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.