इंतेर्विएव्विथ Dr. Neena शिलें,Consultant, Department of Developmental Pediatrics, Sunrise Hospital, Kakkanad

Dr. Neena Shilen is presently working as Consultant, Department of Developmental Pediatrics, Sunrise Hospital, Kakkanad. She is also the Coordinator of ABCD (Assuring Brighter Child Development) Program and is one among the few doctors who has put her efforts towards bringing quality health care to everyone affordably. She did her MBBS and MD Pediatrics at Pt Jawaharlal Nehru Memorial Medical College, Raipur . Previously she worked for Crozer – Chester Medical Center . Crozer-Chester Medical Center is a part of the Crozer-Keystone Health System, a system of five hospitals in Delaware County, U.S.A.She has worked as Resident , Children’s National Medical Center(CNMC), Washington D.C, as Assistant Surgeon, Health Services Dept., Government of Kerala, and as Lecturer in Pediatrics, ACME Medical College, Kannur, Kerala. She has been honoured with “Americas Top Pediatrician” recognition by the Consumer Research Council of America.She has served as Executive Liaison, Committee on Residency Scholarships (CORS) of Resident section of American Academy of Pediatrics(2005-2007);She has been selected for participating in Advocacy Day of American Academy of Pediatrics where she gets an opportunity to go to Capitol Hill to meet Senators or their legal assistants to advocate for kids for reauthorization of assault weapons Ban and presenting assault weapons as a public health hazard for children.

In an interview to Sreeni K.R, Dr. Neena Shilen, gives a glimpse of Developmental Pediatrics and shares his experience on how children with developmental and behavioral problems from birth to adolescence can be treated by consultation and evaluation.

Q1. Exactly what does Developmental Paediatrics deal with?
Ans. The Developmental Pediatrics Department offers comprehensive consultation, evaluation and treatment for children with developmental and behavioral problems from birth to adolescence. A Developmental pediatrician deals with :

1. Any developmental delay and developmental therapy

2. Evaluation of children with developmental or learning disabilities

3. ADHD Assessment and Treatment

4. Autistic Spectrum Disorders

5. Behavioral disorders

6. Cerebral Palsy and Spasticity Management

7. Mental Retardation

8. Traumatic Brain Injury

9. Problems related to family issues, such as divorce

10. Adolescent and young adult sexual identity issues

11. Evaluation of school or related difficulties (hearing problems, hyperactivity, peer problems)

Specialized Treatments like

• Follow-up program for premature infants.

• Short-term and long-term counseling services.
  
  

Q2. Now a days we see lot of behavioural disturbance in children. What,according to you, are the reasons ?
Ans. There is an alarming rise in behavioral disturbances in children and adolescents. One of the important influences is television and electronic games, specially without parent supervision or control. Parents often use the television and the computer as electronic baby-sitters. Other factors include:

1. Nuclear familes and both parents working

2. Decreasing socialization and outdoor activities.

3. Child abuse – psychological and physical

4. Stress during pregnancy, domestic violence

5. Changing dietary habits and lifestyles

6. Some genetic factors are also known.
   

Q3. What is the awareness level about the need of wellness checkups for the children in the state?
Ans. Almost nil. Only the NRI population from U.S, U.K and the likes, would take their kids for well checks. Even though I counsel parents for well baby checks, only a few come for this. The concept of a doctor’s consultation here is only when a child is sick. People think sickness only in terms of physical illness. The importance of mental, emotional and social health is necessary for the overall development of a child,for it to reach its full potential. The main goal of wellness check is Early detection and Early intervention. Intervention done at a later stage is not so effective as early intervention.

Q4. What are the reasons you find for psychological disabilities and learning problems among children ?

Ans. Some of the reasons for psychological disabilities and learning disabilities are:

• Genetic

• Stress factors

• According to the latest research by Cornell University, U.S.A,

• television watching in children below the age of three years is linked

• to ADHD and autism.

• Poor self esteem

• Environmental toxins like lead and cadmium

• Family history of Learning disorder

• Smoking and alcohol during pregnancy

• Complications during birth of child or in newborn period

• Pregnancy complications .Researchers claim that mothers who are stressed or depressed during pregnancy produce offspring who are more prone to developing learning and behavioural problems, depression and anxiety as they get older. The risk is very small.

Q5. At what age group do you advise consultancy?

It is important to do well child check ups at periodic intervals from birth to adolescence to ensure that the child is developing appropriate for his age. Well-care, well-baby, or well-child visits are periodic visits for:

• physical examinations

• immunization updates

• tracking growth and development.

• finding any problems before they become serious.

• information on health and safety issues.

• information on nutrition and physical fitness.

• information on how to manage emergencies and illnesses.
  

Awareness of normal development in children during newborn period, what to expect of development and behavior in a child at a particular age, say 6 months, 1 yr, 2 yrs etc. is key to efficient parenting. Parents should also be aware of changes in behavior and emotional needs of an adolescent. Conflict between parents and adolescents can be avoided if parents understand that some behaviors that seem abnormal are actually part of normal development in adolescent period.

Typically well checks are done more intensively in the 1^st two years as the development of brain is fastest and almost complete by this time .Well checks in the first year of life is done at 1 , 2 , 4, 6, 9 and 12 months of age. In the second year, it is done at 15, 18 and 24 months of age. After two years, once a year check up is satisfactory.

Well checks are more frequent for high risk babies like preterm, low birth weight babies, babies having long NICU stay, and babies of mothers having diabetes, high blood pressure, infections, bleeding, psychiatric problems during pregnancy.

Q6. What all disorders do you commonly see in the children during teenage and adolescent age?

• Conduct disorders

• Oppositional and defiant behavior

• Attention deficit hyperactivity disorder

• Depression.

• Anxiety.

• Lack of self esteem.

• Substance abuse.

• Eating disorders.
  
  Q7. What are the behavioral changes you find when children turn to adolescent age?

Apart from the development of adult sexual characteristics: breasts, menstrual periods, pubic hair, and facial hair, change in voice in boys, there is a dramatic change in behavior around their parents. Theyre starting to separate from parent influence to become more independent and always seeming to have different opinions than their parents, will suddenly begin asserting themselves - and their opinions - strongly and rebelling against parental control.This is a time of emotional ups and downs,

They start to think more abstractly and rationally. Theyre forming their moral code. Kids at this age are increasingly aware of how others, especially their peers, see them.

Parents who know whats coming can cope with it better. And the more you know, the better you can prepare your child. If teenagers want to dye their hair, paint their fingernails black, or wear funky clothes, it may be worth thinking twice before you object. Teens want to shock their parents and its a lot better to let them do something temporary and harmless than going into a rebellious state.

Certain amount of change may be normal during the teen years, but too drastic or long-lasting a switch in a childs personality or behavior may signal real trouble like:

• Drastic changes in personality

• Sudden change in friends

• Skipping school continually

• Extreme weight gain or loss

• Sleep problems – excessive or too little

• Falling grades

• Talk or even jokes about suicide

• Signs of tobacco, alcohol, or drug use

• Frequently breaking laws

• Excessive anger and violent behavior

• Withdrawing from friends and parents
  

Q8. How is the childrens behavior affected by strain among parents?

Ans. Domestic violence, divorce and single parenting are strongly related to behavioral problems in children.

Q9. What exactly is autism and what is the percentage of children affected by autism in Kerala?

Ans. Autism is a neurodevelopmental disorder, which mainly affects communication, speech and socialization skills of a child. Some children show some stereotypic repetitive movements and ritualistic behavior. Children with autism develop normally in the 1^st 18 months to 2 years of age and may be gifted in some areas, so parents may not notice anything abnormal till the symptoms are very obvious. The incidence of autism, which was 1 in 2500 in the past, has now risen to 1 in 100 to 150.

Q10. What do you think about the need for qualified psychologists in schools and colleges in Kerala?

Ans. I think all schools should have a resource room with special educators and counselors who can recognize the signals of psychological distress and learning disorders so that they can refer the children for further evaluation to a qualified psychologist.