SONDAG-INSPIRASIE

Hoekom kan die Spreuke31-vrou lag oor die toekoms?

Want sy wéét wie sy is. Sy kén haar vermoëns en weet waartoe sy instaat is. Sy is innerlik sterk, talentvol, innoverend, ywerig, vol wysheid en insig. Sy sien die struikelblokke van die lewe as uitdagings en nuwe geleenthede, en nie as doodloopstrate nie.

Maar die belangste is: sy ken haar Skepper – die een wat die dag van môre vashou. Hý wat in die hede maar ook reeds in die toekoms is. Haar voete is stewig op die Rots geplant.

Mammas, mag ons vandag inspirasie by die Spreuke31-vrou vind. Want daar’s ‘n stukkie van haar in elkeen van ons.

Vredevolle Sondag vir julle

Sterkte en eer is haar kleed, en sy lag oor die dag wat kom.

Spreuke 31:25

DIE STORT

Ek kan eerlikwaar sê: om te stort is een van die hoogtepunte van my dag…

My stort-tyd is my alleen-wees-tyd, my weer-soos-‘n-vrou-voel-tyd, my herlaai-tyd.

Na ‘n lang, uitdagende-fantastiese-vreugdevolle-uitmergelende dag (want dis hoe dit soms voel om ‘n ma te wees), is daar waarlik ‘n soort ‘magic’ daaraan as jy die stortdeur oopmaak en in die stoom-gevulde kapsule klim. Oudste is in die bed en jongste is óf in die wiegie óf in pappa se veilige arms…en dis dán wat ek vir die eerste keer daardie dag my t y d k a n v a t en r u s t i g wees…

In die warm stort, verander ‘n hang-skouer aspoestertjie in ‘n ‘pampered princess’ – al is dit net in my kop (‘crazy’ met hoe min ons mammas tevrede kan wees, nê?!).
Die warm water stryk die stres-knoppe uit my spiere en saam met die dag se vuil, spoel die ondraaglike voel-ek-kan-nie-meer-aangaan-nie moegheid (en negatiewe gedagtes) ook in die drein af…

Die lewe lyk (en ruik) sommer lekkerder na só ‘n mamma-me-time stortsessie en só sien ek weer kans vir die volgende dag.

Want dis hoe ek dit doen: een stort op ‘n slag. Een dag op ‘n slag. Happie vir happie. Trappie vir trappie.
Deur één tree op ‘n slag te gee, voel ek minder oorweldig. Ek vind weer nuwe inspirasie. En ek kan weer begin droom.

Vrede ♡



GASSKRYWER

BESOEDELING
Deur Magda Burger

Ons hoes en proes wanneer ons ongewensde gasse inasem. My bors kriewel sommer wanneer ek die bruin wolk in die lug sien en net dink hoe sleg dit vir mens is…

Maar hoe mis het ek nie die bruin wolk wat meer as net af en toe om mý hang, gekyk nie. Wanneer ek lelike opmerkings maak, my man afjak of my beeld net bietjie blinker wil laat klink as ander, bou hierdie aaklige gasse om my op – wat my én ander vergiftig.

God het Sy eie asem in Adam ingeblaas. Wat ‘n goeie aanduiding is dat God se asem ook in mý longe is.
So, met die “asem” waarmee ek praat, kan ek aaklige besoedeling aanrig. Hoeveel keer het die Bybel-manne nie geskryf oor watter gemors jou tong kan aanvang nie.

“It’s Your breath in our lungs…”
Blaas ons ook God se asem uit?



》》 Mammas, kom ons KIES vandag woorde wat opbou, inspireer, bemoedig & LEWE bring. 《《

Die tong het mag oor dood en oor lewe. Hulle wat lief is om te praat, moet saamleef met die gevolge van hulle woorde.

SPREUKE 18:21 NLV

DANKBAARHEID

Tel jou seëninge elke dag,
tel hul een vir een
Hou op worry, begin net lag
Kom ons huppel in die reën

Kan jy sien,
proe en hoor?
Word eers stil,
jy’s op die regte spoor…

Het jy ‘n dak oor jou kop?
Én kos én klere?
Kom ons hou op stres
en begin lewe!

Vrede vir julle ♡

ROOMYS

Wie hou nie van roomys nie??

Fokus vandag op die mooi en die lekker wat jy voor jou het. Moenie dat dit voor jou verbygaan en dan mis jy uit op dít wat jy reeds ontvang het nie!

Moenie jouself met ander vroue/mammas vergelyk nie. Hulle het weer hulle eie “struggles”. Al lyk hul lewe Instagram-prentjie-perfek. Jy weet nie van die hartseer oomblikke agter toe deure wanneer die kamera ophou “flash” nie.

Wees vandag dankbaar vir die “roomys” in jou hand: Hoe lyk jou seëninge? Is dit jou man? Is dit jou kinders? Jou gesondheid? Jou kinders s’n? Jy het genoeg kos? Klere? Daar’s ‘n dak oor jou kop? Jy het ‘n werk? Jy haal asem? Jy kan loop, jy kan dink? Jy het vriendinne wat omgee? Jy het familie wat lief is vir jou.
Moenie dít miskyk nie. Netnou smelt dit…

“Gratitude: it turns what we have into enough.”

Onbekend.

Vrede ♡

Quote Cred: Crowned Crane. Vertaal na trots-Afrikaans.

MAGTELOOS

Voel ander mammas ook so magteloos?
Ek wil jou net só graag troos…
Ek voel ek het al ALS probeer
Maar hoekom klink jy steeds hartseer?
Jou skrille-skreeu sny tot binne my
Niks sou my óóit kon voorberei
Soms voel ek vreeslik swak en dom
Hierdie is my beste poging
Al is dit skeef en krom
Weet net mamma is SO lief vir jou
En wil jou altyd naby hou.


Ek wens ek het geweet hoe om jou te troos…ek wens jy kon my sê…dit lyk of jy in pyn is….dalk ‘n wind wat vassit? Dalk krampe? Dalk oorpyn? Miskien kry jy tande? (Dis dalk nog ‘n bietjie te vroeg daarvoor…) Kry jy koud? Kry jy te warm? Jou doek is droog. Ek’t dit sopas geruil. Is jy nog honger?…

Klink dit vir jou bekend?
Voel jy ook so? Het jy ook al herhaaldelik deur dié soort lysie in jou kop gegaan?

Vrede vir jou, mede-mamma.

REFLUX – part 2

Tips & Tricks for the Management of Reflux in Babies, by Dr Nické Theron

In the last few weeks I have spoken to many moms and read many blogs to do some more research regarding reflux in babies. (SEE THE PREVIOUS POST to learn more about what reflux is). There are some interesting and scary treatments suggested out there! As a mom I wish I could give you a miracle-cure that would help your baby sleep better, cry less, spit up less. Unfortunately I know such a cure does not exist, no matter how alluring some moms on social media make it sound. As a pediatrician I would like to stick to what has been proven to work and what is safe for your precious baby now and in the long run. So here goes:

General management for all babies with reflux (GER and GERD):

• Upright positioning (90°) for 20-30min after feeds.
Babywearing keeps your hands free and keeps baby happy and safe.
“Reflux pillows” that elevates your baby’s head while sleeping has not been proven to make a big difference. Please remember the safest sleeping position for a baby is flat on his back to reduce the risk of SIDS (Sudden Infant Death Syndrome).  Even though babies with reflux sleep better on their stomach or left side down, I cannot recommend this if your baby is not monitored continuously.
Placing your baby in a rocker or car seat can worsen reflux due to the scrunched up positioning and increased pressure in their stomachs.

• Feeding volume and frequency:
It helps to give smaller feeds (so that you do not overly distend the abdomen) more frequently. Working out the smaller volumes if you are bottle feeding also prevents over-feeding and unhealthy weight gain.
Breastfeeding moms can feed on demand, but try to help soothe baby in other ways (baby-wearing, sucking on your fingers or a dummy) if the previous feed was less than two hours ago so that you do not worsen the reflux symptoms. Breast milk has a protective effect against reflux, so you are doing a great job!

• Thickening of feeds:
Studies have proven that this can decrease the episodes of spitting-up, but it is a very laborious process. Formula or expressed breastmilk can be thickened with rice or oatmeal-porridge or Maizena.

• Trial of a milk-free diet:
If you are breastfeeding, you can cut out all dairy and beef products from your diet for 2 weeks to see if there are any change in symptoms. You might have to cut out soy-products too.
If you are formula feeding, you can try a trial with an “extensively hydrolyzed formula” (also called hypo-allergenic such as Neocate or Similac Alimentum). It is not recommended to change to a soy-based/ goats-milk based / lactose free formula for this trial as there can be a cross-reaction to the allergens. Once baby is diagnosed with a milk-allergy you can try these substitutes under guidance of your doctor and dietitian.

• Avoid exposure to tobacco smoke as this can further decrease the pressure in the lower esophageal sphincter (see previous post), causing more frequent episodes of reflux.

• Adding probiotics has been suggested, but there is not enough evidence to prove if it will help.

• The use of a Chiropractor is not recommended as most of their procedures are not evidence based. “Subluxations of the spine after birth” mostly cannot be proven, will not cause reflux and the interventions they apply are either too delicate to really change anything in the bony structure, or too rough to be safe for the developing spine of your child. Please be careful.

If you have tried all of these tips and your baby still shows SIGNS OF GERD (as discussed previously) you can discuss the following steps with your doctor:

1. Is it really GERD?
Many diseases can mimic reflux and will not respond to reflux medications:
• Cow’s milk-protein allergy: this is a type of food allergy that can best be diagnosed by an exclusion diet.
• Eosinophilic esophagitis – this is inflammation of the esophagus due to an allergic reaction involving a specific type of white blood cells. These babies can have trouble swallowing, vomiting and chest pain. Diagnosed with a biopsy during an endoscopy.
•  Anatomic abnormalities of the esophagus – sometimes there is a connection between the esophagus and trachea (air pipe), or a web of veins causing a partial occlusion of the esophagus. This can be diagnosed with the help of a contrast swallow.
• Celiac disease – allergy to gluten causing inflammation in the esophagus, stomach and intestines, can also have many other symptoms. Diagnosed with an exclusion diet and can be confirmed with a blood test.

👉As you can see an endoscopy (looking at the esophagus and stomach from the inside with a camera, your baby will need sedation or anesthesia) can help to clarify the diagnoses. It can also evaluate for inflammation and check the response to treatment with PPI’s.

👉Another diagnostic test often used is Ph monitoring where the height of the acid reflux and the amount of episodes over 24hours are tested. Because reflux can also happen in normal infants this test cannot give us a definitive answer.

2. Does my baby need acid suppressing medication?
PPI’s (Proton Pump Inhibitors for example Nexiam, Losec) are used to suppress the amount of acid formed in the stomach. It will NOT decrease the number of reflux episodes or the amount of vomiting, but it could make your baby more comfortable if there was inflammation and pain due to the acid.
The acid in your stomach is actually very important for your baby’s digestion and immune function, and decreasing the acid content certainly does have risks.

👉Who should get PPI’s and for how long ?
• Babies with proven esophagitis seen on endoscopy (use for 3-6months and then re-asses)
• Babies with severe symptoms of GERD that does not respond to conservative measures can be given a trial of two weeks. If there is a definitive improvement, medication can be continued for 3-6months and then re-assessed.

👉Possible complications of PPI’s:
• Higher risk of acute diarrhoea and pneumonia because you remove a line of immunity defence. This can also lead to infection of the gut with Clostridium Difficile.
• Interferes with the absorption of Iron and Vitamin B12 and lead to anemia (low red blood count).
• Can affect calcium absorption and lead to increased risk for fractures.
• Allergic sensitization – there is a link between using acid suppression in infancy and later development of allergies.

When you want to stop the PPI, it is important to wean it slowly as there can be a rebound higher acid production for the first few days after stopping the medication.

3. Are there other medications that could help?
• Antacids such as Gaviscon have been shown to provide some relief in the symptoms of reflux. It works by coating the stomach contents with an alkaline layer which makes it more difficult to push back and less painful to the esophagus. It can be used in the place of thickening feeds in breastfeeding babies. Although there are not a lot of studies done in babies, it seems safe to give for short periods (less than two weeks) or on occasion. Using it for longer periods could lead to aluminium toxicity or rickets (Vitamin D deficiency).
• Prokinetics such as Domperidone (Emex), metoclopramide or erythromycin could help to speed up the passage of feeds through the esophagus and stomach. They could however have many unpleasant side-effects affecting your baby’s movement, brain and heartrate.

4. Will surgery help?
Surgery is usually not indicated in children under 1 year of age. Even in older children and adults the results of a Fundoplication surgery are not very satisfactory.

“Be joyful in hope, patient in affliction, faithful in prayer”

Romans 12:12

If you have read all the way to here you must truly have many questions! I hope that I could give you some answers, some advice and some hope. Remember that you are not alone. Talk to other moms and share the burdens and the joys. Talk to your doctors and walk the road with them, they want to help you.

These days feel long, but the years are short and before you know it your child will be waving goodbye on their first day of school (without vomiting all the milk from their morning porridge)!


Pediatrics and Playdough
Medicine Mommy

Resources:

1. Rosen R, Vandenplas Y, Singendonk M, Cabana M, Di Lorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M; “Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)”; J Pediatr Gastroenterol Nutr. 2018 Mar; 66(3): 516–554. ; doi: 10.1097/MPG.0000000000001889
2. Rybak A, Pesce M, Thapar N, Borelli O; “Gastro-Esophageal Reflux in Children”; Int J Mol Sci. 2017 Aug; 18(8): 1671; Published online 2017 Aug 1. doi: 10.3390/ijms18081671
3. Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P, Barbera C, MagazzùG, Pettoello-Mantovani M, Staiano A; “Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey.”; Pediatrics. 2009;123(3):779.
4. Davies I, Burman-Roy S, Murphy MS, Guideline Development Group ; “Gastro-oesophageal reflux disease in children: NICE guidance”; BMJ. 2015;350:g7703. Epub 2015 Jan 14
5. https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408
6. Safe M, Chan WH, Leach ST, Sutton L, Lui K, Krishnan U; “Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?”; World J Gastrointest Pharmacol Ther. 2016 Nov 6; 7(4): 531–539.; doi: 10.4292/wjgpt.v7.i4.531

REFLUX

What is Reflux?

Dr Nické Theron, pediatrician, is here to empower our mommies with knowledge.

Most moms know the feeling of getting your little one all dressed up and ready to go, just to have them spit/vomit milk all over everything just before you leave!

Thank you for all your questions and comments about your journey with reflux. I will try to answer most of you in the next few paragraphs while I explain more about the what, why and how of reflux:

Gastro-Esophageal Reflux (GER) is a 100% physiological (natural) occurrence in healthy babies, children and adults where the contents of the stomach push back into the esophagus (swallowing tube). It is more prominent in babies (40-60% of healthy babies struggle with reflux) because of their immature lower esophageal sphincter (the gate that is supposed to contract to keep the stomach content inside), fluid diets (fluids push back easier), slower passage of food through the stomach and the fact that they are mostly laying down (yes, gravity does play a role here).

Preterm babies have even more trouble with reflux because the esophagus is still too immature to “swallow” the milk down and they are often fed via feeding tubes (which opens up the lower esophageal sphincter even more).

“So do flux and reflux–the rhythm of change–alternate and persist in everything under the sky.”
― Thomas Hardy, Tess of the D’Urbervilles

Symptoms of reflux can start from the first few days of life when they start drinking larger volumes of milk, and usually subside by the age of 12-18months. This is due to a combination of all the factors mentioned above improving. There are some studies that show that children who had reflux as a baby are more prone to struggle with it as they get older.

Babies who have reflux (GER) usually spit/vomit up milk after feeds (yes, it can come up through their noses), (yes, it can be quite a lot!), they can also be irritable after feeds or arch their backs. They often sleep for shorter stretches and want to feed often (the milk actually soothes their throats, but more milk can also cause more trouble). Remember this is still NORMAL baby-behaviour!

“Silent reflux” is a non-medical term applied when a baby has episodes of reflux into their esophagus and airways without vomiting it out. (Making it more difficult to diagnose). In the end the same diagnostic and treatment rules apply.

Most babies with reflux grow well, feed well, are not extremely irritable and do not have any danger signs. These babies are often referred to as “happy spitters” and do not need any further medical intervention. It is very rare for the stomach contents to contain enough acid to cause discomfort or damage to the esophagus / airways. Even in studies where they monitored the reflux episodes by pH monitoring, they often could not associate the episode with the baby being unhappy or waking up from the reflux.

If your baby is failing to thrive (not gaining weight, not reaching developmental milestones), is refusing feeds (turning away his head while arching his back – Sandifer syndrome) or has signs of esophagitis (this is painful inflammation of the esophagus that can only be diagnosed with a gastroscopy, clues will be excessive crying and irritability when lying flat, shortly after feeds and while refluxing) your baby has Gastro Esophageal Reflux DISEASE (GERD). This is pathological and should be treated.

There are many other causes for the symptoms of reflux. Your baby could be going through a growth spurt or be overstimulated or have flu or gastro-enteritis, but if your baby has any of the following Red Flags, please see your doctor asap to exclude more sinister diseases:

  • Recurrent projectile vomiting (when the vomit hits the other side of the room)
  • Yellow bile or blood-stained vomiting
  • Any other abdominal signs: distension or pain of the stomach, constipation or diarrhoea
  • Fever
  • Any seizures, abnormal movements, abnormal head size or other neurological signs
  • Recurrent pneumonias (lung infections)

When you visit your doctor with symptoms of reflux they will probably be able to exclude most of the dangerous conditions by taking a history from you and doing a good examination. Hopefully this, together with the knowledge you were armed with in this article will help you cope with the day-and-night realities of reflux.

I know the mountains of milk-stained washing and sleep deprivation are tough – check back tomorrow to see what you can do to make your little one a little more comfortable.

Resources:

  1. Rosen R, Vandenplas Y, Singendonk M, Cabana M, Di Lorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M; “Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)”; J Pediatr Gastroenterol Nutr. 2018 Mar; 66(3): 516–554. ; doi: 10.1097/MPG.0000000000001889
  2. Rybak A, Pesce M, Thapar N, Borelli O; “Gastro-Esophageal Reflux in Children”; Int J Mol Sci. 2017 Aug; 18(8): 1671; Published online 2017 Aug 1. doi: 10.3390/ijms18081671
  3. Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P, Barbera C, MagazzùG, Pettoello-Mantovani M, Staiano A; “Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey.”; Pediatrics. 2009;123(3):779.
  4. Davies I, Burman-Roy S, Murphy MS, Guideline Development Group ; “Gastro-oesophageal reflux disease in children: NICE guidance”; BMJ. 2015;350:g7703. Epub 2015 Jan 14
  5. https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408

KLEUTER-REDENASIES

Mamma-wees beteken elle-lange kreatiewe redenasies met jou ‘mini-me’.

Medicine Mommy SA

Ons is alweer op die antibiotika-trein…Oudste het middeloorontsteking. Eina.
Maar “high5” vir hom, want hy is ‘n regte kampioen – glimlag steeds en kla basies niks.

Die probleem kom egter in as dit medisyne-tyd raak…Die melkerige mengsel met die meelerige tekstuur en bitter na-smaak laat niemand se mond water nie! Nog minder ‘n amper 3-jarige s’n. Liewe genade, kon die stropie nie maar sjokolade- of selfs bessiegeur gewees het nie? – so aanloklik soos die Vitamien-beertjies of Reuterina koutablette! Dáái eet hy met graagte. Hy vra sommer vir nog!

Vandag was dit weer ‘n omkopery met appelsap (die bitter medisyne het in ‘n Paw Patrol glasie saam met die soet sap opgeëindig) – dít wou hy steeds nie drink nie. “Néé, mamma, hoekom? Hoekom moet ek dit drink?!” (Ja, ons is op die “hoekom” stadium…volgende storie dalk?) Natuurlik verduidelik ek…maar my antwoorde beïndruk Meneer maar min.

Toe word hy ge”bribe” met ‘n einste Vitamien-beertjie…maar toe die een beertjie nie die “trick” doen nie, maak ek toe maar die omkoopprys meer aanloklik en bied noodgedwonge 2 aan. Hierdie taktiek het gewerk, en ons kon aanbeweeg na die Calpol-stroop. Gewoonlik word só koppie sonder te veel bohaai afgesluk, maar vandag moes hierdie mamma maar ‘n Paw Patrol episode inruil vir die Calpol-drankie aanbied.

Mammas, sê my julle kan ‘relate’ ? 🙈🙃

(Diep asemhaal, tel tot…20… en nogsteeds) Vrede 😉,
Alyssa ♡

GASSKRYWER

AANNEMING // ADOPTION

Deur dr. Lindé Marais

Ek het reeds op skool ervaar dat aanneming deel van my toekoms sou wees. Voor ek en Francois getroud is, het ons ‘n belangrike gesprek oor aanneming gehad, minwetend dat ek jare later só PASSIEVOL daaroor sou voel…
Ek kan nog presies onthou waar ons was toe ek hom vra hoe hy oor aanneming voel…en wonderbaarlik was hy oop vir die idee.

Hierdie DROOM (en passie) het vir ‘n hele aantal jare dormant bly lê…
Aan die begin van 2018, het ek gevoel God is besig om die droom binne my wakker te maak (daar was n soort ‘stirring’ in my gees) en ek het ervaar ek moet begin navorsing oor aanneming doen: die proses, hoe en waar mens dit doen, en natuurlik, wat sê die Woord.

Hoe meer ek opgelees het, hoe meer het ek begin besef dat dit nog altyd deel van God se plan was. Sy groter plan. Met almal van ons.
Daar is 3 goeie preke oor aanneming wat hierdie baie goed verduidelik. (Sien 👉skakel hieronder) Nadat ek daarna geluister het, kan ek nie glo hoe BLIND die vyand ons gemaak het nie…

God het ONS as sy kinders aangeneem! Hy het nie gevra waar ons vandaan kom en wat ons gedoen het om sy liefde te verdien nie. Hy het ons bloot net Sy kinders gemaak. Dáárom is waar ons vandaan kom of wat ons in ons verlede gedoen het, nou irrelevant. WANT Hy is ons Pa en ons is Sy kinders! Ons is nou in ‘n nuwe bloedlyn, die verlede word as’t ware uitgevee, en ons word NUUTSKEPPINGS in Hom en deur Hom.

Jesus het ons gered! (Dit is bo-my-verstand wonderbaarlik.) Maar dit eindig nie daar nie. Nadat ons deur Jesus gered is, word ons deel van God se FAMILIE. Ons word ERFGENAME. Dit is juis in híérdie familie wat ons lewe in OORVLOED kan ervaar.

So, vir my beteken aanneming: LEWE IN OORVLOED. Deur die voorbeeld van my Vader te volg, ontvang ek en my gesin dus lewe in oorvloed. Ons red niemand nie – dít is Jesus se werk. Deur aanneming, tree ons net in ‘n lewe van oorvoed in.

NS. Onthou om die skakel te volg as jy meer wil lees en luister:
👇
https://austinstone.org/resources/sermons/series/49–adopted