Frequently Asked Questions

Please note that the answers here are in keeping with general medical guidelines and does not replace or constitute a consultation with a medical examination by a doctor. Kindly contact Dr Lutchman to make an appointment for a comprehensive consultation.

1How to manage Fever in children:
FEVER management in children

It is important to understand that fever is not an illness – it is the body’s normal response to a possible underlying infection. The treatment of the fever is mainly to relieve the discomfort caused by it. The underlying cause needs to be sort after and managed appropriately. This is especially important in infants younger than 3 months.

Normal body temperature is between 36.5 and 37.5 degrees Celsius. Anything above 37.5 is a Fever.
37.5 – 38 is a low grade fever. > 38 is a proper fever.

With a low grade fever one can cool down the room and take off excess clothes from the child and wipe the child down with a cool cloth.

If the fever is above 38 medication is usually needed.

When treating a fever the most common drugs used are paracetamol and ibuprofen. Aspirin is NOT indicated in children as it has the potential to cause a serious condition affecting the liver called Reye syndrome.

Paracetamol is often the first choice due to its long track record of safety. Paracetamol should be avoided in children with underlying liver problems.

Ibuprofen is a good alternative especially if an anti inflammatory effect is also needed. Ibuprofen, when given chronically or at incorrect dosing, can cause kidney injury, gastritis or a bleeding dysfunction. It should be avoided in children that are dehydrated or are not feeding well.

The dose for both medications is WEIGHT based and one should always check that the dose is correct with EVERY administration. Age should only be used if the weight is not known. If combining or alternating the drugs the dosing instructions and intervals must be thoroughly explained by a doctor. Be sure to always check the active ingredient in the medication BEFORE administration, especially over the counter medication, as paracetamol and ibuprofen often have different trade names and are included in many cough and cold remedies and overdosing should be avoided. Combination Drugs must also be avoided as over the counter medication and only used if prescribed by a doctor.

If the fever persists it is important to seek medical attention.

2How can you tell if a baby is constipated? My 12-week-old passes a stool every three days, on average. Is this okay?

It is important to distinguish between frequency (number) of stools and consistency (hard vs soft) of the stools. A baby who has a soft stool every 3 days and does not find it difficult or painful to pass the stool, is not constipated.

A breastfed baby can have bowel movements that can range from 3 soft stools per day to once a week. A breastfed baby is rarely constipated. Formula fed babies tend to have more formed stools – the consistency of which depends on the type of formula used. A baby on a cows milk based formula or soy formula tends to have harder stools than on a baby on a partially/ or completely hydrolyzed (hypoallergenic) formula.

A baby that is constipated will have hard, pellet- like (consistency) stools. The baby may be very uncomfortable or cry when passing a stool. Some arch their back and may go red in the face. If your baby usually passes a stool every day and is now passing a stool every 3 days, she may be constipated.

The main cause for constipation in infancy would be diet/milk related. About 5% of patients with constipation may have a medical problem and a doctor/pediatrician should always see a child with chronic constipation.

3My child is 9 months and suffers from severe eczema. I have tried several products but nothing seems to work. What are some of the alternative treatments for eczema?

Eczema is a common skin condition seen in many children. There are different types of eczema – atopic and seborrheic eczema being the most common seen in children.

Atopic eczema is a complex disorder with an allergy background but with multiple factors (environmental, genetic etc.) playing a role. The main treatment guidelines include topical moisturizers and topical corticosteroids. More resistant forms need to be reviewed by a pediatrician or dermatologist and more intensive therapy may be prescribed. Education, compliance and correct application of the medication are vitally important for managing the disease. Superimposed infections need to be promptly treated. Allergy testing (skin patch tests/ blood tests) and avoidance of the allergen is also important in the management of atopic eczema.

When there is failure to respond to conventional therapy prescribed by a medical doctor, the diagnosis must be reviewed – other conditions that can present like eczema need to be excluded like other primary skin conditions e. g psoriasis, primary skin infections e. g bacterial, fungal and rare immunodeficiency states and metabolic conditions.

Patients with uncontrolled eczema often try alternative therapies. It is important to understand that there is no evidence for the efficacy for most of these therapies and most data comes from uncontrolled case reports rather than standardized, well controlled trials. Alternative therapies (e. g homeopathies, herbal remedies, aromatherapy, massage therapy) may help with symptom relief but they do not cure or control the condition. No products are currently licensed and one must be aware of possibly aggravation of the eczema or systemic toxicity from the herbs in young infants and children.

4My baby has Gastroenetritis. What is this and how do I manage it?
Gastroenteritis – Dr RR Lutchman

Gastroenteritis is inflammation of the gastrointestinal tract that involves mainly the stomach and small intestine and is most commonly caused by an infectious organism.

There are over 3-5 billion cases a year and it is one of the leading causes of death in third world countries. CHILDREN ARE MOST AFFECTED, with those less than 5 years old at the highest risk.

The signs and symptoms of Gastroenteritis include:

  • Diarrhea and/or vomiting
  • Abdominal cramping
  • Fever
  • Bloody stools
    • Lethargy
    • Sunken eyes
    • Sunken fontanel
    • Dry mouth
    • Lack of tears
    • Delayed capillary refill
    • Poor urine output/ less wet nappies

The most common cause for Gastroenteritis in children is ROTA VIRUS.

Other causes include:

  • Viruses e.g Adenovirus
  • Bacteria e.g Samonella, E.coli,
  • Parasites e.g Giadia,
  • Non-infectious causes e.g antibiotics or food intolerance (glucose/lactose)

Rota virus:

  • Double stranded RNA virus
  • Nearly every child in the world has been infected at least once before the age of 5
  • There are 8 species (A,B,C,D,E,F,G) – A is the most common
  • Transmission mainly by poor hand hygiene and in crowded areas (homes/crèche)
  • Causes nausea/ vomiting/ watery diarrhea and low grade fever
  • Starts with vomiting followed by 4 – 8 days of profuse diarrhea
  • DEHYDRATION - most common cause of death by Rota virus
  • Diagnosis is clinical or with a stool sample.
  • Treatment is focused mainly on HYDRATION (oral or intravenous)
  • PREVENTION with vaccine given at 6 weeks and 14 weeks.
5My three-week-old baby has white pimples on her face. They don't look sore, but I'm worried. What can I do to make them go away?

The majority of rashes in the newborn period are innocent or benign rashes. The most common of these conditions include neonatal acne, erythema toxicum and milia, to name a few. These conditions are not harmful, they require no specific treatment and they resolve on their own. Good skin care includes a gentle soap and baby moisturizer and no harsh detergents. A plain aqueous cream or emollient works well to keep the skin well hydrated.

There are however a few less common conditions that require a prompt diagnosis and require appropriate treatment (e.g seborrheic dermatitis/ secondary superficial infections/ congenital infections etc.) Have your doctor review her skin to put your mind at ease.

6I’m starting to wean my 6 month old onto solids, but I’m unsure about how much breast milk to continue to give him. Please advise

The World Health Organization recommends exclusive breastfeeding until 6 months and then the introduction of appropriate complementary solid foods.

At first (between 6-8 months) breastfeeding still remains the backbone of the nutritional source for the baby with the solids being “snacks” in between. At this stage baby should still receive about 5-6 milk feeds for the day with about 2-3 solid feeds in between, most commonly for breakfast and supper.

This slowly changes (by 10-12 months) once solids are properly introduced to baby having at least 3 full solid meals (breakfast, lunch and supper) and breastfeeding becoming the snack! At this stage baby should have only about 3 milk feeds for the day e.g. one in the morning, one after lunch and one at bedtime.

A good meal plan is essential for a happy content baby.

7My 3 year old son’s feet are turned inward. Should I be worried?

There are a number of reasons why his feet could be turned inwards. This can range from something simple like a ‘variation of normal’ to something more complicated affecting the bones of the lower legs (e g. femoral anteversion or tibial torsion).

Some of these conditions correct on their own (self correcting) as the child grows up but some need medical intervention (earlier rather than later). It is best to have your child evaluated by his paediatrician or an orthopedic (bone) specialist.