Fundas of Parenting 

January 2021
 
No  wonder  they  say  that  the  first  5  years  of  life  is  very crucial for learning. What we don’t learn at 5, we  don’t learn at 50. 
That’s  because  the  brain  develops  rapidly  in  the  first  5  years  of  life,  attaining  almost  90%  of the size of an adult brain. The 
brain  networking  is  what  is  happening  during  this  time,  where  the  brain  connections  are  laid  by  formation  of  synapses, 
between  the  white  matter  and  various  nerve  cells.  A  child  learns  to  use  this  network  and  develops  age  appropriate 
milestones.  And this is what is laying the foundation in all their domains of development, which include physical, language, 
cognition and socio-emotional aspects. 
 
It is the aspiration of every parent to maximise the potential of their child. To do this, we need to actively stimulate their brain 
in the areas mentioned above, by various activities. And these early years lay the foundation for their happy and healthy 
adulthood. 
 
Building a good bond and relationship with the child, right from their early years is crucial. This needs active participation of 
the parents with their children. This in turn, helps the child be socio-emotionally more stable, confident ,self reliant and gives 
them the enthusiasm to learn and explore the world. Hence, as a parent, optimising these early years, is the best investment to 
ensure a bright future for them. 
 
No two children develop alike. Each one of them develop at their own pace, as per their own genetic potential, within the given 
normal range. But, the environment which we provide for them during their early years of life is what shapes them better and 
helps reach their best potential. In this aspect, Child development is also taking a centre stage in India. The Government has 
launched a program called LAKSH, focusing on the development of children in the first 1000days. Hence , reinforcing the 
importance of early years in child development and how we can help maximise it. 
 
We as a group of professionals , comprising developmental pediatricians, general pediatricians, neonatologists, psychologists , 
therapists, special educators, nutritionists, neurologists working in the field of developmental pediatrics , believe that 
knowledge is power. We want to bring forth to you this newsletter with scientific and evidence based information. We believe, 
helping the parents and caregivers build their skills in child rearing practices ,would be one of the best ways to help a child 
achieve their maximum potential. Having said that, we give you this opportunity to make informed choices about 
empowering yourself on child rearing.  
 
  DR NANDINI MUNDKUR​,  
MD DIRECTOR CCDD  
FOUNDER SANGAMITRA  
CO-FOUNDER TOTSGUIDE  

 
 EDITORIAL BOARD     
Over a course of time, we will be sharing knowledge on various aspects of child growth and development. As the 
previous year ends with a lot of despair, we hope this new year dawns great strength and builds more confident 
parents. 
 
Editorial Board : 
 

 
 
 
 
 
 
 
   
Dr Nandini Mundkur,   Dr N Uday Kumar​, 
Dr Kirthika Rajaraman,  Associate Professor of Pediatrics,Head of 
MD​ ​Director CCDD  
DCH, DNB, FIAP (NDP)  KCDU, SRIHER 
Founder sangamitra  
Co-founder TOTSGUIDE  Consultant Developmental Pediatrician 
Motherhood Hospital 

 
  Mrs. Manju Bhargavi, 
Dr. Priya Kuberan,  [Link], Director Sangamitra 
MPT Neurosciences  Consultant special educator 
Consultant Physiotherapist 

 
Compiled and edited by : 
 

1. Dr Haneesha Pinnamarju  1. Dr Anjana B. 

MD Pediatrics, MRCPCH (UK) ,  DCH, DNB Pediatrics. 
IAP NDP fellow  CCDD NDP Fellow 
CONTENTS 

Development Section 
➔ Vision Article 
➔ Vision Activities 
➔ Developmental Quiz 
   
 
 

Nutrition And Brain Development 

➔ BF And Brain Development 
➔ Human Milk Bank 
➔ Challenges In Breastfeeding 
  ➔ Breast Feeding In COVID Times 
➔ Nutrition For Lactating Mothers 
 
 
 

Special Focus 
➔ Amar Seva Sangha 
➔ Feedback Form 
 
 

   
 VISION ARTICLE   
 
VISION​- The world through a child’s eyes 
 

The development of vision is one of the most important aspects of a child’s life, as it provides the maximum information 
to the growing brain. The visual system is the most complex of the sensory systems, serving as a link to the new outer 
world. 

Babies are born with fully formed, yet immature visual systems. They “learn to see” over a 
period of time, just like how they acquire other developmental milestones in a stepwise 
manner. Normal visual development progresses from simple responses to light, all the way 
to complex tasks, like organisation of details into patterns and associating meanings with 
objects . This crucial period of visual maturation is maximum between 0 to 2 years of age. 
The timeline of visual development in the first year is as follows: 

• A newborn can only see shapes and movements. They can only perceive in black, white 
and grey. They have a preference for faces and can see upto a distance of 10 inches.  

• At 2 months babies can focus, make eye-to-eye contact and attain a social smile.  
• By 3 months they can track objects or faces by turning their head 90 degrees on either side. 
 
• By 6 months, babies can see with both eyes coordinately for binocular vision and can 
perceive depth. They attain good hand-eye coordination and hence can aim and reach for 
toys. 

• By 9 months, they can understand the concept of object permanence, which means they 
begin to learn that an object once out of sight , still continues to exist and can play 
peek-a-boo.  

   

Why is vision important?  

Vision has a direct impact on all the areas of brain development, which include physical, social, emotional, intelligence 
and language. Activities to promote visual stimulation will help to unleash their full potential in the growing years and 
have a great impact on acquiring early learning skills. Problems in vision can seriously hamper the child’s overall 
development and, hence is vital to monitor their vision. It is mandatory to follow the below monitoring schedule for every 
child. 
• Checking the RED EYE REFLEX in all newborn babies, as a screening tool to rule out congenital cataract and various 
other eye abnormalities. 

• Sometimes, vision changes can go unnoticed by parents and children, hence a formal assessment of vision should be 
done starting at 3-4 years age, and annually thereafter.  

• In children who are at risk for visual problems like babies born preterm, low birth weight, perinatal / postnatal issues, 
congenital eye conditions, syndromes affecting vision, developmental delays, strong family history of vision 
abnormalities etc, it is crucial to screen them, follow them up regularly and manage appropriately.  

• Vision risk assessment and screening should be done for all babies during their well-child visits as well. This includes 
addressing parental concerns about symptoms related to vision. Symptoms like excessive watering of eyes, eyelid 
crusting, squint, white pupils, extreme sensitivity to light requiring immediate medical attention in any age group. In 
preschool children, amblyopia (lazy eye), nystagmus, refractive errors and squint are some of the common visual 
problems. They can prevent the normal vision development in a child. 

• It is also important to understand that visual problems can manifest as behaviour problems, like decreased attention 
span, holding a book or watching screens too close, head-tilt, avoidance of tasks that require attention to details like 
colouring and solving puzzles. Hence, early recognition and appropriate management is very crucial. 

The development of the visual system and its maturation starts right from the intrauterine period. Hence, preterm babies 
are at a higher risk for visual problems due to improper development and maturation. Preterm babies can develop a 
condition called R ​ etinopathy Of Prematurity​(ROP), that can cause serious visual impairment. To prevent ROP 
following are few important guidelines to follow: 

• Every newborn less than 35 completed weeks of gestation or less than 2 kg birth weight needs to be screened for ROP.  
• Their first screen as early as 2-3 weeks of age and regular follow up thereafter.   
• Regular follow up is necessary to monitor if the visual maturation is age appropriate and also for early detection of 
abnormalities if any. 

• This provides us an opportunity for early intervention like laser therapy, which can be vision saving for the child. 
Another critical , yet treatable condition in children is C
​ ortical Visual Impairment (CVI). ​CVI is emerging as a leading 
cause of visual impairment in children. 

• This is characterised by a defect in integration and interpretation of the visual information that is provided by the eye to 
the brain. In simple words, what the eyes can see, the brain can’t understand. 
• Risk factors include birth asphyxia due to delayed first cry after birth, hypoglycemia, seizures and insults to the growing 
brain. 

• Symptoms include light gazing, not able to focus on faces and no tracking of faces or objects. 
• It is extremely important to recognise and detect early, as if this issue is addressed with visual stimulation before 
6months of age, there is a good scope for recovery. 

An emerging health hazard that hampers a child’s visual development and also social-emotional and cognitive 
development is the excess of screen time. This predisposes to a variety of visual problems like blurred vision, headaches, 
dry eyes in addition to increasing risk of other physical and mental health problems. There are guidelines stating clear-cut 
age-appropriate recommendations for the use of electronic media. These include: 

• No screen time for children less than 18 months  

• For children between 18-24 months, restrict viewing of high quality educational content with caregiver, who explains it 
to the child and the duration should be less than one hour per day 

• For children between 2-5 years, upto 1 hour of screen time per day is acceptable, provided they understand what they 
are seeing and are able to apply it to the world around them. 

• For the child between 6 to 10 years age, 1 to 1.5 hrs of screen time can be permitted but the child. It is important for the 
parents to be aware of the content of the children. Strict non media time zones are set and the family members also 
should practice what they preach , and interact with the child in a positive manner. 

• More emphasis is on promoting good physical activity, ensuring adequate nutrition, spending quality family time – all 
activities that promote good physical and mental health. Play is one of the most important means of improving visual 
developmental skills in children, 

Well begun is half done. This dictum holds good in nurturing our children, so that they achieve their full potential. The 
first five years of a child’s life is the period of maximum growth of the brain. We need to make use of this golden time 
period, empowered with knowledge, to lay a strong foundation for the child’s bright future.  

Prevention is better than cure - Hence, a universal vision screening for all babies, identifying those who are at risk for visual 
problems, regular follow up and early intervention can ensure a child’s optimal visual and brain development.  

 
 

Compiled by  

Dr Anjana B Dr Haneesha Pinamraju 

DCH, DNB (Paeds)  MD Paediatrics, MRCPCH(UK) 
CCDD NDP fellow  IAP NDP Fellow 

   

 
 VISION ACTIVITIES   
 
Vision  plays  a  crucial role in child development and learning. Visual learning is one of the most important modes 
of  learning  for  the  child.  There  are  various  components  of  vision,  which  form  the  building  blocks  for  their 
education  and  academics.  They  help  them  in  learning  language,  math  and  geometrics.  They  include  the 
following: 
 
1. Visual memory:​the ability to remember visual information. 
 
2. Visual  discrimination​:  matching  two  objects  that  are  the  same  and  the  ability  to  recognize  details 
in visual images. 
 
3. Visual  scanning  :  ​Visual  scanning is  the  ability  to  use vision to  search  in  a  systematic  manner,  such  as  top  to 
bottom and left to right. 
 
4. Form  constancy  :  ​the  ability to identify or sort objects, shapes, symbols, letters, and/or words, despite differences 
in size or position. 
 
5. Visual tracking : ​focusing on an object as it moves across a person's visual field. 
 
6. Visual spatial relations​: is the ability to visually perceive two or more objects in relation to each other and to 
yourself. 
 
7. Visual closure​: it is the child's ability to identify forms or objects from incomplete presentations 
 
8. Visual  Sequencing​:  is  the  skill  that  requires  a  student  to  remember  the  order  or  sequence  of  numbers,  items, 
pictures, and/or words after viewing them 
 
9. Figure ground perception​: Visual figure-ground is the ability to see an object in a busy background 
 
If  your  child  is  between  3  -  5  years  of  age,  they  should  be  able  to  do  the  below  activities  pertaining  to  the  above 
components of visual learning. 
 
 
 
 
 
 
1. VISUAL MEMORY :  2. VISUAL DISCRIMINATION: 
 

  
 
 
 
3. VISUAL SCANNING : 4. FORM CONSTANCY: 
 

 
 
 
 
5. VISUAL TRACKING: 6. VISUAL SPATIAL RELATIONS: 
 
 

 
 
 
 
 
 
9. VISUAL CLOSURE: 8. VISUAL SEQUENCING : 
colour the below circles following  
the adjacent sequence 
 
 
 

   
 9. VISUAL GROUND PERCEPTION 
 
 

 
 
 
Compiled by  

Dr Anjana B Dr Haneesha Pinamraju 

DCH, DNB (Paeds) MD Paediatrics, MRCPCH(UK) 
CCDD NDP fellow  IAP NDP Fellow 

   

 
 
 
 
 DEVELOPMENTAL QUIZ   
 
 
The brain is an amazing organ. Recent discoveries in neuroscience enable us to view child development in the latest ways. 
As the secrets of the brain are unraveled one after another, one cannot but marvel at its development, organization, 
efficiency and abilities. The development of the brain goes in an orderly, 
 
sequential manner, and this represents the networking and synapse formations occurring in the brain. This maturation is 
represented by the milestones attained by the child in all 4 domains- physical, cognition, language, socio-emotional. 
There are multiple factors both genetic and environmental, which shape their development and optimize their potential. 
 
Let us see how well you know your child’s developmental milestones. Here are a few images of the developmental 
milestones of a child. 
 
Let us know which age does a typically growing child achieve these milestones. Mail your answers to us. 
 
 
1. Learns to Play peek a boo 2. Social smile 
 
 

 
 
 
 
 
 
 
 
 
 
 
3. Know if they are a boy or girl 4. Pointing 
 

 
 
 
 
 
Compiled by  

Dr Anjana B Dr Haneesha Pinamraju 

DCH, DNB (Paeds) MD Paediatrics, MRCPCH(UK) 
CCDD NDP fellow IAP NDP Fellow 

   

 
 
 
 
 
 
 
 
 
Following up your child’s milestones is very crucial. Use the app below for tracking their age appropriate 
milestones across all their domains. 
 

 
 
Answers: 
 
 
1. Learns peek-a-boo by 9-12 months : 
 
It is a very important social skill for social interaction, communication and language development. Child also learns the 
concept of object permanence- which means the object once out of sight is not out of mind, it continues to exist. 
 
2. Social smile : 
 
A child attains a social smile by 6-8weeks. 
This is one of the earliest milestones to be attained by the child. This is a very important social milestone, reciprocating 
back meaning fully with the mother and caregivers. Also important from vision development as the child can now focus 
and make eye to eye contact. 
 
3. Knows their gender : 
 
A child knows their gender by 3years of age. This is a cognitive milestone of understanding concepts and relations. 
 
4. Pointing : 
 
A child learns to point by 9-12months This is an important language milestone. This is an expressive gesture the child 
learns for communication and showing their needs. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 BREAST MILK AND BRAIN DEVELOPMENT  
 
Breast Milk - The Liquid Gold 
 
 
 
 
“ In all mammalian species the reproductive cycle comprises both pregnancy and breast-feeding : in the 
absence of latter, none of these species, man included, could have survived “ 
​- B
​ o Vahlquist ( Pediatrician 1981) 
  
 
 
 
 
 
 
 
Humans are unique in that they have large brain to body weight ratios (1:40) amongst mammals with an evolved brain. 
Newborns at birth have 25%of adult brain weight which becomes 75% at 2 [Link] means the brain is growing rapidly 
in the first 2 years. This increase in weight requires an appropriate amount and quality of [Link] the Academics in 
Child health endorse that exclusive breastfeeding upto 6 months and continued beyond 1 year, with home based food 
started at 6 months meets this needs effectively. 
 
Breastmilk in the first few days of life is called Colostrum-natural first vaccine. It is not only rich in antibodies which helps 
fight infection, but also has good fatty acids. 
Our body fat is of 2 types- saturated and unsaturated fats. The unsaturated fat like linolenic acid and its end product DHA 
( Docosahexaenoic acid ) ,along with cholesterol form 65%of brain [Link] DHA is naturally present in breast milk 
and promotes brain development. That’s why breastfed babies are smarter (have 3.4 IQ points more) than non breastfed 
babies. If the mother delivers her baby 3 weeks before her due date then it is a preterm [Link] a preterm baby when 
it is fed his/her mother’s breast milk which has even more [Link] these babies are even smarter(have 6.5 IQ points 
more). 
 
Breastfeeding promotes emotional and mental benefits for both mother and her baby. The skin to skin contact releases 
oxytocin in both mother and baby. This substance promotes good emotional bonding and [Link] bacteria that is 
established in the first A few days of life is called Gut Microbiome. When a newborn baby is breastfed soon after birth the 
microbiome that is formed has good effects on both the baby's intestine and brain.  
 
 
 
Exclusive breastfeeding is the best way to give a great start to your baby which will have lifelong medical, academic and 
economic benefits. Nothing other than mothers milk is so custom made, safe, nutritious, convenient, hygienic, 
temperature controlled, immune boosting, and healthy. And this should be started within the first hour of birth. 
 
“ There is only one pretty child and a healthy milk in this world, and every mother has it” 
 
Happy breastfeeding for a healthy society. 

Dr. N Uday Kumar ,  

Associate Professor of Pediatrics,   
Head of KCDU, 
SRIHER 
 HUMAN MILK BANK
 
Human milk bank is an amazing concept. Human milk is also known as Liquid Gold, given its value in every baby's life, 
not just during infancy but even into adulthood. For those babies who do not have the opportunity to have their own 
mother’s milk, this concept was introduced to support and share for those babies in need. This is a well established and 
well used concept across the globe. Human milk bank is where the Human milk is collected, tested, processed, stored and 
distributed under regulation for babies in need of it. In the western world, there are regulatory bodies which constantly 
supervise and maintain the standards of milk banks as per the recommendations. In developing countries like INDIA we 
still fall short of such strict regulations and hence there is still a small chance of infection during the procedure. However, 
if we follow strict precautions and the standard procedures supervised by the regulatory bodies , we could eliminate such 
risks and make it safe for use more frequently. Below is a list of Human Milk banks across India. Kindly use them 
judiciously after talking to your doctor about it. 
 
1. Divya Mother Milk Bank, Udaipur, Rajasthan. 
2. Amara Milk Bank (In collaboration with Fortis la Femme), Greater Kailash, New Delhi. 
3. Lokamanya Tilak Hospital (Sion Hospital), Sion, Mumbai. 
4. Vijaya Hospital, Chennai. 
5. KEM Hospital, Parel, Mumbai. 
6. Institute Of Child Health and Hospital for Children (Tamil Salai, Egmore, Chennai, Tamil Nadu 600008) 
7. Indus hospitals (#18-1-65-66, Opp. Indus Hospital, KGH Down Road, Maharanipeta, Jagadamba Junction, 
Visakhapatnam, Andhra Pradesh 530002) 
8. Sree Avittam Thirunal Hospital (Medical College Campus, Chalakkuzhi, Thiruvananthapuram, Kerala 695011) 
9. Human Milk Banking Association (Yashoda Nagar, No.2, Amravati, Maharashtra 444606) 
10. Divya Mother Milk Bank (R.N.T Medical College, Panna Dhai Rajkiya Mahila Chikitsalaya, Udaipur, 313001) 
11. Aanchal Mother Milk Bank Churu, Rajasthan (D.B.H, Rajasthan) 
12. Aanchal Mother Milk Bank (hospital, Zanana, Alwar, Rajasthan 301001) 
13. BreastMilk Foundation (A2/59, Block A 2, Safdarjung Enclave, New Delhi, Delhi 110029) 
14. Mother dairy (Chandpura Saidabad - Mohanpur Rd, Mohanpur, Bihar 844503) 
15. Mother Dairy Calcutta (No 16, LB 2, near Water Tank, LB Block, Sector III, Bidhannagar, Kolkata, West Bengal 
700106) 

 
 CHALLENGES IN BREASTFEEDING

Breastfeeding is the most natural and instinctive form of feeding for newborn babies. But it can be difficult for preterm 
babies, newborns with postnatal complications and babies with genetic oro-motor deformities. 
 
Oral feeding is a skill that requires good balance in the processes of breathing, sucking and swallowing. New-born babies 
need to co-ordinate their oro-motor and respiratory skills in response to the sensory cues that they receive from their 
mothers’ breast. They also need to modulate and 
respond their feeding behaviours to hunger and satiation cues. Babies need to synchronise muscles of the lips, jaw, tongue, 
pharynx and the respiratory systems to facilitate a safe swallow. 
 
Primitive reflexes such as rooting reflex, gag reflex and a swallow reflex help the baby respond to peri-oral, intra-oral and 
pharyngeal stimuli in the form of mother’s milk. 
 
Independent oral feeding can be difficult to achieve in extreme preterm babies in particular. Preterm infants often have 
long NICU stays and that can interfere with their ability to latch onto the mother’s breast long enough to sustain sucking, 
swallowing and breathing throughout oral feeding. 
 
Comorbidities present in preterm infants can delay development and restrict instances for effective sucking to develop. 
That, in turn, can deprive the baby of cardinal oral sensory and oro-motor experiences during an important brain 
development phase when the central patterning of suck and feeding skill is refined. Medical interventions used with 
preterm infants may result in negative responses to oral feeding and long‐term oral sensitivity. 
 
There are numerous studies supporting the effectiveness of oral interventions in the NICU that facilitate improved 
sucking, improved feeding rhythms, faster transition from tube feeding to oral feeding and improved quality of oral 
feeding. 
 
Some of the evidence – based interventions have been put across as pre-feeding and peri-feeding protocols in NICU care 
all over the world. The techniques that help a preterm adjust better to oral feeding are delivered by NICU nurses or 
physiotherapists or taught to mothers. 
 
1. Kangaroo Mother care; Visiting the baby and holding the baby during feeds even when the baby is being tube fed 
can improve the association between proximity with the mother and feeding. It is a strong form of sensory 
intervention – which stimulates the touch and smell senses of the baby 
2. Peri-oral stimulation with a gloved finger where the therapist strokes the baby from the cheek to the lip to 
stimulate the rooting reflex 
3. Stroking the lip to stimulate mouth opening 
4. Positioning of the tongue in the tongue in the lower vestibule of the mouth with the gloved finger 
 5. Lip approximation techniques 
6. Perioral massage 
7. Allowing the baby to approximate his/her lips around the therapist’s finger and stimulating sucking reflex 
8. Repositioning of the chin and jaw into neck retraction and slight neck flexion to improve suck and swallow 
routine 
9. Expressed breast milk can be used as a sensory stimulus during the above techniques 
10. The mothers are taught various ways of holding and positioning the baby to facilitate sensory access to the breast 
and improved oral feeding. 
 
Cleft lip​​and cleft palate​are two of the common oro-motor deformities often seen at birth, which can hinder 
independent oral feeding. The common difficulties that the baby might experience is with attaining good seal around the 
breast to sustain sucking, gagging, choking, weak suck, preference towards the non-cleft side of the lip, milk leaking 
through the nose. Since the corrective surgery if 
often performed only at the age of 3 months, helping the baby with feeding is almost imperative. Some of the additional 
techniques that can be used are listed below. 
 

1. ​Modified breast hold into the child’s mouth to enable increased soft tissue fit, thereby enabling optimal mouth 
closure 
2. Noisy sucking is often an indication of inadequate suck and often a finger can be placed over the cleft to increase 
the sucking efficiency 
3. If bottle feeding is an option, then bottles need to have wider nipples. The baby needs to be held in an upright 
position and the bottle needs to be positioned in a way that feeding can be facilitated in the downward direction. 
The nipple needs to be positioned on the centre of the lip firmly. 
4. Special bottles are available to improve breast feeding without making the baby perceive difficulty 
5. Frequent burping is advised as the baby might swallow a lot of air during sucking 
A trained lactation consultant can often help the new mother in understanding the various ways in which she can help her 
newborn with feeding difficulties. Most of the feeding interventions are designed to – 
 
 ● Reduce oral hypersensitivity 
● Improve range of motion and strength of muscles for sucking 
● Increase oral motor organisation, and 
● Activate reflex behaviours that facilitate nutritive sucking. 
 
These interventions help with accelerated transition from tube feeding to independent oral feeding, increased volume 
intake, greater weight gain and fewer days of hospitalisation. 
 

By -     
Mrs Priya Kuberan,   
MPT Neurosciences 
Consultant Therapist

 
  

BREASTFEEDING IN COVID TIMES 

 
 
INFANT FEEDING PRACTICES DURING COVID 19 - ASK THE EXPERT 
 
Parenting in pandemic times has thrown up several anxious questions. Especially among new mothers who are 
breastfeeding their babies. 
" I'm COVID 19 positive and I’m so worried. Can I hold my baby?  
Can I breastfeed my baby? 
Would I be exposing my baby to a risk of infection?" 
These are few of the very common questions asked by them. 
Hence, we have our lactation expert answering a few questions on this issue for us.  
 
Studies have shown that there is minimal risk of passing the virus via breastmilk. In fact, specific protective antibodies 
against the virus have been detected. 
So, some general guidelines would be: 
 
1. If a mother has COVID-19 infection and is breastfeeding her baby, can she continue breastfeeding the baby and what 
precautions should be taken by the mother ? 
Answer : 
 • Continue breastfeeding if possible 
 • Wash hands before and after holding/feeding baby 
 • Wear a mask to keep respiratory droplets away from contacting baby 
 • Avoid touching your as well as babies eyes, nose and mouth 
 • Continue skin to skin contact. 
 
2. If a mother is expressing her breast milk and feeding it to her baby, what precautions should she take? 
Answer : 
 • Wash hands before and after expressing milk or touching pump, bottles etc 
 • Sanitise pumps and surfaces regularly. 
 
3. If a mother is still ill and hospitalized, can she still breastfeed / express her milk for feeding her baby? 
Answer : 
 • Breastfeed if possible 
 • Express milk if possible and have a healthy caregiver caring for and feeding the baby while following all the safety 
protocols. 
 
 
 
4. For mothers free of covid 19, what is the advice you would give regarding feeding and weaning practices? 
Answer : 
 • Keep breastfeeding. consider waiting to wean 
 • If combination feeding, try to maximize the amount of breastmilk baby gets. 
 • If not feeding at the breast, follow best practices in sterilizing equipment and preparing the feed, and limit the number 
of people who feed the baby. 
 
As always, the benefits that breast milk provides, outweighs the risk. 
 
 
 
 
 

 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 

NUTRITION FOR LACTATING MOTHERS 

 
Diet For Lactating Mothers- To Improve Lactation 
 
Balanced diet is very important for lactating mothers to maintain the health of mother and baby. Breast milk depends 
upon the quality of food and quantity of fluids that they consume daily, which in turn, will directly affect baby’s 
nourishment and well-being. While lactating energy requirements will increase to enable it to strengthen up, all food 
groups provide energy, which is expressed in technical terms as kilocalories. Lactating mothers need at least 2400 to 2700 
kcals every day for the first 6 months, at this time, the energy requirements will be high for breast feeding to babies. Later 
on weaning foods will be introduced, so lactating mother’s energy requirement will decrease to 2250 to 2550 kcal every 
day. 
 
Food list which makes more milk production for lactation mothers: 
 
1. Fenugreek seeds – have been used for generations and across the world to increase breast milk production. It is 
rich in omega 3 fatty acids which are important for baby’s brain development. 
2. Fennel seeds – reduce gas and colic 
3. Garlic – boosting the immune system, preventing heart diseases 
4. Green leafy vegetables – great source of minerals such as iron, calcium and 
folate and also plenty of vitamins 
5. Cumin seeds – helps with digestion, relieve constipation, acidity and bloating 
6. Sesame seeds – increase breast milk good source of calcium 
7. Holy basil or tulsi – promoting healthy bowel movements and a good appetite 
8. Oatmeal – source of energy and rich in fiber 
9. Carrots – boost lactation and rich in vitamin A 
10. Barley – keeps hydrated 
11. Asparagus – High fiber food that is rich in vitamins A and K. It stimulates the 
hormone that is responsible for lactation 
12. Apricots are great to help stabilize hormonal imbalance 
13. Salmon – rich in omega – 3 fatty acids and essential fatty acids, it makes the milk produced more nutritious 
14. Water – when considering what to have to increase breast milk production people often overlook water staying 
hydrated is absolutely essential to improve milk production, so remember to drink plenty of water throughout the 
day 
 
 
 
 
 
 
Diet sheet for lactation mother - 2200 kcals diet plan 
 
 

7 am  Milk 200ml Badam powder 

Breakfast – 8-9 am  Palak dosa 4 nos 
Chutney one cup 
Vegetable curry and fennel seeds garnished 
Orange/apple juice 200 ml 
Mid-Morning – 10-11 am  Dry fruits sweet 1 no 
Lunch 1-2 pm  Meethi chapathi – 2nos 
Rice 1 cup, veg palya – 1 cup 
Dhal – 1 cup 
Mix green leafy sabji – 1 cup 
Rasam – 1 cup 
Curds – 1 cup  
Evening snacks – 4-5 pm  Oats porridge and vegetables + milk + Badam 
powder/Coffee 
Dinner – 8-9 pm  Mint paratha 1 no 
Ridge gourd chutney, 
Khichdi with vegetables and Ghee 
Curd 1 cup 
Bedtime   milk 200 ml 
 
  

 
 
 
By -   
     
Mrs. Vijayalakshmi, 
Bsc Clinical Nutrition and diets 
Msc early childhood education and administration     
 

 
 
 
 
 
 
 
 AMAR SEVA SANGHA 
 
AMAR SEVA SANGAM- A TRUE INSPIRATION TO ALL! 
 
Amar Seva Sangam (ASSA) is a premier Organization in the field of disability management focusing on rural areas across 
all ages and all disabilities, located in Ayikudi Village, Tenkasi District. Its approach is to establish a centralized resource 
center in the development of physically and mentally challenged. 
 
In the last 39 years ASSA has very successfully implemented several bold and innovative programs and received several 
State, National, International and other awards. ASSA caters to over 16,000 Persons with Disabilities in over 900 villages 
by way of rehabilitation, education, employment and empowerment to enable them to become economically productive 
citizens and join the mainstream society. 
 
Padma Shri S. Ramakrishnan​, established Amar Seva Sangam in June 1981 with just 5 rural poor children under a 
thatched roof. In 1975 Sri Ramakrishnan met with an accident during a Naval recruitment exercise and severely injured 
his spine and became quadriplegic. For his honorable work, Shri S Ramakrishna was awarded the Padma Shri in 2020. The 
Secretary, C​ A S. Sankara Raman​, also a wheelchair person diagnosed with Muscular Dystrophy, a prolific Chartered 
Accountant with gold medal, joined the Sangam in 1992 after leaving his lucrative practice in Chennai. 
 
Their dream is to establish a ​Valley for the physically challenged i​ n a 30+ acre land as a Rehabilitation and Development 
Centre and developing models for self-help initiatives by integrating the disabled individuals with the society for improved 
living conditions. 
 
V
​ ision of Amar Seva Sangam​is to establish a Valley for the Disabled, where physically /mentally challenged persons can 
live in a society where they get equality in opportunities and equality in status. 
 
Mission of ASSA is to empower the disabled citizens by developing a Rehabilitation and Development Centre for the 
region and developing models for self-help initiatives by integrating the disabled individuals with the society for improved 
living conditions in the villages. 
 
 
 
 
 
 
 
 
 
 
 
 
 
Activities at Amar Seva Sangam: 
 
1. Institution based Rehabilitation 
2. Education 
3. Skill development of Disabled through Vocational Training and Employment 
generation 
4. Village based Rehabilitation 
5. Early intervention programme for children with developmental delays 
 
 
Amar Seva Sangam believes, that disability is not a constraint, but a condition that can be managed if intervened early and 
that no child should be denied of schooling 
because of disability. 
 
Amar Seva Sangam , during the COVID-19 pandemic situation, took special care to ensure that there was no interruption 
in the services provided. It extended its services through the mobile applications and rendered necessary therapies through 
video conferencing and other online methods using social media platforms. 
 
In appreciation and recognition of ASSA’s services for the socially downtrodden, economically poor and educationally 
backward classes of Persons with Disabilities, it was conferred with several State, National, International and other 
prestigious [Link] S. Ramakrishnan, the President of Amar Seva Sangam, has been conferred with one of the highest 
civilian awards “Padma Shri” Award in 2020. 
 
This is truly an inspiring journey of people who believed that disability should not deter one from achieving their dreams. 
 
Amar Seva Sangam has been rendering yeoman service to humanity and We wish them more and more success in their 
future endeavours. 
 
 
 
 
 
 
 
 
 
 
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