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Monday 08:00 - 17:00 Tuesday 08:00 - 17:00 Wednesday 08:00 - 17:00 Thursday 08:00 - 17:00 Friday 08:00 - 17:00

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Dr Willem Smit Paediatrician, Suite 4 Sadre Park, 1 C Hibiscus Street, Durbanville (2025)

26/08/2025

ADHD follow-up post:

I would like to follow up on my previous post about ADHD from earlier this year.

Since then, the reach has been meaningful: more than 25,000 people viewed the post, and the feedback from parents has been highly encouraging.
I have welcomed many new patients with ADHD and associated learning difficulties who sought help earlier thanks to the increased awareness generated by the initial post.
It is encouraging to see growing recognition that early intervention is essential for better long-term outcomes.

Key takeaways:
Early identification and intervention can prevent many complications and improve school performance, behavior, and overall quality of life.
Children with ADHD may experience anxiety, emotional symptoms, aggression, or low self-esteem when their needs are not addressed. With timely support, these outcomes can be mitigated.
A multidisciplinary approach is crucial. Medication is one component, and not all children will require it.

On treatment considerations:
When medication is appropriate, my goal is to determine the most effective medication, at the most suitable dose, and in the best possible combination for the child.
The objective is to maximize benefits while minimizing side effects.
Treatment typically begins with a low dose based on the child’s weight and clinical needs, with careful titration to an optimal dose if needed.
The aim is to support focus and functioning without introducing excessive stimulation or adverse effects.

A note on cognitive profiles:
Many individuals with ADHD have average or above-average intelligence, yet may underperform academically due to attentional and processing challenges.
Verbal processing and listening comprehension can be areas of relative weakness that benefit from targeted interventions and support.

Final reflections:
Early, coordinated intervention can prevent many of ADHD’s difficulties and significantly influence a child’s future academic and personal success.
I’m grateful for the positive engagement and the tangible changes in families’ lives stemming from this work.

If you or someone you know would like to discuss ADHD, early intervention, or a tailored multidisciplinary plan, please feel free to reach out and contact my office for an appointment.

07/01/2025

ADHD
AND THE NEW SCHOOL YEAR

It’s important to give your child the best chance to reach their full potential in life.

One major part of being successful in life is to have the ability to learn and retain information and solve problems.

Optimal concentration is required to preform these tasks and get a good education that sets you up for the next phase of life.

The earlier a child with concentration problems is identified the more successful the intervention will be.

Early intervention and treatment of ADHD can also reduce the risk of secondary problems.
Untreated ADHD often leads to anxiety , aggression , poor socialisation and poor self esteem ultimately increasing the risk of substance abuse later in life.

ADHD like most conditions is a spectrum that varies from mild to severe.
Some children are not hyperactive but just inattentive and impulsive and are sometimes less easy to spot and often leads to late diagnosis and delayed treatment.

The ideal is to identify a child with ADHD early when they just start with grade one and even as early as grade R already.

Treatment is often delayed because parents are in denial and first try alternative treatments that does not work.

Sometimes the uninformed think that ADHD is over diagnosed and over treated.

It must be understood that there is no incentive for a doctor to diagnose and treat ADHD other than to help your child reach their full potential.

Often by the time a child ends up in the ADHD specialists office there had been many experts like the teachers, educational psychologists, occupational therapists, remedial teachers and speech therapists to mention a few, that have already spotted the problem.

The diagnosis is based on information obtained by all of the above experts.

All that a parent needs to do is to take all this information given to them and get the opinion of an ADHD specialist and follow their advice.

It’s also advisable that both parents attend the consultation , if possible,to address any concerns and questions parents may have.

Once the diagnosis of ADHD has been made a treatment plan will be discussed and initiated.

A follow up appoint will be scheduled to evaluate the response on the treatment and adjusted if needed.

I personally enjoy treating ADHD because of the amazing response and the difference it makes in the lives of children and their families.

I once had a 7 year old boy come back after a month of treatment and I asked him if he thought the medication worked for him.
His answer was just so good and funny that I have to share it.
He said that the medication did nothing to him but it did make better people of his teacher and his mother….!! And that said it all.

Don’t delay consulting someone that can help your child.

For Appointments
Phone 021 975 00 35

02/01/2025

I would like to wish everybody a happy 2025 with an abundance of everything especially health for all.

Our offices will be opening on Monday 06/01/25 at 08h00.

Please phone early on Monday since I expect it to be a very busy week.

Everybody that books an appointment on Monday will be seen the same day.

Let’s all make a difference for good this year!

I’m looking forward to be of service to all the sick children and concerned parents in 2025 like I’ve done for the past 27 years here in Durbanville.

03/12/2024

The myth of Man-Flu:

The term "man flu" is often used humorously to describe the perception that some men tend to exaggerate their symptoms of common colds or mild illnesses, claiming to be much more affected than women. This notion plays into stereotypes about gender and illness, suggesting that men are less resilient to discomfort and more likely to seek sympathy or attention when they feel unwell.

Research indicates that, generally speaking, women tend to have a stronger immune response to influenza and other viral infections compared to men. This difference can be attributed to various factors, including biological, hormonal, and genetic influences. As a result, men may be at a higher risk of severe complications and death from influenza, particularly in certain age groups and among those with underlying health conditions.

1. Immune Response:
Studies have shown that estrogen and other female hormones can enhance immune responses, while testosterone may have immunosuppressive effects.

2. Age Factors:
Older adults, regardless of gender, are at increased risk for severe influenza and related complications. However, when comparing men and women in older age groups, men often show higher mortality rates from influenza.

3. Comorbidities:
Men are more likely to have certain comorbid conditions (such as heart disease, diabetes, and respiratory issues) that can exacerbate the effects of the flu, contributing to higher mortality rates.

4. Behavioural Factors:
Men may also be less likely to seek medical care early or get vaccinated, which can impact outcomes when they do contract the virus.

Conclusion:

While both men and women can suffer serious consequences from influenza, statistical evidence suggests that men are generally at a higher risk of severe illness and death from the virus, particularly among older populations and those with other health issues. However, individual outcomes can vary widely based on a range of factors, including overall health, access to healthcare, and vaccination status.

The point is that in general when men do get ill they are more ill than women..
That’s my POV and I’m sticking with it🤣

28/10/2024

Just some information on one of the viruses doing the rounds currently.

Human metapneumovirus (hMPV) is a respiratory virus that belongs to the Paramyxoviridae family, specifically the Metapneumovirus genus. It was first identified in the Netherlands in 2001 and is known to cause respiratory infections, particularly in children, the elderly, and immunocompromised individuals.

1. Symptoms:
hMPV infections can present with a range of symptoms, including:
- Cough
- Wheezing
- Fever
- Nasal congestion
- Sore throat
- Shortness of breath
In some cases, it can lead to more severe respiratory illnesses, such as bronchiolitis or pneumonia.

2. Transmission:
The virus spreads through respiratory droplets from coughs or sneezes of infected individuals, as well as through contact with contaminated surfaces.

3. Epidemiology:
hMPV is typically associated with seasonal outbreaks, similar to other respiratory viruses like influenza and respiratory syncytial virus (RSV). Infections are more common in the late winter and early spring.

4. Diagnosis:
Diagnosis is usually made based on clinical symptoms and can be confirmed through laboratory testing, including PCR (polymerase chain reaction) assays or viral cultures from respiratory specimens.

5. Treatment:
There is no specific antiviral treatment for hMPV. Management primarily focuses on supportive care, which may include hydration, fever control, and, in severe cases, hospitalization for oxygen therapy or mechanical ventilation.

6. Prevention:
Preventive measures include practicing good hand hygiene, avoiding close contact with infected individuals, and following respiratory etiquette (covering coughs and sneezes).

7. Research:
Ongoing research is being conducted to better understand the virus, its pathogenesis, and potential vaccines or treatments.

So it’s nothing new to us but people always ask me what is going around and when I say for instance the MPV they expect an explanation of what it is and what it does.

Now you know….

09/10/2024

It’s Allergy season.

As many as 30 % of all children have allergies and in urban areas it could be as much as 40 %.

Children living in urban areas are more allergy prone because of the more hygienic environment that they grow up in than children from farms and rural areas.

The best way to avoid developing allergies is to be born by a normal delivery if possible, breast fed, grow up in a farm environment and eat fresh organically grown fruit and vegetables and meat from free range animals that are also fed organic food.

If one of the parents have allergies the risk for the children is at least 50% to also have it and if both parents are allergy sufferers then the children’s risk goes up to 80%.

Common allergic conditions are:

•Hay Fever
Blocked nose, sneezing , itchy nose ,eyes ,throat and ears.
•Asthma
Wheezy tight chest. Often exercise induced shortness of breath and coughing.
•Eczema
Very dry itchy skin with red inflamed areas and sometimes wet and infected.

•Specific food allergies.
This is not season bound unless the specific causative food has only seasonal availability.
But here it’s much easier to just avoid ingesting the food that causes a reaction if it’s known to the patient.

As we go into summer the airborne allergen count from the environment is rising causing allergy symptoms to flare up.

Some patients can experience seasonal flare ups and others can have symptoms the whole year long.

If you are allergic to pollen and gras it’s usually worse during the summer but if you are allergic to moulds and spores the wet and damp winter months are the worst.

Children that are allergic to house dust mites and / or have pets that they are allergic to ,will also have year long symptoms.

It could be difficult to distinguish between allergy and viral upper airway infections.
Both can cause clear nasal secretions , blocked nose , sneezing and a cough.

If you are an allergy sufferer then you would also be more prone to getting viral infections with potential secondary bacterial infections.

The important point I am making is that a child or adult with allergies should be on the right preventative medication before all the symptoms and complications of allergies start.
Or if you suspect allergic disease in your child to go to a doctor that can diagnose the condition and prescribe the appropriate medication.

All the best medications for allergies are prescription medication and are superior to those you can buy over the counter.
Plus your doctor will instruct you on the correct use of these medications.

Don’t let your child suffer from allergies that are treatable and controllable…

Go see your doctor asap.

22/07/2024

DENTAL CARE AND ORAL HEALTH IN CHILDREN.

HEALTHY MOUTH / HEALTH BODY:
There is good evidence that good oral health correlates well with good overall health.
Poor oral health increases inflammation affecting other parts of the body as well.
Poor mouth hygiene and teeth decay increases risk of cardiac conditions and respiratory infections including pneumonia.
Poor oral health with teeth thats in decay and inflamed or infected gums ,reduces one’s ability to chew and digest the right food that affects one’s nutritional status and therefore the immune system and the bodies ability to ward off infections.

Like with everything in medicine prevention is better than cure and here are the ways to implement prevention.

START EARLY.
Introduce the correct routine at an early stage.
Clean babies mouths and gums regularly with a soft clean cloth.
Start at no later than 3 months of age.

A soon as the first tooth cuts, start brushing it at least twice a day.
In the mornings and before bedtime in the evenings.

Continue to brush your children’s teeth yourself for the first 6 years at least or longer if necessary and until they can do it themselves under your supervision.

Set an example by brushing and flossing in-front of them.

FLUORIDE SUPPLEMENTS:
Fluoride is essential to form strong teeth and bones but too much fluoride can cause staining of the teeth and defective mineralisation of bone resulting in weak bones that can break easier.

In Cape Town the water fluoride content is 0,1 mg/l and the optimum levels are 0,7 mg/l - 1,2 mg/l.
There is no fluoride added to our drinking water and therefore we need to take fluoride supplements in the form of Zymafluor drops or tablets.
One tablet is equal to 4 drops and that is 0,55mg Sodium Fluoride that is equivalent to 0,25mg of pure fluoride.
It is recommended to start with fluoride Suplements as the deciduous (milk)teeth are forming and before they erupt at about 6 months.
Fluoride supplements should be given until 2 years of age when Fluoride containing toothpaste should be introduced.
Until two years the infants teeth should be brushed with non fluoride containing toothpaste as mentioned twice a day plus fluoride supplements.
The amount of fluoride toothpaste from 2-3 years should the size of a rice grain and after 3 years pea sized until the age of 6 years.
At 6 they can control the swallowing of toothpaste and rinse it out after brushing.
Then finally one continues with fluoride supplements till 12 years when the wisdom teeth erupts.

DENTAL CHECK UPS:
It is important to start at 1 year with dental checkups to detect early problems before cavities are formed.
Dentists can also advise on sealants to use to protect your child’s teeth.

DIET:
Avoid food with added sugar and sugar containing drinks.
Sugar lowers the ph in the mouth in combination with the bacteria in the mouth and under a critical ph demineralisation of the teeth starts that causes tooth decay and cavity formation.
It takes the saliva which is slightly alkaline up to 30 minute to correct the ph again.
Children running around with nursing bottles and bottles with tea and sugar or juice may take a sip only every 30 minutes and will end up with bad tooth decay which is then usually blamed on antibiotic usage. Doctors long since stopped prescribing Tetracycline antibiotics to children under 12 years old.

Food to eat is fresh vegetables and fruit (but not fruit juice)and unprocessed dairy products and fresh unprocessed meat and drink plenty of unflavoured water.

TRAUMA PROTECTION:
School going children participating in contact sports like rugby , hockey , boxing, martial arts or any other sport where you can get an impact on your mouth should be fitted with mouth guards.

SECONDARY CARE:
When all the permanent teeth erupted and there is mal alignment it might be advisable to go see an orthodontist to address the issue.

CONCLUSION:
Take good care of your children’s teeth because its your responsibility as parent to do so and not that of the child!
Often when I give this advice to parents the parent will turn to the child and say:” Did you hear what the doctor said”.
Then I will say to the parent: “Did YOU hear me because i was talking to you”.

Happy brushing😊

02/06/2024

Warning against Nasal aspirator:

There is a nasal aspirator on the market which seems to be very popular amongst parents with babies and toddlers.

This specific nasal aspirator is manufactured in Sweden and even registered with the FDA in the USA as a medical device.

Since we are in the middle of the winter and Influenza epidemic as-well as RSV season there are many children with these infections that can be very serious and even fatal in certain individuals.

One of the main symptoms of all these respiratory viral infections is a blocked nose with varying degrees of thick mucous obstructing the nasal passages. The smaller and younger the child is the more dependent they are of having clear nasal passages to breathe comfortably.

One popular way for parents and caregivers to clear the child’s nose is to suction the child with a nasal aspirator.

The NOSE FRIDA is a nasal aspirator that is in my opinion dangerous for the operator to use on somebody that has a contagious airway infection.

It has a larger part with a tip that is shaped to fit the entrance of the child’s nose.
A thinner plastic pipe with a mouth peace is connected to the larger part with a sponge-like filter between them.
So when the parent sucks on the mouth peace the mucous will be caught in the filter.

When you hold that filter to the light the small holes in the filter are visible to the naked eye.

If those holes are at the resolution limit of the human eye(the smallest one can see) they are 0,1 mm in diameter(100 micrometer).
That is 100 thousand nanometers. The INFLUENZA virus is 10 -15 nanometer.
That means that those holes in the filter are 6-10 thousand times bigger than the virus itself.
To give perspective to the size of those holes in the filter it would be like a 3 year old child that is 1 meter tall standing at the entrance of a 10 km diameter hole!!
There is no way that those holes can prevent all small viruses from passing through them.
The mucous might be trapped by the filter and not end up in the airways of the person sucking the aspirator but cannot stop all the viruses from passing through.

When we are exposed to people that have airway infections we inhale the virus containing droplets that get caught in our upper airways and sorted out by our immune systems to prevent infection from setting in.

But if you suck with your mouth on the aspirator the viruses could bypass most of your initial protection mechanisms and end up in your lower airways like bronchi or alveoli causing bronchitis and or pneumonia.

I have admitted thousands of children over the years with respiratory infections.
Most of the parents that use this device are just as ill or even more ill than their children.

I therefore urge people not to use this device to clear the nasal passage of a child that might have a contagious airways infection.

You could end up very ill with a lower respiratory tract infection.

On the device it states the following:
•Doctor recommended
•Effective
•Hygienic
•Safe

I certainly do not recommend this type of device and in my opinion do not think that it is safe for the operator to use.

Be Warned…!

26/04/2024

GET YOUR FLU SHOTS ASAP AND OTHER VACCINES UP TO DATE .

During the winter season, certain infections tend to be more common among children due to factors such as increased time spent indoors, close contact with others in school or daycare, and seasonal changes in viral activity.

Common winter infections that children may be more susceptible to include:

1. Flu (Influenza):Influenza is more prevalent during the winter months and can cause symptoms such as fever, cough, sore throat, and body aches. It is important for children to receive the flu vaccine to help prevent infection. We are currently seeing many cases of children with Influenza ending up in hospital with pneumonia.
Everybody over 6 months of age must get the flu shot to prevent getting seriously ill from Influenza.

2. Common Cold:Children are more likely to catch colds in the winter due to spending more time indoors and in close contact with others. Symptoms include runny nose, cough, sneezing, and sore throat.

3. Respiratory Syncytial Virus (RSV):RSV is a common virus that causes respiratory infections in young children. Symptoms can range from mild cold-like symptoms to more severe respiratory distress, especially in infants.

4.Stomach Flu (Viral Gastroenteritis):Viral gastroenteritis, often referred to as the stomach flu, can cause symptoms like vomiting, diarrhea, and stomach cramps. It can spread easily in close quarters such as schools and daycare centers.

5. Norovirus: Norovirus is another common cause of viral gastroenteritis, leading to symptoms like nausea, vomiting, diarrhea, and stomach cramps. It can spread rapidly in communal settings.

6 . Pneumonia: Streptococcus pneumoniae and other bacteria can cause lung infections and are often the cause of secondary bacterial infections following viral infections like RSV and Influenza. It often causes fever , cough and shortness of breath.

To help prevent the spread of infections among children during the winter, it is important to encourage good hygiene practices such as frequent handwashing, covering coughs and sneezes, and staying home when sick.

Additionally, ensuring that children receive recommended vaccinations, including the flu vaccine, can help protect them from certain infections.

Don’t wait. Get the flu shot this week still!

13/01/2024

If you are wondering why your child is always ill…Then read this.

I’m reposting something I wrote and posted a few years ago but it is still very relevant .

Crèche syndrome (CS)

This is not a condition you will read about in medical textbooks or medical research magazines and literature. Yet CS is probably the most common chronic condition seen by paedaitricians in private practice.

CS is not a diagnosis per sé but rather an acquired state of chronic illness due to being exposed to other children in close proximity like in daycare and crèches or even just older siblings.

CS's main victims are children under the age of 3 years old. The peak incidence would be children under 2 and then it flattens off towards 3 and then gets better as the children outgrow it.

CS's severity has much to do with the parents perception of how ill their child is. For instance if a parent cannot tolerate that an otherwise happy child in the above setting has got a recurrent phlegmy cough and runny nose then it will be 2 years of hell for them. Of cause there are certain signs and symptoms to look out for that may alert you to seek medical advice.

Definition of CS:

There is no exact definition for this condition but there are undoubtedly certain characteristic symptoms.
CS is a condition of recurring wet cough and excessive upper respiratory snottiness and secretions in a setting as mentioned before in the age group of 0-3 years.

Children in daycares and crèches can get as many as 10 -20 upper airway infections per year. These are mainly common colds caused by viruses.
During each episode they could have 10-20 days of a runny nose and a cough as well as fever for the first 3 days (72hours).
This implies that they could have fever for between 30 and 60 days per year just from these viral infections. Furthermore the cough and snotty nose could persist from between 100 to 400 days per year!
In other words it might seem like your child has these symptoms the whole year long non stop. That is why parents often say their child has never gotten better since they were last seen by the doctor but in fact the one infection has just run into the next.

This would just be the primary symptoms due to the viral infections and does not even take into account should they get secondary complications due to these infections.

Complications could include:

•Acute otitis media(middle ear infection) and otitis media with effusion(glue ear)
•Acute or chronic sinusitis.
•Acute recurring bronchitis.
•Bronchiolitis.
•Pneumonia.

The above complications will require medical attention and antibiotics may be prescribed.

Signs to look out for that might require medical treatment.

Fevers that may not be associated with the signs of a common cold or that lasts longer than 3 days.
Fever in a child that looks very ill and fevers that does not respond well to treatment. Fever that repeatedly spikes above 40 degrees Celsius.
Children that look ill and lethargic between fever spikes.

Persistent vomiting. Could be from all the phlegm or it could be due to meningitis or gastroenteritis or urinary tract infections.

Poor feeding. Could be due to a sore throat or pneumonia or bronchiolitis or even middle ear infections.

A child in severe pain. Could be a sign of middle ear infection or meningitis.

Breathing difficulties. Children that are short of breath and breathing fast even between fever spikes. Labored and grunting breathing pattern.This could be due to pneumonia or bronchiolitis.

Contributing factors in CS that should be excluded:

Other underlying causes and contributing factors should be considered by the doctor and excluded if necessary.

Cigarette smoke exposure. Parents , grandparents and friends that smokes in the house. The smoke damages the mucous membranes in the airways which are the first line of defense against infectious agents like viruses and bacteria. Previously the child might not have got ill before placed in an environment like a crèche with a high load of infectious agents. There are tablets that any doctor would be happy to prescribe to anyone that wants to stop smoking.

Common allergies like hey fever, asthma and eczema should be taken into account especially if one of the parents have any of these conditions. Allergies also damages the mucous membranes with an increased risk of infections. These allergies can be easily treated in most cases.

Children with recurrent serious infection should be investigated for immune deficiency disorders. This would usually be done in children that are recurrently admitted to hospital with pneumonia. These conditions are relatively rare but can be treated with intravenous Immunoglobulins.

Other conditions that predisposes children to recurrent respiratory infections should also be thought of and excluded if necessary.
These would also be rare conditions like cystic fibrosis (CF) and anatomical defects and conditions that impairs ciliary movement on the airways mucous membranes.

Treatment of CS.

Good nutrition is very important to prevent iron , zink and vitamin deficiencies. If the child is a picky eater multivitamin supplementation should be considered all though there is little proof that these supplements makes a significant difference. I usually suggest that children should rather drink a nr. 3 formula up to 3 years of age rather than cows milk that does not supply all the required nutrients for brain development and building a strong immune system.
In government clinics children get 6 monthly oral vitamin A to boost their immune systems, all though that is aimed at children that might have a deficiency due to malnutrition.

There is evidence that Moducare ,Ecchinaforce and Propolis may have a positive influence on boosting the immune system. These supplements may have a marginal benefit.

Probiotics seem to be the new kid on the block with lots of evidence that a persons microbioma plays a major role in regulating the immune system.
This is why it is recommended that babies should be born via the natural birth canal if possible and be breast fed for at least a year if possible. Except all the other immune boosting benefits of breast milk it helps to introduce and maintain the bodies natural healthy balance of good micro bacteria called probiotics.

Antibiotics in CS are reserved for the complications of secondary bacterial infection as mentioned. Care should be taken not to prescribe it unnecessarily as this will damage the bodies microbioma and in so doing compromise the immune system making the child even more susceptible to infections. This becomes a vicious cycle .
All courses of antibiotics should be accompanied by a course of
probiotics like Reuterina or Interflora.
It might be of benefit for children in crèches to take probiotics on a daily basis to help boost their immune systems in a setting where they might receive repeated courses of antibiotics.

•So the moral of the story is that children in a crèche will get ill repeatedly for the first 2 - 3 years. They might seem to be never fully healthy.
•Care should be taken not to run to doctors unnecessarily and not to demand antibiotics from the doctor if he/she thinks its not needed.
•If your child is ill try to keep them at home.
•Breast feed for as long as possible.
•Don't expose children to smoke. Stop smoking all together.
•Follow a healthy diet.

CONCLUSION:

Don’t panic, this too shall pass…

Dr Willem Smit Paediatrician

26/08/2025

07/01/2025

02/01/2025

03/12/2024

28/10/2024

09/10/2024

22/07/2024

02/06/2024

26/04/2024

13/01/2024

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Monday	08:00 - 17:00
Tuesday	08:00 - 17:00
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