ones bringing out their culinary skills, family time was enjoyed, we could understand each other better etc., etc., etc.,

For professionals, except the health care professionals, it was a welcome break. We enjoyed staying at home, enjoyed less of driving, hence less polluted city, better air to breathe, more time for hobbies rather than the mundane routine of running to work place. It indeed looked very

good in the beginning, with the death rate being low and number of infections raising at a slow pace.

But, very soon we realized that things were not going to be the same for a very long time now. Slowly it dawned on us that we were not going to meet children in school to complete the assessment process for the year. Children rejoiced at being promoted without going through the chore of preparation for an examination or the anxiety of waiting for results.

As days went by, when the anxiety and scare did not come down, when we saw the world reeling under a new threat, we understood that we are not going to have children in school for their academic transactions. Thus began the preparation for online classes. We experimented with classes X and XII and slowly moved on to the other classes also. It was a novel experience for all, teachers and students alike.

On-line Classes-Rewards, Regrets,Revelations and Remedies

V PadmaPrincipalD A V Girls Senior Secondary School, Gopalapuram, Chennai - 86

20

We were overjoyed when children could become our teachers when it came to technology. We worked on our curricular plan keeping in mind the new normal, lesser working hours, different teaching methodologies, learning technology and what not. The novel experience kept us in good stead for some time. Children enjoyed their time, they were happy that they need not be in uniform, they need not rush to school, they need not wake up early in the morning, they could spend more time with their siblings.

Teachers entered the students’ homes virtually due to online classes. Initially, the parents were thrilled at watching their ward being taught. They were appreciative of what was happening in the class.

As time passed by, we realized that children had lost their routine, which is very important for them. We, teachers understood that the influence that we had on our students had become very less. We found it difficult to make them switch on their cameras, to speak to us. We

also realized that though the child had logged into the class, he/she was not present in front of the system attending classes. The joy that we felt, when children were better than us technologically, became a regret. We found that eliciting an answer from them was the toughest of the tasks. Older the children, tougher was it to make them communicate with us. They were reluctant to answer questions, share what they felt and learn what they need to learn.

The novelty of watching the teacher handling a large number of children waned.

Some parents started commenting and passing judgements against the teachers in the class, when the class was on. It was quite embarrassing for the teachers to handle the situation. Some parents felt that their ward should be heard and be given a chance to participate individually in the class every period.

The working hours of the school was very less, the content was also reduced as per the guidelines of the board. However, the teachers could

21

not have the attention of the students even when they were in class. We could not make them do any written work or monitor their learning at home. Parents became unhappy and frustrated, when assessments were planned. We had a tough time explaining to the parents that we wanted to assess the level of understanding of the children and not whether the parents have taught them or not.

As parents and teachers, we need to understand that we need to adapt to this kind of teaching and learning in future. Even when we reopen schools offline, we may, at least for a few days/months/years, go back and forth and have a hybrid model of education.

Hence, we need to find ways and means of coping with it and making the best out of what is available. While the school on its part, is ready to hand-hold with the child in matters of any facet of child development, we request the cooperation of the parents too.

Now the situation is such that, the parents have a good influence over the children. Teachers have no influence what so ever, as the interaction between the students and the teachers have become very less. So, we request the parents to be friendly parents and not friends. A friend cannot set boundaries or lay rules of conduct and etiquette. A parent can and should. Please keep

the communication channels open. Listening is the most important part of communication. A non-judgemental listening, without an intent to answer/argue should be adopted by parents. A kind ear will do a lot of good to the speaker. It will help the listener pick up problems empathetically as and when they arise and help them at the appropriate moment. Accept that children need a routine to follow to grow up into responsible, productive adults. Irrespective of whether the classes are online/offline, guide them for a healthy routine, by you following it.

Let us understand that academic learning is an important part of childhood experiences. Allow the children to learn, understand by himself/herself. They have the privilege of learning from mistakes. Kindly do not take their lack of performance as your weakness. Assessments are an important part of learning. Being fair, honest and sincere in assessments and following rules and regulations, is important to understand morality and values.

We, parents and teachers have a great responsibility of making the future of the nation and the world. No small task, but a pleasurable task and a very important task in it. Let us work as a team to help our students grow into individuals and members of the society about whom all of us are going to be happy about and proud of.

22

The years 2020 and 2021 have been defining in many ways and have changed our perception of life significantly. The pandemic pushed us to reinvent our social and professional interactions and changed our mindset on how this was possible. If anyone had suggested telehealth for early intervention for children with autism a few years back, then the response would have a resounding “no”. But here we are 18 months into the pandemic, reinventing intervention online.

One of the objectives of behavior analytic intervention, is to work closely with the family of the child with autism, to align goals and expectations with them and to make them an integral part of the intervention program. Though parent training and home goals were always part of the programs, telehealth has moved parents into the zone of primary therapist. This is especially true when the child is very young and has received a diagnosis in the last 18 months. Parents had to take on the role and many of them have slipped seamlessly into it.

At We CAN, the process of telehealth intervention begins with a few sessions with the family on understanding autism, some basic behavior principles like reinforcement, the beginnings of communication, imitation and play. The Behavior Skills Training (BST) approach is used to ease the family into the role of therapist. Concurrently, the family is primed to observe the child for what may function as motivators for him, what does he prefer to do when he is free and what may be relevant goals for the child, based on the training sessions. Of course, telehealth also means that certain teaching goals are harder to implement, and we have rearranged priorities based on this.

Parents may opt for live sessions where the behavior analyst is watching the session synchronously and giving inputs to the parent or they may opt to record the sessions that can be viewed with them for inputs later. The goals are clearly defined, the parent is equipped to run the given program and capture data, the time and duration of the sessions are fixed, making the process efficient and productive.

Telehealth for Developmental issues (A new experience in Pandemic)

Dr. Gita Srikanth BCBA (Board Certified Behavior Analyst)MA in ABA (Ball State University, USA)Founder Chairperson: We CANCo-founder: ProACT LLP

23

Some of the takeaways for us of telehealth intervention:

1. Telehealth keeps the family connected to and involved with the intervention process.

2. Families get a richer understanding of the skills and deficits of the child.

3. The intervention is provided in the most natural environment making learning contextual and practical.

4. Self-help goals can be incorporated effectively into teaching goals since home is where these skills can be practiced.

5. Families can receive access to evidence-based services no matter where they live, at a time that is convenient for them.

6. Educational background/language is not a barrier to parents. Everyone can empower themselves to be effective trainers for their children.

7. Telehealth has made us as interventionists, more sensitive to the needs of the family and more accepting of the challenges they face and of their emotional states.

In many ways, telehealth and online services can never replace the intensity of in-person services or the subtle behavioral observations that can be made while directly working with a child. But it is certainly a workable model in a country like ours where there are not enough quality services available.

A World of Difference:The ultimate autism handbook for mindful

parenting

The book is an attempt to make parenting a child with autism a

journey that is one of learning, joy and mindfulness while using evidence

based practices.

The book is available on Amazon India, UK, USA, Singapore and

Australia. It can also be sourced from Flipkart and ebook readers.

24

• Breastmilk is the most essential liquid for infant’s survival, nutrition and development.

• Continuing the breastfeeding is the best way during this COVID Pandemic.

• Continue Breastfeeding without fear during COVID pandemic but follow the rules of 3Ws

o Wear a mask during feeding,

o Wash hands with soap before and after touching the baby,

o Wipe and disinfect surfaces regularly.

• Are you COVID positive with mild symptoms – Continue breastfeeding because the antibodies for the virus will be released to your baby through breastmilk. So, your baby is safe.

• Are you sick due to COVID infection – if you are able to express milk and ask a non-infected member to feed the baby using a clean paladai or cup and spoon.

• Are you very sick due to COVID infection – get your doctors advice for other feeding methods but never forget the rule of 3 Ws.

• If you are positive for COVID and your baby is negative for COVID maintain a distance of 6 feet between your beds and follow the rules of 3Ws. But never stop Breastfeeding. Use medical mask than a cloth mask.

• Vaccination for breastfeeding woman is recommended. Take vaccine without any fear.

Indian Academy of Pediatrics strongly recommends the continuing of Breastfeeding during the pandemic whether you are infected or not.

_____________________________________________________________________

Awareness message compiled by Dr. P. Sudhakar. MD(Ped).PGD- DN_____________________________________________________________________

Dr. K. Venkatesh Dr. P. Sudhakar

President- IAP CCB Secretary - IAP CCB

COVID and Breast feedingIndian Academy of Pediatrics – Chennai City Branch :

Breastfeeding awareness message

Theme 2021Protect Breastfeeding: A shared responsibility

25

Hai friends,

I am WINTER (it is not my real name). Happy to share with you all that I am going to be the editor of the KIDDY’S Corner section of this monthly Magazine theChild dr.

Friends I feel it will be good to discuss our health problems from our own perspective. If we discuss our problems openly it will definitely help us to get help from our parents and experts.

Pls share your health queries and suggestions to me without any hesitation and I will get the appropriate replies after getting the answers from experts in the respective field.

My special thanks to my cousins Mel and Shel for modelling to this my maiden write up.

Kids please don’t forget to give your support as well as feedbacks for my effort.

Yours loving

WINTER

KIDDY’S Corner

26

We all know that we are sitting in front of desktop or tabs for attending online classes for many hours for the past 2 years and this may affect our vision (of course our parents keep on remind us the rules of screen time only when we play with mobiles ). Jokes apart it’s very unfortunate that we children are suffering a lot of issues due to increased screen time that too for studying purpose.

We all know that recently the number of vision problems in children are on the rise. I have heard that researches done on vision problems in children states that every class room will have 2 to 4 children with spectacles. So, we need to be alert about these vision problems and the ways to prevent it.

Vision problems are easily preventable or at least kept in control by following 3 rules

1) Right food.

2) Bright light.

3) Less Screen time.

In this edition I am going to discuss the healthy food habits to keep our vision sharp.

Our eyes have many important structures like

• Cornea(the transparent layer forming the front of the eye.)

• Lens (it focuses the light rays that pass through it (and onto the retina) in order to create clear images of objects that are positioned at various distances)

• Retina (a layer at the back of the eyeball containing cells that are sensitive to light and send signals to the brain, where a visual image is formed)and many more.

So like other organs eyes also need proper nutrition for a proper function.

Food for Eyes

27

I am surprised to learn a lot that our eyes need lot of nutrients to keep itself healthy which includes Vitamin A, C, E, Zn and Omega fatty acids in a major way and Vitamin B complex in a minor way. Yes, without eyes we can’t see the beauty of this world. So our eyes deserve the right nutrition for various functions like cell function, cell life, stability of the screen and pigment formations.

Now we will look at what kind of vegetables, fruits and food we should take regularly to save our vision.

So first let us see the vitamin rich vegetables and fruits.

While googling I came to know that all fruits and vegetables may contain all vitamins, only the proportion varies. So, we will discuss the major components only here in this small write up.

Vitamin A :

Fruits : Orange, Papaya, Mango Vegetables : Carrots, Pumpkins, Dark green leafy vegetables (amaranth,

spinach), Sweet potatoes., and Tomatoes Food : Cod liver oil, Milk, Butter Egg and Liver,

Vitamin C :

Fruits : Indian gooseberry Orange, Lemon, Kiwi, Strawberries Vegetables : Tomatoes, Green leafy vegetables, Potato, Tomatoes, green and

red pepperFood : cod liver oil, Milk, Butter Egg and Liver,

Vitamin E

Fruits : Avocado, Vegetables : Green leafy vegetables, Sunflower seedsNuts : Almonds and peanuts Oils : Sunflower, Saffola and Soybean Oil

Zinc

Nuts : all nuts Nonvegetarian food : crab, loyster, meat Food : pulses, whole grains

Omega 3 fatty acid

Fish : salmon (kaala fish), mackerel (kilangan fish), tuna (Churai fish) and sardines (mathi fish)

Nuts & seeds : flaxseed, chia seeds, and walnuts)

Plant oils : such as flaxseed oil, soybean oil, and canola oil

28

Finally we all eat ready to eat cereals often. So, whenever you eat them please check with your own eyes whether it has all these vitamins to keep your eyes healthy.

So friends, to protect our vision we need to have a plate full of vegetables, fruits, egg, milk and nuts on a daily basis and fish two days in a week.

Here I am offering my suggestion for your daily food plate for your eyes

So kids let us eat well and save our vision

29

30

Smilestones Child Development Centre#35, Puliyur 2nd Main Road, Trustpuram,

Kodambakkam, Chennai - 600 024.Ph: 044 - 4854 3948, 94450 51166 / 83002 30491

Email: smilestoneschennai@gmail.comwww.smilestonescdc.com