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Over the years, survival of children with chronic diseases has significantly improved and a large proportion of them now are entering into adulthood. Transition of Care (ToC) of such patients with having childhood onset of chronic diseases to the adult health care system is well organized in developed countries, although it is an emerging concept in India. In situations where the systems for ToC are not in place, such cases are fraught with unsatisfactory health outcomes. With proper ToC in place, these patients are likely to receive uninterrupted care by the adult care physicians and hence reach their full potential. This document highlights the need, rationale and way forward for ToC of youth with special health care needs (YSHCN) across the country. It also describes the standard operating procedures to develop the ToC at a hospital level for clinicians and administrators. [ABSTRACT FROM AUTHOR]

Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and linguistic development of a young child. The 'Countdown to 2030' global distribution of 'children at risk of poor development' indicates the need for urgent action and investment in ECD. Nurturing care enhances ECD, even in the presence of adversities. Strategic actions should exist at multiple levels: the family, community, health care providers and government. Previously, child health related policies and programs of the Government of India functioned in isolation, but have recently started demonstrating multi-sectoral collaboration. Nonetheless, the status of ECD in India is far from optimal. There is strong evidence that parenting programs improve outcomes related to ECD. This is dependent on key programmatic areas (timing, duration, frequency, intensity, modality, content, etc.), in addition to political will, funding, partnership, and plans for scaling up. Each country must implement its unique ECD program that is need-based and customized to their stakeholder community. Barriers like inadequate sensitization of the community and low competency of health care providers need to be overcome. IAP firmly believes that responsive parenting interventions revolving around nurturing care should be incorporated in office practice. This paper outlines IAP's position on ECD, and its recommendations for pediatricians and policy makers. It also presents the roadmap in partnership with other stakeholders in maternal, neonatal, and child health; Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum (NNF), World Health Organization (WHO), and United Nation Children Fund (UNICEF) [ABSTRACT FROM AUTHOR]

INDIAN PEDIATRICS 190 VOLUME 58 FEBRUARY 15, 2021 C C C C C O O O O O R R R R R R R R R R E E E E E S S S S S P P P P P O O O O O N N N N N D D D D D E E E E E N N N N N C C C C C E E E E E Position Paper on Kawasaki Disease in India: Pertinent Issues We read with interest the recently published IAP position paper on Kawasaki disease (KD) [1]. The definition of recurrent KD would essentially mean a recurrence after documented remission of the first episode of KD (clinically, echocardiography and laboratory). This condition has clinical features which overlap with other inflammatory diseases in childhood like Kawasaki disease (KD) and toxic shock syndrome (TSS) [2]. Recurrent KD is defined as a repeat episode of KD after complete resolution of the first episode [1,2]. [Extracted from the article]

We read with interest the recently published IAP position paper on Kawasaki Disease (KD) [1]. INDIAN PEDIATRICS 292 VOLUME 58 MARCH 15, 2021 CORRESPONDENCE lower stage of disease, could be of sampling error and data collection from non-heterogeneous population (predominantly stage 1). The definition of recurrent KD would essentially mean a recurrence after documented remission of the first episode of KD (clinically, echocardiography and laboratory). AUTHORS' REPLY We are in agreement with the author that NT Pro BNP is not a well established tool for the diagnosis of KD. [Extracted from the article]

Burden of Influenza is significantly higher in developing countries as compared to developed countries, but the data on the disease burden is less well defined in most of the developing countries including India, and consequently, constraints evolving strategies for prioritization of measures to prevent and control it. The 'swine flu' or 'A(H1N1)' pandemic is on the wane but the virus continues to circulate causing sporadic outbreaks even in 2013. The A(H1N1)pdm09 has replaced the previous circulating seasonal A (H1N1) virus and acquired the status of a seasonal virus. Limited influenza activity is usually seen throughout the year in India with a clear peaking during the rainy season. The rainy season in the country lasts from June to August in all the regions except Tamil Nadu where it occurs from October to December. IAP recommends the ideal time for offering influenza vaccines is just before the onset of rainy season. The efficacy/effectiveness data of trivalent inactivated influenza vaccines are also presented in different age groups and different categories of individuals. The IAP maintains its earlier recommendations of using the current trivalent inactivated influenza vaccine in all children with risk factors but not as a universal measure. IAP has now prioritized different target groups for influenza vaccination based on contribution of the group to the overall influenza burden, disease severity, and vaccine effectiveness in different age groups and categories. The current trivalent inactivated influenza vaccines incorporate the 2009 pandemic strain also, hence avert the need of a separate 'A (H1N1)' vaccine. IAP stresses the need of more refined surveillance; large scale studies on effectiveness of seasonal influenza vaccines in Indian children, and more effective, properly matched, highervalent influenza vaccines. [ABSTRACT FROM AUTHOR]

Justification: Mumps, despite being a widely prevalent disease in the country, is considered as an insignificant public health problem mainly because of poor documentation of clinical cases and lack of published studies. In the absence of adequate published data on disease burden, Government of India has recently decided to introduce measles-rubella (MR) vaccine in its National Immunization Program and neglected mumps component. Process: Following an IAP ACVIP meeting on December 6 and 7, 2014, a detailed review of burden of mumps in India along with vaccination strategies to control the disease was prepared. The draft was circulated amongst the members of the committee for review and approval. Revised final draft was later approved by IAP executive board in January 2015. Objectives: To provide a review of community burden of mumps in India; and to discuss the vaccination strategies to impress upon policymakers to include mumps vaccination in National immunization program. Recommendations: A total of 14 studies and two media reports on mumps outbreak were retrieved. The outbreaks were reported from all the regions of the country. Mumps meningoencephalitis was responsible for 2.3% to 14.6% of all investigated hospitalized acute encephalitis syndrome or viral encephalitis cases in different studies. Data from Infectious Disease Surveillance (ID Surv) portal of IAP and Integrated Disease Surveillance Program (IDSP) of Government of India (GoI) were also reviewed. While a total of 1052 cases were reported by the IDSurv, IDSP had investigated 72 outbreaks with 1564 cases in 14 states during different time periods. Genotypes G (subtype G2) and C were found to be main genotypes of the mumps virus circulating in the country. Three studies studied serological status of young children and adolescents against mumps, and found susceptibility rates ranging from 32% to 80% in different age groups. Conclusions: Mumps poses a significant disease burden in India. This calls for inclusion of mumps vaccine in the National immunization program. [ABSTRACT FROM AUTHOR]

Measles continues to be a major cause of childhood morbidity and mortality in India. Recent studies estimate that 80,000 Indian children die each year due to measles and its complications, amounting to 4% of under-5 deaths. Immunization against measles directly contributes to the reduction of under-five child mortality and hence to the achievement of Millennium Development Goal 4 (MDG 4). The live attenuated measles vaccines are safe, effective and provide long-lasting protection. The key strategies being followed globally for measles mortality reduction are high coverage of measles first dose, sensitive laboratory supported surveillance, appropriate case management, and providing second dose of measles vaccine. Prior to 2010, India was the only country in the world that had not introduced a second dose of measles vaccine in its National immunization program. We herein discuss the current status of measles vaccination along with the rationale and challenges of providing a second opportunity for measles vaccination, and the principles of measles catch-up campaigns. [ABSTRACT FROM AUTHOR]

Adverse event following immunization (AEFI) is a critical component of immunization program. The risk of AEFI with vaccination is always weighed against the risk of not immunizing a child. There is an evolving AEFI surveillance system in India for the vaccines delivered through 'universal immunization program' (UIP) of government sector, but the reporting remained suboptimal for long in the country, and there is almost no participation from private sector. The AEFI reporting from private sector will provide vital information on the safety of new and underutilized vaccines, not part of the UIP in India. The national guidelines are recently revised and updated. The Indian Academy of Pediatrics believes that pediatricians, especially in private sector have a crucial role to play with reporting of AEFI with newer/underutilized vaccines. Programmatic error, vaccine reaction, injection reactions, coincidental and unknown are the five broad categories of AEFI for programmatic purposes. The serious AEFIs (death, disability, cluster and hospitalization) need to be reported immediately and investigated in detail as per the laid down procedures, Once a serious AEFI happens, primary or urban health centre should be immediately informed by the pediatricians practicing in rural or urban areas, respectively. This advocacy paper from the academy provides guidelines to practitioners on how to report cases, and suggests ways for IAP members to help in ongoing efforts of the government in improving AEFI surveillance in the country, The details about the diagnosis and management of known/expected AEFI with UIP and newer vaccines shall be published later. [ABSTRACT FROM AUTHOR]

Objectives: To identify the characteristics of the manuscripts submitted to the Indian Pediatrics; attributes of the peer-review process and decision-making; and factors associated with their acceptance or rejection. Methods: All submissions to Indian Pediatrics during 2002 were analyzed by a retrospective review of records. Manuscripts were categorized by their place of origin (Indian vs. foreign), geographic region of India (north, south, east, west, central), submitting institution (teaching vs. non-teaching), subject (general pediatrics, systemic pediatrics, neonatology, genetic syndrome, allied sub-specialities, etc.), and type of article (research paper, case report, images, letter to editor, review, etc.). Manuscript details were recorded in a database that also included information on peer reviewer assignment, editorial and reviewer comments, and final disposition of the manuscript. Characteristics of accepted and rejected manuscripts were compared. Results: Indian Pediatrics received 687 manuscripts for consideration in the year 2002; mostly from Indian authors (89%). Maximum contributions were received from North India (236, 39%) followed by 165 (27%) from South, 95 (16%) from West, 90 (15%) from Central and 26 (4%) from Eastern part of India. Of 687 papers, 457 (66%) articles qualified for peer review. Agreement between the reviewers was not significantly greater than that expected by chance; kappa for inter-rater agreement was 0.35, 0.17 and 0.21 between any two sets of reviewers for 431,228 and 203 articles, respectively (P <0.005). Of 687 submitted manuscripts, 294(43%) were accepted, 347(50%) were rejected and no decision was possible on 46(7%) manuscripts. The top reasons for rejection were 'absence of a message', 'lack of originality', 'inadequate methods', 'not relevant to journal', 'over-interpretation of results', 'unsatisfactory writing style, 'inaccurate/ inconsistent/insufficient data', and 'inappropriate statistical analysis', in that order. Median number of days (IQR) needed to reach the final decision was 81 (25-210) d; ranging from 8 (3-29.5) d for Images to 180 (90-341) d for Research papers. No preference for acceptance was noted for foreign articles, geographic region of India, type of institution, or a particular topic, on both univariate and multivariate analysis. Conclusion: Indian Pediatrics is receiving contributions from all over India. Majority of the manuscripts are peer-reviewed. Of every 10 articles submitted, almost 4 are accepted. Median time interval from submission to final decision is less than 3 months. The decision-making is not influenced by the place of origin of manuscript. [ABSTRACT FROM AUTHOR]

Trauma is a global challenge and India has one of the highest trauma deaths in the world. Despite the United Nations' target to halve the global number of deaths and injuries from road traffic crashes by 2030, death tolls from road traffic injuries (RTI) are rising in India. In the pediatric age group, falls from height add to the burden of trauma. Uncontrolled bleeding from exsanguination on scene is estimated to account for nearly 40% of RTI trauma related mortality. Stopping the bleeding in the first few minutes is crucial for meaningful survival and hence the role of training lay public who can reach the scene in minutes. Active bleeding control (ABC) pilot research project to simulation train the bystanders to stop the bleed showed promising outcomes in Hyderabad, India. This paper describes the ABC project and discusses the role of pediatricians in training the public to reduce morbidity and mortality from uncontrolled bleeding at the trauma scene. [ABSTRACT FROM AUTHOR]

India introduced competency-based medical education (CBME) in the year 2019. There is often confusion between terms like ability, skill, and competency. The provided curriculum encourages teaching and assessing skills rather than competencies. Though competency includes skill, it is more than a mere skill, and ignoring the other aspects like communication, ethics, and professionalism can compromise the teaching of competencies as well as their intended benefits to the patient and the society. The focus on skills also undermines the assessment of relevant knowledge. This paper clarifies the differences between ability, skill, and competency, and re-emphasizes the role of relevant knowledge and its assessment throughout clinical training. It is also emphasized that competency assessment is not a one-shot process; rather, it must be a longitudinal process where the assessment should bring out the achievement level of the student. Many of the components of competencies are not assessable by purely objective methods and there is a need to use expert subjective judgments, especially for the formative and classroom assessments. A mentor adds to the success of a competency-based curriculum. [ABSTRACT FROM AUTHOR]

Mumps is a global public health problem caused by mumps virus, a member of paramyxoviridae family. MMR (Mumps, Measles, Rubella), an effective vaccine, has been incorporated into routine immunization schedules in over 100 countries. On the contrary, in India, vaccine against mumps has not been included in the routine immunization schedule as mumps is still not viewed as a significant public health problem by the government to warrant such an intervention. An increasing number of mumps outbreaks being reported from many parts of the country in the recent past, is matter of concern. The current paper reviews the situation of mumps in India including the recent surge, and discusses the remedial measures to contain these outbreaks. We conclude that inclusion of Mumps component as MMR vaccine in the Universal Immunization Programme of India along with strengthening surveillance is required to tackle the situation. [ABSTRACT FROM AUTHOR]

The paper attempts to capture the development of the Department of Pediatrics, Safdarjang Hospital, New Delhi, from a historical perspective in its founding years in late 1950s, showing the progress from its nascent state as a part of adult medicine to a full-fledged independent department with state-of-the-art advances in the 2020s. From an ordinary Pediatrics Department, it was reorganized radically to expand clinical facilities as well as education and research by innovative methods, developing subspecialties including an upgradation of the neonatology division, simultaneously establishing linkages with community level centres. The pioneering workshops for training obstetricians and pediatricians paved the way for initiation of multiple such national workshops across the country, by the Government of India, for establishment of neonatal care units countrywide. It was instrumental in the formulation of 'Essential Newborn Care' as the first national newborn care program and later a new concept of 'Mother and Neonatal Care Unit (M-NICU)' for perinatal care, apart from many other contributions for shaping national policies. [ABSTRACT FROM AUTHOR]

Implementing the nurturing care framework (NCF) for early childhood development (ECD) is essentially multisectoral, requiring coordination amongst all sectors and harmoniously integrating it within the existing contact opportunities in the health sector. This paper discusses the relative strengths, persisting gaps, challenges, and the way forward to implement nurturing care for ECD through the public health system. The vast network of frontline health workers and health facilities; community, home, and center-based service delivery; health and wellness centers located close to the communities have the potential to promote nurturing care. Persisting gaps include limited capacities of health workers in the nurturing care domains, lack of community engagement for ECD, weak referral linkages, inability to reach the most vulnerable children, missed opportunities for early identification of children at risk, and early intervention for children developmental delays and difficulties. Moving forward, incorporating nurturing care components into essential services packages, enhancing competencies of health workers, engaging with parents, establishing a mechanism for tracking children at risk, and developmental surveillance by trained service providers can provide the much-needed impetus to ECD. [ABSTRACT FROM AUTHOR]

Medical education research (MER) aims to improve the practice of medical education by applying the theory of educational research. Internationally, medical education research has grown exponentially and has established itself as a distinct field. In contrast, in India, the medical faculty is either bogged down by clinical responsibilities, or is busy with biomedical research. The recent initiatives such as implementation of competency-based medical education (CBME) for medical undergraduates, and push coming from regulatory agencies besides National Education Policy have become game changers. The emerging concept of scholarship, takes in to account all scholarly activities in a fair manner. The scholarship of teaching and learning (SoTL) is helpful in connecting teaching with better patient care outcomes through evidence based approach. It also promotes a community of practice to boost research and publication activities. Finally, there is a need to enlarge the scope of research from treating sick children to promoting total wellbeing, which requires interdisciplinary and interprofessional approach to research. [ABSTRACT FROM AUTHOR]

Justification: The IAP last published the guidelines "Comprehensive Management of Diarrhea" in 2006 and a review in 2016. The WHO in 2002 and the Government of India in 2004 recommended low osmolarity rehydration solution (LORS) as the universal rehydration solution for all ages and all forms of dehydration. However, the use of LORS in India continues to be unacceptably low at 51%, although awareness about ORS has increased from a mere 14% in 2005 to 69% in 2015. Availability of different compositions of ORS and brands in market added to the confusion. Process: The Indian Academy of Pediatrics constituted a panel of experts from the fields of pediatrics, pediatric gastroenterology and nutrition to update on management of dehydration in children with particular reference to LORS and issue a current practice guideline. The committee met twice at CIAP HQ to review all published literature on the aspect. Brief presentations were made, followed by discussions. The draft paper was circulated by email. All relevant inputs and suggestions were incorporated to arrive at a consensus on this practice guideline. Objectives: To summarize latest literature on ORT and empower pediatricians, particularly those practicing in rural areas, on management of dehydration by augmenting LORS use. Recommendations: It was stressed that advantages of LORS far out-weigh its limitations. Increased use of LORS can only be achieved by promoting better awareness among public and health-care providers across all systems of medicine. LORS can also be useful in managing dehydration in non-diarrheal illness. More research is required to modify ORS further to make it safe and effective in neonates, severe acute malnutrition, renal failure, cardiac and other co-morbidities. There is an urgent need to discourage production and marketing all forms of ORS not in conformity with WHO approved LORS, under a slogan "One India, one ORS". [ABSTRACT FROM AUTHOR]

Scientific papers are often assessed by the number of citations they receive in subsequent years. We retrieved the most cited articles published in 'Indian Pediatrics' by counting the number of citations on 'Google scholar'. 17 scientific papers received more than 50 citations; all except one were research articles. The maximum number of most cited articles (six each) were related to neonatology and infectious diseases. Most of these articles made significant impact in formulation of guidelines and/or change in practice and policy. [ABSTRACT FROM AUTHOR]

Residents-as-teachers campaign started abroad during the last decade of the twentieth century. In India, though used informally for teaching of undergraduate students, residents have mostly been used for patientcare and their formal induction as teacher in Indian scenario is rare. Accordingly, not much effort has been made to train them formally in educational technologies. Teaching job requirements of residents are not the same as that of medical college faculty; as such, a program designed for medical college faculty will not prove equally effective for the residents. There is urgent need to train the residents in educational technologies for tapping their full potential as teachers and for this to happen, there must be a training module, tailor-made for the teaching-job requirements of the residents. This paper proposes such a program, after emphasizing the need of inducting residents in departmental formal teaching activities. [ABSTRACT FROM AUTHOR]

Context: With rotavirus vaccines now available globally, it will be useful to assemble the available evidence on the epidemiology and burden of rotavirus gastroenteritis in India, in order to weigh the urgency of introducing a vaccine to help control rotavirus disease. Evidence Acquisition: We reviewed published studies on rotavirus infection and genotype distribution in India, as well as safety and immunogenicity studies of currently available vaccines. PubMed was searched for papers published after 1990, and several authors who are experts in the field recommended papers of known significance. Results: Rotavirus accounts for close to 40% of hospitalizations for diarrhea in India, with more recent studies showing an increased proportion compared with older studies. There is substantial serotype diversity in India, although there is less intra-country variation than previously thought. Two genotypes, G1P[8] and G2P[4], account for roughly 50% of symptomatic infections in non-neonates. Currently licensed vaccines are safe, and although the efficacy appears lower in developing countries, given the extremely high incidence of diarrhea these could still be cost-effective interventions. Conclusions: The epidemiology and burden of rotavirus diarrhea is fairly well characterized in India. Introducing rotavirus vaccine into the UIP, along with adequate surveillance, should be an important part of efforts to reduce diarrhea mortality, the third leading cause of death among Indian children, and achieve the country's MDG goals. [ABSTRACT FROM AUTHOR]

There has been a welcome interest in the issue of malnutrition by policy makers as well as technical experts in the recent years. The current public health systems for management of malnutrition, the ICDS and NRHM, have attempted to evolve approaches to the management of severe malnutrition. This paper makes a fresh analysis of data from well-accepted existing sources, indicating that 36- 44% of all children with Severe Acute Malnutrition (SAM) are likely to be missed by current criteria of screening and referral; simultaneously, a large proportion of children selected for referral to Nutritional rehabilitation centres are likely not to have SAM. The paper also highlights other areas of inconsistencies between the ICDS and the NRHM in the continuum of care required for the prevention and proper management of severe malnutrition. Thus, the paper identifies areas that need further exploration to achieve a seamless and effective program for tackling severe malnutrition. [ABSTRACT FROM AUTHOR]

Context: Severe acute malnutrition (SAM) in children is a significant public health problem in India with associated increased morbidity and mortality. The current WHO recommendations on management of SAM are based on facility based treatment. Given the large number of children with SAM in India and the involved costs to the care-provider as well as the care-seeker, incorporation of alternative strategies like home based management of uncomplicated SAM is important. The present review assesses (a) the efficacy and safety of home based management of SAM using 'therapeutic nutrition products' or ready to use therapeutic foods (RUTF); and (b) efficacy of these products in comparison with F-100 and home-based diet. Evidence Acquisition: Electronic database (Pubmed and Cochrane Controlled Trials Register) were scanned using keywords 'severe malnutrition', 'therapy', 'diet', 'ready to use foods' and 'RLJTF'. Bibliographics of identified articles, reviews and books were scanned. The information was extracted from the identified papers and graded according to the CEBM guidelines. Results: Eighteen published papers (2 systematic reviews, 7 controlled trials, 7 observational trials and 2 consensus statements) were identified. Systematic reviews and RCTs showed RUTF to be at least as efficacious as F-100 in increasing weight (WMD=3.0 g/kg/day; 95% CI - 1.70, 7.70) and more effective in comparison to home based dietary therapies. Locally made RUTFs were as effective as imported RUTFs (WMD=0.07 g/kg/d; 95% CI=-0.15, 0.29). Data from observational studies showed the energy intake with RUTF to be comparable to F-100. The pooled recovery rate, mortality and default in treatment with RUTF was 88.3%, 0.7% and 3.6%, respectively with a mean weight gain of 3.2 g/ kg/day. The two consensus statements supported the use of RUTF for home based management of uncomplicated SAM. Conclusions: The use of therapeutic nutrition products like RUTF for home based management of uncomplicated SAM appears to be safe and efficacious. However, most of the evidence on this promising strategy has emerged from observational studies conducted in emergency settings in Africa. There is need to generate more robust evidence, design similar products locally and establish their efficacy and cost-effectiveness in a 'non-emergency' setting, particularly in the Indian context. [ABSTRACT FROM AUTHOR]

The document is the Presidential Address from the 61st National Conference of the Indian Academy of Pediatrics (PEDICON) held in Kochi, Kerala, India. The National President outlines their vision and plan for the year, focusing on four key areas: Academics, Advocacy, Administration, and Accessibility. They discuss initiatives such as conducting workshops on thesis and scientific paper writing, fostering research on developmental and behavioral disorders, liaising with the government for health policies, and launching public awareness campaigns. The President also emphasizes the importance of inclusivity and unity within the organization. [Extracted from the article]

The article looks at the early years of the journal from 1967 to 1969. The first editorial by Dr. N. G. Mojumdar cited his commitment to keeping the tradition of the journal. The editor also stated the need for the journal to be a source book for future pediatric historians. A reproduction of the last editorial by Mojumdar at the end of his tenure is also presented.

In-training Assessment (ITA) has the potential to test a wide range of competencies which are not testable by the yearend examination. However, despite high validity, educational impact and feasibility; its implementation is flawed. This paper proposes a 'quarter model of in-training assessment' for implementation in the undergraduate medical curriculum in India. The model proposes that assessments be carried out at least quarterly; no teacher should contribute more than 25% of the marks for any student; no single assessment tool should contribute more than 25% marks; and no assessment should contribute to more than 25% of the total marks. We believe that structuring the implementation using multiple tests on multiple content areas by multiple examiners using multiple tools in multiple settings in the proposed quarter model will not only improve the reliability and validity of internal assessment, but also its acceptability. [ABSTRACT FROM AUTHOR]

Typhoid fever, an infection with potentially life threatening complications, is responsible for 11 to 21 million illness episodes and 145,000 to 161,000 deaths each year globally. India is a high burden country and also faces the challenge of antimicrobial resistance, which further narrows treatment options. This review analyzes the need for typhoid vaccination in India, and appraises the evidence on efficacy, immunogenicity and cost-effectiveness of currently available typhoid vaccines. In 2018, WHO prequalified the first typhoid conjugate vaccine Vi-TT and recommended it for children aged 6–23 months, along with measles vaccine at 9 or 15 months of age through the expanded programme on immunization. With the high endemicity of typhoid in India and the proven cost-effectiveness of the conjugate vaccine, a roll-out of typhoid vaccine should be considered at the earliest. [ABSTRACT FROM AUTHOR]

India is committed to reducing childhood mortality and morbidity. This requires evidence-based policy and practice in the realm of public health. This in turn necessitates advocacy and action (among all stakeholders), focused on locally relevant issues. A collaboration to work towards this goal was forged between the Public Health Foundation of India (PHFI), United Nations International Children's Emergency Fund (UNICEF), India; and a team of independent researchers. As a first step, a systematic review of literature on four priority areas of newborn care (community-based interventions) and child health (acute respiratory infection, diarrheal disease, anemia), was undertaken to address important issues including epidemiology, interventions for management, and operational issues of planning, implementing, and measuring actions at a programmatic level. This paper describes the development of the methodology for undertaking these systematic reviews including the process for framing of research questions, building a research team, and executing the systematic review (literature search strategy, data extraction, analysis, and reporting). The challenges associated with ensuring robust methodology, are also described. [ABSTRACT FROM AUTHOR]

Background: WHO estimates that Haemophilus influenzae type b (Hib) caused over 8 million cases of serious disease and 376,000 deaths globally in the year 2000. The introduction of Hib vaccines has essentially eliminated Hib disease in countries where they are routinely used. Now, almost all Hib disease cases and deaths occur in countries where Hib vaccines is not incorporated in the routine immunization program. Process: The Hib and Pneumococcal subcommittee of National Technical Advisory Group on Immunization (NTAGI) in India met in April 2008. This paper focuses on the discussions regarding Hib vaccine introduction; the pneumococcal vaccine discussion is being published separately. The subcommittee reviewed the available published and unpublished literature as well as consulted prominent Hib experts to make an informed decision regarding the introduction of Hib vaccine into the routine Universal Immunization Program (UIP) in India. Objectives: The meeting was conducted with the objectives of reviewing the existing Indian, regional and global data on Hib disease (meningitis and pneumonia), the data on safety and immunogenecity of Hib vaccines manufactured in India, as well as the programmatic and operational requirements for the introduction of Hib vaccine in India, with the goal of making a recommendation on the introduction of Hib vaccine into the UIP. Recommendations: The committee noted that Hib diseases burden is suffiently high in India to warrant prevention by vaccination. Hib vaccines have been demonstrated to be safe, both globally and in India, and extremely efficacious in all settings where they have been used. Hib vaccine fits into the UIP immunization schedule. Several Indian manufacturers are currently producing Hib vaccines, and a detailed analysis showed that supplier capacity would be sufficient to meet the present and future demand for India if given sufficient lead time to increase production. Recognizing that it is the poorest children that are most at risk, the Indian Academy of Pediatrics has already recommended this vaccine for routine use in India. This subcommittee strongly recommended that Hib vaccine should immediately be introduced in India's UIP. [ABSTRACT FROM AUTHOR]

Justification: The transgender community has been long stigmatized, and discriminated against, and faces numerous mental and physical problems. Certain indicators of transgender personality appear during childhood and more often before puberty begins. This puts the onus on Pediatricians to identify and offer evidence-based care for their benefit. There is an urgent and deep-felt need to understand the medical, legal, and social aspects of the care of transgender children. Hence, Adolescent Health Academy decided to release a statement on the care of transgender children, adolescents, and youth. Objectives: To review the existing international and national guidelines and recommendations to formulate a statement for the Pediatricians on (a) terminologies and definitions; (b) legal status in India; and (c) implications for pediatric practice. Process: A task force was convened by the Adolescent Health Academy as the writing committee to draft the guidelines. These were approved by all the members of the task force and the Executive Board of Adolescent Health Academy (2022). Recommendations: Gender identity develops in childhood and adolescence as a feeling of self, and it should be respected to mitigate gender dysphoria. The law permits transgenders the right of self-affirmation and it upholds their dignity in society. The transgender community is prone to victimization, and prejudice leading to a high risk of substance abuse, suicidal ideation, and mental health issues. Pediatricians are the primary care providers of children and adolescents including those with gender incongruence, so they should be abridged with gender-affirmative practices. Gender-affirmative care involves pubertal suppression, hormonal therapy, and surgery which should be done in conjugation with the social transition, by a gender-affirmative care team. [ABSTRACT FROM AUTHOR]

Objective: To examine the accuracy of World Health Organization (WHO) growth standard in under-5 year Indian children, and identify a method to contextualize the WHO standard for India. Participants: Data of Healthy children, defined by WHO selection criteria, extracted from nationally representative Indian surveys (National Family Health Surveys, NFHS-3, NFHS-4, NFHS-5 and Comprehensive National Nutrition Survey, CNNS). Design: Height for age z score (HAZ) and weight for age z score (WAZ) and weight for height z score (WHZ) distributions in healthy sample were compared against the standard normal. If deviant, age-specific correction factors for z scores were estimated by hierarchical linear mixed effects mean and variance polynomial models. A new term, excess mean risk of growth faltering (EMRGF), was introduced to describe growth faltering. Main outcome: Measure of deviation of HAZ, WAZ and WHZ from standard normal distribution. Correction of WHO growth standards for India leading to accurate prevalence of stunting, underweight and wasting in Indian children using NFHS-5 data. Results: Data on 10,384 healthy under-5 year children were extracted, of which 5377 were boys. Across surveys and metrics, the mean z scores were significantly lower than zero (−0.52 to −0.79). HAZ and WHZ variability (1.16, 1.07) were significantly higher than 1. Derived age-specific corrections reduced the NFHS-5 prevalence of growth faltering by 50%. The national EMRGF (after applying the age-specific correction) for height for age was 15.5% (95%CI:15.3–15.8), and weight for age was 15.0% (95%CI:14.8–15.3), respectively, in NFHS-5. Conclusion: The WHO growth standards need contextual customization for accurate estimation of the burden of growth faltering in under-5 year children in India. When corrected, the burden of growth faltering is lower, by half or more, in all the three indices. [ABSTRACT FROM AUTHOR]

Climate change is already impacting children's health in a variety of ways. Indian children are among the most severely affected; they are experiencing respiratory illnesses from air pollution, heat-related illnesses, malnutrition, vector- and water-borne diseases; and mental health problems such as post-traumatic stress disorder from weather disasters. There is a need to increase awareness and capacity building among paediatricians for understanding the impact of climate change on the health of children and educating parents about preventive measures. Detailed environmental history taking will help to identify risk factors. To address climate change issues, professional paediatric associations should increase their advocacy with government agencies. It is essential to ask policymakers to immediately reduce greenhouse gas emissions. Reducing the burning of coal and other fossil fuels and moving to renewable energy sources such as solar and wind will reduce India's carbon emissions and decrease environmental illness among children. The pediatricians of India should declare that climate change is a child health emergency. [ABSTRACT FROM AUTHOR]

The author reflects on the core recommendation in the International Academy of Pathology (IAP) document on Specific Learning Disability (SLD) in India. He is critical of the fact that list of disabilities is not final and uncertain if SLD will continue to be on the list when the Persons With Disabilities Act (PWD Act) is passed. He discusses issues involved in the SLD, including certification of SLD, inability to grade SLD, and decision facilities that may be offered.

Background: Universal developmental screening is recommended at 9, 18, 24 and 36 months. The Government of India Mother and Child Protection (MCP) card is an immunization record that is used to monitor child development, and identify children requiring further evaluation. Objectives: To determine the diagnostic accuracy of the MCP card for developmental screening, and perform its item analysis. Study design: Mixed-method study (prospective study of diagnostic accuracy and qualitative study). Participants: Mother-child dyads of children between 2–36 months of age were recruited from the outpatient department or wards of a tertiary level children's hospital from November, 2019 to October, 2021. Children with confirmed neurodevelopmental disorders/disability, and mothers with less than 6th standard education were excluded. Intervention: Each mother was given a MCP card, and taught how to mark the items. This was followed by the researcher's evaluation (index tool). The reference tool was a comprehensive clinical assessment (CCA) by the researcher and an expert. The CCA included clinical examination of hearing, vision, and neuro-development; and psychometric assessment of development and adaptive function. Each mother underwent an in-depth interview. Overall and group wise psychometric properties of diagnostic accuracy were computed. The interview transcripts were analyzed thematically. Outcomes: The proportion of children with 'fail' and 'delay' by the evaluation of the researcher with the MCP card and the expert by the CCA, respectively. Results: The study population included 213 children (40.4% females). Fifty-two (24.4%) children were identified as 'Fail' by the MCP card and 43 (20.2%) as 'delay' by the expert's CCA. The overall sensitivity and specificity was 83.7% (95% CI 69.3–93.2) and 90.6% (95% CI 85.2–94.5), respectively. Acceptable diagnostic accuracy was found in the age-group 7–9 months, 13–18 months, and 25–36 months. Conclusions: The MCP card may be used for developmental screening at 9, 18, and 36 months. [ABSTRACT FROM AUTHOR]

Introduction: With the advent of direct-acting antivirals (DAAs), the past decade has seen a paradigm shift in the management of hepatitis C (HCV) infection in children. In this review, we summarize the various treatment options for pediatric HCV infection, highlighting the recent changes in the management. Methods: A literature search was performed using the PubMed database with the relevant keywords. Filters included were human, ages 0–18 years, and the English language. Results: Initial phase of HCV treatment using conventional or pegylated interferon and ribavirin combination regimens yielded poor outcomes in children, especially in genotypes 1 and 4, with an overall sustained virologic response of 58%. Also, treatment with interferon and ribavirin combination was associated with significant side effects in up to 52% of those treated. Presently, various combinations of direct-acting antivirals (DAAs) have been approved in children above three years of age with documented evidence of high efficacy (SVR12 of 92% to 100%) and excellent safety, and the current standard of care. Conclusion: With various DAA regimens now being approved for children above three years of age, the treatment of active HCV infection (HCV-RNA positive) in children has become simple. Besides the effectiveness of DAA therapy, public awareness about HCV transmission, better screening, and making the DAAs available at a subsidized price in the public sectors are necessary to eliminate HCV infection in India. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the advocacy of the INDO-US group on the need for pediatric emergency medicine (PEM) in India.

Institute of Child Health, Kolkata is an iconic pediatric institution of India, which had its inception as one of the first pediatric hospital of the country. Pediatrics, as a separate branch of medicine, different from the principles and practices of adult medicine, was conceptualized and materialized in India by the founder of this institution, who is referred to as one of the Father of Indian Pediatrics, Dr. Kshirode Chandra Chaudhuri. This article portrays the journey of ICH, the popular acronym of the famed Institute, through the last seven decades from 1956 till the present, trying to capture the initial years of its establishment in the late 1950s, followed by its gradual evolution to an institution of central importance in pediatric healthcare, medical education, research and development, and service to the society, particularly in Eastern India. [ABSTRACT FROM AUTHOR]

The biggest-ever outbreak of monkeypox disease in non-endemic countries started in May, 2022. Though no monkeypox case has been reported from India, till mid-June, 2022, yet, considering the rate of spread to the non-endemic countries, there is an urgent need of better understanding of the monkeypox virus and disease epidemiology to help clinicians, public health specialists, and policymakers to be prepared for any eventuality. This review summarises the monkeypox disease epidemiology, clinical features, therapies, vaccines and outlines the measures for preparedness and response for a possible outbreak. The disease is known to cause severe outcome in children, pregnant women, and immunocompromised hosts and this group need to be given special attention. The monkeypox disease outbreak (2022) in non-endemic countries should be used as an opportunity by India and other low and middle income countries to strengthen public health surveillance and health system capacity for outbreak and epidemic preparedness and response. [ABSTRACT FROM AUTHOR]

Justification: Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. Objectives: To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Process: Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Guidelines: Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide. [ABSTRACT FROM AUTHOR]

Justification: In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). Process: Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. Objective: To facilitate appropriate management of children with acquired aplastic anemia. Recommendations: Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophosphamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3–6 months for the response assessment and consideration of next line therapy. [ABSTRACT FROM AUTHOR]

The authors comment on a study on the use of universal newborn screening in India. Among the cited obstacles to establishing an effective screening program in India are costs, limitations of treatment modalities, and non-availability of demographic data about genetic/metabolic diseases. Also noted is the difficulty of following the guidelines for obtaining blood samples of children. The authors suggest diagnostic cut-off of thyroid-stimulating hormone (TSH) level as a logical method in India.

Objective: To evaluate the persistence of antibodies three years after primary vaccination with typhoid conjugate vaccine (TCV) of either Cadila Healthcare Ltd. (Cadila-TCV) or Bharat Biotech International Ltd. (Bharat-TCV) administered in a previous phase II/III study, and to study the booster dose response to Cadila-TCV. Methods: This was an open-label, phase IV extension study conducted in tertiary care and multispecialty hospitals in India. 112 subjects (Cadila-TCV-57, Bharat-TCV-55) who had participated in previous study were enrolled. Of these, eligible subjects received a single-dose of Cadila-TCV and were followed-up for 28 days post-booster. Primary outcome was persistence of antibodies 3 years after primary vaccination and seroconversion (≥4-fold rise in antibody titre from baseline) 28 days post-booster. Safety was based on reported adverse events (AEs) post-booster. Results: The baseline GMT reported in the current study was significantly higher than pre-vaccination GMT reported in the previous study. 89/112 (79.5%) subjects had antibody titer ≥10 IU/mL at baseline; eligible subjects (n=17) who had baseline antibody titre <10 IU/mL were administered booster dose. All the vaccinated subjects showed seroconversion post-booster. The GMTs reported at 10 days and 28 days post-booster were significantly higher as compared to GMTs reported after primary vaccination in previous study. 4 (23.5%) vaccinated subjects reported 9 AEs; all were solicited and of mild/moderate intensity. Conclusion: There was a significant persistence of immunogenicity after primary vaccination with both the TCVs, and robust immune response after booster vaccination with Cadila-TCV. [ABSTRACT FROM AUTHOR]

With its colonial past, and a glaring problem of poverty and hunger, India oft fails to acknowledge a new, rapidly growing problem of overnutrition. With the economic boost and entry of various foreign players from the food industry, Indian citizens have been increasingly exposed to ultra-processed, high in sugar, salt and fat foods (HFSS foods). The last decade or so has seen an exponential rise in the consumption of such foods, leading to increasing prevalence of overweight- and obesity-related illnesses like diabetes, hypertension, etc. In this scenario, examining the efficacy of policy-related measures in reducing consumption of these harmful foods and preventing the associated health issues is paramount. Across the globe, several countries have explored options from taxation on HFSS foods to restricting marketing to children, as well as different practices for front of the pack labeling. In the context of India and its increasing burden of preventable, diet-related illnesses, the urgent need of instituting these preventive policies at national scale cannot be neglected. [ABSTRACT FROM AUTHOR]

The article offers information on the history of the "Journal of Indian Pediatrics."

The article focuses on the newborn screening program in India. It notes that the aim of newborn screening is to detect disorders at the earliest time to be able to provide timely interventions and prevent serious consequences. Priority conditions for the initial phase of the program are cited which are congenital hypothyroidism and deafness. Disorders that are considered in the second phase of the program are congenital adrenal hyperplasia and cystic fibrosis.

The study was conducted in seven private co-educational English-medium schools in Cochin to understand adolescent attitudes in this part of the country. Queries submitted by students (n=10660) and responses to separate pretested questionnaires for boys (n=886 received) and girls (n=589 received) were analysed. The study showed a lacuna of knowledge among adolescents with the most frequently asked queries being on masturbation, and sex and sexuality. More than 50% of adolescents received information on sex and sexuality from peers; boys had started masturbating by 12yr age and 93% were doing so by 15yr age. Although 73% of girls were told about menstruation by their parents, 32% were not aware, at menarche, that such an event would occur and only 8% were aware of all aspects of maintaining menstrual hygiene. 19% of boys succumbed to peer pressure into reading/viewing pornography; more than 50% of adolescents admitted to having had an infatuation around 13 yrs of age or after. 13% of boys admitted to having been initiated into smoking by friends; mostly between 14-16 yrs age; 6.5% boys had consumed alcohol with peers or at family functions, starting between ages of 15 to 17yrs. Though >70% of adolescents were aware about AIDS, adequate knowledge about its spread and prevention was lacking. [ABSTRACT FROM AUTHOR]

Objective: To develop, standardize, and partly validate a developmental scale for toddlers (age, 1.6 to 3 years) attending anganwadis in India. Methods: After the development of the 12-item Developmental Assessment Tool for Anganwadis (DATA), its internal consistency, face validity, content validity and construct validity were studied in 100 toddlers in anganwadis and were found to be appropriate. A total of 429 toddlers with a mean (SD) age of 30.9(5.2) months from 36 randomly selected anganwadis were recruited for its standardization. Raw scores were converted to standardized T-scores. Scoring pattern for domains and aggregate developmental scores were formulated. Results: Except for one item in the original scale, all the items were endorsed by parents suggesting a good content validity. Cronbach's α of 0.86 suggested a high internal consistency. Factor analysis replicated the 2-factor structure explaining 56% of variance. An aggregated developmental score based on the standardized T-scores demonstrated that a DATA score between 33 and 28 suggested 'at risk' for developing developmental delays. A score of ≤27 suggested already delayed milestones. A score of 27 to 16 suggested a 'mild delay', a score of 15 to 5 suggested a 'moderate delay' and ≤4 suggested a 'severe delay' in development. Conclusion: DATA is a brief, simple and psychometrically sound measure for use in anganwadis for identifying toddlers at risk or with developmental delays. Differentially identifying toddlers at risk or with developmental delay helps in referring them for appropriate interventions. [ABSTRACT FROM AUTHOR]

The article focuses on the universal immunization program (UIP) and polio eradication in India. It mentions that the Indian Academy of Pediatrics (IAP) gives its full support to the polio eradication initiative (PEI) of the Government of India (GOI) despite the latter's lack of full attention to the professional advice provided by the former. It discusses the PEI which began in 1988 which has the aim of eradicating polio come 2000. It notes that UIP may be reconstructed in the country by following a systematic process of determining success factors.

Justification: Data generated after the first wave has revealed that some children with Coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected COVID-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2–18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval. Objective: To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use. Process: Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of COVID-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on COVID-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized. Recommendations: The IAP supports the Government of India's decision to extend the COVID-19 vaccination program to children between 2–18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out. [ABSTRACT FROM AUTHOR]