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The Novel Coronavirus (2019-nCoV) Explained

This new Coronavirus has everyone in a panic. I have received so many messages from moms asking me how to prevent infection and what symtoms to lookout for. I hope this blog post will answer some of your questions.

WHAT IS NOVEL ABOUT CORONAVIRUS? 

Coronaviruses (CoV) are a large family of viruses that are zoonotic in origin. This means that they primarily circulate in animal populations but because viruses can mutate, they can jump species to other animals as well as humans and be transmitted through the infected animal’s poop or saliva. In humans, the virus causes respiratory symptoms, which are usually mild, but in rare cases these can be more severe. There are some strains of Coronovirus that are now endemic to humans. This means that these strains now circulate within the human population. They originated years ago from animals and cause very mild disease that more or less resembles the common cold.

The Coronavirus was actually responsible for the global epidemics of Middle East Respiratory Syndome (MERS-CoV) in 2012 and Severe Acute Respiratory Syndrome (SARS-CoV) in 2002/2003. Both of these strains originated from bats, which in turn infected camels (MERS-CoV) and civet cats (SARS-CoV) before jumping to humans.

Image Source: Timothy Sheahan, University of North Carolina

This novel Coronavirus (novel because it has never been seen before) was first isolated in Wuhan, China in December 2019 and was given its official name of 2019-nCoV. The animal source of this strain has not yet been identified but it is suspected that the source was from a live animal market in Wuhan, China where the outbreak began.

HOW DOES THE VIRUS SPREAD?

It was originally thought that this virus only spread through direct contact with the infected animal source but it has since been found that the virus is also being spread from person to person. This is occurring in people who have been in close contact with an infected patient be it a family member or healthcare worker.

Since the virus is a respiratory virus, its spread is very similar to other viruses which cause a common cold and the flu and this is through droplet spread. The virus is transmitted in tiny droplets when someone who is infected coughs or sneezes, or from direct contact with nasal discharge from an infected person, or from touching of a surface contaminated with infected droplets.

You cannot get this virus from any farm or wild animal you come across in South Africa and definitely not your pets. The animal has to be infected with the virus first and the source of this strain is in Mainland China so this is not really possible.

WHAT ARE THE SYMPTOMS OF 2019-NCOV?

Most people with this infection seem to be experiencing a mild respiratory illness with symptoms such as a runny nose, sore throat, cough and a fever. However, some people are having a more severe infection with shortness of breath, pneumonia, acute respiratory distress syndrome, kidney failure and even death. It appears that older people and people with pre-existing chronic medical conditions are at risk of more severe disease.

HOW IS 2019-NCOV DIAGNOSED?

The symptoms of 2019-nCoV disease, the flu and even the common cold are very similar, which makes it difficult to diagnose this novel coronavirus infection based on symptoms alone. The only way to make a definitive diagnosis is with laboratory testing. Swabs, sputum and aspirates need to be taken from the airways and the virus has to be isolated.

HOW CAN YOU TREAT 2019-NCOV? 

Currently, treatment is supportive since no specific treatment has been found to be effective yet. Antibiotics do not work against viruses. As we learn more about the virus other treatment options may become available.

WHO IS AT RISK OF INFECTION?

Currently to date there have been no confirmed cases of the virus in South Africa so there is no need for South Africans to panic. However, it is still possible that we may see cases later on.

People at risk include the following:

  • If you have recently been to China or in contact with someone who has travelled there, in the past 14 days.
  • If you have been in close physical contact with a person who has a lab confirmed infection or this person has been diagnosed clinically without lab testing, based on risk factors.
  • Healthcare workers caring for patients who are sick with the virus.

If you are at risk, the moment you experience any flu-like symptoms you should seek medical attention.

In order to protect yourself from getting infected by this virus you should follow basic hand and respiratory hygiene as you would for any common cold and the flu. Wash your hands regularly, keep a distance from people who are coughing, sneezing and/or have a fever and avoid touching your eyes, mouth and nose.

WHAT IS THE CURRENT SITUATION?

As of the 6th February 2020 there have been a total of 28, 276 confirmed cases worldwide. 28,060 of these cases are from China, 3,859 of which have been severe disease and 564 have resulted in death. Outside of China, 216 cases have been confirmed in 24 countries and only 1 death has occurred.

Image Source: WHO

These figures are changing daily as the number of infections is on the rise. The WHO is closely monitoring the epidemiology of this outbreak. If you would like to keep up to date with their daily reports you can click here.

RESOURCES

https://www.businessinsider.com/wuhan-coronavirus-sars-bats-animals-to-humans-2020-1?IR=T

https://www.cdc.gov/coronavirus/index.html

https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html

https://www.discovery.co.za/assets/discoverycoza/health-professionals/general/ncov-quick-reference.pdf

http://www.nicd.ac.za/minister-of-health-south-africa-update-on-coronavirus-2/

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/

https://www.who.int/health-topics/coronavirus

How To Organise Your Drug Cupboard

There is no right or wrong way to organise your drug cupboard, in fact there are quite a few different ways you might want to do this. The most important thing is to categorise your medications to make them easy to find when you need them. No body wants to be searching for the Panado in the middle of the night with a screaming baby.

How you group your drugs is really up to you and also depends on your individual family’s needs. Depending on how many children you have you may want to keep their medications separate from yours or if anyone takes any chronic medications you may also want to label a container specifically for them.

Below are some simple steps to help get your drug cupboard organised.

1. EMPTY EVERYTHING ONTO A TABLE

Take all your medications and whatever else you keep in your drug cupboard and lay it out on a table. This way you will be able to see what all you have, what is actually finished and what is missing. I can’t tell you the number of times I have gone in search of the ibuprofen for myself, only to discover I don’t actually have any.

2. CHECK EXPIRY DATES

Before you start grouping your medications you should have a look at all the expiry dates. Here again, you will be able to add to your shopping list of drugs you need to replace. You should throw all your expired medications into a bag to take back to your pharmacy for safe disposal (see my previous blog post for more information on this).

3. GET SORTING

Now comes the hard work, which can actually get quite confusing. How to best group your medications is a personal preference but I find that if you keep it simple it works best. The amount of groups you make also depends on the amount of space you have for storage. These are my groups.

  • First Aid (includes a first aid kit)
  • Pain & Fever
  • Tummy (nausea, vomiting, constipation and diarrhoea meds)
  • Allergies
  • Eyes & ENT (ear, nose and throat)
  • Colds & Flu
  • Vitamins & Antibiotics
  • Chest (this includes the nebules and saline for the nebuliser)
  • Miscellaneous
  • Daily

I have a daily container, which comes out in the mornings. This makes it easy for me to remember taking my vitamins and any other medications we may be taking acutely, such as antibiotics. Your groups may look different if you don’t use a nebuliser for example, or take any daily meds, or maybe you only have one nose spray that you can group together under allergies. Once you have grouped all your medications together you will be able to see how many separate containers you will need and also how big they need to be. If you don’t have any or enough containers lying around at home, you can get a wide range of different sizes from West Pack Lifestyle stores.

It’s also important for Dad or a caregiver to be able to find the drugs, so don’t get too fancy or try grouping together too much drugs. Mom will almost always know where each drug is kept because more often than not she is the one who bought and packed it away.

4. DRUG STORAGE

Where you store your drugs is important. You need to keep them out of reach of your children and pets and also in a cool, dry place. The bathroom is not a good idea because the heat and moisture from the shower and bath will damage your medication and affect its efficacy. If you choose to store them in the kitchen make sure they are away from the stove, sink and any other hot applicance. I keep my medications in the pantry out of reach of my daughter, the dog, the heat and direct sunlight.

You should always keep your medications in their original containers and do not throw away the information leaflets once opening the boxes. You never know when you need to refer back to them to look for a side effect or drug interaction.

Some medications have silica gel sachets inside them. It’s a good idea to keep those in the bottle because they help absorb moisture in the air and keep your tablets and capsules dry. The cotton ball things you can throw out because those actually pull moisture into the bottle. They are only there for transportation to prevent the tablets from knocking about in the bottle and breaking.

It’s as simple as that! Now you have a tidy and organized drug cupboard, which will not only save you time but also money. You won’t end up buying something you already have because now you know exactly where it is.

How To Discard Of Expired Or Unused Medications

I usually go through all my medications during National Pharmacy Month in September since that’s when I usually remember to do so. It’s also the month I make time to reorganise my drug cupboard. However, this year I have seen many of you start off the new year by decluttering your homes and doing a little bit of “spring cleaning”.

If you are doing this then I definitely recommend going through your medicine box because if you are anything like me, you probably have lots of half used medications that have probably expired.

HOW SAFE ARE MEDICATIONS PAST THEIR EXPIRY DATE?

It seems an absolute waste to throw away medications that are unused or even only half used. Interestingly, a study done by the FDA found that most drugs are actually still safe and effective to use as many as 15 years past their expiry date.

The expiry date is really a guarantee from the manufacturer that the drug will maintain its full potency and effectiveness up until said date. The overall effectiveness of a drug depends on the potency of all its individual ingredients and how the drug is stored in your home. This makes it difficult to determine how long a drug will truly be effective for, outside of a controlled laboratory environment. This is why it’s better to just adhere to the expiry date and discard of your medicines once this date has been reached. You really don’t want to be giving your child a less potent antibiotic, which may result in antibiotic resistance, or a less potent antiepileptic and then your child develops a breakthrough seizure.

SAFE MEDICATION DISPOSAL – WHAT’S RECOMMENDED VS. THE REALITY

Worldwide, the recommended and safest way to dispose of medication is simply to return them to your pharmacy. In South Africa, this is actually the only recommended method of disposal. Pharmacies are by law required to take back your expired or unused medications. I do not know however how well this law is being enforced because as a healthcare professional I did not know about it. In fact on questioning some of my colleagues they confessed to simply just throwing their medications away with their general trash.

I am pretty sure many of us are guilty of this and in some countries it’s not totally wrong, if done properly. This is an alternative used in the US, if you are unable to take back the medication to the pharmacy. What you need to do first is try and disguise them so that they are less appealing to children and even pets if they come across them before you throw them away.

Remove all drugs from their original containers and blister packs and mix them with something like coffee grounds, sand or even kitty litter, this includes liquids. This helps disguise the medication. Put this mixture into a sealable bag and throw into the trash, preferably a bin outside of your house. It is not advisable to crush pills or empty capsules beforehand because of the risk of exposure to the drug through your skin and even by breathing in the dust. Drugs are usually released slowly into the body and by exposure through crushing the immediate dosage may be much higher than normal and can be toxic.

People also like to flush drugs down the drains and toilets, especially liquids. The problem with disposing of drugs in the trash or flushing them down the drain is that at some point they will end up in a landfill or a water system, where they can be harmful to the environment; plants, animals and even humans since they will inevitably find their way back into our food chain. Interestingly though, some medications do actually indirectly end up in our water systems, without us even realizing, since the drugs we take pass through our systems, and the byproducts are eventually excreted in our urine or faeces.

In the US again they actually do allow some drugs to be flushed down the drain if they cannot be taken back to a pharmacy. These are mostly your Opioids and its derivatives, as well as the Benzos such as Valium. The risk of these getting into the wrong hands far outweighs the negative effects on the environment.

There are some special considerations with inhalers. These devices use gases to propel the medication out of the canister. Unfortunately some of these gases are powerful greenhouse gases so these definitely need to be returned to the pharmacy because if not the canisters will end up on some landfill somewhere and continue to release these gases if not completely empty.

You can also check the packaging and drug information leaflets before disposing of the medication. There may be instructions for disposal of that particular drug. Apparently such guidelines are going to be implemented in South Africa in the near future.

IS MEDICATION PACKAGING RECYCLABLE ONCE EMPTY? 

Some glass and plastic medicine bottles can be recycled depending on what type of glass and plastic resin they are made up of. The plastic parts of inhalers can usually be recycled. You should be able to confirm this with your local recycling plants. There are also lots of ways to repurpose old medicine bottles and get crafty with your little ones.

Blister packs are a little trickier because they are a combination of foil and plastic and are therefore not readily recycled in this form. You can however try to separate the parts by peeling away the foil carefully from the plastic (I actually tried this the other day and I found it almost impossible). But the plastic recycling may still be a problem because one can never (or rarely) identify the type of plastic resin used. The foil is readily recycled and so are the paper boxes that house the blister packs. Always remember to remove all personal identifiers on prescription labels before throwing packaging away.

RESOURCES

https://www.bbc.com/news/health-50215011

https://earth911.com/living-well-being/health/recycling-blister-packs/

https://www.fda.gov/consumers/consumer-updates/where-and-how-dispose-unused-medicines

https://www.guild.org.au/news-events/news/forefront/volume-7-issue-1/safe-disposal-of-unwanted-medicines

https://www.hpcsa.co.za/Uploads/Legal/legislation/medicines_and_related_sub_act_101_of_1965.pdf

https://www.iol.co.za/lifestyle/health/expired-medicines-safety-effectiveness-and-disposal-11224738

https://psnc.org.uk/services-commissioning/essential-services/disposal-of-unwanted-medicines/

 

Are Essential Oils Safe For Children?

South Africa has joined the new oil boom and you can now readily find doTERRA and Young Living essential oils on our shores. With all the apparent “positive” effects these oils are having and especially since I am seeing so many parents use these oils on their children, I decided to do a little research, because for me, it’s all in the evidence.

WHAT ARE ESSENTIAL OILS?

Essential oils (EO) are not a new thing, they have been around for years. These oils are extracted from flowers, herbs and other plants and used to promote physical and emotional wellbeing.

Many pharmaceutical drugs used today are actually derived from plant sources. Drugs such as digoxin, quinine, morphine, codeine and aspirin all find their origins in plants. So it only makes sense to assume that essential oils must be effective against some medical conditions too.

IF IT’S NATURAL IT MUST BE SAFE?

Just because it’s natural does not always mean it is safe. Some of the most poisonous toxins in the world are found in plants – think belladonna and oleander.

Children have different absorption, distribution, metabolism and excretion of substances compared to adults. They also have immature body systems, which all make them more sensitive to the side effects of essential oils, regardless of how ‘natural’ a substance may be. There are also some children who are more sensitive than others because they are more allergy-prone.

There are, of course, other concerns with essential oils. Concerns about carcinogenicity, mutagenicity and toxicity to the fetus in pregnant women and also what effects certain oils have on breastfed infants.

IT’S ALL IN THE RESEARCH

Using essential oils in low concentrations and inhaling their vapours is usually safe for most people. But when it comes to our little ones we can never be too safe. There is very little research available on the benefits of essential oils and even less on how these oils affect babies and children.

While aromatherapy has been practiced for centuries in various cultures, it has not yet been properly evaluated for medical effectiveness. Most of the research that has been done has not been done on human subjects and those that have been done on adults are poor quality.

While we can argue that there is some evidence to show that essential oils improve physical and emotional wellbeing, I have reason to be concerned with the drug-like claims some people make about these oils. Essential oils should NOT replace scientifically proven effective (and safe) medical treatments for medical conditions.

SPECIAL CONSIDERATIONS WHEN USING ESSENTIAL OILS IN CHILDREN

  1. Essential oils are not a replacement for medical care.
  2. According to the American Association of Naturopathic Physicians, essential oils should not be used in babies younger than three months old.
  3. Children and babies should NEVER take essential oils orally.
  4. Always make sure you use a pure essential oil. Don’t use ones that are premixed with alcohol or other synthetic fragrances, as these can irritate the skin.
  5. Never apply an essential oil directly onto your child (and even your own) skin. Always mix it with a carrier oil such as coconut or grapeseed oil. You should probably ask a distributor about the difference between linoleic and oleic acids. Oils high in oleic acid are not recommended for sensitive skins prone to conditions such as eczema.
  6. Always dilute essential oils. Follow the recommended dilution ratios. If you are buying your EO from a distributor they should be able to give these to you.
  7. Diffusing oils is generally safer than applying them to the skin. If you are going to be using a diffuser, pay attention to your child’s reaction. Sometimes the oil particles enter the airways and can cause irritation especially if your little one has a reactive airway.
  8. If your child develops a rash or skin irritation, headaches, nausea and/or vomiting, coughing, wheezing or difficulty breathing, stop using the essential oils immediately and contact your healthcare provider.
  9. Do a patch test first to see if the oil causes irritation. Rub the oil into a small part of the forearm and wait 24 hours. If you notice any redness, swelling or a rash develop do not use this oil.
  10. Do not apply essential oils topically to children with sensitive skin, eczema or other chronic skin conditions as this can cause aggravation.

Remember as with all medications in your home, keep them out of sight and out of reach of your children because many essential oils are extremely toxic in overdose. Accidental poisoning with essential oils in children is becoming increasingly more common, since most essential oils smell nice. Children are also more likely to choke on these oils because of their bitter taste. This will send these oil particles straight into the lungs and cause aspiration pneumonia, which can be fatal.

All this being said, I am not anti-essential oils. In fact, I have seen some benefits of their regular and correct usage in my own household. However, what I am against is when parents claim that essential oils can prevent or treat medical conditions. Essential oils are prescribed to help promote wellbeing. Promote meaning to support and not cure.

Since there is no solid evidence that essential oils are safe and effective in children, major organisations such as the American Academy of Pediatrics (AAP) do not recommend using them at all in children. My advice to parents is to use them as directed, as you would administer prescribed medication to a child. Not all oils can be used on children and some can only be used on children over a certain age. Do your homework. Natural does not equate to safe, so please always be mindful.

RESOURCES

https://www.healthline.com/health/parenting/essential-oils-for-babies#TOC_TITLE_HDR_1

https://healthywa.wa.gov.au/Articles/A_E/Essential-oils

https://parenting.nytimes.com/childrens-health/essential-oils-safe

https://pediatrics.aappublications.org/content/112/Supplement_1/240.abstract

https://www.poison.org/articles/2014-jun/essential-oils

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

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