This booklet is intended to give you a practical approach to family life. It has been written in a simple conversational style and deals with minimum basic concepts only. Our intention is not to make you a doctor- rather, we want to develop you as an aware person who knows when and where to seek help if need arises.

We hope, you will enjoy reading this book and also keep it for future reference. Your comments or questions related to this topic are most welcome. You may write to Dr Tejinder Singh, Professor of Pediatrics and Dean, Christian Medical College, Ludhiana 141008 or email at drtejinder@123india.com.

The webpage of the author is http://my.123india.com/pediatrician

Health is too important a matter to be left to chance. Staying healthy requires a deliberate attempt on the part of each one of us. The health of a family depends to a great extent on the attitudes and knowledge of the mother- whether it is feeding the child or selecting a particular cooking medium. Soon you will be entering a crucial phase in your life -that of a wife, a mother and a health keeper of the family. It is felt that if you know about certain basic concepts regarding health, it will help to a large extent in improving the health status of not only your immediate family but also of the society and the nation.

The material is intended to provide you with certain essential information regarding various aspects of health and we are confident that after reading and assimilating this information, you will be able to lead a healthy and a fruitful life.

Your Diet

The food that you consume serves a variety of purposes. It helps in growth and maintaining life. The basic elements of our diet can be classified as

• Carbohydrates
• Proteins
• Fats
• Micronutrients like vitamins and minerals.

Carbohydrates provide energy, proteins provide the building blocks for the body and fats provide the "packing material" in addition to being a reserve source of energy. Vitamins and minerals serve a variety of functions. Iron is required for making of blood cells while calcium is needed for healthy bones and teeth. It is not our intention to go into the finer details of various dietary principles. What we want to emphasize is that you are at a very crucial stage of growth and the foundations that are built now are going to persist throughout your life.

For a healthy growth you must consume a balanced diet. A balanced diet is one, which provides all the nutrients required by the body in addition to providing little extra for reserves. If you eat adequate amount of various foods like wheat, rice, pulses, green leafy vegetables, cheese and curd, your body will get adequate amounts of these nutrients. You should be aware that during this age, most of you might appear slightly obese-the solution to doesn't lie in drastic dieting. Rather, you should try to cut down on fried foods, chips, chocolates, ice creams and cold drinks. If you starve yourself, you may become deficient in essential nutrients.

Adequate amount of homemade diet usually provides full requirements of various nutrients and if you are consuming such a diet, you don't have to be bothered about consuming vitamins and tonics. The only exception to this is the supplementation of iron, even for apparently healthy persons. If you look at your tongue in a mirror, it should have a slightly pink color. If it looks pale, it indicates presence of anemia. In such cases, it is advisable to consult your doctor, who will get certain blood tests done and prescribe appropriate medications.

Marriage:

Marriage is the first step towards beginning of a family. Marriage places an additional responsibility on you and therefore, it is very important to you are prepared physically as well as mentally to shoulder those responsibilities. Most often, early marriage results in early pregnancy and places the burden of motherhood on a girl who herself has not enjoyed life. Scientific research has shown that that if the mother is too young, her children are weak and die more often. It is therefore, advisable to defer marriage till you are at least 21 years of age so that you complete your own physical and psychological development before entering into motherhood.

Planning The Family:

One of the major problems of India is the population explosion- in fact, we keep on adding another Australia every year to our population. Within a short period, our natural resources are likely to give way and therefore, each one of us has the obligation to contribute to the solution of this problem. Family planning refers to the practices, that will help in not only avoiding unwanted pregnancies but also help in timing of wanted births. Research all over the world has shown that child mortality, growth, development and even intelligence is related to family planning. Problems associated with a young mother have already been explained to you. Pregnancies after 35 years of age are also risky. Thus family planning can be used to maintain the quality of life.

A variety of methods are available for this purpose- the important ones include condoms, copper-T and contraceptive pills. Each of these individual methods has its own advantages and disadvantages. Family planning advice is now easily available at most health centers and even some good written material is also available on this aspect. After your marriage, you can approach your doctor, who will guide you regarding the various methods that are available and help you in making a choice that will be best suited for you.

The general recommendations regarding family planning are to delay the first pregnancy and space the second to an interval of 3-5 years. This will help you in not only giving full love and attention to your first child but also help you to regain your own health.

At times, family planning methods may fail causing an unwanted pregnancy. In such cases, one should never try drugs or other such methods to induce abortion on the advice of a friend or neighbor - rather, one should approach a qualified doctor. Abortion is now legal in India and this service is available at most health centers and nursing homes, either free or at a very nominal cost.

Antenatal Care:

Pregnancy is a normal physiological state but the complexity of anatomical and physiological changes that accompany pregnancy tend to stigmatize it as a disease process. However, as already stated, even though it is a normal process, it requires a deliberate attempt to maintain it in a normal state.

The systemic supervision of the woman during pregnancy is called antenatal care (ANC). The objective of ANC is to ensure that every pregnancy culminates in the delivery of a healthy child without having any adverse effect on the health of the mother. The secret of ANC lies in frequent examination of the mother by the health worker and preferably by a child specialist. This ensures that not only any complication of pregnancy is recognized and treated early but also at the time of delivery, the attending health worker is fully aware of the problems that the mother or baby is likely to encounter.

ANC should begin in the first few months of pregnancy and should continue till the end of it, with at least one monthly visit. During such visits, weight, blood pressure and growth of the baby inside the uterus is monitored. Important conditions like diabetes, heart diseases, kidney diseases etc are excluded or treated if present. Mother's hemoglobin, blood group and urine are also tested.

One of the most important inputs during ANC is immunization of the mother against tetanus, which protects the baby also. During first pregnancy, a mother is given 2 doses of tetanus toxoid at an interval of 4-8 weeks while during subsequent pregnancies only one booster dose is required. Supplementation of iron and folic acid is given for an average duration of 3 months, which also helps in improving the weight of the baby.

A pregnant woman has to observe certain precautions and you should be aware of these. All unnecessary drugs should be avoided, especially during the first three months of pregnancy as they can harm the baby. Similarly, x-rays of the mother are also risky. Be aware that till date, there is no such drug, which will help in producing a male baby. Most of the drugs used for this purpose can significantly harm the unborn baby.

It is a common practice these days to get the sex determination of the baby done and in some cases, if the baby is female, this is followed by abortion. This practice is against nature and you can become a supporting pillar by actively resisting such practices.

Deliver:

Safe delivery is the culmination of pregnancy and a slightest mistake at this time can ruin a life. The duration of a normal pregnancy is between 37-41 weeks (calculated from first day of the last menstrual period). As far as possible delivery should be conducted by the same health worker who has been following the mother during pregnancy. This is specifically important if the outcome of the previous pregnancy has been unsatisfactory, the mother has developed high blood pressure, there are twin babies or some operative intervention is required. There are certain danger signals near the time of delivery and you should be aware of them. If anyone of is present, the health worker should immediately be contacted. These include: -

• sudden decrease or increase in the movements of the baby
• onset of labor pains before ninth month
• bleeding
• rupture of "bag of water" for more than 24 hours.

A normal delivery consists of 3 stages. In the first stage, which lasts about 8-16 hours in the first pregnancy, there is a progressive increase in labor pains. During the 2nd there is delivery of the baby while during the 3rd stage there is expulsion of the placenta.

Feeding:

A full term baby is in the position to suck immediately after the delivery- therefore as soon as the mother has recovered from the rigors of labor the baby should be put to breast. During this time, a thick yellow liquid called colostrum is secreted from the breasts, which provides a lot of energy to the baby and also protects it from infections. The suckling movements by the baby help in augmenting milk production. You will appreciate that putting the baby to breast as soon as possible is crucial for later success of breast-feeding. Even where delivery has been following an operation, the baby should be fed as above.

In many communities, there is a practice to give water, honey, cow's milk, ghutti, or similar substances to the baby before putting him to breast. Others give a bottle- feed for initial 2-3 days. There is no scientific basis for these practices and they may harm the baby.

The baby should be exclusively breast fed for first 3 months. Many mothers tend to give one or two bottle feeds during this time on the mistaken belief that otherwise the baby will not accept the bottle later on. This belief is totally unfounded. ? You should appreciate that the poison will be poison whether given once a day or five times a day. Breast-feeding has many advantages. It provides the right amount of milk of the right composition at the right temperature. It eliminates the need for repeatedly boiling the bottles especially at night or when you are going out. It protects the baby against diarrhea, pneumonia and other infections during early life. It has also been shown to protect high blood pressure and heart attacks during later life. It increases the emotional bonding between mother and child and also helps the mother in losing the extra weight gained during pregnancy.

There is a belief among the educated class that breast-feeding will spoil their "figure". There is no basis for this- a mother who is breast-feeding regains her pre-pregnancy weight more rapidly than the other who is not. Use of a well fitting brassiere will help in maintaining the shape and the figure.

Most babies require a feed every 2 to 3 hours but if any baby demands it early, it shouldn't be denied. Another point that you should remember is that the baby cries because of many reasons other than hunger. That the baby cries even after a feed should be no excuse to shift him to bottle. Adequate weight gain in a baby points to adequacy in breast milk.

In certain very rare situations the doctor may advice you to withhold breast feeds. In such situations cow or buffalo's milk is the next best and one does not have to use costly powder which does not offer any distinct advantage. Most babies including newborns can be fed using katori and spoon and as far as possible use of bottle should be avoided. Remember the old saying" Break the bottle and spare the child".

By about 3 months of age, the baby should receive supplementary semi-solid foods. Khichdi, egg, potatoes, banana, dal or rice can be used according to availability and choice. Tinned weaning foods are highly expensive and offer no distinct advantages. The diet of the baby should be gradually increased and almost anything cooked in the house (except peppers and spices) can be given to the baby. Soups, costly fruits, almonds etc. are not essential dietary elements. By one year of age the baby should be taking almost half and by the age of 3 years almost the same amount of diet as his mother is taking.

Routine supplements of tonics and vitamins are not necessary for most babies. However six monthly administration of vitamins A and D and daily administration of iron will help the baby in maintaining good health.

Sometimes the baby may fall sick or have diarrhea. In such situations do not try to reduce the die of the baby. Similarly you may have heard of hot and cold foods. There is no scientific basis for such classifications and the diet of the baby should not be restricted because of these beliefs.

Immunisation:

Immunization is an effective means of preventing many diseases in a cost-effective way. This can be illustrated by a simple example- it costs only Rs 10 to get injected against typhoid but it may cost over Rs 1000 to treat a patient of Typhoid.

In our country, the government has launched a program under National Immunization Mission, which aims to immunize each and every child in our country. It goes without saying that success of this program to a large extent depends on your co-operation. If all mothers take their children for regular immunization, we will soon be able to control many infectious diseases and the amount which is spent on their treatment can be saved and can be used for constructive development work.

The facilities for immunization are available at all government hospitals and most private clinics. There may be slight variation in the immunization schedule followed at these hospitals. We are telling you the schedule, which is recommended by the Indian academy of Pediatrics and the Government of India.

Vaccine:

BCG and OPV -- 1 dose each
DPT and OPV -- 3 doses each (6 weeks,10 weeks, 14 weeks)
Booster at 1 1/2 years, 5 years
Measles and OPV -- 1 dose each (9 months)
(OPV stands for Oral Polio Vaccine)

In addition, vaccines for rubella, mumps, typhoid, hepatitis and brain fever are also available and can be given to the baby is advised by the doctor. You should remember that getting booster doses every few years is very important to maintain the protective effect of the vaccines.

After getting a vaccine, a baby may have slight fever and swelling which are normal accompaniments. Mild fever, cough, cold, or similar illnesses are no contradictions to administration of a vaccine.

It is imperative that a record of immunization received by the baby is maintained and presented to the doctor whenever the baby is shown for any reason.

The cards that are available for this purpose have a provision for regular recording of weight also, thus giving a good opportunity to know about the health status of the baby.

Let's Sum It Up:

In the preceding sections, we have attempted to give you a broad view regarding various aspects of health concerning the mother and the baby. It is possible that in some instances, you may want to know more than we have told and we would welcome any discussion on any of these or related aspects of health.

Maintaining good health requires a deliberate attempt and you as a fortunate mother can play an important role. You should give due attention to your diet. Try to defer your marriage till you are 21 years of age. There are many methods of family and the nearest health worker can be approached for guidance in this regard. Similarly during pregnancy, maintain contact with your health worker so that deviations from normal can be recognized and treated at the earnest.

Breast-feeding remains the best not only for the baby but also for the mother. Continue it for atleast 3 months after which semi-solid foods should be added to a baby's diet. Homemade natural foods should always be preferred over artificial and tinned commercial products.

The immunization schedule should be followed and a proper record of the same should be maintained. Do not hesitate to contact your health worker in case you have a doubt or a query on any of these aspects.