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.

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.

Get in touch out of hours…

GRAND CAYMAN- March 22, 2022 – Integra Healthcare Ltd and Workforce Opportunities & Residency Cayman (WORC) are delighted to announce the launch of two innovative healthcare apprenticeships – development programmes for exciting professional healthcare roles, as Healthcare Assistants or Medical Billing & Administrative staff. The apprenticeship scheme will provide the opportunity for young and/ or healthcare-passionate Caymanians to gain Internationally recognised qualifications alongside direct work experience, while being paid an escalating salary in line with their growing competency.

Katherine Whittaker, Head of Labour Demands, Development and Training for WORC, explained; “It is vital that our Caymanian population is able to participate in modern, professional industries such as healthcare and schemes like this one provide a genuine route to two different professional roles, but without the financial barriers so often preventing capable individuals from gaining the necessary qualifications.”

Head of Education, Director and Consultant Paediatrician & Neonatologist for Integra Healthcare, Dr Sara Watkin added; “I have long been involved in mentoring Caymanian students wishing to train in healthcare, and the block Katherine speaks about is very real. I see some amazing people that just need a route in, and so we created these programmes to provide employment from day 1 but alongside protected and paid for study programmes for professional qualifications. I couldn’t be more proud to finally be pressing the go button.”

The Healthcare Assistant Apprentice Programme, initially 3 healthcare apprenticeships, is based around a similar and hugely successful scheme in the UK, aimed at growing technically competent, knowledgeable and safe staff that can work in care provision, alongside nurses, but without having to fund years of nursing degree courses. Integra has the largest team of private ambulatory, non-hospital, registered nurses, across Women, Children & Family Medicine, with Dermatology, allowing the apprentices to be comprehensively mentored but also across a range of disciplines or specialties too.

The Medical Billing & Administrative Apprentice Programme will allow individuals to be trained under the American Academy of Professional Coders (AAPC), the largest medical coding training and certification association for medical billers and coders, working on the same Current Procedural Terminology (CPT) and International Classifications of Disease (ICD) coding systems used by Cayman health insurers. The role is a highly important one, leading to proper payment for services and thus the stability of medical practices in the Cayman Islands.

Andrew Vincent, Director of Integra Healthcare, commented; “We have grown Integra into the largest private, non-hospital medical practice in the Cayman Islands based on our reputation and our four cornerstone values of Excellence, Integrity, Commitment and Passion. That has given us the scale necessary to offer these programmes, in a professional and employment environment that genuinely supports and values its staff. We have always said that we feel very privileged to be able to provide healthcare services in such an amazing location, and so alongside our passion for improving and innovating in healthcare, our commitment is to also ensure we provide genuine employment or growth opportunities for the very people who so kindly allow us to share their very special home.”

Kimone Chambers, Programme Coordinator for WORC, who worked alongside the Integra team to help establish the programme, stressed; “We always want to make sure that Apprenticeship Schemes are properly organised, with appropriate commitment from the employers. However, even more important is that the employer has the right environment and support mechanisms to ensure apprentices feel supported and mentored and therefore are able to carry through into employment. Integra Healthcare definitely has what it takes, and I am looking forward to welcoming the first cohort of apprentices.”

There has been a global growth in internships, apprenticeships and other entry-into-work schemes, and Dr Francisco Martinez, Medical Director and a GP at Integra, believes it is important to differentiate between low commitment, low wage schemes and professional development programmes such as this; “It is important to us that individuals gain recognised, career-supporting qualifications and get the quality of training they need to be fully fledged, highly valuable members of a professional team. We don’t subscribe to the concept of ‘cheap labour’ and so the salaries for these roles start much closer to a living wage level, not a minimum wage one, and grow with the skills and qualifications of the apprentices, through their healthcare apprenticeships. By the end of the programme, they have gained a fully-paid-for set of recognised qualifications, lots of practical experience, and employment on standard terms for these professions.”

Individuals wishing to discover more about the Healthcare Apprenticeships Opportunities with Integra can visit https://integra.ky/apprenticeships or contact WORC at worc.training@gov.ky or 938-5360.

About Integra Healthcare Ltd

Integra Healthcare Ltd is the largest non-hospital private ambulatory clinic in the Cayman Islands, based out of Grand Pavilion on West Bay Road, with 11 doctors across Women’s, Children’s and Family Medicine, with Dermatology. With a strong history or innovating and in investing in latest technology, they were the first clinic in the whole Americas region to bring the latest Artificial Intelligence FotoFinder for assisting in the detection of Skin Cancer, as well as the latest nanotechnology point-of-care platform for providing advanced analysis of micro-blood samples without the need for sending them to a laboratory. The practice is a champion for implementing evidence-based care and preventative, personalised medicine, built around 4 core values of Excellence, Integrity, Commitment & Passion.

For Immediate Release:February 17, 2022

Update: Abbott announced that the company initiated a voluntary recall of potentially affected products, including Similac, Alimentum and EleCare powdered formulas manufactured in its Sturgis, Michigan facility. Products made at this facility can be found across the U.S. and were likely exported to other countries as well. Canadian health officials have also issued a recall warning.

Additional recall information is available on the FDA website. Parents and caregivers can also enter their product lot code on the company’s website to check if it is part of the recall.

Today, the U.S. Food and Drug Administration announced it is investigating consumer complaints of Cronobacter sakazakii and Salmonella Newport infections. All of the cases are reported to have consumed powdered infant formula produced from Abbott Nutrition’s Sturgis, Michigan facility. As a result of the ongoing investigation, along with the U.S. Centers for Disease Control and Prevention and state and local partners, the FDA is alerting consumers to avoid purchasing or using certain powdered infant formula products produced at this facility. This is an ongoing investigation, and the firm is working with the FDA to initiate a voluntary recall of the potentially affected product. 

The FDA is advising consumers not to use Similac, Alimentum, or EleCare powdered infant formulas if:

• the first two digits of the code are 22 through 37; and 
• the code on the container contains K8, SH or Z2; and 
• the expiration date is 4-1-2022 (APR 2022) or later.

The FDA is investigating complaints of four infant illnesses from three states. All four cases related to these complaints were hospitalized and Cronobacter may have contributed to a death in one case. The FDA has initiated an onsite inspection at the facility. Findings to date include several positive Cronobacter sakazakii results from environmental samples taken by the FDA and adverse inspectional observations by the FDA investigators. A review of the firm’s internal records also indicate environmental contamination with Cronobacter sakazakii and the firm’s destruction of product due to the presence of Cronobacter. 

“As this is a product used as the sole source of nutrition for many of our nation’s newborns and infants, the FDA is deeply concerned about these reports of bacterial infections,” said Frank Yiannas, FDA Deputy Commissioner for Food Policy and Response. “We want to reassure the public that we’re working diligently with our partners to investigate complaints related to these products, which we recognize include infant formula produced at this facility, while we work to resolve this safety concern as quickly as possible.”

Additional Information:

• Products made at the Sturgis, Michigan facility can be found across the U.S. and were likely exported to other countries.
• Products that do not contain the information listed above are not impacted. The FDA advisory does not include liquid formula products or any metabolic deficiency nutrition formulas. Consumers should continue to use all products not covered by the advisory. 
• To date, this investigation has been associated with four illnesses (three for Cronobacter and one for Salmonella) spanning the following states: MN, OH and TX. All four cases related to these complaints were hospitalized and Cronobacter may have contributed to a death in one case.
• Cronobacter bacteria can cause severe, life-threatening infections (sepsis) or meningitis (an inflammation of the membranes that protect the brain and spine). Symptoms of sepsis and meningitis may include poor feeding, irritability, temperature changes, jaundice (yellow skin and whites of the eyes), grunting breaths and abnormal movements. Cronobacter infection may also cause bowel damage and may spread through the blood to other parts of the body.
• Parents and caregivers of infants who have used these products, and are concerned about the health of their child, should contact their child’s health care provider. If your child is experiencing any of these symptoms, you should notify your child’s healthcare provider and seek medical care for your child immediately.
• Salmonella are a group of bacteria that can cause gastrointestinal illness and fever called salmonellosis. Most people with salmonellosis develop diarrhea, fever and abdominal cramps. More severe cases of salmonellosis may include a high fever, aches, headaches, lethargy, a rash, blood in the urine or stool, and in some cases, may become fatal. 
• Parents and caregivers should never dilute infant formula and should not make or feed homemade infant formula to infants.  
• If your regular formula is not available, contact your child’s healthcare provider for recommendations on changing feeding practices. 

The FDA is continuing to investigate and will provide additional consumer safety information when it becomes available.