When weaning is desired, it is best done gradually over several weeks, with one breastfeed at a time being stopped in favour of solids, formula or cow's milk. The milk supply will gradually reduce, and the breasts will return to their original size.
If a mother desires not to feed her baby at all, cannot feed because of disease or drug treatment, or the baby cannot be breastfed because of prematurity or other disease, it may be necessary to suppress milk production.
A firm bra should be worn and nipple stimulation should be avoided. Fluid tablets can assist reducing engorgement, and occasionally oestrogens (as in the contraceptive pill) may be prescribed. The best medication to stop the production of breast milk is bromocriptine (Parlodel), which will dry up most women's milk in three or four days, but it must be taken for at least ten days to stop it from recurring. It may cause some nausea in the first few days, but this settles with time.
The traditional method of using cabbage leaves inside the bra probably works because the leaves are cold and reduce the blood supply to the breast, and the cabbage taste on the nipples will discourage the baby from suckling.
See also BREASTFEEDING
Weight should be taken in the nude, or as near thereto as possible. If a surgical gown or minimum underclothing (vest and pants) is worn, then its estimated weight (about 0.1 kg) must be subtracted before weight is recorded. Weights are conveniently recorded to the last completed 0.1 kg above the age of six months. The bladder should be empty.
The signs that indicate that a doctor should be consulted about an illness include:
- Fever - a child with a fever over 41 °C requires immediate medical attention
- a child with a fever of 40°C requires medical attention within 12 hours
- a child with a fever over 39°C requires medical attention if it persists for more than 24 hours
- a child with a fever between 37°C (normal) and 39°C can be observed for a few days.
- Not eating - a child who refuses to eat for more than 24 hours needs medical assessment
- Not drinking - a child who refuses to drink for more than 12 hours needs medical assessment
- Urine reduced - a child whose urine production is significantly reduced for 24 hours needs medical assessment.
- Diarrhoea - a child with copious watery diarrhoea for more than 24 hours requires medical attention
- Vomiting - a child who vomits for more than 12 hours should be medically assessed.
- Lethargy - a child who is floppy and poorly responsive requires immediate medical attention
- a child who is reluctant to play or get out of bed requires medical attention if it persists for more than 24 hours
- a child with unusual tiredness and listless ness should be checked after a few days
- Breathing - a child who stops breathing for more than 20 seconds needs emergency medical treatment
- a child who has rapid, noisy or shallow breathing requires rapid medical attention
- Skin colour - a child with blue skin needs emergency medical treatment
- a child with pale or mottled skin needs urgent medical assessment.
- Rash - a rash that persists for more than 24 hours should be medically assessed
- Convulsion - any child who has a fit or convulsion requires immediate medical attention
- Pain - a child with pain that causes constant screaming requires urgent medical attention.
- a child with pain that is not relieved by simple analgesics (eg. paracetamol) requires medical attention within a couple of hours
- a child with pain that is relieved by simple analgesics but recurs for more than 12 hours should be medically assessed.
- Neck pain - a child with a painful and stiff neck requires medical attention within a couple of hours,
particularly if they have an accompanying headache and light hurts their eyes.
- if the child also has a dark red or purplish rash, emergency medical attention is essential
- Lumps - a child with a painful lump in the groin requires medical attention within a couple of hours
- a child with a tender painful lump anywhere on the body requires medical assessment within 12 hours
See also CHILDREN; FEVER
Whooping cough (pertussis) was originally an infection of ducks that only passed to humans after these birds were domesticated many thousands of years ago. It is now a preventable bacterial infection of the respiratory tract that may be very serious in children. A much milder form of the disease (parapertussis) is also known, against which the pertussis vaccine gives no protection.
The cause is the bacterium Bordetella pertussis, which is widespread in the community. In adults an infection merely has the symptoms of a cold, but in young children the disease is more severe, and spreads from person to person in the microscopic droplets exhaled or coughed out in the breath of a patient, so an adult with minimal symptoms may carry the disease from one infant to another. The incubation period is one to two weeks.
It starts in a child as a cold that lasts a week or two, but then the cough becomes steadily more severe and occurs in increasingly distressing spasms, characterised by a sudden intake of breath before each cough. Coughing spasms may last up to 30 minutes, and leave the child exhausted, then another spasm starts after only a few minutes. As the infection worsens, the child may become blue, lose consciousness, and thick stringy mucus is coughed up and vomited. The patient has no appetite and rapidly loses weight. Severe coughing may cause bleeding in the lungs, throat and nose, that may be severe enough to cause suffocation. If the child survives, the spasms start to ease after a few weeks, but mild recurrences may occur for months. Permanent lung damage is also possible.
The diagnosis can be confirmed by analysis of a sputum or throat swab. Pertussis IgA antibodies are normally not present, but a positive result indicates a recent or current pertussis infection. A swab taken from the nose and/or throat (the nasopharynx) is tested. The result is positive early in infection, but short lasting. The equivalent blood test (pertussis IgA antibodies) increase late, and persist long term, but only occur with infection, not vaccination.
No cure is available, but the disease may be completely prevented by a vaccination that is usually combined with those for tetanus, diphtheria and other vaccinations, and is given three times before six months of age, and again at 18 months, and five years of age. The vaccination was first used in the 1930s. The vaccine should not be given if suffering from acute illness, significant fever or epilepsy or if previously infected with whooping cough. The side effects are normally minimal but may include local redness and tenderness at the injection site, a persistent lump, fever, tiredness, irritability and a faint.
The treatment of whooping cough involves oxygen, sedatives and careful nursing isolated within a hospital for several weeks. Antibiotics can be used to prevent the spread of the disease to others.
Even in good hospitals about 2% of patients die, and up to 10% have long-term complications. In poorer countries, the mortality rate is much higher.
See also DIPHTHERIA; PARAPERTUSSIS; VACCINATION OF CHILDREN
Babies of both sexes sometimes produce milk from their nipples in the first few weeks of their life. Witch’s milk is the rather off-putting term used for this rather common problem. Babies can be influenced by the hormones in their mother's milk, or may be affected immediately before birth by these same hormones. It is in no way detrimental to their health.
No treatment is needed and the milk production is usually very slight and disappears in a few weeks. Interestingly, any woman or man can be made to produce breast milk if they are given the correct hormone cocktail at almost any time in their lives.