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Read Dr. Parmar’s article on Travel:

Prescription for Healthy Travel Abroad
Shefali V. Parmar, MD, FAAP

India is a popular destination for many of my patient families in the coming months. Annual festivals, weddings, and reconnecting with family are few of the many draws of India, making the long journey worth your while. However, traveling to the Indian subcontinent comes with health risks too. With careful preparation and a quick visit to your doctor, you can better ensure a safe journey and healthy return home.

Vaccination is critical in preventing significant illness. Your doctor will first review and counsel regarding your vaccination status. In addition to routine immunizations, families should specifically ensure protection from Typhoid. Typhoid fever is a serious illness caused by eating food and water contaminated with the bacteria Salmonella Typhi. Typhoid fever often causes significant weakness, fever, abdominal pain and headache. Washing hands, safe eating and drinking practices, and vaccination are key to staying healthy. Two different types of typhoid vaccines are available and your doctor will determine which one is best suited for you and/or your child. And, depending on the timing of your visit, your doctor may prescribe a flu vaccine. Other important immunizations to consider when traveling to India may include Tdap, Hepatitis A, Hepatitis B, Polio, Measles Mumps Rubella, and Varicella. In special circumstances, vaccines for preventing Japanese encephalitis, cholera, and rabies may be additionally recommended. Taking the time to consult with your physician regarding your vaccinations prior to travel is one of the easiest and most cost effective ways to prevent a major health setback.

Second, preventing mosquito borne illness should be a priority too. Malaria, Dengue, Chikungunya, Japanese encephalitis, and Zika are all serious health conditions transmitted by the bite of mosquitos. Fever, headache, joint pain, and weakness may signal mosquito borne infection days to weeks after a mosquito bite. Dengue, Chikungunya and Japanese encephalitis can be life threatening and treatment options are limited. Preventing mosquito bites by wearing proper clothing and applying mosquito repellent are effective strategies. Minimize areas of exposed skin by wearing long-sleeved shirts, long pants, boots/closed shoes, and hats. For exposed skin, apply DEET (up to 30% is safe) containing spray or lotion. I recommend purchasing your repellent prior to travel; common store shelf repellents include those made by OFF!, Cutter, and Repel. In addition to using mosquito repellent, discuss with your doctor which malaria preventive medication is best for you and/or your child. Depending on the person’s age and duration of journey, your doctor may select a once daily or weekly preventive medicine. Avoid areas with standing water and know that mosquitos are more active in early morning and evening. Lastly, use common sense. Anticipate mosquitos if you will be attending an evening outdoor wedding function and be sure to reapply repellents as protection wanes and mosquitoes start to bite.

Food and water safety precautions are important in avoiding the often termed and experienced “delhi belly.” Washing hands, drinking bottled water or beverages from sealed cans/bottles, and being selective about food consumption, helps avoid vomiting and diarrhea. When hand washing is not possible, use alcohol based hand sanitizer with > 60% alcohol to clean hands. When bottled water is not a choice, boiling water is an acceptable method of disinfection (boiling for 1 minute or more ensures margin of safety). However, boiling does not prevent recontamination during storage. Further, avoid ice, raw food, and street food, especially pani puri and sugar cane juice. Eat only freshly cooked hot meals and avoid unpasteurized milk products.

If diarrhea does develop, focus on hydration. Infants and younger children with traveler’s diarrhea are at higher risk for dehydration, which is best prevented by the early initiation of oral rehydration. I generally advise my patient families to travel with Pedialyte sachets. World Health Organization also provides packaged oral rehydration salts widely available for purchase at stores and pharmacies in India. Oral rehydration solution is then prepared by adding 1 packet to the indicated volume of bottled, boiled or treated water—generally 1 liter. If there is bloody or severe watery diarrhea or fever, seek professional medical care. Know how and where to obtain health care should the need arise.
Lastly, do not forget the simple safety rules like buckling your seat belt. Take car seats for your children. Wear a helmet if riding a scooter and be extra careful about the traffic. Avoid all stray animals. Travelers should avoid touching, handling, or feeding animals, including pets since domestic animals may not be vaccinated for rabies. Avoid heavy sun, wear sunblock and ensure ample hydration.

I wish you and your family a most enjoyable visit to our homeland. Taking the above precautions and seeing your doctor before travel will ensure a healthy journey and safe return home.

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Read Dr. Parmar’s article: Sleep Matters

This is my first installment in a series that I hope you will enjoy and learn from.

For those of you who know me (and my 10 year old daughter, Kajal), you also know that by 7 o’clock in the evening we are winding down in our house, reading books, and getting ready for bed. By 8 pm, she is snuggled and ready to drift away into her dreams where I promise to join her later in the night. It is a routine that we rarely stray away from because we know how much each night’s sleep is important to her (and ours) growth, brain development, mental health, and general well-being. The benefits of daily rest overnight are immense; prioritize sleep for your children and yourselves.

Sleep is crucial for the mind and body to grow and repair itself. It is in our sleep when our memories are consolidated, our bodies grow, and brain develops. Those children that get adequate night sleep have shown to perform better in school as a result of better attention span and ability to handle stress. In fact, sleep keeps our mental health in check too. Sleep deprivation can lead to mental fatigue and contribute to symptoms of depression and anxiety. Those children (and parents) that are better rested, generally exhibit better temperament, energy, and positive mood.

Infants and children need to be taught to sleep. These are learned habits that parents will reinforce. Starting around 4 months of age, your infant will have a sleeping pattern or rhythm. Start setting a regular time for a bedtime routine. Night routines often include bath, books, brushing teeth, and lots of cuddles. I like to massage my baby too. Once you have placed your infant in his/her crib, allow him/her to self-soothe to sleep. Essentially place your infant in the crib while drowsy, not asleep. Sticking to your routine allows your infant to know what to expect in terms of rest time and awake time. Don’t let your child get overtired as it will be harder to ease them into sleep. If anything, start early!

As children get older, they may start to have other activities to attend and resist bedtime. Continue to prioritize bedtime. Avoid overscheduling after school activities. Allow downtime for unstructured play. Protecting your child’s sleep during the school week will enhance their school performance. Schedule activities on the weekends and prioritize school, homework, and sleep during the week.

I realize this is easier said than done but sleep is important even for us parents. We know that our bodies are less stressed when rested. Our cortisol level (stress hormone) stays nice and low with good sleep. In fact, research has shown less heart disease and better blood sugar control in those that achieve adequate sleep. We eat better and make healthier decisions when we sleep well. We also know that adolescents and adults have improved emotional resilience when better rested.

So how much sleep does everyone need to gain the benefits aforementioned? Infants and children benefit from 10 to 12 hours overnight; adolescents need 8 – 10 hours; and adults need on average 8 hours of rest overnight. However, each person has different needs – some need more and some need less. Keep track of your sleep and how you or your child is feeling the next day. Aim for full energy, positive spirit, healthy eating, mental sharpness, and good school/work performance.

At times, children and adults have a hard time falling asleep. Set a schedule with a routine wake up and bedtime. Being physically active during the daytime helps induce great sleep too however, avoid exercising just prior to bedtime. Avoid eating a late dinner. Also, importantly, avoid screen time (TV, phones, iPad) at least an hour before bedtime. Give your children and yourself some time to wind down from the day’s activities. As a family, playing board games, working on a puzzle, or praying are relaxing ways to bond and prepare for night’s sleep.

If you or your family members are struggling to get good rest, seek guidance from your family Pediatrician or Physician.

Shefali V. Parmar, MD, FAAP

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