1580-Cannock Chase web:6521-Cornwall 8/4/15 10:24 Page 1 A guide for parents and carers of children aged birth-5 years

Breastfeeding Immunisations Oral health Smoking Worried, need Confused, unsure or Need advice about If you smoke - now is support and advice? need advice? teething, oral health the time to quit. Common or registering? childhood

Speak to your Speak to your Speak to your Health Visitor or Health Visitor or Health Visitor or contact your local Practice Nurse Dentist illnesses & Call 0800 022 4332 Breastfeeding Support or visit Team www.smokefree.nhs.uk well-being There are many everyday illnesses or health concerns which parents and carers need advice and information on.

This handbook has been produced by NHS Cannock Chase Clinical Commissioning Group.

www.cannockchaseccg.nhs.uk 01622 752160 www.sensecds.com Sense Interactive Ltd, Maidstone. © 2015 All Rights Reserved. Tel: 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:24 Page 3 Welcome Contents This book has been put together by NHS Cannock Chase Clinical Who can help? Allergies 34 Commissioning Group with local Health Visitors, GPs and other healthcare A guide to services 4 Upset tummy 36 professionals. Know the basics 6 Constipation 38 Every parent or carer wants to know what to do when a child is ill - use this The first months Earache and tonsillitis 40 handbook to learn how to care for your child at home, when to call your GP and Crying and colic 8 Chickenpox and measles 42 when to contact the emergency services. Most issues your child will experience are part of growing up and are often helped by talking to your Midwife, Health Visitor Being sick 10 Urticaria or hives 44 or local Pharmacist. Almost all babies, toddlers and children will get common Sticky eyes and conjunctivitis 12 General welfare childhood illnesses like chickenpox, colds, sore throats and earache. Nappy rash, rashes and dry skin 14 Healthy lifestyles 46 Some of these are easily treated at home with advice from your Pharmacist, your GP Immunisations 16 Childhood obesity 48 or your Health Visitor rather than going to your surgery or A&E. Teething trouble 18 Bumps and bruises 50 This handbook will point you in the right direction and explain what you can do at Flat head syndrome 20 Burns and scalds 52 home, or where you need to go to get assistance and advice. Trust your instincts, Sleeping 22 you know your child better than anyone else. If you are worried, get further advice. Household accidents 54 Choking 56 This handbook also contains general welfare information which will help you keep Childhood illnesses you and your child safe and healthy. Fever 24 How to resuscitate a child 58 Meningitis 26 Sun safety 60 To view this booklet and extra topics online www.childrensguide.cannockchaseccg.nhs.uk To view this booklet Coughs, colds and flu 28 Domestic abuse 62 online scan this code Wheezing and breathing difficulties 30 All factual content has been sourced from Department of Health, Birth to Five, 2009 edition, NHS Choices, with your smartphone Useful contacts 64 British Association of Dermatologists,Meningitis Now, NICE. This information cannot replace specialist Asthma 32 care. If you are worried get further advice, you know your baby best. 3 1580-Cannock Chase web:6521-Cornwall 8/4/15 14:02 Page 5

A guide to services The NHS has a wide range of healthcare services. See which service or professional is best to help you.

Self care Children’s Centres Many illnesses can be treated in your home by using Families can access a wide range of information in a over the counter medicine from your Pharmacist and friendly environment. getting plenty of rest. Self care is the best choice to Health Visitor Children’s Centres provide a treat very minor illnesses and injuries. If you are still Health Visitors are specialist range of advice including worried contact NHS 111 or your GP. A&E Nurses who can support you health promotion, advice on and your family during your Pharmacist GP Dentist safety and promote all aspects For immediate, child’s early years. They will of child health and well-being. life-threatening Your local Pharmacists You will need to register with Make sure you see a visit you at home or see you in Contact Staffordshire Families emergencies, please 111 can provide advice on a GP - to find a GP in your Dentist on a regular local clinics and Children’s Information Service (see page call 999. most common health area, use NHS Choices at: basis. Discuss If you think you need help urgently Centres to routinely assess 64 for details). A&E and 999 are during the day or night you should your child and family’s health issues. They can www.nhs.uk/service registering your child emergency services that directories. call NHS 111 before you go to any and development needs. suggest and dispense early on with your should only be used other health service. They can help you get extra medicine and other Your GP can offer advice, Dentist and take when babies and children By calling NHS 111you will be directed straight to the support if you need it and can health products. There give medicines and provide them with you to Minor Injuries Unit are badly injured or show local service that can help you best. It is available 24 refer you to other services. are often Pharmacists in information on other appointments. (MIU) symptoms of critical hours a day, 365 days a year and is free to call, Health Visitors link with supermarkets and services. You will need to To find your nearest illness such as choking If your child's injury is not including from a mobile. You should call NHS 111: Midwives and will offer to see many are open late. make an appointment but Dentist visit or breathing difficulties, serious, you can get help from • when you need help fast but it’s not life threatening you antenatally. They will then Visit www.nhs.uk where most GPs will see a baby www.nhs.uk. when they are a Minor Injuries Unit (MIU), • when you think you need to go to A&E or another continue to support you until you can find the service quite quickly if you are For out-of-hours unconscious or unaware rather than going to A&E. NHS urgent care service your child is almost 5. After this locator that will help you worried. After 6.30pm Dentist information of surroundings, have MIUs offer help with a range of • when it’s outside of your GP’s surgery hours you can get advice, information find the Pharmacist weekdays, at weekends call NHS 111. taken poison or tablets, injuries including minor head • when you do not know who to call for medical help and guidance from your School nearest to you. and public holidays you or have severe injuries and burns. • if you do not have a local GP to call. Nurse/ School Health Service. can contact NHS 111. abdominal pain. 4 5 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:24 Page 7

This guide will help you choose well when deciding where to go for advice if your child is ill or injured.

You can treat minor illnesses and injuries at Minor bumps, cuts and bruises, home by using the recommended medicines Know the basics sore throat, coughs and colds, Self Care and making sure they get plenty of rest mild tummy pain or headache www.nhs.uk Being prepared and knowing the signs

If, as a parent, you are Write your Health Visitor’s telephone It is normal to worry that you won't recognise the signs that your baby is unwell. Health Visitor or unsure, confused, need number here: NHS 111 Parents are usually good at noticing when something is wrong with their baby/ help or advice child from quite early on. Trust your instincts, you know your baby best. Learn how to spot the signs of serious illness and how to cope if an accident Pharmacist Mild diarrhoea, constipation, happens. If you know the basics and you are well prepared, you will find it easier For advice on common To find your local pharmacy and its contact Pharmacist says mild skin irritations including illnesses, injuries and details visit: www.nhs.uk/chemist to cope - and less scary. Keep a small supply of useful medicines in a locked spots/rash, mild fever Keep a small supply of useful medication. cabinet or somewhere up high where a child cannot reach them. See box on the right for things to have at home just in case. Make sure you’ve got the right items. Include things like: High temperature, persistent strength of medicine for the age of your child, always follow instructions cough, head injuries not involving GP Write your GP’s (family Doctor) carefully and check use-by dates. Read the label carefully. Do not give Thermometer loss of consciousness, headache, For the treatment of telephone number here: aspirin to children under 16. tummy pain, vomiting/diarrhoea, illnesses and injuries that worsening health conditions will not go away. Paracetamol and ibuprofen Plasters (inside GP hours) Consider using either paracetamol or ibuprofen in children with fever who appear distressed - as a general rule a temperature of over 37.5°C (99.5°F). Liquid painkillers Unexpected and sudden sickness, NHS 111 Paracetamol can help to reduce fever and distress in children and so can (eg paracetamol or ibuprofen) severe pain, worsening health For 24 hour health advice As directed by NHS 111 ibuprofen. Treat them with either paracetamol OR ibuprofen in the first conditions (outside GP hours) and information. instance. It can take up to an hour for either of them to work. Paracetamol and Barrier cream ibuprofen should not be given together at the same time. However, if your child Struggling for breath or choking, remains distressed before the next dose of paracetamol OR ibuprofen is due, Natural oils fitting, loss of consciousness, A&E or 999 As directed by 999 then you may want to try a dose of the other medicine later. like vegetable oil (for dry skin) broken bones, swallowed poisons For very severe or life call handler For example: 8am - paracetamol dose given, 11am - child remains distressed, or tablets, blood loss, gaping threatening conditions. ibuprofen dose given, 2pm - child remains distressed, paracetamol dose given. wound, serious burns Antihistamine Ibuprofen should not be used if a child is at risk of dehydration (eg if not drinking). NHS 111 is free to call from any landline or contract mobile phone. Pay-as-you-go mobile phones require 1p credit to make a call. 6 7 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 9 Crying and colic

Understanding why

All babies cry, especially in the first few weeks after birth. Crying is their way of letting you know they need something or are uncomfortable. They may need changing, they may be hungry or just need a cuddle. Always burp your baby after Health Visitor says a feed as this will help. You will know your baby best Look out for signs that your baby is trying to tell you they are hungry. Early signs of all. Try to understand what it are things like putting their hands to their mouth, becoming restless and is they need. Finding out why stretching. By recognising these cues you may avoid hunger crying altogether and your baby is crying is often a the need to calm baby down before a feed. matter of going through all the GP says Colic possible options. If your baby's crying seems If your baby cries suddenly and often, but they otherwise appear to be happy and Things to check first are: healthy, they may have colic. Colic is common and although uncomfortable it is not different in any way (such as  Does their nappy need serious and usually affects babies only in the first few months of their lives. The a very high-pitched cry or a changing? most common symptom of colic is continuous crying, which typically occurs in the whimper), then seek medical  Could they be hungry? late afternoon or evening. Other signs include a flushed appearance, drawing their advice. Crying can  Could they be too hot? legs to their chest, clenching fists, passing wind and trouble sleeping. sometimes be a sign that  Could they be too cold? your baby is unwell. Trust  Does their cry sound your instincts - you know different? 1 2 3 your baby best. My baby is crying When a baby cries, it It is very important to stay These are simple things which more than usual. can be upsetting. calm and don’t be afraid to could be causing your baby ask for help. Do not shake to cry. your baby.

8 9 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 11 Being sick A problem likely to get better on its own

It is common for babies to be sick in the early weeks as they get used to feeding GP says and their bodies develop. Bringing up small amounts of milk is known as After the first few months, if your possetting. When your baby vomits there will be a much larger amount. It can be baby is suddenly sick it is more frightening for your baby, so they are likely to cry. Lots of things can cause your likely to be caused by a baby to be sick. Health Visitor says stomach virus rather than Make sure your baby is positioned correctly when breast or bottle feeding. Incorrect possetting. Gastroenteritis is a Possetting is ‘normal’ during or positioning can cause a baby to be sick. tummy bug (see upset tummy after a feed. If this carries on at Being sick often or with large amounts may be due to ‘gastric reflux’ where acid page 3:), which can come with other times, between feeds it from the tummy can come up again. Babies can be grumpy and it can sometimes diarrhoea (runny poo). may be a tummy bug. It is lead to poor feeding. If your baby is feeding well but doesn't seem themselves, important for babies to have This is more serious in babies you may just need to change the baby's position during a feed to make them plenty of fluids to stop any than older children because more upright. Feeding smaller amounts and more often may also help. dehydration. If baby is babies easily lose too much exclusively breastfeeding they fluid from their bodies and may just need additional feeds become dehydrated. If they and not additional fluids. become dehydrated they may not pass enough urine, lose their appetite and have cold 1 2 3 hands and feet. I have a new baby. They always seem to This is known as I have just given my baby bring up small amounts ‘possetting’. As they develop Get expert advice. If your baby a feed. of milk. it will stop naturally. Talk to is unwell, or if vomiting has your Health Visitor. lasted more than a day, get your GP’s advice straight away. 10 11 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 13 Sticky eyes and conjunctivitis Two different issues

‘Sticky eyes’ are common in newborn babies and young children while their tear ducts are developing. You may see some sticky stuff in the corner of the eyes or their eyelashes may be stuck together. It normally clears up on its own, but you may have to clean your baby's eyes regularly with damp cotton wool. Use clean, cooled boiled water. Health Visitor says Conjunctivitis Some babies have watering eyes. Massaging the tear ducts may help Wipe each eye from the corner by the nose outwards. Use a clean piece of cotton The signs of ‘sticky eyes’ can to dislodge tears that have collected wool for each wipe. Remember to wash your hands before and afterwards and sometimes be confused with an in the upper part of your baby’s tear avoid sharing towels to prevent spreading infection. infection called ‘conjunctivitis’. duct, as well as encouraging the With conjunctivitis the signs are tear duct to develop. This can be yellowy, green sticky goo which done by applying light pressure with comes back regularly and the your clean, index finger and white part of the eyes may be massaging from the corner of your red. If you notice this and it baby’s eye towards their nose. 1 2 3 continues for more than 24 hours, contact your Health Repeat several times a day for a Is there discharge in the Sticky eyes is a common Use cooled boiled water on couple of months. If this persists corner of your baby’s eye condition that affects most a clean piece of cotton Visitor or GP. This can be past one year, your baby may be and do their eyelashes babies, speak to your wool for each wipe. passed on easily, so wash your referred to an eye specialist for appear to be stuck Health Visitor. hands and use a separate towel treatment. together? for your baby. Source NHS choices Source: DoH 2006. 12 13 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 15

Health Visitor’s nappy rash tips Rashes and dry skin Leave your baby in a A common problem that’s easy to treat warm, safe place with no Health Visitor’s clothes or a nappy on, to It’s normal for babies to develop rashes early on as their skin adapts to a different cradle cap tips let the air get to their skin. environment. If your baby develops a rash and seems unwell contact your GP. Most rashes are nothing to worry about but do be aware of the signs of meningitis (see This is the name given to the large Use a barrier cream. page 26). greasy yellow or brown scales that (see Pharmacist says box appear on your baby’s scalp. opposite). Nappy rash Sometimes they may flake and the skin Nappy rash is very common and can affect lots of babies. It is usually caused when may be red. It should not cause your your baby's skin comes into contact with wee and poo that collects in their nappy. baby any discomfort and should settle Remember to change and A nappy rash causes your baby's skin to become sore. over time. It is important not to pick at check their nappy often. Most nappy rashes can be treated with a simple skincare routine and by using a the scales as this may cause infection. cream you can get from the Pharmacist. With a mild nappy rash, your baby won't Pharmacist says Massaging baby oil or normally feel too much discomfort. Call in and talk to us about natural oil - such as almond creams we can provide you or olive oil - into their scalp Dry skin with over the counter. at night can help loosen A baby’s skin is thinner and needs extra care. Dry, flaky skin, some blemishes, the crust. blotches and slight rashes are normal in newborns and will naturally clear up. If There are two types of nappy your baby is otherwise well but has a rash and you are worried about it contact cream available. One is a Gently wash the scalp and your Health Visitor. barrier cream to keep wee use a soft baby brush or away from your baby's skin. cloth and gently remove any The other is a medicated loose scales. 1 2 3 cream, that is good for clearing If this does not settle, the redness There is a red, sore rash Has baby been in a dirty nappy for Change nappy often. up any soreness but should spreads or your baby is itchy then around the nappy area. a long time? Have you followed Speak to your Health only be used when advised by Baby is uncomfortable advice from your Health Visitor, or Visitor and if you are seek medical advice. a health professional. and cries a lot. spoken to your Pharmacist? worried see your GP. 14 15 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 17

Source: NHSImmunisationInformation. When to immunise Diseases protected against Two months old • Diphtheria, tetanus, pertussis (whooping cough), Immunisations polio and haemophilus influenzae type b (Hib) • Pneumococcal disease Protect your child now and in the future • Rotavirus Immunisations, also known as vaccinations are usually given by injection. Children Three months old • Diphtheria, tetanus, pertussis, polio and Hib in the UK are offered vaccinations against a variety of diseases as part of the • Meningococcal group C disease (MenC) Healthy Child Programme. You can get advice on the vaccinations from your GP or • Rotavirus Health Visitor. A record is kept in the Parent Held Child Health Record (Red Book), Four months old • Diphtheria, tetanus, pertussis, polio and Hib which is a book you keep containing information on your child’s health. • Pneumococcal disease Immunisations are mainly given during the first five years. It’s important to have Between 12 and 13 • Hib/MenC vaccinations at the right age to keep the risk of disease as low as possible. It is months old - within a • Pneumococcal disease normal to worry about vaccinations, so don’t hesitate to ask your Health Visitor or month of the first birthday • Measles, mumps and rubella (German measles) GP for advice - that’s what they are there for! Childhood immunisations are free GP says and most are given at your GP’s surgery. Immunisations are used to Two and three years old • Influenza - The flu nasal spray vaccine is to be protect children from gradually rolled out to other age groups in future Some immunisations are given more than once to make sure the protection years, consult your Practice Nurse or Health Visitor continues. This is known as a booster, so make sure your child gets it. diseases which can be very serious and sometimes even Three years four months • Measles, mumps and rubella The whooping cough vaccine is recommended for all women between 28 and 38 cause death. old or soon after • Diphtheria, tetanus, pertussis and polio (Pre-School weeks pregnant. You should be offered this at your routine antenatal appointment. Booster) The protection immunisations offer your child are worth the small amount of pain. Health Visitor says 1 2 3 You may have concerns Immunisation begins at Your Health Visitor will Immunisations don’t just about the safety of Make sure you keep your child’s Red B ook in a safe place. It is your only two months, when baby's tell you when local protect your child during complete record of their childhood immunisations and they are often needed immunisations, discuss these natural immunity to illness, immunisation sessions childhood, they protect with your GP. Mild side later in life. Check with your Health Visitor on any updates and future begins to drop. are taking place. them for life. immunisations. effects are possible. 16 17 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 19

Dentist’s 4 tooth care tips: 1. Clean teeth twice a day, for two minutes, especially at night. Teething trouble 2. Reduce sugars to meal times only. Do not give fizzy drinks. 3. Visit the Dentist regularly and discuss your child’s oral health. Every baby goes through it 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 sugar and acid The time when babies get their first primary teeth (milk teeth) varies. A few are plenty of time to damage teeth. born with a tooth already, whilst others have no teeth at one year. Teeth generally For help accessing an NHS Dentist callNHS 111 or visit www.nhs.uk start to show when a child is four to nine months old, although every baby develops at their own pace. This is known as ‘teething’. Some babies show few Pharmacist says Health Visitor says signs while others find it more uncomfortable. Some teeth grow with no pain or It can help to give your baby discomfort at all. At other times you may notice that the gum is sore and red If your baby is uncomfortable, something hard to chew on, where the tooth is coming through, or that one cheek is flushed. Your baby may you can buy some medicine such as a teething ring. dribble, gnaw and chew a lot, or just be fretful. from your local pharmacy. These medicines contain a Teething rings give your baby Some people attribute a wide range of symptoms to teething, such as diarrhoea and something to safely chew on, fever. However, there is no research to prove that these other symptoms are linked. small dose of painkiller, such as paracetamol, to help ease which may help to ease their You know your baby best. If their behaviour seems unusual, or their symptoms any discomfort. The medicine discomfort or pain. Some are severe or causing you concern, talk to your Health Visitor. Source: www.nhs.uk teething rings can be cooled should also be sugar-free. first in the fridge. Toothpaste needs to contain a minimum of 1,000 ppm of fluoride to be effective Make sure you read all (most family toothpaste contains more, check tube). Under 3s should have a smear instructions and that the All sorts of things are put down of family toothpaste, over 3s should be using a pea sized amount. Novelty electric product is suitable for the age to teething - rashes, crying, toothbrushes often have large heads that can cause damage in a child’s mouth. of your child. bad temper, runny noses, extra dirty nappies. Be careful not to You can try sugar-free explain away what might be the 1 2 3 teething gel rubbed on the gum. signs of illness by assuming it’s My baby has red Have you asked your Health Try some of the gels or baby Ask your Health Visitor about ‘just teething’. cheeks and seems Visitor about teething? Have you paracetamol available. If you a bit frustrated discussed options with your are worried and things do free oral health packs given at Source: DoH Birth to five edition 2009. and grumpy. Pharmacist? Have you booked a not feel right contact your regular health checks. dental check-up for your child yet? Health Visitor or GP. Source: DoH Birth to five edition 2009. 18 19 1580-SE Staffs web:6521-Cornwall 8/4/15 13:45 Page 21

Health Visitor’s tips Flat head syndrome Increase ‘tummy time’ - put your baby on his front to play. Sleep on his back and let him play on his tummy Supervise him at all times and don’t let him fall asleep like this. Flat head syndrome can occur in the womb or can be caused by a baby sleeping, • Get down to your baby’s level for resting and playing in one position. face-to-face fun so he’ll enjoy Many babies develop a flattened head when they are a few months old, usually lying on his tummy. from sleeping on their back. FHS happens when the back or one side of the • Use a sling to carry your baby baby's head is squashed against a firm mattress for a long time, which eventually upright so he is not always on forces the soft bone of the skull to flatten. his back in a car seat or pram. It often corrects itself over time and is usually nothing to worry about. • Do lots of active play with your baby on your lap. The solution is not to change your baby's sleeping position from lying on their • Change the position of toys and back at night. It is important for babies to sleep on their back as this reduces the mobiles in their cot to encourage risk of sudden infant death syndrome (SIDS). Put your baby to sleep on his back them to turn their head to the and let him play on his tummy. GP says non-flattened side. No treatment is normally needed. Your baby's skull should naturally correct itself • Don’t use a car seat except over time. You can take some simple measures to take pressure off the flattened In cases of craniosynostosis, when travelling. part of their head and encourage them to try different positions (see Health where the plates of your baby's skull have fused too early, It may take 6-8 weeks before Visitor’s tips). surgery will be needed to noticing any improvement. unlock and move the bones. This is a more serious condition 1 2 3 but is very rare. Talk to your I have heard about Their use is controversial, If you have tried the Health Health Visitor or GP if you are helmets that a baby expensive and there is still not Visitor’s tips and are still concerned and have tried the can wear to help. enough evidence to prove it worried talk to your Health will correct the problem. Visitor or GP. measures suggested.

20 21 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 23 A safe sleeping environment Sleeping 1 Place your baby in the ‘feet to foot’ position 7 No pillow, stuffed animals, toys or i.e. baby’s feet at the foot of the cot. bumper pad. Patience, praise and peace Bed-sharing with your baby There are many different reasons why babies do not sleep. It is normal for a baby is never completely safe. at six weeks old not to sleep through the night. Feel confident in yourself to know Newborn babies sleep in a cot in No heavy or loose blankets. It is particularly dangerous 2 8 whether your child is really distressed or just restless. Trust your instincts. parent’s bedroom. for your baby to sleep in Try to establish a regular night time sleep routine early on by putting them to bed your bed if you (or your If a blanket is used, it must be tucked in 9 at a regular time (day and night). Place your newborn baby on their back to sleep, partner): 3 Make sure baby is not too hot nor too cold. and only as high as the baby’s chest. in a cot in your bedroom for the first six months. Prepare a warm, comfortable • Are a smoker (even if you place for them to relax in. Adult beds are not designed for babies and toddlers never smoke in bed or at 4 Put baby to sleep on their back. 10 Crib sheets must fit tightly over mattress. and do not conform to safety standards. It is advised that bottle-fed babies home). should not be fed in bed. If breastfed, babies can be breastfed sitting up and then • Have been drinking alcohol placed back in their cot, or your Health Visitor can show you how to breastfeed in or taken any drugs. Keep baby’s head uncovered. Use a clean, firm, well-fitting mattress. 5 11 a safe, comfortable position. • Have taken any medication Mattresses should carry the BSI number that makes you drowsy. BS-1877-10:1997. Reading to your child at bedtime helps them to unwind, and gives you some 6 Do not smoke. special time together. If your child is scared of the dark, try keeping a night light • If your baby was premature on. Bedwetting may be stressful for both of you and can wake your child. It is not (born before 37 weeks). easy to know why some children take longer to be dry at night than others. Try not • If your baby was low birth to lose your patience or punish them, your child is not doing this on purpose. weight (less than 2.5kg). Children learn at their own pace and praise and support will help. • If you or your partner are overweight. 1 2 3 It is very dangerous to fall I am so tired when my The safest place for your baby Speak to your Health asleep together on a sofa, baby wakes up at to sleep is in a cot by your Visitor about how to keep armchair or settee. It is also night it seems easier bedside for at least the first your baby safe and get risky to allow a baby to Call 0800 022 4332 or visit to share the bed. six months. Try to establish a some sleep. sleep alone in an adult bed. www.smokefree.nhs.uk regular sleep routine. 22 23 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 25

Babies under six months: Fever Always contact your GP, Health Visitor, Practice Nurse, Nurse Practitioner or local clinic GP if your baby has other signs of illness, as well as a Over 37.5°C means a fever raised temperature and/or if your baby’s If your child has a fever, he or she will have a body temperature above 37.5˚C. temperature is 37.5 ̊C (99.5 ̊F) or higher. Your child may also feel tired, look pale, have a poor appetite, be irritable, have a headache or other aches and pains and feel generally unwell. Take the Older children: temperature from the armpit (don’t use in the mouth of under 5s). However, bear A little fever isn’t usually a worry. Contact your in mind that these measurements are less accurate as the armpit is slightly cooler. GP says GP if your child seems unusually ill, or has a A fever is part of the body’s natural response to fight infection and can often be When looking after a feverish high temperature which doesn’t come down. left to run its course provided your child is drinking enough and is otherwise well. • It’s important to encourage your child to drink child at home you should: If your child is having trouble drinking, trying to reduce their temperature may help • Get the child to drink more as much fluid as possible. Water is best. with this. This is important in preventing your child from becoming dehydrated, • Bringing a temperature down is important (where a baby or child is which can lead to more serious problems. As a guide, your child’s urine should be breastfed the most appropriate because a continuing high temperature can pale yellow - if it is darker, your child may need to drink more fluids. be very unpleasant and, in a small child, fluid is breast milk). occasionally brings on a fit or convulsion. Fevers are common in young children. They are usually caused by viral • Look for signs of dehydration: infections and clear up without treatment. However, a fever can occasionally be reduced wet nappies, dry a sign of a more serious illness such as a urinary tract infection, pneumonia, mouth, sunken eyes, no tears, meningitis or a severe bacterial infection of the blood (septicaemia). poor overall appearance, To help reduce temperature: sunken soft spot in babies. You should also contact your GP if fever symptoms are not improving • Undress to nappy/pants. • It is not advisable to give after 48 hours. Check your child during the night. • Keep room at comfortable temp (18 ̊C). ibuprofen if your child is dehydrated. 1 2 3 • Encourage your child to drink more Always seek medical advice if your child develops a fever soon after an (even little amounts often). operation, or soon after travelling abroad. • Know how to identify a non- My toddler is hot Have you tried infant If their temperature blanching rash (see page 26). and grumpy. paracetamol? Have you remains over 37.5˚C and • Give paracetamol or ibuprofen in made sure they are doesn’t come down, the correct recommended dose for your • Check child during the night. drinking lots of fluids? contact your GP. child (see page 7 for advice on usage). Source: NICE, Feverish illness in children Source: DoH Birth to five edition 2009. 24 25 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 27 Meningitis Not common but serious and contagious

Babies and toddlers are most vulnerable as they cannot easily fight infection The glass test because their immune system is not yet fully developed. They can’t tell you how they are feeling and can get a lot worse very quickly. Keep checking them. The glass test is a really useful way of spotting suspected meningitis. If your child has a cluster of red or purple spots, press the side of a clear drinking Meningitis is a swelling around the brain. It is a very serious, contagious illness, glass firmly against the rash. but if it is treated early most children make a full recovery. GP says Go straight to the Accident and You should always treat any case of suspected meningitis as an emergency. If any of the signs below are Emergency Department Early signs may be like having a cold or flu. Children with meningitis can present contact a Doctor. become seriously ill very fast, so make sure you can spot the signs. Your child may have a cluster of red or purple spots. Do the glass test. This rash can be harder to see on darker skin, so check for spots over your baby or child’s whole Fever, cold hands Floppy and body as it can start anywhere (check lightest areas first). However, the rash is and feet unresponsive not always present - be aware of all the signs/symptoms.  The presence of fever and any other of the above symptoms should be taken extremely seriously. Not all children will show all the signs listed on the right. Drowsy and Spots/rash. difficult to wake Do the glass test In this example the spots are still In this example the spots under the visible through the glass. This is called glass have virtually disappeared. It is a non-blanching rash - it does not unlikely to be meningitis but if you fade. Contact a Doctor immediately are still worried call NHS 111, contact 1 2 3 Rapid breathing Fretful, dislikes (e.g. your own surgery or Walk-in/ your GP or go to A&E. My child has a rash Have you tried If the spots do not fade under or grunting being handled and is unwell. the glass test? pressure contact a Doctor (e.g. Urgent Care Centre). If you cannot get Find out more from www.meningitisnow.org help straight away go to A&E. your GP or Walk-in Clinic). If you cannot get help straight away go Unusual cry or moaning to A&E. 26 27 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 29

1 My child keeps coughing and sneezing, has a mild temperature Coughs, colds and flu and seems generally unwell. Not usually serious 2 You will probably find when your child starts mixing with other children they get Have they recently started nursery? Catching colds is lots of coughs, colds and sniffles. There are some good things about this though very common. Have you as it helps the body build up a natural immune system. spoken to your Pharmacist Flu can be more serious than a cold and leave your child feeling quite unwell. Flu about paracetamol and tends to come on more suddenly and severely than a cold. Your child may feel cough medicines? achy and uncomfortable, and be ill for a week or more. Pharmacist says 3 Most bugs will run their course without doing any real harm because they will get If symptoms last for more better on their own. An annual nasal spray flu vaccine is available as part of the Children can often be treated than 10 days or your child NHS Childhood Vaccination Programme. Ask your Health Visitor for details. using over the counter is coughing up yellow ‘goo’ medicines to help to bring they may have an infection. Things you can do at home to help: down a raised temperature. Contact your GP.  Give your child lots to drink. Paracetamol or ibuprofen can  Try paracetamol or ibuprofen (not aspirin) (see page 7 for advice on usage). help. Check the label carefully.  Keep them away from smoke and anyone who smokes. Some are available as a liquid  Talk to your Pharmacist but remember that coughing is the body’s way of for children and can be given keeping the lungs clear. from the age of about three Don't pass it on:  Make sure they get plenty of sleep/rest. months. Check with the Catch it Germs spread easily. Always carry See your GP if: Pharmacist and tell them how tissues and use them to catch coughs or sneezes.  Your baby has a temperature of 37.5˚C or more. old your child is. Bin it Germs can live for several hours on tissues.  They have a fever with a rash. Flu symptoms are more severe Dispose of your tissue as soon as possible.  They are not waking up or interacting. and you may need to see Kill it Hands can pass on germs to everything you  Your child is finding it hard to breathe. your GP. touch. Clean your hands as soon as you can. Source: 2013 NICE guidance. 28 29 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 31

1 Bronchiolitis My child with croup has a distinctive barking cough and Wheezing and Bronchiolitis is a common respiratory tract infection that makes a harsh sound, when affects babies and young they breathe in. children under a year old. The 2 breathing difficulties early symptoms are similar to those of a common cold and Comforting your child is include a runny nose and cough. important as symptoms may Look at the signs worsen if they are agitated or As it develops, the symptoms crying. Mild cases of croup can Any kind of breathing difficulty your infant or child experiences can be scary for of bronchiolitis can include: often be managed at home. parents. It is often nothing to worry about and illnesses like bronchiolitis, mild croup GP’s tips A slight fever, a persistent and a cough can often be treated at home. cough and difficulty feeding. 3 Get help and contact your GP Use your instincts with newborns and babies. It could be: now if your child: Symptoms usually improve If your child has a fever, children's paracetamol will help • Rapid breathing or panting, which is common. There is no other sign of illness, it Seems to find breathing after three days and in most  lower their temperature. comes and goes and your baby is breathing comfortably most of the time, hard work and they are cases the illness isn’t serious. there’s normally no need to worry. sucking in their ribs and However, contact your GP or • Breathing may sound a bit rattly. Try holding your baby upright. tummy. Health Visitor if your child is • Occasional coughing or choking which may occur when a baby takes in milk They can’t complete a only able to feed half the  too quickly with feeds. Try to slow things down a bit. Check feeding position. full sentence without normal amount or is struggling • A cold or mild cough. Keep an eye on them at this stage and use your instincts. stopping to take a breath. to breathe, or if you are If you are worried talk to your Health Visitor. generally worried about them. In older babies and toddlers you may notice: Source: www.nhs.uk/conditions/ • Coughing, runny nose, mild temperature - (see page 28 coughs, colds & flu). Get help and call 999 or go Bronchiolitis/ • Croup (hoarse voice, barking cough) needs to be assessed by a Doctor and to A&E now if: may need treating with steroids.  Their chest looks like it is • Child appears pale. ‘caving in.’ Call 0800 022 4332 or visit  They appear pale or even www.smokefree.nhs.uk slightly blue-ish. Source: NHS Choices - Symptoms of bronchiolitis 30 31 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 33 Asthma Know the symptoms

Asthma is a common long-term condition that can be well controlled in most children. The severity of asthma symptoms varies between children, from very mild to more severe. Asthma has multiple causes and it is not uncommon for GP says Asthma Nurse says two or more different causes to be present in one child. Asthma is more than wheezing. Coughing, recurrent bronchitis and shortness of breath, especially Your GP will normally be able to The most important part of when exercising, are also ways that asthma appears. diagnose asthma by asking about managing asthma is for you The two most common triggers of asthma in children are colds and allergies. your child’s symptoms, examining and your child to know about After infancy allergies become particularly important and avoiding the allergens their chest and listening to their asthma and what triggers an to which your child is allergic may help improve their asthma. breathing. attack. A sudden, severe onset of symptoms is known as an asthma attack, it can be Parents should regularly attend their Our GP asthma clinics offer local asthma clinic and get regular life threatening and may require immediate hospital treatment. If your child has advice and treatment. Ask support on better management of asthma, make sure you know how to use your child’s inhaler properly and about the seasonal flu jab. their child’s asthma at home. This will attend the yearly review with your GP. save unnecessary trips to hospital. Asthma often runs in families and parents should avoid smoking indoors or All children over six months with near to their children. asthma who require continuous or Symptoms of severe asthma repeated use of a steroid preventer Symptoms include repeated coughing and inhaler or oral steroid are offered the wheezing, shortness of breath and bringing up 1 2 3 seasonal flu vaccine. In addition, any phlegm. Symptoms often get worse at night. My child seems to Have you tried reducing any If symptoms persist see child over six months who has been Call 999 to seek immediate medical wheeze and cough a possible amounts of dust your GP. If your child has admitted to hospital with a lower respiratory tract infection should also Call 0800 022 4332 or visit assistance if your child has severe lot, it seems to get around the home? Do you a serious asthma attack be offered the seasonal flu vaccine. www.smokefree.nhs.uk symptoms of asthma. worse at night. smoke? Have you talked to call 999. your Health Visitor?

Source: Department of Health, Birth to five 2009 32 33 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 35

Spotting symptoms Nose, throat and ears Anaphylactic shock This example shows areas where allergy Allergies Anaphylaxis is a dangerous type sufferers may experience symptoms. Runny nose, blocked nose, itchy of allergic reaction which is most Many of these symptoms can develop as nose, sneezing, pain in sinuses, Managing and understanding your child’s allergy likely to be caused by particular a result of other common childhood headaches, post-nasal drip (mucus drips down the throat from behind foods, insect bites or medicines. illnesses. With an allergy, symptoms often 50% of children in the UK have allergies. For parents it is a learning curve in the nose), loss of sense of smell and Early signs of allergic reaction: appear more quickly or suddenly. understanding what to avoid and how to control and manage the allergy. Find out taste, sore throat, swollen larynx • Swelling and itching; the face as much as you can. There are many types of allergies. (voice box), itchy mouth and/or may be flushed and wheals or Eyes throat, blocked ear and glue ear. An allergy is when the body has a reaction to a protein such as foods, insect hives may erupt on the skin. stings, pollens, house dust mite or another substance such as antibiotics. There • Lip or facial swelling. Itchy eyes, watery eyes, prickly are many common allergies. Some families seem to include more individuals with • Acute vomiting or abdominal eyes, swollen eyes, ‘allergic allergies than other families. Children born into families where allergies already pain. shiners’ - dark areas under the exist show a higher than average chance of developing allergies themselves. eyes due to blocked sinuses. Skin Anaphylaxis or severe reactions: Allergic symptoms can affect the nose, throat, ears, eyes, airways, digestion and Urticaria • Difficulty breathing, coughing skin in mild, moderate or severe form. When a child first shows signs of an allergy Wheals or hives, bumpy, itchy raised and/or wheezing. it is not always clear what has caused the symptoms, or even if they have had an areas, rashes. • Loss of colour; cold and clammy. Airways allergic reaction, since some allergic symptoms can be similar to other common Eczema • Loss of consciousness (may childhood illnesses. Urticaria can be one of the first symptoms of an allergic Wheezy breathing, difficulty in Cracked, dry or weepy, broken skin. appear asleep). breathing, coughing (especially at reaction. If the reaction is severe, or if the symptoms continue to re-occur, it is Call 999 and tell the operator you night time), shortness of breath. important that you contact your GP. think the child has anaphylaxis. If available, an adrenaline injection Digestion 1 2 3 should be given as soon as a Food allergies occur Allergens can cause skin reactions Children are most serious reaction is suspected. If Swollen lips/tongue, stomach ache, when the body’s (such as a rash or swelling of the commonly allergic to you already have an EpiPen or feeling sick, vomiting, constipation, immune system lips, face and around the eyes), cow’s milk, hen’s eggs, injection device, make sure you Call 0800 022 4332 or visit diarrhoea, bleeding from the bottom, reacts negatively to digestive problems such as vomiting peanuts and other know the correct way to use it in www.smokefree.nhs.uk reflux, poor growth. a particular food or and diarrhoea, and hay-fever-like nuts, such as hazelnuts advance of an emergency. food substance. symptoms, such as sneezing. and cashew. Source: Allergy UK Source: NICE - Testing for food allergy in children and young people 34 35 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 37 Upset tummy Not nice for you or your baby

Sickness and diarrhoea bugs are caught easily and are often passed on in places where there are lots of children. Feeling sick and suddenly being sick are normally the first signs. Diarrhoea can Health Visitor says follow afterwards. If your child is not vomiting frequently, is reasonably comfortable If you are breastfeeding Pharmacist says in between and you are able to give them frequent small amounts of water, they continue to do so. While are less likely to become dehydrated and probably don't need to see a Doctor. There are lots of ways you can care for breastfeeding you should Speak to your GP if they are unwell for longer than 24 hours or sooner if your child at home. Things to try are: Signs of increase your fluid intake to they are newborn or if you notice signs of dehydration.  Give them regular drinks - try small dehydration help maintain milk supply.  amounts of cold water. Breastfeed If you're breastfeeding, keep on doing so even more frequently. Offer older Less wet nappies (i.e. Source: www.nhs.uk/conditions on demand if breastfeeding. children plenty of water, or an ice-lolly for them to suck. If they want to eat, give  them plain foods like pasta or boiled rice (nothing too rich or salty). they wee less). Being extra careful with hand  More sleepy than usual. hygiene (use soap and water or Keep them away from others, especially children, who may pick up infection. Be  anti-bacterial hand gel and dry extra careful with everyone’s handwashing. Dry mouth. hands well with a clean towel).   Sunken fontanelle (i.e.  Rehydrating solutions come in the soft spot is more pre-measured sachets to mix with dipped in than usual). water. It helps with dehydration. 1 2 3 My baby has Have you given them lots of Speak to your GP if symptoms If your child is unwell for more than 24 diarrhoea and is water? This will help prevent show no sign of improvement hours speak to your GP. If your baby is being sick. them becoming dehydrated if it after 24 hours or straight away newborn or very unwell contact your is a tummy bug. Speak to your if they are newborn. Try rehydrating solution from GP straight away. Pharmacist and ask about a your Pharmacist. rehydrating solution. 36 37 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 39

Bottle-fed baby Constipation If a bottle-fed baby becomes constipated you can try offering Easy to treat cooled boiled water between feeds (never dilute baby milk). If Constipation is a very common problem in children. Many children normally the problem doesn’t go away, talk pass stools as far apart as every few days. Regardless, you should treat hard to your Health Visitor or GP again. stools that are difficult to pass and those that happen only every three days as constipation. From day four and for the first few weeks, your baby should pass at least two yellow stools every day. These stools should be at least the size of a £2 coin. Remember, it’s normal for breastfed babies to pass loose stools. Switching the type of milk or formula can also cause constipation. Health Visitor says Many things contribute to constipation but infants and children who get well- For babies over six months balanced meals typically are not constipated. To avoid constipation and help stop it coming back make sure Ask your Health Visitor for advice. In rare cases, constipation can be due to an your child has a balanced diet underlying illness, so if the problem doesn’t go away in a few days, it’s including plenty of fibre such important to talk to your GP. as fruit, vegetables, baked beans and wholegrain breakfast cereals. We do not recommend unprocessed bran (an ingredient in some foods), 1 2 3 which can cause bloating, Does my child have If your child is constipated, Ask your Health Visitor or flatulence (wind) and reduce the a balanced diet? they may find it painful to Pharmacist whether a absorption of micronutrients. go to the toilet. suitable laxative may help. Drink plenty of fluids.

Source: NICE guidelines 2009, constipation in children 38 39 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 41 Earache and tonsillitis A baby’s ears need to be treated with care

Ear infections, which can result in earache are common in babies and toddlers. They often follow a cold and can sometimes cause a temperature. A child may pull at their ear, but babies often cannot tell where their pain is coming from, so they just cry and seem generally uncomfortable. To reduce ear infections Babies have some natural protection against infections in the first few weeks - this is boosted by breastfeeding. In babies and toddlers, bacteria pass from the nose • A baby’s ears need to be to the ears more easily. Ear infections can be painful and your child may just need treated with care. What are the signs extra cuddles and painkillers from the Pharmacist. Your child may have swollen • Never use a cotton bud of an ear infection? glands in their neck - this is the body’s way of fighting infection. inside your child’s ear. Tonsillitis • If they have a temperature The signs are a raised wax may ooze out. temperature, general irritability Earache can also be caused by tonsillitis (the inflammation of the tonsils). It is a • Use different, clean, damp and pain or discomfort. The ears common type of infection in children. Symptoms include a sore throat, earache, cotton wool on each ear to may be red and your baby may coughing and a high temperature. It is not a serious illness and you only need to gently clean around the outer pull them because they are see your GP if symptoms last longer than four days or become more serious with area. uncomfortable. They may even severe pain, a very high temperature or breathing difficulties. • Avoid smoke. have a pus-like discharge, which • Do not use ear drops or oil can also be associated with a 1 2 3 unless prescribed by your GP. blocked feeling in the ear or My toddler has Have you tried infant Most ear infections get better by hearing loss. Although most ear • If your child is still not hearing earache but seems paracetamol or ibuprofen themselves. Speak to a Doctor if infections settle down without six weeks after infection, your otherwise well. from your Pharmacist? symptoms show no sign of Health Visitor can refer them any serious effects, there can be improvement after 24 hours, your mild hearing loss for a short time to audiology. Call 0800 022 4332 or visit child seems in a lot of pain or you www.smokefree.nhs.uk (two to three weeks). notice fluid coming from the ear. Source: DoH Birth to five edition 2009/NHS Choices. 40 41 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 43 Chickenpox and measles Take rashes seriously

Chickenpox Measles Chickenpox is a mild disease that most children catch at Measles is a very infectious illness. About one in five some point. The spots often look like mosquito bites and children with measles experiences complications such as can appear on any part of the body. After having ear infections, diarrhoea and vomiting, pneumonia, chickenpox, the virus stays in the body. Later in life the meningitis and eye disorders. One in 10 children with virus can come back in a different form known as shingles. measles ends up in hospital. There is no treatment for measles. Vaccination is the only way of preventing it. If your Chickenpox is easy to pass on to someone who has not Health Visitor says children have not yet had the MMR vaccination, do not had it before. If your child has chickenpox keep them away delay. Speak to your Health Visitor. Do not forget to keep up-to- from others. date with immunisations to Once the rash starts, your child will need to rest and you can Chickenpox can be incredibly itchy, but it's important for protect your child from treat the symptoms until your child’s immune system fights children to not scratch the spots so as to avoid future measles (MMR vaccination). off the virus. If there are no complications due to measles, scarring. One way of stopping scratching is to keep the symptoms will usually disappear within 7-10 days. fingernails clean and short. You can also put socks over your child's hands at night to stop them scratching the rash Closing curtains or dimming lights can help reduce light as they sleep. sensitivity. Midwife says If your child's skin is very itchy or sore, try using calamine Damp cotton wool can be used to clean away any crustiness lotion or cooling gels. These are available in pharmacies and If you are pregnant and have around the eyes. Use one piece of cotton wool per wipe for are very safe to use. They have a soothing, cooling effect. had chickenpox in the past it is each eye. Gently clean the eye from inner to outer lid. likely that you are immune to chickenpox. However, please Painkillers contact your GP or Midwife for If your child is in pain or has a high temperature (fever), you can give them a mild painkiller, such as advice. paracetamol or ibuprofen (available over-the-counter in pharmacies) (see page 7 for advice on usage). Do not give aspirin to children under the age of 16. 42 43 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 45 Urticaria or hives Easy to confuse with more serious illnesses

Childhood rashes are very common and often nothing to worry about. Most Foods to avoid: rashes are harmless and go away on their own. There is controversy over the role of Urticaria or hives is a raised, red, itchy rash that appears on the skin. It can be diet in people with long-term hives. frightening especially if you don’t know the cause. It happens when a trigger GP says There are two groups of chemicals in causes a protein called histamine to be released in the skin. Histamine causes Some things which can trigger some foods that may trigger urticaria. redness, swelling and itching, the rash can be limited to one part of the body or urticaria can be avoided, these It is important to discuss your child’s spread across large areas of the body. It can sometimes be confused with other include: diet with your Health Visitor. types of more serious rashes such as meningitis. • Food such as peanuts, Avoid: shellfish, eggs and cheese. • Shellfish Hives can be triggered by many things, including allergens (such as food or latex), • Environmental factors such • Strawberries, bananas, mangoes, irritants (such as nettles), medicines or physical factors, such as exercise or heat. pumpkin, tangerines, kiwi But usually no cause can be identified. It's a common skin reaction that's likely to as pollen, dust mites or • Tomatoes, peas affect children. The rash is usually short lived and mild, and in many cases does chemicals. • Fish not need treatment as the rash often gets better within a few days. If you’re • Insect bites and stings. • Chocolate struggling with it, a medication called antihistamine usually helps. Creams help • Emotional stress. • Pineapple with the itching and are available over-the-counter at pharmacies. Speak to your • Some medications - do not Pharmacist for advice. stop any prescribed Cut down on: medicines before you speak • Spices to your Health Visitor or GP. • Orange juice • Physical triggers such as • Raspberries 1 2 3 pressure to the skin, change • Tea My child has developed It can be difficult to identify If itching persists ask in temperature, sunlight, Source: Allergy UK itchy red spots. what has triggered the rash. your GP about anti- exercise or water. Try to think about any new or histamine medication. Source: www.nhs.uk/ different foods they have had. conditions/skin-rash-children 44 45 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 47

Dietician says What can I do? Healthy lifestyles Salt and Sugar is added to Many parents are unaware of the dangers of Means many things nearly all processed products. childhood obesity but by following the top tips below you can make a difference to your child’s Three-quarters of the salt and Living a healthy lifestyle means many things: having fun, eating well, being active, health. sugar we eat is already in the staying safe, getting enough sleep, taking care of our minds and bodies. Practical 1. Sugar Swaps - Swapping sugary snacks food, the rest is what we add to things too like making sure your child visits the Dentist regularly, their cooking or shake on our meals. and drinks for ones that are lower in sugar immunisations are kept up to date, they are receiving their free daily vitamin drops can make a huge difference. Children need less than 5g of and that they attend health and development checks. Look out and be aware of Screen time 2. Meal Time - It’s important for kids to have salt a day (2g sodium). your child’s health in order to prevent illness and discuss any concerns with your regular, proper meals as growing bodies The first two years of life are a Health Visitor. Developing a healthy attitude early on will help to ensure they respond better to routine. critical time for brain become healthy throughout life. development. TV and other Juice drink 3. Snack Check - Many snacks are full of the electronic media can get in the 23g sugar things that are bad for us - sugar, salt, fat Being physically active every day is important for healthy growth and development way of exploring, playing, (5 teaspoons) and calories. So try and keep a careful eye and impacts on their developing social skills. Babies should be encouraged to be thinking and interacting, which all on how many the kids are having. active from birth. Before your baby begins to crawl, encourage them to be encourage learning and healthy 4. Me Size Meals - It’s important to make sure physically active by reaching and grasping, pulling and pushing during supervised physical and social development. kids get just the right amount for their age. floor play, including tummy time. Children who consistently spend Pizza slice 5. 5 A Day - 5 portions of fruit and/or Minimise the amount of time children spend sitting watching TV, in a buggy, more than four hours per day 2.8g salt vegetables a day. playing computer games and travelling by car, bus or train. Try to make exercise watching TV are more likely to be 6. Cut Back Fat - Too much fat is bad for us. fun and part of everyday life for all the family. overweight (less time for play). It’s not always easy to tell where it’s lurking. TV and electronic media can limit 7. Up and About - Most of us spend too long communication and speech sitting down. Keep active. Encourage your 1 2 3 skills, resulting in the child Fromage frais child to walk, you may need How much exercise Children who can walk on their Safe, active play, such as preferring to listen rather than 12.4g sugar to use child safety reins. should my child own should be active every day using a climbing frame, riding take part in a real-life (2 teaspoons) have daily? for at least three hours. This a bike, playing in water, conversation. TV can affect sleep Source: www.nhs.uk/Start4Life should be spread throughout chasing games and ball DoH 2009 (www.dh.gov.uk/obesity). patterns too. the day, indoors and outside. games should be supervised. 46 47 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 49 Childhood obesity Get the healthy future they deserve

Many parents are unaware of the serious health implications of children being overweight (or obese) with a greater risk of long-term health problems, including cardiovascular problems and type 2 diabetes. Overweight babies and toddlers are more than five times as likely to be overweight as children and adults. Good eating and exercise habits need to be developed early in life. Talk to your Health Visitor about healthy meal ideas for all the family. Be in control Being overweight is rarely to do with a medical problem, and is simply due to an It can be easy for busy parents unhealthy diet and not enough exercise. It is better to prevent your child (or family members) to prioritise becoming overweight in the first place. Good sleep patterns, a healthy varied diet their children’s immediate and regular exercise will all help keep your child to a healthy weight. happiness over their long-term The emotional consequences of obesity in childhood can be severe and long- health, by giving them the lasting, including bullying and low self-esteem. Parents can find it difficult to talk to chocolate bar or sugary drink their child about being overweight as they feel guilty and they do not want to they are crying for. Many upset them by talking about it. parents allow children to decide what goes into the supermarket Parents often underestimate the amount of food that children eat and trolley in order to avoid rows. overestimate the amount of activity they do. Many parents believe their children You are responsible for what are already active enough confusing ‘being boisterous’ with ‘being active’ your child eats. What your child eats now will 1 2 3 set up a pattern for life and My mum confuses giving It can be difficult, but try to Give her some healthy overweight children are being her grandson chocolate explain to her why you would meal ideas and maybe set up for a lifetime of sickness with being kind to him. prefer him to have healthy send him along with some and health problems. She only wants him to be snacks and that in the long fruit or vegetable slices to happy but I am worried. run it is best for him. snack on. 48 49 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 51

Bumps and bruises Head injury One of the signs of a severe Part of growing up head injury is being unusually sleepy, this does not mean you cannot let your child sleep. Minor cuts, bumps and bruises are a normal part of growing up. Allowing your child to explore the world around them (with supervision) helps them develop and You need to get medical learn. Most of your toddler's bumps will require no more than a cuddle to make attention if: them better. You will quickly be able to tell by the noise of the bang, the reaction • They are vomiting of your child and the colour of the area affected, which are the more serious persistently (more than bumps. If your child has unexplained bruising or injury you need to find out how three times). this happened. • They are complaining it hurts. If it looks like the bump may swell then use a cold flannel (soaking the cloth with cold water) or ice pack (but don't put ice directly onto the skin) to help reduce • They are not responding at all. swelling and to cool the area for at least a few minutes. • Pain is not relieved by If your child has had a bump to the head and it looks serious or paracetamol or ibuprofen. symptoms worsen call a Doctor. Read the information on the right. Keeping them safe  If they are tired from what’s If your child is under a year old and has a bump on the head get advice from happened, or from crying, then Being a toddler means your your GP. it is fine to let them sleep. If you child is discovering the world are worried in any way about around them. This can result in their drowsiness, then you bumps and bruises. It is 1 2 3 should wake your child an hour almost impossible to prevent After a fall comfort Give the child Seek immediate help if: after they go to sleep. every accident although there the child, check for some painkillers • They have seriously injured are things we can do at home injuries, treat bumps and let them rest themselves. Check that they are okay, and which might help. and bruises. whilst watching • They are unconscious. that they are responding them closely. • They have difficulty breathing. normally throughout the night. • They are having a seizure.

If you are still worried,contact your GP or GP out-of-hours service.If you cannot get help go straight away to the Accident and Emergency Department. 50 51 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 53

Preventing scalds and burns • Always supervise children in the kitchen. Burns and scalds • The front of the oven can become hot enough to burn a young child. Use the Knowing what to do back rings of cookers when possible. • Never drink hot drinks with a baby or child A burn is damage to the skin, which is caused by direct contact with something in your lap. hot. Burns can also be caused by certain chemicals, electricity and friction. A • Never let a child drink a hot drink through scald is a burn that is caused by a hot liquid or steam. Scalds are treated in the a straw. same way as burns. • Never heat up a baby's milk in a Treat any burn or scald straight after the accident but always take your microwave. Stir baby food well if it is child to hospital for anything more than a very small burn or scald. A baby’s heated in a microwave. skin is very delicate and can be scarred without the right treatment. • Candles should be up high and out of GP says reach. Cool the burnt area by placing under cool running water for at least 20 minutes Do • Put cold water in the bath first, and then (making sure the child does not get too cold). When the burn has cooled, cover it Hold the affected area under bring up the temperature with hot water. with a sterile dressing, food quality cling film or a plastic bag. Don’t wrap it too cold water for at least 20 tightly. Give paracetamol or ibuprofen (see page 7 for advice on usage). Take your minutes. Cover the burn with child to hospital. cling film if you have some, Babies/toddlers pull up on everything when learning to stand and walk. Keep hot then wrap in a cloth soaked in drinks out of reach and not on tablecloths that they may pull onto themselves. cool water. Look at home safety equipment like a stairgate to keep them safe. Don’t Apply fatty substances like 1 2 3 butter or ointment as this My child has Treat the burn or scald straight For small burns take your won't do any good and will burnt or scalded after the accident by running under child to the Practice Nurse only waste time for hospital themself. cold water for 20 minutes.Do not or Minor Injuries Unit. staff who'll have to clean the use creams, lotions or ointments For large or facial burns area before it can be treated. on the burn or scald. you should go to A&E.

If you are still worriedcall NHS 111. If you cannot get help straight away go to the Accident and Emergency Department. 52 53 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 55

Cuts PREVENTION: Glass causes serious cuts with many children ending up in Lock all chemicals, medicines and cleaning products Household accidents A&E. away. WHAT TO DO: PREVENTION: WHAT TO DO: Do not leave drinking glasses on the floor. Make sure glass Find out what your child has swallowed and take it with Falls If your child is choking act immediately and calmly. Make bottles are kept up high. you when you go to A&E. For babies the biggest danger is rolling off the edge of a sure you do not push the object further down the throat. WHAT TO DO: bed, or changing surface. For toddlers it is more about Strangulation falling from furniture or down stairs. Encourage your child to cough. Use back blows, if they • If the cut is not serious bathe the area, make sure there become unconscious call for help (do not leave your child is no glass left and cover with a clean non-fluffy cloth. Window blind cords and chains can pose a risk for PREVENTION: • Make sure your baby cannot roll off any surfaces, put alone) and start CPR. • If the cut is serious, is bleeding a lot or has a piece of babies and children who could injure or even strangle pillows around them. www.redcrossfirstaidtraining.co.uk glass under the skin (maybe they trod on some glass) themselves on the hanging looped cords. • Do not put a bouncing cradle or car seat on a surface go to A&E. PREVENTION: • Install blinds that do not have a cord, particularly in a where they could wriggle off. Head injury child's bedroom. • Use stairgates once your child is mobile. Make sure One of the signs of a severe head injury is being unusually Drowning sleepy, this does not mean you cannot let your child sleep. • Pull cords on curtains and blinds should be kept short balconies are locked and fit restrictors and safety locks Many children drown, often in very shallow water. It You need to get medical attention if: happens in the bath, in garden ponds, paddling pools and kept out of reach. to windows. • They are vomiting persistently (more than three times). and water butts. • Tie up the cords or use one of the many cleats, cord WHAT TO DO: • They are complaining it hurts. PREVENTION: tidies, clips or ties that are available. If your child has a serious fall call 999. • They are not responding at all. • Supervise children near water at all times. Use a grille • Do not place a child's cot, bed, playpen or highchair • Pain is not relieved by paracetamol or ibuprofen. on ponds or fill in a garden pond to use as a sand pit. near a window. Choking • Make sure your child learns to swim. • Do not hang toys or objects on the cot or bed that Babies and toddlers can easily swallow, inhale or choke If they are tired from what’s happened, or from crying, on small items like balloons, peanuts, buttons, plastic toy WHAT TO DO: could be a hazard. then it is fine to let them sleep. If you are worried in any pieces, strings or cords. Get your child out of the water. Try to get them to cough • Do not hang drawstring bags where a small child could way about their drowsiness, then you should wake your PREVENTION: up any water. If they are not responding call 999. get their head through the loop of the drawstring. child an hour after they go to sleep. • Check on the floor and under furniture for small items. www.redcrossfirstaidtraining.co.uk • Find out more about CPR. WHAT TO DO: • Check that toys are age appropriate and in good www.redcrossfirstaidtraining.co.uk Check that they are okay, and that they are responding condition. Poisoning WHAT TO DO: normally throughout the night. • Find out more about CPR (a first aid technique that is a Poisoning from medicines, household products and Untangle child, call 999 and start CPR. combination of rescue breaths and chest compressions. cosmetics are common. Source: The Royal Society for the Prevention of Accidents (RoSPA) Sometimes called the kiss of life). 54 55 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 57 Choking

Act immediately and calmly Children, particularly between the ages of about one and five, often put objects in their mouth. This is a normal part of how they explore the world. Some small If your child is choking: objects, like marbles and beads, are just the right size to get stuck in a child’s • If you can see the object, try airway and cause choking. The best way to avoid this is to make sure small to remove it. But do not objects like these are out of your child’s reach. poke blindly with your In most cases you, or someone else, will see your child swallow the object that fingers. You could make causes the choking. However, there can be other reasons for coughing. If your things worse by pushing the child suddenly starts coughing, is not ill and often tries to put small objects in their object in further. mouth, then there is a good chance that they are choking. • If your child is coughing If your child is still conscious but either they are not coughing or their coughing is loudly, there is no need to do not effective, use back blows. If back blows don’t relieve the choking, and your anything. Encourage them to child is still conscious, give chest thrusts to infants under one year or abdominal carry on coughing and don’t thrusts to children over one year. Even if it is expelled, get medical help. leave them. • If your child’s coughing is not effective (it’s silent or they Health Visitor says Unconscious child with choking: cannot breathe in properly), shout for help immediately Babies and toddlers can easily If a choking child is, or becomes unconscious, put them on a firm flat surface. and decide whether they are swallow, inhale or choke on small • Call out or send for help. Call 999. still conscious. Call 999. items like lolly sticks, balloons, • Don’t leave the child at this stage. • If your child is still conscious peanuts, buttons, nappy sacks, • Open the child’s mouth. If the object is clearly visible, and you can grasp it but either they are not plastic toy pieces or cords. easily, remove it. coughing or their coughing is Is your baby’s environment safe? • Start cardiopulmonary resuscitation (CPR). Visit www.redcrossfirstaidtraining.co.uk not effective, use back blows. 56 57 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 59

Back blows for Chest thrusts for children under children under one year If back blows don’t How to resuscitate one year • Support the baby down your arm, which is relieve the choking • Support your child in placed down (or across) your thigh as you sit and your child is still a head-downwards or kneel. conscious, and position. Gravity can • Find the breastbone and place two middle under one year give a child help dislodge the fingers in the middle. chest thrusts. object. • Give five sharp chest thrusts, compressing • Sit or kneel and support the child on your the chest by about a third of its diameter. Back blows, chest thrusts & cardiopulmonary resuscitation (CPR) lap. If this is not possible, support your child in a forward-leaning position and give the back blows from behind. Abdominal thrusts for Babies under one year old Children over one year old • Don’t compress the soft tissues under the jaw children over 1. Open the baby's airway by placing one hand on the 1. Open their airway by placing one hand on the forehead as this will make the obstruction worse. one year forehead while gently tilting the head back and lifting and gently tilting their head back and lifting the chin. • Give up to five sharp blows to the back with • Stand or kneel behind the the chin. Remove any visible obstructions from the Remove any visible obstructions from the mouth or nose. the heel of one hand in the middle of the back child. Place your arms mouth or nose. 2. Pinch their nose. Seal your mouth over their mouth and between the shoulder blades. under the child’s arms 2. Place your mouth over the mouth and nose of the infant blow steadily and firmly into their mouth, checking that and around their upper and blow steadily and firmly into their mouth, checking their chest rises. Give five initial rescue breaths. Back blows for children over one year abdomen. that their chest rises. Give five initial rescue breaths. 3. Place your hands on the centre of their chest and, with • Back blows are more effective if the child If back blows don’t • Clench your fist and place it between navel 3. Place two fingers in the middle of the chest and press the heel of your hand, press down by one-third of the is positioned head down. relieve the choking and ribs. down by one-third of the depth of the chest. After 30 depth of the chest using one or two hands. • Put a small child across your lap as you and your child is still • Grasp this hand with your other hand and pull chest compressionsat a steady rate (slightly faster than 4. After every 30 chest compressions at a steady rate would a baby. conscious, and over sharply inwards and upwards. one compression a second), give two rescue breaths. (slightly faster than one compression a second), give • If this is not possible, support your child in one year give • Repeat up to five times. 4. Continue with cycles of 30 chest compressions and two rescue breaths. a forward-leaning position and give the abdominal thrusts. • Make sure you don’t apply pressure to the two rescue breaths until they begin to recover or 5. Continue with cycles of 30 chest compressions and back blows from behind. lower ribcage as this may cause damage. emergency help arrives. two rescue breaths until they begin to recover or emergency help arrives. Following chest or abdominal thrusts, reassess your child: • If the object is not dislodged and your child is still conscious, continue the sequence of back blows and either chest thrusts or abdominal thrusts. • Call out or send for help if you are still on your own. • Don’t leave the child at this stage. Source: NHS Choices, DoH birth to five 2009. 58 59 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 61

There are 100,000 new cases of skin cancer in the UK every year. Sun safety Cancer groups are working together to tell us about sun Protect their skin damage from an early age. As parents we can take simple Keep your child cool and protect them from the sun and heat. Babies under six measures to protect our children. months should be kept out of the sun and older children should be allowed in the sun Remember babies and toddlers for a limited time only, and their skin should be well protected. Stay out of the sun, are not interested in tanning and especially during the middle of the day. All types of skin, fair or dark, need protection. sunburn can cause damage to Attach an effective sunshade to the pushchair to keep them out of direct sunlight. A their skin. sun hat, with a wide brim or a long flap at the back, will protect your child's head and Source: www.britishskinfoundation.or.uk neck from the sun. Try to use loose long sleeved clothing. Apply high factor suncream Pharmacist says www.nhs.uk regularly, particularly if your child is in and out of the sea or a paddling pool. The higher the SPF (Sun Protection Factor) the better If your baby is under six months, offer more fluids and if breastfeeding, breastfeed the protection for the skin. You more often. If your baby is over six months old encourage them to drink water. For should use a complete sun older toddlers and children, plenty of fruit will also help to keep their fluid levels up. Vitamin D block on your baby or toddler. SPFs of up to 60 are available Is your child getting enough? and these block out almost all Vitamin D is important for good health, strong of the sun’s rays. Even with bones and growth. Most foods contain very suncream, keep them in the little vitamin D naturally and it is mostly made shade whenever you can and in the skin by exposure to sunlight. However, 1 2 3 make sure newborn babies you shouldn’t over-expose your child to the are never in the sun. Don’t sun, as casual sun exposure is enough. It is a bright day and your Are they in the shade Make sure you protect forget to protect their head, child is playing outside. and wearing sunscreen? your child’s head, skin and skin and eyes. For older Vitamin D helps your baby's body absorb Are they wearing a hat, eyes especially during the calcium, which is needed for the healthy long sleeves and middle of the day. children, you can buy development of strong bones and teeth. trousers? sunglasses from a pharmacy. 60 61 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 63

Long-term abuse is much more likely Domestic abuse What is domestic to cause problems for a child or abuse? young person as they get older. The Keeping your child safe longer children are exposed to Abuse can take many forms: violence, the more severe the effects You are not responsible for your abuser's behaviour. You or your child do not • Physical including sexual on them are. These can include a lack deserve to experience any form of abuse. Your abuser may blame you and other violence. of respect for the non-violent parent, things like being drunk, pressure of work, unemployment and minimise or deny • Mental and verbal cruelty. loss of self-confidence (which will what they are doing. You may have tried changing what you do, say and wear to • Financial control. affect their ability to form relationships try to pacify and not to antagonise the situation. Violence rarely happens only once • Controlling behaviour. in the future), being over-protective of and will get more and more serious as time goes on. You need to make sure you If you are the victim a parent, loss of childhood, problems and your child are safe. It’s not easy to accept that a loved one can act in this way at school and running away. Many people find it difficult to understand why and you may be trying to make the relationship work. The facts people stay in abusive situations. Fear, love, Domestic abuse can affect children in many ways. They may feel frightened, become the risk of homelessness and money worries withdrawn, aggressive or difficult, bedwet, run away, have problems at school, lack Domestic abuse affects many can make it difficult for women with children concentration and suffer emotional upset. Domestic abuse places children at risk of families. Women are at to leave. If you are a victim of domestic significant harm and professional support is needed. It is best that action is taken increased risk of domestic abuse, you are not the only victim - your early to stop things getting worse. Keeping your child safe is your responsibility. abuse during pregnancy and the children are too. You can report domestic Children can often get caught up in the crossfire and become victims. first year after giving birth, even abuse to any professional. There are many if there has not been any abuse Children need time to discuss the feelings they have about violence or abuse. Children agencies working in Staffordshire who will before. Men can also be victims. need to know that it is not their fault and that this is not the way relationships should be. help you to access support. For more Children do hear, they do see information, call Staffordshire Women's Aid and they are aware of violence 24 hour freephone helpline 0870 2700 123. at home, even if you think they 1 2 3 do not. Children react in Even if you think an incident is just a one-off, I am being abused and Don’t keep what is happening Don’t suffer alone, get help different ways to violence and other professional agencies may already have it is effecting my child secret, you have nothing to by talking to someone you research suggests that they are concerns. So your information could be very but if I contact someone be ashamed of. The longer trust or contact one of the more likely to become abusers important. it may get worse. abuse goes on the harder it organisations listed. Be a or victims later in life. gets to take some action. survivor - not a victim. 62 63 1580-Cannock Chase web:6521-Cornwall 8/4/15 10:25 Page 65

Useful national contacts Useful local contacts Allergy UK National Breastfeeding 01322 619 898 www.allergyuk.org Network Helpline For local services Staffordshire Cares Accident and Emergency (A&E) 0300 100 0212, 9.30am-9.30pm www.healthwatchstaffordshire.co.uk/ Family advice and advice on improving your health visit. For immediate life-threatening emergencies Association of Breastfeeding information-hub/resources/choose- Mothers 0300 330 5453 www.breastfeedingnetwork.org.uk 0300 111 8010 call 999 well or www.nhs.uk/Service-Search www.staffordshirecares.info County Hospital (Not 24h) 9.30am-10.30pm www.abm.me.uk National Childbirth Trust This includes late night Pharmacies, Staffordshire Marketplace Stafford ST16 3SA. 01785 257731 Press 4 Asthma UK 0300 330 0700 8am-10pm 7 days a week Minor Injuries Units and Walk-in Parent support, services and things to do. 0800 121 62 44 www.asthma.org.uk www.nct.org.uk Centres. New Cross Hospital www.staffordshiremarketplace.co.uk Baby LifeCheck National Domestic Violence Helpline Staffordshire Mental Health Wolverhampton WV10 0QP. 01902 307999 Ext 5080 www.babylifecheck.co.uk 0808 2000 247 Helpline Manor Hospital Child Accident Prevention Trust www.nationaldomesticviolence For over 18s feeling concerned, GP Out of hours Walsall WS2 9PS. 01922 721172 Ext 7045 020 7608 3828 www.capt.org.uk helpline.org.uk worried, stressed or low or who are GPs are experts in everyday health problems. If you Queen’s Hospital Cry-sis NHS Choices worried about someone they know. need to contact a GP out of hours call NHS 111. Burton-upon-Trent DE13 0RB. 01283 566333 Ext 5004 08451 228 669 www.cry-sis.org.uk Online information from the NHS on 0808 800 2234 conditions, treatments, local services www.staffordshirementalhealth.info Dental Helpline Russells Hall Hospital and healthy living. www.nhs.uk 0845 063 1188 Young Minds Dudley DY1 2HQ. 01384 456111 Ext 2300 Worried about your child’s behaviour, Diabetes UK Red Cross Minor Injuries Units/Walk-in Centres Information on CPR (kiss of life). emotional problems or mental www.diabetes.org.uk If you are in any doubt about which service you need, Alcohol and drugs www.redcrossfirstaidtraining.co.uk health? or which is your closest service, please call NHS 111. Family Lives www.youngminds.org.uk T3 - Young people’s service 0808 800 2222 www.familylives.org.uk Start4Life Healthy tips. Cannock Chase Minor Injury Unit 01785 241393 www.nhs.uk/start4life Staffordshire Families Healthy Start Information Service Information on (10.30am-6.30pm) www.cri.org.uk/t3_staffs.php www.healthystart.nhs.uk Stay at Home Dads Cannock Chase Hospital, Brunswick Road, Dad’s views, chat, news and support. childcare, Children’s Centres and One Recovery - Adult service La Leche League GB Cannock WS11 5XY. www.stayathomedads.co.uk family activities. www.adsolutions.org.uk/one-recovery-staffordshire 0845 120 2918 available 24 hours 0300 111 8007 01543 576200 To find an NHS Dentist 7 days a week. www.laleche.org.uk [email protected] Samuel Johnson Community Hospital Call NHS 111 or visit www.nhs.uk The Good Life The Lullaby Trust First Response In an emergency or for out-of-hours (24h) Home grown by the community of Cannock Chase, www.lullabytrust.org.uk If you are worried about the safety or treatment call your Dentist or NHS 111 Trent Valley Road, Lichfield, Staffordshire WS13 6EF. this website is packed with activities to show living a care of a child. 0800 1313 126 Meningitis Now 01543 412900 Ext 3130 healthy lifestyle is great fun. www.thegoodlife.uk.net 0808 80 10 388 www.meningitisnow.orgThe Institute of Health Visiting 64 Tips for parents. www.iHV.org.uk 65