Abdominal ache

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Alternative terms: stomach ache, abdominal ache

See also: Nausea

 

Allergies

Definition
This is a condition in which a child reacts badly or falls ill when they come into contact with certain substances (allergens).

What causes allergies?
Allergies occur because the body's immune system over-reacts to exposure to certain allergens (Hypersensitivity). Allergies tend to run in families.

A reaction may occur through eating, inhalation, injection or contact with the skin or the other body surfaces.

What are the manifestations of an allergy?
Allergic reactions can be generalised (involving the whole body) or localised. They may manifest as:

• Watery, swollen, sore or itchy eyes.
• A localised or generalised rash. This is usually red and itchy.
• Difficulty in breathing characterised by wheezing and chest tightness.

THE SIGNS AND SYMPTOMS MAY BE SEASONAL

The substances that most commonly cause allergic reactions are:

• Pollen
• Fungus spores
• Mites in house dust
• Animal fur
• Grass

Known medical conditions that are due to allergies are:

• Asthma
• Hay fever
• Contact dermatitis e.g. Nappy rash
• Allergic rhinitis
• etc.

What is the cure for allergy?
There is no cure for allergy. Some children may grow out of it but sometimes it returns in adult life.

What should you do when your child has an allergy?

• It is important to try and identify the substance that caused the allergic reaction. Often this is difficult and in a majority of cases in the world, it is not known what causes some of these reactions. A history from other family members may be helpful.
• If you manage to identify the allergen, then prevent your child from further exposure.
• Antihistamines like piriton and cetrizine are often used in bad cases. Steroid creams may also be useful but this should be used after consultation with your child's paediatrician.
• Your child's doctor will examine your child by visualising the nostrils, the airways and the skin. He may want to do provocation tests under controlled conditions and allergic skin tests.
• If your child is found to be asthmatic, he will be provided with medication which he will use regularly or when needed, according to the severity.

What to do when your child has an allergic reaction?

• If the reaction is mild e.g. a small localised area of a rash, you do not need to do anything other than to remove your child from exposure and to wash off the area lightly with water.
• Known asthmatic children should be provided with their medication.
• Severe reactions need urgent medical attention since they may progress to shock.

DO NOT FORGET TO REMOVE THE CHILD FROM POTENTIAL ALLERGENS IN AN EMERGENCY.

WHAT IS FOOD INTOLERANCE?

Food intolerance is a non-specific term meaning a reaction to food taken either in small quantities or in excess. It due to an allergy but n some case, may not necessarily involve the immune system and may just be due to simple over-indulgence.

Common examples of food intolerances are:

• Cow's milk protein intolerance
• Peanut allergy
• Lactose intolerance

What to do when your child has food intolerance.

• Avoid the foods.
• Consult with your doctor or nutritionist on locally available substitutes e.g. soya milk in case of cow's milk protein intolerance.

 

Asthma

* Excerpt from WebMD.com

Asthma is a chronic disease of the airways that makes breathing difficult. With asthma, there is inflammation of the air passages that results in a temporary narrowing of the airways that carry oxygen to the lungs. This results in asthma symptoms, including coughing, wheezing, shortness of breath, and chest tightness. Some people refer to asthma as “bronchial asthma.” Even though there are seemingly miraculous treatments for asthma symptoms, asthma is still a serious -- even dangerous -- disease that affects millions of people. With proper asthma treatment, one can live well with this condition. Yet inadequate asthma treatment limits the ability to exercise and be active. Poorly controlled asthma can lead to multiple visits to the emergency room and even hospital admission, which can affect your performance at home and work.

 

Bruises

* Excerpted from WebMD.com Bruises develop when small blood vessels under the skin tear or rupture, most often from a bump or fall. Blood leaks into tissues under the skin and causes the black-and-blue color. As bruises (contusions) heal, usually within 2 to 4 weeks, they often turn colors, including purplish black, reddish blue, or yellowish green. Sometimes the area of the bruise spreads down the body in the direction of gravity. A bruise on a leg usually will take longer to heal than a bruise on the face or arms. Most bruises are not a cause for concern and will go away on their own. Home treatment may speed healing and relieve the swelling and soreness that often accompany bruises that are caused by injury. However, severe bruising, swelling, and pain that begin within 30 minutes of an injury may mean a more serious problem, such as a severe sprain or fracture. Bruises that do not appear to be caused by an accidental injury may be caused by abuse. It is important to consider this possibility, especially if the bruises cannot be explained or if the explanations change or do not match the injury. Report this type of bruising and seek help to prevent further abuse.

Burns

Definition
A burn results from destruction of tissues by dry heat, (in form of fire), wet heat (in form of scalds), electricity or chemicals.

Who is at risk?
Young children are most at risk of injury from burns and scalds. Burns and scalds are a major cause of serious injury in children aged 0 to 14 years. Children aged 0 to four years are at greatest risk.

How do they occur?
Children are curious and like to explore their surroundings. They don't know that hot water and hot drinks burn like fire About half of accidents resulting in burns to children happen in the kitchen, with scalds from hot liquids being the most common. Many accidents involve the child reaching up and pulling on a mug or cup of hot drink. Other common causes include children falling or climbing into a bath of very hot water, and accidents with kettles, teapots, coffee-pots, pans, irons, cookers, fires and heaters.
Burns may also occur from:

• contact with electricity,
• contact chemical substances,
• excessive sun
• friction with any hard surface such as roads ("road rash") or carpets.

How severe is a burn?
Treatment of burns depends on how severe they are.

Burns may be:

• First degree is limited to the outer layer of the skin, causing it to be dry, red and painful, but without blistering. Mild or moderate sunburn is an example of a first degree burn.
• Second degree or partial thickness burn is more serious, and involves blistering of the skin. This type of burn is also painful, but unlike a first degree burn, the affected skin will likely appear to be moist.
• Full thickness or third degree burn where all the skin layers have been penetrated and the burned area may be white, charred, firm and leathery.
• Third degree burn which also destroys nerve endings, so your child may not feel pain in the burned area.
• Fourth degree burns, which extend down to muscle and/or bone, but fortunately, these are rare.

Burns are best prevented!!!!!!!!!!!

Tips
Preventing scalds and burns

• Keep young children out of the kitchen unless they are fully supervised.
• The front of the oven, and even the washing machine, can become hot enough to burn a young child. Keep them away.
• Turn pan handles towards the back and away from where a child may reach and grab.
• Never drink hot drinks with a baby or child in your lap.
• Never let a child drink a hot drink through a straw.
• Teach older children how to boil kettles and how to use the cooker safely. There is no right age for this. Every child is different. However, it is important to teach them correctly when the time is right rather than let them experiment and find out for themselves.
• Never heat up a baby's milk in a microwave. It may heat the milk unevenly, and some parts may become very hot. Stir baby food well if it is heated in a microwave.
• Put cold water in the bath or sink first, and then bring up the temperature with hot water.
• Do not set the thermostat for hot water too high in case children turn on the hot tap.
• Preventing fires
• Shut all doors at night. This prevents any fire from spreading.
• Store matches away from children. Teach older children how to use matches correctly and safely. Do not just let them experiment and find out for themselves.
• Have a fire blanket in the kitchen.

Preventing sunburn

• Keep children out of hot sun, particularly between 11am and 3pm.
• When out in the sun remember: Slip, Slap, Slop - slip on a shirt, slap on a hat, and slop on some high protection sunscreen.

What to do if someone is burned - first aid

• Cool the burnt area immediately with cool water (preferably running water) for at least 20 minutes. For example, put the burnt area under a running tap. A shower or bath is useful for larger areas. Note: do not use very cold water or ice.
• Remove rings, bracelets, watches, etc, from the affected area. These may cause tightness or constriction if any swelling occurs.
• After cooling, remove clothing from the burnt area. However, do not try to pull off clothing that has stuck to the skin. This may cause damage.
• A cold compress such as a tea towel soaked in cold water may be soothing over the burnt area. You can apply this after the initial cooling under cool water.
• Before going to hospital cover the burn with cling film or a clean plastic bag and leave it on until seen by a doctor or nurse. Apply cling film in layers rather than round like a bandage to prevent it causing pressure if the burnt area swells.
• Paracetamol or ibuprofen may help to ease pain for small burns.

Do not

• Use very cold water or ice.
• Prick any blisters.
• Apply creams, ointments, oils, grease, etc. (The exception is for mild sunburn. A moisturiser cream or calamine lotion may help to soothe this.)
• Put on an adhesive, sticky, or fluffy dressing.

Home care, or should I get medical help?

• Go to hospital if you are unsure about what to do after a burn.
• However, you may be happy to manage small, mild (superficial) burns at home. Mild sunburn, small mild burns, or mild scalds are best left uncovered. They will heal quicker if left to the fresh air. Even a small blister is best left uncovered to heal.
• If the blister bursts, you can use a dry, non-adhesive, non-fluffy sterile dressing. This will soak up the weeping blister, and stop dirt and germs getting into the wound.

Go to hospital as soon as possible if:

• The burn becomes infected. Infection causes a spreading redness from the burn which becomes more painful.
• You are not up to date with tetanus immunisation.
• Blisters occur. You may be happy to deal with a small burn with a small blister. However, a blister means a partial thickness burn, and it may be best to see a doctor.

Must go straight to hospital (after cooling with water and first aid) for the following:

• Electrical burns.
• Full thickness burns, even small ones. These are burns that cause white or charred skin.
• Partial thickness burns on the face, hands, arms, feet, legs, or genitals. These are burns that cause blisters.
• Any burn that is larger than the size of the hand of the person affected.
• Cover the burn with cling film or a clean plastic bag before going to casualty.

 

Cerebral Palsy

What is cerebral palsy?
This is a condition in which children have an abnormality of posture and movement due to impaired development of the brain during pregnancy or damage to the brain during pregnancy, birth or within 3 months of birth. It does not get worse with time but as the child grows older, some of the abnormalities become more obvious.

What can cause damage to the brain?

• Damages can occur due to deficiencies of certain micronutrients during pregnancy which are necessary for brain development. It may also be due to use of certain drugs or infections during pregnancy which are passed on to the unborn, developing child.
•  Damage may also occur due to difficult delivery during which time the baby is deprived of crucial oxygen and nutrition to the brain.
• It may be due to infections of the baby's brain occurring shortly after birth.
• How does a child with cerebral palsy manifest?
• Initially, abnormalities may not be obvious since a newly born child has limited functions anyway. However, your paediatrician may note some abnormalities during examination at an early age.
• The disability may be mild e.g. weakness of one hand.
• In some cases, there may be weaknesses of single limbs (monoplegia), two lower or upper limbs (diplegia) or all limbs (quadriplegia).
• The muscles involved may be floppy or stiff.
• The child may be unable to support his neck
• He may have impairment of vision, hearing and/or speech.
• Learning difficulties may be apparent later.
• In severe cases, the child may even have difficulties with swallowing.
• As the child grows older, more problems may be revealed.

What should you do when your child has cerebral palsy?

• It is important for the child to be fully assessed so that the whole range of his abnormalities is known. This should be done in hospital and will involve a number of specialists; the paediatrician, hearing specialists, speech therapists, physiotherapists, occupational therapists, psychologists and orthopaedic surgeons.
• These specialists will come up with a plan on how best to help the child to tackle his problems.
• The child is likely to need regular, physical assistance and the physiotherapists will help to make the child more mobile but of course the problem cannot be cured.
• Children with cerebral palsy normally have learning difficulties and a parent is the best person to tell the child's range of abilities. THESE CHILDREN NEED TO GET EDUCATION. This may initially be provided in a playgroup for normal or disabled children. As they reach school going age, they may then join one of the special education schools and be attached to an development assessment centre.
• Further information on education for these children can be provided by the Department of Special Education in the Ministry of Education.

 

Diarrhoea

Definition
Passage of more than 3 episodes of loose stool in a day

Loose stool
Faecal matter that takes the shape of the container

What are the other signs and symptoms?

• Your child may have fever.
• He/she may have vomiting
• There may be abdominal discomfort
• You may observe blood in the stool. When this happens, your child may have dysentery.
• If the child is dehydrated:
  • The skin and the linings of the body orifices may be dry. He/she may be unable to produce tears or saliva
  • The elasticity of the skin may be reduced. This will be apparent when you lightly pinch the skin over the abdomen.
  • The child may be weak and uninterested in the environment. He may be unable to drink anything as a result.

ALL THESE FEATURES MAY BE ABSENT AND THE CHILD MAY JUST HAVE DIARRHOEA ALONE

What causes diarrhoea?

• Most diarrhoeal illnesses are caused by viral infections and the most common culprit is the rota virus. Most of the time, the illness is self limiting.
• A few may be as a result of bacterial infections. These bacteria are known as enteric bacteria.
• Diarrhoea due to infections may be worsened by reduced immunity as in HIV disease.
• Spread of diarrhoea due to viral or bacterial infection is faecal-oral i.e. through ingestion of food or water contaminated by infected stool.
• Diarrhoea may also be due to inborn problems in metabolism, abnormal structures of the gut and food intolerance

Children on exclusive breast feeding may produce loose stool and this should not worry you.

What is toddler's diarrhoea?

• Some children aged between the 1 and 4 years may suffer intermittent bouts of loose stool. The stool may contain partly digested foods.
• This happens for a few days and then resolves to happen again later.
• It may be associated with stress of the child.
• It is thought to occur due to over-activity of the intestinal gut thus not giving the food enough time to be digested.
• This condition is not dangerous and passes with age.

What should you do when your child has diarrhoea?

• Take note of the number of episodes your child is passing stool. This will help you determine the severity.
• Examine the stool for colour, presence of worms and blood stains
• Look for other signs of illness
• Provide oral rehydration solution to your child. Oral rehydration salt can be bought from the shop or the nearest chemist. Formulate with clean water according to instructions on the sachet's cover. Aim to give at least 5mls per Kilogram of the child's weight every hour and with every episode of diarrhoea.
• If your child blood in the stool or has signs of dehydration and is vomiting a lot or unable to take orally, rush him/her to the nearest health facility. Meanwhile, still give ORS.

Alternative terms: Diahorrea, diarrhea, loose stool, "the runs"

Drugs, Diet and the Unborn Child

After trying for a baby successfully and enduring nine months of pregnancy, the best gift a couple can get is a healthy bouncing baby. However, up to 3-4% of newborn babies manifest with congenital abnormalities at the time of birth. A further 2% manifest later, at about the age of 5 years. These abnormalities may be inherited or due to environmental factors. We can control some of the environmental factors that affect the unborn child. This should be done right from the moment you decide to try for a baby as you may not know when you actually conceived and yet most abnormalities occur within the first 3 months, when the organs are forming!

How do environmental factors affect the unborn child?
Environmental factors are in the form of nutrition, drugs and poisons and infections. These factors are referred to as teratogens.
There are various known nutritional states, drugs and chemicals and infections that have been associated with occurrence of congenital abnormalities. Some of these are:

1. Smoking - Fetal growth retardation, increased incidence of miscarriage and prematurity
2. Alcohol - Fetal growth retardation, abnormalities of the face, mental retardation
3. Anti-coagulants e.g. warfarin - abnormalities of the bone, facial abnormalities, mental retardation
4. Anti-cancer drugs - Impaired development of some organs
5. Tetracycline - impaired teeth and bone development
6. Chloroquine - increased occurrence of abnormalities of hearing and vision
7. Infections e.g. Toxoplasmosis, rubella (german measles), herpes, syphilis, Cytomegalovirus, malaria, HIV - these infections pass on to the unborn child and affect the development of the brain and other organs.
8. Poorly controlled maternal illnesses like diabetes and hypertension may result in impaired development of the child and mental retardation
9. Folate deficiency - Impaired development of the child's nervous system.
10. Iron deficiency - Retarded growth of the child.

THESE EXAMPLES ARE MODEST AND THERE ARE SEVERAL OTHER KNOWN CAUSES.

What can you do to avoid exposing your child to potential teratogens?

• Visit the antenatal clinic at the earliest possible time. Then, a couple of blood tests will be done to investigate for some common infections that may be harmful to your child and to find out the level of your blood. You will be advises on the type of diet you should favour and what nutritional supplements you can take.
• When attending the clinic, your pregnancy will be monitored and any abnormalities in progress will be discovered.
• Do not take any drug when you are trying for a baby or during pregnancy without consulting your doctor.
• Avoid smoking, alcohol and use of illicit drugs
• Avoid radiological investigations like X-rays. Alert the doctor of your pregnancy should he/she make such a request.
• Prolonged sauna and hot tub baths may expose your child to high temperatures which may be injurious to its development.
• Eat plenty of proteins (fish, eggs, meat) vegetables and fruits
• If you have any sexually transmitted disease (including HIV), seek treatment.
• Plan for your delivery with your obstetrician and paediatrician.

 

Fever

Definition
Raised temperature i.e. Body temperature greater than 37.8ºC

Normal range
36.8ºC - 37.8ºC

How does it manifest?
Shivering, feeling alternatively hot and cold, shaking

What does it mean if my child has fever?
Your child may have an infection, either viral or bacteria. Infectious organisms interfere with the normal body temperature control mechanisms.

Can a child have a high temperature and yet he/she is not unwell?
Hot weather, very warm clothing, running around and screaming may make a child's temperature rise temporarily.

Can a child be ill and not have a high temperature?
Very young children can have normal temperature or low temperature and yet be seriously ill

What do you do when your child has fever?

1. Take your child's temperature. You can use a mercury thermometer which is cheap (about Kshs. 20) but harder to use and read or a digital thermometer, which is more expensive (about Kshs.500). Place the thermometer in the child's mouth (more reliable) or under the armpit. Maintain the thermometer in place for one full minute if you are using a mercury thermometer and until you get a bleep for a digital thermometer.
2. Be on the look out for other signs and symptoms of infection e.g. rash, lack of appetite, vomiting, irritability, irritation when the child is passing urine.
3. Relieve the child of heavy clothing.
4. Lay the child on the bed or on your lap and sponge his body with a wet cloth. Do not use cold water, use water from the tap
5. Encourage the child to take fluids
6. Administer paracetamol (15-20mg/Kg) or brufen (10mg/Kg), available over the counter
7. Take the child to hospital if there are any other signs of illness and the fever is persistent

DO NOT:

Use cold water to administer tepid sponging
• Give the child aspirin - he may have a complication characterised by malfunction of the liver and brain.

Possible complications:

• -Dehydration - because of loss of water from the skin and through fast breathing
• Convulsions - especially if there is a family history. If this happens, be calm and follow the guidelines for convulsions
• Reye's syndrome - a complication characterised by the malfunction of the liver and the brain. It has been associated with viral infection and the administration of Aspirin. It can result in death.

Fits (Seizures or Convulsions)

What is a fit?
A fit is characterised by involuntary stiffening and jerky movements of the body. A fit happens when there is an abnormal rise in the electrical activity of the brain

What are the other manifestations of a fit?

• The jerky movements may only occur on one limb
• The child is unarousable and will not respond to sound or touch.
• He may cry out.
• He may have frothing from the mouth
• The eyes may roll and look upwards or just stare into space without blinking
• He may breathe heavily and fast
• After the fit, the child may become floppy and sleep
• On examination, you may discover that he/she has passed stool or has urinated on her/himself.
• Some of the fits may not be obvious and may just be characterised by staring gaze and deep breathing or just a short lapse in attention

What causes Convulsions

• In most children, they may be due to fever in which case they are called febrile convulsions.
• Epilepsy may be a reason for convulsions. Epilepsy is described as a tendency to suffer convulsions in the absence of any known illness or fever. These convulsions may have occurred at least twice within one year. The cause of epilepsy may be due to abnormalities present at birth, infections of the brain or after recovery from head injury but in most cases, the cause is unknown.
• A child with head injury may have convulsions.

What do you do when your child has a fit?

• Maintain calm
• Turn his head gently to one side and place something soft underneath
• Stay on site while the fit lasts and when he regains consciousness, re-assure him.
• Do not attempt to put anything in his mouth or restrain his movements during the fit.
• If he has fever, tepid sponge the child with a clean wet cloth and give the child paracetamol or brufen syrup when he regains consciousness
• If the child is known to have epilepsy, make sure he gets his drugs as prescribed and if the fits recur, see the doctor.
• Take the child to the doctor if he is NOT KNOWN TO HAVE EPILEPSY.

Loose stool

See: Diahorrea

Playgroups and Nursery Schools

Why a playgroup?

• Most children spend the early part of their lives being looked after by their parents, grandparents or child minders. However, as they grow older (up to about the age of 2 ½ year), they are suddenly more mobile, playful and inquisitive.
• A playgroup provides your child the richness of interacting with other children his/her age, a wider variety of play equipment and greater mind stimulation. Children start to learn to be independent and get confident in forming relationships.
• During this time, the child may be able to learn a few things when having fun.
• Taking your child to a playgroup will enable him/her to move up to full time schooling more easily when the time comes.
• A playgroup will also free up your time for you to be able to do other things and the absence will make you appreciate your child.

What should you consider when choosing a playgroup?
In order to decide which playgroup to take your child to, it is worth making inquiries from your friends and making time to visit the local play groups.

When you do visit the playgroups, be on the lookout for:

• The way you are received and introduced to the other helpers and supervisors
• If your child has accompanied you, see how your chid is made welcome and if introduced to other children.
• Find out how they handle children with different ethnic and cultural differences. How do they handle racial and ethnic comments from fellow children and even parents?
• Are boys and girls treated differently?
• Is there adequate playing space and is the area safe. Be on the lookout for electrical installations, distance of the play area from the road, open holes and trenches, uncut grass etc.
• Are there a wide range of toys and equipment on offer? Do they have activities such as painting, play dough et.c
• Find out about singing sessions and storytelling times.
• If your child has special needs, it is worth knowing if they have the infrastructure and the staffing to accommodate him/her.
• A playgroup is unlikely to be perfect and if other circumstances are acceptable, your involvement may help in improving the situation.

When you child starts going to a playgroup;

• You need to follow up his activities and feeding from the helpers and supervisors.
• Do not prolong your goodbye sessions when you drop your child.
• Give him time to rest after playgroup as he will probably come back tired. Make sure you provide food early.
• If your child is reluctant to go suddenly, investigate if he has been upset by a playmate or a helper and even offer to go with him at certain times. This will help you confirm if he is being treated well and work on areas you can improve on.

 

Rashes

Definition

• Eruptions on the skin.
• The eruptions can be solid, scaly, have clear fluid in them or contain pus.
• They can be of different sizes, ranging from pinpoint to the size of a coin.
• They may be of different colour e.g. red, violet, white, and dark. These colours are more apparent if the child is light skinned.
• They can be restricted to certain parts of the body like the trunk, the creases of joints or be generalised
• They may have their onset from a particular part of the body e.g. behind the ear like in measles.

How do they manifest?

• Eruptions, as described above
• Pain
• Itchiness

Other accompanying signs and symptoms

• Fever
• Irritability
• Coughing
• Lethargy

MOST RASHES ARE BENIGN AND SELF LIMITING

What could have caused the rash?

• Bacterial or Viral infection e.g. impetigo, chicken pox, measles et.c
• Fungal infection
• Drug allergy
• Food intolerance
• Atopy

What to do?

1. Maintain hygiene
2. Examine diet and possible points of exposure e.g. nappy rash
3. Seek medical assistance if there is:
   • Persistent rash
   • Fever
   • Rashes are filled with pus
   • Persistent itchiness
   • Swollen lymph nodes
   • Reddening of the eyes
   • Running nose
   • Cosmetic concern

Do not
Self medicate unless the child is already in a known treatment regimen.

Sex and Your Child

When should you tell your child about sex?
AS EARLY AS 3-4 YEARS, your child may start asking you questions such as: 'where did the baby come from?', 'what's condom?'. This can be embarrassing especially if the questions are poised in a public place. However, you should not keep the information asked for from the child as he will not rest until he is enlightened. This is therefore your chance to provide appropriate enlightenment.

What should you tell your child about sex?
The information you will provide to your child about sex will depend on her age.

For young children:
picture books showing the growth of the unborn baby in the womb may be useful in explaining the process. You need to explain to the child how daddy placed his seed inside mummy's womb and how the baby was eventually delivered. This interaction should be guided by the child's inquiries and you should not overburden the child with a lot of information. However, you need to instil a sense of discretion and advise on the time and place where this can be discussed.

For adolescents:

• Your child would normally be aware of sex from her peers, school teachings and the mass media. Her body is also likely to be undergoing some pubertal changes.
• You need to try and educate her about the science behind the changes in their body.
• Make her aware of dangers of unprotected sex
• Advise her to abstain from sex. However, your social circumstance may tolerate sex outside marriage and you need to inform her on the use of contraception and protection.
• Pictorials from science and medical books about sexually transmitted diseases can be useful in your discussions.
• Take interest and encourage extra-curricular activities.

What should you know about sexual abuse?
Most acts of sexual abuse are perpetrated by persons who are known and are close to the child like relatives and caretakers.
Up to 50% of children who have been subjected to sexual abuse will have no abnormal features

Sexual abuse may present as:

• Allegations by the child. Children rarely lie about this.
• Injuries to the anus or genitalia.
• The child may manifest with sexually transmitted diseases.
• Your child may be explicit about sexual issues during play or normal talk.
• She may have little trust for individuals close to him

What do you need to do when you suspect that your child has been sexually abused?

• You need to probe the child gently about the circumstances.
• Examine your child for bruising and lacerations around the genitalia and the anus
• Take the child to the nearest health facility for further examination by the doctor. If penetrative sexual abuse has been undertaken, he may need to receive preventive treatment for HIV infection
• The police should be informed about your suspicions for investigation

What should you tell your child about sexual abuse?
By the age of 2 years, most children are aware about their genitalia. From this time, they need to be informed that their bodies are special and it's their own and if anyone touches them in certain places, they should tell them not to and tell you too.

 

Weaning

What is weaning?
Weaning is the process of introducing solid foods into your baby's diet in order to fulfil their growing nutrition. Most parents consider weaning to mean completely stopping breastfeeding - but this is not so.

Why wean?
Weaning is a natural stage in a baby's development. The milk your baby has been drinking is only food he'll have needed' but after six months he will need more iron and nutrients than are found in milk.

When should you start weaning?
There is no right or wrong age to start weaning but it is best that you exclusively breastfeed for the first six months of life. Do not rush into weaning as a result of pressure from parents or friends. Your chid may be ready for weaning if baby:-
" Is unsatisfied after a full milk feed
" Demands for frequent feeds
" Can control head movements
" Is attempting to put things in his or her mouth
" Gaining weight slowly or weight gains level out without a period of illness to explain why
" Starts to wake up at night with hunger after a period when they were sleeping through

How do you start weaning?
Do not stride on with a roasted meal the first time he gets to try solids!

Start with soft tasty foods for example

• Vegetable purees of parsnip, carrot, potato or yam
• Fruit puree of pear, banana mangos or coked apple
• Purees of rice, maize, millet, or baby rice mixed with baby's usual milk

To see how to prepare this ….

There are foods that you are advised to avoid for the first six to eight months as the have been known to cause allergies.
These include

• Nuts and seed foods
• Shellfish
• Exotic or citrus fruits
• Eggs and egg products such as custard
• Cow's milk
• Food which contain glutein to bulk them out

Getting started

• Choose an appropriate time
• Make sure you are both relaxed before you start to feed
• Feed you baby on your lap or a high chair
• Try giving 3 or 4 small teaspoonfuls of food only part way through or after their breast or bottle feed.
• If the food comes back out of the mouth, do not force it down the baby's mouth - the baby does not know how to swallow
• If the baby is reluctant to start with spoon-feeding, you might try by rubbing a clean finger with small amounts of the feed...if these doesn't work you need to try again another day.

Next steps…next 2 months

• Try to gradually increase the amount of food you give to the baby. Give more solids for two of his meals each day
• The baby will also need a drink during and after their feeds. This can be breastmilk or juice given from a bottle or a cup with a spout and two handles
• Add other food to the vegetables, fruit and cereal purees
  • Purees of meat (including liver) and poultry
  • Purees of lentils (dahi) or split pulses
  • Milk products (full fat yoghurt, fromage frails, custard) - unless your family has history of eczema and other allergies

From eight months to twelve months

• Once the baby gets used to eating solid foods you can now introduce more tastes and textures to the diet
• Try fish, other meats and eggs all minced or mashed.
• Ensure that they get at least one serving of protein each day
• Encourage baby to chew. He may not have many teeth but it's advisable to leave a few little lumps in the food so that the bay gets used to the texture.
• You may now give your baby finger food like wholemeal bread, banana slices chapatti, cooked carrot or green beans, to encourage chewing. However you should stay near the baby to give him/her encouragement an to make sure she doesn't choke
• Your baby's intake should still be about half a litre per day
• Gradually increase the amount of solid foods…and by nine months ensure that the baby is getting at least 3 minced meals per day and milk and snacks in between meals

From twelve months onwards

• Your baby's diet should include plenty of starchy foods and a wide range of fruit and vegetables
• It is now ok to start the baby on full fat cows' milk as the main drink (not semi-skimmed or skimmed milk. Aim to give a bout half a litre per day
• It's now time to try feeds that your baby didn't like before

Is weaning going too fast for the baby?
Watch your baby for signs of stress which may indicate that weaning is going too fast:

• A new or increased fear of separation
• Increased crying, whining, clinginess or tantrums
• Sudden increase in night waking
• Biting of the breast when it never occurred
• A new or increased attachment to a stuffed animal, toy or blanket
• New thumb or pacifier suckling
• Stomach ache, constipation, vomiting, refusal to feed 9slthough these should not be taken lightly and a doctor should be consulted as son a possible)
• A new or increased withdrawal and aloofness
• A new or increased fear of separation

Tips

•  Don't rush your baby - give him as much as he needs
•  Go at your baby's pace and o not be upset if he refuses the food - he/she will  get used to the idea
•  Prepare your own food for the baby
•  Foods to avoid:
  
  • Salt - babies do not cope with salt than that which is naturally found in foods.
  • Sugar - encouraging a sweet tooth can lead t tooth decay. Add formula or breast milk to sweeten up the food if necessary
  • Honey - contains similar properties to sugar and will cause tooth decay. You should not give honey to children less than one year, as it occasionally contains spores that may cause severe illness
  • Nuts - whole nuts should not be given to any children under five years of age in case they choke on them
• Weaning can be such a messy business so make sure you are prepared to get your clothes and your baby very dirty indeed! Put newspapers down on the floor to protect your carpets
• If baby is eating food prepared for the whole family make sure his/her portion has been set aside before seasoning.
• All food should be stored, handled and prepared hygienically to prevent diarrhoea and other infections.
• If infant refuses to cooperate, put them in situations where they will see other children their age eating
• Do not add any food to a bottle containing milk
• Allow baby to feed themselves, using their fingers, as soon as they show interest
• Let your baby touch the food in a dish or spoon
• Wait for baby to open his/her mouth when food is offered
• Water is the best alternative to milk. if you decide to use juice, use one part juice and ten parts water
• Over time, your baby's demand for milk will reduce, its however advisable to continue breastfeeding…for your comfort

Do you ever need to see a doctor?
Most difficulties can be resolved by patience, understanding and a lot of positive encouragement. You will need fresh ideas and techniques to deal with the difficulties. If the problem persists you may visit you doctor to exclude possible medical causes.