Hand, Foot and Mouth Disease? All that you need to know

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s Ultimate Guide: Hand, Foot, and Mouth Disease

When a doctor or other health professional diagnoses your child for the first time with hand, foot and mouth disease, it can be quite daunting and your first thought may be, ‘Is this disease serious? Did they catch it from an animal?  Are there any long term complications? How contagious is it? How do we treat the disease?’ The following post will answer all the questions above, inform you about the disease  and  give you some practical advice which worked well in my household.

What is hand, foot and mouth disease?

Hand foot and mouth (HFM) disease is a childhood disease, which in comparison to many other childhood diseases causes a mild illness. It is caused by a number of enteroviruses (mainly the coxsackie group of enteroviruses) and not related to the foot and mouth disease in cattle. The virus harbours in the body for about 3-7 days before symptoms start appearing. It mainly occurs in children under 10 years of age, particularly in the creche/day care setting. It is very contagious and usually if one child presents with hand, foot and mouth disease, most likely the rest of the class will soon follow. Adults can catch the disease but symptoms are usually either mild or not present, but adults can transmit the disease to others without having the symptoms.

How do you catch hand, foot and mouth disease?

HFM disease is caught through air particles via secretions ie nasal mucus, saliva and usually passed on via close contact through coughing and sneezing. It can be contagious through the fluid in the blisters and  the virus is also present in faeces (stools) for several weeks after contracting the illness.  The spots start as small red dots and then become fluid filled turning into blisters, and then slowly drying out and disappearing.

What are the symptoms?

The typical presentation are blisters on the palms of the hands, soles of the feet, in and around the mouth and in the nappy area. The blisters on the hands, feet and nappy region are not itchy or painful however the blisters in the mouth are what causes the most pain and distress in babies/children.  Sore throat, irritability and fever (either mild  or very high) can  be present before the rash appears and loss of appetite is very common until the baby/child has recovered. The spots can also be present around the knees and elbows.The blisters usually appear as red dots and then fill with fluid, people will describe them as small ulcers too. Sometimes the red spots will just remain red spots and will not fill up with fluid, this is usually the case for the nappy region.

The symptoms can go from being mild with the child hardly suffering at all, to being quite severe, causing the child to be miserable, in pain and distressed. Complete recovery takes approximately 7-10 days.

Both my children have suffered with HFM disease and when my eldest daughter contracted the virus, I thought, ‘Great, we got over that disease, one childhood illness down.’ That was until the following year, my daughter came down with a very high fever and spots on the hands and feet and it was diagnosed as HFM disease again. It turns out you can catch HFM disease more than once because, you develop immunity to the specific virus that causes the infection, but because HFM disease is caused by several different viruses, people can get the disease again. My eldest daughter has had it at least 3 times and each time  really suffered with the virus, having very high fevers for at least 3-4 days, very tired and irritated by the condition. My youngest daughter recently contracted it with getting a high fever, spots in her nappy region and little ulcers in her mouth which caused her to be off her food for at least a week but had no spots on her hands and feet and did not seem to be in a lot of discomfort. So it’s important to realise that not  everyone gets all the symptoms of HFM  disease.

Is HFM a serious disease?

No, HFM disease is not a serious disease and although it can be quite unpleasant and distressing for the child (and parents), it very rarely causes complications. Complications include viral meningitis and signs of that would include, headache, back pain or neck pain.  Obviously a baby cannot communicate a headache, back pain or neck pain, however if a baby under 3 months of age ever has a temperature (ie above 38 degrees celsius), it is considered a medical emergency, because without proper urine/blood analysis it is impossible to work out the cause of a fever  and If your child is under 12 months of age with a fever, it is always  recommended to get your child checked out by a gp as soon as possible to get a professional diagnosis.

If you are pregnant whilst your child is suffering with HFM disease, there is no known risk to pregnant mothers or their unborn child.

Do’s

  • Exclude your child from creche/kinder whilst they are suffering with the symptoms and until the blisters have dried up.
  • Symptom relief- Give your child Paracetamol and/or Ibuprofen to help with pain, or if the child is irritated and bothered by the fever. There is no cure or vaccine for the disease, keeping your child comfortable is key.
  • Applying medicated gels to the ulcers in the mouth can help relieve the pain ie SM33 gel contains a numbing agent and can be used every 3 hours.
  • Your child may not want to put anything in their mouth and be off both fluids and solids. Ensure your child is drinking to avoid becoming dehydrated. If your child has a very high temperature, they are likely to become dehydrated fast. To prevent dehydration, keep offering water and what worked well in my household was  making  icypoles from diluted cordial and fruit juices. The ice not only helps prevent dehydration but when placed directly on the ulcers, will numb the pain,  bring comfort and reduce the inflammation of the ulcers. Cold purees helped when offering food. You often hear of babies/toddlers refusing to drink their regular bottle and in that situation watching for dehydration is very important. Signs of dehydration:  Not passing urine ie dry nappies, dry mouth,lack of tears, is pale, has sunken eyes, cold hands and feet, drowsiness and very irritable. When making a bottle or a meal, make sure the temperature is lower than normal because anything hot will feel like burning.
  • Allow your child as much rest as possible, I know my eldest daughter needed a lot of sleep to help her recover.
  • Ensure good hygiene especially when changing nappies as the virus can be present in the faeces. Be extra vigilant when wiping yours or childrens noses, eyes, mouths and when preparing food.
  • See a GP/doctor if:
    • i) your child is not drinking fluids due to painful mouth ulcers.
    • ii)your child has stiff neck, headache, back pain

Don’ts

  • Do not pop the blisters as the fluid that oozes out is highly contagious. The blisters are very unlikely to cause any scarring.
  • Try not to give your child oranges or highly acidic fruits because the juice will sting and irritate the mouth ulcers.
  • Antibiotics are not necessary and do not help, as the disease is caused by a virus and not bacteria.

Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.

11 tips to help bulletproof your child from Gastro

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s Ultimate Guide: Gastro

Gastro, unfortunately is no fun. When you see your child suffer with gastro, you feel helpless, however being informed about gastro, how quickly it spreads, how to treat the symptoms, what to do and not do, as well as what signs to look out for is very important as a parent and hopefully the information below, will arm you with confidence in how to handle a gastro outbreak in your family.

What is Gastro?

Gastro (gastroenteritis) is a term used to describe a bowel infection. Gastroenteritis is most commonly caused by a virus and less commonly caused by a bacteria or parasite.It  can last for 3 to 4 days but can take up to a week to 10 days for the bowel motions to become normal again. The worst is usually over within the first 24 hours of symptoms presenting.

How contagious is it and how do you catch it?

Viral gastroenteritis  is caused by person-to-person contact such as touching contaminated hands, faeces or vomit, or by drinking contaminated water or food.

Gastro is very catchy and is still contagious for 48 hours after the symptoms have stopped so it is important to  keep your child away from other children until she/he has had no vomiting or diarrhoea for at least 48 hours. This is important from preventing  an epidemic throughout the creche/kinder/school/work place.

Symptoms

  • Vomiting
  • Diarrhoea
  • Stomach cramps
  • Fever
  • Loss of appetite
  • Runny nose and sore throat can be present
  • The combination of these symptoms can all lead to dehydration.

How to reduce the risk of Gastro:

1) Wash hands thoroughly with soap and water after going to the toilet, changing nappies, after using a tissue and handling an animal

2) Wash hands thoroughly before preparing food

3) Dry hands with paper towel instead of cloth towel as bacteria can survive on towels for some time

4) Clean toilet seat regularly and baby change tables regularly.

5) When out and about, I carry anti-bacterial hand gel that you can quickly wash both yours and your children’s hands if you feel they need to be cleaned before touching food. This often limits the hassle of having to find a bathroom. Also whilst out, if placing your child in a highchair, always wipe down the tray table with a disposable wipe, because you just never know if an unwell child has sat in the high chair before placing your child in, and bacteria can live on surfaces for up to 24 hours.

If my child does get Gastro, how should I treat the symptoms?

3 Do’s

Firstly if your child is 6 months or under, it’s straight to the doctor because they can go downhill  very quickly and they need to be assessed for dehydration.They may need to return to their GP every 12 hours or so to be continually monitored.

6) Hydration

The biggest problem whilst suffering with gastro is becoming dehydrated because of loss of fluid via vomiting or diarrhoea, so drinking fluid is very important. It’s important to be aware that not every drink your child requests will be good for them whilst suffering gastro and undiluted juices and soft drinks ie lemonade can exacerbate dehydration. Oral rehydration solution is the best way to stay hydrated and are available over the counter from any pharmacy. Examples of these are Hydralyte, Gastrolyte, Pedialyte. These come in a number of different forms ie  powder sachets and effervescent tablets  that you combine with water,  ready pre-made solutions, icypoles and jelly solutions. The only way I can get them into my children is either an icypole or a jelly and even that is a struggle because the flavour is a combination of sweet and salty. Try and get your child to keep sipping water, however if  juice or lemonade is requested, it must be diluted. 1 part lemonade or fruit juice to 4 parts water is the ratio recommended. So if you give 100ml of juice, add 400ml water to make up to a total of 500ml. Alternatively you can use 10ml of concentrated cordial and add  250ml  water (equivalent to 1 cup of water).

a) Breastfed babies/toddlers:

If your baby is breastfed continue breastfeeding more frequently (on demand or at least every 2 hours) in order to increase the fluid intake. Also in between feeds, offer oral rehydration solution or water in a bottle. If your breastfed baby is on solids then do not give solids if your child is vomiting. When the vomiting has stopped or after 24 hours, continue breastfeeding every 2 to 3 hours or on demand and continue to offer water and oral rehydration fluid. You can start to reintroduce the solids if your baby is already on solids even  if their stools are still loose. Offer simple foods to start that are easily digested ie rice cereal, potato or pumpkin.

b) Formula Fed babies/toddlers:

If your baby is formula fed, stop the formula for a maximum of 24 hours, offering oral rehydration solution and water and then return to the formula after 24 hours and continue to offer the oral rehydration solution and water in between feeds. When the vomiting has stopped or after 24 hours start usual formula or milk. The formula or milk do not need to be diluted. Continue to give feeds every 2 to 3 hours or more frequently if demanded. Occasionally children will develop lactose intolerance after suffering a bout of gastro and the loose stools may continue. Your child may need to go onto a lactose free formula (ie Nan L.I gold) for a short period of time (approximately 1 month) until the lactose intolerance settles, this would need to be done under appropriate advice from your child’s health care professional. If your child is older than one and is no longer on formula and drinks full cream milk, with appropriate advice he/she may need to switch to lactose free milk for one month and then be assessed thereafter. You can start to reintroduce the solids if your baby is already on solids even  if their stools are still loose. Offer simple foods to start that are easily digested ie rice cereal, potato or pumpkin.

It can be very difficult to get your child to drink when they are feeling nauseous and really don’t want to put anything near their mouths. Be patient and keep encouraging your child. Children love icypoles, so what I do with my fussy eating 2 and 4 year old daughters, is  always offer the oral rehydration solution in icypole form first, and if that doesn’t work, I make my own diluted (1 to  4 parts) lemonade icypoles or diluted fruit juice icypoles and that’s usually a winner. Another tip is using  exciting looking twirly straws in water or oral rehydration solutions and children have fun watching the fluid go through the straw.

If your child is off their food, that is not a problem. If they do get hungry, start with bland food, ie toast, plain crackers, rice, boiled potatoes. Avoid dairy or hard to digest food as it can upset your child’s tummy. Children can also become  lactose intolerant whilst suffering with gastro and for up to a month after. Once vomiting has stopped slowly re-introduce usual foods. Start with the above that were mentioned as they are easily digested.

How much fluid should my child be drinking?

The best advice is  keep offering your child water and oral rehydration solution and reminding them to drink. Aim for at least 5mls of fluid per kg body weight each hour. ie if your baby is 10kg, you should aim for 50mls fluid each hour to replenish the fluid that is lost.

7) Probiotics:

There is strong evidence to shows that Probiotics co-administered with standard rehydration therapy decrease the duration of  infectious diarrhoea by approximately 30 hours with 2 particular strains of probiotics having the most evidence. ( Lactobacillus rhamnosus GG and Saccharomyces boulardii )

3 Dont’s

8) It’s very important NOT to give any medication to stop the nausea/vomiting and the diarrhoea. Let your baby/child’s body do what it needs to do, and that is, get the virus/bacteria out of their system! If you give medication to stop the nausea it will only keep the bug in their system for longer and delay the recovery.

9) Do not give sports drinks, Lucozade, or undiluted lemonade, cordials, or fruit juices as they can dehydrate your child even more by drawing fluid into their bowels.

10) Do not hesitate to take your child to a hospital for rehydration through an intravenous line if your child is refusing fluid. My nephew when ever he suffered with gastro, refused to drink and would not put any form of fluid close to his mouth, hence he would go downhill very quickly and had to be taken to the hospital for rehydration. My sister knew if her son ever got gastro, she wouldn’t wait too long before she took him to the hospital. Often children will want to drink because they do become thirsty but just be aware they are children, and children can refuse to do what is best for them.

11) See your doctor when:

  • Your child can not keep any fluids down
  • Your child looks dehydrated –ie Not passing urine ie dry nappies, dry mouth,lack of tears, is pale, has sunken eyes, cold hands and feet, drowsiness and very irritable
  • If your baby/child is refusing to breastfeed or drink
  • Rash that doesn’t fade when the skin is pressed
  • Blood in your child’s stools or vomit
  • Vomit is a green colour
  • Severe abdominal pain

Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.

10 questions every first time mum MUST ask themselves about immunisation

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s Ultimate Guide: Immunisation

There has been a lot of discussion recently regarding  immunisation. In Australia, over 90% of children are fully vaccinated, so we are doing a great job, however we need to ensure that we continue to maintain high levels of vaccination in order to eradicate serious diseases. In this post, I want to answer a lot of questions regarding vaccines and allay some common myths to put your minds at rest. If you have any questions please don’t hesitate to ask.

Firstly, congratulations for being committed to your child and community’s health because going  to the health centre or GP at 2 months, 4 months, 6 months, 1 year and  18 months of your child’s life can be painful (literally). It seems like we are forever taking our child to get another vaccination, where your child screams the place down, and looks at you like you are torturing them. However once you collect your thoughts you realise you are saving your child’s life from serious diseases and for a little discomfort, the benefits of immunisation far outweigh the negatives.

1. My baby is so young, won’t I be over stimulating their immune system by vaccinating them?

Healthy people have the ability to mount a response to every infection they encounter. Vaccines stimulate our defence mechanism that provide protection against specific diseases. Children’s immune system begin developing inside their mother’s womb and continue to mature after birth. Whilst our newborn’s immune system is developing they are being protected by the circulating antibodies from their mothers, against many, but not all serious infections. The protection usually lasts for approximately four months and that’s why the national immunisation programs stagger the vaccines after birth to cater for our baby’s developing immune system. In comparison to what babies encounter everyday, putting their hands in the mouths, picking up toys and putting them in the mouths, older siblings coughing and sneezing over babies all stimulates their immune system much more than the small number of antigens found in vaccines.

2. What are the side effects I should expect after each childhood vaccination?

The most common side effect from each vaccine  include  fever and pain at the injection site, these usually occur for 2-3 days after the vaccine however, some vaccines can cause side effects that can occur even up to three weeks after a vaccine ie the MMR (Measles,Mumps,Rubella)  vaccine can potentially cause for 7 to 10 days after vaccination: fever (can be over 39°C), faint red non-infectious rash, drowsiness, runny nose, cough or puffy eyes and swollen salivary glands. The MMRV (Measles,Mumps,Rubella,Varicella-chickenpox) vaccine can also cause the above, as well as a  mild rash like chickenpox for about 5 to 26 days after the vaccination. If you notice your child has a papular rash after the varicella (chickenpox) vaccine, which typically consist of 2 to 5 lesion or commonly at the injection site, this can occur in 5% of babies and typically 8 days after the vaccination. Those spots should be covered by a band-aid to reduce the risk of transmission.

Many vaccine injections may result in soreness, redness, itching, swelling or burning at the injection site for one to two days. Paracetamol might be required to ease the discomfort.

I remember with my eldest daughter at her 2 month old vaccination, my friends in my mother’s group told me their child slept for a couple of hours after the vaccine whereas with my daughter she had a very short unsettled sleep following the vaccine and it wasn’t until I gave her a dose of Paracetamol that she settled calmly. My personal experience with both my daughters I noticed that each vaccination was received differently. Sometimes you wouldn’t have known that they had a vaccination that day and other times it was really evident ie fever, irritability, redness and soreness around the site, and ‘flu like symptoms’ with a rash occurring a week or so after.

If the side effect following immunisation is unexpected, persistent or severe or if you are worried about your child after a vaccination, see your doctor or immunisation nurse as soon as possible or go directly to a hospital.

3. Should I give my baby/child Paracetamol before the vaccine?

Routine use of paracetamol before  each vaccination is not recommended, if fever is present after the vaccination paracetamol can be given. However, there is always an exception to the rule and that is:

i) with a new vaccine called Bexsero. Bexsero is a new Meningococcal group B vaccine available on the private market since March 2014. ( I will discuss this new vaccine in more detail later)

ii)  routine use of Paracetamol to prevent fever at the time of vaccination, is recommended for children with a history of febrile seizures.

With both of my girls, I noticed with some vaccinations, they needed Paracetamol a few hours later when they became warm with a fever and irritable, and other times, the vaccine may have caused them to feel warm but not bothered and so I held off giving them Paracetamol and they were fine.

4.  I heard there are additives like aluminium and preservatives that contain mercury in our vaccines, is this true?

With regards to Aluminium, aluminium salts are added to enhance the immune response to vaccines and the amount of aluminium is lower than everyday intake from diet.

In the past preservatives were required to prevent bacterial and fungal growth if the vaccine was produced in a multidose vial for mass vaccination and often the preservative used was a mercury based product called thiomersal. In practice preservatives are no longer used  in Australia because the vaccines are now produced in single-use sealed vials, so to answer your question, there is no mercury in vaccines.

5. I believe getting my child vaccinated is unnatural and I’d rather my child catch the viruses to build an optimal protection against them.  Do you agree?

The truth is, catching some of these diseases can have some very serious consequences that being,  losing a limb, paralysis or even death. Fortunately we live in a society that we haven’t been subjected to epidemics or pandemics of diseases that kill off millions of people. If you speak to parents and grandparents they will know somebody that suffered with polio or diptheria  and witnessed their peers with legs in braces or brain damage from measles etc. They saw first hand, how devastating these diseases could be. Diseases like meningitis and tetanus kill, whereas a vaccine may give minor side effects that mainly being, sore and hot around the injection site and mild fever or even ‘cold like’ symptoms.

Choosing to vaccinate uses a persons natural response to stimulate their immune system so that if a child comes in contact with disease they have been vaccinated against, their bodies ‘will remember’ that virus/bacteria and mount an effective response to stop the diseases or if it does develop, suffer with a much milder case.

6. I breastfeed,  won’t my baby be getting my immunity through breast milk?

The protection a child gets from their mother is not sufficient to protect a baby from getting all infections. It does also depend on the mothers exposure to the actual disease or whether the mother’s vaccinations are all up to date. So for example pertussis (whooping cough), generally only passes on minimal protection to the baby and the low amount that is transferred rapidly declines during the first few weeks leaving the infant vulnerable to infection if they are exposed to it. That is why we are seeing babies contracting this illness more frequently these days and its very  important that parent and grandparents who are going to have close contact with their newborn child/grandchild be immunised against this particular disease. Whereas another disease like measles, the antibodies transferred to a baby from their mother may have enough protection for the first year of their childs life.

7. Will vaccines make my childs eczema or asthma worse?

Usually the contrary, it is highly recommended that an asthmatic child be given all vaccines, as catching a disease like whooping cough or influenza  can severely exacerbate asthma.

In some people vaccines or their components  can cause an allergic reaction, the risk is low, approximately 1 in a million. However components of vaccines which can trigger an allergic reaction are gelatin,yeast, egg protein. If your child is highly allergic to these things, it is important to contact a specialist immunisation clinic, pediatrician or infectious disease specialist.

8. My child has an egg allergy, can they still be vaccinated?

There are two vaccines that are thought to contain traces of eggs that is the  Measles, Mumps and Rubella  vaccines and flu vaccines. However the measles and mumps viruses for vaccines are grown in chick embryo cell lines not in eggs. It is now recognised that measles and mumps containing vaccines ie MMR and MMRV contain negligible amounts of egg protein and can be given to children with egg allergy even with anaphylaxis to eggs.

The majority of influenza vaccine in use in Australia have only trace amounts of egg protein (less than 1 microgram per dose) and can safely be given to most people with egg allergy. However individuals with a severe allergy to eggs ie anaphylaxis should seek specialist advice.

9. Is it true that the mercury in vaccines cause autism?

This has drawn a lot of attention in the media recently and it has finally been put to rest.The first systematic international review of childhood vaccinations led by researchers from the University of Sydney has found no evidence of a link to the development of autism or autism spectrum disorders (ASDs).The comprehensive review involving more than 1.25 million children, revealed no statistical data to support a relationship between childhood vaccination for the commonly-used vaccines for measles, mumps, rubella, diphtheria, tetanus and whooping cough and the development of autism or ASDs.There has been on-going talk of the MMR vaccine being linked to Autism. This was due to one published study that has since been  retracted due to the data being fraudulent.

Since 2000, vaccines available on the national immunisation program in Australia have not contained the mercury containing preservative called thiomersal. Some vaccines like pneumococcal, MMR and other live vaccines never contained Thiomersal.

10. Is it true that vaccinations in young children cause seizures?

Febrile convulsions are a fairly common response to fever (Febrile convulsions are pretty common, occurring in about 4% of children between the ages of six months and five years). Since fever is a well documented  side effect of vaccines it is not unexpected that febrile convulsions may occur  following a vaccine. The risk is higher following  certain vaccines ie influenza,  MMR, MMRV and Meningococcal group B.

Latest information regarding vaccinations:

i)Meningococcal group B

In Australia the therapeutics goods of Australia (TGA) registered  a vaccine called Bexsero,  for prevention of Meningococcal group B in March 2014.  It is available through the private market ( ie available from your GP) but not funded as yet on the National Immunisation Program (NIP).  The two most common strains of meningococcal disease in Australia are strain B and C. (Globally there are 13 strains, most common ones are: A,B,C, W135, and Y.)  Vaccination for Meningococcal C together with haemophilus influenzae type B is given as part of the national immunisation program at 12 months of age.

There has been a continual decline in  meningococcal C disease since the introduction of the meningococcal C vaccine in 2003. Meningococcal disease can occur in any age group, but a large proportion of cases occur in those <5 years of age, with a secondary peak seen in the 15–24 years age group.In Australia, meningococcal disease in the <5 years age group,( particularly infants aged <1) is due predominantly to infection with  meningococcal B, very few cases of meningococcal C disease are now seen in this age group.

Bexsero- (Meningococcal Group B vaccine) is registered for use in babies from 2 months. For infants less than 6 months, 3 doses of Bexsero are  recommended 2 months apart plus a booster at 12 months. For babies less than 12 months, 2 doses of Bexsero are recommended plus a booster 2 months after the second dose. For children over  2 years old 2 doses are recommended with no booster required.

Bexsero can be given at the same time as the other vaccines recommended in the National Immunisation Program, however it is more common to suffer with fever therefore it is recommended to have a dose of paracetamol half an hour prior to having the vaccine.

ii)Varicella (Chickenpox) vaccine

In Australia at 18 months of age, babies get one dose of Varicella in combination with MMR. This is covered in the national immunisation program. Research is now showing that two doses of the Varicella vaccine will minimise the risk of breakthrough varicella, which is a milder case of chicken pox with fewer lesions than natural infection however, is still contagious. I do recommend speaking to your GP about a second dose of Varicella (chickenpox vaccine)  as two doses are recommended for full coverage. You do need to wait 4 weeks after the first dose to have the second dose.

iii)  In July, 2013, the scheduling of the national immunisation program changed slightly. Previously the chicken pox vaccine (Varicella) was the only vaccine given to children at 18 months, but since July 2013, at 18 months, a child will be given one injection containing the chickenpox vaccine together with the MMR (measles, mumps and rubella) vaccine. This means that the MMR booster has been brought forward from 4 years  to 18 months. When it comes to your child getting their 4 year old vaccinations, they will only receive one injection  (instead of two) that will contain Diphtheria/Tetanus/Pertussis/Inactivated Polio 4 from December 2015.

Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.

10 insights into Probiotics. What they ACTUALLY do!

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s Ultimate Guide: Probiotics

Probiotics are certainly the ‘in thing’ at the moment, and I’m often asked, ‘should I give my child probiotics?’ From walking down the supermarket aisles to listening to the television or radio, we constantly hear about probiotics being added to food to boost our immune system and aid in digestive health. Our friends and family tell us that ‘probiotics treat colic’ or ‘prevent eczema’  or ‘cure asthma’ but are these statements really true? Should we be giving them to our children? who do we believe? Before answering these questions, you need to know what probiotics are? What they do and why do we need them?  In this post, I want to present you with the latest research in this area, as well as provide you with information that sorts out the evidence from the myths.

On the surface of our skin lies an ecosystem containing millions and trillions of microorganisms called Flora. The flora have important health functions, and for our bodies to function properly, normal flora must be present. Intestinal flora help with digestion, the making of certain vitamins (ie biotin, vitamin B12, folic acid, and thiamine)  and plays a crucial role in our immune system.

1. What are probiotics and what do they do?

Probiotics according to the world health organisation is defined as “live microorganisms that, when administered in adequate amounts confer a health benefit on the host.” There are different types of probiotics which act in different ways and have different effects in the body. The most common groups of probiotics are: Lactobacillus, Bifidobacterium, Streptococcus and Saccharomyces boulardii. Probiotics come in different forms. They can be added to foods ie yogurts or they can be given as a supplement in the form of a powder or capsule. At birth, babies introduce bacteria to their gut through breast milk, formula, and eventually through the food they eat.  Probiotics increase the amount of good friendly bacteria to the intestinal tract and this has many benefits. The medical experts believe that  Probiotics aid digestion, boost the body’s natural defenses,  fight off harmful bacteria and restore the  Flora when it  has been disrupted (ie by a virus or antibiotics).

 

2. The evidence:

There is an abundance of studies exploring probiotics potential, as well as speculation about the benefits of Probiotics. There are a lot more studies on probiotics in adults than there are in children but strong evidence shows the following:

 

1) Probiotics coadministered with standard rehydration therapy decrease the duration of  infectious diarrhoea by approximately 30 hours with 2 particular strains of probiotics having the most evidence. ( Lactobacillus rhamnosus GG and Saccharomyces boulardii )

 

2)Antibiotic associated diarrhoea occurs when there is unexplained diarrhoea occurring whilst taking antibiotics or even up to six weeks after a course of antibiotics has been completed. It affects about 25% of patients taking antibiotics. Several probiotics have been evaluated in treating or preventing antibiotic associated diarrhoea but there are two strains of probiotics which have the strongest evidence in preventing antibiotic associated diarrhoea. (Lactobacillus rhamnosusGG and S.boulardii )

 

Children in day care centres have an increased risk of developing gastrointestinal and respiratory tract infections when compared to children cared for at home or in small family day care groups. The following studies and although the numbers were not in the 1000’s  are very good studies showing strong evidence for the use of probiotics:

i)A trial measured the effect of 2 different probiotic strains (Lactobacillus acidophilus and Bifidobacterium lactis) over a 6 month period on immunity in 326 children aged between 3 and 5 years old. Results showed a significant reduction in the frequency of colds and flu as well as the duration of cold and flu-like symptoms in the children who were taking the probiotic combination. Other observations included an overall decrease in the use of antibiotics and an increase in general attendance at both school and day care.

ii) A review of 8 different trials with 988 infants aged up to three years showed a significant improvement in duration of diarrhoea when one strain of a probiotic was given.

Eczema

Probiotics have shown promising potential in reducing the risk of eczema in infants. There  was a trial of 241 mother-infant pairs who  were randomly assigned to receive one of two different probiotics or a  placebo, beginning 2 months before delivery and during the first 2 months of breast-feeding. The infants were followed until the age of 24 months and the results concluded that the risk of developing eczema during the first 24 months of life was significantly reduced in infants of mothers receiving the probiotic combination.

The researchers found that a particular strain of probiotic (L. rhamnosus HN001)  reduced eczema prevalence by a half at the age of two years but the other probiotic had no effect on eczema. It was found that the effect on eczema persisted at four years, that is two years after they stopped the probiotics or placebo, suggesting that when they stopped taking the probiotic they didn’t get a rebound effect where eczema occurred. In other words, it’s been shown to have quite long-term benefits on the children. The research team is currently preparing results from its six year follow-up for publication. With the exception of one other study from Finland, all other probiotic studies have started the intervention at about 35 weeks’ gestation, but for this new study we are starting at between 14 and 16 weeks. Hopefully this way we can influence the underlying allergic status of the child.The main aim with this new study would be to influence that whole spectrum of diseases from eczema and food allergy, to asthma and hayfever.

Colic

There was a study carried out by researchers from the Royal Children’s Hospital, Murdoch Childrens Research Institute and the University of Melbourne. The study included 167 babies with colic and looked at whether giving them daily drops of the probiotic (Lactobacillus reuteri)  improved symptoms, in comparison to giving them inactive placebo drops. The researchers found the treatment did not help. However this study was with only one strain of probiotic and more studies being conducted in this area so watch this space.

Asthma

Can probiotics prevent asthma? Researchers examined this question in a thorough review of 20 different trials (primarily from developed countries) involving 4866 infants who were followed for 24 months. The bottom line is that probiotics are not helpful  when used during pregnancy and early infancy to prevent childhood asthma.

3. What age can you start taking Probiotics?

Probiotics can be given at any age and research suggests that good tolerance has been observed in premature infants and very low birth weight infants. Probiotics are also safe to use in late pregnancy and there is good evidence for a pregnant mother who is at risk of their child suffering with eczema (ie the mother or spouse suffered with eczema as a child or later in life) to take probiotics pre and post-natally. A great probiotic and I wish it was around when I was pregnant is made by Bioceuticals called UltraBiotic pregnancy care.

The first time I had to give my daughter Probiotics was when she was only one month old. I suffered with mastitis very early on and my doctor put me on a course of antibiotics, the next thing I knew was, I had nipple thrush, and passed on oral thrush to my daughter. My lactation consultant who was also a GP, put me on a concoction of medication and supplements and told me that it’s important for both you and the baby to take a probiotic because the antibiotics have gone through the breastmilk and has also wiped out the good bacteria in your daughter’s gut. So off I went to get my daughter a probiotic powder.

The best way to give a baby probiotics

Using a  teaspoon or a plate, dampen the probiotic powder with a couple of drops of cool boiled water and use the back of a teaspoon to mix it into a paste  and either:

i)paste on the nipple before feeding,

ii) paste on the teat (not in the hole) immediately before feeding

iii) insert the paste into the baby’s cheek or between the bottom lip and gum immediately before feeding.

4.Are probiotics safe?

The Murdoch childrens research institute  says, ‘Research does  indicate that probiotics are safe and well tolerated in normal healthy infants and children’. Probiotics are not safe in children who are immunocompromised or have severe underlying illness (ie short bowel syndrome) as there have been reports of bacteraemia and fungaemia caused by probiotics. So if your child does suffer with a chronic illness I would check with your child’s GP if they recommend giving probiotics to your child.

5. How much Probiotics do I need to give my child and can’t I just give them yogurt?

In Australia and New Zealand, the Food Standards Australia and New Zealand requires that fermented products contain certain number of good bacteria per gram of yogurt ie 1 million good bacteria per gram(scientific term is 1 million cfu) so for example if you give your child one of those squeezy yogurt packs which contain between 70-100g of yogurt, they usually contain 1 billion cfu. Giving your child yogurt everyday which contains probiotics is excellent because you are not just giving your child good bacteria but you are also giving your child nutrients such as protein and calcium, which is very important for your child’s health and well being.  I often tell my customers that we recommend a particular probiotic with antibiotics because there is a chance they may get antibiotic associated diarrhoea after taking the course of antibiotics and it is also important to re-introduce good bacteria in your child’s gut after it has been wiped out by the antibiotics? Often I hear, ‘oh that’s ok, i’ll just give my child some yogurt, that will do the trick.’ All yogurts are not the same and contain different strains of probiotics at low doses and it’s not well known to the public which probiotic strains help which condition.  For example Lactobacillus rhamnosus is only found in one particular yogurt and that is the Vaalia brand. Each tub of yogurt contains approximately 1 billion cfu and the evidence for treating viral diarrhoea and antiobiotic associated diarrhoea were at the dose of 10-20 billion cfu. So I personally recommend to give your child yogurt which will continuously be adding good bacteria to their guts but if you want to give them probiotics to treat or help prevent a certain condition then probiotic powders/capsules are a lot stronger and at the right dose.

6. Which brand of yogurt should I give my child?

I mix it up and give my children the following brands:

Jalna-they have added in three different strains of probiotics and would contain three times the concentration of good bacteria than most other yogurts.

Chobani-adds in 5 different strains of probiotics not as highly concentrated as Jalna, but still adds a variety of  probiotics.

Vaalia- It is the only food source of LGG® currently available in Australia. LGG is the probiotic Lactobacillus rhamnosus which has the most amount of evidence in preventing antibiotic associated diarrhoea as well as reducing the duration of infectious diarrhoea.

Vaalia tends to have more sugar than Jalna and chobani yogurts, but tend to be more palatable and less tart, however Jalna and Chobani brands of yogurt from a nutritional point of view is better.

7. Would I give my own children Probiotics?

My children, thank goodness to date have been well, they have definitely had their share of colds, coughs, gastro, ear infections, you name it, they have had most childhood viruses, but they are healthy children.  From the  information that I have presented above in terms of the actual evidence available  and the most up to date information on probiotics I would (and do) give my children probiotics supplements for the following:

1) If they are taking a course of antibiotics, ie whilst they are taking antibiotics and for at least six  weeks following a  course of antibiotics.

2) Whilst suffering with an upset stomach causing diarrhoea (ie during and after gastro). I myself had a personal experience with gastro a few years back, where I had severe gastro that lasted 3 to 4 days and I just couldn’t stop running to the toilet. I had had enough by the third day of drinking water/rehydration solutions, I said to my mum, ‘Can you just go and ask the Naturopath working in the pharmacy if there is anything else she would recommend.’ The naturopath gave my mum some probiotics to give me which I could hardly bring myself to swallow them, but from going 7 to 8 times a day, I got to the end of the day after  taking 2 doses of the probiotic without going to the toilet. Since studying and researching probiotics, that personal experience has stuck in my head, because I remember feeling  pleasantly surprised when they had worked for me.

3) Whilst at creche/daycare, I have given my children added probiotics on top of their regular everyday yogurt.  I purchase Bioceuticals BabyBiotics and sprinkle the powder on their cereal in the morning, and my kids don’t even know they are taking them.

8. Which brand of Probiotic supplement do I recommend?

In order for a probiotics to be effective it must first survive the acidic conditions in the stomach and then be able to survive in the small intestine. Good brands of probiotics include Bioceuticals, Ethical nutrients ie Inner Health Plus, Metagenics etc. I do advise you to speak with a health professional before supplementing because they will recommend the correct dose and strain of probiotics best suited for your child. I tend not to recommend any probiotics unless it is in the fridge because I personally don’t believe they can survive the conditions on the shelf and remain alive for very long.

9. What does a leading paediatric dietician have to say…

Miriam Raleigh, a leading paediatric dietitian who works closely with paediatric gastroenterologists, would recommend probiotics to at least 90% of her patients. Most of her patients often present with irritable bowel symptoms ie constipation issues, diarrhoea issues, fructose or lactose intolerance etc. She will often suggest a probiotic like Inner health Plus kids, because it contains the appropriate strain of probiotics at the right dose for what she is treating and is also very accessible and reasonably priced. Once the patient has a trial of the probiotics then she will assess whether her patient requires a higher dose or different combination of probiotics. Miriam said from her personal experience and the feedback she receives from parents is very positive. Miriam gave me a personal story when her eldest son started solids, he became very constipated, so she gave him a probiotic and within two weeks, his bowel habits completely changed and became very regular again. Miriam Raleigh runs her own practice called Child Nutrition in Windsor and Moonee Ponds Melbourne. For more details: www.childnutrition.com.au

10. A couple of extra tips:

1) Taking probiotic supplements with meals, when the stomach is less acidic, boosts bacterial survival. However, timing is less of an issue if you buy an enteric-coated (slow release) supplement, which is designed to survive transit through the stomach. Look for the words ‘stomach acid resistant’ on the label.

2) Because probiotics are living organisms, they need to be stored properly to ensure their potency. Most of them require refrigeration or they won’t survive, so follow the instructions on the packet, and also because they are temperature sensitive, avoid adding probiotic yoghurts to hot dishes (ie hot porridge).

Probiotics promise to have important roles in wellness and we are looking forward to hearing what the future research holds to help treat and/or prevent many health conditions.

Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.