Treating the Toothache

Teething, like many other things “baby” has so many different suggested treatments that it can get really confusing. Are you currently struggling with a teething monster? Read my previous post to understand more of what is going on in your little one’s mouth. Do you want to know what is really worth your money and time? What is safe for baby? What really works?? I will try to answer these questions by looking at the most used treatments in more detail. If you are short of time skip down to the end to see my tips to calm your teething baby and to keep those teeth white and bright!

As I read about the history of teething, I was horrified at some of the treatments that were used in the past! Substances containing lead and mercury, opioids that caused babies to stop breathing, rubbing of alcohol on the gums (this is from the not too distant past) and even cutting into the gums to ‘relieve the pressure’ were common managements and caused more harm than good. I am wondering what our children’s children will think about the treatments we are using today…

So which medical treatments are available?

Teething gels / drops:

There are two broad groups of gels or drops that causes local pain relief:

  • Local anaesthetic (contains either benzocaine or lidocaine)

These gels / drops (Orajel, Prodol) causes numbing of the gums and tongue only for a short time (about 20 minutes) and although this could bring some relief for the irritation of the gums it may also cause more irritation for your baby. Have you ever had your gums numbed by a dentist? It is not a nice feeling. Some of these drops have a stronger alcohol-content than your glass of wine! Apart from that there is also a risk for a very serious side effect: methemoglobinaemia prevents the red blood cells from carrying any oxygen. The FDA and American Association of Pediatrics has strongly advised against the use of these gels and drops in babies.

  • Local analgesic or homeopathic gels

Some of these gels (Bonjela, Teejel) contain aspirin-like analgesics (choline salicylate) which could cause chemical burns on the gums or even add to the risk factors of Reye syndrome. Homeopathic gels could contain unknown amounts of Belladonna which could also cause severe side effects.

My conclusion would be to know what is in the gel you are using, know the possible side effects, weigh the risk vs benefit for your baby and then only use VERY SPARINGLY.

Systemic analgesia

These are safe to use at the specified dose and intervals, for not more than 5-7 days at a time. Remember that they can affect the liver and kidneys if misused, so only give when it is really necessary. Please consult your doctor or pharmacist about the correct dose for your little one as it should be calculated by weight and thus differs for different children of the same age.

  • Paracetamol (Panado, Calpol): for moderate pain and rise in body temperature
  • Ibuprufen (Nurofen): for inflammatory pain and rise in body temperature
  • Mefenamic acid (Ponstel): for inflammatory pain and rise in body temperature

As you can see all these medications treat roughly the same symptoms, so it works well to use paracetamol with either ibuprufen or mefenamic acid as you can then give analgesia more frequently while giving less of each individual drug. (Eg Paracetamol at 8am, Ibuprufen at 12pm, Paracetamol at 4pm, Ibuprufen at 8pm.) Be careful of combination preparations as you cannot work out the dose of each individual drug perfectly, and it usually contains some form of anti-histamine which is not safe to give to babies under 2years as it can have a lot of side effects.

So what should you do???,

“We have to do the best we can. This is our sacred human responsibility.”

Albert Einstein

A recent meta-analysis done in 8 different countries showed that there are some symptoms associated with teething, and yes, babies feel some discomfort and has a raise in their body temperature (NOT fever >38°C). However, when choosing what to give your baby, try to remember that teething is not a disease!

Instead of spending more money at the pharmacy, here are a few tips to try at home:

  • TLC: Tender, Loving Care. This works for anything from a broken heart to man-flu, it will definitely work for teething too. So amp up the cuddles and know that this will be over all too soon.
  • Chewing or rubbing the gums: let your baby chomp down on his favourite teether / sugar-free teething biscuit or massage his gums with a clean finger. This reduces the pain by overwhelming the pain-receptors in the gums, thus effectively blocking the pain-signal.
  • Cooling: we all know an icepack does wonders for a twisted ankle or a bump on your head. Giving your baby a cool washcloth or raw carrot to chew on also does wonders for irritated gums. Make some “breastmilk-ice lollies”, these are a huge hit for teething babes! The cold numbs the gums, and it also decreases the inflammation in the area.

“Weeping may endure for a night, but joy comes in the morning. “

Psalm 30:5 (AMPC)

The last teething-strategy I would like to address is the amber necklaces / bracelets. Although many moms have claimed that these worked for their babies, there is no scientific evidence to prove that they work better than the above-mentioned tips, and nobody can seem to prove exactly how they work. Add to that the big risk of choking or strangulation, and you can understand why the FDA and American Association of Pediatrics strongly advise parents to not use them. We all try to keep our babies away from plastic bags, peas and small toys exactly for this reason, so please do not attach something to their body that can end up in their airways!

When those little white pearls finally pop out, be sure to take good care of them from the start. We used a silicone brush that fits over our fingers from about 4months to get Eran used to the texture and feel of a toothbrush on his gums. Once the teeth are out brush twice a day with a soft-bristled toothbrush. In South Africa the water is supplemented with Fluoride, thus it is not necessary to use Fluoride containing toothpaste before 2yrs of age. While fluoride helps to protect the teeth against cavities, too much can cause spotting and weakening of the enamel of the permanent teeth. When you do start using fluoride-containing toothpaste make sure to only use a pea-sized smear. Take your little one to the dentist around their first birthday to get more advice and tips to keep those teeth in tip-top shape.

I hope this will help you to have a happier teether! Please share any other tips you have in the comments below or via Instagram / Facebook, I love to hear the creative ways you keep your little teething monster happy!

  1. Massignan C, Cardoso M, Porporatti AL, Aydinoz S, Canto GD, Mezzomo LAM, Bolan M; Signs and Symptoms of Primary Tooth Eruption: A Meta-Analysis; Pediatrics March 2016, VOLUME 137 / ISSUE 3
  2. Memarpour M, Soltanimehr E, Eskandarian T; “Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies”; BMC Oral Health. 2015; 15: 88.
  3. https://sciencebasedmedicine.org/separating-fact-from-fiction-in-pediatric-medicine-infant-teething/
  4. Tshang AKL; “Teething, teething pain and teething remedies”INTERNATIONAL DENTISTRY SA VOL. 12, NO. 5 pg48-61

The Teething Monster

In the second month of our stay in Belgium Eran had flu almost continuously for 3-4weeks. He also acquired 8 new teeth during this time! It made me wonder what to believe: all the millions of mothers who say that teething is to blame for all the fever, drooling, crying, sleepless nights and diarrhea, or the literature that says that none of these symptoms can be scientifically proven to be caused by teething. I set out to find an explanation and this is what I have learned:

Dental development already starts in the 6th week in utero, that is even before there is a heartbeat! It is very important that the mother’s diet contains enough calcium, phosphorus, Vitamin C and Vitamin D for the baby to develop strong teeth. Illnesses and fever of the mother during pregnancy can also influence the teeth in utero. The primary teeth (also called milk teeth) are already formed under the gums prior to birth. From there an amazing physiological process follows: there is bone breakdown above the tooth to form an eruption pathway, and build-up below the tooth to fill in the gap, which pushes the tooth upwards in the jaw to where it will fulfill its function. (1,2) There is no actual “cutting” of the gums, the whole process is driven by genes, hormones, growth factors and inflammatory agents which also causes some cells in the gums to break down and allow the teeth to grow through. (2)

“Watching teething babies is like watching over a thermo-nuclear reactor-it is best done in shifts, by well-rested people.” Anthony Doerr

But why do they need to get teeth so early? Teeth are already vital in babies as it contributes to a normal facial appearance, creates space for adult teeth, aids in speech development and most importantly enables a baby to chew food!

There is a huge variety of normal when trying to predict when babies will get their teeth, but there is a general order that most teeth appear in:

  • The two front teeth (central incisors) in the lower jaw usually emerge first anywhere between 6-10months, followed by the two front teeth in the upper jaw (8-13months)
  • The lateral incisors (just next to the central incisors) also appear between 8-16months
  • The first set of molars appear between 13-19months
  • The eye teeth (canines) sit in between the lateral incisors and the molars and usually show themselves between 16-23 months
  • The second set of molars appear between 25-33months

A child thus has 20 teeth by the age of 3 years. If your baby’s teeth has not erupted 6months after the norm, or if there is an assymetrical eruption that lasts more than 6 months (for example the left central incisor is present, but there is no sign of the right central incisor for more than 6months), consult your Pediatrician or dentist for further workup.

Ok, so those are the physiological facts, but does teething actually cause symptoms? Over the years many symptoms, witchery and even death was contributed to teething, but what does the science say?

Due to the increase in inflammatory agents (cytokines) in the saliva during the eruption of a tooth, I believe that a baby can have some symptoms similar to a mild flu (these symptoms are also mostly caused by your body fighting a virus with inflammatory agents). The combination of an increase of saliva and cytokines also activates the gastro-intestinal system and can change the consistency of the stools. (This explains those soft, sour-smelling nappies, but is not the same as runny diarrhea!)

A large meta-analysis looked at 16 studies from 8 different countries done between 1969-2012. (3) Overall it was found that 70% of teething babies do have some symptoms: red, swollen gums, general irritability and drooling was the most frequent. Other associations that was found with lower statistical significance was sucking of fingers, decreased appetite, agitated sleep, running nose and an increase of body temperature. These symptoms usually appear over 8 days (usually 4 days before and 3 days after the actual eruption of the tooth).

Teething does NOT cause fever (>38°C), vomiting, diahroea, dehydration or convulsions. (4, 5) The problem with blaming every symptom on teething is that more serious symptoms are ignored and potentially dangerous diseases missed. At 6 months when most babies start teething many other things are also happening in their tiny bodies. By 6 months maternal antibodies start to drop in their blood, making them more susceptible to viral and bacterial infections. Many symptoms thought to be due to teething was proven to be a viral infection causing sores in the mouth (Herpes simplex gingivitis). Babies start to explore the world around them at this age and part of the exploration is to put everything in their mouths, introducing more “germs” to their immune system. There is also a mental leap and a growth spurt around 6 months which could affect their eat and sleep routines. So before blaming teething when your baby is fussy / hot / not drinking well, please exclude and treat other causes first.

Is teething painful? This is hard to prove as each baby responds differently to pain. If you look at a “teething” 6 year old child, tooth eruption certainly does not seem painful. Yes, it does cause some irritability and discomfort, but try to remember that it is a natural process of child development, not a disease and needs to be treated as such.

“But as for me, afflicted and in pain – may your salvation, God, protect me.” Psalm 69:29

So when should you be worried? Danger signs in any baby would be fever > 38°C, severe vomiting and diahroea, dehydration, changes in level of consciousness (severe irritability, high pitched cry, very sleepy or cannot wake), abnormal breathing and convulsions. These are NOT caused by teething and should be investigated further, preferably by your GP / Pediatrician that knows your baby.

I hope that I could give you more insight into what is happening in that “tightly shut-, will not let me look or feel- mouth” of your little one, and that this knowledge will equip you the next time when you have to soothe and cuddle your teething baby.

I will discuss baby teeth care and the management of teething in my next blogpost, so be sure to subscribe to the email-list or follow along on Instagram so that you can read the follow-up too!

Which symptoms have you noticed when your baby is teething?

  1. Marks SC Jr; “The basic and applied biology of tooth eruption.” ; Connect Tissue Res. 1995;32(1-4):149
  2. Tshang AKL; “Teething, teething pain and teething remedies”INTERNATIONAL DENTISTRY SA VOL. 12, NO. 5 pg48-61
  3. Massignan C, Cardoso M, Porporatti AL, Aydinoz S, Canto GD, Mezzomo LAM, Bolan M; Signs and Symptoms of Primary Tooth Eruption: A Meta-Analysis; Pediatrics March 2016, VOLUME 137 / ISSUE 3
  4. Swann IL; “Teething complications, a persisting misconception.” Postgrad Med J. 1979;55(639):24.
  5. Wake M, Hesketh K, Lucas J; “Teething and tooth eruption in infants: A cohort study.”; Pediatrics. 2000;106(6):1374. 

To poo or not to poo…

It is amazing how many of my conversations since becoming a mom centers around feeding, sleep and poop! And when one of those are out of balance it feels like your whole life is upside down. Most of these issues do not warrant a visit to the pediatrician on own merrit, but the correct advice and understanding could improve your (and your child’s) quality of life immensly. In the next few blogs I want to address a few common issues that many of my mom-friends have asked me about. I hope I can answer a few of your questions too!

I want to continue with the “hard” topic from my previous blog, so let us talk about constipation in toddlers. Not such a big problem, all kids go through some degree of constipation at some point and they grow out of it, right? Yes, but it is not so simple. I have seen a 5 year old boy admitted for appendicitis who in the end “only” had severe constipation. It is important to understand what happens when toddlers become constipated and to be ready to treat it early to prevent long-term complications.

Toddlers are prone to constipation when they potty-train, start school or when any other life-altering changes happen in their lives. They can also just be too busy enjoying life to waste time on the loo! 😉 That first hard stools can then trigger a chain-reaction of bad experiences. Painful defecation due to large, hard stools or even anal fissures (a small tear in the skin around the anus) can cause withholding behavior and this turns into a very vicious cycle.

Withholding behavior can be anything associated with not responding to the urge to poo.  If you ignore the urge for long enough, it goes away, but the problem does not. Are you ready for the gory details?

The “urge” is triggered by the stretching of the rectal wall (the part of your colon just before the anus) when it is filled with stool. If you do not relax your anal sphincter muscles, the stools are pushed back and the urge goes away. However the rectum is still stretched, and over time becomes less sensitive to stretching when the next stool enters. The rectum’s main function is to extract and conserve as much water as possible. This is why the stool gets harder and dryer the longer it stays in the rectum. Children with fecal loading (where large masses of stool heaps up in their rectum) or impaction (where it is very difficult / painful / impossible for the child to pass the stools without help) can sometimes even seem to have diarrhea when the “newer” stool trickle past the hard stool. This can also manifest as fecal soiling (also called encopresis) where stool leak into the underwear (overflow incontinence).

So what can you do to prevent this? Or how do you treat it when your toddler already has some of these problems?

Acute treatment:

If there are any signs of fecal loading / impaction, it is important to first empty the colon to break the vicious cycle of hard, large, dry stools causing pain – causing withholding – causing hard, large, dry stools. This can be done at home or your doctor might feel it is necessary for your child to be admitted if there is a risk of dehydration.

Disimpaction is done by the aggressive use of poly-ethylene glycol (a laxative called PEG eg Pegicol / Miralax), or enemas or a combination of the two. (1)  This breaks up and softens the hard stools and enables the child to pass them. Once the colon is empty you can start with phase 2 of the treatment.

Maintenance treatment:

It is important that your toddler’s colon is “retrained” to be sensitive to minimal stretching and that the anus can relax and withhold as needed. This takes time. So it is crucial that you and any other caregivers buy into the gameplan for the next 4-6 months.

The treatment consists of a combination of laxative use and behavioural therapy. (2)

In short you need to ensure that your child passes 1-2 soft stools DAILY. (3) You become the laxative-expert by increasing or decreasing the dose as needed. The prescribed laxatives (PEG or lactulose) is very safe and is not absorbed, so you cannot “overdose” your child. It is also safe for long term use and does not cause the bowels to become “lazy” as it does not stimulate contractions of the bowels. (4) See more about the use of laxatives in babies in my previous post.

The behavioural therapy adds a crucial part of the treatment. As a child needs to learn and practise walking / talking, they also need to learn and practise a healthy toilet-routine. Start by encouraging and supervising regular “toilet-sitting” times, 2-3 times a day after meals (this is when there is a natural reflex to pass stool, so use all the help you can get). Make these toilet-sitting times fun and stress-free. Sit for 5min even if there is no poo, and just keep at it. Make sure your child has a good posture on the toilet (a squatting position opens up the pelvis and aligns the rectum in such a way that it is easier to pass a stool) and that they do not have any fears of the toilet. (For some comic relief of all this poo talk, do yourself a favour and watch this video about “The Squatty Potty“).

poop position

It is also important in the long term to address the child’s diet to increase fiber and water intake. These are important skills that you teach your children for maintaining healthy bowel habits for the rest of their life, so it is well worth the effort!

Do you have any poop-related stories to share? It sometimes feels gross and uncomfortable to talk about, but just maybe you encourage the next mom that it is ok, it gets better and there is help available!

 

 

1. Dobson P, Rogers J; Assessing and treating faecal incontinence in children. Nurs Stand. 2009; 24(2):49-56

2. Brazzelli M, Griffiths PV, Cody JD, Tappin D; Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children. Cochrane Database Syst Rev. 2011; (12):CD002240

3. Beck DE; Constipation and Functional Bowel Disease; Clin Colon Rectal Surg; 2005 May, 18(2): 120-127

4. Pashankar DS, Loening-Baucke V, Bishop WP; Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children; Arch Pediatr Adolesc Med. 2003 Jul; 157(7):661-4.

When your baby wants to be Peter Pan – weight gain problems

babaskaal

Since our little baby was born I have been acutely aware of his weight. Initially we went for weekly weight checks at our baby-clinic to determine whether he was gaining well. It is one of the few ways to determine if he was getting enough breast milk. I even went to buy a bathroom scale (something we never had), so I could get an estimate of what his weight was. Over the last 7 months I have realised I am not alone. Many of my friends struggled with babies that did not gain weight appropriately, causing stress on different levels. Every mom wants to know that her baby is healthy and GROWING, and if it all depends on milk that you cannot even see, it is easy to fall into a negative cycle of slow weight gain – anxiety – decreased breast milk production – slower weight gain – add-on feeds – decreased breast milk production – insufficient weight gain and finally changing over to formula feeding all together.

* In the end I agree it is more important that you have a healthy, GROWING baby, and if formula is necessary to achieve that then please give it, but I am at heart a big breastfeeding-fan, so I would like to help you get over this hurdle without giving up on breast milk! 😉

“Growth is never by mere chance; it is the result of forces working together” –  James Cash Penney

So what is normal weight gain and when should you worry?

During the first few days of life it is normal for your baby to lose weight. This is due to all the excess fluids that you and baby retain during the last few weeks of pregnancy and can be exaggerated if you had an epidural / spinal with extra intravenous fluids during the delivery.  Another contributing factor is the volume of colostrum. This liquid gold is very concentrated specifically to give your baby’s kidneys time to get used to working with larger volumes of fluid. It is however important to make sure your baby does not lose more than 10% of his birth weight, and that he starts gaining weight again after a few days. A term baby should reach at least his birth weight by 7-10days of age, a premature baby can take up to 14days to get back to birth weight.

There-after the general rule of thumb for a healthy weight gain is 20-30grams per day (140-200g/week) for the first 4months.  From 4-6months breastfed babies tend to gain 90-120g/week and 50-80g/week from 6-12months. It is important to understand that these numbers are calculated from the average weights of a large number of healthy babies. This means that there were babies who gained more or less than these suggested weights and were still healthy. 1,2

 

“All children, except one, grow up.” ― J.M. Barrie, Peter Pan

 

Peter PanBefore you start weighing daily or weekly for the rest of your baby’s life… remember that growth over time is more important than one good or bad weight. That is why we use growth charts to keep track of your baby’s weight gain over time. We want your baby to follow the shape of the curve (whether he is above or below the “middle” line). This allows your individual baby (who might have very tall or petite parents) to grow within a healthy margin. We as health care practitioners start to worry when your child drops from the line where he used to grow to a lower curve (percentile), or if the weight stands still, causing a flat line on your curve. Once again this should be seen in context. Your little one might have had a bout of gastro just before the weight was taken, or he might have a chronic disease or syndrome where we expect him to grow slower.

If you are worried that your baby is not gaining weight, take a step back and look at some of the other indicators that your baby is getting enough milk and is growing. Is your baby having 4-6 wet nappies per day? How many dirty nappies per day? (The stool frequency can change after 6 weeks, but before that there is usually a minimum of one stool per day). Is the length- and head-circumference measurements increasing? I have seen many babies have a growth spurt in length before the weight catches up. If your baby’s head is growing in circumference, it means his brain is getting enough calories to grow. Is it the same scale that was used previously? Is the scale calibrated?

If your health care provider is also worried about your baby’s weight gain, they should ask a thorough history, do a good clinical examination and appropriate special investigations to understand why baby is not growing well. The underlying cause is usually due to a lack of provided nutrients (baby is not latching well or has started sleeping through the night and is now missing out on calories previously provided by the night feeds), or due to a problem in the absorption of the nutrients provided (severe reflux and vomiting, allergies, certain metabolic diseases), or due to an increased use of the nutrients (acute or chronic diseases, congenital abnormalities).

It is important to understand the cause so that the treatment can be directed in the right direction. It does not help to only give supplemental feeds when the problem is that the baby is not absorbing any of his feeds. Regular follow-ups with your health care provider is very important until your baby gains weight sufficiently again.

Weight is an indicator of wellness over the last few weeks, while length shows us the wellness over months and years. If a baby does not grow well for a prolonged period of time, it may lead to him not reaching his full potential in height and other areas of his development.  There might be complications of specific vitamin and mineral deficiencies and ultimately permanent damage to the brain. Early identification and treatment may help to prevent long-term complications.3

There is a handy app that you can download to your tablet or cellphone to keep track of your baby’s growth. It helps you keep track of the weight, height and head circumference, and will also show you the child’s weight-for-length (a handy measurement that shows overall wellness).

http://get.growthapp.net/ for Iphones

https://play.google.com/store/apps/details?id=com.abqappsource.childgrowthtracker for Android.

I hope your baby will grow and GROW and GROW! 😉

We continually ask God to fill you with the knowledge of his will through all the wisdom and understanding that the Spirit gives,[a] 10 so that you may live a life worthy of the Lord and please him in every way: bearing fruit in every good work, growing in the knowledge of God, 11 being strengthened with all power according to his glorious might so that you may have great endurance and patience. – Col 1:9-11

 

Photo’s from Google Images

  1. https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/infant-growth/faq-20058037
  2. World Health Organization Child Growth Standards, 2006
  3. Perrin E, Frank D, Cole C, et al. Criteria for Determining Disability in Infants and Children: Failure to Thrive. Evidence Report/Technology Assessment No. 72. AHRQ Publication NO. 03-E026. Agency for Healthcare Research and Quality, Rockville, MD, March 2003.

The oral thrush episode…

One of my biggest mom-fails/pediatrician-fails to date must be the episode with the oral thrush…

baby-2980940_1280

‘Love never fails’ 1 Cor 13:8

I still feel really red-in-the-face when I tell this story, but it is important to share. I think we all try our very best as moms to do only what is best for baby, but sometimes the sleepless nights and hormones overwhelm us and then we need our support system to keep us on track. It is also important to know that as a pediatrician I also want what is best for your child, but we are only human and can make mistakes.

At about 3 weeks old I noticed that our baby boy’s tongue had a white patch on the middle of his tongue. I did not think much of it as we have been giving him white, crushed “Magnesium Phosphate” tablets for cramps before each feed and that left a white residue everywhere. I did not notice that the white patch became thicker and larger. At our next weigh-in the sister asked me if I saw that my baby has oral thrush… I immediately objected and told her about the tablets, but she was wise enough to show me that you cannot remove this patch with a tongue-spatula, and that it was indeed oral thrush. I was very upset, not only because my poor baby had a problem, but also because I realised that the pediatrician-me missed a very easy diagnosis! Luckily I have a very supportive husband who quickly calmed me down and reminded me that I am Eran’s mother, not his pediatrician, and as such I do not need to make diagnoses on him, I only need to love him and care for him.

Let me tell you a little bit more about oral thrush:

oral thrushIt is caused by a fungal organism (mostly Candida Albicans)1 and presents as white patches on your baby’s  tongue, cheeks and palate. This white patch cannot be easily wiped off with a washcloth as a milk-patch would be, and if it is removed it might bleed. It can be asymptomatic, but it can also cause a burning sensation in your baby’s mouth or be painful and prevent baby from drinking well.

 

It is very common in babies under one month of age, and can also affect children/adults with a defective immune system. Candida is a fungus that normally resides in your mouth/other mucosal areas together with other organisms we call “flora”, and that all form part of your microbiome. When the balance between these organisms are disrupted, then you get an overgrowth of the Candida which then causes thrush. We started washing Eran’s dummies in Milton when he was 2 weeks old, and I think this wiped out all the “good” flora in his mouth, leaving ample space for the Candida to thrive.

The infection can spread to the mother’s nipples (presenting as very red, tender or a burning sensation of the nipples, or it can cause a red ring to form around the areola), and then can spread back to the baby, so it is very important to treat both the mother and the baby. The baby also swallows the spores, and thus the infection can easily spread to the buttocks where it presents as a red rash that does not improve only by using barrier creams, affects the skinfolds and scrotum, and may have red satellite lesions.

Specific treatment with an antifungal (usually Nystatin drops or Miconazole oral gel) aims to kill the overgrowth of Candida in baby’s mouth and on the mother’s nipples. There are many more “natural” ways to regain the balance in your baby’s mouth, but these should only be used in mild cases, and if it does not resolve, rather get an antifungal. We used a mixture of 1 cup cooled boiled water, ½ teaspoon salt and ¼ teaspoon Bicarbonate of Soda to create a more alkaline environment in which the Candida cannot grow, and then we applied Miconazole gel after every feed. Within 3 days the patches improved dramatically, and within 5 days it was totally cleared up. It is important to continue using the medication for 7-10 days to make sure the Candida does not take over again.

Other measures to ensure there are no more infective spores around baby, is to wash your bras / pajamas in hot water and to properly boil / sterilize his dummies / bottle teats.

Hopefully you will do better in noticing this condition in your baby than I did… Luckily it is not a very serious condition, but we don’t want anything making breastfeeding harder than it already is in the beginning, so rather sort it out asap!

“Even on the days you feel like you are failing, look around, I promise your kids still think you are the best mom in the whole UNIVERSE.” Julie Clark, Motivating Mother

 

 

Photo’s courtesy of Pixabay and Google Images

  1. https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html

Mother knows breast – benefits of breastfeeding for baby (Part 2)

“ …A little child, born yesterday, a thing on mother’s milk and kisses fed…” Hymn to Mercury (one of the Homeric Hymns written in the 6th century), translated from Greek by Percy Bysshe Shelley.

Breastfeeding 4

Babies have been breastfed since the beginning of time. It is interesting to read about the history of infant feeding and how the role of breastfeeding has changed over the eras and according to the cultural expectations. There has always been a need for an alternative feeding mechanism (when the mother died or was very ill), and initially wet nurses were used to fill this need. From about 950-1800BC mothers often opted to use a wet nurse due to social conventions (it was hard to play cards during afternoon tea or wear the beautiful corsets if you were breastfeeding).1

Alternative milk sources have also been used with varying levels of success since early times. Initially only animal milk was used, but as food preservation became more successful, and chemistry evolved, scientists developed substitute infant foods which were advertised widely as the perfect infant food. (This perfect infant food initially consisted of cow’s milk, wheat, malt flour, and potassium bicarbonate!)1 Advertising campaigns in developing countries and directly to the general public did a lot of damage as it painted an ideal picture, and many moms chose formula- over breastfeeding.

So what did you base your feeding choice on? History? Cultural expectations? Need? Social conventions? Advertising? Social media? Your mother or grandmother’s choice? I would like to give you some facts, and then I hope you can make your choice based on love and evidence!

“A baby sucks a finger as instinctively as the breast – but the breast is better for the baby.” Martin H. Fischer (1879-1962)

Breastfeeding 3

Here are some of the benefits for your baby

Preterm infants:

A large part of my career consists of working in the Neonatal ICU, and I have seen the wonder of breast milk for these teeny tiny humans! Although the mother’s milk is the ideal, most of these benefits are also attained if pasteurised donor breast milk is used for the babies.

Short term benefits:

  • Breast milk is better tolerated by the immature bowels, and thus the volume of feeds can be increased quicker and these babies are discharged sooner from the Neonatal ICU.
  • Necrotising enterocolitis (NEC) is reduced up to 6-10 times2 in prems receiving breast milk
  • Breast milk may contain some beneficial factors to reduce the severity of Retinopathy of Prematurity (ROP).3
  • Fewer episodes of late onset sepsis4

Long term benefits: 5

  • Improved Neuro-developmental outcomes in mental, motor and behavioural aspects
  • Lower rates of metabolic syndrome (obesity, heart disease, high cholesterol, diabetes) and thus better insulin metabolism and lower blood pressures.

 

Benefits in Term, healthy babies 5, 6:

Short term :

  • Decrease the risk of otitis media (middle ear infection), and lower respiratory tract infections. I will not bombard you with statistics, but for illustrative purposes hear me out. Your baby’s risk for middle ear infection is 50% less if you breastfeed exclusively for more than 3 months, and 23% less with any breastfeeding! You can give your baby some of the benefits even if you are struggling… just try!
  • Decreased risk for diarrhoea… up to 64% less with any breastfeeding!
  • 36% decrease in the risk of Sudden Infant Death Syndrome.
  • Great for bonding as explained in my previous post, very convenient as it is free, always available, always clean, always the perfect temperature.

Long term:

  • Protective effect against allergic diseases, celiac disease and inflammatory bowel diseases
  • 15-30% decrease in adolescent and adult obesity with any breastfeeding
  • Lower risk of Type 1 Diabetes and childhood leukemia / lymphoma

These are only a few of the benefits that were researched in developed countries. In South Africa it has been found that the risk of a baby dying increases 10 times if a baby is not breastfed, due to the higher risk of poverty, malnutrition and HIV.

“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” Mat 7:11

I have used a lot of medical terms in this blog, so I hope you see my heart through the strange words. If you are a prem-mom, then you will know all the scary conditions like sepsis, NEC and ROP very well. There are many high quality studies that prove that breast milk really is the best food for your baby for the first 4-6months. Currently the World Health Organisation recommends exclusive breastfeeding until 6months, and then continuing to breastfeed until 2years or beyond to achieve the optimal growth, development and health. 7

Will you at least try to give your baby the golden liquid that your body is capable of making, even if it is only for a few months or supplemented with formula? Surround yourself with people who will support you on this journey, join a breastfeeding group and become an advocate for breastfeeding among your friends! In my next blog I will share my journey until now.

If you have any questions or comments, you are welcome to contact me and I will gladly chat with you.

 

 

  1. Stevens EE, Patrick TE, Pickler R; A History of Infant Feeding; J Perinat Educ. 2009 Spring; 18(2): 32–39.
  2. Lucas A, Cole TJ; Breast milk and neonatal necrotising enterocolitis; 1990 Dec 22-29; 336(8730):1519-23.
  3. Okamoto T, Shirai M, Kokubo M, Takahashi S, Kajino M, Takase M, Sakata H, Oki J; Human milk reduces the risk of retinal detachment in extremely low-birthweight infants. Pediatr Int. 2007 Dec; 49(6):894-7.
  4. Underwood MA; Human milk for the premature infant; Pediatr Clin North Am. 2013 Feb; 60(1): 189–207.
  5. Ip S, Chung M, Raman G, et al. Tufts-New England Medical Center Evidence-based Practice Center; Breastfeeding and maternal and infant health outcomes in developed countries; Evid Rep Technol Assess (Full Rep). 2007;153(153):1–186p
  6. American Academy of Pediatrics; Policy Statement, Breastfeeding and the Use of Human Milk; Pediatrics; March 2012, VOLUME 129 / ISSUE 3
  7. http://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/

Benefits of Breastfeeding

Breastfeeding 1

There are a few brand new babies in our friend-circle, and looking at them, I cannot believe how far my little boy and I have come on our breastfeeding journey in just 5months! I have already forgotten the difficulties of those first few days, and he is now breastfeeding like a pro!

“If we wear our nursing covers backwards like capes, then everyone can see we’re breastfeeding superheroes.”  Cassi Clark, Breastfeeding Is a Bitch: But We Lovingly Do it Anyway

Let us be honest with each other, breastfeeding is the most “natural” choice, but it is definitely not the easiest initially and it does not always come naturally to a brand new mom. As you might know, breastfeeding is ruled by two hormones: Oxytocin and Prolactin, both secreted by the pituitary gland in the brain.1 The regulation of both these hormones are very sensitive to pain, fear, stress, love, happiness and bonding with your baby. So basically, breastfeeding is “all in the mind”…

If you choose to breastfeed, make up your mind that you WILL BE ABLE TO! Your body was made wonderfully, so do not let anybody stir doubt in your mind. Surround yourself with people who will be supportive, and people who can help you when you are struggling and then give it your all. It truly is one of the best gifts you can give your baby and yourself.

“Yet You are He who pulled me out of the womb;
You made me trust when on my mother’s breasts.” 
Ps 22:9

I really want to encourage you to breastfeed! There are so many benefits for mom and baby. To help you stick it out over the long haul, I want to look at a few of the benefits of breastfeeding with you. Today I want to only look at the benefits for mom (after all, you will be doing all the hard work), next week we will look at the benefits for baby in both the short and long term, and then I will share a little bit about my own journey.

Breastfeeding 2

Immediate and Early Benefits for Mom:

  • Bonding. This has a lot to do with the hormone Oxytocin (so called “love-hormone”) that is released both in you and your baby while breastfeeding (the suckling, the close skin-to-skin contact and the eye contact  releases oxytocin, but there is also some of the hormone in your breast milk).2 Oxytocin is also released when you hug someone for longer than 6 seconds and after sex… so it is safe to say that a trusting, positive bond should develop between you and your baby.
  • Reduce bleeding after delivery.Once again… that wonderful hormone Oxytocin! It helps the uterus to contract (just like in labour) which in turn limits the bleeding.
  • Reduce stress and improve sleep. You probably know the answer by now… Oxytocin! 🙂 It makes you feel calm and produces feelings of trust, thus lowering your stress levels. It reduces cortisol, lowers blood pressure and improves digestion. This in turn is the perfect recipe for sleep, giving you a little more of a very valuable and scarce commodity in those first few days.
  • Prolong amenorrhoea and an-ovulation.Breastfeeding exclusively has the natural effect of suppressing ovulation, thereby acting as a natural birth control for up to 6 months (or as long as the woman is exclusively breastfeeding and her menses have not returned). This is not 100% fool proof and your gyne will usually discuss other methods of contraception with you at your 6 week follow-up, but it helps. And who will not take the chance to be free of “Aunt Flo” for as long as possible!

Long-term Mom-Benefits

  • Postpartum weight loss. Yes ladies, you heard right… finally something that burns fat!! Pregnancy tends to add on the kilos, but luckily we have a built-in solution. In a large prospective cohort study, Baker et al.4 showed that greater exclusivity and duration of breastfeeding was associated with greater weight loss at 6 and 18 months postpartum in women of all BMI categories. Another great reason to stick it out!
  • Reduce Type 2 Diabetes Mellitus, Metabolic disease and Cardiovascular risk. During pregnancy your body adapts in order to sustain your growing baby. Some of these changes include a mild degree of insulin resistance and changes in your lipid profile. There is some evidence for a “Reset Hypothesis”5 that happens when you breastfeed so that your cells are once again more sensitive to insulin, and that changes your lipid profile back to a healthier combination, thus decreasing the risk for chronic metabolic diseases.
  • Reduce risk for breast and ovarian cancer. According to a 2002 meta-analysis6 (a very trustworthy type of study), your risk for developing breast cancer is reduced by 4.3% per year of breastfeeding. There is also a decreased risk for ovarian cancer. It is thought that this is due to a decrease in the time that your body is exposed to estrogen (during breastfeeding this hormone is suppressed).

 

Benefits that spill over to the whole family…

(These have nothing to do with your biology or health, but believe me they play a big role in your overall well-being!)

  • It is FREE! Babies cost a lot of money, but this is one area that does not have to cost you a cent for at least 4 months. No need for bottles, formula or sterilizing equipment.
  • It is always the right temperature (no more stumbling to the kitchen to try and heat the bottle in the middle of the night)
  • It is naturally sterile! This saves a lot of time, as you do not have to wash and boil water or microwave or steam bottles and teats. In fact, the microbes that baby get into contact with during breastfeeding are GOOD for him! (More on that in the next post).
  • It is always available! If you stay out for longer than planned and baby wants to eat NOW, it is very easy to just find a quiet corner and let baby eat.

After saying all of that, I am sure you can start to understand why I am very passionate about breastfeeding. In the end however I agree that “fed is best”. I do understand that there are some circumstances where the ideal is not achievable, and I know your mommy-heart only wants what is best for your baby. The goal is to have a baby that is healthy, growing well and loved.

“Successful breastfeeding take courage, resilience, patience, and support and it always has. If your partner or support group hasn’t piled on the accolades for your heroism, then let them know you will expect oohs and has when you make it through the first two to three months (no matter how you got there) and your baby is happy and healthy — because you are awesome!” 
Cassi Clark, Breastfeeding Is a Bitch: But We Lovingly Do it Anyway

 

**** Photo’s taken by myself in multiple museums in Italy and Slovenia in 2015.

 

  1. SESSION 2, The physiological basis of breastfeeding; Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals
  2. Takeda S, Kuwabara Y, Mizuno M; Concentrations and origin of oxytocin in breast milk; Endocrinol Jpn. 1986 Dec;33(6):821-6.
  3. Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM; Breastfeeding and Health Outcomes for the Mother-Infant Dyad; Pediatr Clin North Am. 2013 Feb; 60(1): 31–48.
  4. Baker JL, Gamborg M, Heitmann BL, Lissner L, Sørensen TI, Rasmussen KM; Breastfeeding reduces postpartum weight retention; Am J Clin Nutr. 2008 Dec; 88(6):1543-51.
  5. Stuebe AM, Rich-Edwards JW; The reset hypothesis: lactation and maternal metabolism; Am J Perinatol. 2009 Jan; 26(1):81-8.
  6. Collaborative Group on Hormonal Factors in Breast Cancer; Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease; 2002 Jul 20; 360(9328):187-95.