Nov 14, 2010
Today's children are tomorrow's rulers, leaders, policy makers, doctors, scientists, teachers, sports heroes, successful intellectuals, productive citizens and of course parents. The capability of children to develop and become productive adults depends largely on their health and education. If education starts at the early years of life at home, the foundation for a child’s robust health should be put even before its conception. Good health coupled with happy childhood is one of the best gifts that adults have in their power to bestow upon their children. This is the message pediatrician Dr B Shantharam Baliga wants to convey to all the parents, teachers and the children particularly on Children’s Day today. It is a strange paradox that this day also happens to be World Diabetes Day because in future children’s health and type II diabetes will be interconnected if we go by the present day trends where type II diabetes is growing at an alarming rate among youngsters in India.
Dr Shantharam Baliga, DCH, MD, Professor and HOD of Pediatrics at Kasturba Medical College, Mangalore, has always espoused the cause of children’s health and good parenting in bringing up healthy children who will be an asset to the country. Dr Baliga has been in the forefront in pioneering the neonatal and pediatric intensive care units in public and private sector hospitals since 1987 which paved the way for the regionalization of child care in Dakshina Kannada district. He is the brain behind the 12 crore Regional Advanced Pediatric Care Centre, the super speciality unit of the government Wenlock Hospital in Mangalore, set up with the intent of “reaching the unreached” to provide free high-end health care to the needy poor.
Winner of 4 gold medals from Mysore University, Dr Baliga has 3 international publications and 2 international conference presentations to his credit and has been in various health committees of the government. The medical fraternity in general and even some parents may term him as arrogant or obstinate because of his firm stand on certain aspects of child health care, which many medicos and hospitals don’t adhere to. With an elfin smile he says “I speak out what I need to and am steadfast in my commitment to provide good health to the children”. He strongly advocates breast-feeding in order to have healthy children and is known to be parsimonious in prescribing antibiotics in his medication.
During his recent visit to India U S President Barak Obama said “India’s greatest strength is its human resource”, which is no doubt a matter of pride to all of us. Instead of basking in the glory it is time we do a reality check as Dr Baliga cautions that we have a deadly bombshell ahead because it is also true India is fast on its way to becoming a global diabetes ‘hub’ of the world, which will have a telling impact on its human resource. In such an eventuality, this human resource will become more of a liability than an asset to the nation. Therefore, he emphasizes the need to give priority to the twin aspects of “mother-child care” as a prerequisite towards creating a healthy generation next. In a free-wheeling chat with daijiworld.com Dr Baliga enumerates the various aspects of mother-child care, good diet, nutrition and the ill effects of junk food and other facets of child care.
Q. When it comes to child care when does the actual preparation for having a healthy child begin?
A. Actually it begins even before the conception. Many women come to the doctors a few months after conception. Pre-conception counseling of the mother greatly helps on the proper growth of the foetus. Pre-counseling helps the mother to be nutritionally, physically and mentally prepared to conceive a healthy child.
Q. Do we have such a facility even in a city like Mangalore?
A. Unfortunately many educated and well read couple are also not aware of the need for such counseling. It is sad to note that we don’t even have antenatal care and counseling, which is a must to new mothers. She should be taught the right way of breast feeding the child during the antenatal counseling. Breast feeding is a learned experience to mothers which does not come by instinct and that is why it is the first child which makes the mother wiser preparing her better for the second child.
Q. But these days parents opt only for single child…due to the cost involved in upbringing a child..
A. I would rather talk about the merits of having a second child by parents rather than the other way round. But it is a vast and interesting topic which needs to be handled separately.
Q. What are the aspect a would-be mother need to take care during the nine months of her pregnancy?
A. The pregnancy stage is a crucial stage of a child’s growth because 95% cells of the baby’s brain would grow when the child is in the womb. Good nutritious food, healthy environment and good homely atmosphere are some of the aspects pregnant mothers need to take care of. Even before a woman is ready for delivery she has to take care of her nipples and prepare herself for breastfeeding the child.
Q. It is a common practice in India to bathe a baby soon after it is born. Is it the correct practice?
A. Babies are born with a temperature 37 degree centigrade and it is not advisable to bathe a baby, be it in warm or cold water, immediately after birth. This is necessary because babies have difficulty maintaining their temperature at birth and in the first days of life. Newborns lose body heat very quickly and to maintain the temperature they use the energy reserve by utilizing the glucose and the amount of glucose or sugar in the blood decreases. Decrease in glucose affects the baby’s brain and increases the risk of infection putting them to greater risk.
Q. What is the safe method of taking care of the new born?
A. When a baby is born, the best way to maintain its temperature is to wipe off the amniotic fluid using a cloth, wrap the baby in a dry sheet and cover, before the cord is cut off. To keep its temperature constant, the baby should be breastfed within half or one hour after birth or by adopting “Kangaroo-mother-care“ method of the mother holding the baby close to her body.
Q. Many modern hospitals adopt the age old method of bathing the child immediately after birth even now. What is your opinion on it?
A. It is true a good number of hospitals do not follow this. This is mainly because it is very difficult to change the mindset of the people especially those of the educated ones. The baby friendly hospital initiative is a step in this direction and it will take some time before it comes acceptable to all. Because by adopting the safe method hospitals don’t lose anything. What is required is change of mindset and change of attitude. One million deaths of children per year worldwide can be prevented by adopting the correct method of treating the new born.
Q. What is this baby-friendly hospital initiative?
A. It is a worldwide programme of the World Health Organization and UNICEF launched in 1991. The initiative is a global effort to improve maternity services to enable mothers to breastfeed babies for the best start in life. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding. It was launched in India in 1993 and has grown into a unique programme of creating awareness and harnessing support of health workers. Despite this only 23% of women breastfeed their children within one hour of giving birth. “I just want every parent to realize that breastfeeding is the best insurance policy they can have for children.
There is no other insurance policy in the world which can protect the health of the child better then breast milk”. Even working mothers, if convinced, will realize the goodness of breastfeeding the child. Moreover, breastfeeding is the best way of preventing obesity at a later stage in life because we all know too well that formula feeds is one of the causes of obesity. Such children are also susceptible to other related health problems.
Q. How important is a mother’s diet during the lactating period? .
A. It is necessary to ensure that the mother takes nutritious food during the lactation period. Good food does not mean expensive food. Nutritious food should contain all micro nutrients and other nutrients as the remaining 5% of the growth of the brain and other growth occurs within the first six months of a baby’s life. Mother’s milk has everything in it to make the child’s brain “humane”.
Q. But these days lot of young urban women refuse to eat good food during this period for fear of putting on weight ….
A. It is a misconception which stems from ignorance. First, the young mothers should come out of the 40-day confinement after child birth. They put on weight because they restrict themselves to a closeted room without involving in any activities. I would say that attitudinal change is the need of the hour to overcome some of the taboos and misconceived notions.
Q. Parents these days have difficulties in making their children eat nutritious home cooked food. Where do you think they falter?
A. Ignorance about weaning food is another reason for children not getting enough nutrition. Each stage in a child’s growth is critical. There is critical period for everything and the taste for food in a child is developed from 6 to 18 months. By nine months a child is able to appreciate all types of food. But many parents desist from giving normal food to children even after 2 or three years, by which time the critical period of food appreciation or food preference is lost. For example, if a child is introduced to chocolates regularly during this critical period, the parents would be conditioning that child to prefer that food and as a result his entire food habits would go awry.
Q. We see children being used to junk food these days. In what way it has impact on their health?
A. This is a vital aspect of children’s health care because junk food has a deleterious impact on their overall health. Obesity stems from sedentary life style, lack of outdoor activities, mechanization of life, food affordability, junk food and due to craving for more food. Junk food consumption is one of the causative factors of childhood obesity. Childhood obesity causes reduced lung and alveolar capacity, poor metabolism leading to growth and developmental disorders. Reduced physical activity itself can cause reduced bone mass leading to flat feet, narrowing of the arches, knee pain, back pain, and irregular hip position. For most children, these pains and deformities will progress into adulthood with little chance for recovery. 50-80% of obese children will continue on into adulthood as obese adults and fall into the high risk group of Diabetes, Hypertension and Coronary Heart Diseases. Complications of adult obesity are made worse if the obesity begins in childhood as it is harder to treat in adults than in children.
Q. So what does the future hold for India in the health front?
A. I am not pessimistic but a recent study has shown that 25% of the school going boys and 27 to 30% girls in Urban India are obese. It means that by the year 2025 many of today’s obese teenagers will get into the work force putting considerable burden on their employers and their own savings. It will also be a big burden on the country. Obesity puts extra burden on all organs of the body and one fine day everything collapses. Dr William J Klish of Texas hospital had said “If we don’t get this epidemic [of childhood obesity] in check, for the first time in a century children will be looking forward to a shorter life expectancy than their parents.” This may be true in our country soon. If that happens, our “Vision 2020 – health for all” would remain only a dream.
Q. Why is that our taste buds always tickle for junk and outside food?
A. Junk food is energy dense and consuming it means going on adding calories. Junk food has no nutrition and a person who may look healthy to look at is not so within and may fall sick often. Ajina Moto or Monosodium Glutamate, a taste enhancer, which is used in most ready-to-eat foods suppresses or resets the satiation level making people go on a binge spree. Eating right and not in large quantity is the best way to good health.
Q. When it comes to medication you seems to avoid prescribing antibiotics. Any specific reasons?.
A. Repeated use of antibiotics skews the immune system of the body and such a child becomes prone to diseases. According to some research children who are given antibiotics often are more likely to develop asthma and allergies at later stages of life. It gives me immense joy to see some of the parents abide by my advice and there are many children who have not used antibiotics for more than five years now. As a doctor that makes my life fruitful.
Q. Talking about you, there is a strong feeling among the medical fraternity that you are obstinate and egotistical….
A. I am firm on what I strongly believe in. Professionalism is not being goody goody. My main aim is to do least damage to the health of a child. Children’s health is our wealth. That is the greatest gift any parent can give to their children.
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