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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
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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
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COW’S MILK PROTEIN ALLERGY

PART 2

Dr Nické Theron, Pediatrician.

Whether you are pregnant and wondering how to prevent allergies in your little one, or have a baby that has already been diagnosed with Cow’s Milk Protein Allergy and struggling with treatment, read on to find the latest research and tips here:

PREVENTION OF COW’S MILK PROTEIN ALLERGY (CMPA):

There are several risk factors for allergies and unfortunately not so many proven measures to reduce these risks. If you have a family history of allergies or atopic disease (especially eczema or asthma), your children will have an increased risk of developing CMPA – up to 3 times higher in one study. This is the most important factor to consider. Other risks include: Caesarean Section delivery, Prematurity, Older maternal age and Environmental factors.

Measures that have been proven to reduce the risk of CMPA (ONLY necessary when you have a family history of allergies or atopy):

  • Exclusive breastfeeding is the preferred method of feeding up to the age of 6months. Although it has not been proven to prevent CMPA specifically there is good data to prove it has a significantly protective effect against eczema.
  • If you cannot exclusively breastfeed, it is important to use a “partially hydrolysed” infant formula (eg Nan HA, Similac) to decrease the exposure to the full cow’s milk protein. In these formulas the very “offensive” part of the protein has been removed, but it is still perceived by the body as a cow’s milk protein and thus “exercises” the immune system.
  • “Extensively hydrolysed” formula has also been proven to reduce the risk of CMPA, but they are very expensive and have a bad taste, thus rather used in the treatment of CMPA.
  • “Amino Acid formulas” are NOT used in the prevention of CMPA.
  • The mother DOES NOT have to exclude any allergens during pregnancy.
  • When you start solid foods, it is recommended to start no earlier than 17 weeks (4 months) and no later than 27weeks (6 months). It is important to give a varied diet from the start (a restricted diet has a higher risk of allergies) and to introduce allergens such as cow’s milk, fish, peanuts, eggs, soy, wheat early and regularly. Although this is not proven to prevent CMPA specifically, it does decrease your risk for peanut and egg allergy.
  • Unfortunately the studies on the use of pre- and probiotics in babies does not show any reduction in the risk of CMPA. Although we know that your microbiome plays a big role in the fight against allergies and atopic diseases, scientists are struggling to find out exactly which organisms and how much of what gives us an advantage. I am sure there will still be very interesting research in this field!
  • Having pets at home reduces your risk for CMPA according to some studies. 😉

TREATMENT OF CMPA:

Unfortunately none of the above are fool proof to reduce CMPA and if your baby had the symptoms and a positive exclusion test (symptoms improved when cow’s milk protein was removed) you are facing the realities of treating an allergy. Although it can be scary (especially if your child has dramatic, immediate symptoms) and difficult to screen ALL food for cow’s milk protein, it is worth it to see the improvement in your child. I will walk through the basics of the treatment with you, but in the end a dietitian is invaluable to help you with the specifics of exclusion and re-introduction of cow’s milk protein. Please remember that this is just a generalised guideline to explain some of the concepts to you. There is such a big variety in the types of CMPA and the rest of your child’s unique case that you should always discuss any management plans with your pediatrician and dietitian.

Diagnostic Elimination:

  • Breastfeeding infants: Mothers are encouraged to keep on breastfeeding, but to cut out all cow’s milk products (fresh milk, yoghurt, cheese, but also reading all labels for hidden sources) from her own diet for 2 – 4weeks.
  • Formula-fed infants: All cow’s milk protein should be eliminated from baby’s diet and formula changed to an “extensively hydrolysed formula” (eg Similac Alimentum, Pepticate) for 2 – 4weeks. If there is still no improvement in symptoms you can try an “amino acid formula”. However, these are all very expensive and babies take some time to get used to the taste.

If your baby’s symptoms improved after removing cow’s milk, you continue the exclusion diet:

  • Breastfeeding infants: Mother continues to eliminate cow’s milk protein and should drink Calcium supplements (your breastmilk will use the calcium from your bones to provide enough for your baby if you do not eat enough calcium).
  • Formula-fed infants: Most recommendations are to continue “extensively hydrolysed formula” for baby.
  • What about Soy formula (eg Isomil)? This is a much cheaper option, but there are some concerns about cross reaction (in up to 15% of babies) of the allergy, and certain hormonal contents of soy (isoflavone is a phyto-estrogen). Be careful when choosing this option in babies below 6 months.
  • Other mammalian milks such as goat, sheep, camel also has a risk of cross-reacting and might not be nutritionally adapted for use in babies. Please work closely with your pediatrician and dietitian.
  • Rice formulas are gaining popularity but are not yet available everywhere. There is no risk for cross-reactions, but there is a concern that these formulas contain arsenic and have not been studied in CMPA, so once again, be careful.
  • If your baby starts solids, all cow’s milk protein should be excluded from their diet, but all other food groups should be introduced between 17-27weeks, especially the other high-risk allergens.
  • A Dietitian can help to assess your child’s diet to ensure whether the supply of nutrients, especially proteins, calcium, vitamin D, and vitamin A, is sufficient.

Reintroducing Cow’s Milk Protein:

It is recommended that the cow’s milk is eliminated until at least 1 year of age, or for at least 6 months from diagnosis. If however the diagnosis was not confirmed with positive blood tests, or if the symptoms were very mild to start with, your doctor might reintroduce cow’s milk after 1 month.

There are different ways of reintroducing the allergen (also called a “challenge”). If your child was very ill / has immediate reactions, the reintroduction should be done in a hospital. If your baby just had eczema / reflux, you can reintroduce the cow’s milk at home with the guidance of a dietitian.
(See the “Milk Ladder” below.)
If the symptoms return, go back to the previous diet and retry after 6 months.

My take-home message is to take heart! Equip yourself with knowledge, a friendly dietitian and explore some new recipes! Your life does not have to be ruled by fear and FOMO for your child’s sake. Most children will outgrow their CMPA and you can make such a difference in their symptoms until then. The world of allergies is evolving so fast, you can play your part in the education of other moms and who knows, you might just support someone else with a new diagnosis!

“Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, 4 who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God.”

2 Cor 1:3-4

RESOURCES:

1. Ralf G. Heine, Fawaz AlRefaee, Prashant Bachina, Julie C. De Leon, Lanlan Geng, Sitang Gong, José Armando Madrazo, Jarungchit Ngamphaiboon, Christina Ong, and Jossie M. Rogacion;  “Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited”; World Allergy Organ J. 2017; 10(1): 41.
2. Yvan Vandenplas, Martin Brueton, Christophe Dupont, David Hill, Erika Isolauri, Sibylle Koletzko, Arnold P Oranje, and Annamaria Staiano; “Guidelines for the diagnosis and management of cow’s milk protein allergy in infants”; Arch Dis Child. 2007 Oct; 92(10): 902–908.
3. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schappi MG, and Vandenplas Y; “Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines”
4. http://www.uptodate.com
5. Vandenplas Y, Al-Hussaini B, Al-Mannaei K, Al-Sunaid A, Ayesh WH, El-Degeir M, El-Kabbany N, Haddad J, Hashmi A, Kreishan F and Tawfik E; “Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus”; Nutrients. 2019 Jul; 11(7): 1444
6. Sardecka I, Łoś-Rycharska E, Ludwig H, Gawryjołek J, Krogulska A; “Early risk factors for cow’s milk allergy in children in the first year of life”; Allergy Asthma Proc. 2018 Nov 1;39(6):e44-e54.

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COW’S MILK PROTEIN ALLERGY

Written by Dr Nické Theron, Pediatrician.

Cow’s milk protein allergy. So many misconceptions, misunderstandings, fears and confusion locked up behind those few words for both moms and health-care professionals. I was privileged to attend the congress of the European Academy of Pediatrics two weeks ago and the master course focused on nutrition in childhood. I finally have a better understanding of CMPA (Cow’s Milk Protein Allergy) and I hope I can explain it better to you too.

As with many food allergies, CMPA is an allergy (where the immune system mistakenly identifies a protein as harmful and reacts to cause symptoms) to one or multiple of the different protein-structures in cow’s milk. Unfortunately the occurrence of all types of allergies are increasing in Western societies at an alarming rate, with CMPA being the most common (2-7% of babies). Food allergies specifically can cause a lot of anxiety in parents and children as you have to be on alert at all times, and any symptom can be seen as an allergic response. It is high maintenance to totally exclude a specific food group from your child’s diet and this can also cause deficiencies in their diet. It is thus important that your child is diagnosed correctly, and that you have the necessary dietary assistance to help you and your child reach the top of this mountain.

The good news about CMPA specifically is that many babies outgrow it by 1 year of age, and most children should tolerate cow’s milk proteins by the age of 3 years and can return to a normal diet. Having a sibling with CMPA does not increase a new baby’s chance to develop CMPA, but if there is a family history of atopy/allergies the 2nd child will have the same type of risks as the first.

It is important to know that not all symptoms caused by ingesting food are caused by an allergy.

Dr Nické Theron

Lactose intolerance is one example, where poor breakdown (by an enzyme called lactase) and absorption of the sugar component (lactose) in cow’s milk, causes too much lactose to end up in the large intestines resulting in symptoms such as bloating, diarrhoea and abdominal pain. This is very rare in infants who usually have enough lactase-enzymes to digest the lactose in up to 1 litre of breast milk per day. Any left-over lactose in an infant’s gut acts as a prebiotic and improves the development of the immune system. As a baby starts to wean, the lactase percentage drops slowly in about 70% of the population, and this could lead to symptoms of lactose intolerance after the age of 5 years. Even in these children it is usually not necessary to cut out all lactose from their diets as they can cope with a small amount. Premature babies might have lactose intolerance due to their immature gut, and very rarely babies are born with a congenital abnormality where they produce no lactase and they will then present with severe diarrhoea.

Another more common cause of lactose intolerance is a sick gut (secondary lactose intolerance). If your baby had a bout of infective diarrhoea or has severe inflammation of the gut due to eg CMPA, the inside lining of the intestines becomes very thin and then lactase cannot be produced. Removing lactose from the diet can then help to give the intestines a chance to restore the lining and lactose can be reintroduced after 2-4 weeks.

Ok, back to CMPA:
This allergy can develop in exclusively breastfed babies as the cow’s milk protein is passed relatively unchanged through the breastmilk. It can also present later when cow’s milk is introduced into a baby’s diet.

SYMPTOMS

Unfortunately there is not one specific symptom for CMPA, and babies and children can present with a wide variety of symptoms. It can cause anything from vomiting, regurgitation (can be misdiagnosed as reflux), blood in the stools, diarrhoea, constipation, eczema, wheezing or anaphylaxis (a state of shock where the allergic reaction overwhelms the body and is a medical emergency). See the table below for more detail.

Some babies become critically ill shortly after ingesting the protein, while others are happy, healthy and growing with some nagging symptoms. I am sure you can now understand why it is so difficult to diagnose CMPA!

To complicate the matter and the diagnosis even more, there are different types of CMPA because of the different ways the immune system responds to the protein. Some children will have “IgE-mediated CMPA”. (IgE is a specific antibody of the immune system that recognizes proteins as bad and rapidly responds to it.) Children with asthma and eczema also have high levels of IgE in their blood. The advantage is that we can test for this type. They will usually have a positive skin-prick test and positive blood results specifically for CMPA. The disadvantage of this type is that the children usually take longer to outgrow the allergy, and they are more prone to develop other atopic diseases later in life. Their reaction to CMP is also usually more severe and they can develop anaphylaxis.

The immune system can also respond without IgE, leading to a more delayed reaction (some children can still get very ill!) that is usually outgrown earlier. However there are no tests we can do to prove this type of allergy and this can be very frustrating to parents and doctors!

The latest guidelines have thus suggested that the best way to diagnose any type of CMPA is with a good history and physical examination, followed by an elimination of the cow’s milk protein from the diet. If the symptoms improve the child should be “challenged” by giving the cow’s milk protein again, and if the symptoms return the diagnosis is confirmed.

Other tests that might be done are blood tests for total IgE and specific food allergies or a skin-prick test where the reaction of the skin to different allergens are tested.

I will leave you so that you can digest this chunky piece of information, please feel free to ask if you do not understand anything! In my next post I will address the management of Cow’s Milk Protein Allergy from a medical perspective and help you to understand where a Dietitian fits into the picture.

RESOURCES

  1. Ralf G. Heine, Fawaz AlRefaee, Prashant Bachina, Julie C. De Leon, Lanlan Geng, Sitang Gong, José Armando Madrazo, Jarungchit Ngamphaiboon, Christina Ong, and Jossie M. Rogacion; “Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited”; World Allergy Organ J. 2017; 10(1): 41.
  2. Yvan Vandenplas, Martin Brueton, Christophe Dupont, David Hill, Erika Isolauri, Sibylle Koletzko, Arnold P Oranje, and Annamaria Staiano; “Guidelines for the diagnosis and management of cow’s milk protein allergy in infants”; Arch Dis Child. 2007 Oct; 92(10): 902–908.
  3. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schappi MG, and Vandenplas Y; “Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines”
  4. http://www.uptodate.com
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DIE HAMSTERWIEL

Dit voel die laaste tyd of ek op ‘n hamsterwielietjie vasgevang is en iemand het die hokkie se deurtjie styf toe gemaak. Ek beur net al aan vorentoe…ek móét vorentoe. Maar ek beweeg dan net mooi niks nie!😳 Vandag was beslis weer een van dáái dae – een vir die (mammadag)boeke…

Dit was ‘n warboel van snotneusies blaas, vuil vingertjies met ‘wetwipes’ afvee (na Oudste al weer die ou kole in die braai ontdek het – ek moet tóg vir manlief herinner om die braai skoon te maak), die swartkolle op die bank skoonmaak (ek was te laat met die ‘wetwipes’ 😬), neusdruppels ingooi (kleinboet háát dit), Panadostroop toedien, troos, eierbroodjies smeer (en Oudste soebat om asseblief ietsie te eet), saam met Oudste op die bed “bietjie gaan rus” (volgens hom gaan hy beslis nie slaap nie!), wéér troos, dan vir boetiebaba aan die slaap sus, net om te hoor hoe Oudste histeries in sy kamer huil… Gelukkig is my Regterhand ook in die mengelmoes van gebeure en ek stel haar gou aan om by kleinboet oor te vat (ek gaan regtig nog êrens ‘n huldeblyk aan haar skryf, want sjoe, sy’s een van die sterkste vroue wat ek ken …).

Bo in die kamer sit my kabouter kiertsregop, tamatierooi in die gesig, trane en snot wat loop (sorrie julle) en ‘n pynlike uitdrukking op sy gesiggie. Ek kan sien hy’s al weer koorsig… Jip, jy het reg afgelei… My 2 “mini-me’s” is siek. Al weer. Oudste kabouter is natuurlik laasweek vir die eerste keer in 6 weke terug skooltjie toe. Ons moes hom noodgedwonge vir ‘n tydjie uithaal oor hy al die skooltjie-kieme saam hom huistoe dra (dis hoe kleinboet in die hospitaal met meningitis opgeëindig het). Hy het dié keer nie eers ‘n week gehou tot die neusie begin loop het nie. En toe is dit boetie se beurt. En nou is dokter-mamma ook ‘n pasiënt. Probleem is net, vir mamma is daar nie rus nie. Huisdinge moet aangaan…en die kinders soek hul mamma. 100% van mamma.

Goeie d…donkie, besef ek nou: Ek’t al wéér te min water vandag gedrink…en daar lê my verlate 2 kopseerpille nog net so op die toonbank! Deur al die deurmekaarspul het ek (gelukkig) van my knaende min-slaap hoofpyn vergeet…

Vanaand is ek dankbaar vir ‘n stil huis. Ek luister…en hoor net Rupert, ons swart mini Schnauzer, se gesnork. Vanaand beteken die stilte: ons het dit “gemaak”, ‘we survived another day’, die kinders is rustig – pynvry en koorsvry. En hopelik is môre weer ‘n beter en helderder dag. Met méér grappies-en-lag en minder snot-en trane…

“Who’s with me”, mammas? 🙋🏼‍♀️

Vrede (amen!) & lekker slaap!

♡

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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 ♡

Posted on

AG, DIS SOMMER…SNOLLIES

Winter: loop-neusie-seisoen.

Daardie verdomde klewerige mukoïede substanse wat gestalte kry agter in jou baba se petite lugweë…dis regtig sleg.
En dit suig nóg meer as jou klein mensie as gevolg van díé goed nie kan asem kry nie!

Dit klink dalk simpel, maar ek sal jou sê, dit was vir my een van die mees angswekkende ervarings toe my jongste (toe 1 maand oud) erg benoud na sy asem gesnak het – babatjies haal hoofsaaklik deur hul neusies asem – en dít nog in die hospitaal en op suurstof!! Dis mal hoe vinnig so iets kan gebeur….

My boetiebaba was vir die tweede keer in ‘n week se tyd by die hospitaal opgeneem. Eerste keer, virale meningitis (sien op Facebookblad: ‘Meningitis – As jou brein pyn’). Dié keer met bot-toe longetjies, ribbekassie wat intrek en magie wat paradoksaal uitpop soos hy probeer asemhaal. Diagnose: RSV (sien ‘RSV – Really Stupid Virus’).

Later, veilig in die kindersaal, kan ek mos nou semi-ontspan. Vasgeplak teen sy klein wangbeentjies loop die nasale kanules wat suurstof volstoom in sy neusie blaas. Hy kry gereeld neusdruppeltjies om al die hardnekkige slyme los te maak en op te droog. Selfs die fisio kom beklop hom 2 keer per dag. Als was okay. Beter…En toe word dit nag. Letterlik.

Ek weet nou nog nie presies wat gebeur het nie, maar êrens deur die loop van die nag (en kyk, nagtelike ure in ‘n hospitaal kan laaaaank voel!) het hy begin benoud word. Nie van sy borsie nie, maar van sy toe neus! Druppels word klokslag ingegooi, suurstof hardloop op ‘full blast’ en skielik sit ek met ‘n kermende mensie wat hyg-hyg en gor-gor snak na sy asem!

Dank Vader die pediater het vroeg rondte kom doen en hom haastig by my geneem toe sy sien hoe hy sukkel en stoei.

Nou ja, slyme is uitgesuig (die goed gaan lê glo soos ‘n oester agter in die nasofariks), nóg neusdruppeltjies…en my klein mensie skep weer genoeg lug om hom te verlustig aan moedersmelk…

Vrede,
Alyssa ♡

NS. As dit by jou eie kinders kom, raak die skerpste dokter maar lekker dom. Skies, ek veralgemeen nou erg. Maar ons is net nie objektief genoeg nie. Daar’s net té veel emosies betrokke. Daarom is ek maar eerder oorversigtig en kry maklik ‘n tweede opinie. My kinders het ‘n wonderlike pediater…

Foto:
My vriendin het hierdie oulike apparaat aangekoop – die BabyVac. Dit werk soos ‘n bom. Konnekteer hom aan die stofsuier en ‘whaa-laa’.
(Kry hom by Dis-Chem Pharmacies)

Oppas net vir té veel gebruik – dit kan die delikate slymvliese irriteer om nóg meer slym te produseer en swelling te veroorsaak. Sien die vervaardigers se aanwysings.