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MANILA — School-readiness entails a gamut of preparation. After a two-month break, the thought of going back to school came with a mix of extreme excitement and some inconveniences to every student and parent.
Parents with their children usually start off with shopping school supplies, uniform, bag, foot wear, and protective gear. However, another must that most parents tend to overlook are preparing healthy “baon,”, having regular check-ups for children, updated vaccination shots, and other health-significant concerns.
Moreover, in any case that some parents have a child with congenital heart disease (CHD), having a secured medical clearance for him or her and proper and complete communication with school staff regarding the situation were also deemed necessary..
A healthy home should be a family business. The school, which is considered as every student’s second home, should be kept both as a healthy environment and cradle of learning. No matter how excruciating the pain is for anyone who shares from the burden of a children with heart disease, the morale and grace should be kept high to keep their self-esteem ablaze.
These important reminders were tackled during the online Usapang Puso sa Puso (UPP) forum on Sept. 11, 2024, by the Philippine Heart Association (PHA), with its host, PHA Director and Advocacy Chair Dr. Avenilo Aventura, Jr., and aguestt resource person, Dr. Ceres Canto, a member of the PHA Council on Congenital Heart Disease (CHD).
In an episode of UPP titled, “Puso, Pasukan, Tag-ulan,” Dr. Canto emphasized the importance of informing teachers, school nurses, and administrators about the child’s CHD. Canto suggested that a medical certificate containing the diagnosis, activity restrictions, and ongoing medications or treatment and plans is needed to be presented.
Moreover, schools must prepare a medical action plan and take note of the emergency contact details including who to call and where to bring the child in case of emergencies.
Upon the proper communication with the school staff, the educators should be aware on what sports or physical activities are only safe to be done by the student with CHD. Canto described the activities to be “moderate” and “supervised.”
“Children still need some exercise when capable for their health,” she said.
What is CHD?
Canto said CHD is a condition that a child or a baby has since he or she was born with. Congenital means “existing at or dating from birth.”
“Ito ay mga abnormalities o aberya sa istruktura ng puso na meron na ang sanggol mula sa pagsilang,” Canto said. (These are abnormalities or defects in the heart’s structure an infant has from birth.)
CHD has two common types, including the Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) in which the exteriors dividing artium and ventricles were damage and have holes. Meanwhile, a Tetralogy of Fallot (TOF) is a combination of four abnormalities, which make it difficult for the heart to pump blood to supply the right amount of oxygen to the body.
Moreover, Canto said that when a Patent Ductus Arteriosus (PDA), which should be closed right after the delivery of the baby, remained opened, the blood flow will have abnormalities.
Canto said some symptoms of CHD include difficulty in breathing, weariness, bluish color of skin, lips, and nails, and slow physical development.
“Ang CHD ay kadalasangdulot ng kombinasyon ng genetic at environmental factors. Iba’t ibang dahilan ang maaaring maging sanhi nito, tulad ng hindi tamang pag-develop ng puso habang nasa sinapupunan, mga genetic mutations, at ilang mga komplikasyon habang buntis,” Canto said. (More often, CHD is caused by a combination of genetic and environmental factors. Its cause varies, like the heart not developing correctly while in the womb, like genetic mutations, some complications while in pregnancy.)
The data also showed that one in 10 babies are born with CHD from which approximately 25% of it will be needing a heart surgery or other intervention to survive.
Healthy “baon” guidelines to avoid heart problems
Canto encouraged schools to follow the Department of Science and Technology- Food and Nutrition Research Institute (DOST-FNRI) recommendations regarding healthy food that should be prepared for children in school canteens.
“Kailangan rin natin in general i-emphasize iyong role ng school in the proper nutrition of students. Insert ko na riyan iyong pagpasok sa school ay kailangang healthy iyong available food for kids, it’s not only kids with CHD but all kids in general,” Canto said. (We also, in general, need to emphasize schools’ role in students’ proper nutrition. I will add that when kids go to school they should have healthy food for all kids, not only those with CHD.)
“Bawal na bawal iyong mga junk food, processed food and sweetened beverages,” Canto added. (Junk foods are truly prohibited.)
She also suggested that it might be better if children just bring their own snack or lunch at school in order to ensure the complete and balanced diet in the food they eat.
Moreover, she emphasized that the food intake of children with CHD is not significantly different from the ones without the said condition except for few minor adjustments.
”In general, iyong healthy food for kids with CHD is the same for kids na walang sakit sa puso, may mga kaunting adjustments, sometimes these kids, kailangang mas small and frequent feeding, otherwise, sometimes hindi nila kayang i-digest agad or hinihingal sila kapag malalaki iyong meal at one time, and number two, some children, depending on the assesment of their pediatric cardiologist, they may require more nutrients and energy din na oral supplementation but otherwise same lang din as kids na walang sakit sa puso –kailangan balanced and healthy diet,” Canto said. (In general, healthy food is the same for kids with CHD and those without, minor adjustments. Those with CHD should be fed in small amounts and frequent because they may not be able to digest big ones. Should be balance diet for both children.)
In addition, Canto urged the parents and the members of the family to “lead by example,” in order for them to educate the children with proper nutrition.
Canto also mentioned the DOST-FNRI “Pinggang Pinoy,” which is a very simple visual aid to show the right proportion of the dish, explaining that fruits and vegetables that belong to the Glow food category should consume the half of the plate. Meanwhile, the other half should be allotted to both the Go and Grow foods category.
Weather-related illnesses
Canto also talked about the common rainy-season-related illnesses, which include Dengue, Typhoid Fever, Leptospirosis, Diarrhea, and many more.
She emphasized that being hygienic is a must, particularly cleaning the hands, keeping the environment healthy, and getting away with stagnant water.
“Iyong mga stagnant wate, kailangang tanggalin para walang breeding grounds iyong mga mosquitoes, tapos prevalent din ngayon iyong diarrhrea, leptospirosis, so kapag leptospirosis, we make sure yung children they don’t step in flood water and if ever nagkaroon man ng exposure, please consult your doctor kasi mayroong post-exposure prophylaxis, and madalas din ngayon iyong diarrhea, sometimes typhoid fever, so we have to make sure na yung food and drinks ay malinis,” Canto said. (Stagnant water should be removed to get rid of mosquitoes’ breeding grounds; prevalent also are diarrhea, leptospirosis, typhoid (make sure kids don’t wade in waters. Be sure to consult a doctor.)
Canto also said that children should have necessary vaccinations including flu shots, rotavirus, and typhoid vaccines.
“Parents should be vigilant about their children’s health and seek medical advice immediately if symptoms of any disease are detected,” Canto said.
Also, creating an emergency plan tailored to children with CHD, assembling an emergency kit that includes medical supplies and crucial documents, and educating children on how to respond in case of an emergency are significantly needed.
“Siyempre (Of course with my patients especially those with congenital heart disease, I tell them kailangan mas maingat (they need to be more careful) and also to have complete vaccines kasi kapag tinamaan ng sakit iyong mga bata na may sakit sa puso, so mas malala iyong nagiging condition nila, hindi maganda yung (because when children with hearth ailment become sick their condition is more serious) outcome in some patients,” Canto said.
Folic Acid, its importance, how it should be taken
Canto said Folic Acid, type of B-vitamin essential for DNA synthesis, cell division, and overall development, supports the formation of the fetal heart and circulatory system.
With this, maternal folic acid deficiency has been associated with an increased risk of certain congenital heart defects in newborns like VSD, ASD, TOF, PDA, Conotruncal defects, TGA, truncus arteriosus, interrupted aortic arch, and Aortic and Pulmonary Valve Stenosis.
Meanwhile, Canto said the intake should be at least 400-800 micrograms daily for women of childbearing age, and should be taken before conception at least 3 months before pregnancy and during early pregnancy or first trimester.
Folic acid-rich foods like leafy greens including malunggay, spinach, as well as citrus fruits like orange and dalandan, mongo beans, peanuts, and fortified food like cereals and bread are also good to be taken by babies and children.
‘Physical activities over screen time”
Canto also confirmed that lack of sleep during night time may relate to psychological factors like stress with other factors like longer duration of screentime and busy schedule.
”From experience, number one school workloads, number two, yes screentime, that is why we advocate less screentime and more physical activity for kids. That’s one of the things that PHA is advocating — less screentime and more sleep. So sa (in our) Healthy Heart Chart natin ay maroon nakalagay roon na (there’s a) prescribed length of time ng (of) sleep depending on the age. The younger, mas mahaba (longer), so sa mga (so for) toddlers mga (about) 3-5 years old up to 12 hours and mga (the) adolescent pwede nang it is OK) up to 8 hours,” Canto said.
Moreover, in terms of physical growth, Canto said an individual only increase in height when he or she is asleep, as the growth hormone is only secreted when the child is sleeping, therefore, lack of sleep equates to lack of height.
“Progress” on PhilHealth subsidy for coronary intervention
Aventura confirmed that there are approved subsidies to be given for the patients lacking capacity to shoulder a procedure called the “Percutaneous Coronary Intervention.” This was in line with PHA’s request together with other institutions and organizations to relentlessly push for wider Philippine Health Insurance Corporation (PhilHealth) allocation for heart patients that need to undergo angioplasty.
“In fact, they were saying (that) while it was presented in Congress the five percent was given to certain procedure like an RF procedure. Now, they would increase the PhilHealth subsidy to at least 80 percent or maybe a 100 percent by the end of the year. So, this will be covered but now most of the subsidies come from our funds from Congress and legislation. It’s called the Medical Assistance for Indigent and Financially Incapacitated (MAIFIPP) funds, but PhilHealth is going to increase their subsidy,” Aventura said.
Back in 2016, the PHA together with other health associations started to lobby for increased PhilHealth subsidy for angioplasty/Stemi patients and who do not have enough means to cover percutaneous coronary intervention (PCI) procedure. (♡)
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Source/author: Gynna Gagelonia, PHA Communications and Media Head.