Q&A: your health questions answered

Some common health concerns explained.
By Child magazine

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Why does my child always wet her bed?
Bedwetting is a form of enuresis, or loss of bladder control. Trish Holgate, a social worker who specialises in counselling children, says: “A child under the age of about four years who is wetting their bed should really not be considered enuretic. While the parent may long for dry sheets, the child may still not have the required bladder control. Even once dryness has been achieved, the odd wet bed can be expected. It should resolve itself by about the age of seven.”
 
Two types of enuresis
 
Primary enuresis refers to when a child has never managed to achieve dryness at night. There are three contributing factors:
  • Going into a very deep sleep and not waking up from the sensation of a full bladder
  • Having a small functional bladder capacity
  • The overproduction of urine while sleeping (polyuria), caused by a lack of an antidiuretic hormone. This affects about 60% of sufferers.
 
Secondary enuresis refers to children who have achieved dryness at night but then begin wetting their beds again. Causes can be:
  • Constipation
  • Urinary tract infections
  • Congenital defects
 
Interestingly, enuresis is three times more common in boys, and a child is 70% more likely to develop this condition if both parents were enuretic themselves, suggesting a strong hereditary link.
 
Bedwetting solutions
Solutions vary, depending on the cause and nature of the enuresis. It is important to show confidence in your child’s ability to eventually control their bladder function. Letting your child know that you also suffered from this when you were a child provides comfort and reassurance.
 
If you are concerned, let your GP examine your child and advise you of the appropriate steps to take. Medication such as an antidiuretic hormone can slow down urine production at night. Certain foods such as dairy products, caffeine, carbonated drinks and acidic foods irritate the bladder and should be eliminated. Many parents swear by the use of a bed alarm. A sensor is placed inside the child’s underclothes and is connected to an alarm that goes off if the child starts to urinate.
 
It is important to remember that bedwetting is not bad behaviour that needs to be punished.
 
 
What is creche syndrome?
Creche syndrome refers to an ongoing cycle of colds, sniffles and more serious illnesses when young children are infected at a creche or pre-school where they come into contact with other children daily. After repeated infections, their immune systems become compromised. Cape Town paediatrician Dr Hanneke Heyns says creche syndrome strikes from eight or nine months old, when some babies start daycare, and is prevalent among toddlers. “These children have constantly runny noses; it’s usually clear, sometimes with a mild fever attached and there may be coughing from a postnasal drip. It’s about the continuous virus load, one after another, that wears down their health,” she says.
 
Babies have no immunity at birth aside from their mother’s antibodies. Young children need contact with a certain amount of viruses so that if they catch a cold, their bodies can make antibodies to build resistance. But creche syndrome doesn’t build enough resistance because of the unrelenting cycle of illness.
 
Fight it with food
Many toddlers are fussy eaters and parents fall into the trap of feeding them something they know they’ll eat; often frozen and processed meals instead of nutritious foods. Their immune systems and gut health become impaired so they catch colds frequently and become constipated.
 
Creche syndrome checklist:
  • Ask questions when antibiotics are prescribed. Colds, flu and gastro are caused by a virus. Antibiotics don’t kill a virus; they only kill bacteria. Viruses can cause throat and ear infections, but bacterial infections play a bigger role.
  • Give your child an annual influenza vaccine, available from the age of six months onwards.
  • Parents can only relieve the symptoms of creche syndrome. If these danger signs are present, alert your doctor: persistent fever with a temperature above 38°C; fast breathing; a chesty cough and wheezing; green nasal mucus; diminished interest in eating and drinking; and vomiting.
  • Don’t dry out a runny nose. Use a salt-water nose spray to loosen the phlegm. Steam and elevated sleeping also help.
 
 
Why is my child the shortest in the class?
A growth problem can occur at any age and have any number of causes, from genetic to malnutrition, certain syndromes (Prader-Willi and Turner), skeletal disorders, head injuries, chronic medical conditions (kidney, heart, lung and intestinal diseases), serious illnesses (meningitis, encephalitis and brain tumours) and an underactive thyroid. “Most children don’t have a serious problem with growth and will eventually reach a height that’s similar to that of their parents,” says Dr Yasmeen Ganie, a paediatric endocrinologist at Inkosi Albert Luthuli Hospital in Durban. But some have Growth Hormone Deficiency (GHD) and need treatment.
 
Injecting hope
GHD is treated with daily injections until the growth areas of the bones close. “In severe deficiency, treatment may continue into adulthood at a lower dose,” says Ganie. Parents are taught to give the shots, and once they’re older, the children themselves. If a diagnosis is made early enough and a child responds well, they can grow to their normal or near-normal adult height potential, but it’s important to have realistic expectations. Growth hormones can’t override genetic potential, and if both parents are short, the child will probably be short too. (To estimate their adult height, average your height and your partner’s, then add 7cm for a boy or subtract 7cm for a girl.)
 
A slowing of growth can be noticed from around age two, it’s usually diagnosed when children start school and their height is compared to others their age, or at puberty when short children can become self-conscious, or subjected to teasing.
 
When to act
All children need to be measured twice a year and their growth plotted on growth charts. Ask your GP about seeing a paediatrician or paediatric endocrinologist when your child:
  • Is shorter than most others of the same age and the same gender
  • Has a face that looks younger than his peers, a chubby build and prominent forehead with small hands and feet
  • Has delayed puberty (lack of breast development by 13 years in girls, lack of testicular enlargement by 14 in boys).
For more information, contact semdsa.co.za

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