Your child's health

Atopic eczema is a common, chronic inflammatory skin disorder, with 50% of cases occurring before the age of one year, and the remainder typically developing by the age of five.

Triggers can include: Pet dander, old mattresses and carpets such as dust mites, central heating, and grass pollen, contacts with soaps and detergents, Staphylococcus and food allergy.

Restoring the lipid barrier of the skin forms a cornerstone of Atopic Eczema treatment. This is basically achieved through avoidance of soap (which strips the lipids from the skin) and the use of emollients to restore moisture and repair the lipid barrier. Emollients work to reduce eczema symptoms by creating a protective barrier on the top layer of the skin, moisturising it and reducing water loss. 

There are many emollients available, on and off prescription. The choice of an appropriate emollient will depend on the severity of the condition, patient preference, and the site of application. Prescriptions for emollients can be given by a Health Visitor or a GP.

Constipation is a decrease in the frequency of bowel movements; characterized by the passing of hardened stools which may be large and associated with straining and pain.

Normal stool frequency in children: ranges from an average of 4 per day in the first week of life to 2 per day at 1 year of age. Passing between 3 stools per day and 3 per week is usually attained by 4 years of age.

Contributing factors include: Pain, fever, inadequate fluid intake, reduced dietary fibre intake, toilet training issues, the effects of drugs, psychosocial issues, and a family history of constipation.

Signs of constipation

Two or more of the following clinical features indicate that a child is constipated:

1. Fewer than three complete stools per week (unless exclusively breastfed, when stools may be infrequent).
2. Hard stools (see the Bristol stool chart: nice.org.uk/guidance/cg99/resources/bristol-stool-chart-pdf-245459773).
3. Large stool.
4. ‘Rabbit droppings’ stool.
5. Overflow soiling in children older than 1 year of age (commonly very loose, smelly stools, which are passed without sensation or awareness).

Watch this video from Dartford and Gravesham NHS Trust about childhood constipation:

Useful links

The organisations below can provide more information and support for parents and carers of children and young people with constipation:

• ERIC (Education and Resources for Improving Childhood Continence): eric.org.uk
• British Association of Dieticians (fluid intake): bda.uk.com/foodfacts/fluid.pdf

You can also go to NHS UK for more information about constipation in children

Caused by viruses, colds can’t be cured by antibiotics. But you can help relieve the symptoms and support your child's body as it fights the virus. Sore throats can be caused by both viruses and bacteria but are not usually serious. Dry coughs are caused by inflammation in the throat while chesty coughs are the result of phlegm being produced by the lungs. Mucus cough occurs when the phlegm is extra thick and needs thinning before the coughing action can work properly.

Gastroenteritis is an infection of the gut which causes diarrhoea, vomiting and tummy pain. Diarrhoea and vomiting are common in adults, children and babies. They are often caused by a stomach bug and should stop in a few days. Severe gastroenteritis can cause dehydration particularly in young children.

Symptoms

• Watery, usually non bloody diarrhoea — bloody diarrhoea usually means you have a different, more severe infection. The usual duration of diarrhoea is 5–7 days and in most children it stops within 2 weeks.
• Abdominal cramps and pain.
• Nausea, vomiting or both. The usual duration of vomiting is 1 or 2 days and in most children it stops within 3 days.
• Occasional muscle aches or headache.
• Low-grade fever (temperature).

The advice is the same if you have diarrhoea and vomiting together or separately.

Looking after a child with gastroenteritis

You can look after your child at home if they have diarrhoea and vomiting. There's not usually any specific treatment and your child should start feeling better in a few days. You don't normally need to get medical advice unless their symptoms don't improve or there's a risk of a more serious problem. To help ease your child's symptoms you can:

• Encourage them to drink plenty of fluids. They need to replace the fluids lost from vomiting and diarrhoea. Water is generally best. Avoid giving them fizzy drinks or fruit juice, as they can make their diarrhoea worse. Babies should continue to feed as usual, either with breast milk or other milk feeds. If they are vomiting, give fluids little and often. Offering small mouthfuls or use a syringe to see if this is better tolerated.
• Make sure they get plenty of rest.
• Let your child eat if they're eating solids and feel hungry. Try small amounts of plain foods, such as soup, rice, pasta and bread.
• Give them paracetamol if they have an uncomfortable fever or aches and pains.
• Use special rehydration drinks made from sachets bought from pharmacies if they're dehydrated. Your GP or pharmacist can advise on how much to give your child. Don't give them anti-diarrhoeal and anti-vomiting medication, unless advised to by your GP or pharmacist.
• Providing regular mouth care is important to maintain oral hygiene. Keep the lips moist by using a lip balm and clean teeth regularly.

Make sure you and your child wash your hands regularly while your child is ill and keep them away from school or nursery until at least 48 hours after their symptoms have cleared.

Preventing spread of infection:

• Washing hands thoroughly with soap (liquid if possible) in warm running water and careful drying is the best way to prevent the spread of gastroenteritis. Don't rely on alcohol hand gels, as they're not always effective.
• Hands should be washed after going to the toilet and changing nappies, and before preparing, serving, or eating food.
• Toilet seats, flush handles, wash-hand basin taps, surfaces, and toilet door handles should be cleaned at least once daily with hot water and detergent. A disinfectant and a disposable cloth (or one dedicated for toilet use) should be used to clean toilets. It's best to use a bleach-based household cleaner.
• Towels, flannels and cutlery used by infected children should not be shared.
• Soiled clothing and bed linen should be washed separately from other clothes and at the highest temperature they will tolerate (for example 60°C or higher for linen). Soaking in disinfectant is not necessary. The washing machine should not be more than half full to allow for adequate washing and rinsing.
• Children should not go back to school or other childcare facility until at least 48 hours after the last episode of diarrhoea or vomiting.
• Children should not swim in swimming pools for 2 weeks after the last episode of diarrhoea.

Getting medical advice for your child

You don't usually need to see your GP if you think your child has gastroenteritis, as it should get better on its own, and taking them to a GP surgery can put others at risk.

Phone the 111 service or your GP if you're concerned about your child, or they:

• Have symptoms of dehydration, such as passing less urine than normal, being unusually irritable or unresponsive, pale or mottled skin, or cold hands and feet.
• Have blood in their poo or green vomit.
• Are vomiting constantly and are unable to keep down any fluids or feeds.
• Have had diarrhoea for more than a week.
• Have been vomiting for three days or more.
• Have signs of a more serious illness, such as a high fever - temperature of 38°C or higher in children younger than 3 months temperature of 39°C or higher in children aged 3 months or older, shortness of breath, rapid breathing, a stiff neck, a rash that doesn't fade when you roll a glass over it or a bulging fontanelle (the soft spot on a baby's head).
• Have a serious underlying condition, such as inflammatory bowel disease or a weak immune system, and have diarrhoea and vomiting. 

Most headaches will go away on their own and aren’t a sign of something more serious. 70% of young people experience a headache at least once a year. Young people’s headaches may be different to adult’s headache.

For more information and advice when medical help is needed click here

Migraine is not just a headache; migraine can cause the following symptoms:

• Feeling sick or vomiting,
• Being extra sensitive to light or sound
• Tummy pain
• “Aura”- visual disturbances, confusion, numbness and/or pins and needles.

Migraine can be easily be overlooked so you should seek help from your GP if you have any of these symptoms.

Migraine triggers

It is often not just one thing that triggers a migraine attack. If potential causes can be identified, it may be possible to reduce the number of attacks by making changes to your lifestyle and diet.

Common triggers to migraine can include:

• Dehydration – not drinking enough water
• Stress and anxiety including exams
• Certain foods including chocolate, cheese, citrus fruit
• Puberty and hormonal changes
• Not eating regularly
• Changes in sleep pattern
• Too much TV/video games
• Not enough fresh air
• Change in weather
• Flickering lights or reflections in water
• Exercise without food

Head lice infestation is a condition caused by a parasitic insect. Live lice can be found anywhere on the scalp; the eggs are most commonly found behind the ears and at the back of the neck. The severity of infestation varies from a few lice to thousands of lice, but a typical infestation might have about 30 lice per head. Head lice infestation is most common in children 4–11 years of age.

Confirming active infestation of head lice includes systematic combing of wet or dry hair with a head lice detection comb. A live louse must be found in order to confirm active head lice infestation. An itching scalp is not sufficient to diagnose active infestation.

The presence of louse eggs alone, whether hatched (nits) or unhatched, does not indicate active infestation as it is hard to distinguish between dead and live eggs with the naked eye, and eggs may maintain a viable appearance for weeks after death.

All members of the household and close contacts should also be checked for head lice as untreated family members and close contacts may cause re-infestation in the people, who have been treated.

Treatment of head lice

First line treatment is Dimeticone 4% lotion (Hedrin) which is a physical insecticide. This can be purchased over the counter or be given as a prescription. It is rubbed into dry hair and scalp, allowed to dry naturally, shampoo is applied and rinsed off after at least 8 hours (or overnight). A repeat application is needed after 7 days. This prescription can be given by a Health Visitor or a GP.

Find out more on the NHS website

As a general rule, a temperature of 38C (100.4F) or above is classified as a fever in children.

But this can vary from child to child. Some children may be ill with a lower temperature, while others may have a higher temperature and be perfectly well.

What’s most important is what’s normal for your child. You know your child better than anyone – if you’re concerned about their temperature, they probably have a fever.

Find out how to take your child’s temperature.

When to get medical advice

Mild fevers are usually nothing to worry about, and can often be treated at home. They normally pass in a few days.

Read about how to treat a high temperature in children.

Contact your GP, health visitor or NHS 111 if:

• your child is under three months old and has a temperature of 38C (101F) or above
• your child is between three and six months old and has a temperature of 39C (102F) or above
• the fever lasts more than five days
• your child has a fit (seizure) for the first time
• your child also has signs of a serious illness, such as blotchy skin or fast breathing
• you’re worried about your child – trust your instincts if you think they could be seriously ill

Further information: 

• Can I give my child painkillers? 
• How do I take someone’s temperature? 
• Febrile seizures 
• Fever in children 
• Recognising signs of serious illness 

These itchy, temporary rashes are caused by histamine release from blood vessels in response to an allergic reaction. Cause/triggers can be new drugs, heat, sun, food allergy.

Symptoms are on examination pale weals on pink/red flare.

Treatment is an over the counter, dose-related antihistamine i.e. Chlorphenamine (Piriton) from age of one. If under one your child would need to see a GP/Independent Nurse Prescriber for a prescription. The rash will usually settle after a few days. Caution - if a drug allergy is suspected stop drug and refer to doctor.