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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

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

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

 

 

 

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

Is It A Cold Or Is It The Flu?

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

WHAT IS THE DIFFERENCE?

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

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

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

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

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

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

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

TREATING A COLD OR THE FLU

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

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

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

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

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

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

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

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

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

TOP 5 COLD AND FLU MYTHS

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

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

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

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

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

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

RESOURCES

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

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

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

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

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

Should Your Child Be Using Fluoride Toothpaste?

Untreated tooth decay in children is one of the most common conditions worldwide, which is why many toothpaste manufacturers have a wide range of toothpaste aimed at children, available in a variety of sweet flavours with cartoon characters all over the packaging. I wanted to write this post to give parents a little more information about toothpaste because it’s not really about the cute packaging and the taste test (agreed this does help make brushing teeth a lot easier).

Many parents, unfortunately, do not know the proper guidelines when choosing and using toothpaste in children. Majority of mothers start brushing their children’s teeth late, use adult toothpaste and have no idea about the clinical significance of fluoride. Most moms also use a full length of toothpaste on their children’s brushes.

HOW MUCH FLUORIDE IS ENOUGH?

Your body takes in fluoride by swallowing it in food and water. Fluoride occurs naturally in varying amounts in water sources and to a lesser degree in certain foods and drinks. Some countries also fluoridate their public water supply. Another way to take in fluoride is by topical application (in fluoridated toothpastes and mouthwashes). The fluoride taken in from foods and drink also provides some topical benefits when it becomes mixed with saliva.

We all know that brushing your teeth is vital in preventing tooth decay. It helps remove plaque, and the fluoride in toothpaste makes tooth enamel stronger, and more resistant to cavities. But how do you know which toothpaste to buy for your little ones when the amount of fluoride between brands ranges from zero to as high as that of adult toothpaste?

Fluoride in toothpaste is expressed as parts per million of fluoride (ppmF). According to the UK Department of Health, children under three years of age need to use a toothpaste with 1,000 ppmF. Older kids and adults need to use 1,450 ppmF. Young children need less fluoride to reduce the risk of fluorosis.

WHAT IS FLUOROSIS?

Fluorosis is the change of appearance of permanent teeth where they develop white lines or streaks. This happens when the developing teeth under the gums in younger children are exposed to excess fluoride. Too much fluoride affects the mineralisation of the teeth, and children younger than six years are at highest risk. The severity of Fluorosis is dose-dependent.

Image Source: health2blog.com

Fluorosis is a cosmetic condition and not a disease. It does not increase or decrease the risk of cavities. While the majority of cases of Fluorosis are mild, it can still have a significant psychological effect on your child.

HOW MUCH TOOTHPASTE IS ENOUGH?

It can be challenging to get your child to spit out the toothpaste after brushing without swallowing, especially if the toothpaste tastes like candy. It is therefore essential to use a small amount of toothpaste until your child has learnt to spit after they brush since inevitably your child will end up swallowing about half of what’s on the brush.

To prevent too much fluoride from being swallowed, you have to be vigilant about the amount you put on the brush. It is recommended that children under three years of age use no more fluoride toothpaste than a smear or the size of a grain of rice. For children three to six you should use a pea-sized amount of fluoride toothpaste.

Teach your child from an early age to spit. They don’t need to rinse. It’s also a good idea to not let them eat or drink anything after they have brushed their teeth so that the fluoride can do its job overnight.

KEY POINTS

  • Start brushing your baby’s teeth as soon as you see them come through.
  • Brush your child’s teeth morning and night with an age-appropriate brush.
  • Use fluoride toothpaste with the right amount of fluoride recommended for your child’s age. It is no longer recommended that children start using fluoride toothpaste only after the age of two.
  • Use the correct amount of toothpaste for your child’s age.
  • Children under six years of age should never use a fluoride mouthwash.

Fluoride toothpaste is generally safe and recommended for babies and young children provided you use it correctly. The most important thing you need to worry about is the amount of fluoride in the toothpaste. The next time you go out shopping for toothpaste take a look at the ppmF. You will be quite surprised since many of the “children’s” toothpastes have exactly the same amount of fluoride as adult toothpaste. Therefore it really only boils down to cost and taste and whether or not your little is a fan of Barbie.

How To Make The Medicine Go Down

It’s stressful when your kids are sick and even more stressful when they refuse to take their medicines. Not to mention the icky stickiness that is almost impossible to wash off your skin. In this blog I will share with you some tips I have learnt over the years to help make the medicine go down.

1. Disguise the taste

Many over the counter liquid medications available for kids are flavoured. Look on the bottle to see which flavour you are buying. Some brands have different options for the same drug such as Panado’s strawberry and peppermint flavours. Some brands may have the same flavours but taste different. My daughter prefers the strawberry flavour of Calpol than that of Panado. If the medication needs to be made up by a pharmacist, ask them to flavour the medication if possible.

Unfortunately, some meds just taste awful and not all pharmacies stock flavourings. You’ll need to get creative here. You can mix the liquid with fresh fruit or vegetable juice and even honey (if your child is over one year). You can also try mixing meds with milk or yoghurt but the calcium may interfere with the effects of some medications, particularly with certain antibiotics. Acidic foods may also inactivate some antibiotics. It’s important to ask your pharmacist and read the patient information leaflet before you decide to try this method.

If you are hiding the medication in a food or drink, keep the volume small so that the entire dose can be taken. Don’t mix with a full bottle or cup of juice if your child will not finish this.

2. Equipment

I always use a syringe and squirt the medicine along the inside of the cheeks and not onto the tongue. This way you can bypass the taste buds a little. You can also use a medicine dropper the same way. Slide the syringe or dropper along the cheek towards the back of the mouth and squirt the medicine slowly. Do not aim for the throat as your child will gag and cough and if you aim too far in front of the mouth the medicine will simply be spat out.

Using a syringe also allows you to give correct dosages. In kids it’s vital you give the correct dosage of medication. You can wash and reuse the syringes but after a while you should replace them.

3. Keep it chilled

You can also numb the taste buds beforehand. Your child can suck on a block of ice if he or she is older or you could try an ice-lolly for a younger child. Some medications can also be stored in the fridge, which can make them taste better.

4. Wash it down

Whilst Mary Poppins recommended a spoonful of sugar, I’m not sure many of us moms will be too happy with the after effects of this sugar rush before bedtime.

Have a glass of water or your child’s favourite drink on standby to drink as soon as they swallow just so they can wash their taste buds.

5. Coat the taste buds

You can try giving your child a spoonful of something thick and sweet such as maple syrup or honey to coat the tongue before giving the medicine.

6. Try a tablet instead

Some liquid medicines are available as chewables. If your child is old enough you can try these. Whilst there are some tablets that can be crushed and mixed with food. Speak to your doctor or pharmacist before you do this.

You may also find dissolvable tablets. Dissolve the tablet in a small glass of water and add some fruit juice to hide the taste as these can be extremely bitter.

7. Give your child some control

You will find that your kids will be more willing to take their medicine if they are in control or at least think they are. Allow them to choose when to take their medicine, for example, before or after the bath. They can also choose what flavour medicine they would like when you are buying it for them.

IF IT WORKS, STICK TO IT

You might find that more than one trick is necessary. If you have found a technique that works, stick to it. A while back I tried using one of those fancy medicine syringes I got at my baby shower instead of a simple syringe (I had actually forgotten to replace the ones I had thrown out). These syringe type medicine feeders are quite big and I couldn’t get it far enough to the back of the mouth to bypass the taste buds. My daughter did not like this at all and I ended up wearing most of the medicine!

Do you have any other tricks or tips to get your kids to take medicine? Please share in the comments section below!

If your little one requires medicine on a regular basis, here is a medicine chart to help you organise the days and quantities.

How To Clean A Wound: The Controversy Of Antiseptics

What do you do when your little one scrapes their leg? Do you rush off to your medicine cupboard to grab your bottle of Dettol of Savlon? This may actually not be necessary. Whilst it’s important you clean a wound as soon as possible in order to reduce the risk of infection, what you clean it with has been an area of debate in the medical world for years. Research has shown that running tap water over a wounds is just as effictive in cleaning a wound. Antiseptics may actually damage the skin and slow down the healing process.

WHAT IS THE DIFFERENCE BETWEEN AN ANTISEPTIC AND A DISINFECTANT?

A Biocide is the general term for a chemical agent that inactivates microorganisms and depending on their activity they can either inhibit the growth of, or kill microorganisms completely.

Both antiseptics and disinfectants inactivate microorganisms. These terms are often used interchangeably but there is a very big difference. Antiseptics are biocides that are used on living tissues and disinfectants are biocides used on inanimate objects or surfaces. So for example in your kitchen, you would use an antiseptic to wash your hands and a disinfectant to wash the countertops.

HOW SHOULD I CLEAN A WOUND?

Before you clean a wound you have to stop any bleeding. This is done by applying direct pressure. Of course the wound may still continue to bleed a little for a while and/or when you clean the wound it may start to bleed again. As long as the wound is not bleeding excessively you can proceed to clean it.

For most simple wounds I would simply recommend rinsing them under cool running water. In the ER and in theatre we always clean wounds with lots and lots of water. If you are out and about and don’t have running water, you can always use bottled water. If this weren’t available then I would rinse the wound with a diluted antiseptic such as cetrimide or povidine-iodine (if of course there are no known allergies). If you are going to use an antiseptic, use it only once to initially clean and never chronically. When you clean the wound again after a day or so use water. Don’t ever use rubbing alcohol or peroxide to clean an open wound.

You can gently rub off any foreign material using a piece of gauze soaked in water. Use tweezers to remove any debris that may still remain. Remember to disinfect the tweezers before use.

Once the wound is clean you can then apply a moist dressing. You can use petroleum jelly or what I love to use is a lanolin ointment such as a nipple cream. To find out more about moist healing you can read my previous blog: https://www.oneaid.co.za/picking-scabs-popping-blisters/

WHAT ABOUT ANTIBIOTIC CREAMS?

These include creams such as Supiroban, Fucidin and Neosporin. I do not recommend using an antibiotic cream for a simple wound. Most wounds heal very well on their own.

The problem with using these creams is the possibility of developing bacterial resistence. If the wound were to get infected later on and you have been applying an antibiotic cream since day one, this cream would not be very effective against the infection.

Technically you can develop resistence towards antiseptics but this is very unlikely since antiseptics have a broader spectrum of microorganisms they inactivate than antibiotic creams. If the wound was very contaminated and has a high chance of infection then I would rather apply a very thin layer of an antiseptic cream.

Newer research has found that the body’s surface actually supports wound healing on its own. We all have bacteria that live on our skins that cause us no harm. These bacteria help protect us from pathogens in the environment. Using creams and solutions that have antimicrobial activity will upset the balance of organisms on our skins and interfere with this defense system.

WHAT ARE THE SIGNS OF AN INFECTED WOUND?

After you have cleaned the wound and applied a dressing it’s important to monitor the wound for any signs of infection over the next few days:

  • Swelling;
  • Redness;
  • Increasing pain;
  • Bad smell from the wound;
  • Warm skin around wound;
  • Wound is leaking pus; and/or
  • Body temperature > 38 degrees Celsius.

If you notice any of these above changes, go straight to the emergency room.

If you are anything like my mother you probably have very old big bottles of antiseptics lying around. One of my microbiology Professors at University once told us that microorganisms can grow on the surface of these antiseptic liquids after a while. Also the antiseptic components of these solutions deteriorate after some time so always check the expiry dates. Rather buy smaller bottles and don’t keep them too long after they have been opened.

RESOURCES

https://emj.bmj.com/content/19/6/556.1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88911/

https://www.sciencedirect.com/science/article/pii/S1743919117305368

https://www.woundsresearch.com/article/1585

https://www.woundsresearch.com/article/1586

https://www.woundsresearch.com/article/sams-dodd

https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/3613/DoTopicalAntibioticsImproveWound.pdf?sequence=1&isAllowed=y

https://www.researchgate.net/publication/45149036_Benefit_and_harm_of_iodine_in_wound_care_A_systematic_review

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