Written by: Dr. Hilary Jones
Most of us know what it’s like to look after our children when they are poorly. There are few things more harrowing. When they become distressed and throw themselves on your mercy it pulls at your heartstrings. You want to help.
You want more than anything else to put it right and make it better. But that is far from easy, because children’s symptoms can be notoriously complex and confusing.
All parents have considered the possibility of meningitis when their child develops a high fever and a headache, and many have been puzzled by their infant’s continuous coughing or wheezing at night. Mothers and fathers often agonise over how long to leave their child with tummy pain, and wonder how seriously they should take the child’s refusal to eat. But there is so much we can all do as parents to keep our children healthy and to prevent problems occurring in the first place. Immunization is a good place to start.
Immunisation protects both individual children and the community at large from infectious diseases that may cause serious handicap or even kill. Many people still consider the common childhood diseases such as mumps and measles to be fairly trivial conditions.
The sad truth is that although it is usually so, in a small proportion of cases there will be damaging complications such as blindness, deafness, paralysis, brain damage or even death. In the case of measles, inflammation of the brain (encephalitis), pneumonia, bronchitis and deafness may all occur.
With whooping cough there may be long, distressing bouts of coughing and chocking, as many mums and dads know to their cost. In a small infant that is terrible for the parents to encounter, let alone for the child to suffer, and convulsions, brain damage or death can occasionally result.
Not so very long ago, many children died because vaccination was not possible. Over the last half of this century, however, vaccine have become increasingly effective, simple and safe and are now available in either injectable form, or drops that are placed in the child’s mouth. Vaccines work by preparing the body so that it can fight a specific virus or bacteria.
The vaccine resembles the micro-organism, but is either a dead version or a live but drastically weakened version of it. In either case it causes the child’s own defence system to produce antibodies against the real micro-organism so that active immunity is achieved. Here is a list of serious, preventable illnesses against which children can be immunized effectively:
Immunisation protects against
- Whooping cough
- Haemophilus inluenze
- Hep A and B
- Meningococcal meningitis type C
When should my child be vaccinated?
The Department of Health has nationally agreed immunisation schedule which is believed to provide the best possible protection for children of all ages.
At the appropriate times, parents will receive an appointment automatically inviting them to bring their child for vaccination. A full immunisation record should be kept in the personal child health record which is provided by the health visitor to all children.
Haemophilus influenza Type B is a vaccination protecting against life-threatening illnesses in your children. These diseases include meningitis and epiglottitis which resembles a serious form of croup. The vaccine will prevent about 60 or 70 children dying each year in Britain from HIB infections, and is very safe.
Meningitis C (HILARY TO INPUT MORE)
Although the meningitis C vaccine has been hugely successful in bringing about a decrease in cases of Group C meningococcal disease, other forms of meningitis and septicaemia have been on the increase in the UK for a number of years. Cases of Group B meningococcal disease have been rising steadily in the UK and are a reminder that vigilance for the signs of symptoms is still necessary.
BCG and HEAF test
This was once a leading cause of death in Britain until the invention of antibiotics were developed to treat it, but there has been a recent resurgence of the disease in inner cities where overcrowding and poor social conditions exist.
Vaccination using BCG when it is appropriate is normally given between ten and fourteen years of age, but where there is a family history of TB the BCG may be given in the newborn period.
Common side effects
The vast majority of children suffer no ill-effects whatsoever after vaccination.
A few develop a small tender red lump at the site of the injection which may last a day or two. A very few children spike a slight temperature and become a little irritable.
If in doubt, consult your doctor, although usually a small dose of paracetamol is sufficient to overcome the problem. There may also be a faint rash on the skin after the MMR vaccination, and occasionally the mumps component can produce a mild and short-lived swelling of the parotid salivary gland just below and in front the ears. Neither reaction is serious.
Serious side effects
Although often highlighted by scare-mongering media, side effects such as convulsions and encephalitis secondary to vaccination are incredibly rare. So rare in fact that a busy GP like myself would have to remain in practice some 1500 years before seeing a single case. Even then it is difficult to determine whether such symptoms would have naturally occurred anyway or are really the result of the reaction to the vaccination. The risks associated with immunisation are far smaller than the risks of the complications of the disease themselves, including brain damage and death.
The MMR controversy
Controversy over the safety of MMR vaccine (measles, mumps and rubella) has been fuelled by widespread media coverage ever since a hypothetical concern was raised about a possible link between it and the development of autism and an inflammatory bowel disorder known as Cohn’s disease.
Whilst the Department of Health and the vast majority of doctors remain confident that MMR has been conclusively proven not to be linked in such a way, some doctors are still concerned that three vaccinations in one hit is too challenging for an infant’s immune system to deal with at one time, and that a small minority of children (who cannot be identified in advance) might be susceptible to being vaccine damaged.
The real risk we all run at present is that if the MMR vaccination rate falls below 85% in the general population, an epidemic of these potentially lethal viral infections becomes ever more likely with potentially horrendous consequences.
Mini-outbreaks have recently been seen in Ireland and South London and may represent a warning of things to come . Any parent remaining confused and uncertain about what to do should obtain as much information as possible and discuss the matter fully with their GP or if appropriate, the paediatrician or community health doctor to whom their child has been referred.
When should a child not be immunized?
Even today there is confusion in some parent’s minds about when a child should and should not be vaccinated. A small minority of health visitors and doctors themselves may be a little uncertain, or perhaps out of date. If they are in any doubt whatsoever they should defer vaccination and refer the child to a paediatrician. All children should be carefully considered as individuals prior to immunisation procedures. Always be guided by your GP or paediatrician, but in general all children should receive the vaccinations except for a tiny few who fall into the following categories:
- Children who are feverish and unwell when the immunisation is due. In this case the vaccination should be postponed until the child has fully recovered.
- Children who have had a SEVERE reaction to a previous jab.
- Children who have a serious illness or who are taking medication such as oral steroid tablets. These could interfere with the child’s capacity to fight infection. Children using steroid creams and inhalers however, should still be immunised.
Because of the various myths that have abounded, many children who should have been immunised have missed out. Here is a list of children with conditions thought previously to prevent vaccination. In fact, they should ALL be immunised.
- Children who suffer from fits or convulsions
- Children who have close relatives who suffer from the above.
- Children who are snuffly or chesty on the day and their jabs are due, but have no fever.
- Children on antibiotics.
- Children on steroid creams or inhalers.
- Children who were premature or low birth.
- Children with asthma, eczema or allergies.
- Children with a family history of asthma, eczema or allegies.
- Children with Down’s syndrome.
- Children with Cerebal palsy.
- Children who are breast fed.
- Children whose mothers are pregnant.
If this information seems complicated and difficult to take in all at once, don’t worry. Your doctor, health visitor or practice nurse are all able to advise you on which immunisations are due and at what times, as well as checking your child over to see that he or she is in a good state to be given vaccine. Provided parents continue to have children vaccinated, fewer and fewer children will be exposed to the risk of contracting these serious infections, diseases and as the natural reservoir of the germs falls, their permanent eradication becomes ever more likely.
Taking your child’s temperature
A child’s normal temperature is between 36-27 degrees centigrade or 96.8-98.6 degrees Fahrenheit. If your child has a fever, his temperature will be over 37.7 degrees C, and if your child is hypothermic, his temperature will have fallen below 35 degrees C.
What most parents will already know is that children’s temperatures can fluctuate dramatically. It is not at all unusual for a child with a normal temperature to develop a fever of 40 degrees C within a few hours, only for the fever to subside quickly after simple treatment.
In adults a fever takes longer to rise and longer to settle because the central temperature regulating mechanism in the brain is still immature in children and control is less smooth and gradual. This is one of the main reason that doctors are so often called up by worried parents describing their children as “burning up” or suffering with a raging temperature necessarily means a very ill child, or conversely that if the temperature is relatively normal, the child is perfectly well. A high temperature is merely a sign or symptom of what is going on in the rest of the body, so it is well worth knowing how to measure a child’s temperature accurately so that his progress can be monitored.
If a child has a higher than normal temperature, his skin, especially over the forehead will seem hot to touch. Often the back of the hand it used to assess roughly how hot a child seems, but to be accurate, a thermometer should be used. There are four types of commonly used thermometers:
Traditional mercury thermometers
These consist of a glass tube with a bulb at the end holding mercury. An oral one is fine once your child is over the age of seven, as by this time he unlikely to bite the thermometer and break the glass.
Younger children can have their temperature taken in the armpit with the arm held down firmly against the body, over the thermometer.
Ideally in babies up to about 18 months a rectal thermometer should be used as this gives a more accurate reading inner body temperature.
This is important in this age group since any persistent fever is potentially more serious than older children. Before using a mercury thermometer ensure the mercury is returned down the tube into the bulb by holding the thermometer at the top end and shake vigorously.
To take an oral temperature, place the bulb under the child’s tongue and get him to keep it in place using his tongue. His lips should be closed. Remind him to bite the thermometer, and leave it in place for 2 minutes. For armpit use, place the bulb in the centre of the armpit. Lower the arm and hold firmly against the body. Again leave the thermometer in place for 2 minutes, and remember that this method will give you a reading up to one degree lower than the inner body temperature.
For rectal use, position the baby for a nappy change, holding the feet in one hand, lift the legs up and having lubricated the bulb with a little Vaseline, gently insert the thermometer to about one inch and hold in place for 2 minutes.
These have a plastic shell which is generally unbreakable, and therefore they are safe and straightforward to use with children of all ages. They are safe and accurate for oral and rectal temperatures.
Liquid crystal thermometers
These are plastic strips which are held against a child’s forehead. They contain panels of heat-sensitive crystals which change colour at certain temperatures. They are safe and easy to use, but not very accurate.
These are digital, battery operated thermometers. There is a small conical speculum which is placed just inside the ear and provides immediate highly accurate reading of the body’s inner temperature. They are suitable for all age groups, accurate. Many doctors prefer these kind of thermometers for that reason.
What does having a fever really mean?
First of all, remember that in many ways a fever is a good sign. It means the body is mounting resistance to the underlying disorder which has caused it in the first place.
Also, whilst the symptoms of the fever are obviously unpleasant for the child, a raised temperature is highly unfavourable for the micro-organisms responsible for producing the infection.
Any child with a high temperature will be miserable. He will be floppy, flushed and lethargic. If the temperature has been high for any length of time, the child will be thirsty, will have a dry mouth and lips, and the parent may notice a sweet or acidic smell the breath if the child is not eating.
At times he may feel shivery as the fever leads to excessive sweating and heat loss from the skin which then cools, causing the child to feel cold and have goose bumps.
Because of this shivering, many parents have made the mistake of smothering their children in several layers of clothing and even greater numbers of sheets and blankets in an attempt to “sweat out the infection”. This unfortunately only serves to make the child more uncomfortable and miserable. It also increases the risk of dehydration and most importantly, of producing a febrile convulsion or fit as a direct result of fever, something which is particularly common in children under the age of 7. Because of these latter two possibilities it is therefore important to take certain steps to treat the temperature rise and to keep it under control.
Drugs of any kind should only ever be taken when appropriate. If any particular drug is suggested by a doctor or nurse, make sure you know exactly why it is being proposed, for how long it should be taken and how it will help. Ask whether there are any more suitable alternatives and find out also about any possible side effects. Some commonly used medications can make a child feel sleepy or irritable.
Should your child get a reaction to the medication, remember to tell the doctor, not only for his or her immediate advice, but also so that the problem can be recorded in your child’s medical notes to ensure he will not be prescribed the same medicine again.
Make sure you know how much medicine should be given and how often. If this is not on the label, write it down. Make sure you finish the course that is prescribed, especially antibiotics. Not doing so, encourages the emergence of resistant bacteria which can produce a more stubborn infection than the original one. When buying a medicine over the counter a chemist, tell the pharmacist the age of the child who will be taking it. Make sure you read the label carefully. Look at the expiry date, and when any drugs in your medicine cabinet have passed their expiry date, hand them back to the chemist for proper disposal.
Never accept medication from other people since you cannot be sure what has happened to it, and wherever possible use sugar-free preparations to save your child’s teeth.
Always keep your medicine cabinet locked and medicine well out of children’s reach. Finally, make sure you have measuring equipment for liquid medicines in the form of droppers, syringes and specially designed measuring spoons to ensure your child gets the correct dose.
Giving medicine – a spoonful of sugar?
It’s easy for the doctor to say, “Give him this three times a day”. But children are likely to refuse anything unfamiliar and strange. This is perhaps one situation where a little bribery with a favourite food or drink is acceptable, bit if this fails you may have to be forceful because if the medicine has been prescribed, it should be taken.
Giving babies medicine
Babies squirm and wriggle. They also cry a lot when they are poorly. It’s a good idea to get somebody else to help you, or else try wrapping a shawl around your baby’s body so you can hold him steady. Prop him in the crook of your arm and open your baby’s mouth by gently pulling down on his chin.
Using syringes are the easiest way to administer a liquid medicine, but if you use a spoon, make sure the spoon is sterilized and the dose accurate.
Allow the medicine to run into your baby’s mouth a little at a time allowing him to swallow frequently. Offer a drink to help wash the medicine down.
Toddlers and older children
These days most medicines are available in liquid form and are attractively flavoured and palatable. But if not, don’t be tempted to add the medicine to a bottle or drink as the full does will not be taken if the drink is not finished.
To make tablets easier to take, they can be crushed up and mixed in with something nice like jam or honey.
Many preparations contain sugar or substances used to disguise nasty tastes, so it is always best to encourage your child to clean his teeth after taking a medicine.
Lie the child flat and if necessary ask someone to hold him steady. Gently pull down the lower eye lid of the affected eye, and allow the drops to fall onto the eyeball just above the lower lid. Another way is to apply the drops to the corner of the eye with the eyelids closed. They will then run into the eye when it’s opened.
Tilt the child’s head backwards to prevent the drops running straight out again. Three drops in each nostril are normally sufficient. Any more will run down the throat and cause coughing.
Put the child on his side with the bad ear uppermost. Allow 2-3 drops to fall into the ear canal and wait a few moments whilst they find their way downwards. Ear drops should be warmed to body temperature to prevent the unpleasant situation when cold drops are used.
The medicine cabinet
All households should have a properly stocked medicine cabinet. The cabinet should be kept in a clean, dry, dark place, and the first aid kit within it should be preferably with an airtight box.
Never mix different pills in one bottle and never hoard out-of-date medicines.
Keep the medicine cabinet locked at all times and out of reach of children. Essential items should include the following:
- Paracetamol in junior tablet or syrup form. This is a classic pain reliever and fever reducer for children.
- Antihistamine. Older children can take non-sedating antihistamine tablets for allergies and travel sickness, and in combination with paracetamol for stings, sunburn, earache, sore throat, other pains and temperatures. Babies can take antihistamine syrup for similar conditions
- Calamine lotion to apply directly to itchy, burnt or irritated skin.
The first aid kit should contain:
- A thermometer, preferably a digital ear thermometer such as the Braun Thermoscan.
- Plasters of various sizes.
- Cotton wool.
- Antiseptic Cream.
- A roll of surgery tape.
- Scissors and tweezers.
Hopefully, you’ll never need to call upon any of these items from your medicine cabinet and the first aid kit will simply sit there gathering dust. But we all know how Murphy’s Law works in reality. If you don’t have a well-stocked first aid kit for emergency use, you are simply bound to need it when you least expect it.