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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From Womb to World: How Newborn Breathing Works

Before birth, your baby’s lungs aren’t breathing air, they’re filled with foetal lung fluid. Oxygen comes directly from mom through the umbilical cord. This is a remarkable system, but everything changes the moment your baby is born.

During vaginal delivery, contractions squeeze foetal lung fluid out of the lungs. When your baby takes that first breath, the lungs inflate, blood vessels open, and oxygen flows in. The transition is seamless.

After a caesarean section, there’s no squeezing action. Your baby must rely on their first breath to expel the fluid. Sometimes this doesn’t happen quickly enough, which is why caesarean section babies are more susceptible to this condition.

Transient Tachypnea of the Newborn: The Most Common Scenario

TTN is temporary; that’s what “transient” means. Babies struggle with rapid breathing (more than 60 breaths per minute) for 24 to 72 hours, then recover completely. It’s not very serious, but your baby will need NICU monitoring and support.

What causes transient tachypnea:

• Birth by caesarean section (most common)
• Premature birth
• Maternal asthma or diabetes
• Male gender (boys are more susceptible)

Signs your baby has TTN:

• Rapid, laboured breathing starting shortly after birth
• Flaring nostrils
• Grunting sounds
• Retractions (ribs pulling in with each breath)
• Blue-tinged lips or skin

How TTN Is Treated

Your doctor will confirm the diagnosis with a chest X-ray and blood test to check oxygen levels. Treatment depends on severity:

Mild cases: Oxygen via mask

Moderate cases: CPAP machine (provides continuous air pressure to keep airways open)

Supportive care: Tube feeding while your baby focuses energy on breathing

Most babies settle within 72 hours. Once recovered, there are no lasting effects, your child won’t experience ongoing breathing problems.

Persistent Foetal Circulation: The More Serious Condition

Normally, when your baby is born and takes that first breath, pressure in the heart changes, and a valve closes. Blood flows to the lungs, picks up oxygen, and normal circulation begins. With Persistent foetal circulation (PFC) or persistent pulmonary hypertension of the newborn (PPHN), this doesn’t happen. The valve stays open, blood bypasses the lungs, and your baby becomes dangerously oxygen-starved, which is why it requires immediate medical intervention.

PFC causes:

• Birth stress or difficult labour
• Meconium aspiration (baby swallows stool during delivery)
• Infection (sepsis or pneumonia)
• Physical abnormalities like diaphragmatic hernia

Signs of PFC:

• Severe blue discolouration (cyanosis)
• Extreme distress
• Rapid heart rate
• Severe breathing difficulty

Treatment requires:

• High-flow oxygen immediately
• Medications to relax lung vessels and balance pH
• Mechanical ventilation
• Urgent specialised care

Most full-term babies with PFC survive when medical staff recognise it quickly and provide intensive support.

Why NICU Admission Isn’t a Failure

The transition from womb to world is complex. So many incredible processes happen in those first minutes and hours. Sometimes babies need temporary help making this shift, and that’s what NICU exists for. Your healthcare team is there to support you both through this temporary challenge.

Worried about your newborn or had a NICU experience? Book a consultation at my Johannesburg practice. I’m here to answer your questions, review what happened, and support your family’s adjustment.

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If you’re worried about your baby’s ears during an upcoming flight, you’re not alone. Let me explain what’s happening and exactly how to help.

Why Do Babies Get Sore Ears While Flying?

The medical term is ear barotrauma (also called barotitis media or aerotitis media). When a plane descends rapidly, say, from Johannesburg to Durban in under an hour, cabin pressure changes faster than the pressure inside your baby’s middle ear can adjust.

Here’s the anatomy: the Eustachian tube is a tiny pipe connecting the middle ear (behind the eardrum) to the back of the throat. Its job is to equalise air pressure, drain fluid, and protect against infection.

In babies, these structures are still developing and often very narrow. Add a snotty nose, cold, ear infection, or swollen adenoids, and that tube fills with fluid, making pressure equalisation nearly impossible. The result? Intense pain.

Adults experience fullness, popping sounds, and discomfort. Babies? They scream.

Signs Your Baby Has Ear Pain While Flying

Watch for:

• Sudden crying during takeoff or landing
• Pulling at ears
• Arching back or turning the head side to side
• Inconsolable fussiness
• Crying that continues after landing

Simple Strategies to Relieve Ear Pain in Children

You know from experience that swallowing, yawning, or chewing gum helps your own ears. Babies can’t follow these instructions, but you can encourage the same mechanisms:

1. Feed During Takeoff and Landing: Breastfeeding or bottle-feeding triggers swallowing, which opens the Eustachian tube and equalises pressure. Time feeds to coincide with descent; this is your most powerful tool.
2. Use a Pacifier: The sucking motion helps ears adjust to pressure changes. If your baby takes a dummy, this is the time to use it without guilt.
3. Keep Baby Upright: Hold your baby in an upright position rather than lying flat. This allows any fluid in the Eustachian tube to drain, relieving pressure naturally.
4. Offer Plenty of Water (for Older Babies): Drinking and swallowing open the Eustachian tube. The dry cabin air also thickens nasal mucus, making blockages more likely; hydration helps prevent this.
5. Keep Baby Awake: We swallow less frequently while sleeping, making pressure equalisation harder. Try to keep your little one awake during takeoff and landing.
6. Try Breathing Exercises (Toddlers): Make it a game. Breathe in slowly, gently pinch the nose tip to slightly close nostrils, then breathe out through the nose with the mouth closed. This helps equalise ear pressure.

When to Consider Medical Help

As Dr Maraschin, I don’t recommend medicating unnecessarily, but if your child is unwell and you’re concerned about pain, discuss these options with your doctor:

Decongestant Nose Spray: One puff or drop per nostril, given 30 minutes before takeoff (and landing on flights over 4 hours). This clears mucus that might block the Eustachian tube. Use baby-specific formulations only.

Paracetamol: Dosed correctly for your child’s weight, given 30 minutes before takeoff (and landing on longer flights) to control pain and discomfort.

Antihistamines: If your baby is snotty, an infant antihistamine can dry up mucus. Give a few hours before the flight, effects usually last 8-12 hours.

Active Ear Infections: I prefer that children not fly with confirmed ear infections. The added pressure is extremely painful and can rupture the eardrum. Ask your doctor for a postponement letter if possible. If you must fly, take every precaution listed above.

When to Seek Help

Ear barotrauma usually resolves quickly without permanent damage. However, see a doctor if:

• Fussiness continues for days after landing
• You notice bleeding from the ear
• Your child develops a fever or seems unwell

In my daughter’s case, we didn’t realise she had a minor cold starting, which worsened the pressure during that sudden descent. On our return flight, we used every trick, and she slept the whole way peacefully.

Planning holiday travel with your little one? Book a consultation with our Johannesburg practice before you fly. I’ll assess your baby’s ear health and create a personalised plan to keep those flights stress-free.

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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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Understanding Baby Constipation: What’s Normal?

Before we jump into solutions, let’s talk about what actually counts as constipation. I use the Bristol Stool Form Scale with families in my practice. It’s a simple visual tool that shows different stool types. We’re aiming for sausage or chicken nugget-shaped stools that pass easily without discomfort.

Here’s what surprises many parents: breastfed babies can go seven days without a stool and still be perfectly healthy. Formula-fed babies typically go once daily, though every second day is fine too.

Red flags that need attention:

• Hard, dry stools that cause pain
• Blood in the stool (bright red or black)
• Your baby is refusing feeds or spitting up more than usual
• Extreme fussiness or pulling legs up to the tummy

Constipation in Babies Under 6 Months

Important note: If your baby under three months is constipated, please book a consultation. At this age, we need to rule out underlying medical conditions before labelling it as simple constipation.

For formula-fed babies experiencing hard stools, try these steps:

1. Check your mixing ratio — are you following the tin’s instructions exactly?
2. Consider switching formulas — high-casein formulas can worsen constipation
3. Add one to two drops of olive oil to bottles to soften stools
4. Offer diluted juice (after 4 weeks of age) — 30ml of apple or pear juice per month of age, up to 120ml daily for a 4-month-old.*

These juices contain sugars that draw water into the bowel, making stools easier to pass.

*We strongly urge you to offer juice only as directed and for a short period of time. Be sure to stop offering juice once things normalise, as we don’t want excess sugar becoming a habit.

Simple relief techniques:

• Warm baths to soothe and relax
• Gentle clockwise tummy massage
• Bicycle legs, by pressing knees gently toward the chest to mimic squatting
• Stay calm when baby strains for 10 minutes (it’s normal work for weak tummy muscles)

Managing Constipation in Older Babies (6-12 Months)

Is your 7-month-old constipated? Solid foods are often the culprit. As a doctor, I always emphasise getting fibre into the diet early:

Constipation-fighting foods:

• Skinless apples or apple puree
• Strained prunes (nature’s laxative)
• Peaches
• Broccoli
• Whole grains like quinoa, oats, or barley (skip refined cereals)

Add water alongside increased fibre; think of fibre as a sponge that needs liquid to work properly. A good probiotic also supports gut health and regular movements.

When a 1-Year-Old’s Constipation Becomes Complex

Toddlers face different challenges than babies. By this age, eating habits are established, anxiety plays a role, and some children develop negative associations with pooing.

Watch for these symptoms:

• Days without bowel movements (are they actually going?)
• Tummy pain with poor appetite
• Soiled underwear (overflow diarrhoea from impacted stool higher up)
• Strange movements such as clenching the bottom, crossing legs, or pulling faces to avoid the toilet

That last one is withholding, and it creates a vicious cycle: avoiding leads to harder stools, which hurt more, which makes them avoid even more.

Beyond Diet: Other Causes

Stress matters. Children today rush through breakfast, sit in traffic, then bounce between school and activities. This “fight or flight” mode tenses muscles, including the anal sphincter, making bowel movements impossible.

My recommendations:

• Schedule 10 minutes after breakfast and dinner just for sitting on the toilet
• Epsom salt baths to relax muscles and provide magnesium
• Daily physical activity, such as running, jumping, and swimming (movement helps the intestines move)
• Maintain routine during travel or going to camp (new environments often trigger withholding)

The Magnesium-Fibre Connection

Modern diets leave many children magnesium-deficient, and yes, constipation is a symptom. The good news? Magnesium-rich foods also provide fibre:

• Oats (69mg per ¼ cup)
• Dark leafy greens (157mg per cooked cup)
• Pumpkin seeds (150mg per 30g)
• Butternut squash (43mg per cup)
• Quinoa (118mg per ¾ cup cooked)
• Bananas (32mg medium)

When to See a Paediatrician in Johannesburg

If you’ve tried dietary changes, established routines, and your child still struggles with painful or infrequent bowel movements, it’s time for a professional assessment. Severe cases may show faecal loading on X-ray or require medical intervention.

As a paediatrician, I believe in treating the whole child by addressing physical symptoms alongside stress, routine, and family dynamics.

Ready to tackle your little one’s baby constipation? Book a consultation at my Johannesburg practice. Together, we’ll develop a personalised plan to get your child comfortable and back to being a kid.

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In 1992, the American Academy of Paediatrics (AAP) began a campaign called “Back to Sleep”. The campaign was aimed at reducing the number of Sudden Infant Deaths (SIDS). This campaign urged all parents to place babies on their backs when asleep. Since the start of this campaign, there has been a significant decrease in the number of deaths due to SIDS, but another problem has raised its head. Apologies for the pun but infant plagiocephaly and brachycephaly (DPB) and congenital muscular torticollis (CMT) have been on an upward spiral since the “Back to Sleep” campaign began.

It has been noted that babies spend both sleep and awake times in reclined positions on their backs, be it in a cot, pram, bouncy seat, swing or car seat. Due to our busy lifestyles and a baby’s objection to tummy time, babies spend too much time in one position, which affects the head’s shape. While there are articles claiming that the shape of the head does not affect a baby, more recent studies call on practitioners to be aware that these conditions may be linked to a child’s ability to meet certain neurodevelopmental milestones. Whether the flat head causes neurodevelopmental delays or whether a child with developmental issues is less likely to move its head freely, thereby causing the flat head, is still being debated.

Let’s understand some of the terms used when considering the shape of a child’s head before moving on to the other causes, diagnoses, possible effects and treatment options.

What do the terms mean?

The most common term used is Flat Head Syndrome, but in relation to this condition, you may come across other terms such as:

• Plagiocephaly (DP)

  This term refers to a head which is flattened on one side. The face often appears asymmetrical, with one ear being more forward than the other on the head. The eyes are not lined up straight. The face and forehead may bulge a little on the side where the head is flattened.

• Brachycephaly (DPB)

  This term refers to a head that is flattened at the back. It usually causes the head to widen. Imagine a pumpkin lying on the ground. The under-surface of the pumpkin doesn’t become round because of the hard soil. The pumpkin flattens underneath and bulges out on the sides. A baby’s head responds in the same way as the pumpkin if it is allowed to lie on a solid surface for long periods of time. The back of the head flattens, and the forehead may bulge.

• Congenital muscular torticollis (CMT)

  This refers to tight or shortened neck muscles. The muscles on one side of the neck may be tighter than the other leading to a child favouring one side of the head over the other. You know what it is like to wake up with a stiff neck in the morning. We naturally guard the side which is stiff and try to only move to the other side. Babies born with CMT will usually only feed from one breast, avoid turning their heads to look around and favour lying down with their heads facing in one direction. All of these factors will make the baby more likely to face in one direction, which will affect the head’s shape.

What causes Flat Head Syndrome (DP and DBP)?

We have already mentioned two of the possible causes:

• Supine sleeping position

  We have to put babies to sleep on their backs, but studies have shown that 20 to 25% of babies who sleep on their backs develop brachycephaly to some degree or another. This doesn’t mean parents should allow the child to sleep in any other position but should encourage other head positions when the baby is awake.

• Muscular torticollis

  The head tilts in one direction because the muscles of the neck on one side are shortened.

• Prematurity

  These babies have very soft skulls and generally spend time in a neonatal ICU. They spend a long time on their backs, especially if they need to be ventilated. This will cause the back of the head to flatten. Interestingly, during COVID times, the number of premature babies suffering from this condition increased substantially. During this time, visiting was restricted, so it was less likely for the baby to be held by parents and grandparents. When a baby is held in someone’s arms pressure is taken off the back of the head.

• Inadequate space in the womb

  A mother may have a small womb, and this could put pressure on the head before the baby is born. This is also often the case in multiple births. If two or more babies have to grow inside a tummy, there is less space than in the case of a single baby. Where there is too little amniotic fluid in the womb, the head may be squashed against the womb because there isn’t water to cushion the head.

• Inadequate space in the womb

  A mother may have a small womb, and this could put pressure on the head before the baby is born. This is also often the case in multiple births. If two or more babies have to grow inside a tummy, there is less space than in the case of a single baby. Where there is too little amniotic fluid in the womb, the head may be squashed against the womb because there isn’t water to cushion the head.

• Prolonged labour or assisted birth

  A baby in the birth canal for an extended period may experience a lot more pressure on the head, which may lead to flattening in the area of most pressure. In cases where instruments are needed to deliver the baby, the baby’s skull may be affected by the pressure applied to pull the baby out of the mother’s pelvis.

How is Flat Head Syndrome diagnosed?

Usually, the first stage in the diagnosis process is the observation of the parents. Often parents will present to their healthcare provider with concerns about the shape of the head around 6 to 8 weeks of life. Those children who do not have a flattened head at birth may develop this condition after a couple of weeks of lying in a particular position for extended periods.

The healthcare provider will examine the baby and look for specific signs. These would include the movement of the head, symmetry of the eyes and ears. In other words, are the eyes in the same position on either side of the nose and are the ears in the same position on either side of the head? At this stage the healthcare provider may opt to refer the baby to a physiotherapist, chiropractor or prosthetist who deals with Cranial Orthotic treatments.

A physiotherapist would assess the baby’s muscle strength and range. The physiotherapist works on the baby to improve neck movement and would provide caregivers with exercises to do at home, encouraging better head movement and motor development. Certain paediatric chiropractors have techniques to assist with the shape of the head. The prosthetist is usually the professional who advises on the use of a helmet to correct the flat head. The assessment usually involves scientific measurements and tests, looking for adequate space inside the skull for normal brain growth and development.

What are the effects of Flat Head Syndrome on a baby?

In mild cases of this condition, the research seems to indicate no long-term effect on children either from a medical or neurodevelopmental point of view.

In moderate to severe cases, parents and practitioners are advised not to treat this condition merely as a cosmetic problem; in other words, doctors should not just assume that the flat head only affects the way the child looks. Doctors are advised to be aware that this condition may be associated with developmental delays, reduced gross and fine motor skills, hearing and sight problems, communication problems and a lowered ability to solve problems.

When a parent brings a child to the doctor because their baby’s head looks odd, parents are not generally worried about how their baby looks in photos but are more concerned that the strange shape is affecting their baby in some way. Recent studies confirm that parents are right to be concerned about the shape of their child’s head as it may well affect the baby’s future development.

It is still unclear whether Flat Head Syndrome causes these developmental delays or if a child with developmental delays is more likely to develop Flat Head syndrome. Let’s leave this question for the academics to answer. As parents, you need to know that there is a possibility of developmental problems when a child has an odd-shaped head, so seeking advice and a treatment plan is critical.

How or why does a flattened head cause problems?

This is not an easy concept to explain but let me try to use an analogy which you will hopefully relate to. Imagine you are driving along the highway at 120km an hour. Suddenly you encounter one of those yellow barriers blocking your lane. You are forced to hit breaks and wait and see when you are clear to change lanes and get going again.

A study performed in 2020 suggests that this is what occurs in the brain. Messages are rushing along the white material of the brain, carrying instructions for various parts of the body. They suddenly hit an obstruction in the form of a flattened skull, and the instruction is either interrupted or slowed down. The result of this interruption is delays in neurodevelopment, sight, speech and so on.

Since this is a new science, much more work is required to understand Flat Head Syndrome. Having said this, the current studies use modern MRI techniques and have methods which make the study of white matter easier. These studies suggest that a child with a flattened head requires intervention.

If you would like to look at the study, there is an abstract that you can read. The link is https://pubmed.ncbi.nlm.nih.gov/32884966/

What can be done to prevent Flat Head Syndrome?

If your child is born with a flattened area of the head, there is obviously nothing you can do to prevent it, but some of these prevention techniques may help to improve the condition:

• Tummy time. I cannot stress this enough. There is so much evidence showing why a baby needs to experience tummy time from day one. Flattened head syndrome is another reason to institute tummy time. While the baby is still tiny, you can institute tummy time by the way that you hold your baby. This would include your baby:
  • Lying with its face on your chest
  • Lying over your lap
  • Leopard in the tree position where baby lies over your arm
  • On the floor, tummy down with a towel or blanket rolled under the chest.
• Change the way baby spends his or her day. Carry your baby in a sling, put baby into a sloping chair or have the pram back slightly elevated if you are taking baby for a walk. This way baby won’t always be lying on the back of his or her head.
• Change the position of mobiles and toys in the baby’s cot. Babies do like watching mobiles and brightly coloured toys, so shifting their position in the cot will encourage your baby to turn their head.
• Alternate the side of your body where you carry or feed your baby. Most parents carry or feed their baby, favouring their dominant side, but this will also mean that baby is always in the same position.
• If you notice that your baby holds his or her head in a particular position and doesn’t easily move the head from side to side, consult a paediatric physiotherapist for help.
• If your baby appears to have or is developing a flattened head, then I suggest you roll up a little receiving blanket and put it under the head, shoulder, waist and hip of the affected side. This will lift that side of the body and take pressure off the side of the head affected when in the car seat. We had a friend with a very premature baby. They used to change the position of the blanket each time the little one went in the car chair. This was to avoid the head developing flat spots. They used to call it her “panel beating”.
• If your baby is learning to sit, then an upright chair with good back support is wonderful to get the pressure off the back of the head. This can be used from about 3 to 4 months of age and the length of time slowly increased.
• A child must be transported in a car seat, but I would propose getting the baby out of the car seat when you get to your destination. Leaving baby in the chair will increase the amount of time that pressure is kept on the head.

What if these conservative measures don’t work?

If the flattening of the baby’s head has not improved by about four months of age, then I would suggest that the child needs further intervention. At this stage, a helmet or headband may be indicated.

The purpose of the helmet or headband is to apply pressure to the bulging part of the head. The treatment is usually started around the age of 5 or 6 months when the skull is still soft. The child needs to wear the helmet for about 23 hours a day at the beginning of treatment and for less time as the condition improves.

There are certainly challenges with regard to the helmet, and these include:

• The length of time that the child needs to wear it
• Some medical aids do not pay for the helmet, and the treatment is expensive. At present, you are probably looking at around R40 000.
• It can be uncomfortable.
• Some children develop skin rashes, cradle cap and eczema.
• The baby needs to be checked regularly to monitor the growth and make adjustments where necessary.

Conclusion

Flat Head Syndrome is a relatively new concept. Certainly, around the world, centres that treat babies are experiencing ever-increasing numbers of children with this condition. Views around the treatment of Flattened Head Syndrome vary, and parents may find that they get conflicting views.

In my practice, I encourage parents to institute tummy time techniques from day one. If babies struggle to move their heads, I strongly believe in physiotherapists being consulted for torticollis. I had a child come into my practice for the first time at age four. The child’s head was at such a strange angle that he walked completely skew. With an off-centre head, a child is likely to suffer from Flat Head Syndrome but is also at a high risk of jaw, hip dysplasia and postural issues. This particular child was too old for helmet treatment but did go to physiotherapy to help correct the posture.

With regard to helmet therapy for Flat Head Syndrome, the Congress of Neurological Surgeons (CNS) updated their guidelines to state that repositioning, tummy time, physiotherapy and chiropractics are important but concluded that:

“more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy.”

Given all the new data, I would encourage parents and caregivers to institute all conservative methods to avoid or treat Flattened Head Syndrome from day one. Hopefully, these conservative measures will improve the child’s condition and avoid the knock-on effects of untreated Flattened Head Syndrome.

If your baby still has a flat head by three to four months, you should seek medical assistance. In my discussions with Yovanka Torrente, a medical prosthetist and orthoptist, she stated, “I have noted time and time again that my Brachycephaly patients are my late starters.” meaning that these children achieve their milestones later than children without Flat Head Syndrome.

Image source: https://www.healthline.com/health/parenting/flat-head-baby

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Every time a heart beats, two sounds are created. Think back to the very exciting time when you had the first scan. Hearing the whooshing sound of that little heartbeat is such a miracle. It is usually described as “lubb-dupp”, and is created when the heart valves open and close. When there is an extra sound, over and above the expected “lubb-dupp”, then this is known as a murmur.

Is a heart murmur dangerous?

• Innocent murmurs

  Just as its name suggests, an innocent heart murmur doesn’t cause harm. In such cases, there is no issue with the structure of the heart. The extra sound originates from the flow pattern of the blood through the heart. It can be heard at any time during a child’s early years and often into adolescence. This kind of heart murmur won’t usually be associated with any signs or symptoms but may appear for the first time after an illness, especially if the child has had a high fever.

• Pathogenic murmurs 

  These murmurs arise as a result of a structural abnormality of the heart or heart vessels. Children are born with these abnormalities and are often referred to as congenital abnormalities. These abnormalities may be things like a hole in the heart, a cardiac shunt (where there is abnormal blood flow between the chambers or vessels) or a problem with the heart valves. Children with abnormalities in the structure of the heart will usually display signs and symptoms and these may include:

1. 1. Poor feeding which results in insufficient weight gain
   2. Bluish skin which is particularly noticeable on the lips and fingertips
   3. Excessive sweating
   4. Coughing without an apparent cold
   5. Swelling of the lower legs, feet or abdomen
   6. Swelling of the liver or neck veins
   7. Dizziness or fainting
   8. Chest pain

Are there other causes of heart murmurs?

• Rheumatic fever

  This is usually a secondary illness following a throat infection, specifically caused by a bacteria known as Streptococcus. This bacteria can affect the heart valves if it is not treated with antibiotics.

• Anaemia

  A child with a persistent, low red cell count is at risk of developing a murmur.

• Hyperthyroidism

  A child with an overactive thyroid gland may also develop a murmur.

• Endocarditis

  A child with a serious infection may be at risk of developing this condition. The infection found elsewhere in the body may travel through the bloodstream and attack the heart valves or lining.

How is a heart murmur diagnosed?

When your baby is examined, the healthcare provider will use a stethoscope to listen to the heart. What they will be listening for is the normal two beats described in the introduction. If the healthcare provider hears an abnormal sound he or she may recommend that your baby see a paediatric cardiologist. Tests may be performed to look at the structure of the heart as well as to measure the electrical activity of the heart. Such tests may include an x-ray, ECG or echo of the heart.

What treatment will my baby receive if he or she has a heart murmur?

The treatment for a heart murmur will depend on the symptoms, age of your baby and what your baby’s general health is like.

The innocent heart murmurs don’t need any treatment and usually go away on their own. Remember these are the most common type of murmurs in children.

Congenital heart problems may require surgery or to be treated with medication.

Is there anything I can do to prevent my baby from having a heart murmur?

• During pregnancy

There are certain illnesses like uncontrolled diabetes or rubella which, during pregnancy, may affect how your baby’s heart develops. Mothers with diabetes must ensure that their own health is well managed during this sensitive time. Ensuring that you are vaccinated against Rubella before you fall pregnant is also advisable.

Alcohol and drugs definitely affect the developing heart of a foetus and should be avoided at all costs. Certain medications may also increase the risk of your baby developing heart problems. For this reason, a woman should always consult her healthcare provider before taking medication during pregnancy.

• Childhood

Certain illnesses, like throat infections, may lead to heart problems. For this reason, it is always advisable to get medical help if your child is ill. Children with anaemia should be treated with an iron supplement and followed up regularly.

Conclusion

Hearing that your baby has a heart murmur can be very distressing and rightly so. What is important is that you reassure yourself with the knowledge that most murmurs are innocent. Modern medicine is able to provide incredible solutions for children with congenital heart problems, although the road may seem long. Do your best to take care of yourself while you are pregnant. Your developing baby will benefit so much from this. If your child is ill follow your gut. An illness like tonsillitis may seem like a common childhood sickness but left untreated can lead to heart problems. There is a saying “the best gifts come from the heart and not from the store”. In the case of your child health, nothing could be truer than this.

References

• https://www.aafp.org/pubs/afp/issues/2011/1001/p793.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446116/
• https://www.aafp.org/pubs/afp/issues/2001/0601/p2201.html
• http://unmfm.pbworks.com/f/Heart%20Murmurs%20in%20Children.pdf
• https://www.heart.org/en/health-topics/heart-murmurs

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Unchecked this condition will lead to trouble in the teenage years starting with groin pain and then developing into more serious conditions such as osteoarthritis or a hip labral tear.

While babies are usually born with this condition there are things which caregivers can do that could cause or make the condition worse. The way a baby is carried, allowed to sleep or wrapped can cause strain on the hip joint especially if the legs are kept straight and stiff or left hanging. We will look at this in more detail later in the article.

But what is DDH?

Let’s begin with understanding how the hip joint works and then move onto DDH.

At the top of the thigh bone is a ball (femoral head). This fits into the socket part of the pelvic bone (acetabulum) and is able to move around in all directions giving movement to the legs and supporting the body for all sorts of activities like walking, crawling, climbing and running. The important thing is that the ball always needs to stay inside the socket.

In the case of DDH, the socket may be too shallow to cover the ball of the thighbone completely. This allows the thigh bone to slide in and out of the socket. In severe cases the ball comes completely out of the socket and dislocates. In minor cases there may just be minor looseness in one or both of the baby’s hip joints.

It is not hard to imagine that a child’s development will be affected by this condition because the little legs won’t be stable enough for baby to weight bare and this will affect physical development.

What causes DDH?

As with many conditions the exact cause of DDH isn’t known.

In utero:

What we do know is that while baby is in the womb, the hip joint consists of a very soft cartilage. The ball and socket need to fit tightly together so that they can mould one another. If this doesn’t happen then the socket won’t form fully around the ball and the socket becomes shallow.

If a baby has limited space in the womb the ball may move out of position and not have space to move back in, causing the shallowing of the socket. The limited space may be due to a large baby, twin pregnancy or a first baby where mommy’s womb is small.

DDH is also more common in:

• Babies born breech. This means that the baby doesn’t turn to allow the head to engage. When this happens the baby often ends up with one or both legs extended in a partially straight position rather than folded in a foetal position. Unfortunately, this position can prevent a growing baby’s hip socket from developing properly.
• Where there is a family history of DDH.
• Baby girls. Girls are four times more likely than boys to have DDH.

After birth:

As mentioned in the introduction, DDH can also be caused or made worse in babies by the way the baby is carried, allowed to sleep or wrapped.

What signs may indicate that my baby has DDH?

After birth and at the first couple of developmental checks, the doctor will perform 2 tests. The first is called a Barlow test. This involves making little circles with the baby’s legs while in a frog like position. The doctor will be feeling for and listening out for any clicks. The second is the Ortolani test where the doctor will flick the little legs to ensure that the ball doesn’t come out of the socket. Both tests are completely painless but very important.

As parents you can also look out for certain signs such as:

• The skin folds under your baby’s bottom or on the thighs not lining up.
• One leg being shorter than the other
• A difference in the way one leg or hip moves when compared to the other.
• A popping or clicking sound in the hips
• If there is a dislocation on one side of the body, that leg may turn outwards
• Baby may appear to have a larger space between the legs than normal
• Your child developing a limp once he or she starts walking.

How is DDH treated?

There are various treatment methods depending on the severity of the condition. If your health care provider is concerned about your baby’s hips then the baby will usually be referred to an orthopaedic surgeon for further assessment.

Depending on the findings and the age of your baby, there are various treatment options:

1. Observation- If baby is under 3 months of age and the hips are relatively stable, then the doctor may opt to observe the baby. Since the soft cartilage slowly hardens and becomes hard bone there is a good chance that the joint will correct itself.
2. Pavlik Harness-this is a soft harness and is used in babies under the age of 4 months. The baby will generally wear the harness for 24 hours a day for about 12 weeks. The harness holds the hips in the correct position while allowing the legs to move freely. Most babies respond very well to this treatment.

3.  Abduction Brace- If the Pavlik harness fails then an Abduction Brace, made from a lightweight material that supports         the hips and pelvis is used. This is generally worn for 8 to 12 weeks.

4. Surgical options- If both braces fail to stabilise the hips then the orthopaedic surgeon may need to perform surgery.            Surgery may also be required in older children as the cartilage would have turned to hard bone and surgery may be the      only way to position the bones correctly.

How can we help prevent our baby developing DDH?

If your baby develops this condition while still in the womb, there is nothing you can do to prevent it. After birth, however we need to take care with swaddling, carrying and sleeping positions.

1. 1. Swaddling- When wrapping your newborn you can wrap their arms and torso snugly but avoid wrapping baby’s legs in a straight position. This may interfere with the healthy development of the joint. Instead of being kept straight your baby’s legs should be able to fold up into a “frog position”. From the examples of the types of harnesses you can see what the “frog position” looks like. Your baby must be able to move the legs upwards and out to the side at all times.

1. 2. Carrying- Whether you are carrying your baby or wearing baby in a sling, the legs should always be out to the side in a “frog position”. The baby should be supported under its bottom. Try never to allow the legs to point straight downwards or lie together across your body.

1. 3. Sleeping position- Your baby may favour one side of the head for sleeping but having the head in the same position for extended periods of time will affect the position of the hips as well. Try turning your baby’s head to the other side regularly. This will also ensure that baby doesn’t develop a flattened area on one side of the head.

 Conclusion

Developmental Dysplasia of the Hips is a condition which generally responds very well to treatment. Depending on the age at which your baby gets treated, your baby will most likely start walking at the normal age. Children with untreated Developmental Dysplasia of the Hips often start walking late and typically have a limp. Parents and caregivers play a very big role in helping those little joints to develop so that the wonderful milestones like crawling, walking and running are achieved without complication. Allowing good movement of those little legs in the early stages of life is key to the gift of movement later on.

References

• • https://www.stanfordchildrens.org/en/topic/default?id=developmental-dysplasia-of-the-hip-ddh-90-P02755
  • https://hipdysplasia.org/developmental-dysplasia-of-the-hip/
  • https://www.childrenshospital.org/conditions/hip-dysplasia#hip-dysplasia-in-babies

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