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"title": "Newborn screening identifies babies’ illnesses",
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"value": "<p> </p><p>It is said that “an ounce of prevention is worth than a pound of cure.” In the case of newborn screening, early identification leads to better outcome for the child. </p><p>Newborn screening has been around since the 1960s in Western countries. Due to technological advances throughout the years, the screening has expanded in scope. It has been available in Việt Nam for many years, but the newborn screening centre was established in 2014.</p><p><b>What is newborn screening?</b></p><p>Newborn screening is a set of tests administered to newborn babies to identify illnesses that may cause serious medical conditions affecting growth and development if left untreated. Since the test is performed before a baby has any observable symptoms, it allows a condition to be identified and managed before a problem occurs. Newborn screening DOES NOT diagnose an illness. It will only identify children who need further confirmatory tests.</p><p><b>When and how is the test done?</b></p><p>The usual procedure involves taking a small amount of blood from the heel of a newborn within 24-48 hours of birth. The timing of the test is very important. Performing it too soon may decrease the sensitivity of the tests and doing it much later may not give accurate results.</p><p><b>Why is newborn screening important?</b></p><p>Newborn screening is important because affected babies do not show any symptoms at birth and looks “normal.” By the time a symptom appears, the baby’s development may already be impaired. Thus, newborn screening allows the conditions to be identified early. With early detection, the conditions can be treated or managed in most cases.</p><p><b>What are the tests in newborn screening?</b></p><p>Different countries have different illnesses tested under newborn screening.</p><p>In Việt Nam, the government provides free newborn tests to detect Glucose-6-phosphate dehydrogenase (G6PD) deficiency and congenital hypothyroidism. Other tests are charged.</p><p>G6PD enzyme deficiency results when the body lacks this enzyme. Babies with this condition may develop bleeding and anaemia if exposed to certain food or drugs.</p><p>Congenital hypothyroidism is a condition resulting from the lack of thyroid hormones. If left untreated, this may lead to growth failure and intellectual impairment.</p><p>In some international hospitals in Việt Nam, they offer more tests to check for more metabolic diseases. Likewise, a hearing screening is done prior to discharge. Early identification and intervention of hearing loss can prevent severe psychosocial and educational development delay, including speech delay.</p><p>There is also a Critical Congenital Heart Disease screening that is usually done within 24 hours of birth. It is a simple procedure to check the baby’s saturation (level of oxygen in the blood) with a probe. This test will determine if there is a likelihood of a critical congenital heart disease so that an early diagnosis can be made. </p><p><b><i>by Dr. </i></b><b> Agnes R. Viay -</b><b><i> Family Medical Practice HCMC</i></b></p>"
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"title": "How to stay healthy in winter",
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"value": "<p> </p><p>Some secret weapons will help you and your family stay well during the cold, dark months of winter.</p><p>Wash up</p><p>Eliminate viruses and bacteria by frequently washing your hands—and teach your kids to do the same. Simply do this: "Work up a lather and wash for at least 30 seconds before eating and after you go to the bathroom." Wash under your fingernails too. That’s where germs lurk.</p><p>Change your toothbrush</p><p>"Use a new toothbrush after you’ve had a cold, the flu, a mouth infection or sore throat," says the dentist. "Germs can hide in the toothbrush and lead to reinfection."</p><p>Don’t forget your feet</p><p>Winter’s heavy shoes, boots and socks can take their toll on tootsies, large and small. The best defense: Moisturize your feet daily to keep fungi from entering cracked winter skin. And wear socks with synthetic fibers to dispel moisture faster.</p><p>Go toward the light</p><p>Six out of every 100 people may suffer from seasonal affective disorder (SAD), a malady of mood swings that occurs when light diminishes in winter.</p><p>To counter SAD, psychotherapists recommend vitamin D, exercise and light therapy. Some lamps and box lights are designed to treat the disorder.</p><p>To keep your kids upbeat, help them get off the couch and outside whenever there is a sunny day. About 10 to 15 minutes of play in the sun is a good mood-lifter (and source of vitamin D).</p><p>Keep your body well hydrated</p><p>You may not feel as thirsty in the cold weather, but that can up your risk of dehydration. Allowing your body to become dehydrated can leave you more vulnerable to getting sick. Water helps the body carry nutrients to cells and get rid of toxins. Without enough water, you start dragging.</p><p>Get your flu jabs</p><p>It’s smart for families to get annual flu jabs, but they are especially important for expectant and new mothers. They protect mothers from getting the flu, and they pass protective antibodies to the baby. Antibodies are also passed through breast milk. Doctors also recommend that mothers and families get vaccinated for whooping cough.</p><p>The 2018-2019 flu vaccine contains:</p><ul><li>an A/Michigan/45/2015 (H1N1)pdm09-like virus,</li><li>an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus,</li><li>a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).</li></ul><p>Fill up on fibre</p><p>A 2010 study at the University of Illinois found that the fibre in foods like oats, apples and nuts helps reduce inflammation and strengthens the immune system by increasing anti-inflammatory proteins.</p><p>The suggested daily fibre intake for an adult woman and children aged 4 to 8 is 25 grams a day. An apple has 3.5 grams of fibre.</p><p>Rinse your nose</p><p>Studies have shown that those who rinse their nasal passages every day for six months have fewer symptoms from allergies and sinus infections—and cut back on antibiotics and nasal sprays. </p><p><b><i>by Dr. Philippe Jean Collin - Family Medical Practice Hanoi</i></b></p>"
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"title": "Treating flu during pregnancy",
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"value": "<p> </p><p>The flu is an infection that can cause fever, cough, body aches and other symptoms. The most common type of flu is the "seasonal" flu. There are different forms of seasonal flu, for example, "type A" and "type B." All forms of the flu are caused by viruses. The medical term for the flu is "influenza." Besides seasonal flu, there is also the "swine" flu, which caused a worldwide outbreak in 2009 and 2010, and the bird flu (also known as "avian flu") caused by a type of flu virus that first infected birds.</p><p>Influenza occurs in outbreaks and epidemics worldwide, mainly during the winter season. Most people get over the flu on their own within one to two weeks without any lasting problems.</p><p>But pregnant women with flu are at increased risk for serious complications requiring hospitalization and intensive care unit admission, and death. The excess risk may be limited to women infected in the third trimester and the first four weeks after delivery, but available data are poor.</p><p>Flu during pregnancy might have adverse effects on the fetus as well. Increased risk of congenital abnormalities as well as increased risk for spontaneous miscarriage, preterm delivery, low birth weight, birth of a small for gestational age infant and fetal death have been reported.</p><p><b><i>The best way to avoid getting flu is by getting vaccinated.</i></b></p><p><b><i>The 2018-2019 flu vaccine contains:</i></b></p><ul><li><b><i>an A/Michigan/45/2015 (H1N1)pdm09-like virus,</i></b></li><li><b><i>an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus,</i></b></li><li><b><i>a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).</i></b></li></ul><p>In addition to protecting the pregnant woman, flu vaccination during pregnancy protects the infant for several months after birth. Thus, inactivated influenza vaccine is recommended to all pregnant women, regardless of their trimester of pregnancy. The inactivated influenza vaccine is safe to be received during pregnancy.</p><p><b><i>Flu symptoms in pregnancy should be recognised as soon as possible.</i></b></p><p>Pregnant women and women who are within two weeks of delivery with confirmed or suspected influenza should receive prompt treatment with antiviral medications (oseltamivir, zanamivir or peramivir). Antibiotics will not relieve flu symptoms or speed up recovery! Antibiotics are prescribed only in case of bacterial complications of influenza, such as bacterial pneumonia, sinusitis, middle ear infection etc.</p><p>Symptoms in pregnant women are similar to those in the general population and include a sudden fever (temperature higher than 37.9ºC), extreme tiredness, body aches, headache, dry cough, sore throat, shortness of breath, runny nose, loss of appetite, diarrhea, abdominal pain, muscle pain, nausea and being sick.</p><p>Most people find it difficult to distinguish between cold and flu, but flu symptoms tend to be more severe. Flu tends to appear more quickly, within a few hours, and affects the “whole body” and not only the nose and throat. Flu makes one feel exhausted and too unwell to carry on as normal. A cold, on the other hand, appears gradually, affects mainly the nose and throat. A cold makes one feel unwell, but still capable of carrying on with daily activities.</p><p>Flu is very infectious and easily spread to other people, especially in the first five to seven days after the first symptoms occur. It is spread by germs from coughs and sneezes, which can live on hands and surfaces for more than 24 hours. To reduce the risk of both catching and spreading the flu to others, these measures of precaution should be followed: washing hands regularly with soap and warm water after contact with respiratory secretions, covering nose or mouth and using tissues while coughing and sneezing, promptly disposing used tissues and cleaning surfaces like keyboards, telephones and door handles regularly to get rid of germs.</p><p>Most people with flu get better on their own. Bed rest, sleeping, keeping warm, taking paracetamol (acetaminophen) to lower the temperature and treat aches and pains and drinking plenty of water to avoid dehydration will help reduce the symptoms and speed up recovery in both the general population and pregnant women.</p><p>However, pregnant women and women who have just delivered and suspect they have the flu or have been exposed to the flu virus should seek medical advice and help. Those women should get the antiviral medication as soon as possible as they are more likely to develop severe illness. </p><p><b><i>by Dr. Tena Kovacevic - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> </p><p>Seasonal influenza epidemics are annually responsible for between 3 million and 5 million cases of severe illness and between 250,000 and 500,000 deaths worldwide.</p><p>Influenza is a viral infection that attacks the respiratory system, including your nose, throat, bronchial tubes and lungs.</p><p>The flu is caused by three types of viruses — influenza A, B and C. Type A is responsible for the deadly influenza pandemics (worldwide epidemics) that strike between every 10 to 40 years.</p><p>Young children, older adults, people with weakened immune systems and those with chronic illnesses are especially vulnerable.</p><p>Once you’ve had the flu, you develop antibodies to the virus strain that caused it, but those antibodies won’t protect you from new strains. That’s why doctors recommend getting a flu shot every year to protect against new emerging strains of the virus.</p><p>The flu vaccine is safe for children six months or older.</p><p>Influenza symptoms may start abruptly and progress rapidly. Some common signs and symptoms of the flu which may include the following:</p><ul><li>Fever above 38 degrees Celsius. Children with the flu tend to have higher fevers than adults have — often as high as 39 to 40 degrees Celsius.</li><li>Chills and sweats.</li><li>Headache.</li><li>Dry cough.</li><li>Muscular aches and pains, especially in your back, arms and legs.</li><li>Fatigue and weakness.</li><li>Nasal congestion.</li><li>Loss of appetite.</li><li>Diarrhoea and vomiting. Although children may have these signs, diarrhoea and vomiting are rare in adults.</li></ul><p>Treatment: If you’re young and healthy, influenza usually isn’t serious. But high-risk children and adults may develop complications such as ear infections, acute sinusitis, bronchitis and pneumococcal pneumonia.</p><p>Antibiotics: Are not effective against regular influenza but are effective against bacterial pneumonia that may develop after/during the influenza episode.</p><p>Anti-virals: In some cases, your doctor may prescribe an oral antiviral medication such as oseltamivir (Tamiflu) or zanamivir (Relenza).</p><p>These drugs work by deactivating an enzyme the virus needs to grow and spread. If taken soon after you notice symptoms, they may shorten your illness by a day or so. Both medications may cause side effects so discuss with your doctor. </p><p>In addition:</p><p>Drink plenty of liquids. Choose water, juice and warm soups to prevent dehydration. Drink enough so that your urine is clear or pale yellow</p><p>Rest up. Get more sleep to help your immune system fight infection.</p><p>Consider pain relievers. Use an over-the-counter pain reliever such as acetaminophen (Tylenol, Panadol) or ibuprofen (Advil, Motrin) cautiously, as needed.</p><p>In an epidemic situation there are steps which can be taken to prevent personal infection and help reduce spread, namely:</p><ul><li><i>Get an annual flu vaccination. The best time to be vaccinated is September or October. This allows your body time to develop antibodies to the flu virus before peak flu season, which in the Northern Hemisphere is usually December through March.</i></li><li><i>Wash your hands. Thorough and frequent hand-washing (at least 30 seconds) is the best way to prevent many common infections.</i></li><li><i>Healthy habits. Eat right, sleep well. A poor diet and poor sleep both lower your immunity and make you more vulnerable to infections.</i></li><li><i>Limit air travel (especially late fall).</i></li><li><i>Avoid crowds during flu season.</i></li></ul><p>If there is one important message for our readers then quite simply – it is vaccinate, vaccinate, vaccinate! </p><p><b><i>by Dr. William Brian McNaull — Family Medical Practice Hanoi </i></b></p>"
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"title": "Autism: Don’t let it be a lonely world",
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"value": "<p> </p><p><b>Understanding autism</b></p><p>Human beings are “social creatures”. We communicate through body language, gestures, facial expressions, sounds and verbal language. A child with autism, however, is unable to learn these social and communication skills. He has difficulty in understanding and developing a language; he won’t show interest in communicating with other children or adults, seeking their attention or paying attention to them. He won’t be able to interpret the meaning of gestures, body language and expressions. He will struggle to understand other people’s emotions. Some of these children may have limited interest in their surroundings. They will develop a strict and repetitive behaviour. They may play with the same toy repeatedly, often without understanding the nature of the toy (banging a toy car again and again, instead of “driving” it). They will not have an “imaginary friend” like other children at their age, won’t pretend to “cook” or “feed a baby” or tell imaginary stories.</p><p>Decades ago, autism was considered a form of mental retardation because of the inability of the patients to develop communication skills and language. But we now know that children with autism are not necessarily mentally retarded. In fact, many of them exhibit higher intelligence than the average child and some have extraordinary capabilities in different fields, such as memory, mathematics, arts and physics.</p><p><b>The spread of autism</b></p><p>The number of children identified as “autistic” has grown exponentially over the years:</p><p>* During the 1960s and 70s, the prevalence of autism was some 0.5:1,000 (one in every 2,000 children).</p><p>* In the 1980s, this number rose to 1:1,000.</p><p>* A decade ago it was 1:100.</p><p>* Today, in the United States, the prevalence of autism is estimated to be a frightening 1:68. (Boys are four times more likely to be affected than girls).</p><p>We now know that autism has a genetic basis. Over 800 genetic mutations have been associated so far with the condition. If one child suffers from autism, there is a higher risk for other children in the family. An identical twin of an autistic child has a much higher risk. Older fathers are at a greater risk of having autistic children.</p><p>Environmental factors have immense effect on our genes. Environmental pollution, such as air and water pollution, and exposure to heavy metals and other hazardous chemicals can alter our genes and make them brittle, increasing the risk of mutation and dysfunction. But even these factors do not explain the rise in autism cases.</p><p><b>Electromagnetic (EM) radiation</b></p><p>Exposure to electromagnetic radiation through mobile phones, Wi-Fi routers, cellular communication, radio and TV antennas and even high-voltage electricity lines has rapidly increased over the past four decades. These are all around us: on the streets, in shopping malls, cafes and restaurants, in our homes and even in our pockets.</p><p>The rise in autism cases has been shown to correlate to the rise in exposure to EM radiation, which in turn can have a damaging effect on our genes.</p><p><b>What are the red flags of autism</b></p><p>*A baby that does not have a “social reciprocal smile” by the age of two to three months.</p><p>* No proper eye contact.</p><p>* No interest in the surroundings by the age of six months.</p><p>* No “back and forth” sharing of voices (babbling back to parent) and expressions by nine months.</p><p>* No “separation anxiety” or fear of strangers by nine months.</p><p>* No understanding of non-verbal communication, such as gestures, by the age of one year.</p><p>* Lack of speech by the time the baby is 16 months old.</p><p>* No imaginary friend at one-and-a-half years.</p><p>* No meaningful two-word sentences by the age of two.</p><p>* Restricted behaviour and interest.</p><p>* Lack of interest in other children by the age of one-and-a-half years.</p><p>* Any loss of acquired social or communicative skills.</p><p>If a child shows any of these red flags, he should be evaluated by his paediatrician. A child suspected of autism should undergo a hearing test to rule out hearing loss. Sadly, some parents, upon being told about the suspicion of autism in their child, either object to or simply deny the existence of the condition. They prefer to believe that if they ignore the problem and do nothing, the child will get better by himself. As painful as it may be, parents need to understand that the earlier the child gets professional intervention, the better the outcome will be. With professional support, the child will be able to learn new ways of communicating and growing, while the parents will get the much-needed support to cope with the situation. </p><p> <b><i>by Dr. Jonathan Halevy. — Family Medical Practice HCMC</i></b></p>"
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"value": "<p> </p><p>For many kids in Hà Nội, the next few weeks are all about getting back to school after a long summer break. Whether your child is entering school for the first time or about to graduate, back-to-school time is a good opportunity for parents to check up on their children’s health and make sure they’re protected against common childhood diseases and illnesses.</p><p><b>Immunization Review</b></p><p>First on the list should be immunizations. Vaccination requirements can vary by schools. To find out exactly what is required at your child’s school, contact the school directly. A visit to pediatrician is recommended to review all vaccinations and make sure all necessary vaccines have been given. A series of vaccines may be given if they were missed or left incomplete at earlier ages.</p><p><b>Talk with your child’s school nurse</b></p><p>If you have concerns about your child’s health at school, you should set up an individual meeting with a school nurse and your child’s class teachers at the beginning of the school year. Most international schools in Hanoi have a nurse who is also an important part of the team as he/she can provide temporary care or a referral for your child in case of illness or injury on school property.</p><p>Both your child’s teacher and the school nurse are integral to developing a medical action plan for your child if he or she has an acute or chronic illness or asthma, severe allergies like food or bee stings.</p><p>Meet with your school nurse and teachers to determine school-specific policies for self-administration of medications by your child (for example, asthma inhalers). Children diagnosed with attention deficit hyperactivity disorder (ADHD) should also have a family discussion with both teachers and the school nurse and determine if an individualized educational plan is required. All schools in Vietnam must abide by laws regarding use of medications at school.</p><p><b>Does your school make the meal grade?</b></p><p>If healthy meals are a priority for you when sending your child to an International school or kindergarten in Hanoi, check out how your school stacks up. If your school does not make the grade, consider packing your own meals or encouraging your school to include healthier options.</p><p>Most schools provide a copy of their menu or post it in the school. Here are some important things to consider when checking out a school’s food service.</p><p>Is there balance in each meal? Balanced meals mean that there is some sort of protein (meat, seafood, tofu, or egg), starch (rice, potato, noodle, or bread), vegetable, and fruit. </p><p>Are the portions adequate to meet nutrition needs? Or is the meal 90 per cent starch with just a small serving of protein and vegetable? One serving of vegetable is ½ cup when cooked, and considering that school-age children need 3-4 servings per day, school lunches should at least provide one serving, if not two. </p><p>Do they provide a good variety? Do they alternate between watermelon and pears every day for snack or do they serve different types, depending on what is in season? Fruit is important because many varieties are good sources of vitamin C, and antioxidants which may play a role in cancer prevention and heart health. </p><p>Consider the source of your child’s food. If you buy organic at home, and avoid local milk, which has high suspicion of being laden with antibiotics and powdered milk bought from China, make sure that your child is not consuming those very foods at school. If the school does not provide milk from a trusted source, either have your child pack a cup in a cooler bag from home, or just skip it during the school day. </p><p>If there is a parent-teacher committee at the school your child attends, or they welcome feedback, urge them to use organic vegetables. There are several organic farms near or in Hà Nội now, which will reduce the risk that your child is consuming pesticides or other chemicals which cannot simply be washed off.</p><p>Lastly, talk to your child about what they are eating. If your child’s school has a reputation for terrible food, petition for change and if necessary, pack their lunch. If the school allows some choices, ask them what they eat and talk about making good choices. Most of an adult’s eating habits are established during childhood so consider that you have an opportunity now to help determine if your child will have a healthy, productive life, or if they will struggle with obesity or poor nutrition.</p><p><b>Backpack Problems</b></p><p>Overloaded backpacks can injure your child’s back. According to the American Pediatric Association, a child’s backpack should weigh no more than 10 per cent of his or her body weight.</p><p>If your child routinely lugs around more than what’s recommended for her weight, try purchasing a backpack with wheels or one with a support belt to help distribute the weight more evenly.</p><p><b><i>by Doctor Catherine Gonzalez - Family Medical Practice Hanoi.</i></b></p>"
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"value": "<p> </p><p><b>Raising healthy children is never an easy task. Add the extra challenge of moving to a new country with strange and exotic foods and vastly different cultural practices, and it’s easy to understand why many parents are left puzzled over how and what to feed their children. </b></p><p>Whether you are concerned that your children are eating too much, or too little, these basic principles can help you to establish healthy eating habits for your children. </p><p><b>Avoid Rewards</b>: The role of parents is to provide a variety of healthy foods and a calm environment for meals, whereas the child should decide what to eat and how much of each food to eat. Instead of the traditional approach of parents pushing their children to eat their vegetables and promising rewards such as sweets for eating their meals, dessert could even be served with the meal. Are you shocked? Actually, by using certain foods as “reward” or “treats” you cause children to believe they are actually better or more desirable. In addition, they may be overeating beyond their level of hunger in order to finish the meal to get the reward. Have you ever heard an adult say that they were rewarding themselves with chocolate or another high-calorie food? Habits established in childhood can lead to a lifetime of poor eating habits and overeating.</p><p><b>Don’t Be a Push-Over:</b> Another tendency is to just give children anything they want. Although there is no harm in occasional intake of sweets or high-calorie foods, frequent consumption of snack foods and those with little or no nutritional value can lead to malnutrition and unhealthy weight gain. Soda, snack chips, and ice cream are cheap and available on every street shop in Hà Nội. If your children are old enough to walk to the shops, chances are they are buying them. Even if your children are too young to go out on their own, many parents and house helpers crumble at their children’s cries for treats and often give in to make them happy. As difficult as it is, children need to understand that healthy eating is about balance. While ice cream one or two times per week is fine, a soda with every meal is not. Set healthy limits for your children to enjoy treats occasionally. Consider the nutritional value of the treat as well. Ice cream provides some protein and calcium, while soda and candy have nothing but sugar. </p><p><b>Be a Role Model</b>: In addition to having good boundaries about food choices, parents should also be mindful that children learn a lot about eating from their families. Children will quickly learn to avoid certain foods if their parents never eat them, or to try new foods if they see their parents eating them often. When parents offer a variety of foods at the meal, including vegetables, children will be more adventurous to try them. Instead of forcing children to eat vegetables, the simple act of them seeing you enjoy those foods will encourage them to try over time. Likewise, when children see their parents drinking soda or eating fast food, that, too becomes more desirable. </p><p><b>Get the Kids Involved</b>: Take your kids to the market or grocery store to pick out new foods and allow them to help plan meals. Children are much more likely to try something new if they were involved in picking it out or preparing it. Young children could help peel vegetables or mix ingredients for a salad. Older children could help prepare simple foods or even look on the Internet to find a new recipe and help make it. </p><p>No matter if your children are young, or older, these basic principles can help you establish a good foundation of healthy habits. Take advantage of the great variety of fresh fruit and vegetables available in Việt Nam while you are here and encourage your children to try something new. By modeling good habits rather than forcing or enticing your children to eat healthy foods, you will set a positive outlook on foods that will stay with them for life!</p><p>At Family Medical Practice Hanoi, nutrition consultation is available for healthy children, as well as those with nutrition-related concerns such as obesity and feeding problems. Consultation is based on background information about the child’s health and current measurements, and our pediatricians will work with you to ensure the optimal nutrition status of your child based on their needs and lifestyle.</p><p><b><i>by Dr. Philippe Jean Collin - Family Medical Practice Hanoi</i></b></p>"
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"title": "You don’t need to fear these flu vaccine myths",
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"value": "<p> </p><p>Brace yourselves: Flu season is coming. And along with the coughing, fevers and aches, you can expect a lot of unreliable or downright false information about the flu vaccine. While you can’t entirely germ-proof yourself or your children, you can learn to separate fact from fiction, keep your family healthier, and save time, money and frustration. Let’s start by putting some of the more common myths and misunderstandings to rest.</p><p><b>I still have time — flu season hasn’t started yet.</b></p><p>The timing of flu season is unpredictable. While it tends to peak from October to January, it’s hard to say when the virus will start making its rounds. Not only that, but it takes about two weeks for the vaccine to kick in. If you procrastinate, you could end up getting it too late in the season to help. And what’s worse than getting both a shot and sick?</p><p><b>I’m protected because I received the flu vaccine last year.</b></p><p>The virus strains can change every year, so last year’s vaccine may not be effective against this year’s virus strains. The World Health Organization (WHO) recommends that trivalent vaccines for use in the 2017-2018 northern hemisphere influenza season contain the following:</p><p>· an A/Michigan/45/2015 (H1N1)pdm09-like virus;</p><p>· an A/Hong Kong/4801/2014 (H3N2)-like virus; and</p><p>· a B/Brisbane/60/2008-like virus.</p><p><b>I can’t get a flu shot because I have a cold</b></p><p>As long as you don’t have a fever above 38 Celsius or any other significant illness, it’s okay to get the flu shot before your cold clears up.</p><p><b>Flu vaccinations are only for older people.</b></p><p>Not true! The US Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for anyone six months and older. Only in very rare cases does the CDC say people should not receive the flu shot, so you’re running out of excuses!</p><p>These are the following groups the CDC says should not get the shot:</p><p>People who have had a severe reaction to the influenza vaccine</p><p>People with a history of Guillain-Barre Syndrome after receiving the flu vaccine</p><p>People who are moderately or severely ill—they should wait until they’re better before being vaccinated</p><p><b>The flu shot will make me sick. </b></p><p>Flu shots are made with inactivated flu virus, which cannot give you the actual flu. The most common reaction is soreness or redness at the site of the injection. A very small percentage of people will get a low-grade fever and aches as their body builds up an immune response, but this will only last one to two days.</p><p><b>Antibiotics can kill the germs that cause colds and the flu.</b></p><p>Antibiotics work well against bacterial infections, but they don’t treat a viral infection like the flu. If someone develops a serious complication of the flu, such as pneumonia, then they need antibiotics. But antibiotics won’t help your flu at all and may actually cause unwanted side effects.</p><p><b>I’m pregnant so I should not get the shot.</b></p><p>Incorrect! The flu vaccine protects both you and your baby. The flu is, in fact, more likely to cause severe illness and complications if you’re expecting. It can also cause premature labor and other health issues for your baby. And here’s good news: the flu shot you get now will protect your baby after his or her birth.</p><p><b>Flu vaccines don’t work. I’ll probably catch the flu anyway.</b></p><p>Every year, scientists attempt to predict which strains of the flu virus will be most prevalent that fall. It’s a tough estimate, as the flu can mutate quickly over months, and sometimes even within a single season. But if you do end up catching the flu, you’ll have a much milder case of it if you got the vaccine. Flu vaccines reduce the risk of flu substantially, though their effectiveness in any particular year varies. The flu vaccine cuts your risk of getting the flu by 50 to 70 per cent.</p><p>So if you think the flu isn’t a big deal, then you’ve probably never had the flu. If you come visit Family Medical Practice Hanoi in October and November, you’ll see people of all ages, dehydrated and feeling miserable.</p><p>Even worse, certain groups of people are even more vulnerable and can develop deadly complications from the flu. Thousands of people die every year from the flu—as many as 49,000, and over 200,000 are hospitalized.</p><p>It’s that time of the year again—flu shot time. Go get your flu shot! </p><p><b><i>by Dr. Philippe Jean Collin - Family Medical Practice Hanoi</i></b></p>"
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"title": "THE PROBLEM OF PERFECTIONISM",
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"value": "<p> </p><p>Most often when people think of mental health problems, they think of depression or anxiety or something more serious, like schizophrenia. But there are other patterns of thinking that can cause inner turmoil or unhappiness. One of these is <b>perfectionism</b>. It is an internal system that often starts out as a mindset to inspire success, but which can lead to chronic feelings of failure and frustration.</p><p>Most of us are taught that having goals, high standards and lofty expectations is a good thing. These habits can motivate ourselves, and others, to strive toward a particular desirable outcome. When we are able to will ourselves to achieve our goals we feel a sense of accomplishment, which might be called efficacy: the ability to make a plan and carry it out. Goals give us targets to shoot for and help us place our everyday efforts in the broader context of our striving towards the future. Our goals might be in line with our values and ideals. They might reflect what could be our perfect or ideal self. It might be difficult to see what can go wrong with this kind of thinking.</p><p>Our goals and ideals always exist in the hypothetical realm, in what we can imagine. They can become the dream that exists in the cloud of what is possible. And while they may serve as a source of inspiration and motivation, they can also be beyond our reach. How we react when our dreams are unattainable determines whether positive ambition has become unhealthy perfectionism.</p><p>Perfectionists start to believe that what they expect of themselves is always possible and that failure to attain their goals is a failure of the will. While there is value in determination and increasing efforts to meet new challenges, it is a recipe for frustration, anxiety and a sense of failure. When we expect ourselves to be perfect we will inevitably fail. It is common for a perfectionist who accomplishes a goal to devalue that accomplishment while raising the standard for the next goal. They start to chase higher goals, but feel that nothing is enough.</p><p>It is not uncommon for high-functioning people to come to see me at a time when they have faced a challenge that is beyond their ability. They have experienced frustration, anger and anxiety, while feeling like their lives are “out of control”. The only method they have employed is to try harder, to double their efforts, which only serves to frustrate them more.</p><p>Perfectionists are desperate to feel “in control”. They tend to think in terms of either/or, all-or-nothing. While they have accrued a lot of evidence that holding oneself to high standards works, they have not fully embraced the truth that they are human and can never be perfect. They have forgotten or never learned that we cannot live up to what we can imagine ourselves to be. We have to get grounded in reality and discover what is realistic.</p><p>The important step in the process of grounding ourselves is to figure out the line between what is and what is not inside our control. When we realize those limitations we can let go of unrealistic expectations. Secondary control is the way that we let go of what is unrealistic and release ourselves from the frustration, anger, anxiety and all the self-judgment that we heap on ourselves for “failing”.</p><p>It is important to note that this is a system that is often learned. Parents can hold expectations for their children to set goals and to work hard to achieve them—surely a positive and nurturing attitude. But they can inadvertently send the message that the child’s value and worth are connected to their performance. Performance becomes part of a child’s identity and can catch them in the trap of perfectionism.</p><p>Recently I met with a 16 year-old student who was thinking of suicide. She said that she had always been an excellent student, attaining all “A’s”, but now she is finding it difficult to achieve these grades, no matter how hard she tries. The more she feels like she is failing and disappointing her family, who want her to study abroad, the more depressed she gets. This is a downward spiral, one she does not know how to stop. It is clear from the outside that her expectations and ideal self are not in line with what she is currently able to do. Acceptance of that truth is necessary for her to release herself from the stress she is under. Her identity is too linked to her performance and to goals that are possibilities, but should not be expectations. Parents can help in situations like this by rewarding effort and accepting the outcome, whatever it might be.</p><p>Being realistic, rather than perfectionistic, we factor in many variables that might not be considered in our hypothetical expectation. We encounter obstacles outside ourselves and emotional challenges inside ourselves. With empathy, compassion and acceptance we improve the likeliness of our own success, and can learn to feel good about our hard work and dedication, whatever outcome it may produce. </p><p><b><i>by Douglas Holwerda - Family Medical Practice Hanoi</i></b></p>"
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"title": "Non-invasive prenatal testing (NIPT) – a \"diagnostic\" revolution",
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"value": "<p> </p><p>A test that was introduced into clinical practice just a few years ago completely revolutionised prenatal testing and gave confidence to both pregnant women and their healthcare providers. It is called the Non-Invasive Prenatal Test (NIPT), or more accurately, the cell-free DNA test.</p><p>In many countries, invasive procedures such as amniocentesis (a medical procedure where a small amount of amniotic fluid is taken for analysis by inserting a thin needle into the abdomen and the uterus) are still offered as a first line method for detecting babies with Down’s syndrome and other aneuploidies in women after certain maternal age, mostly after age of 35.</p><p>Unfortunately, invasive procedures carry small but still significant risks of an unwanted miscarriage. Therefore, NIPT, as a safe and accurate test, is a great, relatively new option to screen not only those “high risk” women, but all pregnant women, before opting for an invasive procedure.</p><p><b>What are aneuploidies?</b></p><p>Most human cells consist of 46 chromosomes organized into 23 pairs. The 23rd pair is a pair of sex chromosomes named X and Y. Aneuploidy is the presence of an abnormal number of chromosomes in a cell, for example a human cell having 45 or 47 chromosomes instead of the usual 46. An extra or missing chromosome is a common cause of genetic disorders, including some human birth defects. Most cases of aneuploidy result in miscarriage. Among live births, the most common extra chromosomes are chromosomes 21, 18 and 13 resulting in aneuploidies called Trisomy 21, also known as Down’s syndrome, Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau syndrome).</p><p><b>How can we detect babies with aneuploidies?</b></p><p>Babies suspected for aneuploidies can be found during pregnancy by special screening methods and confirmed by diagnostic procedures like Chorionic Villus Sampling (CVS) or Amniocentesis. Combined test (a test that includes biochemistry, ultrasound, maternal age, risk factors) performed in the first trimester has been a gold standard among screening tests for aneuploidies, but diagnosis of fetal aneuploidies still relies on invasive testing, either CVS that is performed in the first trimester, or amniocentesis that is performed in the second trimester of pregnancy.</p><p>Invasive procedures might still be the only diagnostic option, but they also carry the risk of an unwanted miscarriage.</p><p><b>What is NIPT?</b></p><p>Non-invasive prenatal test (NIPT) is a safe, simple and highly accurate prenatal screening blood test that was first introduced into clinical practice around five years ago. It outperforms any other screening strategy described to date.</p><p>NIPT detects trisomies 21, 18 and 13 with an accuracy of more than 99%. Its’ accuracy for detecting babies with Down’s syndrome almost matches that of an invasive procedure. In addition to detecting trisomies 21, 18 and 13, NIPTs offer the possibility of detecting the sex of the baby, sex chromosome aneuploidies and microdeletions. The sex of the baby is reported according to parental preference.</p><p>NIPT can be performed as early as 10 weeks into a pregnancy.</p><p>Although most women would likely opt for the whole NIPT “menu”, most obstetricians and institutions recommend NIPT for detecting trisomies 21, 18, 13 and the sex of the baby, and not for screening for sex aneuploidies or microdeletions.</p><p><b>How does NIPT “work”?</b></p><p>During pregnancy, maternal blood carries short DNA fragments called fetal cell-free DNA that originate from the placenta. By analyzing those fragments, an extra or a missing chromosome can be detected. NIPT only requires a standard blood draw procedure from a pregnant woman who is at least 10 weeks pregnant. Blood is drawn into a tube or two tubes packaged in a special kit and are sent to a laboratory for analysis.</p><p>Most results will be available in 5 to 7 working days.</p><p><b>Is NIPT the right test for you?</b></p><p><i>“All women, regardless of maternal age, should be offered prenatal assessment for aneuploidy“ (ACOG, 2012)</i></p><p>NIPT has been clinically validated in both high risk and low risk populations and can be used in any pregnancy. It can be used in both singleton and twin pregnancies, as also in pregnancies from the IVF (in vitro fertilization) procedure.</p><p>The fact is that the risk for having a baby with an aneuploidy rises with age. However, aneuploidies can be found in women of any age group, thus screening for aneuploidies is recommended to every pregnant woman regardless of age or a risk group.</p><p>If a pregnant woman makes a clear decision to perform an NIPT in pregnancy, I would suggest doing it as a first line screening as early in the pregnancy as possible (between 10 and 11 week gestation).</p><p>Otherwise, if a combined test (1st trimester test that includes maternal age, risk factors, ultrasound measures and biochemistry) has been performed as a first line screening, then NIPT should or should not be performed based on the combined test results.</p><p>However, results that we get from the NIPT are the ones we rely on if compared to any other screening test for aneuploidies available for pregnant women. But it should be noted that a positive result from the NIPT should be confirmed by an invasive diagnostic procedure.</p><p>In conclusion, NIPT is a safe, simple, highly accurate and reliable test that every pregnant woman should know and be informed about. The decision whether to take the test, when and why, relies on both the pregnant woman and her family and the doctor that is following her pregnancy.</p><p>Every pregnant woman is special, has her own medical history and special needs, therefore an individual approach should be stressed. </p><p><b><i>by Dr. Tena Kovacevic - Family Medical Practice Hanoi</i></b></p>"
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"id": 1325,
"title": "Construction sites are a source of sickness",
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"value": "<p> </p><p>I recently had a three-year-old child suffering from recurrent runny nose, ongoing cough, sneezing and sometimes sticky red eyes for three months. He was previously a healthy child, but now he has these symptoms almost daily. He was prescribed many different types of medications for coughing, allergies together with antibiotics. This sometimes helped, but as soon as he stopped taking them, he would become sick again. His mother was concerned his immune system was weakening. After questioning the mother, we found out that just before the child became sick, a construction site started not far from their home.</p><p>Having a construction site in your neighbourhood where they demolish, build or renovate an apartment, house, road or bridge, is much more damaging than just the noise that doesn’t let you sleep. The heaviest toll is air pollution.</p><p>Even if you don’t live next to a construction site or a busy street, you are still exposed to high levels of air pollution. Most who live in big cities, like Hanoi and HCMC, are well aware of the horrible air full of dust, smoke and harmful gases. Exposure to air pollution and little particles of dust cause us to suffer from repeated stuffy noses, cough, sinus problems and eye infections.</p><p>It’s not just the regular dust found in every home. Construction dust contains many different types of chemicals, cement dust, heavy metals, synthetic fibres, sawdust and even asbestos (lung cancer) and silica (chronic lung disease)</p><p>Fumes from cars, trucks, bulldozers, generators and other fuel-operated machinery in and around the site contribute significantly to the pollution of the air we all breathe. Radon is a radio-active gas released from the soil. At construction sites, its levels increase as it is released into the atmosphere. Radon is one of the leading causes of lung cancer (second to cigarette smoking)</p><p>Aspergillus is a fungus (mold) that is ubiquitous in soil. During construction, renovation or demolishing of buildings. it spreads easily into the air and may cause significant respiratory problems and chronic allergy symptoms to those living nearby.</p><p>Construction sites promote infestations, such as rats and cockroaches. These animals can shed their skin into the environment. These are known strong triggers of allergies and asthma.</p><p>Chemicals and heavy metals from construction sites can be absorbed into the soil and water in the neighbourhood and cause further pollution and health problems.</p><p>Air borne chemicals and dust particles can also cause irritation to kin and eyes and cause dermatitis (skin inflammation) and eye infections (stye, conjunctivitis)</p><p>The construction site doesn’t have to be next door. It can be hundreds of meters away and still have a heavy effect on child health. The same goes for construction sites near schools and kindergartens.</p><p>I see many children from different areas of the city who suffer from chronic nasal congestion, sinusitis and enlarged adenoids, chronic bronchitis, asthma and eye infections because their immune system is desperately trying to fight a lost battle with air pollution.</p><p>First, there is a simple way you can tell if your environment is dusty or not: Take a large piece of paper (A4) and leave it on a shelf at your home without touching or cleaning it. Observe the paper for four to five days. Take a picture once a day and see the difference. It will give you an idea on how much dust you have at home.</p><p>Some children may be more sensitive than others. If your child is allergic to dust (more accurately, dust mites) then he is likely to suffer from more severe symptoms.</p><p>There are ways to help reduce exposure to dust and pollution. If you live near busy roads or construction sites, you may need to keep your windows closed.</p><p>If you use air conditioners, make sure the filters are cleaned frequently, at least monthly. These filters tend to accumulate dust and mold and spread them into the room. </p><p>Vacuum clean your home with HEFA filters daily. Remove objects that may accumulate dust from your child’s room (carpets, heavy curtains, furry toys, pillows).</p><p>Clean and air bed sheets and mattresses frequently. If you live near construction sites, busy roads or in a dusty neighbourhood, use a facemask every time your child leaves home. They may help reduce exposure to large dust particles. Unfortunately, most are not useful against tiny particles, chemicals or gases. Sometimes, taking a holiday on the beach where the air is clean can do wonders for your health.</p><p><b><i>by Dr Jonathan Halevy - Family Medical Practice in HCM City</i></b></p>"
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"title": "Antibiotic abuse leads to disaster",
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"value": "<p> </p><p>Many people die from infections caused by resistant bacteria. The culprits include<i> Escherichia Coli</i>, <i>Klebsiella Pneumoniae</i> and <i>Staphylococcus Aureus.</i> Whenever antibiotics are used in excess or in bad conditions, bacteria can mutate and become difficult to eradicate. If nothing is done, there will be no recovery for ordinary infections - and low-risk surgical operations could become life-threatening.</p><p>The resistance of bacteria to antibiotics has become a major health problem. Some people already imagine a disaster scenario. By 2050, these "super-bacteria" could be responsible for 10 million deaths worldwide, as much as cancer today.</p><p>An overconsumption of antibiotics in farm animals creates resistant bacteria that can be transmitted through the food chain.</p><p>Antibiotics can be a necessary evil, especially if you use them to get rid of bacterial, parasitic or fungal infections. But if you think antibiotics fight all colds, flus, or other viruses, then you’re wrong!</p><p>For example, antibiotics do not work if you have a viral infection. In addition to not fighting the virus, taking antibiotics when you do not need them can develop resistance, which makes your body resistant to medication.</p><p><b>The nine dangers of antibiotic abuse</b></p><p><b>Longer illnesses</b></p><p>Antibiotic resistance results from the abuse of antibiotics. This means that when you need these antibiotics, they may not work. Because germs become resistant to treatment, you may stay ill longer than normal.</p><p><b>More expensive healthcare</b></p><p>Because antibiotic treatments will no longer be enough to cure your disease if you are resistant, your bill will increase because of longer visits to the hospital and more expensive drugs.</p><p><b>Additional visits to doctors</b></p><p>The more antibiotics you use to treat colds, flus or other viral infections, the more they will become ineffective against the bacterial infections they are supposed to treat. For this reason, you will need to visit your doctor more often to treat your illness.</p><p><b>Higher risk of spreading diseases</b></p><p>When the human body becomes resistant to antibiotics, the bacteria become resistant to treatment. This means that when you are sick, you will be more likely to spread the disease to others, putting your family and colleagues at risk.</p><p><b>Unsafe alternative treatments</b></p><p>People who are resistant to antibiotics will often have to multiply the treatments before finding the one which will treat the disease. When first-line antibiotics are not effective, your doctor will need to prescribe less used drugs, some with damaging side effects.</p><p><b>Expensive tests, indirect health costs</b></p><p>The additional costs of antibiotic resistance can double or triple when the patient requires medical tests, treatment, hospitalization and absence from work due to inability to treat the disease properly.</p><p><b>Wrong medication</b></p><p>People who are resistant to antibiotics also tend to take their medications incorrectly. For example, they can take in excess or not enough if they start to feel better. Failure to complete the medication prescribed by the doctor may not kill the bacteria involved, and you will remain ill.</p><p>On the contrary, taking too much medicine can destroy the beneficial bacteria in the digestive system, causing other problems.</p><p><b>Abuse of dangerous drugs</b></p><p>You may think that it is a good idea to keep unused antibiotics and re-use them later or pass them on to friends or family, but without informed medical advice, you could endanger your health or that of another by taking inappropriate medication for that particular disease.</p><p><b>Risking your life and others</b></p><p>In rare cases, antibiotic resistance can cause severe health complications and death if patients resist treatment, especially in people with reduced immunity, such as the elderly , infants, or those who are very sick (i.e: cancer, AIDS) </p><p><b><i>by Dr. Philippe Jean Collin - Family Medical Practice Hanoi</i></b></p>"
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"title": "Yeast infection - do you need to see a doctor?",
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"value": "<p> </p><p>If you are a woman reading this article, it is very likely you have already had, you do have or you will have a vaginal yeast infection once in your life.</p><p>Vaginal yeast infections are a common problem in women and one of the most common causes of vulvovaginal itching and discharge. This type of infection is caused by a fungus called "Candida" therefore “vulvovaginal candidiasis” is the term we (doctors) use instead. Candida species are part of the normal vaginal flora of approximately 25 per cent of women.</p><p><b>What are the symptoms of a yeast infection?</b></p><p>Itching of the vulva is the most common symptom of a vulvovaginal yeast infection. However, women may also note pain during urination, soreness or irritation, pain during intercourse, or reddened and swollen vulvar and vaginal tissues. There is often little or no vaginal discharge. If present, discharge is typically white and clumpy (like cottage cheese) or thin and watery. Symptoms of a yeast infection are similar to a number of other conditions, thus a physical examination and laboratory testing are needed to determine the cause of symptoms.</p><p><b>How do you know if your symptoms are caused by a yeast infection?</b></p><p>Most women cannot tell whether they have a yeast infection or something else. Only about 10 per cent of women who have never had a yeast infection will accurately diagnose their infection. The symptoms of a yeast infection are a lot like the symptoms of many other conditions including bacterial vaginosis (a bacterial infection of the vagina), trichomoniasis (a sexually transmitted infection), and dermatitis (irritated skin), so it is hard to tell. The best way to find out if you have a yeast infection is to see your gynecologist who will examine your vulva and vagina. He or she will also swab the vagina to get a sample of discharge, which will be examined under a microscope in a lab.</p><p>I would advise you not to begin any kind of treatment at home until it has been confirmed that you have a yeast infection! Diagnosing and treating yourself (incorrectly) wastes money (on non-prescription treatment), wastes time as you will not feel better until you use the right treatment and can make you itchier and irritated. For these reasons, it’s important to see your gynecologist to confirm that you actually have a yeast infection before beginning the treatment.</p><p><b>How did I get a yeast infection?</b></p><p>In most women, there is no underlying health problem that leads to a yeast infection. The fungus that causes yeast infections (named Candida) lives in the gastrointestinal tract and sometimes the vagina. Normally, Candida causes no symptoms. However, when there are changes in the environment of the gastrointestinal tract and vagina, Candida can overgrow and cause the symptoms described above.</p><p>Here are several risk factors that may increase the chances of developing an infection.</p><p>Use of broad-spectrum <i>antibiotics</i> significantly increases the risk of developing vulvovaginal candidiasis. As many as one-quarter to one-third of women develop the disorder during or after taking these antibiotics because antibiotics kill a wide variety of bacteria, including those that normally live in the vagina and protect the vagina from the overgrowth of yeast.</p><p>Women with <i>diabetes mellitus</i> are at higher risk of yeast infections, especially if their blood sugar is not well controlled.</p><p>Vulvovaginal candidiasis appears to occur more often in the setting of <i>increased estrogen levels,</i> such as oral <i>contraceptive use, estrogen therapy and pregnancy.</i> (Vaginal discharge becomes more noticeable during pregnancy, although yeast infection is not always the cause!)</p><p>Candida infections are more common in <i>immunosuppressed women</i>, such as those taking glucocorticoids or other immunosuppressive drugs, or with human immunodeficiency virus (HIV) infection.</p><p>The role of various contraceptive devices and sexual behaviors on the risk of yeast infection is less clear.</p><p>There is no good evidence showing a link between vulvovaginal candidiasis and hygienic habits or wearing tight or synthetic clothing.</p><p>Vaginal yeast infections are not a sexually transmitted infection. They can occur in women who have never been sexually active, but are more common in women who are sexually active.</p><p><b>How are yeast infections treated?</b></p><p>Treatment is indicated for relief of symptoms. Ten to 20 per cent of reproductive-age women who harbor <i>Candida</i> species are asymptomatic (do not have any symptoms). These women do not require therapy! </p><p>A variety of oral and topical preparations, like pills taken by mouth, vaginal tablets and creams are available for the treatment of yeast infections. Many of them are available over the counter. Every patient should be approached and treated individually based on whether she has an uncomplicated or a complicated infection (i.e. pregnant women, women with more than 3 infections per year, etc.).There is no evidence that eating yogurt or other "probiotic" products containing live Lactobacillus acidophilus, or applying these products to the vagina, is of any benefit in women with recurrent vaginal yeast infections.</p><p>As I mentioned above, vaginal yeast infection is not a sexually transmitted infection, although the infection may rarely be passed from one partner to another thus <i>I do not recommend treatment of a sexual partner.</i></p><p><b>When will you feel better?</b></p><p>Most yeast infections go away within a few days of starting treatment. However, you may continue to feel itchy and irritated, even after the infection is gone. If you do not get better within a few days after finishing treatment, you should call your doctor or nurse for advice.</p><p><b>What if you get yeast infections often?</b></p><p>Be sure to consult your doctor about it. That way you can find out for sure whether your symptoms are caused by a yeast infection and, if so, which type of yeast. There are a few different types of yeast, and they respond to different treatments. Plus, the same symptoms that you get with a yeast infection can sometimes be caused by other types of infections, an allergy, or other problems. Furthermore, if you get frequent infections, you might need a different treatment than you have tried in the past. </p><p><b><i>by Dr. Tena Kovacevic - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> </p><p>When was the last time you visited your gynaecologist?</p><p>If you are older than 21 and it has been more than a year since your last visit, now might be a good time to schedule an appointment.</p><p>Women often ask me when they should see me and what would be the best time to bring their daughters for a consultation. The American College of Obstetricians and Gynaecologists recommends the first visit between 13 and 15 years. While pelvic examination is rarely required during the first few visits, the annual examination that starts early in life helps to establish a close doctor-patient relationship. Women, regardless of their age, should be encouraged to openly discuss with their doctor about their menstrual cycle, methods of birth control, how to protect against sexually transmitted diseases, etc.</p><p>Screening tests begin at the age of 21, and every woman aged 21 or older should see a gynaecologist to evaluate symptoms or concerns as well as get screened for cervical cancer by a simple, quick procedure called Pap test and for genital tract infections.</p><p>Traditionally, an annual pelvic examination (with or without ultrasound), combined with a Pap test, has been a standard practice for all adult women. But in recent times, the goals and outcomes of an annual pelvic examination in women with no symptoms have been questioned. While Pap test guidelines have changed, and many women require screening for cervical cancer only once every three to five years, an annual pelvic examination should not be equated with a Pap test. A Pap test comprises only one small component of the pelvic examination.</p><p>Women should be encouraged to have at least a brief consultation with their gynaecologists every year, irrespective of whether they are due for a Pap test. In fact, any gynaecological problem is often first detected in an annual examination.</p><p>A woman should see her gynaecologist if she has an irregular menstrual cycle, if her periods have stopped or last for many days, if she gets painful cramps or if sex becomes painful. A routine ultrasound can identify the underlying cause.</p><p>Vaginal discharge is also something to keep an eye on. A bad odour or discharge from the vagina is a sign of infection and if left untreated, or is self-treated, the problem can quickly get worse. It is always smarter to visit a gynaecologist rather than treat infections by yourself.</p><p>If you are sexually active and are not planning pregnancy, contraception is one of the topics that need to be discussed with your gynaecologist. Every woman is different and there are plenty of options today, so contraceptive counselling and individualised selection of “the best fit” contraceptive is an important matter to be discussed with your gynaecologist rather than picking it out by yourself.</p><p>Regarding breasts, breast examinations are mostly recommended for women above 40, although earlier examinations are needed if a history of breast cancer runs in the family. A regular breast examination is crucial for early detection of breast cancer. Every woman should be aware that diseases such as breast, cervical and ovarian cancer have few obvious symptoms, and earlier detection increases the chances of survival.</p><p>In conclusion, avoiding routine yearly gynaecological examinations increases the risk of unintended pregnancy and pelvic infections and might potentially delay infertility treatments and pregnancy. While recent trends suggest that annual pelvic examination is now a thing of the past for some women, one must realise that annual appointments with your gynaecologist are still important.</p><p>It may not be every woman’s favourite appointment, but a pelvic examination is indispensable to a woman’s overall health. </p><p><b><i>by Dr. Tena Kovacevic – Family Medical Practice Hanoi</i></b></p>"
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"title": "Sexually transmitted infections no joke",
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"value": "<p> </p><p>Sexually transmitted infections (STIs) are mostly acquired by sexual contact. The organisms that cause sexually transmitted diseases may pass from person to person through blood, semen or vaginal and other bodily fluids. STIs commonly (but not exclusively) include Human Papilloma Virus (HPV), chlamydia, herpes, gonorrhoea and, less frequently, HIV and syphilis. Occasionally, STIs can be transmitted non-sexually too, such as from mother to infant during pregnancy or childbirth.</p><p>STIs can have a range of symptoms, sometimes including no symptoms at all. Some of the signs that might indicate an STI include:</p><ul><li>Painful or burning urination</li><li>Discharge from the penis</li><li>Genital, oral or rectal nodules or ulcers</li><li>Unusual vaginal discharge or bleeding</li><li>Pain during sex</li><li>Painful groin lymph nodes</li><li>Lower abdominal/pelvic pain</li><li>Fever</li><li>Rash</li><li>Neurological symptoms</li></ul><p>The symptoms may appear a few days after exposure and sometimes after many years. If you think you may have been exposed to an STI or are experiencing any of the above symptoms, get tested/screened immediately.</p><p><b>Factors increasing the risk of transmission of STIs</b></p><p>Having unprotected sex. Vaginal or anal penetration by an infected partner who does not use a latex condom significantly increases the risk of STI. Oral sex may be less risky, but infections can still be transmitted without a condom.</p><p>Sexual contact with multiple partners. The more people you have sexual contact with, the greater your risk.</p><p>The presence of one STI makes it much easier for another STI to be transmitted.</p><p>Substance abuse (alcohol) can cloud your judgment, making you more likely to participate in risky behaviour.</p><p>Sharing of needlescan spread many serious infections, including HIV, hepatitis B and hepatitis C.</p><p>Age: Fifty per cent of STIs occur in people between the ages of 15 and 24.</p><p><b>Screening</b></p><p>As many people in the early stages of an STI experience no symptoms, screening for STIs is important to prevent complications.</p><p>Untreated STIs can manifest weeks or even years later as:</p><ul><li>Infertility</li><li>Eye inflammation</li><li>Arthritis</li><li>Painful pelvic inflammatory disease</li><li>Complications in pregnancy</li><li>Heart disease</li><li>HPV-associated cervical and rectal cancers</li></ul><p><b>Prevention</b></p><p>Here is how to avoid or reduce your risk of sexually transmitted infections:</p><ul><li>Abstain from unprotected sex. This is the most effective way to avoid STIs.</li><li>Have a long-term mutual monogamous relationship with a partner who is not infected.</li><li>Think before you act. Avoid vaginal and anal intercourse with new partners until you have both been tested for STIs. Screening tests are now accurate and precise but much less so for genital herpes for both the genders. Moreover, screening for HPV is not available for men.</li><li>Vaccinate. HPV vaccination is available and should ideally be administered to both boys and girls aged 11-12. If that is not possible, then both should get vaccinated by the age of 26.</li><li>Communicate. Before any serious sexual contact, communicate with your partner about practising safe sex. Reach an explicit agreement about what sexual activities will and won’t be acceptable.</li></ul><p><b><i>by Dr William Brian Mcnaull - Family Medical Practice</i></b><b> </b><b><i>Hà Nội</i></b></p>"
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"title": "ABCDE: the alphabet soup of Hepatitis",
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"value": "<p><b>World Hepatitis Day falls on July 28. Hepatitis B is a matter of concern in Việt Nam, with at least 5 per cent of the population infected. Most people have heard of Hepatitis A&B, but not everyone knows that there is also Hepatitis C, D, and E. While A&B can be prevented by vaccination, the other three cannot. </b></p><p>Although there are variations in the symptoms between the different viral liver infections, the following signs and symptoms generally occur in all acute infections:</p><p>Fever, fatigue, loss of appetite, nausea, vomiting accompanied by abdominal pain, dark urine, clay-colored bowel movements, joint pain and jaundice.</p><h4><b>Hepatitis A – Acute Illness</b></h4><p>Incubation period averages 28 days. Mortality is <0.1 in child/teenage years but 2% over 40 years old. Hepatitis A is usually spread when the virus is taken in by mouth from contact with objects, food, or drinks contaminated by the feces (or stool) of an infected person. A person can get Hepatitis A through:</p><p>Person to person contact: when an infected person does not wash his or her hands properly after going to the bathroom and touches other objects or food. Contaminated food or water: Hepatitis A can be spread by eating or drinking food or water contaminated with the virus. Poor sanitary conditions or poor personal hygiene exacerbate the spread. The food and drinks most likely to be contaminated are fruits, vegetables, shellfish, ice, and water. Chlorination of water kills Hepatitis A virus that enters the water supply.</p><p>Vaccine available.</p><h4><b>Hepatitis B – Chronic Infection when acquired pre-puberty: Acute infection with resolution when acquired as adult (as a general rule).</b></h4><p>Incubation period averages 90 days. Acute infection mortality is < 1%. There are 2 major modes of transmission of HBV [i] transmission through activities that involve percutaneous (i.e., puncture through the skin e.g. injection drug use that involves sharing needles, syringes, or drug-preparation equipment. Needle sticks or sharp instrument exposures or even sharing items such as razors with an infected person. [ii] Mucosal contact with infectious blood or body fluids (e.g., semen, saliva), including sex with an infected partner, birth to an infected mother.</p><p>In Viet Nam this is a very important disease with between 5 and 10% of the population being actual ‘carriers’ of the disease. For nearly all Vietnamese affected, it is mucosal contact (saliva) which is the mode of transmission, occurring at an early age or at birth from an infected mother. <i>Usually no symptoms are present when the disease is acquired before puberty but nearly all become chronic carriers</i>.</p><p>Hepatitis B is acquired principally in the ‘developed’ countries as an STD resulting in severe symptoms initially, but total immunity develops upon recovery, usually. Chronic infection may have significant consequences for the individual (Cirrhosis, liver failure and /or liver cancer [HCC]) There are 350 million persons infected worldwide. An estimated 620,000 persons worldwide die of chronic-HBV related liver diseases each year.</p><p>Vaccine available.</p><h4><b>Hepatitis C - Chronic infection</b></h4><p>Incubation period averages 55 days (range 4-12 weeks). Mortality is rare from acute infection. Perhaps the most ‘talked about’ hepatitis in the West is Hepatitis C. About 15-20% of acute infection resolves spontaneously, the remainder go on to be chronic carriers of the disease with consequences ranging from mild sequelae to very severe (Cirrhosis, liver failure, cancer).</p><p>The following persons are at known to be at increased risk for HCV infection: Current or former injection drug users, including those who injected only once many years ago and cocaine ‘snorters’. Recipients of blood transfusions/clotting factors or solid organ transplants before July 1992, when better testing of blood donors became available. Chronic hemodialysis patients. Persons with HIV infection have increased risk of co-infection. History of tattoos should also be considered. Children born to HCV-positive mothers have about a 6% chance of transmission at birth.</p><p>No vaccine available.</p><p><b>Hepatitis D</b> – <b>Chronic infection mainly</b></p><p>Also known as "delta hepatitis". This is a serious liver disease caused by infection with the Hepatitis D virus (HDV), which is structurally unrelated to the Hepatitis A, B or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in most parts of the world. HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with the Hepatitis B virus (HBV). HDV is transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a co-infection with HBV or as super-infection in persons with HBV infection. So you need to have <b>B</b> already to get <b>D</b>.</p><p>No vaccine for Hepatitis D (prevented in persons who are not already HBV-infected by Hepatitis B vaccination).</p><h4><b>Hepatitis E – Acute illness</b></h4><p>Symptoms on average occur 40 days after exposure. Mortality is <4 %. HEV infection usually results in a self-limited, acute illness. It is widespread in the developing world.</p><h4><b>Hepatitis E is most common in developing countries with inadequate environmental sanitation. Hepatitis E epidemics have been reported in Asia, the Middle East, Africa, and Central America. Some epidemics of Hepatitis E have involved tens of thousand of persons affected over a short period of time. People living in refugee camps or overcrowded temporary housing after natural disasters can be at particular risk.</b></h4><p>Hepatitis E virus is usually spread by the fecal-oral route. The most common source of infection is fecally contaminated drinking water.</p><p>No vaccine available .</p><p><i>by Doctor William Brian McNaull - Family Medical Practice Hanoi</i></p>"
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"value": "<p> </p><p>The old adage, “Prevention is better than cure,” holds true today. There are 14 potentially serious diseases that can be prevented in children less than 2 years old with vaccines.</p><p>Following the recommended vaccination schedule ensures protection before the child is exposed to the disease. </p><p>Vaccines contain weakened or killed antigens (substance of the bacteria or virus that causes disease), and hence they not pose a threat to the immune system. These antigens are only a small portion of antigens that babies are continually exposed to everyday.</p><p>Listed below are the 14 vaccine-preventable diseases and the vaccines that prevent them. Almost all these diseases are transmitted via air and direct contact, and hence not easy to avoid without added protection.</p><p><b><i>Diphtheria</i></b> symptoms include fever, sore throat, enlarged lymph nodes and body weakness. It can cause complications like heart failure, paralysis, coma and death.</p><p><b><i>Pertussis</i></b> manifests as severe cough, runny nose, breathing pauses (apnea), and can later develop into pneumonia (lung infection), which could prove fatal.</p><p><b><i>Tetanus</i></b> can be spread via exposure through cuts in the skin. Symptoms include neck and abdominal muscle stiffness, muscle spasm, lock jaw, and can later cause breathing difficulties and death.</p><p>The <b><i>DTaP vaccine</i></b> protects against these 3 diseases and is administered in 4 doses before the child turns 2, and one more dose at 4-6 years old.</p><p><b><i>Poliomyelitis </i></b> may initially manifest as fever, headache, nausea and sore throat which can later lead to paralysis and even death. This disease can be prevented by the <b><i>IPV vaccine</i></b> which is also administered in three doses before the baby is 2 months old, and another dose when he/she has grown to 4-6 years old.</p><p><b><i>Measles</i></b> manifests as fever, rash, cough and colds with pink eye. It can lead to Pneumonia, encephalitis (brain swelling) and death.</p><p><b><i>Mumps</i></b> manifests in several symptoms including swollen salivary glands, fever, muscle pain and easy fatigability. It can lead to complications like meningitis, encephalitis, deafness, and testicular and ovarian inflammation.</p><p><b><i>Rubella</i></b> symptoms include fever, rash and swollen lymph nodes. Complications in infected pregnant women may lead to stillbirth, birth defects or premature delivery.</p><p><b>The</b> <b>MMR vaccine</b> protects against these 3 diseases. Two doses are given: one when the child is a year old, and another when he/she is between 4-6 years old.</p><p><b><i>Hepatitis B</i></b> infection is spread via contact with body fluids including blood. It maybe asymptomatic or may show up as fever, body weakness, vomiting, and yellowish discoloration of skin and eyes. Chronic liver infection, liver failure and cancer may result from this infection. </p><p>The <b><i>HepB vaccine</i></b> protects against this disease and the first dose ideally should be given at birth, the second dose a month later and the third dose 6 months later.</p><p><b><i>Hepatitis A</i></b> has similar symptoms as <b>Hepatitis B</b>, but unlike the latter, is spread via intake of contaminated water or food or direct contact with an infected person. This may also lead to liver failure. Prevented by <b><i>HepA vaccine</i></b> which may be given starting when the child a year old in 2 doses, 6-12 months apart.</p><p><b><i>Pneumococcal disease</i></b> and <b><i>Hemophilus influenza type B</i></b> may both lead to Pneumonia, Meningitis, Sepsis and death. Protection against these two diseases is given by the <b><i>PCV and Hib vaccine</i></b> respectively. The vaccines are administered in four doses starting at 2 months old.</p><p><b><i>Varicella or Chickenpox</i></b> manifests as vesicular rash with fever, easy fatigability and may lead to complications including skin infection, encephalitis and pneumonia. The <b><i>Varicella vaccine</i></b> prevents this disease and is given in 2 doses starting when the child turns one.</p><p><b><i>Rotavirus</i></b> may present as diarrhea, fever and vomiting that can lead to severe dehydration and even death. The <b><i>RV vaccine</i></b> protects against this disease which is given in 2-3 doses, and administered as early as 2 months.</p><p><b><i>Influenza or Flu</i></b> has the symptoms of fever, sore-throat, cough/colds and severe tiredness. This can lead to pneumonia. It is prevented by the <b><i>seasonal Flu vaccine</i></b> which can be given as early as 6 months, one dose annually (for children 8 years and older) and 2 doses, 1 month apart (for previously unvaccinated children younger than 8 years old).</p><p>Missing a dose doesn’t mean you have to start all over again. Just consult with a doctor, catch up with your child’s vaccine schedule, and make suggested adjustments. </p><p><b><i>by Dr. Cynthia Dacanay - Family Medical Practice Hanoi </i></b></p>"
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"value": "<p> </p><p>Atopic dermatitis (eczema) is an itchy inflammation of your skin. It’s a long-lasting (chronic) condition that may be accompanied by asthma or hay fever.</p><p>Signs and symptoms of atopic dermatitis (eczema) include:</p><p>· Red to brownish-gray coloured patches;</p><p>· Itching, which may be severe, especially at night;</p><p>· Small, raised bumps, which may leak fluid and crust over when scratched;</p><p>· Thickened, cracked or scaly skin;</p><p>· Raw, sensitive skin from scratching;</p><p>· Most often this eczema occurs on the hands and feet, the bend of the elbow, behind the knees, and on the ankles, wrists, face, neck and upper chest. Usually begins in childhood before age 5 and may persist into adulthood.</p><p>Factors that worsen atopic dermatitis:</p><p>· Dry skin</p><p>· Long, hot baths or showers</p><p>· Stress</p><p>· Sweating</p><p>· Rapid changes in temperature</p><p>· Low humidity</p><p>· Solvents, cleaners, soaps or detergents</p><p>· Wool or man-made fabrics or clothing</p><p>· Dust or sand</p><p>· Cigarette smoke</p><p>· Living in cities where pollution is high</p><p>· Certain foods, such as eggs, milk, fish, soy or wheat</p><p>· Infantile eczema</p><p>· Infantile eczema often involves an oozing, crusting rash, mainly on the skin of the face and scalp, but it can occur anywhere.</p><p><b>Causes</b></p><p>The exact cause of atopic dermatitis (eczema) is unknown, but it’s likely due to a combination of dry, irritable skin with a malfunction in the body’s immune system. It may be connected to asthma and hay fever.</p><p><b>Complications include:</b></p><p>Neurodermatitis (lichen simplex chronicus). An area of skin that’s frequently scratched becomes thick and leathery.</p><p>Skin infections. Sometimes, scratching can break the skin and cause open sores and fissures that can become infected.</p><p>Eye complications. Severe atopic dermatitis around the eye may lead to permanent eye damage. Hence see your doctor promptly.</p><p>Atopic dermatitis (eczema) is typically diagnosed based on an examination of your skin and a review of your medical history.</p><p><b>Treatments and drugs</b></p><p>Medications: Corticosteroid creams or ointments.</p><p>Antibiotics - for a bacterial skin infection due to fissures caused by scratching.</p><p>Oral antihistamines - if itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be helpful at bedtime. </p><p>Oral or injected corticosteroids - for more severe cases, short term oral corticosteroids, such as prednisone.</p><p>Immunomodulators - tacrolimus (Protopic) and pimecrolimus (Elidel) affect the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. </p><p>Light therapy (phototherapy) - controlled amounts of natural sunlight, artificial ultraviolet A (UVA) or ultraviolet B (UVB) light or narrow band ultraviolet B (NBUVB). However harmful effects include premature skin aging and an increased risk of skin cancer. </p><p><b>Lifestyle and home remedies</b></p><p>To help reduce itching and soothe inflamed skin, try these self-care measures:</p><p>· Try to identify and avoid triggers that worsen the inflammation. Rapid temperature change, sweating and stress can worsen the condition. Avoid wool products as well as harsh soaps and detergents.</p><p>· Apply an anti-itch cream or calamine lotion to the affected area.</p><p>· Avoid scratching whenever possible.</p><p>· Apply cool, wet compresses. </p><p>· Take a warm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal e.g. (Aveeno).</p><p>· Choose mild soaps without dyes or perfumes.</p><p>· Moisturize your skin. Use an oil or cream to seal in moisture while your skin is still damp from a bath or shower.</p><p>· Use a humidifier. Hot, dry indoor air can parch sensitive skin. A home humidifier may help.</p><p>· Wear cool, smooth-textured loose cotton clothing.</p><p><b><i>by Dr Nguyễn Thị Hải Vân - Family Medical Practice Hanoi </i></b></p>"
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"value": "<p></p><p><b>Say goodbye to your sugary drinks</b></p><p>Sodas and other sweetened beverages provide a lot of added sugar that your body does not need. Let’s think about your morning routine. Do you start your day with some coffee or tea with sugar? And do you then drink sodas, sweet tea, or energy drinks all day? This is the first place you can cut back. Giving up these drinks can be hard, but here are some helpful tips.</p><p>Try to cut the amount of sugar in coffee or tea by half each week, until you are down to one teaspoon.</p><p>Substitute the sugary sodas for no-calorie sparkling water, then squeeze in a wedge of lime, lemon, or orange to add flavour. Feel free to add some mint leaves, lemongrass or other herbs you like. </p><p><b>Trans fat – What is it and why should you avoid it?</b></p><p>Artificial trans fat (or trans fatty acid) are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. Trans fats are used commonly in industrial food, especially frying and baking goods. They are easy to use, inexpensive to produce and last a long time. Hence, they extend the shelf life of food products and moreover, they enhance flavours and impact texture. Trans fats are typically found in margarine, fried food, potato chips, cakes, cookies, crackers, and pies.</p><p>Why worry? Because trans fats raise blood cholesterol levels, particularly the "bad" LDL cholesterol and another type of blood fat, called triglycerides. Also, they can reduce the "good" HDL cholesterol. Trans fats increase the risk of heart disease, diabetes and cancer.</p><p>As part of a healthy diet, you need to pay attention to the trans fat amounts listed on nutrition labels (usually on the back or on the side of the package) and aim to keep them to a minimum.</p><p><b>Beer can cause overweight and a beer belly!</b></p><p>Drinking beer can lead to weight gain. It is not necessarily beer but any kind of calorie food/drink - such as sugary drinks, alcohol, fast food - can contribute to belly fat. In general, alcohol is linked to bigger waistlines due to the fact that your liver burns alcohol instead of fat. Let’s do the math. One bottle of beer (330 ml) has about 150 calories. If you drank two bottles a day for 12 days, you would gain 0.5 kg. If you don’t exercise, how would you burn off the extra weight and also the fat in the abdominal area?</p><p>Drinking less alcohol is a good place to start; you should pick up light beers with less calories and also limit the amount of beer per day. If you want to watch a soccer match at a sport bar or go to the stadium during weekends, fill your stomach with healthy food first to help you stay away from unhealthy high- calorie game-day foods. Last but not least, keep in mind that any kind of exercise will help to keep the weight off and don’t forget to increase the intensity.</p><p><b>If a diet is too good to be true, it probably is a fad diet.</b></p><p>Have you heard diets or products promising weight loss of 5 kg a week? Does it sound good? Yes, but it is too good to be true. There is no magic pill that can help you burn fat without moving, and there is no magic diet that results in dramatic weight loss in a short time and can be considered healthy. If you lose too quickly, you are more likely to regain it quickly.</p><p>Avoid any diet that eliminates any food group completely from your life. The most popular food group that usually gets restricted is carbohydrates. A balanced meal is a combination of all food groups that can provide critical nutrients to your body. Also, avoid any diet that includes just certain foods. Your body needs a variety of foods.</p><p><b>Food to avoid when you are sick</b></p><p>Fried & spicy food: the strong smell and the flavor of fried or spicy food may make you crave for those when you are sick. However, they are hard to digest and interfere with your body’s ability to fight off the illness. Stick to simple, easy to digest food, such as chicken soup.</p><p>Sweet treats, such as cookies, candy, and ice-cream comfort you, but sweet treats contain immune-suppressing sugar. Instead, have some fruits and vegetables that are packed with vitamins and can help you recover faster.</p><p>Alcohol and sugary drinks: Alcohol dehydrates you. That means your body has to work even harder to help you recover. Also, sugary drinks can exacerbate inflammation. Drink a lot of water or try some herbal tea.</p><p><b>Fish and pregnancy</b></p><p>Many types of fish provide important health benefits for you and your baby. Most fish are safe to eat during pregnancy. They are a great source of high quality protein, and rich in omega 3 essential fatty acid. If you take omega 3 supplements, you still miss out on high-quality protein and other vitamins and minerals.</p><p>Nowadays, along with the growth of industry and mass production, more mercury is released into the environment. Fish absorb mercury and some have higher mercury levels than others, especially fish that eat other fish, and also those that live longer.</p><p>Here are the best fish choices from the US Food and Drug Administration (FDA) and Environmental Protection Agency (EPA): anchovy, catfish, clam, crab, cod, herring, flounder, lobster, salmon, sardine, scallop, shrimp, squid, tilapia, and tuna (canned). Fish to avoid: shark, swordfish, tuna (bigeye), and marlin. Last but not least, remove skin, fat and internal organs before you cook these marine creatures.</p><p><b>No soda for kids, please</b></p><p>Sodas can be addictive and it is very important to stop the habit before it begins. According to the American Heart Association, children (2-18 years old) should not consume more than 250 ml of sugary drink per week. This includes sweet tea, artificial fruit drinks, energy drinks and sodas. Children under 2 should not be given any sugary drinks. Introducing sugary drinks and sweet treats as late as possible can help your child develop a life-long preference for healthier foods.</p><p>For example, 240 ml of lowfat milk has about 100 calories and 12 grams of sugar, while the same quantity of soda has 100 calories and 27 grams of sugar. Your child does not need the extra sugar, which can cause tooth decay. Did you know that sodas can also deplete bones of much needed calcium? Phosphorus in soda leads to bone loss, and caffeine is also known to interfere with the absorption of calcium and bone density. Children who drink sodas frequently are also more likely to consume less than the daily recommended amount of milk, and are more likely get less than the recommended amount of calcium, magnesium and vitamin A.</p><p>All children need are healthy, balanced meals with a variety of food groups, milk and water.</p><p><b><i>by Jill Tuong Truong - Family Medical Practice Ho Chi Minh City</i></b></p>"
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"value": "<p> </p><p>Constipation is a common problem in childhood. Almost every child will experience it at some point. Constipation is when a child passes infrequent hard painful stools over a long period of time. Unfortunately, many times this problem goes unnoticed. Dr Philippe Collin provides some guidelines to spot the problem early on:</p><p><b>How often should my child poo (bowel movement?)</b></p><p>It depends on how old he or she is. In the first weeks of life, most babies have four or more bowel movements each day. They are soft or liquid. In the first three months, some babies have two or more bowel movements each day. Others have just one each week.</p><p>By age two, most kids have at least one bowel movement each day. They are soft but solid. </p><p>Every child is different. Some have bowel movements after each meal. Others have them every other day.</p><p><b>How will I know if my child is constipated?</b></p><p>Your child might:</p><p>- Have fewer bowel movements than normal;</p><p>- Have bowel movements that are hard or bigger than normal;</p><p>- Feel pain when having a bowel movement;</p><p>- Arch his or her back and cry (if still a baby);</p><p>- Avoid going to the bathroom, do a “dance,” or hide when a bowel movement is coming. This often happens during potty training and when starting school;</p><p>- Leak small amounts of stool into the underwear (if he or she is toilet trained).</p><p><b>Why is my child constipated?</b></p><p>There are many reasons why children become constipated. Most common reasons are:</p><p>- Eating foods that are constipating;</p><p>- Not drinking enough;</p><p>- Holding on to stool when it is not a comfortable or convenient time to go;</p><p>- Being afraid to have a painful stool;</p><p><b>What if my child gets constipated?</b></p><p>In most children with mild or brief constipation, the problem usually gets better with some simple changes. Have your child:</p><p>- Eat more fruit, vegetables, cereal, and other foods with fiber; </p><p>- Drink some prune juice, apple juice, or pear juice;</p><p>- Drink at least 1 litre of water and drinks that aren’t milk each day (for children older than two);</p><p>- Avoid milk, yogurt, cheese, and ice cream;</p><p>- Sit on the toilet for 5 or 10 minutes after meals, if he or she is toilet trained;</p><p>- Stop potty training for a while, if you are working on it.</p><p><b>When should I take my child to the doctor or nurse?</b></p><p>If:</p><p>He or she is younger than four months old;</p><p>He or she gets constipated often;</p><p>You have been trying the steps listed above for 24 hours, but your child has still not had a bowel movement;</p><p>There is blood in the bowel movement or on the diaper or underwear;</p><p>Your child is in serious pain.</p><p><b>When to Seek Help?</b></p><p>Call your child’s doctor immediately (during the day or night) if your child has severe abdominal or rectal pain. and if any of the following occurs:</p><p>- Your child has not had a bowel movement within 24 hours of starting constipation treatment </p><p>- Your infant (younger than four months) has not had a bowel movement within 48 hours of their normal pattern (for example, if an infant who normally has a bowel movement every two days goes three days without a bowel movement). You should call earlier if your infant has other symptoms, such as vomiting or pain;</p><p>- Your infant (younger than four months) has hard (rather than soft or pasty) stools;</p><p>- Your infant or child does not want to eat or loses weight;</p><p>- You see blood in your child’s bowel movement or diaper;</p><p>- Your child has repeated episodes of constipation;</p><p>- Your child complains of pain during bowel movements;</p><p>- You have questions or concerns about your child’s bowel habits.</p><p><b><i>by Dr. Philippe Jean Collin - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> </p><p><i>May 31, 2017 is the World No Tobacco Day</i></p><p><b>Hooked! One substance to rule them all</b></p><p>Nicotine dependence (smoking) is an addiction to tobacco products caused by the drug nicotine. Cigarette, cigar and pipe smoke contains thousands of chemicals, including nicotine. Nicotine results in physical and mood-altering effects to your brain, which is temporarily pleasing, and subsequently leads to dependence.</p><p>Nicotine is the chemical in tobacco that makes you want to smoking, and can be as addictive as cocaine. It increases the release of brain chemicals called neurotransmitters, which help regulate mood and behaviour. One of these neurotransmitters is dopamine, which makes you feel good. Getting that dopamine boost is part of the addiction process. </p><p>To overcome your dependence on tobacco, you need to deal with the behaviour and routine you associate with smoking.</p><p><b>Your Health: The other 4,799 substances!</b></p><p>While it’s the nicotine in tobacco that keeps you hooked, the toxic effects come mainly from other substances in tobacco.</p><p>Tobacco smoke contains more than 60 known cancer-causing chemicals and more than 4,800 other harmful substances. The health problems are real and numerous:</p><p>- <b>Lung cancer risk increases dramatically, as well</b> as emphysema and chronic bronchitis. </p><p>- <b>Heart and circulatory system problems:</b> Smoking increases your risk of dying of cardiovascular disease, including heart attack and stroke. Smoking 15 cigarettes per day doubles your heart attack risk.</p><p>- Smoking is a major cause of cancers of the esophagus, larynx, throat and mouth and is also connected to cancers of the bladder, pancreas, kidney, cervix and stomach.</p><p>- Skin structure changes, causing premature aging and wrinkles.</p><p>- <b>Increased infertility and impotence:</b> Smoking increases the risk of infertility in women and impotence in men.</p><p>- <b>Pregnancy and newborn complications:</b> Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, decreased birth weight and sudden infant death syndrome (SIDS) in their newborn.</p><p><b>Second hand smoke:</b> Spouses and partners of smokers have a higher risk of lung cancer and heart disease compared with people who don’t live with a smoker. If you smoke, your children will be more prone to asthma and ear infections.</p><p><b>Halt the Habit: Always Hope!</b></p><p>Withdrawal cravings, irritability and anxiety? There’s good news -- medication and counseling both work. Medication help you cope with withdrawal symptoms, especially in the first few weeks when the craving is the strongest, while behavioural treatment help you develop the skills you need to stay away from tobacco for the long run. The more time you spend with a counselor (also available at Family Medical Practice Hanoi), the better your treatment results will be.</p><p>Irrespective of age, your health will benefit if you stop smoking. Just 20 minutes after your last cigarette, your heart rate goes down. Twelve hours later, levels of carbon monoxide, a toxic gas, in your blood return to normal. Your lung function improves and your circulation starts to get better within three months. After a year, your risk of having a heart attack drops by half. And after five to 15 years, your stroke risk will be the same as that of a nonsmoker.</p><p><b>Medications</b></p><p><b>Nicotine replacement therapy (NRT) is the main stay of medical treatment for nicotine dependency.</b> NRT gives you nicotine without the other harmful chemicals in tobacco smoke. But if you’re pregnant or breast-feeding or you’re below 18, talk to your doctor before taking any over-the-counter nicotine replacement products.</p><p>Many people mistakenly believe that nicotine causes cancer, but that’s not the case. Nicotine replacement medication, including patches, gums, lozenges, nasal sprays and inhalers, can help relieve difficult withdrawal symptoms and cravings. The best time to start using nicotine replacement is on the day you decide to quit. It is best to talk to us at Family Medical Practice before commencing any of these nicotine products as their usage and potential side effects need to be explained. </p><p><b>Antidepressants:</b> Antidepressant drug bupropion (Zyban, Wellbutrin) increases levels of dopamine and norepinephrine, brain chemicals that are also boosted by nicotine.</p><p>Counseling and support groups: Medication help you cope with withdrawal symptoms, while behavioural treatment helps you develop the skills you need to stay away from tobacco over the long run. The more time you spend with a counselor the better your treatment results will be.</p><p><b><i>by Doctor William Brian McNaull - Family Medical Practice Hanoi </i></b></p>"
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"value": "<p> </p><p>August through November, the so-called “wet months” in Hà Nội, are prime season for mosquito-borne diseases, the number of dengue fever cases in the capital has increased since the beginning of this year.</p><p>Dengue (DENG-gay) fever is a mosquito-borne disease that occurs in tropical and subtropical areas of the world. Mild dengue fever causes high fever, rash, and muscle and joint pain. A severe form of dengue fever, also called dengue hemorrhagic fever, can cause severe bleeding, a sudden drop in blood pressure (shock) and death. </p><p>August through November, the so-called “wet months” in Hà Nội, are prime season for mosquito-borne diseases, the number of dengue fever cases in the capital has increased since the beginning of this year.</p><p>Dengue (DENG-gay) fever is a mosquito-borne disease that occurs in tropical and subtropical areas of the world. Mild dengue fever causes high fever, rash, and muscle and joint pain. A severe form of dengue fever, also called dengue hemorrhagic fever, can cause severe bleeding, a sudden drop in blood pressure (shock) and death.</p><p> </p><p>- Reschedule outdoor activities: Avoid being outdoors at dawn, dusk and early evening, when more mosquitoes are out.</p><p>- Wear protective clothing: When you go into mosquito-infested areas, wear a long-sleeved shirt, long pants, socks and shoes.</p><p>- Use mosquito repellent: Permethrin can be applied to your clothing, shoes, camping gear and bed netting. You can also buy clothing made with permethrin already in it. For your skin, use a repellent containing at least a 10 percent concentration of DEET.</p><p>- Reduce mosquito habitat: The mosquitoes that carry the dengue virus typically live in and around houses, breeding in standing water that can collect in such things as used automobile tires. Reduce the breeding habitat to lower mosquito populations.</p><p><b><i>by Dr William Brian McNaull - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> World Blood Donor Day has been held annually since 2004 on June 14. It was launched in Johannesburg, South Africa, following the success of World Health Day 2000, which was devoted to the theme “Blood Saves Lives. Safe Blood Starts With Me”. The enthusiasm and energy with which this day was marked was a powerful and positive response to the opportunity to thank the millions of people who give the precious gift of life through their donation of blood every year.</p><p>The aim of designating this annual day and linking it to a global celebration was to promote voluntary non-remunerated blood donation throughout the world. By designating one special day to celebrate the role of voluntary blood donors around the world, it is hoped that a new generation of blood donors will follow their example, providing sufficient supplies of the safest blood possible for use wherever and whenever it is needed to save lives. Worldwide last year about 92 million people donated their blood. However more is needed. In Vietnam only 0.88 per cent of the population donates blood on a regular basis.</p><p>There are several types of blood donation:</p><p><b>Whole blood.</b> This is the most common type of blood donation. Approximately one pint of whole blood is drawn and then separated into its components — red cells, plasma, platelets.</p><p><b>Platelets.</b> This type of donation uses a process called apheresis. The donor is hooked up to a machine that collects the platelets and some of the plasma, and then returns the rest of the blood to the donor. </p><p>To be eligible to donate whole blood, platelets or plasma, you must be: In good health, at least 17 years old — the minimum age varies by country but there’s no upper age limit, weigh at least 110 pounds (50 kg) and able to pass the physical and health history assessments</p><p><b>Are there any risks to the donor?</b></p><p>Blood donation is safe. New, sterile disposable equipment is used for each donor, so there’s no risk of contracting a blood-borne infection.</p><p><b>How to prepare</b></p><p>Maintain a healthy diet that includes iron-rich foods, such as spinach, red meat, fish, poultry, beans, iron-fortified cereals and raisins. Avoid fatty foods, such as hamburgers, fries or ice cream before donating as this may affect your tests. Drink an extra 16 ounces (473 milliliters) of water and other fluids before the donation. </p><p>Because of the risk of blood-borne infections, not everyone can donate blood. The following high-risk groups are not eligible in many countries: </p><p>- Anyone who has ever used illegal injection drugs or steroids not prescribed by a physician;</p><p>- Men who have had sexual contact with other men since 1977 (although this is now under review in many countries);</p><p>- Anyone who has ever received clotting factor concentrates;</p><p>- Anyone with a positive test for HIV (AIDS virus);</p><p>- Anyone who has had hepatitis since childhood;</p><p>- Anyone who has had babesiosis or Chagas’ disease;</p><p>- Anyone who has taken etretinate (Tegison) for psoriasis;</p><p>- Anyone who has risk factors for Creutzfeldt-Jakob disease (CJD) or who has a blood relative with CJD or lived in certain countries during specific years.</p><p>After a brief physical examination (including blood pressure, pulse and temperature), a small sample of blood is taken and is used to check your hemoglobin level. If your hemoglobin concentration is normal and you’ve met all the other screening requirements, you can donate blood.</p><p><b>During the procedure</b></p><p>You lie or sit in a reclining chair with your arm extended on an armrest. A tourniquet (BP cuff) is placed around your upper arm to fill your veins with more blood. Then the skin on the inside of your elbow is cleaned. A new, sterile needle is inserted into a vein in your arm. This needle is attached to a thin, plastic tube and a blood bag. Blood initially is collected into tubes for testing. When these have been collected, blood is allowed to fill the bag, about a pint. The needle is usually in place about 10 minutes. A dressing is wrapped around your arm after the needle is removed.</p><p><b>After the procedure</b></p><p>Rest for 10 to 15 minutes, and you can leave but you must: Drink extra fluids for the next day or two and avoid strenuous physical activity for the next five hours.</p><p>Your blood type will be determined - classified as A, B, AB or O - also your Rh factor. This information is important because your blood type and Rh factor must be compatible with the blood type and Rh factor of the person receiving your blood. Next, your blood will also be tested for hepatitis, HIV and syphilis. If these tests are negative, the blood is distributed for use in hospitals and clinics. If any of these tests are positive, the blood bank notifies you, and your blood is discarded. </p><p>At FMP Vietnam we operate a Walking Blood Bank. For information please contact our clinics.</p><p><b><i>by Doctor Yaron Atzmon - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p></p><p><b>Boosting children’s immune system</b></p><p>Summer is here and the children are having a long summer break with a lot of outside physical activities. Summer means hot, long days with plenty of direct sunlight. It is also the rainy season.</p><p>Boosting the family’s immune system is commonly associated with preparations for cold weather. But any change in the weather can cause stress, which affects the immune system and makes one more susceptible to illness when coming into contact with a virus.</p><p>Vitamin C is well known as an immune system booster, which is effective in the prevention of colds and recovery from them. Vitamin C supplements are convenient and packed with 1000% of the daily recommendation. And how much vitamin C is in an orange? It has more than 100% vitamin C than your recommended dose. Moreover, it is also packed with vitamins and minerals such as vitamin A, thiamin, folate, calcium, potassium. Fruits, vegetables and whole grains contain phytochemicals (plant chemical) that may help to fight the development and progression of some chronic diseases, such as cancer. Therefore, “Food first”. Make sure your kids eat a variety of fruits and vegetables to get a variety of nutrients.</p><p>Also, spend more time with your kids, choose some physical activity and do it together rather than sitting in front of the TV for hours.</p><p><b>Iron Deficiency</b></p><p>Iron is an essential mineral that helps transport oxygen throughout the body. Deficiency in iron causes anemia (symptoms including fatigue, weakness, headache, pale skin and fingernails, dizziness). Too much iron may damage your heart and liver. The body is able to regulate uptake of iron so an overdose of iron is rare and occurs when people take supplements.</p><p>Iron from natural food sources (animal and plant sources) is better regulated and causes less damage to the body. Iron from animal sources is better absorbed by the body than iron from plants.</p><p>Iron deficiency anemia is treated with iron supplement taken by mouth or a rich-iron diet. Some of the best animal sources of iron are liver (chicken), seafood, beef and lamb, fish. Vegetarians absorb less iron since their source is plants, so adding a source of vitamin C will enhance iron absorption. Some of the best plant sources of iron are beans and pulses (pinto, kidney, lentils and soybean), dark leafy green (spinach), fortified cereal/bran, enriched rice/breads, tofu, dark chocolate and cocoa powder.</p><p>How to prevent iron deficiency? The key is to eat a balanced, healthy diet with a variety of food groups. Add some vitamin C if your iron source is plants. For example: squeeze a wedge of lemon into your spinach salad or throw some strawberries into your fortified cereal bowl.</p><p><b>Raw milk and health risks</b></p><p>Due to the movement to consume foods that have been minimally processed, there has been a renewed interest in consuming raw milk. “Natural” is the very catchy term when it comes to advertising and marketing a product.</p><p>Is raw milk natural? Yes.</p><p>Is it ok to drink raw milk? No.</p><p>According to the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA), there are no health benefits from drinking raw milk, and it can lead to serious health risks because it may carry bacteria that cause multiple food-borne illnesses. Expectant moms, infants, children and people with weakened immune systems are more susceptible to being affected.</p><p>Raw milk supporters believe that pasteurization kills good bacteria and causes nutrient loss. However, there is no medical evidence to support this theory. Pasteurization is known to kill bacteria that can cause disease and it is still one of the most effective food safety interventions known to public health.</p><p><b>What makes Greek yogurt different?</b></p><p>First of all, both Greek yogurt and traditional plain yogurt in low-fat forms can be a part of healthy diet. Greek yogurt is different because it is strained and this process removes the liquid whey, lactose, and sugar, making it thicker, creamier and smoother than traditional yogurt.</p><p>What about nutrients in Greek yogurt?</p><p>· It has double the protein of traditional yogurt, which makes it more appealing to vegetarians who sometimes struggle to get enough nutrients.</p><p>· It usually contains half the carbs (less lactose) of the traditional one, so lactose-intolerant individuals may tolerate it even better than the traditional type. It is also the ideal snack for diabetic patients. Remember to double check the carb amount listed on the nutrition label.</p><p>· It loses some of its calcium during the straining process: 170 grams of Greek yogurt actually provides about 20% of the daily recommendation. Want some more calcium? Mix your Greek yogurt with seeds or almonds.</p><p>There are many ways to enjoy the yogurt. Make yourself a yogurt parfait by layering yogurt, granola or some dried seeds, fruits such as berries or banana. Or try yogurt smoothies, yogurt fruit dip or yogurt salad dressing. Whether you choose Greek yogurt or traditional yogurt, check the nutrition label for the amount of fat, sugar, protein and calories.</p><p><b><i>by Jill Tuong Truong - Family Medical Practice Ho Chi Minh City</i></b></p>"
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"title": "The monsoon season: beware infectious disease",
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"value": "<p> </p><p>There may be greater risk of certain diseases during and after the monsoon rain in Việt Nam (June through October). The monsoon rains have come, especially to north and central Việt Nam and with them increased incidence of water and mosquito-borne disease. Here are some of the most common ones.</p><p><b>Cholera:</b> This bacterial disease is already in the ground water in the major cities of Việt Nam. Flooding, which occurs regularly after heavy monsoon rains, raises the water table and may increase the chance of contamination of vegetables and herbs by the cholera bacteria. Only about 1 in 10 infected people develop the typical signs and symptoms of cholera, which include: Severe, watery sudden onset diarrhea. Cholera diarrhea often is voluminous and may have a pale, milky appearance that resembles water in which rice has been rinsed (rice-water stool). What makes cholera diarrhea so deadly is the loss of large amounts of fluids in a short time. The main risk to health is that of rapid dehydration from fluid loss with possible shock and even death in a small percentage of cases. How can we do our best to prevent the spread of this disease? </p><p>· Washing hands: Frequent and thorough hand washing with hot, soapy water, especially before eating or preparing food, after using the toilet, and when returning from public places. Carry an alcohol-based hand sanitizer for times when water isn’t available.</p><p>· Avoid untreated water: Contaminated drinking water is the most common source of cholera infection (and other bacteria). For that reason, drink only bottled water. Carefully wipe the outside of all bottles and cans before you open them and ask for drinks without ice. Use bottled water to brush your teeth.</p><p>· Eat food that’s completely cooked and hot: Cholera bacteria can survive in room temperature food for up to five days and aren’t destroyed by freezing. </p><p>· During an outbreak, don’t eat raw or improperly cooked fish and seafood of any kind. Avoid unpasteurized dairy products.</p><p>· Make sure that all fruits and vegetables that you eat are cooked. Sterilize all leafy vegetables before consumption.</p><p>Cholera vaccine. The cholera vaccine is about 60 -70% effective, but during an outbreak is an important defense against contraction of this potentially fatal disease. </p><p><b>Dengue fever</b>: Dengue fever is a disease ranging from mild to severe — caused by four related viruses spread by the Aedes mosquito. Milder dengue fever causes high fever, rash, severe headache, muscle and joint pain. More-severe but much rarer forms of the disease — dengue hemorrhagic fever and dengue shock syndrome — can additionally cause severe bleeding, a sudden drop in blood pressure (shock) and even death (very rare).</p><p>Prevention: The best way to avoid dengue fever is to avoid being bitten by mosquitoes that carry the disease. No vaccine is commonly available as yet to prevent dengue.</p><p>To reduce your risk of mosquito bites, minimize your exposure to mosquitoes:</p><p>· Avoid being outdoors at dawn, dusk and early evening, when more mosquitoes are buzzing about. </p><p>· <b>Wear long-sleeved shirts, long pants, socks and shoes</b></p><p>· <b>Stay in air-conditioned or well-screened housing.</b></p><p>· <b>Apply permethrin-containing mosquito repellent to your</b> bed netting. You can also buy clothing made with permethrin already in it.</p><p>· <b>Use repellent with a 10 to 30 percent concentration of DEET</b> on your skin. Choose the concentration based on the hours of protection you need — a 10 percent concentration of DEET is effective for about two hours; higher concentrations last longer. However, chemical repellents can be toxic, so use only the amount needed. Don’t use DEET on the hands of young children or on infants under 2 months of age. Instead, cover your infant’s stroller or playpen with mosquito netting when outside.</p><p>· Pools of stagnant or standing water are good places for the dengue carrying mosquito (<i>Aedes</i>) to breed – so empty standing water in plant pots or other containers around the house.</p><p><b>Leptospirosis</b>: This disease is caused by exposure to several types of the <i>Leptospira</i> bacteria, which can be found in fresh water that has been contaminated by animal (mainly rat) urine. Commoner in warmer climates, it is not spread from person to person. Usually infection is a result of occupational exposure -- farmers, ranchers, slaughterhouse workers, trappers, veterinarians, loggers, sewer workers, rice field workers, and military personnel. But severe floods can kill rats and the risk of water contaminated by bacterial spirochetes from the rats is higher. Symptoms can take two to 26 days (average 10 days) to develop, and may include: dry cough, fever, headache, muscle pain, nausea, vomiting, diarrhea and shaking chills. Avoid walking or wading unprotected (wear rubber boots if possible) through flood water. </p><p><b>Other Bacterial Infections</b>: Other bacteria that are prevalent in flood water, which in turn may more easily contaminate food – bacteria such as Shigella, Typhoid, E. Coli and Campylobacter as well as viruses such as Hepatitis A, which can all cause severe gastro-intestinal symptoms. Hence pay attention to the careful washing/sterilizing of all salads and cooking all food well.</p><p><b><i>by Doctor William Brian McNaull - Family Medical Practice Hanoi</i></b></p>"
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"title": "[Development] Speech and communication in the early years",
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"value": "<p>The importance of communication begins in the womb.</p><p>From six months of pregnancy, the baby's brain is developed enough to begin to remember, experience and learn. Your baby can also hear from six months which is why babies are comforted by the voice of their parents at birth.</p><p>During your pregnancy, it is great to talk to your baby. Also encourage the father or close others to talk to the baby. Play lullabies and music to your baby and once they are born, they will enjoy the sounds and find comfort in these sounds.</p><p><i>Please refer to our specific guidance on speech and communication from birth to one year.</i> <a href=\"https://www.vietnammedicalpractice.com/hanoi/en/news/himba-development-speech-development-first-year\"><i>https://www.vietnammedicalpractice.com/hanoi/en/news/himba-development-speech-development-first-year</i></a></p><p><b>General milestones for speech are:</b></p><ul><li>Children say their first words by around 1 years old. 'Dada' 'Mama' etc - although general understanding will be before then.</li><li>18 months- children say about 18 words and understand a lot more.</li><li>24 months - children say about 50 words and understand between 200-500 words</li><li>At 3 years - children will use about 300 words</li><li>By 5, children use about 2,500 words</li></ul><p><b>How can you support speech and communication development?</b></p><p>-Point to an object and use its name- build association between names and objects</p><p>-Encourage children to use new words - ask them choices, do you want some yoghurt or carrot sticks?</p><p>-Repetition - children need to hear words regularly before they can learn and say it properly- speak clearly and use the same words often.</p><p>-Turn off background noises - tv/radio will make it more difficult for children to hear words you use</p><p>-Build on a child's sentence - when your child says ' top on', reply with 'Yes, we shall put your top on now'.</p><p>-Use your childs name - this will help gain their attention and make it clear to focus on you and not a toy they are playing with.</p><p>-Read books to your child - discuss what you see, feel and point to objects and name them.</p><p>-Encourage them to meet other children -more interaction introduces them to more</p><p><b>Resources:</b></p><p><a href=\"https://www.cdc.gov/ncbddd/childdevelopment/language-disorders.html\">https://www.cdc.gov/ncbddd/childdevelopment/language-disorders.html</a></p><p><a href=\"https://www.cdc.gov/ncbddd/actearly/milestones/index.html\">https://www.cdc.gov/ncbddd/actearly/milestones/index.html</a></p><p><a href=\"https://www.asha.org/public/speech/development/\">https://www.asha.org/public/speech/development/</a></p><p><a href=\"https://ican.org.uk/about-us/\">https://ican.org.uk/about-us/</a></p><p><a href=\"https://www.nhs.uk/conditions/pregnancy-and-baby/helping-your-childs-speech/\">https://www.nhs.uk/conditions/pregnancy-and-baby/helping-your-childs-speech/</a></p><p></p><p><b>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</b></p><p></p>"
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"id": 687,
"title": "Immunity in Children",
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"summary": "All babies have weak immunity during the first weeks of life. At this time, they are normally protected by the antibodies they receive from the mother’s milk. There are no antibodies in formula milk, so babies who drink formula milk cannot receive this protection.",
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"value": "<p>Microscopic pathogens are all around us—they’re impossible to avoid. Whenever we’re exposed, our immune system fights back by analyzing the threat, designing antibodies, and then producing enough of them to disable the infection. It will also remember that design, allowing it to easily produce more antibodies later if a similar threat comes along.</p><p>At birth, children’s immunity is like a blank sheet of paper. They’ve had no exposure to pathogens, so they carry no memory of how to fight them. </p><p>Usually, a child’s first exposure to bacteria is in the birth canal. This exposure triggers the initial development of the immune system. Children delivered by C-section do not have the same exposure as those naturally-born, which can impair normal development.</p><p>All babies have weak immunity during the first weeks of life. At this time, they are normally protected by the antibodies they receive from the mother’s milk. There are no antibodies in formula milk, so babies who drink formula milk cannot receive this protection.</p><p>Doctors need to wait until a baby’s immune system is strong enough before they administer vaccinations, which rely on the body’s ability to design and remember antibodies. With the exception of hepatitis B, bacilleCalmette-Guerin (BCG) and OPV—which are all given at birth—the recommended age to give most vaccines is at two months, or six weeks at the earliest.</p><p>When functioning properly, the immune system can identify a variety of threats including viruses, bacteria and parasites. Children whose immune systems do not have the strength to fight are more likely to get both recurrent and life-threatening infections.</p><p>For a child, developing a mature immune system is crucial to good health throughout all stages of life. So how can we augment this ability and improve the natural immune system?</p><p>The first way is nutrition:</p><ul><li>Infants of less than one year of age rely on breast milk for their antibodies. We recommend breastfeeding for as long as possible—at least until twelve months of age—and exclusively for at least the first six months.</li><li>By seven or eight months, we need to provide babies with a variety of foods from different food groups. The protein, fat, carbohydrates and even minerals and vitamins in solid food are very important in improving the health of the immune system.</li><li>Many parents routinely give children multivitamins and mineral supplements without seeking medical advice. This is not a good practice, because with some vitamins, an overdose is toxic. Oil soluble vitamins such as vitamins A, K and E can be very dangerous, causing seizures, nausea and vomiting.</li><li>Vitamin D is an exception. Babies normally produce their own vitamin D in response to direct sunlight, but as the exposure to ultraviolet radiation in sunlight is risky, it’s better to supplement the diet with one drop with 400 international units of vitamin D per day.</li><li>While good nutrition boosts the immune system, overfeeding can lead to diabetes. Obesity and gastro-oesophageal reflux are also potential consequences of overfeeding in infancy.</li></ul><p>The second way is sleep quality:</p><ul><li>Good sleep is very important in nurturing the developing immune system, so a child should have an environment that is conducive to the quality of sleep.</li><li>A newborn baby should sleep 18 hours per day, and a toddler 12–13 hours per day. A preschooler should sleep 10 hours per day.</li><li>It’s important not to disturb a sleeping child; which is another reason to avoid bottle feeding infant children, as many parents wake their babies to feed, compromising their developing immune system.</li></ul><p>Hygiene is the third way to boost immunity:</p><ul><li>It is most important to wash hands before preparing meals, or after going to the toilet. The immune system includes the skin and its oil, so washing the hands helps to reduce the spread of pathogens.</li><li>Very young infants should avoid contact with sick people, and not be exposed to smoking in the home, chemicals (choose organic food where possible) and pollutants in the air.</li></ul><p>The last method is vaccination:</p><ul><li>It’s very important to follow the vaccination schedule. The schedule is carefully planned to take into account the developing immune system. If we vaccinate too early, the baby has insufficient ability to produce antibodies. If too late, then the risk of a child being infected without the protection of immunity becomes greater.</li><li>By properly adhering to the standard vaccination system, you give your child the best chance of developing a robust and healthy immunity that will serve as a lifelong protection against infection.</li></ul><p><b><i>*Dr. Nguyễn Hữu Lĩnh’s</i></b><i> studies in France and the US gave him a broad experience base in treating a range of paediatric illnesses. He takes particular care in co-operation, communication and education of parents to ensure a better treatment environment for children in medical need.</i></p><p></p><p><b><i>Dr. Nguyen Huu Linh - Pediatrician, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"title": "Autism Spectrum Disorders",
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"value": "<p><b>HIMBA Autism Spectrum Disorder [ASD]</b>Autism is a spectrum condition referring to a range of conditions of varying impairment relating to social behaviour, communication and language. ASD now incorporates aspergers syndrome and pervasive developmental disorders. 1 in 160 children globally are thought to have an ASD diagnosis.</p><ul><li>Autism is a lifelong developmental disability affecting the way a person communicates with and, experiences the world around them. Often, children with Autism present with other health conditions such as epilepsy, ADHD or mental health disorders. <b>Early intervention and strategies put in place from a young age gives the child the best opportunity for optimal development and achievement.</b></li><li>The reason for why autism affects so many people is unknown but research suggests its a combination of genetics and the environment. It is not an individuals fault or that of their families.</li><li>People on the autistic spectrum are affected differently. No one person is the same and therefore the challenges children and adults face with autism will vary according to other genetic and environmental factors. Some require lifelong support due to the impaired disability, whilst others function independently with fewer difficulties. The human rights of those with autism need to be prioritised at all times as access to education, healthcare and community support can often be difficult,.</li><li>Diagnosing autism usually takes some time and input from a wide range of professionals. Including, paediatrics, therapists and psychologists. Seeking help early is vital.</li></ul><p><b>Children with autism may present having:</b></p><p>- Persistent difficulties with social communication such as not understanding facial expressions, tone of voice ,jokes and sarcasm. They may also have a tendency to feel overwhelmed by people and want to isolate themselves away</p><p>-Restricted and repetitive behaviours or interests which impair everyday functioning</p><p>- Social interaction is challenging and children on the autistic spectrum may behave in a way others perceive as offensive or insensitive. They may then seek out time alone and not want comfort from people.</p><p>- Children on the autistic spectrum often have highly focused interests and may have extraordinary intelligence in one area. This is often seen from a young age.</p><p>Use a <b>framework</b> to understand how to meet the needs of people with ASD:</p><p><b>SPELL</b></p><p><b>S-</b>Structure: Provide an environment that is predictable and safe. It can create a sense of independence for the person.</p><p><b>P -</b>Positive: Focus on the persons strengths and interests. Boost self esteem and through structure and positive encouragement individuals with ASD are more likely to embrace new opportunities and skills.</p><p><b>E -</b> Empathy: Being able to understand the viewpoint of the individual and what may scare them. Respecting, relating and providing calm relationships can support the individual further.</p><p><b>L -</b> Low Arousal: The environment should be calm, not over stimulating, considering light, noise, clutter and the language used to communicate. Stimulation such as sensory rooms are required for development but access to a space that is calm to process is important.</p><p><b>L-</b> Links: Community networks and key workers that all follow the same principles is essential for the feeling of stability, structure and safety for the individual.</p><p><b>Priorities in terms of healthcare.</b></p><p>Children and adults that attend medical appointments such as visiting the dentist or the doctor are likely to find it distressing. Tips on how to ensure health appointments run as smoothly as possible include:</p><p>1) Visiting the dentist or the doctors prior to the appointment. This familiarizes your child with the space.</p><p>2) Allow your child to look at some of the instruments that may be used during the checkup and touch them. Children may have sensory impairments and instruments in the mouth may be very painful for children and noises from the drills etc, very distressing.</p><p>3) Let them meet the medical professional and spend some time preparing the professional about your child’s needs.</p><p>4) Book the medical appointment first thing so there is less tension and anxiety building throughout the day and perhaps book a double slot so the visit is calm and not rushed</p><p>5) Present a clock to your child and inform them when it is over. A time indicator supports their feeling of control and expectation.</p><p>6) Allow a comforter to be present, perhaps music as a distraction.</p><p>7) Before the appointment you may want to introduce a social story. These are concrete ways to improve a persons understanding of a story, explaining sequencing and what comes next. <a href=\"https://www.autism.org.uk/about/strategies/social-stories-comic-strips.aspx\">https://www.autism.org.uk/about/strategies/social-stories-comic-strips.aspx</a></p><p><a href=\"https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders\">https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders</a></p><p><a href=\"https://www.autism.org.uk/about/strategies.aspx\">https://www.autism.org.uk/about/strategies.aspx</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p>Five- to eight-year-old children in my neighborhood often play in the streets. Their voices are musical, punctuated with shrieks and laughter. I don’t know what they say to each other. But the exchanges result in someone rushing off with others giving chase. Their imaginations are alive in the ways they move: never walking… full of skips, hops, twirls and spins… running, chasing, ducking and hiding. They can play for hours, without interruption. Their play is as natural as the wind and the sun. They use sticks they find as props and toys and the bike gets traded around. The falling darkness sets the mood for new adventures before they are called in.</p><p>Maybe we all played like this as kids: games without rules -- our identities changing with our imaginary dramas. There is spontaneity in this kind of play, a readiness for anything. It is also full of passion, emotions rising and falling, conflicts and resolutions alternating in a matter of minutes.</p><p>I believe it is a universal instinct. Children everywhere will play, given the opportunity.</p><p>So what happens as we grow up? How is it that we’ve become so far removed from those days and that kind of joyous interaction? When did life become so serious? Is there something we can learn from the way children play?</p><p>As a psychotherapist I spend my time with people who are having problems in life. Many people are dealing with depression. Low moods shape the lens through which they see life, which depletes the energy they need to function and enjoy life. I meet with people for whom anxiety is an intrusive invader. Anxiety generates worry, making fear a primary ingredient in many of the thoughts they have. These mood-related disorders preoccupy the mind, stealing the ability to feel pleasure and joy and to think freely or to concentrate. It is difficult for depressed, anxious people to be able to play.</p><p>The verb “play” is defined by the <i>Oxford Dictionary</i> as meaning: “to engage in an activity for enjoyment and recreation, rather than for serious or practical purpose”. The origins of the word include ideas such as “to exercise”, “brisk movement” and “leap for joy or dance”.</p><p>In his book <i>Free Play</i>, Stephen Nachmanovitch says: “Creative work is play; it is free speculation, using the materials of one’s chosen form. The creative mind plays with the objects it loves. Artists play with color and space. Musicians play with sound and silence. Eros plays with lovers. Gods play with the universe. Children play with anything they can get their hands on.” And while it is done for enjoyment rather than for a serious purpose, we see that culture is shaped by the art, music and dance people create.</p><p>Much of our "play" energy these days has been directed into something called “game”. But play is different from game. Play is the free spirit of exploration, doing and being for its own pure joy. Game is an activity defined by a set of rules, such as football, sonnet, symphony, and diplomacy. Play is an attitude, a spirit, a way of doing things; whereas game is a defined activity with rules, a playing field and participants. Computer games are governed by rules and mastery: such games often limit choices to either/or. This is quite different from the idea that our freest play happens when we have nothing to gain or lose.</p><p>Don’t get me wrong. There is plenty of creativity involved in the use of structures and limitations. The rules of the games are limits, in the same way as the number of strings on a guitar. Structures and limits channel energy. But play is not concerned with the outcome, the product, the performance or the score. Play is the experience itself, not to be measured, quantified or redone. There is a freedom that comes from not having to try to meet an expectation outside the experience itself. Like children who are fully in the present, play connects us to our bodies, our senses and the immediate environment we are interacting with.</p><p>Standing back, we can see the benefits of play. I am pretty sure that if more people played more often we would feel more flexible in our approach to living. We would find more creative solutions to problems. Spontaneity is where we are most directly connected to what is, so that decision making and moving through life seem to have a natural flow. We would become more intuitive and less burdened by over-thinking or fear-generated restrictions. Play is fun. It gives us the experience of positive emotions, as well as avenues to express ourselves.</p><p>Is it true that in expressing ourselves we discover ourselves? Is it through our imagination that we discover what is real?</p><p>Someone once said, “We don’t sing because we are happy, we are happy because we sing.” </p><p>Play is the way we put life into context. Of course we need to be responsible and serious. But we also need to re-learn how to play from children.</p><p><b><i>By Douglas Holwerda — Family Medical Practice Hanoi</i></b></p>"
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"value": "<p><b>Is it really dangerous to eat from street food stalls in Hà Nội?</b></p><p>Where we eat often determines the risk of developing food poisoning. So eating ‘on the street’ from many of the roadside restaurants can substantially increase the risk for all expatriate Hanoians. It can also make it difficult to determine what foods actually caused the sickness. </p><p>Most of the bacterial (Salmonella, Shigella, Campylobacter,Vibrio) causes of diarrhea and vomiting incubate from between 1 to 5 days, although Staphylococcal infection from cream sauces and pastries can develop within a few hours of ingestion. On the other hand, parasitic diseases like Giardia may take 1 to 2 weeks to develop symptoms and viral hepatitis A (from contaminated shellfish) may take up to a month before symptoms are noted.</p><p><b>We have all suffered from mild stomach upsets but when should we seek medical advice?</b></p><p>Yes, first let me say the classic symptoms of food poisoning are diarrhea and vomiting, maybe with cramps and fever as well. If the diarrhea persists for more than a day, is initially profuse within the first 24 hours, contains blood and there is either significant abdominal pain and/or fever, then you should seek medical advice right away.</p><p><b>Who is at most risk of food poisoning?</b></p><p>Food poisoning is especially serious and potentially life-threatening for young children, pregnant women and their fetuses, older adults, and people with weakened immune systems. These individuals should take extra precautions by avoiding the following foods, although the advice applies to all:</p><ul><li>Raw or rare (undercooked) meat and poultry</li><li>Raw or undercooked fish or shellfish, including oysters, clams, mussels and scallops</li><li>Raw or undercooked eggs or foods that may contain them.</li><li>Raw sprouts, beans and herbs</li><li>Unpasteurized juices and ciders, milk and milk product</li><li>Soft cheeses (such as feta, Brie and Camembert), blue-veined cheese and unpasteurised cheese that have not been properly stored</li></ul><p><b>What can one do to prevent or greatly reduce the likelihood of food poisoning?</b></p><p>Thoroughly wash your hands, utensils and food surfaces often. Keep raw foods separate from ready-to-eat foods. When shopping, preparing food or storing food, keep raw meat, poultry, fish and shellfish away from other foods. This prevents cross-contamination. Cook foods to a safe temperature. You can kill harmful organisms in most foods by cooking them to temperatures between 145 F (62.8 C) and 165 F (73.9 C). Refrigerate or freeze perishable foods promptly. Refrigerate or freeze perishable foods within two hours of purchasing or preparing them. If the room temperature is above 90 F (32.2 C), refrigerate perishable foods within an hour. Put food in the freezer if you don’t expect to eat it within two days.</p><p>Defrost food safely. Do not thaw foods at room temperature. The safest way to thaw foods is to defrost foods in the refrigerator or to microwave the food using the "defrost".</p><p>Throw it out when in doubt. If you aren’t sure if a food has been prepared, served or stored safely, discard it. Food that may look ‘Ok’ and smell normal may in fact be unsafe!</p><p><b><i>By Dr. Brian McNaull - Family Medical Practice Hanoi</i></b></p>"
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"title": "Are you high? High on blood sugar that is",
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"value": "<p>Diabetes mellitus is increasing all over the world, and its particularly increasing in Asia. According to the International Federation of Diabetes’ 2014 annual report, 387 million people were estimated to be living with diabetes. It is estimated to increase to 592 million within the next twenty years.</p><p>Based on recently published medical articles, type 2 diabetes mellitus has increased in Việt Nam.</p><p><b>What is diabetes mellitus type 2?</b></p><p>This is a metabolic disorder in which the body increases blood sugar production. Diabetes mellitus type 2 is the most common form.</p><p><b>What are the symptoms?</b></p><p>Most people are often asymptomatic in its early stages and can remain undiagnosed for many years. Early detection and treatment can decrease the risk of developing the complications of diabetes.</p><ul><li>Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual.</li><li>Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger.</li><li>Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolise glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine.</li><li>Fatigue. If your cells are deprived of sugar, you may become tired and irritable.</li><li>Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus.</li><li>Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections.</li><li>Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck.</li></ul><p>If you noted that you have these symptoms, please see a doctor. He or she will test your fasting blood sugar, oral glucose tolerance test (OGTT) and/or HgbAic. Fasting blood sugar as the test implies is checking your sugar levels after 10 hours of fasting. OGTT test is a test wherein your sugar is tested after eating a specific amount of sugar. HgbAic is a test to check the control of blood sugar.</p><p><b>Who are at risk?</b></p><p>DM type 2 is more common for the following cases:</p><ul><li>Family history (parents and/or siblings with diabetes)</li><li>Certain racial/ethnic groups</li><li>Age: 45 or older</li><li>Low HDL ("good") cholesterol</li><li>High triglycerides</li><li>Unhealthy weight, obesity</li><li>High blood pressure, even if it’s treated and under control</li><li>Gestational diabetes during pregnancy</li><li>Women who have polycystic ovarian disease, gestational diabetes</li><li>Polycystic ovary syndrome (PCOS)</li><li>Acanthosis nigricans: a skin condition with dark rashes around your neck or armpits</li><li>Depression</li><li>Hypertension and/or have history of heart and blood vessel disease</li><li>Other risk factors have to do with your daily habits and lifestyle. These are the ones you can really do something about: Have sedentary lifestyle with little or no exercise, smoking, stress, sleeping too little or too much.</li></ul><p><b>What are the complications?</b></p><p>This is metabolic disease which affects almost every other system in the body.</p><ul><li>cardiovascular diseases (e.g. hypertension, heart attack, stroke)</li><li>blindness</li><li>renal failure</li><li>nerve problems: numbness and/or tingling sensation in hands and feet. If unchecked and there is a non-healing wound in the feet (since the person cannot feel it), this may lead to lower limb amputation.</li><li>pregnancy: large babies</li></ul><p><b>How to stop progress?</b></p><p>We cannot over emphasise the importance of lifestyle changes. Once your doctor tells you that your sugar is elevated, start exercising! Based on American Heart Association, 30 minutes of moderate to intense aerobic activity at least 5x a week for a total of 150 minutes is recommended. Start by walking. You can start slowly at 10 minutes a day. You can spread your activity out during the week, so you don’t have to do it all at once. You can divide your time into two or three segments of 10 to 15 minutes per day.</p><p>Having a healthy well balanced diet is also important. You can read more about this at American Diabetes Association website.</p><p><b><i>By Dr. Cynthia May D. Malong — Family Medical Practice HCMC</i></b></p>"
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"value": "<p>A single miscarriage during the first term of pregnancy is not a rare occurrence. Indeed, this happens to 15 per cent of women. However, just one or two per cent of couples experience Recurrent Early Spontaneous Abortion (RESA), usually defined as three miscarriages before the 12th week of amenorrhea (1st term).</p><p>We will list possible causes and look at the specific tests required for each of these etiologies (cause or sets of causes). A thorough check up must be conducted right away not to lose time and to avoid another miscarriage. Indeed, some doctors recommend the check up as early as after the second early miscarriage.</p><p>The most frequent cause for RESA is chromosomal abnormality; therefore, we will ask for a “karyotype” which is a study of both parents’ chromosomes. Today, we know that, even if all chromosomes are apparently normal, there may be some partial abnormalities that are only disclosed with a more sophisticated technique of investigation (FISH).</p><p>Some are of the view that there could be hormonal disorders responsible for RESA and it is therefore useful to check all hormonal levels of the ovarian function. We tend to link hormonal causes with thyroid imbalance, which must accordingly be explored with particular focus on anti-thyroid antibodies. We will also have to look for possible diabetes or diabetes tendency (tolerance test, insulin).</p><p>We also know that uterus malformations may be responsible for recurrent pregnancy loss, whether it is congenital (mother born with an abnormal shape of her uterus: septum, uni or bicornuate, arcuate fundus (also known as heart-shaped uterus) or whether it is acquired (a fibroid distorting the uterine cavity or a traumatic scar on the uterine wall disturbing proper implantation of the embryo). Some of these malformations can be surgically repaired. We must therefore perform a pelvic ultrasound and hysteroscopy before a new pregnancy.</p><p>Some vaginal infections, generating endometritis (an infection inside uterine cavity) may also trigger miscarriages. Vaginal swab to search for <i>chlamydia trachomatis</i> and <i>mycoplasma</i> (different kinds of bacteria) must thus be part of the screening.</p><p>Environmental causes should also be considered, such as smoking, drugs, excessive consumption of coffee and/or alcohol as well as exposure to chemical toxics.</p><p>It is recommended that multivitamins, especially folic acid, be taken, starting one month before pregnancy and throughout the first trimester.</p><p>Recently, scientific advances have permitted major progress in the treatment of couples affected by Recurrent Early Spontaneous Abortions.</p><p>- First, we have discovered that some auto-immune disorders are related to that pathology. These are evidenced through the screening in the blood for the antiphospholipid antibodies (mostly anticardiolipin). Lupus with its lupus anticoagulant factor is included in this category.</p><p>- Second, we have also found that some coagulation disorders could trigger a small thrombosis in the future placenta responsible for subsequent miscarriage. We will accordingly order specific factors of coagulation such as mutation factor V Leiden or factor II, Plasma homocysteine levels and plasma protein C and S.</p><p>For both these etiologies, treatment combining Aspirin-Heparin has shown excellent results.</p><p>In spite of such thorough screening and tests, almost 50% of RESAs remain unexplained. Proposed treatments will be adapted to the underlying pathology identified through the checkup or will be adjusted empirically if no apparent cause could be identified.</p><p>Lastly, another significant factor must also be taken into consideration: the anxiety level of the patient, as stress is a factor that might induce spontaneous abortions. Indeed, we must not forget that psychological problems may develop in a woman whose first pregnancy ends in spontaneous abortion or who has a second or third consecutive spontaneous abortion. Usually sympathetic discussion and proper counseling, creating a climate of confidence between the couple and the medical team will contribute greatly to positive results.</p><p>In conclusion, one must keep in mind that very significant progress has been made and that with proper monitoring and support, risks of Recurrent Early Spontaneous Abortions may be significantly reduced.</p><p><b><i>By Dr. Elisabeth Blanchi - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p><b>Are allergic reactions to food common in Việt Nam?</b></p><p>Food allergy affects an estimated 6 to 8 per cent of children under age 3, and about 4 per cent of adults worldwide. It’s easy to confuse a food allergy with a much more common reaction known as food intolerance. For expats living in Hà Nội, allergic reactions to local food, especially seafood, can present significant problems that may need to be addressed urgently.</p><p>For some people, an allergic reaction to a particular food may be uncomfortable but not severe. For others, an allergic food reaction can be frightening and even life-threatening. Food allergy symptoms usually develop within a few minutes to an hour after eating the offending food.</p><p>The most common symptoms include: Tingling in the mouth; hives, itching or eczema; swelling of the lips, face, tongue and throat, or other parts of the body; wheezing, nasal congestion or trouble breathing; abdominal pain, diarrhea, nausea or vomiting; dizziness, lightheadedness or fainting.</p><p>Anaphylaxis: In some people, a food allergy can trigger life-threatening symptoms, including: a swollen throat or a lump in the throat that makes it difficult to breathe; shock, with a severe drop in blood pressure and a rapid pulse, dizziness, lightheadedness and/or loss of consciousness. Emergency treatment is critical for anaphylaxis. Untreated, it can result in a coma or death.</p><p><b>How do food allergies develop?</b></p><p>The principal cause of allergic reactions to food is an immune system that mistakenly identifies a specific food substance as harmful. Immune cells release a substance known as immunoglobulin E (IgE) antibodies to fight the culprit food or food substance (the allergen). The next time one eats even the smallest amount of that food, the IgE antibodies sense it and signal to the immune system to release a chemical called histamine. It is this histamine released into the bloodstream that causes the range of symptoms described. </p><p><b>The majority of food allergies are triggered by certain proteins in:</b></p><p>Shellfish, such as shrimp, lobster and crab.</p><p>Peanuts, tree nuts, such as walnuts and pecans, as well as fish and eggs.</p><p><b>What is the most effective treatment?</b></p><p>The only way to avoid an allergic reaction is to avoid the foods that cause the signs and symptoms. However, despite your best efforts, you may come into contact with a food that causes a reaction.</p><p><b>For a minor allergic reaction</b> prescribed antihistamines may help reduce symptoms. These drugs can be taken after exposure to an allergy-causing food to help relieve itching or hives. However, antihistamines alone can’t treat a severe allergic reaction.</p><p><b>For a severe allergic reaction,</b> you may need an emergency injection of epinephrine and a trip to the emergency room requiring IV fluids, anti histamines, epinephrine and even steroids. Many people with known severe allergies carry an autoinjector pen for epinephrine (EpiPen). </p><p>The key treatment is to do your best to avoid the food in question, and work with your doctor to identify what steps you can take to relieve your symptoms and how to spot and respond to a severe reaction.</p><p><b><i>By Doctor William Brian McNaull - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p>Chickenpox. A name that can make your skin crawl. The dreaded chickenpox season is almost upon us, with cases tending to spike between March and May.</p><p>Known as one of the most common of childhood illnesses, and one of the most uncomfortable, chickenpox is an infection caused by the Varicella Zoster virus, which can also cause shingles.</p><p>It causes a fever and widespread crops of blisters, and most children will catch it at some point. It can also occur in adults who didn’t have it in childhood. The illness is usually mild and clears up in two weeks or so, but it can be dangerous for some people, such as pregnant women, newborn babies and people with a weakened immune system.</p><p><b>Symptoms of chickenpox</b></p><p>The symptoms start one to three weeks after infection - a rash that develops in three stages:</p><p><b>Spots</b> – red raised spots develop on the face or chest before spreading to other parts of the body, and over the next few hours or the following day, very itchy fluid-filled blisters develop on top of the spots.</p><p><b>Scabs and crusts</b> – after a further few days, the blisters dry out and scab over to form a crust; the crusts then gradually fall off over the next week or two.</p><p><b>Chickenpox</b> is contagious until all the blisters have scabbed over, which usually happens about five or six days after the rash appears.</p><p><b>How does it spread?</b></p><p>Chickenpox can spread easily. You can get it from an infected person who sneezes, coughs or shares food or drinks. You can also get it if you touch the fluid from a chickenpox blister.</p><p>A person who has chickenpox can spread the virus even before he or she has any rash. Chickenpox is most easily spread from 2 to 3 days before the rash appears and until all the blisters have crusted over.</p><p>You are at risk of chickenpox if you have never had the illness and haven’t had the chickenpox vaccine. If someone you live with gets chickenpox, your risk is even higher because of the close contact.</p><p><b>Dos And Don’ts</b></p><p>Do prevent chickenpox with the chickenpox vaccine. Children should get it as part of their routine immunizations.</p><p>Do keep your child away from school/playgroup/planes and other public areas at the first sign of a rash until the blisters have crusted over as chicken pox is highly contagious.</p><p>Don’t send your kid to a "chicken pox party" so they can catch it and "get it over with". I have seen enough cases of severe reaction to chicken pox (including pneumonia and the brain swelling condition, encephalitis). So parents, please don’t play with your kids’ lives.</p><p>Do keep a watchful eye as early symptoms can be perceived as grouchiness or aching, and the incubation period (from exposure to full onset) varies from 14 to 24 days.</p><p>Do consider offering your child an anti-histamine syrup if they’re older than one year of age, as it can help relieve itching.</p><p>Don’t slather your child with calamine lotion as this dries on the skin to become even itchier. Instead, use calamine gel that cools and provides longer-lasting relief.</p><p>Do keep your little one’s finger nails short and encourage them not to scratch to minimize scarring. Try putting socks on their hands at night.</p><p>Don’t freak out. Chickenpox is typically a mild illness. Once the itching subsides, patients are usually fine and the majority don’t suffer longterm complications.</p><p>Do avoid known outbreaks or carriers if you’re pregnant and have never had the infection, as newborn babies are vulnerable to catching it. If you’re pregnant and have chicken pox your doctor might recommend antiviral or immunoglobin treatment. Exclusive breastfeeding offers good protection for newborns against most infections</p><p>Don’t hesitate to call your pediatricians when:</p><p>a. Your child develops unusual symptoms such as swollen and painful skin, infected blisters or breathing/chest pain.</p><p>b. Your baby is less than four weeks old and has chickenpox</p><p>If you develop chickenpox as an adult and the symptoms haven’t started to improve after six days, you may need treatment to prevent you becoming seriously ill.</p><p><b><i>By Doctor Ian Santos - Family Medical Practice Hanoi</i></b></p>"
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"title": "Losing sleep over insomnia?",
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"value": "<p><b>What is sleep and why do we need it?</b></p><p>Sleep is a natural state of rest for the body, and is common to all mammals, birds and many reptiles and fish. Sleep is not just about energy conservation. In fact, the amount of energy saved during eight hours of sleep is about 50 kCal (the amount of energy in a piece of toast!). Sleep also serves a number of different functions in the body, including hormone regulation and metabolism, wound healing, and immune function and memory consolidation. So the old advice about getting a good night’s rest before those important exams or meetings may be more than just not feeling tired the next day!</p><p>But why do we need it? In fact, no one really knows why and most of our conclusions come from observing what happens with lack of sleep. After 17 hours of being awake, your cognitive function is the same as having a blood alcohol level of 0.05 per cent - which is the legal limit for driving in many countries around the world. Most people can testify to feeling pretty awful after staying up all night too.</p><p><b>How it works</b></p><p>The body is controlled by an internal “clock” which runs on an approximately 24 hour circadian rhythm. This “body clock” is controlled by a special part of the brain which regulates body temperature, sleepiness and the release of certain hormones. These hormones (cortisol, melatonin and adenosine) rise and fall in a regular pattern to cause wakefulness and sleepiness. External stimuli such as light or a busy work schedule can also affect and interrupt these patterns. The best night’s sleep occurs when all our internal and external signals are aligned. And the opposite is true too, which is why jet lag occurs.</p><p>Not all sleep is the same. There are actually several different stages in a sleep cycle, which lasts about 90-110 minutes in total. Sleep is divided into REM (rapid eye movement) and nonREM sleep. Most of the night is spent in varying stages of nonREM sleep, but most people will have about 3-4 periods of REM sleep during the night – the time of dreams.</p><p><b>How much sleep we really need</b></p><p>The amount of sleep needed depends mainly on how old you are. Newborn babies up to 1 year old sleep about 16-18 hours per day, school age children about 11-13 hours/day and adults 7-9 hours/day. Of course this will vary slightly from one person to the next but the amount of sleep we require is what we need not to be sleepy the next day.</p><p>Feeling well rested the next day requires adequate time but also good quality sleep.</p><p><b>What can go wrong with sleep</b></p><p>There are many different types of sleeping disorders. Some cause too much sleep like Narcolepsy, some too little, like Insomnia, and some just poor quality sleep such as Obstructive Sleep Apnoea or Restless Legs Syndrome. Poor sleep can also be an effect of other medical conditions such as heart disease, asthma, reflux, chronic pain, drug and alcohol abuse and mental illness, especially depression and anxiety. If you are concerned about any of these conditions please go and see your doctor to discuss them further, as these issues are beyond the scope of this article.</p><p><b><i>By Doctor Catherine Gonzalez - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p>As a practicing psychotherapist, one of the interesting questions I face is: <b>What aspects of personal psychology are culturally determined? </b> It’s a relevant question because I work with people from many different cultural backgrounds, and this includes the divide between Eastern and Western orientations. The developmental stage where there seems to be a notable difference, particularly between Eastern and Western cultures, is at the point where a person transitions from adolescence to adulthood. It is a clear point where the ideas of individualism and collectivism are demonstrated.</p><p>The danger of writing in broad generalities about large concepts like “Eastern” or “Western” or “individualism” and “collectivism” is that it belies all the examples in which there are exceptions, even whole subcultures that do not fit assumptions prescribed by such concepts. That said, it seems there is a value in trying to understand these differences because, in a changing world where there are few pure cultural examples, people are struggling with the confusion of mixed expectations and changing cultural patterns.</p><p>My psychotherapeutic practice has attracted many confused, anxious and depressed Vietnamese youth who are struggling to take the step from adolescence to adulthood within or alongside expectations of their parents, family, extended culture and social structure.</p><p>While I am able to empathise and facilitate ways for them to deal with difficult emotions and decisions, I sometimes feel that I lack an understanding that would help me better relate to their social context or situation.</p><p>The Western model of individualism holds that the step into adulthood is one where separation, individuation and autonomy are the ideals. Parents raise children to take on more and more responsibility, until they can step into a life they call their own adulthood with the freedom to choose their partners, their jobs, their lifestyle, their friends and where to live.</p><p>Of course, it is not quite as simple as that, both in terms of how it happens and in terms of the degree of separation that exists. While “freedom” is often touted as the greatest benefit of individualism, it is easy to see the downside – so many people who are unable to manage the freedom or the responsibility that comes from the burden of having to know the answers to life’s questions – how to live life.</p><p>I see plenty of depressed, anxious and confused Western clients who are trying to find their way without social structures of family or tradition to contain the process, to show the way. This is particularly true in the United States, where there is no common, deep rooted culture. Too much freedom can create a lot of messes in the way people come to cope with or live life.</p><p>In the Eastern model of collectivism, the individual is embedded in the family, which is set up according to a traditional structure and according to cultural values and all of this is embedded in a social/political structure. The security of an individual comes from knowing the role or place they have within the familial and traditional cultural structures. People know they will be cared for from birth to death, the tasks of living are divided and assure the survival of everyone within the structure of the family. Freedom comes from the security of collective support.</p><p>Some of today’s youth in Việt Nam are caught between these two systems. Having learned English and the ways of the Western world outside of Việt Nam, they have developed a different sense of what is possible. Children of the last 20 years have grown up very differently compared to the childhoods of their parents and grandparents. Many travel or study abroad and come back changed in the way they see the world and what they want from it. They have grown up in the era of social media and immediate exposure to things many older people thought were impossible. The clashes that come from rapid change are affecting young people the most, with depression, anxiety, role confusion and conflict with their parents and other family members.</p><p>As a psychotherapist, my role is not to have readymade solutions or to give advice about how to fix life’s problems. It is more to explore and name the truths of our situations and problems. Understanding and insight can replace shame, guilt, frustration and fear. We look for ways to accept our life, as it is, while recognizing what lies within our control to change things.</p><p>It seems that with change comes the need to orchestrate a new balance between structure and freedom. Too little structure can cause disorder and undirected pathways of living. Too much structure can limit the flow of life’s energy and thwart the progress that comes naturally. The mental health of our young people might be the barometer that helps us measure which ways to adjust ourselves so we can give a full life to the generations that proceed.</p><p><b><i>by Douglas Holwerda - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p><b>The study of reading and writing</b></p><p>Learning to read and write is an obligatory rite of passage at school. But is it easy?</p><p>Doing anything for the first time is challenging : driving, cooking a complicated dish, working for a new company. Learning stages must be respected. Steps can’t be skipped. Concentration, motivation and flexibility are necessary.</p><p><b>What exactly does it mean to read a word?</b></p><p>From a written trace, it is necessary to link a suite of sounds and to make sense of them. Other skills needed to read a word include: good vision, visual attention to reading the word in its entirety, understanding the principle of associating letters with sounds, regrouping letters to make a whole, and the ability to define this word in terms of the reader’s personal lexicon to make sense of it.</p><p><b>What exactly does it mean to write a word?</b></p><p>From an auditive trace, it is necessary to produce a written trace. Skills needed to write a word include: good hearing, remembering the word long enough to write it, good visual and spatial attention to writing the word at a good place on the page, breaking up the word in order to write each letter, and the mental flexibility to check if the word is written correctly. </p><p>What a challenge for a child! </p><p>Written language training requires a lot of skills: visual, auditory, memory, flexibility, attention, mental handling of sounds and syllables, ability to compose and break up a word, a lexicon, and self-confidence. </p><p><b>How can I help my child learn?</b></p><p>To learn how to read and write, four things are necessary: a method adapted to the needs of the individual learner, time, repetition and fun. Thanks to these four elements, the child’s language training will have lasting effects.</p><p>Method: A method provides rules for the child. The child will make errors. Fortunately! Through its errors, the child learns how to generalize the rule. The child must also learn how to identify its own errors and correct them. This is how a child becomes an autonomous learner.</p><p>For example, if a word isn’t written correctly, you can just ask your child how many errors there are, without showing them the mistakes. The child must then identify and correct its own mistakes.</p><p>Time: Learning to read and write takes time. Some children learn faster than others. It is important to respect the individual rhythm of each learner. If your child is finding homework to be tedious or difficult, you can draw up a contract with your child. For example, your child can do an activity it likes before or after doing homework, and you can define a limited amount of time to work together. Establishing a routine makes it possible for a child to anticipate what’s coming and to get organized. </p><p>Pleasure and motivation: Reading and the writing should not be restricted to school exercises. Read stories with your children, play little games where reading and writing are necessary, read cooking recipes and game instructions, write letters. Such shared moments show children that one reads and writes daily. This will motivate your child to want to learn more. You can recommend books to your child, but you can also let children discover and choose what to read. No one learns without being motivated.</p><p>Varied repetition: Repetition is needed during all training sessions. If a child reads or writes a word correctly once, it doesn’t mean the child knows the word. Children need to meet a word many times to integrate it into their personal lexicons. A word must be repeated and used in various contexts for children to generalize and retain it. Play with the word: color a difficult spelling, spell the word, count the syllables, say its meaning, look for synonyms.</p><p><b>Difficulties with written language </b></p><p>Despite motivation, time, and a teaching method adapted to an individual learner’s needs, written language is sometimes very hard for certain children to grasp. Such children need to understand what does not work. They also need to be understood and to be helped.</p><p>A child who works too slowly, does not enjoy reading or writing, and makes many errors may suffer from a written language delay or disorder.</p><p><b>Ask for professional advice</b></p><p>If your child is having trouble learning to read and write, a speech therapist can help you.</p><p>Sometimes an assessment alone is enough. The speech therapist advises and reassures you. The child feels understood, more trusting and may improve spontaneously, without further intervention.</p><p>Sometimes therapy is recommended to help your child. If so, the speech therapist will explain the type and frequency of the sessions, the challenges involved, and the purpose of the therapeutic work to be undertaken. </p><p>Written language is a difficult and important challenge, both for school and for personal growth. Stack the odds in your child’s favor.</p><p><b><i>By Tiphaine de Torcy - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p>Tooth decay in children, also known as early childhood caries, is one of the most common chronic childhood diseases in Việt Nam. In some cases, severe tooth decay can result in tooth loss. A child who suffers from caries may develop serious infections of the gums, sinuses; and it may even spread to the neck. Caries can be painful and may cause your child to refuse eating.</p><p>Unfortunately, many dentists in Việt Nam don’t have experience in treating little kids and they often tell parents that the child doesn’t need treatment until his permanent teeth erupt. This is a mistake. Caries should be treated even if the child is young and still has his or her "Milk Teeth," since the infection can spread and affect the permanent teeth that haven’t erupted yet.</p><p>“Milk” or “baby” teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to emerge. In fact, healthy baby teeth are just as essential to infants and young kids as healthy permanent teeth are to older kids and adults.</p><p>The first primary tooth often erupts between 6 and 9 months of age, and by 3 years, a healthy child should have 20 primary teeth. If the child does not develop his or her first tooth by 9 months, parents should see his/her pediatrician. Healthy primary teeth are white without spots or stains, and healthy gums are smooth and pink. </p><p>From birth to 12 months, parents should gently wipe their baby’s gums with a clean baby washcloth or gauze. When the first tooth appears, clean the surface using a baby toothbrush and water. According to the American Academy of Pediatrics, the best time to clean your baby’s teeth is after breakfast and before bedtime.</p><p>For children from 12 months of age, parents can start using a small tooth brush and toothpaste twice a day. In little children below 3 years old, the amount of toothpaste recommended is the size of a rice grain. Children over 3 need toothpaste the size of a small pea. Start flossing when two of the child’s teeth touch each other.</p><p>When you first introduce a tooth brush to your child, make it look like a toy. Let your baby play with it. Babies at this age usually put every object in their mouth and if they see the object as a toy they will accept it. Let your baby watch how you brush your teeth and how much fun it is, it will encourage him/her to do the same. Dental hygiene does not have to be a chore. Instead, it can be a fun bonding activity for you and your child.</p><p><b>“Baby Bottle Decay’</b></p><p>Don’t put your child down for a nap with a bottle of formula, or milk. Sugary liquids cling to his teeth, feeding bacteria that can cause tooth decay. If you must give your child a bottle to take to bed, make sure it contains only water.</p><p><b>Ditch the pacifier by 2 or 3</b></p><p>There are lots of good reasons why children need pacifiers, but in the long term, it can affect how their teeth line up. It can also change the shape of the mouth. Talk to pediatricians if your child is still using a pacifier past age 3.</p><p><b>Is fluoride safe for young kids?</b></p><p>Fluoride is a special mineral which is important for building a strong enamel layer that protects our teeth. In many countries, fluoride has been added to drinking water and it has proven to reduce caries (teeth infection). If you search online, you will see there is a lot of controversy about use of fluoride and it can be quite confusing. The simple truth is, like anything else in life – too much fluoride is not good but no fluoride is also bad.</p><p>Fluoride is better absorbed into the teeth from the oral space rather than from ingestion. So using fluoridated tooth paste is the ideal way. Adults can also use fluoridated oral rinse solutions (not recommended for little children). However, unless fluoridated toothpaste is explicitly recommended by your dentist or pediatrician, it is best not to use it until your child can safely spit to prevent ingestion of excessive amounts of toothpaste.</p><p><b><i>by Dr. Cynthia Dacanay - Family Medical Practice Hanoi </i></b></p>"
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"value": "<p> <b>Third Culture Kids (TCKs) understand when:</b></p><p>To everyone’s confusion, your accent changes depending on who you’re talking to.</p><p>You’re really good at calculating time differences, because you have to do it every time you call your parents.</p><p>You start getting birthday wishes several hours before your birthday, from friends farther east than you.</p><p>Your passport looks like it’s been through hell and back.</p><p>You get nervous whenever a form needs you to enter a “permanent address”.</p><p><b>Frequent mobility:</b> TCKs are children born or raised in cultures (western or non-western) outside of their parents’ home(s) of origin because of their parents’ occupations or interests; as the world grows, we now have ATKs - Adult third culture children who are TCKs at least 18 years of age or older.</p><p><b>Challenges: </b> Currently there are millions of TCKs in international schools around the world; others in Embassy schools; yearly countless numbers return to their passport countries of origin. Educational psychologists explain once home there are three basic things all children need: Belonging, Recognition and Connection. These basic needs are often wrenched away from them with each relocation. The layers of loss leave deep scars: Friends, Pets, Family, Weather, Food, Loss of identity.</p><p><b>You are not alone:</b> TCKs are not alone. Some of the most famous TCKs are Barrack Obama, Kathleen Turner and Julie Christie. Some TCKs are able to explain losses not successfully resolved in childhood; losses that have an increased likelihood of recurring in adulthood. Questions about who you are, what you are, where you are from will change, or may even wait until long after childhood to bubble up and burst.</p><p><b>TCK Penny</b>: Being a TCK is pretty awesome, but you are always leaving your friends behind. I consider home is where my passport was issued, not necessarily where I was born. My family is important to me wherever they are.</p><p><b>TCK Charlotte</b>: It’s strange but your friends always behave differently in front of you.</p><p><b>ATK Vidya</b>: I’m from the country I live in now; I won’t go back but I won’t forget my heritage. Happy to sit and listen to the elders who are feeling loss; adults take longer to adjust.</p><p><b>How can a psychologist help?</b></p><p><b>Observe children:</b> Therapy is a partnership between an individual and a professional such as a psychologist. Families of TCKs often consider therapy, under the following circumstances:</p><ul><li>Noticing a feeling of intense overwhelming; a prolonged sense of sadness and helplessness, TCKs will become withdrawn and quiet</li><li>Emotional difficulties making it hard for them to function from day to day</li><li>Actions harmful to themselves or to others, e.g. Aggressive, Bullying</li><li>Troubled with emotional difficulties facing family and friends</li></ul><p>Global mobility comes at a price. Psychologists are able to provide therapy and help cope with challenges faced by families and TCKs. Kids can get support in coping with an uncertain world, supporting emotions and physical health which are very closely linked to their overall well being and can have a positive effect on the body’s immune system. —<b>Family Medical Practive Vietnam</b></p><p><b><i>by Bluteau Laetitia </i></b>— <b><i>Family Medical Practive Vietnam</i></b></p>"
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"value": "<p><b>April has come along with two public holidays and the weather is getting warm, allowing many people to enjoy some relaxation, rejuvenation and well-deserved pampering at a spa or the swimming pool. However, beware of these holiday treats and protect your skin!</b></p><p><b>Micro-organisms in foot spas can enter through the skin; so broken skin (e.g., cuts and abrasions) should not come into contact with foot spa water. Do not shave, use hair removal creams, or wax your legs during the 24 hours before receiving treatment in a foot spa. Do not use a foot spa if your skin has any open wounds such as bug bites, bruises, scratches, cuts, scabs, poison ivy, etc.</b></p><p>Do understand that both manicures and pedicures carry a small risk with respect to disease transmission (both viruses and bacteria) especially if the skin is broken. Ensure the instruments are sterilised well and the facility is scrupulously clean.</p><p><b>Hot Tub Common Sense</b></p><p>Is the facility clean? Find out how they clean and monitor the water quality.</p><p>Hot tubs (large tubs filled with hot water for one or more people) or jacuzzis (a tub with aerating or swirling water) are used both for pleasure and increasingly being recommended for therapy. However, the environment of the spa and hot tub, if not cleaned and operated correctly, can become a culture medium for microorganisms. Because the warm water is at the ideal temperature for growth of microorganisms, good disinfection is critical. It is essential that all equipments work properly and that the units are cleaned and disinfected routinely. Ask! Monitoring the water temperature is very important and, depending on the health of the user, can be a matter of life and death (for example someone with significant heart disease should avoid sitting in a hot tub). Time in the heated water should be limited, and the temperature for pregnant users should be below 39°C to protect the unborn baby.</p><p><b>Public Health Issues</b></p><p>Correctly constructed and operated swimming pools are not a major public health problem. However ‘Hanoi users beware’! Pools can become contaminated by various disease-causing organisms.</p><p>How, you ask?</p><p>From other people already carrying infections and by animals that may be come in contact with the water (at night). Studies of disease outbreaks originating from swimming pools and causing gastroenteritis show that about 50 per cent are caused by parasites; 25 per cent by bacteria; 8 per cent by viruses; 3 per cent by a combination of parasites and bacteria, and the remaining of unknown cause. Some bacteria like <i>cryptosporidiosis</i> are highly chlorine resistant! Bacillary dysentery can be a problem where water is polluted by domestic or animal sewage. Swimming pools have also been implicated in outbreaks of <i>leptospirosis</i>. Respiratory diseases, like colds, sinusitis and sore throats can spread more readily in swimming areas as a result of close contact, or improperly treated pool water, coupled with lowered resistance because of exertion.</p><p>Go only to the cleanest of establishments. Use your eyes, think and ask questions. Enjoy your leisure time but play safe! </p><p><b><i>by Doctor William Brian McNaull - Family Medical Practice Hanoi</i></b></p>"
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"title": "April is Autism Awareness Month",
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"value": "<p> Autism Spectrum Disorder (ASD) is an umbrella term used to describe a range of lifelong neuro-developmental conditions that impair a person’s behavior and ability to communicate and interact with others.</p><p>Autism spectrum disorder can be mild or severe and no one knows what causes it.</p><p>It’s difficult to generalize the characteristics of ASD as they can vary so dramatically from person to person, but the hallmarks are communication difficulties, sensory sensitivities and social and emotional development issues.</p><p><b>What are the key symptoms of autism spectrum disorder?</b></p><p>— To be diagnosed with autism spectrum disorder, a child must show signs of the disorder in early childhood. Sometimes the symptoms do not show up until the child is in school. The signs of autism spectrum disorder include problems in two key areas:</p><p><b>Social interaction and social communication:</b> Children with ASD have trouble relating to others:</p><ul><li> They often don’t know how to read facial expressions, and tend to avoid eye contact.</li><li> They often dislike being touched. Many young children with ASD prefer not to play or interact with others.</li><li> Children with ASD often take much longer than other children to learn to speak. Some never learn to speak. But speech is not the only thing that’s affected. The parents of children with ASD sometimes think the children are deaf. But deaf children who cannot speak look for other ways to communicate, such as through hand motions. Children with ASD do not. They do not seem to care whether they can communicate.</li></ul><p><b>Limited interests:</b></p><ul><li>Children with ASD tend to show intense interest in certain things. But they show little interest in anything else. Young children might get completely focused on things that spin or shine and ignore most everything else.</li><li>Older children might become preoccupied with one single topic, such as the weather, numbers or sports.</li><li>Children with ASD also tend to have rituals that they must follow exactly. For example, they might need to eat particular foods in a specific order, or to take the same route from one place to another—every time. If these habits get disrupted, the children get upset. </li></ul><p><b>What are other things that parents should watch for?</b></p><ul><li>Not pointing at objects to show interest (point at an airplane flying over)</li><li>Not looking at objects when another person points at them</li><li>Have trouble relating to others or not have an interest in other people at all</li><li>Avoiding eye contact and wanting to be alone</li><li>Having trouble understanding other people’s feelings or talking about their feelings</li><li>Preferring not to be held or cuddled or cuddling only when they want to</li><li>Appearing to be unaware when other people talk to them but responding to other sounds</li><li>Be very interested in people, but not know how to talk, play or relate to them</li><li>Repeating or echoing words or phrases said to them, or repeating words or phrases in place of normal language (echolalia)</li><li>Having trouble expressing their needs using typical words or motions</li><li>Not playing “pretend” games (pretending to feed a doll, for instance)</li><li>Repeating actions over and over again</li><li>Having trouble adapting when a routine changes</li><li>Having unusual reactions to the way things smell, taste, look, feel or sound</li><li>Losing skills they once had (for instance, stop saying words they were once using)</li></ul><p><b>When should I take my child to a doctor or nurse?</b></p><p>Take your child to a doctor or nurse if you see any of the signs listed above<b>.</b> You might also want to have your child’s hearing tested. That way you can find out whether hearing problems are causing some of the symptoms you see.</p><p>If the doctor or nurse suspects ASD, he or she will probably send you to see a team of experts who know how to spot the disorder. The members of this team will:</p><ul><li>Ask you many questions about your child and your family</li><li>Test your child’s abilities in many ways</li><li>Make sure that the child’s symptoms are not caused by another problem</li></ul><p>If your child does have ASD, the earliest possible diagnosis is vital. Some of the problems caused by ASD can be improved if they are caught early.</p><p><b>How is autism treated?</b></p><p>ASD cannot be cured. However, a healthcare provider can work with parents to develop a treatment plan to help the child reach his or her full potential. The optimal treatment plan depends upon the child’s age, diagnosis, underlying medical problems, and other individual factors.</p><p><b><i>by Dr Philippe Jean Collin - Family Medical Practice Hanoi</i></b></p>"
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"title": "Tummy Time: you need to stomach this",
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"value": "<p> Tummy time is essential from day one to help your baby grow strong – even if your baby fusses and cries when you put him on his belly. Experts find that babies who don’t spend time face-down often have some delays in the development of motor skills.</p><p><b>What is</b> <a href=\"https://pathways.org/glossary/tummy-time/\"><b>Tummy Time</b></a><b>?</b></p><p>Tummy Time is the time during the day your baby spends on their tummy while they are awake.</p><p>Since the American Academy of Pediatrics (<b>AAP</b>) recommends <a href=\"https://pathways.org/glossary/back-sleep/\">Back to Sleep</a>, spending time on their tummy is crucial for baby’s development.</p><p><b>Why does my baby need Tummy Time?</b></p><p>Babies spend a lot of time on their backs. No matter how fascinating baby gyms and mobiles are, spending time on their tummies is important too. It builds muscles and helps with their development.</p><p>Tummy Time helps your baby develop the neck, back, and shoulder muscles needed to meet infant developmental milestones. The experience of being on their tummy helps babies learn to push up, roll over, sit up, crawl, and pull to a stand. It may also help prevent early <a href=\"https://pathways.org/glossary/motor/\">motor</a> delays and conditions such as flat head <a href=\"https://pathways.org/glossary/syndrome/\">syndrome</a> (positional <a href=\"https://pathways.org/glossary/plagiocephaly/\">plagiocephaly</a>) and twisted neck (positional <a href=\"https://pathways.org/glossary/torticollis/\">torticollis</a>).</p><p>The American Academy of Pediatrics recommends placing babies on their backs to sleep and on their tummies to play.</p><p><b>When should my baby start Tummy Time?</b></p><p>Tummy Time can begin as soon as your baby comes home from the hospital.</p><p><b>How much Tummy Time does my baby need?</b></p><p>Your baby should work up to an hour of Tummy Time per day by 3 months. Aim for a few minutes at a time, several times a day.</p><p><b>How to Do Tummy Time with my Baby?</b></p><ol><li><b>Tummy to Tummy or Tummy to Chest:</b> Lie down on the floor or a bed, flat or propped up on pillows. Place baby on your chest or tummy, so that you’re face-to-face. Always hold firmly for safety.</li><li><b>Tummy Down Carry or Football Hold:</b> Position one hand under the tummy and between the legs and carry baby tummy down. Nestle baby close to your body to help baby get accustomed to the position.</li><li><b>Lap Soothe:</b> Place baby face-down across your lap to burp or soothe them. A hand on baby’s bottom will help steady and calm them</li><li><b>Eye-Level Smile:</b> Get down level with your baby to encourage eye contact. Roll up and place a blanket under the chest and upper arms for added support.</li><li><b>Tummy Minute:</b> Place your baby on its tummy for one or two minutes after every diaper change. Start a few minutes at a time and try to work up to an hour a day in shorter intervals by the end of three months.</li></ol><p><b>When should we do tummy time?</b></p><p>Make sure your baby isn’t hungry or tired when you set him tummy-down. On the other hand, don’t place him on a full belly. Wait about an hour after feeding to avoid spit-ups or infant acid reflux.</p><p>When your baby starts to cry — even if it’s only been a minute — try to coax her/him a bit longer by talking or playing with the her/him. When your baby has had enough, pick him up and try again later.</p><p>Your baby’s tolerance for tummy time is likely to increase gradually with experience and a bit of coaxing. And many babies are more content on their tummy once they can roll over and it becomes a matter of choice.</p><p>Some parents find it helpful to roll their babies over on their tummy for a little while after every diaper change. It’s easy to remember to do it, and your baby may come to expect it.</p><p><b>What to do if my baby hates Tummy Time?</b></p><p>If your baby seems miserable on his belly, it’s no wonder. Not only is it unfamiliar, it’s physically uncomfortable. It’s hard work for your baby to keep his head up when she or he’s on his tummy, and he/she can’t see much of anything down there and may even feel abandoned.</p><p>If your baby hates <a href=\"https://pathways.org/glossary/tummy-time/\">Tummy Time</a>, these tips may help make it more enjoyable:</p><ul><li> For newborns, Tummy Time activities should center on carrying and calming baby</li><li> Place baby on an incline using a rolled up towel or receiving blanket under baby’s chest</li><li> Offer Tummy Time at baby’s most content time of day</li><li> Get down on the floor at baby’s eye level.</li></ul><p><b>Don’t get discouraged. Every bit of Tummy Time makes a difference.</b></p><p>If you have done plenty of Tummy Time with baby, but are concerned they are not meeting their milestones, bring your concerns to the baby’s pediatrician or healthcare provider.</p><p><b><i>by Dr. Philippe Jean Collin - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> You might be surprised to learn that sexual contact, including oral sex and kissing can give you throat cancer. Oral cancers caused by the sexually transmitted human papillomavirus (HPV) have skyrocketed 225 per cent in the past 15 years, with men accounting for 75 per cent of all cases.</p><p>Much of the information out there about HPV virus centres on women, since having certain strains of the virus increases their risk of cervical cancer. But HPV virus in men can cause health issues, too. It’s important for men to understand how to reduce the risks.</p><p><b>What is HPV?</b></p><p>Human papillomavirus, or HPV, is a common virus that affects both males and females. There are more than 100 types. In fact, certain types cause common warts on the hands and feet. Most types of HPV are harmless, do not cause any symptoms, and go away on their own.</p><p>Some affect the genitals and up to 80 per cent of males and females will be infected with at least one type of genital HPV at some time.</p><p>HPV is easily spread through direct skin to skin contact. Anyone who has any kind of sexual activity involving genital contact could get genital HPV. That means it’s possible to get the virus without having intercourse. And, because many people who have HPV may not show any signs or symptoms, they can transmit the virus without even knowing it. A person can be infected with more than one type of HPV.</p><p>It is estimated that many people get their first type of HPV infection within their first few years of becoming sexually active.</p><p>Genital HPV infection is very common and for the majority of people, the body’s defences are enough to clear it up. Most, up to 90 per cent, are cleared up within 36 months.</p><p><b>Do I have HPV infection?</b></p><p>Because HPV infection does not usually show signs, you probably won’t know you have it and could thus pass it on inadvertently. Most women first become aware of infection when they have a Pap smear. The virus can cause cellular change (pre-cancerous) to the cervix and this is detected on the Pap smear, and warts can be detected on the genitalia.</p><p><b>Consequences of HPV Infection?</b></p><p>In most people HPV is harmless, but in some people the virus may persist and result in disease of the genital area, including:</p><p>In males: genital warts and some anal cancers.</p><p>In females: cervical cancer, some vaginal, vulval and anal cancers and genital warts.</p><p><b>Can men be tested for HPV?</b></p><p>Yes and no. Although HPV testing for men is used in some research studies, it is not commonly done.</p><p>Men cannot really know, then, if they carry HPV, except if they have genital warts. Warts can be biopsied but this is also rarely done. Most warts are treated by liquid nitrogen application or electro-cautery.</p><p><b>Means of protection?</b></p><p>* Safe Sex</p><p>If used correctly, condoms can help reduce the risk of genital HPV. However condoms don’t provide 100% protection since HPV is transmitted through genital skin contact not just sexual intercourse. It is important to remember that condoms also provide protection against other sexually transmitted diseases.</p><p>* HPV vaccination</p><p>In males vaccinations may help protect against genital warts and some anal cancers.</p><p>In females, vaccination may help protect against cervical cancer, some vaginal, vulval and anal cancers and genital warts.</p><p>Approved vaccines, are active against four HPV strains. Virtually all cervical cancer is caused by HPV, of which HPV 16 and 18 account for 70 per cent. HPV 16 and 18 are also found in 93 per cent of HPV- related anal cancers, 87 per cent of HPV-related penile cancers and 70 per cent of HPV-related cancers of the tongue and throat.</p><p>Therefore, HPV vaccination is strongly recommended for girls and women between the ages of nine and 45 and males between nine and 26. Ideally vaccination should occur prior to starting sexual activity, before being exposed to the HPV virus.</p><p><b><i>by Doctor William Brian McNaull - Family Medical Practice Hanoi</i></b></p>"
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"title": "Hà Nội and the postnasal drip",
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"value": "<p> All unique and beautiful cities have nicknames. These reflect their essence or aspirations.</p><p>New York is the Big Apple, Rome the Eternal City. New Orleans has acquired the monicker "The Big Easy" and Las Vegas, for obvious reasons, "Sin City".</p><p>Amsterdam’s essence is The Venice of the North, whereas Russia’s St. Petersburg aspires to be The Venice of the North (the aspiration). Venice is just Venice; Vienna, home to the Austro-Hungarian Empire, the Imperial City.</p><p>Then there’s the White City of the North - Helsinki, Paris - The City of Lights and Bucharest wannabe Little Paris. Cairo – Paris of the Nile (the aspiration). Give it enough time and Paris will be called Cairo of the Seine (the essence).</p><p>Hà Nội also has a nickname - The City of Lakes. Indeed, there are many lakes in Hà Nội, probably more than in any other city of comparable population and size. The word “lake” conjures up images of tranquility, but not so in Hà Nội. The traffic congestion, the noise and air pollution, require a fertile imagination or a very thick skin to give off a sense of peace and tranquility.</p><p>After spending a few months here and getting a taste of the city, I thought of a different nickname, but before sharing my idea I would like to take a step back into my pediatric practice at Family Medical Practice Hà Nội (FMP).</p><p>One relatively common condition pediatricians see in their offices is called posterior nasal drip, or postnasal drip. This is how it goes: your child develops something which looks like a common cold - a runny nose and a cough. A week goes by with no improvement, then another week, then it becomes a month. You try a cough syrup of one kind, then of another, then you begin to worry and take your child to a doctor who prescribes antibiotics. But a week later your worries mount because the cough continues.</p><p>At FMP one of the first questions we ask is whether this cough is worse at night or in the morning. Invariably the answer is "yes." Typically, the only finding will be nasal congestion and mucus in the back of the throat. Now we have a diagnosis: postnasal drip. Post - from the word "posterior", behind.</p><p>This is what happened: Your child developed a persistent runny nose. When awake and upright, his or her nasal secretions tended to drip out or be swallowed. But when lying down in bed, nasal secretions pool at the back of the throat where they try to sneak into the windpipe, activating a natural defense mechanism: a cough. There is actually nothing wrong with your child’s lungs and no antibiotics can help. Once the diagnosis is made, the treatment is simple - administering oral and topical anti-inflammatory medication - and the result visible within days.</p><p>Before coming to Hà Nội I would usually see one case of postnasal drip in a week or two. But Hà Nội is unique, not only because of its lakes. It also stands out as a very polluted city. Breathing Hà Nội air is often dangerous. Constant chemical irritation of the airways leads, among other things, to chronic inflammation, which subsequently leads to postnasal drip. I usually see two to four children with postnasal drip a day, making it about 15-20 times more than I was accustomed to.</p><p>This is what in my professional experience makes Hà Nội so unique and for this reason I propose to nickname it the City of Postnasal Drip.</p><p><b><i>by Dr. Sergei Shushunov</i></b> —<i> </i><b><i>Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> Everyone who’s been to Việt Nam even once will know that coffee is a big deal here. Since the introduction of the first plantations in the 19th century, Việt Nam has become the second largest producer and exporter of coffee in the world behind Brazil. Coffee business brings in US$3 billion a year and represents a livelihood for nearly 2.6 million people. Walking through city streets, we realize that there are likely more coffee shops in Việt Nam than bakeries and bistros in France. So yes, this plant producing stimulating effect, initially coming from Ethiopia, is a way of life in Việt Nam.</p><p><b>Good for health?</b></p><p>Caffeine is a psychoactive substance found in coffee. It is also found in tea, sodas, cocoa and chocolate. Caffeine promotes the release of exciter neurotransmitters in the brain, which explains its stimulating effect.</p><p>A lot of scientific studies have been carried out over the last 10 years and most of them seem to confirm the beneficial effects of moderate coffee consumption (3 to 4 cups per day) and the absence of negative effects on human health, all in a balanced diet.</p><p>Be careful, however, not to drink it too hot: any burning drink increases the risk of cancer of the oral cavity, the larynx, the pharynx and the esophagus – a precaution that also applies to tea and all hot drinks.</p><p><b>Well-being and cognitive effects</b></p><p>Moderate consumption (3 to 4 cups per day) of coffee generates positive effects. Sensation of well-being, relaxation, good mood, energy, increased vigilance, better concentration are all some of the beneficial impacts. On the other hand, consumption of high doses, induces negative effects, nervousness, aggressiveness, insomnia, tachycardia and tremors. However, the effects vary from one individual to another and are more pronounced in elderly and occasional users.</p><p>Children should not drink coffee.</p><p>Coffee increases the level of alertness, sensory and perceptual discrimination and responsiveness. This effect is particularly marked when individuals are deprived of sleep. On the other hand, before bedtime, even reduced consumption of coffee can have adverse consequences on the onset and quality of sleep. Difficulties and delayed sleep can persist up to 3 hours after taking coffee. Consumed during the day, coffee will have no influence on sleepiness and quality of sleep.</p><p>Low consumption of coffee has a beneficial effect on anxiety and mood. Some studies describe an improvement in well-being. Beyond a certain dose (600mg), on the other hand, caffeine increases nervousness, anxiety and irritability. Responses differ greatly from one individual to another, implying that genetic factors may be involved. A moderate consumption of coffee relieves migraines, dental and abdominal pain by direct analgesic effects on the receptors with which caffeine interacts.</p><p><b>Neurodegenerative diseases</b></p><p>Even more surprising, many studies seem to confirm the beneficial effects of caffeine in certain neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease. Most of these studies found a significant reduced risk of developing these diseases among coffee consumers (3 to 5 cups per day). Although confirmation of a positive association between coffee consumption and a reduction in the risk of developing a neurodegenerative disease requires further studies on large populations, there is increasing evidence of the beneficial role of caffeine in moderate doses. Even in mice, the results of studies suggest a decrease in cognitive deficits associated with caffeine consumption.</p><p><b>Coffee and cancers</b></p><p>Several epidemiological studies looked at the potential relationship between coffee and cancers. Well, it would also seem that in this area, moderate coffee consumption is, at worst, without significant effect and, at best, has a beneficial and protective effect. Studies have shown a reduction in risk for cancers of the colon, liver, breast, prostate, skin. For colorectal cancer, the protection afforded by coffee would be related to the anticarcinogenic properties of antioxidants in coffee, to the property of coffee to induce excretion of bile acids and to stimulate the motility of the colon. Finally, caffeine also inhibits growth of colon cancer cells. All these results are encouraging but should be taken with caution and should be tested on wider populations.</p><p><b>Coffee and the heart</b></p><p>Cardio-vascular risk from coffee consumption is not supported by any recent studies done with large populations. To reduce this risk, however, it is preferable to act on lifestyle changes. In particular, stop smoking, increase physical activity and improve quality of the diet.</p><p><b>Coffee and pregnancy</b></p><p>Concerning effects during pregnancy and postnatal development, moderate consumption of caffeine, in all its forms, does not seem to have a noticeable effect in terms of fertility or fetal growth. Only high consumption could be harmful. Pregnant women should not exceed 200mg of caffeine per day (2 cups of coffee).</p><p>To summarize: better cognitive performance, increased well-being, decreased neurodegenerative diseases, beneficial impacts for cancers and migraines. Encouraging reasons to continue to explore with pleasure the thousands coffee shops of Việt Nam.</p><p><b>What else?</b></p><p>(Source: Nehlig a, 2012. Effets physiologiques du cafe et sante humaine. Cah agric 21: 197-207).</p><p>Caffeine facts: One cup (about 250 ml) of filter coffee contains on average 179mg of caffeine; a 50 ml espresso contains 89mg of caffeine; a cup (about 250 ml) of black tea in a sachet contains 50 mg; a cup (about 250 ml) of green tea contains 30 mg; a can of Coke contains 33mg.—Family Medical Practice Hanoi</p><p><b><i>By Doctor Mathieu Nalpas - Family Medical Practice Hanoi </i></b></p>"
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"value": "<p> No one can predict when an emergency will strike, but with a little foresight or planning we can minimize the damage. We will discuss some common emergencies that can occur on the streets or at home and how to deal with them.</p><p><b>What to keep at home</b></p><p>Key emergency numbers in your area.</p><p>It is important to post these emergency contact numbers on your refrigerator/door so that they are clearly visible.</p><p>The number must include:</p><p>Clinics [for example: FMP Hanoi: 02438430748]</p><p>Trusted friends</p><p>Emergency Medical Response Services [for example: Ho Chi Minh City: * 9999]</p><p>Fire brigade: 114</p><p>Police: 113</p><p>English is spoken by all services</p><p>Analgesics for pain and fever, especially if you have children. Temperature over 38 degrees Celsisus is defined as fever. Use paracetamol to bring down the fever, which must always be kept in the house. When the cause of the fever is unknown, it is better to use paracetamol (PANADOL, TYLENOL) rather that anti-inflammatory medicine.</p><p><b>What to remember</b></p><p>As soon as it is feasible, familiarise yourself with the areas where you live, work, shop and spend leisure time in Hanoi. Then identify the nearest medical clinic/hospital. Proximity and knowledge of where to obtain emergency help can save time and lives.</p><p>Clinic numbers (Memorize them and also store them on your cellphone).</p><p>Diarrhea with fever, abdominal pain or vomiting needs medical assessment immediately, especially in children. </p><p><b>Fractures</b>: You or your friend fall off your bike and you (he/she) are in pain. Or you are involved in a traffic accident and are struck by a car or a fast-moving object. The leg or arm looks deformed or twisted. Do not move unless there is immediate danger of further physical harm. Immobilise the limb. Call for help -- either a clinic or friends -- from your mobile. Remain where you are and wait for the ambulance or help to arrive.</p><p>If a friend falls over three metres, lands on the head and it is necessary to move for immediate safety, support the head and neck and move the victim in the direction of the head without bending the spine forward. Do NOT drag the victim sideways. Keep the victim quiet and warm. Hold the head still by gently placing one of your hands on each side of the head or place rolled up towels or any other piece of clothing on both sides of the head to keep it immobolised. Then call for the nearest emergency medical service.</p><p><b>Bleeding:</b> Apply direct pressure to the wound. Do not apply the tourniquet above the bleeding point unless you cannot control the bleeding with direct pressure.</p><p><b>Unconsciousness</b>: A family member or friend may become unconscious at home or on a street due to several reasons, including injury, loss of blood, poisoning, severe allergic reaction, diabetic reaction, heart attack, illness, fatigue, stress and not eating. If the victim is unconscious due to injury, he/she needs to be treated for a possible head/neck injury.</p><p>Remain calm and assess the situation for safety. Be sure the situation is safe for you to approach. The following dangers will require caution: live electrical wires, gas leaks, building damage, fire or smoke, traffic or violence. If the scene is not safe or at any time becomes unsafe, GET OUT! You will be of no use to that person or anyone else if you get injured too.</p><p>If the scene is safe, assess the patient. Quickly observe the victim. Kneel down by the victim and tap or squeeze, not shake, the victim’s shoulder and ask, "Are you ok?" In case of an infant, you may tap the foot. If the victim responds but is badly hurt or appears to be very ill, get bystanders or friends to activate emergency response -- call the clinic/ambulance. If alone, use your mobile.</p><p>If the victim does not respond to your tap and shout, you must act quickly. You must first call for an ambulance and then check the victim’s breathing and pulse by looking, listening and feeling. If you cannot hear the breathing or feel the pulse, begin Cardio-Pulmonary resuscitation (CPR).</p><p>All age groups are recommended for cycles of 30 chest compressions alternated with two rescue breaths (mouth-to-mouth). Push fast and hard. The frequency of the compression must be 100 compressions per minute by pressing the chest 3-4cm each time. Count out loud the 30 compressions and repeat two mouth-to-mouth breaths. Repeat the cycle of 30 chest compressions alternating with two breaths until help arrives.</p><p>If you are alone and find an unresponsive infant or child, attempt to open the airway and give two breaths that are sufficient to make the chest rise. Then provide five cycles (30 compressions and two breaths = a cycle, about two minutes) before leaving the victim to call for medical assistance. A child is more likely to suffer from asphyxia (respiratory) arrest rather than heart irregularities, and is more likely to respond to, or benefit from the initial CPR.</p><p>When two or more rescuers are present, procedures should occur simultaneously. One or more rescuers must remain with the victim and begin CPR while the other calls for emergency medical service.</p><p><b>Better yet? </b>Enroll yourself or your company in a CPR/emergency course where you can learn and practice basic CPR and trauma management.</p><p><b><i>By Doctor Mathieu Nalpas - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> <i>For expats working long hours in Ha Noi, back pain can frequently cause great discomfort and inconvenience.</i> <b><i>Laurel Winter</i></b><i>, an experienced Australian physiotherapist who works with expats at Family Medical Practice Vietnam in HCM City and Ha Noi, shares her tips for dealing with back pain and office-related stress.</i></p><p>Low back pain (LBP) is pain in your lower back and buttock region. Approximately 80per cent of us will have a least one episode of LBP during our lives. It is the fifth most common reason people visit the doctor. </p><p>Almost all LBP is what we call non-specific -- or mechanical -- low back pain, which refers to pain in the lumbar region that is not the result of specific pathology such as a fracture, tumor or infection. There are usually three types of non-specific LBP: acute, sub-acute and chronic. This categorization is based on the duration of the back pain. Acute LBP is an episode of low back pain for less than 6 weeks, sub-acute LBP between 6 and 12 weeks and chronic LBP for 12 weeks or more.</p><p>Non-specific LBP is a huge economic burden. In the US, it is estimated US$50 million is spent on non-specific LBP each year. There are approximately 150 million work days missed due to non-specific LBP every year.</p><p>But there is good news!</p><p>Non-specific LBP is usually a self limiting condition. It will get better by itself with no medical intervention required. Half of the people with an acute episode of LBP will recover within two weeks without treatment. That number gets even better when we look at 3-4 months after the onset of LBP: 90 per cent of people with get better from non-specific LBP after this length of time!</p><p><b>Tips to ease lower back pain</b></p><p>So what should you do if you suffer an episode of LBP?</p><p>First run through a quick checklist to see if you have any red flags which may be signs or symptoms of more serious pathology. Ask yourself: </p><p>Have you had sudden changes in your bladder or bowel function, or numbness in your saddle region?</p><p> Do you had a fever?</p><p> Have you had recent, unexplained weight loss?</p><p> Have you had a recent fall or trauma?</p><p> Do you have osteoporosis?</p><p>If you answered yes to any of these questions, you should see your doctor or physiotherapist.</p><p>If you answered no to all of these questions, the best thing to do is to keep moving.</p><p>Only a few years ago, people with LBP were advised to spend time on best rest. But we now know that bed rest makes LBP worse. Over the counter analgesia, such as paracetamol, can be used to help control the pain to keep you moving. If paracetamol doesn’t quite cover the pain, your doctor can advise you on other medications that may be suitable.</p><p>Remember, movement is medicine! Any type of movement will do: walking, swimming, yoga, pilates. The list is endless.</p><p>Do you need an x-ray?</p><p>The short answer is no, unless you have any of the red flags mentioned above. An X-ray or MRI can be misleading. A study published in 2014 analyzed the MRI results for a large group of people who had never had back pain. The results were rather interesting. 37 per cent of 20 year olds and 96 per cent of 80 years olds with no back pain had "disc degeneration". 60 per cent of 50 year olds and 84 per cent of 80 year olds had "bulging discs".</p><p>So it turns out a lot of the changes that are seen on imaging are just part of the normal aging process.</p><p>X-rays and MRIs can often do more harm than good. Just by reading the scary sounding results, your back pain may become worse. Health professionals know that "disc degeneration" and "bulging discs" are rarely anything to worry about. Mostly they are just a normal sign of aging. But when you have LBP and read these scary words it often leads you to believe that back pain is harmful and disabling, which then leads to fear and avoidance of movement.</p><p>Movement is medicine, as we know. So being afraid to move will prevent or delay your LBP from getting better.</p><p>To recap: most of us will suffer from LBP during our lives. Most LBP is non-specific and will get better by itself, without medical intervention. If you have any red flags you should consult your doctor or physiotherapist. If you don’t have any red flags, keep moving and use over the counter analgesia if needed. If you are worried about your back pain, or if it is interfering with your life, contact your physiotherapist to help you get moving again!</p><p><b><i> By Laurel Winter - Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> Brace yourselves: flu season is on its way to Hanoi.</p><p>Children are already showing subtle signs of flu, including subdued coughs and stuffy noses. When flu season strikes, your children can be right in the line of fire. Kids are usually the first in a community to get sick with influenza. They’re more likely than adults to catch the flu when they’re exposed to it. And they’re usually to blame for circulating the virus. In addition to coughing, fever and aches, children with flu may also suffer from stomach pain, earaches and even convulsions.</p><p>Here are six tips to keep in mind to help your kids get through flu season:</p><ol><li>Make sure your child gets this season’s flu vaccine.</li></ol><p>Immunise your child against influenza. This is your best bet to keep your child flu-free. The flu shot is up to 90 percent effective for healthy kids. The US Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for children 6 months and older. </p><p>If your child is less than nine years old and this is her/his first flu shot, she/he should have a second dose in four weeks.</p><p>Babies under six months of age cannot be vaccinated, so it’s a good idea to get your own flu shot to protect your little rug-rats. </p><p>The virus strains can change every year, so last year’s vaccine may not be effective against this year’s virus strains.</p><p>The 2016-2017 flu vaccine contains: A/California/7/2009 (H1N1) pdm09-like virus; A/Hong Kong/4801/2014 (H3N2)-like virus; and B/Brisbane/60/2008-like virus.</p><ol><li>Teach your child hygiene</li></ol><p>Washing your hands is another proven method of stopping the spread of germs. Teach your children to wash their hands before they eat, after using the bathroom, and whenever their hands are dirty. Teach kids to wash their hands for at least 20 seconds - about as long as it takes to sing the "Happy Birthday" song.</p><p>Hand sanitiser comes in handy, but young children need to be watched carefully to make sure they rub their hands until they’re dry. Otherwise, they may be ingesting alcohol and other ingredients the next time they put their hands in their mouths.</p><ol><li>Keep your house clean</li></ol><p>Flu viruses can live up to 8 hours, so try to eliminate germs from toys, handles, counters, tables, phones, TV remotes, etc. Use hot soapy water or a cleaning product to kill germs.</p><ol><li>Don’t be a carrier</li></ol><p>Flu germs can be spread up to 2 metres by coughing and sneezing. Teach children to cover their mouths and noses with tissue when they sneeze or cough, then throw away the tissue. Make sure they wash their hands afterwards!</p><p>Kids often catch the flu from their parents. If you already have the flu, you can unwittingly pass germs to your children during the course of your regular parenting duties, such as wiping noses, holding hands, changing diapers or preparing food. Try to minimise the risk by washing your hands frequently.</p><p>Keep your kids home if they are sick and discourage sick kids from visiting. If the rest of the family is already sick, "quarantine" children without symptoms to keep them away from the flu virus.</p><p>If flu is hitting your home hard, avoid large crowds. Cancel play dates, postpone birthday parties, and avoid going to the movies or out for dinner until things settle down.</p><ol><li>Stay healthy</li></ol><p>The healthier you are, the better you are able to deal with anything that comes up, including the flu virus. Good nutrition, moderate exercise (one hour of physical activity on most days of the week), and adequate rest help optimise the immune system. Offer your child a well-balanced diet, including fruits, vegetables, milk and water. Make sure your child gets plenty of sleep (at least 10 hours for school-age children and 12 hours for toddlers).</p><p>6. For kids with flu, treat the symptoms and keep them comfortable</p><p>Home remedies should include rest and plenty of fluids. Fever reducers, such as acetaminophen or ibuprofen can help. But remember to avoid aspirin, which can cause a serious illness called Reye’s Syndrome in children with a viral illness.</p><p><b><i>By Dr. Philippe Jean Collin —</i></b> <b><i>Family Medical Practice Hanoi</i></b></p>"
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"value": "<p> </p><p>Expatriates moving to Hà Nội are often armed with basic knowledge of the city’s water, sanitation and common health problems. We are also fully aware that human parasites exist in this part of Southeast Asia.</p><p>Việt Nam is among the Asian countries with the highest rate of worm infections, according to the World Health Organization. Seventy-five percent of the Vietnamese population, including children 2 to 12 years old, was infected with worms in 2010.</p><p>Yet expats still engage in activities that make contracting parasites highly probable.</p><p>Trying a new restaurant, eating <i>bún chả</i> and <i>nem cua</i> on the street, drinking a night cap in a <i>bia hơi</i>, swimming in public pools, walking barefoot on the lawn, playing in a sandbox, wading in floodwater, getting licked by a pet, dipping our feet into a tub for a <i>mát-xa</i> (massage), planting rice during a field trip, eating undercooked meat and vegetables, drinking untreated drinking water and neglecting to wash our hands greatly increase our chances of getting hookworms, roundworms, ascaris and pinworms.</p><p>Such worms are transmitted via soil or water. For example, Ascaris, which can grow in the human brain, liver and other internal organs, is more common in urban areas. Habitual eating out in cities exposes people to foods contaminated by dust and insects, as well as to raw vegetables that may not be washed properly and which may carry worm eggs.</p><p>And while intestinal infection often causes digestive disorders resulting in weight loss and anemia, worms penetrating one’s bile duct, muscles, liver or brain can be fatal.</p><p>Meanwhile, Vietnamese parents focus a lot on feeding their children, fretting when they think the little ones have not eaten enough, rejoicing when they see a full meal taken. But most of these same parents shake their heads when asked if they ever dewormed their children.</p><p>Worm infestation in children can cause severe health problems, including anemia, vitamin A deficiency and intestinal obstruction. School performance may also be adversely affected. Studies show that regular deworming reverses malnutrition, increases school attendance and facilitates learning.</p><p>Checking to see if children are nurturing dangerous parasitic creatures, like round-worms, is a task that often slips parents’ minds. They do not think it is important.</p><p>Failing to check for parasites exposes children to risk of infections that can leave them too thin and cause severe complications, such as when roundworms cross the stomach to penetrate other organs like the liver, lungs or brain. Children are more vulnerable to worm infections. They can be exposed to parasites via food and also while crawling on the floor and playing with toys and pets.</p><p>So common myths - such as: “ It is not a problem in this day and age” or “Don’t bother to deworm unless you show symptoms” - need to be debunked.</p><p>The relevant question to ask is: “ How often should we deworm?”</p><p>Once every six months is sufficient. If symptoms are noted, consult your physician for a routine stool screening. Otherwise, deworm your whole family twice a year. Children can be dewormed from two years of age on.</p><p>Mebendazole or Albendazole (chewable) tablet is the drug of choice. Its side effects are rare, it helps the body to eliminate worms, and it is safe for pregnant women and unborn babies after the first trimester of pregnancy.</p><p>So, to all Hanoians - newcomers and old-timers alike - pop that deworming pill!</p><p>Global Facts:</p><p>Worms can divert 1/3 of the food a child consumes</p><p>1.5 billion people in the world have roundworms</p><p>1 billion people in the world have whipworms</p><p>1.3 billion people carry hookworms in their gut</p><p>Sources: UNICEF, WSSCC and mtherald.com</p><p>*Fugacar is the brand name of the deworming pill available over-the-counter at Family Medical Practice Hanoi.</p><p><b><i>By Dr. Cynthia Dacanay - Family Medical Practice Hanoi </i></b></p>"
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"value": "<p> </p><p>Fear, joy, sadness and anger are emotions we all feel starting in childhood.</p><p>There is an automatic brain response activated when a situation is interpreted as dangerous. Fear is accompanied by physical sensations such as rapid breathing and heartbeat, sweaty palms, dilated pupils, tense muscles, stomachache, dry mouth, nausea or shaking movements.</p><p>Whatever the origin of the fear, a child needs to be supported by an adult. When a child is afraid, the child is expressing a need for reassurance and attachment. Even if the stated cause of the fear seems wacky, silly, or crazy, parents should always believe a child who says is frightened. It is inappropriate to make fun of fears or to minimize them. Forcing a child to face a fear before the child is ready is harmful.</p><p><b>Defining childhood fears</b></p><p>So-called "traditional" childhood fears are linked to developmental milestones: such as fear of the dark, fear of separation, fear of monsters, and fear of noises. These fears are transient and may disappear and reappear during the child’s development, depending on life experiences. For example, a preschool child attending a new school might develop a fear of monsters or dinosaurs before going to bed. While this fear remains strong, bedtime rituals might seem endless.</p><p>On the other hand, some fears are not linked to experience but result from the brain’s evolution. For example, it’s very common to have fun in the sea with a 2 year old and to see the same child one year later extremely scared about being bitten by a shark.</p><p>There are also fears which result from experiences: “I’m afraid to go to the dentist because I remember it was unpleasant last time”. Or: "I read a book in which a little rabbit was afraid of the dentist, so the dentist must be scary!"</p><p>Be careful. The movies, cartoons and books your children are exposed to might feature overly violent images that can be overwhelming for the young.</p><p>If a child goes through a traumatic experience, he might manifest fear in similar situations in the future. For example, after falling off a horse, a child may be frightened at the sight of horses, even in photos. His internal sense of security might be damaged and, as a result, the child might be afraid of many different things.</p><p><b>Soothing your child</b></p><p>1) Listen compassionately. Make yourself accessible. Let children say what they feel, without judging, interrupting or trying to reason with them. Instead, validate children’s emotions and allow them to cry. It is always better to name the emotions and to ask details about what your child feels, rather than to deny the feelings or to say “don’t worry, this is nothing”.</p><p>2) Be physically reassuring. When children express fears, you can watch with love, take their hands, touch a shoulder, try to keep physical contact. Then take the child in your arms and share your loving presence, a kiss, a cuddle.</p><p>3) Reassure a frightened child by giving simple, rational answers:</p><p>"You’re afraid to go to school because you will not see Mom and Dad all day. Even if we are not together, we both think of you and we are happy because we know we will be together at the end of the day."</p><p>"You’re scared before falling asleep because at your age, your imagination is boundless and you see monsters."</p><p>“There are no sharks on the beach.”</p><p>"Look, the dinosaur you see is actually the shadow of your chair."</p><p>To move forward, you can demonstrate the principle of shadow puppetry.</p><p>4) Play together!</p><p>Play is good for all children, especially those experiencing anxiety. You can role play to create a game about your child’s fear and laugh about it to release the tension.You can also let the child draw the monsters that frighten him, then give the monsters all ridiculous attributes (a red nose, lipstick, a little dress, firefighter hat, etc.). All this must be done very gently and respectfully.</p><p>5) Encourage children to find solutions.</p><p>Whether it’s fear of failing to make friends in a new school or fear of witches, let the child list all solutions, without judging them. This may ease fears. If children need help to do this, guide them and give them options: “What could you do to be less afraid at night? Would you like to have a flashlight?"</p><p>Give the child an object that belongs to you to help reassure your child.</p><p><b>Seeking professional help</b></p><p>Your child’s worries are cause for concern if they develop into severe anxiety and interfere with healthy development. When parents feel helpless, it is probably time to see a therapist who will help you understand the cause and give you tools to reduce anxiety. In all cases, be patient and listen. This is the best way to help a child grow and to develop healthy self-confidence! </p><p><b><i>By Laetitia Bluteau - Family Medical Practice Hanoi </i></b></p>"
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"value": "<p></p><p><i>“Tap water in Việt Nam causes acne”, “pollution is the cause of most health problems”, “street food results in stomach upsets”.</i></p><p><i>These are some of the scary stories and opinions often heard from Vietnamese and expats alike. Dr. Brian McNaull separates the medical facts from fiction.</i></p><p><b>Does Vietnamese tap water give you acne?</b></p><p>If the tap water is heavily contaminated with bacteria it could contribute to acne. However, washing with soap will reduce the negative effects of any bacteria in the water.</p><p>Do not drink from the tap and brush your teeth with safe water. Drink plenty of boiled or bottled water to stay hydrated. Also, only drink with ice cubes made from boiled or bottled water.</p><p><b>Is drinking cold water bad for your health?</b></p><p>There is no evidence to support this notion, which is prevalent in many parts of the world. In fact, the opposite may be true: warm water encourages the growth of bacteria.</p><p><b>Is the pollution in Việt Nam the main cause of health problems?</b></p><p>Pollution is a contributing factor to diminished health, especially to the lungs, but change of lifestyle is probably much more important. As in many countries with the advent of labor-saving technologies and more prosperity, people are exercising less, eating more of the wrong kinds of food (too much animal fat and refined sugar). Positive interventions for long-lasting general health are to stop smoking, eat a well- balanced diet (low fat diary, less animal fat, more fish, skinless chicken and vegetables), and regular exercise (at least 30 minutes, four times per week).</p><p><b>Is coughing up “green stuff” due to weather change?</b></p><p>Increased humidity may encourage certain bacteria and viruses to more easily colonize the airways. Green phlegm or sputum usually indicates significant bacterial infection and medical advice should be sought as soon as possible.</p><p><b>Are air purifiers the solution?</b></p><p>Air purifiers do help remove odors and allergens such as hair, animal fur and fungus from the local environment. They are especially helpful to those who suffer from asthma and its related conditions.</p><p><b>Does eating street food result in diarrhea? </b></p><p>Hanoi’s public health authorities say 90+% of street food contain an unacceptable level of bacteria. That does not mean that everyone will get sick - different factors determine our response to an infectious challenge, such as the amount of bacteria ingested, the amount of acid in our stomach, our own immune health at that time, medicines we might be taking. We all respond differently to mild infectious challenge. Rule of thumb: If the place looks unclean, avoid it.</p><p><b>Should fruit and vegetables be peeled before eating?</b></p><p>We all know small amounts of bacteria in food won’t affect us; our immune systems can fight off minor infections. But this is not the only reason for concern. The term “organic” is under scrutiny in Việt Nam where the use of pesticides and pollutants in the ground is not well controlled. All countries have different standards and enforcement. Việt Nam still needs to progress in both. Vegetables and fruit on supermarket shelves may have some levels of pesticides and pollutants.</p><p>Peeling and scrubbing is always recommended to remove some of the pesticide residues that may be present. It may be advisable to also peel conventionally grown cucumbers, eggplant, potatoes and apples, both because their outermost surface may be the most affected by pesticide spraying and because petroleum-based wax coatings may be harmful to one’s health.</p><p>The medical impact of continually eating polluted vegetables and fruit cannot accurately be quantified. But there is concern about effects on IQ levels, skin infections and constant colds. In fact, a lot of Vietnamese people are turning to growing their own vegetables so they can be assured about the origin of their produce.</p><p><b><i>By Dr. William Brian McNaull, Family Medical Practice Hanoi</i></b></p>"
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"id": 1285,
"title": "Traditional Chinese Medicine: let the buyer beware",
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"value": "<p> Many in Việt Nam, China (of course) and even western countries use TCM (Traditional Chinese Medicine) to treat almost any problem they have, from common cold to chronic arthritis, diabetes and even cancer.</p><p>Many believe that if it is "Traditional" "Chinese" or "Herbal" medication – it’s safe and has no side effects whatsoever. Unfortunately, this is far from the truth. </p><p>First, let’s look at the differences between "Traditional" and "Modern" or "Western" medicine:</p><p>You will be surprised to know that many medications used in Modern medicine actually originate in "Traditional" Medicine, such as Indian and Chinese medicine: Ephedrine, Digoxin, Echinacea, Artemisinin, Quinine, and several anti-Cancer medications, to name a few. Vaccines were actually first invented by Chinese doctors over 5000 years ago.</p><p>So what makes the difference between "Traditional" and "Modern" medicine?</p><p>In Modern medicine – You have to prove 2 things:</p><ol><li>The medicine is effective.</li><li>The medicine is safe to use.</li></ol><p>To do that, every medication has to go through a long exhausting process of research and evaluation to confirm or disprove its effectiveness and safety.</p><p>In "Traditional" Medicine, people rely on other people’s anecdotal experience, assuming that "If it works for them it will work for me as well". That can be very misleading. If a 100-year-old man has been smoking for 80 years, does it mean the cigarettes helped him reach such a long life? Of course not! And we know this because reality and research show that smoking cigarettes is a major cause of disease and death. </p><p>The best way to prove a medication works is by a "Double blind Placebo study."</p><p>In this kind of research, patients are randomly divided into 2 equal groups. One group gets the real medicine and the other group a placebo. Both the patients and the doctors who conduct the study are "blinded" – they don’t know which one is fake and which is true.</p><p>At the end of the research, the information is gathered and studied and a conclusion made based on objective data on whether a medicine is truly effective or not.</p><p>One of the biggest dangers in using TCM is the lack of supervision on production. Studies done by German and Australian authorities on imported TCM discovered that many of them where fake. They did not contain the ingredients they were supposed to. For example, a TCM claiming to contain antelope horn actually contained goat and sheep material.</p><p>Some TCM were found to contain steroids, antibiotics and even poisonous heavy metals like lead and arsenic. A few years ago, Washington University conducted a research at the children’s hospital here in HCM City. They investigated exposure to lead in little children. One of those children, a 3-month-old baby, had a lead over 10 times higher than the acceptable level. The baby was exclusively breastfed, so the source could only have been the mother. They have found out that the mother was taking TCM pills that contained high levels of lead, poisoning both mother and baby. </p><p>Tests done on herbal preparations also discovered that many contained over 68 different species of plants, most of them not mentioned as ingredients and some contained a chemical compound called "Aristolochic acid", a major cause of kidney cancer. Taiwan, where almost a third of the population uses TCM, has the highest rate of kidney cancer in the world.</p><p>Unfortunately, most of the TCM have never been tested properly and there is no objective data to know if they are truly effective and safe.</p><p>When you decide to use TCM, you should be aware of these problems. You need to remember that "Traditional" or "Herbal" doesn’t mean the medicine has no side effects. You should get your TCM only from known reliable practitioners (Never buy medications online) and always inform your doctor if you take TCM. It can have a significant effect on your condition and on other medications you may be using.</p><p><b><i>by Dr. Jonathan Halevy - Family Medical Practice in HCM City</i></b></p>"
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"id": 1263,
"title": "[PODCAST] INFANT HEAD TO TOE CARE",
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"name": "Mom & Baby",
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"value": "<p></p><p>HIMBA PODCAST: Listen to our new podcast on newborn care and guidance on how to care for each area of your baby, from head to toe!</p><p><a href=\"https://soundcloud.com/family-medical-practice-hanoi/infant-head-to-toe-care\">https://soundcloud.com/family-medical-practice-hanoi/infant-head-to-toe-care</a></p><p>Please email: himba@vietnammedicalpractice.com for any questions you may have.</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"id": 1262,
"title": "[Newborn Care] Early Essential Care of the Newborn (EENC) in Vietnam",
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"value": "<p></p><p><b>Early Essential Care of the Newborn (EENC) in Vietnam</b></p><p>❗️❗️In Vietnam the Ministry of Health (MOH) issued regulation on EENC for normal delivery in 2014 and EENC for C-section in 2016 which should be applied for all relevant health care facilities.</p><p>✍️Assessments have been conducted by the MOH in 2017 and 2019 to ensure that healthcare facilities do comply.</p><p>Knowledge is power. Know what you should be entitled to, so you can have the best birth experience.</p><p>All hospital providers, public and private should be following these steps (in the absence of no immediate medical emergency) :<br/>👶 When your baby is born they are placed onto your skin immediately, and dried.<br/>🕐 Your baby should remain skin to skin for a minimum of 60 minutes unless there is an emergency<br/>✂️ Your baby should have their cord clamped and cut between 1-3 minutes after birth- when it has stopped pulsating.<br/>♥️ You should receive encouragement and support from staff to start breastfeeding when your baby shows cues<br/>🤱 Mum and baby should stay and sleep in the same room at all times.<br/>🌙☀️ Breastfeeding should be supported day and night and an assessment completed before you go home.<br/>💧 Your baby should not be bathed within the first 24 hours and dry, warm clothes and a hat put on.<br/>𝗪𝗮𝘁𝗰𝗵 𝘁𝗵𝗶𝘀 𝗰𝗹𝗶𝗽 𝗳𝗼𝗿 𝗺𝗼𝗿𝗲 𝗶𝗻𝗳𝗼𝗿𝗺𝗮𝘁𝗶𝗼𝗻: <a href=\"https://www.youtube.com/watch?time_continue=334&v=_8T2ePCty4E&feature=emb_title&fbclid=IwAR1HTOCKSsYBDrBtcyy3lFa4qa_Fnk0nNFp9XhLsxWcx4cU662BW3_Xxo4k\">https://www.youtube.com/watch…</a><br/>𝗦𝗼𝘂𝗿𝗰𝗲𝘀: 𝗪𝗛𝗢<br/><a href=\"https://www.who.int/westernpacific/news/detail/05-03-2015-who-first-embrace-campaign-to-save-more-than-50-000-newborn-babies-a-year-in-the-region?fbclid=IwAR0MpOVhr3oKavAew5x21BPV3ssGMv9mkUT8eLYIGyguk0K1cA5rxiM8gN0\">https://www.who.int/…/05-03-2015-who-first-embrace-campaign…</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "Testicular Pain and Torsion: teenage boys beware",
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"value": "<p>Males have two oval-shaped structures called testicles which are located inside a thick-skinned sac called the scrotum. Each testicle is supplied with oxygen by an intertwined structure of muscle fibre, nerves and blood vessels called a spermatic cord. When this cord becomes twisted, it cuts off the blood supply to the attached testicle. This condition is called <b>testicular torsion</b>.</p><p>It causes sudden severe pain in the scrotum and testicle. Generally, the pain is quite persistent but may also come and go. Other symptoms that may be noted are nausea, vomiting, swelling on the scrotum, and having one testicle displaced higher than the other.</p><p>It can happen in males of all ages but is common between 12-18 years old. It can occur after strenuous exercise, while asleep or after a sports injury.</p><p>If your son feels pain in his testicles, bring him to the doctor as soon as possible.</p><p>The doctor will usually suspect torsion by physical examination alone but sometimes ultrasound may be done to confirm it. Immediate surgery to untwist the cord is warranted to save the testicle but if it caused too much damage already, the testicle is removed. Take note that there is more than 90 per cent chance of saving the testicle when treatment is given within six hours from the start of pain and only less than 10 per cent chance if more than 24 hours have elapsed.</p><p>Fortunately, even after removal of one testicle, the remaining testicle can still produce sperm and testosterone needed for fertility. However in some rare cases, the risk of infertility can be increased.</p><p>Sometimes, it can be awkward and embarrassing for your teenage son to talk about his genitals. Your son should be aware that any pain in his genitals should not be disregarded and should always be treated as a medical emergency. </p><p><b>by Dr. Cynthia Dacanay, Family Medical Practice Hanoi</b></p>"
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"title": "[COVID-19] Emotional health of children",
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"value": "<p></p><p><b>[COVID-19] Emotional health of children</b></p><p>🌏Children make up 42% of the worlds population yet are deeply affected by a virus that appears to be mainly affects adults.<br/>✍️Research so far suggests 94% of children have been found to either not show symptoms at all or suffer mildly/ moderately when infected with COVID-19. The psychological affects of school closures, lack of routine and parents feeling stressed makes it a difficult time for families.</p><p><b>What can you do?</b></p><ul><li>Maintain structure during the day: including exercise / school work / play and communication via video to friends and family</li><li>Ensure honest and open communication that is age appropriate.</li><li>Follow your child's cues and listen to questions or concerns your child may have and answer honestly and clearly.</li><li>It is tricky to not volunteer too much information but listening to your child’s thoughts and perceptions around what they have picked up about covid19 should help you identify their understanding and guide you on how to clarify appropriately. Children often resort to making sense of situations by themselves if they lack honest information which may lead to them feeling alone and frightened.</li><li>Read stories to your child that focus on emotional topics to help them make sense of their feelings. See a book list for emotional development below.</li><li>Provide a calm living environment and have awareness of how your emotional state will be noticeable to the children around you.</li><li>Prioritise your own self care as parents and seek support as needed.</li><li>Think of behaviour as communication. Children may show challenging or changing behaviour because of emotional stress. Children do not always respond by showing sadness or worry, yes it can be an emotional response but also physical or behavioural.<br/><b>RESOURCES</b></li><li>𝗥𝗲𝗮𝗱𝗶𝗻𝗴 𝗹𝗶𝘀𝘁 𝗲𝘅𝗽𝗹𝗼𝗿𝗶𝗻𝗴 𝗳𝗲𝗲𝗹𝗶𝗻𝗴𝘀 (𝘁𝗼𝗱𝗱𝗹𝗲𝗿𝘀 𝘁𝗼 𝗼𝗹𝗱𝗲𝗿 𝗰𝗵𝗶𝗹𝗱𝗿𝗲𝗻): <a href=\"https://www.zerotothree.org/resources/7-books-about-feelings-for-babies-and-toddlers?fbclid=IwAR37r-biif5rO38AyfimOz9bb-jsw1XeyesgcYQI81o0gVx0eJetg_ikmVg\">https://www.zerotothree.org/…/7-books-about-feelings-for-ba…</a></li><li>𝗦𝘁𝗼𝗿𝘆 𝗳𝗼𝗿 𝘆𝗼𝘂𝗻𝗴 𝗰𝗵𝗶𝗹𝗱𝗿𝗲𝗻 𝗼𝗻 𝗰𝗼𝘃𝗶𝗱 𝟭𝟵:<br/><a href=\"https://nursedottybooks.files.wordpress.com/2020/03/dave-the-dog-coronavirus-1-1.pdf?fbclid=IwAR2gGKJfRERDjf3LcKwuhbU2gGA3jdW4uPyEU4w-h1qUvNO86RXUA3O-kWI\">https://nursedottybooks.files.wordpress.com/…/dave-the-dog-…</a></li><li>𝗦𝘁𝗼𝗿𝘆 𝗳𝗼𝗿 𝟲-𝟭𝟭 𝘆𝗲𝗮𝗿 𝗼𝗹𝗱𝘀 𝗼𝗻 𝗰𝗼𝘃𝗶𝗱 𝟭𝟵- <a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Finteragencystandingcommittee.org%2Fiasc-reference-group-mental-health-and-psychosocial-support-emergency-settings%2Fmy-hero-you%3Ffbclid%3DIwAR3TDHVKhfgTpct3zmK9lrMcDfpM5G3s8SQKDvGw9v3CiodZiHGKlMfVNRs&h=AT2pkkOl6BzkdkHkvv8VM4ALxWKYjkatCLAHf6aafYTxHrGBOqNQqFsyHfTTCTH2xsNlMyRPiK19RIzpFtmTVT3eQkRkzx1OZFh6Obc9WD8s0vZFApUIP7BEuY3Wm7a8aTrqxBrUwYl54SY5jU7qFDwVa1lFwydco9ZsvC3laBn1omU6I0I33FKDAFvaXaEIkQGIp2ZrQUZIU3ggqpfUsl-asopkRMttL6VIfKLASRT6sUSn_4A8uiSGR0WGwMhELzPI-hTYNd07qbZ6tVN957XWeTRGVOfPcLA8xVfeaFtlK2wB7GeFquDwsZN-plld3u5rYIZnLmrTJ_MJSsRJvSpHZNqrk3dcdSNzIOJm2n311ptxRzQf7nX20zxdRfsCYfBzTvyPQ2H3jsHdmmc6HVBirYFiSvE69YoAnke_dduN43Ja_8p4R7S6avSrhJ-N0q0Vqe0pBi1cyBYEBfGmLMmWoSX6fFWinOX-LWckMWIV1fJYIIxJrnlNkyY6kAXt1FiJniMr07F2Bf6ltHdHLV5Ybl_Wf-GSEKeCkySiF_rjL7AT1bg03iPH_wGvg00cenWnFhP3vmsEjdYf9-3TTrFan-FqodxZLuI0FLe1uLqO3GnISp78JG14hZysGl4Ge5k\">https://interagencystandingcommittee.org/iasc-r…/my-hero-you</a></li><li>𝗖𝗼𝗺𝗺𝗼𝗻 𝗮𝗻𝘀𝘄𝗲𝗿𝘀 𝘁𝗼 𝘁𝗼𝗱𝗱𝗹𝗲𝗿𝘀 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻𝘀- <a href=\"https://www.zerotothree.org/resources/3265-answering-your-young-child-s-questions-about-coronavirus?fbclid=IwAR2nhFEJPAVyACA7D875EisgoB2Z9ulT9V6hfYDBwu-U88PEtUGB8ywPSwc\">https://www.zerotothree.org/…/3265-answering-your-young-chi…</a></li><li>Y𝗼𝗴𝗮 𝗮𝗻𝗱 𝗺𝗶𝗻𝗱𝗳𝘂𝗹𝗻𝗲𝘀𝘀: <a href=\"https://www.cosmickids.com/category/watch/?video_category=mindfulness&changed=video_category&fbclid=IwAR3nZY5ZIpuAeJGLjm7WE7T9BI7lYqT6F8imS5TfNjgKd7BMMOrY0uis8t4\">https://www.cosmickids.com/category/watch/…</a></li></ul><p>Sources:<br/><a href=\"https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children.html?fbclid=IwAR2mQ4bTFI9Orh9Shs9kw0cxhKIOC5Nw3o2Xx848VZTxqI8dn4T5z6GBQIc\">https://www.cdc.gov/…/2019-…/daily-life-coping/children.html</a><br/><a href=\"https://www.unicef.org/coronavirus/covid-19?fbclid=IwAR0zZe9bFNcf-ioJs-KuCBcmdjPFf0qrr5Qc8vRzCSqiyerJfE0z_TKGydw\">https://www.unicef.org/coronavirus/covid-19</a><br/>WHO<br/>Dalton L, Rapa E, Stein A. Protecting the psychological health of children through effective communication about COVID-19. Lancet Child Adolesc Health, 2020.<br/>Shen, K., et al., Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. World J Pediatr, 2020.</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[COVID-19] Maintaining physical exercise for children",
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"value": "<p><b>[COVID-19] Maintaining physical exercise for children</b></p><p></p><p>Limiting screen time and encouraging a range of physical games and challenges can be fun and educational for your little ones. The usual recommendation is :<br/></p><ul><li>Children under 1 - once babies are shuffling/ crawling they should be encouraged to be as active as possible playing with toys. Also include 30 minutes of tummy time when they are awake- spread this throughout the day.</li><li>Children 1-4 - 3 hours per day! A mixture of physical activities and games indoor and outside.</li><li>Children 5-17 should be moderately to vigorously exercising for 60 minutes each day.<br/>This should be mainly aerobic. 🏃♂️<br/></li></ul><p>Vigorously intense exercise that strengthens muscle and bone should be completed three times a week. E.g jumping / running/ skipping/ tug of war etc 👟<br/></p><p>These exercises need to raise your heart rate and make children feel warm ❤️</p><p>𝗪𝗵𝘆?<br/>For healthy muscles, bones and joints<br/>Develop healthy lungs and a healthy heart ❤<br/>For better coordination and movement control<br/> Healthy body weight<br/> For a healthy mind - very important due to the current anxiety surrounding covid-19</p><p>𝗥𝗲𝘀𝗼𝘂𝗿𝗰𝗲𝘀 𝗱𝘂𝗿𝗶𝗻𝗴 𝘀𝗼𝗰𝗶𝗮𝗹 𝗱𝗶𝘀𝘁𝗮𝗻𝗰𝗶𝗻𝗴:</p><p>𝗚𝗼𝗻𝗼𝗼𝗱𝗹𝗲- mindfulness and physical games for children devised by athletes and development experts- <a href=\"https://www.gonoodle.com/?fbclid=IwAR1h3hoPr5H5FHz8EvixEINZZQHG66QUeOVZssZE_GeaRMTqQMrOZwzhNv4\">https://www.gonoodle.com</a></p><p>𝗢𝗽𝗲𝗻: 𝗢𝗻𝗹𝗶𝗻𝗲 𝗣𝗵𝘆𝘀𝗶𝗰𝗮𝗹 𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝗡𝗲𝘁𝘄𝗼𝗿𝗸 - family games for an active home and resources for parents to provide physical education as children would receive in school- <a href=\"https://openphysed.org/?fbclid=IwAR3ryDCnIUXQZBfYYvCgX8RUl1Z0gsEi52gj11bzZ7I-01YOj_kHLYTV1ZU\">https://openphysed.org</a></p><p>𝗬𝗼𝘂𝗧𝘂𝗯𝗲 𝗣𝗘 𝘄𝗶𝘁𝗵 𝗝𝗼𝗲 - Physical education videos everyday- <a href=\"https://www.thebodycoach.com/blog/pe-with-joe-1254.html?fbclid=IwAR3MDameZly4KRtnKVuvZOwlIC7OdMHn8zM_l1z860t2KRFNEmxzgXgy2-w\">https://www.thebodycoach.com/blog/pe-with-joe-1254.html</a></p><p>Also... consider creative games indoors such as hide and seek, dancing, balloon volleyball, hula hooping etc</p><p>SOURCES: WHO/NHS/CDC</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom</p>"
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"title": "Apps during pregnancy and to support your baby's health and development",
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"value": "<p></p><p><b>Apps during pregnancy and to support your baby's health and development</b></p><p>💻Technology can bring high quality, evidence based information to more and more people for free! Better health education improves the health of our communities all across the world.</p><p>❤️Share these resources to support those who are able to access good healthcare and also those that are less able to!🌎</p><p>𝗕𝗮𝗯𝘆 𝗯𝘂𝗱𝗱𝘆- this is an app with information from pregnancy to 6 months of age. It can be personalised to provide relevant daily information to you wherever you may be on your pregnancy or parenting journey. It will support the mental, physical and social aspects to becoming a parent.<br/><a href=\"https://www.bestbeginnings.org.uk/baby-buddy?fbclid=IwAR2HD_2DZDKmbo5dUYI6TogTshMEaUhIvMRWxDdciql6UzvW3n3lusX2BL8\">https://www.bestbeginnings.org.uk/baby-buddy</a></p><p>𝗪𝗵𝗮𝘁 𝘁𝗼 𝗲𝘅𝗽𝗲𝗰𝘁 - this is also a tracker and offers a different platform to parents so you can choose which suits you best. <a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.whattoexpect.com%2Fmobile-app%2F%3Ffbclid%3DIwAR00acIXDm_DRBW0qM9T_YnVhlOndB_f0FQcFrZ-voyPghVVCeVyy-_dd-w&h=AT0eKcEc-GeBWT515fTiVsUt7XEP4-7-o0DbjBBC77hlwkZtsxj6In7n3clzr_oXSl2qG7xQgyjeGEC2gN17V71nPJAmsUA51mx5ZHAq2upQTINLgdshgnvDXSHP7P8KpVIh3JKQus5alExLFbrsjvRGfB8mASGN5pNsnq8VEaPRBEMWI8nhdyLW0P7hsJc8x0_9foP6-3mziHtfwyG0AJss_TmeDg6mTMQgesRPmCm1c62iNXlQYG1Ruh-Ylw85xZZh6YYeCxlVYXoIioSSW7UFkC33wCA-NAAPrKJEfhPh6qtjKO9lQrc62qnuDJV2MBTvtneAhD1bm0zsLyTK7py1eQI_dRNwk9ehKZV7Srei0bgH2sLZHOK11VzW9yzMZm58HwxEAAs6M-MUE2yrA03OaYRnLp-z57W3zEtq-TWEzieQi6fGxtBXJfgXAO3FeIiB8FO4nhSgHgK6bl-ZHyiX7QdH1ztkxkX-mT-IJMqaflDivnACZFFG7fVtLEL7EXse72qEq_qto9xs-FT3omLhUVcaTAIeUMp27L59y2fQJX2PgimT-HFrx9Wwju8xoKkhwI8zgEDCVOuhuMFAiIvNpd5I7K6eubCJwlKjpXZtWg_IpP5klcEjf3dohQ\">https://www.whattoexpect.com/mobile-app/</a></p><p>𝗠𝘆𝗠𝗲𝗱𝗲𝗹𝗮- this app provides breastfeeding support and resources as well as a daily feed tracker and growth tool.<br/><a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.medela.com%2Fbreastfeeding%2Fmums-journey%2Fmymedela-app%3Ffbclid%3DIwAR3KSaDUW48GeWE9TlXTFe-ApPenjTdnB73jMpd1EkfcV3l-zh-9I4jTsE4&h=AT0iINnwecAhNYNR6SZ0csnRP4qCvKFlm7c4ZrAK7LtqMfHmSPS_dsA_sdpY3-9tx6xubgXr3StlqHShTT6KqbzH_FJPip3laAsPQ2tZlfGV94omit4WmnEMraDY3uOGn-kGOuXCeFUvVosw1zcsgLFkkrmcYjoHDTh8KAcUl4w7qioRQdKllUMFE4BZkRM-U5FHUme9MlBAR08mXuAJ8o2Ay4W9xAyXIFKWHwqa79btlaDl3vSYpt3x2xDdNTZSeA9zKci4hgbdQDrMPwcDeeXE1baPwOxFRoZrfsyKKkCEuv8sacWL4jEf8wGyBoeMl05EK4vohVFUElwrKrZugIclXER2stMYgIzN8dRCpXBJxVhNdgkG1U6TEPKGuwOPeHVhN-yuChaasH0lLGHcLMUX4B02yDSgOvjBQxRly0MbmMY-WFdj9L6lXTidvomPmMfsAQ3gyS0Kt9KArzard19W6dsDX7Ym1qQfd1Fid8njFrBowrodFh7R_3hIe0kvPBcB9vpk71-N2HWGPTD-zcQBdkzu94gl2231sW0MfCRNgYs9f86fm4P6cmNPhtaGre3eAR_g0UDmryAt_h3wdp3fBsu6AhMyhjAg02B4KVKeH8hcLVq3QtjvxkyqvQ\">https://www.medela.com/breastfeed…/mums-journey/mymedela-app</a></p><p>𝗞𝗶𝗰𝗸𝘀 𝗰𝗼𝘂𝗻𝘁 - track your baby's movements in the womb. <a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.kickscount.org.uk%2Ffree-app%3Ffbclid%3DIwAR0VDOMVhI-P03Sj2j8dylDHuG9ULMAgTbKb5GrEbBm8GTl-548e4hglIow&h=AT2b_Q2BwFT9rhESD3YH9_rvfdi4L1qLxw3tHIpxqozbuNAZ4IPeyJkshUvu0CxeXp4j-ifUjoqR-_9WGwdWyj-SQ6Osd7s6mhKPH-Gny3LrbF-N4xlwS7vNGKBC46NM2larkAuWkuZFW1d2b28FEzAzfxsBk3dGUzunU7mi0orziePj4ssnPYe6Uiy9ubMWELP3Hs2bkWhNIXXqBEPpYDg75HTw5DBCFeJxfb0Th2gIELLP4gxm4aVFlOtzM6ZDcmwe5FpfHHhwRwwk3vDnwFfvn6ig3kzRdohZUe-VFS9ndzsFUIUwb-oxhshPYeNPmvdDZomyoo-hp2wugvve2ptXzTDLca0XxSeE0DLQBz0xAHUX0lD4-S_HcQmi-VRw2dKfI3gv6oAAeAatvX5Ix1VXGmH_fAKCqR-mBvLxZs3CveG5GFd1tUs_cpq1g3V97w5x-NE5eKrDyO2B1U8eLkB9c-gSW86IHQyKRCEXovLq3PYlPENl9eDO4G5DHZ0J86sEW-Yw8EoBIoxiQNYIp7fIHDQcZSKCgNU1mBQkRKdNAmMIweNRRzbgRb6N8KvBBrhO6_TCLsih4j7pBSFLitCgtoHi7d2ou4jjtDkhQwAGc9qizIqvSsYFAElsXQ\">https://www.kickscount.org.uk/free-app</a></p><p>𝗦𝗾𝘂𝗲𝗲𝘇𝘆- an app for pelvic floor exercises which are important during pregnancy and after birth. <a href=\"https://www.squeezyapp.com/?fbclid=IwAR3IF0O2zemrmn_QTf3usZLddpofuc6gjJSA-DodTns8aJiN-N8NzScoMKw\">https://www.squeezyapp.com</a></p><p>𝗛𝗲𝗮𝗱𝘀𝗽𝗮𝗰𝗲 𝗮𝗻𝗱 𝗰𝗮𝗹𝗺 - Mental health and meditation apps. <a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.headspace.com%2F%3Ffbclid%3DIwAR14jpM79cdMxUBXt-yVM-DkeYTeGQJfMLSyeW6V1hBu7dGSTt44s0ge-d4&h=AT3B-ESiuvR6dalKG5GFTPL-R-0r0Curd_aK6GI4lhe2bvXEtWyxPOwRASGb87aXIlCH645L2r-0h8g03TIGTV4SICrKvQ9pLauTsVQOPsABR08txZjymZUPk5yDTF_qHtZdGux0lCRd0AifbitjS4GBCasS1o_6p6kCZi41tUAq1PSwD5xbktyw8Qldj8461I40oPEK3EyV26YDtt1rh7cUm2uZiffBBpeCfJ9l3BjPHfLHmIpe6bW_nc-DgShC0IkR1z60Lez2vQTTRO9ao4Y8gFWRvvVJR3U26f2arYkgkIfAENc1P5NhTBluvZiLVD1U1UynNV4qnFX8WFx0QAuCnlCZWXmKQBQRZR8hkOdQ8cwpb2VPToPzCy9AeJcj6aDJuyrx5My25-5EA0iQT0Lnz-OCeyx4SBa60r5Z1P-jpAy5tVY91qMp09lUVVe3ks8U_BmHEPHxLXpyDGT-rs5lbRazTk8zit_ZImTds6rU3HnNbZte2AS1b37EsIZLaYwCHdMpks6AO7Vj3rIo3IZglUtTG9xQmC7tik0f0jDlFSr73-RSTKdnRkC7O09oT-TF6AQ0xyfix1-tV3wNhvHrV2hurx51EfbhXACfMritAdkJva_UNo9wOx8zaw\">https://www.headspace.com</a> <a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.calm.com%2F%3Ffbclid%3DIwAR37ImZZA1AdmY1clNPmZ7RYAGdj6JYQ0zo7nSASagQjxgAtdbYuVG2xKEE&h=AT18RSy7BEXkBJZH4bl7VF3-2eoi2K_M4prCBa1ryKz47RooUBpyy_DDPLdCFxpj1fdtpTEKxH5X6zdPuyaWTTNIoqmU-uyg0o4fpyNeGF9RtjIfHhSzopz8rjPAYeExHkb1ncSnlNDWAI_S5vqfBM7W6MTUM32bqab9WAfAK9XBRoBcewgNWGm8iZPYnsm9AN5c14FTLFvaHLuZ2ueYg0N13KFJW9aXxaMAFIzcdga-fV04ntqkMF9UqxHE6OfCGnIOfN5AqaIE5VZvZYkJyGYGw0n0SvBPvtE4gFpLLp85_yp63iLRK6QOnefSRXirNbDlLPlG5Z4mMwYvCg-yX7AoJBy_6n3WoTP8SPv-q3P1lZOyGbwUOIvYoTnEMm2oabhgIfuoPerSNEfDTuwEn34v6UCvXDh1UDi7sPthLrboKZMnWEKTbxoo2PKlbMs6Vm8xHjwbd1fUg89PMc45aXZM-6YLgoWLPf-Vj75QfOxCwt8TwYJzSXnniZsM-shwlyAREwESW4Xch6c39z2m1AUavapuHhb0bnOHcQbjru6BMHYWLZKu5rTtBlgx3Eg5moZv13vNVq2VyDUED3gJtwlpgRr6r-wvqCrht551mU9C60aLk36R4JWYs6xmJQ\">https://www.calm.com</a></p><p>𝗕𝗮𝗯𝘆 𝘀𝗽𝗮𝗿𝗸 - free development activities and milestones for babies. <a href=\"https://babysparks.com/?fbclid=IwAR2oK9kJ0Ti9TuWwXqL0YrfUtnJWGGDLEOxZO4s_X6yqnHTBRKC1OCej6cA\">https://babysparks.com</a></p><p>𝗦𝗽𝗿𝗼𝘂𝘁 - track the health and development of your baby with World Health Org growth charts and CDC milestone trackers. <a href=\"https://apps.apple.com/us/app/sprout-baby-baby-tracker/id551448817?fbclid=IwAR2Nqp8i3BhdaSjjO1lHPbi0dCSJ0I3wQi28vS30SvXd23umV2xUoJ00bwg\">https://apps.apple.com/…/sprout-baby-baby-track…/id551448817</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Accident Prevention] Toy Safety",
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"value": "<p></p><p><b>Toy Safety</b></p><p>Children love to explore! Often with their mouths or by experimenting with what may fit in their nose or ears! Lots of accidents happen with toys each year that can cause choking, dislodged objects in the body or gastrointestinal problems.</p><p>Do you have older children in the home with toys for older ages?</p><p>Do they play together?</p><p>Have you considered the safety of the objects in your toy box?</p><p>𝐀𝐝𝐯𝐢𝐜𝐞:</p><ul><li>Go through all your child's toys and check if they are broken ( discard if so ), have small parts that dislodge, sharp areas, areas for finger traps or any loose fabric/ hair that could be a choking hazard.<br/></li><li>Check toys for loose ribbons or neck ties as they pose a strangulation risk.<br/></li><li>Consider batteries. Many toys have them and children can swallow them or dislodge disk batteries into areas of the body</li><li>In summary, check the safety but also if the toys are right for the age and development of your child. Toys should stimulate, inspire and develop your child’s skills further… not pose a danger</li></ul><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"id": 1257,
"title": "[Infant Feeding] Size of a newborn's stomach",
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"value": "<p><b>[HIMBA] Infant Feeding: Size of a baby’s stomach</b></p><p>Often brand new mothers get told… your baby seems to be on the breast every hour… they must be starving and not getting enough!</p><p>When you understand the size of a newborns stomach, this becomes very clear why this behavior is happening. It is the size of a marble with a 5-7ml capacity!</p><p>Babies in the first 24 hours need to be skin to skin for as long as possible, learning to navigate to the breast, suckle and practice as much as possible. This will activate the breast and milk cells to give you the best chance for milk production.</p><p><b>By day 3</b> your baby’s stomach is the size of a walnut. Keep letting your baby feed as often as possible!</p><p><b>By week 1</b> your baby’s stomach is like an apricot and can hold about 30-60mls per feed.</p><p><b>By 1 month</b>, your baby’s stomach is about the size of a chicken egg. It can hold about 80-150mls per feed. It will begin to regulate milk production and will rely more on supply and demand.</p><p>From one month, the same amount of milk is produced until 6 months. This surprises many mothers, the nutritional content will adapt but the volume will not alter significantly now until after 6 months.</p><p>Formula fed babies may feed more due to parents reading the instructions on formula packs- however formula companies want to sell formula… and many babies suffer with colic and reflux symptoms due to having their tummies stretched further than they need!</p><p>Watch your baby, read their cues and feed them when they want and how much they want. Consider sitting your baby up so gravity doesn’t decide the feed.</p><p>If your baby tells you when they want a feed, is content between feeds, is gaining weight well, producing lots of wet and dirty nappies, then you are likely to be feeding the right amount. Always consult a medical professional for review and support with feeding.</p><p>Sources: Unicef Baby Friendly/ NHS / CDC</p><p>https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-1982-9#ref-CR11</p><p><a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/apa.12291\">https://onlinelibrary.wiley.com/doi/abs/10.1111/apa.12291</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Accident Prevention] Suffocation and Strangulation",
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"value": "<p><b>[HIMBA] Accident Prevention: Suffocation and strangulation</b></p><p>Last week we considered chemical and medical poisoning on child health. Now we consider household items that may pose a risk of suffocation or strangulation.</p><p>Children can often pull themselves up before they can walk, which means cords and ropes are very attractive to young babies that want to be standing and ‘cruising’. It is difficult to watch your baby every second so considering the below risks may prevent an accident:</p><p>- Plastic bags/nappy sacks: they can easily suffocate a baby. Keep them away from the pram and cot.</p><p>- Rubber balloons that are unfilled can be chewed and obstruct the airway</p><p>- Do not let pets in the child’s bedroom. Cats in particular can pose as a risk and cause suffocation</p><p>- Ensure cords on curtains/blinds are out of reach so the child cannot get entangled in them</p><p>- Do not hang toys around the cot that are on a string or cord and ensure hanging mobiles out of reach.</p><p>- Consider ropes on dressing gowns and drawstring bags</p><p>- Consider stair railings at home- babies may be able to squeeze themselves between railings and get stuck or even fall.</p><p>- Follow safe sleep advice by keeping babies on their back, on new mattresses and with no excess bedding, pillows or toys nearby (more specific information to follow in a February HIMBA post)</p><p>- Remove bibs when putting your baby down to sleep</p><p>- Avoid putting jewellery on children and avoid dummy strings/attachments</p><p>If using a sling follow the TICKS rule to prevent suffocation:</p><p>T - keep your baby Tight</p><p>I - In view</p><p>C - Close enough to kiss</p><p>K - Keep their chin off their chest</p><p>S - with a Supported back.</p><p>Sources: CDC/WHO/NHS/Child accident prevention trust</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p></p><p>[𝗛𝗜𝗠𝗕𝗔] 𝗔𝗖𝗖𝗜𝗗𝗘𝗡𝗧 𝗣𝗥𝗘𝗩𝗘𝗡𝗧𝗜𝗢𝗡: 𝗖𝗛𝗘𝗠𝗜𝗖𝗔𝗟 𝗔𝗡𝗗 𝗠𝗘𝗗𝗜𝗖𝗜𝗡𝗘 𝗣𝗢𝗜𝗦𝗜𝗢𝗡𝗜𝗡𝗚</p><p>𝘊𝘩𝘪𝘭𝘥𝘳𝘦𝘯 𝘢𝘳𝘦 𝘤𝘶𝘳𝘪𝘰𝘶𝘴 𝘢𝘯𝘥 𝘮𝘢𝘯𝘺 𝘢𝘤𝘤𝘪𝘥𝘦𝘯𝘵𝘴 𝘰𝘤𝘤𝘶𝘳 𝘪𝘯 𝘵𝘩𝘦 𝘩𝘰𝘮𝘦 𝘸𝘩𝘪𝘤𝘩 𝘤𝘢𝘯 𝘤𝘢𝘶𝘴𝘦 𝘪𝘭𝘭 𝘩𝘦𝘢𝘭𝘵𝘩 𝘢𝘯𝘥 𝘪𝘯 𝘴𝘰𝘮𝘦 𝘤𝘢𝘴𝘦𝘴, 𝘧𝘢𝘵𝘢𝘭𝘪𝘵𝘪𝘦𝘴.</p><p>🙋♀️🙋♂️Thousands of children each year present in Accident and Emergency Departments after ingesting chemicals or medicines💊</p><p>𝘛𝘪𝘱𝘴 𝘵𝘰 𝘬𝘦𝘦𝘱 𝘤𝘩𝘪𝘭𝘥𝘳𝘦𝘯 𝘴𝘢𝘧𝘦:</p><p>- Lock all medicines in a cupboard which is secure and away from the reach of children</p><p>- Safely expose of any drugs that are no longer wanted</p><p>- Make sure all toxic agents such as chemical cleaners for the home and laundry capsules are not accessible</p><p>- Consider the chemicals you may also have in the garden, such as weed killer and lock away</p><p>- Prior to giving children medication, always read the label carefully and ensure correct dosage 👀</p><p>- Discuss with guests who regularly visit your home to ensure handbags /jacket pockets are closed and away from children in case they hold medical contents 👜</p><p>- Consider batteries in hearing aids or other electronic equipment and keep these away from children 👂</p><p>- Essential oils and perfumes are also toxic when ingested 🚫</p><p>- Safety locks are sometimes opened by older toddlers/children so ensure the lock you use is appropriate 🔒</p><p>- Take children to the emergency department if you are in any doubt of poisoning 👨⚕️</p><p>Sources: WHO/CDC</p><p></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Infant Feeding] Mixed feeding",
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"value": "<p><b>[HIMBA] Infant Feeding: Mixed feeding</b></p><p>Do you want/need to:</p><p>a) Get your partner to share the feeds?</p><p>b) Go back to work?</p><p>c) Leave your baby for a short period of time?</p><p>d) Want to produce expressed breast milk?</p><p>Learning how to mixed feed may be helpful for you. The world health organization recommend exclusive breastfeeding for the first 6 months but certain choices and circumstances may need you to opt for mixed feeding.</p><p><b>Advice for mixed feeding:</b></p><p>1) It is preferable to start introducing a bottle after breastfeeding has been established (6-8weeks) this is because feeding from a bottle requires different sucking skills and could complicate breastfeeding</p><p>2) Expressed breastmilk is the number 1 milk to give via a bottle. Bear in mind, the amount you can express with a pump does not accurately reflect what your baby gets from the breast… they are much better pumps!</p><p>3) If you introduce formula, the baby will be feeding from your breast less, which will reduce your supply. Do this gradually so that you do not have too much milk in the breast that isn’t getting removed, this can lead to engorgement and mastitis. Try just one formula bottle at a time, or express from your breast.</p><p>4) If you are starting to offer the bottle to go back to work/leave your baby for some time (either expressed milk or formula) then start several weeks before you have to go. This will allow for a gradual shift in your supply and get your baby used to the bottle.</p><p>5) If your baby is 6 months, you may not need to introduce the bottle at all.. try a cup and then you have one less transition at 1 year!</p><p>How to give your baby a bottle:</p><p>1) Try when your baby isn’t hungry and upset. When babies are relaxed they are much more open to trying new things</p><p>2) Try letting your partner or friend give the first bottle so they do not smell your milk and get confused</p><p>3) Try a different position than you use for breastfeeding to try and differentiate from breastfeeding</p><p>NOTE: Some mothers struggle with supply but still want to breastfeed. 2% of mothers do not have the ability in their breast cells to produce the milk. Obtain support for this as there are many ways to maintain the breastfeeding opportunity whilst ensuring your baby receives adequate nutrition.</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Maternal Mental Health] Looking after yourself - New Mothers.",
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"value": "<p></p><p>[𝗛𝗜𝗠𝗕𝗔] 𝗠𝗮𝘁𝗲𝗿𝗻𝗮𝗹 𝗛𝗲𝗮𝗹𝘁𝗵: 𝗟𝗼𝗼𝗸𝗶𝗻𝗴 𝗮𝗳𝘁𝗲𝗿 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳- 𝗡𝗲𝘄 𝗠𝗼𝘁𝗵𝗲𝗿𝘀</p><p>Having a new baby is one of the biggest challenges of a woman’s life. 🏆</p><p>❤️ All women are sensitive to this change and need encouragement + support ❤️</p><p>Hormonal changes ➕ lack of sleep ➕ worry about your baby’s health/ feeding ➕ recovering from birth = 𝗰𝗵𝗮𝗻𝗴𝗲𝘀 𝘁𝗼 𝘆𝗼𝘂𝗿 𝗺𝗲𝗻𝘁𝗮𝗹 𝗵𝗲𝗮𝗹𝘁𝗵</p><p>𝟱𝟬% of all mothers feel tearful and frustrated after birth with 1️⃣ in 5️⃣ women developing mental health problems.</p><p>☁️ ‘Baby blues’ or short term mood changes within the first two weeks of birth is normal and common. ☁️</p><p>Postnatal depression (PND) – this is classified as depressive symptoms that do not go away over a few days or weeks and may start at any time in the first year of your baby’s life. 1/10 women experience PND. Please consult a Dr if you are concerned about this. Symptoms are outlined here:<br/><a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.postpartum.net%2Flearn-more%2Fdepression-during-pregnancy-postpartum%2F%3Ffbclid%3DIwAR15NLpHi-Xod7u2YdE29sNosLWceuVlGUEQFKuRkHanXb7OuT2Sf-8lU7A&h=AT2weio4Lpktmjv8ZHTR_5eYrzBtIi92CtcfLcNqB97YNTfQwzUyLjV1uTrLH4bnZpfQtzh1kykkklgxTJhCsgBOM1D4tW6hFqoScRSh5y68U1HePHYfbjgLDd0DmorbMt2OBrazQnHiNnGWw6fXNtidy2jtsfioabnNE9MhgsGmPc8LkaOaCC99sJv8A2XwY4VC_FTTglE6W5y4dR2btX2NKmIe-pSkAtoMGpNbL2UrSDFnFxOOK1NkfgBLwMjqhOocfUIm_liZQJ5g4dgKpvdpYDG4RdbTSD8pk4MaPop5fVN07bUmKoeur1tjlf6lX7z_fZF6NCNU5nHX7roBEqOYSbMvJjurrwiqRV69Wjq720dFcBZGm9EIYQZL7wS4k4OH81BR2nOubrE1X-0FZQmy5oBBF_2sTw1w2xnYXcLCB7Q99UVIh9BB5CKc9BG_pMOp2J1xYTYvi8wAVPqwKVUMiqirSn82OB4MJEpi21QNdafQIMQyLIhhS2WQ_dGnOHSEdFX6gEaNwvz-Qf5ZkEk28BqGQUMmyaejHBOU7oqui0DB4AgdkWsVv5X4zOarg2AJjHRELfoX-XohenwcUAntD-PR_LpApwAGNxL5vIrjxotuLWVxxh9HiX8uuAyyMds\">https://www.postpartum.net/…/depression-during-pregnancy-p…/</a></p><p>For all maternal mental health problems you can follow the tips below .</p><p>Speaking out and accessing support is vital for recovery👂</p><p>⭐️ 𝗛𝗼𝘄 𝘁𝗼 𝗹𝗼𝗼𝗸 𝗮𝗳𝘁𝗲𝗿 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳 ⭐️</p><p>𝗟𝗼𝗼𝗸𝗶𝗻𝗴 𝗮𝗳𝘁𝗲𝗿 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳 𝗶𝘀 𝘁𝗵𝗲 𝗸𝗶𝗻𝗱𝗲𝘀𝘁 𝘁𝗵𝗶𝗻𝗴 𝘆𝗼𝘂 𝗰𝗮𝗻 𝗱𝗼. 𝗧𝗵𝗶𝘀 𝘄𝗶𝗹𝗹 𝗽𝗿𝗼𝗺𝗼𝘁𝗲 𝗮 𝗵𝗲𝗮𝗹𝘁𝗵𝘆, 𝗵𝗮𝗽𝗽𝘆 𝗻𝗲𝘄 𝗺𝘂𝗺 𝘄𝗵𝗼 𝗶𝘀 𝗮𝗯𝗹𝗲 𝘁𝗼 𝗰𝗮𝗿𝗲 𝘄𝗲𝗹𝗹 𝗳𝗼𝗿 𝗵𝗲𝗿 𝗯𝗮𝗯𝘆.</p><p>Rest and sleep as much as possible, household chores can wait.<br/>Take gentle exercise<br/> Meet other mothers who will support and understand your challenges<br/>Eat regularly- low blood sugars can impact mood further<br/>Enjoy a well balanced diet<br/>Talk about your feelings with your support network- share the concerns and reach for help<br/>Make a list of all the things you want to do and be realistic about whats important TODAY. Take each step at a time<br/>Don’t try to be ‘super-mum’ – take time to adapt to your new role and new relationship with your baby<br/>Write down your feelings to acknowledge and validate how you feel – the good and the bad!<br/>Finally… talk to a healthcare professional if you need more help as medication and/or counseling therapies may be required.</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Healthy Children] Oral Health",
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"value": "<p><b>Healthy Children: Oral Health</b></p><p>DID YOU KNOW?</p><p>When your baby is born, all their teeth are already in their jaw!</p><p>ALSO…</p><p>Breastfeeding reduces your baby’s risk of dental decay, crooked teeth and discolouration!</p><p>The first teeth usually begin to erupt around 6 months, however some babies are a lot earlier and some a lot later… perhaps 14 months!</p><p><b>What can you do to promote good oral health for your baby?</b></p><p>- Babies begin to enjoy solid food from 6 months. They do not naturally want sugary food or have a sweet tooth. They will have tasted different foods through the swallowing amniotic fluid in the womb and through breastmilk.</p><p>- Try offering foods low in sugar first, children do not need sugar.</p><p>- Fruit is best given with meals rather than as a snack to reduce the exposure on the teeth</p><p>- Refrain from giving other drinks other than milk and water until five years old. Children do not need juices or other sweetened drinks.</p><p>- Brush the gums as soon as you introduce food, this will wipe any sugar away that may affect new teeth coming through the gums.</p><p>- All teeth need brushing, despite how small and you can use a soft baby brush with a smear of fluoride toothpaste that is at least 1000 parts per fluoride matter (PPM F) until the child is three years old. Get your child to spit out excess toothpaste but not to rinse with water as this washes away the fluoride.</p><p>- Children from 3 need toothpaste 1350-1500 (PPM F). Supervise your child until at least seven years old.</p><p>- Brush the teeth twice a day and even if you give an evening milk, teeth need brushing after this.</p><p>- Always use sugar free medicines if available and do not give HONEY under one. This is due to the inability for a baby to break it down and it can be toxic.</p><p>- When your baby reaches 1, move onto a free flow valve cup (not a bottle) and book a trip to the dentist. It is important that milk from a bottle is no longer given to prevent dental decay. It also needs more muscles to sip and swallow rather than suck from a bottle!</p><p><b>Resources/sources:</b></p><p>Use your dentist!</p><p>Institute of Health Visiting UK <a href=\"https://ihv.org.uk/wp-content/uploads/2015/11/PT_Childrens-Teeth_V6-WEB.pdf\">https://ihv.org.uk/wp-content/uploads/2015/11/PT_Childrens-Teeth_V6-WEB.pdf</a></p><p>American Dental Association: <a href=\"https://www.mouthhealthy.org/en/babies-and-kids\">https://www.mouthhealthy.org/en/babies-and-kids</a></p><p>Oral health foundation: <a href=\"https://www.dentalhealth.org/childrens-teeth\">https://www.dentalhealth.org/childrens-teeth</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"id": 1224,
"title": "Vaccinations in pregnancy",
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"value": "<p></p><p>Protect yourself and your baby during pregnancy!<br/>Vaccinations are extremely important and safe for pregnant women. The risks associated with the diseases outweigh any concerns over the vaccination.<br/>Two main vaccinations that ALL pregnant women should receive are the FLU vaccine and the WHOOPING COUGH vaccine.</p><p>Flu vaccination during pregnancy lowers the risk of influenza hospitalization in:</p><p>Pregnant women by an average of 40%<br/>Babies less than 6 months old by an average of 72%</p><p>Whooping Cough vaccination during pregnancy lowers the risk:</p><p>In babies less than 2 months old by 78%<br/>In hospitalization in babies less than 2 months old by 91%</p><p>Live vaccines carry risks to the unborn baby so are generally not recommended in pregnancy.</p><p>Tetanus is a safe vaccine in pregnant women and recommended in areas that are high risk- such as Vietnam.</p><p>Check your MMR status prior to conception - Measles, Mumps and Rubella immunity is important to check as if contracted in pregnancy they can cause birth defects and complications to the baby.</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Healthy Children]: Salt Intake",
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"value": "<p></p><p>[𝗛𝗜𝗠𝗕𝗔] 𝗛𝗘𝗔𝗟𝗧𝗛𝗬 𝗖𝗛𝗜𝗟𝗗𝗥𝗘𝗡: 𝗦𝗔𝗟𝗧 𝗜𝗡𝗧𝗔𝗞𝗘.🙋♀️🙋♂️</p><p>⭐️⭐️⭐️FMP brings you a new maternal and child health column with important updates you can now access daily.</p><p>Today topic is HEALTHY CHILDREN: SALT INTAKE<br/>Many children consume too much salt from processed foods and eating out of the home.🍟🥖</p><p>❗️Salt can cause:<br/>- High blood pressure<br/>- Cardiovascular diseases ❤️</p><p>Check food labels and if the salt content is stated as SODIUM you will need to times this by 2.5 and divide by 1000 to get the salt level.<br/>Maximum for adults is 5g a day - One teaspoon.🥄<br/>Milligrams of sodium X 2.5 ÷ 1,000 = salt content.<br/>E.g 800mg sodium x 2.5 = 800 / 1000 = 2g of salt</p><p>📌RECOMMENDATIONS:<br/>Refrain from adding salt to children’s food, the kidneys do not process the salt well.<br/>Refrain from introducing your baby to salty food during weaning.<br/>Refrain from using packaged foods<br/>Make fresh food at home and limit use of stock cubes/gravy/ready made sauces that are high in salt.</p><p>📌SPECIFIC AGE RECOMMENDATIONS:<br/>0-6mths- Exclusive breastmilk which has the perfect vitamins and mineral quantities.<br/>6 months- When weaning do not add salt or introduce salty foods. You can use cows milk in food but not as a drink. One reason for this is because it has higher sodium that formula or breast milk.<br/>6-12 months- ensure salt intake is <1g per day<br/>12mths-36mths - <2g per day<br/>4-10 years - <3g per day<br/>10+ minimal quantities but maximum 5g - one teaspoon🥄</p><p>Resources - WHO/CDC/FIRST STEPS NUTRITION</p><p></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>[HIMBA] Infant Feeding: Benefits of Breastfeeding</b></p><p>Breastmilk is the ONLY source of nutrition a baby needs before 6 months. No additional food or water is needed until 6 months as recommended by the World Health Organization.</p><p>Breastmilk provides… 50% of the childs energy needs between 6-12 months</p><p>Breastmilk provides… 75% of the childs energy needs between 12-24 months</p><p><b>Benefits for the Infant:</b></p><p>-Reduces the rates of infections, allergies, diarrhea and vomiting, childhood cancers, diabetes, asthma, heart disease and obesity, as well as cot death</p><p>- Perfect nutrition which is 'live' and 'active' constantly evolving to the environmental infections that the baby is exposed to.</p><p><b>Benefits for the mother:</b></p><p>-Reduces the rates of breast and ovarian cancer</p><p>- Convenience</p><p>-Exclusive breastfeeding is 98% effective as a contraceptive method</p><p>- Burns around 500 calories a day</p><p>-Reduces hip fractures rates and osteoporosis</p><p>- Saves money</p><p><b>Relationship building:</b></p><p>-Supports bonding and relationship with your baby</p><p><b>Environment</b></p><p>-Reducing plastic and landfill</p><p>-Reduces manufacturing and transportation</p><p>Sources: WHO/UNICEF/La Leche International</p><p>Supportive resources:</p><p><a href=\"https://onlinelibrary.wiley.com/doi/pdf/10.1038/cti.2013.1\">https://onlinelibrary.wiley.com/doi/pdf/10.1038/cti.2013.1</a> ‘Maternal and infant infections stimulate a rapid leukocyte response in breastmilk’</p><p><a href=\"https://www.llli.org/breastfeeding-info/\">https://www.llli.org/breastfeeding-info/</a> La Leche International resource</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Healthy Children] Limit Sugar",
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"value": "<p><b>[HIMBA] Healthy Children: Limit Sugar</b></p><p>Sugar can be harmful to children- increasing risks of cancer, dental decay, diabetes, excessive body fat and psychological conditions.</p><p>Here are the recommended sugar levels for children:</p><p>Under 4 – limit all sugars</p><p>4-6years – 19g – 5 sugar cubes</p><p>7-18years – 24g – 6 sugar cubes</p><p>Adults – 25-30g max per day – 7 sugar cubes</p><p>Limit ‘free sugars’- these are added sugars and found in honey, syrups and sugars released when fruit is blended. This can impact oral health and bodyweight. Naturally occurring sugars from whole fruit, vegetable and milk are not free sugar. Free sugars should only make up 5-10% of your daily calorie intake.</p><p>Tips for reducing sugar in your child’s diet:</p><ul><li>Drink water rather than sweetened drinks.</li><li>Juice is also sugary and should be avoided in children under 4 and limited to 150ml per day for older children - best to dilute with water, 50:50.</li><li>Fruits are better consumed whole as the sugar remains in the structure of the fruit and has higher fibre.</li><li>Fruits are best eaten at meal times to reduce further exposure of sugar and acid on the teeth.</li><li>Avoid packaged foods and read the nutritional content: if sugar is high up on the list try to swap with a less sugary option</li><li>Children often snack in between meals which reduces their appetite for balanced foods at lunch and dinner. Try to limit snacks and provide ‘mini meals’ if the child is hungry such as cheese on a cracker.</li><li>Try not to introduce sweet foods during weaning, this will encourage a taste preference</li></ul><p>Source: WHO, CDC, NHS</p><p>Resource:</p><p><a href=\"https://www.nhs.uk/change4life/food-facts/sugar/sugar-calculator\">https://www.nhs.uk/change4life/food-facts/sugar/sugar-calculator</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>Development: Social Smile</b></p><p>First smiles are very exciting and being aware when this is expected is important for social and emotional development.</p><p>0-6 weeks – Your baby may smile but it is likely to be a reflex and in response to internal feelings such as wind. Your baby’s vision is blurry and the vision is developing slowly with range increasing from 10cm – 20cm approximately. Black and white toys are great at first.</p><p><b>6-8 weeks – The social responsive smile will emerge</b>. Your baby will see you from 20cm away and begin to smile in response to your voice, your facial expressions and stimuli such as singing/toys.</p><p>It is important to encourage and praise this new skill of smiling. Keep interacting with your baby by tickling the feet/singing/talking and placing colourful objects 20cm away and watch your baby follow the toy and smile. Praise your baby and you will see more smiles !</p><p>Up to 12 weeks – All babies should be smiling in response to stimuli. <b>If this is not the case please see a Pediatrician to review social development</b>. It is also important to ensure vision and hearing is developing normally.</p><p>Sources: WHO/CDC/NHS</p><p>Resource for parents: <a href=\"https://www.cdc.gov/ncbddd/actearly/milestones-app.html\">https://www.cdc.gov/ncbddd/actearly/milestones-app.html</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Mental Health] Emotional well-being of fathers",
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"value": "<p><b>[HIMBA] Mental Health: Emotional wellbeing of fathers</b></p><p>Dad’s are providing 50% of the parenting role and are equally as important in a child’s life. The mental health of fathers is really important!</p><p><i>Common causes of poor mental health in fathers:</i></p><p>- Often Dad’s support their partner during pregnancy and birth and this can be a very emotive experience, especially if there have been complications.</p><p>- Dads often feel responsible to remain positive and supportive for their partner whilst also contacting friends and family members with updates. This can be tiring.</p><p>- Dad’s may not be feeding the baby at the beginning so finding an important role they can do to feel part of the parenting experience is really important ... this may be more exciting than just nappy changes! (e.g. baby massage/ bathing)</p><p>- Dad’s may not have time off work and will be trying to balance work life and home life… often on a lack of sleep</p><p>- There is a lot of support for the mother/baby but not on the father/baby</p><p>What can Dads do to look after their mental health after having a new baby?</p><p>- Be aware that sometimes you may feel down after having a baby and this is normal</p><p>- Make time for yourself, aware from work and your family</p><p>- Focus on what you enjoy about parenting, perhaps baby massage</p><p>- Try to protect time for your interests/hobbies</p><p>- Try not to adopt negative coping strategies such as working too hard, drinking too hard etc.</p><p>- Exercise regularly</p><p>- Have reasonable expectations of what you can achieve try not to be ‘super dad’</p><p>- Talk to friends and family</p><p>International resource for new dads: <a href=\"https://www.postpartum.net/news-and-blog/ifmhd/\">https://www.postpartum.net/news-and-blog/ifmhd/</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>Infant Feeding</b>: Starting with formula milk</p><p>For mothers who choose they do not want to breastfeed or cannot breastfeed, infant formula is safe and nutritionally suitable for babies.</p><p><b>Choosing a formula</b></p><p>No brand is better than another. All formulas have to follow strict regulations so they all contain similar ingredients.</p><p>Cow’s milk formula is suitable from birth until one year. Hungry baby milks, soya alternatives and follow on milks are not recommended. Please always follow your doctor’s advice as individual recommendation can differ from general recommendation.</p><p><b>What do you need?</b></p><p>- Bottles and bottle brush</p><p>- Teats</p><p>- Sterilisation equipment</p><p>- Powdered formula</p><p>Please note powdered formula is not sterile. Boil water above 70 degrees when adding to the powder to kill any pathogens. See link below with instructions on how to safely prepare formula.</p><p><b>How to give infant formula.</b></p><p>Ensure your baby is sat fairly upright and is held by you, not propped or sat in a chair</p><p>Keep the teat full of milk to prevent air intake which = wind later on!</p><p>Give your baby short breaks during the feed to assess cues and allow your baby to burp</p><p>Use the recommended amount on the packaging as a guide only- follow your babies cues and never force a baby to finish a bottle</p><p>Throw away all unused formula after one hour of starting the feed</p><p>Sources: CDC/WHO/UNICEF</p><p>Resource: <a href=\"https://www.who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf\">https://www.who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Healthy Children] Encouraging vegetables",
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"value": "<p><b>Healthy Children:</b> Encouraging vegetables</p><p>The most important of all is to be a good role model! Children copy behavior so more vegetables for all the family will naturally increase your child’s familiarity and interest.</p><p>For children 1-4 years at least five vegetables (approximately 40g portions) per day is the general recommendation.</p><p>Top tips for how to improve vegetable intake:</p><p>- Focus on how good vegetables taste rather than health benefit</p><p>- Eat together as a family</p><p>- It can take 10-15 times of a child trying a food before they will like it… keep trying!</p><p>- Give lots of praise to your child for eating vegetables</p><p>- Use stickers rather than sweet foods as rewards as this is counter-productive</p><p>- Ensure vegetables are readily available for snacks/meals and cut into appropriate sizes for a child</p><p>- Get young children involved in choosing the vegetables and preparing it such as washing it with you</p><p>Sources: NHS/CDC/WHO</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Development] Tummy time",
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"value": "<p><b>[HIMBA] Development: Tummy time</b></p><p>This often raises a lot of questions relating to how, what, why and when!</p><p>This HIMBA tip will aim to address these in a nutshell and get your baby enjoying daily time on their tummies.</p><p><b>Firstly…</b></p><p><b>What Is Tummy Time?</b></p><p>- Tummy time is as it says, time your baby can lie on their front whilst awake and supervised.</p><p><b>Why?</b></p><p>-Before your baby crawls and walks they needs to build back, neck and shoulder muscles; therefore tummy time is an essential building block to their gross motor development</p><p>- Tummy time encourages your baby to lift his/her head so increases head control</p><p>-It enables babies to learn how to move side to side which is important before they reach and roll</p><p>- Episodes of tummy time help the head shape to be more rounded</p><p><b>When?</b></p><p>- You can begin introducing tummy time from birth</p><p><b>How?</b></p><p>- Lie your baby on your chest everyday and talk to your baby, they will want to look up at your face which will be good practice for their head movement and lifting strength</p><p>- Once your baby is a couple of weeks old you can purchase a baby gym which has a firm, flat surface and hanging above will be interesting toys, mirrors and lights. Placing your baby on the gym each day for short periods will encourage your baby to enjoy this space. Don’t worry if they cry after 10seconds, pick them, cuddle them and try again later. Regular goes at trying this out will make them more comfortable with it.</p><p><b>Sources – CDC/NHS</b></p><p><b>Resource – Download this milestone tracker</b> <a href=\"https://www.cdc.gov/ncbddd/actearly/milestones/index.html\">https://www.cdc.gov/ncbddd/actearly/milestones/index.html</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"id": 1234,
"title": "[Mental Health] Having a baby and suffering with O.C.D (Obsessive Compulsive Disorder)",
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"value": "<p><b>Mental Health: Having a baby and suffering with O.C.D (Obsessive Compulsive Disorder)</b></p><p>Whether you were diagnosed prior to having your baby or during the perinatal period, OCD can be a difficult condition to manage when you have the responsibility as a new mother or father.</p><p><b>What is it?</b></p><p>OCD is an anxiety disorder that affects about 2% of women during the perinatal period (from conception to one year after birth). It causes recurrent and persistent thoughts that can cause anxiety, depression or fear and lead to compulsive activities that immediately bring some relief but, long term, affect daily life as they become ingrained rituals that are difficult to stop.</p><p>Research suggests that 2/3 of new fathers and 80% of new mothers admit to having worrying thoughts about how to protect their baby from harm. These can be about:</p><p>-Contamination/dirt</p><p>-Cot death</p><p>-Something they did or didn’t do (turn oven off)</p><p>These thoughts are normal and common when you first have a baby and as you relax and get less fearful of your parenting journey they often subside and you can get on with your everyday life.</p><p>BUT… Parents with OCD find these feelings do not subside and it can cause habits and rituals to try and help with the anxiety. For example, watching the baby all night in case of cot death/ cleaning bottles over and over again / checking the oven is off several times before going to sleep.</p><p><b>How can they get help?</b></p><p>- Tell someone. Talking through these feelings is so important. Also realizing that they are common can take some of the anxiety away that you may feel when experiencing an intrusive thought. This can then prevent the rituals/compulsive behavior from starting.</p><p>- Seek help from your doctor. They may consider psychological services or medication</p><p>- Learn about OCD and don’t blame yourself for feeling this way.</p><p><b>Sources</b>: International OCD foundation/ Postpartum net / RcPsych</p><p>Resource for support is: <a href=\"https://iocdf.org/\">https://iocdf.org/</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>Infant Feeding: The ‘golden hour’</b></p><p>Meeting your baby for the first time is a precious and rewarding moment. The first hour after birth is what is referred to as ‘The Golden Hour’. If mother and baby are well following birth it is important to be aware of the benefits that skin to skin can have for both the mother and baby’s emotional and physical health.</p><p>UNICEF and WHO recommend: Uninterrupted skin to skin contact and support to initiate breastfeeding is facilitated immediately, within an hour from birth (as soon as possible dependent on medical circumstances).</p><p><b>Benefits to the mother:</b></p><p>- Birth and skin to skin stimulates a large gush of oxytocin ‘the love hormone’ into your bloodstream. This hormone is responsible for the the ‘let down’ reflex which releases your milk.</p><p>- This increase of oxytocin (studies suggest a 3-4 fold increase at birth) helps expel the placenta and reduce bleeding by contracting the uterine muscles</p><p>- Oxytocin stimulates a switch from a stressful ‘sympathetic nervous system’ to a relaxing ‘parasympathetic nervous system’. This is where the body goes into a relaxed state, where connection with the infant will be optimized</p><p>- Oxytocin can reduce the mothers feeling of pain and stress following birth</p><p>- Skin to Skin increases a mothers bond with her baby and self-efficacy (or confidence) to breastfeed</p><p><b>Benefits to the baby:</b></p><p>- A baby is born with high stress hormones in its bloodstream but skin to skin relaxes the infant</p><p>- Oxytocin creates a warm chest for the baby to lie on and stabilizes the heart rate</p><p>- Less crying</p><p>- High rates of breastfeeding initiation</p><p>- Optimal blood sugars</p><p>- Exposure to good bacteria on the mothers skin for initiating the immune system</p><p>You can have skin to skin at any time with your new baby, if you missed out immediately after birth, don’t worry, benefits can still be had weeks or months down the line. It is a special time and you can do it for as long and as often as you like!</p><p>Source: Unicef/WHO/La Leche International</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>Healthy Children: Encouraging calcium in children’s diets</b></p><p>Nearly all of our bone mass is developed in childhood and the teenage years. Strong bones and teeth are essential for good health as we get older and protects normal nerve and muscle functions.</p><p>From one year, drinking whole milk that has been pasteurized contains lots of calcium! Drinking it from a cup is important for the teeth and children can enjoy around 500mls per day alongside a calcium rich diet.</p><p>Please note that if you want to use a plant based milk after 1 years old they will need to be fortified with calcium. Unsweetened versions are also recommended.</p><p><b>Foods to increase calcium are:</b></p><p>- Green leafy vegetables</p><p>- Beans, chickpeas, lentils</p><p>- Almonds,</p><p>- Figs</p><p>- Seeds</p><p>- Yogurt</p><p>- Sardines</p><p>- Cheese</p><p>- Egg</p><p>TIP: If your child does not want to drink milk, just mix this into foods to supplement the calcium in the diet. i.e making cheesy sauces or putting milk into mashed potato.</p><p>Most people can get good amounts of calcium from their diet but if concerned please consult with a dr.</p><p>Sources: NHS/CDC/ WHO/First steps nutrition</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Development] Sitting up",
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"value": "<p><b>Development: Sitting up</b></p><p>Children all develop at different stages, some babies develop their gross motor skills quicker than their fine motor skills and vice versa. It is important not to worry but to know how to best encourage development in your child and when to seek help if your child is struggling to meet the expected milestones.</p><p>As previously discussed, tummy time begins early and gets your baby’s muscles strong, ready to roll and sit.</p><p><b>Around 3-4 months</b> your baby will enjoy being sat upright on your lap, fully supported. They may now have strong head and neck muscles to hold their head steady. Encourage reading a story whilst your baby is on your lap.</p><p><b>Around 6 months</b> your baby may be able to sit on the floor using their hands to support them. They may still need soft pillows around or to be placed inside your legs to help support their sitting. Remember that time on the floor is so important to provide babies time to learn these new skills. Putting a baby in a stroller or a chair frequently will slow their development.</p><p><b>Around 8 months</b> your baby may be able to sit independently without relying on their hands or soft support. Initially this may be just for a short time but soon and perhaps not until nine months your baby will be able to sit for several minutes as they master new balancing skills and build stronger muscles.</p><p>Remember that babies often need encouragement to stay in positions that require strength and balance. Exciting, colourful and noisy toys can help. Also making noises to encourage your child to look up at you and practice using their head and neck muscles is good for overall development.</p><p>Always remember to proof your house once your baby is confidently sitting and rolling and supervise your child at all times.</p><p>Sources: Ages and Stages/ CDC</p><p>Resource: For activities please refer to Ages and Stages <a href=\"http://archive.brookespublishing.com/documents/asq-activities.pdf\">http://archive.brookespublishing.com/documents/asq-activities.pdf</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Accident Prevention] Safe sleep",
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"value": "<p><b>Accident Prevention: Safe sleep.</b></p><p>The reason why parents are encouraged to learn and apply safe sleep measures is to prevent Sudden Infant Death syndrome - or SIDS for short. There is no single cause for this but there are a number of risk factors which increase the likelihood of SIDS. Luckily, there are a number of preventative measures we now know that you can do to try and keep your baby sleeping as safely as possible.</p><p><b>What reduces the risk of SIDS?</b></p><ol><li><b>Breastfeeding</b></li><li><b>Don’t let your baby get too hot!</b></li></ol><p>Babies do not need excessive clothing. No hats or gloves are required unless medically advised. No duvets or excessive bedding should be used as your baby is likely to overheat. Hands and feet may feel cold and this is normal. Feel your baby’s chest and neck to assess temperature. 36.5-37.5 is the normal temperature of a baby.</p><ol><li><b>The products that you choose for bedding</b></li></ol><p>You need a flat, firm mattress protected with a waterproof cover. A new one is recommended, although not essential. Make sure it fits well to the cot and ensure no soft toys, pods, nests, sleep positioners, bumpers, heavy bedding or cushions are around the cot.</p><p><b>4.The positioning of your baby to sleep as per recommendation</b></p><p>Always place your baby on their back unless medical advice states otherwise.</p><p>There is no evidence that babies are more likely to choke on their backs but the risk of SIDS is reduced by six times compared to sleeping on their fronts</p><p>Feet need to be at the end of the cot/moses basket with their head and face uncovered- no hats!</p><p><b>5.Baby sleeping bags</b></p><p>These are preferable over loose sheets as the baby is more secure. The right tog needs to be considered and a room temperature thermometer used. Aim for around 16-20 degrees.</p><ol><li><b>Car seats and slings</b></li></ol><p>When you are home from a journey, remove your baby from the car seat</p><p>When you are on a journey stop every 2 hours approx to give your baby time outside the car seat</p><p>Use the TICKS rule when using a sling <a href=\"https://www.rospa.com/Home-Safety/Advice/Product/Baby-Slings\">https://www.rospa.com/Home-Safety/Advice/Product/Baby-Slings</a></p><p><b>What increases the risks of SIDS?</b></p><p><b>-</b>Smoking</p><p>-Sharing a bed with your baby after the intake of alcohol or drugs</p><p>- Sleeping on a sofa, armchair or other soft surface with your baby</p><p>-Allowing your baby to get too hot or cold</p><p><b>Resources and sources:</b> <a href=\"https://www.cdc.gov/vitalsigns/safesleep/index.html\">https://www.cdc.gov/vitalsigns/safesleep/index.html</a></p><p><a href=\"https://www.lullabytrust.org.uk/\">https://www.lullabytrust.org.uk/</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Infant Feeding] 'Antenatal Harvesting' or Antenatal Milk Expression.",
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"value": "<p><b>Antenatal Harvesting or Antenatal Milk Expression.</b></p><p>Many places around the world are now recommending women with low risk pregnancies to consider the benefits of expressing colostrums after 36 weeks of pregnancy. Research has shown for it to be safe in low risk pregnancies with no links found that it stimulates the onset of labour.</p><p>Milk production begins as early as 12-16 weeks! It is not recommended that you express any milk off until 36 weeks.</p><p><b>Colostrum</b> is the thick-yellow milk that is first produced in the breast. This is ‘liquid gold’ in terms of the nutritious benefit for your baby.</p><p>It is full with antibodies to protect your baby and support a healthy immune system. It is very good for your babies gut and is a laxative to help clear the meconium (the first black stool) which removed early also reduces jaundice.</p><p><b>Why express before you give birth?</b></p><p>-Builds your confidence in hand expressing</p><p>-Some women have delayed onset of milk after birth due to having a more complex delivery. If you have syringes to give the baby it will reduce the need for formula whilst awaiting for the milk to come in</p><p>-Some babies find it difficult to have stable blood sugars after delivery due to being a low birthweight, exposed to medications in the womb or due to maternal or fetal health conditions. These babies often need supplements if the blood sugars are low and having syringes again is a brilliant resource.</p><p><b>How should I do this?</b></p><p>- Please see this link for a detailed introduction - <a href=\"https://abm.me.uk/wp-content/uploads/ABM-antenatal-expressing.pdf\">https://abm.me.uk/wp-content/uploads/ABM-antenatal-expressing.pdf</a></p><p>- This should only take 3-5 minutes on each breast twice a day</p><p>- Freeze the milk in sterile syringes (1-2ml)</p><p>- To thaw the syringes place them in hot water when you need them and use within 24 hours from when thawed</p><p><b>Please note this is advice for low risk pregnancy. Always consult with your midwife or dr if you would like to do this. It is not advised for women with cervical incompetence, preterm labour history, bleeding in pregnancy or placenta praevia to express antenatally.</b></p><p><b>Sources:</b></p><p><b>La leche International</b> <a href=\"https://www.llli.org/breastfeeding-info/colostrum-prenatal-antenatal-expression/\">https://www.llli.org/breastfeeding-info/colostrum-prenatal-antenatal-expression/</a></p><p><b>Association of breastfeeding mothers</b> <a href=\"https://abm.me.uk/wp-content/uploads/ABM-antenatal-expressing.pdf\">https://abm.me.uk/wp-content/uploads/ABM-antenatal-expressing.pdf</a></p><p><b>Australian Breastfeeding Association</b> <a href=\"https://www.breastfeeding.asn.au/bfinfo/antenatal-expression-colostrum\">https://www.breastfeeding.asn.au/bfinfo/antenatal-expression-colostrum</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Healthy Children] Vitamin D",
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"value": "<p><b>Healthy Children: Vitamin D</b></p><p>Vitamin D is a fat-soluble vitamin which is not found easily in foods, even when enjoying a healthy diet! Vitamin D helps absorb calcium and phosphate to keep us strong and prevent weak bones or rickets –this is where the bones soften and deform. This can cause a ‘bowing’ shape to the legs.</p><p>The best way of getting vitamin D is from sunlight. However it is difficult to say how much is enough because…</p><p>-Everyone is different</p><p>-Darker skin types find it more difficult to synthesize vitamin d from sunlight</p><p>-Depends on level of skin exposure and what a person is wearing/exposure of the skin to the sun</p><p>-Depends on time of the day</p><p>- Too much UV exposure can cause skin cancers and long exposure is not necessary for vitamin D production. This is because your skin can only make a certain amount at one time and there is no research to say how long it may take.</p><p>It is recommended that supplements are considered alongside a diet that includes as many foods high in vitamin D.</p><p>Foods rich in vitamin D are…</p><p>- Oily fish</p><p>- Cod liver oil</p><p>- Meat</p><p>- Eggs</p><p>- Fortified cereals and milks</p><p>Every country has varying advice due to their weather patterns and prevalence of vitamin d deficiency. WHO recommend that from birth to one year, exclusively breastfed babies or infants on less that 500mls of formula have 10mcg daily of vitamin D. Further supplementation is recommended in early childhood (first few years of life). Countries such as the UK, Australia and the U.S also recommend that all adults can benefit from daily supplementation.</p><p>Sources- WHO <a href=\"https://www.who.int/elena/titles/bbc/vitamind_infants/en/\">https://www.who.int/elena/titles/bbc/vitamind_infants/en/</a></p><p>National Cancer Institute US - <a href=\"https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/vitamin-d-fact-sheet\">https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/vitamin-d-fact-sheet</a></p><p>CDC- <a href=\"https://www.cdc.gov/cancer/skin/basic_info/outdoors.htm\">https://www.cdc.gov/cancer/skin/basic_info/outdoors.htm</a></p><p>Australian Ministry of Health <a href=\"https://www.nrv.gov.au/nutrients/vitamin-d\">https://www.nrv.gov.au/nutrients/vitamin-d</a></p><p>NHS -<a href=\"https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/\">https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>Development: Learning to roll.</b></p><p>Just as with the advice last week on sitting up, the strengthening of the head and neck muscles during tummy time is so helpful to develop the more advanced skills of rolling and sitting up.</p><p>Rolling usually begins before sitting after lots of tummy time. Around three months your baby may try a push-up type activity with their shoulders and chest raised off the ground- using their hands to push up. They may even rock up and down on their tummies.</p><p>At around four-six months babies will learn to roll from front to back and later from back to front. This will surprise you !</p><p><b>ACTIVITY</b> - Once your baby has rolled, try lying down on a side, just out of reach and see if your baby will roll over to you, or place a toy to one side to see if this encourages your baby.</p><p>This new rolling skill will strengthen muscles for sitting so consider lots of fun toys you can tactfully place within sight but out of reach to promote lots of rolling.</p><p>Please note: Some babies do not roll and they go straight to sitting and crawling, this is normal for some children.</p><p>Sources: Ages and Stages/ CDC</p><p>Resources: <a href=\"http://archive.brookespublishing.com/documents/asq-activities.pdf\">http://archive.brookespublishing.com/documents/asq-activities.pdf</a></p><p><a href=\"https://www.cdc.gov/ncbddd/actearly/milestones-app.html\">https://www.cdc.gov/ncbddd/actearly/milestones-app.html</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Mental Health] Baby Blues",
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"value": "<p><b>Mental Health: Baby Blues</b></p><p>Everyone always tells you how meeting and getting to know your baby is incredible. This is why it is very confusing for new mothers when they feel anxious, sad, sensitive and tearful.</p><p>These feelings for the first few days after birth are COMMON and NORMAL.</p><p><b>WHY?</b></p><p>Rapid <b>hormonal changes</b> occur after birth which can affect your emotional health</p><p>Labour is a tiring process and <b>lack of sleep</b> in the later stages of pregnancy, birth and then immediate postpartum period can trigger emotional imbalances. Sleep is a restorative and essential element to our health.</p><p>Having a baby takes a <b>huge adjustment</b>- it takes time, support and understanding.</p><p><b>What if it doesn’t go?</b></p><p>If you continue to feel low in mood then it may be a sign of postnatal depression. These symptoms are often more intense, last longer and require treatment. Speak to a healthcare professional and your support network.</p><p><b>What may help?</b></p><p>-It is difficult to sleep with a newborn but try to get naps throughout the day when your baby naps.</p><p>- Try and eat a well balanced diet, it will help with physical and emotional recovery</p><p>-Speak to family and friends and explain your feelings. You should also talk to a healthcare professional.</p><p>- Manage your pain (pain relief or other methods that are advised by healthcare) so that you are as comfortable as possible as this can impact mental health.</p><p>-Try to limit the amount of guests that want to meet your baby for the first few days. It can be tiring and overwhelming and you will need rest and time to establish feeding, caring for your baby and recovering from birth</p><p>- Shortly after birth your healthcare professional will assess your health and inform you if you can get out of the bed to mobilize. It is important to do so to reduce blood clots after birth and also for healthy bowel movements. It also helps with mental health.</p><p>- Set realistic expectations and don’t try to be ‘super-mum’. You are learning and you need to adapt to your new role and responsibilities- it is ok to find this hard.</p><p>Sources: NHS/CDC/WHO/PANDA/BEYOND BLUE</p><p>Resources:</p><p><a href=\"https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/becoming-a-parent-what-to-expect/getting-to-know-your-baby\">https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/becoming-a-parent-what-to-expect/getting-to-know-your-baby</a></p><p><a href=\"https://www.panda.org.au/\">https://www.panda.org.au/</a></p><p><a href=\"https://www.postpartum.net/\">https://www.postpartum.net/</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>Accident Prevention: Sun Safety</b></p><p>Living in ASIA certainly increases a child’s chances of sun exposure. Although the sun has positive benefits for children’s vitamin D, care needs to be taken to protect your child from harm.</p><p><i>The more sun exposure in childhood, the greater risk of cancer in adulthood!</i></p><p>-Babies and children have very thin and sensitive skin. For the first 6-12 months, keep babies out of direct sunlight (UV above 3).</p><p>-Babies will still enjoy the outdoors for stimulation and fresh air; however use a cover such as a pram hood or umbrella to shade your little one and use light clothing to protect the skin. Make sure to place your pram in the shade as using a hood in direct sunlight can increase the temperature within the pram. Regularly check on your child’s wellbeing.</p><p>- Widespread sunscreen isn’t recommended under 6 months as the advice is to keep babies of this age away from direct sunlight. However older babies and children should have sunscreen applied that is at least sun factor 30. Apply it approximately 30 minutes before sun exposure and top up after two hours.</p><p>-Perform a usage test on the forearm for a few days to test how the skin responds to a sunscreen. Consult a dermatologist if there is an allergic reaction.</p><p>-Children under 5 should take oral vitamin D so they do not need direct sunlight to obtain the recommended intake.</p><p>-Children should wear a hat and sunglasses in the sun.</p><p>-Exposing a baby to direct sunlight for jaundice is not recommended- it is neither effective nor safe.</p><p>Sources: NHS/CDC/SunSMART</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p>Infant Feeding: Hand Expressing Milk</p><p>There are many reasons why you may choose to express your breastmilk. Knowing how to do so is important to provide options and flexibility.</p><p>For <b>why,</b> please consult last weeks post titled ‘Antenatal expressing’.</p><p><b>How</b> to hand express…</p><p>- Get a sterile container to collect the milk in prior to collection</p><p>- Sit down somewhere comfortable where you will not be disturbed</p><p>- Enjoy a warm drink or some water to hydrate your body</p><p>- Massage your breasts and using a warm flannel prior to expressing is helpful to encourage milk flow</p><p>- Roll the nipples, stroke them to stimulate</p><p>- Make a ‘C’ shape with your hand, place the thumb on one side of the breast and the fingers on the opposite side, begin about 2-3 cm back from the nipple</p><p>- Gently compress and release in a rhythmic movement. Change and rotate the position of the hand if milk flow stops and complete on both breasts. You may need to go back a little further or forward with your position of the ‘C’ shape.</p><p>- Make sure to try express both breasts and try to do so 8-12 times in 24 hours when trying to stimulate milk production in the first few days.</p><p>Resources- <a href=\"https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/\">https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/</a></p><p><a href=\"https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/expressing-and-storing-breastmilk-bfn/\">https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/expressing-and-storing-breastmilk-bfn/</a></p><p>SOURCES- UNICEF</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Infant Feeding] Breastfeeding and COVID-19",
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"value": "<p></p><p>𝗜𝗻𝗳𝗮𝗻𝘁 𝗙𝗲𝗲𝗱𝗶𝗻𝗴: 𝗕𝗿𝗲𝗮𝘀𝘁𝗳𝗲𝗲𝗱𝗶𝗻𝗴 𝗮𝗻𝗱 𝗖𝗢𝗩𝗜𝗗-𝟭𝟵</p><p>𝐷𝑢𝑒 𝑡𝑜 𝑡ℎ𝑒 𝑐𝑢𝑟𝑟𝑒𝑛𝑡 𝐶𝑂𝑉𝐼𝐷-19 𝑜𝑢𝑡𝑏𝑟𝑒𝑎𝑘 𝑖𝑛 𝐻𝑎𝑛𝑜𝑖 𝑎𝑛𝑑 𝑎𝑟𝑜𝑢𝑛𝑑 𝑡ℎ𝑒 𝑤𝑜𝑟𝑙𝑑, 𝑎𝑛 𝑢𝑝𝑑𝑎𝑡𝑒 𝑑𝑟𝑎𝑤𝑛 𝑓𝑟𝑜𝑚: 𝑈𝑁𝐼𝐶𝐸𝐹, 𝐿𝑎 𝐿𝑒𝑐ℎ𝑒 𝐼𝑛𝑡𝑒𝑟𝑛𝑎𝑡𝑖𝑜𝑛𝑎𝑙 𝑎𝑛𝑑 𝑡ℎ𝑒 𝐶𝐷𝐶 𝑤𝑖𝑙𝑙 𝑠ℎ𝑎𝑟𝑒 𝑖𝑛𝑓𝑜𝑟𝑚𝑎𝑡𝑖𝑜𝑛 𝑎𝑏𝑜𝑢𝑡 𝑡ℎ𝑒 𝑠𝑎𝑓𝑒𝑡𝑦 𝑜𝑓 𝑏𝑟𝑒𝑎𝑠𝑡𝑓𝑒𝑒𝑑𝑖𝑛𝑔 𝑎𝑡 𝑡ℎ𝑖𝑠 𝑡𝑖𝑚𝑒.</p><p>‼Please note – always follow your medical providers advice. Limited evidence is available as COVID-19 is a new virus and a recent global outbreak🌍</p><p>⭐Current information available⭐<br/>1️⃣ A study published in the Lancet (2020) looked at nine samples of women positive with CO-VID 19. Amniotic fluid, cord blood, neonatal throat swabs and breastmilk all tested negative in the CO-VID 19 patients. (Chen et al,2020)<br/>2️⃣ Women infected during pregnancy or whilst breastfeeding are likely to produce antibodies for COVID-19. This will enhance and promote immunity for the newborn.<br/>3️⃣ It is likely that the newborn has already been exposed to air droplets from the mother prior to a diagnosis of COVID-19. Therefore discontinuing breastfeeding could increase the chance of the baby becoming unwell as they no longer have the protective factors from the breastmilk.<br/>4️⃣ Mothers who are infected should follow advice to reduce transmission by…<br/>Wearing a mask, washing hands before and after contact with the baby and cleaning/disinfecting surfaces<br/>5️⃣ If the mother is not feeling well enough, she can express breastmilk.</p><p>𝐶𝐷𝐶 𝑎𝑙𝑠𝑜 𝑠𝑡𝑎𝑡𝑒 𝑡ℎ𝑎𝑡 𝑖𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑐ℎ𝑜𝑖𝑐𝑒 𝑜𝑓 𝑡ℎ𝑒 𝑚𝑜𝑡ℎ𝑒𝑟 𝑎𝑛𝑑 𝑡ℎ𝑒 ℎ𝑒𝑎𝑙𝑡ℎ𝑐𝑎𝑟𝑒 𝑝𝑟𝑜𝑣𝑖𝑑𝑒𝑟 𝑜𝑛 𝑤ℎ𝑒𝑡ℎ𝑒𝑟 𝑡𝑜 𝑐𝑜𝑛𝑡𝑖𝑛𝑢𝑒 𝑜𝑟 𝑑𝑖𝑠𝑐𝑜𝑛𝑡𝑖𝑛𝑢𝑒 𝑏𝑟𝑒𝑎𝑠𝑡𝑓𝑒𝑒𝑑𝑖𝑛𝑔.</p><p>Sources- <a href=\"https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know?fbclid=IwAR21GAs_EuJeRTzVDl1Nqvyl4U8lOjykUt0_8cfFZLm9wAkl7zHGxX-bDOE\">https://www.unicef.org/…/novel-coronavirus-outbreak-what-pa…</a><br/><a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30360-3/fulltext?fbclid=IwAR3YiUKFUADQHuqC0V8E9SDvAMavhZisF4fTJ_7e_mVxaO7aEXSnaFXsZsg\">https://www.thelancet.com/…/PIIS0140-6736(20)30360…/fulltext</a><br/><a href=\"https://www.llli.org/coronavirus/?fbclid=IwAR1lAsAcEAmWA5Y7K8VaRckVqikBY3MnPpkzZD_mjw4GGoWCwY6PDERI7dc\">https://www.llli.org/coronavirus/</a><br/> <a href=\"https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fpregnancy-breastfeeding.html\">https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fpregnancy-breastfeeding.html</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Development] Learning to Walk",
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"value": "<p><b>[HIMBA] DEVELOPMENT: Learning to Walk</b></p><p>Every childs development varies but the World Health Organization state walking independently can occur from 8-18 months. Most children begin to walk either by cruising or with assistance by one year.</p><p><b>TOP TIPS</b></p><p>- Children have a range of gross motor skills they need to accomplish before walking independently. This gives them the overall strength, balance and posture. These include tummy time, rolling, crawling, bottom shuffling, cruising and pulling to stand. Some children skip one or two of these skills.</p><p>- Please note it is not advised to use walkers that children are placed into as they do not support independent walking. Pushing toys are advised to encourage assisted walking.</p><p>- Let your child have plenty of floor time, they will not learn to walk if strapped into strollers/prams/ being held by family members frequently</p><p>- Make sure they have bare feet so they don’t slip. Shoes are not required until walking properly.</p><p>- Keep doing lots of tummy time whilst encouraging walking skills as this will further support back muscles and postural stability</p><p>- Children will pull to stand first and will require soft furnishings to assist them on taking steps.</p><p>- Place toys out of reach so they consider ways to pull up and use furnishings to reach the toy</p><p>- Practice having toys to the left or to the right so they step both ways</p><p>- Once your baby is pulling to stand, hold both their hands and encourage small steps.</p><p>- Encourage independent small steps first, sitting down on the floor and reaching out for a cuddle may encourage them to try one or two steps.</p><p>- If your child has been practicing for some time, let them sit as they will be tired.</p><p>- Transfer of weight from one leg to another using both hands or one hand takes some time and blowing bubbles can encourage them to try and catch these bubbles and let go of the support.</p><p>- Ensure there is a safe space around them so they cannot injure themselves but small bumps and falls are to be expected when learning to walk. Pick them up, cuddle them and try not to cause too much attention to the event.</p><p><b>Red flags.</b></p><p>If a child is not walking by 15-18 months then schedule a review with a paediatrician / physiotherapist. If a child is not weight-bearing on both feet by one year it is also important they are reviewed. Weight bearing is when you are holding their hands and they are supporting their weight on their feet.</p><p>Sources: ASQ stages/CDC/WHO/ NHS</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Mental Health] Eating disorders during pregnancy",
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"value": "<p><b>Mental Health: Eating Disorders during pregnancy</b></p><p>An eating disorder can happen to anyone of any age. It affects people in all countries across the world. An eating disorder is defined as having an unhealthy relationship with food, weight or body image which can cause ill health.</p><p>Pregnancy is a time of great change; mentally, physically, socially, financially… the list goes on. If suffering with an eating disorder it can be even more challenging.</p><p>It is estimated that about 7% of women suffer from eating disorders during pregnancy.</p><p><b>Signs of an eating disorder (not exhaustive):</b></p><p>- You are very worried about your body shape and weight and spend a lot of time thinking about it</p><p>- You try to control your food intake and have strict rules around eating habits/times/types of food</p><p>- Your friends and family are concerned about your eating habits</p><p>- You are doing excessive exercise</p><p>- You are making yourself vomit after food</p><p><b>Key information for pregnancy:</b></p><p>1) Please tell your obstetric team so that mental health specialists can support you alongside your midwife and doctor.</p><p>2) If you are on medication to support your mental health please do not stop your medication until talking to a healthcare professional.</p><p>3) Try and achieve a healthy weight prior to conception and work with a nutritionist or your obstetric team to get the right nutrients for both you and your baby.</p><p><b>Having an eating disorder during pregnancy can affect:</b></p><p>- The growth of the baby</p><p>- Timing of delivery</p><p>- Complications during labour</p><p>- Pregnancy outcome (miscarriage)</p><p>- Postnatal mental health</p><p>- Social life and relationships</p><p>SOURCES: National Eating Disorders/TOMMYS/Eatingdisordersandpregnancy</p><p>Resources:</p><p><a href=\"http://www.eatingdisordersandpregnancy.co.uk/wp-content/uploads/2018/02/Weight-Change-in-Pregnancy.pdf\">http://www.eatingdisordersandpregnancy.co.uk/wp-content/uploads/2018/02/Weight-Change-in-Pregnancy.pdf</a></p><p><a href=\"http://www.eatingdisordersandpregnancy.co.uk/wp-content/uploads/2018/02/Nutrition-Needs-for-Mum-and-Baby_Month-by-Month.pdf\">http://www.eatingdisordersandpregnancy.co.uk/wp-content/uploads/2018/02/Nutrition-Needs-for-Mum-and-Baby_Month-by-Month.pdf</a></p><p><a href=\"https://www.nationaleatingdisorders.org/pregnancy-and-eating-disorders\">https://www.nationaleatingdisorders.org/pregnancy-and-eating-disorders</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Accident Prevention] Water safety in the home",
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"value": "<p><b>Accident Prevention: Water safety in the home.</b></p><p>Unfortunately it is very easy for children to drown in water at home and in the garden. Young children do not have the strength to get out of the water. Drowning is the second leading cause of ‘injury death’ in children under 14.</p><p>When children drown they do not scream and wave their arms in the air – this is a myth. The instinctive response of drowning means the child cannot speak or control their arms.</p><p>Please consider the following preventative actions to protect children.</p><p>Babies can drown in 5cm of water.</p><p>When you bath your baby, do not leave them unattended at all. Even if the door rings or you need to leave to get the shampoo, always lift your baby out of the bath and wrap in a towel.</p><p>Bath seats are supportive devices ONLY. They are not safety devices and a child should never be left in the seat without supervision.</p><p>If the baby is in the bath seat and the parent needs to turn around to get something, a young child should not be asked to watch the baby. They do not have a sense of danger and cannot act appropriately.</p><p>All children under the age of 8 need constant supervision around water.</p><p>Make sure the bath temperature is between 37.5-38.5</p><p>Don’t leave uncovered buckets of water around the house and make sure pools and baths are emptied after use.</p><p>Be careful around swimming pools and the beach when on holiday- supervise children at all times</p><p>Sources: Child Accident Prevention Trust/ IHV/ CDC</p><p><b>RESOURCES:</b></p><p><a href=\"https://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/index.html\">https://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/index.html</a></p><p><a href=\"https://www.capt.org.uk/drowning\">https://www.capt.org.uk/drowning</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"title": "[Healthy children] Milk Intake",
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"value": "<p></p><p>[𝗛𝗜𝗠𝗕𝗔] – 𝗛𝗲𝗮𝗹𝘁𝗵𝘆 𝗖𝗵𝗶𝗹𝗱𝗿𝗲𝗻: 𝗠𝗶𝗹𝗸 𝗶𝗻𝘁𝗮𝗸𝗲</p><p>Evidence shows us that older children who have large amounts of milk are more likely to have poor dietary habits as they have less appetite for food<br/><b>Health recommendations are:</b></p><p>All children to be exclusively breastfed until 6 months and continue breastfeeding alongside food until 2 years.</p><p><br/>From 6 months, cows milk in food can be introduced- such as yoghurts and pieces of cheese.</p><p><br/>From 1 year, all children should be enjoying about 400-600ml of whole pasteurized milk.</p><p><br/>From 2 years, children can now enjoy semi skimmed milk approx 300mls until four years old</p><p><br/>From 1-4 children also get calcium from other sources such as green leafy vegetables, beans, chickpeas, lentils, almonds, Figs, Seeds, Yogurt, Sardines, Cheese and Egg. 2-3 portions of calcium per day is recommended (small pot of yoghurt is one portion).</p><p>If your child is drinking less milk after one year it is ok. Try and encourage other calcium rich foods and put milk into foods like cheesy sauces/milky mash potato etc. Sometimes children do go off milk when they are having more foods- after one years it is important to keep calcium in the diet but this can be found in other sources other than milk if the total quantity of 400-600mls is not being met.</p><p></p><ul><li>Please note children under 1 should not have oat, almond, rice milks etc. All alternative milks do not have the correct nutritional requirements for children under 1. If giving alternative milk over 1 consider the energy differences and nutritional differences in these milks in opposed to dairy. Also make sure to buy fortified versions and unsweetened.</li><li>Rice milks are not suitable for under 5's due to concerns over levels of arsenic.</li></ul><p>Sources- First Steps Nutrition/ CDC/ WHO</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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"value": "<p><b>[HIMBA] Development: Speech development in the first year</b></p><p>Speech begins with exposure and understanding of language. When can babies begin to learn these skills? Babies can hear properly from 22 weeks gestation (whilst you are pregnant) and will be learning to listen to your voice.</p><p>From birth… your baby can now see and from 4-8weeks will begin to smile back at you, a form of communication. Your baby will cry first to communicate and from 2-4 months your baby may respond to changes in your tone… such as cry when you raise your voice or laugh when you say something funny</p><p>Cooing – when your baby begins to coo it develops control of muscles that are later used for speech. Respond to your baby and make similar sounds.</p><p>4-6 months – Your baby may try and imitate sounds and coos. They may enjoy blowing ‘raspberry’ kisses to feel the vibrations on their lips. Try doing this to your baby and see if they begin to respond to their name.</p><p>6-12 months – your baby may identify and understand a word in a context, like bye bye and waving their hand. They will have a small vocabulary of words they understand (they will not be able to say these yet). They will respond to their name.</p><p><b>By one year</b> your baby will combine sounds into longer sequences ‘dadadada’ ‘gagagagga’ ‘mamama’ Try repeating the sounds to your baby and vary your pitch and your volume. Try being face to face with your baby so that they can mimic your facial shapes, feel your lips move and the vibrations made with certain words.</p><p>Top tips – take your baby to new places, to meet new people and this will provide more exposure to language. Children are more likely to have better speech development when parents prioritise this. Talk to your baby and name objects that you play with to build on associations.</p><p></p><p>Resources:</p><p><a href=\"https://www.nhs.uk/conditions/pregnancy-and-baby/helping-your-childs-speech/\">https://www.nhs.uk/conditions/pregnancy-and-baby/helping-your-childs-speech/</a></p><p><a href=\"https://www.cdc.gov/ncbddd/childdevelopment/language-disorders.html\">https://www.cdc.gov/ncbddd/childdevelopment/language-disorders.html</a></p><p><a href=\"https://www.cdc.gov/ncbddd/actearly/milestones/index.html\">https://www.cdc.gov/ncbddd/actearly/milestones/index.html</a></p><p><a href=\"https://www.asha.org/public/speech/development/\">https://www.asha.org/public/speech/development/</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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{
"id": 1252,
"title": "[Mental Health] Going back to work",
"slug": "himba-mental-health-going-back-work",
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"post_date": "2020-05-08",
"category": {
"id": 7,
"name": "Mom & Baby",
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"name": "Mom & Baby",
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"value": "<p><b>[HIMBA] Mental Health: Going back to work</b></p><p>However long your maternity leave is, it is an emotional time when you have to go back to work and leave your baby with someone else. Feelings of sadness, anxiety and low confidence are common. Talk to your family and other mothers who will be going through the same experience.</p><p><b>Top tips to manage the transition:</b></p><p>1) Consider flexible working options if your employer will offer this. Coming in later or working shorter days in the first few weeks can really help manage competing priorities.</p><p>2) Consider ‘settling in days’ before you need to return. This can help you adjust to how your job may have changed, get to know any new processes or people and support any anxieties you may have</p><p>3) How about bring your baby into the office to meet your colleagues? They may have a better appreciation for your demands and understand why it may be a difficult time.</p><p>4) It is normal to return to work and feel less confident. Let your employer know if you need some more training and don’t expect to know what to do straight away.</p><p>5) If you are breastfeeding, begin to transition a few weeks prior to going back to work so you develop a routine that works for you. You may need to discuss with your employer about where you can express milk during the day and the routine that you have. Getting your baby to take from a cup or a bottle (depending on the age) should be achieved a few weeks before you go back to work so you can relax that your baby will be fed whilst you are away.</p><p>6) Consider making some meals and freezing them for your first few weeks to make the transition easier.</p><p>7) Leave your baby with adults you feel confident to care for your baby for short periods in the lead up to returning to work. This can help both of you prepare for the longer hours apart.</p><p>8) Share your routine with your family and those who will care for the child so they know what you expect. Leave them with a list of emergency contacts for the child if needed, such as doctor, workplace number, emergency numbers.</p><p>SOURCES: CDC/ NHS</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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{
"id": 1253,
"title": "[Accident Prevention] Safety with pets",
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"post_date": "2020-05-08",
"category": {
"id": 7,
"name": "Mom & Baby",
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"name": "Mom & Baby",
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"value": "<p><b>[HIMBA] Accident Prevention: Safety with pets</b></p><p>There are many benefits to having pets, however they are a different species to us and we need to be careful leaving children with them.</p><p><b>Reasons to be cautious:</b></p><p>Children treat pets like their friends- hugging, touching and telling off like their friends</p><p>Children often get close to animals which is different to their social behaviors with other animals</p><p>Children and animals can be unpredictable so this is why they can be bitten more than any other population group.</p><p>What can you do?</p><p>Never leave a child unsupervised with an animal</p><p>Ensure your animals are vaccinated, wormed and had flea treatment as per recommendations so they do not pass on any illnesses to your child</p><p>Make sure your animal is well cared for, exercised and well fed. Happy animals are often happier in their behavior.</p><p>Before you bring a baby into the home, play sounds associated with children in the background to prepare the animal</p><p>Bring the cot and pram into the room so that dogs and cats can familiarize themselves</p><p>Create a safe space that your pet has if they do not want to be around the baby/child</p><p>Do not let animals sit near the cot/pram area as this can cause cot death due to animals sitting on children whilst they are asleep.</p><p>Alert medical support if a child has been injured by an animal.</p><p>Always wash children’s hands after they touch, feed or care for the animal</p><p>Teach and watch your child to make sure they do not run and shout around your dog, invade their personal space, hurt or tease them, or disturb them when they are eating, guarding a toy, sick or in pain. Teach your child how to play nicely with your dog.</p><p>SOURCES: CDC/IHV</p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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{
"id": 1221,
"title": "[Newborn care] When is Jaundice not normal?",
"slug": "when-jaundice-not-normal",
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"post_date": "2020-05-05",
"category": {
"id": 7,
"name": "Mom & Baby",
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"id": 29,
"name": "Mom & Baby",
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991
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"value": "<p><b>'When is Jaundice not normal?’</b></p><p></p><p>Physiological jaundice is a condition where a newborns skin appears yellow because of a chemical called bilirubin- produced when your baby’s liver breaks down red blood cells.</p><p></p><p>Babies have an excess of blood cells when they are born so it can take some days for their new liver to function well and the bilirubin to be excreted properly.</p><p></p><p>Jaundice usually begins around day 3 and lasts until day 10 to 14. The incidence rate (how often) is 80-90% of newborn babies.</p><p></p><p><b>What can be done to treat Jaundice?</b></p><p></p><p><b>Feed, feed, feed</b>- every 2 hours. Hydration and calories helps clear the bilirubin by stimulating regular excretion- a great way to get rid of excess bilirubin.</p><p></p><p><b>Phototherapy:</b> this is a special light that the baby is placed under to help break down the bilirubin under the skin. This is required when bilirubin levels are above a specific ‘threshold’. It is important to treat high levels of bilirubin as if this chemical begins to circulate through the blood-brain barrier it can cause permanent brain damage.</p><p></p><p>In the majority of cases, with plenty of nutrition, warmth and some time, jaundice will go with no further complications.</p><p></p><p><b>When Jaundice needs urgent professional review:</b></p><p>-If your baby has jaundice in the first 24 hours</p><p>-If your baby is jaundice and is reluctant to feed- preferring to sleep rather than feed</p><p>-If your baby has yellow urine (urine should always be clear)</p><p>-If your baby has a pale coloured stool (stools should never be pale after day 4 should be yellow)</p><p>-If your baby still has jaundice after day 14 or if jaundice is worsening day by day rather than clearing.</p><p></p><p><b>Resources:</b></p><p>Download the yellow alert app:</p><p><a href=\"https://childliverdisease.org/yellow-alert/\">https://childliverdisease.org/yellow-alert/#</a></p><p></p><p><a href=\"https://www.cdc.gov/ncbddd/jaundice/index.html\">https://www.cdc.gov/ncbddd/jaundice/index.html</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
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{
"id": 1220,
"title": "[Safeguarding Children] Appropriate behavioural management",
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"post_date": "2020-04-29",
"category": {
"id": 7,
"name": "Mom & Baby",
"slug": "MomandBaby"
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"subcategory": {
"id": 29,
"name": "Mom & Baby",
"slug": "MomandBaby"
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"summary": "",
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"locations": [
990,
989
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{
"type": "text",
"value": "<p>'My child is naughty' Have you heard this before? Information about how to manage child behaviour can help you understand that their behaviour can in fact, be normal, or a response to their environment.</p><p>Children learn from observing and copying behaviours. This is why punishments such as smacking or raising your voice at your child will result in children thinking this behavior is ok and copying - making your parenting journey harder rather than easier. This also affects childrens emotional development and relationships.</p><p>Set good examples and be a role model for your child:</p><p>- Create boundaries and rules: Children need structure that is consistent and simple. It is normal for children to test the boundaries- it is part of their development and makes them feel safe.</p><p>- Communication: listen to your child and understand their needs. Talk to them about what behavior your expect when they are calm, including the rewards and consequences of their behaviour. If they are frustrated or angry ask them why, showing sympathy and love.</p><p>-Positive parenting: praise your child for the good behaviours- show plenty of attention for these. They are more likely to do these acts again if they gained a lot of your attention.</p><p>-Parent Expectations and your Child's developmental stage: Toddlers struggle to control their emotions and with every age there are limitations to what children can understand and manage. For example some young children need to learn to control the volume and pitch of their voice- so when you think they are shouting it may not be on purpose. Understanding what is normal will help you as parents to know they are not purposefully 'naughty' but need to be better understood and softly guided to learn further skills.</p><p>-Child health and development: certain behaviours, such as biting, may be due to the oral stage of development which means babies explore through their mouth. Distracting with a calm activity and clearly telling them, when they are calm, that 'biting hurts please dont do that' is good management. Furthermore, some children may have a medical condition or a speech/ hearing difficulty which is causing frustration and issues with understanding your directions. Consider this and see a professional to address this.</p><p>-Consequences: ignoring, distraction, delay of priviledge and time out are all techniques that can be applied to different situations. For e.g if a bad behaviour is shown- distract with a positive act or ignore it if safe to do so. If no attention (negative or positive) is recieved children are less likely to do it again. Time out always needs to be in a safe, boring space. Time is usually directly matching age, i.e 2 minutes for two year old, 3mins for 3 year old. This gives your child time to regulate their behaviour... and you!</p><p>- Give clear directions: 'stop it' 'dont do that' these short phrases do not clearly explain why and children may get frustrated by frequent commands. 'please can you hold my hand crossing the road so we can get across safely' gives your child more context. Children need to understand why and also try getting them involved in decision making i.e 'please get yourself dressed, would you like to wear your blue or red jumper?' Small choices gives them empowerment and independence and they are less likely to resist your instruction.</p><p><b>Follow a step-by-step process each time you see negative behaviour, such as:</b></p><ul><li><i>Identify the behaviour</i></li><li><i>Give warning to your child</i></li><li><i>Give consequence</i></li><li><i>Tell them why</i></li><li><i>Go back to positive communication and move on.</i></li></ul><p>Last of all... get support from friends and family. Read well evidenced books and resources and look after your own emotional health as this directly relates to your child(rens) behaviour and emotions too.</p><p>Resources:</p><p><a href=\"https://www.cdc.gov/parents/essentials/index.html\">https://www.cdc.gov/parents/essentials/index.html</a></p><p><a href=\"https://ihv.org.uk/wp-content/uploads/2015/10/27-PT_Difficult-Behaviour_V4.pdf\">https://ihv.org.uk/wp-content/uploads/2015/10/27-PT_Difficult-Behaviour_V4.pdf</a></p><p><a href=\"https://learning.nspcc.org.uk/research-resources/leaflets/positive-parenting\">https://learning.nspcc.org.uk/research-resources/leaflets/positive-parenting</a></p><p><a href=\"https://www.zerotothree.org/resources/2198-nine-elements-that-power-positive-parenting\">https://www.zerotothree.org/resources/2198-nine-elements-that-power-positive-parenting</a></p><p><a href=\"https://raisingchildren.net.au/toddlers/behaviour/behaviour-management-tips-tools\">https://raisingchildren.net.au/toddlers/behaviour/behaviour-management-tips-tools</a></p><p>Author: Abigail Laurie Registered Midwife and Registered Specialist Public Health Nurse, United Kingdom.</p>"
}
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{
"id": 1200,
"title": "Color Me Run 2019",
"slug": "color-me-run-2019",
"slug_en": "color-me-run-2019",
"slug_vi": "color-me-run-2019",
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"overview_image": {
"id": 414,
"url": "https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_9.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/Color_Me_Run_2018_9.format-jpeg.jpegquality-75.jpg"
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"post_date": "2020-04-22",
"category": {
"id": 2,
"name": "Events",
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"subcategory": {
"id": 6,
"name": "Medical Stations",
"slug": "medical-stations"
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"tags": "",
"summary": "Family Medical Practice is the official medical sponsor at Color Me Run 2019.",
"related_pages_title": null,
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"locations": [
950
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"content": [
{
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"value": "<p></p><p>Family Medical Practice is the official medical sponsor at Color Me Run 2019.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_me_run_2019_5.JPG\" class=\"format-fullwidth\" /><p></p><p>Emergency ambulance service *9999 were available at all times during CMR 2019 to provide peace of mind for all Color Me Run participants. Doctors, nurses, and volunteers were strategically positioned around the event site and the route of the journey.</p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_me_run_2019_4.JPG\" class=\"format-fullwidth\" /><p></p><p></p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_me_run_2019_3.JPG\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_me_run_2019_2.JPG\" class=\"format-fullwidth\" /><p></p><p>Family Medical Practice is the first foreign-owned primary health care provider in Vietnam, at the forefront of international medicine here since 1995. With experienced and professionally trained doctors and medical staff from around the world, Family Medical Practice offers an extensive range of specialty care and treatments for its patients.</p>"
}
],
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{
"id": 1199,
"title": "HCMC Run 2017",
"slug": "ho-chi-minh-city-run-2017",
"slug_en": "ho-chi-minh-city-run-2017",
"slug_vi": "ho-chi-minh-city-run-2017",
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"overview_image": {
"id": 978,
"url": "https://media.fmp-data.bliss.build/original_images/HCMC_Run_8.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/HCMC_Run_8.format-jpeg.jpegquality-75.jpg"
},
"post_date": "2020-04-21",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
},
"subcategory": {
"id": 6,
"name": "Medical Stations",
"slug": "medical-stations"
},
"tags": "",
"summary": "Family Medical Practice provided *9999 medical stations manned by top professional staff, we urged all participants to pay close attention to their own health and safety.",
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948
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"content": [
{
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"value": "<p></p><p>RUNNING—the ultimate in wellbeing, virility, strength, disease prevention and stress relief. Inspiring everybody with the athletic spirit and encouraging healthier lifestyles, the exhilarating HCMC Run 2017 was the first full 42km marathon held here in 25 years. As a medical partner, Family Medical Practice pledged to protect the safety of the 6,500 people taking part, ranging from kids as young as six through to adult professional runners—including members of our own medical team.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/HCMC_Run_7.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/HCMC_Run_4.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/HCMC_Run_5.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/HCMC_Run_2.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/HCMC_Run_3.jpg\" class=\"format-fullwidth\" /><p></p><p>Providing *9999 medical stations manned by top professional staff, we urged all participants to pay close attention to their own health and safety. We encouraged everyone attending (non-runners included) to add *9999 as a phone contact to ensure immediate medical assistance in case of emergency—just like 911 in the U.S.</p>"
}
],
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},
{
"id": 1198,
"title": "Champion Dash 2017",
"slug": "champion-dash-2017",
"slug_en": "champion-dash-2017",
"slug_vi": "champion-dash-2017",
"slug_ko": null,
"slug_ja": null,
"overview_image": {
"id": 967,
"url": "https://media.fmp-data.bliss.build/original_images/Champion_Dash_2017_6.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/Champion_Dash_2017_6.format-jpeg.jpegquality-75.jpg"
},
"post_date": "2020-04-18",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
},
"subcategory": {
"id": 6,
"name": "Medical Stations",
"slug": "medical-stations"
},
"tags": "",
"summary": "Family Medical Practice and *9999 Emergency Medical Response were out in force at the third annual Red Bull Champion Dash in Ho Chi Minh City’s District 7 on Saturday.",
"related_pages_title": null,
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"locations": [
949
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{
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"value": "<p></p><p>Family Medical Practice and *9999 Emergency Medical Response were out in force at the third annual Red Bull Champion Dash in Ho Chi Minh City’s District 7 on Saturday.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Champion_Dash_2017_9.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Champion_Dash_2017_7.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Champion_Dash_2017_4.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Champion_Dash_2017_2.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Champion_Dash_2017_5.jpg\" class=\"format-fullwidth\" /><p></p><p>With three ambulance units on hand, three medical tents in operation, and fully-fledged emergency medical team, competitors were in safe hands as they navigated the 21-obstacle, 7-km track in Phu My Hung. The event attracted over 4,000 people this year including professional athletes, adrenaline seekers wanting to test their limits, and young Future Champions on a separate obstacle course. Our medical stations were busy throughout the race. Out of 4000 attendees on race day, FMP’s EMR *9999 program successfully cared for the medical needs of 150 participants that requested care.</p><p>Champion Dash General Director Russel Johnson – himself a former Canadian firefighter and first responder – was effusive in his praise for the work that the *9999 team were able to offer.</p>"
}
],
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},
{
"id": 569,
"title": "19th BBGV Charity Fun Run",
"slug": "19th-bbgv-charity-fun-run",
"slug_en": "19th-bbgv-charity-fun-run",
"slug_vi": "19th-bbgv-charity-fun-run",
"slug_ko": "19th-bbgv-charity-fun-run",
"slug_ja": "19th-bbgv-charity-fun-run",
"overview_image": {
"id": 212,
"url": "https://media.fmp-data.bliss.build/original_images/BBGV_Run_2019.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/BBGV_Run_2019.format-jpeg.jpegquality-75.jpg"
},
"post_date": "2020-04-17",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
},
"subcategory": {
"id": 6,
"name": "Medical Stations",
"slug": "medical-stations"
},
"tags": "",
"summary": "On Sunday September 29, Family Medical Practice supported the 19th annual British Business Group Vietnam (BBGV) Charity Fun Run in HCMC as a Silver Category sponsor. ∗9999 medical emergency stations and medical team members were on standby for the safety of event participants. \r\nApproximately 110,000 runners have participated in the event over the years it has been held as a great outdoor and team-building day out for corporate members, families, and friends. \r\nAccording to Mr. Le Dang Khoa—one of the notable investors from Shark Tank Vietnam and owner of nearly 20 homegrown brands such as The Bamboo Resort, 38 Degrees Flower Market & Tea House, Cooper & Co. Bespoke and the Danang Dragons Basketball team—serving and sharing with the community is the responsibility of every business, and joining meaningful events such as the BBGV Charity Fun Run is an ideal way for businesses across the country to participate in community and social projects.",
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"value": "<p>On Sunday September 29, Family Medical Practice supported the 19th annual British Business Group Vietnam (BBGV) Charity Fun Run in HCMC as a Silver Category sponsor. ∗9999 medical emergency stations and medical team members were on standby for the safety of event participants.</p><img src=\"https://media.fmp-data.bliss.build/original_images/BBGV_Run_2019_2.jpg\" class=\"format-left\" /><p>Approximately 110,000 runners have participated in the event over the years it has been held as a great outdoor and team-building day out for corporate members, families, and friends.</p><p>According to Mr. Le Dang Khoa—one of the notable investors from Shark Tank Vietnam and owner of nearly 20 homegrown brands such as The Bamboo Resort, 38 Degrees Flower Market & Tea House, Cooper & Co. Bespoke and the Danang Dragons Basketball team—serving and sharing with the community is the responsibility of every business, and joining meaningful events such as the BBGV Charity Fun Run is an ideal way for businesses across the country to participate in community and social projects.</p>"
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