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How Safe Is Your Car Seat?

We all know how long it can take for a child to fall asleep. So when you reach your destination and your little one has finally fallen asleep you couldn’t feel more relieved. You wouldn’t dream of disturbing them by removing him or her from the car seat. Instead you do what is the most convenient, and move your child from your car into a pram chassis or straight into your home without ever moving them from the car seat.

Whilst car seats have saved many lives, they do have some hidden dangers. A study in 2015 found that out of all the sitting and carrying devices for young children, car seats were responsible for the most number of deaths. Hypoxia and suffocation from either poor positioning in the car seat or strangulation by the straps and buckles was the cause of death in all these cases.

HYPOXIA

This is when there is a loss of oxygen in the blood which reduces the amount of oxygen reaching the tissues. When there is an extreme loss of oxygen a child will suffocate.

The developing brain is very sensitive to a decrease in oxygen. Loss of oxygen can cause brain injury and result in a range of developmental problems as well as seizures.

POSITIONING

The position of your car seat is important. The Recline Angle of a rear-facing car seat is critical and an angle between 30-45o from the vertical is recommended. A recline angle more than 45o offers very little protection in the event of a crash.

A newborn or young infant’s head is heavy and the neck muscles are weak. If the recline angle becomes less and the car seat more upright, the head will flop down and obstruct the airway. A newborn should therefore be positioned in the lowest possible position, which still offers crash protection. As babies grow their neck muscles get stronger and the angle of the car seat can become more upright since their head and neck control improves.

 

The recline angle of a rear-facing car

 

A number of studies have looked at the level of oxygen in an infant’s blood whilst in their car seat. A level of oxygen less than 90% is considered dangerous. It was shown that children’s oxygen levels dropped as far down to 83.7% when in incorrectly positioned car seats. The authors also found that the longer the child remained in the car seat the lower the oxygen level would drop.

Another study found that a child in a correctly placed rear-facing car seat is still at risk of suffocation. The vibration produced by a car could cause newborns and young children’s head and shoulders to fall forward, despite correct use of the straps and buckles. This risk was also similar for both term and preterm infants.

Some specialists recommended that young babies spend no more than 30 minutes to an hour in a car seat at a time. If a long journey is unavoidable it may be wise for someone to sit in the back with your child to keep an eye out.

STRAPS AND BUCKLES

Always make sure your child is properly securely in a car seat. If the straps are too loose a child can easily slip or even wriggle down far enough to become strangled by the straps. If the child falls lower down in the seat the child may also suffocate from an obstructed airway if the head falls onto the chest.

NEVER

  • Never place your baby in a car seat on a soft surface such as a bed or couch. This type of surface could cause the recline angle to change resulting in your child’s head falling forward and obstructing the airway.
  • Never loosen or unbuckle any straps if you do decide to keep your baby in a car seat outside of the car. A child can wriggle and slip down far enough to be strangled by the straps and even fall out of the car seat altogether.
  • Never leave an infant or young child unsupervised in a car seat if they are asleep or even if they are awake.
  • Never place your baby in a car seat on an elevated surface such as a table. A baby can wriggle enough to cause the seat to move and fall off the surface.
  • Never place your baby in a car seat on the floor without looking at the recline angle. Some car seats may become more upright when placed on the floor.

Always make sure your car seat is installed correctly. Most car seats come with a built-in indicator that allows you to see if the seat is installed at the proper angle.

Read the manual carefully and if in doubt contact the local manufacturer or distributor. You can also contact Julie at Precious Cargo (www.preciouscargo.co.za) to book a professional car seat installation.

RESOURCES

Arya, R., Williams, G. and Kilonback, A. et al. (2017) Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed, [online] 102, pp. 136-141. Available from: https://fn.bmj.com/content/fetalneonatal/102/2/F136.full.pdf [Accessed 13 September 2018].

Batra, E.K., Midgett, J.D. and Rachel Y. Moon (2015) Hazards Associated with Sitting and Carrying Devices for Children Two Years and Younger. The Journal of Pediatrics, [online] 167, pp. 183-187. Available from: http://dx.doi.org/10.1016/j.jpeds.2015.03.044 [Accessed 13 September 2018].

CPSBestPractice (2018). Rear-facing restraint recline angle. [image] Available at: https://sites.google.com/a/umich.edu/cpsbestpraci/resources/rear-facing-child-restraints [Accessed 14 Sep. 2018].

NHS (2016) Warning over babies sleeping in car seats. [online] Available from: https://www.nhs.uk/news/pregnancy-and-child/warning-over-babies-sleeping-in-car-seats/ [Accessed 13 September 2018].

Rholdon, R. (2017) Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep. Nursing for Women’s Health, [online] 21 (3), pp. 225-230. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28599744 [Accessed 13 September 2018].

The Dangers of Party Balloons

We recently celebrated my daughter’s two-year birthday and, of course, decorated the house with balloons. No children’s birthday party is complete without balloons and although they are very popular with kids, they can also be extremely dangerous. Which is why I wanted to do a post on the potential dangers of balloons:

CHOKING HAZARD

Children can choke on balloons if they breathe them in whilst trying to blow them up. This happens when a child takes in a deep breath before inflating the balloon and accidently sucks the balloon back into his or her mouth. A child can also choke if they swallow deflated balloons or pieces of popped balloons they may chew on. If a balloon pops in a child’s face the child can also inhale the balloon pieces as they fly through the air.

Latex is a dangerous material to choke on as it can fit tightly in the throat and cause a complete airway obstruction very quickly. Whilst foil balloons are usually blown up with helium they can also become a choking hazard if deflated balloons or broken pieces are swallowed. There was a widely reported incident in 2016, where a three-year-old suffocated after putting the foil balloon over her head.

BURSTING HAZARD

Balloons can pop without warning. They can pop if children play with them roughly or if little children chew on them. Poor quality balloons can also pop more easily even if they aren’t being rough-handled. Children can also trip over balloon strings and fall onto the balloons popping them. If balloons pop near a child’s face they can cause serious damage to the eyes as well as cuts to the face.

STRANGULATION HAZARD

This may be an overlooked hazard. The colourful strings and ribbons that are tied to balloons can become a strangulation hazard as children become tangled.

ALWAYS KEEP IN MIND

  • Keep uninflated balloons away from children
  • Do not let children blow up balloons
  • Inflated balloons should be kept out of reach of children
  • Children should never play with inflated balloons
  • Always supervise children when inflated balloons are around
  • Throw away deflated and popped balloons immediately
  • Throw away balloon strings immediately when balloons deflate and pop

In the United States the Child Safety Protection Act requires a warning to be placed on any latex balloon or toy containing a latex balloon. This warning states that children under eight years of age are at risk of choking or suffocating on uninflated or broken balloons. Similarly, in the EU, children under the age of eight are actually legally banned from blowing up balloons without adult supervision.

However, children as old as 10 years have been found, on autopsy, to have suffocated from a balloon, which makes it difficult to define what age is actually safe for kids to handle balloons.

I think its important to stress to your kids that party balloons are not toys. They are purely for decoration and should always be properly secured and disposed of after use.

RESOURCES

CPSC (2012) CPSC Warns Consumers of Suffocation Danger Associated with Children’s Balloons. [online] Available from: https://www.cpsc.gov/s3fs-public/5087.pdf [Accessed 6 September 2018].

Francis, P.J. & Chisholm, I. H. (1998) Ocular trauma from party balloons. British Journal of Opthalmology, [online] 82 (2). Available from: https://bjo.bmj.com/content/82/2/203.1 [Accessed 6 September 2018].

Meel, B.L (1998) An Accidental Suffocation by a Rubber Balloon. Medicine, Science and the Law, [online] 38 (1), pp. 81-82. Available from: https://doi.org/10.1177/002580249803800113 [Accessed 6 September 2018].

Does Your Child Need a Tetanus Shot or Not?

I’ve had parents often come into the emergency room after their child has taken a tumble asking for a Tetanus vaccine, which is why I felt the need to write a post explaining what Tetanus is and why we need to vaccinate our kids.

WHAT IS TETANUS?

Tetanus is a disease commonly known as lockjaw. It is caused by the bacteria, Clostridium tetani and can be fatal. The toxin from the bacteria affects the nervous system and causes severe painful muscle spasms, which can interfere with the ability to breathe. Currently there is no cure for Tetanus and treatment is mainly symptomatic until the effects of the toxin wear off. Complete recovery can take up to several months.

WHERE IS THE BACTERIA FOUND?

Clostridial spores can be found everywhere. They are found in soil, dust and animal faeces (including humans). Once the spores enter a wound they grow into mature bacteria, which produce the powerful toxin. Clostridium tetani is found worldwide.

WHAT ARE THE SIGNS AND SYMPTOMS OF TETANUS?

Signs and symptoms of tetanus can appear anytime from a few days to a few weeks from infection:

  • Spasms and stiffness of jaw muscles (hence the name lockjaw);
  • Spasms and stiffness of the neck muscles;
  • Difficulty swallowing;
  • Spasms and stiffness of other body muscles, commonly the abdominal muscles;
  • Other constitutional symptoms such as fever, sweating and palpitations.

TETANUS VACCINATION

I won’t go into too much detail regarding the various combination vaccines as there are many and every country has its own recommendations. A copy of the latest South African immunisation schedule can be downloaded from my resources page. The WHO recommends an initial 6-dose schedule to achieve tetanus immunity.

1. Primary vaccination

Three primary doses of the vaccine are recommended in childhood starting from 6 weeks.

2. Booster vaccination

Three booster doses are recommended prior to adolescence. Booster vaccines are then recommended every 10 years thereafter.

TETANUS-PRONE WOUND

  • This is any wound that has been contaminated with material that could contain tetanus spores;
  • This is any wound that is deep;
  • This is any wound that is dirty;
  • This is any wound that contains a foreign body.

Note: any wound can be tetanus-prone – cuts, scrapes, burns, animal (including human) and insect bites.

WHEN TO SEE A DOCTOR

It is recommended you see a doctor if:

  • Your child has a tetanus-prone wound and has not had a booster vaccine in the last 5 years;
  • Your child has a minor, clean wound and has not had a booster vaccine in the last 10 years;
  • Your child has a wound and you cannot remember when their last booster vaccine was.

RESOURCES

CDC (2018) Tetanus. [online]. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html#contraindications [Accessed 30 August 2018].

WHO (2018) Tetanus vaccines: WHO position paper, February 2017 – Recommendations. Vaccine. [online] 36 (25). Available from: http://dx.doi.org/10.1016/j.vaccine.2017.02.034 [Accessed 30 August 2018].

WHO (2018) Tetanus. [online]. http://www.who.int/ith/vaccines/tetanus/en/ [Accessed 30 August 2018].

Picking Scabs & Popping Blisters

I remember my mother telling me when I was a little girl that I shouldn’t pick my scabs because it would cause scarring. Now it is believed that the scabs themselves actually cause more scarring and the recommended treatment of skin wounds has moved away from dry healing towards moist healing.

What is dry healing?

This is when a wound is left open to dry out or it’s simply covered with a dressing. This method allows a hard scab to form over the wound on the outside. It was thought that the scab protected the damaged skin underneath and would eventually fall off once the skin defect had healed. The scab was also meant to protect the wound from infection.

What is moist healing?

This is when an ointment is applied to a wound and it is covered with a dressing. It has been proven that epithelialisation (formation of new skin) happens much faster in a moist environment when compared to dry one. Leaving a wound to dry out allows the new skin cells that are trying to grow and cover the skin defect to dry out and die resulting in more inflammation. This causes further pain, slows down the healing process and leads to more scarring. Previous beliefs that a moist dressing resulted in infection have not been proven.

When should you apply a moist dressing?

You should provide a moist, but not too wet, environment for cuts, scrapes and burns. Small cuts and scrapes that have already scabbed can be left open.

What is a blister?

A blister is a pocket of fluid collection within the superficial layers of the skin. They can develop when the skin is damaged by friction, extreme temperature (hot and cold) or certain chemicals that come in contact with the skin. The fluid acts as a barrier protecting the injured tissue underneath so it can heal.

How to treat a blister

Do not pop a blister! The blister protects the underlying skin from infection. The fluid within the blister also contains proteins that help promote healing. As the skin underneath heals the fluid in the blister disappears and the skin peels off. It is best to keep the blister covered with a dry dressing to avoid it getting scraped or torn open. If the blister does burst open, clean the wound gently without pulling off any skin, and apply a moist dressing.

How to clean a wound and apply a moist dressing

  1. Clean your hands thoroughly with soap and water or a hand disinfectant.
  2. Put on disposable gloves if available.
  3. If the wound is bleeding, stop bleeding by applying pressure with a clean gauze, bandage or cloth.
  4. Rinse the wound under running water for 10 minutes. Use a gauze pad or cloth soaked in water to gently wipe the wound and surrounding skin of any dirt and debris.
  5. Gently pat wound dry using a clean gauze or cloth. Do not use cotton wool as the fluff may stick to the wound.
  6. Apply a topical ointment such as petroleum jelly or equivalent. A thin layer of an antiseptic cream such as Cetrimide can also be used if the wound is at risk of infection.
  7. Cover the wound with a sterile dressing such as a non-adherent pad and bandage or a plaster.
  8. Clean the wound daily with running water and reapply a new moist dressing until the wound has healed.

Moist Healing plasters

Many brands have developed plasters that are designed to keep wounds moist without having to apply a topical ointment. These dressings provide a moist environment by absorbing and retaining fluid from the actual wound. Some of these plasters do not need to be changed daily. Make sure to read the directions on the box before applying your plaster.

As our little ones explore this world there is no doubt you will have to deal with many cuts and scrapes and even though wound healing is individualised most minor wounds will heal well with no complications if looked after from the very beginning.

RESOURCES

Elastoplast, (2018). 4 Reasons for Moist Wound Healing. [online] Available at: https://www.elastoplast.com.au/first-aid/wound-care/moist-wound-healing [Accessed 21 August 2018].

Field, C.K. & Kerstein, M.D. (1994). Overview of wound healing in a moist environment. The American Journal of Surgery, [online] 167 (1), pp. S2-S6. Available at: https://doi.org/10.1016/0002-9610(94)90002-7 [Accessed 21 August 2018].

Junker, J.P.E., Kamel, R.A., Caterson, E.J. & Eriksson, E. (2013). Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care, [online] 2 (7), pp. 348-356. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842869/ [Accessed 22 August 2018].

Everything You Need To Know About Safe Babywearing

Babywearing is becoming increasingly more popular with many different types and brands to choose from. All over the world women have fashioned slings out of various blankets, fabrics and cloths.

THE BENEFITS OF BABYWEARING

  1. It is great for bonding with your baby.
  2. It supports breastfeeding.
  3. It helps reduce symptoms of reflux and indigestion in your baby.
  4. It provides deep touch pressure which helps calm your baby. Deep touch pressure affects the nervous system slows the heart rate and results in a calming affect.
  5. It provides vestibular-proprioceptive stimulation which also helps calm your baby by inhibiting the movement muscles and relaxing the body.
  6. It is convenient to have free hands.

HOW TO WEAR A BABY CARRIER

Before you buy a carrier it is important that you know how to wear one correctly so that your baby can be kept safe. Regardless of whether you decide to wear your baby on your back or in the front, facing in or facing out, Airway and Position are the two most important things you have to remember.

Keep Your Baby’s Airway Clear:

Young babies do not have good neck control. The head and neck need to be supported to keep the airway open as there is a real risk of suffocation in a baby carrier.

  • The chin must not rest on the chest but rather be angled up.
  • The face must not be pressing into the chest. Rather position the ear against chest.
  • Make sure there is no fabric covering the face. The face must be visible.
  • Carry your baby close and tight against your body. If your baby is loose, he or she can slide down in the carrier and obstruct their airway.

Position your baby properly:

Improper positioning can also result in airway compromise as well as increase the risk of hip dysplasia. 

  • Keep your baby upright at all times, except when breastfeeding (remember to reposition your baby again afterwards).
  • Position baby high enough to be able to kiss his or her forehead.
  • Your baby’s knees should be positioned higher than his or her bottom and the legs must be spread in order to support the hips and spine (much like a frog).

The Consortium of UK Sling Manufacturers and Retailers have developed an acronym (T.I.C.K.S) to help you remember the correct way to carry your child.

Tight

In view at all times

Close enough to kiss

Keep chin off the chest

Supported back

 

HIP DYSPLASIA EXPLAINED

Hip dysplasia is an abnormality of the hip joint where the ball part of the joint does not sit securely in its socket. An infant’s hip joint is made up of mostly soft cartilage unlike an adult’s hard bone. Therefore it’s easier for the ball part of the joint to slip out. Chronic poor positioning is an important risk factor for the development of hip dysplasia in infants, especially in the first 6 months of life. When the hips are not supported and the legs are kept straight the resulting forces make the joint unstable (fig. 1). As a child gets older the bones start to harden and the joint becomes more stable.

Fig.1: Understanding Position and Hip Dysplasia

CONCERNS ABOUT SLINGS

A sling is basically a tubular piece of fabric in which a baby nestles. They are great for skin-to-skin contact and bonding, however there are a few safety concerns:

  • It is difficult to support and control the position of the head and neck.
  • There is a risk of restricting airflow if the fabric completely encases the baby.
  • There is a risk of obstructing the airway if the face presses up against the fabric.
  • Slings do not allow for proper support of the hips and therefore there is a risk for hip dysplasia.
Fig.2: Incorrect

 

Fig.3: Correct

 

 

CHOOSING A BABY CARRIER

Make sure it is suitable for your baby’s age: Slings and outward facing carriers are not recommended for newborns up to around 4 months of age.

Make sure it can provide proper positioning:Some carriers do not support the spine and hips adequately. Take your baby along when buying a carrier and test it out. Have a look at the sitting position your baby adopts in both inward and outward facing positions. Some carriers are better for inward facing than outward facing. It is easier for an inward facing baby to lean against you and assume a frog-like position with the hips bent. In an outward facing position the hips may not be supported as much and the legs can then hang straight.

Make sure it is comfortable for you to wear: Babies grow very fast in the first few months. Make sure you choose a carrier that is ergonomic and helps take the increasing weight off your back.

Make sure the carrier is ASTM approved: Many baby products have to adhere to strict safety standards and baby carriers are no exception.

DOS AND DON’TS 

  • Do not drink hot fluids while wearing your baby.
  • Do not drive a car or ride a bicycle while wearing your baby.
  • Do not do any form of intense exercise while wearing your baby.

Whatever carrier you do go for, remember to wear it safely!

RESOURCES

Babyslingsafety, (n.d.) The T.I.C.K.S Rule for Safe Babywearing. [Online]. Available from: http://babyslingsafety.co.uk [Accessed15 August 2018].

Esposito, G. et al., (2013) Infant Calming Responses during Maternal Carrying in Humans and Mice. Current Biology. [Online] 23, pp. 739-745. Available from: http://dx.doi.org/10.1016/j.cub.2013.03.041 [Accessed 14 August 2018].

International Hip Dysplasia Institute, (2015) Baby Carriers, Seats, & Other Equipment. [Online]. Available from: http://hipdysplasia.org/developmental-dysplasia-of-the-hip/prevention/baby-carriers-seats-and-other-equipment/ [Accessed 14 August 2018].

Ludington-Hoe, S.M. (2011) Evidence-Based Review of Physiologic Effects of Kangaroo Care. Current Women’s Health Reviews. [Online] 7, pp. 243-253. Available from: http://eurekaselect.com/88428 [Accessed 14 August 2018].

10 Essential Tips To Prevent Poisoning In Your Home

I was recently prescribed some analgesics for a small day procedure. That afternoon, when I got home, I placed the packet of meds on my dresser and later found my daughter sitting on the floor inspecting the packet. My heart stopped! This careless mistake could have had devastating consequences.

Unfortunately poisoning data in South Africa is lacking. One study dating back to 2012 found that the most common cause of accidental poisoning in SA children is pesticides. However, the list of potential poisons throughout our homes is extensive; here are just a few more obvious ones:

  • Medications
  • Household cleaners and disinfectants
  • Cosmetics and toiletries
  • Insect and rodent repellants
  • Weed killers and other outdoor chemicals
  • Swimming pool chemicals
  • Flea and tick shampoos and other products for pets

I have put together a list of some useful tips to prevent accidental poisoning at home. Some of them may seem fairly obvious but as I have recently experienced it is easy to forget.

  1. Keep all potential household and other hazards in their original containers. DO NOT transfer into coke bottles or Tupperware’s.
  2. Make sure seals of potential hazards are tight and secure before locking away. Please note that child resistant packaging of medications is NOT childproof.
  3. Keep potential hazards locked away in the highest cupboard with a childproof lock. The cupboard should even be high for you, as little minds can get quite creative with boxes and stools and climb up onto countertops.
  4. Keep potential hazards out of reach of children when in use and never leave bottles or buckets unattended.
  5. Never call medicine sweets/candy. This is a common mistake parents make in order to get their kids to take medicine when sick. This could lead to a child one day consuming an entire bottle of ‘sweets’.
  6. Never leave your handbag lying around and be extra cautious when you have visitors over as many people keep painkillers in their bags.
  7. Alcohol is often overlooked and is very dangerous to your little ones if consumed in excess. Keep alcohol out of reach of children especially when hosting parties.
  8. Any kind of battery can be dangerous if leaking or ingested. Keep remote controls and other battery containing devices away from children.
  9. If you are unsure about whether or not a household item is hazardous, assume it is and keep it locked away. Things that seem harmless are most often extremely dangerous.
  10. Most importantly TEACH your children about the dangers!

It may be a good idea to identify what potential hazards you have in your home. Do a check of every room in the house including your garage and make sure your home is safe.

RESOURCES

Balme, K., Roberts, J.C., Glasstone, M., Curling, L. & Mann, M.D. (2012) The changing trends of childhood poisoning at a tertiarychildren’s hospital in South Africa. South African Medical Journal. [Online] 102 (3), pp. 142-146. Available from: http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000300023&lng=en&tlng=en [Accessed 8 August 2018].

Veale, D.J.H., Wium, C.A. & Müller, G.J. (2012) Toxicovigilance I: A survey of acute poisoning in South Africa based on Tygerberg Poison Information Centre data. South African Medical Journal. [Online] 103 (5), pp. 293-297. Available from: http://www.samj.org.za/index.php/samj/article/view/6647/5054 [Accessed 8 August 2018].

Emergency Numbers Every Parent Should Know

It occurred to me the day I went back to work after my maternity leave that I didn’t know any other emergency number besides 10111. Thankfully I have never had to use this but I couldn’t risk leaving my daughter at home with her caregiver without leaving a more comprehensive list of important numbers by the phone.

The last thing you want to do in an emergency is dial the wrong number. In the US, the UK and Europe there is only one toll-free number to call from any landline or mobile phone. In South Africa, things are not as simple. Unfortunately there isn’t one single number for an emergency.

I spent a really long time searching the web and making a couple of phone calls but I finally managed to put together this simple list. It is vital that you as parents and/or caregivers know what number to dial when and it is perhaps even more important that your little ones know this too.

USING YOUR CELL PHONE:

Any emergency nationwide – 112 (this number will still work even if you have no airtime)

USING YOUR LANDLINE OR CELL PHONE:

Police/Fire – 10111

Nationwide ambulance (public EMS) – 10177

Netcare 911 (private EMS) – 082 911

ER 24 (private EMS) – 084 124

Poison Information Centre – 0861 555 777

Remember, before making that emergency call, try to stay calm. You also need to have important information ready such as, the type of emergency, details of any injuries and the exact location of the emergency needing attention.

You can download a list of important emergency numbers here. It may be a good idea to stick this on your fridge or somewhere nearby the phone.

Child Immunisation Schedule SA

South Africa offers an extensive child immunisation program. All these vaccines are available at public clinics for free. Private clinics also offer an immunisation program, however, some fee may be involved, as not all medical aids pay for the vaccines. The private schedule offers more vaccines than state clinics and there may also be differences in schedules between private and public.

The following two tables below outline the different immunisation schedules.

Department Of Health Extended Program Of Immunisation (EPI) Schedule:

AGE OF CHILD VACCINATION PROTECTS AGAINST
Birth BCG Bacillus Calmette Guerin Tuberculosis
OPV (0) Oral polio vaccine: OPV-Merieux/Polioral Polio
6 weeks OPV (1) Polio
RV (1) Rotavirus vaccine: Rotarix Rotavirus
DTaP-IPV-Hib-HBV (1) Hexavalent: Hexaxim Diphtheria, tetanus, acellular pertussis (whooping cough), polio, haemophilus influenzae type B, Hepatitis B
PCV 13 (1) Pneumococcal conjugate vaccine: Prevenar-13 Pneumococcal diseases
10 weeks DTaP-IPV-Hib-HBV (2) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
14 weeks RV (2) Rotavirus
DTaP-IPV-Hib-HBV (3) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
PCV 13 (2) Pneumococcal diseases
6 months Measles (1) MeasBio Measles
9 months PCV 13 (3) Pneumococcal diseases
12 months Measles (2) Measles
18 months DTaP-IPV-Hib-HBV (4) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
6 years Td (1) Diftavax Tetanus, Diptheria
9 years (girls only) HPV (1) (repeat 6 months later) Human papilloma Virus
HPV (2) Human papilloma Virus
12 years Td (2) Diftavax Tetanus, Diptheria

Private Practice Child Immunisation Schedule:

AGE OF CHILD VACCINATION PROTECTS AGAINST
Birth BCG Bacillus Calmette Guerin Tuberculosis
OPV (0) Oral polio vaccine: OPV-Merieux/Polioral Polio
6 weeks OPV (1) Polio
RV (1) Rotavirus vaccine: Rotarix/RotaTeq Rotavirus
DTaP-IPV-Hib-HBV (1) Hexavalent: Hexaxim/Infanrix-Hexa Diphtheria, tetanus, acellular pertussis (whooping cough), polio, haemophilus influenzae type B, Hepatitis B virus
PCV 13 (1) Pneumococcal conjugate vaccine: Prevenar-13/Synflorix Pneumococcal diseases
10 weeks RV (2) Rotavirus
DTaP-IPV-Hib-HBV (2) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
PCV 13 (2) Pneumococcal diseases
14 weeks RV (2) or (3) Rotavirus
DTaP-IPV-Hib-HBV (3) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
PCV (3) Pneumococcal diseases
6 months + Flu Influenza vaccine Influenza
9 months Measles (1) Rouvax

Or

MMR (1) Trimovax/Priorix

Measles

Measles, mumps, rubella

MCV (1) Meningococcal vaccine: Menactra Meningococcal diseases
12 -15 months MMR (1) or (2)

Or

MMRV (1) Priorix Tetra

Measles, mumps, rubella

Measles, mumps, rubella, chickenpox

Varicella (1) Varilrix Chicken pox
PCV (4) Pneumococcal disease
MCV (2) Meningococcal disease
HAV (1) Hepatitis A vaccine: Avaxim 80/Havrix Junior (repeat 6 months later) Hepatitis A virus
18 months DTaP-IPV-Hib-HBV (4) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
18-21 months HAV (2) Avaxim 80/Havrix Junior Hepatitis A virus
5-6 years

 

MMR (2) or (3)

Or

MMRV (2)

Measles, mumps, rubella

Measles, mumps, rubella, chickenpox

Varicella (2) Chicken pox
DTaP Infanrix

Or

DTaP-IPV Quadrivalent: Adacel Quadra/Boostrix Tetra

Diptheria, tetanus, whooping cough

DTaP plus polio

9 years + (girls & boys; 13 years) HPV (1) Gardasil/Cervarix (girls only) (repeat 6 months later) Human papilloma Virus
HPV (2) Human papilloma Virus
12 years

 

TdaP-IPV Diphtheria, tetanus, whooping cough, polio

Download a copy of the South African Immunisation Schedule here.

RESOURCES

National Institute for Communicable Disease (2016) Vaccine Information for Parents and Caregivers. [Online] Available from: http://www.nicd.ac.za/assets/files/NICD_Vaccine_Booklet_D132_FINAL.pdf [Accessed 29 June 2018].

Netcare, (2016). Vaccine Schedules for South Africa for 2016. [Online] Available from: http://www.netcarehospitals.co.za/Portals/3/Images/Content-Images/PDF/latest-vaccine-schedule.pdf [Accessed 30 June 2018].

The National Department of Health, (2015). Vaccinator’s Manual “Immunisation That Works” Expanded Programme on Immunisation in South Africa (EPI-SA). [Online] Available from: https://www.westerncape.gov.za/assets/departments/health/vaccinators_manual_2016.pdf [Accessed 29 June 2018].

Medications for Pain & Fever In Children

There are a wide range of medicines on the market for pain and fever that make it confusing for parents to know which one to choose. All medicines are potentially dangerous so it is vital you know what you are buying.

There are two main groups of analgesics – opioids and non-opioids. I will not discuss opioids any further for now as these are usually reserved for severe pain and given the side effects of even the low efficacy opioids, such as codeine, I do not routinely recommend their use in children.

Non-opioids are further divided into three groups. There are a number of generics out there, so it’s important to read the product label carefully to know exactly what it is you are giving your child.

  1. Paracetamol (acetaminophen)
  • Indicated for mild-moderate pain and fever.
  • Has no anti-inflammatory properties.
  • Is non-sedating.
  • Includes but not limited to: Panado, Calpol and Empaped suppositories.
  1. NSAIDs (Non-steroidal anti-inflammatory drugs)
  • NSAIDS have anti-inflammatory, analgesic and antipyretic properties.
  • There are many NSAIDs available but most are not licensed for use in children or for pain and fever.
  • Is non-sedating.
  • Contraindications:
    • Children with asthma;
    • Children with dehydration;
    • Children with impaired renal function;
    • Children with impaired clotting or bleeding; and/or
    • A previous allergic reaction to any anti-inflammatory drug.
  • Includes but not limited to:
    • Nurofen (ibuprofen): >3 months and >5 kgs.
    • Ponstan (mefenamic acid): >6 months
    • Voltaren suppositories (diclofenac): > 2yrs.
  1. Aspirin (acetylsalicylic acid)
  • NOT RECOMMENDED for children and adolescents (<18 years) for routine analgesic and antipyretic use – AVOID!
  • Aspirin is associated with a rare, yet fatal disease known as Reyes syndrome.
  1. Combination preparations
  • These are usually a combination of Paracetamol with any one or more of the following; NSAID, codeine, caffeine, meprobamate, promethazine, dephenhydramine, doxylamine and/or other.
  • Indicated specifically for pain relief only.
  • These preparations are not superior to paracetamol alone for relief of fever.
  • These preparations can be sedating depending on the composition.
  • Includes but not limited to: Ibumol, Lentogesic, Lotem, Mybulen, Myprodol, Stilpane and Stopayne.

PARACETAMOL OR NSAID?

Now that you have a brief overview of what is out there, let’s discuss what to give your kids.

Keep it simple! Avoid combinations, as they are not any more effective than single preparations. Paracetamol is the first line drug for mild-moderate pain and fever. This is because of its high tolerability profile. Do not routinely use Paracetamol AND an NSAID together at the same time or alternatingly. I would recommend using Paracetamol first and if there is no response within an hour, try Ibuprofen.

From personal experience, Paracetamol works wonders and within 30-60 minutes your child will be running around like his/her normal self again.

Please use analgesics and antipyretics only if necessary and regardless of which one you choose, use it for the shortest time needed to control symptoms.  If you decide to use an NSAID DO NOT use more than one type at a time.

VOMITING

  • If your child vomits within 30 minutes of having ingested a dose of Paracetamol or NSAID it is safe to give that same dose again.
  • If your child vomits more than 30 minutes after having a dose of Paracetamol or NSAID DO NOT give another dose. Wait until the next normal dose.

SUPPOSITORIES

  • Oral administration of medicine is preferred since the rectal absorption of medicine is unpredictable, however, if your child is refusing to take medicine or vomiting, a suppository can initially be used.
  • Do not give an oral dose together with a suppository of the same drug at the same time.
  • Rectal administration of NSAIDs has fewer GUT side effects.

SIDE-EFFECTS*

Paracetamol:

  • Rarely causes any side effects if given at the correct dose.
  • Paracetamol overdose is VERY toxic to the liver and can cause liver failure and death.

NSAIDs:

  • Stomach pain, indigestion and/or heartburn;
  • Nausea and/or vomiting;
  • Diarrhoea;
  • Allergic reaction;
  • Bronchospasm;
  • Ringing in the ears; and/or
  • Kidney damage (little or no urine and/or blood in the urine).

*This is not a comprehensive list of all the side effects but rather a list of the more common and/or dangerous ones.

DOSAGE

When it comes to dosing, weight is more important than age, so please read the product label carefully and familiarize yourself with your child’s weight.

I suggest administering medicine using a syringe in order to measure up the dose correctly. Squirt the medicine into the space between the gum and cheek. This will reduce contact with the tongue and taste receptors making the medicine more palatable and having a higher chance of being swallowed.

Paracetamol:

  • 3 months: 15mg/kg/dose every 4-6 hours
  • < 3 months: 10mg/kg/dose every 4-6 hours
  • Max: 60mg/kg/day, up to 1000mg/dose or 4000mg/day, up to 4 doses/24 hrs.

Ibuprofen:

  • 5 mg/kg/dose every 6-8 hours
  • Max: 20mg/kg/day, up to 3 doses/24 hrs.
  • Administer Ibuprofen with food in order to reduce gastric side effects.

 

RESOURCES

de Martino, M. & Chiarugi, A. (2015) Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management. Pain and Therapy. [Online] 4 (2), pp. 149-168. Available from: https://doi.org/10.1007/s40122-015-0040-z [Accessed 18 June 2018].

Gazarean, M. and Graudins, L.V. (2006) Safe use of NSAIDs in infants and children. Medicine Today, 7 (11), pp. 71-73.

Green, R., Jeena, P., Kotze, S., Lewis, H., Webb, D. and Wells, M. (2013) Management of acute fever in children: Guideline for community healthcare providers and pharmacists. S Afr Med J. [Online] 103 (12), pp. 948-954. Available from: doi:10.7196/SAMJ.7207 [Accessed 20 June 2018]

Jannin, V., Lemagnen, G., Gueroult, P., Larrouture, D. and Tuleu, C. (2014) Rectal route in the 21st Century to treat children. Advanced Drug Delivery Reviews. [Online] 73, pp. 34-49. Available from: doi: 10.1016/j.addr.2014.05.012 [Accessed 20 June 2018].

Marzuillo, P., Guarino, S. & Barbi, E. (2014) Paracetamol: a focus for the general pediatrician. European Journal Of Pediatrics. [Online] 173 (4), pp. 415-425. Available from: https://doi.org/10.1007/s00431-013-2239-5 [Accessed 18 June 2018].

Raffaeli, G., Orenti, A., Gambino, M., Peves Rios, W., Bosis, S., Bianchini, S., Tagliabue, C. and Esposito, S. (2016) Fever and Pain Management in Childhood: Healthcare Providers’ and Parents’ Adherence to Current Recommendations. Int. J. Environ. Res. Public Health. [Online] 13 (5), 499. Available from: https://doi.org/10.3390/ijerph13050499 [Accessed 18 June 2018].

Sharif, M.R., Rezaei, M.H., Aalinezhad, M., Sarami, G. and Rangraz, M. (2016) Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children. Iranian Red Crescent Medical Journal. [Online] 18 (1): e27932. Available from: doi:10.5812/ircmj.27932 [Accessed 20 June 2018].

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