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When Your Birth Plan Doesn’t Go According To Plan

If I tell you that things went horribly wrong when I gave birth to my daughter, I am not overreacting. I’m not talking about a poor maternal or foetal outcome here, since both Eryn and I were perfectly healthy throughout the labour process. I’m talking about my birth plan, and somehow I doubt I’m not the only one who had her entire birth plan turned upside down.

If you have only ever read one pregnancy book while pregnant, one of the key messages is always to have a birth plan. In fact you can even download templates online – three-page birth plans, which you have to copy and give to your husband, midwife or gynae and anyone else involved in your labour process.

Birth plans are not altogether a bad thing. They allow you to do some research. To research every labour technique and every pain intervention that exists. This way, you know all of your options going in, so during labour you can panic less about the unknown.

This was my plan… I wanted a NVD (normal vaginal delivery), and I did not want any analgesia and most definitely not an epidural. Yes, I basically wanted to be Wonder Woman. I have seen so many women in labour over the years and thought that it was very doable without any intervention. Of course, my gynae thought I was being ridiculous and asked me at every antenatal visit whether or not I had changed my mind, especially given my advanced maternal age (yep, 35 is OLD). I never did. I had done my homework, and this was my birth plan.

I did buy myself a TENS machine for during labour. These machines provide a drug-free kind of pain relief for the early stages of labour by delivering small pulses of electrical current to the body, which supposedly blocks pain signals. The research here is still not conclusive, but I didn’t care, I was going with it.

The day I went in for my 38-week appointment, my gynae and I established that if I was to wait until 40 weeks, there was no way I would be able to push Eryn out since she was already 3.5 kgs. So, we decided I would come back to the hospital the next morning for an induction. I suppose this was the start of my birth plan derailing. The next morning I woke up at 04h30 with the worst Braxton Hicks, which by the time I reached the hospital were no longer teaser contractions but the real deal.

At around 13h00 in the afternoon, I was a good 5 cm and bouncing quite comfortably on my exercise ball with the TENS machine firmly attached. Come 16h00, I was still 5 cm, and at that point, my gynae wanted to get involved. We decided to augment my contractions (make them stronger since they were clearly not doing the job judging by the relatively pain-free experience I was having). So they put up a drip and gave me the mother of all drugs, Pitocin, which I now have a newfound respect for. I have prescribed this drug many times in the past and had absolutely no idea how strong it was. I went from hero to zero in a minute and demanded painkillers. Then that question popped up… do you want an epidural? I declined the offer and instead opted for Pethidine. This was the biggest waste of time, and after 30 minutes, I was crying for that epidural. The anaesthetist had a tough time getting the needle into the right place since I couldn’t sit still because of the strong contractions I was having, so its no wonder she managed to pierce my dura (more about this to follow later).

After the epidural was given, I managed to dilate fully in under two hours. This meant that when the time came for me to push, I couldn’t feel a thing. I was not able to sense when I needed to push, and so my gynae had to guide myself and my piles through the whole experience.

When I eventually managed to deliver Eryn, things became really blurry. The Pethidine had by now gone to my head, and I was vomiting bile. I was unable to hold my daughter because I was shaking so much that I missed out on that precious skin to skin moment post-delivery. At some point, I succumbed to my numbness and must have fallen asleep, because the next thing I remembered, I woke up alone in a room with a catheter in-situ and no baby in sight. Panic set in and after pressing the emergency button for way too long, a nurse eventually came to remove the catheter and take me to the nursery where I laid clear eyes on my daughter for the first time, some eight hours after giving birth to her.

Unfortunately, my eyes weren’t clear for very long because I ended up developing a spinal headache. The epidural had gone wrong, and I had fluid leaking from my spine. This headache was so bad all I could do was lie flat in bed in one position and drink copious amounts of Redbull. Yes, this was prescribed! I eventually ended up in theatre for a procedure and was discharged three days later. What was supposed to be a short two days in hospital ended up being five very long days.

The bottom line is that labour is unpredictable, and each birth story is unique. Sometimes a magical experience starts off like a nightmare. So yes, research everything there is to know about how you will be able to get your baby out of your womb in a way that speaks to your values but allow yourself some flexibility. The most important thing is that you deliver a healthy little human who you will spend your entire life explaining to why life doesn’t always go according to plan.

The Big Screen Time Debate: How Much Is Enough?

The amount of screen time you should be allowing your little ones is a subject of much debate. It is also a subject that creates a lot of anxiety and shame for us mothers. When I was pregnant I vowed that my daughter would not get any screen time for the first few years but I realised very early on that a, it is impossible to keep  her away from a screen since screens are everywhere and b, a mother needs to allow a little screen time to keep her sanity. Yes, I am “that mom” that sometimes uses her TV as a babysitter.

But how much screen time is safe and what are the latest guidelines? I found the research on this quite interesting and I wanted to share this with you in my latest post.

WHAT IS THE BIG DEAL ABOUT SCREEN TIME?

There are many studies linking screen time with negative physical and psychosocial health in children. To date, excessive screen time has been linked with behavioural problems such as aggression and ADHD, anxiety and depression, sleep disturbances, poor language development and impaired vision.

The problem with this research is that the definition of ‘excessive’ varies between studies and it is also very difficult to measure when there are so many different types of screens (TVs, iPads, iPhones, laptops etc.) and content (video games, social media etc.) available.

WHAT ARE THE LATEST GUIDELINES?

The World Health Organisation (WHO) is a pretty important public health agency so it would make sense to follow what they recommend with regards to screen time. Their latest guidelines were released earlier this year and stress the importance of physical activity, quality sedentary activities such as reading and puzzles, and good quality sleep in children under 5 years of age.

“Improving physical activity, reducing sedentary time and ensuring quality sleep in young children will improve their physical, mental health and wellbeing, and help prevent childhood obesity and associated diseases later in life” – Dr Fiona Bull (WHO)

The WHO hope that with these guidelines healthy habits can be established early on in children’s lives and translate through childhood, adolescence and into adulthood. Below are the WHO guidelines.

Children less than 1 year old should

  • Be physically active for at least 30 minutes several times a day through “interactive floor-based play”, including tummy time.
  • Not be restrained for more than one hour at a time (in a chair/seat and even on a caregiver’s back). When restrained they should get no screen time but instead be engaged in a quality sedentary activity such as reading.
  • Have 14-17 hours (0-3 months) or 12-16 hours (4-11 months) of good quality sleep a day. This includes naps.

Children aged 2-3 should

  • Be physically active for at least 180 minutes a day, spread throughout the day. This includes moderate-vigorous physical activity.
  • Not be restrained for more than one hour at a time (in a chair/seat and even on a caregiver’s back) or sit for extended periods at a time. For children younger than 2 years, screen time is not recommended. Once older than 2 years then no more than 1 hour should be allowed. When sedentary, rather engage in quality activities such as reading and puzzles.
  • Have 11-14 hours of good quality sleep a day. This includes naps.

Children aged 3-5 should

  • Be physically active for at least 180 minutes a day, with at least 60 minutes of moderate-vigorous physical activity, spread throughout the day.
  • Not be restrained for more than one hour at a time (in a chair/seat and even on a caregiver’s back) or sit for extended periods at a time. Children should have no more than 1 hour of screen time a day. When sedentary, rather engage in quality activities such as reading and puzzles.
  • Have 10-13 hours of good quality sleep a day. This includes naps.

In summary, the WHO do not recommend any screen time in children under 2 years and in children between 2 and 5 years of age only a maximum of 1 hour should be allowed.

Lets have a look at some other guidelines. Guidelines in Canada, Australia and South Africa also recommend no screen time in children under 2 and only up to 1 hour in children 2-5 years old.

The American Academy of Pediatrics (AAP) recommend no screen time in children under 18 months. Children aged 18-24 months can be slowly introduced to screens but programs should be of high quality and parents always need to watch with their children. In children aged 2-5 years, screen time should be for a maximum of 1 hour only and parents should still co-view in order to help children understand what they are seeing.

In the UK things are a little different. The WHO recommendations are actually being challenged. I won’t get into the nitty gritty on what constitutes high quality research evidence but basically what the British are saying is that the evidence the WHO guidelines is based on is poor quality and therefore no conclusions can be made. There simply is not enough evidence to confirm that screen time itself is directly harmful to a child’s health at any age and therefore the Royal College of Paediatrics and Child Health in the UK has said it is “impossible to recommend age-appropriate time limits” on screen time.

So now that we know there isn’t much evidence to support the dangers of screen time we can probably breathe a little easier and not feel so guilty the next time we put on Peppa Pig just so that we can enjoy a cup of coffee.

The WHO guidelines are not really based on what negative effects screen time has on the brain but rather based on what negative effects sitting in front of a screen has on a child’s life. Decide for yourself how much screen time is enough for your child. Do this based on their developmental age, individual needs and also on what you want for your family. Screen time should never replace opportunities for your child to learn or be active, it should not replace precious family time and most definitely not delay naps or bedtime. When it does, then it does become a risk to your child’s physical, mental health and wellbeing.

RESOURCES

https://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=353ab0ea-7687-415f-a529-3689514f0bc8%40sessionmgr101

https://www.medscape.com/viewarticle/904624

https://www.medscape.com/viewarticle/908312

https://www.medscape.com/viewarticle/913189

https://www.nhsggc.org.uk/about-us/professional-support-sites/screen-time/screen-time-guidelines/#

https://www.nhs.uk/news/pregnancy-and-child/who-guidelines-screen-time/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851593/

https://www.wits.ac.za/news/latest-news/opinion/2019/2019-02/why-screen-time-needs-to-be-limited.html

https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more

Tips To Reduce Springtime Allergies

Are you or your little ones suffering with itchy, watery eyes and excessive sneezing? As much as we love the warmer weather we don’t really love the symptoms that come with springtime allergies. Seasonal allergies include both hay fever and allergic rhinitis, where the main culprit for these allergies is usually pollen. Not all plants pollinate in spring however, there are some that do in autumn and therefore you may also experience allergies during that time of year as well.

In this post I will go into a little more detail on what causes the allergic reaction and share some tips to try keep the symptoms at bay or at least make them a little more bearable.

WHAT CAUSES AN ALLERGY?

According to the American Academy of Allergy, Asthma and Immunology, an allergy happens “when the immune system overreacts to a harmless substance known as an allergen”.

There are many different allergens out there but common ones include pollen, mold, pet dander, dust mites, bees and certain foods. Exposure to these allergens causes more production of IgE antibodies in some people. These antibodies then stimulate the release of chemicals, which are responsible for the symptoms of an allergy.

ANTIHISTAMINES AND ALLERGIES

Histamine is one of the main chemicals involved in the allergy process and the antihistamines, we commonly buy over-the-counter, help reduce the undesirable effects caused by this chemical. There are many different antihistamines on the market, some of which have undesirable side effects themselves.

Antihistamines are divided into 3 classes called generations. First generation antihistamines are the original ones, which are very effective but usually very sedating. Ever heard of Benadryl? This drug is not available in South Africa but it belongs to this class and is commonly given to children on long haul flights in order to make them drowsy. Shocking right?! Actually, some of these sedating antihistamines can in fact cause hyperactivity in children.

The second generation of antihistamines is equally as effective as the first but they are non-sedating. However, recent studies have shown that this class of antihistamines can cause heart arrhythmias. The newest class is the third generation, which are mostly metabolites of the second-generation antihistamines. These have been found to be both non-sedating and non-cardiotoxic.

Many of the antihistamines are not licensed for use in children less than two years of age and should not be given unless recommended by your healthcare provider.

Common antihistamines available in South Africa include:

First generation Allergex, Phenergan
Second generation Allecet, Allergex non-drowsy, Clarinese, Clarityne, Texa allergy
Third generation Adco-desloratidine, Deselex, Fexo, Telfast, Xyzal

SOME HELPFUL TIPS TO REDUCE ALLERGY SYMPTOMS

Antihistamines may seem like the obvious choice to help reduce the symptoms of allergies but there are a few other things you can do.

1. Put on your cleaning gloves

It’s not called spring cleaning for nothing. Giving your house a good spring clean is highly recommended because it helps get rid of indoor allergens such as dust mites, mold and pet dander that have collected during the winter. This should also be done in autumn.

Vacuum your home often and regularly wash linen, upholstery and all stuffed toys. If you have pets you also need to wash their beds and blankets regularly and it’s probably not a good idea to allow them into the bedrooms.

2. Keep pollen out of your home

During spring it’s always a good idea to keep the windows and doors closed in your home and also in the car, to prevent pollen from being blown inside. It’s advisable to use an air conditioner instead. Stay indoors on dry windy days and avoid outdoor activities early in the day when pollen levels are the highest.

Change your clothes when you enter your house and what’s even better, have a shower. This will help get rid of any pollen you may have brought into the house. You should definitely shower/rinse every day and also rinse your hair so the pollen doesn’t end up in your bed and on your pillow.

Be careful where you hang your laundry. Pollen can also stick to sheets, towels and clothes and then be brought into the home.

3. Keep pollen out of your nose

Keep a saline nose spray on hand and use it regularly throughout the day to gently wash away any pollen stuck to the little hairs inside the nose.

If you do need to resort to antihistamines it’s better to take them in the evening so that by the time morning arrives they are working well, because pollen concentrations are the highest at that time of the day.

Take extra precautions when the pollen counts are high. There are some apps and online resources you can consult to check levels in your city. I like, the Real Pollen Count (https://pollencount.co.za), which gives you a weekly report of what you can expect in major cities around South Africa.

If the symptoms are absolutely unmanageable it’s better to talk to an allergist to find out what exact allergen is causing the allergy.

RESOURCES

https://ep.bmj.com/content/100/3/122

https://link.springer.com/article/10.2165%2F00002018-200124020-00003

https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/allergic-reaction

 

 

 

How To Use a Car Seat Harness Correctly

It’s Child Passenger Safety Awareness Week and I have decided to talk a little about the car seat harness. The car seat harness holds a child down in the car seat so they cannot slide up, forward and out the car seat in the event of a crash.

There are two different types of harnesses; the 5-point and 3-point harness. What this really means is that the harness comes into contact with your child in 5 or 3 points. The 5-point harness has straps over both shouldres, both hips and one between the legs whereas the 3-point harness only has straps over the shoulders and one between the legs. Not only is a 5-point harness more secure but it also allows the forces from an accident to be distributed more evenly across the body.

Using the harness incorrectly is one of the most common mistakes parents make. In this short post I have outlined 3 really simple steps to take to correctly position your child in a car seat. Please remember to always check the manufacturer’s instructions first before using your car seat.

  1. Place your child all the way back in the car seat

Your child must sit snugly in the car seat with the bum and back firmly against the backrest.

  1. Correctly position the shoulder straps

Rear-facing car seats: the shoulder straps should be at or just below shoulder level (+- 2.5 cm)

Forward-facing car seats: the shoulder straps should be at or just above the shoulder level (+- 2.5 cm)

Image: Diono.com

  1. Tighten harness straps snugly

The straps should be tight enough so there is no excess webbing (check this using the pinch test).

Image: Diono.com

The harness should also not be too tight that it pinches your child’s skin or forces them into an unnatural position.

HARNESS RETAINER CLIPS

Image: safekids.org

Car seats made in Europe, Australia and South Africa do not come with harness retainer clips. You will most likely only see these clips if you are in the United States or Canada. These clips are not for added safety and are not designed to keep your child in their car seat in the event of a crash. In fact they are more likely to open up from the impact and slide down the straps. These clips are positioning devices and used to keep the shoulder straps in position pre-crash.

South Africa adheres to European car seat safety standards so you will not find car seats in this country with retainer clips. European regulation requires all car seat harnesses to be released in one motion and therefore a chest clip is simply not allowed. European car seats use other methods to keep the harness in place.

There are many other gadgets and devices available to use together with your harness to provide added comfort or extra protection. These are generally not safe since most of them are not crash tested and therefore can cause serious harm in the event of a motor vehicle accident.

RESOURCES

https://cpsboard.org/cps/wp-content/uploads/2014/01/Technician-Guide_March2014_Module-8.pdf

https://csftl.org/chest-clip-myths-busted/

 

 

Common First Aid Myths

 

I am often surprised by how some of my patients manage their injuries before they come to the emergency room. I think my own mother is also guilty of practising some really strange methods whilst I was growing up. Over the years, medical advice and management has evolved. What may have made sense years ago is now out of date and has been replaced with more sound research and often logic. Here are just a few of the first aid practices and myths that I have seen over the years.

1. BUTTER ON A BURN

The idea behind this myth is not entirely wrong. Butter can help alleviate the initial pain caused by a burn because of its direct cooling effect. This however does not last long because butter, or any greasy substance for that matter, will actually slow down the release of heat from the skin. This means that the trapped heat can continue to burn the skin. Rather run the affected area under cool running tap water for up to 20 minutes immediately after the burn.

2. LEAN YOUR HEAD BACK DURING A NOSEBLEED

This one I see all the time and it is very wrong. If you lean your head back during a nosebleed you will inevitably swallow blood. This blood can irritate the stomach and cause nausea and vomiting. It can also even cause you to choke. Rather pinch the nose closed and lean your head forward.

3. PUT SOMETHING IN SOMEONE’S MOUTH WHEN THEY ARE HAVING A SEIZURE

This is often done to try and prevent someone from biting his or her tongue during a seizure. Tongue biting does happen often, but it very rarely causes any airway obstruction. You are more likely to cause an airway obstruction from whatever you have put in the mouth.

Seizures can look really scary but it’s better to move that person to a flat surface and clear the area around them so that they cannot injure themselves, while waiting for the seizure to end.

4. RUBBING ALCOHOL FOR A FEVER

 Many parents try reduce their little one’s fevers by rubbing alcohol directly on the skin or adding it to a sponge bath. As alcohol evaporates it can significantly cool the skin and potentially help reduce a fever. The problem with this is that rubbing alcohol (isopropyl alcohol) is also quickly absorbed into the skin and the fumes inhaled, which can lead to alcohol poisoning.

5. STAY AWAKE AFTER A BUMP TO THE HEAD

Parents often ask me if their little one is allowed to sleep after taking a knock to the head. It is no longer recommended to keep someone awake after a head injury. The concern was always that if someone with a concussion went to sleep they would not wake up.

If there are no red flags then it is perfectly acceptable to allow your child to sleep. Sleep is actually really important for the brain to heal. You can read more about head injuries here https://www.oneaid.co.za/a-bump-to-the-head-when-should-you-worry/

6. LIFT YOUR ARMS ABOVE YOUR HEAD WHEN YOU ARE COUGHING OR CHOKING

Someone who has a partial airway obstruction will still be able to cough. You should do nothing else but encourage coughing. When I was a child, my mother used to make me lift my arms up above my head. This can actually be dangerous because when you lift your arms, this movement causes the neck to move as well. The object causing the irritation may then slip further down into the airway and cause a complete obstruction.

7. MAKE SOMEONE VOMIT IF THEY HAVE SWALLOWED A POTENTIAL POISON

Do not make your child or anyone vomit by giving Ipecac syrup or even sticking your finger in their throats. This can be very harmful, especially if the poison swallowed is burning or corrosive.

The substance may get breathed into the lungs when vomited up and cause serious damage. The substance may also cause more damage to the lining of the oesophagus when vomited. The best thing to do is to call an ambulance or head straight to your nearest emergency room.

8. IF SOMEONE FEELS FAINT, MAKE THEM SIT WITH THEIR HEAD BETWEEN THEIR KNEES

If you do this and the person bent over does faint, they can fall out of the chair and get injured. Fainting is usually caused by decreased blood to the brain. If you are seated and put your head between your legs you will only slightly increase blood flow to the brain. It is far better to make that person lie down flat on their back and raise their legs. If the person has already fainted you should also lay them on their back and raise their legs.

9. APPLY HEAT TO A SPRAIN, STRAIN OR FRACTURE

Cold is commonly used for acute injuries and heat for more chronic conditions. Heat causes blood vessels to dilate, which increases blood flow, swelling and ultimately pain and cold has the opposite effect. After a sprain, strain or fracture it is better to apply ice to help with the swelling and pain.

Heat is very good for muscle spasms and other inflammatory conditions such as arthritis. Heat reduces muscle tension and causes muscles to relax. The increase in blood flow caused by the heat also helps remove pain-causing inflammatory cells and bring in healing cells.

10. PUT RAW STEAK ON A BLACK EYE

We can probably thank the Looney Tunes for this one! The only benefit you will get from this myth is the effects of the cold. Meat is often full of bacteria so whilst a big piece of raw steak will help with the swelling, it may cause an eye infection in the process. It is much better to apply an ice pack or even a frozen bag of peas.

There are many other myths. Do you have any others you would like to share with me? Can you remember any first aid tips or tricks that your Mother and even your Grandmother used to practice?

How Safe Are Teething Gels?

Every baby is different but common symptoms associated with teething include, mild irritability, drooling, low-grade fever and loss of appetite. If your baby is inconsolable or has a high fever chances are this is not due to teething. Teething should not make your baby very sick but rather very unhappy.

It’s terribly heartbreaking to see our little ones in pain and we would do just about anything to help ease their discomfort. As a result, parents commonly resort to various teething gels. Evidence has shown that some of the ingredients in these teething gels can be dangerous and that teething gels or creams actually offer very little benefit since they get washed out of a baby’s mouth within minutes. In this post I am going to unpack these ingredients and explain why they can be so harmful.

BENZOCAINE AND LIDOCAINE

Both of these ingredients are local anaesthetics and work by numbing the gums to alleviate pain. Whilst there are differences in absorption and duration of action between the two, their side effects are very similar.

One of the most dangerous and thankfully rare side effects is the development of methaemaglobinaemia. This condition basically leads to a reduction in oxygen in the body, which can lead to death. Children younger than two have a higher risk of developing this condition and therefore benzocaine and lidocaine products are not recommended for use in children under this age, unless prescribed by a healthcare provider. 

Another problem with these products is accidental overdose. It is difficult to dose these medications therefore it’s quite possible you can give too much. Inevitably most of the gel you give ends up being swallowed and if too much is swallowed this can lead to seizures, heart problems and even death. Too much of these gels can also numb the back of the throat and inhibit the gag reflex making it easier for young children to choke.

CHOLINE SALICYLATE

Another ingredient found in teething gels is choline salicylate. Teething gels, which contain this ingredient, work by reducing the inflammation and subsequently the pain.

This is the same salicylate found in aspirin and we know that aspirin is not recommended in children under the age of 16 because of the risk of Reye’s syndrome, a rare but fatal disease. Because of the theoretical risk of developing this syndrome from teething gels which contain this ingredient, the United Kingdom has completely banned their use in children younger than 16.

As I have mentioned before, it can be tricky to dose gels correctly so there is also a risk of salicylate toxicity when using gels with this ingredient.

WHAT ABOUT “ALL-NATURAL” TEETHING GELS?

With all the hype around the dangerous ingredients mentioned above there has been an increase in so-called “all-natural” teething gels. The problem with “natural” products is that they do not undergo rigorous scientific testing using clinical trials, which aim to identify any potential side effects. Some natural remedies have been around for years and whilst these herbs may or may not be effective for some, they can be dangerous for others.

The FDA has warned against the use of any homeopathic teething gels. The concern has mainly been over compositions that contain the ingredient belladonna, which is extremely toxic in large amounts. Investigations have found that the amount in the teething products exceeds the amount stated on the label. 

Chamomile and Marshmallow root extract are commonly found in natural teething gels. They are mainly used for their anti-inflammatory properties and do have a relatively low risk of side effects. But since you never really know what you are getting with these herbal products it is recommended you simply avoid them. These products are not tested for safety or effectiveness, and you have no way of knowing if the amount of active ingredient is too small to actually have an effect, or too large to result in serious complications.

SO HOW CAN YOU EASE THE PAIN?

There are a few simpler and safer methods you can try to ease your little one’s teething pain:

  1. Massage your child’s gums with a clean finger.
  2. Give your child a firm rubber teething ring that has been chilled in the fridge and not in the freezer.
  3. Give your child a clean and cooled damp washcloth to chew on.
  4. If you need to resort to medicine use paracetamol or ibuprofen (you can read more about these medicines in a previous blogpost of mine: https://www.oneaid.co.za/medications-for-pain-fever-in-children/ ).

RESOURCES

https://www.aappublications.org/content/35/8/32.1

https://emedicine.medscape.com/article/1009987-overview

https://www.fda.gov/consumers/consumer-updates/safely-soothing-teething-pain-and-sensory-needs-babies-and-older-children

https://www.fda.gov/news-events/press-announcements/fda-warns-against-use-homeopathic-teething-tablets-and-gels

https://www.gov.uk/drug-safety-update/oral-salicylate-gels-not-for-use-in-those-younger-than-age-16-years

https://www.medscape.com/viewarticle/849029_2

https://medsafe.govt.nz/profs/PUArticles/Topical%20oral%20choline%20salicylate%20gels%20-%20safety%20in%20children%20-%20Aug%2009.htm

https://nccih.nih.gov/health/teething

Shouldn’t It Be “Fed Is Best”?

This post is a little different to my others because it is personal. I want to share more of my momlife journey with you so where better to start than at the beginning, with one of the first challenges I had to deal with when becoming a mom.

No one tells you before having kids how difficult breastfeeding really is. The phrase “breast is best” is one I have constantly heard over the years and one that I myself have drummed into my patients. My breastfeeding journey was a time in my life when I have never felt more incompetent. I have spent so much time over the years ‘lecturing’ expectant parents and new moms about the benefits of breastfeeding and even shown some moms how to latch correctly. I would have thought that with all my knowledge I would grasp this breastfeeding skill from the beginning, but I did not.

It took two midwives and three lactation specialists to finally tell me I had flat nipples. Clearly, I have never looked at my breasts properly. With this newfound information I went out to buy a range of different nipple shields thinking this would solve my problem. After 2 weeks of becoming obsessed with breastfeeding I realised my daughter was not gaining any weight and was in fact losing it. So I decided to scrap the shields and embrace my breastpump.

I exclusively pumped for three very long months. I sometimes think that this required even more effort than the breastfeeding. I had to pump at regular intervals throughout the day and night to ensure a good milk supply, since the suction from a pump is not as efficient as the suction from a baby in stimulating milk production. After three months, I went back to work. The pumping was going to be even more difficult and to be honest I was a bit over constantly having to sterilise the parts. And so began my quest to find the best formula.

I remember staring at that formula aisle for a really long time feeling overwhelmed by all the options available. Of course I knew some names like NAN, Isomil and S-26, but there were so many more. I had no idea what the difference between all of them was (they don’t teach us this at med school) so I asked someone for help. You know what I was told? “I am not allowed to tell you anything about formula”. I was now really confused and very angry.

Before the 80’s, women were encouraged to formula feed (obviously to the benefit of the big pharmas). Unfortunately such messages were exploited in underprivaledged communities. This had devastating consequences with rising infant mortality rates in these areas. I won’t go into any detail about the Nestlé formula scandal but it did cause a global uproar and now there is a code in place which restricts the marketing of breast-milk substitutes worldwide in order to protect breastfeeding. South Africa has incorporated this code into legislation and this is why it is so damn hard to get any information about formula. Our former health minister, Dr Aaron Motsoaledi, even suggested formula be banned throughout the world stating it is “no different from skin lightening creams”.  Yes, seriously, this comparison was made.

As if being a mother isn’t hard enough, we now have to find time to do our own research or pay to get this information by going to see our Paediatricians (and I don’t even think they know everything there is to know about formula). If breast is best and if this code is so effective then why are we constantly being bombarded with confusing messages. On one end breastfeeding in public is still very much taboo yet everyone tells us we need to breastfeed. On the other end we should not formula feed our babies yet bottle feeding is easier on the eye and we all need to go out and buy those new self-warming bottles.

Shortly after I stopped pumping I took Eryn to a birthday party. Most of the moms there were successfully breastfeeding either their infants or toddlers. All these women spoke about the entire morning was breastfeeding. I never said a word because I felt ashamed and excluded. In hindsight, I am angry at myself for having felt that way. I was sitting there with a very healthy baby girl on my lap and so what if she was being formula-fed.

I’m sure we can all agree that breast is best but I think we are taking things a little too far. I would like to see the narrative change to “fed is best”. I don’t deny the benefits of breastmilk but this may not work for everyone. The success of breastfeeding is a complex combination of many factors. All it takes is for one wheel to come off and then the whole ride can become very bumpy.

We live in a society where freedom of choice is celebrated. Why then are mothers judged so harshly for the feeding methods they choose? Since becoming a mom I have learnt that mothers are the harshest critics and supreme court judges. We really need to take a step back and start to create a safer all-inclusive space for mothers to exist. A space where single, divorced and widowed moms, breast and formula feeding moms, moms with post-partum depression and anxiety, adoptive and foster moms, working and stay at home moms, biological and stepmoms can all be celebrated as the real mothers they are.

RESOURCES

https://www.who.int/elena/bbc/regulation_breast-milk_substitutes/en/

https://www.news24.com/SouthAfrica/Politics/Ban-infant-formula-Motsoaledi-20100513

Essential Fire Safety Equipment You Need In Your Home

How many of you have smoke detectors installed in your homes? Do you also own a fire extinguisher and if so is it the correct one? In this blog post I want to go into a little more detail on these products and why they are so important to have in your home.

SMOKE AND CARBON MONOXIDE DETECTORS

A smoke detector alarm detects the presence of smoke and possible fire in your home whereas a carbon monoxide (CO) detector alarm alerts you when the levels of CO in your home are dangerously high. Smoke detectors are a must for all homes. You only need a carbon monoxide detector if you use fuel-burning appliances such as gas stovetops, heaters and geysers. CO detectors are also important if your home has a fireplace.

These detectors need to be installed where you can hear them, especially while you are sleeping. It would be pretty pointless to put one in the garage if your bedroom is on the top floor. It is recommended that you have a smoke and carbon monoxide detector either inside or just outside of every bedroom. You also need to make sure there is one on each floor of your house.

Carbon monoxide detectors should also be installed near fuel-burning appliances, just outside the garage and in rooms with wood burning fireplaces. Carbon monoxide is a silent killer. You cannot see or smell the gas and in the early stages CO poisoning will feel more like the flu. You can read more about carbon monoxide and how it affects the body in my previous blog post: https://www.oneaid.co.za/gas-or-wood-how-to-safely-keep-warm-this-winter/

Most of these alarms run on batteries so they need to be tested regularly, at least every month. The batteries should also be replaced once a year.

FIRE EXTINGUISHERS

There are at least four different types of fires that can happen in your home and water is definitely not the safest way to extinguish all of them.

Common causes of house fires:

1.     Class A

These fires involve combustible materials such as wood, textiles, straw, paper etc. These are materials that can combust, i.e. burn in air.

2.     Class B

These fires are caused by the burning of liquids or materials that liquify, such as petrol, paint, alcohol and paraffin.

3. Class F

These fires involve cooking oils and fats in the kitchen.

4.   Electrical appliances (formerly type E)

These are fires caused by electrical appliances

What fire extinguisher do you need?

There are five main types of fire extinguishers; water, foam, dry powder, CO2  and wet chemical. The different types of extinguishers are used to put out different classes of fires. There is not one extinguisher type that works on all classes of fire.

  1. Water fire extinguisher

These extinguishers are used to put out class A fires. The water has a cooling effect, which causes the fire to burn more slowly until all the flames have been extinguished. These extinguishers should not be used on or near electrical appliances.

These are not recommended for class F fires. If you had to use this extinguisher on such a fire in your kitchen, there would be an explosion of steam much larger than the one you see when rinsing a hot pan under water. This explosion would throw hot oils all over your kitchen, which could cause a new fire and most definitely result in thermal burns to your skin and eyes.

2.Foam fire extinguisher

Foam extinguishers are useful against both class A and B fires. Similar to water extinguishers, foam extinguishers have a cooling effect. These should also not be used on or near electrical appliances.

3. Dry powder fire extinguisher

These extinguishers can be used on class A, B, C and electrical fires. They work by forming a barrier on top of the fire so that the burning fuel has no more access to the oxygen it needs to burn.

These extinguishers should not be used in enclosed spaces as the powder that is dispersed can be inhaled. Therefore they are not recommended for home use.

4. CO2 fire extinguisher

CO2 extinguishers are used on class B and electrical fires because CO2 does not conduct electricity. These extinguishers work similar to the dry powder ones whereby they suffocate the fire by removing the oxygen from its surface.

5. Wet chemical extinguisher

These are the extinguishers you would use on a class F fire. They can also be used on class A fires. They work by creating a layer of cooling foam on top of the burning oil or fat and therefore also cut off the oxygen supply.

Before going out to buy a fire extinguisher you need to identify the different fire risks you have in your home, because this will determine which type of extinguishers you need and where you need to keep them. It is probably best to have an expert come and inspect your home and assess your individual needs. They can also guide you on where to install smoke and carbon monoxide detectors.

If you do have a fire extinguisher in your home make sure you know how it works. Read the manual or have someone show you, because in an emergency you really don’t want to be figuring out how the safety pins work.

RESOURCES

https://www.cityfire.co.uk/wp-content/uploads/2018/11/fire-extinguisher-types.pdf

https://www.cpsc.gov/s3fs-public/SmokeAlarmWhyWhereandWhichCPSCPub559RevisedJuly2016PostReview.pdf

https://surreyfire.co.uk/types-of-fire-extinguisher/

Gas or Wood? How To Safely Keep Warm This Winter.

We are now well into winter and definitely feeling the chill! South African homes are not well equipped to withstand the cold and we have to resort to various heating appliances to stay warm during winter. This is why structural fires and carbon monoxide poisoning are so common during the winter months. Below, I outline some safety tips on keeping warm in the home.

WHEN USING A GAS HEATER

  1. Always make sure the gas heater and especially the cylinder is completely turned off before going to bed or leaving the house.

  2. Always keep the room well ventilated to avoid carbon monoxide (CO) build up.

  3. Do not use outdoor gas heaters indoors, as they may produce more CO.

  4. Make sure all components of the heater are well maintained. Ensure the gas bottle is safely secured with no leaks.

  5. Natural gas is odourless. In order to identify leaks more easily manufacturers add chemicals to give it that distinctive rotten eggs smell.  If you smell gas in your home turn off the gas cylinder and do not use an electric fan to try and remove the gas.

  6. When switching your gas heater on always start by first turning on a match or lighter and then opening the gas supply. When switching the heater off always turn the gas cylinder off first.

  7. Never move a gas heater whilst in use.

  8. Do not place anything on or over the heater, such as damp laundry items. This can result in a fire. Do not ever sit on a gas heater either as it could fall over.

  9. Do not use flammable liquids and/or aerosols near a gas heater. Do not use a gas heater in a room that has recently been painted.

  10. Make sure to keep all flammable items a safe one-metre away.

  11. Have smoke and CO detectors installed and test them regularly.

  12. Always keep a fire extinguisher in your home.

 

WHEN USING A FIREPLACE 

  1. Keep a window slightly open.  This will help prevent the room filling up with smelly smoke. It also prevents the build up of carbon monoxide (CO).

  2. Make sure the damper of your chimney is open so that the smoke can leave the house. Only close the damper once the fire is completely extinguished.

  3. Use dry wood and not wet or green wood. Wet and green wood cause more smoke.

  4. Clean out any ash from the previous fire. Thick layers of ash restrict the air supply to the fire and cause more smoke. 

  5. Use smaller pieces of wood because these create less smoke.

  6. Remember to have your chimney cleaned once a year before the winter season. Animal nests and excess soot can block the escape of smoke.

  7. Never leave a fire in the fireplace unattended. Always make sure it is completely extinguished before going to bed and/or leaving the house.

  8. Make sure the area around the fireplace is clear of potentially flammable items such as books, curtains and furniture. Keep a safe one-metre distance.

  9. Keep fireplace tools and accessories such as firelighters, matches and lighters out of a child’s reach.

  10. Use safety screens so your children can’t get burnt by hot flying embers or by touching the hot glass of a closed fireplace.

  11. Have smoke and CO detectors installed in your house and test them regularly.

  12. Always keep a fire extinguisher in your home!

CARBON MONOXIDE POISONING

It may seem counter-productive to keep a window open when you are trying to keep your home warm, but this is extremely important if you are burning a fuel, such as gas, paraffin, coal or wood to generate heat.

Carbon monoxide (CO) is a colourless and odourless gas produced by the incomplete combustion of these carbon-containing fuels. When there is too much CO in the air your body replaces the oxygen attached to red blood cells in the blood, with carbon monoxide. This is because the affinity between haemaglobin (Hb) (in the red blood cells) and carbon monoxide is much stronger than the affinity between Hb and oxygen. This can be extremely dangerous and lead to hypoxia, irreversible brain damage and eventually death.

Symptoms of carbon monoxide poisoning include:

  • Tiredness
  • Shortness of breath
  • Headache
  • Dizziness
  • Nausea or vomiting
  • Weakness
  • Confusion
  • Loss of consciousness

If carbon monoxide poisoning is suspected you need to move the victim into fresh air, either by opening all the doors and windows or getting the person outside. This will allow some oxygen to start displacing the carbon monoxide. Definitive management is however in hospital with high flow 100% oxygen so you need to call an ambulance right away.

ELECTRIC HEATERS

Some of you may have electric heaters in your homes. These are safer than using gas and fire but still not 100% safe. Electric heaters use a lot of electricity so they can easily overload circuits and cause power failures or fires.

You should never plug in more than one electrical device into the same outlet as the heater to prevent overheating and overloading. To prevent electric shocks electric heaters should not be used in rooms where moisture builds up such as bathrooms and kitchens. There is also a fire risk if flammable items such as fabric come into contact with electric heaters that have hot elements and the electric bar heaters pose an additional burn risk.

Whatever heating methods you use this winter none of them are guaranteed safe, so remember to take the necessary precautions. It is important that you teach your children about fire safety from a young age. If your little ones do get thermal burns from poking fires and other heating elements follow the principles of first aid.

To find out more about management of thermal burns you can read my previous post: https://www.oneaid.co.za/baking-with-your-little-ones-safety-and-tips-to-taking-care-of-thermal-burns/. It is also recommended that you develop a fire escape plan and make sure your children know how to safely get out of the house in the event of a fire.

RESOURCES

https://www.betterhealth.vic.gov.au/health/healthyliving/gas-heating-health-and-safety-issues

https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Fire-Safety.aspx

https://www.nhs.uk/conditions/carbon-monoxide-poisoning/ https://riseandshine.childrensnational.org/how-to-protect-children-around-fireplaces/

Is It A Cold Or Is It The Flu?

Winter is here and so are coughs, colds and flu. Common colds and flu are both caused by viruses and share many of the same symptoms however colds are usually milder and do not cause any serious complications. More than 200 viruses can cause a cold whereas the flu is caused by the Influenza virus. This is why there is no vaccine available for the common cold.

WHAT IS THE DIFFERENCE?

Generally colds affect you from the neck up where the flu attacks your entire body. A cold causes a runny or blocked nose and sneezing. There may be a sore throat with a slight headache because of nasal congestion. A cough can develop but this is mostly because of a post-nasal drip. Cold symptoms usually last for about a week. If the symptoms do not improve after a week it is less likely to be a cold and an allergy or sinusitis should be considered.

The flu on the other hand causes more distressing symptoms. These include fever, chills, body aches, cough, weakness and extreme tiredness in addition to all the symptoms of a cold. Most flu symotoms also improve after a week but it is common to still feel a little weak and tired for up to two weeks.

Pneumonia is a complication of the flu, especially in the young, elderly and those with pre-existing chronic diseases. If your child seems to be getting worse, has difficulty breathing, is extremely lethargic or irritable, is refusing to take in enough fluids and/or has a persistently high fever you need to seek medical assistance.

HOW TO REDUCE THE RISK OF CATCHING A COLD OR THE FLU

  1. Vaccinate: make sure everyone in your family gets the seasonal flu vaccine every year. It takes about two weeks for antibodies to develop and offer protection. It is recommended you receive the flu vaccine before the flu season starts but it’s never too late. In South Africa the flu season usually starts around the first week of June but in previous years it has started as early as April.

  2. Hand washing: Make sure you wash your hands frequently and teach your children about good hand washing. Wash with warm soapy water for at least 20 seconds. Cold and flu viruses enter the body through the mucous membranes of the nose, mouth and eyes. This means that every time you touch these parts of your body with hands that have the virus you have a high risk of infecting yourself.

  3. Cover up:  teach your children to sneeze or cough into a tissue or their elbow and NOT into their hands.

TREATING A COLD OR THE FLU

Antibiotics do not work against viruses. Therefore they will not work for a cold or the flu unless a bacterial complication has developed. Often I see that antibiotics are prescribed for viral infections to “treat” the parents rather than the children. This is dangerous and will only lead to the emergence of more antibiotic resistance, which is already a major global problem. Some parents will argue and say that their child started recovering after a few days on antibiotics but this is probably because the viral infection has run its course and is coming to an end instead.  

There are plenty of over the counter (OTC) medicines available for cold and flu symptoms targeting both adults and children. However, these are not recommended for use in children under two years of age. Some experts even suggest avoiding them up to six years. There is very little evidence to prove that these medications work at all and some of them can cause serious side effects in younger children such as hallucinations, irritability, restlessness and abnormal heart rhythms. More importantly codeine, which is an ingredient commonly found in cough, cold and flu medications should not be given to children younger than 18 years of age.

There are some antiviral medicines available for the flu. These are typically prescribed to children at high risk of complications, such as children with asthma. These drugs work best if taken within 48 hours of the onset of symptoms and help by reducing the length and severity of the infection.

Unfortunately, there is no cure for the common cold and flu. It will usually clear up on its own and all you need to do is treat it symptomatically:

Analgesics and antipyretics: you can give your child paracetamol or ibuprofen, NEVER aspirin. To find out more about medicines for pain and fever in children you can read my previous blog: https://www.oneaid.co.za/medications-for-pain-fever-in-children/

Fluids: make sure to give your child lots of fluids to prevent dehydration especially if they have a fever and/or are refusing to eat.

Rest, rest and more rest: allow your child to rest. The body needs rest to recover so keep your child home from school and forget about extra murals for a while.

Nose sprays: the most important nose spray you should use is a saline spray. These help thin the mucus and reduce nasal congestion. There are also other decongestant nose sprays that can be used in older children.

Warm steam and humidifiers: sitting in a steamy bathroom or using a humidifier, which adds moisture to the room, can help loosen mucus in the nose and relieve coughing.

TOP 5 COLD AND FLU MYTHS

  1. Milk and other dairy products make a cold worse
    There is no evidence that dairy products increase mucus production.

  2. “Feed a cold, starve a fever”
    If your child have a fever they need more fluids. Fevers cause dehydration and this happens more rapidly in young children. Provide plenty of fluids when your child is sick and if he or she has an appetite, allow them to eat.

  3. The flu vaccine will give you the flu
    The flu vaccine is made from an inactivated virus so you cannot get the infection. People who do get sick after receiving the vaccine got the infection from another source and were going to get sick anyways. Also, some people develop flu-like symptoms after a vaccine. This is a normal immune response to a vaccine. These symptoms never last as long as the flu would.

  4. You can catch a cold or the flu by going outside in cold weather without a jacket, having wet hair in winter or walking barefoot
    Germs make you sick and not the cold. People make this natural association because the cold and flu season happens during winter. The reason for this is that in colder weather people tend to congregate closer together to keep warm and doors and windows stay closed. This allows viruses to spread more easily.

  5. Chicken soup will make you better
    There are no antiviral properties in chicken soup but it can definitely make one feel better. The warm liquid can soothe a sore throat and keep you hydrated and the steam can help break down nasal congestion and reduce stuffiness.

It’s quite common for children under two to have as many as 8-10 colds a year with prescholars getting around 7-8.  It takes years to develop an immunity to viruses and since there are more than 200 viruses that can cause a cold the high rate of infection in our little ones makes sense. Don’t despair, the cold and flu season does eventually end but for now it’s a great reason to give more healing cuddles and keep our little ones loved up and warm this winter.

RESOURCES

https://www.cdc.gov/flu/symptoms/coldflu.htm

https://www.fda.gov/consumers/consumer-updates/when-give-kids-medicine-coughs-and-colds

https://www.health.harvard.edu/diseases-and-conditions/10-flu-myths

http://www.nicd.ac.za/influenza-season-approaching/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722603/

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