Paediatric Association of Jamaica

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Parents Corner

 A collection of acticles written by our members or guest authors,
they try to help guild or explain commonly asked questions by parents.

The Party Scene - Managing alcohol/drug exposure


During the teen years, it is normal for our children to want to ‘fit in’ and sometimes to give in to peer pressure to be like their friends, do what their friends do, dress like their friends do, even when they don’t think it’s the best thing to do. It’s hard being the odd one out. Negative peer pressure may make our adolescents feel like they need to experiment with substances such as alcohol, marijuana and tobacco - to be cool, to fit in or sometimes to feel better about themselves or forget their problems.

It is our job as parents and caregivers to teach our young people how to recognize negative peer pressure and how to avoid it. It is impossible to hide all drugs away from our children, so we must teach them how to manage if they are exposed to it. Here are a few suggestions on how to do that.


  • Let your adolescent know what behaviour you expect from them. Use everyday opportunities to teach them. For example, you could be watching a movie with your child and a drunk person does something silly that results in problems – talk through it with your child BUT remember not to lecture them, it’s a conversation – sharing ideas and thoughts with each other.


  • Your adolescent will be exposed to drugs – tell them to expect it. Tell them someone is going to offer it to them at some point. Let them practice with you how to say ‘No’. Let them know it’s okay to be different even if everyone else is doing it.



  • Do not use substances around your child/ adolescent and then expect them not to use it. The ‘do as I say not as I do’ rule just doesn’t work. So, if you choose to drink alcohol for example, around your adolescent, then you must do so responsibly. Getting drunk in front of your child should never be an option.


  • If your adolescent is driving they must be told to drink NO ALCOHOL. Most teenagers have limited driving experience and alcohol will impair their driving skills putting themselves, their passenger(s) and other road users at significant risk. Encourage your teenager and their friends to ALWAYS have a designated driver. Remind them they don’t need alcohol or other drugs to have a good time when they go out.


  • Let your child know and understand that they can always call you if they get into trouble. They must call you, their parent/caregiver if they are unable to get home safely. For example: if they are driving but had alcohol to drink and know it’s not safe to drive, if the designated driver decided to drink, if they experimented with a drug(s) and are ‘high’ and can’t get home, or if they feel unsafe where they are for whatever reason – they must call you no matter what the time is. Get them home safely first. Then the following morning discuss how this happened and what the consequences will be, when everyone is calm and thinking straight. Your child must never be too afraid to call you when they need help. They must understand that no matter what, you will always love them – this unconditional love, is what they need.


(Contributed by Dr. Abigail Harrison, Paediatrician and Adolescent Medicine specialist, University Hospital of the West Indies)




The first thousand days of your baby’s life includes the 9 months of pregnancy (270 days) and the 365 days each of the first two years of life.  

During this period, your baby’s body is growing fast.  The brain, the centre of development, is growing the fastest, and developing more than it ever will in your baby’s entire life.  By the time this thousand days ends, your baby’s brain will go from being very small to being two-thirds of the size it will be as an adult.  Inside the brain, the nerve connections responsible for the brain’s growth and development are happening at up to 700 per second.   

What does this all mean?

During this period your baby’s brain has the potential to develop to its best; but during this period your baby’s brain can also be significantly damaged by harmful events.



As a pregnant mother, you need to look after yourself well and you also need to be looked after well by everyone around you in order for your baby’s brain to develop well.  You should have healthy, nutritious foods and attend all your antenatal clinic visits.  But very important to your baby’s brain development is making sure your pregnancy is free from stress and anxiety.  Significant or toxic stress, such as being exposed to violence in your home and in your community, causes hormones to be produced in your body.  These hormones travel to your baby and especially to your baby’s brain and harm brain development. 



In the first two years of life, you and everyone else around your baby will help to determine how your baby’s brain develops.  Your baby needs good nutrition; breast milk is best for your baby’s nutrition and brain development.  Your baby should have breast milk only for the first six months of life and then healthy, nutritious foods afterwards.  Your baby should also be protected from illness through immunisation; make sure you and your baby attend all your well baby clinic visits.  Take your Child Health and Development Passport to all your visits and remember to answer the questions in the passport that specially check on your baby’s development at 6 weeks, 9 months, 18 months and 3 years. 

Brain development is particularly important in the first 2 years of life. 

  • If a baby’s brain is stimulated well, by playing, by singing, by hugging and cuddling, your baby’s brain becomes one that develops well and your baby grows to become a loving and caring person.
  • If your baby’s brain is not stimulated, such as ignoring your baby when they cry and need your love or not playing or signing with him/her, then your baby’s brain does not grow as well and your baby will not develop as well.
  • If your baby’s brain is given the wrong kind of stimulation, such as shouting, hitting or exposure to toxic stress, such as violence at home or in the community, then the wrong kind of brain connections get formed and your baby will grow up to be more difficult to care for and more aggressive. If your baby’s brain is physically harmed by shaking or being injured, your baby’s brain development can also be harmed.  


Let’s work together to make sure all our Jamaican babies have the best development. 


Contributed by
Prof. Maureen Samms-Vaughan,
Developmental Paediatrician



Friday, 23 February 2018 12:21


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Contributed by
Dr. Roxanne Melbourne Chambers,
Paediatric Neurologist at University Hospital of the West Indies and Member, Paediatric Association of Jamaica


Most, if not all parents, at some time in the journey of parenthood wished that children came with a User Friendly Manual that would offer a fool-proof plan for assembly, maintenance and function that would guarantee years of performance and pleasure. BUT…there is no such manual and as parents we discover very quickly that parenting is not a “one size fits all”. Every child is special and unique and even children brought up in the same household with the same background differ greatly in personality, perspective and performance.

I believe however that there are six “P”s that are the foundation of good parenting and that applies to every child.

  1. PLAN. Every child is a gift from God and at no time should be made to feel that his/her conception and existence was a ‘mistake’. Every pregnancy should as far as possible be carefully planned, and the resulting child eagerly awaited, appreciated and loved.
  2. Every child has the right to food, shelter, clothing and an education and parents are duty bound to provide these for every child that they bring into the world.
  3. The world has become a dangerous place for a child to navigate and parents must realize that it is their duty to protect their children from the hazards that are all around them. These can take the form of inanimate objects like television, cell phones and computers where predators lurk and questionable contents are displayed and viewed. Children often succumb to peer pressure, so parents should always make an effort to meet and know their children’s friends and gently guide their choices. Parents may even be called upon to protect the child from himself, using tough love if self-destructive behaviour is observed.
  4. Children do not remain children forever. Parents must equip them with a holistic education that prepares and guides them to make the right career choices so they can take their place in the world as productive, well-adjusted adults.
  5. Children rarely remember the expensive gifts they receive and very often these are soon destroyed, but they do remember the “awesome” family vacations. They remember the time that was spent playing together as a family. Parents need to get off the couch, get outside and get back to running, skipping and jumping with their children.
  6. This is possibly the most important factor in raising children. God is their Manufacturer and knows them inside and out. It is foolhardy to think as parents that we can single-handedly operate these fragile, delicate beings without consulting the Manufacturer……OFTEN!

Proper parenting is an important key to unlocking and realizing the full potential of the future of our nation. The Bible describes children as “arrows in the hand of a mighty man” (Ps.127:4), and as parents, we must point and shoot them in the right direction and with God’s help they will hit their mark and leave a positive impact on their world.

Contributed by
Dr. J. Dunkley-Thompson
Paediatric Consultant
Mandeville Regional Hospital

Friday, 23 February 2018 12:20

Screen Time: Just how much is enough.

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Screen Time: Just how much is enough.

The digital age is here! We have accessibility and content at out fingertips.  Whilst as adults we have the skills to choose wisely our children need guidance in navigating this digital world.  As we nurture our children we must also provide guidance about the who, when, where, and duration our children should be exposed to media use.  The ultimate goal is for smart choices to be made from infancy and beyond.

Who may be exposed?

There is no role for media use in children less than 18 months of age, unless it is Face Time or skype with caregivers and family members. 

Children between 18-24 months whose parents are desirous of introducing media options should do so with high quality content only. 

Between 2-5 years media use should be limited to 1 hour per day. 

Children older than 6 years and older should have clear guidelines regarding time spent, content allowed and the rules whilst engaged in use.   

Where and with whom should children be engaged with media?

Open family areas are the best places for you to engage in media with your child. Programmes should be watched with your child and discussion is encouraged.    

Screen free zones should be created to ensure family interaction.  Dinning and bedrooms should be screen free; conversation is encouraged at dinnertime whilst sleep and relaxation occur in the bedroom.  There should be no digital use either during homework time (monitor online homework), whilst walking, Screen time should be no closer than an hour before bedtime. Devices should be charged and stored in a separate area from the bedroom.  Decide shut down time of media devices.

Choose wisely

Be mindful of “educational apps” which may not have been evaluated for its “educational value”.  Become familiar with programme ratings which are provided by the Jamaica Broadcasting Commission to assist with appropriate age content.  Choose how your child engages with media.  This may be by video chatting, by co-playing video games, creative uses such as making movies, assisting with school tasks and “true educational” shows.

Rules of engagement

As a parent, teach children not to give out personal information, photos, chat or game with strangers.  Review privacy settings with children.  Inform your children about cyberbullying or any photo, message or invitation that you would consider inappropriate.  Provide reassurance that such issues can be discussed.

Be an Exemplary Model

Practice what you preach.  Respect screen free zonesDo not keep phones under table texting or answer phones during meal time.  Rather ask to be excused.  Watch appropriate content in the presence of children.  Balance on-line time with work time and family time.

The digital world is here to stay.  Let’s teach our children how to make smart choices. Don’t feel pressured to introduce digital devices early.  Co-view with children and provide guidelines.  As with all things, moderation is the key and we must practice what we preach.


Contributed by
Dr. Andrea Garbutt,
Developmental Paediatrician, UHWI

Friday, 23 February 2018 12:19

How much sleep do children need?

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How much sleep do children need?

As parents we all know that growing children need good sleep, but many of us don't know just how many hours children require, and what impact lack of sleep can have on them. There is scientific evidence to show babies, children, and teens need significantly more sleep than adults to support their rapid mental and physical development. Children who do not get enough sleep are at risk for wide range of mental and physical problems.

The American Academy of Pediatrics in conjunction with the American Academy of Sleep Medicine, recommends on how much sleep children need (including naps) at different ages and stages of development:

  • Infants 4 to 12 months - 12 to 16 hours of sleep every 24 hours.
  • Children 1 to 2 years - 11 to 14 hours of sleep every 24 hours.
  • Children 3 to 5 years - 10 to 13 hours of sleep every 24 hours.
  • Children 6 to 12 years - 9 to 12 hours of sleep every 24 hours.
  • Teens 13 to 18 years - 8 to 10 hours of sleep every 24 hours.

Regular sleep deprivation often leads to difficult behavior and health problems such as obesity, headaches, hypertension, inattention, irritability and depression. When children get their required hours of sleep for their age on a daily basis, they thrive well with better behavior, better learning, memory, emotional health and overall quality of life.

Therefore we encourage parents to ensure their children develop good sleep habits right from the beginning. Be a role model to your child. Making sleep a priority for yourself shows your child that it is part of living a healthy lifestyle just like eating right and exercising regularly. Try and stick to a healthy sleep routine. Create a sleep supportive environment with dim lights and right temperature just before bedtime. Keep the bed free of toys and gadgets. Do not put your baby to bed with bottle of milk or juice in it. Do not start solid food earlier than six months of age because it can disrupt the sleep due to tummy ache. The American Academy of Pediatrics recommends all screens be turned off at least thirty minute before bedtime and suggests keeping televisions, computers, smart phones and other screens out of children’s bedrooms.

Recognize sleep problems such as snoring, difficulty falling asleep, resisting going to bed, breathing difficulties during sleep and day time tiredness. Talk to the teacher about your child’s behavior, level of attention, alertness and learning at School. It is recommended that you talk to your Paediatrician about your child’s sleep habit s and problems if you recognize any.

Contributed by Dr. Shashikala Gowda, Paediatrician UHWI



Friday, 23 February 2018 12:18

For Parents who are hesitant to vaccinate

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For Parents who are hesitant to vaccinate

Jamaica has one of the best vaccination coverage rates in the region, boasting rates of up to 99% coverage for Diptheria and Pertussis. These commendable rates protect the health of the individual, and safeguard the health of the community. The greater the number of persons vaccinated, the greater the protection to those who cannot be vaccinated such as newborns, infants, and persons with a weakened immune system. Jamaica however falls short with the coverage of the second dose of MMR (measles, mumps, rubella) vaccine with a rate of 85%.

In the last decade parents have become increasingly hesitant to vaccinate .This trend has resulted in outbreaks of severe and occasionally fatal diseases, not occurring in remote parts of Africa, but in countries in the USA and Europe.

Historically in the 1940’s, parents did not hesitate to get diphtheria, tetanus and pertussis vaccines, as they knew that diphtheria and pertussis were common killers of children .They saw tetanus claim the lives of soldiers in World Wars I and II. During the 1950’s polio vaccine was celebrated because it protected children from debilitating paralysis. In the 1960’s parents gladly accepted the measles, mumps and rubella vaccine. They knew that measles caused tens of thousands of hospitalizations and hundreds of deaths primarily from pneumonia each year; that mumps was a common cause of deafness and a rare cause of sterility; and that rubella caused thousands of children to suffer severe birth defects of the eyes, ears and heart. The result of vaccination saw a dramatic decrease or virtual elimination in some cases, of several diseases.

Currently parents are hesitant to vaccinate because of the confusing messages on the internet. First there was a medical report that stated MMR was associated with autism. This proved to be a false report and the paper was withdrawn from the journal .Despite the lack of scientific evidence of this association, persons continue to hold on to this belief supported by lack of evidenced based information. What is known factually is that measles is highly contagious and potentially fatal. Vaccines take years to develop and are tested thoroughly. Adverse effects are reported and investigated by the FDA and vaccine safety is monitored by the CDC and by the Ministry of health.

A vaccine, like any medicine, has side effects. The most common are mild, such as soreness, swelling, or redness at the injection site, others may cause fever, rash, and achiness. Serious side effects are rare. For example oral polio can cause paralytic polio in one in every 2.4 million doses. Giving injectable polio vaccine removes this rare severe complication. The benefits of vaccinations with polio outweighs this rare side effect .Polio was once a disease feared worldwide, striking suddenly and paralysing mainly children for life. Today we are on the verge of a polio free world as occurrences of polio have been reduced by 99%.

The diseases are far more dangerous than the vaccines which prevent them. Let’s keep our children and community safe from vaccine preventable diseases.

Contributed by Dr Tracy Evans Gilbert

DM, MPH, CTropMed



Friday, 23 February 2018 12:18


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Bedwetting or Enuresis (en-you-ree-sis) is involuntary urination that occurs at night. Children often wet their bed until they are 5 years old - this is normal. Bedwetting may occur if the bladder is small and cannot store larger volumes of urine; if the child produces a lot of urine; or is not able to concentrate the urine.

Children who continue to have nighttime wetting after the age of five or experience recurrence after being dry for 6 months should be evaluated. There are two types of enuresis – primary and secondary.


Primary Enuresis occurs when a child has never managed to have consistent dry nights for a 6-month period and there is no daytime wetting. It is more common in boys and there is often a hereditary component -there is often a parent who wet their bed past the age of five years. One can usually predict the age when their child might stop wetting based on the age that the parents/relatives attained dryness. These children are often very deep sleepers and do not wake up when their bladder is full.


Primary enuresis usually resolves on its own as the bladder matures. Management consists of limiting fluids before bedtime, voiding (urinating) before going to bed and avoiding caffeinated drinks such as cola. Parents may also awaken their child before the time their child would usually wet the bed and have them empty their bladder. This can become tiresome for the parent. Bedwetting alarms work much better – they detect moisture in the underpants and set off an alarm awakening the child to urinate. Positive reinforcement by praising and making a big deal when there is a dry night and putting stars on a calendar for dry nights. However, do not persist with this if there are no dry nights over a 2-week period as this may act as a reminder of their failure. Do not scold or punish children for wet nights. It may be useful to have close by a change of clothing and bed linen. The child should be allowed to assist in changing the bed linen.

There are medications that may be given if the child is extremely embarrassed and upset with the wetting or is going to summer camp or having a sleepover.



Secondary enuresis is the return of bedwetting after having been dry at nights for six months or longer. The most common reason for this is a urinary tract infection, others include diabetes mellitus, and conditions where urine cannot be concentrated, such as sickle cell disease and diabetes insipidus. These children are often very thirsty and pass large amounts of urine.

Other important causes are emotional stressors such as the birth of a new sibling, death or loss by separation from a loved one, being bullied and sexual abuse.


As parents and caregivers, it is important to remember that bedwetting is involuntary- your child is not doing it deliberately and has no control of it. They should not be punished or teased.


Contributed by Dr. Marsha Gooden, Paediatric nephrologist, UHWI






Friday, 23 February 2018 12:16

Athletic Screening in Children

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Athletic Screening in Children

Dr.Tamra Tomlinson Morris


Jamaica is a sports loving nation. From Sports day in Basic Schools to playing football and cricket in open lots, it is in our blood. Sports teaches children, not only how to keep fit, but also discipline, time management and team work. As competitive sport participation gets more challenging with age, athletic pre-participation screening should be considered.

What is screening?

Screening should be sensitive, quick and cheap. In pre-participation screening, it is not necessarily so. An athlete is assessed by a physician to detect the presence of a silent condition that could worsen or lead to the child’s demise by continued sports participation. More specific tests are done depending on the results.

What are we looking for in the screen?

Structural (heart muscle and blood vessels) and electrical (rhythm) problems of the heart are examined for. Screening also includes checking for muscle and bone abnormalities that can affect performance.  Although rare, the risk of sudden cardiac death (SCD) from an undiagnosed condition is increased by 2.5 times in sports. Different reports show that SCD is more common in blacks, males, and in sports such as football and basketball.


Who should get screened?

It is generally accepted that any athlete of high school or university age who requires systematic training and participates in regular competition is a candidate for screening. However, any athlete of any age with symptoms, such as chest pain or heart racing, during or immediately after activities, should be screened.


How do we screen?

This topic is debated continuously because of the associated high cost and the low yield. In the USA, screening consists of a questionnaire and a physical examination, while in Italy (where a very successful screening program for the past 25 years exists) it consists of a questionnaire, an examination and an electrocardiogram (ECG).


In Jamaica, it is acceptable to incorporate:

  1. a questionnaire which asks about symptoms, family history, etc.
  2. a physical examination which includes blood pressure measurement, height, weight

iii.            an ECG to assess the electrical activity of the heart.

The ECG may show obvious abnormalities or it may give clues to problems that are present in the heart.

This screening method is routinely used for the national swimmers.


What are the implications?

Being informed that there are no abnormalities is the best news an athlete and family could hear and this is the case for most athletes. Infrequently, however, screening will detect a problem. This can have financial ramifications as more tests are required to determine the extent of the problem, the risk to the athlete and there may be a cost in cases where treatment is indicated. Not to be overlooked is the psychological effect. The athlete may have to stop playing the sport they love, scholarship hopes are abandoned and being labelled ‘sick’ can cause depression.


It is impossible to eliminate all the risks associated with competitive sports and note that even after a negative screen, there may be other factors such as inflammation of the heart muscle (eg with the ‘flu’), use of stimulants (such as energy drinks) among others that can cause life threatening heart rhythms.

Let us take our love of sports and our athletes to heart (pun intended) as screening does save lives.


Dr.Tomlinson Morris is a Paediatrician and Cardiologist at The Paediatric Place




Friday, 23 February 2018 12:14

Are exams stressful to our kids?

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What has happened to the idyllic life of childhood? Are we burdening our children with too many things?  Are our children stressed out, over-structured and hurried?  Tests and exams can be a challenging part of school life for children and teens as well as for their parents or caregivers. Many of our children are engaged in at least one extra lesson or class almost every day and on the weekend’s marathons classes on Saturdays and two classes on Sundays to pass the high-stakes exams such as GSAT and CSEC! 

As we try to get our children to get to the top of the academic mountain successfully, the push to pass examinations becomes hurdles that they may glide over or crash into. 
Parents expect the best for and from their children and as such pressure them to succeed.  Sometimes, this pressure can be too much for some children and manifests itself as stress. 

Children who are experiencing exam stress may manifest it as anxiety and nervousness. What are some of the signs of stress that we need to look out for in our children?

  • worrying a lot- not only about exams but about achieving in school in general
  • feeling tense and getting lots of headaches and stomach pains
  • not sleeping well- too much or too little
  • being irritable and testy
  • losing interest in food or eat more than usual
  • not enjoying activities they previously enjoyed
  • seeming negative and low in their mood, and
  • seeming hopeless about the future

Teachers, parents, and caregivers need to be aware of these signs and seek assistance for the child.

In order to assist our children in coping with examination stress we need to be aware of what are possible causes of this stress.  Three main causes are:

  • Poor preparation: This is one of the main reasons why children feel stressed. They may not have enough time to cover material or they are not aware of test taking strategies to be used with different types of exams or tests.
  • Pressure from family: The expectations from the immediate family to be successful especially if there are other siblings who have done exceptionally well
  • Pressure from within: Children can have their own personal high standards that make them worried about achieving at the level they have set for themselves.


"Not all stress is bad. A certain amount of stress drives healthy competition in the classroom and in extracurricular activities. Good stress induces a student to strive for her personal best on an exam, a term paper or on the debate team."(Wilde, 2016)

How to help them cope?

Evaluation/exams are a natural part of the educational landscape and as such our children should learn how to cope with them. Firstly we need to know that “Exams are important but our children’s whole life does not depend on them”.

We need to be aware of our children’s ability to handle exam stress. We would need to assist them in coping.  Some suggestions are:

  • Listen and notice any expressions of anxiety
  • Talk with them about their feelings and exam nerves
  • Don’t over schedule them
  • Look at how you define success and how you communicate this to your children.
  • Ensure they get enough sleep
  • Limit media/screen time
  • Encourage balanced meals and healthy snacks
  • Help them to study and learn strategies to take exams

Exams are stressful in themselves, don’t add to the stress, but relieve it!


Contributed by
Avril Z Daley PhD, Clinical Psychologist