PDF version - Common childhood illnesses & wellbeing

PDF version - Common childhood illnesses & wellbeing
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A Guide
Free fruit,
vegetables and
vitamins
Do I qualify for Healthy Start?
You qualify for Healthy Start if you’re at least 10 weeks pregnant
or have a child under four years old and you or your family receive
some benefits or tax credits. You can also use the website to
check if you qualify.
This handbook has been produced by NHS Oldham Clinical Commissioning Group.
www.oldhamccg.nhs.uk
For parents and carers of children from birth (and beyond)
Sense Interactive Ltd, Maidstone. © 2015 All Rights Reserved. Tel: 01622 752160 www.sensecds.com
Healthy Start is a scheme that helps you give your growing family
a healthy balanced diet. You can receive free vouchers every week
to spend on milk, plain fresh and frozen fruit and vegetables, and
infant formula milk from registered Healthy Start retailers. To apply,
get an application leaflet from your midwife or health visitor, from
the Healthy Start helpline on 0845 607 6823 or by filling in the
form online at www.healthystart.nhs.uk
Common
childhood
illnesses &
wellbeing
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Welcome
Contents
Who can help?
This handbook has been put together by NHS Oldham Clinical
Commissioning Group.
Every parent or carer wants to know how to do what is best for their growing baby
and to give them the best start in life. This handbook aims to help you understand
what to do and who to ask in a number of situations; including what to do when
your baby or child is ill. Learn how to care for your child at home, when to seek
advice from a health visitor or call a doctor and when to use emergency services.
Most of the issues you will be confronted with are simply an everyday part of
growing up, often helped by a chat with your midwife or health visitor. Almost all
babies, toddlers and children will get the most common childhood illnesses like
chickenpox, colds, sore throats and ear infections. While these are not very nice
at the time, they are easily treated at home with support from your GP or health
visitor, with no need to visit the Accident and Emergency (A&E) department.
The information in this booklet is a guide and cannot replace specialist care.
If you are worried, you must seek further advice - trust your instincts, you
know your child best.
To view the online version of this booklet, visit
http://childhealth.oldhamccg.nhs.uk
An app is available for Android and iPhone, search
Oldham Child Illness
All factual content has been sourced from the Department of Health (DoH), Birth to Five (2009 edition),
NHS Choices, NICE guidelines and other specialist services.
A guide to services
Know the basics
4
6
The first months
To view this booklet
and other related
topics online, scan
this QR code with
your smartphone.
Your contacts
GP:
..................................
Nearest pharmacy:
..................................
NHS 111
Feeding your baby
Being sick
Crying & colic
Rashes & dry skin
Sleeping
Sticky eyes & conjunctivitis
Teething trouble
8
10
12
14
16
18
20
Childhood illnesses
Fever
Coughs, colds & flu
Wheezing & breathing difficulties
Upset tummy
22
24
26
Constipation
Earache & tonsillitis
Chickenpox & measles
Allergies
Meningitis
30
32
34
36
38
Childhood injury
Safety in the home
Medicines & poisonings
Bumps, bruises & falls
40
42
44
General welfare
Healthy kids
Obesity
Emotional wellbeing
Good oral health
Smokefree homes
46
Useful contacts
58
48
50
54
56
28
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A guide to services
Children’s centres
Families can access a wide
range of information in a
friendly environment.
Children’s centres promote all
aspects of child health and
wellbeing and provide a range
of advice including health
promotion and advice on
safety. Each children’s centre
has its own programme of
activities and services.
We have a wide range of healthcare and children and family services.
See which service or professional is best to help you.
Self care
Many illnesses can be treated in your home by using over
the counter medicine from your pharmacist and getting
plenty of rest. Self care is the best choice to treat very
minor illnesses and injuries. If you are still worried, call
NHS 111 or your GP.
GP (doctor)
Pharmacist
111
NHS 111 makes it easier for you to access
local NHS healthcare services. It is available
24 hours a day, 365 days a year. Calls are
free from landlines and mobile phones.
Call 111 if:
• You need medical help fast but it’s not a 999 emergency.
• You think you need to go to A&E or need another NHS
urgent care service.
• You don’t know who to call or you don’t have a GP to call.
• You need health information or reassurance about what
to do next.
If a health professional has given you a specific phone
number to call when you are concerned about your child’s
condition, continue to use that number.
4
Your local pharmacist will
know about most everyday
health issues. They can
suggest the best medicine
to help. There are often
pharmacists in supermarkets
and many are open late.
If your child has a
temperature which has not
come down with
paracetamol or ibuprofen,
see your GP.
Visit www.nhs.uk/chemist
where you can find your
nearest pharmacist.
You will need to register
with a local GP. Your GP
can advise, give you the
medicines you need and
point you in the right
direction if you need other
specialist services. You
will usually need to make
an appointment.
All GPs will see a child
quickly if you are worried.
At evenings and
weekends, when your GP
practice might be closed,
call the practice as usual
and you will be directed
to out-of-hours services.
Urgent care/
walk-in centre
Health visitor
Health visitors are there to
support you when you
need them. They will visit
you at home or see you in
a clinic. They offer support
and advice and can tell
you where to get extra
help if you need it. They
are part of a team who
are there to support you
during the early years,
such as helping with
feeding problems.
Children’s
Community Nursing
Team (CCNT)
The Children’s Community
Nursing Team operates 365
days a year and can provide
treatment and care for 0-18
year olds, for example after
an illness or injury or if a child
has a long-term medical
need such as epilepsy,
diabetes or asthma. If you
think the team could help
you, speak to your GP.
There are local urgent care/
walk-in centres - see page 59
for more details.
Dentist
Make sure you see a
dentist on a regular
basis. Discuss
registering your child
early on with your
dentist and take them
with you to
appointments.
To find your nearest
dentist, visit
www.nhs.uk/dentist
For out-of-hours
dentist information,
call NHS 111.
A&E
For serious and lifethreatening emergencies,
please call 999.
A&E and 999 are emergency
services that should only be used
when babies and children are
badly injured or show symptoms
of critical illness. These may be
choking, breathing difficulties,
severe abdominal pain or when
they’re unconscious, unaware of
surroundings or have taken
poison or tablets.
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Service
Concern
What to do?
Self care
The best choice to treat very
minor illnesses, ailments and
injuries.
• Grazed knee
• Sore throat
• Coughs and colds (runny nose)
Keep a well-stocked medicine cabinet.
You can treat minor illnesses and injuries at home
by using the recommended medicines and making
sure your child gets plenty of rest. www.nhs.uk
NHS 111
For 24-hour health
advice and information.
As a parent:
• If your child is unwell
• If you are unsure/confused
• If you need help
Call 111 when it is less urgent than 999
www.nhs.uk/111
Pharmacist
Can provide expert advice
and treatment for common
illnesses and injuries.
• Mild diarrhoea
• Mild skin irritations (including
spots/rash)
• Mild fever • Headaches
• Bites and stings • Painful cough
To find your local pharmacy and its contact
details visit: www.nhs.uk/chemist
GP/out-of-hours GP
For care outside normal hours,
ring your GP practice. When it
is closed, a message will direct
you to extended hours or outof-hours services.
• High temperature
• Head injuries (not involving loss of
consciousness)
• Persistent cough
• Minor bumps and cuts
• Dehydrated • Vomiting
For the treatment of illnesses and injuries that will
not go away. Your Doctor can provide a range of
services by appointment. Write your GP’s (family
doctor) telephone number here:
Walk-in centre/
Urgent care centre
• Severe pain
• Worsening health conditions
Use for urgent, but not life-threatening situations.
A&E/999
Should only be used for
serious and life-threatening
emergencies.
• Choking • Breathing difficulties
• Loss of consciousness • Fitting
• Severe bleeding that cannot be
stopped
• Fever and they’re lethargic
• Swallowed poison or tablets
Call 999 or take your child to your nearest A&E.
Know the basics
Being prepared and knowing the signs
6
Parents are usually good at noticing when something is wrong with their baby/
child from quite early on. It is normal to worry that you won’t recognise the signs
your baby is unwell. Trust your instincts, you know your baby best.
Learn how to spot the signs of serious illness and how to cope if an accident
happens. If you know the basics and you are prepared, you will find it easier to cope.
Keep a small supply of useful medicines in a locked cabinet or somewhere up high
where a child cannot reach them. See the box on the right for things to have at
home. Make sure you have the right strength of medicine for the age of your child,
always follow instructions carefully and check use by dates. Read the label
carefully. Do not give aspirin to children under 16.
If your baby seems to have a serious illness, get medical help straight away.
Paracetamol and ibuprofen
Consider using either sugar-free paracetamol or ibuprofen for children with a
fever who appear distressed - as a general rule a temperature of over 38°C
(100.4°F), as these can help to reduce fever and distress. Treat them with
either paracetamol OR ibuprofen in the first instance. It can take up to an hour
for either of them to work. Paracetamol and ibuprofen should NOT be given
together at the same time. However, if your child remains distressed before the
next dose is due, then you may want to try a dose of the other medicine. If your
child suffers from asthma, seek advice from your GP or pharmacist before
giving ibuprofen.
Pharmacist says
Keep a small supply of useful
items. Include things like:
Thermometer
Plasters
Liquid painkillers
(e.g. sugar-free paracetamol
or ibuprofen)
Barrier cream
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Hold your baby’s body close with their
nose level with your nipple to help them
attach correctly.
1
The best start in life
Let your baby’s head tip back a little so
that their top lip can brush against your
nipple. This should help your baby to
make a wide open mouth.
2
3
4
When your baby’s mouth opens wide,
their chin is able to touch your breast
first, with their head tilted, so that their
lower lip can make contact with the breast
2-3cm below the nipple.
With their chin firmly touching and their
nose clear, their mouth is wide open and
there will be much more of the darker skin
visible above your baby’s top lip than
below their bottom lip. Your baby’s cheeks
will look full and rounded as they feed.
There are lots of different positions for breastfeeding. You just
need to check the following:
• Are your baby’s head and body in a straight line?
If not, your baby might not be able to swallow easily.
• Are you holding your baby close to you?
Support their neck, shoulders and back. They should be
able to tilt their head back easily.
8
Feeding your baby
Source: DoH, www.lullabytrust.org.uk
Baby’s immediate needs are to feel safe and secure, and to be able to feed whenever
hungry. Holding your baby close to feed and responding to their needs encourages
healthy brain connections. Most of this development will occur within the first two
years. Responsive parenting will enable your baby to reach their full potential, to be
able to form good relationships and communicate well, giving them the best start in life.
Safety advice and sterilising
• The cleaning and sterilising instructions are the same, whether you are using
expressed breast milk or infant formula milk.
• All the equipment you use for bottle feeding your baby should be washed in hot
soapy water, rinsed and sterilised. You should keep sterilising your feeding
equipment until your baby is at least six months old. However, continue to sterilise
bottles until your baby is 12 months old.
• Infections (like gastroenteritis) are rare, but, if they do occur, can be very serious.
Making up a bottle of formula milk
• Wipe down the work surfaces you are going to use with a clean cloth.
• Wash your hands with soap and water.
• Read the instructions on the tin or packet to find out how much water and milk
powder you will need.
• Always fill the kettle with fresh water from the tap. Do not use bottled mineral
water or artificially softened water.
• Boil the kettle and leave it to cool for no longer than 30 minutes. It is important
that the water is still hot, otherwise any bacteria in the milk powder may not be
destroyed. Always take care, as at 70°C water is still hot enough to scald.
• Always check the temperature before feeding it to your baby.
Health visitor’s tips
How to tell your baby is having
lots of milk:
• Lots of wet heavy nappies around six in 24 hours.
• Dirty nappies, two to three
soft stools daily until four to
six weeks, after which two to
three per week.
• Baby is content and settled
during and after each feed.
• During a feed, you can hear
baby swallowing.
• Weight gain - checked by
your health visitor.
Remember, your milk fulfils all of
your baby’s needs for around six
months. It also reduces the
incidence of Sudden Infant
Death Syndrome (SIDS). Cow’s
milk should not be offered until
your baby reaches one year,
although it is suitable to use from
six months in breakfast cereals.
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Being sick
A problem likely to get better on its own
Health visitor says
Possetting is normal during
or after a feed. If this carries
on at other times, between
feeds it may be a tummy
bug. It is important for babies
to have plenty of fluids to
stop any dehydration.
It is common for babies to be sick in the early weeks as they get used to feeding
and their bodies develop. Bringing up small amounts of milk is known as
possetting. When your baby vomits there will be a much larger amount. It can be
frightening for your baby, so they are likely to cry. Lots of things can cause your
baby to be sick.
Make sure your baby is positioned correctly when breast or bottle feeding.
Incorrect positioning can cause a baby to be sick. Your midwife or health visitor
can help with this.
Being sick often or with large amounts may be due to gastric reflux where acid
from the tummy can come up again. Babies can be grumpy and it can sometimes
lead to poor feeding. If your baby is feeding well but doesn’t seem themselves,
you may just need to change the baby’s position during a feed to make them
more upright. Feeding smaller amounts and more often may also help.
1
2
I have a new baby.
I have just given my baby
a feed.
10
3
They always seem to
bring up small amounts
of milk.
This is known as possetting.
As they develop it will stop
naturally. Talk to your health
visitor.
GP says
After the first few months, if
your baby is suddenly sick it is
more likely to be caused by a
stomach virus rather than
possetting. Gastroenteritis is a
tummy bug (see upset tummy
page 28), which can come with
diarrhoea (runny poo).
This is more serious in babies
than older children because
babies can easily lose too
much fluid from their bodies
and become dehydrated. If
they become dehydrated they
may not pass enough urine,
lose their appetite and have
cold hands and feet.
If your baby is unwell, or if
vomiting has green bile stained
fluid or has lasted more than a
day, get your GP’s advice
straight away.
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Crying & 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.
If your baby cries suddenly and often, but they otherwise appear to be happy and
healthy, they may have colic. Colic is common and although uncomfortable, it is not
serious and usually affects babies only in the first few months of their lives. The
most common symptom of colic is continuous crying, which typically occurs in the
late afternoon or evening. Other signs include a flushed appearance, drawing their
legs to their chest, clenching fists, passing wind and having trouble sleeping.
When a baby cries, it can be upsetting, it can be easy to get frustrated and you
may not be getting much sleep. It is very important to stay calm and don’t be
afraid to ask for help.
Never shake your
baby
No matter how frustrated you
feel, you must never shake
your baby. Shaking moves their
head violently, and can cause
bleeding and brain damage.
Source: NHS Choices
12
If your baby’s crying seems different in any way (such as a very high-pitched cry
or a whimper), then seek medical advice. Crying can sometimes be a sign that
your baby is unwell. Trust your instincts - you know your baby best.
1
2
My baby is crying more
than usual.
3
Have you followed the
advice given by your health
visitor? Have you thought
about what your baby is
trying to tell you? It may be
something really simple.
If you have tried this and
it has not worked, speak
to your health visitor, or
contact your GP if you
are worried.
Health visitor says
Know your baby. Try to
understand what it is they need.
Finding out why your baby is
crying is often a matter of going
through all the possible options.
Things to check first are:
Does their nappy need
changing?
Could they be hungry?
Could they be too hot?
Could they be too cold?
Does their cry sound
different?
Could they be teething?
Do they want a cuddle?
These are simple things which
could be causing your baby
to cry.
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Health visitor’s
nappy rash tips
Leave your baby in a
warm, safe place with
no clothes or a nappy
on, to let the air get
to their skin.
Use a barrier cream.
Health visitor’s cradle cap tips
This is the name given to the greasy
yellow-brown scales and crusting affecting
the scalp in newborn babies.
Do not pick the scales as this may increase the
risk of infection. It is not a serious condition and
is not contagious. It is not usually itchy and will
usually clear up within weeks to a few months.
Gently massaging a small amount of
baby or vegetable oil (not olive oil) into
the scalp at night can help to soften
and loosen the scales. In the morning
use a soft baby brush or cloth to gently remove
any loose skin scales. If any hair comes out
with the scales it will grow back. Gently wash
the baby’s hair and scalp with a baby shampoo.
Talk to your health visitor if the rash spreads or
there is any infection or oozing.
Source: NICE Clinical Knowledge Summaries 2013
14
(see ‘pharmacist says’
box opposite).
Remember to
change and check
their nappy often.
Rashes & dry skin
A common problem that’s easy to treat
It’s normal for babies to develop rashes early on as their skin adapts to a different
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 page 38).
Nappy rash
Nappy rash is very common and can affect lots of babies. It is usually caused when
your baby’s skin comes into contact with the wee and poo that collects in their
nappy. A nappy rash causes your baby’s skin to become sore.
Most nappy rashes can be treated with a simple skincare routine and by using a
cream you can get from the pharmacist. With a mild nappy rash, your baby won’t
normally feel too much discomfort.
Dry skin
A baby’s skin is thinner and needs extra care. Dry, flaky skin, some blemishes,
blotches and slight rashes are normal in newborns and will naturally clear up. If
your baby is otherwise well but has a rash and you are worried about it, contact
your health visitor or GP.
1
2
There is a red, sore rash
around the nappy area.
Baby is uncomfortable
and cries a lot.
3
Has baby been in a dirty nappy for
a long time? Have you followed
advice from your health visitor, or
spoken to your pharmacist?
Change nappy often.
If you are worried, see
your GP.
Pharmacist says
Call in and talk to us about
creams we can provide you
with over the counter.
There are two types of nappy
cream available. One is a
barrier cream to keep wee
away from your baby’s skin.
The other is a medicated
cream that is good for clearing
up any soreness, but should
only be used when advised by
a health professional.
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A safe sleeping environment
1
Place your baby in the feet-to-foot position
i.e. baby’s feet at the foot of the cot.
2
Newborn babies sleep in a cot in
parents’ bedroom or room where you
are during the day.
3
4
Sleeping
7
No pillow, stuffed animals, toys or
bumper pad.
Patience, praise and peace
8
No heavy or loose blankets.
There are many different reasons why babies do not sleep. It is normal for a baby
at six weeks old not to sleep through the night. Feel confident in yourself to know
whether your child is really distressed or just restless. Trust your instincts.
9
If a blanket is used, it must be tucked in
and only as high as the baby’s chest.
Make sure baby is not too hot nor too cold.
(approximate room temperature of 16-20°C)
10
Crib sheets must fit tightly over the mattress.
11
Use a clean, firm, well-fitting mattress.
Mattresses should carry the BSI number
BS-1877-10:1997.
12
These tips apply to day time and night
time sleeps.
Put baby to sleep on their back.
5
Keep baby’s head uncovered.
6
Do not smoke and keep the house
smokefree.
Try to establish a regular sleep routine early on by putting them to bed at a regular
time (day and night). Place your newborn baby on their back to sleep, in a cot in
your bedroom for the first six months. Prepare a warm, comfortable place for them
to relax in. Adult beds are not designed for babies and toddlers and do not conform
to safety standards. Only breastfeeding babies should ever be fed in bed and should
be positioned on the outside of the bed and returned to the cot after the feed.
You can help your baby to sleep safe and sound by keeping the temperature in
their room between 16-20°C. A basic room thermometer will help you to keep an
eye on the temperature.
Reading to your child at bedtime helps them to unwind and gives you some
special time together. If your child is scared of the dark, try keeping a night light
on. Bedwetting may be stressful for both of you and can wake your child. It is not
easy to know why some children take longer to be dry at night than others. Try not
to lose your patience or punish them, your child is not doing this on purpose.
Children learn at their own pace and praise and support will help.
1
Call 0800 022 4332 or visit
www.smokefree.nhs.uk
Source: www.lullabytrust.org.uk
16
2
I am so tired when my
baby wakes up at
night it seems easier
to share the bed.
3
The safest place for your baby to
sleep is in a cot (by your bedside
for at least the first six months). Try
to establish a regular sleep routine.
Speak to your health
visitor about how to
keep your baby safe
and get some sleep.
Bed sharing with your baby
is never completely safe.
It is particularly dangerous
for your baby to sleep in
your bed if you (or your
partner):
• Are a smoker (even if you
never smoke in bed or at
home).
• Have been drinking alcohol
or taken any drugs.
• Have taken any medication
that makes you drowsy.
Also, it is dangerous for
your baby to sleep in your
bed if:
• Your baby was premature
(born before 37 weeks).
• Your baby was low birth
weight (less than 2.5kg).
• You or your partner are
overweight.
It is very dangerous to fall
asleep together on a sofa,
armchair or settee. Also, it is
risky to allow a baby to sleep
alone in an adult bed.
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Sticky eyes & conjunctivitis
Two different issues
Sticky eyes are common in newborn babies and young children while their tear
ducts are developing. You may notice sticky discharge in the corner of their 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
Some babies have watering eyes.
Massaging the tear ducts may help
to dislodge tears that have collected
in the upper part of your baby’s tear
duct, as well as encouraging the
tear duct to develop. This can be
done by applying light pressure with
your clean, index finger and
massaging from the corner of your
baby’s eye towards their nose.
Repeat several times a day for a
couple of months. If this persists
past one year, your baby may be
referred to an eye clinic for
treatment.
18
Conjunctivitis
Wipe each eye from the corner by the nose outwards. Use a clean piece of cotton
wool for each wipe. Remember to wash your hands before and afterwards and
avoid sharing towels to prevent spreading infection.
1
2
Is there discharge in the
corner of your baby’s eye
and do their eyelashes
appear to be stuck
together?
Source: NHS Choices
3
Sticky eyes is a common
condition that affects most
babies, speak to your
health visitor.
Use cooled boiled water on
a clean piece of cotton
wool for each wipe.
The signs of sticky eyes can
sometimes be confused with an
infection called conjunctivitis.
With conjunctivitis the signs are
yellowy, green sticky goo which
comes back regularly. If you
notice this and it continues for
more than four to five days,
contact your health visitor or GP.
This can be passed on easily, so
wash your hands and use a
separate towel for your baby.
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Teething trouble
Dentist’s tooth care tips
1. Clean teeth twice a day, for two minutes, especially at night.
2. Reduce sugars to meal times only.
3. Visit the dentist every six months.
4. Don’t give juice drinks in a bottle. Your baby may still like using a bottle as a
comforter and suck away on it for hours, giving sugar and acid plenty of
time to damage teeth.
For help accessing an NHS dentist, call NHS 111 or visit www.nhs.uk/dentist
Every baby goes through it
Health visitor says
It can help to give your baby
something hard to chew on,
such as a teething ring.
Teething rings give your baby
something to safely chew on,
which may help to ease their
discomfort or pain. Some
teething rings can be cooled
first in the fridge.
All sorts of things are put down
to teething - rashes, crying,
bad temper, runny nose and
extra dirty nappies. Be careful
not to explain away what might
be the signs of illness by
assuming it’s just teething.
20
The time when babies get their first primary teeth (milk teeth) varies. A few are
born with a tooth already, whilst others have no teeth at one year. Teeth generally
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
signs while others find it more uncomfortable. Some teeth grow with no pain or
discomfort at all. At other times you may notice that the gum is sore and red
where the tooth is coming through, or that one cheek is flushed. Your baby may
dribble, gnaw and chew a lot, or just be fretful.
Some people attribute a wide range of symptoms to teething, such as diarrhoea and
fever. However, there is no research to prove that these other symptoms are linked.
You know your baby best. If their behaviour seems unusual, or their symptoms
are severe or causing you concern, talk to your health visitor. Source: www.nhs.uk
Think about your child’s tooth care routine. You can brush their teeth with a soft
baby toothbrush and a smear of family toothpaste. Make sure you see your
dentist regularly and discuss your child’s oral health with them (see good oral
health page 54).
1
2
My baby has red cheeks
and seems a bit
frustrated and grumpy.
Source: DoH Birth to five edition 2009
If your baby is uncomfortable,
you can buy some medicine
from your local pharmacy.
These medicines contain a
small dose of painkiller, such
as paracetamol, to help ease
any discomfort. The medicine
should be sugar-free. Make
sure you read all instructions
and the product is suitable for
the age of your child.
You can try sugar-free
teething gel rubbed on the gum.
3
Have you asked your
health visitor about
teething? Have you
discussed options with
your pharmacist?
Pharmacist says
Try some of the gels or sugarfree baby paracetamol. If you
are worried and things do not
feel right, contact your health
visitor or GP.
Ask your health visitor about
free oral health packs given at
regular health checks.
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Page 27
Over 38°C means a fever
Babies under six months
Always contact your GP or health visitor if your
baby has other signs of illness, as well as a
raised temperature and/or if your baby’s
temperature is 38°C (100.4°F) or higher.
Older children
A little fever isn’t usually a worry. Contact your
GP if your child seems unusually ill, or has a
high temperature which doesn’t come down.
• It’s important to encourage your child to drink
as much fluid as possible. Water is best.
• Bringing a temperature down is important
because a continuing high temperature can
be very unpleasant and, in a small child,
occasionally brings on a fit or convulsion.
1
2
My toddler is hot
and grumpy.
22
3
Have you tried sugarfree infant paracetamol
or ibuprofen? Have you
made sure they are
drinking lots of fluids?
If their temperature
remains over 38°C
(100.4°F) and doesn’t
come down, contact
your GP.
To help reduce temperature:
• Undress to nappy/pants.
• Keep room at a comfortable temperature
(16 ̊C-20 ̊C).
• Encourage your child to drink more (little
amounts often).
• Give sugar-free paracetamol or ibuprofen
in the correct recommended dose for your
child (see page 7 for usage advice).
Fever
Part of the body’s natural response
If your child has a fever, he or she will have a body temperature above 38°C
(100.4°F). 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 temperature from the armpit (always use the thermometer under the
armpit with children under five, never use it in the mouth). However, bear in mind
that these measurements are less accurate as the armpit is slightly cooler.
A fever is part of the body’s natural response to fight infection and can often be
left to run its course provided your child is drinking enough and is otherwise well.
If your child is having trouble drinking, trying to reduce their temperature may help
with this. This is important in preventing your child from becoming dehydrated,
which can lead to more serious problems. As a guide, your child’s urine should
be pale yellow - if it is darker, your child may need to drink more fluids.
Fevers are common in young children. They are usually caused by viral
infections and clear up without treatment. However, a fever can occasionally be
a sign of a more serious illness such as a severe bacterial infection of the blood
(septicaemia), urinary tract infection, pneumonia or meningitis.
You should contact your GP if fever symptoms are not improving after
48 hours. Check your child during the night.
Always seek medical advice if your child develops a fever soon after an operation,
or soon after travelling abroad.
GP says
When looking after a feverish child
at home you should:
• Get the child to drink more
(where a baby or child is
breastfed, the most appropriate
fluid is breast milk).
• Look for signs of dehydration:
reduced wet nappies, dry mouth,
sunken eyes, no tears, poor
overall appearance, sunken soft
spot on the top of the head in
babies.
• It is not advisable to give
ibuprofen if your child is
dehydrated.
• Know how to identify a nonblanching rash (see page 38).
• Check your child during the night.
Source: NICE, Feverish illness in children/
2013
Source: DoH Birth to five edition 2009
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1
My child keeps coughing and
sneezing, has a mild temperature
and seems generally unwell.
Not usually serious
2
Have they recently started
nursery? Catching colds is
very common. Have you
spoken to your pharmacist
about sugar-free paracetamol
and cough medicines?
You will probably find when your child starts mixing with other children they get lots of
coughs, colds and sniffles. There are some good things about this though as it helps
the body build up a natural immune system.
If symptoms last for more
than 10 days or your child
is coughing up yellow ‘goo’
they may have an infection.
Contact your GP.
Most bugs will run their course without doing any real harm because they will get better
on their own. An annual nasal spray flu vaccine is available from the age of two as part
of the NHS Childhood Vaccination Programme. Ask your health visitor for details.
3
Don’t pass it on
Catch it Germs spread easily. Always carry
tissues and use them to catch coughs or sneezes.
Bin it Germs can live for several hours on tissues.
Dispose of your tissue as soon as possible.
Kill it Hands can pass on germs to everything you
touch. Clean your hands as soon as you can.
24
Coughs, colds & flu
Flu can be more serious than a cold and leave your child feeling quite unwell. Flu
tends to come on more suddenly and severely than a cold. Your child may feel achy
and uncomfortable, and be ill for a week or more.
Things you can do at home to help:
Give your child lots to drink.
Try sugar-free paracetamol or ibuprofen (not aspirin) (see page 7 for usage).
Keep them away from smoke and anyone who smokes.
Talk to your pharmacist but remember that coughing is the body’s way
of keeping the lungs clear.
Make sure they get plenty of sleep/rest.
See your GP if:
baby has a temperature of 38°C (100.4°F) or more.
Your
They have a fever with a rash.
They are not waking up or interacting.
Your child is finding it hard to breathe.
Persistent temperature does not respond to medicine (see fever page 22).
Pharmacist says
Children can often be
treated using over the
counter medicines to help
to bring down a raised
temperature. Sugar-free
paracetamol or ibuprofen
can help. Check the label
carefully. Some are available
as a liquid for children and
can be given from the age of
three months. Check with
the pharmacist and tell them
how old your child is.
Flu symptoms are more
severe and you may need
to see your GP.
Source: 2013 NICE guidance
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Bronchiolitis
Bronchiolitis is a common
respiratory tract infection that
affects babies and young
children under a year old. The
early symptoms are similar to
those of a common cold and
include a runny nose and cough.
Page 31
1
My child with croup has a
distinctive barking cough and
makes a harsh sound when
they breathe in.
2
Comforting your child is
important as symptoms may
worsen if they are agitated or
crying. Mild cases of croup can
be managed at home. If your
child has a fever, children’s
sugar-free paracetamol will
help lower their temperature.
As it develops, the symptoms
of bronchiolitis can include
a slight fever, a persistent
cough and difficulty feeding.
Symptoms usually improve
after three days and in most
cases the illness isn’t serious.
However, contact your GP or
health visitor if your child is only
able to feed half the normal
amount or is struggling to
breathe, or if you are generally
worried about them.
Source: www.nhs.uk/conditions
3
If symptoms get worse,
contact your GP.
Wheezing &
breathing difficulties
Look at the signs
Any kind of breathing difficulty your infant or child experiences can be scary for
parents. It is often nothing to worry about and illnesses like bronchiolitis, mild croup
and a cough can often be treated at home.
Use your instincts with newborns and babies. You may notice:
• Rapid breathing or panting, which is common. If there is no other sign of illness,
it comes and goes and your baby is breathing comfortably most of the time,
there’s normally no need to worry.
• Breathing may sound a bit rattly. Try holding your baby upright.
• Occasional coughing or choking which may occur when a baby takes in milk
too quickly with feeds. Try to slow things down a bit. Check feeding position.
• A cold or mild cough. Keep an eye on them at this stage and use your instincts.
If you are worried, talk to your health visitor.
In older babies and toddlers you may notice:
• Coughing, runny nose, mild temperature - (see coughs, cold and flu page 24).
• Croup (hoarse voice, barking cough) needs to be assessed by your GP and may
need treating with steroids.
Call 0800 022 4332 or visit
www.smokefree.nhs.uk
26
Source: NHS Choices - Symptoms of bronchiolitis
GP’s tips
Get help and contact your GP
now if your child:
Seems to find breathing
hard work and they are
sucking in their ribs and
tummy.
They can’t complete a
full sentence without
stopping to take a breath.
Get help and call 999 or
take them to A&E now if:
Their chest looks like it is
caving in.
They appear pale or even
slightly blue-ish.
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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.
Health visitor says
If you are breastfeeding
continue to do so and keep
drinking plenty of fluids.
Source: www.nhs.uk/conditions
Pharmacist says
There are lots of ways you can care for
your child at home. Things to try are:
Give them regular drinks - try small
amounts of cooled boiled water.
Breastfeed on demand if
breastfeeding.
extra careful with hand
Being
hygiene (use soap and water or
antibacterial hand gel and dry
hands well with a clean towel).
solutions come in
Rehydrating
pre-measured sachets to mix with
water. It helps with dehydration.
If your child is unwell for more than 24
hours, speak to your GP. If your baby
is newborn or very unwell, contact
your GP straight away.
28
Feeling sick and suddenly being sick are normally the first signs. Diarrhoea can
follow afterwards. If your child is not vomiting frequently, is reasonably comfortable
in between and you are able to give them frequent small amounts of water, they
are less likely to become dehydrated and probably don’t need to see a doctor.
Speak to your GP if they are unwell for longer than 24 hours (or sooner if
they are newborn) or if you notice signs of dehydration.
If you’re breastfeeding, keep on doing so even more frequently. Offer older
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).
Keep them away from others, especially children, who may pick up the infection.
Be extra careful with everyone’s handwashing.
1
2
My baby has
diarrhoea and is
being sick.
wet nappies (i.e.
Less
they wee less).
sleepy than usual.
More
mouth.
Dry
fontanelle (the
Sunken
soft spot on the top of
the head that is more
dipped in than usual).
3
Have you given them lots of
water? This will help prevent
them becoming dehydrated if it
is a tummy bug. Speak to your
pharmacist and ask about a
rehydrating solution.
Signs of
dehydration
Speak to your GP if symptoms
show no sign of improvement
after 24 hours or straight away
if they are newborn.
Try a rehydrating solution
from your pharmacist.
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Tips
Constipation is very rare in babies who
are solely breastfed, but not uncommon
in babies who have formula, or who
have solid foods. Ask your health visitor
or pharmacist for advice on treatment.
Make sure you are making up the
formula powder with the correct
amount of water. Some formulas are
specially targeted at babies who have
minor constipation - your health visitor
can discuss your options.
If your baby is already on solid foods,
then the juice or the fruit itself should be
fine for providing relief. Fruits, such as
apples, pears and prunes, contain
sorbitol which is a natural laxative,
helping the lower bowel retain water,
which helps the poo stay soft and easy
to pass. For younger babies, check with
your health visitor before you start
giving anything other than milk.
Source: www.nct.org.uk
Page 35
Constipation
Rare in babies who are solely breastfed
Constipation is a very common problem in children. Many children normally
pass stools as far apart as every few days. Regardless, you should treat hard
stools that are difficult to pass and those that happen only every three days as
constipation.
Breastfed infants will generally have more stools per day. Their stools vary
more in frequency when compared to bottle-fed infants. For example,
breastfed infants produce anywhere from 5 to 40 bowel movements per week,
whereas formula-fed infants have 5 to 28 bowel movements per week.
Switching the type of milk or formula can also cause constipation.
Many things contribute to constipation but infants and children who have
well-balanced meals are not typically constipated.
Ask your health visitor for advice. In rare cases, constipation can be due to an
underlying illness, so if the problem doesn’t go away in a few days, it’s
important to talk to your GP.
1
2
My bottle-fed baby
gets constipated.
30
3
Try cooled, boiled water
between feeds.
Source: NICE guidelines 2009, constipation in children
If the problem persists,
speak to your health
visitor or GP.
Health visitor says
To avoid constipation and help
stop it coming back, make
sure your child has a balanced
diet including plenty of fibre
such as fruit, vegetables,
baked beans and wholegrain
breakfast cereals. We do not
recommend unprocessed bran
(an ingredient in some foods),
which can cause bloating,
flatulence (wind) and reduce the
absorption of micronutrients.
Drink plenty of fluids.
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Earache & 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.
What are the signs
of an ear infection?
Call 0800 022 4332 or visit
www.smokefree.nhs.uk
32
The signs are a raised
temperature, general irritability
and pain or discomfort. The ears
may be red and your baby may
pull them because they are
uncomfortable. They may even
have a pus-like discharge, which
can also be associated with a
blocked feeling in the ear or
hearing loss. Although most ear
infections settle down without
any serious effects, there can be
mild hearing loss for a short time
(two to three weeks).
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
to the ears more easily. Ear infections can be painful and your child may just need
extra cuddles and painkillers (such as sugar-free paracetamol or ibuprofen) from
the pharmacist. Your child may have swollen glands in their neck - this is the
body’s way of fighting infection.
Tonsillitis - earache can also be caused by tonsillitis (the inflammation of the
tonsils). It is a common type of infection in children. Symptoms include a sore
throat, earache, coughing and a high temperature. It is not a serious illness and
you only need to see your GP if symptoms last longer than four days or become
more serious, with severe pain, a very high temperature or breathing difficulties.
1
2
My toddler has
earache but seems
otherwise well.
3
Have you tried sugar-free
paracetamol or ibuprofen
from your pharmacist?
(See page 7 for advice on
usage).
Source: DoH Birth to five edition 2009/NHS Choices
Most ear infections get better by
themselves. Speak to your GP if
symptoms show no sign of
improvement after 24 hours, your
child seems in a lot of pain or you
notice fluid coming from the ear.
To reduce ear
infections
• A baby’s ears need to be
treated with care.
• Never use a cotton bud
inside your child’s ear.
• If they have a temperature,
wax may ooze out.
• Use different, clean damp
cotton wool on each ear to
gently clean around the outer
area.
• Avoid smoky environments.
• Do not use ear drops or oil
unless prescribed by your GP.
• If your child is still not hearing
six weeks after infection, your
GP or health visitor can refer
them to audiology for further
investigations.
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Page 39
Chickenpox & measles
Health visitor says
Do not forget to keep up-todate with immunisations to
protect your child from
measles (MMR vaccination).
It is never too late for your
children (or you) to catch up
with the MMR vaccination if
they missed it earlier.
Painkillers
If your child is in pain or has a high
temperature (fever), you can give them
a mild painkiller, such as sugar-free
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.
34
Midwife says
If you are pregnant and have
had chickenpox in the past,
it is likely you are immune to
chickenpox. However,
please contact your GP or
midwife for advice.
Chickenpox
Chickenpox is a mild and common childhood illness. It
causes a rash of red, itchy spots that turn into fluid-filled
blisters, which crust over to form scabs, and eventually drop
off. Some children have only a few spots, while others can
have spots covering their entire body. These are most likely
to appear on the face, ears and scalp, under the arms, on
the chest, tummy and on the arms and legs.
Measles
Measles is a very infectious, viral illness which, in rare
cases, can be fatal. One in five children with measles
experience complications such as ear infections, diarrhoea
and vomiting, pneumonia, meningitis and eye disorders.
There is no treatment for measles. Vaccination is the only
way of preventing it, so make sure your child has their
MMR vaccination. Speak to your health visitor.
Chickenpox is caused by a virus. It is infectious from one to
two days before the rash starts, until all the blisters have
crusted over (five to six days after the start of the rash). To
prevent spreading the infection, keep children away from
nursery/school until all their spots have crusted over.
Symptoms develop around 10 days after you are
infected and can include:
• Cold-like symptoms.
• Red eyes and sensitivity to light.
• A fever.
• Greyish white spots in the mouth and throat.
Your child will probably feel pretty miserable and irritable
while they have it. They may have a fever for the first few
days and the spots can be incredibly itchy.
Paracetamol (sugar-free) can help relieve fever and
calamine lotion or cooling gels help ease itching.
Chickenpox usually gets better on its own. However, some
children can become more seriously ill and need to see a
doctor.
Contact your GP straight away if:
• Blisters become infected.
• Your child has chest pain or difficulty breathing.
Source: www.nhs.uk
After a few days, a red-brown spotty rash appears. Starting
behind the ears, it then spreads around the head and neck
before spreading to the rest of the body. If there are no
complications, symptoms usually disappear within 7-10 days.
Contact your GP if you suspect you or your child may
have measles.
Help to make your child comfortable:
• Close the curtains/dim lights to help reduce light sensitivity.
• Use damp cotton wool to clean eyes.
• Give sugar-free paracetamol or ibuprofen.
• Ensure they drink lots.
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Spotting symptoms
This example shows areas where allergy
sufferers may experience symptoms. Many
of these symptoms can develop as a result
of other common childhood illnesses. With
an allergy, symptoms often appear more
quickly or suddenly.
Page 41
Nose, throat and ears
Runny nose, blocked nose, itchy nose,
sneezing, pain in sinuses, headaches,
post-nasal drip (mucus drips down the
throat from behind the nose), loss of
sense of smell and taste, sore throat,
swollen larynx (voice box), itchy mouth
and/or throat, blocked ear and glue ear.
Eyes
Itchy eyes, watery eyes, prickly
eyes, swollen eyes, ‘allergic
shiners’ - dark areas under the
eyes due to blocked sinuses.
Antihistamines
Antihistamines are probably the best
known type of allergy medication,
and most are readily available from
a pharmacy without prescription.
While antihistamines used to have
a reputation for making people
drowsy, more modern
antihistamines only occasionally
have those side effects. Check the
packet for details.
Source: www.allergyuk.org
36
Airways
Wheezy breathing, difficulty in breathing,
coughing (especially at night time),
shortness of breath.
Skin
Urticaria - Wheals or hives, bumpy,
itchy raised areas, rashes.
Eczema - Cracked, dry or weepy,
broken skin.
Allergies
Managing and understanding your child’s allergy
Fifty percent of children in the UK have allergies. For parents, it is a learning curve
in understanding what to avoid and how to control and manage the allergy. Find
out as much as you can. There are many types of allergies.
An allergy is when the body has a reaction to a protein such as foods, insect
stings, pollens, house dust mites or other substances such as antibiotics. There
are many common allergies. Some families seem to include more individuals with
allergies than other families. Children born into families where allergies already
exist have a higher than average chance of developing allergies themselves.
Allergic symptoms can affect the nose, throat, ears, eyes, airways, digestion and
skin in mild, moderate or severe form. When a child first shows signs of an allergy,
it is not always clear what has caused the symptoms, or even if they have had an
allergic reaction, since some allergic symptoms can be similar to other common
childhood illnesses. Urticaria (wheals or hives) can be one of the first symptoms
of an allergic reaction. If the reaction is severe, or if the symptoms continue to
re-occur, it is important that you contact your GP.
1
Digestion
Swollen lips/tongue, stomach ache,
feeling sick, vomiting, constipation,
diarrhoea, bleeding from the bottom,
reflux, poor growth.
Source: Allergy UK/2014
Anaphylactic shock
2
Food allergies occur
when the body’s
immune system
reacts negatively to
a particular food or
food substance.
3
Allergens can cause skin reactions
(such as a rash or swelling of the
lips, face and around the eyes),
digestive problems such as vomiting
and diarrhoea, and hayfever-like
symptoms, such as sneezing.
Source: NICE - testing for food allergy in children and young people
Children are most
commonly allergic to
cow’s milk, hen’s eggs,
peanuts and other
nuts, such as hazelnuts
and cashew nuts.
Anaphylaxis is a dangerous type
of allergic reaction that is most
likely to be caused by particular
foods, insect bites or medicines.
Early signs of an allergic
reaction:
• Swelling and itching; the face
may be flushed and wheals or
hives may erupt on the skin.
• Lip or facial swelling.
• Acute vomiting/abdominal pain.
Anaphylaxis or severe
reactions:
• Difficulty breathing, coughing
and/or wheezing.
• Loss of colour; cold and clammy.
• Loss of consciousness (may
appear asleep).
Call 999 and tell the operator you
think the child has anaphylaxis.
If available, an adrenaline injection
should be given as soon as a
serious reaction is suspected. If
your child has an EpiPen or
injection device, make sure you
know the correct way to use it in
advance of an emergency.
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Page 43
Meningitis
Not common but serious and contagious
The glass test
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
glass firmly against the rash.
Go straight to A&E
Babies and toddlers are most vulnerable as they cannot easily fight infection
because their immune system is not yet fully developed. They can’t tell you how
they are feeling and can become a lot worse very quickly. Keep checking them.
Meningitis is a swelling around the brain. It is a very serious, contagious illness,
but if it is treated early most children make a full recovery.
38
If any of the signs below are
present, contact a doctor.
You should always treat any case of suspected meningitis as an emergency.
Early signs may be like having a cold or flu. Children with meningitis can
become seriously ill very fast, so make sure you can spot the signs. Your 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
body as it can start anywhere (check lightest areas first). However, the rash is
not always present - be aware of all the signs/symptoms.
The presence of a fever or any of the above symptoms should be taken
extremely seriously. Not all children will show all the signs listed on the right.
In this example, the spots are still
visible through the glass. This is called
a non-blanching rash - it does not
fade. Seek immediate medical
attention. If you cannot get help
straight away, go to A&E.
GP says
In this example, the spots under the
glass have virtually disappeared. It is
unlikely to be meningitis but if you
are still worried, contact your GP or
go to A&E.
Find out more from www.meningitisnow.org
1
2
My child is showing
some of the signs of
meningitis.
3
Have you tried
the glass test?
If the spots do not fade under
pressure, seek immediate medical
attention. If you cannot get help
straight away, go to A&E.
Fever, cold hands
and feet
Floppy and
unresponsive
Drowsy and
difficult to wake
Spots/rash
Do the glass test
Rapid breathing
or grunting
Fretful, dislikes
being handled
Unusual cry or moaning
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Page 45
Cuts
Drowning
Choking
Glass causes serious cuts with
many children ending up in A&E.
PREVENTION:
Do not leave drinking glasses on
the floor. Make sure glass bottles
are kept up high.
WHAT TO DO:
• If the cut is not serious, bathe
the area, make sure there is no
glass left and cover with a clean
non-fluffy cloth.
• If the cut is serious, is bleeding a
lot or has a piece of glass under
the skin, go to A&E.
Many children drown, often in very
shallow water. It happens in the
bath, in garden ponds, paddling
pools and water butts (barrels).
PREVENTION:
• Supervise children near water at
all times. Use a grille on ponds
or consider filling it in to use as a
sandpit.
• Make sure your child learns to
swim.
WHAT TO DO:
Get your child out of the water.
Try to get them to cough up any
water. If they are not responding,
call 999.
Babies and toddlers can easily
swallow, inhale or choke on small
items like marbles, beads, lolly
sticks, balloons, peanuts, buttons,
nappy sacks, plastic toy pieces,
strings or cords.
PREVENTION:
• Check on the floor and under
furniture for small items and that
toys with small pieces are not
left out for a toddler to chew and
choke on.
• Check toys are age appropriate,
in good condition and include
toy safety marks.
WHAT TO DO:
If your child is choking, act
immediately and calmly. Make
sure you do not push the object
further down the throat.
Encourage your child to cough.
Use back blows, if they become
unconscious, call 999 (do not
leave your child alone) and start
CPR.
CPR
CPR is a first aid technique that is a
combination of rescue breaths and
chest compressions - sometimes
called the kiss of life. To find out
more about CPR, go to
www.redcrossfirstaidtraining.co.uk
40
Safety in the home
Our homes can be full of danger
Strangulation
Burns and scalds
Window blind cords and chains can pose a risk for
babies and children who could injure or even strangle
themselves on the hanging looped cords.
PREVENTION:
• Install blinds that do not have a cord, particularly in a
child’s bedroom.
• Pull cords on curtains and blinds should be kept
short and kept out of reach.
• Tie up the cords or use one of the many cleats, cord
tidies, clips or ties that are available.
• Do not place a child’s cot, bed, playpen or highchair
near a window.
• Do not hang toys or objects on the cot or bed that
could be a hazard.
• Do not hang drawstring bags where a small child
could get their head through the loop of the
drawstring.
WHAT TO DO:
Untangle your child, call 999 and start CPR.
A burn is damage to the skin, which is caused by
direct contact with something hot. Burns can also be
caused by certain chemicals, electricity and friction. A
scald is a burn that is caused by a hot liquid or steam.
Scalds are treated in the same way as burns.
PREVENTION:
• Keep hot drinks out of reach.
• When running a bath, turn the cold water on first
and always test the temperature with your elbow
before letting your child get into the bath or shower.
• Keep hot irons, curling tongs and hair straighteners
out of reach, even when cooling down.
• Turn pan handles away from the front of the counter.
WHAT TO DO:
• Treat the burn or scald straight after the accident by
running under cold water for 20 minutes.
• Do not use creams, lotions or ointments on the burn
or scald.
• Always take your child or baby to A&E if it is
anything other than a very mild burn.
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Alcohol
Even a small amount can cause
alcohol poisoning in children. Alcohol
affects the central nervous system and
symptoms can include confusion,
vomiting and seizures. The child may
have difficulty breathing and flushed or
pale skin. Alcohol impairs the gag
reflex, which can cause choking. If
your child has drunk alcohol, act
quickly to get your child to hospital.
Storing medicines
Keep medicines well out of reach and
out of sight of young children. Put
them in a high cupboard, a cupboard
fitted with a child-resistant catch, a
lockable cabinet, or even a lockable
suitcase. If a medicine needs to be
kept in the fridge, keep it as high up
and hidden as possible.
Don’t keep them:
• On your bedside table - your child
can easily get into the bedroom
without being seen.
• In your handbag - this is a favourite
place for toddlers to find tablets.
42
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Medicines & poisonings
Keeping children safe
Every week, around 500 children under five are rushed to hospital because it’s
thought they have swallowed something poisonous. Most poisoning accidents
involve medicines, household products and cosmetics. The most common form
of poisoning is from medication.
• Keep medicines high up and out of reach.
• Keep anything that may be poisonous out of reach - this includes all medicines
and pills, alcohol, household cleaners, liquid washing tablets and garden
products, preferably in a locked cupboard.
• Use containers that have child-resistant tops - be aware that by the age of
three, many children are able to open child-resistant tops.
• Keep all dangerous chemicals in their original containers - for example, do not
store weedkiller in an old drinks bottle as a young child may mistake it for
something safe to drink.
• Discourage your children from eating any plants or fungi when outside. Avoid
buying plants with poisonous leaves or berries.
• Keep alcohol out of the reach of children.
1
2
You think your child has
swallowed a harmful
medicine, chemical or
batteries.
3
Find the bottle or packet
and take it with you when
you seek medical help.
Act quickly to get your
child to hospital.
Health visitor says
If you have young children, be
extra careful when you have
guests to stay or when you go to
visit other people. If your friends
and relatives do not have children,
they may not think to keep certain
items out of the reach of children
and their homes may not be child
friendly. Children need to be kept
an eye on and you may wish to
politely ask for items such as
alcohol, medicines and cigarettes
to be kept out of their reach.
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Bumps, bruises & falls
Part of growing up
Falls
For babies, the biggest danger
is rolling off the edge of a bed
or changing surface. For
toddlers, it is more about falling
from furniture or down stairs.
PREVENTION:
• Make sure your baby cannot
roll off any surfaces, put
pillows around them.
• Do not put a bouncing cradle
or car seat on a surface
where they could wriggle off.
• Use stairgates once your
child is mobile.
• Make sure balconies are
locked and fit restrictors and
safety locks to windows.
44
It is almost impossible to prevent every accident, although there are things we
can do at home which might help. 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 learn. Most of your toddler’s
bumps will require no more than a cuddle to make them better. You will quickly
be able to tell by the noise of the bang, the reaction of your child and the
colour of the area affected, which are the more serious bumps. If your child
has unexplained bruising or injury, you need to find out how this happened.
If it looks like the bump may swell, 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
swelling and to cool the area for at least a few minutes.
If your child has had a bump to the head and it looks serious or
symptoms worsen, call your GP. Read the information on the right.
If your child is under a year old and has a bump on the head, get advice from
your GP.
1
2
After a fall, comfort
your child, check for
injuries, treat bumps
and bruises.
3
Give your child some
sugar-free paracetamol
and let them rest whilst
watching them closely.
Seek immediate help if they:
• Have seriously injured
themselves.
• Are unconscious.
• Have difficulty breathing.
• Are having a seizure.
Head injury
One of the signs of a severe head
injury is being unusually sleepy, this
does not mean you cannot let your
child sleep.
You need to get medical
attention if:
• They are vomiting persistently
(more than three times).
• They are complaining it hurts.
• They are not responding at all.
• Pain is not relieved by sugarfree paracetamol or ibuprofen.
If your child is tired from what’s
happened, or from crying, then it is
fine to let them sleep. If you are
worried in any way about their
drowsiness, then you should wake
your child an hour after they go to
sleep. Check they are okay and
responding normally throughout
the night.
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Screen time
The first two years of life are
a critical time for brain
development. TV and other
electronic media can get in
the way of exploring, playing,
thinking and interacting,
which all encourage learning
and healthy physical and
social development.
Children who consistently
spend more than four hours
a day watching TV are more
likely to be overweight (less
time for play).
TV and electronic media can
limit communication and
speech skills, resulting in the
child preferring to listen
rather than take part in a
real-life conversation. TV can
affect sleep patterns too.
46
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Promoting good health and
a healthy weight
With healthy habits from birth, you can give
your baby a good start for a healthy and
happy future. Breast milk is ideal for your
baby’s growing needs. It is easy to develop
healthy eating habits at an early stage in their
lives. Babies like the foods they get used to.
If you give them lots of different, healthy
foods to try when they are babies and
toddlers, they are more likely to eat a variety
of healthy foods as they grow up. Avoid salt,
sugar, honey, nuts, saturated fats, low-fat
foods, raw shellfish or eggs for babies.
The Department of Health recommends that
all children from six months to five years old
are given supplements, in the form of
vitamin drops which contain vitamins A, C
and D. Please speak to your health visitor or
pharmacist who will be able to give you
further advice.
Physical exercise helps with all aspects of
physical and mental wellbeing and it helps
avoid becoming overweight or obese. Try to
have family outings that include walking and
cycling so you can all get fitter together.
Healthy kids
A combination of the right food and exercise
Living a healthy lifestyle means many things: having fun, eating well, being active,
staying safe, getting enough sleep, taking care of our minds and bodies. Practical
things are important too, like making sure your child visits the dentist regularly,
their immunisations are kept up-to-date, they are receiving their daily vitamin
drops and that they attend health and development checks. Look out for, and be
aware of, your child’s health in order to prevent illness and discuss any concerns
with your health visitor. Developing a healthy attitude early on will help to ensure
they become healthy throughout life.
Being physically active every day is important for healthy growth and development
and impacts on their social skills. Babies should be encouraged to be active from
birth. Before your baby begins to crawl, encourage them to be physically active by
reaching and grasping, pulling and pushing during supervised floor play, including
tummy time (when you place your baby on their stomach while awake and you
are watching).
Minimise the amount of time children spend sitting watching TV, in a buggy,
playing computer games and travelling by car, bus or train. Try to make exercise
fun and part of everyday life for all the family.
1
2
How much exercise
should my child
have daily?
3
Children who can walk on their
own should be active every day
for at least three hours. This
should be spread throughout
the day, indoors and outside.
Safe, active play, such as
using a climbing frame, riding
a bike, playing in water,
chasing games and ball
games should be supervised.
Health visitor says
You can give your child whole
(full-fat) cow’s milk as a drink
from one year old (and on
breakfast cereal from six months
old). Do not give children under
two years old semi-skimmed,
1% fat or skimmed milk, these
don’t contain enough calories or
essential vitamins for children of
this age. From two to five years
old, children can drink whole or
semi-skimmed milk.
If your child doesn’t like milk, it’s
important to try to include other
dairy foods in their diet such as
yoghurt or cheese, but don’t
give them lower-fat versions.
Source: www.healthystart.nhs.uk
NHS Choices pregnancy and baby
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What can I do?
Dietician says
Salt and sugar is added to
nearly all processed products.
Three-quarters of the salt and
sugar we eat is already in the
food, the rest is what we add to
cooking or shake on our meals.
Children need less than 5g of
salt a day (2g sodium).
Juice drink
23g sugar
(5 teaspoons)
Pizza slice
2.8g salt
Fromage frais
12.4g sugar
(2 teaspoons)
48
Many parents are unaware of the dangers of
childhood obesity, but by following the top tips
below you can make a difference to your child’s
health.
1. Sugar swaps - swapping sugary snacks
and drinks for ones that are lower in sugar
can make a huge difference.
2. Meal time - it’s important for kids to have
regular, proper meals as growing bodies
respond better to routine.
3. Snack check - many snacks are full of the
things that are bad for us - sugar, salt, fat
and calories. So try and keep a careful eye
on how many the kids are having.
4. Me size meals - it’s important to make sure
kids get just the right amount for their age.
5. 5 a day - five portions of fruit and/or
vegetables a day.
6. Cut back fat - too much fat is bad for us.
It’s not always easy to tell where it’s lurking.
7. Up and about - most of us spend too long
sitting down. Keep active. Encourage your
child to walk, you may need
to use child safety reins.
Source: www.nhs.uk/start4life
Obesity
A growing problem
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, type 2 diabetes, raised blood pressure, cholesterol,
early puberty, asthma and other respiratory problems. 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.
Being overweight is rarely to do with a medical problem, and is simply due to an
unhealthy diet and not enough exercise. It is better to prevent your child
becoming overweight in the first place. Good sleep patterns, a healthy varied diet
and regular exercise will all help keep your child to a healthy weight.
The emotional consequences of obesity in childhood can be severe and longlasting, including bullying and low self-esteem. Parents can find it difficult to talk to
their child about being overweight as they feel guilty and they do not want to upset
them by talking about it. Parents often underestimate the amount of food children
eat and overestimate the amount of activity they do. Many parents believe their
children are already active enough, confusing being boisterous with being active.
1
2
My mum confuses giving
her grandson chocolate
with being kind to him.
She only wants him to be
happy, but I am worried.
3
It can be difficult, but try to
explain to her why you would
prefer him to have healthy
snacks and that in the long
run, it is best for him.
Give her some healthy
meal ideas and maybe
send him along with
some fruit or vegetable
slices to snack on.
Health visitor says
Be in control
It can be easy for busy parents
(or family members) to prioritise
their children’s immediate
happiness over their long-term
health by giving them the
chocolate bar or sugary drink
they are crying for. Many
parents allow children to decide
what goes into the supermarket
trolley in order to avoid rows.
You are responsible for what
your child eats. What your child
eats now will set a pattern for
life and overweight children are
being set up for a lifetime of
sickness and health problems.
www.dh.gov.uk/obesity DoH 2009
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Bonding/attachment
Bonding is the intense attachment that develops
between parents and their baby. Bonding gets parents
up in the middle of the night to feed their hungry baby
and makes them attentive to the baby’s wide range of
cries. Healthy attachment, built by repetitive bonding
experiences during infancy, provides the solid foundation
for future healthy relationships. Bonding experiences
include hugging, holding, rocking, singing, feeding,
gazing, smiling and kissing.
Nonverbal cues and how they can be used to
create a secure attachment bond:
or carry your baby or the way you give your older child a
warm hug, a gentle touch on the arm, or a reassuring pat
on the back can convey so much emotion to your child.
Body language - sit with a relaxed, open posture,
leaning towards your child and your child will feel what
he or she is saying matters to you.
Pacing, timing, and intensity - the pacing, timing and
intensity of your speech, movements and facial
expressions can reflect your state of mind. If you
maintain an adult pace, are stressed or otherwise
inattentive, your nonverbal actions will do little to calm,
soothe or reassure your child.
Eye contact - look at your child affectionately and they
Speak to your midwife, health visitor or GP if you require
will pick up on the positive emotion conveyed which
further information or if you feel you are having problems
makes them feel safe, relaxed and happy.
bonding with your baby.
Facial expression - if your expression is calm and
Source: www.childtrauma.org
attentive when you communicate with your child, they
will feel secure.
Tone of voice - even if your child is too young to
understand the words you use, they can understand the
difference between a tone which is harsh or preoccupied
and a tone which conveys tenderness, concern and
understanding. When talking to older children, make sure
the tone you use matches what you’re saying.
Touch - the way you touch your child conveys your
emotional state - whether you’re calm, tender, relaxed or
disinterested, upset and unavailable. The way you wash, lift
50
Emotional wellbeing
Postnatal depression
Postnatal depression is a type of depression some women experience after
having a baby (which can affect one in 10 women). It can develop within the
first six weeks of giving birth, but is often not apparent until around six
months.
Symptoms include: feeling unable to cope; difficulty sleeping; mood changes;
irritability and episodes of tearfulness. These are common after giving birth
and are often known as the ‘baby blues’, which usually clear up within a few
weeks. However, if your symptoms are more persistent, it could be postnatal
depression. It’s very important to understand that postnatal depression is an
illness. If you have it, it doesn’t mean you don’t love or care for your baby.
Postnatal depression can be lonely, distressing and frightening but, as long
as it is recognised and treated, you can recover. It’s very important to seek
treatment, so speak to your health visitor or GP. The condition is unlikely to
get better by itself quickly and it could impact on the care of your baby.
Source: NHS Choices
1
2
Feeling irritable, unable to
cope, difficulty sleeping
and tearful.
3
It has lasted longer than a
few weeks.
Then speak to your health
visitor or GP immediately do not leave it for the
condition to deteriorate.
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Emotional wellbeing continued
Child mental health
Mental health problems affect about one in 10 children
and young people. They can include self-harm, eating
disorders, depression, anxiety and conduct disorder and
are often a direct response to what is happening in their
lives. The emotional wellbeing of children is just as
important as their physical health. Good mental health
allows children and young people to develop the
resilience to cope with whatever life throws at them and
grow into well-rounded, healthy adults.
Things that can help to maintain wellness include:
• Being in good physical health, eating a balanced diet
and getting regular exercise.
• Having the time and freedom to play, indoors and
outdoors.
• Being part of a family that gets along well most of the
time.
• Going to a school that looks after the wellbeing of all its
pupils.
• Taking part in local activities for young people.
• Feeling loved, trusted, understood, valued and safe.
• Being able to learn and having opportunities to
succeed.
• Accepting who they are and recognising what they are
good at.
• Feeling they have some control over their own life.
• Having the strength to cope when something is wrong
(resilience) and the ability to solve problems.
When to seek professional help
Children and young people’s negative feelings usually
pass but if your child is distressed for a long time; if their
negative feelings are stopping them from getting on with
their lives; their distress is disrupting family life; or they
are repeatedly behaving in ways you would not expect
at their age, it is important to seek professional help.
Additional information about mental health problems
can be found at www.mentalhealth.org.uk
Source: Mental Health Foundation
52
1
2
If children have a
warm, open
relationship with
their parents,
children will
usually feel able
to tell them if
they are
troubled.
3
One of the most
important ways
parents can help
is to listen to
their children and
take their feelings
seriously.
Your child may
want a hug, they
may want you to
help them change
something or they
may want
practical help.
Domestic violence
Domestic abuse affects many families. Women are at
increased risk of domestic abuse during pregnancy and
the first year after giving birth, even if there has not
been any abuse before. Men can also be victims.
Remember, you are not responsible; it is not acceptable
and you are not alone. Violence rarely happens only
once and will become more and more serious as time
goes on. It’s not easy to accept that a loved one can
act in this way and you may be trying to make the
relationship work. Abuse can take many forms:
physical, including sexual violence; mental and verbal
cruelty; financial control and/or controlling behaviour.
Children can often get caught up in the crossfire and
become victims, placing them at risk of significant harm.
They may feel frightened, become withdrawn,
aggressive or difficult, bed wet, lack concentration and
suffer emotional upset. They will need time to discuss the
feelings they have about violence or abuse. Children need
to know it is not their fault and this is not the way
relationships should be. It is best that action is taken early
to stop things becoming worse, so seek professional
support. Keeping your child safe is your responsibility.
Long-term abuse is much more likely to cause problems
for a child as they grow older. The longer children are
exposed to violence, the more severe the effects. These
can include a lack of respect for the non-violent parent,
loss of self-confidence (which will affect their ability to
form relationships in the future), being over-protective of
a parent, loss of childhood, problems at school and
running away. For help and advice, see the domestic
violence helpline on page 58.
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Fizzy drinks
Fizzy drinks can contain large amounts of sugar,
which will increase the risk of tooth decay. All
fizzy drinks (both those containing sugar and
sugar-free or diet versions) contain acids that
can erode the outer surface of the tooth. If you
do have sugary or fizzy drinks, drinking them
with meals can help reduce the damage to teeth.
The best drinks to give children are water, milk
and milkshakes without added sugar.
If you or your children like fizzy drinks, try diluting
fruit juice with sparkling water instead.
Remember to dilute squashes well to reduce the
sugar content in the drink. Diet versions of fizzy
drinks also contain very few nutrients. Milk or
water are much healthier choices, especially for
children. Source: NHS Choices
Good habits
Use a family fluoride toothpaste right from the
start. Remember that good tooth care will come
from you, mums and dads, brothers and sisters.
Take opportunities to let them watch you
brushing your teeth. Explain what you are doing
and why you are doing it. Try to make it fun.
54
Good oral health
Tooth care matters
In theory, tooth care should be quite simple - don’t allow children to have
sugary things too often and make sure their teeth are brushed well twice a
day. In practice, it’s not that easy, the way sugary products are advertised
and promoted can make it difficult to limit them.
Although it’s not always easy, you should get your child into good habits
at an early age. They will need your help until they are seven. Make sure
your child brushes their teeth twice a day with a family fluoride toothpaste
that has levels of 1450 parts per million (ppm) fluoride. When your child
turns three, use a pea sized amount of toothpaste, prior to that use just a
smear. Children (particularly young children) should spit not rinse after
brushing with a fluoride toothpaste for maximum effectiveness.
Get your child used to visiting the dentist and take them to an
appointment with you to reassure them. Talk to your health visitor
and take your child to a dentist as soon as you can. Ask your dentist
to brush on FLUORIDE VARNISH for added protection against tooth
decay (for children aged three and above) - IT’S FREE!
1
2
Golden rule - never
give a sugary drink
last thing at night.
3
It’s never too early to
start taking your child
to the dentist.
Tooth decay is almost
totally preventable.
Get it right from the start.
Know what causes teeth
to go bad.
Dentist says
As soon as teeth appear in the mouth,
parents should brush their baby’s
teeth in the morning and last thing
before bed.
Provide a healthy, balanced diet and
limit sugary food and drinks to
mealtimes only. Sugar or honey should
not be added to weaning foods.
Introduce drinking from a cup from
six months and stop bottle feeding by
one year. If children are brought up to
care for their teeth early on, it should
stand them in good stead for the rest
of their lives.
Do not give your toddler juice in a
bottle or sippy cup. They may use this
as a comforter and expose teeth to
fruit sugar all day long.
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Walk seven steps
from your home
• It can help improve the
health of your children.
• Your children won’t see you
smoking, so might not be
tempted to start.
• It might cut down the number
of cigarettes you smoke.
• It keeps your home smelling
and looking fresh.
Page 61
Smokefree homes
Protecting your child’s health
Second-hand smoke is made up of two types of smoke: mainstream (breathed in
and out by smokers) and sidestream (smoke from the burning tip of a cigarette).
Second-hand smoke is dangerous for children as they are growing up because:
• Smoking near children is a cause of serious respiratory illnesses, such as
bronchitis and pneumonia.
• Exposure to second-hand smoke increases the risk of children developing
asthma and can cause asthma attacks.
• Younger children who are exposed to second-hand smoke are much more likely
to contract a serious respiratory infection that requires hospitalisation.
• There is an increased risk of meningitis for children who are exposed to secondhand smoke.
• Children exposed to second-hand smoke are more likely to get coughs and
colds, as well as middle ear disease (which can cause deafness).
Step right out of your home to ensure it does not affect your children. Also, have a
smokefree car at all times as exposure to the chemicals in second-hand smoke is
increased in a confined space, even with the windows open.
1
Call 0800 022 4332 or visit
www.smokefree.nhs.uk
56
2
Smoking anywhere near
your children, like in the
car, affects their health
as well as yours.
Source: www.steprightout.org.uk
3
Opening a window or
standing by the door is not
enough to protect children
from the effects of smoking.
Step right out and take
seven steps from your
home to ensure you are
protecting your children.
Make your home
smokefree
• Tell everyone in your house,
and any visitors, that your
home is now smokefree.
• Keep a pair of slip-on shoes
and other all-weather items
by your back door, so you
can go out anytime.
• Keep an ashtray outside,
away from your back door
as a reminder. It’ll help keep
the garden tidy too.
• Can’t make it outside?
Nicotine replacement
methods like patches and
gum can help.
• If you smoke, or are exposed
to second-hand smoke
during pregnancy, it means
your baby shares chemicals
from the smoke you breathe.
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National contacts
Allergy UK
01322 619 898, www.allergyuk.org
Association of Breastfeeding
Mothers 0300 330 5453,
9.30am-10.30pm, seven days a week,
www.abm.me.uk
Asthma UK
0300 222 5800, www.asthma.org.uk
Baby LifeCheck
www.babylifecheck.co.uk
British Dental Health Foundation
01788 539780, 9am-5pm, MondayFriday, www.dentalhealth.org
Child Accident Prevention Trust
020 7608 3828, www.capt.org.uk
Cry-sis
08451 228 669, 9am-10pm,
www.cry-sis.org.uk
Diabetes UK
www.diabetes.org.uk
Family Lives
0808 800 2222, www.familylives.org.uk
Healthy Start
www.healthystart.nhs.uk
La Leche League GB
0845 120 2918, available 24 hours,
seven days a week, www.laleche.org.uk
58
The Lullaby Trust
www.lullabytrust.org.uk
Meningitis Now
0808 80 10 388, www.meningitisnow.org
National Stay At-Home Dad Network
www.athomedad.org
National Breastfeeding Network
Helpline 0300 100 0212,
9.30am-9.30pm, seven days a week,
www.breastfeedingnetwork.org.uk
National Childbirth Trust
0300 330 0700, 8am-midnight, seven
days a week, www.nct.org.uk
National Domestic Violence Helpline
0808 2000 247, 24 hours,
www.refuge.org.uk
Netmums
Parenting advice and information,
www.netmums.com
Red Cross
Information on CPR (kiss of life),
www.redcrossfirstaidtraining.co.uk
Start4Life Healthy tips,
www.nhs.uk/start4life
To find an NHS dentist
Call NHS 111 or visit www.nhs.uk/dentist
Local contacts
Call 0800 022 4332 or visit
www.smokefree.nhs.uk
NHS 111
NHS 111 makes it easier for you to
access local NHS healthcare
services. It is available 24 hours a
day, 365 days a year. Calls are free
from landlines and mobile phones.
Call 111 if:
• You need medical help fast but it’s
not a 999 emergency.
• You think you need to go to A&E or
need another NHS urgent care
service.
• You don’t know who to call or you
don’t have a GP to call.
• You need health information or
reassurance about what to do next.
If a health professional has given
you a specific phone number to
call when you are concerned about
your child’s condition, continue to
use that number.
Accident and Emergency
Should only be used in a critical or lifethreatening situation.
The Royal Oldham Hospital,
Rochdale Road, Oldham, OL1 2JH.
Children and young people with
Special Education Needs and
Disabilities (SEND)
www.oldham.gov.uk
Specialised unit (office hours)
0161 856 4551/4555.
In an emergency, call 999.
www.oldham.gov.uk
Family planning and sexual health
services
Free and confidential sexual health
services in Oldham including
information and advice on all types of
contraception and STI testing and
treatment, 0300 303 8565,
www.sexualhealtholdham.co.uk
Oldham’s Family Information
Service
Provides help, advice and support for
parents/carers of children 0-20 years old.
Email: familyinfo@oldham.gov.uk
Oldham’s Local Safeguarding
Children’s Board
If you are worried a child or young
person is being, or is at risk of being
abused or neglected, contact the
Children’s centres
Children’s Assessment Team on
Your local children’s centre offers
0161 770 3790/1. If a child is in
children under five and their families
immediate danger of being harmed or
quality childcare, fun activity sessions, Healthwatch
is home alone, call 999.
To make sure your views on local health
and the chance to meet new friends.
www.oldham.gov.uk/lscb
To find your local children’s centre, visit and social care services are heard,
0161 622 5700,
www.oldham.gov.uk
Out-of-hours services
www.healthwatcholdham.co.uk
To access these, call your GP practice
Children’s Community Nursing
as usual and you will be advised which
Health visiting teams/School
Services in Oldham
services are available to you.
Nursing Service, 0161 622 6425.
www.penninecare.nhs.uk
Walk-in centre
Infant feeding office
Children’s Community Therapy
Treats minor illnesses and injuries that
For help and support with
Services in Oldham
do not need a visit to A&E.
breastfeeding, 0161 621 7553.
www.penninecare.nhs.uk
Ground Floor, Integrated Care Centre
Oldham Citizens Advice Bureau
Domestic violence
(ICC), New Radcliffe Street, Oldham,
1-2 Ascroft Court, Peter Street,
For emergency help or advice.
OL1 1NL.
Oldham, OL1 1HP, 03448 472 638,
General switchboard (24 hours)
www.oldhamcab.org.uk
0161 872 5050.
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