are your tod­dler’s meds turn­ing her into a tyrant?

Could med­i­ca­tion turn your tot into a tyrant?

Your Baby & Toddler - - Your baby files - BY MARGOT BER­TELS­MANN

While it’s won­der­ful to have ac­cess to medicine that can re­lieve ill­ness (not to men­tion life­sav­ing drugs, are we aware enough of the side ef­fects that drugs can have on some chil­dren? We in­ves­ti­gate the most fre­quently ad­min­is­tered child­hood meds – plus the ef­fects you weren’t hop­ing for.

ANAL­GESICS AND ANTIPYRETI­CS

Th­ese very common drugs are used to re­lieve pain and bring down a fever. Most chil­dren’s pain meds con­tain mostly or ex­clu­sively parac­eta­mol (AKA acetaminop­hen), in fa­mil­iar brand names such as Panado, Calpol and Em­paped. Parac­eta­mol in­hibits the pro­duc­tion of painand in­flam­ma­tion-caus­ing prostaglan­dins in the brain. It has no known side ef­fects at reg­u­lar doses but parac­eta­mol is very dan­ger­ous in over­dose (so al­ways obey dosage in­struc­tions).

Some parac­eta­mol-based chil­dren’s painkiller­s have codeine (as well as an­ti­his­tamines) added to them (Sto­payne and Stil­pane). Codeine binds to opi­oid re­cep­tors in the brain and changes your per­cep­tion of and at­ti­tude to pain. It also in­hibits the cough re­flex so it’s some­times used at night for bet­ter sleep in a cough­ing child. “We gave our 18-month-old son Sto­payne on the plane so we could fly in peace. He bounced all over the plane,” re­calls mom Ta­nia Roux – one of many par­ents with a Sto­payne story. How­ever, says pae­di­a­tri­cian Dr Paul Sinclair, “bear in mind that hy­per­ac­tiv­ity re­lated to drugs may be the ac­tive in­gre­di­ents (like the an­ti­his­tamine promet­hazine that is found in Sto­payne), but equally it could be a re­ac­tion to the colourants or preser­va­tives in the liq­uid, such as the big cul­prit sodium ben­zoate. Of­ten sugar is blamed for be­havioural changes when kids have eaten sweets, where the real bad­die was the ad­di­tives.”

The other big group of anal­gesics is made up of the non­s­teroidal anti-in­flam­ma­tory drugs (or NSAIDS). This um­brella term cov­ers ibupro­fen, di­clofenac and mefe­namic acid (Nuro­fen, Voltaren, Pon­stan). NSAIDS af­fect prostaglan­din pro­duc­tion not only in the brain, as is the case with parac­eta­mol, but all over the body. If the prostaglan­dins pro­tect­ing the stom­ach lin­ing have been af­fected, then NSAIDS can cause gas­troin­testi­nal dis­tress, so a sore tummy is a known side ef­fect. (While as­pirin is also an NSAID, it is not listed here as it is un­safe for chil­dren. Never give as­pirin to a child as it is linked to the dan­ger­ous Reye’s Syn­drome.)

AN­TI­HIS­TAMINES

As the name sug­gests, th­ese drugs act against his­tamine in the body in a va­ri­ety of ge­nius ways. His­tamines are the bad guys who cause al­ler­gic re­ac­tions in your body, such as runny nose and eyes, itch­ing, sneez­ing, in­flam­ma­tion, rashes, swelling and so on. An­ti­his­tamines come in syrups, or in top­i­cal form as eye drops or nasal sprays. So­called first-gen­er­a­tion an­ti­his­tamines (such as Al­lergex) are known to have se­dat­ing ef­fects, and can also cause a dry mouth or sore stom­ach. Many par­ents have also learnt to their detri­ment that they can af­fect their child’s mood. “Known as lipophilic an­ti­his­tamines, they cross the blood-brain bar­rier eas­ily and can cause drowsi­ness and per­son­al­ity changes,” says Dr Sinclair.

Phen­er­gan and Val­ler­gan are two ex­am­ples of th­ese older drugs, and they are the big­gest cul­prit when it comes to turn­ing Gandhi into Gaddafi in your house. In fact, says Dr Sinclair, “Val­ler­gan is used as a seda­tive be­fore med­i­cal pro­ce­dures or dur­ing long travel trips – but it can have the re­verse ef­fect! It can also leave kids groggy and hung over. So try it out be­fore your big trip, and use the low­est dose pos­si­ble.”

The sec­ond-gen­er­a­tion an­ti­his­tamines have fewer side ef­fects, but some chil­dren are still sus­cep­ti­ble. “An­ti­his­tamines can make cer­tain kids grumpy and ag­gres­sive, and though less likely, some chil­dren show sim­i­lar side ef­fects even on the more mod­ern nonse­dat­ing an­ti­his­tamines, from twitch­ing to rest­less legs and be­havioural changes,” says Dr Sinclair.

STEROIDS

The word prob­a­bly makes you think of “an­abolic steroids” – the things that build mus­cle and are banned in sports, and which are given to a mother to ma­ture her foe­tus’ lungs if it has to be de­liv­ered early. But it’s cor­ti­cos­teroids that we are talk­ing about here, such as cor­ti­sone and pred­nisone. Th­ese re­duce in­flam­ma­tion and sup­press the im­mune sys­tem, and so they are good treat­ments for asthma, eczema and al­ler­gies. Steroid meds come as a top­i­cal ap­pli­ca­tion (eczema cream, asthma pump) or syrup.

So what about side ef­fects? “Cor­ti­sone (Aspelone) has made my son grumpy,” re­ports one par­ent. “It is usu­ally at the third or fourth dose that he gets so grumpy, and it lasts all day.” Dr Sinclair says that steroids can af­fect be­hav­iour, ap­petite and sleep. “And the higher the dose, the more likely it is to have an im­pact,” he says. “So a hun­gry, ratty, slightly ob­nox­ious child on steroids is prob­a­bly show­ing drug-re­lated be­hav­iour and should set­tle shortly after the treat­ment is com­pleted.”

LTRAS

Asthma is a bat­tle fought on many fronts, and a drug called mon­telukast, a leukotrien­e re­cep­tor an­tag­o­nist (LTRA), sold un­der trade names Sin­gu­lair, Monte-air or Ku­lair, is the lat­est weapon for long term treat­ment. Some fam­i­lies, such as the Gouses from Pre­to­ria, called it “rev­o­lu­tion­ary”: “It was a lifesaver for our son,” says mom Rina. “He turned from con­stantly sick to the health­ier of the two brothers. At the same time, we grew used to him be­ing rather moody. Years later he was placed back on Sin­gu­lair in con­junc­tion with his usual in­haler. It was as if a switch was thrown – the mood­i­ness re­turned, big time!”

“Mon­teku­last is a strange drug,”

2 USIDE LEG KICKS This move tones the outer and in­ner sides of the thighs, as well as the ma­jor glute and hip mus­cles that form part of your hip sta­bil­is­ing group. WHAT TO DO

Stand­ing in waist or hip deep wa­ter, hold onto the side of the pool with one hand slightly in front of you.

Tighten your core, in­hale and lift your leg to the side while tak­ing eight counts to lift it slowly (as in the im­age to the right). Al­low the buoy­ancy of your leg to act as re­sis­tance.

Ex­hale while low­er­ing it back down again to its start­ing po­si­tion, tak­ing four counts to do so. Once again, use the re­sis­tance of the wa­ter to work your legs.

Re­peat the process for ten rep­e­ti­tions and al­ter­nate legs.

LOOK OUT FOR

Be care­ful not to twist your hips to the side – your hip bones should face for­ward at all times.

Make sure that your foot is flexed and that your toes are pointed for­ward. Fail­ure to do so means you will be de­vel­op­ing an in­cor­rect mus­cle strength ra­tio be­tween the outer and in­ner thigh mus­cles of your legs.

Re­mem­ber to keep your core con­tracted through­out this ex­er­cise, avoid­ing the temp­ta­tion to rock your body as mo­men­tum or hike your hip up us­ing your back. 3

TRI­CEP EX­TEN­SIONS You may not re­alise at first how hard this move works your bi­cep and tri­cep mus­cles while still en­gag­ing your core and pelvic floor. WHAT TO DO

Grab hold of a pool noo­dle with both hands and stand in hip deep wa­ter with your back to­wards the pool wall, feet hip-width apart where the pool floor and wall meet.

Lean for­ward while push­ing the pool noo­dle into the wa­ter with ex­tended el­bows (as in 3A). Keep your shoul­ders back and away from your ears. Slowly bend your el­bows while bring­ing the pool noo­dle up with your arms (as in 3B). Bend your el­bows to the point where you are still able to main­tain con­trol of your core and bal­ance. Re­mem­ber to en­gage your core at all times. Breathe by ex­hal­ing on the el­bow ex­ten­sion and in­hal­ing on the bent el­bow po­si­tion. Your goal is to com­plete two sets of ten of th­ese ex­ten­sions. Take four seconds to ex­tend your el­bows and eight seconds to bend them back to your start­ing po­si­tion.

LOOK OUT FOR

Re­lax your shoul­ders and make sure your chin is slightly tucked in to avoid com­press­ing and hurt­ing your neck.

Keep your el­bows point­ing di­rectly be­hind you – this goes a long way in achiev­ing good mus­cle tone with­out strain­ing your neck and shoul­ders.

Try not to arch your back, but keep your tail bone (coc­cyx) tucked in by pulling your navel to your spine.

you may not re­alise at first how hard this move works your bi­cep and tri­cep mus­cles while en­gag­ing your core and pelvic floor

This move strength­ens your shoul­der mus­cles and tones your up­per back. This goes a long way to help­ing you carry that tod­dler.

WHAT TO DO

Move to where the wa­ter is deep enough to reach your shoul­ders and strad­dle your pool noo­dle.

Stretch your arms out to the side with your palms on the sur­face of the wa­ter (as in the im­age to the right). The way you hold your hands has an im­pact on the re­sis­tance lev­els of this ex­er­cise: Easy Fin­gers are splayed out. Mod­er­ate Fin­gers are held tight to­gether. Hard Cut up a pool noo­dle into two pieces of about 15 to 20cm long to use as dumb­bells. Keep your shoul­ders back and away from your ears and push your arms down to your sides. Re­mem­ber how im­por­tant it is to main­tain your core, as this will help you bal­ance. Come back to your start­ing point and re­peat. Re­mem­ber to breathe, ex­hal­ing on the down, in­hale on the up. Aim to do two sets of 15 rep­e­ti­tions and ap­ply the 4-sec­ond: 8-sec­ond ra­tio.

LOOK OUT FOR

It is very im­por­tant to do this ex­er­cise while keep­ing your core con­tracted. Be aware of your lifting your shoul­ders up to your ears. If you are ex­pe­ri­enc­ing any dis­com­fort in your neck this is the likely cause.

Another thing to con­sider is whether your weight is equally dis­trib­uted on the pool noo­dle for bal­ance pur­poses. 5

UABDOMINAL CRUNCHES A new take on the clas­sic crunch, th­ese will strengthen your ab­dom­i­nal mus­cles while main­tain­ing your core.

WHAT TO DO

Po­si­tion the pool noo­dle be­hind your back with each end tucked un­der your armpit. The depth of wa­ter is ir­rel­e­vant in this case.

Lean back and lift your feet up while ex­tend­ing your legs, al­low­ing the pool noo­dle to help you float (as in 5A).

While tight­en­ing your core, in­hale and as you ex­hale bend your knees pulling them up to your chest (as in 5B). Use four seconds to bring your knees to your chest and eight seconds to straighten your legs.

Re­peat the process for ten rep­e­ti­tions and do three sets.

LOOK OUT FOR

Do this ex­er­cise re­mem­ber­ing to keep your core con­tracted. Re­lax your shoul­ders and con­cen­trate on us­ing your stom­ach to pull your legs up.

EX­TRA

N TO THIS AD­DI­TIO YOUR

TAR­GET S MOVE TO MUS­CLE

INAL ABDOM E OBLIQU

noo­dle be­hind the pool un­der Po­si­tion end tucked

with each and lift your back Lean back legs,

armpits. ex­tendin your your g float.

up while help you your feet noo­dle to

and as you the pool al­low­ing in­hale up

g your core, them Tight­enin pulling your knees

twist from ex­hale bend Once bent,

process to your chest.

Re­peat the side to side. ns and

do rep­e­ti­tio for ten

three sets.

a

b

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