FINAL BOOK-COLLEGE-1 engage by Avinashverma verma

Mother and Child Care : Promoting Health, Preventing Disabilities

Department of Human Development and Childhood Studies Institute of Home Economics, (University of Delhi) Hauz Khas Enclave, New Delhi-110016

Guidebook-1

Dr. Geeta Chopra Associate Professor

Publication Year 2002, 2nd Edition 2005, 3rd Edition 2011 Copyright for reprints in English or translations in any language reserved with the author. Cover page design by Dr. Geeta Chopra Art work of Cover Page by Ms. Himani Gupta Art work of Guidebook 1 and 2 by Ms. Himani Gupta and Ms. Reena Eleen Thomas Published by ENGAGE Publications, New Delhi Price : Rs 80/Email- drgeeta_chopra@yahoo.com Mobile : 09811222254

Guidebook - 1 Mother and Child Care : Promoting Health, Pr eventing Disa bilities Pre Disabilities

Geeta Chopra, Ph.D Associate Professor

Department of Human Development & Childhood Studies Institute of Home Economics (University of Delhi), F-4, Hauz Khas Enclave, New Delhi-110 016

Preface In our country where the literacy rates are abysmal and child rearing practices are shrouded in ignorance, myths, gender inequities and social barriers, it becomes extremely important to make an attempt to reach out to people and provide sources of information. The current Guide Books is one such attempt. Many documented sources quote that 70% of disabilities can be prevented from happening if care is taken during prenatal, postnatal period and during the early childhood years. Knowledge of correct child rearing practices specifically pertaining to feeding, immunization, nutrition, hygiene, cleanliness etc can be a major measure in preventing the occurence of diseases and illnesses in children. If an impairment has occurred, it is important that we detect them at the earliest. Early detection of impairments and disabilities provide hope that corrective measures would be undertaken to stop the impairment to progress further. A number of research studies have shown that with little training, early detection of disabilities can be done by the community workers like anganwadi workers, auxillary nurse midwives, lady health workers etc. The current guidebooks have been written as a part of a complete Training Package for grass root level community worker with an objective to impart her necessary knowledge and skills on infant & mother care which would help in reducing the incidence of disabilities and early detection of disabilities. The grass root level workers are in constant touch with women, children and men of her community. If the community workers can acquire factual knowledge on major preventive steps, she can pass on this knowledge to the community and hence act as a catalytic agent in disability prevention. Guidebook 1 Titled "Mother and Child Care : Promoting Health, Preventing Disabilities" focuses on recounting measures for child & maternal care which would would help in preventing disabilities. There is plenty of emphasis on care of pregnant women, immunization, protection from diarrohea and its management, infant feeding, malnutrition, personal and environmental hygiene etc. Guidebook 2 Titled "Early Detection of Childhood Disabilities" is a comprehensive information source containing six chapters. The significance of early detection is underscored. One chapter each is devoted to the four major disabilities. Each of these chapters discusses the causes, early signs and screening schedules for four major disabilities. One chapter discusses services for the disabled, attitudes towards them and managing the disabled child in the family.

(i)

The books have been written for the grass root level community workers. Medical terms have been avoided and an attempt has been made to provide complete information in a comprehensive manner keeping in sharp focus the comprehension level of the learner. The language used is very simple and writing style is facile and communicative. There are frequent pauses and recapitulation points which should help the learner to side-by-side revise and assimilate the contents of the book. These books are laced with a number of exercises and ideas for activities that can be conducted in the community. It is hoped that this book would act as a complete reference on prevention and early detection of disabilities in the field and can be used for training the AWWs, ANMs, LHVs, ASHAs, MPRWs, VRWs and NGOs and also be of use for students and researchers. I hope these will serve as a useful guide in terms of providing the community workers with useful skills and suggestions, which would substantially improve her ability to intervene and make a difference in the specific area of disability prevention and its early detection.

Geeta Chopra (Author)

(ii)

FOREWORD Childhood Disabilities, its prevention, early detection and then inclusion of children with disabilities in early childhood education programmes has traditionally been viewed as an area best handled by professionals. Dr. Geeta Chopra has proved it otherwise. She has deprofessionalised and demystified this field by preparing special training module on this very special topic and by further training community workers on prevention, early detection and then inclusion of children with disabilities in early childhood education programmes using the training material which is part of the module. The stupendous effort includes 3 books, 9 charts and posters, a Disability Screening Schedule and a handful of focus group discussion situations, simulation situations and role play. All the material developed by her is duly piloted, field tested and is ready to use Book 1 â&#x20AC;&#x201C; Infant and Mother Care: Promotive Health and Prevention of Disabilities recounts measures for care during pregnancy, infant feeding practices, immunization, hygiene, diarrhea management etc. Book â&#x20AC;&#x201C; Early detection of Disabilities and Persons with Disabilities in Community discusses all major disabilities such as physical, visual, hearing and developmental, causes and early signs. Book 3 â&#x20AC;&#x201C; Stimulating Development of young Children with Disabilities at Anganwadi and at home lucidly puts forth general principles for managing children with disabilities at home and at school, presents early stimulation activities for parents and teachers. The stimulation activities in Book 3 are such that they would not only be useful for children with disabilities, but can benefit all children and strengthen any ECE program. The charts and posters are on early detection of disabilities and on management strategies if you have a child with disabilities in your Anganwadi/home.

(iii)

She has also prepared a list of institutions working in the field of disabilities in Delhi, which would be most useful for making referrals. This exercise can be done for every state, by the National Trust Registered Organization in each state. The Books are comprehensive, thorough, yet in simple language, in an easily communicative style and without too many medical terms. There are numerous illustrations, intext exercises and many ideas for activities which the community workers can undertake in their community. The entire Module is available in Hindi and English. I would like to congratulate Dr. Geeta Chopra for this mammoth body of work produced by her. It is A QUITE, CONSISTENT AND CONCERTED EFFORT which has spanned over more than a decade. The contribution made by her is unique. The user friendly training module are now available which can be utilized for training vast number of community workers like the Anganwadi workers, ASHA workers, ANMs, LHVs, NGO workers among others. Prevention, early detection and early stimulation of Children with Special Needs is now doable by training the vast force of community workers that exist in our country. How much the trained workers would contribute in human resource development of the nation is difficult to quantify. She has worked in a niche area where hardly any work is available. And in so doing carved a niche for herself. I think now, the module should seriously be considered for inclusion in the curriculum of Anganwadi workers and other grassroot level workers and the work should be upscaled so that its benefit can be accrued by the entire country. My Good Wishes and Congratulations to Dr. Geeta Chopra.

(Poonam Natarajan)

(iv)

INSTITUTE OF HOME ECONOMICS (University of Delhi) F-4, HAUZ KHAS ENCLAVE NEW DELHI-110 016 Phone: 6532402, 6510711 Fax : 6510615

Ref. No. ..............

Message It is a matter of great pride that Dr. Geeta Chopra, Associate Professor in the Department of Child Development, has brought out these publications in the form of two Practical Guidebooks entitled Mother and Child Care : Promoting Health, Preventing Disabilities and Early Detection of Disabilities and Persons with Disabilities in the Community. These Guidebooks have been written by Dr. Geeta Chopra, who has been working in the area of Childhood Disability for almost two decades. Prevention and Detection of Disability was the topic of her doctoral research wherein she designed and tested the manual on grassroot level workers for detection of disabilities in children. Many researchers have documented that upto 70% of disabilities can be prevented, if only proper care is taken during prenatal and postnatal period as well as during the early childhood. Also, if an impairment has occurred resulting in a disability, early detection becomes important for providing corrective measures at an early stage. Practical Guidebook 1 deals in detail with the preventive aspect of disabilities in childhood, at both the Pre and Post-natal stage right upto Six years. Comprehensive information is provided in the Practical Guidebook 2 for the Early Detection of disabilities in children in the community. These books are very well illustrated and written in simple language so that they can be understood by the grass root level community workers. They can act as a complete reference on Prevention and Early Detection of disabilities in children and can be used as a training manual for community workers in the area of health, nutrition and childcare. I congratulate the author for her stupendous effort in bringing out this publication and wish her all success. I recommend this manual as an excellent guide and a good reference material for one and all.

Dr. (Mrs.) K. Khanna (Director) (v)

Acknowledgements dk;Z esa ijekReu~] gks rw vki lgk;A vius vkf'k"k nhft,] eaxy gkFk c<+k;AA No work is possible until GOD wills it. If it is to happen, HE-will give you the indications, the direction, the will, the intellect and the capability to undertake that task. A project of the dimension and scope such as this one was impossible to do until it had the blessings of GOD! I am most grateful to YOU for choosing me as an instrument for this work. I feel HE is always beside me in this cause, which aims to do good to many. Thank you God. The first person that I feel I should express my deep gratitude and heartfelt thank for supporting me in this endeavour is Dr. K. Khanna, Director, Institute of Home Economics. Under her able leadership, guidance, and suport, I knew there was nothing to worry about. If ever faced with a problem, she would be there to help us out with her mature and able directions. She constantly helped me at every point. I am most grateful to her. I would like to thank Mrs. Asha Das, Former Secretary, Ministry of Social Justice and Empowerment, Government of India, whose interest in the field of Disability Prevention and Detection is well known. Her intuitive and insightful understanding of this project helped us a lot. Many suggestions given by her have been incorporated in these books. It is worth mentioning here that it was under her stalwartship that this project was sanctioned by the Ministry. We are indebted to her. Thanks are due to Sh. Rakesh Arora, Project Director, DRC Scheme, Ministry of Social Justice and Empowerment. His unstinting support for this effort went a long way in seeing this project through. The work on this project actually started with my doctoral research work. During this, the academic inputs received from Dr. I.C. Verma, Ex-Professor, Pediatrics, AIIMS, are beyond compare. He was the Supervisor for my Ph.D work and I am grateful to him for reviewing all the chapters of the guidebook. His guidance during preparing and validating the screening schedule is also invaluable. I would like to express my deep gratitude to him for his help. My thanks is also due to Dr. P. Seetharaman, Reader, Institute of Home Economics, who was also the Supervisor for my doctoral work and who constantly provided me with guidance and direction. I would like to thank Dr. S. Anandalakshmy, Former Director, Lady Irwin College, New Delhi, for painstakingly having reviewed the guidebooks in the initial stages itself. Thanks is also due to Dr. Adarsh Sharma, former Director, NIPCCD who has always encouraged me for this work. (vi)

Deep gratitude is due towards Mrs. Poonam Natrajan, Chairperson, National Trust for PWD for her intuitive understanding & appreciation of this work which comes from her long years of extensive and path breaking work in the field of childhood disabilities. I would like to thank Dr. Dinesh Paul, Director, NIPCCD for his support for this endevaour. Thanks is also due towards Ms. Vandana Thappar & Ms. Parul Sharma from NIPCCD for continuing to use this material during various training programmes at NIPCCD. I would also like to thank the Directorate of Social Welfare, Delhi for assigning AWW for training from time to time. The illustrations of the Guidebook have been made by Ms. Himani Gupta and Ms. Reena Eleen Thomas. I appreciate their efficiency in undertaking this gigantic assignment, and I am very thankful to them. I would like to thank Ms. Yukti Mullick, Co-Project Investigator for this project. She discharged the various jobs assigned to her very efficiently and intelligently. Her input has gone a long way in accomplishing the time bound goals of this project. I would like to thank my husband, Sanjay, who has staunchly supported and encouraged me at every step. Without his unfloundering and unflappable support, I may not have been able to accomplish even a miniscule of what I have. I would like to appreciate the cooperation of my lovely children, Arushi and Parth, who have, in a way, tolerated the preoccupation of their mother supportingly. Also, I would like to thank my parents-in-law, who have always been there to nurture my children. My parents, I would like to thank them, because they take so much pride in my achievements, that it really drives me to go higher and stronger! I am very fortunate to have the blessings of my entire extended family for this work.

(Geeta Chopra)

(vii)

CONTENTS

Chapter No

Name of Chapter

Page No.

Chapter 1

Introduction

1-2

Chapter 2

Mother Care

3-13

Antenatal Care of the Mother

2.1.1

Do's and Don'ts During Pregnancy

2.1.2

Messages for Pregnant Women

2.1.3

Warning Signs to be Watched

Care During Delivery and at birth

Care during Infancy and Early Childhood

14-29

3.1

At Birth

3.2

Immunization

3.3

Infant Feeding

3.4

Energy Protein Malnutrition

3.5

Maintaining hygienic conditions

3.6

Respiratory Infections

3.7

Prevention and Management of Diarrhoea

3.8

Keeping a Watch on Development During the First Six Years

2.1

2.2 Chapter 3

CHAPTER 1 Introduction In every community there are people who cannot walk around, have some body part missing or deformed, have difficulty in seeing or hearing, have fits, or find it hard to understand and learn things easily. These people are suffering from some impairment and are having a disability. These disabling conditions do not allow them to perform some functions which are considered important for activities of daily life. These disabilities therefore become a handicap for them. In every community, there are people with different abilities. One expects that out of every 100 people, about 10 will be with some disability. The major disabilities which we see around us are : l

Physical and Locomotor disability.

Hearing and Speech disability.

Visual disability.

Mental disability.

The purpose of writing this book is to communicate, that with simple care exercised during pregnancy, childbirth, infancy and early childhood years, we can rear healthy individuals. The occurence of 70% disabilities can be prevented with proper mother and child care. Even if due to some reason, a child is born with some impairment, or develops an impairment, if detected early, many steps can be taken to prevent the condition from deteriorating and becoming a handicap. Disability is known to affect the child's developmental process, it is therefore necessary to prevent, detect and treat disabilities to encourage normal process of child development. It is important to remember that children with disabilities should be considered children first. Attributing disability to evil eye, karma or divine punishment is not correct. We can instead focus on child rearing practices, controlling diseases, keeping the environment clean and hygienic and providing good nutrition. This Practical Guidebook would provide simple indicators on which community workers can be trained to prevent and detect childhood disabilities.

Exercise A.

What percentage of disabilities are preventable? Tick the correct answer. (i)

Disabilities cannot be prevented

(ii)

25%

(iii)

50%

(iv)

70%

Discuss these situations with local women. What do you conclude? Ramu was born with a missing arm. Neighbours said it was due to evil eye of a local bad woman.

Can you make a list of people in your community who are disabled? Ask the families what they perceive and understand that could have caused the disability. Name and Address

Age

Type of Disability

Probable cause as given by the family

CHAPTER 2 Mother Care If care and caution is exercised during prenatal, post-natal and early childhood years, almost 70% of disabilities could be prevented from happening. Most of the disabilities are caused due to diseases, infections, poor environmental sanitation and hygiene, malnutrition, faulty child rearing practices, ignorance and lack of knowledge about simple ways of averting diseases and disablement. This chapter would disseminate information on how a community worker, armed with knowledge on preventive measures, can act as an agent of change in improving knowledge and practices and help in the prevention of disabilities. For achieving this, a better knowledge is needed to ensure safe motherhood and delivery, good care during the vulnerable and crucial first six years of life and general information about health and hygiene, which has significant though not immediately notable impact on maintaining good health of the community.

2.1

Antenatal Care of the Mother

2.1.1 Do's and Dont's during pregnancy When a man and a woman have a sexual union, pregnancy may happen. The first indicator of a pregnancy is the woman missing her regular menstrual cycle. When menses do not happen for two months, she must visit the health centre for a checkup to get the pregnancy confirmed. The best age to have children is when the woman is between 20-35 years of age. Before 20, her body is still immature, and above 35, her own health status is not very good. Pregnancies before 20 have greater chances of resulting in premature birth, low birth weight and spontaneous abortions, while pregnancies after age of 35 years have greater chance of bearing an infant with congenital defects. The foetus in the mother's womb grows most rapidly. During the first three months of pregnancy, the body part of the baby differentiate, body organs are formed and brain grows most rapidly. Any negative influence during pregnancy specially during the first three months, for e.g. not eating nutritious food or consumption of alcohol by mother, can result in permanent damage to the body and the brain of the developing baby. Since the baby's only source of food is the mother, she should take extra diet, rich in proteins which can be obtained from milk and its products, dal, egg, meat and poultry. She should consume green leafy vegetables in addition to the usual diet that

she eats. A pregnant woman needs balanced meals which contain food that provide calorie, protein and increased Iron elements. This would ensure that the growing baby is receiving adequate nutrition. For achieving this, study the chart provided and try to follow what all she needs.

Category I Body Building Food (Protein)

Category II Protective Food (Vitamins and Minerals)

Category II Energy giving Food

Fig 2.1A

Fig 2.1B

Fig 2.1C

Pulses, beans, sprouts

Green leafy vegetables

Cereals: wheat, rice, barley, maize

Ground nuts, Coconut etc.

All other vegetables

Oil, Butter Ghee

Milk and its products

Fruits

Sugar, Jaggery

Meat, chicken, egg, fish, liver

A pregnant mother should eat food from all the categories listed above in every meal. She should also take food in adequate amount. As pregnancy advances, she may not be able to eat a lot of food in one meal. She might have to increase the frequency of food intake so that she maintains good health and provides sufficient nutrients to the growing baby.

Protect against diseases (Rubella, Mumps etc)

ec R

Go Re for gu Me lar dic al che cku ps

Use child spacing methods ke Ta n

iro d

lic

fo et

Take adequate rest and remain happy

Fig 2.2

d oi g Av kin o sm nd a ke a int f o co al

Avoid

X-Rays and medicines w ith ou t

liv er y ro om cle an pr in es en t ce he tra a o f in att ed bir en th d ins titu a n t / tio n in

consulting a doctor

ve nu id s

Ea t nc ed nu an tri d f o tiou od s

Messages for Pregnant Women

Pregnancy imposes a lot of demands on the mother's body. She should be given iron and folic acid supplements in diet and as tablet. She should try to rest periodically and remain happy. She has to protect herself against diseases like rubella, mumps, influenza, sexually transmitted diseases, and so on. If these diseases are contracted by the mother during the first 3-4 months of pregnancy, then their effect can be quite fatal and they may also lead to the birth of a child with disabilities. It is important that she should not consume any medicines without consulting the doctor. Exposure to X-rays could also harm the foetus. Some women smoke beedi and drink alcohol. They should not do this during pregnancy, because, the smoke/alcohol reaches the baby, and the baby will be born small and weak. It could also result in miscarriage or premature birth. Hence, intake of alcohol, beedi smoking and consuming drugs can be very harmful for the pregnant mother and her yet to be born infant. Pregnant woman should go regularly for health check ups. The delivery should be conducted in hygienic conditions where the hands of the birth attendent, and the blade used for cutting the cord should be clean. If this is not taken care of, it could cause tetanus to mother and child and result in maternal and neonatal death. To avert this, the pregnant woman should be given two Tetanus Toxoid injections within a gap of atleast 1-2 months in the 4-5 months of pregnancy. 2.1.2 Messages for Pregnant women l

The age range recommended for having a baby is between 20-35 years

Eat plenty of green leafy vegetables and fruits

Drink more milk and consume milk products

Protect against diseases like Rubella and mumps

Avoid X-rays and solar eclipses

Do not smoke or drink alcohol

Go for regular health check-ups (Fig. 2.3)

Two TT injections should be received during pregnancy

Fig 2.3

Take iron and folic acid tablets

Do not consume any medicines without consulting a doctor

Pregnant women should especially guard themselves against accidents and falls

Take adequate rest and remain happy. (Fig. 2.4)

Delivery should take place in a clean room and the delivery kit used should be clean one.

Fig. 2.4

2.1.3 Warning Signs to be watched Pregnancy and child birth are natural processes. However, if a pregnant woman experiences any of these problems she should immediately go to the health centre. l

If lips and tongue are very pale (this is a sign of anaemia)

If her face and feet are swollen

If she has fits (Fig. 2.5)

Fig 2.6 Fig 2.5

If she has two babies in the womb (Fig. 2.6)

If the baby has stopped moving in the womb

If the water sac bursts before she has pains

If pregnant woman starts bleeding (Fig. 2.7)

If she has history of miscarriages/difficult labour

If the previous baby born was underweight

If she has high fever or any major illness

If her height is less than 145 cms, and weight less than 45 kgs.

2.2

Care During Delivery and at Birth

Fig 2.7

Adequate care during pregnancy helps the normal birth process. Find out from the mother which local midwife would be visiting her during the delivery. Educate the woman about maintaining hygienic condition during delivery. If the baby is to be born at home, help the family to prepare the material needed for a safe delivery. The family should get several old pieces of cloth, wash them well with soap and water and then dry them on a line or a tree in sun, but not on the ground. These clothes will be used for the following purposes: l

To spread under the mother at delivery so that the baby is born on a clean place.

To wrap the new born baby in.

To put over the vulva to catch blood loss for as long as needed after delivery.

Cut four strips of cloth 20 cm long and 6-7 cm wide and boil them. Hang on the line to dry in hot sun. These are for tying the cord before cutting it.

Get a new razor blade and keep it ready without opening the packet. Keep all this wrapped in a clean cloth which will to be used during delivery time.

CONDUCTING SAFE DELIVERY

Clean and hygienic room

Clean thread

Clean hands

New blade

Fig 2.8

Soap

Clean sheet

A woman is in labour, when pain comes regularly every 10 minutes or more often. The woman feels this pain at the bottom of her back or at the bottom of her belly. With each pain, the top of her womb feels hard. A sticky jelly like substance mixed with blood comes out of her vagina. Explain to the mother that labour takes time. She should prepare for it by: 1.

Passing urine and faeces

Wash hands with soap and water

Wash the genitals

Wash the legs and feet

Put on clean clothes.

The person/midwife who is assisting with the delivery should be qualified to do so. Rules of hygiene should be observed by the person, such as l

Cut nails short

Wash hands with soap

Prepare the birth place by cleaning the room and spreading clean cloth on which mother would deliver. Cut from here

Keep the thread ready to tie the cord on both sides

Keep a new blade, and sterlising it by boiling in water for 10-15 minutes. This blade would be used to cut the umbilical cord

Obtain gentian violet to paint the cut end of new-born's cord (to prevent infection)

Umbilical cord

Cut with a clean blade boiled in water Fig 2.9

Pulling or pushing the baby to hurry the birth can cause permanent damage to the baby, and should not be allowed.

Once the baby is born, check on the following:l

The cord should not be coiled around the baby's neck. This can cause lack of oxygen and brain damage. If it is coiled, uncoil it quickly and carefully.

Baby should cry immediately after birth

Birth weight should be more than 2.5 kg.

When you pinch him, the baby should move own arms and legs

Check if the baby has fits

Colour of the baby should be pink, and not blue

At birth, the baby has moved out from the insulated environment of the mother's womb, and has still to adjust to the temperature difference. After the baby is born, clean and wrap up the baby and keep him warm. Clean both the eyes gently. Put the baby on breast milk at once, and as often as she demands. Breast milk is the best food for the baby. It is clean, hygienic, well balanced and inexpensive. Milk secreted by the mother during the first three days after birth is called colostrum and is very useful for the baby and should not be wasted. It is high in protein and antibodies and protects the baby against infections. Further, babies who are breast fed do not have constipation and are less likely to have stomach infections. In fact, infant should be given exclusive breast milk for 6 months of age. It is important to remember that the mother needs to eat more nutritious food while she is breast feeding, and she also needs more rest during this stage. It is best to continue breast feeding the infant till 2 years of age.

The milk of the mother during first three days after the delivery is especially useful and must be fed to the infant. This milk contains large quantities of anti-bodies which protect the child against infections. Mother's milk is sufficient food for infants upto 6 months of age.

A woman who has just delivered, can have normal diet. She can resume normal activity within a week after delivery, but not strenuous physical activity. She and the new born should visit the health centre about 1 month after birth. The health worker can examine both of them.

Women and married couples should be encouraged to adopt contraceptive methods which would help in child spacing. Frequent pregnancies and child birth result in weak new-borns, who have to struggle for their survival and normalcy of existence. This also puts too much strain on the mother's health, and the families economic resources. All eligible couples should be encouraged to use child spacing methods. Explaining the importance of child spacing and helping couples to select the method suited to their needs is among our tasks. In our society it is normally seen that a woman is always busy taking care of her family members. During this time she does not find it important to take care of her health and neglects herself. However, it is true that for the welfare of the family a woman plays the most important role. Therefore, for the happiness of the entire household, it is important that she takes proper quantity of food and care of her own health. Hence, she should be given equal share in the resources of the family. Only a healthy woman can make a healthy family. Discuss the following situations and statements with the local women. Put down the consensus that emerges. Situation 1: Asha is 16 years old. She has just got married. Her mother-in-law and husband want her to have a baby soon. She also feels that once you are married, babies would automatically follow. Situation 2: Urmil's fifth baby is to be born. Because the family is large and has to be fed, she has to work hard as a domestic help to earn. She eats whatever little is left after other members have finished eating.

EXERCISE-1 Q1. Outline the major factors which are important for the care of a pregnant woman. Ans. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Q2. Child spacing is important for the baby's as well as mother's health. It is within the control of married couples. Advice for this is readily available with local health centres. Comment. Ans. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------11

Q3. Mothers should eat less during pregnancy. The baby born will be small, therefore the delivery easy. Comment. Ans. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Q4. Pregnancy and child birth are natural processes. Health check-up during this time is just a fad and is actually not required Comment. Ans. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Q5. Delivery is best conducted in a dark and small room. Use of delivery kit is not required as it is difficult to use and expensive to. Ans. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Q6. Girls who are well fed during adolescence have lesser problems during pregnancy and child birth. Are girls food needs being taken care of in your community? Discuss. Ans. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Follow up Activities 1.

Make a list of pregnant women in your area.

Find out the beliefs and practices followed by them during this stage.

Find out from them the arrangements they have made for delivery. Enquire if they have contacted local mid wife/health centre.

Liaison with the ANM's of the area.

Give information on maintaining clean, hygienic conditions during child birth to local women.

Find out whether pregnant women in your community take special care for their diet. If not, then organise a meeting in the community which would also include men to tell about its importance.

CHAPTER 3 Care During Infancy and Early Childhood 3.1

At Birth

Once the baby is born check her on the following l

If her size and weight are normal (i.e. more than 2.5 kg)

If the delivery is an uncomplicated one

If the baby cried immediately after birth.

If her colour is pink (face, body, hands, feet and nails)

If the body parts are properly formed

If the baby's arms and hand are in an abnormal position, lying limply by the baby's side

Baby's bone is displaced from its normal position

Baby cries when an arm, leg or shoulder is touched or moved

If any infant suffers from any of the above conditions, then there may be a risk to his life. On finding any of these reasons, special care should be taken of such infants

Immunization

First dose (At Birth)

Second dose

Third dose

Fourth dose First Birthday

3.2

Fig 3.1

Complete Protection

At birth itself the infant's immunization should begin. Diseases are caused by germs that enter the body. Germs are very tiny and are not visible to the naked eyes. Some of the diseases caused in early childhood can be very serious. Immunization protects your child against nine such diseases which if contracted by the child can have life long disabling and debilitating consequences and under very serious conditions, even cause death. These diseases are: 1.

T.B.

Diphtheria

Polio

Whooping cough

Typhoid

Measles

Hepatitis 'B'

Rubella

Mumps

For complete protection of the child, an immunization schedule has to be followed, which is as under: IMMUNISATION SCHEDULE Vaccine

Age

Dose

BCG

At birth

One dose

Polio

At birth

One dose

Hepatitis 'B'

At birth

One dose

Polio

6 week-9 months

Three doses at monthly interval

DPT

6 weeks-9 months

Three doses at monthly interval

Hepatitis 'B'

1 to 2 months

Two doses at monthly interval

Measles

9 months

One dose

DPT

18 months-2 years

One dose

Polio

18 months-2 years

One dose

MMR

15 months-5 years

One dose

5-6 years

One dose

Typhoid

5-6 years

Two doses

It is true that immunization can result in some pain at the spot of administration and even mild fever. But this complication is minor and can be borne. The protection it provides against killer diseases is a great boon. For complete protection, the child has to receive all the vaccines as per schedule. Administration of single doses of BCG and Measles is enough. But for DPT and Polio, three doses should be administered to the child before she completes her 1st year. For accomplishing this, the role of the community worker becomes: l

To identify children who are to be immunized.

To educate the mothers about the advantages of immunization and handle misconceptions and negative attitudes related to it. 15

To inform mothers about the venue, date and time when immunization activity would take place.

To explain to them the importance of keeping the immunization records safe.

We should try our best to complete a child's immunization within one year of birth. By the time the child is one year, she should have received immunization for 1 BCG, 3 DPT, 3 Polio and 1 for whooping cough. However, if for any reason, by the age of 9-10 months, a child is yet to receive immunization, it is still not late. The immunization can still be started. Such a child can be given one dose of BCG, one for polio, one for DPT, and one for whooping cough together. Then after an interval of one month, one dose of DPT and a booster dose of polio can be given. Polio

Hepatitis Measles

Tetanus T.B.

Whooping Congh Diphtheria Mumps Rubella Fig 3.2

Given below are some common myths/beliefs/facts about immunization activities. Misconceptions and facts about immunization (1)

(2)

(3)

Misconception

Only one dose is needed to protect the child against all preventable diseases.

Fact

One dose each is sufficient for BCG and Measles. For DPT and Polio, three doses of each are necessary.

Misconception

Suppose the immunization for DPT and Polio could not be completed and there is now a long gap since the last vaccine received, one has to restart the entire schedule.

Fact

Don't worry if you are a little late. However, vaccines will be effective only after completion of all doses. For complete protection this should be done within the 1st year.

Misconception

All doses have to be received from the same health centre.

Fact

Immunization services are available at all health centres. You can produce the immunization card of the child and get her immunized from anywhere.

(4)

(5)

(6)

(7)

(8)

(9)

Misconception

Immunization should only be given in the winter season.

Fact

Vaccines can be administered in any season without harm.

Misconception

Vaccines should not be given to children younger than one year of age.

Fact

The best time to protect your child is when she is younger than one year.

Misconception

Immunization site should be immediately washed with cow dung or water

Fact

Harmful practice. This increases the chances of infection.

Misconception

Immunization makes the child impotent

Fact

There is no such side effect.

Misconception

After immunization the child falls ill with fever or has abscess formation. All these cause unnecessary trouble to the child and can be avoided by not immunization altogether.

Fact

There are some side effects, but they are not serious. It is more sensible to have little fever and discomfort for a day or two rather not to be immunized and then contact the killer diseases and face consequences like disability, debility and death.

Misconception

Immunization is only available in large cities and on payment.

Fact

Vaccines are available free of cost at all government hospitals and centres all over the country.

If the child is running moderate to high fever, or has a cold, it is better to postpone the immunization. Also, other injections should not be given until absolutely necessary. Each year upto 2 million children are paralysed by polio due to injections. Nearly all of those injections are given when they are not needed. POSTPONE IMMUNIZATION AND DO NOT GIVE INJECTION (UNTIL NECESSARY), IF THE CHILD IS RUNNING FEVER AND HAS A COLD AND INJECTION IS GIVEN AT THAT TIME, IT MIGHT LEAD TO PARALYSIS.

3.3

Infant Feeding

(A)

Breast Feeding

The new-born baby should be put immediately on breast milk right after birth For infants upto 6 months, breast milk alone is enough. As long as the infant is just on breast milk, they do not need to drink any other fluid like water. It is recommended to breast feed the baby till 2 years of age. 17

Fig 3.3

Breast milk is an invaluable gift of nature and is the best food because: 1.

It is pure, hygienic and naturally balanced food to meet the nutritional needs of the baby.

It provides the baby with antibodies which protect him against infections.

It is easy to digest and efficiently used by the baby's body.

It doesn't cause stomach problems like diarrhoea and constipation.

Babies who are breast fed display less respiratory infections.

The baby should be put on the breast as frequently as she demands. The more the baby suckles on the breast, the more milk would get available for her. One should remember that the baby's stomach is small. Therefore, she needs to be fed small quantity of food more often. In order that the baby receives adequate nourishment, the mother should eat and drink enough to produce good milk. One should feed the baby 6-8 times in a day. The mother should ensure that she receives adequate amount of food, and is not undernourished. She should also increase her intake of fluids. It is advised that the baby first empty one breast and then move to the second breast. So wait for the baby to release the first breast on her own. Then offer the second breast. Also, do not force the baby to feed. (B)

Bottle Feeding

If the mother is healthy and physically fit, she should only breast feed her baby. If due to some unavoidable reason she can not, then the baby would need to be given formula infant milk/cow's milk in a feeding bottle. If feeding bottles are to be used 1.

mothers should exercise complete care in keeping the bottles clean.

after every feed, the bottles should be washed

each new feed should be given in a boiled and clean bottle.

do not feed the baby with milk left over in bottle from the previous feed.

Wash the bottle and nipple properly

Boil

Put the cap on and keep away the bottle

Fig 3.4

How to boil a bottle Wash the bottle and put it in a container of clean water and boil it along with the teats. Boil the teats for 3-4 minutes remove. Boil the bottle for at least 20-25 minutes. Use a bottle with a wide mouth as it is easy to clean. If complete care is not exercised in bottle feeding the chances of stomach problems, respiratory infections and other infections become very high. A baby can be given the same milk being used in the house by diluting it a little. When the baby is 18

able to digest this milk, then gradually she can be fed the same without diluting it. Care should be taken that this milk has been properly boiled so that there are no chances of infection to the baby. Since the formula feeds are to be prepared, the tendency to dilute the milk or give fewer feeds leads to poor nourishment. It has been found that for bottle fed babies, the risk of diseases and death are 25 times higher than breast fed babies. As soon as the baby is 4-5 months old, begin feeding milk with cup and spoon and discontinue feeding with the bottle. Initially the baby may fuss, but gradually they adapt to this change. This reduces the likelihood of infection to a very large extent. (C)

Feeding Practices

After 6 months of age, milk alone is not enough to meet the nutritional needs of the rapidly growing baby. This is the time that gradually semi-solid food should be introduced in the baby's diet. When semi-solid food is fed for the first time, the baby may not like it and may throw it out of month. But she will adjust quickly to this added variety and soon begin to relish it. Food for the baby should be cooked hygienically at home every time she is to be fed. INFANT FEEDING

Some of the things that can be fed to an infant are as follows: l Breast Milk alone is enough for infants upto 6 l l l l l l l l l l l l l l

months

Mashed chickoo, orange, banana, l Introduce weaning foods at 6 months papaya. Boiled and mashed potato Boiled and mashed vegetables Khichri Milk/Dalia/Kheer Mashed Fruits Vegetable Soup Suji Kheer Dalia Khichri, Curd Besan, atta and suji halwa Milk, Dal, Eggs Fruit juices Carrot juice-juice of green leafy vegetables Grated and boiled apple/carrot Boiled and mashed egg (after 9 Vegetables months of age) Curd with jaggery or sugar Fig 3.15 Pulses

One can think of many other foods for the baby. You might need to add milk, water, ghee or oil to make the consistency suitable and easy to eat for the baby. The baby should gain weight every month. For this, ensure that the baby is not underfed. When properly nourished, the baby's resistance to infections remains high and she can easily fight infections and remain healthy. A healthy baby should weigh about this much and more: at

6 months - 6 Kg.

9 months - 7 Kg.

at 12 months - 8 Kg. at 18 months - 9 Kg. at 2 Years

- 10 Kg.

When the baby is about 15-18 months old she should be eating everything that the other family members are eating. Mother may have to change the consistency to make it edible for her. Whatever is being cooked for others, some can be put away for the baby before adding spices. The growth of the baby should be recorded regularly and accurately on the growth chart. Normally, each child should follow its typical growth curve. In case, the child's growth suddenly falters, like shown in the chart below, then the child should be taken immediately to the health centre for a thorough examination (Fig. 3.6).

Fig 3.6

3.4

Energy Protein Malnutrition (EPM)

If feeding of a child is not done properly, it can lead to malnutrition. Malnourished children are likely to have significantly lower cognitive development, learning achievement and physical growth. Malnutrition is a dangerous condition, of which the earliest sign is growth faltering. Malnutrition is caused due to l

inadequate food intake

diseases including diarrhoea

poor child rearing practices like delayed introduction of complementary feeding

The beginnings of malnourishment is normally at the time of weaning when a child is around 6 months old. At this time, the child may remain hungry and his nutritional requirements may not be met. In addition, the immunity of the child is very low at this time, as the antibodies received from mother at the time of birth are ending their life span and the new ones have not fully formed. At this time, he is 'at risk' of contracting diseases. The child is prone to contracting diseases like diarrhoea and other infections due to unhygienic surroundings and lack of cleanliness. If the child does not receive proper care and treatment during diarrhoea and special care is not taken of his diet, then it can result in weakness and sudden weight loss. In such a state, the child is especially prone to malnutrition. The early symptoms of EPM in infants are l

apathy-lack of interest in surroundings

lethargy

fretfulness in the child

low weight in relation to height (nutritional dwarfism)

diminished skin folds

loss of skin elasticity

These signs represent the totally preventable and reversible phase of EPM and such children are only a hair breadth away from more danagerous states of Marasmus and Kwashiorkor. Marasmus (Photo 1), one form of EPM, typically occurs in children under 1 year of age. The symptoms of Marasmus are: l

failure to thrive

irritability Photo 1

fretfulness or alternatively, apathy

shrunk child (Photo 1)

little or no subcutaneous fat

Kwashiorkor (Photo 2), the other form of EPM, typically occurs in the second year of life. The signs and symptoms include: l

failure to thrive

anorexia-lack of appetite

diarrhoea

a generalized unhappiness or apathy

odema (Photo 3A, 3B)

failure of growth is an early sign, though odema and presence of some subcutaneous fat make the weight loss look less striking.

Photo 2

wasted muscles; as a result, the child may regress in physical development and may no longer be able to walk or crawl

dyspigmentation of hair

easy pluckability of hair

characteristic moon face with protruding cheeks

flaky skin

diffuse pigmentation of the skin

Photo 3A

Photo 3B

Exercise: Discuss the following statements with the women in your community. Say whether you agree or not. 1.

Bottle Feeding is a more modern and efficient method of feeding the baby in comparison to breast feeding. It is good for the baby's health, (False).

Upto 6 months, breast milk is enough for the baby, if the mother has sufficient milk. During this time, the child does not need to be given any other fluids (True).

The milk secreted by the mother on the first three days after delivery should not be fed to the baby, since it is stale and would harm the baby (False).

After 6 months, milk is not enough for the baby. Soft food should be introduced. Food freshly prepared at home is much better than the tinned variety available in the market (True).

By the 1st Birthday, the infant should be immunized against the nine major killer diseases. Immunization is absolutely necessary and most beneficial for the child (True).

Since mothers have so many family members to look after, it becomes difficult to feed a small baby frequently. They can be fed at the same time with other members (False).

A nursing mother needs to eat nutritions food in extra quantity and drink more fluids so as to produce good milk (True).

Follow up Activities Find out (a)

What is the approximate age upto which infants are breast fed in your community?

(b)

When are semi-solid foods introduced in the infants diet?

(c)

What foods are commonly given to the infant?

(d)

Find out the knowledge and attitude of women towards breast feeding and bottle feeding.

(e)

Identify children in your community who show signs of malnutrition. Make a list. What advice would you give to parents of such children?

3.5

Maintaining hygienic conditions

Unhygienic surroundings is a breeding ground of diseases. Knowledge of keeping surroundings clean is very essential for living a healthy life. l

To ensure healthy family, mother should keep the home clean

She should keep the food stuff coverd Drinking water should be always covered

Wash vegetables before cutting

Fig 3.8

Fig 3.7

Clean water, drawn from a clean source should be used.

Drinking water should be covered, and a separate utensil for drawing out water from the containers should be used (Fig. 3.7)

Hands should be washed before cooking food

Vegetables should be washed before cutting and cooking them (Fig. 3.8)

The nails should be short and clean

Hands must be washed with soap before eating meals

Dirt and human waste should not be allowed to accumulate in and around the house as they breed flies, mosquitoes and infections.

A separate place should be built where the family relieves itself. Urinating and defeacating in the open leads to spread of diseases and also pollution of the environment.

Hands must be washed after urinating and defeceating

Brush your teeth everyday

Keep hair clean and free of lice

Avoid walking bare feet

3.6

Respiratory Infections

Colds with cough and a running nose are very common among children and in most cases, the infection is mild, and the child gets better after some days without treatment. But sometimes, the infections may become severe and referrals need to be made on time. Refer to a doctor if the child does not get better in a week, or has any of the following symptoms: l

High fever

Chest indrawing

Cough which is not dry and seems to be coming from lower down chest rather than throat.

Difficulty in breathing/rapid breathing more than 50 breaths/minute

Loss of appetite and inability to drink

Convulsions

Abnormal sleepiness

Fever and cough which do not get better in a few days.

If the child shows the above mentioned warning signs, such cases must be referred to the health centre. Pneumonia is an acute infection of lungs which develops often after other illnesses like measles and flu. In most severe cases, the child turns blue due to lack of oxygen and this can quickly lead to death.

3.7 Prevention and Management of Diarrhoea When a person has three or more watery stools in a day, it can be considered diarrhoea. In acute cases, the stool could even be green or contain blood. During diarrhoea, the body loses water and salt and can become dehydrated. In young children if this continues, it can even cause death.

DIARRHOEA IS NOT CAUSED BY

Eating more or unlimited food

Teething Evil Eye

DIARRHOEA IS CAUSED BY It is commonly found that mothers accept diarrhoea rather than prevent it. It should be Drinking dirty water carefully explained that diarrhoea is caused by Eating unclean food germs in unclean food or water and can be prevented. However, if diarrhoea begins, it results in loss of water and salt from the body causing rapid dehydration. To prevent the infant from collapsing, immediate steps must be taken Fig 3.9 to hydrate the body.

PREVENTION OF DIARRHOEA

How to prevent diarrhoea l

Wash hands thoroughly with ash or soap after defecating and before cooking or handling food.

Discourage bottle feeding for infants

Encourage breast feeding for infants

Drink only clean water

Thoroughly wash raw vegetables and fruits before eating and cooking them.

Wash hands before defectating and before eathing food

Drink only clean water

Cover cooked foods and protect them from flies.

Do not bottle feed

Wash raw vegetables properly before eating

Encourage Breastfeeding

Cover cooked food

Fig 3.10

When a baby is teething, take care to keep the floor and the baby's hands and toys clean. Since the baby has irritation in the gums, he puts everything in the mouth. Due to this, there are greater chances of the child getting stomach infections and diarrhoea. It is worth noting that it is not teething that causes diarrhoea but putting dirty things in the mouth which causes infection and diarrhoea. Diarrhoea Management 1.

An infant who has diarrhoea needs lot of fluids to drink. She could be given fruit juices, coconut water, lime water, rice gruel, dal water, light tea, whey water and so on. 2.

KEEP AWAY FROMMOSTURE

CENTRAL GOVT. SUPPLY NOT FOR SALE

Along with this, oral rehydration solution (ORS) can be prepared as follows: (a)

Take 1 glass of clean boiled and cooled drinking water.

(b)

Add two finger pinch of fine salt. Mix well. Taste the solution, it should not be saltier than tears.

(c)

Add one heaped teaspoon of sugar. Mix well.

Give sip by sip to the patient. Keep the solution covered.

Fig 3.11

While the baby has diarrhoea continue to breast feed and avoid bottle feeding.

Give soft food to the child frequently.

Once the child begins to get better, give extra food.

While suffering from diarrhoea, make sure that the baby drinks lots of fluids.

Warning signs to be watched in diarrhoea If the infants shows one or more of the following, refer immediately to the health centre: l

Sunken eyes

Sunken fontanelle

Reduced skin elasticity

Breathlessness

Fainting/Convulsion

Dry tongue and lips

No tears

No urination for 6 hours

Vomitting

Swelling of feet and face.

Important Messages l

Diarrhoea is a dangerous disease

Diarrhoea is caused by infection and not due to eating too much

It is not caused due to evil eye

Continue to breast feed during diarrhoea

A child with diarrhoea needs food

Make the child drink lot of fluids

In most cases of diarrhoea, drugs/medicines are not required

Diarrhoea can be prevented by breast feeding, keeping food and water clean, by washing hands before eating food

Dehydration caused due to diarrhoea can even lead to death of the infant

Exercise 3: Comment whether the following are correct or not 1.

Diarrhoea is caused due to overeating. When a child has diarrhoea, she should not be given any thing to eat (False).

Diarrhoea can best be managed by giving lots of fluids to the child (True)

When the child has diarrhoea, baby loses water which contains salt. These, if not replaced soon, can result in dehydration even death. Best way to prevent dehydration is by giving lots of fluids to the child (True).

Discuss these questions with local women and find the correct answer to them Q 1.

Shanti has been giving extra fluids to her baby because the baby had diarrhoea. But the baby has become weaker. Should she continue to give the extra fluid to drink to her baby?

Ans.

Yes, she should continue giving the fluids.

Q 2.

Lakshmi's baby had diarrhoea for two days. Can she obtain an ORS packet from the AWW? Suppose the ORS packet is not available, what can she do?

Ans.

She can get ORS from the AWW. She can even prepare ORS at home as explained earlier.

Q 3.

Will an ill, exhausted, dehydrated baby drink ORS?

Ans.

Yes, babies will drink it if they are fed properly with spoon and cup.

Q 4.

Does ORS stop diarrhoea?

Ans.

No, it does not stop diarrhoea. ORS replaces the essential fluids and salts. Diarrhoea eventually ends on its own.

Q 5.

Make a list of things which the mother should do while the child has diarrhoea.

----------------------------------------------------------------------------------------------------------------

Eyes should be kept clean. They should not be watery, appear dull, or have pus formation.

Provide complete immunization to the child

Child should not complain of frequent earaches/headaches.

Ears should not have pus formation

Baby should be able to do this at approximately the following ages:

Timely Introduction of Weaning Foods

Nutritious Food

Personal Hygiene

Baby should not be malnourished. For this see that the baby is fed in adequate amount and frequency.

Environmental Hygiene

Safe Delivery Breast-feeding Immunization

t en em ag an d M ea an ho on arr nti Di ve of Pre

Keep a check on general health of the baby.

Pr ev en t

dis ea se sa nd ac cid en ts

3.8 Keeping a watch on development during the first six years

Fig 3.12

Begin to sit by 9 months Begin to walk on his own by 18 months Say single words in common use by 2 years

By 2Â˝ to 3 years can say 3 or 4 words together in a short sentence eg. "all go market" etc Providing adequate care during pregnancy and early childhood years largely helps in maintaining good health and preventing diseases and disability. This should be done with greatest seriousness, zest and purposefulness to ensure that fewer children have disabling conditions which affects their lives, families and communities. If still a child has a disability, then early detection and early intervention becomes important, which would be discussed in Book-2.

Acknowledgements Some information and figures have been taken from the following sources 1.

Disabled Village Children

by David Werner

Where There Is No Doctor

by David Werner

Module for Training Urban Community Health Volunteers

Published by Voluntary Health Association of India

Training in the Community for People with Disability

Published by Voluntary Health Association of India

Feeding and Care of Infants and Children

by Dr. Shanti Gosh

Training Module for Incorporation of Family Welfare Messages

Published by National Institute of Health and Family Welfare

Nutritional Problems of India

by P.K. Shukla

Mental Retardation-A Manual for Psychologists

Published by National Institute for Mental Handicap

The Community Health WorkersWorking Guidelines for Training, Guidelines for Adaptation

Published by Voluntary Health Association of India

10.

Viklangta Ki Pehchan Ke Sadhan

Published by Ministry of Welfare, Government of India.

11.

Training Manual-Village Rehabilitation Workers

Published by District Rehabilitation Scheme, Government of India

12.

Anganwadi Workers Kit

RRTC, Mumbai

ACKNOWLEDGEMENTS

Page No.

Figure No.

Book

Page No.

3.1

Module for training Urban Community Health Workers

3.2

3.3

Disabled Village Children-David Werner

3.4

Module for training Urban Community Health Workers

26.

3.9

3.10

About the Author

Dr. Geeta Chopra, Ph.D, Associate Professor in the Dept. Of Human Development and Childhood Studies at the Institute of Home Economics, University of Delhi has been teaching for more than 25 years now. She is a keen researcher and has received funding for research from national and international agencies. She has developed a training module for grassroot level community health and child care workers on Prevention, Early Detection and Early Intervention in Childhood Disabilities. She has also authored guidebooks on 'Mother and Child Care: Promoting Health, Preventing Disabilities; Early Detection of Disabilities' and 'Stimulating Development in Young Children with Disabilities at Anganwadi and Home: A practical guide for Teachers and Parents. She has co-authored a book 'Child Development: A practical manual'. Winner of South-Asia Region-Development Market Place bid called by the World Bank, was awarded project titled Reducing maternal stressors and improving nutrition practices during pregnancy to enhance birth weight and infant survival: Designing an Innovative Intervention Package. She is guiding Ph.D students regularly. Her major interest areas are Childhood Disabilities, Early Childhood Education, Child Survival, Child Rights and Inclusive Education. She is a founder member-secretary of an NGO Manzil, which offers services to preschool children, youth and women mostly belonging to the slumdwellings of South Delhi.

Department of Human Development and Childhood Studies Institute of Home Economics, (University of Delhi) Hauz Khas Enclave, New Delhi-110016

ISBN 978-93-5087-446-2