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Treatment of Child and Adolescent Problems
Thyroid Problems Treatment
Thyroid Disorder Treatment
Paediatric Critical Care
Treatment of Childhood Infections
Child Nutrition Management
Growth And Development Including General Paediatri
Management of New Born Care
Preimplantation Genetic Diagnosis (Pgd)
Congenital Ear Problem Treatment
Treatment of Polycystic Ovary Syndrome In Adolesce
Treatment of Thyroid Disease in Children
Cleft Lip Treatment
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Autism in children is a condition that is characterized by limiting social intelligence, unequal skill development across sectors, and repetitive behavioural patterns. These children may show awkwardness when dealing or speaking with people, as they seem to fail to understand what other people feel. Hence, they are unable to deal out emotional responses in kind. They themselves are very troubled, sometimes, by stimuli that are considered normal by other people, including certain visions, touches, smells and sounds.
The skill set of an autistic child forms and develops unequally. While they are not very social, they sometimes gain intense intellectual abilities in the field of math, music, chess, art and related matters which require the brain to visualize and function.
There are further ways to diagnose underlying autism in a child, and diagnosis is extremely necessary for early treatment and cure. These warning signs are-
• An autistic child will shy away from both tactile and non-tactile contact. Some children may naturally be scared of being touched by a stranger, but autistic children will not even look or smile at you when you are feeding them. They cannot maintain eye contact, and neither will they show signs of affection like small smiles or cuddles, or loving glances.
• Lack of auditory communication - This is another area of communication where an autistic child will be found lacking. Even above and beyond not responding to visual and tactile stimuli, she/he will completely forego aural communication as well. They will not respond to familiar sounds around and go even to the extent of not recognizing or being able to respond to their own name.
• If you point at things in the distance, there is a lack of communication with your child as well. These children do not have the ability to maintain a connection long enough to follow your hand and record what it is gesturing at. Either the child does not feel enough of a connection to you to actually feel your stimulus worth pursuing, or she/he does not have the power or attention span to keep following with eyes the trail your fingers have created.
• The child does not use a lot of aural communication her/himself as well too. She/he does not call out often or call you by acronyms like mother and does not make small whimpering noises like most infants do, in search for some warmth and affection.
She/he does not seem to have a natural affinity for physical touch and love and does not seem to be able to show very much love her/himself through cuddles or disappointment expressed if you get sick.
Autism is a disease that has now spread to a whole range of behavioural peculiarities, termed collectively as the Autism Spectrum Disorder. If diagnosed sufficiently early, this condition can be helped to a great extent. Make sure to monitor your child for the above signs, and contact a doctor immediately if you see cause for concern.
Epilepsy is a neurological condition that leads to recurrent seizures. Seizures arise when electrical activity in the brain suddenly surges causing a temporary disturbance within the messaging systems located between the brain cells.
Epilepsy is more common in children below the age of two years and adults above the age of 65 years.
Seizures are classified into two main categories depending on their area of impact.
A focal seizure is one that affects only one part or area of the brain whereas a generalised seizure affects the whole brain. Further, both focal and generalised seizures have various sub-categories which are as follows-
• Simple Partial Seizure
• Complex Partial Seizure
• Partial Seizure with Secondary Generalization
• Absence Seizures
• Myoclonic Seizure
• Atonic Seizure
• Tonic Seizure
• Tonic-clonic Seizure
• Mixed Seizure
• Status Epilepticus
Latest nomenclature of seizure types:
• Focal aware seizures
• Focal impaired awareness seizures (previously called complex partial seizures)
. Bilateral tonic clonic seizures
Generalised onset seizures-
• Tonic clonic seizures.
• Atonic seizures (sometimes called drop attacks) and tonic seizure.
• Myoclonic seizures.
• Absence seizures.
The well know symptom of epilepsy is a convulsion/ fit, a few other symptoms include-
• Intermittent spells of fainting. When this happens the patient is likely to lose control of his/her bladder or bowel movements. Following this, the person is likely to suffer from extreme tiredness.
• Spells of a blackout with difficulty in remembering
• Becoming unresponsive to any instructions or questions asked during brief periods of time
• Bouts of continuous blinking without any known reason
• Inappropriate movements that keep on occurring
• Changes in sensory perceptions
• Sudden stiffness in the body
Reasons for Epilepsy
Messaging systems within the brain are responsible for every function that goes about in your body. A disruption to this system caused by defective electrical activity leads to epilepsy in a person. Many people inherit epilepsy while others may develop this condition as a result of-
• Head trauma sustained during an accident
• A stroke or a tumour that has affected the brain impairing its normal capabilities
• An injury to the brain before or during birth
• Associated with developmental issues
• Infections of the brain
Treatment for Epilepsy
Epilepsy in childhood can be treated by using medications and by adopting dietary changes in some cases. Medications for epilepsy mainly include-
These medications should be consumed as and when prescribed by the doctor. You must consult a paediatrician for this, as he/she will take your child’s physical and mental in consideration before starting the treatment.
Seizures that occur in childhood may be benign. This means that it will not continue into one’s adult life. Further, those children who have suffered from epilepsy in their childhood have been seen to have normal mental and intellectual development in their adulthood. However, some epilepsy syndromes in children can have a devastating effect on the child.
Seizure threshold is a term that is used to refer to the conditions that are important for the production of seizures. The threshold is lower for people who are more prone to having seizures whereas the threshold is higher for those who do not have a tendency to suffer from seizures.
It is often stated by doctors that a child's brain and body develop through good nutrition, and this starts even before they have been conceived. If you are planning for a baby, then it is a must to tune your body for infant nutrition, as healthy growth of the brain in a child begins much before conception. An example to support this is that, folic acid intake should be started 14 weeks before conception. Folic acid is considered to be helpful in the early functioning of the brain.
By the time a baby is born, already three quarters of the cells of the brain are formed and the quarter which is left is formed by the first birthday. As soon as children reach 3 years, they have a brain which is as big as an adult's, and when children are growing, the neurons of the brain grow and develop with them. Thus a poor diet can hamper the growth of children, and also affect their ability to process information and learn. This becomes worse if the iron levels in the body dip below the required levels.
Iodine shortage also leads to irreversible motor and cognitive developments in the child. Similarly, DHA which is considered to be an essential fatty acid in the child development, if compromised, can lead to learning problems. It is known that DHA is the key component for the intensive production of the synapse which is important in the initial years of life for development and learning. Other nutrients like zinc, folic acid and choline all pay a role in the initial functioning of the brain.
Feeding a variety of food to the baby is important as they help in the development, but certain foods are a must. These are:
- Breast Milk: As per dieticians, a baby can only digest breast milk or formula milk in the initial months. Babies should be breastfed for the first six months as it has the basic nutrients required by a baby, and also gives protection against allergies, digestive diseases and infections. Breast milk also has iron which is crucial for the development of the baby.
- Iron rich cereals: Babies can be fed solid food by 4-6 months. If a baby can sit without support and shows tongue thrust reflex, then he or she is ready for solids. Starting solids with the introduction of cereals or rice cereals is good, as they can be easily digested. It can also be diluted with the breast milk or formula. As these cereals are rich in iron, they are good for the development of the baby. A diet deficient in iron leads to delayed talking and walking of a child.
- Fruits and vegetables: A good time to introduce vegetables and fruits is when the baby is 6-7 months. These foods are loaded with minerals and vitamins which provide different textures and tastes to the baby. Carrots mashed and strained, along with beans, apples, bananas, peaches and peas and pears can be given to the baby. These can be boiled or pureed or mashed for the baby for easy consumption.
- Pureed Food: These foods are generally the meats which can be given from 8-9 months. Meats like lamb, chicken and liver contain iron. The iron of the meats is easily absorbed, as compared to the iron in plants. For the maximum absorption of the iron in the meat, it should be served with vitamin C, some fruits, cantaloupe or broccoli. It is believed that vitamin C boosts the absorption of iron.
Though there are a number of environmental and genetic factors which effect the development of a child, food is one of the most important factors. Thus it should be kept in mind that good food leads to a happy, healthy and a well developing baby. Start from the beginning and focus on the right portions to ensure the health of your baby.
The role of parents in language development of children is a primary one. Basically, it will be a one way communication as babies will not respond but that should not deter you from speaking to them. It has been shown that talking to children early on helps them to talk faster and learn more words. The number of words a child hears is directly proportional to the amount of vocabulary he/she will be able to master.
6 ways to help your baby learn speaking:
1. Let them listen a lot
Children learn speaking by listening first. So more and more words they will listen, so do they will speak. Make sure your child comes in contact with children in the peer group and plays with them. Many words they will learn with the help of their friends.
2. Read a book
You should start to read to your child as early as possible. The type of book is not as important as you may use various touch and feel books such as graphic novels. Initially, you may start with board books and then move on to picture books and finally to story books. It helps in increasing the child's vocabulary.
3. Talk as much as you can
Part of a child's ears and brain that respond to sound are developed since birth, so even though talking to your baby may not make much sense, talking to them enhances their development of speech. The infant absorbs the words which facilitates speaking.
4. Look for cues
If the child is interested in something such as a book or a toy, then engage with the child on that subject. Encourage him/her to ask questions and interact as much as possible. These interactions help in enhancing the child's language skills.
5. Limit television
Using television to teach vocabulary to your child is not as effective as talking directly. The primary reason is that characters in television do not react to your child's cues. This does not allow the child interact which results in reduced language learning.
6. Treat ear infections early
It is important to treat ear infections early as this causes hearing problems which in turn delays language learning. Consulting a pediatrician to get treatment for ear infections of your child is advisable. You should see to it that the child is being administered medications at regular intervals.
Movement disorders can trigger from various types of brain injuries, metabolic disturbances, inflammation, trauma, side effects of medication, genetic disorders, infections etc. The brain structures that get affected are believed to include the thalamus, brainstem, basal ganglia, cortex etc. Since all these structures function together, any abnormalities in any of the structures can compromise movement. For instance, a kid suffering from primary dystonia can lead a near normal life, if the condition is detected and treated early in life. However, on the other hand, if the same condition goes undetected it can cripple the child for the rest of his life.
Different types of moment disorder-
- Chorea: It results from a neurological injury. The movement of children suffering from this condition becomes irregular and dance-like. The child often becomes slow or more forceful in their movement. If the condition affects the legs, a kid can frequently stumble and face difficulty while walking. Sydenham chorea is a condition that is not very severe and is reversible with treatment.
- Tremor: It is a condition that is characterized by trembling or shaky movements. This often results from an underlying and undetected condition that may be genetic in nature or a side effect of other medications. A kid suffering from this condition faces difficulty in fine-tuning movements. Tremor may run in family e.g. essential tremors.
- Myoclonus: It a disorder that involves quick involuntary muscle jerks that a child fails to resist.The jerks can be frequent or occasional, there may or may not be a pattern involved to it. This condition has no long-term complication on a child’s health, but it is necessary to evaluate the type of myoclonus a child is suffering from and must be differentiated from myoclonic seizure.
- Dystonia: It causes the muscle groups to contract abnormally, due to faulty signals of the brain. Instead of a coordinated contraction of muscles, they can contract in opposition causing the push and the pull muscles to work together. This can cause uncomfortable and painful twisting of limbs.
- Tourette syndrome: It is involuntary in nature, where sudden sounds or movements that appear, vanishes over a prolonged time period. This condition is the advanced form of muscle tics. They can involve any part of the body and greatly varies in severity. Children can successfully suppress tics but over time they build a sense of wrongness while resisting it. Most tic disorders are reversible with the right treatment.
- Ataxia: It results from a failure of motor coordination of the cerebellum, due to an injury or dysfunction. This condition can have various patterns involved to it. While few types of ataxia can come and go due to a condition such as metabolic disorder, epilepsy, genetic mutation etc, some begin abruptly due to brain bleed or stroke.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Infantile spasm is a seizure-related disorder that is witnessed among infants and young children. The average age for getting affected with infantile spasm is four months, but some kids might experience this disorder within a month of the birth. This disease can have a subtle appearance, and as such it is difficult to recognize as a serious condition. While a full seizure in an adult is scary, the one observed among infants can be as little as a minor head drop, along with minor body shakes. This might appear to be that serious, but infantile spasm is more serious as compared to a full body convulsion in adults. Unfortunately, an infant suffering from infantile spasm is at great risk of developmental disability, if the condition is not detected and treated early.
There are very few medicines that are approved by the FDA for treating infantile spasms. The two medicines that are widely used by doctors include Adrenocorticotropic hormone (ACTH) and Vigabatrin.
- ACTH: This is the oldest approved medicine by the FDA that was first discovered in the year 1958. This injection needs to be pushed twice in a day. Children tend to gain weight and feel hungry when this injection is injected.
- Vigabatrin: Vigabatrin is very well tolerated by young kids and has a successful track record of treating infantile spasms. Studies have proven that Vigabatrin can tackle tuberous sclerosis and plays an important role in improving developmental outcome.
Second line therapies:
- Pyridoxine: Dependency on Pyridoxine as a cause of infantile spasm is very rare. High dosage of oral administration of pyridoxine has fetched good results for patients, who do not suffer from pyridoxine related seizures.
- Valproic acid: Valproic acid has the best anecdotal rate of success. However, doctors do not recommend this medicine for kids less than 2 years of age because of possible complications.
- Clonazepam: This is one of the earliest non-steroid medicine for the treatment of infantile spasm. Some of the popular medicines used are nitrazepam, benzodiazepines, and clonazepam.
- Ketogenic Diet: This is a decade old practice that has come back to popularity again. Studies have shown that ketogenic diet can help 20-35 % patients of infantile spasm to keep the condition under control.
- IVIG: High dosage of IVIG has been reported to be very helpful in tackling infantile spasms. The dosage ranges from 100-200 mg/kg/dose ranging for about 2-3 weeks at stretch.
- Surgery: The final part of the therapy includes a surgery that removes the abnormal part of the brain. It should only be considered for patients who have not responded to therapies including Vigabatrin and ACTH. It should also be investigated whether the patient has any structural abnormalities of the brain.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Cerebral Palsy is a disorder related to the posture, movement or muscle tone, mostly due to immature development of the brain in a baby. This condition usually crops up, when the baby is already in the womb. The symptoms may surface when the baby is in its infancy or even later. Irregularities in the reflexes, posture, walking style, etc should ring a bell for the parents. Kids suffering from cerebral palsy may also suffer from muscle imbalance of the eye muscles, leading to problems focusing on an object. The range of motions becomes limited as well. There could be conditions such as deafness, epilepsy, impaired brain function and blindness associated with this disease.
Whom to consult for cerebral palsy in kids?
A kid suffering from Cerebral Palsy might have to work with a medical team for a very long time. Parents might need the help of a paediatrician, orthopaedic surgeon, paediatric neurologist, physical therapist, speech-language pathologist, mental health specialist, developmental therapist, recreation therapist and special education teacher.
Treatments that are available for Cerebral Palsy in kids Medication:
Medications: Medications are often used to improve the functional abilities of a kid. Certain spasticity related complications, treatment of pain, and other symptoms of Cerebral Palsy can be treated with medications. It is important to discuss with the doctor, the side-effects involved in taking the medication. There are two types of medications- for isolated spasticity and for generalized spasticity. In case of Isolated spasticity, doctors recommend Botox injections every 4-6 months to stabilize one muscle group. If the whole body is affected due to cerebral palsy, doctors recommend medications such as baclofen, diazepam and dantrolene to relax the contracted and stiff muscles.
Therapies: While there are many therapy treatment, three types of therapies are the most important for treating a child suffering from cerebral palsy. They are physical therapy, occupational therapy and speech& language therapy. Physical therapy is necessary for the flexibility, mobility and motor development of the child. Occupational therapy helps a kid imbibe alternative strategies to participate in daily activities. From teaching a child to walk with a cane to help them operate a wheelchair, physical therapy makes a child self-sufficient as much as possible. Speech and language therapy helps child’s ability to communicate either verbally or with sign-language.
Surgery: Surgery may be necessary to loosen the muscles, correct abnormalities of the bone etc. An orthopaedic surgery is necessary in cases where a kid was born with several deformities. The correction can decrease pain and increase mobility. In severe cases when the normal treatments do not help, doctors cut the tendon of spastic muscle. It helps to relieve the pain and relax the muscle.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Bedwetting, also known as Nocturnal Enuresis, can be referred to as the unintended and involuntary urination during sleep. Enuresis, being a medical term, stands for wetting, whether during the day in full clothing or at night in bed. For young children and infants, urination is certainly involuntary. It is worth note that children who wet their beds are not actually being disobedient or lazy.
Child Bedwetting can be classified into two types- Primary and Secondary
It has been continuing since the phase of early childhood without a halt; which means the child bed-wets every night.
The child is unable to hold urine over the length of the night.
The child cannot wake up in case his or her bladder is almost full..
The child has been taught poor toilet habits as he/she puts off urinating for hours during the day.
Secondary bedwetting can be an indication of a repressed medical or emotional condition.
People suffering from diabetes need to urinate frequently.
Any injury or abnormality of the nervous system can take a toll on the neurological balance that fundamentally controls urination
A peculiarity in the muscles or other organs that are involved in urination can be the reason behind bedwetting.
How to address the problem of bedwetting?
Motivational Therapy: This involves parents motivating their children to reinforce their sense of self-control over bed-wetting.
Moisture alarms that can detect wetness in the child’s trousers while sleeping and sound an alarm bell to wake the child up.
- Tricyclic anti-depressants that lower the amount of urine produced by the kidney.
Epilepsy is repeated episodes of seizures caused by abnormal signals in the nerve cells in the brain, which can result in strange sensations, convulsions, muscle spasms and loss of consciousness. It is frightening to watch your child have an episode of seizure, but the good news is that most children with epilepsy outgrow seizures. An episode usually last from a few seconds to a few minutes.
Types of Seizures
There are 2 types of seizures:
Generalized Seizures affect the whole brain
- Generalized tonic-clonic seizure: It is the most common type of seizures in children. In this condition, the child's body becomes stiff and falls, the child may also experience shaking of the limbs. The skin becomes bluish and teeth are clenched. The child may fall into a deep sleep afterward.
- Absence or Petit Mal Seizures: The child is unresponsive and may have eyelid blinking/ staring.
- Atonic and tonic seizures: The child collapses suddenly due to complete loss of muscle tone. This can result in head injuries.
- Myoclonic Seizures: The child may experience sudden, brief jerky movements of muscles of head, neck, and shoulders.
Partial Seizures affect a part of the brain
- Simple partial seizures are characterized by uncontrollable movement of a part of the body. The child is conscious and aware but can't control the movement.
- Complex partial seizures occur mostly during sleep the child may make odd movements, run, scream and even hallucinate. And if the child is awake, he doesn't recall the event.
Do's and Don'ts during an episode of seizure
- Keep a track of how long the episode lasts
- Turn the child to one side to prevent choking
- Put a pillow under the child's head
- Never try to put anything in the child's mouth as it may obstruct the breathing.
There can be many causes of episodes of seizures
- During high fever in the first 48 hours (febrile seizures)
- Head injury
- Bacterial and viral infections of brain like meningitis
- Lack of oxygen to brain
- Disorders in brain development
- Organic disorders of brain like cysts and tumors
- It is confirmed by a pediatric neurologist
- Various investigations are done to confirm the diagnosis including MRI and EEG.
- Blood and urine tests to diagnose infections
Treatment of epilepsy
The pediatric neurologist usually decides the treatment plan depending on the child's age, weight, and type of epilepsy.
- Antiepileptic medications are the first line of treatment. The drugs are usually required for two years and then if there is no episode for these two years, it is discontinued. These drugs may have some side effects like drowsiness, inability to concentrate and gingival enlargement. Discuss with your pediatrician on ways to manage them.
- Sometimes a ketogenic diet is also prescribed. The child is given a fat rich and carbohydrate low diet.
It is worrisome as a parent if your child is diagnosed with epilepsy, but about 65% children need medication for 2 years and then outgrow seizures. However, remember that the child should never miss their medication and get enough sleep.
High fever is common in kids and a common worry for parents as well. If you are a parent, you need to know when the fever is serious, and when you should worry about it.
Fever is a defence mechanism of the body. Body temperature rises if any foreign body (or antigen) attacks your body. As a defence, body temperature rises making it an unfavourable condition for the antigen. Fever means temperature above normal i.e. 98.6. Normally for kids, thermometer is placed under the armpit to record the temperature. You need to add an extra degree for accuracy. Paediatricians recommend treatment for fever if it's more than 101 degree F.
When to Call a Doctor
If the kid is less than 4 months old and has a fever of 100.4degree F with other mentioned symptoms as highlighted, one must see the doctor as an emergency situation.
If a kid has 104degree F fever, rush to the doctor. Such a high fever in children could lead to seizures.
You must call a doctor if the kid has a fever along with the following symptoms:
- Looks very drowsy
- Has a deteriorated immune system or even any other medical condition
- Has a seizure
- Has symptoms such as rashes, painful throat, annoyance, rigid neck or ear pain
Medication Side Effects:
At times, if you treat your children with some medication that does not suit them, it may lead to high fever.
In case fever in a kid aged less than 2 years lasts for more than one day, it's time to see a doctor. And lastly, remember that normal body temperature is 98.6 degree F.