Q: My daughter was a premature one - to be precise 14 days in advance, her weight at birth was 2.5kgs. She had a suspected birth asphyxia and jaundice on day 3. When she was 10 days old she had her first convulsions followed again on 22nd day and lastly on 42nd day (In all 3). Since then we are taking preventive medicine tegrital and we still give that @ 2.5ml twice a day. When she was 8 months old, we could see that normal growth was slow so we went to a neonatal paediatrician who suggested that she has developmental delays and we should contact a rehabilitation centre. At the centre, they analysed her for DQ (developmental quotient) which was 56%. They categorised her as MILD DEVELOPMENTAL DELAY and prescribed regular physiotherapy and occupational therapy. She received physiotherapy for 3 months and we learnt those exercises which were continued at home but with regular follow-ups from rehab centre. She started showing improvements like balancing her neck, muscles developed and gripping improved. In the meantime we performed BERA test to ascertain her hearing abilities and it was perfectly ok. We still do the follow up with the rehab centre. She has a very mild squint in one of her eye but the ophthalmologist has termed it as not so significant and would subside as she grows. She has lost 5 teeth. She used to bite her lower lip as there are no supporting teeth to push the lower lip out. She used to bite her tongue a lot but it has subsided now. At present she is 4 years & 2 months old, she is walking, understands everything, talks but only a word or two. Her memory is also good and she can recollect things which she did a few months back, at least in action if not verbally. The trouble is we need to repeat our words more than once to let her understand what we are talking about. Once she understands she readily does the things. Her observation is also very keen and remembers things I said earlier. Her weight is around 11 KG as she doesn't take food on her own and we need to feed her sometimes forcefully. She doesn't have a sense for pain, like if we inject her she will not cry. But she has a sense for touch like hot and cold and reacts immediately if she touches something of that nature. How can we help her further?

A:I must congratulate you on the careful observations and the detailed notes on your daughter. She does seem to be getting the best attention possible. Regarding her diet: If she has no teeth, then the food she gets will have to be mashed up in a blender. However, putting vegetables, dal and rice in the same mix, results in a product that is nutritious, but not very attractive. You must increase the attractiveness of the food, to induce your daughter to eat well. Instead of mixing up everything, grind/blend them separately. For example, cooked carrots can be made into a nice orange-coloured heap, greens into a rich green and so on. Use very mild spicing. Custard with soft fruit is a good idea. Any soup that you make must be thick, enriched with cheese or tofu (soy cheese). Tomato soup can look and taste good. Add dal water instead of plain water while the tomatoes cook; this will increase the protein value. Very softly cooked rice, scrambled eggs and mashed potato will be tasty for her. Halva with sooji or kheer with sevayya can also be made specially for her. Fresh fruit should be a regular part of the diet. If you know how to use it, Ragi malt is good, as it is rich in iron. Maybe you can get a bottled version. Complan can be one of the drinks in the day. Make eating time interesting for her by associating games, jokes and stories with meal times. Put on music if she responds to it and let it be on while she eats. If you force food into her, she is going to associate food with being compelled. When the adults are eating give her a small cup of ice cream (and there are many interesting varieties that you can make at home) so that she can join everyone. As you know already, a lot of your time and patience is required to help your child. You seem to be doing an excellent job.