Urology at Our Hospital involved in the study, diagnosis, and treatment of diseases affecting the urinary system – kidney, ureters, bladder and urethra – of men and women, and the genital system of men, from childhood and adolescence up to the elderly. The hospital is committed to maintain the highest clinical governance standards and patient-centric care, incorporating the latest advances in the field. This is the reason why a large number of patients choose Charithasri Hospitals as their most preferred health care partner.
We at Charithasri Hospitals treat all conditions of the urinary tracks and reproductive systems of males and females. We have one of the best doctors and state-of-the-art medical facilities for the treatment of diverse urological disorders. Our hospital is equipped with advanced tertiary care facilities; we deploy interdisciplinary approach to treatment, and give personalized care to our patients.
CHARITHASRI Hospitals has expertise in the following urological diseases:
• Massive kidney stones(with renal failure)
• Severe congenital anomalies of urinary tract
• Male infertility
• Erectile dysfunction
• Prostate enlargements
Charithasri Department of Urology offers:
• Endoscopic Surgerys
• Special treatment for young males with infertility problems and poor semen analyses
• Prostate Gland Surgery
• Removal of stones from the urinary passage of working all ages who can resume work a day after the procedure
• Latest endoscopic equipment for performing urological surgeries with minimal discomfort
• Dedicated clinic for ‘Men’s Health and Male Infertility
• Kidney Transplant Unit
No stone is tougher with our world class DORNIER LITHOTRIPSY, HOLMIUM LASER & FLEXIBLE URS
Charithasri hospital was the first to introduce this new medical equipment in A.P state. The highest precision & quality in breaking the stones. Even the radiolucent stones can be broken as it has both Ultrasound & C-arm facility.
LISA Holmium laser machine 80 watts with flexible URS can be used as lithotripter for ureteric & calyceal stones where conventional rigid URS cannot reach.
Laser prostatectomy can be done which is a painless OPD procedure.
We are geared up to treat all acute & chronic renal failure patients with round the clock dialysis facility.
A highly experienced urologist & nephrologist is an asset to our Institution.
The patient care services provided by the division of Nephrology at Charithasri Hospitals cover all aspects of our clinical discipline including
• Preventive nephrology,
• Acute or chronic kidney failure,
• Electrolyte and acid-base disorders,
• Genetic kidney diseases,
• Renal complications of pregnancy,
• Kidney stone disease,
• Chronic kidney disease (CKD),
• Kidney transplantation,
• Hemodialysis, and
• Peritoneal dialysis.
• Dabetic nephropathy.
We provide primary care to a large group of patients with end–stage renal disease (ESRD) treated with hemodialysis and we have a very substantial peritoneal dialysis program.
Our Dedicated nephrologists provide a complete range of consultative, diagnostic and treatment services for patients with kidney diseases. The scope of care encompasses all stages of kidney disease, from earliest detectable changes in kidney function through end-stage kidney disease, as well as people with high blood pressure,Acute renal failure due to kidney stones, and other kidney-related problems.
Charithasri Hospitals limited has state-of-the-art dialysis machines from world leaders in Hemodialysis. We use only brand new machines. Our Reverse Osmosis plants are also from the best manufacturers in the market. All our dialysis consumables are also of the highest quality. All this is to ensure that your dialysis session is entirely trouble-free and of the highest quality as possible..
Hemodialysis sessions at charithasri Hospital having close monitoring and complicated free. The team that looks after you during your dialysis session at Charithasri Hospital is fully certified in Hemodialysis and has years of experience and exposure.
Diabetes Mellitus is a non-communicable disease which can affect almost every part of the body if proper care and treatment of the condition is not done. In About 40 million people in India are diabetics.
Charithasri Hospitals are providing a complete range of services and treatments to successfully curb this deadly disease.
Our Hospital has been successfully offering a wide range of integrated treatments and solutions to diabetes and diabetes associated problems like High blood pressure, skin infections, kidney/eye and nerve damages etc. Charithasri Hospital has well known Diabetologists to provide round the clock services for complete & best diabetic care. Integrated services of Diabetology include
• Education for patients with type 1 and type 2 diabetes
• Pre-pregnancy and antenatal diabetes care
• Insulin pump service
• Paediatric Diabetes Care
• Clinical psychology service
• Continuous glucose monitoring
• Specialist Dietetic Service
• Diabetes Screening Services
• Diabetic Neuropathy Screening
• Diabetic Retinopathy Screening
• Diabetic Peripheral Vascular Screening
Trauma / Emergency Care at charithasri Hospitals ltd is an exclusive centre that offers immediate treatment in any emergency with the highest level of care, round-the-clock. All our Emergency Medicine specialists, trauma surgeons and support staffs are highly trained to deal with cases from minor injuries to advanced trauma care for patients in need of prompt care. Our trauma care specialists address the patient at the best time possible with the right care.
We manage polutruma cases & head injuries on a top priority basis. Interventions done in the golden hour will save th life o patient and also decrease the morbidity of patient. Our surgical team of doctors comprising of intensiviat, neuro surgeon, orthopedician,general surgeon, vascular surgeon, and plastic surgeon will immediately assess the patient in casuality do the necessary interventions. An inhouse GE CT scan is available in our hospital. Our competent medical teamcomprising of intensivist, cordiologist, physician, pulmonologist, nuurologist, nephrologist, medical gastro enterologist, will regularly interact among themselves to provide best possible outcome. We have a 25 bedded well equipped ICU with ventilators, dialysis machines, monitors with invasive monitoring facilities,. We regularly treats all sorts of poisioning cases, Heart attacks, Cerebro vascular Accidents, pancreatis and other medical emergencies.
General Medicine at charithasri hospitals limited manages all aspects of a patient's general health care and is one of the best general healthcare centres in Andhra Pradesh.
Our General Medicine department is staffed by highly qualified doctors of national repute. This department provides:
General medical care to adult patients through
• Out Patient Services
• Speciality Clinic
• In Patient Services
• Intensive Care Units
Supporting Diagnostic facilities
• Accurate diagnosis
• Prompt treatment
• Patient awareness regarding preventive aspects of the diseases
The department works in close association with all other super specialities to ensure that the needs of all types of patients are properly identified and met.
General Surgery department at our Hospital comprises of general surgeons who bring years of experience in diagnosing, treating and preventing both routine and complex surgical problems. It also provides pre and post-operative follow-up for patients, and wound and injury management and suture removals. The department actively involves patient education that empowers them to prevent any complicated conditions. Some of the medical conditions by this department involve endocrine system, gastrointestinal tract, colon, liver, pancreas and rectum. Continual improvement is a main asset to our surgeons who work in this department. Most of them have been involved with clinical trials to promote advanced treatments for several conditions. They also work in close coordination with doctors from other departments to deliver exceptional patient care by diagnosing and providing on-time surgical environment for complex conditions.
We have burns ward and dedicated team to take care of burns patient. We have physiotherapy department to provide service to the post op recovering patients and bedridden patients in ICU. We have other departments like, diabetology and psychiatry in our hospital.
Charithasri hospitalos is the forefront in offering the latest in Orthopedic treatments and Orthopedic surgical advancements on par with the best centres in the world.
Our Orthopedicians trained at the top centres worldwide, bring with them the latest and best techniques and work in our facilities that have the latest technology in terms of equipments, operating rooms, recovery areas and advanced Physical therapy facilities.
We have dedicated Staff & well equipped Orthopedic surgery theaters with laminar flow & various modern equipment like C-Arm, operating microscope top of the line arthroscopy system etc.
• The Orthpedic department perform surgeries on the bones and joints which include the most current Arthroscopic and Reconstructive techniques. Joint replacements including hip resurfacing and knee replacements are being done in large numbers with excellent outcomes
• Shoulder surgeries and the most delicate hand micro surgeries are all performed with great precision and expertise.
• We are also one of the few institutes having specialised Pediatric Orthopedics units offering the whole range of Pediatric Orthopedics.
• Using a revolutionary combination of CT imaging/mapping, modelling software (virtual) and 3D printing technology
• Our Physio Thearapy doctor units provide rehabilitation and pain management by using sophisticated equipments .
Neurology at Charithasri Hospitals offers expertise in diagnosis and treatment for patients suffering from diseases of the nervous system, which includes the brain, spinal cord and peripheral nervous system. These scientific advances have led to new ways to diagnose neurological disease, new methods for treating previously untreatable diseases, and new insights into the effective management of stroke, dementia, epilepsy, Parkinsonism, amyotrophic lateral sclerosis (ALS), multiple sclerosis, Alzheimer's, Tourette’s Syndrome and other neuromuscular diseases.
Charithasri Hospitals consists of a team of highly competent and dedicated and neurosurgeons with rich experience in Cerebrovascular, Functional, Pediatric neurosurgery, peripheral nerves and trauma. We have a separated and well equipped neurosurgery operation theater enabled with dedicated C-Arm, and neuro head frame. We offer services for in-patients and out-patients round the clock. We perform minimally invasive cranial and spinal surgery regularly.
We offers care to all types of neuro disorders like:
• Neurotrauma and head injury
• Vascular Neurosurgery
• Congentital, Degenerative and Traumatic spinal disorders
• Minimal access spine surgery - Percutaneous screw placements, Key hole surgery
• Spine fractures, spinal fusions
• Craniovertebral junction disorders
• Skull base surgery including Anterior cranial fossa surgery
• Surgery for chronic pain and spasticity by spinal cord stimulation and intrathecal pumps
• Surgery for intractable epilepsy and mesial temporal sclerosis
• Primary, residual or recurrent brain tumors
• Pediatric brain tumors such as medulloblastomas, ependymomas
CHARITHASRI ELDER CARE : A New Innovative Concept Devoloped by CHARITHASRI Elder Care: Geriatrics is a homely care to the elderly people by medical, paramedical trained staff which involves indepth individual, assessment of elderly people useually above 60 years. This department provides complete medical & paramedical care to the needy elderly people by giving them orientation of changes that are likely to happen in the body with aging , council them how to cope up with aging process giving them psychological and emotional boost up.
CHARITHASRI ELDER CARE has two components. 1. Home Care 2. Hospital Care
1 . Home Care: For those people who are walk with support or concious and oriented but not able to walk on their own. Those people need continuous monitoring by structured home visits by our family physician and trained nursing assistant, home based physiotherapy services, identifying health problems if severe, Hospitalization in CHARITHASRI HOSPITALS LIMITED. Nursing care at home will be provided on request with separate payment. Our relationship managers will be in touch with elders on weekly once & on personal visit monthly once. A psychologist councelling will be made every 4 months.
2 . Hospital Care: For people who can not be managed at home, bed ridden with severe bed sores, terminally ill patients requiring only palliative care & who don’t have any domestic support. Nursing care & Medical supervision by our duty doctor to the elder person (Food Optional). Any criticalcare which requires ICU admission, ventilator care, surgery etc.. are payable as per tariffs of CHARITHASRI HOSPITALS. Any special service & consultation is chargable. If it is post operative care after major surgeries like CABG during convalescent phase etc. It will be collected per day with food with chargeable specialist consultation. Incase of emergency by a phonecall or message with free ambulance service, the patient can be shifted immediately to CHARITHASRI HOSPITALS LIMITED. The services of home care will be with in the viscinity of 50 km of vijayawada. To get the services , registrations into one of the packages is mandatory. Total amount to be paid initially. If not satisfied with service, 50% will be refunded befor 6 months.
i. Premium Package:
a. Weekely visit by duty doctor, trained nurse to do general medical checkup, bedcare, basic toothcare, eyecare etc.
b. Two monthly physiotherapist visit & dietician visit to explain about avoiding the likely problems, advice about nutritious diet.
c. Two monthly psychologist councelling to give moral boosting to elders.
d. .Every 6 months ENT & Dental, Ophtholmologist, Diabetologist, Urology checkup will be provided through CHARITHASRI HOSPITALS LIMITED.
e. If identified by visiting doctor any acute problem, hospitalization or consultation with specialists like nephrologist, cardiologist, orthopedician, gynecologist or any other speciality at CHARITHASRI HOSPITALS LIMITED which are chargable seperatly.
f. Weekely visit basic tests: Recording BP, RBS, ECG, Weight, etc.
Two monthly tests: Lipid Profile, RFT, CBP, SR. calcium phosphorous. Yearly Once: PSA, T3T4TSH, Male. Mamography, papsmear, to female bonedensitometry, one endocrinology consultation. All other services & special lab tests if needs are chargable. Every visit will be recorded & sent to their children. Our core group of consultants are Dr. Koneru Vijay kumar, Senior Urologist 20 years Experience. Dr. K. L. Neelima, Diabetologist, Dr. R. Sunil, Intensivist will be in touch with the children of elderly people, whenever required or answer to them on call.
ii. Regular Package:
a. All are same except doctor visit, nursing visit, which is monthly instead of weekly
b. Two monthly visits mentioned in b,c,f. premium package will be for monthly
iii. Executive Package:
a. Daily visit by duty doctor, nursing assistant, to provide bed care, catheter care, feding either rylestube or oral, bed sores management etc. b. This is for sick people daily information will be mailed to the children. The tariffs for all these packages i.e. premium, regular, executive of homecare & hospital care will be in our office . Contact for any queries phone no. 9246490917. Visit our office for all details & clarifications regarding this scheme.
Regular Package = 3000$ (US dollors) per year Premium Package= 4000$ (US dollors) per year Executive Package = 6000$ (US dollors) per year
The Centre for Pulmonary and Critical Care Medicine at Charithasri Hospitals offer comprehensive consultative, diagnostic and therapeutic services for patients with illnesses that affect the lungs and breathing.
Charithasri hospitals surgeons are leaders in the surgical treatment of diseases of the lung and esophagus, including lung cancer, chronic obstructive pulmonary disease (COPD)
* Outpatient and inpatient facilities backed by the Intensive Medical Care Units and excellent Operation Theatre facilities for Thoracic Surgery
* High-tech ICU managed by expert healthcare professionals for acute and severely ill patients
* Excellent Radiology, Laboratory Services, Microbiology and Physiotherapy departments
Charithasri Hospitals offers advanced treatments for various gastro-intestinal disorders. The Centre is equipped with the best facilities and supported by a team of expert doctors. Gastroenterologists use the latest diagnostic and therapeutic equipment for Gastroscopy, Colonoscopy, Endoscopic Retrograde Cholangio-Pancreatiography (ERCP), Endosonography and Manometry. Charithasri Hospitals Ltd has two separate departments in this division to provide effective and dedicated service.
The Department of Medical Gastroenterology deals with various medical problems in gastroenterology in the outpatient, inpatient including emergency services setting. The doctors have expertise in the management of the full spectrum of gastrointestinal, liver and pancreatico-biliary diseases. This includes chronic diarrhea, constipation, peptic ulcer, acute liver failure, portal hypertension, bilio-pancreatic disorders and malignancies.
The Department of Surgical Gastroenterology provides comprehensive care for diseases of the gastrointestinal tract (esophagus, stomach, small intestine and colon, gall bladder, pancreas, endoscopic hernia and liver). Surgical gastroenterology at our hospital has latest equipment for GJ, Lapcoli and all laproscopic procedures. The department emphasizes a team approach, enlisting the co-operation of other departments in providing a multi-disciplinary approach to patient care.
Our Hospital has a full fledged Women’s Health Unit that caters to all the healthcare needs of women. The centre will attend to the needs of women of all ages including adolescence, reproductive years and problems of older women. Highly sophisticated exclusive labour rooms with all modern amenities at the hospital are well equipped and comfortable with the advanced Monitors and Resuscitation Units to ensure the best result from every pregnancy for the mother as well as the child.
Operation theaters near the labour rooms make the access to a caesarean surgery easy. All operation theaters are well equipped with life saving and emergency equipment to ensure that you always in good hands and that we leave nothing to chance when it comes to these vital procedures.
We aim to deliver high quality, family-centered birth experiences. Our Hospital offers women medical expertise and specialized care in a comfortable, homelike setting with all the warmth that is unique.
Rheumatology division at Charithasri Hospitals provide excellent diagnosis and treatment for diseases that affect the body's connective tissue. Our Hospital rheumatologist treat different types of arthritis, including common diseases such as rheumatoid arthritis and osteoarthritis, and rare rheumatoid diseases.. Additionally physicians offer consultative and continuing care for patients with regional musculoskeletal disorders such as shoulder pain, hip pain, and knee pain. Preoperative evaluation and recommendations for patients considering joint replacement and arthritis-related reconstructive surgeries are also provided.
Rheumatology services offered at Charithasri Hospitals include:
• Osteoarthritis (OA)
• Rheumatoid Arthritis (RA)
• Juvenile Rheumatoid Arthritis (JRA)
• Psoriatic Arthritis (PsA)
• Seronegative Arthritis
• Behςet's Syndrome
• Ankylosing Spondylitis (AS)
• Paget's Disease
• Antiphospholipid Syndrome (APS)
• Mixed Connective Tissue Disorders
Vascular Surgery division at our hospitals, diagnose and repair damaged or diseased blood vessels, arteries and veins. Our doctors work on vessels throughout the body to:
• Remove blockages
• Bypass diseased arteries
• Replace or bolster weak, aneurismal arteries
Without treatment, vascular disorders often lead to serious problems, such as stroke or heart attack. With treatment, adequate blood flow is restored to the vessels, reducing the risk of further complications. Our care extends to the full range of arterial, venous, and lymphatic disorders, including diseases of the carotid artery, aorta, visceral, and extremity arteries.
Endocrinology at Charithasri Hospitals has maintained a position of prominence by virtue of the quality of specialists and their ability to remain at the forefront of new developments. We provide expert evaluation and management of hospitalized patients with endocrine disorders with special clinical programs for patients with
• Overactive thyroid
• Endocrine cancers such as thyroid, pituitary and adrenal.
• Thyroid growths,
• Pituitary tumors,
• Abnormalities of water metabolism,
• Weight control problems and
Our unique combination of adult and pediatric specialists & subspecialists poises us to be at the forefront for discovery and treatment of endocrine disorders that span a lifetime from birth to old age. Our team of experts work together in the most modern facilities to provide patients with up-to-date treatments as well as disease education, dietary counseling, and other support services to help patients achieve the best quality of life.
Plastic Surgery department of Charithasri Hospitals provides advanced and natural-looking plastic surgery. Combining the latest in precision technology with the highest standards of surgical craftsmanship, we take good care of our patients and provide a truly first-class experience. We work closely with our patients to provide tailor-made solutions in both aesthetic and reconstructive surgery. Whether the goal is to rejuvenate and enhance or to repair and restore function and appearance, our focus is always on providing exemplary care and gratifying solutions. As a practice we focus on providing a natural appearance and a less-is-more approach especially in our cosmetic procedures. Our treatments respect the balance and proportions of the face and body, and produce results that restore and enhance, but are never overdone.
We have vast experience in high-precision and microsurgical techniques. These methods inform our work at every level, allowing us to perform procedures that would be impossible otherwise and provide us greater refinement in results. We provide a broad spectrum of treatments from simple procedures, such as removal of minor skin lesions, to some of the most advanced cosmetic and plastic surgery procedures provided anywhere
Charithasri Hospitals surgical oncology specialists are dedicated to offering cutting-edge, multidisciplinary treatment of primary and metastatic tumors. Our Surgical Oncology Department is to provide patients with comprehensive care for cancers of the
• Abdominal cavity,
• Adrenal gland,
• Soft tissue and breast
• Gastric cancer,
• Pancreatic cancers,
• Metastatic colon cancer,
• Appendiceal cancers, and
• Sarcomas and melanomas.
Surgical oncology concentrates on the surgical aspects of cancer including biopsy, staging and surgical resection of malignancies. In most cases the surgeon removes the tumor and some tissue surrounding it. Removing nearby tissue may help prevent the tumor from growing back. Surgical oncology encompasses several specific programs, all of which are multidisciplinary to provide patients with the most comprehensive, streamlined care.
Physiotherapy and Rehabilitation Department provides services to inpatients and ambulatory care patients at Charithasri Hospitals, focusing on restoring the health, functional abilities and quality of life of people of all age groups affected by acute illness, injury or disability such as stroke, cerebral palsy, spinal cord injuries, heart surgery, amputation, joint replacement, sports injuries or spinal disorders, cancer surgery & congenital disorders.
Dermatology division at Charithasri Hospitals provides best-in-class medical and surgical dermatological care. The specialty deals with all diseases like common and rare problems related to skin, hair, nail, and mucous membranes. Our experienced dermatologist provides excellent treatment for common skin ailments like eczema, psoriasis, vitiligo, alopecia, leprosy, scabies, etc. We also provide counseling and treatment for all sexually transmitted diseases.
Our department provides high quality care, ensuring patients the most advanced treatment options available. Comprehensive services are offered to the patients through integrated diagnostic and therapeutic services.
• Removal of all benign growths, moles.
• Radio frequency for removal of skin tags, warts.
• Derma-roller for removal of acne scars.
• All types of chemical peels and
• Vitiligo surgery.
Our goal is to provide patients with exceptional care for heart disorders, from prevention and diagnosis to treatment and rehabilitation. We strive to provide a unique experience for patients by bringing together the finest in medical expertise and research in the context of a tradition of compassionate care for every individual. Medical Cardiology at our hospital offered:
• 2D Echo
Our hospital is a center for Ear Nose Throat has a team of surgeons whose credentials go beyond the ordinary. Our ENT team is one of the finest in the region with the expertise to handle any kind of trauma / emergency and also undertakes complex surgeries on a regular basis. World-class equipment such as flexible and rigid endoscopes, high resolution video camera system and other accessories are used regularly in the treatment of patients.
Dental division at charithasri hospital has stood one amongst the top multispecialities. Our hospital offering world-class dental care to patients. The hospital can effectively carry out any kind of advanced treatment with ease. We have a highly experienced dentists, advanced treatment options for dental care.
Our experts can perform any dental procedure including Aesthetic dentistry, Prosthodontics, Endodontics, Periodontics, Implantology, Oral & Maxillofacial Surgery and Orthodontics under hygienic and rigorous sterilized environment. Providing highly standardized and impeccable dental solutions at affordable costs has set us apart from our competitors.
Our Offerings are:
• Root canal Treatment
• Tooth replacement by implants
• Dental Bridges
• Dental Bonding
• Maxillofacial surgery and trauma care
• Teeth whitening
• Enamel shaping
• Oral cancer diagnosis and treatment
• Teeth cleaning etc.,
The Department of Anaesthesia at Charithasri Hospitals provides round the clock preoperative services for both emergency and elective surgeries. We have an ideal mix of experienced and dedicated anaesthesiologists with a varied skill set to cater to the different subspecialties of anaesthesia like General, Cardiac, Uro, Neuro, Obstetric, Paediatric and Day care anaesthesia.
The department has emergency services with 24×7 available.
The services offered by the department include:
• Preoperative Anaesthesia
• Anaesthesia Services for all Elective and Emergency Surgeries
• Post operative care in Intensive Care Units
• Monitored Anaesthesia care
• Anaesthesia for out-of-theatre locations like Endoscopy Suite and MRI/CT scans
• Acute Pain services and a Chronic Pain Clinic
At our Pain Clinic, we have a compassionate patient-centered program to obtain the most effective long-term pain relief.
Our pain clinic Offerings include:
• Low Back Pain
• Neck Pain
• Headache and Facial Pain
• Neuropathic (Nerve) Pain
• Pain after Surgery
• Myofascial pain and Fibromyalgia
• Post-Injury Chronic Pain
Common therapeutic Pain Management procedures include:
• Lumbar and Cervical facet joint injection
• Sacroiliac Joint injection
• Epidural steroid and Nerve root injection
• Sympathetic Blocks
• Neuro Stimulation
• Epidural Lysis of Adhesions
Psychiatry at Charithasri Hospitals offers a wide range of services to treat and care patients with most challenging illnesses and various mental disorders. The exceptional depth and breadth of patient services includes emergency and urgent care, general and specialty outpatient care, well equipped inpatient wards, psychological and educational assessment services, dedicated psychiatry services for both medical and surgical inpatients and outpatients, and de-addiction program. The department's psychiatrist and psychologists are uniquely trained and well experienced in Psychopharmacology, cognitive behavioral therapy and behavioral medicine.
We successfully treat the most complex psychiatric cases requiring multidisciplinary treatments. Our experienced psychiatrists also do counseling and have great expertise in treating people with substance abuse and dependence.
Our wide range of Specializations in psychiatry involved
• Mood Disorders (Depression and Mania)
• Anxiety Disorders and phobias
• Panic, Social Anxiety, Generalized anxiety
• Obsessive Compulsive Disorder (OCD)
• Post Traumatic Stress Disorder (PTSD)
• Stress related Disorders
• Sexual Disorder
• Geriatric psychiatric illnesses (Dementia and Behavioral changes etc)
• Eating and Sleeping disorders
• Addiction Problems
• Personality Disorder etc
• Child Psychiatric Disorders
• Attention Deficit Hyperactivity Disorder (ADHD)
• Emotional and Behavioral problem in Children