About The Book
This book is a distillate of pediatric
procedure related information from Modem Pediatrics, Panchakarma, Kayachikitsa and
Samhitas, along with the inputs from internet
and the clinical experiences of author and other pediatricians.
This handbook has been designed
primarily to serve as a guide for performing modem and Ayurvedic pediatric procedures in an Ayurvedic setup, in a clinically
efficient and legally justified manner. Point wise format, clear cut
therapeutic indications and self speaking illustrations are the hallmarks of
this book. As brief, yet instantly enlightening subjective background behind
various elements of an Ayurvedic (and
modem procedures as well) procedure has been provided frequently (e.g., in
boxes), the practitioners and researchers from other systems of medicine
interested in Ayurveda, may
also find this book useful. It will also cater to the 'Pediatric
procedures' chapter of the new CCIM syllabus for MD (Kaumar bhritya/Bala roga), PG Diploma in Pediatrics (Ay) and
Dr Mayank Srivastava is amongst the young promising Ayurvedic pediatricians.
He graduated from SKD Govt. Ay. College, Mzn. (U.P.)
and thereafter completed his post graduation in Kaumarbhritya (Ayurvedic Pediatrics)
from the prestigious institute, "Institute of Medical Sciences", BHU,
Varanasi (U.P.) in 2007. Since then, for almost last 7 years, he has been
actively teaching and practicing Ayurvedic
Presently he is working as Associate Professor and
HOD in Dept. of Kaumarbhritya in Himalayee
Ayurvedic Medical College and Hospital, Dehradun
(U.K.). He is also a reputed Pediatrician and Neonatalogist in the holy city of Rishikesh (U.K.), well
known for his skills in Pediatric emergency
management and rational Ayurvedic management
of the various Pediatric illnesses. He is a visiting
paediatrician in various nursing homes and schools of Rishikesh.
He has a wide experience and in depth knowledge of
the theoretical and practical aspects of Kaumarbhritya. He has presented papers,
participated and chaired scientific sessions in national and international
seminars and has many publications in his name as well. In nutshell, he is an
outstanding writer, a proficient teacher and a skilled practitioner of Kaumarbhritya, the Ayurvedic Paediatrics. Hence this book will be of immense
benefit to the practicing doctors and the trainee student .
Ayurveda, the science of life, helps
the person lead a healthy and happy life by alleviating all sorts of pain.
Entire Ayurveda is classified
into eight branches and Kaumarbhritya is
one of them. Dalhana while commenting on Sushruta Samhita Uttartantra
1/5, mentioned the name of Kaumarbhritya's specialized text books namely Parvataka, Jeeva- kam, Bandhaka etc, which are
presently unavailable. Enumeration of these specialized books on Kaumarbhritya suggests its importance as an
independent and well-developed branch of Ayurveda.
Information regarding the specialized knowledge of Kaumarbhritya is available since Vaidika kala
(Rigveda 517817-9,' Atharvaveda 1111/5;
Atharvaveda 8/6/13,' Bodhayan Grihyasutra; Paraskara Grihyasutra). In
Brihattrayi, information about the procedures to
prevent and treat various disorders related to the children are available -
some are performed in children right at the time of their birth such as Prana-Pratyagamana
and Garbhodaka-vaman; whereas many more are performed
thereafter, such as use of Tricyle and Shodhana karma procedures in the management
of Phakka roga (done
as per their respective indications).
Procedures may also serve diagnostic purpose.
Various subjective and objective parameters are used to know the health status
of a child. Out of these parameters, some are used to confirm the diagnosis and
in turn help in planning a judicious management. Kashyapa
too has suggested a clinical diagnosis to assess the health status of
children'. Clinical features of 'Arogya'
confirmed by various subjective & objective parameters and need use of different procedures.
This shows the importance of objective parameters as hematological,
biochemical, stool & urine
examination in diagnosis and management of diseases in children.
So the procedures are very essential, both in
diagnosis and management of various pediatric
disorders. But good books devoted to pediatric
procedures having modem as well as Ayurvedic aspects are not presently
Dr. Mayank Srivastava is a young author, dynamic teacher, good
clinician and orator. Properly drawn on his experience, he has published this
literature to offer a complete
and lucid discussion of each procedure.
To make the subject more perceptible, he has
classified all the procedures, broadly into two categories - 'Modem' and 'Ayurvedic' procedures. The book
includes most of the modem procedures used to manage emergency conditions of
children in day-to-day practice and they should
essentially be learnt by each pediatrician in
order to save the life of more and more children; while the Ayurvedic procedures are mainly related
to Kaumar-panchakarma i.e. those Panchakarma procedures which are commonly
performed in children. Panchakarma procedures,
which were mentioned in Ayurvedic classics
hither and thither, have been collected systematically in this book and
explained from the pediatric point of view, in a to
the point manner. This has further augmented the usefulness of this book for
the postgraduate and graduate students. '
"A Hand Book of Pediatric
Procedures for Ayurvedic Pediatricians" has
generously used photographs, algorithms and text- boxes for explaining the
subject-topics. This book has taken initiative to make a lucid presentation of
all those procedures which are mandatory in grooming of the medical students
and practitioners in the field of Ayurvedic
Study of this book will equip the students with
ample skill to perform the procedures easily with a minimal effort. This book
will be useful to the BAMS, PG-Diploma, PG students and for all those who are
engaged in active care of the newborns, infants and children.
Finally, I congratulate the author of this book for
his excellent effort in bringing forth a worthful
contribution in the field of Kaumarbhritya, the
Procedures are merely procedures. They should better
be viewed 'condition specific' rather than the 'system of medicine specific'.
In that sense, most procedures have an unparalleled utility and as such one
must not abstain from performing it merely because it was born in another
system of medicine. The essentiality of a procedure in a health issue may range
anything from it being safely avoidable, to it being an essential part of
management or even life saving. For clinically and medico legally judicious
management of a case, an Ayurvedic pediatrician must be able to perform all the necessary Ayurvedic and modern procedures with
an equal degree of expertise.
The literatures available on modern pediatric procedures usually lack the clarity on issues
which albeit not required by the practitioners of modern pediatrics,
are essential for grooming of an Ayurvedic
pediatrician. Coming to Ayurvedic procedures, these are less
often practiced in children and whatsoever performed, are written in standard
texts primarily keeping in mind the grownups; also their indications in
children are vaguely defined. Thus there exists a big lacuna in Ayurvedic pediatric
practice when it comes to having a single resource book focussed exclusively on
performing all necessary Ayurvedic and
modern procedures in children. This often leads to mismanagement. Keeping this
in mind and to fill that void, this book has been written from the perspective
of an Ayurvedic pediatrician.
This book being a blend of all important modern and Ayurvedic pediatric
procedures along with their clear cut therapeutic indications (needs user's
discretion), will primarily serve following purposes:
A single hand book for performing all commonly
needed modern or Ayurvedic pediatric procedures in an Ayurvedic set up .
Acquaint an Ayurvedic
pediatrician with some important legal aspects
of pediatric procedures.
To cater to the 'Pediatric
procedures' chapter of the new CCIM syllabus for MD (Kaumarbhritya/Bala
roga) , PG Diploma in Pediatrics
(Ay) and BAMS courses.
Conscious efforts have been made to maintain a point
wise approach in the book, bundled under various titles and subtitles, so that
the reader can read and coin prehend easily and thus
perform the procedures with confidence. Practical tips have also been notified
(as "N.B.") at many places. For a better insight into the procedure
(especially Ayurvedic), wherever
needed, a brief subjective background behind various elements of a procedure
have been provided (as in boxes). As such, the practitioners and researchers
from other systems of medicine may also find this book useful. As a picture
speaks better than thousand words, this book has been generously enriched with
self speaking illustrations. All this has made this book both concise and
thorough, making it an ideal companion book while performing common procedures
in Ayurvedic pediatric practice.
I am greatly indebted to my honourable teachers
Prof. Madam P.V. Tiwari, Dr. B.M. Singh sir and Dr.
Sangeeta Gehlot madam for their incessant
inspiration, guidance and affection, which went long in completing this work.
During the' preparation of this book I was constantly reminded 'of the
countless lessons I learnt from my talented mentor Dr. B.M. Singh, our seniors
and other hospital staff of BHU, Varanasi. I express my heartfelt gratitude
towards my family who have been readily sacrificing 'their' precious part of my
time, in order to make me complete this and the forthcoming endeavours. The
publisher, Mr Atul Kumar also deserves special thanks
for accepting my ideas and publishing this book in a format conventionally
different from the routinely published Ayurvedic books. My
sincere thanks to one and all behind this book.
pediatrics flourishes further, procedures
which have been knowingly withheld to reduce the volume of the book, may find
place in forthcoming issues. Constructive criticism and suggestions are always
welcome for improving the future editions.
Procedures may be needed in management of both
emergency and non emergency conditions. Emergency procedures if performed
timely and with due precautions are often life saving in children. In general,
it takes comparatively more time to perform a procedure in a child than an
adult. Each unsuccessful attempt is traumatic not only for child but also for
the parents, doctor and assistant. So the procedures should be mastered by
observation, performing under supervision and thereafter repetitive
performance. After all, 'Practice makes a man perfect'!
Procedure room and lightening
There should be a strategically located separate procedure
room, having good illumination facility. It should be spacious and comfortable
(preferably air conditioned) to the patient, doctor and assistant as well. It
should be well equipped with all necessary equipments (of various sizes),
drugs, oxygen, specimen collecting containers, etc. Their presence should be
verified daily and also before taking the child to procedure room.
In medical practice, anything beyond routine
requires an 'informed consent'. It
is essential to obtain a well informed consent in vernacular language prior to
the procedure, preferably in hand writing of the major/ parent/ legal guardian and
duly signed by them.
The consent should cover
procedure or treatment,
and potential hazards associated with the Tit or procedure (risk - benefit ratio of the procedure),
if the patient remains untreated,
Any alternative procedure available.
This is because legally, the onus of disclosure of
information lies with the doctor, whereas the right to decide the manner in
which his/her body will be treated lies with the patient. It is worth
mentioning here that the widely practiced broad spectrum 'blanket consent' has
no legal validity.
in medical emergencies:
Medical and not legal considerations are of greater
importance in life- threatening conditions. So in cases of medical emergency or
unconsciousness, all considerations regarding consent will be set aside and a
doctor should do whatever is necessary to save the life 'of .a patient I save him from
permanent disability I from unnecessary pain and sufferings. It implies that in
life threatening situations, doctors would not be required to consult with
parents of minor patients in contrast to in normal course of events where
consent is needed for decision making. However, the doctor should do only that
which is necessary for patient's well being; if during an emergency procedure,
some coincidental &
problem is encountered, it should be dealt later, after obtaining the consent.
can give a legally valid consent?
As per IPC
section 90, consent given by a child under 12 yrs age (minor) is invalid.
Any person of
sound mind who has attained the age of 18 yrs may give a legally valid consent.
age group of 12-18 yrs, if having sufficient understanding and intelligence to
enable him/her understand the nature and consequences of It or procedure, can themselves give consent and in such cases,
parental consent is not necessary.
If a patient
cannot give consent himself for reasons as being minor unconscious I not in sound state of mind, 'proxy
be obtained from legal guardian or a near relative.
A procedure should not be performed against the
desire of parents.
Presence of guardians during
A flexible attitude must be adopted as to whether
child's parents should be allowed during a procedure or not. Presence of
parents can make anxious children cooperate better. But those parents, who
refuse to observe the procedure, should not be forced as they may develop vasovagal syncope. The nature of procedure and operator's
own confidence to manage the situation even in presence of parents,
should also be duly considered.
Counseling the child
Affectionate and gentle handling is important to
reduce their anxiety and fear. Older children may be given a reasonable
explanation regarding the procedure, as this may decrease their anxiety and
increase their cooperation for the procedure. Gently talking to the child throughout
the procedure is often reassuring to them and helps in a smooth completion of
the procedure. Praise the child before, during and after the procedure.
A common problem in all pediatric
procedures is the proper restraint of infant. In this regard, availability of
an experienced assistant is an asset. For some procedures, restraining the
child by wrapping him/her in a sheet (mummy wrap)
(Source: Medical emergencies in children, 5th edn. Meharban Singh.
Sagar publications, N.Delhi; 2012).
N.B.: Children, who can sit by themselves, are more
comfortable in sitting rather than lying down position during a procedure.
Making them lie, may at times frighten even a calm looking child.
Bag and Mask ventilation
Umbilical vein catheterization
Exchange blood transfusion (EBT)
Blood transfusion (BT)
Bone marrow aspiration
Lumbar puncture (LP)
Nasogastric (NG) tube insertion
Suprapubic bladder aspiration
Urethral (bladder) catheterization
Reduction of radial head subluxation
Extrication of penile zipper entrapment
Massage technique for congenital nasolacrimal duct obstruction
Physiotherapy for congenital torticollis
Peak expiratory flow, rate (PEFR) measurement
Procedures for external oleation
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