Why do a parenting skills course?

I am a firm believer in parenting skills courses.  Many, if not most, parents of young children nowadays were disciplined physically by their parents when their behaviour was unacceptable.  Parents are now told that that is not an acceptable way to treat their children but where is the advice on how to do it otherwise?  I do not believe that most people have innate parenting skills and even those who take to it like a duck to water will have moments of self doubt and lapses of judgement.  I certainly do.  I started off as a single parent of 1, am now a step parent to 2 more and have had a further 2 with my husband.  There is no way I could have coped without the parenting courses I initially attended as a learner and then co-facilitated for a few years.  I am now looking for some time in which to attend another course on parenting teenagers…

The good news is that the advice on the techniques to use – and, more importantly, the peer support from others going through exactly the same thing – is out there and often free of charge. 

The following charities and local organisations run parenting skills courses:

http://www.familycaring.co.uk/, www.careforthefamily.org.uk, http://familylives.org.uk/, http://www.theparentpractice.com/, http://www.parentinguk.org/.  Also have a look at your local adult education college.  Waltham Forest offers 20 different free parenting courses for its residents.  Click here to see their brochure.

Everyone should go on one, they are liberating – even if just to realise that you are not alone.  And there is no doubt that the children benefit too!

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Does my baby need vitamin drops?

The UK Department of Health recommends that all children between 6 months and 5 years receive vitamin supplements.  This is especially important if they are fussy eaters and/or if they fall into a high risk group for Vitamin D deficiency.  The advice is nicely laid out at http://www.nhs.uk/Planners/birthtofive/Pages/Vitamins.aspx.  If you are pregnant and under 18 or if you are receiving certain benefits and have children under 4 you may qualify for Healthy Start vouchers and free vitamins.  Check here.  Some health centres will sell vitamins (much cheaper than the supermarket) to those parents who do not qualify for the free vouchers. 

This is the link to the department of health’s advice about vitamin D supplementation for the at risk population. 

We are becoming more and more aware that Vitamin D deficiency is very common amongst members of the London population with darker skins.  This is because we synthesise Vitamin D from sunlight; people with heavily pigmented skins, those who cover up for religious or cultural reasons and even those who wear lots of sun block are more likely to be Vitamin D deficient.  Babies born to mothers from these groups who did not receive adequate Vitamin D supplementation during pregnancy and breastfeeding will also be deficient and that is not at all ideal for growing bones.  There is currently no national guideline for Vitamin D supplementation in the UK but a fairly sensible looking one came out of Barts and the London Hospital in January 2011 and this is what I currently go by.  Many doctors are still not quite sure what to do about Vitamin D deficiency, particularly if there are not many symptoms attached to it.  You may like to download the Barts protocol here as a basis for discussion with your GP.  A number of studies are under way and advice may change over the next few years.

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Is jaundice in the first few days of life serious?

60% of newborn babies born between 37 and 42 weeks gestation look a bit yellow (early onset neonatal jaundice) around about day 2 or 3 of life.  Babies born earlier than 37 weeks are even more likely to be jaundiced. 

So if it is that common why do we worry about it?  The answer is that a tiny number of these babies are at risk of brain damage from extremely high levels of bilirubin and we want to make sure we catch these ones early enough to get the levels down before any damage occurs.  To put things in perspective, there are about 5 cases of brain damage due to bilirubin toxicity a year in the UK and that is out of about 690,000 (2007 figures) babies born per year, at least 414,000 of whom would have been visibly jaundiced.  So we do a huge amount of fairly disruptive testing for very little gain.  However if your baby is one of the 5 a year it is devestating especially as the problem is potentially preventable.

The recent NICE guidelines on newborn jaundice say that any baby who the family or health professionals think is jaundiced must have their bilirubin level checked.  Bilirubin is a breakdown product of the excess red blood cells that babies are born with and it is this that makes them look a bit yellow.  Bilirubin can be measured in the skin painlessly with a small hand held device called a transcutaneous bilirubinometer.  If your midwife does not have one of these or the reading on it is above a certain level then your baby will need a blood test.  They may then need further tests to monitor the bilirubin level and check that your baby does not need treatment.  Treatment in all but the most severe cases is phototherapy.  The baby is put under or on a blue light or wrapped in a luminous blanket.  The wavelengths of light in phototherapy break the bilirubin in the baby’s blood down into a soluble form which the baby can then safely wee out.  Unless the bilirubin levels are very high you should be able to continue to breastfeed your baby while he or she is undergoing phototherapy. 

NICE has a detailed parent information leaflet on jaundice available here.

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My child has fits with high fevers. Does he have epilepsy?

Probably not.  It is not uncommon for children between the ages of about 6 months and 6 years to have a seizure if their temperature rises quickly to over 38.5 degrees C.  3-4% of children will have had one by the time they reach 7 years old and it often runs in families. 

Usually the fit involves rhythmic movements of both arms and both legs with rolling back of the eyes.  It lasts for a couple of minutes, then they go to sleep and the child is back to normal again by about 20 minutes later.  The child is unconscious throughout a fit like this and it is the parents who are most upset by it.  It is frightening to see your own child have a seizure.  Even when they are back to their normal selves afterwards parents worry about possible brain damage or if they are at risk of having further fits or even epilepsy in the future.

Your child’s risk of having further febrile fits depends on the age he was when he had his first one, whether he fits at a fairly low temperature and whether there is a family history.  Overall the risk of recurrence is 30-40%. 

The vast majority of children do not go on to develop epilepsy.  Those who have underlying neurodevelopmental problems, who have a family history of epilepsy and who have unusual (termed “complex”) febrile seizures have a higher risk of developing epilepsy in the future.  If your child has none of the above risk factors he has no more risk of developing epilepsy than a child who has never had a febrile fit. 

Short fits do not cause brain damage.  Lie your child on their side if they are having a fit, do not try to prise their mouth open, you can try to cool them off a bit by removing extra layers of clothing.  Call an ambulance if it is the first time thay have had a fit or if it goes on for more than a couple of minutes or if you are worried that this is not your child’s “normal” sort of febrile fit.  Read a bit more on first aid for a fitting child – and indeed other problems – at http://www.firstaidforlife.org.uk/febrile-convulsions-what-are-they-and-what-should-you-do/.

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My baby has a flat head

Most babies with flat heads have something called positional plagiocephaly.  The various “Back to Sleep” campaigns which have happily reduced the incidence of cot deaths have also led to 5-48% of newborns ending up with a rather flat back of their head.  The easiest way to sort this out is for your baby to spend more time on his/her front when awake.

Attempting to remould babies’ heads with LOCbands or helmets is still a controversial area with little evidence behind the wearing of a helmet for many hours a day for many weeks. They are not available on the NHS as far as I am aware. There are some private clinics in London who offer this service but, for the moment, I think I would agree with the sentiments expressed in Great Ormond Street Hospital’s patient/parent information sheet available at http://www.gosh.nhs.uk/gosh_families/information_sheets/plagiocephaly/plagiocephaly_families.html#diagnosed.

Very occasionally there is a bit more to it than positional plagiocephaly.  A baby’s skull is made up of a number of bones which, in order to allow the brain to grow, are not fully joined up when they are born.  The edges of these bones, where they touch and will eventually fuse with, another of the skull bones are called “sutures”.  Sometimes they appear as ridges when the baby is first born.  These ridges should have gone by your baby’s 6 week check.  Very rarely one or more of these sutures fuse too early and this can lead to your baby having a noticeably asymmetric head, a condition called craniosynostosis.  Your baby’s paediatrician will be able to discuss possible causes of this and do further investigations and referrals if necessary.

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What is an “umbilical granuloma”?

When a baby’s umbilical cord drops off, it sometimes leaves a raw area underneath.  The area “granulates” as it heals and leaves a small pink fleshy lump that protrudes out of the baby’s belly button.  It does not cause your baby any distress but parents are often worried about it.  They tend to resolve spontaneously over time and I no longer bother to try and treat them with silver nitrate sticks.  Some GPs still do.  It seems, from what little evidence there is, that using salt or a steret wipe is just as effective as using silver nitrate without the side effect of turning the skin around the belly button black.  Click here for instructions for the salt method.

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My child won’t eat!

Some children seem to survive on thin air!  So many parents are concerned about this that the paediatric branch of the British Dietetic Association have produced a very helpful leaflet with this cry as its title.  The leaflet is not available on line but your health visitor may have copies to give out.  Failing that, the paediatric dieticians at Poole Hospital have put together a simplified version which is available here.

Not many children have a purely medical or physical reason for not eating; the majority fall into the “fussy” or “picky” eater group.  Those whose height and weight are increasing normally do not need much in the way of investigation, those whose growth is faltering a little usually do get investigations but the results are often normal.  Dieticians and speech and language therapists may run Feeding Clinics in your area where the child is assessed and the family given some tips for non-confrontational meal times.  You may find a chat with these health professionals, your GP or paediatrician reassuring.

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My 4 month old baby has bad eczema. Could he be allergic to cows’ milk protein?

Possibly, but not necessarily.   The National Institute for Health and Clinical Excellence (NICE) guideline for eczema in children suggests that health professionals should consider cows’ milk protein allergy (CMPA) in babies under 6 months of age who have not responded to optimised eczema treatment.  Allergists will tell you that 80% of young babies with significant eczema do indeed turn out to have some sort of food allergy. 

CMPA is not always easy to diagnose.  Allergy tests are often negative and the only way to really tell is to exclude cows’ milk from the baby’s diet for a few weeks and see if the eczema improves.  Bottled formula milk is based on cows’ milk so this is not something to be done lightly.  Goats’ and sheep’s milk have very similar proteins to cows’ milk so can not be used instead.  Not many breastfed babies exhibit signs of CMPA due to traces from dairy foods in Mum’s diet although there are some rare cases.  Soya milk is not recommended for babies under 6 months, particularly baby boys, because of phyto-oestrogens that have been found in it and many CMPA children are also allergic to soya so it often doesn’t help anyway.

The milks we use in CMPA babies are only available on prescription and, because of the difficulty getting enough calcium from these formulas, your baby should be under close review by a paediatrician, paediatric dietician or GP. 

You may find the following patient/parent information useful:

Click here for NICE guidance for parents on eczema in the under 12s

Click here for NICE guidance for parents on diagnosing food allergies

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I think my child strains NOT to poo

Constipation is one of the most common complaints I deal with in my clinics; it is very common amongst toddlers in particular.  To people who have never had to cope with a constipated child it seems such a minor ailment, but it actually has a very negative effect on the child’s behaviour, family dynamics, and parents’ coping skills.  The National Institute for Health and Clinical Excellence (NICE) published a very clear guideline in 2010 on how to manage constipation in children.  You may be interested to read the parent/patient information section at http://www.nice.org.uk/nicemedia/live/12993/48752/48752.pdf.  A good support group is www.eric.org.uk.

Children with fecal impaction tend to hide in corners, go up on tiptoes and clench their buttocks together in a desperate attempt NOT to poo when they start to feel the urge to open their bowels – because their experience is that it hurts.

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Does my child have asthma?

The answer to this is not as straight forward as the question!  GPs and paediatricians are unwilling to label a child as “asthmatic” too early on in life and indeed it seems to be later and later before we will get off the fence.

In Britain we diagnose and treat asthma according to the British Thoracic Society and Scottish Intercollegiate Network guidelines.  These are updated periodically and the latest version was published this year (2011).

If your child only wheezes when they have a cold and they don’t really respond to a blue “puffer” then asthma is unlikely.  Features in your child’s presentation which may suggest asthma include recurrent wheezing, shortness of breath, chest tightness which is brought on by things like exercise, a change in the weather, laughter or emotion and contact with pets.  Family and personal history of eczema, asthma, hayfever, food allergies are all markers of possible asthma in a wheezy child as is feeling significantly better with blue inhalers (eg. salbutamol, Ventolin).

A fantastic resource for parents of wheezing children whether they have asthma or not is http://www.asthma.org.uk/.  There is even a video on how to use your inhaler and spacer.

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