• My child was diagnosed with generalized epilepsy a few years back. She has had no convulsions during the past nine months. Is my child cured from epilepsy and can I stop her treatment (anticonvulsant medication)?

No, stopping your child’s medication at this point in time might lead to a phenomenon we as clinicians call: “breakthrough convulsions”. This condition often presents as severe convulsions after cessation of medication and this might manifest as more severe convulsions than your child had before and can even lead to “status epilepticus”: a condition during which your child has a prolonged (longer than 30 minutes) convulsion which is very difficult to control.

A general rule: NO convulsions for a period of one year (some clinicians even feel this should be extended to two years) and depending on the severity, age and type of epilepsy, your paediatrician might decide to “start weaning” anticonvulant therapy over a period of six months. This means gradually decreasing the dose and dosage interval of the medication whilst closely observing your child for any reoccurrence of convulsions. If convulsions occur during this “weaning “period, unfortunately prompt recommencement of anticonvulsants must be started at the original dose (dose before weaning started).

Please not that weaning and ultimately stopping your child’s anticonvulsant therapy must only be done with the help of a trained professional (like your paediatrician).

  • My child currently suffers from an acute upper airway infection. My general practitioner prescribed oral antibiotics and now, after three days my child is much better. Should he continue to use antibiotics or can I stop it if he’s better?

There are some antibiotics on the market that can be taken once a day, only for three days. Otherwise, a good duration of treatment (even in an mild upper airway infection that responds after three days) is SEVEN days. Latest research has shown that a duration of three to five days is too short (unless certain types of antibiotics are used i.e. Azitomycin for three days). Even if your child is better, he MUST finish his treatment course for at least seven days, with the exact dose and dose interval as prescribed by your healthcare professional). Failure to adhere to this, might lead to antibiotic resistance, this meaning that the bacteria that causes this infection will not be completely killed and removed from your child’s upper airway with the remaining organisms finding ways to fight that specific antibiotic when it is used in the future. This phenomenon has for example lead to the occurrence of penicillin resistance: meaning that today far less types of bacteria will be killed by penicillin compared to a few years ago. (Remember: penicillin was, not so long ago, our only antibacterial medicine that could be used in humans).

  • My little girl of three years old suffers from recurrent flu and coughing. My general practitioner keeps on prescribing oral antibiotics for seven days. In the past six months, she completed three courses of oral antibiotics, each lasting seven days. Is my child’s treatment correct or are there alternative treatment options, other than oral antibiotics, for her.

Remember that the majority of colds and flu infection in children is caused by viral infections and antibiotic use is NOT INDICATED in these circumstances. Antibiotic treatment should only be used for a suspected or proven BACTERIAL infection and it is 100% INEFFECTIVE with uncomplicated viral infections. The rationale behind your general practitioner’s treatment could be that he suspected a secondary bacterial infection, complicated by a preceding viral infection. Viral infections (especially in the upper airways) can weaken a child’s protection (immune system) that can lead to so called opportunistic bacterial to invade these areas and cause secondary bacterial infections. Further investigations in your child are indicated to determine resistance of organisms against oral antibiotics your child is currently receiving. Blood tests might also help to determine the severity of the infection and to determine if your child’s immune system is protecting her efficiently. Also remember that common allergies can easily be confused with common colds. A general allergy test might therefore also be indicated. My suggestion would be to share your concerns with your general practitioner and to ask him/her whether a referral to a paediatrician could be arranged before the next course of antibiotics is prescribed.

  • My little baby boy is due for his 6 weeks immunization at the local clinic. Are there any dangerous side effects to immunizations? I am allergic to eggs. Can my child also be allergic to eggs and in that case, are immunizations safe for him?

Nowadays, immunizations are safe. Generally there are little side effects observed from immunizations.

A low grade fever, mild skin rash and “grumpiness” are the most frequently observed adverse reactions to immunizations observed by parents. These gradually occurs a day after immunizations and disappear spontaneous after two to three days. Mild antipyretic/analgesic syrups obtainable as “over the counter medicine” is effective. Your child could be allergic to eggs, as egg allergy, like many other allergies are genetically inherited from parents. Modern immunizations are prepared by manufacturers differently compared to the past. This makes allergies to specific substances, like eggs, less of a problem and even if your child is proven to have an egg allergy, immunization could still be safely administered to your six week old. If you want to be careful, schedule an appointment with your healthcare professional/paediatrician. After the immunization, you can wait in the reception area of your doctor’s consulting rooms for an hour or two to enable you and the healthcare professional to observe and report adverse-/anaphylactic events, should they occur. Some specialists/paediatricians even advise a short course of anti allergic medicine (i.e. phenergan) before and after the immunization.

  • I am breastfeeding my one month old baby. Should he receive anything else (for example water and multivitamins) whilst I breastfeed?

No. BREAST IS BEST! Breast milk contains enough water, vitamins and minerals and nutrition for your baby until the age of six months and beyond. At the age of three to four months, gradual introduction of small amounts if other food sources might be of use to expose your baby’s body to different/ new factors. Research has shown that even at this young age, early introduction of “foreign” substances, leads to reducing the risk of allergies (i.e. asthma, hay fever, middle ear infections and sinusitis) later in life. Until this age, exclusive breastfeeding is the only “food and water” your baby needs.

  • My child is attending a day school during the week. Is there a danger that my child can contract serious diseases like gastroenteritis, Tuberculoses or HIV from other children?

Gastroenteritis is caused by a variety of viruses and bacteria. The most common pathogens involved are: Rotavirus and Adenovirus. Other more serious bacterial causes of acute gastroenteritis can be caused by Salmonella and Shigella. All these organisms unfortunately spreads easily in a day school/ crèche environment via the faecal-oral route. This means that if your child’s hand touches stools infected by this organisms, even if it is his/her own and after that puts his finger in his/her own mouth, he can contract the disease. So YES, gastroenteritis pose a big threat to these poor children and therefore personal hygiene i.e. hand washing/ nappy change are of utmost importance.

Tuberculoses and HIV CANNOT spread from one child to the other. Pulmonary Tuberculoses spreads only from adult to child if that adult has so called “open lung” tuberculoses. These adults can cough in the vicinity of a child and spreads with tiny droplets to the nearby situated child. A child never has “open lung tuberculoses”, making droplet spread impossible.

HIV is only spread by DIRECT inoculation of infected body fluids (i.e. semen or blood). Although there are HIV viral particles in the sputum and nasal secretions of an infected individual, the viral load found in upper- and lower airway secretions in individuals with HIV is not high enough and does not spread “directly enough” to a close by child, to cause infection. Teachers must always be on the lookout for children that sustain injury on the playground causing bleeding. This can cause a threat for the spread of HIV particles and prompt action must be taken to stop bleeding and to cover the wound. The teacher must ensure that she, herself is protected whilst taking care of a child’s bleeding wound by always wearing gloves!

  • My one week old infant cries during certain times of the day without me knowing what’s wrong. It puts a huge amount of stress on me and my husband. During this crying episodes, he does not seem to hungry/thirsty, his nappy is dry and he doesn’t seem to be sick. He cries inconsolably and all attempts to stop this do not seem to help. PLEASE HELP!

Your child might experience a condition previously called: “infantile colic”. These days, due to the stigma linked to this name, we as paediatricians rather call this: “excessive crying in babies”. This can happen to any baby: from birth to the age of 6 months and sometimes even beyond. The cause of excessive crying in babies is still unknown, but it can cause serious disruption between the relationship between mother and baby, mother and father and ultimately it can even end up as a complete destruction of the family. It causes huge concern to parents and they are often worried about a serious illness in their child. The definition of excessive crying in babies is: inconsolable, high pitched crying associated with pulling up of legs, fisting, and pulling of the face as if in severe pain. This must happen more than three weeks in a month, more than three days in a week and for longer than three hours at a time for it to qualify as excessive crying and in between these “attacks” of crying, he seems to be a normal, happy infant with normal weightgain. “Highly strung”, nervous, first time mothers are especially vulnerable to this condition. Various treatment options exist: calming mother and father down and reassuring them, after a thorough examination by a qualified healthcare professional, preferable a paediatrician whilst excluding other conditions (like a urinary tractus infection), that there is nothing serious wrong with their baby and that this condition will ultimately subside. Occupation therapy, environmental changes during feeding times, calming music, baby massaging and change if baby’s formula milk to an “anti colic” formula might help. Remember as always: “Breast is Best”. Studies have shown that breastfed babies have the lowest incidence of excessive crying compared to babies that receive other forms of feeding. Make an appointment with your paediatrician and he will advise and refer you to the relevant services that deal with this problem on a daily basis. REMEMBER, HELP IS AVAILABLE.

  • I am 39 years old and I do not have any children yet. My younger sister’s child was recently diagnosed with “Down’s Syndrome”. Does this mean, due to my family history, my chance of also having a child with this condition is now significantly larger? Should I rather opt for adopting a normal child?

Down’s syndrome is a genetic condition which happens randomly and “by chance”. This means that this is one of the few genetic conditions that are NOT associated with a family history. This genetic error, whilst the foetal cells are starting to divide, very early in pregnancy, just after conception, can happen to ANYONE. A family history of Down’s does not increase your chances to have a child with this abnormality. I concerning factor, however, is your age. Recent studies have shown that the chance for a mother above 35 years of age, to have a child with Down’s syndrome child, is approximately 1 out of 220. This dramatically increases with a maternal age above 45 years (1 out of 20). It seems as if an increasing maternal age (especially above 40 years) definitely increases a mother’s chance to have a child with Down’s syndrome. This must NOT discourage you to have children of your own. I would just advise you, even from a very early stage in your pregnancy (gestation) to have close contact and frequent visits to your obstetrician. He/she will follow your pregnancy up very closely and will probably advise on a early “chorionic villus sample biopsy” and/or “amniocenteses” with regular ultrasound examinations (foetal sonar) to determine if any abnormalities in chromosomes or physical growth could be detected from your baby that could signify Down’s Syndrome.

  • My friend’s child milestone development, according to her, is faster than is expected. At 10 month’s he was already able to stand against object and at one year he could already say a few words. He was also eating a “full, adult” diet at one year. She always says that this indicates that he’s going to be a very intelligent little boy. Is this true?

It could be true, but intelligence is determined by a variety of factors, such as genetics, intellectual stimulation from the parents and environment and a healthy nutritional diet. Intellectual ability (IQ) has no correlation with your child’s milestones and milestones is NOT and indication of the degree of intelligence. Milestone development is an indication of your child’s brain growth. It is sequelae of physical events that need to follow in a specific order (one after the other). One milestone must take place in order for the next one to follow. One milestone is a preparation for the next (i.e. sitting, preparing for crawling, preparing to pull up against objects and ultimately preparing for standing, strolling and walking/running). Milestone development indicates physical development of your child’s brain and physical ability and does not signify emotional- or intellectual well being.