Shaken Baby Syndrome

A large number of child deaths are reported in South Africa each year. A lot of deaths relate to neglect, abuse or murder. Despite this, there's a knowledge gap in relation to understanding the issue....

Amniotic fluid problems

The importance of amniotic fluid Amniotic fluid is essential for pregnancy and foetal development. Amniotic fluid is a watery substances residing inside a casing called the amniotic membrane or sac. ...

Choosing a pre-school

Becoming a parent is a momentous; life-changing event filled with hopes, expectations and naturally some fears. Parents often learn and grow alongside their children, as they face the challenges of pa...

Newborn reflexes

Although newborn babies are physically helpless and vulnerable at birth, they have a number of amazing innate abilities or reflexes. Reflexes are involuntary movements or actions, designed to protect ...

Mastitis

Mastitis is an inflammation of the breast that can lead to infection. The word “mastitis” is derived from the Greek word “mastos” meaning “breasts”, while the suffix “-itis” denotes “inflammation”. Ma...

Pelvic floor exercises

Although your new baby will probably bring you immense emotional satisfaction, physically you may feel uncomfortable and strange in your own skin. After 9 months of pregnancy and hormonal changes, you...

Colic

Babies cry because they need to communicate something and most parents, especially new moms, find it distressing to see or hear an unhappy baby. In time, you will learn to recognize the various causes...

Antenatal Classes

Antenatal classes are informative sessions provided to prepare expecting parents for the birth of their child and the early days of being a parent.Most antenatal classes are run by Midwives and occasi...

Strap-in-the-Future

The Decade of Action for Road Safety 2011-2020 was launched on the 11 May 2011. It is a global declaration of war against road crashes and fatalities. According to Mr Sibusiso Ndebele, MP Minister of ...

  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Allergies

What is an allergy?

An allergy is an immune system response or allergic reaction to a substance, known as an allergen, that the body perceives to be harmful. Allergies are type 1 sensitivities to what are normally harmless substances (allergens). Allergic individuals have an abnormal immune system response or allergic reaction to contact, inhalation or ingestions of these allergens. When these allergens enter the body through the skin, respiratory system or gastrointestinal tract, the body produces antibodies, known as IgE. The allergen, together with the antibodies, settles on certain tissues, such as the skin, stimulating the production of histamines and resulting in an extreme anti-inflammatory response. For example, histamines may cause the blood vessels in the skin to dilate, producing redness or hives, the mucous glands to secrete mucus, producing symptoms such as cough, runny eyes and nose, or fluid in the middle ear, and the respiratory muscles to contract (asthma or wheezing) (Leary, 1990; Wikipedia, 2010; Wisegreek, 2003-2010).

 

The most common allergic reactions include eczema, hives, hay fever, asthma, food allergies and reactions to insect stings (bees/wasps). Allergic reactions vary from mild, in the case of hay fever, to potentially life-threatening anaphylactic reactions (Wikipedia, 2010; Wisegreek, 2003-2010).

 

Allergy testing

At some point your doctor may wish to refer your child to an allergist for further evaluation. Once a diagnosis of asthma, rhinitis, anaphylaxis or other allergic disease has been made, there are 2 tests commonly used to discover the cause of the allergy (Leary, 1990; Wikipedia, 2010).

 

Skin testing

Skin testing, also known as ‘puncture testing’ or prick testing’ involves introducing a small amount of the allergen onto your child’s skin using a small plastic or metal device to puncture the skin or injecting the allergen using a needle and syringe. The test is usually carried out on the arm or the back. An allergy exists if a visible inflammatory reaction occurs, usually within 30 minutes. This may range from slight reddening to full-blown hives in more sensitive individuals (Wikipedia, 2010).

 

Skin tests are generally preferred to blood tests because they are more sensitive and specific, simpler to use and less expensive. However, if an anaphylactic reaction is the reason for your child’s visit, your allergist may prefer to run preliminary blood tests before performing the skin test. Skin tests are not recommended if your child has widespread skin disease or if she has taken antihistamines in the last few days (Wikipedia, 2010).

 

Blood tests

Various blood allergy tests are available to detect allergy-specific substances. These tests measure a ‘total IgE level’ or estimate the IgE or allergic antibodies contained in your child’s blood, e.g. the RAST or radioallergosorbent test. These tests can be expensive and are not used in all allergy evaluations (Leary, 1990; Wikipedia, 2010).

 

 

Treatment of the allergic child

Treatment of respiratory allergies generally involves one or more of the following: removing the offending allergen or ‘trigger’, blocking the immune system’s response to allergens by means of allergy shots, and using medication to block the production and effects of histamines throughout the respiratory tract (Leary, 1990).

 

Removal of the offending allergen or ‘trigger’

If your child’s respiratory problems have an allergic basis, the best form of treatment is to identify the trigger, remove the offending allergen and implement the following environmental controls to help alleviate your child’s symptoms. Older children with long-standing allergies generally know what they are allergic to. In younger children, some detective work may be required. The most common inhalant allergens include:

Outside allergens – trees, grass, ragweed pollen.

Household allergens – dust, feathers, moulds, mildew, tobacco smoke, animal dander,  cooking odours, deodorisers, air fresheners, fireplace smoke, stuffed animals and household plants (Leary, 1990).

 

Since your child spends a great deal of time in her bedroom, it is important to maintain a dust-free environment as far as possible.

Remove all dust collectors:

·         Heavy drapes should be replaced with cotton or synthetic curtains or pull-down blinds.

·        If possible, remove all upholstered furniture from your child’s room. Wooden furniture

    accumulates less dust and is easier to clean.

·         Allergic children should avoid fuzzy, soft toys. As an alternative, stuff animals with

    rubber foam and cover them with a synthetic fabric, such as nylon.

·         One of the main dust collectors in most homes is the wall-to-wall carpet. Ideally, the   

    carpet in your child’s room should be removed and a few cotton throw-rugs can be    

    used.

·         Mattresses and pillows should be made from rubber foam. Use airtight, non-allergic

     plastic covers on all mattresses, pillows and box springs to prevent the accumulation of

     dust. Feather pillows and wool or down blankets are contra-indicated in children with

     allergies.

·         Keep clothing in closets to a minimum and store them in tightly zippered garment bags.

·         Books and toys should not be kept in the bedroom.

·         Some sprays act as dust inhibitors and can be used on rugs, upholstery and other dust

     collectors (Bupa, 2010; Leary, 1990).

Cleaning your child’s room:

·         Wash bedding and stuffed animals frequently in hot water.

·         To clean, remove all furniture, books, toys and curtains from your child’s room and dust

     them.

·         Wash throw-rugs weekly.

·         Wall-to-wall carpets need to be vacuumed daily while your child is out of the house.

·         Wash and dust floors, walls, ceilings and beds thoroughly (Bupa, 2010; Leary, 1990).

Pets:

Do not allow pets in your child’s bedroom and bathe them weekly to remove surface allergens (Bupa, 2010).

Other:

·         Moulds and mildew are highly allergenic. Avoid exposing your child to moulds by

     keeping her out of damp basements or water-damaged areas in your home. Non-toxic

     sprays are available to prevent mould growth.

·         Keep indoor humidity low, because dust mites and moulds increase in higher humidity.

·         Avoid the use of ceiling fans.

·         Air-conditioners often help filter dust particles in the air but some allergic children are

     sensitive to them.

·         Cover air vents with filters to help control airborne allergens.

·         Provide a smoke-free environment for your child.

·         House plants commonly produce allergic reactions. Keep them in an area of the house

     where your child spends little time.

·         Most allergic children are allergic to chemical inhalants such as paint and it is therefore

     preferable to do any remodelling or decorating when your child is out the house (e.g. at

     camp).

·         In the case of seasonal allergies, keep windows in your house and car closed to prevent

     exposure to pollen and limit outdoor activities. Pollen counts are at their highest in

     early spring mornings (tree pollen), summer afternoons and early evenings (grasses),

     and midday during autumn (ragweed) (Bupa, 2010; keepkidshealthy.com;  Leary, 1990).

Food allergies.

·         The only treatment for food allergies is to avoid the allergen. If there is a family   

history of food allergies, your child has a higher risk of being allergic. This risk is minimised if you use the following preventative measures:

·         Breast feed your infant for a minimum of 1 year.

·         Only begin introducing solids at 6 months of age and begin with the least allergenic

     foods.

·         Avoid giving your infant food combinations because if they are allergic to one of the

     components of the mixture, it may be difficult to isolate the offending allergen.

·         Do not introduce commonly allergenic foods until after the age of one (nuts, eggs,

     dairy) (Leary, 1990).

 

Treatment aimed at blocking the immune response to the offending allergen – allergy shots or

immunotherapy

Desensitisation or hyposensitisation is an allergy treatment that involves vaccinating your child with increasing doses of an allergen over a long period of time. It works on the premise that your child will then develop antibodies against her particular allergen/s, which helps reduce the severity or eliminates their hypersensitivity to the allergen altogether, i.e. your child builds up an immunity to increasing amounts of the allergen in question over time (Leary, 1990; Wikipedia, 2010).

 

Your doctor will consider several factors before submitting your child to immunotherapy. Controversy exists about whether allergy shots are effective in the majority of children. Also, these injections may have a psychological impact on your child because of the frequency with which they have to be given. Immunotherapy requires long-term commitment. Your doctor also needs to consider 2 sets of evidence. On the one hand, the majority of children with hay fever and asthma outgrow their allergy symptoms naturally, but on the other hand, if left untreated, your child runs the risk of developing more severe and lasting allergies. Finally, the type and severity of your child’s allergic reactions needs to be taken into account. Does the allergy interfere with her growth and development? How much does her allergies bother her? Does she frequently miss school or play activities? Is her sleep being disturbed? Is she having recurrent asthma attacks that are increasing in frequency and severity? And so on (Leary, 1990; Wisegeek, 2003-2010).

 

There is obviously the desire to provide your child with any treatment that may lessen the severity and duration of their allergies or remove the problem completely. Allergy shots have proven to be effective against insect stings. The value of these injections has not been proven in the treatment of asthma, infectious bronchitis or eczema (Leary, 1990).

 

Pharmacology

Medications to block the production or effects of histamine substances: See Asthma treatment under Asthma, and Treatment of Allergic Rhinitis under Allergic Rhinitis.

 

 

ALLERGIC RHINITIS (runny nose/hay fever)

 

Allergic rhinitis, or hay fever, is a common problem in infants and children. It involves the inflammation of the lining of the nose due to an allergic reaction. It is characterised by a runny or stuffy nose with a clear nasal discharge, watery, itchy eyes, sneezing, sore throat, throat clearing and a cough that is generally worse at night and in the morning (keepkidshealthy.com; Leary, 1990).

 

There are 2 forms of allergic rhinitis: the seasonal variety that occurs at certain times of the year and usually corresponds to being exposed to outdoor allergens, such as pollen, grass and weeds, and the perennial variety in which symptoms occur throughout the year from exposure to indoor allergens, such as moulds, animal dander, dust mites and second-hand smoke (Collins, 2003; keepkidshealthy.com).

 

Allergic rhinitis often runs in families and is more common in children who suffer from other allergies. Since young children are primarily nose breathers, when their nasal passages become swollen due to allergic rhinitis, they may begin breathing with an open mouth and snoring at night. Like children with chronic adenoidal problems, they may develop what is known as a typical ‘allergic faces’: open mouth breathing, dark circles under the eyes or ‘allergic shiners’ and a bridge across the top of the nose caused by constantly rubbing the nasal tip with the palm of the hand (allergic salute). In many children, the symptoms of allergic rhinitis decrease in severity as they grow older and eventually disappear (Collins, 2003; Leary, 1990).

 

Treatment for allergic rhinitis

There are 3 medications used to control the symptoms of allergic rhinitis: decongestants, antihistamines and steroids. They are designed to reduce inflammation in the respiratory tract and control the production of mucus. In other words, these medications ‘dry up’ the nose and sinuses and are effective for the treatment of allergic rhinitis, if used in accordance with your doctor’s advice (kepkidshealthy.com; Leary, 1990).

 

Nose drops and nasal sprays

Drops and sprays containing a corticosteroid drug, or sodium cromoglycate, are designed to constrict the blood vessels in the nose and relieve congestion. Use only those prescribed by your doctor, as over the counter nose drops may contribute to rather than relieve congestion. Your child may also benefit from nasal irrigations, using saline solution. These drops may be used 3 times per day and will help the sinuses drain, keep nasal secretions thin and fluid and prevent them from becoming infected (Collins, 2003; Leary, 1990; keepkidshealthy.com).

 

Prescription allergy medications

These include the newer non-sedating antihistamines, such as Claritin or Zyrtec. Take them in accordance with your doctor’s instructions. Antihistamines are effective if the problem lies in the upper respiratory tract. They should not be used for asthma, unless specifically prescribed by your doctor, because they may dry up secretions in the lower respiratory tract, making secretions thicker and more difficult to cough up. This results in a mucous plug or excessive mucus in the bronchi that is difficult to dislodge and may become infected. Avoid using over the counter antihistamines as they have varying side-effects. While adults may experience drowsiness, children may become hyperactive, experience sleep difficulties and undergo personality changes (Leary, 1990; kepkidshealthy.com).

 

If your child is not responding to a combination of an antihistamine and steroid, a decongestant (e.g. Sudafed) or a combination medication, such as ClaritinD, may be added to their treatment regime (keepkidshealthy.com).