Babies and children / winter ailments

Coughs, colds and flu in babies and children

Here in the southern hemisphere, Easter is more about autumn leaves, avocado-pears and oranges than daffodils, bunnies and chickens. While the northern hemisphere celebrates the coming of warmer days and longer nights, we’re taking out our winter woollies and putting the duvets back onto our beds.

Winter is also the season of flu, coughs and colds. It takes just one person infected with a virus to unwittingly spread it to family, friends, colleagues and just about everyone he comes into contact with. The elderly, pregnant women, people with poor resistance, children and babies are particularly vulnerable. This week’s blog is about vulnerable children and babies and respiratory tract infections.

The nose, mouth and throat are the first line of defence when it comes to fighting microbes. Microscopic tuberculosis spores, fungi, viruses, bacteria and parasites are everywhere – in the air we breathe, on surfaces we touch and the people we mix with. The fine hairs inside the nose filter the biggest of these. When they’re particularly irritating, they make us sneeze. The mucous lining of the mouth, nose and throat is our second line of defence. This moist, slippery surface contains a fluid that is able to protect the body from invading micro-organisms.

When a virus or bacteria manage to bypass these defences, babies and children can come down with an upper or lower respiratory tract infection.

An upper respiratory tract infection begins with rhinitis, or runny nose caused by a virus. This infection can spread up the nose into the sinuses causing sinusitis. A middle ear infection can be bacterial or viral and is mostly spread from the nose and through the eustachian tube (this connects the middle ear to the top of the nose called the nasopharynx) to the middle ear. Tonsillitis and pharyngitis are bacterial upper respiratory tract infections.

Lower respiratory tract infections spread downwards into the chest and are mostly viral. These begin with laryngotracheal-bronchitis and tracheobronchitis that can become bronchitis.

The greatest concern about these infections is that upper respiratory tract infections in very small babies and young children can spread to the brain and become meningitis or encephalitis. In severe cases this can cause life-long complications. Severe lower respiratory tract infections can become pneumonia.

What to look out for when your baby/child is sick:

• Before your baby/child shows typical symptoms, they will be just plain miserable and clingy, reluctant to play and eat.
• They may look flushed or very pale with a temperature of 38°C or more
• Your baby/child may be thirsty but not hungry. If they’re coughing and are very ‘mucousy’ they may vomit their feeds
• Because they’re drinking less, babies will wet fewer nappies. Children will use the toilet less often. This is a sign of dehydration.
• A baby’s cry will tell you that s/he is not well. It becomes a whimper rather than a loud lusty cry
• Lack of feeding and a fever will make your baby/child listless, limp and lethargic
• Coughing may get worse. If your baby/child has an ear infection, s/he will rub the infected ear
• Some infections cause a rash.

 These symptoms are good reason to take your baby/child to the doctor, especially if they are becoming dehydrated.

What should you do when your child is ill:

Take him/her to the doctor. An antibiotic will only be prescribed if the infection is bacterial. Viral infections cannot be cured with an antibiotic.

• Make sure you give your child the correct dose of medicine at the right time and at the intervals that they’ve been prescribed
• Treat the symptoms i.e. give your child medicine for a fever regularly. While the fever persists, give your baby/child a tepid (not cold) bath and keep him/her very lightly dressed. Give them rehydrate in small doses very often until they can tolerate liquids. Give them easy-to-swallow and digest food like jelly and soup.
• Leave them to sleep undisturbed while their body heals
• Nebulising and physiotherapy helps with lower respiratory tract infections

If the symptoms persist, or get worse, please take your baby/child back to the doctor.

Luckily, babies and small children are exceptionally resilient and recover remarkably quickly. Keep them healthy this winter with lots of vitamin C – found in just about every fruit available. Keep them warmly dressed (especially in the early morning and late evening when they are being fetched from crèche or nursery school), and if they’re picky-eaters, give them a good multivitamin (ask your pharmacist to recommend a brand with a combination of vitamins and minerals made specially for children).    

How to avoid listeriosis food poisoning

Listeriosis and pregnancy

There has been a Listeriosis bacterial food-poisoning outbreak in South Africa recently (more especially in Gauteng where I live). This has highlighted the need for vigilant quality control by health inspectors (the outbreak began in two cold-meat and hot-dog sausage factories), scrupulous cleanliness where food is processed and in supermarket delicatessens, alertness by the public (especially those who are immune-compromised) and kitchen hygiene.

I contacted a doctor, dietitian, laboratory and NICD (National Institute for Communicable Diseases) for more information.  This is what I learned.

NICD:  

Unlike most germs, Listeria bacteria grow and spread in cold temperatures – including cold storage and your fridge. Bacteria can spread inside and outside food packaging and contaminate other food in the fridge and kitchen surfaces.

People are advised to:

• Keep kitchens, fridges and working surfaces scrupulously clean. Wash your hands before working with food. Wash fruit and veggies. Scrub chopping boards after use. Soak dishcloths and kitchen towels in bleach (e.g. Jik)
• Keep the fridge temperature below 4°C and the freezer at -18°C

The more bacteria are allowed to multiply, the more people will get sick. During the Listeriosis outbreak, people were advised not to eat processed meat products and ready-to-eat meats. Retailers were instructed to thoroughly clean shelves, fridges and all surfaces where polony and ready-to-eat meat was stored. It is essential that meat slicing equipment is dissembled, washed and disinfected daily.

Doctor:

Bacteria, viruses, fungi and parasites are everywhere – all the time. It’s important to pay attention to hygiene at all times – but especially when people are immune-compromised, pregnant and when there is an infectious outbreak.

Symptoms of food poisoning:

• Flu-like symptoms, such as fever, headache, and body ache
• Vomiting, diarrhoea, and abdominal pain

Pregnant women are particularly vulnerable because, even though she may have only have mild, flu-like symptoms (or may not feel sick at all), listeriosis (at any stage of her pregnancy) can lead to miscarriage, stillborn, low-birth weight and health problems for her new-born.

Dietitian:

Pregnant women should always be cautious about eating ready-to-eat refrigerated foods, unpasteurized milk, and foods made with unpasteurized milk. They should also avaoid soft cheeses (such as feta, brie, camembert, blue-veined cheeses, "queso blanco," "queso fresco" or Panela), unless they are made with pasteurized milk, sushi and raw meat.

Top tips:

• Wrap or cover foods with a sheet of plastic wrap or foil, put foods in plastic bags or clean covered containers before putting them in the fridge. Check that foods do not leak juices onto other foods.
• Use precooked and ready-to-eat foods as soon as possible. The longer they are stored, the more Listeria has a chance to grow.
• Keep meat, poultry, seafood, and eggs separate from other foodstuffs while shopping and in the fridge.
• Only eat freshly cooked food. Reheat hot dogs and lunch meats until steaming hot.

Laboratory:

Testing for Listeriosis:

It’s unnecessary to screen healthy people for Listeriosis. Gastritis is short-lived and for people who have not eaten contaminated food – but have food poisoning from another source – laboratory testing and antibiotics are unnecessary. However, testing should be done when people are immunocompromised (HIV, cancer and cancer treatments, lupus, liver and kidney disease) pregnant women, babies younger than six weeks and people older than 65 who have eaten contaminated food. Stool cultures may be negative because the test is not sufficiently sensitive to detect the bacterium, and blood tests are not sensitive enough either so they should not be done. For women who have given birth, the placenta can be sent for culture.

 (Information supplied by Ampath Laboratories)

Parenting teenagers

5 mistakes I made when my kids were teens

Okay, I made a lot more than five mistakes – but these were the biggies.

• I thought that my children would be mine forever (after all, I made them).  I had to learn to ‘let go’ so they could make their own decisions (and yes, their own mistakes too)
• I took it personally when their friends (and their friend’s opinions) were more important than mine
• I wasn’t the greatest ‘spectator’ mom when it came to sporting events (OMGosh I missed my son’s cricket ‘hat trick’ and countless other sporting feats)
• I never imagined that my teenagers would dabble in sex, alcohol or drugs
• I compared my parenting skills with other parents (usually those who had perfect kids!)

Looking back, I realise that, just 30-something, I had four children. At 40-something, I was a grandmother.

I should have known then what I know today. Luckily, kids are forgiving – and so are their parents.

Top tips:

Make time for your teenager:

Teens are private people. They like to spend time alone. They hate family outings. Church is out of the question. So, when your teenager asks a question or your opinion (usually when you’re hectically busy) STOP what you’re doing and listen. Let the food burn, the phone ring, the dogs bark. Give your teenager your 100% attention. A teenager’s window of communication is small. Don’t miss out on this opportunity.

Give clear instructions:

It’s so easy to presume that teenagers understand what you’re telling them to do because they usually grumble “I know, I know!” But teenagers live in a world of their own. When they’re in love, time stands still. They listen but hear nothing. When there’s a misunderstanding, they can misread your emotional signals and see them as angry and hostile.

Teenagers have to learn the hard way:

Millennials live in a harsh adult world. They’re unprotected from the lure of sex, drugs and alcohol. On top of this, their brains are flooded with dopamine – the chemical that reinforces pleasurable behaviour. We know that teenagers are fascinated by the forbidden (weren’t we young once?). They get a thrill out of risk-taking. Pointing out these dangers is meaningless and punishment provokes resentment. It’s best to warn them about tangible consequences – like getting kicked off the football team if they don't get better grades.

Their internal clock is screwed:

It’s called ‘diurnal rhythm’. In other words, teenagers are wide-awake when everybody else is asleep and seriously sleepy when they should be awake. Look up pineal gland in the brain and you will learn that this is the gland that secretes the hormone called melatonin or the ‘darkness hormone’. It helps us fall asleep. Babies are born without melatonin, but once they’re experiencing day and night, they start making this hormone and this is when their sleeping pattern settles down. Levels of melatonin peak for adults at about 10pm when we start getting ready for bed, but for teenagers, it’s as though their brain is programmed to start night-time much later. This is about 1am.

Feed them – teenagers get ferociously hungry:

A teenager’s brain is undergoing pruning, ovaries and testicles are pouring oestrogen and testosterone into the blood stream, teenagers are growing and they’re the most physically active they will ever be. Adrenalin is attaching itself to serotonin and other brain chemicals that affects their mood and excitability. Add low blood sugar levels to this cocktail and you have an extremely irritable teenager on your hands. Keep the fridge stocked with healthy alternatives besides chocolate cake and frozen pizza.

Adolescence lasts only six years. At the time, it seems like an eternity. It’s rewarding when your teenagers become adults. You can have a conversation with them. Ultimately, you become extremely fond and proud of them. Then you realise that all the hard work that went into making them, was well worth the effort. Don't give up!

Answering those difficult questions

Answering awkward questions

Children have a habit of putting you on the spot by asking ask awkward questions – usually when you are in a busy shopping mall. I remember quickly steering my shopping-cart into the next aisle when my daughter said (in her loudest possible voice): ‘Look mommy, that man is having a baby, just like you!’

Children are curious and want to know about things that adults are not always comfortable talking about. We’re happy to tell them about childhood fantasies like Father Christmas and the tooth mouse, but we get tongue-tied when children ask about death or divorce and where babies come from.

It’s important to answer children’s questions honestly and frankly because you want to build a trusting relationship with your child, so that when they get older, they will come to you with questions about love and life.

Your child asks about death

Children are not spared death and dying. Whether it’s their pet mouse, a grandparent or sometimes even a parent, it’s not easy explaining to them that death is permanent. Children, as do adults, need to be given the chance to grieve. This means feeling sad, angry, frustrated and even rejected. Children should be given the chance to cry and talk about how they are feeling.

Approach the subject by telling the child that dying is part of living. If we shield children from the realities of death, we’re reinforcing denial. If we’re secretive and don’t want to talk about death, we make children feel insecure and afraid of the unknown. When we’re honest with children and tell them that their loved one’s spirit has simply left their earthly body to find everlasting happiness in heaven – their imaginations (depending on their age) will create happy images. And, that's good news.

Sometimes adults believe that children should not go to funerals. When I was a child, my siblings and I were ‘spared’ going to our father’s funeral. I remember everybody crying and wearing black, but nobody spoke to us about what was happening. As a result, we children never got closure and our fathers ‘disappearance’ remained an unspoken sadness. Many years later, when I was in my 40’s, a psychiatrist gave me a box of tissues and told me to have a good cry!

Where do babies come from?

Today’s children don’t buy the stork-story – they know about big tummies and babies growing in there. How did it get there – well mommies have an egg, and the little egg grows into a baby. That’s it. Pre-schoolers are not interested in sperm and sex, and pre-teens will say yuk!  

Tweens should be told more about the consequences of sex, that sex is special and, like waiting to buy their first motor-car or leaving home one day, there’s a right-time for everything in life.

Your child asks about condoms

Oops! Your child found those neat little packages in your bathroom cabinet – and what’s more, showed them to his friends and they blew them up!

Don’t shout, make your child feel guilty or embarrassed. If your child is still young and naïve, admit they are special balloons, but not for birthday parties!

Your teenager won’t ask about condoms – they’ll be too embarrassed. It is a good idea when you’re having the ‘birds-and-the-bees’ talk to tell them about condoms and their purpose. Point out that while they help to prevent pregnancy and provide some protection against a few sexually-transmitted-infections like gonorrhoea, HPV and HIV, they can’t do much for genital warts (that can become cancerous) and syphilis.

    

Pads and tampons:

These are often advertised on TV and in magazines, prompting the question: what are they? You can say that they’re cotton wool that women like to use.

Your child says "I hate you …"

Don’t take it personally. Very young children are experimenting with words and reactions from adults. Simply ask why they hate you – most of the time you’ll be pleasantly surprised when you discover that there’s a pretty simple explanation to their outburst.  

Your child says: "I've got a boy/girlfriend"

“Oh yes,” you say. “And what is his/her name?”

When all else fails, answer a question with a question. Your child’s answer will give you a clue as to where the question came from in the first place. It will also give you a chance to think about it and come up with the right answer!

When a woman becomes a mother for the first time

Coping with a new baby

I recently visited a mom with her new-born and listening to her story about the birth reminded me how difficult and traumatic those early weeks of motherhood can be, and how little women are prepared for this ordeal.

Riva Rubin, an American midwife in the 60’s, who worked with hundreds of women in post-natal wards, was the first to recognise and document the behaviour of a new mother. Back then, women used to spend 10 days (at least) in hospital – longer if she had a C-section. During the first week after birth, Rubin identified three distinct phases: Taking-in, Taking-hold and Letting go.

Taking-in: This phase typically lasts the first and second day. During this time, the mother recovers from the birth and is not particularly interested in her baby. This is because she is exhausted, sore and hungry. She only wants to eat and sleep. When the mother is awake, she relives every minute of her labour and birth. It’s the only thing she can think and talk about, comparing her expectations to what actually happened - which are usually poles apart. She may be disappointed about many things – from the labour ward to the bedside manner of her gynaecologist!  

Taking-hold: On the second and third day (incidentally this coincides with her milk ‘coming-in’) the mother is feeling a lot better and can focus on her baby. She feels more in control and wants to learn everything she can about baby-care. She is keen to breast-feed, bath and look after her baby.

Letting-go: This is when a new mother ‘let’s-go’ of who she was and learns to accept her new role as a mother. Her life has changed. Never again will she watch the news of school shootings, drowned refugee toddlers and starving children with the same eyes. Her instincts to protect and nurture her baby surface with the vengeance of a mother-bear. Even her relationship with her baby’s father changes.

It’s not surprising then that women are not ‘elated’ after the birth of her baby. She has so much to deal with – so many things she was not expecting. The pain – sore breasts, sore perineum (the area between the vagina and anus that suffers the most trauma during a natural birth) or her cut after a C-section. She is exhausted adjusting to being ‘on-call’ 24/7 to a squirmy little parasite who only poops, pukes and cries! She feels insecure every time her baby cries – and wonders what she is doing wrong. She wonders if she is doing things right – changing the nappy, burping the baby, feeding! She resents magazines and baby-books for their idyllic pictures of happy mothers with content babies when she feels just the opposite.

In my experience, the letting-go phase is the most difficult to deal with and can last much longer than a few weeks. This is when post-natal stress can become post-natal depression. Superficially, women have to cope – and be ‘super-women’ – preparing gourmet meals, looking glamorous and getting back into their skinny-jeans. The bigger the gap between womanhood (her first period) and motherhood, the longer it takes to adapt. Younger women who have not established a career tend to accept motherhood a lot quicker than company CEO’s – even when she can afford a night-nurse and daytime nanny when she goes back to work. Little do people realise that behind her desk, she’s in never-never land!

Coping tips:

• Babies are new-born for the first 6 weeks. This is your 'baby-moon' when you learn to be a mother.
• This is the time to focus on yourself – spend time with your baby and not worry about routine or chores.
• Mooch around in your slippers and dressing gown in the morning – but have a bath and be dressed by noon.
• When friends offer to help, ask them to bring you meals, help with the laundry or even sit with the baby while you take a bath or shower.
• Eat healthy. Drink lots of liquids.
• Talk to other women who are wearing the T-shirt.
• Don’t sweat the small-stuff. The world will keep turning without you.

Remember that one day you will wake up and the sun will be shining. Everything will feel ‘right’ – at least for a while!