Saturday, November 8, 2014

Cooperaton For Improvement of oral health of Children in Nepal

Childhood is considered the golden period of life but it is also a phase when diseases are lurking in every nook and corner to attack these tiny buds. Like systemic diseases there are a number of oral health problems that affect children which includes tooth decay, various habits like thumb sucking, gum diseases, oral lesions and early tooth loss. Among these early childhood tooth decay is the number 1 chronic disease affecting young children and is 5 times more common than asthma and 7 times more common than hay fever. Teeth are at risk of dental caries from the time they start to appear in the mouth, putting children from approximately six months of age onwards at risk. Severe form develops very quickly and teeth may be destroyed within six months of its onset. Many of the dental diseases of the childhood can be prevented with proper education of the parents. To achieve this objective, a greater interaction between Pediatricians and Pediatric Dentists are important.

Pediatric Dentistry is the branch of dentistry dealing with children from birth through adolescence including children with special health care needs. Pediatric Dentists are the Pediatricians of Dentistry. Pediatric Dentists promote the dental health of children as well as serve as educational resources for parents. American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) recommend that a dental visit should occur within six months after the presence of the first tooth or by a child's first birthday. A Pediatric dentist has two to three years of specialty training (course) following dental school and limits his/her practice to treating children only. The American Academy of Pediatrics (AAP) recommends a child to visit a pediatrician 6 times in the first year of life and 10 times by 3 years of age. Pediatricians have the opportunity to provide care for children 6 times before the recommended visit to a dentist. In May 2003, the AAP developed a policy statement on oral health risk assessment timing and establishment of the dental home. The policy states “pediatricians and pediatric oral health professionals should develop the knowledge base to perform oral health risk assessments on all patients beginning at 6 months of age to identify high risk children at an early age in order to provide anticipatory guidance, behavior modifications in terms of oral hygiene and diet”.


The importance of dentistry during the early years of child’s life has been well documented. Pediatricians are considered to be in a unique position to contribute to the dental health of their child patients because children often visit their offices at a young age and the parents accept their recommendation well. They can contribute to oral health in the following manner:

Educate parents in many areas such as 
Good oral hygiene: educating the parents about the basics of maintaining oral hygiene.

Prevention  of dental injuries

Prevention of nursing caries by establishing proper feeding habits. Education about the  harmful effects of putting the baby to sleep with a bottle of milk as well as the effects of sugars from juice or milk  on a baby's teeth. The role of feeding habits on development of baby bottle tooth decay. 

Diet counseling demonstrating food guide pyramid and importance of healthy food habit for healthy teeth

Educating parents about the importance of the first dental visit, which is recommended at the time of the eruption of the first tooth and no later than 12 months of age.(AAPD guidelines)

CARIES PREVENTION:  assess whether infants receive optimal fluoride exposure from drinking water or in fluoride-deficient areas by supplementation.

REFERRAL of all children for routine dental care to limit destruction associated with the milder forms of caries as well as referral of infants with cleft lip and palate for fabrication of feeding obturators.

LIFTING THE LIP examination of the child during well baby visits to assess the initiation of decay as well as identify the oral hygiene status and other oral lesions.


Initial reverible stage: Chalky, white spots or lines; no pain.

Deep stage : Yellow or brownish discoloration or cavities; pain or sensitivity to hot or cold.

Damaged Stage: Advanced decay with loss of tooth structure. Moderate to severe pain.

Traumatic Stage: severe tooth decay and fractures of one or more carious teeth

Any of the above findings warrants a need to visit the dentist as soon as possible to prevent further progress and complications.


                        Initially in Nepal there was a dearth of Pediatric Dentists but today there are around 15 Pediatric Dentists registered in Nepal, working in various Dental institutions, hospitals and dental clinics. BPKIHS has started Post Graduate degree in PediatricDentistry and the first batch students have already acquired the degree. The only problem with people not seeking care at the proper place is lack of awareness regarding it. The Pediatricians are the first doctors for a child so they can play a major role in being the messiah of oral health by educating and referring the child to the proper channels. The co-operation from their side can help us nurture a child with a positive dental attitude as well. 
               With a little effort and co operation, together we can provide healthy smiles to children all over our nation.


Dr. Parajeeta Dikshit is an Assistant Professor, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at Kantipur Dental College teaching hospital and research center Basundhara , Kathmandu and Consultant Pediatric Dentist at Smile Square Dental Care Center, Maharajgunj, Kathmandu.

Dr. Mamta Dali is an Assistant Professor, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at BPKIHS, Dharan.

Friday, October 17, 2014

Healthy Food for Growing Children

Children require a steady supply of all the vital nutrients as they grow to facilitate healthy growth and development in general; physically, mentally and socially. In this article you will get to know about the necessary foods for growing kids, their nutrient compositions and their benefits to your child. Here is a detailed look:


Children spend most of their time playing and consequently utilize most of the energy present in their bodies. As such, it is important that carbohydrates be included in the child's diet so as to provide the body with sufficient energy to not only facilitate playing but also growth of strong and steady muscles, bones and wits.

Foods rich in carbohydrates and which are easy to find include:

Eggs Whole grains and cereals


Green vegetables


Fruits like citrus, berries, apples and watermelons among others.


Proteins are among the most vital nutrients for kids as they facilitate body building; directly affecting physical growth. They also help boost the body's immunity against certain illnesses, further ensuring healthy development. As such, you should ensure that your child gets a steady supply of proteins by eating foods like:

Eggs and other poultry products

Dairy products like milk, cheese and yoghurt

Beans and nuts

Lean meat

Vitamins and minerals

Vitamins are necessary for a healthy immune system in growing children. They help to directly improve the body's immune system, helping fight off infections which may be deadly if lest to spread in the body. Other vitamins also help improve the body's general capabilities like eyesight and skin firmness and texture among others. Minerals like calcium on the other hand facilitate growth of strong bones and teeth in the body.

Foods rich in vitamins and minerals include:

Potatoes, carrots and dark green leafy vegetables for vitamin A

Fruits like berries, tomatoes and citrus for vitamin C

Fish oil and cod liver oil for vitamin D to facilitate absorption of other minerals like calcium

Albeit it may not seem as important, fibers help keep the body's system clean and running smoothly while also improving digestion and proper body growth and development. They hence help keep your child feeling fit and comfortable.
They are easily obtained from foods like:

Legume like peas, beans and lentils among others

Fruits with peels like apples and peach

Brown rice and pasta made from whole grains

Bread made from whole wheat

Fats are considered to be generally bad by most people owing to the rising cases of overweight people. However, fats are just as vital as other nutrients. Furthermore, there is a wide range of natural foods with good fats as compared to unhealthy fats and cholesterol found in fast foods. Among other things, fats help store energy in the body for future use They also help give the skin a healthy and supple look and feel; enhancing a healthy and beautiful appearance.
Fats can be easily obtained from foods such as:

Dairy products like cheese, yoghurt and milk

Meat and oily fish

Avocados Margarine and butter

Conclusion. Ensuring that your growing child has a stable supply of these vital nutrients will facilitate strong and healthy body growth. This will consequently ensure that he/she is free of the common illnesses.

Author Bio:I am Jessica Cranwell, I am a Blogger and Freelancer. I love reading blogs, and writing for them on various themes like Travel, Auto, Lifestyle, Education and Health. As of now I am doing research of Ehic cards.

Tuesday, October 14, 2014

Blood Transfusion Guidelines in Neonates and Children- Red Cell Transfusion

Red Blood Cell transfusion is a common process in Neonatal Intensive care Unit, Pediatric Intensive care and in sick children. A guideline on when to give blood transfusion are provided below. These guidelines are derived from Worldwide accepted textbook - Nelson and Cloherty

Tranfusion Guideleines For Premature Infants- Cloherty

1.  Asymptomatic infants with Hct  less than 21 % and reticulocytes  less than 100, 000/UL (2%)

2. Infants with Hct less than 31% and any of below

  • hood O2 less than 36% or mean airway pressure less than 6 cm H2O by CPAP or IMV  
  • more than 9 apneic and bradycardic episodes per 12 h or 2/24 h requiring bag and mask ventilation while on adequate methylxanthine therapy 
  • HR more than 180/min or RR more then 80/min sustained for 24 h
  • Weight gain of less than 10 g/d for 4 d on 100 Kcal/kg/d 
  • Having surgery

3. Infants with Hct less than 36% and requiring more than 35% O2 or mean airway pressure 6-8 cm H2O by CPAP or IMV

CPAP = continuous positive airway pressure by nasal or endotracheal route; HR = heart rate; Hct = hematocrit; IMV = intermittent mandatory ventilation; RR = respiratory rate. From the multicenter trial of recombinant human erythropoietin for preterm infants.
Source: Data from Straus RG. Erythropoietin and neonatal anemia (Editorial). N Engl J Med 1994;330:1227.




   Acute loss of > 25% of circulating blood volume
   Hemoglobin < 8.0 g/dL[†] in the perioperative period
   Hemoglobin < 13.0 g/dL and severe cardiopulmonary disease
   Hemoglobin < 8.0 g/dL and symptomatic chronic anemia
   Hemoglobin < 8.0 g/dL and marrow failure

   Hemoglobin < 13.0 g/dL and severe pulmonary disease
   Hemoglobin < 10.0 g/dL and moderate pulmonary disease
   Hemoglobin < 13.0 g/dL and severe cardiac disease
   Hemoglobin < 10.0 g/dL and major surgery
   Hemoglobin < 8.0 g/dL and symptomatic anemia

Wednesday, September 24, 2014

New Immunization Schedule of Nepal 2014 - IPV, PCV and MR vaccines added

In 2014, September, the National Immunization Schedule was planned for an update with introduction of few new vaccines for prevalent diseases in Nepal. Nepal became the first nation to introduce Injectable Polio Vaccine (IPV) in South East Asia. IPV is recommended in addition to the Oral Polio Vaccine (OPV) and not as it's replacement.

Added Vaccines:

  1. PCV - Pneumococcal Conjugate Vaccine
  2. iPV - Injectable Polio vaccine
  3. MR - Mealsles and Rubella vaccine

The New Immunization Schedule of Nepal:

Thursday, September 4, 2014

Common Cold in children : Concerned Parents

A child may catch cold several times in a year. Common cold is a benign condition but raises a level of anxiety and concern in parents and is pretty much obvious. After all children are as delicate as they look.
Cough is a common symptom that causes a big concern in parents and commonly they are worried about their child having a chest infection - Pneumonia. Another symptom that worries parents is noisy breathing that may be a simple nasal blockade but can be due to Asthma, Croup and other conditions.

The common cold are symptoms caused by a number of different viruses. More than 100 virus cause cold but  rhinovirus, the type of virus responsible for the greatest number of colds. Other are enteroviruses (echovirus and coxsackieviruses) and coronavirus.

Common Cold common symptoms

Children under 6 years get average six to eight colds per year.

Although  colds occur during the fall and winter months,in any geographic location, it can occur though out the year. It is transmitted from person-to-person, either by direct contact or by contact with the virus in the environment. Colds are most contagious during the first two to four days.
Droplets containing viral particles can be exhaled into the air by breathing or coughing. Rhinoviruses are not usually transmitted as a result of contact with infected droplets, although influenza virus and coronavirus can be transmitted via small droplets. Cold viruses are not usually spread through saliva.

What are the Common Cold Symptoms?
In children, nasal congestion is the most prominent symptom.
Children can also have clear, yellow, or green-colored nasal discharge;
Fever (temperature higher than 100.4ºF or 38ºC) is common during the first three days of the illness.
Sore throat
Decreased appetite.
Red and swollen nasal area
Neck lymph nodes may become slightly enlarged.

What are the Complications of Common Cold?
Most children who have colds do not develop complications.
However, parents should be aware of the signs and symptoms of potential complications.
Ear infection — 5 - 15 percent of children with a cold develop a bacterial or viral ear infection.
If a child develops a fever (temperature higher than 100.4ºF or 38ºC) after the first three days of cold symptoms, an ear infection may be to blame.
Asthma - noisy breathing also referred to as wheezing, called Reactive airway disease in smaller children
Pneumonia- high grade fever, lethargy, fast breathing, cough and child looks toxic.

 Symptomatic treatment —
1. Plenty of fluids - hydration
2. Warm clothing and warm environment.
3. Nasal care- Cleaning and in older children - steam inhalation with soother can be helpful. Steam inhalation in small children should be avoided as it can cause burns.
Saline nasal drops can be used in case of nasal stuffiness and blockade
4. Adequate rest - speciially children in daycare centres and school should be let to stay warm at home.
5. Antipyretics- High fever can cause discomfort and irritability. Dose of Antipyretics can be given for fever exceeding 100.4 F PRN.
6 Children may present with wheezing
   - Such children may require immediate doses of Nebulization with Salbutamol and if improves can be discharged on oral beta2 agonist

Usually Antibiotics are Not needed as Viruses don't respond to antibiotics. So requesting doctor for an antibiotic and administering over the counter antibiotics are not recommended.

When to seek Medical Help?
Refusal to drink or feed
Inconsolability and undue irritability
Lethargy (decreased responsiveness - Sick/toxic looking);
Difficulty breathing,
Fast Breathing
High grade fever greater than 101ºF (38.4ºC) lasts more than three days.

Such children need immediate medical attention regardless of time - night or day