A Parent’s Guidewaltham-forest.sensecds.com/docs/waltham-forest.pdf · during the day or night...

A Parent’s Guide

Sens

e In

tera

ctive

Ltd

, Maid

ston

e. ©

201

8 Al

l Righ

ts R

eser

ved.

Tel:

016

22 7

5216

0 w

ww.s

ense

cds.

com

This handbook has been produced by NHS Waltham Forest Clinical Commissioning Group (May 2015)

We would welcome your feedback on this booklet for our next edition. Please email Waltham Forest CCG [email protected]

BreastfeedingWorried, need

support and advice?Call the National

Breastfeeding Helpline0300 100 0212. Open

daily 9.30am to 9.30pm

ImmunisationsConfused, unsure or

need advice?Speak to your health visitor or

GP practice nurse

Call 0800 032 0102 or visit

www.smokefree.nhs.ukChild health& common

illnesses

From birth to five and beyond

To view the latest version of this booklet and extra topics onlinewww.walthamforestccg.nhs.uk/childhealthguideAn app is also available for Android and iPhone, search childhealthguidewf

1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23

WelcomeThis book has been put together by NHS Waltham Forest ClinicalCommissioning Group.

Every parent or carer wants what is best for their growing baby and to givethem the best start in life. You can use this handbook to help you know whatto do when your baby/child is ill. Learn how to care for your child at home, whento seek advice from a health visitor/call a doctor and when to contactemergency services.

Most issues are simply an everyday part of growing up, often helped by a chatwith your midwife or health visitor. Almost all babies, toddlers and children willget common childhood illnesses like chickenpox, colds, sore throats and earinfections. While these are not very nice at the time they are easily treated athome with support from your GP or health visitor rather than going to A&E.

If you are worried you must get further advice - you know your child best - trustyour instincts.

All factual content has been sourced from Department of Health, Birth to Five 2009 edition, NHSChoices, British Association of Dermatologists, Meningitis Now and NICE guidelines. This informationcannot replace specialist care.

3

To view this bookletand other related

topics online, scanthis QR code withyour smartphone.

GP:..................................Nearest pharmacy:..................................Health visitor:..................................Dentist:..................................

Your contacts

To view the latest version of this booklet and extra topicsonline www.walthamforestccg.nhs.uk/childhealthguideAn app is also available for Android and iPhone, searchchildhealthguidewf

Who can help?A guide to services 4Know the basics 6

The first monthsFeeding your baby 8Crying & colic 10Jaundice 12Being sick & reflux 14Baby blues 16Nappy rash & cradle cap 18Sleeping 20Immunisations 22Sticky eyes & conjunctivitis 24Flat head syndrome 26Teething trouble 28

Childhood illnessesFever 30Coughs, colds & flu 32Chickenpox & measles 34Meningitis 36Wheezing & breathing difficulties 38

Asthma 40Earache & tonsillitis 42Diarrhoea & vomiting 44Hand, foot & mouth 46Rashes & eczema 48Constipation 50Urticaria or hives 52Allergies 54Head lice & threadworms 56

General welfareSmokefree homes 58Healthy Start vitamins 60Healthy weight & exercise 62Speech & language 64Tics, headbanging & unusual behaviour 66Sun safety 68Household injuries 70Burns & scalds 72Choking & poisoning 74How to resuscitate a child 76

Useful contacts 78

Contents1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 3

54

GP (Doctor)You will need to register with a local GP. Your GP can advise, giveyou the medicines you need and point you in the right direction ifyou need other specialist services. You will usually need to makean appointment. All GPs will see a child quickly if you are worried.To find a GP in your area, search on the NHS choices websitewww.nhs.uk/Service-Search/GP/LocationSearch/4After 6.30pm weekdays, at weekends and public holidays you cancall the GP out-of-hours service on NHS 111.

New Evening and Weekend GP ServiceUrgent and routine GP appointments are now available outsidenormal GP surgery opening times in the evenings and at weekends.

For your convenience you can now see a GP or Practice Nurse in theevenings from 18.30 to 22.00 Monday to Friday (book on the day) or8.00am to 8.00pm on Saturday and Sundays. Ring 0208 519 3999 to book an appointment.For latest information see the Waltham Forest CCG websitewww.walthamforestccg.nhs.uk

For urgent enquiries outside these hours you can call the GP out-of-hours service on NHS 111.

If you think you need help urgentlyduring the day or night you should callNHS 111 before you go to any other

health service. NHS 111 is available 24 hours a day,365 days a year and is free to call, including from amobile. You will be directed straight away to the localservice that can help you best. Call NHS 111:• When you need help fast but it’s not life-threatening.• When you think you need to go to A&E or another

NHS urgent care service.• When it’s outside of your GP’s surgery hours.• When you do not know who to call for medical help.• If you do not have a local GP to call.

111

Many minor injuries and illnesses can be besttreated in your home by using over-the-countermedicine from your pharmacist and getting plenty ofrest. If you are still worried call NHS 111 or your GP.

Self care

PharmacistYour local pharmacist can provide advice on mostcommon health issues and can suggest and dispensemedicines. There are often pharmacists insupermarkets and many are open late. Visit www.nhs.uk to find the pharmacy nearest to you.Some local pharmacies operate a free minor ailmentsscheme (Care at the Chemist), or they can direct youto one that does. See your local pharmacist for aconfidential consultation about coughs, colds, sorethroats, pain and temperature, minor eye infections,head lice and lots more. This NHS scheme is availablefrom age one and over and any medicine dispensed isfree if you do not pay for your prescriptions.

We have a wide range of healthcare and children and familyservices. See which service or professional is best to help you.

A guide to services

Your midwife assessesyours and your baby'shealth and well-being atvarious stages throughoutyour pregnancy andsupports you both in thetwo weeks after the babyis born.They will also supportyou if you choose ahome birth.

Midwife

1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 5

A&E&

999

For immediate, life-threatening emergencies.A&E and 999 are emergency services that shouldonly be used when babies and children are badlyinjured or show symptoms of critical illness. These

include choking or breathing difficulties, unconsciousor unaware of surroundings, taken poison or tablets,severe abdominal pain, fewer wet nappies suggestingdehydration.

Health visitorsHealth visitors are there to support you until your baby is fiveyears old. They will visit you at home for a new birth visitwhen the baby is about 10-14 days old, and invite you forhealth checks when your baby is 6-8 weeks, 1 year and 2years old. You can also drop in to see them at a baby clinic.They will help with advice about feeding and weaning or anyother worries, and then can direct you to where to get extrahelp if you need it. See contacts.

Family Nurse PartnershipIn Waltham Forest, young women under 19 years in theirfirst pregnancy can receive extra support from specialistchildren’s nurses until their baby is two years old.

Children & Family CentresChildren & Family Centres are family friendlyenvironments which provide support and advice foryour child’s health and development up until theystart school. Activities include play sessions, infantfeeding support groups and parenting sessions.They can also direct you to other local health andsocial support services. Families need to registerwith their local Children & Family Centre soon afterbirth to access services provided. Visitwww.walthamforest.gov.uk/cypd to find activitieshappening near you.

DentistMake sure you see a dentist on aregular basis or ask about oralhealth at your nearest Children andFamily centre. Discuss registeringyour child early on with your dentistand take them with you toappointments.To find your nearest dentist visitwww.nhs.ukFor out-of-hours dentist informationcall NHS 111.

A guide to services


Being prepared and knowing the signs

7

Know the basics

Thermometer

Plasters

Liquid painkillers(e.g. sugar-free paracetamolor ibuprofen)

Barrier cream

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

Paracetamol and ibuprofenFever in itself is just a sign of your child's body fighting an infection. Considerusing either sugar-free paracetamol or ibuprofen for children with significantfever who appear distressed (a temperature of over 38°C), as these can helpto reduce fever and pain. Treat them with either paracetamol OR ibuprofen inthe first instance. It can take up to an hour for either of them to work.Paracetamol and ibuprofen should NOT be given together at the same time.However, if your child remains distressed before the next dose is due, thenyou may want to try a dose of the other medicine. Aspirin should not be givento children under 16 years of age.

6

If a child in your care is ill or injured, choose 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

Severe painWorsening health conditionsChokingLoss of consciousnessFitting/convulsionsBroken bones

Self Care

NHS 111For 24 hour health adviceand information.

PharmacistFor advice on commonillnesses, injuries andmedication.

GPFor the treatment of illnessesand injuries that will not goaway.

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

A&E or 999For very severe or life-threatening conditions.

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

Call 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

Write your GP’s (family doctor) telephone numberhere:

Use NHS 111 out-of-hours service

A&E

High temperatureHead injuries not involving loss of consciousnessPersistent coughWorsening health conditions(inside GP hours)Minor bumps, cuts and possible fracturesDehydratedHeadacheAbdominal pain

Concern Service What to do?

Parents are usually good at noticing when something is wrong with their baby fromquite early on. It is normal to worry that you won't recognise the signs that yourbaby 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 prepared, you will find it easier to cope. Keep a small supply of useful medicines in a locked cabinet or somewhereup high where a child cannot reach them. See box on the right, for things to haveat home just in case. Make sure you’ve got the right strength of medicine forthe age of your child, always follow instructions carefully and check use by dates.Read the label carefully. If your baby seems to have a serious illness get medical help straight away.


There are lots of different positions for breastfeeding. You justneed to check the following:• Are your baby’s head and body in a straight line?

If not, your baby might not be able to swallow easily.• Are you holding your baby close to you?

Support their neck, shoulders and back. They should beable to tilt their head back easily.

8

The best start in life

9

Hold your baby’s whole body close withtheir nose level with your nipple to helpthem attach correctly.

Let your baby’s head tip back a little sothat their top lip can brush against yournipple. This should help your baby tomake a wide open mouth.

When your baby’s mouth opens wide,their chin is able to touch your breastfirst, with their head tilted, so that theirlower lip can make contact with the breast2-3cm below the nipple.

With their chin firmly touching and theirnose clear, their mouth is wide open andthere will be much more of the darker skinvisible above your baby’s top lip thanbelow their bottom lip. Your baby’s cheekswill look full and rounded as they feed.4

3

2

1

Source: DoH, www.lullabytrust.org.uk

1 2 3Have you beenshown how tohand express?This is a reallyuseful skill,and it's free.

For further breastfeedingsupport or one-to-oneassistance contact theInfant Feeding Helplineduring office hours 020 8496 5222.

The Best Start team host infant feeding cafesand drop-in sessions in Children & FamilyCentres, visit www.walthamforest.gov.uk/cypdto find out what’s on near you.Other mums and Peer Supporters will be thereto give you lots of tips.

At birth, giving your baby a long cuddle: Skin to skin contact for up to one hour,calms both mum and baby, it regulates baby’s heart rate and temperature, andstimulates mothering hormones which helps to form a close bond and increasebreast milk supply. Baby’s immediate needs are to feel safe and secure, and to beable to feed whenever hungry. Holding your baby close to feed, and responding toall of baby’s needs encourages healthy brain connections. Most of this developmentwill occur within the first two years. Responsive parenting will enable your baby toreach its full potential, to help them form good relationships and communicate well,giving them the best start in life.

Sterilising and bottle hygiene• All the equipment you use for bottle feeding your baby needs to be washed in

hot soapy water, rinsed and sterilised.• The cleaning and sterilising instructions are the same, whether you are using

expressed breast milk or infant formula milk.• You need to keep sterilising your feeding equipment until your baby is at least

six months old.• Infections (like gastroenteritis) are rare, but if they do occur, can be very serious.

Feeding tipsHow to tell your baby is havinglots of milk:• Lots of wet heavy nappies -

around six in 24 hours.• Dirty nappies, two to three

soft stools daily until four tosix weeks, after which two tothree per week.

• Baby is content and settledduring and after each feed.

• During a feed, you can hearbaby swallowing.

• Weight gain - checked byyour health visitor at the localbaby clinic.

Remember, your milk fulfils all ofyour baby’s needs for around sixmonths. It also reduces theincidence of sudden infant deathsyndrome (SIDS). Ordinarysupermarket cow’s milk shouldnot be offered until your babyreaches one year, although it issuitable to use from six monthsin breakfast cereals.

Feeding your baby1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 11

Introducing solid foods or ‘weaning’Weaning should start when your baby is around 6 months old. Gradually, you’ll be able toincrease the amount and variety of solid food your baby eats until the main part of theirdiet is solid food and they can eventually eat the same food as the rest of your family, insmaller portions. www.ouh.nhs.uk/women/maternity/postnatal/infant-feeding/documents/solid-foods.pdf


10

Never shake yourbaby

No matter how frustrated youfeel, you must never shakeyour baby. Shaking moves theirhead violently, and can causebleeding and brain damage.Source: NHS Choices

Health visitor saysKnow your baby. Try tounderstand what it is they need.Things to check first are:

P Does their nappy needchanging?

P Could they be hungry?

P Could they be too hot?

P Could they be too cold?

P Does their cry sounddifferent?

P Could they be teething?

P Do they want a cuddle?

P Are they tired and need asleep?

These are all things which couldbe causing your baby to cry.

Crying & colicUnderstanding whyAll 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 can be easy to get frustrated and youmay not be getting much sleep. It is very important to stay calm and don’t beafraid to ask for help.

If your baby's crying seems different in any way (such as a very high-pitched cryor a whimper), then seek medical advice. Crying can sometimes be a sign thatyour baby is unwell. Trust your instincts - you know your baby best.

11

1 2 3My baby is crying morethan usual.

What is your baby trying totell you? It may besomething really simple.

If you are still worried,speak to your healthvisitor, or contact your GP.


12

JaundiceWhat is newborn jaundice?Jaundice is a common condition in newborn babies that causes yellowing of theskin and the whites of the eyes. In black and brown-skinned babies, the yellowingmay be more difficult to see and visible only in the palms of the hands and thesoles of the feet. It is very common and usually nothing to worry about.

You should feed as often as possible to encourage frequent bowel movements. Ifyou are breastfeeding, you should continue to breastfeed your baby regularly. Insome breastfed babies, the skin can continue to look a little bit yellow for up to 12weeks. This is related to the breast milk, and is normal as long as your baby isotherwise healthy and thriving.

In more severe cases, you may be required to bring your baby back to thehospital to spend some time under a special ultraviolet light. Newborn jaundice isusually gone by about two weeks of age. More severe jaundice may needtreatment. If jaundice continues for over 14 days you must contact your healthvisitor or GP.

13

Testing for jaundiceStep 1Press your fingers lightly on theskin, as if you are checking apeach to see if it is ripe, andlook at the colour of the spotwhere your finger was. Trypressing the tip of their nose. Step 2If it looks yellow (rather thanwhite), it is likely to bejaundice. This test must onlybe used under good daylightor fluorescent lighting (next toa window is ideal). The babyshould be undressed sodifferent parts of the body canbe compared. On darker skincheck palms of hands andsoles of the feet.Step 3Talk to your health visitor or GP.

1 2 3My baby appears tohave mild jaundice,what should I do?

Feed your baby as oftenas possible to ensure theyare not dehydrated.

If worried ask your midwife,health visitor or GP.

Midwife saysJaundice usually disappears after10 to14 days. Jaundice appearingin the first few days of life shouldbe reported as soon as possible tothe midwife. Jaundice starting atless than 24 hours of age is anemergency and requires an urgentblood test.

See your GP without delay if:• Your baby’s jaundice does not

disappear after two weeks.• The jaundice does not start until

seven days after they are born.• Your baby’s faeces (poo) are

chalky white.


14

Health visitor saysPossetting (vomiting a smallamount of milk) is normalduring or after a feed. If thiscarries on at other times,between feeds it may be atummy bug. It is important forbabies to have plenty of fluidsto stop any dehydration.

A problem likely to get better on its ownIt is common for babies to be sick in the early weeks as they get used tofeeding and their bodies develop. Bringing up small amounts of milk is knownas possetting. When your baby vomits there will be a much larger amount. Itcan be frightening for your baby, so they are likely to cry. Lots of things cancause your baby to be sick.

Make sure your baby is positioned correctly when breast or bottle feeding.Incorrect positioning can cause a baby to be sick. Your midwife or healthvisitor can help with this.

Being sick often or with large amounts may be due to ‘gastric reflux’ whereacid from the tummy can come up again. Babies can be grumpy and it cansometimes lead to poor feeding. If your baby is feeding well but doesn't seemthemselves, you may just need to change the baby's position during and aftera feed to make them more upright. Feeding smaller amounts and more oftenmay also help.

15

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

They always seem tobring up small amountsof milk. This is known as‘possetting’.

As babies develop it willstop naturally. Talk to yourhealth visitor.

GP saysAfter the first few months, if yourbaby is suddenly sick it is morelikely to be caused by a stomachvirus rather than possetting.Gastroenteritis is an infectionwhich can come with diarrhoea(runny poo).

This is more serious in babies thanolder children because babieseasily lose too much fluid fromtheir bodies. If they becomedehydrated they may not passenough urine, lose their appetiteand have cold hands and feet.

If your baby is unwell, or if vomitinghas green bile stained fluid or haslasted more than a day get yourGP’s advice straight away.

Being sick & reflux1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 19

Our children’s health is closely linked

1 2 3I often overlook my ownwell-being as I want to dothe best for my child.

Your child’s well-being islinked to your health.

It is important to have ahealthy family lifestyle andtreat your own health asimportantly as your child’s.

Your six week postnatal checkYou should have your postnatal check about sixweeks after your baby’s birth to make sure that youfeel well and are recovering properly and to discusscontraception etc. Tell your GP if:• You are having trouble holding urine or problems

opening your bowels. • Having sex is painful.• You are feeling very tired, low or depressed.• You are worried about anything.

Your baby’s six week checkThis is an essential part of the Healthy Child Programme. Thecheck should take place between 6-8 weeks and include:• A physical examination.• A review of development.• Health advice.• An opportunity for you to express any concerns. Don't forget to take your baby's Child Health Record, usuallyknown as the ‘Red Book’, as all the results will be recorded in it.

As parents whether you are a single parent, a mum, dad or carer we all want todo what’s best to keep our children safe, fit and well. However, it can be easy toforget about our own health and well-being. If as parents we have a positiveattitude, a good social outlook and a healthy lifestyle it is often the case that ourchildren will too.

Family life plays an important role in the well-being of both children and parents.Doing active and creative things together can really boost happiness levels allround. Children & Family Centres can be great places for you to socialise andmeet other parents as well as giving your child the opportunity to meet friends.Sometimes it can be a bit daunting when meeting a group of complete strangers,but it can be an easy way to meet new people and make friends, after all, you allhave something in common - your children!

We are often our children’s first teachers and they not only learn about practicalthings from us, but pick up on attitudes that can last a lifetime. It is important to takecare of your own physical and mental health in order to be able to ‘parent’ well.

Baby blues

16 17

Postnatal depressionSome women experiencedepression after having a babyand this is more common thanmany people realise. It candevelop within the first few weeksafter giving birth, or may notoccur until around six monthsafter the birth. Some women feelthey are unable to look after theirbaby or they feel too anxious toleave the house or keep in touchwith friends.Treatment will benefit both yourhealth and the healthydevelopment of your baby, aswell as your relationship with yourpartner, family and friends.Seeking help for postnataldepression does not mean youare a bad mother or unable tocope. Talk to your health visitor orGP about how you feel.


Nappy rash is very common and can affect lots of babies. It is usually caused whenyour baby's skin comes into contact with wetness 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 should 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.

Talk to your pharmacist about creams that you can buy over the counter. Thereare two types of nappy cream available. One is a barrier cream to keep wetnessaway from your baby's skin. The other is a medicated cream, that is good forclearing up any soreness but should only be used when advised by a healthprofessional.

A common problem that’s easy to treat

19

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 nappies often.Speak to your health visitorand if you are still worried,your GP.

Leave your baby in awarm, safe place withno clothes or nappyon, to let the air getto their skin.

Use a barrier cream.

Remember tochange and checktheir nappy often.

18

This is the name given to the greasy yellow-brown scalesand crusting affecting the scalp in newborn babies.Do not pick the scales as this may increase the risk of infection. It is not a serious condition and is not contagious. It is not usuallyitchy and will usually clear up within a few months.

Talk to your health visitor if the rash spreads or there is anyinfection or oozing.

Gently wash the baby’s hair and scalp with a babyshampoo. Use a soft brush or cloth to loosen andremove the loose skin flakes.

Soften the scales with natural oil such as coconut oil(not olive oil) overnight. After softening the scales usea soft brush or cloth and gently remove any loosescales and wash the hair with a baby shampoo. Ifany hair comes out with the scales it will grow back.

Health visitor’s cradle cap tips

Source: NICE CKS 2013

Health visitor’s nappy rash tips

Nappy rash & cradle cap1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 23

20

Call 0800 032 0102 or visitwww.smokefree.nhs.uk

A safe sleeping environment

1 Place your baby in the ‘feet to foot’ positioni.e. baby’s feet at the foot of the cot.

2 Newborn babies should sleep in a cot inparent’s bedroom or room where youare during the day.

3 Make sure baby is not too hot nor too cold.

4 Put baby to sleep on their back to reducethe risk of cot death.

5 Keep baby’s head uncovered.

6 Do not smoke and keep the housesmokefree.

7 No pillow, stuffed animals, toys orbumper pad.

8 No heavy or loose blankets.

9 If a blanket is used, it must be tucked inand only as high as the baby’s chest.

10 Crib sheets must fit tightly over mattress.

11 Use a clean, firm, well-fitting mattress.Mattresses should carry the BSI number BS-1877-10:1997.

12 These apply to day time and night timesleeps.

1 2 3I am so tired when mybaby wakes up atnight it seems easierto share the bed.

The safest place for your baby tosleep is in a cot by your bedsidefor at least the first six months. Tryto establish a regular sleep routine.

Speak to your healthvisitor about how tokeep your baby safeand get some sleep.

Bed-sharing with your babyis never completely safe. It is particularly dangerousfor your baby to sleep inyour bed if you (or yourpartner):• Are a smoker (even if you

never smoke in bed or athome).

• Have been drinking alcoholor taken any drugs.

• Have taken any medicationthat makes you drowsy.

• If your baby was premature(born before 37 weeks).

• If your baby was low birthweight (less than 2.5kg).

• If you or your partner areoverweight.

It is very dangerous to fallasleep together on a sofa,armchair or settee and it is alsorisky to allow a baby to sleepalone in an adult bed.

SleepingPatience, praise and peaceThere are many different reasons why babies do not sleep. It is normal for a babyat six weeks old not to sleep through the night. Feel confident in yourself to knowwhether your child is really distressed or just restless. Trust your instincts.

Try to establish a regular sleep routine early on by putting them to bed at a regulartime (day and night). Place your newborn baby on their back to sleep, in a cot inyour bedroom for the first six months. Prepare a warm, comfortable place forthem to relax in. Try to avoid always rocking your baby or ‘feeding them’ to sleepas this can become a habit. Adult beds are not designed for babies and toddlersand do not conform to safety standards. Only breastfeeding babies should everbe fed in bed and should be positioned on the outside of the bed and returned tothe cot after the feed.

You can help your baby to sleep safe and sound by keeping the temperature intheir room between 16-20°C. A basic room thermometer will help you to keep aneye on the temperature.

Reading to your child at bedtime helps them to unwind, and gives you somespecial time together. If your child is scared of the dark, try keeping a night light on.

21Source: www.lullabytrust.org.uk


ImmunisationsProtect your child now and in the futureImmunisations, 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 so that your baby will beborn protected against whooping cough infection, a very serious infection foryoung babies.

23

When to immuniseBirth to 12 months

Two months old

Three months old

Four months old

Between 12 and 13months old - within amonth of the first birthdayTwo, three and four yearolds

Three years four monthsold or soon after

Diseases protected against• BCG protects against tuberculosis (TB)

• 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 be

gradually rolled out to other age groups in futureyears, consult your practice nurse or health visitor

• Measles, mumps and rubella• Diphtheria, tetanus, pertussis and polio (Pre-School

Booster)

Source: NHS Imm

unisation Information.

22

Make sure you keep your child’s Red B ook in a safe place. It is your onlycomplete record of their childhood immunisations and it is often needed laterin life. The MenB vaccine will be introduced as part of the routine childhoodvaccination programme, check with your health visitor.

For updates please see www.walthamforestccg.nhs.uk/childhealthguide

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

The protectionimmunisations offer toyour child against seriousdiseases are worth thesmall amount of pain.

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

Image ©

Harlow Printing lim

ited

GP saysImmunisations are essential toprotect children from diseaseswhich can be very serious,causing long-term complicationsand even death.

If you wish to have furtherinformation on childhoodimmunisations, visitwww.nhs.uk or speak to yourheath visitor, practice nurse or GP.


24

Health visitor saysSome babies have watering eyes.Massaging the tear ducts helps todislodge tears that have collectedin the upper part of your baby’stear duct, as well as encouragingthe tear duct to develop. This canbe done by applying light pressurewith your clean, index finger andmassaging from the outer corner ofyour baby’s eye towards their nose.Repeat several times a day for acouple of months. If this persistspast one year, your baby should bereferred to an eye specialist fortreatment.Source NHS choices

‘Sticky eyes’ are common in newborn babies and young children whiletheir tear ducts are developing. You may see some sticky stuff in thecorner of the eyes or their eyelashes may be stuck together.It normally clears up on its own, but you may have to clean your baby'seyes regularly with damp cotton wool. Use clean, cooled boiled water.

Wipe each eye from the corner by the nose outwards. Use a clean pieceof cotton wool for each wipe. Remember to wash your hands before andafterwards and avoid sharing towels to prevent spreading infection.

Protect your baby's eyes

Source: DoH 2006. 25

ConjunctivitisThe signs of ‘sticky eyes’ can sometimesbe confused with an infection called‘conjunctivitis’ which can be caused by avirus or a bacteria. With conjunctivitis thewhite of the eyes become red and thereis more yellow or green sticky goo whichcomes back regularly. If you notice thisand it continues for more than 24 hours,contact your health visitor or GP as itsometimes needs treating with antibioticdrops. This can be passed on easily, sowash your hands and use a separatetowel for your baby.

1 2 3Is there discharge inthe corner of yourbaby’s eye and do theireyelashes appear to bestuck together?

Sticky eyes is a commoncondition that affectsmost babies - mostcases do not needantibiotic drops.

Use cooled boiled wateron a clean piece ofcotton wool for eachwipe.

Sticky eyes & eye health 1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 29

Eye checksThe signs of ‘sticky eyes’ can sometimes Babies can see whenthey are born but their focussing develops gradually.

Routine eye tests are offered to newborn babies and at the babysix-week check to identify any problems early on in theirdevelopment. Baby’s should fix their parent’s gaze and followtheir faces with their eyes by the age of 2-3 months. However,It's quite normal for the eyes of newborn babies to ‘cross’(squint) occasionally, particularly when they're tired. Speak toyour GP if this you notice this is still happening after threemonths of age or is happening most of the time. Left untreated,lazy eye can develop. Children with a family history (parents orbrothers and sisters) of squint or wearing glasses in childhoodshould be referred to an eye clinic (orthoptist) after eight monthsof age.

Although serious vision problems during childhood are rare, earlytesting ensures that any problems are picked up and managedas early as possible. All children should go to the optician forannual eye tests from five years of age.

Please see our eye health leaflet for more information.


Sleep on his back and let him play on his tummy

2726

Health visitor’s tipsIncrease ‘tummy time’ - put yourbaby on their front to play.Supervise them at all times anddon’t let them fall asleep like this.• Get down to your baby’s level for

face-to-face fun so they willenjoy lying on their tummy.

• Use a sling to carry your babyupright so they are not always ontheir back in a car seat or pram.

• Do lots of active play with yourbaby on your lap.

• Change the position of toys andmobiles in their cot to encouragethem to turn their head to thenon-flattened side.

• Don’t use a car seat exceptwhen travelling.

It may take 6-8 weeks beforenoticing any improvement.

Flat head syndrome can occur in the womb or can be caused by a baby sleeping,resting and playing in one position. Many babies develop a flattened head when they are a few months old, usuallyfrom sleeping on their back. Flat head syndrome happens when the back or oneside of the baby's head is squashed against a firm mattress for a long time, whicheventually forces the soft bone of the skull to flatten. It often corrects itself over time and is usually nothing to worry about. The solution is not to change your baby's sleeping position from lying on theirback at night. It is important for babies to sleep on their back as this reduces therisk of sudden infant death syndrome. Put your baby to sleep on their back andlet them play on their tummy.No treatment is normally needed. Your baby's skull should naturally correct itselfover time. You can take some simple measures to take pressure off the flattenedpart of their head and encourage them to try different positions (see health visitor’stips).

GP saysMost cases of mildplagiocephaly correctnaturally by about one year.Download the excellentinformation leaflet from GreatOrmond Street Hospitalwww.gosh.nhs.uk

Flat head syndrome

1 2 3I have heard abouthelmets that a babycan wear to help.

Their use is controversial,expensive and there is still notenough evidence to prove itwill correct the problem.

If you have tried the healthvisitor’s tips and are stillworried talk to your GP.


28

Health visitor saysIt can help to give your babysomething hard and safe tochew on, such as a teethingring, which may help to easetheir discomfort 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. Be careful not toexplain away what might be thesigns of illness by assuming it’s‘just teething’.Source: DoH Birth to five edition 2009.

Dentist’s 4 tooth care tips:1. Clean teeth twice a day, for two minutes, especially at night.2. Reduce sugars to meal times only.3. Visit the dentist every six months.4. Don't give juice drinks in a bottle. Your baby may still like using a

bottle as a comforter and suck away on it for hours, giving sugarand acid plenty of time to damage teeth.

For help accessing an NHS dentist call NHS 111 or visit www.nhs.uk

Every baby goes through it

29

Teething trouble

Pharmacist saysIf your baby is uncomfortable,you can buy medicinecontaining a small dose ofpainkiller, such as paracetamol,to help ease any discomfort.The medicine should also besugar-free. Make sure youread all instructions and thatthe product is suitable for theage of your child.

You can try sugar-freeteething gel rubbed on the gum.

Ask your health visitor aboutfree oral health packs given atregular health checks.

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

Ask your pharmacistabout options forteething.

Try some of the gels or sugar-free baby paracetamolavailable. If you are worried andthings do not feel right contactyour health 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 soft babytoothbrush and a smear of family toothpaste. Make sure your child is registered witha dentist by around 2-3 years and has yearly check-ups. Children’s Centre staff andhealth visitors can also give you advice about your child’s oral health - just ask.


30

Young babies:Always contact your GP or NHS 111 if your child:• Is under three months of age and has a

temperature of 38 ̊C or above.• Is between three and six months of age and

has a temperature of 39 ̊C or above.• Is over six months and shows other signs of

being unwell - for example, they are floppy anddrowsy or you are concerned about them.

Older children:A little fever isn’t usually a worry. Contact yourGP if your child seems unusually ill, or has ahigh temperature which doesn’t come down.It’s important to encourage your child to drinkas much fluid as possible. Water is best.

To help reduce temperature:• Undress to nappy/pants.• Keep room at comfortable temp (18 ̊C).• Encourage your child to drink more

(even little amounts often).• Give sugar-free paracetamol or

ibuprofen in the correct recommendeddose for your child (see packaging).

1 2 3My toddler is hotand grumpy.

Have you tried infantparacetamol? Have youmade sure they aredrinking lots of fluids?

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

Fever

Source: DoH Birth to five edition 2009. 31

A child with a significant fever 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 thetemperature from the armpit, using an electronic thermometer (don’t use in themouth of under 5s) or use an ear thermometer. Remember that measurementsfrom under the arm are less accurate as the armpit is slightly cooler.

A fever is part of the body’s natural response to fight infection and can often beleft to run its course provided your child is drinking enough and is otherwise well.If your child is having trouble drinking, trying to reduce their temperature may helpwith this. It is important to preventing your child from becoming dehydrated,which can cause kidney problems. Your child’s urine should be pale yellow - if it isdarker, your child needs to drink more fluids.

Fevers are common in young children. They are usually caused by viralinfections and clear up without treatment. However, a fever can occasionally bea sign of a more 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 improvingafter 48 hours. Check your child during the night.

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

GP saysWhen looking after a feverishchild at home you should:• Get the child to drink more

(where a baby or child isbreastfed the most appropriatefluid is breast milk).

• Look for signs of dehydration:reduced wet nappies, drymouth, sunken eyes, no tears,poor overall appearance, sunkensoft spot on baby’s head.

• It is not advisable to giveibuprofen if your child isdehydrated.

• Know how to identify ameningitis rash (see page 36).

• Check child during the night.Source: NICE, Feverish illness in children/2013

Part of the body’s natural response


32

Don't pass it on:Catch it Germs spread easily. Always carry tissues anduse them to catch coughs or sneezes.Bin it Germs can live for several hours on tissues.Dispose of your tissue as soon as possible.Kill it Hands can pass on germs to everything youtouch. Wash your hands with soap as soon as you can.

1My child keeps coughing andsneezing, has a mild temperatureand seems generally unwell.

2Have they recently startednursery? Catching colds isvery common. Have youspoken to your pharmacistabout sugar-free paracetamoland cough medicines?

3If symptoms last for morethan 10 days or your childis coughing up yellow ‘goo’they may have a bacterialinfection. Contact your GP.

You will probably find when your child starts mixing with other children they get lots ofcoughs, colds and sniffles. There are some good things about this though as it helpsthe body build up a natural immune system.

Flu can be more serious than a cold and leave your child feeling quite unwell. Flutends to come on more suddenly and severely than a cold. Your child may haveaching limbs and feel uncomfortable, and be ill for a week or more.

Most viruses will run their course without doing any real harm because they will get betteron their own. An annual nasal spray flu vaccine is available from the age of two as part ofthe NHS Childhood Vaccination Programme. Ask your GP or pharmacist for details.

Things you can do at home to help:

P Give your child lots to drink.

P Try sugar-free paracetamol or ibuprofen (not aspirin) (see page 7).

P Keep them away from smoke and anyone who smokes.

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

P Make sure they get plenty of sleep/rest.

Contact your GP if:

P Your baby has a persistent temperature of 38˚C or more.

P They have a fever with a rash.

P They are drowsy and less interactive.

P Your child is finding it hard to breathe.

P Persistent temperature does not respond to medicine (see page 30, fever).

Not usually serious

Source: 2013 NICE guidance. 33

Pharmacist saysChildren can be treatedusing over the countermedicines to bring down araised temperature if it iscausing distress. Sugar-free paracetamol oribuprofen liquid can helpand can be given from theage of about three months.Check the label carefully. If indoubt, check with thepharmacist and tell themhow old your child is. Flu symptoms are moresevere and you may need tosee your GP.

Coughs, colds & flu1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 39

34

PainkillersIf your child is in pain or has a hightemperature (fever), you can give themparacetamol. Do no give ibuprofen tochildren with chickenpox because itmay increase the risk of skin infection.Aspirin should not be given tochildren under the age of 16.

Health visitor saysDo not forget to keep up-to-date withimmunisations to protect your childfrom measles (MMR vaccination). It isnever too late for your children (oryourself) to ‘catch up’ with the MMRvaccination if they missed it earlier.

Midwife saysIf you are pregnant and have hadchickenpox in the past it is likely thatyou are immune to chickenpox.However, please contact your GP ormidwife for advice.

ChickenpoxChickenpox is a mild and common childhood illness. Itcauses a rash of red, itchy spots that turn into fluid-filledblisters, which then crust over to form scabs, whicheventually drop off. Some children have only a few spots,while others can have spots covering their entire body. Theseare most likely to appear on the face, ears and scalp, underthe arms, on the chest, tummy and on the arms and legs.Chickenpox is caused by a virus. It is infectious from one totwo days before the rash starts, until all the blisters havecrusted over. To prevent spreading the infection, PublicHealth England advises to keep children off nursery/schooluntil five days after the onset of the rash. Your child will probably feel pretty miserable and irritablewhile they have it. They may have a fever for the first fewdays and the spots can be incredibly itchy.Paracetamol can help relieve fever and calamine lotion orcooling gels help ease itching.Chickenpox usually gets better on its own. However, somechildren can become more seriously ill and need to see adoctor.Contact your GP straight away if:• Blisters become infected. • Chest pain or difficulty breathing.

MeaslesMeasles is a very infectious, viral illness which, in rarecases, can be fatal. One in five children with measlesexperience complications such as ear infections, diarrhoeaand vomiting, pneumonia, meningitis and eye disorders.There is no treatment for measles. Vaccination is the onlyway of preventing it, so make sure your child has theirMMR vaccination. Speak to your health visitor.Symptoms develop around 10 days after you areinfected and can include:• Cold-like symptoms. • Red eyes and sensitivity to light. • A fever. • Greyish white spots in the mouth and throat.After a few days, a red-brown spotty rash appears. Startingbehind the ears it then spreads around the head and neckbefore spreading to the rest of the body. If there are nocomplications symptoms usually disappear within 7-10 days.Contact your GP if you suspect that you or your childmay have measles.Help to make your child comfortable:• Close the curtains/dim lights to help reduce light sensitivity.• Use damp cotton wool to clean eyes. • Give sugar-free paracetamol or ibuprofen. • Ensure they drink lots.

Chickenpox & measles

35Source: www.nhs.uk


36

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.

If the spots are still visible through theglass. This is called a non-blanchingrash - it does not fade. Contact adoctor immediately (e.g. your ownGP). If you cannot get help straightaway go to A&E.

If the spots under the glass havevirtually disappeared. It is unlikely tobe meningitis but if you are stillworried call NHS 111, contact yourGP or go to A&E.Find out more from www.meningitisnow.org

Go straight to the Accident and Emergency Department

Rare but serious and contagiousBabies 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.

Sepsis (often called septicaemia or blood poisoning) is a lifthreatening conditiontriggered by an infection. The skin may also develop pinprick bruises or largepurple areas, which do not change colour if you roll a glass tumbler over them.This is a common sign of meningococcal septicaemia, a type of blood poisoningcaused by the meningococcus bacteria, which can also cause meningitis.

You should always treat any case of suspected meningitis or septicaemia asan emergency.

Early signs may be like having a cold or flu. Children with meningitis can becomeseriously ill very fast, so make sure you can spot the signs. Your child may have acluster of red or purple spots. Do the glass test. This rash can be harder to see ondarker skin, so check for spots over your baby or child’s whole body as it canstart anywhere (check lightest areas first). However, the rash is not alwayspresent - 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.

37

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 are

present contact a doctor.

_

Meningitis & sepsis1590-Waltham Forest CCI web2.qxp_6521-Cornwall 19/01/2018 13:23 Page 43

1 2 3My child is showingsome of the signs ofmeningitis.

Have you triedthe glass test?

If the spots do not fade underpressure contact a doctor (e.g.your GP). If you cannot get helpstraight away go to A&E.


38

BronchiolitisBronchiolitis is a common respiratorytract infection that affects babies andyoung children under a year old. Theearly symptoms are similar to thoseof a common cold and include arunny nose and cough.

As it develops, the symptoms ofbronchiolitis can include: A persistent cough, noisy breathingand difficulty feeding.

Symptoms usually improve afterthree days and in most cases theillness isn’t serious. However,contact your GP or health visitor ifyour child is only able to feed halfthe normal amount or is strugglingto breathe, or if you are generallyworried about them. Source:www.nhs.uk/conditions/Bronchiolitis/

CroupCroup causes a distinctivebarking cough with a harshsound, when the childbreathes in.Comforting your child isimportant as symptomsmay worsen if they areagitated or crying. Mildcases of croup can bemanaged at home. If yourchild has a fever and isdistressed, paracetamolcan be given from the ageof three months and willease discomfort. If symptoms get worsecontact your GP.


Look at the signs

39

Any kind of breathing difficulty your infant or child experiences can be scary forparents. It is often nothing to worry about and illnesses like bronchiolitis, mild croupand a cough can often be treated at home.

Use your instincts with newborns and babies:• Rapid breathing or panting is common. If 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 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 32, coughs, colds & flu).• Croup (hoarse voice, barking cough) needs to be assessed by your GP and may

need treating with steroids.• Child appears pale.• Wheezing is fairly common in the under 5s associated with colds. It is not

usually suggestive of asthma unless symptoms occur between viral infections.

Wheezing & breathing difficulties

GP’s tipsGet help and contact your GPnow if your child:

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

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

Get help and call 999 ortake them to A&E now if:

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

P They appear pale or evenslightly blue-ish.


40

Symptoms of severe asthmaSymptoms include repeated coughing andwheezing, shortness of breath and bringing upphlegm. Symptoms often get worse at night.Call 999 to seek immediate medicalassistance if your child has severesymptoms of asthma.

Asthma Nurse saysThe most important part ofmanaging asthma is for youand your child to know aboutasthma and what triggers anattack. Make sure your child’sasthma action plan is kept upto date.Our practice Asthma Clinicsoffer advice and treatment. Ask about whether your childneeds the flu vaccine.


AsthmaKnow the symptoms

Source: Department of Health, Birth to five 2009 41

GP saysYour GP will normally be able todiagnose asthma by asking aboutyour child’s symptoms, examiningtheir chest and listening to theirbreathing. A peak flow test may beuseful if your child is old enough.Parents should regularly attend theirpractice Asthma Clinic to getsupport on better management oftheir child’s asthma at home, as thiswill save unnecessary trips tohospital. Ask your GP or practicenurse to give you an asthma actionplan for your child.All children over six months withasthma who require continuous orrepeated use of a steroid preventerinhaler or oral steroid tablets shouldhave the seasonal flu vaccine.

1 2 3My child seems towheeze and cough a lotand it seems to getworse at night. Is there afamily history of asthma?See your GP for advice.

Do you smoke?Try to stop. Donot smoke inthe house ornear children.

Has your child got a personalasthma action plan? See yourpractice’s asthma nurse or GP forregular reviews (read more atwww.asthma.org.uk).If your child hasa serious asthma attack call 999.

Asthma has many causes and is a common long-term condition that can bewell controlled in most children. The severity of asthma symptoms variesbetween children, from very mild to more severe. Asthma is more than justwheezing. Other symptoms can be coughing, difficulty breathing and a tight,sore feeling in the chest. Asthma is difficult to diagnose in children under theage of two years as nearly one third of children will wheeze at some point.

The two most common triggers of asthma in children are colds and allergies.In older children allergies become particularly important, so avoiding thetriggers to which your child is allergic may help improve their asthma. Don’t getany pets if your child has asthma and make sure no-one in the house smokes.

A sudden, severe onset of symptoms is known as an asthma attack, it can belife threatening and may require immediate hospital treatment. Make sure youknow how to use your child’s inhaler properly and attend the yearly review withyour GP.

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


42

What are the signsof an ear infection?

The signs are a raisedtemperature, general irritabilityand pain or discomfort. The earsmay be red and your baby maypull them because they areuncomfortable. They may evenhave a pus-like discharge, whichcan also be associated with ablocked feeling in the ear orhearing loss. Although most earinfections settle down withoutany serious effects, there can bemild hearing loss for a short time(two to three weeks).

Newborn HearingScreening

All newborn babies should beoffered a hearing test. If yourbaby's hearing is not screenedin hospital, ask your midwife orhealth visitor to arrange anappointment.


Earache & tonsillitisA baby’s ears need to be treated with care

Source: DoH Birth to five edition 2009/NHS Choices. 43

Looking after yourbaby’s ears

• A baby’s ears need to betreated with care.

• Never use a cotton bud insideyour child’s ear.

• If they have a temperaturewax may ooze out.

• Use different, clean dampcotton wool on each ear togently clean around the outerarea.

• Avoid smoky environments.• Do not use ear drops or oil

unless prescribed by your GP.• If your child is still not hearing

six weeks after infection, yourGP/health visitor can referthem to audiology for ahearing test.

1 2 3My toddler hasearache or a sorethroat but seemsotherwise well.

Have you tried sugar-freeparacetamol or ibuprofenfrom your pharmacist?(See page 7).

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.

Ear infections are common in babies and toddlers following a cold. 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 pass from the noseto the ears more easily. Earache can be painful and your child may just need extracuddles and painkillers (such as sugar-free paracetamol or ibuprofen) from thepharmacist.

Tonsillitis - Earache can also sometimes be caused by tonsillitis (inflammation ofthe tonsils). It is a common type of infection in children. Other symptoms include asore throat, coughing and a high temperature. Your child may have swollenglands in the neck - this is the body’s way of fighting infection.

It is not a serious illness and you only need to see your GP if symptoms lastlonger than four days or become more serious with severe pain, difficultyswallowing, a very high temperature or breathing difficulties.


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

P Give them regular drinks - try smallamounts of boiled cooled water ifbottle fed.

P Breastfeed on demand ifbreastfeeding.

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

P Rehydrating solutions come inpre-measured sachets to mix withboiled cooled water. It helps withdehydration.

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

44

Health visitor saysIf you are breastfeedingcontinue to do so and keepdrinking plenty of fluids.Source: www.nhs.uk/conditions 2015

Diarrhoea & vomitingNot nice for you or your babySickness and diarrhoea bugs are caught easily and are often passed on in placeswhere there are lots of children.

Feeling sick and suddenly being sick are normally the first signs. Diarrhoea canfollow afterwards. If your child is not vomiting frequently, is reasonably comfortablein between and you are able to give them frequent small amounts of water, theyare less likely to become dehydrated and probably don't need to see a doctor.Speak to your GP if they are unwell for longer than 24 hours or sooner ifthey are newborn or if you notice signs of dehydration.

If you're breastfeeding, keep on doing so even more frequently. Offer olderchildren plenty of water, or an ice-lolly for them to suck. If they want to eat, givethem plain foods like pasta or boiled rice (nothing too rich or salty).

Keep them away from others, especially children, who may pick up infection. Beextra careful with everyone’s handwashing.

_Signs of

dehydration

P Less wet nappies.

P More sleepy than usual.

P Dry mouth.

P Sunken fontanelle (thesoft spot on the top ofthe head that is moredipped in than usual).

Try a rehydrating solutionfrom your pharmacist.

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 your GP if symptomsshow no sign of improvementafter 24 hours or straight awayif they are newborn.

45


46

This is a disease caused by a group of viruses that usually affect young children.It causes blisters on the hands and feet, and mouth ulcers inside the cheeks andon the tongue. Those affected may have a sore throat and develop a hightemperature. These symptoms last for 7 to 10 days. It is generally a mildinfection and those affected will make a complete recovery.

The virus is spread by coughs and sneezes, and is also found in the faeces (poo)of infected children. Some children infected with the virus do not have symptomsbut can still pass it to others.

There is no specific treatment for hand, foot and mouth disease - it is usually amild and self-limiting illness. If a child feels unwell paracetamol may be helpful(do not use aspirin in children under 16 years of age). Antibiotics and creams orointments for the blisters are not effective. Children recover just as quicklywithout them.

A common mild illness

If you are still worried, contact your health visitor or doctor. 47

Health visitor saysChildren should avoid contactwith pregnant women but onlyneed to be kept off school ifthey are unwell.To avoid transmitting infection,scrupulous attention mustalways be paid to handwashingafter using the toilet.Whilst a person has the blisterspresent they should avoidsharing towels and face cloths/flannels with other people.Soiled clothes, bedding andtowels should be washedseparately on the ‘hot cycle’ ofthe washing machine.

Hand, foot & mouth

1 2 3Your child has blisters onthe hands and feet, andmouth ulcers inside thecheeks and on the tongue.

There is no specifictreatment. Antibioticsand creams or ointmentsare not effective.

Generally it is a mildinfection and thoseaffected will make acomplete recovery.


48

Health visitor saysBaby skin is more delicate thanours. Try to limit the amount ofproducts you use on their skinand never leave your baby outin the sun.

Rashes & eczemaBaby skin needs extra careA baby’s skin is thinner and needs extra care. Dry, flaky skin, some blemishes,blotches and slight rashes are normal in newborns and will clear up naturally. Ifyour baby is otherwise well but has a rash that you are worried about contactyour midwife or health visitor. Heat rash is common and is nothing to worry about.It mainly appears on the head and neck as tiny red spots. Keep babies warm butnot hot and try to dress them in natural cotton clothes, with nothing that can rubon their skin.

EczemaEczema is common in babies and they normally grow out of the condition.Eczema in babies often starts between the ages of two and four months. Thesymptoms are patches of red, dry and itchy skin. If you think your child haseczema, speak to your GP or health visitor.

In all cases of eczema, frequent unperfumed emollients (moisturisers) help. Thesecan also be used for washing and bathing and should also be used at nurseryand school.

49

1 2 3Your baby’s skin may beflaky and dry. Dry skin iscommon in newbornbabies, as their skin is 15times thinner than that ofan adult.

Avoid soap andfragranced products onyour baby’s skin. Washyour baby in clean,warm (not hot) water.

Use non-biological‘sensitive’ washing powderand fragrance free fabricsoftener when washingyour children’s clothes.

GP saysGo to A&E immediately if yourbaby has a rash that does notdisappear when you press aglass to it. This may be a signof meningitis (see page 36) andneeds to be seen by a doctorno matter how well your babyseems.

Seek immediate advice if yourbaby has a rash and a hightemperature or vomiting.


50

Breastfed babiesConstipation is very rare in babieswho are solely breastfed, but notuncommon in babies who haveformula milk, or who have solidfoods. Make sure you are makingup the formula powder with thecorrect amount of water.

If your baby is already on solid foodsthen the juice or the fruit itselfshould be fine for providing relief.Fruits, such as apples, pears andprunes, contain sorbitol which is anatural laxative, helping the lowerbowel retain water, which in turnhelps the poo stay soft and easy topass. For younger babies, checkwith your health visitor before youstart giving anything other than milk.Source: www.NCT.org.uk

ConstipationRare in babies who are solely breastfedConstipation is a very common problem in children. Many children normallypass stools (faeces/poo) as far apart as every few days. Regardless, youshould treat hard stools that are difficult to pass as constipation.

Breastfed infants will generally have more stools per day but occasionally canpass normal soft stools only once a week. Their stools vary more in frequencywhen compared to bottle-fed infants. For example, breastfed infants produceanywhere from 5 to 40 bowel movements per week whereas formula-fedinfants have 5 to 28 bowel movements per week. Switching the type of milk orformula can also cause constipation.

Many things contribute to constipation but infants and children who get well-balanced meals typically are not constipated.

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 2009, constipation in children 51

1 2 3My bottle fed babygets constipated.

Try cooled, boiled waterbetween feeds.

If the problem persistsspeak to your healthvisitor or GP.

Health visitor saysTo avoid constipation and helpstop it coming back make sureyour child has a balanced dietincluding plenty of fibre suchas fruit, vegetables, bakedbeans and wholegrainbreakfast cereals. We do notrecommend unprocessed bran(an ingredient in some foods),which can cause bloating,flatulence (wind) and reduce theabsorption of micronutrients.Drink plenty of fluids.


52

Urticaria or hivesEasy to confuse with more serious illnessesChildhood 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.Urticaria is common and can be triggered by many things, including a viralinfection. Less often it may be allergens (such as food or latex), irritants (such asnettles), medicines or physical factors, such as exercise or heat. Usually no causecan be identified. 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 it is veryitchy, a medication called antihistamine usually helps. Creams can help with theitching and are available over-the-counter at pharmacies. Speak to yourpharmacist for advice. (See page 54 allergies).

53

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 ask yourpharmacist about anti-histamine medication.

GP saysSome things which can triggerurticaria should be avoidedwhere possible, these include:• Food such as peanuts,

shellfish, eggs.• Environmental factors such

as pollen, dust mites orchemicals.

• Insect bites and stings.• Emotional stress.• Some medications - but do

not stop any prescribedmedicines without speakingto your 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 of diet in people with long-term hives. There are two groups of chemicals in some foodsthat may trigger urticaria. It is important to discuss your child’sdiet with your health visitor.

Source: Allergy UK

Possible triggers:• Shellfish• Strawberries, bananas, mangoes,

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

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


54 Source: Allergy UK/2014

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

Spotting symptomsMany of these symptoms can develop as aresult of other common childhood illnesses.With an allergy, symptoms often appearmore quickly or suddenly.

Nose, throat and earsHay fever symptoms - runny/blocked/itchy nose, sneezing, pain in sinuses,headaches, post-nasal drip (mucusdrips down the throat from behind thenose), loss of smell and taste, sorethroat, swollen larynx (voice box), itchymouth and/or throat, blocked/glue ear.

SkinUrticaria - Wheals or hives, bumpy,itchy raised areas, rashes.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 in breathing,coughing (especially at night time),shortness of breath.

AllergiesManaging and understanding your child’s allergy

Source: NICE - Testing for food allergy in children and young people 55

Anaphylactic shockAnaphylaxis is a dangerous typeof allergic reaction which is mostlikely to be caused by particularfoods, insect bites or medicines.Early signs of allergic reaction:• Swelling and itching; the face

may be flushed and wheals orhives may erupt on the skin.

• Lip or facial swelling. • Acute vomiting/abdominal pain. Anaphylaxis or severereactions:• Difficulty breathing, coughing

and/or wheezing. • Loss of colour; cold and clammy.• Loss of consciousness (may

appear asleep). Call 999 and tell the operator youthink the child has anaphylaxis.If available, an adrenaline injectionshould be given as soon as aserious reaction is suspected. Ifyou already have an EpiPen orinjection device, make sure youknow the correct way to use it inadvance of an emergency.

AntihistaminesAntihistamines are anti-allergymedicines, and most are readilyavailable from a pharmacywithout prescription. While olderantihistamines have a reputationfor making people drowsy, moremodern antihistamines onlyoccasionally have those sideeffects. Source: www.allergyuk.org

1 2 3Food allergies occurwhen the body’s immunesystem reacts negativelyto a particular food orfood substance.

Allergens can cause skinreactions, digestive problemsand hay fever-like symptoms.

Children are mostcommonly allergic to cow’smilk, hen’s eggs, peanutsand other nuts, such ashazelnuts and cashew.

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 medicines such as antibiotics. Some familiesseem to include more individuals with allergies than other families.

Allergic symptoms can be mild, moderate or severe. When a child first showssigns of an allergy it is not always clear what has caused the symptoms, or even ifthey have had an allergic reaction, since some allergic symptoms can be similar toother common childhood illnesses. Urticaria (wheals or hives) can be one of thefirst symptoms of an allergic reaction. If the reaction is severe, or if the symptomscontinue to re-occur, it is important that you contact your GP.


56

A common problemHead lice are tiny wingless insects that are grey-brown in colour. They are thesize of a pinhead when they hatch and 3mm long (the size of a sesame seed)when fully grown. Head lice cannot fly, jump or swim. They are spread byhead-to-head contact and climb from the hair of an infected person to the hairof someone else. Head Lice are not the result of dirty hair or poor hygiene.Children are often affected by head lice because they tend to have more head-to-head contact while at school or during play. Head lice are most common inchildren between 4 to 11 years old.Getting rid of head lice:Head lice can be effectively treated using medicated lotions or by wet-combing, using a specially designed head lice comb. Neither treatmentmethod will protect against re-infestation if head-to-head contact is made withsomeone with head lice during the treatment period.The wet-combing method involves removing the head lice by systematicallycombing the hair, from the scalp towards the ends, using a special fine-toothed comb with a spacing of less than 0.3mm. Your pharmacist can adviseyou on which combs are suitable. No medicated products are necessary forwet-combing.

Medicated lotion or spray is an alternative method for treating head lice.However, no medicated treatment is 100% effective.

You can also ask your school nurse, health visitor or pharmacist.

57

Pharmacist’s tipsYour Pharmacist can recommendan over-the-counter lotion or spray.Medicated treatments should onlybe used if a living (moving) headlouse is found. Conditioners andshampoos are not thought to beeffective and are therefore notrecommended. Make sure that youhave enough lotion to treateveryone in your family who isactually affected by head lice.

Threadworms are tiny parasitic wormsthat hatch eggs in and infect the largeintestine of humans. They are the mostcommon type of worm infection in the UKand are particularly common in youngchildren under the age of 10.

Threadworms are white and look likesmall pieces of thread. You may noticethem around your child's bottom or inyour child's faeces (poo). They don'talways cause symptoms, but may causeitchiness or signs of scratching aroundtheir bottom. This can be worse at nightand can sometimes disturb sleep.

When to see your GPIf you think you or your child may havethreadworms, you can usually treat theinfection yourself with medication availableat pharmacies without prescription.

You only need to speak to your GP if youare pregnant or your child is under twoyears old, as the usual medication is notsuitable.

ThreadwormsHead lice & threadworms


Protecting your child’s health

Source: www.steprightout.org.uk58 59

Make your homesmokefree

• Tell everyone in your house,and any visitors, that yourhome is now smokefree.

• Keep a pair of slip-on shoesand other all-weather bits byyour back door, so you cango out anytime.

• Keep an ashtray outsideaway from your back dooras a reminder. It’ll help keepthe garden tidy too.

• Can’t make it outside?Nicotine replacementmethods like patches andgum can help.

• If you smoke, or are exposedto secondhand smokeduring pregnancy, it meansthat your baby shareschemicals from the smokeyou breathe.

1 2 3Smoking anywhere nearyour children, like in thecar, affects their healthas well as yours.

Opening a window orstanding by the door is notenough to protect childrenfrom the effects of smoking.

‘Step right out’ to ensureyou are protecting yourchildren.


Step right out• Take seven steps from your

home.• It can help improve the health

of your children.• Your children won’t see you

smoking, so might not betempted to start.

• It might cut down the numberof cigarettes you smoke.

• It keeps your home smellingand looking fresh.

• When returning inside aftersmoking, remember to washyour hands and try to changeyour clothes before touchingor cuddling your baby/child.

for your free local Stop Smoking service

Smokefree homesSecondhand smoke is made up of two types of smoke: mainstream (breathed inand out by smokers) and sidestream (smoke from the burning tip of a cigarette).Secondhand smoke is dangerous for children as they are growing up because:• Smoking near children is a cause of serious respiratory illnesses, such as

bronchitis and pneumonia.• Smoking around babies increases the risk of sudden infant death syndrome (SIDS).• Exposure to secondhand smoke increases the risk of children developing asthma

and can cause asthma attacks. • Younger children who are exposed to secondhand smoke are much more likely to

contract a serious respiratory infection that requires hospitalisation. • There is an increased risk of meningitis for children who are exposed to

secondhand smoke. • Children exposed to secondhand smoke are more likely to get coughs and colds,

as well as middle ear disease, which can cause deafness.‘Step right out’ of your home to ensure it does not affect your children. Also, have asmokefree car at all times as exposure to the chemicals in secondhand smoke isincreased in a confined space even with the windows open!Help to stop smoking is free on the NHS, for quitting support and advice visit thesmokefree website.


60

Healthy Start vitaminsWhat is Healthy Start?

61

Healthy StartVoucher Scheme

You qualify for Healthy Start ifyou’re at least 10 weekspregnant or have a child underfour years old and you or yourfamily get:• Income Support, or• Income-based Jobseeker’s

Allowance, or• Income-related Employment

and Support Allowance, or• Child Tax Credit (some

exclusions apply), or• Universal Credit (some

exclusions apply).You also qualify if you areunder 18 and pregnant, even ifyou don’t get any of the abovebenefits or tax credits. Seeyour midwife or health visitorfor an application form or callthe Healthy Start helpline on0845 607 6823 or visitwww.healthystart.nhs.uk

See your midwife or healthvisitor for an application formor call the healthy start helplineon 0845 607 6823 or visitwww.healthystart.nhs.uk

1 2 3Where do I getmy free HealthyStart vitamins?

Ask your midwife or healthvisitor if you have any questionsabout the local or nationalHealthy Start vitamin scheme.

When you finish your free bottlesof vitamins, please continue totake Vitamin D supplementsavailable at your local pharmacist.

In addition to eating a healthy diet, we recommend everyone, especially pregnant andbreastfeeding women and children aged six months to five years take a vitamin Dsupplement to help them grow and maintain strong bones and prevent other diseases.If breastfeeding you should also be taking vitamin D to ensure that your own levelsare high enough to benefit your baby. To help baby get off to the best start, inWaltham Forest you will receive three free bottles of vitamin tablets for yourself, andthree free bottles of vitamin drops for your baby, each bottle provides two monthsworth of free vitamins. We strongly recommend that children continue thesevitamin drops up to the age of five.At the new birth visit, your health visitor will tell you when to start giving your babythe vitamin drops depending on how your baby is feeding. Breast fed babies shouldstart the vitamins at four weeks of age.If you are registered on the national Healthy Start Scheme, you will receive voucherswhich you can use to continue to get free vitamins as well as weekly supplies of freshmilk and vegetables. Lots of shops accept Healthy Start Vouchers but if you are havingtrouble finding local shops where you can use your vouchers call 0345 607 6823.For where to collect your baby’s free bottle of Healthy Start vitamin drops or toexchange vouchers for vitamins please see useful contacts.


Promoting good health and a healthy weightWith healthy habits from birth, you can give your baby a good start for a healthyand happy future. Breast milk is ideal for your baby’s growing needs. Talk toyour health visitor if you have any questions about how and when best to weanyour baby.

It is easy to develop healthy eating habits at an early stage in their lives. Babieslike the foods they get used to. If you give them lots of different, healthy foods totry when they are babies and toddlers, they are more likely to eat a variety ofhealthy foods as they grow up. Avoid salt, sugar, honey, nuts, saturated fats,low-fat foods, raw shellfish or eggs for babies.

Being physically active takes brain and muscle power so it plays an importantpart in your baby's development. As they grow, you can help them by playingwith them and helping them make new movements and explore theirsurroundings. Physical exercise helps with all aspects of physical and mentalwell-being and it helps avoid becoming overweight or obese.

63

A healthy weightMany parents are unaware of the dangers oftheir child being overweight or obese but byfollowing the top tips below you can make adifference to your child’s health.1. Meal Time - It’s important for kids to

have regular, proper meals as growingbodies respond better to routine.

2. 5 A Day - Include 5 portions of fruitand/or vegetables a day.

3. Sugar Swaps - Avoid sugary drinksparticularly between meals - water or milkare the best option.

4. Snack Check - Many snacks are full ofthe things that are bad for us - sugar, salt,fat and calories. So try fruit, cut vegetablesor breadsticks as an alternative.

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

6. Up and About - Children are naturallyactive. Limit the amount of time theyspend watching TV or playing computergames.

Source: Change4Life - DoH 2009(www.dh.gov.uk/obesity).

Tips for fussy eaters• Your child will learn from you so

eat your meals together ifpossible.

• Give small portions and praiseyour child for eating, even ifthey only manage a little.

• If your child rejects the food,don’t force them to eat it. Try tostay calm!

• Don’t leave meals until your childis too hungry or tired to eat.

• Your child may be a slow eaterso be patient.

• Don’t give too many snacksbetween meals. Limit them to amilk drink and some fruit slicesor a small cracker with a slice ofcheese, for example.

• It’s best not to use food as areward. Your child may start tothink of sweets as nice andvegetables as nasty. Instead,reward them with a trip to thepark or play a game with them.

Source: NHS Choices Fussy Eaters/Department of Health62

1 2 3My child is a fussy eaterand I worry that they arenot getting enough food.

If your child is active,gaining weight and it'sobvious they're not ill,then they’re gettingenough to eat.

As long as your child eatssome food from the four mainfood groups (milk and dairyproducts, starchy foods, fruitand vegetables, protein), youdon't need to worry.

Healthy weight & exercise



64 65

It starts with you!Language (as well as body language) is how we get to know each other and buildrelationships. Talking to babies, and having fun with nursery rhymes and songs is agreat way to lay the groundwork when it comes to learning speech.If a parent or carer is responsive to a baby’s signals or cues, and communicateswith them from birth, babies develop a secure attachment. Communication is thefoundation of relationships and is essential for learning, play and social interaction.This involves listening, understanding, thinking, wanting and needing to speak, andbeing able to coordinate all the right muscles. Talking to babies every day isimportant, preferably without using ‘baby talk’.If a child can start school with good speech and language skills they can maximise theirfull personal and social potential. These skills underpin all areas of a child’s development.Children with poor communication skills are at increased risk of being bullied. Friendships are incredibly important for children. Making and keeping friends isdifficult with poor communication skills, so self-esteem and confidence can beaffected. Children often choose friends who are good at communicating, so childrenwith difficulties are doubly disadvantaged.If you think your child’s language skills are not developing as they should, youcan discuss with your health visitor, children's centre or school who canadvise about local speech therapy drop-in sessions or a referral to a speechand language therapist (SALT) if needed.

If children can’t understand thewords they hear, they willstruggle with reading, writingand spelling. Children with communicationdifficulties are more likely tohave behavioural problemsand often see themselves asless able and less popular thantheir friends. Without effectivehelp a third of children withspeech, language andcommunication problemsrequire treatment for mentalhealth problems in adult life.

Start early

Dummies Speech, language &communication

For children under two years evenchildren’s TV has been found to havelimited value. It is suggested thatchildren of this age find it more difficult tolearn new words from the TV than theydo in a face-to-face situation.*Children under two should not be leftwatching screens on their own, becauseresearch has shown that this may slowlanguage development.*Source: www.gov.uk - Research Report DFE-RR134

TV tips

Babies suck on dummies differently from theway they suck on the breast. Giving a dummy inthe first few weeks can interfere with establishingbreastfeeding. It is better to use the dummy only when settlingthe baby to sleep to be sure that you are notmissing feeding cues by replacing a feed withgiving the baby a dummy. UNICEF UK Baby Friendly Initiative statement on dummy use

Prolonged dummy use and thumb sucking forlong periods each day can affect a child’sspeech and language development, as well asteeth alignment. They also reduce babbling anda child’s experimentation with sounds which isan important step in learning to talk.If your toddler or child continually uses adummy after 12 months it may affect speechand language development by restrictingtongue movement.


Tics, head banging &unusual behaviourCan mean lots of things

67

Health visitor saysPossible reasons your toddlermay bang his head:• Self-comfort. Most children who

bang their heads do it to relax.• Pain relief. A child is more likely

to bang his head when he has anear infection or is suffering fromsome other physical discomfort.

• Frustration. Your child maybang his head during tempertantrums as a way of ventingstrong emotions.

• A need for attention.• A developmental problem.

Head banging can be associatedwith autism and otherdevelopmental disorders, but inmost of these cases, it's just oneof many behavioural issues.Rarely does head banging alonesignal a serious problem.

Extreme and unusual behaviour can be lots of things such as children hurtingthemselves on purpose, developing a tic or head banging.

Stress is something as adults we come to accept and manage. Young childrenare unable to recognise and cope with stressful situations. Instead, they oftenshow their anxiety in physical and emotional outbursts. Sometimes stress canlead to a ‘tic’ - a sudden, repetitive, non-rhythmic movement involving a distinctmuscle group, like uncontrolled eye blinking. Head banging or banging the headagainst a wall or cot on purpose is also common, especially in boys. They are nottrying to be naughty or annoying.

In rare cases, a tic or another behaviour patten may be the symptom of a morecomplicated condition. Your health visitor or GP can advise if you are worried. Ingeneral, the best thing to do is just ignore the tic, help minimise stress and make sureyour child is getting enough sleep.

With head banging or other forms of self-harm like severe nail biting, scratching orhitting, keep your child safe and get them to stop by distracting them. Try to getthem to vent their frustration in another way, like stomping their feet or throwingsomething really hard (maybe a ball at a wall outside). These are the best measuresto help your child deal with a problem that will most likely disappear in a short time.

66

1

2

3

My son is almost a year old,and has started to bang hishead on the wall or the floorwhen he's cross or frustrated.We try not to react too much,but we are shocked!

This behaviour is very normalin a pre-verbal child,especially in a boy. He doesnot have the verbal skills toexpress his frustration so thisis a way he can make hisfeelings known to you.

Interrupt the banging byteaching him less hurtfulways to express hisfrustration (such as stompinghis feet). Fortunately, extremebehaviours in children thisyoung often end as suddenlyas they start. Talk to yourhealth visitor or GP if thiscontinues.


Sun safetySimple steps to protect their skin and eyes

6968

Pharmacist saysThe higher the SPF (SunProtection Factor) the moreprotection. Use a completesun block on your baby ortoddler. SPFs of up to 60are available which blockout almost all of the sun’srays. Even with suncream,keep them in the shadewhenever you can andmake sure newborn babiesare never in the sun. Donot forget to protect theirhead, skin and eyes. Forolder children, you can buysunglasses from apharmacy. Check they offer100% UV protection.

Vitamin DIs your child getting enough?Vitamin D is important for good health, strongbones and growth. Most foods contain verylittle vitamin D naturally and it is mostly madein the skin by exposure to sunlight. However,you shouldn’t over-expose your child to thesun, as casual sun exposure is enough.

Vitamin D helps your baby's body absorbcalcium, which is needed for the healthydevelopment of strong bones and teeth. (See page 60 Healthy Start Vitamins).

1 2 3It is a bright day and yourchild is playing outside.

Are they in the shade andwearing sunscreen? Arethey wearing a hat, longsleeves and trousers?

Make sure you protectyour child’s head, skin andeyes especially during themiddle of the day.

Keep your child cool and protect them from the sun and heat. Babies under six monthsshould be kept out of the sun and older children should be allowed in the sun for a limitedtime only, and their skin should be well protected. Stay out of the sun, especially during themiddle of the day. All types of skin, fair or dark, need protection.As parents we can take simple measures to protect our children. Remember babiesand toddlers are not interested in tanning and sunburn can cause damage to their skin.Attach an effective sunshade to the pushchair to keep them out of direct sunlight. A sunhat, with a wide brim or a long flap at the back, will protect your child's head and neck. Useloose long sleeved clothing. Apply a thick layer of high SPF suncream 30 minutes beforesun exposure to allow time for it to absorb into the skin. Reapply a thick layer every twohours, particularly if your child is in and out of the sea or a paddling pool. Don't forgetbehind the ears, backs of the hands and the soles of the feet on the beach.If your baby is under six months, offer more fluids and if breastfeeding, breastfeed moreoften. If your baby is over six months old encourage them to drink water. For oldertoddlers and children, plenty of fruit will also help to keep their fluid levels up.If you’re making a journey in the car, do make sure your car has a sunshade to protectyour child. Take drinking water for the journey and ensure children do not becomeoverheated. Never leave children in cars parked in the sun.


70

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 urgent 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, thenit is fine to let them sleep. If you are worried in any wayabout their drowsiness, then you should wake your child anhour after they go to sleep. Check that they are okay, andthat they are responding normally throughout the night.

Most accidents happen at homeBabies and toddlers learn by exploring. Shouting or smacking will not teach themabout safety and when they are too young to understand the dangers it is up tous to make sure they are safe. A typical household is full of possible dangers.There are lots of things we can do to help prevent accidents in the home. Equallywe need to make sure children are safely contained within the house with doorlocks and windows being closed and having safety catches. There can bedangers from outside, so make sure your child understands that if they are able toopen the door, they do not open it to anyone they do not know or trust.Check toys with small pieces are not left out for a toddler to chew and choke on.Make sure toys have safety marks.Balconies and outdoor spaces and garden ponds can be danger areas, so makesure your child is never left alone. Make sure there is nothing they can climb ontowhilst on a balcony and ensure there are no gaps through which they could squeeze.Even the most good-natured pet can lash out or bite. Animals and young childrenshould not be left alone together. Never trust an older toddler to be left alone witha baby even for a few minutes.

71

• Sockets, wires and plugs -use plug guards.

• Danger of falls - use windowlocks, stair guards and do notleave babies alone on beds orchairs.

• Smoking at home - STOP.• Burns - children can get burnt

from straightening irons, hotpans, scalding water. Use anoven guard and install asmoke detector.

• Medicines, drugs andchemicals - keep them up highand in a locked cupboard.

• Pets - never leave a childalone with a pet.

• Small items which could beswallowed and cause choking.

Dangers around the home

Household injuries

1 2 3Spend some time at homeexploring as if you were atoddler.

Make a list of potentialdangers.

Think about types of safetyequipment or how you canmove these things out ofyour child's reach.Call 0800 032 0102 or visit

www.smokefree.nhs.uk


Burns & scaldsA burn is damage to the skin, which is caused by direct contact with somethinghot. Burns can also be caused by certain chemicals, electricity and friction. Ascald is a burn that is caused by a hot liquid or steam. Scalds are treated in thesame way as burns.

Treat any burn or scald straight after the accident but always take your child tohospital for anything more than a very small burn or scald. A baby’s skin is verydelicate and can be scarred without the right treatment.

Cool the burnt area by placing under cool running water for at least twentyminutes. When the burn has cooled, cover it with a sterile dressing, food qualitycling film or a plastic bag. Don’t wrap it too tightly. Give sugar-free paracetamolor ibuprofen (see know the basics). Then take your child to hospital.

Remember to keep hot drinks out of children’s reach.

Knowing what to do

73

1 2 3Treat the burn or scaldstraight after the accidentby running under coldwater for 20 minutes.

Do not use creams,lotions or ointments onthe burn or scald.

Always take your child orbaby to hospital if it isanything other than a verymild burn.

GP saysDoHold the affected area undercold water for at least 20minutes (make sure your childdoes not get too cold). Coverthe burn with cling film, thenwrap in a cloth soaked in coolwater.

Don’tApply fatty substances likebutter or ointment as this willnot help and will only wastetime for hospital staff who willhave to clean the area before itcan be treated.

Source: www.nhs.uk/conditions 201572


74

ChokingBabies and toddlers can easily swallow,inhale or choke on small items likemarbles, beads, lolly sticks, balloons,peanuts, buttons, nappy sacks, plastictoy pieces, strings or cords.

PREVENTION:• Check on the floor and under furniture

for small items and that toys with smallpieces are not left out for a toddler tochew and choke on.

• Check that toys are age appropriate,in good condition and include toysafety marks.

• Find out more about resuscitation (CPR)visit online/app version of this guide.

WHAT TO DO:If your child is choking, act immediatelyand calmly. Make sure you do not pushthe object further down the throat.Encourage your child to cough. Use backblows, if they become unconscious, callfor help (do not leave your child alone)and start CPR.

Keeping children safe

Choking & poisoning

AlcoholEven a small amount can causealcohol poisoning in children.Alcohol affects the centralnervous system and symptomscan include confusion, vomiting,and seizures. The child may havedifficulty breathing and flushed orpale skin. Alcohol impairs the gagreflex, which can cause choking.If your child has drunk alcohol callNHS 111 or go to A&E.

Every week around 500 children under five are rushed to hospital because it'sthought they have swallowed something poisonous. Most poisoning accidentsinvolve medicines, household products and cosmetics. The most common formof poisoning is from medication.

• Keep medicines high up and out of reach.• Keep anything that may be poisonous out of reach - this includes all medicines

and pills, alcohol, household cleaners, liquid washing tablets and gardenproducts, preferably in a locked cupboard.

• Use containers that have child-resistant tops - be aware that by the age ofthree, many children are able to open child-resistant tops.

• Keep all dangerous chemicals in their original containers - for example, do notstore weedkiller in an old drinks bottle as a young child may mistake it forsomething safe to drink.

• Discourage your children from eating any plants or fungi when outside. Avoidbuying plants with poisonous leaves or berries.

• Keep alcohol out of the reach of children.

75

1 2 3If you think your childhas swallowed a harmfulmedicine or chemicalincluding batteries or amagnet.

Find the bottle or packetand take it with you whenyou seek medical help.

Immediately contact yourpharmacist, GP, go toA&E or call NHS 111.



Back blows forchildren under one year• Support your child in

a head-downwardsposition. Gravity canhelp dislodge theobject.

• Sit or kneel and support the child on yourlap. If this is not possible, support your child in a forward-leaning position and givethe back blows from behind.

• Don’t compress the soft tissues under the jawas this will make the obstruction worse.

• Give up to five sharp blows to the back withthe heel of one hand in the middle of the backbetween the shoulder blades.

Back blows for children over one year• Back blows are more effective if the child

is positioned head down.• Put a small child across your lap as you

would a baby.• If this is not possible, support your child in

a forward-leaning position and give theback blows from behind.

Chest thrusts for children under one year• Support the baby down your arm, which is

placed down (or across) your thigh as you sitor kneel.

• Encircle the chest with your hands putting yourtwo thumbs on the middle of the breastbone.

• Give five sharp chest thrusts, compressing thechest by about a third of its diameter.

Abdominal thrusts forchildren over one year• Stand or kneel behind the

child. Place your armsunder the child’s armsand around their upperabdomen.

• Clench your fist and place it between naveland ribs.

• Grasp this hand with your other hand and pullsharply inwards and upwards.

• Repeat up to five times.• Make sure you don’t apply pressure to the

lower ribcage as this may cause damage.

Following chest or abdominal thrusts, reassess your child:• If the object is not dislodged and your child is still conscious, continue the sequence of back blows and either chest

thrusts or abdominal thrusts. • Call out or send for help if you are still on your own. • Don’t leave the child at this stage.76

How to proceed ifyour child isconscious andunder one year,give chest thrusts. If the child isunconsciousproceed to CPR.

How to proceed ifyour child isconscious andover one year, giveabdominal thrusts. If the child isunconsciousproceed to CPR.

If your child is not breathingBabies under one year old1. Open the baby's airway by placing one hand on the

forehead while gently tilting the head back and lifting thechin, keeping the face parallel with the ground. Removeany visible obstructions from the mouth or nose.

2. Place your mouth over the mouth and nose of the infantand blow steadily and firmly into their mouth, checkingthat their chest rises. Give five initial rescue breaths.

3. Place two fingers in the middle of the chest and pressdown by one-third of the depth of the chest. After 30chest compressions at a steady rate (slightly faster thanone compression a second), give two rescue breaths.

4. Continue with cycles of 30 chest compressions andtwo rescue breaths until they begin to recover oremergency help arrives.

Children over one year old1. Open their airway by placing one hand on the forehead

and gently tilting the head back and lifting the chin,keeping the face parallel with the ground. Remove anyvisible obstructions from the mouth or nose.

2. Pinch their nose. Seal your mouth over their mouth andblow steadily and firmly into their mouth, checking thattheir chest rises. Give five initial rescue breaths.

3. Place your hands on the centre of their chest and, withthe heel of your hand, press down by one-third of thedepth of the chest using one or two hands.

4. After every 30 chest compressions at a steady rate(slightly faster than one compression a second), givetwo rescue breaths.

5. Continue with cycles of 30 chest compressions andtwo rescue breaths until they begin to recover oremergency help arrives.

Source: NHS Choices, DoH birth to five 2009.

How to resuscitatea childCardiopulmonary resuscitation (CPR)

77

Choking


Useful contacts

78

Allergy UK01322 619 898 www.allergyuk.orgAssociation of BreastfeedingMothers 0300 330 5453 9.30am-10.30pm www.abm.me.ukAsthma UK0300 222 5800 www.asthma.org.ukBaby LifeCheckwww.babylifecheck.co.ukChild Accident Prevention Trust020 7608 3828 www.capt.org.ukCry-sis08451 228 669 www.cry-sis.org.ukDental Helpline01788 539780 www.dentalhealth.orgDiabetes UK0345 123 2399 www.diabetes.org.ukFamily Lives0808 800 2222 www.familylives.org.ukHealthy Start0345 607 6823www.healthystart.nhs.ukLa Leche League GB0845 120 2918 available 24 hours7 days a week. www.laleche.org.ukThe Lullaby Trust0808 802 6869 www.lullabytrust.org.uk

Meningitis Now0808 80 10 388 www.meningitisnow.orgNational Breastfeeding Network Helpline0300 100 0212, 9.30am-9.30pmwww.breastfeedingnetwork.org.ukNational Childbirth Trust0300 330 0700 8am-10pm 7 days a weekwww.nct.org.ukNational Domestic Violence Helpline0808 2000 247www.refuge.org.ukNetmumsParenting advice and information.www.netmums.comRed CrossInformation on CPR (kiss of life)www.redcrossfirstaidtraining.co.ukStart4Life Healthy tipswww.nhs.uk/start4lifeNational At-home Dad NetworkDad’s views, chat, news and support.www.athomedad.orgTo find an NHS dentistCall NHS 111 or visit www.nhs.uk

NATIONAL LOCAL

Children and Young People'sDirectoryFor a range of local family supportnetworks, health providers and socialactivities in Waltham Forest.www.walthamforest.gov.uk/cypd

Breastfeeding SupportThere are infant feeding support groupsand breastfeeding cafes throughoutWaltham Forest. Call the Infant Feedinghelpline during office hours 020 8496 5222, ask your midwife,health visitor or Children & FamilyCentre or download an up to date listof support groups fromwww.walthamforest.gov.uk/cypd(search ‘infant feeding’)

Health visitors and school nursesThe Healthy Child Programme 0-19has a new single point of access (SPA).0300 3001970 [email protected]

Children & Family CentresIf you need social support, job centreadvice, food bank or baby bank, popinto your local Children & Family Centre

- they provide you with support or pointyou in the right direction of localservices to help you. To find your localChildren & Family Centre, go towww.walthamforest.gov.uk/cypd(search ‘Children & Family Centre’)

Child Health ClinicsAsk your GP or contact one of theclinics below to find out about drop-inbaby clinics. You can also pick up yourfree Healthy Start vitamin drops foryour baby at the following sites.Chingford Health Centre109 York Road, Chingford E4 8LF.020 8430 8010Comley Bank Clinic46 Ravenswood Road, WalthamstowE17 9LY. 020 8430 7171 Forest Rd Medical Centre354-358 Forest Rd, Walthamstow E17 5JG. 020 8430 7710Langthorne Health Centre13 Langthorne Rd, Leytonstone E11 4HX. 020 8430 7510Leyton Green Health ClinicLeyton Green Rd, Leyton E10 6BL.0208539 8646

Parenting supportFor more information, ask at your localChildren & Family Centre or contact theEarly Intervention & Prevention Serviceto register.020 8496 3000

Healthwatch Waltham ForestTo make sure your views on localhealth and social care are heard.020 3078 9990www.healthwatchwalthamforest.co.uk

79


Call 999 in an emergency

If you think you need help urgentlyduring the day or night you should callNHS 111 before you go to any otherhealth service. By calling NHS 111you will be directed straight away tothe local service that can help youbest. It is free to call, including from amobile, and is available 24 hours aday, 365 days a year.When should I call NHS 111?• When you need help fast but it’s

not life-threatening.• When you think you need to go to

A&E or another NHS urgent careservice.

• When it’s outside of your doctor’ssurgery hours.

• When you do not know who to callfor medical help.

• If you do not have a local doctor to call.

NHS 111

Free Two Year Old EducationAll 3 and 4 year olds and sometwo-year-olds in Waltham Forestcan get up to 30 hours a week offree early education andchildcare. Your child will get tomake new friends, try differentactivities, learn through play andhave fun. To find out if you areeligible and to apply, visitwww.walthamforest.gov.uk/freechildcare


A Parent’s Guidewaltham-forest.sensecds.com/docs/waltham-forest.pdf · during the day or night...

Documents

Transcript of A Parent’s Guidewaltham-forest.sensecds.com/docs/waltham-forest.pdf · during the day or night...