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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

A Simple Guide To Bandages

With so many different types of bandages available its easy to get confused with what bandage to use when. Bandages are generally used to cover wounds, to apply pressure to bleeding wounds and to support and immobilise sprains, strains and broken bones.

I have put together a list of the most common types of bandages and when to use them. As you will see most of them have interchangeable uses so its really a matter of preference and of course, cost.

There are three major types of bandages – roller bandages, triangular bandages and tubular bandages.

ROLLER BANDAGE

These are long single strips of breathable material. Depending on the thickness and elasticity, these bandages are the most versatile.

The different roller bandages are described below:

1. Conforming bandage
This bandage has a high degree of stretch so that it can conform to any shape. This bandage comes in a light, medium and heavy weight

Use:

  • Can be used to hold a dressing in place
  • Can be used with a dressing to apply pressure to control bleeding wounds
  • A thicker weight can be used to compress and support a sprain or strain

2. Crepe bandage
This is a thicker weight than conforming bandage.

Use:

  • Can be used to hold a dressing in place
  • Can be used with a dressing to apply pressure to control bleeding wounds
  • Can be used to compress and support a sprain or strain
  • Can be used to compress a limb in the event of a poisonous snake bite

Both conforming and crepe bandages are never applied directly onto open wounds. A dressing must be in place first.

3. First aid dressing
This is a roller bandage that has a dressing pad sewn into it. The bandage is usually lightweight with some elasticity.

Use:

  • The pad is applied directly onto an open wound and then the bandage is rolled to keep it in place. There is no need to apply a separate dressing first.

4. Elastic adhesive bandage
This roller bandage has a very sticky adhesive, which can be taped directly onto the skin. This bandage is thick weight. However, this is not my favourite bandage as it can be very painful to remove if there is a lot of hair on the skin and some people may have an allergy to the adhesive.

Use:

  • Can be applied onto a joint to compress and support a sprain or strain
  • Can be applied over a conforming or crepe bandage for additional pressure to control bleeding wounds. Great for amputations and arterial bleeding.
  • Can be applied onto a conforming or crepe bandage to secure it in place
  • Can also be used to hold ice packs in place on the injured area

5. Cohesive bandage
This is a thin lightweight breathable bandage that sticks to itself, without actually being sticky. There is no risk of pulling out any hairs when removing this bandage.

Use:

  • Most commonly used to compress and support sprains and strains

TRIANGULAR BANDAGE

This is the most versatile bandage. It is usually a single sheet of thick cotton or calico in the shape of a large triangle. It can be applied to areas of the body where it may be more difficult to apply a roller bandage such as the scalp.

Use:

  • These bandages are most commonly used to construct slings for soft tissue injuries, broken bones or dislocations. Some triangular bandages come with safety pins to help you construct the sling but most of the time you will not need them;
  • Can be used to secure splints;
  • Can be used as a pad on top of a dressing to apply extra pressure for a bleeding wound;
  • Can be folded down to form a strip of bandage and wrapped around a wound to hold a dressing in place and/or apply extra pressure to control bleeding;
  • Can be used to elevate a limb to reduce blood flow to the area if bleeding a lot from an open wound;
  • Can be used to elevate a limb to reduce blood flow and limit swelling; and/or
  • Can be used as a tourniquet in an emergency when the use of a tourniquet may be warranted.

TUBULAR BANDAGE

These bandages are not normally found in first aid kits. They can be medium to heavy weight.

Use:

  • The thicker weight bandages are used for compression, support and to reduce swelling for joint sprains and strains;
  • Can be used to protect the skin under a cast for a broken bone;
  • Can technically be used to keep a dressing in place and apply pressure to bleeding wounds but care needs to be taken when applying it so that the dressing does not shift when the tube is pulled over the injured area.

WHAT IS A DRESSING?

A dressing is something that is applied directly onto a wound to cover it. A bandage can then be applied over a dressing to keep it in place if the dressing is not adhesive.

WHAT IS A PLASTER?

Depending which way you look at it, a plaster can either be an adhesive dressing or an adhesive bandage with an attached dressing. Plasters are more commonly known as adhesive dressings and Band-Aid is a brand of plasters.

Bandages are only helpful if used properly. It’s important to recognise the bandages you have in your first aid kit and to know which bandage you should use when and how to properly apply them.

First Aid Tips Every Mom Should Know

10 First Aid Tips Every Mom Should Know

I was recently asked by All4Women to put together my top 10 first aid tips for moms. I wanted to share these with all of you in this blog post. You can find more tips in my MiniKit Pocket Guide (https://www.oneaid.co.za/product/minikit/).

  1. Keep emergency numbers on speed dial: Every parent should know who to call in an emergency. You should also teach this to your children. Write the numbers down and stick them on your fridge or somewhere near the phone.
  2. Cuts and scrapes: Stop any bleeding by pressing firmly on the wound with a gauze or cloth. Then rinse the wound under cool running water before applying a dressing such as a plaster. Tap water is perfectly fine, you don’t need fancy antiseptic solutions.
  3. Burns: Rinse burns under cool running water for up to 20 minutes. This will prevent any further damage and reduce pain. Do not use freezing cold water or ice
  4. Bee stings: Remove the stinger if still attached and apply an ice pack to reduce swelling. Don’t use tweezers as this may squeeze out more poison. Rather scrape the stinger off with a flat-edged object such as a bankcard.
  5. Nosebleed: Lean your child forward so they don’t swallow any blood and pinch the nose closed just below the bony part. Blood can irritate the stomach and cause nausea and vomiting.
  6. Broken bones: If you suspect a broken bone don’t move the limb or apply any weight. Splint the injured limb to prevent any movement before going to the emergency room.
  7. Seizures: Never put anything into the mouth of a child who is having a seizure. This includes medicines for fever if your child is having a febrile convulsion. Roll your child onto his or her side and wait for the seizure to stop.
  8. Heat exhaustion: Get your child out of the heat and elevate his or her legs. Prevention is key so make sure your child drinks plenty of fluids before and during any activity in hot weather.
  9. Poisoning: If you suspect your child has swallowed a potentially harmful substance do not make them vomit or give them anything to eat or drink unless told to do so by emergency services. Here are 10 essential tips to prevent poisoning in your home (https://www.oneaid.co.za/10-essential-tips-to-prevent-poisoning-inyour-home/).
  10. Be prepared: Always have a well stocked first aid kit on hand so you can manage minor injuries without delay and reduce the risk of infection or severity of injury.

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