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FOR PARENTS AND CARERS of children aged birth-5 years

Commonchildhood

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If a child in your care is ill or injured, choose well from the following services available:

NHS 111 is free to call from any landline or contract mobile phone. Pay-as-you-go mobile phones require 1 pence credit to make a call.

Grazed kneeSore throatCoughs and colds

As a parent if you are:UnsureConfusedNeed help

Mild diarrhoeaMild skin irritations (includingspots/rash)Mild fever

High temperatureHead injuries not involving loss of consciousnessPersistent coughWorsening health conditions(inside GP hrs)

Minor bumps, cuts and possible fractures (during 9-5)DehydratedHeadacheTummy pain

Unexpected and sudden sicknessSevere painWorsening health conditions(outside GP hrs)

ChokingLoss of consciousnessFittingBroken bones

Self Care

NHS 111For 24 hour health adviceand information.

PharmacistFor advice on commonillnesses, injuries andmedication.

Doctor/GPFor the treatment of illnessesand injuries that will not goaway.

Minor Injuries UnitFor treatment of minorillnesses and injurieswithout an appointment.

Urgent CareWhen you need healthcarein a hurry 24 hours a day.

A & E or 999For very severe or lifethreatening conditions whenit is safe to move your child.

You can treat minor illnesses and injuries at homeby using the recommended medicines andmaking sure they get plenty of rest www.nhs.uk.

Ring NHS 111 when it is less urgent than 999Tel: 111www.nhs.uk/111

To find your local pharmacy and its contact details visit:www.nhs.uk/chemist OR text ‘pharmacy’ to 64746 for your nearest 3 pharmacist details.

Write your GP (family doctor) telephone numberhere:

Minor Injuries Unit

A & E

A & E

1560-East/West Suffolk CCI:6521-Cornwall 23/5/14 11:47

WelcomeWho can help?

A guide to services 4

Well-being and lifestyle 6

Know the basics 7

General welfareImmunisations 8

Choking 10

Household accidents 12

Bumps & bruises 14

The first monthsBreastfeeding 16

Crying 18

Being sick 20

Nappy rash & dry skin 22

Sticky eyes & conjunctivitis 24

Teething trouble 26

Childhood illnessesCoughs & colds 28

Wheezing & breathing difficulties 30

Asthma 32

Allergies 34

Ear infection 36

Fever 38

Meningitis 40

Chickenpox & measles 42

Urticaria or hives 44

Upset tummy 46

Constipation 48

Useful contacts 50

Contents

3

This book has been put together by NHS Ipswich and East Suffolk ClinicalCommissioning Group.

Every parent or carer wants to know what to do when a child is ill - use thishandbook to learn how to care for your child at home, when to call your GP andwhen to contact the Emergency Services. Most issues your child will experienceare part of growing up and are often helped by talking to your Midwife, HealthVisitor or School Nurse. Almost all babies, toddlers and children will get commonchildhood illnesses like chickenpox, colds, sore throats and earache.

Some of these are easily treated by your GP or at home with support from yourGP or a Health Visitor rather than a trip to Accident and Emergency.

This handbook will point you in the right direction and explain what you can doat home, or where you need to go to get assistance and advice. It has been puttogether with help from healthcare professionals. Trust your instincts, you knowyour child better than anyone else. If you are worried you must get further advice.

This handbook also contains general welfare information which will help you keepyou and your child safe and healthy.

Visit www.ipswichandeastsuffolkccg.nhs.uk to view this booklet online.

All factual content has been sourced from Department of Health, Birth to Five, 2009 edition, NHSChoices, British Association of Dermatologists, Meningitis Now. This information cannot replacespecialist care. You need to get specialist help if you are worried, you know your baby best.

To access the mobileweb version of this

booklet TEXT

SICK KIDZTO 60II0

Visit Positive parentingon

www.ipswichandeastsuffolkccg.nhs.uk

1560-East/West Suffolk CCI:6521-Cornwall 23/5/14 11:48 Page 5

54

A&EFor immediate, life-threatening emergencies,please call 999. A&E and999 are emergencyservices that should onlybe used when babiesand children are badlyinjured or showsymptoms of criticalillness such as choking,chest pain, blacking out,or blood loss.

DentistMake sure you see aDentist on a regularbasis. To find a Dentist that istaking on patients callPALS 0800 389 6819.PALS can also assist infinding an emergencyDentist for patientsin pain. For out-of-hoursDentists call NHS 111.

GPYou will need to register with aGP - to find a GP in your area,use the NHS Choices FindServices System on:www.nhs.uk/servicedirectoriesYour GP can advise, givemedicines and information onother services. You will need tomake an appointment butmost GPs will see a baby quitequickly if you are worried. After6.30pm weekdays, atweekends and public holidaysmost services are covered by aGP out-of-hours service callNHS 111.

Health VisitorHealth Visitors are thereto support you and yourfamily during the earlyyears. They will visit youat home or see you inyour local clinic. Theyassess your health anddevelopment needs andcan tell you where to getextra help if you need it.

PharmacistYour local Pharmacistscan provide advice onmost common healthissues. They cansuggest and dispensemedicine and otherhealth products. Thereare often Pharmacists insupermarkets and manyare open late. Visitwww.nhsdirect.nhs.ukwhere you can find theservice locator that willhelp you find thePharmacist nearest to you.

Children’sCentres

Families can access awide range ofinformation in a friendlyenvironment.Children’s Centresprovide a range ofadvice including healthpromotion and advice onsafety. They promote allaspects of child healthand well-being.

NHS 111 makes it easier for you to access local healthservices. Calls are free from landlines and mobilephones. If you need urgent healthcare, you should callNHS 111 before you go to any other service. By callingNHS 111 you will be directed straightaway to the localservice that can help you best. It is available 24 hours aday, 365 days a year.When should I call NHS 111?• When you need help fast but it is not life threatening.• When you think you need to go to A&E or another

NHS urgent care service.• When it’s outside of GP surgery hours.• When you are visiting the area.• When you do not know who to call for medical help.

A guide to servicesHere in Suffolk we have a wide range of healthcare and children and family services. See which service or professional is best to help you.

111


Being prepared and knowing the signs

Source: NHS choices76

Know the basics

Paracetamol - junior paracetamol can be given for pain or fever to childrenover 2 months. Check you have the right dose and strength for your child’sage. Read the box carefully.Ibuprofen - junior form can be given to babies and children of 3 months andover who weigh more than 5kg. Read the box carefully. Avoid if your child hasasthma unless advised by your GP.Aspirin - do not use for children under 16.

Childhood ObesityMany parents are unaware of the dangers ofchildhood obesity but by following the toptips below you can make a difference toyour child’s health.1. Sugar Swaps - Swapping sugary snacks

and drinks for ones that are lower insugar can make a huge difference.

2. Meal Time - It’s important for kids tohave regular, proper meals as growingbodies respond better to routine.

3. Snack Check - Many snacks are full ofthe things that are bad for us - sugar, salt,fat and calories. So try and keep a carefuleye on how many the kids are having.

4. Me Size Meals - It’s important to makesure kids get just the right amount fortheir age.

5. 5 A Day - 5 portions of fruit and/orvegetables a day.

6. Up and About - Most of us spend toolong sitting down. Keep active.Encourage your child to walk, you mayneed to use child safety reins.

Source: Start4Life(www.dh.gov.uk/obesity).

Parents are usually good at noticing when something is wrong with their babyfrom quite early on. It is normal to worry that you may not recognise the signs thatyour baby is unwell. Trust your instincts, you know your baby best.

Learn how to spot the signs of serious illness and how to cope if an accidenthappens. If you know the basics and you are well prepared, you will find it easierto cope - and less scary. Keep a small supply of useful medicines in a lockedcabinet or somewhere up high where a child cannot reach them. There is a usefullist in the box on the right, of things to have at home just in case. Make sureyou’ve got the right strength of medicine for the age of your child, always followinstructions carefully and check use by dates. Read the label carefully and usesugar-free options where you can.

If your baby seems to have a serious illness it’s important to get medical attentionas soon as possible. Take a look at the Birth to Five book from the Department ofHealth www.dh.gov.uk

Promoting good health

Well-being &lifestyleWe cannot stop our children getting illnesses or passing on coughsand colds which form a part of growing up. However, by makingsure our children lead a healthy lifestyle, eat well, are safe, haveemotional support and get enough exercise early on, we can reallyhelp with their long-term health and well-being.

Thermometer

Natural oils like olive oil or almond oil(for dry skin)

Plasters

Liquid painkillers(e.g. paracetamol oribuprofen)

Barrier cream

Pharmacist saysKeep a small supply of usefulmedicines. Include things like:

Antihistamine


When to immunise

Two months old

Three months old

Four months old

Between 12 and 13months old - within amonth of the first birthday

Two and three years old

Three years four monthsold or soon after

Diseases protected against

• Diphtheria, tetanus, pertussis (whooping cough),polio and haemophilus influenzae type b (Hib)

• Pneumococcal disease• Rotavirus

• Diphtheria, tetanus, pertussis, polio and Hib• Meningococcal group C disease (MenC)• Rotavirus

• Diphtheria, tetanus, pertussis, polio and Hib• Pneumococcal disease

• Hib/MenC• Pneumococcal disease• Measles, mumps and rubella (German measles)

• Influenza - The Flu Nasal Spray vaccine is to begradually rolled out to other age groups in futureyears, consult your Practice Nurse or Health Visitor

• Measles, mumps and rubella• Diphtheria, tetanus, pertussis and polio

Source: NHS Immunisation Information.

8

ImmunisationsProtect your child now and in the future

Immunisations, also known as vaccinations are usually given by injection. Childrenin the UK are offered vaccinations against a variety of diseases as part of theHealthy Child Programme. You can get advice on the vaccinations from your GP,Practice Nurse or Health Visitor. A record is kept in the Parent Held Child HealthRecord (Red Book), which is a book you keep containing information on yourchild’s health.

Immunisations are mainly given during the first five years. It’s important to havevaccinations at the right age to keep the risk of disease as low as possible. Don’thesitate to ask your Health Visitor or GP for advice - that’s what they are there for!Childhood immunisations are free and most are given at your GP’s surgery.

Some immunisations are given more than once to make sure the protectioncontinues. This is known as a booster, so make sure your child gets it.

If you are pregnant, you will be offered the whooping cough vaccine at your GP’ssurgery. The ideal time is 28 to 32 weeks of pregnancy, your baby will be bornprotected against whooping cough infection, a very serious infection for youngbabies.

9

GP saysImmunisations are used toprotect children from diseaseswhich can be very seriouscausing long-termcomplications and even death.

The protection immunisationoffers to your child are worththe small amount of pain.

If you wish to have furtherinformation on theimmunisations offered to yourchild, visit www.nhs.uk or speakto your Heath Visitor, PracticeNurse or GP.

Health Visitor saysMake sure you keep yourchild’s Red B ook in a safeplace. It is your only completerecord of their childhoodimmunisations and they areoften needed later in life.

Check with your Health Visitoron any updates and futureimmunisations.

Some children with medicalconditions may needadditional vaccinations ifrecommended by theirpaediatrician.

1 2 3Immunisation begins attwo months, when baby'snatural immunity to illness,begins to drop.

Your Health Visitor willtell you when localimmunisation sessionsare taking place.

Immunisations don’t justprotect your child duringchildhood, they protectthem for life.


1110

Choking Act immediately and calmly

Children particularly between the ages of about one and five, often put objects intheir mouth. This is a normal part of how they explore the world. Some smallobjects, like marbles and beads, are just the right size to get stuck in a child’sairway and cause choking. The best way to avoid this is to make sure smallobjects like these are out of your child’s reach.

In most cases you, or someone else, will see your child swallow the object thatcauses the choking. However, there can be other reasons for coughing. If yourchild suddenly starts coughing, is not ill and often tries to put small objects in theirmouth, then there is a good chance that they are choking.

If your child is still conscious but either they are not coughing or their coughing isnot effective, use back blows. If back blows don’t relieve the choking, and yourchild is still conscious, give chest thrusts to infants under one year or abdominalthrusts to children over one year. Even if it is expelled, get medical help.

Try these suggestions:• If you can see the object, try

to remove it. But don’tpoke blindly with yourfingers. You could makethings worse by pushing theobject in further.

• If your child is coughingloudly, there is no need to doanything. Encourage them tocarry on coughing and don’tleave them.

• If your child’s coughing is noteffective (it’s silent or theycannot breathe in properly),shout for help immediatelyand check whether they arestill conscious.

• If your child is still consciousbut either they are notcoughing or their coughingis not effective, use backblows.

Babies and toddlers can easilyswallow, inhale or choke onsmall items like lolly sticks,balloons, peanuts, buttons,nappy sacks, plastic toy piecesor cords.

Unconscious child with choking:If a choking child is, or becomes unconscious, put them on a firm flat surface.• Call out or send for help if you are still alone.• Don’t leave the child at this stage.• Open the child’s mouth. If the object is clearly visible, and you can grasp it

easily, remove it.• Start cardiopulmonary resuscitation (CPR).Don’t use blind or repeated finger sweeps. These can push the object further in,making it harder to remove and cause more injury to the child.


13

FallsFor babies the biggest danger is rolling off the edge of abed, or changing surface. For toddlers it is more aboutfalling from furniture or down stairs.PREVENTION:• Make sure your baby cannot roll off any surfaces, put

pillows around them. • Do not put a bouncing cradle or car seat on a surface

where they could wriggle off.• Use stair gates for toddlers. Make sure balconies are

locked and fit restrictors and safety locks to windows.WHAT TO DO:If your child has a serious fall call 999.

ChokingBabies and toddlers can easily swallow, inhale or chokeon small items like balloons, peanuts, buttons, plastic toypieces, strings or cords.PREVENTION:• Check on the floor and under furniture for small items.• Check that toys are age appropriate and in good

condition. • Find out more about CPR (a first aid technique that is a

combination of rescue breaths and chest compressions.Sometimes called the ‘kiss of life’).

WHAT TO DO:If your child is choking act immediately and calmly. Makesure you do not push the object further down the throat.Encourage your child to cough. Use back blows, if theybecome unconscious call for help (do not leave your childalone) and start CPR. www.redcrossfirstaidtraining.co.uk

Head injuryOne of the signs of a severe head injury is being unusuallysleepy, this does not mean you cannot let your child sleep.You need to get medical attention if:• They are vomiting persistently (more than 3 times).• They are complaining it hurts.• They are not responding at all.• Pain is not relieved by paracetamol or ibuprofen.

If they are tired from what’s happened, or from crying,then it is fine to let them sleep. If you are worried in anyway about their drowsiness, then you should wake yourchild an hour after they go to sleep.WHAT TO DO:Check that they are okay, and that they are respondingnormally throughout the night.

CutsGlass causes serious cuts with many children ending up inA&E.PREVENTION:Do not leave drinking glasses on the floor. Make sure glassbottles are kept up high.WHAT TO DO:• If the cut is not serious bathe the area, make sure there

is no glass left and cover with a clean non-fluffy cloth.• If the cut is serious, is bleeding a lot or has a piece of

glass under the skin (maybe they trod on some glass)go to A&E.

DrowningMany children drown, often in very shallow water. Ithappens in the bath, in garden ponds, paddling poolsand water butts.PREVENTION:• Supervise children near water at all times. Use a grille

on ponds and fill in a garden pond to use as a sand pit.• Make sure your child learns to swim.WHAT TO DO:Get your child out of the water. Try to get them to coughup any water. If they are not responding call 999.

PoisoningPoisoning from medicines, household products andcosmetics are common.

PREVENTION:Lock all chemicals, medicines and cleaning productsaway.WHAT TO DO:Find out what your child has swallowed and take it withyou to A&E.

StrangulationWindow blind cords and chains can pose a risk forbabies and children who could injure or even stranglethemselves on the hanging looped cords.PREVENTION:• Install blinds that do not have a cord, particularly in a

child's bedroom. • Pull cords on curtains and blinds should be kept short

and kept out of reach. • Tie up the cords or use one of the many cleats, cord

tidies, clips or ties that are available. • Do not place a child's cot, bed, playpen or highchair

near a window. • Do not hang toys or objects that could be a hazard on

the cot or bed.• Do not hang drawstring bags where a small child could

get their head through the loop of the drawstring.• Find out more about CPR.

www.redcrossfirstaidtraining.co.ukWHAT TO DO:Untangle child, call 999 and start CPR.

Source: The Royal Society for the Prevention of Accidents (RoSPA)

Household accidents

12


14

Bumps & bruisesMinor cuts, bumps and bruises are a normal part of growing up. Allowing childrento explore the world around (with supervision) helps them develop and learn. Mostof your toddler's bumps will require no more than a cuddle to make them better.

A minor head injury is when your child has not lost consciousness, is alert or interactswith you, may have vomited but only once, may have bruising or cuts to their headbut is otherwise normal. Most minor head injuries just cause bruising and pain for ashort while and your child will make a full recovery. Apply ice or a cool wash to theinjured area to help reduce the swelling. If your child has a cut, apply a clean dressingand apply pressure to it for about five minutes. Cuts to the head will often bleed a lot.

In the next day or two watch for:• Headache. Give paracetamol to relieve the pain.• Vomiting. If vomiting continues go back to the Doctor.• Drowsiness. Immediately after the head injury your child may be sleepy. There

is no need to keep your child awake if they want to sleep. If your child does goto sleep wake them every half to one hour to check their condition and theirreaction to familiar things. You should do this until they are no longer drowsyand have been awake and alert for a few hours.

Part of growing up

If you are still worried, contact your GP or GP out-of-hours service. If you cannot get help go straight away to the Accident and Emergency Department.15

Head injurySome problems that may resultfrom a minor head injury can behard to detect at first. In thenext few weeks parents maynotice irritability, mood swings,tiredness, concentrationproblems and behaviouralchanges. Talk to your GP if youare worried about any of these.Go to your GP or hospitalimmediately if your child hasunusual or confused behaviour,severe or persistent headachewhich is not relieved byparacetamol (irritability in ababy) frequent vomiting,bleeding or discharge from theear or nose, a fit or convulsion,a spasm of the face or arms orlegs, difficulty in waking up ordifficulty in staying awake.

Keeping them safeBeing a toddler means yourchild is discovering the worldaround them. This can result inbumps and bruises. It is almostimpossible to prevent everyaccident although there arethings we can do at home whichmight help. See householdsafety tips on page 12.

Think about the particularenvironment you are in. Forinstance, farms can bedangerous places. Take extracare with farm machinery,animals and chemicals if you liveon or are visiting a farm.

1 2 3Comfort you child andcheck for injuries, hold acloth soaked in cool wateron a bump or bruise.

Give your child painkillers if needed (infantparacetamol), let them restbut keep an eye on them.

Get help if your child isseriously injured, unconscious,has difficulty breathing or ishaving a seizure.


16

BreastfeedingGiving your baby a healthy diet is one of the most important things you can do forthem - not just now, but for their future years too.

Breastfeeding is recommended for babies because breast milk containsantibodies that help protect against illnesses. Breastfeeding isn’t just healthier foryour baby - it can be really rewarding for you too. It provides an opportunity tobond with your child and feel close to them. Breastfeeding reduces the risk ofBreast and Ovarian Cancers, it also helps you get back into shape more quickly.

In the beginning feeding can be more frequent but you will both gradually get intoa pattern of feeding and the amount of milk you produce will settle.

Breastfeeding also helps you and your baby to get closer - physically and emotionally.So while you are feeding your baby, the bond between you grows stronger.

When your baby is six months old, they will still need to breastfeed but now is thetime to offer your baby some solids. This period is called ‘weaning’, which means‘trying’. Remember that babies can’t drink cow’s milk until they’re a year old.

A great start, but keep it up!

Source: Department of Health, Birth to Five 2009 edition.17

Midwife saysBreastfeeding is the best giftyou can give your baby,continue right up until they areweaning and teething begins.Until your baby is six monthsold, breast milk has goteverything they need.Breastfeeding can sometimestake a little while for you andyour baby to get used to, butonce established, breastfeedingis easy for most mothers andbabies. Many mums stop breastfeeding at 6-8 weeks. Keep atit, for at least 6 months if youcan and make it part of youreveryday routine.

1 2 3Eat a healthy diet whilebreastfeeding.

Do not smoke whilebreastfeeding. Eat no morethan two portions of oily fisha week, avoid alcohol,caffeine, salt and shellfish.

If you are worried about afood type, or have anyallergies talk to yourMidwife or Health Visitor.

Hold your baby’s whole bodyclose with the nose level withyour nipple.

It is important to find a position that is comfortableand safe.

Let your baby’s head tip backa little so that their top lip canbrush against your nipple.This should help your baby tomake a wide open mouth.

When your baby’s mouthopens wide, the chin is ableto touch the breast first, withthe head tipped back so thatthe tongue can reach asmuch breast as possible.

With the chin firmly touching,and with the nose clear, themouth is wide open, andthere will be much more ofthe darker skin visible aboveyour baby’s top lip thanbelow their bottom lip - andtheir cheeks will look full androunded as your baby feeds.

Source: Departmentof Health, Birth toFive 2009 edition.

Call 0800 022 4332 or visitwww.smokefree.nhs.uk


18

CryingUnderstanding why

All babies cry, especially in the first few weeks after birth. Crying is their way ofletting you know they need something or are uncomfortable. They may needchanging, they may be hungry or just need a cuddle.

If your baby cries suddenly and often, but they otherwise appear to be happy andhealthy, they may have colic. Colic is common and although uncomfortable it is notserious and usually affects babies only in the first few months of their lives. Themost common symptom of colic is continuous crying, which typically occurs in thelate afternoon or evening. Other signs include a flushed appearance, drawing theirlegs to their chest, clenching fists, passing wind and having trouble sleeping.

When a baby cries, it can be upsetting. It is very important to stay calm and don’tbe afraid to ask for help.

19

Health Visitor saysKnow your baby. Try tounderstand what it is theyneed. Finding out why yourbaby is crying is often amatter of going through allthe possible options.

Things to check first are:

� Does their nappy needchanging?

� Could they be hungry?

� Could they be too hot?

� Could they be too cold?

� Does their cry sounddifferent?

These are simple thingswhich could be causing yourbaby to cry.

GP saysIf your baby's crying seemsdifferent in any way (such asa very high-pitched cry or awhimper), then seek medicaladvice. Crying cansometimes be a sign thatyour baby is unwell. Trustyour instincts - you knowyour baby best.

1 2 3My baby is crying morethan usual.

Have you followed theadvice given by your HealthVisitor? Have you thoughtabout what your baby istrying to tell you, it may besomething really simple.

If you have tried this and ithas not worked speak toyour Health Visitor, orcontact your GP if you areworried.


A problem likely to get better on its own

Being sickGP says

After the first few months, ifyour baby is suddenly sick it ismore likely to be caused by astomach virus rather thanpossetting. Gastroenteritis is atummy bug (see Upset tummypage 46), which can comewith diarrhoea (runny poo).

This is more serious in babiesthan older children becausebabies easily lose too muchfluid from their bodies andbecome dehydrated. If theybecome dehydrated theymay not pass enough urine,lose their appetite and havecold hands and feet.

Get expert advice. If yourbaby is unwell, or if vomitinghas lasted more than a day,get your GP’s advicestraightaway.

It is common for babies to be sick in the early weeks as they get used to feedingand their bodies develop. Bringing up small amounts of milk is known aspossetting. When your baby vomits there will be a much larger amount. It can befrightening for your baby, so they are likely to cry. Lots of things can cause yourbaby to be sick.

Make sure your baby is positioned correctly when breast or bottle feeding.Incorrect positioning can cause a baby to be sick (see Breastfeeding page 16).

Being sick often or with large amounts may be due to ‘gastric reflux’ where acidfrom the tummy can come up again. Babies can be grumpy and it can sometimeslead to poor feeding. If your baby is feeding well but doesn't seem themselves,you may just need to change the baby's position during a feed to make themmore upright (see correct positioning advice on page 16). Feeding smalleramounts and more often may also help.

2120

1 2 3I have a new baby. I have just given my baby a feed.

They always seem to bringup small amounts of milk.

This is known as‘possetting’. As theydevelop it will stopnaturally. Talk to yourHealth Visitor.

Health Visitor saysPossetting is ‘normal’ duringor after a feed. If this carrieson at other times, betweenfeeds it may be a tummybug. It is important for babiesto have plenty of fluids tostop any dehydration.


22

Leave your baby in awarm, safe place with noclothes or a nappy on, tolet the air get to their skin.

Use a barrier cream.(see Pharmacist says boxopposite).

Remember to change andcheck their nappy often.

Health Visitor’s nappy rash tips

This is the name given to theyellowish, greasy scaly patches onthe scalp of newborns and usuallyappears in the first 3 months. It canlook like a bad case of dandruff andclears up over time without causingyour baby discomfort.

It is important not to pick at thescales as this may cause infection.

Wash scalp gently everyday using luke warm water.

Use a small amount ofnatural oil (olive orvegetable) on the scalpand leave on for 15minutes before washingoff with luke warm water.

Health Visitor’s cradle cap tips

Nappy rash & dry skinNappy rash is very common and can affect lots of babies. It is usually caused whenyour baby's skin comes into contact with wee and poo that collects in their nappy.

A nappy rash causes your baby's skin to become sore. The skin in this area may becovered in red spots or blotches. You might need to change their nappy more often.

Most nappy rashes can be treated with a simple skincare routine and by using acream you can get from the Pharmacist. With a mild nappy rash, your baby won'tnormally feel too much discomfort.

Dry skinA baby’s skin is thinner and needs extra care. Dry, flaky skin, some blemishes,blotches and slight rashes are normal in newborns and will naturally clear up. Ifyour baby is otherwise well but has a rash and you are worried about it contactyour Health Visitor.

A common problem that’s easy to treat

23

Pharmacist saysCall in and talk to us aboutcreams we can provide youwith over the counter.

There are two types of nappycream available. One is abarrier cream to keep weeaway from your baby's skin.The other is a medicatedcream, that is good forclearing up any soreness but should only be usedwhen advised by a healthprofessional.

1 2 3There is a red, sore rasharound the nappy area.Baby is uncomfortable andcries a lot.

Has baby been in a dirtynappy for a long time? Have you followed advicefrom your Health Visitor, orspoken to your Pharmacist?

Change nappy often.Speak to your HealthVisitor and if you areworried see your GP.


24

‘Sticky eyes’ are common in newborn babies and young children while their tearducts are developing. You may see some sticky stuff in the corner of the eyes ortheir eyelashes may be stuck together.

It normally clears up on its own, but you may have to clean your baby's eyesregularly with damp cotton wool. Use clean, cooled boiled water.

Wipe each eye from the corner by the nose outwards. Use a clean piece of cottonwool for each wipe. Remember to wash your hands before and afterwards andavoid sharing towels to prevent spreading infection.

Two different issues

Source: DoH 2006.25

GP says -Conjunctivitis

The signs of ‘sticky eyes’ cansometimes be confused with aninfection called ‘conjunctivitis’.With conjunctivitis the signs areyellowy, green sticky goo whichcomes back regularly. If younotice this, contact your HealthVisitor or GP. This can bepassed on easily, so wash yourhands and use a separate towelfor your baby.

1 2 3Is there discharge in thecorner of your baby’s eyeand do their eyelashesappear to be stucktogether?

Sticky eyes is a commoncondition that affects mostbabies, speak to yourHealth Visitor.

Use cooled boiled water ona clean piece of cottonwool for each wipe.

Sticky eyes & conjunctivitis


Source: DoH Birth to five edition 2009. www.nhs.uk

Every baby goes through it

2726

Teething trouble

Pharmacist saysIf your baby is uncomfortable,you can buy some medicinefrom your local Pharmacy.These medicines contain asmall dose of painkiller, suchas paracetamol, to help easeany discomfort. The medicineshould also be sugar free.Make sure you read allinstructions or ask yourPharmacist about how to use them.

For babies over four monthsold, you can try sugar-freeteething gel rubbed on the gum.

Health Visitor saysIt can help to give your babysomething hard to chew on,such as a teething ring.Teething rings give your babysomething to safely chew on,which may help to ease theirdiscomfort or pain. Someteething rings can be cooledfirst in the fridge.

All sorts of things are put downto teething - rashes, crying,bad temper, runny noses, extradirty nappies - but be carefulnot to explain away what mightbe the signs of illness by sayingit’s ‘just teething’.

Source: DoH Birth to five edition 2009.

1 2 3My baby has red cheeksand seems a bitfrustrated and grumpy.

Have you asked yourHealth Visitor aboutteething? Have youdiscussed options withyour Pharmacist?

Try some of the gels or babyparacetamol available. If youare worried and things donot feel right contact yourHealth Visitor or GP.

The time when babies get their first primary teeth (milk teeth) varies. A few areborn with a tooth already, whilst others have no teeth at one year. Teeth generallystart to show when a child is four to nine months old, although every babydevelops at their own pace. This is known as ‘teething’. Some babies show fewsigns while others find it more uncomfortable. Some teeth grow with no pain ordiscomfort at all. At other times you may notice that the gum is sore and redwhere the tooth is coming through, or that one cheek is flushed. Your baby maydribble, gnaw and chew a lot, or just be fretful.

Some people attribute a wide range of symptoms to teething, such as diarrhoea andfever. However, there is no research to prove that these other symptoms are linked.You know your baby best. If their behaviour seems unusual, or their symptomsare severe or causing you concern, talk to your Health Visitor.

Think about your child’s tooth care routine. You can brush their teeth with a softbaby toothbrush and a smear of family toothpaste. Make sure you see yourDentist regularly and discuss your child’s oral health with them.


1 2 3

28

Coughs & coldsYou will probably find when your child goes to playgroup or nursery that they getlots of coughs, colds and sniffles. There are some good things about this thoughas it helps the body build up a natural immune system.

Most bugs will run their course without doing any real harm because they will getbetter on their own, however there are things you can do at home to help:

� Give your child lots to drink.

� Try infant paracetamol (not aspirin).

� Keep them away from smoke, do not let people smoke at home, around yourchild or come into contact with your child if they have recently smoked.

� Keep calm - a cuddle goes a long way.

� Talk to your Pharmacist but remember that coughing is the body’s way ofkeeping the lungs clear.

If your baby is under three months, or you are concerned, contact your GP.

Not usually serious

29

Pharmacist saysChildren can also be treatedusing over the counterpainkillers to help to bringdown a raised temperature.Junior paracetamol and coughmedicines can help. Check thelabel carefully. Some areavailable as a liquid for childrenand can be given from the ageof about three months. Always check with yourPharmacist if you aren’t surewhich treatments you can give your child.

Don't pass it on:Catch it Germs spreadeasily. Always carrytissues and use them tocatch coughs or sneezes.

Bin it Germs can live forseveral hours on tissues.Dispose of your tissue assoon as possible.

Kill it Hands can pass ongerms to everything youtouch. Clean your handsas soon as you can.

Whooping CoughA contagious bacterial infection of the lungsand airways. It starts with a persistent dryand irritating cough that progresses tointense bouts of coughing - followed by adistinctive 'whooping' noise. Othersymptoms include a runny nose, raisedtemperature and vomiting after coughing. Ifwhooping cough is diagnosed during thefirst three weeks of infection, a course ofantibiotics may be prescribed.

It is important to avoid spreading theinfection to others, particularly babies undersix months. Babies with whooping coughare sometimes admitted to hospital as theyare most at risk of severe complications,such as serious breathing difficulties.

Your GP will advise you about how tomanage the infection at home using somesimple self-care measures, such as restingand drinking plenty of fluids.

Children with whooping cough should bekept away from school or nursery for fivedays from the time they start taking aprescribed course of antibiotics.

My child keeps coughingand sneezing, has a mildtemperature and seemsgenerally unwell.

Have they recently startednursery? Catching colds isvery common. Have youspoken to your Pharmacistabout junior paracetamoland cough medicines?

If symptoms last for morethan 72 hours or your childis coughing up yellow‘goo’ they may have aninfection. Contact your GP.



Look at the signs

Source: NHS Choices - Symptoms of bronchiolitis3130

Any kind of breathing difficulty your infant or child experiences can be scary forparents. It may be nothing to worry about and could just be normal baby ‘snuffles’.

Use your instincts with newborns and babies. It could be:• Rapid breathing or panting, which is common. There is no other sign of illness, it

comes and goes and your baby is breathing comfortably most of the time,there’s normally no need to worry.

• Breathing may sound a bit rattly. Try holding your baby upright.• Occasional, coughing or choking which may occur when a baby takes in milk

too quickly with feeds. Try to slow things down a bit. Check feeding position.• A cold or mild cough. Keep an eye on them at this stage and use your instincts.

If you are worried talk to your Health Visitor.In older babies and toddlers you may notice:• Coughing, runny nose, mild temperature - (see page 28 Coughs & colds).• Croup (hoarse voice, barking cough) needs to be assessed by a Doctor and

may need treating with steroids.• Child appears pale or even slightly blue-ish.

If you’re worried about your child wheezing or having breathing difficulties evenafter reading this, contact your GP or call 999 immediately.

Wheezing &breathing difficulties

GP saysGet help and contact your GPnow if your child:

� Seems to find breathinghard work and they aresucking in their ribs andtummy.

� They can’t complete a full sentence withoutstopping to take a breath.

Call 999 or take them to A&Enow if:

� Their chest looks like it is‘caving in.’

� They appear pale or evenslightly blue-ish.

BronchiolitisA common respiratory tract infectionthat affects babies under a year old.Early symptoms are similar to those ofa common cold and include a runnynose and cough.

As it develops, the symptoms ofbronchiolitis can include: A slightfever, a dry and persistent cough anddifficulty feeding.

Symptoms usually improve afterthree days and in most cases theillness isn’t serious. However, contactyour GP if your child is only able tofeed half the normal amount or isstruggling to breathe, or if you aregenerally worried about them.

Source: www.nhs.uk/conditions/Bronchiolitis

CroupMild cases of croup can be managed at home. Ifyour child has a fever, children's paracetamol willhelp lower their temperature. They should alsodrink plenty of fluids.

Allowing a child to breathe in steam from a hotbath or shower in a closed room can easesymptoms. Steam treatment should only be usedunder careful supervision as there is a risk ofscalding your child.

1

2

3

If your child has arunny nose and coughbut also has rapidbreathing and difficultyfeeding or is vomiting,it may be bronchiolitis.

Even though mostcases of bronchiolitisare not serious, thesesymptoms can be veryworrying for parents.

Contact your GP If yourchild has symptoms ofbronchiolitis (see box). This is particularlyimportant if your baby isunder 12 weeks. Call999 if your child hassevere breathingdifficulties or exhaustionfrom trying to breathe.



32

AsthmaKnow the symptoms

Source: Department of Health, Birth to five 200933

GP saysYour GP will normally be able todiagnose asthma by asking aboutyour child’s symptoms, examiningtheir chest and listening to theirbreathing.Parents should regularly attend theirlocal Asthma Clinic and get regularsupport on better management oftheir child’s asthma at home. This willsave unnecessary trips to hospital.All children over six months withasthma who require continuous orrepeated use of a steroid preventerinhaler or oral steroid are offered theseasonal flu vaccine. In addition, anychild over six months who has beenadmitted to hospital with a lowerrespiratory tract infection should alsobe offered the seasonal flu vaccine.

Symptoms of severe asthmaSymptoms include repeated coughing andwheezing, shortness of breath and bringing upphlegm. Symptoms often get worse at night.

1 2 3

Asthma Nurse saysThe most important part ofmanaging asthma is for youand your child to know aboutasthma and what triggers anattack.Our GP Asthma Clinics offeradvice and treatment. Askabout the seasonal flu vaccine.

My child seems towheeze and cougha lot, it seems toget worse at night.

Have you tried reducing anypossible amounts of dustaround the home? Do yousmoke? Have you talked toyour Health Visitor?

If symptoms persistsee your GP. If yourchild has a seriousasthma attack call 999.

Asthma is a common long-term condition that can be well controlled in mostchildren. The severity of asthma symptoms varies between children, from verymild to more severe. Asthma has multiple causes and it is not uncommon fortwo or more different causes to be present in one child. Asthma is more thanwheezing. Coughing, recurrent bronchitis and shortness of breath, especiallywhen exercising, are also ways that asthma appears.

The two most common triggers of asthma in children are colds and allergies.After infancy allergies become particularly important and avoiding theallergens to which your child is allergic may help improve their asthma.

A sudden, severe onset of symptoms is known as an asthma attack, it can belife threatening and may require immediate hospital treatment.

Asthma often runs in families and parents should avoid smoking indoors ornear to their children.

Call 999 to seek immediate medical assistance if your child hassevere symptoms of asthma.



34

AllergiesManaging and understanding your child’s allergy

Source: NICE - Testing for food allergy in children and young peopleSource: Allergy UK35

GP saysIf you suspect you or your childmay have a food allergy, it isvery important to ask for aprofessional diagnosis from yourGP, who may refer you to anallergy clinic.

Many parents mistakenlyassume their child has a foodallergy when in fact theirsymptoms are due to acompletely different condition ora food intolerance.

50% of children in the UK have allergies. For parents it is a learning curve inunderstanding what to avoid and how to control and manage the allergy. Find outas much as you can. There are many types of allergies.

An allergy is when the body has a reaction to a protein such as foods, insectstings, pollens, house dust mite or other substances such as antibiotics. Thereare many common allergies. Some families seem to include more individuals withallergies than other families. Children born into families where allergies alreadyexist show a higher than average chance of developing allergies themselves.

Allergic symptoms can affect the nose, throat, ears, eyes, airways, digestion andskin in mild, moderate or severe form. When a child first shows signs of an allergyit is not always clear what has caused the symptoms, or even if they have had anallergic reaction, since some allergic symptoms can be similar to other commonchildhood illnesses. If the reaction is severe, or if the symptoms continue to re-occur, it is important that you contact your GP.

1 2 3Food allergies occurwhen the body’simmune systemreacts negatively toa particular food orfood substance.

Allergens can cause skin reactions(such as a rash or swelling of thelips, face and around the eyes),digestive problems such as vomitingand diarrhoea, and hay-fever-likesymptoms, such as sneezing.

Children are mostcommonly allergic tocow’s milk, hen’s eggs,peanuts and other nuts,such as hazelnuts andcashew.

EyesItchy eyes, watery eyes, pricklyeyes, swollen eyes, ‘allergicshiners’ - dark areas under theeyes due to blocked sinuses.

Spotting symptomsThis example shows areas where allergysufferers may experience symptoms.Many of these symptoms can develop asa result of other common childhoodillnesses. With an allergy, symptoms oftenappear more quickly or suddenly.

Nose, throat and earsRunny nose, blocked nose, itchynose, sneezing, pain in sinuses,headaches, post-nasal drip (mucusdrips down the throat from behindthe nose), loss of sense of smell andtaste, sore throat, swollen larynx(voice box), itchy mouth and/orthroat, blocked ear and glue ear.

SkinUrticaria - wheals or hives, bumpy,itchy raised areas, rashes (seeUrticaria or hives page 44).Eczema - cracked, dry or weepy,broken skin.

DigestionSwollen lips/tongue, stomach ache,feeling sick, vomiting, constipation,diarrhoea, bleeding from the bottom,reflux, poor growth.

AirwaysWheezy breathing, difficulty inbreathing, coughing (especially atnight time), shortness of breath.



36

Ear infectionA baby’s ears need to be treated with care

Ear infections, which can result in earache are common in babies and toddlers.They often follow a cold and can sometimes cause a temperature. A child maypull at their ear, but babies often cannot tell where their pain is coming from, sothey just cry and seem generally uncomfortable.

Babies have some natural protection against infections in the first few weeks - thisis boosted by breastfeeding. In babies and toddlers, bacteria or viruses pass fromthe nose to the ears more easily. Ear infections can be painful and your child mayjust need extra cuddles and painkillers from the Pharmacist. Your child may haveswollen glands in their neck - this is the body’s way of fighting infection.

Children who live in households where people smoke (passive smoking) or whohave a lot of contact with other children, like those who go to nursery, are morelikely to get ear infections. Speak to your Health Visitor about safely cleaning yourbaby’s ears as they can be easily damaged.

Source: DoH Birth to five edition 2009.37

Health Visitor’s tipsThe best ways to prevent earinfections are to:

� Avoid others who are illwhen possible.

� Wash hands to preventthe spread of viruses.

� Never smoke indoors.

� Breastfeed your child.

� Do not allow your child todrink while lying down.

What are the signs of an ear infection?

The signs are fever, ear pain, fussinessor irritability especially when lying down(this increases the pressure on the innerear causing more pain when aninfection is present), disturbed sleeppatterns, fluid draining from the ear. Although most ear infections settledown without any serious effects, therecan be mild hearing loss for a shorttime (two to three weeks). With youngchildren you can expect that your GPwill want to re-evaluate your child’s earagain in three or four weeks. 1 2 3

My toddler hasearache but seemsotherwise well.

Have you tried infantparacetamol from yourPharmacist? Do not put oilor cotton buds into yourchild’s ears.

Most ear infections get better bythemselves. Speak to your GP ifsymptoms show no sign ofimprovement after 24 hours, yourchild seems in a lot of pain or younotice fluid coming from the ear.



FeverOver 38°C means a fever

Source: DoH Birth to five edition 2009.3938

If your child has a fever, he or she will have a body temperature above 38˚C. Yourchild may also feel tired, look pale, have a poor appetite, be irritable, have aheadache or other aches and pains and feel generally unwell. Take the temperaturefrom the armpit (don’t use in the mouth of under 5s). However, bear in mind thatthese measurements are less accurate as the armpit is slightly cooler.

A fever is part of the body’s natural response to infection and can often be left torun its course provided your child is drinking enough and is otherwise well. If yourchild is having trouble drinking, trying to reduce their temperature may help withthis. This is important in preventing your child from becoming dehydrated, whichcan lead to more serious problems. As a guide, your child’s urine should be paleyellow - if it is darker, your child may need to drink more fluids.

Fevers are common in young children. They are usually caused by viral infectionsand clear up without treatment. However, a fever can occasionally be a sign of amore serious illness such as a severe bacterial infection of the blood(septicaemia), urinary tract infection, pneumonia or meningitis.

You should also contact your GP if fever symptoms are not improving after 48hours.

Always seek medical advice if your child develops a fever soon after an operation,or soon after travelling abroad.

GP saysCall 999 if your child:

� Has a fit.

� Has a temperature of over38˚C and you are worried,especially if there is a rash.

� Develops a non-blanchingrash i.e. the rash doesn’tdisappear when pressed.

Go to A&E if your child:

� Has a fever.

� Has not responded toparacetamol and is sleepyor lethargic.

Babies under 6 months:Always contact your GP, Health Visitor,Practice Nurse, Nurse Practitioner orlocal clinic GP if your baby has othersigns of illness, as well as a raisedtemperature and/or if your baby’stemperature is 38 ̊C (102 ̊F) or higher.

Older children:A little fever isn’t usually a worry.Contact your GP if your child seemsunusually ill, or has a high temperaturewhich doesn’t come down.• It’s important to encourage your child

to drink as much fluid as possible.Water is best.

• Bringing a temperature down isimportant because a continuing hightemperature can be very unpleasantand, in a small child, occasionallybrings on a fit or convulsion.

• Undress to their nappy/pants and vest.• Keep the room at a comfortable

temperature (18 ̊C).• Give infant paracetamol in the correct

recommended dose for your child.

1 2 3My toddler is hotand grumpy.

Have you tried infantparacetamol? Have youmade sure they are drinkinglots of fluids?

If their temperatureremains over 38˚C anddoesn’t come down,contact your GP.


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MeningitisNot common but serious and contagious

Babies and toddlers are most vulnerable as they cannot easily fight infectionbecause their immune system is not yet fully developed. They can’t tell you howthey are feeling and can get a lot worse very quickly. Keep checking them.

Meningitis is a swelling around the brain. It is a very serious, contagious illness,but if it is treated early most children make a full recovery.

You should always treat any case of suspected meningitis as an emergency.

Early signs may be like having a cold or flu. Children with meningitis can become seriously ill very fast, so make sure you can spot the signs. Your childmay have a cluster of red or purple spots. Do the glass test. This rash can beharder to see on darker skin, so check for spots over your baby or child’s wholebody as it can start anywhere (check lightest areas first). However, the rash isnot always present - be aware of all the signs/symptoms.

The presence of fever and any other of the above symptoms should be takenextremely seriously. Not all children will show all the signs listed on the right.

If you are worried, contact a Doctor (e.g. your Doctor or Walk-in Centre). If you cannot get help straight away go to A&E. 41

Fever, cold hands and feet

Floppy andunresponsive

Drowsy anddifficult to wake

Spots/rash.Do the glass test

Rapid breathing or grunting

Fretful, dislikesbeing handled

Unusual cry or moaning

GP saysIf any of the signs below arepresent contact a Doctor.

�

The glass testThe glass test is a really useful way of spotting suspected meningitis. If yourchild has a cluster of red or purple spots, press the side of a clear drinkingglass firmly against the rash.

In this example the spots are still visiblethrough the glass. Contact a Doctorimmediately (e.g. your own surgery orNHS 111). If you cannot get helpstraight away go to the Accident andEmergency Department.

In this example the spots under theglass have virtually disappeared. It isunlikely to be meningitis but if youare still worried contact your GP orgo to the Accident and EmergencyDepartment.

Source: Meningitis Now

Go straight to the Accident and Emergency Department

1 2 3My child is showing someof the signs of meningitis.

Have you tried the glasstest?

Treat all cases of suspectedmeningitis as anemergency. If the spots donot fade under pressure call 999 or go to A&E.


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Take rashes seriously

ChickenpoxChickenpox is a mild disease that most children catch atsome point. The spots often look like mosquito bites andcan appear on any part of the body. After havingchickenpox, the virus stays in the body. Later in life thevirus can come back in a different form known as shingles.

Chickenpox is easy to pass on to someone who has nothad it before. If your child has chickenpox keep them awayfrom others.

Chickenpox can be incredibly itchy, but it's important forchildren to not scratch the spots so as to avoid futurescarring. One way of stopping scratching is to keepfingernails clean and short. You can also put socks overyour child's hands at night to stop them scratching the rashas they sleep.

If your child's skin is very itchy or sore, try using calaminelotion or cooling gels. These are available in pharmacies andare very safe to use. They have a soothing, cooling effect.

MeaslesMeasles is a very infectious illness. About one in fivechildren with measles experiences complications such asear infections, diarrhoea and vomiting, pneumonia,meningitis and eye disorders. One in 10 children withmeasles ends up in hospital. There is no treatment formeasles. Vaccination is the only way of preventing it. If yourchildren haven’t yet had the MMR vaccination, don’t delay.Speak to your Health Visitor.

Once the rash starts, your child will need to rest and you cantreat the symptoms until your child’s immune system fightsoff the virus. If there are no complications due to measles,the symptoms will usually disappear within 7-10 days.

Closing curtains or dimming lights can help reduce lightsensitivity.

Damp cotton wool can be used to clean away any crustinessaround the eyes. Use one piece of cotton wool per wipe foreach eye. Gently clean the eye from inner to outer lid.

PainkillersIf your child is in pain or has a high temperature (fever), you can give them a mild painkiller, such asparacetamol (available over-the-counter in pharmacies). Always read the manufacturer's dosage instructions.Do not give aspirin to children under the age of 16.

Chickenpox & measles

Midwife saysIf you are pregnant and have hadchickenpox in the past it is likelythat you are immune tochickenpox. However, pleasecontact your GP or Midwife foradvice.

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Urticaria or hivesEasy to confuse with more serious illnesses

Childhood rashes are very common and often nothing to worry about. Mostrashes are harmless and go away on their own.

Urticaria or hives is a raised, red, itchy rash that appears on the skin. It can befrightening especially if you don’t know the cause. It happens when a triggercauses a protein called histamine to be released in the skin. Histamine causesredness, swelling and itching, the rash can be limited to one part of the body orspread across large areas of the body. It can sometimes be confused with othertypes of more serious rashes such as meningitis.

Hives can be triggered by many things, including allergens (such as food or latex),irritants (such as nettles), medicines or physical factors, such as exercise or heat.But usually no cause can be identified. It's a common skin reaction that's likely toaffect children. The rash is usually short lived and mild, and in many cases doesnot need treatment as the rash often gets better within a few days. If you’restruggling with it, a medication called antihistamine usually helps. Creams helpwith the itching and are available over-the-counter at pharmacies. Speak to yourPharmacist for advice.

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1 2 3My child has developeditchy red spots.

It can be difficult to identifywhat has triggered the rash.Try to think about any new ordifferent foods they have had.

If itching persists askyour GP about anti-histamine medication.

GP saysSome things which can triggerurticaria can be avoided, theseinclude:• Food such as peanuts,

shellfish, eggs and cheese.• Environmental factors such

as pollen, dust mites orchemicals.

• Insect bites and stings.• Emotional stress.• Some medications - do not

stop any prescribedmedicines before you speakto your Health Visitor or GP.

• Physical triggers such aspressure to the skin, changein temperature, sunlight,exercise or water.

Source: www.nhs.uk/conditions/skin-rash-children

Foods to avoid:There is controversy over the role ofdiet in people with long-term hives.There are two groups of chemicals insome foods that may trigger urticaria.It is important to discuss your child’sdiet with your Health Visitor.Avoid:• Shellfish• Strawberries, bananas, mangoes,

pumpkin, tangerines, kiwi• Tomatoes, peas• Fish• Chocolate• Pineapple

Cut down on:• Spices• Orange juice• Raspberries• TeaSource: Allergy UK


46

Upset tummyNot nice for you or your baby

Sickness and diarrhoea bugs are caught easily and are often passed on in placeswhere there are lots of children - like playgroups or nurseries.

Feeling sick and suddenly being sick are normally the first signs. Diarrhoea canfollow afterwards. Diarrhoea can cause dehydration so increase fluid intake. Take them to see your GP if they are unwell for longer than 24 hours orsooner if they are newborn or if you notice signs of dehydration.

If you're breastfeeding, keep on doing so. Offer older children plenty of water, oran ice-lolly for them to suck. If they want to eat, give them plain foods like pastaor boiled rice (nothing too rich or salty).

Keep them away from others, especially children, who may pick up infection.Regularly wash hands with warm water and soap to fight off the infection. If youare out, use hand gel.

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Signs ofdehydration

� Sunken fontanelle (i.e. thesoft spot on top of thehead is more dipped inthan usual).

� Less wet nappies (i.e.they wee less).

� More sleepy than usual.

� Diarrhoea.

� Dry mouth.

Try a rehydrating solutionfrom your Pharmacist.

VomitingThe most common cause ofvomiting is gastroenteritis. Thisis an infection of the gut. It alsocauses diarrhoea. This is usuallynothing to worry about and willpass in a few days. Being sickcan sometimes be caused byother things like food allergies,accidentally swallowing a poisonor drug, or an infection.

You should contact your GP ifyour child:• Has been vomiting for more

than 24 hours.• Has not been able to hold

down fluids for the last eighthours, or you think they aredehydrated.

• Is floppy, irritable, won't eattheir food, or they are nottheir usual self.

• Has severe tummy pain.• Has a headache and stiff neck.

There are lots of ways you can care foryour child at home. Things to try are:

� Give them regular drinks - try smallamounts of cold water. Breastfeedon demand if breastfeeding.

� Being extra careful with handhygiene (use soap and water oranti-bacterial hand gel and dryhands well with a clean towel).

� Rehydrating solutions come inpre-measured sachets to mix withwater. It helps with dehydration.

If your child is unwell for more than 24hours speak to your GP. If your baby isnewborn or very unwell contact yourGP straight away.

Pharmacist says

1 2 3My baby hasdiarrhoea and isbeing sick.

Have you given them lots ofwater? This will help preventthem becoming dehydrated if itis a tummy bug. Speak to yourPharmacist and ask about arehydrating solution.

Speak to a Doctor if symptomsshow no sign of improvementafter 24 hours or straight awayif they are newborn.


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ConstipationEasy to treat

Constipation is a very common problem in children. Many children normallypass stools as far apart as every few days. Regardless, you should treat hardstools that are difficult to pass and those that happen only every three days asconstipation.

Breastfed infants will generally have more stools per day. Their stools varymore in frequency when compared to bottle-fed infants. For example,breastfed infants produce anywhere from 5 to 40 bowel movements per weekwhereas formula-fed infants have 5 to 28 bowel movements per week.Switching the type of milk or formula can also cause constipation.

Many things contribute to constipation but infants and children who get well-balanced meals typically are not constipated. When babies are weaned ontosolid food their poos can change colour, smell and frequency.

Ask your Health Visitor for advice. In rare cases, constipation can be due to anunderlying illness, so if the problem doesn’t go away in a few days, it’simportant to talk to your GP.

Source: NICE guidelines 2010, constipation in children49

Health Visitor saysTo avoid constipation and help stopit coming back make sure yourchild has a balanced diet includingfruit, vegetables, baked beans andwholegrain breakfast cereals. Wedo not recommend unprocessedbran (an ingredient in some foods),which can cause bloating, flatulence(wind) and reduce the absorption ofmicronutrients. Drink plenty of fluids.Keeping your child physically activewill also help to prevent constipation.

If a bottle fed baby becomesconstipated you can try offeringwater between feeds (never dilutebaby milk). If the problem doesn’tgo away, talk to your Health Visitoror GP again.

1 2 3Does my child havea balanced diet?

If your child is constipated,they may find it painful togo to the toilet.

Ask your Health Visitor orPharmacist whether asuitable laxative may help.


Useful contacts

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Asthma UK0800 121 62 44www.asthma.org.uk

Baby LifeCheckwww.babylifecheck.co.uk

Call 11124 hour - for when it is less urgent than 999

Start4LifeHealthy eating tipswww.nhs.uk/start4lifewww.nhs.uk/change4life

Dental Helpline0845 063 1188

Diabetes UKwww.diabetes.org.uk

Family Lives0808 800 2222www.familylives.org.uk

GingerbreadSingle parent helpline0808 802 0925

Meningitis Now0808 80 10 388www.meningitisnow.org

National Breastfeeding Network Helpline0300 100 0212www.breastfeedingnetwork.org.uk

National Domestic ViolenceHelpline0808 2000 247www.nationaldomesticviolencehelpline.org.uk

NetmumsParenting advice and information inEngland, Wales, Scotland and NorthernIreland.www.netmums.com

NATIONAL

NSPCC0808 800 [email protected]

RedcrossInformation on CPR (kiss of life)www.redcrossfirstaidtraining.co.uk

The Lullaby Trust (FSID)www.lullabytrust.org.uk

www.healthystart.nhs.uk

Suffolk Safeguarding Children BoardAre you worried about the welfare of a child?Contact Customer First/Emergency DutyService 0808 800 4005www.suffolkscb.org.uk

East Suffolk Child Development Centre01473 712233

Breastfeeding supportwww.familiesandbabies.org.uk/suffolk

Families Online Suffolkwww.familiesonline.co.uk/LOCATIONS/Suffolk

Health Visitors:

North Ipswich 01473 275273

South Ipswich 01473 694170

East Ipswich 01473 275808

West Ipswich 01473 242159

Felixstowe 01394 458840

Framlingham & Leiston 01728 403012

Woodbridge & Kesgrave 01394 615220

Stowmarket 01449 776040

High Suffolk 01379 873782

South Suffolk 01473 820147

LOCAL

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