FAQ

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Table of Contents

General

Your child should not only see the paediatrician for an illness. It is also important to schedule check-ups regularly, beginning in infancy. These routine examinations provide the best opportunity for the doctor to observe the progress of your child’s physical and mental growth and development; to counsel and teach parents; to detect problems through screening tests; to provide immunisations, and to get to know one another and a time for you to ask questions. Check-ups are strongly recommended as part of preventive paediatric care.

Yes, in fact we strongly encourage parents-to-be to visit our office for a free prenatal appointment. This is a great way to get acquainted with our office and our doctors. During this visit, we will answer any questions that you have about our practice or your new child. 

Paediatricians are doctors with a specialisation in treating babies, children, and adolescents. From the time you deliver your baby all the way until they are full grown and even into early adulthood, your child can see a paediatrician as their primary physician. The answer depends on each individual patient.

Our staff includes four paediatricians, and two nurse with extensive experience with children and neonates. For an same-day appointment for a sick child the first available doctor will see you. For routine appointments you can book with the doctor of preference. Your patient file is available to any of the consulting doctors for continuity.

Feeding

Firstly, we are happy to support our patients’ mothers with whatever feeding choice they make. Still, breast milk has been associated with numerous health benefits for both the baby and the mother. To quote the American Academy of Pediatrics policy statement of 2 February 2005: “Research in developed and developing countries of the world, including middle-class populations in developed countries, provides strong evidence that human milk feeding decreases the incidence and/or severity of a wide range of infectious diseases including bacterial meningitis, bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, and late-onset sepsis in preterm infants. In addition, postneonatal infant mortality rates in the United States are reduced by 21% in breastfed infants.” Also, breast milk is less expensive, breast feeding mothers have lower rates of breast cancer later on in life, and the cuddling and bonding between mother and baby can be beneficial for both.

New infant formulas, bottles, and teats appear on the market regularly, all with the aim of making bottle feeding as convenient and as similar to breastfeeding as possible, however our practice encourages breast feeding even if only for a short time.

 

When you are bottle feeding, there are a couple of essential points to bear in mind.  The formula should be properly made up so that your baby gets correct amounts of both nutrients and water, and your baby should be able to draw milk at a comfortable rate.  You can make up one bottle at a time, mixing it in a bottle according to the manufacturer’s instructions, or a batch of several.

In general, it is virtually always a way to work it out so breastfeeding can be successful and without pain.

Our mothers can always call our rooms for advice.

We also refer mothers to the following skilled lactation consultants:

Pam Vorster               082 576 3749

Sr Ansu                        082 935 1386

The following is a very useful web site which you may peruse:

La Leche League South Africa           http://www.llli.org/SouthAfrica.html

The Breastfeeding Association of South Africa’s contact details are:

Gauteng Tel: (011) 883 9873 

Cape Town Tel: (021) 686 8363 
KwaZulu Natal Tel: (033) 396 2040  

Wouldn’t it be nice to know if your child’s eating was normal? The following list of feeding milestones for children is a guideline to a child’s feeding/eating development.  It also gives some baby feeding tips, introducing solid foods and cup drinking to your child.

0-4 months
At 0-4 months babies are solely breast and/or bottle fed. They have oral reflexes for suckling and swallowing.

4-6 months
At 4-6 months babies begin sucking and are no longer only suckling. The action of drinking a bottle or breast feeding is becoming less automatic and more voluntary. It is during this time period that many babies will be introduced to soft solid foods such as cereals and pureed fruits and vegetables. Cup drinking may also be introduced at this time (6 months) as they will practice their skills for future transition to the cup.

6-9 months
Between the ages of 6-9 months babies are able to open their mouths and wait for the spoon to enter. They are also able to use their upper lip to clean food off the spoon. At this time dissolvable soft foods may be introduced as well as ground or lumpy solids. Many babies are able to drink from straws at 9 months.

10-12 months
Mashed or chopped table foods with noticeable lumps are introduced during the age range of 10-12 months. Babies also begin to take most of their liquids from a cup although bottle or breast feeding may continue for bedtime. Their tongue may protrude under the cup in order to add additional stability. At 12 months they also have a controlled, sustained bite and are able to bite through a soft cookie and possibly a harder one depending on the presence of teeth.

12 -18 months
12 -18 month olds will playfully bite on the spoon. They will also begin to bite on the cup while drinking. They will improve with their biting skills and are better able to use a controlled bite to bite through a hard cookie. Chopped table food continues to be provided and more control over the lips and tongue has developed. 13-15 month olds can use a straw or regular cup.

16-18 months
At 16-18 months children are given more challenging foods that require chewing such as most meats and many vegetables. By 18 months they are capable of chewing with their lips closed however they often will not, however when their lips are open they should not be losing any significant amount of food or liquid while eating and drinking.

19-24 months
In the 19-24 month range children will begin to gain more control of cup drinking and will bite the cup less and less. They are learning to drink in longer sequences with little to no spillage. By the age of 2 children are able to manage any type of food they like as they have learned all the skills they need to eat every type of food, although they will continue to “fine tune” these skills over the next few years. (It is still recommended that foods that may be choking hazards such as grapes and hot dogs be cut in smaller pieces to avoid choking as many 2 year olds are always moving and playing placing them at risk for choking.)

About half way thought the first year of life, babies being to outgrow their liquid diet of human milk or
formula which, because of their increasing demands, may no longer supply them with enough nutrients
to support their rate of growth. Soft foods are introduced at 4 -6 months of age – for both breastfed
and bottlefed babies.
This second phase of childhood nutrition is a time of transition from milk to soft foods, finger foods and
finally to family foods.
The Adult’s Role
It’s the adults role to provide nutritious foods for their children.
Adults are responsible for what their children are given and when it is given.
Children are responsible for deciding how much to eat
This means that the parent controls the kind of foods served for meals and snacks.
You should not force children to eat
Children’s appetites and the amounts they eat change from day to day
Introducing solid foods (or complimentary foods) to your infant’s diet can be divided into three stages.
These stages correspond with physical and feeding milestones taking place as your baby matures.

Development

Child development refers to how a child becomes able to do more complex things as they get older.  Development is different to growth.  Growth only refers to the child getting bigger in size.
 
When we talk about normal development, we are talking about developing skills like:
 
• Gross motor:  using large groups of muscles to sit, stand, walk, run etc.  keeping balance, and changing positions
• Fine motor: using hands to be able to eat, draw, dress, play, write and do many other things
• Language:  speaking, using body language and gestures, communicating and understanding what others say
• Cognitive:  Thinking sills: including learning, understanding, problem-solving, reasoning and remembering
• Social:  Interacting with others, having relationships with family, friends and teachers, cooperating and responding to the feelings of others.
 
This is why we have routine check-ups, to check on development as well as growth.

The fastest growth phase of a child’s life is In the first year. By the end of the first year your child will have trebled or quadrupled in weight, increased 22-24cm in length and increased to approximately a 55cm head circumference to accommodate the growing brain. To achieve all this, your baby needs adequate nutrition. Plotting your child’s growth is a critical window to nutrition and development. Always ask your health care worker to plot your baby’s weight and height on the growth chart.

New Borns

Weight Loss

Your baby will lose weight in the first few days and this is a loss of water, it is not a reflection of how you are feeding.

Jaundice

This is common, mild, and rarely needs testing or treatment.  It is usually obvious by the third day and the medical staff will monitor and advise you.  Fluorescent lighting makes jaundice look worse.

Thyroid

Thyroid testing is done in the hospital on the third day to screen for low thyroid hormone levels.

Hearing

Hearing tests are also done in the hospital on about the third day.

Babies who are breastfed may have bowel motions with every nappy change or alternatively may only have one bowel motion every 6-10 days. Either pattern is normal. Some babies will seem to squirm and get a little uncomfortable after several days without a bowel motion, but the stool itself is soft when it arrives and therefore is not true constipation.
Occasionally babies will develop constipation particularly if they have been mildly dehydrated at any time. An occasional bottle of diluted prune juice might help with this. Drugs to relieve constipation should be avoided unless they have been prescribed by the doctor. Occasional green bowel motions are of no concern if the baby is feeding well and there is no vomiting.

• Frequently change nappy
• Rinse your baby’s bottom with warm water as part of each nappy change
• Gently pat the skin dry with a clean towel or let it air dry
• Don’t overtighten nappy. 
• Give your baby’s bottom more time without a nap
• Consider using ointment / nappy cream regularly
• If rash becomes angry and red, or you are concerned check-in with our rooms

Babies cry for many reasons, mainly to communicate.  Don’t be alarmed!

A good approach is to:

  • Cuddle, wind and check nappy.
  • The next 10 reasons for a crying baby are hunger, offer a feed (when you last fed is irrelevant).
  • Colic or “mystical winds” are uncommon in babies under 6 weeks.
  • If the above actions do not settle baby there may be an infection (e.g. cold, virus …) bothering your baby, contact your doctor if baby does not settle.

Relax, rest, eat well, and drink plenty of fluids.  Review the steps for “the crying baby” on the previous page.

Immunise, consider weekly weighing (your baby will gain approximately 150g per week in the early stages).

Treat umbilical cord vigorously with cotton bud and spirits until it has fallen off.

Please book this appointment when you first get home.

This is an important check-up to see that baby is growing and developing normally.  On the day of your appointment please phone one hour before your appointment to check that your paediatrician is running on time (emergencies are unpredictable).  A breastfeeding / changing room is available.  If you have any questions in the first 6 weeks, please check our website or give us a call.

Immunisation is a simple yet vital way of preventing children from contracting life threatening diseases.  If the recommended schedule is followed children will be fully protected by 24 weeks of age against Polio, Hepatitis B, Diphtheria, Tetanus & Whooping Cough.

 

Your babies’ first vaccine will be given in hospital and the next will be due in at the 6-8 week checkup. Please book both your paediatrician for your check up, and your nurse for the vaccine when you call in or go online.  

 

Please download The VaccineApp and register yourself as parent and your child. When your next vaccine is given our nurse will update the vaccine on you digital vaccine card. If you ever need it you can simply print it out as a pdf.

Download the vaccine app

Rooms questions

  1. Your first checkup will be at 6-8 weeks and other routine checkups will folllow. Please book in advance (011 706 1153). You can also book online at drmikegreeff.co.za
  1. When you call on the day for your sick child we will assist you with the paediatrician of your choice or the first available paediatrician on the day, if necessary.
  1. Our team of Paedicatric Associates provid an after-hours specialist emergency cover. If your GP or the Emergency Rooms at Sandton Clinic (Sandton Clinic ER 011 709 2111) are concerened and need specialist advice after they have examined your baby, they can access this after hours service on your behalf. The doctor in ER will contact the Paediatrician on call for that evening.

These services can be booked online.

Immunisations are offered at our rooms on an appointment basis and weekly weighing (for babies up to six weeks old).  There are charges for these services as nurses often spend significant time with moms.

As this is a specialist practice and it should be understood that your Medical Aid and plan of choice may or may not cover all the fees charged by the practice.  We appreciate payment for all services delivered in our paediatric practice at the time of appointment.  You can check our rates online when you book or call the rooms.  The rates that The Department of Health has unilaterally determined for doctors, which are known as the Reference Price List (RPL) and we choose to deliver a longer appointment and charge an independent rate.  We appreciate that you have chosen our dedicated team at Dr Greeff & Associates to care for your child.