National Immunization Schedule (NIS) for Infants, Children and Pregnant Women

 

                 National Immunization Schedule (NIS) for Infants, Children and Pregnant Women

Vaccine	When to give	Dose	Route	Site
For Pregnant Women
TT-1	Early in pregnancy	0.5 ml	Intra-muscular	Upper Arm
TT-2	4 weeks after TT-1*	0.5 ml	Intra-muscular	Upper Arm
TT- Booster	If received 2 TT doses in a pregnancy within the last 3 yrs*	0.5 ml	Intra-muscular	Upper Arm
For Infants
BCG	At birth or as early as possible till one year of age	0.1ml (0.05ml until 1 month age)	Intra-dermal	Left Upper Arm
Hepatitis B - Birth dose	At birth or as early as possible within 24 hours	0.5 ml	Intra-muscular	Antero-lateral side of mid-thigh
OPV-0	At birth or as early as possible within the first 15 days	2 drops	Oral	Oral
OPV 1, 2 & 3	At 6 weeks, 10 weeks & 14 weeks (OPV can be given till 5 years of age)	2 drops	Oral	Oral
Pentavalent 1, 2 & 3	At 6 weeks, 10 weeks & 14 weeks (can be given till one year of age)	0.5 ml	Intra-muscular	Antero-lateral side of mid-thigh
Rotavirus#	At 6 weeks, 10 weeks & 14 weeks (can be given till one year of age)	5 drops	Oral	Oral
IPV	Two fractional dose at 6 and 14 weeks of age	0.1 ml	Intra dermal two fractional dose	Intra-dermal: Right upper arm
Measles /MR 1st Dose$	9 completed months-12 months. (can be given till 5 years of age)	0.5 ml	Sub-cutaneous	Right upper Arm
JE - 1**	9 completed months-12 months.	0.5 ml	Sub-cutaneous	Left upper Arm
Vitamin A (1st dose)	At 9 completed months with measles- Rubella	1 ml ( 1 lakh  IU)	Oral	Oral
For Children
DPT booster-1	16-24 months	0.5 ml	Intra-muscular	Antero-lateral side of mid-thigh
Measles/ MR 2nd dose $	16-24 months	0.5 ml	Sub-cutaneous	Right upper Arm
OPV Booster	16-24 months	2 drops	Oral	Oral
JE-2	16-24 months	0.5 ml	Sub-cutaneous	Left Upper Arm
Vitamin A*** (2nd to 9th dose)	16-18 months. Then one dose every 6 months up to the age of 5 years.	2 ml (2 lakh IU)	Oral	Oral
DPT Booster-2	5-6 years	0.5 ml.	Intra-muscular	Upper Arm
TT	10 years & 16 years	0.5 ml	Intra-muscular	Upper Arm

·         *Give TT-2 or Booster doses before 36 weeks of pregnancy. However, give these even if more than 36 weeks have passed. Give TT to a woman in labour, if she has not previously received TT.

·         **JE Vaccine is introduced in select endemic districts after the campaign.

·         *** The 2^nd to 9^th doses of Vitamin A can be administered to children 1-5 years old during biannual rounds, in collaboration with ICDS.

·         #Phased introduction, at present in Andhra Pradesh, Haryana, Himachal Pradesh and Orissa from 2016 & expanded in Madhya Pradesh, Assam, Rajasthan, and Tripura in February 2017 and planned in Tamil Nadu & Uttar Pradesh in 2017.

·         $ Phased introduction, at present in five states namely Karnataka, Tamil Nadu, Goa, Lakshadweep and Puducherry. (As of Feb’ 2017)

Child Development Milestones for 16-18 Months

 

What are the cognitive milestones for a 16-18 month old?

At this age, toddler is very curious and loves to explore new things, experiment, and play. This is how they develop imagination, creativity, and problem-solving skills. Your toddler will play with toys in a meaningful way (for example, feeding a doll or pushing a toy car) and engage in pretend play (like pretending to eat with a toy spoon). You may notice that your child copies you doing household activities, like folding clothes or setting the table.

 

What are the physical milestones for a 16-18 month old?

At this age, toddler starts to walk without holding on and may try to run or walk up and down stairs with support from you or sturdy objects. Children will also climb on and off a chair without help. Around 16-18 months, your child will feel much more confident with scribbling, drinking from a cup, using a spoon, and turning pages in a book.

 

What are the speech and language milestones for a 16-18 month old?

Around 16-18 months, child might say a few words and you will hear more and more real words, like the names of objects and labeling actions, as they babble. Your child begins to follow simple commands without gestures, like ‘open the door’ or ‘give the cup to papa.’ They will also begin to understand their own name.

What are the social and emotional milestones for a 16-18 month old?

At this age, toddler has developed strong emotional attachments to the people they love. You may notice your child moving away from you to play but look to make sure you are close by. They may also exhibit separation anxiety, which is typical at this age of development. Your child will participate in more daily routines with ease, like putting out their hands for you to wash them, looking at a few pages in a book with you, and helping you dress them.

Tips for parents

Encourage your child to participate in everyday routines like getting dressed.

What is Urethral Stricture Disease

The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.

What Happens under Normal Conditions?

The bladder empties through the urethra and out of the body (called voiding). The female urethra is much shorter than the male's. In males, urine must travel a longer distance from the bladder through the penis.

In males, the first 1" to 2" of the urethra that urine passes through is called the posterior urethra. The posterior urethra includes:

the bladder neck (the opening of the bladder)

the prostatic urethra (the part of the urethra by the prostate) 

the membranous urethra

a muscle called the external urinary sphincter

Strictures that happen in the first 1" to 2" of the urethra that urine passes through are called posterior strictures.

In males, the final 9" to 10" of the urethra is called the anterior urethra. The anterior urethra includes:

the bulbar urethra (under the scrotum and perineum- the area between the scrotum and anus)

the penile urethra (along the bottom of the penis)

the meatus (the exit at the tip of the penis)

Strictures that happen in the last 9" to 10" of the urethra that urine passes through are called anterior strictures.

Diagram of the Male and Female Urinary Tracts

Enlarge

Causes

Men are more likely to have a urethral disease or injury because of their longer urethra. For this reason, strictures are more common in men. They are rare in women and in infants.

Stricture (narrowing of the urethra) can happen at any point from the bladder to the tip of the penis. This narrowing restricts or slows the flow of urine in. Some common causes are:

trauma to the urethra

infection such as a sexually transmitted disease

damage from surgical tools

conditions that cause swelling

In most cases, no cause can be found.

In adults, urethral strictures are most often due to:

injury from a fall onto the scrotum or perineum

prostate surgery

kidney stone removal

urinary catheterization

other surgical tools

Posterior Urethral Stricture

Posterior urethral strictures happen in the first 1" to 2" of the urethra. This kind of stricture is due to an injury linked to a pelvic fracture (e.g., motor vehicle or industrial accident). In these cases the urethra is disrupted, or completely cut and separated. Urine cannot pass. A catheter must be placed either through the abdomen into the bladder (suprapubic tube), or through the penis into the bladder. This lets urine drain until the stricture can be fixed.

Anterior Urethral Stricture

Anterior urethral strictures happen in last 9" to 10" of the urethra. This kind of stricture is caused by:

trauma from a straddle injury (from falls onto objects where the legs are on either side)

direct trauma to the penis

catheterization

Symptoms

Simply put, the urethra is like a garden hose. When there is a kink or narrowing along the hose, no matter how short or long, the flow is reduced. When a stricture is narrow enough to decrease urine flow, you will have symptoms. Problems with urinating, UTIs, and swelling or infections of the prostate may occur. Severe blockage that lasts a long time can damage the kidneys.

Some signs are:

bloody or dark urine

blood in semen

slow or decreased urine stream

urine stream spraying

pain with urinating

abdominal pain

urethral leaking

UTIs in men

swelling of the penis

loss of bladder control

Diagnosis

There are several tests to determine if you have a urethral stricture including:

physical exam

urethral imaging (X-rays or ultrasound)

urethroscopy (to see the inside of the urethra)

retrograde urethrogram

Urethroscopy

The doctor gently places a small, bendable, lubricated scope ( a small viewing instrument) into the urethra. It is moved up to the stricture. This lets the doctor see the narrowed area. This is done in the office and helps your doctor decide how to treat the stricture.

Retrograde Urethrogram

This test is used to see how many strictures there are, and their position, length and severity. This is done as an outpatient X-ray procedure. Retrograde in this case means "against the flow" of urine. Contrast dye (fluid that can be seen on an X-ray) is inserted into the urethra at the tip of the penis. No needles or catheters are used. The dye lets the doctor see the entire urethra and outlines the narrowed area. It can be combined with an antegrade urethrogram (antegrade means "with the flow" of urine). Dye inserted from below fills the urethra up to the injured area. Dye inserted from above fills the bladder and the urethra down to the stricture. These tests together let the doctor find the gap to plan for surgery.

Also, if you have trauma to the urethra, you may have this X-ray procedure after emergency treatment. Contrast dye can be injected through the catheter that was placed for healing.

Prevention

Avoid injury to the urethra and pelvis.

Be careful with self-catheterization

Use lubricating jelly liberally

Use the smallest possible catheter needed for the shortest time

Avoid sexually transmitted infections.

Gonorrhea was once the most common cause of strictures.

Antibiotics have helped to prevent this.

Chlamydia is now the more common cause.

Infection can be prevented with condom use, or by avoiding sex with infected partners.

If a problem occurs, take the right antibiotics early. Urethral strictures are not contagious, but sexually transmitted infections are.

Treatment

There are many options depending on the size of the blockage and how much scar tissue is involved.

Treatments include:

dilation – enlarging the stricture with gradual stretching

urethrotomy – cutting the stricture with a laser or knife through a scope

open surgery – surgical removal of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty)

There are no available drugs to help treat strictures.

Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can't pass urine), which could lead to an enlarged bladder and kidney problems.

Dilation

This is usually performed in the urologist's office with local anesthesia. The stricture is stretched using larger and larger dilators called "sounds." A special balloon on a catheter can also stretch the tissue. But this stretching is not really a cure and needs to be repeated regularly. If the stricture comes back too quickly, you may be taught how to insert a catheter from time to time to prevent it from coming back. Side effects include bleeding and infection. Sometimes a "false passage" or second urethral channel may form from the stretching.

Urethrotomy

This uses a special scope that is moved along the urethra until the stricture is found.

A knife blade or laser at the end of the cystoscope is used to cut the stricture and create a gap. A catheter may be placed into the urethra to hold the gap open and let it heal. The suggested time to leave a catheter tube draining is based on the length of the stricture.

Open Surgery

Many reconstructive procedures have been used to treat strictures, and some involve 1 or 2 operations. In all cases, the choice of repair is based on the location and length of the stricture and how serious it is. No single repair is right for all cases. The 2 main types are anastomotic urethroplasty and substitution urethroplasty.

Anastomotic Urethroplasty

This method is usually reserved for short urethral strictures. In this case, a cut is made between the scrotum and rectum. The urethra can then be reconnected after removing the stricture. This is usually performed as an outpatient procedure or with a short hospital stay. A small, soft catheter is left in the penis for 10 to 21 days. It is then removed after an X-ray is taken to make sure the repair has healed.

Substitution Urethroplasty

When the stricture is long, tissue can be transferred to replace the section that had the stricture. In difficult cases, substitution repairs may need to be done in stages. These repairs should be done by a urologist experienced with these surgeries. Overall the success rates are very good. The 3 kinds of substitution procedures are:

Free graft

Skin flap

Staged

Free Graft

This method replaces or enlarges a section of the urethra using your own tissue. The tissue may be skin (taken from the shaft of the penis) or, more often, buccal mucosa (taken from inside the cheek). After surgery, you may need a short hospital stay and use a catheter for 2 or 3 weeks.

Skin Flap

With this surgery, flaps of skin are rotated from the penis to create the new section of the urethra. This is needed when a graft needs to be long, and the stricture is severe. These procedures are complex and should be done by a surgeon with plastic surgery experience. After surgery, you may need a short hospital stay and use a catheter for 2 or 3 weeks.

Staged

This method is used when local tissue will not work for a free graft or a skin flap.

First stage – The underside of the urethra is opened, which shows the full length of the stricture. A graft is secured to the opened urethra. The graft heals and matures for 3 months to a year. During that time, you will urinate through a new opening behind the stricture. This may mean that you have to sit down to urinate while the graft heals.

Second stage – Several months after the graft around the urethra has healed, and it is soft and flexible, the graft is formed into a tube. The urethra then returns to normal. A small, soft catheter is left in the penis for 10 to 21 days.

After Treatment

Because urethral strictures can come back after surgery, you should be followed by a urologist. After the catheter is removed, your doctor will want to check you with physical exams and X-rays as needed. Sometimes the doctor performs urethroscopy to check the repair. In some patients, the stricture may return but may not need additional treatment. But if it causes obstruction, it can be treated with urethrotomy or dilation. Repeat open surgery may be needed for serious strictures that come back.

Important Milestones: Your Child By Eighteen Months

 Toddler development at 18-24 months: what’s happening

Feelings
At this age, toddlers start to experience new emotions like anger and frustration, guilt, shame, possessiveness and excitement. These ‘big’ emotions can be hard for your toddler to deal with, and you might see some tantrums as a result.

Although your toddler’s separation anxiety peaks at around 18 months, by 2 years it usually starts to settle down. But when your toddler plays, they might still want to be near you, a familiar adult or a sibling.

Your toddler is also beginning to think about how they feel and might link feelings with words. For example, your toddler might tell you they’re ‘sad’. They might show affection by giving you a kiss or hugging a doll, which is also part of developing empathy.

Everyday skills
Around this time, toddlers are keen to do more things independently. For example, your toddler is learning to feed themselves using a spoon and cup, and maybe even a fork – there might even be fewer spills than before!

Your toddler might try to help when getting dressed and undressed. At this age, it’s easier for your toddler to take off socks, shoes and clothes without buttons.

Generally, your toddler might show signs that they’re ready for toilet training from 2 years on. But some children start to show signs of being ready earlier, at around 18 months.

Playing and learning
Play is important because it’s how children learn.

At this age, your toddler will start imagining and creating through pretend play – for example, pretending to drink from a cup. As your toddler grows older, pretend play gets more complex, and you might find your toddler doing things like sweeping the floor with a tree branch. Your toddler will enjoy spending time with siblings and other children, even if they don’t play directly with others.

Talking
Toddlers enjoy talking at this age. Your toddler’s words might even have up-and-down tones, just like an adult’s. You’ll most likely hear a mix of ‘babble’ and real words.

At 18 months, your toddler is learning words all the time – usually 1-2 words a week, or maybe even a word a day. Your toddler might name and point at familiar objects, people and body parts – for example, ears, nose or toes. Your toddler might also make animal sounds like ‘moo’ or say the same sound or word over and over.

Your toddler knows their own name and the idea of ‘mine’. They’re getting better at understanding simple sentences and instructions like ‘Bring it to Mum’ or ‘Let’s go for a walk’. You’ll be able to understand more of what your toddler says to you.

By 2 years, your toddler might be able to say ‘I’, ‘you’ and ‘me’ and use sentences with 2-3 words – for example, ‘Mummy car’ or ‘me do it’.

Moving
Toddlers usually walk on their own by 18 months and begin to run. Your toddler will probably walk up and down stairs or climb furniture with your help. Throwing and kicking a ball, scribbling with pencils or crayons, and building small towers of blocks might be some of your toddler’s favourite things.

It’s a good idea to look at how you can make your home safe for your active toddler to move around in.

At this age, your toddler might also:

• ask for ‘more’ and say ‘no’ when asked to do something
• copy you – for example, they might help you sweep the floor
• sit themselves in a small chair
• walk around carrying larger objects
• use one hand more than the other by 2 years.

When your toddler learns a new skill, celebrate the achievement with plenty of praise and positive attention. It’s also a good idea to help and encourage your toddler to keep doing the things they’ve learned, even if those things are difficult.

Helping toddler development at 18-24 months

Here are simple things you can do to help your toddler’s development at this age:

• Be there for your toddler: if you’re nearby while your toddler plays and explores, it gives your toddler confidence to try new things on their own. This can help your toddler to be independent and self-confident later on.
• Give your toddler the chance to play with others: play is a great way for your toddler to learn how to be with other children, make friends and develop social skills like sharing and taking turns.
• Spend time playing outdoors: being out and about with you lets your toddler explore the world and test out their growing physical skills. When you’re outside, remember to be safe in the sun.
• Encourage your toddler to practise everyday skills like feeding themselves, drinking from a cup and getting dressed. These skills involve both small and big muscle movements, as well as your toddler’s ability to think about what they’re doing.
• Talk with your toddler: naming and talking about everyday things – body parts, toys and household items like spoons or chairs – develops language skills. At this age, you can teach your toddler that a ‘chair’ can be a ‘big chair’, ‘red chair’ or even a ‘big red chair’.
• Give meaning to your toddler’s talking by listening and talking back. If your toddler says ‘Mama milk’, you might reply by saying ‘You want Mum to get you some milk?’ This encourages conversation and builds your toddler’s communication skills. It also makes your toddler feel valued and loved.
• Read with your toddler: you can encourage your toddler’s talking and imagination by reading together, telling stories, singing songs and reciting nursery rhymes. These activities also help your toddler learn to read as they get older.

Parenting toddlers at 18-24 months

As a parent, you’re always learning. It’s OK to feel confident about what you know. And it’s also OK to admit you don’t know something and ask questions or get help.

It’s also important to look after yourself. Looking after yourself physically, mentally and emotionally is good for you, and it’s good for your toddler. When you’re well, you can give your toddler the loving attention they need to grow and thrive. You can also guide your toddler’s behaviour in positive ways, even when you find their behaviour challenging.

And remember that part of looking after yourself is asking for help, especially if you’re feeling stressed, anxious or angry. There are many people who can support you and your toddler, including your partner, friends, relatives, child and family health nurse and GP.