ޑރ. ނިޔާފްގެ އޮންލައިން ކްލިނިކް

ބުރަކަށީގެ ދެ ބަދަ ދޭތެރެޔަށް ކަށި ޖަހައިގެން ފެން ނެގުން

2008-04-01T23:09:00.004+05:00

ބައެއް ބަލިބަލި ހޯދައިގަތުމަށް ތަހުލީލު ކުރުމަށްޓަކައި ބުރަކަށީގެ ދެ ބަދަދޭތެރޭގެ ޖާގައަށް ޙާއްޞަ ކައްޓެއް ޖަހައިގެން ފެނަންގެއެވެ. ޒަމާނީ ބޭސްވެރިކަމުގެ ޢިލްމުގެ އަލީގައި މިގޮތަށް ނެގޭފެން ފޮދު ޓެސްޓުކޮށްގެން މެނުވީ ހޯދައި ނުގަނެވޭ ބަލިބަލި ހުންނަކަން ސާބިތުވެއެވެ. މިފަދަ ބަލިތަކުގެ ތެރޭގައި ވަކިން ޙާއްޞަކޮށް "މެނިންޖައިޓިސް" ފާހަގަ ކޮށްލަމެވެ. މީގެ އިތުރުންވެސް ޒަމާނީ ބޭސްވެރިކަމުގައި ހޭނެއްތުމަކާއި ނުލައި،އައްސި ކޮށްގެން ކުރެވޭ ބަޔެއް އޮޕަރޭޝަނަށް އައްސި ކުރުމްށް ވެސް މިގޮތަށް ކަށި ޖެހެއެވެ. މިގޮތަށް ކަށިޖެހުމްށް "ލަމްބަރ ޕަންޗަރ" ކިޔައެވެ.

މިގޮތަށް ކަށިޖަހަނީ ކޮންނޮން ހާލަތްތަކެއްގައިތޯއެވެ؟
• ސިކުޑިއާއި ސިކުޑި ވަށްއިގެންވާ ފަށަލަތަކގައި އިންފެންޝަން އެއް ހުރިތޯބެލުމަށް ޓެސްޓު ކުރުމަށް ފެންނެގުން (މިގޮތުން ފާހަގަ ކޮށްލެވޭ ބައެއް ބަލި ބަލި: މެނިންޖައިޓިސް، ޓޮކްސޯޕްލަސްމޯސިސް، އެންކެފަލައިޓިސް).
• އޮޕަރޭޝަނަކަށްޓަކައި ފޫޅުންތިރި އައްސި ކުރުމަށް ކަށިޖަހައިގެން އައްސި ކުރާ ބޭސް ދިނުން.
• ބައެއް ބާވަތް ބާވަތުގެ ކެންސްރު، އެވައްތަރަކުން ސިކުޑީގެ ފަށަލައަކަށް އަސަރުކުރާކަމަށް ޝައްކުކުރެވޭ ހާލަތްތަކުގައި، އޭގެ އަސަރެއްހުރިތޯ ބެލުމަށް ޓެސްޓު ކުރުން.
• ސިކުޑިވަށައި ހުންނަ ފެންފަށަލައިގެތެރޭ ފެންގިނަވާން ދިމާވާ ބެއެއް ބަލި ބަލީގައި، ވަގުތީގޮތުން ފެން މަދިކުރަންޖެހޭ ހާލަތްތަކުގައި ފެންނެގުން.

މިގޮތަށް ކަށިޖަހައިގެން އެ ނެގެނީ ކޮންފެނެއްތޯއެވެ؟
ސިކުޑިއެތެރޭގައާއި ސިކުޑިވަށައިގެންވާ ފަށަލައެއްގައި ޙާއްޞަ ފެނެއް ހުރެއެވެ. މިގޮތުން ސިކުޑީގެ އެތެރޭގައިވާ ފެންހުންނަ ޖާގަތަކާއި ސިކުޑީއާއި މައިނާރުގެ ވަށައިގެންވާ ފެންފަށަލައާއި ވާނީ ސީދާގޮތެއްގައި ގުޅިފައެވެ. ތަސްވީރުން ތިޔަފެނިވަޑައިގަންނަވަނީ މިދެންނެވި ތަންތަނެވެ.
ބުރަކަށީގެ ދެ ބަދަދޭތެރެއިން ޖާގައަކަށް ކަށިޖަހައިގެންނެގޭ ފެނަކީ ސިކުޑިއާއި ސިކުޑި ވަށައިގެންވާ ޙާއްޞަ ފަށަލައަކުން އުފައްދާ ޙާއްޞަ ދިޔައެކެވެ.

ކަށި ޖަހަނީ ކިހިނެއް އަދި ފެން ނަގަނީ ކިހިނެއް؟
މިކަމަކީ ވަރަށް ރައްކާތެރި ގޮތެއްގައި މިކަމަށް ތަމްރީނު ލިބިފައިވާ ޑޮކްޓަރުން ހައްދަވާދެއްވާނެ "ޕްރޮސީޖާ" އެކެވެ. މިގޮތުން އެއްއަރިއަކަށް ބަލިމީހާ ބާއްވައިގެން ނުވަތަ ބުރަކަށި ދިއްވާގޮތަށް ބައިންދާލައިގެން، ކަށިޖެހުމަށް ފާހަގަކުރެވޭ ޕޮއިންޓާއި ވަށައިގެންވާ ހަމުގެ ސަރަހައްދު ޙާއްޞަ ގޮތެއްގައި ޖަރާސީމުގެ އަސަރެއްކުރުން ދުރުކުރުމަށްޓަކައި ސާފުކޮށް، ކުރިން ފާހަގަ ކުރެވިފައިވާ ބުރަކަށީގެ މައިބަދައިގެ ދެބަދަ ދޭތެރޭގައިވާ ކަށި ނެތް ޖާގައަށް މިކަމަށް ޙާއްޞަ ކުރެވިފައިވާ ކައްޓެއް ޖަހާ ފެންފަށަލައާއި ހަމައަށް ކަށީގެ ކޮޅު މަޑުމަޑުން ވައްދައިގެން އެފަށަލައިން ފެން ނަގައެވެ.
ފެންނެގުމަށް ކަށިޖެހުމުގެ ކުރިން ކަށިޖަހާނެ ސަރަހައްދު އައްސި ކުރުމަށް ޙާއްޞަ ޖެލްއެއް އުގުޅިދާނެއެވެ، ޏުވަތަ އެސަރަހައްދުގެ ހަން އައްސިކުރުމަށް އިންޖެކްޝަނެއްވެސް ޖެހިދާނެއެވެ.
ފެންފަށަލައަށް ކަށީގެ ކޮޅު ފޯރުމުން ކށީގެ އެތެރޭގައިވާ ހިމަ ހޮޅިއެތެރެއިން އަންނަފެން ފޮދު އެކަމަށް ޙައްޞަ ކުރެވިފައިވާ ފުޅި ނުވަތަ ދަޅަކަށް ވަރަށް ރައްކާތެރިކަމާއި އަދިއެހާމެ ސާފުތާހުރު ކަމާއެކު ނެގެއެވެ. ޢާންމު ގޮތެއްގައި ނެގެނީ ވަރަށް މަދު ފެންފޮދެކެވެ.

މިގޮތަށް ކަށިޖަހައިގެން ފެންނެގުމުން ލިބޭ ގެއްލުންތަކެއް ހުރޭތޯއެވެ؟
މިކަމަކީ ވަރަށް ރައްކާތެރިކަމާއި އެކު މިކަމަށް ތަމްރީނު ލިބިފައިވާ ޑޮކްޓަރަކު ކުރައްވައިފިނަމަ އެކަމުން ގެއްލުމެއްވުން ނާދިރު ކަމެކެވެ. އެހެންނަމަވެސް މަދުމަދުން ނަމަވެސް ދިމާވެދާނެ ކަންކަން ފާހަގަ ކޮށްލަމެވެ.
• ފެންނަގަން މަސައްކަތްކުރެވި ފެންނެގޭގޮތް ނުވުން. މިއީ ވަކިން ޙާއްޞަކޮށް ވަރަށް ތުއްތު ކުދިންގެ ދިމާވެދާނެ ގޮތެކެވެ. ރައްކާތެރިކަމާއި އެކު ފެންނެގުން ދަތިވާ ހާލަތުގައި އެވަގުތަށް ފެންނެގުމުގެ މަސައްކަތް ހުއްޓާ ލައްވާނެއެވެ. އަދި ފަހުން ފެންނެގުމަށް ޕްލޭން ކުރެވިދާނެއެވެ.
• ގިނަވެގެން 3 ފަހަރުމަތިން މަސައްކަތްކޮށްގެން ކަށި ރަގަޅަށް ޖެހެންވާ ޖާގައަށް ނުޖެހޭނަމަ އެވަގުތަށް ފެންނެގުމުގެ މަސައްކަތަ ހުއްޓަވާލައްވާނެއެވެ. ގިނަފަހަރު މަތިން ކަށިޖެހިއްޖެނަމަ ކަށި ހެރުނު ސަރަހައްދު ކުޑަކޮށް ދުޅަވެ ކުރު މުއްދަތަކަށް އެހިސާބުގައި ރިއްސާގޮތް މެދުވެރިވެދާނެއެވެ.
• ކަށިޖެހުމުގައި މައިބަދައިގަ ކަށީގެ ތޫނު ކޮޅު ނުޖެހިވޭތޯ ޑޮކްޓަރު މަސައްކަތް ކުރައްވާނެއެވެ. އެހެންނަމަވެސް ކަށިޖެހުމަށް މަސައްކަތް ކުރެވެމުންދާ ވަގުތު ބަލިމީހާއަށް ގެނެވޭ ކުއްލި ހަރަކާތަކުން ނުވަތަ އެނޫންވެސް ސަބަބަކާ ހެދި ކަށީގެ ތޫނު ކޮޅު މައިބަދައިގަ ޖެހި މައިބަދައިގެ ކައްޓަށް ކުޑަ އަނިޔާއެއް ވެދާނެއެވެ. މިހެން ދިމާވެއްޖެނަމަ ކުރު މުއްދަތަކަށް އެ ކަށީގައި ރިހުމެއް ހުރެދާނެއެވެ.
• ފެންނެގުމަށް ކަށިޖެހުމަށް ކަޑައަޅަނީ ބުރަކަށީގެ އެތެރޭގައިވާ މައިނާރުގެ އެންމެ ތިރީކައިރިޔަށް ވުރެ ތިރީގެ ދެބަދައެއްގެ މެދުން ފާހަގަ ކުރެވޭ ހުސްޖާގައަކަށެވެ. މައިނާރަށް އަނިޔާއެއްވެދާނެފަދަ ހިސާބަކަށްކަށި ނުޖައްސަވާނެއެވެ. އެހެންނަމަވެސް އެފަދަ އަނިޔާއެއް ވެއްޖެ ހާލަތެއްގައި ބުރަކަށީގެ ސަރަހައްދެއް ކުރު ނުވަތަ ދިގު މުއްދަތަކަށް އައްސިވެ ނުވަތަ އިހުސާސް ކެޑޭގޮތް ވެދާނެއެވެ.
• ސިކުޑި އެތެރޭގެ ފެނަހުންނަ ޖާގައެއްގައި އާދަޔާ ޙިލާފަށް ޕްރެޝަރް އިތުރުވެފަ ވާނަމަ ފެން ނުނަންގަވާނެއެވެ. ތުއްތު ކުއްޖެއްނޫންނަމަ މިފަދަ ކަމެއްހުރިތޯ ބެލުމަށް ވަކިން ޙާއްޞަ ގޮތެއްގައި ބަލިމީހާ ޗެކް ކުރެވޭނެއެވެ. އެހެންނަމަވެސް މިފަދަ ހާލަތެއްމެދުވެރިވެފައިވާ ދަޑިވަޅެއްގައި ފެންނެގުމަށް ކަށިޖެހިއްޖެނަމަ ވަރަށް ކުއްލި ގޮތެއްގައި ބަލިމީހާގެ ލޭގެ ޕްރެޝަރު ދަށްވެ، ހިތުގެ ހިގުން ބަދަލުވެ ނޭވާ ލުމަށް ދަތިވެދާނެއެވެ. މިއީ ވަރަށް ނުރައްކާތެރި ކަމެކެވެ. ވަރަށް މަދުންނަމަވެސް މިއީ އެކިއެކި ޤައުމު ތަކުގައި ދިމާވެފައިވާ ކަމެކެވެ.
ފެންނަގަން ކޮންމެހެން ޖެހޭ ބަލިބައްޔަކީ އޭގެއަމިއްލަ ޒާތުގައި ބޮލުގަ ރިހުން، ނާރުތަކުގެ ނުވަތަ ވަކިނާރެއްގެ ބާރުދެރަވުން، ފިޓު ޖެހުން، ބުއްދިޔަށް އަސަރުކުރުން، އަދި މިނޫންވެސް ސިކުޑިއާއި ގުޅުންހުރި ކުދި ބޮޑު އެކިއެކި ކަންތައްތައް ބަލީގެ ކުޑަ ބޮޑު މިނުން ދިމާވެދާނެ ބަލިބައްޔެވެ. ބައްޔަށް އެކަށީގެންވާ ފަރުވާ ލިބުމަށްނަގާ ވަގުތާއި، ފަރުވާ ފެށުނުނަމަވެސް ބަލި ކޮންޓްރޯލުވެ ރަގަޅުވާން ނަގާ މުއްދަތުގައި، މިފަދަ ބަލިބަލީގައި އެކިވަރުގެ ގެއްލުން ލިބިދާނެއެވެ.
މަދުމަދުންނަމަވެސް އާނަމުންގެ ތެރޭގައާއި ބޭސްވެރިކަމުގެ ދާއިރާގައި އުޅުއްވިނަމަވެސް އެކަމުގެ މައުލޫމާތު މަދު ބޭބޭފުޅުން މިގޮތަށް ބަލިން ލިބޭ، ނުވަތަ ލިބިފައިވާ ގެއްލުންތަށް ފަރުވާކުރުމުން، ނުވަތަ ފަރުވާކުރުމަށް ކުރެވުނު ކަމަކުން ވީކަމެއްގޮތަށް މާނަކުރައްވައެވެ. މިއީ ވަރަށް ދެރަކޮށް ދިމާވާ ކަމެކެވެ. އެހެނީ މިކަހަލަ ވާހަކަތަކުގެ ސަބަބުން މިފަދަ މުހިންމު އަދި ބޭނުންތެރި ޕްރޮސީޖަރްއެއް އާންމުން ބަލައި ނުގަނެ، ބަލި ރަގަޅު ގޮތުގައި ހޯދައިގަނެ އެކަމަށް އެންމެ އެކަށޭނަ ފަރުވާ ދިނުމަށް ޑޮކަޓަރުންނަށް ދަތިވާގޮތް އެބަވެއެވެ.
މިކަމުގެ ހައްލެއްކަމުގައި މިކަންކަމާ ބެހޭ ސާބިތު މައުލޫމާތު އާންމުންނަށް ފޯރުކޮށްދިނުން އެއީ ވަރަށް މުހިންމުކަމެއްކަމުގައި ދެކެމެވެ.

ނެގޭފެން ޓެސްޓު ކޮށްގެން ލިބޭނީ ކޮނަ މައުލޫމާތެއްތޯއެވެ؟
• އިންފެކްޝަނެއް ހުރިނަމަ އެކަމާބެހޭ މައުލޫމާތު ލިބެއެވެ. އަވަސް ގޮތެއްގައި އިންފެކްޝަން ހުރިތޯ ނުވަތަ ނެއްތޯ ހޯދެއެވެ. އަދި އިންފެކްޝަނެއް ހުރިނަމަ ކޮން ކަހަލަ ޖަރާސީމަކުންތޯ ހޯދައިގަނެއެވެ. ވަކިން އެ ޖަރާސީމު ފެނި އެސާފު ކުރުމަށް ދޭނެ ބޭހެއް ހޯދިދާނެއެވެ. މި ފަހު ނަތީޖާ އަކީ ތަންކޮޅެއް ލަހުން ލިބޭނެ މައުލޫމާތެކެވެ.
• ކެންސަރުގެ އަސަރެއް ހުރިތޯ ބެލުމަށް ޓެސްޓު ކުރާނަމަ އެފަދަ ސެލްއެއް ފެނުނުތޯ ނުވަތަނޫންތޯ ހޯދިދާނެއެވެ.
ބަލި އެންގި އެބައްޔަށް ޙާއްޞަ ފަރުވާ ދިނުމަށް ޓެސްޓުގެ ނަތީޖާއިން އެހީތެރިވެދެއެވެ.

އިތުރު މައުލޫމާތު ބޭނުންފުޅުނަމަ ޑޮކްޓަރާއި ސުވާލު ކުރައްވާށެވެ. ބޭނުންފުޅުވާ މައުލޫމާތު ލިބިގަތުމަކީ ބަލިމީހާއާއި ބަލިމީހާގެ ކަންތައްތަކާއި ހަވަލުވެ ހުންނެވި އެހީތެރިއެއްގެ ހައްޤެކެވެ.

ފިޒާންގެ އެދުމުގެ މަތިން

2008-03-29T00:37:00.003+05:00

މިއީ ފިޒާންގެ އެދުމުގެ މަތިން ދިވެހި ޓެމްޕްލޭޓެއް ހެދުމްށްޓަކައި ބްލޮގަރ ގެ ޓެމްޕްލޭޓް ބަދަލު ކުރެވޭތޯ އަޖުމަބަލާލުމުގެ ގޮތުން ޓެސްޓަކަށް ޓެމަޕްލޭޓް ބަދަލު ކޮށްލައިގެން ލިޔެލާ މެސެޖެކެވެ. ކޮމެންޓް ކުރުމަށް މަސައްކަތް ނުކުރައްވާށެވެ. ކޮމެންޓް ޕޭޖު ވަނީ ޑިސްއޭބަލް ކުރެވިފައެވެ.

The Ferritin and Desferal discussion

2008-01-20T11:33:00.000+05:00

Recent update of Dr Niyaf's Online Clinic

Read the recent update on Ferritin levels and Desferal.

Coming soon....

2008-01-03T02:12:00.000+05:00

Beta Thalassaemia.
Adenoiditis.
Premature baby: what to expect.

Last week on Dr Niyaf's Online Clinic

2007-11-30T18:18:00.000+05:00

The issue is Drug Abuse! Not the type that we most commonly hear about. This is different but nonetheless deeply worrying and potentially dangerous and in extreme cases potentially life threatening.

Drug abuse of a different kind.

Sharing content

2007-11-29T12:37:00.000+05:00

Any content found on the blog or the parent website, niyaf.com maybe shared provided that reference is made and a link placed to the source.

Breastfeeding: common misconceptions

2007-10-05T15:21:00.000+05:00

Breastfeeding is the most natural and by all accounts the best food that the newborn baby can have. For some breastfeeding comes naturally, while for many others this natural skill needs to be augmented by assistance from experienced mothers and breastfeeding counselors.

Some common misconceptions have created problems for breastfeeding mothers, in some leading to failure of feeding.

I will be discussing some of these common misconceptions here.

Small are breasts less capable of making milk!

It has been shown that the milk producing parts of the breast are of the same size in breasts of different sizes. The difference in size has been found to be due to difference in amount of supportive tissue like fat.

So breasts of different sizes are still capable of making good volume of good quality breast milk, regardless of whether they are small or big.
The size of the nipple affects breast feeding!

The size of the nipple may cause some difficulty with attachment and cause difficulty with latching on. However, with good attachment technique these problems can be over come and good feeding established.

It is important to note that with good attachment, the baby is not holding onto or sucking on the nipple! The nipple is deep inside the mouth and is only little more than the outlet for the milk.
With too large a nipple occasionally baby may have gagging. With time, the baby adjusts to this and can achieve good feeding.

No milk comes in during the first 2-3 days after birth!

Milk does come soon after birth. The first milk that comes is different in composition and is called Colostrums. Colostrum contains many important constituents; most importantly it contains agents that improve the immunity of the newborn baby.

It is true that the volume of milk is much less during the first few days, but the colostrums has more calories per volume than the milk that comes in later.

The transition to what is called the "mature milk" occurs during the first week to 10 days. This transition occurs sooner if the baby is allowed to suckle as frequently and for as long as he wants to.

Baby needs some water during the first few days!

Baby does not require any additional water at all during the first 6 months of life. The reason I say additional water is because breast milk contain about 70-80% water by volume. This is more than enough for the baby.

The additional water if given will be filling the baby's small capacity stomach with non-calorie containing fluid in place of breast milk that contains both calories and water.

Baby has to be given water to clean his mouth after a feed!

Breast milk contains agents that prevent the growth of bacteria and other harmful organisms. There is no point in washing away this protective effect of breast milk with water.

Some mothers are concerned about the yellowish color seen over the baby's tongue. This is a normal finding and is due to the fat content of the breast milk.

Others are worried that if the milk is not washed away, oral thrush may occur. Breast milk contains anti-fungal agents to that prevent that from happening.

Mothers who have had Caesarean section make less milk!

Some mothers (and their relatives) worry that because a mother is not allowed to drink and eat soon after a Caesarean section, they will not make enough or any milk at all.

These mothers are given fluids by other mean during this time. If fluid goes into the mothers body (whether by oral route or not) it does not make any difference. Water will still be available to make milk.

They may have reduced milk production for other reasons. Pain, discomfort and worry are known to reduce the amount of Prolactin (the hormone that act on the milk producing glands in the breast to make milk) that can result is reduced milk production.

Mothers need to drink milk to make breast milk!

Mothers need a nutritious diet to make breast milk. Milk may be part of that diet. However, milk is not necessary to make breast milk.

A balanced nutritious diet whether milk is a part of it or not make equally good breast milk.

Baby needs to be fed every 2 hourly!

Many mothers have been told that their baby needs to be fed every 2 hourly, especially during the first few weeks to a month.

The baby would need to be fed as frequently as he demands; this maybe every half-hourly or 3 hourly. In some babies, if not most, there is no fixed time interval between feeds.

If the baby is hungry, he needs to be fed and if he is not hungry he should not be forced to feed. A baby will wake up and demand feeds when he feels hungry.

Rigid feeding schedules (like 2 hourly feeds) can cause the baby to refuse feeds or take progressively less volume (or spend less time) at each feed because he may be filling up a stomach which is still too full! This refusal or apparent reduced feeding could cause much concern to the mother.

If the baby's nose touches the mother breast during a feed he can suffocate!

Mothers who have been either told this or believe it to be true on their own will be very concerned during each feed.

With a good attachment, having the baby's chin touching the mothers’ breast, the nose should be as far away from the breast as is possible. With the mouth (attached to the breast) acting as a fulcrum, the closer the chin is the further from the breast the nose moves.

Even if the nose does touch the breast, a very common finding even with good attachment, there is not risk of suffocation. The baby is attached to the breast on his own choice, he should not be held on to the breast by force. If for any reason the bay cannot breathe because of blocked nose (and touching the breast is not one of them), he would let go of the breast to breathe (his natural reflex being to cry).

Baby has to be fed from both breasts at each feed!

Once the "mature milk" has set in the character of the milk changes during the course of each feed. The milk that comes out during the first few minutes of each feed (called fore-milk) contains more water by volume. The milk that comes during the later part of the feed (called hind-milk) contains more fat and proteins and less water by volume that the fore-milk.

For this reason it is important to feed from the first side that is offered till that side is emptied, so that the baby gets the goodness of the proteins and fats in the hind-milk.

If the baby was offered one breast first and then before it was emptied, is offered the second one, he would not get much protein or fat that is essential for his growth.

The second breast should be offered if the baby is still hungry after finishing feeds from one side.

Breastfeeding has to be stopped if the mother becomes sick!

With most illnesses there is no need to stop breastfeeding. However with some illnesses and use of some medications breastfeeding has to be withheld for some time.

For minor illnesses, breast feeding should not be discontinued. If there is any doubt, the mothers’ doctor would need to be consulted especially for this issue.

If breastfeeding mother who becomes pregnant should stop feeding!

Some mothers have been advised to stop feeding their baby because they got pregnant with another.

There is no need for this. There is no evidence that breast feeding during pregnancy has any negative effect on the unborn baby or the breast milk itself.

However it is important to note here that, in this situation, mothers would need more nutrients to keep up with the demands of the unborn baby and production of milk.

Breastfeeding: attachment

2007-10-05T15:08:00.000+05:00

A major share of breastfeeding difficulties, especially in first-time mothers, is because of difficulties with attachment of the baby to the breast during a feed.
Many difficulties and discomforts such as:

Sore nipple (whether pain during or after a feed)

Cracked nipple (whether with or without bleeding)

Apparent inability for baby to suckle

Refusal by baby to feedcould be because of difficulties with attachment that lead to poor attachment.

What are the signs of a good attachment?

The following features are seen when a baby and nursing mother achieves a good attachment.

Baby's chin will be touching the mother’s breast. (This reduces the distance between the baby's mouth and the nipple making it easier for him to get a good attachment).

Baby's mouth will be seen to be widely open (if the baby only has the nipple in his mouth it only need to be open big enough to let the nipple in his mouth, but because he needs to have the nipple and part of the areola - the dark pigmented area surrounding the nipple - in his mouth, it will have to be widely open).

Baby's lower lip will be turned outward (meaning that you will be able to see the inner pink surface of the lower lip, sometimes baby's tongue may be visible during suckling action).

More of the mothers areola will be visible above than below the level of baby's mouth (this is a sign to show that baby has taken part of the areola into his mouth. This maybe difficult to appreciate if the areola is small -the size of the areola does not affect breastfeeding!).

(a) And (b) show good attachment (c) and (d) show poor attachment.

Some babies would feed very well indeed, even without all the features above being present. If the baby and you are comfortable with the attachment then it is good enough.One dominant feature of a good attachment is that feeding becomes pain free, even in those who have a sore nipple.

Starting to feed

2007-10-05T15:01:00.000+05:00

Feeding should ideally begin soon after birth. However, the process of starting to feed has to begin much earlier.

When feeding issues should be first discussed?
The period of time just before and following soon after the process of giving birth can a very stressful one for some parents. This will not be the right time to make decisions on baby feeding.
Perhaps the best time to begin the discussion on this issue is at the time when one comes to know about pregnancy or sometime within the early months of pregnancy.

Pregnancy is a time period when all parents are very receptive to counseling and discussions. This state of receptiveness is the ideal time to initiate a discussion on the baby's feeding.
Decision on what to feedThis is a decision that needs to be made by the couple. The options available are breastfeeding and artificial feeding. Most mothers express a strong desire to breastfeed, however this is not universal.

Every couple should gather information on feeding options and make a decision based on the information obtained.

Breastfeeding is the recommended ideal feeding practice and this needs to be discussed and support provided.

Preparing to breastfeed
The preparation begins early in the pregnancy. This is done by acquiring knowledge about the benefits of breastfeeding [this will increase the level of commitment from the mother], discuss with experienced mothers and breastfeeding counselors [to help understand the common problems with feeding and their solutions and also get a feeling of the rewards from the experience].

Some women would like to prepare by purchasing maternity clothing that helps with breastfeeding [clothes and under garments].

Nothing needs to be done to the breast during pregnancy to improve breastfeeding. The breasts would need to be examined by the Obstetrician or Nurse after the 6th month of pregnancy to help identify the possibility of difficulty with feeding. Prior to this there is no need for such an assessment as the breast changes related to pregnancy are still ongoing. Interventions before 6th month of pregnancy have not been known to affect feeding.

The first feed.
This should happen as soon after birth as possible; ideally within the first half an hour of birth.
This is important because the baby has a period of alertness during this period lasting about 30 to 45 minutes [approximate]. This alert period should be used for feeding, as following this period baby has shorter cycles of alertness on the first few days.

The early feeding would also prevent the baby developing low blood glucose. Feeding soon after birth has advantages to the mother too. It helps to contract the uterus helping both in the delivery of the placenta and in controlling the bleeding after birth.

Babies are born with an inherent reflex to suckle even from this early period and need no teaching to feed or suckle.

What should happen after the first feed?
That was a good beginning. Following the first feed, the baby should be fed as and when he wants to. This may be every half an hour or 2 hours. It is up to the baby, his hunger is the impulse that should control the frequency of feeding. It is wrong to enforce a timed schedule.
Frequent feeding is important to help increase the volume of milk produced. The total volume of milk and its character would change with each passing day. Suckling and emptying of the breast at feeds is the stimulus in the mother to increasing milk production.

Breast feeding should be an enjoyable experience. It is essential that all new mothers receive support from trained counselors and or experienced mothers.

Febrile seizures

2007-10-05T14:48:00.000+05:00

Few events are more alarming to a parent than their child having a seizure

- Dr A Simon Harvey, Pediatric Epileptologist, Royal Children's Hospital, Melbourne, Australia in the opening of his Chapter on Seizures and Epilepsies, Practical Pediatrics.

Febrile fits are common in the Maldives.

A child is said to be having a febrile fit, when a child with no previous history of non-febrile fits has abnormal movements of the body in association with changes in the conscious level in the presence of fever more than 38 degrees Celsius with no evidence of infection involving the brain.
What to do when the child is having a fit.

At home, this will be a challenging situation. There will always be a strong desire to do something and a belief that something needs to be done and fast.
Usually not much is required to be done.

Safety for the child is important. It is important to prevent injury to the child from fall or harm from objects in the environment.
If there is anything in the mouth, it may be removed. However nothing should be placed in the mouth. Contrary to popular belief, there is no need to place a spoon or other objects in the mouth to prevent tongue bite. It has been found that such measure are more likely to cause injury than prevent them.
The child may be laid on the ground to prevent injury from a fall.
There is no need to restrain the child, the movement with the seizures cannot be control by physical means. It could cause injury.
Controlling the fit: this is usually not required. The fit usually lasts a few seconds to a couple of minutes. However if the fits last longer than 3-5 minutes control of fits becomes important. for this reason it would be a good idea to have some one call an ambulance as soon as seizures begin so that if it lasts for long help is available.
In those patients who have already been diagnosed as patients with febrile seizure, who have been given diazepam suppository- it should be used. No medicine should be given by the mouth!
If a fit occurred, it is import to have the child seen by a doctor for assessment.
Fever control measures like giving antipyretics or gentle cooling by sponging have no role during a fit!

What to do if a child known to have febrile seizures has fever.

It has long been a routine practice to prescribe a regimental approach to controlling fever in patients known to have febrile fits. There is some debate about the role of gentle antipyretics and gentle cooling in these patients. There is evidence in medical literature that these measures do not help prevent febrile fits! However, many Pediatricians still do recommend these measures.
Paracetamol is perhaps one of the safest antipyretics available.
For cooling, it is important not to use cold water as it could cause shivering and a rise in temperature.
There is a great deal of controversy whether use of oral or rectal diazepam during fever is beneficial in preventing fits from occurring. Some children are prescribed such medications on an individual basis, not as a routine. This maybe tried in those children in whom febrile fits occur frequently.
Use of anticonvulsant/antiepileptic medications [like Phenobarbitone, Sodium Valproate...etc] on a daily basis to prevent febrile seizure is not currently recommended. There is no convincing evidence that it is beneficial. In addition because of the significant side effects associated with long term regular used of these medications current practice is to avoid them.

If a child has febrile fit, what are the chances of him having epilepsy later in life?

About 3% of the kids between 5 months to 5 years have febrile fits. A third of the cases of febrile fits are recurrent, more so if the onset is in infancy or there is a family history.

Approximately 3% of patients with febrile fits go on to have epilepsy later in life. The risk is higher if there is developmental delay, family history of epilepsy or the febrile fits are prolonged, focal or multiple within one febrile illness.

Febrile fits per se is not associated with later intellectual impairment.

Common Cold in Children

2007-10-04T16:29:00.000+05:00

During infancy and early childhood Upper Respiratory Tract Infections (URTI) are very common. In this age group [up to 5 years of age] on an average, children have about 6-8 episodes every year. It is higher in those children who have siblings of the same age. It can be up to 12 in some.

What causes common cold?
Common cold or URTI is a viral illness. It is usually caused by a group of viruses called Rhinovirus. Other viruses can sometime cause URTI.

How does it spread?
The common cold viruses are highly contagious. It can spread from one to another very easily. The usual mode of transmission is by droplets (tiny drops of sputum and nasal secretions scattered into the air during sneezing, coughing or even speaking).
The virus can also be spread via nasal secretions transferred by hand, handkerchiefs, toys, cot sides and clothes.

What are the main symptoms?
Nasal discharge (from watery to thick yellowing discharge), sneezing, sore throat, red and watery eyes are the common symptoms. Symptoms are usually mild, with either no fever or mild fever.

How long does it last?
The symptoms usually resolve in about 5-7 days.

Is there any treatment?
There is no specific treatment. Paracetamol can be used to help make the child feel better. Especially in small children it is important to ensure that fluid is taken orally in adequate amounts. It is usual for children to refuse solid food for a few days, but as long as fluids are taken in adequate amounts there is no reason to be unduly concerned. The food habits would usually return to pre-illness pattern in a few days.

There is no role of antibiotics in the treatment of common cold.

2007-08-26T16:03:00.000+05:00

ކުޑަކުދިން ހޮސްޕިޓަލުގައި ތިބޭ ބަލިމީހުންނަށް ޒިޔާރަތް ކުރުން

ހޮސްޕިޓަލަކީ އެކިއެކި ބަލިބައްޔަށް ފަރުވާކުރުމަށް ގިނައަދަދެއްގެ ބަޔަކު ދާތަނެކެވެ. މިހެންވެ، ކިތަންމެ ސާފުތާހިރު ކުރެވުނުނަމަވެސް ވަރަށްގިނަ އަދަދެއްގެ ވަރަށް ނުރައްކާތެރި ޖަރާސީމު އެފަދަ ތަންތަނުގައި ހުންނާނެއެވެ. މިފަދަ ތަނަކަށް، އެތަނުގެ ޙިދުމަތެއް ބޭނުންވުމަކާނުލައި އެކި އުމުރުގެ ކުޑަކުދިން ގެންދިއުމަކީ އެކުދިން ނުރައްކާތެރި ބަލިތަކަކަށް ހުށަހެޅި އެފަދަ ބަލިތަށް ޖެހުމަށް މެދުވެރިވާ ސަބަބަކަށް ވުން ވަރަށް ގާތެވެ

ނުރައްކާތެރި ބަލިތަށް މިހާ ޢާންމު ދުވަސްވަރެއްގައި މިފަދަ ކަންތަކާ ދޭތެރޭ ބެލެނިވެރިން ހޭލުންތެރިވެ، އެކުދިންނަށް ބޭނުންވާ ޙިދުމަތެއް ލިބިގަތުމަށް މެނުވީ ކުޑަކުދިން ހޮސްޕިޓަލަށް ނުގެންދެވުން ވަރަށް މުހިންމެވެ