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Constipation in Children

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Constipation is a very common problem for children. For most children, constipation means passing hard poo (faeces, stools or motions), with difficulty, less often than normal. Regular soiling (often mistaken for runny diarrhoea) may indicate that a child has bad constipation with impaction (a blockage of faeces). Where no particular disease or illness is the cause of the constipation, it is called idiopathic constipation. It is important that constipation be recognised early to prevent it from becoming a long-term (chronic) problem. Note: there is a separate leaflet called Constipation in Adults.
Parents often get very worried about their child's bowel habit. This anxiety can start when the child is a baby, with concern over the number of dirty nappies. The main thing to realise is that every child is different. Normal can vary quite a bit. It is a change in what is normal for your child, that suggests a problem.
Babies will open their bowels anything from several times per day, to once every few days. The frequency of bowel movements is not very important. What is important is that the poo (faeces, stools or motions) is soft and easily passed.
Breast-fed babies tend to pass runnier, mustard yellow-coloured stools. This is because breast milk is better digested than infant formula (bottle feeds). Newborn breast-fed babies may open their bowels with every feed. However, it is also normal for a breast-fed baby to go up to a week without a bowel movement.
Bottle-fed babies often need to open their bowels daily, as the stools are bulkier. Bottle-fed baby stools smell worse (more like an adult's).
It is not uncommon for your baby's stools to vary in colour and consistency from day to day. Any prolonged change to harder, less frequent stools might mean constipation.
As babies are weaned to solid foods, their stools will change in colour and smell. The frequency may again change. Generally, the stools become thicker, darker and a lot more smelly. You will notice that your baby's stools will alter depending upon what you have fed him or her. Some high-fibre foods, such as raisins, may even pass through your baby's bowels virtually unchanged, appearing in the nappy at the next change.
As your baby grows up, into a toddler and then a young child, you may see further changes in their stool frequency and consistency, often dependent on what they are eating.

As you can see, there is great variation in a child's bowel habit, dependent on their age and what they are fed. As already mentioned, it is a change in what is normal for your child, that suggests a problem. Anything from three times a day to once every other day is common and normal. Less often than every other day means that constipation is likely. However, it can still be normal if the stools are soft and well formed, and passed easily.
It may be normal for your baby to go a bit red in the face when straining to pass a stool. Constipation is more of a problem than this. Breast-fed babies seldom get constipated, as breast milk contains exactly the right balance of nutrients to keep the stools soft and easily passed.
Diarrhoea usually means very runny stools, often passed more frequently than normal. Breast-fed babies get diarrhoea less frequently than other babies, as breast milk has a protective effect against the germs that can cause diarrhoea.
Constipation in children or babies can mean any, or all, of the following:
  • Difficulty or straining when passing stools.
  • Pain when passing stools, sometimes with a tiny amount of blood in the nappy or on the toilet paper, due to a small tear in the skin of the back passage (anus).
  • Passing stools less often than normal. Generally, this is less than three complete (proper) stools per week.
  • Stools that are hard, and perhaps very large, or pellet-like and small, like rabbit droppings.










Other symptoms of constipation

As well as less frequent, hard (and perhaps painful) stools, constipation can cause:
  • Tummy ache (abdominal pain).
  • Poor appetite.
  • General malaise (feeling 'off colour').
  • Behavioural changes, such as being more irritable or unhappy.
  • Fidgeting, restlessness and other signs that the child needs to go to the toilet.
  • Feeling sick (nausea).
Severe constipation can cause impaction (where a very large stool is stuck in the rectum). This can cause further symptoms. In particular, this can cause a child to soil their pants regularly with very soft faeces, or with faecal-stained mucus. This is often mistaken by parents as diarrhoea. Impaction is discussed in detail later.
  • Idiopathic constipation. This is common. The word idiopathic means of unknown cause. Various factors may be involved (discussed later), but many children become constipated for no known reason.
    • Short bouts of constipation. It is common for children and babies to have a bout of mild constipation for a day or so. This may settle quickly, often without the need for medical treatment.
    • Long-term constipation. In about 1 in 3 children who become constipated, the problem becomes more long-term (persistent). This is also called chronic idiopathic constipation.
  • Constipation due to an underlying disease or condition. This is uncommon. The constipation is said to be secondary to this other problem. Some examples of conditions and problems that can cause constipation are:
    • Some neurological conditions.
    • An underactive thyroid gland (hypothyroidism).
    • Cystic fibrosis.
    • Rare diseases with abnormal development of the bowel, such as Hirschsprung's disease.
    • As a side-effect of certain medications that a child has to take for another condition.
Treatment may involve treating the underlying condition (if that is possible) in addition to tackling the constipation. Worrying symptoms or signs that may indicate a secondary cause include the following. These should be mentioned to your GP. It is also possible that some of these symptoms could mean your child is more seriously unwell:
  • Being sick (vomiting).
  • Weight loss or failure to gain weight (thrive).
  • A swollen, stretched tummy.
  • Severe pain.
  • A baby that does not pass its first stool (called meconium) within the first 48 hours of life.
  • Abnormalities of the back passage (anus) - for example, if it is closed over.
  • Nervous system (neurological) problems such as weak or paralysed legs.
  • Sores or ulcers near the anus.
  • Excessive thirst.
  • Urinary symptoms - such as passing huge volumes of urine, urine that is very dark or painful urination with smelly urine.
  • Very pale-coloured stools (especially if the urine is very dark too).
The rest of this leaflet is about idiopathic constipation.

Tests are not normally needed to diagnose idiopathic constipation. Your GP is likely to ask various questions and do a general examination to rule out secondary causes of constipation. By examining your child's tummy (abdomen), a GP can tell if there are lots of stools in the bowel. This can give an indication if blockage (impaction - discussed later) has developed. (If an underlying cause of constipation is suspected, your GP will refer your child to a children's doctor (a paediatrician) and further tests may be done.)
Idiopathic means that there is no disease or known cause for the constipation. However, it is thought that various factors may contribute to constipation developing, or make it worse. These include diet, stool holding and emotional factors.

Diet

Dietary factors that may play a part in constipation are:
  • Not eating enough foods with fibre (the roughage part of the food that is not digested and stays in the gut).
  • Not having enough to drink.
Stools tend to become harder, drier, and more difficult to pass if there is little fibre and fluid in the gut.

Stool holding

This means the child has the feeling of needing the toilet, but resists it. The child holds on to the stool, trying to ignore the desire to empty the bowels. This is quite common. You may see your child crossing their legs, sitting on the back of the heels, or doing similar things to help resist the feeling of needing the toilet. Your child may clench his or her buttocks to try to stop the stool from coming out, and may seem quite fidgety. You may notice smudges of stool on your child's pants, often when they are unable to hold on any longer. The longer the child holds on, the bigger the stool gets. Eventually the child has to go, but the large stool is more difficult to pass, and often more painful. This may lead to a bit of a vicious cycle where the child is even more reluctant to open his or her bowels the next time. There are a number of reasons why children may hold on to stools:
  • A previous stool that they passed may have been a struggle or painful. So, they try to put off doing it again.
  • Their back passage (anus) may be sore or have a crack (anal fissure) from passing a previous large stool. It is then painful to pass further stools. So, the child may resist the urge to pass a stool.
  • They may have a dislike of unfamiliar or smelly toilets, such as at school or on holiday. The child may want to put things off until they get home.

Emotional problems

Constipation problems may be made worse with upset due to change in surroundings or routine. Common examples are moving house and starting nursery. Potty training may be a factor if a child becomes scared of using the potty. Fears and phobias are usually the underlying reasons for these problems.
Impaction means that the bowel is, in effect, blocked by a large amount of hard stool. Idiopathic constipation with impaction most commonly develops in children between the ages of 2 and 4 years, but older or younger children can be affected. Symptoms and features include:
  • Recurrent episodes when the child is uncomfortable or distressed trying to pass a stool.
  • The child soils their pants regularly with very soft faeces, or with faecal-stained mucus. This is often mistaken by parents as diarrhoea.
  • The child may also become irritable, not eat much, feel sick, have tummy pains from time to time, and may be generally out of sorts.
  • A doctor can often feel a backlog of hard, lumpy stools when he or she examines the child's tummy (abdomen).
The diagram below shows how a child may develop impaction, and the symptoms this may cause.
chronic constipation in children
  • Normally, stools build up in the lowest part of the bowel.
  • When stools accumulate, they start to pass into the last part of the bowel (the rectum), which stretches. This sends nerve messages to the brain, telling you that you need to empty your bowels.
  • If the stool is not passed out then more stools from higher up also reach the rectum.
  • Eventually, large hard stools may build up in the rectum.
  • The rectum may then stretch and enlarge (dilate) much more than normal, to cope with the excessive amount of stools.
  • A very large stool may develop and get stuck (impacted) in an enlarged rectum.
  • If the rectum remains enlarged then the normal sensation of needing the toilet is reduced. The power to pass out a large stool is also reduced (the rectum becomes 'floppy').
  • More stools build up in the colon behind the impacted stool in the rectum.
  • The lowest part of an impacted stool lies just above the back passage (anus). Some of this stool liquefies (becomes runny) and leaks out of the anus. This soils the child's pants or bedclothes. Also, some softer, more liquid stools from higher up the colon may bypass around the impacted hard stool. This also leaks out and soils the pants or bedclothes and can be mistaken for diarrhoea. The child has no control of this leaking and soiling.
  • When a stool is eventually passed, because the rectum is distended and weakened, it simply fills up fairly quickly again with more hard stool from the backlog behind.

Laxatives

Idiopathic constipation that has lasted for more than a few days is usually treated with laxatives. Your doctor will advise on the type and strength needed. This may depend on factors such as the age of the child, severity of the constipation and the response to the treatment. Laxatives for children commonly come either as sachets or a powder that is made up into a drink, or as liquid/syrup. The laxatives used for children are broadly divided into two types.
  • Macrogols (also called polyethylene glycols) are a type of laxative that pulls fluid into the bowel, keeping the stools soft. They are also known as osmotic laxatives. For example, Movicol® Paediatric Plain is one brand that is commonly used first. This is mixed into water to make a drink to which cordial, such as blackcurrant squash, can be added to make it taste nicer. Lactulose is another type of osmotic laxative.
  • Stimulant laxatives. These encourage (stimulate) the bowel to pass the stools out. There are several different types of stimulant laxative. Sodium picosulfate, bisacodyl, senna and docusate sodium are all examples. A stimulant laxative tends to be added in addition to a macrogol if the macrogol is not sufficient on its own.










Laxatives are normally continued for several weeks after the constipation has eased and a regular bowel habit has been established. This is called maintenance treatment. So, in total, the duration of treatment may be for several months. Do not stop the laxatives prescribed abruptly. Stopping laxatives abruptly might cause the constipation to quickly recur. Your doctor will normally advise a gradual reduction in the dose over a period of time depending on how the stools have become in their consistency and frequency. Some children may even require treatment with laxatives for several years.

Treatment of impaction - if needed

Similar treatments are used for the the treatments listed above. The main difference is that higher doses of laxatives are needed initially to clear the large amount of faeces blocking the last part of the bowel (the rectum). Secondly, laxatives are also usually needed for much longer, as maintenance treatment. The aim is to prevent a build-up of hard stools recurring again, which will prevent impaction returning.
As a result of maintenance treatment:
  • The enlarged rectum can gradually get back to a normal size and function properly again.
  • Constipation is then unlikely to recur.
If laxatives are stopped too soon, a large stool is likely to recur again in the weakened 'floppy' rectum which has not had time to get back to a normal size and strength.
Treatment to clear impacted stools from the rectum can be a difficult time for you and your child. It is likely that your child will actually have a few more tummy pains than before, and that there will be more soiled pants. It is important to persevere, as these problems are only temporary. Clearing the impacted stools is an essential part of treatment.
In rare instances, where treatment of impacted stools has failed, a child may be treated in hospital. In hospital, stronger medicines to empty the bowel, called enemas, can be given via the rectum. For very hard to treat cases, a child can have a general anaesthetic and the bowel can be cleared out manually by a surgeon.










Diet

Dietary measures should not be used on their own to treat idiopathic constipation, as it will be unlikely to solve the problem. However, it is still important to get a child into a habit of eating a good balanced diet. This is to include plenty of drinks (mainly water) and foods with fibre. This will help to prevent a recurrence of constipation once it has cleared.
Eating foods with plenty of fibre and drinking plenty makes poo (faeces, stools or motions) that is bulky, but soft and easy to pass out. Getting plenty of exercise is also thought to help.

Food and fibre

This advice applies to babies who are weaned, and children. Foods which are high in fibre are: fruit, vegetables, cereals, wholemeal bread. A change to a high-fibre diet is often 'easier said then done', as many children are fussy eaters. However, any change is better than none. Listed below are some ideas to try to increase your child's fibre intake:
  • A meal of jacket potatoes with baked beans, or vegetable soup with bread.
  • Dried (or semi-dried) apricots or raisins for snacks.
  • Porridge or other high-fibre cereals (such as Weetabix®, Shredded Wheat® or All Bran®) for breakfast.
  • Offering fruit with every meal - perhaps cut up into little chunks to make it look more appealing.
  • Perhaps do not allow sweets or desserts until your child has eaten a piece of fruit.
  • Another tip for when children are reluctant to eat high-fibre foods is to add powdered bran to yoghurt. The yoghurt will feel grainy, but powdered bran is tasteless.

Drink

If a bottle-fed baby has a tendency to become constipated, you can try offering water between feeds. (Never dilute infant formula (milk) that is given to bottle-fed babies.) Although it is unusual for a breast-fed baby to become constipated, you can also offer water between feeds. Older, weaned babies can be given diluted fruit juice (preferably without added sugar). Pureed fruit and vegetables are the usual starting points for weaning, after baby rice, and these are good for preventing constipation.
Encourage children to drink plenty. However, some children get into the habit of only drinking squash, fizzy drinks or milk to quench their thirst. These may fill them up, and make them less likely to eat proper meals with food that contains plenty of fibre. Try to limit these kinds of drinks. Give water as the main drink. However, fruit juices that contain fructose or sorbitol have a laxative action (such as prune, pear, or apple juice). These may be useful from time to time if the stools become harder than usual and you suspect constipation may be developing.

Some other tips which may help

  • Try to get children into a regular toilet habit. After breakfast, before school or nursery, is often best. Try to allow plenty of time so they don't feel rushed.
  • Some kind of reward system is sometimes useful in younger children prone to holding on to stools. You could give a small treat, or use stickers or star charts to reinforce the message.
  • Praise your child for passing a stool in the potty or toilet, but do not punish accidents. It is easy to become frustrated with soiled pants or a child who refuses to pass a stool.
  • Try to keep calm and not make a fuss over the toilet issue. If your child can see that you are stressed or upset, they will pick up on this feeling, and the toileting issue can become even more of a fraught battle. The aim is to be 'matter of fact' and relaxed about it.

Further help & information

British Nutrition Foundation
References & Disclaimer | Provide Feedback
Original Author:
Dr Tim Kenny 		Current Version:
Peer Reviewer:
Dr John Cox
Last Checked:
28/02/2013 		Document ID:
4584 (v41)		© EMIS
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Why Some Pregnancy Books Cause More Harm Than Good

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With the rise in holistic medicine and alternative healing, it�s surprising Dr. Jennifer Barham-Floreani�s Well Adjusted Babies is one of the few pregnancy books available on the subject for mothers and babies. �Dr. Jen� as she is known, must be an overachiever type, because the book is over 700 pages!

The length also tells us that there was a huge untapped need for pregnancy books about holistic healing for babies and kids.

Well Adjusted Babies has been out a few years now. And yet nothing seems to have changed in the world of traditional pregnancy books. There is barely a whisper in most of them about anything holistic.

That�s like a 90-story skyscraper being built next to your house and you pretend you don�t see or hear anything!











A U.S. Department of Health and Human Services Center for Disease Control and Prevention study said the use of Complementary and Alternative Medicine has grown by leap and bounds from 2002 to 2009.

In Australia, the Alternative and Complementary Medicine industry is estimated to be worth over $1 billion and growing at over 30% per year.

And yet, traditional pregnancy books reflect the values of the larger world of mainstream medicine in general: treat the symptoms while avoiding or ignoring the root cause.

The only thing involving preventive care for most traditional medical practitioners is changing the oil every month in their luxury cars.

It�s funny they call it �traditional medicine� when over reliance on drugs and symptomology is fairly recent in history. Some so called �alternative� medical practices have been effective for 5,000 years!

So has Dr. Jen mellowed her message?

Let�s see�in recent years she�s published the 2nd edition of Well Adjusted Babies with new chapters, case studies, and the latest research; expanded her website and blog WellAdjustedBabies.com; and recently she completed a series of TV and radio appearances around Australia.

Looks like she�s in to win it.

...

About Dr Jennifer Barham-Floreani

Recently awarded �Woman of the Year� (WCWC) and �Australian Chiropractor of the Year�, Dr Jennifer is an accomplished pediatric chiropractor with four children of her own. Aside from pregnancy books, Dr Jennifer also regularly writes information for parents and chiropractors about holistic parenting in her blog.

If you would like to find out more information about Dr Jennifer, her books, or visit her free Pregnancy & Parenting resource blog, please take a look at http://www.welladjusted.me
About The Author
Matt is an independent journalist and pregnancy books reviewer based in Melbourne.
The author invites you to visit:
http://www.welladjustedbabies.com










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Ridwan Mia - Doctors on the forefront of innovation.

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ridwanmiaozhealthcarecommunications
Epicel, a cloned skin was used for the first time in South Africa on 2 year old Pippie Kruger. (Image: Oz Healthcare Communications)


• Dr. Ridwan Mia
Surgeon
Sandton Medi-Clinic
+27 11-463-6591
info.drmiaplasticsurgeon@yahoo.co.zaThis email address is being protected from spambots. You need JavaScript enabled to view it.  

• Under the robotic knife
• South African team develops new rabies antidote
• Drug delivery gets sophisticated
• New medical school for Eastern Cape
• Pushing the science envelope


Melissa Jane Cook


Pippie's skin graft
It was like a scene from a horror film when firelighter gel exploded and little Pippie Kruger was engulfed in flames. Her father was lighting a fire to make a braai and the gel exploded. When she was admitted to hospital she had sustained 80% deep burns and her body was three to four times her usual body size from the swelling caused by the injury.
Six months after Pippie's accident, she was the first person in South Africa to have radical cloned skin grafts, which were a success. Speaking to the media, Dr Ridwan Mia, her plastic and reconstructive surgeon, said: "From a professional perspective, for a two-and-a-half-year-old child to sustain such severe burns and survive, takes a massive team effort."










Ria explained that cloned skin had been available in the United States since the 1970s but Pippie's case was the first time Epicel, as it was called, was used in South Africa. "The technology that produces the cloned skin is incredible. The Genzyme laboratory is in Boston, and every aspect of the laboratory is so tightly controlled that it smacks of a science-fiction movie… A tiny portion of Pippie's skin was sent over and they were able to grow sheets of it on a scaffolding of mouse cells that had been irradiated to remove every trace of mouse DNA. The radiation used is so powerful that the FBI audits the laboratory on a regular basis."
Once enough sheets of skin were cultured, they were flown back to South Africa – another feat that highlighted just how capable South Africans were at getting the job done. "The cloned skin is viable for only 24 hours after leaving the lab," Mia explained. "It was flown in, and when the flight landed at OR Tambo [International Airport, in Johannesburg], the cloned skin was escorted to the hospital during rush hour traffic. The usual hour's journey took less than 16 minutes." While details of the grafts made international news and tissue engineering entered a new era, Mia was quick to point out that he was not the man of the moment, but rather part of a team that contributed to the success of Pippie's skin graft.
"We have the skills in South Africa to practise high-tech medicine. Tragically, our country also has a high incidence of burn patients, and a facility that could clone skin would be ideal. But the set-up costs are prohibitive. To date, only about 100 American patients have benefited from cloned skin.










"The face of medicine is changing rapidly and in a few years' time, harvesting skin for grafts as we do now is probably going to be regarded as barbaric. Tissue engineering is the way of the future," Mia concluded.


Dedicated, pioneering professionals are forging forward with – in some cases bizarre – measures and saving lives, taking innovative approaches to medical care. A neonatologist, a prosthetic and a plastic and reconstructive surgeon have totted up some extraordinary achievements.
These three doctors swore the Hippocratic Oath, one of the oldest binding documents in history. Its principles are held sacred by doctors to this day: treat the sick to the best of one's ability, preserve patient privacy and teach the secrets of medicine to the next generation. It is evident the oath taken by these doctors has earned them great gratitude from those they have saved.
Baby Allegra in a bag
Allegra Lategan spent the first few weeks of her life in 2011 in a ziplock bag to protect her paper-thin skin from tearing against the sheets and to prevent heat loss from her fragile body. She was born at 22 weeks and weighed only 515 grams.
"We were lucky with Allegra in that we knew she would arrive early, so we had time to get an excellent team in place," Dr Ricky Dippenaar, a neonatologist who works at Netcare's Blaauwberg and N1 City Neonatal ICU in Cape Town told the Bulletin health journal. "The fact that she decided to arrive naturally and not by Caesarean section took us by surprise, but didn't catch us off guard as everybody was ready and waiting. At one point there was such a large team of nurses, obstetricians and other specialists gathered around this minute baby that it was almost impossible to see her.
"The use of the humble ziplock bag is already taught in advanced neonatal life support classes as a makeshift mechanism to support premature babies from heat loss," said Dippenaar, "but Allegra also needed a humid environment. Babies born so young have very immature skin and they lose a lot of fluids, and this can upset their electrolyte balance. You need an environment in which they can mature and grow gradually. While we were waiting for the Giraffe incubator to be flown down from Johannesburg, the plastic bag worked perfectly."
For neonatologists, the Giraffe incubator was the Mercedes-Benz of incubators. "Not only does it provide 100% humidity, but it also has a built-in X-ray access tray and scale, which means vulnerable babies don't have to be moved unnecessarily," he explained. "It also has a specialised mattress that supports the premature babies while helping to minimise pressure sores."
Medhold flew one down from Joburg for Allegra, but as a result of the publicity, Netcare had procured its own Giraffe and, despite the enormous costs, was in the process of getting more so other babies would also get the best start, he added.
True to the Hippocratic Oath and passing on knowledge, Dippenaar is able to pass on these incredible skills via a satellite neonatal training facility that has been set up at N1 City in conjunction with the University of Cape Town's medical school.
Annette's Symbionic Leg
In 2012, Annette Fox received the world's first commercially available, fully integrated bionic prosthetic leg. The Symbionic Leg is a self-learning prosthetic that uses advanced sensor technology to predict her gait. Jayson Chin said that the Symbionic Leg was manufactured by Össur, an innovative Icelandic company that created the famous blades of Olympic athlete Oscar Pistorius.
Fox had a cancerous leg removed and Cape Town prosthetist duo Chin and Dave Herman of the Cape Amputee Clinic enabled her to walk again. Chin told the Bulletin: "It's very exciting to see this level of technology in South Africa. The leg was unveiled only in 2011 at the American Orthotic Prosthetic Association's conference in Las Vegas. Until recently, prototypes have been fitted only in a trial environment. For us it's a great challenge and privilege to take this forward. Working with Annette has been incredible because she is so positive."
He explained that the combination of motion and speed sensors and advanced computing meant that the Symbionic Leg could detect small changes in movement and direction. This made it better than other models at changing the rigidity of the knee and the positioning of the foot, providing better balance and stability. "The system's electronic 'brain' uses advanced load sensor cells and angulometers [sensors that measure the angles of the joints] to analyse how the user walks," Chin added.
"These ultra-sensitive sensors measure changes in the terrain to ensure motion that is as natural as possible. At the heart of the system is an advanced actuator: this uses magnetorheological [MR] fluid that varies the knee's resistance throughout every step. The MR fluid contains miniscule iron particles and operates by having a magnetic field applied. This causes the iron particles to form chains, and resistance consequently increases – technology also used for shock absorbers by car manufacturers like Ferrari."
SYMBIONIC-LEG
Annette Fox's self-learning symbionic leg is made by Össur, the company that designed Oscar Pistorius' prosthetics. (Image: Össur)


Read more: http://www.mediaclubsouthafrica.com/tech/3809-doctors-on-the-forefront-of-innovation#ixzz2zAgRxKsp









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#Apps Great Pregnancy Apps..

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These apps help you to connect with baby in the womb and stay on top of its development with great health tips too.

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What to Expect: Pregnancy Tracker

The popular American pregnancy book's mobile app features a due-date calculator, weekly updates on your baby's development and your changing body, daily tips, photo album, due-date countdown and size estimates.
Read more about it here.
Cost: free. Get it on Android and iTunes.
  

BabyCenter: My Pregnancy Today

Track your baby's development with daily updates and health tips, illustrations and videos.
Read more about it here.
Cost: free. Get it on Google Play and iTunes.

Mediclinic baby: Pregnancy App

This app takes you through your pregnancy week by week, features a weight gain tracker, contraction timer, calendar for you to mark special dates, photo album for your bump pics and list of what to pack for hospital. It also offers more information about the Mediclinic baby programme.
Read more about it here.
Cost: free. Get it on iTunes. 










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Smoking and pregnancy

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You want to quit. But you’re still craving it and you just can’t help it. Here’s how to stop smoking once and for all.
By: Ingi Salgado

Smoking and pregnancy
 
    
The risk of causing permanent harm to my baby was the trigger that finally helped me kick a 15-year addiction to cigarettes. It was sheer relief when, taking a puff of a cigarette around my ninth week of pregnancy, I knew it would be my last.
Many women smokers don’t realise they are pregnant, at least for some weeks, and expose their developing babies to tobacco toxins at an important development stage.










According to science

Patrick Holford and Susannah Lawson, authors of “Optimum Nutrition Before During and After Pregnancy”, say that smoking in the first few weeks after conception affects the way cells replicate and interferes with protein synthesis.
This is believed to be why babies born to smokers are more likely to suffer malformations, in particular cleft palates, hare lips, deafness and squints. They point out that the risk of birth defects increases by two and a half times, even if the woman doesn’t smoke while her partner does. This is because the mutagenic compounds of tobacco damage the chromosomes of sperm.

Motivation to quit

There is strong incentive to quit during the early stages of pregnancy. If women stop by the fourth month of pregnancy, they can reduce some of the risks associated with smoking, such as delivering low birth weight babies. Conversely, the more women smoke during pregnancy, the greater the reduction in birth weight.
Birth weight is a key indicator of health in later life. Lower weights have greater correlations with heart disease, strokes, diabetes and overall susceptibility to illness. Higher weights are associated with intellectual development.

Step-by-step

For me, the motivation was simple: if the health of my baby couldn’t convince me to quit, what would? Even then, it took a little time.










The first step to encouraging a pregnant woman to quit is to arm her with a detailed understanding of the risks associated with smoking, in a factual and non-judgmental manner.
The next is to help her (and possibly her partner) through a cessation programme, and to maintain this after birth to prevent a relapse.

The risks

Before pregnancy

Smoking damages the quality of women’s eggs, and thus lowers the number that can make a healthy baby. It also reduces sperm concentration by about 24 percent.

During pregnancy

Women who smoke have a 27 percent higher risk of miscarriage, and a greater risk of still birth. They are also more prone to complications such as bleeding, pre-term delivery, premature rupture of membranes and placental problems. Some women experience higher levels of nausea associated with smoking.

At birth

Babies born to smokers have lower average birth-weights (between 150 and 300 grams, although good maternal nutrition can reduce the differential). This is because nicotine and carbon monoxide from cigarettes depletes oxygen and reduces blood flow from the placenta to the womb, leading fewer nutrients to reach the baby.

After birth

Babies born to maternal smokers suffer twice the risk of sudden infant death syndrome. They are prone to complications such as respiratory infections, bladder and kidney problems, and disorders of the nervous system, senses, blood and skin. Some studies show a correlation between smoking during pregnancy and attention deficit disorder.

Tips on how to quit

Stopping

  • You can follow a similar programme to non-pregnant smokers. The starting point is to select the date on which you will stop and, instead of deciding to try, simply decide to stop.
  • You may opt for the cold turkey approach, or you may prefer a gradual cut-back.
  • Plan what you will do when a craving comes. They tend to last just a short time, so something simple might work, such as visualising your baby growing strong as you inhale clean air.
  • Enlist the support of family, friends and colleagues. Ask them not to smoke around you.

Smoking other stuff

It’s not just tobacco that’s bad for babies. Although there is inconsistent data on the effects of marijuana, mostly because it is often used with other drugs such as alcohol or tobacco, marijuana usage in pregnancy is associated with hyperactivity and cognitive impairment in children.
Regular marijuana use in men is associated with reduced sperm count.
Women who are dependent on heavy narcotics such as tik and heroin need to seek help. Their babies are often born dependent themselves and suffer withdrawal symptoms such as irritability and vomiting. Other problems include premature birth, low birthweight, breathing problems and low blood sugar.

Best kick-the-habit tips from CANSA:

  • Decide on a date to quit smoking and do it
  • Throw away your smoker’s paraphernalia: ciggie packets, ashtrays, lighters
  • Drink lots of water - it will help flush the nicotine from your body
  • Become more active - exercise ie walk, jog
  • Change your routine. Avoid smokers and things that make you want to smoke for the first couple of days
  • Tell your family and friends that you are trying to quit so that they can offer you support
  • You may experience some dizziness, headaches or coughing once you have stopped smoking. This is normal and should improve after a day or two and disappear within 14 days
  • The first two to three days are the most difficult, after that it gets easier. Your cravings will reduce and eventually disappear.
  • If you are worried about gaining weight, eat at regular times during the day. Snack on fruit between meals. Take time for exercise. Not all ex-smokers gain weight.
  • Do not use a crisis or special occasion as an excuse for "just one" cigarette. One cigarette leads to another and another, and another.
  • Don’t be too hard on yourself if you can’t cope with going cold turkey. You’re addicted to a serious drug, and you might need to get professional help to quit the addiction for once and for all.

Call in the heavy artillery

There are numerous natural therapies recommended by practitioners. Some people have managed to quit using hypnotherapy, acupuncture and reflexology. 
 
Resources:
For more information on qualified hypnotherapy practitioners in your area, contact the South African Institute of Hypnotherapy at 0861 102 318 or visit www.hypnotherapy.co.za
To find a registered homeopath, reflexologist or acupuncturist in your area, contact The Allied Health Professions Council of South Africa at www.ahpcsa.co.za
To find out where you can attend a "Smokenders" course in your city or town, log onto their website at www.smokenders.co.za
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All about vaccination and immunisation

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Vaccinations are important. Before they were available, many children died or became very sick. Although babies and children can still contract diseases and die, vaccination programs have been effective in controlling this.
By: Di Peacock
  
 
All about vaccination and immunisation
 
 
    
The human body has a natural immune system, which is acquired by the unborn child from its mother. Further immunity from various diseases is acquired either from exposure to, and recovery from these infections, or through immunisation.
The body produces antibodies to that infection, which remain in the tissues as part of the body’s immune system, which is able to “remember” these infectious organisms. These anti-bodies combat subsequent invasions of the same disease.
Immunisation by vaccine is produced by the introduction of a dead or weakened form of this organism into the body. The immune system is simulated to respond by producing antibodies to thwart any future infections of the same disease.

In the past

Before vaccinations were available many children died or developed severe complications after suffering from infectious diseases. Even with modern medical care, a child contracting any of these diseases would suffer dangerous complications or die.

The benefits of vaccination

Vaccination programmes have been extremely effective in controlling some dangerous diseases and it is hoped by health authorities that once certain diseases are completely killed off there will be no need for vaccination.










The downside of immunisation

The downside of immunisation is that adverse events or problems have been reported after their administration.
For example, vaccines cause a change to the immune-response system, which may result in an alteration to the body’s natural immunity, particularly in those families that have a history of autoimmune disorders. However, these cases appear to be unusual in the vast majority of children and occur in about one child for about 2 million doses of vaccines administered.

About the additives in vaccines

Many parents are concerned about the safety of vaccinations. Some claim that it’s the additives in the vaccines, for example, gelatine or formaldehyde, rather than the vaccine itself that causes the problems.
Thimerosal (a mercury-based preservative found in certain vaccines) has also caused some concern that its use can result in developmental problems such as autism. Despite exhaustive studies this has been found not to be the case.
A dramatic increase in diagnosed cases of the autism-spectrum disorders have been noted by researchers globally, but this has not been linked to any vaccination.

In support of vaccinations

The majority of medical professionals worldwide seem to be of the opinion that the benefits of vaccination to the whole community and the prevention of the appalling consequences of the outbreak of infectious disease far outweigh any risks, which are minimal and affect only a few.
In deciding whether to have your child immunised you need to weigh up the risks of the vaccine against those from the disease.
Most vaccines have no side effects or only mild side effects, such as swelling and redness at the site of the injection or a mild fever. Some crying and irritability is fairly common. A dose of paracetemol 30 minutes before the vaccination and 4-6 hourly thereafter for a day should alleviate these effects, which should disappear within 24 hours. No child should receive any vaccine when ill.

Allergies

Any child who is known to be allergic to the antibiotics streptomycin, neomycin or polymyxin B should not receive the oral polio vaccine.
Certain vaccines, such as the influenza (flu) vaccine, contain egg proteins and gelatine. These may provoke a reaction in children allergic to these substances
The pertussis vaccine is never given to children who suffer from convulsions (fits) or any active (ongoing) central nervous system disorder, other than febrile convulsions (those suffered as a result of a high fever.)

About the MMR vaccine

The MMR vaccine has received a lot of bad press as it is rumoured to be linked to autism. No sound evidence has been found to substantiate this claim. Children who have experienced a life-threatening allergic reaction to gelatine, the antibiotic neomycin or to a previous dose of the MMR vaccine should not have it.
South Africa’s recommended Childhood Vaccination Schedule is adopted from the World Health Organisation. These vaccines are available free of charge at local clinics and community health centres.

Vaccinations

  • Birth: OPV 0 and BCG
  • 6 weeks: OPV 1 and DPT 1 and HepB 1 and Hib 1
  • 10 weeks: OPV 2 and DPT 2 and HepB 2 and Hib 2
  • 14 weeks: OPV 3 and DPT 3 and HepB 3 and Hib 3
  • 9 months: Measles 1
  • 18 months: OPV 4 and DPT 4 and Measles 2
  • 5 years: OPV 5 and DT

Abbreviations

  • BCG: Bacillus Calmette Guerin vaccine
  • OPV Oral polio vaccine
  • DPT: Diphtheria, pertussis and tetanus vaccine
  • HepB: Hepatitis B vaccine
  • Hib: haemophilus influenzae B vaccine
Additional vaccines that you can opt to buy at your own cost include Measles, mumps, rubella (MMR) and Varicella (chicken pox).










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