Happy International Women’s Day! Strong women – healthy children.

Friday the 8th March is International Women’s Day (IWD,) a day on which we celebrate and reflect how far we have come and also how far we still need to go to achieve gender equality. (1) Unfortunately gender inequality is still a significant problem word wide, including here in Australia.

Gender based violence is defined as violence against an individual based on his or her gender or gender identity. In Australia one in three women have been the victim of gender based violence and women are more than three times more likely than men to have experienced violence from an intimate partner. (2) Gender inequality is also an ongoing concern in the Australian workforce. In Australia in 2018 women earned on average 15.3% less than men – when employed in comparable full-time roles. Women are also under represented in senior management roles and often overlooked when appointing people in leadership roles. Women also spend almost twice as many hours as men performing unpaid care work each week and have significantly less superannuation available on retirement. (3)

Why is gender equality important? Apart from the fact that it is a basic human right, by empowering women or allowing women to empower themselves, it not only changes her life, but also the lives of her family and community. Women tend to reinvest more of their income back into their families and are often responsible for funding their children’s education, preparing healthy food and ensuring that their children receive appropriate access to medical care. (4) 

Gender equality is very important from a child health perspective. By empowering women health outcomes for children improve on all levels. The single biggest factor that reduces death among children younger than five is better education and schooling for girls. Childhood mortality decreases in proportion to the years of schooling that a mother has attained and can reduce the risk of infant mortality by approximately 50%, as educated women can make better choices about nutrition, hygiene, immunisation and contraception.  (5,6) 

How can we empower our daughters? 

  1. Through education and schooling: In my view this is probably the most important tool in empowering our children, both boys and girls. Children should be given the opportunity and encouraged to attend school, post schooling education and children should feel safe and secure in learning environments. Alternative education platforms should be available for children who are not able to finish mainstream school. 
  2. By reducing gender based and family violence and providing support to survivors. Raising awareness of the significant ongoing problem this is in our society will reduce stigma and empower women to speak out and stand up against family violence. 
  3. By preventing teenage pregnancies.
  4. By providing opportunities and supporting women who start their own businesses. 
  5. Through legislation to reduce discrimination.

There is no tool for development more effective than the empowerment of women. 

Kofi Annan, 7th UN Secretary General

  1. www.unwomen.org.au
  2. https://www.ourwatch.org.au/understanding-violence/facts-and-figures
  3. https://www.humanrights.gov.au/education/face-facts/face-facts-gender-equality-2018 
  4. https://opportunity.org/news/blog/2017/03/empowered-women-change-the-world?gclid=Cj0KCQiAn4PkBRCDARIsAGHmH3fJua8mlgXaUK-ncbtihFCmTv2Z8onLnmMpxSXo5fJYE77TsYFOnVoaAibDEALw_wcB 
  5. https://www.scientificamerican.com/article/graphic-science-female-education-reduces-infant-childhood-deaths/ 
  6. https://www.scientificamerican.com/article/babys-life-mothers-schooling/ 

Sleep difficulties in children

When I had to do night shifts during my medical training, I came to understand how sleep deprivation could sometimes be used as a form of torture. After being awake for sometimes 30 plus hours, life just did not seem right. My body felt as if it lost the ability to regulate itself, especially emotionally. Sleep deprivation can wreak havoc in families and it is thus not surprising that it is a common problem that we discuss in consultations.  

Sleep difficulties are very common in children with cross sectional surveys finding that between 20-30% of children having some sleep related difficulty at any given time. Addressing these difficulties are very important, as lack of sleep could impact on a child’s physical, emotional, cognitive and social wellbeing…. Not to talk about the parents’ emotional wellbeing.   

The most common cause of sleep problems is behavioural, such as bed time refusal, delayed sleep onset and prolonged night time awakenings requiring parental intervention. Some medical conditions can also cause sleep difficulties such as obstructive sleep apnoea, movement disorders or other sleep conditions called parasomnias. A child could also struggle sleeping secondary to an underlying medical condition, such as breathing difficulties, pain, medication or due to psychological stressors, anxiety or depression. In our practice, one of the most common co-existing conditions we see associated with sleep difficulties are in children with ADHD or autistic spectrum disorder with between 50-70% of children with ADHD having an associated sleep disturbance. 

It is important to try and identify the reason for the sleep difficulties and to treat this if possible. Some children might require further investigations to assess ongoing difficulties, especially children with associated breathing or movement disorders in sleep. For children who have behavioural insomnia, behavioural interventions can improve sleep for most children. Bedtime routines, systematic ignoring or extinction, bedtime fading and positive reinforcement are a few strategies that have been proven effective, if used consistently. In some children, medication might be needed to help a child back into a sleep routine if other strategies have not been successful. 

For further reading, the Sleep Health Foundation of Australia have several useful factsheets. https://www.sleephealthfoundation.org.au/public-information/fact-sheets-a-z.html  

Sweet dreams!

Dr. Adele Heyer

Sugar – That Sweet Poison

It is well known that too much sugary food and drinks has a negative effect on health, contributing to weight gain and increasing the risk of type 2 diabetes. Thus one of the best things we can do for our health is to reduce sugar and refined carbohydrates from our diets. The World Health Organisation (WHO) recommends that we limit our daily intake of free sugar to less than 25 grams, which is no more than 6 teaspoons in an adult, and even less in children. On average in Australia we consume more than double this amount, with some, mostly teenage boys, up to 90g per day. 

What is meant by free sugars?

Free sugars are sugar added to food in the production or cooking process. Sugars such as found in honey, syrups and fruit juices should also be taken into consideration when keeping track of sugar intake. The WHO guidelines do not refer to sugars in fresh whole fruit, vegetables and milk, as there are no adverse effects of consuming these unprocessed food groups. 

How can we reduce our sugar intake?

  • Drink water rather than sweetened drinks. Avoid soft drinks, cordials, fruit juices, fruit smoothies, ice teas, energy drinks or any other sweet drinks. For example, a can of soft drink contain 40 grams (10 teaspoons) of sugar.
  • Sweets, lollies and baked goods are obvious sources of sugar, but beware of hidden added sugar in other processed food and condiments. 
  • Beware of so called “healthy” foods such as breakfast cereals, low-fat yoghurts and muesli bars. These foods often have high amounts of added sugar. Consider swapping to a more savoury home cooked breakfast.
  • Learn how to read food labels. Be mindful that there are many different names for the different types of sugar. Dextrose, maltose, fructose and corn syrup are just a few. 
  • Shop around the perimeter of the supermarket where the fresh food and fridges are, and avoid the middle isles with all the process foods and snacks. Or better even, support our local farmer markets!

Dr Adele Heyer

Just Eat Real Food

With so many conflicting opinions about diets in the popular media it can be very difficult to decide what to eat, and what “healthy” really means. Should I eat paleo or vegetarian? Low fat or low carb? Atkins or Zone? There is probably no one size-fits-all approach that will suit everyone. Planning your diet will depend on your own personal preferences, lifestyle factors and what your goals are. 

My personal view is that one cannot go wrong by eating real food. By real food, I mean unprocessed food where you can still clearly see where the food originated from. Real food does not come with a bar code or a long list of ingredients that contains numbers or unfamiliar names. It is food that you can buy from your local greengrocer, butcher or farmer. It is mostly the type of food our grandparents used to eat. 

You might be ready to change, but what happens if the younger members of the family do not share your enthusiasm? Children might be more likely to try new foods if they were involved in the planning process. Start a veggie patch with the children. They will love choosing seedlings at the nursery and will be delighted to eat home grown cherry tomatoes or peas straight from the garden. Or alternatively, let them choose recipes from colourful recipe books, visit one of our local farmers markets to gather the necessary ingredients and involve them in the preparation process. 

For most us, a real food approach will keep us healthy and prevent unwanted weight gain. So next time you shop, skip the supermarket isles with the sugary cereals, refined carbohydrates, packaged and baked goods and stock up on fresh veggies, eggs, dairy and meat. Bon appetite.

 

Dr Adele Heyer

The Power of Play

The American Academy of Paediatrics recently published a statement on the importance of play – and we could not agree more.

Safe and nurturing relationships and developmentally appropriate play activities are probably the most important factors for the development of essential life skills. Today’s society is often very focused on structured activities to promote academic results, but these activities are often introduced very early in the child’s life in the preschool years, unfortunately at the cost of less playful learning opportunities. Introducing academic skills at a very young age has not been shown to provide any academic advantage in later years. On the other hand, learning social skills through play enables children to develop the necessary life skills needed throughout life. 

What is play? Play can loosely be defined as voluntary, fun activities with no external goals. Play can be 

with objects, rough and tumble physical play, pretend or social play and outside play, to name a few. Play allows children to develop life skills while buffering them from real life consequences. Play activities stars at a very young age when babies start smiling in a social way. The back-and-forth verbal games lay down the foundation for more complex reciprocal interactions later in life. Play develops further and becomes more complex as the child progresses through the different developmental stages of childhood. 

Play is also needed for brain development and leads to changes at molecular, cellular and functional levels. The beneficial effects can be seen with improvement in executive functioning, language, early math skills, social development, peer relations and physical development and health. The opposite is also likely true with increasing prevalence of ADHD-type disorders in children that are play deprived. 

Adults can also benefit from play activities. Playing with your child strengthens the bond, improves communication and understanding between parent and child and reduces parental stress. Seeing the world from our children’s eyes can bring back the joy of our own childhood experiences.  

Thus, our advice would be to put down the phones, switch of the TV’s and computers and let your childhood imagination run wild!

If you would like more information, please have a look at the original publication at this link: http://pediatrics.aappublications.org/content/142/3/e20182058 

Childproofing Tips for Grandparents

As a grandparent, your grandchild’s well-being and safety are extremely important to you. Particularly when she is under your care—at your home, in her own home, in the car, or elsewhere—make sure that you’ve taken every step possible to ensure that she is safe and secure. Before you have your grandchild visit or stay at your home, make certain that you have reviewed and adopted the safety recommendations you will find below.

Safety Inside Your Home

There are plenty of safety measures you should implement in your home to protect your grandchild. To keep some of these guidelines in the forefront of your mind, use the acronym SPEGOS to help remind you of the following:

  • Smoke detectors should be placed in the proper locations throughout the house.
  • Pets and pet food should be stored out of a child’s reach.
  • Escape plans should be thought about in advance, and fire extinguish­ers
  • should be readily available.
  • Gates should be positioned at the top and bottom of stairs.
  • Outlet covers that are not a choking hazard should be placed over sockets to prevent your grandchild from putting herself at risk of an electrical shock. Use furniture or other objects to block access to electrical outlets, wherever possible.
  • Soft covers or bumpers should be positioned around sharp or solid furniture.

In addition to these general rules, be sure to keep important phone num­bers by the telephone and programmed into your mobile device. In an emergency, you’ll want to call not only 000 when appropriate, but also certain specific family members.

Another safety consideration:

Your special chairs or walking aids could be unstable and present a risk; if possible, move them into the closet or a room that your grandchild won’t be able to enter when he visits.

Nursery & Sleeping Area Safety

  • If you saved your own child’s crib, stored in your attic or garage, per­haps awaiting the arrival of a grandchild someday, you should replace it with a new one. Guidelines for children’s furniture and equipment have changed dramatically, and a crib that is more than a few years old will not meet today’s safety standards. This is likely also true for other saved and aging furniture that could pose risks to children, such as an old playpen.
  • Buy a changing table, use your own bed, or even a towel on the floor to change the baby’s diapers. As she gets a little older, and she becomes more likely to squirm, you may need a second person to help in changing her diaper.
  • Do not allow your grandchild to sleep in your bed.
  • Keep the diaper pail emptied.

Kitchen Safety

  • Put “kiddie locks” on the cabinets; to be extra safe, move unsafe
  • cleansers and chemicals so they’re completely out of reach.
  • Remove any dangling cords, such as those from the coffeepot or toaster.
  • Take extra precautions before giving your grandchild food prepared in microwave ovens. Microwaves can heat liquids and solids unevenly, and they may be mildly warm on the outside but very hot on the in­side.

Bathroom Safety

  • Store pills, inhalers, and other prescription or nonprescription medi­cations, as well as medical equipment, locked and out of the reach of your grandchild. Be especially vigilant that all medications of any kind are kept up and away from a child’s reach and sight.
  • Put nonslip material in the bathtub to avoid dangerous falls.
  • If there are handles and bars in the bathtub for your own use, cover them with soft material if you are going to be bathing the baby there.
  • Never leave a child unattended in a tub or sink filled with water.

Baby Equipment Safety

  • Never leave your grandchild alone in a high chair or in an infant seat located in high places, such as a table or countertop.
  • Do not use baby walkers.

Toy Safety

  • Buy new toys for your grandchild that have a variety of sounds, sights, and colors. Simple toys can be just as good. Remember, no matter how fancy the toys may be your own interac­tion and play with your grandchild are much more important.
  • Toys, CDs, and books should be age-appropriate and challenge chil­dren at their own developmental level.
  • Avoid toys with small parts that the baby could put into her mouth and swallow. Follow the recommendations on the package to find toys suitable for your grandchild’s age.
  • Because toy boxes can be dangerous, keep them out of your home, or look for one without a top or lid.

Garage & Basement Safety

  • Make sure that the automatic reversing mechanism on the garage door is operating.
  • Keep all garden chemicals and pesticides as well as tools in a locked cabinet and out of reach.

Safety Outside of the Home

  • Buy a car seat that you can keep inside your own car. Make sure you in­stall it properly (or have a trained professional install it for you) and that you can strap your grandchild into it easily.
  • Experiment with the buckles and clasps before you buy the car seat since their ease of use varies.
  • Make sure you know that your grandchild is out of harm’s way before backing your car out of the garage or down the driveway.
  • Purchase a stroller to use when taking the baby for a walk in your neighborhood.
  • On shopping trips, whenever possible choose stores that offer child-friendly shopping carts with seats that are low to the ground. Do not place your own car seat into a shopping cart, and avoid putting your grandchild in the seat at the top of the cart if possible. If you have a tricycle or bicycle at your home for your grandchild, make sure you also have a helmet for her. Let her choose a helmet in a special design or color.
    Although playgrounds can be fun, they also can be dangerous. Select one that has been designed to keep children as safe as possible; those at schools or at community-sponsored parks are often good choices.
  • Inspect your own backyard for anything hazardous or poisonous.

If you have a backyard swimming pool, or if you take your grandchild to another home or a park where there is a pool, familiarize yourself with these water safety guidelines:

  • There should be at least a 4-foot-high fence with a locking gate surrounding the pool.
  • Make sure that fences enclose neighbors’ pools, as well.
  • Practice touch supervision anytime your grandchild is in or near water.
  • You should also know CPR and how to swim.

How to build an essential first aid kit for townsville

Every year in Townsville our ER: cuts, ticks, infected bug bites, sunburns, eye injuries, broken bones, and all other kinds of fun gone wrong.

Being prepared means you need a first aid kit and know how to use it. Although pre-made store-bought first aid kits are a good start, these kits typically lack many items you’ll need for your family.

Shopping List for Your Summer First Aid Kit

So to help you get ready, I have prepared a shopping list below for your summer first aid kit. Get it built now, so that you spend your summer having fun, not in the ER.

  1. Premade first aid kit: It’s cheapest and easiest to start by buying a premade kit, because otherwise it is difficult to find small packages of all the different kinds of gauze, tape, and antibiotic ointment you will need. Find a large kit with a sturdy container with extra space to hold all the things you will add to it. Or, get a small duffle bag or backpack to hold your first-aid kit, and start by putting the pre-made kit in the bag. Be sure the pre-made kit includes Band-Aids, gauze, tape, antibiotic ointment, and anti-itch or steroid ointment.
  2. Water bottle for cleaning out wounds: The first thing you’ll need to do with a crying kid is clean out their wound. And the nearest water source is probably too far to walk. You can use your water bottle to treat dehydration, too.
  3. Benadryl (Diphenhydramine): Benadryl is probably the most important over-the-counter medication to have in your first aid kit—it’s a first line treatment for insect bites, hives, and other allergic reactions that can be deadly. Some premade kits will include Benadryl tablets, but if you have young children be sure to include a bottle of liquid, Children’s Benadryl or the generic equivalent. Benadryl is also a great treatment for an attack of seasonal allergies.
    EpiPen: If you have a family member with a history of severe allergic reactions (anaphylaxis), ask your physician for a prescription. I keep mine in the outside pocket of my first aid kit for quick, easy access.
  4. Numbing spray: Wound numbing spray can be purchased over-the-counter at any pharmacy and can really save-the-day when a child is burned, sunburned, or has a painful cut or scrape.
    Prescription medication: Ask your physician for an extra prescription for any medication you use frequently, especially asthma and allergy medications. Keep the extra supply in your car first-aid kit. You’ll be grateful when you can stay at your child’s sporting event rather than head home for an inhaler or other medication.
  5. Ibuprofen and Tylenol: Most pre-made kits include these standard pain medications, but you will have to add the liquid kind for children.
  6. Dramamine, nausea medication: There’s an easy fix for vomiting, car sick kids—nausea medication. Don’t leave home without it. You’ll kick yourself for not having it while you clean the vomit out of your car.
  7. Sunblock: The worst sunburns occur when you least expect it—at sports events, or while doing yard work. Have some 30+ sunblock ready to cover those little spots on your ears and neck that your hat doesn’t cover.
    Include some SPF lip balm or ChapStick, too.
  8. Bug spray: The best protection comes from a repellant that contains 30% DEET. Insect bites are annoying at best, but at worst they get scratched and infected. We are seeing a growing number of insect bites that become infected with the antibiotic-resistant bacteria MRSA, which is difficult to treat.
  9. Afrin nasal spray for nosebleeds: Although I generally don’t recommend Afrin nasal spray for congestion related to allergies or illness, Afrin is a quick fix for a nosebleed. This medication causes the capillaries in the nose to constrict, thereby limiting the blood flow to the nasal mucosa and stopping the bleeding.
  10. Hydrocortisone ointment: This inexpensive over-the-counter medication will treat almost anything that itches—insect bites, etc. If you stop the itch, the kids won’t scratch, and you reduce the risk of secondary infection.
  11. Flashlight/headlamp: If you don’t have a reliable light on your cell phone, include an LED flashlight or headlamp. You can buy these very affordably now, even at the dollar store. A flashlight is not just for nighttime injuries—you’ll need a bright light to get a good look at splinters, or look in kids’ mouths, ears, etc.
  12. Baby wipes: Even if your kids are out of diapers, a pack of baby wipes is infinitely useful in the car, especially for keeping hands clean and wiping noses.
  13. ChapStick: ChapStick or lip balm can sooth cold sores, lip injuries, and sunburned lips in addition to regular chapped lips. You’ll be glad you have it when you child complains about their chapped lips for the sixth time in ten minutes while you are on a family outing.
  14. Clean towel: A nice clean towel is perfect for setting up your first-aid station while you dress a wound or remove a splinter. It’s also useful for containing bleeding on bigger injuries. Consider a highly absorbent micro fiber towel that can be stuffed into a small space.
  15. Feminine hygiene supplies: Besides their obvious uses, tampons and maxi pads are very helpful for wound management and are an essential part of any first aid kit. An tampon can very effectively treat a persistent nosebleed. The smallest tampons fit nicely in the nose. Bleeding wounds can be easily controlled with a maxi-pad held in place with an Bandage.
  16. Premade finger splint: Not sure if that finger is broken or not? Just put it in a pre-made finger splint until you get your child to the doctor. You can buy premade finger splints at any pharmacy.
    Alcohol wipes: I mostly use these for sterilizing my first aid kit instruments, such as tweezers and scissors. They are also useful for cleaning skin before trying to remove splinters.
  17. Bandage: Although a first line treatment for sprains and strains, bandages are also useful for holding bandages in place on bigger wounds, and holding splints on fractures.
  18. Small scissors: For cutting dressings to the right size, cutting medical tape, opening packages, trimming fingernails and hangnails, etc.
  19. A bottle of Gatorade: Very useful for hypoglycemia, dehydration, etc. Also useful as an occasional bribe for an over-tired, hungry child.
  20. Ziplock bags: Ziplocks are essential for keeping track of teeth that fall out or are knocked out. Did you pull a tick off your child? Stick it in the Ziplock bag for later identification. Certain kinds of ticks are more likely to carry pathogens that cause other illnesses.
  21. Tweezers & small magnifying glass: I mostly use these for removing splinters, but occasionally they are necessary to remove bugs from ears, fishing hooks from fingers, etc. Of note, tweezers are NOT the best way to remove a tick.

Keep Your First Aid Kit in Your Car. You’ll never have to remember to pack it. If you need something while you are at home, just go out and get it. If you have more than one family car, consider making a first aid kit for each car.

Childproofing your home

Before or as soon as children begin crawling or walking, parents and caregivers need to take extra steps to make sure harmful items are out of reach, out of sight, and locked up if possible.
Check each room in your home to ensure the items below are stored out of reach of children and/or stored in a locked cabinet with a safety latch.

Cleaning products:

  • All-purpose cleaners
  • Bleach
  • Dish washing detergent (liquid, powdered, or single-use packets or tablets)
  • Drain openers and toilet bowl cleaners
  • Furniture polish
  • Laundry detergent (liquid, powdered, or single-use packets or tablets)

Personal and hygiene products:

  • Nail polish removers
  • Cosmetics
  • Mouthwash
  • Perfume and aftershave

Items that may be stored in your basement or garage:

  • Antifreeze and windshield wiper fluid
  • Gasoline, kerosene, and lamp oil
  • Insecticides

Medicines:

  • Prescription medicines
  • Over-the-counter medicines
  • Vitamins and supplements

Houseplants:

Certain houseplants may be harmful. Call Poison Help at 13 11 26 for a list or description of plants to avoid. You may want to do without houseplants for a while or, at the very least, keep all houseplants out of reach.

Small objects:

  • Beads, buttons, coins
  • Button batteries
  • Pins
  • Refrigerator magnets or products and toys with small or loose magnets Screws

Alcohol:

  • Alcohol can be very poisonous to a young child. Remember to empty any unfinished drinks right away.

Trash:

  • Keep in mind that children may get into trash containers. Trash containers that contain spoiled food, sharp objects (like discarded razor blades), or batteries should have a child-resistant cover or be kept out of a child’s reach. Purses and other bags that hold potential hazards, including medicines, should be kept out of a child’s reach too.

Important Reminders:

  • Most poisonings occur when parents or caregivers are home but not paying attention.
  • Keep products in original packaging.
  • Store in locked cabinets or containers, out of sight and reach of children.
  • Install a safety latch—that locks when you close the door—on child accessible cabinets.
  • Detergent in single-use laundry packets is very concentrated and can be toxic. Even a small amount of the detergent can cause serious breathing or stomach problems or eye irritation.
  • Never let your children handle or play with the packets. The packets dissolve quickly when in contact with water, wet hands, or saliva.
  • Remember to seal the container and store it in a locked cabinet after each use. Make sure the container is out of sight and reach of children.
  • Adults should follow the instructions on the product label.
  • Medicines can be harmful if not taken as directed.
  • Purchase and keep medicines in original containers with safety caps.
  • Check the label each time you give a child medicine to ensure proper dosage.
  • Small objects can be choking hazards or harmful if swallowed.
  • Check your floors regularly for small objects. This is particularly important if someone in the household has a hobby that involves small items or if there are older children who have small items.
  • Make sure battery covers are secure on remote controls, key fobs, musical books, and greeting cards. Store devices that contain small button-cell batteries out of reach and sight of children. Button batteries can cause
  • Severe injury or death if ingested.