The Baby Directory Guide to Children's Health

BREASTFEEDING

Breast is best! We’ve all heard that cry, but why is it best?
Because it is a food designed specifically for human babies, containing everything they need to grow and flourish. In particular, the complex fats in human breastmilk are vital in brain development and may have an effect on intelligence in later life.

What else? Well, breastfed babies are ten times less likely to be hospitalised with gastro-enteritis in the early months than formula-fed babies, and they also gain immunities against all sorts of other infections. Plus, the wonders of the human body mean that your milk changes during the course of a feed: it starts off thin and thirst-quenching (the “foremilk”), before becoming filling and packed with nutrients (the “hindmilk”). So breastfed babies rarely need any other drink and get just the right proportions in their food.

What about the advantages for you?
To start with, there is the incomparable closeness and bonding provided by breastfeeding your baby, knowing that you are giving him or her the best start in life. More practically, it’s a great deal easier than bottle-feeding, once you’ve got the hang of it: no bottles to sterilise, feeds to mix, or worries about heating the feed, Instead, it’s always available, always sterile and always at the right temperature. And you always have a sure-fire way of calming a crying baby! Add to this the facts that many women lose weight more easily after the birth if they breastfeed, and that there is strong evidence that breastfeeding gives some protection against breast cancer in later life, and you have a pretty strong argument in favour of breastfeeding.

If you’re finding it hard going, do contact our breastfeeding counsellor. But first of all, if you have sore nipples or your baby doesn’t seem to be getting enough milk, think about your positioning. The baby should be taking as much as possible of the areola (the dark area around your nipple) into his or her mouth, in particular the section under the nipple. If your baby is sucking just on the nipple, you will get very sore and the baby will get hungry.

And if you want to breastfeed, don’t be tempted to give the occasional bottle, at least in the early days: you could confuse the baby (teats are much easier to suck from than breasts) and make him or her less hungry, thus diminishing your supply.

Contact our Breastfeeding Network counsellor by e-mail:
113327.1544@compuserve.com
Or telephone our National Childbirth Trust counsellor on: 01425 402057
Or email: mailto:swaynem@parliament.uk

VARICELLA-CHICKENPOX

Chickenpox is very common and highly infectious, but usually a mild illness in children. The incubation period is 14-16 days, and there are often no symptoms other than the rash. Some children develop a mild fever in the first 2-3 days. The spots appear in crops, first as small bumps, and rapidly changing into little blisters. The blisters soon dry and crust, and scabs form over the top. The scabs fall off without scarring. Occasionally they can form in the mouth to produce ulcers. If the spots are scratched at an early stage they can sometimes leave small scars. The rash generally only lasts 8-10 days. Calpol can relieve general irritation to a small degree, and calamine creams are useful to help relieve any itching from the spots.

COUGHS and COLDS

Most children will have at least six respiratory infections each year. These are almost always mild, last only a few days and have no consequences. Children will simply get a blocked, runny nose, may have a mild fever and feel slightly unwell. In young babies (who are nose breathers) feeding can become difficult for a couple of days. Children should be treated with paracetamol or ibuprofen if they have a fever, and may be helped by nasal decongestants. There is rarely a place for antibiotics. Occasionally coughing, especially at night times can be the main symptom of asthma, and children with persistent nocturnal coughs should see a doctor.

EAR ACHE

Ear ache is very common in children, and frequently associated with chest infections, coughs and colds. In many of those cases there is no primary infection of the ear itself; the pain is due to a blockage in the Eustachian tube, which normally maintains the correct pressure inside the ear. In true otitis media (middle ear) infection the ear drum is red and inflamed and the child will usually have a fever. Babies may not specifically complain of earache, or hold their ears and may simply become irritable, restless and scream. There is much debate as to the place of antibiotics in treating otitis media and children with fever and earache should certainly see their doctors.

STICKY EYES

This is very common in young babies. Usually there is no underlying infection, and simple salt-water washes are sufficient. Cotton wool soaked in saline should be used two to three times per day. The problem resolves in a few days, but can recur. Sometimes conjunctivitis in babies is caused by infections which do require antibiotic treatment. The eye will usually be red and inflamed with pus, rather than simply sticky with yellow secretions. In this case you should see your doctor so the eye can be swabbed and appropriate antibiotics started.

FEVER

All children get fevers at some time. Usually this is caused by common viruses such as 'flu, spotty illnesses like measles or ear and chest infections. Children feel uncomfortable when they get hot, often cry, need comforting and lose their appetite. They should be given paracetamol- based elixirs (Calpol in England) or non-steroidal anti-inflammatory paediatric elixirs (eg. ibuprofen) to lower the temperature, and kept cool with damp tepid (not cold) sponges. Aspirin should not be used for children. Excess clothing and bedclothes should be removed. You should not exceed the recommended daily dose of any medications. Most causes of fever will resolve within two to three days. You should certainly see your doctor in case your child requires antibiotics if an infection is present, but this is not usually an emergency. However, if your child becomes drowsy, complains of headaches or neck stiffness, is intolerant of light or develops a blotchy dark rash, or multiple small spots, you should call your doctor immediately. Convulsions Occasionally young children (between three months and five years) will have a febrile convulsion. This is a brief fit with jerky movements of arms and legs, lasting less than ten minutes, and generally occurs at the beginning of febrile illnesses. Febrile convulsions are not epilepsy, do not continue through childhood, and do not cause or imply any sort of brain damage. Children should be laid on their front and their necks extended, cooled and treated with appropriate antibiotics. For diagnosis of accompanying rash, see Rash

FIFTH DISEASE

Children develop a red rash initially over the face (hence "slapped cheek disease"), which then spreads down the body and limbs. The colour fades first from the central areas leaving a lacy appearance to the rash. It lasts about a week, and there are rarely complications. Children are not particularly unwell, and epidemics often occur in schools.

MEASLES

Measles has become much less common since the introduction of the MMR (measles, mumps, rubella) vaccine in the UK. Measles is very infectious. The incubation period is about 10 days, after which time children become febrile, snuffly, may cough and develop conjunctivitis (red eyes). After three or four days a florid reddish rash appears, initially on the face and head, which then spreads downwards to cover the whole body. The rash often becomes blotchy. The rash begins to fade by the fourth day, and the child then gradually improves. Paracetamol preparations (Calpol in the UK) are effective at reducing the fever, and relieving many of the symptoms. There is no specific treatment. Pneumonia and ear infections are common complications, which should be treated promptly. Children who become drowsy, start vomiting or complain of headache should be taken to a doctor, as encephalitis (inflammation of the brain) is a rare but well recognised complication of measles occurring 7-10 days after the onset of the illness.

MUMPS

Mumps is a common viral infection, often causing no symptoms at all. The incubation period is 16-21 days, after which children become febrile, feel unwell and lethargic. At this stage the child's face may swell up, due to enlargement of the parotid salivary glands over the angle of the jaw, just below the ears. The child may complain of earache and difficulty in swallowing, and the swollen glands are often tender and painful. There is no specific treatment, and the swelling subsides in a few days. The MMR vaccine has reduced the incidence of mumps infection. Meningitis is a common complication, in which the child has headache, a stiff neck and intolerance of light. Mumps

SORE THROAT

Pharingitis and tonsillitis - this is very common, especially between the ages of four and seven. Children will complain of pain on swallowing and eating, often with ear ache and fever. Soft food will be easier to eat. Drinking fluids should be encouraged, and children should see a doctor especially if they have a fever too. Often pharyngitis is caused by viruses and so will not always require antibiotic treatment. Surgical extraction of tonsils is rarely performed now.

VOMITING and DIARRHOEA

Almost all children will get diarrhoea or vomiting at some stage, especially if taken to foreign countries on holiday. In almost all cases the illness will be brief and self-limiting, however it is important to treat children promptly to prevent them becoming dehydrated. Younger babies are more vulnerable than older children to the effects of diarrhoeal illnesses. In developed countries viral infections are responsible for most cases of acute gastro-enteritis in children under five years old. Children will often vomit before diarrhoea starts, and diarrhoea will often be watery. It may be difficult to distinguish from urine in a nappy. Dehydration initially causes children to become fretful, then lethargic, with sunken eyes and lax dry skin. Severe dehydration causes young children to become prostrate with deeply sunken eyes and cold mottled skin. Mild dehydration can be treated at home. Children should be given oral rehydration fluids, which can be bought at chemists. These are powders containing salts and sugar and which are dissolved in water. They allow prompt reversal of dehydration, and are more effective than water alone. No food should be given for 24 hours, after which time the normal diet can be gradually restarted. Moderate to severe dehydration requires hospitalisation for intravenous fluid therapy. In tropical countries, adding salt to coca cola also acts meningitis is usually mild, and rarely causes any long term problems.

RASH AND SPOTTY ILLNESSES

These are becoming rarer with increasing acceptance of vaccination against measles, mumps, rubella, diphtheria, and so on.

All of these infections have varying incubation periods during which time there is no evidence that the children are infected or unwell, but during which period they are infectious. Hence chickenpox, for example, will tend to rapidly infect a whole nursery or class of children, since the virus will have already spread before the first child becomes spotty.

The following table is a crude guide to the appearance of the commonest childhood spotty infections. Click on the name for more information.

Measles Red rash on trunk and face, fever and miserable child with sore eyes and cough
German measles Pink rash, mostly on trunk with cough or catarrh
Chickenpox Rash on trunk, scalp and groin with mild fever initially small blisters with pustules in clusters. Scabs later
Mumps Swelling of salivary glands of face (over and under the jaw) with fever
Fifth disease Red rash starting over cheeks ("slapped cheek"), spreading to trunk
Roseola infantum Fever followed by spotty rash lasting less than two days

A child who rapidly becomes unwell, is drowsy and develops a red rash, either blotchy or with small spots, should see a doctor immediately as this may be caused by meningitis. It is not common.

For treatment of accompanying fever see Fever

ROSEOLA INFANTUM

This affects young children less than two years old. The infant will have a high fever, though appear remarkably well, and 3 or 4 days later the temperature will rapidly drop to normal. At this time, after the fever has gone, a faint rash appears which only lasts 1 or 2 days at most. There are no complications.

RUBELLA-GERMAN MEASLES

Rubella is usually a mild illness and is often not recognised, the child simply being 'under the weather'. Its importance is the potential effects on an unborn foetus if infection is acquired during early pregnancy. The introduction of the MMR vaccine has reduced the incidence of primary rubella infection, and the number of severely affected unborn babies. The incubation period is 14-21 days, fever is often mild, and children do not feel particularly unwell, unlike measles infection. A pink rash appears 3-4 days after the onset of the illness, mostly on the body, and lasts for only about 3 days. Children may have a cough, and their glands may swell slightly for a few days. Complications are very rare. There is no specific treatment. Woman who may be pregnant should not come into contact with infected children. In the future, the risk of infection in pregnancy should be reduced as the currently immunised children grow into protected adults.