A to Z of Health
Our A-Z of Health is a comprehensive guide to common childhood conditions. To find more information about these conditions, simply select the relevant letter.
Acne (see Milia also)
Acne is common in newborn children. Spots can appear between 2 weeks and 2 months of age, and last until your child is between 4 and 6 months old. It usually presents as small whiteheads on the face and occasionally on the back. These spots are different from the little bumps called milia that your baby may have had on their face at birth and which usually disappear after three to four weeks. Acne is caused by the hormones that your baby gets from the mother in the womb and through her breast milk. It is best to leave the spots alone as they should clear by themselves. However, if you are in any doubt as to whether it is acne, or if the rash is elsewhere on your baby's body see your child's doctor as it could be eczema or cradle cap.
Anaphylactic shock is a rare, but life threatening, severe allergic reaction. It can occur after an insect sting, after a particular food (such as peanuts)has been eaten, or after a drug has been taken..
The allergic reaction causes histamine and other chemicals to be released which cause the blood vessels to dilate causing a sudden drop in blood pressure. Your child will quickly become wheezy and have difficulty in breathing, their tongue and throat will swell and they may get an itchy, raised rash.
If your child has such a reaction you should call 999 as it is a medical emergency and requires an injection of adrenaline as soon as possible.
A useful contact is the 'The Anaphylaxis Campaign' (01252-542029). Their website is www.anaphylaxis.org.uk. It provides a lot of information about allergies and anaphylactic shock along with alerts on foods that have been found to contain known allergy causing substances.
Appendicitis occurs when the appendix, which is a small protrusion of the large intestine, becomes inflamed. If it is not treated the inflamed appendix can burst, causing peritonitis (which is inflammation of the lining of the abdomen)or an abscess.
Your child possibly has appendicitis if they have a pain in the lower right-hand corner of their abdomen, a slight fever, appetite loss and vomiting.
If you suspect your child has appendicitis you must contact your child's doctor urgently or else go to the accident and emergency department at your nearest hospital. Your child may need an operation as soon as possible to have the appendix removed before it bursts.
Asthma is a condition, which narrows the small airways in the lungs and makes breathing more difficult. During an attack a person's airways tend to become inflamed and fill with mucus. Asthma is caused by an over reaction of the body's normal immunity against certain 'foreign' agents.
Asthma in children can show itself in different ways:-
- By wheezing
- A persistent cough
- Coughing and wheezing each time the child gets a cold.
- Getting more out of breath than they should when doing sport/running around
Some children get these problems occasionally whereas others have to contend with these symptoms regularly. Asthma attacks can be life threatening.
There are many things that can provoke an asthma attack although for many children there is no obvious reason for their attacks. Possible causes of asthma attacks are :-
- Allergy - allergies, amongst other things, to pollen, house mites (found in house dust) and furry animals can trigger asthma. Food allergies may also act as a trigger to an asthma attack.
- Infection - viral respiratory infections, such as colds and coughs are particularly common triggers for asthma in young children.
- Exercise - running in particular can provoke asthma.
- Emotion - great excitement, upset, anxiety or tension can trigger an asthma attack.
- Weather - sudden changes in climate, such as sudden wind are able to provoke asthma.
- Smoke - cigarette smoke can trigger wheezing as can some industrial fumes, paint fumes and perfumes.
There are many different treatments for asthma and your child's doctor will suggest one which best suits your child.
Avoiding factors that trigger an asthma attack:- this is about trying to avoid things that are known to trigger asthma - for example avoiding smoky atmospheres and reducing dust in the house for a child who is sensitive to house mites.
Inhalers that prevent an asthma attack:- these can be given regularly or only when there is a problem. Your child's doctor may suggest starting treatment when your child gets a cold to prevent an attack and similarly he may suggest taking an inhaler before exercise, if exercise causes wheeziness. The purpose of the inhaler is to stop the reaction that triggers an attack, by getting the drugs to the lungs in the quickest way. Young children may find it difficult to use an inhaler and if this is the case a 'spacer' can be used. A spacer is a large transparent ball where the medicine is sprayed in at one end and the child breathes in and out through the other.
To treat an asthma attack:- bronchodilators treat wheezing by opening the airways and offering instant relief. In severe asthma attacks your child may have to be admitted to hospital.
Many children grow out of asthma as they get older - only one in five will still have persistent symptoms in early adult life.
The National Asthma Campaign is the independent UK charity that offers support and advice for parents through its publications, its network of local branches and the Asthma Helpline which is staffed by asthma specialist nurses. Local rate helpline 0845-7010203 (open Monday-Friday,9am-7pm)
Their web address is www.asthma.org.uk. This is an excellent site which is full of information and has booklets that you can order such as "Asthma and children under 5".
You may also find the British Lung Foundation a useful source of help and information. They can be contacted on 020-7831-5831.
Their web address is www.britishlungfoundation.com
Another word for bed wetting is 'enuresis'. Bedwetting during the first two to three years of life is normal and to be expected. As children get older the number who are still bedwetting decreases and by the age of five about 1 in 7 children regularly wet the bed.
Bedwetting is more common in boys than in girls and tends to run in families. Only a tiny proportion of children suffering from bedwetting have a physical problem, such as an abnormality of the urinary tract.
If your child is still bedwetting at the age of five consult your doctor although if you have worries before this speak to them sooner. The most common form of treatment is to use an alarm which sounds when the child urinates on the bed. Occasionally medicines may be prescribed to help with bedwetting.
The Enuresis Resource and Information Centre (ERIC) is the only organisation in the UK dedicated to bedwetting (tel 0117-960-3060). They have a great website www.eric.org.uk, which has advice for parents and special pages for children.
Birthmarks are areas of raised or flat discoloured skin that are usually visible on a baby's skin at birth. They tend to be the result of an abnormal development of blood or lymph vessels, but no one knows the exact cause of all birthmarks. Some birthmarks may not show up for several days or weeks after a baby's birth. Some marks endure for life, whilst others fade away over time. Birthmarks are very common and most of us have one or more somewhere on our body.
The most common variety of birthmarks are:-
- Stork marks - these are reddish or purple marks, which are overgrown capillary veins near the surface of the skin and are found on the back of a baby's neck. They are harmless and usually fade within the first year but if they don't they will probably be covered with hair anyway.
- Strawberry marks - these are raised red areas with white marks and are called so because they resemble a strawberry. They are caused by the overgrowth of blood vessels. They usually start as small red spots which then get bigger and can occasionally become quite large. Generally these marks will disappear by themselves and most are gone before a child's fifth birthday.
- Mongolian blue spots - these refer to patches of darker pigment which are mostly seen on a baby's bottom and lower back. They are most common in babies with dark skin. They are harmless and will fade as the baby grows.
- Port wine stains - these are irregular patches of dark, berry coloured skin which unfortunately do not fade or diminish with time. They are most common on the face and head.
The Birthmark Support Group have a very good website which gives information on all the different types of birthmarks.
Chicken pox is caused by the varicella zoster virus, which is very contagious. A person who has chicken pox can pass it on to someone else just by touching another person, or else the virus can be released into the air by sneezing, coughing or even breathing.
A runny nose, sneezing, coughing and fever are the first typical symptoms of chicken pox. Then about three to five days later the chicken pox usually shows up as an itchy rash that starts as small red pimples. These bumps then quickly change into blisters filled with clear fluid which eventually crust over. This process takes about 4 days. As well as the chicken pox being itchy for your child they may also be tired, slightly feverish and feeling unwell.
Generally speaking chicken pox is not dangerous but, if your child has a weakened immune system, or else is taking steroid medication for asthma, serious complications can occur. The advice is to see your doctor at the first sign of chicken pox or even if your child has been exposed to the virus. However, even healthy children can develop serious complications from chicken pox, so if your child seems sicker than expected you should call your doctor.
Treatment is aimed at making your child as comfortable as possible and trying to minimize the scratching. Scratching of the spots can occasionally lead to the spots becoming infected and scarring. Calamine lotion dabbed on the spots can help. Wearing non-itchy clothing and ensuring your child's nails are cut short can all help minimise the itching.
Your child should be kept out of contact with other children for at least a week to prevent him or her from spreading the disease. Also, if your child has chicken pox they should not be in contact with pregnant women, to prevent exposing the foetus to the virus. If the pregnant woman has definently had chicken pox in the past there should not be a risk of exposing the foetus to the virus but, to be on the safe side, contact should be avoided. Unfortunately children are most contagious in the day or two before the rash shows and you should assume that your child is still contagious until all the spots have crusted over.
Please call the nursery to discuss when your child should return.
Cold sores are very common in children and they are nothing to do with colds. They are caused by the herpes simplex virus (HSV-1) which should not be confused with the herpes simplex virus (HSV-2) which causes genital herpes.
Your child normally picks up this virus for the first time before they reach five years of age. They may develop a temperature, have a sore mouth and enlarged neck glands. The illness may last for up to 2 weeks and recovery is usually complete.
Once your child gets the virus it stays in his or her body for good, hidden in nerves. In some people, the virus lies dormant and never causes harm whilst in others it becomes active causing cold sores around the mouth.
A cold sore starts as an itchy, burning and painful area around the mouth or on the lips, which develops into a blister. It then develops into an ulcer which heals by forming a scab. If left untreated the cold sore will heal in 2 weeks.
Most children pick up the virus by sharing food and drinking cups with someone who has a cold sore. However, they can also get the infection from someone who doesn't have an obvious sore but has the virus in his or her saliva.
When your child has a cold sore a mild pain reliever may help relieve the associated pain. Also Acyclovir (Zovirex) cream will heal cold sores if used as soon as the cold sores appear. Try to keep your child from infecting other parts of his or her body, or giving the virus to others. Do this by washing their hands regularly and not allowing your child to pick the sore. Do not give your child salty, spicy or acidic food which may irritate the sore.
Colic is a term used to describe uncontrollable crying in an otherwise healthy baby. A colicky baby may show signs of discomfort, such as drawing their knees up over their stomach during screaming fits and often punching their fists. The crying and discomfort can happen at anytime of the day but it is usually most intense between 6pm and midnight. About 20 percent of all babies become colicky, usually starting between 2 and 4 weeks of age and the majority are better by 4 months of age.
There is no one common cause of colic and it is not known why some babies develop it. A popular theory is that it is simply caused by an immature nervous system which is not yet able to control the intestines properly. This would explain why colic disappears as the baby gets older. Another thought is that the immature nervous system is unable to cope with all the stimulation of the world and so by the evening the baby can't cope with any more stimuli, therefore cries to let off steam.
It may be that your baby is having a digestive or allergic reaction to the milk they are drinking. If you are breastfeeding you could try changing your diet to see if you notice less crying - though you should discuss this with your health visitor or doctor.
There are a number of things that may help to calm your baby:-
- gripe water and Infacol (which contains a mild antacid) can be given - follow the instructions on the bottle.
- babies often find sucking, whether it be your little finger or a sterilised dummy a great comfort and a distraction from the pain.
- rocking, cradling and walking around with your baby may be of help as well.
There is no evidence that taking in extra wind causes colic and so anti-wind teats and bottles will not necessarily help.
CRY-SIS has a helpline (020-7404-5011) for parents with a colicky baby which is open 7 days a week from 8am-11pm. They also have a good website www.our-space.co.uk/serene.htm, which gives many ideas on how to reduce colic.
The National Childbirth Trust (0870-444-8707) which is open 9am-5pm Monday-Thursday and Friday 9am-4pm provides networks of parents who are facing similar problems. They also have a very good website, which is www.nctpregnancyandbabycare.com.
Colds are upper respiratory tract infections caused by one of many different viruses. They are generally caught when someone with a cold sneezes or coughs thus releasing the virus into the air where a healthy person may catch it. Colds can also be transmitted through hand-to-hand contact. It is estimated that your baby will get between eight and ten colds during their first two years. Symptoms of a cold may include a temperature, cough, reddened eyes, a sore throat, and a runny nose.
Your child may also be irritable and lose his or her appetite. Small babies may have trouble breathing and therefore wake up more than usual during the night. It is often not until a child is about four years of age that they are able to blow their nose properly. Most colds will get better between five and seven days but if at all worried about your child please contact your child's doctor.
There is little that can be done to treat a cold but your child will probably want plenty of rest. You should ensure that they drink plenty of liquid. If your child has a raised temperature you may want to give some paracetamol suspension under a doctor's direction. Do not give any cold remedies without first consulting your doctor.
The purpose of coughing is to get rid of mucus and dust from the lungs. Coughing occurs when the windpipe is irritated by something, but if there is nothing to clear from the lungs it can be a nuisance.
Children may cough when they have a cold because of the mucus trickling down the back of the throat. Generally, it is nothing to worry about if your child is eating and breathing normally. But, if they are not or if your child appears wheezy or the cough won't go away you should see your child's doctor.
A cough, along with a raised temperature may indicate a chest infection which your doctor may prescribe antibiotics for.
If your child has a cough that is initiated by exercise or is persistent, contact your doctor because it may be a sign of asthma.
Most doctors believe that cough mixtures do little to relieve coughing. You may like to give your child warm, clear fluids to drink to help relieve the cough.
Cradle Cap (infantile seborrhoeic dermatitis)
Cradle cap looks like a bad case of dandruff. It shows up as greasy, yellow scaling patches that may eventually cause the baby's scalp to be covered in a thick scaly layer.
It is very common and often occurs during the baby's first couple of weeks. It is thought to be as a result of hormonal changes which stimulate secretions from the oil glands in the skin. It usually disappears on its own within a few months of birth. Baby oil can be used to soften the scales.
In rare cases, the condition can spread to the face, or to the body, where it can cause eczema in the nappy region and the armpits.
Please talk to your health visitor if you have any concerns.
Croup is an infection that causes the trachea (windpipe) and larynx (voicebox) to swell. Croup often follows on from a cold because the virus has spread downwards. Croup causes hoarseness and a barking cough. It may also cause a crowing noise (called stridor) when the child breathes in through the narrowed windpipe. Croup usually lasts 5-6 days. The symptoms may be worse at night and croup symptoms most commonly occur in children between the ages of one and three years.
Most children with mild croup can be treated at home by letting them breathe in steam (mist treatment). This can be done by filling a bath with hot water and sitting in the bathroom with the door and any windows closed. Sit with your child in this steamy atmosphere for about 10 minutes or so until their breathing has become easier, although it may still sound noisy. If you still have any worries before, during, or after the mist treatment you should contact your child's doctor immediately (for example, if the breathing hasn't improved after the mist treatment).
Croup can be life-threatening and if breathing seems to be getting worse, if the child is becoming more tired, if there is blueness around the mouth, nose and nails, you should contact your child's doctor immediately or else go to the Accident and Emergency department at your nearest hospital. Serious cases of croup result in hospital admission where the patient will be given oxygen, adrenaline and inhalation treatment with corticosteroids.
The conjunctiva is the clear covering that coats the white of the eye and the inside of the eyelids. It can become inflamed as a result of an infection, an allergic reaction or else a foreign body in the eye.
Generally both eyes are affected, but often one starts before the other.
When it becomes inflamed it causes the eyes to be sore, itchy and red. The eye oozes pus and often after sleep the eyelids are stuck together.
If your child develops conjunctivitis you should gently clean your child's eye with cotton wool soaked in cooled, boiled water using a clean piece for each eye. Wash your hands after cleaning your child's eyes as conjunctivitis is very contagious and therefore germs can easily be spread.
You should also consult your child's doctor who will probably prescribe some antibiotic eye drops if an infection is the likely cause.
As conjunctivitis is highly infectious your child should not attend nursery whilst the eye is still oozing pus. Please consult the nursery about when your child should return.
(see Hand, Foot and Mouth disease)
Dyslexia is a reading disability that affects boys more than girls. The child will have difficulty in recognising written words and will often reverse letters and words (such as b for d). Their reading skills will be behind that of their friends although their intelligence is normal.
It is important that dyslexia is diagnosed as soon as possible - you should consult your child's school.
The British Dyslexia Association runs a national helpline (0118-966-8271) which is open Monday to Friday, 10am-12.45pm and 1.45pm-4.45pm) which offers information about support available in your area. Their web address is www.bda-dyslexia.org.uk where you can buy publications online.
Children are very prone to earache which is most usually caused by an infection of the middle ear (otitis media). Children often develop an ear infection after they have had a cold or sinus infection.
When a child has a middle ear infection, the Eustachian tube, that normally allows fluid from the ear to throat to drain down, swells and becomes blocked. Thus, there is a build-up of fluid in the middle ear which puts pressure on the eardrum and causes earache.
Signs that your child may have an ear infection are:-
- appearing miserable.
- they may say their ear hurts or babies and younger children may pull at their ears.
- raised temperature
- diarrhoea and/or reduced appetite because ear infections can cause gastrointestinal upset.
Occasionally, if the ear infection is not picked up on early enough the pressure of fluid in the middle ear may build up so much that the eardrum bursts to relieve the pressure. In turn, this causes blood/pus to be discharged from the ear. If this happens clean the discharge with cotton wool and cooled boiled water but do not poke around.
If you suspect that your child has an ear infection you should visit your child's doctor who may prescribe antibiotics.
Foreign bodies in the ear:-
Foreign bodies in the ear that your child may have poked in can cause infection and may damage the eardrum.
If you suspect that your child has poked something into their ear do not attempt to remove it because it may make it get stuck further. Instead consult your child's doctor or go to casualty where they will attempt to remove it.
Infantile eczema is a skin condition whereby the skin becomes dry, sore, red and scaly. The skin can become very itchy and small watery blisters can develop. It can affect any part of the body but the underside of elbows, behind the knees, the face and hands are most commonly affected. If the eczema starts to produce pus you must consult your child's doctor as it could be that there is a bacterial infection.
Eczema can affect children very badly over a long period, or it can be mild and disappear quite quickly.
Infantile eczema is usually due to an allergic reaction. It can be triggered by allergies to food, for example cow's milk and eggs. Substances such as pet fur and soap powders can also cause eczema.
Eczema tends to run in families - three quarters of children with infantile eczema have asthma or hay fever in the family. Most children grow out of eczema but they may develop asthma or hay fever later in life.
Consult your child's doctor or health visitor if you suspect your child has eczema. They may prescribe creams to help and may suggest emollient creams for the bath to help keep your child's skin smooth and moisturised. If you suspect that food is to blame don't change your child's diet without consulting your child's doctor/health visitor first.
A useful contact if you want more information about eczema, advice or support is The National Eczema Society. It provides a wealth of information from specific treatments to specialist product stockists.
There is an information service number to answer any questions about eczema you may have. The number is 0870-241-3604 and it is available between 1 and 4pm, Monday to Friday. Their website address is www.eczema.org
Another useful contact is www.healthy-house.co.uk which sells products to help minimise allergies around the home. For example special vacuum cleaners and bedding.
Fits in children who are 6 months to 4 years old are usually caused by a rapid increase in body temperature and are known as febrile convulsions. They are common and one in fifty children will have a febrile convulsion by the time they are 5 years old.
More rarely, fits can be caused by meningitis or epilepsy.
A fit is caused by a temporary burst of uncontrolled brain activity. Signs and symptoms of fits are :-
- slight to violent shaking
- child's skin turns pale and may even turn blue
- high temperature
After the fit the child will feel confused, drowsy, will probably have a headache and will want to sleep for several hours.
As soon as your child starts to have a fit move anything hard or sharp from the area. When the convulsion stops turn your child onto their side into the recovery position. Once they have regained consciousness they should be given paracetamol to lower their temperature.
Your child's doctor should be contacted, especially if this is their first fit. If your child does not regain consciousness after the fit, if he or she is not breathing properly, or if the fitting lasts more than 5 minutes you should phone 999 for emergency help.
A child has a fever if their temperature is above 37.7C and their skin is warm. They may also seem agitated and miserable. Your child's temperature should be between 36 and 37C.
A high fever can cause a febrile convulsion.
If your child has a temperature you can remove their outer clothing, sponge them down with lukewarm water and encourage them to drink cold water. They can be given paracetamol made for children - follow the directions.
If their temperature does not drop or you are at all worried at any time it is important to contact your child's doctor as soon as possible for advice.
Gastric reflux is the bringing back up, or refluxing, of stomach contents. Many babies burp and bring up a little feed after almost every meal, but those with gastric reflux have marked difficulty in keeping down their food and may vomit frequently after meals. Gastric reflux is most common in babies under the age of one year.
Why do babies suffer from gastric reflux?
Gastric reflux occurs when muscles forming a valve at the bottom of the tube connecting the throat to the stomach (oesophagus) do not work properly. They cannot squeeze the opening at the top of the stomach fully closed and, as a result, stomach contents can pass back upwards into the throat.
NB: If your baby vomits continuously and sometimes produces projectile vomits that travel a long way, this may be due to another condition called pyloric stenosis, in which the exit from the stomach is abnormally thickened and narrowed. Pyloric stenosis usually develops between 3 to 8 weeks after birth and is five times more common in boys than in girls.
How will you know if your baby has gastric reflux?
Many babies are quite happy to sick all over you and smile at your reaction. If baby is vomiting but gaining weight and thriving, there may not be a problem except for the constant washing of clothes, stains and difficulty going out with your baby or hand her over to anyone else to look after.
Reflux only becomes a medical problem if it causes complications. Stomach acid coming up into the oesophagus causing painful heartburn and, in severe cases, can lead to scarring and make it difficult to swallow. Other complications can include poor weight gain, dehydration with few wet nappies, and choking due to aspiration of stomach contents into the respiratory tract which, although not common, is very serious. If you think your baby has reflux, it is important to tell your doctor, for example if:
- • she continually vomits after feeds, with or without distressed crying
- • she grizzles, screams or arches her back in discomfort during or after a feed because of painful heartburn
- • she brings up milk that is blood stained
- • you keep finding sick on her sheets
- • she spills milk over you when you pick her up from a lying down position
- • she refuses feeds (because she knows they will cause pain afterwards)
- • she develops bad breath with a sickly smell
- • she grinds her teeth
In severe cases, a baby may wheeze, cough, and gag if food gets into the respiratory tract – if this happens seek urgent medical advice.
If your baby only brings up a few mouthfuls of milk after a meal, it is probably just wind or a spit-up which is nothing to worry about. If she forcefully brings up all or most of her food more than twice a day, however, she may have gastric reflux. Some babies have silent reflux, however, and may be miserable due to heartburn without producing much visible vomit as they manage to get the sick back down again. If you are at all worried, seek advice from your doctor or health visitor.
How can you help your baby if she’s suffering?
Hold baby in a more vertical position while feeding, and for 30 to 60 mins afterwards.
Give less breast milk or formula at each feed, and make up for it with more frequent feeds. Each baby is different, however – while some prefer short, frequent feeds, others are better with a longer break between feeds. Feeding too often (eg hourly) does not give sufficient time for the stomach to empty and may increase the incidence of reflux.
Formula users can try using a thicker product designed for hungrier babies as this may stay down better. You may also want to try alternative formulas (e.g. Goat's milk). Reflux is just as common in babies who are breast fed as in those who are bottle fed, however, so don’t be tempted to stop breast-feeding before you are ready.
Depending on the age of the baby, a spoonful of solids after a milk feed may help keep the feed down. When giving first solids to babies with reflux, keep them very smooth as textures such as lumps may cause gagging and make reflux worse
Avoid foods that may make reflux worse. All babies are different, so try to see what triggers problems in your baby eg fruit and fruit juices (especially oranges, apples, bananas), tomatoes and tomato sauce, spicy foods, fatty foods, fizzy drinks, tea.
Pears are the least acidic fruit and are an ideal first fruit for refluxing babies.
Feed her at least an hour before bedtime so she has time to digest her food.
Try feeding her at night when she is half asleep, keeping the room darkened and avoiding stimulation.
If she had problems at night, try to keep her a little upright – eg put her in her car seat if it has a reclining position, place a couple of books under the top legs of her cot.
Prop your baby up a little while changing her nappy – if lying totally flat, you may trigger an episode of reflux when lifting her legs to change her as this puts extra pressure on her tummy
Put her in loose clothing - remove any elastic from around the waist of clothes.
Check her weight gain regularly and plot it on her growth chart – if she starts falling away from her growth line, let your doctor know.
Avoiding 'bouncing' and active play which may trigger reflux.
Keep a container handy to catch vomit, and a cloth sheet or nappy over the feeding chair, and over your shoulder at all times. Using a hard plastic bib with a trough on older babies will also help catch spills.
TIP: Baking soda is useful for removing damp vomit stains from carpet and clothing, and taking away the smell. If the stain is not fresh, wet it then sprinkle on a thick layer of baking soda, wait a couple of hours and vacuum it off.
Are there any ways to prevent it?
Your doctor may prescribe a thickener to add to feeds, or treatment to help reduce stomach acidity such as an antacid or, in more severe cases, a drug that temporarily switches off production of stomach acid.
Occasionally, if symptoms are severe, or treatment doesn’t work, your baby may have a few tests (eg barium swallow, endoscopy, pH probe measurements) to confirm the cause and severity of the problem.
Where reflux is severe, an operation called a fundoplication may be needed to help tighten the valve muscles around the stomach opening. This is only performed as a last resort when all other measures have failed, however.
Will she grow out of it?
As the valve closing off your baby’s oesophagus develops more fully, it usually starts to work properly. The problem often resolves by the time a baby is one year old.
Will my next baby get it?
Reflux is more common in boys, although girls can get it too. It has been estimated that, if you have a baby boy with reflux, there is a high chance (66%) that your next baby will be affected, too. If you have a girl with reflux, however, the chances of your next child also having the problem are thought to be higher – perhaps as high as 99%. However, every baby and every family are different, so think positively – your next baby may well be a perfect feeder.
Article written By Dr Sarah Brewer in response to an "Ask the Doctor" question.
Glue ear is caused by a blockage of the Eustachian tube in the ear but, unlike the pus caused by an infection, this fluid is sterile, although it may still cause earache.
The tube can become blocked due to allergies, swollen adenoids or acute otitis media (an ear infection) and other infections of the nose and throat. The build up of fluid prevents the bones in the ear and the ear drum from vibrating normally, and thus can cause some hearing loss. Poor hearing may affect a child's speech development and their ability to learn and interact with others. Normally, the fluid is thin and eventually drains naturally, but occasionally it becomes thick and glue like - hence the expression 'glue ear'.
Doctors can tell if there is fluid in the middle ear by looking at the condition of the ear drum, testing the child's hearing and measuring the middle ear pressure. If the fluid does not drain by itself a doctor may remove it by making a tiny opening in the ear drum under anaesthetic and sucking it out.
Your doctor may suggest fitting grommets in the ear drum at the same time as the fluid is drained. The grommets, which are tiny plastic hollow tubes, prevent fluid from building up. They generally remain in the ear for between 6 and 18 months after which they fall out and the hole heals up and hopefully the middle ear stays free of fluid.
Headlice are small insects, about 2mm in length that are found on the scalp. They feed off blood by making tiny pin-pricks in the scalp and sucking blood through the little hole. When a louse lands on a person's scalp they lay eggs (called nits) which adhere to the base of the hair follicle.
Headlice are passed from person to person by close contact or by sharing hairbrushes, hats etc. Consequently headlice can spread rapidly amongst children so it is very important to let the nursery know as soon as you suspect your child may have headlice, to try to minimise the spread.
Ways to spot for headlice :-
- look for the lice by initially looking behind the ears, the nape of the neck and the crown of the head. The lice appear as small pinheads stuck close to the scalp and may be distinguished from dandruff by the fact that they are not easily removed.
- a rash on the scalp.
- your child may itch his or her scalp.
Ask your pharmacist for advice on getting rid of the headlice - they may suggest a lotion/shampoo, or they may suggest a 'nitcomb' which is used in conjunction with hair conditioner to remove the headlice. It is important that all affected children and adults in the household are treated, otherwise the problem will recur.
Hand, Foot and Mouth disease
In some countries the virus is called Coxsackie, after the town of Coxsackie, New York, where the virus was first identified.
Hand, foot and mouth disease is caused by a virus. It usually affects children under 10 years.
The illness usually starts suddenly with a sore throat, temperature (fever) and small, blister-like sores develop in the mouth and on the hands and feet.
It's highly contagious and is easily transmitted through coughing and sneezing. The virus is also spread through faeces, so hygiene in the home is very important.
The incubation period (the time between the infection and outbreak of the condition) is about 3 to 5 days. A child is most contagious in the week before symptoms appear, so it can be hard to anticipate or prevent.
There is no specific treatment for the infection. The infected person will get better on their own without treatment. The blisters in the mouth usually clear within 4 to 6 days and the blisters on the body usually last for 7 to 10 days.
A child who has a temperature (fever) should be kept cool by a fan, by reducing the amount of clothing/bedding and by sponging the child down with cool water. If advised by your doctor, give paracetamol to children in the dose prescribed for the child's age.
Your child should stay away from nursery until the blisters have gone.
The purpose of immunisation is to prepare our body to fight against diseases in case we come into contact with them. To do this immunisation gives the body a modified, but not dangerous, form of a bacteria, virus or toxin (poison) to 'alert' the immune system to it. Therefore if the infection is encountered later in life, the body is already ready to act against it. For example, when your child is immunised against polio the immune system is stimulated into producing antibodies against the disease. Therefore if your child comes into contact with polio their body will have produced the antibodies to fight it.
Some immunisations have to be given more than once to keep the level of antibodies topped up - this is known as a 'booster'.
Generally there are few side effects from immunization, however, your child may become irritable, feel unwell and have a temperature. Very rarely, your child may have an allergic reaction straight after an immunization. If you have any concerns after your child has been immunized you should consult your child's doctor.
Health Promotion England have a great site with lots of information about immunisation. Their web address is www.immunisation.org.uk
The Department of Health also has information about the MMR immunization. Their web address is www.doh.gov.uk/mmrvac.htm
If you have any worries or futher questions about immunisation please contact your doctor or health visitor.
Impetigo is a bacterial infection of the skin that is very infectious and itchy. It begins as small blisters around the nose, mouth and/or ears that turn into areas of pus covered in thin skin. After a day or two these become hard and form crusty, yellowish scabs.
You should consult your child's doctor who may prescribe an antibiotic cream. At home, your child should avoid contact with people as much as possible, and ensure that your child uses separate flannels and towels.
You should consult the nursery to see when your child should return.
Jaundice occurs when the yellow pigment that is normally excreted in the bile builds up in the blood due to the liver, which produces the bile, not working properly. Consequently, the child's skin and the whites of their eyes turn yellowy.
Jaundice often affects babies soon after birth, especially if they are born prematurely. This is due to the liver being immature. In older children jaundice is much rarer but can be due to infective hepatitis (inflammation of the liver). Symptoms of infective hepatitis are loss of appetite, headache, nausea and vomiting, abdominal pain (due to an inflamed liver) and sometimes a fever can be present.
Jaundice in a new born often clears within a few days without treatment although phototherapy (which is treatment using light) may be needed.
If you suspect your child of having jaundice you should consult your child's doctor.
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Leukaemia is the most common childhood cancer and it is a cancer of the white blood cells. The bone marrow produces too many abnormal white blood cells to the detriment of the normal white cells, red cells and platelets. These abnormal cells then get into organs such as the spleen and liver and affect their ability to work properly.
Symptoms of leukaemia are:-
- excessive tiredness
- pain in the bones and joints of the arms and legs
- bleeding ie;blood in stools and bleeding gums when cleaning teeth
- excessive bruising
- persistent infections
If your child exhibits any of these symptoms you should consult your child's doctor.
The Leukaemia Research Fund (020-7405-0101) have a very good website www.lrf.org.uk,which is full of information and they have a patient information booklet titled "Acute leukaemia in children" available.
The Leukaemia Care Society (0845-7673203) provides information and supports people through a 24 hour careline (0800-169-6680).
Measles, along with mumps and rubella (German measles) were once common childhood illnesses but are now quite rare due to immunisation (the MMR vaccination is given to babies between 12 and 18 months).
Measles is one of the most contagious viral diseases and anybody who has not already had measles can be infected. If pregnant women catch measles it can cause an infection of the unborn child and may, in the worst case, result in foetal death.
The incubation period (the time between the infection and the outbreak of the condition), is usually one to two weeks. Patients are infectious from four days before the onset of the rash until five days after it appears.
The symptoms of measles include a high temperature, a cold, a hacking cough, sore throat, reddish eyes, sensitivity to light and swollen lymph nodes in the throat. Small greyish spots may appear in the mucous membrane of the mouth (just around the molar teeth) and can be seen before the rash appears. The actual rash usually begins around the ears and spreads to the body and legs within a couple of days. The rash begins as small red spots that quickly increase in size and begin to join together.
Your child's doctor should be consulted as soon as your child appears unwell.
Meningitis is a rare but very serious illness that needs urgent medical attention. Children under the age of one are most at risk from meningitis, followed by children from one to five. Vaccination providing protection against group C meningococcal infection (which causes about 40% of cases) is now available although there is not a vaccination available for the group B strain.
It can be caused by several different viruses or bacteria which cause inflammation of the lining of the brain which is called the 'meninges'.
Viral meningitis is not usually life-threatening where as bacterial meningitis is a severe and life-threatening illness. The most common bacterial cause is the meningococcus bacteria, which can also lead to septicaemia (blood poisoning). The child can become ill very quickly and it is vital that if you suspect your child has meningitis you should get them to a doctor immediately.
Signs and symptoms in babies and very young children:-
- a rash that may be anywhere on the body. If your child has a rash you should try the tumbler test : firmly press a glass against the rash and if the rash does not fade, but remains visible through the glass, meningitis should be suspected and urgent medical attention sought.
- difficulty waking/unusually sleepy
- a high pitched cry
- repeated vomiting and not just after feeds.
- loss of appetite
- a tight or bulging soft spot on your baby's head (called the fontanelle).
- a temperature may or may not be present.
Signs and symptoms in older children:-
- a rash which doesn't fade when you do the tumbler test (see above for details)
- a constant headache
- a high temperature
- loss of appetite
- intolerance of light
- a stiff neck - your child may find it painful to bend the neck to the chest
If your child exhibits one or more of these signs and symptoms you should contact your doctor immediately
The Meningitis Trust runs a 24 hour helpline (0845-6000-800 local rate) led by a nurse. They also have a website www.meningitis-trust.org.uk.
The Department of Health which can be contacted via their website have a very good, detailed section on the meningitis vaccine. The address is www.doh.gov.uk/meningitis-vaccine/index.htm
Many babies often get a kind of rash called milia, soon after birth. It looks like tiny white or yellow bumps or spots across the tip of the nose or chin. They are caused by overactive oil glands in the face which have become overactive due to the trace amounts of their mother's hormones circulating in their system. The spots usually peak when babies are about 3 weeks and generally clear about a month or so later without any medical intervention. Avoid touching or squeezing the spots as this will only make matters worse. If you think the spots are milia, but you're not sure, it may be worth asking your doctor or health visitor.
Mumps along with measles and rubella (German measles) were once common childhood illnesses but are now quite rare due to immunization (the MMR vaccination is given to babies between 12 and 18 months).
Mumps is a viral infection spread by sneezing or saliva. Although small children can get mumps, the disease is most common after the age of two.
The incubation period, (the time between the infection and the outbreak of the condition), can be as long as three weeks. Patients are infectious for about a week before the onset of the rash and for about ten days after.
Mumps normally begins with an increasing temperature and red watery eyes, followed by swelling of the glands under the jaw. Your child may have a headache, earache and pain on chewing and swallowing. Boys can occasionally get pain in the testicles due to inflammation. Viral meningitis is a rare complication.
Your child's doctor should be consulted, particularly if your child develops a stiff neck, persistent earache, swollen testicles or abdominal pain.
Most babies will suffer from nappy rash at some point. Some get it very occasionally whereas others seem to get it a lot more - it seems that some babies skin's are more sensitive than others.
Nappy rash is a skin irritation that occurs on the skin of a baby in the nappy area. It can be caused by ammonia which is produced if a wet or dirty nappy is not changed for a while. The ammonia begins to eat into the baby's skin causing it to sting. Alcohol, which is found in a lot of baby wipes can also trigger nappy rash. If you use terry nappies it may be that the washing powder you use, especially if it is biological, may cause nappy rash.
Not all nappy conditions are nappy rash, it could also be heat rash, eczema or thrush.
Symptoms of nappy rash vary from fairly mild sore red spots, to skin that is red and cracked and sometimes blisters as well.
To treat nappy rash you should ensure that your babies nappy is changed frequently, you should let your baby be without a nappy as often as possible (may be easier said than done!), use alcohol free wipes (or better still cotton wool and water), and a zinc and castor oil cream can be used at every nappy change.
If you have any concerns or the rash does not disappear please consult your child's doctor.
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(see Whooping Cough)
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Roseola is a common infection characterised by a fever and a rash, and it generally strikes children between 6 months and 2 years. Roseola is contagious before the rash is visible and passed on through oral secretions.
During the first few days of roseola you child may have a slightly raised temperature along with a runny nose, mild diarrhoea, sore throat, earache or decreased appetite. As their temperature returns to normal a rash of tiny red spots appear on body that last a day or two.
Consult your doctor as a precaution but like most viruses, roseola just needs to run its course.
Rubella (German measles), along with measles and mumps were once common childhood illnesses but are now quite rare due to immunization (the MMR vaccination is given to babies between 12 and 18 months).
Rubella is a mild viral infection that is spread via the breath of an infected person.
The incubation period (the time between the infection and the outbreak of the condition) is usually two to three weeks. Patients are infectious a week before the onset of the rash until one week after it has disappeared.
Your child may first develop a mild fever, a light cold and swollen glands before they develop the rash. The slight pink rash begins behind the ears and on the forehead and then spreads to cover the whole body. The spots may join up so that the skin looks flushed. It is not itchy and generally disappears after about two to three days.
No specific treatment is required but consult your child's doctor if you have any concerns.
It must be remembered that the disease is highly infectious and particularly dangerous to pregnant women who have not been immunised. If they catch rubella, in particular during the first three months of pregnancy, it may seriously damage the unborn baby.
The web address www.sense.org.uk/rubella gives more detail on rubella.
Rotavirus is a very common cause of severe diarrhoeal disease in infants and young children and is the main cause of gastroenteritis in children under 2 years.
Infants and young children who become infected with the virus suffer vomiting, fever and watery diarrhoea. Most cases are mild, but in severe cases the child can become very dehydrated. Because infection is so common, most children will develop immunity to the virus within their first two to three years of life
It is highly infectious and the incubation period (the time between the infection and outbreak of the condition) is approximately 48 hours.
There are no appropriate drug treatments. You need to ensure that your child is drinking plenty of fluids but if at all concerned you must contact your doctor.
Your child should not return to nursery until the vomiting and diarrhoea have stopped and your child no longer has a temperature.
Scabies is caused by an eight-legged mite which burrows into and under the skin and deposits its eggs. It's burrowing, the faeces it leaves, and the eggs eventually cause a significant allergic reaction of the skin which accounts for the rash and the itching. The time between the mite's initial burrowing and the rash to appear is about one month. The rash is composed of very itchy red bumps on the skin which are sometimes filled with pus. In babies the rash occurs particularly on their hands and feet but often spreads to other parts of the body. In older children the rash may be found in the crevices of the body, such as the armpits, although again it can be found in other parts of the body as well.
Scabies is very contagious and generally when a child is diagnosed with it everyone in the family should be treated at the same time. Treatment tends to be in the form of a cream prescribed by your doctor. However, because the itching is an allergic reaction, it can be a good week or so until the itching eases off.
Slapped Cheek Disease
Slapped cheek disease is a viral infection that, as the name suggests, makes your child's cheeks red and look as though they've actually been slapped. A rash may also appear on your child's body and limbs. Your child may have a slight fever and feel achy and flu-like or have no other symptoms at all. The rash is not itchy but can last up to 14 days. Like other viruses, it is contagious and thus can be caught, for example, by hand-to-hand contact and sneezing. Your child is most contagious the week before symptoms appear and once the rash appears he is minimally contagious. Please consult the nursery to discuss when your child should return.
There is no treatment for it and it disappears by itself.
Pregnant women are at a small risk of slapped cheek disease if they haven't had the virus as a child so if you're pregnant and have been exposed to the virus, please consult your GP. In rare cases, the virus can cause miscarriage in early pregnancy.
Scarlet fever is a fairly common childhood illness. It is caused by bacteria (streptococci) and the main symptoms are a bad sore throat and fever.
It produces a rash which appears as a fine, raised, red rash (feels like sandpaper) which disappears momentarily when pressed. It is most commonly found on the neck, chest, under the arms, elbows and inner thighs. The child's face appears flushed and with no rash.
It is infectious to close contacts of the patient.
The incubation period (the time between the infection and outbreak of the condition) is usually 1-3 days.
Penicillin reduces the length of the illness and the possibility of rare complications. There are alternatives for people allergic to penicillin.
If you think that your child may have Scarlet Fever you should consult your doctor.
It is important that you keep a child with a fever cool by reducing clothing and bed clothes. If advised by the doctor give paracetamol in the dose prescribed for the child's age.
Sponging a child down with cool water will help to bring the temperature down.
If possible, babies and people with low resistance to infection (immunosuppression) should avoid contact with the patient.
Children are infectious from the day the sore throat starts until 24-48 hours after starting antibiotics. After that they should be able to return to nursery.
Threadworms are very common and nearly half of all children under ten have had them at some time. The eggs are present in dust and because they are so small and widespread they get under finger nails and are easily swallowed. Once inside the bowel they hatch into worms and feed on the contents of the intestine. They then travel to the rectum where they lay their eggs around the anus. This is what causes the itching, which is the main symptom of threadworms.
In girls the worms can also get into the vagina thus increasing the itching.
Treatment is by a drug that paralyses the worms so that they are unable to lay eggs and are then passed out of the system. A second dose is taken two weeks later to catch any worms that may have hatched in the meantime. The whole family should be treated because the eggs are so easily transmitted. Other ways of minimising the spread of the eggs are to let your child wear pyjama bottoms or pants in bed, to wash your child's bottom every morning, ensure every family member has their own towel that is kept separately from the others, wash hands regularly and ensure that the toilet seat and handle is disinfected regularly.
Thrush is caused by a fungus called Candida albicans. This is normally present in our bodies but occasionally there is an imbalance of it which can cause an infection.
Thrush is most common in babies because mothers have Candida albicans in their vagina and, during birth, their baby's mouth becomes infected.
Thrush generally shows up as white furry patches or spots on the tongue and the side of the mouth which causes it to be very sore. Babies with it generally feed less well as food makes their mouth sore. It is also possible that if your baby has that doesn't clear this may be due to thrush. In older girls vaginal discharge, along with soreness, redness or itching can be due to thrush.
If you suspect that your child has thrush you should consult your child's doctor who will probably prescribe a cream.
The testicles develop in the abdomen during pregnancy, and, before birth, they normally go down into the scrotum. However, occasionally one or both of the testicles do not descend. When your baby boy is born he will be examined to check that both have dropped into the scrotum. If they haven't, the condition will usually correct itself within the first year.
If both testicles haven't descended by the age of one or two, the child will require treatment which is usually surgery. Surgery may be to lengthen the ligament which supports the testicles, or it could be to remove tissue that is preventing the testicles from descending. It is important that the problem is corrected because it appears that testicles do not mature properly when they are not in the scrotum. Consequently the risks of testicular cancer and infertility can be increased.
Urinary Tract Infections
Your child may have a urinary tract infection if they complain of pain when passing urine (it's a burning sensation) and/or if there is blood in their urine. The urine may also be smelly and cloudy. They may also have a fever and a back or stomach ache.
Urinary tract infection can affect the urethra which is the tube leading to the bladder, the bladder and/or the kidneys. If your child frequently suffers from urinary tract infections it could be that they have a structural abnormality of the urinary tract, making it prone to infection.
If you suspect your child has a urinary tract infection you should consult your child's doctor who may take a urine sample to be sent away for analysis. If infection is confirmed, antibiotics will be prescribed. Also, encourage your child to drink a lot of fluid to dilute the urine and make it less painful to pass urine.
A verruca is a wart on the sole of the foot. They are contagious and are generally picked up from contaminated floors in swimming pools. They are caused by the Human Papillomavirus (HPV) of which there are 60 types.
A verruca shows up as a small growth or cluster of growths on the sole of the foot which may have black dots in the middle. They may cause pain and discomfort.
Verrucas are known to be hard to treat and can persist for months or even years. Consult your doctor or podiatrist for treatment advice. Treatment can include cream applied to verruca and the freezing of the verruca with liquid nitrogen.
Whooping cough, which is also known as pertussis, is a very serious disease. Fortunately, due to immunisation which is initially given at two months old, it is now quite rare.
Whopping cough is caused by a bacteria and is one of the most contagious bacterial infections around. The infection is transferred through airbourne droplets and when an infected person coughs. Therefore, anyone who has not been vaccinated is likely to develop the disease if they are in contact with an infected person.
The incubation period, (the time between contracting the disease and the symptoms first showing), is between 5 and 15 days. Whooping cough is contagious from the first sneezes until the end of the disease which can be up to three months.
Whooping cough has three distinct stages:-
- the first is the snuffly phase with a runny nose, a slight cough and a mild fever.
- The second phase is the whooping cough stage. In this stage the child will cough until there is no air left in the lungs. The child will then do a deep intake of air which produces the characteristic 'whooping' sound when the air passes the voicebox. This intense coughing may cause the child to go blue or grey during an attack because of lack of oxygen. The child may also vomit. This phase may last 2 or more weeks.
- The final phase is when the child is coughing more mildly and this may last up to three months.
Most cases of whooping cough require no specific treatment but you should consult your doctor to get their advice. Severe cases of whooping cough may have to be admitted to hospital.
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