Six months to two and a half years
Milestones at six months
The importance of Head Circumference
Common Health Problems
Milestones at six months
The sixth month is an important milestone in the life of your child. It is around this time that:
- The child opens its previously clenched fist.
- The child learns to identify and distinguish faces. Thus it smiles at a familiar face and may cry or frown at an unfamiliar person.
- It attempts to turn over.
In most children, teething starts from the age of six months and by the time the child is two and half years old it has 20 teeth. For some children, teething starts only from their second year. Teething can be delayed because of a variety of factors such as heredity, poor nutrition etc. By the seventh or eighth year these milk teeth start to be replaced by permanent teeth. The belief that teething in children is accompanied by diarrhoea and incessant fever, is a myth. In fact the only thing dentition starts is, well--- teeth.
The importance of Head Circumference
At birth a child has an average head circumference of around 35 cms.
This increases at the rate of 1.4 cms per month for the first four months.
At the end of 1 year the Head Circumference (HC) is about 45 cms;
At the end of 3 years the H.C. is about 48 cms;
At the end of 6 years the H.C. is 49.5 cms;
The head circumference can be measured at home by using the following method:
Use a string or twine for measuring. Take it around the baby's forehead, passing it above the ears to the back of the head until the two ends of the twine meet. Mark this point on the string and measure the length on a scale and that gives you the head circumference.
If the head circumference of the child varies from the normal, there is no need to panic. Only if the developmental milestones of the child are also delayed is it important to seek medical attention.
Around the sixth month, breast-feeding is tapered or even stopped and the child is put on bottle feeds and other supplementary foods. This period is called the weaning period. Though there is no substitute for breast milk, as the child grows older it requires supplementation of calories and proteins. As the gums harden and teeth start to grow, the child must be given chewable foodstuffs.
The child may be given rice or wheat kanji (gruel) in a semisolid form using a spoon. Many a time, the child spits out the feed and this may happen for quite a while. Mothers often complain that their child does not like the gruel. But the truth is that the child, unaccustomed to semi-solid food, is afraid to accept it. When mothers persevere with these feeds patiently, the child starts to accept them well.
Common Health Complaints
Soon after the weaning period begins, one segment of the intestine may cannon into another. This condition is called intus susception. When children develop intestinal obstruction, it is life threatening. Approximately five hours following this event the child may pass blood via the rectum and it is essential to seek medical help urgently.
Gastro-Enteritis or Diarrhoea is one of the most common problems afflicting many children. Imbibing contaminated food or water and lack of proper sanitary facilities are the two major reasons for children developing diarrhoea. Some children may have an allergy to cows milk and this may produce diarrhoea. A variety of viruses and bacteria cause diarrhoea.
Diarrhoea causes loss of water content from the body, resulting in dehydration. The administration of Oral Rehydration Solution (ORS), a simple first aid remedy, is helpful in preventing dehydration.
To prepare ORS, add a pinch of salt and a teaspoon of sugar to one tumbler of boiled water and stir the solution well. The child should be given this solution from the first few hours of the onset of diarrhoea. (This remedy can be given at home and even children without diarrhoea can be given this fluid in the summer.)
If the child starts vomiting or if the eyes become sunken rush to the doctor.
If the diarrhoea persists, it is a common practice to lay the blame on an evil eye cast on the child and often faith healing is resorted to. While elders advise a host of remedies based on faith it is important not to ignore or delay medical attention for the child.
Some children start vomiting along with diarrhoea. These patients can be given the same oral rehydration solution (ORS) mentioned above but giving large quantities at a time may actually provoke vomiting. So those children are given small feeds at intervals of ten minutes or so. Arrowroot gruel, Bengal Gram gruel and Tender coconut water can all be given to children with diarrhoea.
Most children affected by Diarrhoea do not require an antibiotic. However, in cases of Dysentery where the child passes blood or mucus in the stools, antibiotics are necessary.
It is a major blunder to starve children with diarrhoea thinking that by providing rest to the intestine, the children will get better. This will lead to disastrous consequences. The only time a child with diarrhoea can be starved is when it is receiving drips (Intravenous fluids). Modern thinking is towards giving nutritious diet to children with diarrhoea and nothing can be worse than starving them. However, it is better to avoid fruits as the fermentation and gas they induce can cause problems
Here are a few simple tips to avoid Gastro-Enteritis:
- Wash your hands well before mixing feeds.
- Always ensure that the rubber nipple of the feeding bottle is sterilised in boiling water before use.
- Do not place the feeding bottle on the pillow and turn the child's head to the bottle to allow it to feed.
- A tumbler with a spoon or "Paaladai" (beaked feeding cup) is always preferable to a bottle.
- Wash and clean the child's hands and legs well
after each motion the child passes.
Children between the ages of six months and two years are prone to developing respiratory infections. Though the common cold is almost universal in children it is often the precursor of more problematic conditions like Tonsillitis and Pneumonia and so it is unwise neglect it.
The predisposing factors for catching a cold include, exposure to cold air, frequent oil baths especially when oil is poured into the ears and nose, inhaling incense and aspiration during feeds. The practice of blowing into the nose or mouth to remove the phlegm is dangerous and often makes matters worse as does bathing the child in excessively warm water.
Kissing the child frequently, especially on the lips, is another way in which infection is spread to the child. This is a case of "Affection resulting in infection".
The child could have got pneumonia if the respiratory infection gets severe, and the child has difficulty in breathing. At this stage the child refuses to feed and cries incessantly.
There are a few simple procedures for treating common cold at home. One of them is, dip a clean muslin cloth in warm water to which half a spoon of salt has been added, twist it like a wick and then introduce the cloth into the baby's nostril to remove the phlegm. Alternatively betel juice or Tulsi (the herb Ocimum sanctum) juice may be given orally. If the child has respiratory difficulty due to Asthma, the administration of Oxygen may become necessary.
Beware of Cough Syrups
It is best to avoid giving cough syrups to children who are less than a year old. The sedative effect of the cough syrup may induce drowsiness and may even lead to coma.
The news that their child is neurologically retarded is a shattering blow to any parent. To limit the extent of disability, it is essential to start the treatment early.
There are two kinds of neurological impairments. In the first type the child is mentally retarded with the area of the brain responsible for intelligence and intellect being affected. In the second type the so-called motor area of the brain which controls the movements of the body is affected. In this type of retardation, the child has difficulty in walking, running, lifting objects or performing simple tasks like these.
It is very important for pregnant women not to venture out of the house during an eclipse, as there is a risk of their babies being born with neurological defects. Scientists have now provided rational evidence to back up what was once thought of as an old wives tale. It is, therefore, important for pregnant women to report such happenings to their obstetricians without fail.
Some children develop neurological impairment as a result of their brain being deprived of oxygen in the immediate period following birth. Normally a child should start crying immediately or at the latest within five minutes following birth. Failure to cry soon after birth is often indicative of neurological damage in a child.
When the child is about a year old there is a possibility of it developing a few new problems one of which is Primary Complex.
Loss of Appetite, irritability, diminished interaction with parents and others, loss of weight, intermittent low-grade fever are all features of Primary Complex.
Parents often wonder how it is possible for their children who have been immunized with B.C.G. Vaccine soon after birth to develop Primary Complex. The fact is that the B.C.G. Vaccine is not 100% effective in protecting children against Primary Complex / Tuberculosis. However B.C.G. Vaccine should be given to all children as it significantly helps in reducing the severity of the complications of Tuberculosis like Meningitis or Military T.B. even though it may be unable to prevent a child from getting a Primary complex. Primary Complex, which is due to bacteria, does not spread from one child to another. The child usually acquires the infection from an infected adult.
Doctors still rely on the Mantoux test to diagnose Primary Complex. A substance called P.P.D. (Purified Protein Derivative) is injected intradermally on the child's forearm and 48 hours later the area is examined for induration and swelling which if present beyond a specified extent indicates a Positive Mantoux. A chest x-ray is then taken to confirm the diagnosis.
In the early days long-term treatment was required to treat Primary Complex. Due to the discovery of newer medicine, nowadays, children with Primary Complex are treated for only six months during which time a cure is effected. However, there is a chance that the child may acquire the infection again.
Casual contacts like servants at home, rickshaw driver who takes the child to school or any such persons with whom the child comes into contact can transmit the infection to the child by their cough.