Don’t let your baby’s reflux repeat on you!

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: Reflux in babies

As I reflect back to the time both my girls were newborns, my experiences with them were very different especially when it comes to reflux. My eldest daughter, I cannot remember her ever bringing up or vomiting any milk and I clearly remember my sister, a mother of twins saying to me, ‘You don’t realise how lucky you are that Sophie is not a ‘chucky baby’. Those words did come back to haunt me when my youngest daughter was born, because my luck did run out, as Georgia was a very ‘chucky baby’. After most feeds, a small portion of milk would come back up, with no sign of it causing Georgia any discomfort. I think it bothered me more than it bothered her, in terms of the inconvenience of cleaning and extra washing I had to do. However as she got older, the frequency of regurgitation reduced and by the age of one, they were few and far between. In this blog I aim to discuss reflux, what causes it? What makes it worse? How simple lifestyle modifications can make a huge difference  as well as pointing out signs and symptoms of when to get help.

All babies are born with weak oesophageal muscles above their stomach, that can easily open  and allow milk to rise up and out of a baby’s mouth. It is a normal process which will resolve itself usually by the time a baby is 12 months old. Some babies regurgitate more frequently than other babies but as long as the baby is not bothered by it, there is no reason to be concerned. Often parents worry saying, ‘My child is bringing up most of their feed’. Often  the amount bought up does look more than it really is, and if your baby is slowly putting on weight and developing normally, there is no medical problem. Just remember your baby’s digestive system is still immature and developing, and getting use to different quantities of milk in their ‘little tummies’. If the muscle relaxes for a split second some milk can escape and come out of the mouth. Slowly that muscle will strengthen and the frequency of ‘spill ups’ will reduce. However there are times to be concerned and need to be seen by the GP for any of the following signs or symptoms:

  • has blood in the vomit
  • coughing and/or wheezing
  • refusing feeds
  • irritability and arching their backs before or after vomiting
  • extremely difficult to settle
  • weight loss and crossing percentiles
  • fever

The following are some simple lifestyle measures to help reduce reflux:

  • If breastfeeding, try and position your baby in a more upright position. Experiment with how you hold your baby whilst you breastfeed and you may find the under arm hold ie the ‘football hold’ may work better for a baby with reflux.
  • If bottle feeding, also position your baby in a more upright position. Sit them up and burp them every 2-3 minutes.
  • When burping, a good position is placing their diaphragm over your shoulder(obviously whilst supporting their neck), this will apply pressure up and force any trapped air, making it easier for your baby to burp.
  • Elevate the head of the cot by 40 degrees, this is shown to be of great benefit.
  • When bottle feeding, ensure the baby is not swallowing air, constantly check the teat is full of milk and when preparing the formula don’t shake so vigorously like you are making a milkshake. Tap the bottle prepared, on the bench a few times to settle any bubbles before giving formula to your baby.
  • Frequent feeding may make it easier for your baby to digest smaller volumes of milk. There are times when your baby will cluster feed and it is recommended if breastfeeding to remain on the one side and avoid swapping to the other breast each time. This is to avoid your baby ending up with a high lactose load. It is usually recommended to swap sides when breastfeeding however if you are feeding more frequently ie less than 3 hourly, try to feed on one side until it is empty and then switch, as the composition of breastmilk changes from the beginning of the feed to the end. The initial composition of breastmilk will consist of water and a high lactose load. This will quench the baby’s thirst and as the feed goes on, the fat content of the milk will rise. Staying on the one breast until you feel it is mostly empty, will  ensure your baby,  not only consumes the thirst quenching part of the breast milk, but also the higher fat content which will satisfy their hunger and keep them full for a longer period of time.
  • Try and change your baby’s nappy before feeding, it is better not to raise the legs after a feed as it will apply pressure to the oesophageal muscle.
  • Baby slings/carriers have been shown to help as they keep the baby in an upright position and allow gravity to keep the milk down.
  • Caffeine- A small amount of caffeine is fine when breastfeeding but if your baby is showing reflux symptoms, it may help to reduce or eliminate caffeine.

The facts:

  • Reflux occurs in two thirds of babies
  • Both breast fed babies and formula fed babies can have reflux
  • It is estimated that 65‐85% of premmie babies suffer with reflux
  • Reflux peaks at 4 months of age
  • Spitting up is normal upto 4 times a day
  • Silent reflux is when the the stomach content comes part way up the oesophagus  and often either doesn’t make it up all the way up to the mouth or the baby swallows the contents and can be harder to diagnose.

Treatments:

  • After lifestyle measurements have been tried, the first line of treatment is to try a thickened formula or formula thickeners. There are both commercially available thickened formulas in Australia (eg.  Karicare Aptamil AR and NAN A.R) as well as a powdered thickener (eg.Karicare Aptamil feed thickener) that you can add to express milk or the formula your baby is used to. Just remember the teat you are using may need to be changed to one with a variable flow, as they can get clogged with the thickener.

Some parents notice that whether they are breastfeeding or formula feeding and trying the above recommendations, their baby is still very miserable, bringing up a lot of milk and even arching their backs in pain. After a lot of discussion with their maternal health nurse, doctor and/or paediatrician, a milk allergy may be suspected. About 40% of infants referred for specialist management of reflux symptoms have allergy to cow’s milk protein. 50-80% percent of babies diagnosed to a cow’s milk protein allergy will be able to tolerate soy. A breastfeeding mother, if she chooses to continue breastfeeding, will be advised to remove all the dairy and food consumed which contain cow’s milk protein. This elimination diet needs to be tried for at least 4 weeks to notice an improvement. It can be tricky to start with and a specialist dietician would be recommended to advise the mother of suitable substitutes to maintain an adequate intake of calcium and other important nutrients. There are a lot of foods that contain milk solids and hence contain cow’s milk protein.  If formula feeding, the formula will be changed to either  a soy, an extensively hydrolysed formula (eg.Alfaré (Nestlé) or Pepti-Junior (Nutricia)), or an amino acid based formula (EleCare (Abbott) or Neocate (SHS)). There is no place for partially hydrolysed (known as HA) formulas or other mammalian milks (such as goats milk) in treating cow’s milk protein allergy. It all depends on the age of the baby with what their pediatrician thinks is best for the particular baby they are treating. If the baby is less than 6 months, they will usually try them on an extensively hydrolysed formula and if that is not tolerated after a trial, will move on to an amino acid based formula. A lot of parents say that when they do initially try an extensively hydrolysed formula or amino acid formula that the baby won’t drink it. It is worth persisting as they do get use to it. It can be frightening for a parent thinking ‘my baby won’t drink this formula’’ but keep trying because I do hear a lot of parents say, that my child gradually got used to it.

Studies show that lifestyle modifications together with changing formula or diet will give 78% improvement of reflux scores. If all other measures have failed, and reflux symptoms are problematic or associated with complications, a trial of either a Histamine 2 receptor antagonist (eg. Zantac) or  a proton pump inhibitor (PPI) (eg.Losec) medication may be prescribed. The research does show that PPI’s are superior to Histamine 2 receptor antagonists. As a pharmacist and speaking to many parents, I will often hear, ‘Thank goodness for this medication, I have a completely different baby now.’ The most common PPI given to infants is Omeprazole (Losec) made into a liquid suspension. They all work in the same way by reducing the amount of acid produced by up to 90%. Omeprazole suspensions need to be prepared by a compounding pharmacy who will also pleasantly flavour the suspension. Other brands of PPI’s include Nexium and Zoton and parents will be given instructions on how best to give the medication to their baby. They are given as a once a  day dose,  and will be trialled for at least one month. As your baby grows, the dose often needs to be increased not due to tolerance but  between 6 and 12 months, babies metabolise the medication faster (ie their bodies break it down faster). The treatment will be reviewed regularly by your doctor and when the symptoms are well controlled, stopping treatment may be considered. A step down approach is recommended over a period of time, whether that be giving the medication every second day or lowering the dose (gradually), and then obviously assessing how the baby responds to that, but the length of treatment will vary for each child.

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.

Finally! Vitamin D Simplified

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- Vitamin D

 

Pharmamum’s Ultimate Guide: Vitamin D

As parents we get bombarded with a lot of advice; ‘Make sure your child receives adequate sunshine so they are getting enough Vitamin D’. ‘You need to protect your children’s skin from harmful UV rays’, ‘Ensure you ‘slip slop slap’. What advice should we follow? If we are protecting our children from the sun, how will they get enough Vitamin D? Is my child vitamin D deficient? Why is Vitamin D so important? Can’t my child obtain it from a healthy diet? I breastfeed my child, surely they are getting enough Vitamin D from me, right?

In this blog, I aim to answer the above questions, explain what this Vitamin does in our body and why is it so important? How do we balance protecting our skin from the sun whilst still allowing our bodies to synthesise enough Vitamin D. In Australia, we have the highest rates of skin cancer in the world, we need to concentrate on recommending sensible sun exposure to ensure we do not become a nation full of vitamin D deficient unhealthy people.

What is Vitamin D?

Vitamin D is a fat soluble vitamin. It is also known as a hormone which is made in the skin when we are exposed to sunlight, in particular the ultraviolet B rays. We can obtain Vitamin D three ways:

  1. Sunlight
  2. Diet
  3. Vitamin D supplements

We depend on sun exposure to maintain our Vitamin D levels, and the source of 90-95% of most people’s vitamin D requirement, comes from casual exposure to sunlight. Relying on food alone will not give your children the adequate amounts of vitamin D that is required. Approximately 5-10% of your daily Vitamin D requirement is obtained through food. It is found in some oily fish (eg wild salmon, sardines, tuna and in eggs). Some foods are fortified with Vitamin D eg Infant formula, margarine, some milks and yogurts. It is possible to maintain adequate vitamin D levels by taking a Vitamin D supplement.

Vitamin D deficiency is an important health issue in Australia and is common in adults and children. Vitamin D levels can be measured by a simple blood test measuring the major circulating form of vitamin D (25(OH)D). Levels below 50nmol/L is considered Vitamin D deficient. Population surveys from Australia and New Zealand have shown that 40-57% of newborns have 25(OH)D levels <50 nmol/L. We can get adequate levels of vitamin D with sensible sun exposure. You don’t need to tan or burn to get adequate levels of vitamin D. Our society, especially in Australia, has been brainwashed to think we have to stay out of the sun. In fact it’s the opposite, we need the sun shining on our skin to maintain good health and wellbeing, but we need to expose ourselves to it sensibly.

What does Vitamin D do in our bodies?

Vitamin D’s best known role is to help you develop strong and healthy bones by absorbing calcium from the diet through our intestines. If vitamin D is lacking we cannot absorb as much calcium from the diet for bone development. This leads to Rickets in children, where you see deformities in bone structure as the child grows, and in adults, osteoporosis. If this was the only role of vitamin D, that would be important enough to make sure we don’t become Vitamin D deficient. However,  recent research is showing that Vitamin D can do much more. In fact, many of the body’s tissues have vitamin D receptors, and when Vitamin D binds to those receptors, it has a positive effect on those tissues. One important function Vitamin D is showing to have, is it’s role in immunity eg decreasing the risk of many chronic illnesses including common cancers, autoimmune diseases, infectious diseases and cardiovascular disease.There is also evidence that low vitamin D is linked to other health problems including, a higher risk of bowel cancer, heart disease, high blood pressure, stroke and depression. That is why we, as parents need to ensure, not only our children get enough Vitamin D, but also ourselves.

When I look at my children and think, how much sun they are exposed to during the winter months, I am concerned about their  Vitamin D levels. Could they be deficient in this vitamin? I send my eldest daughter to kinder and my youngest to creche, and both have up to half an hour of play outside, once or sometimes twice a day. I dress them covered up on cold winter days in a jumper and leggings and usually when they are outside, they play with jackets on, so the only exposure to the sun is to their face and hands. On the weekends, we try to spend some time outdoors, at a park or outside playing in the garden, but again with the cold weather they are covered up. How do you know if your child is vitamin D deficient? The answer is, you don’t, unless you get a blood test and doctors won’t routinely make a child undergo a blood test simply for checking Vitamin D levels unless they have one or more risk factors for Vitamin D deficiency. They will discuss with you and assess how much sun exposure your child is receiving together with other factors eg breastfed or formula fed, skin type, environment,diet etc and from there,  will recommend appropriate measures eg sensible sun exposure or a Vitamin D supplement.

Signs of vitamin D deficiency

Unfortunately, there are no obvious signs of Vitamin D deficiency. Vague symptoms of fatigue, bone pain and weakness can occur, but they can also be symptoms of other diseases. These symptoms are also impossible to be aware of in an infant. Unfortunately it’s often when the levels are extremely low, that symptoms really present ie bone deformities, delayed motor development and fractures. That is why it is important to assess your own situation and be informed about Vitamin D, how we can get it, do I need to take a supplement because my own circumstances aren’t allowing myself or my children to get adequate sun exposure. The following information will help:

So how much sun exposure do we need?  The amount of sun exposure that we need will vary depending on:

  • What time of the year it is, summer or winter?
  • The UV level-The part of the sun’s rays that is required to make Vitamin D is UVB. On a cloudy day less UVB penetrates through the clouds, therefore your skin makes less Vitamin D.
  • The time of day– Our skin produces the most amount of Vitamin D in the middle of the day
  • Our skin pigmentation-People with naturally very dark skin will require 3-6 times the more sun exposure  than those with fair to olive skin.
  • Latitude (ie where you live), the further you are from the earth’s equator the less UVB available for your body to produce vitamin D. However, in the summer the earth rotates, and more UVB is available for your skin to produce Vitamin D.
  • Age-As we get older, our skin’s ability to produce Vitamin D lessens.

In Australia, the Cancer council provides guidelines to follow,  to balance the risk of skin cancer from over exposure, whilst still maintaining adequate vitamin D levels:

During summer, in the southern parts of Australia (eg Sydney, Melbourne, Canberra, Adelaide, Hobart and Perth), and all year round in northern Australia (Brisbane and Darwin), most of us need a few minutes a day of sun exposure in the mid-morning or mid-afternoon, to an area of skin equivalent to your face, arms and hands to help with vitamin D levels. Be extra cautious in the middle of the day when UV levels are most intense and temperatures are uncomfortably high.

In winter, in the southern parts of Australia, where UV radiation levels are below 3 all day, most of us need about two to three hours, spread over each week, to the face, arms and hands to help with our vitamin D levels.

In the northern parts of Australia (eg Brisbane and Darwin), UV levels are above 3 all year round, so sun protection is needed daily.

In the southern parts of the country, (eg in Adelaide, Melbourne and Hobart) the average daily UV levels remain below 3 from May to August, so sun protection is not required, unless you are at high altitudes, outside for extended periods or near highly reflective surfaces like snow.

An interesting fact is that Vitamin D is a fat soluble vitamin which means it is stored in body fat and is often released during winter when Vitamin D cannot be produced. Sensible sun exposure over the summer will allow our bodies to store vitamin D in our fat and release it in the winter when needed. The problem that we are facing, is we have become a nation that has listened to all  ‘cover up in the sun messages’ that by the end of summer we are seeing vitamin D deficiencies and cannot rely on our stores to carry us through the winter.

The summer sun

  • The larger the area of skin exposed to the sun, the more Vitamin D is produced in the skin.  It happens very quickly (5-10 minutes) and exposing your skin for a short time will make all the vitamin D your body can produce in one day.
  • Sunscreen blocks most Vitamin D production. In fact if you wear SPF 15 it blocks 99% of Vitamin D synthesis. In summer, allow your child to get their Vitamin D dose in the sun and then use appropriate measures to protect their skin. When you are at home, your children can run around in the garden for 5 minutes and then you call them in to apply sunscreen or cover up with appropriate clothing eg protective swimwear, hats etc.
  • The face does not produce much Vitamin D, and is the most sun damaged. Always protect your’s and children’s face with either an appropriate sunscreen or a moisturiser with a high SPF in the summer months. Never use a sunscreen aerosol/spray, use a cream/lotion you can roll on or apply with your hands, as you do not want your children (or yourself) inhaling sunscreen particles.
  • You cannot make vitamin D through glass, eg in the car if the window is up and the sun is shining through, your skin will not synthesise vitamin D through glass.

Who is at risk of vitamin D deficiency?

  • People with naturally very dark skin
  • People with little or no sun exposure. That includes people who avoid the sun for medical or cosmetic reasons or people who have office jobs, shift work etc
  • Breast fed babies who fall into the ‘at risk’ categories and whose mother has little Vitamin D stores.

Pregnancy and breastfeeding

If there is one particular time in your life you can not afford to be vitamin D deficient, it is when you are pregnant or breastfeeding because if you do not get enough vitamin D when you are pregnant or breastfeeding, your baby’s bones can become soft. Getting enough vitamin D when you’re pregnant ensures your baby will get enough too. All pregnant women should be screened in early pregnancy and treated for vitamin D deficiency in the first trimester of each pregnancy. Both of my pregnancies were over the summer and I used to sit outside in my back garden and expose my growing belly to the sun, just for 5 minutes to make sure my vitamin D levels were adequate.

Breast milk contains little Vitamin D and breastfed babies depend solely on their mother’s Vitamin D levels. If you are breastfeeding your baby it is worth getting your vitamin D levels tested to ensure you are not deficient and passing that deficiency on to your baby. Breastfed infants of dark skinned or veiled women (with unknown vitamin D status) should be supplemented with vitamin D 400 IU per day for the first 12 months of life as there is inadequate vitamin D in their breast milk.

I am by no means recommending to put an infant in the sun, in fact it is not recommended to place an infant  in direct sunlight for the first 6 months of their life, due to their delicate skin.  However, if your baby is breastfed,  ensure your Vitamin D levels are sufficient. If possible, try get out for walks with your newborn, enjoy the sun and fresh air, and expose your arms and legs to any available sun, for the recommended times.

If you are formula feeding- there is vitamin D fortified in all formula, so your baby’s vitamin D levels are sufficient through formula.

The most natural way to get vitamin D is exposure to the sun. Did you know, that if our bodies synthesise Vitamin D from exposure to sunlight, it stays around in the body at least twice as long as it would if you take a supplement. I personally supplement both my children and myself with Vitamin D only during the winter and after assessing how much sun we are exposed to.

In Australia, there are a few brands of Vitamin D available specifically for children. They come in liquid form, that you either squirt using a syringe directly into your child/babies mouth (Ostelin) or  drop into your child/babies mouth ( Bioceuticals Vitamin D3 drops).
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.

How to formula feed your baby and travel too! Part 2/2

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: Breastfeeding/Formula Feeding (Part 2 of 2)

Formula Feeding

Breast feeding didn’t come easy and what ended up working best for me, was combine feeding. At each feed I would breastfeed first and then top up with formula. This worked well, as I wasn’t blessed with a large milk supply no matter how often I breastfed or expressed, to try build up my supply, the production of breast milk  just wasn’t keeping up with the demands. I had no problem with formula feeding, as long as my baby was not going hungry, I felt I would give what I had, and top up with formula to satisfy their needs.

When It came to formula feeding, I needed to make it as practical and convenient as possible to prepare formula when on the go, doing routine daily activities.

I will explain the best way to prepare formula when you are at home and what is recommended by the world health organisation. I will then describe what worked for me, because as a parent, and dealing with everyday busy life, being organised makes life easier and if preparing bottles for the day ahead, we need to ensure it is prepared in a hygienic and safe way for your baby.

Best way to prepare formula:

1) Before you do anything, wash your hands

2) Ensure all the bottles, teats, caps, lids etc are sterilised

3) Use fresh clean water to fill the kettle and boil. Do not re-boil previously boiled water left in the kettle.

4) Allow the water to cool for no more than half an hour as the temperature of the water you pour into the sterilised bottle should not be less than 70 degrees celcius. At this temperature you are killing off any bacteria that may be present.

5) Pour the amount of water required into the bottle first, and then using the measuring scoop provided with the formula, scoop the correct amount of powder and level if off with the leveler provided. Use the chart on the back of the tin to tell you how many scoops of powder is needed. ie one scoop of formula may be required per 30ml of water. If baby is drinking 120ml, 4 scoops of powder will be required. Every formula is different and one scoop of powder may be needed for 50ml of water. It is important to read the directions carefully. As giving too much or too little formula can be dangerous for your baby’s health.

6) Put the teat onto the bottle together with the lid and give it a gentle shake to ensure it is evenly mixed.

7) The bottle will need to be cooled down to a lukewarm temperature to give to your baby. To do this, sit the bottle in some cold water.

8) Test the temperature on the inside of your wrist and then begin feeding your baby.

9) Throw away any left over milk that your baby did not drink, never save it for the next feed.

Preparing the formula at 70 degrees C, will kill off any bacteria that may be present in the powdered formula. Once powdered formula is open, the tin can be used for up to one month. Write the date on the tin to know when to discard. When repeatedly opening the tin  and using the scoop to prepare formula, there is a chance for bacteria to enter. By preparing the formula at 70 degrees you are reducing the chance of any bacteria surviving. Preparing the bottles as you need is what’s recommended. However, with the busy lives that we lead, preparing bottles ahead of time can make life easier. The following method worked perfectly for me, it was great when travelling or  when I was out and about and didn’t feel restricted to feeding at home:

  • Sterilise the number of bottles required for the day.
  • Use fresh clean water to fill the kettle and boil.
  • Allow the water to cool for no more than half an hour as the temperature of the water you pour into the sterilised bottle should not be less than 70 degrees.
  • Pour in each bottle the required amount of water and place them in the fridge.
  • Fill in a separate container the amount of powdered formula required per bottle. I always carried  in my nappy bag the Avent 3-in-1 formula dispenser, which allows you to carry 3 pre-measured portions of formula powder in separate compartments.
  • When the formula is required, scoop the required amount of formula ( or pour the pre-measured portion) into the bottle and place the teat and cap on the bottle and swirl the bottle first, to avoid the formula getting stuck in the teat and then shake the formula gently to mix it evenly.
  • Heat up the formula by placing the bottle in warm/hot water. Some babies are more than happy to drink room temperature formula.

A handy tip:

As I got confident with preparing bottles, I worked out that I could refrigerate two thirds of the required water needed and when it came to preparing a bottle,  I boiled the kettle and added the remaining third of water to the refrigerated water in the bottle and found that it was at the perfect temperature for feeding. The formula powder was then added and we were ready to go.

Always remember-

Do’s

  • You are required to sterilise your baby’s bottles and feeding equipment, until your baby is 12 months old
  • If you are going out with  pre-made bottles,store them in the coldest part of the fridge before leaving the house. They need to be placed in a cooler bag with ice packs and consumed within 4 hours. If you don’t have an ice pack and you are taking a pre-made formula out of the fridge and into room temperature, then it must be consumed within 2 hours.

Don’ts

  • When heating up formula, never use a microwave, always sit it in warm/hot water and allow it to warm up, as microwaves can heat unevenly, it can put your baby at risk of burns.
  • Using a bottle warmer is fine, but do not sit formula in the warmer for longer than 10 minutes, as it can increase the risk of bacteria build up.
  • Do not keep the scoop and leveler provided in the formula tin. Keep them clean, dry and in a separate container. This avoids contamination from hands to the powdered formula.
  • Do not use bottled water to make up formula (there are situations that you may need to, and will be mentioned later)

 

Travelling

When travelling to areas that do not have safe drinking water, you need to use bottled water to make up formula.

  • You need to boil the bottled water first.
  • Ensure you have sterilised your baby’s bottles. Whilst travelling there are smaller, compact microwave sterilisers that can be purchased. Otherwise you can use cold water sterilising tablets ie Milton’s sterilising tablets, which can be placed together with water into a large container with a lid and will sterilise in 15 minutes. The milton’s solution can stay in the container for 24 hours so you can keep placing bottles, dummies or other items in the solution for 24 hours before needing to re-make the solution.
  • Look at the label of bottle waters before purchasing, as some bottled water contain too much salt and sulphate. You need to check the label on the water and ensure that there is no more than 200mg of salt (Na) per Litre of water and no more than 250mg of Sulphate (SO or SO4) per litre of water. Brands of bottled water that are safe are Evian and Volvic. Ensure there is a seal on the bottled water to make sure the water has come directly from the company.
  • When travelling by plane, depending how long the flight is, you will need to work out how many bottles to bring. Always take 1 or 2 extra bottles in case of delays and trust me they happen. We travelled with our daughter when she was 8 months and on our return flight, what should have taken 4 hours to get home took 9. Thankfully I did pack an extra 2 bottles and plenty of snacks that came in handy. When flying, to help equalise the pressure in babies ears, it helps to feed your baby when taking off and when landing. -The rules for only being allowed to take on board 100mls of liquid does not apply to baby bottles. Prepare how ever many bottles you need with the usual amount of water required. When on board the aeroplane, the staff can bring you warm water to sit your bottle in to heat up when needed. You can purchase the formula dispensers that will fit 3 individual doses of formula in one container or depending on what formula you use you can purchase individual packaged sticks of formula that are great for travelling.
  • Depending where you are travelling to, you may need to bring a tin or two of formula, I would not recommend changing formula brands on a trip as you don’t want to deal with a baby who’s tummy is not tolerating a new formula whilst trying to enjoy your holiday. Do your research before you go to find out if your baby’s formula is readily available in your chosen destination.

 

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.

How to breastfeed your baby and have a life too! Part 1/2

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- Breastfeeding

 

Pharmamum’s Ultimate Guide: Breastfeeding/Formula Feeding (Part 1 of 2)

When you come home from the hospital with your precious little miracle, just managing to work out how to get them home safely in the baby car seat is a big achievement in itself, let alone working out how you can be polite to your in-laws that you are not ready for visitors the minute you arrive home. You are completely focused on making sure your baby is fed, warm and comfortable. Whether you’re breastfeeding or formula feeding, in this post, I aim to present you with some useful information that hopefully you can keep referring to when issues arise. I will cover how long expressed milk can be kept in the fridge/freezer, how to thaw milk when you and your partner need a night out or have a special function you need to attend. How best to prepare formula. How long does it keep, if we are going out for the day and don’t have access to a fridge. How do I travel with formula? I will discuss all of these scenarios and when you are faced with these situations along your baby journey,  you will be able to refer back to this post for the answers.

Breastfeeding

It is a good idea to express when breastfeeding so that when circumstances arise, eg an important function, you need to go back to work or  have a ‘date night’ out with your husband, knowing you can express and your  baby can drink from a bottle will give you great peace of mind. It is worth trying to express early on, not in the first two weeks as your body is adjusting to working out how much your baby requires, but when you feel ready to try and you are not dealing with other issues eg mastitis or attachment problems. You may try when your baby is 3 – 6 weeks old as the older they are, the more comfortable they get with breastfeeding and tend to reject a bottle later on. The amount of breast milk produced or stored in your breasts will keep changing as your baby grows. The breast milk will change in quantity and composition, keeping up with the needs of your baby eg when your baby goes through growth spurts, illnesses or when it’s hot outside and your baby is thirsty and requires more fluid. Your body is constantly keeping up with both internal and external environments through lots of different mechanisms. However, when you express, some people can express very well, and obtain a large supply of milk and some people cannot, and only obtain small amounts at a time, and that is perfectly normal. The amount you express is no indication of how much breast milk your baby is getting. Your baby is the best at clearing the breast and achieving a good let down reflex through the chemical reactions that occur when their mouth attaches to the breast. Expressing is the next best thing and what may help to obtain more milk whilst expressing, is thinking about your baby or looking at a photo of them, even imagining large amounts of milk flowing out of your breast. You can express three ways; by hand, a manual pump or with an electric pump. My personal preference was with an electric pump and if you can manage to express from both breasts at the same time you are more likely to obtain a larger volume of breast milk.

When expressing you will need the following:

  1. 4-6 Baby bottles- which come with teats,rings, caps and lids
  2. Storage containers or disposable bags specifically designed for breast milk collection and freezing. Many companies make containers that connect directly to the breast pump
  3. Steriliser: There are 4 different methods you can sterilise:
    1. Steam/electric steriliser
    2. Microwave steriliser
    3. Chemical sterilising tablets eg Milton antibacterial solution/tablets
    4. You can simply  place all your bottles, teats, caps or anything else that requires sterilisation into a large saucepan and cover with water, place the lid on and boil for 5 minutes. My prefered method was using a steam steriliser. It’s very easy to use and will keep everything inside sterilised for up to 6 hours or if you keep it on a cycle setting, can keep your bottles sterilised 24/7.

Everything that comes in contact with breastmilk needs to be sterilised eg. bottles,teats,lids, storage containers that are collecting the milk, and all parts of the breast pump that comes in to contact with the breast and breast milk. It is best to rinse out all of the used bottles and place them in the sink filled with warm soapy water. Get a bottle brush and use it to wash and clear any remnants of milk. Once the bottles, storage containers and parts of the pump have been washed and rinsed, place them in to the steriliser.

If you are expressing using an electric breast pump, the parts that come in contact with the breast and breast milk need to be washed in warm soapy water after each use and sterilised at the end of the day. However, if you place the parts of the breast pump in a container into the fridge after you have expressed, you do not need to wash the parts after each use, only at the end of the day together with sterilising.

 

Once you have expressed, how long can breast milk keep?

The colder the temperature you store it in, the longer it will last ie

Room temperature (ie < 26 C): 6 hours

Refrigerator: 3 days (no more than 72 hours, kept at the back of the fridge at 4 C)

 

Freezer:

2 weeks in the freezer section inside a refrigerator: -15 C

3 months in freezer (with a separate door ) -18 C

6 months in a deep freezer -20 C

I would recommend to put expressed breast milk in the coldest part of the fridge ie towards the back of the fridge on the shelf above the draws and when freezing, in the coldest compartment of the freezer.

 

Thawing

The best way to thaw breast milk, is to take it out of the freezer and place it in the coldest part of the fridge and allow it to thaw overnight. Thawing in the fridge will take 10-12 hours and  must be used within 24  hours of taking it out of the freezer. If you require the breast milk sooner,  you can sit the container of breast milk in warm water and it will defrost quickly. Once defrosted in warm water you can place it back in the fridge but must be consumed within 4 hours. What I used to do if I didn’t take the breast milk out of the freezer the night before and the babysitter was arriving soon, was take the breast milk out of the freezer and sit it in warm water, and allow the breast milk to defrost. The breast milk, still very cold, and now in liquid form, would be placed  back in the fridge and it would stay there until needed. I would tell the baby sitter, as soon as she hears the baby wake up, take the breastmilk bottle out of the fridge and  sit it in some warm water to prepare for feeding. Attend to the baby, change nappy etc Sit the baby in a safe area eg swing, bouncer and check milk temperature.

Important facts:

  • When heating up breast milk, sit bottle in warm water, test the breast milk on your wrist before giving it to your baby to ensure temperature is not too hot.
  • Never warm up breast milk in a microwave and never sit the bottle of water in a pan of boiling water. This runs the risk of:
    1. Burning the baby
    2. Destroying important components of the  breast milk
  • Never refreeze thawed breast milk
  • If your baby drinks only a small amount of milk, I understand how heartbreaking it can be throwing out expressed breast milk especially when it takes so long to express, but it does need to be thrown out at the end of the feed.
  • After expressing, always label the container storing the breast milk with the date collected and expiry date. Use the oldest one first as long as it is still in date.
  • If collecting small amounts at a time when expressing, you can mix the breastmilks together but only once the last breast milk collected, meets the previous refrigerated breast milk temperature, ie you will have two separate breast milk containers sitting in your fridge and once they are both  at fridge temperature ie 4 C, you can mix the two together.
  • When breast milk is stored in the fridge, it does separate, so you will see a cloudy liquid at the bottom and a white thicker liquid on top and when placing the bottle in the warm water to heat up the breast milk, give the bottle a swirl to mix the milk together.
  • Always give expressed milk a swirl to mix, never shake breast milk vigorously as it can break down important components of breastmilk.

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.

How to stop conjunctivitis from becoming a sticky situation

Disclaimer –  The material on this blog is 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- Conjunctivitis

Pharmamum’s Ultimate Guide: Conjunctivitis

Have you ever tried putting eye drops into a toddler’s eyes? From personal experience, It is by no means an easy task. Just trying to hold your child down, whilst you steady your hand to place an eye drop in their eye is an almighty challenge, let alone the actual eye drop ending up in the affected eye. In this post I aim to explain the difference between the main types of conjunctivitis babies and children may present with, as well as share some insights to treating conjunctivitis and offer some useful tips with administering eye drops and eye ointments.

What does it mean when your baby/child has  been diagnosed with conjunctivitis? Any medical term that ends with ‘itis’, means that part of the body is inflamed ie conjunctivitis is when the conjunctiva in the eye is inflamed. The conjunctiva is like a film that covers the whites of the eyes and lines the inner eyelid. The conjunctiva helps to lubricate the eye by producing mucus and tears and helps to prevent bugs entering the eye. Conjunctivitis is usually caused by an infection or allergy which causes the eye to look red and irritated.

The three main types of conjunctivitis  in babies and children are:

i)Bacterial

ii) Viral

iii) Allergic

You can differentiate between the three types by the symptoms your child presents, however the  symptoms do cross over and at times can be difficult to work out if the conjunctivitis is bacterial, viral or allergic. Bacterial and viral conjunctivitis is highly contagious and will be contagious until the discharge from the eye has ceased. Allergic conjunctivitis is not contagious. Sometimes your child may present with some discharge  in the corner of the eye when they have head congestion. This can be confused be with bacterial conjunctivitis but it is just another way mucus can be excreted.

Bacterial conjunctivitis– Presents in one eye and often spreads to the other eye. The eye may appear red and feel gritty producing a yellow/green thick discharge that can cloud vision upon waking and can form a crust on the eyelid. Over night if enough discharge builds up, the eyelids can stick together.

Viral conjunctivitis– Also causes a red and inflamed eye but the discharge is usually clearer and more watery.Viral conjunctivitis usually goes hand in hand with a respiratory infection. The eye may be itchy and sometimes confused with allergic conjunctivitis.

Allergic conjunctivitis– presents with an itchy, burning and  inflamed eye and a more watery discharge. Children with allergic conjunctivitis usually also have hayfever symptoms ie itchy runny nose, itchy scratchy throat.

Treatment:

Bacterial Conjunctivitis:

Usually bacterial conjunctivitis does not need treatment and it will resolve on its own within 5 days, however symptoms can last longer. No harm will occur if bacterial conjunctivitis is left untreated, however treating with an anti-bacterial eye drop/ointment will speed up the recovery. As a mother, I know how difficult it is to avoid treating when you are constantly wiping away the discharge from the eye and looking at your child with red and irritated eyes. 5 days can seem like a long time to wait especially when your child is not allowed to go back to daycare/school until the discharge has ceased.

First line treatment is Chloramphenicol eye drops/eye ointment. Brands include Chlorsig or chloromycetin eye drops/eye ointment.

Directions of use:

Eyedrops: from birth- 18 years-  1 eye drop every 2 hours for the first day, then gradually decrease to every 6 hours as improvement occurs.

Eye ointment: Birth (at term) – 18 years- use eye ointment at night if drops are used during the day, or as a single agent 3 or 4 times daily. It is recommended to use the eye drops/ointment for two days after the symptoms have improved but If treating you should try limit the use of chloramphenicol drops/ointment to 3-5 days.

Chloramphenicol is safe to use in children from birth, however if you do go into a pharmacy, a pharmacist may be apprehensive to dispense it for a child who is under 2 and that is because in infants, the eyes are still developing and it is difficult to exclude serious causes of a red eye that could potentially cause serious or long term damage to the eye without a proper examination by a doctor or optometrist.

If you are currently pregnant, a topical course of chloramphenicol (chlorsig) is category A, meaning it is safe to use in pregnancy and a single course of chloramphenicol is safe to use whilst breast feeding.

Upon waking and several times during the day when the eyes may stick together, you will need to clean the eye. The best way to clean your baby/child’s eyes is with  warm (not hot) water and a cotton pad/ball. If you are having to clean their eyes a few times a day, it is not recommended to clean their eyes with saline as constantly wiping away the same area with saline can be quite irritating to the skin. Use a separate cotton pad for each eye dipped in warm water and wipe away the discharge sweeping in one direction. If you can not remove the discharge after the first attempt, keep the warm cotton ball soaked in water on the eye for a few seconds to loosen the dried discharge and keep wiping away the discharge gently.

Viral conjunctivitis:

Unfortunately there is no treatment for viral conjunctivitis and it will clear on its own. You can treat the symptoms and if  your child allows you, use a cold compress several times a day or  artificial tears (ie Tears Natural, Poly-tears, Re-fresh eye drops) to soothe the eyes. If your child is very young (ie <6 years old), just keeping the eye clean and wiping away the discharge is about all you can do.

Allergic conjunctivitis:

In babies and children, an antihistamine can relieve the itchy eyes and discomfort. Telfast liquid can be used from 6 months and Claratyne (Loratadine), Aerius(Desloratadine) and Zyrtec(Cetirazine) liquids can all be used from 1 year of age. Claratyne also make a chewable tablet from 2 years of age. Oral antihistamines should control the allergy symptoms and avoid the need for eye drops.

Applying eye drops:

Have your baby/child lying down, open their eye with your index finger and thumb and  ask your child to look up and to the side and put the eye drop in with the other hand. If it’s easier get your child to close their eyes and drop 1 drop in the inner corner of their eye. The drop will run into your child’s eye once they open their eyes. Wipe away any excess from your baby’s eye with a clean tissue/ cotton pad.

Applying an eye ointment:

Have your baby/child lying down and ask your child to look up and to the side. To stabilise your hand, place your wrist that you will be applying the ointment, resting gently on your child’s forehead and just like you apply eyeliner to your lower eye lid, pull down gently the lower eye lid and apply 1 cm of ointment along the lid. Rotate the tube slightly to detach the ointment from the tube. Ask your child to blink to disperse the ointment. If this is too difficult ask your child to close their eyes and apply a small amount in the corner of the eye and with your child blinking the medication will disperse into the eye.

Useful Tips:

  • Ensure you are not applying cold drops in your baby/childs eyes. Keep the bottle in the palm of your hands for a couple of minutes to warm them up. Applying eye drops straight from the fridge  may give your child a fright or feel like a sting in the eye compared to room temperature eye drops.
  • Some eye drops can give an after taste because eye drops, just like tears drain into the back of the nose and then down to the back of the throat. In particular Chlorsig/ chloromycetin (chloramphenicol) eye drops for bacterial conjunctivitis can leave a bitter taste not long after you apply the eye drops. A good idea is to give your child something to eat or drink straight after applying the eye drops or a breast or bottle feed straight after to avoid the bad aftertaste.
  • If your baby is very active and at an age where reasoning with them just does not work, you may need to kneel on top of them holding them in position with your knees either side of them. What worked well with my children, was playing a little game of peek-a-boo to get your toddler to close their eyes whilst sneakily dropping an eye drop in or moving the eye drops from side to side and getting them to follow the bottle with their eyes before administering them as hovering over your child may cause them to become anxious.
  • All eye drops once dispensed and opened need to be discarded after one month.
  • Your child/baby will be contagious and needs to excluded from child care until there is no longer any discharge being produced.
  • Ensure good hygiene practice to avoid the spreading of bacterial and viral conjunctivitis ie washing hands regularly, avoid sharing face towels and dispose of tissues appropriately.

Blocked tear ducts

Approximately 5% of newborns are born with blocked tear ducts which can increase the risk of your baby contracting  conjunctivitis, however if you see a build up of mucus in your child’s eye, it doesn’t necessarily mean your baby has an infection, it is more likely that the tear duct is blocked and mucus from the tear film accumulates instead of clearing naturally. Often a blocked tear duct will resolve on its own by approximately 6 months of age. Gentle massage from the corner of the eye down towards the nose can help the duct open up. If that does not work, your paediatrician may organise a gentle procedure under anaesthesia that will resolve the blocked tear duct. The best way to manage a blocked tear duct is keeping the eye clean and wiping away the discharge regularly. For purulent discharge antibiotics are not indicated unless signs of conjunctival inflammation is present and a doctor would need to diagnose this. My youngest daughter had a blocked tear duct for the first 3-4 months of her life and because the tear duct was blocked she would constantly have a watery eye and when she awoke she would have crusty eyes that needed to be cleaned. The best way to clean your babies eyes is with  warm (not hot) water and a cotton pad/ball. If you are having to clean their eyes a few times a day, it is not recommended to clean their eyes with saline as constantly wiping away the same area with saline can be irritating to the skin. Use a separate cotton pad for each eye dipped in cooled boiled water and wipe away the discharge sweeping in one direction.

When to see a doctor-

i)If the baby/child is sensitive to light, ie they can barely open their eyes when light is present

ii) If there is swelling around the eye

iii) If there is any pain in the eye

iii)loss of vision

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.