When to introduce solids to your baby

It’s incredibly important to know when your baby is ready to be introduced to solids.

There are many reasons why parents may want to start solids earlier than 6 months, particularly if weight gain is an issue in your little one. Family and peers can be a major source of pressure to push you into introducing solids sooner than planned.  In some cases even medical practitioners may encourage you to start solids sooner to assist in weight gain.

But how do you know if your child is actually ready?

Your child will let you know when they are ready from a developmental point of view as well as from a medical aspect, their digestive system needs to be mature enough to be able to process and digest solids. These two aspects normally work hand in hand and your child showing their developmental readiness gives a strong indication that they are ready for solids.

From a developmental point they need to:

  • Be able to sit unaided. This means they need to be able to hold up and control their own body weight without the assistance of an infant seat or cushions.
  • Have lost their tongue-thrust reflex. This is when they stop automatically pushing solids out of their mouths with the use of their tongue.
  • Be showing an active interest in your food and mealtimes, trying to grab food from your plate and intently watching you eat.
  • Be developing a good pincer grasp by being able to pick up food and/or other objects between their thumbs and forefingers.
  • Most notably is that a baby under the age of 4 months has not developed the required oral co-ordination and muscle strength and cannot suitably work or process solids. The lack of oral and muscle co-ordination places your baby at risk of choking and aspirating on food their body is telling you that they are not ready for.

From a digestive aspect they need to:

  • Be a minimum of 4 months old, but 6 months is preferable.
  • The recommendation is to exclusively feed a child breastmilk/formula for the first 6 months of their lives as their digestive system is not developed enough yet to suitably process and digest more than breastmilk/formula

The introduction to solids before the age of 4-6 months can pose serious risks and complications for your baby, including:

  • an increased risk of food being sucked into their airway and causing aspiration;
  • causing your baby to get either too much or too little calories or too much nutrients;
  • increase their changes of obesity;
  • cause an association of discomfort and distrust to solids; and
  • increase the risk of developing allergic reactions, eczema and bouts of wheezing.

Recently statistics were released in South Africa showing the very real danger of introducing solids to infants before their digestive systems, oral motor skills and specific developmental milestones have been met:

‘’According to the 2018 Stats SA’s report on Mortality and causes of death in South Africa, the leading cause of death among infants is respiratory and cardiovascular disorders specific to the perinatal period (responsible for 14,8% deaths), while intestinal infectious diseases is the third leading cause of death (responsible for 6,7%). Professor Siyazi Mda, principal paediatrican at Dr George Mukhari Academic Hospital near Ga-Rankuwa, says babies and young children who suffer from diarrhoea, lower respiratory infections and undernutrition as a result, risk these conditions increasing with the introduction of solids before six months.

According to Professor Mda, a number of studies show that the early introduction of solids in babies is associated with allergic diseases, including eczema and an increased rate of wheezing. “In developing countries, babies who start solids early are prone to undernutrition, while in developed countries there is an association with obesity and increased body fat, which are risk factors for diabetes,” he says.

He adds that the oral muscles of a child younger than four months are not suitable for solid foods and there is often a problem with the coordination of swallowing, increasing the chances of choking.

Heidi du Preez, a professional natural scientist from Cape Town, says that before four months, the digestive tract of a baby is immature and solids increase the risk of baby developing allergies.

The intestine of an infant during the first six months is very porous, which means foreign proteins in allergy-producing foods are easily absorbed from the intestine into the blood. Introducing grains too soon can lead to constipation, blocked noses and itchy skin and food intolerances,” she says.’’

https://www.parent24.com/Baby/Newborn/why-you-shouldnt-feed-your-newborn-solids-20160829

If your baby hasn’t shown all these signs, they are not ready for solids. Up to the age of 6 months breastmilk and formula are all which they require to stay nourished, healthy and growing.

As parents we are placed under immense pressure from our peers and sometimes medical practitioners for our children to weigh a certain amount at a certain age. Family will offer up their own stories of how their children were fed solids at 2 months old and ‘were fine’. Medical professionals will push that your infant needs to gain weight faster because they aren’t fitting into a graph well enough. If your baby is healthy, happy, wetting and dirtying nappies at a normal rate, sleeps well, feeds well, is growing consistently and meeting their developmental milestones, why rush the process and potentially place them at unnecessary risk for complications that place both their health and well being at risk?

As the mother of a child with a history of severe oral muscular complications, food aversions and weight gain issues I know all too well the pressure which is placed on parents. We went with medical advice to start on solids before our daughter was developmentally ready and I still firmly believe it is one of the main contributing factors that led towards her struggles with learning the right skill sets and confidence for a successful start and transition onto solids.

Give them the time they need to develop the right set of skills that will encourage a positive introduction into solids and make the process an enjoyable one for all involved.

Understanding Influenza A and it’s vaccination.

For those of us in the Southern Hemisphere, winter is upon us. Riding in it’s coat tails and holding on steadfast is all forms of cold and flus waiting to attach themselves onto anyone in their path.

In Port Elizabeth, South Africa, we saw the closure of a prominent primary school yesterday as a result of an outbreak of Influenza A. A reported 20-25% of staff and pupils diagnosed and listing as absent from school attendance.

One of the biggest questions I’ve seen being asked is why do people get sick more frequently in winter than in summer?

Well, it’s not the weather which is directly responsible for people getting sick, but rather that viruses tend to spread easier in lower temperatures. In drier climates it’s even suggested that because of the dry air conditions it is easier for viruses to enter the body.

How do we protect ourselves from picking up unwanted viruses?

Two of the most effective methods of prevention is hygiene and vaccinations.

If you are exhibiting signs of illness it is advised to stay home for the duration of your illness, to prevent the spread of the virus.

If you have no choice but to go into public spaces and risk exposing others, wear a face mask, wash your hands, cough into a hankerchief or into the elbow of your arm, not your hand. Keep sanitizer on hand to wash your hands regularly. Sanitise your hands before touching items and objects in public spaces that others will be exposed to.

The same goes for prevention. If you are going into public spaces, grab some sanitizer and wipe down objects that you may need to touch, or use a sanitizer wipe as a surface barrier between your skin and the object.

The second most effective method of prevention is vaccinations. While this can be a hot topic of discussion in other forums, it isn’t one in our world, it’s a non negotiable for our family.

What are we vaccinating against?

Every year the World Health Organization (WHO) develops a flu vaccine for protection against specific strains of Influenza.  The annual vaccination normally provides protection against three strains of the flu which is predicted to be the greatest threat for that year.

This year the vaccination is designed to provide immunity against two different Influenza A strains and one Influenza B strain.

Influenza A can be found in humans, animals and birds while Influenza B is isolated to humans.

Who should be vaccinated?

In an ideal world we should all be receiving a vaccination to best protect us.

The most at risk of individuals, as well as their family members should vaccinate themselves. At risk individuals are best described as those who:

  • Babies and small children;
  • Immune compromised individuals (HIV-positive individuals and individuals receiving radiation or chemotherapy);
  • Individuals who are over the age of 65 years;
  • Asthmatics and emphysema sufferers;
  • Individuals who suffer chronic from chronic conditions such as diabetes, heart issues, organ issues; and
  • Woman in their second or third trimester of pregnancy.

Can the vaccination make me sick?

There is a misconception that the Influenza vaccination can actually give you the very viruses which it is designed to combat. This is false. It does not contain the live virus, but it can exhibit mild ‘flu-like’ symptoms which are short term in duration. It can have some side effects (as is the risk with any medication) but the side effects should be no more than some pain, redness or swelling around the site of the vaccination, muscle aches and drowsiness. In rare cases allergic reactions have been reported, but the risk versus reward outweighs this concern.

Why should we vaccinate?

The flu causes an estimated 6 000-11 000 deaths every year in South Africa alone. The most affected are the elderly who account for nearly 50% of deaths, followed by 30% being related to HIV-positive patients. The highest rates of hospitalization occurs between children of 5 years age and under along with elderly and HIV-positive individuals. Last year in South Africa 8-10% of patients hospitalized for pneumonia and 25% of patients who showed flu-like symptoms tested positive for influenza.

When should I or a loved one have one?

Just ahead of the flu season is the best time. But if you missed that, then right now!!!  Vaccinations are available at most pharmacies. Most medical aids cover the injection and if medical aid doesn’t, it costs near R100.00 for a vaccination. 

How long will it protect me?

Remember that the vaccine itself needs around 10 days from administration to become fully effective. It should keep you protected for the duration of the winter/flu season. But understand that you are not protected against all strains of influenza, only those which the vaccine was designed to combat.

https://www.heraldlive.co.za/lifestyle/leisure/2019-05-28-flu-vaccine-may-protect-against-influenza-a-and-b/

Please note that I am not a medical practitioner and it is always advisable to consult with your family doctor, specialist and/or paediatrician about your overall health and well being.

Bullying

A few days ago I posted a seemingly harmless comment on an online news article relating to a convicted criminal who was facing new charges for a different transgression.  It was suggested that because this individual was already serving time for other convictions, that new charges were ‘kicking a person while they are down’.  Going against better judgment, I commented that if a person was guilty, and proven so, that they should rightly be charged and serve their additional sentence. Commenting and offering opinions on articles of this nature goes against my better judgment, but nobody is perfect, sometimes we do things that we know we probably should just turn and walk away from. Entertaining fools offers no rewards.

I’m intelligent enough to know that right and wrong aren’t viewed the same for everyone. If we all did, we’d have no need for prisons, law enforcement and justice systems. Be that as it may though, my small opinion on any particular topic really does mean nothing in the greater scheme of things, not everyone will agree with them and that is also OK. What a dull world this would be if we all agreed with each other 100% of the time.

So I have to admit to being slightly surprised at the retaliation with which I was greeted with. Comments were made attacking both my opinion and my physical appearance, as an attempt to goad me into defending myself and retaliating. They were aimed at hurting me, making me feel inferior and a less worthy human being. Had those comments been hurdled at me even a year ago, I may well have taken them to heart. But I’m not the same person that I was a year ago. I’m stronger now. More confident. More self-assured in who I am and who I want my daughter to have as a role model growing up.

I want her to learn from me that there is a difference between right and wrong. That a society can only function when we uphold and understand right from wrong. I want her to show compassion and respect to others. She needs to form her own opinions on people based on their actions and not on their appearance. She needs to know that bullying, threatening, undermining and belittling someone to boost her own ego will get her absolutely nowhere in life.  I want her to embrace the fact that we are by design, all different, that your physical appearance has absolutely no bearing as to who you are as a person.   She needs to know that people will have different opinions and views in life and that is perfectly OK. She also needs to know that using her words to undermine, hurt and humiliate others for personal gain and self-confidence does not make you worthy anyone’s respect. I want her to treat others how she would expect to be treated herself.

I’m proud of who I am as a person. I do not shy away from standing up for myself or for my loved ones. I had to advocate, fight and throw my opinions around to keep my daughter alive, from before she was even born. I had opinions on her eating problems from the very first few weeks of her being home. I voiced those to every medical professional we encountered. They weren’t always heard, they weren’t always taken seriously, but in the end, they went a great way towards finding professionals who were able to diagnose her and help us, to this day.

I’m proud of the fact that my stance on right and wrong makes me the type of person that some people do not want to be associated with, because the feeling is mutual. Life is short. I’d prefer to spend my time with likeminded people who have respect for the law and understand the difference between right and wrong. I want the people with which my daughter will grow up being surrounded by, to be good, honest, loving people and role models with integrity and a set of morals and ethics that will go towards building her up into a strong, confident and compassionate person.

I’m also proud of my breasts, which were referred to as ‘pap sakke’ (saggy bags). Another comment and dig aimed at degrading an undermining me. These saggy bags nourished my daughter for 4 months. Against all the odds stacked against me, after nearly dying while trying to give her a chance at life, they were able to produce milk for her first few months in life. They nestled her when she grew strong enough to be held. Their warmth and comfort stabilized her blood pressure, breathing and heart rate. When she was suffering with reflux and screaming from exhaustion, pain and hunger, they comforted her. When she was sick and needed comforting, they were there for her and still are. They may not be as perky and pretty as a young woman’s, but I’m not a young woman anymore, so I can’t expect them to be what they aren’t.

We aren’t designed to leave this world in mint condition. My body and my breasts may not be in their best shape. But they have made sacrifices for my child that few can understand. To my own detriment in many ways I neglected my own mental and physical health and appearance for the last few years while focusing on raising our medically fragile daughter. I fought through deadly levels of high blood pressure, fluid building up in my lungs, my liver and kidneys failing, the risk of blood clots, heart attacks and strokes, all for our daughter to have a chance at life. I placed so much focus and energy in her first few months that I failed to recognize a potentially devastating combination of PTSD and PPD which very nearly resulted in me taking my own life.

So, if the worst insults that somebody can come up with is that my opinions irritate the shit out of them, and that my breasts are saggy, then I consider my life so far to be a fairly good success.

Once we have left this world, our outward appearance is going to be one of the least remembered attributes. We won’t be remembered for how much money we made, what types of cars we drove, or how big our houses were. We will however, be remembered for how we treated others, the lessons we taught them, the time we spent with them, and how we spent that time. We will be remembered for our actions, and words.  Best we use those words wisely and spread positivity, integrity, understanding, love and respect.

Now if you’ll kindly excuse me, our sickly toddler want to nuzzle up to her moms saggy breasts for comfort as she fights her first cold of the winter.

Potty Training

Two months ago we had an evaluation on Charlottes development. While she is no longer technically referred to as a micro preemie, and her age is no longer adjusted to accommodate her early birth, we do still need regular appointments to assess her overall development. With her last assessment over 9 months ago and her third birthday fast approaching we decided it was time to see how she was faring.

We had a checkup with her paediatrician the same time. He checked her out from head to toe, measured her, weighed her, checked her spine, ribs, posture and muscle tone. He asked about her home life, how she was talking, sleeping, eating. And I quietly held my breathe and waited for his verdict. Nerves fraught with tension, waiting for the inevitable concerns that would be listed. Instead he started beaming, told me to breathe and declared that he was so very proud of our little mouse and her progress! He was thrilled actually! Yes, her weight was still nowhere near where it should be, but she was healthy, strong, meeting every milestone ahead of schedule and she was still growing, even hitting the 25th percentile for height!

We got equally brilliant feedback from her OT! She is ahead in development, formulating sentences of a 3 year old (given that technically she was still only 2.5 years in age at the time of the assessment, this was amazing). She is counting to 20 which is double the number that is expected of her. She can recite the ABC song and is recognizing letters of the alphabet in the world around her. She’s phenomenal at memory games and building puzzles with far more pieces than is expected of a child her age. Overall the news was nothing but positive. Yes, she has some muscle tone issues we need to work on, particularly her upper body and arms, but we’re hitting those head on with specific fun activities to tone and enhance her skills and strengths!

There seems to be one benchmark that she’s not hit and nailed head on. The much desired and dreamed of phase of parenting a young and impressionable toddler. Potty training.

It seems that it’s the ultimate noddy badge for parents, a sign that you are well and truly the best and most successful parent in the world. If your tot turns three and still wakes up in a nappy, you as a parent are a terrible failure. Comparisons in parenting are part of the process though aren’t they?! I find myself being asked daily if she is weaned from her nappies. I see the wide eyed stare when I reply with ‘no’. The smug smirk that slowly spreads across a parents face when they proudly declare that their offspring is. The momentary judgement cast upon you as they assess your parenting skills on how quickly you were able to get rid of nappies in your life.

I would like to believe I’ve navigated these interactions relatively smoothly so far. But this topic is going to land me in hot water, soon. I’m going to put my foot in it without effective self restraint at some point.

Charlotte isn’t potty trained, and it’s not for a lack of effort on our part. We’ve tried so many tricks and methods and have come up nappy full. She has taken on a mentor, someone she loves dearly, follows like a hawk, loves to feed and cuddle with. Someone with ultimate patience, adoration and gentle love. Unfortunately her mentor also happens to enjoy pooping on the lawn.

Yep, her mentor is our Labrador, Paris. Not the greatest of mentors I’ll admit. There are many other traits of Paris that I’d love for her to sample, like a voracious appetite and the ability to sleep through any and all noises. But, as we all learn with parenting, our kids do as and when they will, with complete disregard to our own desires for them.

So yes. Our beautiful child is three and still in nappies. But does this affect your life? Does this make us lazy parents? Have we failed in raising her suitably? Are her chances of being a successful adult ruined because she’s still pooping in her nappy? The answer to all is ‘NO’. We’ve learnt from before she was even born that she marches to her own beat. She has never conformed to any yard stick of convention and norms. She does things as and when she feels she is ready. No amount of forcing the issue will change her mind, if anything, it only further discourages her to do something that she will do when she is good and ready.

So if your darling is potty trained and eating with silverware by the age of three, give yourself a pat on the back. But for the love of all the bacon in this world, don’t be a smug ass about this achievement. It doesn’t mean that you are a better parent than others. It simply means that developmentally your precious creation was ready sooner than ours.

So spare a thought for those of us still transitioning, instead of judging us. We literally dream of the morning that we’ll wake up and we don’t have to begrudgingly sort out dirty nappies. We dream of walking down the aisle and not needing to grab a bag of nappies for the trolley. We’ll get there I promise!

Mammas who are still dealing with nappies daily. I see you!!!!

THE NICU EXPERIENCE

The TV series ‘this is us’ recently aired an episode in its latest season where one of the main characters experiences a premature birth at 28 weeks. I’ve not yet been able to watch the episode myself, but I have seen many comments eluding to the fact that it is sadly, wildly inaccurate and does not portray the NICU experience as well as it could have. I can understand though how much of a daunting task this could have been for producers though, so I’ll reserve judgement for when I’ve seen the episode myself.

Thing is though. The NICU is near impossible to describe. Nothing can prepare you for what you experience when you walk in there for the first time. It is terrifying. It’s like bulldozing through a brick wall, in a hazy slow motion, while someone is throwing bricks at you. Blow by blow you keep moving forward one step at a time, you can’t stop, you can’t run for cover, you have no choice but to keep moving forward one step at a time.

Before you even get to see your child for the first time there are ground rules, things to learn, things to do. Learning how to wash your hands, where to leave your phone, what you may and may not wear, what you may not bring in, where you leave your handbag, bottled water, much needed coffee, etc. These are only the beginning and once you’ve navigated your way through washing your hands and ensuring that your clothes are cupboard fresh and not covered in hospital germs, you enter your babies room. Any number of life saving equipment surrounds their incubator, attached to them, keeping them alive. You search in the dark of the incubator for the tiny body that is apparently your baby. When your eyes finally settle on her you are shocked at just how small and fragile she is.

A rare moment when the Giraffe Incubator is open. Charlotte is in there, somewhere.

You are only beginning to comprehend what lies ahead for you and your family. While you are still trying to comprehend what’s happened, your babies nurse gently explains her vitals to you and tries to navigate you through it all. She’s honestly giving you as little information as possible during your first visit. But it feels as though she’s throwing a medical journals worth of information at you in one go. You can hear her, but you can’t really make sense of it all. All you can do is to look at your child. Breaking eye contact is next to impossible, you fear that if you stop looking at them that something will happen to them, that they’ll feel you leaving their side and not want to fight any more. You are trying to hear the nurse, but there are a thousand pieces of equipment humming, pinging and beeping in the background. Just outside the door are more nurses discussing their patients, alarms beep in the background, a radio plays a familiar inappropriately cheerful song in the background. In the corner a mom is reading softly to her baby. You want to ask questions, but your tongue has gone dry. And with every unfamiliar new alarm sounding off suddenly in the background or in your babies room, your heart stops beating, fearing that the alarm is announcing death.

Welcome to the NICU. Your journey is only just beginning. For most babies, their stays will be nothing more than a formality or precaution and a night or two, albeit, these few nights will be understandably terrifying for their parents. For others the stay will be for a few days, perhaps even a week. And for a small percentage, the stay will be months.

It’s a unique world. One that can only be comprehended and understood once you have been unwillingly cast into it. If you were fortunate enough like we were to be part of a small and intimate NICU, you find yourself becoming part of the furniture almost. You sit at your daughters door, confined to her room, her sleeping on your chest finally, or still confined to her incubator, reading out requested nursey rhymes to staff and parents. You share jokes, knit patterns, favourite recipes.

You learn to read the nurses faces in the morning when you arrive, you know when there’s been a new arrival and it’s been touch and go. You learn which paediatrician is on duty, purely from a nurses demeanor when you greet them. You grab coffee for everyone from the staff canteen, you’ve been there so long that people start assuming you are part of the staff content of the hospital. You assist new parents when they are standing by the basin, unable to remember exactly how to wash their hands, terrified that if they do it wrong that they will kill their baby, so they stand there and stare blankly at the basin.

You stare in awe at your baby and wonder when you’ll be able to do more than just hover your hand above her body, her skin so fragile that a simple touch can tear it open. You wonder if she can hear your voice. You are overwhelmed with emotion on the day you walk in and are told you can hold her for the first time. You’ve been yearning to hold her for weeks and the time is finally there. You can’t believe she is yours, how perfectly natural it is to hold her, in spite of the equipment attached to her. And then the shear horror when she is so comfortable that she altogether stops breathing or her heart stops beating while she lies sleeping on your chest. When nurses calmly massage her to get her heart pumping again and when essentially you learn to revive your own child every time it happens again after in the seconds it takes the nurse to get there. You begin to fear that holding her will kill her. You spent weeks aching to hold her but now you are too afraid to do so.

You learn the palour of her skin and the change of her vitals and know that the paediatrican will be asking for you to sign the umpteenth consent form for a blood transfusion. You stare at her first outfit, neatly folded and waiting beside her nappies, where it’s been for weeks, waiting for her to be strong enough, old enough, big enough to wear her first clothes.

You spend your days at your child’s bedside watching new babies arrive and go home before yours. For every two steps closer to taking your baby home, there is a guaranteed step backward as well. You swell with love and pride when you say goodbye to parents taking their babies home, but your heart aches for yourself, you wonder how it feels, and if you will ever feel it for yourself.

You overhear things naturally through your time there. You find out which babies are terminal, inoperable, made miraculous recoveries, gained weight, successfully transitioned onto breast milk, pulled through NEC, came off ventilation, were going to be discharged and so much more.

You go home every single day wondering if that night is going to be the night that you get a call to go back because something bad happened. You lay awake at night, waiting for the phone to ring. You stare at the ceiling and wonder how you will make it through the next day, but somehow you do. You look over at the calendar on the wall and realize you haven’t marked off yet another day in the NICU, 75 and counting you realize. When will it be our turn to bring our baby home???

Going home is the ultimate goal though isn’t it?! And when you are given the date you are thrilled, overjoyed, overwhelmed, and strangely terrified. You realize that you won’t be able to rely on all the equipment to tell you if your baby has stopped breathing or if her heart forgot to carry on beating. That looking after your baby will be on your shoulders only. After months of relying on the help and guidance of an entire medical team of professionals, you’re now responsible to care for a medically fragile infant. Suddenly you’re not so sure you want to go home after all.

Almost wire free and ready to go home.

Life within those walls is something that can rarely, if ever, be adequately put to words. Daily, you or those around you, are faced with scenarios you never imagined possible. There is no time to process what has happened, you live moment to moment, crisis to crisis, victory to victory. You watch the clock and count the days until you can take your baby home. Because when you walk out those doors, your life will pick up where you left it. The truth is though, that for most, life will never be the same again.

The NICU is an experience that changed me for life. I walked out those doors with my daughter as a different person. I’ve only skimmed the waters edge with some of what I personally experienced and what many other parents experience in their time there. Every babies journey is different, but the fear their parents feel when they know their child will be spending an indefinite amount of time there is universally understood by anyone who has worked or spent time there.

On our way home for the first time, after 91 days in the NICU.