Pneumonia again; and stitches in the head

My daughter came down with pneumonia again in November and was admitted to the hospital for 4 days.  She had had pneumonia for 4 times now since she was born, and she’s only 3 ½ years old. Poor thing. I’ve never been admitted to a hospital in my life until I gave birth to her. 

It started innocently enough; she developed a mild cough, so did her little brother. But as her brother recovers, hers got worse to the point that she started wheezing. The night before she was admitted, she couldn’t sleep (neither could I) because she had trouble breathing and she was already burning up in a fever.  Both my husband and I are well versed in pneumonia attacks - as she’s had it 3 times previously – we were pretty sure she’ll have to be admitted. 

Aliah getting the nebulizer treatment in the emergency room

So when the doctor confirmed that she needed to be admitted, no one was surprised – except maybe my daughter herself. Luckily we left her brother at day care before coming to the hospital. This time was a little more complicated than before; all previous pneumonia attacks happened before her brother was born, meaning she was still the only child. Now we had to think of who could take care of her brother, as I couldn’t watch both a sick child and monitor a healthy child. My husband could not take additional leave days; his job was pretty crazy at the moment. Lucky for us, his parents had just retired a few months ago, so they volunteered to care for the little guy. But as my son is still breastfeeding at night, so my husband would have to pick him up after he leaves work at night. So all four of us camped out at the hospital for 3 nights; me and my daughter on the bed, and my husband and my son on a small, travel mattress on the floor. The first night we had to stay in a four-bedded children’s ward as all single bed wards were full. 

My husband left for work around 6.30am, so I have to bath both kids, dress them and feed them breakfast while waiting for my in-laws to pick up my son for the day. Not an easy feat when one of them is a healthy child. Luckily all the other beds were empty (all of them got transferred to other wards during the previous night) so we had the ward to ourselves. He managed to spill orange juice, spill a container of cornflakes on the bed and on the floor, pressed the nurse button several times (I had to apologize embarrassingly to the nurse) and almost tipped over the IV drip stand; all in the stretch of a couple of hours. At the same time, I had to coax my daughter to take her oral medication and her nebulizer treatment, which she had to take every 4-5 hours.

We got to transfer to a single bedded ward on the second day, around 8pm. So the remaining 2 nights we slept more fitfully, as we got an extra bed; the travel mattress was left in the bag. On the third day, a fruit basket with a Smurfette arrived for my daughter; my office sends fruit baskets to all employees that got hospitalized. The cheerful faces were like a ray of sunshine in a rainstorm; both kids were tearing up the plastic covering like crazy. I was smiling to watch them whooping in delight, until my son started playing soccer using the persimmon as a ball. Lucky the persimmon didn’t crush into pulp under his little feet. 

so happy!

All in all, I think kids and hospital just can’t go together, especially when the kid had to be strapped to an IV drip. The bed was pretty confining and TV got boring after a while; I had to let her watch the Disney Channel to keep her occupied, which kept playing Mr. Bean cartoons again and again. Whenever the IV drip was taken off, she begged to go to the playground at the children’s ward entrance or the small shop downstairs. I spent some money buying magazines, small toys and various biscuits for her, to keep us both from going insane. At first she doesn’t mind the nebulizer treatments, but later she started acting up and refused to take it. I had to make it an entertainment for her; sometimes I carried her and we danced around the bed where the IV line permitted; sometimes I took a few turns at the nebulizer myself, to be ‘fair’ to her. What a mom wouldn’t do to get her child healthy again. So on the fourth day when the doctor proclaimed that my daughter is good to go home, we left as soon as possible, hoping not to come back to the hospital until next year, at least.

My hopes were short-lived.

It was almost 3 weeks after my daughter left the hospital. I was doing a full medical checkup at that same hospital. My employer covers a full medical checkup for all employees once in every three years, and this was my first time. I was waiting for the ultrasound when my maid called. She was new and had just worked with us 2 days after my daughter left the hospital; she doesn’t understand our language very well, so there were some communication problems in the beginning, but she was getting better. She told me that she was washing up my daughter (she just pooped) when my son came running into the bathroom, slipped and fell down, hitting the back of his head on the door ledge. I didn’t hear my son crying, so I didn’t worry too much about it. 

I immediately called my husband, asking him to get home and check on our son. He was at a car workshop, luckily nearby our home. My son seemed perfectly fine despite cutting his head open; he was already playing with his sister as usual, he wasn’t even crying anymore. My husband took one look, called me and said “I think he’ll need stitches.” I was like “What???” I thought it was like a graze when you fall down on your knees. Since I was already at the hospital, my husband packed up the kids, hailed a taxi (our car was left at the workshop) and came to the hospital to meet me.

I had to cut short my medical checkup and postpone to a later date, and went to the emergency room to meet them. It was already noon, so naturally the kids were getting a little cranky for their naps. I was a little freaked out to see my boy’s little head cut like that. The blood was just oozing slightly out of the cut, without any spills. He doesn’t seem to be aware of the pain too much; he remembered the pain when somebody touched his head, or when he lied down on my lap to nurse. Even when the doctor first looked at him, he said “He doesn’t seem to be in any pain at all.” But he did cry when the doctor cleaned his wound and bandaged his head. We had to wait for the general surgeon for about an hour, to come to stitch him up. While waiting, he jumped around on the sofas, ate some chocolate biscuits and pulled off the head bandage three times. A nurse commented to me, “Weren’t you here a few weeks ago…” I was like, “Yeah yeah, that was my daughter getting pneumonia, now my son cut his head.” 

Aliff in his head bandage

Then the surgeon arrived, looked at his wound, and asked us whether we would prefer for our son to take the general anesthesia or the local anesthesia. To take general anesthesia, he would have to be admitted, not eat anything for 6 hours and stay at the hospital at least for one night. I had had enough of hospital wards, so we decided to take the local anesthesia. I didn’t have the heart to watch my son’s head being stitched up, so my husband stayed with him during the procedure. My daughter was already asleep in the stroller outside in the waiting room, so I stayed with her. 

But that didn’t stop me from hearing my son’s cries, which was pretty distressing for me, imagining what he was going through. I braved myself enough to peek through the door, and I saw him lying face down on the table, my husband soothing him while holding him down with a nurse, the doctor on his left side, stitching away. My son was whining and crying a little, definitely uncomfortable. I was glad that my husband stayed with him; this was totally different than holding down my daughter while she was being pricked in the hand for an IV line. 

Half an hour passed and my husband came out, holding the little boy in his arms. He immediately reached out for me, crying. It was the combination of discomfort, pain, weariness, disorientation and the after effect of the local anesthesia. He doesn’t want to be put down on his feet, but when he does stand on his own feet, he seemed to sway a little on the spot. I tried showing him my phone to distract him but then he took my husband’s phone and matched them, saying “same.. same..” Truth be told, it was rather funny. After getting his meds, we hailed a taxi and scrambled back home. I breastfed my son, and he was asleep within 10 minutes. 

Sleeping on his tummy, like I said.

For the first 3 days, he was still feeling the pain, so he remembered to sleep on his tummy or on his side at night. He was even scared to lie down to nurse or to put on his diapers, so we had to hold his head or put a small bolster pillow underneath his neck to support him. On the 4^th day he could already lie down with his head supported with a soft pillow. Now he’s already forgotten the pain and could put his head down like normal. Every time he jumps on the sofa or on the bed, we’ll remind him that he might fall down and hurt his head again. He’ll remember the pain for 5 seconds, touch his head and continue jumping. Ahh, the blissful ignorance of childhood.

Water Babies - Toddler update

When teaching your toddler to swim, the 3 most basic things to teach would be:

• Blowing bubbles
• Going underwater
• Floating

Blowing bubbles

When you teach your child to blow bubbles, you’re actually teaching him to blow out the breath while underwater, which is the proper form while actually swimming. People who have never joined a real swimming lesson would say, swim a breaststroke, while holding the breath while being underwater and blow out the breath when the head breaks the water surface (like myself, before I joined a swimming class. See, even a clueless adult can get this wrong). It’s actually the reverse; you take a deep breath, dip your head into the water and blow out your breath in bubbles while underwater.

Firstly, teach your toddler to blow soap bubbles, which is great fun!

Photo courtesy of www.earthhopenetwork.net

Once he’s got the hang of it, you can try and get his face close to the water and blow something across the water, say a boat or a rubber duckie. When he’s comfortable enough, you can show him to blow bubbles underwater. You can demonstrate by taking a deep breath, put the lower half of your face into the water and blow out bubbles.

Photo courtesy of www.iswimemler.com

These gradual steps ease the fear and pressure off your child, while increasing his confidence with water. Most children love to play with water, by getting your head underwater is whole different story.

Going underwater

There are basically 2 ways to go underwater, by holding your breath or by blowing out your breath (duh). In my opinion, blowing out is easier for a child than holding the breath. Some kids simply do not understand how to hold the breath! It’s better if you can make a game out of it, say holding your breath and blow out three candles at once. Or using the earlier example, hold your breath and blow a rubber duckie as far as you can across the pool.

Once he can do this, then you can teach him to hold the breath, while you pour water over his face. Another way is to hold the breath before you pour the water, and blowing out when you actually pour the water. When he masters this, then you can proceed to telling him to hold his breath, and gently dipping him in the water.

Holding the breath is one of the most basic skills needed when one learns to swim. If you have ever enrolled yourself in a swimming lesson or you’ve tried swimming on your own, the first thing you do to swim is hold your breath, head underwater, arms up and straight in front of your head and kick your legs. Teaching your toddler to hold his breath is a preparation for this, sparing him the unfortunate swallowing or inhaling water through the nose or mouth, which can be very painful and traumatic. It could even scare your child off from trying to hold his breath again.

Floating

A basic back float can be a life saver if a child accidentally falls into a pool or a lake. The key to floating on your back is to relax. Fear and panic will definitely bring him down into the water. This is why teaching a baby to float is much easier, because babies are more relaxed and feels comfortable in water, due to their previous water-like surroundings in the mother’s womb.

To ease this fear, you could help your child to float by laying him gently on his back in the pool, with his head resting on your shoulder, one of your hands on his back in the water and your other hand on his chest to make him feel more secure. When he’s confident enough in this position, you could move your hand from his chest and support the back of his head. When he’s relaxed enough, gently let go of your hands.

Okay, time to take a picture!

“Going down to the pool” has become a weekly activity for my kids. Both of them had not started swimming yet, but they certainly enjoy just being in the pool, splashing each other and play ball. My daughter, while wearing arm floats, has started floating on her back, which she practically learned on her own. I was watching my boy when my husband, who was taking photos from the side, called out. I turned around and saw her floating on her own. She has yet to learn to go without the float, though.

And there's my little boy.

Just for fun, watch these videos of my kids in the pool. Sorry about the video quality, it was taken from my 2 MP old camera phone. And please excuse yours truly yelling in the background. A mom just gets too excited sometimes. Heh.

References:

www.suite101.com, www.swimming-techniques-learn.com

Pneumonia and Bronchitis in babies

Courtesy of www.earaymundo.com

I’ve had a number of sleepless nights for almost two weeks now. It’s because my daughter has been coughing vigorously in her sleep and vomits out milk that she just drank hours ago. (A few days ago, it was rice with fish and some vegetables and bean sprouts. She must have swallowed them whole.) As I’m a rather light sleeper, I’d usually wake up when she starts to cough that kind of deep, belly cough filled with phlegm and mucus, just in case she vomits. Usually I get up from bed and out of the room to get a spare plastic basin for her to vomit in. Or just in the nick of time, like last night, I stopped in the middle of my prayers and put my hand in front of her mouth to catch her vomit, so minimal amount of vomit spills onto her cot. This has happened several times, in bed, in the car or pretty much anytime I noticed her coughing. Yesterday and this morning, I arrived at the office with my hand smelling of vomit.

When this kind coughing spells hit, I would of course, consequently sleep less smoothly. I noticed that my daughter is quite sensitive to certain kind of foods i.e. cold food like puddings cold drinks, oily food like fried fish crackers, even some types of tropical fruit. Her coughing would start that very night after she consumed such foods. Incidentally, she’s quite prone to catch colds and coughs infection, because she goes to a nursery where there are a lot of kids. (This is one very well-known disadvantage of sending your child to a children day-care centre.) It’s unlikely that a day-care centre with two or three caregivers to monitor very strict cleanliness of ten to fifteen toddlers at the same time. And it’s quite certain, that when one kid gets sick, others would get catch the virus pretty quickly.

The diagnosis

My daughter was diagnosed with pneumonia once, when she was around 10 months old and had to be hospitalized for three days. (The doctor asked to stay for another two days, but we politely declined. We promised to give her medicine and all that.) How the pediatrician diagnosed her was pretty much by the text book; he watched how she breathed and listened to her lungs with a stethoscope for her breathing patterns sounds and any abnormality. He mentioned that she breathed more rapidly to take in more oxygen because of the mucus in her lungs. And because babies do not know how to spit out the phlegm, she simply swallows them back into her lungs, causing an infection. After looking at my daughter’s chest x-rays, he confirmed it pneumonia and asked us to register her into the hospital ward.

The symptoms

It all started with the coughing and high fever, which are the main symptoms of pneumonia. She was certainly coughing hard until she usually vomits, and her temperature went up to 41 degree Celsius. Her breathing was quickened, she refuses to drink her milk, sometimes drinking only once a day and she was very weak, she keeps lying down and slept by herself. (If you knew how very hyperactive she is, then you’ll know that this is VERY rare.)

Difference between pneumonia and bronchitis

Bronchitis is an infection of the bronchial tubes. Pneumonia is an infection of the lungs. Bronchitis is a less severe form of pneumonia, but it will develop into pneumonia if left unchecked. Both illnesses have common symptoms and are caused by either these two reasons; bacteria or virus.

Courtesy of www.thingamababy.com

Treatment

If it is caused by virus, the main treatment would be lots of rest and consuming plenty of liquids, to fight dehydration from the rapid breathing and fever. You can try a cool mist humidifier in the room to combat the dryness in the air that’s causing her to cough. (FYI, air-conditioning is very drying, not only to the skin, but also to the throat.)

If it is caused by bacteria like what my daughter had, she was given antibiotics and other medications though a needle in her hand, which is more effective than consuming them orally. She was also give some nasal medication to dry up her runny nose and at times, fitted with an oxygen mask to help ease her breathing. And of course, lots of fluid and rest is essential to any sick child.

Prevention

Some ways of upping her chances to stay healthy are:

• Keep her vaccinations up to date as this helps to ward off many illnesses that can lead to pneumonia and bronchitis, such as measles. In Malaysia, taking up chicken pox and pneumococcal vaccines is not part of the normal routine vaccination schedules, but my daughter’s pediatrician did recommend it. It’s more expensive, by the way.
• Practicing good hygiene is important too. Frequent hand-washing prevent the spreading of germs and bacteria. But as you probably know, it’s impossible to keep watch on your child every second of the day. Sharing cups, plates and utensils spreads germs easily too, so that’s why kids at day care centres get sick more easily. My point is, try to be clean as humanely possible, but please not to the extent of contracting obsessive compulsive disorder (OCD).
• Try to maintain the home smoke-free. Ask any person or guests who smokes to do it outside. Studies have shown that children who live around cigarette smoke get sick more frequently and are more susceptible to pneumonia, upper respiratory infections and asthma. What better reason to quit smoking than to have healthy children?
• On a personal note, take notice on any factors that could make your child sick, e.g. how eating oily or cold food can start coughing bouts for my daughter. When family members offer such foods, politely decline. This could prove to be difficult too, as my daughter would want to try to eat anything she sees. So if we don’t her to want to eat, better to hide it in the first place.

Although prevention is better, I must say it’s rather impossible to totally keep pneumonia out the door. Babies and young toddlers are highly prone to bronchitis and pneumonia as their immune systems are weak and are still developing. And for me, it’s rather unrealistic to keep tabs on every single food that passes through her little hands. Kids are explorers, after all. So just do your best to protect your child.

Sources: www.babycenter.com, www.gurgle.co.uk, www.tenderbabycare.com