Frequently Asked Questions

Parent's Tips

Things you need to know

Kids Consume Too Much Salt: High sodium intake is associated with elevated risk for high blood pressure, especially in obese and overweight children. Reviewing: Yang Q et al. Pediatrics 2012 Oct 130:611.
Allergies to Cows Milk, Eggs, Peanuts and Soy are the most common food allergens we see in children. However any food can potentially cause food allergy. The good news, many allergies are outgrown in early childhood particularly milk and egg allergies by age 5 years.
Paracetamol is the most commonly prescribed medicine for children. We continue to prescribe doses based on a child's age but this does not take account of the wide variation in children's weights. Thus a 2 year old who is underweight may be overdosed on a recommended age based dose' but an overweight child would be under-dosed. We need to develop weight based guides. Arch Dis Child 2012;97:279-282.
In Ireland, Europe, USA and Australia all hospitals and health settings are seeing increased numbers of small babies and older children with distressing coughs that can persist for 3-4 months. Whooping cough used to be known as the '100 day cough'. Parents need to be aware of the importance of vaccination and boosters in certain cases.
Parents often worry about severe allergic (anaphylaxis) reactions following vaccination. Recent study of UK and Irish children showed NO reactions following more than 5 million infant vaccine doses given between 2008-2009. This should provide great reassurance to all families.
New Pertussis (Whooping Cough) vaccines contain purified protein as opposed to the older "whole cell" vaccine. These were developed due to concerns about adverse events with the old "whole cell" vaccine. This review demonstrates the new vaccine is as effective with fewer side effects. However the coverage is never 100%. This new vaccine prevented serious Whooping Cough in 84-85%. This observation is backed up by recent reports of Pertussis outbreaks in Europe, USA and Ireland. There may be a need to introduce boosters in school age children in the future. My own son aged 11yrs currently has infection despite vaccination!
In studies bans did lower consumption in school but not overall consumption. In other words children drank less sugar laden drinks in school but continued to drink such beverages at home or outside of school. There is general agreement across the medical profession concerning risks of dental disease and obesity risks with such consumption.
Recent American Academy guidelines would suggest the majority of children only require an ultrasound of their kidneys after a urine tract infection. More invasive and often unpleasant procedures that were widely done in past, are no longer necessary except in certain high risk patients.
Population screening studies on coeliac disease have suggested a prevalence of 1% among European and US children. Prevalence of gluten avoidance may be 5 times higher than this. Children should not be on exclusion diets unless physician diagnosed indication such as wheat allergy or Coeliac Disease.
A recent study from Archives of Disease in Childhood compared combined treatment of fever with Paracetamol and Ibuprofen versus each drug alone. There is little evidence of any benefit or harm from the combined treatment compared with the use of each drug alone. In the absence of such benefit, there is little to recommend the unnecessary use of polypharmaceutical (more than 1 drug) methods to treat a symptom that does not require treatment, when effective monotherapies (a single drug) exist.
There is evidence to show that computer game playing (particularly in the bedroom) may have significant impact on the quantity and quality of sleep in children. This may lead to daytime sleepiness and poor concentration.
>Risk-reduction recommendations include putting infants to bed on their back on a firm mattress, preferably with a pacifier (mechanism unknown) and in a shared room (but in a separate bed).Prone ('on the belly') and side sleeping, overheating, bed sharing, soft bedding, and smoking by mothers during pregnancy or around infants should be avoided.
Tobacco smoke exposure (passive smoking) is associated with increased risk of respiratory tract (chest) infections in children. Children with early signs of allergy (eczema, food allergy) seem to have an even greater risk of chest infections if mother smokes during pregnancy.
Following a review by the Irish Medicines Board (IMB) of the safety and effectiveness of these medicines, it is advising that over the counter cough and cold medicines are no longer used in children under the age of six years. The product information for these medicines is currently in the process of being updated to reflect this advice.
There may be significant benefits for mothers themselves receiving Influenza vaccine but also for their children. A recent study of hospitalized infants of vaccinated mothers were about 50% less likely to have 'the flu' than hospitalized infants of unvaccinated mothers.
There may be significant benefits for mothers themselves receiving Influenza vaccine but also for their children. A recent study of hospitalized infants of vaccinated mothers were about 50% less likely to have 'the flu' than hospitalized infants of unvaccinated mothers.
Cows milk is the most common food allergy amongst children. Studies suggest that over time many will be able to tolerate milk by school age. However cooking milk at high temperatures ('baking')to make muffins or waffles can make milk less likely to cause allergy. Recent study suggests that giving 'baked milk' may accelerate the child's tolerance to regular unheated milk.
Recent New Zealand study reassures us that the majority of child with head shape irregularities (plagiocephaly, brachycephaly) resolve by age 4 years with no intervention. We see increasing numbers of children with this problem probably secondary to the Back to Sleep program which has been very effective in reducing Cot Death. None of the children in the study required "scrum cap" therapy to gain correction. It is not our practice to recommend such expensive unproven therapies.
In this recent study, swimming did not increase risk for asthma or atopy (allergic disease). In an accompanying pro/con exchange, editorialists debate these findings in light of studies showing increased rates of atopy and allergic disease in recreational swimmers, higher rates of occupational asthma in indoor swimming-pool workers, and increased asthma-like symptoms in competitive swimmers. The study results are reassuring for recreational ('fun') swimmers. I believe that we should encourage all patients with asthma to exercise regularly but still caution them that prolonged exposure to chlorine products (e.g., in elite swimmers) could cause lung injury.
A recent piece of research from Children's Hospital Boston examined the timing of the introduction of solid food ('weaning') in infants and the risk of obesity in early childhood. Their findings would support our current practice not to introduce solid foods, in most circumstances, before 4 months of age. The risk of obesity now appears to be another reason (others are risks of food allergy, choking) why we should continue to delay weaning until age 4 months. Among formula-fed infants or infants weaned before the age of 4 months, the introduction of solid based foods before the age of 4 months was associated with the increased odds of obesity at age 3 years.
Are oral antibiotics as effective as IV (delivered into vein) when treating childhood pneumonia from the community? A recent article in Archives of Disease in Childhood indicated that oral antibiotics are as effective as IV antibiotics. Placing needles in children is painful, costly and a potential source of further infection. Thus oral antibiotics should be tried on all but the sickest children. It is important however to ensure the child is taking the antibiotic, is tolerating it and not vomiting and the child is improving each day. If in doubt consult your General Practitioner.
Vitamin D Deficiency is highly prevalent (common) and rising in countries lying at high altitude such as Ireland. We get our Vitamin D from sunlight (mostly) and dietary intake. This is a particular risk during winter when sunlight is minimal. Vitamin D is very important for our health in particular it allows us absorb more Calcium from our gut. We know how important Calcium is for bone growth and if deficient one may develop rickets. The HSE is implementing a National policy on Vitamin D Supplementation for Infants in Ireland which was adopted earlier in 2010. This policy is based on research evidence and has been endorsed by the Department of Health and Children. This policy recommends universal Vitamin D supplementation for all children under 1 year of age. Extract from the HSE Policy: It is recommended that all infants, from birth to 12 months, whether breastfed or formula fed, be given a daily supplement of 5 �g (200 IU) vitamin D. This should be provided by a supplement containing vitamin D exclusively.
In young asthmatics the best way to deliver medicine directly to the lungs is to use an inhaler. Medicine delivery is further improved by using a spacer device (aerochamber, volumatic).

Q: Is it best to use a single maximum large breath when using the inhaler or to take a number of normal breaths?

A: A recent Australian study (Schultz, Paediatrics 2010) suggests that 2-3 normal breaths (tidal breaths) are best. No additional drug gets to the lung with “extra breaths”, therefore 2 breaths are sufficient for small spacer (aerochamber), and 3 for a larger device (volumatic).