Dr. Chetan Ginigeri: Director Pediatrics at Manipal Hospitals Bengaluru

Ajouté : 2026-05-28

[00:00:02]Mothers will also tell us that you know when I'm having a bad day my baby is crying more it is vomiting more it is having some loose tools and the reason is biological because most of the stress that the mother feels the stress hormone gets secreted through the breast milk and baby also has a physiological response to that. So mother's happiness is very important in the first 6 months to look after the baby and have a smoother transition from happy couple to one new center of the universe around which the whole life of the mother revolves. When they come back from work we tell them stay in the car just listen to your favorite music switch your mode to a mother mode now and then before meeting the child go freshen up okay let the child be hidden because when you come in front of the child the child will need undivided attention for next 3 to four hours. Pediatric Association advises. So no screens till first 2 years of age. After first 2 years of age, it has to be a very limited time of highly educational slow speed content like animal planet and sports and these kind of things. High-speed animation and cartoons really really hook on the children and have a very strong addictive potential. Do not expose children to that. Do not use screens as unpaid babysitters and a reward for feeding. Once that happens, it is very difficult to wean children away from that. So inflammation starts. Then early childhood obesity starts. Precoxious puberty has started. Now children are becoming more mature. Children no longer can remain bold. No boredom is such an important part of childhood because that is where most of the creative juices are generated. Have more home-based diet with seasonal fruits and vegetables.

[00:01:38]Avoid packaged food. So both screens and packaged food have serious addiction potential which we are not aware about.

[00:01:44]Let us protect our children from this big food and then digital screens and social media till they grow. Hi everyone, welcome to talking through. My name is Rahul and today we have a very interesting guest with us. He is India's leading pediatrician and has over 25 years of experience in this particular field. Currently he is serving as director pediatrics at Manipal Hospital Bangalore. So without any further ado, let me introduce you all with our today's guest Dr. Chetan.

[00:02:12]>> Thank you Rahul G. Thank you for having me here. It's great pleasure.

[00:02:14]>> All thanks to you sir for taking time out from your busy schedule and to start this podcast formally. I'd like to know more about Dr. Chetan and your professional journey.

[00:02:25]>> So uh our professional journey started way back in 1995. I joined my MBBS in Jupiter and then I did my post-graduate in um pediatrics um in post-graduate institute Chandigar that is known as one of the best institutes for pediatrics and we underwent a three-year commando training I would say because it was very rigorous and very intensive and that's also where I developed my uh interest for uh pediatric intensive care pediatric acute care rather a combination of emergency ICUs and critical And then following that I did my um senior residency in Jupiter and then relocated to Bangalore in Narana Health Anod Devishetti's team. So I went briefly to UK for my training in transplant intensive care and since then I have been practicing in Bangalore for the last 20 years or so.

[00:03:16]>> Great. Great. And sir I like to know more about uh pediatric critical care as a super specialized field before we move ahead. So pediatric intensive care is in a way a very generic uh super specialty that means we are not focused only on one body part like you hear cardiologist dealing with heart neurologist dealing with brain and its issues. Pediatric intensive care is about acutely sick critically ill children who are in our ICUs under monitoring on one child may have epilepsy with status epilepticus.

[00:03:50]One child may be having breathing difficulty, respiratory failure on mentality report. One child may be having a complication of cancer. One child may be having an organ transplant.

[00:03:59]So it is basically understanding the physiological derangements which the disease causes. And as intensive care specialist, we need to know how the disease works, what how to support the baby's physiology and how to bring him out from the acute illness stage. So that is what as pediatric intensivist we do. It is high knowledge, high intensity, high skill required uh specialty and because we deal with children right from 1 year old to 18 years old, we also need to understand certain mental uh and psychological aspects of each of these children and managing the family is an additional responsibility we all have. So it's an exciting field. Uh it's a tiring field because for at least till your mid-40s you're doing night duties, you are always hypervigilant. you are always um you know running and trying to save as many children as possible.

[00:04:50]>> Understood. And sir, what kept you motivated? As you have mentioned, it's very high intensity and very responsible job because we are dealing with kids, right? So what has kept you motivated since like 25 years and you are continuously working in this field? One is that the joy it brings because our decisions are life and death decisions and um and and academically it is very challenging because we are not confined to a one single organ system. We have to understand every the worst case scenario of every organ system and how it interplays with each other and how uh it is also a specialty where we get opportunity to do procedures and exercise our hand eye coordination. It is a very decision- intensive specialtity because every step you have to anticipate, decide, anticipate, decide and um so joy is in the recovering children and and children are special because they they they do miraculous recovery. They the positive vibes that we get after a recovering family is significantly high that is the high we live for and and but it is all at the same time losing a child in ICU is equally you know devastating for us.

[00:06:00]So it's a combination of the attitude towards action, the aptitude it requires towards understanding the basic physiology, exercising it on day-to-day basis, um the adrenaline thrill that it it brings uh as a profession and the the just the joy of recovering children. I would say that all this combination of factors uh has made me continue in this field for so long. And before we do like deep discussion on your related to your area of super specialization, I like to know more about this particular book playful what was the thought behind and uh why any parent or any uh children should read this particular book.

[00:06:41]>> So the idea for this book actually culminated in my senior resident days when we were uh asked to teach first aid to medical students to the medical students who are doing MBBS. Then when we were teaching them pediatric first aid we realized that most of the injuries which happen in children are actually preventable.

[00:07:01]So and in my ICU practice also we have started to see a right from when we started our careers the disease profile was completely different you know diarrhea pneumonia septic shocks infections but now trauma and childhood injuries especially unintentional preventable injuries occupy almost 30 to 40% of our ICU space these are children who are mean playing innocently somewhere but fallen down from balcony drowned in swimming pools drowned in today's newspaper if you see um we have had a child who had drowned in a bucket of water you know while taking bath consuming household poisons. So we are living in an era where the joint family structure has broken. Uh children in their formative years when they are in the first one to five years when they are curious and fearless there is nobody to observe the children and go behind them and uh the the parenting styles has has become little different because uh we are an aspirational generation of parents. We are also working full-time know both parents are working full-time and then our uh and there is a increasing overlay of digital devices into our homes. So joint family structure breaking down children being curious and fearless and uh distracted parenting because of all the digital overlay has come together to cause this problem significantly more. Today every single minute one normal child dies on this planet because of a freak unintentional accident.

[00:08:40]And in India itself almost 165 children die because of a preventable accident every uh every day. And what also is very very shocking is that for every death in a child that happens 30 children suffer serious injuries and 75 children just escape you know and to take care of those 30 children the the whole process of getting them to hospital you know going uh through the ICU care sometimes lifelong rehabilitation for mental um for the mental trauma that they went through the physical disabilities that they have they have acquired All this if you have to really understand the financial implication of bringing up these children cumulatively it is more than the Aish man bharat healthcare budget of the country you know so that is the economic burden so so and almost 90% of these injuries are preventable if we do certain design elements inside our homes inside our schools inside any space which children inhabit and to create awareness to the parents that is why I wrote this book and then also later on subsequently converted it into a video series which is available on YouTube mainly because the current generation of parenting is very distracted. They need to know and we cannot blame children for these things. You know children are children they are they are going to be naughty.

[00:10:05]They are going to be fearless. They are going to be curious. Um so rather than you know blaming them I think we need to have a safety plan. Safety plan comes by understanding uh our children better uh and also putting in practice the preventive aspects and also learning first aid as parents. So whenever things happen they are able to respond fast and bring the child to the hospital on time.

[00:10:29]Okay. Great. So thank you so much for bringing this particular point like into this discussion and I also feel as a parent I have two kids at home that awareness level not only in India across the globe is limited maybe because we don't have much much literature available or anything which is on the digital space. So uh through this book uh I'm sure whoever has already read this particular book uh they have they must have got some value out of it and through this podcast uh we we like to encourage all our audience to watch the videos get this particular book and there are many like preventable instances accidents you guys can prevent at home and uh sir I like to understand one more point which is related to child safety which you have already incorporated in this particular book through your practice because on a daily basis you must be meeting with like weekly monthly basis thousands of patients. So during your one-on-one discussions apart from giving the general line of treatment what kind of advice you give to young parents? So first thing u I do is I acknowledge with them that parenting is not easy because there is uh the the the support for the new age parents is very little.

[00:11:52]Grandparents are not sometimes living with them. Along with that the information overload is significantly high. I mean all mothers are scrolling Instagram to look for what best they can do for the baby. And uh post pregnancy when the baby comes into your hands many times it is the first baby they have handled in their life and whatever you know the expectations of of having a baby and the joy it is supposed to bring does not happen because um because of the demands of parenting. It is time consuming. It is very intensive and with cumulative sleep loss uh not eating poor support systems it becomes very difficult for new age parents to cope up. So first my first u counseling for when babies come to our opds is to understand and acknowledge that it is difficult um and give yourself some time give yourself some space and support each other as as husband and wife you know support each other through this journey. Then uh I I mostly educate them about the how the development of the baby happens and what kind of um preparation parents need to do for that development. Simple things like when child reaches 3 to four months of age they will start rolling over. Then it is not safe to leave the child on the court alone without a proper protective mechanism. The moment child starts crawling then you need can't have lowlaying switches where children can put their hands into it.

[00:13:27]So these kind of behavioral aspects like you know when child gains mobility nature puts fear into them. So children who were going to everyone in the family suddenly they'd start developing stranger anxiety at 9 to 12 months.

[00:13:39]Okay. They start seeing lot of dreams and nightmares between 9 to 15 months.

[00:13:43]So children wake up in the night suddenly cry with their eyes closed. So every consultation is based on the age appropriate child. What the parent should expect in the child in that particular age. This is over and above the routine advices in terms of diet, how to uh maintain cleanliness, how to prevent the seasonal health problems in the children and how to protect children from from injuries. These are all the things we discuss in a single consultation with new age parents. And then we also ask them specificly are they interested to know something which they they want to discuss something and many of the parents we tell come prepared you know many times most of the mothers carry diaries or mobile phones just to note down all the questions which are there in our in their head and we also tell them to depend on you know trained people's advice because today uh influencers are there in every field and and uh that information overload some of which is not right sometimes affects how mother perceive these information and use this information.

[00:14:49]>> Absolutely. It's very difficult to filter out what is authentic information and not and what is the cred credibility of the person on Instagram or any other channel.

[00:14:58]>> So that that is something which confuse like not only parents but in every field.

[00:15:04]>> Yes. So and it's it's very important. So the the the engagement also see small children we leave it with the mother's lap. uh if it's toddlers they like to explore if by this time child would have roamed around the whole office so we let them explore we just are observing the children for any developmental red flags at that time because we are also seeing a sudden explosion of incidence of hyperactivity autism uh these kind of issues have started to crop into our office practice significantly lot of functional issues like constipation poor diet habits poor sleeping habits over dependence and addiction to mobile phones. These are all the new age problems that we are facing in our office practice. So counseling the parents, interacting with the child and for slightly older child, we sit down with the children to to explain to them why their health is their responsibility. No, it is not mommy daddy's responsibility or a doctor's responsibility. They need to understand.

[00:16:00]And when we deal with adolescents again it's a completely more mature conversation with adults um like adults because sometimes adolescents will be rolling their eyes you know they they don't make a sometimes we tell parents to wait outside if the child wants to express something so it is that way pediatric is very exciting field because one end toddler will walk in next a small newborn will come and next an adolescent will come. So we had to keep switching between their developmental phases to be able to support the parents and the child accordingly.

[00:16:31]>> And in your current practice in your personal practice or uh in Manipal Hospital is you or your team running any counseling or any works workshops for parents or for for kids?

[00:16:43]>> We do it all the time because that's why the reason uh is because we feel the need you know. So, so um now we have even telling that um the boys and girls before even getting into a relationship before getting married they need to understand how relationships work. Then if they have decided to marry and have children I think before conceiving they need to understand what parenting challenges uh will bring about and also with that what joy it will bring about.

[00:17:13]We don't only talk about you know bad things but also about the good things that that they need to expect. So so we have uh the country's first kind of uh system called uh child life services.

[00:17:27]This is a group of psychology consultants who are in who are hospital-based. We started it as an experiment almost 3 to four years back when we realized that you know children especially in in a very high complex city department like ours which is more subsp specialty heavy we do have children spending four to 6 months in hospital with us children who are undergoing cancer care who are going transplant care. So to look after them and support them mentally, emotionally we have the psychologist always engaging with them either through play therapy, distraction therapy, age appropriate storytelling with them. Then from inpatient care then we realized that there is a huge need for um this team to to uh do OPD practice because in the uh family structures too there is a lot of friction you know spouse friction uh then parents and children friction children and school friction children and children friction. So, so these are issues which need to be spoken about uh in a safe space discussed um in a mature fashion and solution given to parents and also a road map given to the child.

[00:18:37]So our child life services headed by Dr. Sushma Gopalan is one of the country's only childlife services department. It is now available across Manipal Hospitals in Bangalore and we are proud that we started it almost 3 to four years back and today it is one of the busiest uh units of our of our work actually. It's really remarkable sir and I'm sure this particular initiative is like one of a kind in India and u hopefully more and more hospitals adopt such kind of like holistic way of not only curing patients through medicines but through other means also.

[00:19:12]>> Yes. All the best sir and uh just to understand better about child care right so can we divide like 0 to 6 months 6 to 12 and 1 year and above kids uh and what kind of like precautions uh parents can take what kind of like eating habits vaccinations anything and everything which is related to child care of these three ages >> so 0 to 6 months is mainly it's a newborn period child is dependent on parents for everything and the only communication their child will have is crying. So, so what we tell parents is to start understanding your baby a little bit more deeper. Um the when the newborn is with you and the mother is the primary caretaker most of the time.

[00:20:01]Um have a schedule. Okay. So after first two weeks when we advise breastfeeding every 2 to hours or so uh later on shift to demand based feeding but don't use breastfeeding only as a comfort factor.

[00:20:17]Understand the hunger cues in a child and then only offer feeding. Many time when the baby cries lot of mothers have a tendency to overfeed the baby know.

[00:20:29]So we have to understand that small babies are by reflex tuned to feed. It comforts them significantly and small babies do not also have a mature satiety center. So even if the the the stomach is full if you offer breastfeeding they will feed. Okay. So every cry is not a cue for feeding. So that is the tendency to overfeed is very strong in Indian mothers. So that is something we tell them not to do that. uh pick up the baby, talk to the baby more and also when you're feeding the baby, look at the baby and talk to the baby. So while you're doing that, when baby is watching your face, it it it associates breastfeeding and the comfort and the hunger um hunger to go away along with the mother's face and voice. So next time baby cries, if the mother picks up and talks to the baby, it becomes calm.

[00:21:23]Okay. So also mothers also need to realize that first 3 months babies cannot see very clearly. So the only way they will sense the mother's presence is through touch, smell and taste. So the moment mother picks up the baby, baby calms down. The moment baby leaves the mother leaves the baby on the c baby starts crying. So mothers get stressed.

[00:21:44]Why is it? So that's why traditionally if you see most of the babies were wrapped in mother's old clothes. Huh?

[00:21:50]the the science was that you know the baby senses the mother's presence around it and it feels calmed down. Okay. So so that is how these are few few tricks that we we tell mothers to adopt. Very important other thing is that the stress level which the mother goes through and we always work on the stress of the mother because the moment mother is stressed baby also will be stressed and give her more trouble that day. Mothers will also tell us that you know when I am having a bad day my baby is crying more it is vomiting more it is having some loose tools and the reason is biological because most of the stress that the mother feels the stress hormones get secreted through the breast milk and baby also has a physiological response to that. Okay. So mother's happiness is very important in the first 6 months to look after the baby and have a smoother transition from a happy couple to a to one new center of the universe around which the whole life of the mother revolves. The moment 6 months crosses then the focus comes on to what to do in terms of feeding the baby.

[00:22:58]Okay. Now we had to start complimentary feeding because breastfeeding alone will not suffice and that is the time we introduce them to the techniques and and the uh art of kind of complimentary feeding. So so it there is this is partly science partly art partly psychology. So we start by telling parents that you know start mainly with cereals more easy to digest cereals like rice and ragi keep the consistency of the food very very liquidy initially understand that the baby's stomach size will be equal to the fist size of the baby and it slowly expands to two to three times that so so don't try to have a big ball and ensure that the baby feeds. Do not ever target for a chubby baby. Okay. So, so a thin scrawny baby who is healthy, active, energetic is definitely a healthy baby.

[00:23:50]So, from cereals you move on to um you know from 7th 8th month you move on to adding dal or wheat and then to pulpy fruits and vegetables. So like pulpy fruits will be apple, chiku, papaya, banana. Sulpy vegetables will be boiled carrot, boiled potato, sweet potato, spinach, pumpkin, beetroot and and increase the consistency to be a little bit like a honey consistency which is slightly thicker in consistency. When you pick up from finger it should slowly drip off and by 9 months you do what is known as family pot feeding means vegetarian food.

[00:24:27]The consistency of the food should be like toothpaste.

[00:24:30]It is stuck stuck and you do like this it is fine. Okay. And by 1 year you introduce animal proteins like cow's milk, egg, non-veg and and things like that. No hard and grated food till 3 years of age. Till 3 years of age it has to be mashed food because sometimes they can choke on it. So choking risk is significant in this age.

[00:24:54]That is why hard candies, hard nuts, um kachawa, carrot, vagera which child cannot bite and chew that should not be given in the first 3 years. It has to be mashed and grated from 6 years. The other problem the children develop is they start falling sick. Okay? Because whatever immunity is transferred from mother to the baby that gets waned off by 6 to 9 months. So the moment child develops the handmouth coordination at 9 months he becomes more mobile more exploratory teeth start erupting from outside uh inside out they start falling sick means um some cold cough fever little bit womiting loose tools can happen. So not to panic just maintain good hygiene maintain good hand hygiene for the baby using soap and water.

[00:25:41]Generally we advise no hand sanitizers for children less than 5 years. Okay. So use only soap and water and then um kind of children have more respiratory tract infection in this time lot of fever, cough, cold. So we tell them general precautions for that and schoolgoing children because nowadays also what has happened is lot of children do go to daycare or schools right from 1 year old 2 years >> cross infections.

[00:26:08]>> Yeah cross infection is very very high.

[00:26:10]So so we tell them basic rituals you know you drink warm water during winters. So because that moisturizes the airway that um kind of reduces the viral load. In children we don't advise steam because children's noses are very small and it gets blocked very easily with secretions with swelling inside the nose because of any of the viral infections or allergy. Children start mouth breathing noisy breathing having uh snoring at night that causes repeated infections throat infection some of it goes down the chest and causes wheezing.

[00:26:42]So, so we advise parents key children child should be always breathing from the nose only then the air gets warm, humidified, filtered. So, how to make the child nose breathe? You can do it by uh making them drink warm water and doing something known as hot wet towel.

[00:26:59]Small towel, dip it in hot water, ring the water nicely, wipe the baby's face, squeeze the nose. So, that clears of the nose and makes the child breathe from the nose. As long as child is breathing from the nose, the triggered cough and these episodes will be much much lesser.

[00:27:13]And for babies who go to school, daycare such early in life, always always give bath after school because they are carrying infections from school.

[00:27:22]Nowadays, I have also started telling parents to do simple saltwater mouth rinse because most of the common route of uh transmission of infections is through the mouth. So, so simple saltwater rinse of mouth as soon as the child comes back from school will prevent most of these childhood infections. So, six 0 to 6 months newborn infant period 6 to 12 months mobility infection uh child safety is a risk. From uh one year onwards children become like little scientists. They are everywhere. They're hyperactive and they have very high energy. So in this age what we tell parents is that you know child has 10 times more energy than you and a tired baby is a well- behaved baby. So when we have to find physical outlet for their energy which is again parents don't understand this because they go for work they come back child is already hyperactive uh they don't sleep at uh sleeping time they want to extend their play till around you know uh 1:00 2:00 because at that age also lot of attachment uh issues develop you know the secure attachment which the child has with mother the separation anxiety starts so so child wants to be close to the mother and as awake as possible as for as long as possible.

[00:28:40]>> So and then mothers go through a very strong cycle of guilt during this age especially if they're working mothers. So in this age we tell that you know child is going through that phase where all the heavy emotions the child is feeling will be dumped on the mother. So so that's why mothers have to self-regulate have the self-awareness. When they come back from work, we tell them stay in the car. Just listen to your favorite music. Switch your mode to a mother mode now. And then before meeting the child, go freshen up.

[00:29:13]Okay? Let the child be hidden. You go enter the house, you freshen up properly. Because when you come in front of the child, the child will need undivided attention for next 3 to four hours. No, you can't enter the house, pick up the child, drop the child, go to washroom, then come back, cook something and then come and then child is crying for your attention but you're not able to give. Okay. So these simple things will really really create a more harmonious uh family life and the daily friction which which and the stress which parents feel can really be dealt with.

[00:29:48]>> Great. Great. Very insightful sir. And Dr. Uh I like to know more about uh certain red flags uh during like this particular age group which we have discussed 0 to one year >> because more and more parents they are exposed to too much of knowledge so much of knowledge available on internet and at times they are confused in which particular cases they need to visit some specialized doctor or sometimes they try to give some like self- medication or home remedies. So as a specialist what is your suggestion in what all cases they should definitely visit a doctor >> zero to one years common things which we want don't want to miss is a simple infection becoming more serious infections and that is where I think lot of parents prescription they try to medicate and then we will try and and things like that so we don't say no to that but then it is very important to keep in contact with your doctor any child who is having high fever um in infancy we want to be careful because uh first 6 months babies are usually protected by the immunity which is transferred from the mother so children usually will not get fever episodes in the first 6 months if in the first 6 months the child gets fever and it is moaning groaning and the most important red flag is if it is stopped to feed it is not looking at the mother it is not making good eye contact that is something suggestive of a serious illness requires hospital visit and meeting a pediatrician. Okay.

[00:31:26]Later on in the a in the age also if associated with fever when we tell that you know baby is well in between the fever episodes if the fever reduces and baby becomes active interactive and is able to eat and drink little bit not as much as when he was well that is still acceptable to stay at home and and continue the treatment as such. But if the child is not eating, not uh drinking, not taking medicines, is becoming excessively drowsy or excessively irritable um then it means and in between the fever episodes if he's not comfortable then again it suggests a more lingering serious infections underneath for which the child needs a visit to the hospital.

[00:32:08]Okay. The uh this is with respect to the infection. Now the other important red flags which happen in the infancy is primarily to do with uh your developmental red flags. Huh? The motor development most of the parents pick up.

[00:32:27]So neck control has not come. He's not able to stand, he's not able to walk. So these obvious milestones are fine. The subtle milestones which gets missed is child not making eye contact with the child uh with with the parents. Child not speaking at 2 years 2 and a half years.

[00:32:44]>> Any child appropriate behavior or any neurodyiversity issues they are very difficult to >> very difficult to pick up and also because uh the sometimes parents may not reach the right person or a right doctor for that issue and then they will say that okay let's wait and see. Then there is a grandparent sometimes let's wait for another 6 months.

[00:33:06]>> This is the biggest dilemma.

[00:33:11]Yeah. So these these are things which which are culturally a little bit ingrained but also it is good to check with the doctor. See simple things we'll tell you when how does child learn language. Child learns language by more face-to-face conversation by listening to what we say and by looking at our lip moments. Now what is happening? Babies are not doing face tof face conversations. They are doing more face to mobile conversations mobile synchronization and it is very fast. So children are not able to pick up language. Okay. And then there is an overstimulation of hearing and vision which happens through the digital devices. So all these things are contributing to significant speech delay. So we tell parents as soon as baby becomes you know 6 months he starts looking at your face have more face tof face conversations and and continue that through the age of 3 to 4 years. So storytelling is a beautiful way of doing face tof face conversations talking to the child. So the parents who talk to the child more have more face-to-face conversations obviously have children who learn to talk better and faster and also the second sibling third baby because he's got exposed to elder siblings also children who interact with other children again have have a earlier kind of developmental milestones. So developmental red flags are important important motor milestones.

[00:34:35]If the child's interaction with parents is less, eye contact is less. If he's really hyperactive, if he's addicted to mobile phones, if there are certain ritualistic activities he does at home, he's obsessed with water. He's obsessed with certain toys which go round and round. He's always lost in his own world.

[00:34:59]it it is he has no clue of what happening in the immediate surroundings.

[00:35:03]These are developmental red flags which parents some of these uh skills which are u which the child has lost or not acquired we can re-engineer it by by therapy and by uh the right interventions at the right time.

[00:35:28]>> Mhm. And sir in your personal practice you must have seen more and more cases of like ADHD and autism spectrum disorders are uh getting increased day by day. So couple of things you have already discussed like uh screen time other things. So any specific guidelines from pediatric association related to screen time or uh any related thing which can avoid like the kids going into like severe cases of ADHD and autism.

[00:36:01]>> So again it is a neurodedevelopmental issue. Uh we tell it autism ADHD as neurodedevelopmental issue. There are u definitive um architectural and neurobiochemical changes which happen in the brain which predisposes children to this. The what we tell parents is that in the first five to six years all the five senses have to get equally stimulated that means touch, smell, taste, hearing and vision. Nowadays what is happening is that because of the mobile phones and screens which have come in there is an overstimulation of hearing and vision because of which the other faculties and the brain development does not happen. Okay. How does brain development happens? First is a overlay of nerve cells. Then the interconnection between these nerve cells which happens for the period of first 3 to 5 years and then whichever activity the child is doing repeatedly those connections become more and more mature and leaving the other connections immature and that is why the child cannot sit quiet without a mobile phone.

[00:37:09]He's so overstimulated that whatever is happening on the screen is so fast and there is such bombardment of color and sound from those screens that the moment it is off child does not know what to do because the real life is so slow and so so uh boring. Okay. So that that is what results in this expression as hyperactivity and um then the various various spectrum issues which leads on to that. So there is definitely baseline prevalence of autism ADHD. The whole digital screen um which has entered our households is making it worse. So our advice or the pediatric association advises so no screens till first 2 years of age. After first 2 years of age it has to be a very limited time uh of highly educational slow speed content like animal planet and and sports and these kind of things. um high-speed animation and cartoons really really hook on the children and have a very strong addictive potential. Do not expose children to that and do not use um screens as unpaid babysitters and a reward for feeding. Once that happens, it is very difficult to wean children away from that. And Dr. Couple of things which is which are related to overall child development and health. Uh that is cross infection because children nowadays started going to dayc carees start like 6 months 1 year and they get like severe cross infections and uh because they have like copying other kids as well at times they started eating some of the stuff which is not appropriate for their own digestive system. So uh in your practice what kind of advice you give to parents? So, so daycare is a very recent kind of interventions >> because of working parents but yes it increases the risk of um cross infections definitely. So both we work with both the daycarees one to to ensure that they create safe space ensure that all the people who are working in those daycarees um know about children know about the physical mental emotional demands of the child the um and the the needs for when they pass urine when they pass tools how the hygiene needs to be maintained to prevent any other uh infections. Um what is the diet parent should send or u what the daycare provides to the children? How balanced it it should be? What should be the taste and texture for the for the uh of the food which needs to be provided?

[00:39:51]Like simple example being no sugar and very minimal salt till 2 years of age.

[00:39:56]Okay. So, so because the the if the child has high salt, high sugar, more high saturated fat in the first two years, then his likelihood of hooking on to all the packaged food is very very high. Then he will stop eating homebased diet and then he's always wanting the the packaged food in forms of chocolates, chips and all the other savories. So when parents come and tell us that my child doesn't eat at all, it is not that he doesn't eat, he eats the wrong things. So that again comes with uh understanding about how children's relationship with food is formed. Okay.

[00:40:34]How the now it has moved on from healthy food to more junk and packaged food because of the taste enhancers that that has entered our food chain. These taste enhancers are all chemicals which are tweaking your your neurobiology. Okay. they are not really healthy for us and because the preservative levels are so high um nature we are we are disrupting natural processes by storing food for 2 3 years and then it reaches our plate. Okay. And when we eat them the the the body is not ready for that kind of a chemical onslaught. So inflammation starts then early childhood obesity starts precoxious puberty has started. Now babies uh children are becoming more mature uh sexually girls at 8 years 7 years and boys at 9 years 8 years. So that has got prepponed now. So the kind of environment we create for children in terms of their food in terms of what they spend time on. Children no longer can remain bored. No, boredom is such an important part of childhood because that is where most of the creative juices u you know are are generated and children's imagination, children's creativity with its own environment.

[00:41:50]It's interaction with the parents, interaction with other human beings in in the uh in the living space uh starts getting built. So and then the next comes uh with respect to the safety of the of the child in these immediate surroundings. A hyperactive child is always high prone for for injuries. So these are all things which we have to keep um we keep advising parents and children. So for parents in in a simple way after 1 years till around 3 4 years when you are putting children in daycare first is examine the daycare thoroughly for yourself. Talk to the staff and try and understand what is their level of maturity in handling children of younger age. What do they have a routine set for uh activity for sleep for play and for food in the school? What hospitals have they tied up with in case of any emergency that happens? So if these things are more clear and parents are happy then they can go with that daycare and and continue uh as such. Right.

[00:42:55]Right. And Dr. There is lot of debate in and around what kind of food stuff especially vegetables need to be given to kids regarding the timings which mornings.

[00:43:11]So what's your suggestion? For example, banana, it gives energy.

[00:43:20]So they are all again um more nuanced cultural influences. Um science basically tells that you know a child should have four meals uh with good interval in between because again food is so easily available that children are snacking through the day. So we tell four meals say 8:00, 12:00, 4:00, 8:00.

[00:43:42]Each meal should have five components, fruits, vegetables, grains, source of protein, and a dairy. So my five plate, we call it the my five plate. Okay. So So every plate should have 25% fruits, 25% vegetables, 25% grains, 25% proteins, and a bowl of curd. Okay. So that becomes five components. My five.

[00:44:05]Now coming to fruits again in the younger age we suggest pulpy fruits like apple, chiku, papaya, banana, melons, juicy fruits like grapes, oranges, pineapple, kiwi which are more rich in in um vitamin C. We we can start in in slightly older age group. That is my personal advice. So not not that there is pure science behind it. Vegetables we tell rainbow color. I mean all colored vegetables, seasonal vegetables are important to be done in child's um diet.

[00:44:38]It is not easy because again um just asking the child to eat may not work.

[00:44:45]Sometimes cheating has to cheating has to be done. So we tell parents to hide vegetables in the gravies, hide vegetables in the parathas, hide vegetables in dossas. Like you have orange dosa with scraped carrot. One day you have a green dosa with spinach. One day you have a light green dosa with cucumber. One day so these are the kind of innovations which parents have to do to trick children to develop that um relationship with food for the child.

[00:45:11]Also it is very important to understand what is your child's eating habit. Till very late we are always feeding the baby. So child has never touched the food, never had that made that moment of picking up the food, putting it in the mouth, u chewing, understanding the taste, check texture because also he's looking at the mobile. So the whole process of eating has to happen in in a on a dining table without the distraction of screens so that children are looking at what they are eating.

[00:45:39]They're touching and feeling what they're eating and when they put it in the mouth, they're chewing and they're sensing the taste and the texture as well. So these are important basic habits which uh families have to start adopting to give the child a wholesome growth.

[00:45:53]>> And what about the timing of meal?

[00:45:55]>> Yeah. So timing of meal again the so one thing what we have um one issue what we are seeing in our practice is that the school times have become 8:00 7:30. So children are waking up at 6:00 and uh standing in the bus stop at 6:30. The bodies are not ready for receiving food at that time. And what do parents substitute it with? They substitute with a glass of milk which again is is is not uh the current day mass-roduced dairy milk is so harmonized and it slows down gastric emptying. It causes constipation and then it kills the hunger for the ch for the child. So even if uh what we have started to tell because we started to see a lot of functional abdominal pains in our outpatient practice is that uh if the child is waking up at 600 6:30 and standing at bus stop at 7:00 don't force him to eat. Let him go with a glass of water. The first short break which is at 9 9:30 is fine. Let him have the first meal. Then again combination of fruits, dry fruits, a simple easy to digest cereal and then a lunch break which can be a little bit more parathas or subzies and salads or a rice preparation and when they come back the the usual homebased diet can take over and Dr. Most of the parents they are always worry about their kids gastro health and respiratory health like constipation is again a very big issue.

[00:47:20]So as per your suggestion as a medical professional like what should be the frequency of like kids going to toilet uh if they are not going for 2 3 days it's a worrisome thing or it's a normal for kids in like 1 to 5 years of age bracket.

[00:47:37]>> No. So we would definitely want the child to pass motion every day uh once or twice that is the ideal thing but again it needs to be cultivated because morning times before school there is time stress you know you can't send a small toddler five six or say even 7 year old child to the washroom and keep banging the door saying time in the stress babies cannot evacuate properly. So when they don't evacuate, they hold it in. Then they spend the whole school uh timing um not wanting to use the school washroom. So even sometimes they don't pass urine in the school washroom. So they hold it hold it hold it. That also predisposes them for more urinary tract infection and the dysfunctional bowel and bladder. So when they come home they they have to eat then they go to play then academics takes over then they sleep and next day cycle repeats. So what we generally have started telling parents is that after dinner let the child sit on the commute for at least 20 to 30 minutes. It is a phase where it is end of the day. It is relaxed.

[00:48:42]So and then you do that for at least 1 month. Then what happens? Your gut brain access automatically gets activated.

[00:48:49]child is able to evacuate and pass motion and sleep in a rest and digest phase so that the next day morning stress does not accumulate. So once a day is definitely if parents are waking up children and rushing them to school it is better that they pass motion in the night after dinner by sitting in the commote for 20 to 30 minutes.

[00:49:09]>> Got it. And so there is lots of like online content and thesis available to improve gut health. Yeah.

[00:49:15]>> But uh in your suggestion anything which can be given to young kids just to improve their overall gut health and like good bacteras. Again one important thing is that um we tell children should have a lot of water. Again not drinking water is a major issue which contributes to you know uh constipation and poor gut health. So children have to drink a lot of water and parents have to I think actively make them drink water. In school they may forget but the moment they are at home they should start drinking more water. So water intake has to go up. Second is include more soluble fiber in the diet like papaya, banana, aloe vera juice with fiber. So these act as a very good um I would say prebiotics. They they they they provide nutrition to all the good bacteria in the gut increasing it numbers. The junk food, the food coloring agents and the preservatives are all harmful for the babies. So and then what it does it it makes the gut colonize the bad bacteria. Bad bacteria by itself will create craving for more of these things. So then it's a cycle.

[00:50:27]So bad bacteria is craving for junk food. Baby craves more for more junk food, has more junk food. More junk food causes inflammation of the gut and then the cycle starts. So, so that's why packaged food is extremely harmful. And good ways to change that balance between good bacteria and bad bacteria is to have homemade curd which is very good.

[00:50:49]Um you know pickled vegetables is a very good source of pre and probiotics.

[00:50:56]um soaked rice with with um curd and and some onions as a prebiotic which we call rice kanji or ragi kanji in in in um southern India we use it a lot that really keeps the gut health um healthy and any suggestions on improving overall body's immunity because again various ads like chavan praash and various supplements are available with multivitamins so medically what is prescribed because all the parents are they really worry about their kid irrespective of their age.

[00:51:30]>> So generally we advise commercially available supplements does not really work that well. Whatever the biological sources there those are the ones which are good. One important aspect of immunity is also the the uh idea of good sleep. Children who do not sleep well will definitely have deficit both in their cognition memory but also immunity. both if for adults and children it is relevant. So good home-based food with the mifi concept that I spoke about seasonal fruits and vegetables drinking a lot of water uh movement exercise walking play if you do this and then get 8 to 10 hours of sleep every day then that itself uh indicates that your body is functioning in in a in a flow and you don't need additional supplements to to uh to circumvent that.

[00:52:22]children who are recovering from serious illnesses just to bridge that nutritional gap we do give supplements of multivitamins, B vitamins, zinc supplements so that the they the um whatever the nutritional gaps are there which the current illness is not able to match we are supplementing it but routine use of supplements we do not advise.

[00:52:45]>> Correct. Correct. And uh Dr. Sub along with this like I like to understand the vaccination part as well. uh across like 0 to 5 years because again there is some debate around vaccinations and uh like again more and more information is coming at times somebody condemns some some vaccines and people go crazy they stop doing the vaccination of all of all all of a sudden so what's your advice what vaccinations should not miss at all at any cost >> so what I would say is that vaccin inations are one of the most important medical interventions in the last 50 to 75 years of age. You know 50 years of back children used to die of polio. They used to become permanently disabled. Um children smallpox comes and then the whole village is wiped out. Okay.

[00:53:40]Hepatitis A, hepatitis B it comes and then you know there hepatitis A is a waterborn disease and so many children will have jaundice and some of them may even succumb to that. We are not no longer seeing illnesses like dtheria tetanus which we saw in during our training days. We are not seeing them in our ICUs now. Why is that? Because of all these vaccination. We are not seeing pneumonia's brain fever. Why? Because vaccinations are available for those things now. So vaccinations per se are significantly improved the child's immunity against these life-threatening diseases. That is one. Second, all vaccinations like any other medications will have a small very small fraction of possible side effects. Some of them are uh short-term side effects. Some of them are long-term. But to site one in say 1 million side effect and to to equate that cause to the vaccine is I would say too much of an overkill. So to create that fear phobia against vaccination because of one or two incidences which may have happened even though there is no direct correlation but this is a narrative which is being built by the antivaxer uh kind of um community. I would say that vaccinations have done a wonderful job in keeping our children healthy at all times. So the vaccines which parents should not miss is our national uh UIP guidelines which we tell which includes polio, dictia, tetanus, pertusis or whooping cough. Then hepatitis B um then the pneumonia vaccine um MMR which is measles moms reubella these are the um definitive compulsory vaccines each child should get. Then there are optional vaccines which which patients can afford then they can take like hepatitis A, typhoid, chickenpox and the yearly flu vaccine which we would like to give for the first 6 years of life and after 60 years of life. So and for children who are also having some background asthma, cardiac disease on chemotherapy. So these are all optional vaccines. Okay. So, so it's always better to vaccinate the children because our ICUs we if suppose a child comes with hepatitis A because summers are starting you have hepatitis A the care for a child with hepatitis A with jaundice with an hepatic and kephilopathy involving the brain ICU stay for 10 to 15 days so much expense and the child may have some damage uh from which he may not recover and you can prevent it by a vaccine of 1,000 rupees so so I would definitely as a pediatrician advocate for usage of vaccine and urge all the parents do not miss vaccine without discussing with your pediatricians. Absolutely. Never do that.

[00:56:27]>> So uh Dr. S I like to understand more about preventive vaccinations how important they are and any any suggestions you like to give for example for uh cadence of flu vaccine and some other vaccines.

[00:56:39]>> So all the vaccines by nature are preventive. Okay. The seasonal flu vaccine is the one vaccine which has to be given every year because based on the epidemiology of which virus is affecting which hemisphere in which season the the the vaccine um comes out with this those particular strains and those are the vaccines which provide influenza is viral infection against which we do not have a very competent antiviral medication because of which it is always good to have a preventive vaccine In first five to 6 years children are more predisposed for these flu infections and um we can avoid hospitalizations. We can avoid absent school absentism because of these seasonal viral infections. In India there are two peaks. One is the onset of monsoon one is onset of winter in which this viral surge happens and then lot of children in the community gets affected and then lot of them need to be hospitalized as well. So seasonal flu vaccine for all children less than 6 years and for children who are otherwise having some higher predisposition for pneumonia like children with heart disease, children undergoing chemotherapy, uh children with amma, we want to continue flu vaccine for some more years beyond six also.

[00:57:55]>> And Dr. Sab, one more point I like to touch upon is related to some genetic diseases maybe telenia or any chromosomeal issues. So in your practice uh are these sort of cases increased in last 10 years? Is there a decline and how we can prevent such instances? So genetic diseases are some of which are extremely random. Okay. So there is nothing you can do to prepare uh a family for a child to be born with that random mutation we call it. Okay. But the current science of fetal medicine and the ability to scan and diagnose the baby's condition when it is in the womb itself is significantly improved. So whenever we on the scan if we see the baby's growth is uh not optimal or the organ systems are not developing as per uh as per schedule then we subject them to certain genetic tests and if the babies uh is not viable not tenable for a normal happy life we offer termination to parents before 20 weeks of gestation.

[00:59:06]Huh. So, so that is one way of genetic um avoidance of genetic diseases in babies who are going to be born. So, this is with random mutations some of it can happen. So, deformities and and congenital anomalies can be there in the baby. The other thing is that because also the the parenthood is getting postponed so much there is higher incidence of infertility nowadays.

[00:59:31]mothers are are kind of postponing uh their pregnancy to 3540. So biologically when the age advances the quality of sperm and egg deteriorates and that predisposes for a uh child with anomaly or children who mothers who have undergone infertility treatment multiple pregnancies also there is higher risk of anomalies. So in those definitely prenatal screening uh precon before conceiving itself the screening of the parents for any of the genetic diseases is now available accessible to all the parents and we can really really reduce the risk of the the newborn child having some of these genetic diseases. Um all parents want a normal baby in their hand. And um one is to prevent and tell you the exact risk of genetic diseases in your in in in the baby which is coming and second is if uh the conceived baby has a genetic issue then offering termination before 20 weeks of gestation and there are some of the genetic diseases which can be treated um later on. So that also option is available with the newer advances in genetic diseases. Currently thalismia is a slightly different u issue because it's a single gene defect. If mother and parents mother and father are a carrier of thalismia gene then there is a 25% chance that um the child can have these.

[01:01:02]So but we can diagnose it by doing fetal sampling and uh we call it hemoglobin electrophorosis and diagnosing if the child is going to be or he's going to be thyalmic carrier which is which is okay and or he's going to be completely normal.

[01:01:17]>> And what is the current state of these?

[01:01:19]I know a lot of like medical advancement but still there is like people are struggling for cure.

[01:01:27]>> Yes. So thalismia is a hemoglobinopathy where the child's blood kind of gets destroyed very fast and that's why after some time child requires a monthly transfusion. Uh as such the complications with monthly blood transfusion is that there's a high risk of transmission of viral infections sometimes and also iron overload. This iron overload sits in the liver, sits in the heart and then sits in the skin and starts damaging. And the lifespan of a child who's on monthly blood transfusion is almost 3540 years with the best support uh he can get when he gets medicines to chilate all the iron and come bring it out of the body. Uh stem cell transplantation is one of the option for children withmia.

[01:02:13]uh and if we find a donor in the family that is ideal. If it can be a fully matched donor or a partial matched donor or a matched unrelated donor, stem cell therapy uh works forthmia. In recent advances um gene editing is something which is coming up in this field and um single gene defects will really benefit by recent advances in this gene editing technology. Hopefully we will get some like solid cure because thousands and lacks of kids are suffering and >> like blood transfusion is like the only cure we have right now and it's not the like permanent solution.

[01:02:54]>> Mhm. And in your practice of like 25 years have you seen any rise in like autoimmune or rare diseases in kids or it's in a declining phase?

[01:03:04]>> No, they were always there. our ability to diagnose them has significantly improved. Most of these genetic diseases or say autoimmune diseases or immune deficiency diseases, we have this whole new group of illnesses called inborn errors of immunity, inborn errors of metabolism. So what are these diseases?

[01:03:22]They are genetic diseases wherein say inborn errors of immunity means among all the as the body is attacked by an infection, the immune cascade gets activated. In any of these steps if there is a deficiency then the child is not able to fight that infection and save himself then what happens is that the child um suffers either death or recurrent hospitalizations when we diagnose it again stem cell transplant is a treatment for these inborn errors of metabolism inborn errors of immunity inborn errors of metabolism is is basically there is a metabolic cascade what food we eat it gets digested and fats carbohid hydrates, proteins gets processed very differently. Again in this whole uh steps if there is a chemical deficiency then there is accumulation of these toxin products which affects the growth of the child and then super added stress like an infection or a fever can decompensate the children very fast. So these illnesses were always there. Previously we thought that it is all infection because they were mimicking like infection. Child comes with fever deteriorates dies. Okay. One child dies, second child dies, third child dies.

[01:04:32]Then we look at okay maybe there is a genetic component here. Now the science has become so evolved in the fields of imunology, in the field of genetics, in the field of metabolics that we are able to diagnose them more. The rare disease incidence has not gone down. They are random mutation gene genetic defects. It already exists in India. at least one in thousand child will definitely have a rare disease incidence and that is that is huge for a population like India and sir one more thing u I like to discuss with you related to down syndrome there are thousands of kids who have down syndrome and along with like uh visiting to pediatrician they are also going to special therapies and uh occupational therapies but um uh I have seen that kids with down syndrome prone they are very prone to uh uh like infections uh constipation or maybe uh anything related to respiratory. So while looking at such patients what kind of counseling and support you provide at your practice? So down syndrome is again a genetic disease. It's tricom 21 we call it. Um children have a very peculiar happy face um dysmorphism um small eyes uh which is there but they also have um other problems like poor muscle tone because of which the chances of aspiration is more the they cannot cough out mucus because of which the respiratory infections are more. Their thyroid is functioning suboptimally so they have constipation. They put on weight um quite significantly. they have baseline immunity is almost 30% lesser.

[01:06:20]Some of them also have predisposition for certain types of certain types of cancers. So all these things uh require a very very multi-disiplinary approach with down syndrome. So we have that strict protocol once the baby is born.

[01:06:35]Um it gets assessed by a pediatric cardiologist because they also have a predisposition for certain heart illnesses. We call it atroventrical septile defect. So cardiologist, endocrinologist, uh neurologist and physical therapist to to train the baby and also empower the parents to take care of these babies in the way that they need to be. There is a 6 monthly toearly screening for these uh of these babies for these things. So some of them have decent IQ, some of them have little lesser IQ. But even with that they most of the down syndrome kids can be functional if provided all this uh parallel medical support.

[01:07:15]>> And Dr. S through this podcast if you like to burst any like myths misconceptions during your practice you must have listened thousands of like misconceptions parents may have. So through this podcast please go ahead and give a clear like scientific medical explanation or advice just to bust those myths. So one thing to to new parents is that parenting is definitely a very difficult challenge and I think you should prepare for yourself during the time of pregnancy. Support each other as partners um to make sure that the child lives in a very harmonious way. Then the important thing I would tell all the new age parents is that really do not expose your children to screen till 2 years of age. That is a real humble request because we have lost a generation of children who are addicted to screens who are um kind of socially inept who are intellectually kind of not as strong. And we are going to see that effect in these children becoming parents of the future. The next message will be to have um more homebased diet with seasonal fruits and vegetables. Avoid packaged food. So both screens and packaged food have serious addiction potential which we are not aware about. Let us protect our children from this big food and then the the digital screens and social media till they grow. More human to human interaction, more physical play, more in sync with nature, more in touch with nature. If you follow these basic ground rules um in bringing children up, I think you will bring a very well-rounded welladjusted child who is going to be physically, mentally, emotionally and psychologically strong.

[01:09:14]>> Thank you Dr. Sam. And honestly it was really a knowledge enhancing session.

[01:09:18]And uh I must say this like 45 60 minute time is not enough to discuss so many important topics. And uh definitely whenever we come to Bangalore again we will request you for one more hour wherein we can do some deep dive on some important topics which may we may not have been able to touch upon basis on your guidance. But till then from the entire talking through team I sincerely thank you for your time and your guidance and the way you have simplified uh all these important topics which are concerning to all the parents. It's really remarkable and uh the initiatives you are doing through your personal practice and through Manipal Hospital.

[01:10:02]Uh all the best for uh that particular initiative sir.

[01:10:06]>> Thank you so much Rahu G. Thank you.

[01:10:08]Pleasure and and it's real honor to be here.

[01:10:11]>> Likewise. Thank you. Thank you.