Pediatrics Practical

PEDIATRICS
PRACTICAL
X-RAY IDENTIFICATION
RIGHT SIDED
HYDRO-PNEUMOTHORAX
COMPILED BY S BANERJEE IMS AND SH 3

HILAR
LYMPHADENOPATHY

RICKETS

RIGHT UPPER LOBE
CONSOLIDATION

CARDIOMEGALY

MILIARY TB

MORGAGNI HERNIA

CARDIOLOGY

BOCHDALEK HERNIA

RT. UPPER LOBE
CONSOLIDATION

RIGHT LUNG COLLAPSE

CARDIOMEGALY

RICKETS

LEFT PLEURAL
EFFUSION

BOCHDALEK HERNIA

MILIARY TB

INTESTINAL
OBSTRUCTION

HYDROPNEUMOTHORAX

THALLASEMIA

IMMUNISATION AND NUTRITION

TYPES OF VACCINE
Types category names
Live attenuated Bacterial BCG, Oral TYPHOID

Viral OPV,measeles,MMR,varicela,rotavirus
,yellow fever
Killed/inactivated Bacterial DTwP,Typhoid,

Viral IPV,rabies,hepatitis A,influenza
Toxin/toxoid DT,TT,Hib,meningococal
Subunit Bacterial Acellular pertusis

Viral Hep-B,Influenza
National Immunization Shedule
AGE VACCINES GIVEN
BIRTH BCG, b-OPV-0 , HBV-0
6 weeks b-OPV-1, Pentavalent-1, Rota-1, f-IPV-1, PCV-1*
10 weeks b-OPV-2, Pentavalent-2, Rota-2
14 weeks b-OPV-3, Pentavalent-3, Rota-3, fIPV-2, PCV-2*
9-12 months MR-1, JE-1** , PCV-3*
16-24 mo MR-2, JE-2**, DPT)-B1, b-OPV – B
5- 6 yrs DPT-B2
10 yrs Tetanus & adult Diphtheria (Td)
16 yrs Td
* PCV in selected states/districts: Bihar, Himachal Pradesh, Madhya Pradesh, Uttar Pradesh
(selected districts) and Rajasthan; in Haryana as state initiative
** JE in endemic districts only
NIS for Infants
VACCINE SCHEDULE DOSE ROUTE SITE
BCG At birth or as early as possible till one year of age 0.1ml ID Left Upper Arm
HBV-0 At birth or as early as possible within 24 hours 0.5 ml IM AL - mid-thigh
OPV-0 At birth or as early as possible within first 15 days 2 drops ORAL ORAL
OPV-1,2 & 3 At 6 weeks, 10 weeks & 14 weeks 2 drops ORAL ORAL
(OPV can be given till 5 years of age)
Pentavalent 1, At 6 weeks, 10 weeks & 14 weeks 0.5 ml IM AL - mid-thigh
2&3 (can be given till one year of age)
Rotavirus At 6 weeks, 10 weeks & 14 weeks 5 drops ORAL ORAL
(can be given till one year of age)
f-IPV Two fractional dose at 6 and 14 weeks of age 0.1 ml ID ID-Rt Upper arm
MR-1 9 completed months-12 months. 0.5 ml SC Rt Upper arm
(can be given till 5 years of age)
JE-1 9 completed months-12 months. 0.5 ml SC Lt Upper arm
Vit A-1 At 9 completed months with Measles Rubella 1 ml Oral Oral
COMPILED BY S BANERJEE IMS AND SH 1 lakh IU 27
NIS for Children
VACCINE SCHEDULE DOSE ROUTE SITE
DPT-B1 16-24 months 0.5 ml IM AL-mid-thigh
MR-2 16-24 months 0.5 ml SC Rt Upper arm
OPV-B 16-24 months 2 drops ORAL ORAL
JE-2 16-24 months 0.5 ml SC AL-mid-thigh
Vit A 16-18 months. 2 ml ORAL ORAL
2nd to 9th dose Then one dose every 6 months up to the age of 5 (2 lakh IU)
years.
DPT-B2 5-6 years 0.5 ml IM AL-mid-thigh

TT 10 years & 16 years 0.5 ml IM Upper arm

OPV
1. Minimum age- at birth or within 15 days(zero dose), 3 primary dose 4 wks apart and booster at 15-18
months & 5 years
2. National programme -Till 1 year if missed
3. Catch up vaccination-
1. It is recommended till 5 years of age
IPV
1. Minimum age- 6wks, 3 primary dose 4 wks apart (or two dose at 6and 14 wks) and booster at 15-18
months
2. National programme-Till 1 year if missed
1. It is recommended till 5 years of age, 3 dose at 0, 2 and 6 months

BCG
1. Minimum age- at birth
2. Contraindication-cellular immunodeficiency
3. ADR- local ulceration, discharging sinus, axillary lymphadenitis, osteomyelitis, scrofuloderma
Copenhagen (Danish 1331) or Pasteur
Protects against disseminated TB/ TB meningitis

Hep B
1. Minimum age- at birth(within 24 hrs) ,
2. Schedule-birth ,1 month,6 months or birth 6wk,14 wks or birth ,6,10,14 weeks or 6,10,14 wks
1. 3dose series – ideal interval between second dose after 4wks and third dose after 8 wks

DTwP/DTaP
1. Minimum age- 6 weeks(3 primary dose 4 wks apart and booster at 15-18 months AND 5,10 ,16 yrs)
2. IAP-Tdap/Td AT 10-2 YRS ,Td every 10 yrs
1. <7years-DTwP/DTaP at 0,1 and 6 months
2. >7years-Tdap at 0 months,Td at 1 and 6 months
3. Precaution-hypotonic-hyporesponsive episode(collapse) seizure (within72hrs)

Hib conjugate vaccine
1. Minimum age- 6 weeks (3 primary dose 4 wks apart and booster at
15-18 months)
2. 6-12 months- 2 primary doses 8 weeks apart & 1 booster at 15-18 months
3. 12-15 months- 1 primary dose & 1 booster at 15 to 18 month
4. >15 months-60 month- Single dose; not recommended >5 yrs except
hpo/asplenia

Rotavirus Vaccination
1. Minimum Age- 6 weeks (max age of 1st dose is <15 WKS and final dose less
than 8 month)
2. RV-1→ 2 doses with the first dose at 6 weeks of age & second dose 4 weeks
later.
3. RV-5→ 3 doses at 6,10 & 14 weeks of age
4. Catch up vaccination
1. Maximum age for the first dose in the series is 14 weeks 6 days
2. Vaccinations should not be initiated for infants aged 15 weeks, 0 days or older
3. The maximum age for the final dose in the series is 8 months, 0 days

Measles Mumps & Rubella (MMR) vaccine
1. Minimum age- 9 months
2. 1st dose at 9 months of age, 2nd dose at 15 months & 3rd dose at 4-6
years
3. The 3rd dose may be administered before 4 years of age, provided
at least 4 weeks have elapsed since the first dose
1. Ensure all school aged children & adolescents have had 2 doses of MMR
vaccine; the minimum interval between the 2 doses is 4 weeks
2. 1 dose if previously vaccinated with at least 1 dose
5. Edmonton Zagreb strain

OPTIONAL VACCINE

PNEUMOCOCCAL VACCINE (PCV-13/10)
Age at first dose Primary series Booster dose
PCV-13 PCV-10 PCV-13 PCV-10
6 wks-6 mo 3 doses 3 doses 1 dose 1 dose

12-15 months* 12-15 months*
7-11 months 2 doses* 2 doses* 1 dose during 2nd 1 dose during
year 2nd year
12-23 months 2 doses+ 2 doses+ NA NA
24-59 months 1 dose 2 doses+ NA NA
• *At least 6 months after the third dose

• + At least 8 weeks apart (NA-Not Applicable)
CATCH UP VACCINATION
• Administer one dose of PCV-13 or PCV-10 to all healthy children aged 24 through 59
months who are not completely vaccinated for their age.
• For PCV13- catch up in 6-12 months, 2 doses 4 weeks apart & 1 booster & for 12-23
months- 2 doses 8weeks apart & 24 months or above- single dose
• For PCV-10- catch up in 6-12 months, 2 doses 4 weeks apart & 1 booster & for 12
months-5 years- 2 doses 8 weeks apart
• For high risk persons PCV & PPSV are used
• 24 through 71 mo- 1 dose of PCV13 if 3 doses of PCV received or 2 doses of PCV13
at least 8 weeks apart if less than 3 doses received
• Single dose of PCV13 between aged 6-18 years who have asplenia, HIV, cochlear
implant, CSF leak
• Administer PPSV23 at least 8 weeks after the last dose of PCV to children aged 2yrs
or older with certain underlying medical condition

VARICELLA VACCINES
1. Minimum age- 12 months
2. Administer the 1st dose at age 15 through 18 months & 2nd dose 3 months after the first dose or
at age 4 through 6 years (4 weeks interval after 1st dose is acceptable)
1. Between 12mo through 12 years the minimum interval between doses is 3 months
2. 13 years or above the minimum interval between doses is 4 weeks
3. For persons without evidence of immunity, administer 2 doses if not previously vaccinated or the second dose if only
one dose has been administered
OKA strain

TYPHOID VACCINES
• Minimum age- TCV- 6 months
Vi-PS(Polysaccharide) vaccine- 2 years
• Schedule-
• Vi-PS conjugate (TCV)- Single dose at 9-12 months & a booster during second year
of life
• Vi-PS(Polysaccharide) vaccines- Single dose at 2 years, revaccination every 3 years
• Catch-up vaccination- Recommended throughout the adolescent period i:e till 18

years

INFLUENZA VACCINE
• Minimum age- 6 months for trivalent inactivated influenza vaccine (IIV3)
• First time vaccination- 6 months to below 9 years- 2 doses 1 month apart
9 years & above- Single dose
• Annual revaccination with single dose
• Dose- Aged 6-35 months- 0.25ml ;
3 years & above- 0.5ml
• All the currently available IIVs in the country contain the “Swine Flu” or “A(H1N1)” Ag;
(no need to vaccinate separately)
• Best time to vaccinate- as soon as new vaccine is released & available in the market,
preferably 2 weeks before the onset of influenza season in the area
• Michigan, Singapore, Colorado, Phuket strains

MENINGOCOCCAL VACCINE
• Recommended only for certain high risk group of children, during outbreaks,
international travelers including students going abroad for studying purpose.
• Conjugate vaccines are preferred over polysaccharide vaccines due to their
potential for herd protection & their increased immunogenicity, particularly
in children below 2 years of age.
• Quadrivalent conjugate and polysaccharide vaccines are recommended only
for children 2 years & above
• Monovalent group A conjugate vaccine, PsA-TT can be used in children above
1 year of age

CHOLERA VACCINE
• Minimum Age- 1 year[Killed whole cell Vibrio Cholerae]

• Recommended only for vaccination of persons residing in highly
endemic areas & travelling to areas where risk of transmission is very
high like kumbh mela etc.
• Two doses 2 weeks apart for >1 year old

ADVERSE EVENTS FOLLOWING IMMUNIZATION IN
COMMONLY USED VACCINES
VACCINE REACTION ONSET INTERVAL FREQUENCY

BCG Fatal dissemination of BCG infection 1-12 months 0.19-1.56/1000000
OPV Vaccine associated paralytic poliomyelitis (VAPP) 4-30 days 2-4/1000000
DTwP Prolonged crying & seizure 0-24 hrs <1/100
HHE 0-24 hrs <1/1000-2/1000
Measles Febrile seizures 6-12 days 1/3000
Thrombocytopenia 15-35 days 1/30000
Anaphylaxis 1 hrs 1/100000
Rotavirus Intussusception 3-14 days 1-2/100000

NUTRITION

NUTRITION
• MACRONUTRIENTS- those needed in large quantities & referred as

energy components of diet i:e they breakdown into simpler
compounds to provide energy.
• MICRONUTRIENTS-those needed in small quantities, but are essential

to keep us healthy

DAILY ENERGY REQUIREMENT CALCULATION
• 10 Kg body weight – 1000 kcal

• Weight >10 kg - 20 kg – 1000 kcal + 50 kcal for each kg above 10 kg ( Ex-
15 kg-1250 kcal)
• Weight > 20 kg – 1500 kcal + 20 kcal for each kg above 20 kg (Ex- 30 kg-
1700kcal)
• Normal Balanced diet- Carbohydrates (55-60%), fats (25-30%) &

proteins (10-12%)

APPROX. NUTRITIVE VALUE OF COMMON FOOD ITEM
Food items Amount Energy (kcal) Protien (g)
Human milk 100 ml 65 1.1
Cow’s milk 100 ml 73 3.2
Egg(whole) 45g 74 5
Egg white 25g 11 4
Egg yolk 20g 60 3.2
Rice 25g 90 2
Millet grains 25g 94 3
Dal(moong/arhar) 25g 80 6
Green leafy veg 100-125g 25 2
Banana 100g 110 1.5
Mango/apple 100g 70 0.6
Refined oil/ghee 5 ml 45 -
Coconut oil 5 ml 42 -
Sugarcane juice 100 ml 60 -
Coconut water 100 ml COMPILED BY S BANERJEE
14IMS AND SH 0.2 49
NUTRITIONAL CHARACTERISTICS OF COMMON
FOOD ITEMS
FOODS MAIN NUTRIENTS OTHER CHARACTERISTICS
Milk & milk products protein, fat, Ca, P, Vit B2 High protein lactose & unsaturated fats
Lack in iron & vit C
Egg (hen) protein, fat, P, riboflavin High protein lactose & unsaturated fats
Lack in iron & vit C
Contains saturated fats & cholesterol
Chicken protein, P High quality protein & all B vitamins
No carbohydrate, protein & fats
Fish protein, fat, Ca, Vit B12 High quality protein & fat containing Omega 3 fatty acids
Lacks carbohydrate
Green leafy veg CAROTENOIDS, FOLIC ACID, CA Good source of SOLUBLE FIBER
Deficient in protein, fat, vit C, iron, B2
Fruits Carbohydrate, Potassium Good source of fiber & roughage
Juicy fruits have high K content
Banana is a good source of energy but poor source of K

NORMAL BALANCED DIET FOR VARIOUS AGE GROUP
• EXCLUSIVE BREASTFEEDING- An infant should be exclusively

breastfed till six months of age.
• COMPLEMENTARY FEEDING- After six months of age, breast milk is

not enough to make an infant grow well. Complementary feeding
refers to food which complements breast milk & ensures that the
child continues to have enough energy, protein & other nutrients to
grow normally

FACTORS TO BE CONSIDERED WHILE PLANNING
FOOD FOR YOUNG CHILD
• ENERGY DENSITY- It can be increased without increasing the bulk by adding
• Oil/Ghee
• Thickening the gruel
• Amylase rich foods (ARF)
• NUTRIENT DENSITY- It is done by including a variety of foods in order to
meet all the nutrients
• AMOUNT OF FEED- Child should be given time to adapt gradually to larger
quantities from teaspoon to table spoon & then katori
• CONSISTENCY OF FEED
• FRQUENCY OF FEEDING- Complementary foods 3-4 times/day at 6-8 months
& 9-11months & 4-5 times/day at 12-24 months
• HYGIENE
INSTRUMENTS

IV Maintenace
•IV solution bags and syringes are to be replaced at least every 24 hours
•IV tubing is changed at a minimum of every 96 hours for continuous infusions (Intermittent and lipid containing IV
tubing is changed very 24 hours)
Complications
•Infiltration/ Extravasation:Dislodgment of cannula from the vein into the surrounding tissue
•Site Infection:Infection at the IV insertion site
•Hematoma:Localized swelling filled with blood resulting from a break in a blood vessel
•Phlebitis:Inflammation of the vein

LUMBAR PUNCTURE
•Instrument –Sterile spinal needle with stilette, 22 –gauge (black), length according to age (1.5‐3.5 inch)
Indications
❖Diagnostic –
I.CNS infections like meningitis, encephalitis, subarachnoid haemorrhage, pseudotumor cerebri, inflammatory CNS
diseases like Guillain –Barre syndrome
II.Instillation of intrathecal dye for imaging procedures (e.g.: myelography )
III.Measurement of CSF pressure.
Therapeutic indication
•Instillation of intrathecal medications ( e.g.: chemotherapeutic CNS prophylaxis in leukaemia, tetanus immunoglobulin
in tetanus , rarely antibiotics in severe meningitis)
• Spinal anaesthesia
Contraindications
▪Elevated Intracranial pressure owing to a suspected mass lesion of the brain or spinal cord.( So fundusexamination &
head CT are mandatory)
▪Severe respiratory distress & shock etc. as that may worsen with positioning in flexion.
▪Thrombocytopenia. ( ˂ 20,000 cells/mm3 )
▪Local infection at the site
Complications
• Post LP headache and backache
• Iatrogenic meningitis
• Cerebellar herniation in sudden drop of elevated intracranial pressure.
Indications –Diagnostic
• Diseases like leukaemia, to detect marrow infiltration in disorders like lymphomas and other non hematologic
malignancies.
• To rule out malignant process in ITP before starting steroid therapy
• Bone marrow culture in diseases like typhoid, malaria

Oxygen Hood
•Fits over an infant’s head and neck
•Set O2 flow at 10-15 Liters / min
•Set prescribed O2 dose
Laboured breathing

Simple Mask
•For acute situations and very short-term use (set at 6 -10 Liters per minute).
•O2 flow MUST be set to a minimum of 5 Liters/min to facilitate clearance of CO2

Nasal Cannula
•Offers low flow O2 concentration for extended periods of time. Maximum O2 flow should be 2 Liters/min for
newborns and infants.
•Maximum O2 flow for older children should be 4 Liters/min

Indication
•Hypercapnic respiratory failure
•Hypoxic respiratory failure
•Apnea
•Altered mental status with inability to protect the airway
•Pre-Oxygenation prior to intubation

ENDOTRACHEAL INTUBATION
•Indications: Assisted ventilation
•Drugs through ET route Surfactant administration in newborn RDS
•Sizes based on age -Preterm –ETT (size) 2.5-3.0, term –3.0 –3.5,
6 months –3.5 –4.0, 1 yr = 4.0 –4.5
•For 2 -10 years –
i). UncuffedETT (mm) –Age (years)/4 + 4,
ii). Cuffed tube (mm) –Age (years)/4 + 3.5
•ETT depth (from lip to mid trachea) mm–ETT internal diameter (size) x 3

Laryngoscope
•Straight i.e. Miller for < 2 years or difficult airway
Sizes -> # 00 -1 for premature to 2 months age

# 1 for 3 months to 3 years
# 2 for > 3 years
•Curved i.e. Mac more effective > 2 years
sizes –Mac #2 for >2 years

Mac # 3 for > 8 years

NASOGASTRIC TUBE
•Indications –stomach aspiration, poisoning etc.Nasogastric feeding
•Different sizes are available No.5‐No 10 are used at various ages for infants
•The length to be inserted is measured from the nostril to the tragus of the ear and then to the xiphisternum. Once
inserted push air through the tube & auscultate over the epigastrium to check position

DRUGS

PARACETAMOL
• •Dose –10 -15 mg/kg/dose

• •Formulation –syrup, drops, tablet, injectables, suppository
• •Route –oral, iv, im, per rectal
• •Indication –fever, pain

INJ CEFTRIAXONE
• •To which group of antibiotic this drug belongs?

• •What are the indications?
• •Third generation cephalosporin

• •Meningitis
• •Septicemia
• •Enteric fever

INJ AMPICILLIN
• •What class of antibiotic is ampicillin?

• •What is the dose in pneumonia treatment?
• •If it produces a rash in a child with fever, what are the possibilities?
• •Beta lactam antibiotic(semisynthetic penicillin)

• •50mg/kg/dose 6 hrly
• •Allergy to Penicillin group of drugs

VANCOMYCIN
• Dose –40 -60 mg/kg/day

• Indication –Gram positive organism, MRSA, meningitis
• Important side effect –Red Man syndrome

INJ DEXTROSE
• •1. What are the clinical indications?

• •2. What are the concentrations available and up to what concentration we can give through a peripheral
line?
• •Symptomatic hypoglycemia.
• •5%, 10%, 25%.
• •Up to 10%, we can give through peripheral line. Beyond that we have to use central line.

LORAZEPAM
• •DOSE –0.1 mg/kg

• •Formulation –injectable (2ml/4mg)
• •Route –iv, im
• •Indication –Seizure
• •Important Side effects –respiratory depression
• •Similar drugs –midazolam –0.1 -0.2 mg/kg/dose -iv/im/ intranasal

INJ PHENYTOIN SODIUM
• •What are the clinical uses of Phenytoin?

• •How do you administer IV phenytoin?
• •What is the serious side effect if administered rapidly?
• •What are the 2 important side effects following long term use of phenytoin which can be prevented?
• •Anticonvulsant (especially IV phenytoin is the drug of choice in status epilepticus beyond neonatal age
group), anti arrhythmic action is also there.
• •It should be diluted and given at a rate not more than 1mg/kg/minute
• •Cardiac Arrhythmia, Gum hypertrophy, hirsutism.

INJ PHENOBARBITONE
• •What is the clinical use?

• •What clinical parameter is to be monitored while giving this medicine intravenously?
• •Is there any other clinical use for the same oral medicine?
• •Anticonvulsant
• •Monitor respiration while giving it IV.
• •It can increase the excretion of bilirubin by increasing liver metabolism, so used in neonatal jaundice as
well as some cholestatic liver diseases like neonatal hepatitis syndrome.

INJ ADRENALINE
• •What are the clinical uses?

• •What are the doses?
• •What are the possible routes of administration?
• •Anaphylaxis, cardiac arrest, shock, croup, as local vasoconstrictor.

• •Doses & routes -Usual dose (1:1000) -0.01ml/kg sc/min anaphylactic shock
• •In croup: < 6 months 2.5ml and > 6 months 5ml undiluted adrenaline nebulized.
• •In cardiac arrest use IV 0.1ml/kg (1:10000) or intra tracheally 0.1ml/kg(1:1000)

INJ HYDROCORTISONE

• •Acute severe asthma
• •Anaphylaxis
• •Hypo adrenalism
• •Shock

IV FLUID: RINGER LACTATE

• •What is the concentration of sodium in this?
• •It is a crystalloid.
• •Used as volume expander in severe dehydration, acute haemorrhage, shock etc.
• •Sodium 130meq/l (other contents are potassium 4, calcium 3, chloride 109, lactate 28 meq/l)

ISOLYTE P
• •What is the use of this fluid?

• •How much fluid you will advice for a 15 kg child?
• •This is the Neonatal maintenance fluid. Given when oral intake is not possible or is contra indicated.
• •It has lower concentration of sodium 23mEq/l

IV FLUID: NORMAL SALINE
• •What are the uses?

• •What is the concentration of sodium in this?
• •Uses are same as that of Ringer Lactate.

• •More preferred fluid to treat shock.
• •Sodium 150meq/L

IV FLUID: DNS
• •This is the Pediatric maintenance fluid. Given when oral intake is not possible or is contra indicated.
• •Calculation is by Holliday Segar formula.
• •Up to 10kg: 100ml/kg/day. 11‐20kg: 1000ml+ 50ml/kg for each kg above 10kg. More than 20kg:
1500ml+20ml/kg for each kg above 20kg.

SPOT DIAGNOSIS

MARASMUS

SAM

DOWN SYNDROME

NEONATAL JAUNDICE

LAB CHARTS

DIAGNOSIS
• 1. SICKLE CELL ANEMIA
• 2. IRON DEFICIENCY ANEMIA

DIAGNOSIS
• 1. IRON DEFICIENCY ANEMIA
• 2. HYPOPLASTIC ANEMIA

DIAGNOSIS
• 1. TUBERCULOR MENINGITIS
• 2. VIRAL MENINGITIS

DIAGNOSIS
• 1. BACTERIAL MENINGITIS
• 2. THROMBOCYTOPENIA

DIAGNOSIS
• 1. BETA THALLASEMIA MAJOR
• 2. LEUKEMIA

DIAGNOSIS
• 1. CML
• 2. UTI

DIAGNOSIS
• 1. HEMOGLOBINUREA
• 2. NEPHRITIC SYNDROME

DIAGNOSIS
• 1. NEPHROTIC SYNDROME
• 2. DKA

DIAGNOSIS
• 1. HEPATITIS B
• 2. OBSTRUCTIVE JAUNDICE

DIAGNOSIS
• 1. COMPLICATED MALARIA
• 2. ASCARIASIS

DIAGNOSIS
• 1. HEPATITIS B
• 2. VERY SEVERE FEBRILE DISEASE

DIAGNOSIS
• 1.SOME DEHYDRATION
• 2. SEVERE COMPLICATED MEASLES


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PEDIATRICS

COMPILED BY S BANERJEE IMS AND SH 3

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Live attenuated Bacterial BCG, Oral TYPHOID

Killed/inactivated Bacterial DTwP,Typhoid,

Subunit Bacterial Acellular pertusis

DPT-B2 5-6 years 0.5 ml IM AL-mid-thigh

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PCV-13 PCV-10 PCV-13 PCV-10

6 wks-6 mo 3 doses 3 doses 1 dose 1 dose

24-59 months 1 dose 2 doses+ NA NA

• *At least 6 months after the third dose

COMPILED BY S BANERJEE IMS AND SH 38

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• Catch-up vaccination- Recommended throughout the adolescent period i:e till 18

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• Minimum Age- 1 year[Killed whole cell Vibrio Cholerae]

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VACCINE REACTION ONSET INTERVAL FREQUENCY

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• MACRONUTRIENTS- those needed in large quantities & referred as

• MICRONUTRIENTS-those needed in small quantities, but are essential

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• 10 Kg body weight – 1000 kcal

• Normal Balanced diet- Carbohydrates (55-60%), fats (25-30%) &

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• EXCLUSIVE BREASTFEEDING- An infant should be exclusively

• COMPLEMENTARY FEEDING- After six months of age, breast milk is

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