What is the Rotavirus?

 

Rotavirus is the most common cause of severe diarrhea among infants and children throughout the world.
Children between the ages of 6 and 24 months are mostly affected.
Most children become infected with rotavirus by age 3.
Adults sometimes become infected, but the resulting illness is usually mild.
Rotavirus affects populations in all socio-economic groups.
Rotavirus infections can occur anytime of the year, but usually peaks in the dry, cooler months of autumn and winter i.e. in South Africa the rotavirus season may peak from late March to early August.

What are the symptoms of Rotavirus infection?

 

The incubation period, before the child presents with symptoms is usually for about 3 days after exposure.
It begins with frequent vomiting which lasts 1-2 days, vomiting sometimes as often as every 5-10 minutes or every time the child tries to eat or drink something.
Diarrhea begins about a day later, and can also be as often as every 5-10 minutes lasting up to 5 days.
The diarrhea stools are usually watery and can smell foul.
A fever of 37.9°C or greater and abdominal pain.
Symptoms may last three to nine days.
Severe dehydration can lead to death in rare cases, it is important to recognise and treat dehydration:
A lethargic infant, dry, cool skin, an absence of tears when crying.
Dry or sticky mouth, extreme thirst.
Sunken eyes or sunken fontanelle (the soft spot on the head of infants).

How is Rotavirus spread?

 

The Rotavirus is highly contagious. The primary mode of transmission of rotavirus is a fecal-oral route: Children can transmit the virus when they forget to wash their hands after using the toilet or before eating. Touching a surface that has been contaminated with rotavirus and then touching the mouth area can also result in infection.

How is Rotavirus diagnosed?

 

The only way to confirm if it is the Rotavirus is to conduct a laboratory test on stool specimens.
What is the treatment of Rotavirus infection?
There is no specific treatment for rotavirus, since it is a viral infection.
The main aim is to prevent dehydration by increasing fluid intake.
About one in 40 children with Rotavirus require hospitalisation to treat dehydration by receiving intravenous fluid.

Can Rotavirus infection be prevented by vaccinations?

 

Because the virus is so prevalent, it is almost impossible to prevent rotavirus infection, even places with excellent standards of hygiene and sanitation can become contaminated. Vaccination is the most effective preventive measure. While the Rotavirus vaccines will not prevent all forms of diarrhea in children, it will prevent severe dehydration that requires hospitalisation and prevents deaths due to dehydration in children infected with Rotavirus. The SA Department of Health has announced the introduction of the Rotavirus vaccine into the national immunisation program. It is, therefore, reassuring to know that the Rotavirus vaccine could potentially prevent about one in 20 deaths in children under five years of age in South Africa.

Almost all babies get nappy rash at some point during the first year or two of life. A parent can take every precaution to help prevent nappy rash, but sometimes a baby will get a rash on his bottom despite this.

What does nappy rash look like?
Nappy rash usually causes mild redness and / or raw skin on your baby’s buttocks, genitals or upper thighs.

In some cases, the rash can cause pimples, blisters or small, red spots which may slowly spread.

What could be the cause?
A wet or dirty nappy, which has been left touching the skin for too long, is the most common cause of nappy rash.

Check your baby’s mouth. Is there a white coating or patches inside the baby’s cheeks or lips?
It could be a symptom of oral thrush (Candida). This fungal infection is also a leading cause for nappy rash.
Have you used a new brand of disposable nappies or baby wipes? Your baby may be sensitive to this specific brand.

Have you changed the brand of detergent or fabric softener that you use for washing the baby’s cloth nappies?
Is the nappy too tight or is it possibly chafing the skin?
Has there been a change in diet? Have you introduced a new food type or milk? This can increase the number of stooles, which can aggravate a sensitive skin. It could also indicate sensitivity to that specific food.
Has baby had diarrhoea recently?
Have you recently changed the brand of soap or lotion that you use?
Is baby currently receiving medication or antibiotics for other illnesses?
Tips on preventing and treating nappy rash
The key to preventing and treating nappy rash is frequent nappy changing.
When the rash is at its worst, it may be necessary to change the nappy up to 12 times a day.
Stop using wipes while there is a rash. Use a soft facecloth or cotton wool with warm water, to gently wash the nappy area every time the nappy is changed.
If baby has raw or broken skin, soaking in a shallow warm bath for a few minutes, may be a gentle and soothing way to cleanse the skin.
Allowing baby to play without a nappy for a while, in a warm room, is one of the best ways of treating and preventing a nappy rash.
Pat the skin with a soft towel, making sure the area is completely dry before putting on another nappy.
Apply a layer of protective ointment over your baby's nappy area to keep moisture away from skin.
When putting the nappy on, it should fit loosely so that the area is allowed to 'breathe'.
If baby is crying or very uncomfortable because of a raw bottom, give medication to relieve the pain.

Other tips:
Fragrance-free and alcohol-free wipes are less likely to irritate baby’s skin.
If nappy rash persists, try changing the brand of wipes, disposable nappies, soap or washing detergent you are using.
Switch to disposable nappies if you suspect that cloth nappies are the cause (even if it is just until the rash is clear). Although, some babies can actually be sensitive to disposable nappies and you might want to give cloth nappies a try!
Use a gentle detergent to wash a baby's cloth nappies.
Rinse cloth nappies twice to remove all traces of the detergent and avoid using bleach or fabric softener.
Give a probiotic to a child who is on an antibiotic or has diarrhoea as it may help to prevent Candida infections.
Give baby more fluids (water or cranberry juice) to drink than you usually do, to dilute the urine.
Do not introduce any new food types while baby has a nappy rash.

Visit your doctor if:
The rash doesn’t get better after trying the “tips on treating nappy rash” for 5 days.
The rash occurs in the first 6 weeks of life.
Baby has a fever.
If there are pimples, boils or small ulcers. If blisters form or the skin becomes even more red, warm and swollen.
If baby’s penis is swollen and red, or if there is a greenish discharge from the penis.
If you check your baby’s mouth and find the signs of oral thrush as well.
If it is a yellow, scaly, crusty rash which appears not only in the nappy area, but elsewhere, such as on the head, behind the ears or under the arms.

1. Look into your baby's eyes while you are talking to her.

 

Make eye contact, widen your eyes and change the pitch and tone of your voice to get your baby's attention. Start by using simple words and phrases, speaking clearly. Watch for signals from your baby, if she is smiling and keeping eye contact, she is saying she is enjoying herself and wants you to keep on talking.

2. Have a "conversation" with your baby.
She will listen to what you say, and then make sure you give her a moments silence to respond to you. She will make cooing and gurgling sounds as she 'talks' back to you.  She’ll begin to understand, even at this early age, that communication is a give and take.

3. Naming things:
Hold her hand as you reach out to “touch the dog, flower, toy…etc”. Sound the word out slowly and praise her as she tries to “say it back to you.”

4. Describe what you see her doing. 
When your baby reaches for your nose, cooing, you can say, "That’s my nose. Are you going to grab it with your little hand?" When she turns toward the sound of the door opening, you can say, "You heard the door opening. Is that your sister coming in?" When the cat approaches and she starts gurgling and kicking her feet, you can say, "Ohhh, you see Tiger coming. Hello Tiger!"  Ask your baby questions even though she can't answer. "Would Sarah like to have her milk now?" "Does Sarah want to go outside? If she yawns say,”Oh, does Sarah want to have a sleep?"

5. Talk to your baby about what you are doing.
As you dress, bath and change your baby, talk about what you're doing. Tell her you are changing her nappy or what food you are feeding her.  Before you pick her up, you can reach your hands towards her and say, "I’m going to pick you up." This not only helps her learn language, it also helps her learn to expect what will come next. Add gestures to your talk. Wave as you say "bye-bye" to Daddy. Play games such as peek-a-boo with your baby or cover your face with your hands and say, “Where is Mommy? Where is Mommy? There’s Mommy!”

6. Repeat yourself: 
Again and again and again…..and again!

7. Sing songs.
Songs or nursery rhymes are a wonderful, fun way to learn a language. With repetition, children soon learn them. When a baby has learnt a clapping song, she can ask for it by clapping her hands, even before she knows how to say, "I want to sing the clapping song!"

8. Read to your baby.
Reading, while a lovely excuse to cuddle and have one-on-one time; is also one of the best ways to promote your child's vocabulary. Look for books with photos or stories that include large colourful pictures of other babies, a dog, cat or other familiar household items. Use a lively voice and an expressive face as you read stories, nursery rhymes and poems to her. While you read to your child, be sure to point to objects and say what they are or ask him to point to certain objects, saying “Where is the tree…dog?” etc. You can also make books for your child, using photos or pictures of familiar objects, pets and people (family and friends), mount them on little cardboard pages, cover them with plastic to protect them from drool and teeth; and tie them together with string.

9. Wean your child off the dummy:
Experts agree that prolonged, excessive use of the dummy / pacifier, beyond one year, can contribute to speech delay.

10. Why Sign?
Babies can easily learn sign language between the ages of 6 months to 36 months, which allows you to communicate with your pre-verbal baby. Most babies will invent their own “signs”, for example a baby may learn to wave bye-bye or point to his nose when it needs a wipe. Believe it or not, your child can tell you if his tummy hurts or when he wants a bottle and what he wants in it! He can let you know he wants his dummy, a banana, a biscuit, a sandwich or even his blanket, without you having to guess, “What do you want?“ It must be emphasized that it is always used with words and not instead of words.
Learning sign language does not delay speech, years of research has proven that it in fact aids speech development. This form of communication is inspirational and downright amazing and is fun for both the parent and child!

By the end of nine months of pregnancy, every woman is more than ready to meet her baby. Every ache and twinge is analysed, as she eagerly anticipates that this might be the beginning of labour. You may not experience all these tell-tale signs that labour might soon start, and remember ‘soon’ in labour terms could mean 2 days or 2 weeks! The secret to childbirth is to make peace with the fact that, yes, there is so much that you cannot predict or control, and yet there is no need to be afraid!

Emotional changes in labor

You may be easily irritated, argumentative, have mood swings, overwhelmed, tearful about the smallest thing, in your own ‘world’, distracted and unable to focus. You might feel that your partner does not understand you; but then at this stage you really don’t understand yourself either!

Spurt of energy / Nesting instinct

Having a burst of energy before the birth of your baby, many women will clean the house like it has never been cleaned before! The tasks she might not be able to do herself; might mean that an unsuspecting partner invariably receives a list of his own! As wonderful as it is, to have boundless energy, please try not to overdo the physical activity at this time — you'll need your energy for labor and all those upcoming sleepless nights!

Engagement

Also known as the baby 'dropping’ or ‘lightening’ is when the babys head lowers deeper into the pelvis and nestles into position for birth. In first pregnancies engagement will generally occur before labor, but in subsequent pregnancies, the baby may not engage into position until right before labor. If you are told that your baby is ‘lying low’ and ‘might come early’ do not get your hopes up; there is still a big possibility that you could carry to 42 weeks!

Effacement / Ripening of the cervix: The cervix prepares for birth by softening and thinning, or effacing.

Dilatation of the cervrix: Is the Opening of the cervix. Your doctor or midwife will measure the dilation in centimeters from zero to ten. Many women are dilated 2 to 3 centimeters for days or even weeks before labour actually begins.

Increased Braxton Hicks Contractions

These "practice contractions" are experienced as a tightening over the abdomen (it is your uterus becoming hard) – which may be 1-3 minutes long. As labor approaches they occur frequency and become more uncomfortable.

Mucus Plug or ‘Bloody’ Show

As the cervix begins to open (dilate), the mucous plug which seals the cervix during pregnancy begins to loosen. It is a thick, sticky, jelly-like discharge which may be tinged pink, brown or red. Losing the mucous plug is a sign that labour may begin soon, but it’s not a guarantee. Labour may still be a week or more away.

Diarrhoea

In the days prior to birth, your body will produce prostaglandins, which will cause loose bowel movements, emptying the bowels in preparation for birth.

Rupture of Membranes

Television often portrays a very dramatic, public scene of a women’s water breaking at an inopportune time and place, with her barely making it to the hospital on time. When actually as few as 15-25% of women will start labour this way. Call your midwife or go to the hospital immediately.
Some indicators of ruptured membranes:
Your first thought is: “Oh no! I have a weak bladder and have just wet myself.”
It is clear (perhaps a slight tinge of blood) and odourless which may be a continuous trickle or a gush of fluid.
You have no control over the flow and need to wear a sanitary towel

Clues of early contraction

Low nagging menstrual pain with dull, lower backache which reappears at regular intervals
Contractions feel like regular, painless tightening of the stomach, lasting 15-30 seconds
Labour contractions
Real contractions are regular and will become closer together; last longer and become more painful over time.
With true contractions there is always a gradually build up to a peak, then the uterus slowly softens until it gently fades away completely.

Timing Contractions:

How far apart are the contractions? Time your contractions from the beginning of one contraction to the beginning of the next one.
How long do they last? Measure the length of each contraction by timing from when it begins until it fades.

When to go to the hospital?

If you are unsure how to interpret the signs that you are experiencing or just feel confused and anxious.
If you suspect that your membranes have ruptured.
If your contraction are regularly 5 minutes apart, lasting about 45 seconds long.

The Birth of a Baby is a powerful experience, an unforgettable life-changing moment! The first step before making any decision is to find out what kind of birth YOU want!
This will guide you in your choice of caregiver and place of birth.

Choosing a Caregiver
It is very important to carefully choose a care giver who has the same perspective about birth, as you do.

Family physician, GP
A medical doctor with years of specialized training in primary health care, including obstetrics.

Obstetrician, Gynaecologist
A medical doctor who has received specialized training in obstetrics.

Private Midwife
A midwife means "with women". She is a Registered Nurse / Midwife who offers individual care throughout pregnancy, labor, birth and the postnatal period, with a back up Doctor if complications should arise .

Doula
Besides the midwife or doctor, many women are choosing to have a doula present. She is a trained birth companion or midwife, who offers tremendous support to women and their families during labour and birth.

Childbirth Educator
There should be no doubt in your mind that it is essential to attend Childbirth Classes!
Birth is one of life’s most precious and memorable days; with preparation and planning, you will feel less fearful and more empowered! Antenatal classes should welcome the ‘dads’ involvement; preparing both of you for childbirth, breastfeeding and practical skills to care for your baby.

Choosing a Birth Place
The choice of hospital is usually determined by what kind of birth experience you are wanting, as well as the doctor, who may have consulting rooms at a particular hospital.

Birth Centre
This is a homely, relaxed and intimate environment usually within a medical facility. This active birth unit encourages partner and family centered maternity care.. The caregiver could be your gynaecologist or a private midwife. Unfortunately, Birth Centre’s are not yet available in all cities.

Homebirth
An intimate birth experience attended by 2 midwives, in the privacy of your own home surrounded only by those people you invite to the birth. You will have Antenatal check-ups with your midwife, who will guide you in how you need to prepare for the birth and what to expect on the day. The midwives will arrange a back up doctor and hospital facilities in case of emergencies. Home birth can be an option if you have a low risk pregnancy.

Hospital Maternity Unit 
Arrange to take a tour of the Maternity unit. The following questions will give you an idea of what to look for - and what to ask – to help you make a decision.

Is the maternity staff warm and welcoming; open to take you on a tour of the unit?
Is the labour ward environment clinical or friendly and home-like?
Are they open to help you achieve your Birth Plan? Is a Doula permitted to support you in labour?
Do they allow you to create your own birthing environment and bring in your own music and birthing ball?
Is there a birthing pool or bath to use for relief of pain during labour?
What is their view on using alternate birth position (squatting, side-lying, hands and knees)?
Do they prefer to monitor baby continuously or just every now and then?
How many beds are in their postnatal wards? Are there any private rooms available after birth?
Do they have facilities for fathers to sleep over?
Do they encourage breastfeeding and allow baby to room-in with you?
What are the rules for visiting? Do they allow fathers access at any time?

Your birth experience can be a reflection of you; your creativity and personal preferences. The first step is to discover what kind of birth YOU want!

Here are three frequently asked questions from parents of newborns:

How do I know that I am giving my baby enough to milk to drink?

• In the first weeks (and even months) of life, a baby's primary tasks are to eat, sleep, and grow.
  
• Newborns need to eat every 3 or 4 hours and sometimes as often as every 1 or 2.
• Whether you choose to breast feed or bottle feed, the unavoidable fact is that you will spend much of your days (and nights) feeding your newborn.
• Weigh baby weekly at a Baby Clinic and expect a weight gain of between 150-250g per week
  
• Frequent wet nappies (babies normally urinate 6-10 times a day)
  
• A contented baby who sleeps well
  
• Stools every day

How do I know my baby’s stools are normal?

• A newborn's first stool (called meconium) is blackish and sticky. Day 2-3 it changes into brown-green or yellow-green stools and by day 3-4, when your milk has come in, baby will have very liquid yellow stools with or without white curds.
  
• Breastfed newborns can have a stool after every feed or 2 large watery stools a day. After 6 weeks a breastfed baby, who is gaining weight can have one stool in seven day and not be constipated
  
• Formula fed babies will have 1-2 putty-like stools a day, by one week.
  
• Stools should not be offensive smelling or more than your baby’s usual pattern.

My baby has a rash, when should I be concerned?
Newborns have many rashes, as long as baby does not appear ill or have a fever; there is no need to be concerned. Here are a few:
Milia
‘White heads’ appearing on the nose, cheek and chin due to obstructed oil glands. When the glands begin to function the milia will begin to fade away, taking a number of months to disappear.

Newborn rash
Red spots with yellow or white pimples in the centre (like an insect bite) on the body, arms and legs. It appears in the first week of life and can be very disturbing to parents.

Facial Rashes
Mild rashes on the face commonly occur in the first months of life. Smooth pimples, small red spots, or rough red spots and rarely require treatment.

Heat rash
Clusters of tiny pink pimples surrounded by pink skin, mostly on shoulders and neck.
This is caused by overdressing or overwrapping baby. Baby’s neck & stomach is a great place to check if baby is overheating. If it is clammy, then your baby is getting hot so consider taking a layer of clothing or blanket off.

Baby acne
Babies have exposure to Mom's hormones in utero, which can cause baby acne at about 4 weeks. It is harmless and goes away on its own.
Here are typical newborns skin conditions which require little or no intervention.

What might help:
Use fragrance free products on baby’s skin
Bennetts Aqueous Bath Drops will moisturise baby’s skin
Wash baby’s clothes in washing powder for babies and rinse baby’s clothing well
Do not squeeze any pimples!

When should I introduce solids?
The World Health Organisations (WHO) current recommendation is to exclusively breastfeed for 6 months and that no solid foods are introduced to baby for the first 6 months. There are good reasons for this:

• The risk of allergies increases if baby's first foods are introduced too soon and early feeding can cause obesity.

Many medical professionals still advise introducing baby's first foods anywhere from 4 to 6 months depending on the following guidelines. If you've answered yes to most of these questions, then it might be time for baby's first foods. Does your baby:

• Seem hungrier than usual and dissatisfied after his milk feeds?
  
• Eagerly watch you when you are eating, opening his mouth?
  Push up with his arms when lying on his tummy? Wake at night after previously sleeping through?
  
• Sit well, without support? Doubled his birth weight?
  
• Does your baby have good head and neck control?

Getting Started

• Take the edge off your baby's hunger by giving him half his formula or breast feed first.
  
• Get him comfortable - depending on baby's age, it might be a bit too early for a high chair, try his baby car seat or you could just sit him on your lap to feed him.
  
• Mix about two teaspoons of baby rice cereal (gradually increasing to 2-4 tablespoons over a few days) with enough breast milk or warmed formula to give an almost watery consistency. It is a popular first food as it is easy to digest, and when mixed with breast milk or formula, its taste will be familiar to baby. Alternatively, you could start with a pureed vegetable / fruit such as carrot, butternut, sweet potato, pear or avocado.
  
• Using a rubber-tipped spoon will be softer on baby's gums.
  
• One of two things could happen - your baby will either open his mouth eagerly to accept this wonderful new experience ... or he will pull a face and thrust his tongue forward “spitting” out the food.
  
• It may take a few days for baby to learn to enjoy eating.

How can I tell when my baby has had enough food?
Baby could lean back, turn his head away, try to play with the spoon, refuse to open his mouth or keep spitting out the food! Try to read your baby's signals - and do not force feed. Throw away the leftover food and then offer baby the remainder of his milk feed.

The four day rule:

Giving your baby new food is so exciting, but by patiently following the “four day rule” you will immediately be able to tell which food is causing a problem. An allergic reaction usually appears within 1/2 an hour of your baby eating the food and digestive problems or potential reactions can take up to 3 or 4 days to occur.
Introduce only one new food to your baby at a time and continue to feed your baby that food for four days. You can add it to other foods which you have already safely introduced. If you are introducing solids to your baby before he is 6 months old, you might want to increase it to seven days.

Foods more likely to cause an allergic reaction / allergies or digestive discomfort.
Gluten (in wheat, oats, barley), egg (especially the whites), soya proteins, fish (tuna, salmon, mackerel, sardines), shell fish (lobster, prawns, crab and shrimp), peanut products, and cows milk, pork, cinnamon, citrus fruits (orange, grapefruit, lemon, lime and tangerine), sesame seeds and sesame oil, corn, tomatoes. NEVER give honey to a baby under one year of age as it contains botulism spores which can produce life-threatening toxins.
Reactions: Excess wind, nausea, vomiting, possible blood in stools, constipation, stuffy or runny nose, watery or red eyes, wheezing or eczema. Consult with your doctor or clinic nurse if you suspect a reaction.

Helpful hints:

• Choose a time of the day when you are not rushed or feeling pressured and when baby is not tired or ill.
  
• Introduce new foods in the morning or at lunch time, so that if baby experiences any discomfort it will happen during the day and hopefully not disturb your nights sleep!
  
• Do not add sugar, salt, butter to the food as it can put strain on the kidneys and liver.
  
• If you are preparing your own foods - label what it is (pureed foods can look alike once frozen) and note the date it was prepared. Freezing the vegetables into ice-cubes means you can grab a variety of cubed veggies at one meal time.
  
• I recommend introducing vegetables first, as fruits are naturally sweeter - if your baby gets used to the sweet taste of fruit, he may be less willing to try vegetables.
  
• Milk is a VERY important part of baby's diet for the first year. Take things slowly, increasing the size and frequency of solid meals as your baby's appetite dictates.
  
• Eating should be a happy, messy experience! After the first few attempts you may both need a bath. Keep your sense of humour and have fun!

Although it can be very scary when your child’s temperature rises, it is important to remember that fever is not harmful!

It is actually beneficial! Fever helps the body fight infections by stimulating the body’s natural defense mechanisms. Knowing what to do to lower the temperature and when to see a doctor, will give you peace of mind and will remove the fear out of a fever.

How Do I Know if My Child Has a Fever?
Your child has a fever when his temperature is at or above one of these levels: 38° Celsius measured rectally (in the bottom) 37.5° Celsius measured orally (in the mouth) 37.2° Celsius measured under the arm.

What causes a fever?
Fever is not an illness — it is a symptom of an underlying infection. The most common causes of fever are viral or bacterial infections. Teething may cause a slight rise in body temperature, but it will probably not cause a child's temperature to go higher than 37.8° Celsius. Your child might also develop a low-grade fever for a day or two after vaccinations.

Choosing a thermometer

• Digital thermometers are easy to use and usually provide the quickest, most accurate readings. It is especially recommended for babies 3 months or younger.
  
• Electronic ear thermometers are quick and easy to use in older babies and children, but aren't as accurate for infants younger than 3 months because their narrow ear canals make it hard to insert the sensor properly.
  
• Forehead thermometers / plastic strip thermometers will tell you whether your child has a fever, but aren't accurate if you need to know your child's exact temperature.
• Glass mercury thermometers are no longer recommended as there have been concerns about the mercury they contain.

When to consult a doctor
An infant under 3 months of age with even a slight fever can be a cause for concern, consult your doctor immediately!

If your child has the following symptoms with a fever: extreme irritability, lethargic and difficulty waking, a rash or purple spots that look like bruises on the skin (that were not there before the child got sick), infant's soft spot on the head seems to be sunken inwards or bulging outward, stiff neck, inconsolable crying, difficulty breathing which becomes rapid or shallow, the child is becoming dehydrated and a fever which persists for longer than 2-3 days.

What you can do to help your child Feel Better
For 90% of infant and childhood fevers, parents can successfully support their child at home with the following tips:

• A Sponge bath. Allow your child to play in a bath of lukewarm water or undress your baby, submerge a clean towel into a basin of lukewarm water; squeeze out the excess water and place it across your baby's forehead and/or abdomen until it become warms due to his body heat, repeat this process a few times being careful to avoid her becoming too cold and begin shivering.
  
• Encourage your baby to drink plenty of fluids. Small babies will need to continue with breast milk or formula. For the older child, offer ice lollies, clear soups, or diluted fruit juice. Many children lose their appetite, so do not be concerned if she refuses to eat.
  
• Keep your child's room at a comfortable temperature not too hot or too cold. If it is pleasant out doors, a walk in the fresh air can help cool baby down and is a good distraction for baby and you.
  
• Dress your baby in light, cotton clothing and if the weather is warm, allow him to be in nappy or underwear. Cover him or her with a light sheet or blanket while sleeping – avoid overdressing and overwrapping as it can prevent body heat from escaping and can cause the temperature to rise.
  
• Control the fever with prescribed medication. Remember that the fever has a purpose - to fight infection. So it would not be necessary to medicate the child with a mild fever. Medication (such as Paracetamol) won't treat the underlying infection but will bring a temperature down temporarily. Once the medication wears off, the temperature is likely to rise again, so it may need to be repeated 4-6 hourly if the temperature persists. Babies under three months old should not be given any medication for fever without your doctors instruction. The baby older than three months may receive the recommended dose for their age. * Never give aspirin to a child (unless instructed by a doctor) due to its association with Reye syndrome, a rare but potentially fatal disease.
  
• Suppositories (a tablet that is inserted into your baby's bottom) are a very effective, quick and easy method of reducing a high fever. Especially useful for a baby who is vomiting, who won't take medicine by mouth or spits it out.
  
• Rest and Light Activity Children with a fever will often sleep more often or longer than usual. Staying in bed all day is not necessary; allow your child to be lightly active if they feel like it.
  
• Homeopathy Aconite, Belladonna, Nux Vomica and Pulsatilla are four common remedies indicated in childhood fevers. Seek advice from a Homeopath for help selecting the proper remedy.

Remember; although it can be frightening when your child's temperature rises, fever itself causes no harm and can actually be a good thing — it's the body's way of fighting off infections.

What to Expect when your Baby is Teething
The transition from a gummy grin to a toothy smile is a very long process, taking your child up to three years to complete. Children teethe at their own unique pace, with 1 in 2 000 babies surprisingly born with teeth! Premature babies may teeth later than other children, while some babies may even keep you waiting a year before a single tooth appears, but generally, the first tooth peeks through, between 4 and 7 months of age. This calls for a celebration, taking memorable pictures and noting the date of its arrival in your child's baby book. By the time your toddler is three years old, he or she may have a full set of 20 baby teeth. Your baby might get their new teeth in this order: First the bottom two middle teeth, then the top four middle teeth, after that come incisors, the front molars and finally the back molars.

Signs that your baby is teething
Teething pain may start a month or two before the first tooth appears - as early as 8 weeks of age.
Drooling, which can lead to a rash around the mouth and chewing on their hands may be the very first signs.
Gums might be swollen, red, with little white dots on them.
Sleeplessness, fussiness, more crying than is usual, and a ‘whiney’ toddler.
Biting and chewing on anything such as the cots bars, table legs and ouch…even the breast! Whatever they can find to sink their teeth into!
Refusing food or milk.
Loose stools may be a part of teething (with nappy rash) but if there is fever, mucous or diarrhoea, you should consult your doctor.
Gum inflammation may cause a low grade fever, but if your baby runs a high fever, consult with your doctor.

Helpful Tips to soothe your baby’s gums
Cold will soothe the gums: chewing on chilled teething rings, a cold, wet washcloth cooled in the refrigerator, ice-lollies made with fruit juice, chewing chilled whole carrots, which can be gummed without the risk of falling apart and eating cold foods, like pureed apples or yogurt.
Put his dummy in the freezer and then give it to him to chew on.
Put a few frozen grapes, banana or even just crushed ice in the baby feeder mesh bag. It's a little messy, but baby will love chewing on it.
Chewing on teething biscuits and a variety of toys made of rubber or plastic.
Your baby could get quite attached to a teething blanket, so I suggest that you buy two. One can be washed while the other is in use.
When your baby can't sleep because of teething pain, you can use numbing gels to anaesthetize the sore gums, pain medications (like infant Ibuprofen) or homeopathic remedies.
Massaging his gums is another way to soothe his discomfort — after washing your hands, rub his gums gently but firmly, massaging them with your finger.
You may find your baby goes through loads of bibs with the continuous drooling.
A little petroleum jelly applied around the mouth and chin can help protect from drooling rash.

How to care for your baby's gums and teeth
Even before your baby has his first tooth, it's a good idea to get him used to you wiping his gums. Wrap a soft, wet cloth or gauze around your index finger and rub it gently over the gums at least twice a day.

One quick swipe over his tongue as well (if he'll let you) will remove the bacteria that can cause bad breath.

As your child's teeth start to appear, buy a baby toothbrush with a small, soft bristle head and a larger grip. Gently brush on both the inside and outside of the teeth twice a day. Once your child is 2 to 3 years old, a pea-sized amount of fluoridated toothpaste may be used to brush teeth.

Avoid milk feeds at bedtime or during the night as far as possible, as a baby who goes to bed with a milk bottle is at risk of tooth decay, as the sugars in the milk will eat away at his teeth during the night.

Your baby's first dentist visit should happen around the time he turns 3, unless his doctor sees a problem that needs earlier attention, or if you feel that your baby is at risk for developing dental problems.

The teething process seems to take forever and often requires a large amount of patience from you, the parent. If your baby struggles with the discomforts of teething you will most probably try all the comfort measures mentioned above, but sometimes all your baby wants when they are feeling fussy, is you! Your gentleness, while holding them can be the best soother in the world. You are irreplaceable!

Pregnancy is the time to take extra special care of your teeth and gums!

Gum and Teeth Changes
Pregnancy causes hormonal changes and increased blood flow throughout your body which affects your gums as well. This can make your teeth and gums are extra sensitive to bacteria, causing swollen, sensitive gums, which may bleed when you floss or brush your teeth. You may also notice that your mouth produces more saliva during pregnancy.

Pregnancy Gingivitis affects about 50% of all pregnant women. It is caused by bacteria that form between your teeth and gums. When you eat, tiny particles of food get stuck between your gums and teeth. These particles soon attract bacteria, resulting in red, puffy, and inflamed gums which can bleed when you are brushing and flossing. If left untreated, gingivitis can progress into periodontal disease, also known as gum disease.

Periodontal Disease is a gum infection, which can destroy the bones and fibers that help to keep your teeth in place. It can cause some very unpleasant side effects, including bleeding from the gums, tooth loss, and infection. Periodontal disease is of particular concern during pregnancy as it increases the risk for miscarriage, premature labour or having a low birth weight baby.

Pyogenic Granulomas can form if you are suffering from pregnancy gingivitis or gum disease. You may notice a small nodule or growth on your gum or palate. These nodules may bleed when you brush your teeth, they can also make it hard to speak and can cause pain when you eat or swallow. This condition usually clears up by itself after the birth of your baby, but don't ignore it if it becomes too uncomfortable. These tumors can be removed by your dentist if necessary, so talk to your dentist if the problem persists.

Tips for Healthy Teeth and Gums:

1. Tips for Brushing
If you can, brush after every meal. Otherwise, brush at least twice a day. Brushing removes plaque, a film of bacteria that clings to teeth. When bacteria in plaque come into contact with food, they produce acids. These acids lead to cavities.
Use a soft-bristled brush and brush gently. Place a pea-sized dab of fluoride toothpaste on the head of the toothbrush. Brush across the teeth gently, using a small circular motion. Continue with this motion cleaning one tooth at a time. Give your tongue a few gentle strokes, brushing from the back of your tongue forward. This helps remove bacteria and freshens your breath. After brushing your teeth for two to three minutes, rinse your mouth with water.
Replace your toothbrush with a new one every 3 to 4 months.
Switch toothpastes if you find that it triggers nausea.
Brush your teeth after vomiting if you have morning sickness or rinse your mouth out with warm water or an antibacterial mouthwash.
If you have a lot of sensitivity, try using toothpaste designed for sensitive gums.

2. Tips for Flossing
Floss daily, but if possible, floss after every meal. 
Flossing gets rid of food and plaque between the teeth, where your toothbrush cannot reach. If plaque stays between teeth, it can harden into tartar, which must be removed by a dentist.

3. Tips for Eating Right
Eat a balanced diet high in calcium (found in diary products), vitamin B12 and vitamin C. These vitamins help to keep your gums and teeth healthy.
It is also important for you to drink plenty of water.
Pregnant women often have small, more frequent meals and are not inclined to brush after these snacks. This is what increases tooth decay in pregnancy, especially if they are snacking on starchy, sugary foods such as potato chips, hard “sucking sweets”, biscuits, cakes and sugary chewing gum.

4. Call up your dentist and make that appointment!
Schedule at least one checkup and dental cleaning during pregnancy, preferably during the second trimester.
You should also see your dentist if you have swollen gums or if you are noticing blood or pus around your gum line, bad breath that doesn't go away, toothache, a broken tooth or cavity, a lump or growth in your mouth.
Ask your dentist about dental sealants which coat the top, chewing surfaces of the teeth and thus protects the tooth from decay.
Always be sure to tell your dentist that you're pregnant.

There is an old wives tale which says that you lose a tooth for every pregnancy. Taking special care of your teeth and gums, means that this will not be true for you!

What is Pre-eclampsia?
Pre-eclampsia is a condition that occurs in 5 to 8% of all pregnancies where the mother has high blood pressure and there is protein in the urine. It starts after 20 weeks gestation, in the late 2nd or 3rd trimesters although it can occur earlier. Pregnancy Induced Hypertension (PIH) and toxemia, HELLP Syndrome and eclampsia are terms related to pre-eclampsia.

Who is at risk for developing pre-eclampsia?
The precise cause is unknown but often seen in:
First pregnancies, when carrying multiple babies, teenage mothers, obese women or older than age 40.

A family history, where mother or sisters had pre-eclampsia. Women who have had high blood pressure, certain blood clotting disorders or kidney disease before they became pregnant have an increased risk.

Symptoms of Pre-eclampsia
The most common symptoms of reclaims are:
High blood pressure, abdominal pain, sudden weight gain
Excessive swelling in hands, face and other parts of your body
Protein in your urine, small amounts of urine or no urine passed. Blood in your urine
Severe headaches, dizziness, ringing or buzzing sound in the ears
Excessive vomiting or vomiting blood
Fever, double vision, blurred vision or sudden blindness

• Swelling is a normal part of pregnancy especially of the feet, but when swelling is sudden and occurs in face and hands, I suggest you pay a visit to your doctor, to exclude pre-eclampsia.

What tests can show if I have pre-eclampsia?
No one test diagnoses pre-eclampsia. Your doctor will check for signs of pre-eclampsia at every antenatal visit with blood pressure checks, weighing you, urine test for signs of protein and severe swelling. If you have signs of pre-eclampsia, your doctor may want to see you at least once a week or even more often if he suspects pre-eclampsia.

If I have high blood pressure does it mean I have pre-eclampsia?
Not necessarily. If your doctor sees that your blood pressure is high, he or she will watch you closely for other symptoms.

If I have swelling does it mean I have pre-eclampsia?
Swelling alone doesn't necessarily mean you have pre-eclampsia. Some swelling is normal during pregnancy. For example, your rings or shoes might become too tight. Swelling is more serious if it doesn't go away after resting, if it's very obvious in your face and hands, or if it's a rapid weight gain.

What are the risks of pre-eclampsia to the baby and me?
Pre-eclampsia can prevent the placenta (which gives air and food to your baby) from getting enough blood. This will reduce the amount of oxygen and nutrients to your baby. It increases the risk of placental abruption, low amniotic fluid levels and low birth weight of your baby. A few women develop a condition called eclampsia (seizures), which is very serious for the mother and baby.

What is the treatment for pre-eclampsia?
The only “cure” for pre-eclampsia, to protect both the mother and the baby is the birth of baby. This isn't always possible, because it may be too early for the baby to live outside of the womb, his lungs might not be mature enough to be born. In that situation, steps will be taken to manage the pre-eclampsia until the baby can be safely born.
These steps include:
Strict bed rest, plenty of fluids and medication to lower blood pressure.
Instructions to lie on your left side while you are resting which will increase the flow of blood and take weight off your large blood vessels.
You might be hospitalized so that you and your baby can be carefully monitored. This could even be for a few weeks until such a time that it would be safe for your baby to be born.
You may receive medication to mature baby’s lungs in the case of premature birth.
You should receive counseling on what to expect were baby to be born prematurely e.g. Neonatal ICU procedures.

If my doctor decides to deliver the baby early, will I have to have a cesarean section?
This is up to your doctor and you. A cesarean section is more likely if your health or your baby's health is in danger. If things aren't this serious, your doctor could start your labor (induction of labour) with medication, such as oxytocin which means you could still experience a vaginal delivery.

Good News about Pre-eclampsia
Fortunately, pre-eclampsia can be detected early if women have regular visits to her doctor or midwife during pregnancy and most problems can be prevented.

Packing your labour bag? What to take...
Having your hospital bags packed by 36-37 weeks in your pregnancy will give you a peaceful feeling of “I am ready and waiting to meet you, my baby!” I would encourage you to approach your labour creatively, the list below will give you many ideas on how to become an active participant in this beautiful experience…making it an expression of yourself….And yes you may not use all you pack, but the preparation and excitement is well worth it!

Ideas for your labour bag
A birth plan: Sue Allen-Mills, says, "Writing a birth plan doesn't of course make your plans happen and shouldn't, I would say, be set in stone. But, having a birth plan does help the midwife who's attending you to know what your preferences are, so that she can help you to achieve them insofar as it's possible."

• Most hospitals will encourage you to wear comfortable clothes of your own in labour, loose fitting T-shirt and dark stretchy pants for walking around in the hospital.
• A night gown, pajamas and slippers for after the birth.
  
• Warm, soft socks will keep your feet warm during labour
  
• Hair bands to keep your hair out of your face
  
• Lip-ice for dry lips in labour
  
• A bottle for ice-water or ice chips as your mouth can get so dry
  
• Watch with a second hand to time contractions
  
• Create a relaxing environment by having a variety of music you enjoy - You may need to provide your own CD Player or Tape Player or iPod.
  
• Candles; as well as your favorite fragrance of essential oils and a burner
  
• Massage tools - Oils, powder, massagers, two tennis balls in a sock make for a deep massage.
  
• Barley Bag - microwave heated; soothes back labour.
  
• TENS pain relief machine
  
• Rescue remedy will calm your anxiety.
  
• Something to focus on, for example, a favorite photo or something you love
  
• Glucose sweets, energy drinks and nutritious snacks for you and your birthing partner.
  
• Face cloth or face spray for your partner to cool your face, arms as well as the back of your neck between contractions.
  
• Birthing ball (if not supplied by the hospital)
  
• Sitting on the birthing ball is one of the most comfortable positions in labour. It encourages the opening of the pelvis; and keeps your body relaxed as it is impossible to have any tension while rocking and bouncing!.Kneeling over the ball is great if you are experiencing back labour.
  Your own pillows from home if you cannot sleep comfortably without it
  Camera, video camera, Tripod with spare film, batteries and charger
  
• You may need to request permission to film in some hospitals, so check with your Obstetrician / hospital.
  
• Cell phone and charger - Phone card & list of people to call after the baby is born
  
• List of people to call after the baby is born
  
• Toiletries, face cloths preferably dark colored ones work better
  
• Tooth brushes for mom & partner and toothpaste.
  
• Mouthwash, chewing gum
  
• Tissues
  
• A costume or top for the bath, if that would make you feel more comfortable than being naked.
  
• Change for the vending machine for your partner
  
• Diary / writing material for those that like to capture the experience in writing while it is still fresh in your mind.
  
• Underwear, underwear and more underwear!!! “Disposable underwear. Darker colours are good in case of leaks. If you buy 2-3 per day you should be covered. Don’t forget to pack a separate plastic bag to put your worn underwear in.
  
• Plastic bag for soiled clothes or underware Sanitary pads You should not use tampons after you have given birth due to risk of infection. Pack enough for about 8 a day.

Accidents in the home can happen so quickly and yet so many of them can be avoided! Here are some guidelines on how to make your home environment as safe as possible for your child as they explore their world.

Bedroom Safety:

• Do not use a crib with missing, loose or broken parts. The distance between bars should be no less than 2,5cm and no more than 5cm. Make sure that the mattress is flat, firm and that it fits snugly against the sides of the cot. There should not be a gap larger than two fingers space between the mattress and sides of the cot.
• Do not position your cot near window blinds and curtain cords as they carry a risk of strangulation.
• Always keep the drop side of the cot up when you are not in the room.
• Always put your baby to sleep on his back, with his feet at the bottom of the cot to reduce the risk of Sudden Infant Death Syndrome (SIDS).
• Once your child can push up onto her hands and knees and/or as soon as your child can reach up and touch them, you will need to remove the mobile and other toys hanging in or across the cot.
• Never put stuffed animals, pillows or heavy blankets in the cot with your infant.
• Your child is ready to move to a bed when the cot mattress is at its lowest height and the top rail is below your child’s chest when they are standing.
• Never leave your baby unattended on the changing table or bed.

Choosing safe toys:

• Until your child turns 3 years, toys should be bigger than his mouth. To determine whether a toy poses a choking risk, try fitting it through a toilet paper roll. If it can fit through, it's not safe! It should be a good quality, age appropriate toy i.e. Read the labels on toys carefully, “Not recommended for children under 3 years of age”.
• Of all children's products, un-inflated balloons and balloon pieces are the leading cause of suffocation death in children under 6 years. Keep toys with magnets and marbles away from young children.

Bathroom Safety:

• The bath water should be comfortably warm when you submerge your forearm; about 23 -24 degrees Celsius. The depth of water 5 to 7cm for babies less than 6 months and no higher than waist height for older children.
• Always begin by running the cold water in first, and then add hot water. Never run the water while your baby is in the bath. Children can drown in only a few centimetres of water in seconds, so never, ever, leave your child alone in the bath or with an older sibling, not for a minute! If you have to answer the doorbell or phone, wrap them in a towel and take them with you. Remember that bath seats or rings can not be trusted, to keep your child safe.
• Baths can be very slippery, so place a non-slip mat in the bath to prevent falls.
• Teach your child to stay seated in the bath at all times – a message worth repeating again and again until it sticks!
• Keep the toilet lid down. You might even consider securing the toilet lid with a lock, as many young children are fascinated by putting objects down toilets and soon learn to “flush them away”.
• Make sure the bathroom door closes securely or install a hook-and-eye lock above adult eye level on the outside of the door.

Kitchen Safety:

• Never leave baby alone in a high chair and secure your child in it by using all the safety straps on the chair.
• Keep a watchful eye when they eat foods such as nuts, whole grapes and popcorn.
• Do not place your baby in any infant seat or bouncers on a countertop or table. The baby’s movements can cause the seat to fall, resulting in head or other injuries.
• Keep glass, breakables, knives and cleaning products out of reach of children.
• Keep poisons, medicines and vitamins safely locked away and out of the reach of children. Remember that “child resistant” lids are not necessarily “child proof.”
• Lock matches and lighters in a cabinet that is higher than your shoulders. A drink heated to a temperature of 60 degrees Celsius can create a burn in 5 seconds and at 70 degrees a burn occurs in 1 second. Don’t carry your child while you are also carrying hot food or liquids.
• Know how to treat burns, keep the supplies in your First Aid kit and have emergency numbers at the phone.
• Use the back plates of the stove for cooking and turn the pot handles toward the back of the stove.
• Small children love to explore, so make sure that your low cupboards contain nothing that could be a danger. Never leave a bucket filled with water in or around the house.
• Keep plastic bags out of reach as they are a suffocation hazard for young children.

Safety around the house:

• Use safety gates to block the top and bottom of stairs and other dangerous areas.
• Keep chairs and furniture away from windows so children can’t climb up and out.
• Secure furniture to avoid it tipping-over.
• Use plastic plug inserts, to prevent child sticking objects or fingers into un-used plugs.
• Store tools, garden and lawn equipment, in a locked cupboard or shed.
• Know the types of trees and plant life on the property in case children ingest berries, leaves, or other plant life.
• If you have a swimming pool, install a fence with a childproof gate; that separates the house from the pool.

• Breastmilk is the best possible food and drink for a baby

• Find good support. An experienced and sympathetic adviser helps avoid or solves many common problems.

• Start to breastfeed as soon as possible after birth, as this stimulates the production of breastmilk.

• You can feed in many different positions. Whether you are sitting or lying, make sure you and your baby are well supported and comfortable, so that you can relax.

• Equally important is the position of the baby on the breast. Hold baby very close to you with his whole body and head turned towards you. Baby should be well supported, with his head, neck and back in a straight line. Baby should feel relaxed and secure.

• Wait for baby to open mouth wide. Make sure he takes your nipple to the back of his mouth. His bottom lip should be turned back against your breast.

• If your nipples hurt while feeding, your baby is more than likely positioned incorrectly, so stop and try again.

• Check that baby takes long, deep, strong, rhythmical sucks with occasional rests.

• Let baby come off the breast himself when he has finished.

• The more baby sucks, the more milk is produced. Let him suck as often and as long as he wants, including during the night.

• After feeding, pat your nipples dry and apply a thin layer of Bennetts Nipple Cream.

• You will know your baby is thriving if he is gaining weight and looking healthy. Breastfeed your baby on milk only for the first four to six months.

• After six months a variety of additional foods is necessary, but breastfeeding should continue well into the second year of a child's life.

 

Up to 30% of all new mothers in all cultures and circumstances develop Postnatal Depression during the first year after the birth of a baby. This is a clinical depression and is treatable, but untreated can become chronic. How long it takes for a woman to recover will depend on many factors, including how quickly she receives the correct help. A combination of anti-depressant medication, psychotherapy or counselling and attending a ‘Support Group’ should be used to treat the condition. It is vital that the mother receives support and encouragement throughout this very difficult time in order to get well.

Symptoms
Does this sound familiar?

“I’m so irritable and confused”
“I feel like crying for no reason”
“I feel helpless, inadequate, and unable to cope...”
“I worry all the time”
“I often feel scared and panicky”
“I feel ashamed and guilty”
“I don’t know who I am any more”
“I have no interest in anything”
“I don’t sleep the way I used to”
“I don’t eat the way I used to”
“I don’t love the baby the way I should”
“I don’t want sex any more”
“I sometimes think of hurting myself or the baby

What causes PND?

Why some people suffer from postnatal depression is not clear. Generally it is thought to be the result of a combination of factors, namely physical, psychological and social. It is often said to be ‘hormonal’, however this is not the case since fathers and adoptive parents can suffer from it too.

A combination of factors contribute to PND, such as:

• Being a perfectionist
• Lack of support
• A traumatic birth
• Unplanned or difficult/complicated pregnancies
• Financial and other stress
• Loneliness
• An unsatisfactory relationship with the baby’s father
• A previous history of depression

What helps when you’re feeling depressed?

• Don’t be fobbed off with others telling you to ‘pull yourself together’ and ‘you should be grateful…’
• Speak to someone – your clinic sister or doctor, a postnatal support telephone network.
• Speak to your partner or a close friend.
• Accept that this is not your fault.
• Ask for help from others.
• Plan for enough rest and time off.
• Drop your standards; you can’t do as much as you used to around the home.
• Join a support group where you can share this experience with others who understand how you feel.
• Take one step at a time.

FOR FURTHER HELP
Contact the Post Natal Depression Support Association (PNDSA) on :-

National Helpline: 082 882 0072
Head Office: (021) 797-4498
Gauteng Helpline: 082 373 7373
KwaZulu Natal: (031) 265-9790
Email: info@pndsa.org.za
Website: www.pndsa.org.za

• Change the nappies frequently to keep area clean and dry. Change nappy after giving a feed and as baby gets older give evening fluids early to reduce wetting at night.
  

• Wash buttocks and surrounding area with warm water on cotton wool to remove all traces of urine and stools. Soap and the perfume on "nappy wipes" can burn sensitive skin.

• Pat dry carefully.

• When possible, leave the nappy off, allowing air to get to the skin.

• Apply Bennetts Baby Bum Creme to keep baby's skin moist and healthy.

• If you use cloth nappies, use nappy liners to keep the skin dry.

• Rinse nappies well after washing to remove all traces of detergents or softeners. Try a double rinse cycle in washing machine.

• Do not use plastic pants over the nappy.

• Use disposable nappies, particularly at night when baby is sleeping for longer periods, as they keep the fluid away from the skin.

• If the rash does not settle after a few days, or is very raw and the skin broken, discuss with your clinic sister or doctor.