< PreviousMATERNAL, INFANT AND CHILD HEALTH caymanhealth.com28MATERNAL, INFANT AND CHILD HEALTH CHILDHOOD IMMUNISATION SCHEDULE Protect your children from serious disease. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. To ensure your child(ren) get all the vaccines they need, take them to a district health centre or private paediatrician. At Birth 6 Weeks 2 Months 4 Months 6 Months 9 Months 12 Months 15 Months 3-6 Years 11-12 Years (Girls) 14-16 Years Hep BHep BHep B BCG DTaPDTaPDTaP DTaP Booster 1 4 Years DTaP Booster 2 Td/Tdap IPVIPVIPV 4 Years 4 Years IPV HibHibHibHib RVRVRV PCVPCVPCVPCV FLU 6 Months 6 Months & Older& Older MMR 18 Months MMR VaricellaVaricella HPV 2-dose Series HPV 15 Years 3-dose Series Hepatitis B Vaccine (Hep B): Protects against a serious liver disease caused by hepatitis B virus. BCG Vaccine (BCG): Protects against tuberculosis – an infection usually of the lungs. However, tuberculosis can affect other areas of the body. Hib Vaccine (Hib): Protects against Haemophilus influenzae b disease which can cause serious infections of the brain, spinal cord, blood and other organs. Influenza - Yearly (FLU) (2 doses for some) MMR Vaccine (MMR): Protects against measles, mumps and rubella (German measles). DTaP Vaccine (DTaP): Protects against diphtheria (a serious throat infection), tetanus (lockjaw) and pertussis (whooping cough). Rotavirus Vaccine (RV): Protects against severe vomiting, diarrhea and dehydration caused by Rotavirus. Varicella Vaccine (Varicella): Protects against chickenpox. Human Papillomavirus Vaccine (Gardasil) (HPV): Protects against 2 types of HPV that cause cancer of the cervix and 2 types that cause genital warts. HPV vaccine is offered in schools and district health centres. Polio Vaccine (IPV): Protects against polio – a paralytic disease. Pneumococcal Vaccine (PCV): Protects against serious infections for example pneumonia, meningitis, blood poisoning and ear infections caused by pneumococcal bacilli. • Rotavirus Vaccine - is given orally (by mouth). All other vaccines are given by injection. • DTaP, IPV and HIB Vaccines - are given in one injection. Booster 2 minimum age 4 years. • MMR Vaccine - Minimum age for 1st dose: 12 months, the 2nd dose may be administered before age 2 provided at least 4 weeks have elapsed since the first dose. • Varicella Vaccine - Minimum age for 1st dose: 12 months, the 2nd dose may be administered before age 3 provided at least 3 months have elapsed since the first dose. • HPV Vaccine - Females under 15 years: 2 dose schedule with 6 months interval between doses. Females 15 years and older: 3 dose schedule: 0; 2 months and 6 months after first dose. Source: HSA caymanhealth.com29CAYMAN’S MATERNITY WARDS Cayman Health takes a look at the islands’ maternity facilities, including the amenities and what parents-to-be can expect for the arrival of their new-born members of the family. Cayman Islands Hospital Maternity Ward, Health Services Authority Location: 95 Hospital Road, George Town t: 244-2841/2842 Rooms: Five double and three single rooms, plus three labour/delivery rooms. All rooms have ensuite bathroom facilities and are connected via nurse call system. Birthing partners: During active labour, birthing partners are permitted to be with the mother. This includes overnight visits. There are no overnight visitors allowed outside of these circumstances. Neonatal intensive care unit: The neonatal intensive care unit (NICU) is well equipped to care for up to six newborns who may be premature or may need special observation or intensive care. There is also a nursery for assessment of well babies and special teaching sessions for parents. Healthy newborns usually stay with their mothers in their rooms. As per restrictions current in July 2021, due to COVID-19, only one set of parents is allowed in the NICU at designated times. Visitors & siblings: In line with international guidance, the maternity unit has limited visitation to one designated visitor or birthing partner per day. No siblings or visitors under 18-years-old are permitted. Visiting hours: Regular visiting hours are from 11am to 8pm daily. Due to COVID-19, only one approved visitor, per day is allowed to visit a patient. If you need to reach a patient, call 949-8600. Maternity care: HSA emphasises the team approach to maternity care with the midwife having the central role in normal births, while an obstetrician is available 24 hours a day. HSA staff consists of a well-qualified and experienced team of midwives, obstetricians, paediatricians, anaesthetists, neonatal nurses, nursing assistants and ancillary support staff. Other specialists are also available for consultation when needed. Midwifes offer professional care ranging from antenatal preparation and advice to safe delivery and follow-up care after birth. The extensive knowledge and experience of the birthing process enables their midwives to deal with high-risk cases and emergency situations. Private obstetricians and paediatricians also use HSA facilities to care for their clients. The maternity unit offers facilities for both low-risk and high-risk mothers and babies. These services are comprised of antepartum care (before birth), labour and delivery, post-partum (after birth) and neonatal care, including normal births, twin births, breech, vacuum, forceps and caesarean section deliveries. Breastfeeding: The HSA promotes and support breastfeeding. Their ‘rooming in’ practice is conducive to Cayman Health 2021 MATERNAL, INFANT AND CHILD HEALTH 30CAYMAN’S MATERNITY WARDS breastfeeding, and maternity staff will assist mothers in breastfeeding their babies. On discharge, the Breastfeeding Support Group and the community midwives will continue to give support for breastfeeding. If you do not plan to breastfeed, you will be advised and assisted with alternative methods of feeding. Other maternity services include: • Prenatal counselling, whether a high- or low-risk patient. • Antenatal care, available through women’s health services. These clinics consist of combined care between the obstetrician and midwives. Patients are encouraged to start attending clinics from 12 weeks of pregnancy. • Classes for expectant parents – a free eight-week educational series called Parent Craft. Classes are held on Monday evenings 5.30pm-7.30pm at the Women’s Health Centre located at the Cayman Islands Hospital. There is no charge or need to register in advance. Parent Craft topics • Nutrition for pregnancy • Labour and delivery • Knowing your baby • Breastfeeding • Infant CPR • Alternative methods of delivery and immediate postnatal care • Postnatal care at home, safety, immunisation & family planning • Relaxation in pregnancy • Motor development in the first 12 months • Tour of the maternity ward • Genetic screening Changes due to COVID-19 As well as current visitation changes, visitors to the HSA and maternity ward must always wear masks. The mother is required to wear a mask as much as possible, however, will not be asked to wear one during labour. All mothers-to-be will be tested for COVID-19 and have their result prior to arrival at the hospital for planned caesarean sections and inductions. Women who arrive in labour will be tested on arrival. All medical staff are routinely tested. Due to the evolving nature of the pandemic, the information provided is subject to change. Visit hsa.ky or call the maternity unit on 244-2841/2842 to for the latest information. caymanhealth.com31Cayman Brac birthing room: Location: Faith Hospital in-patient unit t: 948-2243 ext 7625 Rooms: Faith Hospital has a room in a birthing room with one bed, and a room on the inpatient unit with two beds. This room is used for maternity and paediatric patients. There is no NICU. Visiting hours: 11am to 8pm I would certainly recommend the Cayman Islands Hospital to other expectant mothers. The maternity team is excellent. They operate with great sensitivity in consideration of you, your baby and family and communicate regularly in all stages of your stay. – Anne-Marie Gray-Diaz Doctors Hospital Maternity Unit Location: 16 Middle Road, George Town t: 949-6066, ext 6400/6460 Rooms: Four private maternity suites. Doctors Hospital is the only facility offering private maternity suites in the Cayman Islands. Birthing partners: Doctors Hospital welcomes a spouse or support person to accompany the expectant mother, be present during labour and delivery, and stay with mother and baby in one of its private maternity suites. Neonatal intensive care unit (NICU): No NICU. Should complications arise in pregnancy, during delivery, or with a newborn, Doctors Hospital physicians and nurses are well prepared to care for mother and baby by swiftly and safely transferring them to the HSA neonatal unit (immediately next door to Doctors Hospital) to continue their care. Visiting hours: Visiting hours are 11am to 7pm. Due to COVID-19 protocols, visitor numbers are limited. Maternity care: Support and respect for patients’ preferred method of childbirth is a vital component of the Doctors Hospital maternity programme. Cayman Health 2021 MATERNAL, INFANT AND CHILD HEALTH 3 2The highly personalised approach respects the mother’s dignity, privacy and confi dentiality, always allowing them to exercise their right to make choices regarding their pregnancy and childbirth. Equality and freedom from discrimination are fundamental human rights and principles that are practiced without exception at the facility. Doctors Hospital is committed to delivering leading medical care guided by evidence-based clinical pathways at the highest international standards. The experienced team receives ongoing education and has extensive training in high-risk situations. Whether patients utilise Doctors Hospital’s obstetricians and paediatricians – or a healthcare provider from another facility – they ensure a smooth and seamless transition across providers and services, from prenatal care to their complete recovery and transition back home. Breastfeeding: One-on-one support with the midwife before discharge. Patients needing more support are referred to the Breastfeeding Support Group. Other maternity services include: • Antenatal classes • Feeding support • Postpartum care • Educational materials The Doctors Hospital team was absolutely amazing during the birth of our third child. Every nurse, midwife, physician, and staff member did their part to ensure the delivery (and recovery) was safe, easy and as comfortable as possible. – Kate (patient and mother) caymanhealth.com33COMMON TESTS DURING PREGNANCY Antenatal urine tests Urine tests at each prenatal visit to detect blood, ketone, protein, bacteria and glucose. Blood glucose tolerance test A blood test at 24 to 28 weeks measures the level of sugar in patient’s blood. Abnormal levels may indicate gestational diabetes. Initial test is a glucose challenge test, with sugar levels tested one hour after drinking a glucose solution. In the case of abnormal results, a follow up glucose tolerance test is required, which involves blood being drawn at various times over the course of several hours after drinking a glucose solution. Genetic screening Optional or may be recommended if family history of genetic disorders. Can be done by multiple marker test, amniocentesis, chorionic villus sampling, cell-free DNA testing, percutaneous umbilical blood sampling, or ultrasound scan. Iron deficiency anaemia testing Blood test at first prenatal visit, and around 28 weeks. Anaemia during pregnancy can cause problems for both mother and baby. Pap smear Usually done at first prenatal visit for cervical dysplasia. An HPV ((human papillomavirus) test can also be done. Pertussis/Tdap (whooping cough) vaccination Given at 28 weeks and 34 to 36 weeks. Protects mother and baby against whooping cough. Rh factor testing If you don’t know your blood type you may be tested to see if your blood type is Rhesus negative or positive. If negative, and the baby’s father is positive, or does not know his blood type, you will be given a Rho(D) immune globulin (RhoGAM) injection at 28 weeks, and again within 72 hours of delivery if your baby is Rh positive. RhoGAM would also be given after any other event that could result in mixing of maternal and foetal blood, for example chorionic villus sampling, amniocentesis, vaginal bleeding or trauma during pregnancy, miscarriage, ectopic pregnancy or abortion. Ultrasound Abdominal or transvaginal 2-D ultrasounds are available, as well as 3-D or 4-D scans although these are not routine. Used to establish due date, diagnose ectopic pregnancy or miscarriage, examine uterus, detect some foetal abnormalities, check amniotic fluid, observe foetal behaviour, examine blood-flow patterns, monitor foetal growth, assess placenta, and measure length of cervix. The number of ultrasounds offered will vary by practitioner, but commonly include a first trimester sonogram and a 20-week anatomy scan. Dr. Howard Deosaran Cayman Health 2021 MATERNAL, INFANT AND CHILD HEALTH 34 The highly personalised approach respects the mother’s dignity, privacy and confi dentiality, always allowing them to exercise their right to make choices regarding their pregnancy and childbirth. Equality and freedom from discrimination are fundamental human rights and principles that are practiced without exception at the facility. Doctors Hospital is committed to delivering leading medical care guided by evidence-based clinical pathways at the highest international standards. The experienced team receives ongoing education and has extensive training in high-risk situations. Whether patients utilise Doctors Hospital’s obstetricians and paediatricians – or a healthcare provider from another facility – they ensure a smooth and seamless transition across providers and services, from prenatal care to their complete recovery and transition back home. Breastfeeding: One-on-one support with the midwife before discharge. Patients needing more support are referred to the Breastfeeding Support Group. Other maternity services include: • Antenatal classes • Feeding support • Postpartum care • Educational materials The Doctors Hospital team was absolutely amazing during the birth of our third child. Every nurse, midwife, physician, and staff member did their part to ensure the delivery (and recovery) was safe, easy and as comfortable as possible. – Kate (patient and mother) caymanhealth.com33 The highly personalised approach respects the mother’s dignity, privacy and confi dentiality, always allowing them to exercise their right to make choices regarding their pregnancy and childbirth. Equality and freedom from discrimination are fundamental human rights and principles that are practiced without exception at the facility. Doctors Hospital is committed to delivering leading medical care guided by evidence-based clinical pathways at the highest international standards. The experienced team receives ongoing education and has extensive training in high-risk situations. Whether patients utilise Doctors Hospital’s obstetricians and paediatricians – or a healthcare provider from another facility – they ensure a smooth and seamless transition across providers and services, from prenatal care to their complete recovery and transition back home. Breastfeeding: One-on-one support with the midwife before discharge. Patients needing more support are referred to the Breastfeeding Support Group. Other maternity services include: • Antenatal classes • Feeding support • Postpartum care • Educational materials The Doctors Hospital team was absolutely amazing during the birth of our third child. Every nurse, midwife, physician, and staff member did their part to ensure the delivery (and recovery) was safe, easy and as comfortable as possible. – Kate (patient and mother) caymanhealth.com33Vaginal swab for Group B strep (GBS) Taken between 34 and 37 weeks. Tests for GBS, a type of bacteria which can cause illness during pregnancy. GBS may cause chorioamnionitis, postpartum infection and urinary tract infections. Newborns can contract infection during pregnancy or labour and delivery. Weight and height checks These will be checked at first prenatal check, and your weight may be checked again throughout your pregnancy, with frequency dependent on practitioner. Weight measurement The amount of weight you gain during pregnancy is important for the health of the pregnancy and for the long-term health of you and your baby. How much weight you gain during pregnancy is based on your body mass index (BMI). Pregnant with one baby: normal weight BMI of 25-29.9; you should gain 25 to 35 lbs. Pregnant with twins: normal weight BMI of 18.5-24.9; you should gain 37 to 54 lbs. Urinalysis Involves checking the appearance, concentration and content of urine. It screens for a variety of disorders such as diabetes, kidney disease and liver disease. Blood pressure measurement A normal blood pressure is 120/80. Blood pressure (BP) is measured in units of millimetres of mercury (mmHg). BP below 90/60 mmHg indicates hypotension. BP above 140/90 mmHg in pregnancy indicates hypertension. An abnormal BP during pregnancy is cause for concern. Both mother and baby may be at an increased risk of health complications. Foetal monitoring Done throughout the pregnancy. 1. Transvaginal scan to 12 weeks gestation. 2. Transabdominal scan from 12 weeks. 3. Nonstress test done in the office. 4. Daily foetal kick chart done by the patient, usually at 34 weeks. 5. Cardiotocography at labour and delivery monitors foetal heart rate and contractions of the uterus. Genetic screening 1. Cell-free DNA – blood test from nine weeks gestation. 2. Alpha feto-protein test. 3. Amniocentesis. 4. Chorionic villus sampling. 5. Percutaneous umbilical blood cord sampling. Blood studies 1. At 12 weeks, gestion include: HIV, Hep B, C, blood group and Rh, HB electrophoresis, Rubella, COVID-19 Ig G antibody, cytomegalovirus Ig G and Ig M, toxoplasmosis Ig G, Ig M. 2. At 26-28 weeks gestation: O’Sullivan’s screen for gestation diabetes. If the value is greater than 135, then the patient will have an oral glucose tolerance test which includes: fasting glucose and 1-hour, 2-hour and 3-hour glucose testing. 3. Complete blood count at 36 weeks to ensure no anaemia prior to delivery. Swabs HVS (high vaginal swab) at booking to rule out Group B Streptococcus (GBS) ECS (endocervical swab) at booking to rule out chlamydia. HVS at 34 to 37 weeks for GBS. Information provided by Dr. Howard Deosaran, obstetrician and gynaecologist, Centre for Women, Family and Child Health and TrinCay Medical Centre . caymanhealth.com35 The highly personalised approach respects the mother’s dignity, privacy and confi dentiality, always allowing them to exercise their right to make choices regarding their pregnancy and childbirth. Equality and freedom from discrimination are fundamental human rights and principles that are practiced without exception at the facility. Doctors Hospital is committed to delivering leading medical care guided by evidence-based clinical pathways at the highest international standards. The experienced team receives ongoing education and has extensive training in high-risk situations. Whether patients utilise Doctors Hospital’s obstetricians and paediatricians – or a healthcare provider from another facility – they ensure a smooth and seamless transition across providers and services, from prenatal care to their complete recovery and transition back home. Breastfeeding: One-on-one support with the midwife before discharge. Patients needing more support are referred to the Breastfeeding Support Group. Other maternity services include: • Antenatal classes • Feeding support • Postpartum care • Educational materials The Doctors Hospital team was absolutely amazing during the birth of our third child. Every nurse, midwife, physician, and staff member did their part to ensure the delivery (and recovery) was safe, easy and as comfortable as possible. – Kate (patient and mother) caymanhealth.com33TIMELINE OF INFANT HEALTH CHECKS The normal growth and development of infants and children, coupled with timely and effective intervention where necessary, is the primary goal of parents and paediatricians alike. The American Academy of Pediatrics recommends that all children have regular well-child checks with their doctor, in support of this goal. These visits provide the opportunity to address many vital components of achieving that goal, including: Confirming that your child is growing and developing normally, through formal assessments by your paediatrician Giving you an opportunity to discuss any concerns that you have Allowing your child’s doctor to advise you on what to expect or watch out for in the next period of life, both normally and with respect to any adverse signs or symptoms that may emerge These appointments are offered by all the private paediatricians on-island. They ensure that if your child is not developing as he or she should, additional support can be put in place early. For example: physiotherapy, occupational therapy or speech and language therapy, the early provision of which can have a significant impact on your child’s success in school. If your child is not growing as he or she should, it is important that this is investigated further, especially to differentiate between simply being short versus a range of more serious conditions. Your doctor learns a tremendous amount about your child at each of these checks. What’s more, research shows that failing to adhere reliably to the schedule is linked to increased emergency admissions and late diagnosis of conditions that warrant early treatment. All in all, they are a vital part of ensuring happy, healthy, thriving children. THE SCHEDULE In the first two years, visits are frequent, matched to a child’s own rapid rate of development. As time progresses, visits become annual. Routine well-child checks follow the following schedule: 4 to 7 days 1 month 2 months 4 months 6 months 9 months 12 months 18 months 2 years Annually thereafter until age 21 WHAT IS CHECKED? Many different things are specifically assessed at each visit and the checks are designed to build up a sequential picture, over time. Additionally, at each visit, your paediatrician learns a great deal from observing and examining your child. It’s difficult to list all of what’s done at each individual visit, but we have provided a flavour below by highlighting certain aspects at each stage. Dr. Sara L Watkin Cayman Health 2021 MATERNAL, INFANT AND CHILD HEALTH 36 The highly personalised approach respects the mother’s dignity, privacy and confi dentiality, always allowing them to exercise their right to make choices regarding their pregnancy and childbirth. Equality and freedom from discrimination are fundamental human rights and principles that are practiced without exception at the facility. Doctors Hospital is committed to delivering leading medical care guided by evidence-based clinical pathways at the highest international standards. The experienced team receives ongoing education and has extensive training in high-risk situations. Whether patients utilise Doctors Hospital’s obstetricians and paediatricians – or a healthcare provider from another facility – they ensure a smooth and seamless transition across providers and services, from prenatal care to their complete recovery and transition back home. Breastfeeding: One-on-one support with the midwife before discharge. Patients needing more support are referred to the Breastfeeding Support Group. Other maternity services include: • Antenatal classes • Feeding support • Postpartum care • Educational materials The Doctors Hospital team was absolutely amazing during the birth of our third child. Every nurse, midwife, physician, and staff member did their part to ensure the delivery (and recovery) was safe, easy and as comfortable as possible. – Kate (patient and mother) caymanhealth.com33 The highly personalised approach respects the mother’s dignity, privacy and confi dentiality, always allowing them to exercise their right to make choices regarding their pregnancy and childbirth. Equality and freedom from discrimination are fundamental human rights and principles that are practiced without exception at the facility. Doctors Hospital is committed to delivering leading medical care guided by evidence-based clinical pathways at the highest international standards. The experienced team receives ongoing education and has extensive training in high-risk situations. Whether patients utilise Doctors Hospital’s obstetricians and paediatricians – or a healthcare provider from another facility – they ensure a smooth and seamless transition across providers and services, from prenatal care to their complete recovery and transition back home. Breastfeeding: One-on-one support with the midwife before discharge. Patients needing more support are referred to the Breastfeeding Support Group. Other maternity services include: • Antenatal classes • Feeding support • Postpartum care • Educational materials The Doctors Hospital team was absolutely amazing during the birth of our third child. Every nurse, midwife, physician, and staff member did their part to ensure the delivery (and recovery) was safe, easy and as comfortable as possible. – Kate (patient and mother) caymanhealth.com334 to 7 days Your doctor will be checking your baby has not lost too much weight which can be a sign of a poor milk supply or other problems. The doctor will look for jaundice which may need treatment with special light therapy to prevent harm to your baby. There is a big focus on ensuring your baby has successfully transitioned from their cosy intrauterine home to the big wide world. 2 months Your doctor is now particularly interested in your child’s very early development and whether they are reaching their first milestones. Direct observations are made, for example early assessment of vision, to ensure vital intervention is provided as early as possible, if necessary. 4 months There will be lots to discuss at this visit, including teething, moving to solid food at six months and, of course, lots of development. There are some very specific things to assess, such as the presence or absence of strabismus (an eye turning in or out). 6 months At this point, your doctor will be checking that your child is not anaemic. They will discuss feeding solids and preventing food allergies, teeth cleaning and more. Safety is an additional focus at this point, important in preventing or addressing a range of common accidents. 9 months This is a very important time for your doctor to observe your child’s developmental progress and a time when many more signals can be found through assessment. Your doctor may discuss sleep training, if your child still wakes in the night, as well as other emerging behaviours. 12 months This is an important time to review your child’s nutrition and examine growth, as your child enters a new phase of physical development. 18 months By this time, behavioural and physical changes allow your doctor to perform a screening test for autism, which, if picked up, allows some particularly important interventions to be provided at the earliest possible point. 24 months At this check your doctor may well repeat the autism screen, as a follow-on from the 18-month check. Your doctor will be carefully observing and assessing your child’s speech and interactions with them, as well as their growth. Your doctor will be able to provide advice on potty training, temper tantrums and the ‘terrible twos’. Annually thereafter In annual checks, your child’s doctor is assessing both growth and behavioural development, including social development. From age 4 onwards, checks will be made to ensure your child’s spine is growing straight and that their blood pressure is normal. Each visit contains specific checks, unique to that point in life, as well as allowing continued, sequential follow-up of earlier assessments. If you would like to know more about any single visit, please contact your paediatrician, who should be happy to discuss the visit and what they will be assessing. Information provided by Dr. Sara L Watkin, specialist paediatrician & neonatologist, Integra Healthcare Ltd. caymanhealth.com37 The highly personalised approach respects the mother’s dignity, privacy and confi dentiality, always allowing them to exercise their right to make choices regarding their pregnancy and childbirth. Equality and freedom from discrimination are fundamental human rights and principles that are practiced without exception at the facility. Doctors Hospital is committed to delivering leading medical care guided by evidence-based clinical pathways at the highest international standards. The experienced team receives ongoing education and has extensive training in high-risk situations. Whether patients utilise Doctors Hospital’s obstetricians and paediatricians – or a healthcare provider from another facility – they ensure a smooth and seamless transition across providers and services, from prenatal care to their complete recovery and transition back home. Breastfeeding: One-on-one support with the midwife before discharge. Patients needing more support are referred to the Breastfeeding Support Group. Other maternity services include: • Antenatal classes • Feeding support • Postpartum care • Educational materials The Doctors Hospital team was absolutely amazing during the birth of our third child. Every nurse, midwife, physician, and staff member did their part to ensure the delivery (and recovery) was safe, easy and as comfortable as possible. – Kate (patient and mother) caymanhealth.com33Next >