1601-west cheshire cci 0-4.qxp 6521-cornwall...a guide to services 4 know the basics 6 children’s...

A Parent’s Guide

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m Commonchildhood illnesses &well-being

Children aged 0-4

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

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

Grazed kneeSore throatCoughs and colds

As a parent if you are:UnsureConfusedNeed help

Mild diarrhoeaMild skin irritations (includingspots/rash)Mild fever

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

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

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

ChokingLoss of consciousnessFittingBroken bones

Self Care

NHS 111For 24 hour health adviceand information.

PharmacistFor advice on commonillnesses, injuries andmedication.

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

Minor Injuries UnitFor treatment of minorillnesses and injurieswithout an appointment.

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

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

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

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

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

Write your GP (family doctor) telephone numberhere:

Minor Injuries Unit or Walk-in Centre

A&E

A&E

NHS West Cheshire Clinical Commissioning GroupNHS Vale Royal Clinical Commissioning Group

1601-West Cheshire CCI 0-4.qxp_6521-Cornwall 19/01/2016 09:59

WelcomeThe first years of a child’s life are crucial to their healthy development andwill have a big influence on their well-being. Parents, carers and otherfamily members are often children’s prime carers and educators.

During the early years we can start to lay the foundations for positive long-term development. The time before school starts is also the perfect time forfamilies to adopt a positive attitude to their health and well-being. If parentsare confident they are doing all they can to make sure their children aresafe, well-nourished, play and learn actively and create opportunities whichbuild social and emotional confidence, they can rest assured that they aredoing all they can to lay the path for a happy and positive future.

As well as general well-being, this handbook will help you to understandwhen is the right time to call NHS 111, visit your GP, chat to your healthvisitor or take a visit to your local pharmacy.

Every parent wants to know what to do if their child is unwell and how torecognise the signs. Trust your instincts, you know your child best, so if youare worried get further advice.

Visit www.cheshirewestandchester.gov.uk/fis orwww.valeroyalccg.nhs.uk or www.southcheshireccg.nhs.uk or www.westcheshireccg.nhs.ukto view this booklet online.

All factual content has been sourced from Department of Health, NHS Choices, BritishAssociation of Dermatologists, Meningitis Now, NICE guidelines.

Who can help?A guide to services 4

Know the basics 6

Children’s medicines 7

The first monthsFeeding your baby 8

Crying & colic 10

Teething trouble 12

Nappy rash, rashes & dry skin 14

Sticky eyes & conjunctivitis 16

Sleeping 18

Bonding & communication 20

Childhood illnessesFever 22

Meningitis & sepsis 24

Coughs, colds & flu 26

Wheezing & breathing difficulties 28

Earache & tonsillitis 30

Asthma 32

Allergies 34

Chickenpox & measles 36

Diarrhoea & vomiting 38

Constipation 40

Well-beingA healthy start 42

Fussy eaters 44

Immunisations 46

School readiness 48

Burns, scalds & shocks 50

Choking & poisoning 51

Household accidents 52

Smokefree homes 54

Useful contacts 55

Contents

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To view this booklet via the app, search

cheshire child health

1601-West Cheshire CCI 0-4.qxp_6521-Cornwall 19/01/2016 09:59 Page 3

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Health visitorHealth visitors are there tosupport you when you needthem. They will visit you athome or see you in a clinic.They offer support and adviceand can tell you where to getextra help if you need it. Theyare part of a team who arethere to support you during the early years.Your midwife may be thehealthcare professional whoknows you and your baby bestin the early days. They can helpwith any feeding problems.

GP (Doctor)You will need to registerwith a local GP. Your GPcan advise, give you themedicines you need andpoint you in the rightdirection if you needother specialist services.You will usually need tomake an appointment. AllGPs will see a childquickly if you are worried.After 6.30pm weekdays,at weekends and publicholidays you can call theGP out-of-hours serviceon NHS 111.

A directory of localinformation forCheshire West andChester residents. www.westcheshirelocaloffer.co.uk

A guide to services

If you think you need help urgently duringthe day or night you should call NHS 111before you go to any other health service.

By calling NHS 111 you will be directed straight awayto the local service that can help you best. It is available24 hours a day, 365 days a year and is free to call,including from a mobile. You should 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 illnesses can be treated in your home by usingover the counter medicine from your pharmacist andgetting plenty of rest. Self care is the best choice totreat very minor illnesses and injuries. If you are stillworried call NHS 111 or your GP.

Self care

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 may be choking or breathing difficulties,unconscious or unaware of surroundings, takenpoison or tablets, severe abdominal pain, fewerwet nappies suggesting dehydration.

DentistMake sure you see adentist on a regularbasis. Discussregistering your childearly on with yourdentist and take themwith you toappointments.To find your nearestdentist visitwww.nhs.uk For out-of-hoursdentist informationcall NHS 111.

Children’s centresChildren’s centres are familyfriendly environments whichprovide support and advicefor your child’s health anddevelopment up until theystart school. Activitiesinclude stay and playsessions, infant feedingsupport groups andparenting sessions. For local centre information,see www.cheshirewestandchester.gov.uk and searchfor children’s centres.

There are a wide range of healthcare and children and family services.See which service or professional is best to help you.

PharmacistYour local pharmacistcan provide advice onmost common healthissues and can suggestand dispensemedicines. There areoften pharmacists insupermarkets and manyare open late.

Visit www.nhs.uk to findthe pharmacy nearestto you.

Local Offer


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Being prepared and knowing the signs

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 ibuprofenConsider using either sugar-free paracetamol or ibuprofen for children withfever who appear distressed (as a general rule a temperature of over 37.5°C99.5°F), as these can help to reduce fever and distress. Treat them with eitherparacetamol OR ibuprofen in the first instance. It can take up to an hour foreither of them to work. Paracetamol and ibuprofen should NOT be giventogether at the same time. However, if your child remains distressed before thenext dose is due, then you may want to try a dose of the other medicine.Aspirin should not be given to children under 16 years of age.

Parents are usually good at noticing when something is wrong. However, it isnormal to worry that you won't recognise the signs that your baby is unwell. Trustyour 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. Do not give aspirin to children under 16.

Find out about CPR (resuscitation) before a possible emergency, visitwww.redcrossfirstaidtraining.co.ukIf your baby seems to have a serious illness get medical help straight away.

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Children's medicinesNot always needed for childhood illnesses

Antibiotics for childrenIf you’re offered a prescription for anantibiotic, talk to your GP about why it isneeded and how it will help. Ask aboutany possible side effects for example,whether it could make your child sleepy orirritable and other side effects likesickness and diarrhoea.

Repeated use and misuse of antibioticsare some of the main causes of theincrease in resistant bacteria. Antibioticsare now no longer routinely used to treatchest infections, ear infections inchildren and sore throats.

If your child is prescribed antibioticsalways finish the whole course to makesure all the bacteria are killed off. Yourchild may seem better after two or threedays, but if the course is five days, theymust carry on taking the medicine. Theillness is more likely to return if your childdoes not finish all the antibiotics.

Most illnesses get better by themselves and make your childstronger and able to resist similar illnesses in the future.

Paracetamol and ibuprofen are often used to relieve the discomfortcaused by a high temperature. Some children, for example those withasthma, may not be able to take ibuprofen, so check with yourpharmacist, GP or health visitor.

Don't give aspirin to children under 16, and if you're breastfeeding, askyour health visitor, midwife or GP for advice before taking aspirin yourself.

Children don’t often need antibiotics. Most childhood infections are causedby viruses. Antibiotics are medicines which kill bacteria. They work onlyagainst bacteria, not the viruses that cause the majority of sore throats,colds, sinus infections and bronchitis. For bacterial infections however,antibiotics work quickly and symptoms usually improve within 24-48 hours.Often children can feel completely better shortly after beginning the antibioticcourse. To beat the bacterial infection, it is important that your child finishesthe entire course as prescribed, even if your child seems better.

1 2 3My child has a bad coldand I want to get someantibiotics from my GP.

Do not expect your GPto automatically giveyou antibiotics (or anyother medicine).

Antibiotics aren'talways the answerwhen your child isunwell.


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.

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The best start in life

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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

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2

1

Source: DoH, www.lullabytrust.org.uk

1 2 3Have you been shownhow to hand express?This is a really usefulskill, and it's free.

For one-to-one assistanceor further breastfeedingsupport speak to yourmidwife, health visitor orchildren's centre.

Go to your local BreastfeedingSupport Group. Other mumsand Peer Supporters will bethere to give you lots of tips.See page 55 for contact details.

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 baby


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Health visitor saysYou will know your baby bestof all. Try to understand what itis they need. Finding out whyyour baby is crying is often amatter of going through all thepossible options.

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?

These are simple things whichcould be causing your baby to cry.

Crying & colicUnderstanding why

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GP saysIf your baby's crying seemsdifferent in any way (such as avery high-pitched cry or awhimper), then seek medicaladvice. Crying can sometimesbe a sign that your baby isunwell. Trust your instincts -you know your baby best.

1 2 3My baby is cryingmore than usual.

When a baby cries,it can be upsetting.

It is very important to stay calmand don’t be afraid to ask forhelp. Do not shake your baby.

All babies cry, especially in the first few weeks after birth. Crying is their way ofletting you know they need something or are uncomfortable. They may needchanging, they may be hungry or just need a cuddle. Always burp your baby aftera feed as this will help.

Early signs that your baby may be hungry are things like putting their hands to theirmouth, becoming restless and stretching. By recognising these cues you may avoidhunger crying altogether and the need to calm baby down before a feed.

If you feel you can’t cope with your baby’s crying, it can help to talk to otherparents. There are support groups such as www.cry-sis.org.uk

ColicIf 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 andimproves on its own. The most common symptom of colic is continuous crying,which typically occurs in the late afternoon or evening. Other signs include a flushedappearance, drawing their legs to their chest, clenching fists, passing wind andtrouble sleeping. Infacol can help relieve pain from colic which may be caused byswallowing air (trapped gas).


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

All sorts of things are put downto teething - rashes, crying,bad temper, runny noses, extradirty nappies. Be careful not toexplain away what might be thesigns of illness by assuming it’s‘just teething’.

Dentist’s 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.

5. Offer your child water or milk to drink rather than juice or squash.For help accessing an NHS dentist call NHS 111 or visit www.nhs.uk

Every baby goes through it

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Teething trouble

Pharmacist saysIf your baby is uncomfortable,you can buy some medicinefrom your local pharmacy.These medicines contain asmall dose of painkiller, suchas paracetamol, to help easeany discomfort. The medicineshould also be sugar-free.Make sure you read allinstructions and that theproduct is suitable for the ageof 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.

Have you asked yourhealth visitor aboutteething? Have youdiscussed options withyour pharmacist?

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. Brush their teeth with a soft babytoothbrush and a smear of family toothpaste. See your dentist regularly and discussyour child’s oral health with them. Take your baby with you so they get used to thesurgery early on. Your child will need help with brushing until the age of seven.


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This is the name given to the large greasyyellow or brown scales that appear on yourbaby’s scalp. Sometimes they may flake andthe skin may be red. It should not cause yourbaby any discomfort and should settle overtime. It is important not to pick at the scalesas this may cause infection.

If this does not settle, the redness spreads oryour baby is itchy then seek medical advice.

Gently wash the scalp and use asoft baby brush or cloth and gentlyremove any loose scales.

Massaging baby oil or natural oil -such as almond or olive oil - intotheir scalp at night can help loosen the crust.

Health visitor’s cradle cap tips Rashes & dry skinIt’s normal for babies to develop rashes early on as their skin adapts to a differentenvironment. If your baby develops a rash and seems unwell contact your GP. Mostrashes are nothing to worry about but do be aware of the signs of meningitis (seepage 24).

Nappy rashNappy rash is very common and can affect lots of babies. It is usually caused whenyour baby's skin comes into contact with wee and poo that collects in their nappy.A nappy rash causes your baby's skin to become sore.

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

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

A common problem that’s easy to treat

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

There are two types of nappycream available. One is abarrier cream to keep wetnessaway from your baby's skin.The other is a medicatedcream, that is good for clearingup any soreness but shouldonly be used when advised bya health professional.

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

Has baby been in a dirty nappy fora long time? Have you followedadvice from your health visitor, orspoken to your pharmacist?

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

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

Use a barrier cream.(see Pharmacist saysbox opposite).

Remember tochange and checktheir nappy often.

Health visitor’s nappy rash tips


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Health visitor saysSome babies have watering eyes.Massaging the tear ducts may helpto dislodge tears that have collectedin the upper part of your baby’s tearduct, as well as encouraging thetear duct to develop. This can bedone by applying light pressure withyour 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 may bereferred to an eye clinic fortreatment. Source: NHS choices

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

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

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

Two different issues

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ConjunctivitisThe signs of ‘sticky eyes’ cansometimes be confused with aninfection called ‘conjunctivitis’.With conjunctivitis the white ofthe eyes become red and thereis more yellow or green stickygoo which comes back regularly.If you notice this and it continuesfor more than 24 hours, contactyour health visitor or GP. Thiscan be passed on easily, sowash your hands and use aseparate towel for your baby.

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

Sticky eyes is a commoncondition that affects mostbabies, speak to yourhealth visitor.

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

Sticky eyes & conjunctivitis


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Call 0300 123 1044 or visitwww.nhs.uk/smokefree

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 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.

Source: www.lullabytrust.org.uk

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 baby atsix 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 in yourbedroom for the first six months. Prepare a warm, comfortable place to relax in. Try toavoid always rocking your baby or ‘feeding them’ to sleep as this can become a habit.Adult beds are not designed for babies and do not conform to safety standards. Onlybreastfeeding babies should ever be fed in bed and should be positioned on theoutside of the bed and returned to their cot after the feed.

As they become toddlers, bedwetting may be stressful for both of you and can wakeyour child. Try not to lose your patience or punish them, your child is not doing this onpurpose. Children learn at their own pace and praise and support will help.

You can help your baby to sleep safe and sound by keeping the temperature in theirroom between 16-20°C. A basic room thermometer will help you to keep an eye onthe temperature.

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A variety of factors may causelanguage and speech delays,including:• Lack of communication from

parents or carer.• Lack of emotional bonding.• A learning disability.• Hearing loss, which may occur in

children who have severe middle earinfections or occur as a result ofcertain medications, trauma, orgenetic disorders.

• Autistic spectrum disorders (ASD) agroup of neurological disorders thatmay involve impaired communicationas well as impaired social interactionand cognitive skills.

It helps to talk to your child andencourage sounds and speech froman early age.

Helping children thrive

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Look out for signs ofemotional attachmentdelays, including:• They do not like to be touched

or hugged.• They are indiscriminately

affectionate with strangers.• They resist social interaction.• They seem to want to be

alone.• Display intense anger (rage).• They can be destructive or

aggressive.

If you suspect a child may haveattachment difficulties they willrequire a specialist assessment.Talk to your health visitor,nursery nurse or GP.

1 2 3I feel my toddler doesn’twant to communicatewith me, he seems toavoid any contact.

Does he seem to want toengage with strangers,need to be alone andresists being hugged?

Speak to your healthvisitor, who may refer youto a specialist service.

The bond (attachment, connection) is the unique emotional relationship between youand your baby. If a parent or carer is responsive to a baby’s signals or cues andcommunicates with them from birth onwards, babies develop a secure attachment.Communication is the foundation of relationships and bonding and is essential forlearning, play and social interaction.

Language (including body language) is how we get to know and bond with oneanother and build relationships. In talking and listening, we help our child developand learn as well as make close connections.

What can I do to help my baby’s communication?By consistently responding to your baby’s sounds, gestures and facial expressions,they should be developing the skills which are needed to begin using language bythe end of their first year. Be positive and use praise, try not to use too much ‘babybabble’. Read stories, rhymes and sing together. Talk to your baby about everydaythings. Look at pictures and repeat words. Give them some of your undividedattention with your mobile phone and TV switched off.

If your child seems to be having difficulties chat to your health visitor or nurserynurse in the first instance, they may recommend Parenting Programmes or helpyou get more support if you need it.

Bonding & communication


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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

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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 in preventing your child from becoming dehydrated, whichcan 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 24).

• Check child during the night.

Source: NICE, Feverish illness in children/2013

Part of the body’s natural response


24

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

In this example the spots are stillvisible through the glass. This is calleda non-blanching rash - it does notfade. Contact a doctor immediately(e.g. your own surgery or Walk-in/Urgent Care Centre). If you cannot gethelp straight away go to A&E.

In this example the spots under theglass have virtually disappeared. It isunlikely to be meningitis but if you are still worried call NHS 111, contactyour GP or go to A&E.

Find out more from www.meningitisnow.org

Go straight to the Accident and Emergency Department

Not common but serious

25

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

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


26

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 6).

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 22, fever).

Not usually serious

Source: 2013 NICE guidance.27

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 & flu


28

BronchiolitisBronchiolitis is a common respiratorytract infection that affects babiesunder a year old. The earlysymptoms are similar to those of acommon cold and include a runnynose 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 has a distinctivebarking cough and makesa harsh sound, when theybreathe 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, sugar-freeparacetamol can be givenfrom the age of threemonths and will help bringdown a raised temperatureand ease discomfort. If symptoms get worsecontact your GP.


Look at the signs

29

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

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

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

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

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

If you are worried talk to your health visitor.

In older babies and toddlers you may notice:• Coughing, runny nose, mild temperature.• 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.


30

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: www.nhs.uk, NHS Choices.31

To reduce earinfections

• 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 but seemsotherwise well.

Have you tried sugar-freeparacetamol or ibuprofenfrom your pharmacist?(See page 6 for advice onusage).

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

Babies have some natural protection against infections in the first few weeks - thisis boosted by breastfeeding. In babies and toddlers, bacteria pass from the noseto the ears more easily. Ear infections can be painful and your child may just needextra cuddles and painkillers (such as sugar-free paracetamol or ibuprofen) fromthe pharmacist. Your child may have swollen glands in their neck - this is thebody’s way of fighting infection.

Tonsillitis - Earache can also be caused by tonsillitis (the inflammation of thetonsils). It is a common type of infection in children. Symptoms include a sorethroat, earache, coughing and a high temperature. It is not a serious illness andyou only need to see your GP if symptoms last longer than four days or becomemore serious with severe pain, a very high temperature or breathing difficulties.


32

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.GP Asthma Clinics offer adviceand treatment. Ask about theseasonal flu vaccine.


AsthmaKnow the symptoms

Source: Department of Health, www.nhs.uk33

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

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

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

Make sure you know how to use your child’s inhaler properly by attending theyearly review with your GP practice. This can help prevent worsening orpotential asthma attacks. A sudden, severe onset of symptoms is known as anasthma attack, it can be life threatening and may require immediate hospitaltreatment, please seek immediate medical attention.

Parents should avoid smoking indoors or near to their children.

1 2 3My child seems towheeze and cough alot, it seems to getworse at night.

Have you tried reducing anypossible amounts of dustaround the home? Do yousmoke? Have you talked toyour health visitor?

If symptoms persist seeyour GP. If your child hasa serious asthma attackcall 999.


34 Source: Allergy UK/2014

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

Spotting symptomsThis example shows areas where allergysufferers may experience symptoms. Many ofthese symptoms can develop as a result ofother common childhood illnesses. With anallergy, symptoms often appear more quicklyor suddenly.

Nose, throat and earsRunny nose, blocked nose, itchy nose,sneezing, pain in sinuses, headaches,post-nasal drip (mucus drips down thethroat from behind the nose), loss ofsense of smell and taste, sore throat,swollen larynx (voice box), itchy mouthand/or throat, blocked ear and 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 people35

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 probably the bestknown type of allergy medication,and most are readily available from apharmacy without prescription.While antihistamines used to have areputation for making peopledrowsy, more modernantihistamines only occasionallyhave those side effects. Source: www.allergyuk.org

An allergy is when the body has a reaction to a protein such as foods, insectstings, pollens, house dust mite or other substance such as antibiotics. There aremany common allergies.

Allergic symptoms can affect the nose, throat, ears, eyes, airways, digestion andskin in mild, moderate or severe form. When a child first shows signs of an allergyit is not always clear what has caused the symptoms, or even if they have had anallergic reaction, since some allergic symptoms can be similar to other commonchildhood illnesses. Seek medical advice if your child has, or has had, a severeallergic reaction. Even if symptoms have died down, they could flare up again andeven become life-threatening.

Urticaria - also known as hives, or nettle rash can be one of the first symptomsof an allergic reaction. It appears as a raised, itchy rash on just one part of thebody or spread across large areas. Your child may have had a reaction to: • Food, such as nuts, eggs, chocolate, citrus fruits, strawberries, shellfish, a

reaction to cow's milk can also happen in babies younger than six months.• Irritants such as nettles, latex and chemicals. • Toddlers who have developed an allergy to cats may also break out in hives

when stroking a pet.• Some medicines. • Insect bites and stings. • Heat. A child can break out in hives if they become overheated.

It may go away in a few hours or days. If hives are particularly itchy or swollen,see your GP.


36

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

37Source: www.nhs.uk


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

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

P Being extra careful with handhygiene (use soap and water or aliquid soap and dry hands wellwith a clean towel).

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

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

Pharmacist says

38

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 baby

Sickness 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 (i.e.they wee less).

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.

39


40

Breastfed babiesConstipation is very rare in babies whoare solely breastfed, but not uncommonin babies who have formula milk, orwho have solid foods. Ask your healthvisitor or pharmacist for advice ontreatment. Make sure you are makingup the formula powder with the correctamount of water. Some formulas arespecially targeted at babies who haveminor constipation - your health visitorcan discuss your options.

If your baby is already on solid foodsthen the juice or the fruit itself should befine for providing relief. Fruits, such asapples, pears and prunes, containsorbitol which is a natural laxative,helping the lower bowel retain water,which in turn helps the poo stay softand easy to pass. For younger babies,check with your health visitor before youstart giving anything other than milk.Source: www.NCT.org.uk

ConstipationRare in babies who are solely breastfed

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

41

1 2 3My baby getsconstipated.

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.


42

A healthy startIt’s never too early

What happens to children before they are born and in their early years can affecttheir health and life opportunities later on. For example, babies that are breastfedhave less chance of getting infections or of becoming obese and thereforedeveloping type 2 diabetes and other illnesses as they get older. Those whogrow up in a caring and safe environment and have a healthy relationship withtheir parents are more likely to do better as they go through life.

If we know how to prevent illness, and encourage healthy behaviour frompregnancy onwards, our children stand a great chance of having a healthy life.

Vitamins are essential nutrients that your body needs in small amounts so that itcan work properly. Even though you can get lots of vitamins from a healthybalanced diet, you still might not get everything you need at certain times in yourlife - such as when you’re pregnant, a new mum or a small child. Ask your healthvisitor about the free Healthy Start vitamin vouchers (see box on page 42).

If you don’t already live a healthy lifestyle, now is a great time to start.

43

1 2 3Should I give mybaby sweet things toeat and drink, sheloves fruit squash?

Drinks with added sugar areparticularly bad for babies’ teeth -it’s like giving a baby a lolly to suckon all day. Giving your baby a‘sweet tooth’ also means that theyare more likely to keep pesteringand crying for sugary things.

It's much easier to getyour baby on the righttrack now than to tryand change what theyeat later.

Healthy Start is a government scheme for pregnant women orwomen with children between the ages of 1-4. Women receivevouchers every week to support a healthy diet if they are receivingincome support or other related benefits. The value of thevouchers depends on the number and age of the children. Thevouchers can be used to purchase, plain cow’s milk, fresh orfrozen fruit and vegetables (with no added ingredients), whole orchopped, packaged or loose.Healthy Start vouchers can be used in participating shops.Women and children getting Healthy Start vouchers also get a freeweekly vitamin voucher to exchange for Healthy Start vitamins(these can be obtained from certain children’s centres). All womencan purchase vitamins at subsidised prices. Ask your health visitoror GP for details or visit www.healthystart.nhs.uk

As well as giving your baby a healthy start, you can help supportthem in early experiences and discovering the world around them.During the early months, babies explore and learn using their feetas well as their hands to feel textures and form. Leave their socksoff when you can.

It's also important to spend one-to-one time, giving them yourcomplete attention, without any distractions like the TV or mobilephone.

Start4LifeStart4Life supports theHealthy Child Programme for 0-5 year oldsStart4Life has joined up with theNHS Information Service providinghealth advice for pregnant womenand new mums, as well as offeringtips and advice by e-mail, free ofcharge. It is part of the largerChange4Life initiative, which aimsto help adults and families to eatwell and move more.www.nhs.uk/start4life

free fruit,vegetables andvitamins


44

Tips which may help• Eat well and eat together, whenever

you can. • Limit snacking between meals. • Give lots of praise and

encouragement for good eating.• Stick to a routine for mealtimes.• Limit the options at mealtimes offer a

meal that includes at least one thingyou know they like.

• Introduce new foods gently andoffer just one new food at a time.

• Keep an eye on milky andsweetened drinks and sugarysnacks which may fill them upresulting in poor appetite at mealtimes.

• Consider your toddler's sensitivepalate, they may not like the texture,colour, or taste of some foods.

• Think about a vitamin supplementspecially designed for toddlers. It maybe useful if your toddler is a fussy eater.Ask about the Healthy Start scheme.

• Get them involved in preparing andtasting food.

Often a normal part of growing up

45

Health visitor saysYour health visitor or GP canweigh and measure yourtoddler to check that he isgrowing well, and reassureyou. If the problem shows nosign of improving, or if you areworried about your child’sweight, growth, or health youshould contact your GP orhealth visitor.

1 2 3My child often refuses toeat anything so I make himsit at the table for an hour.

Set a time limit of 20-30minutes. If the food isn’teaten, take it away.

Don’t get cross. Refusingfood often loses its appealif you ignore it.

Fussy eatersMany parents experience problems around mealtime with their children. Manychildren go through phases of refusing to eat, being ‘fussy’ eaters, or having othereating problems. This is often a normal part of growing up.

It's natural for parents to worry about whether their child is getting enough to eat.As long as your child is active and gaining weight, and it's obvious they're not ill,then they’re getting enough to eat.

Try to make sure your child eats some food from the four main food groups (milkand dairy products, starchy foods, fruit and vegetables, protein), even if it’s alwaysthe same old favourites. Gradually introduce other foods or go back to the foodsyour child didn’t like before and try them again.

After the first year weight gain will slow down. This will affect their appetite. Yourtoddler may well eat lots at some meals, and barely touch anything during others.

You may feel that your toddler cannot sit still long enough to eat much but theyare generally good at regulating their own food intake. Picky eating may also beyour toddler's way of showing independence. Many toddlers want to see how farthey can push the limits of your authority and try to assert some control. This isone reason why pressurising your toddler to eat will often backfire. Try to keepmealtimes stress free and sociable.


ImmunisationsProtect your child now and in the future

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

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

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

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

47

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

The protection immunisationsoffer to your child are worth thesmall amount of pain.

Check with your health visitor,practice nurse or GP for furtherinformation, updates and futureimmunisations or if your childhas a chronic medical condition.

When to immunise

8 weeks

12 weeks

16 weeks

Between 12 and 13months old - within a month of the firstbirthday

Two to six year olds(including children inschool years 1 and 2)

3 years 4 months

Diseases protected against

DTaP/IPV/Hib and PCV and MenB and Rotavirusdiphtheria, tetanus, acellular pertussis (whoopingcough), inactivated polio vaccine, haemophilusinfluenzae b (Hib) vaccine and pneumococcal vaccineand meningococcal B vaccine and rotavirus vaccine

DTaP/IPV/Hib and MenC and Rotavirus diphtheria,tetanus, acellular pertussis (whooping cough), inactivatedpolio vaccine, haemophilus influenzae b (Hib) vaccine andmeningococcal C vaccine and rotavirus vaccine

DTaP/IPV/Hib and PCV and MenB diphtheria,tetanus, acellular pertussis (whooping cough),inactivated polio vaccine, haemophilus influenzae b (Hib)vaccine and meningococcal B vaccine

Hib/MenC haemophilus influenzae b (Hib) vaccine andmeningococcal C vaccinePCV pneumococcal conjugate vaccineMenB meningococcal B vaccineMMR Measles, mumps and rubella

Influenza (flu) - nasal spray vaccine in autumn each year

DTaP/IPV/Hib diphtheria or low dose diphtheria,tetanus, acellular pertussis, inactivated polio vaccine,(Pre-School Booster)MMR Measles, mumps and rubella

Source: N

HS

Imm

unisation Information.

46

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

Your health visitor will tellyou when localimmunisation sessionsare taking place.

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


School readinessIs my child ready for school?

The phrase 'readiness for school', seems to be cropping up all over the place.Part of the problem is that there is no clear definition of the term, and it can bedifficult for parents to understand what their child will be expected to know anddo. School readiness is more than just about children. It involves children, families,early environments (like nurseries and playgroups), schools and communities.

The earliest years in a child's life provide the foundation for everything that follows. Wemust all make sure that children are supported and encouraged to achieve their fullpotential as inquisitive, confident and secure individuals. This isn’t just about makingsure they can hold a pencil - children need the resilience, confidence and personalskills to be able to learn. If children lack the tools to benefit from education before theyeven get to the school gate it makes their chances of learning more difficult.

The key areas are: personal, social and emotional development, physicaldevelopment and communication and language.

If you are worried about aspects of your child’s development chat to your localchildren’s centre or your health visitor.

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Basic skills like toilet training, communications skills, being able tounderstand and follow simple tasks, taking turns and having some socialskills all prepare a child to be ready for learning. Teachers and classroomassistants are then freed up to teach rather than spend time toileting,feeding children and helping them with the most basic social skills.

How can I get my child school ready?• Make sure they are toilet trainedP• Help them understand how to follow simple tasksP• Help them to answer to their nameP• Encourage them to share and understand turn-takingP Teacher’s tip

One helpful pre-school activitythat parents can practice isgiving their children theopportunity to listen to andlearn language through storytelling. One of the best ways toprepare children for school is toread to them. Not only doesstory reading offer a one-to-one quiet time, it helps developchildren's listening andlanguage skills.If you want to improve readingskills, there are lots ofopportunities. There are adultlearning courses, find out morefrom your local children’s centre.

1 2 3My child seems to haveno friends and makesno effort at nursery tomix with other children.

Closeness between parent andchild, combined with consistentrules, are most likely to lead tochildren doing well andbecoming more social.

Do not panic. Invite one ortwo children over for teawith their parents. Chat toyour health visitor or localchildren’s centre.


ChokingBabies and toddlers can easily swallow,inhale or choke on items like marbles,beads, lolly sticks, balloons, peanuts,buttons, nappy sacks, plastic toy pieces,strings or cords.PREVENTION:• Babies can suffocate or choke on nappy

sacks, keep all plastic bags out of reach. • Check that toys with small pieces are not

left out for a toddler to chew and chokeon.

• Check that toys are age appropriate, ingood condition and include toy safetymarks.

• Find out more about resuscitation (CPR)visit www.redcrossfirstaidtraining.co.uk

WHAT TO DO:If your child is choking, act immediately andcalmly. Make sure you do not push theobject further down the throat. Encourageyour child to cough. Use back blows, if theybecome unconscious, call for help (do notleave your child alone) and start CPR.

Keeping children safe

Choking & poisoningEvery week around 500 children under five are rushed to hospitalbecause it's thought they have swallowed something poisonous.Most poisoning accidents involve medicines, household products andcosmetics. The most common form of 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 tabletsand garden products, preferably in a locked cupboard.

• Use containers that have child-resistant tops - be aware that by theage of three, many children are able to open child-resistant tops.

• Keep all dangerous chemicals in their original containers - forexample, do not store weedkiller in an old drinks bottle as a youngchild may mistake it for something safe to drink.

• Discourage your children from eating any plants or fungi whenoutside. Avoid buying plants with poisonous leaves or berries.

• Keep alcohol out of the reach of children. Even a small amount cancause alcohol poisoning in children.

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1 2 3If you think your childhas swallowed aharmful medicine orchemical includingbatteries or a magnet.

Find the bottle orpacket and take itwith you when youseek medical help.

Immediately contactyour pharmacist, GP,go to A&E or call NHS 111.

Safe around electricityRoSPA* recommends that allelectrical equipment is stored safelyaway when not in use and childrenare supervised and warned to keepaway from plug socket outlets. 13-amp power sockets made to BS1363 incorporate a shuttermechanism, which stops access (oflittle fingers) to the live connectors. If your child has had a shock turnoff the power before approachingyour child. If this isn’t possible, pushthe child away from the source ofthe electricity with a material thatdoes not conduct electricity, suchas a wooden stick or a woodenchair. Try tapping their feet orstroking their neck and shouting"hello." If you get no response fromyour child, start CPR and call 999immediately. Get medical attentionfor any electrical burn or shock.*RoSPA: The Royal Society for thePrevention of Accidents

A burn is damage to the skin caused by direct contact with something hot.Burns can also be caused by certain chemicals, electricity and friction. A scald is a burn that is caused by a hot liquid or steam. Scalds are treated in the sameway as burns.

Treat any burn or scald straight after the accident but always take yourchild to hospital for anything more than a very small burn or scald. Ababy’s skin is very delicate and can be scarred without the right treatment. Treatany electrical or chemical burn as serious, call 999 or go to A&E.

Cool the burnt area by placing under cool running water for at least 20 minutes(making sure the child does not get too cold). When the burn has cooled, coverit with a sterile dressing, food quality cling film or a plastic bag. Don’t wrap it tootightly. Don’t apply fatty substances like butter or ointment. Give paracetamol oribuprofen (see page 6 for advice on usage). Take your child to hospital.

Babies/toddlers pull up on everything when learning to stand and walk. Keep hotdrinks out of reach and not on tablecloths that they may pull onto themselves.

50If you are still worried call NHS 111. If you cannot get help straight away, go to A&E.

Knowing what to do

Burns, scalds & shocks


• Do not place a child's cot, bed or highchair near awindow.

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

get their head through the loop of the drawstring.• Find out more about CPR. WHAT TO DO:Untangle child, call 999 and start CPR.

FracturesA fracture is a broken or cracked bone. PREVENTION:Supervise play, use correct safety equipment (helmet, kneeand elbow pads) for scooters, skateboards and bikes.How do I know it’s a break?• Sometimes it’s obvious and you can see the bone

through the skin.• They are in pain and sometimes shock.• Limb can appear to be disjointed.• Swelling and bruising.WHAT TO DO:• Don’t let them eat or drink in case they need an

anaesthetic.• Hold an ice pack (frozen peas) wrapped in a tea towel

gently onto the area.• Stabilise a broken arm using a towel as a sling.• Support the limb, especially when in a car, so ask

someone else to drive if possible.• Go to A&E.

FallsFor babies the biggest danger is rolling off the edge of abed, or changing surface. For toddlers it is more aboutfalling from furniture or down stairs.PREVENTION:• Ensure baby cannot roll off any surfaces (use pillows). • Do not put a bouncing cradle or car seat on a surface

where they could wriggle off.• Use stairgates once your child is mobile. Make sure

balconies are locked and fit window safety locks.WHAT TO DO:If your child has a serious fall call 999.

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

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

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CutsGlass, knives and sharp objects can cause serious cuts.PREVENTION:Do not leave drinking glasses on the floor. Make sure glassbottles are kept up high. Hide kitchen knives.WHAT TO DO:• If the cut is not serious bathe the area, make sure there

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

glass under the skin go to A&E.

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

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

Insect bites and stingsMost insect bites and stings cause small reactions thatare confined to the area of the bite (localised reactions).They can usually be treated at home. PREVENTION:Avoid swarms, use a net over a pram or pushchair ifoutside.

WHAT TO DO:Most insect bites and stings cause itching and swellingthat usually clears up within several hours. Minor bitesand stings can be treated by:• Washing the affected area with soap and water. • Placing a cold compress or ice pack (frozen peas

wrapped in a towel) over the affected area to reduceswelling.

• Avoid scratching the area as it can become infected. • If painful give paracetamol or ibuprofen (children under

16 years of age shouldn't be given aspirin). • Use a spray or cream that contains local anaesthetic,

antihistamine or mild hydrocortisone (1%) to preventitching and swelling.

• Take an antihistamine tablet to help reduce swelling(ask your pharmacist).

Call 999 if there is swelling or itching anywhere else on thebody after being bitten or stung, or if they are wheezing orhave difficulty swallowing. See your GP if the redness anditching gets worse or doesn't clear up after a few days.

StrangulationWindow blind cords and chains can pose a risk of injuryor strangulation.PREVENTION:• Install blinds that do not have a cord. • Pull cords should be kept short and out of reach. • Tie up the cords or use one of the many cleats, cord

tidies, clips or ties that are available.

Household accidents

Household accidents

Source: RoSPAFor advice on CPR and dealing with other injuries www.redcrossfirstaidtraining.co.uk


Useful contactsAllergy UK01322 619 898 www.allergyuk.orgAsthma 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.ukDiabetes UKwww.diabetes.org.ukFamily Lives0808 800 2222 www.familylives.org.ukHealthy Startwww.healthystart.nhs.ukLa Leche League GB0845 120 2918 available 24 hours7 days a week. www.laleche.org.ukThe Lullaby Trustwww.lullabytrust.org.ukMeningitis Now0808 80 10 388 www.meningitisnow.org

National Breastfeeding Network Helpline0300 100 0212, 9.30am-9.30pmwww.breastfeedingnetwork.org.uk

National Childbirth Trust0300 330 0700 8am-10pm 7 days a weekwww.nct.org.uk

National Domestic Violence Helpline0808 2000 247www.nationaldomesticviolencehelpline.org.uk

NetmumsParenting advice and information.www.netmums.com

NHS Information Service for Parentswww.nhs.uk/start4life

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

RoSPA - The Royal Society for thePrevention of Accidents0121 248 2130www.rospa.com

To find an NHS dentistCall NHS 111 or visitwww.nhs.uk/dentist

Call 999 in an emergency

Local OfferA directory of local information forCheshire West and Chesterresidents. www.westcheshirelocaloffer.co.uk

Local breastfeeding groupsCountess of Chester Hospital -www.coch.nhs.uk/all-services/ infant-feedingLeighton Hospital 01270 612 287Winsford and Northwich -www.cherubsbreastfeeding.co.uk

For information on local GPpractices:NHS Vale Royal ClinicalCommissioning Groupwww.valeroyalccg.nhs.uk

NHS South Cheshire ClinicalCommissioning Groupwww.southcheshireccg.nhs.uk

NHS West Cheshire ClinicalCommissioning Groupwww.westcheshireccg.nhs.uk

NATIONAL LOCAL


Protecting your child’s health

Secondhand 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. • 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.

Take 7 steps outside your home to ensure it does not affect your children. Also,have a smokefree car at all times as exposure to the chemicals in secondhandsmoke is increased in a confined space even with the windows open!

Source: www.take7stepsout.co.uk

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 7 stepsfrom your back door as areminder. It’ll help keep thegarden tidy too.

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

• If you smoke, or are exposedto secondhand smoke duringpregnancy, it means thatyour baby shares chemicalsfrom the smoke you breathe.1 2 3

Does it really affect mychild if I smoke withthe car window open?

Yes, and it is now illegalto smoke in a vehiclecarrying anyone agedunder 18.

It is also illegal not tostop any passengerssmoking. There is afine for both offences.

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Smokefree homes


1601-west cheshire cci 0-4.qxp 6521-cornwall...a guide to services 4 know the basics 6 children’s...

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