CP

							CP/01(P).ENVIRONMENTAL & PERSONAL HYGIENE PRACTICES OF MOTHERS’
OF CHILDREN LESS THAN 5 YEARS OF AGE IN CHANDIGARH.
Parmar VR, Parmar S, Singla M., Basu S.
Department of pediatrics GMCH Sector 32-B Chandigarh,

Objective: a. To study the hygiene behavior of mothers of children less than 5 yr of age
attending Pediatric OPD.b.       To compare the practices of mothers of children presenting with
diarrhea with those presenting with other illnesses. Study setting & design: Prospective care control
study in Pediatric OPD from April 2003 to august2003 Methods: Mothers accompanying children
below 5 years of age attending Pediatric OPD for any ailment were interviewed. Results: Out of 231
mothers, 100 mothers had children presenting with diarrhea (Group I) and 131 with other illnesses
such as ARI/ Immunization visits (group II) There were 166 boys and 65 girls. 57% of children
were below 12 months 24% between 13-2 years and 18.9% between 2-5 years of age. 44.5% (105)
mothers were urban (37 in group I and 68 group II) and 54.5% (126) were rural (63 group I and 63
group II). Sex distribution in group I and II was similar. 26% mothers in group I (8% urban
vs.36.5% rural) & 26.6%mothers in group II (4.4% urban vs.22.2%rural) were illiterate, being
significantly higher in group I Although tap water was available to 75% house holds in group I
(97% U v/s 62% R) and 79% in group II (94% U v/s 63.4% R) but, its unhygienic storing and
utilization was prevalent in urban and rural mothers {54% group I (43% U vs. 60.3% R)and 52% in
group II (38% U v/s. 67%R)}. 27% of rural mothers in each group used open fields for defecation
and 28.6% and 25.4% respectively in group I&I I used community toilets. 40% rural mothers(46%
group I & 34% group II ;p<0.05) made their under five children defecate in the courtyards/ open
house drains. 37.2% rural (36.4% group I & 38% group II) & 13% urban mothers cleaned hands
only with water after visiting the toilet/cleaning their children. Proper hand washing before eating/
preparing food was being not being practiced by 28.5% of rural mothers (30% group I &27% group
II) in comparison to 3-4% in urban mothers in each group respectively. Similarly 31%rural mothers
(33% group I &28% group II) did not wash hands of their children before eating. Long and dirty
nails were supported by 36.8% mothers in group I (32. % U vs. 41%R) and 21% in group II (27% U
vs. 14%R) 15%ruralmothers (11% group I and 19% in group II) did not wash the fruits and
vegetables before consumption & 19% of them (21% group I and 18% in group II) often bought &
gave cut fruits and vegetables to their children. Cooked food was kept uncovered by12% of them.
Consumption of road side candies in rural mothers in both the groups was significantly high
(33%grouI&35% group II) than (16%). in urban mothers 41% rural mothers (48% group I & 34%
group II) used bottle for feeding and the bottle hygiene was poor in 72 %( 79% group I & 64%
group II). The corresponding figures in urban mothers were 53 %( 50% group I & 55% group II)
and poor bottle hygiene 43% (36% group I &50% in group II).Most of these mothers started bottle
feed before 6 months age. Conclusions: Poor hygiene prevailed among rural and also in low literacy
urban mothers, and was higher in Group I.
CP/02(O).ARE OUR SCHOOL LATRINES CHILD FRIENDLY?
T. M. Ananda Kesavan, V.K.Parvathy:
Dept. of Pediatrics, Govt. Medical College, Thrissur

a) Introduction:One of the 10 Commandments of the Child Friendly School Initiative (CFSI)
Programme is that there should be an adequate number of hygienic toilets.
(b) Aims & Objejectives: The situation of school latrine in many schools are very bad.As a part of
CFSI programme we inspected the school and checked the toilet and latrine facilities (c) Material &
Methods We conducted a survey in 52 schools during July 2005 to February 2006. Both high
schools and UP schools were included. 73% of them were private or aided schools. This is our
report on the sanitary facilities in these schools. d) Results: 62% of schools have good toilets. The
majority of them are in the private sector, and latrines are cleaned 2-3 times a week. 9 private
schools had made arrangements for cleaning the latrines after each interval. Toilets in Govt. schools
are poorly maintained and there are schools where toilets are not cleaned for the entire academic
year. We observed that in many schools: Number of toilets is totally inadequate No continuous
water supply No proper doors No toilet facility in first floor Only one school had provision for
disposing of sanitary pads Lack of health educationUsing it as a place to smoke, or for waste
disposal (e) Conclusions. 1) Adequate number of toilets (1 urinal for 60 students, 1 latrine for 100
students, Separate for girls and boys) 2) Daily cleaning (Cleaning agent need not be costly
detergents) 3) One teacher should be appointed by the PTA to supervise the toilet cleaning 4)
Health education to students and PTA Members.

CP/03(R).PREVALENCE OF SEBORRHEIC DERMATITIS IN INFANCY
Lt Col Amarendra N Prasad, Col (Mrs) Mukti Sharma
Deptt. of Pediatrics, Military Hospital, MHOW, Indore - 453441

Objective: Seborrheic dermatitis and pityriasis capitis (cradle cap) are common in infancy. Many
infants with the condition are not brought to the attention of the medical services and the precise
incidence is unknown. In the majority of cases it is a benign self-limiting condition, which usually
clears spontaneously during the first 12-24 months of life, but in a small number it can be
particularly troublesome and require treatment. Seborrheic dermatitis in infants occurs
predominantly on the scalp and upper face producing an appearance, which may give rise to some
concern from parents. Methods: Four hundred and fifty consecutive newborn infants reporting to
well-baby clinic of the pediatric outpatient department during three years were studied
prospectively. Diagnosis of seborrheic dermatitis was made on visual examination and clinical
grounds. Results: In our survey of 450 infants, the overall age- and sex-adjusted prevalence of
seborrheic dermatitis was 10 percent in boys and 9.5 percent in girls. The highest prevalence
occurred in the first three months of life, decreasing rapidly by one year of age. Most infants (76
percent) had minimal to mild seborrheic dermatitis. Pityriasis capitis occurred in 40 percent of the
infants examined. Conclusion: Seborrhoeic dermatitis is a common benign condition of infancy
(occurs more frequently in infants within the first three months of life). Often the most appropriate
treatment is to do nothing, however, children with scalp seborrhoeic dermatitis still make regular
presentations to paediatric outpatient clinics with disease burden enough to warrant treatment.
CP/04(R).TUITION EDUCATION IN PRE SCHOOL CHILDREN: IS IT JUSTIFIED?
Ravinder K. Gupta, Ritu Gupta, B.R. Gupta
Child Care Centre, 136, Nai Basti, Jammu Cantt., (J&K) - 180003

Objective:To study various health and behavioural problems due to the tuition
education in preschool children. Design: Prospective study. Setting: Pediatric clinic.
Methods: About five hundred (< 6yrs) preschool children from various schools in urban and
periurban areas who used to get tuition education were taken for the study over a period of one year
i.e. May 2005 to April 2006. These children were coming for routine check up or for vaccination in
Pediatric clinic. The parents were taken into confidence and given a pre-structured performa.
Besides age, sex, socio-economic status, educational status of parents, these parents were asked
about the timing of tuition education, place of tuition (at home or away) and reasons for it. Various
health and behavioural problems of these children were assessed. Health education and counselling
were done. Results: There was a definite male predominance (M : F ¡ú 1.4 : 1). About 24%, 33%
and 47% children belonged to 2-3 year, 3-4 year and 4-5 year age group respectively. About 37%
children belonged to joint family. Majority of parents (87%) were having education above higher
secondary. There were about 42% working parents. Majority of children (67%) belonged to families
where per capita income ranged from Rs. 5000 to Rs. 15,000/-. Tuition education to the children
used to be imparted at home by about 12% parents, while rest of children were going away from
homes and the distance from home ranged from 100 meters to 4 kilometres. The timing of tuition
used to be 3 pm - 4 pm in 20%, 4pm - 5 pm in 23%, 5 pm - 6 pm in 32% and 6 pm - 7 pm in 25%.
The various reasons given by parents for tuition education were: - to gain knowledge (62%), to
revise whatever taught in school (52%), to avoid nuisance at home (48%), social status (42%),
working parents, and unable to give time to their child (34%), not satisfied with the school
education (34%), preparing the child for better and big formal school (32%), no one at home to look
after (32%). The various health problems observed were overweight (52%), obesity (32%),
musculo-skeletal problems (28%), recurrent chest infections (24%), poor appetite (22%), vomiting
(18%), scabies (18%), eye problem (18%), dental problems (12%) etc. The behavioural problems
observed were disturbed sleep (24%), temper (22%), teeth grinding (14%), thumb sucking (14%),
stuttering/stammering (12%), pica (10%), school phobia (6%), night terrors/dreams (6%).
Conclusions: - Tuition education in pre-school children is not justified, as it is definitely detrimental
to both physical and mental health. Behavioural changes depict sense of insecurity in the child.
Prolonged separation from mother in early childhood is not advisable. The issue of tuition education
in early childhood needs to be discouraged especially by the pediatricians and also by educationists
so that specific strategies can be developed at home so that the early childhood education should be
friendly and enjoyable.
CP/05(P).CLINICAL EXAMINATION OF ASYMPTOMATIC SCHOOL CHILDREN IN A
SCHOOL IN A SEMI URBAN AREA OF BHUBANESWAR
Samarendra Mahapatro
Department of Paediatrics, Hi-Tech Medical College & Hospital, Bhubaneswar

AIM: To find out asymptomatic clinical findings in a government school in semi-urban area of
Bhubaneswar. MATERIALS AND METHODS: The study was conducted in academic year 2004-
05. Two hundred and ninety-nine students aged between 9-15 yr were studied. Out of which 146
(48.82%) were males and 153 (51.17%) were females. Detail clinical examination with present and
past history were noted on a specific proforma. Students having any congenital cardiac and chronic
neurological diseases were excluded. Students were from low socio economic status.
OBSERVATIONS: Though the students seem to be healthy but a large number of relevant clinical
findings were obtained. The commonest finding was Pallor (28.0%), followed by Dental caries in
17% of students. Bitot‘s spot was noted in 11% of cases. In 16% of students had cervical
lymphadenitis. Enlarged tonsil was detected in 7% of students. Acute respiratory tract infection and
Angular stomatitis were noted in 2% of students. Chronic infection like CSOM, Asthma, and
Scabies were detected in each 1.3% of cases. CONCLUSION : 1.Parent counselling is required to
give medical attention to the diseases which did not affect the daily activities of their
children.2.Regular Dental check up.3.Improvement of nutritional diet by modifying the diets which
are locally available to prevent anemia and Vit-A deficiency.4.Regular ENT check up is required to
prevent CSOM. General hygiene to be taught to the students to prevent skin diseases.

CP/06(P).PREVALANCE OF OCULAR DISORDERS IN SCHOOL CHILDREN IN RURAL
ORISSA
Samarendra Mahapatro, Ashok Kumar Nanda.
Department of Paediatrics, Hi-Tech Medical College & Hospital, Bhubaneswar

OBJECTIVE: To analyze the ocular health status of school going children between 9 to 15 years of
age in 3 villages present within 30 km. from Bhubaneswar and to detect causes of visual impairment
and blindness.
DESIGN: A cross sectional study. MATERIAL AND METHODS: The study was conducted
between April 2006 and June 2006 from 3 schools in 3 different villages present within 30 km. from
Bhubaneswar. The children were mostly from low or middle socio economic background. All
children were screened by us and an Ophthalmic Assistant and those detected to have either sub
normal vision or any ocular findings were referred to the Medical College for reexamination &
management. RESULTS: Out of the 976 children screened 513 (52.56%) were boys and 463
(47.43%) were girls. A total of 166 (17%) were found to be having visual impairment. Mild visual
impairment (vision between 6/9-6/18) was present in 126 (75.9%) students. Moderate visual
impairment (vision between 6/24-6/60) was seen in 32 (19.27%) students. Server visual impairment
(blindness as defined by WHO) was seen in 8 (4.8%). Out of the 166, 122 children were followed
up in hospital. 5 students (4.09%) were hypermetropic and 117 students (95.90%) were myopic. All
children did improve with glasses to obtain a vision of 6/9 or more except 7 ( 3 children who were
found to have amblyopia in one eye, 2 children due to corneal scar, 1 having developmental cataract
and one having coloboma of iris, choroid & retina). Vit-A deficiency (Bitot‘s spot & conjunctival
xerosis) was seen in 39 students (3.99%). Allergic conjunctivitis was seen in 4% of children.
CONCLUSION: As visual impairment is high in school children, periodical Opthalmological check
up is required. School health check up can be a cost effective modality for screening and early
intervention of ocular diseases. More over correcting visual impairment in children will improve
their productivity and performance. So teachers need to be oriented to and educate the importance
of ocular health, screening for early detection of ocular diseases and prevent serious compilations.
CP/07(P).INTERVENTION PROGRAM FOR ENHANCEMENT OF COMMUNICATION
SKILLS OF INTERNS OF SETH G.S. MEDICAL COLLEGE & KEM HOSPITAL, INDIA.
Milind S. Tullu, Henal R. Shah, Keya R. Lahiri, Shubhangi Parkar
Departments of Pediatrics & Psychiatry, Seth G.S. Medical College & KEM Hospital, Mumbai.

Aims & Objectives: 1. To assess the attitude of interns (as a doctor) as regards communication
skills before & after introduction of a planned intervention program (directed at enhancing
communication skills); & 2. To assess their ability for effective communication before & after the
intervention. Methods: Setting- Pediatric department of tertiary care teaching hospital. Type-
Prospective study. Study period- 2 months (Mar-Apr 06). Communication Skills Attitudes Scale-
CSAS (positive attitude scale-PAS & negative attitude scale-NAS) was administered at beginning
of 1 month clinical posting. Interns were observed by 2 judges (MST & HRS) as they interviewed
parent of admitted Pediatric patients (using Modified Amsterdam Attitude & Communication Scale-
AACS). A module-based intervention (aimed at improvement of communication skills; consisting
of lecture on underlying principles & role-play) was carried out (duration 1.5 hrs). CSAS & AACS
were repeated after the intervention (at end of posting). Statistical methods- Pearson correlation &
paired ‗T‘ test (SPSS 10.0). Results: 1. Demographic data- 25 interns (avg. age: 22 years; 16 males
& 9 females) enrolled. 2. CSAS (PAS)- There was significant (p<0.001 ‗T‘ test & p<0.016 Pearson
correlation) increase in positive attitude after the intervention (pre-intervention score of mean 51.8,
range 41-58, median 52 and post-intervention score of mean 55.2, range 48-63, median 55). 3.
CSAS (NAS)- There was significant (p<0.004 ‗T‘ test & p<0.012 Pearson correlation) decrease in
the negative attitude after the intervention (pre-intervention NAS Score of mean 33.08, range 29-40,
median 32 and post-intervention NAS Score of mean 30.84, range 24-35, median 32). 4. AACS
(Combined average scores of both Judges, MST & HRS)- There was significant (p<0.002 ‗T‘ test &
p<0.001 Pearson correlation) improvement in average total AACS scores post-intervention (mean
pre-intervention score of 42.32, range 34-52.5, median 41 and mean post-intervention score of
61.42, range 53-68, median 62.5). Conclusions: 1. Significant improvement was noted in attitude of
interns (as regards communication- CSAS) after the intervention (with increase in positive attitude
& decrease in negative attitude). 2. Significant improvement was noted in communication skills of
the interns (at observed interviews- AACS) after the intervention. 3. Module-based intervention is
effective in improving attitude & communication skills among interns.
CP/08(R).AWARENESS OF HEALTH CARE WORKERS REGARDING PROPHYLAXIS
FOR PREVENTION OF TRANSMISSION OF BLOOD-BORNE VIRAL INFECTIONS IN
OCCUPATIONAL EXPOSURES.
Milind S. Tullu, Keya R. Lahiri, Akshay Baheti
Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012.

OBJECTIVES: To study and compare the awareness regarding transmission and post-exposure
prophylaxis (PEP) for prevention of transmission of HIV, HBV (Hepatitis B virus) and HCV
(Hepatitis C virus) amongst medical (Resident medical officers/ RMOs and interns) and
paramedical professionals (nurses and technicians). METHODS: 304 RMOs, 100 medical interns,
201 nurses and 50 technicians answered the pre-designed questionnaire. The responses were
analyzed as percentages. Inter-group comparisons were performed using the chi-square method
between junior & senior RMOs, RMOs & nurses, RMOs & interns and RMOs & technicians.
RESULTS: Knowledge about the fact that the exposed site must be immediately washed with soap
and water was higher in RMOs and interns (73% and 83% respectively) than in nurses and
technicians (40.8% and 58% respectively). Knowledge about whom to contact for PEP was good
among RMOs, interns and nurses (55.9%, 83% and 57.2% respectively) but low amongst
technicians (20%). 18.1% of the RMOs, 24% of interns, 19.4% of nurses and 10% of technicians
have had prior occupational exposure. CONCLUSIONS: Knowledge base of the nurses and
technicians lagged behind the RMOs. The knowledge of interns was comparable, and in many
aspects better than that of RMOs. The knowledge base of junior (1st and 2nd year) and senior (3rd
and 4th year) RMOs was similar. Sensitization of medical & paramedical personnel and regular
reinforcement of the measures to prevent transmission of blood-borne viral infections is important
for prevention of transmission of these infections.

CP/09(P).HEALTH CARE SEEKING BEHAVIOR AFTER SEIZURE IN CHILDREN
Sandeep B Bavdekar, Professor and Rahul Ghule, MBBS student
Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai 400012

Introduction: Hardly any Indian data is available regarding practices employed by parents for
preventing injuries and aspiration and controlling convulsions in children. Aims: To describe the
healthcare-seeking behavior and practices employed by parents when a child has convulsions
Material and Methods: Inpatients aged 1mo-12yr admitted with history of convulsions were
enrolled prospectively. A pre-tested questionnaire was used for eliciting information from parents
regarding demographic characteristics, time lag, preferred healthcare provider and measures taken
in a convulsing child. Results: The study enrolled 140 (M:F=1.46:1; 76 with first episode) Forty
nine of 64 children with subsequent seizures had previous contact with a healthcare provider. The
median duration of seizures was 10min (Mean: 54.15+/-366.39min); but children were brought to
the hospital after a median of 2hr (Mean: 5.22+/-10.37hr). At home, measures such as smelling
onions, oral administration of cold water, reading religious texts and insertion of mouth gag were
taken. Although 45 of the 49 parents with previous contact with a healthcare provider agreed that
they were informed about measures to be taken, none of them could remember more than one
measure for preventing injuries and aspiration and controlling seizures. Only four narrated ―per-
rectal administration of diazepam‖ as a measure; although only one implemented it. Only four
general practitioners used per-rectal diazepam to control seizures. Conclusions: There are gaps in
the knowledge of and practices followed by parents and general practitioners for managing children
with convulsions. Children reach healthcare provider after a considerable delay putting them at
higher risk for developing neurological sequel. There is a need to develop appropriate strategies for
disseminating information about ―first aid‖ measures and steps for controlling convulsions and
imparting relevant skills to parents.
CP/10(P).LOW BACK PAIN IN SCHOOL CHILDREN: ASSOCIATION OF BAG
WEIGHT, OTHER MECHANICAL FACTORS AND PSYCHOSOCIAL FACTORS
Shravan Mehra
Apollo Cener for Advanced Pediatrics,Apollo Hospitals,Mathura Road, New Delhi

Aims: Low back pain (LBP) in school children with no apparent clinical cause is a common
problem, but very little is understood regarding its etiology. Moreover there is no published data
from the Indian subcontinent. We looked at the prevalence of LBP in adolescents and the role of
mechanical and psychosocial factors (emotional, behavioral problems, other somatic complaints).
Methods: A cross sectional, prospective study was done in 1,134 school children aged 10 15 years.
Pain was ascertained using a modified questionnaire of Fairbank et al. A self-questionnaire, and
parent questionnaire were also administered; height, weight and weight of school bag were
measured Results: The incidence of back pain was 38.3%. LBP was significantly associated with
age (p = .004), height (p<.001), emotional problems (p =.0012), conduct problems (p=.04),
troublesome headaches (p<.001), abdominal pain (p=.001) and leg pain (p<.001). Median bag
weight was 8 kg, with 60.2% bags weighing > 6kg. 77.3% children carried bags > the recommended
10% of body weight. Children carrying bags 10% or more of their body weight had higher
frequency of LBP. (p=0.024). Other mechanical factors like physical activity were not associated
with LBP. On multivariate analysis, headache, leg pain and bag weight carried (% body weight)
were found to be independently associated with LBP. Conclusions: The results suggest that LBP is
common in North Indian school children, and is associated with both mechanical (% body weight
carried) and psychosocial factors. Further, LBP is most common among children reporting other
frequent childhood symptoms and may be a marker of somatisation.

CP/11(O).STUDY OF THE BEHAVIOURAL PROBLEMS                               IN SCHOOL          GOING
CHILDREN (AGE GROUP 6-18 YEARS)
Dharmendra Kumar Gupta, S.P. Goel, R.Tuli,Samyak Jain
Department of Paediatrics, LLRM Medical College, Meerut

Objective: To find out the occurrence of behaviour disorders/problems and its relationship with age,
sex and socioeconomic status in normal school going children aged 6-18 years of Meerut. Method:
400 children between 6-18 years attending the Paediatric OPD and studying in various public
schools in Meerut were randomly selected and arbitrarily divided into 2 age groups of 6-12 and 12-
18 years and screened for aggressive reactions, withdrawal reactions, sexual problems and deviation
of behavioural problems in children with history of risk factors. Gupta and Mahajan classification,
modified into 3 socio-economic status (SES) of upper (>1500), middle (500-1500) and lower
(<500) was used. Results: In aggressive reactions, commonest problem was disobedience (22%)
followed by lying (14%). Disobedience was equally common among girls in both age groups,
20.40% (6-12 years) and 21.56% (12-18 years) as told by children and 20.4% (6-12 years) and
29.41% (12-18 years) as told by parents. Among boys, 18.55% of 6-12 years and 27.18% of 12-18
years were disobedient while this was 20.61% and 44.66% respectively as reported by parents for
these age groups, showing a significant difference between the report of children and parents in the
12-18 year group. Lying was nearly equal in both age groups of both sex, 13.40% among 6-
12 years and 16.5% among 12-18 years while according to parents, it was more common among
boys of 6-12 year age group (125.24%). Rest of the problems were frequent in 12-18 years age
groups (p < 0.05), except temper tantrum which was common in 6-12 years age group of both sex (p
<0.05). Conclusion: The data obtained from the children aged 6 to 18 years and their parents reveal
that these apparently normal looking children have significant behaviour problems, which needs
attention of parents and paediatricians. Steps should be taken to regularly screen these children for
proper guidance and management.
CP/12(O).TO STUDY THE PREVALENCE, SOCIOECONOMIC & BEHAVIOURAL RISK
FACTORS FOR OVERWEIGHT & OBESITY AMONGST ADOLESCENT SCHOOL
CHILDREN IN BERHAMPUR, ORISSA.
S. Bisoi, S. K. Sathpathy, S. K. Agarwalla, S. K. Panda
Department of Paediatrics, M.K.C.G. Medical College & Hospital, Berhampur, Orissa.

Introduction- Prevalence of childhood obesity in India is on the rise. In the midst of under nutrition,
the socioeconomic cost of morbidity associated, will be immense for a country like India.
Objective- To study the prevalence, socioeconomic & behavioural risk factors for overweight &
obesity amongst adolescent school children in Berhampur, Orissa. Design- Prospective horizontal
study: Material & method- Five schools selected in urban Berhampur the purpose. Students of class
8—12 were approached. After taking the informed consent, 668 students were enrolled for study by
systematic random sampling method. Sample size was determined by standard method basing upon
a pilot study. Demographic, socioeconomic data regarding habits were recorded by questionnaire.
Thorough examination for weight, height, BMI & other relevant factors were documented. Data
analysed by standard procedures. Result- Obesity was detected in 1.8% & overweight in 5%
children respectively. Overall prevalence of obesity & overweight combined, in males & females
was 21(6.4%) & 25( 7.8%) respectively. The overall prevalence of hypertension was 7.2%..
Statistically significant association was observed between higher socioeconomic status &
prevalence of obesity & overweight. No significant association was observed between duration of
T V viewing or the child being vegeterian or non vegeterian with prevalence obesity & overweight.

CP/13(P).PREVALANCE OF OCULAR DISORDERS IN SCHOOL CHILDREN IN RURAL
ORISSA
Ashok Kumar Nanda, Samarendra Mahapatro,
Hi-Tech Medical College & Hospital, Bhubaneswar.

OBJECTIVE : To analyse the ocular health status of school going children between 9 to 15 year of
age in 3 villages present within 30 km. from Bhubaneswar and to detect causes of visual impairment
and blindness. DESIGN : A cross sectional study. MATERIAL AND METHODS :The study was
conducted between April 2006 to June 2006 from 3 schools in 3 different villages present within 30
km. from Bhubaneswar. The children were mostly from low or middle social economic background.
All children were screened by us and an Ophthalmic Assistant and those detected to have either sub
normal vision or any ocular findings were referred to the Medical College for reexamination &
management. RESULTS : Out of the 976 children screened 513 (52.56%) were boys and 463
(47.43%) were girls. A total of 166 (17%) were found to be having visual impairment. Mild visual
impairment (vision between 6/9-6/18) was present in 126 (75.9%) students. Moderate visual
impairment (vision between 6/24-6/60) was seen in 32 (19.27%) students. Server visual impairment
(blindness as defined by WHO) was seen in 8 (4.8%). Out of the 166, 122 children were followed
up in hospital. 5 students (4.09%) were hypermetropic and 117 students (95.90%) were myopic. All
children did improve with glasses to obtain a vision of 6/9 or more except 7 ( 3 children who were
found to have amblyopia in one eye, 2 children due to corneal scar, 1 having developmental cataract
and one having coloboma of iris, choroid & retina). Vit-A deficiency (Bitot‘s spot & conjunctival
xerosis) was seen in 39 students (3.99%). Allergic conjunctivitis was seen in 4% of children.
CONCLUSION :As visual impairment is high in school children, periodical Opthalmological check
up is required. School health check up can be a cost effective modality for screening and early
intervention of ocular diseases. More over correcting visual impairment in children will improve
their productivity and performance. So teachers need to be oriented to and educate the importance
of ocular health, screening for early detection of ocular diseases and prevent serious compilations.
CP/14(P).CLINICAL PROFILE OF HIGH RISK CHILDREN AT ASHA CENTRE
Rakesh Gupta , P L Prasad
Dept of Paediatrics, Military Hospital Mathura cantt.

The care of high risk children is the most difficult task which is efficiently handled in the Armed
Forces by ―ASHA‖ centre supported by dedicated ladies of Army wives welfare association
(AWWA). These high risk children include cerebral palsy, deaf mutism, Mental retardation (MR) ,
post encephalitic sequlae , etc .These high risk children may need special care for their physical and
mental growth. Suitable physical / mental and occupational training by means of special exercises
and devices by devoted staff is done at ASHA Centre in most of the family military stations all over
country. This study was undertaken to evaluate the clinical profile of high risk children at ASHA
centre and to evaluate their etiological factors. Results: Out of 30 high risk children evaluated at
ASHA centre 25 were male with a sex ratio of 5 : 1 . The commonest handicap was cerebral palsy
seen in 13 ( 43 % ) of cases . Other cases were Mental retardation, post encephalitic sequlae, Down
syndrome and deaf mutism. The head circumference was below 3 SD in 12 (40%) cases. External
features of Down syndrome seen in 3 and crouzon in 1 case. Subnormal intelligence was observed
in 20(66% )cases. Convulsions were noticed in 8 (27% ) cases . The ocular defect was seen in 3
cases while hearing handicap was seen in 7 ( 23% ) cases. The delayed speech was another
significant handicap observed in 27 ( 90 %) cases . History of perinatal asphyxia was found in 9
(30%) cases and was the single most common predisposing factor . Infection emerged as the most
common post natal factor seen in 7 (23% ) cases . In 9 (30%) cases, however no predisposing
factors was seen . Hypothyroidism was detected in 2 cases of mental retardation who showed
significant improvement after the therapy was started . ASHA centre is a nodal centre to provide not
only the physical & mental training to these high risk children but also provide occupational and
vocational training in order to make them as independent possible . It also helps and guide in
providing various financial,educational social and rehabilitative assistance . In conclusion, this
study revealed that natal causes are leading predisposing factors in these cases . There is thus an
urgent need to further strengthen the existing maternal and child health services in our country as
prevention of these disorders, when feasible remains the only truly effective treatment
CP/15(P).RNTCP IMPLEMENTATION IN MEDICAL COLLEGE HOSPITAL :PRIVATE -
PUBLIC CO-OPERATION.
Narayanan.E, Arun.M.K, Vasanth.T,U.V.Shenoy
Kasturba Medical college, Mangalore.

BACKGROUND-Success of the RNTCP programme has been widely reported from various parts
of the India. It is being realized that further success can take place only by ensuring private sector
participation under the programme. OBJECTIVES-To identify the underlying obstacles for private
sector participation in RNTCP in pediatrics practice and the projected solutions so as to effect a
private–public cooperation in the revised programme.            MATERIALS AND METHODS-All
patients admitted in both private and govt hospital from Jan06 to September06 with TB were
included .Direct questionnaire with DOTS officer, nodal officer, Medical officer govt, private
hospital, Microbiology department was done and regular meeting minutes and statistical data were
analyzed. RESULTS-Vital components of programme were supervision and monitoring of
diagnosis of referred cases from treating doctors, registration & treatment with DOTS. Treatment
success was achieved in 90 % of new cases. Treatment completion rates have tripled. Death rates
reduced. Referral cases increased by 18.7% in private & 4.4 % in govt hospital and follow up have
been increased. All requirements as set up by RNTCP are achieved. Nodal officer (pulmonary
specialist) is overall in charge. Separate medical officer is in charge in govt and private
sector.Paediatric diagnosis was mainly made by Mx test and chest x-ray and categorization was
made by pediatricians. Regular monthly meeting is held in govt and private hospital regarding the
monthly progression, follow up and feedback from other places. College RNTCP meeting is held
comprising of Dean, Hod of other dept and nodal officer. Plan to be taken including measures to
improve referral, DOTScentre function are discussed. Sensitization programme to college staff and
PG‘s is held regularly. All samples sent for AFB routed through DOTScentre. Programme
implementation is discussed with PG‘s. Regular feed back is a problem outside the district.
CONCLUSION- Creation of link in the form of a referral system between the private and public
sectors is contributing positively to the performance of RNTCP.

CP/16(P).PROFILE OF CHILDHOOD POISONING PATIENTS AT A TERTIARY CARE
CENTRE IN NORTH INDIA.
Utkarsh Kohli, Vijesh Sreedhar K, Rakesh Lodha.
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029

Objectives: To determine the profile and outcome (discharge from emergency room after
observation for 6 hrs, admission or death) of pediatric patients presenting with acute poisoning to a
tertiary care centre in north India. Methods: We retrospectively reviewed the last 2 year (July, 2004
to July, 2006) hospital records of pediatric emergency room to profile all cases of pediatric
poisoning during that period and noted their outcome. Results: We analyzed hospital records of 111
patients (75 boys). Mean age of our patients was 3.1 + 2.0 yrs. Majority of our patients (63.9%) was
in the 1-3 yr age group. Kerosene (27.9%), Medicinal Drugs (19.8%) and Insecticides (11.7%) were
the substances most frequently implicated. 96.9% ingestions were accidental in nature. 75 patients
(67.6%) developed symptoms related to toxic ingestion. The common serious symptoms were
altered sensorium, respiratory distress, seizures, ataxia, hypotension, cyanosis and burns and three
patients required intubation and mechanical ventilation. Gastric lavage was done for 35.1% of our
patients (none in patients with kerosene poisoning or any other inappropriate indication). 31.6%
patients were discharged after 6 hrs of observation in the pediatric emergency ward Conclusion:
The profile for pediatric poisoning noted at our centre is not very different from those observed in
hospital based studies done more than 10 yrs ago. In sharp contrast to developed countries, where
majority of ingestions are of common non-toxic household products, most of our patients require
hospitalization because of severe symptoms related to dangerous nature of toxins ingested.
CP/17(O).THE MAGNITUDE OF CHILD MALTREATMENT BY INDIAN PARENTS
Dipty Jain, Wanda Hunter
IndiaSAFE Team, CEU, Government Medical College, Nagpur

Background: In India, attempts to address the problem of child abuse have been hampered by lack
of data related to the magnitude and the nature of the problem. The current study was devised to
address both these issues in order to provide estimates of various severe discipline strategies that
Indian mothers and fathers use with their children from birth to age 17. Methods: 9938 Indian
mothers, aged 15-49, participated in a population-based survey that was designed and implemented
using the standardized methods and instruments from the WorldSAFE (World Studies of Abuse in
the Family Environment) collaboration. The study was conducted in seven geographic sites.
Findings: 40 % of children of the 9938 children had been hit with a stick or other implement in the
year preceding the survey. Total beaten, kicked, shaked, choking, smothering, or burning children
were also reported but were less frequent. 20% across all sites experiencing at least one of these
practices from at least 1 parent in the last year. Mothers also reported on whether they or their
husbands has used severe verbal or psychological strategies such as threatening the child with
ghosts or evil spirits 24%, threatening to abandon the child 38%, and threatening the child with a
gun or a knife 8%. Overall parents in rural areas were most likely to use severe discipline strategies,
while urban non-slum parents were the least likely to use such strategies.

CP/18(O).SEXUAL ABUSE EXPLOITATION AND TRAFFIKING OF CHILDREN - THE
MYSORE EXPERIENCE
Indira Amla
Krupanidhi Memorial Institute of Mother and Child, No.426 Contour Road, Gokulam 3rd Stage,
Mysore - 570 002

Sexual Abuse is a global industry. India is black listed and leads at 4,00,000 children annually
(UNICEF 1997). This study inconpasses a 30 years study of abuse of two categories (i) Home and
Domestic including Peadiatric cases, Gynaecological Psychiatric referrals and police cases . This
study involves 55 cases (45 girls (4-14 years) and 10 boys (3-10 years). Perpetrators aged 16-60
years, where fathers, relatives, servants, teachers, drivers and others. (ii) Children coerced into
prostitution, traffiking, street children, childrens smuggled across borders who disappear into
brothels. This study was done at Odanadi which is a rescue and rehabilitation residential center
comparising girls and boys under 18 years. Traffiking involved drugs and kidnapping of children
who awake in brothels and beaten into submission. Street children who are abused by elders in
exchange for protection. Social causalties are child marriages, children employed as domestic
labour and prostitution by sale of children, child marriages. Childhood pornography is not evident.
Totally 400 girls and 296 boys were rescued from the inception in 1994 from many parts of
Karnataka by the intrepied workers of Odanadi residential facility. Majority were minors. Older
girls were rehabilitated into the main stream. Street children, orphans and run aways are given
informal education from 1st to 6th standrad and formal education at Government Schools. Food and
activities like music, dance, drama and karate are provided. Some marriages have been performed
with grooms who have volunteered and checked out by the authorities. Health surveilance and
counselling is maintained. Health care is provided by pediaterians both at Odanadi and Government
Hospitals. Conclusions : Child Protection Services should be provided at the Government level
which should be coordinated with Department of Women and Child Welfare and the Police.
Advocacy and Protection through the Government must be provided against this Human Rights
Violations against these haples children.
CP/19(O).SOCIO-DEMOGRAPHIC AND NUTRITIONAL CORRELATES OF CHILD
LABOUR IN URBAN AREA OF MEERUT
Dharmendra Kumar Gupta, S.P.Goel,R.Tuli,K.Goel
Department of pediatrics LLRM Medical College, Meerut,U.P. Pin.-250004

Aims and objectives: To carry out a comparative study of various socio-demographic correlates in
working children of different occupation as well as to study their nutritional and health problem.
Material and methods: A total of 400 (344 males, 56 female) 100 children from each group were
randomly selected & (i) hotels/restaurants, (ii) domestic/mess (iii) automobile industry, and (iv)
sports industry. were contacted to assess their health profile and problems. Results: The results of
the present study reveal that poverty(69.0%)and illiteracy (61.5%)especially female illiteracy, were
the main determinants for child labour but other factors like large family size(53.5%),broken
homes, family disharmony, delinquency, bonded labour, desire for more earnings and family
involvment. Females were less(14%) as working children and they were mostly working as
Domestic/Mess servants. Overall their personal hygiene was better. Except for pallor(33.3%) other
health problems were less as compared to males. Except for domestic/mess servants working
conditions and personal hygiene was poor among all groups. Universal immunization was very poor
among all the groups & BCG scar was present only in 11.5%. Most of the children were
malnourished(51.75%) and it is alarming that 10.5% were severely malnourished. The most
common disease among working children was gastrointestinal problems(28.5%), followed by
disease of teeth and gum(27.00%) particularly dental caries, pallor(26.5%), respiratory tract
problems(25.5%), diseases of skin(18.00%), vitamin A deficiency(13.75%) and few children also
had occupational related problems(3.5%) and substance abuse(10.3%). Conclusion: Government of
India is planning to ban child labour in these occupations from 10 October 2006. The child labour
prohibition act is in force for last 10 years without any significant dent hence strong political will
and co-operation from different sections of society is needed for strict implementation of this law.
Beside this, universal compulsory primary education, and improvement in social-economic status
can only eradicate child labour evil.

CP/20(P).TELEMEDICINE IN RURAL CHILD HEALTH CARE
V. Vilvanathan, Radha Rajagopalan, K. Ganapathy
Pediatrician, Apollo Hospitals Aragonda (V), Thavanampalli (M), Chittoor (Dist.), Andhra Pradesh
– 517 129

Introduction: The first pediatric tele consultation was brought to global attention by a popular
magazine ―Radio-New‖ in 1924. Rural sick children benefited using Telemedicine employed by
medical specialists with held of technologists. As early as 2000, Indian Pediatric Telemedicine was
described as ―the emerging medicine of the new millennium‖. Adequate reports are now available
to demonstrate that Telemedicine has become an integral part of Pediatrics. Objective: To highlight
the first rural experience in Indian Pediatric Telemedicine. Material & Methods: A ‗proof of
concept validation‘ project using Telemedicine between a corporate tertiary hospital and a rural
community hospital, is analyzed with emphasis on children requiring special health care. Data from
March 2000 to August 2006 was analyzed. 1074 pediatric telemedicine consultations were studied.
Results: Most Tele consultations involved pediatric sub specialties namely Dermatology (39.1%),
Cardiology (15.2%), Psychiatry (11.5%), Neurology (6.0%), Surgery (5.4%), Endocrinology (2.8%)
etc. 153 weekly Pediatric Tele- Grand Rounds benefited doctors and patients. This study has shown
that pediatric Telemedicine in rural India is practical, safe, cost effective and acceptable by doctors
and patients in rural areas. Conclusions: Telemedicine proved to be an acceptable means of
delivering pediatric services to rural children and successful as part of an integral health service
delivery. Telemedicine alleviated scarcity of super specialists & specialists. As an excellent CME
medium, it helped train postgraduates. Telemedicine helped in eliminating unnecessary travel and
cost for patients. Most important it increased the skill of doctors working in remote areas.
CP/21(R).CHILD ABUSE IN INDIA: AN ANALYTICAL STUDY
Nadeem Mohsin, Kiran Aggarwal
C/o Dr. Kiran Aggarwal, DII/2,14, Rajpur Road, Civil Lines,Delhi –54

OBJECTIVES: Background The idea of undertaking a National Study on Child Abuse was mooted
by the Ministry of Women and Child Development in February 2005. Prayas Institute of Juvenile
Justice was the NGO identified to undertake this major study. The meeting was attended by experts
from various disciplines from different parts of the country. Purpose In order to bring about a law
pertaining to child abuse, it is essential to understand the magnitude of the problem and also to
understand its dynamcs . Child Abuse in India is a completely unexplored area. No sincere efforts/
research has been done to assess the extent of child abuse prevailing countrywide. Some
microscopic studies have been done with very small sample indicating abusive situations of
children. The purpose of this paper is to share the findings of a mega study conducted in India, the
largest in-country study in the world, with a sample of about 17,000 respondents, covering all forms
of abuse among five different categories of children. METHODOLOGY: The first major activity
undertaken, as part of finalizing the project proposal, was a National Level Consultation on Child
Abuse, held in New Delhi in April 2005, to discuss various issues related to project formulation,
right from defining the concept of child abuse to evolving a methodology for the project, identifying
instruments for data collection and identifying the various categories of respondents. This
Consultation had a ripple effect, as it was able to involve experts from various disciplines to
exchange views on the common theme of child abuse, perhaps for the first time in the whole of the
country. The experts included academicians, social workers, activists, NGO representatives,
teachers, researchers, police, judiciary, representatives from funding agencies like UNICEF, Save
the Children, USAID, US Agency, Plan International, Catholic Relief Services, SARI Equity, etc.
The follow up of this Consultation was a three-days brain storming meeting (24-26 May 2005) at
UNICEF India Country office and a series of round table discussions in the Ministry of Women and
Child Development and Prayas Institute of Juvenile Justice, involving experts from various
disciplines, to develop a protocol and identify the processes involved in developing the protocol. A
Core Research Team, led jointly by Mr. Amod Kanth, General Secretary, Prayas & DGP, Arunachal
Pradesh and Dr. Loveleen Kacker, Joint Secretary, Ministry of Women and Child Development,
Govt. of India, and headed by Dr. Nadeem Mohsin, Project Director, National Study on Child
Abuse, apart from a Technical Advisor and other experts, was formed, with a view to supervising
and monitoring the project on a continuing basis. A Research Support Team, constituting a group of
experts was also formed, to elicit support for effective implementation of the project. The project,
right from its inception, automatically emerged as an advocacy and awareness generation software,
which was extremely useful from the standpoint of a country where child abuse existed in the most
rampant manner, and yet so little about the issue was being talked about. The basic tool for eliciting
information from children on various forms of abuse is the Focus Group Discussion (FGD),
followed by one-to-one interaction with children. In conducting FGDs and personal interviews,
great care has been taken to adhere to ethical considerations, which included the basic principles of
research on children, the child protection code of conduct and the consent of various stakeholders:
parents, teachers, caregivers and children themselves. The instrument for eliciting information from
children is the information schedule for children, which contains information about the socio-
economic profile of children and information pertaining to the five different forms of abuse:
physical abuse, neglect (gender disparity), emotional abuse, substance abuse and sexual abuse. The
categories of children covered are: children with families not going to school, school going
children, street children, working children (child labour) and children in institutional care. MAJOR
OUTCOME/RESULT: The most significant contribution of this study so far has been that it has
initiated a process of awareness generation through dialogue among various stakeholders on the
issue of child abuse, a hitherto neglected aspect of all child protection initiatives. It has also been
able to mobilize a team of experts whose involvement at various stages of the study has not only
facilitated the process of advocacy and awareness generation on issues related to child protection,
but has also helped exchange views and ideas in making more pronounced commitments on the
issue. This study is expected to pave way for a more focused policy initiative and programme of
action taken by the Centre and various State governments, creating, thereby, an environment for a
proactive stance on the issue of child protection, both by the government and the civil society. The
study is expected to lead to the following plan of action: Training of various stakeholders on issues
related to child abuse Formulation of a national level plan of action to address child abuse
Developing schemes, strategies and programs based on targeted interventions at the State level.
Developing IEC materials, including audio-visuals on child abuse to be used in schools and other
institutions Organizing media campaigns on child abuse through the print, electronic and traditional
media, to create awareness among parents, teachers, police, NGOs, etc. Review of existing laws
addressing the issue of child abuse. The data collection work has nearly been completed. The
tabulation and analysis will be done thereafter. The draft report is expected to be ready by the end of
the year. The findings of the study will be presented in the Pedicon Conference. CONCLUSIONS:
It is premature to draw conclusions at this stage, since the data is in the process of being analysed,
the following conclusions can be drawn on the basis of experience encountered during field work
and through interaction with research investigators and other field functionaries: Child Abuse is
largely under reported since the victim has an everlasting feeling of guilt and is apprehensive that
reporting or disclosure make cause more harm to the victim than good. Neglect is almost perpetual
and continuous as far as the girl child is concerned and it is taken as a part of the girl‘s up bringing
and also for the fact that girls are taken to be responsible for undertaking responsibility and are
denied freedom. Physical abuse is also taken as part of disciplining the child and is accepted as an
established norm by a large majority of parents, teachers and care givers. Sexual abuse occurs
largely in familial surroundings, the perpetrators largely being close relatives of the victims. Sexual
abuse is more under reported for fear of social ostracization of the victims. It is very difficult to
elicit response from children on sensitive issues like sexual abuse in a limited framework. Ethical
issues of research need to be given due attention while conducting research on violence/abuse
against children since the damage caused to children may be much ,more than one can visualize of
ethical considerations are ignored. It is extremely essential to take consent of parents, teachers, care
givers and children themselves before talking to children on issues pertaining to child abuse, as
these have legal implications. Focus Group Discussions are the best method for creating a
conducive environment for eliciting information from children on child abuse.All categories of
children, children of all age groups and children from all socio-economic status are subjected to one
form of abuse or the other.

CP/22(P).INDIA’S LOST DAUGHTERS: ABORTION TOLL IN MILLIONS
Sidharth Kumar Sethi, M.M.A. Faridi, Shilpa Baghmar
Department of Pediatrics, UCMS & GTB Hospital, Shahdara, Delhi

Son preference is one of the most evident manifestations of gender discrimination in our society.
Sex- selection has become a rampant phenomenon and the technologies that are misused for this
very purpose are becoming increasingly sophisticated. The use of advanced medical science and
technology has made sexual discrimination and the elimination of female babies even before birth
an invisible deed. As many as 10 million female fetuses may have been aborted in India over the
last 20 years as families try to secure a male heir. It is only by a combination of monitoring,
education campaigns, and effective legal implementation that the deep-seated attitudes and practices
against women and girls can be eroded. We herein present latest statistics of the gender
discrimination and discuss what actions can be taken at all levels to curtail such practices.
CP/23(P).A CROSS SECTIONAL STUDY OF RISK FACTORS FOR OBESITY IN
HIGHSCHOOL STUDENTS OF BELGAUM
Shruthi T.K , Meenakshi Sindwani , Kavitha D Mogale, N.S.Mahantshetti, V.D.Patil
Dept. of Pediatrics , JN Medical college/ KLES Hospital & Research Centre ,Belgaum

Obesity, one of the most wide spread and major problems affecting children and adolescents, is of
global nutritional concern.Aims and objectives : 1.To study the prevalence of obesity in high school
students of Belgaum.2.To study the risk factors for obesity like Parental obesity ,Dietary habits and
Physical activity.Design - A cross sectinal study of 9 months (June 2003 - February 2004).Materials
and Methods : 1008 students of 12-16 yrs of age randomly selected highschools of Belgaum were
the subjects of the study.Age , height ,weight , BMI ,skin fold thickness(SFT) and dieatery habits
were rccorded on a predesigned proforma, parental height and weight obtained through post
card.Statistical analysis done by using odds ratio for risk factors and uncorrected chi-square test for
comparing two groups one with BMI < 85th percentile and other with BMI >85th percentile.
Results:The incidence of obesity was found to be 6.4% for girls and 5.5% for boys and overweight
was 13.7 % in girls and 11% in boys, with combined incidence of 5.9 % and 12.2% for obesity and
overweight respectively. The study showed a female preponderance               (p < 0.001).Amongst the
riskfactors studied, obesity was more in children with more junk food consumption( OR 5.84,
p<0.05) and in children with decreased physical activity(OR 7.7, p<0.05) . According to the study
parenteral obesity has a influence on childhood obesity(p < 0.05).Relation of SFT and BMI
correlated well, it was found that 90% of the children who were overweight according to BMI had a
SFT which was > 97% percentile and all the obese children had SFT >97%.Conclusion:The
prevalance of overweight is 12.2 % and obesity is 5.9%.There was statistical significant evidence
for the association of risk factors for obesity like parenetral obesity ,dietary habits, physical activity
.The rapid increase in prevalance of obesity demonstrates potent effects of environment on
adipocity implying that obesity can be treatable via lifestyle modification.
CP/24(P).VALIDATION OF IMNCI ALGORITHM FOR YOUNG INFANTS (0-2MONTHS)
AT A TERTIARY LEVEL HOSPITAL
S Kaur, Akdutta, V Singh
Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi

Objectives: To check the validity of Integrated Management of Neonatal and Childhood Illness
(IMNCI) algorithm for young infants (0-2 months) among medical and paramedical personnel.
Design: Prospective observational Setting: The Outpatient Department and Emergency Room of a
Medical College attached hospital. Methods: 419 infants (176between 0-7 days,243between 7days–
2months) presenting to Outpatient Department or Emergency Room were assessed and classified as
per IMNCI algorithm and treatment steps were identified. However, the actual diagnosis and
treatment (which served as Gold Standard) was done as per the protocol of treating unit .The
diagnostic and therapeutic agreement between Gold Standard and IMNCI was computed. Further, a
subgroup of infants (n=52) were assessed and classified according to IMNCI guidelines by a staff
nurse and validated against the medical person. Results: the referral criteria as per the IMNCI
algorithm had a good sensitivity (96.9, 93.6 and 95.1% in 0-7 days, 7days–2months and 0-2months
respectively) and specificity (84.6, 87.3 and 86.8 in three age groups respectively). The algorithm
covered majority of recorded diagnosis (80%). In 50% cases a total diagnostic agreement with
IMNCI was found. The sensitivity of algorithm to identify bacterial infection was high (88.5%)
while specificity was relatively low (57.4%). The algorithm performed well in detecting jaundice
(131/131) and evidence of any dehydration (30/30) although it tended to overdiagnose the severity
of dehydration among those dehydrated (6/30). The algorithm had provision for preventive services
of immunization and feeding counseling (53% and 30% possibility of availing missed opportunities
for immunization and feeding counseling respectively). The staff nurses showed a reasonable
degree of performance in using IMNCI algorithm and picked up bacterial infection and jaundice
with a good sensitivity. However, assessment of dehydration status was incorrect in 50% cases
.There was complete diagnostic agreement between staff nurses and researcher in 61.5%,
underdiagnosis in 25% and overdiagnosis in 13.5%. Decision regarding referral was correct in 85%
cases. Conclusion: There is a sound scientific basis for adopting IMNCI approach in young infants
since co-existence of morbidities is a rule rather than exception. The algorithm has good sensitivity
and specificity for referring children with severe illness. It also has provision for immunization and
feeding counseling.
CP/25(P).SOCIAL ISSUES IN HIV
R.R.Palliana, S.Y.Joshi,V.V.Kulkarni, P.A.Sankhe,N.L.Birla
Dr.R.N.Cooper Municipal General Hospital, Juhu[West], Mumbai.

Social stigma attached to HIV is a grave unaddressed issue apart from AIDS defining illnesses.
Aims & Objectives:To determine the psychosocial impact of HIV status and to analyse the role of
hospitals and NGO's in helping patients. Material & Methods: This study has been conducted at a
municipal general hospital in Mumbai. So far 120 HIV positive couples have been registered over 3
years. They were interviewed by a questionnaire which covers the psychosocial impact of the
disease,patient attitude, adjustments,plans for the future etc; Results:85% of individuals had
complete knowledge of the disease.72% of the women preferred to breastfeed their child due to
economic constraints and fear of being stigmatised.70% of individuals disclosed their status to
family members of which 60% accepted the situation,35% faced hostility and 5%were rejected by
them.The remaining preferred not to disclose their status fearing ostracism.15% of couples were
saving for their childrens future on the initiative taken by the NGO.25% accepted their status and
preferred to remain ignorant,15% had suicidal tendencies and were resigned to fate.60% preferred
to seek professional help and lead a quality life. Conclusion: There is still unawareness and
ignorance about the disease and its implications and those aware still prefer not to disclose their
status to avoid stigma and discrimination.Sensitivity of doctors and paramedical staff is of
paramount importance to gain confidence of patients to seek professional help. NGO's also play a
pivotal role as grassroot level workers in reaching out to affected people and helping them lead a
quality life.

CP/26(P).PARENTAL PERCEPTIONS OF EMOTIONAL AND BEHAVIORAL
PROBLEMS IN CHILDREN WITH SPECIFIC LEARNING DISABILITY
Anjana Thadhani, Sunil Karande, Madhuri Kulkarni, Meena Shiledar, Rukhshana Sholapurwala,
Anita Chitre
Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion,
Mumbai

Introduction: Specific learning disability (SpLD) is an invisible handicap leading to persistent
difficulties in acquiring academic skills required to achieve efficient reading (dyslexia), writing
(dysgraphia) and mathematical abilities (dyscalculia). SpLD leads to poor school performance and
eventually causes tremendous stress on the child and parents. Aim: To study the emotional and
behavioral problems associated with children having SpLD. Design: Prospective hospital based
study. Setting and Methods: This study was carried out at our Learning Disability Clinic over a
period of 10 months (March 2005 to December 2005). Parents (either mother or father) of 100
children with SpLD were interviewed at the time of diagnosis. Parental responses were documented
using a structured questionnaire and analyzed. Results: Of the 100 children, 63 were boys and 37
were girls (male:female ratio of 1.7:1). 14 children were in the age group 7 to 9 years, 34 in 10 to 12
years and 52 in 13 to 15 years. Associated comorbid conditions in the 100 children were ADHD
(20%), ODD (4%), anxiety disorder (3%), depression (1%) and conduct disorder (1%). The most
common emotional problems documented were a general sense of failure towards life in 82%
children, and a habit of giving up a task, both academic and non-academic, in 73% children.
Behavioral problems such as aggressive behavior were documented in 58% children, while 42%
children had developed withdrawal behavior. Poor peer group relationships was reported in 14% of
children. Conclusion: Children with SpLD are at high risk for developing emotional and behavioral
problems. Regular counseling sessions are necessary to empower parents to help ameliorate
emotional and behavioral problems in their children.
CP/27(P).DEVELOPMENT OF SOCIO-EMOTIONAL DIMENSIONS IN AUTISTIC
CHILDREN THROUGH PLAY ACTIVITIES
Shabina Ahmed, Mrs Shreya Barbara,
Assam Autism Foundation, 5 Dinesh Ojha Path, Rajgarh, Guwahati 781005

Introduction: The major challenge in autism is ambiguous socio-emotional understanding, and is a
major component of deficit in development and there is a major need to synchronise the autistic
child‘s environment through play and cultural activities imparted via individual and group work
modules. Aims and Objectives: Skill development for social acquaintance Develop the aptitude for
reflection and dialogue Self and Peer identification Methods used: Autism was diagnosed by DSM
IV Social emotional assessment done by Autism Questionnaire on Socio Emotional dimension. 20
children between the ages 4 to 10 were followed up for a period of one year, effective 1 st August
2005 to 1st August 2006. 80% of whom were nonverbal, the rest verbal Strategies used: Social
stories and role play; Audiovisual illustrations of rhymes; Co-learning Results: 1. Helped in
development of Receptive and expressive language 2. Helped in development of Self-concept
3.Helped in development of Interpersonal relationships Conclusion: Teaching through play helps a
child to imbibe learning faster and the play activities given were within the Indian cultural context,
which may be replicated

CP/28(P).IS THERE GENDER BIAS IN REFERRAL TO A TERTIARY CARE
PERINATAL CENTER?
Gupta P, Kulkarni A, Kaul S, Gupta V And Balan S.
Indraprastha Apollo Hospital, New Delhi.

Gender bias is still a reality in India, starting from the womb. Sick newborns require timely referral
to a higher center and this may be affected by gender. Aims: To assess factors reflecting gender
bias, morbidity and mortality in outborns at a tertiary care center. Methods: This is a retrospective
analysis of 500 neonates transferred to NICU from August 2001 to December 2004. Group A
comprised of 157(31.4%) cases retrieved by our transport team (equipped with incubator,
ventilator, life support system) after stabilization of temperature, glucose levels, perfusion and
oxygenation. Group B comprised of 343 (68.7%) self transported babies. We studied rectal
temperature, blood sugar, capillary refill time (CFT), oxygen saturation, blood gas at arrival, and
survival at 48 hours. Results: Overall MF ratio was 3.5: 1(390M: 110F). Both the Groups A and B
had higher males (73.2%, 80.2%). Of the VLBW babies transported majority were males in both the
Groups (A: 73%, B: 43.6%) Vs female (A: 19%, B: 19.8%). Similarly on comparing the timing,
females were referred late (> 96 hrs) in both the groups (A: 54.7%, B: 41.1%) Vs male (A: 12.2%,
B: 37.5%). In Group A we found hypothermia in 10.4%M, 9.5%F; hypoglycemia in 15.6%M,
7.1%F; cyanosis in 0.86%M, 2.38%F; CFT>3 sec in 7.8%M, 7.1%F; acidosis in 18.2%M, 9.5%F,
mortality <48 hr in 14.7%M and 7.1%F. In Group B we found hypothermia in 65.8%M, 50%F;
hypoglycemia in 33%M, 27.9%F; cyanosis in 19.2%M, 4.4%F; CFT>3 sec in 33.1%M, 22.1%F;
acidosis in 28%M, 26.4%F, mortality <48 hr in 23.6%M and 16.1%F. Conclusions: More males
overall, and especially in the group <32 weeks gestation, being referred to us and the earlier referral
in them, suggested a gender bias towards boys. We feel that the lower immediate morbidity and
mortality in Group A girls again reflected a selection bias. The highest mortality was in Group B
(self transported) boys, suggesting the willingness of parents to make greater efforts for males.
CP/29(P).HIV AND INFANT FEEDING: ISSUES AND A CENTER EXPERIENCE
M.M.A.Faridi, Sidharth Kumar Sethi, Deepika Harit
Department of Pediatrics, UCMS & GTB Hospital, Shahdara, Delhi

Breastfeeding is the ideal way to feed infants and should be protected, promoted and supported. Its
benefits go beyond sound nutrition in that it protects against common childhood infections.
However, as it is one of the routes for mother-to-child HIV transmission, HIV-infected women in
this country need to consider carefully the information about relative risks and benefits to their
babies of breastfeeding, compared with alternatives. Most children with HIV are infected as a result
of transmission of HIV infection from their mothers. Mother-to-child transmission can occur before
or during birth, or after birth through breastfeeding. We herein, discuss all the issues related to HIV
and Breast feeding and the options that can be offered to such mother. Experience at our center and
the options, which the mothers took at our centre, will also be discussed.

CP/30(P).INFANT AND YOUNG CHILD FEEDING PRACTICES
Ashish Lothe, Alka Jadhav, Mamta Manglani
Department of Pediatrics, Lokmanya Tilak Municipal Medical College & General hospital, Sion,
Mumbai

Introduction: Human breast milk, nature‘s perfect gift is vastly superior to any other feeding
method. Feeding practices play a major contribution to India‘s lion‘s share of malnourished children
in the world and it‘s a basic issue directly concerning with the physical, mental, and social
development of child. Aims & Objectives: 1) To assess the existing infant and young child feeding
practices. 2) To evaluate attitude and knowledge of mothers about these practices. Materials &
Methods: This observational cross sectional study was conducted at G – North ward of Mumbai
city for duration of one year. Details of 300 children in age group 2-3 years were recorded through
direct interviews of their mothers which included knowledge, attitude and feeding practice oriented
questions. Observations & Results: 44 % mothers were illiterate which had greater impact on
feeding pattern. 83 % mothers fed prelacteals commonly sugar water. Only 24 % mothers breast fed
exclusively for 6 months. 17 % mothers initiated breast feeding in first 6 hours of birth. Bottle
feeding was practiced by 29 %. Only 11 % were fully aware of advantages of colostrum. 21 %
mothers opined commercial formula as the best milk for baby. Conclusions: Faulty feeding
practices exist mainly with respect to breast feeding, complementary feeding, colostrum feeding and
prelacteals. Also there is lack of knowledge and awareness about these issues. Literacy, family
planning, nutrition, education, encouragement and support to lactating mothers should be stressed
upon the minds of public as they form the mainstay in improving the feeding practices.
CP/31(P).SOCIO-DEMOGRAPHIC PROFILE OF CHILDREN PRESENTING WITH
VACCINE PREVENTABLE DISEASE IN CHANDIGARH
Chandrika Azad, Veena Parmar, Srikanta Basu, Suksham Jain
Department of Paediatrics, Govt. Medical College & Hospital, Chandigarh.

Objective:To study the socio-demographic profile, complications and immunization status of
children presenting with vaccine preventable diseases (VPD) Setting & Design: Retrospective case
record analysis of children presenting with vaccine preventive diseases (except tuberculosis) to the
department of Pediatrics, GMCH, Chandigarh from Jan2K1 to Sep 2K2 Results: All children
presenting with VPD and related complications were analyzed in above said period. In all 260
children (34% girls & 66% boys) were registered. 43% came from slums, 34% from urban and
27% from rural area. 116(45%) had measles, 13(5%) Diphtheria, 18(7%) Pertussis, 21(8%) Tetanus,
52 (20%) AFP, 3(8%) Mumps & 7% Chickenpox. 36% of measles, 23% diphtheria, , 50% tetanus
(9/11 neonatal tetanus) , 55% whooping cough, 12% AFP and 11% chickenpox were below 1 year
of age, 44% and 24% of measles, 37% & 53% of diphtheria, 31% & 45% of tetanus, 44% & 18% of
pertussis and 23% & 44% of AFP were from slums and rural areas respectively. Immunization
status of all the children presenting with VPD was very poor, only 9 of the children presenting with
measles, 1 of pertussis, 1 of tetanus and 2 of AFP had received immunization. For others either the
status was not known to mothers or they had not received any immunization. Conclusion:
Resurgence of VPD has been observed over last 6 years. Maximum cases came from slum and
rural areas. Immunization status of most of the children was poor though all of them had received
pulse polio dosages.

CP/32(R).THE CURRENT STATUS OF OPTIMAL INFANT FEEDING IN KANPUR AND
THE IMPACT OF ANTENATAL COUNSELLING OF MOTHERS
Joshi T, Tripathi Vn , Srivastav Vk ,Dr Rp Singh
Department of Pediatrics and Preventive Medicine,G S V M Medical College, Kanpur

OBJECTIVE: (1)To study the actual status of exclusive breastfeeding in urban and rural infants, (2)
to study the time of initiation of complementary feeding in urban and rural infants,(3) To study the
impact of antenatal counseling on exclusive breastfeeding and the time of initiation of
complementary feeding. METHOD: This cross-sectional study was conducted in the Well Baby
Clinic of the Department of Pediatrics ,G S V M Medical College, Kanpur, from January to June
2006.168 respondent mothers, of infants aged 0-12 months , were interviewed on the basis of a
pre-designed questionnaire. Information thus gathered was tabulated, analysed and conclusions
drawn. RESULTS: Of the 168 mothers interviewed, only 18(10.71%)infants were exclusively
breastfed, while 36(21.42%) were partially breastfed and 68(40.47%) were top fed. Only 52
(30.95%) mothers had started or intented to start complementary feeding by 6-8months. Antenatal
counseling has a significant effect on the exclusivity of breastfeeding (p<0.05) and time of initiation
of complementary feeding (p<0.05). CONCLUSION: the current rate of exclusive breastfeeding in
Kanpur is much lower than that recommended by WHO. Community knowledge about optimal
infant feeding needs to be augmented by providing counseling to mothers during antenatal check-
ups and well baby clinics.
CP/33(R).THE STUDY ON HEALTH CARE UTILIZATION PATTERN AMONG
ADOLESCENTS IN KANPUR, INDIA
Kumar gaurav gupta, V.N. Tripathi, R.P.Singh, S.Chandra
Department of Pediatrics and Preventive Medicine,G S V M Medical College, Kanpur

OBJECTIVE: To study on health care utilization pattern among adolescents in Kanpur. DESIGN: A
cross sectional school based study conducted in 6 government and 4 private schools in kanpur
covering class V to XII of 10-18 years of age.(n= 1382) METHOD: A pretested and validated, close
ended, self-administered questionnaire was used. In this study issues for which adolescents most
likely to visit a health center, problems for which they have received health care recently,
willingness to visit health center with parents and most common cause of non utilization of health
services by them were studied. RESULTS : Among total 1382 students surveyed commonest
adolescent issues for which they likely to visit health centers were weight and height
problems(78.4%), eating habits and disorders(72.2%)common illnesses (71.6%), acne and
pimples(68.8%). Majority of students were willing to visit health center along with parents for
common health issues but never for sensitive issues like sexual problems (56.3%), alcohol drinking
problem(51.7%), birth control (48.%). Most common cause of non utilization of health services by
them were embarrassment (42.5%). CONCLUSION: Non visiting of adolescents to the health
center for sensitive issues indicate that adolescents are very personal about their private lives and
confidentiality might be big issue if we want to bring adolescent to health center.

CP/34(P).PREVALENCE OF EARLY WEANING PRACTICES.
Arun.M.K, Santosh T.Soans
A.J .Institute of Medical Sciences, Mangalore

Background- Early weaning without valid indications is increasing and can be associated with some
problems due to top-feeding. Material and methods - The study was done in O.P.D of a private
clinic. In babies less than 4 months during immunization visits and well baby clinic were examined.
Feeding history was taken and if top feeding is started, a set of questions were asked to mothers or
were requested to answer the questionnaire.Results – Top-feeding was seen in 18% and 26% at 6
wks and 10 wks respectively. 45% cases top feeding was started at 14 week visit. Majority of
parents belonged to middle socio-economic class. Majority were literate. Birth order 1st (42%), 2nd
(36%). In such cases top feeding in previous baby before 4 month was seen in 62% cases. Reason
for starting feeds were not adequate milk (72%), not gaining weight (15%), and for better weight
gain. Mothers concluded insufficient feeds based on excessive cry, lesser duration and frequency of
feeds, inadequate milk in previous child. Majority of cases duration & frequency were normal.
Weight gain was satisfactory and no evidence of underfeeding in 85%. Source of information was
other family member/ neighbor, or previous top feeding. 14% cases it was advised by a doctor.
Majority of cases weight gain not documented or advice to continue breast feeding and weight gain
after feeding advice noted. 86% mothers did not consider formula feeds as weaning food although
majority knew age of introducing home made foods.40% acknowledged that it is wrong to start/ can
cause some problems. Type of feed was inappropriate in 40% cases and dilution and quantity were
wrong in majority. Regurgitation was more common, 16% had h/o ear infection/LRI. 15% babies at
4 months weight gain was more than expected. After counseling majority appeared convinced but
follow-up 40% continued top-feeding.
CP/35(P).THE INFLUENCE OF THE MEDIA ON CHILDREN
Samir Dalwai, Deepti Kanade,Minal Sane, Sohini Chatterjee
New Horizons Child Development Centre, Saira Mansion, Pahadi School, Road no.2, Jayprakash
Nagar,
Goregaon(E), Mumbai- 63

As Television, Computers, Video games and the Internet become an unavoidable part of our life,
the Media is akin to an Environment enveloping us. The current study was undertaken to assess
influence of T.V. viewing on children‘s behavior. Design: A prospective community based study.
Methods and Material: A random sample of 50 children age 6- 12 years and a group of 12 children
who have no access to Television and Computers were assessed on the Child Behavior Checklist
(CBCL, Author- T.M. Achenbach). Constructs measured were Depression, Uncommunicative
Behavior, Aggression, Hyperactivity, Obsessive Compulsive Features, Schizoid traits, Somatic
Complaints, Delinquency, and Social Withdrawal. Questionnaire of Number of weekly hours of
T.V. viewing, time spent in Video/ Computer games, Internet, Preference for channels and
programs, Favorite characters on Television, whether TV viewing is monitored, other Recreational
Activities, and Average Academic Performance. Results: 55% of children engaged in unsupervised
television viewing. On average children watched TV and played computer games for 17.5 hours a
week. Only 10% of children engaged in reading as a recreational activity. None watched any
Educational Channels or programs. Cartoon Network was the preferred channel by 89%. On CBCL
highest scores were found on the sub-test of Aggression followed by Depression, Hyperactivity,
Obsessive Compulsive and Uncommunicative Behavior. There was no statistically significant
correlation(r = 0.074, p<0.10) between the number of weekly hours of TV viewing (including video
games and internet) and scores on the CBCL. There was no statistically significant difference
between the mean scores on CBCL of children having access to media entertainment and children
having no access to television viewing. Conclusion: The study brings to light the importance of
media entertainment as the sole mode of recreation. Although statistical differences and correlations
were not found, this study implicates need for further studies with larger sample size.
CP/36(P).DOMESTIC          CHILD-LABOUR          AMONG        DOCTORS:       PREVALENCE,
CORRELATES AND THE EFFECT OF THE 'LAW ON PREVENTION OF CHILD
LABOUR.'
Prem Arora, Devendra Mishra
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, (Maulana Azad Medical College)
Geeta Colony, Delhi-31.

Background: Children under 14 years of age constitute 3.6% of the total labour force in India. We
seem to have a culture of child labour and it is so deeply ingrained in society that it appears
perfectly normal to us when children work. The middle class is expected to be the cultural
barometer of society‘s values and doctors are an important group among the middle class. The
recent law on prevention of child labour bans the use of children as domestic servants.Objectives:
1.To determine the prevalence of domestic child labour amongst doctors. 2.To study the effect of
the recent law on this group. Design&Setting:Cross-sectional survey amongst doctors in Delhi and
Madhya Pradesh during December-January 2005-06 and follow-up in August 2006.Methods:Survey
of personal acquaintances among doctor colleagues by personal interaction/telephonically. Results:
A total of 87 doctors were approached, of which four refused consent. The remaining 83 were
interviewed either by telephone (68 respondents) or personal interaction (15 respondents) to
determine the prevalence of child labour in this group. Of these, nearly two-thirds (44, 64.7%) were
found to employ domestic servants younger than 14 years of age. In total there were 46 domestic
servants, median age:12.5 (range; 8.16-14) year and male-female ratio, 1:1.68. 2/3rd of these were
full-time domestic servants and the rest were working part-time. Of the part-time workers, majority
(11, 73.3%) were employed at the clinics of the employer. No differences were observed between
the employment of child labour and, the medical specialty and the work setting of the employer. In
the follow-up survey, only 69 respondents participated and none reported employing a domestic
servant below 14 years. These findings and their implications would be discussed. Conclusions: The
study showed a high prevalence of child domestic labourers employed by medical professionals in
two states in India. A follow-up telephonic survey, after the enactment of a law prohibiting this
practice, saw decreased participation and low prevalence of the practice. Suggested Action: All of
us need to take appropriate action at personal level to at least stamp out this practice from our
homes, before expecting statuary remedies to have any impact on this widespread problem

CP/37(P).SOCIAL STATUS OF HIV/AIDS INFECTED CHILDREN.
Ravikanth, Vykuntraju.K.N, Shivananda
Indira Gandhi Institute of Child Health, Tertiary care centre. Bangalore.

A Prospective study. Objectives: To study the social factors of HIV/AIDS. Methods: 177 children
diagnosed with HIV/AIDS are enrolled in this study between September 2004 and August
2006.History, Examination, relevant investigations were done. They are classified according to
WHO, CDC, Immunological stages. Results: Total no children 177. M: F= 60:40, most common
age group is 1-5 years (40 %). 97.7% acquired by vertical transmission Blood transfusion and
injections(?) are responsible for 1.1% each. Father is alive in 44%.mother is alive in 52.2%.both
parents are alive in only 25%.Double orphan in 40%.None of the affected adolescents have both
parentsl.father is173 affected in and mother is affected in 174. 77.7% are from urban and 22% are
from rural area. Common occupation of father is driver 16.3%, agriculturist 12.5%, and business in
7, 8% and others. Mother occupation house wife in 80%.education of parents both parents are
illiterate in 30%.14.1% of children are expired, 17% lost for follow up. Summary and Conclusion.
Most common age group 1-5 years and 60% of them are boys. 97.7% acquired by vertical
transmission, 1/3rd of both parents are illiterate. Double orphan in 40%, 3/4th from urban
area.Common occupation of father is driver, agriculturist and business. 17% are lost for follow up.
CP/38(P).EARLY INTERVENTION IN INFANTS WITH DELAYED DEVELOPMENT :
EXPERIENCE OF A SERVICE HOSPITAL REHABILITATION CENTRE
D Y Shrikhande, P Kumar, S Shrikhande, , R Ghuliani, S Tandon, R Choudhary
HOD & Senior Adviser Paeditrics, Command Hospital (Eastern Command) Alipore, Kolkata
700027

Introduction - The motor and learning disabilities can be prevented or decreased by early
intervention in infants with neurological insults at birth or as neonate. Methods of intervention are
based on the principal of neuronal plasticity in the developing brain which enables the damaged
brain to adapt, mould and function better in response to proper inputs provided at an early age.
Objectives : To assess the response to early intervention in infants ( 6 – 12 months) with overt
neurological deficit or developmental delay & their follow up for next 3 years Methods : Infants
with 6 – 12 months age were assessed for developmental delay based on history, mile stones and
neurological examination. Assessment of delay was also done by using Nursery Evaluation Scale
Trivandrum & Universal Intervention model ( Portage model ). Intervention therapy was given by a
team consisting of Pediatrician, Special Educator, Social worker, Speech and Occupational
therapist and one or both parents. 30 infants completed 2 years supervised therapy given 5 days
a week. Monthly follow up for first year and later 3 monthly follow up for 2 years was done for
assessment of gross & fine motor mile stones , cognitive development, speech, personal & social
development. Results : 60 infants in age 6 months - 1 year enrolled in 2002 were followed up
for 2 – 3 years . Underlying causes of delay were HIE 50% , septic meningitis & TORCH
infection 10%, Meningomyelocele and hydrocephalus 5 % and Down‘s syndrome in 5 % . In
30%, cause of delay could not be confirmed. Seizures were seen in 60 % cases who were on anti
epileptic drugs. Multi disciplinary interventions including sensory stimulation, vestibular,
labyrinthine and proprioceptive inputs, visual and auditory developmental inputs and dietary
interventions were provided. Analysis showed remarkable response in babies with Grade I & II
HIE, satisfactory in post infective etiology and not so good in grade III HIE. Conclusion : Early
intervention therapy is very effective in decreasing and preventing long term developmental delay
in infants with various neurological insults in new borns and infants. Medical personnel dealing
with children, parents and society should be sensitized about its advantages.

CP/39(P).RETRTACTED NIPPLES IS A MAN MADE PHENOMENA.
Hemant Joshi, Archana Joshi.
Joshi Children‘s Hospital &research center. Virar-401303

Study : We studied pigs, cows,bufallows & discussed with veterinary doctors in practice & those at
Dapoli agriculture university. Our study of comparative zoology shows that no animals have
retracted nipples. About 7 % mothers have feeding difficulties due to nipple problems.The mothers
get breast engorgement and abcesses and children starve, have hypoglycemia. exaggerated jaundice
due to dehydration due to inadequate feeding.
CP/40(P).TIPS ON OFFICE PRACTICE
Hemant Joshi, Archana Joshi.
Joshi Children‘s Hospital &research center. Virar-401303

1.Make Namaste with folded hands your welcome greeting. It is understood by every one from
womb to tomb. The face of the grandmother, grand faather and every one brightens up with a happy
smile. It instantly creates a heart to heart bond between the pediatrician and the child and the
family.This bond is our best protection against consumer protection act. Experience it and tell it to
all.Say Salam Alekum to muslims, Jai Jinendra to Jains, Vanakkam to tamilians.2.Warmer::
Receive all sick newborns under a warmer, especially in winter in a cold region of the
country.3.Install a METAL DETECTOR I,e,a multi para moniter in OPD to detect BOMB
CARRYING           TERRORISTS I,e, critical babies. Demonstrate                hypoxia by pulse
oxymetry,tacycardia suggesting sepsis,and hypotension.for better communication.4Asthma: make
parents hear Rhonchi. Tell them what you heard is Asthma.Let them diagnose Asthma.Parents
change the doctor if the doctor diagnoses asthma.5.you are as god as your staff is. If your all staff
should be as good as you. Perpetually teaching staff all possible skills ensures this. 6.mirrors in
clinic: Have a mirror on the ceiling of our examinatin table. Infants lying on the table watch
themselves happily and allow a peaceful examination. Have a mirror on th side wall. A baby on the
lap or in arms,happily watching himself or herself quietly allow a good clinical examination.Mirror
also makes a good hemoglobinometer. March the colour of forehead or cheeks of the parents,
especially of father with that of children. Fathers usually have a better haemoglobin. Recommend
iron suppliment till the baby‘s colour matches that of father.This hemoglobin assessment is
instant,cost free,painfree. Tell to all.7.From Singapore we brought a laser torch.It measere the
length traveled by the laser beam. It is good for measuring height. It costed rs.2000 at Mustafa‘s
Mall.
CP/41(P).ADVOCACY:IMPORTANCE OF IAP THE                              INDIAN      ACADEMY          OF
PAEDIATRICS.MATERNITY LEAVE FOR 6 MONTHS:
Hemant Joshi, Archana Joshi.
Joshi Children‘s Hospital &research center. Virar-401303

Indian National Congress was born to put forth ideas of people. Earlier it was a tooth less body that
made resolutions on public welfare. But these ultimately gave us Independence. Story 2.During
practice we realized that a maternity leave of six months will enable mothers to breast feed babies
for longer time and this will improve child survival. So at a plenary session in IAP annual
conference at Bangalore. Dr. Hemant Joshi put forth the idea of maternity leave for 6 months. Then
at Hydrabad IAP annual general body meeting held during the annual IAP conference, Dr. Hemant
Joshi and Dr. Archana Joshi proposed that IAP should recommend maternity leave for 6
months.Some members felt that instead of giving maternity leave of 6 months people will prefer to
terminate women and give jobs to men. Respected Dr. Ramesh Potdar intervened and said that a
breast feeding resolution should not fail at a IAP meeting. He suggested that the proposal be studied
by the committee of experts in breast feeding. This group later in the year had a full day meeting.
It had stalwarts like the then IAP president Dr. Kumtha, Dr. R.K. Anand etc. This committee
recommended that Maternnity leave should be of 6 months. In the subsequent annual IAP annual
general body meeting at Nagpur, on the recommendations of this committee, IAP unanimously
passed the the resolution that maternity leave should be of 6 months. Within one week Haryana
and Punjab state governments announced and granted maternity leave for 6 months to their staff.
We printed leaflets asking for Maternnity leave should be of 6 months, and gave them to all news
papers and unions.Dr. Uday Bodhankar and many other pediatritians worked to sensitize politicians
and beaurocrats on this issue. When 5th pay commission of central government came, unions asked
for increasing maternity leave from 3 months to 6 months. During negotiations the government
agreed to give maternity leave of four and a half months.And parliament passed it. Now all
nationalized banks, Life Insurance corporation of India etc. give a maternity leave of 6 months. It is
learnt that Times of India group also gives a maternity leave of 6 months. Inference: A small
resolution at IAP changed the maternity leave for numerous mothers reducing the child morbidity
and mortality. Learn from this experience.Bring about the necessary changes to make India a better
place for children and pediatritians.
CP/42(P).CLINICAL AND ETIOLOGICAL PROFILE OF NON-NUTRITIONAL RICKETS
Rajesh R. Joshi, Sudha Rao
B.J.Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai

Objective: Clinical and etiological profile of non-nutritional rickets Setting and methods:
Retrospective study of 21 children with non-nutritional rickets . Results: Age of presentation : 9
months to 15 years (median 4 )- 9 male and 12 female children with consaguinity in 8. Modes of
presentation - Limb deformities (11 patients), short stature(2),failure to thrive(10), difficulty in
walking(3), carpopedal spasms/convulsions(3), delayed primary dentition(1), polyuria and
polydipsia(9), past history of fracture/s in 2 .12 patients had received vit D therapy before
presentation. Examination revealed short stature(Ht<3rd centile) in majority(20
patients),frontal/parietal bossing(7), wrist widening(19), double malleolus(12),bow legs(6), knock
knees(6), other deformities of lower/upper limbs(7), pigeon chest deformity(3), costochondral
beading(15), alopecia(3), kyphosis(1), hepatosplenomegaly(5),and hypertension with CRF(2).
Investigations revealed hypocalcemia(10 patients), hypophosphetemia(12), increased alkaline
phosphatase(18 patients),increased sr. creatinine(3), hyperkalemia(2), metabolic acidosis(15),
calciuria (urine ca/creatinine> 0.22 or 24 hrs urine Ca> 4mg/kg in 10/21 patients), hypokalemia(10),
urine pH>6(6),USG revealed nephrocalcinosis(7), dysplastic kidneys(1),bilateral hydronephrosis(1).
Tubular reabsorption of phosphorus[ 100 -100(urinary phosphorus/sr phosphorus x                     sr
creatinine/urinary creatinine) ] (normal>85%) done as needed in 12- 3 had proximal tubular defect
(phosphaturia) and one of them had glucosuria.NH4Cl loading test done in one patient suggested
distal RTA. Vit D metabolites were done as needed.25-hydroxy vit D levels were normal (10-50
ng/ml) in 6/8 and borderline high (had received vit D )in 2/8 patients. 4/6 patients had high 1,25
dihydroxy vit D levels(>150 in 3 and >100 in 1) (normal :20-60 pg/ml), one had low and one
borderline level(21pg/ml – receiving 1,25-dihydroxy vit D 1mcg/day when tested). Slit lamp
examination done in 7 patients, three showed corneal crystals suggesting cystinosis. X-rays in all
patients revealed rickets. Conclusion: 6 had vit D dependent rickets, 2 with type I and 4 with type II
; 3 had chronic renal failure and 12 had Renal Tubular Acidosis -3 proximal and 9 distal RTA as
cause of non-nutritional rickets.
CP/43(R).ATOPIC DERMATITIS IN CHILDREN OF KANPUR : CLINICO-
IMMUNOLOGICAL PROFILE
Mani Kant Kumar, V.N. Tripathi, R.P. Singh, Sushil Chandra, S.K. Arora, Asha Agrawa
Department of Pediatrics, GSVM Medical College, Kanpur

.Objective : To study clinicoimmunological aspects of Atopic Dermatitis in children of Kanpur
region between the age of 6 months to 15 years.Design : Prospective Hospital based study. Setting
– Patients attending OPD, Department of Pediatrics, and Deptt of Dermatology. Method : One
hundred thirty two cases of atopic dermatitis has been included in this study between the age of 6
months to 15 years. Patient with drug rashes, congenital skin disorder, contact dermatitis and infants
less than 6 months were excluded from this study. Differential count was done by counting 100
cells in blood film sained by Leishman‘s stain and total serum IgE titre by CLIA method. Results:
Incidence of Atopic dermatitis was 0.62% of all skin disorders attending OPD in this age group. In
our study 29% children presented during infancy and 90% presented before the age of 5 years.
Majority of patients (94%) presented with itching followed by excoriation of skin (82%), female
were affected more commonly than male (57% vs. 43%). Severity exacerbated in winter and
attenuated during summer. In our study 69.6% children with atopic dermatitis were on top feeds
during early infancy and 68.2% belonged to middle to high class i.e. Class I and II. Dry skin and
excoriation of skin were principal examination findings.Eosinophil counts (>5%) was increased in
72.7% patients while total serum IgE titre level (>230 IU/ml) was increased in 64% of
patients...Conclusions: Majority of patients presented before 5 yrs of age. Top feeding and high
socio-economic class appears to be risk factors for atopic dermatitis.Itching and chronic relapsing
eczema, were predominant presenting complaint and dry skin and excoriation of the skin were
predominant signs. Although eosinophil counts and total serum IgE level were increased in
majority of patients but could not be taken as diagnostic of atopic dermatitis. However, eosinophil
counts and IgE antibody titre might be taken as supportive evidence in diagnosing atopic dermatitis.
CP/44(P).STUDY OF IMPACT OF ACTION ON BREAST FEEDING PRACTICES
S. Nath, R. Pancholi, S. Sinha Roy, S. Trivedi
Dept of Pediatrics, Tata Motors Hospital, Jamshedpur

Objective: To evaluate the result of intervention taken on the baseline survey on knowledge of
breast feeding practices among mothers in an industrial set up. Materials: Design: Prospective study
Setting: Pediatric ward including NICU, Post natal ward and Well Baby Clinic Study Period:
January 2006- August 2006 Methods: Common issues related to breast feeding were identified and
a structured questionnaire was formulated. By using this method information were collected from
primi mothers with babies less than 6 months. Based on this baseline survey some action were taken
such as teaching regarding breast feeding To mothers in antenatal clinic, Pediatric ward, NICU, Post
natal ward and Well baby clinic To nursing staff of both Pediatric and Maternity ward Active
maternal participation in NICU After a course of action for six months repeat survey was done by
using same questionnaire. Results: 100 mothers who were surveyed before intervention was taken
as group I and 100 mothers who were included in the study after the action taken was considered as
group II. 79% were educated and 28% were working in group I and in group II 76% and 30%
respectively. Although in group I 56% mothers believe in early feeding within 1 hour but they
prefer (67%) prelacteal food whereas in group II early feeding knowledge has improved to 72%
mothers with less number (45%) gave preference to prelacteal feed.68% of the mothers in group I
feel that colostrum should not be given in comparison to 35% of group II. Exclusive breast feeding
for six months is known to 62% in group II in comparison to 47% in group I. Top milk is preferred
by 79% mother in group I whereas 58% in group II feel that it should be given. Most important
causes of giving top milk are perception of decreased milk as babies cry even after breast feeding,
working mother and pressure from mother in-law. Conclusion: We feel that not only Obstetrician,
the Pediatrician also should take active part in spreading the knowledge to mother before childs
birth to achieve our goal of successful breast feeding to all babies. Active participation of mother in
NICU, teaching to the mothers in post natal ward and immunization clinic and also teaching to our
nursing staff got significant role in spreading the message of proper breast feeding practices.