Common Misconceptions

…and yes, many educated people believe in them, too!

She’s coughing a lot. Don’t  give them yoghurt etc. etc. WHY not?

Extremely common misconception. Yoghurt is good, specially if they are on antibiotics. It contains lot of good bacteria which will help restore their gut Microbiome (good bacteria), which may have been wiped off by antibiotics. It may help them recover from diarrhoea, secondary to prolonged antibiotic use. It’s the watery part of the yoghurt which has all the bacteria. The thick part is just the (broken down) milk. We, as such don’t restrict anything from children, which a well child can otherwise eat. (Including Ice cream, Mango, lollies etc.) Sometimes, children who are admitted with severe tonsillitis, can will only suck on Ice lollies and would refuse everything else. So WHY NOT?  

Shall I talk about what expectant and post delivery mums are given to eat ?(by their mothers / m-in-laws)I can tell you. it’s not needed.

As soon as you are pregnant, you are treated as a patient (I agree, things are improving, but most parts, it’s same old story). You are not allowed to walk fast, eat certain things, etc. etc. First trimester, you have to be careful, but later, you can relax a little bit. But not for our expectant mums. You have to eat for 2 and more. No evidence for that. Instead research is advising to eat healthy. Mothers make special SUPER HIGH CALORIE stuff made with Pure Ghee mixed with pot of nuts and sugar (is possibly the most calorific food in the world – very good for Marasmic children, but not for mums). It gets worse after you’ve given birth. Some cultures still don’t allow you to come out of a room or take a shower (can you believe it?)  You are kept in one room and everything is brought to you. Your baby is also not allowed to come out. The whole room stinks with ghee and other ‘Dawa’ (traditional medicines). Some expert local midwives say, it helps uterus contracts. Uterus contracts anyway, and does very well in all European and American mums. Doesn’t need ‘Ajwain’. The room is poorly ventilated, humid, no fresh air, and surprise, you get mastitis (infection of breast), infection of lower vaginal area and stitches, and get more unwell. Breast feeding has to be stopped and antibiotics started. You now, genuinely can’t move because of pain and still continue to eat (a lot). Your risk of DVT (Deep vein thrombosis goes up a lot). Your weight keeps on piling up and you do look like a mother (may be 10 years older than before you were pregnant). If you come back to senses when you feel (or somebody like me, jokes, have you got another baby there?), you try to loose all the FAT. It then takes 5-6 years to get rid of, unless you take intensive diet programme and exercise (not recommended). Unless, you get pregnant again and put another 10 kilos by the end! So free advice

1. Eat healthy (http://www.nhs.uk/news/2012/05may/Pages/pregnancy-diet-weight-management.aspx)
2. Be mobile as much as possible, till you can manage. Labour will be much easier
3. Some activities (guess which one!) which are thought to be impossible in pregnancy are actually OK in 2nd trimester
4. They are also useful if your due date has passed and nothing is happening. It can trigger labour 😉
5. Drink plenty of fluids when breastfeeding, along with healthy balanced diet. That’s good enough for you milk production.
6. Take a shower soon after delivery and move around if comfortable. Take painkillers if you need to.
7. Go for walks with the baby in fresh air and relax. It’ll help your milk production.
8. Keep the room at a comfortable temperature and well ventilated. It reduces risks for the bay to get SIDS.

YOU SHOULD TAKE ‘COMPLETE BED REST’  (Really!!)

Usually not a good advice. Very few conditions that I know, need bed rest. In most of the other situations, staying mobile is the better option. Please do discuss in detail with your doctor / therapist, as to why they are advising bed rest. I hear in many cases in India where bed rest is the ‘standard’ after any operation specially Caesarean or even normal delivery. The reason I say bed rest is BAD is because

1. It increases the risk of blood clot formation, which can then migrate to your brain/heart/lungs, leading to major complications like stroke etc.
2. Your muscles and joints will become stiff if you stop walking and it will take them longer to return back to normal, later you start walking.
3. You will put on weight and you know most of us are already ‘overweight’!
4. Your bones and muscles will become weak as they need constant stretching to keep them strong, which you’ll loose if you stop putting weight on them.
5. If you are restricted to a bed, and not allowed to take even a shower, it increases the risk of you getting infection in various areas specially the groin area.

It is indicated in some cases like some maternal or foetal complications of pregnancy, such as preterm labor, high blood pressure, incompetent cervix, short cervix, foetal growth restriction, preterm premature rupture of membranes (PPROM), placenta praevia or placental abruption. In normal pregnancy or even after Caesarean section, usually women are advised to start mobilising as soon as possible (with adequate pain relief) and to clean themselves or ideally take a warm shower. This reduces the risk of infections like mastitis and stitch infections. By confining post partum MOTHERS in a dark room with poor ventilation and not allowing them to shower for a week (a month in some cases), predisposes them to multiple infections and severe complications thereafter.

 Why should I get rid of that holy (RED) thread from my hand? It has to fall off!! I know that’s what we have been told. Why though? No one knows. The only problem that I have with that is, if it’s in the Right hand, it will be touching many other ‘stuff’ inadvertently. You do use your Right hand for many daily activities, don’t you ! Imagine that old thread with a long tail, touching all that it comes in contact with, gathering, all known bacteria and viruses to mankind. And then you eat with the same hand, so no wonder it’ll touch your food. Can you picture this. It’s not Rocket science. So please keep it for a day or two (max), say sorry, and please untie or cut it.  And please do wash your hands regularly. That’s the only way you prevent transmission of infection, not by wearing mask or any other measure. (That’s another topic). Can I take painkillers, like Paracetamol with Antibiotics?  Another very common misconception. Many people don’t know that these are two completely different things. You should take painkillers (I prefer Ibuprofen, unless you have stomach ulcers)  for any type of pain  or fever. They reduce inflammation (swelling, redness), thereby reducing pain and control the temperature,  which could be caused by virus, bacteria or trauma etc. Antibiotics, on the other hand,are given to fight bacteria in a bacterial infection (most infections are viral though) They work in a totally different mechanism to painkillers and do not help in reducing pain or fever. Eventually they kill the bacteria, if that is responsible for the pain and fever. They may take take 24-48 hrs to ‘kick in’ and have some effect. Paracetamol and ibuprofen also work in different ways and are handled by liver and kidney respectively, so can be taken together without any problem (provided your liver and kidney are OK 🙂 Why are you not giving Antibiotics (A very common problem, UK GPs face with Asian / EU patients) Despite enormous effort by Department of Health and various other agencies, some people still fail to understand that most infections are ‘Viral’ and don’t need antibiotics. The reason is actually simple. What they have seen all their life in their own countries like India, is that minor infection like sore throat or a cough cold episode, you get Antibiotics from Pharmacy, your local doctor, hospital, dispensary or even friends. It seems to work because the viral infection is getting better anyway. Nobody waits a day or two for the infection to settle by itself. On the other hand, you hear cases when a person got very unwell because they were not ‘taken seriously’ and not given antibiotics. These cases are rare and happen, 1 in  a million, but obviously media get a good story and blows it out of proportion. Most infections are viral and antibiotics will not help. Instead, if antibiotics are taken, the bacteria will develop resistance for that particular antibiotic. We see this very commonly in people coming from India where they grow ‘multi-resistant’ organisms which will not respond to common antibiotics like Penicillin, Erythromycin etc. These patients have been treated with Broad spectrum ‘BIG GUNS’ like Cephalosporins, Meropenam and have now developed resistance to all commonly used antibiotics. It becomes very tricky then to choose an antibiotic which will work. Those antibiotics usually have significant side effects. So how to judge wether someone needs antibiotics That obviously is a professional clinical decision. From patients point of view, you should give adequate painkillers (same as antipyretics) like Paracetamol and Ibuprofen in correct doses. Adult Paracetamol dose is two 500mg tablet (not One) and similarly Ibuprofen two 200mg tablets. For children see my dosing blog. Look for red features like ‘non blanching rash, drowsiness, difficulty in breathing, colour change etc. If you are worried, get professional advice. Most common colds, sore throats, will get better within 4-5 days. If the fever is not coming down with adequate doses of P & I, then seek professional advice.  Keep the room cool and well ventilated. Keep them well hydrated and don’t worry if they are not eating. As long as they are drinking enough and passing urine regularly, it’s OK.

Kuchh khata nahi hai / Bahut Kamzor hai ! (Doesn’t eat anything / Is very weak) I’ve had some complaints from Non-Hindi speaking mums as they don’t get, what I am talking about, thus the translations.

In my clinic, I very often hear the complain – ‘Kuchh khata nahi hai !”. I plot the child on the WHO growth chart. They are above the 75th centile for their age. I feel like saying, please don’t feed him. He’s doing absolutely fine. He’ll eat what he wants to eat. They don’t like me anymore. But, it’s my job to tell them if they are putting their child at risk of obesity leading to lot of problems as I said in my other posts. We Indians (in fact , all South Asians and Chinese alike, I think), have an obsession in feeding our children. I have never come across a single English parent in my 15 years in UK, who has said, that our child does not eat. They actually say, ‘He eats for England !”. No Indian mum will ever say that, though their child may be eating for India, in case ‘Nazar lag jaye’! Running after children to feed them is a common site. (It’s a good exercise for mums and some dads as well, not enough though 😉 Latest is of-course, feeding while showing them iPad / iPhone. Unbelievable !! I have a theory, (not research based). I think by feeding, and invariably overfeeding children, they become aversive to food (don’t like the idea of eating). It’s not an enjoyable activity any more. When they are little (6 months – 1 year), their stomachs are tiny. You can’t expect them to eat too much. I have seen my friends and family, holding their children’s mouth and shoving the food in. I think it’s abuse, but they think it’s motherly ‘love’. Since then, they associate the first sight of food as a very painful and uncomfortable experience. This, I have confirmed with my Speech & Language Therapists (SALT). What to do Parents are then advised to stat from scratch and let the child play with the food and mess around. Food is offered to them in front of them and they can pick and eat as much as they want. Slowly, ‘eating’ becomes enjoyable and fun again, as it should be in the first place. Cover her up, she’s got fever  Very common misconception. When the body temperature rises, body shivers to get rid of the heat by muscle movements.You do feel like covering up but that stops heat loss by ‘Convection’, meaning the air flow trying to cool your body. If the child is wrapped up, her temperature is going to rise even further as the layers will act as an insulator. What you should do? Olden days, I remember, douching children with cold water. Don’t do that now. Take all the clothes off (or as many as possible), take them in a colder environment and put a fan on to keep cool air circulating around them.  Ensure they are drinking enough. If the temperature is too high or the child is uncomfortable / in pain, give Ibuprofen / Paracetamol (Check doses section, http://ramnikm.sg-host.com/2016/06/21/paracetamol-ibuprofen-dosing/ ). Latest guidelines say, that if the child is otherwise well, then you don’t even need to use medication/ But to be honest, it may be difficult to know that in a very small child. Small babies should be checked over by a medical professional (unless it’s post vaccination fever – http://ramnikm.sg-host.com/2016/06/21/please-give-paracetamol-with-vaccinations/).