Swine vs Canine !

Such is the scare , mainly fueled by the media, that the parents are willing to shell out any amount to get their children vaccinated against Swine flu. But when I ask them, have they vaccinated their child against rabies, they look  amused. “But that is given after a dog bites, and we dont have dogs around” they reason. They are not even aware of the ‘Pre Exposure ‘ schedule of Rabies vaccination. The media has not told them about this, probably because the concerned vaccine company has not paid them to do so.
Little do the parents know that Rabies is a 100% fatal disease, with no cure, can happen any time of the year, kids being more at risk and vaccination only effective way to be safe, giving a long term protection. While Swine flu is not fatal in the most of cases, curable, happens only in a particular season and vaccine is effective only for one season.
So which will you chose, Swine of canine !

Aceclofenac for fever in children ?

These days there is a spate of medicines for children, containing a combination of Aceclofenac and  Paracetamol. Almost every Pharma company worth its salt has launched this combination, using brand names of their (now banned) previous fever medicines. One such medicine is Syrup Nimucet AF. 
What most of the quacks, chemists and most parents dont know is that Aceclofenac is a non-steroidal anti-inflammatory drug  (NSAID) analog of Diclofenac. It is used for the relief of pain and inflammation in rheumatoid arthritis, osteoarthritis and ankylosing spondylitis. It is not a drug for fever, and it is NOT recommended for use in children.

ref. http://en.wikipedia.org/wiki/Aceclofenac

Umbilical cord care

Myth:

Umbilical Cord stump heals faster when Neosporin Powder is applied.

umbilical-cord-stump-fresh-small

Reality:

Researchers have found that a cord heals faster if left alone. Powder will in fact accumulate dirt with it and might predispose the cord to infections.

Ideal cord care:

  • Keep the stump clean. Parents were once instructed to swab the stump with rubbing alcohol after every diaper change. Researchers now say the stump might heal faster if left alone. If the stump becomes dirty or sticky, clean it with plain water — then dry it by holding a clean, absorbent cloth around the stump or fanning it with a piece of paper.
  • Keep the stump dry. Expose the stump to air to help dry out the base. Keep the front of your baby’s diaper folded down to avoid covering the stump. In warm weather, dress your baby in a diaper and T-shirt to improve air circulation.
  • Stick with sponge baths. Sponge baths might be most practical during the healing process. When the stump falls off, you can bathe your baby in a baby tub or sink.
  • Let the stump fall off on its own. Resist the temptation to pull off the stump yourself, even if it’s hanging on by only a thread.

Sunlight for Jaundice in newborn

Myth:

Early Morning sunlight cures jaundice in newborns.

Reality:

A special light is needed to reduce the level of Bilirubin in blood. This wavelength of light(the blue spectrum from approximately 390 to 470 nm.) can only be provided by  special equipment known a Photo Therapy Unit.  Sometimes  parents try to treat their jaundiced babies on their own without the proper equipment. Placing a baby under lights at home, near a windowsill in the sunlight, or outside in the sun will not lower the amount of bilirubin in his or her blood. Your baby’s skin may get burned by the lights or the sun. In addition, your baby may get too cold. Special lights and controlled surroundings are always needed to treat jaundice safely.

The myth, that exposure to sun cures jaundice, probably originated because the sunlight contains all wavelengths of light including the desired blue as well as the harmful Ultra Violet. Filtered sunlight has een used at remote places where the proper equipment (or electricity to run them) is not available. But there, a UV filter has to be used and the baby has to be put naked under the filtered sunlight for a minimum of 6 hours.

 

Childhood Asthma, what you should know about it.

What Is Asthma?

Asthma is a chronic disease of the tubes that carry air to the lungs. These airways become narrow and their linings become swollen, irritated, and inflamed. In patients with asthma, the airways are always irritated and inflamed, even though symptoms are not always present. The degree and severity of airway inflammation varies over time.

Children with asthma can have symptoms start or worsen when they are exposed to many indoor substances such as

• Dust and dust mites

• Cockroaches

• Animals such as cats and dogs

• Molds

• Secondhand cigarette smoke

Children with asthma may also be sensitive to colds and other viral infections, cold air, and particles or chemicals in the air. Ongoing exposures to these substances will not only worsen asthma symptoms, but also continue to aggravate airway inflammation.

Inflammation of the airways causes them to be oversensitive and “twitchy,” often called “hyperreactive.” When the airways are hyperreactive, they can go into spasms, causing blockage and symptoms of wheezing, chest tightness, and shortness of breath.

Who Gets Asthma?

Asthma is a common condition in childhood. In the United States, 10% to 15% of children in grade school have or have had asthma. It can cause a lot of sickness and result in hospital stays and even death. The number of children with asthma is increasing, and the amount of illness due to asthma may also be increasing in some parts of the country. The reasons for these increases are not exactly known; however, outdoor air pollution and increased exposure to allergens are not likely causes.

Recent studies suggest that how often and how early a child is exposed to certain infections and animals can influence the development of asthma. For example, children who come from large families, live with pets, or spend a considerable amount of time in child care in the first year of life are less likely to develop asthma. This early exposure to common allergens may actually protect against the development of asthma.

Studies have also shown that a child’s exposure to infections early in life can determine whether he develops allergies or asthma. Some infections seem to decrease the risk of developing asthma, whereas one infection, respiratory syncytial virus, increases the risk.

 

How Is Asthma Treated?

Any child who has asthma symptoms more than twice per week should be treated. One of the most important treatments of asthma is to control the underlying inflammation of the airways. This can be done with medications or by avoiding environmental factors that cause or aggravate airway inflammation.

Knowing the causes and triggers for asthma can allow families to reduce or avoid these triggers and reduce ongoing airway inflammation and hyperreactivity. This can reduce the severity and frequency of asthma symptoms and, hopefully, the need for as much asthma medication.

 

How Is Asthma Diagnosed?

It is often difficult, especially in young children, to be entirely certain that asthma is the diagnosis. After a careful physical examination, your paediatrician will need to ask you specific questions about your child’s health. The information you give your paediatrician will help determine if your child has asthma. Your paediatrician will need information about

• Your child’s symptoms, such as wheezing, coughing, and shortness of breath

• What triggers the symptoms or when the symptoms get worse

• Medications that were tried and if they helped

• Any family history of allergies or asthma

It is very important that your paediatrician test your child’s airway function. One way to do this is with a pulmonary function test using a device called a spirometer. This device measures the amount of air blown out of the lungs over time. Your paediatrician may also want to test your child’s pulmonary function after giving her some asthma medication. This helps confirm that the blockage in the air passages that shows up on pulmonary function tests goes away with treatment.

Some children do not find relief from their symptoms even after using medications. If that is your child, your paediatrician may want to test your child for other conditions that can make asthma worse. These conditions include allergic rhinitis (hayfever), sinusitis (sinus infection), and gastroesophageal reflux disease (the process that causes heartburn).

It is important to remember that asthma is a complicated disease to diagnose, and the results of airway function testing may be normal even if your child has asthma. Also keep in mind that not all children with repeated episodes of wheezing have asthma. Some children are born with small lungs, and their air passages may get blocked by infections. As their lungs grow they no longer wheeze after an infection. This type of wheezing usually occurs in children without a family history of asthma and in children whose mothers smoked during pregnancy.

 

Non-pharmacological Approaches to Asthma Management

Asthma Triggers

Certain things cause asthma “attacks” or make asthma worse. These are called triggers. Some common asthma triggers are

• Things your child might be allergic to. These are called allergens. (Most children with asthma have allergies, and allergies are a major cause of asthma symptoms.)

– House dust mites

– Animal dander

– Cockroaches

– Mold

– Pollens

• Infections of the airways

– Viral infections of the nose and throat

– Other infections, such as pneumonia or sinus infections

• Irritants in the environment (outside or indoor air you breathe)

– Cigarette and other smoke

– Air pollution

– Cold air, dry air

– Odors, fragrances, volatile organic compounds in sprays, and cleaning products

• Exercise (About 80% of people with asthma develop wheezing, coughing, and a tight feeling in the chest when they exercise.)

• Stress

Be sure to check all of your child’s “environments,” such as school, child care, and relatives’ homes, for exposure to these same things.

Help Your Child Avoid Triggers

While it is impossible to make the place you live in completely allergen- or irritant-free, there are things you can do to reduce your child’s exposure to triggers. The following tips may help.

• Do not smoke or let anyone else smoke in your home or car.

• Reduce exposure to dust mites. The most necessary and effective things to do are to cover your child’s mattress and pillows with special allergy-proof encasings, wash their bedding in hot water every 1 to 2 weeks, remove stuffed toys from the bedroom, and vacuum and dust regularly. Other avoidance measures, which are more difficult or expensive, include reducing the humidity in the house with a dehumidifier or removing carpeting in the bedroom. Bedrooms in basements should not be carpeted.

 

• If allergic to furry pets, the only truly effective means of reducing exposure to pet allergens is to remove them from the home. If this is not possible, keep them out of your child’s bedroom and consider putting a high-efficiency particulate air (HEPA) filter in their bedroom, removing carpeting, covering mattress and pillows with mite-proof encasings, and washing the animals regularly.

• Reduce cockroach infestation by regularly exterminating, setting roach traps, repairing holes in walls or other entry points, and avoiding leaving exposed food or garbage.

• Mould in homes is often due to excessive moisture indoors, which can result from water damage due to flooding, leaky roofs, leaking pipes, or excessive humidity. Repair any sources of water leakage. Control indoor humidity by using exhaust fans in the bathrooms and kitchen, and adding a dehumidifier in areas with naturally high humidity. Clean existing mould contamination with detergent and water. Sometimes porous materials such as wallboards with mould contamination have to be replaced.

• Pollen exposure can be reduced by using an air conditioner in your child’s bedroom, with the vent closed, and leaving doors and windows closed during high pollen times. (Times vary with allergens, ask your allergist.)

• Reduce indoor irritants by using unscented cleaning products and avoiding mothballs, room deodorizers, or scented candles.

• Check air quality reports in weather forecasts or on the Internet. When the air quality is poor, keep your child indoors and be sure he takes his asthma control medications.

• Decreasing your child’s exposure to triggers will help decrease symptoms as well as the need for asthma medications.

 

Pharmacologic Management of Asthma

Asthma Medications

The goals of treatment for asthma are to minimize symptoms and allow children to participate in normal physical activities with minimum side effects. It is also important to prevent emergency department visits and hospitalizations due to asthma attacks. Ideally, this means your child should not experience asthma symptoms more than once or twice per week, asthma symptoms should not wake your child at night more than twice per month, and your child should be able to participate in all play, sports, and physical education activities.

Asthma medications come in a variety of forms, including the following:

• Metered-dose inhalers

• Dry powder inhalers

• Liquids that can be used in nebulizers

• Pills

Inhaled forms are preferred because they deliver the medication directly to the air passages with minimal side effects.

Medications Used to Treat Asthma

Asthma is different in every patient, and symptoms can change over time. Your health care provider will determine which asthma medication is best for your child based on the severity and frequency of symptoms and your child’s age. Children with asthma symptoms that occur only once in a while are given medications only for short periods. Children with asthma whose symptoms occur more often need to take controller medications every day.

Sometimes it is necessary to take several medications at the same time to control and prevent symptoms. Your health care provider may give your child several medications at first, to get the asthma symptoms under control, and then decrease the medications as needed. Your health care provider may also recommend a peak flow meter for your child to use at home to monitor lung function. This can help you make decisions about changing therapy or following the effects of changes made by your health care provider.

Asthma medications are divided into 2 groups: quick-relief medications and controller medications.

Quick-Relief Medications

Quick-relief medications are for short-term use to open up narrowed airways and help relieve the feeling of tightness in the chest, wheezing, and breathlessness. They can also be used to prevent exercise-induced asthma. These medications are taken only on an as-needed basis. The most common quick-relief medication is albuterol.

Controller Medications

Controller medications are used on a daily basis to control asthma and reduce the number of days or nights that your child has symptoms. Controller medications are not used for relief of symptoms. Children with symptoms more than twice per week or who wake up more than twice per month should be on controller medications.

 

Controller medications include the following:

• Inhaled steroids

• Long-acting bronchodilators

• Combination products that contain inhaled steroids and long-acting bronchodilators

• Leukotriene receptor antagonists (only available in pill form)

• Inhaled nonsteroids (such as cromolyn or nedocromil)

• Methylxanthines (for example, theophylline)

Inhaled corticosteroids are the preferred controller medication for all ages. When used in the recommended doses, they are safe for most children. In your child’s particular case, however, your health care provider may recommend another type of controller medication.

Asthma Management Plan

It is usually helpful to have an asthma management plan written down so you can refer to it from time to time. Such a plan should contain information on daily medications your child takes as well as instructions on what to do for symptoms. A plan should also be provided to your child’s school.

Exercise-Induced Asthma

Exercise can often trigger symptoms in children with asthma. It can almost always be prevented with use of quick-relief medications taken 10 to 15 minutes before exercise. If it occurs frequently, however, it may mean your child’s asthma is not under control. Proper asthma control can make a great difference in the ability for a child to exercise normally. It is important for parents to speak to their child’s physical education teachers and coaches about their child’s asthma management.

 

Management Aids

Devices to Help Deliver Asthma Medications

Medications for asthma can be given to your child using a variety of devices including the following:

• Nebulizer—This is often used with younger children. This device uses an air compressor and cup to change liquid medication into a mist that can be inhaled through a mouthpiece or mask. Inhaled steroids and quick-relief medications can be given this way.

• Metered-dose inhaler (MDI)—This is the most commonly used device for asthma medications. However, your child will need to learn how to use it properly, which means pressing (or actuating) the device while taking a deep breath at the same time. The technique is reviewed on the following pages. Some MDIs are “breath actuated,” that is, they give out a puff of medication when you start to take a breath. These types of MDIs are much easier to use, but are only available for one type of quick-relief medication. Spacers can be used to help relieve some of the coordination problems in using MDIs and should always be used when using inhaled steroids.

• Dry powder inhaler (DPI)—This device is available for some medications. It is easier to use because you do not need to coordinate breathing with actuation. It also has less taste, and often has a built-in counter to help keep track of doses taken and doses left.

Some asthma medications only come in pill form. However, inhaling the medication using one of the devices listed above is usually better because the medication passes straight into the airways. As a result, side effects are reduced or avoided altogether. Because there are several different inhalers on the market, your health care provider will suggest the one that is best for your child. There are important differences in the way they are used and in the amounts of medications they deliver to the airways. Your child will be taught how to use the inhaler, but her technique should be checked regularly to make sure she is getting the right dose of medication.

Peak Flow Meter

To help control asthma, your child may need to use a peak flow meter. This is a handheld device that measures how fast a person can blow air out of the lungs. Asthma treatment plans using peak flow meters use 3 zones—green, yellow, and red, like traffic lights—to help you determine

 

if your child’s asthma is getting better or worse. Peak flow rates decrease (the numbers on the scale go down) when your child’s asthma is getting worse or is out of control. Peak flow rates increase (the numbers on the scale go up) when the asthma treatment is working and the airways are opening up.

When to Use the Peak Flow Meter (if your health care provider has recommended one)

Check your child’s asthma using the peak flow meter at the following times:

• Every morning, before he takes any medications.

• If your child’s symptoms worsen or if he has an asthma attack. Check the peak flow rate before and after using medications for the attack. This will help you to see if the medications are working.

• Other times during the day, if your health care provider suggests.

Keep in mind, there are differences in peak flow rate measurements at different times of the day. These differences are minimal when asthma is well controlled. Increasing differences may be an early sign of worsening asthma. Also, children of different sizes and ages have different peak flow rate measurements.

Keep a record of your child’s peak flow numbers each day. This will help you and your health care provider see how your child’s asthma is doing. Bring this record with you when you visit the paediatrician.

The developmental milestones your child should reach by twelve months of age.

From eight to twelve months of age, your baby will become increasingly mobile, a development that will thrill and challenge both of you. Being able to move from place to place will give your child a delicious sense of power and control—her first real taste of physical independence.

Here are some other milestones to look for.

Movement milestones

  • Gets to sitting position without assistance
  • Crawls forward on belly by pulling with arms and pushing with legs
  • Assumes hands-and-knees position
  • Creeps on hands and knees supporting trunk on hands and knees
  • Gets from sitting to crawling or prone (lying on stomach) position
  • Pulls self up to stand
  • Walks holding on to furniture
  • Stands momentarily without support
  • May walk two or three steps without support

Milestones in hand and finger skills

  • Uses pincer grasp
  • Bangs two cubes together
  • Puts objects into container
  • Takes objects out of container
  • Lets objects go voluntarily
  • Pokes with index finger
  • Tries to imitate scribbling

Language milestones

  • Pays increasing attention to speech
  • Responds to simple verbal requests
  • Responds to “no”
  • Uses simple gestures, such as shaking head for “no”
  • Babbles with inflection
  • Says “dada” and “mama”
  • Uses exclamations, such as “oh-oh!”
  • Tries to imitate words

Cognitive milestones

  • Explores objects in many different ways (shaking, banging, throwing, dropping)
  • Finds hidden objects easily
  • Looks at correct picture when the image is named
  • Imitates gestures
  • Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)

Social and emotional milestones

  • Shy or anxious with strangers
  • Cries when mother or father leaves
  • Enjoys imitating people in play
  • Shows specific preferences for certain people and toys
  • Tests parental responses to his actions during feedings (What do you do when he refuses a food?)
  • Tests parental responses to his behavior (What do you do if he cries after you leave the room?)
  • May be fearful in some situations
  • Prefers mother and/or regular caregiver over all others
  • Repeats sounds or gestures for attention
  • Finger-feeds himself
  • Extends arm or leg to help when being dressed

Developmental health watch

Each baby develops in his own manner, so it’s impossible to tell exactly when your child will perfect a given skill. Although the developmental milestones listed in this book will give you a general idea of the changes you can expect as your child gets older, don’t be alarmed if his development takes a slightly different course. Alert your pediatrician if your baby displays any of the following signs of possible developmental delay in the eight- to twelve-month age range.

  • Does not crawl
  • Drags one side of body while crawling (for over one month)
  • Cannot stand when supported
  • Does not search for objects that are hidden while he watches
  • Says no single words (“mama” or “dada”)
  • Does not learn to use gestures, such as waving or shaking head
  • Does not point to objects or pictures

(Source:AAP)

The developmental milestones your child should reach by seven months of age.

From age four to seven months, the most important changes take place within your child. This is the period when he’ll learn to coordinate his emerging perceptive abilities (the use of senses like vision, touch,and hearing) and his increasing motor abilities to develop skills like grasping, rolling over, sitting up, and possibly even crawling.

Here are some other milestones to look for.

Movement milestones

  • Rolls both ways (front to back, back to front)
  • Sits with, and then without, support of her hands
  • Supports her whole weight on her legs
  • Reaches with one hand
  • Transfers object from hand to hand
  • Uses raking grasp (not pincer)

Visual milestones

  • Develops full color vision
  • Distance vision matures
  • Ability to track moving objects improves

Language milestones

  • Responds to own name
  • Begins to respond to “no”
  • Distinguishes emotions by tone of voice
  • Responds to sound by making sounds
  • Uses voice to express joy and displeasure
  • Babbles chains of consonants

Cognitive milestones

  • Finds partially hidden object
  • Explores with hands and mouth
  • Struggles to get objects that are out of reach

Social and emotional milestones

  • Enjoys social play
  • Interested in mirror images
  • Responds to other people’s expressions of emotion and appears joyful often

Developmental health watch

Because each baby develops in his own particular manner, it’s impossible to tell exactly when or how your child will perfect a given skill. The developmental milestones listed in this book will give you a general idea of the changes you can expect, but don’t be alarmed if your own baby’s development takes a slightly different course. Alert your pediatrician, however, if your baby displays any of the following signs of possible developmental delay for this age range.

  • Seems very stiff, with tight muscles
  • Seems very floppy, like a rag doll
  • Head still flops back when body is pulled up to a sitting position
  • Reaches with one hand only
  • Refuses to cuddle
  • Shows no affection for the person who cares for him
  • Doesn’t seem to enjoy being around people
  • One or both eyes consistently turn in or out
  • Persistent tearing, eye drainage, or sensitivity to light
  • Does not respond to sounds around him
  • Has difficulty getting objects to his mouth
  • Does not turn his head to locate sounds by four months
  • Doesn’t roll over in either direction (front to back or back to front) by five months
  • Seems inconsolable at night after five months
  • Doesn’t smile spontaneously by five months
  • Cannot sit with help by six months
  • Does not laugh or make squealing sounds by six months
  • Does not actively reach for objects by six to seven months
  • Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180 cm] ranges by seven months
  • Does not bear some weight on legs by seven months
  • Does not try to attract attention through actions by seven months
  • Does not babble by eight months
  • Shows no interest in games of peekaboo by eight months

(Source: AAP)

The developmental milestones your child should reach by three months of age.

 By the time your baby is three months of age, she will have made a dramatic transformation from a totally dependent newborn to an active and responsive infant. She’ll lose many of her newborn reflexes while acquiring more voluntary control of her body. You’ll find her spending hours inspecting her hands and watching their movements.

Here are some other milestones to look for.

Movement milestones

  • Raises head and chest when lying on stomach
  • Supports upper body with arms when lying on stomach
  • Stretches legs out and kicks when lying on stomach or back
  • Opens and shuts hands
  • Pushes down on legs when feet are placed on a firm surface
  • Brings hand to mouth
  • Takes swipes at dangling objects with hands
  • Grasps and shakes hand toys

Visual and hearing milestones

  • Watches faces intently
  • Follows moving objects
  • Recognizes familiar objects and people at a distance
  • Starts using hands and eyes in coordination
  • Smiles at the sound of your voice
  • Begins to babble
  • Begins to imitate some sounds
  • Turns head toward direction of sound

Social and emotional milestones

  • Begins to develop a social smile
  • Enjoys playing with other people and may cry when playing stops
  • Becomes more communicative and expressive with face and body
  • Imitates some movements and facial expressions

Developmental health watch

Although each baby develops in her own individual way and at her own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention. If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.

  • Doesn’t seem to respond to loud sounds
  • Doesn’t notice her hands by two months
  • Doesn’t smile at the sound of your voice by two months
  • Doesn’t follow moving objects with her eyes by two to three months
  • Doesn’t grasp and hold objects by three months
  • Doesn’t smile at people by three months
  • Cannot support her head well at three months
  • Doesn’t reach for and grasp toys by three to four months
  • Doesn’t babble by three to four months
  • Doesn’t bring objects to her mouth by four months
  • Begins babbling, but doesn’t try to imitate any of your sounds by four months
  • Doesn’t push down with her legs when her feet are placed on a firm surface by four months
  • Has trouble moving one or both eyes in all directions
  • Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
  • Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings
  • Still has the tonic neck reflex at four to five months

(Source:AAP)

The developmental milestones your child should reach by one month of age.

In the very beginning, it may seem that your baby does nothing but eat, sleep, cry, and fill his diapers. By the end of the first month, he’ll be much more alert and responsive. Gradually he’ll begin moving his body more smoothly and with much greater coordination—especially in getting his hand to his mouth. You’ll realize that he listens when you speak, watches you as you hold him, and occasionally moves his own body to respond to you or attract your attention.

Here are some other milestones to look for.

Movement milestones

  • Makes jerky, quivering arm thrusts
  • Brings hands within range of eyes and mouth
  • Moves head from side to side while lying on stomach
  • Head flops backward if unsupported
  • Keeps hands in tight fists
  • Strong reflex movements

Visual and hearing milestones

  • Focuses 8 to 12 inches (20.3 to 30.4 cm) away
  • Eyes wander and occasionally cross
  • Prefers black-and-white or high-contrast patterns
  • Prefers the human face to all other patterns
  • Hearing is fully mature
  • Recognizes some sounds
  • May turn toward familiar sounds and voices

Smell and touch milestones

  • Prefers sweet smells
  • Avoids bitter or acidic smells
  • Recognizes the scent of his own mother’s breastmilk
  • Prefers soft to coarse sensations
  • Dislikes rough or abrupt handling

Developmental health watch

If, during the second, third, or fourth weeks of your baby’s life, she shows any of the following signs of developmental delay, notify your pediatrician.

  • Sucks poorly and feeds slowly
  • Doesn’t blink when shown a bright light
  • Doesn’t focus and follow a nearby object moving side to side
  • Rarely moves arms and legs; seems stiff
  • Seems excessively loose in the limbs, or floppy
  • Lower jaw trembles constantly, even when not crying or excited
  • Doesn’t respond to loud sounds

(Source :AAP)

Treating Children since 1989