Blog

What is normal, what is not? Parenting is a mammoth task, and brings with it a lot of uncertainty as to what is actually within the norm, and what may need more urgent attention. I shall therefore attempt to sketch a picture of what is considered normal, with initial focus on the first few months of life, which are particularly panic-provoking! This includes a few words on the dreaded “C-word”…Colic. I shall then go through system by system what may go wrong and when to seek help. As a paediatric allergist, I have a particular interest in allergy prevention strategies, hence shall attempt to dispel a few myths and iron out some truths about what we can do to reduce allergies in the offspring. What is normal in the first few months? The first few months of parenthood are particularly tough as you take full responsibility for a precious but needy little baby, and have to function on minimal sleep. My advice: accept all the help you can, don’t set your expectations too high, and don’t expect your baby to fit into a mould! This is “survival time” for all- the enjoyment of parenthood will come! For the first 3-4 months babies’ brains and tummies are still very immature. This time has been dubbed the “fourth trimester.” The baby is not yet able to manipulate you hence it is not really possible to “spoil” a baby during this time. However, routines can be established from an early age and it is useful to try have a baby in some kind of a routine of sleep, feeding and play by 12 weeks or so if possible. The predictability of a routine helps you as well as other caregivers as well as your baby. Remember to be flexible and especially adaptable at times of travel, sickness and immunisations when the routine may be disturbed for a while. The first few months are vital for establishing a bond with your baby and a relationship of trust- the baby needs to know that “warmth and food and cuddles will come my way when I need them.” Remember that it is normal for a baby to cry as it is its only way of communicating. Crying increases from an average of about 1 hour a day at birth to 2-3 hours a day at 6 weeks, then slowly decreases again to about 1-2 hours a day at 3 months. Remember this “crying curve” when you are tearing your hair out at 6 weeks post birth! Gripes and Groans in the first few months The immature gut during the first 3-4 months means that most babies have gripes and groans to varying degrees. “Colic” by definition is excessive crying of more than 3 hours a day, more than 3 days a week, typically from 2-3 weeks until 3-4 months of age. Truly colicky babies by definition are thriving and usually have a pattern of an unsettled period, typically (but not always) in the early evening, when they cry inconsolably and may draw their legs up in discomfort. Although the specific cause of colic is rather mysterious, the general feeling is that it may be caused by an immature gut and immature nervous system (oversensitivity). Colic does not cause long term harm or distress to the baby. Simple measures such as winding the baby carefully, holding them upright with gentle pressure on the tummy, movement, driving, “white noise”, wind drops and probiotic drops may be useful. More potent colic mixtures can be sedating hence should be used sparingly only for “crisis” times once or twice a day after discussion with your clinic sister or doctor. Individual colic “medications” do not have a great success rate, and each one may work in only about a third of patients. Therefore, if they do not make a difference after a week or 2, stop them. Time is the great healer for colic, but this is hard to accept when you have a little baba crying 24/7! Some cases of excessive crying and discomfort may be caused by reflux of acid and milk into the throat, lactose intolerance and cow’s milk protein allergy. Please discuss concerns of with your clinic sister and doctor, especially if there is excessive vomiting, constant crying, inadequate weight gain, severe nappy rash, or chestiness. On that note, most babies vomit as they have an immature valve at the top of their stomachs which lets milk go up again. This is normal. Vomiting, in fact, only peaks at 4 months. However, if the vomiting seems excessively painful, the baby back-arches a lot, refuses to lie on the back, and is extremely miserable after feeds or fusses excessively during feeds, reflux “disease” should be considered and discussed with your healthcare practitioner. Stools During the first few days of life the baby passes meconium, which is a black or dark green stool of “marmite” consistency. After a few days, stools change. Breastfeeding stools are normally mustard yellow with white “seeds” of curdled milk. Breastfed babies have a wide variety of stooling habits. In the first few weeks they tend to pass stool after most feeds. After a few weeks they settle into a pattern which is widely variable: from 7-8 stools per day to one stool per week- this is all within normal limits. Babies on predominantly formula feeds should ideally pass stool at least once a day. Babies often groan and strain and become red in the face when they are passing stools- this is normal unless accompanied by painful crying. If you are concerned about constipation- (if stools are infrequent or unusually hard or painful to pass) please consult your doctor. Sleep Sleep is always an issue in families with young kids. We won’t go into detail here as every child and family is so different. Don’t expect miracles before 6 months- the young baby is programmed to require night feeds which can be normal until 8-9 months of age. Thereafter, demanding a milk feed is usually not a nutritional issue but a comfort “prop” to help them fall asleep again. Teaching a child to self soothe is an important tool to impart on your young one and can be done from about 4 months of age. They may need a comforter such as a special blanket, soft toy or dummy (or a combination of these) to help them fall asleep. Babies are generally reasonably easy for the first 10 days or so then may become more difficult as colic and wind sets in. Their sleep requirements are high (about 16 hours a day in total for the first few weeks), gradually settling into a pattern of approximately 3 naps per day by 3 months of age. If possible, some naps should be more than 40 minutes long to provide restoring sleep. At night time they will continue to wake 3-4 hourly for feeds for the first few weeks; by 3 months there is often a longer “stretch” of sleep during the night of 5-6 hours. Remember that the safest sleep position for your baby is on the back. The “back to sleep” campaign in the UK has seen the rate of cot deaths halve over only a few years. If the family is really not coping with the interrupted nights, or if there is a sudden change in sleep pattern, it is worth having the child looked at to make sure there is not a physical ailment disrupting the sleep. The routine and feeding pattern should be examined to make sure the daytime sleep and feed requirements are being met. There are a variety of forms of sleep training available, from controlled checking to gentle gradual separation techniques- please discuss with your clinic sister or doctor before embarking on these. If a child is unwell or going through a stage of separation anxiety, it is not a good time to sleep train. Remember that “this too shall pass” and that most children- even the worst initial sleepers- sleep very well by the age of 5 or 6 years. Feeds Initial feeds should be 3-4 hourly during the day, and on demand at night. Some babies only manage 2 hours in between feeds initially- this should stretch once they are able to drink more at one time. Breastfeeding is ideal for babies for several reasons including cost, convenience, allergy prevention and to boost their immune systems. The clinic sisters have vast experience with breastfeeding, please consult them for advice if you are battling. However, not all mothers manage to breast feeds or have insufficient milk- nothing to feel guilty about. There is a vast choice of formula milks and the approximate volume that a baby needs for the first few months is 150 mL milk per kg per day (divide this volume into the number of feeds per day). For example, a 4 kg baby on formula milk who feeds 3 hourly needs approximately 150 x 4= 600 mL per day; ie approximately 75 mL per feed every 3 hours. (8 feeds per day) Some babies need less milk, some need more- the best way to judge is by their weight gain. For this reason we plot babies’ weights on the growth chart regularly to make sure they are not falling off the growth curve. Babies lose weight during the first few days of life- loss of up to 10% of their birth weight is normal. The baby should regain its birth weight by 2 weeks of age. After that, for the first 3 months or so weight gain should be between 150-350 grams per week. After 3 months it slows down somewhat. Solids can be introduced any time from 4 months (17 weeks) onwards. Throughout the first year of life milk is the most important component of the infant’s diet, and even on 3 solids meals a day, during the first year the infant requires at least 450-600 ml milk per 24 hours. After the age of one, milk can be cut down gradually to 300-500 mL per day- overfeeding with milk after a year of age will interfere with an appetite for solids and may lead to problems such as anaemia. From about 14 months or so many toddlers notoriously go through a fussy eating stage-their growth curve naturally slows down and the world around them is SO much more interesting than food! It is therefore important to try and introduce a great variety of foods to the toddler before the fussy stage begins. Developmental Milestones Every baby develops at a slightly different pace, but generally the sequence of development is similar. Stimulation of a baby’s development will be covered by my colleagues. As soon as the baby starts fussing and seems fed up, stop with the stimulating process so that they can calm down in preparation for the next nap. Below are basic milestones typical at different ages. Remember each child develops at a different pace, and individual babies may be advanced in a certain area e.g, grabbing and mouthing yet a bit slower in other areas e.g. sitting/crawling. If your child is lagging behind significantly please consult the paediatrician: the sooner delays are picked up, the quicker we can intervene to find a diagnosis and treatment. Developmental milestones Age Gross Motor Skills Fine Motor Skills Hearing and Language Development Visual Development Personal/Social Birth Very little head control Hands are closed and grasp reflex present Startles to loud noises -Eyes close in response to bright light -Best distance of vision is about 30 cm away -Black and white vision Cries 6 weeks Moderate amount of head control -Can make tight fists -Places hands in mouth -Responds to sounds by calming, startling or crying -Starts making cooing sounds May follow slow moving objects through 90 degrees Begins to smile in response to familiar face or voice 3 months -Very little head lag -Can lift upper body and head when lying on tummy -Leg kicking and stretching -Standing reflex develops (pushes down on a surface with legs when held up) -Hands held loosely -Inspects hands and grasps objects that are place within hands -Can bring hands together -Recognises and responds to parents -Coos and gurgles -Blows bubbles Follows objects moving up to 180 degrees in the field of vision -Smiles spontaneously -Develops facial expressions to show basic emotions -Recognises mother’s face and scent 6 months -Supports head well -Can support upper body with hands when lying on stomach -Sits with support -Can roll over -Reaches for and grasps objects -Places objects in mouth -Transfers objects from hand to hand -Responds vocally when spoken to -Uses sounds such as squealing or laughter to express emotions -Uses repetitive monosyllabic sounds like bababa Can move eyes in all directions Recognises toys 9 months -Sits without support -Crawls on stomach and then on hands and knees -Starts to pull body into a standing position -Can pick up, shake and drop small objects -Grasps food and places in mouth -Holds a bottle Begins to point Starts imitating sounds -Stranger anxiety- Knows and trusts a limited number of caregivers -Recognises own name 12 months -Cruises around furniture -Starts to walk (walking may take up to 18 months) -Begins to throw objects -Good pincer grip -Holds 2 objects and bangs together -Still mouths a lot -Speaks 2-3 words -Makes sounds at toys Picks up tiny things from the ground -Searches for hidden or fallen toys (0bject permanence) -Waves goodbye, - points -Shakes head 15 months -Walks steadily -Starts to climb Stacks 2- 3 blocks Speaks 3-4 words -Has temper tantrums when frustrated -Becomes attached to a soft toy or other object 18 months -Walks steadily. -Runs -throws ball underhand -kicks -Scribbles -Stacks 3-4 blocks -Speaks 6-8 words -May have some 2 word phrases As above -Starts to use fork and spoon -“reads” picture books on his own 24 months -Runs -Jumps with 2 feet -Walks down stairs one foot at a time -stacks 6 blocks -scribbles -may still use both left and right hands to draw -Names at least 6 body parts -Uses 2-3 word sentences -Half of speech understandable -Starts to learn some colours Adult visual acuity -Asks “why?” -Begins to show interest in playing with other children but finds it difficult to share. Play is often in parallel -Helps with dressing -Uses fork and spoon 30 months -Jumps easily -Balances on one foot for a few seconds -Walks down stairs with alternating legs -Draws vertical line and circle -Pencil grip starts to develop -Handedness becomes evidence -Able to name some colours and shapes -2-4 word sentences -Able to recite name -Able to brush teeth with assistance -Washes and dries own hands 36 months -Hops on one leg -Rides a tricycle -Copies a circle -Shows definite handedness -3-4 word sentences -Able to follow 2-3 word commands -Starts to play with other children -can name a friend -Able to help with dressing Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town

Illnesses system by system Most babies contract recurrent minor illness within the first 2-3 years of life when their immune systems are immature and all the bugs they encounter are “new” to their systems. Babies in crèche/daycare and babies with older siblings are exposed to more bugs and tend to get sick more frequently. Do not be surprised if the child has 5-10 minor infections (eg common colds) per year in the first 2-3 years of life. In addition, every cold may last 1-3 weeks so it can feel as if your baby is “always sick.” Remember that children have a higher breathing rate than adults (30-50 breaths per minute can be quite normal for young children, compared with 16-20 in adults); they also have a higher resting heart rate (90-150 beats per minute), which is increased even more when they have a fever. Coughs and colds/Respiratory illnesses Snuffly noses and wet coughs are usually caused by the common cold virus, which lasts 1-3 weeks, and for which there is no specific treatment. Keep the child comfortable with saline nose drops, paracetamol if needed, frequent small feeds and lots of hugs. Children are often “grumpy” or “difficult” when they feel unwell, and often that is the first sign of a viral illness Ask your doctor about doses of fever/pain medication that need to be given. An example of commonly used fever medications are: Paracetamol (eg calpol syrup, panado syrup- NOT infant drops): 0.6mL per kg body weight 6 hourly, eg For a 5 kg child: Panado syrup 3 mL 6 hourly; for a 10kg child 6 mL 6 hourly Ibuprofen (e.g. Nurofen syrup) : 0.3mL per kg body weight 6 hourly. e.g for a 10 kg child: Nurofen syrup 3 mL 6 hourly We do not recommend over the counter cough or flu medicines or sedatives for young children except if advised by your doctor. Not every snuffle needs a doctor’s opinion; however please see your doctor if the child is: - feeding poorly - has a high fever (> 38 degrees in the first 6 months and > 38.5 degrees after that) - is unusually lethargic or irritable - is breathing fast (more than one breath per second/60 breaths per minute; especially if you have already controlled the fever) - has a wheeze when breathing out (often bronchitis or asthma) or a “whoop” when breathing in (usually croup) - is not “getting better” after 5 days or (they may have developed a secondary bacterial infection such as a middle ear infection or tonsillitis). Tummy bugs/Gastroenteritis The most common cause of an upset tummy is a viral gastroenteritis; these viruses are very catchy and often pass through the family. Typically, they present as vomiting for a day or two, followed by diarrhoea for 3-7 days. Of course there can be many variations of this pattern. Keeping the child hydrated is the most important management step, it works best by feeding them fluid little and often. If they are drinking and active despite runny stools, they are coping well. Relax about solids while the child has gastro- fluids are much more important. Commercially available rehydration solutions are best, if your child refuses those try some diluted apple juice or even milk if all else fails. If the diarrhoea lasts more than a week, you may need to try a lactose free diet (eg lactose free formula, reduce dairy in the diet) for the child a week or two while the tummy settles. Consult your doctor if: The vomiting is persistent and the child can’t keep any fluids down The diarrhoea is very frequent (> 10 stools a day) or has blood in it The child looks drowsy or is very lethargic as they may be dehydrated The child has a high fever or a rash. Rashes Rashes are very difficult to self- diagnose so a prompt visit to your doctor is justified if you are not certain of the cause. Some rashes are part of a harmless virus (usually pink spots that fade if you apply pressure to them and are non-itchy); some are the very common, such as seborrhoeic dermatitis (cradle cap) rash in the first few months of life (scaly rash on face and upper body, typically non itchy). Consult your doctor if: The rash is accompanied by a high fever or the child is very unwell The rash consists of red spots which do not fade when you press a glass on them (this may be the dreaded meningitis rash) The rash is itchy (this may be eczema which should be treated promptly) The rash is getting worse with time Other illnesses A child with a high fever and no obvious source of infection (like a runny nose), may well have a flu-like illness (often other members of the family are also unwell), but always seek medical attention if the child is: Very irritable (meningitis and urine infections will need to be excluded) Has respiratory distress or unexplained rashes The illness “Roseola” typically presents with a high fever and irritability for 2-3 days, followed by a rash once the fever settles. Very often the child will have incorrectly be placed on an antibiotic while they have a fever (the throat may also be red), and when the rash appears it gets misinterpreted as a reaction to the antibiotic! Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town

The optimal timing for cord clamping after birth has been the subject of controversy and debate for decades. But what does the research say? At the beginning of the 1950's, early clamping was defined as clamping of the umbilical cord within one minute of birth, and late clamping, defined as clamping more than five minutes after birth. Today cord clamping is usually performed within 15 to 20 seconds after birth – unless otherwise requested. There have been many studies and reviews done to evaluate the benefits of delayed or late cord clamping and yet no ideal time period has been established. WHAT THE RESEARCH SAYS Several systematic reviews have suggested that clamping the umbilical cord in all births should be delayed for at least 30 to 60 seconds. The infant should also be maintained at or below the level of the placenta because more of the blood in the placenta can then flow into the baby’s body before clamping. This increases the baby’s blood volume, reducing the need for blood transfusion, decreasing the incidence of intracranial haemorrhage (bleeding in the skull) in preterm infants, and less incidence of iron deficiency in term infants. Some studies of blood volume changes after birth were done by researchers in Sweden, United States, and Canada, and it was reported that in healthy term infants, more than 90 percent of blood volume was achieved within the first few breaths the infant took after birth. Because of these findings, the interval between birth and umbilical cord clamping has begun to be shortened. Especially in wealthier nations it is common practice to clamp the baby's umbilical cord less than a minute after birth. However, a recent review of published studies, (Cochrane database of systemic reviews), data collected from 4000 women suggests that delayed cord clamping results in healthier blood and iron levels in babies. Philippa Middleton of the Australian Research Centre for Health of Women and Babies at the University of Adelaide, explains: "In light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants, a more liberal approach to delaying clamping of the umbilical cord in healthy babies appears to be warranted." Stopping the blood from the placenta reaching the baby before the final few pulses, means there may be a chance the infant will not receive enough blood from the mother and may in turn have lower iron levels. While there are many benefits, Middleton says they did find that clamping the cord later was linked to higher numbers of babies needing treatment for jaundice. "The benefits of delayed cord clamping need to be weighed against the small additional risk of jaundice in newborns. Later cord clamping to increase iron stores might be particularly beneficial in settings where severe anaemia is common." THE JURY IS STILL OUT Currently, there is insufficient evidence to support or to refute the benefits from delayed umbilical cord clamping for term infants that are born in settings with rich medical resources. Although a delay in umbilical cord clamping for up to 60 seconds may increase total body iron stores and blood volume (which may be particularly beneficial in populations in which iron deficiency is prevalent) these potential benefits must be weighed against the increased need for neonatal phototherapy (treatment for jaundice). No difference is apparent between infants who undergo early umbilical cord clamping versus those who undergo delayed umbilical cord clamping with respect to immediate birth outcomes, such as Apgar scores, umbilical cord pH, or respiratory distress. Although maternal outcomes have not been rigorously studied, the incidence of postpartum haemorrhage is reported to be similar between immediate umbilical cord clamping groups and late umbilical cord clamping groups. Evidence does however support delayed umbilical cord clamping in preterm infants. As with term infants, delaying umbilical cord clamping to 30-60 seconds after birth with the infant at a level below the placenta is associated with neonatal benefits, including improved transitional circulation, enhanced establishment of red blood cell volume, and less need for blood transfusion. The reviewers concur "a more liberal approach" to delaying cord clamping is likely to benefit babies, "as long as access to treatment for jaundice requiring phototherapy is available." What is cord clamping? During pregnancy your baby is attached to the placenta via the umbilical cord. Oxygen and nutrients are passed from the blood circulating through the placenta via the umbilical cord to your baby, and waste is removed in the same way. In the majority of births, as soon as the baby emerges, a clamp is attached to the cord to stop blood flowing through it. The cord is then cut. This stump eventually dries out and drops off (after a week to ten days) to form a belly button. First published in the December 2013/January 2014 issue of Your Pregnancy Magazine

In the first few months of some babies’ lives (generally under 8 months) they may experience a general scaliness and redness around the scalp area. This condition is known as “cradle cap” and is common in new born babies. It causes scales that are yellow/brown in colour and may also appear as red or slightly pinkish, crusty or flaky patches. It can also occur on a baby’s face, behind the ears, on the forehead or eyebrows and in the diaper area. Cradle cap is caused by the over production of sebum, an oily substance that is needed to keep your little one’s skin healthy. This causes the oil-producing sebaceous glands on the head to become irritated, resulting in inflammation, redness and an irritation that can extend to the face. Although it may look unsightly, it is mostly not serious. For most babies, cradle cap will heal on its own within a few months. The underlying cause of the condition is not well understood. It is thought to be related to levels of maternal hormones in the womb which stimulate the oil-producing glands of the unborn baby’s skin during pregnancy which can lead to cradle cap in susceptible infants. It is a fallacy that shampoo plays a part in causing cradle cap, as gentle shampooing with a mild shampoo has shown to be helpful. There are products that help reduce the length of time and the unsightliness of the condition such as Purity Pedia Kids Cradle Cap Cream. This cream is a special blend of nutritive oils to help alleviate symptoms of cradle cap and reduce inflammation. Purity Pedia Kids Cradle Cap Cream contains a blend of Lavender, Almond, Calendula, Jojoba and Vitamin E to help soften the thick crusty scales of cradle cap and can also be used to help alleviate dandruff as well as dry skin. How to treat cradle cap: Gently massage Purity Pedia Kids Cradle Cap Cream onto the affected area to soften the patches of skin 2 – 3 times a day Use soap-free baby shampoos to wash your little one’s hair and rub off any loose scales Do not be tempted to pick off any scales as your little one’s skin can become infected. If the condition keeps getting worse instead of better despite treatment, consult your healthcare professional for advice. This article is brought to you by Purity; a 2015 Johnson’s Baby Sense Seminar sponsor

Over 200 viruses can cause a cold; hence it is called the “common cold”. Colds are caused by a group of viruses with the Rhino virus being the most common. These viruses have the ability to change, making it difficult to build 100% immunity. Children average 3 to 8 colds per year and they will continue getting them throughout childhood. Colds can occur year-round, but they mostly occur in the winter. The 3 most frequent symptoms of a cold are: Nasal congestion, runny nose and sneezing. Young children also often run a fever. Depending on which virus is causing the symptoms, the virus may also cause the following: Sore throat and/or Cough Decreased appetite Headache Muscle Ache Post nasal drip Blocked and runny nose (clear, watery and profuse discharge) Watery eyes Symptoms start two days after contact with the virus and most colds last 7-14 days. Sneezing, nose-blowing, and nose-wiping spread the virus and one can catch a cold by inhaling the virus if sitting close to someone who sneezes, or by touching your nose, eyes, or mouth after you have touched something contaminated by the virus. You cannot catch colds because of not wearing shoes or running around outside in the evening! Use a cream or petroleum jelly under the nose to help with chafing. Use Nasal Drops to soften the mucous Cough syrups can be helpful. Vapour gel on the chest and back can give relief to blocked noses Throat Pops help soothe sore throats Antibiotics do not kill viruses. Syrups containing antihistamines to lessen the mucous production should be used sparingly. Viruses are fought by the body’s own immune system. Boost your little ones’ immune system with adequate nutrition and Vitamin & Mineral supplements. Give your little one lots of fluids. Treat the fever with Paracetamol. Never use Aspirin (Salicylates) for fever in young children as it can lead to Reyes Syndrome and death in susceptible children! Wash hands frequently Cough/sneeze into a tissue and not hands Discard used tissues "When to seek medical attention?"> If breathing difficulties develop High fever – if your little one’s temperature is higher than 38°C and is not responding to efforts to bring it down High fever – consistently over 39°C or lasts longer than 2 days Ear infection with severe pain Very sore throat, smelly breath and yellow pussy discharge from the nose Vomiting If symptoms worsen or do not improve after 7 to 10 days This article is brought to you by Purity; a 2015 Johnson’s Baby Sense Seminar sponsor.

Image Source: finds.hellobee.com Why is it that just when your baby is able to start sleeping through the night, and may in fact, already have started doing so, that teeth decide to make an appearance! Ann Richardson looks at the effects of teething on sleep. Teething, per se, does not cause a sleeping disorder. Rather accept that when your child is teething, sleep may be disrupted temporarily. Avoid falling into the trap of blaming “teeth” for bad sleeping habits that never seem to go away. It is important to recognize some important facts about teething, so that you can have a clear understanding of what your child is feeling when he is cutting his precious new teeth. Teething, by definition, is when the actual tooth cuts through the gum and appears in your baby’s mouth. This may occur anytime from 3 months of age (very unusual) up to 1 year of age. Early teething (in babies younger than about 7 months) usually follows a family history of early teething. Late teething (after one year of age) is also unusual, and also follows a family history. Check with your parents when you cut your first tooth, and invariably, your child will follow suit. On average, most babies cut their first tooth at around 7 months of age. However, it is not unusual for your baby to celebrate his first birthday with no sign of teeth! This actual “cutting” may be preceded by a period of discomfort (may last weeks) as the teeth settle into the gums and prepare to start pushing upwards. This is usually when your baby drools excessively, and loves to chew and bite down on objects. This period is seldom characterized by fever, loss of appetite and other illness such as diarrhea and ear ache. If your baby is 15 months or older with no sign of teeth, consult your Dentist who may want to X ray his mouth to check that his teeth are present. Signs that your baby may be ready to cut his first tooth include the following: Excessive drooling and biting down on objects Loss of appetite, especially sucking on the breast or bottle A low grade fever, or periods of intense fever A red and spotty rash around his mouth Nappy rash – may be severe Frequent, loose stools A runny nose Ear ache There is a theory that teething may “weaken” your baby’s general immune system and make him more susceptible to illnesses such as otitis media (ear infections), bronchitis (chest infections) and tummy upsets. This, however, has not been scientifically proven. Many parents confuse normal developmental milestones (such as chewing on fingers and hands, and blowing bubbles) with teething. Remember that at around 3 months of age, your little one will find his hands (Oh joy!) and chew excessively on them, creating plenty of drool and bubbles! Don’t confuse this exciting developmental milestone with teething or hunger! If your child is feeling unwell whilst teething, please treat him with teething medication that is available from your pharmacy. Do you remember when your wisdom teeth started appearing? This is what your little one is experiencing whilst he is cutting his teeth. He may have a headache, and have a sore mouth, especially with eating. If your nights are becoming difficult, medicate with the prescribed medication at bedtime, and repeat the dose at prescribed intervals during the night if needs be. Keeping your babies dummies and teethers in the fridge is also a good idea, as the coolness helps to soothe inflamed gums. Accept that teething is a normal part of your baby’s development. You (and your baby) may be lucky and sail through the teething stage, or there may be some seriously wobbly days (and nights) ahead. Either way, rest assured that teething is a temporary phase, and that peaceful days and nights will occur again! By Ann Richardson

“People who say they sleep like a baby usually don’t have one” Leo J Burke Ask any sleep deprived mother and she will attest to the fact that her ability to function and parent well is hindered by lack of sleep. We crave the energising and renewing feeling sleep gives us and yet for many, sleep becomes an enigma or fond distant memory during our baby’s first year. The first step to dealing with sleep deprivation is in fact not getting more sleep, but being realistic about what we should expect from our babies. As soon as we know what to expect from our babies in terms of sleep we have made the first step towards acceptance. By knowing what to expect, we stop unrealistic cravings for sleep and start to deal with sleep deprivation constructively. Many common misconceptions abound about baby’s sleep: If you sleep well, you sleep like a baby! You should aim for your baby to sleep through the night at 6 weeks Once your baby has slept through a feed for three nights in a row it will not require that feed again and should be ‘dummied’ to prevent feeding at that time. All babies sleep through the night at 3 months By waking your baby at 10pm for a feed you will encourage them to drop the early morning feed A full nights sleep is 7pm to 7am These misconceptions are not true and by expecting your baby to do them you set your self up for disappointment and frustrations on the path to developing good sleep habits. So the question is what can you reasonably expect from your baby? All babies wake or at least stir at night The young baby has a sleep cycle of 45 minutes. A sleep cycle stretches from one light sleep state through a deep sleep state to the next light sleep state. All babies stir every 45 minutes as they come into the light sleep state. Good sleepers can resettle themselves without needing intervention, whereas poor sleepers signal to their mothers, needing help to fall back asleep. So the notion that if you sleep well, you sleep like a baby is incorrect as all babies are in fact stirring every 45 minutes. Her baby slept through the night from 6 weeks when will mine? The idea that some babies ‘sleep through’ at six weeks or all babies should sleep through by 3 months is not correct. Some babies will sleep through the night earlier than others, if your baby does this enjoy it but know it may be short lived as many babies start to wake again after six months. Babies should be allowed to expect a night feed until they are on full solids (6 months), if they need it. As a rule of thumb, babies under 6 weeks are feeding almost as frequently at night as they do during the day, possibly stretching to four or five hours once at night. Between 6 to 12 weeks your baby will probably drop a night feed, usually the 10pm to 11:30pm feed and therefore only require one feed in the early morning and then another at dawn. Do not wake your baby for the evening feed to prevent the morning one as this frequently leads to problems as you are not allowing your baby’s natural sleep rhythms to develop. At three to six months your baby can be expected to sleep from the early evening to a very early morning feed – after 3am. During this period, your baby will probably need to start eating solids but not proteins until after 6 months. So what is ‘sleeping through’ and when should my baby sleep through? Sleeping through entails sleeping from early evening (approximately 7pm) for a stretch of 10 to 12 hours, which means waking between 5am and 7am. During this time, your baby may stir but a ‘good sleeper’ resettles himself. By understanding your baby’s sleep and having reasonable expectations, night feeds and night wakings become more bearable. As exhausting as this early mothering period is, it is precious and short lived. By instilling good sleep habits from early on you will soon enjoy a longer night’s sleep, but not for many years will your sleep habits resemble those blissful pre-pregnancy sleep-ins or a solids night’s sleep. By Meg Faure

Illness can affect your child’s sleep, so Ann Richardson gives ideas on getting your baby through the night. It is a fact of parenting that somewhere along the line your little one will come down with a cough and a cold (commonly called “the flu”). Most of the time it will simply be a viral illness which will most likely manifest itself in the form of a head cold, often associated with an infected throat or infected ears, and coughing. If you are really unlucky, your baby may end up with an ear or chest infection requiring medication, and in some cases, hospitalization. When it comes to sleep, coughs and colds can play havoc with a well-established sleep routine, or they can have the opposite effect, where your little one is feeling so poorly that they seem to do nothing else but sleep! Certain decongestant and fever reducing medications may also make your baby drowsier than normal. If this is the case, ensure that your baby is drinking sufficient fluid (especially if she is running a temperature), as she will most likely have no appetite for food, and will appear to sleep her day away. However, should your little one be suffering from a rotten cold, she will most likely be miserable, clingy and will wake frequently during the night. The most common reason for frequent night waking in this case is due to the fact that she may be feeling achy and sore all over, coupled with excessive mucous production (the body’s natural defense mechanism with a cold), which may be blocking her nose and sinuses, making it difficult to breathe easily. Her mouth and lips will be dry and parched, and her throat will most likely be feeling like she has swallowed a box of razor blades! Small wonder that she is restless and fretful during the night. Expect many disturbed nights whilst the cold runs its course, so try and cancel any unnecessary outings or events during this time, and do your best to keep your child well-nourished and hydrated. If your baby is eating solid food, she will probably be off her food, so try to stick to small, frequent, nutrient dense foodstuffs such as chicken or meat broth, veggie and fruit puree or egg. Encourage plenty of fluids. If she has tonsillitis or a bad throat, offer her smoothies in place of solid food. Keep up with pain and fever- reducing medication as prescribed by your health care provider – think about how grotty you feel and how your body aches when you have a bad cold! Bath your baby twice a day, especially if she is running a fever – this will help to cool her down and will help her to settle for the night. If she is very bunged up in her nasal and sinus passages, keep a humidifier in her room and put her to sleep in an upright position to help the mucous to drain. Keep her lips moistened with a bit of Vaseline or lip balm. Offering her frequent sips of water (add a bit of honey and lemon if she is older than 1 year) will help to alleviate an irritating cough. Your baby may need to be with you in your bed if you are worried about her breathing, and if she has a very high temperature. For older babies (over the age of two), a cough suppressant may be advised if there is no chest congestion, but please ask your health care provider first before giving this to your child – this may help alleviate that irritating tickle throughout the night which may be keeping the household awake. If your baby has croup (a viral infection of the larynx, or wind pipe), this is usually worse at night. Running the hot water tap on full in the shower and sitting in the steamy bathroom area (not the shower!) with your child will help alleviate the spasm. If it does not help, seek medical attention immediately. The good news, however, is that coughs and colds do resolve within a few days. You may well spend a few nights patrolling the passages, dispensing medicine, wiping snotty noses and dishing out many hugs! The important issues are to keep your baby hydrated by offering small, frequent feeds – don’t stress about solid food at this stage use medication strictly as prescribed by your health care provider treat a high temperature (anything over 38 o c ) with paracetamol and tepid sponging down – seek medical help if these measures are not effective within ½ hour seek medical attention immediately if your baby is having difficulty breathing, or if her general condition deteriorates rapidly You will know when your child is well again, so if sleep habits have shifted enormously, it may well be time to revert back to your previous tried and tested routine and boundaries regarding sleep. By Meg Faure