Tag Archive | "health"

About Grandparents

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About Grandparents

Posted on 07 September 2015 by Kristrun

Most of us were lucky enough to grow up in a loving family and environment.  Most of us have parents that we love and who love us back.  As mentioned in my last blog, parents can be helpful, and also unhelpful, when it comes to the first days with a new baby, partly because when they were raising their children, the environment and advice was very different to now.

It is hard for parents to abandon their beliefs and habits and they do not always understand the way our generation does things as parents – all the access to courses and information, how we research and investigate before we do anything.

In fact, our parents are often of the belief that despite it being great to be able to get support from the internet and our friends, the overflow of the same is only making our lives more confusing and frustrating. Taking away the independence and “get on with it” parenting.

Of course, we all know this and probably agree to a point, but we cannot go back in time.  And to be honest, there are so many things from the past that we are grateful to not have to go through. I am not even going to start the list of comparison.

What I wanted to remind us all of was that grandparents, despite their perhaps different opinions and other difficulties (the typical MIL issue), are not something we should take for granted.

The day will come, and has already come for some, that the grandparents will say goodbye for good. There will be no more remarks or comments, no more unrealistic demands or opinions, no more decisions on how to split the holidays etc. 

And in my opinion, to have grandparents in my children’s lives, is such a treasure.  They add such tremendous value and richness into the lives of those kids – they teach them so much by just being there.  By their manners, their personalities, the way they speak, think, the things they have gone through in life, their way of handling situations, money, travels, how they hold books when they read and how they patiently cut the food for the children.  How they have time, and make time, and quietly teach them without teaching them.

Everything about the grandparents is different and not easily emulated by those of a younger generation.  It is something that comes from living through the times they lived through, growing up amongst larger families and more generations of people under the same roof. Having gone through the times where money, electricity, heat, access to all sorts of products and services was limited, travel was not an option so easily and more and more.

If we grew up in a loving household where our parents were kind to us and did their best, our parents deserve, however annoying they may sometimes be (I mean this in a humorous way), that we treat them with dignity and kindness back. Perhaps they can sometimes just have their way with the kids, without us getting annoyed.  Perhaps it will not do any harm to our children.  And perhaps, we need sometimes to slow down and remember to enjoy all the moments that we have with our own parents too. 

Every year I try and “let go“ of my kids for a few weeks and they grow up in the arms of their grandparents. I try and let them not be guests in the homes of their grandparents, but rather to live with them. I am lucky, as the grandparents have health and the willingness to offer and welcome this.  They get something out of it too, of course.  But it is not something I take for granted. 


Of things in life that my children have, I rate this amongst the highest of all things.


Hulda 2015


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Recommended Immunisations in Hong Kong

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Recommended Immunisations in Hong Kong

Posted on 03 November 2014 by Kristrun

blockforVaccinationsARrticleThere is not much difference between vaccinations in the public health system and the private health system in Hong Kong. A few things to consider are:

The Hong Kong government schedule recommends to give Hep B and BCG at birth. Some parents have a preference to delay those vaccines and then usually the Hep B is given at 1, 2, and 6 months as a part of a combined vaccine with DaPT and HIB (Haemophilus Influenza B).

The BCG (only one dose is needed), is then usually given in the buttock instead of the other option of the upper arm if given by the Government hospital staff.  There is not any obvious reason for this except that many parents feel that the scar will not be visible there as in the arm (the BCG is the only vaccine that always produces a scar, which is usually circular and can be 1 to 2 cms in diameter).  Some doctors claim that there is more risk of an infection by the BCG vaccine, or in the pimple that it gives before the scar is formed (the first three months or so there is a pimple that may burst, with some pus, but then eventually heals) – the infection being caused by rubbing of the diaper on the area, urine, stools etc.  

The HIB part of the 2, 4, and 6 months vaccine is not available in the public health system and therefore if you wish to give this to your child, you must see a private doctor.   For this you will pay a consultation fee and the fee for the vaccine.  Because the HiB can be given as a part of the 5 in 1 mentioned above, many parents then choose to give all of these together, instead of having the DTaP and Polio in the Government clinic, and then HiB in the private clinic, at the same time (2, 4 and 6 months).  It is more expensive to get the full 5 in 1 than it is to just get the HiB but it saves a trip and one injection (the actual needle).  In terms of giving many vaccines at the same time, this is a discussion of a different story, – in developed countries it is considered the safest to give these vaccines and they have been on the market for a long time, so they are not considered unsafe because of heavy metals, interactions, etc.

  • In the past, the Hepatitis B vaccine contained Mercury as a preservative, but nowadays, in Hong Kong, the vaccine used is a Mercury free Hepatitis B (ENGERIX).
  • Both private and government doctors recommend to give the MMR vaccine around 12 to 15 months.    This is the only vaccination given that contains live vaccines, and usually has side effects (the actual symptoms of all three diseases, or at least some fever and usually rashes, around 10 to 14 days after injecting it).
  • It is very important that the child is free of any diseases, colds etc. when being vaccinated, and as some get a little sick and feverish, and it may be a good idea to have some paracetamol on hand, doses depending on age and weight of baby.
  • All vaccines, can cause side effects, but they’re generally mild and short-lived and the benefits outway the risks of severe illness or fatality due to disease.

Below is information about the most common vaccinations in Hong Kong:
The 5-in-1 vaccine, the DTaP/IPV/Hib vaccine, is a single injection which protects against five serious childhood diseases. These five illnesses are diphtheria, tetanus, whooping cough, (pertussis) Polio and Haemophilus influenza type b.  In the government system, this vaccine is a 4 in 1 (without the HIB), as there are not many outbreaks of HIB in Hong Kong, although other countries see a reason to vaccinate against this.  Private clinics in Hong Kong offer this as a 5 in 1, vaccinating against the following diseases:

Diphtheria is a highly contagious bacterial infection that mainly affects the nose and throat. Less commonly, it can also affect the skin. The bacteria spread when an infected person coughs or sneezes and droplets of their saliva enter another person’s mouth or nose.  Diphtheria can lead to potentially life-threatening complications, such as breathing difficulties and problems with the heart and nervous system.

Tetanus is a serious but rare infection caused by bacteria. It usually occurs when a flesh wound becomes contaminated. The symptoms include: Stiffness in jaw muscles usually the first symptom, also known as lockjaw. Muscle spasms and stiffness then spread from jaw into neck and limbs. Other symptoms include high temperature (fever), sweating, rapid heartbeat (tachycardia), and high blood pressure (hypertension).  Muscle spasms in neck can make swallowing difficult (dysphagia). In the most serious cases, severe breathing difficulties could develop. This may lead to suffocation and death.

Whooping cough (pertussis), Whooping cough is a highly contagious bacterial infection of the lungs and airways. The condition usually begins with a persistent dry and irritating cough that progresses to intense bouts of coughing. These are followed by a distinctive ‘whooping’ noise, which is how the condition gets its name.  Other symptoms include a runny nose, raised temperature and vomiting after coughing. The coughing can last for around three months. Whooping cough is caused by a bacterium called Bordetella pertussis, which can be passed from person to person through droplets in the air from coughing and sneezing.

Polio, in the past was very common it caused paralysis and death. Since a polio vaccine was introduced in 1955, the number of polio cases has dramatically reduced. There are now only a few countries in which the condition remains a serious problem.

Haemophilus influenza type B. HiB is a bacterial infection that can cause a number of serious illnesses especially in young children. Many of children who get HiB infections become very ill and need hospital care.  HiB can cause any of the following infections: meningitis (lining of the brain and spinal cord), pneumonia (lungs), pericarditis (lining surrounding the heart), epiglottitis (epiglottis – flap that covers the entrance to your windpipe), septic arthritis (joints) and cellulitis (skin and underlying tissues). Some of these infections can lead to septicaemia (blood poisoning), which can be fatal.

Side-effects of the 5 in 1 vaccine:   
The 5-in-1 vaccine is very safe but some babies do have side effects. Your baby may have any of the following side effects after receiving the 5-in-1 DTaP/Td/IPV infant vaccine.

Very common reactions include:  pain, redness and swelling at the injection site, irritability and increased crying, being off-colour or having a fever.

Common reactions include: loss of appetite, diarrhoea, vomiting,

Rare reactions include:  febrile convulsions (fits) and floppiness.

Pneumococcal infections are caused by the bacterium Streptococcus pneumonia which can lead to pneumonia, septicaemia (blood poisoning) and meningitis.

Side effects of pneumococcal vaccine

Although the pneumococcal vaccination is safe, both the childhood and adult versions of the vaccines can cause mild side effects, including:

a mild fever, redness at the site of the injection, hardness or swelling at the site of the injection

Occasionally, the childhood version of the vaccine may lead to more serious side effects including:

high temperatures sometimes leading to convulsions (febrile seizures)
mild allergic reactions in the form of itching skin rashes
In very rare cases, children and adults can have a serious allergic, anaphylactic reaction and it can cause life-threatening breathing difficulties and collapse. It’s a serious side effect and is very alarming at the time, but it can be completely treated with adrenaline. The doctor or nurse giving the vaccine will have been trained to know how to treat anaphylactic reactions and, provided they receive treatment promptly, children and adults make a complete recovery.

Rotavirusis a highly infectious stomach bug that typically strikes babies and young children, causing an unpleasant bout of diarrhoea, sometimes with vomiting, tummy ache and fever. Most children recover at home within a few days, but nearly one in five will need to see their doctor, and one in 10 of these end up in hospital as a result of complications such as extreme dehydration. A very small number of children die from rotavirus infection each year. The rotavirus vaccine is expected to prevent four out of five cases of vomiting and diarrhoea caused by rotavirus and there could be 70% fewer hospital stays as a result.

Side effects of rotavirus vaccine

Common side effects: restless and irritability, mild diarrhoea
Rare side effects: As with all vaccines, there is a very rare (approximately one in a million) possibility of the rotavirus vaccine causing a severe allergic reaction called anaphylaxis. Anaphylaxis is very serious and a medical emergency, but with prompt treatment most people make a full recovery. All health professionals responsible for giving vaccines should be trained to recognize and treat anaphylaxis. In very rare cases (about two in every hundred thousand babies vaccinated), the rotavirus vaccine can affect the baby’s lower gut and they may develop a rare gut disorder called intussusception. The symptoms of intussusception are tummy ache, vomiting and sometimes passing what looks like redcurrant jelly in their nappy. If this happens, contact your doctor immediately.

The Meningitis group C bacteria, can cause two very serious illnesses: meningitis and septicaemia.  The Men C vaccine does not protect against meningitis caused by other bacteria or by viruses such as meningococcal group B, so it’s important for parents to be aware of the symptoms of meningitis.

Side effects of Meningitis C vaccine

The Men C vaccine has an excellent safety record. The most common reactions tend to be minor and very temporary.   Many children and adults have no side effects at all after having the meningitis C vaccine, and in those that do, any side effects tend to be mild and short-lived.

Common reactions are: swelling, redness and pain around the injection site, mild fever, vomiting and diarrhoea (more common in babies and toddlers), crying, irritability, drowsiness, disrupted sleep and going off food (more common in babies and toddlers), headaches and muscle aches (teenagers and adults).
Rare side effects:  A baby can have an allergic reaction soon after the injection. This may take the form of a rash or itching that affects part or all of their body.
In very rare cases, an anaphylactic reaction – a severe allergic reaction – within a few minutes of the vaccination. This can cause breathing difficulties and collapse. It’s very alarming at the time, but the doctor or nurse giving the vaccine will have been trained to know how to treat these reactions and, provided they receive treatment promptly, children and adults make a complete recovery.  Very rarely, vaccine may trigger dizziness, fever-related seizures, fainting, numbness and a type of muscle weakness called hypotonia.

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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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. Consult Lenser for more.

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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Screen time and Toddlers

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Screen time and Toddlers

Posted on 07 February 2014 by Kristrun

Most of us are guilty of using Peppa Pig or Thomas the Tank Engine as a pseudo baby sitter. Or these fantastic apps that can keep little ones occupied for indefinite periods. I’m putting up my hand, here – I use screens in my house to buy peace and quiet, some quality time for me and often just that one email or a cup of coffee. I do it despite knowing that when I remove the screen, they will cry, there will be a fight and they will beg for “just one more”. It’s amazing how addictive this screen is to these little creatures and how difficult it can be to balance screen-time and non-screen-time. The very fact that this term “screen-time” has so quickly become a part of our vocabulary is alarming in itself.

How much screen time is safe?

Research has suggested that if you introduce the screen too early, language development may be affected. Some even say that the child can be six times more likely to develop speech problems. Teachers and early childhood educators know that a child’s vocabulary can vary greatly from one child to another, and that can often be linked directly to screen time versus oral interaction with real human beings. People ultimately do not learn language from a TV. Expression, emotion, tone, pitch, and the myriad of subtleties linked with any language comes from human interaction. I recommend less than 1 hour total screen time per day per child from the age of 1-5. None, or as little as possible, for babies younger than 12 months of age.

Screen time and Sleep

We know that screen time close to bedtime will affect sleep. The lights from the screens – especially screens that are kept very close to little faces will have an impact on their sleeping patterns. Try to balance the routine around bedtime so that watching anything on screen is kept as far from the actual sleeping time as possible. Easy way to do it is to use the screens to quiet things down, then switch off, play quietly, have dinner, then bath, read a book and go to sleep.

Screens and meals

As tempting as it may be, we all know it is not a good habit to allow children to be in front of the screen when having a meal. It can affect the amount of food they consume and their overall eating habits. They may eat like robots and completely out of balance with their appetite. Children want to copy everything adults do – including eating. If you have fussy eaters or children not interested in meal times, the best advice is to eat with your children or have your helper eat with them, if it is impossible for you to do so. This will help in making them interested and engaged during feeding times. Eating should be a social time, and it is never too early to instill this association.

Stick with what works

Some will argue that there are many educational apps and TV programs that can be very good for children. That may be right – there are certain programs that are very well designed and can stimulate and teach children all manner of things. But children learn far more from interaction with you, or others around them. Focus on labelling your surroundings – talk about size, shapes, colours, emotions, distances etc. Also focusing on stimulating their senses by allowing them to touch and feel their environment, and make an effort to have them exposed to soil, sand, grass, stones, pebbles – as many different environments as you can. This varying stimulus is so important to a baby’s development. Good old fashioned books, nursery rhymes and songs, always work. One of the biggest problems society will face in the future will be children who have severe problems socializing and they will be hiding behind their computer screens, unable to cope with the world around them in all its unpredictable, messy, disordered, wonderful glory. By focusing on communication, verbal interaction and stimulation, we will help build a foundation for life.

Bear all of this in mind whilst being realistic. Sometimes the screen is a lifesaver for everyone. When travelling with my children in the double buggy- the small screens makes us capable of doing these long haul flights with layovers. And when they are sick – it completely saves everything to have Peppa Pig with us to shorten the day. But let’s make it an exception, rather than a rule. A treat, rather than the norm. A conversation with Mummy or Daddy beats Peppa Pig, hands down, every time.

Kristrun Lind – Mother of two toddlers

B.Ed, M.Ed. (Iceland, HK), C.E.C.E. (HK)


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Childhood Fevers: Paracetamol and Ibuprofen

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Childhood Fevers: Paracetamol and Ibuprofen

Posted on 07 February 2014 by Kristrun

Remember that a fever is a symptom, not an illness in itself. It is the body’s way of creating an unfavourable environment for a viral or bacterial infection. Pathogens do not do well in elevated temperatures so it is a way of “fighting” the infection. So, if your child is not uncomfortable or in pain, it may be that you can leave the fever to do its work without intervention.

Relief can be given by keeping your child cool, removing clothing if necessary and making sure they stay well hydrated with sips of fluids. Do not wrap them up or use cold sponges.

However, if you are alarmed by an increasing high fever, or your child is in pain, you can give infant paracetamol or ibuprofen (although we do not recommend any medication under the age of three months). Always see a doctor if you are worried in any way or you suspect the fever is a symptom of a more serious illness. See here for more tips and advice on childhood fevers.

Infant Paracetamol can be used for pain relief and to help reduce temperatures. It comes in variety of forms including liquid medicine, chewable tablets and regular pills. It is sold widely without prescription as Calpol, Disprol, Medinol, Panadol and other brand names depending on the country of origin. Children’s version can be purchased sugar-free.

Be careful to check that your child is not getting paracetamol in other medicines (eg cold relief sachets) and always follow the instructions with regards to doseage. It is important to calculate this by weight of the child, not by age. There is no point in under-dosing (because they are “not very sick”) but great care must be taken not to over-dose.

Infant Ibuprofen can also be known as Nurofen, Brufen and Calprofen. Other brand names are also sold without a prescription – check with a pharmacist if you are unsure. Ibuprofen should not be given to babies under the age of three months or under 5kg unless prescribed by a doctor, and always follow instructions on the bottle for doseage.

Do not give both medications at the same time, and never give aspirin. However, it is possible to “stagger” dosing with both paracetamol and ibuprofen in some cases (such as a painful ear infection). Always check with a doctor for advice about this.

See here for more information on treating children with painkillers.

Conchita Amende.  Specialist community health nurse (health visitor UK).


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Common Childhood Illnesses and when to call a doctor

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Common Childhood Illnesses and when to call a doctor

Posted on 07 February 2014 by Kristrun

babyWithBluehat2All kids get sick. It’s a normal part of being a child, and as such, dealing with sickness is something all parents will come to face sooner or later. Of course we do our best to limit the risk of infection by maintaining good hygiene (hand washing being up there as most important) but the day will come when your child becomes ill with something or other. Some circumstances warrant a trip to the doctor or even the emergency room, others do not.

It’s important to remember that most children’s illnesses are viral, and hence anti-biotics are ineffective. In these cases, such as the common cold and coughs, we can treat the symptoms of the illness and strive to make our little ones feel comfortable, but a trip to the doctor is not always necessary. Bear in mind also that a viral infection can take up to 2 weeks to resolve. With a cold or flu-like virus, acute stage of feeling lousy will likely last 4 or 5 days (or more), but other symptoms, such as a lingering cough, can hang around for up to 2 weeks. This is ‘normal’.

Here’s a quick low down of some of the more common afflictions and what to do if your household is affected. Please remember that whatever the circumstances, you know your child best of all. If you feel that something is “not right”, then go and see a doctor and get it checked out.

Coughs and colds

It is normal for young children to get several colds per year and right now, it is affecting many families in Hong Kong. There are hundreds of different cold viruses and your baby has no immunity against any of them. Gradually, with time, they will get fewer as their immunity builds. Most colds get better in 5 to 7 days and there is usually no need to see a doctor. Some relief can be brought by treating the symptoms but do keep an eye on their general condition, as a cold can deteriorate into a chest or ear infection or worse.


Children often cough when they have a cold because of mucus trickling down the back of the throat. Usually nothing to worry about if child is eating, drinking, breathing normally. When to see a doctor: wheezing, a bad cough that is not improving, a high fever, or breathlessness. These may be indicators of a chest infection which, if bacterial, may need antibiotics so see a doctor.

Sore throats

Often caused by viral illness such as colds or flu. Paracetamol or ibuprofen may be given to reduce pain. Most sore throats clear up on their own within a few days. When to see a doctor: prolonged symptoms (more than 4 days), high temperature and general unwellness, inability to swallow fluids or saliva.


Infection of the tonsils at the back of the mouth. Can be caused by bacteria but mostly viral. Symptoms include a sore throat, read swollen tonsils, pain and difficulty swallowing, fever, coughing and headache. Glands in the neck may also be swollen and there may be spots of pus on the tonsils. Most common between the ages of 5 and 15 and spread by coughing, sneezing or through touch. See doctor to check if bacterial (and therefore antibiotics may be advised). Treat symptoms using paracetamol, ibuprofen, throat lozenges or throat sprays (if age appropriate).

Slapped Cheek Syndrome

A viral disease which triggers mild cold-like symptoms, as well as one or two red cheeks. Rash elsewhere on the body can also develop and your child may experience joint pains. Most common between the ages of 2 and 14 years and no treatment (other than paracetamol) is necessary. It is difficult to prevent the spread of this virus as people are most infectious before symptoms appear.


Most common in children under 10 years of age, infection is spread by inhaling droplets of the virus from the air, but can also be spread by direct contact with blister fluid. Incubation period is between 1 and 3 weeks and most infectious time is 1-2 days before rash appears. However, your child continues to be infectious until the blisters have crusted over. Symptoms start with general unwellness, maybe a rash and a slight fever. Spots will develop, which are red and become fluid-filled blisters within a day or two. They eventually dry into scabs, which will drop off. Scarring is not common, but can occur if they are badly infected.

Hand, Foot & Mouth Disease (HFMD)

A viral infection, for which there is no specific treatment and which normally clears up by itself after 7-10 days. Symptoms are blisters on feet, hands, inside the mouth and sometimes in the nappy area. You can help your child’s symptoms by: Encouraging them to rest and drink plenty of fluids (water and milk is ideal, but avoid acidic drinks such as orange juice or cola). Offering soft foods which are easier to chew and swallow. Pain relieving medication if very uncomfortable. HFMD is contagious so stay home until the blisters have dried.

Scarlet Fever

Highly contagious bacterial infection which starts with a throat or skin infection and leads to a fever, flushed face and wide-spread, pinkish-red rash. The rash feels rough, like sandpaper, and may be itchy. It is caught through contact with an infected person, or through contact with infected items, such as door handles. Most common in children between the ages of 4 and 8. See your doctor as antibiotics are needed within 10 days. If not treated, immune reactions can lead to complications such as kidney problems or rheumatic fever. Stay home, and away from others and do not share towels, clothes and bed-linen with others.


You know your child better than anyone else. Trust your instinct and if you feel something is “not right” or you are worried in any way, always seek help from a health professional.

If your child’s condition deteriorates rapidly, take them to a hospital straight away.

It is always better to be safe than sorry.

Here’s to a happy and health Year of the Horse!

Conchita Amende. Specialist community health nurse (health visitor UK).



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Jaundice in Newborns –  Olafia gives us the lowdown

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Jaundice in Newborns – Olafia gives us the lowdown

Posted on 29 November 2013 by Kristrun

In_hospital_postJaundice is a common condition in newborn babies affecting some 6 out of 10 babies (higher in premature babies). “The most common and 

obvious sign is a yellowing of the skin and the whites of the eyes” says midwife Olafia, but other indications are dark urine and pale coloured stools. “The baby may also be lethargic, difficult to rouse and not wanting to feed“.

Jaundice is caused by the build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells are broken down.

Baby may be sleepy and reluctant to nurse, but regular feeding is essential in treating jaundice as the bilirubin is excreted when baby poos and pees” says Olivia. Exposure to UV light also helps to break down the bilirubin.

If you are receiving home visits from a midwife, jaundice will be something she will routinely look out for – yet another reason to have continuous midwife-led care after your birth.

Most cases of jaundice will disappear without treatment but in many instances, it is ineffective feeding which will hinder resolution. Post-natal support is so important in ensuring good feeding techniques immediately after birth.

A small proportion of cases will have other underlying causes, such as infection or disease, so please seek professional advice if you suspect your baby is jaundiced.”

To arrange postnatal home visits - contact info@annerley.com.hk or book on-line 

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Exercise during pregnancy

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Exercise during pregnancy

Posted on 09 August 2013 by Kristrun

Feeling great and staying safe

bekkabumbaIt was not so long ago that pregnant women were encouraged to cut back on exercise, if not stop altogether. We now know, of course, that the right sort of physical activity is only ever a good thing.

Maintaining a regular exercise routine throughout your pregnancy can help you stay healthy and feel your best. Pregnancy can drain your energy, so the boost of feel-good hormones which result from exercise can really help your mood. It can improve your posture and decrease some common discomforts such as backache and fatigue. There is evidence that physical activity may prevent gestational diabetes, relieve stress, and build more stamina needed for labor and delivery.

“Maintaining an exercise programme which is right for you can only ever be beneficial, and will also help you prepare for labour, birth and beyond” says Annerley midwife  Sofie Jacobs.

Even if you have been a couch potato up until now, you can still begin an exercise regime whilst carrying your baby. Just take it easy and start slowly – walking is a great way to begin – and always consult your doctor if exercising is something new for you and how to chose the best nurses stethoscope for home usage.

What exercise is safe during pregnancy?

Actually, as it has been made evident on sites like FitnessTrainer.com, most forms of exercise are fine to continue, as long as you are careful and don’t overdo it. Activities with low risk of injury, such as swimming, brisk walking, indoor stationary cycling, step or elliptical machines, and low-impact aerobics or dancing can be continued until birth.

Tennis, badminton and other racquet sports are also usually fine, but as you grow larger and your centre of gravity changes, your balance may be affected as you make rapid movements. If you were previously a jogger, then carry on with care. Just listen to your body and don’t push yourself to the point of exhaustion.

If you are an athlete or have been working with a personal trainer before your pregnancy, then it is usually fine for you to carry on as before. One point to note with cardio-vascular exercise is that the “talk-test” is far more important than monitoring your heart-rate, as you may have been used to doing pre-bump. In other words, stop before you reach the point where breathing becomes so laboured that you can no longer hold a conversation easily.

Pre-natal yoga and pilates are wonderful ways to increase flexibility, strength and stamina – just the things you need when preparing for birth! But it is important to make sure your instructor is qualified in this field, as the hormones produced during pregnancy can cause the ligaments which support your joints to loosen and stretch. This helps your baby to enter the world come the Big Day, but can also increase your risk of injury during exercise. The same goes for the extra and varying distribution of weight which can lead to stresses and strains and increase the risk of loss of balance.

Exercises to avoid

Common sense would tell us that any activity which has a high risk of falling or injury is not a good idea, so maybe save the skiing or horse-riding until after baby has arrived. Contact sports such as football, volleyball, hockey, basketball etc have the double risk of injury from a fast-moving projectile coupled with a lot of jarring movements and rapid changes of direction both of which can cause abdominal trauma.

Activities often advised against are those which require extensive jumping, hopping, skipping, bouncing, or running as well as certain movements such as deep knee bends and leg raises. However, if you were doing this kind of thing before, it may be perfectly fine for you to carry on as normal so always check with an expert first.

Bouncing whilst stretching is never a good idea, pregnant or not, and exerting yourself in hot, humid conditions is of course discouraged. Better swap the Hong Kong summer hikes up hills for something cooler!

Avoid exercises which involve lying flat on your back for prolonged periods of time. This can cause compression of a large blood vessel called the vena cava and cause dizziness and discomfort.

When you should stop

It’s very important to listen to your body and only do what feels good for you. You may not be able to continue with the same level of exercise which you were used to back when the only “body” you had to consider was your own! Stop exercising and consult your midwife or doctor if you feel anything out of the ordinary, other than breathing a little faster and the familiar feeling of muscles working.

Most pertinent to pregnant women would be any abdominal or pelvic pain/contractions, an absence or decrease in fetal movement, headache, vaginal bleeding or leaking, sudden swelling of any part of your body, difficulty in walking or muscle weakness. As well as, of course, the regular signs to watch out for such as chest pain, shortness of breath, dizziness etc.

When it’s not a good idea

You should always talk with your health care provider if you have a pre-existing condition such as asthma or diabetes. Exercise may also not be advisable if you have a pregnancy-related condition such as a low placenta, recurrent miscarriage, history of early labour or an incompetent cervix.

If you have any questions to ask regarding exercise during pregnancy, or after birth, why not book a private consultation with one of our midwifes. Available in the office, on Skype or over the phone.  

Related article: Brazilian Jiu Jitsu In San Diego.

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Thank you Emma and Olivia!

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Thank you Emma and Olivia!

Posted on 29 March 2012 by hulda

Emma Saunders, who recently gave birth to Olivia, had this to say about her experience with Annerley:

“After hearing such positive feedback about Hulda and the team at Annerley I had no hesitation in booking my package when finding out I was pregnant. The antenatal classes with Fiona were perfect in preparing us for the birth of our baby. It also gave us an opportunity to meet other parents, who in fact have become great friends.

When Olivia was born I had a tricky time with breastfeeding.  The first stages of motherhood were quite daunting and the visits from Fiona and then Hulda were an amazing support. The help and advice were incredible and I can really say it is what got me through the first few months. It really is such a great comfort to know there is someone there to reassure and guide you. I felt much calmer when Hulda arrived and so did Olivia! Watching her with Olivia was very special and I learnt so much. It really is like you’re sitting with a member of your family and how amazing to have that when your family are so far away.

Thank you so much for everything; I don’t know what we would have done without you and the whole team at Annerley.  What is so special is that you always feel there is somewhere to go to and even at 3 months I am still reassured to know that Hulda and her team are only a phone call away. I will continue to enjoy the expertise and courses that Annerley have to offer now and in the future.  I recommend Annerley to all new parents. I promise you, you won’t be disappointed but just ecstatic that you have found the best support network in HK to see you through your pregnancy, birth and first stages of motherhood!”

Emma Saunders, 2012

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