Wednesday 18 July 2018

Consultant Paediatrician on how to make the right call with sick children

We have one of the healthiest generations ever, yet doctors have never been busier. Consultant paediatrician and co-author of 'When Your Child is Sick', Professor Alf Nicholson, wonders what has gone wrong

Paediatrician and girl
Paediatrician and girl
Children are seeing doctors more fequently than in the past
When Your Child is Sick by Professor Alf Nicholson and Grainne O'Malley

How often do parents lift the phone to their child's doctor or queue at the doctor-on-call? Do you make that visit regularly, 'just in case'? It seems that you are not alone. But it bothers me that children see the doctor more frequently than in the past. Hospitalisation rates are also high and this has to be traumatic for any small child. It bothers me because children are not any sicker. In fact, thanks to vaccination and improved living conditions (and despite obesity issues) we have one of the healthiest generations ever. Many life-threatening infections have all but disappeared. So why are our doctors so busy?

Parents, ironically, appear to be more anxious than ever. This is despite medical expertise at the click of a mouse and despite the very welcome Under-6 GP scheme. Or perhaps it is because of these.

Certainly, the responsibility as a parent weighs very heavily. Should you visit the doctor, as a precaution? What if that temperature is meningitis? What if you've missed something? Understandably, no parent wants to take chances with their small child. Of course, you may also be facing the pressures of work and day care in the morning and it may seem safer to check with an expert. And so the queues at doctors' surgeries and hospitals lengthen.

I wrote When Your Child is Sick with parent and author Gráinne O'Malley because I believe that parents want to - and can - play a central role in managing their sick children. However, the pressure to get it right is now considerable. Is it any wonder that parents can lose confidence in their own judgment? It wasn't always like this. Fifty years ago, there was no internet and less medical information but instead there was a community of experience. In every street there were neighbours who had raised six children and who could tell when a child was truly sick. There were families who had lived through everything from gastroenteritis to croup.

I have no doubt that it is more difficult for parents today. Now our families are smaller, our neighbourhoods are less connected and many new parents find themselves learning on the job from other new parents - or from the internet. There is an overload of medical information and it's not always balanced by common-sense experience. The effect, unfortunately, has been to disempower parents. The free access to GP services, which is so welcome, may even contribute unintentionally. Could it send parents a message that they should go to their GP?

I believe that we have lost sight of what is normal when a child falls ill. What is normal, as most doctors know, is a very minor illness which can usually be treated by the parent at home.

In the main, there are 20 reasons why children are taken to the doctor and we have built our book, When Your Child is Sick, around these 20 core childhood illnesses. It is a health guide that any parent, carer or crèche manager can very easily use. At a glance, you can learn how to recognise and treat the illness at home and the danger signs that need a call to the doctor. The book draws on 25 years' experience as a paediatrician in children's hospitals in both Europe and Australia and in this new edition I have also considered the most advanced thinking in the 'new illnesses' of childhood - allergy, obesity, hyperactivity, asthma - and complementary health remedies.

The book empowers you to make informed decisions about your own child's health and an informed parent is a tremendous ally for any doctor. It lays out what is common during childhood and answers every parent's health worry - "is this normal?" So the next time your child is sick, will you visit the doctor - or will you handle it yourself first, with great common sense?

Common health problems - and what to do



Be quick to get help with an asthma attack.

Call a doctor or hospital immediately if:

• The breathing is fast and shallow.

• He is so breathless that he cannot complete a sentence when he talks.

• He is constantly coughing.

• His colour changes. If his lips seem blue, go straight to a hospital.

• Trust your instincts. If it feels dramatically wrong, it probably is.



The five-step approach

It is relatively easy to control eczema, but it is an ongoing thing:

1. USE MOISTURISING CREAMS GENEROUSLY The secret is keeping the skin moist. You cannot put on too much moisturising cream (emollients). I tell parents to put their hand in the tub and lash on agricultural dollops of it. But they have to keep it up, even when the rash stops. Cream alone can control mild eczema, but make sure it is unperfumed.

2. AVOID IRRITANTS There are triggers that make eczema worse. Simply remove them where you can (eg soap) or keep contact to a minimum.

3. USE STEROIDS SPARINGLY If the eczema does not improve with moisturising, you will need to rub a steroid on the skin. But use it sparingly because it can thin the skin; and use the least potent one that works.

4. CATCH SKIN INFECTIONS EARLY Look out for signs of blisters, weeping sores or crusting skin. They will add to his problems unless nipped in the bud.

5. CONTROL THE ITCHING Some children get into an 'itch-scratch-itch' cycle that can be hard to break, especially because the skin starts to thicken (lichenification) and that makes it itch all the more. Try to catch itching early. Parents are surprised when I recommend daily baths. Doesn't a bath dry the skin? In fact, the baths hydrate it, they soothe itching and they are a great way to get baby oiled.


Food Allergy

Is it a food allergy?

Diagnosing is a little like being a detective. Timing is especially interesting. Did the symptoms appear shortly after he ate the food? With an allergy, the symptoms will usually show - quite fast- in one of four parts of the body:

SKIN He may have a general blotchy rash, which is itchy. In some cases, there may be swelling or puffiness around the eyes. These signs will appear within minutes or hours of exposure to the food.

GUT His tongue, lips or palate may swell soon after eating the food. He may also vomit, have stomach pain or diarrhoea. The symptoms will, however, be mild.

CHEST If it shows in the chest, it will most likely be a runny (or blocked) nose, sneezing, a cough or a wheeze. Nothing particularly severe. If it is, make sure it is not asthma or allergic rhinitis.

EYE Food intolerance can show up as itchiness around the eyes or as conjunctivitis.

BUT The symptoms of anaphylaxis are different. It needs urgent help.


'When Your Child is Sick' will be published by Gill Books on April 22, priced at €19.99.

Irish Independent

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