Q: I decided to mix milk powder with milk in order for my baby to grow faster. The paediatrician said this is not advisable. Why?

A: Powdered milk has to be reconstituted exactly as it says on the back of the tin. Usually it is 1 level measure (provided in the pack) of the powder to an ounce (30 ml) of boiled cooled water. This then contains proteins and electrolytes in the correct proportions for the digestive tract of babies. It is supposed to replicate natural milk (human or cow) as far as possible. If you add the powder to natural milk, the resulting solution will become too concentrated (hypertonic) in terms of protein and electrolyte content. It can damage the immature kidneys of the baby. A child should ideally double its birth weight by the fifth month and triple it by the end of the first year. Thereafter the growth rate slows. Also the milk content should be reduced at one year to 400 ml a day.

Old mom

Q: I am 36 years and my husband is 42 years old. We are having our first baby. I am afraid there may be something wrong with the baby because of our advanced age. Are there any precautions I can take?

A: Many older couples are now having children for personal reasons. Since you are over 35 years there is a greater risk of the baby having chromosomal anomalies, the most common of which is Down’s syndrome. The baby may be born before the due date and be premature and small in size. Your age may place you at risk for diabetes, high blood pressure and obesity. The pelvis or birth canal is likely to be less flexible so that you may require a caesarian section. All these complications can occur in younger mothers as well. The percentage just increases as age advances. You need to go for regular checkups, blood tests and scans. Then your obstetrician will be able to pick up complications or problems sufficiently early for appropriate intervention.

Hepatitis B

Q: I am hepatitis B positive. It was discovered accidentally when I went to donate blood. I am married with two young daughters. What should I do?

A: You need to check your family’s Hepatitis B status. If they are negative, and are not immunised, then they need primary immunisation with three doses of hepatitis B vaccine. You may also give them a booster after 5 years. You need to have tests for viral load etc. That can be done in any gastroenterology or hepatology centre.

Oil boil

Q: I woke up at night with severe pain in the right ear. The whole ear was swollen. My wife says she can see a boil in it. She wanted to pour hot coconut oil into the ear but I did not agree.

A: You need to consult an ENT surgeon. A boil in the ear canal is usually an infection in the skin lining it. It can be very painful. It requires antibiotics and analgesics. You should not really pour oil into the ear as you are not sure what is causing the pain. If you have a hole in the eardrum as a result of a previous childhood infection, the oil will enter your middle ear and damage it. These boils develop as a result of abrasions to the skin. Do not put foreign objects like pins or ear buds into your ear to clean it.

Weight watch

Q: My daughter is 12 years old and weighs 72 kilos. She is depressed about her weight as the only role she ever gets in school plays is that of the grandmother. She is never selected for dance programmes. What diet can I give her?

A: At 12, your daughter is still growing, so injudicious diet restriction is not a solution. You need to calculate her BMI (Body Mass Index) by dividing her weight by her height in metre squared. The normal value is 23. Try to allow chips, chocolate and ice cream only once a week. Cut off all aerated cola drinks. Reduce television viewing to an hour on Saturday and Sunday. Make her physically more active. Ask her to cycle, jog or run for an hour a day. Enrol her in dance or structured sports classes.

HIV status

Q: I am HIV positive and I feel I have received a death sentence.

A: HIV is a disease that can be controlled even though it cannot be cured. It is not fatal if treated. Go for regular check-ups. The doctor will check your blood CD4 levels. These are specialised cells in the immune system which protect the body from infection. If the number of CD4 cells drops below 200 CD4 cells, your body's immune system is no longer strong enough to prevent illness and infection. At that point you will be started on medication for AIDS and any secondary infection that may have occurred.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in