Understanding Reflux in Babies

Here’s the tricky part: reflux looks like what it is, spit-up and crying. But so do hunger, allergies, and a dozen other things. Gastroesophageal reflux (GER) is common and usually harmless. Gastroesophageal reflux disease (GERD) is more serious, causing real pain and feeding problems.

The challenge? Both present the same way, which means diagnosis matters before treatment.

What to Try First

Change feeding patterns
Many babies improve with smaller, more frequent feeds. Instead of one 120ml bottle every three hours, offer 80ml every two hours. Less volume in the stomach means less comes back up.

If breastfeeding
Thickeners exist for expressed milk, but they’re messy, and the mixture can turn gelatinous or your baby may refuse it. Instead, investigate whether your baby reacts to cow’s milk protein in your diet. Many reflux babies improve when mothers eliminate dairy. Give it four weeks to work.

Thicken the feeds
This works surprisingly well. Adding starch thickens the formula and reduces regurgitation. For formula-fed babies, switch to a thickened anti-reflux (AR) formula. The starch binds the milk, keeping more of it down.

Consider formula options
If cow’s milk seems problematic, try an extensively hydrolysed formula (proteins broken down into tiny units). If that fails, an amino acid-based formula removes the allergen entirely.

These approaches work for many families. I’ve seen parents skip medication completely once they make these changes.

When PPIs Enter the Picture

Proton pump inhibitors reduce stomach acid by blocking the enzyme that produces it. They work, but they’re not first-line treatment.

If simple measures fail and your child has confirmed GERD (not just reflux), PPIs may help. Here’s what matters:

Dosing principles

• Use the lowest effective dose
• Treat for the shortest possible time
• Only start with confirmed GERD, not suspected reflux

The stopping problem
Never stop PPIs abruptly. Your baby’s stomach will overproduce acid (rebound hyperacidity), bringing symptoms roaring back. Taper slowly under your doctor’s guidance.

Side effect concerns
PPIs should only be used if there is a clear diagnosis of GERD and all of the above-mentioned conservative treatments have failed. PPI’s strip away a baby’s stomach acid, which is helpful if the baby has GERD. On the flip side, this can increase the risk of infections, allergies and weaken bones. 

The Real Question

Should your baby take medication? Maybe. But not before you’ve tried the basics. My own son suffered from reflux. At the time it was a poorly understood condition. Today, reflux is better understood, and so are the non-pharmaceutical options.

The goal is identifying true GERD, treating conservatively first, and using PPIs only when nothing else works.

Your baby’s reflux needs proper assessment. Book a consultation at my Johannesburg practice. I’ll help you distinguish between normal spit-up and true reflux, and we’ll develop a treatment plan that doesn’t jump straight to medication.

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What Is Thalassaemia?

Thalassaemia is passed directly from parent to child through genes. Your body makes haemoglobin from alpha and beta chains. Alpha chains have four genes (two from each parent), and beta chains have two genes (one from each parent). If either parent is missing genes, which they might not even know, they become carriers.

You can carry thalassaemia genes without symptoms. You might feel slightly tired or be mildly anaemic. But if both parents carry the gene, their child can inherit a more serious form.

Who’s at Risk?

Thalassaemia is more common in families with heritage from malaria-endemic regions. These include:

• Mediterranean countries (Italy, Greece, Cyprus)
• Southeast Asia (Thailand, Vietnam, Cambodia, Malaysia)
• Middle East (Saudi Arabia, Iran, Iraq, Lebanon)
• Africa and Northern/Western India

This genetic protection evolved because thalassaemia carriers were more resistant to malaria. The irony is that while it protected populations, it created a new challenge: babies born with moderate to severe thalassaemia.

How Thalassaemia Presents in Babies

If your baby shows these signs, consider asking your doctor about thalassaemia:

• Pale skin, lips, and inside eyelids from anaemia
• Recurrent infections when the immune system is weakened
• Enlarged spleen (palpable on examination)
• Poor feeding or slow weight gain
• Fatigue and low activity levels

Babies often appear generally unwell without an obvious cause. Parents describe them as “not thriving” or “always catching something.”

Getting a Diagnosis

If I suspect thalassaemia, I order three key tests:

Full Blood Count (FBC): Shows whether your baby has too many or too few red blood cells

Iron Studies: Distinguishes thalassaemia from simple iron deficiency anaemia

Haemoglobin Electrophoresis: Identifies different types of haemoglobin and reveals imbalances in chains

These tests give a complete picture. Skipping diagnosis means missing treatment that could prevent serious complications like bone weakness, growth problems, or delayed puberty.

Treatment Depends on Severity

Mild thalassaemia: Often needs no treatment beyond monitoring

Moderate to severe thalassaemia: Requires:

• Regular blood transfusions (frequency depends on severity)
• Chelation therapy (removes excess iron from the body)
• Folic acid supplementation (helps produce healthy red cells)

A child receiving proper treatment can live a relatively normal life. The key is early detection and consistent management.

Next Steps

If your baby shows signs of this blood disorder, don’t delay investigation. Thalassaemia responds well to treatment when caught early, but untreated cases lead to serious complications.

Worried your baby might have thalassaemia? Book a consultation at my Johannesburg practice. I’ll assess your family history, run appropriate tests, and guide you through next steps with clear explanations and realistic expectations.

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Understanding Reflux in Babies

Here’s the tricky part: reflux looks like what it is, spit-up and crying. But so do hunger, allergies, and a dozen other things. Gastroesophageal reflux (GER) is common and usually harmless. Gastroesophageal reflux disease (GERD) is more serious, causing real pain and feeding problems.

The challenge? Both present in the same way, which means diagnosis matters before treatment.

What to Try First

Change feeding patterns
Many babies improve with smaller, more frequent feeds. Instead of one 120ml bottle every three hours, offer 80ml every two hours. Less volume in the stomach means less comes back up.

If breastfeeding
Thickeners exist for expressed milk, but they’re messy, and the mixture can turn gelatinous or your baby may refuse it. Instead, investigate whether your baby reacts to cow’s milk protein in your diet. Many reflux babies improve when mothers eliminate dairy. Give it four weeks to work.

Thicken the feeds
This works surprisingly well. Adding starch thickens the formula and reduces regurgitation. For formula-fed babies, switch to thickened formulas like Novalac AR or NAN AR. The starch binds the milk, keeping more of it down.

Consider formula options
If cow’s milk seems problematic, try an extensively hydrolysed formula (proteins broken down into tiny units). If that fails, an amino acid-based formula removes the allergen entirely.

These approaches work for many families. I’ve seen parents skip medication completely once they make these changes.

When PPIs Enter the Picture

Proton pump inhibitors reduce stomach acid by blocking the enzyme that produces it. Nexium and Prilosec are common brands. They work, but they’re not first-line treatment.

If simple measures fail and your child has confirmed GERD (not just reflux), PPIs may help. Here’s what matters:

Dosing principles

• Use the lowest effective dose
• Treat for the shortest possible time
• Only start with confirmed GERD, not suspected reflux

The stopping problem
Never stop PPIs abruptly. Your baby’s stomach will overproduce acid (rebound hyperacidity), bringing symptoms roaring back. Taper slowly under your doctor’s guidance.

Side effect concerns
PPIs are generally safe in children. However, adult studies show risks of vitamin B12 deficiency, low magnesium, and bone fractures. Whether these apply to babies remains unclear; we need more research. Some evidence suggests increased infection risk, but it’s not conclusive.

The Real Question

Should your baby take medication? Maybe. But not before you’ve tried the basics. I treated my own son’s reflux many years ago when he was a baby, and people thought I was mad to suggest medication. Today, reflux is better understood, and so are the non-pharmaceutical options.

The goal is identifying true GERD, treating conservatively first, and using PPIs only when nothing else works.

Your baby’s reflux needs proper assessment. Book a consultation at my Johannesburg practice. I’ll help you distinguish between normal spit-up and true reflux, and we’ll develop a treatment plan that doesn’t jump straight to medication.

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What Is Meningococcal Meningitis?

Meningitis happens when an infection causes swelling of the meninges, the protective layers surrounding your brain and spinal cord. While many organisms can cause meningitis, the meningococcal bacteria (Neisseria meningitidis) is particularly deadly.

These bacteria live harmlessly in many people’s throats and noses. But when they invade the bloodstream or cerebrospinal fluid, they move fast. We’re talking hours, not days. The infection spreads easily in close living quarters: boarding schools, university residences, camps, and creches.

Who’s most at risk?

• Infants between 6 months and 3 years
• Teenagers and young adults
• Anyone in close living quarters (dormitories, camps)

Meningococcal Meningitis Symptoms: What to Watch For

The speed of this illness is what makes it so dangerous. A healthy child can deteriorate within hours.

Early warning signs:

• High fever that appears suddenly
• Severe headache
• Stiff neck
• Nausea and vomiting
• Confusion or difficulty concentrating
• Extreme sensitivity to light

Critical symptoms requiring immediate medical attention:

• Petechial rash (brown or purple pinpricks on the skin that don’t fade when pressed)
• Drowsiness or difficulty waking
• Seizures
• In infants: bulging fontanel (soft spot), constant high-pitched crying, body stiffness

That rash I mentioned? It’s caused by broken blood vessels. In severe cases, it leads to tissue death and amputations. This is why every hour counts.

Why Isn’t This Vaccine on the Government Schedule?

Many parents ask me this. The meningococcal immunisation isn’t part of South Africa’s free EPI schedule as yet, which means you’ll need to get it privately. But consider the numbers from the USA: before the vaccine, they saw 15,000 cases annually. In post-vaccination programs, the USA reported 422 cases in 2023 and 503 in 2024.

As Dr Maraschin, I’ve walked the meningitis path with families. The children who survived without permanent damage are the minority. Most face lifelong challenges, learning difficulties, hearing loss, or physical disabilities. When prevention exists, why take the risk?

When Should Your Child Get the Meningococcal Vaccines?

Recommended schedule for Men B vaccine:

• First dose: 10 weeks
• Booster: 18 weeks
• Catch-up schedules available for older children and adults

Recommended schedule for MEN A, C, W, Y:

• First dose: 9 months
• Booster dose: 15 months
• Catch-up schedule for older children and adults

Other Vaccines That Protect Against Meningitis

The meningococcal vaccine is important, but other routine vaccinations also prevent meningitis:

Pneumococcal vaccine (given at 6 weeks, 14 weeks, 9 months): Prevents pneumococcal meningitis, which primarily affects infants and young children.

Haemophilus influenzae vaccine (part of the 6-in-1): This bacterium once caused 80% of childhood meningitis cases. The vaccine has virtually eliminated it.

MMR and chickenpox vaccines: These prevent viral meningitis complications, less deadly than bacterial, but still serious.

Keeping your child’s vaccination schedule current provides layers of protection against multiple meningitis-causing organisms.

Beyond Vaccination: Daily Protection

Since meningococcal bacteria spread through respiratory droplets and saliva, teach your children:

• Don’t share drinks, food, or eating utensils
• Wash your hands thoroughly before eating and after using the bathroom
• Cough and sneeze into elbows, not hands
• Stay home when sick

These same practices we emphasised during COVID-19 apply here too.

The Bottom Line

I’ve treated children with meningitis. The devastating reality is that many don’t recover fully, despite our best medical interventions. Their parents face a lifetime of caring for a child with disabilities that could have been prevented.

The meningococcal vaccines aren’t perfect, no vaccine is, but it dramatically reduces risk. When you’re looking at an untreated mortality rate greater than 50% for an infection that strikes within hours, prevention makes sense.

Book your child’s meningococcal vaccine at our Johannesburg practice. As a paediatrician, I’ll review your child’s complete vaccination status and discuss which additional immunisations might benefit your family’s specific situation.

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Despite these challenges, childhood cancer is highly treatable when detected early. In high-income countries, survival rates exceed 80%. In contrast, South Africa’s survival rate is around 50%, with much of the African continent reporting rates as low as 20%. One of the primary reasons for this disparity is delayed diagnosis and referral, leading to advanced disease at the time of treatment.

Raising awareness and education is crucial in bridging this gap. By improving early detection and ensuring timely referral to specialists, we can significantly increase survival rates and provide better outcomes for children battling cancer.

What is Cancer?

Cancer occurs when cells in the body grow uncontrollably and spread into other tissues, causing significant damage. Often, doctors use terms like neoplasm, malignant tumour, or malignancy—all of which refer to cancer.

The most common childhood cancers include:

• Haematological cancers (blood cancers), such as leukaemia and lymphomas.
• Solid organ tumours, which develop in the brain, eye, bones, and kidneys.

Fortunately, medical advancements are improving childhood cancer treatments, making survival more likely—but only if the disease is diagnosed early. Therefore, recognising the warning signs and seeking medical attention without delay is critical.

Early Warning Signs of Childhood Cancer

To aid early detection, the team at Chris Hani Baragwanath Hospital in Soweto developed the St Siluan mnemonic, a guide that highlights key symptoms. This system has since been adopted by both the South African Children’s Cancer Study Group and the International Society of Paediatric Oncology.

The St Siluan’s Warning Signs of Childhood Cancer:

🩺 S – Seek medical help early for persistent or unexplained symptoms.
👁 I – Eye changes: A white spot in the eye, sudden blindness, a new squint, or a bulging eyeball.
🦠 L – Lump detection: Unusual lumps in the abdomen, pelvis, head, neck, limbs, testes, or glands.
🌡 U – Unexplained symptoms: Prolonged fever lasting over two weeks, persistent weight loss, pallor, fatigue, easy bruising, or bleeding.
🦴 A – Aches and pains: Persistent pain in the bones, joints, or back, or frequent unexplained fractures.
🧠 N – Neurological changes: Issues with walking, balance, or speech, developmental regression, persistent headaches (with or without vomiting), or an enlarging head.

Recognising the Signs Early

Spotting these symptoms can be challenging, particularly because children are naturally active and prone to minor injuries. Parents often assume aches, bruises, and fatigue are part of normal growth or play. However, when symptoms persist or worsen, it’s essential to seek medical advice.

If any of these warning signs appear, consulting a paediatrician is the safest course of action. Early diagnosis significantly improves survival rates, making immediate medical attention crucial.

Taking Action to Improve Survival Rates

Childhood cancer survival is closely linked to early detection and access to treatment. Currently, many South African children face delays in diagnosis, often due to a lack of awareness or late referrals to specialist centres.

By raising awareness, educating parents and healthcare providers, and ensuring faster referrals, we can improve survival rates. Every child deserves the best chance at life, and timely intervention plays a key role in achieving that.

If you’re concerned about any symptoms in your child, don’t wait—schedule a medical check-up immediately. The sooner cancer is detected, the greater the chances of survival.

Final Thoughts

Cancer in children is a serious but treatable condition. While South Africa’s survival rates remain lower than in high-income countries, early detection and access to treatment can change that. Parents, caregivers, and healthcare providers must work together to spot the signs early and act swiftly.

If you suspect something unusual in your child’s health, trust your instincts and seek medical advice—early intervention can save lives.

References:

1️⃣ World Health Organization (WHO): Childhood Cancer. www.who.int – Accessed 01/09/2024.
2️⃣ Mullen et al. Timeliness of Diagnosis and Treatment: The Challenge of Childhood Cancers. British Journal of Cancer, 2021 Dec;123(12):1612-1620. DOI:10.1038/s41416-021-01533-4.
3️⃣ Cancer Association of South Africa (CANSA): Childhood Cancer Warning Signs. www.cansa.org.za – Accessed 01/09/2024.
4️⃣ Poyiadjis et al. The Saint Siluan Warning Signs of Cancer in Children: Impact of Education in Rural South Africa. Pediatric Blood Cancer, 2011 Feb;56(2):314-6. DOI:10.1002/pbc.22853.

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What is Whooping Cough (Pertussis)?

Whooping cough is a bacterial infection that causes respiratory tract inflammation and uncontrollable coughing fits. The “whoop” sound occurs when a person gasps for air after a coughing spell.
Click here to listen to the distinct whooping sound in children.

How is Whooping Cough Spread?

The infection spreads easily through respiratory droplets when an infected person coughs, sneezes or breathes near others. Once exposed, symptoms typically appear within 5 to 10 days.

Symptoms of Whooping Cough

Whooping cough progresses through three stages:

1️⃣ Stage 1 (Early Symptoms):

• Runny nose, sneezing, mild fever, and a mild cough.
• Infants may have difficulty breathing rather than coughing.

2️⃣ Stage 2 (Severe Coughing Fits):

• Lasts 1 to 6 weeks, sometimes up to 10 weeks.
• Rapid, violent coughing fits that worsen over time.
• Symptoms may include vomiting, extreme exhaustion, and the signature “whoop.”
• Babies may experience apnoea (pauses in breathing for over 20 seconds).

3️⃣ Stage 3 (Recovery):

• Lasts 2 to 3 weeks.
• Coughing becomes less severe but may return for months.
• Increased vulnerability to respiratory illnesses.

Why is Whooping Cough a Concern?

Whooping cough can be particularly dangerous for infants under six months old due to their limited immunity. Complications may include:

• Breathing difficulties (apnoea).
• Pneumonia.
• Dehydration and weight loss from poor feeding.
• Pulmonary hypertension (increased pressure in the lungs and heart).
• Seizures.
• In severe cases, brain damage due to lack of oxygen.

Older children and teenagers may experience less severe complications such as:

• Broken blood vessels in the eyes or skin.
• Bruised or cracked ribs.
• Abdominal hernias from intense coughing.

How to Protect Your Child from Whooping Cough

Whooping cough is preventable through vaccination. Both the South African Government and private schedules recommend pertussis vaccines at the following intervals:

• 6 weeks, 10 weeks, and 14 weeks.
• Booster doses at 6 years and 12 years.
• Pregnant women: A pertussis vaccine in the second or third trimester protects newborns during their most vulnerable first six weeks of life.

💡 Key Tip: Don’t skip the booster vaccines at 6 years and 12 years. Many cases occur in teenagers due to missed boosters, combined with vaccine hesitancy and the absence of mask-wearing.

What to Do if Your Child Contracts Whooping Cough

If your child develops whooping cough, immediate medical care is essential. Antibiotics are used to prevent the spread of the infection but do not cure the cough itself. Other supportive treatments include:

• Clearing thick mucus from the airway through suctioning.
• Administering oxygen during severe coughing fits.
• Providing intravenous fluids if dehydration occurs.

These treatments often require hospitalisation to monitor and manage symptoms effectively.

Conclusion

Whooping cough is a preventable disease that causes significant distress and complications, particularly in infants. Vaccinations remain the most effective way to protect your family from this illness. Let’s work together to ensure our children are vaccinated and kept safe.

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