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8 controversial issues of pediatrics: the pediatrician responds

8 controversial issues of pediatrics: the pediatrician responds

Pediatrician José Luís Fonseca answers some questions from the field of pediatrics that sometimes generate some controversy and many doubts. Dr. José Luís Fonseca has been a pediatrician for 35 years in the district of Braga and, throughout his professional career, has undergone some vicissitudes regarding changes in guidelines and paradigms in child care.

Children for many years were treated as if they were smaller adults, without the notion of the abysmal difference of the particularities that people have over different ages, especially here, considering the ages of childhood and adolescence. However, the recognition of the child as a biopsychosocial being, as well as his rights as a citizen have been delineated throughout history, parallel to the care and health care to this population segment. The National Plan for Child Health in Portugal has undergone transformations and is still in constant construction. Nowadays, there is a great concern of the society, and especially of the parents, to protect, to empower and to realize the development of the children. There are issues that raise doubts and controversies, many times not for the validation of the studies themselves, but for the adequacy of the circumstances of each particular situation.

We started pedriatic interviews with 8 controversial questions 

1.COLUMN Many people argue that in the first months of life children should not get used to their lap whenever they cry. They say that babies should calm themselves in the crib. What is the basis for this attitude? Is more overpowering harmful?

The question already implies an answer, that is, when classifying the colo as "the more" you are already saying that what you are referring to is an exaggeration. But a colinho is a good attitude, for parents and children! There are times when the autonomy, which we must implement for children, is impaired if it is a lap at inappropriate times, which are different, depending on the age of the "child".


2. VACCINATION Vaccination, a subject that should not be controversial, has in recent times generated some discord. Vaccination prevents the onset of disease and makes it possible to eradicate it. However, there are parents who choose not to vaccinate their children. Why should we vaccinate our children? Should we fear the side effects of vaccination or is the benefit / injury ratio so great that it should not even be called into question?

Fortunately, Portugal is one of the countries with the best vaccine coverage in the world at the pediatric age. This is certainly related to the decrease in infant mortality and morbidity (disease). Social networks have as a special feature giving visibility to things that are, largely, minority and that appear magnified, making small situations in national problems. This is the case with anti-vaccine groups. In fact, fortunately in Portugal, these groups are little minorities and will one day be judged by the evil they are causing in their children. Vaccines, when they arrive in our country, are already widely tested, in their effectiveness and in the small side effects they can cause. That's why smart people do not embark on "the policy of annihilation of the world through vaccines," or that "the whole world is bought and the multinationals make believe that the vaccines are accurate, but they never were" . These are the fundamental ideas which these groups want to spread and that in some countries have dramatic consequences ... The vast majority of vaccines, which are indicated to do in Portugal, have the support of the main Scientific Societies and have managed to control serious and epidemic diseases. The small cons are the cost of the vaccine.



3. BREASTFEEDING For mothers who sometimes think that "breastfeeding is harder than I thought" would answer the following questions. Why should I breastfeed? How do I know that my milk is enough to feed my baby? I've heard of weak milk. How do I know if my milk is weak?

Breast milk is a gift from humankind to humanity! It has in the process of breastfeeding, and in its constitution, factors that leave good sequels in the life of this little and little defended human being. The beneficial effect begins in the newborn and lasts throughout life. For those who can do it, breastfeeding is giving health and happiness to you and yours, for the rest of your life. There are alternatives, but they are light years away, in their positive effects! So we should be very well informed when we want to make the decision to breastfeed or not. We must inform ourselves in places of trust and not in the means of small groups, which present pseudoarguments, but which can catch the unwary. How do I know that my milk is enough to feed my baby? Children at these ages require health support at intervals as small as necessary to ensure that mother and child are doing enough to make things go well. In practice, it is known that milk will only be insufficient if technical errors or physical disabilities occur during these periods. Otherwise, at the beginning it will be difficult, but then everything will run on wheels and, in this story too, everyone will end up happy. I've heard of weak milk. How do I know if my milk is weak? It's a myth. There are no weak milks of the mother. However weak they are, they are virtually the best in the world for the child.



4. HYPER-PROTECTION "Hyper-protection is also an act of neglect." How do you comment this expression?

Society is always evolving ... and in modifications that tend to be unbalanced if we do not pay attention to its exaggerations! Mostly, there was a phase of authoritarianism, in which the parents were dictators and the children "did not need explanations", to another phase in which "the child knows, if he can not be traumatized". Parents are responsible for educating , for happiness and autonomy. Parents should realize what stage their children are in and what they can and should do alone. This contributes to their ability to live in society, without being dependent on others. Hence, parents can not escape this responsibility of letting their children be autonomous, otherwise they may in fact be negligent in excess of protection, contributing to the dysautonomy of their children.



5. HYPERACTIVITY There is "social pressure for students to behave well". For psychiatrist Daniel Sampaio, the change is clearly not in the behavior of minors: "There is pressure from parents and teachers to make students less turbulent. Teachers ask parents to take the children to the psychologist and the psychiatrist because they are very turbulent and can be hyperactive. " There are over-medicated children and others who are not medicated and need. What repercussions does this have on the child's health?

I think that in the content of the question lies the crux of the matter, which has so distressed society, especially those who have children who need to be medicated and who have children who are medicated and do not need. In my opinion, all medicines are double-edged and two-way knives: one that points to treatment and another that points to side effects. The smaller the children, the more we should think about the consequences that a medication can have on life and on their health. In the case at hand, when a child needs a medication, to be able to produce what his physique and his mind allow him, and if we omit that medication, we may be damaging the child's life forever. It is the example of glasses: if the child sees it wrong and we do not give him glasses, so that he can perform his visual functions (without great negative consequences in its use), we are depriving him of a healthier life. So in this, as in many other situations, the most important thing is to have a Physician in whom we entrust our child and offer what our child is entitled to, whether to give or not to give a medication.



6. DISINFECTION In the last century, most humans recognized the importance of hygienic habits. Nowadays we can say that the world has never been such a clean place. But are we coming to a detrimental extreme with regard to excessive disinfection?

It seems to me to be an exaggeration to classify the world as a clean place, when we are still so far from it that it can happen and we can benefit from the discussion if it is worth it to be so hygienically treated. It is a utopia. We can discuss utopias, but we must know that the theories that the hygiene, cleanliness, care of transmission of certain infectious diseases that jeopardize our well-being and even our survival are far from the reality of the great most of the world. So while we can, we must teach to be as hygienic and asetic as possible, especially to the most fragile human beings, and yet we are not avoiding the transmission of millions of microbes, some of which are quite harmful. However, protection against infectious agents, healthy habits of contact with land and animals, at appropriate ages and with appropriate care can not be confused.

The years in which the babies lay in the pens and in the sludge of animal waste, in which the infant mortality was 100 times superior to the one that today, is verified in our country. Memory is fundamental not to fall into the same mistakes of a recent past and that much work is still to be done to fight.


Some topics that can be used for discussion:

• Researchers find some parents' actions to be exaggerated such as using gel / antiseptic alcohol before touching the baby, sterilizing the pacifiers before each use, wiping the pacifier with antibacterial wipes if it has fallen on the floor.

• Play on earth only from the age of three, because only then is the immune system fully developed.

• An article published in the Journal of Allergy and Clinical Immunology (USA) reviewed 22 studies and found that having a dog during pregnancy or the baby's first months of life reduces the child's risk of developing eczema (allergic skin reaction) by 30%. and having asthma by 20%.

• Child exposure to allergens in childhood helps to reduce the incidence of allergies in the future. Studies show that in the Nordic countries, where the disinfection habit started many years ago, there is now a higher incidence of allergies.)


7. MIPMED As you know our initiative to do interviews in the field of pediatrics, stems from our focus as a medical products company. As we consider that pediatrics is an area of ​​extreme importance, we want to give it due attention and have the best products available to our customers. What is your opinion regarding quality and dangers when choosing pediatric products that exist in the market?

It is clear from our previous replies that we have to continue to be very careful in the choice of products which are now much more accessible for purchase in the global market and whose unfiltered advertising brings us through the screens of the television, the computer, smart phones. Therefore, it is worth appreciating the effort in the rigor of the proven quality, which MIPMED has, and in the concern of scientific updating, as exemplified by this simple interview, so that they can continue to strive for good prices and great quality in the products, I am concerned, for childhood and adolescence, for maternal and child health.



8. FOLLOW-UP Dr. José Luís Fonseca has a private practice in Braga. A modus operandus of your clinic is not to accept children over the age of three months. What is the basis for such an ideology?

We all have our beliefs. Mine is that scientific truth is one of the few that can be demonstrated, having as its immediate effect, that which can also be more easily unmasked, proving otherwise with the same means. Evidence-based medicine is therefore much more important than a personal experience, as we are putting many thousands of scientifically validated studies against an opinion with half a dozen cases, which have influenced us positively or negatively. But not everyone thinks so, and so "picking" on a child whose parents are already "poisoned" with pseudo-truths and pseudo-judgments that led parents to fulfill certain purposes for their children, is very difficult. Keeping in mind that a Pediatrician has to support his clients 24 hours a day, it is important that there is a fundamental knowledge exchange for this relationship to work. Therefore, the earlier a child is guided by me the more benefits they will bring to their parents. This is demonstrated by those who have been with me for more than 30 years and who are followed by me from birth to 18 years of age.



Thank you very much Dr. José Luís Fonseca for your participation. Certainly it clarified many doubts or generated more controversy. In any case, reflection and discussion (constructive) allow us to evolve, to create new habits or to establish existing habits, to question and to seek to know more.

On the other hand, thank you very much for the opinion you have shown about our products. Let us consider your advice when looking for new products.