Would you know what to do if your little one was choking?

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Transcription:

Kath

If you are pregnant, or you've recently had a baby, this podcast is for you. I am your host Kath Baquie. a physiotherapist working in women's health and mum of three. Join me each week as we dive into all things pregnancy care, childbirth, and postnatal recovery, helping you have a wonderful pregnancy and after birth experience, and don't forget to hit subscribe so you don't miss any episodes. You're listening to the FitNest Mama Podcast with Kath Baquie episode number three. 

Well hi again and welcome to our third episode of the FitNest Mama Podcast. I am your host Kath Baquie and am founder of FitNest Mama, where I'm a physiotherapist and women's health who has helped hundreds of women have active pregnancies, confident childbirths, and strong postnatal recoveries, helping them get back to doing what they love with confidence and bubba by their side. 

Are you pregnant? And are you pregnant and you're perhaps a little unsure about what you need to know about baby first aid when you first arrive home from hospital? Or have you recently had a baby? And you're beginning to think about the next phase of introducing solids, but you're not quite sure what to do if your baby was choking? If you answered yes to any of those questions, keep listening. Because today is an amazing podcast episode as I'm bringing on the lovely Nikki from Tiny Hearts Education. Nikki is a former paramedic, mama of two little ones and co-founder of Tiny Hearts Education, a training organization providing essential birth and first aid education to parents across Australia. We get into a great conversation answering questions such as:

•  Do you think first aid training is required during pregnancy, or just before your baby's starting solids. 
• We discuss safe sleeping and guidelines for the prevention of SIDS including what to do if you're in that situation. 
• We dive into starting solids and the main tips and things to be aware of. 
• And we also discuss allergies and rashes, including when is a rash of bad rash, 
• and so much more. So get ready for this amazing podcast episode!

But before we do jump into this episode, I just want to let you know of the Fitnest Mama Launch Giveaway. To go into the drawer to win one of five 3 months memberships to Fitnest Mama, all you need to do is head to www.fitnestmama.com/giveaway and enter your name and email address. It's super easy to do. And the link is in the show notes. If you win, you will have an access to online workouts, amazing resources, guest speakers and have support from myself perfect for any stage of pregnancy or after birth. This giveaway ends on Friday 16th of October 2020. Right let's get into the show. 

So Nikki, thank you for joining me today. It's lovely to have you on the show. 

Nikki:

Thank you so much, Kath for having me on. I'm excited to be here and chatting with you.

Kath:

So for those who don't know who you are or what you do, could you give us a little quick introduction, please?

Nikki:

Hi, my name is Nikki. I am the co-founder of Tiny Hearts Education. So we are an education provider. And I guess to sum it up, we are here to remove that anxiety around birth in your bar there and you know once they arrive and making sure that you're empowered to have a positive birth.  And also once they're here to be able to ensure that you can keep them healthy and safe as well. I have two babies of my own. So Nala is three and Wolfie is I believe he's now 14 months. It's always with the second that you start to lose track of their age.

Kath:

Absolutely!

Nikki:

I’m in the business with my sister. We've been doing it for seven and a half years now. And yeah, we're just incredibly passionate about empowering parents.

Kath:

That's amazing. And you're a paramedic in your past life. Is that right?

Nikki:

Yeah, that's the career I guess that led me to starting Tiny Hearts. I worked as a paramedic with ambulance Victoria for about eight years. And in that time, it was I guess, just going to different jobs where I felt there wasn't enough information and we didn't have enough time to give parents information on different jobs. Obviously the nature of the work we were doing, so Rachel and I would just constantly have this conversation about it. There's nothing out there. They don't know what to do. And you know, parents are worried and how do we do something about that. And that's how we came up with the idea of Tiny Hearts, we want to give that information to parents so that they no longer worried and they know when to call us and what to do before we get there if needed.

Kath:

Yeah, that's so great, because I know even with my first which was seven and a half years ago, now, it was not even talked about to get baby first aid until I think it was mentioned once the baby started solids, which back then was six months old. And so the whole concept of having baby first aid during pregnancy just wasn't a thing. Whereas I can see so many benefits of having just some basic awareness and knowledge, which will hopefully help to reduce a bit of that anxiety or overwhelm that might happen in that early newborn phase.

Nikki:

Yeah, definitely. Well, most of the couples that come along, are actually expecting their bubbas. I think the reason is, is because when you're expecting a bub, parents are so proactive these days, they want to do everything, they want to learn everything and, and they are so excited for that little precious one. But they also can, like you say, be quite overwhelmed with making sure that they they look after them, and they keep them safe. So, as I was saying to you off air, that baby first aid wasn't really something that was on the list before Tiny Hearts started. And now if you speak to an expecting mom, most of the time, it'll be birthing and baby first aid will be, you know, right, just under that course, as well, which is, which is great. But, you know, you never know what's going to happen. And there's some things that you need to know, as soon as your Bub comes home, there are lots of different topics that we cover. And I guess that's how you remove that anxiety and you replace it with that empowerment should something happen, you know exactly what to do. So I love the fact that women and couples have so proactive these days in learning everything before their little one comes to them. They're ready, because let's be honest, once that baby comes, you don't have a whole lot of time to even Google things, you know, knowing where to get the right information and being empowered before they join, I think is key.

Kath:

Absolutely, you might not need it. But if you do, it might be life changing. During pregnancy, what do you think, are the key things to be aware of before you've got your bubba and before you brought them home?

Nikki:

During pregnancy, so on our social media, we're always sharing information on the fact that you are the most connected with your bub. So I think that is probably the biggest thing that the parents need to be aware of, is that when you're pregnant, you are that little ones connection to the world. So making sure you're monitoring movements and being aware of what's normal and abnormal, and then trusting yourself enough to to go and actually seek help if you think something's wrong. And I think that is the key message that spans across, from the moment you find out that you're expecting a bub to once they're here as well. 

Because if you think something's wrong with them, and you think something's not going right with them, or they might be facing an illness or a sickness, that one thing as paramedics we would hear from parents is “something's not right with my baby”. And we would take that over any piece of equipment that we could use to tell us anything, because we know that parents are so in tune and can often tell us what's wrong with their Bub before we can actually pick it up. So in regards to topics, there's so many different topics that I think are important that that you need to learn about, we were just talking about this - about your work and what you do and how, you know, its so important that women know about [pelvic floor], and how to actually stay healthy during pregnancy. But yeah, there's just a huge array of information. But I think what underpins everything, is trusting yourself as a parent, and, and being educated on lots of different elements, and that is the key when you're pregnant.

Kath:

Yeah, I love that. And it is good to feel empowered, because it's very easy to lose that trust in yourself. So to have some basic foundations that you can pull upon will really help you to trust yourself, I reckon. From a personal experience.

Nikki:

Yeah. Well, we have people always come through and say, how do you deal with it, like you've got the experience of a paramedic and I say everything goes out the door when it's your own children and that's what we're trying to do, teach you simple things that you can recall in an emergency so that you can go back to that, because it's it's terrifying when it's your own children. So it kind of doesn't matter where you are or what your profession is, you just need to know those basic core skills that you can go back to in those moments of need.

Kath:

Absolutely. And I don't think you could do a first aid training too many times in your life, because we always forget parts, there's always new things to learn too. So, okay, so let's try to break it down. So if I've brought a new baby home, the first thing that comes to mind is safe sleeping, and we all know the risks. If you don't mind, could we break down the main points and how to prevent SIDS? And how to improve safe sleeping? And then, touch wood, if you were in that situation, what would you do?

Nikki:

Safe sleeping is something I think a lot of Mamas and couples are worried about. And that's why we do cover it in birthing course, and also our baby first aid, because there are things that you can do and ways you can prepare before baby comes home, that will actually dramatically reduce the chance of SIDS, since organizations that I'm sure you've heard about, like red nose, who have targeted this area and brought so much information to light. 

And then of course, you know, organizations like us delivering that to the masses, they've had a huge decrease. I think it's 85% decrease in SIDS cases, when you really put that into a figure, that's a huge amount of babies.

Kath:

My mum slept me on my tummy on sheepskin. Well, that's one I hear,

Nikki

Yes, yeah, you hear a lot. And I think, you know, we look at ourselves and oh, we're okay. But when you really do go back and look at the statistics, you know, the SIDS and deaths related to sleeping in unsafe environments, or on their side or their tummy, they are really, really high. So in regards to SIDS, the best thing is to prevent obviously, to follow those those guidelines, which is always put your bub to sleep on their back, not on their side, not on their tummy.  It is quite dramatic the risk increase when you sleep on their side and their tummy as well. So making sure that when you put them down that their head and feet are uncovered, so doing things like putting their feet at the bottom of the cot, rather than in the middle of the bed. And you know, those blankets that you're using are wrapped tightly around, so they're not going to come loose, I guess you know, things we just don't think about is those blankets coming loose and covering Bub's face and they're just not developmentally ready to actually remove that. 

Kath:

And feet at the bottom of the cot, that so they don't wriggle down underneath the blankets Is that right?

Nikki:

100%. So they can't actually move further down, a lot of people are actually starting to use sleeping bags now. So they were really popular. So as long as they're fitted properly, again, you want to make sure that they're fitted around the neck and the arms as well. So they can't ride up. But that's kind of reducing the anxiety because then you can literally put the sleeping bag on and put them anywhere in the bed. And as we know, they'll start to wriggle around and move around. So it removes that kind of anxiety that's related with the extra furnishings and blankets in there. 

The other thing that you'd be very aware of obviously is being healthy during your pregnancy and in particular, obviously making sure there’s no smoking and there's no smoke around bub afterwards as well, because that's linked with an increase in SIDS. And obviously the making sure the cot  meets the standards, it's a safe mattress, you've got safe bedding, so not putting sheepskin, and sleeping bubba in your room for the first six to 12 months is also shown to decrease cases of SIDS, and that's in their own cot in in the room. 

And the final thing is breastfeeding baby, if you're willing and able to do that, it is also linked with a decrease. So I think knowing those six steps that you can take before baby arrives and making sure that you are preparing their sleeping environment is the best way to prevent SIDS from happening.

Kath:

Yeah, that's great. So with lying them to sleep on their back, for how long is this? At what age would you consider that important? So for example, if you wake up and your baby is on its tummy, what would you say there?

Nikki:

So the guidelines in regards to this, we get so many questions about this because it's so confusing. And it's so frightening, this happened to me with my second, and I was like “can you just stay on your back please!”. So they're not in a bassinet any longer. So once they're moving around to that point, you want to move them into their own cot in their own environment. The other thing is you want to make sure that they're not in their swaddle anymore. Some parents commented on a post recently saying that their bubbles showing signs of rolling or rolling one way from as early as eight weeks of age. I think was the earliest. So as soon as they are showing those signs, you're unwrapping their arms. And the reason is, is because if they do get into a spot on their tummy, they can move their head into a position where they can actually breathe. But once they can roll both ways, the guideline is let them find their own comfortable sleeping environment, as long as they're not swaddled. So with my boy, I made sure he was out of a swaddle, I'd put him to bed on his back, and then I just let him do his thing. Once he could roll both ways.

Kath:

Babies roll generally from their front to their back first, right, and then it usually takes a bit longer to roll from back to front. That would mean that these guidelines are only in place for the first few months potentially. So that’s an interesting one.

Nikki: It's a frightening time for parents when they can only roll one way because the guidelines say you need to be putting them back on their back. So if your baby is rolling onto their tummy and not being able to roll back, because they don't have that strength, you're going to be popping them on the floor, really encouraging that tummy time, so they can build up that strength. So they can get both ways because, yeah, parents are like “do I just wake up and and pop them back?” And I'm like, “you need to do what you're comfortable with”. The guideline says that if you find them on their tummy. And they can only roll one way, then yeah, you need to put them back on their back. But you know, that's not always realistic. I don't think in all hours of the night.

Kath:

Well, I guess, that why the guidelines aren't there, they're creating a framework. And then you use that framework to suit your baby and yourself, and you work around that. But there's some great tips there, some some practical, easy to do tips for the safe sleeping side of things.

Nikki:

So if you did actually go in to get your bub up, and you found that the baby was unconscious and not breathing normally or not breathing at all, it doesn't matter what the cause is. And of course, you're not going to be knowing at that stage what has caused it, and you'd be doing what we call the primary survey, which is involves assessing bub, it's steps to call an ambulance. And then you would be starting CPR until paramedics arrive and tell you to stop. So in that situation, if our baby is ever unconscious, and not breathing, normally, we're always going to follow those same steps, and obviously call for advanced medical help like the paramedics.

Kath:

Yep. And I know CPR, it's a very practical training. So this would never take the place of going to do your first aid training. But was there any information you can impart to us to help us in that situation? Like as I said, I would never want this to replace [first aid training]. And it's not meant to but if you're pretty familiar with the way that things go, what would you suggest?

Nikki:

It's such a difficult thing, I think the reason that the primary survey exists is because you get on the phone to the ambulance really quickly, because that is going to be your lifeline. Obviously, if you are performing CPR on your own child or even somebody else's child, it is going to be absolutely traumatizing. However, your adrenaline kicks in. And we hear that from parents all the time in the tiny hearts community that it just comes back to you. And it's simple for a reason - so you can remember it in an emergency. And all you need to do is 30 compressions to two breaths and continue until a paramedic arrives and tells you to stop. So I think the best way to think about this is that you are, at that point, your baby's best chance of survival, listening to the call taker really carefully.  Making sure you're unlocking the door,  so the paramedics can get access. And as best as you can just focus on that task at hand. And just don't let yourself run away with your thoughts in that moment. I know even as a trained paramedic, that can happen. But I guess in that moment, that focus of what you're doing is absolutely vital.

Kath:

Oh that sends shivers down my spine just talking about it. And it does make me think I need to update my first day of training. Actually that's a good question for you - how often would you recommend to get your training updated?

Nikki:

We would say usually every year so I think the reason is, it’s like you touched on before, you forget things and some things are more relevant to you at certain times. So when you're pregnant, you'd be wanting to listen into what happens if a baby gets a temperature under three months of age, you are going to be very in tune with the different elements of the course then when your baby is say six months old and starting solids, you're going to be worried about allergies and choking. So we have lots of different options. And once you do a course with us, we have an option for a refresher course which is basically just an online course. It's half price. And people can just go in and do that course whenever they feel they need to update on some certain elements. So usually we'll have people coming back to refresh their knowledge every year.

Kath:

That's good advice. And it would be a great course to get the grandparents to do to.

Nikki:

200%. We do private in home sessions for that reason, because people say, you know, I've got so many people that are going to be helping me look after my bulb, and I want to make sure that they know what to do if something happens as well. So we have aunties, uncles, grandparents, lots of different people coming along.

Kath:

That's great. Okay, well, can we move on to a slightly different topic now? And that's allergies, and rashes. I know there's always a lot of questions from New mums about when is a rash a bad rash? What rash should you seek help with?

Nikki:

Yeah, there are so many different rashes. And that as you would know, that you come across… you get nappy rash, you get teething rash, and post viral rashes. You get rashes if bub has an allergy to something when they have anaphylaxis. So there's so many different rashes.  The way that we like to break it down… and obviously, there are some really medical terms for different rashes, which isn't practical for parents… but the way that we like to break it down is a blanching rash and a non blanching rash. So a blanching rash is when you have a rash and you put pressure on it, so you place two fingers on the rash, hold it for a couple of seconds, and then pull your fingers away. If that rash goes from the rash red color, or whatever color it is, to a blanched white color. It means that the rash is not a serious rash as such. If the color does not change, when you apply pressure to a rash, it's a non blanching rash. So these rashes are serious rashes. So these are rashes that we get with meningococcal, these are rashes we get with anaphylaxis. And this is when we say you will be calling triple zero to get someone.  In regards to breaking rashes down any further you don't really need to.  You would always follow up with a doctor for a blanching rash no matter what, and you'd be watching the baby symptoms. So if bub was breathing fast if bub had a really high temperature and was under three months, these are more concerning signs than a rash when it is blanching, so we always say do the test. So there's a great post on our Instagram that shows the difference between a blanching and non blanching rash. It's a great video that we found you can also use a glass to roll over because sometimes it can be difficult to tell if that rash is blanching or not. So that's a really great one. Because once you know that it's a blanching rash. 99% of them will be, you know that you're watching for other signs and symptoms, and you following up with a doctor.

Kath:

I think the next main thing that I might be wrong, but new mums would come across is starting solids. And again, I know this is a big topic because it goes into CPR training and all the rest. But if you could just name your top few tips, or things to be aware of when starting solids, what would they be?

Nikki:

You so right starting solids is, and in particular allergies and choking, is one of the biggest reasons for people to sign up for our cours.

It's exciting, I mean, your baby's reaching this milestone, but also it's this really anxiety invoking time when you have an allergy, my tips would be... Make sure your body's ready. There's some different conflicting information out there. But you're wanting to make sure that your baby's around the six months of age, not before four months. So that's the guideline around it. So the reason is, we know that when babies are around that six months of age, they need more energy, and they need more nutrients than what mum's breast milk or formula can provide in particular, as we know, the iron is lacking at that six months. And we also know that when they reach that age, they're developmentally ready. So we know that most of our bubs are actually able to sit up and they've got good head and neck control, which means that reduces that chance of choking. And they're probably showing other signs that they are ready, like they're grabbing for your food or they're opening their mouth. So I think that's really super important to understand that it can have adverse effects if you start solids when your baby isn't ready in different elements, so making sure you're looking for those signs. 

My next thing would be to make sure you understand what allergenic foods are. So those are the top allergy causing foods.  Sometimes we're not aware of what they are. But I think when you're aware, you can do it in a structured manner. And you can make sure that also when you're giving those foods you can feel confident because you know what you're looking for, and, you're doing it in the right way.  So that top allergy causing foods are those that include egg, cow's milk, peanut, sesame, fish, and shellfish, tree nuts, soy, and wheat. 

So they cause 90% of all allergies, food related allergies in our babies. So they're the ones that we're kind of really aware of, and we're wanting to introduce gradually. The other thing is that research used to kind of say, to delay the introduction of these allergenic foods, whereas now they're saying your baby needs to have them all before they turn one as it reduces the chance of them having an allergy. So making sure that you're introducing those foods one at a time. So if you're giving egg making sure that it's well cooked, you're not giving egg, cow's milk and peanuts in the same meal, you're just doing one at a time. So then you can identify if anything has caused a reaction.

Kath:

And these guidelines changed a lot in the last one or two years, would you say?

Nikki:

There has been guideline changes in regards to introducing and things like that, but certainly I think that education and information and awareness of parents is much greater around this, and anxiety too that comes with that. So I think a lot more parents are asking about and more knowledgeable about this. I know when Rach started introducing solids, she was like “I was pretty clueless”, there wasn't a lot of hype, there wasn't a lot of talk about it and her boys 10 now, so yes, definitely a huge increase in focus. 

The other really important thing to know about the allergenic foods is that it usually won't happen on the first exposure. So a lot of us as parents will go in going, “Okay, we're good with egg, egg is okay.” But we don't realize that it's usually the second, third or even fourth, fifth exposure to that, that an allergy can occur. So my tip is just being super vigilant and making sure once you give one of those allergenic foods, that you're making sure that you keep it up twice a week, because that maintenance is really important for the body. So you're not starting and then stopping, and then starting again, because that increases the chance of an allergy.

Kath:

 Interesting. And would you say then as well to not combine the foods too quickly either. So don't just try it once and then start to having a few allergens altogether? Still keep them separate for the first few months?

Nikki:

I'd definitely err on the side of caution. Some people don't. Like you said before, these are all just guidelines, and everyone finds their own rhythm to the way they do it. But for me, that's what I did. I would add egg to something like a puree or something that I know that he'd had before and there were no issues. And then you know, once you'd have it 5,6,7 times, then I'd be fine to be you know, adding egg or something else in.

Kath:

And then with solids as well... Another question. I remember for months, I just would hate the whole gagging reflex and I felt I could never relax while they're eating because of the gagging reflex. So could you talk us through that?

Nikki:

Yes, gagging and choking. Listen, there's a lot of focus on the difference between gagging and choking, but really we just say it's pretty much doing the same thing. Like if you see your bub gagging, you're not 100% sure it's a gagging reflex until it's over. But it usually only lasts for one to two seconds. The gagging reflex usually starts to actually disappear around the six months as well. My kid has super sensitive gag reflexes, so it went on for a little bit longer.  But I guess it's just that, you know, you look at it, and it does initially look like a choking incident because it looks exactly the same, except it stops and they remove it. So I think parents find a lot of confidence in knowing that it's actually a reflex that keeps them safe. It stops them from choking but yeah, my gosh, it's a confusing one. You just have to wait that few seconds out. And yeah, I guess it's just, for anyone who doesn't know what it looks like, it looks like a dry reach and it is basically just protecting them from a choking incident. Whereas if your bub was choking, they’d either be coughing, which is a partial obstruction or with a complete obstruction - it's very similar and looks very similar to a gagging episode. However, they will quickly change color and they will not pass that obstruction and that's where you'll need to step in. So it's such a difficult one because yeah, just to kind of wait and watch for that gag and just pray that it ends soon and that it's gagging not choking.

Kath:

Okay and I don't think we today will go into what happens if it doesn't clear? Or is there anything you didn't want to share with us? Because I know that's a big topic again.

Nikki:

A practical topic too. I guess what I will say is its one of the most common reasons for an ambulance to be called is for a child that's choking. But it's also one of the most common reasons for the ambulance to be canceled, because parents can quickly recognize it, they can quickly jump into action. And most of the time, will clear that.  So I think that's really reassuring to know that if you know what you're looking for, and you know what to do, and you're supervising your child, when they eat most of the time, even if they do have a complete obstruction, you can handle it at home. And you know, even if paramedics arrive, we won't transport to a hospital or anything because, you know, parents have swooped in and done what they needed to do. We do have a really great video on our Instagram of Rach demonstrating the technique with a baby mannequin and a child mannequin. But yes, it's a little bit difficult here to demonstrate it, but I highly recommend learning that skill If nothing else, because that one is definitely a lifesaver.

Kath:

Yeah, absolutely. And I think that's one that, would you say you’re most likely to need to use? 

Nikki:

Hundred percent.

Yep, definitely. That's the most thing that we have Tiny Hearts. parents come through and say, “I did your course. And this is what happened today. And thanks to you guys. You know, everything is okay”. So it's, yeah, it's definitely the one that gets used the most

Kath:

Amazing thank you, Nikki, I feel like we've talked about safe sleeping. We've talked about rashes, and the whole starting solid side of things. So it's been really informative. Thank you. And I think we've already mentioned it a little bit, but do you want to just let everyone know where they can find you? Or how they can find you?

Nikki:

Yeah, absolutely. So you can follow us on Instagram @tinyheartseducation or visit our website to have a look at what's included in our birthing and baby first aid courses by visiting www.tinyheartseducation.com.

Kath:

Amazing. Thank you. And before we sign off, please remember that my team and I will be putting together the Show Notes for this episode with all the links at www.fitnestmama.com. And you will be able to connect with Nikki over there in the show notes too. So as I mentioned earlier, if you enjoyed this episode, I would love you to share it especially on your Instagram stories and tag me @fitnestmama so that I can give you a shout out too.  And Nikki It was great having you, thank you so much. 

Have a fabulous day everyone and I look forward to you joining me next week for another amazing episode of the FitNest Mama Podcast. And before I sign off, please remember, if you would like to be in the launch giveaway, all you need to do is head to fitnestmama.com/giveaway. You will then go into the draw for a free amazing gift pack and three months free membership to FitNest Mama, which will help you to have a healthy pregnancy, confident birth and strong postnatal recovery. And don't forget to hit subscribe to this podcast so you don't miss any future episodes. Have a fabulous day everyone and I look forward to you joining me very soon for another episode of the fitness mama podcast.