NATIONAL POISONS CENTRE 24 HOUR HELPLINE 0800 POISON (0800 764 766) Don’t make your child vomit or give anything to eat or drink. Wait for advice.

Childhood Poisoning Handout Version 1.0

References: http://www.childcareonline.co.nz and http://www.poisons.co.nz

- 4-

WHAT ARE CHILDREN MOST COMMONLY POISONED WITH? Reason for top 12 calls relating to under 5 year olds to the National Poisons Centre:

1 Paracetamol / Pamol 5 Ibuprofen/ Nurofen 9 Black nightshade 2 Multivitamins 6 Dishwashing liquid 10 Claratyne 3 Silica gel 7 Voltaren 11 All purpose cleaner 4 Oral contraceptives 8 Air freshener 12 Dimetapp

- 1-

FACTS ABOUT CHILDHOOD POISONING Small children are at greatest risk of poisoning.

• Children aged 1 to 3 years are the most likely age group to be poisoned

• Poisoning is a major cause of hospitalisation for young children in NZ with an average of two admissions of children every day due to poisoning

• About 20% of families with pre-school children will experience at least one poisoning incident each year

• Most poisonings occur in the child's own home

WHAT ARE THE REASONS FOR POISONING IN CHILDREN? • Parents are not aware of how poisonous some products are

• Children are curious about taste, texture, smell of different things. Most things go straight into their mouths. They don’t have the ability to know what will harm them

• Parents don't realise how quickly their child’s skills can advance and so don’t pre-empt their child's ability to climb and reach

• Small children often think poisons or medicines are lollies or drinks

• Children mimic adults and think they are "helping" by cleaning, or taking medicines

• Products are not put away straight after use

• Products are not stored or labeled properly

• Children are not supervised properly

THE THINGS CHILDREN SWALLOW – PROBLEMS WITH FOREIGN OBJECTS Some objects are just not meant to be swallowed. A foreign body is an object that is not normally meant to enter the body. They can be swallowed, causing the airway or gastrointestinal (GI) tract to become blocked. If the airway becomes blocked the person may be unable to breathe. Children may also insert objects in their nose or ear. Children account for 75% of foreign body calls to the National Poisons Centre, and the majority of these occur in children under 5 years. What makes a foreign body dangerous? • Size and shape: large or strangely shaped objects are more likely to get stuck • Type of object:

o Magnets (If 2 are ingested, they can attract each other across membranes) o Button batteries (contain corrosive substance that burns if the battery leaks) o Coins (often big enough to cause blockages) o Sharp objects (knives, earrings, blades, drawing pins can cut the GI tract) o Lead objects (cause toxicity if they do not pass naturally from the GI tract) o Expandable objects (i.e. "Grow a..." toys and tampons absorb water so they may

become bigger once swallowed) Should I be worried if my child ingests a foreign body? It depends on the size and type of object, and if your child has any symptoms. If your child is not choking - check with the National Poisons Centre 24-hour helpline 0800 POISON (0800 764 776) or other medical professional to see what treatment is necessary. If your child is displaying signs of choking: • Immediately call an ambulance by dialling 111 • If you are able to, follow first aid protocols for choking and/or resuscitation

NATIONAL POISONS CENTRE 24 HOUR HELPLINE 0800 POISON (0800 764 766) Don’t make your child vomit or give anything to eat or drink. Wait for advice.

Childhood Poisoning Handout Version 1.0

References: http://www.childcareonline.co.nz and http://www.poisons.co.nz

- 4-

WHAT ARE CHILDREN MOST COMMONLY POISONED WITH? Reason for top 12 calls relating to under 5 year olds to the National Poisons Centre:

1 Paracetamol / Pamol 5 Ibuprofen/ Nurofen 9 Black nightshade 2 Multivitamins 6 Dishwashing liquid 10 Claratyne 3 Silica gel 7 Voltaren 11 All purpose cleaner 4 Oral contraceptives 8 Air freshener 12 Dimetapp

- 1-

FACTS ABOUT CHILDHOOD POISONING Small children are at greatest risk of poisoning.

• Children aged 1 to 3 years are the most likely age group to be poisoned

• Poisoning is a major cause of hospitalisation for young children in NZ with an average of two admissions of children every day due to poisoning

• About 20% of families with pre-school children will experience at least one poisoning incident each year

• Most poisonings occur in the child's own home

WHAT ARE THE REASONS FOR POISONING IN CHILDREN? • Parents are not aware of how poisonous some products are

• Children are curious about taste, texture, smell of different things. Most things go straight into their mouths. They don’t have the ability to know what will harm them

• Parents don't realise how quickly their child’s skills can advance and so don’t pre-empt their child's ability to climb and reach

• Small children often think poisons or medicines are lollies or drinks

• Children mimic adults and think they are "helping" by cleaning, or taking medicines

• Products are not put away straight after use

• Products are not stored or labeled properly

• Children are not supervised properly

THE THINGS CHILDREN SWALLOW – PROBLEMS WITH FOREIGN OBJECTS Some objects are just not meant to be swallowed. A foreign body is an object that is not normally meant to enter the body. They can be swallowed, causing the airway or gastrointestinal (GI) tract to become blocked. If the airway becomes blocked the person may be unable to breathe. Children may also insert objects in their nose or ear. Children account for 75% of foreign body calls to the National Poisons Centre, and the majority of these occur in children under 5 years. What makes a foreign body dangerous? • Size and shape: large or strangely shaped objects are more likely to get stuck • Type of object:

o Magnets (If 2 are ingested, they can attract each other across membranes) o Button batteries (contain corrosive substance that burns if the battery leaks) o Coins (often big enough to cause blockages) o Sharp objects (knives, earrings, blades, drawing pins can cut the GI tract) o Lead objects (cause toxicity if they do not pass naturally from the GI tract) o Expandable objects (i.e. "Grow a..." toys and tampons absorb water so they may

become bigger once swallowed) Should I be worried if my child ingests a foreign body? It depends on the size and type of object, and if your child has any symptoms. If your child is not choking - check with the National Poisons Centre 24-hour helpline 0800 POISON (0800 764 776) or other medical professional to see what treatment is necessary. If your child is displaying signs of choking: • Immediately call an ambulance by dialling 111 • If you are able to, follow first aid protocols for choking and/or resuscitation

NATIONAL POISONS CENTRE 24 HOUR HELPLINE 0800 POISON (0800 764 766) Don’t make your child vomit or give anything to eat or drink. Wait for advice.

Childhood Poisoning Handout Version 1.0

DISHWASHING DETERGENTS BURN!

What to do if a child swallows dishwashing detergent? Call the National Poisons Centre 24 hour helpline on 0800 POISON (0800 764 776) Try to get the detergent out of their mouth by scooping it out with your fingers, or rinsing the mouth with water and having the child spit this out. Don’t make your child vomit – this may cause more harm. Seek medical advice immediately on 0800 POISON. (764 776)

-2-

NATIONAL POISONS CENTRE HELPLINE

0800 POISON (0800 764 766)

Do not make your child vomit or

give anything to eat or drink until you have obtained advice

- 3-

PREVENT POISONING • Store poisons, such as household cleaners, detergent & medicines, up high,

out of sight and out of reach

• Install child safety catches on cupboard doors

• Ask your pharmacist to use child safety caps on all medicines

• Store poisonous substances in their original containers – never in food or drink containers

• Keep handbags containing medicine out of reach of children

• Supervise children closely when visiting other homes where poisons may not be stored as safety

• Safely dispose of all poisons, such as unused medicines, garden chemicals, and cleaning fluids

NATIONAL POISONS CENTRE 24 HOUR HELPLINE 0800 POISON (0800 764 766) Don’t make your child vomit or give anything to eat or drink. Wait for advice.

Childhood Poisoning Handout Version 1.0

DISHWASHING DETERGENTS BURN!

What to do if a child swallows dishwashing detergent? Call the National Poisons Centre 24 hour helpline on 0800 POISON (0800 764 776) Try to get the detergent out of their mouth by scooping it out with your fingers, or rinsing the mouth with water and having the child spit this out. Don’t make your child vomit – this may cause more harm. Seek medical advice immediately on 0800 POISON. (764 776)

-2-

NATIONAL POISONS CENTRE HELPLINE

0800 POISON (0800 764 766)

Do not make your child vomit or

give anything to eat or drink until you have obtained advice

- 3-

PREVENT POISONING • Store poisons, such as household cleaners, detergent & medicines, up high,

out of sight and out of reach

• Install child safety catches on cupboard doors

• Ask your pharmacist to use child safety caps on all medicines

• Store poisonous substances in their original containers – never in food or drink containers

• Keep handbags containing medicine out of reach of children

• Supervise children closely when visiting other homes where poisons may not be stored as safety

• Safely dispose of all poisons, such as unused medicines, garden chemicals, and cleaning fluids

1

MOVING AND MUNCHING

June 2007

Kirsten Crawford – Dietitian

INTRODUCING SOLIDS AND ESTABLISHING GOOD NUTRITION

Central to consuming a healthy diet later in life is the aim to consume a wide variety of foods as well as developing a taste that likes natural flavours of foods without excessive addition of salt, fat and sugar.

From early months to one year of age infants energy requirements will almost double. This energy need is gradual, allowing infants to become accustomed to eating solid foods. In the space of 12 months your baby will roughly triple its birth weight.

At the start of the weaning process, solids play a more important role developmentally than nutritionally. Progressing onto more textured foods encourages chewing which is important for tongue development and mouth needed for speech.

Cues that an infant is ready to start solids

• Baby can hold its head up and has good head control

• Baby frequently puts hands and toys in mouth

• Baby may be intensely watching you and other people eat, or reach for food in your hand

• Baby opens mouth easily when spoon touches its lips or as food approaches

• Tongue does not protrude when offered spoon and food stays in mouth and is moved to back of mouth and swallowed

Advice to start usually between 4-6 months – but every baby is different and some reach this stage sooner than others.

Very First Solids

• Choose a time when you and baby are relaxed and not rushed or tired. Midday seems to be popular

• Give the milk feed first and offer solids as a ‘top-up’

• Sit baby on your knee or in high chair if ready

• Try 1 teaspoon first and gradually increase to 3 -4 teaspoons a meal

• Use breast milk/formula or cool boiled water mixed in with the chosen first solid

• First foods need to be soft, smooth and sloppy

• Offer a new food one at a time every 3 to 4 days

2

• If baby seems enthusiastic about the idea of food, you can start to introduce solids after another milk feed each day

• Don’t be put off if baby pulls a funny face or spits out food (a lot tends to go over the lips and mouth anyway!) Remember baby is getting used to a new taste and way of taking food (from spoon instead of sucking).

• Be guided by your baby’s appetite or interest to food. NEVER force food on your baby. If they turn their head away or push the spoon away, this may indicate baby has had enough

• Loads of smiles and clapping/happy encouragement is useful

Texture and Consistency

• First foods need to be smooth/soft/sloppy and free of all lumps

• Use a blender, wand stick, mouli or push through a small fine sieve

• Expressed breast milk, formula, or cool boiled water can be added to achieve the right consistency. Serve warm

Single Foods at First

• Introduce one food at a time and continue with this same food for 2 to 3 days before introducing another

• Baby rice, puréed fruit or vegetables are first foods. I think baby rice is a good one because it is very bland and is mixed often with the milk known to baby already and isn’t such a shock taste while getting their head around texture and spoons.

• If baby doesn’t seem to like it the first time, leave it for a few days and try again with a small amount

• Research has shown that some babies need to try a food up to 10 times before they accept it – so don’t give up!

• Babies have four times more taste buds than adults, so you shouldn’t prepare baby’s food to suit your own tastes

• Don’t add sugar or salt to food you make for baby

How Much / How Often ?

• Offer solids at only one meal after a milk feed

• Gradually increase the amount to 2 to 3 tablespoons per meal and then increase the number of meals to 3 per day

• A tip to check if baby wants more is to offer the spoon empty of food and if they open their mouth for more, then offer more food until they lose interest

• Baby’s appetites vary from day to day. Let them decide if they have had enough

• After feeding, discard any leftovers in the feeding bowl. Do not store for later use as saliva from the spoon may spoil the food.

3

Combining

• Once baby has tried and accepted a number of single foods, you can combine foods to increase variety e.g. banana and avocado or potato and kumara

Texture

• Textures of food prepared need to be increased as the infant gets older to encourage chewing

• Offer thicker consistency progressing to soft but more lumpy or mashed food

• 4-6 months – smooth sloppy food

• 6-7 months – thicker mashed / soft lumps/ smooth fine puréed meat (watch stringy meat like puréed lamb). Also offer water in a cup or beaker with meals

• 8-9 months – firmer lumps and finger foods, and offer solids before milk foods

• Normal for babies to ‘gag’ often. It is natural reflex that prevents choking. While this is alarming and stressful for parents, try not to show you are worried or over-react

• Don’t worry if baby has no or few teeth. Babies chew very well with their gums

• Remember the larger the range of tastes and foods that can be introduced before the stage of independence and autonomy the better the chance of food acceptance rather than fussy/picky eating

Finger Foods

• When small lumps can be managed, provide finger foods e.g. steamed/baked vegetables

crackers soft fruit toast rusks pieces of cooked meat little meat balls / patties Aria farm meat strips Chicken tenderloins

• These encourage self feeding , interest in food and are very helpful if baby is having some aversion to lumpy foods

• Finger foods also give baby some control and independence. Useful while you may be feeding the main part of the meal with your spoon

• Older babies love to hold their own spoon while you are feeding their meal. This often produces a ‘fast’ meal while baby is absorbed in the independence of having their own spoon!

• As baby gets older, progressing with different textures is as important as adding to the food types and flavours

4

Allergy Alerts

• Strong family history means one or both parents have a strong allergic reaction to an environmental stimulus

• Allergies to food seem to be increasing but are still not common

• If a strong family history to food allergy exists, delay introduction of wheat, dairy, fish, soy, peanuts and eggs

Iron

• Start to introduce meats and iron rich foods at 6-7 months of age

• Move towards giving meat nearly every day of the week at a meal

• Consider fruit and/or vegetables with the meat meals

• Continue to add baby cereals and/or rice in with other breakfast cereals of foods

• Some successful iron rich foods are: pate on crackers, grated cooked liver in vegetables, steak and kidney

Enjoy

Don’t worry about your baby’s progress through the different stages of weaning. Every baby has their own pace and there are no set rules to keep.

An ongoing process of learning and development for both of you and your child

Enjoy the one on one time that introducing solids allows you and your baby to have!

Microwave Rusks (teething bread)

One slice of sandwich slice bread Cut off crusts Spread with margarine/butter Light spread of vegemite/marmite Roll up Microwave 40 seconds (hot and steaming when removed) Let cool and harden (approx 2 to 5 minutes)

Useful Websites:

www.forbaby.co.nz

www.nutriciababy.co.nz

www.heinzbaby.com

www.nestle.co.uk

Here I am. I want to stay Please watch me closely and if one day I seem unwell or like a stranger Remember my life just might be in danger From Pneumonia or Gastro or Meningitis –

Ask the doctor right away Don’t you wait another day

Pneumonia If I am coughing or wheezing Or find it hard breathing Quick short grunts mean I’m in trouble Get me to the doctor on the double

Be sure I’m seen without delay Please don’t wait another day

Gastroenteritis If I throw up more than twice Give me more drinks – that would be nice If my dirty naps are very smelly Or if it’s runny like melted jelly If both my ends are busy together I’ll need help to make me better

So see the doctor straight away Do it now and don’t delay You can’t wait another day.

Meningitis If I’m cross and drowsy or will not wake Or my cry is strange and hard to take

Ring the doctor straight away Please don’t wait another day.

Ear Troubles If my ear is running or I pull at it If I cry a lot or have a fit

Ask the doctor if I’m OK Please don’t wait another day

All Illness If I won’t have my normal feeds Or if I’m floppy hot or cold

Ask the doctor if I’m OK Please don’t wait another day

If we’ve been to the doctor but I don’t get better Though you’ve done what they said right to the letter

Ring them and ask what’s more to do, to make me just as good as new Do this now – and right away! Please don’t wait another day.