. . . and know when not to. Most childhood illnesses are minor and will pass quickly, writes EMMA CULLINAN.
WHEN OUR children are born, the protective instinct kicks in and so when they become ill we often imagine the worst-case scenario but, reassuringly, serious illnesses are rare.
A childhood illness that is panicking you is likely to be just the type of thing that Prof Alf Nicholson, a consultant paediatrician with the Children’s University Hospital, in Temple Street, Dublin, will see in his clinics all the time.
“In my clinic this morning there were three children with constipation, three asthmatics and one with a urinary tract infection,” says Nicholson, who also treats many children with obesity, eczema, hyperactivity and colic.
"A primary function of a paediatrician is to reassure parents, following a detailed examination. Most things are minor, will pass quickly and parents are able to cope with themselves," says Nicholson who has now put such reassurances and home remedies into the form of a book called When Your Child is Sick, What you can do to help.
To make the text parent- friendly he collaborated with Gráinne O’Malley, a writer and parent who comes from a medical background.
“The illnesses we talk about are very common – the symptoms described in the book are based on the 20 main reasons why children go to a doctor – but they cause a huge amount of anxiety,” says Nicholson.
And to illustrate the point, O’Malley says: “While I was writing the book, over two years, my two children had every single ailment described in it.” However, she has also visited the rarer end of the child illness spectrum, including cancer, heart surgery and Down syndrome, with her son and daughter.
“In my 20 years as paediatrician I have seen a large number of very sick children,” says Nicholson, “but it is important for parents to get reassurance that tummy upsets, fevers and headaches occasionally are all very common. My own four children would have had 90 per cent of the top 20 conditions in this book.”
The book is clearly laid out – in chapters and boxes – to allow parents to find information fast in an emergency and then to read more deeply at quieter times.
The pair feel that parents are less equipped nowadays to interpret how serious their child’s illness is and to know when to call a doctor.
“Admission rates to hospitals of children with asthmas and minor illnesses have risen in recent years,” says Nicholson, “not because we are sicker. We are relatively healthy but people are worried and want to be certain that it isn’t something serious so they go seeking out-of-hours GPs and to AE. Yet if you have the knowledge – which this book aims to give – and throw in a huge amount of common sense, then you are near where you want to be.”
He feels that we are doing too many tests to find out what is “wrong”: “We should try to get away from investigative paediatrics to more common sense paediatrics. It is like bags going through airport security: the vast majority are normal and only one in hundreds of thousands are very significant.”
O’Malley understands how “parents are hugely scared of getting it wrong and missing the one exception to the rule. Deep down people will know that something is minor but the tendency is to go seeking more information. This book offers a rule-of-thumb approach about what is normal when a child is sick.
“There are four particular symptoms that parents really worry about,” she says. “Vomiting, fever, rash and breathing problems. We give immediate answers for those.”
We are less sure about when to go for help because we may not live near our parents or grandparents but instead might gather information among groups of less-informed parents who tell each other scare stories and generate a sense of panic, say the authors.
Another reason for a growth in hospital admissions is the greater incidence of certain illnesses, due to our lifestyles.
“In most western European countries children grow up in warm, cosy homes and there has been a surge in asthma, rhinitis and food allergies,” says Nicholson. “Children don’t come into contact with dirt, so their immune system changes and predisposes them to allergies.”
An incredible 20 per cent of children have asthma now; 20 per cent have eczema; and 25 per cent have rhinitis, says Nicholson.
Another “disease” that is common in Nicholson’s clinic is obesity – which he rarely saw 15 years ago but which now affects about 10 per cent of all children. He argues that a medical response alone cannot deal with it. “It’s a sedentary lifestyle problem and needs a commonsensical family response. Children are referred to me in ever-increasing numbers but what would be much nicer than coming here is to go back to the family. Getting children into medical programmes has been tried all over the world and they don’t really work.”
Where children have the advantage over obese adults is that they can literally grow out of obesity: “Putting a child on a diet is not the way to go,” says O’Malley. “The idea is to maintain their weight so that they slim down as they grow.”
The book maintains a balance between the concerns of parents and the perspective of a doctor who takes all of these illnesses in his stride.
Red alert boxes throughout the book indicate when you need to call a doctor and the symptoms are – bizarrely reassuringly – severe, meaning that most parents will know when a child is really ill, for instance, with asthma, it includes being so breathless that it is hard to talk and lips turning blue. What is also very helpful, says O’Malley, is to know when a child is okay despite being sick: “You probably don’t need to worry about a baby who is smiling.”
Nicholson agrees and says: “Parents will usually be aware if a child is desperately unwell, but it is also important to be aware that a child can get worse very quickly and a mild illness in the morning can turn into a critical bacterial illness four hours later. You must go by your instinct. If you feel something is dramatically wrong, you must get help, but if your child is smiling and interactive then you can sit tight for a while.
“This is the book that I wish I had had starting out as a parent,” says O’Malley, “because it is reassuring and practical but, very importantly, it tells you when to get help.”
Common illnesses: when to get help
Asthma: Breathing is fast and shallow, difficult to talk because breathless, constant coughing, colour changes and blue lips.
Colic:Under three months and has temperature, over three months and temperature with other symptoms; pale, screaming and blood in stools; if threat from parent at end of tether.
Chest infection:Over 40 breaths a minute, chest heaving in and out with diaphragm and muscles working hard; skin turning bluish around lips or tongue, high temperature, child makes grunting sound.
Ear and eye infection:If ear oozes yellow pus which eases pain (this could be symptomatic of a burst eardrum); can not keep eyes open due to a gritty feeling; eyeball red but not inner eyelids, swollen eyelids; yellow, creamy bloody mucus from eye.
Fever:With spreading rash, headache, listlessness, pain, vomiting, reaction to bright light, stiff neck, limping. Listless.
Food allergy:Can be urgent if itching, strange taste in mouth, swelling mouth and throat, wheezing, rash, stomach pain, fainting, feeling "strange".
Fits:If lasts longer than five minutes, if first fit, if baby is under three months.
Gastroenteritis:If vomit is "grass green"; blood in stools; listless, flat spots that don't fade when pressed; vomits more than four times in 24 hours; stomach pain for more than four hours, under six months old, chronic diarrhoea.
Eczema:If there are blisters, skin weeping or crusting, condition suddenly gets worse, if it covers more than 20 per cent of the body and badly flaking or scaling.
When Your Child is Sick – What you can do to help, Gill and Macmillan, Prof Alf Nicholson and Gráinne O'Malley