Δρ Νικόλας Καλογήρου - Παιδίατρος / Dr Nicolas Kalogirou Paediatrician

Δρ Νικόλας Καλογήρου - Παιδίατρος / Dr Nicolas Kalogirou Paediatrician I am a UK trained paediatrician and a member of Royal college of Paediatrics. I have a special interest in developmental paediatrics

I look after children of all ages , including well baby checks, immunisations and continuity of care throughout childhood.

21/05/2026

ON ''RIGHT NOW'' DEMANDS AND WHY I QUIETLY STOPPED WALK- IN APPOINTMENTS

There's a principle drummed into anyone who's ever sat through a business course: you adapt to meet your clients needs. And fair enough. One of the most consistent things I hear — from pretty much everyone — is that waiting times are too long. We're all busy. Time is scarce. Every hour spent in a queue is an hour not spent doing something that actually matters.

So it might seem odd, then, that I've started saying no to the "I need to be seen RIGHT NOW" requests. I suspect this has made some people rather cross. Here's my thinking.

Right now, there are probably small babies in my waiting room due for their vaccinations. You cannot bring a five-year-old with a cough and plonk them next to a six-week-old infant. It's not a bureaucratic objection. It's just not safe !

And after that? There's almost certainly someone who rang two weeks ago, arranged childcare, took time off work, and is sitting waiting for their slot. Delaying their appointment because someone else can't wait isn't fair. Their time is not worth less than yours.

There's also the question of what rushed medicine looks like. I don't do my best work under that kind of pressure. Nobody does.

Here's what we actually do instead: every morning and every afternoon, I keep slots back. Reserved. Not bookable in advance. Specifically for people who need to be seen that day. Ring us, and we aim to get you in within two to four hours.

It's not perfect and sometimes it falls short, and when it does, I'm genuinely sorry. But every decision I make has to hold the wellbeing of everyone in my care at its centre — not just the person who got there first, or the one making the most noise for that matter . That's the job.

07/03/2026

SOME THOUGHTS ON 24/7 SEEKING

Occasionally I get tagged in posts where people ask for doctor recommendations and sometimes people mention my name. I usually don’t look at these but every once in a while I have a sneaky peek .

One post a while back caught my attention . A family was asking for suggestions for a paediatrician who should more or less be at work 24/7 or something along these lines . It transpired that they were not happy with their doctors opening hours on the weekends (!) . Although it was a relief to see that many of the comments below were reprimanding and acknowledging that doctors can’t work 24/7 , quite a few others were highly recommending doctor X or Y as being always available and therefore super caring .

Convenience notwithstanding , we all fancy going to supermarket on Sundays because we have more free time , I found that deeply problematic. Mainly because most of us are oblivious to human limitations . Although I wouldn’t expect everyone to be familiar with the nuances of clinical risk analysis there is some basic common sense in this . These were lessons taught from aviation industry and adopted across the board in all professions in high stake environments . That is anywhere where human errors may prove fatal or have serious consequences ( ie not supermarket cashiers ) . In the so called ‘’dirty dozen’’ of human factors leading to errors the top 3 are : fatigue , distractions and working under pressure.

Simply put, the way you don’t want your pilot to be sleep deprived and exhausted by the same token , you do not want the doctor examining your child to be on his 7th consecutive day of 12 hour shifts - no matter how much caffeine he consumed or how superhuman he thinks he is .

By the way this also reminds me of a senior colleague in his retirement years who I met one night at a restaurant who was bragging about seeing 50 patients a day and not been for holidays or out of office for many years and how we ‘’snowflake generation’’ are too lazy and entitled .

I am sorry but ‘’He/she is always available therefore is a caring doctor’’ is not a valid argument . If anything I can argue the exact opposite . That he or she may actually be compromising patient safety .

11/01/2026

IS CO-SLEEPING WITH YOUR BABY SAFE ?

Disclaimer: The information provided in this post is for informational purposes only and does not constitute medical advice. I do not endorse co-sleeping under my professional capacity.

As a health professional tasked with discussing Sudden Infant Death Syndrome (SIDS) prevention with new parents during their first visit , I am obliged to reiterate the safe sleep guidelines which is that co-sleeping increases the risk for SIDS and should be avoided. I am fully aware that this message may be at odds with the harsh reality of a new mother’s life. However co-sleeping could result in the loss of a life . Therefore most doctors feel is safest to simply tell all parents to never cosleep .

We know that newborns have not been designed to let their mothers sleep for 8 consecutive hours and there are good reasons for that . For starts breastfed infants get hungry every couple of hours ( but this is not an argument in favor of using formulas of course ). Also babies do not like it when not being held or cuddled and feel uneasy with lack of proximity , hence why the get upset when put down on the cot. This is an evolutionary remnant from back in the day when living in the savannas the world was not a safe place to leave a baby out of arm’s reach. Babies who cried when left unattended were most likely to survive and not be eaten by tigers.

So how do parents cope? Studies show that a high percentage of nursing mothers bring their infant into their bed even if they do not admit this. Many parents end up co-sleeping as it settles their baby and enables everyone to sleep.

So why is co-sleeping being labelled hazardous ? Data from the UK and the US show that approximately half of SIDS babies die during co-sleeping . So the maths say that co-sleeping increases the risk of SIDS by 10 fold which is pretty shocking . The caveat here though is that most of this co-sleeping related deaths happen when other hazardous factors are also at play , mainly co-sleeping on sofas , while taking sedative medications or alcohol , or when a parent is a regular smoker . Therefore when we take these factors out of the equation and look at co-sleeping alone the risk is lower , although it is still non-zero . An interesting fact is that SIDS cases in Japan where co-sleeping is the norm for cultural reasons are half of those in the US.

I think shocking messages that imply that all co-sleeping leads to death are not very helpful. They do not reflect the complexity of the evidence, they ignore the harsh reality of looking after a newborn baby, they induce guilt to parents and close down honest conversations .

For those interested in reading more about co-sleeping the lullaby trust website has some great resources on the topic.

07/01/2026

INFANT FORMULA RECALLS !!

Dear all the following infant formulas are being urgently recalled from the market due to concerns regarding potential contamination with a toxin leading to food poisoning

NAN EXPERT pro Lactose Free Batch 51520346AD
NAN EXPERT pro sensitive plus Batches 51250742C1, 52610742C2
S26 GOLD - 1 batch 51550346AE

be mindful that the recall only affects the above specific products and not all products of the NAN or S26 series .

07/12/2025

IS THERE A LINK BETWEEN MICROBIOME AND AUTISM ?

The idea that the gut microbiome may have a causal link with autism has become quite mainstream in recent years. A rule of thumb is that outrageous claims require an outrageous level of evidence before we should believe them. In this case, there is no scientifically coherent story and yet parents of autistic children
are being sold expensive treatments and diets on the basis of it.

WHAT WE KNOW WITH CERTAINTY :

Gastrointestinal issues are very common in Autism Spectrum Disorder , affecting around 50% of individuals,. Problems like constipation, diarrhea, abdominal pain, bloating, and reflux, are more common and more severe than in the general population.

Many studies have reported for the most part that children with autism differ from those without on aspects of the gut microbiome

WHAT IS NOT CERTAIN:

Although there is a ton of data showing associations between dysbiosis ( which means abnormal microbiome ) and a wide range of conditions from schizophrenia to rheumatoid arthritis, there is very little evidence of causation and even less evidence that reversing the dysbiosis has any therapeutic benefit

The key here is that association does not mean causation. For example there is a statistical association between children’s ice cream consumption and death by drowning . Not because the first causes the latter but because both are more frequent during summer months. There is also a statistical association between margarine consumption and divorce rates and tons of other spurious correlations .

WHAT ARE OTHER POSSIBLE EXPLANATIONS

Quite simply that the dysbiosis results from autistic behaviours and not vice versa. Autistic individuals have very restricted diets which take a toll on their microbiome . I see lots of children with autism in my practise and I am yet to meet the one who is eating his 5 a day of fruits and veggies. This is not rocket science.

Correcting long standing abdominal discomfort and pain will improve an autistic child’s behaviour especially the difficult ones. Being happier and less distressed will make you more agreeable and easy going. That does not mean that the core symptoms of autism have gone away.

The new hype - amplified by US health secretary RFK and President Trump – that the rise in autism must be explained by an environmental cause such as Paracetamol or vaccines.

Too many vested interests in the commercial world . There is the food industry, biotech startups and “wellness” companies who profit out of this hype . This notion has formed the basis for tons of supplements , special diets and ‘‘natural’’ remedies promoted by a global wellness industry.

WILL IT HARM ?

I personally do not think probiotics supplements cause any harm and I would not discourage a parent from giving them a try especially in the face of gut problems. But I would be realistic in my expectations and be clear that it would not cure autism . I would discourage you however from embarking on special diets like keto or gluten free against medical advise.

01/10/2025

THE FOLATE HYPE

I see a trend in the community of families with autistic children and other developmental challenges to test for folate deficiency or use folate as a means of therapy . This is an extremely complicated and nuanced topic and I thought I ‘d do a quick review of the evidence. Please note that this not in any way a medical advise and you should discuss this matter further with your healthcare provider before you take any actions.

1. There are 4 different forms of vitamin B9. Folate is the form as it occurs in foods and folic acid is the synthetic form found in vitamin supplements . Folinic acid ( aka leucovorin ) and methyl-folate are activated forms of folate which by pass the body’s pathway of activating folate into a chemically active substance ( in case these pathways are defective which is sometimes the case).

2. Vitamin B9 is extremely important in brain growing during fetal life and early childhood as well as brain function thereafter . The mechanisms behind these are complex but if we were to think of our brains as a car engine then folate would be as important as engine oil.

3. MTHFR gene is involved in one of these folate activation pathways. It has been proposed that in some people with autism defective forms of this gene may be responsible for causing deficiency of active folate forms and thereby the autism . Hence autism would be reversed if one gave this child folate supplements . To date this theory has not been validated by evidence. In simple terms there is no definitive link between MTHFR gene mutations and autism and testing for this is not recommended.

4. Folate receptor autoantibodies (FRAT ). In our brains there is a folate receptor which helps move folate from blood into the brain. There is evidence that in SOME autistic people FRAT block this process hence causing deficiency of folate in our brains thereby causing autism. It is clear that folinic acid ( which does not need to use folate receptor to enter brain) can correct this problem in this specific population . It is NOT a cure for autism in general .

5. It is not very clear what subset of children with Autism have folate defects or have FRAT -related autism and would benefit from supplements nor there is any consensus in the medical community as to whom we should be giving folate or should be testing for FRAT antibodies. FRAT antibody testing is not currently available in Cyprus ( at least that I am aware of )

Parents sometimes fall pray to dubious advise by practitioners of alternative and integrative medicine and I can totally see the appeal . Especially if on the other end what classic medicine has to offer is sometimes an authoritative ‘’respect my authority – I know what is best for your child’’ attitude and giving you a list of 10 generic one-size-fits-all recommendations and wishing you good luck. This can lead to a breakdown in rapport and trust.

If I was a parent of a child with autism I would probably be willing to try pretty much everything provided is safe. So knowing that there is a vitamin that stands a chance of inducing positive changes in some autistic children wouldn’t I too be knocking on my paediatrician’s door asking for it just in case my child would benefit ? Absolutely .

This begs the question : given the complexity of testing would it be reasonable to do a trial of folinic acid in all children with autism ? I do not have the answer to this and there are much more clever and important figures in the science community out there who I trust will help with this very valid question .

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