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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My baby has sticky eyes. Does he need antibiotics?

Usually not.

If his eyes are very red with copious amounts of pus coming from them and he is less than a month old you should seek medical advice urgently.

The majority of babies however just have a blocked duct which does not require antibiotics.  Your midwife or health visitor should be able to show you how to clean your baby’s eyes.

The naso-lacrimal duct usually canalises around about 36 weeks gestation but 20% of newborns show signs that one or both are blocked. Eyes start watering within 6 weeks of birth, they get sticky eyes and occasional conjunctivitis which is when the whites of the eyes go red. We would usually take a swab and treat with antibiotic eye ointments only if the eyes are red.







You should massage the sac between the corner of the eye and the nose (see diagram above) 6 times per day and clean with cool boiled water.  90 – 96% of cases resolve by one year of age.  Your GP can refer your baby to a paediatric ophthalmologist if he is one of the 4% who still has sticky eyes at a year of age.

There is a good parent information leaflet on this topic here.

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Is it normal for children to have “bow legs”?

Take a look at this graph that shows you that children tend to have slightly bowed legs (“varus” in medical terminology) when they start to walk which should straighten up around the age of 2 and may then “overshoot” into knock-knees (“valgus”) for a couple of years which then settle down into whatever sort of position is common in their family by about 8 years.

Children who walk early (before their first birthday) may have bowing of their legs up to the slightly later age of 3 but you should seek medical advice if your child’s leg bowing goes on longer than that or if only one side is affected or if their legs are painful.  There is some nice parent information on common childhood orthopaedic problems at http://kidshealth.org/parent/medical/bones/common_ortho.html.

Many children in north London are vitamin D deficient and not taking the daily multivitamins that the Department of Health advises they should.  Severe vitamin D deficiency can lead to rickets in the under 3s which needs high doses of vitamin D under the care of a doctor to rectify as it is not only the bones that are affected when things get this severe.  Take your child to see your doctor if their wrists and knees are swollen, they are not growing properly, seem to be reluctant to walk, have bow-legs and seem generally miserable.  There is good parent information on rickets at http://www.patient.co.uk/health/Rickets.htm.

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What is “sleep myoclonus”?

Some children briefly jerk – usually their hands and feet – while sleeping.  If it only happens when they are asleep and they are otherwise growing and developing normally they need no investigations and no medications.  YouTube has a good video of a child with sleep myoclonus: http://www.youtube.com/watch?v=Id5fXEKaA8M&feature=related.

Newborn babies sometimes worry their parents with similar myoclonic (jerking) movements but again, as long as it only happens in sleep, it is benign (not dangerous) and they will grow out of it (about 60% have grown out of it by 4 months of age).  Multiple investigations only worry the family more and anti-epileptic medications may make the movements worse.  Again, there is a nice video on youTube: http://www.youtube.com/watch?v=7z2FXVtxgaI.  I have struggled to find some suitable parent information leaflets on this but if you want to read something medical about it, try this recent comprehensive review article.

Babies and children who have unusual movements while awake or who are not developing as one might expect for their age do need to see their GP or paediatrician.

Thank you for all the interest in this post. I have had lots of comments and queries from parents about their child’s twitching habits. Please note that I cannot answer individual queries on this site. You do need to see your GP or a paediatrician if you have concerns. If you want to make a private appointment to see me, please contact Highgate Hospital or Spire Roding Hospital directly. (Added 24/4/16)

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What is colic?

If only we knew…

As outlined at http://www.helpguide.org/mental/pdf/Colic.pdf, colic is a general term used when a baby cries for more than 3 hours a day for more than 3 days a week.  We are not entirely sure what causes the crying though there are many theories about it.  About 1 in 5 babies have it.  The important thing is that the baby is otherwise thriving.  If he or she is not putting on weight as expected then you should take them to see your doctor as there may be another reason for the crying.

One of my junior colleagues has put together a very comprehensive article on colic for doctors who use my other website which supports their continuing medical education.  The language for that particular article is not too medical and you might find some of the background theories interesting. 

See also http://www.northlondonpaediatrician.co.uk/?p=84 on whether it is normal for babies to cry.

Babies grow out of colic but not soon enough for most parents.  Make sure you have lots of support and get a break from the crying every now and again.  You can always put the crying baby in his/her cot and walk away for a few minutes to calm yourself down.

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My daughter has head lice again!

So does mine and I am equally exasperated.  80% of cases occur in primary school children and 10% of children have them at any one time.  I am fairly sure it is more than that at my children’s school.  I don’t think that using chemicals to get rid of them has any long term effect and there are concerns that some of the lice are now immune to the pesticides.  “Bug-busting” with a fine-toothed comb and lots of conditioner works but does require determination.  Read all about it at http://www.chc.org/.  You can also buy the (reusable) kit from this website. 

The following information is taken directly from the UK Health Protection Agency’s website:

What are head lice (Pediculosis)?

  • Head lice are parasitic insects called Pediculus humanus capitis. They only live on the heads of people.
  • There are three forms of head lice:
  • Nits are head lice eggs. The oval, yellowy white eggs are hard to see and may be confused with dandruff. They attach themselves to the hair shaft and take about a week to hatch. The eggs remain after hatching and many nits are empty egg cases.
  • Nymphs hatch from the nits. The baby lice look like the adults, but are smaller. They take about 7 days to mature to adults and feed on blood to survive.
  • Adults are about the size of a sesame seed. They have six legs and are tan to greyish-white. The legs have hook-like claws to hold onto the hair with. Adults can live up to 30 days and feed on blood.
  • Head lice cannot jump, hop or swim.

Who catches head lice?

  • Anyone can catch head lice, but preschool children, primary school children and their families are most at risk.
  • Studies in the United States have shown that black African Americans rarely get head lice.

How do you catch head lice?

  • Head lice are transmitted through direct, prolonged head-to-head contact with an infested person. This is especially common during play or sport at school and with close contacts at home.
  • Transmission is possible through infected clothes, combs, brushes or towels, but extremely unlikely. The lifespan of a louse is very short once detached from the hair so fumigation is not necessary.

How infectious is head lice?

  • The rate of transmission is low.

What is having head lice like?

  • The head lice are most commonly found behind the ears and at the back of the neck. It is rare to find them on the body, eyelashes, or eyebrows.
  • A person with head lice may feel a tickling or itching feeling of something moving in the hair. Most people only realise that they have head lice after the itch has developed which can take from one week to 2-3 months after initial infection.
  • Itching may also occur due to an allergic reaction to the bites.
  • Sores can develop due to scratching and can become infected.

How serious are head lice?

  • Head lice are not a serious health problem.
  • Head lice rarely cause anything more than an itchy scalp.

Can you prevent head lice?

  • Head lice are a mild disease. Some schools used to have routine screening, followed by the exclusion of those affected. This was a waste of time. It was also ineffective in preventing spread.
  • The best way to stop infection is for people to learn how to check their heads for lice.
  • Good hair care only helps to control lice in as much as it will help to spot and treat lice early.

Should a child with head lice be kept off school?

  • No! The DfEE/DoH guidelines for infection control in schools and nurseries state that there is no need for a child who has head lice to stay away from school.
  • One reason for this is that if a child does have lice, he or she will have had them at school for several weeks before diagnosis.
  • Letters notifying other parents of cases have not been found to curtail spread but often provoke itching and anxiety as a psychological response.

How can you treat someone with head lice?

  • A diagnosis of head lice can only be made if a living, moving louse is found.
  • Detection combing by parents/family members according to instructions is the best method of diagnosis.
  • Chemical treatments are available, but must only be given after a doctor or experienced nurse has made a diagnosis.
  • Close contacts of patients living in the same house are usually checked and treated if they have head lice.

 Good luck with your eradication attempts.

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By what age should a child be walking?

The textbooks will tell you “by 18 months”.  However it does depend a bit on what method of locomotion a child is using before he/she gets up and walks.  15% of children never crawl.  They may do a sort of commando crawl or shuffle on their bottoms (I used to do that apparently and so did my eldest son) or roll everywhere and these children often walk later than 18 months, sometimes beyond their 2nd birthday. 

Occasionally delayed walking (beyond 18 months) is a sign of a more serious developmental problem and it is probably worth getting your child checked out by your GP or paediatrician.  It is not necessarily linked to delay in any other aspect of development.  www.babycentre.co.uk/baby/development/walking has a nice explanation of child development leading to walking written by health professionals but the site also has lots of advertising which I do not necessarily endorse.  There is a wide range of normal when it comes to stages and ages of development and remember babies born before 37 weeks of gestation (ie. more than 3 weeks early) are allowed to be behind your sister’s/friend’s/neighbour’s child born at full term at the same time….

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My son is 8 and he still wets the bed

So do about 7% of his mates according to a great patient support website on this topic (termed enuresis in medical jargon) called www.eric.org.uk.  And, if you ask his grandparents, you may find that there is a seldom spoken about family history of it as well.

The important thing that the doctor or nurse seeing your child has to ascertain is “has he ever been dry at night?”  Children who have been dry for over 6 months and have started wetting again need to be checked for a urine infection, diabetes or emotional upset.  The vast majority of 8 year old children who wet the bed have never been dry and end up with a diagnosis of primary nocturnal enuresis which is something that they should grow out of but may need help with especially if it is starting to affect their social lives, sleepovers, cub camps etc.

The problem is caused by 1 or more of:  an inability to wake up to feelings of fullness in his bladder, an overactive bladder or a delayed maturation of the gland in his brain which secretes a hormone which stops most of us producing as much urine at night.  Your GP, paediatrician or school nurse should be able to work out from your son’s history which aspect is affecting him most and, taking into account his age, can then decide on the appropriate way forward. 

Enuresis services are quite stretched (because it is such a common problem) and tend to only see children from the age of 7 although they are supposed to now offer appropriate information to parents of younger children too if it is affecting family harmony.   Some studies suggest that if a child is still wetting when older than 11, it starts to get harder to sort it out for them so I wouldn’t leave it too late to get him initially assessed. 

All the background information, explanations and advice you and your child need is at http://www.eric.org.uk/Bedwetting/info_bedwetting_wetting_parents.  They also have an on-line shop for such things as alarms, disposable and washable protective bedding covers etc.  Another resource is the parent information leaflet from the recent NICE guideline on enuresis that health professionals should be following, available here.

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What is a heart murmur?

Heart murmurs are common in children.  When a doctor listens to a child’s heart with a stethescope, they normally hear a “lub-dub, lub-dub, lub-dub” noise.  Occasionally there is an extra noise so we now hear “lub-shh-dub, lub-shh-dub, lub-shh-dub”.

By far the most common type of murmur we hear falls into the “innocent” category which means we are hearing the normal flow of blood round the heart which is more vibratory in some children, especially if they have a bit of a fever or are anaemic.  The child is usually very well and growing normally and the murmur is only picked up incidentally when they go to the doctor with a chest infection.  Most experienced GPs and paediatricians will be able to pick out the innocent murmurs in children over the age of 2 and may feel that a referral to a paediatric cardiologist is not warranted.  Under the age of 2 it is a bit harder to be sure that the murmur is innocent and this age group usually do end up seeing a cardiologist if the murmur is persistent.

Newborn babies often have murmurs in the first 24 hours of life which disappear over the first couple of days as various “short cuts” in their circulation close off as they adapt to life outside the womb.  Recent studies have shown that it is worth measuring the oxygen saturation of a baby’s blood if they still have a murmur on day 2 of life as lower oxygen saturations may point to there being something structurally not quite right with the baby’s heart.  Just less than 1 in 100 newborn babies have some sort of congenital heart problem ranging from a tiny hole between the main pumping chambers of the heart which will close up itself over the first weeks of life to a serious plumbing problem that necessitates major heart surgery in the first few days of life.  In these babies the murmur is caused by turbulence around leaky or partially blocked valves or the pressure of blood being pushed through a hole between either the collecting or the pumping chambers of the heart that shouldn’t be there.

Unfortunately not all congenital heart problems are picked up by scans done during pregnancy but most of the missed major ones will become obvious in the first day or two of life.  A school aged child who is growing well with normal oxygen saturations and has an incidental finding of a quiet heart murmur, especially if it changes in character with the child’s position, is unlikely to have much seriously wrong with them.

http://kidshealth.org/parent/medical/heart/murmurs.html# is one of the top American sites on children’s health aimed at the general public.  It provides balanced information in clear English about heart murmurs for parents who are worried that their GP or paediatrician has picked up a heart murmur when examining their child.

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It is normal for babies to cry

All babies cry.  If they don’t there is something wrong with them.  But it can be very upsetting for parents who can’t quite work out why they are crying.  I had a friend who used to keep a pillow next to her so when she was at her wits’ end with her daughter’s colic she could bash the pillow instead of the baby.  If you are a new parent reading this you will be horrified that anyone could feel that way.  If your baby is about 6 weeks old and colicky you may well feel a certain amount of empathy with that friend of mine.  I see babies (and their exhausted parents) in the Emergency Department every week whose presenting complaint is “crying all the time”.  I don’t think I can do better in this post than the information written on a superb self help American site; take a look at https://www.helpguide.org/articles/parenting-family/when-your-baby-wont-stop-crying.htm and take comfort that you are not alone.  My own first child had colic, the second was so good I thought I had obviously learnt how to do it better and the third proved me wrong as we returned to long evenings of jiggling, feeding, winding, jiggling, feeding, winding, driving round the block, jiggling, winding, feeding…..

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