Sun safe

Picture courtesy of Baby Banz

Hints and tips to protect your child in the sun.

1. Keep babies under 6 months out of the sun altogether.

2. Stay out of the sun between 11am and 3pm when the strength of the sun's rays are strongest.

3. Use shade whenever possible eg trees, umbrellas, etc.

4. Dress your child in loose baggy clothing eg an oversized tee shirt. Natural fibres are better. Don't let them run around all day naked or just in a swimsuit.

5. Protect your child's neck, shoulders and tops of arms as these are common areas for sunburn.

6. Use a floppy hat with a big brim to shade their face and neck.

7. Use sunscreen even if it seems overcast or cloudy. Re-apply frequently. The higher the sun factor the better. Try never to use one that's less than spf 30 and spf 50 is better.

8. Protect toddler's eyes with sunglasses preferably with an ultraviolet filter.

9. Use waterproof sunblock if your child is swimming or playing in water.

10. Make sure you offer cool drinks at frequent intervals.

Flat head shapes.

(Picture courtesy of Neurographics)
Positional plagiocephaly - this is when the shape of the head is flat in one or more spots.

Q. What causes flattening of a babies head?
A. Sometimes it's caused by lack of room in the womb, so twins, or a small pelvis or womb can be contributing factors.
Wryneck or Torticollis is another cause. This is when one or more of the neck muscles is tight so the head is restricted in it's range of movements.
Prematurity can contribute as the bones of a new baby increase almost tenfold in firmness in the last few weeks of pregnancy.
Back sleeping. Since it's recommended that baby's sleep on their backs to reduce the risk of cot death there has been an increase in the numbers of infants seen with flat heads.
Carseats, carriers and swings. In these devices the back of the head is resting against a very firm surface. If infants are allowed to spend a lot of time in them eg sleeping it accentuates the problem.

Q. Is there anything else that can cause a flat head?
A. There are a small number of other, less common causes eg premature closure of a fontanelle. Always ask us or your GP if you are worried about your baby's head shape.

Q. What can I do to prevent or treat it?
A. Frequent repositioning of your infant's head will help. Alternate the position of toys in the cot and the direction you lie your baby. Do not let them sleep for too long in a carrier seat or swing.
Regular tummy time when your baby has supervised time lying on their stomach. Ask us for the tummy time leaflet.
If you are worried at all ask us for advice, we may refer your baby for physiotherapy if we feel this is appropriate.

Q. Will it resolve?
A. Yes. The vast majority of infants will have the problem resolve on it's own over time if parents follow the suggestions and advice. Sometimes a head shape may be inherited. A flattening of the head in positional plagiocephaly doesnot affect the growth of the babies brain.
If you ever have a concern about the shape of your baby's head please ask us or your GP

Blues and Postnatal Depression

Baby blues often occur the first week after having a baby. Mum can feel emotional, tearful, touchy, depressed or anxious. These feelings are all normal and usually only last for a few days. It's thought that the hormonal changes within the body following childbirth are responsible for these feelings.

Q. If that's the blues, then what is postnatal depression?
A. Postnatal depression usually starts two to eight weeks post delivery and 1 in 10 women are thought to be affected. It can occur six months to a year after the babies birth. In some cases the baby blues don't go away or become worse. For other women the symptoms include, tiredness, irritability, poor appetite, lack of concentration or disinterest, anxiety, panic attacks, crying and feeling hopeless.

Q. Am I a bad mother if I feel like this?
A. No. It is an illness like any other and there are a lot of things that can help you and support you during this time.

Q. What should I do if I feel like this?
A. Talk to us. The health visitors offer a listening service and we can help support and advise you during this time. It's often easier to talk to an outsider than a family member. Remember anything you say to us is confidential.
See your GP and tell them how you feel. They work closely with us and it may be that medication can do a lot to help you on the road to recovery.

Q. I'm worried about taking medication?
A. Modern medicines for post-natal depression are not habit-forming. Your GP will prescribe the one thats right for you and we can offer support.

Q. What about specialist counselling?
A. Again, talk to us or your GP and we can refer you to a specialist service if you feel that is something that would help you.

Q. Is there anything else that might help me?
A. We know it can be difficult but meeting other Mum's really does help. Why not come to our Babyclub? Or use the Meet a mum service (see sidebar).
Try to get out and about as much as you can. Fresh air can help you and your baby.
Try baby massage or sing and play if you are worried about bonding with your baby. Ask Ruth for details.
Don't be scared to ask others for help. Ask your partner or a friend if they can help you with the baby or take time out just for you to relax or follow a hobby eg going to the gym or cross stitch, whatever would make you feel better.
Avoid alcohol, it is a depressant and may make you feel much worse.

If you ever feel that you might harm yourself or your baby seek medical advice or tell someone immediately.

Stork marks

Q. What are these?
A. These are also known as Salmon patches. They often occur at the nape of the neck, the forehead, the eyelids and under the nose of newborns. They are simply dilated blood vessels.

Q. Will they always be there?
A. No, they fade from the face during the first year of life. They are harmless and don't require treatment. The mark in the base of the neck may remain for life in some children.

Strawberry birthmarks

Q. What is it?
A. It's medical name is haemangioma. It's caused by a proliferation of immature blood vessels and forms a raised red mark resembling a strawberry.

Q. Is it always a red mark?
A. No, sometimes you can get other types which develop deeper under the skin and can look like bluish swellings. These can be called Cavernous haemangiomas.

Q. Are they more common in boys or girls?
A. Boys and girls can have them but they are more common in girls and pre-term babies. Some children can have several marks.

Q. How are they treated?
A. Most disappear by the time a child is five without any treatment. They often grow quite quickly until the baby is one they then become static and shrink over the next few years.

Problems.
Because they are a collection of blood vessels they can bleed. Most bleeds can be dealt with by applying firm pressure with a dressing or wad of tissue.
If the birthmark affects the babies feeding or vision or breathing your GP may refer your baby for treatment. Treatments include, laser therapy, injected corticosteroids, or surgical removal.

Cradlecap

Q. What is Cradlecap?
A. It's proper name is seborrhoeic dermatitis. It occurs soon after birth and is most common in the first two years. It's a build up of greasy white or yellowy brown scales on the baby's scalp or/and forehead.

Q.What causes it?
A. It's thought to be caused by an over activity in the baby's oil producing glands due to the hormones still circulating in the babies bloodstream.

Q. How do I treat it?
A. Loosen the scales by massaging warm olive oil or baby oil into baby's scalp. Leave it overnight then brush gently with a soft brush before shampooing out. If after repeating this a few times it doesn't improve you may want to try a cradle cap shampoo.

Problems.
If baby's skin is red or inflamed or the cradle cap is very severe we advise you see your GP as a mild hydrocortisone cream may be needed.

Nappy Rash

Many babies get nappy rash in the first year or so.

Q. What causes nappy rash?
A. It's caused by the skin being in prolonged contact with amonia from urine (wee) or bacteria from stools (poo) which can burn or irritate the skin. Other causes include:
sensitive skin
rubbing/chaffing
diarrhoea or illness
change in diet eg weaning
bubble bath or soap
baby wipes

Q. What does it look like?
A. It looks like red patches. The skin looks hot and sore and there may be spots.

Q. How do I prevent it?
A. Change the nappy frequently as soon as it's wet or dirty. Clean thoroughly use mild soap or gentle baby wipes. If you use soap make sure you rinse and dry the skin well. Leave the nappy off when you can and let fresh air get to the skin. A barrier cream may help.

Q. How do I treat it?
A. Follow the steps to prevent nappy rash. Ask us about which barrier creams are suitable and how to apply them.

Q. The rash isn't getting better, now what?
A. If it doesn't improve after treatment or if there is a persistant red, moist rash with little red or white pimples which have also spread into the skin folds, the baby may have thrush. In this case a special anti-fungal treatment is needed. Ask us, your GP or chemist for advice.

If in any doubt seek medical advice.

Crying baby

All babies cry. Some babies cry a lot. As a parent you want to make your baby happy but sometimes even after feeding, changing, rocking and playing nothing seems to work.
Here are some things to try.
If you are breastfeeding let your baby suckle at the breast.

If you have a baby sling try putting your baby in it and hold them close against you as you move about gently. Try gentle rocking or dancing to soft music.

Rock your baby gently back and forth in their pram or buggy. Try going out for a walk or drive. A lot of babies fall asleep in cars or while on a walk and if they wake as soon as you get home at least you've had a respite from the crying.

Find something new to look at or listen to. Cot mobiles, the radio, a stroll around the garden or park.

Some babies suck their thumbs or like a dummy. When a little older they may have a particular toy or blanket they like to suck or cuddle. Choose something washable and have a duplicate that you can alternate.

Stroke your baby firmly and rhythmically while holding them close to you. Baby massage may help. We will be offering courses for parents soon in baby massage. Talk to Ruth if you are interested.

If your baby likes a bath, this may help soothe them.

Put your baby down after a feed and leave the room for a few minutes. Sometimes a baby can be overstimulated.

Remember - this difficult time won't last forever.
Never be tempted to shake your baby to make them stop.
Contact us if you feel as if you are struggling.
There are some organisations which can help if the problem is prolonged. Check out the links in the sidebar or ask us.
If your babies cry is high pitched, or your baby has a temperature or appears in any way unwell contact your GP for advice.

Baby walkers

As health professionals we would like to see baby walkers banned from sale.

Q. Why don't you like baby walkers?
A. Baby walkers are associated with more injuries to infants than any other type of nursery equipment. In 2002 over 2,350 babies in the UK went to hospital following an injury sustained while in a baby walker. Almost 70% were under a year old. One third of all babies using a walker will be injured.

Q. What type of injuries do you mean?
A. Falls, the walkers can tip and baby can be thrown down steps or stairs. They can crash into sharp corners or fall on fires or hot stoves.
Burns and scalds. As well as the risk of falling against something hot because the baby can reach higher objects there is an increased risk of scalds due to the child pulling hot liquids down onto themselves.
Research from a hospital in Wales showed a quarter of babies aged 6-12 months in hospital with burns or scalds had sustained these injuries while in a baby walker. Many of these injuries were to the face and head.
Poisoning. The baby can acess things which previously they couldn't reach. An Australian study found baby walkers were the second most common factor associated with poisonings in children under 1.

Q. But I thought they would help my child's development.
A. This is untrue. There is a body of evidence that shows they DELAY development. Rolling, sitting and crawling are the building blocks for walking. They can actually cause problems, eg muscle shortening, destabilisation of the hips, tiptoe walking.

Q. Aren't they a good place to keep my baby occupied while I'm busy?
A. No. If anything a baby in a walker needs a greater level of supervision. Baby walker accidents happen very quickly and an American study showed in 70%of accidents the child was allegedly being supervised at the time.

Q. I thought new modifications had improved these problems and new walkers were safe to use?
A. This is unsupported by the evidence. There has been no reduction in the number of accidents.

Ask us for more information or collect our free handout from clinic if you would like to know more. Better still why not ask your MP about getting these dangerous items banned from sale.
(Our thanks to the Child accident prevention trust for use of their statistics)

Toddler diarrhoea

Between the ages of 1 and 5 some children may pass frequent, loose, smelly stools (poo). Usually the children are healthy and growing well. Your GP may not find any serious cause for this. This is known as Toddler Diarrhoea.

Q. My child is suffering from this and my doctor can't find a cause. What can I do?
A. Give less fluids between meals if your child drinks a lot. Drinks which contain artificial sweetners, low calorie drinks and some fruit juices can make this condition worse. You may need to do this gradually if your child drinks a lot. Sometimes giving a small snack such as bread and butter with a smaller drink may help.
Give more foods with a higher fat content e.g full-fat yoghurt, fromage frais and butter.
If your child eats a lot of high fibre foods eg wholemeal or cereal then try reducing these or swap to white bread, pasta and rice.

Problems.
If your child is vomitting at the same time or the diarrhoea is very watery or lasts longer than a few days, or if it contains blood or your child has severe or prolonged tummy ache then contact your GP urgently for advice.
Diarrhoea is not usually worrying, do not give any anti-diarrhoea medicine unless your doctor has prescribed it and make sure everyone in the family is extra careful with hand washing. Use a separate towel for the affected child.

Diarrhoea (Babies)

Diarrhoea is when a baby has frequent unformed watery stools (poo). If they have diarrhoea and sickness together this is called gastroenteritis.

Q. Why is this a problem?
A. If your baby has diarrhoea or gastroenteritis for more than a few hours they can become dehydrated from losing too much fluid.

Q. How do I know if my baby is dehydrated?
A. The baby may be lethargic/floppy. Baby may have a dry mouth, their skin may seem loose and the eyes and soft spot (fontanelle) on the top of the head may seem sunken. They may not pass much urine (wee). Seek medical advice if you have any doubts.

Q. How do I prevent this or treat it?
A. To prevent or treat dehydration your baby needs extra fluids. You can get special solutions from the chemist. These are called rehydration fluids. Names you may see are Dioralyte, Rehidrat or Electrolade.

If the diarrhoea continues for more than a few hours or your baby is also vomitting (being sick) then contact your GP or us urgently for advice.

Q. So, for mild diarrhoea what should I do?
A. Give extra fluids between feeds or after each watery stool. Oral rehydration fluids are best.
Don't stop breastfeeding - give the extra fluids in addition to the milk.
Don't stop formula feeding - give extra fluids and normal feeds. Donot alter the strength of the milk.

Q. What should I do if it's more severe?
A. Don't stop breastfeeding - give oral rehydration fluids as well as the breastfeed.
Stop formula feeds and give oral rehydration fluids for 3-4 hours, then resume normal formula feeds.

Ask us or your GP for advice. Normally we donot advise stopping formula feeds for 24 hours as we once used to. If your baby is unwell or has watery diarrhoea for more than one day seek medical advice straight away.

Feet

We get asked all the time about feet. Here are some of the commoner things we get asked.
The bones in baby's feet and toes are very soft. It's important to make sure that they aren't cramped by tight socks, sleepsuits or shoes. Make sure there is room for growth in length and width as baby's feet grow very quickly.

Q. When should I buy shoes?
A. When your baby has been walking independantly for 4-6 weeks.

Q. Why is it important that their feet are measured?
A. Shoes need to be aprox 1cm longer than the longest toe and wide enough for all the toes to lie flat. Shoes that are too small or too big can cause clawing or deformities of the foot as well as callouses or blisters.

Q. What kind of shoes are best?
A. Shoes made of natural materials, leather, cotton or canvas are better as they allow the foot to breathe and mould to the shape of the foot. Shoes with a buckle or lace or velcro will hold the shoe in place and prevent slipping.

Q. How often should I have their feet measured?
A. Once they start wearing shoes children under 4 need to be checked every 8 weeks. Over 4's every three months. Remember to check and discard socks at the same time as you check and discard outgrown shoes. Socks that are too small can be as damaging as ill-fitting shoes. never buy secondhand shoes or pass shoes down from one child to another. Shoes take on the shape of the previous owners foot and could cause damage. Don't rely on asking your child if their shoes feel comfortable. Because their bones are soft they may not be aware of cramping.

Problems.
When baby's begin too walk they often appear to 'waddle'. They may also appear to be 'bow-legged' or 'knock-kneed'. Or walk with their toes turned in or out. Most minor foot problems in young children will correct themselves. If you are concerned about your child's feet or how they walk, come and see us.

Bowlegs - A small gap is seen between the ankles and knees when the child is standing. This can normally be seen until the baby is 2. If it is very pronounced or doesn't correct seek advice from us or your GP.

Knock Knees - This is when a child stands with their knees together and the ankles are at least 1inch apart. A gap of 2-23/4 inches is normal between the ages of 2 and 4. Knock knees usually improve and correct themselves by the age of 6.

In-toeing (pigeon toes) - This is where the feet turn in. It is very common in young children and usually corrects itself by the time the child is 8 or 9. If it is very bad or you are worried please come and see us for an assessment.

Out-toeing - As above only this time the feet point outwards. Again it is very common and usually resolves itself.

Flat feet - Many babies appear to be flat footed. This is because babies have a pad of fat beneath the arch of the foot. This fat disappears as the child grows and walks. If the arch forms when your baby stands on tip toe then usually no treatment is needed. If you are concerned come and ask us for advice.

Tip toe walking - If your child consistantly walks on tiptoe and appears to be unable or reluctant to stand flat contact us for an assessment. Sometimes this can be a consequence of using a baby walker or it may mean your child needs exercises to help stretch the muscle at the back of the legs. A physiotherapist's opinion is usually helpful and we can refer you.

Delayed walking - Most children are walking by the age of eighteen months. However there are a number of conditions or factors which may lead to delayed walking. So don't panic if your child is late in reaching this milestone. We do however strongly recomend that you contact us or your GP for advice if your child isn't walking at this stage.

Helen is a qualified shoe fitter and has had special training in foot problems so please ask us for advice if you are unsure about any of the points in this post.

Head Lice (Nits)

Images courtesy of medline

Q. What are headlice?
A. Headlice are tiny grey/brown insects. They are the size of a sugar granule, they cling to hair but need to live near the scalp. They lay eggs which take 7-10 days to hatch. Nits are the empty white egg cases left behind on the hair when the lice have hatched. They look like dandruff but unlike dandruff, they donot easily brush out.

Q. How do you catch them?
A. They are NOT a sign of poor hygiene or being dirty. They cannot jump or fly. They are only caught by close head to head contact. If they are away from their food source, the scalp for more than twenty minutes, they die.

Q. How do you know if you have headlice?
A. These may vary from person to person but can include any or all of the following:
Rash on the scalp.
Droppings, a fine black powder like pepper on pillowcases.
Head itching - this is not always the first sign. Lice may have been on the scalp for quite sometime before the head starts to itch.
Nits - pinhead sized white shiny balls firmly attached to the hair shaft. Often found in warmer parts of the scalp eg behind the ears.

Q. How do I get rid of them?
A. There are two main schools of treatment. Wet combing and lotions.

Wetcombing.
Wash the hair using ordinary shampoo.
Use lots of conditioner and comb through the wet hair with a fine comb. Make sure you go from the roots to the tip. (Combs can be purchased from the chemist)
Clean the comb between each stroke with a tissue or paper towel.
This should take thirty minutes or so to do it thoroughly making sure every part of the head has been combed.
Rinse well and dry as normal.
Repeat every three to four days for the next two weeks so emerging lice can be removed.

5-6 cases out of every ten can be treated using this method and it is also useful if you are looking for lice. Remember the nits (whitecases) may remain in the hair long after any live lice have been killed.
Bugbusting kits and more information can be obtained from www.nits.net

Lotions.
You should use these only if you see live lice. Nits may remain in the hair long after the lice have been cleared.
8-9 out of ten cases can be cleared using lotion. There are various brands. The active ingredient is usually malathion or phenothrin. Shampoo, cremes and mousses are less effective than lotions and are not recommended.
Water based lotions are safer as some people with asthma, eczema or broken skin cannot use alcohol based lotions.
Always ask your pharmacist, GP, practice nurse, school health adviser or health visitor for advice if you are uncertain about a treatment.
Follow the instructions on the packaging.
Reapply the lotion again after 7 days unless directed differently.
Inspect the head using the wet combing method described above 2-3 days after the second application. If live lice are still present seek advice.

Q. Any problems?
A. Sometimes lice may be resistant to a lotion so repeated treatment using the same active ingredients may not solve the problem.

Q. Do preventers or deterents work?
A. These have not been subjected to research so the effectiveness of eg teatree oil, herbal remedies etc is unknown.

Q. What about dimeticone?
A. This is a silicone based product and it is thought may clear lice in 7 out of ten cases. It works by a physical rather than chemical effect. It doesnot kill unhatched eggs so two treatments are needed 7 days apart. The lotion in this case is left on overnight for eight hours before washing off.

Q. Can my child still go to school?
A. This varies on the individual school's policy. If your child has been treated then yes, they can. It would be good practice to tell the parents of your childs close friends that you have treated your child as they may have either passed on the lice or caught them from each other during play.

Main points
Check your childs hair regularly.
Only use lotion if you see live lice.
Check all the family if lice are discovered.
The itch may take two or three weeks to go after the lice have gone.
Nits may be seen after the lice have gone.
Alcohol based lotions are flammable - safety first!

If in doubt ask your GP practice, health visitor, pharmacist or school health advisor.

Oral (Mouth) Thrush

Q. What is it?
A. It's an infection caused by a germ called Candida. When it occurs in the mouth it is called oral thrush. Candida can cause infections elsewhere too, like the nappy area, vagina or nail folds.

Q. How do babies get it?
A. 1 in 7 babies can develop oral thrush. It is most common in babies under 10 weeks old. Candida normally lives in small amounts on the skin and in the mouth but sometimes an 'overgrowth' can occur.

Q. What does it look like?
A. White spots develop on the mouth and tongue. These may join together to form larger patches. Sometimes they look grey or yellow in colour. The mouth may become sore, causing poor feeding and sometimes the baby might dribble excessively.

Q.How is it treated?
A.Mild cases may last a day or so and clear without any treatment. Your doctor may prescribe a gel which works by killing the Candida germs inside the mouth or he may decide to prescribe a dropper which places the treatment on the affected areas. If the thrush doesn't clear in 7 days then you need to reconsult your GP.

Q. What else can I do?
A. Regularly sterilise feeding equipment, dummies and toys. A drink of cooled boiled water after a feed may help as it rinses away any residual milk in the mouth.

Remember, if in doubt ask us!

Sticky eye

Newborn babies often have watery or sticky eyes. This is common and often goes without needing treatment.

Q. What causes a blocked tear duct?
A. Usually the cause is a delay in the duct opening fully. Aprox 1 in 5 babies have this problem. Usually by the time the baby is one year old it will have resolved.

Q. Is it serious?
A. No, sometimes when baby has been asleep the affected eye looks sticky or the lashes matted with a gluey material. The eyeball should look healthy and white.

Q. How do I treat it?
A. Massage the area above the centre of the eyebrow working down towards the duct. (see pic above)Clean using a cotton wool ball and cooled boiled water wiping from the inside of the eye (tearduct side) to the outside. Use fresh cotton wool each time you touch the eye. The massage will stimulate the duct, clearing any matter and helps the duct to develop.

Q. Any problems I should look for?
A. If the eyeball becomes red or inflamed seek medical advice as this may mean conjunctivitis has developed and may require antibiotic drops. If the baby rubs the eye a lot or seems in pain or doesn't like opening the eye or light appears to bother them then seek medical attention.

Remember, if you aren't sure just ring and ask us for advice.

Cool Kids Use Cups

Q.When to introduce a cup?

A.From around six months of age.

Q. What kind of cup is best?

A. Ideally one without a lid so baby learns to sip rather than suck. If a lidded cup is used get one which allows the drink to drip out if upended.

Q. What drinks should I give?

A. Milk and water are the best drinks for teeth.

Q. When should I offer drinks?

A. Mealtimes are the best times. Having lots of drinks can cause children to have poor appetites and lead to food refusal because they feel full up.

Q. My baby doesn't like the cup?

A. Be patient and give lots of encouragement. Always supervise your baby while he/she drinks because of the risk of choking.

Your aim is to make a switch from breast or bottle to a cup by the time your baby is one. This will protect their teeth, help establish good eating patterns and help avoid speech problems.

Walk For Health

Wombourne Health Visiting team support the local initiative Walk for Health.
When - Thursdays at 12 midday
Where - Meet at the noticeboard outside the Civic Centre
Cost - Free
How long for - Walks last between thirty and forty five minutes.
Is it difficult - No, the walks are designed to be suitable for any level of fitness and you can build up to a full length walk if you think it may be too much to tackle straight away.
Do I need special equipment - No, just sensible shoes and a good waterproof coat.
Do I need to consult my doctor - If you haven't exercised for some time or have particular health needs we advise you check with your GP prior to walking.
Questions that aren't answered here? Ring us on 01902 324569 and ask for Ruth or Helen.

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