– Dr. Ramsha Salimuddin is a consultant pediatrician at Tender Palm Hospital, Lucknow

Dr. Ramsha Salimuddin

My eight-year-old son is underweight. I have tried different ways to help him gain weight, but in vain. Please advise.

— Veena Chakravarty, Bengaluru

Healthy weight gain is not about “eating more,” but about eating smart, eating regularly, and eating right. Follow these guidelines:

• Monitor your son’s development milestones using WHO or IAP growth charts, focusing on weight-for-age, height-for-age, and BMI-for-age trends rather than daily weight checks. Record weight and height every three months, observing and recording steady upward trends, not rapid gain. If weight gain is poor despite good food intake, consult a pediatrician to rule out anemia, worm infestation, or chronic illness.
• Plan a balanced food plate. Meals should be nutrient-rich, practical, and culturally familiar — not dependent on expensive “health foods.” A healthy plate for this age group should include carbohydrates (roti, paratha (limited oil), rice, poha, oats); high-quality proteins (dal, paneer, curd, milk, eggs, soy, nuts); healthy fats (ghee, butter (small amounts), groundnut oil, mustard oil) and micronutrients (vegetables (especially green leafy), fruits, jaggery, dates).

• Underweight children often eat in small volumes, so meal frequency is critical. Ideally, children should eat three main meals and two-three planned snacks daily. Avoid long gaps between meals. Ensure breakfast is not skipped, as it sets the metabolic tone for the day.
• Make smart snack choices. Replace calorie-poor packaged snacks with energy-rich, homemade options such as peanut chikki, roasted chana, banana with peanut butter, paneer or cheese sandwich, boiled eggs, curd with fruit and homemade laddoos with nuts and jaggery. These provide calories, proteins and minerals, unlike chips and biscuits.
• Encourage appetite to develop naturally by ensuring he gets adequate sleep (9-10 hours), limiting screen time and encouraging daily outdoor play. Avoid force-feeding.
• Milk is important, but excess milk (more than 500-600 ml/day) can suppress appetite for solid foods. It should support meals, not replace them.
• Address emotional and academic stress. Poor weight gain is often linked to exam pressure, picky eating, or anxiety. A calm meal environment and positive reinforcement make a significant difference.
• Over-the-counter appetite tonics are not recommended. Supplements such as iron, vitamin D, or multivitamins should be given only after medical assessment and advice.

I am concerned about earwax buildup in my seven-year-old daughter. What should I do to prevent it and when is professional cleaning necessary?

— Minu Daman, Mumbai

Earwax (cerumen) is often misunderstood. It is not dirt, but a natural protective substance that traps dust, prevents infection, and keeps the ear canal healthy. In children, problems arise mainly due to overcleaning, improper habits, or delayed attention. Here are my recommendations:

• Avoid routine ear cleaning at home. The most important preventive step is not inserting anything into the ear. Cotton buds, hairpins, or earbuds push wax deeper and increase the risk of impaction, pain, or infection.
• Clean only the visible outer ear (pinna) using a soft cloth after bathing. The ear canal cleans itself naturally through jaw movements like chewing and talking.
• Frequent use of earphones prevents natural wax expulsion and causes buildup. Limit prolonged earphone use. Ensure earphones are clean and avoid sharing earplugs.
• Watch for early warning signs such as reduced hearing or frequent “What?” responses, ear fullness or discomfort, itching or occasional ear pain and decline in attention levels at school.
• Don’t use over-the-counter drops routinely. Wax-softening drops should not be used regularly or without advice, especially if there is pain, discharge, or a history of ear infections.

Professional ear examination and cleaning by a pediatrician or ENT specialist is required when the child has

• Hearing difficulty affecting school performance
• Ear pain, ringing, or dizziness
• Wax is completely blocking the ear canal
• Speech delay or learning issues
• History of recurrent ear infections or ear surgery 

I live in Mumbai, where the weather is humid. How can I prevent fungal skin infections such as ringworm in my children?

— Joby Thomas, Mumbai

Fungal skin infections such as ringworm (tinea) are very common in children, especially in humid climates. Here are some practical preventive measures:

• Keep skin clean and dry. Fungus thrives in moisture. Bathe the child daily and dry skin thoroughly, especially neck folds, groin, underarms, and behind knees. Use a separate towel for each child and wash towels regularly.
• Choose the right clothing. Dress children in loose, cotton clothes. Avoid tight jeans, leggings, or nylon innerwear. Change school uniforms and socks daily and ensure shoes are aired and dried completely before reuse.
• Smart school hygiene habits. Advise children not to share towels, handkerchiefs, caps, helmets, socks, shoes, water bottles, hairbrushes or combs. Encourage them to wash hands after outdoor play and after using the washroom. Change sweaty clothes as soon as they return home.
• Nails and skin care. Keep children’s nails short and clean. Discourage scratching of itchy areas, as it spreads infection to other sites. Cover small cuts or abrasions properly.
• Be careful with pets and play areas. Ensure pets are checked regularly by a veterinarian. After playing with animals, children should wash their hands. Restrict children from sitting directly on damp floors, grass, or shared gym mats.

Take care not to apply steroid-based combination creams for itching or rashes without medical advice, and avoid home remedies that irritate the skin. Consult a pediatrician if a circular, itchy rash appears and does not improve in 3-4 days; the rash spreads rapidly or becomes painful and multiple family members develop similar lesions. Don’t stop antifungal treatment earlier than prescribed — this leads to recurrence.

How can I safely introduce swimming/ water safety skills to my toddler in indoor pools to build confidence and prevent drowning risks?

— Hitesh Dalvi, Delhi

Introducing swimming and water safety skills early — ideally between ages two and four — enables children to develop confidence in and near water and significantly reduce drowning risks. Here are my suggestions:

• Start with water familiarity, not swimming. At this age, the goal is comfort and respect for water, not formal swimming strokes. Begin with parent-toddler water sessions and let her splash, sit at pool edge, and play with floating toys. Keep sessions short (15-20 minutes) to avoid fatigue and fear.
• Choose the right swimming pool and program. Opt for pools that maintain strict hygiene and water quality standards; employ trained lifeguards; offer toddler-specific programs with certified instructors and use heated water, as cold water causes youngest children distress.
• Constant, close supervision is non-negotiable. For toddlers, supervision means having an adult within arm’s reach at all times. Don’t overly rely on instructors or lifeguards and ensure no distractions such as mobile phones.
• Teach simple water safety skills. Even toddlers can learn basic survival-oriented skills such as entering and exiting the pool safely, holding the pool edge and “monkey walking”, floating on the back with support and blowing bubbles and getting faces wet. These skills help reduce panic if she accidentally enters water.
• Use safety aids wisely. NB coast-approved life jackets are safer than inflatable arm floats and that floatation devices should support learning, not replace supervision. Therefore, avoid overdependence on floaties — they can build false confidence.
• Health and hygiene considerations. Avoid swimming if the child has fever, diarrhea, skin infections, or open wounds. Ensure a pre-swim and post-swim shower. Thoroughly dry ears and skin after swimming to prevent infections.
• Reinforce water rules at home. Teach her simple rules such as never to enter a pool without an adult and to avoid running near water pools. However, note that swimming lessons don’t make a child drown-proof. Even confident toddlers need continuous adult supervision and physical barriers like pool fencing where applicable.