Parents: when should you call the doctor?

Children in Ireland today are one of the healthiest generations ever, yet large numbers of them are being brought to a GP or hospital more frequently than in the past. This is an observation that troubles consultant paediatrician Prof Alf Nicholson. The same 20 ailments, he says , are the reason for most children's visits to a doctor and these illnesses are likely to be very minor. Most of the time, the child could be treated by a parent at home.

However, he senses that parents are deeply anxious and losing confidence in their own abilities to handle such minor childhood illnesses. In this era of paranoid parenting, we are quick to catastrophise a sniffle into pneumonia, a spot into a meningitis rash or a headache into a brain tumour.

Another reason for the rush for medical opinion is that people like certainty now, suggests Nicholson, who is RCSI professor of paediatrics and is based in the Children's University Hospital, Temple Street in Dublin. "They don't like dealing with 'we will see how it goes over the next four to six hours . . . ' Because of technology, they like immediate answers to a question."

He sees the make-up of today’s families as a factor, too. Fewer children and less involvement by grandparents means there is little experience and wisdom to draw on. Parents’ first port of call is the internet, which is likely to scare them even more.

“They catch a symptom, say fever, go straight on to Google and come up with an incredible array of horrendous outcomes,” he says. While there is an abundance of information out there, parents don’t know how to process it or how accurate and valuable it is.

A passionate believer in a doctor-parent partnership approach to children's ill health, Nicholson, with co-writer Gráinne O'Malley, has now produced an updated, extended and redesigned edition of their book When your Child is Sick . . . Seven years after it was first published, he believes hospitals and doctors' surgeries are still unnecessarily full – and the introduction of the free GP visit card for under-sixes less than a year ago has exacerbated that (see panel).

So it is good timing for this easy-to-read manual which, Nicholson says, is intended to empower parents, giving them the information they need to make the best possible decisions about their children’s health.

At one point in the book, he writes: “Nothing substitutes for a doctor’s expertise, but I’m a great believer in the instincts of a smart parent. When a mother tells me she is very worried about her child, I get worried.”

O’Malley’s role was to keep the parents’ perspective to the forefront at all times and ask of Nicholson all the questions she thought they would want answered. “I was trying to see what the parents were looking at the internet – what they were exposed to and the information they were sharing – and testing it against what we were saying.” She hopes the end result will “help parents panic less, cope better and be very smart partners with the doctors”.

The book works through the 20 most common childhood ailments, from colic and constipation to hyperactivity and obesity, explaining what to expect, how to deal with it at home and the “red flags” that indicate when it is time to call the doctor.

O’Malley says her two children, now aged 15 and 20, went through all but one of those 20 illnesses – “the only thing they didn’t have is asthma”. However they did have other health issues, as her daughter has Down syndrome and her son was diagnosed with cancer at age 3½, so O’Malley is no stranger to the health services.

Recalling her own inclination at one time to hover over the phone at the slightest sign of a temperature, “now I would be much more inclined to wait and see and presume it’s minor, unless it’s shown to be otherwise”, she says.

However, she has great sympathy for new parents, who have to contend with the combination of sleep deprivation, work pressure, the internet and, probably, no grandmother on the doorstep. “You are very much left to your own decisions and you will scare yourself very easily.”

Nicholson draws on trends he has noticed in the past seven years for additions to the book, including a new chapter on health in the pre-teen years. Children are bigger than they were before, leading to earlier puberty and adolescent issues. Also, through their savvy use of technology, “they are exposed to a lot more, a lot more quickly”, he says. “That is a significant change.”

Nicholson recalls how, when he started working as a paediatrician in Mullingar in 1991, mobile phones hadn’t come out. Now, where once when children could pick up a small, soft raisin was regarded as a developmental milestone, now it’s when they can scroll a mobile phone, he says, only half-jokingly – at about nine months apparently.

Among adolescents he has seen a significant rise in mental health and psychosomatic illness that can manifest itself in lots of different ways: tummy pains, headaches, chest pains or post-viral fatigue type symptoms – although he is quick to stress that he is not suggesting post-viral fatigue itself is psychosomatic.

The marked increase of allergy and allergic disease is also a feature of childhood illnesses in recent years. It is incredible, Nicholson says, that nearly 40 per cent of children are affected by one or more of the following: allergic rhinitis (runny nose), eczema, food allergies or asthma.

Some recently retired colleagues said they had never encountered a case of anaphylaxis – an acute, life-threatening allergic reaction. Now Temple Street hospital could expect to deal with up to six a year, most of them food related.

Nobody really knows why allergies are on the rise but the so-called “hygiene hypothesis” seems to make the most sense, he says, “which essentially is that living in centrally heated, spankingly clean homes with highly vaccinated children leads towards allergic disease”. When a child’s immune system, which is geared towards fighting infection, finds itself almost redundant, the thinking goes, it is diverted into allergic responses.

Children have also become part of one of the biggest health problems of our time – obesity. Twenty years ago, Nicholson rarely saw a case; now more than a third of 10- and 11-year-olds are either overweight or obese.

He thinks parents can be slow to see the warning signs. Tackling obesity is all about reducing portion sizes, getting children out and exercising, while eating together as a family is of “massive benefit”. The current modern family meal is four different people in four different rooms gobbling stuff in front of screens, he remarks.

In terms of public policy, Nicholson believes it is “absolute madness” that advertising of fast food is allowed during peak children’s TV viewing times and he is also in favour of a sugar tax.

Finally, he predicts a continuing rise in the use of natural therapies and is happy to highlight evidence-based options. He sees it as an industry that “is complementary to medicine rather than competitive to medicine. I don’t have the feeling that all complementary therapies are a load of bunkum and that the people who practise it are trying to hoodwink the public.” However, “I don’t like the ‘desperado’ sort of approach to natural therapy”, he adds, stressing the need for parents to be well-informed.

“They need to know they are safe and they need to know they may have some benefit. The only problem with them is that unlike drug treatments for children, they have not been trialled.”

In the Nicholson household there was, of course, no question of an unnecessary trip to GP or hospital emergency department when his four children, now aged 18 to 24 were growing up. “They had to have their leg hanging off for me to sit up and take notice,” he admits, “and that is much worse – they would say!”

When your Child is Sick – What you can do to Help, by Prof Alf Nicholson and Gráinne O'Malley, is published by Gill Books this Friday, €19.99.

swayman@irishtimes.com

GP visit card by the numbers

2,274: The number of GPs who have signed "under-six" contracts – about 93 per cent of the 2,452 GPs who have GMS contracts. 241,761: The number of GP visit cards which have been issued to applicants since the scheme started in July 2015. 238,585: The number of children who currently have an eligible GP visit card*. 240,000: The estimated number of eligible children at the outset.

*As of April 1st, 2016 Source: Health Service Executive