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Immunisations and anal pharmacists

Sabine Devins · 8 Feb 2012, 07:43

Published: 08 Feb 2012 07:43 GMT+01:00

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This month, my daughter reaches an important milestone: it's her last round of immunizations until school age. It will be a relief for me to see her chubby little thighs bandage-free until she's marching off to school with an overloaded Schultüte.

Luisa and her counterparts in North America and the UK are lucky to count going to the doctor as a fact of life. When a baby is born in Germany, he gets presented with a Babypass. Like my Mutterpass, the little book is a transportable medical file that mothers can take from doctor to doctor with her medical history. It also tracks baby's development.

All of the check-ups, or Untersuchungen, are abbreviated to U1, U2, U3, etc. Luisa's appointments are labelled on the front of her Kinderpass with what dates they should fall between, going all the way to April 2016. Each Untersuchung has a page for the doctor to fill out. It also leaves me with a handy little guide to how much Luisa has grown over the last year (it's a lot!).

Most of the exams so far have been simple physicals. Making sure Luisa is growing properly and all her little parts with it. At the U3, there is an ultrasound to look for hip dysplasia — something that I find Germans to be disproportionately concerned with. As there is some hip joint issues in Luisa's family medical history, she received an ultrasound at her U2, then again three weeks later, then with a specialist, and then again at the U3. The conclusion: “Her hips are just fine, we just like to be very careful when it comes to hip dysplasia,” said our doctor.

According to the International Hip Dysplasia Institute, hips that require treatment only occur in two to three children per 1,000.

What I do like about Germany's scheduled medical care for babies is that they do immunizations a little later than in the English-speaking world. While Luisa's friends in the US, the UK, and Canada all had their first round of shots at two months, Luisa didn't get her first Impfungen until she was nearly four months. The first round is done in conjunction with the U4 check up, when Luisa is between two and four months old. Since her appointment was booked closer to the end of the fourth, that was simply when she got her first round.

As for the immunizations themselves, they are very much the same as what children in North America and the UK are given. Right now, Luisa has fighting power against tetanus, diphtheria, pertussis or whooping cough, polio, pneumococcus and hepatitis B. On the advice of my paediatrician, I skipped the Rotavirus immunisation and many German parents also leave out the Hepatitis B. After her last round, Luisa will also be armed against measles, mumps, and rubella.

Overall, there isn't much difference between the care Luisa would get here versus there. But what is different in Germany is the at-home care and what Mamas keep in their at-home medical kit.

I've written before on the various uses of breast milk to cure these things, but that does come to an end and now those ailments lead me to the medicine cabinet.

For stuffed noses, we have saline solution. It's hated by our little one and therefore seldom used. As Germany is the birthplace of homoeopathy, I can find all sorts of natural remedies. My favourite is called Osanit and they're little pearls I use for teething pain. It's main medicinal ingredient is chamomile. Whenever those gums start causing problems, babes are dosed with a few little pearls that they can roll around in their mouth and it seems to work. Life goes on. American mom Laurie has a similar product in her cabinet called Dentinox-Gel N, which also contains chamomile but in a gel format.

For those fevers, we use paracetamol, but its application is what makes our stash “very German”. The favoured method of dosing your child by the Mamas is Zäpfchen, or suppositories.

I wasn't sure what to make the first time I realised what my doctor had prescribed after Luisa's first round of immunizations in case of fever. But she was hot and miserable and so it happened and it was awful for everyone, but it did make her feel better. The next day I went to the pharmacy and asked for liquid paracetamol to give her instead.

The pharmacist was confused by my request. “But with the suppositories, you know she's getting the right amount. You don't have to worry about getting her to swallow it and once it's done, it's done,” she said, very pragmatically.

With the next fever, I took out a spoon and tried to get Luisa to swallow her medicine. It didn't work. Her mouth clamped shut, she shook her head and sticky, orange-flavoured syrup got all over the floor. The practical German in me took over and we went back to the Zäpfchen. I'm now a convert.

I'm not the only one. British mum Tori told me she thinks they're brilliant. “I would have never used them if I were raising Max [in England], but my husband, who is a doctor, was the one who stocked up the medicine shelf and at first I wasn't so sure, but now they're all I use.”

But others aren't convinced.

Story continues below…

When Laurie's son has a fever, she uses liquid ibuprofen, which her pharmacist told her not to use until he was six months old. Before that, she had infant's Advil and Triminic sent from the US. She also keeps American-bought Neosporin on hand. She also wishes that children's acetaminophen were more available in the Fatherland.

English mum Susannah won't touch the Zäpfchen. “Sticking things up a baby's bum is not an idea I'd ever considered until I became a parent here. I would have no idea how to go about it, and would worry I was hurting her.”

Instead, she stocked up on the beloved English cure-all Calpol on her last trip home. “It's poured liberally down English children's throats from a very young age, whereas Germany seems less into plying babies with drugs,” she explained. “By extension, the German equivalents seemed less trustworthy in my mind: Irrational but true.”

She also has Calpol saline nose spray, as an assistant at her local pharmacy “raised her voice and eyebrows at my request for — what she called — a brutal product. She pretty much accused me of wanting to shoot drugs into my innocent child's brain tissue.” But Susannah felt the German saline drops weren't working and was delighted when she read “Suitable from birth” emblazoned on the English saline spray.

These days, we more readily turn to Google than our mothers to answer the million times we need to know: “Is this normal?” However, when it comes to comforts and cures, we turn back to what we know from childhood, whether it's Laurie who goes for Neosporin to treat her son's scrapes or Susannah who trusts one name to cure it all. Even if similar products are available in the German Apotheke, it's just not the same as what we know.

And just because I use the Zäpfchen, doesn't mean I wouldn't be grateful for your tips on getting your babes to swallow their medicine.

Sabine Devins (news@thelocal.de)

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Your comments about this article

09:46 February 8, 2012 by Mapleleafdude
Use Nurofen Junior Fiebersaft Erdbeer 2%/Orange 2%/Erdbeer 4% Suspension zum Einnehmen. Zäpfchen are just a pain in the a. and unnecessary these days.

Our kids get it and it's much easier to administer. Problem solver that also tastes great. :-)

On TT we have discussed this I think.
11:23 February 8, 2012 by epochVHS
As another foreigner going through the quirks of parenthood here, I think you should be careful of statements like "As Germany is the birthplace of homoeopathy, I can find all sorts of natural remedies."

Homeopathy and natural remedies are two very different things. However, it is in the interest of those who sell homeopathic remedies to claim they are the same.

Natural remedies can have (but don't always have) scientific evidence for their effectiveness, while homeopathy is closer to a religion and has no scientific basis. It's a good idea to read up on homeopathy in Wikipedia-try not to let people mix those two terms. Homeopathy should live or die on its own merits, not piggy-back on reputations of things like Aloe Vera or Chamomile (spoiler: homeopathy has no merits outside of the placebo effect).

Otherwise, I am enjoying this series, as my son is eight months old and we have gone through a lot of the same curiosities as you have!
14:35 February 8, 2012 by murka
Motherhood in the Fatherland - what a brilliant title :)
15:05 February 8, 2012 by JenDigs
My issue is simply that I don't speak German very well (I have yet to progress beyond the most basic of German after 4+ years, my fault, I know...) Also, my experience has been that I don't get a lot of background information from German doctors or pharmacists... I get the impression (sometimes subtle, sometimes very clearly spelled-out) that I am not supposed to ask "why?" or "What is best?", but rather accept whatever they tell me without question or reason. (I find this in all things in Germany actually- from my child's education to utilities to health... we are not supposed to ask questions about a process or reasoning for a rule or law- just obey.) As an American, this is very, very hard. I am used to asking questions and in America, professionals (doctors, lawyers, electricians, pharmacists, mechanics, what-have-you) are accustomed to answering. Here, you are looked at as though you have lobsters crawling out of your ears when you question someone's authority or their judgement (even if your question is phrased politely as something for your own edification, not as a challenge...) So, I tend to stock-up on home-visits rather than face the wrath of the pharmacist or doctor...
15:44 February 8, 2012 by bugger
Well, 'tetnus' and 'hepititus', where does one catch those?
16:01 February 8, 2012 by auslanderus
JanDigs, you are not alone. I am in the same boat as you and have to ask a friend what am I suppose to do to take some meds. Doctors here tell you nothing. Just here, take this. No how much, how often, what about side effects...etc. As you said, asking a doc a question is not done here. Maybe were suppose to know everything about meds or have a meds book that tells you about all the meds they have here.Never ask the question: why or how.

Good luck living here.
16:46 February 8, 2012 by raandy
Both my children were born here. i never had to ask ,how much or how often? the Kinder-Arzt always told me.

Doctors do not like to pass out antibiotics here, which is a good thing.

The last time I went when my daughter had an ear ache, the Doctor said ,I am sorry but she needs antibiotics,

I have found the child care here excellent.
01:04 February 9, 2012 by Artiewhiltefox
All kids need U,C,S, care .They need to be evaluated by a good kind of chiropractic. Atlas orthogonal, Grostic or NUCCA for them would be a good choice. Right now sorcery is being used. There is now way health could ever be in a shot or Pharmaceutical no matter how clean,and sterile the environment.
13:09 February 9, 2012 by Schroedinger99
¦quot;Osanit¦quot; is a homeopathic "remedy" and thus has no active ingredients whatsoever (they have all been diluted to the point where not a single molecule remains). The "pearls" are xylitol - a kind of sugar which - though tooth friendly - won't do anything for teething other than taste sweet. My advice: don't waste your money on ingredient-free medicine and please don't plug this kind of quackery to others.
14:40 February 9, 2012 by Gretchen
Hej, I am German and never thought that Zäpfchen are something strange until I read your article :) I have three children and live in Sweden. Here Zäpfchen are prescribed just like in Germany and until the age of 3 or 4 I have used them for my children. After that it feels a bit strange. Nice to hear that Germany seems to do a god job for you in general when it comes to child medical care. All the best, G.
16:11 February 9, 2012 by indo-german
Hi Sabine, in case you get to read this, a tip for you.

Sometimes it still helps to take good tips from mothers and mother-in-laws.

We were having trouble in giving our litte one the prescribed Vitamin D drops (I tried it, it tastes...yuck). My M-I-L suggested an age old trick. Just give a gentle blow (pusten...) after giving (forcing) the syrup into the infants mouth, kids normally swallow as a reflex.

Works pretty well.
20:14 February 9, 2012 by Schroedinger99
BTW - going by my experience bringing up small kids in both countries - the reason little kids won't swallow the German form of paracetamol syrup is that it does not taste as nice as the UK "Calpol" (or even as nice as the generic paracetamol syrups available in the UK). It's best to buy the "sugar-free" versions (either generic or branded) but STICK EXACTLY to the recommended dosages! Paracetamol (being a medicine with real ingredients) is extremely safe at the correct dosage but extremely dangerous if you exceed the recommended dosage.
09:51 February 10, 2012 by kimmygibblerallgrowedup
Hey Sabine - really enjoy the series.

Your friend Laurie doesn't have to go without acetaminophen, since it's the same thing as paracetamol. Both names come from the chemical compound -

para-acetylaminophenol. The Americans and Europeans chose to chop up and use different bits for common usage.
11:03 February 10, 2012 by Silvia CR
we never made it with the "Zäpfchen"

But, the Nurofen has a syringe which allows you to give the medicine easily to your kid.

Our pediatrician always says fever is good to heal, but when is midnight and our son cries because the fever doesn't let him sleep, then we cheat and give him Nurofen: he falls asleep inmediately!
12:50 February 10, 2012 by JenDigs
I forgot to mention that other reason I do stick with the medicines from home- the oral medicines here taste horrible. (My son being 10, suppositories are out of the question...) I asked the pharmacist why the kids medicines taste so awful and isn't there something that tastes better and she looked at me like I was stupid and insane and responded that, "if it tastes good, the child will want it all the time!" This is clearly ridiculous. My son never asks for medicine- he knows it is only needed when there is a fever (or real pain...like when he broke his nose, I gave him a half dose to ease the discomfort...)

Also, to Indo-German: My dad is from Holland and I distinctly remember him doing this to me when I was 2 or 3 and being very, very upset about it... I would run away and be in pain rather than have someone blow in my mouth or nose to get me to swallow medicine... He's shocked I remember this, but I remember it well and would not do it to my child...
13:53 February 12, 2012 by charlottenbaby
Great article! We have also had a good experience with the Nurofen. Although I don't use the Zäpfchen because I never felt like I was putting the suppository in right and it seemed too tramatic, the benefit from what I understand would be that it bypasses the stomach. For an sick infant, or baby with a throw-up type virus who was unable to keep anything down, this would be a good idea.

I have found the medical care here to be excellent and love that anti-botics are not over perscribed. My doctor seems to answer all of my why-questions should I have any.
21:47 February 12, 2012 by MaKo
I'm American, but both of my sons were born here, and we live here still. Reading about the "Zäpfchen" made me smile - it is definitely not the first thing that comes to mind when baby has a fever!!! I managed to come around to the 'Zäpfchen' after a nurse friend told me that the medicine is absorbed into the blood stream very quickly when administered, well, there. You just have to hold them in your hand before administering so that they soften just a little. But it is definitely uncomfortable for both mama and baby at first!

I'm sorry to hear that some of you are having such negative encounters with medical professionals :( I do sometimes have to press the pediatrician for details, but when it comes to instruction on how to administer medication, he always tells me, and the pharmacist usually writes it on the package, too. All this in Bavaria, not exactly reknown for its friendliness toward outsiders.
22:21 February 13, 2012 by quidditchmom
To give liquid medicine to an infant or small child, simply use a small syringe and squirt a small amount to the side of the mouth against the cheek. Swallowing is automatic. Follow up with something tasty to wash the yucky taste down.

This is also an important trick to know if anyone is getting dehydrated from some sort of intestinal virus or keeps vomiting. One ml of re-hydration liquid to the inside of the cheek at a time, bit by bit, and you can get them re-hydrated without having to go to the hospital and have a painful IV. Such a small amount trickles into the stomach without activating the vomiting reflex. My California doctor taught me this trick.

I find children here are left to suffer with a lot of discomfort from viruses and bacterial infections unnecessarily. My son had a simple cold that turned into viral bronchitis that turned into bacterial bronchitis, lasting from Halloween almost until Christmas. Our local German doctor had prescribed camomile tea and some homeopathic liquid that was 10 percent ethanol. I threw it out. Despite pleading with friendly pharmacists, I couldn't find anything to thin mucus or any decongestant that didn't come with aspirin (which is not safe for a five-year old). I was frantic! At the third doctor visit he was prescribed five days of standard antibiotic (amoxicillin), not the ten days we are used to for a serious case. After five days he was a bit better, but still not well. Through a lucky mix-up by the doctor, we actually got enough for eight days. He still was quite ill. I finally managed to track down an acquaintance with military connections who bought Mucinex expectorant to thin mucus and Triaminic decongestant at the military store for me. Within two days my son was almost well and he was totally healthy for Christmas. He was sick for so long he thought he was going to always be sick in Germany. It was totally unnecessary!

I grew up in the "question authority" generation with the "Our Bodies, Ourselves" philosophy of taking charge of your own health. So I also find medical professionals less than forthcoming with information and rather surprised when I ask questions and try to have a discussion of options. It's a different frame of reference.
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