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Ultrasound Scan at 13 Weeks of Pregnancy
If you are 13 weeks pregnant, then it's time that you have a little celebration as you are in the safe zone now. Every stage of pregnancy is important (and can be risky), but women have a sigh of relief once they pass the first 12 weeks of pregnancy, as the chances of miscarriage lower considerably once a pregnant woman reaches the 13th week of her pregnancy.
From this week onwards, your baby will grow rapidly and your doctor might suggest an ultrasound scan to check his progress. An ultrasound scan in the 13th week can tell you a lot about your baby's health and is important. So read on to know why you should have an ultrasound scan at 13 weeks and how it is performed.
Why Should You Have an Ultrasound at 13 Weeks?
Performing an ultrasound scan at 13 weeks of pregnancy can help your doctor understand how your baby is developing. By this time, your baby's kidney should function and he should have a urinary tract system. It means that your little should start peeing in the utero. His fingerprints will also take shape by this time. A scan performed in this week can help detect how he is progressing. It will also tell you how his other organs are coming along apart from his head.
How to Prepare for Your 13th Week Pregnancy Scan
This is one of the most significant ultrasounds performed during the pregnancy phase. And to prepare for your 13th-week ultrasound scan, you should drink lots of water before the scan, as it is essential to keep your bladder full during the ultrasound. This will help the technician get a clearer image of the foetus in your belly.
How Long Does It Take to Perform an Ultrasound Scan?
A 13-week scan can take around 15 to 30 minutes and can go up to 45 minutes if the baby is lying in an awkward position. But the duration of the scan will also depend on the technician who conducts it and on your baby’s position in your belly.
How Is an Ultrasound Scan Performed?
To perform an ultrasound scan at the 13th week of pregnancy, the sonographer will ask you to lie down on the examination table and expose your belly. The sonographer will then apply some gel on your belly and press a transducer on your belly. The purpose of applying the gel is to make sure that a good connection is established between the skin and the transducer device. The device will be adjusted based on the image of the baby that is seen on the screen. The sonographer may apply some pressure on your belly to get a clear view of the baby. But don’t worry, as you will not experience pain during this process.
What Will You See on the Scan at the Thirteenth Week of Your Pregnancy?
An ultrasound scan performed in the 13th week of your pregnancy will reveal a lot of minute details about your baby. You will be able to hear your baby's heartbeat and notice that some of his body parts have developed. In the earlier scans, you must have noticed that your baby's head was slightly more prominent and bigger as compared to the rest of the body, but now your baby's other parts of the body will develop fast and you will notice the size of the head becoming proportionate to the body. The scan will also indicate any abnormalities (if any) in the baby and other details of the development. During the 13th week ultrasound, Down's syndrome can also be detected by measuring the nuchal thickness.
What If Some Abnormalities Are Discovered in the Scan?
If any problem is detected during the ultrasound, your doctor will give you more clarity about the health of your baby and your situation. Sometimes doctors even suggest a few more scans and some specific tests to ascertain the full extent of the abnormalities before coming to any conclusion.
An ultrasound will help you connect with your little one in your belly. All this while you could feel the life inside of you, but now you will get to see your baby develop and come to life. These will be the significant moments of your pregnancy journey. If there are abnormalities that are detected, don’t let it dishearten you too much at this point, instead, talk to your doctor and see what can be done about it.
Also Read: First Trimester Scans Read more
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Vitamin K for Newborns - Why It Is Important at Birth
Vitamin K is a fat-soluble vitamin that our bodies need to make blood clot. It is an essential micronutrient. It helps in producing prothrombin, the protein responsible for clotting of blood. Without this, even a small cut can keep on bleeding and result in serious blood loss. New-born babies are born with low levels of Vitamin K. Therefore; they need to be given the same at birth.
Why is Vitamin K Necessary for New-born Babies?
It is necessary for new-born babies as it helps in preventing a rare but serious disease called Haemorrhagic Disease of New-Born (HDN), also known as Vitamin K Deficiency Bleeding (VKDB). Babies do not naturally have the vitamin in them. Unfortunately, breastfeeding also does not have adequate amounts of the vitamin to protect the babies from VKDB. This disease occurs in the first week of life and can cause internal bleeding that can damage organs permanently and can even be fatal. Hence, supplements should be given to newborns to make sure they do not have a deficiency.
Vitamin K is made by a gut bacteria in adults. However, babies do not have gut bacteria to synthesize the same in the first week of their life. Premature babies and babies that need surgery are at high risk of developing Vitamin K Deficiency Bleeding.
Can All New-borns Have Vitamin K?
All new-borns require a supplement of the vitamin.
Premature babies, sick babies and new-borns that require surgery are at higher risk of having VKDB
Giving the same orally may not be suitable for some babies.
Injections have been found to be more effective for babies than oral doses.
During pregnancy, if you have taken medication for blood clots, epilepsy or tuberculosis, let your doctor know. This may prevent your baby from being able to absorb the vitamin orally and an injection maybe required instead.
Why Do Infants Have Low Level of Vitamin K?
Babies do not have enough Vitamin K because sufficient amounts do not get transferred through the placenta during pregnancy or via breast milk. Also, it is synthesized in our bodies by gut bacteria. However, babies do not have enough gut bacteria at birth to make the same. Here are some ways that the situation can be remedied:
1. Vitamin K injection for New-borns
This is the most dependable way to give babies vitamin K. The injection is given in the leg. A single injection at birth can protect the baby for several months.
2. Oral vitamin K for New-borns
Oral supplements not as effective as an injection as the babies do not absorb it well when they are given orally. This is because the vitamin does not last long in the body, and hence 3 doses are required – at birth, at 1 week and then at 6 weeks.
How is Vitamin K Given to Babies?
It is given to babies either orally as drops or by intramuscular injection in the baby’s leg. The oral doses are not as effective as the injected dose. A single injection at birth is enough for several months. If given orally, 3 doses are needed. There is a chance that the later dose may be missed or that the baby does not swallow the drops properly. The correct Vitamin K new-born dose, when administered orally, is 3 doses for breastfed babies and 2 doses for bottle-fed babies. Vitamin K drops for new-borns are available in all hospitals, and you can opt for it if given a choice. However, the injection is recommended as it is much more effective than the oral dose.
Are There Any Side Effects of Giving Vitamin K to Baby?
There are no side effects of giving vitamin K to babies. It helps in clotting of blood and prevents bleeding. There have been numerous studies on their effect in babies, and they show that it causes absolutely no side-effects in babies.
Where to Get Vitamin K?
The paediatrician in the hospital where your baby is born usually administers the Vitamin K to your baby. Your nurse or doctor will usually ask you if you want to give the same to your baby as an injection or as oral drops. It is better to opt for the injection as it is more effective than oral drops.
Which Babies are at The Higher Risks of Developing Vitamin K Deficiency Bleeding (VKDB)?
Some babies can develop deficiency-related bleeding more quickly than other babies:
Babies born before 37 weeks of pregnancy.
Babies who had breathing trouble at birth and suffered from a lack of enough oxygen at birth.
Babies born via ventouse or caesarean delivery or by forceps delivery, where bruising may have occurred.
Babies whose mothers took anti-clotting drugs, epilepsy medication or drugs for tuberculosis while they were pregnant.
Babies who have symptoms of prolonged jaundice and babies who have dark coloured urine and pale stools.
Possible Symptoms of Vitamin K Deficiency
The symptoms include:
Your baby bruises very easily
Nasal bleeds, bleeding from the umbilical cord or gut.
Increased bruising around the face and head of the baby.
Vomiting, pale skin and gums, and irritability.
If the baby is more than 3 weeks old and has jaundice that is worsening.
When to Consult a Doctor?
A paediatrician should be consulted immediately if you notice any of the signs and symptoms of vitamin K deficiency. If you find blood oozing from the umbilical cord stump or if bleeding does not stop for a while after a heel-prick test, or if the baby has a sudden nosebleed, call the doctor right away. If this is not treated immediately, it could cause internal bleeding, organ damage and even death.
Vitamin K is essential for clotting of blood as without it, the blood will not clot, leading to uncontrolled bleeding. Babies have poor levels of it, and hence they need to be given supplements for the same at birth. It is better to give this in the form of an injection as this will protect the baby from any deficiency-related bleeding for several months. By the age of 6 months, the baby will have enough gut bacteria to synthesize her own.
Also Read:
Causes of Vitamin D deficiency in Infant
Common Supplemental Vitamins for Babies Read more
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Tips and Tricks to Manage Your Baby's Fake Crying
Is your baby crying for no evident reason and leaving you wondering what the problem might be? Well, sometimes your little munchkin may not be actually crying but faking it. Yes, it is possible for your baby to fake cry! If you are wondering how to put an end to this habit, read on to know some useful tips and tricks on how to manage your baby's fake crying.
Do Babies Really Fake Cry?
Babies can actually practise fake crying. Well, there may be different reasons to do so. It has been observed that babies adopt fake crying to gain the parents’ attention.
Why Do Babies Fake Cry?
Here are some common reasons for fake crying in infants and babies:
1. Not Able To Express Themselves
Have you ever wondered what would it be like if you couldn't express yourself in front of others? Babies go through this ordeal on a day-to-day basis, so they sometimes opt for fake crying as one of the ways of putting across their feelings.
2. To Gain Attention
How can a baby tell his mommy that he’s hungry, wet, sleepy or tired? Well, he may simply start crying because that is how he can express that something is bothering him. Therefore, a baby fake crying is a very common phenomenon because it is one of the ways in which he gets his parents' attention.
3. The Baby Wants Something
If your baby wants something, he may cry. Be it a toy that he cannot reach for or some comfort from you - he may just opt for crying. If you are a parent who succumbs to your baby’s demands like this, then there is a likelihood that he may continue to exhibit this kind of behaviour.
4. Change in Routine
sometimes you may make certain changes in your baby’s schedule, and these may not be welcomed by him. Guess what he will opt for? Yes, fake crying. He may do so to express his displeasure or discomfort. The changes in feeding, sleeping, or anything else may make your baby cranky.
5. Emotional Outbursts
Feels a bit strange, but your toddler’s fake crying could be a way of him expressing himself emotionally. This may happen on the death of a pet, a family member, a divorce or anything else difficult. Kids opt for such kind of crying to deal with unpleasant situations.
How to Stop Fake Crying in Babies?
No parent can see or tolerate their baby crying, even if he is fake crying. Regardless of whether it's real or fake, every parent would want to know how to put an end to their baby's crying. Here are a few easy ways of handling your baby's fake crying:
1. Try and Distract Your Baby
One of the best ways of putting an end to a fake crying bout is by distracting your baby. You may take him out, sing a lullaby or simply rock your baby. Distracting your baby might help him forget the reason he may be crying.
2. Do Not Be Rigid; Give in Sometimes
Though it would be a bit difficult if you keep giving into your baby's crying and make it a habit, it's okay to give in sometimes. This is because your baby might sometimes just want some comfort of your love, and giving in can reassure him about your love.
3. Try and Ignore Him
If your baby has made it a habit to fuss and have his way, it is important that you put a stop to it. The best way to do so is to ignore when your baby starts crying for no reason. There is no doubt that it will be a bit difficult, but it is important to implement this or else this will turn into an annoying habit that will become difficult to break as your baby grows.
4. Get to the Root
What is making your baby exhibit this kind of behaviour? It is important to get to the root cause of it and remove it. If it is a toy that your baby cannot reach to and wants to hold it, give him that.
5. Say 'No'
It is important to explain to your baby that this kind of behaviour is unacceptable. Babies may not be able to understand your words, but they are very sharp in understanding tone and gestures. Show your displeasure, and eventually, your baby will understand that this kind of behaviour is not acceptable.
Hope these easy tips prove to be useful in helping you stop your baby’s fake crying!
Also Read: How to Calm Crying Baby Read more
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Cough in Children - Causes, Diagnosis and Remedies
With the arrival of monsoons and the cold weather approaching soon, the chances of illnesses increase and so do general conditions that dawn upon us due to the changing weather. A dry cough in kids becomes quite prominent around this time, which might not be immediately noticed until it seems to stay for a few days or so. Although it may not always seem so, a cough is definitely a sign of the body reacting to a discomfort. Therefore, it is necessary to understand what caused a cough and take corrective action if needed.
What is Cough?
A cough is nothing but the body’s natural tendency to try and push out a foreign object or clear any obstruction that might be present in the pathways of the throat. This is why coughing often throws up various substances such as an infected mucus or lung infection that seeps out and needs to be removed from the body. In some cases, coughing might indicate the inability to breathe properly.
An occasional cough is usually present in many children. But when this repeats quite often, along with breathing issues, or coughing up gooey substances or even blood, that is a sign of trouble.
Types of Coughs
Each type of a cough that occurs in a child has a different sound and a different reason for occurring.
1. A Cough That Sounds Like A Bark
These generally occur due to a swelling of the upper portion of the airway. Any enlargement of the larynx or trachea can cause a cough to sound like a bark. This is usually observed in children that are less than 3 years old. It is also accompanied by a harsh sound when the child inhales.
2. A Cough With A Whooping Sound
Whooping cough in a child is usually a result of a bacterial infection. Bordetella pertussis is a potent bacteria that infects the airways and causes repeated phases of a cough that continue without breaks. Each a cough ends with inhaling a deep breath, which tends to make a sound that resembles a “whoop”. A blocked nose and fever can also be observed in these children. This cough is quite contagious and a child less than a year old can have severe repercussions because of it, especially if not vaccinated.
3. A Cough With A Wheezing Sound
At times, you might notice a slightly whistling or wheezing sound every time your child breathes. This sound is a strong indication of swelling in the lungs and might indicate the presence of a viral infection, such as bronchitis or even the presence of asthma. If this has been happening recently, check if the child has swallowed something accidentally, if that sound is also accompanied by a tendency to cough.
4. Coughing Especially At Night
Many types of coughs get severe as night arrives. This usually happens due to the trickling of mucus down the sinuses into the throat, causing a cough sensation. In other cases, the presence of asthma is stronger at night since the throat is more sensitive at that time.
5. Coughing In The Day
A number of parameters can cause a child to cough primarily in the day. This could range from cold wind or the presence of other irritants in the air, such as cigarette smoke, aerosols, animal hair, and so on.
6. A Cough Accompanied By Fever
If your child is suffering from a cough and is accompanied with a runny nose and a little fever, it is a classic sign of contracting common cold. However, if the kid is weak and the breathing is rapid, with fever above 102 degrees or so, this could even indicate pneumonia.
7. A Cough Accompanied With Vomiting
The coughing reflex can get quite strong in a child that can be out of their control. This constant coughing without breaking for breath, can invariably hit their gag reflex, and result in them puking. In certain illnesses, if a lot of mucus is swallowed by the child, it can cause nausea and lead to vomiting it all out.
8. Coughs That Continue For A Long Time
At times, certain infections can keep a cough to be present for more than a week. This is usually the case with viral infections, especially if followed by a common cold. The presence of any other allergens or an asthmatic condition can make a cough omnipresent. Get a doctor’s advice if a cough tends to stay for around a month or so.
What are the Causes of Cough in Children?
Just as there are various types of a cough, there are multiple reasons why a cough might occur in the first place.
1. Infection In The Chest Due To Cold
This is usually due to bacteria, which results in bronchiolitis. Usually spread from one child to another, it results in a wet cough that lasts for a few days. Such coughs are observed quite frequently in children, nearly once a month or once in two months.
2. Asthma
Usually seen in the night or early morning or after your kid has returned from playing, this cough is a strong sign of your child having asthma. A wheezing or allergic reaction might also accompany it, indicative of a triggering allergen, too.
3. Bronchiectasis
Letting a cough stay for longer than a month or so can be quite debilitating. The presence of wet cough in a child that leaves him coughing constantly could result in bronchiectasis, which ends up damaging the lungs due to repeated scarring of it while coughing.
4. Exposure To Smoke
Surprisingly, second-hand smoke is known to be a leading reason for children to start coughing. If you’re a smoker, it’s best to restrict your habits to outside your home and in your children’s absence. Make sure any visitors refrain from smoking in his vicinity, too.
5. Whooping Cough
It generally seems more like the advent of a common cold or influenza, but over time, the cough continues to get stronger and might even lead to phases of coughing spasms. These can continue for many weeks at a time.
6. Croup
A typical viral illness that leads to narrowing of the upper region of the airway, it often causes a cough to sound like a bark, further accompanied by raspy breathing. The inflamed pathways and larynx cause more mucus to be formed, narrowing the airway further.
How is a Cough Diagnosed during Childhood?
To evaluate the proper reason behind coughing, a proper physical examination and medical tests are considered essential for the diagnosis. Sending samples to the lab, checking X-ray slides for chest anomalies, are all checked along with the parameters of:
The presence of an unconscious motor condition that causes the child to cough without knowing it
The surroundings areas and the presence of any kind of pollutants or allergens.
Fever getting worse over the days, indicative of pneumonia or other diseases.
Previous events such as GERD due to feeding, leading to a cough.
The activities that are known to result in coughing, such as running around or playing a sport.
The presence of a foreign body inside the child, which could even be an aerosol.
The sound of a cough, checking for any barky or wheezy features.
The time for which a coughing spasm stays and the intensity of it.
Medical Treatment for Cough in Children
Choosing what to give kids for a cough depends a lot on the reason why a cough is occurring.
For any instances of infections that occur due to the presence of common cold, medications rarely cause any substantial effect. On the other hand, they can be quite harmful. Taking home remedies for this is the best way to recover from it.
If there is a swelling in the throat, especially the larynx, then a humidifier-based medicine can help relieve the inflammation. The croup can be countered by using a medicine called dexamethasone, which is known to be quite beneficial.
For throat-based infections that are caused by bacteria, namely the infection of the sinus tracts and the presence of pneumonia, your doctor will usually prescribe a course of antibiotics that can help combat the infections as soon as possible.
The wheezing sound is the sign of a discomfort in the airway. So this is usually done by giving medication that can be inhaled. However, if the wheezing is due to inhaling a foreign object, your doctor might advise undertaking a bronchoscopy to take it out.
A cough caused due to gastrointestinal reflux or GERD requires administering thick formula with oral medications that help in treating the acid reflux present right from the oesophagus. In rare conditions that result in a child from suffering cystic fibrosis, your doctor might advise a multi-layered approach that reduces the impact of the disease gradually.
Home Remedies to Deal with your Child's Cough
A few cough remedies for kids at night and for any other coughing conditions can be quickly undertaken by using a bunch of techniques right at home, using elements that are readily available.
Make sure your child has enough intake of fluids. These are instrumental in thinning the mucus that stays deposited and provides some relief. Hot fluids are extremely beneficial in this regard and bring great relief in the chest and lungs.
Let your child inhale air that is humidified. The presence of water vapour in the air can reduce the chances of coughing frequently.
Make use of humidifiers in your child’s room if needed. While taking a bath, let hot water stay in a closed bathroom for some time before your child enters. It will fill it with water vapour increasing the humidity.
A dry or a croup cough can be deftly handled by letting your child inhale some cool air. The coughing usually occurs due to a swollen respiratory pathway. The cool air will help alleviate some of the swellings.
Let your child breathe fresh air from his window in such cases. Taking a small drive with the windows open can also help. Make sure your child avoids any exercise or strenuous activity until he recovers.
Opt for medication only if required and advised by the doctor. These are mostly available in the form of cough syrups that act on loosening the mucus. Other syrups act to mitigate the reflex of coughing, for dry coughs. But these should not be used for wet coughs at all.
When to Call the Doctor?
Contact your doctor immediately if:
Your baby is barely 3 months old or is premature
Your child has immense difficulty in breathing
Your kid swallows a small object and coughs a lot even while eating
Your little one turns blue while coughing repetitively and fails to breathe properly
The coughing spasm of your child results in him vomiting
A cough stays for more than two weeks and gets severe
The sound of a cough can easily get irritating for parents and cause a lot of discomfort to a child who is used to playing around without any obstacles. Undertaking a few home remedies for dry cough in kids can bring some quick relief and aid in the speedy recovery of the child. Do not hesitate to contact your doctor in case of any complications or in deciding which medicine to opt for.
Also Read:
Homemade Cough Syrups for Kids
Home Remedies for Cough in Kids
Foods to Eat and Avoid during Cough in Children Read more
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5 Must Dos to Continue Being Super Fit
Fitness challenges can be demanding. But they make you feel awesome once you're through! However, it's not enough to have one fitness phase in your life to remain fit. Fitness must be cemented in your lifestyle like a routine. Motivate yourself with these healthy habits of people who always stay fit. Love your training sessions, eat wholesome, and get ample sleep to stay fit!
Fitness isn't just a single chapter in one’s life; it has to be a way of life. For instance, being fit doesn't mean giving up on all your favourite food; it just means knowing when to eat, what to eat and how much to eat. Make fitness a 'forever' part of your life too - you can do it!
What Do Fit People Do That You Must Too
1. Love Your Body
It's natural to feel insecure of your body, thanks to a sea of fashion magazine covers featuring hot women. But remember one thing, we're all different and therefore we all have different body types. You can be perfectly fit on the inside and yet not have the ideal figure on the outside. This doesn't mean you're any less than someone who does have the ideal figure. In fact, you may be fitter than them! Love your body. Period.
2. Exercise, Exercise, Exercise
If you want to pick up one healthy habit of people who always stay fit, pick this one up. Find a way to love working out. Look forward to it. Let it become therapeutic for you. Allow your training to become one of the best parts of your day. Once you've done so, fitness will never leave your life.
3. Get Enough Sleep
A good night's sleep is something that cannot be recommended enough by doctors and trainers alike. It's essential for your well-being, and for your physical and mental fitness too. From living longer and enjoying the benefits of better memory to looking more attractive, there are many reasons to allow yourself at least 8 hours of peaceful sleep. Yes, it's a total win-win situation and one of the most important healthy habits of those fitter than you.
4. Have a 'Cheat Day'
Cheat days are the days you live for, the days you can eat anything you want to. Practicing physical fitness takes immense discipline and will-power. But then, all this can often be frustrating. This is when a 'cheat day' comes in handy. Pick one day of the week when you get to splurge on any kind of food - from warm, freshly baked brownies to chocolate tarts. Whatever you want. These cheat days will pamper your sweet tooth and keep you from going overboard with an over-curated diet.
5. Have a Wholesome Breakfast
Staying skinny doesn't mean skipping your meals, especially breakfast. What do fit people do? They find a version of breakfast that's healthy yet suitable for their food needs. A healthy and wholesome breakfast means adequate energy to go through your day and regular workout too.
Fitness can take some time to incorporate itself into your lifestyle permanently. But once you use these techniques, you'll fall into the habits of those who always stay fit. Fitness will then not be a challenge but a reality! Read more
Dr Ghouse has added a new answer
Mom of a Newborn child
11 hours ago
Q. y does my baby spit up so much,is it fault of my breast milk
does eating tamird make baby to spit up
Dr Ghouse
Paediatrician
11 hours ago
A. nothing to do with mothers diet ok. small babies will be having lot of gas because of various reasons it is advisable to do burping of the baby immediately after feeding please give colimex DF drops to the baby they are safe
Dr. Minal Acharya has added a new answer
Guardian of 0 children
11 hours ago
Q. difference between lactogen 2&3
Dr. Minal Acharya
Nutritionist
10 hours ago
A. dear Mum the difference between lactogen 2 and 3 is related to the age
lactogen 2 is for the age group of after 6 months upto 12 months
lactogen 3 is formulated for the age group of after 12 months upto 18 months
Dr Ghouse has added a new answer
Expecting Mom due this month
9 hours ago
Q. Explain me procedure of epidural …how it works
Dr Ghouse
Paediatrician
8 hours ago
A. most of the times the anaesthesia will be inside dura but in epidural it is above the dura matter oj. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Rashmi has added a new answer
Trying To Conceive
8 hours ago
Q. In august 2023 I diagnosed OHSS with ectopic pregnancy in September we abort that pregnancy after that my period cycle was not proper very irregular or scanty periods now can i plan next pregnancy naturally? How can i plan how to get rid of irregular periods
Read moreRashmi
Mom of a 9 yr 7 m old girl
8 hours ago
A. You have to take proper medications to balance your hormones and that is what is going to be helpful in a regular period cycle once your periods are regular you’ll be sure about the time when you’re on dating and that would be the right time for you to conceive so that is how you need to work upon it
Nishath kousar has added a new answer
Expecting Mom due in 3 months
3 hours ago
Q. 6 month konse week se start hota hai
Nishath kousar
Expecting Mom due in 4 months
3 hours ago
A. 24th week
Dr Vandan H Kumar has added a new answer
Guardian of 0 children
2 hours ago
Q. #asktheexperts how to deal with labour pain
Dr Vandan H Kumar
Paediatrician
1 min ago
A. this will require examination and check up as well as history evaluation with the gynecologist.x
please meet the doctor at your convenience for proper treatment as well as investigations if required. c
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