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

Fever is a normal response of the body when fighting an infection. All children will experience fever during childhood at some point, especially in pre school years. I have created a fever advice sheet for you which offers information and advice on what to do when your child has a fever.

It’s been a strange couple of years for us all. Few would have imagined that we would have had to face the global threat of a pandemic that saw us all having to test, isolate and miss out on the things we had all taken for granted – like seeing friends or family, socialising, being together. Some of the most profound effects of this have been on our children of the pandemic.

As adults we get exposed to many challenges across our years but for children this has been hugely significant. Our children have got used to mask wearing, frequent lateral flow tests, time out of school and away from friends and living with a level of fear and anxiety around infection.  My own children remember clearly the time during the height of the pandemic in London, before we had the protection of the Covid vaccine, when I would return from working in the hospital and they couldn’t come near me until I had showered to make sure I didn’t bring Covid into our home.It’s difficult to comprehend the anxiety something like that generates.

To put some sense of the magnitude of the effects on our children of the pandemic, as early as 2020, a survey of 1,000 parents across the US, conducted by the Ann & Robert H. Lurie Children’s Hospital of Chicago, found that 71% of parents said the pandemic had taken a toll on their child’s mental health, and 69% said the pandemic was the worst thing to happen to their child. A national survey of 3,300 high schoolers conducted in spring 2020 found close to a third of students felt unhappy and depressed much more than usual. The American Psychological Society brings where we are in 2022 with the starkly worded Trends Report; Children’s mental health is in crisis.

So how can we help them?

It was a scary time for them; schools had closed and they became fearful to leave the house at all, even for daily exercise. As a family we tried to embrace time together and create new memories of a time that would soon pass; the time when London slowed down and we began to hear the birds again as the traffic disappeared.

Most children are resilient and can adapt to new situations by just taking things in their stride. Others will find it harder and may be feeling sad or anxious, some even terrified.

So how do we support our children in navigating their way through these Covid-times?

It starts with encouraging open and honest conversations. Checking in regularly with your child about how they are, is key when we all lead busy lives. If we don’t ask, we can’t expect them to spontaneously share. Allowing children time and space to express their feelings, whatever they may be, is important.

For younger children, feelings may be communicated by a change in behaviour or routine. Although we naturally want to reassure, we also need to accept the way they may be feeling and try to understand it. We should all recognize that the mental health of our children is as important as their physical health, and of course the two are inseparable too in many respects. Remember that a healthy diet, exercise and encouraging healthy sleep habits are vital for all children physically and mentally. Things that perhaps seem less important when facing the magnitude of the pandemic may well be key to ensuring some sense of normality, and some of them, like diet or exercise, are huge important to mental wellbeing.

I would also encourage anyone who is concerned about their child to go and see your Paediatrician and discuss those concerns. It isn’t always easy to see what is going on but as parents we often know something is amiss. When it comes to child mental health, it is vital we don’t ignore those signs. You paediatrician should be able to signpost to more resources and support, and provide direct guidance on specific issues.