Babies are drinking too much milk in the 6 to 18 month window period. This period is critical in establishing healthy eating behaviour. Too much milk not only deprives the body of nutrients it needs from solid foodstuffs, it also leads to iron deficiency and contributes to chronic or recurrent constipation. Riekie Van der Vyfer, a local dietician based at Quenet's Family Pharmacy, gives some tips to help getting baby off the bottle (and breast).
Die 2019 griepinspuiting is beskikbaar vir toediening. Maar is dit regtig nodig? Ek glo dit is. Ons het in 2018 merkbaar baie kinders toegelaat in die hospitaal met verskillende vorms van griep - 'n goeie persentasie hiervan sekerlik verhoedbaar met immunisasie. Dit was verbasend in watter vorme die griepvirussiekte gemanifesteer het en hoe laat in die jaar ons steeds gevalle gesien het. Baie kinders het voorgedoen met koors en braking en opgeëindig met onnodige lumbale punksies om breinvliesontsteking uit te skakel. Party kinders was deurmekaar; 'n paar kinders kon vir 'n paar dae nie loop nie weens spierinflammasie. Ander kinders het voorgedoen met kroep, brongitis en longontsteking. Meeste gevalle in andersins gesonde kinders. Buiten die siekte self, kan baie kinders van onnodige (en dikwels pynlike) toetse gespaar word deur die griepinspuiting te kry vanaf April elke jaar.
Die formele indikasies vir die jaarlikse griepinspuiting is :
- Alle kinders onder 5 jaar en veral alle kinders onder 2 jaar. Definitief aangedui as jou kleintjie in dagsorg of kleuterskool is.
- Alle kinders (en volwassenes) met 'n hoër risiko vir gekompliseerde griepsiekte :
Pasiente met asma
Pasiente met aangebore/verworwe harttoestande
Pasiente met aangebore/verworwe immuuntekorte (insluitend kinders op chemoterapie vir kanker)
Pasiente met suikersiekte
Pasiente met brein- en spinaalkoordabnormaliteite, soos serebrale verlamming, epilepsie of spierswakheid
Pasiente met niersiekte
Pasiente met aangebore metaboliese steurnisse
- Alle swanger vrouens
- Alle gesondheidswerkers (dokters en verpleegpersoneel)
- Alle oppassers van kinders in dagsorg
- Alle mense ouer as 65
- Alle mense in versorgingseenhede of ouetehuise
Praktiese dinge :
Die griepinspuiting kan toegedien word vanaf 6 maande.
Die griepinspuiting kan gegee word vanaf April tot aan die einde van die winter.
Kinders onder 3 jaar (36 maande) kry 'n halwe volwasse dosis; kinders ouer as 3 jaar kry 'n volwasse dosis.
Kinders jonger as 8 jaar wat die griepinspuiting vir die eerste keer ontvang, moet 'n tweede dosering van die griepinspuiting 4 weke na die eerste dosering kry. In die daaropvolgende jare, kry hulle net 'n enkele dosering.
If your little one has been diagnosed with non-specific vulvo-vaginitis (inflammation of the inner lining of the female genital area), adhering to these measures are recommended to treat and prevent an episode of vulvovaginitis in prepubertal girls.
General hygiene measures :
Lonette De Vries, a registered occupational therapist in Robertson, has been kind enough to suggest a few developmental exercises you can do with your baby in the first few months of life. Have fun!
1. Make family mealtime a priority. Have a routine meal together as a family at least once a day - dinner is most practical.
2. Avoid distractions during mealtime. No TV.
3. Maintain a calm and pleasant attitude during mealtime.
4. Encourage the appetite during the day : have shorter and more frequent meals : limit meal duration to 20-30 minutes and have 4-6 meals or snacks per day with water in-between meals. No milk/juice/sweetened beverages between meals - use these rather as a reward after meals.
5. Systematically introduce new foods and don't give up easily - try new foodstuffs up to 8-15 times before giving up.
6. Give age-appropriate foods.
7. Encourage self-feeding.
8. Accept age-appropriate mess.
As recommended by the World Health Organization.
1. Thaw ready-to-eat frozen food in the fridge or microwave - don't thaw at room temperature.
Yes, it is available in Worcester. A few drops of your baby's blood can be collected onto a blood card in the first few days of life (best on the day of discharge) to screen for a number of metabolic and other inherited diseases (see below for the complete list). As a screening test, the aim is to identify newborns that require further, definitive testing. The benefits include early diagnosis and potential treatment of these relatively rare (1 in 4000 babies affected), but potentially serious and lifelong, conditions. They can be quite difficult to diagnose (if one waits for symptoms and signs to appear) and by the time they are, some of the complications may be irreversible. It is strongly recommended to have the screening test done if there is a family background of one of these conditions. Why isn't everyone having the test for their baby? It is relatively expensive (currently up to allmost R1600) and your medical aid probably won't cover the cost.
Conditions screened for with the newborn screening test :
Amino acid disorders : Citrullinemia type 1, classic phenylketonuria, homocystinuria, maple syrup urine disease, tyrosinemia type 1.
Organic acid disorders : 3-hydroxy-3-methylglutaric aciduria, 3-methylcrotonyl-CoA carboxylase deficiency, glutaric acidemia type 1, holocarboxylase synthase deficiency, isovaleric acidemia, methylmalonic acidemia (cobalamin disorders), methylmalonic acidemia (methylmalonyl-CoA mutase), propionic acidemia, beta-ketothiolase deficiency.
Disorders of fatty acid oxidation : carnitine uptake defect/ carnitine transport defect, medium-chain acyl-CoA dehydrogenase deficiency, very long-chain acyl-CoA dehydrogenase deficiency.
Disorders of carbohydrate metabolism : classic galactosemia.
Endocrine disorders : congenital adrenal hyperplasia, primary congenital hypothyroidism.
Other disorders : biotinidase deficiency, cystic fibrosis.
More information :
Newborn screening in South Africa
Newborn screening in the USA
Is it important? Yes. Iron deficiency is common and may have lasting adverse effects on your child’s cognitive abilities. It has also been associated with headaches and the development of ADHD (attention deficit hyperactivity disorder) and strokes in children.
What can we do to decrease the prevalence of iron deficiency? At delivery, your baby’s umbilical cord should only be clamped after 30-60 seconds, if safe to do so for mom and baby. If your baby is at high risk for the development of iron deficiency, he or she needs to be supplemented with iron from 2 weeks after birth. This is especially important for babies of mothers who had iron deficiency during the course of their pregnancy, premature or low birth weight (<2.5kg) babies, and babies who lost blood before (in the womb), during or after delivery. If breastfeeding exclusively, your baby needs to be supplemented with iron from 4 months of age. When starting with supplemental feeds @ 4-6 months, start with an iron-enriched baby cereal and do not wait until after 7 months to start with pureed meats. Delay giving unmodified cow’s milk until after 12 months of age, as its intake before this time can lead to poor iron absorption and silent bleeding in your baby’s gut, with chronic blood loss aggravating the iron deficiency. Toddlers older than a year of age should not be drinking more than 600ml of unmodified cow’s milk per day; if they are and cannot be weaned from doing so in the short term, they should be supplemented with iron. Routine iron supplementation is also recommended if your child (between the age of one and five years) is eating less than 3 portions of iron-rich foodstuffs per day (<85g meat per day). Liver, prune juice, spinach and iron-fortified cereal are some of the less well-known iron-rich foodstuffs. Meat not only contains good amounts of iron, but also inherent factors that promote the absorption of iron from other (non-meat) iron-rich foods. Food elements having a negative effect on the absorption of iron, include tea, coffee and calcium (beware excessive amounts of dairy in the diet). Tea may decrease iron absorption by 90%. Ascorbic acid (vitamin C) promotes the absorption of iron : it is a good idea to give a (diluted) vitamin C-enriched juice with (iron-rich) meals. Children should be dewormed at least every 6 months in the first 5 years of life – the worms attach to the inside of the gut, leading to significant blood loss over time if the amount of worms are enough.
Human breastmilk is the optimal form of nutrition for a baby in the first few months of life.
Short term gastro-intestinal benefits include :
- Enhanced stomach emptying (better for reflux)
- Increased gut motility (rare for a breastfed baby to become constipated)
- Natural acquisition of beneficial gut micro-organisms (Bifidobacteria, Lactobacillus) through human milk oligosaccharides to establish a healthy gut microbiome, which plays a role in metabolism, immunity and allergy prevention.
- Decreases the incidence of necrotising enterocolitis (serious gut infection) in premature babies
Breastmilk contains many antimicrobial substances, preventing and decreasing the severity of illness during and for a period after breastfeeding :
- Gastro-enteritis (diarrhoea)
- Respiratory tract infections (up to the first year of life)
- Acute and recurrent otitis media (middle ear infection) (up to the first 2 years of life)
Long term benefits :
- Post-natal flavour learning.
Eating vegetables during breastfeeding will increase the chance that your baby will eat them too.
- Allergy prevention
- Auto-immune disease prevention
(type 1 diabetes mellitus and inflammatory bowel disease)
- Decreased risk of cancer (decreases leukemia risk by 20%)
- Decreased risk of type 2 diabetes mellitus
- Improved vision and hearing
- Better bonding between mom and baby
Potential long term benefits (not convincingly proven yet):
- Decreased risk of becoming obese (overweight)
- Improved neuro-development (better IQ)
- Less childhood behavioural problems
Colic is a descriptive, subjective diagnosis : it only means that your young baby is crying excessively in the first few months of life. It is a diagnosis of exclusion : your doctor needs to exclude other potential causes for crying; colic can only be diagnosed once other causes of crying in a young baby have been excluded. Although there are theories surrounding the cause of colic, we actually don’t understand why it happens. There is also no solid medical treatment available that consistently alleviates crying in all babies with colic. One can, however, rest assured that it is a temporary phenomenon – almost all babies with colic stop crying between 3 and 4 months of age.
There is no good evidence that any medication consistently helps with bronchiolitis. A small percentage of patients might improve with a beta-agonist airway muscle relaxant aerosol like Ventolin. Aspelone, nebulised Pulmicort/Budoneb, Monte air/Topraz/Sintrine, antibiotics, nebulised adrenaline, nebulised hypertonic saline, cough mixtures, chest physiotherapy… none has been proven to effect a quicker cure, despite being commonly prescribed and used. Antibiotics are only indicated for severe bronchiolitis. Supportive treatment in hospital entails providing oxygen (if needed), managing fever, ensuring adequate fluid intake and managing complications like otitis media and pneumonia (lung infection). In-hospital stay is usually only necessary for a day or two to gauge the course of the disease process. It may take weeks to resolve completely.
The basics. The when, the what, the how much, the do's, the don'ts. Start here before you start.
Breastmilk can be frozen (in a sterilized bottle). If special containers for this purpose aren’t available, you may express into a normal (sterilized) bottle, covering it with plastic or foil to prevent contamination.
How to thaw : swirl bottle with frozen expressed breast milk under running, warm water. Don’t thaw at room temperature : it takes too long, spoiling may occur. Never heat in a microwave. Never refreeze once thawed.
How long can expressed breast milk be stored?
- Fridge ice compartment : 2 weeks
- Freezer : 3 months.
Wash hands and all feeding utensils well.
Boil all feeding items for 5 minutes. Close cleaned, dry bottles until used.
Boil fresh water for 5 minutes; allow to cool down to lukewarm before pouring into bottle.
Prepare one feed at a time. Only use the scoop provided with the formula - scoop sizes vary between brands. Read the label carefully to see the recommended volume of the feed according to your baby's age and/or weight and the amount of water to be mixed with a scoop of formula powder. Level each scoop with the back of a clean, dry knife.
If formula needs to be warmed, it should be done with a bottle warmer or by placing the bottle in a container of warm water. Do not warm in a microwave (creation of hotspots with the risk of causing burns). Do not warm for longer than 15 minutes (certain bacteria may start to proliferate). An appropriate temperature for the formula is between room and body temperature. Test a few drops on the inside of your wrist to check the temperature before you offer it to your baby.
Any infant formula not consumed within 2 hours should be discarded. Leftovers should never be reheated, refrigerated or saved for the next feed.
Routine follow-up visits
Follow-up visits of high risk infants and children with chronic diseases are individualised. Routine follow-up of your healthy baby, infant, toddler or child is recommended at the following ages:
6 Months (especially for first-time parents)
Yearly after age 2
The idea behind routine follow-up visits is to see the children when they are well and capable of being screened for developmental problems. Time is spent on the little things. Advice on nutrition, supplementation, prevention of common childhood problems and immunization is provided. A quick systemic examination is performed and all measurements are assessed. Time to bring in the little list of questions you have compiled over the last few months!
If your baby is jaundiced, be sure to know when your paediatrician would like you to have the jaundice test to be repeated. In general, if the jaundice test was done on the day of discharge from hospital, it is recommended to have it repeated within the next 48 hours. It is also recommended to repeat testing if your baby is still jaundiced after 2 weeks.
Feeding And General Baby Care
If you experience any feeding difficulties or if you have any questions regarding routine care of your baby, please contact Sr Anelle Greyling on 083 564 6722 for feeding advice and support.
Regular Weighing Of Your Baby
It is recommended that you have your baby weighed regularly in the first few weeks – weekly initially for the first 2–4 weeks and then biweekly thereafter.
If Dr Stander attended to your baby after his or her birth in hospital, you will be contacted to arrange a follow-up visit at the practice within 5 days of discharge from hospital, as well as an appointment for a routine check-up at 6 weeks, usually arranged for the same day you have a check-up with your obstetrician.
Routine immunizations are done at 6 weeks, 10 weeks and 14 weeks in the first few months of your baby’s life. This is irrespective of whether your baby was born prematurely or at term. The practice will arrange for your baby’s immunizations at our in-house immunization clinic, Kleinding Kliniek.
It is recommended to have your baby’s hearing tested after birth. The hearing test can be arranged with the following audiologists in Worcester :
Elda Van Dijk 082 331 8889 (66 Fairbairn Street)
Ula Rabie 023 347 4176 (30 Russell Street)
Helmien Van Rooyen 072 179 8486
If you have any further questions or experience any problem not addressed above, be sure to give the practice a call – we will gladly assist you.
Office hours 08h00-16h30 023 342 2333
After hours 079 294 3199
1. Have a set bedtime and bedtime routine for your child.
2. Bedtime and wake-up time should be about the same time on school nights and non-school nights. There should not be more than about an hour's difference from one day to another.
3. Make the hour before bed a shared quiet time. Avoid high-energy activities, such as rough play, and stimulating activities, such as watching television or playing computer games, just before going to bed.
4. Don't send your child to bed hungry. A light snack before bed is a good idea. Heavy meals within an hour or two of bedtime may interfere with sleep.
5. Avoid products containing caffeine for at least several hours before bedtime. These include caffeinated fizzy drinks, coffee, tea and chocolate.
6. Make sure your child spends time outside every day whenever possible and is involved in regular exercise.
7. Keep your child's bedroom quiet and dark. A low-level night light is acceptable for children who find completely dark rooms frightening.
8. Keep your child's bedroom at a comfortable temperature during the night (24 degrees Celsius).
9. Don't use your child's bedroom for time-out or punishment.
10. Keep the television set out of your child's bedroom. Children can easily develop the bad habit of "needing" the television to fall asleep.
Source: Owens J, Mindell J. Sleep hygiene : Healthy sleep habits for children and adolescents. In: A clinical guide to pediatric sleep, 2nd ed, Lippincott, Williams & Wilkins, Philadelphia 2010.
Die volgende hoeveelheid ure slaap per 24-uur siklus (slapies deur die dag ingesluit) word aanbeveel :
0-3 maande : 14-17 ure
4-11 maande : 12-15 ure
1-2 jaar : 11-14 ure
3-5 jaar : 10-13 ure
Bron : National Sleep Foundation (VSA), 2016
Your baby's Road To Health Booklet (the red or green one you received home in the maternity ward) contains a schedule only for the essential Expanded Programme on Immunization vaccines, available to each child in South Africa via a public sector immunization facility. There are additional cover available for protection against the following diseases :
When does my baby, infant or toddler have diarrhoea? When there is a significant increase from the usual bowel movement frequency, associated with a change in the character of the bowel movement to a liquid consistency.
Consult a doctor when your baby/infant/toddler has diarrhoea in the presence of any of the following :
Consult a doctor in the case of:
Consult a doctor:
Immediately consult a doctor if :