Why does my 5 year old daughter have an itchy bottom all the time? My doctor says it is not thrush.

Your doctor is right and I wish more doctors said this instead of treating pre-pubertal girls with an itchy bottom for candidiasis or thrush, which is a fungal infection that post-pubertal girls and women get, and is very rare in primary school aged girls.

Itchy bottoms however are extremely common.  Pre-pubertal girls get something called vulvovaginitis and it is caused primarily by a lack of oestrogen at this age.  They get red and sore around the opening to the vagina and, in extreme cases, the labia can get stuck together.  It hurts to wee and there may be a small amount of discharge (which shouldn’t be smelly).

Emollient creams may help but antifungals are unnecessary.  We can prescribe oestrogen creams in severe cases but it’s best not to use them for too long as they can be absorbed across the vaginal mucosa. Your daughter should wear cotton underwear during the day and no underwear at night.  You should not use soap or shampoo in the bath.  Try to avoid her wearing tights or tight leggings/trousers.  The linked factsheet talks about putting vinegar in her bath (see below).

Threadworms are very common in primary school children; they look like short threads of white cotton and they come out at night to lay their eggs around the child’s anus.  They can cause a very itchy bottom which can spread forward into the vulval area as the distance is not very great.  Threadworms are easily treated with one dose of antiworming medicine from your pharmacist.

Occasionally children with a well demarcated, bright red area either around their anus or vulva have a streptococcal bacterial infection which is treatable with antibiotics.  So you can see that there are lots of possible causes for your daughter’s predicament but thrush is probably not one of them.

Recommended reading:

There is a helpful Australian parent information leaflet at http://www.rch.org.au/kidsinfo/fact_sheets/Vulvovaginitis/

 

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My 13 year old son has started complaining of headaches. How do I know if it’s serious?

Headaches are common in the young (and older) adult population.  They often come on in the teenage years and parents are not sure if they are stress or hormone related or due to the fairly universally poor sleeping habits of adolescents.  Some worry that they are a sign of something more serious underlying.

Most commonly in 13 year olds I would say are the tension type headaches and migrainous headaches, followed by headaches caused by things like sinusitis.

Tension headaches usually get worse towards the end of the day or when tired.  It is a squeezing type pain on both sides of the head, around about the temples or in the front of the head.  There are no added features like nausea or seeing bright, flashing lights but there can be associated light sensitivity.  Paracetamol or non-steroidals such as ibuprofen work fairly well for this type of headache.

Migraine often runs in families and you may recognise some of the symptoms in your son if you are a sufferer yourself.  The pain is often described as throbbing and is more severe than with a tension headache and the young person usually feels better if lying down in a quiet, dark room.  They may feel nauseous with it and may get an aura (warning) beforehand consisting of flashing lights or blind spots.  If he is not getting very many then pain relievers as above may be the most appropriate management but there are a number of different preventative medicines for people whose life is severely affected by frequent migraines.  In about 20% of cases certain foods can make migraines worse eg. chocolate, coffee, oranges, cheese.

Sinusitis can cause headaches; does he have a blocked nose?  Dark rings under his eyes?  Pain on pressing above the eyebrows or under the eyes or on moving his eyes from side to side?  Sometimes antibiotics are needed to clear up a bout of sinusitis.

The sort of things that should make you take him to the doctor straight away are pain which wakes him up at night, sudden severe pain (sometimes called “thunderclap” pain), weakness or numbness down one side of his body, on-going slurred speech or double vision, headache on coughing or laughing and any change in behaviour.

Recommended reading:

https://www.nice.org.uk/guidance/cg150/resources/headaches-pdf-243935625157: parent and young person information on tension headaches, cluster headaches and migraine.

 

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My two-year-old can only just string two words together. Is she delayed?

A simple rule of thumb is that, by their second birthday, children should be speaking in some two word sentences. This may be things like “mummy gone”. Health visitors know to refer children to speech and language therapists at the age of two if this is not happening. If you feel that your child falls into this group, then you need to speak to your health visitor or GP. Have a look at  http://www.talkingpoint.org.uk which is a site brimful of information on speech and language development for parents, health visitors and other health professionals. The site houses an online quiz that you can do to see whether your child is meeting their language development milestones.

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How can I help my child sleep better?

A child not sleeping as early/late/long/peacefully as his or her parents expect is one of the most common topics of conversation in my consultations – even if that was not the main reason for making the appointment!  If the child doesn’t sleep well, neither does the parent and after a while that gets everyone down.

One of my registrars has written a helpful leaflet on this topic which neatly summarises most of what I say in these situations – and what I tried to do (with varying degrees of success) when my own children were younger.  It is available here.

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How to take a child’s heart rate

I spend much of my working time seeing unwell children in a busy A and E department.  Parents are always keen to tell me how high their child’s temperature is but I am far more interested in the child’s heart rate.  Once they are over 6 months old, temperature is of no use at all as a marker of how sick the child is.  Both heart rate and respiratory rate are much more important.  When my own children are unwell I take their heart rates and don’t bother with the thermometer that my non-medical husband bought at some point and is now lost I think.  Heart rate went into the 2013 National Institute of Health and Clinical Excellence guideline on the assessement of children under 5 with a fever but no-one seems to have thought to tell the nation’s parents how important it is.  So click here for my guide to how to measure your child’s heart rate and respiratory rate.  Do leave comments below.

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www.offspringthing.com

Please note that, since its launch in February 2013, I am now answering FAQs on children’s health at the parenting lifestyle website called www.offspringthing.com.  Please try there for any topics you can not find here.

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How do I wean my baby with a dairy intolerance?

Many infants will be growing out of their cows milk protein allergy (CMPA) towards the end of their first year.  Weaning starts at 4-6 months and there are some very well written guides to first tastes and weaning stages at http://www.lnds.nhs.uk/_HealthProfessionals-LifestyleDietaryManagementResources-NutritionforInfantsandChildren.aspx but nothing I could find from dieticians on weaning your dairy intolerant baby!

Take a look at this excellent guide to dairy free weaning from the makers of one of the extensively hydrolysed formulas used for babies with cows’ milk protein allergy: http://www.allergyuk.org/downloads/news-and-media/cows-milk-protein-resources/Aptamil_Recipe_Booklet.pdf

“Neocate Spoon” came on the market in 2011.  It is a first weaning food for very cows’ milk protein intolerant infants who may have been on an amino acid formula for the first few months of life.  Sachets of it are available on prescription (or over the counter although the manufacturers would prefer that it is used under the auspices of a paediatrician or paediatric dietician).  You mix a sachet with 60mls of water and give it to your baby as it is or mixed with other weaning foods such as pureed vegetables.  The dose is 1-2 sachets per day depending on stage of weaning.  More product information at http://nutricia.co.uk/files/uploads/documents/Neo_Spoon_LP_2pp1.pdf

Dairy free infants do run the risk of dropping their calcium levels and should ideally be under a paediatric dietician if they are going to be dairy free for longer than a few weeks.  Soya infant formula milk and yoghurts can be used from 6 months but some children with CMPA (probably less than we used to think) are also allergic to soya so keep an eye out for any return of the symptoms.

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We are vegetarian. How do I ensure my baby’s diet is adequate?

More and more people are moving away from the heavy meat diets we were used to as children ourselves but lots of us worry about ensuring adequate nutrients when we do that – for ourselves as well as for our babies and children.  Millions of people in the world have been vegetarian for generations so all we really need is a bit of education and information. 

I can not do better than the paediatric dieticians in Leicester, UK who have produced some truly excellent diet sheets for parents on lots of different aspects of feeding your children.  Take a look at http://www.lnds.nhs.uk/Library/FeedingtheVegetarianBabyA4Aug10.pdf.

The full list of their downloadable sheets is at http://www.lnds.nhs.uk/_HealthProfessionals-LifestyleDietaryManagementResources-NutritionforInfantsandChildren.aspx

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Why has my previously normal 4 year old started to stammer?

5% of children develop stammering (synonym: stuttering) and 80% grow out of it.  It tends to come on around the age of 3 or 4 on the background of normal language development up until that point. It seems that it occurs at the time that language acquisition becomes more complex.

Stammering is known by Speech and Language (SLT) therapists as “dysfluency” and there should be a dysfluency service in your region that your GP or paediatrician can refer you to.  My local SLT service tells me that outcomes are better if the child is seen by them within a year of the onset of the stammer.  They are keen on a parent led programme called the Lidcombe programme.  Click on the link in the name to read more about it.  Stammering persists into adulthood in about 1 in every 5 cases.

You may find the following links helpful:

The Michael Palin Centre for Stammering Children in Islington runs intensive courses in school holidays for older children.  Tel 02033168100 www.stammeringcentre.org.

The British Stammering Association (http://www.stammering.org/) has a wealth of information, in many languages, for professionals, parents and children on its website.  It also has a phone helpline staffed by people who stammer.  Tel 0845 603 2001/0208 8806590

The Fluency Trust (http://www.thefluencytrust.org.uk) provides residential courses in activity centres for children older than 10 years with dysfluency.

City University, London, provides intensive week long courses in school holidays for those over 8 years.  Contact Bethan Lewis, tel 0207 040 8288 (http://www.city.ac.uk/health/public-clinics/compass-centre/stammering-clinic/instensive-courses-for-people-who-stammer)

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What causes tummy ache in children?

Much of the time we don’t know is the honest answer. There are a number of diagnoses that your GP or paediatrician will try to rule out by asking you and your child lots of questions about the nature of the pain and any associated symptoms like change in bowel habit. Most children do not need blood tests or other investigations but many get them anyway. We are seeing more coeliac disease (sensitivity to gluten which is a protein found in wheat) now that we are looking harder for it but in the majority of cases, if the history is not worrying, any tests done are normal.

We term the following triad of symptoms, functional abdominal pain:
• pain that waxes and wanes
• pain that occurs with three episodes within a three-month period of time
• pain which is severe enough to affect a child’s activities (eg. school attendance)

Functional abdominal pain is difficult to manage and we know that if parents appreciate the interplay between emotional and physical health, play down the pain and address any underlying fears or worries their child may have, recovery will be faster. It is not that the child is putting it on; their brains are very good at feeling emotional pain as physical pain, partly to protect themselves and partly because they can not as yet make sense of psychological hurt. Having a tummy ache makes more sense.

http://www.keepkidshealthy.com/welcome/commonproblems/abdominal_pain.html is a sensible, reassuring American patient information leaflet which I would recommend to you.

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