Q: My daughter is 1 year and 3 months old. She has had all vaccines except Hepatitis B. We missed it somehow. The doctor conveyed that a combined AB vaccine can be given later. Her height is OK but she weighs only 8.4 kg. She was 8 kg at the age of 11 months as well. She is normal and energetic. But she has a very low appetite. She refuses to take any solid food most of the times. Is there a conjugate vaccine available for Hepatitis A and B? How much does it cost and when can it be given? Why is she not gaining weight properly, even after a lot of efforts from our end? Does she have some iron or any other mineral deficiency in her body? How can it be identified?

A:A combined Hepatitis A and B vaccine is available, and the immunization course comprises three doses at 0 (when given), 1 month and 6 months. The cost of one shot of vaccine is about Rs. 1500/-. The child may simply be following her own growth trajectory, which is a combination of her growth potential (genes) and environment (nurture). If the child is active and playful, it is unlikely to be due to environmental factors, and the child should be left alone. Attempts to force feed the child and/or add excessive energy dense feeds may make the child put on excessive fat, which is likely to have adverse consequences including the risk of developing diseases like diabetes, hypertension, etc. in adult life. There are biochemical tests to identify various mineral and micronutrient deficiencies, and the clinical presentation of each deficiency varies. Iron deficiency usually presents as anaemia.