For Parents

Talking with parents: 

Is the baby now 3 months old now? Then this letter is for you!

The  newborn has now grown into a ‘smiley’ 3month old infant. He is now learning to turn over, hold his head up, look around, search his mother’s face, cry when hungry or uncomfortable, and then smile meaningfully. He looks at dangling colourful toys, tries to reach out and finally grasps it at around 4 months. Now he can laugh aloud with pleasure! Infants at this age also begin to explore their own bodies and a sense of self emerges. How does that happen? Let’s try to explain with an example. The little infant wiggles his hands in-front of his face and also touches a dangling toy. Each time he can see his fingers moving and realizes they are fully under his control, he realizes that they are his own. Those hands will touch the toy whenever he wants it to. On the other-hand, when he cries, most often he sees the known smiling face (mom’s face), but not ALWAYS. So that is not his self. In this way slowly the ‘self’ versus ‘non-self’ concept evolves in the little one’s brain.

Four-month-old infants seem to be “hatching” socially, as he starts taking more interest in the outer world. During feeding, infants no longer focus exclusively on the mother but become distracted.

In another few months he can sit up and crawl. He notices small objects, tries to pick them with a ‘pincer’ grasp with 2 fingers and put it in his mouth. By now, he is making a lot of sounds and trying to communicate with those around. He loves to play with whatever is around by holding, dropping, poking and mouthing whatever he can lay his hands on.

 His attachment for his parents becomes intense and the preference is also very clear by 4- 5 months. The primary emotions of anger, joy, interest, fear, disgust, and surprise appear in appropriate contexts as distinct facial expressions by 4-6 months.

As he progresses along the development ladder, he is always banking on new stimulation and responses. Each new endeavor is backed by a cause and effect analysis in the little brain. So, an enriched environment ensures growth while stressful experiences can impede proper blooming. As a parent we need to pick up the little one’s cues and respond appropriately and consistently. Inconsistence in the parent’s behavior will confuse the child.

Babies develop attachment right from birth to the primary care-giver, most often the mother. Her touch, her smell, her voice and her face evokes a special response in the newborn baby and he responds by looking into her eyes as she feeds him, or by calming down when held and caressed by her. This attachment increases as the baby grows and the love and care is reciprocated by the parents. This reciprocation generates stability in the baby. Parents who are emotionally available, sensitive, perceptive, and effective at meeting the needs of their infant throughout the early months of life are likely to have securely attached infants. Parents who are affectionate and responsive to the child’s physical and emotional needs, who provide adequate stimulation, carry a positive attitude, and give adequate emotional support see their babies grow into stable and sociable individuals. Children’s secure attachment to caregivers also is associated at a later age with more effective coping with stress and better performance at school.

During these early months, just as the baby is developing an attachment, the parents are also getting to understand their baby and his needs. It is a two way bonding, each strengthening the other. By 3 months of age, the child and parents achieve a synchronized reciprocation through vocal and affective exchanges. A happy, smiling interactive parent evokes smiling, cooing, and playfulness in the infant. This is the seed laid down for effective social reciprocation in later life. Good attachment with parents provides a secure base, which allows infants to explore their world with confidence.

This little infant has begun to bloom and is just learning to explore her immediate environment. Her tiny grip on your finger, her winning smile, and her squeals will win your heart. What does this little angel want from you? Your active presence and your milk. So, go ahead with breast feeding on the baby’s demand and play with her, enjoy her company. She now has a definite bonding with you and enjoys every smile, every caress every glance you give her. The more active stimulation she gets in the form of handling, caressing, feeding, smiling, laughing and singing, the more responsive she will be. And it is so much fun to see her do something new almost every other day!

The baby, by now can express his basic emotions, as we have discussed earlier. He also seeks reciprocation of his expressions.  The infant makes face-to-face behavioral expressions, which reveal his ability to share emotional states, the first step in the development of communication. If the parent does not respond, he tries to draw her attention and engage her and cries angrily if he fails to evoke the required attention. If this lack of response perpetuates, infants gradually make lesser efforts to re-engage. Rather than anger, they show sadness and a loss of energy when the parents continue to be unavailable. This is often seen in infants of depressed parents or abandoned infants.

Now a busy mother might repent that she is unable to be with her baby as much as she wants to. No fear dear, babies will accept separation provided it is predictable and Baby realizes that Mom will be back. It is consistent availability that matters, not necessarily constant availability. Little babies are unable to handle unpredictable circumstances and get frustrated. It is the quality time that she demands. So please remember the golden rule to be Consistent, Responsive, Predictable and Comforting (CRPC). Your lively, animated presence will spark the expressions in the little one and help her develop newer skills.

For most parents, this is a very happy and rewarding period of parenting. Don’t you agree?

Enjoy nurturing God’s special gift for you….and if, in the process, you have any questions for me, mail me at udbhaas@gmail.com

I will be back for the baby turning 7 months.

Bye for now,

Dr N Chatterjee

Paediatrician, Udbhaas

An Open Letter for all Parents

Dear Parents,

It is such a pleasure to see you all so happy with your children. As I close my eyes I see children of all ages, from newborns to teenagers, clinging to their parents, sometimes happy & merry, sometimes sad and crying, some healthy, some sick, some content and pleasant, some irritable and cranky. But one thing is common in all the parents– their eagerness to help their children. Every parent has numerous questions to ask pertaining to better child care. As a paediatrician I have been responding to these questions for long many years. But now when I look back I feel, much has remained unspoken and unexplained. So in this open letter I will try to address the parental queries that I can recollect.

Newborn -2 months

Let’s start with the young mother with her newborn baby, who is ready to give all for her baby but just doesn’t know what is best. Dear Mom, don’t waste time, start breast feeding as soon as possible and feed her as frequently as she wants, holding her close. The best gift you can give her is your milk and your lap. This will provide not only nutrition and warmth, but also sense of security and gratification.

As the baby grows in your lap, look into her eyes, smile at her and talk with her. Very soon she will start to recognise you and reciprocate with her own cues. This is the beginning of social interaction. Whenever the little baby cries to express any need, respond immediately. This pacifies the baby and gives her a sense of control over her environment. She learns the meaning and impact of her own cry. This is her first exposure to the cause and effect phenomenon.

We must remember that the newborn baby can see, hear and feel too, just like us adults; they are not inert! They can also express their feelings and needs with their cry, their gestures and body movement. It is for us to honour their senses and pay attention to their cues…and the mother is the best at it. Strong or flickering lights, loud noise, harsh touch, hot or cold temperature…all these irritate a baby, whereas he/she is soothed by soft music, soft light and soft, warm touch. This is why the little one is so peaceful and comfortable when mama holds him in her arms, humming a lullaby.

Even a newborn can see and they preferentially focus on human faces. So you will notice that in a few days the baby is looking at your face as you feed him. Look back with a wide, warm smile. Here, we must remember, during the first six weeks of life the baby is much like a demanding, grumpy old man, either feeding, sleeping or showing discontent. He will need frequent feeds and a lot of sleep but doesn’t seem to pay heed to your smiles. Don’t lose heart, your efforts aren’t lost. He feels the comfort of your lap and warmth of your smile and is developing an attachment, though still unable to express happiness.

  • Come 6 weeks and he will start showing responses. As you look into his eyes, he will stare back and gradually a smile will appear anytime between now and 2 months. This ‘social smile’ implies that he is beginning to understand human behaviour and can win your attention with his smile. This is the beginning of his communication skills. Your consistent and animated response will boost his confidence and self control. He will learn that his feelings are important and he can affect his environment.

A lot of things you see the baby do during these early days may seem unnatural and problematic. He may want to feed almost every few minutes, he may pass watery stool with yellowish granules upto 8-10 times a day, or, not pass stool at all for a week, there may be peeling of skin all over, big blue patches on his back, a baby girl may have bloody discharge from her vagina, there may be a blister on the upper lip or maybe a tooth or two…these are all normal variants. Do not panic, but consult your doctor to make sure.

Enjoy nurturing God’s special gift for you….and if, in the process, you have any questions for me, mail me at udbhaas@gmail.com

I will be back for the baby turning 3 months.

Bye for now,

Dr N Chatterjee

Paediatrician, Udbhaas


Autism:  Facts parents want to know

What is Autism?
Autism is developmental disorder that generally becomes evident by the third year of life. It causes impairment or disturbance in three main areas:

  • Poor Social skills
  •  Poor Communication (verbal & non-verbal)
  • Repetitive and restricted behaviors.
  • Abnormal responses to sensations.

All these difficulties manifest in altered behaviour i.e. abnormal ways of relating to people, objects and the environment.   Autism is known as a ‘spectrum disorder,’ because the severity of symptoms ranges from a mild learning and social disability to a severe impairment, with multiple problems and highly unusual behavior.                                                                                 The disorder may occur alone, or with accompanying problems such as mental retardation or seizures.

Autism is not a rare disorder, being the third most common developmental disorder. Typically, about 2 out of 1000 children  may have autistic symptoms. 80% of those affected by autism are boys.

Autism is found throughout the world, in families of all economic, social, and racial backgrounds.

What is a child with autism like?

A child with high functioning autism may have a normal or high I.Q., be able to attend a regular school and hold a job later in life. However, this person may have difficulty expressing himself and may not know how to mix with other people. Moderately and more seriously affected children with autism will vary widely. Some autistic children do not ever develop speech, while others may develop speech but still have difficulty using language to communicate. Often, there is an unusual speech pattern, such as echoing whatever is said to them, repeating a word over and over, reversing “you” and “I” when asking for something, and speaking only to express needs, rather than emotions.

A child with autism looks just like any other child, but has distinctive behaviour patterns. A child who is autistic may enjoy rocking or spinning either himself or other objects, and may be happy to repeat the same activity for a long period of time. At other times, the child may move very quickly from one activity to another, and may appear to be hyperactive. Many autistic children have sensitivity to certain sounds or touch, and at other times, may appear not to hear anything at all. Autistic children may have very limited pretend play; they may not play appropriately with toys or may prefer to play with objects which are not toys. Autistic children may be able to do some things, like sing songs or recite rhymes very well, but may not be able to do things requiring social skills very well.

How is autism diagnosed?
There are no medical or genetic tests to detect autism. A diagnosis of autism requires a sensitive and experienced doctor to observe the child very carefully, ask the parents about the development of the child, and then objectively follow internationally recognized criteria for diagnosis. Onset may occur at birth, or a child may have a period of normal development followed by a deterioration of verbal and social skills around 1 1/2-2 1/2 years. Where onset is at birth, the disorder can be detected as early as one year. Autism may occur alongside conditions such as mental retardation and hyperactivity, but the autistic traits in the person are typically what require attention.

What is the cause of autism?
We still do not know what exactly causes Autism. However, current research indicates that structural or functional damage to the central nervous system can lead to Autism. We know that certain viruses and known genetic conditions are associated with Autism. In addition, there are families that have more than one child with autism. At present, it is believed that about 10% of all cases can be accounted for genetically. It is difficult to tell parents why their child has autism, but it is not caused by an unhappy home environment, both parents working, mental stress during the pregnancy, poor handling by the mother, an emotional trauma, or other psychological factors. You cannot cause a child to become autistic.

Can it be prevented? Can it be cured?
At present, there is no medical cure for autism. The only consistently effective treatment for autism is a supervised structured training program, started early; therefore, a combination of a good school and parent training is very important. Autistic children can make significant progress if the intervention is early, appropriate and consistent. Early intervention, before the child is three, is especially crucial to the child’s progress. This is why an early and accurate diagnosis is so important

How is it different from Mental Retardation?
In mental retardation there is equal lag in all segments of mental development, e.g., motor, communication, social, self-help, cognition etc. In Autism, there is an uneven skill development– in some areas the child may show age-appropriate skills, in some the skills may be below average and again, in some areas exceptional skills may also be seen.

Can the child ever live an independent life?
Children with Autism have potential for building up their skills and they can be helped if they receive early, well-focused intervention. Depending on the child’s individual skill profile and the appropriateness and intensity of intervention he or she receives, children with Autism can lead relatively independent lives.

What are the chances of his going to a regular school?
Autistic children can be integrated into regular schools, with the support of special education facilities. Most children with Autism have different learning styles from regular children and therefore teaching styles also need to be different. The chances of main-streaming depend on several factors, like, the child’s skill profile, early diagnosis and effective early intervention.

Will my child ever speak? When?
A large member of autistic children (about 30-50%) do not use speech. It is very difficult to say when and whether the child will ever speak. It is confirmed that there is no difficulty in their physical abilities to speak, but it is their lack of initiative to communicate that stops them from speaking. Some children who might have spoken as infants and then lost their speech may or may not get their speech back. Currently, it is unknown why some children develop speech and others do not. Experience with children with autism has shown that if the environment is accepting, and people are aware of the kind of speech they themselves need to use with the child, it can produce positive results.

Can Speech Therapy help?
Speech Therapy can help some children. It is absolutely essential for the speech therapist to understand Autism and the individual child. However, every child with autism can benefit from interventions that help build communication skills, verbal and non-verbal.

Why is he hyperactive?
 Most children with Autism are restless because of an impairment of their imaginative and social skills. They cannot play with  toys or other children meaningfully and find it very difficult to occupy themselves and become restless. Hyperactivity can be reduced as the children are taught new skills to keep themselves occupied.

Why does he keep playing with his fingers/ rocking himself back and forth/ spinning around etc?
Children with Autism respond to sensations differently. These unusual mannerisms like flapping and rocking etc. are natural responses or methods of coping with their sensory difficulties. These behaviours may help them to relax.

Is there any hostel for such children?
 In India there are few hostels for people with mental disabilities and ones exclusively for autistic individuals do not exist here.  In the early years of development, it is important for an autistic child to live and grow in a home environment.              As the child grows up, he can be trained to live in a group home but it is very important for the autistic people living in such homes also to integrate with society in general and not just be abandoned in a home or hostel.

Are people with Autism also mentally retarded?
It is very difficult for people with autism to take an IQ test because they may have certain skills but are not able to use them or exhibit them in a test. About 50% of people with autism are also mentally retarded. Autism can occur in association with other difficulties like Cerebral Palsy, Dyslexia, Downs Syndrome, Visual Impairment, and Seizure Disorder.



Asperger syndrome (AS) is a neurobiological disorder and comes under the group of conditions referred to as Autism Spectrum Disorder. The disorder was first described by Hans Asperger, a Viennese pediatrician in 1940.

Features of AS

This condition is common in boys. These boys typically have normal intelligence and language development, but, they have impaired social skills, are unable to communicate effectively with others, and have poor coordination. They may also have obsessions, odd speech patterns, and other peculiar mannerisms. Children with AS often have few facial expressions and have difficulty reading the body language of others; they might display an unusual sensitivity to sensory stimuli (for example, they may be bothered by a light that no one else notices; they may cover their ears to block out sounds in the environment; or they might prefer to wear clothing made only of a certain material).

Other characteristics of AS include motor delays, clumsiness, limited interests, and peculiar preoccupations. Adults with AS have trouble demonstrating empathy for others, and social interactions continue to be difficult.

Overall, people with AS are capable of functioning in everyday life, but tend to be somewhat socially immature and may be seen by others as odd or eccentric.

It’s important to note that, unlike kids with autism, those with AS might show no delays in language development; they usually have good grammatical skills and an advanced vocabulary at an early age. However, they typically do exhibit a language disorder — they might be very literal and have trouble using language in a social context.

Often there are no obvious delays in cognitive development or in age-appropriate self-help skills such as feeding and dressing themselves. Although kids with AS can have problems with attention span and organization, and have skills that seem well developed in some areas and lacking in others, they usually have average and sometimes above-average intelligence. Many have excellent rote memory and become intensely interested in one or two subjects.

To summarise, the common symptoms & signs of AS are:

Social problems:

  • Difficulty in making friends
  • Socially inappropriate behavior;
  • Difficulty judging personal space
  • Rigid social behavior.

Abnormal communication patterns:

  • Awkward or inappropriate body language;
  • Unusual style of speaking;
  • Difficulty with “give and take” in conversation; or
  • Lack of sensitivity about interrupting others during conversations.
  • “Scripted,” “robotic,” or repetitive speech


  • Inflexible adherences to routines;
  • Apprehensiveness about change; or an
  • Intense interest in a particular subject or activity.
  •  obsession with complex topics such as patterns or music
  • Odd behaviors or mannerisms

Sensory sensitivity:

  • Sensitivity to sound, touch, taste, light, and smell.

               Motor skill delays:

  • clumsiness or poor coordination,
  • history of delayed development of motor skills;
  • deficits in visual-motor and visual-perceptual skills; including problems with manual dexterity, handwriting, balance, and imitation of movements
  • problems with reading, math, or writing skills

Aspergers Syndrome is commonly diagnosed after age 3, with most diagnosed between the ages of 5 and 9.

What Causes Asperger Syndrome?

The cause is not definitely known. Heredity may be a factor; environmental factors that affect brain development might play a role.

AS is not caused by emotional deprivation or the way a person has been brought up. It is not a  result of bad parenting .


Currently, there is no cure for the disorder — kids with AS become adults with AS. But many lead full and happy lives, and the likelihood of achieving this is enhanced with appropriate education, support, and resources.

The following may benefit the child:

  • parent education and training
  • specialized educational interventions for the child
  • social skills training
  • language therapy
  • sensory integration training for younger kids, usually performed by an occupational therapist, in which they are desensitized to stimuli to which they’re overly sensitive
  • psychotherapy or behavioral/cognitive therapy for older children
  • medications

All the child’s caregivers should be involved in the treatment. The health professionals who are caring for your child should know what the parents & other care givers are doing at home


1 Response to "For Parents"

My daughter is autism child of 7 years old. Please inform me the prosedure of teaching and materials about this.

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  • Udbhaas: Thanks for the interest you have shown in our organisation. UDBHAAS Child Development Clinic & Specal school is in north Kolkata. Our address is 2
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