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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Burns vs. Scalds: What’s the Difference?

Scalds come from wet heat: hot liquids, steam, or bathwater.

Burns result from dry heat: fire, hot metals like irons, electricity, friction, or chemicals.

Both cause tissue damage and require identical treatment. Kitchen accidents (hot drinks, microwaved foods, electrical cords) and bathroom scalds are the most common injuries in young children.

Prevention: Simple Steps That Save Lives

Many parents focus on obvious safety tips, turning pot handles inward, tucking appliance cords away. But these lesser-known precautions are equally critical:

Set Your Geyser to 49°C
Your water heater thermostat is your first line of defence. In America, hot tap water causes 1,500 hospital admissions and 100 deaths yearly. A child can suffer serious burns in just 5 seconds at 60°C. Set it correctly, and this danger disappears.

Never Carry Hot Liquids While Holding a Child
One quick movement and scalding liquid spills. Coffee at 79°C requires only two seconds of contact to cause surgery-level burns.

Create a 1-Meter “No Play Zone”
Children must stay clear of stoves, ovens, and braais. That one-meter boundary prevents curious hands from reaching dangerous heat sources.

Microwave Safety Matters
Steam builds dangerously inside heated containers. If your little helper lifts the lid, a steam burn follows. Avoid microwaving bottles, they heat unevenly and create dangerous hot spots.

An Accident Happens: The 6 C’s for First Aid

Clothing
Remove any fabric from the burned area immediately. This stops heat from being trapped and prevents restricted blood flow if swelling occurs.

Cooling
Run cool or lukewarm water over the burn for 10-20 minutes, never use ice, which causes further tissue damage.

Cleaning
If debris is present, gently dab with mild soapy water. Don’t scrub.

Chemoprophylaxis
Apply cooling cream, burn packs, or aloe vera gel. These protect while cooling the wound.

Cover
Use cling wrap if bandages aren’t available. It prevents infection without sticking to the skin.

Comfort
Give paracetamol or ibuprofen immediately. Burn pain is extreme and requires urgent relief.

Critical Don’ts

• Don’t remove clothing stuck to skin
• Avoid breaking blisters, they protect underlying tissue
• Never apply butter, oil, turmeric, or toothpaste (these trap heat and increase infection risk)
• Don’t use adhesive bandages, cotton wool, or fluffy materials (they stick and damage healing skin)

The Psychological Impact Is Real

Burns heal, but trauma lingers. Children who’ve experienced serious burns face increased risk of anxiety, depression, and post-traumatic stress. Parents often carry guilt that affects the whole family.

Preparation transforms crisis response. Keep an emergency box with burn packs, phone numbers accessible to all caregivers, and ensure everyone knows basic first aid. After immediate treatment, always have a medical professional assess your child to prevent complications like infection, slow healing, or disfigurement.

Life can change in seconds. Your preparedness and quick response can mean the difference between a minor injury and lifelong scarring.

Is your family prepared for emergencies? Book a consultation at my Johannesburg practice. As a paediatrician, I can review your home safety, discuss age-appropriate prevention, and ensure you’re equipped to handle childhood injuries with confidence.

The post Burn Awareness in Children | Prevention and First Aid appeared first on Dr Maraschin - Paediatrician.

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.

The post Reflux in Babies: Do You Really Need Proton Pump Inhibitors? appeared first on Dr Maraschin - Paediatrician.

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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Let me walk you through the most common gait patterns I see and when they need attention.

Understanding Your Child’s Gait: Three Common Patterns

In-Toeing (Pigeon-Toed)

This is one of the most frequent concerns parents bring to my office. A pigeon-toed child walks with feet turning inward, and the cause changes with age:

Under 1 year: Feet turn inward at the midfoot
Ages 1-3: Appears bow-legged due to shinbone rotation
Ages 3-6: Thigh bone turns inward from the hip (often genetic)

Here’s the good news: 95% of cases self-correct without treatment. I recommend assessment only if the in-toeing worsens, causes pain or persists past age 6. Conservative treatments like orthotics and muscle-strengthening exercises usually work well. Surgery is rare and reserved for cases affecting daily function.

Out-Toeing (Duck Walking)

That adorable waddle when toddlers first walk? That’s out-toeing, feet pointing outward as they gain balance. Most children outgrow this between ages 2 and 6. Children with flat feet may also walk this way.

When to assess a duck walking child:

• Pain or limping occurs
• Frequent tripping
• Affects only one leg
• Continues past age 3

If out-toeing persists at age 10, intervention is recommended because the unusual foot position stresses knee joints. Weight management becomes critical too, obesity significantly increases arthritis risk in these children.

Treatment typically involves physiotherapy or shoe inserts, though many cases need no intervention at all.

Toe-Walking

New walkers often go up on tiptoes or the balls of their feet. It’s cute initially, but persistent toe-walking after age 2 risks shortening leg muscles, creating balance issues, and causing pain after extended walking.

Most children toe-walk out of habit. Gentle reminders to drop their heels usually work if development is otherwise normal. However, toe-walking can signal autism spectrum disorder, cerebral palsy, or muscular dystrophy, especially when coupled with other developmental concerns.

Treatment progression:

1. Physiotherapy (stretching calf and foot muscles)
2. Leg braces or splints for moderate cases
3. Serial casting if needed
4. Botox injections to relax calf muscles
5. Surgery to lengthen muscles/tendons (last resort)

If toe-walking relates to an underlying condition, treatment addresses the whole picture, not just the gait.

Red Flags: When to See a Paediatrician

While most gait differences resolve naturally, certain milestones shouldn’t be missed:

By 12 months:

• Not pulling up to stand
• Not cruising along furniture
• Stiff or floppy legs

15-18 months:

• Not walking independently
• Walking on toes consistently without flat steps
• Uneven movements (favouring one leg)
• Frequent falling

2 years:

• Still not walking or only walking with support
• Difficulty standing from floor without help
• Unable to manage stairs without holding on

3 years and beyond:

• Uncoordinated or unsteady walking
• Tripping more than peers
• Difficulty running, jumping, or climbing

Long-Term Consequences of Untreated Gait Issues

If gait problems haven’t been corrected by ages 6-8, life-long consequences may follow:

In-toeing causes joints to wear unevenly in hips, knees, and ankles. Children trip more frequently, risking injury and teasing that leads to exercise avoidance.

Out-toeing accelerates osteoarthritis onset and creates foot deformities like bunions and hammertoes. Weak calf and glute muscles affect balance and coordination.

Toe-walking permanently alters foot structure, shortens calf muscles, and increases fall risk. The social stigma and teasing can devastate a child’s self-confidence.

The Bottom Line

As Dr Maraschin, I tell parents that watching those first wobbly steps is magical. As muscles, bones, and joints mature, most gait quirks disappear naturally. But physical exercise, peer acceptance, and self-confidence all depend on pain-free, coordinated movement.

Trust your instincts. If walking seems delayed or increasingly different from peers, early intervention prevents unnecessary complications.

Concerned about your child’s walking pattern? Book a consultation at my Johannesburg practice. Together we’ll assess your child’s gait, discuss normal development, and create a plan if intervention is needed.

The post Is Your Child’s Walking Pattern Normal? appeared first on Dr Maraschin - Paediatrician.

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.

The post The Meningococcal Vaccine: What Parents Need to Know appeared first on Dr Maraschin - Paediatrician.

What Is Separation Anxiety?

Remember playing peekaboo with your baby? Those delighted shrieks aren’t just cute, they’re learning moments. You’re teaching “object permanence,” the understanding that things exist even when out of sight. This same concept explains why your little one panics when you leave: they’re learning that you still exist when you’re gone, and yes, you’ll come back.

Infant separation anxiety typically starts around 8 months and peaks between 10 and 18 months. Your baby is beginning to understand they’re separate from you but hasn’t quite grasped that you’re returning. By age two or three, this intense anxiety usually fades as confidence builds.

But here’s what catches parents off guard: separation anxiety can resurface during transitions, new schools, house moves, or the arrival of a sibling. These episodes are usually brief once your child feels secure again.

Signs of Separation Anxiety by Age

8-18 Months:

• Hysterical crying when you leave the room
• Raising arms desperately to be picked up
• Refusing to be put down

Toddlers and Preschoolers (2-5 Years):

• Difficult drop-offs at school or playdates
• Clinginess before anticipated separations
• Changes in sleep routines
• Quick settling once distracted

School-Age Children (5-12 Years):

• Reluctance about camps or sleepovers
• Sunday night tummy aches or headaches
• Fear that something bad will happen to the family
• Difficulty concentrating at school

Practical Strategies That Actually Work

As Dr Maraschin, I’ve guided countless families through these tearful transitions. Here’s what makes the difference:

1. Manage Your Own Emotions. Your guilt about working or leaving doesn’t make you a bad parent; it makes you human. But children pick up on hesitation. Trust your childcare choices, and your child will too. Save the tears for the car.
2. Keep Goodbyes Short and Confident. Teachers handle meltdowns daily. Lingering sends confusing messages. Say goodbye and leave. Your child is safe, and you know it.
3. Create a Quick Ritual. Unpack the bag, spot a friend already playing, give a big squeeze, and say, “Have a fun day.” Repeat this every single time. Consistency creates security.
4. Use the Distraction Technique. Psychology calls this the 3-3-3 rule. Ask your child to name three friends at school or three activities they’ll do today. You’re shifting focus from worry to something manageable.
5. Tie Your Return to Their Routine. “I’ll be back right after nap time” works better than “I’ll be back at 2pm.” Small children don’t understand clock time, but they understand routines perfectly.
6. Never Sneak Out. Despite what grannies suggest, don’t disappear while your child isn’t looking. They need to learn that you leave and you return. Sneaking breaks trust.

When to Worry: Separation Anxiety Disorder

Most separation anxiety is completely normal. But sometimes the intensity crosses into concerning territory. Watch for:

• Refusal to attend playdates or school for weeks
• Constant messaging or phone calls
• Physical symptoms (headaches, stomach pain) that persist
• Inability to concentrate due to worry
• Intense fear that harm will come to the family

If reassurance and routine don’t help after several weeks, book a consultation. Separation Anxiety Disorder (SAD) is treatable with cognitive behavioural therapy and family interventions. Early support makes all the difference.

The Bottom Line

Separation anxiety is rarely a problem; it’s proof that your child is attached and developing normally. Acknowledge their feelings while staying consistent with routines. Hold your side of the bargain: say goodbye, leave confidently, return when promised.

Most children adapt within days or weeks once they trust the pattern. And remember, this phase passes. Your child will grow into someone who confidently waves goodbye and runs toward their next adventure.

Struggling with persistent separation anxiety? Book a consultation with our Johannesburg practice. As a paediatrician, I’ll help you determine whether what you’re seeing is typical or needs additional support.

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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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