Vaccine Preventable Diseases

DPT Vaccine
Preventable Disease VaccineThis is given when your child is 1 1/2, 2 1/2 and 3 1/2 months old with a booster at the age of 1 1/2 years. It protects against three diseases viz : Diptheria, Polio and Tetanus.

Diphtheria
It is an acute infectious disease of childhood caused by a bacteria. It usually manifests with sore throat and quickly progresses to fever, headache & loss of appetite. It can damage the heart, the nervous system and in severe cases it can kill. Through the incidence of diphtheria has greatly reduced but it has not yet completely wiped out.

Pertussis
Also associated with Whooping Cough is a highly contagious disease of the respiratory tract.
It starts with features of a common cold but quickly progresses to a severe exhausting cough. The cough comes in prolonged bouts during which the child appears unable to breathe & looks anxious.It lasts for upto 6 - 8 weeks and leave the child extremely weak & malnourished because of vomitting associated with cough & the disinclination to eat because of the fear of precipitating bank of cough.

Tetanus
The germs of tetanus are found in soil. They can enter the body through a cut, a bruise or a prick of thorn. To toxim of tetanus acts on the nervous system which then affects the muscle causing severe stiffness of spasms. It is a very painful & distressing illness which if not treated promptly can lead to death. It can start inocuosly as stiffness in the neck or spasm of the jaw and thin rapidly progresses to lead to breathing difficulties & severe painful spasms of the limbs or the back etc.

Polio Vaccine
It is given at the age of 1 1/2, 2 1/2 and 3 1/2 months, usually along with the DPP vaccine. Booster doses are given at the age of 18 months. Additionally for the last few years the Searchvt. of India has been running the Pulse Polio Program in all children under the age of 5 years are given Polio drops twice a year in addition to their vaccination schedule.

Polio
Polio is a disease caused by a virus that attacks the nervous system and can cause permanent muscle paralysis or weakness. When the virus affects the muscles of the chest, it can kill because of the paralysis of the muscles used in respiration.

BCG Vaccine
The vaccine can be administred right after the birth and if not taken then, then it can be taken as early as possible with other vaccines. This vaccine affords protection against Tuberculosis.

Tuberculosis
It is a disease which primarily affects the lungs, through it can involve virtually any past/system of the body. It usually manifests or cough of long duration, loss of weight & night sweats.

Measles Vaccine
It is a given at a age of 9 months.

Measles
It is a disease of the respiratory tract which begins with fever, cough, running nose & watery eye. The rash of measles is very characteristic of the disease, starting on the neck and quickly spreading to the trunk & limbs. Measles is very infectious. The complications occur in a fair percentage of children who feel it. These include chest infectious, fits, brain damage etc.

Cataract in Child

What is cataract?

Cataract is a clouding or opacity of the normally transparent lens inside the eye. Cataract is a common cause of poor vision in older adults, but it may also occur uncommonly in infants and children.

What causes cataract in children?

The child may either be born with cataract or may develop cataract early in life after birth. It may be caused due to some disease in mother during pregnancy or due to some problem with child's general health, or injury to the eye. Sometimes it may be hereditary, being passed to the child, usually from a parent who has the same problem. The ophthalmologist or pediatrician generally runs a few tests to find out the cause of cataract. In many cases, though, no cause may be found.

How to know if one's child has a cataract?

The child may have cataract in both the eyes or in only one eye. At birth, each child is examined by the pediatrician to rule out any congenital abnormality, including cataract. If the child has significant cataract in both the eyes, the family members can usually notice that the child does not see well. The child may not be able to recognize mother (normally recognizes by 2 months of age), may not respond to visual stimuli etc. Sometimes when it involves only one eye, it may be difficult to detect, as the child may be seeing normally. The cataract may make the black pupil of the eye look white or gray. Sometimes the eye with cataract may wander out of line causing squint, or may show a jiggling movement (nystagmus). Presence of nystagmus and squint are poor signs in cataract, as they may signify that vision may not return fully after surgery.

Note that the child may have poor vision due to other reasons also besides cataract. Moreover, cataract in child may be associated with other diseases of the eye as well. Therefore it is mandatory to see an ophthalmologist in case you notice the child has any of the above problems.

My child has a cataract. Would he be able to see?

It is very important to treat this condition as soon as possible to get the best results. Most children who are treated for cataract at the right time end up seeing well. Though there might be certain conditions in which the vision is low even with the best possible treatment. Your ophthalmologist will keep you informed about this.

Why is it important to treat childhood cataract early?

The presence of cataract in a child does not let the eye get proper visual stimulus to develop. This prevents the normal development of the eye, especially if the cataract is present in only one eye. This condition is known as amblyopia or lazy eye. Therefore it is important to treat this condition at the earliest to prevent and to treat amblyopia.

What are the methods of treatment for childhood cataract?

The treatment options are:

* No surgery with periodic follow up
* Cataract removal without intraocular lens implant
* Cataract removal with intraocular lens implant

What factors decide the treatment option and the timing of surgery?

The treatment option and the timing of surgery will be decided by the ophthalmologist, based on the following factors:

* Age of the child
* Density of cataract
* Whether cataract involves one eye or both eyes


If the cataract is not very dense and the child is able to see through it, then the surgery may not be required or it may be deferred till the child reaches a age where a cataract surgery with lens implant can be done safely.

Generally the lens implantation is not preferred in a child below 2 years of age because these eyes are still in growing stage, moreover there is a tendency for severe inflammation (uveitis) in these young children and the chances of aftercataract (opacification of the capsule of lens) is almost 100%.

Cataract involving only one eye has to be treated more urgently because the chance of amblyopia is greater in these cases.

What are the complications of surgery?

Cataract surgery is very safe, but as in any surgery, complications are possible. There is a very small risk of serious bleeding or infection after the surgery. If a lens has been implanted, there is a very high chance of aftercataract formation, which may require laser treatment or even a small surgery. Even years after surgery, related eye problems such as retinal detachment can develop and threaten sight. For this reason it is very important to have a regular follow up even after the surgery is done. To examine the eye properly in an uncooperative young child after cataract surgery, the ophthalmologist may occasionally give sedative medicine or even general anesthesia.

What to do after surgery?

The care of the eye after surgery is the most important part of treatment. As we remove the lens of the eye, the refractive power of the same has to be compensated in some form to enable the eye to see properly. Also, because the lens is not there, the eye can not change the power for near work (accommodation). For this reason, the child will require to wear an additional near addition (like in presbyopia) for doing near work. The various options available for this purpose are:

* Glasses
* Contact lens
* Intraocular lens implant

The advantages of glasses are that they are very convenient and simple to use and there is no chance of harming the eye. The disadvantages are that they are very thick and heavy, and the child (especially teenagers) may not like to wear them because of poor appearance and because it hampers in sports. Moreover, they are unsuitable for children who have cataract in only one eye, because the vision from the two eyes cannot be properly combined in the brain, when one eye focuses in the normal way and the other looks through a very strong spectacle lens.

Contact lenses provide both vision and appearance that is normal. But the main disadvantage is that they have to be properly cleaned and maintained, or else there is a small risk of infection. It may be difficult to place them in the eye and to remove them for cleaning especially in small children between 1 to 5 years of age. Also the chances of losing the contact lens is also very high in this age group.

Intraocular lenses are a very good option, as they do not require any maintenance. But these are not preferred in children below 2 years of age. They also have a higher chance of developing aftercataract.

The best form of visual rehabilitation for child is a very complex decision and the ophthalmologist will decide after discussing these issues with the parents.

Amblyopia therapy: In some cases of cataract in children below 5-6 years of age, especially in those where only one eye is involved, the child may have to be treated for amblyopia.

Poor Vision in a Child

How to know if my child has poor vision?

Normally a child should be able to recognize mother and have a social smile by 6-8 weeks of age. If the child has poor vision in both the eyes, then he/she may not recognize the mother or may not respond to the visual stimuli. Once the child starts walking, he/she may frequently bump into objects.

If the child has poor vision in only one eye then it may be difficult to notice it. The eye with poor vision may not be aligned properly with the other eye, thus causing squint (strabismus). The child may also have rhythmic jiggling movements of the eyes (nystagmus).

Sometimes the cause of poor vision may be visible as a whiteness of the cornea or whiteness behind the pupil. In some cases the eyes of child with glaucoma may be watering and very sensitive to light.

The poor vision may also be noticed incidentally when the child is being examined by a doctor or during vision screening in the school.

What are the causes of poor vision in a child?

These causes are:

* Refractive error
* Cataract
* Glaucoma
* Squint (strabismus)
* Injury to the eye (sometimes the child may not tell about the injury to parents)
* Diseases of cornea
* Diseases of retina and optic nerve
* Inherited disorders
* Tumor (Retinoblastoma)
* Other eye abnormalities

What to do if I suspect that my child does not see properly?

As we see, there can be many causes for poor vision in a child. Some of these are very simple and treated easily, while others may be very difficult to manage and sometimes may even be life threatening. Therefore it is prudent to contact an ophthalmologist at the earliest if you suspect poor vision in your child. He or she will confirm poor vision and then look for the cause of the same. A timely treatment is very crucial in saving the sight and sometimes the life of the child.

How can one determine the vision in a small child who will not cooperate for vision testing?

There are many special tests available which help the doctor in determining the visual acuity of children in all age groups. The ophthalmologist will decide which tests to use and will get an idea of the visual loss and the chances of getting good vision after treatment.

Developmental Milestones in Children

As a parent you are in best position to note your child's development and milestones given below can be used as guidelines

6 WEEKS

Gross Motor
When child is pulled to sit, his head lags considerably but not completely
Yes / No

Does your child intermittently raise his chin off the couch in prone position?
Yes / No

Hands
Does the child keep his/her hands open most of the time?
Yes / No

Vision
Does your child fix eyes on objects and follows a moving person up to 90 degrees?
Yes / No

General understanding
Does your child smile at the mother in response to overtures?
Yes / No

12 WEEKS

Gross Motor
When your child is held upright is he able to support his head for few minutes?
Yes / No

Does your child hold chin and shoulders off couch and weight is borne on forearm in prone position?
Yes / No

Hands
Does your child keep hands frequently loosely open?
Yes / No

Vision
Does your child follow-dangling toy from side to side (180 degrees)?
Yes / No
Does your child promptly looks at object in midline?
Yes / No

Hearing
Does your child turn head to sound?
Yes / No

Vocalization
Does your child respond when spoken to and makes squeaks of pleasure?
Yes / No

16 Weeks

Gross Motor
When your child held in sitting position does he hold his head constantly up?
Yes / No

Hands
Does your child bring hands together when he plays?
Yes / No

Does your child play with rattle when it is placed in his hand?
Yes / No

Hand HeldVision
Does your child have immediate regard of dangling object?
Yes / No

Vocalization
Does your child laugh aloud?
Yes / No

20 WEEKS

Gross Motor
Does your child put his/her weight on forearms when lying in prone position?
Yes No

Does your child put his feet to mouth in supine position?
Yes / No

When child is pulled to sit, there is no head leg.
Yes / No

Hands
Is your child able to grasp object voluntarily?
Yes / No

General understanding
Does your child smile at his/her mirror image?
Yes / No

24 WEEKS

Gross Motor
Does your child put weight on hands and not forearms; chest and upper part of abdomen are off couch when made to lie prone?
Yes / No

Does your child roll prone to supine?
Yes / No

When your baby is held in standing position is he able to put most of his weight on his legs?
Yes No

Hands
Does your child hold bottle or grasp his feet?
Yes / No

Vision
Does your child see small objects such as crumbs?
Yes / No

Hearing
Does your child turn his head to sounds that originate out of his immediate area?
Yes / No

General understanding
Does your child smile and vocalize at his/her mirror image?
Yes / No

28 WEEKS

Gross Motor
Does your child sit with hands on couch for support?
Yes No

Does your child roll from supine to prone?
Yes / No

Hands
Does your child feeds self with biscuit?
Yes / No

Cubes
Does your child transfer cube from hand to hand?
Yes No

Hand Eye CoordinationGeneral understanding
Does your child imitate simple acts?
Yes / No

Does your child respond to name(s)?
Yes / No

Speech
Does your child speak syllabels like da,ba,ka
Yes / No

32 WEEKS

Gross Motor
Does your child sit momentarily on floor without support?
Yes / No

Does your child bear whole weight on leg when supported?
Yes / No

Imitation
Does your child imitate sounds?
Yes / No

Speech
Does your child combine syllabels like da-da, ma-ma
Yes / No

36 WEEKS

Gross Motor
Can your child sit without support for few minutes?
Yes / No

Does your baby crawl?
Yes / No

Hands
Does your child pick up objects of size of currant between tip of finger and thumb?
Yes / No

Cubes
Does your child compare two cubes by bringing them together?
Yes / No

40 WEEKS

Gross Motor
Can your child pull self to sitting position?
Yes / No

Can your child stand holding on to furniture?
Yes / No

Hands
Does your child go for objects with index finger?
Yes / No

Index Finger approach to objectCubes
Does your child allow objects to let go off (release)?
Yes / No

Imitation
Does your child wave bye-bye? Plays pata-cake?
Yes / No

44 WEEKS

Does your child creep with abdomen off couch?
Yes / No

Does your child put object in and out of container?
Yes / No

Does your child say one word with meaning?
Yes / No

Dressing
Does your child hold arms out for sleeve or feet out for shoe?
Yes / No

48 WEEKS

Does your child twist around to pick up object (pivots)?
Yes / No

Stand holding on to furnitureDoes your child walk holding on to furniture?
Yes / No

Does your child say one word with meaning?
Yes / No

Does your show interest in picturebook?
Yes / No

Does your child release toy when asked to?
Yes / No

1 Year

Gross Motor
Does your child walk one hand held?
Yes / No

Does your child say two or three words with meaning?
Yes / No

Does your child walks on hands and feet like a bear when prone?
Yes / No

Does your child understands the meaning of where is book? where is shoe?
Yes / No

16 Months

Does your child walk without help?
Yes / No

Can your child get into standing position without support?
Yes / No

Cubes
Does your child build tower of two cubes?
Yes / No

Feeding
Does your child feed self-picking up cup , drinking, putting it down etc?
Yes / No

18 Months

Does your child walk upstairs one hand held?
Yes / No

Does your child make tower of three cubes?
Yes / No

Does your child take off his shoes by himself?
Yes / No

Does your child feed himself without much spilling?
Yes / No

24 Months

Does your child go up and down stairs alone?
Yes / No

Does your child run?
Yes / No

Does your child make towers of 6 cubes?
Yes / No

Does your child put on shoes, socks, pants, and takes off shoe and socks?
Yes / No

Does your child join two or three word in sentences?
Yes / No

Does your child turn pages of book singly?
Yes / No

Does your child tell you what he wants?
Yes / No

Does your child repeat words others say?
Yes / No

Does your child look at picture in a picture book?
Yes / No

Does your child point to atleast one named body parts?
Yes / No

2½ Years

Does your child jump with both feet?
Yes / No

Does your child know full names?
Yes / No

Does your child know whether he is a boy or girl?
Yes / No

Does your child help to put things away?
Yes / No

Does your child name at least one colour?
Yes / No

Does your child make a tower of eight cubes?
Yes / No

3 Years

Does your child go upstairs one foot per step?
Yes / No

Does your child stand on one foot for few seconds?
Yes / No

Does your child ride tricycle?
Yes / No

Does your child dress and undress fully if helped with buttons?
Yes / No

Does your child copy a circle?
Yes / No

Does your child make a tower of nine cubes?
Yes / No

4 Years

Does your child go downstairs, one foot per step?
Yes / No

Can your child button clothes fully?
Yes / No

Can your child name pictures in books?
Yes / No

Can your child tell you what action is taking place in a picture?
Yes No

Does your child use action words(Verbs)?
Yes / No

Does your child copies cross?
Yes / No

Does your child play imaginative plays with doll?
Yes / No

5 Years

Does your child skip on both feet?
Yes / No

Can your child tie shoelaces?
Yes / No

Can your child copy a triangle?
Yes / No

Can your child name four colours?
Yes / No

Does your child react well when you leave him with a friend or baby sitter?
Yes / No

Can your child name a coin correctly?
Yes / No