Importance of Newborn Health Checkup. How long should parents continue regular checkup for their babies? - Dr. Seema Gaonkar

Autism actually now we tell it as autism spectrum disorders that is ASD. It is kind of very devastating thing for a parent to have because this could be a lifelong problem but the early detections, early management definitely helps for it. What it is? Autism is actually a developmental disorder in which the baby usually from the toddler age itself after one year or one and half year you'll see that there is some amount of deviation from the normal development, normal behavior, normal emotional quotient. All these things are seen in a baby with the autism. Is it a genetic disorder? Yes it has certain genetic connections. There are some genetic mutations which happen but most of the time cause is unknown. In the same family there are many children only one child could be autistic but there is a risk of second child also becoming autistic. So it has plus minus genetic relations happening but what does the child affected with? Usually in the autistic child the development one is obviously the milestones get delayed or the milestones which they already had attained during their first year of life will become you know diminishing, they start vanishing, the child who started to speak something like Amma or Appa has certainly stopped or a child who started to stand up with the support or something suddenly stop standing up and sits and starts worsening, regression of milestones what we say that can happen or they may never get those milestones at all. It is not only about the development they are also emotionally having lot of other things. They suddenly become too sensitive for small things and they don't show any sensitivity for some things like if the mother has got some fire on their fingers and she suddenly reacts that baby has no reaction if it's like having that autistic spectrum disorder. They also have other things mainly the social problems like they can't interact, they don't make the eye contacts and they will try to be away from the people the gathering they get very irritated or suddenly they become show sudden reactions when lot of people come unknown people come and sometimes when the people are of their age the toddlers are there they will not be able to communicate with them they will have some adjustment problems or they don't just communicate with them and they don't take turns like we see in kids when they play they do one thing and the next person will wait for the turn they don't wait for the turn they don't know that they need to wait for the turn. So such social you know interaction, social communications that also will be difficult for them. Also they will have certain repetitive behaviors either finger movements or you know twitching of the mouth or sometimes they'll be doing the same work again and again and again and again same cubes they're putting removing but if you restrict from there they get very violent with that sudden violent behavior. So many things are there actually it's a big chapter Autism is a big chapter. So in general they behave they have emotionally different they have socially little different disconnections they are developmentally delay, their speech may delay all these things and usually as the this question states like it's neonate there's nothing like autism in a neonate. You can't figure out autism in the neonate. This usually to the maximum you may be able to figure out before one year nine months to you know one year but definitely we can figure it out before 18 months. Ideal time is at least by one year to 15 months. So that time you can figure it out. 18 months definitely you should figure it out so that you can do early interventions. The later it is you know diagnosed or later it is figured out the later the interventions the damage done is more and how do you diagnose it? How do you diagnose? It it's not like some blood test you can do and diagnose Autism. It's not so easy and many of the times the busy OPD practices doctors have no time or they don't have sensitivity enough to ask questions but we should at least ask the questions basic questions like whether a baby has attained the milestones, how is the social interactions, how is the emotional reactions. Most of the times parents themselves come up with the problems but that may take three years four years sometimes after they go to school or something. So when they are in that six months to one and a half year window period itself some checklists are there.

So soft spots on the baby head. Basically these soft spots are called as fontanelle in medical language. They are actually not soft spots they have their firm scalp layer but they are basically the areas in between the skull bones. Skull bone is not a single bone it is a multiple bones which are communicating and those bones in between those bones you will have this soft spots. So why are they there? Because you know when they're born their brain is not completely grown and when they come from the mother's pelvis it's a hard bony structure with some soft structures when baby has to come out through that narrow passage they have to negotiate, the head has to negotiate the head being the hard part and the big part it has to negotiate negotiation means it has to you know mold. When they have to mold obviously it has to be open if like an adult head all the sutures all these skull bones are fixed then it can't be able to mold or overlap on one another. So to do that molding first thing is the sutures are not closed and there are in between soft spots so that when the baby comes out easily molds and baby comes out and slowly those sutures again open up. Second important reason why these soft spots are there is because when the baby is growing, when the babies come out the head size is quite less compared to an adult head size. It's around 33 to 36 centimeters so it has to grow to almost 15 centimeters more in a size going for the adult head. So the brain growth has to happen in next two to two and a half years. So for the brain to grow it needs space otherwise if all the sutures are closed the brain can't grow. Correct? So the brain has no space and the skull will have abnormal shape. So that is why this nature has made like there are some spots soft spots what you see and there are sutures which are not at closed and they are just having some fibrous closure or fibrous structures in between. So as and when the head grows they will be giving space for it to grow. Later when the brain growth is almost complete these structures will slowly slowly slowly close and will become the permanent one vault of the skull. That is why these soft spots are there. Now are these soft spots too delicate? No, they are not delicate. Soft spots though they feel delicate for the parents they have their own thick membrane of scalp structures. If you touch them gently or you know you massage the head there won't be any damage to the baby. So there is no harm in doing any of these activities with the baby and what is the significance of them other than you know just growth of the brain or anything? What they matter is also they tell us that if they are not closed you know they have to close in certain age you know. So when they're closing? There are two basic head spots that is front is called as Anterior Fontanelle, back is called as Posterior. Actually there are other spots also on the sides but the significant are these two. So the posterior one can close anywhere from birth to three months and the front one which can close from one and a half years to maximum of two years. Ideally it should close by one and half years. So what if they don't close? Usually if they don't close there are certain reasons for it like one is thyroid problems what you say hypothyroidism, some some genetic problem like down syndromes or some babies with rickets where there's Vitamin D deficiency in those babies especially the Anterior Fontanelle may not close at the particular time. In some babies it may close very fast so that the brain growth also it won't give the time for the compartment to increase like in hyperthyroidism, hyperparathyroidism and there is a condition called as craniosynostosis where there is a premature closure of these sutures happen so that the brain is not getting space to you know grow only. So the head size will go in a variation size it won't grow in a round shape what an adult size so either it goes longitudinally or on the back so abnormal shapes of the head also can come because of early closures of the or yet birth only closures of the sutures and the soft spots. That's the significance of these soft spots.

Bulging and Sunken fontanelle in newborn. What does it mean? Causes, Diagnosis, and when to see the doctor? - Dr. Seema Gaonkar

Tummy time for the baby means you are putting the baby on tummy. So what does it mean? Your baby is most of the time sleeping on the back when the baby is born and that is a natural position for most of the babies. When you put the baby on the tummy with supervision which kind of exercise for the baby what you're going to do and it is advised by the doctors also. When is it advised? It is advised usually after the neonatal period that is around 20 to 30 days of life. In fact a newborn also can be done but since they are very tender, vulnerable we don't advise it. After two to three weeks of time usually we advise the mothers to do some tummy timing for the baby till they want the baby to be done. Some babies are happy to do it after four to six months, some babies don't do they start doing other activities, they don't sit for it. So what is Tummy Time done? Tummy time means you put the baby on the tummy with face or chin should be lifted up so that the baby should not be hitting on the floor and the mother should be or anybody attender should be supervising the baby so that baby doesn't get you know any discomfort with that. Ideally it should be done not on full tummy. It should be done at least after baby is fed for 40-45 minutes so that the vomiting hazards also or choking hazards also are prevented. Why is it Tummy Time done? Tummy time is mainly done one is because it helps for the baby to get into the next developmental milestones like rolling or turning to one side or the both the sides. It helps the neck muscles to grow because as they grow around two months, three months their neck muscles will be developing more so their head control will be starting. So this position will help them to get the tone of these muscles of the neck, face and the back and also it helps them to get away from the colic. Colic is something which happens in babies over second to third week of time that is when they produce lot of gas in their tummy. So when you put them for tummy time that also helps them to relieve the gas. It acts like a burping method for them to be happy on that. There are babies who are very happy on tummy time there are babies who don't like tummy time. How much time you can do? It is like two to three times in a day also you can do start with once a day for initially begin with three minutes or two minutes and slowly increase the time and the number of times you do it as your baby enjoys. It should be done on a firm surface but important thing is somebody should be supervising the baby when the baby is doing the tummy time but it is really beneficial for their neck muscle

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