– Fedor, you have two daughters. Don’t you worry at all?
– In the health of children, own peace of mind and lack of panic are most important. Situations in which it makes sense to worry, are extremely rare, and they are pretty obvious. If mom starts to panic, it is advisable to ask dad.
After all, when you deal with your own children, it happens that the mind is overshadowed. And I have one.
– When should you start to panic? Signs of …
– Lack of breathing is a fairly distinct sign. Pulses … Obvious situations related to injuries: falls from a great height, serious injuries, especially those accompanied by bleeding, burns, poisonings.
It is necessary to react quickly and call an ambulance.
If we talk about banal diseases – mainly these are infections: respiratory, intestinal, urinary – then most of all parents are concerned about when to start worrying during this infection. Here it flows quietly, and suddenly something happens.
This may be primarily a difficulty in breathing, the appearance of an incomprehensible rash, especially in combination with temperature. Excessive lethargy of the child, drowsiness, up to loss of consciousness.
Inadequate response to stimuli. Discoloration of the skin: when the child is blue or pale, this is not a good sign. That is, these are the signs that will make any person frightened.
Just raising the temperature to 39, even if it badly gets off, is not a reason for panic, but a reason to understand. You can notify the doctor, and then he will decide whether to do something about it.
– Doctors are different. For example, I am very grateful to my pediatrician when, in response to another cry, he says: “We are not doing anything, we are watching.”
My favorite phrase. But not everyone was lucky.
How to find your doctor?
– A pediatrician with a patient should form a partnership. Therefore, in the first place, I would run from those doctors who practice the paternalistic approach, do not listen to the patient, and issue recommendations in the form of an order.
Parents have the right to ask why this or that examination is necessary, this or that vaccination, and in general any intervention in the child’s health, and the doctor should explain this to him in detail.
Otherwise, you can leave the office with a pile of prescriptions that are not used in modern medicine in developed countries. This is such a marker is not very competent doctor.
– For example, what drugs?
– Immunomodulators, antiviral, homeopathy, antitussive and expectorant drugs in children. A good pediatrician is one that does not treat ARVI.
– What to do with ARVI?
– My favorite recommendation: to water and to love. You can wash your nose.
In some rare cases bury the vasoconstrictor. But mostly otpaivanie, fever by necessity and care.
Of course, in different situations a child can be helped, but not in order to cure him, but in order, for example, to improve the quality of life. When a mosquito bites a child, I say you don’t need to do anything about it. But, on the other hand, I understand that itching can interfere with sleep.
And it would be good to anoint the bites with lotion. And in some cases, the reaction is so pronounced that blisters blow, bruises remain.
And then a short course of hormone cream will not interfere in order to relieve this inflammation and reduce the undesirable effect. But this is not a cure for mosquito bites.
And, if nothing is done with them, they will pass by themselves.
– What is wrong with homeopathy? She, of course, does not cure, but there is no harm.
– Homeopathy is considered no more effective than placebo. I do not support the practice of prescribing a placebo, it makes a fool of people, forms the habit of medicines for the child, the idea that all problems must be treated.
A lot of problems do not need to touch at all. Need to calm down.
– Another option: go to an osteopath …
– Until I am convinced of the reverse scientific data, I will assume that osteopathy is a quackery. This is indicated by two things.
First, the theoretical basis on which osteopathy is built does not stand up for any scientific criticism. It is a fantasy. The second: according to the results of research, osteopathy does not work.
In addition to individual situations, which, in particular, include back pain. But while the same results show manual therapy and nonsteroidal anti-inflammatory drugs.
It turns out the same placebo. A person is engaged in something, walks somewhere, something rubs him. But it would be much more effective to do physical exercise.
Plus, osteopathy does not have sufficient control and safety criteria.
– Let’s now kick antiviral. What are they bad?
– Antiviral drugs exist in a very limited set for specific viruses: HIV, hepatitis, herpes, influenza. Against viruses that cause SARS (except flu), there are no drugs.
And all that is called deception.
– What, in your opinion, diagnoses and appointments should not be?
– If the child has problems with the skin or with the stomach and the pediatrician asks you to give a stool for dysbacteriosis, it is better to find another.
Parents consider the diagnosis of biliary dyskinesia. And it is usually based only on the fact that they found the inflection of the gallbladder on ultrasound.
This is not a disease.
Very often, when the child is ill, it is not known what (most likely, a prolonged acute respiratory viral infection), pediatricians tend to look for all sorts of herpes infections. They can be found in almost everyone and blame everything on them.
And to prescribe some alleged antiviral treatment. Firming.
Similarly, with frequent bronchitis they like to look for mycoplasma and chlamydia.
The meanest diagnosis is “perinatal encephalopathy” from neurologists with the appointment of nootropics. You can make such a diagnosis to anyone, and after a course of useless injections is prescribed, the smallest and most unprotected suffer from obscurantism.
Neurologists also often put hypertensive-hydrocephalic syndrome. The conclusion is made by a small expansion of the ventricles of the brain, which is found on ultrasound, which should not be done.
Ultrasound is generally a subjective method. Therefore, whether there is an extension or not is also a big question.
Harmless, but completely meaningless appointment – baby massage. Children supposedly begin to develop. For some reason, masseurs are silent about how babies are already developing.
On their own.
– How many times a year from the moment of birth do you need to visit a pediatrician?
– If everything is in order, five to six visits are enough, and almost all of them are timed to vaccination. Premature, poorly added and underweight babies require closer monitoring.
– What should not be done from what is offered in clinics without fail?
– In the first year of life there is no need to visit such a large number of specialists. In particular, if the ultrasound examination of the hip joints is okay, then I see no need to consult an orthopedist.
An echogram (ultrasound of the heart) is useful, but an ultrasound of the abdominal organs, kidneys, and head (neurosonography) as a screening is considered unnecessary. This often leads to more anxiety than to a useful diagnosis.
If everything is good according to the audio test (it is done in the maternity hospital), then you should not visit Laura.
I consider it obligatory to visit an oculist. A neurologist can be consulted later.
Not in the month of life, as is done, but in the region of four.
– And why is this all prescribed, meaning?
– These are non-invasive, harmless methods. I believe that doctors want to take on as little responsibility as possible, they want to carry out a complete examination as much as possible, so that this responsibility can be shared with all specialists and functional diagnosticians.
In countries where medicine is adequately paid, this is too expensive and unjustified. The examination should always follow the clinical picture, that is, the visible symptoms.
– We turn to the mandatory procedures. What is the logic for creating a vaccination calendar?
– It takes into account the age at which a disease can be particularly dangerous. The structure of the pathogens that cause diseases varies with age. For example, for teenagers, meningococcal meningitis is more likely to get sick, and for a 3-year-old child, pneumococcal.
Therefore, vaccinations are made in certain periods: when they are most relevant. Rotavirus can get sick in adulthood, but we only vaccinate babies, because the first two years of life is the most dangerous and potentially fatal disease.
Whooping cough has recently begun to make pregnant women to protect newborns. Because while we vaccinate the child himself, he has been living for several months, the most dangerous, when whooping cough can kill him. When creating a calendar, the territorial epidemiological situation is taken into account.
There is no point in inculcating encephalitis in Sochi or in typhoid fever in Karelia. The calendar is based on the known vaccine efficacy; the frequency of their introduction depends on when we get an adequate response. For some, this is a one-time vaccination, others need to be done three times.
Economic factors also affect. All vaccines included in the national calendar, the state must provide.
Therefore, it lacks a lot of vaccinations.
– Meningococcus, chickenpox, hepatitis A, rotavirus, hemophilic infection. Pneumococcus often do not.
They need to buy.
“I wonder why mommies chase after children with chickenpox and try to infect theirs from them if there is a vaccine.”
– Many simply do not know about its existence. Vaccination against chickenpox is different from the chickenpox itself in that the second is a disease and it is unpredictable. It can flow hard, give complications – encephalitis, pneumonia, cause unpleasant consequences.
Probably need to say that chickenpox is a deadly disease. And although the chance at preschool age to die is rather low, it is in infants and adults.
The disease adversely affects the immune system. After blisters, pockpots can remain for life. A varicella virus, remaining in the body, can subsequently cause herpes zoster.
And the virus that is contained in the vaccine is less likely to do so.
In addition, it is simply unpleasant – to look at a child who is suffering, lies with a high temperature, rotates from side to side and cannot get rid of the itch. Chickenpox vaccine is well tolerated.
Done twice and for life.
– Tell us about meningococcus and how to escape from it.
– Meningococcus is a relative of the bacteria that causes gonorrhea. It can provoke various diseases: from a simple cold to purulent meningitis and the fulminant form of meningococcemia, blood poisoning by meningococcus, which leads to death within 24 hours.
The child dies quickly, unpredictably, little can be done.
There are five main types of meningococci. Four of them are saved by the modern Menactra vaccine. Fifth, meningococcus B, is vaccinated separately with Bexsero vaccine, which is not yet available in Russia.
I recommend to do this vaccination in other countries. In America, it is practiced only as a teenager, and in England it is made from two months.
– What are two months? We are afraid to do vaccinations if the child has snot.
– There are several clear contraindications, they are written in any instructions for vaccines, neither snot nor cough do not apply to them. Temperature above 38° is contraindicated.
Although in some countries – above 38.5. But it, most likely, will not affect the development of undesirable reactions, but will reduce the effectiveness.
Therefore, we are waiting.
– Let’s talk about one more scary story – “the diet of a nursing mother.”
– It does not exist. The reasons for this mythical diet may be two. The first is to lose weight after pregnancy.
It is quite selfish, can affect lactation. The second is the fear of allergies.
But he is absolutely unjustified! By default, the child has no allergies. They evolve over time.
And the later a person is faced with some products, the more likely it is that he will develop an allergy.
Therefore, it is now practiced throughout the world earlier introduction of a variety of complementary foods. As for mom, she should limit herself if she sees a direct connection between what she ate and some kind of problem in a child.
It is unreasonable to conduct an experiment and eat again.
– And when is the correct feeding?
– Between 4 and 6 months. After six months, the milk becomes insufficient for its nutritional value.
For a variety of nutrients and microelements. And children without complementary foods may develop a deficiency, leading, for example, to anemia, a decrease in hemoglobin. Reduced hemoglobin leads to a lack of oxygen.
And this may already provoke a delay in development, a decrease in immunity. Timely introduction of complementary foods is necessary in order to develop the brain. With the help of different tastes in the brain, new connections are formed between neurons.
To accustom the child to new tastes well, while he has not yet learned how to actively refuse. It happens that with the late start of feeding at 9-10 months, the child begins to reject the food, and it is much more difficult to train him.
And it is necessary that he pass in time to solid food: chewing stimulates speech.
– Your approach to the profession is somewhat different from the generally accepted.
– My practice is based on three things: evidence, partnerships and a non-anxious approach. This means that I try to use only those methods that have shown their efficacy and safety in large studies, I build equal relations with patients and are more inclined to close observation than to the survey “just in a row just in case”.