Though a child needs care at all the stages of life, especially by parents. But initially since birth to the age of five years, special care and proper attention should be paid in caring a child.
Care of the Child till 5 Months of Age
1. Breast Feeding : Continue breast feeding exclusively. Nothing else (not even water) is to be given to the baby. This remains the only diet of the baby in this period (till 5 months of age ).
2. Breast engorgement : The breast becomes heavy and painful due to the incomplete emptying of milk from it. The accumulation of milk causes it to become engorged. To relieve it one has to express out the milk manually. A hot shower or massaging the breast tissue with warm water will facilitate the milk expression by making the breast tissue softer.
3. Immunization : Get your child immunized as per this schedule. These vaccines are available free of cost from all hospitals and health centres. Immunization protects your child against killer and debilitating diseases like. T.B. (Tuberculosis, ‘Tapedik’), Diphtheria (‘Gal Ghontu’) Pertussis (‘Kaali Khansi’) Tetanus (‘Dhanushbaari’), Measles (‘Khasra’) and Poliomyelitis (Polio, ‘Lakwa’)
Do remember that vaccines like DPT can cause fever, swelling and pain at the injection site. Due to these symptoms, the child can become irritable and cries a lot. Don’t panic. These are normal side-effects of DPT vaccine and only show that the vaccine is working.
They can be minimised if you give syrup of Paracetamol to the child as per advise of the health worker.
When BCG vaccine is given, no evidence of it remains at the site of injection. However, about 3-4 weeks later, a small grain like lesion appears at the site. Within 5-6 days, it increases in size and is filled with a watery solution. After this, it breaks and forms an ulcer. Within next 7-10 days, this ulcer heals on its own and a nice scar is formed.
These are all normal events after BCG vaccination and don’t require any intervention like bandaging, application of ointments or powders etc. Just protect the ulcer from dust and flies.
Similarly if your baby has diarrhoea on the scheduled date for giving OPV, still give the dose to the child but don’t count it. As soon as the child recovers from diarrhoea give this dose again and then record it on the Immunization Card of your child. Immunization Card should be made for every child.
It is also nice to remember that if the child is suffering from mild fever or minor problem like a common cold, all vaccines mentioned in the table can be given.
No child should ever be denied the benefits of immunization.
4. Growth Monitoring : Get your baby weighed regularly. During this period, it is recommended that the child is weighed every month on a beam scale. Make a ‘Growth Chart’.
These activities are carried out in every hospital/health centre/Anganwaadis or Balwadis.
Regular weighing of your child and plotting it on the Growth Chart will tell you whether your child is growing well or not. It is good to remember that at the age of 5 months, your child’s body weight should be double of the birth weight.
If the child is not gaining weight normally, you should contact the health worker at the earliest.
5. Common problems : During this period are diarrhoea and respiratory infections. These can be dangerous and need to be given urgent attention. Both these problems are discussed separately.
6. Bathing and Massage : Depending upon the season, give regular baths. A soft soap like Johnson baby soap or Pears or Dove can be used. An oil massage in the Sun before a bath is very useful and helps in good development of the bones of the child. Olive oil is always good for the bones of children. A gap of half an hour is must in between Massage and Bathing.
7. Clothes : The child also needs to be kept comfortable in appropriate clothes according to the season. Avoid synthetic clothes. Cotton clothes are more appropriate for weather of India.
If you are going out, you can use nappy pads or diapers, but be vigilant that there should not be rashes around anus area or on groins.
Care of the Child from 6th month to 1 year
A normally growing child would have achieved the following milestones in growth and development by the age of 5 months:
1. Looks at the mother and smiles (6-8 weeks)
2. Holds the head straight ( 3 months)
3. Recognises mother, listens and begins to reach out for objects (5 months).
The period starting from 6th month is very crucial in a child’s life because this is the time when malnutrition can set in if proper attention is not given to the child. Hence, attention to the child’s diet remains the most important aspect of the care is this period.
Diet : Your child has been only on the breast milk so far. However, with rapid growth and development taking place in a child, nutritional requirements of the child also go up. Breast milk alone is not sufficient at this age.
So, along with breast milk, include the following in a child’s diet. Introduce the child to liquid supplements followed by semisolid foods and solid foods. This process is called ‘weaning’. Weaning foods have to be cheap, nutritious, easily available, affordable and acceptable according to local food habits.
At the beginning of 6th month, continue breast feeds. Using a katori and spoon, start giving top milk (without water), vegetable and pulse soups, orange juice, rice water with a pinch of salt etc.
but must continue breast feeding
Within a few days introduce very soft foods like mashed banana, khichri, porridge and kheer in a child’s diet. As the child’s stomach is small, she/he can’t consume large quantities of food in one go. hence, give small quantities of food but frequently. If you add a little ghee to diet of a child who is not willing to eat large amounts, it provides more calories.
Gradually, add other food items like mashed potatoes, biscuits, mashed chapati soaked in ghee or milk, seasonal whole fruit. Slowly and steadily, keep increasing the quantity of food items.
By the time the child reaches 1 year of age, she/he can be given practically all food items normally cooked in a household. Keep the spices low and the food should also be well cooked.
It is always desirable to wash your hands with soap and water before cooking and before feeding the child. Always use clean utensils. Katori, glass and spoon used must be clean and of course, continue breast feeding.
Ensure that the child gets safe water to drink. If you are not sure about quality of water, give water which has been boiled for 20 minutes and then cooled. If that is not possible, put water in a bottle and keep it for a few hours in the open, in sunlight. Cool it and give it. Sunlight, to some extent, makes the water germ free.
Weight and Height Recording : A child who is being given adequate food of good quality will continue to gain weight and height. Weight gain can be easily seen on the Growth Chart of the child.
You should continue to get the child weighed every month till 1 year of age.
Immunization : During this period a child requires only one injection of Measles Vaccine to be given at the age of 9 months (9-12 months) This will prevent occurrence of measles in the child. Remember, measles and its complications can be extremely dangerous for the child.
Vitamin-A Solution : You would be surprised to know that thousands of young children in India lose their eye sight every year due to deficiency of Vitamin ‘A’ in their diet. This vitamin is essential for good eyesight and skin.
To prevent this, it is advised to include vitamin A rich food stuffs in the child’s diet. They include milk, butter, green leafy vegetables, carrots, mangoes and yellow fruits etc.
Along with these, also give solution of vitamin A ( 1 lack unit) to the child at the age of 9 months ( along with Measles Vaccine).
Common illnesses during this period are diarrhoea and acute respiratory infection.
Dentition : This is also the time when a child starts cutting teeth. It can start anytime between 6-12 months. ( sometimes even earlier)
Many children have diarrhoea as they cut teeth. A lot of parents think that it is due to dentition. That is not correct. Due to pressure exerted by the erupting teeth on the gums, there is irritation and some pain in them. To soothe this irritation, a child often puts her/his fingers into the mouth. If they are dirty, the child gets diarrhoea because of the germs present on dirty fingers.
It is advised that a child’s hands are washed frequently to avoid diarrhoea. If needed, you can also give a clean, soft object to the child to bite upon or chew.
Other aspects of care will include keeping the child clean. Also don’t forget to play with the child as much as you can. Shower your affection on her/him. It is also advised not to distort words when you ‘talk’ to the child. Speak correctly and clearly. That will help in a fast and correct development of child’s language abilities.
With your good quality care, by the end of first year, a child is likely to achieve the following new milestones in growth and development. Do remember that some delay in achieving these by the child should not be a cause for worry. Many normal
children achieve these milestones slightly late.
Care during Second year of Life
As you have taken good care of your child in first year of life, you have already laid a good foundation for her/his proper growt and development in the life ahead. The following are main points in good care in the second year of life.
1. Diet : A child can now eat everything cooked at home. It is essential that the child is given a balanced, nutritious diet. The child’s daily diet should include atleast 500 ml milk ( without water); wheat or rice, pulses, seasonal vegetables; fresh whole fruit and if possible egg, meat or chicken. Dark green leafy vegetables should be included in child’s diet very frequently as they are good sources of iron and vitamin A.
This is also the time when urban parents often start giving junk food like noodles to the child. Avoid that. Similarly, take care of not allowing the child to have too much of chocolates, sweets cold drinks and ice-creams.
Also make sure that the child does not eat any food which is sold in open, exposed to dust and flies. Market food is best avoided for young children.
Ensure safe drinking water for the child.
Always wash raw vegetables and fruits thoroughly in running water before giving them to the child.
If the child still wants breast-feeds, continue that as long as you can.
2. Care of the mouth and teeth : Lay the foundation for good health of teeth. To begin with, you should brush the child’s teeth. By the end of second year, a child would have about 20-24 teeth. Gradually, allow her/him to handle brushing of teeth on her/his own. Children love to do it.
Brushing of teeth twice a day should become an important activity in the child’s daily routine.
3. Immunization : Between 16-24 months, a child will only require one dose (booster dose) each of OPV and DPT. The sooner you give it, the better.
4. If the child has diarrhoea or acute respiratory infection, you need to follow some basics to help the child overcome them.
5. Vitamin ‘A’ Solution : To be given at 18 months of age and again at 24 months. Your child will now require 2 ml of this solution each time.
6. Washing of hands : One very important and good habit that you must inculcate in your child is to wash hands with soap and water before eating and after going to the toilet. A child of this age often wants to feed herself/himself. To protect them from food borne infections, wash the child’s hands with soap and water. If soap is not available, use ash (but never mud).
Make sure that the child does not put hands/ fingers into mouth very often.
7. De-worming : Despite best of efforts, a child may be infested with intestinal worms such as thread worms or round worms. Apart from causing pain and discomfort in abdomen and diarrhoea, these worms (especially round worms) can cause malnutrition in the child because these worms eat off most of the food eaten by the child.
It will be advisable that starting from 13th month of age, the child is given a preventive dose of de-worming medicine after every 3-6 months. Ask the health worker about these medicines and their doses.
Also, don’t allow the child to play/walk barefoot in the open fields. Apart from injuries, this can be responsible for infestation with an intestinal worm called the hookworm.
8. Toilet training : This can be initiated in this period. However, don’t be fussy about it. This initiation should be done in a very relaxed manner for the child.
be trained to pass stool at a specified place
9. Growth Monitoring: You can now get the child weighed every 2 months and keep a record of the child’s weight in the Growth Chart.
You should learn from the health worker the meaning of those lines on the Growth chart. If the child is of low weight, consult a health worker or paediatrician at the earliest.
You should know that by the end of one and a half year, healthy Indian child has a body weight of 11 kgs. and by the time the child is of 2 years of age, it should be about 14 kgs.
10. Development milestones : This is the period when you can see your child developing at a very fast pace. Every day the child learns a new thing thus giving immense joy to the parents.
The major developmental milestones achieved by the child in this period are :
to run at 18-21 months of age
1. Starts walking and begins to run (18-21 months)
2. Joins words together, begins to explore (18-21 months).
3. Runs, speak short sentences, stops wetting clothes during the day (24 months).
11. Accidents : As the child is walking around in the house and is also very inquisitive, make sure the child does not become a victim of accidents in any way. Use common sense and anticipate the probable situations for such mishaps and take preventive action. For example, a child can trip due to a wet floor, a piece of cloth or string lying on the floor. Always keep medicines and electrical appliances (room cooler, iron, heater etc.) away from the reach of children.
A little carefulness goes a long way in preventing accidents, e.g., while cooking, don’t allow the child to come near fire. Keep the handle of the cooking vessel away from child’s reach.
12. General Hygiene : Keep the child neat and clean. Don’t wipe the eyes of the child with dirty cloth especially when there is some eye problem, e.g., eyes are sore.
Care of the Child during Third year till completion of 5 years of age
You need to follow all the guidelines in this period in the same manner as for second year of life except that:
1. No immunization is needed during this period. However, as the child completes 5 years of age, you can give one injection of DPT Vaccine.
2. The child should be weighed once in 3 months in the third year and subsequently after every 6 months.
3. Vitamin ‘A’ solution needs to be given after every 6 months atleast till the child completes 3 years of age.
4. Inculcate moral values and good habits in the child. Act as a role model for her/him. This is a highly impressionable age of the child and even without you realising it, a child keeps on all good and bad values and habits from the environment around her/him.
5. These values and habits will ultimately decide the kind of human being she/he is going to become in life ahead. Hence, be careful on this score. Set right examples for the child.
With your good care, the child would have achieved the following milestones in growth and development by the time she/he is 5 years of age.
