Frequently Asked Questions

 

The below questions and answers are some of the most common that I get asked as a Paediatrician. My hope in providing this information is that it empowers and puts at ease parents when it comes to health concerns that they might have about their child without feeling the need to book an appointment.

ARE VACCINES SAFE?

With so much media attention on vaccines, parents are often unsure whether vaccines are good for their child’s health. In the United States vaccines are very well studied, safe and strictly regulated by both the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).

When children are not vaccinated, the diseases we are protecting against reappear. For example, in 2011 in California there were more cases of measles than in the whole of the last decade and we’ve suffered the largest whooping cough epidemic since the 1950s. Vaccinations are the best thing you can do to protect your child against dangerous and life-threatening diseases.

New vaccines are constantly under development and rigorous safety studies done prior to being put on the market.

HOW DO I MANAGE CONSTIPATION IN MY CHILD?

Constipation exists when stools are difficult to pass or irregular in frequency. It does not necessarily point to a specific disease and is quite common in the pediatric population. Many children retain stools as they ignore the sensory stimulus of having to pass a stool. This can lead to a progressive cycle of constipation and pain in defecation. Both dietary as well as behavioral interventions needs to be applied in order to relieve the symptoms.

Dietary goals will include adding high fibre food in the child’s diet, ensuring adequate fluid intake through the course of the day as well as including whole-grains or cereal based food at each meal.

In terms of behavioral issues, children needs to be encouraged to spent regular as well as adequate tims on the toilet. A relaxing and comforting atmosphere will help in ensuring a positive experience. Children’s feet should not be hanging in the air but rather supported on a small bench when sitting on the toilet. Avoiding long periods of stool holding is essential.

Additionally physical activity will aid in relieving constipation. It is safe to use stool softening medication on a prolonged basis if above measures does not yield adequate results.

SHOULD I WAKE MY BABY FOR FEEDING?

Most parents are afraid of waking their babies up when it’s time to feed them, thinking that when the baby’s hungry, they’ll wake up on their own and cry. However, this is not true. In the first few weeks of life, the baby can’t tell if they’re hungry. It means that feeding must be regular. The parent needs to feed their infant every few hours and wake them up if they’re sleeping.

As they grow, babies will need less frequent meals and it won’t be so necessary to wake them up that often to feed them. But it’s better to do it during the first weeks in order to ensure healthy weight gain.

MY INFANT BABY HAS ABNORMAL COLOURED STOOL – IS THIS A PROBLEM?

Infant stools comes in all kinds of colors. Babies often present with bright yellow or even green stool nappies. If you breastfeed your baby, the stool will be yellow or mustard color – usually a runny consistency with pieces of solid stool inbetween. In Infant formula fed babies the stool is usually darker and a more putty consistency. Infant stool can vary at times and turn green or brown.

There are three colors that signify that a possible abnormality with the stool. If the poop is red (blood), black (old blood), or white (a liver problem) your child needs to be consulted.

HOW IS CHILDHOOD ECZEMA DIAGNOSED AND TREATED?

Atopic eczema is characterized by pruritis foremost, followed by dry skin. Childhood eczema goes hand in hand with allergic rhinits, asthma and other food allergies. Breastfeeding newborn babies exclusively for 4 months can help decrease the risk of developing eczema in an at-risk infant.

General management guidelines include:

  • Avoiding irritants as well as overheating
  • Skin should be kept covered with clothing, avoiding wool fabrics.
  • Bath daily for several minutes and use an emmolient directly after bathing
  • The use of topical steroids can be considered if no resolution after above measures

Other more intensive therapies include the use of oral antihistamins, phototherapy or the use of calcineural inhibitors.

SPITTING UP – SHOULD I BE CONCERNED?

Most parents get scared if their baby’s spitting up after most meals. However, it doesn’t necessarily mean that the kid is having a medical problem. In fact, regurgitating is normal for over two-thirds of healthy babies. Most likely, your infant will outgrow it by the age of 1. You can help the baby with it and relieve their unpleasant symptoms if you eat less spicy and fatty food (if you’re breastfeeding) and if you feed them smaller and more frequent meals.

But if spitting up is accompanied by poor weight gain, irritability, and sleeping problems, check your baby with a doctor and see if there’re any problems.

SHOULD MY CHILD RECEIVE THE FLU / INFLUENZA VACCINE?

Influenza is an acute respiratory illness caused by influenza A or B viruses, which occurs in outbreaks and epidemics worldwide nearly every year, mainly in the winter season in South Africa.

In healthy children, influenza is generally an acute, self-limited, and uncomplicated disease although it can present with an acute fulminating clinical course. It causes an appreciable disease burden (eg, school and work absence, increased frequency of outpatient medical visits). In addition, in certain “high-risk” groups of children, the infection may be complicated and severe.

The flu vaccine is registered for use from 6 months of age onwards. Children has to be immunized annually with the flu vaccine. The Influenza viruses change frequently, leading to ineffectivity of the previous years vaccine. The content of the vaccine is changed annually, depending on the year’s particular flu viruses pattern. For full protection, a patient needs to receive a dose of vaccine before the flu outbreak begins. Two doses of influenza vaccine are necessary for optimal protection in children younger than 9 years of age.

Some special cases should not be immunized with the flu vaccine. This includes children who have had a severe allergic reaction to a flu vaccination in the past and children who have a severe allergy to eggs. Children younger than six months should not have a flu vaccination. If you are unsure or have any questions contact me.

WHEN SHOULD I START POTTY TRAINING?

Each child will be ready to start using the toilet in their own time – when they are emotionally and physically ready. This can’t be forced. In fact, the more you insist, the less likely it’s going to happen. Instead of asking your child whether he needs to go to the bathroom – with a guaranteed response of “NO!” – change the environment and take the pressure off of him. Instead, go into the bathroom yourself and bring whatever activity he is engaged in with you. Your child will usually follow you. If he really needs to go, you’ve provided the setting and opportunity, and he’ll take advantage of that.

Many daycare facilities assist with this process in a structured way with great success.

FEVER IN CHILDREN / MANAGEMENT OF FEVER

Fever is a common symptom of various illnesses and is usually caused by a viral infection, such as cold or flu, but sometimes by bacteria. Fever is defined as a body temperature above 37,5 measured orally, or above 37,2 under armpit.

What would prompt a parent to seek immediate attention?

  • any infant three months or younger should be seen by a doctor right away in case of any fever.
  • when child is less than six months old and has a high fever ( above 37,9 ) and older child has fever of  above 38,3.
  • when infant seems very ill, unusually drowsy or fussy
  • when the child has a stiff neck, severe headache, severe sore throat or severe ear pain
  • when infants or children have an unexplained skin rash, repeated vomiting and or diarrhoea
  • when infants or children had a seizure ( fit )
  • when infants or children have sickle cell disease, cancer or are taking steroids

How to manage mild to moderate fever. Non medical management includes;

  • dressing the child in light-weight clothes
  • not too many blankets covering the child
  • keeping child cool ( but avoiding drafts )
  • tepid bath
  • giving small drinks of fluid
  • no vigorous physical activity
  • Medical management includes using Ibuprofen or Paracetamol according to age appropriate doses
HOW DO I START FEEDING IN MY BABY?

There is a reasonably small window of opportunity to start your baby on solids. Too soon (before 16 weeks postnatal age) and there is an increased risk of allergy and anemia because the gut is not ready. Most babies do not yet have enough control over their tongues and mouth muscles. Instead of swallowing the food, they push their tongues against the spoon or the food. This tongue-pushing reflex helps babies when they are breastfeeding or drinking from a bottle. Most babies lose this reflex at about 4 months of age.

Too late (after 7- 10 months postnatal age) and your baby may have developed a resistance to having anything but milk in his or her mouth. There is also a risk of anemia with starting solids late because a baby is born with only enough iron stores to last about 6 months and after that needs to get iron from food. If your baby was born prematurely, use the following points to help you decide if he or she is ready:

Earliest time – the mid point between 16 weeks from birth and 16 weeks from the expected due date.

  • Assess your baby’s progress with the “Eating readiness cues for introduction of solids” chart
  • Latest time – Before 7 months after birth

Baby’s first solids

At first you may want to pick a time when you do not have many distractions. However, keep in mind that as your child gets older he or she will want to eat with the rest of the family.

  • Give the milk feed first and offer solids as a top up
  • Start solids with one new food at a time
  • First try plain soft foods such as sweet potato, carrot, butternut, gem, pureed apple, pear, apricot, peach or mashed ripe banana
  • Try one teaspoon first and gradually increase as the baby wants more
  • When baby is having 3 to 4 teaspoons at a meal it is time to add a second meal at a different time of day
  • Try one new food every day. If they don’t like it the first time, leave it for a few days and try again. Sometimes a baby will need to try a new food ten times before they will like it.
  • It is important for preterm babies to be offered lumpy foods by the time they are 9 months old
HOW CAN I GET MY CHILD TO SLEEP THROUGH THE NIGHT?

It’s natural to want to help your infants,older than 6 months to fall asleep. Infants wake up about every three hours during the night and if they know how to fall asleep by themselves, they will be able to get back to sleep each time without waking you for help and hence sleep through.

Interventions in trying to let babies sleep (for instance singing, reading a book, darkening the room and feeding), should be reduced over time to let babies fall asleep themselves. Parents often seal the sleep deal with feeding. To help your child learn to fall asleep without relying on food and sucking, reverse the order of your bedtime routine. Start with feeding, then go through the rest of the routine.

WHY DOES MY CHILD ALWAYS SEEM TO HAVE A COLD?

Many different viruses cause upper respiratory infections or the “common cold.” Children can get

8 to 10 colds per year, mostly in winter. With each cold lasting one to two weeks, that means two to four months of continuous illness! Many children have one cold right after another, which can make it seem like they have a cold that lasts for months. This often happens to young children in daycare or preschool. Older children have built up some resistance to common viruses, and get well more quickly.

It can be hard to tell the difference between allergies and recurrent colds. There are clues that your child’s runny nose is allergies. These are: no fever, sneezing, itchy eyes or nose, and clear mucus that stays clear instead of following the usual pattern for a cold: clear mucus that becomes yellow or green and then clear again. A typical cold will follow this pattern over the course of a week or two. Allergies are more common in Spring and Fall, when pollens are being blown around, and usually last for longer.

IRON SUPPLEMENTATION

Iron supplementation is important for premature babies. Premature babies have lower iron stores at birth than term infants and therefore a higher risk of iron deficiency. Iron is needed to make red blood cells, which carry oxygen throughout the body.

It also plays an important role in immunity, brain development and growth. Babies who do not get enough iron will become tired, faint, pale, and uninterested in play. Low iron levels in the body may cause anaemia. To improve blood iron levels babies need a variety of iron containing foods everyday.

The best sources of iron include red meats such as beef and lamb, Offal meats such as liver and kidney (try pate on toast), Chicken, Pork, fish and shellfish (later). Offer cold meats such as ham or chicken as a snack

Other iron containing foods include iron-fortified breakfast cereals, leafy green vegetables (eg. spinach, parsley, broccoli), eggs and dried fruit.

Vitamin C helps iron to be absorbed by the body, so try to include a serve of vitamin C rich food such as fruits (especially citrus fruit, kiwifruit, strawberries, rockmelon and paw paw) and vegetables (especially tomato, broccoli and capsicum) with meals.

WHY SHOULD A BABY SLEEP ON THEIR BACK?

It is absolutely necessary that an infant sleeps on their back. Infants sleeping in any other position has a significant risk of SIDS (sudden infant death syndrome). Sudden infant death syndrome (SIDS) is a term that has been used to describe unexpected deaths of infants or young children when subsequent investigations fail to demonstrate a definite cause of death. The highest risk of SIDS occurs in children below one year of age. Current guidelines indicate that apnea monitors are only indicated in high-risk infants (for example infants with an underlying lung disease). Other factors that contribute to the risk of SIDS include:

  1. Parental smoking
  2. Thermal stress (high room temperature)
  3. Preterm Birth
  4. Low birth weight
  5. Male babies

Put your baby on their back into the crib and check on them a few hours later to make sure that they didn’t turn themselves on their side or belly. Only when the baby learns to roll over can you let them sleep on the side. Don’t put anything else into the crib until the baby is about 5 months of age. That means no stuffed toys, pillows, or blankets (they can be a suffocation hazard). The only thing that should be in your baby’s crib is a good firm mattress.

HOW IS ENURESIS MANAGED?

Enuresis is classified as being primary in a child who has never achiever a satisfactory period of nighttime dryness; and secondary if a period of at least 6 months has been achieved in the past.

The age at which enuresis is considered to be problematic varies depending upon the family. For the child, nocturnal enuresis usually becomes significant only when it interferes with his or her ability to socialize with peers. As a general rule, children younger than 7 years of age may be managed expectantly, including reassuring parents that nocturnal enuresis will resolve spontaneously in the majority of these children.

Treatment may involve one or a combination of:

Nonpharmacologic measures

  • Motivational therapy: Once the child agrees to accept responsibility, he or she can be motivated by keeping a record of progress. Motivational therapy is a good first line of therapy for primary nocturnal enuresis, particularly in younger children
  • Bladder training:
 Most children with nocturnal enuresis have a functionally small bladder capacity. Bladder retention training involves asking the child to hold his or her urine for successively longer intervals (“as long as possible”) after first sensing the urge to void
  • Fluid management: Recording a fluid intake diary can help to assess the balance of fluid intake throughout the day. Fluid maintenance programs differs from isolated fluid restriction in the evening hours, which is often attempted by parents to control enuresis. Isolated nighttime fluid restriction, without compensatory increase in daytime fluid consumption, may prevent the child from meeting his or her daily fluid requirement, and is usually unsuccessful
  • Behavioral alarms: Conditioning therapy using an enuresis alarm is the most effective means of controlling nocturnal enuresis

Pharmacologic modalities include the use of Desmopressin or Tricyclic antidepressants.

DOES MY BABY NEED VITAMINS?

Babies over six months who are mostly breastfed and are not eating iron fortified baby cereal every day should take a multivitamin with iron until they begin eating different foods that are high in iron. Breastfed babies also need a good source of Vitamin D in their diet. Vitamin D can be given in a multivitamin, or through sensible sun exposure for mom and baby – this is about half an hour, in the middle of the day, two to three days a week. You should have some skin exposed – arms and legs are best, and no sunscreen until after your “Vitamin D session” is over.

Older children can get all of the vitamins and minerals they need from their diet if

there is variety in what they eat, including fruits and vegetables. Vitamins are not a bad idea, but they are no substitute for a balanced and varied diet.

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