Frequently Asked Questions about Neonatal Hearing Screening

Dr. Jennie Jariwala-Kapadia (Audiologist & Founder-ListenIndia.in)

1. Why should my child undergo a Neonatal Hearing screening test?

On average 4/1000 babies born in India have some degree of hearing loss at birth. This number usually is much higher in babies who required NICU (Neonatal Intensive Care Unit) care.

There are no clear indicators of hearing problems in newborn babies, in addition to this, more than 90% of babies with hearing loss are born to normal hearing parents so parents may not be able to tell if their baby has difficultly hearing.

Language learning starts in the first few months of life and is largely dependent on hearing. If hearing loss is not detected and treated early, it can poorly affect speech, language, and cognitive development. Over time, such a delay can present severe learning difficulties and negatively impact the child’s academic performance. On the other hand, if babies born with hearing loss are identified early and provided with treatment as soon as possible they have the opportunity to develop healthy speech, language, and cognitive skills just like their peers.

2. When should the hearing screening be done?

The guideline used for newborn hearing screening in the USA is 1-3-6, that is, screen newborn before 1-month of age, confirm the diagnosis of hearing loss and fit hearing aid before 3 months, and enroll the child for early intervention before 6 months of age. A similar guideline needs to be followed in India by screening every baby delivered in a birthing facility before discharging the mother and child

3. What does the hearing screening for a baby look like? Is the test painful?

Two different types of tests are used to screen the hearing of an infant.

Depending on the test used either an earphone or a probe is used to play sounds in the baby’s ear canal and the response is measured in terms of a “pass” or a “refer”. “Pass” means that the baby does not have a hearing loss at the time of testing, however, a “refer” means that further testing is required to diagnose the presence of a hearing loss.

These tests may be used in combination or independently depending on the birthing facility and the birth history of your child. Both these tests are painless and take only a few minutes to test.

4. What if my baby does not pass the newborn hearing screening test?

If your baby does not pass the hearing screening at birth, it does not automatically mean that your child has a hearing loss. Sometimes the presence of vernix (a waxy white substance found coating the skin of newborn babies) in the ear canal, fluid in the middle ear, excessive baby movement, or crying can get in the way of testing. However, if the baby does not pass on a repeat test, he/she will need further diagnostic testing. In addition to your pediatrician and audiologist, your baby will need to be seen by a pediatric otolaryngologist.

5. If my baby passes the newborn hearing screening, does it mean he or she will not have hearing loss later?

Not necessarily, some babies may develop hearing loss later in life. Causes of late-onset or progressive hearing loss in children can include genetic factors, frequent ear infections, infections like measles or meningitis, a head injury, and exposure to damaging levels of loud noises.

Even if your baby passed the newborn hearing screening at birth, you should still watch for possible signs of hearing loss as your child grows. Talk with your pediatrician if your child:

· Don't startle at loud noises by 1 month or turn toward sounds by 3-4 months of age.

· Doesn't seem to enjoy being read to.

· Is slow to begin talking, hard to understand, or doesn't say single words such as "dada" or "mama" by 12 to 15 months of age.

· Doesn’t turn when you call their name.

At present less than 40% of the birthing facilities in India are screening babies for hearing loss. This means that a significant number of babies are at risk of not being diagnosed until it is too late to develop speech and language skills.

Remember timing is everything. Studies have shown that babies who are diagnosed with a hearing loss before 3 months of age and provided with the right intervention services (like hearing aids and cochlear implant) within a month of being diagnosed have better chances of developing good speech and language skills on par with that of their hearing peers.

For more information please visit the website www.ListenIndia.in

Understanding the Different Types of COVID-19 Tests

Over the last six months, the world’s scientists and experts have discovered and proven unique methods for identifying the coronavirus.

As science advances and becomes widespread, you may have a hard time following along with the Latest test and methodologies. You aren’t alone.

We asked Brian Mochon, PhD, a clinical microbiologist and system medical director at Laboratory Sciences of Arizona for infectious disease testing, to provide his insight on the unique sample collecting strategies associated with COVID-19 testing.

He listed three ways to reach a diagnosis – throat swabs, nasal swabs, and nasopharyngeal swabs. Dr. Mochon also discussed other alternative collection methods such as the use of saliva and the pooling of patient samples.

Why your child should get vaccinated: myths vs reality.

Protecting your child’s health and safety is very important. On-time vaccine is important in infancy as it serves to provide protection when children are exposed to life-threatening illnesses. That’s why millions of parents across the globe choose immunization. Vaccination is a powerful defense that has proven to be safe and effective.

How does it work?

Vaccines contain a dead or weakened form of the disease-causing virus or bacteria. These cause the body to make antibodies and other beneficial responses that protect the child from that disease. Vaccination shields children from serious sickness and the complications of diseases that can be life-threatening. All the vaccines go through a long and cautious survey by researchers, specialists, and the government to ensure they are effective & safe to use. Without vaccines, your child is at risk for getting seriously ill and suffering pain, disability, and even death from diseases like measles and influenza, and whooping cough.

Here are a few reasons why vaccination is very important:

  1. Vaccination is very safe and effective: Vaccines are approved for use only after a long and careful review of safety by scientists, doctors, and healthcare professionals. Quality check of vaccines is carried out to ensure that they are safe and effective for administration to children of required age. The disease-prevention benefits of getting vaccines are much greater than any possible side effects for almost all children. One should always remember that prevention is better than cure.
  2. Side effects are minimal andgo away within a few days - Like any medicine, vaccines can cause side effects such as a low-grade fever, or pain and redness at the injection site. Mild reactions subside within a day or two on their own. Long lasting severe adverse events related to vaccine are rare. If you have questions or concerns about a vaccine, talk with your paediatrician.
  3. Prevents the ones around you from getting ill: vaccination only protects your kid but also helps prevent the spread of these diseases to your family and friends. A vaccine-preventable disease that may make your child sick for a week or two could prove to be deadly for your new-born, or parents in case it spreads to them. When you get vaccinated, you are preventing this. A decision not to immunize your child also involves risk and could put your child and others who come into contact with him or her at risk of contracting a potentially deadly disease
  4. Immunizations can save your child’s life- Many of the vaccine-preventable diseases can be life-threatening for our young ones. There is no better way to protect young children from these serious illnesses than vaccination. Some diseases that harmed or killed thousands of children have been eliminated primarily due to safe and effective vaccines. One of the greatest examples being the elimination of polio in our country which was once the most-feared disease, causing death, disability, and paralysis across the country.

Can multiple vaccines at a time cause problems?

Extensive research has been done to evaluate the safety of combined vaccination. None has shown that multiple vaccines cause a problem. Giving babies multiple vaccines at the sa

me time means fewer office visits. This saves you time and money. Moreover, this can be less traumatic for the child.

What to do if we miss a scheduled vaccine?

Sometimes a vaccine is missed because of various reasons. No matter what the reason, it’s important to make up missed immunizations. Most of the times your healthcare provider will just resume the vaccine schedule after minor adjustments. If for any reason, your child gets additional doses of a vaccine, this is also not a concern. But your child will still need any future doses according to the recommended schedule. Always bring your immunizations record with you to all of your child's office visits. Make sure the healthcare provider signs and dates every immunization.

Vaccines are some of the safest and most effective medicines we have. They have made many hazardous childhood diseases rare today. Like any medicine, vaccines can cause side effects such as a low-grade fever, or pain and redness at the site of injection. Mild reactions go away within a few days of their own. If you have questions or concerns about a vaccine, talk with your child’s doctor

Colic relief: What can the parents do?

Does your baby have periods of crankiness each day when it seems you can do nothing to comfort her? Many children starting from 3 weeks of age till the age of 4 months cry relentlessly at night which causes a lot of anxiety and fear among the parents. This behavior is called infantile colic and is quite common, particularly between 6:00 p.m. and midnight—just when parents themselves are feeling tired. Fortunately, colic doesn't mean a baby has health problems & they don't last long. With time, colic goes away on its own, mostly by 4-6 months of age. There is no reason to worry if the baby calms down within a few hours and is playful or quiet for the rest of the day.

What Causes Colic?

Most often, colic means simply that the child is unusually sensitive to stimulation or cannot "self-console", but there are multiple possible causes for colic like digestion problems or a sensitivity to something in the baby's formula or that a nursing mom is eating or gaseous distension of intestine.

Although You Simply May Have to Wait It Out, Several Things Might Be Worth Trying:

Colicky behavior also may signal a medical problem. Report your regular pediatrician immediately if the baby has any of these signs :

  • has a fever of 100.4°F (38°C) or higher
  • is less alert or active than usual
  • isn't feeding well
  • isn't sucking strongly when taking the bottle or breast
  • has loose stools or blood in the stool
  • is throwing up (when food comes out of the baby's mouth or nose with force)
  • can't calm down no matter what you do

Caring for a colicky baby can be hard. If your baby won't stop crying call a friend or family member for support or to take care of the baby while you take a break.

Weaning or, Complementary feeding: what parents should know

What is Complementary feeding or weaning & when to start complementary feeding?

Weaning or Complementary feeding is the introduction of semisolid food, usually started in babies beyond 5-6 months of age. Beyond 6 months of age, the mother’s milk is not sufficient to meet the nutritional requirement of the baby. The aim is to introduce a soft digestible diet containing adequate calories, proteins, and micronutrients that is free of contamination. Also at this period, infants enjoy ‘mouthing and gumming’, and also new tastes. Teeth eruption follows baby can do chewing and grinding movements. The growth of a child may slow down if complementary foods are not introduced at this age or if they are provided improperly.

What can be included in complementary feeding?

The first food of the infant after breast milk should be the family’s staple cereal. The first cereal can be rice (which is gluten-free and easily digestible), mixed with mashed potatoes or dal and vegetables. Other options are porridge made with suji (semolina), broken wheat (Dalia), atta (wheat flour) ground rice, ragi, millet, etc, by using a little water or milk, if available.

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In case a family can not prepare the porridge for the infant separately, pieces of chapatti could be soaked in half a cup of milk or dal and some vegetables to make a quick and nutritious meal for the baby. This mixed food could be mashed well and fed to the baby after adding a little oil or ghee. Fruits like banana, papaya, chikoo, mango, etc. could be given at this age in a mashed form or can be boiled and added to the food mixture.

How to make food calorie-dense?

Adding a little sugar or jaggery and ghee, butter or oil is important as it increases the energy value of the food. The stomach capacity of a baby is small so we should try to give a small amount of energy-dense feeds. Dilute weaning food can lead to growth faltering and malnutrition.

What are Protective foods?

Protective foods that are rich in vitamins and minerals are essential for good immunity and prevention of deficiencies. They include fruits and vegetables, eggs, fish, and dairy products like milk, curd, lassi. They are also important to help in the healthy growth of infants. To build a strong immunity we should give children a mixture of various protective foods like green leafy vegetables, carrots, pumpkin, and seasonal fruits like papaya, mango, chikoo, banana, which are important to ensure good vitamin A and iron status of the child.

What to do if the baby spits out food every time?

Remember that baby is learning to swallow slightly denser food and in the process may spit it out which is natural. So start slow by giving one spoon at a time and once the baby learns to swallow comfortably then gradually increase. Using a tiny spoon and holding it between the lips so that the baby opens the mouth and can suck it off can be rewarding.

How to go about starting the complementary feeding?

Food should be thin, to begin with, graduating to semi-solid. Make sure all food is given in the form of a smooth puree. Use a shallow spoon to feed the baby so that he/she can use a sucking action to some extent. Start with one new food at a time, two to three teaspoons to begin with. Variation can be brought in food after a week or two. If the baby dislikes a particular food, avoid it for 10 to 15 days. Then reintroduce it by mixing it in something else so that he develops the taste for it e.g. egg can be mixed with vegetables. Homemade food should be chosen because it allows the family diet to be assimilated, making the baby comfortable with the region's traditional foods. It should be prepared nicely and served in a clean dish.

How long to continue Breastfeeding?

Breastfeeding remains a critical source of nutrients for the young infant and child even though other complementary food is available. Infants should be fed breast milk until two years of age along with complementary food. It is important as the first 2 years is a period of rapid brain growth and breast milk contains micronutrients essential for brain growth and development. It provides about one half of an infant’s energy needs up to the age of one year, and up to one-third during the second year of life.

What precautions need to be taken during Complementary feeding?

A baby’s appetite varies at times. Babies eat less when they are sleepy, or not well. It is better not to force-feed your child but to watch for the signs of hunger. You cannot follow a rigid schedule, however, a healthy baby will regulate the feeling of hunger within a month on their own.

While changing over or supplementing, check the supply of milk to the child, proper monitoring of the weight and stool of the child should be done. In the event of weight loss of more than 7 to 10%, the parents should consult a physician. Regulate the liquid and solid food intake if the baby is having loose motion and take advice from a physician.

Avoid drinks like tea, coffee, and sugary carbonated beverages, and cow’s milk, etc, as they make the child full and reduce the intake of nutritious food.

What should be the amount & frequency of complementary food?

What to do if your child is a fussy eater? 7Effective ways make your kid eat better

Children of age one to five years sometimes avoid eating and eat too little or eat only a single variety of food. This is a very common problem; so many parents are tired of it and have anxiety regarding this behavior. The first thing we need to understand is that it is normal behavior and it is associated with their child's growth pattern.

For the initial two years of life, children grow very rapidly and then the growth rate becomes relatively slower. They tend to eat less as their appetite comes down. The reason being their appetite is related to the speed of their growth. So, if your child is growing well (gaining the expected weight and height) and is active, having the energy to play, learn things, and do their routine activities, they will be just fine.

Here are a few Do’s and Don’ts to help you establish good dietary habits that will help your child enjoy eating and reduce their lack of interest in food.

What can we do for imparting better nutritional practices?

You can carry out the following practices to impart better nutritional practices to your child.

Eat together -Family members should sit and eat together and it should be cultured in children. This family practice helps a lot, as children learn by observing adult behavior. This habit is one of the easiest ways to make children eat without any fuss. Preferably avoid television or mobile phones while eating.

Balance diet -A well-balanced diet is at the heart of good nutrition.Meals should contain a mixture of cereals, legumes, fruits, and fresh green vegetables to meet the daily requirement of calories, protein, vitamins, and minerals to support the growth of your child.

Remember to add -sugar or jaggery and butter, ghee, or oil to their diet. It is important as it increases the energy value of the food. As children have a smaller stomach capacity, so it is important to give small energy-dense feeds at frequent intervals to ensure adequate energy intake by the child. And these additions make the food tastier as well.

Let them choose -You should Offer your child healthy choices & let your toddler select the type of food they want to eat; this creates an interest in food in them. In each meal, at least one part of a meal should be of their choice like some fruit, vegetable, potato, eggs, whatever they love to eat.

Try Finger food - Finger foods are liked by some children. Foodstuff like banana or cucumber or carrots for older children can be given to allow them to control their eating habits.

Praise good behavior -You should always try to encourage good feeding habits by talking about them, loving them, and appreciating them.

Have Patience -You need to slowly let the child get accustomed to new food one at a time, research has shown that it may take 10-15 times of trying to get a child used to a certain food item.

What we should avoid doing?

One should avoid the following while trying to feed children.

· Avoid food fights: Don’t force your child or children to eat. If they don’t want to eat just let them go. Fighting and punishing behavior creates even more dislike for the food. A baby’s appetite varies at times. If he is sleepy, excited, or not well, he will eat less. Do not try to force-feed but watch for signs of hunger.

· Don’t bribe: Do not bribe your child or children to make them eat food. In the long run, they just start liking the chocolate or chips more than regular food.

· Don’t switch on the TV or play something on mobile while eating. It is a major distraction.

· Don’t criticize or keep telling others that your child isn’t eating. It reinforces the behavior, as children are very sensitive, and they adhere to their tag.

· Avoid too much snacking of artificial and junk food, as they make children feel full. Hence, at the time of meals, they might not feel hungry at all.

Conclusion

If you're concerned that picky eating is compromising your child's growth and development, consult your pediatrician. He or she can plot your child's growth on a growth chart. A food diary can also help your child's doctor determine any problems and ensure that your child is getting a healthy balanced diet to grow and develop.

Remember, picky eating usually is a normal developmental stage for toddlers. Most children outgrow this problem as they grow older.

8 Steps to boost your child’s immunity this winter

The immune system is like a fort that protects our body against infections like fungi or parasites, bacteria, viruses, etc. Our immune system can discriminate effectively, between the body’s cells and foreign infections, and kills the infective agent entering our body by different mechanisms. A weak immune system makes us vulnerable to various kinds of infections, which can be detrimental to a growing child. Children usually have an immature immune system which gradually develops as they grow. Here are a few healthy habits you can adopt that can help your child develop a strong immune system.

1. Stick to Breastfeeding

Breastfeeding (BF) is the number-one way to support your baby's immune system. The thin yellow 'pre-milk' that comes from the breasts during the first few days after childbirth, is called Colostrum. It is abundant with antibodies that fight the diseases. Studies have shown that babies who are breastfed for at least six months have a better developed immune system and are less prone to ear infections, allergies, diarrhea, pneumonia, meningitis, urinary tract infections. One reason mother's milk is so unique and potent may be human milk oligosaccharides (HMOs) and special prebiotics that are abundant in breast milk. HMOs feed the good bacteria in your baby's gut & help to support the baby's immune system and digestive system.

2. Follow the Immunisation schedule

Ensure that the vaccination schedule advised by the pediatrician is followed and the child gets the required shots on time. Vaccination is designed to protect children from various serious infections, building an induced immunity. This is vital for all children.

3. Serve a balanced diet rich in vegetables and fruits A well-balanced diet rich in veggies and fruits is the key to develop good immunity. Carrots, green beans, oranges, strawberries, berries, bell peppers, and broccoli are rich in antioxidants that fight off infections. Oranges and citrus fruits are rich in Vitamin C. They boost immunity and act as a hurdle against infections. Green leafy vegetables like spinach have a high content of iron. They help in the production of white blood cells (WBC) and antibodies. Nuts, seeds, grains, and beans are the source of omega fatty acids. Eggs are a good source of protein and fat. They can be added to the daily diet in various forms.

4. Use yogurt for a healthy gut

Yogurt is rich in probiotics, which aids the growth of good bacteria & keeps the intestinal tract healthy. This dairy product is rich in calcium and several other nutrients that help maintain strong and healthy bones.

5. Ensure your child gets sufficient sleep

Research has shown that adequate sleep naturally boosts our immunity. Most children need between 10 to 14 hours of sleep. Try to give an oil massage or read a story to your child to help them fall asleep.

6. Play with your child to stay fit as a family

Regular exercise plays a vital role in overall fitness. Playing in the park, garden, or playground can be amazing for a child’s health. It helps to boost the immune system. Exercising together or playing a sport as a family is fun and a great way to bond and stay healthy. Whenever possible, take children outdoors for fresh air, it helps in making vitamin D too.

7.Practice Hygiene Good hygiene keeps away harmful germs and reduces infections. Simple practices like washing hands after play, before and after meals, after coughing, and after using the toilet should be taught regularly, so they become a habit. Advise children to brush their teeth after waking up in the morning and at night before going to bed.

8. Let them get a little Dirty

Encourage your child to explore outdoors, play with pets, run around barefoot in the grass. Allow children to get a little dirty, which can help them get a dose of healthy bacteria. However, do ensure proper hand-washing when they come indoors.

8 Benefits of Breastfeeding for the mother

Breast milk provides the ideal nutrition for a newborn baby and plays a vital role in providing them with early immunity. It also has a lot of benefits for the baby like prevention of allergy, asthma, diabetes, obesity with age. However, very few people are aware that breastfeeding has a plethora of benefits for maternal health. Read on to find out the benefits breast milk provides to the mother.

The reason doctors recommend breastfeeding is that it can improve the new mother’s health in multiple ways-

  • Benefits for the uterus – Breastfeeding leads to the release of a hormone called oxytocin in the mother that helps the uterus go back to its pre-pregnancy size. It also reduces bleeding from the uterus in the immediate period after pregnancy.

Breastfeeding has immense health value for both baby and mother. So go ahead and do it!

Breast milk storage: How to store this precious gift for your baby

Breast milk is complete nutrition for babies till 6 months of age & can be continued even till 2 years of age. If you're a working mother and breastfeeding, then you need to express your breast milk and store it safely for the baby to be fed when you are not around. Here are a few frequently asked questions by working mothers on how to store and utilize the expressed breast milk for their baby

How to express breast milk?

Expressing breastmilk can be done by hand or by hand-held pump or by an electrical pump

We have listed the procedure on how to express breast milk. You can follow these procedures.

Expressing breastmilk with a hand-held pump

What type of container should be used to store expressed breast milk?

Clean your hands with soap and water before expressing or manipulating breast milk. Remember; always store the expressed milk in a hygienic, capped food-grade glass bottle or hard plastic container that is not manufactured with the chemical bisphenol A (BPA). Special plastic bags designed for milk collection and storage can be used. Don't keep breast milk in disposable bottle liners or plastic bags designed for general household use.

What's the safe way to store expressed breast milk?

Once you have collected the milk in the desired container as mentioned above, store it in the back of the refrigerator or freezer where it is cold. Place the milk temporarily in an enclosed refrigerator or ice packs if you don't have access to a fridge or freezer. Fill each container with the milk your baby will need for one feeding session. You might start with 60 to 120 ml, and then adjust as needed. It is advised not to fill milk up to the brim of the container as breast milk expands during the process of freezing.

Label each container with the date using waterproof labels and ink. Add your baby's name to the label if you are storing it at a child care facility

For how long we can store expressed breast milk?

Breast milk remains in proper condition if storage is good. How long breast milk should be stored depends on the storage process. Follow the below guidelines:

How do I thaw frozen breast milk?

Thaw the oldest milk first. Place the frozen container in the refrigerator the night before you intend to use it. You can also gently warm the milk by placing it under warm running water or in a bowl of warm water.

Don't heat a frozen bottle in the microwave or very quickly on the stove, as it denatures the milk protein. Experts recommend discarding thawed milk that isn't used within 24 hours.

Not sufficient milk: How mothers can increase their Breast milk secretion.

Breast milk is the most precious gift you can give to your new-born. It has a plethora of benefits for both baby and the mother. The first few weeks are essential for any mother for establishing breastfeeding habits. This is the time when many mothers feel that their breast milk production is not enough, hence they wrongly get dependent on formula milk which further causes a reduction in breast milk production and deprives the baby of all the benefits from breast milk.

Here are a few tips which can increase your breast milk secretion and help in continuing exclusive breastfeeding.

1. Increase the amount of breastfeeding – The golden rule to increase the amount of breast milk is to breastfeed more. This is because your body produces breast milk based on a supply and demand basis. When the baby suckles on your breast, certain hormones (prolactin, oxytocin) trigger your breast to produce milk. Thus breast milk production can be increased by carrying out breastfeeding 8-12 times a day.

2. Practice Feeding from both breasts - Feed your baby from both of your breasts during each breastfeeding session. Offer them the first breast until he or she stops feeding, then offer the next breast. This stimulation of both breasts increases the milk supply. This will almost always ensure that your infant gets adequate breast milk.

3. Stimulating the breasts - After you finish a breastfeeding session, you can stimulate the breasts using a breast pump or a hand expression technique. This will help in producing more milk.

4. Ensure good hydration– The most important thing to enhance breast milk production is good hydration. Stay hydrated by drinking lots of water, fresh fruit juices, lassi, buttermilk, or soup. This is very important as a lot of body water is required for the generation of breast milk.

5. Maintain a healthy lifestyle: Daily lifestyle choices also affect milk production. The mother must receive a balanced diet, a lot of emotional support, adequate rest and care during the initial phases of breastfeeding, as factors like pain, stress, and anxiety are the major factors that can reduce breast milk production. Excessive smoking, drinking, stress, and fatigue can interfere with your milk supply, so this needs to be avoided.

6. Keep the baby awake during breastfeeding - Some new-borns are sleepy during their first few weeks. Try to wake the baby up after every 3 hours to breastfeed if he or she is sleepy. Also, make sure the baby is awake during breastfeeding. Try rubbing the feet of the baby to keep him/her awake. When the baby is awake and feeding properly, it will provide your body with the required stimulation to produce more milk.

7. Get Additional Nutrition- Always focus on making healthy choices that will increase your milk production. Diet rich in protein items, such as lean meat, eggs, dairy, beans, lentils, and seafood low in mercury content should be used. Choose a variety of whole grains as well as fruits and vegetables. Nursing mothers require an additional 400 calories a day to get the energy and nutrition to produce milk. To get these extra calories, opt for nutrient-rich choices, such as a slice of whole-grain bread with a tablespoon (about 16 grams) of peanut butter, a medium banana or apple, and 8 ounces (about 227 grams) of yogurt.

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