B(L)OU-BLOKKE

Die nuutste gier by my 3-jarige is ‘n BLOU vierkantige doolhof-boksie (‘maze’) met ‘n silwer balletjie wat ek sommer eendag by Mambo’s gekoop het. Die ‘aim of the game’ is om die balletjie deur die doolhof te lei en al die gaatjies te vermy om sodoende by die volgende kant van die vierkantige boksie uit te kom. Mens begin by die maklikste kant met 2 gaatjies, dan 3, dan 4 en die laaste kant het 5.

My seuntjie wil dit bietjie anders doen. Die een met die 2 gaatjies is vervelig. Hy skud daai boksie op en af en heen en weer, want die balletjie moet aspris by die moeilikste kant uitkom. Hy wil dáár begin. By die een met die 5 gaatjies.
Ek moet sê, ek’s nogal gaande oor sy soeke na ‘n uitdaging. Hou so vol, boetie.

NS. Het sommer gewonder of hierdie nie so bietjie ‘n metafoor vir die lewe is nie…
• Soek die uitdagings, ‘challenge’ jouself en moenie tevrede wees met ‘boring’ nie.
• Gebruik die ‘stumbling blocks’ in die lewe eerder as BOU blokke…
hoër.
klim
En

DIARRHOEA IN KIDS

~ All you need to know…

Written by Dr Nické Theron, Pediatrician.

When Eran was 8months old we woke one night to a cot full of vomit. Things deteriorated from there… Two days of diarrhoea (with stools leaking through everything) and vomiting with a mild fever followed. I am grateful that it was a very mild episode and he was never dehydrated, but I still had a lot of worry and washing! I have spent many nights admitting children to ICU with severe dehydration and I know how fragile they are, but there is a lot you can do at home to prevent a crisis.

Let us look at the how and why of diarrhoea.
According to the WHO the definition of diarrhoea is 3 or more loose or watery stools per day, or any change from the child’s usual stool patterns. Diarrhoea is still one of the top 5 causes of childhood death in children under 5 years in the developing world and should always be taken seriously.

“Looking after a very sick child was the Olympics of parenting.”

Chris Cleave

Diarrhoea can be divided into acute (continues for less than 5-7 days), intermittent (7-28 days) and chronic (>4weeks).

  1. Acute diarrhoea in children is mostly caused by viral infections (up to 60-70% of moderate to severe cases of diarrhoea in children under 2years). The children usually have some vomiting, watery stools and a mild fever (38-39°C). Most children with a viral diarrhoea only need supportive treatment and the disease usually clears up spontaneously within a few days.
    Bacterial infections are the cause of diarrhoea in 30% of cases in children between 2-5years. These kids are almost always more toxic (high fevers above 40°C, looks ill, severe stomach pain, blood or mucous in the stools). The diagnosis can be made with stool or blood cultures.
    Another common cause of acute diarrhoea is antibiotic-associated diarrhoea. It usually starts during or shortly after a course of antibiotics such as Amoxicillin or Amoxicillin with clavulanic acid. The diarrhoea is due to a disturbance in the microbiome in the colon as described or could be due to a secondary infection due to overgrowth of a “bad bacteria” because the antibiotic wiped out all the “good bacteria” from the colon.
  2. Intermittent diarrhoea (also called persistent diarrhoea if more than 14days) is mostly due to a combination of factors. When you have a severe bout of infectious diarrhoea the inflammation causes damage to the bowel wall, thus decreasing the absorption of sugars and water. Your child could thus have a type of “lactose intolerance” while the bowel wall is being restored and this causes a prolonged episode of diarrhoea.
  3. Chronic diarrhoea is diagnosed when your child has diarrhoea for most days for more than 4 weeks. That is not fun for anyone involved. Some rare causes of chronic diarrhoea are parasitic infections, inflammatory bowel diseases, malnutrition, or malabsorption secondary to diseases such as Cystic Fibrosis. Your doctor will probably request tests on the stool itself, and your child might need some blood tests.

Another more common cause is “Functional diarrhoea”, also named “Toddler’s diarrhoea”. This diagnosis is made when a child has more than 4 stools a day for more than 4 weeks, and more serious issues were excluded. It is often caused by a diet high in fruit-sugars or milk-sugars (or other nutrients that are not absorbed), thus pulling more water into the bowels, leading to diarrhoea. Functional diarrhoea should clear up after a visit to a dietitian.

When your baby starts to spew bodily fluids all over the place, I am sure you don’t really care so much about the cause, so let me tell you the things to look out for and when to start worrying.

⚠️If your child has any of the following symptoms when they have diarrhoea, please see a doctor as it could indicate a cause that need specific treatment:

  • Blood in the stools (could indicate a bacterial or serious gut disease that needs urgent treatment)
  • Mucous in the stools (usually indicative of a bacterial or parasitic infection)
  • Severe stomach pain, especially when it is concentrated in one area
  • Other infections that accompanies the diarrhoea such as pneumonia or ear infections
  • History of eating wild mushrooms or any other form of toxins

The severity of the diarrhoea and vomiting, and associated fluid loss, can vary greatly.

⚠️Here are some complications to look out for:
• Dehydration is the biggest complication associated with diarrhoea, so be sure to look out for the following symptoms:
Mild dehydration starts with the child feeling thirsty or drinking fluids eagerly, a dry mouth and passing slightly less urine. This can still be managed at home.
If your child loses more fluids, they could also have sunken eyes and a sunken fontanelle (soft spot on their head). They can be irritated and pass very little urine. At this stage (moderate dehydration) it is better to see a doctor to make sure you can keep up with the fluid intake.
If the fluid losses continue without replacement, children become sleepy or unresponsive, they pass no urine and they go into a state of shock where there is insufficient blood circulation to the important organs of the body. This is a medical emergency (severe dehydration) and they need intravenous fluids to catch up with the losses.
• Hyponatremia or Hypokalemia (too little salts in the blood) is another possible complication of severe diarrhoea because of the movement of water and salts over the bowel wall. This can cause muscle weakness, cramps, headaches, confusion, convulsions and heart dysrhythmias.
• Hypoglycaemia (low blood sugar) could complicate diarrhoea as the little ones often does not want to eat and does not absorb food well while their bowels are ill. This could also cause irritability, convulsions and loss of consciousness.

‘Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.’

Phil 4:6

Treatment of Diarrhoea

“Prevention is better than cure” is one of my favourite mantras.

The World Health Organisation has a few recommendations to prevent diarrhoea:

  • Breastfeeding
  • Consumption of safe food and water. (We often take this step for granted, but many people do not have access to clean water. However, we should all boil any water given to a baby under the age of 6months (especially as part of their formula) and rinse fruit and vegetables well before eating it. Take note of the expiry dates on expendable foods and keep meat separately in the fridge.
  • Handwashing for everyone.
  • Sterilizing bottles and dummies given to babies under the age of 6months
  • Immunizations against the Rota Virus has sharply decreased the number of babies admitted with severe diarrhoea and dehydration.

Unfortunately it is almost inevitable that your children will get poonamies or vulcanic vomiting at some point.

Let me give you a strategy for when the poo hits the fan:

  • Offer fluids regularly. The main aim of treatment is to prevent or treat dehydration. The best fluids to use are a combination of pre-mixed electrolytes (such as Rehydrat), diluted with boiled, cooled water. These sachets have the correct ratio of sugars to carry the salts and water back into the body. Another study compared the use of diluted apple juice (1:1 diluted with water) to these sachets and found that in children with mild dehydration the outcomes were the same, making diluted apple juice a good alternative. Using water with no supplements could lead to low salt-levels in the blood, using chicken broth could lead to dangerously high levels of salts in the blood.
  • To prevent or treat mild dehydration (see previous post), you should give your child between 50-100mls of fluids/kg over 4 hours. Eg: Your child weighs 12kg. You should give 600-1200ml over 4 hours (150-300ml/hr). It works best if you give a spoonful/ a few sips every 5-10min. Big volumes can make them vomit again.
  • If your child has signs of moderate/severe dehydration, or they keep on vomiting the fluids that you give them, please go to the Emergency Unit asap.
  • Continue to offer food during snacks and mealtimes
  • It is important to continue breastfeeding and giving regular foods (even dairy products) during a bout of diarrhoea. Your child might not have a good appetite, so offer them foods that they usually like, and do not worry if they only take a few bites. It is important to keep the lining of the bowels healthy, or the diarrhoea might be prolonged.
  • Anti-diarrhoea medications: Never give children medication to stop the diarrhoea. This causes a build-up of the toxin/virus/bacteria in the bowels, causing it to push into the bloodstream, and this can make them really sick. Anti-vomiting medication is also dangerous as it can make them sleepy (thus they drink less) or have dangerous side-effects in children. Medications like Diosmectite (Smecta) can be really efficient as it binds the toxin/virus/bacteria and expells it. It also improves the consistency of the poo. It is not absorbed, thus is safe to give to babies over 6months. It does taste quite horrible, but we have managed to give it to Eran with a syringe while blowing on his face to distract him/ help him swallow.
  • Antibiotics: As most episodes of diarrhoea are caused by viruses, antibiotics are mostly not necessary. If your child has high fevers or bloody diarrhoea there is mostly a bacteria involved which needs to be treated with antibiotics as prescribed by your doctor.
  • Supplements:
  • ~ Zinc: Several studies have proven that Zinc supplements can decrease the severity and duration of diarrhoea in children under 5 years. Eg Zinplex syrup.
  • ~ Probiotics: The use of probiotics can help to restore the microbiome of the bowel and thus help to get the diarrhoea under control. Reuteri drops are safe to give even from birth and although researchers cannot prove which dose or strain gives the best results, we know it should not cause any harm.

And then, most importantly, give them a lot of TLC!

“The secret of the care of the patient is in caring for the patient.’

Dr. Francis Peabody

I hope these tips will help to get your kiddies eating and playing again sooner rather than later!

Let me know what food / fluids works best for you when your child has diarrhoea?

Resources

  1. Jenkins R, Whyte LA; “Pathophysiology of diarrhoea”; Paediatrics and Child Health Volume 22, Issue 10, October 2012, Pages 443-447
  2. Elliot EJ; “Acute gastroenteritis in children”; BMJ; 2007 Jan 6; 334(7583):35-40
  3. http://www.uptodate.com
  4. WHO; “Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries”
  5. Freedman SB, Willan AR, Boutis K, Schuh S; “Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial.”; JAMA. 2016;315(18):1966.
  6. Lukacik M, Thomas RL, Aranda JV; “A meta-analysis of the effects of oral zinc in the treatment of acute and persistent diarrhea.”; Pediatrics. 2008;121(2):326.
  7. Lazzerini M, Ronfani L; “Oral zinc for treating diarrhoea in children.”; Cochrane Database Syst Rev. 201

SUMMER SUN & YOUR SKIN

~ B E  S U M M E R  R E A D Y ~

Dr Tarryn Jacobs is a specialist Dermatologist in private practice in Pretoria and she will be sharing some helpful info on skincare & being SUN SAFE this SUMMER.

Her clinical interests include chronic inflammatory skin diseases and early skin cancer detection. Dr Jacobs is passionate about education and promotion of skin health in her local and social media communities.

What is the effect of sun on my skin?

Continued and repeated exposure to the sun can cause permanent damage to the skin. Over time the cumulative UV radiation exposure can cause DNA damage in the skin cells. This damage can result in skin cancers, and precancerous lesions called solar keratoses.

In addition to these severe effects, the sun is also the most common cause of skin aging, which we call photoaging. UVB rays are absorbed by skin cells and cause damage to cellular DNA. UVA rays, on the other hand, penetrate deeper in the skin and is the main cause of photoaging. The sun is thought to contribute 80-90% of what we see as visible signs of aging. This includes wrinkles, sun spots, visible blood vessels (telangiectasia) and loss of elasticity.

What does SPF mean?

SPF stands for “Sun Protection Factor”, and it is the measure of the efficacy of sunscreens by focusing on the time it takes for UVB rays to cause the skin to go red. When adequately applied a product with an SPF of 15 would allow 15 times as much time in the sun with the same level of redness as if without applying sunscreen. Similarly, a product with the SPF of 30 would allow 30 times as much exposure than without sunscreen. So this does not mean that an SPF 30 product absorbs twice as much radiation as the SPF 15 product. Higher number SPF blocks slightly more of the suns UVB rays, but no sunscreen can block 100 per cent of the suns UVB rays.

Generally, I would recommend an SPF 30 at least for everyday wear. Look for a sunscreen that says broad-spectrum, meaning it has both UVA and UVB coverage.

How much and how often should I apply sunscreen?

Sunscreen needs to be applied every 90 minutes to get the SPF that is on the bottle. Many of us are guilty of not doing this! Find simple ways to touch up – e.g. facial spray sunscreens or powder forms that can be applied over makeup or on the go.

Most of us also do not apply the right amount of sunscreen. At least a shot glass of sunscreen is needed for the whole body, that equates to 35mls. A good way to remember this is about a teaspoon for every body area.

What is “sun allergies” and “photosensitivity”?

Photosensitivity occurs when the skin reacts in an abnormally sensitive way to the sun or artificial sources of light. It usually presents as an eczema-like skin condition on sun-exposed areas. A sun allergy (photo-allergy) is a type of photosensitivity disorder. Many things can cause this, including medications, plants, autoimmune conditions or genetic disorders.

What causes my skin to “tan”?

Tanning is also known as delayed pigment darkening, which develops in individuals over hours to days of sun exposure. After our skin is exposed to sunlight, the pigment cells called melanocytes produce a pigment called melanin, in an attempt to absorb the UVR. A tan is a sign that the skin has been damaged and is trying to protect itself. There is no safe way to tan! Every time you tan, you damage your skin cells, and as this damage builds, you speed up your skin aging and your risk for skin cancer.

What does it mean if the sunscreen states it is “water resistant”?

The term water-resistance indicates that a sunscreen product’s labelled SPF protection is retained for a certain period of time after immersion in water. Sunscreen can be Water Resistant (effective for up to 40 minutes in water), or Very Water Resistant (effective for up to 80 minutes in water). Do remember to reapply after getting out of the water, even when using a water-resistant sunscreen.

Can I use the same opened bottle of sunscreen that I used last year? Would it still be effective? Or does it have a “shelf life”?

Sunscreen does expire. Most sunscreens should include an expiration date – if the date has passed, throw it out! Generally, sunscreen should last for up to three years.

How can I protect my children’s skin from the harmful UV rays? And do they need more or different protection from the sun than adults?

Parents need to take all the necessary measures to protect their children’s skin from the harmful effects of UV rays. Sunscreen has been proven to reduce the risk of skin cancer, and it only takes one blistering sunburn during childhood to double a person’s chance of developing melanoma later in life. Teaching children sun-safe behaviour is essential from an early age. Use a high SPF, water-resistant, broad-spectrum (UVA+UVB coverage) sunscreen. Mineral sunscreens containing physical blockers such as Titanium dioxide and Zinc oxide are excellent choices for children as the ingredients are gentler on children’s sensitive skin. 
Do not rely on sunscreen as the only method of sun protection. It should be used in conjunction with protective clothing such as wide-brimmed hats, UV suits and rash guards.

A ‘take home message’ for all the parents (& grandparents)?

Remember – prevention is better than cure! Keep your skin looking healthy, protect it and check it regularly.

Thank you, Dr Jacobs, for empowering us with helpful info and SUN SAFE tips! 🌞

👉 Go check out Dr Tarryn Jacobs’ IG account @drtarrynjacobs ♥️

DANCE WITH ME

Do you realise
how precious you are?
I know your every freckle
I know every scar
I’ve seen every heartache
and tear you have cried
I’ve been here all along
with My arms open wide
Even when you walked away
I never asked why
I’ll always take you back
after you said goodbye
My heart swells with love
when you walk into the room
My love is in every rainbow
It’s in every flower’s bloom
Have you read My love letters?
Have you heard My heart beat?
It’s written in the lives
of every person that you meet
I’m watching you with interest,
I’m cheering you on!
Much sooner than you may realise
this life will soon be gone…
Please take my hand
and I will take the lead
You are no longer in bondage:
by My grace you are freed!
Will you open your heart?
Or pretend not to see?
Come, My love,
will you dance with Me?

♡ A.L.

KYK OP

Soveel keer wanneer dit swaar gaan – as ek mismoedig en ‘down’ voel (jy weet daai los-my-uit-en-moenie-met-my-praat-nie-gevoel) –
dan is ek geneig om na my hande te kyk…
na my foon te kyk…
of na my voete te kyk…
na die grond te kyk…
na die lelike-maar-praktiese-bottelgroen-nylon-vasgeplakte-blokkies-mat by die werk te kyk.

En so is dit júís in hierdie tye, die moedelose en oorlaaide tye, wat ek boontoe moet kyk, die gordyn moet ooptrek en die lig inlaat!

Soms wanneer ek effens te swak voel om dit self te doen, is ek ongelooflik dankbaar as daar ‘n goeie vriendin is wat die venster sommer wýd oopswaai en die vars lug én lig laat instroom…
Vir wie kan óns dalk vandag daardie vriendin wees?

Mamma, jy het nou genoeg af gekyk…
af na jou afgesloofde hande…
af na jou geskifde-punt-neus skoene…
af na jou situasie, jou tekortkominge, jou vrese, jou seer.

Vandag kyk ons op.
Laat die sonstrale op jou wange speel, laat toe dat die helder lig in jou oë glinster soos jy die grasgroen bome en oneindige blou lug raaksien (en as jy in die Kaap bly, kyk op na die berge!).
Laat jou mondhoeke boontoe krul soos jy vir geen rede net begin glimlag.
Net omdat jy kan.
Net omdat jy nog híér is.
En net omdat jy (en ek) vandag ten minste één ding kan tel waarvoor ons dankbaar kan wees…

Kom ons kyk op.

Psalms 121:1-8

STAPSOLDAATJIE

Hierdie gediggie is opgedra aan my Oudste. Sy naam beteken nie verniet “Brave warrior” of “dapper in die stryd” nie! Toe ek 14 weke swanger was met hom het my blindederm gebars. Ek moes ‘n noodoperasie kry… voor die narkotiseur my in teater instoot, buk sy af en kyk stip in my oë: “Jy besef daar is soos ‘n 80% kans dat jou babatjie kan aborteer?”

Ten spyte van alles, is Oudste vandag lewend en gesond.

Blou-gevlekte vingertjies
En kleine modder-voetjies
Skulpie-oortjies, Glimlag-bekkie
Knop-neusie met son-sproetjies

Klim en klouter, klein kabouter
Spring en hop, balle skop
Swaai swaai, skoppelmaai
Skaterlag en kekkelkraai

Inkleur, teken, blokkies bou
Die hoogste toring –
“Hier’s hy nou!”
Jou ogies blink, jy glimlag trots
“Die wyse man bou sy huis op die rots!”

Rympies opsê, liedjies sing
Handjies klap, dans in ‘n kring
Resies hardloop – “Ek gaan wen!”
Wat ‘n voorreg om jou te ken!!

GLUTEN FREE ALMOND CHOCOLATE BROWNIES

who doesn’t like CHOCOLATE?

See below for a quick & easy gluten free choc brownie recipe!

These brownies are absolutely #delish ! It’s decadent, wholesome PLUS it’s much healthier than “normal” chocolate brownies 😉

Thank you Alicia Wessels for sharing your recipe with us!

I’ll be making them for my upcoming birthday…

IRON DEFICIENCY

PART 2

Written by Dr Nické Theron, Pediatrician.

Iron deficiency anaemia occurs when the iron stores are so empty that there is not enough iron to make proper new red blood cells. The new red blood cells are thus fewer, smaller and paler and cannot carry oxygen effectively. Your body will always prioritize the available iron to first be used in the red blood cells, but iron has many other functions in the body (see previous post). So by the time that there is iron deficiency anaemia, the brain especially has already suffered from the lack of iron.

This is a sneaky disease because there are almost no symptoms initially. It is thus important that your doctor asks about the risk factors for developing iron deficiency during well-child-visits.

Babies and toddlers between the age of 6months to 3years have an especially high risk to develop iron deficiency anemia. The American Association of Pediatrics recommend that all children should be screened between 9-12 months of age because of the serious effects it has on long term neurodevelopment. Several studies show that the delays in development improves with treatment, but does not normalise completely.

The most common cause of iron deficiency is insufficient intake (see previous post for tips on prevention). Other causes could be blood loss from the gut, specific syndromes where iron is not absorbed from the gut or chronic inflammatory diseases.

Symptoms of Iron deficiency anaemia:

Mild:

  • No specific symptoms
  • Iron deficiency could lead to behavioural changes in your child that is sometimes difficult to pin-point eg. children become more wary, hesitant, solemn, unhappy, keep closer to their mothers.
  • Restless leg syndrome, breath holding spells, sleep disturbances, short attention span, learning difficulties have also been seen to improve when iron deficiency was treated.
  • Pica : an intense craving for weird non-food items such as clay, dirt, chalk, soap, paper, raw rice or ice (pagophagia). No one knows how this works, but it responds very well to iron supplementation.
  • Poor growth

Severe:

  • Pallor (seen especially around the eyes, in the mouth, the nails and on the palms/soles)
  • Severe tiredness and loss of interest in otherwise fun activities
  • Irritability
  • Poor appetite, sores in the corners of the mouth, painful tongue
  • Fast heartbeat, heart failure, fast breathing.
  • Other complications associated with iron deficiency anaemia: Febrile seizures (although no relational cause could be found, several studies have found that children with febrile seizures are more prone to be iron deficient). Iron deficiency also causes paralysis of some parts of the immune system.

If your doctor suspects iron deficiency anaemia blood tests will be the next step to confirm. A hemoglobin or full-blood count and ferritin count will be enough. Treatment with Iron supplements will be started and the effect on the red blood cells will be evaluated after one month of treatment. If there are no response further investigations should be done for other causes of the anemia.

Treatment of iron deficiency anaemia

Ferrous sulphate 3-6mg dly (can be given once a day or in divided dosages.
The best absorption of iron happens when you give it with orange juice (or other juice high in Vitamin C as this improves absorption) in between meals. Foods that can block absorption of iron are dairy, eggs, tea or coffee, whole-grain breads and cereals / bran.

Iron supplements are notorious for having many side effects. However if you start at a low dose and slowly increase it, and give the iron with meals most children tolerate it quite well. Remember to give the drops at the back of your child’s mouth or give it mixed in juice with a straw. Some iron supplements may stain the teeth, but this can be removed by brushing with baking soda (talk to your dentist first). There are many different iron formulations of which some are better absorbed/better tolerated, but this also comes with a significant price increase. In the end the most important thing is that your child drinks the supplement. (Studies show no difference in the end-result for different formulations).

VERY IMPORTANT: Treatment for iron deficiency anaemia should be given for at least 3months, even if the blood count normalises before that. Remember that the body will use any available iron for the red blood cells first, and then the stores still need to be filled to prevent future problems.

Dietary advice

It is important that your child’s diet is also adapted to include more iron rich foods. It is adviced that they should eat at least 2-3 iron rich meals per day. Remember that the iron in animal products is absorbed better and thus you need to eat bigger quantities of plant-based iron to absorb the same amount.

Some foods that are high in iron include:

  • Meat – red and white. Liver is especially high in iron.
  • Other animal sources: Eggs (especially the yolk), fish
  • Dried fruits: raisins, apricots
  • Green leafy vegetables
  • Dried beans and lentils
  • Oats, other grains
  • Soybeans

I hope you now feel more confident in the whys and hows of iron deficiency. There are still so many ongoing studies and new developments with regards to the influence and treatment of different neurodevelopmental diseases such as autism and ADHD that I am sure this is a topic that we will still hear a lot about!

Resources

  1. Ozdemir N; “Iron deficiency anemia from diagnosis to treatment in children”; Turk Pediatri Ars; 2015 Mar; 50(1): 11-19
  2. http://www.uptodate.com
  3. https://www.mayoclinic.org/drugs-supplements/iron-supplement-oral-route-parenteral-route/description/drg-20070148

IRON DEFICIENCY

PART 1

Written by Dr Nické Theron, Pediatrician.

This is a topic that I have been avoiding for a while because there is so much conflicting advice and evidence available. I started giving our son iron supplementation from 6months but because it tasted horrible and stained all his clothes and he struggled with constipation, I stopped at around 10months. After attending the European Academy of Pediatrics congress in September I was reminded about how important iron is for brain development, and I felt very guilty that I did not give Eran enough iron-supplements. But was it really necessary? When should babies and toddlers use iron-supplements and what sort of iron should they use? Read on to learn with me:

Iron is a vital mineral in our bodies. It is used in red-blood cells to carry oxygen and to help manage the storage and usage of oxygen in the muscles. Iron also plays a very important role in brain development in babies and toddlers, regulating the structure as well as the hormonal messengers of the brain. The immune system also needs iron to function well. Luckily the body regulates iron very closely, and as red blood cells break down it is recycled and used again. We do however loose a small amount of iron daily from our skins and gut, and during menstruation. If we do not take in enough iron to counter-act these losses, it leads to iron deficiency.

Adults need to absorb about 5% of their daily iron needs from food. Children need to absorb up to 30% due to their rapid growth and development. This already places them at a high risk for iron deficiency.

“Iron deficiency” occurs when there is not enough iron in the “stores” of the liver. (Mostly measured by doing a “Ferritin level” on a blood test). If there is no treatment it will progress to “Iron deficiency anaemia” where the iron-levels in the red blood cells are also dropping, leading to fewer and smaller red blood cells. (Measured by testing the “Hemoglobin level” or a “Full Blood Count”). It is mostly only when a child becomes pale and tired that the problem is picked up. However there is already a big effect on brain-development, behaviour and growth long before the “Iron deficiency anaemia” causes symptoms. Sadly iron deficiency is the most common nutrient deficiency in the world, and the effect it has on children’s behaviour and development is scary.

“As iron sharpens iron, so one person sharpens another”

Proverbs 27:17

Children who have a high risk of iron deficiency are:

  • Mother has an iron deficiency during pregnancy (the baby will still take the iron it needs, but there is not enough iron to totally fill all the stores)
  • Mother has hypertension or diabetes mellitus during pregnancy (the iron in the mother’s body is not as easily available for baby / the baby has a higher need for iron)
  • Premature babies (iron stores are filled during the last few months of pregnancy, so premature babies miss out on this. They also have a smaller blood volume and undergo many blood-tests while in NICU).
  • Low-birth-weight babies (multiple reasons for high risk)
  • Early cord clamping (allowing more blood to flow to the baby from the placenta increases the amount of iron they start out with)
  • Insufficient dietary intake during early infancy
  • Early introduction (<1 year) of unmodified cow’s milk or consuming large amounts of cow’s milk (>500ml) after 1year of age. (Early introduction may cause an increase of blood loss from the bowels as the bowels are not ready for the large proteins / via allergic reactions. Cow’s milk contains very little iron, thus the risk is high if your baby does not eat enough other iron-containing foods)
  • Exclusive breastfeeding for longer than 6months (breastmilk has a very low iron content. See below. It is important to start iron-rich supplemental food from 6months).
  • Picky-eaters, children with multiple food allergies, children following specific diets.
  • Obese children
  • Children with malnutrition, chronic diseases or bowel-diseases.

I would like to explain a little more about the iron-needs in babies. Term, healthy infants usually has enough iron in their bodies for the first 5-6months of life (they have a relatively high “hemoglobin” at birth and their stores are filled during the 3rd trimester). Their iron-needs are thus quite low during the first few months. Breastmilk contains very little iron (+- 0.3mg/L) but it is very easily absorbed (up to 50%). Formula milk is usually supplemented with up to 12mg/L iron, but it is not as available to be absorbed (4-6%).

After 6months of age the iron requirements increase rapidly, and thus breastmilk alone is not enough to sustain the iron-needs in babies. They need to take in extra iron in some form. Iron-rich foods and iron-fortified foods such as cereals has been shown to be more effective than medical supplements in the long term to sustain normal iron stores. (If your baby already has a deficiency it is easier to fill up the stores with medical supplements, see next article).

So how do you prevent iron-deficiency?

  • The American Association of Pediatrics recommends that all healthy term babies who are exclusively breastfed should receive supplemental iron (1mg/kg/day) routinely from the age of 4months until they eat sufficient quantities of iron-rich food. (At least 2 meals per day containing iron rich food or iron-fortified food). The European society feels that there is no need for general iron supplementation in healthy babies and children as long as there are no other risk factors.
  • Formula-fed babies should receive enough iron in the formula for the first 6months and thus do not need further supplementation.
  • All premature babies should receive iron supplementation from the age of 2weeks until 1year (2-4mg/kg/day).

You can give the supplements as part of a multivitamin (eg Vidaylin with iron) or separately (eg Ferro-drops or Ferrimed). Seeing that there are some risks involved in using iron supplements in otherwise healthy children (some studies show that babies with normal iron stores that were supplemented with iron did not grow as well in length as those that were not supplemented) I think it is very important to discuss this topic with your pediatrician at the 6week check-up to make an informed decision with them after looking at all the risk factors for YOUR baby.

Iron deficiency has serious implications in your child’s development and should be carefully managed and monitored. In the next article I will discuss the effects of iron deficiency anemia and the treatment thereof.

Resources:

  1. Lonnerdal B, Georgieff MK, Hernell O; “Developmental physiology of iron absorption, homeostasis and metabolism in the healthy term infant”; J Pediatr 2015 Oct; 167(4 0): S8-S14
  2. Baker RD, Greer FR, The Committee on Nutrition; “Diagnosis and Prevention of Iron Deficiency Anemia in Infants and Young Children (0-3years of age)”; American Academy of PediatricsClinical Report
  3. Friel J, Qasem W, Cai C; “Iron and the Breastfed infant”; Antioxidants (Basel). 2018 Apr; 7(4): 54
  4. ESPGHAN guidelines for Iron Requirements of Infants and Toddlers
  5. http://www.uptodate.com

OUMAS (& OUPAS)

Dit is ‘n ongelooflike voorreg as oupa en ouma naby genoeg bly om gereeld oor en weer te kan kuier. Kleinkinders hou die grootouers jonk😉 en oupas en oumas kan soveel wyshede vir ons kinders leer en onvoorwaardelike bederf-liefde in hul hartjies deponeer.

‘n Mamma met ‘n pasgebore baba het iemand nodig wat vir babalyfie kan vashou, dat sy net vinnig iets kan eet of stort of aantrek of badkamer toe gaan – dat sy net weer mens kan voel. Dis wonderlik as Ouma of selfs Oupa naby is om hand by te sit.

‘n Moëe mamma is ook bitter baie dankbaar as Ouma die kinders bietjie kan besig hou – veral die besige kleuters met hulle oulike sê-goedjies en houdingtjies. Díé mini-mensies kan wel soms baie veeleisend raak as daar ‘n klein babalyfie ook in die huis is… (sien gerus “Die Baba-siklus” storie)

In ons geval, bederf Ouma en Oupa ons dikwels met saam-eet middagetes of ons ry uit na ‘n lekker restaurant met ‘n mooi uitsig. Dis presies wat hierdie ‘cabin-fever’-mamma nodig het om nie heeltyd net soos ‘n ‘jersey’ koei te voel nie!

Ek dink dis belangrik om aan die Oupas en Oumas spesifiek te kommunikeer oor wat jy van hulle verwag en hoe hulle jou kan help en bystaan. Elkeen se situasie lyk verskillend…

Mammas, dit is ook belangrik om grense te stel. Jy en jou huweliksmaat besluit saam oor hoe julle jul kinders wil grootmaak, die waardes wat jul hul gaan leer en hoe julle gaan dissiplineer ens. Grootouers moet die grense wat julle stel, respekteer. Al stem hul nie noodwendig daarmee saam of is dit nie dieselfde manier waarop hulle jóú groot gemaak het nie. (Hierdie kan soms ‘n taai toffie wees!)

Oumas (en Oupas), dit sal wonderlik wees as julle betrokke en beskikbaar kan wees…sonder om te veel voor te skryf. Om raad te gee wanneer daar vir jou gevra word… In my geval, het ek begin voel my ma laat my nie toe om die mamma te wees nie. Ek het gevoel my manier van dinge doen is nie goed genoeg nie. Want dis nie háár manier nie. Die oorsaak van hierdie “inadequate” gevoelens is ‘n kombinasie van postpartum hormone, slaap-tekort en leuens van die vyand. Oumas, wees maar bietjie meer sensitief daarvoor en luister na jou dogter/skoondogter se hart. As sy kla of huil, wees net daar. Sy’s op ‘n baie kwesbare en uitdagende plek in haar lewe, en gewoonlik wil sy graag net ‘n klankbord hê…en nie regtig iemand wat kom met lyste van “oplossings” nie.

Oumas, dit beteken nie jy het nóóit ‘n geldige opinie of moet op eiers loop nie! (Ek’s seker jy weet waarvan jy praat! Jy het immers jou kinders mooi groot gekry 😉) Dis maar net ‘n fyn balans van die regte hoeveelheid ondersteuning, sonder om “judgemental” oor te kom (al bedoel jy goed). Laat haar toe om self te probeer, leer en foute te maak – solank dit nie dodelik is of ewigheidskade aanrig nie!

Oumas, val maar eerder in by die ma. Vra byvoorbeeld eers wat die kinders mag eet of nie mag eet nie. Dieselfde reëls wat by die huis geld, moet by Ouma se huis ook toegepas word. Dubbelstandaarde is frustrerend en verwarrend. Konsekwentheid is die sleutel.

(Nuwe) mammas, ek wil afsluit deur te sê dat ons ook ekstra bietjie genade met die oumas moet hê. Ons moet onthou hulle was eens op ‘n tyd ook die mamma – en dít is wat hulle ken en onthou…Nóú moet hul ‘n splinternuwe rol aanleer en dít bring dalk onsekerhede en misverstande…
“Have a little grace. It goes a long way.”