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Research results and conclusions.

• This research has found two major traditional Ghanaian practices that harm the natural development of the brain of a baby. 

• The use of hot water in massaging the head of a baby at the beginning of the daily bath which is done twice a day (morning and evening). It is done from the first day of the life of a baby until the baby is about 2 months old. In some cases, even until the baby is 6 months old.

• The application of Robb ointment and similar ointments or oil on the "breathing place" as it is called by the Ghanaian or the soft spot (anterior fontanelle) in the head of a baby.

The daily bath of the baby.

Usually, the grandmother prepares the hot water in a bucket. She determines the heat of the water by the touch of her hand. The bath includes the following stages:

1. Massaging the head: more effort in term of time and pressure of the massage is applied on the soft spot (anterior fontanelle) in an effort to close it.

2. Massaging the body: massaging the back, chest, hands and the legs by repeating the same method applied on the head. 

3. Washing the body: with soap and water

4. Cosmetic treatment: After wiping the baby with a towel, oil is applied to the head and the body of the baby. Often, it is the Robb ointment, that is rubbed on the head of a baby.

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Hot water bath of Kofi who was 11 days old and Kwesi who was 9 days old.

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Observation:

From the observation of hot water massage on Ghanaian babies it was found that the hot towel was placed directly on the anterior fontanelle, the soft spot, and because of that, the anterior fontanelle was continually under a high temperature of at least 40 to 41.5 degrees Celsius. The temperature of the neck indicated the temperature of the blood coming from the brain. Three minutes after the neck temperature rose to 39 degrees Celsius, there was a drastic change in the behavior of the babies.

Kofi who cried at first, fell asleep (as the mothers call it). He waked up when the temperature of his neck and his anterior fontanelle  were less than 37 degrees Celsius. Kofi suffered from unnatural sleeping, which indicated that he had lapsed into unconsciousness.

Kwesi, who was quiet at first, began to cry. After two minutes of crying, he started screaming. His screaming subsidized when his mother started massaging his body. At that time the temperature of his anterior fontanelle was 38 degrees Celsius, and the temperature of his neck was around 37 degrees Celsius. However, he started screaming again when she massaged his chest even though the temperature of his anterior fontanelle and neck were 37 degrees Celsius and below. When the mother finished to massage his chest, Kwesi continue to cry up to the end of the bath.

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Explanation:

During the hot water massage on the head of a baby, some babies cry but some stop to respond; they do not move or cry. Many Ghanaian women, and the grandmother of Kofi thought that when the baby does not response it means that the baby fell asleep during the hot water massage on his head. However, the baby was not asleep but he fainted or lost consciousness. Kwesi did not faint, however, he cried during the whole bath and was screaming from pain in such a force that it was almost unbearable to hear and see him in his suffering.

The anterior fontanelles of both babies were under high temperature of 40 to 40.8 degrees Celsius (Kofi) and 40 to 41.2 degrees Celsius (Kwesi). The brains of both babies were over heated or under hyperthermia. This resulted in an increase in the level of the neurotransmitter glutamate that led eventually to the decrease in cerebral blood flow. Following this, there was a severe reduction in oxygen to the brain that resulted in a loss of consciousness, which can explain the fainting of Kofi. In addition, the reduction in the delivery of blood supply to the brain led Kwesi to hyperventilation. Hyperventilation is a quick and uncontrollably breathing in effort to get enough oxygen to the lungs and to the blood vessels. This causes heaviness and pain in the chest. If Kwesi suffered from hyperventilation, it would have lasted longer than the time of exposure to the high temperature. This can explain the worsening condition of Kwesi who screamed once the mother applied additional pressure on the chest while massaging it, even though the temperature of the head of Kwesi was low.

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What can past research in animals and human offspring exposed to hyperthermia tell us about the condition of Kofi and Kwesi?

The area under the anterior fontanelle in the heads of Kofi and Kwesi was for a few minutes between 39 and 41 degrees Celsius, as 2 to 4 degrees Celsius above the normal temperature of the body which is 37 degrees Celsius. The temperature of the brains of Kofi and Kwesi were for a few minutes above 38 degrees Celsius, at least 1 degree Celsius above the normal temperature of a body. They suffer from mild hyperthermia and even heat stroke. Optimal growth of cells is at 37 degrees Celsius, and heat above 41 degrees Celsius would break the chemical bonds in many proteins and denature them. Research in animals showed that when the temperature in the brain is above 38.5 degrees Celsius, there is a brain damage that includes a combination of chemical changes as a result of the Blood Brain Barrier leakage, changes in the neurons and their synapses structures, and death of the nerve cells.  For few minutes there was a high probability that the cells under the anterior fontanelle and its surrounding area in the brains of Kofi and Kwesi suffered damage as a result of protein denaturation, chemical changes, and changes in the neurons and the structures of the synapses.​ If we assume that the brain can compensate for the damage the hot water caused by speeding the development of the neural circuit, we are wrong. Even though development may seem to be a continual process, each neuro-developmental process occurs within a relatively narrow temporal window in time. This means that a damage in the brains of Kofi and Kwesi which occurs in a specific "temporal window" could not be repaired once the time of that "temporal window" of development has passed, and so their brains could not compensate for the damage.

 

Conclusion on the damage that Kofi and Kwesi suffered:

1. What was damaged in the first week of their life could not be completely rebuilt in the second week of their life, and so on.

2. Damage to processes, such as the delay in the cell dividing, would continue hours after the bath. Since the bath was repeated in the evening, the time that passed between the morning and the evening bath would not be enough to compensate for the loss of cells in the brain. Thus, the degree of damage was even higher because of the frequency of the baths.

3. The number of neurons would be reduced because of an apoptosis.

4. There would be a delay in the proliferation of glial cells and the differentiation into astrocytes and oligodendrocytes. There would be smaller sized pyramid cells with shortened dendrites leading to less connections and a reduced network complexity. These would reduce the cognitive abilities in the prefrontal area of the brain.

Kofi and Kwesi would therefore, have:

1. Smaller brains composed from less neuron than what should have been expected from them without passing the hot water massage.

2.  Less glial cells that support and maintain the neurons.

3. The structure of the neural circuit and its network would be less complex in number of nerve cells and connections between the neurons.

4. Swollen synapse due to an oedema (excess liquid in the tissue) that would disturb the neural circuit, causing breakdowns in the passage of information along the neural circuit, which will be exhibited in symptoms of slow action and thinking. ​

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The harmful effect of the Robb ointment that is rubbed on the soft spot after the bath.

Robb ointment is meant for the relief of symptoms of cold and muscle pain and there is warning against using it for children under 12 years old.  However, ointments like Robb are applied on the head of Ghanaian babies every morning and evening for a period as long as two years.

Some chemicals in the ointment are poisonous and harmful to the brain. They are menthol, methyl salicylate and Camphor.

• In the first two years of the life of Ghanaian babies, the level of menthol in the brain accumulates gradually as the Robb ointment is applied regularly on the head once or twice a day. 

• High level of menthol increases the level of BDNF (Brain-Derived Neurotrophic Factor) which is associated with ADHD (Attention Deficit Hyperactivity Disorder).  

• Thirty percent of Ghanaian pupils suffer from ADHD, and this can be the result of rubbing the Robb ointment on the head of the Ghanaian pupils when they were babies.

• Methyl salicylate and menthol damage the complexity of the neuron network.

• Camphor causes oedema and cell death. In high doses of exposure, it will cause death.

       In lower doses it will cause slow neural impulse transmission and damage to the cognition of the baby.

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All these ingredients are harmful to the development of neurons, and to neural circuits which continue to develop many months up to years after birth. Neural circuits are formed in the brain by establishing new synaptic connections between neurons. This process is a long-term development which starts in human as a baby and lasts along all the life of an adult as he or she experiences new thing. 

Applying the Robb ointment after heating the head of a baby enables the chemicals of the Robb ointment to pass more easily through the skin and be absorbed by the cells of the brain.

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Application of these chemicals with the heat twice a day increases the presence of these chemicals in the brain during the most sensitive developing window time of brain development. It causes irreversible damage, whereas under normal conditions they would not have been present. We therefore should expect that babies who passed the hot water massage and the Robb ointment treatment to have their cognition adversely affected.

The areas of the brain that suffer mostly from the heat during the hot water massage to the head, are the front of the prefrontal cortex and the back of the head of a baby. Both areas are involved in working memory and reasoning.

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Difficulties in learning.

The prominent learning impairments observed among the children from Nursery 1 up to Primary 2 in Creative foundation School (children who usually passed hot water massage to their heads when they were babies) were as follows: 

• Inability to use both hands; the dominant hand with the support of the non dominant hand to perform a task such as coloring shape on a paper or building with Lego bricks.  Because the non dominant hand does not support the activity of the dominant hand, the dominant hand fails to do the work as demanded (Nursery 1, 2 and Kindergarten 1). 

• Short span of attention (all ages). This led in Primary 1 to a great difficulty in joining pieces of a puzzle, even 9 pieces puzzle.

• Memorizing or repeating without understanding (all ages). This affected severely the learning of math. The children found it very difficult to understand what the meaning of quantity is, and the changes in the quantity. They could not anticipate the change in the quantity based on the subtraction and addition symbols, and they confused between them.

• Basing their reasoning with no connection to their daily life experiences (Kindergarten 2 up to Primary 2), and inability to detect an error in their reasoning that led to inability to change their wrong answer.

For more details see: "Learning impairments" page.

Deficiencies in the cognitive and reasoning abilities of children and adults can be the reason for the reports of low educational achievements, particularly in Math and Science, and the high level of Attention Deficit Hyperactivity Disorder (ADHD) among Ghanaian children and youth.

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Effect on long term cognition.

The hot water massage and the application of ointments to the head of the baby can affect the infrastructure and the chemical balance of the neural network. Therefore, it would affect the complexity and the organization of the memory and reduce the efficiency of the memory in processing new information. This will lead to impaired leaning capabilities, reciting in place of understanding and wrong decisions making in life. For more details see​: "Memory and learning" and "Connectionism and Hierarchical models of the neural circuits" pages.

 

If these two practices are harmful to the brain of a baby, why do Ghanaian mothers practice them?

In Ghanaian traditional knowledge it is believed that because of the pressure in the birth canal during delivery of a baby, cracks (sutures) and holes (soft spots, fontanelles) are formed in the skull of the baby. Air enters the head of a baby through these cracks and holes and causes illness. In order to avoid the damage, they believe in, the women use hot water to massage the head of the baby and apply on the head the Robb ointment with the conviction that they are healing the holes, cracks and wounds in the skull. The biggest hole in the head of a baby is the soft spot, anterior fontanelle, or as it is called by the Ghanaian the "breathing place". The movement of the skin on the soft spot gives the wrong impression that air passes through that place into the brain. 

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What should be done in order to stop these deeply rooted customs?

There is the need to educate the Ghanaian communities about the real purpose of the sutures (cracks) and the fontanelles (soft spots, holes) in the skull of a baby. They are there not by accident, but this is how the skull of a baby is form already in the womb. During giving birth of a baby, his or her head passes through the birth canal which has a smaller diameter than that of the head of the baby. In addition, the birth canal is surrounded by the pubic bones that form a stiff ring around it. This limits the extent of the expansion of the birth canal. Therefore, the bones of the skull of the head of a baby are not yet fused together. This condition allows the bones temporally to shift and reduce the diameter of the head of a baby in order to allow it to pass through the narrow birth canal without damage. The fact that the bones of the skull will be fused together slowly and not at once, allows the growth of the brain of a baby as he or she grows. All the sutures and fontanelles will be closed naturally. There are no spaces in the skull that air can pass through them because each space (suture or fontanelle) is covered with a connective tissue that does not allow air to pass into the head. The vibration of the biggest fontanelle (the anterior fontanelle or the soft spot), is as a result of the vibration of the blood vessels beneath the skin covering the anterior fontanelle. As the heart pumps the blood forward, it vibrates the blood vessels. If you put one hand on the biggest soft spot, the anterior fontanelle in the head of a baby and the other hand on his or her chest where the heart is, you will feel in both hands the same rhythm of pules. For more details see: "The soft spot" page.

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Can we tell the mothers "Do not use hot water on the baby's head"? What about warm water? NO!!!

The physical effect of the Mpemba effect is important for the campaign against the use of the hot water on the head of a baby because many times the instruction from the hospital is not to use very hot water. The women then, lower the temperature of the water. However, as the temperature of the water is low also the rate of loosing its heat is small. It means that the women should only use lukewarm water, or room temperature water. The temperature of lukewarm water is 37 degrees Celsius and the heat that starts to cause changes in the brain is 38.5 degrees Celsius. The difference between 37 and 38.5 degrees Celsius is only 1.5 degrees Celsius. Such a small difference is difficult to manage. Detecting the temperature of the water by hand is not sufficient and therefore, not recommended. 

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Recommendations:

The instructions to the mothers should be:

1. Do not do any treatment to the head of the baby.

2. Do not massage the head of a baby at all.

3. Do not apply any ointment on the head of a baby.

4. Do not press the head of a baby. Just leave the head by itself. 

5. Wash gently the head of a baby with room temperature water and soap. The head of a baby is not dirty.  Do not scrub the head. 

6. If the baby catches cold, he or she sneezes, coughs, or has phlegm in the throat, exposure to cold air can contribute to the illness of the baby. The cold air enters the head through the nose into the cavities of the sinus in the skull, which are located above the nose and under the eyes. The cold air enters the chest into the lungs only through the nose and mouth.  Therefore, you can dress the baby with warm clothes and put a cap on his or her head to keep him or her warm.

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