Index

HEALTHY LIFE:
Sleep in the first year of life // Heel Prick Test // Food Diversification // 
SAFETY:
Pharmacy on the go // 
HEALTH PROBLEMS:
Baby Fever //  My baby has diarrhea // Baby anaphylaxis  // Scabies // My baby has hit his/her head // Infant Colic // Atopic Eczema // Cough //

HEALTHY LIFE

Sleep in the first year of life

Text by Paediatrician: Dr. António Salgado

.

.

A Baby’s sleep is a subject which has a great impact on the lives of families, who lose up to 700 hours of sleep in the first year of life.

Sleep needs vary in the first year of life: newborns - 16 to 20 hours; infants up to 4 months - 14 to 15 hours; from 4 to 12 months - 13 to 14 hours, and daytime sleep gradually decreases.

There are different sleep patterns over the first year. For infants up to 3-4 months old, when falling asleep, active, more superficial sleep begins, and about 20 minutes later, peaceful, deeper sleep. From 3-4 months old and for life, the cycle alternates between Non-REM sleep, after falling asleep, deeper, and REM sleep, more superficial and closer to awakening. In the transition between sleep cycles there are micro-awakenings. In the first year of life, REM sleep predominates, and the cycles are shorter, causing more micro-awakenings. It is intended to be short and for the child to fall asleep again.

In the first 4 months, the day-night cycle is established. This contributes to the increase, at the end of the day, of a hormone that induces sleep, melatonin. To take advantage of the peak of this hormone, it is important that the child is aware of the day-night transition, by being exposed to sunsets.

There are conditions and routines that must be adopted by families and the baby so that sleep is an early factor that contributes to good health.
Read the full article: SLEEP IN THE FIRST YEAR OF LIFE by Paediatrician Dr. António Salgado.

Heel Prick Test

Text by Paediatrician: Dr. Pedro Costa e Cruz

.

.

What is it?
The heel prick test is an examination that allows the early diagnosis of 24 inherited diseases of metabolism and congenital hypothyroidism. It is free and, although it is not mandatory, it is highly recommended to all newborns.

When and how is it done?
It must be carried out between the 3rd and 6th day of life, at the Hospital or Health Center, through the collection of a small amount of blood by means of a prick in the baby's heel. The blood is applied directly on a filter paper which is then sent for analysis to the Neonatal Screening, Metabolism and Genetics Unit of the National Institute of Health Doutor Ricardo Jorge.

How to get the result?
The result is available three weeks after the harvest and can be consulted individually at www.diagnosticoprecoce.pt, introducing the code that is delivered to the parents when carrying out the test. When the test comes back positive, or there are doubts that require repetition of the test, the parents are contacted directly.

Food Diversification

.

.

Food is one of the most important pillars of health, and the good habits associated with it should be encouraged from an early age.

One of the early aspects that parents face is the introduction and diversity of foods in the first months of life.

Consult our paediatricians’ advice:

• From 4 to 6 months
• From 6 to 9 months
• From 9 to 12 months

SAFETY

Pharmacy on the go

Text by Paediatrician: Dra. Inês Serras

.

.

Traveling is more and more frequent, whether for work or holiday, particularly with children.

What to take as medication for the trip usually comes at the time of packing, for those traveling with children.

The needs of each family will depend on the ages of the children, the destination and the duration of the trip.

When traveling abroad, we must take into account that the food, the climate and the customs may be different from ours, which may entail some increased health risks. In order to protect ourselves from any unforeseen circumstances, we must know what diseases may arise and the health resources that exist in the region.

In general, the travel pharmacy bag may contain:

• Single vials of saline, thermometer, bandage, disinfectant single vials (e.g. Betadine), bandages, sterile compresses, scissors, tweezers, etc.
• Antipyretics / anti-inflammatories: paracetamol and ibuprofen with reference to doses according to the child's weight (very useful in situations of fever or acute pain - ear pain, sore throat, etc.).
• Oral antihistamines or ointment in case of allergy
• Probiotic and oral rehydration solution, for cases of diarrhoea and vomiting
• Usual medication, in the case of pre-existing illness or other medications that may be useful, according to the child's history.
• Repellent with adequate protection against insects that transmit malaria, dengue and yellow fever in endemic countries. The repellent must contain DEET or IR3535.
• Sunscreen and moisturiser after sun exposure
• Nasal decongestant, for nasal congestion
• Laxative / enemas for constipation issues

Before traveling, you should contact your paediatrician, in order to personalise this list, according to your child's possible needs.

Pay special attention to medicine packaging.

In the case of air travel, remember that there are specific rules for the transport of medication in hand luggage, in order to be able to access the drugs during the trip, or in case of loss / delay of hold baggage (you can consult the specifications of each airline in the respective website).

Ideally, you should have a copy of the prescription, containing the name of the active substance and the dose of the usual medications, for security control at the airport.

Solid medications, such as pills or capsules, have no restrictions. The same is not true in the case of syrups, carried in hand luggage. These must be transported in sealed packages, with a maximum volume of 100mL (a maximum of 1 Litre per passenger), in a plastic bag, similar to hygiene items.

If you are going to travel within Europe, consider taking the European Health Insurance Card (link on the website), which allows you to access public health care in the country where you are located. If traveling outside Europe, it is advisable to take out travel insurance.

A very complete source of travel information can be found at: www.travelhealthpro.org.uk

HEALTH PROBLEMS

Baby Fever

Text by Paediatrician: Dr. António Salgado

.

.

What is fever and how to measure it?
It is the temperature 1°C above the average of the individual daily basal temperature, in the same measurement location.

Fever is considered the following values:

• Rectal ≥ 38ºC
• Axillary ≥ 37.6ºC
• Tympanic ≥ 37.8ºC
• Oral ≥ 37.6ºC

Fever is a manifestation of fighting infections and therefore beneficial. When situations with a fever are severe (5% of cases), there are always other associated manifestations, the so-called “warning signs”.

What are the “warning signs” in a child with a fever?
In the presence of one or more of these warning signs, the child should be assessed:

• Irritability and/or groaning
• Excessive drowsiness or inability to fall asleep
• Inconsolable crying / Does not tolerate being picked up
• Pained expression
• Fast breathing with tiredness
• Purple lips or nails and/or intense and prolonged tremors in the thermal rise
• Cloudy and/or smelly urine
• Seizure
• Skin spots in the first 24 to 48 hours of fever
• Repeated vomiting between meals
• Insatiable thirst
• Total food refusal for more than 12 hours
• Difficulty in mobilizing a limb or gait change
• Fever lasting more than 5 days.

In a child with a fever, what are the "soothing signs"?
Although they may be uncomfortable for the child and may require medical observation, these signs suggest minor illness:

• Child who plays and has normal activity
• Open or easy smile
• Pain swallowing with white plaques in the throat and/or associated with red eyes and/or cough
• Painful, red, bleeding gums
• Oral thrush
• Mild (or moderate) diarrhoea without blood, mucus or pus
• Eats less, but does not refuse liquids
• Is soothed when picked up and behaves regularly
• Very frequent dry and irritating cough, which is the symptom that most disturbs the child
• Wheezing without breathing difficulty
• Red eyes with secretions
• Scattered red spots that appear only after the 4th day of fever.

What to do when the child/adolescent has a fever?

• Offer water and/or milk; adjust clothing and bedding according to the feeling of cold or heat; respect his/her appetite
• If he/she is comfortable, you don’t need to lower the temperature, but keep an eye out for “warning signs” (described above)
• If he/she is uncomfortable, you should take an antipyretic (which is also an analgesic, that is, it relieves pain); but you should not try to cool him/her with a bath, compresses, fans, etc
• As with antipyretics, you can also use paracetamol and/or ibuprofen (exceptions: allergy; age <6 months; chickenpox; diarrhoea and moderate to severe vomiting). They can be administered individually every 8h or, if febrile peaks are close, alternated up to 4h.

The antipyretic is considered to be effective if the temperature drops by 1.0º to 1.5ºC in 2 to 3 hours. The purpose of the antipyretic is to relieve the child's discomfort and not eliminate fever at all costs. Even if not medicated, the temperature will, as a rule, end up spontaneously dropping a few hours later, rising again after a few hours, and so on, until the disease passes.

When should a child / teenager with a fever go to the hospital/contact a paediatrician?

• Age less than 3 months of age (corrected age if premature)
• Age less than 6 months with axillary temperature ≥ 39.0ºC or rectal ≥ 40.0ºC
• Axillary temperatures greater than 40.0 ° C or rectal temperatures greater than 41.0 ° C
• Presence of one or more “warning signs” (described above)
• If a serious chronic disease coexists
• If fever has been present for 5 or more days, or if the fever reappears after 2 to 3 days at normal temperatures.

Key points to remember

• Fever is just a symptom and not a disease
• The treatment of fever (antipyretics) does not shorten the duration of the fever or contribute to the resolution of the causative disease; if the temperature does not return to normal after the administration of antipyretics, alone, it is not a cause for concern as long as it drops from 1.0º to 1.5ºC
• The treatment of fever prevents febrile seizures which, globally, are uncommon (<1% of febrile episodes up to 2 years old, decreasing after that age); seizures frighten those who witness them, but, as a rule, they do not cause brain damage
• In the fever rising phase, cooling (with a bath, wet compresses, alcohol or fans) is not recommended: it does not contribute to the control of the disease, nor to the well-being of the child
• The presence of “warning signs”, the child's general condition and/or being less than 3 months old, are more important than the temperature degrees and/or the duration of the fever
• The appearance (or not) of the “warning signs” dictates the need (or not) to be observed, regardless of the day of fever
• Viruses, responsible for the vast majority of febrile episodes, last on average 4 full days (and 5 days, or more, in 30% of cases).

My baby has diarrhoea

Text by Paediatrician: Dr. António Salgado

.

.

What is diarrhoea?

Diarrhoea is an increase in the volume of stools compared to what is normal for your child.

In babies, who usually have more intestinal transits, it means that the stools are more watery or even more frequent.

Older infants may show only an increase in the number of daily stools (usually 3 or more).

What causes diarrhoea?

The most common causes of diarrhoea are viral infections and side effects after taking antibiotics. Bacterial infections are less frequent.

If the dejections are accompanied by blood and mucus (similar to “snot”), the probability of bacterial infection is greater and the child must be observed and eventually, a culture from the faeces collected, to exclude these causes.

What should I do?

Your child can continue to eat a normal diet, namely: white meats, rice, bread, pasta, milk and yogurt (lactose free), fruits and vegetables (except, for example, some fruits such as plum and green leafy vegetables). Fatty foods and sugary drinks should be avoided.

If he/she is being breastfed, you must maintain this.

Food should be offered, without insisting, as he/she may have less appetite.

Liquids should be reinforced, being offered more times a day and an oral hydration solution (which exists to promote balanced hydration) can be administered.

To promote normalisation of intestinal transit, pre and probiotics can be administered (with several options available). There are other medications, such as antisecretaries, among others, that should be administered only on the recommendation of your doctor.

When should he/she be checked?

• If he/she shows signs of dehydration, such as dry tongue, crying without tears, less urination, sunken eyes or depressed fontanelle (“soft spot”)
• If he/she is prostrate (sleepy and less reactive to stimuli) or with irritability and moaning.
• If the bowel movements are very frequent (more than 6 in 12 hours) and/or they leak out of the nappy.
• If there is persistent vomiting (after the second consecutive)
• If the diarrhoea is bloody.
• If he/she is less than 12 months old and has not eaten or drunk anything for more than a few hours.
• If he/she has continuous, severe and/or persistent abdominal pain.
• If he/she has a high fever (> 39.5 ° axillary) which is proving difficult to lower (even after medication). 

Baby Anaphylaxis

Text by Paediatrician: Dr. João Tavares

.

.

What is Anaphylaxis?
It is an immediate, acute and systemic hypersensitivity reaction, in which the signs and symptoms reflect the physiological effects of the release of cellular mediators (peripheral mast cells and basophils from the blood) that cause vasodilation and smooth muscle spasm, particularly at the bronchial level. It occurs after exposure to a specific antigen.

What are the causes?
The most common causes are hypersensitivity to food, drugs and stings. Among the food antigens, the most common are eggs, milk, nuts, peanuts and seafood, being the rare presentation before 12 months of age. Antibiotics, namely penicillin and cephalosporins, and topical anaesthetics are frequent agents at later ages.

What are the symptoms?
Symptoms usually appear seconds to minutes after exposure to the antigen (which may or may not have been previously known). There is usually flushing, itching that is localized to generalized, cutaneous lesions, dizziness, tearing, red eye, lip and perioral oedema. It may be associated with shortness of breath, difficulty in swallowing, cramps, nausea, vomiting. Anaphylactic shock, angioedema and bronchial obstruction are usually manifestations of serious illness and, in these cases, represent a paediatric emergency.

How can I help my child? Should I go to the hospital?
If an anaphylactic reaction is suspected, a medical observation should take place. In mild cases, supportive treatment may be sufficient and an analytical study may help to define the etiology. The treatment of choice is adrenaline (increases peripheral vascular resistance, relaxes smooth muscle and relieves oedema and urticaria) and can be administered through injectable pens previously prescribed by the attending physician or in a hospital setting in cases with no prior history.

Depending on the severity of the situation, there may be additional therapies and, due to the risk of biphasic reaction with reappearance of symptoms 6-24 hours after the initial manifestation, he/she should be kept under clinical observation during this period.

What happens after discharge?
Confirmed cases of anaphylaxis should be referred to an Immunoallergology consultation, in order to identify/optimise eviction of the antigen and decide on a course of action in the event of a new anaphylactic reaction.
For further clarification, consult your attending physician.

Scabies

Text by Paediatrician: Dr. João Tavares

.

.

What is Scabies?
Scabies, also known as sarcoptosis, is a cutaneous ectoparasitosis caused by the Sarcoptes scabiei variant hominis, with high worldwide incidence and is frequent in paediatric ages. It is highly contagious, with transmission by direct skin contact or, less frequently, by fomites, that is, through surfaces/objects, reaching all age groups and social classes.

How can it manifest itself?
It is usually manifested by an initially localised rash (with posterior spread), which is very itchy and frequently affects multiple cohabitants or those who have had direct contact. In the youngest children (usually in the first two years of life), this may be more predominant on the palms and soles and may be associated with a non-specific conditions, itchiness being often absent and, initially manifested as sleep/eating disorders and irritability. Even after effective treatment, itchy skin can be maintained for 2-4 weeks after treatment, without indicating a lack of cure.

How is the diagnosis made and where should I go?
The diagnosis is clinical and can be made by a paediatrician / dermatologist. You can go to the Permanent Assistance Service or schedule a Paediatrics / Dermatology appointment. After the treatment is carried out, a clinical reassessment is recommended after two weeks to confirm the cure. In particular cases, due to clinical doubt or lack of therapeutic response, confirmation by microscopic observation may be used.

How is it treated?
Curative treatment is generally topical, adapted to age and on a case-by-case basis, and is generally extended to the entire household (classmates and asymptomatic teachers do not require treatment). Supportive treatment should not be overlooked, with a view to minimizing itching and associated secondary injuries and optimizing skin regeneration. Concomitant treatment of fomites (sheets, clothes, etc.) is essential to prevent reinfection.

Can the child return to school after treatment?
After 24 hours of effective treatment, the child can return to school activities and parents can return to their daily routines - all without restrictions.
For further clarification, consult your attending physician.

My baby has hit his/her head

Text by Paediatrician: Dr. António Salgado

.

.

Head injuries are common in paediatrics, especially in the first years of life.

Most of them are mild and without consequences, but a major cause for concern for parents, with some symptoms that, if present, should prompt a check-up by a medical professional, due to the increased risk of intracranial injury.

After a head injury, children and/or young people should be monitored for signs and symptoms that can determine the severity of the situation. These, although more frequent in the first 12 hours after the trauma, should be monitored until about 48 hours later.

If present, they may require an image examination.

Therefore, they must be observed, if:

• Exaggerated drowsiness with difficulty awakening and outside the usual sleep times
• Change in habitual behaviour (agitation, irritability)
• Persistent vomiting (3 or more)
• Severe and worsening headache (no improvement with paracetamol)
• Seizure or fainting
• Lack of strength or “numbness” on one side of the body
• Change in vision, speech or gait (imbalance)
• Exit of blood or liquid through the nose or ear
• If he/she is less than 2 years old and there is a bulging of the anterior fontanelle (“soft spot”)
• Haematoma (bruising) on the head that was not previously present
• High impact fall: drop of more than 90 centimetres in children under 2 years old or more than 1.5 meters in children over 2 years old, road accident, being hit by a moving vehicle or a penetrating wound
• If you have a bleeding wound or enlarging bruise

If you do not have any of these signs and symptoms, you can apply ice on the spot, administer paracetamol (except when the headache worsens - should be checked by a medical professional) and promote a calm environment.

Do not forget that prevention is better than cure.

Children should always wear a helmet when they ride a bicycle or skateboard, they should always have an adult nearby when they ride, comply with safety rules for transportation by car and the rules of traffic should be taught as soon as they are understood, stairway barriers should be put in place and infants should never be left on high places without adult supervision.

Infant Colic

Text by Paediatrician: Dr. Víctor Miranda

.

.

Infant colic is defined as the baby's exaggerated and inconsolable crying, usually occurring in the first 4 months of life.

Babies naturally have some crying during the day, associated with situations of hunger or discomfort (cold / heat, dirty nappy, need for sleep).

In colic, crying is usually more intense than usual, more acute, and without improvement with comfort measures (lulling, restraint, suction), sometimes associated with greater tension in the belly, arms and back.

The intestinal discomfort and stimulation of the baby are factors that contribute to colic, which also appears in a phase of progressive regulation of the response to discomfort.

To prevent or relieve colic, some precautions are recommended:

• Prevent the baby from swallowing too much air during breastfeeding or bottle feeding
• Use a feeding position where the baby is more “seated”
• Frequent abdominal massage
• Baby containment measures (“swaddling”)
• Transport the baby in contact with the caregiver, in a sling or baby carrier
• Take a drive
• Use “white noise” (high frequency noises that calm the baby)
• Bathing the baby
• In cases indicated by the attending physician: change the baby's milk formula or use food supplements (probiotics, lactase, simethicone, infusions, etc.)

When to seek a medical evaluation:

• Parents' concern about the baby's health or difficulty dealing with the situation
• Frequent regurgitations, diarrhoea or very distended belly
• Colic that persists after 4 months of age
• Poor weight gain

Dealing with a baby with colic is a frequent cause of anxiety and frustration in parents. It is important to recognize these signs when dealing with “a colic baby” and to find strategies to remain calm in the face of the situation - alternating caregivers, putting the baby down safely for a short time.

We must take preventative measures so that frustration doesn’t turn into aggression! It is a difficult situation, but neither the baby nor the caregivers are to blame, it is essential to properly deal with the notion that it is a passing problem.

To define the best way of dealing with infant colic, you can seek support from the medical and nursing staff who monitor your baby.

Atopic Eczema

Text by Paediatrician: Dr. Víctor Miranda

.

.

Atopic eczema (or atopic dermatitis) is a skin disease that develops with dry/inflamed skin lesions and itching.

It often appears in people with other allergies, or with a family history of eczema.
Symptoms include itching, changes in skin colour (usually flushing), regions of drier skin sometimes with flaking.

Eczema can occur at any age, but it is more common before the age of 5. The distribution in the body varies with the age group. In infants and children under 2 years of age it affects the face and the front face of the limbs; in older children it is more common to have lesions in the skin folds (in particular in the arms, knees and neck).

Over time and without treatment, some regions of the skin may become thicker or even scarred.

The diagnosis of atopic eczema is made by observing the characteristics of the skin and the lesions.

The treatment consists of hygiene and proper hydration of the skin, as well as care to avoid skin maceration. Sometimes it is necessary to use more specific medication to control itching and inflammation (antihistamines, topical or oral corticosteroids, immunomodulators).

In case of infection of eczema lesions, the use of antibiotics may be necessary.

Good hygiene and skin care from an early age can prevent the onset or at least reduce the severity of eczema.

Cough

Text by Paediatrician: Dr. Víctor Miranda

.

.

Coughing is an important reflex mechanism for clearing the airways, which also serves to protect them from accidental inhalation.

In some situations, it is a symptom of illness, which is why it is a frequent reason for consultation in Paediatrics.

We can classify a cough as ‘dry’ when there is no mucus associated, or ‘productive’ when it has. The intensity is also variable, and in more severe cases it may be associated with breathing difficulties.

There are several possible causes for coughing in children, including viral or bacterial infections, foreign object inhalation, asthma, other respiratory diseases.

The alarm signals that require medical evaluation are:

• Persistent cough in young children (under 4 months)
• Cough that induces vomiting
• Breathing difficulty or wheezing
• Coughing up blood or yellowish/greenish sputum
• Persistent cough after choking
• Difficulty in eating food or liquids
• Fever or other associated symptoms that cause concern
• Cough with 2 weeks of progression without improvement

In order to assess the cause of the cough, in addition to observing the child, additional tests (blood tests, radiography, respiratory tests, bronchofibroscopy, etc.) may be necessary, depending on each situation presented.

Initially, to help with the resolution of the cough, you should offer fluids to the child and create a humid atmosphere in the bath or with an aerosol dispenser. Routine use of expectorant or antitussive syrups is not recommended, especially if you do not have a medical indication to do so.

Treatment will depend on the cause of the cough and antibiotics, bronchodilators, anti-inflammatories, antihistamines, decongestants, among others, may be required.

Since cough is a common symptom for various conditions and diseases, a well-developed medical history and observation of the child is necessary in order to achieve a correct approach and treatment.