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How To Organise Your Drug Cupboard

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

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

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

1. EMPTY EVERYTHING ONTO A TABLE

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

2. CHECK EXPIRY DATES

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

3. GET SORTING

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

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

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

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

4. DRUG STORAGE

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

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

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

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

How To Discard Of Expired Or Unused Medications

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

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

HOW SAFE ARE MEDICATIONS PAST THEIR EXPIRY DATE?

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

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

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

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

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

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

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

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

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

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

IS MEDICATION PACKAGING RECYCLABLE ONCE EMPTY? 

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

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

RESOURCES

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

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

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

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

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

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

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

 

Are Essential Oils Safe For Children?

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

WHAT ARE ESSENTIAL OILS?

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

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

IF IT’S NATURAL IT MUST BE SAFE?

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

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

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

IT’S ALL IN THE RESEARCH

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

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

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

SPECIAL CONSIDERATIONS WHEN USING ESSENTIAL OILS IN CHILDREN

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

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

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

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

RESOURCES

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

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

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

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

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

How To Use a Car Seat Harness Correctly

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

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

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

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

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

  1. Correctly position the shoulder straps

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

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

Image: Diono.com

  1. Tighten harness straps snugly

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

Image: Diono.com

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

HARNESS RETAINER CLIPS

Image: safekids.org

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

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

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

RESOURCES

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

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

 

 

Common First Aid Myths

 

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

1. BUTTER ON A BURN

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

2. LEAN YOUR HEAD BACK DURING A NOSEBLEED

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

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

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

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

4. RUBBING ALCOHOL FOR A FEVER

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

5. STAY AWAKE AFTER A BUMP TO THE HEAD

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

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

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

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

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

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

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

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

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

9. APPLY HEAT TO A SPRAIN, STRAIN OR FRACTURE

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

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

10. PUT RAW STEAK ON A BLACK EYE

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

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

Essential Fire Safety Equipment You Need In Your Home

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

SMOKE AND CARBON MONOXIDE DETECTORS

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

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

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

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

FIRE EXTINGUISHERS

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

Common causes of house fires:

1.     Class A

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

2.     Class B

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

3. Class F

These fires involve cooking oils and fats in the kitchen.

4.   Electrical appliances (formerly type E)

These are fires caused by electrical appliances

What fire extinguisher do you need?

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

  1. Water fire extinguisher

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

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

2.Foam fire extinguisher

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

3. Dry powder fire extinguisher

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

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

4. CO2 fire extinguisher

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

5. Wet chemical extinguisher

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

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

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

RESOURCES

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

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

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

Keeping Your Children Safe During Bath time

I’m sure many of you will agree that bath time is loads of fun for our kids. Whilst the bathroom is a fun place, it can also be a scary place with a number of dangerous hazards such as the drowning, burns and poisoning.

It’s important that you are always in the bathroom with your children before, during and after bath time. Drowning is a major cause of death in children under five years. According to the Consumer Products Safety Commision in the United States, 80% of the 87 children, under five years who drown at home each year, have drowned in the bathtub. Young children are top heavy and can slip suddenly and drown in very little water. Infants and toddlers also don’t have the upper body and core strength to lift themselves up if that slip under the water.

HOW TO RUN A BATH

  • Keep your child away from the bath until the water is the right temperature.
  • The safe temperature of bath water should be between 37oC and 38oC (36OC for a newborn). Children have thinner skin than adults so they can burn much more quickly. Even if the bath feels warm to you it may be hot to your little one. Your plumber can also set the thermostat of your geyser to a maximum of 50oC.
  • Always fill your bath with cold water first. Your child could put his hand or foot in the water before the bath is ready and get burnt. If you have a mixer tap, run hot and cold together but start with the cold and slowly increase the amount of hot.
  • Run cold water through the tap before your child gets into the bath to cool the tap and prevent them from getting burnt if they touch it.
  • If you have a mixer tap, point the lever on the cold setting when you are finished running the bath to ensure the hot water does not get accidentally turned on in the bath.
  • Do not overfill the bath. Fill the bath water to just over your little one’s knees.

HOW TO HAVE A S-A-F-E BATH

S: Supervision is key! Always supervise babies, toddlers and children less than six years in the bath and when you run the water. Never leave an older child to supervise.
A: Arrange everything you will need for bath time in advance for e.g. towel, soap, shampoo, nappy, clean clothes and any medications.
F: Feel the water with your elbow first. It should feel warm but not hot. You can also use a water thermometer. Remember to swirl the water around to ensure an even temperature with no hot pockets.
E: Empty the bath as soon as bath time is over.

SLIPS, TRIPS & FALLS

Slips, trips and falls in the bathtub and shower are a common cause of injury in young children and according to statistics more common than tub drownings.

Use a non-slip mat in the bath. If you are using a bath seat or ring, your child will still need to be supervised. A bath seat is not a safety device. These seats are actually associated with an increasing number of reported drownings. This is because the device gives parents a false sense of security and they are therefore more likely to leave their baby alone in the bath.

Infants should be bathed in the bathroom basin or a smaller infant bathtub. This way they can’t roll over or ever be completely covered by the water.

Wipe up any splashes before your kids get out the bath so that nobody, including you, can slip and hit their head. As your kids get older you should also teach them to remain seated in the bath and not to stand up and jump.

Be sure to keep a MiniKit in your bathroom for peace of mind. Each kit contains a range of thoughtfully selected first aid items geared towards common childhood injuries. You can purchase one here: https://www.oneaid.co.za/product/minikit/

WHEN CAN YOU STOP SUPERVISING YOUR CHILD IN THE BATH?

This is a difficult question to answer as children mature at different ages. Since most children who drown in bathtubs are under the age of five, the general consensus is children under the age of six should never be allowed to bath alone and even those over six should be closely monitored. Even if your child knows how to swim you should never be too far away.

OTHER BATHROOM HAZARDS

Toilet: luckily my daughter has never been interested in exploring the toilet bowl but I have had moms tell me how their child likes to play with the water in the toilet. Keep the toilet lids closed at all times and if your little one is particularly curious install a toilet-lid lock.

Appliances: make sure any electrical appliances in the bathroom are unplugged and out of reach when your child is having a bath. Regular plug sockets may actually not be fitted in bathrooms for safety reasons so rather keep extension cords out.

Medicines: many of us keep medication in the bathroom. Make sure they are all locked away, out of sight and out of reach.

Dangerous items: make sure you keep cosmetics, razor blades, nail scissors, cleaning products and other dangerous items away.

Don’t get distracted during bath time. Keep your phone on silent or rather keep it out of the bathroom and join in on the fun. You could also try having a shower with your child instead for some extra fun. My daughter loves this and the best part is that I manage to get cleaned up as well freeing up some time later in the evening for something else. Just make sure you get a slip-proof mat for the shower first.

RESOURCES

https://www.aappublications.org/news/2015/11/11/PPBath111115

https://medlineplus.gov/ency/patientinstructions/000154.htm

http://www.ncbi.nlm.nih.gov/pubmed/19596735

https://pediatrics.aappublications.org/content/124/2/541.long

https://pediatrics.aappublications.org/content/100/4/e1.long?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=Pediatrics_TrendMD_0

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

Tips For Choosing The Right High Chair

Before going out and buying a high chair it’s important to know the safety requirements. A US study found that more than 9 400 children, aging three years and younger, were treated each year for high chair related injuries in emergency rooms from 2003 to 2010. That’s one child every hour!

Nearly all of these injuries were as a result of a fall where the child either climbed in or out of the chair or stood in it. Majority of the injuries seen were head injuries (37%) then bumps and bruises (33%) followed by lacerations (19%). Most of us use our high chairs in the dining room or kitchen where the flooring is usually hard, so you can imagine the impact this has on a small brain.

This has prompted the US to update their safety standards (unfortunately there are no available statistics for South Africa). From mid-2019 all high chairs in the US will have to have a passive crotch restraint and a three-point restraint system, which means there has to be a fixed post that sits between a child’s legs and restraints that are fixed to the high chair in three different places. They found that children were able to slip out the bottom of a high chair and hope a fixed post will prevent this.

High chairs are not recommended for children younger than 6 months of age. A child is only ready for a chair once they have good head and neck control and are able to sit up on their own. If one is used too early a child could experience positional asphyxia. You may however, be able to start a little sooner with a reclining high chair (see my previous blog, ‘How safe is your car seat?’). https://www.oneaid.co.za/how-safe-is-your-car-seat/

CHOOSING THE RIGHT HIGH CHAIR

Framework: choose a high chair that is sturdy. Put some weight on it and see if it squeaks, deforms or moves or collapses.

Gaps: make sure there are no gaps your child can slip out of. Also check for gaps that little fingers can get caught in.

Harness: choose a high chair with either a three-point or five-point harness that includes a crotch strap or a post. The restraint should go over the shoulders, around the waist and if a five-point harness then between the legs.  

Wide base: a high chair becomes top heavy when your child is in. Choosing a chair with a wide base will make it more stable so that it does not tip easily.

Wheels: if you choose a high chair with wheels, make sure they can be locked when the chair is in use.

Folding locks: if the high chair folds check that the locks work well enough so that the chair cannot fall or collapse when in use.

Joints: choose a high chair with metal joints. These are stronger than plastic, which can crack after time.

Safety standards: make sure the high chair meets current safety standards and has been approved by an international safety authority.

BOOSTER SEATS AND HOOK-ON SEATS

Please be careful when you use these chairs. If not used correctly these seats can be dangerous.

Hook-on seat: These chairs are mounted directly onto a table and should only be used once your baby has good head and neck control and can sit upright. The mounts must be slip resistant and because this seat carries the entire weight of your baby the table has to be strong so that it does not tip over.

Booster seat: These seats are attached to normals chair by straps to raise a child’s height. They are usually used when a child has outgrown the high chair but is not quite tall enough to sit at the table unaided. They should also have straps to keep your child in the seat.

KEEPING YOUR CHILD SAFE IN A HIGH CHAIR

  • Never leave your child unsupervised when they are in a high chair.
  • Always use the safety straps when your child sits in the chair, even if only for a few minutes. The tray is not a restraint.
  • If the chair folds, make sure it is locked each time you set the chair up.
  • If the chair has wheels, make sure they are locked each time you set the chair up.
  • Never allow your child to stand in the high chair.
  • Do not place the high chair near a counter or table. Your child may be able to push against the surface and cause the chair to tip over.
  • Don’t allow older children to climb or play on the high chair while another child is seated in it because it could tip over.
  • Position the high chair at its lowest possible height if this is adjustable.
  • Make sure potential hazards such as hot food, drink and sharp cutlery are out of reach.

When choosing a high chair opt for an age-appropriate one with plenty of safety features. It’s also important to check often for recalls once you have purchased your chair. High chairs are commonly recalled because of their safety issues. Recent recalls include the Skip Hop Tuo convertible high chair and the Graco Table2Table 6-in-1. You can check http://www.recalls.gov to see if your high chair has been recalled.

RESOURCES

https://journals.sagepub.com/doi/abs/10.1177/0009922813510599

http:// https://www.nationwidechildrens.org/newsroom/news-releases/2013/12/new-study-finds-24-children-a-day-are-treated-in-us-emergency-departments-for-high-chair-related

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.

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