Saturday, 17 May 2014

Rotavirus Gastroenteritis – A mothers nightmare

Wanjiku considered herself one of the lucky mothers because when her baby Wayne was born her younger sister Linda had finished form 4 and since she was not immediately reporting to college, she offered to stay with her and help with the baby. She never had to worry about how the baby would be fed, cleanliness and comfort since Linda handled this very well. This was however to change when Linda was called to college.
For some reason every house girl she received required a lot of training on basic issues like hand washing, appropriate handling of the baby’s food and literally everything around the house not to mention that the baby also had to adjust to the new girls. None of them seemed to measure up to Linda and it was getting really frustrating. So when a neighbour offered to babysit Wayne for a few days it was a big relief. This was after her fourth girl decided to leave without notice and Wanjiku could unfortunately not get permission to stay away from work.
For a few days things seemed to settle but after 3 days the neighbour informed her that Wayne had refused to eat his food and was running a mild fever. That night Wanjiku did not sleep, Wayne vomited everything he was fed and had so many loose motions. By the next morning when Wanjiku was taking the child to hospital he was immediately admitted and started on fluids. The doctors informed her that her child was severely dehydrated and if she had wasted any more time at home, she might have lost her baby. Further investigations revealed that Wayne had a rotavirus infection, which was shocking to Wanjiku as she had never heard about it. When Wanjiku called her neighbour to brief her on what was happening, the neighbour confessed that her child had also suffered the diarrhoea but it had not been severe and it was resolved quickly.

What is Rotavirus Gastroenteritis?
Rotavirus Gastroenteritis is an infection that is caused by a virus called Rotavirus. It is one of the commonest causes of diarrhoea in children and infants and tends to occur between 4 months and 2 years of age, but still affects children up to 5 years of age. During the course of the infection the child may additionally experience fever and vomiting.

The virus easily spreads from an infected person to another person through contact.
The virus is usually present in the stool of the infected child so when handling the stool of an infected child e.g. when changing their diapers, the virus may contaminate the hands of the caregiver who in turn passes the virus onto any surfaces they touch if they do not clean their hands well.
If the child is able to use a toilet or potty the surfaces may be contaminated or the child may contaminate their hands in the process. If they don’t wash their hands well with soap and water then the virus will be spread to any surfaces they touch.
When another child touches the infected surfaces or items and puts their hands in the mouth or eats foods, they get the virus into their bodies and subsequently get the infection.
The reason why the virus spreads so easily is because it can live for long on surfaces if it’s not disinfected immediately.

How to minimize transmission
  • Hands should always be washed thoroughly with soap and water after nappy or diaper change.
  • If the child is able to use the toilet or potty their hands should also be thoroughly cleaned with soap and water.
  • When a child has an infection, toilet seats and potties should be thoroughly cleaned with soap and water and a disinfectant if available, after every use.
  • Soiled nappies and diaper should not be left on the bed or other surfaces and should be discarded or washed immediately.
  • Toys, doorknobs, sinks, tables and any other surfaces at risk of contamination should be cleaned regularly with soap and water.

Symptoms of rotavirus
The symptoms of the infection may appear after about 48 to 72 hours of contact with the virus. Among the main symptoms are:
  • Vomiting    
  • Fever    
  • Large bouts of foul smelling watery diarrhoea
  • Abdominal cramps    
The diarrhoea may last between 3 and 8 days and the severity may vary depending on the child.
In certain instances when the diarrhoea and vomiting are severe and the child is unable to keep any food or drink in the stomach, the child may become dehydrated i.e a situation where the child has lost too much water from the body. This can be life threatening and requires immediate medical attention.

How would you know that your child is getting dehydrated?
  • When the child vomits every food or drink they take and is unable to retain anything.    
  • If your child has many large watery diarrhoeas.    

How would you know that your child is dehydrated?
  • If the child does not passing any urine for a period of six hours.    
  • If your child is crying and no tears are running down their eyes. The eyes may be sunken in severe cases.   
  • If the child’s mouth and tongue appear dry.    
  • If your child appears very weak and lethargic or very irritable.    
  • If the child’s hands and feet become cold.
  • If your child sleeps for too long and struggles to wake up during the course of the illness.

These symptoms require immediate medical attention and if you suspect that your child is getting dehydrated you should immediately take the child to the hospital.

How is rotavirus diagnosed in hospital?
A small sample of your child’s stool is collected and sends to the laboratory for analysis, which reveals the presence of the rotavirus in the stool.
How is rotavirus treated?
Because this is a viral infection there is no specific drug treatment for the virus.
Antibiotics and antidiarrhoeal drugs that may be used to treat other forms of diarrhoea have no role in the management of children with rotavirus.
The goal of treatment is to ensure that the child does not get dehydrated.

While at home:
  • Encourage the child to drink as much fluid as possible so as to replace what they is losing in the diarrhoea.
  • If the child is vomiting, give small amounts of fluid regularly to encourage it to stay down.
  • If the child is breastfed, encourage them to breastfeed more to compensate dehydration.  
  • Change your child’s diaper or nappies immediately after they get soiled and keep the child comfortable.
  • If your child develops a nappy rash because of the frequent diaper changes, you can apply a nappy rash cream to soothe and heal the sore buttocks.
  • Use cotton wool and warm water to clean the baby to minimize irritation.

In hospital:
The management of your child will depend on the severity of the illness and the degree of dehydration. Your doctor/nurse will prescribe treatment depending on their assessment.
  • If your child is mildly dehydrated, your nurse or doctor will advise you on the quantity of appropriate rehydration fluid to give your child.
  • You will be advised to encourage your child to drink the rehydration fluid as tolerated.    
  • If the child is unable to drink you may be advised to give the fluid with a cup and spoon.
  • If the dehydration is severe your doctor might advise that your child be admitted and started on a drip. This is a fluid containing different salts that is infused into your child’s body through the vein.
  • In other cases your doctor might recommend that a tube called a nasogastric tube is put through your child’s nose and goes directly into the stomach. This tube is used to give your child the rehydration fluid when they are completely unable to drink.    
  • If your child has a fever the doctor might prescribe a drug to control the fever.
During this time if the child is breastfed they should continue breastfeeding as normal.
If the child eats encourage them to eat small quantities of food as tolerated and resume to normal feeds as soon as it is possible.
Parents are discouraged from giving fizzy drinks like sodas and citrus fruit juices because these can irritate the stomach and worsen the abdominal pain normally experienced.

How to prevent rotavirus.
  • It may not be completely possible to prevent rotavirus however vaccines have been produced and are given to children from the age of 2 months.   
  • The vaccine may not stop a child from acquiring the infection but it is said that vaccinated children get a less severe form of the infection.

    Attribution: Avallain Ltd

Friday, 16 May 2014

Complementary Feeding - How to successfully wean your baby


Hot chocolate, ovaltine and cocoa drinks, fenugreek and dill seeds, moringa and other herbs are some of the elements that constitute many mothers’ diets in the first six months after the birth of their babies. This is not to mention the jugs of porridge and bone soup, black beans and traditional vegetables that they have to take religiously all in a bid to increase their breast milk and ensure their little ones have enough to drink. So when the babies hit the 6 months mark it’s a period of celebration for most mothers not just because they have exclusively breastfed for 6 months but also because they no longer have to worry about the quantity of breast milk they have since the baby is now allowed to take a little more than just breast milk. The mother no longer has to be overly concerned about what they eat and of course, the extra weight that comes from eating all manner of food, can now be shed.

It is indeed a major milestone that however, brings in new challenges because the breast milk is no longer adequate for the baby and the mother has to start complementary feeding. While on breast milk the mother would never have to worry about preparation or whether the nutrient value of the milk was adequate, because the breast milk comes ready to drink meaning no preparation is required except warming and it is nutritionally whole with the full complement of nutrients that the baby requires for growth and development.

The transition to family food by complementary feeding is critical because if it is not done in the right way, the growth of a baby who was flourishing on breast milk could be slowed and in some circumstances the baby growth can be stunted. Poor food handling during this time can result in infections like diarrhoea that further affect the growth. Hence, a lot of caution has to be exercised during this period to ensure that the gains made during the period of exclusive breastfeeding are sustained.

What is complementary feeding?

Complementary feeding is the introduction of food to a baby’s diet in addition to the breast milk. It is recommended that complementary feeding begins from six months of age up to 24 months so as to ensure that the baby receives adequate nutrients to continue growing strong and healthy.

Before six months of age, the mother’s milk in combination with the babies nutrient reserves stored in the infants body when he was growing in the uterus, are usually adequate to meet the nutritional requirements for optimal growth. However, by six months of age, the baby has used most of the nutrients that had been stored and needs extra.

The other reasons why complementary feeding should commence at six months of age is that the babies’ growth and development is very rapid at this age, hence, they require additional nutrients to sustain adequate growth and development during this period. Also their digestive system has matured adequately to be able to digest other foods apart from breast milk.

The quality and quantity of food

It is critical that complementary feeding be practiced in a manner that ensures that the quality and quantity of food the baby receives is adequate to sustain optimal growth and development. The nutritional value in the food being given to the baby has to be adequate. In this regard, the baby should receive food from all the classes i.e proteins, carbohydrates and vitamins.
The frequency of feeding should be optimum i.e., the food should be introduced gradually beginning with around two feeds a day and gradually increasing to whole meals and snacks like the rest of the family.

The consistency of the food should be carefully changed as the child grows i.e., the food should not be too thick or too thin. Large sized shaped pieces of food should be initially avoided as they can easily choke a child. The variety of food provided during this period should be adequate to cover the child’s nutritional needs. Avoid giving the child only one type of food.

As a way of maintaining optimum quality, parents should ensure that the risk of food contamination is minimized. In order to reduce the risk of infection to the child, the caregiver should prepare and give the food in a clean environment and observe simple measures like proper hand washing before handling the baby’s food and thoroughly cleaning utensils used by the baby.

How do you encourage the baby to feed?

The transition from breastfeeding to eating may be challenging to most babies and effort needs to be put into making the process easier. It is important to make the process as smooth as possible so that the baby can easily adapt.

The caregiver should be sensitive to the child’s cues for hunger and respond appropriately. Do not let the child cry for food before they’re fed. Feeding the child when they’re too tired or sleepy limits the amount of food they can take. The food should be at the correct temperature, a baby may find it difficult to eat food that is either too hot or too cold.

The baby should not be forced to feed and neither should they be punished even if they’re reluctant or fussy feeders. The caregiver should be patient and encourage the baby to feed. The baby should be allowed to take all the time they need without being rushed. It’s okay for a baby to play in between feeds as long as they continue to eat.

The baby should be engaged by talking to them and complimenting them as they feed. Positive reinforcement will motivate them to eat more. Distractions should be minimized. If the caregiver becomes harsh, the baby might resent feeding and this will ultimately affect their food intake and growth.
Ultimately the caregiver should ensure that the feeding experience is interesting and happy otherwise the baby may develop a negative attitude towards feeding altogether hence compromising their growth and development.

It is recommended that the feeding is commenced gradually and slowly increased as the baby grows:
  • Between 6 and 8 months: the baby should be fed 2 to 3 times a day.
  • Between 9 and 11 months: the baby is fed 3 to 4 times daily.
  • Between 12 and 24 months: the baby is fed 3 to four times with additional nutritious snacks in between meals.

Food preparation to a big extent determines the ease with which a baby will take food hence, caregivers should be careful to ensure that the food is appropriate for age and time.
High standards of hygiene should be observed when preparing the baby’s food. Care should be taken to ensure that hands are always washed with soap and water before handling the food and before actually feeding the baby. Fruits and vegetables should always be washed before preparation and the baby’s utensils should be thoroughly cleaned.
It is recommended that parents start their children on food that is easily available and affordable in their local setting since this will ensure that the baby’s food is always fresh. Cooked food should be preferably used in a day because storing for future use risks the food being stale.
While it is important to ensure that food is tasty, it is recommended that the use of salt and sugar is minimal. Spices and herbs should be initially avoided until the baby is ready to take family food.

How to introduce food
One food should be introduced at a time to allow the child to get used to it and also for observation of allergies and tolerance .i.e, do not introduce two different types of food at the same time.
The texture of food should gradually change from semi-solid food to solid. By eight months babies can eat finger food and by one year most babies can comfortably eat the same type of food as the rest of the family.
The variety of food should also gradually change and increase as the child grows i.e, alternate different proteins, carbohydrates and fruits at different meals to get a good range of nutrients.
If the locally available foods are not adequate in meeting the nutritional needs of the child, then fortified foods should be considered to avoid the risk of malnutrition.

There are common challenges while introducing complementary feeding such as lack of knowledge on the appropriate food to feed the child - many parents do not have access to professional advice on complementary feeding hence they rely on information provided by relatives and friends which may not be adequate. As a result the quality of food is compromised:
  • Foods provided may be lacking or have insufficient quantities of essential nutrients including minerals and vitamins.
  • The variety of food provided is too little and the baby gets bored and refuses to eat.
  • The consistency of the food is inappropriate for their age hence difficult for the child to feed on.
A lot of working parents are unable to stay at home with their babies during this time because of work commitments hence, the children are left with caregivers who may not adhere to recommended practices like hygienic food preparation and proper cleaning of utensils.
Competing economic priorities may be another challenge. A very small portion of the family budget is allocated to food for the child because of other pressing needs.

Breastfeeding should not be stopped during this period. Breast milk is still important in
ensuring the babies get adequate nutrition hence should be continued as food is gradually introduced.

The period between 6 months and 24 months is very critical for babies because there is rapid growth and development and if the nutritional needs are not adequately met this time, the baby can become malnourished and affected for the rest of their life.
Malnutrition experienced in the first two years of life is majorly due to poor complementary feeding practices and can have long term irreversible consequences because the brain and body development being affected.

The long term consequences of malnutrition at this age include reduced future learning abilities, reduced ability of the body to fight infection and reduced economic output. Children are most vulnerable to illness during this period because of the risk of infection during the introduction of food and handling of food hence, a lot of caution should be exercised during this period.

Attribution: Avallain Ltd 

Tuesday, 13 May 2014

Infatile Colic – A mothers nightmare


Mary had gone through a successful delivery and enjoyed all the attention she received after the arrival of her bundle of joy. The nurses were always at hand to help with the baby as she entertained her visitors who streamed in to congratulate her. They would take the baby to the nursery when she cried and only brought her back when she was calm, changed and well fed. When she went home it was all bliss until one night 2 weeks down the line when they were all startled by the baby’s sharp crying. She had been fine the whole day and had been put to bed as usual. Mary panicked and called her neighbour. They tried to soothe the baby but nothing worked. After about 30 minutes of non-stop crying, Mary and her husband drove to the hospital. All the while the baby was crying. When they got there, two hours later, the baby just passed a bowel motion then went quiet and slept.
The baby was examined at the hospital and was found to be fine. This was a big relief for Mary and her husband. The doctor reassured them and discharged them home indicating that the baby might have colic. For the few weeks that followed, Mary had to deal with this situation until her baby was 4 months old.

What is colic?
Colic is a term that describes a situation where a baby cries inconsolably for a particular duration of time, usually around three hours. The baby would normally cry around the same time every day and for more than 3 days in a week. In addition to this, colic is associated with the following situations:
  • The baby is otherwise healthy, well fed and adding weight appropriately.
  • The crying is usually sudden with no obvious association.
  • The baby usually cries louder than they normally would and all strategies to sooth and calm the baby down, don’t usually succeed.  
  • The infant may actually sound like they are in pain and remain irritable and fussy.
  • The baby with colic commonly calms down after passing a bowel movement or gas and goes back to sleep peacefully leaving an exhausted mother.

What causes colic?

There are several myths that try to explain the causes of colic, treatment and management. In most Kenyan communities children are named after their grandparents or other deceased relatives and it was commonly believed that if the ancestors were not happy with the name a baby was given the baby would cry inconsolably until the name was changed.  
It is also commonly believed that babies cry to manipulate their parents. Some babies are believed to be spoiled and want to be carried all the time hence the crying. It is also commonly believed that baby boys cannot get satisfied on breast milk alone hence require substitution very early.
It is not clear what the exact cause of colic is however it is believed that colic is associated with the inability of the baby to expel the air trapped in their gut during feeding. It is also believed that the premature guts get irritated by certain components in mother’s milk and elimination of the same may improve things for the colicky baby.

Management of colic.
It is recommended that different strategies be used in combination to manage colic with the main aim being reducing the infants crying and helping the family to cope during this period. Here are some of the things you can do to help manage colic:

  • Burp the baby immediately after feeding. If the baby is bottle fed and drinks a lot of milk you could burp him half way through the feed.
  • Alter your diet to minimize foods associated with excessive gas production, these include cabbage, beans, broccoli or peas.
  • Cut on dairy products, nuts and eggs. These foods are associated with allergy and some babies with colic appear to improve when they are eliminated from the diet.
  • Some studies suggest that formula-fed babies with colic improve when their formula is changed to a hypoallergenic formula or soy-based formula. The results of these studies are inconclusive and you need to consult your healthcare provider before changing.
  • Parents often get distressed when their babies get colic and therefore need support. Parents should get help with the baby during this time to minimize the fatigue and anxiety experienced when the baby is crying.

It is advisable that parents visit a hospital to have all other possible causes of excessive crying ruled out.
Medication like simethicone and herbal remedies like chamomile and fenugreek are sometimes recommended but there isn’t adequate scientific evidence to prove that they work.

During the crying episode
  • Be calm and patient, this will help in coping with the situation.
  • Make sure that the baby is dry, try to breastfeed in case the baby is hungry, keep the baby warm and put them in a comfortable position. These are common causes of baby’s crying just for the sake of it.
  • Other strategies that appear to soothe babies include walking around the house, gently rocking the baby, playing some music or changing the environment. Different children respond differently to all this so a mother should find what works best for their child.

What to avoid
  • Do not give your baby any medicine to make them sleep as it may be harmful.
  • During the crying episode do not violently shake the child as this may injure the child.

Be sure to seek immediate medical help if:
  • You suspect that the crying could be a result of injury.
  • The baby appears lethargic, has reduced consciousness and/or becomes very irritable.
  • The child refuses to feed for hours and there is reduction in the amount of urine they pass.
  • The baby has a fever of above 38.0 degrees.

Outcome of colicky babies
  • Colic spontaneously resolves when the baby is around 4 months of age and the child does not suffer any deficits associated with the condition later in life.

    See for more information of newborn related problems.

    Attribution: Avallain Ltd