Pregnancy Awareness - Platinum Health

Pregnancy Awareness

pregnancy awareness_Layout 1 2016/07/25 8:22 AM

STEP I first visitVisit GP to confirmpregnancy. Ante-natal screening tobe done and ifrequired patient willbe referred to specialist.

Maternity programmePlatinum Health offers a comprehensive ante-natal service for pregnant members andbeneficiaries. This includes visits to generalpractitioners and gynaecologists, and threeultrasound scans with pre-authorisation.

First visit with Gynaecologist. • A referral letter fromGP/Specialist is required tosee Gynaecologist.

• The referral letter and ante-natal laboratory results needto be sent to CaseManagement for approvaland appointment.

Authorisation will be valid for only the date of treatment.

Submit the referral letter to Case Management via:Tel: 014 591 6600 or 080 000 6942 ORFax: 086 247 9497 or 086 233 2406 ORPlatinum Health facilities OREmail: [email protected] (specialist authorisation)


Register on the Maternity programme bycompleting and submitting the relevantMaternity programme documentationto Case Management via email, fax or

at a Platinum Health facility.

Members need to follow the same procedure for consultations with Paediatricians and Gynaecologists.1. General practitioner2. Case Management (obtain authorisation)3. Gynaecologist or Paediatrician

If a specialist referral is approved or rejected:Approved• Case Management evaluates the request with the assistance of theMedical Advisor.

• Member receives an authorisation number via SMS, email,telephone or from Platinum Health facility.

• Copy of referral letter, X-rays, blood results and all relateddocumentation to be taken with to the specialist.

• Member to give authorisation number to specialist.

Rejected• Case Management evaluates the referring request with theassistance of the Medical Advisor and rejects referral.

• If a member’s authorisation is rejected, the member will receivenotification via SMS, email, telephone or from Platinum Healthfacility; stating the reason why authorisation request was declined.

• Member can contact Case Management and Platinum Healthfacilities at their sites with regards to follow-up queries.


Routine specialist consultations are performed between weeks 10 and 12, and20 and 22 gestation. From approximately week 32, the check-ups will be doneevery two weeks, and from 36 weeks onwards, every week until delivery.

STEP 2 follow-up visits

Member to book a bed at a hospital approved by the scheme. Platinum Healthwill fund a normal maternity bed as part of the delivery. The member can askfor a private room but will have to pay the difference between the maternityroom and the private room. Hospital benefit is applicable per option.

• The principal member has to complete and sign a Platinum Healthapplication form and submit a copy of a birth certificate within 30 days ofthe baby's birth. A Hospital Confirmation/Notification document cantemporarily be submitted together with the application, however, thisdocument is only valid for 30 days.

• As soon as the new-born baby has been registered with the Department ofHome Affairs, the member is responsible to submit a copy of the birthcertificate to the scheme within 30 days of date of birth.

Please take the following documentation with upon registering your babywith Platinum Health:• Principal member's identification document.• A registered birth certificate.• If the baby's surname differs from the principal member's surname, an

affidavit must be submitted stating the reason.

Register your new-born baby within 30 days of birth. The new-born shouldbe registered at your Employee Services processing Walk-in centres orHR/EB offices or at respective Platinum Health Client Liaison offices.

• If there is a need for more visits during pregnancy due to previously orpresent pregnancy complications, a clinical motivation letter is neededfrom the GP or treating specialist.

• Pregnant HIV positive ladies should be given counselling and started ontreatment regime to prevent mother-to-child transmission.

Delivery

Pre-authorisation for bed-booking is issued by Case Management via SMS,email, telephone or Platinum Health facility.


INDEXMaintaining a healthy pregnancy 8The first step is to consult with your general practitioner (GP) 8

First Trimester of Pregnancy 12

Second trimester of Pregnancy 16

Third Trimester of Pregnancy 21

Take care of yourself 26Eat well 26

Take a supplement 26

PAT/OTC Over-the-counter medications during pregnancy 27

Be careful about food hygiene 28

Personal hygiene 29

Exercise regularly 30

Begin doing pelvic floor exercises 31

Cut out alcohol intake 31

Cut back on caffeine 33

Stop smoking 33

Get some rest 34

Heels vs Flats in Pregnancy 35

Buckle up! 36

Important health conditions to consider during pregnancy 37Pregnancy and high blood pressure and pregnancy 37

Pregnancy and gestational diabetes 41


Pregnancy and HIV/AIDS 46

Pregnancy and Anaemia 48

Before the baby arrives 54Be Prepared: 54

Book your delivery bed 54

Have your suitcases packed 55

Be prepared for the unexpected 55

When the baby arrives 55Important – register your baby 55

Handling a new-born 55

Bonding with your baby 56

Diapering Do’s and Dont’s 56

Bathing basics 57

Umbilical cord care 60

Feeding and Burping your baby 61

Sleeping basics 62

Infant and Child Health 64Colic 64

Cradle Cap 66

Croup 67

Diarrhoea and Vomiting 68

Fever 72

Fever Seizures 75

Heat Rash 77


Childhood Immunisation Schedule 78BCG Vaccine against Tuberculosis 80

Chickenpox 80

Diphtheria, Tetanus and Pertussis (DTP) 82

Haemophilus Influenzae Type B (Hib) 84

Hepatitis A Virus (HAV) 85

Hepatitis B Virus (HBV) 86

Measles, Mumps, and Rubella (MMR) 87

Pneumococcal Infection 93

Poliomyelitis (Polio) 94

Rotavirus Gastroenteritis 95

Child Safety and Training 96Child car seats 96

Bed-wetting 98

Toilet Training 98


Maintaining a healthy pregnancyAs a mother-to-be, you can empower yourself to make themost of your pregnancy by being informed about and beingprepared for the significant changes your body will go through,also the fluctuating emotions that you might experience.

The first step is to consult with your general practitioner As soon as you suspect you’re pregnant, you should make an appointmentwith your general practitioner to confirm your pregnancy and organise yourante-natal care.

Upon confirming your pregnancy, you need to register on the PlatinumHealth Maternity programme by completing and submitting the relevantdocumentation to Case Management via email, fax or at a Platinum Healthfacility.

Case Management contact details:Tel: 014 591 6600 or 080 000 6942Fax: 086 247 9497 or 086 233 2406Email: [email protected](specialist authorisation)

Platinum Health offers a comprehensiveante-natal service for pregnant membersand beneficiaries. This includes visits togeneral practitioners andgynaecologists, and three ultrasoundscans with pre-authorisations. Pleasenote that members need to be referredby healthcare providers in order toconsult with gynaecologists.

8


9

Ultrasound scans are performed three times – at 12 and 22 weeks, andbetween 23 and 40 weeks. Other sonars will be for the member’s ownaccount, if no complication is registered.

By organising your care early means you will get good advice for a healthypregnancy right from the start.

During your first visit with the healthcare provider you need to discussthe following:• If you have any chronic illnesses or are on any chronic medication.• If you are HIV positive you have to be registered on the HIV programme.

Your healthcare provider will assist you with registering on the HIV/Aidsprogramme and advise you on the way forward.

• If you have a history of previous pregnancy complications, it is importantfor your healthcare provider to beaware of it so that you canbe advised what to doto prevent futurecomplications.


Embryonic periodThe rudiments of the respiratory,digestive, circulatory, nervous andexcretory systems are formed. Theheartbeat starts.

The rudiments of the intestine, liver,kidneyand lung are formed. Themuscular systemand spine are formed.The formation of the neural tube iscompleted.

Organs and systems start to form, as doparts of the brain. The umbilical cordappears. The upper lip and nasal cavityare formed, as are the rudiments of theextremities and nails.

The brain and its divisions form. Theformation of the placenta and themuscles of the face begin. Therudiments of the hands and fingers form.

The uteroplacental circulation starts.The upper limbs are developed. The eyes and rudiments of the auricles startto form.

The heart, lungs, brain, urinary systemand reproductive system are formed.Eyes, eyelids, nose, ears and theformation of the lips are completed.

10


Fetal periodThe first hair appears and bonesbecome more robust. Changes takeplace in the genital organs - the prostategland forms in boys and the ovariesmigrate to the pelvic cavity in girls.

The immune system is created. themodes of sleep and wakefulness beginto take effect. The baby has the abilityto distinguish sound and see thesurrounding world.

The bone marrow and spleen start toproduce blood cells. Taste buds aredeveloped. the face is fully formed,including eyelashes and eyebrows.

The folds start to disappear. Hands andfeet become plump. The skin ceases tobe red. The endocrine system begins tosecrete hormones. The lungsaccumulate surfactant.

Subcutaneous fat develops. The bonesof the skull remain soft with gaps(fontanelles). The baby experiences acontinued weight gain and growth.

The three-dimentional can be perceivedof the brain. The eye focuses on thedistance of 30cm. The fuzz hasdisappeared, the baby has hair on itshead. The baby is ready for birth.

11


First Trimester ofPregnancy Having a baby is one of the most joyoustimes in many women's lives. Fromanticipating the day you'll bring your littleone home, to picking a name and nurserycolours, the excitement is palpable.

But no matter how well you plan for their arrival, you may not be fullyprepared for all of the changes your body will go through now. Knowing whatto expect will help you get ready for the months ahead.

What to Expect: Changes in Your BodyPregnancy is different for every woman. Some women glow with good healthand vitality during those first three months; others feel absolutely miserable.Here are some of the changes you might experience, what they mean, andwhich signs warrant a call to your healthcare provider.

Breast tenderness. Sore breasts are one of the earliest signs of pregnancy.They're triggered by hormonal changes, which are preparing your milk ductsto feed your baby, and will probably last through the first trimester. Going upa bra size (or more) and wearing a support bra can make you feel morecomfortable; you can go back to the lacy bras after your baby is finishednursing.

Constipation. During pregnancy, the muscle contractions that normallymove food through your intestines slow down because of higher levels ofthe hormone progesterone. Add to that the extra iron you're getting fromyour prenatal vitamin, and the result is uncomfortable constipation and gasthat can keep you feeling bloated throughout your pregnancy. Increase yourfibre intake and drink extra fluids to keep things moving more smoothly.Physical activity can also help. If your constipation is really bothering you,

12

Week 1-12


talk to your healthcare provider about what mild laxative or stool softenersare safe to use during pregnancy.

Discharge. It's normal to see a thin, milky white discharge (called leukorrhea)early in your pregnancy. You can wear a panty liner if it makes you feel morecomfortable, but don't use a tampon because it can introduce germs into thevagina. If the discharge is foul-smelling, green, or yellow, or if there's a lot ofclear discharge, call your healthcare provider.

Fatigue. Your body is working hard to support a growing fetus, which canwear you out more easily than usual. Take naps or rest when you need tothroughout the day. Also make sure you're getting enough iron (too little canlead to anaemia, which can cause excess fatigue).

Food cravings and aversions. Although you may not want a bowl of mintchip ice cream topped with dill pickles, as the old stereotype goes, yourtastes can change while you're pregnant. More than 60% ofpregnant women experience food cravings and more thanhalf have food aversions, according to research. Giving into cravings from time to time is OK, provided you aregenerally eating healthy, low-calorie foods. Theexception is pica -- a craving for non-foods like clay, dirt,and laundry starch, which can be dangerous for youand your baby. If you experience this kind ofcraving, report it to your healthcare providerright away.

Frequent urination. Your baby is stillpretty small, but your uterus is growingand it's putting pressure on yourbladder. As a result, you may feel likeyou constantly have to go to thebathroom. Don't stop drinking fluids --your body needs them -- but do cut down

13


on caffeine (which stimulates the bladder), especially before bedtime. Whennature calls, answer it as soon as you can. Don't hold it in.

Heartburn. During pregnancy, your body produces more of the progesteronehormone which relaxes smooth muscles -- including the ring of muscle in yourlower esophagus that normally keeps food and acids down in your stomach.This muscle relaxation can lead to acid reflux, otherwise known as heartburn.To avoid the burn, eat frequent, smaller meals throughout the day; don't liedown right after eating; and avoid greasy, spicy, and acidic foods (like citrusfruits). You can also try raising your pillows when you sleep.

Mood swings. Increased fatigue and changing hormones can put you on anemotional roller coaster that makes you feel alternately elated and miserable,cranky and terrified. It's OK to cry, but if you're feeling overwhelmed, try tofind an understanding ear -- if not from your partner, then from a friend orfamily member.

Morning sickness. Nausea is one of the most universal pregnancy symptoms,affecting up to 85% of pregnant women. It's the result of hormone changes inthe body, and it can last through the entire first trimester. For some pregnantwomen, nausea is mild; others can't start their day without vomiting. Nauseais usually worst in the morning (hence the name, "morning sickness"). To calmyour nausea, try eating small, bland, or high-proteinsnacks (crackers, meat, or cheese) and sippingwater, clear fruit juice (apple juice), or gingerale. You may want to even do this beforegetting out of bed. Avoid any foods thatmake you sick to your stomach. Nauseaitself isn't anything to worry about, but if itpersists or is severe, it can affect theamount of nutrition getting to your baby, socall your healthcare provider if you can'tstop vomiting or can't keep down any food.

14


Weight gain. Pregnancy is one of the few times in a woman's life whenweight gain is considered a good thing, but don't overdo it. During the firsttrimester, you should gain about 1,36 to 2,72kg (your healthcare provider mayrecommend that you adjust your weight gain up or down if youstarted your pregnancy underweight or overweight).Although you're carrying an extra person, don't go by theadage of "eating for two." You only need about an extra150 calories a day during your first trimester. Get thosecalories the healthy way, by adding extra fruits andvegetables, milk, whole-grain bread, and lean meat toyour diet.

Red Flag SymptomsAny of these symptoms could be a signthat something is seriously wrong withyour pregnancy. Don't wait for yourprenatal visit to talk about it.

Call your healthcare provider rightaway if you experience:• Severe abdominal pain.• Significant bleeding.• Severe dizziness.• Rapid weight gain or too little weight gain.

15


Second TrimesterEvery stage of pregnancy brings differentissues and concerns. Use this part of theguide as a roadmap to the second trimesterof your pregnancy journey.

What to ExpectAs you enter your second trimester of pregnancy, themorning sickness and fatigue that plagued you during the last threemonths should be fading, leaving you feeling more energetic and like yourold self again.

The second trimester is, for many women, the easiest three months ofpregnancy. Take the time now, while you're feeling better and your energyis up, to start planning for your baby's arrival.

During the second trimester, your baby is growing quickly. Ultrasoundscans are performed at week 12, week 22 and between 23 and 40 weeks.

Although you should be feeling better now, big changes are still takingplace inside your body. Here's what you can expect.

Changes in Your BodyBackache. The extra weight you've gained in the last few months isstarting to put pressure on your back, making it achy and sore. To ease thepressure, sit up straight and use a chair that provides good back support.Sleep on your side with a pillow tucked between your legs.

Avoid picking up or carrying anything heavy. Wear low-heeled,comfortable shoes with good arch support. If the pain is reallyuncomfortable, ask your partner to rub the sore spots, or treat yourself toa pregnancy massage.

16

Week 13-27


Bleeding gums. About half ofpregnant women develop swollen,tender gums. Hormone changesare sending more blood to yourgums, making them moresensitive and causing them tobleed more easily. Your gumsshould go back to normal afteryour baby is born. In themeantime, use a softertoothbrush and be gentle whenyou floss, but don't skimp ondental hygiene. Studies show thatpregnant women with gum disease(periodontal disease) may be morelikely to go into premature labour anddeliver a low-birth-weight baby.

Breast enlargement.Much of thebreast tenderness you experiencedduring the first trimester should bewearing off, but your breasts are stillgrowing as they prepare to feed yourbaby. Going up a bra size (or more) and wearing a good support bra can make you feel more comfortable.

Congestion and nosebleeds. Hormonal changes cause the mucusmembranes lining your nose to swell, which can lead to a stuffy nose andmake you snore at night. These changes may also make your nose bleedmore easily. Before using a decongestant, check with your healthcareprovider. Saline drops and other natural methods may be safer ways to clearcongestion during pregnancy. You can also try using a humidifier to keep theair moist. To stop a nosebleed, keep your head up straight (don't tilt it back)and apply pressure to the nostril for a few minutes until the bleeding stops.

17


Discharge. It's normal to see a thin, milky white vaginal discharge (calledleukorrhea) early in your pregnancy. You can wear a panty liner if it makes youfeel more comfortable, but don't use a tampon because it can introducegerms into the vagina. If the discharge is foul-smelling, green or yellow,bloody, or if there's a lot of clear discharge, call your healthcare provider.

Frequent urination. Your uterus will rise away from the pelvic cavity duringthe second trimester, giving you a brief break from having tokeep going to the bathroom. Don't get too comfortable,though. The urge to go will come back during the lasttrimester of your pregnancy.

Hair growth. Pregnancy hormones can boost hairgrowth -- and not always where you want it. The hair onyour head will become thicker. You may also beseeing hair in places you never had it before,including your face, arms, and back. Shaving andtweezing might not be the easiest options, butthey're probably your safest bets right now. Manyexperts don't recommend laser hair removal,electrolysis, waxing, or depilatories duringpregnancy, because research still hasn'tproven that they are safe for the baby.Check to see what your healthcareprovider recommends.

Headache. Headaches are one of themost common pregnancy complaints. Tryto get plenty of rest, and practice

relaxation techniques, such as deep breathing.Aspirin and ibuprofen shouldn’t be takenduring pregnancy, but your healthcareprovider may say it's OK for you to takeacetaminophen if you're really uncomfortable

18


Heartburn and constipation. These are caused by your body making more of ahormone called progesterone. This hormone relaxes certain muscles, includingthe ring of muscle in your lower esophagus that normally keeps food and acidsdown in your stomach, and the ones that move digested food through yourintestines. To relieve heartburn, try eating more frequent, smaller mealsthroughout the day and avoid greasy, spicy, and acidic foods (such as citrus fruits).For constipation, get more fibre and drink extra fluids to keep things movingmore smoothly. Physical activity will also help move things along.

Hemorrhoids. Hemorrhoids are actually varicose veins -- swollen blue orpurple veins that form around the anus. These veins may enlarge duringpregnancy, because extra blood is flowing through them and there isincreased pressure on them from the growing uterus. Varicose veins can beitchy and uncomfortable. To relieve them, try sitting in a warm tub or sitzbath. Ask your healthcare provider whether you can use an over-the-counterhemorrhoid ointment.

Quickening. By the midpoint of your pregnancy (20 weeks) you will probablyhave started to feel the first delicate flutters of movement in your abdomen,which is often called "quickening." If you aren't feeling your baby move yet,don't worry. Some women don't experience quickening until their sixth monthof pregnancy.

Skin changes. Pregnant women often look as though they are "glowing"because changing hormone levels make the skin on the face appear flushed.An increase in the pigment melanin can also lead to brown marks on the face(often called the "mask of pregnancy") and a dark line (linea nigra) down themiddle of the abdomen. All of these skin changes should fade after the babyis born. In the meantime, you can use make up to conceal them. Your skin isalso more sensitive to the sun right now, so make sure to wear a broad-spectrum (UVA/UVB protection) sunscreen with an SPF of at least 30whenever you go outside. Limit your time in the sun, especially between 10a.m. and 2 p.m., wearing long-sleeved clothes, pants, a broad-brimmed hat,and sunglasses. You may also notice thin, reddish-purple lines on your

19


abdomen, breasts, or thighs. These stretch marks emerge as your skinexpands to accommodate your growing belly. Although many creams andlotions claim to prevent or eliminate stretch marks, there is little evidence thatthey actually do. Using a moisturiser can help soften your skin and reduceitchiness. Most stretch marks should fade on their own after you deliver.

Spider and varicose veins. Your circulation has increased to send extrablood to your growing baby. That excess blood flow can cause tiny red veins,known as spider veins, to appear on your skin. These veins should eventuallyfade once your baby is born. Pressure on your legs from your growing babycan also slow blood flow to your lower body, causing the veins in your legs tobecome swollen and blue or purple. These are called varicose veins.Although there's no way to avoid varicose veins, you can prevent them fromgetting worse by getting up and moving throughout the day and proppingup your legs on a stool whenever you have to sit for long periods of time.Wear support hose for extra support. Varicose veins should improve withinthree months after you deliver.

Weight gain. Morning sickness usually diminishes by the end of the firsttrimester. After that, your appetite should return, and will probably grow.Although food is looking much more appetizing, be aware of how much you'reeating. You only need about an extra 300 to 500 calories a day during the secondtrimester, and you should be gaining about 0,22 to 0,45kg a week.

Red Flag SymptomsAny of these symptoms could be a sign that something is wrong with yourpregnancy. Don't wait for your prenatal visit to talk about it.

Call your healthcare provider right away if you experience:• Severe abdominal pain or cramping• Bleeding• Severe dizziness• Rapid weight gain (more than 6.5 pounds per month) or too little weight

gain (less than 10 pounds at 20 weeks into the pregnancy)

20


Third Trimester ofPregnancy Now that you've reached the third trimester,you're in the home stretch of your pregnancy.You've only got a few more weeks to go, butthis part of your pregnancy can be the mostchallenging.

What to Expect - Changes in Your BodyBackache. The extra weight you've gained isputting added pressure on your back, making itfeel achy and sore. You might also feeldiscomfort in your pelvis and hips as yourligaments loosen to prepare for labour. To easethe pressure on your back, practice goodposture. Sit up straight and use a chair thatprovides good back support. At night, sleepon your side with a pillow tucked betweenyour legs. Wear low-heeled, comfortableshoes with good arch support. To relieveback pain, use a heating pad and ask yourhealthcare provider whether it's OK for youto take acetaminophen.

Bleeding. Spotting may sometimes be asign of a serious problem, including placentaprevia (the placenta grows low and coversthe cervix), placental abruption (separationof the placenta from the uterine wall), orpreterm labour. Call your healthcareprovider as soon as you notice anybleeding.

21

Week 13-27


Braxton Hicks contractions. You might start to feelmild contractions, which are warm-ups to prepareyour uterus for the real labour to come.Braxton Hicks contractions often aren't asintense as real labour contractions, butthey may feel a lot like labour and caneventually progress to it. One maindifference is that real contractionsgradually get closer and closer together -- and more intense. If you're red in theface and out of breath after yourcontractions, or they're coming regularly, callyour healthcare provider.

Breast enlargement. By the end of your pregnancy, your breasts will havegrown by as much as 0,9kg. Make sure you're wearing a supportive bra soyour back doesn't suffer. Close to your due date, you may start to see ayellowish fluid leaking from your nipples. This substance, called colostrum,will nourish your baby in the first few days after birth.

Discharge. You might see more vaginal discharge during the third trimester.If the flow is heavy enough to soak through your panty liners, call yourhealthcare provider. Close to your delivery date, you might see a thick, clear,or slightly blood-tinged discharge. This is your mucus plug, and it's a signthat your cervix has begun dilating in preparation for labour. If youexperience a sudden rush of fluid, it may mean that your water has broken(although only about 8% of pregnant women have their water break beforecontractions begin). Call your healthcare provider as soon as possible afteryour water breaks.

Fatigue. You might have been feeling energetic in your second trimester, butare weary now. Carrying extra weight, waking up several times during the nightto go to the bathroom, and dealing with the anxiety of preparing for a babycan all take a toll on your energy level. Eat healthy food and get regular

22


exercise to give yourself a boost. When you feel tired, try to take a nap, or atleast sit down and relax for a few minutes. You need to reserve all your strengthnow for when your baby arrives and you're really not getting any sleep.

Frequent urination. Now that your baby is bigger, the baby's head may bepressing down on your bladder. That extra pressure means you'll have to goto the bathroom more frequently -- including several times each night. Youmight also find that you're leaking urine when you cough, sneeze, laugh, orexercise. To relieve the pressure and prevent leakage, go to the bathroomwhenever you feel the urge and urinate completely each time. Avoid drinkingfluids right before bedtime to cut down on unwanted late-night bathroomvisits. Wear a panty liner to absorb any leakage that does occur. Let yourhealthcare provider know if you experience any pain or burning withurination. These can be signs of a urinary tract infection.

Heartburn and constipation. They're caused by extra production of thehormone progesterone, which relaxes certain muscles -- including themuscles in your esophagus that normally keep food and acids down in yourstomach, and the ones that move digested food through your intestines. Torelieve heartburn, try eating more frequent, smaller meals throughout the dayand avoid greasy, spicy, and acidic foods (like citrus fruits). For constipation,increase your fibre intake and drink extra fluids to keep things moving moresmoothly. If your heartburn or constipation is really bothering you, talk to yourhealthcare provider about what medications may be safe for you to take forsymptom relief.

Hemorrhoids. Hemorrhoids are actually varicose veins -- swollen veins thatform around the anus. These veins enlarge during pregnancy because extrablood is flowing through them and the weight of pregnancy increases theamount of pressure to the area. To relieve the itch and discomfort, try sittingin a warm tub or sitz bath. Ask your healthcare provider whether you can alsotry an over-the-counter hemorrhoid ointment or stool softener.

Shortness of breath. As your uterus expands, it rises up until it sits just under

23


your rib cage, leaving less room for your lungs to expand. That addedpressure on your lungs can make it more difficult to breathe. Exercising canhelp with shortness of breath. You can also try propping up your head andshoulders with pillows while you sleep.

Spider and varicose veins. Your circulation has increased to send extrablood to your growing baby. That excess blood flow can cause tiny red veins,known as spider veins, to appear on your skin. Spider veins may get worse inyour third trimester, but they should fade once your baby is born. Pressure onyour legs from your growing baby may also cause some surface veins in yourlegs to become swollen and blue or purple. These are called varicose veins.Although there's no way to avoid varicose veins, you can prevent them fromgetting worse by:• Getting up and moving throughout the day• Wearing support hose• Propping up your legs whenever you have to sit for long periods of time.• Varicose veins should improve within a few months after you deliver.

Swelling. Your rings might be feeling tighter these days, and you may alsonotice that your ankles and face are looking bloated. Mild swelling is theresult of excess fluid retention (edema). To reduce swelling, put your feet upon a stool or box whenever you sit for any length of time, and elevate yourfeet while you sleep. If you have sudden onset of swelling though, seekmedical attention immediately as it may be a sign of preeclampsia, adangerous pregnancy complication.

Weight gain. Aim for a weight gain of 0,2 to 0,5kg a week during your thirdtrimester. By the end of your pregnancy, you should have put on a total ofabout 11,33 to 15,87kg (your healthcare provider may have recommendedthat you gain more or less weight if you started out your pregnancyunderweight or overweight). The extra kilograms you've put on are madeup of the baby's weight, plus the placenta, amniotic fluid, increased bloodand fluid volume, and added breast tissue. If your baby seems to be toosmall or too big based on the size of your belly, your healthcare provider

24


will do an ultrasound to check his growth.

Red Flag SymptomsAny of these symptoms could be asign that something is wrong withyour pregnancy. Don't wait foryour regular prenatal visit to talkabout it.

Call your healthcare providerright away if you experience:• Severe abdominal pain or

cramps• Severe nausea or vomiting• Bleeding• Severe dizziness• Pain or burning during

urination• Rapid weight gain (more

than 4kg per month) ortoo little weight gain

25


Take care of yourselfEat wellAim to eat a healthy, balanced diet whenever you can. Try to have:• At least five portions of fruit and vegetables daily.• Plenty of carbohydrates, such as bread, pasta and rice, as the basis of

your meals. Choose wholegrain carbohydrates rather than white, so youget plenty of fibre.

• Daily servings of protein, such as fish, lean meat, eggs, nuts or pulses,and some milk and dairy foods.

• Two portions of fish a week, at least one of which should be oily. Fish ispacked with protein, vitamin D, minerals and omega-3 fatty acids.Omega-3 fatty acids are important for the development of your baby'snervous system.

• Proper hydration is another vital component for a healthy pregnancy.Favourable fluids you should be drinking include water, club soda,bottled water, vegetable juice, seltzer, calcium-fortified fruit juice, andskim or 1% low-fat milk. Liquids you should steer clear of are alcohol,coffee, tea, soft drinks, diet cola (and other artificially sweetened drinks),and questionable herbal teas.

Important to remember:You don't need to eat for two when you're pregnant. You don't need extracalories for the first six months of pregnancy. In the last three months you'llneed about an extra 200 calories a day. You can keep up your energy levelswith healthy snacks.

Take a supplementPregnancy vitamin supplements aren't a substitute for a balanced diet. Butthey can help if you're worried you're not eating well, or you're too sick to eatmuch. Talk to your healthcare provider or pharmacist before taking an ante-natal supplement. Make sure your supplement contains 400 micrograms(mcg) of folic acid. You need this while you're trying for a baby and for the

26


first three months of pregnancy. Taking folic acidreduces the risk of your babydeveloping a neural tube defectsuch as spina bifida.

Also, check that yoursupplement contains 10mcgof vitamin D. Vitamin D isimportant for your baby'sfuture bone health. If you don'teat fish, fish oil supplementsmay be helpful. Choose asupplement made from thebody of the fish, not the liver.This is because fish liver oils(such as cod liver oil) maycontain the retinol form ofvitamin A, which isn'trecommended in pregnancy.

Supplements provided by the PlatinumHealth Maternity programme are folicacid during the first trimester and FA, B-12 and Fe combination from the secondtrimester onwards, supplemented by calciumafter week 28.

Over-the-counter medications during pregnancyHere's the rule to remember about the medications you can buy over-the-counter (OTC): Just because these medications are readily available and safefor you to use, does not mean they are safe for your baby. Some of theremedies we all take without a second thought, need to be okayed by yourhealthcare provider before you can take them during your pregnancy—aspirin, cold remedies, yeast infection medications, preparations for digestive

27


problems, and sleep aids, for example. Your healthcare provider orpharmacist can weigh the risks and benefits and decide what is best for bothyou and the baby.

Be careful about food hygieneThere are some foods that are safest not to eat inpregnancy. This is because they can carry a health riskfor your baby.

Listeriosis is an infection caused by listeria bacteria. It's rareand doesn't usually pose a threat to your health. However, itcan cause pregnancy or birth complications. Listeriosiscan even lead to miscarriage.

The following foods may harbour listeriaand so are best avoided:• pate of any type• unpasteurised milk• undercooked ready meals• soft, mould-ripened cheeses, such as brie• blue-veined cheeses, such as Roquefort

As listeria bacteria are destroyed by heat, make sureyou heat ready meals thoroughly.

Is it safe to eat soft-boiled or raw eggs during pregnancy?Cook eggs until the white and yolk are solid. Thoroughly wash utensils,boards and your hands after handling raw poultry. Food hygiene isespecially important now that you're pregnant. Toxoplasmosis is an infectioncaused by a parasite. It's also rare, but it can affect your unborn baby. You cancut down your risk of catching it by:• cooking meat and ready meals thoroughly• washing fruit and vegetables well to remove soil or dirt• wearing gloves when handling cat litter and garden soil

28


Personal hygieneDuring pregnancy personal hygiene must be of utmost importance becauseat that point in time it’s not just about you but about your unborn baby too.Improper hygiene can lead to infections which the baby can acquire throughthe mother.

• Wash your handsCytomegalovirus, commonly denoted as CMV, is a virus that spreadsthroughout the body across the lymphatic and blood channel. CMVspreads in the body of a pregnant woman when it comes in contact withinfected saliva, urine or any body fluid. CMV risks the cognitive health ofyour baby along with hearing and vision impairment. So, make sure youwash your hands with warm water and disinfecting soap for 20 seconds.Do carry a sanitiser with you at all times to keep you and your baby safeand protected against all infections.

• Dental HygieneWhen you are pregnant remember that oral health will directly influenceand impact the health of your baby. Make sure that you brush and flossregularly. It is advisable to visit your dentist as soon as you get pregnantand go for routine check-ups. Poor dental hygiene of the mother maylead to periodontal disease. This disease is very dangerous as it mayreach your foetus through infected amniotic fluid and risk factors likepremature birth and low birth weight may heighten the impact ofperiodontal disease on your unborn child.

• Breast CareInto the 12th week of pregnancy your breasts will start secreting fluid calledcolostrums. This fluid will be consumed by your baby unless the milk in thebreasts is completely formed for feeding purposes. The release of this fluidwill make your breasts damp and itchy all the time. This can be prevented byusing padded bra’s that can soak up the fluid. The pads need to be changedat regular intervals depending on the extent of fluid secretion. Ensure youdon’t let your breast become too damp as it may lead to nipple cracks.

29


• Vaginal HygieneBe careful to consider what you clean your vagina with during pregnancy.Numerous lotions, bubble baths and tampons can lead to irritation andallergy and since the vagina is in close contact and is the pathway to youruterus, it may infect the foetus as well.

Maintain overall hygiene and shower everyday unlessyour healthcare provider advises against it. Keepingyour body clean will not only prevent infections but alsomake you more comfortable during this testing periodof pregnancy.

Exercise regularlyRegular exercise has many benefits for mums-to-be.It can:• Build your strength and endurance. This may help

you to cope better with the extra weight ofpregnancy and the hard work of labour.

• Make it easier for you to get back into shapeafter your baby is born.

• Boost your spirits and even help to ward offdepression.

30


Good exercise choices for pregnancy include:• brisk walking• swimming• aqua natal classes• yoga• Pilates

If you play sport, you can continue as long as it feels comfortable for you.However, if your particular sport carries a risk of falls or knocks, or extra stress onyour joints, it's best to stop. Talk to your healthcare provider if you're unsure.

Begin doing pelvic floor exercisesYour pelvic floor comprises a hammock of muscles at the base of your pelvis.These muscles support your bladder, vagina and back passage. They can feelweaker than usual in pregnancy because of the extra pressure upon them.Pregnancy hormones can also cause your pelvic floor to slacken slightly.

Weak pelvic floor muscles put you at risk of developing stress incontinence.This is when small amounts of urine leak out when you sneeze, laugh orexercise.

Strengthening your muscles by doing pelvic floor exercises regularlythroughout your pregnancy can help. Having a toned pelvic floor may helpyour baby's birth go more smoothly too. You'll feel the benefit if do eightpelvic floor squeezes, three times a day.

Cut out alcohol intakeAlcohol and pregnancy don't mix. No one knows exactly what potentialharmful effects even the smallest amount of alcohol has on a developingbaby. If you are trying to conceive or are already pregnant, we recommendthat you don’t consume alcohol at all.

When you drink, the alcohol quickly travels through your bloodstream,crosses the placenta, and reaches your baby. Your baby breaks down alcohol

31


more slowly than you do, so he/she may end up with higher levels of bloodalcohol than you have.

Drinking endangers your growing baby in a number of ways: It increases therisk of miscarriage and stillbirth. As little as one drink a day can raise the oddsfor having a baby with a low birth weight and raise your child's risk for havingproblems with learning, speech, attention span, language, and hyperactivity.

Foetal alcohol spectrum disorders (FASD) is the termexperts use to describe the range of problems relatedto alcohol exposure before birth. The most severe

result of alcohol use is foetal alcoholsyndrome (FAS), a lifelong conditioncharacterised by poor growth (in thewomb, after birth, or both),abnormal facial features, anddamage to the central nervoussystem.

32


Frequent drinking (seven or more alcoholic drinks per week, including liquor,wine, and beer) or binge drinking (four or more drinks on any one occasion)greatly increases the risk that your baby will suffer from FAS. Even babieswhose mothers drink less can also develop this syndrome. Babies exposed toalcohol before birth – even if they don't have the full spectrum of FAS – maystill be born with some of these birth defects or later exhibit a number ofmental, physical, or behavioural problems.

Cut back on caffeineCoffee, tea, cola and energy drinks are mild stimulants. There are concernsthat too much caffeine may increase your risk of miscarriage. It's also thoughtpossible that too much caffeine may contribute to your risk of having a low-birth-weight baby.

Current guidelines state that up to 200mg of caffeine a day won't hurt yourbaby. That's the equivalent of two mugs of instant coffee.

As with alcohol, you may prefer to cut out caffeine altogether, particularly inthe first trimester. Decaffeinated tea and coffee, fruit teas and fruit juices areall safe alternatives.

Stop smokingSmoking during pregnancy can cause serious health problems, for you andyour baby. These risks include an increased risk of:• miscarriage• premature birth• low birth weight• cot death (SIDS)

Smoking may even be associated with the loss of a baby at birth.

Smoking makes the following pregnancy complications more likely:• Nausea and vomiting (morning sickness).• Ectopic pregnancy.

33


• Placental abruption, where the placenta comes away from the uterus wallbefore your baby is born.

If you smoke, it's best to stop, for your own health and that of your baby. Thesooner you stop smoking, the better, but it's never too late. Ask yourhealthcare provider to help you with ways to give up.

Get some restThe fatigue you feel in the first few months is due to high levels of pregnancyhormones circulating in your body. Later on, it's your body's way of telling youto slow down.

If you can't sleep at night, try to take a quick nap in the middle of the day tocatch up. If that's impossible, at least put your feet up and try to relax for 30minutes.

34


If backache is disturbing your sleep, try lying on your left-hand side with yourknees bent. Placing a wedge-shaped pillow under your bump may help easethe strain on your back.

Exercise may also give you some relief from backache. It can help with sleepproblems, too, as long as you don't exercise too close to bedtime.

To wind down ready for bed, try relaxation techniques, which are safe inpregnancy, such as:• yoga• stretching• deep breathing• visualisation• massage

Always let your exercise teacher know that you're pregnant or, ideally, chooseclasses tailored to pregnant women.

Everyday life doesn't stop once you are pregnant. Most healthy pregnantwomen are able to continue with their usual routine and activity level. Thatmeans going to work, running errands, and for some, traveling away fromhome.

Heels vs Flats in PregnancyIt is one of the defining moments of pregnancy: the realisation that the four-inch heels you once wore with ease, now have you groaning in pain. It's bestto put your heels away while you're pregnant, or at least keep them just forspecial occasions.

During pregnancy, your body releases the hormone relaxin to loosen thetissues that keep your joints stable (ligaments). This makes your pelvis moreflexible, ready for childbirth, but it also means that extra pressure on yourjoints may contribute to lower back pain. When you put your heels on, yourposture changes slightly, putting more pressure on your back, and on your

35


knee and ankle joints. You may also feel more clumsier while you're pregnant.It's common to feel dizzy sometimes, so being in high heels may not be thesafest way to get around!

Swelling (oedema) is very common during pregnancy, especially in your thirdtrimester. This will make heels particularly uncomfortable, especially if you’reat work or at an event where you haven’t got something more comfortable toslip into.

But it’s not only high heels that cause problems for pregnant women. Very flatshoes like ballet pumps or sandals offer very little support to the foot and cancause Achilles pain, calf strain and flattening of the arches which can lead toplantar fasciitis.

At a time when the feet need support when walking on hard surfaces, this isnot ideal. So should mothers-to-be ditch heels or beloved ballet pumpsaltogether?

Not necessarily. The recommended optimum height for a shoe duringpregnancy is around two inches - although the exact height depends on thestructure of each individual’s foot.

However, there is some flexibility. The type of shoe worn is not as important asthe activity that the person does in them. The best advice we can give pregnantladies is to wear comfortable, supportive footwear with some shock absorbency -such as trainers or a cushioned shoe with arch support - for walking orcommuting. Heels are fine, but walking long distances on hard surfaces shouldbe avoided. Inexpensive shock-absorbent insoles bought from chemists can beslipped into regular shoes to give padding and support.

Buckle up!Wearing a seatbelt during car and air travel is safe while pregnant. The lapstrap should go under your belly, across your hips. The shoulder strap shouldgo between your breasts and to the side of your belly. Make sure it fits snugly.

36


Important health conditions toconsider during pregnancyPregnancy and High blood pressure Having high blood pressure (hypertension) duringpregnancy — whether you develop thecondition before or after conception —requires special care. Here's what you need toknow about high blood pressure andpregnancy.

Are there different types of high bloodpressure during pregnancy?Sometimes high blood pressure is present beforepregnancy. In other cases, high blood pressuredevelops during pregnancy. For example:• Gestational hypertension. Women

with gestational hypertension havehigh blood pressure that developsafter 20 weeks of pregnancy. Thereis no excess protein in the urine orother signs of organ damage.Some women with gestationalhypertension eventually developpreeclampsia.

• Chronic hypertension. Chronichypertension is high bloodpressure that was present beforepregnancy or that occurs before 20weeks of pregnancy. But becausehigh blood pressure usually doesn'thave symptoms, it might be hard todetermine when it began.

37


• Chronic hypertension with superimposed preeclampsia. Thiscondition occurs in women with chronic high blood pressure beforepregnancy who then develop worsening high blood pressure and proteinin the urine or other health complications during pregnancy.

• Preeclampsia. Sometimes chronic hypertension or gestationalhypertension leads to preeclampsia, a pregnancy complicationcharacterised by high blood pressure and signs of damage to anotherorgan system — usually after 20 weeks of pregnancy. Left untreated,preeclampsia can lead to serious — even fatal — complications formother and baby. Previously, preeclampsia was only diagnosed if apregnant woman had high blood pressure and protein in her urine.However, experts now know that it's possible to have preeclampsia, yetnever have protein in the urine.

Why is high blood pressure a problem during pregnancy?High blood pressure during pregnancy poses various risks, including:• Decreased blood flow to the placenta. If the placenta doesn't get

enough blood, your baby might receive less oxygen and fewer nutrients.This can lead to slow growth, low birth weight or preterm birth.Prematurity can lead to breathing problems for the baby.

• Placental abruption. Preeclampsia increases your risk of placentalabruption, in which the placenta separates from the inner wall of youruterus before delivery. Severe abruption can cause heavy bleeding anddamage to the placenta, which can be life-threatening for both you andyour baby.

• Premature delivery. Sometimes an early delivery is needed to preventpotentially life-threatening complications.

• Future cardiovascular disease. Having preeclampsia increases your riskof future heart and blood vessel (cardiovascular) disease. The risk is evengreater if you've had preeclampsia more than once or you've had apremature birth. To minimize this risk, after delivery try to maintain yourideal weight, eat a variety of fruits and vegetables, exercise regularly, anddon't smoke.

38


What do I need to know about preeclampsia?Preeclampsia sometimes develops without any symptoms. High bloodpressure might develop slowly, but more commonly it has a sudden onset.Monitoring your blood pressure is an important part of pre-natal carebecause the first sign of preeclampsia is commonly a rise in blood pressure.Blood pressure that is 140/90 millimeters of mercury (mm Hg) or greater —documented on two occasions, at least four hours apart — is abnormal.

Other signs and symptoms of preeclampsia might include:• Excess protein in your urine (proteinuria) or

additional signs of kidney problems.• Severe headaches.• Changes in vision, including

temporary loss of vision, blurredvision or light sensitivity.

• Upper abdominal pain, usuallyunder your ribs on the right side.

• Nausea or vomiting.• Decreased urine output.• Decreased levels of platelets

in your blood(thrombocytopenia).

• Impaired liver function.• Shortness of breath, caused

by fluid in your lungs.• Sudden weight gain and

swelling (edema) —particularly in your face andhands — often accompaniespreeclampsia.

But these things also occur in manynormal pregnancies, so they're notconsidered reliable signs of preeclampsia.

39


Is it safe to take blood pressure medication during pregnancy?Any medication you take during pregnancy can affect your baby. Althoughsome medications used to lower blood pressure are considered safe duringpregnancy, others are generally avoided during pregnancy.

Treatment is important, however. If you need medication to control your bloodpressure during pregnancy, your healthcare provider will prescribe the safestmedication at the most appropriate dose. Take the medication exactly asprescribed. Don't stop taking the medication or adjust the dose on your own.

What can I do to reduce the risk of complications?Taking good care of yourself is the best way to take care of your baby. Forexample:• Keep your pre-natal appointments. Visit your healthcare provider

regularly throughout your pregnancy.• Take your blood pressure medication as prescribed. Your healthcare

provider will prescribe the safest medication at the most appropriate dose.• Stay active. Follow your healthcare provider's recommendations for

physical activity.• Eat a healthy diet. Choose foods low in sodium.• Know what's off-limits. Avoid smoking, alcohol and illicit drugs. Talk to

your healthcare provider before taking any over-the-countermedications.

What about labour and delivery?Your healthcare provider might suggest inducing labour a few days beforeyour due date to avoid complications. If you develop preeclampsia or othercomplications, induction might be needed even earlier. If you have severepreeclampsia, you might be given medication during labour to help preventseizures. In some cases, a Caesarian-section might be needed.

Will I be able to breast-feed my baby?Breast-feeding is encouraged for most women who have high bloodpressure, even those who take medication. Discuss any medication

40


adjustments you'll need to make with your healthcare provider ahead of time.Sometimes an alternate blood pressure medication is recommended. Yourhealthcare provider might also recommend that you avoid breast-feedingright after you take your medication.

Pregnancy and Gestational diabetesGestational diabetes develops during pregnancy (gestation). Like othertypes of diabetes, gestational diabetes affects how yourcells use sugar (glucose). Gestational diabetes causeshigh blood sugar that can affect your pregnancy andyour baby's health.

Any pregnancy complication is concerning, but there'sgood news. Expectant moms can help control gestationaldiabetes by eating healthy foods, exercising and, ifnecessary, taking medication. Controlling blood sugar canprevent a difficult birth and keep you and your baby healthy.

In gestational diabetes, blood sugar usually returns tonormal soon after delivery. But if you'vehad gestational diabetes, you're atrisk for type 2 diabetes. You'llcontinue working with yourhealthcare team to monitor andmanage your blood sugar.

CausesResearchers don't know why somewomen develop gestationaldiabetes. To understand howgestational diabetes occurs, it canhelp to understand how pregnancyaffects your body's glucoseprocessing.

41


Your body digests the food you eat to produce sugar (glucose) that entersyour bloodstream. In response, your pancreas — a large gland behind yourstomach — produces insulin. Insulin is a hormone that helps glucose movefrom your bloodstream into your body's cells, where it's used as energy.

During pregnancy, the placenta, which connects your baby to your bloodsupply, produces high levels of various other hormones. Almost all of themimpair the action of insulin in your cells, raising your blood sugar. Modestelevation of blood sugar after meals is normal during pregnancy.

As your baby grows, the placenta produces more and more insulin-blockinghormones. In gestational diabetes, the placental hormones provoke a rise inblood sugar to a level that can affect the growth and welfare of your baby.Gestational diabetes usually develops during the last half of pregnancy —sometimes as early as the 20th week, but generally not until later.

SymptomsFor most women, gestational diabetes doesn't cause

noticeable signs or symptoms.

When to see a healthcare providerIf possible, seek healthcare early so yourhealthcare provider can evaluate your risk ofgestational diabetes as part of your overallchildbearing wellness plan. Once you'repregnant, your healthcare provider willaddress gestational diabetes as part ofyour pre-natal care. If you developgestational diabetes, you may needmore-frequent checkups. These aremost likely to occur during the last threemonths of pregnancy, when yourhealthcare provider will monitor yourblood sugar level and your baby's health.

42


To make sure your blood sugar level has returned to normal after your baby isborn, your healthcare team will check your blood sugar right after deliveryand again in six weeks. Once you've had gestational diabetes, it's a goodidea to have your blood sugar level tested regularly. The frequency of bloodsugar tests will in part depend on your test results soon after you deliver yourbaby.

Risk factorsAny woman can develop gestational diabetes, but some women are atgreater risk. Risk factors for gestational diabetes include:• Age greater than 25. Women older than age 25 are more likely to

develop gestational diabetes.• Family or personal health history. Your risk of developing gestational

diabetes increases if you have prediabetes — slightly elevated bloodsugar that may be a precursor to type 2 diabetes — or if a close familymember, such as a parent or sibling, has type 2 diabetes. You're alsomore likely to develop gestational diabetes if you had it during aprevious pregnancy, if you delivered a baby who weighed more than4,1kg, or if you had an unexplained stillbirth.

• Excess weight. You're more likely to develop gestational diabetes ifyou're significantly overweight with a body mass index (BMI) of 30 orhigher.

ComplicationsMost women who have gestational diabetes deliver healthy babies. However,gestational diabetes that's not carefully managed can lead to uncontrolledblood sugar levels and cause problems for you and your baby, including anincreased likelihood of needing a C-section to deliver.

Complications that may affect your babyIf you have gestational diabetes, your baby may be at increased risk of:• Excessive birth weight. Extra glucose in your bloodstream crosses the

placenta, which triggers your baby's pancreas to make extra insulin. Thiscan cause your baby to grow too large (macrosomia). Very large babies

43


— those that weigh 4.5kg or more — are more likely to become wedgedin the birth canal, sustain birth injuries or require a Caesarian sectionbirth.

• Early (pre-term) birth and respiratory distress syndrome. A mother'shigh blood sugar may increase her risk of early labour and delivering herbaby before its due date. Or her healthcare provider may recommendearly delivery because the baby is large. Babies born early mayexperience respiratory distress syndrome — a condition that makesbreathing difficult. Babies with this syndrome may need help breathinguntil their lungs mature and become stronger. Babies of mothers withgestational diabetes may experience respiratory distress syndrome evenif they're not born early.

• Low blood sugar (hypoglycemia). Sometimes babies of mothers withgestational diabetes develop low blood sugar (hypoglycemia) shortlyafter birth because their own insulin production is high. Severe episodesof hypoglycemia may provoke seizures in the baby. Prompt feedings andsometimes an intravenous glucose solution can return the baby's bloodsugar level to normal.

• Type 2 diabetes later in life. Babies of mothers who have gestationaldiabetes have a higher risk of developing obesity and type 2 diabeteslater in life.

Untreated gestational diabetes can result in a baby's death either before orshortly after birth.

Complications that may affect youGestational diabetes may also increase the mother's risk of:• High blood pressure and preeclampsia. Gestational diabetes raises

your risk of high blood pressure, as well as, preeclampsia — a seriouscomplication of pregnancy that causes high blood pressure and othersymptoms that can threaten the lives of both mother and baby.

• Future diabetes. If you have gestational diabetes, you're more likely toget it again during a future pregnancy. You're also more likely to developtype 2 diabetes as you get older. However, making healthy lifestyle

44


choices such as eating healthy foods and exercising can help reduce therisk of future type 2 diabetes.

Of those women with a history of gestational diabetes who reach their idealbody weight after delivery, fewer than 1 in 4 eventually develops type 2diabetes.

Preparing for your appointmentIn most circumstances, you'll learn you have gestational diabetesas the result of routine screening during your pregnancy. If yourblood sugar tests high, you'll likely be asked to come in for anappointment promptly. You'll also have more-frequent regularpre-natal appointments to monitor the course of your pregnancy.

Here's some information to help you get ready for yourappointment and know what to expect from your healthcareprovider.

What you can do• Be aware of pre-appointment

restrictions. When you make yourappointment, ask if you need to fastfor blood work or do anything elseto prepare for diagnostic tests.

• Write down symptoms you'rehaving, including those thatmay seem unrelated togestational diabetes. You maynot have noticeablesymptoms, but it's good tokeep a log of anything unusualyou notice.

• Write down key personalinformation, including major

45


stresses or recent life changes.• Make a list of all medications, including over-the-counter drugs and

vitamins or supplements you're taking.• Take a family member or friend along, if possible. Someone who

accompanies you may remember something that you missed or forgot.

Questions to ask your healthcare providerMake a list of questions to help make the most of your time with yourhealthcare provider. For gestational diabetes, some basic questions to askyour healthcare include:• What can I do to help control my condition?• Can you recommend a dietitian who can help me plan meals, an exercise

programme, and coping strategies?• What will determine whether I need medication to control my blood

sugar?• What symptoms should prompt me to seek medical attention? Don't

hesitate to ask other questions.

What to expect from your healthcare providerYou can take steps to control gestational diabetes as soon as you'rediagnosed. If your healthcare provider recommends further evaluation, makeyour follow-up appointments as soon as possible. Every week counts for youand your baby.

Follow your healthcare provider’s advice, and take good care of yourself. Eathealthy foods, exercise and learn as much as you can about gestationaldiabetes.

Pregnancy and HIV/AIDSMotherhood is a wonderful experience. Regardless of your HIV status, youmay want to have children. . Just because you have HIV doesn't mean yourchild will get HIV. You will have many choices to make about lowering the riskof passing HIV to your baby.

46


Take these steps to lowerthe risk of giving HIV to yourbabyIn South Africa, before effectivetreatment was available, about 25percent of pregnant HIV-positive motherswho didn't breastfeed and did not receiveanti-HIV treatment in pregnancy passed thevirus to their babies.

Today, the risk of giving HIV to your newborn is below 2percent. But you and the baby must get the right HIV drugs at theright times. Until recently, the World Health Organisation (WHO) advisedHIV-positive mothers to avoid breastfeeding if they were able to afford,prepare and store formula milk safely. But research has since emerged,particularly from South Africa, which shows that a combination of exclusivebreastfeeding and the use of anti-retroviral treatment can significantly reducethe risk of transmitting HIV to babies through breastfeeding.

The steps below can lower the risk of giving HIV to your baby.• Start HIV treatment before pregnancy if you need it for your own health.

Or, you can start treatment during pregnancy to lower the risk of passingHIV to your baby. If you are already on treatment, do not stop, but dosee your healthcare provider right away. Some HIV drugs should not beused while you're pregnant. For other drugs, you may need a differentdosage.

• Make sure your baby is tested for HIV right after birth. Your healthcareprovider should be experienced in managing babies who have beenexposed to HIV. They will tell you what follow-up tests your baby willneed, and when.

• Ask your healthcare provider about starting treatment for your baby rightaway if your baby is diagnosed with HIV. This may require a number oftests and you may not know until he is 2 to 4 months old.

• Until you know that your baby is HIV-positive or HIV-negative, ask your

47


healthcare provider if your baby might benefit from anti-HIV medicines.New research shows that putting a newborn on a 2- or 3-drug anti-HIVmedicine plan cuts the infant's risk of HIV by 50 percent (compared tousing one drug only).

• Ask your healthcare provider about other medicines the baby may needto prevent opportunistic infections until you know for sure whether thebaby has HIV.

IMPORTANTAs a Platinum Health member you have the benefit of registering on thePlatinum Health HIV programme, giving you access to sound advice fromyour healthcare provider and access to the necessary medication for HIVtreatment. Your healthcare provider will assist you with registering onthe HIV programme and give you advice about the treatment process.

Anaemia in PregnancyWhen you're pregnant, you may develop anaemia. When you have anaemia,your blood doesn't have enough healthy red blood cells to carry oxygen toyour tissues and to your baby. During pregnancy, your body produces moreblood to support the growth of your baby. If you're not getting enough ironor certain other nutrients, your body might not be able to produce theamount of red blood cells it needs to make this additional blood.

It's normal to have mild anaemia when you are pregnant. But you may havemore severe anaemia from low iron or vitamin levels or from other reasons.Anaemia can leave you feeling tired and weak. If it is severe but goesuntreated, it can increase your risk of serious complications like pre-termdelivery.

Types of Anaemia During PregnancySeveral types of anaemia can develop during pregnancy. These include:• Iron-deficiency anaemia• Folate-deficiency anaemia• Vitamin B12 deficiency

48


Here's why these types of anaemia may develop:

Iron-deficiency anaemiaThis type of anaemia occurs when the body doesn't have enough iron toproduce adequate amounts of hemoglobin. That's a protein in red bloodcells. It carries oxygen from the lungs to the rest of thebody. In iron-deficiency anaemia, the blood cannotcarry enough oxygen to tissues throughout thebody. Iron deficiency is the most common causeof anaemia in pregnancy.

Folate-deficiency anaemia Folate, also called folic acid, is a type of Bvitamin. The body needs folate to produce newcells, including healthy red blood cells.During pregnancy, women needextra folate. But sometimes theydon't get enough from their diet.When that happens, the bodycan't make enough normal redblood cells to transport oxygento tissues throughout the body.Folate deficiency can directlycontribute to certain types ofbirth defects, such as neuraltube abnormalities (spinabifida) and low birth weight.

Vitamin B12 deficiency The body needs vitamin B12 to formhealthy red blood cells. When apregnant woman doesn't getenough vitamin B12 from her diet,her body can't produce enough

49


healthy red blood cells. Women who don't eat meat, poultry, dairy products,and eggs have a greater risk of developing vitamin B12 deficiency, which maycontribute to birth defects, such as neural tube abnormalities, and could leadto pre-term labour. Blood loss during and after delivery can also causeanaemia.

Risk Factors for Anaemia in PregnancyAll pregnant women are at risk for becoming anemic. That's because theyneed more iron and folic acid than usual. But the risk is higher if you:• Are pregnant with multiples (more than one child)• Have had two pregnancies close together• Vomit a lot because of morning sickness• Are a pregnant teenager• Don't eat enough foods that are rich in iron• Had anaemia before you became pregnant

Symptoms of Anaemia during PregnancyThe most common symptoms of anaemia during pregnancy are:• Pale skin, lips, and nails• Feeling tired or weak• Dizziness• Shortness of breath• Rapid heartbeat• Trouble concentrating

In the early stages of anaemia, you may not have obvious symptoms. Andmany of the symptoms are ones that you might have while pregnant even ifyou're not anemic. So be sure to get routine blood tests to check for anaemiaat your pre-natal appointments.

Risks of Anaemia in PregnancySevere or untreated iron-deficiency anaemia during pregnancy can increaseyour risk of having:• A pre-term or low-birth-weight baby

50


• A blood transfusion (if you losea significant amount of bloodduring delivery)

• Postpartum depression• A baby with anaemia• A child with

developmental delays

Untreated folate deficiency canincrease your risk of having a:• Pre-term or low-birth-weight

baby• Baby with a serious birth defect of the

spine or brain (neural tube defects)

Untreated vitamin B12 deficiency can also raise your risk of having a babywith neural tube defects.

Tests for AnaemiaDuring your first pre-natal appointment, you'll get a blood test so yourhealthcare provider can check whether you have anaemia. Blood teststypically include:• Hemoglobin test - it measures the amount of hemoglobin -- an iron-rich

protein in red blood cells that carries oxygen from the lungs to tissues inthe body.

• Hematocrit test - it measures the percentage of red blood cells in asample of blood.

If you have lower than normal levels of hemoglobin or hematocrit, you may haveiron-deficiency anaemia. Your healthcare provider may check other blood tests todetermine if you have iron deficiency or another cause for your anaemia. Even ifyou don't have anaemia at the beginning of your pregnancy, your healthcareprovider will most likely recommend that you get another blood test to checkfor anaemia in your second or third trimester.

51


Treatment for AnaemiaIf you are anemic during your pregnancy, you may need to start taking an ironsupplement and/or folic acid supplement in addition to your pre-natalvitamins. Your healthcare provider may also suggest that you add more foodsthat are high in iron and folic acid to your diet. In addition, you'll be asked toreturn for another blood test after a specific period of time so your healthcareprovider can check that your hemoglobin and hematocrit levels areimproving. To treat vitamin B12 deficiency, your healthcare provider mayrecommend that you take a vitamin B12 supplement.The healthcare provider may also recommend that you include more animalfoods in your diet, such as:• meat• eggs• dairy products

Your OB may refer you to a hematologist, a healthcare provider whospecializes in anaemia/ blood issues. These specialist may see youthroughout the pregnancy and help your OB manage the anaemia.

Preventing AnaemiaTo prevent anaemia during pregnancy, make sure you get enough iron. Eatwell-balanced meals and add more foods that are high in iron to your diet. Aim for at least three servings a day of iron-rich foods, such as:• lean red meat, poultry, and fish• leafy, dark green vegetables (such as spinach, broccoli, and kale)• iron-enriched cereals and grains• beans, lentils, and tofu• nuts and seeds• eggs

Foods that are high in vitamin C can help your body absorb more iron. Theseinclude:• citrus fruits and juices• strawberries

52


• kiwis• tomatoes• bell peppers

Try eating those foods at the same time that you eat iron-rich foods. Forexample, you could drink a glass of orange juice and eat an iron-fortifiedcereal for breakfast.Also, choose foods that are high in folic acid to help prevent folate deficiency.These include:• leafy green vegetables• citrus fruits and juices• fortified breads and cereals• dried beans

Follow your healthcare provider’s instructions for taking a pre-natal vitaminthat contains a sufficient amount of iron and folic acid. Vegetarians andvegans should consult with their healthcare provider about whether theyshould take a vitamin B12 supplement when they're pregnant andbreastfeeding.

53


Before the baby arrivesBe PreparedBook your delivery bed:• Make sure your delivery bed is booked in time. • Note that Platinum Health members are obliged to utilise a Designated

Service Provider (DSP) hospital in which case the scheme will cover 100%of the costs.

• Also important to note is that the hospital benefit is applicable peroption. For more information contact Client Liaison on 014 591 6600.

• Platinum Health will fund a normal maternity bed as part of the delivery.The member can ask for a private room but will have to pay thedifference between the maternity room and the private room.

• Pre-authorisation for your bed-booking is issued by Case Managementvia SMS, email, telephone or Platinum Health facility. If you have anyqueries kindly contact Case Management on014 591 6600.

• If you are going to deliver by Caesareansection, make sure your delivery bed isbooked and you have pre-authorisationfrom Case Management.

54


Have your suitcases packed:• It is helpful to have your suitcases packed and baby’s clothes prepared

ahead of time. You may want to pack a smaller bag for your labour and alarger one for your hospital stay.

• Have all the baby essentials ready like a cot, car seat, bath tub, diapers,wipes, sterilization and baby food making and feeding kit and clothes. Ifyou’re investing in new ones, be sure to get them a few weeks earlier toallow for ‘airing’ – where any potentially harmful fumes can diffuse beforeyour baby is home.

Be prepared for the unexpected:• Arrange alternative transport with a family member or friend in case your

spouse is not with you when you go in labour.

When the babyarrivesHandling a New-bornIf you haven't spent a lot of time aroundnew-borns, their fragility may beintimidating. Here are a few basics toremember:• Wash your hands (or use a hand

sanitizer) before handlingyour baby. New-bornsdon't have a strongimmune system yet,so they aresusceptible toinfection. Makesure that everyonewho handles yourbaby has cleanhands.

55

ImportantRegister your new-born babywithin 30 days of birth. Thenew-born should be registeredat your Employee Servicesprocessing Walk-in centres orHuman Resource/EmployeeBenefits offices or atrespective Platinum HealthClient Liaison offices.


• Be careful to support your baby's head and neck. Cradle the head whencarrying your baby and support the head when carrying the baby uprightor when you lay your baby down.

• Be careful not to shake your new-born, whether in play or in frustration.Shaking that is vigorous can cause bleeding in the brain and even death.If you need to wake your infant, don't do it by shaking — instead, tickleyour baby's feet or blow gently on a cheek.

• Make sure your baby is securely fastened into the carrier, stroller, or carseat. Limit any activity that could be too rough or bouncy.

• Remember that your new-born is not ready for rough play, such as beingjiggled on the knee or thrown in the air.

Bonding with your babyBonding, probably one of the most pleasurable aspects of infant care, occursduring the sensitive time in the first hours and days after birth when parentsmake a deep connection with their infant. Physical closeness can promote anemotional connection.

For infants, the attachment contributes to their emotional growth, which alsoaffects their development in other areas, such as physical growth. Anotherway to think of bonding is "falling in love" with your baby. Children thrivefrom having a parent or other adult in their life who loves themunconditionally. Begin bonding by cradling your baby and gently stroking himor her in different patterns. Both you and your partner can also take theopportunity to be "skin-to-skin," holding your newborn against your own skinwhile feeding or cradling.

Diapering Do’s and Dont’sYou'll probably decide before you bring your baby home whether you'll usecloth or disposable diapers. Whichever you use, your little one will dirtydiapers about 10 times a day, or about 70 times a week. Before diaperingyour baby, make sure you have all supplies within reach so you won't have toleave your infant unattended on the changing table. You'll need:• a clean diaper

56


• fasteners (if cloth pre-fold diapersare used)

• diaper ointment if the baby has arash

• a container of warm water• clean washcloth, diaper wipes, or

cotton balls

After each bowel movement or if the diaper iswet, lay your baby on his or her back andremove the dirty diaper. Use the water,cotton balls, and washcloth or thewipes to gently wipe your baby'sgenital area clean. Whenremoving a boy's diaper, do socarefully because exposure tothe air may make him urinate.When wiping a girl, wipe herbottom from front to back to avoida urinary tract infection. To preventor heal a rash, apply ointment. Alwaysremember to wash your hands thoroughly after changing adiaper.

Diaper rash is a common concern. Typically the rash is red and bumpy andwill go away in a few days with warm baths, some diaper cream, and a littletime out of the diaper. Most rashes occur because the baby's skin is sensitiveand becomes irritated by the wet or poopy diaper.

To prevent or heal diaper rash, try these tips:• Change your baby's diaper frequently, and as soon as possible after

bowel movements.• After cleaning the area with mild soap and water or a wipe, apply a

diaper rash or "barrier" cream. Creams with zinc oxide are preferred

57


because they form a barrier against moisture.• If you use cloth diapers, wash them in dye- and fragrance-free

detergents.• Let the baby go undiapered for part of the day. This gives the skin a

chance to air out.

If the diaper rash continues for more than 3 days or seems to be gettingworse, call your healthcare provider — it may be caused by a fungal infectionthat requires a prescription.

Bathing BasicsYou should give your baby a sponge bath until:• the umbilical cord falls off and the navel heals completely (1-4 weeks)• the circumcision heals (1-2 weeks)

A bath two or three times a week in the first year is fine. More frequentbathing may be drying to the skin.

Have these items ready before bathing your baby:• a soft, clean washcloth• mild, unscented baby soap and shampoo• a soft brush to stimulate the baby's scalp• towels or blankets• a clean diaper• clean clothes

Sponge baths. For a sponge bath, select a safe, flat surface (such as achanging table, floor, or counter) in a warm room. Fill a sink, if nearby, or bowlwith warm (not hot!) water. Undress your baby and wrap him or her in a towel.Wipe your infant's eyes with a washcloth (or a clean cotton ball) dampenedwith water only, starting with one eye and wiping from the inner corner to theouter corner. Use a clean corner of the washcloth or another cotton ball towash the other eye. Clean your baby's nose and ears with the dampwashcloth. Then wet the cloth again and, using a little soap, wash his or her

58


face gently and pat it dry.Next, using baby shampoo, create lather and gently wash your baby's headand rinse. Using a wet cloth and soap, gently wash the rest of the baby,paying special attention to creases under the arms, behind the ears, aroundthe neck, and in the genital area. Once you have washed those areas, makesure they are dry and then diaper and dress your baby.

Tub baths. When your baby is ready for tub baths, the first baths should begentle and brief. If he or she becomes upset, go back to sponge baths for aweek or two, and then try the bath again.

In addition to the supplies listed above, add:• an infant tub with 2 to 3 inches of warm — not hot! — water (to test the

water temperature, feel the water with the inside of your elbow or wrist).An infant tub is a plastic tub that can fit in the bathtub; it's a better sizefor babies and makes bathing easier to manage.

59


Undress your baby and then place him or her in the water immediately, in a warmroom, to prevent chills. Make sure the water in the tub is no more than 2 to 3inches deep, and that the water is no longer running in the tub. Use one of yourhands to support the head and the other hand to guide the baby in feet-first.Speaking gently, slowly lower your baby up to the chest into the tub.

Use a washcloth to wash his or her face and hair. Gently massage your baby'sscalp with the pads of your fingers or a soft baby hairbrush, including the areaover the fontanelles (soft spots) on the top of the head. When you rinse thesoap or shampoo from your baby's head, cup your hand across the foreheadso the suds run toward the sides and soap doesn't get into the eyes. Gentlywash the rest of your baby's body with water and a small amount of soap.Throughout the bath, regularly pour water gently over your baby's body so heor she doesn't get cold. After the bath, wrap your baby in a towelimmediately, making sure to cover his or her head. Baby towels with hoodsare great for keeping a freshly washed baby warm.

While bathing your infant, never leave the baby alone. If you need to leave thebathroom, wrap the baby in a towel and take him or her with you.

Umbilical Cord CareUmbilical cord care in newborns is important. Some healthcareprovider’s suggest swabbing the area with rubbing alcohol untilthe cord stump dries up and falls off, usually in 10 days to 3weeks, but others recommend leaving the area alone. Talkto your child's healthcare provider to see what he or sheprefers.

An infant's navel area shouldn't be submerged in wateruntil the cord stump falls off and the area is healed. Until itfalls off, the cord stump will change colour from yellow tobrown or black — this is normal. Consult your healthcareprovider if the navel area becomes reddened or if a foul odour ordischarge develops.

60


Feeding and Burping Your BabyWhether feeding your newborn by breast or a bottle, you may be stumped asto how often to do so. Generally, it's recommended that babies be fed ondemand — whenever they seem hungry. Your baby may cue you by crying,putting fingers in his or her mouth, or making sucking noises.

A newborn baby needs to be fed every 2 to 3 hours. If you're breastfeeding,give your baby the chance to nurse about 10-15 minutes at each breast. Ifyou're formula-feeding, your baby will most likely take about 2-3 ounces (60-90 milliliters) at each feeding.

Breast milk is the ideal food for babies younger than 4 to 6 months. According tothe national guidelines, it is recommended that babies be breast-fed for at leastthe first year of life. However, the length of time that breast-feeding shouldcontinue differs for each mother and her child. Although breast-feeding is best,

babies can also get good nutrition from formula.

Breast milk contains substances that help your baby resistinfections and other diseases. Breast-fed babies have fewercolds and ear infections, less diarrhoea, and less vomiting.Breast milk is easier to digest than formula.Some newborns may need to be awakened every fewhours to make sure they get enough to eat. Call yourbaby's healthcare provider if you need to awaken yournewborn frequently or if your baby doesn't seem interestedin eating or sucking.

If you're formula-feeding, you can easily monitor ifyour baby is getting enough to eat, but if you'rebreastfeeding, it can be a little trickier. If your babyseems satisfied, produces about six wet diapersand several stools a day, sleeps well, and isgaining weight regularly, then he or she isprobably eating enough.

61


Another good way to tell if your baby is getting milk is to notice if your breastsfeel full before feeding your baby and less full after feeding. Talk to yourhealthcare provider if you have concerns about your child's growth or feedingschedule.

Babies often swallow air during feedings, which can make them fussy. You canprevent this by burping your baby frequently. Try burping your baby every 60-90milliliters if you bottle-feed, and each time you switch breasts if you breastfeed.

If your baby tends to be gassy, has gastroesophageal reflux, or seems fussyduring feeding, try burping your little one every ounce during bottle-feeding orevery 5 minutes during breastfeeding.

Try these burping strategies:• Hold your baby upright with his or her head on your shoulder. Support

your baby's head and back while gently patting the back with your otherhand.

• Sit your baby on your lap. Support your baby's chest and head with onehand by cradling your baby's chin in the palm of your hand and restingthe heel of your hand on your baby's chest (be careful to grip your baby'schin — not throat). Use the other hand to gently pat your baby's back.

• Lay your baby face-down on your lap. Support your baby's head, makingsure it's higher than his or her chest, and gently pat or rub his or herback.

If your baby doesn't burp after a few minutes, change the baby's position andtry burping for another few minutes before feeding again. Always burp yourbaby when feeding time is over, and then keep him or her in an uprightposition for at least 10-15 minutes to avoid spitting up.

Sleeping BasicsAs a new parent, you may be surprised to learn that your newborn, whichseems to need you every minute of the day, actually sleeps about 16 hours ormore! Newborns typically sleep for periods of 2-4 hours. Don't expect yours

62


to sleep through the night — the digestive system of babies is so small thatthey need nourishment every few hours and should be awakened if theyhaven't been fed for 4 hours (or more frequently if your doctor is concernedabout weight gain).

When can you expect your baby to sleep through the night? Many babies sleepthrough the night (between 6-8 hours) at 3 months of age, but if yours doesn't,it's not a cause for concern. Like adults, babies must develop their own sleeppatterns and cycles, so if your new-born is gaining weight and appears healthy,don't despair if he or she hasn't slept through the night at 3 months.

It's important to place babies on their backs to sleep to reduce the risk ofsudden infant death syndrome (SIDS). In addition, remove all fluffy bedding,quilts, sheepskins, stuffed animals, and pillows from the crib to ensure thatyour baby doesn't get tangled in them or suffocate. Also be sure to alternatethe position of your baby's head from night to night (first right, then left, andso on) to prevent the development of a flat spot on one side of the head.

63


Many newborns have their days and nights "mixed up." They tend to bemore awake and alert at night, and sleepier during the day. One way to helpthem is to keep the stimulation at night to a minimum. Keep the lights low,such as by using a nightlight. Reserve talking and playing with your baby forthe daytime. When your baby wakes up during the day try to keep him or herawake a little longer by talking and playing.

Even though you may feel anxious about handling a new-born, in a few shortweeks you'll develop a routine and be parenting like a pro! If you havequestions or concerns, ask your doctor to recommend resources that canhelp you and your baby grow together.

Infant and Child HealthWhen your children get sick or hurt, you are usually the first person to providecare. Your calmness, confidence, and competence in caring for your children’shealth problems will help them enjoy good health and learn the importanceof self-care for their own use as they mature.

ColicColic is not a disease; it is a condition that causes otherwise healthy babies tocry inconsolably, usually in the evening and at night. Doctors aren’t sure whatcauses colic. It is equally common among male and female babies andamong breast-fed and bottle-fed babies.

All babies cry, so how do you know if your baby has colic? Colic usuallyfollows the “rule of three”: Crying starts in the first 3 weeks to 3 months afterbirth and continues more than 3 hours a day, more than 3 days a week, formore than 3 weeks. Fortunately, colic goes away as the baby matures, almostalways by the end of the fourth month – sooner for many babies. Although nosingle method always works to relieve colicky babies, there are a number ofthings you can try. Unfortunately what works one time may not work the next.Be creative and persistent.

64


Home Treatment• Most important: Stay calm and try to relax. If you start to lose control,

take a minute to calm down. Never shake a baby; it can cause permanentbrain damage and even death.

• Make sure your baby is getting enough to eat, but not too much. Theproblem may be hunger, not colic.

• Make sure your baby isn’t swallowing too much air while eating. Feed thebaby slowly, holding him or her almost upright. Prop your baby up for 15minutes after feeding.

• If your baby is bottle-fed, use nipples with holes large enough to dripcold formula at least 1 drop per second. Babies will swallow more airfrom around the nipple if the hole is too small.

• Heat formula to body temperature. Don’t overheat.• Babies may need to suck on something for up to 2 hours a day to be

satisfied. If feedings aren’t enough, use a dummy.• Keep a regular routine for meals, naps, and playtime. Mealtime should

be quiet and undisturbed by bright lights and loud noises.• Make sure that your baby’s nappy is clean, that he or she isn’t too hot,

and that he or she isn’t bored.• Don’t overstimulate your baby. Some babies cry because there is too

much light, noise, or activity, or too many people around them.• Try rocking or walking your baby. Putting him or her stomach-down over

65


your knee or forearm may be helpful.• Calm your baby with a car ride or a walk outside. Placing your baby near

the hum of a clothes dryer, dishwasher, or bubbling aquarium may be asoothing effect.

• Don’t worry about spoiling a baby during the first few months;comforting a baby makes both of your feel better.

• Don’t leave your baby alone for more than 5 to 10 minutes while he orshe is crying. After 10 minutes, try the above suggestions again.

When to Seek HealthcareColic generally does not require professional treatment unless it isaccompanied by vomiting, diarrhoea, or other signs of a more serious illness.If the baby looks healthy and acts normally between crying episodes, and ifyour emotions can stand the noise for the first 3 to 4 months, you have littlecause for worry.

However, if colic lasts more than 4 hours a day, or if you feel like you needhelp, contact your healthcare provider for advice. In rare cases, colic may beso severe that you and your healthcare provider may consider a medicationfor the baby. Ask your healthcare provider about side-effects.

Cradle CapCradle cap is an oily, yellow scaling or crusting on ababy’s scalp. It is caused by a build-up ofnormal oils on the skin.

Home Treatment• Wash your baby’s head with baby

shampoo once a day. Gentlyscrub the scalp with a soft-bristled brush (a soft toothbrushworks well) for a few minutes toremove the scales. Rinse well.

• You can also rub mineral oil on

66


your baby’s scalp an hour before shampooing to loosen the scales.• If scrubbing with baby shampoo doesn’t work, try using a dandruff

shampoo, such as selenium, ketoconazole, or econazole. Use theseproducts carefully, because they can irritate your baby’s eyes.

CroupCroup is a respiratory problem that develops most often in children from 6months to 4 years of age. Croup usually accompanies a viral infection, such asa cold. The main symptom is a harsh cough that sounds like a seal’s bark andmay cause the child to become very frightened. A fever up to 38ºC is alsocommon. Croup may last 2 to 5 days. Symptoms usually get worse at night,but they generally improve with each passing night.

Home Treatment• Do whatever you can to calm your child. Crying can make breathing

more difficult.• Get moisture into the air to make it easier for your child to breathe. Use a

cool humidifier (do not use a hot vaporiser). Use only water in thehumidifier. Set your child in your lap, and let the cool vapour blowdirectly into your child’s face.

• If your child does not improve after several minutes, take him or her intothe bathroom and turn on all the hot-water faucets to create steam.Close the door, and sit with your child while he or she breathes in themoist air for several minutes.

• If your child’s breathing still does not improve, bundle him or her up andgo outside into the cool night air.

When to Seek HealthcareCall Netcare 911 if the child stops breathing or begins to turn blue. Giverescue breathing until help arrives.

Call a health professional:• If you have been trying home treatment for 30 minutes and your child is

not improving at all.

67


• If these signs of respiratory distress appear and persist despite hometreatment:

• Squeaky or raspy sound as the child inhales (stridor).• Sucking in or retraction between ribs as the child inhales.• Flaring nostrils.• If the child is so short of breath that he or she can’t walk or talk.• If the child drools or is breathing with the chin jutting out and the mouth

open.• If the child is not calm enough to sleep after being in a room with a

humidifier or breathing cold outdoor air for 20 minutes.• If the child has a fever of 38.5ºC or higher or any fever that doesn’t go

away after 48 hours.• If you or the child becomes hysterical and cannot calm down.• If this is the first case of croup in your family and you need reassurance.• If croup lasts longer than 3 nights without improving.

Diarrhoea and VomitingDiarrhoea and vomiting may be caused by viral stomach flu or by eatingunusual kinds or amounts of food. An infant’s developing digestive systemsometimes will not tolerate large amounts of juice, fruit, or even milk. Breast-fed babies are less likely to develop diarrhoea. Stomach flu often starts withvomiting that is followed in a few hours (sometimes 8 to 12 hours or longer)by diarrhoea. Sometimes there is no diarrhoea.

Infants and young children, especially those younger than age 1, need specialattention when they have diarrhoea or are vomiting, because they can quicklybecome dehydrated. Careful observation of the child’s appearance and fluidintake can help prevent problems.

Home TreatmentDiarrhoea in babies up to 1 year• If your baby is breast-fed, breast-feed at more frequent intervals to

replace lost fluids.• If your baby is formula-fed, give small feedings at more frequent intervals

68


to make up for lost fluids.• Supplement feedings with a children’s oral electrolyte solution only if

signs of dehydration develop. The amount of electrolyte solution yourbaby needs depends on his or her weight and degree of dehydration.Call your healthcare provider if your baby shows signs of dehydration.

• You can give the oral electrolyte solution a little at a time in a dropper,spoon, or bottle. For children over 6 months of age, you can improve thetaste by adding a pinch of jelly powder.

• Don’t use sports drinks, fruit juice, or soda to treat dehydration. Thesedrinks contain too much sugar and not enough of the minerals(electrolytes) that are being lost. Do not give your baby plain water.

• Don’t use oral electrolyte solutions as the sole source of fluid for morethan 12 to 24 hours.

• Offer your baby easily digestible solid foods (cereal, strained bananas,mashed potatoes) if he or she was eatingthem before.

• Protect the nappy area with zinc oxidecream. Nappy rash is common afterdiarrhoea.

Diarrhoea in children 1 year through 11years:• Give 120 ml (1/2 cup) to 240 ml (1 cup) of achildren’s oral electrolyte solution, half-strengthorange juice, or plain water (if the child iseating food) each hour. Add jellyflavourings if needed. Allow your child to drink as much as he or she wants.

69


• Don’t give your child apple juice, chicken broth, sports drinks, soft drinks,or ginger ale. These drinks do not contain the right mixture of mineralsand sugar to restore lost fluids and may make the diarrhoea worse.

• Give your child frequent small meals of easily digestible foods (cookedcereal, crackers, mashed potatoes, applesauce, bananas). Avoid foodsthat contain a lot of sugar. Don’t use an electrolyte solution as the solesource of fluids and nutrients for more than 24 hours.

As the child gets better, the stools will become smaller and less frequent.Some types of diarrhoea may cause watery stools for 4 to 6 days. Watch forsigns of dehydration. You can treat the illness at home as long as the child istaking in enough fluids and nutrients, is urinating normal amounts, and seemsto be improving.

Vomiting in babies up to 6 months:• Do not feed your baby anything for 30 to 60 minutes after he or she has

vomited. Watch your baby closely for signs of dehydration.• Do not give your baby plain water.• If your baby is breast-fed, switch to an oral electrolyte solution. Offer 15

ml every 10 minutes for the first hour. After the first hour, graduallyincrease the amount of fluid you offer your baby. You can return toregular feedings once 6 hours have passed without your baby vomiting.

Vomiting in children 7 months through 3 years:• After 1 hour has passed since your child last vomited, give 30 ml of a

clear liquid (not plain water) every 20 minutes for 1 hour. Increase theamount by 90 ml per hour every hour that your child does not vomit. Forexample, give your child 60 ml of fluid every 20 minutes during thesecond hour (180 ml total) and 90 ml of fluid every 20 minutes during thethird hour (270 ml total). Clear liquids that are safe include children’s oralrehydration solution; fruit juice mixed to half strength with water; clearbroth; and gelatin dessert.

• Do not use sports drinks, undiluted fruit juice, or soda. These drinkscontain too much sugar. Do not offer plain water or diet soda, because

70


they lack the kilojoules and essential minerals your child needs.• Offer your child regular foods after 6 hours with no vomiting. Avoid high-

fibre foods (such as beans) and foods with a lot of sugar, such as sweetsor ice cream.

When to Seek Healthcare• If vomiting occurs with severe headache, sleepiness, lethargy, or a stiff

neck.• If the diarrhoea is bloody, tarry, or dark red.• If the urine becomes bloody or cola-coloured.• If there is blood in the vomit.• If signs of severe dehydration appear:

- Sunken eyes, no tears, dry mouth and tongue.- Sunken soft spot (fontanelle) on infant head.- Little or no urine for 8 hours.- Skin that is doughy or doesn’t bounce back when pinched.- Rapid breathing and heartbeat.- Sleepiness, lethargy, listlessness, and extreme irritability.

• If a child with diarrhoea or vomiting refuses todrink or cannot take in enough liquid toreplace lost fluids.

• If severe vomiting (vomiting most orall clear liquids and feedings) occursin an infant younger than 3 monthsof age. For older children, call ifsevere vomiting continues:- Longer than 4 hours in an infant age3 to 12 months.- 8 hours in a child age 1 to 3 years.- If occasional vomiting occurswithout other symptoms andthe child is able to keepfluids down betweenvomiting episodes.

71


Call if this continues longer than:- 1 to 2 days in an infant under 3 months of age.- 2 to 4 days in an infant age 3 to 6 months.- 1 to 2 weeks in a child age 7 months to 3 years.

• If severe diarrhoea (large loose stools every 1 to 2 hours) continues forlonger than:- 4 hours in an infant under 3 months of age.- 8 hours in an infant under 3 months of age.- 8 hours in an infant age 3 to 6 months.- 24 hours in a child age 7 months to 11 years.

• If a mild to moderate diarrhoea continues without obvious cause or othersymptoms for longer than:- 24 hours in an infant under 3 months of age.- 1 to 2 days in an infant age 3 to 6 months.- 4 days in a child age 7 months to 11 years.

• If the child has a fever of 39ºC or higher or a lower fever with diarrhoeafor more than 12 hours.

• If the child has stomach pain that:- Is severe.- Is persistent, with frequent vomiting for more than 12 hours but little orno diarrhoea.- Started several hours before vomiting began and seems like more thanjust stomach cramps.- Is localised to one part of the abdomen, especially the lower rightsection. This may be difficult to determine in a small child.

FeverFever is usually defined as a rectal temperature above 38ºC. Rectaltemperatures is the most accurate for checking for fever in a child. Rectalthermometers are recommended for children younger than 6. Rectaltemperature is 0.3ºC to 0.6ºC higher than oral temperature. • Clean the thermometer. If you are using an alcohol or mercury

thermometer, shake it down to 35ºC or lower.• Put petroleum jelly or another lubricant on the bulb.

72


• Hold the child bottom-up across your lap.• Hold the thermometer 2.5 cm from the bulb and gently insert it into the

rectum no more than 2.5 cm. do not let go. Hold the thermometer rightat the anus so it cannot slip in farther.

• Wait for 3 minutes (or until a digital thermometer beeps.• How to read a thermometer that does not have a digital readout:• Roll the thermometer between your fingers until you can see the thin

ribbon of mercury (silver) or alcohol (red). Note that the thermometer ismarked from 33º to 42ºC.

• Each large mark indicates 0.5ºC of temperature each small markindicates 0.1ºC.

In most but not all cases, fever indicates that an illness is present. By itself, afever is not harmful; in fact, it may help the body fight infections moreeffectively.

In children, viral infections, such as colds, flu, and chickenpox, can cause highfevers. Flu can cause a high fever for 5 days or longer. Bacterial infections,such as soar throat and ear infections, also cause fevers. Teething does not

73


cause a fever. If a baby is teething and has a fever, other symptoms may bepresent that need to be evaluated. Body temperature can also rise abovenormal when an infant is overdressed or in a room that is too warm.

Children tend to run higher fevers than adults do. Although high fevers areuncomfortable, they do not often cause medical problems. Seizures fromfever occur only occasionally. There is no medical evidence that fevers frominfection can cause brain damage. The body limits a fever caused by infectionfrom going above 41ºC. however, heat from an external source (like sunshineon a parked car) can cause the body temperature to go above 41.5ºC, andbrain damage can occur rapidly.

Home TreatmentIt can be hard to know when to call your healthcare provider when your childhas a fever, especially during the cold and flu season. The height of a fevermay not be related to the seriousness of the illness. The way your child looksand acts is a better guide than the thermometer is.

Most children will be less active when they have a fever. If your child iscomfortable and alert, eating well, drinking enough fluids, urinating normalamounts, and seems to be improving, home treatment is all that is needed.• Encourage the child to drink extra fluids or suck on an ice lolly.• Dress the child lightly, and do not wrap him or her in blankets.

If the fever is higher than 39ºC and your child is uncomfortable:• Give paracetamol or ibuprofen. Do not give aspirin to anyone younger

than 20, because of the risk of Reye’s syndrome.• Keep encouraging the child to drink extra fluids, and watch for signs of

dehydration.

When to Seek Healthcare• If fever occurs with vomiting, severe headache, sleepiness, lethargy, stiff

neck, or a bulging soft spot on an infant’s head.• If fever is accompanied by these symptoms:

74


• Rapid, difficult breathing.• Drooling or inability to swallow.• Purple rash that does not lighten when you press on it.• Vomiting, diarrhoea, and stomach pain.• Signs of dehydration.• Unexplained skin rash.• Ear pain (babies often pull at painful ears).• Pain when urinating (crying when urinating), not caused by painful nappy

rash.• New swelling, pain, redness, or warmth in one or more joints.• Any unusual or severe pain.• If an infant younger than 3 months of age has a fever of 38.5ºC or higher.• If a child age 3 months to 3 years has a fever of:

• 40.5ºC or higher.• 40ºC or higher that does not come down after 4 to 6 hours of hometreatment.• Between 38.5º and 40ºC for more than 12 hours.• 38º to 38.5ºC for more than 24 to 48 hours.

• If the child has a fever and seems sicker than you would expect from aviral illness such as a cold or the flu.

• If the child becomes delirious or has hallucinations.• If the child’s fever began after he or she took a new medication.

Fever SeizuresFever seizures are uncontrolled muscle spasms that can happen while achild’s temperature is rapidly rising. Sometimes the seizure occurs before youare even aware that the child has a fever. Once a child’s fever has reached ahigh temperature, the risk of a seizure is probably over.

75


A child having a fever seizure may lose consciousness. The child’s muscles willstiffen, and his or her teeth will clench. Then the child’s arms and legs willstart to jerk. The child’s eyes may roll back, and he or she may stop breathingfor a few seconds. The child might also vomit, urinate, or pass stools. Seizuresusually last 1 to 5 minutes.

Although frightening, fever seizures in children age 6 months to 5 years areseldom serious and do not cause harm. Two to 4 percent of children in thisage group are prone to fever seizures. About 30 percent of children who havea fever seizure will have another one in the future.

Home TreatmentDuring a seizure:• Try to stay calm, because that will help calm the child.• Protect the child from injury. Ease the child to the floor, or hold a very

small child face down on your lap. Do not restrain the child.• Turn the child onto his or her side. This will help clear the mouth of any

vomit or saliva and will keep the airway open so the child can breathe.• Do not put anything in the child’s mouth to prevent tongue biting,

because it may inure the child.• Time the length of the seizure, if possible.

After the seizure:• If the child is having difficulty breathing, turn his or her head to the side

and, using your finger; gently clear the mouth of any vomit or saliva sothe child can breathe.

• Check for injuries.• Give paracetamol or ibuprofen and lukewarm sponge baths if the fever is

higher than 38.5ºC and your child is uncomfortable. Do not give aspirinto anyone younger than 20, because of the risk of Reye’s syndrome.

• Put the child in a cool room to sleep. Drowsiness is common following aseizure. Check the child often. The child should return to his or hernormal behaviour and activity level within 60 minutes after the seizure.

76


When to Seek HealthcareCall Netcare 911:• If the child stops breathing for longer than 30 seconds or has difficulty

breathing.• If a seizure lasts longer than 10 minutes or if a second seizure occurs.

Call your health professional:• If the child is younger than 6 months of age; if the child is 5 years or

older; or if the seizure only affects one side of the body.• If fever occurs with vomiting, severe headache, sleepiness, lethargy, stiff

neck, or a bulging, soft spot on an infant’s head.• If a seizure occurs without fever.• If it is the child’s first seizure, or if you haven’t discussed with your

healthcare provider what to do if there is another one.

Heat RashHeat rash, also called prickly heat, sweat rash, ormiliaria, is a rash of red or pink dots that appearson infants’ head, neck, and shoulders. The dotslook like tiny pimples.

Heat rash often develops when parents dresstheir baby too warmly, but it can develop in anybaby when the weather is hot. An infant should bedressed just as lightly as an adult and will becomfortable at the same temperature. It is normalfor a baby’s hands and feet to feel cold to thetouch.

PreventionDo not overdress your baby. Placeyour hand between the baby’sshoulder blades. If the skin is hotor moist, the baby is too warm.

77


Home Treatment• Dress the baby in as few clothes as possible during hot weather.• Keep the baby’s skin cool and dry.• Keep the baby’s sleeping area cool.

When to Seek Healthcare• If the rash looks infected or lasts longer than 3 days. • If the infant looks sick.• If heat rash is accompanied by a fever of 38ºC in an infant younger than 3

months of age and the fever don’t come down within 20 minutes afteryou remove some of the infant’s clothing.

Childhood Immunisation ScheduleImmunisations help your baby’s immune system recognise and quickly attackdisease-causing organisms before those organisms can cause problems.

Please note that Platinum Health does notcover the costs of child immunisations.

This is for themember’s ownaccount.

78


79

Childhood Immunisations ScheduleBirth BCG (for Tuberculosis)

6 weeks Polio dropsComb-Act-HibHepatitis B



9 months Measles (not given if baby has egg allergy)

15 months MMR (may be given at 18 months)

18 months PolioDTP / Comb-Act-Hib / Measles / MMR (if not givenat 15 months)

5 years PolioDT

Key:BCG Tuberculosis vaccine

Comb-Act-Hib Combination injection for DTP and Haemophilusinfluenza type b

DTP Diphtheria, tetanus, and pertussis (whooping cough)vaccine

MMR Measles, mumps, and rubella vaccine

DT Diphtheria / tetanus booster


BCG Vaccine Against TuberculosisThe Bacille Calmette-Guérin (BCG) vaccine is used to immunise againsttuberculosis (TB) infection. TB is a contagious (disease spread by contact)infection that commonly affects the lungs. People with active TB oftencontaminate the air with bacteria when they cough or sneeze. These bacteria canstay in the air for several hours. If another person breathes the bacteria in, theymay become infected. TB kills about 3 million people worldwide, every year.

SymptomsCoughing, night sweats and generally feeling unwell, with decreased energyand appetite are the most common symptoms.

Why vaccinate?TB is a leading infectious case of deaths in adults, killing about 1.5 millionpeople every year. The BCG vaccination (given to prevent TB) is given tomore than 80% of the world’s children.

ChickenpoxChickenpox (varicella) is a common, contagious viral infection. In otherwisehealthy children, it is usually a relatively minor illness. For the first couple ofdays, your child will feel ill and have fever, loss of appetite, headache, andfatigue. Then a rash of red, pimple-like spots will appear. A child may have asfew as 30 spots, but usually there are hundreds. The rash may cover the child’sentire body, including the throat, mouth, ears, groin, and scalp. The spotsturn into clear blisters that become cloudy, break open, and crust over. Therash itches a lot. Spots continue to appear for 1 to 5 days and subside over 1to 2 weeks.

Chickenpox is very contagious. After exposure to the chickenpox virus,symptoms usually appear in 14 to 16 days before the rash appears and lastsuntil all the spots have crusted over. Children can usually return to school orday care after the sixth day of the rash as long as any blisters that have notcrusted over are covered with clothing. Encephalitis is a rare but dangerouscomplication of chickenpox.

80


PreventionThe chickenpox vaccine can be given to children age 12 months and olderand to teens and adults who have not had the illness. It is especiallyimportant to immunise teens and adults who have not had chickenpox,because the disease is more severe in adulthood. Adults who have not beenvaccinated and who have not had chickenpox should avoid exposure tochildren who have it and avoid exposure to people who have shingles.Pregnant women who have never had chickenpox and have not beenvaccinated should also avoid exposure, because the illness can harm thedeveloping foetus. The vaccine cannot be given during pregnancy.

Home Treatment• Use paracetamol to relieve fever if your child is uncomfortable or has a

very high or rapidly rising temperature. Do notgive aspirin to anyone younger than 20 whomay have chickenpox, because aspirin useis related to Reye’s syndrome.

• Control itching. Oral antihistamine andwarm baths with baking soda added tothe water will help. Avoid antihistaminecreams because it is difficult to controlthe dosage when the medicine isapplied to the skin.

• Cut your child’s fingernails to preventscratching. If scabs are scratched off tooearly, the sores may become infected.

• Apply calamine lotion to help soothethe itching skin.

When to Seek Healthcare• If the child is at risk for complications

from chickenpox because he or sheis taking steroid medications, isreceiving cancer chemotherapy,

81


or has a weakened immune system.• If a child age 3 months to 3 years has a fever of 38◦C or higher for 24

hours.• If severe itching cannot be controlled with home treatment.• If bruising appears without injury.• If sores appear in a child’s eyes.• If you notice signs of encephalitis:• Fever, severe headache, and stiff neck• Unusual sleepiness of lethargy• Persistent vomiting• If a teenager or adult gets chickenpox.

Diphtheria, Tetanus and Pertussis (DTP)Diseases like diphtheria and pertussis caused many deaths before a vaccinewas developed to prevent them. This vaccine also protects against tetanus(“lockjaw), which can result from bacterial infection of a deep cut or puncturewound. Childhood immunisations for these diseases consist of a series of fourinjections given at age 6 weeks, 10 weeks, 14 weeks, and 18 months. The firstDT (tetanus and diphtheria) booster is given at age 5 years. After that, a DTbooster is recommended every 10 years. Diphtheria is a contagious, sometimesfatal infection of the upper respiratory tract. The bacteria that cause diphtheriaare usually spread in droplets of moisture coughed into the air. Symptomsinclude: sore throat, chills, general feeling of illness and fever. The lymph nodesin the neck may swell.

Why vaccinate?Diphtheria is readily preventable by means of vaccination. In children youngerthan 5 who are not vaccinated, the mortality rate can be as high as 20%.

Tetanus (“Lockjaw”)Tetanus results from a toxin produced by the anaerobic bacteria Clostridiumtetani. The toxin makes muscles become rigid and contract involuntarily.Tetanus bacteria may enter the body through wounds contaminated with soilor faeces and skin punctures.

82


SymptomsTetanus in children starts with headache, jaw cramping, and muscle spasms(sudden, involuntary muscle tightening).It also causes the following:• Painful muscle stiffness all over the body• Trouble swallowing• Seizures (jerking or staring)• Fever and sweating• High blood pressure and fast heart rate

Tetanus is often called “lockjaw” because the jaw muscles tighten, and theperson cannot open his mouth.

Why vaccinate?Worldwide, about 50% of people who have tetanus die. Preventing tetanus isfar better than treating tetanus. Tetanus rarely develops in people who havecompleted a primary series of tetanus vaccinations and have had vaccinationsevery 10 years as recommended.

Pertussis (Whooping Cough)Whooping cough—or pertussis—is a very seriousrespiratory (in the lungs and breathing tubes) infectioncaused by the pertussis bacteria. It causes violentcoughing you can’t stop. Whooping cough is mostharmful for young babies and can be deadly.

SymptomsWhooping cough starts with the following symptoms:• Runny or stuffed-up nose• Sneezing• Mild cough• A pause in breathing in

infants (apnea)

83


After 1 to 2 weeks, coughing, which can be severe, starts. Children andbabies may then begin to develop these more serious problems:• Coughing very hard, over and over.• Gasping for breath after a coughing fit. They may make a “whooping”

sound. This sound is where the name “whooping cough” comes from.Babies may not cough or make this sound—they may gag and gasp.

• Difficulty breathing, eating, drinking, or sleeping because of coughingfits. These coughing fits happen more at night.

• Turning blue while coughing from lack of oxygen.• Vomiting after coughing fits.

Coughing fits can last for 10 weeks, and sometimes happen again the nexttime the child has a respiratory illness.

Why vaccinate?Complications of pertussis can include pneumonia, ear infections and in rareinstances brain damage. Active immunisation is part of the standardchildhood vaccination schedule.

Haemophilus Influenzae Type B (Hib)Hib disease is a serious illness caused by the bacteria Haemophilus influenzaetype b. Babies and children younger than 5 years old are most at risk for Hibdisease. It can cause lifelong disability and be deadly. Hib spreads when aninfected person coughs or sneezes. Usually, the Hib bacteria stay in a person’snose and throat and do not cause illness. But if the bacteria spread into thelungs or blood, the person will get very sick.

SymptomsHib disease causes different symptoms depending on which part of the bodyit affects.

The most common type of Hib disease is meningitis. This is an infection ofthe covering of the brain and spinal cord. It causes the following:• Fever and headache• Confusion

84


• Stiff neck• Pain from bright lights• Poor eating and drinking, low alertness, and vomiting (in babies)

Hib disease can also cause the following:• Throat swelling that makes it hard to breathe• Joint infection• Skin infection• Pneumonia (lung infection)• Bone infection

Why vaccinate?Vaccines are available for children older than 6 weeks of age in South Africaand have decreased the incidence of serious infection by 99%. All childrenshould be immunised against Hib.

Hepatitis A Virus (HAV)Hepatitis A is a serious liver disease caused by the hepatitis A virus. Children withthe virus often don’t have symptoms, but they often pass the disease to others,including their unvaccinated parents or caregivers. Hepatitis A virus is found inthe stool of a person who has the virus. It spreads when a person puts somethingin his or her mouth that has the hepatitis A virus on it. Even if the item looksclean, it can still have virus from stool on it that can spread to others. The amountof virus can be so tiny that it cannot be seenwith the naked eye. You can get it bytouching objects such as doorknobsor diapers or eating food that hasthe virus on it. These individualscan get very sick.

SymptomsChildren under 6 years old oftenhave no symptoms. Olderchildren and adults feel very sick

85


and weak. Symptoms usually appear 2 to 6 weeks after a person gets thevirus. The symptoms may include the following:• Fever• Loss of appetite (not wanting to eat)• Tiredness• Stomach pain• Vomiting• Dark urine• Yellow skin and eyes

Hepatitis B Virus (HBV)Hepatitis B is generally more serious than hepatitis A and is occasionally fatal.It’s hard to imagine putting your newborn through the pain of a shot. But alittle stick early in life is an important first step to protecting your baby againsta deadly disease. All babies should get the first shot of hepatitis B vaccinebefore they leave the hospital. This shot acts as a safety net, reducing the riskof getting the disease from moms or family members who may not know theyare infected with hepatitis B.

When a mom has hepatitis B, there’s an additional medicine that can helpprotect the baby against hepatitis B, called the hepatitis B immune globulin(HBIG). HBIG gives a baby’s body a "boost" or extra help to fight the virus assoon as he is born. This shot works best when the baby gets it within the first12 hours of his life. The baby will also need to complete the full hepatitis Bvaccination series for best protection.

86


Babies and children can get hepatitis B in the following ways:• At birth from their infected mother• Being bitten by an infected person• By touching open cuts or sores of an infected person• Through sharing toothbrushes or other personal items used by an

infected person• From food that was chewed (for a baby) by an infected person

Symptoms Infants and young children usually show no symptoms. But, in about 7 out of10 older children and adults, hepatitis B infection causes the following:• Loss of appetite (not wanting to eat)• Fever• Tiredness• Pain in muscles, joints, and stomach• Nausea, diarrhea, and vomiting• Dark urine• Yellow skin and eyesThese symptoms usually appear 3 or 4 months after being exposed to thevirus.

Measles, Mumps, and Rubella (MMR)Measles (rubeola), mumps, and rubella (German measles) were once commonchildhood illnesses. Today they are quite rare, thanks to the MMR vaccine. Afirst dose of measles-only vaccine is given at 9 months. The first MMRinjection may be given at age 15 months, but it is not a requirement. At 18months of age, a child must be given either a second dose of the measles-only vaccine or an MMR injection.

If there is a measles outbreak in your area and your baby has not beenimmunised, call your healthcare provider or visit your local clinic to discuss anearly MMR injection. Women who are planning to get pregnant need to makesure they have been vaccinated. Rubella contracted during pregnancy,especially during the first few months, increases the risk of miscarriage,

87


stillbirth, and severe birth defects. Measles is a highly contagious viralinfection that is most common in children. It is spread mainly by airbornedroplets of moisture coughed out by an infected person, or by touchingitems contaminated by such droplets. It is contagious for several days beforeand after the rash develops.

SymptomsThe infected child first develops a fever, runny nose, hacking cough and redeyes. Tiny white spots appear inside the mouth followed by a sore throat. Amildly itchy rash appears 3 to 5 days after the start of symptoms. Startingaround the ears and spreading to the trunk, arms, and legs, the rash starts offas flat red areas that soon become raised. The child may develop a very hightemperature (40◦C).

Home TreatmentThere is no specific medical treatment for measles. To help managesymptoms, which usually last for about 2 weeks, give your child plenty offluids and encourage extra rest. If a fever is making your child uncomfortable,you can give a non-aspirin fever medicine, such as acetaminophen oribuprofen.

Kids with measles should have their condition closely monitored by ahealthcare provider. In some cases, measles can lead to other complications,such as otitis media, croup, diarrhea, pneumonia, and encephalitis, whichmay require antibiotics or hospitalisation. Children with measles should bequarantined for 4 days after their rash appears. If they have a weakenedimmune system, they should stay in isolation until they make a full recoveryand all symptoms are gone.

When to Seek HealthcareCall the healthcare provider immediately if you suspect that your child hasmeasles. Also, it's important to get medical care after measles exposure,especially if your child:• is an infant

88


• is taking medicines that suppress the immune system has tuberculosis,cancer, or a disease that affects the immune system

Why vaccinate?Worldwide, measles infects about 20 million people annually, causing about 200000 deaths, primarily in children. Complications can be severe and includepneumonia, encephalitis (infection of the brain) and middle ear infections.

Mumps is a disease caused by a virus that usually spreads through saliva(spit). It can infect many parts of the body, especially the parotid salivaryglands. These glands, which make saliva for the mouth, are found toward theback of each cheek, in the area between the ear and jaw. In cases of mumps,these glands typically swell and become painful.

SymptomsCases of mumps may start with a fever of up to 39.4°C, as well as a headacheand loss of appetite. The well-known hallmark of mumps is swelling and painin the parotid glands — a child might look like a hamster with food in its

89


cheeks. The glands usually become increasingly swollen and painful over aperiod of 1-3 days. The pain gets worse when the child swallows, talks, chews,or drinks acidic juices (like orange juice). Both the left and right parotidglands may be affected, with one side swelling a few days before the other, oronly one side may swell. In rare cases, mumps will attack other groups ofsalivary glands instead of the parotids. If this happens, swelling may benoticed under the tongue, under the jaw, or all the way down to the front ofthe chest. Mumps can lead to inflammation and swelling of the brain andother organs, although this is not common. Encephalitis (inflammation of thebrain) and meningitis (inflammation of the lining of the brain and spinal cord)are both rare complications of mumps. Symptoms appear in the first weekafter the parotid glands begin to swell and may include: high fever, stiff neck,headache, nausea and vomiting, drowsiness, convulsions, and other signs ofbrain involvement.

Home TreatmentIf you think that your child has mumps, call your healthcare provider, who canconfirm the diagnosis and work with you to monitor your child and watch forcomplications. Because mumps is caused by a virus, it cannot be treated withantibiotics. At home, monitor and keep track of your child's temperature. Youcan use non-aspirin fever medications such as acetaminophen or ibuprofen tobring down a fever. These medicines will also help relieve pain in the swollenparotid glands. Aspirin should not be used in children with viral illnessesbecause its use in such cases has been associated with the development ofReye syndrome, which can lead to liver failure and death.

Serve a soft, bland diet that does not require a lot of chewing, and encourageyour child to drink plenty of fluids. Avoid serving tart or acidic fruit juices (likeorange juice, grapefruit juice, or lemonade) that make parotid pain worse.Water, decaffeinated soft drinks, and tea are better tolerated. When mumpsinvolves the testicles, the doctor may prescribe stronger medications for painand swelling. A child with mumps doesn't need to stay in bed, but may playquietly. Ask your healthcare provider about the best time for your child toreturn to school.

90


When to Seek HealthcareCall the healthcare provider if you suspect that your child was exposed tosomebody with mumps. Because mumps can also involve the brain and itsmembranes, call the healthcare provider immediately if your child wasdiagnosed with mumps and has any of these symptoms: stiff neck,convulsions (seizures), extreme drowsiness, severe headache, or changes ofconsciousness. Watch for abdominal pain that can mean involvement of thepancreas in either boys or girls or involvement of the ovaries in girls. In boys,watch for high fever with pain and swelling of the testicles.

Rubella— commonly known as German measles or 3-day measles — is aninfection that mostly affects the skin and lymph nodes. It is caused by the rubellavirus (not the same virus that causes measles). Rubella spreads when peoplebreathe in virus-infected fluid, such as the droplets sprayed into the air when aperson with rubella sneezes or coughs, or share food or drink with someonewho's infected. It also can pass through a pregnant woman's bloodstream toinfect her unborn child. It's a generally mild disease in children; the primarymedical danger of rubella is the infection of pregnant women because it cancause congenital rubella syndrome in developing babies.

SymptomsIn children, rubella usually causes thefollowing symptoms that last 2 or 3 days:• Rash that starts on the face and

spreads to the rest of the body whichis often the first sign of illness that aparent notices. The rash can itch andlasts up to 3 days. As the rash clears,the affected skin might shed in veryfine flakes.

91


• Low fever (37.2-37.8°C) Before the rash appears, older children and adults may also have:• Swollen glands usually in the back of the neck or behind the ears• Cold-like symptoms• Aching joints (especially in young women)

About half of the people who get rubella do not have symptoms. Rubella in apregnant woman can cause congenital rubella syndrome, with potentiallydevastating consequences for the developing fetus. Children who areinfected with rubella before birth are at risk for growth problems; intellectualdisability; defects of the heart and eyes; deafness; and liver, spleen, and bonemarrow problems.

The rubella vaccine should not be given to pregnant women or to a womanwho may become pregnant within 1 month of receiving the vaccine. If you arethinking about becoming pregnant, make sure that you're immune to rubellathrough a blood test or proof of immunisation. If you're not immune, youshould receive the vaccine at least 1 month before you become pregnant.Pregnant women who are not immune should avoid anyone who has theillness and should be vaccinated after delivery so that they will be immuneduring any future pregnancies.

Home TreatmentRubella cannot be treated with antibiotics because they do not work againstviral infections. Unless there are complications, rubella will get better on itsown. Any pregnant woman who has been exposed to rubella should contacther obstetrician immediately. Rubella usually is mild in kids, who often can becared for at home. Monitor your child's temperature and call the healthcareprovider if the fever climbs too high. To ease minor discomfort, you can giveyour child acetaminophen or ibuprofen.

When to Seek HealthcareCall your healthcare provider if your child appears to be getting sicker thanthe mild course of symptoms described above.

92


Pneumococcal InfectionPneumococcal disease is an illness caused by bacteria called pneumococcus.It is often mild but can cause serious symptoms, lifelong disability, or death.Children younger than 2 years of age are among those most at risk for thedisease. Pneumococcal disease spreads when an infected person coughs orsneezes. Some children may not even feel sick, but they could have thebacteria in their noses and throats. These children can still spreadpneumococcal disease.

SymptomsThere are many types of pneumococcal disease. Symptoms depend on thepart of the body that is infected.Pneumococcal pneumonia (lung infection) is the most common serious form.It causes the following:• Fever and chills• Cough• Rapid breathing or difficulty breathing• Chest pain

93


Pneumococcal meningitis is an infection of the covering of the brainand spinal cord. It causes the following:• Stiff neck• Fever and headache• Increased pain from bright lights• Confusion

In babies, meningitis may cause poor eating and drinking, lowalertness, and vomiting. Blood infection (bacteremia and sepsis)causes fever, chills, and low alertness. Pneumococcal disease causesup to half of middle ear infections (otitis media). Symptoms are earpain, a red, swollen ear drum, and sometimes, fever and sleepiness.

Why vaccinate?Pneumococcal vaccines help protect against bacterial infectionssuch as ear infections, sinusitis, pneumonia and meningitis.

Poliomyelitis (Polio)Polio is a highly contagious, viral infection that affects nerves andcan produce permanent muscle weakness, paralysis andsometimes death. Polio is caused by a virus and is spread bydigesting contaminated material. The first dose of vaccine isgiven at birth, and the immunisation series gives lifelongprotection (immunity). Although the acute illness usually lasts lessthan 2 weeks, damage to the nerves could last a lifetime.

SymptomsIn the majority of polio infections there will be no symptoms. Ofthe infected people with symptoms, most will have mildsymptoms including fever, headache, sore throat and vomiting.

Why vaccinate?Extensive vaccination has almost eradicated polio in developedcountries. However, cases still occur in regions with incomplete

94


vaccination such as sub-Saharan Africa and Southern Asia. The injectablepolio vaccine given during childhood produces protection in more than 95%of recipients.

Rotavirus GastroenteritisRotavirus is one of the most common causes of diarrhoea in children andspreads quickly and easily. Rotavirus infects nearly every child before their 5thbirthday. Diarrhoea from rotavirus can quickly lead to dehydration.Dehydration can result in hospitalisation and even death for children who donot receive treatment in time.

SymptomsSymptoms begin with fever, stomach pain and vomiting, followed by waterydiarrhoea, which typically lasts 5 to 7 days. If fluid losses are not replaced,dehydration develops. This makes the child weak and listless.

Home TreatmentThe most important thing is for you to keep your baby or child hydrated. It isrecommended that parents give Oral Rehydration Solution (ORS) to babiesand young children with gastro. It can be useful to have some at home so thatyou can start using the best treatment for gastro as soon as possible.

When to Seek HealthcareIf the child has diarrhoea and is not drinking, see a healthcare provider assoon as possible to check for dehydration and to decide if the child needsother treatment. If a baby is vomiting and/or has diarrhoea or a child is veryunwell (eg high fever, drowsy, not interested in anything) see the healthcareprovider as soon as possible.

Why vaccinate?In South Africa approximately 6 children die every day from severe rotavirus.Worldwide, approximately 600 000 children die each year from rotavirus.Rotavirus vaccination is now available at your local clinic for all infants olderthan six weeks and younger than 24 weeks of age.

95


Child safety and trainingChild Car SeatsInfant and child car seats save lives. They are recommended for all children underage 4 and those weighing less than 18kg. Children who are not in car seats canbe seriously injured or killed during crashes or even by abrupt stops at lowspeeds. For maximum safety, follow the manufacturer’s recommendations for carseat use.

All children under age 12 should be in the backseat, especially if the car has airbags. Infants under 9 kg, regardless of age: Use an infant car seat that reclinesand faces the rear. Infants younger than 1 year, regardless of weight: Use andinfant car seat that reclines and faces the rear.

Children over 9 kg and older than 1 year: Use atoddler seat that faces the front of the carand has a shield or harness. Someinfant seats can be converted totoddler seats.

Children over 18 kg and over age 4:Use a booster seat that raises the childso that the regular lap and shoulderbelts fit properly. Adjust the shoulderbelt to fit across the shoulder,not the neck. Use thebooster seat until yourchild is big enough to usethe seat belt properly.

Set a good example foryour children by always wearingyour own seat belt, and alwaysinsist that they buckle up.

96


Bed-WettingBed-wetting (enuresis) in children who have never been dry is common, but mostchildren will outgrow it by age 5 or 6. In almost all cases, bed-wetting is really nota disease, but rather a normal variation in development.

In some cases, a child who has been dry for several months or longer may start towet the bed again. This can happen without a clear cause, or it may be caused bya urinary tract infection or emotional problems.

Home TreatmentThere are a number of ways to deal with bed-wetting. Ask your healthcareprovider for advice in managing bed-wetting until your child outgrows it.• Do not punish, embarrass, or blame your child. Praise and reward your child

for dry nights.• Have your child empty his or her bladder before bed.• Remind the child to get up during the night to urinate. Providing a bedside

potty chair and night-light may help.• Do not force your child to wear nappies at night. Try waterproof, extra-

absorbent underwear instead. A thick pad or a vinyl mattress cover willprotect the mattress.

• Encourage the child to take responsibility for changing his or her clothesafter wetting, for putting a dry towel down on the bed, and for helping washthe bed linens.

• Add 120 ml (1/2 cup) vinegar to the wash water to eliminate odour inclothing and bedding.

When to Seek HealthcareYour healthcare provider can rule out or treat any physical causes of bed-wettingand help you and your child manage the problem. Call your healthcare provider:• If bed-wetting occurs with pain or burning during urination or other signs of

a urinary tract infection.• If bed-wetting occurs in a child older than 6 years, and home treatment is

not successful after 4 to 5 weeks.• If bed-wetting becomes more frequent or severe despite home treatment.

97


• If bed-wetting occurs in a child who had previously been dry for severalmonths.

• If a child age 4 or older is wetting the bed and leaking stool.• If a child over age 3 has daytime bladder control problems after having been

toilet-trained.

Toilet TrainingEvery child has a unique timetable for becoming toilet-trained. Most children areready to begin toilet training between 24 and 30 months of age. Your child maybe ready if he or she:• Passes stools at about the same time each day.• Is able to have a dry nappy for at least 2 hours at a time during the day.• Makes certain facial expressions when urinating or passing stools.• Let’s you know when a nappy is dirty and asks to have it changed.• Seems eager to please and can follow simple instructions.• Tells you that he or she wants to use the toilet or wear adult underwear.

If you think you child is ready to begin toilet training, the following tips may makeit go more smoothly:• Get your child a potty chair. Let the child get used to using the chair by

having him or her sit on it with a nappy on when he or she is passing stoolsor urinating.

• Let your child watch you or a sibling of the same sex use the toilet. Talk withyour child about what you are doing.

• Select clothing for your child that is easy to take off. Clothes with elasticwaistbands or easy-to-open fasteners work best. Pull-on nappies are alsohelpful.

• Reward every success with hugs and words of praise. Accidental wetting andsoiling are common in the first few weeks, but don’t scold or punish yourchild when they happen. Keep a casual attitude.

Bladder control may take longer than bowel control. If the child is aware of whenhis or her bladder is full, try putting the child on the potty chair every 30 to 60minutes. Praise the child for success and give gentle encouragement when thechild wets his or her pants.

98


The most important part of this journey of life is to enjoy your baby to the fullest.We, as the Platinum Health medical team are available to support and assist youin any way we can.

If you need any assistance, kindly contact:Client Liaison Rustenburg RegionClient Liaison Call Centre

014 591 6600 / 080 000 6942Client Liaison Supervisor083 791 1345Client Liaison Officers083 842 0195 / 060 577 2303 /060 571 6895

Thabazimbi RegionClient Liaison Supervisor081 037 2977Client Liaison Officer083 795 5981 / 083 719 1040

Eastern Limb RegionClient Liaison Supervisor083 414 6573Client Liaison Officers083 455 7138 / 060 571 0870

Case Management014 591 6600 or 080 000 6942

After-hours emergency082 800 8727

99


Pregnancy Awareness - Platinum Health

Documents

Transcript of Pregnancy Awareness - Platinum Health