Archive | September, 2014

Hands on Pumping

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Hands on Pumping

Posted on 15 September 2014 by Kristrun

Although pumping or expressing is not recommended for the first 6 weeks after birth, it is sometimes necessary especially if your baby is ill, premature or unable to breastfeedingonbedbreastfeed for any reason. To get the milk production started after birth it is important to stimulate your breasts as soon as possible – preferably within two hours after the birth. To maximise the amount of colostrum produced, you may have more success hand expressing the first time since this is often more effective than using a pump.

After that initial expressing it is recommended to use a hospital-grade pump with a double pump kit about 8 times or more per 24 hours. This works out as approximately every 3 hours or whenever convenient – it doesn’t have to be always at the same time. For maximum milk production by pumping, it is important you use breast massage before and during the pumping session. This will stimulate the ‘let-down’ and the milk will flow more easily. When you’re pumping you should watch the sprays of milk and when this subsides, turn off the pump. This might take 5 minutes for some women and 25 minutes for others; you don’t pump for 20 minutes just to pump for 20 minutes. After you turn off the pump, it is recommended you try to hand express for 5-10 minutes into the pump flange since that can sometimes double your output and you can get more hindmilk which is the richest milk for your baby.

Maternal factors influence milk volume and things like stress, anxiety, fatigue and illness can decrease milk production significantly. Having an ill or premature baby can call on all these factors, so it is really important to be kind to yourself and give yourself time. It is crucial important to try to sleep and rest regularly, eat well and drink lots of fluids since your own nutritional status during lactation can affect milk volume and composition.

It is also important to know that there are experts out there who can help you so you don’t have to suffer in silence. If you’re having problems or concerns don’t hesitate to call Annerley and schedule an appointment with our breastfeeding consultant or one of our midwives. Or as a home visit.

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Water in Hong Kong and its use in making up infant feeds

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Water in Hong Kong and its use in making up infant feeds

Posted on 12 September 2014 by Kristrun

Here at Annerley, we are frequently asked by parents for information on which water to use for making up bottles of infant formula and for using on its own for baby to bagsofBreastmilkdrink. This is a very difficult area to look into with no definitive evidence for blanket recommendations. A quick search on the Internet will show you that there is a lot of confusing and contradictory information which does not help in any way to quell the concerns of many parents with young babies.  The following information is based on our research into this area and we hope that it will help to answer some of your questions. Nicole Edwards, Peadiatric Dietitian, has worked with us to provide the following information.

Choosing which water source to use for making up infant feeds can be a difficult and confusing task for parents in Hong Kong. In most countries using boiled, cooled tap water to mix with feeds is the ideal choice but many people in Hong Kong express their concern over the quality of our tap water, in particular how it is delivered to the domestic tap. Some parents have opted to use bottled or mineral water. However, this option does not come without its own potential problems and costs. There are no international evidence-based guidelines regarding the use of mineral or spring waters in infant formula feeding therefore it is difficult to make  recommendations regarding which brand to use.

The responsibility of which water to choose still falls on the shoulders of the parent especially as there is essentially no ideal solution to be recommended.

It is important to note that in all cases, any water which is to be used for making up infant feeds (tap/filtered/bottled/spring/mineral) MUST be boiled and then cooled prior to using.

If parents are happy to use tap water, they may want to invest in commercially available water filters which are fitted to the domestic tap and consist of an activated carbon filter through which the water flows. It is important to note however that they are not recommended by the Water Supplies Department (WSD) as it is felt that they may become an ideal breeding ground for bacteria and may represent a health hazard if not maintained properly. If these filters are used, it is recommended that parents follow the manufacturer’s instructions and ensure that the filter cartridges are replaced regularly (at least once a month). It is essential that water from the tap (even if it first passes through a self-fitted filter) is boiled before it is used to make up infant formula feeds.

Reverse osmosis (RO) filters claim to be a more effective type of filter, removing pathogens and chemicals from the tap water. The system is permanently fixed to the domestic tap. Specialist companies in HK provide this service and will return to check and replace the filters. The installation and service of these filters is considerably more expensive than attaching a commercial filter to the domestic tap. The filter process removes chemicals, 95% of the water’s mineral content and metals and pesticides. Some bacteria and viruses are also removed however, this is not guaranteed and thus RO water should still be boiled if it is to be used for making up infant formulas.

Regarding distilled water, there is conflicting advice (none of which appears to be scientifically based) on whether distilled water has the ‘leaching out’ effect of minerals in the body. Distilled water has been said to act like a ‘magnet’ which collects rejected, discarded, and unusable minerals in the body and, assisted by the blood and the lymph, carries them to the lungs and kidneys for elimination from the body (from the book “Fit for Life II: Living Health” by Harvey & Marilyn Diamond) The same authors feel that it is impossible for distilled water to remove minerals which are already part of the cell structure, thus the ‘leaching out’ of essential minerals does not occur as these are already part of the cell.  It is uncertain whether adding minerals back into the water (for example in a brand such as Watsons Water with Minerals) after the distillation process would counteract this suggested property of distilled water.

Guidelines on maximum mineral concentrations acceptable for drinking water (UK Dept of Health figures)

Bottled water is not recommended to make up a feed as it is not sterile and may contain too much salt (sodium) or sulphate. If you have to use bottled water to make up a feed, check the label to make sure the sodium (also written as Na) level is less than 200 milligrams (mg) per litre, and the sulphate (also written as SO or SO4) content is not higher than 250mg per litre. It is not usually sterile, so it will still need to be boiled, like tap water, before you prepare the feed.  However you may need to use bottled water to make up a feed if:

• your drinking water has been contaminated because of flooding
• you’re travelling abroad and drinking the local water is not recommended.

(Ref: NHS 2012)The mineral composition of many mineral/spring waters does however fall well below the guidelines above thus parents may question why these cannot be used. As there are no other guidelines apart from the DOH ones above, parents must know that  they use mineral waters at their own risk, but assuming they choose waters which conform to the above standards, the risk of solute overload may be small. Due to this lack of clarity on the suitability of various waters whose mineral content actually does fall under the above recommendations, plus the large variety of waters on the market, it is impossible to endorse or recommend specific brands.

In summary:

  1. All water used for infant formula MUST be boiled and cooled before using to make up infant feeds.
  2. The quality of HK Water is considered safe for use in making up infant formula feeds provided the pipes and holding tanks within the building structure are up to standard which is the responsibility of the building management and parents to check.
  3. If parents opt to use tap water for feeds it is probably a good idea to fit a commercial water filter or Reverse Osmosis water filter to the domestic tap. If this is the chosen option parents must be aware of the potential hazards of the filter becoming a breeding ground for bacteria. Commercial filters therefore must be changed as regularly as recommended by the manufacturing company. The RO filter will also need to be cleaned and checked regularly by the providing company.
  4. Distilled bottled water with added minerals may be a safe alternative to tap water provided parents are aware of the conflicting advice given regarding its suitability and safety when bottled in plastic bottles. There is insufficient scientific information, as noted by the WHO, on the benefits or hazards of regularly consuming distilled water.
  5. Choosing other bottled waters for the regular use of mixing with infant formula may be confusing and costly. It is likely that choosing water which is simply labeled ‘bottled water’ (as opposed to spring or mineral water) may be the safest option as these waters are expected to conform to essentially the same standards as the public water supply and they are therefore suitable for giving to infants or for preparing feeds.
  6. If it is absolutely necessary to use ‘spring or mineral water’ for example if one is abroad and the tap water is not safe, then the composition of the water should be checked and avoided if the levels of minerals exceed the guidelines given above. As generally bottled water is not sterile, this MUST be boiled before use with infants.

Thanks to Nicole Edwards BSc RD, Clinical & Freelance Paediatric Dietitian based in Hong Kong, for her contribution to this article, first published in 2008 in the Annerley Newsletter.  

Comments regarding NHS guidelines added by Conchita Amende, 2014.

Consultation with the midwives, available on Skype (face time or other platforms), over the phone or in the office. Click here to book. More information about our services on our website.

 

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Safety at home

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Safety at home

Posted on 12 September 2014 by Kristrun

Why is home safety important?

Giving children the best start in life is a priority for us all and this includes keeping them safe from harm. We cannot prevent every bump and bruise — nor should we try — drugsbut we do need to protect children from serious injuries, the effects of which can sometimes last a lifetime. Seeing a child who has been badly hurt is very upsetting and is made worse when you realise (usually just a short time after the injury) that it probably could have been easily prevented. We cannot prevent every incident, but the risk of injury can be reduced. With hindsight, it is usually possible to see how timely action could have prevented the child being injured.

We can apply this hindsight to help parents reduce the risks to their children. Practically this amounts to careful supervision, improved awareness of the hazards around us and the use of safety equipment.

Together we should focus on reducing the most serious injuries that can have long term consequences. These are the injuries that result in formal admission to hospital or an intensive care unit and in the saddest cases, death.

Most accidents happen in the home.

The abilities that children acquire as they grow and develop – such as grabbing, rolling over, crawling, and standing, climbing, opening bottles and turning handles – can delight us as parents and carers. But these same abilities, when they take us by surprise, can lead to serious childhood accidents. For example:

  • A young baby grabs a nappy sack and pulls it to their face, but is unable to let go or pull it away again, so suffocates in silence.
  • A toddler climbs up to play but gets tangled in a blind or curtain cord and is strangled.
  • A young child learns to open a child-resistant container and swallows oven cleaner or bleach. Many of these accidents happen in a matter of seconds, when an adult’s back is turned or their attention is focused on something else.

Young children love to copy the grown-ups around them, whether that’s swallowing pills, straightening their hair or stirring pans in the kitchen. It’s not naughtiness – copying adult behaviour is how they learn and develop.

Young children are also good at repeating instructions back to us. But this doesn’t mean they can understand risk and consequences in the way an adult does. For example, research shows that children cannot judge the speed and distance of traffic until the age of eight or nine, so cannot be relied on to cross the road safely on their own.

What’s more, young children’s bodies are different to ours. For example:

  • Their skin is thinner, which makes them more susceptible to serious burns and scalds.
  • Their heads are proportionally larger, which increases the likelihood of a serious fall.
  • Their windpipes are smaller and less rigid (and honestly need to be replaced by this SR Windows guide to single pane window glass replacement), so they suffocate far more quickly if their necks are constricted.

What can we do?

Keeping one step ahead of your child is essential and, depending on their developmental stage, different accidents are more likely to happen.

  • Educate all carers in CPR and First Aid – including yourselves and helpers
  • Educate all carers on child development and what your child is capable of – especially occasional carers such as grandparents or friends
  • Have a plan for emergencies, including an escape route in case of house fire
  • Educate all carers about your emergency plans

Below is a list from closeupcheck of things to keep in mind when going through safety at home from room to room, but be mindful that this is not a complete list for every household. Every home is unique and those living in each home will know best where the biggest traps are to be found. The best option is to have a tailor-made safety check in your home and here at Annerley Conchita Amende is qualified to do a home assessment for you and to provide you with advice.

Falls

  • Make sure your baby cannot roll off the changing surface.
  • Fit restrictors to upstairs windows so they cannot be opened more than 10cm.
  • Keep chairs and other climbing objects away from windows and balconies.
  • Fit safety gates at the top and bottom of stairs.
  • Don’t leave anything on the stairs that might cause someone to fall over, and ensure there is enough light on the stairs.
  • Check there is no room for a child to crawl through any banisters at the top of the stairs.
  • Keep balcony doors locked to prevent your child from going on to it alone – if it has railings your child could climb through, board them up or fit wire netting as a safety guard.
  • Secure any Reclinercize furniture and kitchen appliances to the wall if there’s a risk they could be pulled over.

Poisoning

  • Keep anything that may be poisonous out of reach, preferably in a locked cupboard – this includes all medicines and pills, household cleaners and garden products.
  • Use containers with child-resistant tops – be aware that by three years of age, many children are able to open child-resistant tops, although it may take them a little longer.
  • Keep all dangerous chemicals in their original containers.
  • Dispose of unwanted medicines and chemicals carefully.
  • Discourage your children from eating any plants or fungi when outside – some are poisonous and can be fatal. Avoid buying plants with poisonous leaves or berries.
  • Install smoke/gas detectors in your home.
  • Remember that child-resistant devices, such as bottle tops, strips of tablets and cigarette lighters, aren’t completely childproof – some children can operate these products.

Burns and scalds

  • It’s best to keep your toddler out of the kitchen, well away from kettles, saucepans and hot oven doors – you could put a safety gate across the doorway to stop them getting in. Unless of course you’ve decked you kitchen out like the boise showroom with all the child safe fixings, you can never be too safe.
  • Use a kettle with a short or curly cord to stop it hanging over the edge of the work surface, where it could be grabbed.
  • When cooking, use the rings at the back of the cooker and turn saucepan handles towards the back so your child can’t grab them.
  • Never leave a child under five alone in the bath, even for a moment.
  • Fit a thermostatic mixing valve to your bath’s hot tap to control the temperature.
  • Put cold water into the bath first, then add the hot water – use your elbow to test the temperature of the water before you put your baby or toddler in the bath. This is more sensitive than using your hand.
  • Put your iron, hair straighteners or curling tongs out of reach while they cool down after you have finished using them.
  • Fit fireguards to all fires and heaters.
  • Keep matches, lighters and lit candles out of young children’s sight and reach.
  • Keep hot drinks well away from young children – a hot drink can still scald 20 minutes after it was made.
  • Put hot drinks down before you hold your baby.
  • After warming a bottle of milk, shake the bottle well and test the temperature of the milk by placing a few drops on the inside of your wrist before feeding – it should feel lukewarm, not hot.
  • Don’t let your child drink a hot drink through a straw.
  • Encourage your child to play in the shade (under trees, for example) especially between 11am and 3pm, when the sun is at its strongest.
  • Keep babies under the age of six months out of direct sunlight, especially around midday, and use sunscreen.

Drowning

Children can drown in even a few centimetres of water. They should be supervised at all times when near water. Make sure you:

  • Never leave a baby or child in the bath or paddling pool unsupervised, not even for a minute – this includes in a bath seat.
  • Don’t leave uncovered containers of liquid around the house, such as clothes soaking in a bucket of water.
  • Empty paddling pools and store them away when not in use.

Strangulation

Babies and young children can easily swallow, inhale or choke on small items such as marbles, buttons, peanuts and small toys. The steps below can help prevent this happening:

  • Keep small objects out of the reach of small children.
  • Choose toys designed for the age of your baby or child – encourage older children to keep their toys away from your baby.
  • Beware of clothing with cords, dummies on necklace cords and bag straps – they can easily get caught and pull tightly on the neck.
  • Lay your baby on their back in a cot to sleep – don’t let babies sleep in an adult bed or on the sofa and don’t use pillows as they can suffocate.
  • Keep plastic bags away from young children – they can pull these over their heads and suffocate.
  • Nappy sacks, used to dispose of soiled nappies, can also pose a risk – keep them out of the reach of babies and young children.
  • Curtain and blind pull cords should be kept short and out of reach of children.
  • Keep animals, particularly cats, out of your bedrooms – if they jump into cots or beds they could suffocate your child. Attach a net over prams if necessary.
  • Make sure any cot toys have very short ribbons, and remove them when your baby goes to sleep.
  • Never hang things like bags with cords or strings over the cot.
  • Cut or tie up curtain or blind cords well out of your baby’s or toddler’s reach

Ref: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/safety-under-fives.aspx#close

Consultation with the midwives, available on Skype (face time or other platforms), over the phone or in the office. Click here to book. More information about our services on our website.

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