School holidays are a time for family, friends, and fun activities; and teens can stay up as late as there’s no school! After holidays (such as the upcoming Easter break), our teens can become sluggish and low on energy. They go to bed late and must wake up early for school. Yup, a thrown-off sleep schedule.

Experts have said that from puberty up until the age of 22 that 9 hours of sleep is required to be mentally, physically, and cognitively healthy. A teenager being a teenager, will debate this theory.

But paediatricians have declared that insufficient sleep is a public health issue. There are some ways in which sleep schedules could get back on track after holidays, which we discuss below.

Screen Time

Have your teens turn off all their electronic devices an hour before they go to bed. The reason being is that screens emit blue light. This blue light then sends signals to the brain, suppressing melatonin production and keeping kids from feeling tired. So, though they are not tired at the moment when they eventually do fall asleep, they wake up exhausted.

Snacking

While having a quick late-night snack is tempting, it can do more harm than good when keeping a proper sleep schedule. Eating late postpones sleep and can increase hunger, contributing to the risk of obesity, acid reflux, blood pressure, and blood sugar issues.

Commitment

While it is easier to set a sleep schedule for a younger child, that can be much harder for a teen. Unless they recognise that more sleep is and will make them feel better, they aren’t likely to want to change their sleeping habits. This is where parents come in; show your teen that a good night’s sleep is essential and talk it out and reason with them.

Setting a Good Example

Believe it or not, no matter the age, your children still follow the example they see from their parents. Work with your child on implanting healthy sleeping habits, and you lead by example. Even helping your child earlier with their homework so you can ensure that they have their work done and eat on time, settle into their rooms at a better time, and get the rest they need.

Consistency

Do you know how they say consistency is key? Well, the same applies to sleeping habits. This is crucial, especially if healthy sleeping habits are trying to be built. Child and adolescent psychiatrist Alison Maker, MD, says it is vital for a teen to go to bed as close as possible to the same time every night and get as close to 8 hours of sleep as possible. But it is also essential to stay in that same sleep routine and weekends and holidays.

These are a few examples of ensuring we don’t have a cranky teenager after the holidays. A happy teenager means an even happier parent!

See the attached link to find more ways to improve your teen’s sleep schedule.

If you find these tips aren’t as effective with your teen or are noticing your teen’s sleep schedule deteriorating, this could be a sign of something more serious such as a sleeping disorder. Integra’s highly experienced paediatric team offer a range of services including treatment for children and teens with sleeping disorders. For more information click here.

This article aims to demystify common food allergies, breaking down the misconception that certain foods and drinks such as cow’s milk, eggs and peanuts should not be given to children at such a young age.

Most common food allergies

Food allergy occurs when a child’s immune system decides that a certain food is a “danger” to their health. The child’s immune system causes IgE antibodies which can react to certain foods and cause the release of histamines and other chemicals – causing an allergic reaction. It impacts roughly 2-5% of children and 10% of babies and unfortunately, the reason for this response in the body is not yet known.

It is important to note that a food allergy is different than an intolerance. A food intolerance means while food can cause a negative reaction for children such as colic or delayed development, it does not impact their immune system. An allergy, as mentioned above, does.

The most common foods that can cause allergic reactions are:

• Cow’s milk
• Eggs
• Peanuts
• Wheat
• Soy
• Tree nuts
• Fish
• Shellfish

Early Exposure to Allergens is Beneficial

For the past several decades, parents have been encouraged to not give children and babies these particular foods. While in some cases, babies do develop allergies and intolerances at a young age such as cow’s milk and may need to avoid these, it is offering the advice as the standard in which researchers argue the possible adverse affect this advice has done.

Professor Carlsen, who evaluated the PreventADALL study, one of the largest studies on food allergy in children concluded from the results that the longer infants are kept away and not exposed to these common food allergens, the more likely they are to have allergies to these foods beyond infancy and into childhood.

It is advised by the NHS that solely breastfeeding or first infant formula should be given to a baby for their first 6 months. At the 6 month mark, they recommend starting to introduce these foods and if there is no allergic reaction or intolerance to keep the foods in the diet to prevent any reaction later down the line. The NHS says that doing these tests of the foods before the baby turns one has proven effective in reducing the allergies they have.

The Norwegian PreventADALL study revealed that the age to start the introduction of these foods could safely be reduced to 4 months as this has shown to reduce allergies even more than starting at 6 months (which is also the recommended age in Norway) and are now rallying for this to be the official recommendation in Norway.

This month (March 2023), a UK study has also found similar findings to this Norweigan study in regards to exposing babies to peanut butter from as early as 4 months. The study revealed exposing them to this food at a young age can cut the cases of peanut allergies by over three quarters.

Therefore early exposure of the food allergies are very important.

How to know when something triggers an allergic reaction

As mentioned previously, while this method of early exposure to these foods has shown to improve the overall chances of children getting food allergies or intolerance, allergic reactions can and still do occur.

Allergic reactions can progress quickly and cause an onset of several symptoms including:

• Asthma
• Itchiness
• Nausea
• Stomach cramps
• Hives
• Swelling of the face and lips, tongue or mouth
• Itchiness of throat
• Shellfish
• Feeling faint
• Diarrhoea
• Severe reactions such as anaphylaxis – if this occurs seek medical attention immediately or call 911

Get in touch

Even if a child has an allergy, there is a chance they may grow out of it. Some allergies will last their whole life such as tree nut allergies but with other food allergies such as eggs or peanuts, children can outgrow these are they get older. However, it is vital to consult with your doctor before trying to add these foods back into your child’s diet.

At Integra we have four highly experienced Paediatricians who offer food allergy and intolerance testing, advice and a host of other paediatric services. For more information and to book your appointment, click here.

Approximately 3000 people in the USA alone are diagnosed with bacterial meningitis (less common and more severe type of meningitis versus viral meningitis being more common and less severe) each year, with a majority of these cases being children. Therefore it is fundamentally important for parents to stay aware of ways to check whether a child’s rash or spots is not an indicator of something more serious such as a meningitis infection.

Rolling glass method

The rolling glass method is one of the most common methods of testing whether your children’s rash might be a meningitis rash. Gently press a side of clear glass cup against your children’s rash on their skin. If the rash does not fade, this could indicate this rash is a meningitis rash.

However, meningitis is a tricky disease with a host of symptoms that don’t always appear in the same order for each person. In the first stages of meningitis, some children might not have a rash or the children’s meningitis rash could fade. Some individuals may even be asymptomatic.

Other symptoms

The NHS offers an extensive list of symptoms which includes:

• Rash or spots (Important note: There may be more difficulty identifying this on children with a darker skin complexion. Check the parts of the skin that are naturally less pigmented/paler which includes: palms of hand, soles of feet and the roof of the mouth.
• A fever/high temperature
• Cold hands and feet
• Nausea and vomiting
• Muscle aches and pains
• Headache or migraine
• Stiff neck
• Seizure
• Fatigue

In infants symptoms can include:

• Refusing feeding
• Unresponsive or stiff
• Noticeable soft spot on their head
• Being irritable
• High-pitched cries

Preventative meningitis: Men B vaccination

One of the most effective ways of reducing your children’s chances of contracting meningitis and also reducing your worries as a parent, is for you to ensure they receive the Men B vaccine.

This vaccine helps provide some immunity for your child from the ‘meningococcal group B bacteria’, a bacteria that 90% of meningococcal infections (often the precursor to meningitis) originate.

Get in touch

At Integra we offer the Men B vaccine as part of our development and well-child services.

If you would like to book an appointment for your baby’s Men B vaccine or are unsure of whether your child has meningitis or not, it is always best to be safe and get it checked out.

Visit our paediatrics page to book an appointment.

If you have confirmed that your the rash is not a meningitis rash, our expert Dermatology team also offer a range of paediatric dermatology services. 

To read more on this topic visit the sites below:

• https://www.hopkinsmedicine.org/health/conditions-and-diseases/meningitis-in-children
• https://www.nhs.uk/conditions/meningitis/symptoms/#:~:text=Meningitis%20rash&text=It%20does%20not%20fade%20if,glass%20firmly%20against%20the%20skin.&text=The%20rash%20can%20be%20harder,the%20inside%20of%20the%20eyelids

Choosing your Paediatrician – Parental Rights

Choosing your Paediatrician – Parental Rights as a topic is an important one but it should not be a stressful one and we hope this short article will provide you with some helpful insight, both about your rights as parents and in how to choose a paediatrician in the Cayman Islands.

In many places around the world, access to a paediatrician is through referral by a GP, who provides the first line of care. In Cayman, it is different. The vast majority of paediatric care here is provided by paediatricians, most of whom are based outide of hospitals and who provide all routine and some complex care needs. So, it is normal here for the adult family members to have a GP and the children to have a paediatrician.

Parental Rights

This is the simple bit. You are fully in control. However, let’s consider the scenarios where a parent finds themselves choosing a paediatrician and examine some of the issues at those stages. It’s a scenario you find yourself facing generally in 4 situations:

• You’ve just move to the Cayman Islands and so do not have one
• You’re pregnant and choosing one to attend birth and provide newborn care
• You have a paediatrician but they are off-island, on vacation or unwell
• You have a paediatrician and you would like to change, for whatever reason (and it doesn’t matter!)

In all of these scenarios, you have complete choice over seeing whomever you wish. As long as the practice accepts your insurance, then there is no real restriction on going to any practice, provided they have the capacity and are open for new patients. Essentially, when choosing your paediatrician – parental rights are explicitly clear by law – it’s your choice and it should be respected.

WHEN PREGNANT

When pregnant, you may have special considerations or needs, such as wanting a paediatrician with a formal neonatal (newborn) training in case there is a complication. If you already have a paediatrician, it’s perfectly fine to do this and you just need need to let that paediatrician know if you intend to return to your established one afterwards. Good paediatricians will be perfectly happy with this and ensure your normal paediatrician gets a good handover or care afterwards.

Occasionally, you may find an OBGYN steers you towards a paediatrician, which can happen most often if they have one in their practice. However, you still absolutely have every right to choose the one you really want and it is a good idea to meet others to be sure. An OBGYN shouldn’t object to your choice of paediatrician and once they know who you have chosen, they should respect that choice. We have many excellent obstetricians in the Cayman Islands, and whether they are openly happy to accommodate a parents wishes is an obvious a useful gauge or factor in whether they are the right one for your pregnancy too.

VACATION & SICKNESS COVER

In the Cayman Islands, the paediatricians all know each other fairly well. They get together at professional meetings and societies, they cover for each other and help each other. You can feel completely confident in asking to see another paediatrician if yours is unavailable for some reason and good paediatricians will ensure a good handover back so your normal one knows what’s happened in their absence.

At Integra, because we have 4 paediatricians and newborn specialists, there is always someone available, and we run an out-of-hours single number system to ensure you always reach someone – (345) 326 4370 – and a during office hours there are always paediatricians available on our main number (345) 745 7450. We will always respect your normal paediatrician if we are stepping in.

TIME FOR A CHANGE

For many, this is the more stressful situation, because underpinning it is a reason. There can be many reasons why people want to change, including:

• For geographical reasons
• They want a practice with better cover, out-of-hours or vacations
• They want to attend the same practice as parents
• For a specific aspect of healthcare where someone specialises
• Unhappy with the service or care from an existing practice
• Child doesn’t seem happy where they are (accepting no child likes injections etc!)

The reason doesn’t matter and you have absolute choice. You do not even have to tell your existing practice why, unless you want to. If you do find yourself wanting to change and do not want to go through even the embarrassment of explaining this, you may simply register with another practice and ask them to acquire the medical notes from your previous one. As paediatricians, we have ethical obligations in ensuring that we facilitate that process so your child is never put at risk. This is very rarely an issue and we are all used to handling this. What might feel stressful to you, is normal to us, so just ask.

Choosing your Paediatrician – Other Considerations

There are many reasons for choosing one paediatrician over another and because it is often a long relationship, you want to choose carefully and well, ensuring a good match to yours and your child’s needs.

We have a whole guide on the sorts of considerations you may have or want to consider.

Choosing a Paediatrician in the Cayman Islands

Recent articles from The Times and the BBC revealed that several families in the UK have already tragically suffered loss of their children with the death toll for Strep A reportedly rising to seven since September 2022. Four-year-old Camila Rose Burns’ family asking the public for prayers as their daughter battles an intense infection of Strep A and has been placed on a ventilator and are also pleading for parents to get their children checked for Strep A if they feel their children, particularly young children are showcasing any symptoms.

A Plea to Parents

Camila’s parents along with several other families of children who have died or were seriously ill due to Strep A in the UK are now also speaking out about the symptoms of Strep A that their children experienced, in hopes of helping other parents to be able to spot if their child has these and seek medical attention immediately.

The Signs and Symptoms

Some of the symptoms reported by the parents included:

• Rash
• Chest pains
• Black vomit
• Heart murmur and strong pain in legs

Infectious disease paediatrician Prof Beate Kampmann also added some other symptoms that parents should be mindful of that child with Strep A when they were first infected including:

• High fever
• Sore throat
• Very red tongue

There were also reports of some of the children looking to have seemingly gotten better at first but then their symptoms reappeared and intensified. Six out of the seven children who have died were believed to have had the more intense and invasive infection of Group A streptococcal disease (iGAS). Normally in winters, the total number of children that have this is around one or two. GOV.UK defines iGAS as:

“a bacterium which can colonise the throat, skin and anogenital tract.”

iGas can cause several other respiratory infections. Therefore, it is also important for parents to observe if their child has symptoms similar to infections including tonsillitis, pneumonia or scarlet fever.

We understand this can be scary news to you as parents, especially those travelling to the UK for the holidays. At Integra, we are committed to providing quality care and are committed to helping you and your children. Our paediatric team is one of the largest on island and with highly experienced and respected doctors. If you are concerned about your child, please get in touch below. We’re here for you.

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