Best Practices

  1. Vaccination




The objective of vaccination programme is to provide coverage against major illness causing organism. Many diseases occurring in pediatric age group are preventable. Vaccination programme help to overcome this burden. The aim is to provide good quality services at a lower cost. Vaccine like hepatitis A, pneumococcal vaccines, varicella typhoid are provided at much lower rates than outsides institutes. Vaccination is provided by trained doctors with assistance of experienced and well-trained staff nurses. With each vaccination, a set of instruction of do’s and don’ts is provided to parents. Potential side effects are explained and quick remedies are also taught. A good quality and easy to comprehend vaccination card makes it easier for parents to keep a regular follow up, thus ensuring maximum coverage.


  • Common issue faced by us during vaccination is the difficulty in maintaining proper cold chain.
  • Despite providing an easy to read vaccination card some parents casually lose follow up. This problem is addressed by keeping a telephonic record of each parent who visits the OPD.


A proper record is maintained of each delivery which helps to cover each and every new baby. Post 1st vaccination a telephonic record is maintained of each parent. Measures to reduce local symptoms/ side effects are explained to each parent. Daily in OPD hours vaccination is provided at lowest rates. This ensures parents to come and visit at their own convenient hours. A trained nurse is present through out to reconstitute vaccine with all aseptic precautions. Vaccination is provided by the trained pediatric residents posted in the outpatient department. At the time of vaccination each child bought by parents goes through general examination. This helps the parents to avoid any extra visits to the paediatrician. Every child brought for vaccination is assessed for weight gain/loss at subsequent visits, keeping in the mind the importance of a healthy child.


A separate wash basin in the vaccination room is required at present. Good ventilation and cross ventilation should be provided. Separate vial holders for different vaccination should be present. A separate rotational duty of each resident exclusive for vaccination duty should be present. A separate staff appointed exclusively for gaining contact details of relatives. Accompanying the patient and for proper record maintenance should be appointed. Proper disposal of syringes should be looked into at the point of generation. A needle burner should be present at the site of vaccination.




Benefits of Kangaroo Mother Care (KMC).


  1. KMC is a method of bonding between the newborn and mother
  2. It is an add on care to incubator facilities provided by their months to preterm/ low birth weight newborn.
  3. KMC facilitates thermal regulation of babies who are more prone to hypothermia
  4. It is early and prolonged care with continuous skin to skin contact between mother and her low birth weight infant until 40 weeks post gestational age
  5. Early discharge after delivery is the hallmark of KMC approach
  6. KMC ensures nutrition by supporting the mother to breastfeed her baby, frequently and exclusively
  7. KMC provides infection prevention.


  1. Challenging issue which require attention are infection control.
  2. Each newborn is susceptible to infection. Especially the low birth weight newborns. Special emphasis is given on hygiene practices that should be strictly adhered to by mother.
  3. Regular and timely cleaning of gowns used by mothers should be done.
  4. Some mothers find it difficult to sit comfortably on KMC chairs owing to weight gain/local sutures.
  5. Sometimes it is difficult to monitor the level of hygiene followed by mothers while feeding their newborn.
  6. Some mothers face an issue while holding their pre-term newborn leading to ineffective skin to skin contact
  7. Some mothers do not provide KMC for longer duration.


  1. Separate KMC section is available away from the area where babies are admitted and unstable.
  2. The room is well built and isolated to avoid unnecessary infections.
  3. Each mother is taught regarding the benefits of KMC
  4. Mothers are taught KMC techniques.
  5. Mothers are provided with techniques of feeding their newborns.
  6. Their practice facilitates bonding. Mothers are provided with autoclaved KMC gowns and separate KMC chairs.
  7. Each mother is monitored by a trained staff nurse, hygiene practice is taught to mothers.
  8. It reduces the chances of infection at the mother and baby share same place.
  9. A hot plate induction is available outside KMC section where mothers and caretakers can sterilize utensils before each use.


  1. KMC provision reduces the incidence of apnea episodes in preterm babies.
  2. Chances of infection are reduced.
  3. It facilitates early discharge.
  4. Hypothermia episodes are reduced
  5. Mothers gain confidence in handling babies.
  6. It is a free of cost and effective techniques.


Some problem faced during KMC

  1. KMC bags should be made available at our KMC section.
  2. Some mothers find it difficult to handle their newborn due to fear of neck flexion/ mishandling.
  3. KMC bags facilitates ensure proper holding of babies, close to mothers.
  4. Separate KMC sections should be available at our hospital
  5. Primary becomes an issue sometimes for mothers while providing KMC
  6. If mother is unable to provide KMC due to unavoidable reasons, fathers/others caregivers should be trained to provide KMC.


  1. Lactation clinic


Lactation practices


  1. To prepare the mother antenatally for lactation.
  2. To reduce any anxiety in the mind of the mother related to the lactation
  3. To reduce the chances of neonatal hypoglycemia.
  4. To promote neonatal mental and physical well-being.
  5. To provide immunity to the baby
  6. To help mothers and baby to get off a great start.
  7. Position to latch your baby
  8. Find solution if breast feeding is not comfortable at first
  9. Feel comfortable that you can breastfeed for as long as your baby wants
  10. To train the mother to exclusively breastfeed her baby for 6 months.


Attending a lactation class is a good idea. A mother will learn how important skin to skin contact is in initiating her milk supply and receive other breastfeeding advice too. Health care professionals such as doctors, midwives, nurses, have a standard training in lactation clinics.  Health professional recommended that breastfeeding should begin with first hour of a baby life. Mothers may pump milk so that it can be used later when breastfeeding is not possible. Breastfeeding have a lot of benefits to mother and child.

Breastfeeding reduces the risk of respiratory tract infection and diarrhea; other benefits include lower risk of asthma, food allergies. Breastfeeding may also improve cognitive development and reduce the risk of obesity in the adulthood.

Benefits to mothers include less blood loss following delivery, better uterus shrinkage and decrease postpartum depression. Lactation delays the return of menstruation and fertility known as lactational amenorrhea. Long term benefits for the mothers include decrease risk of breast cancer, cardiovascular diseases and rheumatoid arthritis. Mothers who take recreational drugs and medication should not breastfeed. Smoking, limited amount of alcohol and coffee are no reason to avoid breastfeeding.


It is recommended for mothers to initiate breastfeeding within the first hour after birth. In fact, it can begin from birth immediately. The baby is placed on the mother and feeding starts as soon as the baby shows interest. Majority of the babies do not immediately begin to suckle if placed between the breasts. However, there is increased evidence that suggest that early skin to skin contact between mother and baby stimulates breastfeeding behavior in the baby.

The baby naturally follows a process which leads to first breastfeed. Initially after birth, the baby cries with its first breaths. Shortly after, it relaxes and makes small movements of the arm, shoulder, and head, and if placed on the mother’s abdomen, the baby then crawls and begin to feed. After feeding it is normal for a baby to remain latched to the breast while resting.

A newborn baby typically demands feeds every one to three hours for first 2 to 3 weeks.


  1. Reduction in the infant mortality rate is noted
  2. Reduction in the maternal mortality rate is also seen
  3. Reduction in the chances of infection to the newborn
  4. Aiding in the general health, growth, and development in the infants
  5. At one year, breast feed babies tend to be leaner than formula feed babies which improves long run health
  6. Less obesity is noted at ages of 2 and 4 among infants who were breastfeed for at least four months.
  7. It reduces the risk of necrotizing enterocolitis.


  1. Mothers not willing for lactation.
  2. Lack of proper resources and knowledge to the patients.
  3. Babies who can’t latch.
  4. Breast disorder like sore nipples, breast engorgement, etc.
  5. Some mothers are worried about their supply over first few days.
  6. Proper knowledge about breastfeeding and lactation is to be provided to the mothers.
  7. Ample amount of resources are to be provided for the maximum coverage.
  8. Midwives, ASHA workers are to be trained for the rural level areas.
  9. Proper treatment is to be done for the breast related conditions.
  10. Recreational drugs and medication should be avoided.