Q & A with Natalie Herman- Baby Consultant & Sleep Specialist

 

QandA Natalie Herman

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Natalie Herman is a former HR Manager who passionately pursued a career change after giving birth to her daughter. In an attempt to find a more work life balance and enjoy her new role as Mum, Natalie trained to become a certified child sleep consultant.  She runs her consultancy business ‘Natalie Herman Baby Consultant & Sleep Specialist’ from her home in Israel and since its creation, has successfully worked with clients all over the world including: Israel, Australia, Spain, Germany and the UK. Many who know her personally, refer to her as the resident ‘sleep lady’.  Natalie has a 2.5 year old daughter Liele.

Pharmamum: Natalie, what inspired you to become a sleep consultant and where did it all start?

Natalie: Prior to giving birth to my daughter I worked in various HR positions in global companies, often having to travel to Europe on business trips.  When I gave birth I realised that my previous career would not allow me much home time. I knew it was important for at least one parent to be a constant in my daughter’s life and my husband is a lawyer and works crazy long hours so he wasn’t available to help out.  It was during this realisation as a new mum that I felt encouraged to pursue another career.  That, and also the fact that I was literally obsessed with getting my baby to sleep.  I believed at the time and still do, that implementing routine from an early age can often prevent poor sleeping habits from occurring later down the track.  I thought to myself that if I was able to pass on the knowledge I had learnt to other mums who were struggling with sleep deprivation or depression postpartum, then I could genuinely be making a change to their life, personal wellbeing, as well as to their ability to be a good mother. A tired exhausted mum simply cannot function the way they need to.

Pharmamum: How did you go about pursuing this career change?

Natalie: I searched online for the most comprehensive infant sleep course around led by  professionals who had been actively working in this field for 30 years. I was taught by pediatricians, psychiatrists, dieticians, pediatric nurses and senior sleep consultants.  The course involved face to face coursework and a  training period working in real life situations with families who were struggling with sleep. By the time I had started studying, I had already found myself helping so many other mummy friends and friends of friends with their babies. I knew I had to turn this into a business.

Pharmamum: I’m aware there are sleep consultants out there with different methods of sleep training, can you tell us a bit about what training method you follow?

Natalie:My motto to parents during our first meeting is: ‘it’s not about what I would do with my child, or what is good for me, it is about you and your family and what is good for you and your lifestyle’. Within the parameters of what are healthy sleeping habits, I offer parents a gentle sleep training approach providing them a detailed sleep plan and routine for both the day and night so they have something tangible and practical to work with. We start the training at bedtime and then tackle the night and finally the day time. There is no way a parent can do the training all at once, they would be exhausted, so we handle it in stages. I believe it is important to empower parents to do the work, so that once the consultation period is over, they are able to apply the knowledge I have taught them when they are confronted with dips in their child’s sleep as a result of: jetlag, illness or teething.

Pharmamum: Natalie,  let’s pretend that one of our mums have just started to experience some problems with their first child’s sleeping, and they want to come and see you.  Lets take them on a journey: what would be the first thing that you would do with them and what kind of journey would they expect to go on? What would it all involve?

Natalie: As I work both locally and globally I partner with technology in a huge way, as I help parents from all over the globe.  Parents can simply be in the comfort of their own home and chat together via skype calls or if my client lives in Israel, I happily do home visits. What I offer is:

For expecting mums or mums with newborns – 5 months, I offer parents a 3 hour home visit which includes everything and anything related to sleep. During this visit or skype call, I can talk about anything from routine and how to settle your baby, to how to prepare your baby room ensuring it is a good sleep environment for your child.

Once a baby is 5 months or older I start more gentle sleep training which includes a 3 hour house visit (or a long skype call)and following this visit we consult for up to 2 months, or until the child’s sleeping issues have been resolved. During this process I work on a daily basis with parents checking in on them to see how things are progressing so they receive consistent support and guidance from me. With this package parents will receive a personalised sleep plan and training guide.

For parents that just have a few quick questions, I also offer a phone consultation package.  All my packages are available both locally and globally to clients via skype.

In addition to this I run small workshops at crèche’s and childcare centers around Israel for new parents.

Pharmamum: We find we give birth to our beautiful baby, and they are an angel for us in the hospital sleeping so well. We bring them home, and the fun starts. At what point do you recommend getting in touch with yourself and what benefit is there in starting sleep training early on? Is there such a thing as starting too early?

Natalie: I never believe it is too early to be educated on infant sleep. I have met with mums with 1 week old babies. Getting off to a good start from the very beginning can help to minimize lots of problems down the track.  Obviously in the early days when your baby is still developing their habits, it is important to try and minimize poor sleeping habits. However, at the same time, it is also important to give them lots of love and affection to ensure they develop a good sense of security and attachment to their parents.  I help new mums find this balance of loving but also encouraging their baby to be able to eventually self sooth. By 3 months if you have been monitoring your baby’s sleep, you should start to see a routine forming, especially in terms of their nap times. At 5 months your baby’s habits are more fixed and harder to change, so if they have learnt poor sleeping habits parents will most likely need the help of a sleep consultant in order to correct them.

Pharmamum: I think a lot of parents thinks sleep consultants are like an angel sent from up above, a life saver, they are able to get parents through their darkest hour, the sleep deprived, exhausted,  almost non-functional stage.  Do you find you have a good success rate with parents and what sort of feedback do you get?

Natalie: I have to say that yes to date I have had a very good success rate with my past clients. Mostly due to the fact that I am an avid perfectionist and couldn’t bear to separate from a family if I knew their baby was still not sleeping well. It would literally keep me up at night!  Many parents believe I really have saved their life, their marriage and their sanity. I really do understand them. If I had no alone with my husband and I had to get up on the hour every hour, I would turn into a very dark and depressed person. I make parents see another way; that it doesn’t have to be so bad, that they can enjoy ‘the gift of sleep’. That it is ok and normal to ask for help when you literally do not know what to do in order to get your baby to sleep. By normalizing their feelings, they feel comfortable to work with me.

Pharmamum: What did you find most challenging with your child’s sleeping patterns and how did you overcome them?

Natalie: I am glad you asked this question as many parents see sleep consultants as a kind of super nanny with perfect children who are dream sleepers. And whilst my daughter does sleep well now, it did take a lot of work and effort, especially in the early days. The worst time I had in regards to her sleep was when I returned home after a short few days away. She was 2.5 years at the time. Initially I thought all was ok, but on that first night back, it all came out. Clearly she had been internalizing her fears and anxieties while I was away and when left alone in her room felt the need to express her emotional distress. I understand now that she was scared I wouldn’t be there when she woke up in the morning and no level of sleep training or hard lessons would have helped to get her back to sleep. What she needed from me was comfort and emotional support.  This was a very hard phase for us, with her waking up every night for hours at a time. Often during these times you need to put yourself in your child’s shoes and try to understand what kind of help they need from you. Also, it’s very important to know these phases will not last forever. What I recommend to do, is to give your child what they need at the time and once they are calm and settled to resume your normal routine and ensure you don’t start developing poor sleeping habits.

Pharmamum: Nat, I’d love to ask you a few questions that probably every mother listening would love answered:

At what point is it ok to settle our babies back to sleep instead of feeding them?

Natalie: In Australia it is recommended that from six months of age, babies who are developing well no longer need night feeds. According to the Health Ministry here in Israel, from 7.5KG, as long as your baby is consistently putting on weight and eating well during the day and getting the calories they need according to their age, they no longer need to eat during the night. In the early months you should aim to feed every 4-5 hours and re-settle your baby at other times when they wake up at night. Gradually as your baby gets older you should try and stretch this out till 5-6 hours and then eventually leave them once they are sleeping through.

Pharmamum:What are your thoughts on ‘roll over feeds’ should we really wake our baby up to feed?

Natalie: I definitely support the idea of a roll over feed or more commonly known as a ‘dream feed’. When it works, it works like a charm. The idea is that you are implementing what is known as ‘pre-emptive feeding’. Which means, that you are pinpointing a specific hour at night (usually from 10-11pm) where you are feeding your baby, rather than relying on them to tell you. The dream feed is best during these hours whilst your baby is in their deeper stage of sleep and less likely to wake up, rather than the early hours of the morning when they are in a light stage of sleep. Eventually if you are consistent and feed at the same time each night, the idea is that your baby’s stomach will get used to eating at this hour and will not ask for a feed at another time during the night. I also recommend it, as often it ensures your baby will sleep for longer stretches at night. Just make sure to burp your baby after.

Pharmamum:What are your thoughts on dummies? I know in the sleep schools they have here in Melbourne, the minute you get there, they get rid of all dummies? I know personally I wouldn’t have survived without dummies for my children.

Natalie:I am a fan of anything that helps your baby to self sooth. So a pacifier, a thumb and a lovey are all great tools to help your baby to get to sleep on their own and to ensure they sleep for longer periods.  If your baby is showing signs of either being a pacifier or thumb sucker, you should aim to go with them and not force them to take a direction either way.

Pharmamum: Before we finish up, what would be the single most important piece of information you could give to a first time mother about to have a baby or just had a baby in relation to their child’s sleep?

Natalie:Never keep your new baby up for longer than 1-1.5 hours during the day until they are about 3 months old. This includes feeding, changing and burping. A new baby cannot handle too much awake time and keeping them up for too long will mean it is very difficult to get them to sleep.

Pharmamum:Natalie, if any of our mums are interested in learning more about you and your business, where can they go?

Natalie: You can follow me on Facebook at Natalie Herman Baby Consultant & Sleep Specialist.

or If you would like to hear more about myself and my services, you can go to

W: www.natalieherman.com

or email me at:

E: nataliehermanbaby@gmail.com

P: +972 50 595 9156

 

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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.

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.

Constipation: With these practical tips, this too shall pass.

 Pharmamum’s Ultimate Guide: Constipation for first time mums

As a change of pace I want to discuss a common health concern amongst mothers with newborns. This health concern requires prompt management and needs to be addressed, otherwise it can lead to a lot of pain and be very distressing. Often, we concentrate on our baby’s health and at the back of our mind, think ‘I’ll deal with my issues later.’ We need to keep ourselves healthy in order to look after our babies.

Constipation is very common once we have given birth. Whilst we are getting used to managing our baby’s health as well as our own health, there are many reasons constipation can occur and not only in breast feeding mothers. If we allow constipation to continue, it can lead to potential straining, pelvic floor issues and potential tears around the anus called ‘anal fissures’. Anal fissures are common within the first 6 months of giving birth and can be prevented if we manage constipation effectively.

Why is constipation such a problem?

Constipation can occur initially once we give birth. We often dread our first bowel motion after birth due to a number of factors:

  • Pain medication given during labor which  may slow down our gut processing speed.
  • Tears/stitches in the region
  • A  change in hormone levels

All these factors increase the risk of constipation mainly by slowing down the pathway to passing a bowel motion.

Constipation can occur whilst breastfeeding due to a lot of fluid transferring to baby. When we become dehydrated, our bodies first draw on the fluid from the bowel, causing our bowel motions to dry up and become firm. Hence, it is extremely important to drink plenty of water whilst breastfeeding. If you notice every time you sit down to breastfeed, you feel thirsty, this is because your body is signalling you to replace the lost fluid that your baby is consuming. Whilst breastfeeding the progesterone levels are high and this hormone is also known to slow the bowel motility and hence allow more opportunity for the body to absorb fluid from the bowel motions.

Time: When we are so focussed on our babies, we become time poor and often forget to drink enough water. It is very common to have a headache in the early days, and that reason is often due to dehydration and  not finding the time to replenish our fluid. Try and carry a bottle of water  wherever you go and also have a large glass of water next to your bed over night. I found I had to have a large glass of water with me every time I breastfed, otherwise I felt uncomfortably thirsty.

Fibre: Same applies with eating, we often eat whatever is quickest and easiest in those early days, but it is really important to eat well and have a nutritious diet. Our bodies need fibre to pass through our digestive system, as well as protein rich food and ‘good fats’ to also ensure good quality breast milk.

Iron supplements- Your doctor may have you either continuing on an iron supplement from pregnancy or you may require an iron supplement after giving birth if a lot of blood loss occurred. Your obstetrician and local GP will let you know whether you need to take an iron supplement and many iron supplements can cause constipation. There are many brands of iron that have an improved  formulation to prevent constipation and ensure the iron is absorbed and not excreted in the bowel motions. An easy test to know if the majority is passing out through our bowel motions is if the colour of our stools are almost black.  I am fan of Ethical nutrients Iron Max, Spatone, or Bioceutical Iron sustain. These formulations are easy to absorb and won’t cause the side effect of constipation.

So what can I do to help relieve constipation?

Water: is one of the most important factors in preventing constipation. Minimise fluids that are dehydrating ie coffee, tea, other caffeinated drinks eg. Coke, pepsi max etc.

Fibre: Try and eat fibrous foods, ie plenty of fruit and vegetable, cereals, wholemeal bread or pasta. However it may be worth supplementing with a fibre supplement eg. Metamucil, Benefibre, Fybogel which are all  safe whilst breastfeeding.

Gentle exercise: Light walking can get the bowels moving and make it easier to pass a motion.

Medication: Stool softeners (eg coloxyl tablets )and osmotic laxatives (eg Lactulose) are safe to use at the recommended doses while breastfeeding until the bowel motions are soft. Stimulant laxatives are not recommended such as senna (eg. Senokot) or bisacodyl (eg.Dulcolax). They may pass into the breast milk and cause diarrhoea in your baby. Ensuring the stools passed are soft will prevent painful bowel motions. Painful bowel motions can lead to tears around the anus causing an anal fissure. If you find when making a bowel motion, there is extreme sharp pain and you break out in a sweat when making a bowel motion, you most likely have a tear in the anus. It is important to see your doctor and get it diagnosed, and your local GP will recommend a cream which aids in the pain relief and will  assist in wound healing. The medication applied is different  to creams used for hemorrhoids. Hemorrhoid creams will not treat an anal fissure.

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.

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.

Can i do anything to help my babies cough? Here’s what you can try

Pharmamum- Cough

 

Pharmamum’s Ultimate Guide: Cough

I went to the doctor today with my 4 year old daughter. For the last 4 days she has been coughing and coughing to the point it has caused her to vomit. My doctor said it was viral and there is not much you can give a young child with a cough. It will just subside on its own.

As a pharmacist and a mother of 2 under the age of 4, I am continually being presented with coughs, from my own children as well as giving advice to parents wanting to know what to do with their children’s cough.

In 2012, the Therapeutics Goods of Australia changed the recommendations for cough and cold preparations as a result of a review of safety and efficacy for over the counter cough and cold medicine used in children. It was found that these medicines may cause harm to children  and the benefits have not been proven for children under 6 years of age.

When you think about why a baby/child has a cough and what their little bodies are trying to do, it is obvious that they are trying to clear and expel what is irritating their airways. If you give your child a cough suppressant, it will suppress your baby/child’s cough and stop  what their body is trying to do.

So what causes a baby/child  to have a cough?

Virus- Both bacterial and viral infections can cause a cough however the most common reason a baby has a cough is due to a virus causing an upper or lower respiratory tract infection.

Asthma -Asthma will not be formally diagnosed until your child is 5 years old. However around 70% of children have intermittent asthma, which means they have short, isolated episodes of asthma, usually in response to a respiratory infection or environmental allergen.

Post nasal drip– A cold/flu may start out as  congestion in the nasal passage and then often the  excess fluid will drip down the back of the throat, irritating the airways and causing a cough. Often by the morning a phlegmy sounding cough arises, as the body is trying to expel the buildup of mucus.

Irritants- Cold air, cold food eg. milkshakes, ice-cream all constrict the airways and trigger a cough. Other Irritants  eg smoke and allergens eg. pollen also can a trigger a cough.

So when a parent comes in to the pharmacy, what advice do I give them? I give the advice that works for me with my children:

1.Hedera helix (Ivy leaf extract) – There are a few different brands currently on the market eg Prospan and  Little coughs. Prospan is more concentrated than Little coughs. With my eldest daughter Prospan causes her to vomit whereas my youngest can take it with no ill effects. However they both can take the less concentrated Little Cough liquid with no side effects. In 2% of children, Ivy leaf extract can cause vomiting or diarrhoea, it is worth trying as it has been proven to be effective. Ivy leaf extract does not suppress a cough. It loosens mucus so that your baby/child can cough up the mucus and get it off their chest. It also has a soothing effect on the airways  and stops the cough that ‘hurts’  whilst relaxes the airways. It can be used in infants and children and is the only cough medicine available and safe for children under 6 years of age.

2. A vaporiser- A vaporiser won’t necessarily stop a cough but it adds moisture to the air in your baby/child’s room. This allows your baby to breathe more comfortably and stops the cold dry air hitting the airways, which often triggers the airway to constrict and cause your baby/child to cough.   I recommend just water in the vaporiser as the steam generated is what makes your baby/child breathe easier. I would not recommend the use of menthol/eucalyptus inhalant liquids in the vaporiser until your baby is over 2 years of age for the relief of nasal congestion. Once eucalyptus is added to a vaporiser, always keep the door open to prevent  the eucalyptus concentration building up in the room.  I would also recommend on those cold nights, if you have heating, to make your child’s bedroom temperature around 19-20 degrees, just for the same reason, it stops the cold air hitting the lungs and tightening.

3. Baby Vicks eucalyptus rub-  Rubbing the Vicks on your baby’s feet and putting socks on, really helps a cough. I honestly don’t know how it works but whenever I rub it on my children’s feet, they often have a better nights sleep with a lot less coughing. Vicks BabyBalsam is also great on the chest so the vapour can help a blocked nose. Vicks BabyBalsam can be used  from 3 months of age.

4. Speak to your doctor- If the above options are not helping, I would recommend speaking to your family doctor, as once they listen to your baby/child’s chest they may recommend an inhaler that will open  and relax the smooth muscle in the airways and/or an anti-inflammatory inhaler. Sometimes oral medication may be prescribed too ( eg a corticosteroid liquid). Often when a baby/child has a virus they can get what is called a ‘post viral asthma’ where the body produces mucus to try and kill the virus and remove it from the body. This mucus production that sits in the airways narrows the airways causing them to constrict. An inhaler relaxes the smooth muscle allowing your child to breath easier and obtain more oxygen. If an inhaler is recommended, a spacer with a mask is important to use to ensure the medication gets to the airways. Obviously a baby would not understand to breath in through the mouth,  so using a mask will ensure your child/baby  will be breathing in the medication and it will reach the lungs.  Once the airways are relaxed, you may notice your baby coughing  more initially, as the mucus loosens and expelled.  Your doctor will also need to assess whether antibiotics are required. Most commonly a cough is due to a virus and antibiotics will not help, however your doctor will need to gather information from you and make an informed decision.

Unfortunately there is no way of preventing a cough and a cough can often linger on for a couple of weeks after a cold/virus. However if a child is otherwise happy and going about their daily activities with no problem whilst their cough persists, then there is no cause for concern, the cough will pass. However if there are any of the following symptoms, it is very important to see your local doctor:

  • Your child has difficulty in breathing and you are hearing a wheezing sound on their breath out
  • When your child  coughs, there is a ‘whooping’ sound on their breath in.
  • Your child gets out of breath when coughing
  • Your child’s cough comes on suddenly with a fever
  • If your child’s skin turns very pale or even a blue colour whilst coughing
  • The cough is just not going away

Other tips:

  • You can give a baby older than 1 year, a teaspoon of honey which may give some short term relief by coating the lining of the throat which acts as a barrier to irritants.
  • Give your child warm (not hot) drinks.The warm liquid will often help soothe the airways.
  • Avoid cold drinks and ice cream, as you will notice it sets off a cough.
  • Avoid air conditioners, this will often exacerbate a cough.

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.

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.

Baby sleep tips for first time mums, Interview with Natalie Herman

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 Show Episode 2: Baby sleep tips for first time mums, Interview with Natalie Herman

  • Baby sleep tips for first time mums
  • Interview with Natalie Herman (Founder, Natalie Herman Baby Consultant & Sleep Specialist)
    www.natalieherman.com

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.

Continence and Women’s Health for first time mums, Interview with Hayley Sternson

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 1st Podcast Episode: Continence and Women’s Health for first time mums, Interview with Hayley Sternson

As a change of pace, Pharmamum is proud to present its FIRST podcast episode, which covers Continence and Women’s Health issues for first time mums through an interview with APA Physiotherapist Hayley Sternson.

 

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.

Your easy to digest guide to constipation

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: Constipation

I feel I have had my fair share of constipation issues to deal with as a parent. Both of my daughters caused me a lot of stress with  their bowel habits but thanks to them and my knowledge as a pharmacist, I will be able to pass on what I have learned and provide you with good practical advice with how to treat and hopefully prevent constipation.

It’s amazing when your child is born, besides worrying about the most obvious feeding and sleeping issues, I’d say the next most common concern is about the child’s bowel habits? Is my child opening their bowels enough? Is my child constipated? Are you sure that is what a baby’s poo should look like? Is it too green? Too yellow? Too much? How much can one little baby poo? We seem to discuss our children’s poo quite often at mother’s group, as if we are discussing the weather.There is always one baby that opens their bowel at every nappy change and then one like my eldest  daughter, would open her bowels once a week.

When your baby is born, your baby’s first bowel motion (meconium) is a black, thick, tarry looking excretion.  Once the meconium is out, the bowel motions tend to become thinner, lighter and watery excretion.Your baby should have a bowel action within the first 24-48 hours after birth. If they don’t it is important that they be seen by a doctor. Depending on whether your child is breastfed or formula fed will determine the consistency, appearance and odour of the bowel motion. If breastfed, the bowel motion is more watery, light brown mustard colour, not much of a smell and easy to remove. Stools can be greenish in colour and that can be perfectly normal too. Formula fed babies have stools that can range in colour from yellow green and brown (depending on which formula they are on) , thicker, pastier, and a stronger smell. I  had a combination of both. I breastfed my children, but needed to top up with formula, so I had a combination of bowel excretions.  It does depend on your baby’s gut processing speed as to how often your baby’s bowel opens. Both of my children were very slow with their gut processing and this led to very infrequent bowel motions.  I remember with my eldest daughter, once we got home from the hospital, her bowels would open every 1 or 2 days and then it began to slow down and would open every 3 to 4 days, and then between 2 and 4 months of age her bowels  sometimes didn’t open for up to 10 days. To be honest I was freaking out by that stage, but every maternal nurse, doctor, paediatrician I asked, gave me the same answer. That answer was, ‘some’ babies poo 12 times a day and that is perfectly normal and some babies poo once every 12 days and that is perfectly normal.’ I had two babies that opened their bowels every 10-12 days and I learnt that that was perfectly normal. That put my mind at ease, but when they finally opened their bowels, they would go bright red in the face and look like they were really straining. However, the bowel motion was always soft. When babies are getting use to making a bowel motion they can often go red in the face, grunt or even cry and still produce a soft bowel motion. Long periods between stools in a baby who is generally well, putting on weight and thriving is not a cause to worry. As long as the baby’s tummy feels soft, they are not distressed or consistently crying, and the stool produced is soft. The important thing to understand is that even though a baby may only have a bowel action every 12 days, it is not considered  ‘constipation.’ A baby/child is only considered to be constipated if their bowel motions are very hard and firm and described as passing ‘pebbles’.

It is very unusual for breastfed babies to be constipated unless there is a medical problem (eg. Milk protein allergy, hypothyroidism,coeliac disease). This is because breastmilk is easy to digest and there is a hormone in breast milk that stimulates bowel contractions. Formula fed babies can become constipated on formula for a few reasons:

  • Formula preparation– each formula requires a different amount of water to make up the formula. It is important to always check, because if not enough water is  added, that can lead to constipation and dehydration.
  • Depending on the infant formula, the ingredients and the ratio of proteins ie. whey to casein, can all affect how your baby digests the formula. Most formulas are whey dominant which is easier to digest than a casein dominant formula. Casein dominant formulas are harder to digest and hence will move slower through the bowel, allowing more fluid to be reabsorbed, which can lead to constipation. As the casein is slower to digest than whey protein, it may keep baby’s tummy full for  longer. Every baby is different and sometimes it really is trial and error as to which formula is right for your baby. As a mother you can tell if your child is comfortable on the formula. However, it can be very hard in the early days as sometimes it can be a multitude of factors ie colic, reflux etc. Constipation may be caused by a milk-protein allergy or intolerance. If your pediatrician/GP diagnoses your baby with a milk-protein allergy they will switch your baby’s formula to one that isn’t milk-based. I would always recommend consulting a doctor before switching formulas.

Once a baby starts solids, it can be a time where the bowel habits change dramatically. Going from a liquid diet (ie breast milk or formula) to introducing solids, your baby’s digestive system needs to ‘up its game’ by working out how to digest and breakdown food in the form of a solid.  The body needs ‘to learn’ how to digest the food that is being introduced and there may be some initial problems’ in the form of constipation. You may start to notice that you see certain foods that have been partially digested and you can recognise them in your baby’s bowel motion.  Babies can become constipated when starting solids because as the food is making its way through the intestines the body will  absorb the nutrients and the water content. The longer it takes for certain foods to make its way out of the body, the more opportunity the body has to absorb the water content for the solid. My daughters both suffered with constipation when starting solids. What I learnt from treating their constipation and trying to avoid further bouts of constipation was:

  • Keep offering water. Try and have a sippy cup always on hand offering sips of water in between normal breast/ formula feeds. I was recommended that once I made up the formula using the correct amount of water, to add an extra 10mL of water just to increase the fluid content. I would never recommend diluting formula any further as then it compromises the nutritional needs of your baby. It is preferred to offer sips of water in between feeds.
  • Certain foods are binding and can increase the risk of constipation in babies and others may promote a loose bowel action. What I found over time was depending on the consistency of  my childs bowel actions, determined what foods I would add or avoid in their diets to either try and make the stools  firmer or looser. Finding a balance is important.

Binding foods:- Rice cereal (Rice is binding and all rice cereals are  fortified with iron which can cause constipation), Bananas, the starchy vegetables (eg.potatoes and sweet potatoes), apples, white bread and rice. Too much dairy can also lead to constipation.

Foods that can speed up gut processing: stewed Prunes and apricots, Pears, Kiwi fruit, peaches, plums,  diluted prune juice (small amounts), green fibrous vegetables (eg broccoli, beans, brussel sprouts, zucchini). Fibrous foods (eg wholemeal pasta, brown rice and fruits such as blueberries, grapes, raspberries and strawberries are all high in fibre.

I was never able to give my daughters rice cereal because of its constipating effect. I needed to make my own baby cereal by blending oats and millet and then cooking it and mixing it with pureed pears and prunes etc.

  • As soon as you notice your baby is constipated, the quicker it is resolved the better. You don’t want to get to the point where the bowel motion is so hard, that an anal fissure occurs which is a little tear in the anus. Anal fissures are painful and you don’t want your baby associating a bowel action with pain as this will set up fear and anxiety when passing stools.

If your child is constipated and under the age of one, it is important to speak to your baby’s doctor immediately with any of the following symptoms:

 

  • Constipation with a hard belly and vomiting
  • Passing blood in bowel motions
  • Tear or soreness around the anus
  • Looking unwell
  • Reduced number of wet nappies in a day
  • Constipation with poor growth and development

Once you have seen the doctor and they have checked for any serious health problems, they may recommend the above remedies (eg increased water and diet) as well as some medication to soften the bowel motions or help encourage the stool to be excreted. What happens is a hard dry stool forms at the anus and once that has passed, the faecal matter that follows is loose. Hence, you may need to treat both orally and anally. The aim is to have your baby’s bowel empty and keep it empty by maintaining soft lubricated stools:

  • Infant glycerol suppositories can be used once a day. They are very small rocket shape suppositories that you can insert into the anus. A bowel action can occur within 5-30 minutes. If that initial stool is really firm,passing it may cause your baby  to be in pain. I would also recommend applying some vaseline on a clean finger around the anus to help stimulate the bowel to open.
  • Coloxyl Drops contain a stool softener called poloxamer. The drops can be used in infants and can be added to bottle feeds or diluted fruit juice.  They help soften the stools.
  • Lactulose can be given orally to infants from one month old. Lactulose works by drawing in fluid into the abdomen to soften the bowel motions. It is very sweet and can be mixed in water, milk or dilute fruit juice.

Usually constipation will settle within 2 to 3 months of starting solids.

Any medication given orally can take 1 to 3 days to work, however once the bowel motions are loose and your baby can comfortably produce a bowel motion without straining, any association of pain with excreting a stool will soon disappear.

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.

Is breastfeeding a skill we’re born with? or is it something we need to learn?

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

When I think back to when I first breastfed my eldest daughter, the first thought that comes to mind was, ‘I really had no idea what I was doing’.  I remember when my beautiful baby girl was placed on my chest and then moments later, the midwife said, ‘Ok let’s give her a feed’. At that point, I  thought, ‘I’ve been pregnant for 9 months and I didn’t even think once, to do any research on breastfeeding’. My plan was to get through the birth and then worry about breast feeding. And that’s exactly what I did, I worried a lot about breastfeeding for at least the first 6 weeks, because for me, it didn’t come naturally. I needed a lot of education.

I think it took approximately 5 to 6 weeks to feel comfortable breastfeeding. From dealing with attachment issues, bleeding and cracked nipples to mastitis, nipple thrush and vasospasm, looking back I think I had it all. The following post will deal with many breast feeding challenges, how I dealt with these issues personally and as a pharmacist, I want to share with you, the products that can help with treating these common problems.

Attachment issues

From the minute I started breastfeeding, I struggled with attachment. For the first couple of weeks,  I constantly had to place my daughter Sophie on the breast, and then take her off, as she often, would not have enough of the nipple in her mouth and nor was she getting enough breast milk whilst attaching poorly. Whenever Sophie would start suckling, I was in pain, it felt like she was just clamping down on the nipple, so I had to gently break the seal with my pinky finger and take her off the breast and try again. I would often see the tip of my nipple with a red line down it, illustrating that she was not positioned correctly. On the positive, I was in hospital and had the constant support of the midwives  watching over and helping me to become confident with attaching Sophie correctly to the breast. Every midwife that observed, had an extra tip and this really helped. However, by the third day, my nipples were starting to bleed and I was in so much pain I was advised just to give the nipples a break and express for a day, to allow them to heal.

What I learnt:

  • The baby’s mouth needs to cover as much of the areola as possible ( more so on the baby’s lower jaw side) to drain the breast well.
  • The chin should be pressed into the breast and ensure the nose is clear to breathe freely.
  • The babies head should be tilted slightly back, at the same level as your breast.
  • Their  nose should be level with your nipple.
  • The babies lips should be flanged out.
  • The baby’s upper lip should be touched by your nipple as you begin to breastfeed. When baby opens the mouth wide, place on the breast, and aim the nipple towards the roof of their mouth.
  • Keep your breast compressed in your hand until the baby is actively suckling.

By ensuring all of the above is performed whilst breastfeeding, there should be no pain.

Treating sore, cracked and bleeding nipples:

Once you address the problem of attachment and correct positioning with the help of a lactation consultant or midwife, the nipples will begin to heal. There are products that can be used in the meantime to soothe and speed up the healing:

  • I found the best treatment for my sore nipples was hand expressing a few drops  of breast milk and spreading it over the sore nipples. Breast milk has wonderful healing properties as well as anti-bacterial properties and works really well to soothe sore cracked nipples. Just allow them to air dry before putting the bra back on.
  • Lanolin eg Lansinoh is a an ultra purified grade of Lanolin. It soothes and protects sore cracked nipples and provides a moist wound healing environment. Applying Lansinoh on the nipples when they are cracked and sore can be difficult as the Lansinoh is a thick waxy substance and at room temperature can be difficult to spread. With clean hands, warm a pea size amount by moving it around between your fingers, this will make it easier to apply. Lansinoh does not have a smell or taste to it and can be applied after a breastfeed. It is not necessary to wipe it away before a breastfeed. A small percentage of people using lanolin may have a reaction. It will occur if you are sensitive or allergic to wool. I always recommend doing a skin test and  applying a small amount to the skin, even if it is on your hand just to test that you are not sensitive to it. However Lansinoh’s lanolin formulation  have removed the part of lanolin that most people are sensitive to.
  • Hydrogel soothing pads provide cool soothing relief to sore nipples. They help heal damaged nipples and are placed directly on the nipples in between feeds. You can place them in the fridge before applying them to the nipple and that will provide cooling comfort and reduce inflammation. They also provide a barrier to the nipple, so that the nipple is cushioned and not rubbing against the bra when sore and irritated. The pads can be reused and  rinsed with warm water in between use. There are a few different brands available eg Mother’s mates, Dr Brown’s hydrogel soothing pads and Rite Aid. I found them to be really soothing in between feeds.

Mastitis

When I got home from hospital with my baby daughter, my milk had not come in yet. I had my daughter on a Tuesday and by Sunday my milk finally came in. My breasts that evening suddenly became engorged, they were red, felt  lumpy  and I had a fever. I rang my obstetrician and he mentioned to me that a fever can occur when the milk is coming in, but come to his rooms the next morning and he will check for mastitis. My obstetrician confirmed it was mastitis and gave me a prescription for an antibiotic. He said, it is important to start the antibiotics straight away. Mastitis often comes on quickly and it can feel like you are coming down with the flu,  feeling feverish and unwell.  It is an infection caused by a blocked duct that has not cleared properly. The milk is banking up and going in to the breast tissue causing inflammation which gives the breast a red appearance  and often the skin can appear shiny. The breast becomes hot, very sore and inflamed.

Treatment:

  • It is imperative to get treated for the infection with antibiotics as soon as possible, within 12 hours.
  • Often one’s first reaction is to want to leave the breast alone, because it is so painful, however that will only make the infection worse. The milk ducts needs to be cleared and by getting your baby to breastfeed on the infected side will help drain the breast best. It is perfectly safe for your baby to drink from the infected side. To clarify, the baby cannot catch the infection as any bacteria in the milk will get killed by the digestive juices in the babies tummy.
  • It is important to breastfeed more often (approximately every 2 hours) alternating breasts with each feed but do try and feed from the infected side first because often the babies suck will be stronger initially before the baby gets tired.
  • Your baby  may be hesitant to drink from the affected breast just because it feels different eg harder and lumpier, and may be a little more difficult to feed from, but not because the milk tastes differently.
  • The breast must be drained often and the baby is best at draining the milk from the breast, however if the breast is too painful to feed from, express with an electric pump for less pain and feed baby using a bottle until feeling better and more comfortable.
  • Keep massaging the breast in the direction of the nipple to encourage the clearing of the blockage and ensure the milk flows in the right direction. Gentle pressure behind the lumpy area may help clear the blockage too.
  • In terms of whether to use ice or heat:

Heat: Apply a heat pack about 10 minutes prior to breastfeeding to help the flow of milk. You can use a hot water bottle, a wheat pack, or even sit in a warm/hot bath.

Ice: Apply ice immediately after a feed, for pain relief. Don’t place ice directly on to breast, ensure you wrap an ice pack in a tea towel and place it on the affected area. A cabbage leaf can be placed in the bra to also give some pain relief.

  • It is worth waking your baby to feed from the breast, however if your baby is too tired or not interested, then express as often as you need, until you feel comfortable.

Drink plenty of water and rest as much as possible to recover quickly.

Paracetamol and Ibuprofen can be taken when needed for pain relief. They are both safe to use whilst breastfeeding.

Some breastfeeding mothers may not experience a fever or flu like symptoms when they notice a clogged or blocked duct in their breast. They may feel an area that is tender or a knotty hard lump in the breast where the milk duct is not draining well. It can become sore and inflamed. The blocked ducts do need to be addressed quickly to avoid developing mastitis, which is where the above symptoms are accompanied with fever, nausea, and flu like symptoms. If the milk flows freely and the bacteria is flushed out, then the bacteria doesn’t have the opportunity to multiply. However if the milk stagnates, the growth of bacteria can occur in the ducts. Hence, the above dot point treatment plan for mastitis apply here as well, feeding frequently and draining the breast completely along with massage and heat  to ensure those hard lumps/areas do not progress to mastitis. Women’s health physiotherapists also offer an effective treatment using ultrasound which can relieve the symptoms of breast engorgement, blocked ducts and mastitis.

I was recommended by a GP who was also a lactation consultant to give my new born baby probiotics after my course of antibiotics as a small amount of the antibiotics would pass through my breast milk to the baby. Occasionally, a rash and disruption of the baby’s good bacteria in their digestive tract can result in diarrhoea or thrush. Bioceuticals make a probiotic that can be given to infants including ‘premmies’ called Baby Biotics and Inner health make a probiotic powder that can be given from three months. They contain the most common bacteria present in the gastrointestinal tract of healthy breastfed newborns and infants. Both can be mixed with a small amount of breastmilk and made into a paste and tiny amounts placed in their mouths, or on the mother’s nipple for the baby to consume whilst breastfeeding. Obviously be mindful of the risk of choking and only place it in their mouths when they are awake and in an upright position.


Nipple thrush

When you hear the word ‘thrush’ most people  think of  itching and discharge. However, those symptoms are not present in nipple thrush and the symptoms are completely different to  vaginal thrush. Nipple thrush is a fungal infection and extremely painful. Nipple thrush can occur after a course of antibiotics  or after nipple damage, ie where cracks in the nipple and/or bleeding occur. The warm, moist environment is a good breeding ground for a fungal infection. I remember personally suffering with nipple thrush, however due to the trouble I was having with attachment and pain when breastfeeding, I remember thinking, ‘what’s this stinging feeling? Is this normal?’ I thought maybe it’s my body reacting to the constant breast feeding followed by expressing to try and increase my milk supply.  That stinging sensation became worse, and I felt it more so after I finished each breastfeed. I made an appointment with a lactation consultant who happened to be a doctor as well, and she diagnosed nipple thrush but thought I  may also be suffering with nipple vasospasm.

Symptoms of nipple thrush include cracked nipples which don’t heal,  Nipples can be pink/red and shiny, with or without white areas on the folds and there can be a burning sensation as well. Thrush on the nipples can enter the milk ducts which can cause deep breast pain. Thrush pain lasts while your baby is feeding and usually gets worse after feeds. I remember in the middle of the night feeds, going back to bed and lying there in agony because the stinging sensation after feeding was unbearable, and I could feel the sting all the way to the top of the breast.

Treatment:

Nipple thrush includes treating:

1)the surface of the nipple

2)the baby’s mouth

3)Oral treatment for the  mother (if the pain is deep within the breast.)

In order to get pain relief the above three areas need to be treated at the same time, to avoid passing it back and forth, from mother to baby.

The surface of the nipple– Can be treated with an anti-fungal cream e.g. Miconazole 2% (Daktarin, Resolve). Apply a thin smear of the cream to the whole nipple after each feed. Before a feed, just wipe away any excess cream but it is not necessary to wash the nipple before breast feeding.

The baby’s mouth- There are anti-fungals that can be given to infants to treat oral thrush, eg. an oral gel (Daktarin oral gel)  or drops (Nilstat or Mycostatin oral drops). They both have to be used four times a day and after a feed. I prefer to recommend the oral gel to a baby as the gel can be applied to the affected area and stays around in the mouth for a longer period of time. The drops can miss the affected areas and just be swallowed. It is safe to swallow both products. The manufacturer of  Daktarin gel states, it can be used from 4 months up and that is because it comes with a measuring spoon and the concern is the risk of choking. It is recommended to measure the dose on the measuring spoon but not to put the spoon in the baby’s mouth, rather using a clean finger apply a small amount on the affected areas of the mouth, usually the tongue or you may see plaques along the inside of the cheeks. It is recommended to treat the baby until the symptoms are gone and for two days after.

Oral treatment for the mother- Your doctor will write a prescription for an oral anti-fungal tablet to take which is safe whilst breastfeeding. Complete the course and by the end of the course the pain should have subsided. If it has not, obviously speak to your doctor.

Thrush grows in a moist warm environment so try as much as possible to keep the nipples dry, by changing breast pads often. Wash bras and towels in hot water. Canestan also make an anti-fungal wash that you can purchase from any supermarket. You can put 1-2 capfuls in the washing machine to kill any fungal species.

Nipple Vasospasm

Vasospasm is when the blood vessels in the nipple constricts and spasms causing an intense pain in the nipple and often the tip of the nipple can turn white from pink. Nipple thrush and nipple vasospasm can often be difficult to differentiate. They both cause a burning sharp stinging pain in the nipple and often an infection or nipple damage can trigger vasospasm. Often the vasospasm is first treated as Nipple thrush to ensure there is no infection and then if the vasospasm continues to occur, it is recommended to ensure the nipples are not exposed to cold air which is the main trigger. Often after the baby finishes breastfeeding and the nipple is exposed to the cold air, vasospasm will occur so breast warmers  can help. They can sit in the bra and the heat will just relax the blood vessels and stop the pain. They can be purchased through the breastfeeding association of Australia. Rubbing olive oil directly onto the nipples has also been shown to help. It can reduce the frequency of the nipple spasms and can also settle the pain quickly. Supplements like fish oil or evening primrose oil  and magnesium (eg 300mg twice daily) are also recommended  to help relax the blood vessels. If the above methods are not helping, last resort, your doctor can prescribe medication which stop the vasospasms from occurring.
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.

With spring just around the corner.. Here’s Pharmamum’s Ultimate Guide to Hay fever for immediate relief

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.

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From wet dressings to natural skincare we’ve got you covered!

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: Eczema (Part 2 of 2)

Wet dressings for Eczema

It is often thought, wet dressings are used for severe and infected eczema! Wrong! Wet dressings should almost be first line treatment. Wet dressings are essential when your child is itchy and hot. Wet dressings keep the skin cool and reduce the itch. They help hydrate the skin, keep the skin protected from trauma, and they are extremely helpful if your child scratches during the night, to the point blood is drawn. Wet dressings can be applied as often as needed and should be taken off before they are dry or first thing in the morning when your child wakes up. Wet dressings also help keep the skin clean when the skin is infected. Applying wet dressings as soon as the skin flares up, reduces the amount of cortisone creams required to control the eczema.

According to Melbourne’s  Royal Children’s hospital the recommended method to apply wet dressings is:

  1. Wet disposable towels in a bowl of tepid water and add one capful of bath oil.
  2. Apply cortisone or tar creams, if they are due to be applied.
  3. Apply moisturiser to the body and face.
  4. Wrap the wet towels around the affected areas gently,using a few layers.
  5. Wrap crepe bandages around the wet towels, firmly but not tightly. Avoid direct contact with the skin.

Wet dressings can also be applied to the neck, as a scarf or around the scalp and forehead, as a bandana. Children should not sleep with the scarf or bandana on, and should  be supervised whilst wearing them.

Signs of infection:

Bacterial and viral skin infections are more common in eczema sufferers. This is due to breaks in the skin from dry, itchy skin. Signs of infection are:

  • the skin has blisters, pustules or dry crusts
  • skin weeping a clear or yellow fluid
  • there is reddening, itching, soreness and sudden worsening of the eczema
  • yellow pus spots appear
  • generally feel unwell

If you think the eczema is infected, you should go to your family doctor and your doctor will either swab the infected area and/or start your child on a course of antibiotics. If there are areas of crusts, it is very important to remove them to treat the infection properly. To remove the crusts it must be done gently. Soak a face cloth in warm water and apply it to the crusted area for 5-10 minutes. The crusts once softened should be gently wiped away. If the crust does not gently come away, the area needs to be soaked for a longer period of time. Ego QV produce a bath oil called QV flare up bath oil that can be used when the skin is infected or at risk of infection. It contains an antibacterial to reduce the level of bacteria on the skin, and an oil which provides a thin film to maintain the hydration in the skin.

Remember:

  • Treat a flare up as soon as possible with wet dressings, cortisone creams and moisturisers
  • Maintain healed skin with moisturisers and bath oils.
  • Do not use skincare  products that contain sodium lauryl sulfate as they can damage the skin barrier and cause irritation
  • Keep your child cool, dress them in loose cotton clothing
  • Try and control scratching by using methods of distraction. Keep fingernails very short and consider using cotton gloves or mittens on the hands oven night.
  • If your baby sucks a dummy and the saliva irritates the skin, apply a moisturising ointment eg. Dermeze  around the mouth and down the neck where the dribble runs. If you apply the ointment just before a sleep, this will provide a barrier between the irritating saliva and the skin.
  • If swimming causes a flare up, moisturise the whole body in Dermeze, it repels the water and feels pleasant on the skin. Have a shower after to rinse off the pool water.
  • Wash clothes in sensitive washing powder/liquids eg. Purity washing liquid.

Diet and food Sensitivities

To date the evidence available states:

  • Exclusive breastfeeding for at least 4 months compared with  cow’s milk protein formula may decrease the cumulative incidence of  eczema and cow’s milk allergy in the first 2 years of life.
  • For formula fed infants at high risk of developing eczema, there is evidence that use of an extensively hydrolysed (only on prescription) or partially hydrolysed formula ( ie the HA formulas)  may reduce the risk of eczema.
  • There is insufficient evidence to support avoiding certain foods in pregnancy or breast feeding in order to prevent a child’s allergies.
  • It is thought that in about  30% of children with eczema, food may be one of the causes of a ‘flare up’ but in about 10% of those children,  food will be the main or only trigger. This means that only a small amount of children’s eczema improves when they make dietary changes.  If you remove the food the child is allergic to, the eczema will not be cured, but it will result in better eczema control. An elimination diet with food challenges may be trialled under medical supervision to avoid causing any nutritional deficiencies. If it looks like a food or an environmental factor like pollen, or animal fur is causing an eczema flare-up, a paediatrician or allergy specialist may organise a skin prick test, to find out exactly what your child is allergic to, and hence will give you a better picture of what to avoid.

Breast fed babies with eczema may have ‘flare ups’ due to the maternal diet as allergens do pass through the breast milk. Some mother’s may need to keep a food diary, to help them work out what food is potentially triggering a ‘flare up’ in their baby’s eczema . If a breastfeeding mother is eliminating certain foods it may reduce the severity of the eczema in the baby. The aid of a dietitian will be helpful to advise foods that can be substituted in order to avoid any nutritional deficiencies in both,  the mother and baby. Elimination diets are tried only if the eczema is severe enough to be affecting the quality of life of the child. If the eczema is well controlled with topical steroids and emollients, then dietary changes may not be necessary.

What else can I do?

Probiotics

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.

Ethical nutrients has a product available from most pharmacies called Eczema relief. One capsule can be opened and  dissolved in  either  water or milk for young infants/children. It has been shown to reduce itching associated with eczema, reduce sleeplessness associated with eczema and reduce the symptoms of eczema.

Vitamin D has not been proven to cure eczema but has shown to help eczema. There was a small clinical trial of 74 children who was grouped into mild, moderate and severe eczema and the study did show that the lower the vitamin D level, the worse the eczema.  While observational studies have suggested that vitamin D may be of benefit to children with eczema, future clinical trials are necessary to clarify whether or not vitamin D is useful in this skin disorder. However vitamin D is safe and inexpensive, so it seems a reasonable consideration.

Fish oil

Oral fish oil is often used to help skin with eczema, but not recommended if you have a seafood allergy.  Omega-3 fatty acids found in fish and fish oil help fight inflammation. They impact both elasticity and formation of the skin,helps moisturise and lubricate the skin internally.  Foods rich in essential fatty acids e.g oily fish, olive oil, flax seed oil, avocado, nuts all support many body systems and is important for  healthy immune function. There are many fish oil products available for children, but one I often recommend is Ethical nutrients Hi strength fish oil liquid for kids. It has a pleasant orange flavour and can be given from one year of age.

Newer prescription creams:

There is another class of eczema medication called topical calcineuron inhibitors eg. Elidel cream. Like topical steroids, they reduce the inflammation, however they are not the first line of treatment as they do not work as quickly as topical steroids and the long term safety has not yet been established.

Natural skin care ranges:

There are skin care ranges (eg.MooGoo, Weleda and Gaia) who pride themselves on using natural ingredients and avoid adding cheap harmful chemicals to their skin care products eg Sodium Lauryl Sulphate, Parabens, Petroleum etc. These companies dedicate their careers to research and development to wellness and optimal health. They have discovered how to add natural healing ingredients whilst still keeping their products preservative free with using natural agents that have antibacterial or antifungal properties. Whether its extracts from flowers, herbs, natural oils, vitamins etc they all have roles in maintaining optimal skin health. One particular range called MooGoo was developed in our very own country Australia. Their products are exceptional. However some people have allergies to natural products eg nuts and even though they can be healthy for you, if you are sensitive to a particular natural products your skin will react. It is important if you are trying a new cream on your child a skin patch test is important. Apply a small amount of the product on the inside of your child’s arm and monitor and observe for any skin reactions. Moogoo has a large range of products ie

  • Eczema and psoriasis cream- containing: Aloe Vera, Chamomile and  Sage oil
  • Soothing MSM cream- containing: Sweet almond oil, olive oil, coconut oil, organic sulfur, Aloe Vera, Vitamin E and Allantoin
  • Soothing Cream nut oil free- containing: olive oil, organic sulfur, evening primrose oil, honey, hops, allantoin and aloe vera.

These are just three products from their large range.

The role of these ingredients is to provide healing, enrich the moisture in the skin, calm the skin, nourish with vitamins, decrease inflammation and keeping the skin clean having antibacterial and antifungal properties.

Eczema sufferers have very delicate and sensitive skin and from what I hear as feedback from parents, some will say their child’s eczema was completely controlled by these products and others will say it either didn’t do much or infact their child’s skin was sensitive to the product. Always do a skin test before applying a large portion of the product to the body.

Eczema takes a lot of time and attention to keep it under control, however it is easier to keep it under control than to manage it when it is infected or severe.

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.

3 Practical Steps to Treating Eczema

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: Eczema (Part 1 of 2)

Red, itchy, dry, scaly skin, comes to mind when I think about eczema. As a pharmacist, I see eczema in babies and children all the time, and no wonder, Atopic or ‘Allergic’ eczema occurs in 10-20% of children in Australia. In this blog I aim to discuss eczema, give the facts and recommend some great tips to manage eczema and advise how to prevent and avoid ‘flare ups’.

What is eczema?

The skin is our largest organ and possesses a rich blood supply which is involved in thermoregulation, wound healing, immune reaction and control of blood pressure. Healthy cells are plump with water. The skin cells produce an oil, which allows the skin to retain moisture and allows the skin to act as a protective barrier  and prevent harmful substances or bacteria from entering our bodies. In eczema, the skin barrier does not work very well. A person with eczema has less water retaining properties and moisture is easily lost from the skin. Less oil is produced on the skin’s surface to retain the moisture inside the cells.  Hence, there is increased risk of bacteria and irritants passing through,  causing skin irritations and even infections. In eczema, there is an overproduction of immune cells called T cells, which start to work overtime when triggered, causing the skin to become red, inflamed and itchy. When you scratch, chemicals are released making the skin more itchy. This causes an ‘itch scratch cycle.’

What causes Eczema?

The cause of eczema is unknown however it is almost like an interaction between genetic factors and environmental factors.  There is no cure for Eczema, nor is it contagious. Eczema can be aggravated by many factors, sometimes eczema can flare for an unknown reason.

The facts:

  • Eczema affects 10-20% of children
  • If one parent has eczema, there will be a 60% chance of their children developing eczema
  • If both parents have eczema, there is an 80% chance of their children developing eczema
  • 50% of children will no longer be affected by Eczema by the age of 2
  • 85% of children will no longer be affected by Eczema by the age of 5
  • About 40% of babies with eczema develop asthma and/or hay fever when they get older.

Treatment

Education plays a huge role in managing eczema. A person will have a number of ‘flare ups’ in their life and they need to learn:

a) What triggers a ‘flare up’

b) What is the best way to treat a ‘flare up

c) How can I prevent another ‘flare up’ in the not too distant future.

For mothers with babies who have eczema, this will be a huge learning curve especially if you did not suffer with eczema growing up. In babies, eczema often presents itself in the first 6 months of life usually first on the face. You may notice that dummies, dribble, teething  and food around the mouth can all irritate the skin and cause  eczema ‘flare ups.’  Eczema can also occur on the scalp, behind the ears, on the body, arms and legs (especially in the elbow and knee creases). The rash is red, dry and itchy. The skin can crack, weep and bleed and this can lead to infection.

3 step treatment guide

1) Avoid the triggers

Over time, learn what triggers your child’s eczema eg:

  • Dry skin
  • Soap, perfume, baby wipes, washing powder
  • Allergens eg dust mites, pet fur, pollens
  • Teething
  • Hot baths
  • Stress
  • swimming eg chlorinating chemicals
  • Soaps and detergents
  • Different fabrics- ie wool, nylon,acrylic fabrics
  • Food allergy and sensitivities
  • Viruses/infections
  • Heat ie overheating in the cold dryer months

2) Protect the skin by bathing and moisturising

Understanding how skin cells are affected in eczema, illustrates how bathing and moisturising the skin has a huge role in preventing eczema ‘flare ups’ and improving the barrier function of the skin. Bathing allows moisture into the skin and moisturising straight after a bath ‘locks’ that moisture in.  Short baths are recommended, a bath less than 10 minutes re-hydrates the skin where as a long bath dehydrates the skin. The bathing routine should be followed diligently during a ‘flare up’ and after as a preventative.

Bathing tips:

  • The water should be lukewarm. During a ‘flare up’ the bath temperature should not be more than 29 degrees celsius.
  • Apply a capful of bath oil into the bath and use this as a soap substitute. eg QV bath oil, Hamilton’s bath oil, Dermaveen bath oil etc.
  • Use a soap free gentle cleanser on the parts of the body that requires additional cleaning. eg QV gentle wash, Hamilton wash, Dermaveen extra gentle baby soap free wash etc
  • If eczema is on the face, soak a face cloth in the water and bath oil and gently apply to face.
  • Take care with babies and toddlers as their skin can be slippery in the bath.
  • Pat dry with a soft natural fibre towel
  • Moisturiser should then be applied to the damp skin

Moisturising tips:

As a parent, you walk into a pharmacy, head towards the skin care area, and become  overwhelmed with the amount of choice there is for moisturisers.  Moisturisers are classified based on their oil and water content. Ointments have the greatest oil content, followed by creams and then lotions. Which one do you choose?  What you choose, should depend on a number of factors eg:

  • What season  we are currently in
  • Where the Eczema is on the body
  • What ingredients are in the preparation
  • Severity of the eczema.

Winter can be a challenging time for eczema sufferers, their skin often gets dry and very itchy. When the heaters are on and the air is dry, thick moisturisers will be of benefit ie Dermeze ointment. In the summer more humid months, eczema should improve, and thick moisturisers may feel very uncomfortable on the skin and a lighter cream/lotion may be more appropriate eg QV cream or lotion.

Moisturisers are used to prevent the skin from drying. They should be used frequently, and are very important in the management of eczema. Moisturisers can be used alone or they can also be applied over a cortisone cream and under wet dressings.(Which will be discussed in Eczema part 2).  Moisturisers can be applied as often as required and they should be applied all over the face and body and not just to the areas of eczema. Apply moisturisers during ‘flare ups’ as well as whilst in remission to prevent ‘flare ups’. I always recommend a simple moisturiser, one which is fragrant free and purely formulated for sensitive skin. Go by how your child reacts, if they are too young to express themselves and they cry hysterically when you apply a certain cream/lotion, that could be an indication the cream is stinging them and worth changing to a different cream. Creams and lotions often have added preservatives that may sting when applied. Ointments usually don’t sting and generally preferred over creams for this reason. However If your child gets pimples under their skin, that is a sign of blocked pores and would be an indication that the ointment is too heavy for the skin, and changing to a thinner moisturiser would be recommended.

Make bath time and moisturising fun, have bath toys  and massage the creams into your child’s skin in a relaxing and fun way. I used to sing songs whilst moisturising my children or play peek-a-boo in the bath with face washes etc.

The following skin care ranges all produce a bath oil, a soap free body wash and moisturising creams and lotions and all suitable for eczema prone skin:

Ego QV skin care

Alpha Keri

Mustela Stelatopia

Hamilton

Dermaveen

Moisturisers are first line treatment and if used on their own, will only treat mild eczema. In most people, they will treat the dryness, improve the skin barrier function  and help prevent eczema ‘flare ups.’ Moderate to severe eczema cannot be treated simply by moisturisers, no matter how expensive or fancy the moisturiser is. Once the skin becomes red and inflamed, it requires a topical steroid  to bring the eczema under control.

3) Treat ‘flare ups’

When the skin becomes red, inflamed and even broken, a topical steroid is required to bring the redness and inflammation down and break the ‘itch scratch cycle’. Topical steroids come in creams, lotions, ointments and scalp lotions.There are a lot of ‘myths and misconceptions’ about topical steroids that have developed over the years and have made parents understandably concerned about using them. Parents can be so fearful to use them on their children, that their eczema becomes ‘‘under treated.’ The eczema sufferer will scratch the skin to the point that the skin opens and bleeds. This often leads to infection.  Continual itching, rubbing and scratching over time causes the skin to eventually thicken when eczema is under-treated.  Cortisone is a natural hormone produced in the body with one of its roles being controlling inflammation. Cortisone creams, if used as recommended by your doctor are completely safe. In sensitive areas (eg face) mild cortisone creams are recommended eg hydrocortisone (brands include:Sigmacort and Dermaid). The following statements will dispel myths associated with the use of topical steroids:

a) Topical steroids (cortisone) will affect growth and development

Untreated severe eczema can impact on physical, psychological and social development, and this can affect children’s growth and development. When steroid creams are applied correctly, often a child’s growth recovers as the eczema improves. Steroid creams and ointments almost never get absorbed into the bloodstream, and so will not affect growth and development, or the body’s ability to fight infections.The exception is in babies and very young children when topical steroids are applied in large quantities all over the body (especially if used under occlusive bandages)  absorption into the bloodstream is possible. For this reason, strong (potent) topical steroids should not be used in children under 12 months of age except under the supervision of a dermatologist, who would ensure that there was no long-term risk to the child.

b)Topical steroids will cause my child’s skin to thin

It is true that potent and very potent topical steroids can cause thinning of the skin if used for too long and without a break.  Dermatologists hardly  ever see patients with skin thinning because they recommend using the cream in intermittent bursts and by using the appropriate strength and quantity. Many eczema sufferers can control their skin with weak topical steroids ie hydrocortisone (Sigmacort1%/Derm-Aid1%). With these preparations, skin damage is very uncommon even when they are used on and off for years.

c)Topical steroids should not be used on broken skin

If you have bad eczema and the skin is broken and cracked, then using a topical steroid on broken skin is perfectly safe if used according to your doctors instructions and often will help the skin heal faster.

d)Topical steroids should only be used in very small amounts

Whilst your doctor and pharmacist will advise to use the cream/ointment sparingly and only use a thin layer, often people will not use enough. A good rule of thumb to go by, is to squeeze a length of steroid cream/ointment onto the tip of an adult index finger, from the tip of the finger to the first finger crease you come to (approx. 2 cm). This amount of steroid should be enough to cover an area of skin the size of two flat adult palms of the hand (including fingers).

Stay tuned for part 2 eczema blog, which will  contain information about the following:

1) Wet dressings for eczema

2) Infection in Eczema

3) Diet and food sensitivities

4) Supplements to help treat eczema

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.